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)

A 27-year-old man was admitted to our hospital with the complaint of general fatigue. He had cervical and mediastinal lymphadenopathy. Laboratory examination revealed anemia, hypergammaglobulinemia, and increased levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). A chest radiograph showed opacities in both lung fields. Pathological findings from thoracoscopic mediastinal lymph node and lung biopsies were compatible with multicentric Castleman's disease (MCD), plasma cell type with pulmonary involvement. Chemotherapy combined with radiation therapy resulted in no improvement of his lymphadenopathy and inflammatory symptoms. Eight mg/kg humanized anti-human IL-6 receptor antibody (tocilitumab) was thus administered biweekly. Soon after initiating the tocilitumab treatment, the patient's general fatigue disappeared, and anemia, CRP, ESR, hypergammaglobulinemia and lymphadenopathy all improved remarkably. Further treatment with tocilitumab for two years resulted in maintenance of this good response without any severe adverse events, but the pulmonary findings showed no obvious improvement. Tocilitumab therapy was effective in this MCD patient, however its influence on concurrent lung disease needs to be investigated further.
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PMID:[Effectiveness of long term administration of humanized anti-interleukin-6 receptor antibody (tocilizumab) for multicentric Castleman's disease with pulmonary involvement]. 1698 13

Nocturnal hypoxemia is associated with excessive daytime sleepiness in patients with chronic respiratory disease. This relationship has not been explored in patients with cancer. This study examined the prevalence of nocturnal hypoxemia in patients admitted to a specialist palliative care unit, and explored relationships with demographic and physiological parameters, opioid or other sedative drug use, and daytime sleepiness, fatigue, and quality of life. Demographic details, diagnosis, performance status, body mass index, opioid or other sedative drug use, hemoglobin, spirometry, and sniff nasal inspiratory pressures were obtained, along with Epworth Sleepiness Scale, Multidimensional Fatigue Inventory, and Short Form-36 health questionnaire scores. An oximeter recorded resting daytime oxygen saturation (SaO2); overnight SaO2 was recorded for a minimum of five hours. Nocturnal hypoxemia was defined as SaO2<90% for >or=2% of the monitored nighttime. Of 100 patients, 35 had nocturnal hypoxemia. These were more likely to have lung disease (P<0.05), a lower forced expiratory volume in one second % predicted (P=0.01), lower daytime SaO2 (P=0.01) and higher levels of mental fatigue (difficulty concentrating) (P=0.02), compared to those without nocturnal hypoxemia. Both groups exhibited abnormal levels of daytime sleepiness. Nocturnal hypoxemia is common in this group of patients and may contribute to mental fatigue (difficulty concentrating).
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PMID:The prevalence of nocturnal hypoxemia in advanced cancer. 1849 14

(1) Interstitial pneumonia usually develops gradually. The signs and symptoms are non-specific, and generally include dyspnea, cough, fatigue, and weight loss. In other cases onset is acute, sometimes beginning with a flu-like syndrome. Interstitial pneumonia can lead to acute respiratory failure, sometimes gradual deterioration of respiratory function, and pulmonary fibrosis progressing to respiratory failure. The fibrosis does not regress when the causal factor is withdrawn. (2) There are numerous causes of interstitial pneumonia, including medicinal drugs. (3) Amiodarone generally induces slow and insidious lung disease. (4) Methotrexate induces lung disease. Most cytotoxic drugs cause chronic dose-dependent lung disease and fibrosis, in some cases long after treatment cessation. (5) The many other implicated drugs include nitrofurantoin, Nonsteroidal antiandrogens, drugs that induce connective tissue diseases, laxatives based on mineral oil, and many other drugs, some of which are known to cause hypersensitivity reactions. (6) In practice, a drug-related cause should be kept in mind in cases of interstitial pneumonia, as symptoms generally improve after drug withdrawal, unless fibrosis has already started to develop.
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PMID:Drug-induced interstitial pneumonia. 1851 14

Lymphangioleiomyomatosis (LAM) is a rare lung disease affecting women. Following case reports that pregnancy exacerbates LAM, patients are frequently advised to avoid pregnancy. Our objective was to determine pregnancy and health outcomes in LAM to provide better evidence with which to council patients contemplating pregnancy. We surveyed 328 women with LAM regarding pregnancy outcomes, pulmonary function, subjective and psychological functioning, quality of life, dyspnoea and fatigue. Amongst childless women the main reason not to attempt pregnancy was based on concerns about potential effects of pregnancy on LAM. Almost two thirds of patients had been pregnant, the majority before LAM was diagnosed, in whom pregnancy outcome was generally favourable. Women diagnosed with LAM (n=15) during pregnancy had high rates of pneumothorax (67%), miscarriage (7%) and premature birth (47%). The group diagnosed with LAM before or during pregnancy (n=12) had lower mean FEV(1), FVC and DLCO after pregnancy compared with those diagnosed following pregnancy or never pregnant. There were no differences in subjective or psychological functioning, quality of life, dyspnoea or fatigue scores between groups. In newly diagnosed LAM patients there was a high incidence of premature birth and pneumothorax. These adverse outcomes may be a marker of aggressive LAM.
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PMID:Pregnancy experiences among women with lymphangioleiomyomatosis. 1911 42

Rhabdomyoma is a rare tumor in the posterior mediastinum. We present a case of adult rhabdomyoma that occurred multifocally in the head, neck and mediastinum. There have been as few as four previous reports on rhabdomyoma in the posterior mediastinum. An 80-year-old white man was admitted to the Division of Pulmonary Diseases because of dyspnea, hemoptysis and fatigue. Physical examination revealed a tumor in the left submandibular area. Computed tomography (CT) of the head and neck showed a mass which caused a marked prominence of the left posterolateral wall of the pharynx. Chest CT revealed a contrast-enhancing tumor. The mass was 20 x 19 x 55 mm in size and was in contact with the lateral wall of the esophagus. Histological examination showed that the tumor was composed of cells typical of adult rhabdomyoma. The patient has been followed in our outpatient clinic for more than the last 7 years. To our knowledge, this is the fifth case of adult mediastinal rhabdomyoma. We believe that rhabdomyoma is a rare tumor which should be considered in a differential diagnosis of tumors detected in the posterior mediastinum.
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PMID:Rhabdomyoma as a tumor of the posterior mediastinum. 1977 7

Paediatric neuromuscular disease compromises both the gas exchange and pump functions of the respiratory system. This can have profound implications for both growth and development of the respiratory system, as well as morbidity and mortality. Aspiration lung disease is common, and leads to increasingly restrictive pulmonary physiology over time. Abnormal lung and chest wall mechanics, and weak respiratory muscles, can combine to cause respiratory failure. Improving the balance between the work of breathing (by decreasing the respiratory load) and the respiratory pump (by improving respiratory muscle strength and decreasing respiratory muscle fatigue) can help prevent the onset of respiratory failure. Airway clearance techniques and non-invasive ventilation are two important tools in this effort. Better ways of assessing the respiratory pump, mechanical function, control and fatigue are needed especially in children.
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PMID:Pulmonary complications of neuromuscular disease: a respiratory mechanics perspective. 2011 87

A 42-year-old Japanese woman was referred to our university hospital due to progressive anemia and bilateral hilar lymphadenopathy with diffuse ground-glass attenuation on chest computed tomography in December 2009. She had suffered from exertional dyspnea and fatigue for several months. Laboratory findings on admission demonstrated leukocytosis (10,950/ul), elevation of C-reactive protein (4.7 mg/dl), IL-6 (19.9 pg/ml), IgG4 (567 mg/dl) and polyclonal hyper gamma-globulinemia. Chest computed tomography represented mediastinal and bilateral hilar lymphadenopathy with diffuse centrilobular fine nodules and intralobular septal thickening. Histopathological findings of the specimens obtained by thoracoscopic lung and mediastinal lymph node biopsies revealed massive infiltration of IgG4-positive plasma cells in lung tissue and lymph nodes. Pathological findings and high levels of C-reactive protein and interleukin-6 suggested a diagnosis of multicentric Castleman's disease (MCD). In addition, pathological findings of peribronchiolar infiltration of IgG4-positive plasma cells and lymphoid follicles with infiltration of IgG4-positive plasma cells with a high level of IgG4 were indicative of the complication of IgG4-related lung disease. Radiological and serological findings improved rapidly soon after the initiation of oral corticosteroid treatment. It was speculated that this case indicated the close relationship between MCD and IgG4-related lung disease.
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PMID:[A case of multicentric Castleman disease with massive infiltration of plasmacytes presenting IgG4]. 2173 45

Acute fibrinous and organising pneumonia (AFOP) was recently described as an unusual pattern of diffuse lung disease. Particular characteristics make the differential diagnosis with the well recognised clinical patterns of diffuse alveolar damage, cryptogenic organising pneumonia or eosinophilic pneumonia. The lack of hyaline membranes, the presence of intra-alveolar fibrin, absence of noticeable eosinophils and patchy distribution suggests that AFOP define a distinct histological pattern. The authors describe the case of a woman diagnosed with AFOP after surgical lung biopsy, in association with primary biliary cirrhosis. The patient presented dyspnoea, fatigue, dry cough and thoracic pain. The CT scan showed bilateral patchy infiltrates predominantly in the lower lobes. Flexible bronchoscopy and subsidiary techniques were inconclusive and biopsy through video-assisted thoracoscopic surgery led to anatomopathological diagnosis of AFOP. The patient is having a good clinical response to prednisone.
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PMID:Acute fibrinous and organising pneumonia. 2260 88

Testosterone seems to play a role in the pathophysiology of OSAS but the mechanisms are not yet well defined. Research of this relationship has focused on two main assumptions: first case support the emergence of OSAS or augmentation of OSAS severity in men treated with testosterone for symptomatic hypogonadism; the second hypothesis suggest that serum testosterone deficiency is due to hypoxia and microarousals generated by OSAS with direct impact on hypothalamic-pituitary-gonadal axis. The correlation between sleep apnea and androgenic disorders should be considered in the light of the intervention of many other factors which can act as confounding factors: age, obesity and other associated pathologies (chronic lung disease, smoking status). Many studies conducted so far on this interrelation (sleep apnea, endocrine system) have ignored these factors. In most cases CPAP (continuous positive airway pressure) therapy revert low serum testosterone levels to normal levels. Depressive status and fatigue, as OSAS consequences associated with hypogonadism have been reported in the literature and may have clinically significant aspects due to summary effect, with notable improvement after CPAP therapy avoiding adverse effects of hormonal or antidepressant treatment. The clinical implications and major consequences of association between androgen dysfunction and sleep apnea syndrome require a correct management in the recognition and treatment of obstructive sleep apnea syndrome associated with comorbidities.
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PMID:[Association between the serum level of testosterone and other comorbidities in obstructive sleep apnea]. 2278

The full picture of immunoglobulin G4-related lung disease (IgG4-RLD) has not yet been elucidated. A 69-year-old man was referred to us with a more than 2-week history of productive cough and fatigue. Chest CT showed an airspace consolidation along the bronchovascular bundles. The pathological findings that were obtained from an open-lung biopsy showed both organizing pneumonia and interstitial pneumonia. Based on the established, comprehensive diagnostic criteria for IgG4-related disease (RD) as of 2011, this patient was given a definitive diagnosis of IgG4-RD. A further accumulation and analysis of those cases that concomitantly present with both IgG4-RLD and organizing pneumonia, like our patient, may contribute to the elucidation of the pathology of IgG4-RLD and the establishment of the disease spectrum.
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PMID:Immunoglobulin G4-related lung disease accompanied by organizing pneumonia. 2404 21


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