A new surgical method of treating patients with unstable insulin-dependent diabetes (IDD) has been developed-that of surgically shunting pancreatic blood into the systemic blood flow with the purpose of creating a more optimal interaction of subcutaneously administered insulin and pancreas-secreted glucagon. The long term results of the operation depend on the patency of a splenorenal anastomosis. This has been studied by following up 137 patients over periods from half a year to three years. Anastomotic patency was determined by renal and splenic venography and celiacy arteriography, which revealed a patent anastomosis in 114 patients, and an obliterated one in 23. Patients with patent anastomoses showed a lowering of glycosylated hemoglobin (HbA lc ) from 13.3±0.03% to 9.3±0.6%, p<0.05, a decrease of the injected insulin dose from 0.97±0.04 to 0.72±0.03 U/ kg, p<0.05, disappearance or considerable abatement of pain in the lower extremities, and of hypoglycemia. Improvement of clinical status was accompanied by an increase of glucagon in the systemic blood stream from 60.8±10.1 to 91.5±9.4 pg/ml, p<0.05, a rise of tissue oxygen pressure, PO 2 , from 49.2±2.4 to 58.1±1.9 mm Hg, p<0.05. In patients with oblivious anastomoses postoperative HbA lc levels did not change from preoperative values: 12.9±0.4% and 12.8±0.7%, p<0.05, respectively; the insulin dose remained the same-0.91 ±0.07 U/kg and 0.85±0.07 U/kg, p<0.05, no rise of the systemic blood glucagon content was noted, and former complaints continued. The suggested method is not an alternative for insulin therapy, but considerably enhances its potential.

The paper reports 3 cases of physical and sexual retardation in girls aged 14-22 with nephropathy: 1 girl had uremia in a conservative stage, 1 patient was put on a chronic hemodialysis for terminal uremia, 1 girl received a renal transplant. In response to combined treatment (zinc sulfate+parlodel) in the former two patients and norcolute therapy in the latter one body mass and growth increased in all the 3. The discussion is concerned with mechanisms of developmental defects in nephropathies, comparative efficacy of the drugs used and social rehabilitation of nephropathy girls with small height and sexual infantilism.

Two groups of patients aged 16.5-31 years with pathospermia given immunodepressants (IDS) for glomerulonephritis (group I) or rheumatoid arthritis (group II) before and/or at the moment of examination were examined. Five out of 6 patients of group I and all the patients of group II showed azoospermia. As a result of the treatment with zinc (30-90 mg of elementary zinc a day) and parlodel (2.5 mg/day) for 2-23 months, spermatogenesis improved or returned to normal in 2 patients of group I and in 2 patients of group II. It should be mentioned that out of 8 patients who turned out refractory to the treatment, 7 received glucocorticoids and cytostatics (CT) whereas among those who responded to the treatment, only 2 patients out of 4 were given CT. The reported data on the gonadotoxic dose of CT are discussed. The conclusion is made about the necessity of carrying out active treatment policy for pathospermia in patients who received IDS.

Ten adolescents aged 10-18 years with physical and/or sexual development retardation associated with nephropathy were examined. Eight patients were treated with immunodepressants before and/or at the moment of examination. The difference between the age indicated in the patient's passport and bone age ranged within 0 to 3 years. On spermogram examination 3 of 4 patients manifested pathospermia. The serum prolactin level and the level of gonadotropins appeared normal but the testosterone content and plasma zinc level were lowered. As a result of the treatment with parlodel and/or zinc acetate for 1.5 to 23 months, 9 of 10 patients demonstrated the rise of the height and body weight and developed secondary sexual signs. In 3 of 4 patients examined for that parameter, the spermograms improved. In the whole group, the concentration of blood prolactin decreased, that of testosterone and zinc rose, whereas the content of gonadotropins remained unchanged.

The kinetics of 131I-labeled intravenous insulin was examined in 13 patients with diabetes mellitus and in 2 nondiabetics, and the kinetics of unlabeled intravenous insulin ('insulrap') was followed up in 7 patients with insulin-dependent diabetes. Antibodies to exogenous insulin were titered in examinees' blood sera. The kinetic curves of labeled and unlabeled insulin were processed with the use of a two-compartmental model, thus obtaining compatible kinetics parameters. This permits the use of routine insulin dosage forms in pharmacokinetic studies, followed by the blood serum insulin radioimmunoassay. Antibodies to exogenous insulin increase the level of insulin dissemination, slow down its elimination from the blood (mostly in the beta-phase) and the total insulin clearance, with the antibody titer rise being parallelled by an acceleration+ of insulin dissemination and by deceleration of its elimination from the blood; besides, the fraction of antibodies, by fixing which insulin is slowly metabolized, increases.

Signs of hypogonadism and an elevated prolactin level (EPL) were found in the blood serum of 12 men and 9 women with different stages of chronic renal insufficiency (CRI) as compared to 20 healthy persons. The treatment with parlodel, a EPL secretion inhibitor, at a dose of 2.5-7.5 mg a day for 1-6.5 mos raised potency in 10 men, brought the sperm composition to normal in 5. Dysfunctional uterine bleeding was cut short in 4 women, the menstrual cycle was resumed in 3, the absence of any effect was noted in 2. The EPL level decreased significantly in all the patients. The results of the parlodel therapy of uremic hypogonadism were discussed with respect to CRI gravity and duration and the time period of a therapeutic course. Problems concerning the pathogenesis of uremic hypogonadism were considered.

The relationship of the symptoms of hypogonadism (HG) with the serum level (SL) of zinc was investigated in 31 uremic male patients: 16 on hemodialysis (I group), 10 on a low-protein diet (II group), and 5 kidney graft recipients (III group). A conclusion has been made that in renal pathology a zinc SL does not always reflect the content of zinc in the body however zinc acetate therapy is effective in the treatment of HG patients as well as in the treatment of retarded physical and sexual development in adolescents with nephropathies.