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

Subclinical hypothyroidism is associated with aspecific complaints such as tiredness, cognitive and depressive complaints, subtle disturbances in lipid values, an increased risk of cardiovascular disease, ovulatory dysfunction and a negative effect on foetal psychomotor development and pregnancy outcome. Subclinical hyperthyroidism is associated with atrial fibrillation, osteoporosis and dementia. Not enough prospective randomised studies with hard outcomes are available to provide evidence-based general recommendations. Therefore, the decision as to whether or not a patient should be treated needs to be made on an individual basis. For subclinical hypothyroidism it is advisable to consider treatment in the case of positive thyroid peroxidase antibody tests, a TSH concentration higher than 10 mU/l, the presence of one or more risk factors for cardiovascular disease, infertility on the basis of ovulatory dysfunction, and pregnancy. In the case of complaints of tiredness and certainly in the case of depression or cognitive dysfunction, a 3-month trial treatment can be considered. This leads to a decrease of the complaints in about 25% of cases. As negative effects are associated with the treatment, we advise an expectant approach in all other cases with a yearly monitoring of the TSH concentration. For subclinical hyperthyroidism it is advisable to consider treatment in the case of a nodular goitre, and especially in the case of atrial fibrillations. If subclinical hyperthyroidism persists in the absence of nodular thyroid disease, an expectant approach appears to be justified.
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PMID:[Subclinical functional disorders of the thyroid gland]. 1284 32

Fatigue-induced microdamage in bone contributes to stress and fragility fractures and acts as a stimulus for bone remodelling. Detecting such microdamage is difficult as pre-existing microdamage sustained in vivo must be differentiated from artefactual damage incurred during specimen preparation. This was addressed by bulk staining specimens in alcohol-soluble basic fuchsin dye, but cutting and grinding them in an aqueous medium. Nonetheless, some artefactual cracks are partially stained and careful observation under transmitted light, or epifluorescence microscopy, is required. Fuchsin lodges in cracks, but is not site-specific. Cracks are discontinuities in the calcium-rich bone matrix and chelating agents, which bind calcium, can selectively label them. Oxytetracycline, alizarin complexone, calcein, calcein blue and xylenol orange all selectively bind microcracks and, as they fluoresce at different wavelengths and colours, can be used in sequence to label microcrack growth. New agents that only fluoresce when involved in a chelate are currently being developed--fluorescent photoinduced electron transfer (PET) sensors. Such agents enable microdamage to be quantified and crack growth to be measured and are useful histological tools in providing data for modelling the material behaviour of bone. However, a non-invasive method is needed to measure microdamage in patients. Micro-CT is being studied and initial work with iodine dyes linked to a chelating group has shown some promise. In the long term, it is hoped that repeated measurements can be made at critical sites and microdamage accumulation monitored. Quantification of microdamage, together with bone mass measurements, will help in predicting and preventing bone fracture failure in patients with osteoporosis.
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PMID:Detecting microdamage in bone. 1292 17

Despite the proven efficacy of low-dose pamidronate in adults with osteoporosis, the efficacy of the low-dose regimen in children has not been studied. Pamidronate (1 mg/kg) was administered intravenously once every 3 months to 11 children with osteoporosis. Treatment was associated with reduced fracture rates and increased areal (BMD) and volumetric (BMAD) bone mineral density measured by dual energy X-ray absorptiometry (DXA). The mean annualized percent gain was 20.1 +/- 16.9 (4.7 to 59.1, n = 9) for spinal BMD and 15.1 +/- 18.1 (-11.0 to 40.2, n = 9) for spinal BMAD. Common adverse effects including fever, muscle aches, nausea and fatigue were self-limited and generally occurred only after the first infusion. Clinically significant hypocalcemia did not occur. Low-dose pamidronate appears promising in the treatment of childhood osteoporosis.
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PMID:Low-dose intravenous pamidronate reduces fractures in childhood osteoporosis. 1294 2

Stress-related injuries of the pelvis are an important consideration in sports medicine. Diagnosis of stress injuries may be difficult and requires a high index of suspicion. Plain radiographs are the first step in imaging but magnetic resonance imaging is the imaging modality of choice for definitive diagnosis. Repetitive forces transferred to the bone, either through muscle fatigue or from the tensile forces generated by the contracting muscles, are thought to be the causative mechanism of stress injuries. Interestingly, the reparative and reorganisational process of bone result in a temporary weakening before ultimately producing a reinforced structure better adept at supporting repetitive stress. This temporary weakness occurs for several weeks after the initiation of a training programme. Knowledge of the mechanism and aetiology of stress injuries provides the foundation for treatment and prevention. Resting the involved bone through modifying the training programme is the mainstay of treatment. Every effort to prevent stress injuries should be made when initiating a training programme. A cyclical training programme, one that does not place continued and undue stress on any one bone, but provides adequate rest for bone recovery, is recommended. Attention to proper nutrition is emphasised for both treatment and prevention. Maintenance of a normal hormonal balance is additionally important in the female athlete. The bone-maintaining properties of estrogen from a normal eumenorrhoeic menstrual cycle should be preserved. Rarely, women may develop an inter-related problem of disordered eating, amenorrhoea and osteoporosis, the female athlete triad. The female athlete triad is a serious problem that may result in a permanent loss of bone mass. This article more fully explains the mechanism of stress injuries to bone, and provides a more detailed discussion of diagnosis, treatment and prevention.
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PMID:Pelvic stress injuries in the athlete: management and prevention. 1460 27

Several epidemiological studies have demonstrated a gradual decrease of serum testosterone with aging in men. A considerable number of men will experience hypogonadal androgen levels, defined by the normal range for young men. Thus, in addition to the long-standing use of androgen replacement therapy in the classical forms of primary and secondary hypogonadism, age-associated testosterone deficiency has led to considerable developments in application modes for testosterone. Since oral preparations of testosterone are ineffective, due to the first-pass effect of the liver, or, in case of 17 alpha-alkylation, cause hepatotoxicity, intramuscular injection of long-acting esters, such as testosterone enanthate, have been the mainstay of testosterone therapy. However, the large fluctuations of serum testosterone levels cause unsatisfactory shifts of mood and sexual function in some men; combined with the frequent injections, this delivery mode is thus far from being ideal. In contrast, the transdermal testosterone patches are characterized by favorable pharmacokinetic behavior and have proven to be an effective mode of delivery. Safety data over 10 years indicate no negative effect on the prostate. Nevertheless, the scrotal testosterone patch system is hampered by the application site, which is not easily accepted by many subjects; the non-scrotal patch has a high rate of skin irritations. In view of the drawbacks of the currently available preparations, the most recent developments in testosterone supplementation appear to be highly promising agents. Androgen, which has been available in the United States since mid-2000, will be introduced this year in most European markets as Testogel, a hydroalcoholic gel containing 1% testosterone. Doses of 50-100 mg gel applied once daily on the skin deliver sufficient amounts of testosterone to restore normal hormonal values and to correct the signs and symptoms of hypogonadism. The gel has shown to be very effective and successful in American patients, who have benefited from its availability for almost 3 years. Furthermore, in phase II and III clinical studies, the intramuscular injection of 1000 mg testosterone undecanoate every 12-15 weeks has led to extremely stable serum testosterone levels for a prolonged period of time and has resulted in excellent efficacy. It is very likely in the future that these products will be the mainstay of testosterone supplementation. Whereas the indication for testosterone substitution for men with classical forms of hypogonadism is unequivocal, the use of testosterone in men with age-associated hypogonadism is less uniformly accepted. Yet, the few studies addressing this question indicate that men with testosterone serum levels below the lower normal limit for young adult men and with lack of energy, libido, depressed mood and osteoporosis may benefit from testosterone supplementation. However, it should be kept in mind that the experience documented in studies is limited. Nevertheless, serious side-effects, especially in regard to the prostate, did not occur, with the longest study extending over 3 years.
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PMID:Testosterone supplementation: what and how to give. 1462

Cage layer fatigue was first noticed after laying hens began to be housed in cages in the mid-20th century. Hens producing eggs at a high rate were most susceptible to the disease. Early research revealed that cage layer fatigue was associated with osteoporosis and bone brittleness. Severe osteoporosis leads to spontaneous bone fractures commonly in the costochondral junctions of the ribs, the keel, and the thoracic vertebrae. Vertebral fracture may damage the spinal cord and cause paralysis. Osteoporosis appears to be inevitable in highly productive caged laying hens. The condition can be made worse by metabolic deficiency of calcium, phosphorus, or vitamin D. Hens in housing systems that promote physical activity tend to have less osteoporosis and rarely manifest cage layer fatigue. Genetic selection may produce laying hens that are less prone to bone weakness. The welfare implications of osteoporosis stem from pain, debility, and mortality associated with bone fracture. The chicken has well-developed neural and psychological systems specialized to respond to pain associated with trauma and inflammation. Although studies on the chicken have not focused on pain due to bone fracture, physiological and behavioral similarities to other species allow inference that a hen experiences both acute and chronic pain from bone fracture. There is little information on osteoporosis in commercial caged layer flocks, however, evidence suggests that it may be widespread and severe. If true, most caged laying hens suffer osteoporosis-related bone fracture during the first laying cycle. Osteoporosis also makes bone breakage a serious problem during catching and transport of hens prior to slaughter. Estimates of mortality due to osteoporosis in commercial caged layer flocks are few, but range up to a third of total mortality. Many of these deaths would be lingering and attended by emaciation and possibly pain. Osteoporosis-related bone breakage during processing has reduced the marketability of spent caged laying hens, contributing to the need to develop humane on-farm killing methods to support alternative means of spent hen disposition. Overall, the evidence indicates that cage layer osteoporosis is a serious animal welfare problem. A determined effort must be made to make the laying hen no longer susceptible to the harmful effects of excessive bone loss.
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PMID:Welfare implications of avian osteoporosis. 1497 68

Fatigue loading of bone, from the activities of daily living in the elderly, or from prolonged exercise in the young, can lead to increased risk of fracture. Elderly patients with osteoporosis are particularly prone to fragility fractures of the vertebrae, where load is carried primarily by trabecular bone. In this study, specimens of bovine trabecular bone were loaded in compressive fatigue at four different normalized stresses to one of six maximum strains. The resulting change in modulus and residual strain accumulation were measured over the life of the fatigue test. The number of cycles to reach a given maximum compressive strain increased with decreasing normalized stress. Modulus reduction and specimen residual strain increased with increasing maximum compressive strain, but few differences were observed between specimens loaded to the same maximum strain at different normalized stresses.
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PMID:Fatigue of bovine trabecular bone. 1498 99

This study aims at the mechanism of foveola formation in bovine trabecular bone under fatigue process and its relation with biomechanical pathogenesis of senile osteoporosis. The scanning electron microscope equipped with fatigue stage was used to observe fatigue micro injury accumulation of cancellous bone. The massive foveola formation in the laminal bone of vertical trabeculae was found in the tensile fatigue test. There existed the collagen avulsion in the foveola. The massive foveola formation was also observed in the lamina bone of the horizontal trabeculae in the compressive fatigue test. The bone collagen fibers were protracted, debound with hydroxyapatite crystal, and then avulsed under tensile and bending stresses. Finally the retraction of the avulsed collagen fibers brought on the massive formation of foveolae in lamina bone. The mechanical capacity of bone also declined greatly. We infer that the direct mineralization of avulsed collagen and foveola in lamina bone would be one of the main processes of self repair in vivo, which brings on the increase in fragility and stiffness of trabeculae of senile osteoporotic bone along with the agelong accumulation of collagen fatigue injury and foveola formation in the lamina bone.
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PMID:[Prospect of the foveola formation in the bovine trabecular bone under fatigue process]. 1502 64

With the increasing indications for the use of androgen-deprivation therapy in the treatment of men with prostate cancer, side effects of the therapy deserve greater attention. Side effects such as hot flashes, decreased libido, decreased sexual function, and fatigue primarily affect the patients quality of life. Other side effects such as osteoporosis and changes in lipid profiles may also affect the patients overall health. Treatments such as estrogen, megestrol acetate, antidepressants, and bisphosphonates are useful in the management of many of the deleterious side effects of androgen deprivation. In addition, alternative management strategies such as intermittent androgen ablation and antiandrogen monotherapy may be useful in minimizing side effects caused by androgen ablation. Patients and physicians should be well aware of the potential side effects of androgen-deprivation therapy as well as the preventive and treatment strategies for these side effects in order to improve patients quality of life and health.
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PMID:Complications of androgen-deprivation therapy for prostate cancer. 1504 Aug 57

Androgen deprivation, as a form of treatment for prostate cancer, has been used for decades. Within the last decade, however, its use has increased significantly. Therefore, it is incumbent upon the physician to be familiar with the side effects associated with this treatment. Some of these side effects (eg, osteoporosis, changes in lipid profiles, and anemia) may be associated with significant morbidity, whereas others (eg, impotence, decreased libido, fatigue, and hot flashes) primarily affect the patient's quality of life. Prevention strategies and treatments exist for many of these side effects. In addition, alternative forms of antiandrogen therapy such as intermittent hormone ablation and antiandrogen monotherapy may be effective, with the added benefit of minimizing side effects. This review focuses on the wide range of side effects associated with androgen ablation as well as preventive and treatment strategies.
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PMID:Complications of androgen deprivation therapy: prevention and treatment. 1506 1


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