scholarly journals Successful Treatment of Acromegaly and Associated Hypogonadism with First-Line Clomiphene Therapy

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Juan D. Palacios ◽  
Ricardo J. Komotar ◽  
Atil Y. Kargi
Keyword(s):  
Oral Treatment ◽  
Clomiphene Citrate ◽  
Single Agent ◽  
Somatostatin Analogs ◽  
Cost Effective ◽  
Pituitary Surgery ◽  
Treatment Withdrawal ◽  
First Case ◽  
Dual Management ◽  
Incomplete Surgery

Clomiphene citrate (CC) has been reported as an effective add-on therapy to somatostatin analogs and dopamine agonists in patients with acromegaly accompanied by hypogonadism; its use as a single agent to treat acromegaly and associated hypogonadism following incomplete surgery has not been previously reported. We report the first case in which clomiphene was utilized as a single agent for the dual management of acromegaly and hypogonadism, not controlled by pituitary surgery alone. The treatment was well tolerated and proved to be effective after a process of treatment withdrawal and reintroduction. We propose that clomiphene may be considered as a cost-effective oral treatment option in select cases of hypogonadal acromegaly.

scholarly journals Heat Exchanger Network Retrofit of an Oleochemical Plant through a Cost and Energy Efficiency Approach

2021 ◽  
Vol 5 (2) ◽  
pp. 17
Author(s):  
Valli Trisha ◽  
Kai Seng Koh ◽  
Lik Yin Ng ◽  
Vui Soon Chok
Keyword(s):  
Energy Consumption ◽  
Heat Exchanger ◽  
Cost Effective ◽  
Capital Cost ◽  
Global Market ◽  
Annual Saving ◽  
Heat Exchanger Network ◽  
First Case ◽  
Payback Time ◽  
Better Than

Limited research of heat integration has been conducted in the oleochemical field. This paper attempts to evaluate the performance of an existing heat exchanger network (HEN) of an oleochemical plant at 600 tonnes per day (TPD) in Malaysia, in which the emphases are placed on the annual saving and reduction in energy consumption. Using commercial HEN numerical software, ASPEN Energy Analyzer v10.0, it was found that the performance of the current HEN in place is excellent, saving over 80% in annual costs and reducing energy consumption by 1,882,711 gigajoule per year (GJ/year). Further analysis of the performance of the HEN was performed to identify the potential optimisation of untapped heating/cooling process streams. Two cases, which are the most cost-effective and energy efficient, were proposed with positive results. However, the second case performed better than the first case, at a lower payback time (0.83 year) and higher annual savings (0.20 million USD/year) with the addition of one heat exchanger at a capital cost of USD 134,620. The first case had a higher payback time (4.64 years), a lower annual saving (0.05 million USD/year) and three additional heaters at a capital cost of USD 193,480. This research has provided a new insight into the oleochemical industry in which retrofitting the HEN can further reduce energy consumption, which in return will reduce the overall production cost of oleochemical commodities. This is particularly crucial in making the product more competitive in its pricing in the global market.

scholarly journals Postoperative use of somatostatin analogs and mortality in patients with acromegaly

2019 ◽  
Vol 180 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Mark R Postma ◽  
Thalijn L C Wolters ◽  
Gerrit van den Berg ◽  
Antonius E van Herwaarden ◽  
Anneke C Muller Kobold ◽  
...  
Keyword(s):  
Disease Control ◽  
Univariate Analysis ◽  
Standard Deviation Score ◽  
Somatostatin Analogs ◽  
Pituitary Surgery ◽  
Postoperative Treatment ◽  
Primary Therapy ◽  
Strong Trend ◽  
Primary Surgery ◽  
Standardized Mortality Ratios

Objective To assess the effect of somatostatin analogs (SSAs) on mortality in relation to disease control of acromegaly after pituitary surgery. Design A retrospective study in two large tertiary referral centers in The Netherlands. Methods Overall, 319 patients with acromegaly in whom pituitary surgery was performed as primary therapy between January 1980 and July 2017 were included. Postoperative treatment with SSA was prescribed to 174 (55%) patients because of persistent or recurrent disease. Disease control at last visit was assessed by IGF1 standard deviation score (SDS). Adequate disease control was defined as IGF1 SDS ≤2. Univariate determinants of mortality and standardized mortality ratios (SMRs) were calculated for groups with and without SSA at any moment postoperatively and at last visit. Results In total, 27 deaths were observed. In univariate analysis, determinants of mortality were inadequate disease control (relative risk (RR): 3.41, P = 0.005), surgery by craniotomy (RR: 3.53, P = 0.013) and glucocorticoid substitution (RR: 2.11, P = 0.047). There was a strong trend toward increased mortality for patients who used SSA (RR: 2.01, P = 0.067) and/or dopamine agonists (RR: 2.54, P = 0.052) at last visit. The SMR of patients with adequate disease control who used SSA at any moment postoperatively (1.07, P = 0.785) and at last visit (1.19; P = 0.600) was not increased. Insufficiently controlled patients had a significantly raised SMR (3.92, P = 0.006). Conclusions Postoperative use of SSA is not associated with increased mortality in patients with acromegaly who attain adequate disease control. In contrast, inadequate disease control, primary surgery by craniotomy and glucocorticoid substitution are associated with increased mortality.

scholarly journals Combined treatment for acromegaly with long-acting somatostatin analogs and pegvisomant: long-term safety for up to 4.5 years (median 2.2 years) of follow-up in 86 patients

2009 ◽  
Vol 160 (4) ◽  
pp. 529-533 ◽  
Author(s):  
SJCMM Neggers ◽  
WW de Herder ◽  
JAMJL Janssen ◽  
RA Feelders ◽  
AJ van der Lely
Keyword(s):  
Combined Therapy ◽  
Combined Treatment ◽  
Somatostatin Analogs ◽  
Pituitary Surgery ◽  
Median Dosage ◽  
Previously Treated ◽  
Long Acting

BackgroundWe previously reported on the efficacy, safety, and quality of life (QoL) of long-acting somatostatin analogs (SSA) and (twice) weekly pegvisomant (PEG-V) in acromegaly and improvement after the addition of PEG-V to long-acting SSA.ObjectiveTo assess the long-term safety in a larger group of acromegalic patients over a larger period of time: 29.2 (1.2–57.4) months (mean (range)).DesignPegvisomant was added to SSA monotherapy in 86 subjects (37 females), to normalize serum IGF1 concentrations (n=63) or to increase the QoL. The median dosage was 60.0 (20–200) mg weekly.ResultsAfter a mean treatment period of 29.2 months, 23 patients showed dose-independent PEG-V related transient liver enzyme elevations (TLEE). TLEE occurred only once during the continuation of combination therapy, but discontinuation and re-challenge induced a second episode of TLEE. Ten of these patients with TLEE also suffered from diabetes mellitus (DM). In our present series, DM had a 2.28 odds ratio (CI 1.16–9.22; p=0.03) higher risk for developing TLEE. During the combined therapy, a clinical significant decrease in tumor size by more than 20% was observed in 14 patients. Two of these patients were previously treated by pituitary surgery, 1 with additional radiotherapy and all other patients received primary medical treatment.ConclusionLong-term combined treatment with SSA and twice weekly PEG-V up to more than 4 years seems to be safe. Patients with both acromegaly and DM have a 2.28 higher risk of developing TLEE. Clinical significant tumor shrinkage was observed in 14 patients during combined treatment.

A phase 1b, open-label, dose-escalation study to evaluate camidanlumab tesirine (Cami) as monotherapy in patients (pts) with advanced solid tumors.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 2556-2556
Author(s):  
Igor Puzanov ◽  
Patricia LoRusso ◽  
Kyriakos P. Papadopoulos ◽  
Christopher T. Chen ◽  
Yvan LeBruchec ◽  
...  
Keyword(s):  
Antitumor Activity ◽  
Solid Tumors ◽  
Dose Escalation ◽  
Stable Disease ◽  
Single Agent ◽  
Treatment Withdrawal ◽  
Advanced Solid Tumors ◽  
Open Label ◽  
Phase 1B ◽  
Grade 3

2556 Background: Depletion of tumor-infiltrating CD25+ regulatory T cells (Tregs), which inhibit tumor-specific immune responses, could contribute to tumor eradication. Cami (ADCT-301), an anti-CD25, pyrrolobenzodiazepine-based antibody-drug conjugate, targets CD25+ Tregs. A mouse surrogate has shown potent antitumor activity in solid tumor models. Here we report preliminary data from the monotherapy arm of a phase 1b trial of Cami in pts with selected advanced solid tumors. Methods: The monotherapy dose-escalation part of this open-label study enrolled pts (aged ≥18 years) with selected advanced solid tumors and no suitable existing therapy. The primary objective was to characterize safety and tolerability, and to identify the recommended phase 2 dose of Cami monotherapy. Secondary and exploratory objectives included evaluation of preliminary antitumor activity, pharmacokinetics (PK), pharmacodynamics (PD), and immunogenicity. Pts received Cami every 3 weeks (1 cycle) with dose escalation per a 3+3 design. Disease control rate (DCR) was assessed (complete and partial responses [CR, PR] and stable disease). Results: At data cut-off (Dec 17, 2020), 44 pts were enrolled, with primary tumor types (stage IVA/B: 27 pts; 61.4%) of colorectal (15 pts; 34.1%), pancreatic (14 pts; 31.8%), head and neck, ovarian/fallopian tube, and renal cell carcinoma (all 3 pts; 6.8%), non-small cell lung cancer (2 pts; 4.5%), gastric, esophageal/GEJ, melanoma, and triple-negative breast cancer (each 1 pt; 2.3%). Median (range) age was 60.5 (33–82) years; median (range) number of prior systemic therapies was 4 (1–9). Pts received a median (range) of 2 (1–6) Cami cycles at doses of 20–150 µg/kg. Median (range) treatment duration was 22 (1–178) days. No dose-limiting toxicities were reported. The maximum tolerated dose (MTD) was not reached. All-grade treatment-emergent adverse events (TEAEs) in ≥20% pts were nausea (18 pts; 40.9%), decreased appetite and fatigue (each 16 pts; 36.4%), constipation (13 pts; 29.5%), abdominal pain (11 pts; 25%), and rash (10 pts; 22.7%). The only Grade ≥3 TEAE in ≥10% pts was anemia (5 pts; 11.4%). Grade 3 autoimmune AEs (colitis, immune-mediated AE, systemic inflammatory response syndrome) and neurologic AEs (dysphagia and asthenia, but not GBS) were reported in 3 (6.8%) and 2 (4.5%) pts, respectively. 1 (2.3%) Cami-related TEAE led to treatment withdrawal; no Cami-related TEAEs were fatal. DCR was 25% (95% CI: 11.1, 34.7); 11/44 pts attained stable disease. No pts had CR or PR. Conclusions: Dose escalation of Cami monotherapy is complete. The safety profile is encouraging and MTD was not reached. PK/PD data will be presented. 150 µg/kg is the highest dose investigated for single-agent Cami and the highest to be investigated combined with pembrolizumab in selected advanced solid tumors in the current protocol. Funding: ADC Therapeutics SA NCT03621982. Clinical trial information: NCT03621982.

scholarly journals Combined lenvatinib and pembrolizumab as salvage therapy in advanced adrenal cortical carcinoma

2020 ◽  
Vol 8 (2) ◽  
pp. e001009
Author(s):  
Sara Bedrose ◽  
Kevin Charles Miller ◽  
Lina Altameemi ◽  
Mohamed S Ali ◽  
Sameh Nassar ◽  
...  
Keyword(s):  
Systemic Therapy ◽  
Salvage Therapy ◽  
Checkpoint Inhibitors ◽  
Single Agent ◽  
Case Series ◽  
Progression Free Survival ◽  
Adrenal Cortical Carcinoma ◽  
Retrospective Case ◽  
First Case ◽  
Platinum Based Chemotherapy

BackgroundThere is no effective systemic therapy for metastatic adrenal cortical carcinoma (ACC) after failure of platinum-based chemotherapy. The efficacies of single-agent oral multikinase inhibitors (MKIs) or salvage immune checkpoint inhibitors (CPIs) have been very limited. It is unknown whether combining CPIs, such as pembrolizumab (PEM), with other therapies, such as MKIs, could yield higher response rates in ACC, yet this combination has shown promise in other cancers. Herein, we describe the first case series using PEM in combination with the MKI lenvatinib (LEN) in patients with progressive, metastatic ACC.MethodsA retrospective case series describing the use of LEN/PEM as salvage therapy in patients with progressive/metastatic ACC.ResultsEight patients were treated with the LEN/PEM combination therapy. Half were female, and the median age at time of diagnosis was 38 years (range 21–49). Three (37.5%) patients had hormonally active ACC. The median number of prior lines of systemic therapy was 4 (range 2–9). Six (75%) patients had had disease progression on prior CPIs and five (62.5%) patients had progressed on prior MKI therapy. The median progression-free survival was 5.5 months (95% CI 1.8–not reached) and median duration of therapy was 8.5 months (range 2–22). Two (25%) patients had a partial response, one (12.5%) patient had stable disease, and five (62.5%) patients had progressive disease. None of the eight patients stopped therapy because of adverse events.ConclusionsIn our small cohort of heavily pretreated patients with ACC, the combination of LEN/PEM was associated with objective responses in a subset of patients without significant toxicity. This combination should be formally investigated in phase II clinical trial with robust correlative studies to identify predictors for response.

scholarly journals A novel case using femtosecond laser-acquired lenticule for recurrent pterygium: case report and literature review

2018 ◽  
Vol 46 (6) ◽  
pp. 2474-2480 ◽  
Author(s):  
Om Prakash Pant ◽  
Ji-long Hao ◽  
Dan-dan Zhou ◽  
Fan Wang ◽  
Cheng-wei Lu
Keyword(s):  
Femtosecond Laser ◽  
Corneal Thickness ◽  
Anterior Segment ◽  
Single Layer ◽  
Cost Effective ◽  
Laser Technique ◽  
First Case ◽  
Lenticule Extraction ◽  
Recurrent Pterygium ◽  
Thin Cornea

Small incision lenticule extraction (SMILE) is a minimally invasive, safe and flapless femtosecond laser technique used mainly to correct myopia through extraction of a corneal lenticule. Lenticules obtained in this way are transparent and of high quality, and thus, can be used to treat other corneal diseases. A 65-year-old male patient presented with recurrent pterygium complicated by thin cornea. The patient was treated surgically using a SMILE-extracted lenticule to avoid further complications and to maintain eyeball integrity. The lenticule was sutured over the thin section of cornea using 10-0 interrupted nylon sutures and enclosed by a single layer of amniotic membrane. The patient was evaluated using slit-lamp biomicroscopy and anterior-segment optical-coherence tomography. During an 8-month follow-up, the graft remained intact with no sign of rejection and corneal thickness was maintained. Tectonic keratoplasty using a SMILE-extracted lenticule appears to be a safe, cost-effective and reliable method for treating thin cornea due to repeated surgeries for recurrent pterygium. This is the first case of recurrent pterygium complicated by thin cornea managed surgically using a SMILE-extracted lenticule.

An Integrated Work Flow for a Comprehensive Evaluation of Thin, Silty Hydrocarbon-Reservoir Sequences

2016 ◽  
Vol 19 (01) ◽  
pp. 041-053
Author(s):  
Wei-Chun Chu ◽  
Jan Steckhan
Keyword(s):  
Comprehensive Evaluation ◽  
Cost Effective ◽  
Work Flow ◽  
Fluid Type ◽  
Well Performance ◽  
Individual Layer ◽  
Individual Level ◽  
Hydrocarbon Reservoir ◽  
Single Probe ◽  
First Case

Summary A robust work flow is established to identify low-resistivity pay (LRP) in thinly laminated sands with silty and/or shaly layers. The work flow integrates data from gas-while-drilling, conventional logging, and nuclear-magnetic-resonance (NMR) logging for picking intervals for further examination with a wireline formation tester (WFT). A mini-drill-stem test (DST) is performed by means of a WFT equipped with either a single probe (SP) or a dual packer (DP) to determine the fluid type and productivity of each individual level. Two field examples are presented to compare well performance predicted by the microscale mini-DSTs with macroscale production tests. In both cases, the traditional DST is eliminated from the drilling/completion program. The final verification consists of comparing contributions of individual levels derived from the mini-DSTs with production logs. In the first case, mini-DSTs are able to provide the fluid type and individual-level transmissibility (kh/μ) for eight out of 13 distinct levels. A cost-effective approach of running mini-DSTs by means of a WFT equipped with a single probe is demonstrated to investigate multiple levels in the thin-hydrocarbon reservoir sequence. Guidelines are provided as to when a WFT with a DP is to be deployed to perform a mini-DST in a laminated formation. In the second case, the same work flow was applied to derive the fluid type and transmissibility for two wells consisting of more than 30 distinct levels in the same field. After integrating mini-DST results from the two wells 750 m apart, a framework is constructed to establish both vertical and lateral heterogeneities of thinly laminated reservoirs. The integration helps visualize the multiple-layer reservoir. Our examples confirm that mini-DSTs effectively define individual-layer producibilities in multiple-layered reservoirs. The benefits are illustrated through case histories that demonstrate our ability to manage expectations of well performance in thin hydrocarbon-reservoir sequences.

Fatigue Life and Reliability Consideration During Field Repair of Coke Drum and Piping

2017 ◽  
Author(s):  
Tej Chadda ◽  
Umakanthan Anand
Keyword(s):  
Fatigue Life ◽  
Case Studies ◽  
Fatigue Cracks ◽  
High Stress ◽  
Cost Effective ◽  
Thermal Operation ◽  
Delayed Coking ◽  
First Case ◽  
Crack Repair

Aging coke drums and their connected overhead piping in delayed coking units experience fatigue cracks which most commonly occur at the skirt junction and high stress pipe welds. This paper presents 2-case studies of this new cost-effective repair methodology with fatigue resistant design upgrade. The first case study applies to coke drum weld build-up solid skirt crack repair and the second for overhead vapor line weld crack repair. This paper presents new field repair methodology which could also improve long term fatigue resistance. It also suggests optimizing the thermal operation & thermal gradients of coke drums for further reliability improvement. Based on FEA, successful field execution and our experience, these case studies demonstrate a long term improvement in reliability and fatigue life of the order of 2.5 to 3 or higher especially if combined with thermal operation optimization.

Cushing's first case of transsphenoidal surgery: the launch of the pituitary surgery era

2005 ◽  
Vol 103 (3) ◽  
pp. 570-574 ◽  
Author(s):  
Aaron A. Cohen-Gadol ◽  
James K. Liu ◽  
Edward R. Laws
Keyword(s):  
Transsphenoidal Surgery ◽  
Pituitary Surgery ◽  
First Case
Sign in / Sign up

Export Citation Format

Share Document