Age-of-onset of menopause is associated with enhanced painful and non-painful sensitivity in fibromyalgia.

Fibromyalgia (FM) is a chronic pain condition characterized by high prevalence in women. In particular, estrogen deficit has been considered as a potentially promoting factor of FM symptoms. This study was aimed to examine the relationship between age-of-onset of menopause and pain sensitivity in FM. For this purpose, pain sensitivity was assessed in 74 FM and 32 pain-free control women. All participants were postmenopausal and underwent a detailed semi-structured clinical interview, including data about menopause transition, previous history of hysterectomy or ovariectomy, and menses time. Participants were divided into two groups depending on age-of-onset of menopause: early menopause [≤49 years] vs. late menopause [>49 years]. Pain and non-pain thresholds were assessed by using cold, heat, mechanical, and electrical stimulation. FM women showed higher overall pain sensitivity as compared with healthy subjects. FM women with early age-of-onset of menopause displayed greater pain and non-pain sensitivity than FM women with late age-of-onset of menopause, whereas no differences were observed in healthy women due to age-of-onset of menopause. These results suggest that an early transition to menopause (shortening the time of exposure to estrogens) may influence pain hypersensitivity and could be related to aggravation of FM symptoms.

[Prevalence of cholelithiasis in El Real-Gandia]. / Prevalencia de la enfermedad colelitiásica en El Real-Gandia.

The aim of this study was to know the prevalence of cholelithiasis (C) in the El Real-Gandia (Spain) as well as the degree of the response of the population. Health examinations were performed in 1,803 adults from El Real (2,000 inhabitants) and Gandia (54,000 inhabitants) using abdominal echography as the screening technique. Cholelithiasis was defined as the presence of biliary lithiasis (BL) or previous cholecystectomy (PC). Of 1,268 (70.3%) participants in the study, C was found in 126 cases (BL in 102 and P in 24) representing a standardized prevalence of around 15% in women and 5% in men. Cholelithiasis was more frequent in females (13.8%) than in males (5.7%) (p < 0.001) increasing linearly with age (p < 0.005). The proportion of PC was significantly higher in women (23.9%) than in men (5.9%) (p < 0.05) and in Gandia (34.4%) than in El Real (13.8%) (p < 0.02). The prevalence of biliary mud and polyps was of 0.3% and 1.1%, respectively. Working obligations (35.4%) and fear of hospitals (22.4%) were the most frequent causes for no response (NR). Males with more than primary a school education originating from outside the Valencian community (VC) were significantly associated with NR in multivariant analysis.

[The significance of the elevation of basal and exercise segments on Q-leads after acute myocardial infarct]. / Significado de la elevación basal y al esfuerzo del segmento ST en derivaciones con onda Q tras un infarto agudo de miocardio.

INTRODUCTION: ST segment elevation on Q-leads has been related to a greater infarct size and to the existence of ventricular aneurysm. On the other hand, ST elevation during exercise testing has been related to the presence of myocardial viability. OBJECTIVES: In the present study we investigated the relation between ST segment elevation on infarct-related electrocardiographic leads at rest and during exercise with: a) the extension and severity of the regional dysfunction; b) the presence of myocardial viability (response to dobutamine), and c) the residual stenosis in the culprit artery. MATERIAL AND METHODS: The study group was composed of 51 patients; cardiac cathetherism (8 +/- 3 days) and exercise testing (8 +/- 2 days) were performed during the pre-discharge period. In contrast ventriculography (centerline method) we determined the circumferential extension (rads) and the severity (SD/rad) of the regional dysfunction at rest and after dobutamine (10 micrograms/kg/min). The minimal luminal diameter (MLD) in the culprit artery was also measured. Results are expressed as median [Q1-Q3] and the differences among the groups were assessed by Mann-Whitney U. RESULTS: Patients with ST segment elevation in two or more leads at rest (n = 36) showed a greater (41 [30-51] rads vs 20 [14-41] rads; p = 0.007) and more severe regional dysfunction (1.9 [1.5-2.5] SD/rad vs 0.6 [0.5-2.4] SD/rad; p = 0.01), less response to dobutamine (% of reduction of the dysfunction extension after dobutamine) (17 [0-42]% vs 50 [24-100]%; p = 0.004) and smaller MLD (0.5 [0-0.9] mm vs 0.8 [0.6-1.1] mm; p = 0.03). Likewise, patients with exercise-induced ST segment elevation (n = 28) showed less response to dobutamine (15 [0-45]% vs 40 [21-57]%; p = 0.03) and smaller MLD (0.5 [0-0.7] mm vs 0.9 [0.5-1] mm; p = 0.02). There were non significant differences between patients with and without ST elevation during exercise in the extension or severity of the regional dysfunction. ST segment elevation both at rest (RR 0.2; CI 95% 0.04-0.85) and during exercise (RR 0.19; CI 95%: 0.05-0.69) decreased the probability of improvement with dobutamine. CONCLUSIONS: We conclude that ST segment elevation on Q-leads at rest is related to a more extended and severe dysfunction. Patients with ST segment elevation (at rest or during exercise) show less response to dobutamine (myocardial viability less likely) and a more severe residual coronary stenosis.

[The pseudothrombophlebitic syndrome: a new diagnostic approach]. / El síndrome pseudotromboflebítico: una nueva aproximación diagnóstica.

The clinical manifestation of popliteal or Baker's cysts, either intact or complicated due to rupture or dissection, can be a thrombophlebitis (pseudothrombophlebitis), greatly difficulting the differential diagnosis and the management of these patients, being their treatment completely different. The doppler echography is a reliable, quick and low-cost method which allow to differentiate between this two types of pathology and the magnetic resonance (MR) is the ideal technique to assess the complications of popliteal cysts. We present a case of pseudothrombophlebitis due to compression of the popliteal vein by a Baker's cyst.