Hyperhidrosis Holistic Treatments

Sweat Miracle Excessive Sweating Cure

The Sweat Miracle eBook a complete 150 page guide about treating hyperhidrosis naturally. It is designed by Miles Dawson, a top nutrition specialist. The therapy illustrated in the Sweat Miracle eBook was tested by Dawson before he brought the option to different groups of people who have hyperhidrosis. It is a highly practical and holistic approach to treat the problem of hyperthyroidis. Dawson in his Sweat Miracle eBook encourages the use of natural treatments and all the information contained in his program work for all age groups. The instructions are prepared by someone who experienced hyperhidrosis and did research to eliminate the problem.The program is actionable and practical for all people living with hyperhidrosis. It will offer you guidance and set you on the path to eliminate excessive sweating in a simple and clear language. The nature of the eBook or the program's simple approach makes the detailed holistic process easy to comprehend hence allowing sufferers to treat their problem swiftly with no fuss. The product is beginner friendly and doesn't require any level of technical skills to understand due to its simplicity. Read more here...

Sweat Miracle Excessive Sweating Cure Summary


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Sweating guarded hot plate skin model

The thermal insulation and the water vapour resistance of one or several textile layers can be assessed with the skin model (sweating guarded hot plate (ISO 11092 1993), and (EN 31092 1993)). The skin model consists of an electrically heated plate, which is located in a climatic chamber. Square samples are put onto the plate, and air at a defined temperature, relative humidity and velocity (1 m s) is blown tangentially from a fan over the sample. The plate is heated to 35 0C and the measuring surface is surrounded by a guard that is heated to the same temperature in order to avoid any heat loss (Fig. 10.2). 10.2 Scheme of the sweating guarded hot plate (skin model) according to ISO 11092. 10.2 Scheme of the sweating guarded hot plate (skin model) according to ISO 11092.

Polydore Vergils 1534 description of the Sweating Sickness from Shaw 1933 2701

Stomach, moreover there was a terrific sensation of heat. Therefore the patients cast off the bed coverings from the beginning, as some of them suffered less heat if they lay in bed if they were dressed they stripped off their clothes, the thirsty ones drank cold water, others suffering from this fetid heat, provoked a sweat which had a foul odor, by adding bed clothes, all of them dying immediately or not long after the sweat had begun so that not one in a hundred evaded it. Nor did any art of medicine or science avail to help it, meanwhile, for this strange disease escaped all their knowledge. In fact, after twenty four hours (the severity of the disease continued for that length of time) the sweat departed bringing this conclusion, i.e., that they were not cleansed by the sweat, as many of them perished. But that fact pointed out a final measure in the treatment for this great torture those who had sweat once, since they sickened again put into use those things which they had...

Thermal and sweating manikins

Some of these thermal manikins can additionally release moisture to measure the evaporative resistance of garments (Meinander 1992, Fan et al. 2001, Richards and Mattle 2001, Burke and McGuffin 2001) and ASTM is drafting a standard for sweating thermal manikins (Standard Test Method for Measuring the Evaporative Resistance of Clothing Using a Sweating Manikin, ASTM Committee F-23 on protective clothing). However, an interlaboratory study (McCullough et al. 2002, Richards and McCullough 2004) on different sweating manikins showed that the variability among the systems was relatively high, mostly because of the varied designs of the manikins.

Sweating Sickness

The sweating sickness, or sudor anglicus, is Once in London, the epidemic displayed some of its most characteristic and consistent features higher mortality among men than women, peaking during middle adulthood among the economically advantaged, and a sudden, acute fever accompanied by profuse sweating. Its victims generally lapsed into coma and died within 48 hours. Similar outbreaks have been identified in 1508, 1517, 1528, and 1551. Oddly, the disease preferred Englishmen at home and abroad. In the British Isles, Scots, Welsh, and Irish were spared. Building on the suggestion that peculiarities of the sixteenth-century English diet might account for the disease, Adam Patrick argued that the Sweat resembled a shock reaction, with its hyperacute pyrexia (fever) and sweating, occasionally associated with evidence of circulatory collapse. Among the most likely toxins, he passed over bacterial endotoxins and exotoxins in favor of fungal toxins associated with food poisoning. Ultimately,...


The physiologic capacity for heat dissipation is closely linked to the ability to sweat. This depends on the size of the individual, on the physical fitness, and on the state of heat acclimatization. Maximal sweating rates may vary between 600 and 700 mL h for a sedentary person, to about 4L h in very well trained and heat-acclimatized individuals exercising in dry heat. The evaporation of 1L sweat removes approximately 2500 kJ (2430 kJ). However, in humid conditions the amount of sweat which can evaporate may be restricted (evaporation depends on the difference in water vapor pressure between skin and air). If the water vapor pressure difference is too small not all the sweat produced can evaporate only the evaporated sweat removes heat, the rest drops off and is wasted 26 . Due to the physical limits for evaporation, heat loss is drastically impaired in hot humid environments, and exercise is often associated with advancing degrees of

Extrinsic Risk Factors

Shear forces result from traction on the skin, which causes a relative displacement of the underlying structures. This usually occurs when patients are positioned in bed more than 30 degrees, or seated, and then slide down. In these patients the underlying sacrum is at risk for pressure sore development. Friction between the skin and a stationary source such as bedclothes or sheets is another factor. Care must be taken to avoid friction, especially during transfers in and out of bed. Excessive moisture can lead to skin maceration and subsequent skin breakdown. Common causes include incontinence, diarrhea, and excessive perspiration (AHCPR, 1994 Patterson and Bennett, 1995).

Anxiety and Obsessive Compulsive Disorder Syndromes

Anxiety is an extremely common occurrence that affects everyone at some time and is characterized by an unpleasant and unjustified sense of fear that is usually associated with autonomic symptoms including hypervigilance, palpitations, sweating, lightheadedness, hyperventilation, diarrhea, and urinary frequency as well as fatigue and insomnia. Anxiety is thought to be mediated through the limbic system, particularly the cingulate gyrus and the septal-hippocampal pathway, as well as the frontal and temporal cortex. The term anxiety disorder is used to denote significant distress and dysfunction resulting from anxiety, including panic attacks and anxiety with specific phobias. Chronic, moderately severe anxiety tends to run in families and may be associated with other anxiety disorders or depression. The differential diagnosis of anxiety states includes other psychiatric conditions such as anxious depression as well as schizophrenia, which may present as a panic attack with disordered...


According to Janet Travell, trigger points in muscle are activated directly by overuse, overload, trauma, or chilling and are activated indirectly by visceral disease, other trigger points, arthritic joints, or emotional distress. Myofascial pain is referred from trigger points that have patterns and locations for each muscle. Trigger points are hyperactive spots, usually in a skeletal muscle or the muscle's fascia, that are acutely tender on palpation and evoke a muscle twitch. These points can evoke autonomic responses (i.e., sweating, pilomotor activity, and local vasoconstriction). Palpations should be done with the athlete in the supine position. Always compare bilaterally.

Impact of Skin Disease on the Patient

Diseases of the skin play a profound role in the way the affected patient interacts socially. If located on visible skin surfaces, long-standing skin diseases may actually interfere with the emotional and psychologic development of the individual. The attitude of a person toward self and others may be markedly affected. Loss of self-esteem is common. The adult with a skin disorder often faces limitation of sexual activity. This disruption of intimacy can foster or increase hostility and anxiety in the patient. Skin is a sensitive marker of an individual's emotions. It is known that blushing can reflect embarrassment, sweating can indicate anxiety, and pallor or ''goose bump'' skin may be associated with fear.

Assessing Depth of Anesthesia

More than 150 years after the first public display of surgical anesthesia, most anesthesiologists still infer your depth of anesthesia from your physical signs. Anesthesiologists are still taught in their training that physical signs like heart rate, blood pressure, sweating, tearing, and gross movement are indirect, or surrogate, indicators of the patient's depth of anesthesia. Yet no research has ever shown that these physical signs correlate in any predictable or measurable way with the patient's level of consciousness. In fact, the clinical signs that are widely used by anesthesiologists to assess depth of anesthesia are notoriously inaccurate and unreliable for predicting depth of anesthesia. In a study of patients who had awareness during general anesthesia, only a small number manifested any physical signs of light anesthesia.1 The anesthesiologist should be monitoring these physical parameters for many reasons, but they are not a reliable indicator of depth of anesthesia.

Primary Anxiety Disorders

Ated in children and adolescents with comorbid medical conditions that may also be associated with somatic symptoms. The psychological symptoms of anxiety are routinely associated with physical signs of autonomic activity (e.g., palpitations, shortness of breath, tremulousness, flushing, faintness, dizziness, chest pain, dry mouth, muscle tension). The most common somatic symptoms reported by children and adolescents with DSM-IV-TR anxiety disorders (i.e., social, separation, and generalized anxiety disorders) were as follows restlessness (74 ), stomachaches (70 ), blushing (51 ), palpitations (48 ), muscle tension (45 ), sweating (45 ), and trembling shaking (43 ) (Ginsburg et al. 2006).

Monitoring the central nervous system

At the present time this is done clinically. The signs of sympathetic overactivity such as lacrimation, sweating, increasing pupil size or increase in heart rate or arterial pressure indicate that anaesthesia is too light. These signs are, however, not reliable but cerebral function monitors (CFM) are not at present in widespread practice. The depth of anaesthesia is often assumed from the measurement of end tidal volatile anaesthetic concentrations. It is only since the advent of neuromuscular blockers and the abolition of patient movement that undetected awareness has become a potential complication.

Methodological issues

The acute stress response is the normal reaction to a stressor that can be either external (a bully kicking sand into your face) or internal (the thought of Christmas with your family). This reaction has two components one physiological and the other psychological. The gamut of these responses both physiological and psychological is largely mediated by the adrenergic neurotransmitter system. The changes associated with activation of adrenaline and noradrenaline in the acute stress response include increased heart rate, dry mouth, piloerection (hair standing on end), sweating clammy palms, paraesthesia (sensory loss or numbness usually of the hands and feet), nausea and headache, increase in urinary frequency, and hypersensitivity to sensory stimuli.

Selective Serotonin Reuptake Inhibitors and Venlafaxine

The initial dose of SSRI is similar to that used in depression. Patients should be titrated as tolerated to response. Many patients will require maximum recommended daily doses. Patients with comorbid PD should be started on lower doses (Table 40-6). When discontinuing SSRIs, the dose should be tapered slowly to avoid withdrawal symptoms. Relapse rates may be as high as 50 , and patients should be monitored closely for several weeks.60, 1 Side effects of SSRIs in SAD patients are similar to those seen in depression and most commonly include nausea, sexual dysfunction, somnolence, and sweating.

Measuring the evaporative resistance of protective clothing systems

There are relatively few sweating manikins available for measuring the evaporative resistance or vapor permeability of clothing (McCullough et al., 2002). Some manikins are covered with a cotton knit suit and wetted out with distilled water to create a saturated sweating skin. However, the skin will dry out over time unless tiny tubes are attached to the skin so that water can be supplied at a rate necessary to sustain saturation (McCullough et al., 1989). Other manikins have sweat glands on different parts of the body (Holmer et al., 1996). Water is supplied to each sweat gland from inside the manikin, and its supply rate can be varied. A new type of sweating manikin uses a waterproof, but moisture-permeable fabric skin, through which water vapor is transmitted from the inside of the body to the skin surface (Fan and Qian, 2004). Some manikins keep the clothing from getting wet by using a microporous membrane between the sweating surface and the clothing, but this configuration may...

Understanding Tolerance Dependency Addiction and Withdrawal

Physical dependence and withdrawal occur with the chronic use of opioids, but they are not psychological phenomena and therefore are completely unrelated to addiction. Physical dependence means that withdrawal symptoms might occur if the drug is suddenly stopped. These symptoms include anxiety, irritability, alternating chills and hot flashes, excessive salivation, tearing eyes (lacrimation), runny nose, nausea, vomiting, abdominal cramps, insomnia, sweating (diaphoresis), and goose bumps (piloerection). Physical dependence is easily treated, thereby avoiding withdrawal, by gradually decreasing the daily doses of the opioid, for example, by 10 to 25 percent. Once a low daily dose of morphine (20 mg orally) is reached, the opioid can be discontinued without withdrawal symptoms occurring.

Manikin tests vs fabric tests

Sweating guarded hot plates can be used to measure and compare the thermal resistance and evaporative resistance of different types of fabrics and multi-component systems (McCullough et al., 2004). The most commonly used methods for this purpose include ASTM F 1868, Standard Test Method for Thermal and Evaporative Resistance of Clothing Materials Using a Sweating Hot Plate (ASTM, 2005) and ISO 11092, Textile B Physiological Effects B Measurement of Thermal and Water Vapor Resistance Under Steady State Conditions (Sweating Guarded Hot plate Test) (ISO, 1995). Fabric insulation is often expressed as a performance index, such as insulation per unit weight or insulation per unit thickness when comparing different materials.

Thermoregulation of the human body

Human beings are homoeothermic, which means that they have to maintain their core temperature within close limits around 37 0C. During every activity, the body produces a certain amount of heat lying between 80 W while sleeping and over 1,000 W during most strenuous efforts. The surplus energy can be transferred to the environment by three means respiration and release of dry (radiation, convection and conduction) and evaporative heat through the skin. The total heat loss at moderate temperatures (around 20 0C) and 50 RH is approximately divided into 20 evaporation, 25 conduction, 45 radiation and 10 respiration (Aschoff et al. 1971). At low temperatures, respiration can account for over 30 of the heat loss. When the ambient temperature is over about 34 to 37 0C, evaporation is the only way to cool the body. Evaporative cooling is a very efficient means of heat dissipation, as one litre evaporated sweat removes 672 Wh from the body at a temperature of 35 0C. The body evaporates from...

Test methods for heat and moisture transfer

One of the most widely used methods is the sweating guarded hot plate to measure the water vapour permeability or the thermal insulation of material samples, as it is probably the best standardized test method to simulate the heat and mass transfer conditions on a clothed body. There are, however, several other methods to determine these characteristics. It is difficult for consumers to interpret these figures, especially concerning the breathability of clothing, as the different methods do not always provide comparable results. The reason for this

Measurement of the thermal resistance and thermal transmission

The measurement of the thermal resistance with the sweating guarded hot plate according to ISO 11092 assesses the intrinsic resistance of the specimen plus a transition resistance from fabric to air. This transition resistance is dependent on the convective and the radiant heat loss from the surface of the fabric to the atmosphere. If a fabric is worn as an under-garment, there will usually be no convection and only limited radiation between the layers. Spencer-Smith (1977a) showed that internal convection between layers can be neglected if the air layer is smaller than 8 mm. Furthermore, as long as the fibre content in a fabric is higher than 9 , only thermal conduction needs to be considered in the fabric (Woo et al. 1994). It is therefore important only to assess the thermal

Dynamic moisture permeation cell

ASTM F2298 (2003) describes a method to determine the steady-state and transient water vapour permeation behaviour of fabrics. This method was developed by Gibson et al. (1997). A mixture of dry and water-saturated nitrogen streams are passed over the top and the bottom surfaces of the cell containing the sample. The relative humidity of the mixed streams is controlled by the proportion of dry and saturated components. Via measurement of temperature and relative humidity of the flows entering and leaving the cell, the flux of water vapour diffusing through the sample may be calculated. Gibson et al. (1997) compared this method with the sweating guarded hot plate ISO 11092 and found a very good correlation for different fabrics and microporous membrane laminates. There was also a correlation of this method with the inverted cup method (ASTM E 96 procedure BW).

Reviews And Selected Updates

Fealey RD, Low PA, Thomas JE Thermoregulatory sweating abnormalities in diabetes mellitus. Mayo Clin Proc 1989 64 617-628 45. LeWitt PA, Newman RP, Greenberg HS, et al Episodic hyperhidrosis, hypothermia, and agenesis of corpus callosum. Neurology 1983 33 1122-1129 48. Freeman R, Waldorf HA, Dover JS Autonomic neurodermatology (Part II) Disorders of sweating and flushing. Semin Neurol 1992 12 394-407

Key issues in thermal protection evaluation

Current standard tests for performance evaluation provide only a basis for measuring the thermal insulation of clothing materials. These methods focus on intense thermal environments in dry condition and consider no stored thermal energy effects. Data produced by decades of fire research on structural fires shows that most burn injuries sustained by firefighters occurred in the low-level thermal environments.5' This thermal environment could be outside the flaming envelope, post-flashover or pre-flashover fires. In addition, these tests are conducted only under dry conditions before and after multiple cycles of laundering. Of particular concern is the effect of moisture in the clothing system on its protective performance. This moisture can be introduced both externally by hose spray and internally by sweating. Because moisture, present in protective clothing systems, has a complex influence on heat transmission and potential for skin burn injuries, there is significant interest in...

Modeling thermal degradation in fabrics

As previously noted, Staggs' model does not consider transport of gaseous products from the degrading polymer material. This model can be supplemented with a model that describes transport of these products through the fabric layer, modeled as a thermally degrading porous medium. One of the issues to be addressed is the change of permeability of the porous medium as a result of its thermal degradation. It is expected that degradation will produce a decrease of permeability in the fabric and thus worsening its mass transport characteristics. This will hinder not only transport of the gaseous products of polymer degradation, but also moisture transport through the degrading fabric. This, in turn, can lead to accumulation of heat moisture in the fabric because the moisture that results from sweating will not be removed. Moisture accumulation in fabrics has been proven to have a profound influence on heat transfer and thermal protective performance.

History And Development Of Iontophoresis

The history of iontophoresis has been detailed by Banga and Chien (1988) and the concept of the application of an electric current to increase skin penetration was described as early as the 1700s. One of the earliest and most well-documented experiments in this field, however, was conducted by Ludec at the beginning of the twentieth century, where he demonstrated the importance of polarity when using direct current to administer strychnine and cyanide to two rabbits (Chien and Banga, 1989). Though iontophoresis was explored significantly in the 1930s and 1940s, its use has declined in subsequent years, with more recent investigations focusing on applications such as sweat testing for the diagnosis of cystic fibrosis (pilocarpine), hyperhidrosis (tap water, atropine), local anesthesia (lidocaine with epinephrine), and for ulcers (histamine, zinc oxide) (Rai and Srinivas, 2005). Additionally, over the last few decades, iontophoresis has come to be used as a technique researched...

Complications of salivary gland surgery

Following a parotidectomy, the patient may complain of sweating of the skin over the area of the parotidectomy, especially on eating. The problem is quite common following a parotidectomy but is only troublesome in about 10 of patients. This is thought to occur because of the inappropriate regeneration of injured autonomic nerve fibres, which are misdirected and supply the sweat glands of the overlying skin. Elevating a thick skin flap when performing the parotidectomy can reduce its incidence. Most cases are not too troublesome and can be controlled by the use of an antiperspirant. More troublesome cases may require other procedures such as a tympanic neurectomy or the interposition of a tissue flap between the skin and the parotid bed, procedures that have a variable rate of success.

The neuronal origin of sleep the sleep circuit

Current thinking is that we have specific neural circuits that keep us awake and if these are switched off we fall asleep. These neurons are in the reticular activating system in the brainstem. Signals from this system feed into the thalamus, which combines them with the sensory information it is receiving and relays it all to the cortex. The system uses a neurotransmitter, glutamate, which tends to activate nerves and therefore acts like a gate, allowing the passage of sensations to the thalamus and thence to the cortex. If this gate closes, we become insensible to the outside world, which is why we can sleep through noise or movement. There is a second wakefulness system in the hypothalamus, which is part of the autonomic nervous system and therefore responsible for regulating heart rate, breathing, sweating and other automatic processes. Signals spread from here

Evaporative resistance

Evaporative resistance of fabrics is measured with a heated water hotplate (ISO-5085-1, 1989, IS0-11092, 1993). Sweating manikins are available, but results show the relative effect of sweating on heat exchange rather than the actual evaporative resistance (McCullough, 2001 Meinander, 2000). A wetted cover on a dry, thermal manikin may provide reliable values for the permeability index (Breckenridge and Goldman, 1977). A combination of fabric and manikin measurements may allow the determination of clothing evaporative resistance (Umbach, 1992).

Influences of water and moisture

In the cold there is a steep temperature gradient from skin, across clothing layers to ambient air. The dewpoint temperature and eventually also the freezing temperature may be reached inside the clothing by the moist air passing from the skin. Condensation occurs and moisture builds up in discrete layers. Wetting of clothing reduces the effective thermal insulation (Holmer, 1985, Meinander, 1994, Meinander and Subzerogroup, 2003). Four winter ensembles were measured during three hours with a sweating thermal manikin at two sweating rates, 100 and 200g (m *h), respectively. The air temperatures varied from 0 to 40 0C. Table 14.3 shows the accumulated water during the three hours and the associated reduction in effective insulation (Meinander and Subzerogroup, Table 14.3 Actual evaporation and difference in total thermal insulation as result of sweating and sweat accumulation Ensemble Total dry Sweating rate Sweating rate

The multilayer principle

Next to skin quickly increases humidity and moisture is transferred to outer layers. The advantage is an increased awareness of heat imbalance (discomfort), but moisture remains in the clothing system. The ventilation principle requires a vapour barrier worn next to skin. Microclimate humidity quickly rises with sweating, but water vapour cannot escape to outer layers. The humid microclimate forces the wearer to open up the clothing and ventilate the microclimate. This principle is preferably used in resting and low-activity conditions. The absorbing technique may be useful for low to moderate activities with limited sweating. The transporting principle may be applied to all kind of activities, but in particular for high activity with sweating. They are most suitable for sports events and long-term exposures. Another important factor for cold protection is moisture control. This means that wetting of layers must be avoided at all time (from inside by sweating or from outside by rain...

Natural and synthetic fibres

Textiles such as wool and wool blends possess a high absorbing capacity and can handle smaller amounts of moisture without losing their insulation properties. Wool can be used as a next-to-skin fabric and may keep the skin relatively dry. When the fabric becomes saturated, however, moisture control is reduced. Cotton is absorbing as well, but clings to skin when wet and should not be close to skin in cold environments. Many synthetic textiles are hydrophobic and the moist air moves from skin through the fabric to the next layer. The skin microclimate quickly becomes humid during sweating. This humidity is uncomfortable and causes the wearer to take action for appropriate adjustments. This is also the main effect and purpose of using vapour barrier fabrics next to skin. Moisture absorbed in garments, in addition to causing discomfort at some stage, adds to the weight carried by the person. In addition it gradually reduces thermal insulation of that particular layer. When activity drops...

Panic Disorder Definition

The key feature of panic disorder in DSM-III is the occurrence of three or more panic attacks within a three week period. These attacks cannot be precipitated only by exposure to a feared situation, cannot be due to a physical disorder, and must be accompanied by at least four of the following symptoms dyspnea, palpitations, chest pain, smothering or choking, dizziness, feelings of unreality, paresthesias, hot and cold flashes, sweating, faintness, trembling or shaking (APA, 1980). In DSM-III-R, the definition was revised to require four attacks in four weeks or one or more attacks followed by a persistent fear of having another attack. In DSM-III-R, the list of potential symptoms was revised to include nausea or abdominal distress and to exclude depersonalization or derealization (APA, 1987).

Pathogenesis and Presentation

The classic presentation of DKA is a child or adolescent who has become increasingly weaker over 3 to 5 days with dyspnea and lethargy. Vomiting and abdominal pain can result from gastric distention caused by marked hyperglyce-mia. Profound acidosis can cause Kussmaul's respirations, with retractions and lifting of the clavicle, to expand the chest fully for maximal hyperventilation and elimination of carbon dioxide (CO2). Rarely, the odor of acetone may be perceived. The pulse rate may be rapid, with low blood pressure indicative of hypovolemia. Elevation of the temperature is not unusual, caused by a precipitating infection or the mechanical work of heavy breathing, because dehydration prevents normal sweating and cooling.

Benign Tumors Pheochromocytoma

Pheochromocytomas are rare benign tumors characterized by the abnormal proliferation of the adrenal chromaffin cells derived from the primitive neuroectoderm. As a result, a high level of catecholamine is produced. Ninety percent of these tumors are found in the adrenal medulla of the kidney. They may be associated with neurofibromatosis, von Hippel-Lindau disease, tuberous sclerosis, Sturge-Weber syndrome, and as a component of the multiple endocrine neoplasm syndrome, which is briefly described in the section on mucosal neuroma. Hypertension, whether sustained or episodic, is the most common clinical sign of pheochromocytomas. Headache, excessive truncal sweating, and palpitations are also commonly observed in these patients.78 The diagnosis of these tumors includes assaying for serum and 24-hour urine catecholamines, as well as their metabolites such as vanillylmandelic acid (VMA) and metanephrines. Malignant transformation, by local invasion or metastasis, occurs in 10 of patients...

Clinical Manifestations and Pathology

The classical malaria paroxysm is initiated by a chill, lasting up to an hour and often accompanied by headache, nausea, and vomiting. The chill is followed by a period of spiking fever lasting several hours. The subsiding fever is accompanied by sweating, often profuse. The relieved patient may drift off to sleep, to awaken feeling relatively well. The early paroxysms may be asynchronous. As the clinical episode progresses, P. malariae paroxysms occur about every 72 hours (quartan periodicity), whereas those of the other three species occur with tertian (48-hour) periodicity. P. falciparum infection is less likely to become clearly synchronous, and the classic

Clinical Features

Headache, sweating, palpitations, and paroxysmal hypertension is prototypical of these symptoms.12 The hypertension may be so severe that peripheral blood pressure measurements may be difficult to obtain because of the extreme vasoconstriction. Cardiac decompensation suggestive of acute myocardial infarction can also occur, sometimes precipitated by partial necrosis of the tumor with sudden release of a bolus of epinephrine and norepinephrine into the bloodstream (Fig. 71-1). FIGURE 71-1. A, CT scan of patient coincidentally found to have pheochromocytoma during medical evaluation in preparation for knee surgery as a result of excessive sweating. B, CT scan of the same patient only 10 days later, 2 days after patient was admitted through the emergency room with chest pain, vasoconstriction, and electrocardiographic changes worrisome for myocardial infarction. Note that the back wall of the tumor is blurred, consistent with acute necrosis and release of catecholamines. FIGURE 71-1. A,...

Clinical Manifestations

All of these movement disorders can be part of Parkinson's disease. The bradykinesia shows up as a delay in the execution and initiation of voluntary movement, and also there is difficulty arresting the movement once it has been started. Akinesia is simply an extreme state of immobility, and some Parkinson's patients, particularly before treatment with levodopa became available, eventually ended their days totally rigid and immobilized. Rigidity is resistance to passive stretch of muscle, and the patients with parkinsonism have a characteristic stiffness of the muscles of the body. This stiffness can be brought out by passive rotation of the wrist or flexion-extension at the forearm. It is also present in the truncal muscles and can be examined by placing one's hands on the dorsal aspect of the patient's back muscles and having the patient flex and extend the body at the waist. The rigidity that is characteristic of parkinsonism is the rigidity that usually...

Who should be considered for treatment

As to the objective signs of relative androgen deficiency, although a decrease of muscle mass and strength and a concomitant increase in central body fat and osteoporosis can most easily be objectified, they are not specific signs. Decreased libido and sexual desire, loss of memory, difficulty in concentration, forgetfulness, insomnia, irritability, depressed mood as well as decreased sense of well-being, are rather subjective feelings or impressions, less easily objectified and certainly difficult to differentiate from hormone-independent aging. Complaints of excessive sweating are not uncommon, whereas true hot flushes do occur in elderly men, although they are mainly prevalent in severe acquired hypogonadism such as under hormonal treatment for prostate cancer.

The amygdala and emotional expression

Following Kluver and Bucy's initial reports of the blunting of affect in monkeys with temporal lobe damage including the amygdala, several studies have shown that selective amygdala damage results in a syndrome characterized by decreases in responsivity to affective stimuli. After amyg-dalotomy, monkeys fail to respond differentially to a wide range of painful shock intensities, and are poor at temperature discrimination. These animals also fail to show classic orienting responses to unexpected salient noises or visual stimuli, which normally include changes in heart rate and respiration. These animals also have a diminished galvanic skin response, the change in skin resistance associated with sweating. Monkeys with amygdala damage also demonstrate diminished selectivity in feeding, diminished sensitivity to food deprivation, and depressed shifts in behavioral performance normally associated with changes to food reward magnitude or type of food reward. Parallel impairments in...

Textiles for environmental protection

Military ground forces face the most difficult operational conditions of all. Modern UK forces such as infantry, marines and parachutists operate as lightly equipped, highly mobile brigades who are expected to move at short notice to any part of the world. Once in place they have to wear or carry all their personal equipment, and can be exposed to the widest range of environmental conditions. These are detailed in standard publications (Defence Standard 00-35, 1996). Unlike civilians, ground forces cannot choose to operate in good weather, nor can they take control over their work rates. Soldiers typically operate in short bursts of high activity, running carrying equipment and weapons. In between they may have to lie immobile under cover or in trenches for long periods of time. Keeping dry and comfortable is essential. Excessive activity and sweating in a cold climate followed by inactivity can lead to hypothermia (cold stress), whereas high work rates whilst wearing layers of...

Thermal and water vapour resistance data for combat clothing systems

The thermal resistance (Rct) and water vapour resistance (Ret) values for the UK combat clothing ensemble have been measured using a sweating guarded hotplate apparatus (ISO 11092, 1993). The values are additive, although the true total is somewhat higher due to the air gaps between layers (Congalton, 1997). From these the water vapour permeability index (imt) can be calculated such

Diagnosis Of Postpartum Hemorrhage And Postpartum Prevention

Healthy, young women can compensate for routine post-delivery blood loss very effectively, and this toleration is increased even further if there has been a healthy increase in blood volume during pregnancy22. Normally, plasma volume increases by 1250 ml and the red cell mass also increases, resulting in women being able to tolerate a drop in their pre-delivery blood volume of up to 25 and remain hemodynamically stable22. In practice, this means that midwives need to be encouraged to ignore machines and use their clinical skills of observation. They need to be alert to signs of earlier stages of shock - pallor, sweating and muscle weakness characterized by severe and rapid fatigue22. When women become restless and confused, shock is advancing rapidly and immediate, aggressive treatment is needed if not already instigated22 (see also Chapter 8).

Sensitivity analysis or fertilizing and grafting decision trees

Goes on a week-long car trip with a physician friend. The man complains of pain in the left shoulder radiating to the left arm. The journey is long, and the man complains of sudden fatigue and sweating. Knowing that his friend suffers from angina, the physician might suspect a myocardial infarction, and might try to get his friend to the nearest hospital as fast as possible. He might also dismiss this episode as a simple spell of fatigue due to hot weather, with radicular pain caused by the long drive. Figure 13.7 illustrates the physician's two options and their consequences

Hypertension The Pressures On

Blood pressure is measured by a sphygmomanometer. A normal reading is about 120 80 a reading of 140 90 measured at least on two office visits is officially considered high blood pressure. Hypertension rarely exhibits symptoms, so it's often called the silent killer. Left untreated, high blood pressure can lead to serious conditions such as vision problems, heart attack, stroke, or kidney failure. If early symptoms do occur, they may include headaches, sweating, muscle cramping, palpitations, rapid pulse rate, dizziness, vision problems, or shortness of breath. Having your blood pressure checked every four to six months is an easy precaution to ensure your pressure is staying on course.

Acu Points to Relieve the Fatigue

Easily catch colds, low voice, pale complexion, spontaneous sweating, and pale tongue. Lung yin deficiency. Dry throat, dry cough, exhausting breathlessness, hoarse voice, afternoon feeling of overheating, sweating in palms, feet, and center of chest, night sweats, and flushed face.

Hereditary Neuropathies

These include pes cavus, absent tendon reflexes, a high-stepping or slapping gait, footdrop, slowly progressive wasting and weakness of peroneal muscles, foot ulcers, joint arthropathy, and absence of sweating. Without a specific treatment for these neuropathies, efforts are focused on management of physical disabilities, education, genetic counseling, and reassurance. Hereditary neuropathies and CIDP can both have a familial pattern, the important difference being that CIDP is treatable.

Effect of moisture on thermal protection

The performance levels set in the standards are given for new or prewashed materials or material combinations. In normal use the garments are often wet and dirty. The garments can be wetted from the outside by extinguishing water or from the inside by sweat. The sweating rates for persons carrying out heavy firefighting tasks can rise up to 2,000g h (M kinen et al., 1996). The extinguishing method determines how much water is used.

Test method development

In the current test methods for heat protection the energy transferred to a copper disk sensor placed behind a fabric specimen is measured. Other types of sensors are skin simulants whose combination of thermal properties is such that they absorb heat at about the same rate as human skin. Tests are being developed to evaluate the stored energy in a garment and the effects on human skin when this energy is released (Torvi et al., 1997 Torvi, 1999). A test fixture for thermal properties developed by the Ktech Corporation, provides a small-scale test apparatus for calculating the thermal properties of firefighting clothing materials at low heat flux exposure levels allowing also the evaluation of wet materials. Further development of the apparatus permits testing under various compression loads, and also non-destructive testing can be done to track the thermal properties of in-service firefighting coats and jackets (Gagnon, 2000). Furthermore, test method development in the area of...

A44 Common medical terms used to describe symptoms and signs of heart and blood vessel disorders

Myocardial infarction a term used to describe irreversible injury to heart muscle, which results in loss of function or inability of the muscle to pump blood. Common symptoms include crushing central chest pain that may radiate to the jaw or arms. Chest pain may be associated with nausea, sweating, and shortness of breath.

Partial Focal Seizures

Complex partial or tonic-clonic seizures. Multiple symptoms or signs may occur during a single seizure. Simple partial seizures with motor features include focal tonic and clonic activity, vocalizations, speech arrest, and version, defined as sustained, forced, involuntary turning of the eyes or head. The epileptic focus is usually in the hemisphere contralateral to the motor manifestations. The classic Jacksonian march in which focal clonus in distal muscles gradually spreads proximally along the motor homunculus occurs only rarely. Simple partial seizures with sensory symptoms include somatosensory, visual, auditory, vertiginous, gustatory, and olfactory disturbances. Autonomic phenomena include epigastric sensation, pallor, sweating, flushing, piloerection, and pupillary dilatation. Seizures with psychic symptoms include affective and cognitive disturbances and illusions or hallucinations of memory (deja vu, jamais vu), visions, sounds, self-image, and time.

Diagnosis of Anxiety Disorders

Panic attacks, a collection of distressing physical, cognitive, and emotional symptoms, may occur in a variety of anxiety disorders, such as specific phobias, social phobias, PTSD, and acute stress disorder. Panic attacks are discrete periods of intense fear in the absence of real danger, accompanied by at least 4 of 13 cognitive and physical symptoms (Box 47-4). The attacks have a sudden onset, build to a peak quickly, and are often accompanied by feelings of doom, imminent danger, and a need to escape. Symptoms of panic attacks can include somatic complaints (e.g., sweating, chills), cardiovascular symptoms (pounding heart, accelerated heart rate, chest pain), neurologic symptoms (trembling, unsteadiness, lightheadedness, paresthesias), GI symptoms (choking sensations, nausea), and pulmonary symptoms (shortness of breath). In addition, patients with panic attacks may worry they are dying, going crazy, or have the sensation of being detached from reality.

History and Physical Examination

An investigation for focal neurologic signs should be done. For example, asterixis (flapping of maximally dorsiflexed hands) is characteristic of hepatic encephalopathy, but not unique to it. Tremor may be present in withdrawal states, as are signs of autonomic dysfunction (hypertension, tachycardia, mydriasis, sweating).

Toxicity Amelioration

Pilocarpine, a cholinomimetic natural alkaloid with muscarinic action, has been shown to be, in two prospective double-blind, placebo-controlled, multicenter phase III trials, associated with increasing saliva production, as measured by sialometry and symptom improvement (intraoral dryness, ability to speak, mouth comfort) as assessed by questionnaires. In both trials, patients received radiation therapy alone at doses 4000 cGy and received pilocarpine after the radiation treatment.14 There is also evidence, according to an open-label randomized trial, that a maintenance dose of oral pilocarpine for 36 months following radiation treatment improves oral function. Mild-to-moderate sweating is the most common side effect, and urinary frequency, lacrimation and rhinitis may occur less frequently.101

Side effects and acceptability

Possible side effects of hormonal male contraception might be caused by too high or too low testosterone levels or by additional substances. Decreased testicular volumes reflecting suppression of spermatogenesis is inherent to all hormonal methods, but is not considered a serious effect by the volunteers as long as sexual function remains unaltered. Weight gain is most likely an anabolic effect of testosterone. Due to the high peak serum testosterone levels caused by testosterone enanthate in the earlier studies, acne and mild gynecomastia could be observed in individual cases. Except for local skin reactions, side effects of GnRH analogues are mainly attributable to decreased testosterone levels, not sufficiently compensated for by testosterone supplementation. Sweating and in particular, nocturnal sweating is a feature of some added progestins (see Table 23.2). Nocturnal sweating

Acromegaly Patient Encounter 1 Medical History Physical Examination and Diagnostic Tests

EB, a 48-year-old woman, presents to a new primary care clinic. EB's chief complaints are chronic pain of the knee and pins and needles and numbness in both hands. Over the past few years, she feels that her body has been changing. EB reports increased urinary frequency, excessive sweating, worsening headaches, an increase of two shoe sizes, and facial hair that she shaves once a week. She says that her hands have enlarged to the point that my wedding band won't fit anymore.

Syndromes of Lesions Involving Peripheral Branches of Cranial Nerve V

In addition, there are several syndromes involving the peripheral trigeminal branches. Cluster headache appears as multiple attacks of severe head or facial pain and may be confused with trigeminal neuralgia. y Cluster headache typically occurs in middle-age men and is more prominent at night. Attacks are of short duration they occur in clusters that recur with variable frequency. Unlike trigeminal neuralgia, trigger points are not a characteristic feature. The associated symptoms of cluster headache such as lacrimation, conjunctival injection, sweating, ipsilateral nasal blockage, miosis, and ptosis are quite distinct from symptoms of trigeminal neuralgia. Studies have suggested, however, that disruption of normal autoregulatory trigeminovascular innervation may be responsible for cluster headache. y and that differs in character from classic trigeminal neuralgia. Many of these atypical facial pain syndromes including Charlin's nasociliary neuralgia, Sluder's pterygopalatine ganglion...

Migraine with Aura Classic Migraine

The pain of migraine is invariably accompanied by other features. Anorexia is common, and nausea occurs in almost 90 percent of patients, while vomiting occurs in about one third of patients.y Many patients experience sensory hyperexcitability manifested by photophobia, phonophobia, and osmophobia, and seek a dark, quiet room. Blurred vision, nasal stuffiness, diarrhea, polyuria, pallor, or sweating may be noted during the headache phase. There may be localized edema of the scalp or face, scalp tenderness, prominence of a vein or artery in the temple, or stiffness and tenderness of the neck. Impairment of concentration and mood are common. Lightheadedness, rather than true vertigo, and a feeling of faintness may occur. The extremi- ties tend to be cold and moist. Following the headache, during the postdrome phase, the patient may feel tired, washed out, irritable, and listless, and may have impaired concentration, scalp tenderness, or mood changes. Some people feel unusually refreshed...

Autonomic Dysfunction Secondary to Focal Central Nervous System Disease

Temporolimbic seizures may induce changes in heart rate, heart rhythm, and blood pressure. Cardiovascular manifestations of seizures include sinus tachycardia or bradyarrhythmias (including sinus arrest) with syncope. Seizure-induced ventricular tachycardia and fibrillation have been implicated in sudden death. Other autonomic manifestations of seizures include flushing, pallor, shivering, sweating, symmetrical or unilateral piloerection, visceral sensations, vomiting (ictus emeticus), and respiratory changes. , y Ischemic damage to the insula Episodic hyperhidrosis with hypothermia has been associated with cardiac arrhythmias and contralateral hyperhidrosis. When the cingulate and paracentral cortices are involved, urinary incontinence may occur because of uninhibited bladder contractions. Diencephalon Syndromes. Disorders affecting the hypothalamus may produce disturbances of thermoregulation, osmotic balance, endocrine function, and state of alertness....

Painful de Quervains Thyroiditis

The disorder classically progresses through four stages.24 The initial hyperthyroid phase, due to release of thyroid hormone, lasts 3 to 6 weeks and may be accompanied by symptoms such as tremors, sweating, palpitations, and heat intolerance in 50 to 70 of patients. Patients then progress to the second or euthyroid phase. Hypothyroidism, which is the hallmark of the third phase, occurs in about 20 to 30 of patients and lasts from weeks to months. The last phase is characterized by resolution of the disease and returns to the euthyroid state in more than 90 of patients. Of note, some patients may progress directly from the hyperthyroid phase to the recovery phase, without the intervening hypothyroid phase. A few patients develop recurrent disease.

Systemic Hypotension Border Zone Infarction

Clinical Features and Associated Features. Faintness, pallor, dim vision, dim hearing and lightheadedness, dizziness, and lack of thought clarity are commonly noticed. The patient is worse when sitting or standing, and the blood pressure is low. Profuse sweating is common. Temporoparietal border zone ischemia most often causes visual abnormalities. Balint's syndrome is common and consists of asimultagnosia (difficulty in seeing multiple objects at one time), optic ataxia (abnormal hand-eye coordination in one or both visual hemifields), and apraxia of gaze (difficulty in directing the eyes where willed) 2 . Ischemia in the anterior border zone between the anterior and middle cerebral arteries affects mostly the convexal surface of the precentral and postcentral gyri and causes arm and thigh weakness, usually with sparing of the face, feet, and often the hands. Occasionally patients have ischemia in the cerebellar border zones between the posteroinferior, anterior, and superior...

Combined Upper and Lower Motor Neuron Syndromes

Marked disturbances in autonomic function can occur below the level of the lesion. Loss of sweating and trophic skin changes occur, as well as loss of temperature control and vasomotor instability, which can result in sudden changes in body temperature and blood pressure, including hypertensive crises. Initially, after an acute lesion, the bladder

Mecanism Of Centripetal Lipid Accumulation Supraclavicular Fat And Face

Hypersecretion of GH is related to a somatotroph adenoma in 98 of cases. Approximately 20 of GH-secreting adenomas also secrete PRL. Other causes include excess GHRH from a hypothalamic hamartoma or choristoma, or from ectopic production (i.e., bronchial carcinoid, pancreatic islet cell tumor, or small-cell lung cancer). Hypersecretion of GH leads to the clinical syndrome of acromegaly in adults and gigantism in children. Acromegaly is characterized by an enlarged protruding jaw (macrognathia) with associated overbite enlarged tongue (macroglossia) enlarged, swollen hands and feet resulting in increased shoe and ring size coarse facial features with enlargement of the nose and frontal bones and spreading of the teeth (Table 6-1). Musculoskeletal symptoms are a leading cause of morbidity and include arthralgias leading to severe debilitating arthritic features. Skin tags hyperhidrosis (in up to 50 of patients), often associated with body odor hirsutism deepening of the voice...

Autonomic Neuropathy of Multiple System Atrophy Shy Drager Syndrome

Often in the male, the first symptom is impotence and loss of libido, with disturbance in micturition being common in both sexes. The characteristic orthostatic hypotension may be seen either as so-called drop attacks or as a gradual loss of consciousness over about a minute that is often associated with a neckache that radiates to the occiput and shoulders. Generally, there is at least partial loss of thermoregulatory sweating. Respiratory disturbance occurs as involuntary gasping, cluster breathing, and laryngeal stridor that may lead to obstructive sleep apnea and even death, or to central sleep apnea.

Ischemic strokes and transient ischemic attacks caused by low cerebral flow posterior circulation

Transient Cerebral Ischemic Attacks

An 82-year-old woman with insulin-dependent diabetes mellitus suffered from recurrent short episodes with nausea, vertigo (sensation of being turned around), sweating, blurred vision, weakness and sudden falling without losing consciousness. Episodes were particularly frequent after reduction of elevated blood pressure. Stenosis of the basilar artery proximal to the AICA (anterior inferior cerebellar artery) was assumed to be the cause of these drop attacks. Symptoms disappeared after stent-PTA of the stenosis. Figure 9.2. Drop attack. An 82-year-old woman with insulin-dependent diabetes mellitus suffered from recurrent short episodes with nausea, vertigo (sensation of being turned around), sweating, blurred vision, weakness and sudden falling without losing consciousness. Episodes were particularly frequent after reduction of elevated blood pressure. Stenosis of the basilar artery proximal to the AICA (anterior inferior cerebellar artery) was assumed to be...

Directed Neurological Examination

The examiner may recognize sudomotor failure by noting a dryness of the skin and a lack of resistance to gentle stroking with the fingerpads or to a tuning fork run over the skin. Sudomotor failure may take the form of an isolated generalized anhidrosis or a diffuse autonomic failure with other associated findings. A search should be made for localized increases in or absence of sweating and for asymmetrical patterns of skin temperature or color. In patients with disturbances of autonomic innervation of the face, the physician may note gustatory sweating, flushing, and facial anhidrosis. Acral vasomotor changes that may be observed include acrocyanosis, pallor, mottling, livedo reticularis, or erythema. y Skin temperature changes can be assessed by palpation. Other findings to be noted include atrophic skin changes, alopecia, hypertrichosis, nail thickening, skin decoloration or deformation, and Charcot's joints. Allodynia and hyperalgesia are components of a complex regional pain...

The Prevention And Management Of Pressure Sores

Degree Tilt Pressure Care Pictures

Friction occurs when two surfaces rub together. The commonest cause is when the patient is dragged rather than lifted across the bed. It causes the top layers of epithelial cells to be scraped off. Moisture exacerbates the effect of friction. Moisture may be found on a patient's skin as a result of excessive sweating or urinary incontinence. Body weight should also be considered. Very emaciated patients have no 'padding' over bony prominences. They have less protection against pressure. On the other hand, very obese patients are difficult to move. Unless great care is taken, they may be dragged rather than lifted in the bed. Another problem of the obese patient is that moisture from sweating may become trapped between the rolls of fat causing maceration. Both of these types of patient may also have a poor nutritional status.

What do you do now

Autonomic functions are also often affected. Sweating, thermal regulation, and vasomotor control may differ on the two sides of the body. Cardiovascular abnormalities include tachycardia, orthostatic hypotension without cardiac rate acceleration, and intermittent bradycardia. Gastrointestinal autonomic dysfunction includes decreased esophageal motility, gastroesophageal reflux, and gastric retention.

What are some of the side effects of hormonal therapy and how are they treated

The cause of hot flashes and sweating (vasomotor symptoms) associated with hormone therapy (shots or orchiectomy) is not well known. The symptoms are similar to those that women experience while going through menopause, yet they are not typically experienced by men, whose testosterone level slowly declines with aging. The symptoms appear to be related to the sudden large decrease in the testosterone level and the effects that testosterone has on blood vessels. There are no identifiable factors that put one individual at higher risk for hot flashes than another.

Methods to Promote Relaxation

Because stress, muscular tension, spasm, distress, and the body's responses to these phenomena (sweating, increased blood pressure, changes in brain chemicals and blood flow, or heart rate) can increase pain and make it harder to deal with, techniques to reduce these negative feelings may help alleviate pain. Some conditions such as irritable bowel, headache, and muscle spasm may be direct results of tension states. Even when pain is unrelated to tension, relaxing muscles can prevent or alleviate increased pain due to tension. Although relaxation and self-hypnosis techniques have been used in Eastern cultures for centuries to produce physiological changes, Western science has only recently acknowledged the powerful effects of these techniques. A robust body of studies has shown relaxation to be very effective in producing physiological reductions in heart rate, blood pressure, respiratory rate, and oxygen consumption. In addition, these changes, along with increases in brain waves...

Pharmacologic Therapy

Anxiety Treatment Algorithm

Treatment with imipramine, the most studied TCA, leaves 45 to 70 of patients panic-free. Both desipramine and clomipramine have demonstrated effectiveness in PD as well. Despite their efficacy, TCAs are rendered second-line pharmacotherapy due to poorer tolerability, patient acceptance, and toxicity on overdose.49,50 TCAs are associated with a greater rate of discontinuation from treatment than SSRIs.54 PD patients taking TCAs may experience anticholinergic effects, orthostatic hypotension, sweating, sleep disturbances, dizziness, fatigue, sexual dysfunction, and weight gain. Stimulant-like side effects occur in up to 40 of patients.49,50 Venlafaxine is FDA approved for the treatment of PD. In doses of 75 to 225 mg day, it reduced panic and anticipatory anxiety in short-term controlled trials, and it prevents relapse with extended treatment over 6 months.55,56 The most common side effects include anorexia, dry mouth, constipation, somnolence, tremor, abnormal ejaculation, and sweating.

Sensibility Assessment Instruments

Moberg's ninhydrin test and the wrinkle test identify areas of disturbance of sweat secretion after peripheral nerve disruption. The involvement of sympathetic fibers in a peripheral nerve injury results in areas of dry denervated skin that do not react to environmental warmth (dry or wet) by sweating or wrinkling. The ninhydrin and wrinkle tests measure physiologic reactions that cannot be controlled by the patient. Onne (1962) and Phelps and Walker (1977) have shown that these sympathetic responses correlate positively with sensibility return only in early, completely transected peripheral nerves.45,47 This significantly reduces the validity and reliability of these tests. While inclusion of a sympathetic response test in an assessment battery for use with specific patients, e.g., children, patients with language problems, or patients whose motivation may be suspect, the inclusion criterion of early complete transected nerve is paramount. If this criterion is met, sympathetic...

Hormone Secreting Tumors

Pheochromocytoma is a rare disorder that can occur in both children and adults and is associated with catecholamine secretion from a tumor in the renal medulla. This secretion results in acute, episodic, or chronic symptoms of anxiety that are often associated with hypertension. Clinical symptoms include increased heart rate, increased blood pressure, myo-cardial contractility, and vasoconstriction. Patients may present with headache, sweating, palpitations, apprehension, and a sense of impending doom (Goebel-Fabbri et al. 2005). A pediatric case report documents a 15-year-old with pheochromocytoma who presented with panic attacks, depression, headache, and jaundice (Gokge et al. 1991). Thyroid adenoma or carcinoma, parathyroid tumor, adreno-corticotropic hormone-producing tumors, and insulinomas are other hormone-secreting tumors associated with anxiety symptoms.

Materials and design

Professor Elizabeth McCullough of Kansas State University, USA, has followed a distinguished career in human protection, and writes Chapter 9 on the evaluation of complete protective clothing systems using instrumented manikins that simulate the human thermoregulatory responses. She emphasises the importance of testing clothing systems complete with closures, design features, and auxiliary equipment such as tool belts and respirators. Elizabeth includes thermal insulation and vapour permeability data that is typical of specific protective clothing systems. Heated, sweating, and moving manikins are becoming more widespread throughout the world, emphasising their increasing importance in providing realistic but safe evaluation procedures. Doctor Rene Rossi from the laboratories of EMPA at St Gallen, Switzerland expounds on the interactions between protection and thermal comfort. The perennial problem of the contradiction between increased protection and thermo-physiological load, and...

Pupillary Syndromes Anisocoria

This anisocoria is usually asymptomatic. Another finding in Horner's syndrome is mild ptosis of the upper eyelid from weakness of Muller's smooth muscle in the lids. Less well recognized, however, is that weakness of Muller's muscle in the lower lid also causes the lower lid to elevate. Upper lid ptosis and elevation of the lower lid together cause narrowing of the palpebral fissure. This contributes to an illusion that the involved eye is displaced backward in the orbit, which is the so-called apparent enophthalmos described with Horner's syndrome. A third component of Horner's syndrome involves sympathetic fibers serving the skin of the forehead just above the brow that travel with the nasociliary branch of the first (ophthalmic) division of the trigeminal nerve. With intracranial postganglionic sympathetic lesions, altered vasomotor tone and decreased sweating may be limited to a triangular patch of skin just above the brow extending to the midline....

Extracorporeal gas exchange ECGE

Sweating, vascular pressures up, pyrexia, i.v. feeding Sweating, gnmacing, vascular pressures up It is possible to monitor the cardiovascular system clinically by the volume of the pulse, skin temperature, capillary refill, detection of tachycardia and sweating, or by identifying surrogate markers of cardiac output such as urine output. Biochemical evidence of established tissue hypoxia, such as metabolic acidosis with a raised blood lactate concentration, is another indicator of shock but may also occur in other forms of metabolic derangement. These are all late insensitive signs of shock, and significant delays in treatment, with an adverse effect on prognosis, occur if reliance is placed on them.

Concepts of Addiction The US Experience

Addiction has remained a vague concept in spite of efforts to define it with physiological and psychological precision. The word's Latin root refers to a legal judgment whereby a person is given over to the control of another. In recent centuries the meaning has ranged from a simple inclination toward an activity or interest to an uncontrollable desire to take opium, which historically was viewed as the most addictive of drugs. Opiate addiction is characterized chiefly by the repeated use of the drug to prevent withdrawal symptoms, which include muscle and joint pains, sweating, and nausea. The extreme discomfort of withdrawal passes away after one to three days, although a yearning for the drug may last for a very long time. Some attempts to define addiction in medical terms (e.g., restricting it to opiate withdrawal phenomena) have led to confusion among members of the public because cocaine, according to that restricted definition, would be considered nonad-dictive and, by...

Patient Encounter 1 Part 1 Patient History

A 74-year-old Caucasian woman with a history of chronic obstructive pulmonary disease (COPD) and gastroesophageal reflux disease (GERD) presents to the clinic for follow-up. She reports intermittent daytime and nighttime sweating that comes on suddenly. She reports soaking her bed sheets when this occurs. She had a hysterectomy at age 20 and has never taken estrogen replacement. She reports good relief of reflux symptoms on her current regimen. She started taking a calcium supplement approximately 2 years ago on the suggestion of her friend because she has never gotten much calcium in her diet. She states she does not like milk and never drank it even as a child. She occasionally eats some dairy products such as cheese and ice cream approximately once a week.

Famine and Infectious Disease

Nutritional balance is adversely affected by a number of reactions to infection. These include higher caloric expenditure resulting from greater mobilization of protein due to increased stress and adrenocortical activity decreased food intake owing to general malaise, increased secretion of mucus, and appetite loss and intestinal changes leading to reduced absorption of ingested foods. With regard to energy expenditure, relatively little is known beyond the fact that, if infection involves fever, basal metabolism increases. Nevertheless, it is suspected that even in the absence of fever virtually all infections increase the demand on energy sources. The effects of illness on protein nutrition have received a great deal of attention. Protozoal and helminthic diseases such as malaria and hookworm have adverse affects on nitrogen balance proportional to parasitic load. Most bacterial and viral infections have negative effects on nitrogen balance. Bacterial and viral infections of the...

Special precautions for certain disabled groups

Thermoregulation is impaired in SCI individuals, due to the loss of autonomic nervous system control of skin blood flow and sweating below the level of the spinal cord lesion. Therefore the core temperature rises more during exercise in the athlete with a spinal cord lesion than in an able-bodied athlete, and the temperature rises more the higher the spinal cord lesion is localized 36,67 . To avoid heat cramps, heat exhaustion or even heat stroke during exercise or sport in high temperatures, in particular when associated with high humidity, it is important to have shaded facilities near by, ready access to drinking water, and water for wetting exposed body surface areas. Adequate hydration is fundamental, and daily weighing may be a practical way to keep track of hydration status if exercising or competing in very hot and humid environments 68 .

Associated Neurological Findings

The clinician should look for evidence of autonomic hyperactivity including the presence of palpitations, cold clammy extremities, sweating, sighing, trembling, or hypervigilance, which can be indicative of anxiety disorders, anxiety associated with neurological diseases, or drug withdrawal syndromes.

Treatment and Outcomes

In infancy and childhood, the clinical presentation of PDA varies, from completely asymptomatic through to the full spectrum of congestive heart failure. Symptoms may be completely absent, but could include failure to thrive, dyspnea, poor feeding, and excessive perspiration. In older children, adolescents, and adults, congestive symptoms are less likely. It is not uncommon for the diagnosis to be suspected when an incidental murmur is heard during a well-child examination. Rarely, patients who have not been diagnosed in infancy may present with

The Goal of Evaluation

Subclinical Cushing

The typical patient with pheochromocytoma is hypertensive and may have paroxysmal hypertension and related symptoms (headache, hypertensive crisis, sweating, and cardiac arrhythmias). The proposed term subclinical pheochromocytoma refers to the totally asymptomatic clinically inapparent adrenal masses that histologically proves to be a pheochromocytoma. In several series of clinically inapparent adrenal masses, the frequency of pheochromocytomas ranges from 10 to 40 .3133 Although the percentage of asymptomatic pheochromocytomas among patients with nonfunctioning adrenal tumors is relatively high, most test positive on hormonal evaluation, which is a measurement of 24-hour urinary metanephrines and VMA or fractionated urinary catecholamines. In the National Italian Study Group, 27 patients (3.4 of the total patients with incidentaloma) were found to have pheochromocytoma 24-hour urinary catecholamine and VMA concentrations were elevated in 86 and 4.6 of patients, respectively,22...

The Postoperative Bleeding Tonsil

These patients fall into two separate groups those with an acute bleed in the immediate postoperative period (usually in the recovery area) and those who ooze blood slowly from the tonsil bed. This latter group are usually diagnosed on the ward, on the basis of the clinical signs of hypovolaemia - tachycardia, pallor and sweating. Swallowing is not uncommon, followed by vomiting of a large quantity of blood. Anaesthesia for these children is difficult and the assistance of an experienced anaesthetist must be sought. An i.v. infusion is essential and blood transfusion may be required.

Reflex Sympathetic Dystrophy

Reflex sympathetic dystrophy (RSD) is a term given to a collection of symptoms following an injury, usually to a distal part of a limb. Symptoms are similar to those following nerve damage, although RSD is not associated with overt neurological damage indeed, trauma preceding RSD is said to be 'mild', and symptoms 'disproportionate to the inciting event'. Symptoms include burning pain, allodynia, oedema, discoloration and abnormal sweating. Despite the clinical impression of pain secondary to overactivity of the sympathetic system, there is little scientific evidence that intravenous guanethidine (an a-adrenoreceptor antagonist) is effective. A diagnosis of RSD can be made despite a lack of response to a sympathetic block RSD is simply a collection of symptoms of unknown pathology.

Parasympathetic agonists

Synthetic parasympathetic agonists (e.g. carbachol, bethanechol) produce predominantly muscarinic effects and have been used historically as gastrointestinal tract and bladder smooth muscle stimulants. Bethanechol is not hydrolysed by AChE and its action lasts several hours. Pilocarpine is a naturally occurring agonist which is used as a topical miotic in the treatment of glaucoma. Bradycardia, flushing, sweating and excessive salivation are predictable adverse effects, which may occur after topical or systemic administration.

Organophosphorus compounds

These substances are considered to be irreversible inhibitors of acetylcholinesterase, as by phosphorylation of the enzyme they produce a very stable complex which is resistant to reactivation or hydrolysis. Synthesis of new enzyme must occur before recovery. These agents, which include di-isopropylfluorophosphonate (DFP) and tetraethylpyrophosphate (TEPP), are used as insecticides and chemical warfare agents. They are readily absorbed through the lungs and skin. Poisoning is not uncommon among farm workers. Muscarinic effects, such as salivation, sweating and bronchospasm, are combined with nicotinic effects, such as muscle weakness. Central nervous effects such as tremor and convulsions may occur, as may unconsciousness and respiratory failure. Reactivators of acetylcholinesterase are used to treat this form of poisoning they include pralidoxime and obidoxime. Atropine, anticonvulsants and artificial ventilation may be necessary. Chronic exposure may produce a polyneuritis....

Minimum alveolar concentration MAC

Control of depth of anaesthesia by varying the inspired concentration of volatile agent requires constant assessment of the patient's reaction to anaesthesia and surgery to produce adequate anaesthesia, while avoiding overdosage and excessively 'deep' anaesthesia. This rapid control is one of the main advantages of inhalation anaesthesia. The signs of inadequate depth of anaesthesia include tachypnoea, tachycardia, hypertension and sweating.

Assessment Of Consciousness

Therefore, that an anaesthetist strives to maintain unconsciousness. Unfortunately, at present, there is no reliable monitor and the anaesthetist relies upon administering an adequate dose of anaesthetic whilst observing for signs of light anaesthesia (excess sympathetic activity manifest as sweating, tachycardia, hypertension, dilatation of pupils and pallor). Recently, considerable attention has been directed to developing monitors of electrical function of the brain which are thought to vary with consciousness. Other uses are shown in Table 38.13.

History and Geography

Moving back in time, Hippocrates describes an apparent outbreak of relapsing fever on the island of Thassus, off Thrace, and it is possible that the yellow fever of seventh-century Europe may have been relapsing fever. The disease may also have been among those constituting the epidemics of sweating sickness that affected England in 1485-1551. There were probably a series of relapsing fever epidemics in late-eighteenth-century Gloucestershire, and the first reliable observation of the illness was recorded in Dublin by John Rutty in 1739. The disease was observed principally in Britain and Ireland before the mid-nineteenth century, when it became more active. An outbreak in Scotland in 1841 spread south into England, and from there to the United States. The disease was present, with typhus, in Ireland during the Great Famine of 1846-50. Epidemics also occurred in Prussia (1846-8) and Russia (1864-5), which presaged repeated outbreaks in Germany and Russia during the remainder of the...

Classification Clinical Manifestations and Pathology

Tion of the diaphragm and chest muscles. The eyes may roll up or turn to one side, and the tongue may be bitten. After this, a period of jerky, clonic, spasms alternately flex and extend the muscles of the head, face, and extremities. During this phase, the patient may injure him- or herself as well as be incontinent. Cyanosis is generally marked. Breathing is deep, and there is sweating and salivation. Subsequent to the seizure, the patient may wake in a confused state (postictal twilight state) and even display some bizarre behavior. Sometimes patients are hard to arouse, sleep for hours, and awaken with headache or sore muscles. Although most tonic-clonic seizures last for only a few minutes, some patients develop a series of seizures with no letup, or a continuous prolonged seizure. This is a serious condition known as status epilepticus, which may lead to death if immediate care is not provided.

The Acutely Ill Patient

The first task is to recognize when a patient is acutely ill. An unusual appearance or behavior may be the only sign. These include breathing difficulties, clutching the chest or throat, slurring of speech, confusion, unusual odor to the breath, sweating for no apparent reason, or uncharacteristic skin color (e.g., pale, flushed, or bluish).

Examination of the Infant

Heart history of murmur, cyanosis trouble feeding, sweating during feedings, squatting (in older infants and toddlers this is a symptom in children with tetralogy of Fallot, because squatting increases peripheral resistance and decreases the right-to-left shunting across the ventricular septal defect).

Evaluate General Appearance

The general appearance of the patient often furnishes valuable information as to the nature of the condition. Patients with renal or biliary colic writhe in bed. They squirm constantly and can find no comfortable position. In contrast, patients with peritonitis, who have intense pain on movement, characteristically remain still in bed because any slight motion worsens the pain. They may be lying in bed with their knees drawn up to help relax the abdominal muscles and reduce intra-abdominal pressure. Patients who are pale and sweating may be suffering from the initial shock of pancreatitis or a perforated gastric ulcer.

Black Widow Spider Envenomation Clinical Summary

The black widow spider (Latrodectus mactans) is the prototype for the genus Latrodectus, several members of which cause human disease. The black widow spider is not particularly aggressive but will defend her web, which is often found in woodpiles, basements, and garages. Most envenomations occur between April and October, with bites most commonly located on the hand and forearm. The clinical presentation of severe and sustained muscle spasm is produced by a neurotoxic protein, which causes the release of acetylcholine and norepinephrine at the presynaptic neuromuscular junction. The initial bite may be mild to moderately painful and is often missed. Within approximately 1 hour, local erythema and muscle cramping begin, followed by generalized cramping involving large muscle groups such as the thighs, shoulders, abdomen, and back. Associated clinical features can include fasciculations, weakness, fever, salivation, vomiting, diaphoresis, localized sweating at the envenomation site,...

Multiple choice questions

B independent of the activity level c affected by the sweating capacity d the same as 'comfortable' temperature conditions e the interval in which shivering responses occur f reduced in water. 3 In hot conditions a maximal sweating rate is not so important for endurance performance

Selection of Medication

Including dose-related hypertension, excessive sweating, and dry mouth (Thase, 2008a Thase et al., 2005). Hypertension, sweating, nausea, constipation, dizziness, sexual dysfunction Dry mouth, constipation, blurry vision, orthostatic hypotension, weight gain, somnolence, headache, sweating, sexual dysfunction

Confusion and Delirium

Delirium, usually associated with agitation, is a confusional state in which the autonomic nervous system is overactive. Symptoms include flushed face, dilated pupils, sweating, and rapid heartbeat. It may be caused by a physical problem, such as by a tumor affecting the central nervous system, organ failure, infection, or other complication. It may also be caused by the indirect effects on the central nervous system of certain medications (including chemotherapy agents). In contrast to agitated delirium (described above), some patients experience hypoactive delirium, where the confusion is associated with sleepiness and reduced activity and response.

Autonomic and Other Problems

Drooling may be accompanied by speech problems and dysphagia. Anticholinergics, botulinum toxin injections, and sublingual atropine can decrease drooling. Speech therapists perform swallowing studies to assess the risk of aspiration, and nutritionists optimize diet. Patients at high risk of aspiration or poor nutrition may require placement of a percutaneous endoscopic gastrostomy tube. Nausea improves if patients take their PD medications with meals or pharmacologic therapy (domperidone in Canada or trimethobenzamide). Sexual dysfunction or urinary problems may require a urolo-gic evaluation. Adjustment of PD therapy to increase on time, removal of drugs that decrease sexual response, and pharmacologic therapy (sildenafil or yohimbine) may help treat sexual dysfunction. Patients with urinary frequency may find a bedside urinal along with a decrease in evening fluids helpful. Improvement in PD symptom control can improve urinary frequency, but worsening symptoms may require...

What are some of the side effects of opioids

Nausea is common, especially at initiation of therapy, and usually responds to treatment with antiemetics. Constipation occurs in most patients, and prophylaxis is important, using dioctyl sodium sulfate (DSS) plus Senokot, two to four tablets at night. For more resistant constipation, polyethylene glycol (MiraLax) is often useful. Other side effects include itching (which is not an allergic reaction), sweating, and dry mouth. There may be sexual dysfunction due to opioid-induced lowered testosterone, which is treated by the use of a testosterone patch or gel.

Syndromes of Overactivation

GUSTATORY SWEATING Also known as Frey's syndrome, this results from anomalous re-innervation of sweat glands by axons intended for the parotid gland. Normally, sweat glands are innervated by postganglionic sympathetic fibers which are unique in that they use acetylcholine as the transmitter (rather than norepinephrine). The parotid gland is innervated by postganglionic parasympathetic fibers also using acetylcholine as their transmitter to regulate salivary flow. After parotidectomy, the cholinergic fibers originally intended for the parotid gland end up innervating the sweat glands. While eating, stimuli that should cause an increase in salivation instead lead to facial sweating. Parotidectomy is the most common cause.

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