Periodic breathing during sleep in patients affected by fibromyalgia syndrome.
Authors: Sergi M, Rizzi M, Braghiroli A, Puttini PS, Greco M, Cazzola M, Andreoli A
Servizio di Fisiopatologia Respiratoria, Azienda Ospedaliera--Polo Universitario L. Sacco, Milano, Italy.
Journal: European Respiratory Journal 1999 Jul;14(1):203-8
PMID: 10489852, UI: 99418384
[Note: "Periodic breathing" is a cycle of breathing in which one type of inhalation/exhalation is repeated several times, then a totally different type (or possibly a pause in breathing) is repeated several times, and then the two step process is repeated. It is common and normal in newborn infants and is a symptom of high-altitude sickness.]
In this study, the authors studied the sleep patterns of 17 patients with FMS and 17 matched healthy controls, using polysomnography, a sleep questionnaire and lung function tests. They found numerous differences between the groups and concluded that periodic breathing is linked to a reduction of transfer factor of the lung for carbon monoxide and could play a major role in the symptoms of poor sleep of fibromyalgia patients.
For more detail, see:
Function of the hypothalamic adrenal axis in patients with FM undergoing mud-pack treatment
Function of the hypothalamic adrenal axis in patients with Fibromyalgia syndrome undergoing mud-pack treatment.
Authors: Bellometti S, Galzigna L. Thermal Research Center P. d'Abano, Padua, Italy.Journal: International Journal of Clinical Pharmacology Research 1999;19(1):27-33
NLM citations: PMID: 10450540, UI: 99379034
The authors suggest that mud packs together with antidepressant treatment are able to influence the HPA axis, stimulating increased levels of adrenocorticotropic hormone, cortisol and beta-endorphin levels in blood; and that the two treatments work together by "helping the physiological responses to achieve homeostasis and to rebalance the stress response system."
The abstract may be read at:
Posted to Co-Cure Sat, 14 Jul 2001 08:35:24 -0700 by Melissa O'Toole
Role of intracellular calcium ions in the physiopathology of fibromyalgia syndrome
Full Title: Role of intracellular calcium ions in the physiopathology of fibromyalgia syndrome.
Journal: Boll Soc Ital Biol Sper 2000 Jan-Feb;76(1-2):1-4
Authors: Magaldi M, Moltoni L, Biasi G, Marcolongo R.
Affiliation: Institute of Rheumatology, University of Siena, Policlinico Le Scotte, Viale Bracci 1, I-53100 Siena.NLM Citation: PMID: 11449822
Calcium ions have a key role in the physiology of muscular contraction: changes
in calcium ion concentration may be involved in the pathogenesis of fibromyalgia. Although the plasmatic level of calcium in fibromyalgia patients is always in the normal range, it seemed interesting to evaluate the intracellular calcium concentration.
The study was carried out on two groups of subjects: 70 affected by fibromyalgia and 40 healthy controls.
The results obtained show that in fibromyalgia patients the intracellular calcium concentration is significantly reduced in comparison to that of healthy controls: the reduced intracellular calcium concentration seems to be a peculiar characteristic of fibromyalgia patients and may be potentially responsible for muscular hypertonus.
The effective role of this anomaly in the physiopathology of fibromyalgia and the potential role of drugs active on the calcium homeostasis are still to be confirmed.
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Visceral Hypersensitivity Is Not a Feature of Fibromyalgia Syndrome
Full Title: Visceral Hypersensitivity Is Not a Feature of Fibromyalgia Syndrome
Journal: J of Musculoskeletal Pain, Vol. 9(1) 2001, pp. 47-55
Authors: Fabio Pace, Piercarlo Sarzi-Puttini, Guendalina Manzionna, Paola Molteni, Maurizio Turiel, Benedetta Panni, Gabriele Bianchi-Porro
Affiliations: Fabio Pace, MD, Guendalina Manzionna, MD, Paola Molteni, MD, and Gabriele Bianchi-Porro, MD, are affiliated with the Gastroenterology Unit, University Hospital L. Sacco, v. G. B. Grassi 74, 20157 Milan, Italy.Piercarlo Sarzi-Puttini, MD, and Benedetta Panni, MD, are affiliated with the Rheumatology Unit, University Hospital L. Sacco, Milan, Italy. Maurizio Turiel, MD, is affiliated with the Internal Medicine Division II, University Hospital L. Sacco, Milan, Italy.
Address correspondence to: Dr. Piercarlo Sarzi-Puttini, University Hospital L. Sacco, Rheumatology Unit, Via G. B. Grassi 74, 20157 Milan, Italy [E-mail address: Sarzi@tiscalinet.it].
Submitted: August 23, 1999.
Revision accepted: May 9, 2000.
Objective: Visceral hyperalgesia is commonly observed in irritable bowel syndrome [IBS], a common cause of comorbidity with fibromyalgia syndrome [FMS]. The aim of this study was to evaluate in patients affected by FMS the presence of IBS-like symptoms and of visceral hyperalgesia.
Methods: Twenty-seven FMS patients were studied and compared with 32 IBS patients for visceral hyperalgesia by the anorectal balloon distension test.
Results: Eighteen [66%] of FMS patients fitted the Rome criteria for IBS. Patients with IBS presented lower than normal thresholds for the sensation of urgency and pain [P < 0.05], whereas the sensation of gas present in the rectum and of desire of defecation were not statistically different from normals. On the contrary, patients with FMS, either with or without IBS-like symptoms, presented values similar to normals for all the examined thresholds [P > 0.05].
Conclusions: Our study confirms that IBS symptoms are present in a relevant proportion of FMS patients, and that the majority of IBS patients present a condition of visceral hypersensitivity, as induced by a rectal balloon distension test. Patients with FMS, however, do not present this feature. The reason why FMS patients frequently have IBS-like symptoms with a normal visceral hypersensitivity remains elusive.
KEYWORDS. Fibromyalgia syndrome, irritable bowel syndrome, visceral hypersensitivity
In recent years, it has become increasingly clear that visceral hyperalgesia (1) is a distinctive feature of the irritable bowel syndrome [IBS]. Fibromyalgia syndrome [FMS] is a chronic painful musculoskeletal syndrome (2,3), occurring in up to 2% of the general population, characterized by diffuse pain and tender points which shares many clinical and epidemiological features with IBS, such as, for example, the age [peak age of both conditions about 30-40 years], the gender [female are 80 to 90% of the patients] and associated conditions such as sleep disturbances, depression, and anxiety (4). The two conditions frequently coexist (5), with IBS described in 34-50% of cases (6-8); in addition, the presence of IBS is a minor criterion that has been proposed for the diagnosis of FMS (9). It has therefore been suggested that IBS and FMS may have a common pathogenetic mechanism (10, 11).
The aim of the present study has been to ascertain whether a condition of visceral hyperalgesia is present in patients with FMS as it is in IBS patients. For this purpose we have used the rectal balloon distension test, as previously described by Prior et al. (12).
[Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: email@example.com Web site: www.HaworthPress.com]
© 2001 by The Haworth Press, Inc. All rights reserved.
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￼Relationship between musculoskeletal symptoms and blood markers of oxidative stress in patients with chronic fatigue syndrome. (Abstract) Vecchiet J, Cipollone F, Falasca K, Mezzetti A, Pizzigallo E, Bucciarelli T, De Laurentis S, Affaitati G, De Cesare D, Giamberardino MA. Department of Medicine and Science of Aging, G. D'Annunzio University of Chieti, Italy. "Increased oxidative stress and decreased antioxidant defenses are related to the extent of symptomatology in CFS, suggesting that antioxidant supplementation might relieve muscle symptoms in the syndrome."
￼Specific oxidative alterations in vastus lateralis muscle of patients with the diagnosis of chronic fatigue syndrome.
. (Abstract) Fulle S, Mecocci P, Fano G, Vecchiet I, Vecchini A, Racciotti D, Cherubini A, Pizzigallo E, Vecchiet L, Senin U, Beal MF. Lab. Interuniversitario di Miologia, Dip. Biologia Cellulare e Molecolare, Universita di Perugia, Perugia, Italy "From these results we hypothesize that in CFS there is oxidative stress in muscle, which results in an increase in antioxidant defenses. Furthermore, in muscle membranes, fluidity and fatty acid composition are significantly different in specimens from CFS patients as compared to controls and to patients suffering from fibromyalgia. These data support an organic origin of CFS, in which muscle suffers oxidative damage."
￼A first study of cytokine genomic polymorphisms in CFS: Positive association of TNF-857 and IFNgamma 874 rare alleles. (Abstract) N. Carlo-Stella , C. Badulli , A. De Silvestri , L. Bazzichi , M. Martinetti , L. Lorusso , S. Bombardieri , L.Salvaneschi , M. Cuccia  Affiliations:  University of Pavia,  San Matteo Polyclinic Hospital, Pavia;  S. Chiara Hospital, Pisa;  M. Mellini Hospital, Chiari, (BS), Italy. "We hypothesize that CFS patients can have a genetic predisposition to an immunomodulatory response of an inflammatory nature probably secondary to one or more environmental insults of unknown nature."
http://www.ncbi.nlm....ov/sites/entrez PubMed ricerche myalgic encephalomyelitie-chronic fatigue syndrome -ricerche pub; 3582 -11 febraio 2008
Acetyl l-carnitine (ALC) treatment in elderly patients with fatigue.
Arch Gerontol Geriatr. 2007 Jul 19 [Epub ahead of print]
Malaguarnera M, Gargante MP, Cristaldi E, Colonna V, Messano M, Koverech A, Neri S, Vacante M, Cammalleri L, Motta M.
Centro di Ricerca “La Grande Senescenza”, Università degli Studi di Catania, Via Messina 829, I-95126 Catania, Italy.Fatigue is one of the conditions most frequently complained by the elderly. There are few effective treatment options for patients with chronic fatigue syndrome. To determine the efficacy, tolerability and impact on the fatigue, as well as on cognitive and functional status of elderly subjects with acetyl l-carnitine (ALC), 96 aged subjects (>70 years, range 71-88) were investigated (50 females and 46 males; mean age 76.2+/-7.6 and 78.4+/-6.4 years, respectively). They met four or more of the Holmes major criteria or at least six of Fukuda minor criteria. Fatigue was measured with the Wessely and Powell [Wessely, S., Powell, R., 1989. Fatigue syndromes: a comparison of chronic postviral fatigue with neuromuscular and affective disorders. J. Neurol. Neurosurg. Psychiatry 52, 940-948] scores, with the fatigue severity scale. At the end of the treatment, we observed a decrease of physical fatigue: 6.2 (p<0.001), of mental fatigue: 2.8 (p<0.001), of severity fatigue: 21.0 (p<0.001) and improvements in functional status: 16.1 (p<0.001) and cognitive functions: 2.7 (p<0.001). By the end of the treatment, significant differences between the two groups were found for the following parameters: muscle pain -27% versus -3% (p<0.05); prolonged fatigue after exercise: 51% versus -4% (p<0.0001); sleep disorders: 28% versus 4% (p<0.05); physical fatigue: 7 versus -0.5 (p<0.0001); mental fatigue: -3.3 versus 0.6 (p<0.0001); fatigue severity scale: -22.5 versus 1.2 (p<0.0001); functional status 17.1 versus 0.6 (p<0.0001); mini mental state examination (MMSE) improvements: 3.4 versus 0.5 (p<0.0001). Our data show that administering ALC may reduce both physical and mental fatigue in elderly and improves both the cognitive status and physical functions.
PMID: 17658628 [PubMed - as supplied by publisher]
G Ital Med Lav Ergon. 2006 Apr-Jun;28(2):172-3.
Lorusso A, Bruno S, L'Abbate N.
Sezione di Medicina del Lavoro B Ramazzini, DIMIMP, Università di Bari, Italy.Occupational fitness of workers with fibromyalgia syndrome
Fibromyalgia is a syndrome characterized by widespread musculoskeletal chronic pain and by other clinical manifestations such as stiffness, fatigue, sleep disturbances, anxiety and depression. The disorder has a considerable impact on the ability to perform work and daily living activities, often reducing workforce participation. Fitness to work, in relation to biomechanically taxing tasks execution, vibration exposure, environmental microclimatic conditions and night shift, is discussed.
PMID: 16805451 [PubMed - indexed for MEDLINE]
Eura Medicophys. 2006 Jun;42(2):97-102.
Submaximal aerobic exercise with mechanical vibrations improves the functional status of patients with chronic fatigue syndrome.
Saggini R, Vecchiet J, Iezzi S, Racciatti D, Affaitati G, Bellomo RG, Pizzigallo E.
Physical Therapy Institute, Department of Medicine and Aging, G. D'Annunzio University, Chieti, ItalyAIM: Chronic fatigue syndrome (CFS) is an illness characterised by disabling fatigue of uncertain aetiology and other nonspecific symptoms. Typically CFS patients complain of a severe fatigue made worse by exercise, with a consistent reduction of working activity. A physical deconditioning could explain CFS features as well as a neuromuscular dysfunction, of central or peripheric origin. METHODS: Ten CFS patients were enrolled in a protocol of a rehabilitative treatment over a six-month period: they underwent a submaximal and predominantly aerobic exercise with a reduced O2 consumption using a Galileo 2000 system that provides mechanical vibrations characterised by sinusoid vertical sollecitations. Before and after such treatment, all patients underwent a pressure pain thresholds profile, an evaluation of physical and psychosocial parameters using the visual analogue scale (VAS) of Scott-Huskisson, and a muscle performance analysis by the CIBEX 6000 dynamometer. RESULTS: After the six-month period of study there was an overall improvement of the above described parameters as compared to the basal determinations. CONCLUSION: We conclude that the rehabilitative exertion provides an useful treatment for CFS patients particularly to realize an effective training of the explosive strength.
PMID: 16767057 [PubMed - indexed for MEDLINE]
Clin Exp Rheumatol. 2006 Mar-Apr;24(2):179-82
A first study of cytokine genomic polymorphisms in CFS: Positive association of TNF-857 and IFNgamma 874 rare alleles.
Carlo-Stella N, Badulli C, De Silvestri A, Bazzichi L, Martinetti M, Lorusso L, Bombardieri S, Salvaneschi L, Cuccia M.
Immunogenetics Laboratory, Dept. of Genetics and Microbiology, University of Pavia, Italy. firstname.lastname@example.orgOBJECTIVE: In the past two years we have developed a biological bank of genomic DNA, cDNA, serum and red blood cells of Italian patients with certified CFS from the two Italian referral centers for the syndrome. Recent studies have shown an imbalance in cytokine production in disease states similar to Chronic Fatigue Syndrome (CFS), such as sickness behavior, both in animals and in humans. However we notice that serum cytokine concentrations are often inconstant and degrade rapidly. With this in mind, we investigated cytokine gene polymorphisms in 80 Italian patients with CFS in order to ascertain whether in this group of patients it is possible to describe a genetic predisposition to an inflammatory response. METHODS: We analyzed the promoter polymorphisms of IL-10, IL-6 and the IFNgamma 874 T/A polymorphism in intron 1 with a PCR-SSP method (Cytogen One Lambda Inc. Canoga Park, CA, U.S.A) in 54 patients and TNF-308 G/A and -857 C/T promoter polymorphisms with a PCR-RFLP method (in 54 and 80 patients respectively). RESULTS: There is a highly significant increase of TNF -857 TT and CT genotypes (p = 0.002) among patients with respect to controls and a significant decrease of IFN gamma low producers (A/A) (p = 0.04) among patients with respect to controls. CONCLUSIONS: We hypothesize that CFS patients can have a genetic predisposition to an immunomodulatory response of an inflammatory nature probably secondary to one or more environmental insults of unknown nature.
PMID: 16762155 [PubMed - indexed for MEDLINE]
Curr Neurovasc Res. 2006 May;3(2):149-57.
Autoantibodies associated with psychiatric disorders.
Margutti P, Delunardo F, Ortona E.
Dipartimento di Malattie Infettive, Parassitarie e Immunomediate, Istituto Superiore di Sanità, Rome, Italy. email@example.com.Growing evidence suggests that autoantibodies to neuronal or endothelial targets in psychiatric disorders exist and may be pathogenic. This review describes and discusses the possible role of autoantibodies related to the psychiatric manifestations in autoimmune diseases, autoantibodies related to the psychiatric disorders present in post-streptococcal diseases, celiac disease, chronic fatigue syndrome and substance abuse, and autoantibodies related to schizophrenia and autism, disorders now considered of autoimmune origin.
PMID: 16719797 [PubMed - indexed for MEDLINE]
South Med J. 2006 Mar;99(3):315-6.
L-carnitine reduces severity of physical and mental fatigue and improves daily activities in the elderly.
Malaguarnera M, Di Mauro A, Gargante PM, Rampello L.
PMID: 16553112 [PubMed - indexed for MEDLINE]
Aliment Pharmacol Ther. 2005 Sep 1;22(5):489-94.
Fatigue in adult coeliac disease.
Siniscalchi M, Iovino P, Tortora R, Forestiero S, Somma A, Capuano L, Franzese MD, Sabbatini F, Ciacci C.
Gastrointestinal Unit, Department of Clinical and Experimental Medicine, Federico II University of Naples, Italy.BACKGROUND: Fatigue is reported by many adults at the moment of diagnosis of coeliac disease and during follow-up. AIM: To evaluate the prevalence, characteristics and associations of fatigue in adult coeliac disease patients. METHODS: The investigated sample comprised adults from Campania, Italy. A total of 130 coeliac disease patients were consecutively recruited in both treated (59 on gluten-free diet) and untreated conditions (71 on normal diet). The control group was made up of 80 healthy controls. Coeliac disease patients and healthy controls underwent laboratory tests, a set of questionnaires for studying fatigue: visual analogue scale for fatigue, chronic fatigue syndrome questionnaire, fatigue severity scale and a modified version of the Zung self-rating depression scale. RESULTS: Coeliac disease patients showed a significantly lower body mass index than controls (P = 0.0001), lower serum iron (P = 0.04). The entire cohort of coeliac disease patients reported greater modified version of the Zung self-rating depression scale score (P = 0.001), greater visual analogue scale for fatigue score (P = 0.0001) and greater chronic fatigue syndrome questionnaire score (P = 0.0001) compared with healthy controls. Coeliac disease patients on a gluten-free diet had a significantly higher modified version of the Zung self-rating depression scale score than coeliacs on a normal diet (P = 0.001). The prevalence of pathological modified version of the Zung self-rating depression scale score was 17% in all coeliac disease patients and 0% in healthy controls. A significant correlation was found between modified version of the Zung self-rating depression scale score and fatigue scale scores in coeliacs on a normal diet. Presence/absence of gastrointestinal symptoms did not show any significant correlation with modified version of the Zung self-rating depression scale score and fatigue scale scores. In coeliacs on a gluten-free diet, modified version of the Zung self-rating depression scale and fatigue scales scores did not significantly differ from coeliacs on a normal diet and were not related to dietetic compliance. CONCLUSION: In coeliacs, fatigue is a common finding, which ameliorates with the gluten-free diet and is strictly correlated to depression although coeliacs on a gluten-free diet showed more frequent and more severe depression symptoms than coeliacs on a normal diet.
PMID: 16128688 [PubMed - indexed for MEDLINE]
J Intern Med. 2005 Sep;258(3):291-2.
Chronic fatigue syndrome, exercise, cortisol and lymphadenopathy.
Baschetti R. PMID: 16115307 [PubMed - indexed for MEDLINE]
Curr Med Chem. 2005;12(15):1801-9.
Drug targets in stress-related disorders.
Covelli V, Passeri ME, Leogrande D, Jirillo E, Amati L.
Division of Neurology, Polyclinic Hospital, Bari Italy.Nervous and immune systems mutually cooperate via release of mediators of both neurological and immunological derivation. Adrenocorticotropin hormone (ACTH) is a product of the hypothalamus-pituitary adrenal axis (HPAA) which stimulates secretion of corticosteroids from adrenals. In turn, corticosteroids modulate the immune response in virtue of their anti-inflammatory activity. On the other hand, catecholamines, products of the sympathetic nervous system (SNS), regulate immune function by acting on specific beta-adrenergic receptors. Conversely, cytokines released by monocytes/macrophages and lymphocytes, upon antigenic stimulation, are able to cross the blood-brain-barrier, thus modulating nervous functions (e.g., thermoregulation, sleep, and appetite). However, cytokines are locally produced in the brain, especially in the hypothalamus, thus contributing to the development of anorexic, pyrogenic, somnogenic and behavioural effects. Besides pathogens and/or their products, the so-called stressors are able to activate both HPAA and SNS, thus influencing immune responses. In this respect, many studies conducted in medical students taking exams have evidenced an array of stress-induced immune alterations. Phobic disorders and migraine without aura (MWA) represent examples of stress-related disorders in which phagocytic immune deficits, endotoxemia and exaggerated levels of proinflammatory cytokines [Tumor Necrosis Factor-alpha (TNF- alpha), and interleukin- 1 beta] have been detected. Quite interestingly, administration of a thymic hormone could ameliorate clinical symptoms in phobic patients. In MWA patients, a beta-blocker, propranolol, could mitigate migraine, whose cessation coincided with a drop of TNF-alpha serum concentration. In phobic disorders and in MWA, benzodiazepines are very often administered and, in this respect, some of them, such as diazepam, inhibit immune functions, while others, e.g., alprazolam, enhance immune responses. Alprazolam could improve clinical symptoms in MWA patients. Chronic Fatigue Syndrome (CFS) is a disorder whose etiology and pathogenesis are still unknown. In this syndrome both abnormalities of nervous and immune systems have been reported. Despite many immune parameters evaluated in CFS no specific biomarkers of disease have been found. Our own data are in agreement with current literature in that we found decreased levels of serum (IFN)-gamma in these patients, thus indicating a predominance of T helper (h)1 response in CFS. Also leptin, a hormone which regulates food intake, fluctuates within normal ranges in CFS individuals. Quite interestingly, in depressed patients, used as controls, leptinaemia was more elevated than in CFS. Finally, in a series of recent therapeutic trials several immunomodulating agents have been used, such as staphypan Berna, lactic acid bacteria, kuibitang and intravenous immunoglobulin. In conclusion, it seems that major drug targets in stress-related disorders are immune cells in terms of inhibition of proinflammatory cytokines and modulation of Th responses. In particular, according to recent evidences, antidepressants seem to exert beneficial effects in experimental autoimmune neuritis in rats by decreasing IFN- beta release or augmenting NK activity in depressed patients.
PMID: 16029148 [PubMed - indexed for MEDLINE]
Recenti Prog Med. 2004 Nov;95(11):546-52; quiz 560.
Chronic fatigue syndrome: a review]
[Article in Italian]
Carlo-Stella N, Lorusso L, Candura SM, Cuccia M.
Laboratorio di Immunogenetica, Dipartimento di Genetica e Microbiologia, Università, Pavia.Chronic fatigue sindrome is a relatively unknown and underdiagnosed entity in Italy where its epidemiology remains uncertain, as well as its etiology, although it causes important disability in those affected. Classification criteria by Fukuda are available to diagnose the syndrome. Its epidemiology indicates that it is probably more frequent in Northern countries and it is described in Gulf War veterans. Etiological hypotheses include infectious diseases, immunology and neurology. Among these hypotheses sickness behavior mimes certain aspects of this syndrome and is characterized by a cytokine imbalance in the central nervous system and in the periphery. There are no valid therapies available at the moment. In the laboratory of Immunogenetics, we are constituting a biological bank of the syndrome to study the immunogenetic aspects of the disease in the hope of delucidating some of the obscure areas of its etiopathogenesis.
PMID: 15598093 [PubMed - indexed for MEDLINE]
Ann Oncol. 2004 Oct;15(10):1576.
Ann Oncol. 2004 May;15(5):712-20.
Fatigue in cancer patients receiving chemotherapy: an analysis of published studies.
Spazzapan S, Bearz A, Tirelli U. PMID: 15367422 [PubMed - indexed for MEDLINE
: Int J Immunopathol Pharmacol. 2004 May-Aug;17(2 Suppl):57-62.
Study of immune alterations in patients with chronic fatigue syndrome with different etiologies.
Racciatti D, Dalessandro M, Delle Donne L, Falasca K, Zingariello P, Paganelli R, Pizzigallo E, Vecchiet J.
Sections of Infectious Diseases, Department of Medicine and Sciences of Aging, Centre of Excellence on Aging, University G. D'Annunzio, Chieti, Italy. firstname.lastname@example.orgThe Chronic Fatigue Syndrome (CFS) is characterized by symptoms lasting for at least six months and accompanied by disabling fatigue. The etiology of CFS is still unclear. At the National Center for Study of the Infectious Diseases Department of the Chieti University some immune investigations were performed with the purpose of detecting markers of the disease. CD4+, CD8+, NK CD56+ and B CD19+ lymphocytes were studied in 92 male and 47 female patients and in 36 control subjects. CFS patients were divided in three groups with a post-infectious onset (PI-CFS), an non post-infectious onset (NPI-CFS) and a non post-infectious onset with associated infections (NPI-CFS + AI). Both CD4+ and CD8+ lymphocytes were reduced in the CFS patients. However, the CD4+/CD8+ ratio was increased in the CFS patients without difference between males and females. CD56+ cells of CFS patients were also reduced. In particular, blood CD56+ cells counts were significantly higher in PI-CFS patients than in the NPI-CFS subjects. These data confirm our preliminary results suggesting a key-role of a dysfunction of the immune system as a precipitating and-or perpetuating factor of the syndrome.
PMID: 15345193 [PubMed - indexed for MEDLINE]
Recenti Prog Med. 2004 May;95(5):257-8
Polyneuritis cranialis HHV-6 infection associated]
[Article in Italian]
Brustia D, Uglietti A, Garavelli PL.
SCDO Malattie Infettive, Azienda Sanitaria Ospedaliera Maggiore della Carità, Novara.Human herpesvirus 6 (HHV-6) has been shown to be a common cause of acute febrile disease in young children, including exanthema subitum. HHV-6 has also been associated with a number of neurologic disorders including encephalitis and the virus has been postulated to play a role in acquired immunodeficiency syndrome, multiple sclerosis and chronic fatigue syndrome. The disorder of multiple cranial nerve palsies without spinal cord involvement is referred to as polyneuritis cranialis and is rare. The Authors describe a case of polyneuritis cranialis in a 52-year old woman treated with ganciclovir and only complete eradication of the virus.
PMID: 15202678 [PubMed - indexed for MEDLINE
J Vet Med B Infect Dis Vet Public Health. 2001 May;48(4):267-81.
Chronic fatigue and immune dysfunction syndrome associated with Staphylococcus spp. bacteraemia responsive to thiacetarsamide sodium in eight birds of prey.
Heron Veterinary Clinics' of Nus (Aosta) and Castiglione del Lago, Perugia, Italy.
Chronic fatigue and immune dysfunction syndrome (CFIDS) is a recognized human illness with zoonotic implications that is rarely described in animals. Eight birds of prey examined between 1992 and 1995 and sharing common symptoms (asthenia, inability to fly, poor appetite and emaciation) underwent laboratory tests revealing immunodeficiency, anaemia, high creatine kinase levels and low serum magnesium levels. Diagnosis of CFIDS was based upon these features. The effectiveness of an arsenic-based medication, thiacetarsamide sodium, administered intravenously for 2-3 days at low dosages (0.1 ml/kg/day) has been demonstrated by checks carried out 10, 20 and 30 days after therapy. The symptoms and the immune and haematological dysfunctions disappeared within 2-4 weeks of treatment. In all patients, micrococcus-like organisms found adhering to the outer surface of many red blood cells, had disappeared at post-treatment controls. Two of five blood cultures were positive for Staphylococcus spp. (S. intermedius and S. xilosus). Consideration is given to the pharmacological activity of an arsenic-based drug in animal illnesses resembling CFIDS.
PMID: 15129582 [PubMed - indexed for MEDLINE]
J Neurol Sci. 2004 Mar 15;218(1-2):103-8.
Comparison of the effects of acetyl L-carnitine and amantadine for the treatment of fatigue in multiple sclerosis: results of a pilot, randomised, double-blind, crossover trial
Tomassini V, Pozzilli C, Onesti E, Pasqualetti P, Marinelli F, Pisani A, Fieschi C.
Department of Neurological Sciences, University of Rome "La Sapienza", viale dell' Università 30, Rome 00185, Italy.
Treatment with acetyl L-carnitine (ALCAR) has been shown to improve fatigue in patients with chronic fatigue syndrome, but there have been no trials on the effect of ALCAR for treating fatigue in multiple sclerosis (MS). To compare the efficacy of ALCAR with that of amantadine, one of the drugs most widely used to treat MS-related fatigue, 36 MS patients presenting fatigue were enrolled in a randomised, double-blind, crossover study. Patients were treated for 3 months with either amantadine (100 mg twice daily) or ALCAR (1 g twice daily). After a 3-month washout period, they crossed over to the alternative treatment for 3 months. Patients were rated at baseline and every 3 months according to the Fatigue Severity Scale (FSS), the primary endpoint of the study. Secondary outcome variables were: Fatigue Impact Scale (FIS), Beck Depression Inventory (BDI) and Social Experience Checklist (SEC). Six patients withdrew from the study because of adverse reactions (five on amantadine and one on ALCAR). Statistical analysis showed significant effects of ALCAR compared with amantadine for the Fatigue Severity Scale (p = 0.039). There were no significant effects for any of the secondary outcome variables. The results of this study show that ALCAR is better tolerated and more effective than amantadine for the treatment of MS-related fatigue.
PMID: 14759641 [PubMed - indexed for MEDLINE]
Eur J Clin Invest. 2003 Dec;33(12):1029-31.
Chronic fatigue syndrome: an endocrine disease off limits for endocrinologists?
Retired Medical Inspector of the Italian State Railways, Fortaleza, Brazil. email@example.comEndocrinologists were not included in the multidisciplinary working groups that prepared two recent reports on chronic fatigue syndrome, despite its unequalled clinical overlap with Addison's disease, which is a classic endocrine disorder. The failure to include at least one endocrinologist in those panels may explain why in their extensive reports there is not a single word about the 42 clinical features that chronic fatigue syndrome shares with Addison's disease, including all the signs and symptoms listed in the case definition of this syndrome.
PMID: 14636284 [PubMed - indexed for MEDLINE]
N Z Med J. 2003 Aug 8;116(1179):U549
Fludrocortisone and chronic fatigue syndrome.
Baschetti R. PMID: 14513090 [PubMed - indexed for MEDLINE]
Neuromuscul Disord. 2003 Aug;13(6):479-84.
Modification of the functional capacity of sarcoplasmic reticulum membranes in patients suffering from chronic fatigue syndrome.
Fulle S, Belia S, Vecchiet J, Morabito C, Vecchiet L, Fanò G.
Laboratorio Interuniversitario di Miologia, Università 'G. d'Annunzio', Nuovo Polo Didattico, 66013 Chieti Scalo, Italy. firstname.lastname@example.orgIn chronic fatigue syndrome, several reported alterations may be related to specific oxidative modifications in muscle. Since sarcoplasmic reticulum membranes are the basic structures involved in excitation-contraction coupling and the thiol groups of Ca(2+) channels of SR terminal cisternae are specific targets for reactive oxygen species, it is possible that excitation-contraction coupling is involved in this pathology. We investigated the possibility that abnormalities in this compartment are involved in the pathogenesis of chronic fatigue syndrome and consequently responsible for characteristic fatigue. The data presented here support this hypothesis and indicate that the sarcolemmal conduction system and some aspects of Ca(2+) transport are negatively influenced in chronic fatigue syndrome. In fact, both deregulation of pump activities (Na(+)/K(+) and Ca(2+)-ATPase) and alteration in the opening status of ryanodine channels may result from increased membrane fluidity involving sarcoplasmic reticulum membranes.
PMID: 12899875 [PubMed - indexed for MEDLINE]
Curr Pharm Des. 2003;9(24):1951-5.
A point of view: The need to identify an antigen in psyconeuroimmunological disorders.
Covelli V, Pellegrino NM, Jirillo E.
Division of Neurology, Azienda Policlinico, Bari, Italy. email@example.comSeveral lines of evidence support a mutual relationship between the nervous system and the immune system. Therefore, it is not surprising that some neuropsychiatric disorders are also characterized by immune abnormalities. In patients with phobic disorders and in patients with migraine without aura some common immune abnormalities have been detected and, in particular, natural immunity deficits, exaggerated release of proinflammatory cytokines and circulating bacterial endotoxins have been found. In other neurological disease, some etiologic factors have been detected as in the case of Guillain-Barrè syndrome in which molecular mimicry between Campylobacter jejuni endotoxin and GM1 ganglioside may cause an acute inflammatory polyneuropathy. On the other hand, attempts to identify an antigen have been made in patients with Alzheimer's disease and schizophrenia. Finally, the chronic fatigue syndrome, an old illness in search for an antigen, risk factors and precipitating agents have been described but evidence for a specific antigen is still lacking.
PMID: 12871180 [PubMed - indexed for MEDLINE]
QJM. 2003 Jun;96(6):454.
Assessing chronic fatigue.
Baschetti R. PMID: 12788966 [PubMed - indexed for MEDLINE]
1: Neuropsychobiology. 2003;47(2):94-7.
L-carnitine decreases severity and type of fatigue induced by interferon-alpha in the treatment of patients with hepatitis C.
Neri S, Pistone G, Saraceno B, Pennisi G, Luca S, Malaguarnera M.
Department of Senescence, Urological and Neurological Sciences, University of Catania, Catania, Italy.BACKGROUND: Hepatitis C virus (HCV) is one of the major agents of chronic hepatitis and liver disease worldwide. Infection with HCV leads to chronic hepatitis in about 80% of the cases. The most used treatment is based on interferon (IFN)-alpha, which is effective in less than 50% of patients; however, a high proportion of responders may relapse after interferon withdrawal. Fatigue is a common complaint in patients with liver disease. The aim of our study was to evaluate the efficacy of carnitine on IFN-induced fatigue in subjects with chronic hepatitis C. PATIENTS AND METHODS: We studied 50 patients (30 males and 20 females) with chronic hepatitis C. Chronic hepatitis was diagnosed by determination of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels (at least 2-fold upper normal values for 1 year). Our study series was divided into two groups and matched as to number, age, sex, as well as grade and duration of disease. Group 1, composed of 25 patients, was treated with leucocytic IFN-alpha at a dosage of 3 million IU thrice a week; group 2 (25 patients) was treated with the same protocol as group 1, but was also administered carnitine 2 g per os daily. Patients' response was evaluated on the basis of serum levels of AST and ALT as well as liver functions; fatigue was evaluated by Wessely and Powell scores. All patients studied were tested before treatment and then 1, 3 and 6 months after the beginning of IFN administration. RESULTS: The difference of physical fatigue between the two groups after 1 month of therapy was significant (p < 0.01) for patients treated with carnitine. This significance continued at the end of month 3 (p < 0.01). With reference to mental fatigue, the comparison between the two groups showed a significant difference for group 2 after 1 month (p < 0.01). Finally, with respect to the fatigue severity, the comparison between the two groups showed that after 1 and 3 months of therapy, fatigue was significantly less severe in group 2 than group 1 (p < 0.0005). CONCLUSIONS: If we take into account baseline values of mental and physical fatigue as well as the severity of this symptom in our study series, one observes that therapy with IFN alone induces fatigue in the majority of cases after 1 and 3 months, while at month 6, the values decrease. In contrast, patients treated with IFN + carnitine show a marked and early significant reduction of fatigue levels. These data suggest that the greater energetic substrate utilised by group 2 patients may in some way provide a better response of the patients to this side-effect. Abnormalities of neurotransmission concerning serotonine seem involved in the genesis of depression and fatigue. In addition, depression and fatigue commonly occur together, and the former is the most commonly observed symptom in patients with chronic fatigue syndrome. Copyright 2003 S. Karger AG, Basel
PMID: 12707492 [PubMed - indexed for MEDLINE]
1: Postgrad Med J. 2003 Mar;79(929):185.
Phantom lymphadenopathy. An association with chronic fatigue syndrome.
Baschetti R. PMID: 12697934 [PubMed - indexed for MEDLINE]
1: Acta Vet Hung. 2003;51(1):61-72.
Immunological anomalies and thrombocytopenia in 117 dogs and cats diagnosed with chronic fatigue syndrome (CFS).
Clinica Veterinaria Airone of Nus, Aosta, Italy. firstname.lastname@example.orgRetrospective analysis of immune dysfunctions found in 55 dogs and 62 cats diagnosed with Chronic Fatigue Syndrome (CFS), revealed leukopenia in 11% of dogs (n = 6) and 22.5% of cats (n = 14), lymphopenia in 14.5% of dogs (n = 8) and 10% of cats (n = 6), hypogammaglobulinaemia in 9% of dogs (n = 5) and 13% of cats (n = 8) and thrombocytopenia in 20% of dogs (n = 11) and 68% of cats (n = 42). All patients had creatine kinase enzyme levels above the normal range (CK = 5-100 IU/L) and carried micrococcus-like organisms on erythrocytes. Blood cultures proved positive for Staphylococcus spp. in 16 cases. After low-dosage arsenic-based therapy (thiacetarsamide sodium) all animals experienced complete clinical remission. Subsequent controls demonstrated immune restoration in 4 representative FIV-FeLV negative cats, previously diagnosed with CFS associated with leukopenia, lymphopenia, hypogammaglobulinaemia and thrombocytopenia. The main conclusion is that a CFS-like disease in dogs and cats, characterised by the common hallmarks of high CK levels, absence of known causes of chronic fatigue in animals and presence of micrococcus-like organisms in the blood, can be associated with humoral and/or cellular immune deficiencies in 9-22.5% of cases and with thrombocytopenia in 20-68% of cases. Considerations are made on the possible role of micrococci in the aetiology of the condition and on the similarities with CFS in humans.
PMID: 12688127 [PubMed - indexed for MEDLINE]
1: Int J Immunopathol Pharmacol. 2001 Jan-Apr;14(1):11-15
Chronic fatigue syndrome: circadian rhythm and hypothalamic-pituitary-adrenal (HPA) axis impairment.
Racciatti D, Guagnano MT, Vecchiet J, De Remigis PL, Pizzigallo E, Della Vecchia R, Di Sciascio T, Merlitti D, Sensi S.
Clinic of Infectious Diseases, University of Chieti, Chieti, Italy.Chronic Fatigue Syndrome (CFS) is a clinical condition characterized by a persistent or relapsing debilitating fatigue at rest, lasting more than 6 months, and made worse by exercise. At the present moment, there are three potential etiopathogenic factors: immunologic, viral and neuroendocrine. The purpose of our study was to evaluate possible alterations of the hypothalamic-pituitary-adrenal (HPA) axis in our CFS patients by studying the circadian rhythms of prolactin (PRL), thyrotropic hormone (TSH), adrenocorticotropic hormone (ACTH), and cortisol (CS). A total of 36 patients were enrolled according to the Centers for Disease Control and Prevention case-definition criteria. Twenty healthy subjects were included as controls. Blood samples were taken every 4 hours during a single 24-hour period. We performed a fluorometric enzyme immunoassay with serum PRL, cortisol and TSH, and an immunoradiometric assay with plasma ACTH. The circadian rhythms of PRL, TSH, ACTH and CS were statistically significant in both CFS and control groups. At 24:00 and 04:00 hrs the CFS patients showed lower ACTH levels than healthy subjects (p < 0.001); the PRL levels were higher at 04.00 h in CFS patients than in healthy subjects.
PMID: 12622884 [PubMed - as supplied by publisher]
Neurosci Lett. 2003 Jan 2;335(3):151-4
Relationship between musculoskeletal symptoms and blood markers of oxidative stress in patients with chronic fatigue syndrome.
Vecchiet J, Cipollone F, Falasca K, Mezzetti A, Pizzigallo E, Bucciarelli T, De Laurentis S, Affaitati G, De Cesare D, Giamberardino MA.
Department of Medicine and Science of Aging, G. D'Annunzio University of Chieti, Italy.In 21 patients with chronic fatigue syndrome (CFS) versus 20 normal subjects, we investigated the oxidant/antioxidant balance and its correlation with muscle symptoms. Patients versus controls showed significantly: lower Lag Phase and Vitamin E (Vit E) concentrations in plasma and low-density lipoproteins (LDL), higher LDL thiobarbituric acid reactive substances (TBARS), higher fatigue and lower muscle pain thresholds to electrical stimulation. A significant direct linear correlation was found between fatigue and TBARS, thresholds and Lag Phase, thresholds and Vit E in plasma and LDL. A significant inverse linear correlation was found between fatigue and Lag Phase, fatigue and Vit E, thresholds and TBARS. Increased oxidative stress and decreased antioxidant defenses are related to the extent of symptomatology in CFS, suggesting that antioxidant supplementation might relieve muscle symptoms in the syndrome.
PMID: 12531455 [PubMed - indexed for MEDLINE
1: Postgrad Med J. 2002 Dec;78(926):763; author reply 763
Chronic unexplained fatigue.
Baschetti R. PMID: 12509703 [PubMed - indexed for MEDLINE]
1: Minerva Pediatr. 2002 Dec;54(6):631-7.
[Article in Italian]
De Sanctis V, Mangiagli A, Campisi S, Raiola G.
UO di Pediatria ed Adolscentologia, Arcispedale S. Anna, Ferrara, Italy.Fatigue is defined as a subjective sensation of tiredness or weariness that occurs at rest. The perception of fatigue among 12-15 years-old Italian adolescents in a school survey was about 70%. Generally the symptoms are reported after a viral illness or an infection. In adolescents with persistent or severe fatigue a selected screening evaluation to look for an underlying organic disorder is warranted. A practical diagnostic approach is given and a brief description of chronic fatigue syndrome is reported according to CDC revised diagnostic criteria published in 1997.
PMID: 12388954 [PubMed - indexed for MEDLINE
Clin J Pain. 2002 Jul-Aug;18(4):270-3
Peripheral blood mononuclear cell beta-endorphin concentration is decreased in chronic fatigue syndrome and fibromyalgia but not in depression: preliminary report.
Panerai AE, Vecchiet J, Panzeri P, Meroni P, Scarone S, Pizzigallo E, Giamberardino MA, Sacerdote P.
Department of Pharmacology, Istituto di Ricerca e Cura a Carattere Scientifico, University of Milan, Italy.OBJECTIVE: The aim of this study was to examine the possible role of the immune system in the pathophysiology of chronic fatigue syndrome and fibromyalgia syndrome and in the differential diagnosis of depression by investigating changes in peripheral blood mononuclear cell levels of beta-endorphin, an endogenous opioid known to be involved in regulation of the immune system function. DESIGN: Beta-endorphin concentrations were measured by radioimmunoassay in peripheral blood mononuclear cells from healthy controls (n = 8) and patients with chronic fatigue syndrome (n = 17), fibromyalgia syndrome (n = 5), or depression (n = 10). RESULTS: Beta-endorphin concentrations were significantly lower in patients with chronic fatigue syndrome or fibromyalgia syndrome than in normal subjects and depressed patients (p <0.001 and p <0.01, respectively). They were significantly higher in depressed patients than in controls (p <0.01). CONCLUSIONS: Evaluation of peripheral blood mononuclear cell beta-endorphin concentrations could represent a diagnostic tool for chronic fatigue syndrome and fibromyalgia and help with differential diagnosis of these syndromes versus depression. The results obtained are also consistent with the hypothesis that the immune system is activated in both chronic fatigue syndrome and fibromyalgia syndrome.
PMID: 12131069 [PubMed - indexed for MEDLINE]
1: Recenti Prog Med. 2002 May;93(5):327-34
Alternative tests in the diagnosis of food allergies]
[Article in Italian]
Senna G, Gani F, Leo G, Schiappoli M.
Unità Operativa di Allergologia, Ospedale Civile Maggiore, Verona. email@example.comIn the last years an increase of allergic diseases has been observed whose prevalence is about 20-30% in general population of western countries. However there is a risk of an over diagnosis of allergic diseases as many different diseases (migraine, chronic urticaria, chronic inflammatory bowel diseases, chronic-fatigue syndrome etc.) are considered due to food allergy or intolerance. In many patients the diagnosis is based on the results of alternative diagnostic tests such as the cytotoxic test, the provocation/neutralization sublingual or subcutaneous test, the heart-ear reflex test, the kinesiology, the biorisonance, the electro-acupuncture, and the hair analysis, or on immunological tests (immunocomplex or specific food IgG). We reviewed the scientific evidences of these tests (specificity, sensibility, rationale, reproducibility). According to most studies none of them had to be recommended as useful for the diagnosis of food allergy or intolerance. Physicians should alert patients about the risk of an indiscriminate use of these test in the diagnosis of food allergy. In fact the use of an incorrect diet could be dangerous, particularly in childhood, as recently shown.
PMID: 12050918 [PubMed - indexed for MEDLINE]
1: Minerva Pediatr. 2001 Oct;53(5):383-9.
[Adolescents and the problem of a chronic disease]
[Article in Italian]
De Toni T, Calvillo M.
Istituto G. Gaslini, Dipartimento di Pediatria, Centro di Adolescentologia, Università degli Studi, Genova, Italy. PMID: 11668255 [PubMed - indexed for MEDLINE]
1: Comp Immunol Microbiol Infect Dis. 2001 Oct;24(4):233-46.
Chronic fatigue syndrome (CFS) associated with Staphylococcus spp. bacteremia, responsive to potassium arsenite 0.5% in a veterinary surgeon and his coworking wife, handling with CFS animal cases.
Chronic fatigue syndrome (CFS) in human patients remain a controversial and perplexing condition with emerging zoonotic aspects. Recent advances in human medicine seem to indicate a bacterial etiology and the condition has already been described in horses, dogs, cats and birds of prey in association with micrococci-like organisms in the blood. To evaluate the possibility of a chronic bacteremia, a veterinary surgeon (the author) and his coworking wife, both diagnosed with CFS and meeting the CDC working case definition, were submitted to rapid blood cultures and fresh blood smears investigations. Blood cultures proved Staph-positive and micrococci-like organisms in the blood were repeatedly observed in the 3-year period preceding the arsenical therapy, during which several medicaments, including antibiotics, proved unsuccessful. Following treatment with a low dosage arsenical drug (potassium arsenite 0.5%, im., 1 ml/12 h, for 10 days) both patients experienced complete remission. At the post-treatment control made 1 month later, micrococci had disappeared from the blood, and the CD4/CD8 ratio was raising.
PMID: 11561958 [PubMed - indexed for MEDLINE]
: Lancet. 2001 Jul 21;358(9277):240; author reply 240-1
Lancet. 2001 Mar 17;357(9259):841-7. : Br J Gen Pract. 2001 Jan;51(462):19-24.
Cognitive behaviour therapy for chronic fatigue syndrome.
Baschetti R. PMID: 11480431 [PubMed - indexed for MEDLINE
Cognitive behaviour therapy and chronic fatigue syndrome.
Baschetti R. PMID: 11458489 [PubMed - indexed for MEDLINE
: Comp Immunol Microbiol Infect Dis. 2001 Jul;24(3):165-85.
Chronic Fatigue Syndrome (CFS) in 15 dogs and cats with specific biochemical and microbiological anomalies.
firstname.lastname@example.orgA great deal of controversy and speculation surrounds the etiology of Chronic Fatigue Syndrome (CFS) in human patients and the existence of a similar illness in animals. To evaluate the association with a presumptive staphylococcal infection and bacteremia, seven dogs and eight cats diagnosed with CFS (two meeting the CDC working case definition) were submitted to rapid blood cultures and fresh blood smears investigations. Nine out of 15 blood cultures proved Staph-positive and four isolates were specified as S. xilosus (3) and S. intermedius (1). The presence of micrococci-like organisms in the blood was of common observation among these subjects, in association with fatigue/pain-related symptoms and biochemical abnormalities suggestive of a myopathy. Following treatment with a low dosage arsenical drug (thiacetarsamide sodium, Caparsolate, i.v., 0.1 ml/kg/day) all patients experienced complete remission. Micrococci disappeared from the blood at post-treatment controls made 10-30 days later. The outcomes were compared with those of five healthy controls and five 'sick with other illness' patients showing significant difference.
PMID: 11440190 [PubMed - indexed for MEDLINE
1: Arch Intern Med. 2001 Jun 25;161(12):1558-9
Chronic fatigue syndrome, decreased exercise capacity, and adrenal insufficiency.
PMID: 11427109 [PubMed - indexed for MEDLINE
JAMA. 2001 Mar 21;285(11):1441-2; author reply 1443.
Comment on: JAMA. 1996 Feb 7;275(5):359; author reply 360. JAMA. 2001 Jan 3;285(1):52-9.
Orthostatic hypotension and chronic fatigue syndrome.
Baschetti R. PMID: 11255414 [PubMed - indexed for MEDLINE]
1: Comp Immunol Microbiol Infect Dis. 2001 Jan;24(1):57-70
Chronic fatigue syndrome in horses: diagnosis and treatment of 4 cases
Veterinary Surgeon, Castiglione del Lago, Perugia, Italy.A report from England has suggested that Chronic Fatigue Syndrome exists in equines and constitutes an emerging veterinary problem. Preliminary epidemiological studies seem to confirm the zoonotic implications of CFS. An arsenical drug, sodium thiacetarsamide, was administered to four horses with a diagnosis of Chronic Fatigue Syndrome (CFS), already treated unsuccessfully with different medications. The CFS-like lethargy, with accompanying symptoms and signs, of the four animals obtained a complete remission after intravenous treatment with this drug at low dosage (0.1 mg/kg/day). No adverse side effects were ever noticed. This clinical response was associated with recovery from anaemia and decrease of muscular enzyme values in two of the four horses. In all patients, micrococci-like bacteria found before treatment adhering to the outer surface of many red blood cells, disappeared at post-treatment controls. Considerations are made on the possible action of an arsenical drug, used in isolation, in the treatment of CFS.
PMID: 11131041 [PubMed - indexed for MEDLINE]
1: Arch Intern Med. 1999 Nov 8;159(20):2481; author reply 2482-3.
Comment on: Arch Intern Med. 1999 Apr 26;159(8):777-85.
Fibromyalgia, chronic fatigue syndrome, and Addison disease.
Baschetti R. PMID: 10665898 [PubMed - indexed for MEDLINE]
1: Horm Metab Res. 1999 Jul;31(7):439.
Comment on: Horm Metab Res. 1999 Jan;31(1):18-21.
Overlap of chronic fatigue syndrome with primary adrenocortical insufficiency.
PMID: 10450837 [PubMed - indexed for MEDLINE
1: N Z Med J. 1999 Jun 25;112(1090):242
Comment on: N Z Med J. 1999 Mar 26;112(1084):104-5.
Chronic fatigue syndrome.
PMID: 10449006 [PubMed - indexed for MEDLINE]
1: J Clin Endocrinol Metab. 1999 Jun;84(6):2263-4.
Investigations of hydrocortisone and fludrocortisone in the treatment of chronic fatigue syndrome.
PMID: 10372750 [PubMed - indexed for MEDLINE
1: J Intern Med. 1999 Apr;245(4):409-10
Comment in: J Intern Med. 1999 Apr;245(4):410-2.
Comment on: J Intern Med. 1997 Dec;242(6):465-78.
Cortisol deficiency may account for elevated apoptotic cell population in patients with chronic fatigue syndrome.
Baschetti R. PMID: 10356605 [PubMed - indexed for MEDLINE
1: JAMA. 1999 May 26;281(20):1887; author reply 1888-9.
Comment on: JAMA. 1998 Sep 23-30;280(12):1061-6.
Low-dose hydrocortisone for chronic fatigue syndrome.
Baschetti R. PMID: 10349884 [PubMed - indexed for MEDLINE]
1: Lancet. 1999 May 8;353(9164):1618; author reply 1619-20
Comment on: Lancet. 1999 Feb 6;353(9151):455-8.
Hydrocortisone and chronic fatigue syndrome.
Baschetti R. PMID: 10334276 [PubMed - indexed for MEDLINE]
1: Postgrad Med J. 1998 Nov;74(877):701.
Comment on: Postgrad Med J. 1998 Apr;74(870):229-32.
Chronic fatigue syndrome.
Baschetti R. PMID: 10197206 [PubMed - indexed for MEDLINE
1: CMAJ. 1999 Mar 9;160(5):636, 638.
Comment on: CMAJ. 1998 Sep 8;159(5):519-20. CMAJ. 1998 Sep 8;159(5):533-4. CMAJ. 1998 Sep 8;159(5):537-41.
What causes chronic fatigue?
Baschetti R. PMID: 10101996 [PubMed - indexed for MEDLINE
1: N Z Med J. 1999 Feb 26;112(1082):58-9.
Comment on: N Z Med J. 1998 Oct 23;111(1076):410-2.
Psychological factors and chronic fatigue syndrome.
Baschetti R. PMID: 10091899 [PubMed - indexed for MEDLINE]
1: Clin Sci (Lond). 1999 Jan;96(1):117-25.
Comment in: Clin Sci (Lond). 1999 Sep;97(3):319-22.
Chronic fatigue syndrome: a hypothesis focusing on the autonomic nervous system.
Pagani M, Lucini D.
Centro Ricerca Terapia Neurovegetativa, Ospedale L. Sacco, University of Milan, Via G.B. Grassi, 74, 20157 Milan, Italy.
Chronic fatigue syndrome is a debilitating illness of unknown aetiology, with estimated levels of prevalence of up to about 8. 7/100 000 in the U.S.A. Like pain fatigue it is a personal, emotionally rich experience, which may originate from peripheral or central sites (or both). The nature of the symptoms is complex and reflects the interaction of the patient with the environment and cultural milieu. Accordingly the common use of the same terminology for different types of fatigue may be misleading. Autonomic activation is a key component of both real and simulated physical exercise. Alterations in autonomic nervous system activity are a key component of several physiopathological conditions. In chronic fatigue syndrome disturbances in autonomic activity, and in other homoeostatic mechanisms, such as the hormonal and immune systems, have been reported recently. In this review we followed the hypothesis that in chronic fatigue syndrome the paradoxical condition of disturbing somatic symptoms in the absence of organic evidence of disease might be addressed by focusing on attending functional correlates. In particular we addressed possible alterations in cardiovascular autonomic control, as can be assessed by spectral analysis of R-R interval and systolic arterial pressure variability. With this approach, in subjects complaining of unexplained fatigue, we obtained data suggesting a condition of prevailing sympathetic modulation of the sino-atrial node at rest, and reduced responsiveness to excitatory stimuli. Far from considering the issue resolved, we propose that in the context of the multiple physiological and psychological interactions involved in the perception and self-reporting of symptoms, attendant changes in physiological equivalents might furnish a convenient assessment independent from subjective components. Indices of sympathetic modulation could, accordingly, provide quantifiable signs of the interaction between subject's efforts and environmental demands, independently of self descriptions, which could provide convenient measurable outcomes, both for diagnosis and treatment titration in chronic fatigue syndrome.
PMID: 9857114 [PubMed - indexed for MEDLINE]
1: Clin Exp Rheumatol. 1998 Nov-Dec;16(6):729-32.
Decreased immunoreactive beta-endorphin in mononuclear leucocytes from patients with chronic fatigue syndrome.
Conti F, Pittoni V, Sacerdote P, Priori R, Meroni PL, Valesini G.
Istituto di Clinica Medica I, Università degli Studi di Roma La Sapienza, Rome, Italy.OBJECTIVE: To investigate beta-endorphin concentrations in the peripheral blood mononuclear cells (PBMC) of patients with chronic fatigue syndrome (CFS). METHODS: Sixteen patients with CFS were enrolled in this study. Ten healthy subjects were studied as controls. Beta-endorphin concentrations were measured in PBMC by radioimmunoassay performed with antibodies specific for the C-terminal portion of human beta-endorphin. RESULTS: Beta-endorphin concentrations in the PBMC of chronic fatigue patients were significantly lower (p < 0.001) than in healthy subjects (mean +/- SD: 8.5 +/- 7.0 vs. 42.6 +/- 22.6). CONCLUSION: Patients with CFS were found to have low levels of PBMC beta-endorphin. This finding may reflect the condition of chronic immune activation in CFS that has been reported in previous investigations. Beta-endorphin concentrations in PBMC seem to mirror the central nervous system homeostasis of the opioid. Therefore, we would postulate that the fatigue and weakness typical of CFS could be related to low beta-endorphin concentrations at the central nervous system level.
PMID: 9844768 [PubMed - indexed for MEDLINE]
1: Arch Intern Med. 1998 Nov 9;158(20):2266-7
Comment on: Arch Intern Med. 1998 Apr 27;158(8):908-14.
Treatment for chronic fa
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