Climacteric complaints, female identity, and sexual dysfunctions.

Forty early menopausal women seeking relief from sexual symptoms within a long-term marital relationship and 40 matched women seeking relief of climacteric complaints completed questionnaires concerning three subject: vasomotor and psychosocial symptoms, sexual dysfunctions, and female identity. Results showed that women with sexual dysfunctions were more likely to suffer from vasomotor and psychosocial complaints and their feminine identity was based mainly on ideals of motherhood and beauty. In addition, sexual desire disorders were present significantly in those women with higher psychosocial symptoms, while sexual arousal disorders were particularly evident in women suffering more vasomotor symptoms.

Pituitary LH reserve suggests high risk of bulimia in amenorrheic women.

The present study was aimed at investigating a) the risk of having bulimia in a heterogeneous population of secondary amenorrhea; b) the LH and FSH secretion under basal and stimulated conditions (GnRH challenge) according to the presence of bulimic risk in our study population; c) the clinical and endocrine factors predictive of the bulimic risk in amenorrheic women. Amenorrheic women (n=73; age: 23.1+/-4.8 yrs; BMI:20.2+/-2.2 kg/m2) filled in a self rating scale for bulimia (BITE) and were classified accordingly, as being at low risk (score <10), at medium risk (score between 10 and 24), and at high risk (score > or =25) of having bulimia. In each subject basal mean plasma LH levels were calculated over one hour, sampling every 10 minutes, while in a subgroup of 45 patients the area under the curve (AUC) of plasma LH and FSH levels following a challenge with two doses of GnRH (10+10 microg, every two hours), sampling every 15 minutes, was also evaluated. High risk of bulimia was present in 12.3% of the population whereas 45.2% showed a low risk and 42.5% were at medium risk of developing the disorder. Mann-Whitney U test revealed that basal LH values were differently distributed with significantly lower levels (P<0.046) in amenorrheic women at high risk of bulimia in comparison with amenorrheic women at low risk. The AUC of LH secretion following the first challenge of GnRH was significantly higher in amenorrheic women with a high risk of bulimia in respect with both groups of women at low (P<0.034) and medium (P<0.009) risk. A similar result was found with FSH AUC following the first GnRH challenge (P<0.04 high risk vs low risk and P<0.014 high risk vs medium risk). In a multiple regression analysis, the best model predicting the risk of bulimia (BITE total score) included both the LH response to GnRH challenge and BMI. In conclusion, when facing secondary amenorrhea at first consultation, long before a precise pathophysiologic diagnosis of the disease, low basal plasma LH levels and LH response to GnRH challenge may allow one to suspect the presence of abnormal eating pattern of bulimic type.

[Acute appendicitis in patients under 5 and over 60 years of age]. / L'appendicite acuta nei pazienti al di sotto dei 5 anni d'età e al di sopra dei 60.

The authors reviewed the records of 48 patients, 24 under age 5 and 24 over age 60, from a total of 690 patients who underwent emergency appendectomy for acute appendicitis between 1974 and 1989. The natural history of acute appendicitis was similar for the two groups. A perforated appendix was found in 20.8% of patients under age 5 and in 37.5% of patients over age 60; the corresponding rate for the total of 690 patients was 12.8%. The high percentage of perforation, when compared to the total of patients, is probably due to the thin wall of the appendix in infants and to the inability of the child to communicate the effective symptoms. As for the elderly, a reduction of the lymphoid and muscular tissues associated with a reduced lumen and vascularization of the organ, and at last, a delay in seeking medical care could account for the high perforation rate. The most common complications were due to infection. The mortality rate was 0% in children and 8.3% in the over-sixty age group.