scholarly journals Advances in the Treatment of Prolactinomas

2006 ◽  
Vol 27 (5) ◽  
pp. 485-534 ◽  
Author(s):  
Mary P. Gillam ◽  
Mark E. Molitch ◽  
Gaetano Lombardi ◽  
Annamaria Colao
Keyword(s):  
Medical Therapy ◽  
Critical Analysis ◽  
Dopamine Agonists ◽  
Multimodal Therapy ◽  
Efficacy And Safety ◽  
Treatment Resistant ◽  
Tumor Mass ◽  
Molecular Therapies ◽  
Novel Approaches ◽  
And Control

Prolactinomas account for approximately 40% of all pituitary adenomas and are an important cause of hypogonadism and infertility. The ultimate goal of therapy for prolactinomas is restoration or achievement of eugonadism through the normalization of hyperprolactinemia and control of tumor mass. Medical therapy with dopamine agonists is highly effective in the majority of cases and represents the mainstay of therapy. Recent data indicating successful withdrawal of these agents in a subset of patients challenge the previously held concept that medical therapy is a lifelong requirement. Complicated situations, such as those encountered in resistance to dopamine agonists, pregnancy, and giant or malignant prolactinomas, may require multimodal therapy involving surgery, radiotherapy, or both. Progress in elucidating the mechanisms underlying the pathogenesis of prolactinomas may enable future development of novel molecular therapies for treatment-resistant cases. This review provides a critical analysis of the efficacy and safety of the various modes of therapy available for the treatment of patients with prolactinomas with an emphasis on challenging situations, a discussion of the data regarding withdrawal of medical therapy, and a foreshadowing of novel approaches to therapy that may become available in the future.

Efficacy and safety of dopamine agonists in psychiatric patients treated with antipsychotics and presenting a macroprolactinoma

2019 ◽  
Author(s):  
Lucie Allard ◽  
Frederique Albarel ◽  
Jerome Bertherat ◽  
Philippe Caron ◽  
Cortet-Rudelli Christine ◽  
...  
Keyword(s):  
Dopamine Agonists ◽  
Psychiatric Patients ◽  
Efficacy And Safety

Thromboembolic complications prevention in the obstetric practice

2017 ◽  
pp. 19-24
Author(s):  
O.V. Grishchenko ◽  
◽  
V.V. Bobrytska ◽  
Keyword(s):  
Pulmonary Embolism ◽  
Comparison Group ◽  
Main Group ◽  
Control Group ◽  
Efficacy And Safety ◽  
Thromboembolic Complications ◽  
Moderate Risk ◽  
Obstetric Practice ◽  
Thrombotic Complications ◽  
And Control

The objective: To evaluate the clinical efficacy and safety of Enoxaparin-Pharmex for the prevention of thrombotic complications (pulmonary embolism) in the postoperative period in patients with moderate risk of these complications. Patients and methods. The study included 50 women after a caesarean section had an average degree of risk of pulmonary embolism. Patients were divided into the main group (n=25) and control group (n=25) in accordance with the treatment: patients of the main group received postoperative Еnoxaparin- Pharmex, group comparisons enoxaparin sodium (brand foreign manufacturer’s). Patients in both groups received the drug at a dose of 20 mg for 5 days, 1 time per day subcutaneously. Results. The research data analysis showed identity results of hemostasiogram of patients in the main group and the comparison group, no side effects after treatment in both groups. Conclusion. The clinical studies suggest the drug Enoxaparin-Pharmex is effective, safe LMWH, which can be used to prevent troboembolic complications, including post-operative treatment in obstetric practice. Spectrum of Enoxaparin-Pharmex can be extended to the prevention and treatment of thromboembolic conditions of varying severity with appropriate doses of the drug. Key words: Enoxaparin-Pharmex, prevention of pulmonary embolism.

Optimizing anaerobic co-digestion plants: MIR online instrumentation and dynamic real-time substrate feed optimization

2015 ◽  
Vol 63 (7) ◽  
Author(s):  
Daniel Gaida ◽  
Christian Wolf ◽  
Robin Eccleston ◽  
Michael Bongards
Keyword(s):  
Predictive Control ◽  
Closed Loop ◽  
Closed Loop Control ◽  
Control Loop ◽  
Loop Control ◽  
Plant Operation ◽  
Novel Approaches ◽  
The One ◽  
Middle Infrared ◽  
And Control

AbstractClosed-loop control of the substrate feed as well as the application of online instrumentation are important to achieve optimal biogas plant operation. Therefore, this paper presents two novel approaches for online instrumentation and control to achieve optimal AD plant operation based on middle-infrared spectroscopy on the one hand and nonlinear model predictive control on the other hand. At present, research into both techniques is being performed separately, with the intention that in the future the spectroscopic measurements will be integrated into the control loop.

scholarly journals Use of Biologics in Pityriasis Rubra Pilaris Refractory to First-Line Systemic Therapy: A Systematic Review

2019 ◽  
Vol 24 (1) ◽  
pp. 73-78
Author(s):  
Avee Naidoo ◽  
Cathryn Sibbald ◽  
Patrick J. Fleming ◽  
Vincent Piguet
Keyword(s):  
Large Scale ◽  
Randomized Clinical Trials ◽  
Case Series ◽  
Efficacy And Safety ◽  
Inclusion Criteria ◽  
Treatment Resistant ◽  
First Line ◽  
Disease Treatment ◽  
Pityriasis Rubra Pilaris ◽  
Systemic Therapies

Pityriasis rubra pilaris (PRP) is an uncommon, inflammatory, papulosquamous skin disease. Treatment of PRP is challenging as the disease is often refractory to conventional therapies, such as retinoids and methotrexate. There has been an increasing number of studies reporting the successful use of biologic therapy in patients with PRP; however, the data on the efficacy and safety are limited. Our objective was to evaluate the existing evidence for utilizing biologics, whether alone or in combination with established systemic therapies, in patients with treatment-resistant PRP. We systematically reviewed evidence within Medline and Pubmed databases between January 1, 2000, to March 31, 2019. Articles consisted of patients diagnosed with PRP who have failed to respond sufficiently to first-line systemic therapies, or who had comorbidities that precluded their use. In total, 363 unique articles were identified, 56 of which were considered relevant to the clinical question. Of the 56 articles highlighted, 35 met the inclusion criteria and were limited to case series and case studies. Therapy with biologics was found to be successful for both monotherapy (81.1% [27/33]) and when used in combination with existing systemic therapies (87.5% [14/16]). The existing evidence suggests that biologics may be regarded as a tool for PRP treatment alone or in combination therapy with existing treatments, although large-scale randomized clinical trials are necessary to better assess their efficacy and safety.

scholarly journals Treatment Resistant Hypertension

2015 ◽  
Vol 25 (4) ◽  
pp. 495 ◽  
Author(s):  
Brent M. Egan
Keyword(s):  
Resistant Hypertension ◽  
Treatment Options ◽  
Diuretic Therapy ◽  
Clinical Information ◽  
Treatment Resistant ◽  
Antihypertensive Medications ◽  
Optimal Therapy ◽  
Medication Costs ◽  
And Control ◽  
Measurement Artifacts

<p>Treatment resistant hypertension (TRH) is defined by office blood pressure (BP) uncontrolled on ≥3 or controlled on ≥4 antihypertensive medications, preferably at optimal doses and including a diuretic. Apparent (a)TRH is used when optimal therapy, adherence, and measurement artifacts are unknown. Among treated hy­pertensives, ~30% of uncontrolled and 10% of controlled individuals have aTRH, with a higher prevalence in Blacks than other race-ethnicity groups. In ≥50% of aTRH patients, BP measurement artifacts (‘office’ TRH), suboptimal regimens, or suboptimal adher­ence are present, ie, pseudo-resistance. While patients with ‘office’ TRH have fewer cardiovascular events than those with ‘true’ TRH, no evidence confirms that patients with suboptimal regimens or adherence are spared. Averaging several office BPs obtained with an automated monitor can reduce ‘office’ TRH. Home or ambulatory BP monitoring can identify office resistance. Prescribing ≥3 different antihypertensive medication classes, eg, thiazide-type diuret­ic, renin-angiotensin blocker and calcium antagonist at ≥50% of maximum recom­mended doses reasonably defines optimal therapy. Intensifying diuretic therapy, eg, adding an aldosterone antagonist, is effec­tive for many TRH patients who are volume expanded. Clinical information, hemody­namic and renin-guided therapeutics can inform other treatment options. Attention to adverse effects, medication costs, and pill burden can improve adherence and control. Patients with aTRH and suspected second­ary hypertension should be evaluated. Inter­fering substances or medications should be discontinued. These approaches will identify or correct the problem in ~80% of aTRH patients. Referral to a hypertension special­ist and newer therapeutic approaches are options for TRH patients who cannot take or do not respond to optimal therapy. <em>Ethn Dis. </em>2015;25(4):495-498; doi:10.18865/ ed.25.4.495</p>

Simulation of VANET Applications

2010 ◽  
pp. 264-282 ◽  
Author(s):  
Valentin Cristea ◽  
Victor Gradinescu ◽  
Cristian Gorgorin ◽  
Raluca Diaconescu ◽  
Liviu Iftode
Keyword(s):  
Traffic Safety ◽  
Traffic Control ◽  
Critical Analysis ◽  
Simulation Tool ◽  
Future Trends ◽  
And Control

This chapter systematically presents actual issues regarding the simulation of VANET applications. Some of them refer to challenges in developing VANET simulators. The chapter discusses simulator architectures, models used for representing the communication among vehicles, vehicles mobility features, and simulation tool implementation methods. A critical analysis of the solutions adopted in some well-known actual simulators is also included. Other issues relate to the use of simulation in the evaluation of applications that aim at improving the traffic safety and control. Representative city and highway application scenarios are discussed, and results that can be obtained by simulation, along with ways these results can be exploited by VANET developers and users are highlighted. Future trends in the development of simulators that produce more accurate results and their use for the evaluation of more sophisticated traffic control solutions are also included.

Assessment of the Efficacy and Safety of BMS-820836 in Patients With Treatment-Resistant Major Depression

2015 ◽  
pp. 1 ◽  
Author(s):  
Zubin Bhagwagar ◽  
Anne Torbeyns ◽  
Delphine Hennicken ◽  
Ming Zheng ◽  
Boadie W. Dunlop ◽  
...  
Keyword(s):  
Major Depression ◽  
Efficacy And Safety ◽  
Treatment Resistant

Lamotrigine augmentation in treatment-resistant unipolar depression: A comprehensive meta-analysis of efficacy and safety

2019 ◽  
Vol 33 (6) ◽  
pp. 700-713 ◽  
Author(s):  
Kah Kheng Goh ◽  
Chun-Hsin Chen ◽  
Yi-Hang Chiu ◽  
Mong-Liang Lu
Keyword(s):  
Adverse Events ◽  
Rating Scale ◽  
Meta Analysis ◽  
Unipolar Depression ◽  
Severe Illness ◽  
Discontinuation Rate ◽  
Efficacy And Safety ◽  
Treatment Resistant ◽  
Chinese Studies ◽  
Hamilton Rating Scale

Objective: Augmentation strategies are commonly applied when an individual is unresponsive to antidepressant monotherapy. Lamotrigine is currently considered at best only as second line augmentation for treatment-resistant unipolar depression while its clinical efficacy and safety profiles remain inconclusive. We intended to assess the therapeutic effects and safety profiles of lamotrigine augmentation in patients with treatment-resistant unipolar depression by conducting a meta-analysis. Methods: MEDLINE, Embase, EBSCO, Cochrane, Web of Science, Scopus, Wanfang and Ariniti databases were searched. Coprimary outcomes, including changes in severity of depression and response rate, were measured in this study. Secondary outcomes were defined as the safety profile of the intervention, including reported discontinuation rate and adverse events. Results: Eight double-blinded randomized controlled trials with 677 patients overall were included. Significant improvements in Hamilton Rating Scale for Depression scores and response rates were shown in lamotrigine augmentation groups compared with control groups, of which the pooled result of six Chinese studies showed positive effects of Hamilton Rating Scale for Depression improvement while the pooled result of two non-Chinese studies was statistically non-significant. Patients with more severe illness and longer duration of illness were more effectively treated with lamotrigine augmentation. The magnitude of depression improvement after lamotrigine augmentation was higher in patients treated with selective serotonin reuptake inhibitors than those treated with serotonin-norepinephrine reuptake inhibitors. Lamotrigine augmentation is well-tolerated in terms of all-cause discontinuation rate and adverse events. Conclusions: Lamotrigine augmentation may serve as a possible choice for patients with treatment-resistant unipolar depression and further trials are warranted to clarify the optimal dosage of lamotrigine augmentation together with the treatment duration and safety over time.

scholarly journals Sevoflurane augmentation in treatment-resistant depression: a clinical case study

2020 ◽  
Vol 10 ◽  
pp. 204512532095712
Author(s):  
Shikai Wang ◽  
Shanfei Cheng ◽  
Min Feng ◽  
Ping Guo ◽  
Mincai Qian ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Clinical Case ◽  
Efficacy And Safety ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Clinical Case Study ◽  
Antidepressant Effects ◽  
Mucous Membranes ◽  
Resistant Depression

Compared with other inhaled anaesthetics, sevoflurane has a faster onset and offset, causes less irritation to the mucous membranes, and has a better safety profile. These characteristics warrant investigating the effect of sevoflurane in depression. In this Case Report, we describe that sevoflurane treatment was feasible and well tolerated by a patient with treatment-resistant depression (TRD). Sevoflurane had rapid and durable antidepressant effects, with few adverse effects. Moreover, the patient showed significant improvements in neurocognitive measurements. Our preliminary results suggest that further clinical trials are needed to determine the independent efficacy and safety of sevoflurane in patients with TRD.

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