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)

Haemodynamic studies at rest and during exercise together with radionuclide ventriculography, pulmonary function and clinical well-being assessment were evaluated in ten patients with COPD and secondary pulmonary hypertension (mean PAP 25 mm Hg), before and after 6 months therapy with pirbuterol 20 mg thrice daily. Despite the continued pharmacological action of pirbuterol on the heart and systemic circulation during peak pirbuterol levels at 6 months, no significant effect on the pulmonary circulation was observed. Seven patients reported an improvement in the level of fatigue, the partial pressure of carbon dioxide fell significantly (6.5 +/- 0.9 to 6.1 +/- 0.9 kPa: P less than 0.01) and there was a slight bronchodilator effect [forced expiratory volume in 1s (FEV1) 0.60 +/- 0.18 to 0.71 +/- 0.2 1s-1: P less than 0.02] after 6 months. The drug was generally well tolerated but three patients with pre-existing biliary tract disease developed obstructive jaundice.
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PMID:Long term haemodynamic, pulmonary function and symptomatic effects of pirbuterol in COPD. 251 10

Two cases of obstructive jaundice due to advanced gastric cancer were treated with intravenous administration of cisplatinum. The first case was a 46-year-old female who had undergone gastrojejunostomy 5 months earlier because of Borrmann type 3 gastric cancer. The tumor involved the head of the pancreas and a portion of the duodenum with distant intraperitoneal dissemination (S3N3P3H0). She was admitted to Shimodate Municipal Hospital on June 8 because of abdominal pain and jaundice. Her abdomen was distended with ascites, and there was a fist-sized tumor in the lower portion. CT examination revealed that the jaundice was caused by obstruction due to the main tumor. Histologically, the tumor consisted of poorly differentiated adenocarcinoma. Intravenous administration of CDDP (50 mg/body/week X 4), MMC (4 mg/body/week X 4) and FT (400 mg/body/day for 4 weeks) was carried out. After the chemotherapy, the jaundice, abdominal pain and ascites disappeared, and the abdominal tumor had markedly reduced in size which was regarded as PR. The second case was 66-year-old male who had received subtotal gastrectomy and transverse colectomy 16 months ago because of Borrmann type 3 gastric cancer. The tumor comprised well-differentiated adenocarcinoma and infiltrated to the mesentery of the transverse colon with positive lymphnodes (S3N1P1H0, stage IV). This time he was admitted to the hospital because of general fatigue and jaundice. According to CT examination, the common bile duct was obstructed by metastasized lymphnode around the pancreas. He had elevated serum level of total bilirubin (7.7 mg/gl) and CA 19-9 (23,000 U/ml). After the administration of CDDP (50 mg/body/week X 4) and MMC (4 mg/body/week X 4), his complaints disappeared and the serum total bilirubin level and CA 19-9 level returned within normal range. These data suggest that combination chemotherapy using CDDP was effective in these 2 cases.
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PMID:[Two cases of obstructive jaundice due to advanced gastric cancer with marked response to the intravenous administration of cisplatinum]. 313 2

We report the use of a nasobiliary catheter in the management of a 55-yr-old female with autosomal dominant polycystic kidney disease who developed obstructive jaundice from a hepatic cyst. The patient presented with a 2-wk history of fatigue, jaundice, nausea, vomiting, and abdominal pain. Physical examination was remarkable for tender hepatomegaly. Computerized tomography revealed multiple hepatic cysts and dilated intrahepatic biliary radicles. Endoscopic stent placement failed to relieve the obstruction. Computerized tomography guided percutaneous aspiration of the obstructing hepatic cyst was successful with the aid of a nasobiliary cholangiogram allowing visualization of the biliary tree and identification of the obstructing hepatic cyst. However, the cyst rapidly accumulated fluid, and the obstruction recurred within 1 wk of simple aspiration. Relief of symptoms was maintained only after alcohol sclerosis of the obstructing hepatic cyst. Review of the literature shows that alcohol sclerotherapy is a safe and effective nonsurgical means of treating symptomatic hepatic cysts.
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PMID:Alcohol sclerosis for polycystic liver disease and obstructive jaundice: use of a nasobiliary catheter. 807 38

To investigate the common causes and differential diagnosis of malignant jaundice, we reviewed 903 cases with obstructive jaundice in PUMC hospital in recent 16 years. 383 of them were malignant jaundice (42.4%). The most common origin of malignant jaundice was carcinoma of the pancreatic head with 198 patients (51.7%), and carcinoma of the ampulla Vater with 94 cases (24.5%) and carcinoma of the extrahepatic bile duct with 71 cases (5.2%). The clinical symptoms and signs were not much helpful to the differentiation of malignant jaundice. No specific early signs were found to the malignant jaundice, but most of the patients felt epigastric distension and distress, anorexia, loss of body weight and fatigue before jaundice appeared. More than one third patients had discontinuous fever. The imaging investigation had decisive roles in the diagnosis and differential diagnosis of the malignant jaundice. The positive rate of diagnosis in sonography was 95.5%, but the correct rate only 85.0% (P < 0.05). We regard that sonography might be the first imaging examination for the malignant jaundice and clue for further investigation. ERCP can clearly reveal the papilla, biliary and pancreatic ducts with high positive rate (97.7%) and correct rate (95.1%). PTC was only used in those patients who had the contraindications to ERCP or the cannulation of ERCP was not successful. The positive rate of PTC was 95.8% in the cases with extrahepatic cholangiocarcinoma. The combination of ERCP and PTC could determine the position and extent of extrahepatic cholangiocarcinoma.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[The common causes and differential diagnosis of malignant jaundice]. 826 74

A case of breast cancer that metastasized to the head of the pancreas 6 yearsand 8 months after mastectomy is reported. The pancreas head metastasis was associated with general fatigue and obstructive jaundice. The serum levels of CEA, CA15-3 and NCC-ST-439, tumor markers of breast cancer, were within normal limits, but CA15-3 was immunohistochemically demonstrated in the resected metastatic lesion, in a manner similar to lobular carcinoma of the breast.
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PMID:A Case of Breast Cancer Metastatic to the Head of the Pancrea. 1109 5

A 22-year-old man visited our hospital (National Cancer Center Hospital East) complaining of fatigue and anorexia. A laboratory investigation demonstrated a biochemical 'picture' of obstructive jaundice. An abdominal CT showed a low density mass in the retropancreatic area with multiple enlarged periportal lymph nodes. Upper gastrointestinal endoscopy revealed active ulceration on the dorsal wall of the descending part of the duodenum, and histopathology of the biopsy specimen revealed an ulcer with reactive inflammatory cell infiltration; no tumor cells were detected. The possibility of neoplasm had been ruled out by the use of CT and angiography. The jaundice recovered spontaneously and the abdominal mass gradually decreased in size. Endoscopic retrograde pancreatography showed no evidence of pancreatic disease; however, endoscopic retrograde cholangiography showed a choledocho-duodenal fistula. This patient showed hypersensitivity against the tuberculin skin test and Mycobacterium tuberculosis was successfully detected in gastric juice by using a polymerase chain reaction method and culture. Biopsy samples obtained from the duodenal ulcer at the second upper gastrointestinal endoscopy showed chronic inflammation with an epithelioid granuloma, suggesting tuberculosis. We thus diagnosed this case as a duodenal tuberculosis with a choledocho-duodenal fistula. To the best of our knowledge, there has been no report available of duodenal tuberculosis being the cause of a choledocho-duodenal fistula.
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PMID:Duodenal tuberculosis with a choledocho-duodenal fistula. 1120 10

A 47-year-old man was admitted to hospital with complaint of general fatigue. Shortly before the admission a suspected obstructive jaundice was diagnosed at a local hospital. On admission, the physical examination was significant for jaundice; total bilirubin was 6.43 mg/dl. The tumor marker CA19-9 was 2056 U/ml. Endoscopic retrograde cholangiopancreatography (ERCP) was performed and showed dilatation of common bile duct and main pancreatic duct, accompanied with an endoscopic naso-biliary drainage (ENBD) in order to reduce the jaundice. The duodenoscopy showed enlarged and deformed papilla. Hypotonic duodenography showed a filling defect at the medial side of the second portion of the duodenum. Ultrasonography (US) showed a hyperechoic lesion, sized 15 mm in diameter, at the pancreas head with dilatation of biliary tract and main pancreatic duct. An abdominal enhanced CT scan showed a mass sized 15 mm at the lower edge of the common bile duct. A selective hepatic arteriography showed no special finding. We performed a pancreatoduodenectomy with dissection of the lymph nodes. The tumor, sized 22x15x20 mm, was white colored and solid on the papilla. Histopathological inspection of the specimen showed an adenosquamous cell carcinoma of the bile duct in the papilla. The tumor was found to infiltrate the neighboring pancreas and to contain metastasis in lymph nodes in the hepatoduodenal ligament, post pancreaticoduodenal and para-aortic lymph nodes. This is the first report on a case of adenosquamous carcinoma of the papilla major.
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PMID:Adenosquamous cell carcinoma arising from the papilla major. 1183 99

An 83-year-old man was admitted to our hospital complaining of general fatigue, fever, and obstructive jaundice. Percutaneous transhepatic bile duct drainage was performed. Gastroduodenal fiberscopy revealed carcinoma of the ampulla of Vater, and early gastric cancer was suspected. A pancreatoduodenectomy with lymph node dissection was performed. Although a biopsy specimen from the gastric lesion was suspected to be well-differentiated adenocarcinoma, no cancerous lesion was found in a specimen resected from the stomach. The histopathologic findings of the ampullary lesion were compatible with a diagnosis of signet-ring cell carcinoma. This is a rare lesion, and a review of the literature revealed only three previous similar cases.
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PMID:Signet-ring cell carcinoma of the ampulla of Vater: report of a case. 1276 76

The patient was a 58-year-old man who suffered from non-resectable gastric cancer, staged intraoperatively for peritoneal dissemination and paraaorta lymph node metastasis at another hospital in December 2002. He was initially treated with TS-1 as an outpatient. However, he was readmitted on March 4, 2003 for hematuria, general fatigue, jaundice and dyspnea. He was diagnosed with gastric cancer duodenum invasion, obstructive jaundice and lymphangitis carcinomatosa, and began weekly TXL as second-line chemotherapy on March 26. TXL (70 mg/ m2) was infused once a week for 3 weeks followed by a 1-week interval as one cycle. One week after the first infusion therapy, the jaundice and dyspnea were greatly improved. CT scan showed the lymphangitis carcinomatosa had disappeared and paraaorta lymph node metastasis was reduced to 60% after one cycle of the treatment. The toxic events were leukopenia (grade 1) and alopecia (grade 1).
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PMID:[Weekly paclitaxel therapy is useful for gastric carcinoma as second-line chemotherapy]. 1557 Sep 37

The most common biliary problem in patients with inflammatory bowel disease is primary sclerosing cholangitis (PSC). The treatment of this disease is multifaceted and frequently requires a multidisciplinary approach involving internists, nutritionists, gastroenterologists, and surgeons. Unfortunately, other than liver transplantation, no therapy that is currently available has been proven to alter the natural history of PSC or prolong survival. Ursodeoxycholic acid is currently the most promising pharmacologic treatment option for slowing disease progression and should be used in higher than usual doses (20 to 30 mg/kg/d). Treatment of symptoms due to cholestasis, such as pruritis and steatorrhea, is an important aspect of the medical care of patients with PSC. Our preferred treatment of pruritis due to cholestasis is with bile acid binding exchange resins such as cholestyramine or colestipol (which is generally better tolerated than cholestyramine). Endoscopic therapy should be reserved for patients with obstructive jaundice, cholangitis, or symptomatic dominant biliary strictures. We recommend dilation of dominant strictures with graduated or balloon dilators followed by temporary stenting if the postdilation cholangiographic appearance is not improved or adequate biliary drainage cannot be assured. There is indirect evidence that the combination of ursodeoxycholic acid and endoscopic therapy to maintain biliary patency may improve transplant-free survival in patients with PSC, although this remains to be proven. Liver transplantation remains the only effective treatment of advanced PSC, and should be considered in patients with complications of cirrhosis or intractable pruritis or fatigue.
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PMID:Treatment of Biliary Problems in Inflammatory Bowel Disease. 1576 33


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