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Two cases of painless subacute thyroiditis were presented in whom fever, fatigue and arthralgia except for thyroidal pain and swelling were complained. Until a intense uptake of the thyroid was found on radiogallium scintigraphy, the examinations of the thyroid had not been done. Laboratory data showed increased erythrocyte sedimentation rate, C-reactive protein and serum alkaline phosphatase, and mild leukocytosis. Skeletal, hepatic and biliary diseases were denied. In patients who have fever, increased erythrocyte sedimentation rate and serum alkaline phosphatase elevation without apparent sources, thyroid function should be evaluated because subacute thyroiditis can be associated with elevation of the serum alkaline phosphatase.
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PMID:[Unsuspected painless subacute thyroiditis detected by radiogallium scintigraphy]. 149 93

Twenty-two studies on the effects of psychological treatment on cancer patients are reviewed. Only studies that compared one or more experimental conditions with at least one control group have been considered. The studies were evaluated with respect to a) research methods, b) psychological interventions, and c) results. Tailored counseling has been shown to be effective with respect to distress, self-concept, (health) locus of control, fatigue, and sexual problems. Structured counseling showed positive effects with respect to depression and distress. Behavioral interventions and hypnosis were effective with respect to specific symptoms such as anxiety, pain, nausea, and vomiting. The research methods, interventions and results of the studies are reviewed critically. Several recommendations for future research are made.
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PMID:Effects of psychological treatment on cancer patients: a critical review. 150 90

The purposes of this study are to identify the nursing diagnoses occurring in an oncology population, to validate these using the clinical validation model, and to determine whether clusters of defining characteristics and etiologies occurred among the diagnoses identified. Secondary analysis was conducted using the patient care records of 48 oncology patients. Twenty-five nursing diagnoses were identified. The most common diagnoses were alteration in comfort (pain) and alteration in nutrition (less than body requirements). The etiologies of stress, pain, life changes, disease, and treatment occurred in some combination in 14 diagnoses. The defining characteristics of pain and fatigue/weakness occurred in over six diagnoses. Clusters of defining characteristics occurred with eight diagnoses. Clusters of etiologies occurred with the diagnosis of sleep/rest disturbance. Validation of defining characteristics and etiologies indicated variation from those proposed by the North American Nursing Diagnosis Association. One overriding variation was in the degree of specificity of defining characteristics used in clinical practice. The findings of this study support the need for continued validation of nursing diagnoses and continued education of nurses in the use of nursing diagnoses. The findings also contribute to the body of knowledge in nursing diagnoses in oncology patients, and contribute to the work beginning to be done in the field of nursing diagnosis with research into the existence of clusters of defining characteristics, etiologies, and/or nursing diagnoses.
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PMID:Nursing diagnoses in an oncology population. 150 55

This report assesses the validity of subscales from the Quality of Life Index (QLI). Subscale validity is tested across different samples of patients with cancer and other diseases. The results of the factor analyses of different versions of the QLI tested in six studies confirm four important health-related quality of life dimensions. These dimensions are psychological well-being, physical well-being, symptoms/side effects, and nutrition. Psychological well-being is represented by a satisfying life, having a good (general) quality of life, having fun, feeling happy and enjoying life. Physical well-being is defined by tiring easily (fatigue), ability to work/carry out usual tasks, strength, and feeling healthy. The symptoms/side effects dimension is characterized by nausea, vomiting, pain distress, and perhaps, by pain amount and pain frequency. Finally, the nutrition dimension is represented by able to eat/eat sufficiently, eating pleasure/appetite, worry about weight, and possibly also taste changes. Good construct validity can be attributed to these health-related quality of life subscales.
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PMID:Validity of health-related quality of life subscales. 151 79

The efficacy and tolerability of 5-hydroxy-L-tryptophan (5-HTP) were studied in an open 90-day study in 50 patients affected by primary fibromyalgia syndrome. When all the clinical variables studied throughout the trial (number of tender points, anxiety, pain intensity, quality of sleep, fatigue) were compared with baseline results, they all showed a significant improvement (P less than 0.001). The overall evaluation of the patient condition assessed by the patient and the investigator indicated a 'good' or 'fair' clinical improvement in nearly 50% of the patients during the treatment period. A total of 15 (30%) patients reported side-effects but only one patient was withdrawn from the treatment for this reason. No abnormality in the laboratory evaluation was observed. It is concluded that 5-HTP is effective in improving the symptoms of primary fibromyalgia syndrome and that it maintains its efficacy throughout the 90-day period of treatment.
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PMID:Primary fibromyalgia syndrome and 5-hydroxy-L-tryptophan: a 90-day open study. 152 74

1. Motor memory and the sense of effort have been investigated in a man with a complete large fibre sensory neuropathy for over 16 years. The perceptions of pain, heat, cold and muscular fatigue remained but he was without perceptions of light touch and proprioception below the neck. 2. The subject was able to discriminate weights held in the hand with an accuracy only slightly worse than control subjects (20 g in 200 g) when forearm movement and visual inspection were allowed. With eyes shut however he could only distinguish a weight of 200 g from 400 g. It is concluded that a crude sense of effort remains which may have a peripheral origin. 3. A limited motor memory was also present, which allowed him to maintain a posture or continue a simple repetitive movement. No novel movement was possible without visual feedback. 4. Differences in movement ability between this subject and others with similar if less pure sensory neuropathies are ascribed to rehabilitation.
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PMID:The perceptions of force and of movement in a man without large myelinated sensory afferents below the neck. 152 22

Two studies investigated the use of lumbar integrated electromyography (iEMG) during flexion-extension exercises of the lumbar spine. The first study compared the iEMG fatigue slopes of 12 pain-free controls during a standardized isotonic workout with a heavy weight and a light weight. Results indicated that the slopes of the iEMG across flexion-extension repetition was negative in both conditions, with the heavy weight producing significantly steeper fatigue slopes. In the second study, iEMG was compared from 16 chronic low back pain (CLBP) patients and 12 asymptomatic controls during isotonic exercise. Integrated EMG was recorded during 18 lumbar extension-flexion cycles (3 min) at a standard pace. Each subject exercised at a weight equal to 60% of his maximum isometric torque produced at the most extended position. Results indicated significantly less iEMG was produced by the CLBP group during both concentric and eccentric exertion. For both groups, eccentric exertion produced significantly less iEMG than concentric exertion. The groups showed significantly different iEMG fatigue slopes, with the control group showing declining iEMG by repetition, while the CLBP group showed flatter, slightly increasing iEMG. This occurred for both eccentric and concentric comparisons. A muscle deficiency model of CLBP is supported and results suggest the importance of endurance factors in addition to strength in rehabilitation efforts. Results also suggest the possibility of using this methodology for detecting insincere efforts in lumbar spine assessment.
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PMID:Lumbar iEMG during isotonic exercise: chronic low back pain patients versus controls. 153 29

Laparoscopic cholecystectomy seems to be the most promising new technique for the treatment of symptomatic gallstone disease. For different reasons, controlled clinical trials comparing comfort and trauma for the patient of conventional versus laparoscopic cholecystectomy are difficult to perform at our institution. We therefore report on the results of our first 400 laparoscopic cholecystectomies using a strict and detailed protocol on technical performance, safety and benefit for the patient. Data was obtained immediately after the operation and after a short-term follow-up. To analyze the technical performance and the safety of the procedure, we developed a new classification system (I-V) of adverse events, including both the patients' and the surgeons' viewpoints. Our results show that in nearly 80% of the cases an optimal result (no adverse events in any respect) was obtained. For different reasons, the surgical procedure had to be changed during the operation in 20 cases (5%). In 3 cases (0.8%), an injury of the common bile duct occurred; 2 patients died (mortality 0.5%). On the first post-operative day, vomiting occurred in only 8% and nausea in 19% of the patients. Pain intensity was always below the level where patients demand analgesic medication and declined near zero the day after the operation. Patients fatigue was measured on a scale from 0-10 and rose from 2.2 preoperatively to 3.3 postoperatively. Only a short hospital stay of 3 days median was required. At short-term follow-up 6 weeks after the operation, pain was only rarely reported, the patients were fit and only 20% avoided some kind of food. We conclude that laparoscopic cholecystectomy is the treatment of choice for this precisely defined patient population with symptomatic gallstone disease.
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PMID:Laparoscopic cholecystectomy: technical performance, safety and patient's benefit. 153 13

For cancer patients, fatigue is a disturbing symptom caused by many factors. Since fatigue is the most common side effect of localized radiation to the breast, this treatment provides a unique opportunity to follow patients prospectively as they develop one type of fatigue. We evaluated the effect of radiation treatment in 15 women with Stage I or II node-negative breast cancer who were otherwise healthy. Fatigue, contrary to our hypothesis, did not increase linearly with cumulative radiation dose over time. It dropped from the first to second week and rose in the third week. The cumulative effects reached a plateau in the fourth week (after an average of 17 fractions), which was maintained during the remaining weeks of treatment. Within 3 wk after treatment, fatigue had diminished. No patient had sustained depressive symptoms. Cardiopulmonary exercise capacity in 5 patients at 6 and 12 wk did not change from just before radiation. Other markers, including reverse triiodothyronine and pulse change with orthostatic stress, did not correlate with subjective fatigue nor cumulative radiation in 15 patients. The curve of the fatigue syndrome during treatment conforms to the adaptation of the organism to a continuing stress and begins to describe a mild fatigue syndrome associated with radiation.
J Pain Symptom Manage 1992 Jan
PMID:Fatigue syndrome due to localized radiation. 153 80

Fatigue is one of the most common complaints among patients seen in the primary care setting. Chronic fatigue syndrome, which has recently been called chronic fatigue immune dysfunction syndrome, is distinctive, with an abrupt onset of symptoms that wax and wane for at least six months. Usually there is low-grade fever, pharyngitis and tender, but not enlarged, lymph nodes. The fatigue can be disabling and is often made worse by physical activity. Some patients with this disorder have also been found to have highly characteristic immunologic abnormalities. Treatment can be rewarding and is based on patient education and support, exercise and symptomatic therapies for abnormal sleep patterns, musculoskeletal pain and other symptoms.
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PMID:Chronic fatigue syndrome. 154 5


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