ADVANCES IN THE NEUROSURGICAL AND COMBINED TREATMENT OF PATIENTS WITH ACROMEGALY

Aim. The study was carried out to identify and analyze the factors of a positive outcome of surgical and radiation treatment of acromegaly. METHODS. The work was performed on clinical material and summarizes treatment results of 256 patients (90 males and 166 females). 86% of patients underwent surgical treatment, 14% of patients received radiation therapy during 2002-2018. Significance of factors of a positive outcome of treatment was carried out using the RStudio program. RESULTS. The results of the study revealed that: 1. Significant factors (p <0.05) of a positive outcome of surgical treatment of acromegaly are somatostatin analogs (SSA) therapy before surgery, a small tumor size (microadenomas), and the absence of extrasellar tumor spread. 2. The most significant factor in achieving remission of acromegaly after non-radical adenomectomy is postoperative therapy with SSA (p <0.05). 3. Aggressive pituitary tumors invading surrounding structures, high baseline IGF-1 levels, unfavorable histological findings, macroadenomas, growth hormone levels above 10 mu g/L before therapy, and extrasellar tumor spread were associated with less favorable outcomes of acromegaly radiation therapy (RT) (p <0.05). The most significant factor in achieving remission of acromegaly is SSA therapy after RT (p <0.05). CONCLUSION. Surgical treatment is the optimal primary treatment for acromegaly. Drug therapy with SSA is effective and the preferred treatment after non-radical surgery

THE RESULT OF SURGICAL AND COMBINED TREATMENT OF PATIENTS WITH ACROMEGALY

Purpose of the work: to evaluate the results of surgical and combined (medical and surgical) treatment of patients with acromegaly. Materials and methods: 121 patients with a diagnosis of acromegaly (81 women (66.94%); 40 men (33.06%) were operated on. All patients were divided into 4 groups, comparable in terms of gender and age parameters: group 1 consisted of 30 patients (mean age of 46.89 +/- 2.34 years) who underwent surgical treatment; group 2 included 30 patients (mean age of 47.01 +/- 2.35 years) who received preoperative drug treatment with somatostatin analogues and underwent surgical treatment; group 3 consisted of 30 patients (mean age of 45.02 +/- 2.25 years)who underwent surgical treatment and received postoperative drug treatment with somatostatin analogues; group 4 included 31 patients (mean age of 44.9 +/- 2.25 years) who underwent surgical treatment and received drug treatment with somatostatin analogues both in the preoperative and postoperative periods. Observation of patients was carried out in the postoperative period (on the 7th day), as well as after 6 and 12 months. Results: In most cases, when using these methods of surgical intervention, a significantly greater number of total tumor resection was performed. The largest number of patients, in whom remission was registered after the surgical treatment, was observed after 12 months of observation (50% and 51% of cases, respectively, for each type of surgery). Pre-and postoperative administration of drug treatment (somatostatin analogs) increases the frequency of "remission in the entire group" up to 27.4%, reaching 96.7% in group. Conclusion: The use of combined methods of treatment contributed to the achievement of remission in a greater number of cases compared with only surgical treatment. Moreover, the largest number of patients who reached a state of remission was observed 12 months after the start of therapy. Copyright (C) 2013 - All Rights Reserved - Pharmacophor

INFERIOR ALVEOLAR NERVE BLOCK BY INJECTION INTO THE PTERYGOMANDIBULAR SPACE USING GUIDING DEVICES: A SYSTEMATIC REVIEW

The AIM of our research was to analyze and compare different inferior alveolar nerve blocking techniques and the effectiveness of various guiding devices. METHODS: A search was conducted on specialized databases for search and selection of works in which a guiding device for lower alveolar nerve block (IANB) was described. The propriated articles were evaluated and selected in 3 stages for final review based on predefined criteria, followed by a critical evaluation stage. As the research result - various types of IANB guide devices and the results of its using were recorded and analyzed. RESULTS: The systematic review of devices for conducting IANB was done. The success of IANB can be achieved by adjusting the syringe with the anesthetic needle trajectory - it increased the probability of a successful hit in the area of the mandible foramen. Examples of devices in which the syringe is fixed at the moment when the tip of the needle is injected into the medial side of the branch of the lower alveolar nerve are considered. And also, the special techniques based on orientation on the soft tissues are described. However, when creating a device of this type, the following factors must be taken into account: the angle of the needle to the insertion point, the position of the insertion point relative to the anatomical landmarks (taking into account individual characteristics), and the insertion depth. Also, other IANB guiding blockade methods are considered: 3D navigation while local anesthetic injection. Thus, the patient's discomfort, the risk of nerve damage and the risk of unsuccessful mandible anesthesia could be minimized. CONCLUSION: The advantages and disadvantages of these anesthesia methods, the success rate, and patient comfort were analyzed. Prospects for further research in this area were identified