Psychological Characteristics of the Patients with Myofascial Pain Syndrome in Shipyard Work

OBJECTIVE: This study was conducted to analyze the psychological factors which influence myofascial pain syndrome and to evaluate whether the electromyographic study on the myofascial trigger point in shipyard workers satisfied the diagnostic criteria of myofascial pain syndrome. METHOD: We studied 61 patients who were employed in the shipbuilding industry and diagnosed myofascial pain syndrome. We investigated them using the Minnesota Multiphasic Personality Inventory (MMPI) and the visual analogue scale (VAS) and also obtained spontaneous electrical activity (SEA) by electromyographic study on myofascial trigger point. RESULTS: Mean VAS of subjects was 5.88. On the MMPI profile, the patients scored highest in psychopathic deviate, and then in hypochondriasis, depression and hysteria, in that order. The correlation of the VAS with results of electromyographic study and with the MMPI were not significant. In the electromyographic study, 19 patients out of 61 (31%) showed initial positive deflection on spontaneous electrical activities. CONCLUSION: This study suggested that considering the psychosocial aspect of myofascial pain syndrome, as well as organic aspects in hard manual labor such as shipyard work might be useful for treatment.

The Risk Factors of Lymphedema after Breast Cancer Surgery

OBJECTIVE: This is a study to evaluate relationships between the occurrence of lymphedema and clinicopathologic factors in postmastectomy patients. METHOD: We studied 448 patients who underwent breast cancer surgery during the periods from January 1998 to December 2000, of which 69 patients developed lymphedema during the follow up period. We investigated the medical records of these follow-up patients. The general characteristics were tested by a chi-square test and student t-test and the possible risk factors were comparatively analyzed on these patients by a multiple logistic regression analysis. RESULTS: The incidence of lymphedema was significantly high with higher stages (p<0.05). The incidence of lymphedema was significantly high in higher N staging, but not in higher T staging. Patients who received radiation therapy also showed higher incidence rates (p<0.05). Patients who underwent Patey procedure showed higher incidence than those who underwent Auchincloss procedure. With increasing age, more lymphedema developed (p<0.05). CONCLUSION: These results suggest that the stage of tumor, state of lymph node metastasis, methods of surgical treatment, use of irradiation, and patient's age are the possible risk factors for the development of lymphedema. These risk factors might be useful as clinical indices for the prevention of postmastectomy lymphedema. So, we have to exert our efforts to minimize the development of lymphedema.

Changes of Bone Mineral Density, Lipid Profiles, and Biochemical Markers after Combination Therapy of Estrogen and Alendronate in Postmenopausal Osteoporosis

OBJECTIVE: To investigate the changes of bone mineral density (BMD), biochemical bone markers, and lipid profiles after combination therapy of continuous hormonal replacement therapy (c-HRT) and alendronate in postmenopausal osteoporosis. METHOD: We studied 89 women with postmenopausal osteoporosis (T-score<2.5) who visited at Department of Rehabilitation Medicine, Kosin Medical Center from August 1999 to March 2001. Subjects were divided into two groups; Group I (n=40), treated with estrogen and alendronate (10 mg/day), and Group II (n=49), treated with estrogen alone. BMD at the lumbar spine and femur, osteocalcin, urine deoxypyridinoline and lipid profiles were measured at baseline and 1-year after treatment. RESULTS: 1) BMD at the lumbar spine increased significantlyin two groups, and BMD in Group I increased significantly more than that in Group II. But, change of BMD on femoral neck was not significantly different. 2) Biochemical bone markers (osteocalcin and urine deoxypyridinoline) decreased significantly in two groups. 3) Total cholesterol and LDL cholesterol decreased significantly in two groups, but HDL cholesterol and triglyceride showed no significant change in two groups. There was no significant differences between two groups in lipid profiles. CONCLUSION: We concluded that combination therapy with c- HRT and alendronate in postmenopausal osteoporosis was more effective than c-HRT, which would not influence on positive effect of estrogen for lipid metabolism.

The Changes of Bone Mineral Density, Biochemical Bone Markers, and Lipid Profiles according to Duration of Menopause and HRT

OBJECTIVE: To investigate the changes of bone mineral density (BMD), biochemical bone markers, and lipid profiles according to the duration of menopause in postmenopausal osteoporosis patient receiving continuous hormonal replacement therapy (c-HRT). METHOD: Sixty seven patients with postmenopausal osteoporosis who have been under c-HRT for more than two years were used as subjects and divided into two groups according to the time past menopause: group I (0~10 years), group II (over 10 years). The changes of BMD, biochemical bone markers, lipid profiles on one year and two years of c-HRT were comparatively analyzed in each group. RESULTS: 1) BMD of lumbar vertebra was increased and biochemical bone markers were decreased after c-HRT in both groups, but BMD of femur from both groups showed no statistical significant changes. 2) The changes in lumbar vertebra, deoxypyridinoline and osteocalcin were significantly higher after first one year than next one year of c-HRT in both groups, with no statistical differences between two groups. 3) Total cholesterol and LDL-cholesterol were decreased, but HDL-cholesterol and triglyceride showed no significant changes after c-HRT in both groups. CONCLUSION: The effects of c-HRT on BMD, biochemical bone markers, lipid profiles were not influenced by postmenopausal period. And the effects of c-HRT during first one year were more prominent than those of c-HRT during next one year.

Transient Pancytopenia and SIADH associated with Administration of Carbamazepine

Carbamazepine is widely used to manage of seizures and symptomatic treatment of trigeminal neuralgia and central pain. We experienced two cases of exceedingly rare but potentially fatal side effects following carbamazepine administration. One traumatic brain injured patient developed pancytopenia 3 weeks after beginning to take carbamazepine for prophylactic management of seizure and the other C6 incomplete spinal cord injured patient receiving carbamazepine for the management of central pain sequentially developed syndrome of inappropriate secretion of antidiuretic hormone (SIADH) 1 week after administration. Because of more frequent indications of carbamazepine, these side effects must be borne in mind and cautious administration will be desirable.