Vol 7, No 1 (2013)

Articles
Pharmacoeconomic analysis of epidermal growth factor (HeberprotP ®) for the treatment of diabetic foot ulcers
Galstyan G.R., Ignatieva V.I., Avksentieva M.V., Dedov I.I.
Abstract
Introduction. The epidermal growth factor (EGF; HeberprotP ®) is the new treatment for deep persistent diabetic foot ulcers (Wagner grade 3–4). The effectiveness of EGF measured as the reduction of the time to complete granulation of tissue lesions was confirmed in randomised clinical trials, but the cost of this new treatment is high. Aim. To analyze the costs and outcomes of the use of EGF (Heberprot-P®) for the treatment of DFU in high- ly specialized medical institutions. Material and methods. We tested the hypothesis that the use of Heberprot-P® in diabetic foot ulcers – DFU – (Wagner grade 3–4) would reduce the rate of amputations and increase survival at acceptable cost for the Russian healthcare system. We used the data from international published literature to construct mathematical model representing clinical outcomes in the cohort of patients treated with only standard methods or standard methods in combination with Heberport-P®. We calculated direct costs associated with both strategies of treatment taking into account the risk of amputation. Results. The use of Heberprot-P® may prevent 52 amputations and save 29.54 years of life in a cohort of 100 DFU patients (Wagner grade 3–4). The incremental costs of EGF treatment were RUR 1.170.000 per life year gained and did not exceed the accepted threshold of less than three times GDP per capita. Conclusion. Mathematic modelling demonstrated the feasibility of introduction of EGF in combination with standard treatment for DFU in highly specialized medical institutions.
Endocrine Surgery. 2013;7(1):4-15
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Catecholamineinduced cardiomyopathy in patients with pheochromocytoma
Beltsevich D.G., Kuznetsov A.B., Lysenko M.A., Kats L.E., Gomgjin I.S., Yukina M.Y.
Abstract
The article discusses the reasons of specific cardiomyopathy in patients with pheochromocytoma and post operation lungs oedema. 106 pheochromocytoma patients were operated between 2004 and 2012 in Endocrine Research Center, 19 of them were investigated for ischemia myocardial changes. This cohort is divided into 2 groups: the first one includes 13 patients with preoperation notes of acute myocardial infarc tion (non Q developing), the second one consists of 6 patients with lung oedema in early postoperation time. All patients were operated after adequate preparation with α and βblockers. After clinical examina tion only 1 patient had conclusive ischemia, which required correction. Among reasons influencing a lung oedema (tumour size, manipulation time, age, sex, fluctuations of blood pressure) only the epinephrine type of tumor secretion was significant. Conclusion. Patients with adrenaline type secretion of pheochromocytoma have a higher risk of a lung oedema. The level of risk doesn’t depend on myocardial ischemia. Discussion. Possibility and necessity of administration of tyrozinkynase inhibitor (αmetylparatyrozine) or sensitisers of myocardial contraction (levosemindan) as the main means for preparation to a pheochromo cytoma surgery in epinephrinetype patients must be considered.
Endocrine Surgery. 2013;7(1):16-22
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Graves disease (clinical lecture)
Vanushko V.E., Fadeev V.V.
Abstract
Endocrine Surgery. 2013;7(1):23-33
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World endocrine surgery news
Simakina O.V.
Abstract
Endocrine Surgery. 2013;7(1):34-41
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Laserinduced thermotherapy application in treatment benign nodular thyroid pathology
Petrov V.G., Antonova E.V., Nelaeva A.A., Mashkin A.M., Malinin D.I.
Abstract
Results of the treatment laserinduced thermotherapy (LITT) of 107 patients with benign thyroid nodules. The average volume of nodes before and after treatment was reduced from 5.0 cm 3 to 2.8 cm 3 (44%). Of nod ules up to 1 cm 3 average volume decreased by more than 60%. Among large nodules larger than 8 cm 3 aver age decreased only slightly more than 40%. Among the nodes up to 1 cm 3 after LITT most decreased by more than 50% (19 of 33), 8 of them (24.2%) decreased by more than 75%, 6 (18.3%) nodes have disap peared completely. Among the nodes of 2.1 cm 3, more than half also fell by more than 50% (17 of 29), of which more than 75% – 6 knots (20.7%). Of nodules more than 4 cm 3 was not a single node, which would decrease in volume by more than 75%. However, most of them fell by more than 25%. There was a statisti cally significant difference according to volume reduction of the number of node points of the laser action. Three patients (2.8%) had a small burn the skin at the puncture needle. LITT method benign thyroid nodules is high, because overwhelmingly majority of cases leads to either the disappearance or significant reduction of thyroid nodules.
Endocrine Surgery. 2013;7(1):42-48
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Efficiency and safety of OctreotidLong FS therapy in acromegaly patients
Dreval’ A.V., Trigolosova I.V., Vinogradova A.V., Tishenina R.S.
Abstract
Aim of this study was to investigate efficiency and safety of OctreotidLong FS in patients with acromegaly. Materials and methods. 41 patients with acromegaly (8 – de novo and 33 patients after different somato statin analogs treatment) was treated OctreotidLong FS one injection in 28 days. Growth hormone (GH), Insulin like Growth Factor 1 (IFG1), fasting glucose (FG) and HbA1c were assess after 3, 6 and 12 month of therapy. Results. We found out the decreasing of GH and IGF1 from 12,8 (8,0–82,7) mU/ml to 3,8 (1,6–13,8) mU/ml ( p < 0,05) and %IGF1 increasing (% IGF1) from 231 (150–286)% to 9,5 (−26–111)% ( p < 0,05) in 8 de novo acromegalic patients. We also revealed that IGF1 didn’t change and GH decreased after 3 month (33 patients), 6 month (22 patients) and 12 month (8 patients) of OctreotidLong FS treatment. We didn’t observed negative effect of OctreotidLong FS treatment to carbohydrate metabolism in patients with acromegaly. Conclusion. The therapy of OctreotidLong FS leads to induce successful control of GH and IGFI in 50% de novo patients and didn’t change the number of patients with control of acromegaly after another somato statin analogs treatment. Carbohydrate metabolism also didn’t change after OctreotidLong FS treatment.
Endocrine Surgery. 2013;7(1):49-53
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