RESUMEN
OBJECTIVE: This study was performed to examine whether bilateral oophorectomy is related to depressive symptoms. STUDY DESIGN: A secondary analysis of data collected from a cohort study of 1047 premenopausal women undergoing hysterectomy with or without concomitant oophorectomy for benign indications was performed. Data on depressive symptoms, based on the Profile of Mood States survey, were collected presurgically and 12 months postoperatively. RESULTS: The effect of bilateral oophorectomy on postoperative depressive symptoms varied, depending on the presence of baseline depressive symptoms. Bilateral oophorectomy was associated with a decrease in risk of depressive symptoms in women without baseline depressive symptoms (risk ratio [RR] 0.36 [95% confidence interval (CI), 0.17, 0.78]) and did not change significantly in those with baseline depressive symptoms (RR 1.21 [95% CI, 0.73, 2.00]). CONCLUSIONS: Bilateral oophorectomy, in comparison with unilateral or no oophorectomy, is associated with less risk of postoperative depressive symptoms in women without baseline depressive symptoms undergoing hysterectomy.
Asunto(s)
Depresión/etiología , Histerectomía/efectos adversos , Ovariectomía/efectos adversos , Adulto , Estudios de Cohortes , Femenino , Humanos , Persona de Mediana Edad , Premenopausia , Factores de Riesgo , Factores de TiempoRESUMEN
OBJECTIVES: To explore the prevalence of orofacial pain (OFP) among patients with vulvar vestibulitis syndrome (VVS) and to examine the relationship between signs and symptoms of OFP and clinical characteristics of women with VVS, we investigated differences in psychologic characteristics and severity of painful intercourse. METHODS: In this cross-sectional exploratory study, 137 women with VVS completed questionnaires that assessed levels of pain, anxiety, somatization, and presence of signs and symptoms suggestive of clinical and subclinical OFP. Demographic data were gathered from medical records. RESULTS: OFP was found to be a highly prevalent (78%) condition among women with VVS. Compared with women who had no OFP symptoms (n=30), those with symptoms (n=64) reported higher levels of anxiety (45.0 vs. 37.8, Bonferroni adjusted P=0.017), somatization (125.2 vs. 96.0, Bonferroni adjusted P<0.001), and psychologic distress (62.8 vs. 56.0, Bonferroni adjusted P=0.002). Although we observed a similar trend among women with subclinical OFP (n=43), this trend only reached statistical significance with respect to somatization. Differences were not detected for demographics, duration of pain, and severity of pain during intercourse across the 3 groups. DISCUSSION: OFP is a common condition among women with VVS. Because severity and duration of painful intercourse did not differ by OFP classification but psychologic characteristics did, we must begin to question a unidimensional focus on vestibular mucosa as a reason for pain and persistent distress.
Asunto(s)
Dolor Facial/complicaciones , Dolor Facial/epidemiología , Vestibulitis Vulvar/complicaciones , Vestibulitis Vulvar/epidemiología , Adulto , Trastornos de Ansiedad/etiología , Estudios Transversales , Depresión/etiología , Dolor Facial/psicología , Femenino , Humanos , Dimensión del Dolor , Prevalencia , Psicometría , Encuestas y Cuestionarios , Vestibulitis Vulvar/psicologíaRESUMEN
OBJECTIVES: Tamoxifen, a well-tolerated oral hormonal agent with biological activity in ovarian cancer, is a potentially attractive option in asymptomatic patients with recurrent disease. Unfortunately, the clinical utility of the drug in this specific setting has not been well documented. PATIENTS AND METHODS: A retrospective review was conducted of patients with cancers of the ovary, fallopian tube, and primary cancer of the peritoneum at the Cleveland Clinic who experienced recurrence of the malignancy, in the absence of large volume disease (by physical exam and radiographic evaluation) or any cancer-related symptoms, and who received tamoxifen (20 mg [most patients] or 40 mg/day) before re-initiation of cytotoxic chemotherapy. RESULTS: Fifty-six patients (45 after primary chemotherapy; 12 after second-line treatment) satisfied the criteria noted above. The median duration of treatment was 3 months (range 1-30 months), with 42% and 19% of patients remaining on tamoxifen for >/=6 and >/=12 months, respectively. Reasons for discontinuation were equally divided between three causes: (a) continued rise in CA-125 antigen level without symptoms or other objective signs of cancer; (b) evidence of progressive disease by physical exam or radiographic evaluation in the absence of symptoms; and (c) development of cancer-related symptoms. CONCLUSION: In the absence of data from a randomized controlled trial which defines optimal management of the asymptomatic ovarian cancer patient with documented recurrent disease, tamoxifen is a rational management option, although it remains unknown if the delay in subsequent administration of chemotherapy in some individuals for periods greater than 6-12 months results from a direct effect of this agent or simply reflects the natural history of disease in a subset of patients in this clinical setting.