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

Years after the initial onset of poliomyelitis, patients often report new problems, including fatigue, weakness, pain, breathing difficulty, decreased endurance, problems with swallowing, choking, increased sensitivity to cold, and psychological problems. The premise of this article is that underlying pathophysiology of these problems can be assessed on the basis of a detailed history, a multisystem physical examination, and supplemental information provided by investigative tests. The indications for treatment of the late sequelae of poliomyelitis based on the underlying pathophysiology and the rationale for treatment prescription are explored. Possible outcomes of the assessment include no intervention; prescription of a balance between activity and rest, a reduction in activity, or an increase in activity; interventions to improve postural alignment, prescription of orthoses, and weight control; prescription of walking aids and mobility devices; respiratory care; lifestyle modification; or some combination of these outcomes. If treatment can be directed at the underlying causes of the late sequelae, the possibility of reducing further deterioration and of optimizing function in these patients will likely be enhanced.
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PMID:Clinical decision making in the management of the late sequelae of poliomyelitis. 194 14

We describe a retrospective study of 42 patients admitted to Sunnaas Rehabilitation Hospital with suspect postpolio syndrome over a period of two years. The patients were 32 females and 10 males aged 28-74 years (mean 54 years). 29 were married or cohabitant, 31 had children, and 20 were in paid employment. The mean age at onset of polio was 12 years, with an average interval of 36 years between onset of polio and onset of new problems. The mean duration of new health problems was seven years. The most common such problems were pain in muscles and joints, general fatigue and new weakness of the muscles. 28 of the patients needed personal assistance to carry out everyday activities. 33 had braces, crutches or wheelchair for ambulation. Lung function was moderately reduced and physical working capacity was severely reduced. Physiotherapy, ergotherapy and technical aids were provided for 38 of the patients, 16 received assistance to organizing social support or help at home, 13 were helped to make practical changes in their homes, and eight were provided with a wheelchair. According to this study, most patients with the postpolio syndrome need interdisciplinary evaluation and management in a rehabilitation hospital.
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PMID:[42 patients with post-polio syndrome. A retrospective study from Sunnaas hospital]. 194 38

Many of the hundreds of thousands of survivors of polio are now developing postpolio syndrome. Symptoms include progressive muscle weakness, fatigue, decreased endurance, joint and muscle pain, weight gain, respiratory difficulties, and sleep disturbance, often precipitated or exacerbated by a Type-A Personality pattern. A postpolio patient with Type-A Personality was taught self-hypnosis as a vital component of treatment. Pre-post testing included the Profile of Mood States, the State-Trait Anxiety Inventory, the State-Trait Anger Inventory, and the Personal Orientation Inventory; the patient's spouse was interviewed during the follow-up. At the 6-month follow-up, improvements were documented in pain level, depression, self-regard, self-acceptance, capacity for intimate contact, time competence (living in the present), confusion, anxiety, insomnia, and in trait and state anger. Only a mild improvement occurred in fatigue, and no improvement was found in weight control. Follow-up at 12 months confirmed the maintenance of improvements. Self-hypnosis training may prove extremely helpful for postpolio patients and may prove helpful in modifying central characteristics of Type-A Personality.
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PMID:Hypnosis for postpolio syndrome & Type-A behavior. 195 Nov 42

It has been suggested that early features of scurvy (fatigue and weakness) may be attributed to carnitine deficiency. Ascorbate is a cofactor for two alpha-ketoglutarate-requiring dioxygenase reactions (epsilon-N-trimethyllysine hydroxylase and gamma-butyrobetaine hydroxylase) in the pathway of carnitine biosynthesis. Carnitine concentrations are variably low in some tissues of scorbutic guinea pigs. Ascorbic acid deficiency in guinea pigs resulted in decreased activity of hepatic gamma-butyrobetaine hydroxylase and renal but not hepatic epsilon-N-trimethyllsine hydroxylase when exogenous substrates were provided. It remains unclear whether vitamin C deficiency has a significant impact on the overall rate of carnitine synthesis from endogenous substrates. Nevertheless, results of studies of enzyme preparations and perfused liver in vitro and of scorbutic guinea pigs in vivo provide compelling evidence for participation of ascorbic acid in carnitine biosynthesis.
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PMID:Ascorbic acid and carnitine biosynthesis. 196 62

A series of four patients with pulmonary infiltrates, pleural effusions, hypoxemia, peripheral eosinophilia, and symptoms of dyspnea, fatigue, and weakness is reported. Lung tissue obtained in three patients revealed interstitial pneumonitis, small-to-medium-vessel mixed-cell vasculitis, and alveolar exudate of histiocytes and eosinophils. All patients reported ingestion of L-tryptophan-containing products at a time when an association between L-tryptophan and the eosinophilia-myalgia syndrome was established. This clinical pattern of pulmonary involvement may be part of the continuum of the eosinophilia-myalgia syndrome. The pathophysiology of this syndrome and the relationship with the ingestion of L-tryptophan-containing products have not yet been identified.
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PMID:Acute eosinophilic pulmonary disease associated with the ingestion of L-tryptophan-containing products. 198 92

A survey was conducted to better understand complaints of fatigue in patients previously diagnosed as having polio. Eighty-six individuals with postpolio syndrome and 20 healthy controls completed a questionnaire about their fatigue, the Beck Depression Inventory, and the CAGE questionnaire. The results showed that fatigue in postpolio syndrome usually occurred on a daily basis and increased in severity as the day progressed. Both the study group and controls described their fatigue as tiredness and a lack of energy. However, physical weakness was reported only in the postpolio group. Minimal physical exercise exacerbated fatigue in 48% of the postpolio group, whereas it diminished fatigue in 70% of the controls and in 15% of the postpolio group. Twenty-seven percent of the postpolio group and none of the controls reported mild to moderate depressive symptoms. However, depression, age, alcohol abuse, and employment status did not significantly affect the differences between groups in reported prevalence or description of chronic fatigue. Criteria to separate psychologic from organic causes of fatigue and treatment interventions are discussed.
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PMID:Fatigue in postpolio syndrome. 199 Oct 11

We describe a patient who developed fever, fatigue, muscle weakness, dyspnea, skin rash, and eosinophilia after taking "high doses" of tryptophan for insomnia for two years. A gallium-67 scan revealed diffuse increased uptake in the lung and no abnormal uptake in the muscular distribution. Bronchoscopy and biopsy confirmed inflammatory reactions with infiltration by eosinophils, mast cells, and lymphocytes. CT scan showed an interstitial alveolar pattern without fibrosis. EMG demonstrated diffuse myopathy. Muscle biopsy from the right thigh showed an inflammatory myositis with eosinophilic and lymphocytic infiltrations.
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PMID:Gallium uptake in tryptophan-related pulmonary disease. 199 38

Digitalis intoxication is among the most common serious adverse drug reactions in clinical medicine. While the recent development of a radioimmunoassay to accurately measure serum concentrations of digoxin has been of assistance, digitalis intoxication remains a difficult diagnosis to make with certainty. The difficulty in diagnosing digitalis intoxication arises from the nonspecificity of its associated signs and symptoms. The most common symptoms include fatigue, weakness, nausea, and anorexia. These symptoms can occur with many illnesses other than digitalis intoxication. Similarly, the electrocardiographic disturbances caused by cardiac glycosides may be nondiagnostic. The arrhythmias commonly associated with digitalis toxicity are often nonspecific and can be a reflection of the patient's underlying heart disease. The measurement of serum digoxin levels is useful, but studies have demonstrated overlap of the levels between groups with and without toxicity. Due to the modulation of the cardiac effects of digitalis glycosides by such clinical variables as underlying myocardial or renal disease, electrolyte and acid-base imbalances, and other factors, the correlation of toxicity with particular serum digoxin concentrations may vary. Because of the inherent difficulties in confirming the diagnosis of digitalis intoxication in some cases, digoxin-specific Fab antibodies may play a role as a diagnostic tool. Certainly, digoxin-specific Fab antibodies play a significant part in the treatment of digitalis intoxication. Fab antibodies have been successfully used to reverse the effects of digoxin, digitoxin, and oleander poisoning. These antibodies are useful in the treatment of acute and chronic digitalis intoxication in all age groups, including geriatric and pediatric populations.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Recognition and management of digitalis intoxication: implications for emergency medicine. 199 19

Two and a half years after manifestation of treatment-refractory lipoatrophic diabetes a 16-year-old girl had blood-sugar levels of about 500 mg/dl and hypertriglyceridaemia with fasting levels of about 3000 mg/dl, while there was no increase in ketone bodies. All the clinical, histological and radiological findings were those of generalized fatty tissue atrophy. In addition, she had marked axillary and periorbital acanthosis nigricans. Main symptoms were fatigue, weakness and excessive appetite. Intravenous insulin of at first 1200 IU daily reduced blood-sugar levels to normal. A good metabolic state was maintained by intensive insulin treatment with four intramuscular injections daily. On a dosage of 600-700 IU daily the HbA1 value dropped from 16.7% to 7.8%, triglyceride concentration to 300-400 mg/dl. The symptoms also regressed with normalization of the metabolic state.
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PMID:[Successful insulin therapy in lipoatrophic diabetes]. 200 87

We identified a cohort of 300 individuals who had paralytic polio between 1935 and 1955. All lived in Olmsted County, Minnesota. From the 247 survivors, we selected 50 subjects for detailed historical, functional, psychological, clinical, and electrophysiologic evaluation. Sixty-four percent of these 50 survivors complained of new symptoms of muscle pain, fatigue, and weakness after a period of prolonged stability. This led to changes in lifestyle or activity in only 18%. The likelihood of expressing new complaints was not related to present age or interval since polio, and electrophysiologic testing did not distinguish between those with or without new problems. The development of new difficulties in a limb was most strongly predicted by significant paralysis of that limb at the time of the acute illness. Patients with leg weakness were twice as likely to complain of new problems compared to those with arm weakness. Elevated creatine kinase levels were present only in those with new complaints.
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PMID:Late effects of paralytic poliomyelitis in Olmsted County, Minnesota. 201 Dec 46


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