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The National Cancer Institute (Canada) sponsored a workshop on symptom control in Banff, Alberta, in October 1993. This article reports on the workshop recommendations for research on one symptom complex, the cachexia-anorexia-asthenia syndrome. In addition to encouraging study generation, the recommendations provide a baseline for assessing the scope and strength of future Canadian research initiatives on cachexia-anorexia-asthenia.
We report a case of mitochondrial myopathy discovered in a 55-year old woman who was being investigated for the cause of her asthenia. Physical examination showed ptosis of the upper eyelid and proximal muscle deficit. Histological examination of a muscle biopsy disclosed rare fibres with mitochondrial aggregates. Biochemical exploration of muscle tissue revealed a double enzyme deficit involving complexes I and IV of the respiratory chain. Clinical improvement was obtained after the patient was put on coenzyme Q10. We conclude that a diagnosis of mitochondrial myopathy must be considered in patients, including middle-aged adults, presenting with muscular asthenia.
Qualitative and quantitative alterations of mitochondrial DNA (mtDNA) in the skeletal muscle from two patients with cirrhosis and severe asthenia have been studied. The 4977 bp (mtDNA(4977)) and the 7436 bp (mtDNA(7436)) mtDNA deletions, as well as other mtDNA deletions, revealed by long extension PCR (LX-PCR), were found in the two patients, whereas the 10,422 bp (mtDNA(10,422)) mtDNA deletion was absent. Altogether, the qualitative alterations of mtDNA in cirrhotic patients with severe asthenia were comparable to those of age-matched healthy individuals. The mtDNA content, on the contrary, was substantially decreased in both patients with respect to control. Such mtDNA depletion might be explained by an increased, disease-related, oxidative damage to mtDNA, which probably affects the replication of the mitochondrial genome as already suggested in other oxidative stress-associated diseases.
Forty patients with severe asthenia were subjected to clinical, neurological, psychometric, and neurophysiologic examination before and after Enerion therapy. Psychoneurophysiological assessment with cognitive evoked potentials P300 and psychometric tests revealed serious impairment of cognitive functions in patients before therapy (compared to healthy individuals). Enerion therapy decreased the degree of psychoautonomic syndrome and asthenia and improved cognitive functions.
The syndrome variously called Da Costa's syndrome, effort syndrome, neurocirculatory asthenia, etc has been studied for more than 100 years by many distinguished physicians. Originally identified in men in wartime, it has been widely recognised as a common chronic condition in both sexes in civilian life. Although the symptoms may seem to appear after infections and various physical and psychological stresses, neurocirculatory asthenia is most often encountered as a familial disorder that is unrelated to these factors, although they may aggravate an existing tendency. Respiratory complaints (including breathlessness, with and without effort, and smothering sensations) are almost universal, and palpitation, chest discomfort, dizziness and faintness, and fatigue are common. The physical examination is normal. The aetiology is obscure but patients usually have a normal life span. Reassurance and measures to improve physical fitness are helpful.
The transition from curative to palliative care for elderly patients with cancer-related asthenia presents complex challenges to oncologists. A result of this complexity is a lack of regard for the maintenance of physical and mental function. This study examined the effects of comprehensive, multidisciplinary, inpatient rehabilitation on the physical and mental function of elderly cancer patients with asthenia. We found that both physical and mental function improved following inpatient rehabilitation. However, it is difficult to predict which patients benefit most from rehabilitation. Nevertheless, functional improvement following rehabilitation may allow medical caregivers to better distribute the type and intensity of care, and reduce the caregiver burden experienced by family members in the home.
An 11-year-old cat was evaluated because of dyspnea. Since 11 months of age, the cat had hyperextensibility of the skin consistent with cutaneous asthenia. Radiographic examination revealed a diaphragmatic hernia with intestinal loops in the thorax. Electron microscopic examination of skin specimens revealed collagen fibers of highly variable diameter, consistent with cutaneous asthenia. The diaphragmatic hernia was surgically repaired and healed well. Four weeks later, a left-sided perineal hernia was repaired surgically, and 4 months later, a right-sided perineal hernia was repaired surgically and colopexy and cystopexy were performed. All surgical procedures were successful and tissues healed well. Dermatosparaxis is a rare hereditary disorder that commonly results in cutaneous fragility and hyperextensibility in affected animals. The diagnosis depends on clinical findings and light and electron microscopic changes in affected tissues. Surgical repair can be performed successfully in an affected cat, and healing of incisions can occur without complications.
Enerion was used in the treatment of 40 patients with psychovegetative syndrome and asthenia. Before treatment, the patients have pronounced asthenia appearances, anxiety disorders, relevant autonomic disorders, mild depression and decrease of working capacity, attention concentration and memory. The treatment was conducted as monotherapy during 28 days with enerion dosage 400 mg/day. After treatment, expression of autonomic and asthenic disorders was reduced significantly, along with improvement of psychometric and neurophysiological indices. High efficacy of the medication was detected in 75% of the patients and moderate one--in 25%. The drug was well-tolerated.
AIMS OF THE STUDY: Asthenic symptoms such as weakness accompany illness. This study investigates whether the centrally acting cholinergic agent, vitamin B analogue (sulbutiamine), is effective and acceptable in relieving these symptoms in infectious disease when combined with specific anti-infective treatment. METHODOLOGY: In a prospective uncontrolled, non-randomised, commercial, observational study, 1772 patients with an infectious disease and asthenic symptoms, drawn from the practice of 350 randomly selected physicians throughout India, received vitamin B analogue (sulbutiamine) in addition to specific anti-infective treatment for 15 days. The primary outcome variable was complete resolution of asthenic symptoms with treatment. RESULTS: The number (%, 95% confidence interval) of patients with complete resolution of all asthenic symptoms was 916 (51.7, 49.4-54). In the remaining patients, severe asthenia was reduced but persisted in 11 (0.6, 0-26); and moderate asthenia in 94 (5.3, 0-17.6). The response was greater in patients with acute infection and symptoms more related to cerebral function. Side effects occurred in 10 (0.6%), patients and well being improved significantly. CONCLUSIONS: Vitamin B analogue (sulbutiamine) may be a useful adjunct to specific anti-infective treatment.
OBJECTIVE: To study the change of anorectal manometry in asthenia type constipation patients and effect of reinforcing Qi and moistening intestine oral liquid (RQMI) on it. METHODS: The fotal of 135 cases were divided into healthy group, RQMI treated group, Maren pill (MRP) treated group and prepulside (PPS) treated group, their anal maximal voluntary squeeze pressure, rectoanal contraction reflex, rectoanal inhibitory reflex, defecation reflex, rectal volume sensory threshold and rectal maximal tolerable volume were observed. RESULTS: The rectal sensory function of patients weakened obviously and anal sphincter reactivity reduced as compared with those of healthy person (P < 0.01), and both were improved by RQMI treatment (P < 0.05). CONCLUSION: RQMI is superior to MRP and prepulside in improving anorectal dynamic abnormality in constipation patient of asthenia type.
The dynamics of asthenic syndromes was subjected to a psychopathological analysis in 200 patients. It has been established that asthenia may manifest not only as a transitory neurotic disorder (either completely reversible or preceding the formation of steady morbid manifestations of the other structure) but also represent a number of independent psychopathological disorders that determine the clinical picture of the disease at the main stages of its development. The essence of asthenic syndrome transformation may be reduced to polar change of the morbid manifestations: hyperesthesia--hypesthesia, with estrangement of bodily sensations and own activity. The dichotomy indicated may be distinguished as a prognostically informative differentiating sign. In the light of the typology suggested the authors consider not only the place of asthenia in the continuum of pathological disorders but also its correlation with negative alterations.
In July 2000, a 62-year-old female, with a ten-year history of chronic hepatitis C virus infection and persistently normal aspartate amino-transferase and alanine aminotransferase levels, presented with asthenia, weight loss, peripheral polyneuropathy and increased levels of aspartate aminotransferase (8 times upper normal limit), alanine aminotransferase (10 times upper normal limit) and gamma glutamyl-transferase (6 times upper normal limit). The ultrasound findings were consistent with massive liver steatosis. The patient had been previously diagnosed elsewhere as having hepatitis C virus-related "hepatitic flare" with neurological involvement related to concomitant mixed type-III cryoglobulinaemia. However intense exposure to trichloroethylene since April 2000 was revealed and liver histology was fully consistent with non-alcoholic steatohepatitis. The pathogenetic role of the solvent was definitely supported by the complete clinical and biochemical remission within six months of trichloroethylene withdrawal.
BACKGROUND: Asthenia fatigue syndrome (AFS) is a common symptom perceived by patients with cancer and consists of reported pathologic fatigue, poor endurance, and impaired motor and cognitive function. OBJECTIVE: The purpose of this study was to examine the relationship between a traditional measure of AFS, visual analogue scale (VAS) fatigue ratings, and a set of more objective functional and physiologic measures (Dietz oncology classification, C-reactive protein, serum albumin, hemoglobin, body mass index [BMI]), Motor Functional Independence Measure (FIM) Score, Cognitive FIM Score. We hypothesized a relationship could suggest the utility of alternative means of assessing and addressing AFS. METHODS: We retrospectively examined the records of 131 patients admitted to our facility for inpatient rehabilitation because of disability-causing cancer or its treatment. RESULTS: Of our sample, 94.7% (124 cases) indicated at least mild fatigue and 97.7% (128 cases) showed abnormal serum albumin, C-reactive protein, hemoglobin, or BMI. We used multiple regression analysis to examine the relationship between VAS fatigue ratings and the aforementioned set of functional and physiologic variables. The regression explained a significant proportion of the variability in VAS fatigue ratings (F = 2.25, df = 7,123, p = 0.03, R = 0.34, R(2) = 0.11). However, only Motor FIM Score accounted for a significant independent contribution to the variability in VAS fatigue ratings. CONCLUSION: The data indicate physiologic and functional variables may provide an alternative, objective, and reliable operational definition of AFS. Specifically, using Motor FIM Score, as a surrogate for VAS fatigue ratings may be used to measure the efficacy of AFS treatment.
The hemodynamic reactions of 30 young men with neurocirculatory asthenia (NCA) were compared to those of 30 healthy controls in isometric handgrip test, orthostatic test, and cold pressor test in order to study the regulation of the central circulation of NCA patients. The measurements were made using sphygmomanometry, ECG, and impedance cardiography. In the isometric handgrip test the heart rate and the diastolic and mean blood pressure increased slightly more (P less than 0.05) in the NCA group than in the controls. In the NCA group the blood pressure rise was, on average, due to an increase in the peripheral vascular resistance, while in the control group it was caused by an elevation in the cardiac output. In the orthostatic and cold pressor tests the hemodynamic alterations were quite similar in the two groups. It is concluded that the NCA patients have in the orthostatic and cold pressor tests a normal ability to elevate the blood pressure by increasing the peripheral vascular resistance. The lack of rise in the cardiac output during the isometric handgrip test in the NCA group is an abnormal reaction, the reason of which remains to be studied.
Neurocirculatory asthenia (NCA) is a fairly common functional disorder often encountered among military recruits. Symptoms in NCA tend to appear in waves, and are believed to disappear completely with the passage of time. Elevated arterial pressure is known to occur as part of the various haemodynamic manifestations of NCA. However, the exact prevalence of hypertension, as well as its long-term prognosis, is still unknown. The present case-control study was designed to address these two issues. The target population consisted of 370 patients with NCA representing two separate cohorts: patients diagnosed in 1979, 10 years prior to this study, and patients diagnosed in 1983-84, 5 years prior to the study. An overall 20% prevalence rate of mild hypertension at diagnosis was calculated for the entire study population. In total, 100 patients representing equal numbers of hypertensive and matched normotensive subjects from each cohort were re-evaluated. At follow-up, hypertension was present in 27% (1979 cohort) and 30% (1983-84 cohort) of patients originally considered to be hypertensive. Hypertension was either non-existent (1979 cohort) or limited to a single case (1983-84 cohort) among originally normotensive individuals. In parallel, resting heart rate was higher in the hypertensive subjects of the 1979 cohort both at presentation (85.5 +/- 3.2 vs. 73.7 +/- 2.4 beats min-1; P less than 0.005) and at follow-up (79.6 +/- 3.2 vs. 70.0 +/- 2.5 beats min-1; P less than 0.01). These results indicate that hypertension complicates the diagnosis of NCA in 20% of patients and that, contrary to common belief, it cannot be regarded as another transient manifestation of this condition. Thus hypertension in this context is, as in the younger members of the population in general, a major risk factor for lifelong hypertension, rather than an inconsequential phenomenon.
Hereditary collagen dysplasias comprise a complex group of connective-tissue disorders that result in the reduced tensile strength of affected tissues. These processes are called cutaneous asthenia in the skin of dogs and cats. We report here the case of a crossbred male cat, aged 6 months, that presented with two skin wounds in the region of the right thorax and right iliac tuberosity. The skin of these regions and of the animal's dorsum was hyperextensible, smooth to the touch, and easily torn with minor trauma. Microscopic examination of skin samples revealed reduced dermal connective tissue consisting of shortened and fragmented collagen fibers. Normal fibers were intermingled with altered fibers. Ultrastructural changes in collagen fibers included disorientation of fibrils within the same bundle, marked spacing differences, and variation in the diameter of transverse sections. The fibrils maintained the transverse striations characteristic of normal collagen.
To explore the relationship between pituitary morphology and function, we performed mid-sagittal MRI and endocrinological evaluation in 38 patients with asthenia. Six patients were diagnosed as having complete empty sella (ES) and 16 patients partial empty sella (PES). BMI, blood pressure, serum Na, ACTH, cortisol, TSH and T(4) were lower in ES group and PES group than in the group with normal pituitary size. Age in the patients with ES was oldest. Multiple regression analysis revealed that serum cortisol level was independently correlated with the size of the pituitary (beta = 0.586, p = 0.0069). Other variables, including age, BMI, blood pressure, serum Na, ACTH, TSH and T(4), were not correlated with the pituitary size when multivariate analysis was employed. In conclusion, there is a close relationship between the reduction of size of pituitary gland and the degree of adrenocortical dysfunction in asthenic patients. It is suggested that the pituitary-adrenal axis is especially vulnerable in empty sella syndrome, and therefore, meticulous evaluation of the hypophysial adrenal axis is recommended in subjects with reduced pituitary size even in elderly population.
In order to analyze the nature of the cardiovascular complaints in neurocirculatory asthenia (NCA) and related diseases, 83 cases were studied on the basis of the results of psychological tests (Cornell Medical Index and Yatabe-Guilford test) and cardiovascular and respiratory parameters. Almost all of the patients with normal psychological test results had abnormalities in one or more of the following: blood pressure, pulse rate, cardiac index, TII in the standing position, and cardiothoracic ratio. The data suggest that the cardiovascular complaints of the normal psychological test group can be attributed to somatic factors, especially to a small size of the heart. On the other hand, the group with psychological abnormalities had hearts of normal sizes, a less marked lowering of TII in the standing position, but markedly abnormal respiratory patterns. This indicates that the respiratory abnormalities seen in this group are likely to be the symptoms of cardiac psychoneurosis.