Medical hypotheses
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Review
The pathogenesis of chronic pain and fatigue syndromes, with special reference to fibromyalgia.
Syndromes characterized by chronic pain and fatigue have been described in the medical literature for centuries. Fibromyalgia is the term currently used to describe this symptom complex, and considerable research has been performed in the last decade to delineate the epidemiology, pathophysiology, and genesis of this entity. Although fibromyalgia is defined by its musculoskeletal features, it is clear that there are a large number of non-musculoskeletal symptoms, such that we now understand that there is considerable overlap with allied conditions such as the chronic fatigue syndrome, migraine and tension headaches, irritable bowel syndrome, and affective disorders. This article will review our current state of knowledge regarding fibromyalgia and these allied conditions, and present a unifying hypothesis that describes both the pathophysiology of symptoms and the genesis of these disorders.
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Humans and apes show clear differences in brain anatomy. In the human cerebral cortex, for instance, the areas that control the fine movements of the hand, the areas that control the breathing and speech musculature, and the association areas have strongly expanded. It will be argued that these differences are best explained by the aquatic ape theory of human evolution (AAT) and originated in our semi-aquatic past, notably in the adaptations necessary for diving and shellfish collection at sea coasts.
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The first rodent longevity study with the insulin-sensitizing nutrient chromium picolinate has reported a dramatic increase in both median and maximal lifespan. Although the observed moderate reductions in serum glucose imply a decreased rate of tissue glycation reactions, it is unlikely that this alone can account for the substantial impact on lifespan; an effect on central neurohormonal regulation can reasonably be suspected. Recent studies highlight the physiological role of insulin as a modulator of brain function. ⋯ Since both the pineal gland and thymus are dependent on insulin activity, chromium may aid their function as well. Thus, the longevity effect of chromium picolinate may depend primarily on delay or reversal of various age-related changes in the body's hormonal and neural milieu. A more general strategy of hypothalamic 'rejuvenation' is proposed for extending healthful lifespan.
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A high plasma fibrin(ogen) concentration is a known risk for thrombosis and cardiovascular disease. Because fibrin(ogen) binds alpha-thrombin with high affinity, it has potential to modulate the interactions of the enzyme with its inhibitors and other substrates in plasma. ⋯ A push-pull hypothesis is proposed for bioregulation of coagulation by fibrin(ogen). The experimental work which led to the formulation of this hypothesis is outlined.
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Whatever induces general anesthesia, i.e. cerebral arrest, tends to cause respiratory and cardiac arrest also. However, general anesthesia does not necessarily exclude nor block all other mechanisms which can provoke one or more of these three phenomena. Amongst many such more or less equipotent factors are intracranial, intrapleural, intra-abdominal and intratracheal pressures. These mechanical factors occurring but unrecognized in surgical patients cause puzzling complications including, insomnia, coma and unexpected sudden death.