The most important prognostic variable in early breast cancer is axillary lymph node involvement. Based on past experience, after 10 years about 70% of node-negative patients will be alive and apparently free of disease; about 30% will have relapsed or died. Patients with positive nodes may have a 30% to 60% relapse rate, depending on the number of positive nodes and other prognostic factors, such as the presence of estrogen receptors (IC Henderson et al, in VT DeVita, Jr et al, eds, Cancer: Principles and Practice of Oncology, 3rd ed, Philadelphia:Lippincott, 1989, p 1197). Which of...

Flumazenil (Mazicon - Roche), a benzodiazepine receptor antagonist, has been approved by the US Food and Drug Administration to reverse the sedative effects of benzodiazepines after anesthesia, sedation for brief surgical or diagnostic procedures, or after benzodiazepine overdosage. The drug does not antagonize opioids, non-benzodiazepine sedatives, or anesthetic drugs.

Itraconazole (Sporanox - Janssen), an oral antifungal triazole that has been available in the USA since 1992 for treatment of deep fungal infections (Medical Letter, 35:7, 1993), is now being marketed for treatment of dermatophyte infections of the toenails, with or without fingernail involvement.

High-dose chemotherapy followed by bone marrow transplantation continues to be widely used in the treatment of malignant diseases (Medical Letter, 37:25, 1995). The source of the transplant has been autologous or allogeneic bone marrow or, more recently, stem and progenitor cells harvested from peripheral blood (Medical Letter, 37:71, 1995). Now, blood taken from the umbilical cord and placenta of a newborn infant is being tried as a source of cells to restore the bone marrow. A single collection of umbilical cord blood contains about as many progenitor cells as most autologous bone...

Ardeparin sodium (Normiflo - Wyeth-Ayerst), a low-molecular-weight heparin, and danaparoid sodium (Orgaran - Organon), a heparinoid, have been approved by the FDA for prevention of deep vein thrombosis. Without anticoagulation, deep vein thrombosis occurs in up to 30% of patients after abdominal surgery, and in 40% to 70% of patients after major orthopedic operations on the lower limbs. Danaparoid sodium is approved in the USA only for use in hip replacement. Ardeparin is approved here only for use in knee replacement.

The first human vaccine for prevention of Lyme disease (LYMErix), has been approved by the FDA for use in patients 15 to 70 years old.

Botulinum toxin type A (Botox - Allergan) and type B (Myobloc - Elan) are now approved by the FDA for treatment of cervical dystonia. Botulinum toxin type A has been approved since 1989 for treatment of strabismus and blepharospasm. It is also used cosmetically to reduce wrinkles on the face and neck.

Drotrecogin alfa (activated) (Xigris - Lilly), recombinant human activated protein C, has been approved by the FDA for treatment, in combination with standard therapy, of critically ill adults with severe sepsis and a high risk of death.

A once-weekly 35-mg oral formulation of the bisphosphonate risedronate (Actonel) has been approved by the FDA for prevention and treatment of postmenopausal osteoporosis. A once-weekly formulation of alendronate (Fosamax) was approved last year (Medical Letter 2001; 43:26). Bisphosphonates bind to the mineral surface of bone and decrease osteoclast activity, inhibiting the resorption phase of the bone turnover cycle. These drugs are not metabolized and remain bound to bone for several weeks.

Memantine hydrochloride, which has been used to treat dementia in Germany (Axura Merz) since 1982, has become the latest word-of-mouth miracle drug for Alzheimer's disease in the US (G Kolata, NY Times, June 15, 2003). Forest Laboratories has submitted a New Drug Application to the FDA for memantine. This review describes the standard treatment for Alzheimer's Disease, mechanism of action, clinical studies, adverse effects and dosage. Also included are sections on availability of the drug and how some people are obtaining memantine from abroad.