BACKGROUND: 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) has a long half-life of 5-10 years in human beings as a result of its high lipophilicity, and little or no metabolism. We monitored TCDD, its form, distribution, and elimination in Victor Yushchenko after he presented with severe poisoning. METHODS: In late December, 2004, a patient presented with TCDD poisoning; the levels in his blood serum (108000 pg/g lipid weight) were more than 50 000-fold greater than those in the general population. We identified TCDD and its metabolites, and monitored their levels for 3 years using gas chromatography and high-resolution mass spectrometry in samples of blood serum, adipose tissue, faeces, skin, urine, and sweat, after they were extracted and cleaned with different organic solvents. FINDINGS: The amount of unmodified TCDD in the samples that were analysed accounted for about 60% of TCDD eliminated from the body during the same period. Two TCDD metabolites-2,3,7-trichloro-8-hydroxydibenzo-p-dioxin and 1,3,7,8-tetrachloro-2-hydroxydibenzo-p-dioxin-were identified in the faeces, blood serum, and urine. The faeces contained the highest concentration of TCDD metabolites, and were the main route of elimination. Altogether, the different routes of elimination of TCDD and its metabolites accounted for 98% of the loss of the toxin from the body. The half-life of TCDD in our patient was 15.4 months. INTERPRETATION: This case of poisoning with TCDD suggests that the design of methods for routine assessment of TCDD metabolites in human beings should be a main aim of TCDD research in the metabolomic era. FUNDING: University of Geneva Dermatology Fund, and Swiss Centre for Applied Human Toxicology.
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Comment In: Lancet. 2009 Oct 3;374(9696):1131-219660808
Physical activity promotes health and prevents disease. When patients with atopic dermatitis (AD) undertake exercise, the itch often gets worse due to sweating, and this may reduce their engagement in physical exercise. The aim of this study was to determine the level of physical exercise in patients with AD compared with a control group from a normal population. Our hypothesis was that patients with AD have a lower level of physical exercise due to their skin disease. A total of 110 patients with AD and 196 subjects from a normal population, age range 20-34 years, answered a questionnaire. Eleven patients with AD underwent an in-depth interview. The patients with AD had the same level of physical exercise and attitude to physical exercise as the normal population. Therefore, our hypothesis could not be confirmed. In conclusion, the skin symptoms of AD do not appear to be an obstacle to moderate physical exercise.
The authors evaluated the autonomic and cardiovascular side effects of citalopram with particular emphasis on their relation to the age of treated patients. The data that formed the basis for the U.S. Food and Drug Administration approval of citalopram were provided by Lundbeck (Copenhagen, Denmark). This database included placebo-controlled short- and long-term studies in major depressed patients. The list of side effects comprised all "heart rate and rhythm disorders" as well as "autonomic nervous system disorders" that had been reported by at least 5% more than that reported for the placebo group of subjects. The database encompassed 1344 subjects treated with citalopram (20-60 mg/day) for a period of no less than 6 weeks. Statistically significant age-related distribution was found for five side effects: bradycardia, nausea, diarrhea, sweating and headache. Bradycardia was more prevalent in elderly (>65 years) patients as compared to the younger population (2.4% vs. 0.2%, P
In a retrospective survey of 1112 patients with atopic dermatitis we found that the age of onset of lesions localized to the lower gluteal and posterior femoral regions reached its peak at the age of 7 to 8 years. We speculated that this is due to sweat retention caused by prolonged sitting when these predisposed individuals start school.
In this chapter, I have presented a potpourri of examples of proper clothing to wear during various exercise demands in different environments. These examples are not wholly exact for all persons. For example, during the 1984 Olympics in Los Angeles, clothing wear related to the particular environment was totally different. We have already described the aerodynamic necessities of cyclists and runners. At the other extreme, equestrians had to contend with a warm, moderately humid environment, plus a solar load that added to the effective heat stress, while wearing clothing having clo values of nearly 0.8-0.9, plus headgear that limited evaporative heat loss. Obviously, garments with high water vapor permeation and bellows properties were necessary. Runners in the marathon faced equal thermal challenges. In addition, they incurred variable levels of hypovolemia and cardiovascular strain. A. Salazar, for example, was advised to omit shower sprays, and he ran with a prototype high-permeability singlet. The excessive wetting plus time to maneuver to the spray was deemed of no value, since Mr. Salazar chafes easily from wet clothes (L. Armstrong, personnel communication). One interesting response to this advice is to consider the clothed runner as a wet globe thermometer under forced convection. A high-contact fabric, especially one like cotton, does allow evaporative cooling, provided that the skin-ambient vapor pressure gradient is not diminished by high relative humidity. Salts in sweat may reduce the skin's vapor pressure ; however, Woodcock and Breckenridge point out that "secreted sweat (especially with heat acclimation) is so dilute that no appreciable lowering of vapor pressure would occur unless sweat were concentrated many times by evaporation." Thus, the degree of "human" wet bulb depression simulated by a completely wet runner may or may not be an advantage, since all other variables are also constant (i.e., humidity, weight of clothing as in Figure 13, etc.) or the level of hypovolemia is not excessive and the person is fully heat acclimated. Problems such as these may be theoretical, but they serve to show that the thermal biophysics and physiology of exercise follow similar fundamental pathways that can be highly pertinent. As we sought to point out in this chapter, these pathways have merged in the last 30 years with developments such as warmth without bulk for backpackers (which is a welcomed contrast to heavy arctic wear), materials that allow athletes to remain somewhat comfortable while sweating, and other advances that luckily have replaced the less appealing sports apparel such as the old woolen baseball uniform.(ABSTRACT TRUNCATED AT 400 WORDS)
Palmar, axillary, and plantar hyperhidrosis is often socially, emotionally, and physically disabling for adolescents. The authors report surgical outcomes in all adolescents treated for palmar hyperhidrosis via bilateral thoracoscopic sympathectomy at the Barrow Neurological Institute by the senior author.
A prospectively maintained database of all adolescent patients undergoing bilateral thoracoscopic sympathectomy between 1998 and 2006 (inclusive) was reviewed. Additional follow-up was obtained as needed in clinic or by phone or written questionnaire.
Fifty-four patients (40 females) undergoing bilateral procedures were identified. Their mean age was 15.4 years (range 10-17 years). Average follow-up was 42 weeks (range 0.2-143 weeks). Hyperhidrosis involved the palms alone in 10 patients; the palms and axilla in 6 patients; the palms and plantar surfaces in 17 patients; and the palms, axilla, and plantar surfaces in 21 patients. Palmar hyperhidrosis resolved completely in 98.1% of the patients. Resolution or improvement of symptoms was seen in 96.3% of patients with axillary and 71.1% of those with plantar hyperhidrosis. Hospital stay averaged 0.37 days with 68.5% of patients discharged the day of surgery. One patient experienced brief intraoperative asystole that resolved with medications and had no long-term sequelae. Otherwise, no serious intraoperative complications occurred. No patient required chest tube drainage. The percentage of patients who reported satisfaction and willingness to undergo the procedure again was 98.1%.
Biportal, bilateral thoracoscopic sympathectomy is an effective and low-morbidity treatment for severe palmar, axillary, and plantar hyperhidrosis.
BACKGROUND: The purpose of this study was to describe the characteristics and outcome in relation to sex in consecutive patients who were transported by an ambulance due to symptoms arousing suspicion of acute coronary syndrome. MATERIAL/METHODS: Our research involved all patients transported by ambulance over a 3-month period in the community of Göteborg due to such symptoms. The P-values were age adjusted. RESULTS: Of the 930 transported patients fulfilling the given criteria, 452 (49%) were of women. The women were older and had a lower incidence of previous acute myocardial infarction, angina pectoris, and current smoking. Women less frequently had a final diagnosis of acute coronary syndrome (22.3% vs 36.6%; p
From: Fortuine, Robert et al. 1993. The Health of the Inuit of North America: A Bibliography from the Earliest Times through 1990. University of Alaska Anchorage. Citation number 979.
Cited in: Fortuine, Robert. 1968. The Health of the Eskimos: a bibliography 1857-1967. Dartmouth College Libraries. Citation number 203.
In six male subjects the sweating thresholds, heart rate (fc), as well as the metabolic responses to exercise of different intensities [40%, 60% and 80% maximal oxygen uptake (VO2max)], were compared at ambient temperatures (Ta) of 5 degrees C (LT) and 24 degrees C (MT). Each period of exercise was preceded by a rest period at the same temperature. In LT experiments, the subjects rested until shivering occurred and in MT experiments the rest period was made to be of exactly equivalent length. Oxygen uptake (VO2) at the end of each rest period was higher in LT than MT (P less than 0.05). During 20-min exercise at 40% VO2max performed in the cold no sweating was recorded, while at higher exercise intensities sweating occurred at similar rectal temperatures (Tre) but at lower mean skin (Tsk) and mean body temperatures (Tb) in LT than MT experiments (P less than 0.001). The exercise induced VO2 increase was greater only at the end of the light (40% VO2max) exercise in the cold in comparison with MT (P less than 0.001). Both fc and blood lactate concentration [1a]b were lower at the end of LT than MT for moderate (60% VO2max) and heavy (80% VO2max) exercises. It was concluded that the sweating threshold during exercise in the cold environment had shifted towards lower Tb and Tsk. It was also found that subjects exposed to cold possessed a potentially greater ability to exercise at moderate and high intensities than those at 24 degrees C since the increases in Tre, fc and [1a]b were lower at the lower Ta.
