ISSN:1061-2270    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

Executive SummaryStroke may be classified into two major categories, ischemic and hemorrhagic. Ischemic stroke can be further classified as thrombotic or embolic, depending on its origin. Of the two types, thrombotic stroke is the most common, accounting for about two-thirds of all ischemic strokes and about half of all strokes among western populations.Strokes occur in men more often than in women, (about two to one, and particularly at younger ages) but women more often die as a result of a stroke. In fact, stroke is the second-leading cause of death in American women ages 45 to 64, killing more females than breast cancer.Signs are common in thrombotic events within a few hours, but may take a few days to fully evolve. In contrast, embolic strokes and intracerebral hemorrhage develop very rapidly and without warning.Central nervous system diseases differ from other diseases because unlike other tissues, the brain and spinal cord do not “heal”. Damage to these organs is irreversible and results in loss of whatever function the damaged nerves controlled. Moreover, brain function is usually lost in the reverse order to which it developed. Accordingly, “higher functions” such as reasoning, cognition and social skills are the first functions lost in diseases such as Alzheimer's because these were the last functions to develop.Stroke can be viewed as a neurodegenerative disorder arising from vascular trauma due to chronic disease development. As such, there are multiple points for therapeutic intervention. Treatment can either be from a stroke prevention aspect (prophylactic), or as intervention after the event has occurred. Intervention itself has two components; issues dealing with blood flow and CNS tissue damage. In the case of ischemic stroke, restoration of blood flow is of critical importance. For hemorrhagic stroke, preventing further bleeding and managing the resulting cerebral edema is the main focus.Most success to date has been in stroke prevention as it has been the path of least resistance compared to the more problematic CNS damage arena. While mainly indicated for elevated blood pressure, the antihypertensive agents have had an impact on stroke reduction. The currently available statin class of cholesterol-lowering agents received primary indications for stroke reoccurrence, and have a solid hold on the market. More interestingly, aspirin (antiplatelet) remains to be one of the most effective, (efficacy, safety and price), agents currently available for stroke prophylaxis.

ISSN:1061-2270    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

Executive SummaryThe science of what makes a couple able to conceive is still evolving and the cause of infertility in the majority of women with the diagnosis is unknown. However, of the patients where the causes can be ascertained, the most prevalent problems are ovulatory failure, tubal damage, and endometriosis. Of course, it is not always the female that is responsible.If ovulation is achieved and the patient is still unable to conceive, she becomes a candidate for assisted reproduction techniques (ART). If infertility is caused by tubal disease, the patient can either undergo microsurgery to remove adhesions from the uterine tubes and ovaries (salpingo- oovariolysis) or falloposcopy to cannulize the tube, or she may consider ART. The most common ART procedures are in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT).Infertility in women has also been shown to be a function of age. The ability to conceive decreases after age 35 and the ability to conceive and carry a child through to a normal birth decreases after age 30.The high cost of infertility therapy is a combination of professional, clinic, diagnostic and monitoring, and drug costs. While drug costs for individual patients can be high, this does not translate into a large drug market, because the numbers of patients who can afford the cost and inconvenience of therapy is small.No major changes are forecast for the infertility market in this decade. Product development programs tend to focus on incremental improvements, especially reduction in side effects, and these will have a small positive effect on the market. Breakthrough therapies are not expected; no substantial improvement in the success rate of infertility is forecast. Market growth is essentially demographics.

ISSN:1061-2270    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

Executive SummaryAlthough no specific cause is attributed to the acute leukemias, radiation and a number of chemotherapeutic agents are associated with increased risk of acute leukemia, and with anomalies in chromosomes 5 and 7. Unfavorable outcomes are associated with anomalous chromosomes 5 and 7, Philadelphia chromosome, and 11q23. More favorable therapeutic outcomes are associated with translocations of chromosomes 8;21 and 15;17.Early indolent CLL generally requires no specific therapy. Patients with symptomatic or progressive CLL are still often started on chlorambucil. Fludarabine treatment produces a higher response rate and more complete, lasting responses, but can also produce long-lasting immunosuppression.CML afflicts 4,300 Americans annually. Recombinant interferon alpha has long replaced hydroxyurea for treatment of chronic phase CML. The interferon prolongs the chronic phase, and thus prolongs survival. The side effects of treatment are difficult for many patients to tolerate. The combination of interferon with low-dose cytarabine appears to be more effective than interferon alone. Retinoid therapy has been effective in promyelocytic leukemia. The only currently available curative treatment is allogeneic bone marrow transplantation.Signal transduction modulators remain the area of most intense development effort although an approved product is still off in the future. Immunoconjugates and cytokines with approved product in the market are still very active areas of development.Bone marrow transplant (BMT) is an alternative treatment for patients who fail to achieve initial remission, or relapse after chemotherapy. However, the dearth of compatible donors and graft-versus-host disease can limit the usefulness of BMT.Monoclonal antibodies are a very promising technology platform that has already yielded effective products for the treatment of two cancers. In the opinion of researchers, target selection for a therapeutic MAb is the most critical factor for its success in treating a disease. The identification of several new targets has spurred development activity in this platform.Monoclonal antibodies are expected to replace chemotherapy as the drug of choice for leukemia by the year 2010.

ISSN:1061-2270    

出版商:ADIS    

年代:2001

数据来源: ADIS

摘要:

Executive SummaryThe number one complaint of women undergoing menopause is a vasomotor instability that presents as hot flashes and sweats. A hot flash is a sudden onset of intense body heat with profuse perspiration and reddening of the skin over the head, neck and chest. Flashes last from a few seconds to several minutes and are more frequent and severe at night, when they awaken women from sleep. The frequency varies greatly.After menopause, the mortality rate from CHD increases greatly. In fact, it is the leading cause of death in older women. As experience is gained in tracking women on hormone replacement therapy, the positive effects of treating women with estrogen are becoming apparent. In 1992 Grady et al. published a study in the Annals of Internal Medicine that analyzed 32 epidemiologic studies. All but one showed that estrogen use lowers the risk of CHD by 35%.A study published in January 1996 in the Journal of Obstetrics and Gynecology provided additional evidence of benefit to postmenopausal women of taking estrogen. In women over the age of 80, the rate of death from all causes was 46% less in the group receiving hormone replacement therapy. This group had a 60% reduction in coronary heart disease and 73% reduction in mortality related to stroke.In addition to women undergoing natural menopause, every year a large number of women undergo the removal of their uterus, or hysterectomy. This is the second most performed surgery in the US; only cesarean sections are performed more often. There are many clinical reasons for this procedure. It is often done as a life-saving procedure in order to remove cancers, to stop hemorrhaging, or to treat infections.Women who have undergone a surgical menopause caused by the removal of their ovaries are also considered to be candidates for therapy. In fact, because surgical menopause is more abrupt than natural menopause, women who undergo hysterectomies have more symptoms and a greater need for therapy. A majority of physicians believe that, because these women do not have an endometrium, it is acceptable to give unopposed estrogen.Disturbingly, in the June 15, 1995 issue of the New England Journal of Medicine, results were published from the Nurses' Health Study that was initiated in 1976 and extended to qualify the relationship between the use of hormones and the risk of breast cancer in postmenopausal women. The women in the study group were asked to fill out questionnaires every two years to update information on their menopausal status, use of HRT, and any diagnosis of breast cancer. The risk of breast cancer was significantly increased among women who were currently using estrogen alone or estrogen plus progestin, as compared with post-menopausal women who had never used hormones.Intravaginal rings are under development by several companies. The advantage of these delivery systems is the ability to provide continuous delivery of estrogen and progestin for up to 3 months. This is especially appealing in treatment of women who are unable to see a physician as often, or who may have difficulty remembering to take a daily medication, as in the case of certain women in a nursing home environment, or those suffering from Alzheimer's or other dementia.Menopausal therapy is one of the truly exciting growth markets of the future. The population in the age segment that is most affected is projected to increase by 40% between 1994 and 2010. The percent of women seeking therapy and the physicians who believe that therapy is necessary is also expected to increase as evidence of the benefits mounts. The number of women under 50 with ovariectomies will also contribute to this growing market.

ISSN:1061-2270    

出版商:ADIS    

年代:2001

数据来源: ADIS

ISSN:1061-2270    

出版商:ADIS    

年代:2001

数据来源: ADIS

ISSN:1061-2270    

出版商:ADIS    

年代:2001

数据来源: ADIS