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

Ten dialysis patients were followed in a prospective study to determine the neurotoxicity of metabolites in the middle molecule (MM) molecular weight (mol wt) range of 500-200 daltons/molecule. In the absence of readily available direct serum measurements of MM concentrations, a theoretically calculated dialysis index, D1(MM), which included the combined effects of dialysis and residual glomerular filtration rate (GFR) on MM removal was used to estimate changes in their predialysis concentrations. The ten patients were dialyzed on protocols which yielded a D1(MM) less than 1.0. Evidence of uremic neuropathy developed in six of these ten patients, and five of these six also developed a progression in their anemia. Two additional patients with no signs of neuropathy developed a progression in their anemia. One patient developed pericarditis with tamponade. A total of eight patients developed complications. One additional patient developed increased weakness, tiredness and general malaise without change in objective findings. When the dialysis therapy to reduce MM concentrations by increasing the D1(MM) above 1.0 was instituted, the complications were reversed. Our data support the findings of others, namely, that there are toxic substances in the MM mol wt range of 500-2000 daltons/molecule. However, a synergism between elevated concentrations of small molecules and MM cannot be ruled out.
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PMID:Uremic neuropathy: evidence of middle molecule toxicity. 68 20

During the course of an obscure illness in a teenage girl it was eventually realized that the diagnosis was 'epidemic neuromyasthenia'. The illness which occurred between February and September 1976 was characterized by fatigue, pallor, headache, nuchal pain, alterations in mentation, dizziness, nausea and vomiting, paraesthesiae, weakness and heaviness of limbs, and a prolonged relapsing course. Investigation brought to light fourteen patients with similar symptoms--twelve female and two male. In view of the shortcomings of retrospective enquiries, especially those involving the assessment of notes made by other people, and the problem of trying to define a nonfatal illness with protean symptoms, many of a nonspecific nature, with few physical findings and negative laboratory studies, caution is necessary. Under these circumstances it is claimed on clinical epidemiological evidence that a diagnosis of 'epidemic neuromyasthenia' could be sustained confidently in three patients and probably in a fourth. Six patients were considered possible cases and four were rejected.
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PMID:'Epidemic neuromyasthenia' in Southwest Ireland. 74 20

P50 and 2,3 DPG content of erythrocytes were determined in 25 patients with heterozygous beta thalassemia minor to assess the adaptive mechanisms to anemia. 2,3 DPG levels were appropriately elevated for the degree of anemia. However, P50 values were not proportionately increased. No correlations were noted between hemoglobin level, 2,3 DPG, or P50 and the presence of symptomatic complaints of fatigue or weakness in these heterozygous patients.
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PMID:Intraerythrocytic adaptation (2,3 DPG,P50) in thalassemia minor. 83 53

Men under 20 and over 50 years of age used a free walk-in clinic of the Navy more than women of the same age. Women 20-50 years old used it more than men in this age group. This appears to be a result of the distribution of Navy health care facilities in the study area. Teenagers used the clinic as much as patients over 50. Sore throat, skin rash, abdominal pain, earache, and backache were the five most common complaints (302 per 1,000 patients.) These complaints and 19 other problems were responsible for 822 patient visits per 1,000 in a study of 2,272 consecutive new patient visits. Eighteen percent of all visits were return visits for a specific complaint. An analysis of complaints by body system showed that 21.9 percent were otolaryngological, 18.8 percent musculoskeletal, 12.5 per cent gastrointestinal, 9.7 percent dermatological, 8.7 percent cardiopulmonary, 7.8 percent genitourinary, 9.0 percent general (fatigue, nervousness, malaise, or weakness), and 11.6 percent other system (neurological, hematological, and miscellaneous). These data indicate that a physician's time might be used more efficiently in a walk-in setting and that training for such a clinic must be different from traditional training for such fields as internal medicine.
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PMID:Chief complaints in a free walk-in clinic: a study of 3,009 consecutive patient visits. 84 87

The primary care physician has a critical role in the recognition and early screening of pituitary lesions. Often the symptoms are nonspecific--headache, fatigue, and weakness. With menstrual irregularity, visual field loss, growth abnormality, or changes in body habitus or appearance, however, further investigation is needed. A single lateral skull X-ray may be enough to indicate pathology and warrant endocrine referral. If doubt exists even with a normal skull film, endocrine evaluation is worth undertaking. With increasing selectivity and safety of neurosurgical procedures, and with the help of physicians and radiotherapists, the neurosurgeon is able to offer the patient with a pituitary tumor a good chance of cure with minimal morbidity. However, the surgeon must often depend on the primary care physician to discover new visual field loss or endocrine changes that may signal recurrence, as well as to suspect the diagnosis of a pituitary lesion. The diagnosis, treatment, and follow-up of these lesions is best handled by an interdisciplinary team of physicians.
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PMID:Diagnosis and surgical treatment of pituitary lesions. 92 5

A syndrome of alveolar hypoventilation has been identified in a group of patients with bilateral diaphragm paralysis. Eight patients were studied in whom diaphragm weakness had been suggested by paradoxical (inward) movement of the abdominal wall on inspiration, of whom seven had evidence of a generalized neuromuscular disorder. Diaphragm function was assessed quantitatively by measurement of the change in transdiaphragmatic pressure during a maximum inspiration (deltaPDi). In five patients, deltaPDi was zero and in the others ranged from 2-6 cm H2O (normal greater than 25 cm H2O) indicating paralysis and severe weakness in the respective groups. Fluoroscopy of the diaphragm was found to give misleading results, and the resons for this are considered. Vital capacity ranged from 65-30 per cent of the predicted normal in the upright posture, typically falling by about a half in the supine posture. Alveolar hypoventilation was present in five patients when supine and in six when asleep, the deterioration in blood gases associated with sleep generally being much greater in these patients than in normal subjects. Respiratory rate was significantly greater than age-matched controls. The ventilatory response to CO2 was impaired. The PCO2 could be brought to normal levels by voluntary hyperventilation, and the unreliability of voluntary respiratory manoeuvres of this kind as indices of ventilatory reserve is emphasized. Alveolar hypoventilation was associated with disturbed sleep, morning headache and day-time fatigue. Symptomatic benefit was achieved by the use of a cuirass respirator at night.
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PMID:Diaphragm function and alveolar hypoventilation. 106 15

Maximum velocity and amplitude of repetitive ( 1-per-second) 30 degrees saccadic eye movements were quantitatively assessed for 4 minutes before and after intravenous edrophonium chloride as a diagnostic test for myasthenia gravis. Atropine was given initially to suppress muscarinic side effects. Eye movements were recorded by electrooculography and a digital computer identified saccadic eye movements and plotted amplitude-velocity relationships. When compared with control subjects, eleven of twelve patients with proven MG had a significant increase in saccade amplitude and/or maximum velocity after edrophonium chloride. Only three of twelve proven MG patients had clinically apparent extraocular muscle weakness. The initial period of fatigue improved the sensitivity of the test in those patients who began with normal saccade amplitude and maximum velocity. Two of the patients with positive saccade fatigue tests had no change in optokinetic nystagmus amplitude before and after edrophonium chloride. It is concluded that, quantitative assessment of repetitive large angle saccades before and after edrophonium chloride is a sensitive test for extraocular muscle involvement in MG.
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PMID:Saccade fatigue and response to edrophonium for the diagnosis of myasthenia gravis. 106 99

The efficacy of prazosin given either alone or in combination with polythiazide was assessed in a study of 50 outpatients with essential hypertension. Among the 29 who completed 42 months of therapy, blood pressure fell significantly in 76%. Of the 21 who dropped out of the study after 1 to 41 1/2 months, 43% showed improvement, 38% showed no change, and 19% showed worsening of hypertension. The most common side effects were lack of energy and weakness. Diabetics and alcoholics tolerated prazosin well. Of the 50 patients who started treatment with prazosin alone, only 23 required addition of polythiazide.
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PMID:A long-term clinical trial of prazosin. 110 91

(1) EMG investigations in 17 female manic-depressive patients under long-term treatment with lithium salts showed a reduction of the maximal motor nerve conduction velocity (NCV) and of the duration of isolated potentials (IPs) in six cases. These changes, however, were not clearly due to the influence of lithium only. Psychopathology, additional medication, and other variables may have been also responsible for these finding. (2) NCV and IPs as well as the concentration of electrolytes in serum and RBC were determined in seven healthy volunteers before, during, and after lithium administration. NCV was significantly decreased and the duration of IPs slightly increased after 1 week of lithium intake. The magnesium serum concentration increased steadily during the experimental period. (3) Thus, the possibility cannot be excluded that symptoms of fatigue and muscular weakness in lithium-treated patients might be caused at least partially by changes of the peripheral nervous-muscular function.
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PMID:Effects of lithium on electromyographic recordings in man. Studies in manic-depressive patients and normal volunteers. 114 Sep 3

For the first time in Germany cases of a "centronuclear myopathy" are described in a 14-year-old boy and his 18-year-old sister. First symptoms in both patients appeared at 4 to 5 years of age with a "sleepy facial expression", clumsy gait and rapid fatigue. Within few years the disease progressed to generalized muscle weakness and atrophy, ptosis, ophthalmoplegia externa and areflexia. Weakness and atrophy were most pronounced in the distal muscles of the lower extremities. Both patients were free of epilepsy and the EEG recordings were normal. Motor and sensory nerve conduction velocities were normal. Repetitive stimulation of nerves revealed a normal transmission from nerve to muscle. Muscle biopsy showed a type I muscle fiber hypotrophy and a type II muscle fibre hypertrophy in addition to a predominance of type I fibres. Both fibre types showed central nuclei, sometimes appearing as chains in longitudinal sections. In most cells with central nuclei there persists a very small pericentral zone free of myofibrils but with increased activity of oxidative enzymes and phosphorylase. 2--3% of muscle fibres in cross sections showed a decreased of absent enzyme activity in the most peripheral fibre zone. Electron microscopy showed evidence of a centrally distinct myofibrillar disintegration. The father of both children had a ptosis at least from the 20th year of age. 5 years later generalized progressive muscle atrophy was recorded. Aged 51 years he died of pneumonia. Though not proved most probably the father suffered from the same disease as the children, pointing to an autosomal dominant inheritance in this family. The disease, according to the literature, seems to be genetically heterogeneous. The clinical picture seems to be independent of the mode of inheritance. Our patients showed a relatively rapid progression of symptoms. Pathogenetically the "centronuclear myopathy" may result from a disturbance of correlated nerve-muscle structures starting during early fetal life.
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PMID:[Centronuclear myopathy with autosomal dominant inheritance(author's transl)]. 115 Feb 40


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