Complementary and alternative medicine and musculoskeletal pain in the first year of adjuvant aromatase inhibitor treatment in early breast cancer patients.

BACKGROUND: Patients with breast cancer (BC) show strong interest in complementary and alternative medicine (CAM), particularly for adverse effects of adjuvant endocrine treatment - e.g., with letrozole. Letrozole often induces myalgia/limb pain and arthralgia, with potential noncompliance and treatment termination. This analysis investigated whether CAM before aromatase inhibitor (AI) therapy is associated with pain development and the intensity of AI-induced musculoskeletal syndrome (AIMSS) during the first year of treatment. PATIENTS AND METHODS: The multicenter phase IV PreFace study evaluated letrozole therapy in postmenopausal, hormone receptor-positive patients with early BC. Patients were asked about CAM use before, 6 months after, and 12 months after treatment started. They recorded pain every month for 1 year in a diary including questions about pain and numeric pain rating scales. Data were analyzed for patients who provided pain information for all time points. RESULTS: Of 1396 patients included, 901 (64.5%) had used CAM before AI treatment. Throughout the observation period, patients with CAM before AI treatment had higher pain values, for both myalgia/limb pain and arthralgia, than non-users. Pain increased significantly in both groups over time, with the largest increase during the first 6 months. No significant difference of pain increase was noted regarding CAM use. CONCLUSIONS: CAM use does not prevent or improve the development of AIMSS. Pain intensity was generally greater in the CAM group. Therefore, because of the risk of non-compliance and treatment discontinuation due to the development of higher pain levels, special attention must be paid to patient education and aftercare in these patients.

What does a young girl experience in her first gynecological examination? Study on the relationship between anxiety and pain.

STUDY OBJECTIVE: The purpose of the two-part study was to determine how the initial gynecological examination was experienced, examining the relationship between anxiety and pain. DESIGN AND PARTICIPANTS: A total of 669 patients who had attended the special gynecological outpatient clinic for female children and adolescents, and 800 female pupils of either high schools (H) or vocational schools (V), were retrospectively asked to complete a standardized questionnaire (30 questions). The statistical instruments used were Chi-square test, loglinear models, and Spearman correlation coefficients. RESULTS: A total of 169 completed questionnaires could be evaluated in the case of children who attended the special outpatient clinic and 210 in the case of the pupils. (1) There was a significantly positive correlation between anxiety and pain; however, the sex of the examiner had no influence on how the examination was experienced. The accompanying persons underestimated the anxiety of the patients prior to the examination and overestimated the pain experienced. (2) Loglinear models showed that there is no relationship between the type of school attended and the pain score, a significant relationship between the type of school and the anxiety (P <.01), and a significant relationship between the anxiety and pain score irrespective of the type of school attended. CONCLUSIONS: The studies showed a surprisingly high frequency of pain, anxiety, and their correlation during the initial gynecological examination. Further studies of influencing factors and interventions are needed.

Partial uncoupling of luteinizing hormone and prolactin pulse coincidence in hyperandrogenemic women.

A partly synchronized pulsatile secretion of luteinizing hormone (LH) and prolactin has previously been suggested as an indication of the coupling of the respective pulse generators under certain conditions. In women with hyperandrogenemic chronic anovulation, episodic LH secretion is disturbed. It was, therefore, the aim of the present study to evaluate possible changes in episodic prolactin secretion pattern and in LH/prolactin co-pulsatility, and to relate the results to the accelerated LH pulse frequencies often seen in patients with hyperandrogenemic chronic anovulation. Blood samples of 32 patients with hyperandrogenemia were taken at 10-min intervals between 10.00 and 20.00. Nine regularly cycling women with normal hormone levels served as controls. In the women with hyperandrogenemia, despite an average 41% rise of LH pulse frequency, prolactin pulse frequency decreased slightly by 14% as compared to controls; no correlation between the two parameters was found (r = 0.162). The number of coincident LH and prolactin pulses increased continuously with accelerating LH frequency. The best fitting function was a hyperbola which was limited by the maximal observed prolactin frequency. As a consequence, the fraction of LH pulses that were co-secreted with prolactin episodes decreased with higher LH pulse frequencies, while the fraction of prolactin pulses concomitant with LH pulses increased. Our data provide evidence that in women with hyperandrogenemic chronic anovulation a pathological LH pulse frequency is no longer coupled with pulsatile prolactin secretion, suggesting an isolated alteration of the central neuronal control mechanism for LH secretion.

[Diagnostic differentiation between precocious puberty and premature thelarche using ultrasonography and the stimulated LH/FSH quotient]. / Differentialdiagnostische Abgrenzung der Pubertas praecox gegen die prämature Thelarche mit Hilfe der Ultrasonographie und dem stimulierten LH/FSH-Quotienten.

True precocious puberty represents a serious developmental disorder necessitating immediate therapeutic measures, whereas premature thelarche is a harmless variation from the norm. For the differential diagnosis the ultrasonographic evaluation of the internal genitalia is of value. Girls with precocious puberty reveal a statistically significantly greater uterus length and volume as well as ovarian size. The stimulated LH/FSH quotient allows verification of the diagnosis. This value is found always to be greater than 1 in precocious puberty and always less than 1 in premature thelarche.

[Is microsurgical preserving operation of tubal pregnancy sensible?]. / Ist die mikrochirurgisch-konservierende Operation einer Eileiterschwangerschaft sinnvoll?

During the period from 1976 to 1986, 179 women were operated at the Department of Gynaecology of the University of Düsseldorf. In 112 patients conservative techniques were used to retain the Fallopian tube. Of these 112, a group of 24 patients had a functioning adnexa on only one side at the time of operation. The conceptions of these women were investigated. In 8 of these patients, an intrauterine pregnancy occurred. 6 of these 8 patients had a salpingotomy, 1 woman underwent resection with immediate anastomosis and in another case both Fallopian tubes were treated (left Fallopian tube: reanastomosis status post resection three years earlier, right Fallopian tube: immediate anastomosis). 7 patients had a repeat ectopic pregnancy. Of these cases, direct anastomosis was performed 5 times and salpingotomy twice. 7 patients did not fall pregnant again. The Fallopian tubes of 6 patients were found to be open upon subsequent examination, while only one was found to be closed. One patient could not be followed-up, and one had neither a subsequent examination nor became pregnant again.

[The segmented phantom insert for the formation of a neovagina according to Vecchietti]. / Das gegliederte Steckphantom zur Bildung einer Neovagina nach Vecchietti.

Formation of a neovagina by surgical cavitation with an olive-shaped plastic form following Vecchietti, yields good functional and cosmetic results. By replacing the olive with a motile model consisting of a variable number of single segments, complications can be reduced. The newly developed model leads to better dilatation and stabilization of the newly-formed vagina. Wound secretion is drained by an interior canal and by lateral perforations. Through this canal, catheter irrigations and drug application are possible. 15 cases of this novel surgical technique are reported.

[Dysgerminomas. Clinical aspects, therapy and prognosis with reference to the cooperative therapy study MAIKEI 83/86 for non-testicular germ cell tumors of the Society of Pediatric Oncology]. / Dysgerminome. Klinik, Therapie und Prognose unter Berücksichtigung der kooperativen Therapiestudie MAKEI 83/86 für nichttestikuläre Keimzelltumoren der Gesellschaft für Pädiatrische Onkologie (GPO).

In comparison to other malignant germ cell tumors, dysgerminomas of the ovary show a high sensitivity to radiotherapy. According to histology and biological behaviour, dysgerminomas of the ovary are similar to testicular seminomas, which seem to be very sensitive to chemotherapy. Therefore, in the protocol for non-testicular germ cell tumors of the German Society of Pediatric Oncology (GPO) a treatment for dysgerminomas is established, in which the indication for primary tumor resection and a supplementary radiotherapy, or, in selected cases, primary chemotherapy and delayed tumor resection after the spreading, has been graded. After a median follow-up of 26 months, 17 of 18 patients were alive and disease-free, from which 3 patients with tumor progression after initial ovariectomy are in the second remission phase following relapse therapy. One patient died of tumor progression despite combined chemotherapy and irradiation. With a stratified therapy regime, fertility could be preserved with high probability in 13 of 17 patients.