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

The adequate treatment of a disease syndrome is dependent upon a clear definition of the symptomatic, pathological, physiological and prognostic targets against which therapy is to be deployed. The syndromes of ischaemic heart disease, including angina pectoris, are complex in origin, pathology, pathophysiology and natural history, and a complete clinical profile is difficult, if not impossible, to achieve in individual patients. The prime goals of pharmacotherapy in ischaemic heart disease are easy to define, but difficult to accomplish in practice. Relief of pain, breathlessness and fatigue are the prime clinical targets for pharmacotherapy. In view of their sinister significance, the electrophysiological indications of myocardial ischaemia, whether symptomatic or silent, are also crucial targets towards which therapy must be directed. Ischaemic heart disease is accompanied by a wide variety of regional and global abnormalities of myocardial contractile function associated with widespread reflex stimulation of the peripheral vascular system and neuroendocrine systems. Primarily, drug therapy must be directed at correction of these pathophysiological components of the syndrome. Longer term but no less essential goals in the treatment of ischaemic heart disease are the prevention of the clinical sequelae of the syndrome and its progression. A natural sequel of coronary artery obstructive disease is successive thrombotic events and loss of myocardium. Calcium antagonists, by preventing the increase in myocardial cytosolic calcium during acute ischaemic episodes, defer cell necrosis; in this respect, they are unique among currently available antianginal drugs. With regard to progression, the prime pathological cause of ischaemic heart disease is coronary atheroma.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Therapeutic targets in ischaemic heart disease. 137 82

Epidural administration of hydromorphone was evaluated using a patient-controlled analgesia (PCA) delivery system in 170 healthy women undergoing elective cesarean delivery with epidural bupivacaine who were randomly assigned to one of four epidural PCA treatment groups: group I, hydromorphone alone by bolus administration; group II, hydromorphone, with a continuous (basal) infusion; group III, hydromorphone in combination with 0.08% bupivacaine by bolus administration; or group IV, hydromorphone and bupivacaine, with a concurrent infusion of both drugs. Patients in group I required significantly less opioid medication (2.1 +/- 1.1 mg [mean +/- SD]) during the first 24 h than patients in group II (3.3 +/- 1.3 mg). Similarly, patients in group III self-administered significantly less hydromorphone (2.0 +/- 1.0 mg) and bupivacaine (23.3 +/- 11.4 mg) during the first 24 h of PCA therapy, compared with patients in group IV (hydromorphone [2.7 +/- 1.1 mg] and bupivacaine [31.5 +/- 11.6 mg]). The concomitant use of a local anesthetic or basal opioid infusion with hydromorphone via epidural PCA did not decrease the number of PCA demands or delivered doses. In addition, patients in all four groups had similar pain, sedation, discomfort, fatigue, and anxiety scores. The frequency of awakening at night to self-administer analgesic medication was not decreased when a basal infusion was used.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Epidural patient-controlled analgesia: influence of bupivacaine and hydromorphone basal infusion on pain control after cesarean delivery. 138 97

The purpose of this study was to assess the perception of muscle tension in chronic pain patients and healthy controls. Twenty chronic back pain patients, 20 patients who suffered from temporomandibular pain and dysfunction, and 20 healthy controls were instructed to produce eight different levels of muscle contraction in either the m. masseter or the m. erector spinae. Each level was produced three times; trials were presented in random order. Analyses of the accuracy and the sensitivity of discrimination of muscle tension levels revealed that the patients were less able to perceive muscle contraction levels correctly and that they underestimated their actual levels of muscle tension. Patients and controls did not differ in the extent to which they contracted muscles not involved in the task. Patients suffering from musculoskeletal disorders seem to display a genuine deficit in discrimination of muscle tension that is related to neither local physiological changes at the site of pain, lack of motivation, in-attention, nor fatigue.
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PMID:Discrimination of muscle tension in chronic pain patients and healthy controls. 138 53

This article reports the results of the validation of a life activity record. We devised a self-administered daily log (the NIH Activity Record, ACTRE), for persons with rheumatoid arthritis (RA), which recorded specific daily activities over a 24-hour period and identified the level of physical effort for each task. In addition, each activity was assigned a level of pain, fatigue, difficulty, competence, meaningfulness and enjoyment. Twenty-one persons with RA completed the log. They underwent an articular examination (AI) (Ritchie Articular Index) as well as completed the following self-reports: Psychosocial Adjustment to Illness Scale (PAIS); The Feeling Tone Checklist (FTC), a measure of fatigue; The Modified Health Assessment Questionnaire (ALI); and the Pain and Disability Index (PDI). Significant correlations were found between fatigue measured by ACTRE and FTC (p = 0.028); pain measured by ACTRE, PDI (p = 0.002), and (p = 0.01) and the visual analog scale in the ALI (p = 0.0002). Pain experienced while performing self-care measured by ACTRE correlated with AI (p = 0.001) and ALI (p = 0.0013). Difficulty with self-care activities on the ACTRE correlated with difficulty (p = 0.007) and pain (p = 0.012) on the ALI. The ACTRE is a valid measure of symptoms and perceptions that can be quantified, and is unique in that it identifies specific daily activities likely to produce them.
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PMID:Validation of the NIH activity record: a quantitative measure of life activities. 139 Sep 68

Children with juvenile rheumatoid arthritis (JRA) often exhibit fatigue and prolonged exercise recovery. Improved fitness through physical conditioning has not been a goal of standard medical or physical treatment regimens for JRA, and fitness levels of children with JRA have rarely been studied. We compared physical fitness in 20 6 to 11-year-old patients with polyarticular JRA with sex-, age-, and size-matched controls, using the Health Related Physical Fitness Test (HRPFT), a national, standardized, norm-referenced test. We correlated fitness scores with summary joint counts, and with an articular severity index (sum of joint swelling, tenderness, pain, and limited range for each child). The results showed that children with polyarticular JRA were less physically fit than normally active (noncompetitively athletic) children of the same sex, age, and size. There was no statistically significant relationship between increased joint counts, and/or disease severity scores, and reduced fitness scores. This suggests that physical fitness levels are less related to degree of "disease activity" than is often thought. We conclude that (1) a readily available, nationally standardized fitness test can be used to assess children with JRA: and (2) fitness levels and measures of disease activity do not correlate. We believe that multiple factors, perhaps including family, physician, and school concerns about potential disease exacerbation following exercise, may account for the low fitness levels observed in children with JRA.
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PMID:Physical fitness levels in children with polyarticular juvenile rheumatoid arthritis. 139 Sep 70

During a period of 20 weeks 18 female patients with fibromyalgia participated in a 60-minute exercise program twice a week. A control group, comprising 17 patients, was told not to change their physical activity level. Eleven patients in the training group and fourteen in the control group completed the study. The results at entry were compared to those after 20 weeks, as well as being compared to the results of the control group. No statistically significant changes or differences in general pain, pain coping and fatigue were seen after 20 weeks. Improved dynamic endurance work performance for the upper extremity was found, however, in the training group, measured as the strength of the first (p = 0.01) and the last repetition (p = 0.003). These results differed from the results of the control group (p = 0.02 and p = 0.003). It is concluded that fibromyalgia patients may undergo low-intensity dynamic endurance training without experiencing exacerbation of their general pain and fatigue symptoms.
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PMID:The effects of 20 weeks of physical fitness training in female patients with fibromyalgia. 139 19

In 11 patients, all women, 21-55 years of age, with unilateral work-related myalgia of the trapezius muscle, the right and left trapezius muscles were examined simultaneously for electromyogram (EMG) signs of localized muscle fatigue. All patients were tested with 0-kg hand load for 5 min, holding the arms straight at 90 degrees of elevation in the scapular plane. Only 4 of the patients tolerated exposure to higher load levels. They were tested with 1 kg hand load for 3 min and 2 kg hand load for 2 min, with a period of rest of 30 min between the trials. The EMG mean power frequency (MPF) and root mean square (rms) were calculated. Data were normalized with the initial value as a reference and regression analyses were performed. On both sides a decrease of MPF and an increase of rms were found with increasing time and load, i.e. classical EMG signs of localized muscle fatigue. Compared with the nonaffected side smaller changes were found on the affected side, possibly due to pain inhibition, impaired microcirculation and biochemical changes along the muscle fibres. At 0-kg hand load we found no change of MPF on either side despite subjective feelings of fatigue and pain. We interpreted these findings as an indication of reduced capacity of the affected trapezius muscle to sustain static load with early development of pain-associated local fatigue.
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PMID:Electromyographic changes in work-related myalgia of the trapezius muscle. 139 55

Patients with erythema multiforme (EM) often have chronic or recurring oral lesions that cause intense pain and interfere with a variety of functions including eating and speech. Previous studies suggest that levamisole restores to normal the function of phagocytes and T lymphocytes, and activates the inflammatory response. In our previous double-blind study 8 of 13 patients with EM had a decrease in severity and frequency of attacks. The purpose of this open prospective study was to evaluate short-term and long-term clinical efficacy of levamisole in patients with mucocutaneous EM. Thirty-nine patients with mucocutaneous EM seen in the Oral Medicine Clinic, School of Dentistry, University of California-San Francisco, comprised our study group. Levamisole was used alone in 17 patients or in combination with prednisone in 22 patients and was given as a single dose of 150 mg/day for 3 consecutive days. Thirty-one patients showed a complete response from levamisole (alone in 13 and in combination with prednisone in 18). Four showed a partial response of signs and symptoms, and four others had no benefits from levamisole whether alone or in combination. The most common side effects from levamisole were skin rash, tiredness, weakness, myalgia, taste change, and insomnia.
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PMID:Clinical response to levamisole in thirty-nine patients with erythema multiforme. An open prospective study. 140 89

1. Head and neck tumors occur predominantly in men between 50 and 70 years of age who typically abuse tobacco or alcohol. These individuals often have poor oral hygiene and dentition as well as nutritional deficits, and achlorhydria, anemia, and iron and riboflavin deficits are common. 2. The tumor and treatment of head and neck cancer may cause many devastating effects, such as facial disfigurement, dysphagia, alterations in airway and communication, partial or total loss of taste and smell, xerostomia, pain, or fatigue. Treatment and rehabilitation may take months. 3. Although advances in technology and reconstructive surgery have not improved the overall survival rate, they preserve appearance, function, and, ultimately, the patient's quality of life.
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PMID:Head and neck cancer resection and reconstruction: from past to present. 141 30

Upper extremity cumulative trauma disorders became a potentially significant occupational hazard among sign language interpreters at the National Technical Institute for the Deaf in the 1988-89 academic year. The following case control study was conducted to identify factors that might play a role in developing, exacerbating, and maintaining upper extremity cumulative trauma disorders among interpreters. Investigations were conducted to determine whether medical status, physical capacities, interpreting styles, pain, fatigue, and job stress differed among NTID's sign language interpreters. This report provides a general summary of selected findings as well as a conceptual framework that should help clarify the factors associated with upper extremity cumulative trauma disorders in sign language interpreters. The results indicated that the upper extremity cumulative trauma disorder diagnosed most often is tendinitis rather than a nerve entrapment syndrome (e.g., carpal tunnel syndrome). Analysis of the frequency of potential biomechanical risk factors indicated that those reporting pain demonstrated higher frequency of hand and wrist deviations from the neutral position, higher frequency of the upper extremities leaving a predefined work space, fewer rest breaks during interpreting sessions, and higher evaluator ratings of pace of finger and hand movements. Specific features of interpreting styles were associated with increased pain and fatigue.
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PMID:Cumulative trauma disorders among educational interpreters. Contributing factors and intervention. 141 70


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