Current women's health reports最新文献

Long QT syndrome is a hereditary disorder of cardiac ion channels causing abnormal electrical activation of the heart and leading to life-threatening ventricular tachycardia. Syncope, ventricular tachycardia, or sudden cardiac death in the absence of structural heart disease is the typical presentation, often starting in childhood. Women are more commonly affected by both the congenital form and the drug-induced acquired form of this disease and are particularly at risk in the postpartum period. The long QT syndrome can be recognized by a prolonged QT interval on the electrocardiogram. Several mutations in six genes encoding subunits of cardiac potassium and sodium channels have so far been identified, and gene-specific epidemiology, risk stratification, and management are emerging. beta-blockers are the mainstay of therapy for primary prevention of cardiac events and implantable defibrillators for secondary prevention. Patient education, screening of family members, and increasing awareness of this disorder among physicians are important steps toward prevention of sudden death in these otherwise healthy young individuals.

Due to the high incidence of breast cancer and the excessively high false-positive rate of current screening technologies, adjunctive risk assessment measures are needed. Nipple aspiration cytologic analysis and random fine-needle aspirations have been proposed; however, ductal lavage and cytologic analysis of the effluent is a more sensitive and specific test. The dilemma lies in what should be done subsequent to a ductal lavage yielding malignant or atypical cells. Discussion of the proceeding procedures and potential management strategies are discussed.

The latest report from the National Cholesterol Education Program has reaffirmed that the primary lipid goal for the prevention of atherosclerotic vascular disease (AVD) is to achieve a normal low-density lipoprotein (LDL) cholesterol (<130 mg/dL) by diet in normal individuals, and by diet and statin therapy in patients with multiple risk factors. Patients with any clinical AVD (which includes diabetes) will need a statin to achieve an optimal LDL cholesterol (<100 mg/dL). The recent Heart Protection Study might revise our thinking further. Patients at high risk achieved a reduction in mortality and vascular events taking simvastatin 40 mg, even if they had a low baseline LDL value. Individuals with the metabolic syndrome and insulin resistance do not typically have a very high LDL, but rather have elevated triglycerides and a low high-density lipoprotein (HDL) cholesterol. They, too, need to be treated with a statin, first to achieve an appropriate LDL goal. This is insufficient if the triglyceride value exceeds 200 mg/dL. They should be treated to achieve a non-HDL cholesterol goal (equal to total cholesterol minus HDL cholesterol) that is 30 mg/dL higher than the LDL goal.

Fatigue is common in women with gynecologic cancers and is thought to be multifactorial. Anemia, cachexia, pain, and depression are frequently associated with cancer and treatment-related fatigue and should be evaluated and treated. The National Comprehensive Cancer Network Fatigue Practice Guidelines are helpful in the assessment and treatment of women with gynecologic cancer-related fatigue.

Primary treatment of advanced ovarian cancer is well established. The combination of tumor debulking and platinum/taxane polychemotherapy has led to improved treatment results in recent years. However, most patients with ovarian cancer will relapse, rendering treatment of recurrent ovarian cancer of great clinical interest. Relapse therapy should depend on the treatment-free interval. Patients with progressive disease during primary treatment or cancer relapse within 6 months after the completion of primary treatment are platinum refractory, and, therefore, prognostically unfavorable. For these patients with poor outcome, quality of life should be predominantly considered before initiation of treatment. Cancer relapse after an interval of more than 6 months after the completion of primary treatment cannot be cured; however, platinum-based chemotherapy, in individual cases combined with secondary tumor debulking, can lead to persisting remissions.

Evidence from the obstetric literature suggests that the frequency of labor induction is increasing. According to the National Center for Health Statistics, the rate of labor induction has more than doubled during the past 10 years: from 9% in 1989 to 19.9% in 2000. As labor induction has become more widely used in recent years, the number of medications used for preinduction cervical ripening has expanded greatly. In this article, we review the evidence-based literature assessing the safety and efficacy of the most common cervical ripening and labor induction agents.

The stage and tumor remnants after radical surgery are the most important prognostic factors in patients with ovarian cancer. Because the incidence of ovarian cancer is highest in elderly women, and mostly advanced stages occur, radical surgery is necessary in this population as well as in younger patients. Age and the surgeon's expertise are the factors that influence the quality of surgical treatment of ovarian cancer. Surgical treatment of ovarian cancer should therefore be confined to centers with the required infrastructure and expertise.

Fetal cells in maternal blood represent the future of prenatal screening and diagnosis. The possibility of analyzing fetal cells recovered from maternal blood could provide screening and diagnostic protocols characterized by high sensitivity and specificity with no direct risk to the developing fetus. Years of investigation have thus far not led to the development of reliable and consistent protocols; nonetheless, fetal cell recovery promises to be an attractive addition to noninvasive prenatal diagnosis.

Approximately 50% of all pregnant women experience back pain during pregnancy. The causes and risk factors associated with the back pain encountered during pregnancy continue to be evaluated. The key to evaluating and managing these patients is the history and physical examination. Recognizing characteristics of the frequently encountered back pain of pregnancy as well as uncommon sources of back pain during pregnancy is essential in establishing an accurate diagnosis and initiating prompt and effective management.