1/8. Periodic fatigue symptoms due to desynchronization in a patient with non-24-h sleep-wake syndrome.A 43-year-old man complaining of recurrent fatigue symptoms and sleep disorders occurring periodically every 4 weeks was studied. Using a wrist worn actigraphy and an ambulatory rectal temperature monitoring apparatus, his sleep-wake cycle and rectal temperature were measured continuously for 4 months, while diagnostic evaluation and therapeutic interventions were conducted. It was found that after he gave up an attempt to keep to a 24-h-day, a free-running sleep wake pattern appeared but his fatigue symptoms disappeared. An analysis of the relationship between his sleep-wake cycle and the rectal temperature rhythm found that his fatigue symptoms did not appear when both rhythms were synchronized with each other. Artificial bright light therapy entrained him to a 24-h day without relapsing of fatigue symptoms. Desynchronization between a 24-h sleep-wake schedule and his circadian pacemaker may have caused his periodically appearing fatigue symptoms.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
2/8. fatigue in women receiving adjuvant chemotherapy for breast cancer: characteristics, course, and correlates.This study investigated the characteristics, course, and correlates of fatigue in women receiving adjuvant chemotherapy for breast cancer. Fifty-four patients were assessed before the start of chemotherapy and during the first three treatment cycles. An age-matched sample of women with no cancer history was assessed at similar time intervals for comparison purposes. Results indicated that breast cancer patients experienced worse fatigue than women with no cancer history. These differences were evident before and after patients started chemotherapy. In addition, fatigue worsened among patients after treatment started. More severe fatigue before treatment was associated with poorer performance status and the presence of fatigue-related symptoms (e.g., sleep problems and muscle weakness). Increases in fatigue after chemotherapy started were associated with continued fatigue-related symptoms and the development of chemotherapy side effects (e.g., nausea and mouth sores). These findings demonstrate the clinical significance of fatigue in breast cancer patients before and during adjuvant chemotherapy treatment. Results also suggest that aggressive management of common side effects, such as nausea and pain, may be useful in relieving chemotherapy-related fatigue.- - - - - - - - - - ranking = 0.5keywords = cycle (Clic here for more details about this article) |
3/8. Recurrent high anion gap metabolic acidosis secondary to 5-oxoproline (pyroglutamic acid).High anion gap metabolic acidosis in adults is a severe metabolic disorder for which the primary organic acid usually is apparent by clinical history and standard laboratory testing. We report a case of recurrent high anion gap metabolic acidosis in a 48-year-old man who initially presented with anorexia and malaise. physical examination was unrevealing. Arterial pH was 6.98, P co 2 was 5 mm Hg, and chemistry tests showed a bicarbonate level of 3 mEq/L (3 mmol/L), anion gap of 32 mEq/L (32 mmol/L), and a negative toxicology screen result, except for an acetaminophen (paracetamol) level of 7.5 mug/mL. Metabolic acidosis resolved with administration of intravenous fluids. Subsequently, he experienced 5 more episodes of high anion gap metabolic acidosis during an 8-month span. methanol, ethylene glycol, acetone, ethanol, d -lactate, and hippuric acid screens were negative. Lactate levels were modestly elevated, and acetaminophen levels were elevated for 5 of 6 admissions. These episodes defied explanation until 3 urinary organic acid screens, obtained on separate admissions, showed striking elevations of 5-oxoproline levels. Inborn errors of metabolism in the gamma-glutamyl cycle causing recurrent 5-oxoprolinuria and high anion gap metabolic acidosis are rare, but well described in children. Recently, there have been several reports of apparent acquired 5-oxoprolinuria and high anion gap metabolic acidosis in adults in association with acetaminophen use. acetaminophen may, in susceptible individuals, disrupt regulation of the gamma-glutamyl cycle and result in excessive 5-oxoproline production. Suspicion for 5-oxoproline-associated high anion gap metabolic acidosis should be entertained when the cause of high anion gap metabolic acidosis remains poorly defined, the anion gap cannot be explained reasonably by measured organic acids, and there is concomitant acetaminophen use.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
4/8. A case of ovulatory cycle-dependent symptoms in woman with previous interferon beta therapy.A woman with a menstrual cycle-dependent fever (more than 38 degrees C) and severe fatigue that disrupted her ability to work was referred to our hospital. Six years ago, the patient received interferon beta injections (6,000,000 IU day-1x48 days) for the treatment of hepatitis c virus. Although the treatment was successful against the virus, the symptomatic fever occurred monthly since the third year after receiving the treatment. The symptoms occurred a few days after ovulation in every menstrual cycle. When the ovarian function was suppressed by GnRH agonist (GnRHa), the symptoms disappeared. While in anovulation, the patient received estrogen followed by estrogen with progestogen, which resembles the sex hormone milieu of a normal menstrual cycle without the LH surge; this treatment did not induce the symptoms. When human CG (hCG) was injected on the beginning day of estrogen with progestogen following treatment with estrogen alone, the previous symptoms reappeared. However, the hCG injection without estrogen priming did not induce the symptoms. These studies indicated that the LH surge after estrogen priming induced the symptoms. Changes in serum inflammatory cytokine levels (interleukin-1, interleukin-6, and tumor necrosis factor-alpha) were examined during the ovulatory cycle and the interleukin-1 levels during the treatment. There were no significant changes on these levels in the febrile period. The patient experienced normal menstrual cycles after finishing the five-month GnRHa treatment. Although her symptoms still occur, they are mild and do not require further medical treatment.- - - - - - - - - - ranking = 4.5keywords = cycle (Clic here for more details about this article) |
5/8. depression, chronic fatigue, and the premenstrual syndrome.depression, chronic fatigue, and premenstrual syndrome often coexist in women seeking treatment for premenstrual distress. A reliable diagnosis can be made by prospectively rating symptoms for two cycles, taking a careful history, performing physical and gynecologic examinations, and obtaining basic laboratory test results and a psychosocial evaluation. Appropriate dietary, hormonal, or antidepressant treatment provided in a caring and competent manner can benefit many women suffering from this otherwise disabling/condition.- - - - - - - - - - ranking = 0.5keywords = cycle (Clic here for more details about this article) |
6/8. Increase in median power frequency of the myoelectric signal in pathological fatigue.During bicycle ergometry, surface EMG analysis was performed on the m. vastus lateralis in a patient with pathological fatigue (due to skeletal muscle carnitine deficiency). With prolonged, submaximal, exercise (30% VO2 max, 2 h) the median frequency of the power density spectrum increased, despite fatigue and lactate production. This observation questions the general validity of the present concepts on myoelectric aspects of fatigue.- - - - - - - - - - ranking = 0.5keywords = cycle (Clic here for more details about this article) |
7/8. A hypernychthemeral sleep-wake syndrome: a treatment attempt.The wake and sleep-onset times of a patient with a sleep-wake cycle longer than 24 hr were recorded by the patient for 4 years. During this time, the patient found himself unable to maintain a 24-hr sleep-wake schedule. When treated with 1-2 mg clonazepam, taken nightly, he was able to become entrained to a 24-hr day. Despite entrainment of his sleep-wake cycle, the patient reported depression, lack of motivation and fatigue and chose not to continue taking the drug.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
8/8. Establishing a physiological basis to multiple sclerosis-related fatigue: a case report.OBJECTIVE: Although fatigue is a common debilitating complaint in multiple sclerosis (MS), its relationship to the cardiopulmonary exercise response has yet to be defined. DESIGN: A patient with MS manifested primarily by profound fatigue undergoes complete pulmonary function testing and a maximal incremental cycle ergometry study with gas exchange measurements and determination of ejection fractions. SETTING: Outpatient, community hospital pulmonary function laboratory. RESULTS: The patient is found to have respiratory muscle weakness and a severely depressed exercise performance. The latter was associated with an early anaerobic threshold but a normal central cardiovascular response (radionuclide ventriculography), implying problems in peripheral O2 distribution/utilization. The respiratory muscle involvement, although substantial, was nonlimiting to the exercise performance. CONCLUSIONS: Despite its central neuropathophysiology, MS as it relates to fatigue may be associated with an abnormal peripheral exercise response, namely, problems in peripheral O2 utilization. Such a concept could prove invaluable as it would provide a physiological basis for defining the severity and therapy of "MS fatigue."- - - - - - - - - - ranking = 0.5keywords = cycle (Clic here for more details about this article) |