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The article discusses the causes of genitourinary disorders (GD) and also highlights several treatment options for GD. Topics discusses include use of U.S. Food and Drug Administration (FDA)–approved dimethyl sulfoxide in the treatment of interstitial cystitis, effectiveness of acupuncture in the treatment of bedwetting, and the role of probiotics in maintaining a healthy intestine and helping in digestion.

Here we report a case of co-infection with Orientia tsutsugamushi, the causative agent of scrub typhus, and Arsenophonus nasoniae in a woman with a rash and an eschar who returned from a trip to Southeast Asia. A. nasoniae was previously considered to be a secondary insect and tick endosymbiont of unknown pathogenicity in humans. We amplified both O. tsutsugamushi and A. nasoniae DNA from a skin eschar with qPCR, and a seroconversion for O. tsutsugamushi and A. nasoniae was observed with immunofluorescence assays and western blotting for this patient. And we used 2-D western blotting with an A. nasoniae antigen and polyclonal mouse anti-A. nasoniae antibodies produced in our laboratory to detect the specific antigenic A. nasoniae proteins. [ABSTRACT FROM AUTHOR]

The objectives of this study were to evaluate the clinical effectiveness of gentamicin as an initial empirical antimicrobial agent and to determine the effects of gentamicin resistance on clinical outcomes in women with uncomplicated acute pyelonephritis (APN). We analyzed data of 2,033 women with a diagnosis of APN admitted to Catholic University St. Vincent's Hospital. Of those, we enrolled 274 cases of community-acquired uncomplicated APN due to Escherichia coli who received gentamicin as initial antibiotics. Of these 274 patients, 47 patients had gentamicin-resistant (GM-R) E. coli APN, and 227 patients had gentamicin-susceptible (GM-S) E. coli APN. The early clinical response rates were 55.3% (26/47) versus 81.5% (185/227) at 72 hours; 61.7% (29/47) versus 96.9% (220/227) at 96 hours in the GM-R and GM-S groups, which was significantly higher in the GM-S group ( p < 0.001). Overall clinical cure rates were 100% (47/47) and 99.6% (226/227) in the GM-R and GM-S groups, respectively. APN patients in the GM-R group had longer hospitalization (9.72 ± 3.46 and 7.89 ± 2.27 days; p < 0.001) than those in the GM-S group. Resistance of E. coli to gentamicin, bacteremia, and C-reactive protein level showed independent effects on early clinical failure. Aminoglycoside such as gentamicin can be an alternative antibiotic option for initial empirical therapy of community-acquired uncomplicated APN as the fluoroquinolonesparing or broad-spectrum cephalosporin-sparing agents in an era of increasing antimicrobial resistance, especially in areas where medical resources are limited or antibiotic resistance rate of the uropathogens is high. [ABSTRACT FROM AUTHOR]

The quadrivalent human papillomavirus (HPV) vaccine was recommended in 2006 for routine vaccination of 11 or 12-year-old girls, with catchup through age 26 years, for the prevention of genital HPV-related diseases. The Vaccine Adverse Event Reporting System (VAERS) is a national spontaneous surveillance system of adverse events following vaccination in the United States. The objective of this study was to identify and review VAERS reports of invasive and in situ cervical cancer in women immunized with the quadrivalent HPV vaccine. A VAERS database search was performed to identify such cases reported in the United States from January 1, 2006, through April 9, 2009. Medical Dictionary for Regulatory Activities (MedDRA) search terms used were “cervix carcinoma,” “cervix carcinoma stage 0,” “cervix carcinoma stage III,” “carcinoma in situ,” and “cervical dysplasia.” Case inclusion required a report to contain a clear statement of a cervical carcinoma or carcinoma in situ diagnosis on any screening or diagnostic test after at least one dose of the HPV vaccine. All reports were reviewed by two investigators. Four VAERS reports for MedDRA term “cervix carcinoma,” one for “cervix carcinoma stage 0,” none for “cervix carcinoma stage III,” three for “carcinoma in situ,” and 53 for “cervical dysplasia” were identified. Of these, three cases of carcinoma in situ and one case of microinvasive cervical cancer met study inclusion criteria. Cases of cervical cancer and precancers are not unexpected in vaccinated women. Cervical cancer screening continues to be important, even for women who have received the HPV vaccine. [ABSTRACT FROM AUTHOR]

The prevalence of atrophic vaginitis (AV) is particularly high among postmenopausal women who experience decreased ovarian estrogen production. This common menopausal condition, which is often underreported and underdiagnosed, is caused by estrogen-related changes to the vaginal epithelium and can adversely affect quality of life. An accurate diagnosis of AV and its severity is important in choosing the appropriate treatment. Numerous formulations for estrogen therapy are available, and the safety and efficacy of these preparations for the treatment of AV have been evaluated in randomized controlled clinical trials. Although systemic administration of estrogen is effective in treating acute vasomotor symptoms typically associated with perimenopause and early menopause, standard doses may not be sufficient for the treatment of AV-related symptoms that generally arise after long-term estrogen deficiency. Thus, vaginal estrogen preparations (e.g., creams, tablets, rings) are more often recommended for women with moderate to severe AV. With any estrogen therapy, consideration of the potential adverse effects vs. associated benefits is necessary. Appropriate clinical intervention with vaginal estrogen formulations may safely offer postmenopausal women relief from undesirable symptoms and emotional distress associated with AV. [ABSTRACT FROM AUTHOR]

Background: This study examined dysfunctional sexual behavior and sexual concerns in women treated for posttraumatic stress disorder (PTSD). There were three objectives: to characterize the relationship between symptoms of PTSD and sexual outcomes, to examine the effect of treatment on sexual outcomes, and to examine the relationship between change in PTSD and change in sexual outcomes. Methods: Female veterans and active duty personnel with PTSD ( n = 242), 93% of whom had experienced sexual trauma, were randomly assigned to receive 10 weekly sessions of either Prolonged Exposure or Present-Centered Therapy. PTSD and sexual outcomes were assessed before and after treatment and then 3 and 6 months later. Results: At baseline, the reexperiencing, numbing, and hyperarousal symptom clusters were related to one or both sexual outcomes. Although prior analyses had shown that Prolonged Exposure resulted in better PTSD outcomes, there were no differences between treatments for either dysfunctional sexual behavior or sexual concerns. However, loss of PTSD diagnosis was associated with improvements in sexual concerns. Conclusions: The findings suggest that clinically meaningful improvements in PTSD are necessary in order to reduce sexual problems in traumatized women. [ABSTRACT FROM AUTHOR]

Postmenopausal osteoporosis is an asymptomatic skeletal disease that is often underdiagnosed and undertreated. Osteoporotic fractures are associated with substantial morbidity and mortality and impaired quality of life—socially, emotionally, and financially. Considering the growing burden of osteoporotic fractures worldwide, there remains an ongoing need for progress in the diagnosis of osteoporosis, identification of individuals at high fracture risk, and treatment to prevent fractures. Adequate intake of calcium and vitamin D is recommended as baseline therapy for osteoporosis prevention and treatment. Available pharmacological agents for the management of postmenopausal osteoporosis may not be appropriate for all women. Oral bisphosphonates are generally considered first-line therapy for patients with osteoporosis, but their use may be limited by gastrointestinal side effects. Other agents include hormone therapy, the selective estrogen receptor modulator (SERM) raloxifene, salmon calcitonin, teriparatide (human recombinant parathyroid hormone), and strontium ranelate (in some countries). Factors that may contribute to poor compliance and persistence with current osteoporosis therapies include drug intolerance, complexity of dosing regimens, and poor understanding of the relative benefit and risk with treatment. Emerging therapies for postmenopausal osteoporosis include novel SERMs (bazedoxifene, lasofoxifene, ospemifene, arzoxifene) and denosumab. Because SERMs can display mixed functional estrogen receptor agonist or antagonist activity depending on the target tissue, they may confer beneficial effects on bone with limited stimulation of other tissues (e.g., breast, endometrium). Clinical investigation of these promising new agents is ongoing to evaluate efficacy and safety, with the goal of developing effective strategies to maximize long-term tolerance, compliance, and persistence with therapy. [ABSTRACT FROM AUTHOR]

The article presents several topics related to women. A website in human health was developed by the Office of Research on Women's Health and the Food and Drug Administration. An increasing number of patients admitted to the hospital for medication of osteoporosis-associated fractures was reported by the Agency for Healthcare Research and Quality. A British study reveals that women with breast and ovarian cancer often choose to surgically remove their breasts or ovaries to reduce cancer risk.

Objective: We evaluated a series of questions pertaining to vulvar pain symptoms to determine their association with a localized vulvodynia (vestibulodynia) diagnosis in women from the general population. Methods: A sample of 12,435 women completed a self-administered screening questionnaire for the presence of specific types and characteristics of vulvar pain lasting 3 months or longer. Sensitivity, specificity, and predictive values were calculated for each cross-classification of vulvar pain type and characteristic, using as the gold standard 121 subjects with a clinically confirmed vestibulodynia diagnosis. Results: Relative to women with clinically confirmed vestibulodynia, 83% reported >10 episodes of pain on contact at the time of tampon insertion, intercourse, or pelvic examination, and 83% also reported pain on contact that limited or prevented sexual intercourse. These strong associations with a vestibulodynia diagnosis were not observed with respect to women who reported vulvar pain symptoms of burning or knifelike pain, or vulvar pain characteristics of continuous versus intermittent pain, or provoked versus spontaneous pain. Conclusions: Our findings suggest that a small number of symptoms may be suitable for identifying a large proportion of women suffering from vestibulodynia which may be ideal for the development of an effective screening test in the future. However, we also recognize that a large proportion of women experiencing vulvar pain symptoms will not meet the diagnostic criteria for vestibulodynia. Thus, implementing such a screening procedure as part of a routine examination or testing would require a subsequent pelvic examination to confirm a vestibulodynia diagnosis and to rule out other known explanations for vulvar pain. [ABSTRACT FROM AUTHOR]

We evaluated pain frequency and severity in 339 women enrolled in the Women's Interagency HIV Study (WIHS). Among these, 63% were 39 years of age or younger, 17% were white, 54% African American, and 29% Hispanic; 32% did not complete high school; 58% had a CD4 less than 200; 65% had clinical AIDS; 60% were on highly active antiretroviral therapy (HAART); and 32% had a viral load of 50,000 or more. Data were collected between 1996 and 1998. Within the past 6 months 190 (56%) women experienced pain 6 or more days and 168 (50%) women indicated pain severity scores of 4 or 5 (5-point scale). Pain frequency and pain severity were not associated with age, education, ethnicity, current therapy, or location of the WIHS site. Pain frequency and severity were related to lower CD4 count, higher depression, with a history and longer duration of smoking and use of marijuana. Severity was associated with a history of crack/cocaine or heroin use or with injection drug use as the transmission category. In the multivariate models, pain severity was related to CD4 count and depression and to current tobacco use but not to crack, cocaine, heroin, or marijuana use. Pain frequency was related to depression and to former tobacco, crack, cocaine, heroin, or marijuana use but not to current use. The long-term effects of tobacco use may be to increase pain experience but women may also smoke tobacco or use other substances to give mild pain relief. Pain is frequent and often severe among women with HIV requiring medical management. [ABSTRACT FROM AUTHOR]

This study was undertaken to determine the prevalence of female genital Aspergillus infections. Additionally, the study explored whether genital Aspergillus infections were associated with Aspergillus infections elsewhere (e.g., pulmonary, cardiac, orthopedic, or ophthalmologic). Between October 2005 and October 2007 vulvovaginal fungal cultures were performed for all patients seen in the Vulvar Disorders Center at the Good Samaritan Hospital (Cincinnati, OH) and similarly at Wright State Medical School Department of Obstetrics and Gynecology (Dayton, OH). Prospectively, any cultures showing Aspergillus species were segregated and a running list totaling 16 patients was maintained. The patients were all followed and examined at each subsequent visit for genital and extragenital disease. The patients responded to therapy with a culture-proven elimination of the fungus. Sporanox® (itraconozole; Janssen Pharmaceuticals, Titusville, NJ) 200 mg daily for 30 days proved to be the most objectively effective agent for fungus elimination. No systemic Aspergillus infections were observed during the follow-up period. [ABSTRACT FROM AUTHOR]

Background: Previous studies have suggested that women with cardiovascular disease may receive less aggressive care than men. Using a large cardiology database from a tertiary referral center, we sought to determine if treatment differences still persist in the current era. Methods: We analyzed data on 2462 patients who were referred for secondary prevention to the Preventive Cardiology Clinic at The Cleveland Clinic Foundation between 1997 and 2004. The primary objective was to evaluate use of effective secondary preventive therapies, by gender, as outlined in the ACC/AHA guidelines, such as antiplatelet therapy, beta-blockers, statins, and angiotensin-converting enzyme (ACE) inhibitors. Multivariate logistic regression analysis was performed to assess the independent effect of gender on all cause mortality. Results: Women were older (62.2 ± 11.1 vs. 59.4 ± 11.0, p < 0.001) and more likely to be hypertensive (68.1% vs. 56.1%, p < 0.001) than men. Overall, women were more likely than men to have higher baseline C-reactive protein (CRP) (6.14 ± 13.4 vs. 4.9 ± 10.7, p < 0.001), low-density lipoprotein cholesterol (LDL-C) (135 ± 66 vs. 116 ± 46, p < 0.001), high-density lipoprotein cholesterol (HDL-C) (52 ± 17 vs. 41 ± 11, p < 0.001), and total cholesterol (238 ± 98 vs. 202 ± 65, p < 0.001). Women were less likely to be on antiplatelet therapy (76.6 % vs. 85.0%, p < 0.001) and statins or any lipid-lowering therapy (62.6% vs. 67.1%, p = 0.04) compared with men on presentation. Conclusions: Even in the current era, women with established cardiovascular disease continue to receive less aggressive care than men. They are less likely to be on aspirin and statin therapy. More aggressive efforts should be made to treat both men and women with standard secondary preventive efforts. [ABSTRACT FROM AUTHOR]

Background: Atherothrombosis is associated with significant mortality and morbidity in both men and women. Management of this disease, however, is generally guided by evidence from trials conducted predominantly in men, with few studies focused on women alone. Our objective was to review the characteristics and management of atherothrombotic disease in women, with particular emphasis on the therapeutic role of antiplatelet agents. Methods: Landmark clinical trials and other studies pertaining to atherothrombosis in women (including risk factors, clinical outcomes, and treatment patterns) were obtained through Pubmed and Medline literature research and reviewed. Results: Primary prevention studies indicate a clear benefit of antiplatelet therapy in the reduction of cardiovascular events and, in particular, the risk of stroke in women ≥65 years. In men, this benefit is attributable to a reduction in the risk of myocardial infarction (MI). Combination therapies, including aspirin plus dipyridamole or clopidogrel, effectively reduce the risk of recurrent ischemic events in women. However, the effects are not consistent between men and women across studies. Similarly, gender differences exist in the effect of intravenous glycoprotein IIb/IIIa inhibitors plus aspirin on the risk of death or cardiovascular events. Conclusions: The effects of antiplatelet therapy regimens differ between men and women. The mechanisms underlying these differences are still to be elucidated; this report highlights the need for more studies focused on women in order to optimize gender-specific therapy and, therefore, improve clinical outcomes in women with atherothrombosis. [ABSTRACT FROM AUTHOR]

The article discusses constipation management in women in the U.S. The irregular and infrequent bowel movement is a common gastrointestinal disorder and is said to be prevalent in women than in men that rises up with age. The condition affects pregnant women by 38 percent that occur most often during the third trimester and even lasts until postpartum. Other causes of prevalence of the symptoms in women could be access to healthcare, cultural and psychological differences. Depression which is common in women may also caused bowel disorders. A medical study suggests that all women may practice exercises that would strengthen the pelvic muscle or seek medical intervention for immediate intervention.

Background: To assess the efficacy (in particular, in pain, functional impairment, and quality of life) and safety and tolerability (incidence of adverse events, discontinuation rates, changes in laboratory findings, and vital signs) of duloxetine in female patients with fibromyalgia. Methods: Data were pooled from two placebo-controlled clinical trials of similar design (randomized, 12-week, and double-blind), comparing duloxetine 60 mg a day (q.d.) or 60 mg twice daily (b.i.d.) ( n = 326) with placebo ( n = 212), in women who met the American College of Rheumatology criteria for primary fibromyalgia. Results: Compared with the patients receiving placebo, duloxetine-treated female patients demonstrated a significantly greater improvement in the Brief Pain Inventory (BPI) average pain severity score and in the Fibromyalgia Impact Questionnaire (FIQ) total score, beginning at week 1 and continuing through week 12 ( p < 0.001). Duloxetine was superior to placebo on all efficacy measures, including mean tender point threshold, Clinical Global Impression of Severity, Patient Global Impression of Improvement, and average interference from pain scores. The duloxetine-treated group was superior to placebo on all quality of life and functional measures, including each domain of the Medical Outcomes Study Short Form-36 (SF-36). A direct treatment effect of duloxetine on pain reduction was demonstrated and shown to be independent of secondary improvement in mood (based on BPI average pain score). Significantly more duloxetine-treated patients reported treatment-emergent adverse events (296 [90.8%] duloxetine-treated and 165 [77.8%] placebo-treated, p < 0.001). Rates of serious adverse events were similar between duloxetine-treated and placebo-treated patients. Conclusions: The pooled results of these studies demonstrate that duloxetine is a safe and efficacious treatment for both the pain and functional impairment associated with fibromyalgia in female patients, while significantly improving quality of life. [ABSTRACT FROM AUTHOR]

We describe the case of a 48-year-old woman who underwent emergent diagnostic and therapeutic laparoscopy after sustaining two self-inflicted abdominal stab wounds. After evacuation of approximately 1.5 L hemoperitoneum, a through-and-through liver injury with active bleeding was locally packed with hemostatic agents (Surgicel and Avitene) to achieve successful hemostasis. The patient also underwent systematic exploration of the abdominal cavity, which was free of associated injury. She had an uneventful recovery. This case adds to the growing evidence supporting the role of therapeutic laparoscopy in the safe management of carefully selected stable patients with penetrating abdominal trauma. [ABSTRACT FROM AUTHOR]

The article presents a conversation with Michelle Petri discussing lupus management. Systematic Lupus Erythematosus(SLE) is often diagnosed in women, particularly in their childbearing years. Common symptoms are kidney complications, skin rashes and pain or swelling in joints. It is also stated that SLE is a complicated, autoimmune disease needing an improve diagnosis and proper management. Michelle Petri also tackled the relation of estrogen to the disease, alternative and advanced treatment and future options of treating the disease.

Several abstracts of articles about human diseases is presented, including "Gabapentin for Hot Flashes in 420 Women With Breast Cancer: A Randomised Double-Blind Placebo-Controlled Trial," "Testosterone Patch Increases Sexual Activity and Desire in Surgically Menopausal Women With Hypoactive Sexual Desire Disorder," "Does Maternal Race or Ethnicity Affect the Expression of Severe Preeclampsia?" "The Probability for a Pap Test to be Abnormal is Directly Proportional to HPV Viral Load: Results From a Swiss Study Comparing HPV Testing and Liquid-Based Cytology to Detect Cervical Cancer Precursor in 13,842 Women" and "Comorbidity and Survival Disparities Among Black and White Patients With Breast Cancer."

Introduction: Lymphoepithelial carcinoma of the uterine cervix is rare. Fortunately, these lesions are responsive to treatment, and patients typically have a favorable prognosis. Case report: In this paper, we discuss the case of a 54-year-old woman who presented with pelvic pain. Imaging studies demonstrated an 11 × 6 cm complex pelvic mass. The patient was treated with abdominal hysterectomy and bilateral salpingo-oophorectomy. Final pathology revealed invasive lymphoepithelial-like carcinoma. She remains free of disease with 3 years of follow-up. Conclusions: Lymphoepithelial carcinoma of the cervix is a rare entity with few reports of clinical outcome following treatment. (J GYNECOL SURG 21:185) [ABSTRACT FROM AUTHOR]

Background: Metabolic syndrome and C-reactive protein (CRP) are independent predictors of cardiovascular disease (CVD) among women. The extent to which cardiorespiratory fitness influences the relationship between CRP and metabolic syndrome is unknown. Methods and Results: Cross-sectional associations among fitness, CRP, and metabolic syndrome were examined in 135 African American, Native American, and Caucasian women (55 ± 11 years, 28 ± 6 kg/m2). Fitness was quantified with a symptom-limited maximal treadmill exercise test. Plasma CRP concentrations were determined with the Dade-Behring high-sensitivity immunoassay. Metabolic syndrome was defined according to NCEP-ATP III. Metabolic syndrome, CRP, and fitness varied (p < 0.05) by race. Race-adjusted CRP values were directly associated (p <0.05) with each metabolic syndrome component. After adjusting for age and race, the relative odds of metabolic syndrome was 3.6 (95% CI = 1.5 - 8.4) in women with elevated (>2.0 mg/L) vs. low CRP. Adjustment for smoking, hormone therapy, body mass index (BMI), and HOMA insulin resistance did not eliminate this association (p < 0.05). The association between CRP and the metabolic syndrome was no longer significant (OR = 1.3, 95% CI = 0.9 - 5.9, p = 0.59) after adjustment for fitness. Conclusions: Higher cardiorespiratory fitness may be an important consideration in the milieu of vascular inflammation and metabolic syndrome. [ABSTRACT FROM AUTHOR]

Great advances have been made in the field of osteoporosis treatment and prevention in recent years that have led to the availability of powerful new drugs. These drugs are viewed by patients and physicians as a major breakthrough in the management of osteoporosis. Unfortunately, this view has led many to ignore the importance of concurrent calcium supplementation to ensure the maximum benefit from these drugs, as evidenced by the recent decline in use of calcium supplements. As the majority of patients fail to consume the minimum recommended dietary intake of calcium, it is critical to recommend calcium supplements to raise total daily calcium intake to the levels needed to ensure maximum efficacy of osteoporosis treatments. Furthermore, osteoporosis drug labeling should be strengthened to encourage proper use of these drugs in combination with calcium supplements. [ABSTRACT FROM AUTHOR]

This article discusses the cardiovascular disease. Women are about as likely as men to die of a heart attack. About 35% of heart attacks in women go unnoticed or unreported. Women are more likely to die after a first heart attack, and a similar fate awaits women who undergo coronary bypass surgery. One reason may be that women tend to reach the emergency room too late to benefit from lifesaving therapies. The traditional therapeutic approach to heart disease in women can be summed up as too little, too late, but that is now changing.

Discusses the acute and preventive therapy of urinary-tract infections (UTIs) for female patients. Factors that may contribute to the incidence of acute UTI in young women; Responsibilities of health care professionals who care for women due to the likelihood of having to treat many patients with symptomatic and asymptomatic UTIs; Symptoms of urethritis in women.

Visceral leishmaniasis (VL) or ka1a-azar (KA) affects the rural poor, causing significant morbidity and mortality. We examined the epidemiological and social impact of KA in an affected village in Bangladesh. A population-based survey of the village residents showed a case fatality rate of 14.7% among females and 5.3% among males. Before initiation of the study, female patients were ill longer than males before they received treatment, Future work needs to focus on understanding the implications of KA on women and to develop sustainable strategies for appropriate and timely access to treatment. [ABSTRACT FROM AUTHOR]

Carotid endarterectomy is the standard of care for people with severe symptomatic carotid stenosis. We analyzed population administrative data and clinical trial data to determine whether sex differences exist in the use and outcomes of this surgical procedure. We studied patients in Ontario who underwent carotid endarterectomy between 1982 and 1994 (n = 12,949) and patients with severe carotid stenosis who were enrolled in two randomized trials of endarterectomy (n = 1646). We compared the proportion of men and women who underwent carotid endarterectomy in each group, over time, and after adjustment for demographic factors. Men were twice as likely as women to receive carotid endarterectomy in the administrative analysis (65% versus 35%, p < 0.001) and in the clinical trial analysis (70% versus 30%, p < 0.001). The relatively lower use in women was consistent in every age group and in every year studied. Men in the administrative database were somewhat less likely than women to die or be institutionalized after surgery (5% versus 6%, p = 0.007). Men in the clinical trial database were also less likely than women to experience perioperative stroke or death, although the results were not statistically significant (6% versus 7%, p = 0.32). Patients who were assigned to surgical therapy, compared with those assigned to medical therapy, had a significant decrease in the risk of adverse events at 1 year, and the net benefit appeared similar in women and men. Carotid endarterectomy is performed relatively infrequently on women despite their similar lifetime burden of disease and similar short-term perioperative risks compared with men. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) genital infection is a sexually transmitted disease that affects a large proportion of college-aged women. In addition to the distressing medical aspects of HPV infection, sometimes including lengthy and painful treatments, symptom recurrence, a lack of a definitive cure, and its potential for malignant transformation, HPV also results in significant emotional and psychosexual sequalae for the patient. Concurrent with the range of negative emotions experienced by the patient is also a knowledge deficit regarding the disease, its prevention, and its management. This combination of factors within the young women afflicted with this disease often precludes them from effective adherence to their treatment and follow-up plan of care, which are both essential elements in managing this chronic condition. Clinicians who are treating patients with HPV infection must address not only the medical aspects of the disease, but the psychosocial needs as well. This case report describes a newly diagnosed young woman with HPV infection and discusses the necessary psychosocial and educational interventions that should be provided to all female patients who are diagnosed with HPV infection. Inclusion of these interventions can reduce the emotional stress that occurs with the diagnosis and can augment a patient's coping skills, thereby serving to improve adherence to the treatment plan and promote a greater sense of empowerment and wellness for the patient. [ABSTRACT FROM AUTHOR]

Epidemiological studies suggest that women with heart failure differ from men with heart failure in that their survival is better. Therapeutic trials have not clearly demonstrated a survival benefit for women. This study was to determine the tolerance for high doses of angiotensin-converting enzyme (ACE) inhibitor-nitrates in women versus men and to compare their symptomatic response, exercise tolerance, and ventricular functional improvement over 1 year. Eighty-eight sequential patients with heart failure, 54 men and 34 women with left ventricular ejection fraction ≤ 35%, were prospectively followed for 1 year. For all patients, ACE inhibitor-nitrate therapy was intensified. Each patient had three 6-monthly echocardiograms at baseline, at 6 months, and at 1 year, and metabolic stress testing. Patients were 57.3 ± 12.3 years old, with New York Heart Association (NYHA) class severity 2.6 ± 1.0. Lisinopril dosages were raised from 14 ± 14 mg/day to 57 ± 26 mg/day, isosorbide mononitrate from 15 ± 27 mg/day to 126 ± 72 mg/day, and carvedilol (n = 34) to 17 ± 16 mg/day. Women and men were epidemiologically comparable, with similar baseline echocardiographic parameters (left ventricular ejection fraction 19% ± 7% versus 17% ± 6%, respectively). Both tolerated up-titration in medical therapy. Final 12-month ejection fractions were equivalent for women and men at 34% ± 17% and 34% ± 13%, respectively, with similar improvements in left ventricular diameters. At 1 year, women had higher resting heart rates and remained more symptomatic with lower exercise capacity. However, the relative changes in NYHA status and aerobic capacity were similar for women and men. Thus, both women and men tolerated uptitrated ACE inhibitor-nitrate medical therapy, with comparable reversal of heart failure remodeling. Although women continued to be more symptomatic than men, relative improvements in symptomatic status, in execise capacity, and in hospitalization rate were equivalent. [ABSTRACT FROM AUTHOR]

The article presents various abstracts of studies presented at the Seventh Annual Congress on Women's Health & Gender-Based Medicine in June 1999. The research paper "Obstruction After Burch Retropubic Urethropexy: The Goal of Surgery," aims at the treatment of incontinence by surgery. Surgical intervention for incontinence may compound rather than cure by inducing a new problem, urge incontinence. This may result from increase in outlet resistance after the bladder neck suspension. The research paper "Assessing the Need for Women's Health Faculty Development Among Internal Medicine and Family Practice Teaching Faculty," focuses on increasing women's health in the curriculum of residents, by faculty development. A Multi-institution needs assessment among Internal Medicine and Family Practice teaching faculty for continuing medical education in women's health is reported. The paper "Factors Affecting Breast and Cervical Cancer Screening in Women With Disabilities," by Sandra L. Welner suggests that there are 28 million women in the U.S. with disabilities and the year 2000 census will certainly show higher figures. Such women are at the same or sometimes greater risk for the development of breast and cervical cancer.

The article presents information on a study which assessed predictors of reported performance of screening clinical breast examination (CBE) by internists, family physicians and gynecologists. Results from randomized controlled trials show the benefit of breast cancer screening among women 50-69 years of age. Meta-analyses have shown a 20%-30% reduction in death from breast cancer among women screened with mammography and CBE. This reduced mortality is evidence that early detection and treatment of asymptomatic breast cancers among women ages 50-69 years has a true advantage over no screening. As a result of these findings, annual or biannual mammography and CBE for women over age 50 is recommended by the U.S. Preventive Services Task, Force, the American College of Obstetrics and Gynecology, the American College of Physicians and the American Cancer Society. This study evaluates use of and attitudes about the use of CBE by primary care doctors. The goal was to uncover factors most highly associated with reported performance of screening CBE in a primary care setting.

This article addresses social and ethical priorities on the agenda for women's health research in the next century. Specifically, the relevance of genetic discoveries for healthcare reform and why both topics ought to be among these priorities are discussed. If the present gap between diagnosis and treatment of genetic diseases could be bridged, especially in such common diseases as cancer and heart disease, arguments for universal access to healthcare would be vastly strengthened. Important scientific and ethical problems are involved in bridging the gap, including volatile issues of research with human embryos and fetuses. Other issues deserve high priority on the women's health research agenda: adequate funding for biomedical research, maintaining an equitable number of women in clinical trials, and creating a knowledge base in gender-based biology. Progress in genetic research is clearly relevant to women's health for understanding and treating common diseases, as well as for reproductive decisions. Until recently, genetic services have been aimed exclusively at reproductive choices, including counseling, prenatal diagnosis, and carrier screening. However, the meaning of the term needs to be vastly broadened to include the uses of genetic information in mainstream medicine. Through genetic testing and DNA technology, it will be increasingly possible for physicians to have access to family history and a reliable profile of each patient's genetic health risks. Drugs will be designed that will be responsive to individual genetic variability and risks for disease. If scientific and ethical obstacles are overcome, there may also be effective human gene therapy to correct mutations and prevent lifelong harm. In my view, linking the agenda for women's health research with the unfinished social task of ensuring access to adequate primary and preventive care, which foreseeably will include genetic services and human gene therapy, strengthens the agenda and promotes solidarity with the needs of the majority of Americans. This link will help to prevent political and moral isolation of women's health research. [ABSTRACT FROM AUTHOR]

The article describes a laparoscopic right-liver trisectionectomy using the intrahepatic Glissonian approach, based on a video of a 22-year-old woman with a giant angiomyolipoma who was referred for surgical treatment. The surgical instruments, techniques and organ condition are also described. A commentary on the video and its content is presented.

Vaginal sildenafil citrate (Viagra, Pfizer, Inc., New York, NY) has been shown to be useful in increasing endometrial thickness and achieving pregnancy in women with varied uterine disorders. However, it failed to demonstrate favorable results in the setting of Asherman's syndrome, a condition characterized by the presence of uterine synechiae. We have successfully applied this treatment in two women noted to have inadequate endometrium after surgical resection of uterine synechiae. Both patients had a history of a postpartum uterine curettage with subsequent secondary infertility. Asherman's syndrome was surgically demonstrated and treated in both patients. Postoperatively, both patients were noted to have a thin endometrium and failed to conceive despite fertility treatment. Subsequently, these women achieved pregnancy in the first treatment cycle with vaginal sildenafil citrate. Using transvaginal ultrasound, endometrial thickness was noted to improve when sildenafil citrate was administered. It is suspected that this medication causes selective vasodilatation, resulting in improved endometrial development. [ABSTRACT FROM AUTHOR]

The article discusses developments in medical science. The American Heart Association has published new guidelines for preventing heart disease and stroke in women. The guidelines take a personalized approach to cardiovascular disease (CVD) prevention, tying the aggressiveness of treatment to the individual's risk of disease in the next 10 years. Women are classified as low, intermediate, or high risk based on a standardized scoring method developed by the Framingham Heart Study. The guidelines are based on the highest-quality evidence from all available research related to CVD prevention.

The article presents a list of research papers related to women's health published in various periodicals. Some of the papers included in the list are "Premature Menopause: Multiple Disruptions Between the Woman's Experience and Her Lived Body," by M.A. Boughton, published in the March 2002 of "Journal of Advanced Nursing;" "Estrogen-Replacement Therapy After Ischemic Stroke," by R.B. Ness, J.A. Cauley and L.H. Kuller, published in the March 21, 2002 issue of "New England Journal of Medicine;" "Recognition of Osteoporosis by Primary Care Physicians," by S.H. Gehlmach, M. Fournier and C. Bigelow, published in February 2002 issue of "American Journal of Public Health;" "Hormone Therapy and Heart Disease," by J.C. Stevenson, published in March 2002 issue of "Lancet;" "Body Mass and Stage of breast Cancer at Diagnosis," by Y. Cui, M.K. Whiteman, and J.A. Flaws, published in March 2002 issue of "International Journal of Cancer;" and Target Treatment of Female Urinary Dysfunction," by A. Capewell, published in March 2002 issue of "Lancet."