Jean C. Aldag

Restless legs syndrome and leg cramps in fibromyalgia syndrome: a controlled study.

Restless legs syndrome is characterised by an unpleasant, difficult-to-describe sensation in the legs that produces an invariable urge to move them frequently.1 2 3 This symptom typically occurs at rest or before sleep and is alleviated by activity.1 2 3 Restless legs syndrome may occur without or with an associated condition, such as rheumatoid arthritis.1 3 We investigated the prevalence of restless legs syndrome and of leg cramps in patients with fibromyalgia syndrome, a common condition with widespread musculoskeletal aching and tender points,2 4 and in controls. One hundred and thirty five consecutive new female patients referred with primary fibromyalgia, 54 women with rheumatoid arthritis without concomitant fibromyalgia, and 87 healthy, pain free women acting as controls were studied at our outpatient rheumatology clinic. All patients with fibromyalgia …

Relationship between body mass index and fibromyalgia features

Objective: to evaluate the relationship between body mass index (BMI) and features of the fibromyalgia syndrome (FMS). Methods: 211 female patients with FMS seen consecutively in our rheumatology clinic were analyzed. Spearman correlation was used. Further, FMS features were compared at different levels of BMI (kg/m 2 ), e.g., < 25.00 vs S 25.00 (normal vs overweight). P value of h 0.01 was accepted as significant. Results: A significant positive correlation was found between BMI and age (p < 0.001) and a negative correlation between BMI and education (p < 0.009). Health Assessment Questionnaire (HAQ) score was significantly correlated with BMI (p < 0.001), whereas fatigue and number of tender points (TP) showed a trend (p = 0.035 and 0.037, respectively). Conclusion: The HAQ score is significantly associated with BMI in FMS with a trend towards significance for fatigue and TP. Weight loss may improve physical functioning in this disorder.

Comparison of Milk Output Between Mothers of Preterm and Term Infants: The First 6 Weeks After Birth

This study reports the temporal pattern of milk output in 2 groups of lactating mothers during the first 6 weeks postpartum. A study aim was to examine if the average milk output for postpartum days 6 and 7 (baseline) predicts milk adequacy at week 6 postpartum. Mothers of preterm (= 31 weeks) infants (n = 95) used mechanical expression to initiate and maintain their milk supply; mothers of a singleton healthy term infant (n = 98) fed their infant at the breast. Baseline milk output was predictive of milk adequacy, defined as = 500 mL/d at week 6 (P = .000). Preterm mothers were 2.81 times more at risk of not producing adequately than term mothers were. Study findings suggest that interventions that promote the initiation and maintenance of an adequate milk supply during the first week postbirth are critical.

Effects of pumping style on milk production in mothers of non-nursing preterm infants.

Milk production was examined in 39 lactating mothers of non-nursing preterm infants from 2 tertiary care centers. The purposes of this study were (1) to compare milk production of those using sequential single (SEQ) or simultaneous double (SIM) breast-pumping regimen, and (2) to examine the relationship of selected variables to inadequate (<3500 g/week) and adequate (>3500 g/week) milk production. In multivariate analysis, mothers using SIM produced a similar amount of milk by weight during weeks 2 to 5 postpartum compared to those using SEQ. A logistic regression model including frequency of kangaroo care, frequency of pumping, high versus low income, and previous breastfeeding experience was predictive of mothers producing adequate versus inadequate milk volume 79% of the time. All of the mothers producing >3500 g at week 2 produced adequate amounts of milk at weeks 4 and 5. None of the mothers producing < 1700 g at week 2 reached adequate production by weeks 4 and 5. Of the remaining mothers who produced 1700 g to 3500 g at week 2, 54% achieved adequate production during weeks 4 and 5 postpartum.

Relationship between fibromyalgia features and smoking.

Objective. The objective of this study was to examine a possible relationship between smoking and fibromyalgia features among 233 female patients with fibromyalgia syndrome. Methods. Data on clinical and psychological features were collected by a protocol. Smoking status was evaluated by a question inquiring about the packs of cigarettes smoked per day. Differences between the smokers and non-smokers were tested by Mann Whitney U test. To adjust data for age and education, a partial correlation test was used. A p value of h 0.01 was accepted as the level of significance. Results. Fifty-one patients (21.9%) smoked. After adjustment for age and education, significantly positive relationship was found between smoking and pain, patient global severity, functional disability, and numbness. There was no difference between smokers and non-smokers for fatigue, morning fatigue, sleep difficulties, tender points (TP), depression, anxiety and stress. Conclusions. Smokers reported significantly more pain, numbness, patient global severity, and functional difficulties than non-smokers. There was no significant difference between smokers and non-smokers for fatigue and TP.

Ketorolac versus meperidine and hydroxyzine in the treatment of acute migraine headache: A randomized, prospective, double-blind trial

STUDY OBJECTIVE To compare the effectiveness of IM ketorolac with that of meperidine and hydroxyzine in the treatment of acute migraine headache. DESIGN Prospective, randomized, double-blind trial. SETTING Urban emergency department with an annual census of 42,000 patients. PARTICIPANTS Forty-seven adult patients with migraines enrolled on 50 visits. INTERVENTIONS Patients were randomly assigned to receive a single injection of either 60 mg ketorolac (group 1) or 100 mg meperidine and 50 mg hydroxyzine (group 2). Pain assessment was made using both visual-analog and verbal descriptor scales. RESULTS At 60 minutes, 15 patients (60%) from group 1 (25) and 14 patients (56%) from group 2 (25) reported a great deal of complete relief (P = .77) Sixty-minute mean pain relief scores (3.35 versus 3.37) were different (P = .76). Nine patients (36%) from group 1 and seven patients (28%) from group 2 required additional analgesia (P = .76). CONCLUSION Ketorolac is as effective as meperidine and hydroxyzine for the treatment of acute migraine headache.

Fibromyalgia syndrome among the elderly. Comparison with younger patients.

Thirty‐one elderly fibromyalgia (EFM) patients (60 years of age and older) were studied by protocol and compared with 63 younger fibromyalgia (YFM) patients with this syndrome. Common and characteristic features of fibromyalgia among the elderly included diffuse musculoskeletal aching and stiffness at multiple sites; modulation of aches and pains by physical fatigue, poor sleep and weather factors; associated symptoms of general fatigue, poor sleep, anxiety/tension and subjective soft tissue swelling; and multiple tender points on physical examination. These features were similar to those among the younger patients, with the exception of chronic functional headaches, self‐assessed anxiety/tension, and symptom aggravation by weather factors, mental stress, and by poor sleep, all of which were significantly less common among the elderly (P < .05). Importantly, fibromyalgia was recognized by referring physicians in only 17% of the elderly patients with this condition. Misdiagnoses and inappropriate treatment were common among these patients, with corticosteroid therapy in 40% before their rheumatology consultation.

Initiation and frequency of pumping and milk production in mothers of non-nursing preterm infants.

This secondary data analysis examined if time of initiation of milk expression and pumping frequency influenced milk weight weeks 2-5 postpartum. Of the 39 subjects in the convenience sample, 20 were in the early initiating (EI) group, (n = 12 high frequency [HF], n = 8 lowfrequency [LF]), and 19 were in the late initiating (LI) group, (n= 7HF, n = 12LF). The EI group initiated pumping = 48 hours after birth; the HF group pumped a minimum of 6.25 times daily. A two-way analysis of variance indicated that milk weight was significantly higher in the HF as compared to the LF group. While there was no significant difference in milk weight between the EI and LI groups, therewas a significant interaction between frequency and initiation. Milk weight for the LF group appeared to be positively influenced by the initiation of mechanical expression soon after birth.

Chronic subdural hematomas and seizures: the role of prophylactic anticonvulsive medication.

BACKGROUND The rates of seizure activity associated with surgical treatment of chronic subdural hematoma (CSH) reported in the literature has varied greatly. The efficacy of prophylactic anticonvulsive medication (ACM) has been debated and its use been erratic. With improved diagnosis, reduction of associated morbidity impacts greatly on the mortality rate, and so the use of ACM may be important to the patient with CSH. METHODS We conducted a retrospective analysis of the records of patients treated surgically for CSH and examined the prevalence of seizure activity, morbidity, and mortality and the effects of anticonvulsant medication. RESULTS Ninety-eight patients (65 = male) were identified with a mean age of 72 years and a range of 4 to 97 years. Six patients had a preexisting seizure disorder; despite therapeutic serum levels of ACM, 3 of these 6 patients experienced seizures without mortality. Seizures occurred in 20/98 (20.4%) patients during hospitalization or follow-up. Of the 92 patients without a preexisting seizure disorder, 42 (46%) received prophylactic phenytoin with therapeutic serum levels. One patient among the 42 (2.4%) who received prophylactic ACM experienced seizure activity in comparison to 16 of 50 (32%) patients who did not receive adequate prophylactic ACM (P = < 0.001). Six of 11 deaths within one month of discharge occurred in patients with a new onset of seizures (P = < 0.005). Age, sex, history of trauma, Markwalder scores on admission, location of hematoma, or type of surgery were unrelated to the occurrence of seizures or mortality. Following hospital discharge, patients were continued on ACM for a mean duration of 8 months without seizures. CONCLUSIONS The onset of new seizures was found in 17 (18.5%) of 92 patients and was associated with increases in morbidity and mortality. Patients who received prophylactic ACM demonstrated a significant decrease in the occurrence of seizures, and we therefore recommend the use of phenytoin prophylaxis in patients treated surgically for chronic subdural hematoma.

Smoking and breastfeeding status.

In women who breastfeed, cigarette smoking is associated with early termination of lactation. The relationship among smoking, demographic variable, and breastfeeding status at 8 weeks postpartum was examined in 400 mothers of term infants and 110 mothers of low-birth-weight (LBW) infants using multivariate analysis. Women who smoked were more apt to stop breastfeeding early in both study samples. In addition, in the term sample, older and married women more frequently reported breastfeeding at 8 weeks than younger, nonmarried women. In the LBW sample, those who were employed were less apt to report breastfeeding at 8 weeks than those who were unemployed. Also, a greater proportion of smokers in both samples indicated insufficient milk as a reason for a decline in breastfeeding compared to nonsmokers. The effects of cigarette smoking should be examined in subsequent studies of breastfeeding patterns.