Treatment Of Female Patients Research Articles

Gender-based issues in interventional cardiology: a consensus statement from the Women in Innovations (WIN) initiative

Cardiovascular disease (CVD) is the leading cause of mortality in women, yet studies have suggested that it is often under-recognized. Of particular concern is the apparent suboptimal treatment of women in comparison to men, with less revascularisation and use of evidence-based medications. The Women in Innovations group of cardiologists aims to highlight these issues and change perceptions to optimize the treatment of female patients with CVD, to support future research, and to encourage and guide training of female interventional cardiologists.

Transposition of Distal Urethra in Female Patients with Recurrent Lower Urinary Tract Infections Associated with Sexual Intercourse

Background: Recurrent lower urinary tract infection (UTI) is often associated with sexual intercourse. Usually these patients are young females. Repeated courses of antibiotic therapy help some, but not helpful to all patients. Distal urethra vaginal ectopy seems to play an important role in accumulating microorganisms, resulting in recurrent UTI. The repositioning of the distal part of the urethra may potentially minimize microbial contamination in this area. Objective: The purpose of this study is to share the results of minimal invasive procedures, such as distal urethral transposition, in the treatment of female patients with symptomatic UTI associated with sexual intercourse. Patients: A total of 328 woman (mean age 25.9 years) with recurrent symptomatic lower UTI associated with sexual intercourse and repeated unsuccessful conventional treatment were found to have intravaginal urethral displacements during vaginal examinations. Two hundred and seventy-one patients underwent distal urethral transposition (group I) – a procedure depicted on a DVD provided with this article. Fifty-seven patients (mean age 25.9 years) with the same histories, anatomical findings, and symptoms and signs of lower UTI, receiving conventional treatment, served as controls (group II). The mean follow-up time of the 271 patients from group I was 52.5 months (48 – 57 months). Surgical Procedure: The operation makes it possible to withdraw the meatus from the area concerned. Measurements: All patients were initially diagnosed and treated for chronic cystitis and urethritis for at least 6 months without success. During vaginal examinations, special emphasis was given to the position of the distal urethra. A plastic penile imitator was introduced vaginally to evaluate urethral movements simulating intercourse. All patients were required to avoid sexual intercourse postoperatively for 1 month and were treated with standard antibiotic therapy for a mean time of 3 weeks. Results and Limitations: Patients from group I were evaluated after 3 months, showing no postoperative complications. Examinations of 204 (75.3%) patients from group I 1 year later showed no symptoms or signs of UTI. Sixty-seven (24.7%) patients required further antimicrobial prophylaxis after the procedure because of the longer preoperative duration of their symptoms. Nineteen patients (7.0%) showed poor results. One hundred and eighty-three patients were available for additional examinations after 3 and 5 years, (mean 4.4 years) revealing stable results with no lower UTI for these patients. Group II patients were followed-up for 1 year. Fortysix (80.7%) of them were found to have recurrent symptoms with poor response to the therapy, and had to undergo repeated treatment. Conclusions: Young female patient suffering from recurrent lower UTI should be evaluated with a specific emphasis on possible intravaginal urethral displacement during sexual intercourse. Conventional treatment can be long and often unsuccessful for the majority of patients. Distal urethral transposition is feasible, replicable, and can be used for these patients, leading to good and stable results in 93% of cases.

Long-term continuation treatment after short-term day treatment of female patients with severe personality disorders: Body awareness group therapy versus psychodynamic group therapy

Objective: To investigate and compare the treatment effects of psychodynamic group therapy (PGT) and body awareness group therapy (BAGT) as outpatient treatment following day treatment for personality disorders. Materials and methods: Twenty-one female patients given PGT were compared with 29 female patients receiving BAGT. The average length of outpatient therapy was 24 and 25 months, respectively. The patients were assessed trough the quality assurance system of the Norwegian Network of Psychotherapeutic Day Hospitals, including the Mini International Neuropsychiatric Interview (M.I.N.I.) and Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) for diagnostic purposes. Outcome was assessed using the Global Assessment of Functioning (GAF), Symptom Check List 90-R sum score (Global Severity Index, GSI), Circumplex of Interpersonal Problems (CIP), at admission and at discharge from day treatment, and at the end of outpatient group therapy. Results: Patients undertaking BAGT improved significantly on GAF, GSI and CIP, and reported high ratings of satisfaction with therapy and group climate at the end of outpatient treatment. The magnitude of change on GAF and CIP was significantly higher in the BAGT group compared with the PGT patients who displayed only minor changes after outpatient treatment. Conclusions: BAGT is possibly an effective outpatient continuation therapy for women with severe personality disorders, but because of limitations of this study, these results warrant a larger randomized study.

Age at diagnosis predicts outcomes in gefitinib-treated female patients with non-small-cell lung cancer

We performed this retrospective study to evaluate the association between age at diagnosis and outcome in female patients with non-small-cell lung cancer, who were treated with gefitinib. We analyzed the outcomes for 162 female patients who had received gefitinib monotherapy. Receiver operating characteristic curve analysis was performed to select a cutoff value for age with respect to tumor response. Patients were categorized as older and younger, with a value of 55 years. Most of the study population comprised never-smokers (89%) and patients with adenocarcinoma (82%). The mean age was 58 years and the response rate was 47% (76 patients). Older female patients showed higher response rates than younger patients (57% and 27%, respectively; P < 0.001), whereas there were no differences between never-smokers and smokers ( P = 0.824). Patients with adenocarcinoma had better response rates than those with nonadenocarinoma but this difference was not significant (50% and 34%, respectively; P = 0.139). In terms of progression-free survival, older age ( P = 0.005) and adenocarcinoma histology ( P = 0.008) were favorable factors but never-smoking was not ( P = 0.316). Multivariate analysis confirmed that age predicted progression-free survival (hazard ratio, 0.60; P = 0.008) and overall survival (hazard ratio, 0.60; P = 0.014). Our data indicate that age at diagnosis may predict outcomes after gefitinib treatment in female patients with non-small-cell lung cancer. When molecular tests are not feasible, our results might help physician to select a beneficial subgroup in female patients.

Home Treatment as an Alternative to Hospital Admission for Mothers in a Mental Health Crisis: A Qualitative Study

This study explored the experiences, treatment preferences, and needs of mothers of dependent children who were treated at home as an alternative to hospital admission for an acute severe mental health crisis. In this qualitative study, mothers were recruited who were treated by one of four crisis resolution teams in two inner London boroughs. Semistructured interviews were conducted with 18 mothers and five of their children. Transcripts were coded by thematic analysis to extract relevant themes. Home treatment provided good patient care, but most participants felt that they struggled to parent adequately and to meet their children's needs. Common difficulties included meeting the children's physical needs, feeling emotionally distant, being dependent on children during the crisis, and struggling to protect the children from exposure to symptoms or distress. Most mothers preferred home treatment to hospital admission, because they felt safer and better looked after at home. However, most children preferred parental hospital admission, because it relieved the children of distress and responsibility. Mothers were reluctant to seek help with parenting from professionals because of fears of custody loss. Home treatment for female patients with child care responsibility meets patients' needs, but their children may be exposed to additional risks and currently lack appropriate support. The needs of children should be considered in the planning of home treatment for psychiatric crises.

How effective is tegaserod for the treatment of female patients with mixed subtype IBS?

This Practice Point commentary discusses the findings and limitations of a study by Chey and colleagues that evaluated the safety and efficacy of tegaserod in women with mixed subtype IBS (alternating constipation and diarrhea) or constipation-predominant IBS. This trial, the largest performed in patients with mixed subtype IBS, demonstrated improvement in both global and individual IBS symptoms in patients treated with tegaserod (6 mg twice daily) compared with those receiving placebo. Tegaserod was generally well tolerated, with the most common adverse event being diarrhea. The limitations of the study include short duration (4 weeks) and the absence of men. This trial confirms the outcomes of previous studies demonstrating that pharmacologic modulation of the serotonin system can improve IBS symptoms in some patients. Unfortunately, the immediate clinical relevance of this study is now questionable, given the withdrawal of tegaserod from the US market in March 2007.

Xience V Spirit Women Clinical Trial: Characterization of the Female Population Undergoing Stent Implantation

The XIENCE V SPIRIT WOMEN study will focus on specific aspects of women's health in relation to coronary artery disease, such as menopausal status, use of hormonal contraceptives or their surrogates, and the referral path and symptoms at presentation. The study is a prospective, open-label, single-arm, multicenter study designed to evaluate the performance of the XIENCE V Everolimus-Eluting Coronary Stent System in the treatment of female patients with coronary artery lesions. It also includes a prospective, single-blind, double-arm, randomized, multicenter substudy, in which patients will be randomized in a 2:1 ratio between the XIENCE V stent and the CYPHER Plus. In total, approximately 2000 female patients, derived from the general interventional cardiology population, will be enrolled from up to 130 sites outside of the USA.

Photoepilation

The field of dermatological laser medicine consists of four main areas: therapy for blood vessels, therapy for pigmented lesions, ablation of tissue, and photoepilation. The first tests were carried out in 1993, and since 1996 there has been a growing demand for "permanent hair removal." This strong demand and the rapid development of devices call for extensive knowledge in terms of current technical innovation or affirmation of proven procedures. This article gives a general survey of the different systems that can be used for "permanent hair removal" [ruby laser, alexandrite laser, diode, Nd:YAG laser, so-called intense pulsed light (IPL) systems, and combined radio frequency/IPL systems], including their inherent advantages and disadvantages. Physical and biological aspects necessary for photoepilation are pointed out. Furthermore, we emphasize new methods concerning removal of depigmented and therapy-resistant hair, as well as the treatment of female patients with polycystic ovary syndrome.

An unusual case of advanced bilateral male breast cancer

Background: Breast cancer in men is a rare malignancy. The majority institutions involved in treatment of male patients with breast cancer do not have a wide experience as it is mostly based on single cases rather than clinical studies. Case report: We report an unusual case of a 46 years old male patient presenting with a 6 years history of breast cancer. The patient was diagnosed with cancer of the left breast and surgically treated with modified radical mastectomy with no axillary dissection in the district general hospital. The reason for not doing axillary dissection is unknown. Adjuvant therapy consisted of 4 x EC, radiotherapy and tamoxifen. 2 years later there was a local recurrence in the area surrounding mastectomy scar and skin metastases on the chest wall as the most dominant clinical sign. The patient underwent axillary dissection and rotating plastics and continued to be treated with chemo-and endocrine therapy. Later local recurrences and progression of skin metastases were treated with various systemic and local chemotherapies, and intraarterial administration of chemotherapy. 5 years later the patient was also diagnosed with inflammatory cancer in the right breast. Further progression of disease affected the chest walls along with consequent limitations of the movements of the neck and the left arm. Two months prior to death liver metastases were detected. Conclusion: In case of male breast cancer surgical treatment including axillary dissection and adjuvant therapy are necessary as it is equally required in treatment of female patients with breast cancer

Serum levels of sex steroid hormones and matrix metalloproteinases after intra-articular glucocorticoid treatment in female patients with rheumatoid arthritis

Objectives:To study metalloproteinase activity and sex steroid hormone production in serum after intra-articular glucocorticoid treatment for knee synovitis.Methods:18 female patients with rheumatoid arthritis and synovitis of the knee with need...

Monoamine oxidase A variant influences antidepressant treatment response in female patients with Major Depression

The monoamine oxidase A (MAO-A) has been suggested to be involved in the pathogenesis as well as the pharmacological treatment of Major Depression. In the present study, 340 patients with a Major Depressive Episode ( f = 194, m = 146; DSM-IV) of Caucasian descent were genotyped for the functional MAO-A VNTR. The clinical response to antidepressive pharmacological treatment was assessed by weekly intra-individual changes of HAM-D-21 scores over six weeks. The longer MAO-A alleles (3a, 4, 5) conferred a significant risk of slower and less efficient overall response over the course of 6 weeks of antidepressant treatment in patients with Major Depression, with the effect being restricted to female patients ( p = 0.028; corrected for multiple testing). The present results suggest that high-activity MAO-A genotypes possibly by consecutively decreased serotonin and/or norepinephrine availability negatively influence antidepressant treatment response during the first six weeks of pharmacological treatment in female patients with Major Depression.

Effects of Bladder Training and/or Tolterodine in Female Patients with Overactive Bladder Syndrome: A Prospective, Randomized Study

We compared the effects of bladder training and/or tolterodine as first line treatment in female patients with overactive bladder (OAB). One hundred and thirty-nine female patients with OAB were randomized to treatment with bladder training (BT), tolterodine (To, 2 mg twice daily) or both (Co) for 12 weeks. Treatment efficacy was measured by micturition diary, urgency scores and patients' subjective assessment of their bladder condition. Mean frequency and nocturia significantly decreased in all treatment groups, declining 25.9% and 56.1%, respectively, in the BT group; 30.2% and 65.4%, respectively, in the To group; and 33.5% and 66.3%, respectively in the Co group (p<0.05 for each). The decrease in frequency was significantly greater in the Co group than in the BT group (p<0.05). Mean urgency score decreased by 44.8%, 62.2% and 60.2% in the BT, To, and Co groups, respectively, and the improvement was significantly greater in the To and Co groups than in the BT group (p<0.05 for each). Although BT, To and their combination were all effective in controlling OAB symptoms, combination therapy was more effective than either method alone. Tolterodine alone may be instituted as a first-line therapy, but may be more effective when combined with bladder training.

Emergency department management of sexually transmitted infections in US adolescents: Results from the National Hospital Ambulatory Medical Care Survey

Study objective Adolescents are at risk for developing a variety of sexually transmitted infections for many reasons. Many of these adolescents present to the emergency department (ED) for their care. We describe the management of adolescent sexually transmitted infections in US EDs. Methods Data were obtained from the 1992 to 1998 National Hospital Ambulatory Medical Care Survey. All visits by adolescents aged 12 to 19 years were identified by any International Classification of Diseases, Ninth Revision code related to sexually transmitted infections. Treatment was reviewed and compared with existing guidelines from the US Centers for Disease Control and Prevention (CDC). Multivariate logistic regression was used to determine the independent association of each of the following variables on antibiotic prescribing rates: sex, race and ethnicity, hospital location, age, and insurance. Results Eighteen thousand nine hundred ninety-nine records that represented 70,693,603 adolescent visits to US EDs were identified during the 7-year study period, of which 351 records representing 1.2 million visits were for a sexually transmitted infection. Mean age was 17.1 years, and 92% were female patients. Overall, 80% of patients diagnosed with a sexually transmitted infection were treated (received antibiotics or were admitted to the hospital); 91% of patients had pelvic inflammatory disease and 71% of patients had other sexually transmitted infections. Eight percent of patients diagnosed with pelvic inflammatory disease were admitted to the hospital. However, treatment for female patients with pelvic inflammatory disease was fully compliant with CDC recommendations in only 35% of cases (95% confidence interval [CI] 19% to 45%) and partially compliant in another 45%; 20% (95% CI 12% to 31%) of patients received either no treatment or treatment not in accordance with guidelines. Male patients were more likely to be treated for sexually transmitted infection (adjusted odds ratio [OR] 6.3; 95% CI 1.0 to 38.7), and Hispanic patients were less likely (adjusted OR 0.3; 95% CI 0.1 to 0.9) to be treated. Age, insurance type, and hospital location were not a factor in receiving antibiotics. For female patients who had a sexually transmitted infection, only 43% had a pregnancy test done, and of all adolescents diagnosed with a sexually transmitted infection, only 1 (0.3%) had an HIV test performed. Conclusion Significant numbers of adolescents sought care for sexually transmitted infections in US EDs. Evaluation and treatment of these adolescents is not optimal. Male patients are more likely to be treated for a sexually transmitted infection. Hispanic patients are less likely to be treated for a sexually transmitted infection. Pelvic inflammatory disease is not always treated with antibiotics, and few patients with pelvic inflammatory disease are admitted to the hospital. HIV testing was almost never done. Further study is necessary to explain these disparities and optimize care.

Efeitos da radioiodoterapia nas gerações futuras de mulheres com carcinoma diferenciado de tireóide

A radioiodoterapia tem conseguido desempenhar um papel significante no tratamento do carcinoma diferenciado de tireóide. A literatura é limitada em relação a possíveis efeitos secundários do 131I, embora o interesse tenha aumentado nesse campo. A importância de se saber mais sobre os efeitos mutagênicos da radiação em filhos de mães expostas ao 131I para tratamento do carcinoma diferenciado de tireóide é devida à possibilidade de ocorrência de abortos, anormalidades genéticas e aparecimento de malignidades nas crianças. Nesta revisão da literatura vários estudos têm demonstrado a segurança desse tipo de tratamento em mulheres na idade fértil, sendo apenas aconselhadas a evitar gravidez pelo período de, pelo menos, um ano após a administração da radioiodoterapia.

Valproic acid fails to induce polycystic ovary syndrome in female rats

Purpose: Valproic acid (VPA) treatment in female patients is suggested to be associated with the occurrence of a variety of endocrine side effects that include many characteristic symptoms of polycystic ovary syndrome (PCOS). The aim of our study was to prospectively measure whether VPA treatment was associated with the presentation of PCOS symptoms in rats, as well as determine whether this model could be used to examine the underlying mechanism by which these effects are induced. Methods: Normal estrus-cycling female rats ( n=22) were treated perorally three times daily with VPA (300 mg/kg/day), divalproex sodium (DVS) (330 mg/kg/day), or phosphate-buffered saline for a minimum of 30 days. PCOS-associated symptoms (estrus cycle, weight, estradiol and testosterone levels, aromatase activity, and ovarian morphology) were assessed at baseline, mid-, and endpoint. Results: There was no significant difference in the mean number of days animals were in proestrus–estrus or metestrus–diestrus between the three groups. All groups of animals gained weight during the study and there were no appreciable differences in mean weight gain or leptin between groups. Total serum estradiol or testosterone levels and ovarian aromatase activity were not significantly different between the groups. The number of corpora lutea was not significantly different between the groups; however, cystic follicles were present in 50% of the drug-treated animals compared to 25% of saline-treated animals. Conclusions: VPA and DVS treatment were associated with a higher proportion of animals developing cystic follicles but did not mimic the VPA-induced PCOS that is observed in women. Thus, it appears that the rat has limited usefulness for modeling VPA-induced symptoms associated with PCOS.

Growth potential of female prolactinomas

BACKGROUND The indications for treatment in female patients with small prolactinomas and mild or no symptoms are controversial. The aim of this study was to investigate whether we can predict the growth potential of a given small prolactinoma. METHODS The proliferation potential of 25 female prolactinomas and 5 prolactin-containing adenomas found incidentally at autopsy was determined immunohistochemically using the Ki-67 (MIB-1) antibody. The results were compared according to age, clinical and endocrine findings, and tumor volume. RESULTS Small prolactinomas (<1.0 cm 3) with mild hyperprolactinemia (<150 ng/mL) showed significantly low proliferation potential irrespective of age, resembling prolactin-containing adenomas found at autopsy. The patients tended to present with mild symptoms and rarely had estrogen deficiency. CONCLUSION These findings indicate that female patients with a small prolactinoma, mild hyperprolactinemia, and no symptoms or those who do not desire fertility may have no specific reason for treatment, but can be followed by serum prolactin level and serial magnetic resonance imaging.

Alosetron, a 5‐HT3 receptor antagonist, delays colonic transit in patients with irritable bowel syndrome and healthy volunteers

Alosetron is a potent and selective 5-HT3 receptor antagonist, which has been shown to be beneficial in the treatment of female patients with non-constipated irritable bowel syndrome. To investigate the effect of alosetron on whole gut, small bowel and colonic transit in patients with irritable bowel syndrome (Study 1) and healthy volunteers (Study 2). Thirteen patients with irritable bowel syndrome and 12 healthy volunteers. Both studies were randomized, double-blind, placebo-controlled with a two-way crossover design, in which each subject received alosetron (2 mg b.d. administered orally) or placebo for 8 days. Mean whole gut transit was determined from the excretion of radio-opaque markers; small bowel transit was determined from rise in breath hydrogen after a meal; and colonic transit and segmental transit were evaluated from abdominal X-ray. In addition, colonic transit was calculated by subtracting small bowel transit time from whole gut transit time. Alosetron increased colonic transit time by prolonging left colonic transit in both patients with irritable bowel syndrome and controls. This resulted in a tendency for the whole gut transit to be delayed in irritable bowel syndrome patients (P=0.128), which was confirmed in controls (P=0.047). Alosetron delays colonic transit by prolonging left colonic transit. These results add to the body of evidence suggesting that alosetron should have a therapeutic role in patients with non-constipated irritable bowel syndrome.

An alternative mantle irradiation technique using 3D CT- based treatment planning for female patients with Hodgkin’s disease

Purpose: For female patients, radiotherapy treatment for Hodgkin’s disease invariably results in the irradiation of breast tissue that may lead to radiation induced secondary cancers. The risk for secondary breast cancer is correlated with dose. We have developed a technique in an attempt to increase breast sparing during mantle field irradiation for female patients. Material and Methods: To minimize the irradiated breast volume, a virtual simulation technique making use of a Styrofoam breast immobilization board has been developed whereby the patient lies prone with the breasts positioned in grooves within the board. The breast position is adjusted using Styrofoam wedges, and breast placement is verified using an AP CT-pilot view. A CT scan of the neck and thoracic regions is taken, and the lymph nodes, breast volume and critical structures are outlined. Virtual simulation of the mantle fields (typically AP/PA isocentric beams) is performed, and beam blocks are drawn on the digitally reconstructed radiographs (DRR) generated by the virtual simulation package. The shielding is designed to allow adequate margins around the lymph nodes while maximizing shielding of the lung and breast tissues. The para-aortic fields are also easily determined through virtual simulation, where multi-planar reconstructions (MPR) and 3D renderings of the patient’s CT data are used to determine the field limits and beam gaps. In addition to allowing for the geometric optimization of the positioning of the breasts under the lung shields, the virtual simulation technique provides the necessary information for a 3D dosimetric analysis, including dose-volume histograms (DVHs) of the irradiated breast volume. Results: The 3D breast sparing technique was qualitatively and quantitatively compared to non-CT-based techniques and other 3D techniques currently available to assess the protection of the breasts. In a preliminary analysis, virtual simulation images (DRRs, 3D rendering and multi-planar reconstruction) demonstrated the advantage of using the breast sparing technique. A further analysis of DVHs showed a reduction of at least 50% in the volume of breast tissue irradiated when using the breast positioning board and virtual simulation as compared to the conventional simulation techniques where a breast immobilization board was not used. Conclusions: The use of a breast immobilization board and of a virtual simulation technique is recommended for the planning and treatment of female patients with Hodgkin’s disease. DVH analysis has shown that this leads to a decrease in the volume of breast irradiated. It is hoped that this approach will reduce the risk of secondary breast malignancies in female patients with Hodgkin’s disease.

Comparative Analysis of Azithromycin and Doxycycline Efficacy in the Treatment of Female Patients with Acute Urethral Syndrome Caused by Ureaplasma urealyticum

(2000). Comparative Analysis of Azithromycin and Doxycycline Efficacy in the Treatment of Female Patients with Acute Urethral Syndrome Caused by Ureaplasma urealyticum. Journal of Chemotherapy: Vol. 12, No. 2, pp. 186-188.

Consecutive Urinary Gonadotropin and Ovarian Hormone Excretory Patterns during LH-RH Analog Treatment in Female Patients with Central Precocious Puberty

To study the initial stimulative and subsequent suppressive effects of Luteinizing hormone releasing hormone analog (LHRH-a) therapy on the hypothalamic-pituitary-ovarian axis, serial urinary excretion of gonadotropin and ovarian steroids were investigated in 23 female patients with central precocious puberty. Among them, seven were treated with intranasal administration of buserelin (G1), seven with daily subcutaneous injection of buserelin (G2) and nine with subcutaneous injection of super-long-acting LHRH-a every 28 days (G3). After the initial therapy in G1, the levels of urinary gonadotropin excretion increased greatly with a high level persisting for a longer period. Responding to these increases, the levels of urinary total estrogen excretion increased to an excessively high maximum level. After the initial injection in G3, the levels of urinary gonadotropin and total estrogen excretion were augmented at the same time for a shorter period with a lesser excretion of urinary total estrogen. Ovarian cysts developed after urinary total estrogen attained a maximum and tended to grow depending on the duration and degree of high urinary total estrogen excretion.The size of ovarian cysts was greater in G1 than in G3. During therapy in all groups, the mean urinary gonadotropins were significantly suppressed compared with pretreatment. The mean urinary total estrogen excretory level during treatment in G1 was not significantly suppressed compared with before treatment, but on the other hand, with significant suppression in G3. During therapy, urinary FSH excretion increased within 24 hours of every injection of super-long-acting LHRH-a with a slight rise in LH only in all patients in G3 studied. Studies in many more patients are required because the number of subjects was limited in this study.