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lifestyle it was not possible to reach visible results in reduction of weight in this group.
In the group of patients, where exentide was applied, on both parameters the accuracy was reached; that is explained by the mechanism of action of medication (slowing down the gastric emptying, increasing saturation duration that leads to reduction of the consumed food, and by that to weight reduction that causes the return development
of gastroesophageal reflux disease, by decrease in intraabdominal pressure).
In the third group, applying metformin, the decrease in body weight, but considerably less expressed in comparison with the second group, was noted that was also reflected in reduction of the number of sour refluxes, but without statistical confirmation. (see the table).
Table 1. - Indicators of BWI and DeMeester index, depending of the therapy
start 3 months P 6 months P
omeprazole
BWI 42,1+6,3 42,0+6,4 0,99 41,8+6,5 0,98
DeMeester index 66,7+2,8 52,25+8,6 <0,05 40,7+3,6 <0,05
exenatide
BWI 39,4+4,2 36,9+4,3 <0,05 35,3+4,6 <0,05
DeMeester index 36,1+2,1 32,2+2,0 0,47 28,9+8,6 <0,05
metformin
BWI 39,1+4,9 38,2+4,8 0,26 38,1+5,3 <0,05
DeMeester index 42,0+9,1 39,5+6,2 0,67 37,6+4,2 0,44
Conclusions
On the basis of the obtained data, it is possible to claim about the greater efficiency of antihyperglycemic medication exenatid on decrease in the body-weight index, in comparison with the metformin. Also during the research comparable data on efficiency of exenatide and omeprazole on the course of
GERD were obtained. The listed data seem perspective in application of exenatide with patients with 2 type diabetes mellitus on the background of obesity suffering in parallel the gastroesophageal reflux disease. That conforms to modern requirements of medicines in multiefficiency of the combined pathologies.
References:
1. Kushnir I. E. GERD in patients with obesity: pathophysiological mechanisms of development, feature of course and approaches to therapy, Zdorov'ya Ukraini -3.2013 P. 70-71.
2. Tkachenko E. I., Uspenskii Yu. P., Karateev A. E. And colleagues. Gastroesophageal reflux disease: pathogenetic bases of the differentiated treatment tactics//Expert and clinical gastroenterology. - 2009. - № 2. - P. 104-114.
3. Uspenskii Yu. P., Balukova E. V., Baryshnikova N. V., Gastroesophageal reflux disease in patients with obesity, Special issue № 2, 2015 «GASTROENTEROLOGY».
4. Moreia Dias L. Pantoprazole: a proton pump inhibitor//Clin. Drug Investig. - 2009. - Vol. 29, suppl. 2. - P. 3-12.
Khamedova Firuza Saidovna, Independent scientific the applicant Bukhara State Medical Institute, Bukhara, Uzbekistan
E-mail: [email protected]
Features of a clinic and diagnostics of patients with the family anamnesis of inactive adenomas of hypophysis
Abstract: The paper gives the results of examination of patients with inactive adenomas ofhypophysis (IAH). All patients with IAH were divided into 2 groups: sporadic and familial forms of IAH. It has been found that in patients with familial IAH before clinical signs appear, the number of clinical symptoms was greater for the disease was more aggressive, and the prognosis was unfavorable.
Keywords: inactive adenomas of hypophysis, tumor, sporadic, family, differrential diagnostics, headaches, neurologic violations, symptoms, sexual violations.
Early diagnostics of inactive adenomas of hypophysis are seldom diagnosed and more often casually found [3]. The (IAH) relates to difficult questions of modern diagnosis is, as a rule, verified when adenoma already reaches neuroendocrinology [1; 2]. At a stage of microadenoma IAHs a considerable size [4]. IAH is met in 25-43% of hypophysial
Features of a clinic and diagnostics of patients with the family anamnesis of inactive adenomas of hypophysis
adenomas and up to 10% of all intracranial tumors [5]. Molecular and genetic researches established that up to 5% of IAH cases refer to genetically predisposed people [6]. At the same time in literature there is prac-tically no comparative data on clinical flow and disease diagnostics in populations between sporadic and family IAH disease [7].
The aim of the research was to study features of clinical semiology, their value for differ-rential diagnostics in population of patients with the sporadic and family IAH anamnesis.
Materials and methods. Researches were implemented on the basis of the Republican specialised scientific practical medical center of obstetrics and gynaecology from 2009 to 2014. The inspection included 71 IAH patients with intracellar adenoma of a hypophysis — the tumor sizes were from 1 and more mm. The IAH diagnosis was verified on the basis of the carefully collected anamnesis, studying of dynamics of course of the disease, results of a magnetic and resonant tomography (MRT), and also enzyme-linked immunosorbent assay-definitions of the contents of hypophysial hormones in blood serum. In IAH diagnostics an important place in our researches is occupied by the family anamnesis collection for establishment of hereditary predisposition to this disease. The family anamnesis found out by means of the standard que-stionnaire "Family anamnesis" — the isolated forms of adenoma of a hypophysis (Familial isola-ted Pituitary Adenomas — FIPA, WHO — 2005) [8; 9].
According to a goal and research problems patients with IAH were divided into two alter-native groups: the 1st group — 50 (70.4%) patients with environmental factors without the bur-dened family anamnesis and 2nd — 21 (29.6%) with the burdened family anamnesis, including with a panmiksiya — 9 (2.7%) and an inbriding — 12 (16.9%) patients.
Results and discussion. The analysis of the received data showed that on the average from total number surveyed patients were at the age from 18 till 70 years (middle age 44.5 ± 3.85 years). At the same time the greatest number of the arrived IAH patients to fall on age from 35 (23.9%) to 40 (25.4%) years and to a lesser extent be elderly to 30 (18.3%) and 55 (5.6%) and is more senior than years that will be coordinated with literary data [10].
As a result ofthe analysis ofthe received data it is established that at IAH patients seldom meets separate symptoms, more often they are combined and/or more come to light a disease of many symptoms — on 3-5 symptoms at the same time. The combination of 2-3 symp-toms of a disease in 1-group is revealed at 17 (34.0%), a of many symptoms at 20 (40%) and a of many symptoms at 13 (26.0%). In 2-group the combination of 2-3 symptoms is revealed at 7 (33.3%), a of many symptoms at 13 (61.9%) and a of many symptoms at 1 (48%). Both in the 1st, and in the 2nd group at IAH patients important clinical manifestations were — sexual viola-tions at 64 and 90%, decrease in sight — at 36 and 76.2%, headaches — at 54 and 80%, lack of periods — 22.0 and 28.0%, violation of
a menstrual cycle — at 18.0 and 23.8% at the age of wo-men till 50 years, and at men till 55 years — violation of sexual functions — at 24 and 38.1%.
It should be noted that at patients of 2-group with hereditary IAH signs is more often than at patients of 1-group — without hereditary signs prevail frequency of clinical signs, such as sexual violations — 26.5%, decrease in sight — for 40.2%, headaches — for 26.5%, doubling in eyes — for 15.0%, visual discomfort — for 12.5% and other, on duration of a disease among women till 5 and 20 years — for 12.3 and 24.6%, but to a lesser extent till 20 and more than 21 years — for 23.2 and 15.2%, and among men of such difference it is not revealed. On the size of a tumor to 20 mm and huge women of 2-groups, and among men in 2-group the sizes of a tumor to 10 mm — it is less than in 1-group — for 21.2%, and with huge, on the contrary it is more — for 31.3%.
Interesting data are revealed by us when studying frequency of complaints to neurologic violations at IAH patients in groups depending on the size of a tumor. In 1-group with a tumor to 10 mm of the complaint to headaches showed — 46.7% of IAH patients, in 2-group — 50.0%, in the same group of 50.0% of patients showed complaints to dizziness.
With a tumor to 20 mm in 1-group of the complaint to a headache, dream violation, diz-ziness showed 58.8; 17.6 and 11.8%, and in 2-group on 62.8% of cases patients showed complaints to a headache and dream violation. At patients with huge IAH tumors in 1-group in 100% of cases complained of a headache and dizziness, 66.7% — on dream violation. In 2-group of the complaint in 100% of cases showed on headaches, dream violation, dizziness and on 9.1% of cases for lack of sense of smell, decrease in memory and apathy.
Thus, the analysis of the received results of researches showed that at IAH patients 1-and 2-groups considerable visual, sexual and neurologic violations that it is possible to believe are observed is connected with development by hypophysial insufficiency of various degree of expressiveness, owing to pressure of a normal hypophysial fabric or a hypophysial leg therefore, it is possible to believe, hormones can not reach a hypophysis. Sick patients with a size have tumors to 20 mm and huge according to the majority of researchers, sexual and all-somatic violations are more often than complaints on visual and neurologic, and also.
Intracranial hypertensia with a headache, nausea, vomiting arising suddenly, as a rule, are accompanied by fast decrease in sight, hypotension, is a typical picture a hypophysis apopleksiya owing to a hemorrhagic heart attack of a tumor, and in certain cases the first IAH manifestation. It is possible to believe that increase in frequency of complaints with progressing of growth of a tumor distinction of symptoms of a disease there correspond degrees of a compression or an invasion of the next structures. In this regard, as a rule, the diagnosis was established by doctors, when the sizes of a tumor already were big, defiant violations of sight, a headache and/or hypopituitarism, and microadenomas — tumors to 10 mm
are identified seldom because of insig-nificant symptoms of a disease. Due to the growth of tumoral process as it is often noted at IAH patients with the size of a tumor to 20 mm and huge signs of a secondary hypothyroidism, inclu-ding such symptoms as apathy, a hypothermia, dryness of skin, thirst, bradycardia, hypotonia, etc. or secondary adrenal insufficiency — weakness, fast fatigue, hypotension come to light. Im-portant hypothalamic manifestations which can be shown at IAH patients in a combination to a secondary hypothyroidism increase and/or decrease in weight of a body, drowsiness, vegetative crises, dizziness, lack of sense of smell, decrease in memory and apathy.
It is important to emphasize that at IAH patients 2-groups of the complaint to disorder of sight, violation sexual, neurologic and the general clinical symptoms arise much more often and are diagnosed much earlier generally at the age of 30-40 years, in this group of patients, to a thicket come to light as at men, and women with the size of a tumor to 20 mm and huge.
Thus practically at all patients with macroadenoma the tumor is well visualized in hiazma-intracellular area to what usually homogeneous strengthening after introduction of contrast substance testifies. Existence of necrotic or cystous educations on CT us is not revealed. It is important to note that the increase in a tumor found at MRT-studied, coincides with dy-namics of a clinical course of a disease.
Therefore, the carried-out clinical researches showed that at patients in population between with the sporadic and hereditary is IAH there are features, both on severity of a clini-
cal current, and on terms of identification of symptoms of a disease.
At patients with the family it is IAH the main clinical
symptoms of a disease associate:
— visual, sexual, headaches, vegetative crises, a climax come aged till 20 25 years, and time of establishment of the diagnosis — 10-20 years;
— adenomas > 10 mm which progress quicker, in huge adenomas, with the heavy course of a disease more often come to light, than at patients from the single is IAH;
— the IAH family form and development of clinical symptoms at early age should be object of diagnostic screening and be considered as one of modifying factors of emergence of this disease.
Thus, clinical studies have shown that patients with familial form IAH prevalence of 29.6% in contrast to the sporadic form is associated with earlier clinical manifestations, aggres-sive course, a large number of clinical symptoms, the early development of refractory to treat-ment, poor prognosis disease. For sporadic IAH as hereditary family IAH latent characteristic for patients with a family history of more frequent symptoms of reduced vision, double vision, tearing, oligomenorrhea, galactorrhea, headaches, memory loss, vascular disorders.
This is of great importance in the early diagnosis and detection of risk of developing the disease. Based on the above it is safe to note that the signs of the total may be subject to differential diagnostic screening and monitoring of patients with hereditary traits IAH.
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