Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

1. By recording with 2 pairs of wire electrodes from human sacral nerve roots (S3-S5) rhythmic as well as occasional firing was observed in alpha 2 and alpha 3-motoneurons in response to physiologic stimulation of the urinary bladder and the anal canal. The rhythmic firing consisted of periodically occurring impulse trains, most likely produced by true spinal oscillators which drove the motoneurons. 2. Alpha 2-motoneurons, innervating fast fatigue-resistant muscle fibres, were observed to fire with impulse trains of about 2 to 4 action potentials (Ap's). These impulse trains occurred every 110 to 170 msec (5-9 Hz). Alpha 3-motoneurons, innervating slow fatigue-resistant muscle fibres, fired about every 1400 msec (approximately 0.7 Hz) with impulse trains of about 11 to 60 Ap's. Alpha 1-motoneurons, innervating fast fatigue muscle fibres, and gamma-motoneurons were not observed in the continuous oscillatory firing mode. 3. Sphincteric motoneurons were observed most likely in the oscillatory firing mode in response to the sustained stretch (reflex) of the external and sphincter or to retrograde filling of the bladder (urethro-sphincteric guarding reflex), in order to preserve continence. A urethral sphincteric alpha 2-motoneuron increased its mean activity from 0.5 to 18 Ap's/sec during retrograde filling by changing its firing pattern from the occasional spike mode via the transient oscillatory firing mode to the continuous oscillatory mode. Up to a filling of the bladder of 500 ml the mean activity of the stretch receptors, measuring probably mural tension, increased roughly proportionally and the sphincteric motoneuron increased its activity to about 1 Ap/sec in the occasional spike mode. Up to 600 ml, the motoneuron responded in the transient oscillatory mode with mean activities of up to 5 Ap's/sec. With higher bladder fillings, the flow receptors afferents fired additionally, probably according to pressure symptoms, and the motoneuron switched into the continuous oscillatory firing mode and increased its activity up to 18 Ap's/sec at 700 ml. When the bladder was about 800 ml full, the stretch afferent activity decreased, the flow receptor activity increased strongly and the alpha 2-motoneuron activity decreased; the overflow incontinence had probably started. Micturition was not observed, probably because of brain death. 4. It is suggested that one adequate stimulus for an alpha 2-motoneuron of the external anal sphincter to jump into the oscillatory firing mode, was the activity from secondary spindle afferent (SP2) fibres from external anal sphincter muscle spindles.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Oscillatory firing of single human sphincteric alpha 2 and alpha 3-motoneurons reflexly activated for the continence of urinary bladder and rectum. Restoration of bladder function in paraplegia. 193 58

Six patients incapacitating faecal incontinence, in whom conventional treatment had either failed or was contraindicated, were treated by a new technique. A neonanal sphincter was constructed by transposing the gracilis muscle around the anal canal. Chronic neuromuscular stimulation via an implanted electrical stimulator was then used in an attempt to convert the muscle to a slow twitch fatigue resistant muscle. Physiological measurements suggested that this conversion had begun, enabling the neosphincter to mount a sustained contraction. Five patients had their covering stomas closed, and continence was improved in all of them. However, one patient could not cope psychologically with the stimulator, and another patient was continent for long periods only when the neosphincter was used in conjunction with a silastic plug. This new technique may benefit selected patients with incontinence whose only alternative would be a permanent stoma.
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PMID:Construction of a neoanal sphincter by transposition of the gracilis muscle and prolonged neuromuscular stimulation for the treatment of faecal incontinence. 233 92

In a study of bacteriuria in elderly (mean age 85 years, range 69 to 101), mostly middle- and upper-class Jewish subjects, attempts were made to determine if bacteriuria without dysuria is otherwise asymptomatic. Seventy-two subjects (59 women and 13 men) without dysuria were questioned about other urinary symptoms (incontinence, frequency, urgency, suprapubic pain, flank pain, fever) and symptoms indicating a lack of well-being (anorexia, difficulty in falling asleep, difficulty in staying asleep, fatigue, malaise, weakness) when they were with and without bacteriuria. Twenty-two subjects had bacteriuria that resolved spontaneously; bacteriuria subsequently developed in 24 nonbacteriuric subjects; and 26 subjects had bacteriuria that resolved with antimicrobial therapy. Subjects occasionally reported urinary symptoms (especially incontinence) and commonly reported symptoms indicating a lack of well-being when they were with and/or without bacteriuria. However, no differences in symptoms were found when bacteriuric subjects were compared with themselves when they were nonbacteriuric. Thus, bacteriuria without dysuria in the elderly appears to be asymptomatic.
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PMID:Lack of association between bacteriuria and symptoms in the elderly. 379 58

The striated musculature of the dog urethra was studied histochemically. Two main groups of muscle fibers could be identified: 1 with slow twitch oxidative fibers, which are fatigue resistant (type 1), and 1 with fast twitch fibers (type 2). The fast twitch fibers were subdivided into glycolytic (fatiguable) and oxidative glycolytic (fatigue resistant) fibers: the latter constitute 20 per cent of all fast twitch fibers. Type 1 constitutes of 35 per cent of the whole musculature and its proportion tends to decrease toward the distal end of the external urethral sphincter. From these observations we infer that type 1 fibers are likely responsible for continence at rest and that type 2 fibers are recruited in stress conditions, for example, during coughing or sneezing. Additional studies are needed to confirm this conjecture. The clinical implications of these studies for the control of incontinence, urinary retention and dyssynergic urethral sphincter are presented.
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PMID:Histochemical study of urethral striated musculature in the dog. 621 91

The stimulated gracilis neosphincter is a viable procedure in selected patients with fecal incontinence. The aim of this paper is to review the technique of this staged operative procedure and review the problems and complications. Stage 1 consists of the vascular "delay" of the gracilis muscle and the creation of a temporary stoma. Stage 2 consists of transposition of the muscle around the anus with implantation of the stimulator. Low-frequency electrical stimulation is applied to the muscle for 12 weeks, after which stage 3 (stoma closure) is undertaken. From March of 1993 to March of 1995, 14 patients (9 females and 5 males) with a mean age of 44 years (range 20 to 67 years) underwent the procedure. Two patients died within 1 year of the operation from unrelated causes. Two patients developed anal stenosis and required permanent stomas. Other complications noted during ascent of the learning curve included seroma, excoriation of the skin above the stimulator, transposition of the stimulator, premature battery discharge, wound infection, rupture of the gracilis tendon, fatigue during programming sessions, and electrode displacement or fibrosis from the nerve. However, 8 of the 10 eligible patients had stoma reversal; the manometric results showed an average mean squeeze pressure that increased from 43 mmHg prior to surgery to 151 mmHg after the operation (p < 0.01). Based on an objective functional questionnaire, 60 percent of the patients who could be evaluated reported improvement in continence, social interactions, and the quality of their life. In conclusion, despite a steep learning curve, the stimulated gracilis operation is a viable operation for selected patients with severe incontinence.
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PMID:The stimulated gracilis neosphincter for fecal incontinence: a new use for an old concept. 877 92

Fifty-five spousal caregivers of persons with multiple sclerosis completed a questionnaire assessing the stress associated with caregiving. They were found to experience a range of negative effects, similar to those reported by other groups of carers of persons with degenerative neurological diseases. The behaviors causing most distress to the carers were associated with motor problems, sudden mood changes, partner upsetting other people, incontinence and pain. Overall, wives had higher burden scores than husbands. This was accounted for primarily by their higher levels of physical distress such as tiredness. Following the stress-appraisal-coping model of Lazarus and Folkman (1984) it was hypothesized that individual differences in burden would be accounted for primarily by the carers' appraisal of the symptoms, perceived social support, and satisfaction with coping. Regression analyses supported the importance of satisfaction with coping and social support as predictors of perceived burden. In addition, life satisfaction was found to be predicted by burden independently of other predictors.
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PMID:Psychosocial consequences of caring for a spouse with multiple sclerosis. 907 37

The present study was made not only to clarify endogenous factors (physical and psychological factor of the subjects) and exogenous factors (caregiver residential environment, social assistance) in the urinary incontinence of elderly persons at home undergoing public visiting nursing, both by sexes and by age-groups [65-74 years (young old), 75-84 years (middle old), more than 85 years (old old)], but also to examine nursing care problems at home. The subjects were 252 elderly persons > 65 years (46.8% of all subjects), who were detected for urinary incontinence by incontinence screening examination from among 538 subjects (224 males, 314 females), who underwent visiting nursing by Public Health Centers, and the health and welfare department of intra-metropolitan S Ward from April 1992 to August 1994. The screening examination was made via visiting interview and hearing by Public Health Nurses in charge, about items for examination such as disease, treatment, degree of independency for ADL, residence, utilization of social resources. nursing burden sensation, etc. The analysis was made comparatively by age-groups and by sexes, as mentioned above. The following information was obtained; 1) In terms of the incidence of urinary incontinence, female subjects showed higher incidence for higher age-grade (36.5%, for YO group, 45.1% for MO group and 61.4% for OO group), and male subjects showed higher incidence than female subjects (56.8% for YO group, 54.4% for MO group and 74.5% for OO group). 2) A few subjects were found within 3 months of the onset of urinary incontinence. Incontinence-favorite time zone was predominantly the midnight zone of 0-6 o'clock a.m. (23.5-52.2%). Care approach by caregiver was predominantly "use of diaper" (52.2-90.2%) and "use of diaper even with micturition" represented 30-50%. 3) Endogenous factors involved onset of cerebrovascular disease or dementia, narrow range of ADL, symptoms such as numbness and pain, bedsores, constipation, low social activity, etc. 4) Exogenous factors involved elderly caregiver persons, residual care fatigue sensation, inconvenient toilet and other housing condition, etc. 5) Endogenous-exogenous compound factors in possible urinary incontinence involved paralysis, contrature, social activity, start of visiting for morbid state observational nursing, guidance and utilization of social services for YO group, suggesting strong factor involving the care rather than physical problems of the subject concerned for elder group. From the above, suggestions for the subject concerned were made as follows; 1) start of visiting aiming at the prevention and improvement of urinary incontinence in early stage of onset of cerebrovascular disease (especially for males) or dementia (especially for females) and 2) promotion of rehabilitation for tension provocation of pelvic muscular group and enlargement of ADL and walking distance, and suggestions for caregiver were made as follows; 1) giving appropriate advice for excretory nursing at home and 2) assessment of the relationship with the subject concerned. From the viewpoint of housing environment, reconstruction of such a toilet as is easily usable by both an elderly person and its nursing person and from the viewpoint of regional system, necessary preparation of 24-hour approach to diminution of nocturnal excretory nursing burden was suggested.
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PMID:[A study of endogenous-exogenous factors in urinary incontinence and home care nursing of the elderly at home]. 928 14

Neurovascularly intact gracilis-muscle transposition to the proximal urethra is an exciting new technique for sphincteric incontinence. The functional urethral closure of gracilis myoplasty assures dryness, permits intermittent self-catheterization when necessary, and avoids the risks of erosion associated with the artificial urinary sphincter. Electrical stimulation of the transposed muscle (dynamic urethral myoplasty) using intramuscular electrodes and a subcutaneously placed pulse generator can alter the molecular physiology of the gracilis muscle from that of predominantly fast-twitch to that of slow-twitch fibers that are fatigue-resistant and more suitable for long-term sphincter function.
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PMID:Gracilis muscle transposition with electrical stimulation for sphincteric incontinence: a new approach. 937 85

Maladaptive behaviours are known to present as a feature of dementia amongst people from the general population, but there has been little research to examine whether this has implications for people with learning disabilities who develop dementia. Out of 143 people with learning disabilities aged 65 years and over living in Leicestershire, England, 134 (93.7%) participated in the study. Twenty-nine people diagnosed as having dementia were compared against 99 people without dementia; six people with possible dementia were excluded from the analysis. Comparisons were made on the results of a checklist of maladaptive behaviours. Seventeen out of the 22 maladaptive behaviours examined were found to be more prevalent amongst the people with dementia. The behaviours which were significantly more prevalent in the group with dementia included lack of energy, lack of sense of danger, sleep disturbance, agitation, incontinence, excessively uncooperative, mealtime/feeding problem, irritability and aggression. Dementia is becoming more prevalent amongst people with learning disabilities because of their increasing life span. Maladaptive behaviours are commonly associated with dementia. This can cause a significant burden for individuals and their carers, which may influence the viability of a person's residential placement.
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PMID:A population-based health survey of maladaptive behaviours associated with dementia in elderly people with learning disabilities. 943 52

In a post-marketing surveillance study of 752 patients suffering from urgent incontinence, mixed urgent-stress incontinence, reflex incontinence, urgency and enuresis were treated with propiverine hydrochloride. Clinical efficacy of propiverine hydrochloride was verified by the improvement of symptoms related to detrusor hyperactivity, hypersensitivity and hyperreflexia during a 12-week surveillance period: daytime and overnight urinary incontinence, as well as the frequency, nocturia, urgency in day time and at night decreased. These results are well demonstrated by decreased pad use and statistically significant decrease of Gaudenz urgency score during treatment, confirming the efficacy of propiverine hydrochloride already proved in clinical trials. The safety profile of propiverine hydrochloride displayed characteristic anticholinergic symptoms (dry mouth, accommodation disorders, constipation, tiredness, dizziness) with decreasing incidence during the 12-week treatment period. The residual urine volume decreased also. Serious adverse events were observed rarely and could be explained by the lack of consideration of contraindications, warnings and interactions with other drugs. The positive risk-benefit relationship of propiverine hydrochloride in the treatment of detrusor hyperactivity, hypersensitivity and hyperreflexia was reconfirmed in this post-marketing drug surveillance study.
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PMID:[Tolerance and effectiveness of propiverine hydrochloride in 752 patients with symptoms of detrusor hyperactivity and increased sensitivity and irritability of the urinary bladder: results of a study monitoring drug utilization]. 960 Jan 63


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