Current women's health reports最新文献

Magnetic resonance imaging (MRI) of the pelvic floor specifically to evaluate causes of fecal incontinence is relatively new. Along with physical examination and endoanal ultrasound, recently developed MRI techniques can be used to more accurately diagnose and characterize pelvic floor disorders leading to fecal incontinence. All three compartments of the pelvic floor can be evaluated simultaneously using MRI. During an MRI study, images are rapidly obtained in the sagittal plane at rest and during strain, and in the axial plane at rest. In symptomatic patients, abnormal descent of pelvic viscera is indicative of muscle or fascial weakness. Abnormal descent of pelvic viscera is readily detected on sagittal MR images. Muscle and sphincter tears can also be visualized, although most fascial damage is incurred secondarily. The detailed information gained from an MRI can be used to plan optimal treatment, surgical or otherwise.

Osteoporosis is characterized by compromised bone strength that predisposes a person to an increased risk of fracture. It is a major public health problem that is often unrecognized in clinical practice. This paper provides an evidence-based approach for diagnosis, investigation, and treatment of osteoporosis. Identification and treatment of secondary causes of bone loss have also been discussed. Pharmacologic options include hormone replacement therapy, raloxifene, calcitonin, bisphosphonates, and parathyroid hormone. Nonpharmacologic therapies serve as useful adjuncts to medical treatment and include hip protectors, bracing, exercise, vertebroplasty, and kyphoplasty. This increasing range of treatment options allows better matching of therapy to patients.

Laparoscopic surgery has developed quickly and is preferred over laparotomy for most surgery in female infertility. In vitro fertilization (IVF) has emerged as the main treatment for tubal infertility, but surgery still has a definite place. In particular, patients with hydrosalpinx should undergo a laparoscopy for evaluation of salpingectomy before IVF or reconstructive surgery for attempts of spontaneous conception. Mild-to-moderate adhesions are also suitable for surgery. Although it has been shown that fibroids influence implantation negatively, the value of myomectomy for small and intramural or subserosal fibroids has been insufficiently investigated. The surgical management of endometriosis is controversial. The ablation of endometriotic peritoneal implants might increase the spontaneous conception rate. Repeat surgery in severe disease should be avoided. The indications and results for these and other fertility-enhancing procedures are evaluated according to the most recent publications.

The intrauterine device (IUD) has experienced a resurgence of popularity. Much of this popularity is attributable to reassessments of the association between IUD use and pelvic inflammatory disease (PID) in which authors conclude that the association is attributable to factors other than the IUD. This article examines recent studies that assess the risk of PID with IUD use, explains why some of the assumptions on which the arguments regarding a lack of an association between IUD use and PID are based might not be correct, and recommends additional trials to evaluate IUDs as one of several contraceptive options.

The rate of congenital syphilis is declining in the United States, but congenital syphilis is still a significant public health problem. Maternal serum screening is the mainstay of diagnosis. Maternal treatment will prevent most, but not all, cases of congenital syphilis. Access to prenatal care is critical to further reduce the rate of congenital syphilis.

Postpartum endometritis is an important cause of maternal morbidity after cesarean section. Prophylactic antibiotic therapy reduces the risk by approximately 60%. The benefit of antibiotic therapy for laboring women has been established. For nonlaboring patients, there is still some uncertainty. Intravaginal metronidazole as surgical preparation and oral methylergometrine after delivery are two interventions that show promise as additional prophylactic interventions. The gold standard therapy, once endometritis has been diagnosed, is intravenous clindamycin and gentamicin. If an alternative regimen is chosen, it should have a similar spectrum, including good coverage for gram-positive anaerobes such as Bacteroides fragilis. Antibiotic therapy can be discontinued once the patient is afebrile without continued oral antibiotics. Treatment failure occurs in approximately 10% of cases and should trigger investigation of other infectious complications. Prolonged fever of undetermined etiology is not uncommon and requires prolonged antibiotic therapy, with or without heparin.

The financial, emotional, and personal costs of dealing with urinary tract infections are tremendous. However, these expenditures are multiplied when the infections become recurrent. The categorization, pathogenesis, and treatment strategies of recurrent urinary tract infections have developed significantly during the past 10 years. Clearly, those with recurrent urinary tract infections have differences at the cell surface level that render them more susceptible. Treatment is changing direction from combatting bacteria with antimicrobials to bolstering host defenses.