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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Little has been reported about the rehabilitation of heart recipients who experience disabling neurologic complications. This is of particular interest to physiatrists because the number of cardiac transplants is increasing and the cardiovascular response of the denervated heart to exercise is altered. The case reported here describes a 42-year-old woman who underwent heart transplantation for ischemic cardiomyopathy. One year after transplantation, the patient was hospitalized for evaluation of headaches and mental status changes. A lymphoma involving the left basal ganglia was diagnosed and the patient underwent a course of radiation therapy. She was transferred for rehabilitation of a left hemiparesis and made functional gains in mobility and self-care skills. Weekly recordings of heart rate and blood pressure were obtained before and after ambulation. Small increases in both heart rate and blood pressure were recorded after ambulation to the point of fatigue. In both parameters, the patient's maximum response was below that reported for nondisabled cardiac recipients, highlighting the need for symptom-oriented exercise guidelines in these patients.
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PMID:Cardiovascular response to gait training and ambulation in a hemiparetic heart recipient. 233 89

The purpose of this study was to investigate, in a sample of patients with hemiparesis secondary to cerebrovascular accident, the relationship between the ratio of stimulus on time to off time and muscle fatigue using a commercial electrical stimulation unit. An experimental model was used to test the hypothesis that the smaller the stimulus off time relative to stimulus on time, the greater will be the muscle fatigue over time. The wrist extensor muscles of 18 patients with hemiparesis were stimulated electrically, and isometric force output was recorded continuously using an adapted strain gauge-recorder apparatus. For each testing session, peak on time of the electrical stimulus was set at 5 seconds, and off time was set at 5, 15, or 25 seconds. Six randomly assigned treatment groups participated in three separate treatment sessions in a different order at 48-hour intervals. Treatment sessions were continued either until wrist extensor muscle force output decreased to 50% of its initial value or for a maximum of 30 minutes. Data analysis revealed that significant differences in muscle tension developed among all duty cycles (p less than .01). Duty-cycle ratios of 1:1, 1:3, and 1:5 were shown to be progressively less fatiguing. Within the limits of this investigation, the 1:5 duty-cycle ratio was determined to be the best suited for initial use in programs of prolonged stimulation to the wrist extensor muscles of patients with hemiparesis. The hypothesis was accepted that the smaller the stimulus off time (rest interval) with respect to the stimulus on time, the greater will be the muscle fatigue over time.
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PMID:Relationship between functional electrical stimulation duty cycle and fatigue in wrist extensor muscles of patients with hemiparesis. 325

The patient was a 52-year-old woman who was initially admitted to our hospital with a recent history of diplopia, ptosis and visual impairment on the right, adding to 6 years history of the right orbital pain and temporal headache. She had gradually developed pain and fatigue of the right knee since childhood and had been suffered from multiple subcutaneous tumor in the both hands and the right foot from youth onward. On neurological examination, she has had right exphthalmos and 3rd and 6th cranial nerve palsies on the right. Skull X-ray and CT scan showed parasellar calcified mass on the right. In chromosome examination, the inversion of the No. 1 chromosome was disclosed by the Q- and C-band dyeing of her leucocytes and skin culture. Cavernous hemangioma of her skin lesion and enchondroma of the skeletal lesion were diagnosed by X-ray examination and histological specimen, indicating so-called Maffucci's syndrome. One year and a half later, she was readmitted to our institution, because of progressive visual loss on the right and left hemiparesis. Malignant change of the parasellar lesion was suspected by the clinical course and neuroradiological findings and was confirmed histologically by the second peration. During postoperative course, intratumoral hemorrhage had occurred twice and the patient died, and postmortem examination confirmed her clinical affair. This is the case which was clarified malignant transformation of enchondroma in the parasellar region, and is the first case verified the chromosome abnormalities in Maffucci's syndrome.
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PMID:[Maffucci's syndrome with intracranial manifestation and chromosome abnormalities--a case report]. 370 42

Two patients had clinical findings of encephalopathy that progressed in 4 to 5 months. One patient had headache, fatigue, lethargy, hemiparesis, and a seizure. The second patient had only forgetfulness, confusion, and lethargy without focal signs. Herpes simplex virus was grown from brain biopsy in the first patient and from CSF in the second patient. These cases suggest that herpes simplex virus caused the encephalitis and that it should be considered in the differential diagnosis of chronic encephalopathy.
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PMID:Chronic encephalitis possibly due to herpes simplex virus: two cases. 403 28

We examined the efficacy of percutaneous cervical cordotomy (PCC) and subarachnoid phenol block using fluoroscopy (SAPB-F) for control of chest and/or back pain from costopleural syndrome. The efficacy of each block was evaluated by changes in pain score (PS), analgesic dose and performance status 1 week after the block, as well as by the complications. Between 1980 and 1986, PCC was performed in 10 patients. SAPB-F was performed in 13 patients between 1987 and 1991. Pain was not well controlled by analgesics in any of these patients. For PCC the follow-up period was 94.7 +/- 71.1 days. PS (VAS, 0-10) reduced from 8.5 +/- 0.9 to 3.0 +/- 2.7. No analgesics were needed in 4 patients. Pain recurred in 1 patient. Hemiparesis occurred in 2 patients. General fatigue occurred in 6 patients. In 4 patients with these complications performance status deteriorated and did not recover during the follow-up period. For SAPB-F the follow-up period was 71.8 +/- 44.0 days. SAPB-F was designed to achieve selective phenol deposit at the targeted nerve root. PS decreased from 7.5 +/- 1.9 to 2.7 +/- 2.6. No analgesics were needed in 5 patients. Pain recurred in 3 patients. There were no complications and no changes in performance status. From this study we concluded that PCC is an effective method of pain control for costopleural syndrome, but a risk of serious complications is involved. SAPB-F is an effective and safe method and should be the first choice of nociceptive pathway block.
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PMID:Percutaneous cervical cordotomy and subarachnoid phenol block using fluoroscopy in pain control of costopleural syndrome. 747 94

We report a 46-year-old man with bacterial endocarditis and cardiac failure, who developed status epileptics. The patient was apparently well until July of 1991 when there was a gradual onset of fever and general fatigue. He was hospitalized to the cardiology service of our hospital where diagnosis of bacterial endocarditis and aortic insufficiency was made. On October 9, 1991, he suddenly developed cardiogenic shock, and emergency replacement of the aortic valve was made; at the operation, the main trunk of the left coronary artery showed embolic occlusion, and the myocardial movement was markedly diminished; serum creatine kinase was 3.150 IU/l. His cardiac failure did not resolve, and renal failure developed in December 1991, for which peritoneal dialysis was necessary. On February 2, 1992, he suddenly developed a clonic seizure which started from his face with a transient post-ictal left hemiparesis; a cranial CT scan was unremarkable. He was treated with phenytoin and glycerol, however, he developed status epileptics on February 3; he developed cardiac arrest after the injection of phenytoin 750 mg. He was resuscitated, however, his status did not resolve. Neurological consultation was asked on February 4. On physical examination, his blood pressure was 80/40 mmHg heart rate 77/min and regular, and body temperature 39.1 degrees C. The palpebral conjunctiva were slightly anemic, however, the bulbar conjunctiva were not icteric. No cervical adenopathy was noted. Glade II systolic murmur was heard in the apex; the lungs were clear. The abdomen was flat and soft without organomegaly. No edema was present in the legs. On neurologic examination, he was comatose without response to painful stimuli. He repeatedly had convulsion lasting for 30 seconds every 2 to 3 minutes; his convulsions started with the conjugate deviation of the eyes to the left followed by turning of the head toward left, and then clonic convulsions started in this left upper limb extending to other extremities. The optic fundi were unable to visualize because of corneal clouding; light reflex was sluggish on the right side; no oculocephalic response was elicited; corneal reflex was also lost bilaterally. Extremities were hypotonic, and no automatic movement was seen. The triceps brachii reflex was diminished, but all the other deep reflexes were lost; no plantar response was elicited. Meningeal sign was absent. He was treated with intravenous diazepam; the interval of convulsions prolonged, however, blood pressure dropped to 40 to 40 mmHg. On February 4, intravenous thiopental anesthesia was instituted, and assisted respiration was started.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[A 46-year-old man with cardiac failure and statues epileptics]. 794 26

A concern for individuals with hemiparesis affecting their gait, which heretofore has never been studied, is the possibility that various compensations occurring in the unaffected limb may strain or fatigue the muscles or ligaments and/or predispose to joint injury in that limb. We studied the biomechanics of the unaffected limb during walking in 20 subjects with hemiparesis who had stiff-legged gait as a result of stroke. An optoelectronic motion analysis and force platform system was used to estimate torques in all three planes about the hip, knee, and ankle. Sagittal plane joint motion and power about the unaffected hip, knee, and ankle were also studied. Data were compared with control walking data collected from 20 able-bodied controls. On average, peak torques and powers were all either reduced or the same compared with controls, even though in some instances values were >2 standard deviations (SD) above the control means. Our findings suggest that on average the probability of excessive muscular-tendon effort and the risk for biomechanical injury in the unaffected limb are minimal compared with able-bodied, walking controls. However, given individual variability, we recommend routine clinical gait analysis for all people with stiff-legged gait to eliminate excessive values in certain biomechanical parameters, which could, if not addressed, predispose to muscle-tendon strain or joint or ligamentous injury.
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PMID:Spastic paretic stiff-legged gait: biomechanics of the unaffected limb. 1041 42

The objective of this prospective study was to investigate further the clinical features of patients with giant cell (temporal) arteritis (GCA). All patients diagnosed from July 1999 to March 2001 at the Department of Neurology of the Second Xiangya Hospital in China were included. The final diagnosis was based on clinical manifestations, a temporal artery biopsy, response to steroid, and follow-up. The American College of Rheumatology (ACR) criteria for the classification of GCA were tested in the patients identified. Sixteen patients with GCA were identified; 13 (81.25%) patients fulfilled the 1990 ACR criteria for the classification of GCA. Clinical findings included the following: mean age at disease onset 43.13 years (range 28-60) and 81.25% of the patients under the age of 50 when the disease began; men 93.75%; the common initial symptoms including new headache 62.50% and.visual symptoms 18.75%; the common clinical findings at presentation including new headache 93.75%, temporal artery abnormality 81.25%, visual abnormality 56.25%, and fever 25.00%; raised erythrocyte sedimentation rate (ESR) 68.75%; and uncommon findings including jaw claudication, ptosis, fatigue, syncope, hemiparesis; all 16 patients underwent a temporal artery biopsy; inflammatory cell infiltration 68.75% in arterial wall, fragmented internal elastica 100.00%, fibrinoid necrosis 18.75%, smooth muscle cell changes 62.50%, and thrombosis in the lumen 31.25%. The mean time from symptom onset to suspicion of GCA or biopsy was 5.52 months (range 0.25-24.33); the initial diagnosis was wrong in 87.50% of patients. These examples are too small a number to permit definite conclusion. But the results suggest that GCA may not be a rare disorder in China, mean age at disease onset was relatively young, males may be more susceptible, the clinical features of GCA have not been widely appreciated yet, there was a delay between diagnosis and treatment, and initial diagnosis was wrong in many patients.
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PMID:Giant cell arteritis in China: a prospective investigation. 1214 52

Multiple myeloma (MM) is a plasma cell malignancy characterized by infiltration of bone marrow, bone destruction, infiltration of soft tissues with plasma cells, and suppression of normal hematopoiesis. The production of monoclonal immunoglobulins with or without light chains is a major feature of the disease. Full spectrum of plasma cell dyscrasias include monoclonal gammapathy of undetermined significance, smouldering myeloma, indolent multiple myeloma, and fully developed, symptomatic multiple myeloma. The usual presenting features of MM include bone pain, weakness, fatigue, fever and infection. Neurologic symptoms are less common but one must not forget that MM may present with a neurologic disease. Careful neurologic history and examination are mandatory in patients with MM. Neurologic symptoms may be a direct manifestation of MM or may be due to the immune effect of monoclonal proteins directed against different neural structures. Finally, metabolic consequences (uremia, hypercalcemia, hyperviscosity) of MM may produce a broad spectrum of different neurologic symptoms including headache, blurring of vision, drowsiness, precoma, coma, vertigo, ataxia, hemiparesis and epileptiform seizures. The most common location of bone changes in MM is the thoracic spine, where it causes osteolytic changes with consequent compressive fractures. The most disastrous sequel is paraplegia. Multiple vertebral involvement with the evidence of osteolytic changes in other bones is usual, but solitary vertebral myeloma may occur. Myeloma usually involves the bone of the vertebral body and then spreads into the extradural space. However, patients with solitary extradural myeloma have been reported. Skull myeloma is frequently asymptomatic. It may grow externally or, rarely, there is intracranial expansion. Involvement of the cranial nerves is not rare, with II, V, VI, VII and VIII cranial nerves being most often affected. Isolated intracerebral plasmacytomas are extremely rare. Diagnostic approach includes plain X-rays of the skeleton, which was found to be the method of choice for demonstration of osteolytic changes, whereas magnetic resonance with gadolinium enhancement most reliably displays the degree of vertebral involvement and demonstrates any associated soft tissue mass. Current treatment of osteolytic changes in multiple myeloma include chemotherapy, radiotherapy in combination with dexamethasone, monthly infusions of bisphosphonates, surgical decompression, and kyphoplasty. Therapeutic approach is dictated by the presenting symptoms. In case of pain as the predominant symptom, treatment with chemotherapy and radiotherapy may be appropriate. Compressive symptoms are relieved with dexamethasone followed by radiotherapy and chemotherapy. Surgical decompression is used in patients with vertebral collapse and vertebral instability. Kyphoplasty is a new method used in the treatment of osteolytic changes of vertebral bodies. A viscous cement is injected into the cavity by a balloon-like inflatable bone tampon. It has been successfully employed to improve the quality of life, to reduce pain, and to increase overall functioning in patients with vertebral compression fractures by restoring most of the original height of the vertebral body. Bisphosphonates reduce pain associated with osteolytic changes in multiple myeloma, but also significantly reduce skeletal events (pathologic fracture, spinal cord compression, surgery or irradiation of bone) via unknown mechanism. It seems that bisphosphonates, by inhibiting bone resorption, alter the microenvironment in which the MM cells grow.
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PMID:[Neurologic sequelae of bone changes in multiple myeloma and its therapy]. 1263 Mar 41

The case of a 30-year-old woman who had two episodes of photopsia along with sudden-onset monocular visual field defects, developing into bilateral tunnel vision within 4 years, is reported. She also had episodes of a right hemiparesis and right-sided hypoaesthesia, accompanied by severe fatigue. This patient fulfilled the criteria for both clinically definite multiple sclerosis and acute zonal occult outer retinopathy (AZOOR). AZOOR can have an onset with monocular visual field loss, and can be distinguished from optic neuritis. In addition, some observations suggest common neuropathological and inflammatory mechanisms between multiple sclerosis and AZOOR.
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PMID:Acute zonal occult outer retinopathy and multiple sclerosis. 1686 65


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