Experience of severe fatigue in long-term survivors of stem cell transplantation.

The literature suggests that cancer survivors with more aggressive treatments are more at risk for postcancer fatigue. In this study, we investigated the prevalence of fatigue after completion of stem cell transplantation (SCT). Furthermore, we studied if medical variables are associated with fatigue and if the model of perpetuating factors of postcancer fatigue derived from previous studies in cancer survivors, without SCT, is applicable in SCT survivors. Ninety-eight patients treated with autologous or allogeneic SCT filled out several questionnaires. Medical characteristics were obtained from the medical charts. All patients had to be in persistent complete remission for at least 1 year. Thirty-five per cent of the patients experienced severe fatigue. The percentage of patients with severe fatigue remained stable during the years after transplantation. Several psychosocial factors, but no medical factors, were associated with fatigue. The model of perpetuating factors appeared to be applicable. Contrary to cancer survivors without SCT, we found no decrease in fatigue complaints during the first years after SCT. Cognitive behaviour therapy (CBT) is a general form of psychotherapy directed at changing condition-related cognitions and behaviours. CBT especially designed for postcancer fatigue, aimed at perpetuating factors, can also be used to manage fatigue in cancer survivors treated with SCT.

Effects of torsions in the wrist joint on carpal-bone behaviour and the radiotriquetral ligaments: an experimental study.

The orientations of the radiotriquetral ligaments in the wrist joint suggest the role of counteracting torsions in the radiocarpal joint. This is tested in a series of kinematic experiments with three specimens, the joints being forced to rotate about the longitudinal axis of the third metacarpal. The reorientations of the marked insertion sites of the dorsal and palmar radiotriquetral ligaments are assessed and related to the individual carpal-bone movements. The three specimens react similarly to the imposed torsions: a hyperpronation is related to a dorsal flexion and a hypersupination to a palmar flexion. The dorsal radiotriquetral ligaments are highly addressed during hypersupination, but the palmar ligaments show no significant elongations during hyperpronations. The mechanism of wrist joint injuries due to trauma like a fall on the outstretched hand is poorly documented. The torsions occurring during these trauma are simulated in cadaver experiments. Large effects upon the dorsal ligaments are found in comparison to the palmar ligaments. This indicates that the palmar radiotriquetral ligaments protect the joint against hyperpronations. Planning of the restoration of hand function in the injured hand should include the different roles of these two ligaments.