Associations between Vasomotor Symptoms and Depression, Stress and Quality of Life in Midlife Women / 정신신체의학

OBJECTIVES: The aim of this study was to evaluate the associations between vasomotor symptoms and factors such as sociodemographics, health behaviors, medical condition, depression, stress, anxiety, attitude toward menopause, and quality of life. METHODS: We conducted a cross-sectional study in peri- and post-menopausal women enrolled by the Korean Association of Health Promotion. Subjects submitted self-report questionnaires about vasomotor symptoms and other clinical symptoms. Associations between vasomotor symptoms and clinical variables were analyzed using stepwise multiple regression analyses. RESULTS: 1951 women completed self-report questionnaires and 1022 women were enrolled in the study. The prevalence of vasomotor symptoms in peri- and post-menopausal women was 63.9%. Variables showing significant differences between subjects with vasomotor symptoms and subjects without them were score of Beck Depression Inventory, Brief Encounter Psychosocial Instrument-Korean Version, proportions of clinically significant depression(Beck Depression Inventory≥16), Menopausal rating scale, attitude towards menopause, the 4 subscales of World Health Organization Quality of Life-BREF(Physical health, psychological, social relationships, environment), and a History of Premenstrual syndrome/Premenstrual dysphoric disorder. Stepwise multiple regression analyses indicated that Beck Depression Inventory, Brief Encounter Psychosocial Instrument-Korean Version, Menopausal Rating Scale, and the Psychological subscale of World Health Organization Quality of Life -BREF show associations with vasomotor symptoms. CONCLUSIONS: Menopausal vasomotor symptoms are associated with various psychological factors, especially with depression. Midlife women suffering vasomotor symptoms should therefore be screened for depression. Future prospective studies where clinical subjects are diagnosed using structured interviews, focusing on the causal relationship between depression and vasomotor symptoms are necessary.

Volume Changes of Thy roid Nodules after Thy roxine Suppression Therapy: The Usefulness in Predicting Malignancy

PURPOSE: To evaluate the usefulness of volume change after thyroxine suppression therapy in predicting the malignancy of thyroid nodules. MATERIALS AND METHODS: We analyzed 28 cases of thyroid nodules diagnosed as benign by aspiration cytology or biopsy before thyroxine suppression therapy and which did not decrease more than 50% in volume after therapy. Using Ultrasonography we measured the volume of nodules before and after thyroxine suppression therapy and then determined volume change by calculating nodule volume suppression rate (NVSR) and comparing this beween benign and malignant nodules. All cases were surgically confirmed. N V S R ( % ) = nodule volume after treatment x 1 0 0 nodule volume before treatment RESULTS: Seventeen (60.7%) of 28 thyroid nodules which showed less than 50 % NVSR after thyroxine therapy were shown by surgical resection to be malignant, while 11(39.3 %) were benign. The malignant cases were papillary carcinoma (n=9) and follicular carcinoma (n=8), while benign cases were either follicular adenoma (n=7) or adenomatous hyperplasia (n=4). The mean volume of malignant thyroid nodules was 5.2 +/- 4 .5cm3 before thyroxine suppression therapy and 5.9 +/- 4 .5 cm3 after therapy, and that of benign nodules, 12.1 +/- 10.3 cm3 before therapy and 10.1 +/- 9.9 cm3 after. NVSR was 127.2 +/- 46.2 % in malignant nodul es and 79.4 +/- 21.0% in benign nodules, with no significant difference between the two groups (P < 0.05). CONCLUSION: Although further studies may be required, fine needle aspiration cytology or biopsy showed that among benign thyroid nodules which did not decrease more than 50 % in volume after thyroid therapy, the incidence of malignancy revealed by surgical resection was more than 60 %. Surgical exporation of these nodules is therefore highly recommended.

High-Resolution CT in Paraquat Poisoning of the Lung: Role of Prognosis Prediction

PURPOSE: To evaluate the prognosis of patients with paraquat poisoning by measuring the extent of lunginvolvement, as seen on HRCT. MATERIALS AND METHODS: Forty-one patients with paraquat poisoning were treatedaccording to our hospital's routine protocol and underwent HRCT scanning 1-21(mean 7-8) days later. In 31, theresults were abnormal, and these were retrospectively analysed. Differences in the extent of lung involvement,patient age, ingested amount of paraquat, and blood WBC count were compared between the group of survivors andthose who had died. RESULTS: Among the 31 patients with abnormal HRCT findings, 11 died and 20 patients survived.The extent of lung involvement among the group of survivors was 14.8+/-14.8%; among the deceased group, it was72.3+/-16.3%. The age of the survivors was 37.5+/-13.5(11-67) years, while that of the deceased was25+/-8.9(16-41)years. Those who died showed a significantly higher extent of lung involvement than the survivors,and were younger (p0.05). CONCLUSION: In paraquat poisoning, the extent of lung involvement onHRCT, is useful for prediction of the prognosis and severity of poisoning.