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

Muscle fibre conduction velocity (MFCV) can be used as an index of the structural and/or functional modifications that can occur during fatigue or pathological processes. Current evaluation of MFCV from surface electromyography (SEMG) classically produces an average value. However, a single mean value is not sufficient when modifications affect only a small part of the conduction velocity distribution. In such a case, an estimation of the whole motor unit conduction velocity distribution (MUCV) would be advantageous. The aim of this study was the evaluation of the quality of two short-term methods based on cross-correlation (CC) and peak-to-peak (PP) estimation. A comprehensive simulation program was used to generate signals with known MUCV distributions. The Dmax statistic of Kolmogorov-Smirnov was used as an error criterion to quantify the estimation error and to optimise the MUCV distribution computation algorithms. The minimum error was observed for an analysing window of 10ms for PP and 15ms for CC. Dmax was significantly lower for PP (0.195+/-0.054) than for CC (0.343+/-0.073). Various simulations showed the strong effect of the variance of the true distribution on the features of the estimated ones. Clinical data measured on the abductor pollicis brevis were studied. MUCV was estimated on a healthy subject (3.63+/-0.87ms(-1)), a patient suffering from a myopathy (2.73+/-0.51ms(-1)) and one suffering from a neuropathy (4.38+/-0.23ms(-1)). The results demonstrate the overall superiority of a peak-to-peak approach.
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PMID:Motor unit conduction velocity distribution estimation: assessment of two short-term processing methods. 1204 9

Improvements in preventive and rehabilitative care have transformed many cases of Human Immunodeficiency Virus (HIV) from being an absolute fatal disease to a chronic, expensive illness. As survival rates and life expectancy increase for people with HIV/AIDS, work plays a more central role in improving their quality of life [5]. Persons with HIV/AIDS face numerous physical challenges in maintaining employment. Signs and symptoms of HIV infection and related opportunistic infections include fatigue, muscle weakness, neuropathy and decreased sensation, bowel and bladder incontinence, persistent cough, weight loss, decreased range of motion and coordination, limited endurance, cardiac problems and vision loss. Occupational therapy practitioners must identify the unique impact they can make on a client's quality of life by addressing work-related issues faced by the HIV/AIDS population.
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PMID:HIV/AIDS and work: The implications for occupational therapy. 1244 56

Twenty-one patients with relapsed and refractory Durie-Salmon stage III multiple myeloma who had either failed at least three previous regimens or presented with poor performance status, neutropenia, or thrombocytopenia were treated with up to four cycles of combination melphalan (50 mg intravenously), thalidomide (titrated to target of 400 mg orally daily), and dexamethasone (40 mg/day orally on d 1 to 4) every 4-6 wk. Maintenance treatment consisting of daily thalidomide and monthly dexamethasone was continued until disease progression. Although generally tolerated, combination melphalan/thalidomide/dexamethasone produced grade 4 neutropenia and thrombocytopenia in 52% and 38% of patients, respectively. Grade 3 nonhematologic toxicities included fatigue (14% of patients), neuropathy/paresthesia (5%), and nausea (5%). Four patients died while on therapy: two from neutropenic complications and two from progressive disease. Melphalan/ thalidomide/dexamethasone was highly active in this poor prognosis population: Serum monoclonal protein reductions > or = 25% occurred in 14 (70%) of 20 evaluable patients, including 1 patient with a complete response and 2 (13%) patients with reductions of 96%. Median progression-free-survival was 270 d (range: 73 to > 787 d) and median overall survival was 382 d. Median progression-free survival (> 420 d) has not been reached among patients responding to melphalan/thalidomide/dexamethasone. These results show that melphalan/thalidomide/dexamethasone therapy is active and generally tolerated in heavily pretreated multiple myeloma patients whose prognosis is otherwise poor.
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PMID:Use of melphalan, thalidomide, and dexamethasone in treatment of refractory and relapsed multiple myeloma. 1251 15

This review briefly describes current concepts concerning the nosological status, pathogenesis and management of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). CIDP is an uncommon variable disorder of unknown but probably autoimmune aetiology. The commonest form of CIDP causes more or less symmetrical progressive or relapsing weakness affecting proximal and distal muscles. Against this background the review describes the short-term responses to corticosteroids, intravenous immunoglobulin (IVIg) and plasma exchange that have been confirmed in randomised trials. In the absence of better evidence about long-term efficacy, corticosteroids or IVIg are usually favoured because of convenience. Benefit following introduction of azathioprine, cyclophosphamide, cyclosporin, other immunosuppressive agents, and interferon-beta and -alpha has been reported but randomised trials are needed to confirm these benefits. In patients with pure motor CIDP and multifocal motor neuropathy, corticosteroids may cause worsening and IVIg is more likely to be effective. General measures to rehabilitate patients and manage symptoms, including foot drop, weak hands, fatigue and pain, are important.
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PMID:Management of chronic inflammatory demyelinating polyradiculoneuropathy. 1253 32

The primary objective of this study was to determine the maximum tolerable dose (MTD) and dose-limiting toxicity (DLT) for bolus 5-fluorouracil (5-FU) administered on a biweekly schedule and in combination with fixed doses of leucovorin (LV) and oxaliplatin. The secondary objectives were to evaluate the toxicity profile and antitumor activity of this regimen for pre-treated patients with advanced colorectal cancer. A total of 26 patients with documented fluoropyrimidine-resistant, advanced colorectal cancer were enrolled into this phase I study. Fixed dose of oxaliplatin (85 mg/m2) was delivered as an i.v. infusion over 2 h, followed by LV (20 mg/m2) and 5-FU bolus every 2 weeks. The starting dose of 5-FU was 600 mg/m2, which was then incremented by 100 mg/m2 for each dose level. The DLT was determined for the first two treatment cycles, while toxicity and efficacy were evaluated throughout treatment. Six dose levels were tested. The MTD of 5-FU was deemed to be 1000 mg/m2 since dose-limiting fatigue was noted for three of the five-patient cohort during the first two cycles of chemotherapy at dose level 6. The most frequent treatment-related toxicities during the study were neutropenia, vomiting, diarrhea, fatigue and neuropathy. In an intent-to-treat analysis, the objective response rate was 30.8% (95% confidence interval 11.8-49.8%) for the 26 patients. The combination of bolus 5-FU/LV and oxaliplatin every 2 weeks is a feasible and effective treatment at the recommended dosages. A phase II study, to more-precisely define activity and toxicity, is ongoing.
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PMID:Biweekly bolus 5-fluorouracil and leucovorin plus oxaliplatin in pretreated patients with advanced colorectal cancer: a dose-finding study. 1256 1

Conduction block is an important functional consequence of demyelination whereby nervous transmission is abolished. Its mechanism has been discussed with respect to the loss of insulation due to disruption of myelin. Recent development of threshold tracking techniques, which enabled noninvasive assessment of axonal membrane potentials and ion channels, has provided evidence that axonal excitability changes significantly and contributes to conduction failure. This view, based upon axo-glial interaction, clarifies the mechanism of muscle fatigue and fasciculation associated with peripheral demyelination and possibly explains selective motor involvement in multifocal motor neuropathy.
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PMID:Physiology of conduction block in multifocal motor neuropathy and other demyelinating neuropathies. 1263 14

Platinum-based combinations are efficacious in the treatment of advanced non-small cell lung cancer (NSCLC) but their toxicity makes them unsuitable for elderly and for patients with co-morbidities. We assessed the efficacy and toxicity of low-dose of paclitaxel in patients who were elderly or who had contraindications against cisplatin therapy. Seventy-one patients (median age 68; range 42-82 years) with unresectable NSCLC were treated with weekly paclitaxel (80 mg/m2) infusion (1 h) for several cycles without intervening rest periods. Thirty-seven patients had PS 1 and 34 had PS 2 status. A total of 614 courses were administered (median 9, range 2-20). There were no episodes of grade 4 toxicities and only 1 patient had grade 3 thrombopenia. Grade 3 anemia or neutropenia were not observed and severe non-hematological toxicity was uncommon: grade 1-2 fatigue in 52%; grade 1-2 motor neuropathy in 42% and grade 3 in 5.5%; grade 1-2 sensory neuropathy in 46.3% of patients. Twenty-seven of the 67 evaluable patients (40.3%) had an objective response, whereas 26 patients (38.8%) had stable disease. The median overall survival for the entire group was 8.4 months (95% CI = 5.6 to 11.2) and the 1-year and 2-year survival was 37.4% and 12.1%, respectively. The median time-to-progression was 5.4 months (95% CI = 3.3 to 7.4). Our data show that low-dose weekly paclitaxel is active and well tolerated in this group of patients with NSCLC and poor prognosis and, as such, is useful for patients in whom platinum-based combinations are not suitable.
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PMID:Weekly paclitaxel for advanced non-small cell lung cancer patients not suitable for platinum-based therapy. 1293 54

In this study, the authors describe 2 patients who experienced confirmed exposures to anticholinesterases that commenced in the 1970s. Subsequently, elevations in creatine phosphate kinase (CPK) were initially detected more than a decade following the first acute exposure. Beginning in the early 1980s, the patients suffered from progressive generalized muscle weakness, chronic fatigue, myopathy, neuropathy, and severe neurobehavioral impairments. Previous occupational exposures included pyridostigmine, as well as isopropyl methylphosphonofluoridate (percutaneous lethal dose [LD50] < 28 mg/kg body weight), and 1 patient had exposure to agricultural organophosphates. The authors hypothesize that the workers' CPK elevations, first detected more than a decade following acute exposures to anticholinesterases, were sentinel events for impending muscle damage and necrosis. Many Gulf War veterans with Gulf War disease who reported exposures to anticholinesterases 1 decade earlier currently suffer from vague neuromuscular and cognitive impairments. Therefore, medical programs for Gulf War veterans with Gulf War Syndrome should include surveillance for elevated CPK, abnormalities of neuromuscular conduction, and genetic susceptibility, and they should promote therapeutic trials for palliation.
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PMID:Creatine phosphate kinase elevations signaling muscle damage following exposures to anticholinesterases: 2 sentinel patients. 1536 80

Studies of HIV-related symptom and treatment side effect prevalence often fail to distinguish individual causal attributions between the two types of problems. However, an understanding of causal appraisals is critical to clarifying and intervening on coping in the context of HIV symptoms and treatment side effects. The objectives of this study are (1) to present causal attributions of symptoms reported by HIV+ adults taking combination therapy and (2) to describe the differential impact on health-related quality of life. In a cross-sectional interview study, a convenience sample of 109 HIV-positive adults taking highly active antiretroviral therapy (HAART) were interviewed using a combination of self- and interviewer-administered measures of quality of life, physical problem checklists, and side effect and HIV-related symptom attribution assessments. The most prevalent physical problems were fatigue, stiff/painful joints, aching muscles, diarrhea, feelings of depression, and neuropathy. Those most commonly labeled as side effects of HAART included upset stomach, nausea/vomiting, constipation, and changes in taste. Most commonly cited as symptoms related to HIV disease were tender lymph nodes, night sweats, weight loss, fever, and loss of strength. Impact of side effects, symptoms, and both were associated with impaired physical and social functioning. Disease-related symptoms, but not side effects, were related to perceptions of general health. Results suggest that HIV-positive persons taking HAART make distinctions between symptoms of disease and side effects of treatment. Perceived disease-related symptoms and side effects have significant and unique associations with quality of life. Findings have implications for symptom and side effects management, provider relations, and future research.
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PMID:The drugs or the disease? Causal attributions of symptoms held by HIV-positive adults on HAART. 1458 96

There are several complications and disadvantages related to sitting position. Among the most frequent are air embolism, pneumocefalus, quadriplegia presumably due to flexion myelopathy, the risk of haematomas at the operative site and the fatigue of the surgeon. Despite the advent of technical innovations the choice of patient position is still done depending on the surgeon preference or experience. We report an unusual complication of sciatic neuropathy due to the pyriformis syndrome after an operation performed in a 29 year old patient who underwent removal of an acoustic neurinoma in sitting position.
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PMID:[Sciatic nerve compression as a complication of the sitting position]. 1460 91


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