Biomedical subjects
Murray A Freedman
Publications and source records attributed to Murray A Freedman.
Quality of life and menopause: the role of estrogen.
The use of estrogen or hormone replacement therapy (ERT/HRT) in preventing disease in menopausal women has been well documented. Less attention has been paid to the menopausal symptoms that can impair the quality of life of menopausal women, such as hot flushes, sleep disorders, sexual dysfunction, and alterations in mood. Researchers have used a variety of methods to investigate these concerns. Decreases in ovarian hormones that occur with menopause have been implicated in these symptoms. Ovarian hormones affect the central nervous system and urogenital tissues directly via receptors for estrogen, progesterone, and androgens. Changes in the symptoms of menopause consequential to estrogen therapy reflect the effect of this therapy on these tissues. Evidence supporting the effectiveness of ERT/HRT in the treatment of symptoms affecting quality of life is growing and supports the use of ERT/HRT during menopause. Because the most dramatic hormonal changes associated with menopause are related to estrogen and because estrogen is usually coadministered with a progestogen in patients with an intact uterus, this review is focused primarily on ERT/HRT. Because androgen therapy may also improve quality of life by enhancing perimenopausal and postmenopausal sexual desire, function, and general well-being, a brief discussion of androgen supplementation of ERT/HRT is also included. The ideal doses and combinations of hormones must be determined on an individual basis, taking into consideration benefits, risks, and interactions of the different hormone therapies.
Necrotizing fasciitis in gynecologic and obstetric patients: a surgical emergency.
OBJECTIVE: We reviewed the cases of 23 patients who were admitted to the hospital with a primary diagnosis of histopathologically confirmed necrotizing fasciitis in the lower abdomen or pelvis. Rapid demise of a healthy postpartum women piqued our interest in trying to identify the early signs and symptoms that may lead to earlier diagnosis and treatment of this often fatal disease. STUDY DESIGN: A retrospective analysis of charts of all patients who were admitted to the gynecology and obstetrics services of our hospital systems with a diagnosis of necrotizing fasciitis for the past 14 years was performed. Age, comorbid factors, precipitating events, weight, symptoms and signs, microbiologic factors, radiographs, surgical therapy, and morbidity were correlated. RESULTS: Definitive operation was accomplished within 48 hours of the diagnosis of necrotizing fasciitis in all but 3 patients. Of the 17 patients who were not puerperal, 88% of the women were obese; 65% of the women were hypertensive, and 47% of the women were diabetic. Of the total 23 patients, 70% of the women complained of severe pain, and 35% of the women had radiographic diagnostics for necrotizing fasciitis ("gas"). Four patients had diverting colostomies, and 39% of the patients had flaps or synthetic grafts. Three patients died (mortality rate, 13%). One patient who was puerperal died of a severe rapid septicemia; the 2 late deaths were the result of systemic candidiasis. CONCLUSION: Necrotizing fasciitis is a rapidly progressive, often lethal, infectious disease process that requires early aggressive debridement. Any patient with inordinate pain and unilateral edema in the pelvis, especially in the puerperium, should be suspected of having this disease. Radiographic studies are often diagnostic of this condition. The triad of pelvic pain, edema, and any sign of septicemia carries an extremely grave prognosis and mandates immediate surgical intervention.
Female sexual dysfunction.
Happiness is an attitude, not an event! The glass is either half-full or half-empty; it simply depends on the viewer. Some rich people are miserable...some poor people are ecstatic. You cannot change the world but you can change yourself. You, and you alone, control your destiny. With very little practice, you can learn to think positively. Postmenopausal estrogen deficiency leads to urogenital atrophy. Sexual dysfunction and urinary dysfunction are the most inevitable but least publicized consequences of estrogen deficiency, and these represent important quality-of-life issues that patients and health care providers are often reluctant to discuss. In addition to estrogen deficiency, oophorectomized women may be subject to androgen deficiency and problems with libido. While the relationship with one's partner is the quintessential factor in female sexuality, hormone deficiency remains important, especially in reference to genital atrophy. Humans are the products of learned behavior. We literally become what we think. "I am sick and tired" becomes a self-fulfilling prophecy. Self-esteem represents learned behavior just as ego does...but there is a world of difference between the two. Sexuality is enhanced by good self-esteem and hindered by ego: two partners working together can reach far greater heights than either alone ever imagined...one and one can equal three! There are good data to substantiate that happy people have more sex and that people who have more sex are happier. Partners need to learn to honor one another, communicate in a positive manner, develop touching salutations, be a spouse at home, and make their bedroom a sacred sanctuary. With a little behavior modification and hormone therapy, sexuality can remain a priority ad infinitum.