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PubMed1989

Salient clinical features of Sheehan's syndrome.

The natural history of Sheehan's syndrome is chronic. There is a long delay between peripartum hemorrhage and diagnosis. The majority of patients delivered at home and resided in rural areas where modern obstetric care was not readily attainable. The syndrome should be suspected in patients who present with asthenia-weakness, adrenal crisis and secondary amenorrhea. The symptoms that the patients usually had were secondary amenorrhea, asthenia-weakness, loss of axillary and pubic hair and failure to lactate. The important physical signs were loss of pubic and axillary hair, dry skin, slow relaxation phase of deep tendon reflex, hypopigmented areolar and pallor. The common laboratory features of the patients were anemia, eosinophilia, hypoalbuminemia, elevation of serum SGOT but not SGPT, hyponatremia and low fasting plasma glucose.

Adolescent↗
PubMedDate not supplied

[Radiologic characteristics of cardiogenic pulmonary edema in the elderly].

The radiologic appearance of atypical cardiogenic pulmonary edema (ACPE) is presented in 10 cases admitted from 1983 to 1985, with age ranges from 74 to 89, and with diagnosis of ischemic heart disease, with myocardial infarction in 50% of them. Clinically they had asthenia, adynamia and anorexia in 80%, cough and weight loss in 50%. All of them had tachycardia, pulmonary rales and 50% pericardial rub. ECG showed in 80% anterior subepicardial ischemia, 60% posteroinferior subepicardial ischemia, 60% bifascicular block, and 50% left anterior fascicular block. Chest films were interpreted at first as pulmonary fibrosis in 90% of the cases with superior lobe involvement in 50%. Heart enlargement was present in 50%. A chronic lung disease was disclosed on clinical and pulmonary physiological grounds. It is concluded that asthenia, adynamia and anorexia were atypical manifestations of heart failure in the elderly. Silent myocardial infarction was observed in half of our patients and it was complicated with pericardial involvement in 50%. Irregular distribution of fluids in pulmonary edema was attributed to anatomic changes in elder lung. These atypical behaviour of pulmonary edema, has been misinterpreted on radiologic basis with pulmonary infection, tumours, metastasis or fibrosis. Those radiologic changes disappeared or improved in 72 hrs. with treatment of left ventricular failure.

Aged↗
PubMed1983

Haematological and clinical data in 200 cases of thalassaemia trait in eastern Spain.

A total of 200 cases of thalassaemia trait, 102 of F thalassaemia and 98 of A2 thalassaemia were studied, evaluating haematometric, and morphological aspects of both groups. Significantly higher values were found in F thalassaemia for PCV, MCV and MCH, with 33.5% of women and 52% of men being found anaemic in F thalassaemia and 45% of women and 62% of men in A2 thalassaemia. Asthenia was usually present in A2 thalassaemia more so in women 50.9% as compared to 25% in man. Only 4% of F thalassaemia carriers were affected by asthenia. Cholecystectomy had been performed on 10% of the A2 thalassaemia group and on 5% of the F thalassaemia thamia group. Both groups show a high proportion of red cells with basophilic stippling (80%), the groups being morphologically indistinguishable. Intrafamilial segregation of Hb F values affected 22% of families carriers of F thalassaemia, whereas only 8% of families carriers of A2 thalassaemia showed segregation of HbA2 values. The values obtained in this study were compared with those of other authors.

Adolescent↗
PubMed1981

[Bilateral parotid enlargement from malignant lymphoma (author's transl)].

A rare case is reported of a 32-year-old man presenting with bilateral enlargement of the parotids only, later found to be due to a malignant lymphoma of the non-Hodgkin's type. Diagnosis was impossible at this stage because of the absence of other clinical signs, except for asthenia, and the negative results of complete investigation. Diagnosis became possible after the appearance of cutaneous lesions followed by a parotid nodule, which were shown by biopsy, over a period of two years, to be extensions of a non-Hodgkin's type 2 malignant lymphoma, according to the classification of Bryon et al. from Lyon. The initially prescribed corticoid treatment was replaced by multiple chemotherapy, and parotid enlargement, asthenia, and skin lesions were no longer present eight months later. The authors emphasize that no lesions occurred in the hematopoietic organs during the course of the disease, which clearly differentiates this case from the parotid lesions seen fairly frequently in blood diseases and Gougerot-Sjögren syndromes complicated by lymphoid leukemia.

Adult↗
PubMed1995

[Epidemic of type B botulism: Sion, December 1993-January 1994].

12 cases of food-borne botulism were registered in Sion, Switzerland, between 31 December, 1993 and 12 January, 1994. A type B toxin was isolated from the serum of one patient and from the incriminated ham. Clinical data of 10 male patients aged 21 to 54 years and some epidemiologic data are reported. The clinical course was mild to moderate with predominant autonomic and gastro-intestinal symptoms and signs: blurred vision (10 patients of 10), dry mouth with dysphagia (9/10), asthenia (7/10), diarrhea and/or constipation (7/10), nausea and vomiting (6/10), abdominal cramps (5/10), impaired sexual function (5/10), dilated pupils (4/10). Some discomfort (mainly blurred vision, asthenia and impaired sexual function) persisted for several months in most patients. Neuromuscular involvement was never the reason for seeking medical assistance and had often disappeared at the time of the first visit. Two patients were hospitalized, one for transient ileus of unknown origin and the second (first suspected case) for monitoring and infusion of trivalent equine botulinum antitoxin. This treatment was administered on day eight after intoxication and had no effect on this patient's outcome when compared with others. No patient died. Epidemiology, diagnosis, treatment and prognosis of botulism are discussed.

Adult↗
PubMed1994

L-carnitine adjuvant therapy in essential hypertension.

This study was undertaken to demonstrate L-carnitine therapeutical effect in patients with essential hypertension. Two groups were tested, A and B. First group (A) was split in two subgroups, A1 and A2. Subgroup A1 included 14 patients with essential hypertension, they were treated with antihypertensive drugs and L-carnitine. Subgroup A2 included 14 patients with essential hypertension, that were treated with antihypertensive drugs only. Group B included 9 patients with essential hypertension and they were treated with L-carnitine only. Subgroup A1 patients were treated with oral L-carnitine 2 gm per day for 22 weeks; group B patients were treated with the same dose for 10 weeks. The asthenia symptom was evaluated, a resting and dynamic E.C.G. was carried out, serum triglycerides, serum total and high-density lipoprotein (HDL) cholesterol, serum sodium and potassium, serum creatinine, serum glucose and blood pressure were determined before and at the end of test in group A patients. Test procedure of group B patients included also serum evaluation of apolipoproteins A1 and B and radionuclide angiocardiography. In subgroup A1 patients extrasystoles as well as some electrocardiographic signs of minor changes of ventricular repolarization reversed or diminished, the asthenia symptom was improved significantly and triglyceride values decreased from 148 +/- 15.8 mg/dl to 121 +/- 14.3 mg/dl (p < 0.025).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

Comparative double blind multicentric randomised placebo controlled clinical trial of a herbal preparation of eye drops in some ocular ailments.

A double masked placebo controlled multicentric randomised clinical trial was conducted in 157 patients suffering from different eye ailments namely, cataract, dry eye syndrome, ocular asthenia, refractive errors and allergic conjunctivitis with a herbal eye drop preparation and placebo. In both dry eye syndrome and ocular asthenia the herbal eye drop preparation was found better than placebo. In a few cases of cataract, the vision seems to be improved. In early myopia it seems to correct the refractive errors while in high myopic conditions it controlled the progressive deteriorations. Subjective improvements were also noted with hypermetropia, presbyopia and astigmatism. Its healing capacity in allergic conjunctivitis was certainly better than placebo. It had no short term or long term side-effects. It is considered to be a useful drug in all conditions studied.

Double-Blind Method↗
PubMedDate not supplied

[Hodgkin's disease in a patient with sarcoidosis].

We present the case of a 37 years old woman with mediastinal lymphadenopathy since the age of 13. At de age of 14, the patient presented a left cervical lymphadenopathy and the onset of episodic nodose erythema. One year later, histological examinations of an enlarged lymph node revealed sarcoidal granulomata. Corticotherapy was prescribed and the patient became asymptomatic. At the age of 31, the patient complained of asthenia and fever with left parotid tumefaction. Corticotherapy was therefore resumed with good response. Three years later, the patient presented left parotid tumefaction, left cervical lymphadenopathy and painful eye congestion. The patient was submitted to parotidectomy and lymphadenectomy. One month later, an ulceration with progressive enlargement developed in the surgical scar, and the patient suffered from asthenia, anorexia, weight loss, fever, nocturnal sweating and cervical and axillary lymphadenopathy. At Santa Maria Hospital, the patient's condition was diagnosed as Hodgkin's disease, mixed cellularity subtype, stage II Bb with local cutaneous involvement. The prescribed treatment was MOPP/ABV-8 cycles- and complete remission was achieved. The patient is still asymptomatic after a follow-up of 6 years. Cutaneous involvement in Hodgkin's disease is rare and generally associated with advanced disease and poor prognosis, facts that did not occur in this case. The differential diagnosis between sarcoidosis and sarcoid reaction in Hodgkin's disease, the accidental coexistence of both entities and the evolution of sarcoidosis into lymphoma are also discussed. The sarcoidosis immune defect may be the result of the same immune disorder. No relationships between sarcoidosis and cutaneous involvement in Hodgkin's disease were found in the literature.

Adrenal Cortex Hormones↗
PubMed1997

Phase I study of paclitaxel administered as a 1-hour infusion: toxicity and pharmacokinetics.

Paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) is one of the most important new drugs used in the treatment of solid tumors. Use of paclitaxel, however, is associated with some toxicity. The main adverse side effects include myelotoxicity, neurotoxicity, hypersensitivity reactions, and asthenia. Toxicity seems to be schedule dependent. Currently, paclitaxel is routinely administered via 3- or 24-hour infusions. This study was performed to evaluate the toxicity and pharmacokinetics of a 1-hour infusion. Thirty-four patients with incurable solid tumors were included. Dose levels were escalated from 150 to 250 mg/m2. Thirty-four patients received a total of 105 courses of paclitaxel. The dose-limiting toxicity was World Health Organization grade 3 neuropathy at a dose of 250 mg/m2 in two of three patients. Two patients were not evaluable for dose-limiting toxicity because treatment was stopped after fewer than three courses due to disease progression. Neither had experienced a dose-limiting toxicity. Other toxicities were World Health Organization grade 1/2 neutropenia, asthenia, myalgia, arthralgia, and grade 1 hypersensitivity. Twenty-one patients were evaluable for preliminary anticancer efficacy. A partial response was observed in five patients (24%), stable disease in three (14%), and progressive disease in 13 (62%). The maximum tolerated dose was established at 250 mg/m2. A dose of 225 mg/m2 is recommended for further phase II trials. There was considerable interindividual and some intraindividual variability in pharmacokinetic parameters. Paclitaxel pharmacokinetics were linear up to 225 mg/m2, while a slightly overproportional increase in the peak plasma concentration and the area under the concentration-time curve was observed at 250 mg/m2, suggesting that paclitaxel's pharmacokinetic characteristics may be nonlinear at higher doses.

Adolescent↗
PubMed2002

Asymptomatic homozygous deletional beta(0)-thalassemia in an African individual.

Homozygosity or compound heterozygosity for beta(0)-thalassemia mutations most commonly results in a transfusion-dependent thalassemia major phenotype. In this report, we describe a 55-year-old male, from Guinea-Bissau, that had been asymptomatic and never transfused until being admitted to hospital with anemia, fever, splenomegaly, and asthenia. Following hospital admission, HIV-2 and Mycobacterium tuberculosis infections were diagnosed, and biochemical and molecular studies revealed homozygosity for beta(0)-thalassemia. At the molecular level, this is the first description of homozygosity for the beta(0)-Black 1,393-bp deletion. In this case, the complete absence of beta-globin gene expression seems to be compensated by an unusually high fetal globin gene expression (Hb F 96%). Beta-globin haplotyping results were compatible with the propositus being homozygous for the Black 2 haplotype and for the absence of the XmnI polymorphism at -158 of (G)gamma-globin gene (-/-). Co-inheritance of genetic factors usually associated with high Hb F levels was not detected. Otherwise, the propositus is a heterozygote for the alpha-globin gene 3.7-kb deletion that is a beneficial modulating factor but not sufficient to explain this extremely mild phenotype. This unusual genotype/phenotype association is discussed in terms of the mechanisms underlying hemoglobin switching during development.

Anemia↗
PubMed2003

A phase II study of weekly docetaxel plus capecitabine for patients with advanced nonsmall cell lung carcinoma.

BACKGROUND: Docetaxel is an active agent in advanced nonsmall-cell lung carcinoma (NSCLC) and demonstrates preclinical and clinical synergism with capecitabine. We conducted the current Phase II study to evaluate the efficacy and safety of the docetaxel/capecitabine combination in chemotherapy-naive patients with advanced NSCLC. METHODS: Eligibility required Stage IIIB or IV NSCLC, bidimensionally measurable disease, and an Eastern Cooperative Oncology Group performance score of 2 or lower. Treatment consisted of docetaxel 36 mg/m(2) intravenously on Days 1 and 8 plus capecitabine 1000 mg/m(2) orally twice per day on Days 1-14 of a 21-day cycle, for a maximum of 6 cycles. RESULTS: Of 39 patients enrolled, 39 and 36 patients were evaluated for toxicity and response, respectively. The overall response rate was 53% (95% confidence interval [CI], 37-69%) with 19 partial responses (no complete response). The median duration of response was 6.2 months (range, 2.1-15.7 months). At a median follow-up of 14.2 months, 19 patients died. The median overall survival time was 17.8 months, with a 1-year survival rate of 56.4% (95% CI, 40.9-72.0%). There were two treatment-related deaths (one death due to pneumonia and one due to sepsis). Hematologic toxicity was mild to moderate. Thirteen percent of the patients had Grade 3 or 4 neutropenia. However, Grade 2 or 3 nonhematologic toxicities were frequent, which included asthenia (51%), stomatitis (33%), hand-foot syndrome (33%), and diarrhea (29%). CONCLUSIONS: The docetaxel/capecitabine combination showed promising antitumor activity for chemotherapy-naive patients with advanced NSCLC, However, it was frequently associated with moderate-to-severe nonhematologic toxicities, suggesting clinical synergism in both efficacy and toxicity. Further adjustment of the dose schedule is recommended to maximize the therapeutic index.

Adult↗
PubMed1984

Trichloroethylene occupational exposure: elements for better prevention.

One hundred and eighty-eight workers occupationally exposed to trichloroethylene (TRI) were studied by physical examination, exposure parameters (measure of atmospheric TRI and urinary trichloroacetic acid (CA) and evaluation of personal factors (age, alcoholic and tobacco consumption). A statistical comparison (chi 2 test) of the frequency of the symptoms observed in the high- and low-exposure populations with an analysis of nonprofessional factors allowed us to distinguish different classes of symptoms. Those more likely linked with TRI exposure are trigeminal and optic nerve impairment, asthenia, headache and dizziness. An interaction between TRI exposure and alcohol intake on the occurrence of clinical liver impairment and degreaser flush is suggested.

Adult↗
PubMed1995

Phase I study of RP 49532A, a new protein-synthesis inhibitor, in patients with advanced refractory solid tumors.

Giroline (RP 49532A) is a new protein-synthesis inhibitor with broad antitumor activity in experimental models. In the present phase I study, Giroline was given by 24-h i.v. infusion every 3 weeks at doses ranging from 3 to 15 mg/m2 to 12 patients with advanced refractory solid tumors. The dose-limiting toxic effects were delayed hypotension and severe asthenia. The maximum tolerated dose (MTD) was 15 mg/m2. Transient nausea and vomiting during infusion were reported at all dose levels. Mild reversible prolongation of prothrombin time and activated partial thromboplastin time was observed in most patients at dose levels above 3 mg/m2. No antitumor activity was observed. The toxicity profile of Giroline precludes further evaluation in cancer patients.

Adult↗
PubMed2000

[Fatigue and exhaustion in tumor patients. Etiology, diagnosis and treatment possibilities].

Fatigue is a frequent symptom in tumor patients. Although the phenomenon is well known, there is no homogeneous definition. Decreased quality of life, exhaustion, fatiguability, tiredness, malaise and asthenia are synonymous or overlapping terms used for this syndrome. Validated fatigue questionnaires show that fatigue and exhaustion are present in at least 75% of all tumor patients. Fatigue and exhaustion are enhanced by chemo-, radiation- and immunotherapy as well as surgery. Fatigue in tumor patients has many reasons and comprises physical, mental and emotional facets. The expression exhaustion should be applied for physical fatigue in order to differentiate this form from mental or emotional fatigue. Tumor anemia, atrophy of the skeleton muscles and tumor cachexia are the decisive factors for exhaustion. Treatment of fatigue improves quality of life in tumor patients and enhances their compliance. This paper gives an overview about the different types of fatigue and demonstrates various forms of treatment.

Asthenia↗
PubMed2004

Phase I study of weekly (day 1 and 8) docetaxel in combination with capecitabine in patients with advanced solid malignancies.

PURPOSE: Capecitabine in combination with docetaxel given every 3 weeks has shown a high degree of activity in a number of tumor types, but at the expense of significant toxicity. To improve the therapeutic index, we evaluated a weekly regimen of docetaxel in combination with capecitabine, and determined the maximum tolerated dose, toxicities and pharmacokinetics of this combination. PATIENTS AND METHODS: Patients with advanced solid malignancies were treated with docetaxel on days 1 and 8, and capecitabine, twice daily on days 1-14, of an every-21-day cycle. Pharmacokinetics of docetaxel were assessed on days 1 and 8 of the first cycle of chemotherapy. RESULTS: Enrolled in the study were 25 patients. The most frequent toxicities were asthenia, hand-foot syndrome and mucositis. Inability to deliver at least 75% of the planned doses of both drugs during the first two cycles of chemotherapy was noted at dose levels 2, 3 and 4. Dose level 1 (docetaxel 30 mg/m2 and capecitabine 825 mg/m2 twice daily) is the recommended dose for phase II studies. Five patients experienced a partial response, and eight patients had stabilization of disease. Coadministration of capecitabine did not alter the pharmacokinetics of docetaxel. CONCLUSION: The regimen consisting of docetaxel 30 mg/m2 (days 1, 8) and capecitabine 825 mg/m2 twice daily (days 1-14) was well tolerated. Capecitabine did not alter pharmacokinetics of docetaxel. Further testing of this regimen in tumor-specific trials, especially gastric, lung and breast cancer, is warranted.

Aged↗
PubMed2006

Germinoma located in the basal ganglia in an 8-year-old girl.

CASE REPORT: The authors describe a unique case of an 8-year-old girl with a germinoma located in the left basal ganglia. Medical history begins 5 months before with a central diabetes insipidus, loss of weight (5 kg at admission), vomiting and asthenia. Computed tomography (CT) and cranial magnetic resonance imaging (MRI) are performed and demonstrate a left basal ganglia tumour (nucleus lentiformis). Diabetes insipidus is considered as non-visible germinoma localization on the pituitary stalk rather than as a possible consequence of peri-tumoural oedema surrounding the hypothalamus. Spinal MRI is normal. Neurological as well as general examination is normal. DISCUSSION: The first hypothesis is low-grade glioma, but pathological examination following a stereotactic biopsy of the lesion reveals a cerebral germinoma. A few days before the biopsy, the girl experienced a mild left facial palsy, and CT scans at the time of biopsy reveals an intra-tumoural haemorrhage. Alpha fetoprotein and human chorionic gonadotrophin were negative as blood and cerebrospinal fluid markers, whereas placental alkaline phosphatase was positive on immunohistochemical profile of the tumour samples. Dedicated chemotherapy, followed by focal irradiation (40 Gy, 30 sessions, 45 days; SIOP CNS GCT 93 protocol), is performed with a complete response. The outcome is good (Glasgow Outcome Scale=I), without any cognitive impairment and the persistence of a mild facial palsy and a slight right arm dystonia on last neurological examination. There is still no evidence of tumour recurrence.

Antineoplastic Agents↗
PubMed2004

Second line therapy with weekly low-dose docetaxel for pretreated non-small-cell lung carcinoma patients: a multicenter Italian phase II study.

Docetaxel is one of the most active drugs in second-line therapy for non-small-cell-lung-carcinoma (NSCLC). The aim of this multicenter study was to evaluate the safety and efficacy of weekly low-dose docetaxel. Forty-two patients with advanced NSCLC pretreated with cisplatinum-based chemotherapy were enrolled. Docetaxel was administered at a dose of 25 mg/m(2) weekly for 12 consecutive weeks. A total of 386 doses were given with a median number of 10 doses per patient (range: 3-12). Treatment showed low incidence of hematologic toxicity and modest non-hematologic toxicity. An episode of grade 4 thrombocytopenia was reported but no episodes of grade 3 or 4 neutropenia. Most frequent non-hematologic toxicities were asthenia and alopecia. Response rate was 10.5% and median survival time (MST) was 12.8 weeks. Weekly treatment with 25 mg/m(2) docetaxel for 12 consecutive weeks appears to be a feasible and active regimen with mild toxicity in heavily pretreated NSCLC patients.

Adult↗
PubMed1982

Jacob Mendez DaCosta: medical teacher, clinician, and clinical investigator.

J. M. DaCosta, a scholarly, well-trained and observant clinician, was recognized during his lifetime as a well-known authority on physical diagnosis and had an unexcelled reputation as a clinical teacher. Chairman of Medicine at the Jefferson Medical College for 19 years, president of the College of Physicians of Philadelphia in 1884 and again in 1895, he was one of the original members of the Association of American Physicians and its president in 1897. Earlier in his career, his extensive Civil War study of "a form of cardiac malady common among soldiers . . . the study of which is equally interesting to the civil practitioner" was described in his 1871 paper "On Irritable Heart; A Clinical Study of a Form of Functional Cardiac Disorder and Its Consequences." Soon labeled DaCosta's syndrome, the irritable heart lineage can be traced through the soldier's heart, the effort syndrome, and neurocirculatory asthenia in World War I, anxiety neurosis in World War II, and the mitral valve prolapse syndrome in the second half of the 20th century.

Cardiology↗