α-Fetoprotein and β-Human Chorionic GonadotropinGregory, John; Finlay, Jonathan
doi: 10.2165/00003495-199957040-00001pmid: 10235686
Tumour markers can aid in areas such as diagnosis, surveillance of recurrence, staging and prognosis. This article focuses on 2 tumour markers, α-fetoprotein (AFP) and β-human chorionic gonadotropin (HCG). These tumour markers have been examined for their utility as prognostic indicators in 2 different manners. First, the marker level at diagnosis has been studied to determine if it is prognostic of outcome presumably because of its relation to tumour bulk or to the biological nature of the tumour. A more recent trend has been to investigate tumour marker decline. The finding of a delayed rate of decline suggests a poorer response of the malignancy to chemotherapy. The major focus of the article will be on marker decline of AFP and HCG as prognostic tools in peripheral and central nervous system (CNS) germ cell tumours (GCTs) and hepatic tumours (hepatoblastoma and hepatocellular carcinoma).
Host Defence (bdCationic) PeptidesHancock, Robert
doi: 10.2165/00003495-199957040-00002pmid: 10235687
Host defence, cationic antimicrobial peptides are now recognised as an important component, in most species, of the early innate and induced defences against invading microbes. They are small (12 to 35 amino acids), cationic due to the presence of an excess of arginine and lysine over acidic amino acids, and able to fold into a variety of different secondary structures. They have highly desirable properties, such as the ability to kill rapidly a broad spectrum of microorganisms including drug resistant bacteria and often fungi at around the minimal inhibitory concentration, a low level of resistance development in vitro, the ability to protect animals against both topical and systemic infections and the capability to neutralise endotoxin and demonstrated synergy with conventional antibiotics. In addition, given the 20 building blocks (amino acids) for these peptides, even a small peptide offers enormous diversity and potential for design of improved variants. For this reason such peptides have entered clinical trials, largely as agents for topical therapy of polymicrobial infections and are considered to have excellent potential for being a novel antibiotic class.
Current Drug Therapy for Multiple MyelomaHuang, Yi-Wu; Hamilton, Audrey; Arnuk, Omar; Chaftari, Patrick; Chemaly, Roy
doi: 10.2165/00003495-199957040-00004pmid: 10235689
Recent years have witnessed tremendous advances in the molecular pathogenesis and management of multiple myeloma. Standard chemotherapy (melphalan and prednisone; MP) has been the mainstay of treatment of multiple myeloma for about 3 decades. However, it is no longer considered the ‘gold standard’, particularly for those patients who will subsequently undergo intensive chemotherapy with autologous or allogeneic peripheral blood stem cell (PBSC) or bone marrow transplantation (BMT), or for patients with refractory myeloma. A variety of induction combination chemotherapy regimens have been developed, some of which have demonstrated an improved response rate and duration and a superior 5-year survival rate when compared with standard chemotherapy. The early use of high dose chemotherapy with autologous PBSC support or BMT has significantly increased the complete remission rate, and has prolonged event-free survival and overall survival. Allogeneic bone marrow or PBSC transplantation may be a good option for selected patients with poor prognostic features.
Treatment of Epilepsy in PregnancyNulman, Irena; Laslo, Dionne; Koren, Gideon
doi: 10.2165/00003495-199957040-00006pmid: 10235691
Pregnant women with epilepsy constitute 0.5% of all pregnancies. Proper seizure control is the primary goal in treating women with epilepsy. The commonly used anticonvulsants are established human teratogens. Factors such as epilepsy, anticonvulsant-induced teratogenicity, patient’s genetic predisposition and the severity of convulsive disorder may attribute to adverse pregnancy outcome for the children of women with epilepsy. Anticonvulsant interaction with folic acid and phytomenadione (vitamin K) metabolism may lead to an increased risk for neural tube defect and early neonatal bleeding. Psychological, hormonal and pharmacokinetic changes in pregnancy may escalate seizure activity.
Current Guidelines for the Treatment of Patients with Rheumatic FeverThatai, Deepak; Turi, Zoltan
doi: 10.2165/00003495-199957040-00007pmid: 10235692
Rheumatic fever is a multisystem inflammatory disease that occurs as a delayed sequelae to group A streptococcal pharyngitis. The important clinical manifestations are migratory polyarthritis, carditis, chorea, subcutaneous nodules and erythema marginatum occurring in varying combinations. The pathogenesis of this disorder remains elusive: an antigenic mimicry hypothesis best explains the affliction of various organ systems after a lag period following pharyngeal infection. In its classic milder form, the disorder is largely self-limited and resolves without sequelae, but carditis may be fatal in severe forms of the disease. Chronic and progressive damage to the heart valves leads to the most important public health manifestations of the disease. Anti-inflammatory agents provide dramatic clinical improvement, but do not prevent the subsequent development of rheumatic heart disease. The role of corticosteroids in treatment of carditis is uncertain and controlled studies have failed to demonstrate improved long term prognosis. Chorea, once considered a benign self-limited disease, is now felt to require more aggressive treatment, in particular with sedatives. Prevention of first and subsequent attacks of rheumatic fever is the mainstay in the limited arsenal available to alter the natural history of this disease.