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Section 7. Medical science
The average value of correction defeat in 2 years was 6.5±1.45 °, or 7.5% of the total value of the achieved correction. At the term from 3 to 5 years — 3.8±1.22 °, or 4,4% correspondingly. The average volume of pathologic kyphosis correction was 62.3±2.73°. Correction of the pathologic kyphosis in the cases of thoracic and thoracic-lumbar location was approximated to the physiological level in all the patients, among them 8 patients had hypercorrection and hypokypho-sis state. Pathologic kyphosis correction defeat in 2 years was 4.6±0.5, or 7.4%, while at the term from 3 to 5 years 3.8±0.31 ° more, or 6.1%. In one of two patients with lumbar location of pathologic kyphosis we were successful to form physiological lordosis, and in the second one — hypolordosis.
The balance of frontal axis was recovered to 87.4±3.8% average. The loss of the balance within 2-5 years of monitoring didn't exceed 1,5%. Hyper lordosis was changed to 44.2%, to physiologic size, average up to 35.8±1.54 ° in the group. In the process of the correction we achieved growth increase to 10.3+1.24 cm (6-27 cm) by means of increasing body length. In 2 years there was average loss of body length to
2.9±1.26 cm, and at the terms from 3 to 5 years to 0.8±0.01 cm more.
There were noted 5 complications and it was 3.9% of the number of the performed operations and 10.8% of the operated patients. Three patients had 4 additional operations for the elimination of complications. All patients were stand to a vertical position on the 3-5th days after correction and discharged home on the 8-19 days after the final stage without external immobilization. In a month the patients could start studying and working with some limitations, and in 6 months without any limitations.
Conclusion. Thus, the step-by-step segment reconstruction and instrumental correction is better than other modern world analogies and it was a selective method in the complex radical therapy ofsevere (95 -186 ° Cobb) forms of scoliolytic disease among children and teenagers.
For the maintenance and maximal safekeeping of sco-liolytic deformation correction in the short and longer period it is necessary to apply step-by-step surgical method, which provides significant deformation correction to 73%.
References:
1. Kuleshov A. A. Surgical therapy of severe secondary scoliolytic vertebral deformation.//Bulletin of traumatology and orthopedics under the name of N. N. Priorov. 2006; 2: 51-53.
2. Mikhailovski M. V. Surgical correction of vertebral deformation in case of neurofibromatosis: CDI application /M. V. Mikhailovski, A. M. Zaidman, M. N. Lebedeva//Vertebral surgery. 2008; 3: 8-15.
3. Helenius H., Remes V., Yrjonen T. Harrington and Cotrel-Dubousset Instrumentation in adolescent idiopathic scoliosis. Longterm functional and radiographic outcomes//J. Bone Jt. Surg. - 2003. - V. 85 - A, № 12. - P. 2303-2309.
4. Richards B. S., Herring J. A., Johnston C. E. Treatment of Adolescent Idiopathic Scoliosis Using Texas Scottish Rite Hospital Instrumentation//Spine. - 2000. - Vol.25. - № 6S. - P. 69-76S.
5. Hamzaoglu A., Ozturk C., Aydogan M., Tezer M., Aksu N., Bruno M. B. Posterior only pedicle screw instrumentation with intraoperative halo-femoral traction in the surgical treatment of sever scolosis (> 100°). Spine. 2008; 33 (9): 979-983.
6. Rinella A., Lenke L., Whitaker C., et al Perioperativ halo - gravity traction in the treatment of severe scoliosis and kyphosis. Spine. 2005; 30: 475-482.
Unanova Inessa Alexandrovna, Stavropol state medical university teaching assistant of the chair of endocrinology and diabetology
Andreeva Elena Ivanovna, Candidate of medical sciences, associate professor at the department of endocrinology, pediatric endocrinology and diabetology Andreeva Ekaterina Anatolevna, teaching assistant of the chair of Intermediate level therapy E-mail: unanova_inessa@mail.ru
More than hypoglycemic therapy
Abstract: Exenatide has a more evident hypoglycemic effect in comparison with metformin, herewith it has positive effect on the clinical course of GERD, which makes it possible to consider it as agent of choice with patients with type 2 diabetes mellitus and gastroesophageal reflux disease.
Keywords: gastroesophageal reflux disease, obesity, analogue to receptor of glucagon-like peptide-1, metformin, diabetes mellitus.
More than hypoglycemic therapy
The world researches devoted to the study of the issue of gastroesophageal reflux disease (GERD) developing affected by obesity becomes more and more actual as the combination of these pathologies considerably worsens quality of life of patients and complicates treatment.
The role of type 2 diabetes mellitus and obesity, in pathogenesis of GERD is classified ambiguously. According to some authors, the symptoms of GERD are registered irrespective of the value of the body weight index (BWI) of patients, according to other authors, the symptoms of GERD are more expressed at patients with the raised BWI, and abdominal obesity is a risk factor of development of erosive esophagitis [2; 4].
The most characteristic symptom for GERD, the heartburn, in patients with obesity is rare, along with it the regurgitation symptoms prevail (nausea, eructation, bitter in mouth, hiccups) [1; 3]. Also for patients with obesity frequent development of extra-esophageal signs of GERD, such as night cough, voice hoarseness, reflux-associated bronchial asthma, cardiac abnormalities, cardialgia, is characteristic. [1] Cases of asymptomatic disease course are frequent. The factors aiding the development of GERD in persons with overweight are irregular meal, prevalence in a diet of spicy and fat food, sweet dishes and bakery products, alcohol, sweet fizzy and caffeinated drinks. [1] The situation becomes considerably complicated at development of 2 type diabetes mellitus (2 type DM) on the background of obesity as it confuses the differential diagnostics of extra-esophageal signs.
On the basis of the Stavropol State University focused attention is given to this issue, the results of researches are regularly published in medical literature.
Purpose
The present research aimed to reveal the influence ofvarious antihyperglycemic medications, such as metformin (biguanid group) in a dose of2000 mg per day and exenatide in a dose of 10 mg per day (GLP-1 group) subdermally, on decrease in body weight and by that reduction of the number of sour refluxes, in comparison with a medication of the standard GERD treatment of the group of inhibitors of a proton pomp — omeprazole in a dose of 20 mg two times per day.
Materials and methods
Research included 96 obese patients with the determined diagnosis of GERD. All patients had carbohydrate metabolism disorder (by withdrawal criteria the percent of glycated hemoglobin did not exceed 7) that in turn dictated the hypoglycemic therapy approach (modification of lifestyle, both in monotherapy, and in a combination with metformin or exenatide). The age of participants of the research fluctuated from 29 to 71.
The obesity degree evaluation was carried out using the formula of body weight index, at the studied persons this indicator was ranging from 30 to 50.
By means of daily impedance monitoring pH ("Gastroskan 24") and calculation of the DeMeester index which variability
was beyond limits the reference range (from 15,9 to 112,4), the diagnosis of GERD was confirmed.
Duration of the present research made 6 months. Intermediate control was carried out in 3 months from the beginning of treatment.
Processing of results was carried out by means of the EXEL, BIOSTAT, Student's t-test and Mann-Whitney U test.
All included patients were divided into 3 groups. Entered into the first group — 33 person, extent of carbohydrate metabolism disorder allowed to use as treatment only modification actions (diet therapy, physical activities) without application of the antihyperglycemic medications and as pathogenetic therapy of GERD the inhibitors of a proton pomp were appointed (omeprazole 20 mg/2 times per day), into this group entered (18 women, 15 men). The second group included 34 persons (20 women, 14 men) — their level of glycated hemoglobin allowed to use along with the change of a lifestyle, the analogue of GLP 1 — exenatide 5 mg/2 times per day subdermally as antihyperglycemic medication, this antihyperglycemic was chosen taking into account expected weight reduction, due to delay of gastric emptying, and also due to the impact of medication on structures of a gipotalamus that can theoretically entail reduction of signs of GERD. The third group included 29 people, (11 women and 18 men) taking into account the percent of glycated hemoglobin, as hypoglycemic therapy was appointed metformin in a dose of 2000 mg per day.
Statistical calculations were made by means of Exel, Biostat. BWI was calculated by means of pair Student's t-test, index of Mann-Whitney U test due to the big dispersion of indicators.
During the research we confined us only to total statistics, without considering it on the basis of gender status.
Results and discussions
At examination of patients, at the introduction stage all of them had overweight, and also the standard index values were exceeded (see the table)
After the 3-month treatment in all three groups dynamic examination of the named parameters was conducted. In the analysis of data, in group of omeprazole reception, as expected changes of the body-weight index was not noted, however, there was accurate dynamics of reduction of the number of sour refluxes (p<0,05). In the second group, taking into account the pleiotropic effects of the applied medication, statistically significant decrease in the body-weight index was noted. It is important to note that despite the lack of accuracy, the tendency to quantitative reduction of an acid regurgitation was noted.
In the third group no considerable changes in weight were noted that correlates as well with DeMeester index values.
The final point of the research was of the greatest interest; in the first group, as well as earlier, positive dynamics was noted only on one indicator — the number of sour refluxes, that fact found also the reflection in statistical parameter (p<0,05). Despite the carried-out advisory work on modification of
