During the last decade, circadian and episodic fluctuations of the plasma levels of pituitary hormones have been demon~ trated in man. The interest in the time dependence of the pituitary secretions partially originates from their close functional relation with the neuroendocrine mechanisms pre- sumably responsible for the control of the circadian.rhyth- micity in man. High frequency blood sampling techniques and specific radio- immunoassays have allowed to describe in detail the varia- tions over the 24-h cycle of the hormonal concentrations in healthy individuals under basal conditions as well as after manipulation of external synchronizers such as the sleep- wake cycle, the dark-light cycle and the feeding schedule. Alterations in normal hormonal var~ions have been sugges- ted to play a role in the etiopathogeny of several metabo- lic and mental diseases, such as obesity or manic-depressio~ Important clinical implications regarding treatment and pre- vention are expected to be developed in the near future. However, so far, data obtained in different groups are dif- ficult to compare because different hormones were studied using different protocols and statistical methods. As a result, unclear or controversial issues are not uncommon.

Nineteen eighty-six is a most appropriate year in which to be writing about developments in the organ-specific, autoimmune endocrine diseases. It celebrates the publication 30 years ago in 1956 of the classic papers of Roitt and Doniach and their co-workers I , and of Rose and Witebsky2 and Adams 3 and Purves . These three sets of fundamental observations provided the initial building blocks upon which much of what has been established in the field in the last 30 years was built. No publication of this nature on endocrine autoimmune disease can cover every aspect of the subject. I have chosen to highlight the organs (thyroid and pancreeas) which have attracted the most attention, and the areas of work within these fields within which most research effort is currently focused. There are still some gaps; the insulin and TSH receptors are not considered, nor in any detail are the role of cytotoxic mechanisms in mediating gland destruction. Molecular biology will undoubtedly in the next few years clarify once and for all the controversy that surrounds the structure of the TSH receptor and T cell cloning, the role of cell-mediated cytotoxicity. The pathogenetic mechanisms underlying autoimmunity are increasingly well understood and the search for the aetiology has begun.

A lot of time has been spent trying to convince health care providers and policy makers of the enormous importance of macrovascular disease in persons with type 2 diabetes. In this volume, we present facts that dem onstrate how important it is to recognize macrovascular disease in these patients in daily practice. This volume has been compiled to help those already involved in dia betes care, to be more involved in cardiovascular risk control, a task that is not easily achieved. The area of cardiovascular risk in type 2 diabetes is heterogeneous. Trying to characterize it, we can only say: certainly we know more than we do, but for sure we do less than we could. Our challenge is to change this. Nicolae Htmcu Professor N. Hancu was born in Romania in 1940. He studied medicine at the Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, and obtained his speciality in internal medicine in 1970, and in diabetes, nutrition and metabolic disease in 1986. He was appointed Professor and Head of the Department of Diabetes, Nutrition and Metabolic Diseases of the same university in 1993. He has been a full member of the Romanian Academy of Medical Sciences since 1995. Professor Hancu's major interest is related to clinical lipidology, visceral obesity, and cardiovascular risk in type 2 diabetes. He has published over 200 papers and 14 books in this area. He has been invited as Visiting Professor at many universities in Madrid, Valladolid, Barcelona, and Los Angeles.

The mechanisms by which animals regulate the volume and composition of their body fluids has long had a particular fascination for students of biology. As a consequence, the subject can lay claim to an impressive record of ground breaking scientific achievements as well as a provocative body of philosophical speculation concerning the role of the system in the origin and evolution of life. Indeed, the entire concept of homeostasis on which so much of o r current biologic thinking is based, derives from Claude Bernard's pioneering exploration of the forces that determine the composition of this 'internal sea'. Other seminal achievements credited to this area of inquiry include the first description of a genetically transmitted human disease (familial neurogenic diabetes insipidus); the first isolation sequencing and synthesis of a peptide hormone (vasopressin and oxytocin); the first demonstration of peptide hormone synthesis by way of a larger protein precursor; the first description of resistance to the biologic actions of a hormone (nephrogenic diabetes insipidus); and the conceptual realization of the unique counter-current mechanism that permits concentration of the urine. This record of far reaching and fundamental advances has been distinguished by many fruitful inter actions between clinical and basic science."

A little over 12 years ago I wrote a small volume entitled Infertility. It seemed to me at that time that significant advances in the field called for the publication of such a volume. The following is from the preface to that volume: During the past 15 years considerable progress has been made in the field of infertility diagnosis and management. It is perhaps a paradox that much of this increased knowledge has come about because of Western medicine's preoccupation with the search for a means to control reproduction. As a result, we have achieved new insights into the physiologic mechanisms involved in reproduction, and we have found better methods for measuring physiologic changes in reproductive health and disease. To these advances can be added improvements in the utilization of endoscopic and surgical techniques, in the diagnosis and treatment of infections and endometriosis, and in the treatment of hormonal disorders. During this period, too, through workshops and conferences and in journals and texts, these latest advances have been made available to physi cians, an outstanding example being the two volumes of Progress in Infer tility, edited by Drs. Jan Behrman and Robert Kistner. As necessary as these publications are, they do not offer an overall view of infertility diag nosis and management."

These four volumes comprlslng "GnRH Analogues in Cancer and Human Reproduction" are a distillation of the presentations of the invited speakers at a landmark International Symposium bearing the same name, organized by one of us (B. L. ) and held in Geneva, SwitLerland in February 1988. The Symposium was truly interdisciplinary spanning gonadal hormone dependent disease including various forms of cancer and ranging to control of fertility, both pro- and conception. The international flavor can be caught from the 480 participants and 259 contributors drawn from 14 countries. The Symposium, and therefore this book, would not have been possible without the backing of The International Commitlee for Research in Reproduction and the sponsorship of the International Society of Gynecologic Endocrinology, The Swiss Society of fertility and Sterility, The University of Geneva School of Medicine, The Swiss Society of Endocrinology and The US foundation for Studies in Reproduction Inc. , and help from the World Health Organization. B. H. Vickery B. Lunenfeld June 1989 xiii LIST OF CONTRIBUTORS TO THE SERIES A. Abbondante H. Bartermann First Institute of Obstetrics and Urologische Universitatsklinik Kiel Gynecology Arnold-Heller Strasse 7 University "La Sapienza" D-2300 Kiel 1, FRG Rome, Italy M. Bartholomew P. Abel Department of Medicine/Endocrinology Department of Urology Milton S. Hershey Medical Center Hammersmith Hospital Pennsylvania State University DuCaneRoad PO Box 850, Hershey, PA 17033, USA London W12 OHS, UK D. Beck H.

In this book on diabetes mellitus both the pathogenesis and treat ment of the disease will be discussed. Pathogenetic studies have led to the distinction between type I and type II diabetes. In type I hyperglycaemia is due predominantly to insulin deficiency; in type II insulin resistance is more important. Three pathogenetic factors are thought to play a role in the etiol ogy of type I diabetes: heredity, viral infections and immunity. There may be a relationship between these three aspects since genetic pre disposition changes the susceptibility to viral infections and/or the immunological defence against these infections. Insulitis ensues. Auto immune processes initiated by this chain of events may contribute to the destruction of the B cells in the islets of Langerhans and diabetes -may eventually follow. This means that at the time of the sudden out break of the disease, the destructive process has already been active for years."

This volume in the series Developments in Medical Virology deals with viruses involved in diabetes mellitus, a syndrome with a strong genetic background that causes damage to the regulation of insulin synthesis and function. Viruses were found either to cause or to stimulate diabetes mellitus in man and in animal models. The nature of the role of viruses is described by many of the scientists who participated in the original studies. To complete the picture, chapters were included that deal with the insulin gene, the secondary structure of the proinsulin and insulin receptor polypeptides, pancreatic Langerhans islets, and clinical considerations of the disease. The aim of Developments in Medical Virology is to elucidate processes involving viruses as pathogens of cells and organisms, with special attention to human diseases. A number of volumes will be devoted to viruses affecting specific organs (e.g. brain, liver, etc.), while others will elaborate on the clinical experience in the use of antiviral drugs. The series is published in parallel with Developments in Molecular Virology, designed to present an analysis of molecular mechanisms implicated in virus infection and replicative processes. In addition, the series Developments in Veterinary Virology provides information on viruses causing diseases in animals, with special emphasis on aspects of interest to veterinarians.

Painful Diabetic Neuropathy in Clinical Practice provides a concise, didactic and essential resource for clinicians in the management of neuropathic pain in diabetic patients. This volume opens with overviews of epidemiology, classification and clinical features, including a discussion of the negative effect of painful neuropathic symptoms on quality of life. These are followed by a chapter on diagnosis and staging, which includes approaches to history taking, clinical examination, pain assessment scales, testing and staging. The book concludes with a chapter on the various approaches in the management of neuropathic pain, including the most up-to-date guidelines on the pharmacological treatment of this condition. This concise handbook is an invaluable reference for primary care practitioners and diabetologists who wish to keep up to date with the diagnosis and management of neuropathic pain. Content Level Professional/practitioner

A concise, handy reference to one of America's most challenging health issues. Diabetes is not yet fully understood. Its main forms, Type 1 and Type 2, follow different courses of progression and require different types of treatments. The occurrence of Type 2 diabetes linked to obesity and inactivity is on the rise. More than 23 million children and adults suffer from diabetes, and approximately 1.6 million new cases are diagnosed in adults each year in the United States, according to the American Diabetes Association. The A to Z of Diabetes is a complete guide to the different types of this disease, signs and symptoms, and management and treatment. The 246 entries explain the causes of diabetes, how the disease affects the body, and how it impacts daily life. Appendixes include directories of organisations, periodicals, research centres, and Web sites. Key topics include: Carbohydrate and carbohydrate counting Complications of diabetes Diabetic eye diseases Diabetic nephropathy Diabetic neuropathy Emergency issues Gestational diabetes Insulin and insulin pumps Lifestyle adaptations Medications.

This issue of Medical Clinics devoted to prediabetes and diabetes prevention belongs in the hands of every practicing internist, PCP, hospitalist, nurse practitioner, endocrinologist, and any healthcare provider who is concerned about the diabetes epidemic. The importance of this resides in our ability to prevent diabetes by early identification of individuals with a precursor condition termed prediabetes that affect 54 million adult Americans. This entity has grown globally over the recent decades paralleling the obesity epidemic. No country or region of the world is immune. Overweight and obesity affect approximately 60% of our population and children as well as adolescents are not spared. Approximately 13% of adolescents have prediabetes which has doubled since the year 2000. Both type 2 diabetes and prediabetes are preventable and reversible with lifestyle changes involving weight loss and exercise. This issue gives a historical perspective on diabetes prevention, examines its public health implications, and explores diabetes prevention initiatives. Essential topics covered include prediabetes definition, epidemiology, mechanisms of complications, pathophysiology, diagnosis, and treatment recommendations. Diabetes prevention trials and the economics of prevention are also covered.

The growing problem of diabetes presents difficult challenges for sufferers and for those in the healthcare professions, who are in the unenviable position of trying to convince patients to change their lifestyle "for their own good." Handbook of Diabetes Management provides practical knowledge and advice that can help you anticipate the challenges of working with these Patients. What's more, since the knowledge here is evidence-based, you can assure your patients that the guidelines you're presenting to them have been shown to be effective. This guide takes into account the complexity of the disease, the diversity of the populations it affects, and the continued improvement of care systems. It discusses the origins of diabetes and medication management and treatment, then presents advice based on the latest research findings on: -behavioral health and self-management issues and interventions -tips for patients dealing with issues such as travel, surgery, and foot care -treating specific patient populations including Latinos, Native Americans, rural communities, and the uninsured -case studies from successful, replicable programs Also addressing the business aspects of diabetes care related to such areas as legal and regulatory issues and health policy initiatives, Handbook of Diabetes Management, brings you practical insights based on the latest research. "This handbook book by expert professionals covers every aspect of diabetic care. It is a sound, evidence-based, culturally informative, practical approach to diabetes prevention and disease management." -Kathleen Lambert, BSN, RN, JD, from the Foreword

Behavioral medicine has blossomed as an area of systematic investiga tion during the past 10-20 years. Throughout its steady growth, there have been increasing interest and specialization in the study of neuro psychological and behavioral aspects of diabetes. This book attempts to capture and report exciting new developments in the study of both insulin-dependent (Type I) and non-insulin-dependent (Type II) dia betes mellitus. Accordingly, it is divided into two major sections. Physiological aspects of each disease, which differ significantly in pathophysiology and course, are discussed in separate medical over views that introduce each major section. These overviews are written by Drs. Tsalikian and Zimmerman, leading medical researchers in insulin and non-insulin-dependent diabetes, respectively. Each section also contains chapters describing neuropsychological and cognitive disease correlates, psychosocial patterns of adjustment, and treatment adher ence issues. Psychological aspects of insulin-dependent diabetes have been studied more extensively than non-insulin-dependent diabetes, perhaps because it is more often associated with graver medical compli cations. Therefore, there is a larger body of research to review and the first section has been divided into chapters on cognitive disease se quelae in populations of children and adults, separately. In his chapter, Dr. Ryan discusses developmental factors related to the unique sensi tivity of the brain to metabolic derangement. Dr. Holmes reviews studies of adults with diabetes and the cognitive correlates of both acute and chronic blood glucose disruption. Developmental disease is sues are further covered in Dr."

Sex Hormone Replacement Therapy addresses important issues in contemporary endocrinology. Its major emphasis is on the consequences of the menopause and on androgen deficiency in the absence of overt disease of the hypothalamus and/or pituitary in men. The use of hormone therapy for the primary prevention of cardiovascular disease in post-menopausal women has become an area of major debate, and the pros and cons are examined in detail. Secondary prevention also remains controversial and is addressed in this volume. An issue of particular concern is the treatment of estrogen deficiency symptoms in women with the diagnosis of breast cancer. Whether older men with some androgen deficiency symptoms and equivocally low plasma testosterone concentrations should be treated with androgens is also a matter of great debate, as is the efficacy and safety of plant estrogens in the treatment of menopause-related complaints. Sex Hormone Replacement Therapy will be of interest to students and non-specialists, as well as a wide range of medical practitioners including endocrinologists, gynecologists, rheumatologists and cardiologists.

Is the nephrology community facilitating excess cardiovascular deaths in patients with kidney failure and anemia by treating to a subnormal hematocrit? Why have clinicians and nephrologists permitted health insurance companies and the government to decide when anemia therapy should begin in persons with progressive kidney failure? Is iron the only variable that can be manipulated to maximize response to recombinant erythropoietin? Are we using too much intravenous iron in kidney failure patients, and is oral iron supplementation worthless in sustaining iron stores during long-term erythropoietin treatment? When does left ventricular hypertrophy begin to emerge in patients with progressive renal disease and is there convincing evidence that anemia is a significant cause of LVH in this setting? Is darbepoetin alfa, a new novel, long-acting erythropoietin, really superior to recombinant erythropoietin? This book is a compilation of proceedings from a conference in Brooklyn convened to address these and other controversial and unresolved issues in renal anemia management.

This timely book provides an overview of topics related to obesity. These include associated health risks, childhood obesity, genetics, evaluation, treatment, behavioral strategies, and successes and failures in preventing obesity. The volume covers evaluation guidelines, different approaches to treatment, including diet, exercise, behavior, drugs, and surgery to deal with the current world-wide obesity epidemic.

The cover of this book summarizes the central features of the sequestration hypothesis: Commonplace appearances seen in human coronary artery, fat stained in paraffin seetions by a new technique explained in Chapter Eleven, are arranged to suggest pathways of evolution toward atheroma. The hypothesis formulated and defended in the pages ofthis book is this: Fibroplasia progresses upward in column "a" from "la" to "3a" as a characteristic feature of aging. This starts sooner and progresses faster in men than in wornen. Numbers ofSMC's remain essentially constant so that fibroplasia per SMC steadily increases. The rise upward conveys an increasing propensity to sequester atherogenic lipids, causing transition rightward into column "b." Sequestered extracellular lipid then attracts fatty streak elements, especially foam cells and lyrnphocytes, to propel the arterial site rightward into column "c." Frame "lc" corresponds to the AHA Lesions Committee classification type IIb, the progression resistant fatty streak arising directly without prior lipid sequestration; this can progress to atheroma, but slowly after much delay, although extreme provocation can accelerate the process. Such progression is rightward toward atherorna with thin cap, not upward toward fibroplastic thickening. Frame "2c" corresponds to the AHA classification, type Ha, progression prone fatty streaks. These readily evolve into atheroma, again by horizontal progression.

Research into the paraoxonase (PON) multigene family has really only blossomed in the last 10 years. Before this time only PON1 was known and research was restricted to toxicologists investigating the metabolism of organophosphate insecticides and nerve gases and a few mad scientists searching for natural substrates.

Since this time two new members PON2 and PON3 have been discovered, all 3 PONs have been shown to act as antioxidants and the PON family has taken centre stage as major players in the development of a wide variety of diseases such as cardiovascular disease, diabetes mellitus, rheumatism, Alzheimer and many more while remaining important in determining organophosphate toxicity.

In September 2006 the 2nd International Conference on Paraoxonases took place in Hajduszoboszlo, Hungary, bringing together the world's foremost experts in the field. The current book is a distillation of the plenary lectures which took place at the meeting, resulting in a comprehensive up to date, state of the art review of current paraoxonase research."

Diabetes affects an estimated 20 million people in the United States, with many people remaining unaware that they suffer from the disease. While the number of diabetics continues to rise, the number of caregivers who specialize in diabetes treatment does not. In Educating Your Patient with Diabetes, Katie Weinger and Catherine Carver assemble commentary from a panel of leading diabetes practitioners and researchers and put together a highly readable guide to supplying patients with diabetes with the information and ability to successfully cope with their disease. The authors and editors provide substantive data on successful models of diabetes education and the process of educating diabetes sufferers. Additional chapters discuss diabetes in pregnancy, the challenge of weight and diabetes management in clinical practice, and diabetes education in geriatric populations. Timely and accessible, Educating Your Patient with Diabetes is a must have for all diabetes educators, physician assistants, nurses, and endocrinologists who endeavor to support their patients' diabetes self-care efforts and help them maximize the opportunities for patient learning.

Diabetes mellitus is the collective name for a group of diseases associated with hyperglycemia (high levels of blood glucose) caused by defects in insulin p- duction, insulin action, or both. About 6. 2% of the US population (17 million people) have diabetes mellitus. It is the leading cause of kidney failure, bli- ness, and amputations. It is also a major risk factor for heart diseases, stroke, and birth defects. Diabetes Mellitus: Methods and Protocols provides a state-of-the-art account of the experimental methodology for studying the molecular defects leading to diabetes mellitus, both at the molecular and biochemical levels. The chapters cover a wide range of topics written by experts in their respective fields and are organized in two sections: Insulin Production and Insulin Action. The detailed experimental protocols presented, including the notes of interest, provide a very useful tool for basic researchers and clinicians for investigating and treating this disease. Each chapter starts with an introduction to a specific technique and explains its application in the field of diabetes research. Following the list of materials, a detailed description of the technique is presented in the methods section in a way that enables the successful execution of the protocol. The "Notes" section at the end discusses the pitfalls of the technique and alternative approaches. I am grateful to the numerous scientists who have contributed to this volume by writing both highly detailed and understandable chapters.

This volume includes the latest diagnostic criteria for PCOS and comprises the most up-to-date information about the genetic features and pathogenesis of PCOS. It critically reviews the methodological approaches and the evidence for various PCOS susceptibility genes. The book also discusses additional familial phenotypes of PCOS and their potential genetic basis. All four editors of this title are extremely prominent in the field of PCOS.

This book provides comprehensive coverage of the three most important themes in the field of Endocrine Disrupting Chemicals (EDC) research: the basic biology of EDCs, particularly their effects on reproductive systems; EDC effects on humans and wildlife, including biomedical considerations; and potential interventions and practical advice for dealing with the problem of EDCs.

In this practical book, the authors of each chapter have synthesized the currently available evidence regarding specific issues in diabetes care. The chapters have been written by an interdisciplinary team of scientists and medical professionals. Such an approach emphasizes the need for collaboration in the care of any individual with diabetes and in the effort to find new therapies for the disease. This reference provides practical guidance in a single resource.

This book covers the most important clinical and bench science aspects of metabolic syndrome. It will be of value to all of those seeking a comprehensive update on the metabolic syndrome. Furthermore, it will provide a broad basis for advancing research in the multiple intersecting disciplines encompassed by the metabolic syndrome.

The aim of this book is to inform clinicians of recent advances in obesity research and provide a review of current treatment issues and strategies. Part 1 covers new discoveries in the physiological control of body weight, as well as the pathophysiology of obesity. Part 2 covers a range of issues that are central to the clinical management of obese patients. This illustrated volume will stimulate and engage clinicians.