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Query: UMLS:C0015672 (fatigue)
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Twelve cases of Lyme's disease with neurological complications are reported. Seven patients had meningoradiculitis of the Garin-Bujadoux-Bannwarth type, with facial palsy in 2 cases. In 1 case the radiculitis involved only the cauda equina. Two more patients had meningomyelitis. Of the remaining 3, 1 had subacute inflammatory polyneuritis with albumino-cytologic dissociation, 1 had probable dorsal epiduritis, and the last one developed parkinsonism and communicating hydrocephalus after an otherwise classical meningoradiculitis. Three patients recalled a tick bite but only one a cutaneous eruption. No arthritis or cardiac involvement were observed. In 2 cases the CSF contained pseudo-neoplastic cells. Severe pain was a prominent feature in most cases. Pain consistently and rapidly improved on high-dose intravenous penicillin, while other signs or symptoms (e.g. paresthesias or fatigue) often lasted several months. Parkinsonism and hydrocephalus were not influenced by penicillin, and both required specific therapy. Isolated neurological (both central and peripheral) involvement is not unusual in Lyme's disease and may give rise to a wide range of signs and symptoms. This diagnosis is to be considered even when other features of Borrelia burgdorferi infection are lacking.
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PMID:[Neurologic forms of Lyme disease. 12 cases]. 266 39

A 40-year-old man who was resected ascending colon and terminal ileum (10 cm) in Aug. 1978, with the diagnosis of Crohn's disease, was admitted to our hospital with general fatigue, paresthesia and tremor in May. 1984. A peripheral blood examination on admission revealed Hb 10.1 g/dl, RBC 234 X 10(4)/mm3, MCV 131.4 fl, MCH 43.2 pg. A bone marrow specimen showed marked erythroid hyperplasia (W/E 1.44) with megaloblastic change. While serum folate level was normal, serum vitamin B12 value was low and Schilling test showed vitamin B12 malabsorption. Roentgenologic and endoscopic examinations revealed diffuse cobblestone appearances in small intestine (from anastomosis part to duodenal bulb). These examinations suggested vitamin B12 malabsorption with diffuse Crohn's disease caused megaloblastic anemia. The patient had been treated with vitamin B12 1,000 micrograms/day injection and, in Sep. 1984, he recovered from megaloblastic anemia (Hb 13.4 g/dl, RBC 440 X 10(4)/mm3, MCV 90.7 fl, MCH 30.4 pg).
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PMID:[Megaloblastic anemia associated with diffuse intestinal Crohn's disease]. 271 98

In 984 patients with generalized anxiety disorder who received buspirone in double-blind studies, the incidence of drowsiness (9 percent) did not differ significantly from that (10 percent) reported in 334 patients who received placebo. A probability value of p less than or equal to 0.10 was the criterion for significance. The incidence of drowsiness in buspirone-treated patients was significantly less than that in each of the groups receiving diazepam (32 percent), clorazepate (26 percent), lorazepam (58 percent), or alprazolam (43 percent). The side effects that did occur significantly more frequently in the buspirone group than in the placebo group were dizziness (9 percent versus 2 percent), headache (7 percent versus 2 percent), nervousness (4 percent versus 1 percent), light-headedness (4 percent versus less than 1 percent), diarrhea (3 percent versus less than 1 percent), paresthesia (2 percent versus less than 1 percent), excitation (2 percent versus less than 1 percent), and sweating/clamminess (1 percent versus 0 percent). The severities of these effects were predominantly rated as only mild or moderate. Fatigue occurred less frequently in buspirone-treated patients than in those receiving any of the benzodiazepines, and weakness occurred more frequently in diazepam-treated patients. Depression occurred less frequently in buspirone-treated patients than in those receiving clorazepate, diazepam, or lorazepam. Impotence occurred only in clorazepate- and lorazepam-treated patients. Decreased libido occurred more frequently in diazepam-treated patients, whereas increased libido was more frequent in clorazepate-treated patients. Nausea was reported more frequently in buspirone-treated patients than in those receiving clorazepate, diazepam, or alprazolam; diarrhea occurred more frequently in the buspirone group than in the diazepam group. The mean daily doses of the various treatments were buspirone, 20 mg; diazepam, 20 mg; clorazepate, 24 mg; lorazepam, 3 mg; and alprazolam, 1.5 mg. In an open-field study in West Germany involving 5,414 patients, gastrointestinal-related complaints were the most frequently reported side effects.
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PMID:Review of the side-effect profile of buspirone. 287 Jun 41

A 28-year-old man presented with paresthesias, fatigue, central cyanosis, and erythrocytosis. A first pass flow study with Tc-99m as free pertechnetate was done, among other tests, to exclude a central shunt when a persistent left superior vena cava was incidentally detected. The value of radionuclide angiocardiography to examine the central circulation noninvasively was again illustrated in this case.
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PMID:Persistent left superior vena cava detected with radionuclide angiocardiography. 298 23

Twenty-one percent of 500 unselected patients, aged 17 to 50 years, seeking primary care for any reason were found to be suffering from a chronic fatigue syndrome consistent with "chronic active Epstein-Barr virus (EBV) infection," They had been experiencing "severe" fatigue, usually cyclic, for a median of 16 months (range, six to 458 months), associated with sore throat, myalgias, or headaches; 45% of the patients were periodically bedridden; and 25% to 73% reported recurrent cervical adenopathy, paresthesias, arthralgias, and difficulty in concentrating or sleeping. The patients had no recognized chronic "physical" illness and were not receiving psychiatric care. While antibody titers to several EBV-specific antigens were higher in patients than in age- and sex-matched controls subjects, the differences generally were not statistically significant. A chronic fatigue syndrome consistent with the chronic active EBV infection syndrome was prevalent in our primary care practice. However, our data offer no evidence that EBV is causally related to the syndrome. Indeed, we feel that among unselected patients seen in a general medical practice currently available EBV serologic test results must be interpreted with great caution.
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PMID:Frequency of 'chronic active Epstein-Barr virus infection' in a general medical practice. 303 38

By creating motility disorders, functional pancreatic insufficiency, inadequate bowel absorptive surface, bacterial overgrowth, or mucosal changes, several disease states and treatments have an adverse impact on the body's ability to digest and/or absorb nutrients adequately. The subjective and objective observations associated with the malabsorption syndrome--fatigue, paresthesia, weight change, alterations in bowel movements, and laboratory abnormalities--are caused by losses of macronutrients, electrolytes, minerals, and vitamins in the stool. The absorption workup consists of tests for fat absorption, bowel integrity, pancreatic function, and bacterial overgrowth, which may be performed alone or in combination to aid in identifying specific absorptive defects. Other diagnostic procedures include abdominal x-rays and CAT scans and intestinal biopsy. A logical, well-planned workup is essential in order to avoid unnecessary and/or costly testing. Nutrition management utilizes parenteral, enteral, and oral feeding in combination with adjunct medical measures for maximizing nutrient absorption and minimizing nutrient losses.
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PMID:Malabsorption in adults: etiology, evaluation, and management. 309 70

Fibrositis is a disorder of musculoskeletal pain and aching with at least a five to one female-to-male ratio. It is most commonly seen between the ages of 40 and 60, and has a prevalence in the clinic of 6 to 15 percent. Its most common mode of presentation involves generalized musculoskeletal pain and aching, but articular pain, axial skeletal pain, myalgias, and neurovascular complaints sometimes predominate. All patients have multiple areas of local tenderness called "tender points" that are easily identified during physical examination, and are diagnostic. Essential symptoms of fibrositis are disturbed sleep, morning stiffness, and fatigue. Additional rheumatic symptoms include subjective swelling, paresthesias, and numbness. Headaches and irritable bowel syndrome are common nonrheumatic complaints. Modest improvement follows treatment by tricyclic agents such as low-dose cyclobenzaprine and amitriptyline, by physical measures, and by reduction in stress. Remission occurs in 20 percent of patients, but is generally short-lived.
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PMID:The clinical syndrome of fibrositis. 346 12

A longitudinal survey on the prevalence of vibration syndrome among professional forest workers was conducted from 1972 (118 workers) to 1983 (206 workers). The prevalence of vibration-induced white finger (VWF) was 40% among the workers in 1972; it gradually declined to 5% in 1983. Three new workers developed VWF symptoms during the follow-up period. They had only used saws equipped with antivibration handles. The prevalence of VWF has decreased mainly due to the reduction of chain-saw vibration. The prevalence of paresthesias of the hands and arms declined from 78% in 1972 to 37% in 1976, and then increased to 51% in 1983. The recent increase was thought to be due to static muscle load and the ageing of the workers. No correlation was found between the severity of VWF and peripheral nerve symptoms. No significant changes in muscle fatigue occurred during the follow-up period; it was present in about 10-15% of the workers. The forest workers subjectively assessed musculoskeletal load and strain as being more harmful than the symptoms of vibration syndrome. The preventive measures aimed at reducing chain-saw vibration, implemented since 1970, have been beneficial and explain the decreased prevalence of VWF.
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PMID:Vibration syndrome among Finnish forest workers, a follow-up from 1972 to 1983. 349 Jun 88

Animal studies suggest that pulmonary oxygen toxicity proceeds more slowly in diluted oxygen breathing mixtures than in pure oxygen at the same inspired partial pressure. We exposed 12 healthy subjects to air at 5 ATA (PiO2 = 1.05 ATA) in a hyperbaric chamber for 48 h, and compared the rate of development of symptoms of O2 toxicity to rates seen in previous studies using 100% O2 at 1 ATA. Symptoms consisted of chest tightness, cough, substernal discomfort, exertional dyspnea, anorexia, nausea and vomiting, headache and digital paresthesias starting at about 12 h, and continuing several days into the recovery period. Pulmonary function changes consisted of significant decrements in vital capacity, flow rates, and DLCO. Initial recovery was in a 0.50 ATA oxygen atmosphere, with the majority of subjects showing definite recovery in both symptoms and pulmonary function. Subjects showed complete recovery in about 8 d, although symptoms of fatigue and exertional dyspnea continued for a month in some cases. In contrast, none of the above changes were noted in an additional 6 subjects exposed to a 5 ATA environment with 6% oxygen (PiO2 = 0.30 ATA). No change in resting gas exchange, as indicated by alveolar-arterial oxygen gradients, was detected in either group. Comparison of these data to that for pure oxygen studies reveals no significant difference in the progression or character of pulmonary oxygen toxicity.
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PMID:Progression of and recovery from pulmonary oxygen toxicity in humans exposed to 5 ATA air. 361 41

Twelve patients with advanced malignant disease were entered onto a Phase I study of escalating doses of beta-interferon serine given by 4-h i.v. infusion twice a wk. Three patients each were entered at starting doses of 0.01, 1, 10, and 30 million units (MU)/m2. Doses escalation within individual patients was allowed to a maximum dose of 400 MU/m2. Fever, chills, fatigue, and acral cyanosis were commonly seen and increased in frequency at higher doses. Myalgia, nausea, diarrhea, headache, and confusion were seen at lesser frequencies. Mild leukopenia, paresthesia, infusion site erythema, and hypotension were each seen in one patient. No conventional maximal tolerated dose could be defined, since several patients underwent escalation to the highest allowable dose and seemed to develop tolerance to acute toxicities. However, a maximal starting dose of 10 MU/m2 was identified, such that those begun at this level or below tolerated semiweekly dose escalation, while those begun at 30 MU/m2 could not tolerate continued therapy. Detectable serum interferon levels were noted during treatment at 10 and 30 MU/m2, the levels at which significant toxicity also first appeared. A maximal starting dose of 10 MU/m2, with gradual escalation as tolerance to side effects develops, is suggested if therapy with high-dose beta-interferon serine is given by 4-h infusion.
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PMID:Phase I study of recombinant beta-interferon given by four-hour infusion. 380 98


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