Symptoms Of Asthenia Research Articles

DEPRESSION AND CANCER

The study included 100 patients from 25 to 75 years. Out of them women were 60, Men- 40, surgery had only 45 patients, chemotherapy 16. 4 After radiation therapy, combined therapy - 35 patients. 6 were Suffering from lung cancer, 22 -breast cancer, skin cancer -6, 7 -gastric cancer, prostate and bladder cancer -4 patients , 15- ovarian cancer . The uteruscancer-25, from 100 patients 20% was suffering from mild depression , The average - 44%., Severe - 35%. without depression -1%. Suicidal taught was detected in 45% of surveyed patients, a panic or somatic -vegetatic disorders -79% (headache, dizziness, palpitations, and weakness). A large part of the patients, 80% complained of sleep disturbance (difficulty in sleeping, in the middle of the night awakening, early awakening), some of the symptoms of asthenia was found in 56%. psychological rehabilitation centers for cancer patients is necessary to establish on a base of oncology clinics. Professional psychological help will improve oncology patients 'quality of life'.Cancer patients diagnosed with major depression may benefit from a combined modality approach that includes both psychosocial and pharmacologic interventions. Psychosocial treatment approaches that may be of value include those that provide information and support and those that address any combination of emotional, cognitive, and behavioral factors.

Severity of tricuspid regurgitation (TR) only based in echo parameters? The failure of guidelines. The 4A in patients with significant TR as a new clinical score to evaluate patients with TR

Abstract Background Significant Tricuspid Regurgitation (TR) is associated with increased morbi-mortality. Symptoms due to TR are often insidious and not always characterized by dyspnea. Identification of symptoms and optimal timing for intervention is challenging and intervention is often preformed late. A more specific clinical classification focused on the detection of systemic congestion may help identify those who may benefit from an earlier intervention. Purpose To evaluate the prognostic impact of a new proposed “4A” clinical score: Asthenia, Ankle swelling, Abdominal pain or distention and/or Anorexia, in patients with significant TR. Methods Consecutive patients in stable clinical condition evaluated in the Heart Valve Clinic with significant TR (moderate to severe, severe, massive or torrential TR) were included. Signs and symptoms of Asthenia, Ankle swelling, Abdominal pain or distention and/or Anorexia (“4A score”) where registered, follow up was performed every 6 months. The 4A clinical score ranged from 0 (no A) to 4 (all four A's present). The difference in the 4A score between the first and last visit was determined. A combined endpoint of hospital admission due to right heart failure and cardiovascular mortality was defined. Results 86 patients were included in this study (age 76±11 years, 70% female, 87% functional TR). At first visit, 92% were in NYHA class I or II and 77% had a 0 or 1 “4A score”. After a median follow-up of 24 months (IQR: 11–35 months), “4A score” was significantly impaired (score mean difference: 0.42±0.8) and only 59% remained with a 0 or 1 “4A score”. 32.6% of the patients (n=28) experienced the combined endpoint. The change in 4A score was a significant predictor of events (hazard ratio per unit 1.88 [1.22–2.88], p=0.004) Conclusion We demonstrate for the first time a new clinical score predictive of right heart failure and death in patients with significant TR. Funding Acknowledgement Type of funding sources: None.

Efficacy and safety of Mildronate in treatment of postinfectious asthenic syndrome (clinical examples)

Asthenic syndrome is a non‑specific syndrome that is often found in general medical practice in patients with various somatic pathologies both during an exacerbation of a chronic disease, and after an acute process. The leading symptoms in the clinic of asthenia are pathological weakness and fatigue. According to various researchers, they are found in 15–45 % of people. To date, there is no universally accepted definition and clear classification of this syndrome. The main pathogenetic concepts are the psychosocial, infectious‑immune theory of asthenia. The development of asthenic syndrome in patients with somatic pathology may be associated with the depletion of the functional capabilities of the nervous system due to disturbances in the blood supply to the brain, auto‑toxicity or exposure to exogenous toxic factors in bacterial, viral infections. There is no specific treatment for this condition. This article presents two clinical cases of the development of post‑infection asthenic syndrome in a 47‑year‑old patient against community‑acquired pneumonia and in a 36‑year‑old patient after an acute respiratory‑viral infection of moderate severity. In both cases, drug treatment with Mildronate was carried out with a positive trend in the form of regression of asthenia symptoms, side effects during treatment. Mildronate belongs to the class of cytoprotectors – antihypoxants, activates glycolysis and prevents impaired transport of adenosine triphosphate, providing a sufficient level of energy synthesis, which allows cells to maintain homeostasis and morphological integrity. The immunoadjuvant properties of Mildronate are very important in post‑infectious asthenic syndrome, since a violation of the immune response plays a central role in its pathogenesis. The immunoadjuvant properties of Mildronate have been discovered in a number of studies.

Treatment of multiple sclerosis patients with sleep disorders associated with anxiety

Sleep disorders (SD) have a crucial impact on enhancement of disability and decreasing quality of life alongside with motor, cognitive and psycho-emotional disorders in patients suffering from multiple sclerosis (MS). The aim of our study was to determine efficiency of treatment of MS patients suffering from sleep disorders associated with anxiety and evaluation of possible medication’s effect on fatigue severity, cognitive impairment and asthenia features among participants. Twenty patients enrolled in the current study were suffering from MS with relapsing-remitting and secondary-progressive types (mean age 43,7 ± 8,9; disease duration 11,3 ± 7,6) and had sleep disorders of different severity associated with anxiety. The following questionnaires were applied in the study: The Pittsburgh Sleep Quality Index (PSQI), Hamilton Anxiety Rating Scale (HAM-A), The Montreal Cognitive Assessment (MoCA), Modified Fatigue Impact Scale (MFIS), Asthenic State Scale (ШАС). According to results of the Pittsburgh Sleep Quality Index 10% of participants had mild sleep disorders, 35% had moderate and 55% had severe. Based on HAM-A results 30% had mild, 25% had mild and 45% had severe anxiety. A drug Valeo-Dorm Duo (kryzin, melatonin) was applied for treatment. The dynamics of sleep quality, anxiety, cognitive impairment and asthenia indicators during the treatment were evaluated with the use of corresponding scales. A significant improvement of sleep quality was found in 70% of patients after treatment, as well as decreased level of anxiety in 45% to mild and in 55% to moderate according to HAM-A scale. Applying of Valeo-Dorm Duo proved to be effective in cases of treatment of patients suffering from a combination of sleep disorders with anxiety. It prompted sleep normalization and decreasing of anxiety and asthenia symptoms, thus the treatment improved quality of life of these patients.

Sleep disorder and its correction for patients with discirculatory encephalopathy

The paper presents a comprehensive clinical, neurological, psychodiagnostic and neurophysiological study results of the Valeo-Dorm Duo drug use for 30 patients (average age 46.9 ± 2.3 years) with initial stages of discirculatory encephalopathy to correct the symptoms of insomnia, anxiety and asthenic syndrome. The Valeo-Dorm Duo drug was taken for two months simultaneously with the basic therapy; there was a 14 days break between the months of admission. A comparative analysis with a control group (30 people) who received only basic symptomatic therapy is carried out. The study design includes a comprehensive examination of all patients before the start of therapy, one month and two months after the start of treatment. It is shown that the combined use of Relax capsules in the daytime and Sleep capsules in the evening complement each other's effects, influencing the different parts of insomnia pathogenesis. The effectiveness of Valeo-Dorm Duo drug appears as an improvement of subjective night sleep indicators, a decrease of daytime sleepiness, and a declined severity of anxiety manifestations and asthenia symptoms during the first month of therapy, while the stable positive dynamics maintain until the end of treatment. According to an objective night sleep assessment using polysomnography, by the end of the treatment course, patients taking Valeo-Dorm Duo had a statistically significant reduction of the falling asleep process duration and the length and percentage of the REM phase increased; the delta sleep and slow wave sleep episodes in general have become longer too; cyclic sleep organization has recovered; the total duration of sleep increased, what resulted in the high rates of the night sleep efficiency index.

Вариабельность ритма сердца в покое и разнонаправленных нагрузочных пробах у молодых мужчин

The article presents the study of 105 healthy young men 18 - 25 years. The aim of the study is to assess the state of autonomic regulation of sinus heart rhythm in young men: conscripts, students and cadets. Methods: the therapeutic examination, Vein Questionnaire, asthenic scale, hospital anxiety and depression scale HADS, and visual analogue pain scale, high - resolution rhythmocardiography at rest and mixed autonomic stress testing. Results: rhythmocardiography at rest showed longer RR - intervals in the group of cadets, which testifies to their greater physical aptitude. Among conscripts significantly lower heart rate variability and amplitude of respiratory arrhythmia at rest and in the Valsalva - Burker maneuver. Students showed more scores on the anxiety and depression scales, more symptoms of asthenia and autonomic dysfunction, headache and back pain. Cadets had no disorders of psycho - emotional and autonomic status, rhythmocardiography showed a high level of physical fitness and good adaptive capacity.

Influence of Adamantilbromphenylamine on Parameters of Immunity and Symptoms of Asthenia in Patients with Non-Psychotic Mental Disorders

Our aim was to assess effect of antiasthenic drug adamantilbromphenylamine on the immune system and symptoms of asthenia in patients with non-psychotic mental disorders and to reveal possible criteria for prediction of treatment efficiency. Uncontrolled study with interrupted time series was carried out. According to efficiency of treatment patients were divided into two groups (group 1 (n=21)--very much improved and much improved; group 2 (n=9)--minimally improved). Adamantilbromphenylamine was administered to patients as a monotherapy 100 mg a day for 28 days. Examination was conducted before and after therapy. Severity of asthenic symptoms according to MFI-20 scale was identified; cellular and humoral immunity parameters, mitogen-induced production of interleukins (IL) 1β and IL 4 by immunocompetent cells of patients were assessed. 30 patients with non-psychotic mental disorders with predominance of asthenic symptomatology in clinical picture of the disease were examined. Before therapy every proband had over 60 points across 5 items of MFI-20 scale. As compared with control decrease of number of lymphocytes of CD3+-, HLA-DR+, CD16+-phenotypes; increase in the ratio of CD4+/CD8+; concentration of serum IgM; phagocytic activity of neutrophils were revealed. In the end of therapy in group 1, sum total of points of asthenia decreased up to 26(23-37) (p<0.001); in group 2--up to 57(47-61). Only in group 1 positive dynamic of immune parameters was revealed. It was shown that baseline level of proinflammatory cytokine IL 1β in group with apparent therapeutic effect of the drug was reliably lower, than in group with minimal improvement (p=0.005). These differences remained also after course of therapy (p=0.042). Interrelationship of clinical-immunological effect of adamantilbromphenylamine has been revealed; intensity of production of IL 1β may be considered as a criterion of prognosis of efficiency of treatment with adamantilbromphenylamine in patients with non-psychotic mental disorders.

The symptoms of pathological fatigue, apathy, and depression in patients after stroke

Objective: to comparatively analyze the rate and correlation of the symptoms of pathological fatigue, apathy, and depression in patients in the termination phase of an acute stroke period. Patients and methods. The symptoms of asthenia (pathological fatigue), apathy, and depression were comparatively investigated in 105 patients at 3–4 weeks after stroke. The fatigue rating scale, apathy rating scale, and hospital anxiety and depression (HAD) scale were used to evaluate the symptoms of pathological fatigue, apathy, and depression. The level of anxiety was also estimated using the appropriate HAD subscale and the Epworth daytime sleepiness scale; the magnitude of cognitive impairments was judged from the Montreal cognitive assessment. The type, basin, and recurrence of stroke were registered. The severity of neurological deficit was evaluated using the U.S. National Institutes of Health Stroke Scale (NIHSS); limited functional capacities were estimated by the modified Rankin scale (mRS). The presence of prestroke fatigue was also determined. Results and discussion. The symptoms of asthenia were observed in 56% of the patients and associated with the severity of poststroke disability. The symptoms of apathy were detected in 10.5% of the patients; those of depression were present in 18% and determined by the magnitude of neurological deficit and the degree of poststroke disability and cognitive impairments. All the three phenomena were correlated with the magnitude of anxiety, daytime sleepiness, and between them. This suggests that they may complicate a reciprocal course in some cases. The symptoms of depression, asthenia, and apathy may also develop on their own, which is borne out by their different rates and correlations. Each of these phenomena requires an individual approach to diagnosis and treatment. Conclusion. The symptoms of pathological fatigue are most common and least specific in patients with mild poststroke neurological deficit. Apathy may be also associated with depression or develop on its own. Further investigation of mechanisms for the development of poststroke pathological fatigue and apathy is important for developing effective methods to correct these abnormalities.

Asthenia in adolescents with attention deficit disorder and their treatment

To study asthenia in adolescents with attention deficit hyperactivity disorder (ADHD) and assess the efficacy of nooclerin. We examined 60 patients, aged from 12 to 15 years, with ADHD. A comparative analysis of ADHD demonstrated the predominance of an inattentive type (ADHD-I) and a combined type (ADHD-C). Symptoms of asthenia were found in 56% of adolescents with ADHD-C and in 96.7% with ADHD-I. The high efficacy and safety of nooclerin in the treatment of ADHD was demonstrated. The improvement of mental state was achieved in 76.7% of patients with ADHD-I and in 53.3% patients with ADHD-C.

Post-thyroidectomy chronic asthenia: self-deception or disease?

There is clinical evidence that post-total thyroidectomy (TT) patients can present persistent asthenia. The aim of this study was to evaluate the prevalence of asthenia symptoms in such patients, assess whether a chronic asthenia syndrome could be caused by TT or become evident after it. An observational study was carried out comparing two groups of 100 patients each, all with homogeneous characteristics. Group A was treated with total lobectomy (TL), Group B with TT. All patients presented normal thyroid hormone levels. The patients were interviewed in order to identify the ones affected by post-operative asthenia persisting for at least six months, with reduced ability to perform physical and mental work, not showing improvement with rest. The severity of the symptoms has been measured by means of the brief fatigue inventory (BFI). Statistical analysis was performed to evaluate statistically significative differences between groups and prognostic factors in TT group. The incidence of post-operative asthenia was 0% after TL and 25% after TT, with the operation being the only significant variable. Asthenia is well known as symptom of post-thyroidectomy, but it has not been adequately investigated as consequence of surgery. We demonstrated that the complete removal of the thyroid gland could determine chronic post-thyroidectomy asthenia, although with intensity limited to low/moderate. Post-thyroidectomy asthenia is a relevant sequela interfering with quality of life of at least 25% of patients operated, suggesting the need to identify its real causes and limit the indication to TT only when strictly required.

EPA-0293 – Peculiarities of therapy of endogenous depressive disorders with anxious symptoms

In order to work out therapeutic tactics for treatment of depressive disorders with anxious symptoms 44 patients were examined. It was performed a correlation analysis between parameters of anxiety with clinical-psychopathological and pathopsychological parameters. It was found out that a general anxiety of patients was connected with a situational and personality anxiety (0.34 and 0.44 correspondingly), with its affective and somatic components (0.86 and 0.98 correspondingly), phobic and asthenia symptoms (0.35), emotional discomfort (0.34) and social defense reaction (0.33). Thus, a high anxiety level was determined by an experience of various fears and an emotional discomfort, and was connected with a high level of a situational and personality anxiety. The therapeutic tactics should to be built taking into account above mentioned peculiarities of manifestation of anxiety in the structure of endogenous depressive disorders. From the very beginning of treatment the therapy should be integrated and should include pharmacotherapy (antidepressants and anti-anxious medications) and psychotherapy (the cognitive-behavioral psychotherapy). We developed and approbated an integrative approach which included 3 stages of correction: sedative-maintaining (1 week), treatmentstabilizing (3–4 weeks), and adjustment-preventive (6–8 weeks). An assessment of efficacy of this treatment approach indicated that 72.72 % of the patients had got a recovery or a significant improvement and 27.28 % of the patients had got an improvement.

Treatment of asthenic syndrome in patients with chronic brain ischemia: results of the non-interventional observational program TRIUMPH

To assess the severity of asthenic syndrome (AS) in chronic brain ischemia (CBI) in primary health care settings. The study included 1170 patients with brain ischemia, aged 45-65 years, treated with phenotropil in dose 100 mg during 2 and 3 months. Clinical examination and MFI-20 subscales were administered. RESULTS AND СONCLUSION: The high incidence of asthenic syndrome was observed across all MFI-20 subscales. The decrease in asthenic syndrome severity was significant already in the end of the first month of treatment with phenotropil. Such dynamics maintained to the end of the second and third month of treatment. More than 2-fold decrease in the severity of asthenia symptoms was achieved in all subgroups 3 months after treatment. More rapid and apparent decrease in asthenic syndrome was observed in younger patients.

Desviación traqueal en radiografía de tórax

Tracheal curvature in chest X-ray A 67 year old male patient sought medical attention at a primary health centre with symptoms of asthenia, anorexia, progressive weight loss, along with dyspnea upon slight exertion. He did not show symptoms of heart failure, did not present dysphagia or dysphonia and did not have fever. In a simple chest X-ray, compression and right curvature of the tracheal air column and discreet overinflation of both lung fields could be seen. An ultrasound scan was carried out at the health centre and intrathoracic goitre was visible. No other alterations in the mediastinum were found.

A case report of type 2 diabetes mellitus with biatrial thrombi and pulmonary embolism caused by atrial fibrillation: successful treatment with anticoagulant therapy

A 75-year-old woman with a history of type 2 diabetes mellitus was admitted to our hospital with symptoms of asthenia. Laboratory results demonstrated a severe inflammatory response, abnormal kidney function, and hyperglycemia. Electrocardiography revealed atrial fibrillation. The patient was treated with antibiotics and insulin injection upon admission, and laboratory data relating to inflammation, kidney, and blood glucose level gradually improved. On the 4th day of hospitalization, chest contrast-enhanced computed tomography showed the existence of masses in both atria and the right pulmonary artery. The differential diagnosis of the left atrial mass included a thrombus and a neoplasm, such as an atrial myxoma. Because surgical removal of the masses, presumed to be thrombi, was declined by the patient, anticoagulation therapy (heparin i.v. followed by warfarin) was initiated. After 12 months of anticoagulation therapy, the masses disappeared completely without systemic embolization.

Primary melanoma of the adrenal gland: a case report and review of the literature

BackgroundPrimary melanoma of the adrenal gland is exceptionally rare as demonstrated by the few cases reported in the medical literature, and it has a high fatality rate. We present the case of a patient with two relapses and survival to date.Case reportWe describe the case of a 58-year-old Caucasian woman who consulted her doctor with symptoms of asthenia, anorexia and weight loss. A mass was palpated in her abdomen at the height of the left hypochondrium. A computed tomographic scan revealed a retroperitoneal mass measuring 10 cm × 15 cm originating in the left adrenal gland. A left nephroadrenalectomy and splenectomy were performed. Histopathologically, the retroperitoneal mass corresponded to a melanoma, and no primary melanoma was found in any other location. The patient was treated with interferon-α-2b. Three years after her diagnosis the patient presented with a retroperitoneal relapse of the mass measuring 7.2 cm, which was removed. Five years after the first relapse a new retroperitoneal relapse mass was diagnosed, which was also removed. Since then the patient has been healthy and free from illness.ConclusionHistological and immunohistochemical studies, together with the criteria described by Ainsworth et al. and Carstens et al., allowed us to diagnose primary melanoma of the adrenal gland.

Characteristics of disturbances of intercortical and cortical-subcortical integration in various clinical forms of neurotic depression

Cross-correlation, coherent, and factor analyses of the EEG were used to detect disturbances of spatial organization of brain bioelectric activity, with certain specific features determined by concomitant anxiety and asthenia syndromes in 20 patients with various clinical forms of neurotic depression. In the group of patients with dominance of the depressive syndrome without marked symptoms of asthenia or anxiety, opposite changes in the anterior areas of the right and left hemispheres were found; the interregional relationships of the EEG of anterior areas of the right hemisphere were decreased as compared to the norm, while the normal level of systemic interaction of bioelectric potentials of the cortex of the left hemisphere was increased. In patients with the depressive syndrome combined with increased anxiety, as well as in patients with distinct asthenic symptoms, a considerable decrease in the level of interregional interactions of bioelectric potentials in frontal regions of the cortex of both hemispheres was detected. This was accompanied by an increase, as compared to the norm, of the level of distant relationships of the EEG in posterotemporal, parietal, and occipital regions. The data indicate that, in the case of neurotic depression, irrespective of concomitant anxiety and asthenia syndromes, there is transient inhibition of the functional activity of frontal regions along with an increased rigidity of systemic interactions of the posterior regions of the cortex of both hemispheres. This suggests that neurotic depression is accompanied by dysfunction of intercortical and cortical-subcortical integration, which causes a disturbance of the systemic organization of ordered interactions of the activity of the anterior and posterior regions of both hemispheres, with certain specific features in patients of each group.

Conjugated Linoleic Acid-Induced Toxic Hepatitis: First Case Report

A 46-year-old female patient was referred to our department with presenting symptoms of asthenia, jaundice, and pruritus. There was no medical history or clinical evidence of viral hepatitis, autoimmune hepatitis, hemochromatosis, or Wilson's disease. The patient revealed that 14 days prior to admission she had begun self-medicating with conjugated linoleic acid (CLA) to reduce body fat, leading to the suspicion of CLA hepatotoxicity, which was subsequently confirmed by a liver biopsy. After the patient ceased to ingest CLA, liver enzymes levels normalized. To the best of our knowledge, this is the first report of hepatotoxicity due to CLA ingestion.

A combination therapy with fludarabine, mitoxantrone and rituximab induces complete immunophenotypical remission in B-cell prolymphocytic leukaemia

Dear Editor, We present here the cases of two patients with B-cell prolymphocytic leukaemia (B-PLL), both expressing a translocation t(8;14)(q24;q32) with rearrangement of cmyc gene found in FISH analysis. A treatment protocol that includes six cycles of Fludarabine and Mitoxantrone followed by four injections of Rituximab allows obtaining complete cytological and immunophenotypical remission. B-PLL is a rare disease that accounts for less than 2% of chronic lymphatic leukaemia (CLL). The characteristics of the disease include high lymphocytosis, over 4 Gigas/L, with at least 55% cells described as prolymphocytes and splenomegaly. The prolymphocytes are medium-sized cells with prominent, round or oval nuclei and a single, central nucleolus [1]. Bone marrow aspirate shows a heavy infiltration by prolymphocytes with a variable degree of residual haematopoiesis. Immunophenotypically, there is a strong expression of the B-cell antigens CD19, CD20, CD21, CD79b and FMC7 and of surface IgM, whereas CD23 is negative and CD5 is variably expressed [1]. In cytogenetic studies, the implication of the 14q32 region of the chromosome 14 is found in 50% of the cases [1]. Translocation (11;14) is present in 25% of the cases, in particular t(11;14)(q13;q32) with a rearrangement of bcl1 protein. Other partners for the IgH gene of the 14q32 region of chromosome 14 could be genes from the regions 11q23 and 13q14 [1]. A translocation (8;14)(q24;q32) typically exists in type 3, B-cell acute lymphoblastic leukaemia and Burkitt lymphomas. This anomaly, which also involves cmyc, was found in only a few cases [2, 3]. B-PLL is not treated when asymptomatic or there are no signs of bone marrow deficiency. Treatment options are various, including combination chemotherapies with alkylating agents or purine nucleoside analogues as monotherapy. Monoclonal antibodies such as Rituximab and Alemtuzumab are also used. A 63-year-old man was first seen in October 2006 with symptoms of asthenia and dyspnoea. A physical examination revealed a splenomegaly grade 3 and lymphadenopathy. The blood count showed a significant anaemia (Hb 5,4g/dL), thrombocytopenia (108 Gigas/L) and a hyperleukocytosis at 247Gigas/L with 92% abnormal circulating lymphocytes, which presented the typical morphology and phenotype of B-PLL. Genetic studies revealed a complex caryotype (Fig. 1), involving a translocation t(8;14)(q24;q32) with a rearrangement of c-myc, confirmed by fluorescence in situ hybridisation analysis (Fig. 2). Ann Hematol (2009) 88:85–88 DOI 10.1007/s00277-008-0541-5

Pediatric Jejunal Gastrointestinal Stromal Tumor Diagnosed by Wireless Capsule Endoscopy

Pediatric Jejunal Gastrointestinal Stromal Tumor Diagnosed by Wireless Capsule Endoscopy

Placebo-controlled trial to evaluate zidovudine in treatment of human immunodeficiency virus infection in asymptomatic patients with hemophilia. NHF-ACTG 036 Study Group

One hundred ninety-three asymptomatic patients with hereditary coagulation disorders and human immunodeficiency virus (HIV) infection were studied in a controlled trial of zidovudine (ZDV) versus a placebo (with an average of 9.7 months on study). Pretreatment characteristics were well balanced between the placebo and drug-treated groups, including CD4 distributions, types of clotting disorders, transaminase abnormalities, and use of various hemostatic agents. At the time of analysis, 161 patients either were still receiving treatment or had previously reached an endpoint of disease progression while receiving treatment. Twenty-five patients withdrew voluntarily. The toxic effects noted included granulocytopenia and anemia, especially in older patients, and subjective symptoms of asthenia, malaise, and nausea, consistent with the known consequences of treatment with 300 mg ZDV five times daily. There was a trend toward more diagnoses of acquired immunodeficiency syndrome (AIDS), advanced or early AIDS-related complex (ARC), single ARC symptoms, or death in placebo recipients as compared with those receiving ZDV (22 v 13). Because older patients with hemophilia have more rapid disease progression, the same efficacy analysis was performed in the 89 patients aged more than 30 years who were receiving treatment. In this subgroup, there was a similar trend (11 v 6). With regard to the most advanced problems of the infection among the older patients, there were five patients who were newly diagnosed with AIDS or died in the placebo group versus none in the ZDV group (P = .02) among the older patients. The pretreatment distribution of CD4 counts for the placebo and ZDV groups were similar, but patients aged more than 30 years had significantly (P less than .049) fewer CD4 cells than patients aged less than 30 years. A beneficial ZDV effect is also supported by a trend toward higher CD4 counts (a 48-cell increase in the ZDV group at 24 weeks as compared with a four-cell increase in the placebo group) and a significant (P = .03) difference in weight gain in the ZDV patients aged more than 30 years (8 pounds) as compared with the older placebo patients (aged more than 30 years) (2 pounds) at week 24. The findings in the asymptomatic hemophilic patients aged more than 30 years support a useful effect of ZDV, which is similar to observations in the larger study of its use in asymptomatic, nonhemophilic patients.