Current women's health reports最新文献

Treating women suffering from trauma poses significant challenges. The diagnostic prototype of post-traumatic stress disorder (PTSD) is based on single-event trauma, such as sexual assault in adulthood. Several effective cognitive- behavioral treatments for such traumas have been developed, although many treated patients continue to experience residual symptoms. Even more problematic is the complex developmental psychopathology stemming from a lifetime history of multiple traumas, often beginning with maltreatment in early attachment relationships. A history of attachment trauma undermines the development of capacities to regulate emotional distress and thereby complicates the treatment of acute trauma in adulthood. Such complex trauma requires a multifaceted treatment approach that must balance processing of traumatic memories with strategies to contain the intense emotions this processing evokes. Moreover, conducting such treatment places therapists at risk for secondary trauma such that trauma therapists also must process this stressful experience and implement strategies to regulate their own distress.

Obesity is a problem of epidemic proportions that is associated with adverse cardiovascular outcomes. The long-term efficacy of currently available treatments is limited, and therapeutic benefits might paradoxically be achieved only at the expense of other serious adverse cardiovascular consequences. Owing to these limitations, new paradigms in the management of obesity are being explored, including expanded surgical and pharmacologic therapies. Recent discoveries in the pathogenesis of obesity, including the discovery of leptin, might lead to new treatment options. Leptin dysregulation within the central nervous system or in peripheral adipose tissue has a putative role in the pathogenesis of obesity. Furthermore, important differences exist between men and women in regard to leptin levels; these discrepancies might ultimately impact the therapeutic approach in a gender-specific manner. The goals of obesity therapy and the appropriate therapeutic endpoints are being evaluated to maximize the efficacy of therapy and improve cardiovascular outcomes, while diminishing the risk of adverse cardiovascular complications.

In the United States, coronary heart disease (CHD) is the leading cause of death for women. Combined with hypertension, stroke, and other vascular conditions, one in every two women dies annually owing to a cardiovascular condition. During the past 20 years, overall death rate from CHD has declined, but the rate of decline has been lower for women compared with men. Trials and studies have demonstrated that CHD might be preventable; however, optimal treatment strategies for women are still in question. It is, therefore, essential that the medical profession continues its current efforts to focus on the development of clinical practice guidelines that critically evaluate both diagnostic and therapeutic treatment options for women with CHD.

During pregnancy, significant changes occur in the hormonal and hemodynamic state of women that make arrhythmias more likely to occur. Palpitations are frequently reported, but are usually found to be associated with sinus tachycardia. The incidence of paroxysmal supraventricular tachycardia is increased during pregnancy, whereas atrial fibrillation and ventricular tachycardia are rarely seen. Women with long QT syndrome experience significantly more cardiac events in the postpartum period, making beta-blocker therapy most important during this time. Acute treatment of arrhythmias for pregnant women is much the same as that for nonpregnant patients. However, chronic drug therapy during pregnancy should be reserved for only the frequent, hemodynamically significant arrhythmia episodes.

Since its introduction in the 1960s, ultrasound (US) has never been more important in breast disease management as it is today. Its historical role as an adjunct modality to mammography in differentiating cystic from solid lesions has been widely expanded. US-guided sampling procedures represent widely accepted modalities in lesion evaluation. Preoperative localization under US guidance is one of the methods of choice for nonpalpable solid lesions. Screening breast US is currently being investigated and might prove useful for high-risk women and women with dense breasts. Continuous technologic advances, such as high-frequency transducers, new Doppler-based techniques, microbubble contrast agents, harmonic and compound imaging, three-dimensional US, elasticity imaging, US detection of microcalcifications, perfusion US imaging, and computer-aided diagnosis all carry promise of further increases in US utility in the diagnosis and detection of breast disease.

Menopause is arguably the most important phase of a woman's social, physiologic, and personal life. Approximately 1.3 million women reach this age in the United States annually. In the past decade, numerous studies have correlated breast cancer and the use of ERT (estrogen replacement therapy) or HRT (hormone replacement therapy) in menopausal women. Whether this is an actual increase in the creation of new cancers or a result of a diagnostic or other bias has yet to be determined. Even more uncertainty surrounds the use of hormones once breast cancer is diagnosed. Previously, once a woman was diagnosed with an estrogen-dependent tumor, ERT and HRT were simply forbidden. As discussed herein, that is no longer the case.

Congestive heart failure represents a growing health issue with significant morbidity, expense, and mortality. Unfortunately, despite heart failure affecting men and women equally, women historically have represented a minority in heart failure trials. Despite this disparity, treatment decisions rely heavily on these trials. Women with heart failure often have different clinical features than men, such as age of onset and comorbidities. Compared with men, women also demonstrate differences in remodeling and the response to injury, such as volume or pressure overload and myocardial infarction. We are only beginning to understand the clinical implications of these gender differences and their impact on pharmacologic treatments. After discussing these differences, a review of the agents useful in systolic failure is made, including angiotensin-converting enzyme inhibitors, b-blockers, digoxin, and aldosterone inhibition. Treatment of diastolic heart failure with empiric guidelines follows.

Obesity is a chronic disorder that is associated with significant co-morbidity and early mortality. Since the 1970s, amphetamines and amphetamine analogs have been trialed for weight loss. In 1997, the anorexigen agents, fenfluramine (Pondimin; AH Robins, Richmond, VA) and dexfenfluramine (Redux; Wyeth-Ayerst, Philadelphia, PA) gained worldwide attention when reports of associated cardiac valvulopathy and pulmonary hypertension emerged. A landmark report from the Mayo Clinic describing valvular heart disease (VHD) among women exposed to the anorexigen agent combination phentermine-fenfluramine ignited widespread concern, and the products were voluntarily withdrawn from the market by the manufacturers. Currently, the causal relationship between anorexigen agent use and valvulopathy has been validated, yet the extent and complexity of this important clinical issue remains ill-defined.