Sufficient "cover" provides

Sufficient "cover" provides parenteral introduction of Hidrocortizonum on 50 mg everyone 6 or acetate Cortisonum on 100 mg everyone 12 , and after operation of a dose of steroids quickly reduce. In the postoperative period it is necessary to estimate pituitary body function to solve a question on necessity of replaceable therapy. After operation of the patient it is necessary to survey carefully about development , especially because in the braked condition thirst can not be shown. Even in case of an easy trauma of a leg of a pituitary body in the nearest postoperative period the polyuria and the raised osmolality of plasma is often observed. voltaren gel Conservation of these disturbances during more 48 after operation usually specifies in a destruction of a leg or a back share of a pituitary body and constant disturbance of function by last. Some patients have an improvement phase, after to - again there is the corresponding semiology remaining already constantly. The period of improvement of a condition consider as result of liberation of a vasopressin from degenerating pituicytes of a back share. As succession of events within the several first postoperative days is unpredictable, it is necessary to watch carefully water balance and if necessary to prescribe to the patient is not long operating preparations of a vasopressin, and its aqueous solution (5 intramusculary). In more details treatment questions are discussed in chapter 9. If after transsphenoidal operation from a nose appear allocation, follows by means of impregnated strias () to check up, whether represents itself discharge . Postoperative rhinorrhea often spontaneously disappears in 7-10 days. If it does not occur, surgical correction of defect of a bottom of a Turkish saddle is required. Radial therapy Alternatively to surgical excision of adenomas of a pituitary body apply various kinds of radial therapy.
As candidates on radial therapy consider patients at whom the pituitary body tumour practically does not extend above a Turkish saddle. At the expressed defects of fields of vision application of an external irradiation is fraught with the raised danger of the further depression of sight owing to the initial inflammatory reaction arising in a tumour. Besides, the big area of an irradiation necessary at tumours with appreciable by diffusion, frames the raised risk of damage of surrounding nervous structures. Nejrorentgenologichesky researches which need to be spent at the patients subjected to radial therapy, are so extensive, as before surgical operation. At nonfunctioning tumours it is especially necessary to exclude possibility etodolac aneurysms by means of an arteriography and to define degree diffusions by means of a pneumoencephalography and Kt-scanning. Now at treatment of the majority of patients use an exposure dose in 45-50 Dzh/kg, effectively blasting tumoral cells and not damaging normal a tissue that is observed at a dose of 80-90 Dzh/kg. Plural fractional exposure doses by means of rotatory apparatus are applied, that usually leads to only minimum by-effects and practically does not cause abaissement of hair on a head. More often are used usual radiation of sources of high energy (). Stereotoxic implantation of pills c 90Y in the beginning considered as effective alternative to an external irradiation, but often developing complications, including a wrong site of pills and rhinorrhea , have forced to refuse this procedure. Rather effective method is the irradiation serious particles (a proton fascicle), but now it is accessible only in few geographical districts where there is a cyclotron [148-150]. It is possible to give the necessary dose in some hours, and received results, at least not more low, and probably and above, than at usual radiation. Neurologic complications, including paralyses of third cranial nerves, disturbance of fields of vision and a necrosis of a temporal share, meet a little bit more often, than at a usual irradiation, but they are seldom considerably expressed. Pituitary body function, at least in the nearest terms after an irradiation, remains, apparently, at 80-85 of patients. In the beginning considered, that cranyopharyngiomas unlike chromophobic adenomas are radio refractory tumours. However there are reports on positive takes of radial therapy and at these tumours [151, 152]; this form of treatment remains worthy. The factors influencing a choice of a method of treatment Many patients with pituitary body tumours are candidates either on surgical, or on radial treatment as the basic way of therapy. The main advantages of surgical treatment are: 1 - quickly received result, that sometimes is necessary with reference to visual symptoms and a hypersecretion of hormones (see more low); 2 - possibility of an estimation of a condition of a tissue and effective influence on rather radio refractory tumours (for example, cystic tumours and cranyopharyngiomas).