Efficiency of normalisation

Efficiency of normalisation of level is in inverse relationship from the sizes of a tumour; If the sizes of a tumour exceed 2 sm, that far not always allows to carry out its selective excision results appear much less favorable. Though the sizes of buy anafranil a tumour are not necessarily bound to level in blood, probability of normalisation of its maintenance in plasma it is essential more low when before operation it exceeds 100 ng/ml. Almost at all patients from whom it was possible to achieve moderate depression of level , there comes remission of clinical symptoms and metabolic changes, characteristic for an acromegalia. However these indicators not always correlate with hypersecretion degree , and at some patients clinical implications can disappear completely even at conservation of raised level . Thus, level in plasma is the most objective criterion of an estimation of efficiency of treatment. The recurrent tumour at patients at whom it was possible to normalise level , meets seldom (approximately in 5 of cases) and almost always throughout 1st year after operation [147, 177, 179].
At larger tumours when for normalisation of level excision almost all can be demanded, it is expedient leave tissue enough to keep function of a forward share of a pituitary body, and then to apply postoperative radial therapy. Radial therapy Two forms of an external irradiation now apply to primary treatment of an acromegalia. Usual () the irradiation accessible in the majority of the large medical centres, assumes use of a fascicle of photons with energy 1 or above at an influence dose on a pituitary body of 40-50 Dzh/kg. An irradiation spend fractional doses with intervals 4-6 . As an independent method treatment by serious particles (a proton fascicle) at which the radiation energy reaches much bigger size (340-900 ), and a dose of an irradiation-some above (45-65 Dzh/kg) can serve. Usual radial therapy does not demand medrol pack a preliminary pneumoencephalography an arteriography and is less often accompanied by undesirable by-effects (in respect of damage structures), than an irradiation serious particles. It is supposed, that in the first case also the hypopituitarism less often develops. The irradiation is not shown by serious particles at tumours with appreciable diffusion as danger of damage of an optic nerve thus amplifies. Both methods yield comparable results concerning a softening of clinical semiology and depression of level , and its normal level in 2 years after an irradiation is observed at 70-80 of patients. It became perceptible, that use of a proton irradiation yields the best results in 5-10 years but while the number of the patients observed throughout such period, is insignificant. Because of difference of groups of patients, treated a surgical and radial method, direct comparison of efficiency of these two methods is enough, difficult, but the general impression is that, that they yield about identical results. Their main difference consists in rate of normalisation of level and possibility of loss of others functions. To compare frequency of relapses also it is rather difficult, as the sizes of the tumours deleted surgical by now have changed, and term of postoperative observation became in most cases shorter. As a way of depression of frequency of relapses it is recommended to apply after surgical excision StG-sekretirujushchih of tumours an irradiation [154]. This reference, apparently, is justified in cases of conservation of hypersecretion the ambassador-operation. The same patients at whom after operation level was normalised, possibly, do not have necessity to additional radial therapy. Pharmacotherapy The beginning of pharmacotherapy of an acromegalia was application of hormones which as it was supposed, (estrogens) counteract peripheric effects or any not completely in the clear image brake secretion by a tumour (progesterone). Some regress of clinical symptoms of disease, though at the majority of patients effect if it became perceptible was minimum was sometimes observed. Secretion at an acromegalia brakes [181], but its continuous intravenous infusion is for this purpose necessary. Data about that peroral reception L- acutely suppresses secretion at an acromegalia [163], have formed a basis of attempts of application of this agent for chronic inhibition of secretion of a hormone. Partial inhibition managed to be reached, but a brevity of action of this substance and the frequent collateral Y Y effects of its application in the necessary doses interfere with a wide circulation of this method of treatment. However 2 -bromergokrpptin () - derivative with expressed the activity, studied originally as the agent of suppression of secretion of Prolactinum, possesses at an acromegalia powerful reducing action [182].