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[Current views on the etiopathogenesis of goiter in children]. 【儿童甲状腺肿发病机制的研究现状】。
Małgorzata Brzozowska, Adam Kretowski

The most frequent cause of goiter in children is a deficit of iodine, leading to endemia of goiter in the regions with insufficient supplementation of this element. Goiter occurs also in the course of autoimmunological diseases of the thyroid gland (Hashimoto disease, Graves' disease), genetically-related disorders of thyroid hormones, biosynthesis/impaired biosynthesis of thyroid hormones. According to the theory of goiter pathogenesis, excessive enlargement of the thyroid gland is due to adaptation of follicle cells of the gland aiming at neutralizing the impaired synthesis of the thyroid hormones caused by various intrathyroid, environmental and genetic factors/agents. The mechanisms stimulating thyrocytes to hyperplasia or hypertrophy are very complex and still unknown in spite of having identified many physiological and pathogenetic factors connected with goiter.

儿童甲状腺肿最常见的原因是缺碘,在碘补充不足的地区导致甲状腺肿。甲状腺肿也发生在甲状腺自身免疫性疾病(桥本病、格雷夫斯病)、甲状腺激素遗传相关疾病、甲状腺激素生物合成/生物合成受损的过程中。根据甲状腺肿的发病机理,甲状腺的过度肿大是由于腺体的滤泡细胞为了中和各种甲状腺内、环境和遗传因素/因素造成的甲状腺激素合成受损而进行的适应性调节。刺激甲状腺细胞增生或肥大的机制非常复杂,尽管已经确定了许多与甲状腺肿有关的生理和病理因素,但仍不清楚。
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引用次数: 0
[Guidelines concerning insulin dosage in children and adolescents with type 1 diabetes on continuous subcutaneous insulin infusion]. [儿童和青少年1型糖尿病患者持续皮下注射胰岛素剂量指南]。
Agnieszka Szypowska, Ewa Pańkowska, Maria Lipka

The treatment of diabetes mellitus with a continuous subcutaneous insulin infusion (CSII) has become very popular and is well accepted by diabetic patients. Pump therapy mimics the physiological insulin secretion and has been shown to be a safe and effective method of insulin administration alternative to the method of multiple injections. Continuous insulin infusion provides greater flexibility in the timing of meals and snacks with higher treatment satisfaction. Programmed basal rates improve nocturnal glycemic control and help to minimize a pre-breakfast increase of blood glucose level (the dawn phenomenon). Moreover, CSII can reduce exercise-induced and nocturnal hypoglycemia. Insulin pump therapy is effective in lowering glycated hemoglobin levels without higher risk of severe hypoglycaemia and ketoacidosis. To achieve a proper metabolic control with this method of treatment, the patient and his family requires appropriate education including knowledge of diet management, insulin therapy and manual competence of pump device. Here we present general guidelines for patients education concerning insulin dosage, programming of basal insulin rates and meal boluses based on carbohydrates and protein-fat exchanges.

持续皮下胰岛素输注(CSII)治疗糖尿病已经非常流行,并为糖尿病患者所接受。泵疗法模拟胰岛素的生理分泌,已被证明是一种安全有效的胰岛素给药方法,可替代多次注射的方法。持续胰岛素输注提供了更大的灵活性,在吃饭和零食的时间,更高的治疗满意度。程序化的基础速率可以改善夜间血糖控制,并有助于减少早餐前血糖水平的升高(黎明现象)。此外,CSII可减少运动性和夜间低血糖。胰岛素泵治疗在降低糖化血红蛋白水平方面是有效的,而不会增加严重低血糖和酮症酸中毒的风险。为了通过这种治疗方法实现适当的代谢控制,患者及其家属需要适当的教育,包括饮食管理知识、胰岛素治疗知识和泵装置的手动操作能力。在这里,我们提出了关于胰岛素剂量、基础胰岛素率规划和基于碳水化合物和蛋白质-脂肪交换的膳食丸的一般指导方针。
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引用次数: 0
[Influence of fat tissue distribution on metabolic complications in children and adolescents with simple obesity]. [脂肪组织分布对儿童和青少年单纯性肥胖代谢并发症的影响]。
Małgorzata Firek-Pedras, Ewa Małecka-Tendera, Katarzyna Klimek, Agnieszka Zachurzok-Buczyńska

Background: Increased prevalence of obesity in children and adolescents results in more common metabolic complications characteristic for adults, particularly those with abdominal obesity. The objective of the study was to determine the relation between the fat tissue distribution and metabolic complications and to estimate the prevalence of the metabolic syndrome in obese children and adolescents.

Material and methods: We studied 64 children (42 girls and 22 boys) with simple obesity (BMI =97 pc) in the mean age 12.4+/-3.4 years. The fat tissue distribution was assessed on the basis of waist circumference, hip circumference, waist to hip ratio (WHR) and skinfold thickness (suprailiac, subscapular, biceps and triceps). In all children plasma concentrations of total cholesterol, HDL and LDL cholesterol as well as triglycerides were estimated. Plasma glucose and insulin levels were measured in fasting state and during the oral glucose tolerance test (OGTT). Fasting insulin to glucose ratio (FIGR) was calculated. Blood pressure was measured in triplicate.

Results: In 33 (51.6%) of children dyslipidemia, in 10 (15.6%) hyperinsulinemia or impaired glucose tolerance and in 12 (18%) hypertension was diagnosed. The Metabolic syndrome was present in 9 (14%) children. The anthropometric predictor for the risk of metabolic complications was a greater waist circumference, while greater hip circumference decreased the risk.

Conclusions: The metabolic complications characteristic of metabolic syndrome, previously diagnosed exclusively in adults, may occur also in obese children and adolescents. As in adults, abdominal obesity is the most relevant risk factor of the metabolic syndrome.

背景:儿童和青少年肥胖患病率的增加导致成人代谢并发症的增加,特别是腹部肥胖。本研究的目的是确定脂肪组织分布与代谢并发症之间的关系,并估计肥胖儿童和青少年代谢综合征的患病率。材料和方法:我们研究了64名单纯性肥胖儿童(42名女孩,22名男孩),平均年龄12.4+/-3.4岁,BMI =97。根据腰围、臀围、腰臀比(WHR)和皮褶厚度(耻骨上、肩胛下、肱二头肌和肱三头肌)评估脂肪组织分布。对所有儿童的血浆总胆固醇、高密度脂蛋白和低密度脂蛋白以及甘油三酯浓度进行了评估。空腹和口服葡萄糖耐量试验(OGTT)时测定血糖和胰岛素水平。计算空腹胰岛素葡萄糖比(FIGR)。测量血压一式三份。结果:儿童血脂异常33例(51.6%),高胰岛素血症或糖耐量异常10例(15.6%),高血压12例(18%)。9例(14%)儿童存在代谢综合征。代谢并发症风险的人体测量预测因子是更大的腰围,而更大的臀围降低了风险。结论:代谢综合征特有的代谢并发症,以前只在成人中诊断,也可能发生在肥胖儿童和青少年中。与成人一样,腹部肥胖是代谢综合征最相关的危险因素。
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引用次数: 0
[Relationship between body mass index and leptin levels in children treated for acute lymphoblastic leukemia during and after maintenance therapy]. [儿童急性淋巴细胞白血病维持治疗期间和之后体重指数与瘦素水平的关系]。
Katarzyna Muszyńska-Rosłan, Maryna Krawczuk-Rybak, Magda Topczewska, Małgorzata Sawicka-Zukowska

Unlabelled: We analyzed the relationship between serum leptin levels and body mass index in children treated for acute lymphoblastic leukemia during and after the maintenance therapy.

Material and methods: We studied 99 survivors (62 boys) in mean age 12.65 years +/- who have been treated for ALL according to the Polish Paediatric Leukemia and Lymphoma Study Group. During the maintenance therapy there were n=34 patients (23 boys) and after treatment n=75 (39 boys). 16 patients received cranial irradiation (12 Gy). We calculated body mass index (BMI) using the formula weight/(height)2 (kg/m2). Leptin levels were measured with the RIA method. The results were expressed as SDS.

Results: 1. No difference was found in leptin SDS and BMI SDS from zero -- in the whole study group, similar in boys and girls. The leptin/BMI ratio was significantly higher in girls than in boys. 2. No differences were observed in the group during and after therapy in values of BMI SDS and leptin SDS. We found higher leptin SDS in boys during (4.86+/-1.01) and after puberty (1.53+/-0.75). We found higher leptin SDS in boys than in girls during (1.6+/-1.1 vs. 0.6+/-0.6) and after therapy. 3. In boys and girls diagnosed before puberty leptin SDS were higher in boys (1.7+/-1.3 vs. 0.2+/-1.7). The leptin/BMI ratio was significantly higher in girls than in boys diagnosed before puberty. 4. We found correlations between leptin levels and BMI in the whole group as well as in boys and girls analysed according to puberty and time of treatment. 5. No differences were observed between patients with and without cranial irradiation.

Conclusions: Anti-neoplastic treatment for acute lymphoblastic leukemia and age of disease did not influence body mass index and leptin level in the examined population.

未标记:我们分析了急性淋巴细胞白血病患儿在维持治疗期间和之后的血清瘦素水平与体重指数之间的关系。材料和方法:我们研究了99名幸存者(62名男孩),平均年龄12.65岁+/-,根据波兰儿科白血病和淋巴瘤研究组,他们接受了ALL治疗。维持治疗期间n=34例(男孩23例),治疗后n=75例(男孩39例)。16例患者接受12 Gy颅脑照射。我们使用公式体重/(身高)2 (kg/m2)计算身体质量指数(BMI)。用RIA法测定瘦素水平。结果以SDS表示。结果:1。瘦素SDS和BMI SDS从零开始没有差异——在整个研究组中,男孩和女孩相似。女孩的瘦素/BMI比值明显高于男孩。2. 治疗期间和治疗后两组BMI SDS和瘦素SDS值均无差异。我们发现男孩在青春期(4.86+/-1.01)和青春期后(1.53+/-0.75)瘦素SDS较高。我们发现,在治疗期间(1.6+/-1.1 vs. 0.6+/-0.6)和治疗后,男孩的瘦素SDS高于女孩。3.在青春期前诊断的男孩和女孩中,男孩的瘦素SDS更高(1.7+/-1.3 vs. 0.2+/-1.7)。女孩的瘦素/BMI比值明显高于青春期前确诊的男孩。4. 我们发现了瘦素水平和BMI之间的相关性,并根据青春期和治疗时间对男孩和女孩进行了分析。5. 在接受和未接受颅照射的患者之间没有观察到差异。结论:急性淋巴细胞白血病的抗肿瘤治疗和疾病年龄对检查人群的体重指数和瘦素水平没有影响。
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引用次数: 0
[Estimation of the correlation of insulin resistance and selected adipocytokines in children with simple obesity--preliminary study]. [单纯性肥胖儿童胰岛素抵抗与选定脂肪细胞因子相关性的初步研究]。
Agnieszka Rudzka-Kocjan, Maria Szarras-Czapnik, Janusz B, Maria Ginalska-Malinowska

Background: Insulin resistance--a key element of the metabolic syndrome--is observed in children with simple obesity. Adipose tissue is producing bioactive substances called adipocytokines. Some of them may play a role in the development of insulin resistance.

Aim of the study: Estimation of the frequency of insulin resistance and its correlation with leptin, adiponectin and resistin levels in children with simple obesity.

Material and methods: The 53 children (BMI>97 centile), mean age 13.57 years. Mean BMI was +4.04 SDS. Oral glucose tolerance test (OGTT) was performed. Insulin levels at 0' < or = 15 microIU/mL and/or insulin peak during OGTT < or = 150 microIU/mL and/or peak at 120' < or =75 microIU/mL were established as normal values. Homa ratio was calculated. Patients were divided into groups depending on the presence or absence of hyperinsulinemia / insulin resistance. Concentrations of adiponectin, leptin, resistin were measured.

Results: In 13.23 % children various types of hyperglycemia were diagnosed and hyperinsulinemia in OGTT was noted in 83.02 %. Severe insulin resistance (HOMA>3) was diagnosed in 71.82 %. In the hyperinsulinemia group higher glucose levels in OGTT were stated comparing to the non hyperinsulinemia group. In children with insulin resistance, higher BMI and SD BMI were observed. In this paper results of correlations of adipocytokines levels and anthropometric parameters or carbohydrates metabolism in children with / without insulin resistance are presented.

Conclusions: In children with severe insulin resistance adiponectin concentrations correlate negatively with glucose levels, there is a positive correlation of adiponectin and glucose and insulin in a group without severe insulin resistance. In patients with insulin resistance leptin concentrations correlate positively with the degree of obesity and insulin levels in OGTT.

背景:在单纯性肥胖儿童中观察到胰岛素抵抗——代谢综合征的一个关键因素。脂肪组织产生被称为脂肪细胞因子的生物活性物质。其中一些可能在胰岛素抵抗的发展中起作用。研究目的:评估单纯性肥胖儿童胰岛素抵抗的频率及其与瘦素、脂联素和抵抗素水平的相关性。材料与方法:53例儿童(BMI>97百分位),平均年龄13.57岁。平均BMI为+4.04 SDS。进行口服糖耐量试验(OGTT)。胰岛素水平在0′<或= 15微iu /mL和/或OGTT期间胰岛素峰值<或= 150微iu /mL和/或峰值在120′<或=75微iu /mL时为正常值。计算Homa比值。根据是否存在高胰岛素血症/胰岛素抵抗将患者分为两组。测定脂联素、瘦素、抵抗素的浓度。结果:13.23%的患儿有不同类型的高血糖,83.02%的患儿有OGTT高胰岛素血症。重度胰岛素抵抗(HOMA>3)占71.82%。高胰岛素血症组OGTT血糖水平高于非高胰岛素血症组。在胰岛素抵抗的儿童中,观察到较高的BMI和SD BMI。本文介绍了有/无胰岛素抵抗儿童脂肪细胞因子水平与人体测量参数或碳水化合物代谢的相关结果。结论:在严重胰岛素抵抗儿童中,脂联素浓度与葡萄糖水平呈负相关,而在非严重胰岛素抵抗组中,脂联素与葡萄糖和胰岛素水平呈正相关。在胰岛素抵抗患者中,瘦素浓度与OGTT的肥胖程度和胰岛素水平呈正相关。
{"title":"[Estimation of the correlation of insulin resistance and selected adipocytokines in children with simple obesity--preliminary study].","authors":"Agnieszka Rudzka-Kocjan,&nbsp;Maria Szarras-Czapnik,&nbsp;Janusz B,&nbsp;Maria Ginalska-Malinowska","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Insulin resistance--a key element of the metabolic syndrome--is observed in children with simple obesity. Adipose tissue is producing bioactive substances called adipocytokines. Some of them may play a role in the development of insulin resistance.</p><p><strong>Aim of the study: </strong>Estimation of the frequency of insulin resistance and its correlation with leptin, adiponectin and resistin levels in children with simple obesity.</p><p><strong>Material and methods: </strong>The 53 children (BMI>97 centile), mean age 13.57 years. Mean BMI was +4.04 SDS. Oral glucose tolerance test (OGTT) was performed. Insulin levels at 0' < or = 15 microIU/mL and/or insulin peak during OGTT < or = 150 microIU/mL and/or peak at 120' < or =75 microIU/mL were established as normal values. Homa ratio was calculated. Patients were divided into groups depending on the presence or absence of hyperinsulinemia / insulin resistance. Concentrations of adiponectin, leptin, resistin were measured.</p><p><strong>Results: </strong>In 13.23 % children various types of hyperglycemia were diagnosed and hyperinsulinemia in OGTT was noted in 83.02 %. Severe insulin resistance (HOMA>3) was diagnosed in 71.82 %. In the hyperinsulinemia group higher glucose levels in OGTT were stated comparing to the non hyperinsulinemia group. In children with insulin resistance, higher BMI and SD BMI were observed. In this paper results of correlations of adipocytokines levels and anthropometric parameters or carbohydrates metabolism in children with / without insulin resistance are presented.</p><p><strong>Conclusions: </strong>In children with severe insulin resistance adiponectin concentrations correlate negatively with glucose levels, there is a positive correlation of adiponectin and glucose and insulin in a group without severe insulin resistance. In patients with insulin resistance leptin concentrations correlate positively with the degree of obesity and insulin levels in OGTT.</p>","PeriodicalId":11550,"journal":{"name":"Endokrynologia, diabetologia i choroby przemiany materii wieku rozwojowego : organ Polskiego Towarzystwa Endokrynologow Dzieciecych","volume":"12 3","pages":"211-5"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26291789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Tumor necrosis factor alpha (TNF-alpha) gene G-308A polymorphism relationship to insulin resistance and lipid abnormalities in children with obesity]. [肿瘤坏死因子α (tnf - α)基因G-308A多态性与肥胖儿童胰岛素抵抗和脂质异常的关系]。
Beata Pyrzak, Alicja Wiśniewska, Barbara Rymkiewicz-Kluczyńska

Introductions: High levels of tumor necrosis factor (TNF-alpha)-cytokine produced by adipocytes, are involved in the development of obesity-related insulin resistance and metabolic syndrome. Therefore, we investigated whether the polymorphism of TNF-alpha-308 gene can predict the conversion from insulin resistance and obesity parameters in children with obesity. THE STUDY comprised 72 children with obesity simplex (9-18 y.o). The following anthropometric parameters: weight, height, BMI, SDS for BMI, WHR, sum of 3, 10 skinfolds and percentage of body fat by Slaughter's equation were calculated. In each child, after 12 hour overnight fast, glucose, insulin, leptin and lipids: triglycerides (Tg), cholesterol total (Chol-T), cholesterol HDL (Chol-HDL), cholesterol LDL (Chol-LDL) were measured. The oral glucose tolerance test was performed and HOMA-IR was calculated.

Results: Using the technique of PCR-RELP and SSCP, three variants of genotype TNF-alpha were obtained: G/G-68%, A/G-29%, A/A-3%. Statistical analysis of anthropometric, biochemical and leptin variables in groups G/G, vs. A/G +A/A, in boys and girls was performed. We did not find any significant differences between groups (G/G vs. A/G +A/A in all group, and between G/G girls, boys vs A/G +A/A girls, boys) Our data indicate that in smaller children studies, TNF-alpha polymorphism does not seem not to be associated with the degree of obesity and insulin resistance.

高水平的肿瘤坏死因子(tnf - α)-一种由脂肪细胞产生的细胞因子,参与肥胖相关胰岛素抵抗和代谢综合征的发展。因此,我们研究了tnf - α -308基因多态性是否可以预测肥胖儿童胰岛素抵抗和肥胖参数的转换。该研究纳入了72名单纯性肥胖儿童(9-18岁)。计算下列人体测量参数:体重、身高、BMI、BMI的SDS、臀重比、3、10个皮褶的总和和体脂率(采用Slaughter’s方程)。各组患儿禁食12小时后,测定血糖、胰岛素、瘦素及血脂:甘油三酯(Tg)、总胆固醇(cholt)、胆固醇高密度脂蛋白(choll -HDL)、胆固醇低密度脂蛋白(choll -LDL)。进行口服糖耐量试验,计算HOMA-IR。结果:采用PCR-RELP和SSCP技术,获得3个基因型变异:G/G-68%, A/G-29%, A/A-3%。统计分析G/G组、A/G +A/A组男孩和女孩的人体测量学、生化和瘦素变量。我们没有发现组间的任何显著差异(所有组中G/G vs. A/G +A/A,以及G/G女孩、男孩与A/G +A/A女孩、男孩之间)。我们的数据表明,在较小的儿童研究中,tnf - α多态性似乎与肥胖程度和胰岛素抵抗无关。
{"title":"[Tumor necrosis factor alpha (TNF-alpha) gene G-308A polymorphism relationship to insulin resistance and lipid abnormalities in children with obesity].","authors":"Beata Pyrzak,&nbsp;Alicja Wiśniewska,&nbsp;Barbara Rymkiewicz-Kluczyńska","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introductions: </strong>High levels of tumor necrosis factor (TNF-alpha)-cytokine produced by adipocytes, are involved in the development of obesity-related insulin resistance and metabolic syndrome. Therefore, we investigated whether the polymorphism of TNF-alpha-308 gene can predict the conversion from insulin resistance and obesity parameters in children with obesity. THE STUDY comprised 72 children with obesity simplex (9-18 y.o). The following anthropometric parameters: weight, height, BMI, SDS for BMI, WHR, sum of 3, 10 skinfolds and percentage of body fat by Slaughter's equation were calculated. In each child, after 12 hour overnight fast, glucose, insulin, leptin and lipids: triglycerides (Tg), cholesterol total (Chol-T), cholesterol HDL (Chol-HDL), cholesterol LDL (Chol-LDL) were measured. The oral glucose tolerance test was performed and HOMA-IR was calculated.</p><p><strong>Results: </strong>Using the technique of PCR-RELP and SSCP, three variants of genotype TNF-alpha were obtained: G/G-68%, A/G-29%, A/A-3%. Statistical analysis of anthropometric, biochemical and leptin variables in groups G/G, vs. A/G +A/A, in boys and girls was performed. We did not find any significant differences between groups (G/G vs. A/G +A/A in all group, and between G/G girls, boys vs A/G +A/A girls, boys) Our data indicate that in smaller children studies, TNF-alpha polymorphism does not seem not to be associated with the degree of obesity and insulin resistance.</p>","PeriodicalId":11550,"journal":{"name":"Endokrynologia, diabetologia i choroby przemiany materii wieku rozwojowego : organ Polskiego Towarzystwa Endokrynologow Dzieciecych","volume":"12 3","pages":"171-4"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26291826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Thyroid volume evaluation in girls with Turner syndrome according to normal range for healthy population]. [按健康人群正常范围评价特纳综合征女童甲状腺体积]。
Anna M Kucharska, Michał Brzewski, Barbara Czarnocka, Aleksandra Januszek-Trzciakowska, Barbara Rymkiewicz-Kluczyńska

Introduction: Turner syndrome is a common chromosomal aberration. Among other features of that syndrome susceptibility to autoimmune diseases is well known. Most often there is Hashimoto's thyroiditis. Because of short stature the evaluation of thyroid volume according to chronological age seems to be not efficient. THE AIM of the study was to find an adequate method of thyroid volume evaluation in girls with Turner syndrome using standards for healthy children.

Material and methods: 54 girls with Turner syndrome were examined, mean age was 11 years and 9 months. Physical and ultrasonographic examination of thyroid gland was performed. The hormonal state and presence of antithyroid autoantibodies were evaluated. The thyroid volume was evaluated according to normal range (by Delange) for chronological and height age of each girl.

Results: According to chronological age the thyroid volume was in normal range, but according to height age in 3 patients the thyroid volume was over 97 percentile. They were the same girls in whom we detected goiter according to physical examination.

Conclusions: We suggest that proposed method gives the possibility of an accurate evaluation of thyroid volume in patients with Turner syndrome and in other patients with growth deficiency.

特纳综合征是一种常见的染色体畸变。在该综合征的其他特征中,对自身免疫性疾病的易感性是众所周知的。最常见的是桥本甲状腺炎。由于身材矮小,根据年龄对甲状腺体积的评估似乎不太有效。本研究的目的是利用健康儿童的标准,寻找一种适合特纳综合征女童甲状腺体积评估的方法。材料与方法:对54例特纳综合征女童进行检查,平均年龄11岁9个月。行甲状腺物理及超声检查。评估激素状态和抗甲状腺自身抗体的存在。甲状腺体积按正常范围(Delange法)测定年龄和年龄。结果:3例患者按实足年龄甲状腺体积在正常范围内,按身高年龄甲状腺体积在97%以上。她们就是我们在体检中发现甲状腺肿大的那些女孩。结论:我们认为所提出的方法为特纳综合征患者和其他生长缺陷患者提供了准确评估甲状腺体积的可能性。
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引用次数: 0
[The usage of the personal insulin pump for treatment of a 7 week infant with neonatal diabetes mellitus]. [个人胰岛素泵治疗1例7周新生儿糖尿病]。
Malgorzata Mysliwiec, Anna Balcerska, Joanna Bautembach-Minkowska, Maciej T Malecki, Joanna Nazim

Unlabelled: Etiology and the course of diabetes mellitus type 1 diagnosed in infancy remains the subject of intensive investigations, nonetheless the diagnosis of hyperglycemia in this period obliges prompt start of the insulin therapy. The treatment of newborns and infants is challenging because of the necessity to use very low doses of insulin.

Case report: A boy was transferred from the neonatal ward on the 8th day of life with the diagnosis of diabetes mellitus. He was born of young healthy parents (mother: 27, father: 30 years old), with no family history of diabetes or other autoimmune disorders. The course of the pregnancy remained normal until 37th week of gestation when due to alterations in the fetal heart rate the cesarean section was done. In spite of precise i.v. insulin therapy fluctuations in glucose levels persisted. Additionally the achievement of the metabolic compliance was complicated by generalized infections caused by hospital pathogens that required broad-spectrum i. v. antibiotic therapy. At the age of 7 weeks personal insulin pump Pradigm 712 for the delivery of NovoRapid insulin was introduced. Already on the 3rd day of such treatment, the daily insulin dose could be decreased from 0.7 unit/kg/24 hrs down to 0.5 unit/kg/24 hrs, and glucose levels normalized. In the course of this treatment the patient weighed 6300 g at the age of 6 months, and his psychomotoric development reached the milestones adequate for the age. The biochemical examinations revealed C-peptide levels both fasting and after glucagon stimulation <0.5 ng/ml. Additionally, the analyzed immunologic markers of type 1 diabetes are negative. The genetic testing for Kir6.2 mutation gave negative results.

Conclusions: The presented case shows that the insulin therapy carried out via personal insulin pump is the possible and effective treatment in children diagnosed with diabetes mellitus during infancy.

未标记:在婴儿期诊断的1型糖尿病的病因和病程仍然是深入研究的主题,尽管如此,在这一时期诊断出高血糖要求及时开始胰岛素治疗。新生儿和婴儿的治疗具有挑战性,因为必须使用非常低剂量的胰岛素。病例报告:一名男孩在出生第8天被诊断为糖尿病从新生儿病房转出。他出生于年轻健康的父母(母亲27岁,父亲30岁),没有糖尿病或其他自身免疫性疾病的家族史。妊娠过程一直保持正常,直到妊娠第37周,由于胎儿心率的改变,进行了剖宫产。尽管进行了精确的静脉注射胰岛素治疗,血糖水平的波动仍然存在。此外,代谢依从性的实现因医院病原体引起的全面性感染而复杂化,需要广谱静脉抗生素治疗。7周龄时引入个人胰岛素泵Pradigm 712,用于输送NovoRapid胰岛素。在治疗的第3天,胰岛素的日剂量可以从0.7单位/kg/24小时下降到0.5单位/kg/24小时,血糖水平恢复正常。在此治疗过程中,患者在6个月大时体重为6300克,他的精神运动发育达到了与年龄相称的里程碑。结论:本病例提示,在婴儿期诊断为糖尿病的患儿中,通过个人胰岛素泵进行胰岛素治疗是一种可能且有效的治疗方法。
{"title":"[The usage of the personal insulin pump for treatment of a 7 week infant with neonatal diabetes mellitus].","authors":"Malgorzata Mysliwiec,&nbsp;Anna Balcerska,&nbsp;Joanna Bautembach-Minkowska,&nbsp;Maciej T Malecki,&nbsp;Joanna Nazim","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Unlabelled: </strong>Etiology and the course of diabetes mellitus type 1 diagnosed in infancy remains the subject of intensive investigations, nonetheless the diagnosis of hyperglycemia in this period obliges prompt start of the insulin therapy. The treatment of newborns and infants is challenging because of the necessity to use very low doses of insulin.</p><p><strong>Case report: </strong>A boy was transferred from the neonatal ward on the 8th day of life with the diagnosis of diabetes mellitus. He was born of young healthy parents (mother: 27, father: 30 years old), with no family history of diabetes or other autoimmune disorders. The course of the pregnancy remained normal until 37th week of gestation when due to alterations in the fetal heart rate the cesarean section was done. In spite of precise i.v. insulin therapy fluctuations in glucose levels persisted. Additionally the achievement of the metabolic compliance was complicated by generalized infections caused by hospital pathogens that required broad-spectrum i. v. antibiotic therapy. At the age of 7 weeks personal insulin pump Pradigm 712 for the delivery of NovoRapid insulin was introduced. Already on the 3rd day of such treatment, the daily insulin dose could be decreased from 0.7 unit/kg/24 hrs down to 0.5 unit/kg/24 hrs, and glucose levels normalized. In the course of this treatment the patient weighed 6300 g at the age of 6 months, and his psychomotoric development reached the milestones adequate for the age. The biochemical examinations revealed C-peptide levels both fasting and after glucagon stimulation <0.5 ng/ml. Additionally, the analyzed immunologic markers of type 1 diabetes are negative. The genetic testing for Kir6.2 mutation gave negative results.</p><p><strong>Conclusions: </strong>The presented case shows that the insulin therapy carried out via personal insulin pump is the possible and effective treatment in children diagnosed with diabetes mellitus during infancy.</p>","PeriodicalId":11550,"journal":{"name":"Endokrynologia, diabetologia i choroby przemiany materii wieku rozwojowego : organ Polskiego Towarzystwa Endokrynologow Dzieciecych","volume":"12 4","pages":"296-9"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26502552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Estimation of growth hormone secretion during sleep as a screening test in the diagnosis of GH deficiency]. [睡眠期间生长激素分泌的评估作为诊断生长激素缺乏症的筛选试验]。
Monika Obara-Moszyńska, Eugeniusz Korman, Andrzej Kedzia, Barbara Rabska-Pietrzak, Marek Niedziela

Background: Because of many disadvantages of growth hormone (GH) stimulation tests the diagnosis of growth hormone deficiency (GHD) is still problematic for the clinician. THE AIM of the study was the estimation of diagnostic usefulness of the GH provocation tests and basal IGF-I concentration measurement in the diagnosis of GHD.

Material and methods: The study group consisted of 180 children with short stature diagnosed in the Department of Pediatric Endocrinology and Diabetes in the years 1998-2003. Pharmacological stimulation test with insulin, clonidine, glucagon and L-dopa were used. GH concentration in physiological test after the onset of sleep was also measured. In 60 patients IGF-I concentration was estimated. For statistical analysis Spearman test was used.

Results: The highest mean GH concentrations (19.18 microl U/ml) and GH peaks (26.39 microl U/ml) were observed in sleep test. IGF-I concentration was correlated with GH concentration levels in physiological test after onset of sleep (r=0.4; p<0.05).

Conclusions: Sleep is the strongest stimulatory agent for GH secretion. The estimation of GH secretion after the onset of sleep can be used as a screening test in the diagnosis of GHD. Because of many diagnostic problems in estimation of pituitary function the auxologic parameters should be considered as the most important part in the diagnostic work-up of children with short stature due to GHD.

背景:由于生长激素(GH)刺激试验存在诸多缺陷,临床医生对生长激素缺乏症(GHD)的诊断仍然存在问题。本研究的目的是估计生长激素激发试验和基础IGF-I浓度测量在诊断GHD中的诊断有用性。材料与方法:研究对象为1998-2003年在儿科内分泌与糖尿病科诊断的180例矮小儿童。采用胰岛素、可乐定、胰高血糖素、左旋多巴等药物刺激试验。同时测定入睡后生理试验GH浓度。对60例患者的IGF-I浓度进行了估计。统计分析采用Spearman检验。结果:睡眠时生长激素平均浓度最高(19.18 μ l U/ml),生长激素峰值最高(26.39 μ l U/ml)。入睡后生理测试中IGF-I浓度与GH浓度水平相关(r=0.4;结论:睡眠是促生长激素分泌的最强刺激剂。睡眠后GH分泌的测定可作为诊断GHD的筛查试验。由于垂体功能的诊断存在许多问题,因此在矮小儿童GHD的诊断工作中,应将生理参数作为最重要的部分。
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引用次数: 0
[Correlation analysis between diabetic retinopathy and early atherosclerotic changes in adolescents with type 1 diabetes -- preliminary report]. 【青少年1型糖尿病视网膜病变与早期动脉粥样硬化改变的相关性分析——初步报告】。
Barbara Głowińska-Olszewska, Mirosława Urban, Beata Urban, Joanna Tołwińska

Objective: Recent studies have shown a correlation between advanced diabetic retinopathy and late stages of atherosclerosis. There are no findings on a possible relation between diabetic retinopathy and diseases of the cardiovascular system at their earliest stage in young people with diabetes type 1. The purpose of the study was to analyze a correlation between diabetic retinopathy and early atherosclerotic changes in adolescents with type 1 diabetes.

Research design and methods: The study included 28 adolescents aged 17.6+/-1.4 years suffering from type 1 diabetes mellitus for 7.9+/-3.1 years, the mean age of the disease onset - 9.5+/-3.7 years, a mean level of HbA1c - 8.6+/-1.9%. Eight patients with developing simple retinopathy, were separated from the whole group of young people. First control group consisted of the remaining patients with type 1 diabetes chosen with regard to age and sex, without disease complications. Second control group consisted of 11 healthy young people. The function of endothelium by measuring the brachial artery dilatation -- FMD and the intima-media complex thickness of the common carotid arteries were evaluated ultrasonographically.

Results: Young people with retinopathy had higher systolic pressure: 133+/-19 mmHg in comparison with patients without complications: 117+/-14 mmHg (p<0.05) and healthy people: 115+/-8 mmHg (p<0.05). All patients with diabetes showed significantly lower FMD (7.6+/-5.1%, p<0.05). In the group with retinopathy, FMD equaled 7.8+/-4.1% (p=0.04) and in the group without retinopathy - 7.6+/-5.5% (p<0.05) in comparison with 12.1+/-5.1% in healthy volunteers. Significantly higher IMT was found in all patients with diabetes in comparison with healthy young people: 0.49+/-0.06 vs. 0.42+/-0.03 mm (p<0.001). Patients with retinopathy had a significantly higher value of IMT in comparison not only with controls but also with patients without complications: 0.56+/-0.06 vs. 0.47+/-0.03 mm (p<0.001).

Conclusions: 1. Young people with type 1 diabetes had a significantly impaired function of endothelium and higher IMT in comparison with healthy young people. 2. Adolescents with retinopathy were characterized by significantly higher values of systolic arterial blood pressure when compared to patients without complications 3. Higher IMT was found in patients with diabetic retinopathy in comparison with patients without complications, which may suggest that macrovascular changes are more advanced in case of complications than in patients without retinopathy.

目的:最近的研究表明,晚期糖尿病视网膜病变与动脉粥样硬化之间存在相关性。目前还没有发现糖尿病视网膜病变与年轻1型糖尿病患者早期心血管系统疾病之间的可能关系。该研究的目的是分析1型糖尿病青少年糖尿病视网膜病变与早期动脉粥样硬化改变之间的相关性。研究设计与方法:28例青少年1型糖尿病患者,年龄17.6+/-1.4岁,病程7.9+/-3.1年,平均发病年龄- 9.5+/-3.7岁,平均HbA1c水平- 8.6+/-1.9%。8名患有单纯性视网膜病变的患者,从整个年轻人组中分离出来。第一个对照组由其余的1型糖尿病患者组成,根据年龄和性别选择,没有疾病并发症。第二组由11名健康的年轻人组成。超声测量肱动脉舒张- FMD及颈总动脉内膜-中膜复合体厚度,评价血管内皮功能。结果:年轻视网膜病变患者的收缩压较高:133+/-19 mmHg,而无并发症患者的收缩压为117+/-14 mmHg。与健康青年相比,1型糖尿病青年内皮功能明显受损,IMT较高。2. 青少年视网膜病变的特点是收缩压值明显高于无并发症的患者3。与无并发症的患者相比,糖尿病视网膜病变患者的IMT更高,这可能表明并发症的大血管改变比无视网膜病变的患者更早。
{"title":"[Correlation analysis between diabetic retinopathy and early atherosclerotic changes in adolescents with type 1 diabetes -- preliminary report].","authors":"Barbara Głowińska-Olszewska,&nbsp;Mirosława Urban,&nbsp;Beata Urban,&nbsp;Joanna Tołwińska","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>Recent studies have shown a correlation between advanced diabetic retinopathy and late stages of atherosclerosis. There are no findings on a possible relation between diabetic retinopathy and diseases of the cardiovascular system at their earliest stage in young people with diabetes type 1. The purpose of the study was to analyze a correlation between diabetic retinopathy and early atherosclerotic changes in adolescents with type 1 diabetes.</p><p><strong>Research design and methods: </strong>The study included 28 adolescents aged 17.6+/-1.4 years suffering from type 1 diabetes mellitus for 7.9+/-3.1 years, the mean age of the disease onset - 9.5+/-3.7 years, a mean level of HbA1c - 8.6+/-1.9%. Eight patients with developing simple retinopathy, were separated from the whole group of young people. First control group consisted of the remaining patients with type 1 diabetes chosen with regard to age and sex, without disease complications. Second control group consisted of 11 healthy young people. The function of endothelium by measuring the brachial artery dilatation -- FMD and the intima-media complex thickness of the common carotid arteries were evaluated ultrasonographically.</p><p><strong>Results: </strong>Young people with retinopathy had higher systolic pressure: 133+/-19 mmHg in comparison with patients without complications: 117+/-14 mmHg (p<0.05) and healthy people: 115+/-8 mmHg (p<0.05). All patients with diabetes showed significantly lower FMD (7.6+/-5.1%, p<0.05). In the group with retinopathy, FMD equaled 7.8+/-4.1% (p=0.04) and in the group without retinopathy - 7.6+/-5.5% (p<0.05) in comparison with 12.1+/-5.1% in healthy volunteers. Significantly higher IMT was found in all patients with diabetes in comparison with healthy young people: 0.49+/-0.06 vs. 0.42+/-0.03 mm (p<0.001). Patients with retinopathy had a significantly higher value of IMT in comparison not only with controls but also with patients without complications: 0.56+/-0.06 vs. 0.47+/-0.03 mm (p<0.001).</p><p><strong>Conclusions: </strong>1. Young people with type 1 diabetes had a significantly impaired function of endothelium and higher IMT in comparison with healthy young people. 2. Adolescents with retinopathy were characterized by significantly higher values of systolic arterial blood pressure when compared to patients without complications 3. Higher IMT was found in patients with diabetic retinopathy in comparison with patients without complications, which may suggest that macrovascular changes are more advanced in case of complications than in patients without retinopathy.</p>","PeriodicalId":11550,"journal":{"name":"Endokrynologia, diabetologia i choroby przemiany materii wieku rozwojowego : organ Polskiego Towarzystwa Endokrynologow Dzieciecych","volume":"12 2","pages":"96-102"},"PeriodicalIF":0.0,"publicationDate":"2006-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26122760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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Endokrynologia, diabetologia i choroby przemiany materii wieku rozwojowego : organ Polskiego Towarzystwa Endokrynologow Dzieciecych
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