Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In this report we describe fatigue of the His-Purkinje system during retrograde stimulation of the His bundle by ventricular programmed stimulation. The patient underwent electrophysiologic evaluation for syncope. Antegrade conduction and supraventricular studies were normal with the exception of baseline left bundle branch block. During programmed ventricular stimulation, the patient developed intra-Hisian and infra-Hisian block with symptomatic 3:1 atrioventricular heart block requiring insertion of a permanent pacemaker. This case demonstrates the need for careful study of both antegrade and retrograde conduction properties of the His bundle and atrioventricular node when performing standard His bundle studies in evaluation of syncope.
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PMID:Fatigue of the His-Purkinje system during routine electrophysiologic studies. 245 12

Atrioventricular (AV) block occurring in the His-Purkinje system may occur sporadically and can be difficult to document. In this article, we describe two patients with spontaneous episodes of AV block, in whom the use of upright tilt during electrophysiological testing led to a diagnosis of His-Purkinje disease. In both cases, testing in the supine position only uncovered mild or no abnormalities of infra-nodal conduction. In the first case, high grade block distal to the His occurred and the mechanism appeared to be bradycardia-dependent block. In this case, increased sympathetic tone due to upright tilt may have enhanced the slope of phase 4 depolarization in abnormal His-Purkinje cells, leading to block. In the second case, high grade block distal to the His was seen with upright tilt and the mechanism of block appeared to be fatigue phenomenon in the His-Purkinje system. These cases emphasize the elusive nature and varied mechanisms of His-Purkinje block and illustrate the utility of electrophysiological testing in the upright position in patients with suspected conduction system disease.
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PMID:Bradycardia-dependent block and fatigue phenomenon of the His-Purkinje system manifested during upright tilt. 248 Dec 85

The uremic syndrome is multifactorial, and affects most tissues and organs. Disturbances in protein and amino acid metabolism may play important roles, especially in chronic uremia, either directly or by production of toxic metabolites, with resultant negative nitrogen (N) balance, muscle wasting, reduced protein synthesis, and characteristically abnormal intracellular free amino acid concentrations. There are also grossly abnormal amino acid levels in the plasma of uremic patients, e.g., increases in conjugated amino acids, high levels of several nonessential and low levels of essential amino acids. The ratios of tyrosine/phenylalanine and of valine/glycine are decreased. The low tryptophan levels may contribute to encephalopathy as a result of an imbalance in neurotransmitter synthesis. Citrulline is found in excess; the explanation is unresolved. There are elevated concentrations of the sulfur-containing amino acids: cystine, taurine, cystathionine, and homocysteine. Excess of the latter is implicated in the atherogenesis of renal failure. Disturbed metabolism and interorgan exchange of amino acids in the uremic state explains some of the abnormalities in tissue and plasma concentrations of individual amino acids. Enzymatic defects are involved in the disturbed metabolism of branched chain amino acids (BCAA), with possible antagonism among them, which impairs growth and amino acid utilization. Carbohydrate intolerance, associated with insensitivity of peripheral tissues to insulin and hyperinsulinemia, elicits decreased plasma BCAA. Protein synthesis rates in normal and pathological conditions are more closely related to the intracellular amino acid pool than to plasma amino acid levels. Concentrations of individual amino acids in the plasma pool are poor indicators of their intracellular concentrations. Muscle contains the largest pool of protein and free amino acids in the body. In chronic renal failure patients, the intracellular concentrations of valine, threonine, lysine, and carnosine are low. With low protein diets and in hemodialysis, serine, tyrosine, and taurine often are also low. The low taurine may be related to fatigue and to uremic cardiomyopathies. The commonly used amino acid supplements generally fail to correct the intracellular amino acid deficits. A "New Formula" has been developed to correct these intracellular amino acid abnormalities, and to supplement a low protein diet. It provides more valine than leucine, increased tyrosine and threonine, and less histidine, leucine, isoleucine, lysine, methionine, and phenylalanine than in formulas customarily used for patients with chronic renal failure. It is uncertain whether other ap
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PMID:Amino acid metabolism in uremia. 267 58

We report a patient with acute nonlymphocytic leukemia (FAB classification: M 2) with trisomy 4, which is the first case in our country. A 42-year-old man was admitted to our hospital because of fever and general fatigue in May, 1988. His WBC count was 8,100/microliters with 90% of leukemic cells and bone marrow smear showed 76.1% leukemic cells. The chromosomal analysis of marrow cells by G-banding revealed 47, XY, +4. In spite of administration of chemotherapy complete remission was not obtained, and he died of septic shock and severe liver damage 4 months after making the diagnosis. Chromosomal abnormality of trisomy 4 has been reported to be associated with predominantly either M 4 or M 2, and to be less than 0.1% of incidence in ANLL, according to the Second MIC Cooperative Study Group. It is suggested that trisomy 4 may be caused by exposure to some environmental factors such as toxic substances, since this chromosomal abnormality has been reported in the last 10 to 20 years.
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PMID:[Chromosomal abnormality of trisomy 4 in a patient with acute nonlymphocytic leukemia (FAB: M2)]. 269 22

Deferoxamine (DFO) has been widely used in the treatment of aluminum toxicity in patients on chronic dialysis. Mucormycosis is an opportunistic infection caused by fungi of the Mucorales order and some reports suggested a role for DFO in the precipitation of this infection. A 50-year-old man had been on hemodialysis for 16 years. 6 weeks before admission, he was begun on DFO because of aluminum toxicity. 2 weeks before admission, general fatigue and fever developed and followed by headache and loss of vision. He was admitted to this hospital with disturbed consciousness. His clinical course and a CT scan of the head suggested cerebral infarction. Within 24 hours he required ventilatory support and died 5 days after the admission. On autopsy, rhino-cerebral mucormycosis was demonstrated with a mycotic thrombus involving the left middle cerebral artery. Dialysis-related mucormycosis has recently appeared in the literature. We feel that hemodialysis patients on DFO may be at risk for potentially fatal mucormycosis infections. With a possible relationship between DFO treatment and this fatal opportunistic infection, caution should be given before using this drug and the indications should be definitive.
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PMID:[A case report of rhinocerebral mucormycosis in hemodialysis patient receiving deferoxamine]. 274 4

A 74-year-old man was admitted on November 1986 because of general fatigue. His peripheral blood showed pancytopenia without immature cells since December 1985. Hematological data showed RBC 150 X 10(4)/microliter, PLT 7,000/microliter, WBC 12,000/microliter with 93.6% leukemic cells. The bone marrow smear revealed NCC 14.5 x 10(4)/microliter with 76% leukemic cells. The leukemic cells were characterized by faint staining with peroxidase stain and strong positivity for CD 13 antigen determined with immunoperoxidase method and flow cytometric analysis. The chromosomal analysis of tumor cells represented as follows: 44, XY, -3, -4, -9, -20, 2q+, 6p-, 7q-, 12q+, +2 mar. Although remarkable reduction of leukemic cells in peripheral blood was obtained one month after initiation of 19-days intravenous continuous infusion of N4-behenoyl-1-beta-D-arabinofuranosylcytosine (BHAC), he suffered from severe systemic candida infection with severe leukopenia and died. Not only advanced age but also complex karyotypic abnormality would contribute to failure of treatment in this case. The significance of complex karyotypic abnormality in acute non-lymphocytic leukemia in discussed based on the current literature.
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PMID:[Complex karyotypic abnormality in an aged patient with acute myeloid leukemia (M 2)]. 279 97

A 58-year-old man, born in Nagasaki prefecture, was admitted to our hospital because of anorexia and general fatigue on November 22, 1984. Hepatosplenomegaly was found without skin eruption. The blood examination on admission revealed leukocytosis (50,800/microliter) and atypical lymphocytes with hyperlobulated nuclei. He had hypercalcemia, and hepatic and renal damage. A diagnosis of adult T cell leukemia (ATL) in the acute stage was made. Treatment with KM2210, a conjugate of chlorambucil and estradiol, was started, and his peripheral leukocytes decreased gradually reaching, 19,700/microliter by the end of this medication. His leukocyte count continued to decrease after discontinuation of KM2210 and reached a nadir of 4,700/microliter. Hepatosplenomegaly and hypercalcemia also improved. About one month later, recurrence of the disease occurred and he was again treated with KM2210. Although the second course of the KM2210 therapy was also successful in relieving hepatosplenomegaly and leukocytosis, it proved impossible to ameliorate his poor condition and he died of DIC. Our case suggests that KM2210 has a remarkable cytotoxic effect against ATL cells even in the acute stage but the optimal schedule of treatment with this new drug should be established in order to obtain more satisfactory therapeutic results.
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PMID:[A case of adult T cell leukemia treated with a new chemotherapeutic agent, KM2210]. 287 13

A 29 year old white homosexual man presented with a two and a half week history of severe sore throat, fever, and extreme fatigue. His symptoms did not respond to antibiotics. He had mild bilateral conjunctivitis, a rash over his chest and back, and enlarged lymph nodes, but examination of the nervous system yielded normal results. He had low total white cell and platelet counts. The results of enzyme linked immunosorbent assay for human immunodeficiency virus (HIV) were equivocal when HIV IgM was detected in serum. Despite treatment with ampicillin his temperature remained high and he developed abnormal neurological signs, including a paraparesis and hyperreflexia of the arms. HIV was isolated from lymphocytes from blood and cerebrospinal fluid. Over the next six weeks the patient improved and was discharged. Two months later abnormal neurological signs persisted in his legs. Although various neurological syndromes associated with seroconversion to HIV have been described, this is probably the first report of a patient with myelopathy at the time of seroconversion.
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PMID:Acute myelopathy associated with primary infection with human immunodeficiency virus. 288 58

Rare upper airway lesions may be mistaken for asthma. A 16-year-old Hispanic male athlete presented to our allergy clinic with a 4-month history of wheezing and snoring with hoarseness and progressive fatigue on exertion or during sleep. His mother taped periods of harsh stridor and sleep apnea. There was no family history of vocal cord abnormalities. A year before the onset of symptoms, he suffered injury to his oral cavity with a loss of consciousness during a wrestling match. He denied dysphagia or dysphonia. He failed to respond to bronchodilators, cromolyn, or prednisone therapy during 4 weeks. On referral to our clinic, his physical examination and tape recording were characterized by harsh inspiratory stridor. His pulmonary function tests were significant for peak flow depressed out of proportion to FEV1 with reduced FVC, no response to bronchodilator, and flattened inspiratory loop unresponsive to cough or panting. Fluoroscopy and endoscopy of the upper airway was consistent with "marked bilateral limitation of vocal cord abduction." Sleep study demonstrated desaturation with CO2s in the 60s during sleep. He was started on continuous positive airway pressure, 10 cm at night, with no desaturation or sleep disturbance on follow-up.
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PMID:Bilateral abductor paresis masquerading as asthma. 337 24

Muscle and plasma amino acids, subjective fatigue and body weight were studied in 16 patients before and 20 days after uncomplicated elective abdominal surgery. Fatigue increased from a mean (+/- SEM) preoperative level of 2.4 +/- 0.4 arbitrary units to 4.4 +/- 0.5 on postoperative day 20, while body weight fell from 67.3 +/- 2.5 to 64.7 +/- 2.9 kg (both differences p less than 0.001). Correlation was found between increase in fatigue and fall in body weight (r = 0.56, p less than 0.05). Plasma amino acids showed little change after surgery. In muscle, the nonessential amino group taurine, asparagine, glutamate and glycine increased and histidine and arginine decreased (both p less than 0.05) postoperatively. No correlation was found between postoperative fatigue and weight loss versus changes in muscle amino acids. Some of the well-defined immediate postoperative changes in muscle amino acids thus persisted into late, otherwise uncomplicated convalescence, but postoperative fatigue was related only to weight loss--not to changes in muscle or plasma amino acids.
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PMID:Fatigue and muscle amino acids during surgical convalescence. 343 98


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