Attacks In Women Research Articles

Disease expression in women with hereditary angioedema

Fluctuations in sex hormones can trigger angioedema attacks in women with hereditary angioedema. Combined oral contraceptive therapies, as well as pregnancy, can induce severe attacks. The course of angioedema may be very variable in different women. Within the PREHAEAT project launched by the European Union, data on 150 postpubertal women with hereditary angioedema were collected in 8 countries, using a patient-based questionnaire. Puberty worsened the disease for 62%. Combined oral contraceptives worsened the disease for 79%, whereas progestogen-only pills improved it for 64%. During pregnancies, 38% of women had more attacks, but 30% had fewer attacks. Vaginal delivery was usually uncomplicated. Attacks occurred within 48 hours in only 6% of cases. Those more severely affected during menses had more symptoms during pregnancies, suggesting a hormone-sensitive phenotype for some patients. The course of angioedema in women with C1 inhibitor deficiency is affected by physiologic hormonal changes; consequently, physicians should take these into account when advising on management.

Statins and Adverse Cardiovascular Events in Moderate Risk Females: A Statistical and Legal Analysis with Implications for FDA Preemption Claims

This article presents: (1) meta analyses of studies of cardioprotection of women and men by statins, including Lipitor (atorvastatin), and (2) a legal analysis of advertising promoting Lipitor as preventing heart attacks. The meta analyses of primary prevention clinical trials show statistically significant benefits for men but not for women, and a statistically significant difference between men and women. The analyses do not support (1) statin use to reduce heart attacks in women based on extrapolation from men, or (2) approving or advertising statins as reducing heart attacks without qualification in a population that includes many women. The legal analysis raises the question whether Lipitor's advertisements, which omit that Lipitor's clinical trial found slight increased risk for women, is consistent with the Food, Drug, and Cosmetics Act and related Food and Drug Administration (FDA) regulations. The analysis suggests that FDA regulation should not preempt state law actions challenging advertising that is not supported by FDA-approved labeling. Our findings suggesting inadequate regulation of the world's best-selling drug also counsel against courts accepting the FDA's claimed preemption of state law causes of action relating to warnings and safety. Courts evaluating preemption claims should consider actual agency performance as well as theoretical institutional competence. Billions of health care dollars may be being wasted on statin use by women but the current regulatory regime does not create incentives to prevent such behavior.

P.6.001 Comorbid anxiety and mood disorders in patients with alcohol abuse and alcoholism: a pilot case-control study

The term menstrual migraine refers to migraine that is associated with menstruation by more than chance, but it does not define pathophysiology. Menstrual migraine affects about 20–25% of female migraineurs in the general population, and 22–70% of patients presenting to headache clinics. In women diagnosed with menstrual migraine, perimenstrual migraine attacks are associated with substantially greater disability than their non-menstrual attacks. Loose interpretation of diagnostic criteria has led to conflicting results in studies on prevalence figures, clinical characteristics, and response to treatment. Importantly, clinical trials often do not distinguish between perimenstrual attacks in women diagnosed with menstrual migraine and attacks associated with menstruation by chance. Two pathophysiological mechanisms have been identified: oestrogen withdrawal and prostaglandin release. Although management strategies targeting these mechanisms might be effective, the evidence is not robust. Given how common and debilitating this distinct condition is, more research investment is needed to expand understanding of its pathophysiology and to develop more effective treatment strategies.

Premenstrual Attacks of Acute Intermittent Porphyria in an Adolescent Female

Background: Acute intermittent porphyria (AIP) is an autosomal dominant inherited disorder causing decreased activity of the heme biosynthetic pathway. AIP can be a severe and potentially life-threatening syndrome which presents a clinical quandary. Endogenous steroids are significant determinants of disease activity, as displayed by the female preponderance, the rarity of attacks prior to puberty and after middle age, and the presentation of premenstrual attacks in women. Patients with AIP require prompt evaluation, diagnosis, and management.

Hormone-Related Headache

Epidemiological data suggest a link between migraine and the female sex hormones. Indeed, it is known that estrogen affects various brain functions, including pain perception. The prevalence of migraine is similar in boys and girls before puberty, but is 3-fold higher in postpubertal females compared with males. Migraine attacks in women are more likely to occur in the perimenstrual period and occur exclusively so in some women. The acute treatment of menstrual migraine is similar to that of non-menstrually related attacks, but the response to treatment may be less favourable. Perimenstrual prophylaxis, with NSAIDs, triptans or estradiol, is effective in decreasing attack frequency and severity. The use of oral contraceptives (OCs) may change migraine frequency and severity. Since both migraine and hormonal contraceptive use are risk factors for ischaemic stroke, the use of OCs in women who experience migraine should be made only after consideration of the benefit-risk ratio. Migraine typically, but not invariably, improves during the last two trimesters of pregnancy, and may worsen in the postpartum period. When using drugs to treat migraine during pregnancy, potential risks to the mother and fetus should be considered. The prevalence of migraine decreases with advancing age and it improves in many, but not all, women after the menopause. However, in the perimenopausal period, migraine may worsen as a result of fluctuations in estrogen levels. Reducing the estrogen dose and changing the estrogen type or the route of administration of hormone replacement therapy (HRT) from oral to transdermal may reduce headache. Migraine is not a risk factor for stroke in postmenopausal women. When considering symptomatic HRT for postmenopausal migraneurs, the usual indications and contraindications should be applied. HRT may also exacerbate migraine.

Further Evaluation of Rizatriptan in Menstrual Migraine: Retrospective Analysis of Long‐term Data

To determine the long-term efficacy of oral rizatriptan 10-mg wafers in the treatment of menstrual migraine attacks. Data from an extension study where patients with migraine used rizatriptan 10 mg to treat moderate or severe migraine attacks occurring over periods of up to 6 months were included in a retrospective analysis. Patients used a diary card to record details of each migraine attack and onset of menstruation. Attacks in women were classified as menstrual or nonmenstrual according to 3 time windows relative to onset of menstruation (day 0): -3 to +3 days (7-day window), -2 to + 2 days (5-day window), and 0 to +1 days (2-day window). The analysis looked at the efficacy of rizatriptan 10 mg by menstrual category of attack for each definition on three measures: pain relief at 2 hours (reduction of pain to mild or none), pain free at 2 hours, 24-hours sustained pain free (pain free at 2 hours with no headache recurrence and no use of additional medications from 2 to 24 hours). Ninety-five women used rizatriptan 10 mg to treat a total of 1,839 attacks. The percentage of menstrual attacks was 30% for the -3 to +3 days definition, 23% for the -2 to +2 days definition, and 11% for the 0 to +1 days definition. Rizatriptan 10 mg was equally effective in menstrual and nonmenstrual migraine attacks regardless of the definition used. For example, using the -3 to +3 days definition, 78% of menstrual migraine attacks were relieved at 2 hours after dosing compared with 78% of nonmenstrual attacks. Pain relief rates for the other definitions were as follows: -2 to +2 days, menstrual = 78%, nonmenstrual = 78%; 0 to +1 days, menstrual = 79%, and nonmenstrual = 78%. No differences between menstrual and nonmenstrual attacks were found for the 2-hour pain free and 24-hour sustained pain free measures for any of the three definitions. Rizatriptan 10-mg wafers were equally effective in the treatment of menstrual and nonmenstrual migraine attacks occurring over 6 months, regardless of the precise definition of menstrual association used and even when the outcome criteria were very stringent. These data provide further evidence that triptans are effective treatments for menstrual migraine.

Summaries for patients. Unrecognized heart attacks in women with known coronary artery disease.

Summaries for patients. Unrecognized heart attacks in women with known coronary artery disease.

Estradiol supplementation suppresses hyperventilation-induced attacks in postmenopausal women with variant angina

OBJECTIVESWe sought to examine whether estradiol (E2) supplementation suppresses anginal attacks in women with variant angina.BACKGROUNDEstrogen is known to improve endothelial function. Coronary spasm plays an important role in the pathogenesis of not only variant angina but also ischemic heart disease in general, and endothelial dysfunction seems to be involved in the pathogenesis of coronary spasm.METHODSFifteen postmenopausal women with variant angina (mean age 54.2 years) were given a hyperventilation (HV) test, a provocation test for coronary spasm, in the early morning of day 1 (baseline), day 3 (after 2-day transdermal E2supplementation, 4 mg) and day 5 (after 2-day placebo administration). We measured the flow-mediated (endothelium-dependent) dilation (FMD) of the brachial artery with the ultrasound technique before each HV test.RESULTSThe anginal attacks with ST segment elevation were induced by HV in all patients on days 1 and 5. However, no attacks were induced on day 3. Supplementation with E2augmented FMD (3.5 ± 0.6∗, 8.9 ± 0.7 and 4.0 ± 0.5∗ on days 1, 3 and 5, respectively; ∗p < 0.01 vs. day 3). The serum E2levels on days 1, 3 and 5 were 22.7 ± 2.8∗, 96.2 ± 9.2 and 30.7 ± 7.1∗ pg/ml, respectively (∗p < 0.01 vs. day 3).CONCLUSIONSThe present results demonstrated for the first time, to our knowledge, that E2supplementation suppresses the HV-induced attacks in women with variant angina, in part because of the improvement of endothelial function.

Migraine in women: hormones, triggers and pregnancy

Migraine is estimated to affect 8-10% of the adult population, with women affected three times more often than men (Johnson and Johnson, 1998). Before puberty, boys and girls suffer in equal numbers, suggesting the hormonal changes that occur during puberty in girls, and remain throughout adulthood, trigger migraine attacks in women. About 60% of female migraine sufferers have menstrually-related migraine, with attacks exacerbated around this time of the month (Epstein et al, 1975).

Effects of chronic morphine on biliary tract responses to cholecystokinin-octapeptide in female guinea pigs

Acute and chronic opiates impairs the emptying of bile from the gallbladder of male guinea pigs. In view of the higher incidence of gallstone attacks in women, the aim of this study was to determine if this impairment would extend to female guinea pigs. Implantation of morphine pellets (400mg) in female guinea pigs did depress CCK-induced emptying of gallbladder bile. Likewise, gallbladder muscle strips isolated from the morphine treated animals showed depressed responses to CCK. The morphine treatment also antagonized CCK-induced cessation of bile flow present in female guinea pigs. In addition, the morphine treatment blocked both CCK-induced phasic contractions of the isolated isolated Sphincter of Oddi and the secondary cessation of bile flow observed following iv CCK. Thus this study demonstrates that opiate antagonism of CCK does extend to the biliary tract of female guinea pigs, and suggests that resultant biliary stasis could facilitate gallstone formation.

Tuberculous peritonitis and laparotomy.

Tuberculous Peritonitis and Laparotomy M. F. Dixon, M.B., and J. A. Davies, M.R.C.P. 674 Hospital Advisory Service G. W. Taylor, M.R.C.G.P 674 Rh Immunization in Ruptured Tubal Pregnancy R. D. Barr, M.R.C.P 674 Thiocyanate Metabolism in Human Vitamin Bi Deficiency A. G. Freeman, F.R.C.P 675 Children of Anaesthetists R. Wyatt, M.B., D.A. and A. M. Wilson, F.F.A. R.C.S. 675 Contact Sensitivity to Toothpaste L. G. Millard, M.R.C.P 676 Constraints on Consultants R. D. Scott, M.R.C.P 676 Tumoral Calcinosis in Britian K. S. Vasudev, M.B., and others 676 Drop Attacks in Women -N. Capener, F.R.C.S.; T. E. Lear, M.R.C.PSYCH. 676 Cell-mediated Immunity in Thyroid Disease N. R. Farid and others 677 Teachers and Patients H. H. 0. Wolff, F.R.C.P 677 Serum Alkaline Phosphatase and Rickets in Urban Schoolchildren A. S. Truswell, M.D 677 Lignocaine in Donor Blood J. A. G. da Costa, M.R.C.P., and others ...... 677 Congenital Hemihypertrophy A. W. Johnston, M.D 678 Day Hospitals and Day Centres J. R. Wilkie, M.B 678 Diseases of Western Civilization Surgeon Captain T. L. Cleave, M.R.C.P.; W. M. Castleden, F.R.A.C.S 678 Viral Infection and Renal Transplant Rejection J. R. T. Gabriel, M.R.C.P., and others...... 679 Postherpetic Neuralgia J. M. S. Pearce, M.D 679 Tragic Dilemma J. Lowther, M.B 679 Oil Myelography D. J. Mitchell, F.F.R.R.C.S.I 680 Efficacy of Whooping-cough Vaccines G. W. J. Bousfield, M.D 680 Immunization against Influenza T. C. G. Smith, M.B 680 Short-term Service Abroad P. Rabindran, M.R.C.P 680 Role ofPacing after Myocardial Infarction Helen H. Tucker, M.B., and others ........ 680 Cranial Nerve Palsy in Tetanus R. P. Patel, M.B., and M. Sorokin 681 Mode of Action of Verapamil D. G. McDevitt, M.D., and R. G. Shanks, M.D 681 Gateshead Tuberculin Survey E. L. Feinmann, F.R.C.P., and others ...... 681 Pregnancy after Hysterotomy R. F. Heys, M.R.C.O.G 681 Loin Percussion in Acute Pyelonephritis B. T. B. Manners, M.R.C.P 682 Earnings of General Practitioners J. Winter, M.D.; E. Platts, M.R.C.O.G.......682 Management of the N.H.S. P. N. Dixon, D.P.H 682 London Pride? R. Buchan, F.R.C.S.ED 682

Drop Attacks in Women

Drop Attacks in Women

Drop Attacks in Women

Drop Attacks in Women

Cryptogenic drop attacks: an affliction of women.

A drop attack was defined as falling without warning, not apparently due to any malfunction of the legs, not induced by change of posture or movement of the head, and not accompanied by vertigo or other cephalic sensation. All 33 patients attending a neurological clinic with a primary complaint fulfilling these criteria were women, and a further seven examples were found by questioning 200 consecutive patients at a gynaecological clinic. No affected male was found.In all but one patient, falls occurred only when walking. They were not due to wearing high-heeled shoes. The average age at onset was 44.5 years and in younger women onset was often during pregnancy. The accepted causes of drop attacks were not found with certainty in any of these patients. The sex incidence and the circumstances of the falls suggest that the cause may lie in differences between the two sexes in the mechanism of walking rather than in any central disturbance. Drop attacks in women commonly occur as an isolated symptom for many years, and although distressing have no serious prognostic implications.

The EEG in cerebral ischemic lesions in women taking oral contraceptives.

This paper correlates the clinical angiographical and electroencephalographical findings of cerebral ischemic attacks in women using oral contraceptives to reveal any differences between these EEG changes and the EEG changes of patients suffering cerebral lesions without hormonal provocation. Material for this study was gathered from EEG recordings of 33 women with an average age of 28 years all of whom had been using oral contraceptives and had suffered cerebral ischemic attacks. The women were divided into 2 groups: 1) those who had experienced transient attacks of 5 minutes to 24 hours in duration and 2) those who had symptons of longer duration. The electroencephalographic abnormalities did not correlate with the duration of contraception or the occurrence of vasomotor headaches. A CORRELATION was found between severity and localization of the EEG changes and the clinical findings as well as with the angiographically verified arterial occlusions. The EEG findings for the group using oral contraceptives were of the same nature as those for the non-hormone-using patients with cerebrovascular insults.