Elisabeth Sölder

Chronic pain syndromes and their relation to childhood abuse and stressful life events

OBJECTIVE Childhood abuse, stressful life events, and depression have been repeatedly reported to correlate with chronic pain, but little is known about the mutual relationships among these variables. METHODS Forty-three women with chronic pelvic pain (CPP), 40 female patients with chronic low-back pain (CLBP), and a female pain-free control group (n=22) were investigated by means of a semistructured interview assessing childhood sexual and physical abuse as well as stressful life events. Additionally, the Beck Depression Inventory (BDI) was used. For multivariate analyses, structured equation modeling was applied. RESULTS Childhood physical abuse, stressful life events, and depression had a significant impact on the occurrence of chronic pain in general, whereas childhood sexual abuse was correlated with CPP only. Moreover, childhood sexual abuse was related to depression. Both childhood sexual and physical abuse showed a close relationship to an increased occurrence of stressful life events. CONCLUSION There are complex mutual interactions among childhood abuse, stressful life events, depression, and the occurrence of chronic pain. Therefore, clinicians should take into consideration these psychosocial factors while treating chronic pain patients.

Influence of oral contraceptives on coagulation tests in native blood and plasma

Routine coagulation laboratory tests, clotting times in native (not anticoagulated) whole blood, platelet-rich and platelet-poor plasma, and recalcification times in citrated whole blood, platelet-rich and platelet-poor plasma were performed in 14 healthy premenopausal women. Blood was taken before and after one or two cycles of low-dose oral contraceptives. After oral contraceptives a reduction in clotting time in native platelet-rich plasma and activated partial thromboplastin time were observed. Recalcification times in whole blood and platelet-rich plasma were shorter than clotting times in their native counterparts. The observed changes are compatible with a procoagulant effect seen soon after the start of oral contraceptive use. The absence of these changes in the recalcification times in citrate systems suggests a masking effect of citrate. The reduction in clotting times in native platelet-rich but not in platelet-poor plasma indicates that the hypercoagulability in oral contraceptives users is mainly related to platelets.

Diagnosis of Extrauterine Pregnancy with Transvaginal Ultrasound

We reviewed all cases of suspected ectopic pregnancy (EP) that had transvaginal ultrasound (TVU) prior to surgery from 1987 to 1989. Of 265 patients who had culdocentesis and laparoscopy for suspected EP, 206 had EP. IN 28 of the 59 cases that proved negative at laparoscopy, EP was suspected at TVU. An ectopic embryo was seen at TVU in 28 cases where laparoscopy confirmed the TVU diagnosis. In 163 cases where EP was considered probable at TVU this was confirmed at laparoscopy. 15 cases of EP were overlooked at TVU.