1/7. Somnolence syndrome after focal radiation therapy to the pineal region: case report and review of the literature.Somnolence syndrome classically occurs in children after cranial irradiation for acute lymphocytic leukemia. Symptoms include somnolence, fever, nausea and vomiting, and headache. The authors report a 29 year-old female who developed symptoms compatible with the somnolence syndrome after completing radiation therapy for a benign meningioma near the pineal region. Five weeks after completing conformal radiation therapy (54 Gy), she developed profound fatigue, headaches, and 102-degree fevers. physical examination and routine laboratory work were unrevealing. Imaging was not performed. prednisone was prescribed and within 1 week her symptoms had largely resolved. This is the first report of the somnolence syndrome after focal radiation therapy. The possible etiology of the somnolence syndrome is discussed.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
2/7. fatigue and related human factors in the near crash of a large military aircraft.INTRODUCTION: During approach to a remote island location, a U.S. Air Force heavy-airlift aircraft was flown into an aerodynamic stall, resulting in the loss of more than 4000 ft of altitude, with the crew recovering the aircraft just before impact would have occurred. methods: An analysis of the mishap was conducted through a review of non-privileged USAF mishap data, cockpit voice recordings, flight data records, and interviews of the aircrew involved. A thorough examination of fatigue-related factors was conducted, including computerized fatigue modeling. RESULTS: The crew traveled over 11,000 mi in a westward direction over a 6-d period. They had been on duty for nearly 21 h on the day of the mishap, with minimal in-flight rest. The pilots were late beginning their descent for landing, and a minor aircraft malfunction distracted the crew, contributing to channelized attention and degraded situational awareness. A breakdown in crew communication and failure to adequately monitor and interpret true aircraft state culminated in loss of aircraft control. Analysis of the crew's work/rest schedule confirmed that multiple elements of fatigue were present during this mishap, including acute and cumulative fatigue, circadian disruptions, and sleep inertia. Additionally, reduced situational awareness and spatial disorientation, exacerbated by the underlying fatigue, were causal in this mishap. DISCUSSION: This mishap highlights the importance of maintaining a high degree of situational awareness during long-haul flights with a continuing need to address issues regarding spatial disorientation, proper application of human engineering principles in modern cockpits, and mitigation of aircrew fatigue factors.- - - - - - - - - - ranking = 5keywords = near (Clic here for more details about this article) |
3/7. Palliative management of fatigue at the close of life: "it feels like my body is just worn out".fatigue is the most common chronic symptom associated with cancer and other chronic progressive diseases. The assessment and treatment of fatigue at or near the end of life can be complex. Some of the challenges include its subjective nature, with great variability in its source, how it is expressed, and how it is perceived, requiring treatment to be based on patient report of frequency and severity; its multidimensional character; and the limited understanding of its pathophysiology. Using the case of an 82-year-old retired nurse with fatigue that could be explained by a number of concurrent conditions, including anemia, weight loss, depression and isolation, dyspnea, deconditioning, and medications, the authors illustrate the clinical approach to assess and treat fatigue at the end of life.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
4/7. Treatment of hereditary angioneurotic edema with tranexamic acid and cinnarizine.Six out of 7 Finnish patients suffering from hereditary angioneurotic edema were helped during attacks, by treatment with tranexamic acid (AMCA, Cyklokapron, Kabi) in doses of 1.5 g 3 times daily, follow-up time 3-25 months. 3 of these patients also had continuous AMCA treatment, in the course of which 2 remained nearly symptom-free on a dosage of 1 g 2-3 times daily. Even the third one had shorter and milder attacks. One patient, however, had to stop taking AMCA after 6 weeks' treatment, because of fatigue and nausea. Follow-up time for the others was 9-11 months. For comparative purposes, 3 patients were given continuous treatment with an antihistamine, cinnarizine in a dosage of 20-30 mg daily. Two of the patients were helped by it, one becoming nearly symptom-free and the other having fewer and milder attacks; follow-up time 9-10 months.- - - - - - - - - - ranking = 2keywords = near (Clic here for more details about this article) |
5/7. sleep-related injuries in the U.S. Army, 1984-1991.U.S. Army safety Center files for the years 1984-1991 were searched for ground accidents involving sleeping soldiers. There were 68 incidents which could be so categorized, 53 of which resulted in injuries and 15 in fatalities. The average cost to the Army, adjusted to 1991 dollars, was $8,300 for each injury and $61,900 for each fatality. The injured required an average 24.6 days of lost duty time for recovery. The incidents most commonly occurred when soldiers slept near vehicles and less commonly when they slept in designated "safe" areas. With improved guidance and training, such accidents could be reduced.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
6/7. Necrotizing vasculitis associated with hepatitis c virus infection: successful treatment of vasculitis with interferon-alpha despite persistence of mixed cryoglobulinemia.Type II cryoglobulinemia may be associated with chronic hepatitis c virus (HCV) infection and may be characterized by vascular purpura. We report on a case of histologically proven necrotizing vasculitis associated with type II cryoglobulinemia and HCV infection. Within 14 days of interferon-alpha therapy (3 x 3 million IU/ml/week), purpuric skin lesions disappeared as well as fatigue and arthralgia; 9 months after initiation of therapy, liver enzyme values were nearly normal despite persistence of HCV rna tested by PCR and mixed cryoglobulinemia. rheumatoid factor activity, however, decreased markedly. To our knowledge, our patient is the first reported case with histologically proven necrotizing vasculitis with a beneficial effect of interferon-alpha. Because of the persistence of cryoglobulins, but reduction of the IgM fraction in the cryoglobulin complex under interferon-alpha treatment, it would seem worthwhile to further elucidate the pathogenic role of qualitative instead of quantitative changes of cryoglobulins and the mechanism of action of interferon-alpha.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
7/7. High dose gabapentin in refractory partial epilepsy: clinical observations in 50 patients.Fifty patients with refractory partial seizures took part in a prospective, observational study of adjuvant gabapentin (GBP) in increasing doses. Thirty-three were started on 400 mg GBP daily with further weekly increments of 400 mg until seizures came under control for at least 6 months or to the limit of tolerability. A further 17 patients, not fully controlled on low dose GBP, followed the same regimen. All patients took the drug three times daily. Comparisons were made with seizure numbers during a 3-month baseline during which antiepileptic medication remained unchanged. overall, 24 of the 50 patients documented a seizure reduction of 50% or more. Fifteen did so at or below 2400 mg GBP daily. Three of these patients became seizure-free. The remaining nine appeared to respond to higher daily doses of GBP (1:2800 mg; 3:3600 mg; 1:4000 mg; 1:4800 mg; 3:6000 mg), with two becoming seizure-free. Side-effects most commonly reported included tiredness, dizziness, headache and diplopia. On GBP doses exceeding 3600 mg daily, three patients developed flatulence and diarrhoea and two more had myoclonic jerks. Mean circulating GBP concentrations (mg/l) at each 1200 mg dose level were as follows: 1200 mg-4.1; 2400 mg-8.6; 3600 mg 13.2; 4800 mg 15.5; 6000 mg-17.2. In six patients, including three taking 6000 mg daily, GBP concentrations continued to rise linearly at each dosage increment. Although limited, our results do not support the suggestion that GBP absorption is saturable. High dose GBP may be effective in controlling seizures in patients with refractory partial epilepsy.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |