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doi: 10.2165/00003495-199958001-00002pmid: 10576516
Insulin sensitivity, which can be impaired in both glucose-intolerant and non-glucose-intolerant individuals, is a valuable parameter because of its potential as a marker for the future development of diabetes and increased cardiovascular risk. Techniques available for the determination of insulin sensitivity include the glucose clamp, insulin tolerance test, insulin suppression test, the frequently sampled intravenous glucose tolerance test and the regional artero-venous balance. Model assessment methods are also available for the measurement of insulin sensitivity at steady-state plasma glucose and insulin levels or after a standardised glucose infusion. Methods vary in their complexity, and the choice between them depends on the nature of the information required. There is also evidence for a strong genetic contribution to insulin sensitivity; although identification of the relevant gene(s) has not yet been successful, accurate phenotyping should still be carried out as part of the assessment of a patient’s clinical status.
doi: 10.2165/00003495-199958010-00006pmid: 10439930
▴ Capecitabine is an orally administered fluoropyrim-idine carbamate used for the treatment of paclitaxel- or anthracycline-refractory breast cancer. ▴ Capecitabine is metabolised via a 3-step process to the active agent fluorouracil. The final step of this process occurs preferentially in malignant tissue. ▴ In patients with paclitaxel-refractory breast cancer receiving capecitabine (2510 mg/m2 /day for 2 weeks of a 3-week cycle) the objective tumour response rate was 20%. Disease progression occurred in 34% of patients and 40% had stable disease. ▴ In this trial, the median duration of response was 241 days. Disease progression or death occurred in 83% of patients, and median time to progression was 93 days. Median survival time was 384 days. ▴ In previously untreated patients with breast cancer, the response rate was higher and time to disease progression was longer after oral capecitabine (2510 mg/m2 /day for 2 weeks of a 3-week cycle) than after intravenous cyclophosphamide, methotrexate and fluorouracil therapy. ▴ In clinical trials, generally gastrointestinal or haematological adverse events were reported most frequently. Other commonly reported events included hand-and-foot syndrome, fatigue, hyperbilirubinaemia, dermatitis and anorexia.
Heard, Kennon; O’Malley, Gerald; Dart, Richard
doi: 10.2165/00003495-199958010-00002pmid: 10439926
Envenomations are an important cause of injury in the Americas. While supportive care alone may result in an acceptable outcome, antivenom offers a specific therapy that can significantly reduce the injury and symptoms of the envenomation. Antivenoms are hyperimmune sera collected from animals immunised with venom. The antibodies contained in the serum bind and inactivate venom components. This leads to cessation or reversal of the toxic effects of the venom. The serum is often processed to increase the level of antibodies directed against venom components and decrease the amount of inactive proteins that may cause allergic reactions. The processing may include precipitation of inactive proteins, Chromatographic methods and cleavage of the immunoglobulins to form antibody fragments known as Fab or F(ab)2.
McClellan, Karen; Plosker, Greg
doi: 10.2165/00003495-199958010-00016pmid: 10439934
The orally administered antianginal agent trimetazidine increases cell tolerance to ischaemia by maintaining cellular homeostasis. In theory, this cytoprotective activity should limit myocyte loss during ischaemia in patients with angina pectoris.
Pugeat, Michel; Ducluzeau, Pierre
doi: 10.2165/00003495-199958001-00010pmid: 10576524
Polycystic ovary syndrome (PCOS) is the most common disorder of ovarian function in premenopausal women. PCOS is characterised by chronic anovulation and androgen excess with clinical manifestation of irregular menstrual cycles, hirsutism and/or acne. Insulin resistance with resultant hyperinsulinaemia, irrespective of excess weight or frank obesity, has been reported in patients with PCOS, and, as insulin has a direct effect on ovarian androgen production in vitro, insulin resistance may play a crucial role in the physiopathology of PCOS. Although the molecular mechanism(s) of insulin resistance in PCOS is unclear, excessive insulin-independent serine phosphorylation of the β subunit of the insulin receptor, as reported in some patients with PCOS, has been put forward as a new mechanism for insulin resistance.
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