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PubMed2000

Minimally invasive surgery in pediatric endocrinology.

The use of minimally invasive surgery (MIS) in children and adolescents is steadily increasing. The aim of the present review was to summarize the status of MIS in pediatric endocrinology. We found that laparoscopic procedures have been proven useful for the diagnosis or treatment of endometriosis and its associated manifestations, undescended testicles, ambiguous genitalia, adnexal torsion and ovarian cyst. Considering the safety and efficacy of these applications, the more rapid recovery of the patients, and the considerably less pain induced, we believe MIS will gradually take precedence over standard procedures in many areas of endocrinology in the young population.

Adolescent↗
PubMed2006

Endocrinology: the next 60 years.

Advances in clinical chemistry, molecular biology and information technology have brought about major changes in the field of endocrinology. The future practice of endocrinology will be influenced by secular health trends, consumer expectations and the globalisation of health. Pharmacotherapy will remain the backbone of endocrine therapy led by developments in drug delivery technology, pharmacogenomics, combinatorial chemistry and paracrinology. The endocrine-related consequences of obesity and ageing will be major health problems, demand for anti-obesity and anti-ageing treatments will escalate. There will be increased blurring between endocrine disease and non-disease. The future clinical endocrinologist must continue to practice evidence-based medicine to improve the treatment of genuine endocrinopathies.

Aging↗
PubMed2004

Evidence-based endocrinology: how far have we come?

Evidence-based medicine is the judicious, conscientious, and explicit use of the best available evidence from clinical research in making clinical decisions. This definition recognizes a hierarchy of evidence that arranges study designs by their susceptibility to bias. The top of the hierarchy includes n-of-1 trials, systematic reviews of randomized trials, and single randomized trials reporting patient-important outcomes. The bottom of the hierarchy includes physiologic studies and unsystematic clinical observations. The definition posits that evidence alone is never enough to guide clinical decisions. In addition to evidence from clinical research, decision making requires careful and expert assessment of the patient's circumstances and elicitation of the patient's values and preferences. The latter should drive decisions, particularly when the trade-offs (of benefit and risk) are close or unclear. The evidence-based medicine process involves: (i) asking an answerable question; (ii) acquiring the best available evidence; (iii) appraising the evidence to judge the strength of inference of its results; and (iv) applying the results to the individual patient. Evidence-based endocrinology is hindered by limited high-level evidence assessing patient-important outcomes, limited systematic summaries of this evidence, lack of time, and lack of systematic training of endocrinologists in evidence-based medicine. Current endocrine practice may require a redesign to enhance the role of endocrinologists as information brokers for colleagues and patients. In the last 10 years, evidence-based medicine has matured as a philosophy of clinical care and medical education. An appraisal of its role in endocrinology awaits the pervasion of its principles into all of endocrine practice.

Clinical Competence↗
PubMed1996

Gastrointestinal endocrinology.

During the last quarter of this century gastrointestinal endocrinology has grown explosively. In 1970, three hormones (secretin, gastrin, and cholecystokinin) were identified and by authorities in the field considered sufficient to explain the entire hormonal regulation of digestion. That was some underestimation. Today the gut is known to express more than 20 different hormonal/regulatory peptide systems. Their widespread cellular occurrence, gene expression cascades, secretory mechanisms, receptors and receptor binding, as well as normal and pathophysiological effects are now also fairly well known owing to the marked progress in basic sciences and biochemical technologies (immuno and peptides chemistry, molecular and cell biology). Thus, the gut is now recognized as the largest endocrine organ of the body; and a substantial part of the gastroenterologic research over the latest decades has been devoted to gut hormones. The following review describes the recent development, with emphasis on gastrointestinal peptide systems that have been studied and even discovered in Denmark. Hence, as reflected by the number of doctoral theses and PhD studies (> 50 since 1974), gastrointestinal endocrinology has been a major research area in this country in the past 25 years.

Denmark↗
PubMed1999

[Endocrinology 1997-1998].

The author presents an account on advances in endocrinology in 1997-1998, starting by mentioning the Nobel prize for physiology and medicine in 1998 and the discovery of nitric oxide as an active substance. Subsequently the author discusses data on "new gerontology", i.e. hormonal aspects of the menopause, andropause, adrenopause and somatopause. Endocrinological contributions to oncology pertain in particular to the discovery of active substances which inhibit neovascularization (endostatins) and some new aspects of the action of antioestrogens and oestrogens. The possible action of hormonal factors in neurodegenerative processes are obvious in ubiquitine, CREB and "heat shock proteins". New types of Ca-channels were detected, in particular "promiscuous" channels, conveying Ca as well as Na, which can be influenced by endogenous ouabain. Subsequently attention is paid to ryanodine receptors and compounds acting as Ca on the sensor for Ca in the parathyroid bodies and inhibition parathormone secretion. The greatest future advances will be achieved obviously in the sphere of oncology, gerontology and hormonal analogues with unforeseen effects.

Calcium Channels↗
PubMed2000

[Information processing in the gynecological endocrinological laboratory. Current concepts and integration strategies].

While computer applications are widely accepted in clinical chemical departments, small numbers of computer systems are used in gynecological endocrinological laboratories. Modern applications should be integrated in local area networks and clinical information systems that improve communication and data exchange within hospitals and the outer resources. Better communication may improve medical quality and will lead to a better therapy for gynecological endocrinological patients.

Clinical Laboratory Information Systems↗
PubMed2000

[Gestational diabetes: the Rennes Study of joint obstetrical and endocrinological management].

OBJECTIVE: To assess the efficacy of a co-program of care in gestational diabetes conducted by the obstetrical and endocrinological units of the Rennes South Hospital (Hopital Sud) and the possibility of adapting obstetrical care to existing risk factors. PATIENTS AND METHODS: A retrospective analysis was made of 200 cases of gestational diabetes diagnosed between January 1993 and December 1996 in the obstetrical units. RESULTS: Instrumental extraction and cesarean section were required for 13.5% and 20.5% of the deliveries respectively. Shoulder dystocia occurred in 2%. 19.9% of the infants had macrosomia and 5. 3% were small for gestational age. Neonatal morbidity required transfer to the pediatric intensive care unit for only 2.9% of the infants. Frequency of cesarean section and macrosomia correlated with poor blood glucose control and excess maternal weight for gravidic hypertension. At 3 months post-partum, glucose intolerance and non-insulin-dependent diabetes were diagnosed in 13% and 2% respectively. CONCLUSION: Systemic screening and obstetrical and endocrinological care allowed patients to prevent maternal and fetal complications in gestational diabetes and to initiate hygiene and dietary habits for the prevention of post-partum non-insulin-dependent diabetes. Obstetrical care can be adapted to risk factors such as overweight, late screening or poor blood glucose control.

Body Mass Index↗
PubMed2000

Adolescent endocrinology in Saudi Arabia.

OBJECTIVE: The importance of providing special health care services for adolescents has been recently stressed. In Saudi Arabia, adolescents have no special services. In this study, we describe our first 5 years experience of an adolescent endocrinology clinic in Security Forces Hospital. We believe it is the first clinic with this objective in the Kingdom. METHODS: An adolescent endocrinology clinic was run by a team composed of pediatric endocrinologist, diabetic nurse educator, clinic nurse and a dietician in collaboration with other supportive staff and consultants from other disciplines. The methodology of setting up, staffing and running the clinic is described. RESULTS: About 223 cases were registered over 5 years. The most common problems were short stature 53 (24%), diabetes mellitus 49 (22%), obesity 40 (18%), thyroid disorders 28 (13%), delayed puberty 20 (9%) and rickets (8%). The clinic was well accepted by parents and their families. We learned a lot on how to handle these problems locally. CONCLUSION: Based on our experience, we recommend establishing special health care services for adolescents both at the primary care, as well as secondary and tertiary care levels.

Adolescent↗
PubMed1997

[Endocrinology in childhood].

The article illustrates the special problems of endocrinology in childhood, where disturbances of growth and development may be explained by disorders of the endocrine organs. To-day, as a result of early diagnosis and effective treatment the understanding of the spontaneous course of some classical endocrine disorders in children is known essentially from historical descriptions. This article also describes the historical development of childhood endocrinology in Denmark.

Child↗
PubMed2004

[Practical prevention and treatment of cardiovascular diseases in patients with diabetes mellitus type 2 in an endocrinological department].

AIM: To analyse retrospectively quality of medical correction of modified risk factors (RF) and treatment of cardiovascular diseases (CVD) in patients with diabetes mellitus type (DM) 2 admitted to specialized endocrinological departments. MATERIAL AND METHODS: Analysis of medication policy of CVD RF was made retrospectively for 250 patients treated in endocrinological departments of Moscow hospital in 2003. RESULTS: Arterial hypertension, coronary heart disease were diagnosed in 93.2 and 87.2% examinees. History of myocardial infarction and brain stroke was in 8.4 and 6% patients. Statins were prescribed in 2.4% cases. Examination for dyslipidemia was not satisfactory. ACE inhibitors were prescribed in 71.2% patients. Aspirin was prescribed (18%) primarily by the cardiologist. CONCLUSION: Quality of medical prophylaxis of CVD RF in DM type 2 patients in the departments does not satisfy modern clinical recommendations.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2005

[Endocrinological transition clinic].

Patients with chronic endocrinological diseases, whether congenital or manifesting in childhood, have to date been the domain of the pediatric clinic long beyond puberty into adulthood. The reason for this is the complete lack of adequate communication between pediatricians and internists specialized in endocrinology. However, intensive and constant cooperation between the two specialties is a prerequisite for the successful transition of adolescent to adult patients. The transition clinic is of central importance for the appropriate management and a stable status of the patient. Nevertheless, only very few university centers so far established such a clinic. Only by overcoming sectoral boundaries, and the creation of a network structure between university policlinic, non-university outpatient department, specialty practice and the family doctor can the intensity and quality of management be improved. The requirement fortransition clinics urgently needs to be met, also in the form of model projects.

Adolescent↗
PubMed2004

The American College of Endocrinology and Endocrine University.

Subspecialty training in endocrinology depends in part on local expertise, with fellows having "hands-on" experience in some areas but only "book knowledge" in others. To provide more uniform training in new technologies, The American College of Endocrinology developed Endocrine University, which provides on-site didactic and interactive sessions on thyroid ultrasound, bone densitometry, and other topics over 6 to 7 days. The inaugural event in 2002 was attended by 137 fellows. A second conference in 2003 had capacity attendance of 143. A third course is scheduled for 2004. Fellows pay a token registration fee; the College provides grants to defray the cost of registration, travel, etc. Financial support comes from the College and industry, with plans for an endowment to sustain the program. Fellows value the educational sessions and also the unique opportunity to meet and visit with their peers. This innovative program can serve as a model for other specialties.

Endocrinology↗
PubMed1991

UK external quality assessment scheme for immunoassays in endocrinology.

UK EQAS provide the UK with a comprehensive system for EQA in endocrinology, as well as in other aspects of clinical chemistry and laboratory medicine. UK EQAS in endocrinology are scientifically designed to yield an objective assessment of participants' performance and stimulate improvements in between-laboratory agreement. The design uses appropriate specimens, based on liquid human serum and prepared with minimal processing and additives in the organising centres to enable detailed study of recovery and other important factors. Target values are validated by reproducibility on repeated distribution and by recovery and parallelism studies. Reports are presented informatively, and emphasise the cumulative scoring system (bias and variance) for performance assessment. Computerised data processing and data presentation form an integral part of these schemes, and a common core computing system is in use throughout these UK EQAS. Participants receive advice and assistance in the interpretation of performance data and, when appropriate, in the resolution of problems.

Chemistry, Clinical↗
PubMedDate not supplied

[Use of the microcomputer in teaching clinical endocrinology].

The paper is concerned with the results of the use of the Electronika NMS 01900.1 microcomputer manufactured in the USSR for teaching clinical endocrinology. Owing to its small dimensions, simple maintenance and sufficiently vast computing potentialities it can be widely used for teaching. A program with broad functional possibilities was prepared permitting students to objectivize their knowledge in clinical endocrinology. Fast automated test control of knowledge raises the efficacy of teaching many times.

Audiovisual Aids↗
PubMedDate not supplied

[Achievements of molecular endocrinology and biochemistry of hormones and new approaches to the study and correction of endocrine disorders].

Considerable progress in a study of the molecular mechanisms of the hormone biological effect has shown that practically all hormones regulate metabolism in the body by influencing the cell genetic system. These fundamental results served as a basis for a rapid development of a new direction--molecular endocrinology. In recent years effective approaches that make it possible to penetrate the secret of human and animal gene structure have been worked out. The paper is concerned with the results of a study of nucleotide sequences of genes and mRNA of various protein hormones and an analysis of the importance of these developments for present-day endocrinology and biochemistry of hormones.

Animals↗
PubMedDate not supplied

[Specialized endocrinological care of rural populations].

According to the Food Program, adopted at the May (1982) plenum of the CPSU CC, the problem of the level approaching the medical aid rendered to the rural and urban population assumes ever greater actuality. The difficulties in providing the rural population with endocrinological aid and the routes for their overcoming were analyzed by the author on the basis of 20-year experience of endocrinological work in the Chelyabinsk region.

Endocrinology↗
PubMed1995

[Endocrinology 1994-1995].

In a brief review of advances made in endocrinology during the past two years surprisingly the receptors for TSH and thyroid hormones occupy the foremost position. Mutations of the TSH receptor may cause congenital hyperthyroidism or resistance to TSH (mutation of the gene for TSH-receptor). An interaction of thyroid hormone receptor with a conserved transcriptional mediator was discovered. The reports on the treatment of neonatal respiratory distress syndrome with TRH are still controversial. CRH deficiency reveals neonatal but not adult glucocorticoid need--at least in mice. The concept of receptors was challenged by the discovery of "inverse agonists", i.e. ligand binding by (already) activated receptors. To make endocrinology even more complicated it was shown, that the congenital lipoid adrenal hyperplasia may be caused not by a deficiency in an adrenal cortex enzyme, but by a mutation of the mitochondrial transport protein (StAR), steroidogenic acute protein). The gene for X-linked congenital adrenal hypoplasia (DAX-1) was isolated, its mutation can cause a hypogonadotropic hypogonadism, too. Animals lacking functional estrogen receptor develop osteoporosis--this is true even in humans. Nitric oxide (NO) has more jobs in the body than previously thought-e.g. for maintenance of diurnal rhythms. The interest in endogenous cannabinoids is still flourishing, especially in the brain. Clinical implications of basic research are best documented by the discoveries of G-protein roles in clinical syndromes (e.g. pseudohypoparathyroidism, McCune-Albright syndrome, acromegaly and "testitoxicosis"). It should be emphasized that Nobel prize for medicine and physiology for the year 1994 was awarded to A. G. Gilman and M. Rodbell for the discovery of G-proteins.

Animals↗
PubMed1998

[Gynecologic endocrinologic information sources in the internet].

Within the last months a great number of internet pages have become a highly interesting source of up-to-date information in gynecological endocrinology. Most of these World Wide Web-pages present actual scientific fields and abstracts with close relations to basic science, while clinical discussion groups are still rare. The potential of internet presentations will strongly influence communication in cases of gynecological endocrinology.

Computer Communication Networks↗