1/8. Episodic hypothermia with hyperhidrosis in a pregnant woman.BACKGROUND: Episodic hypothermia with hyperhidrosis is a disorder of thermoregulation, believed to be secondary to a hypothalamic dysfunction, which affects the body's thermoregulatory centers. During this rare condition, the body may sweat profusely in an attempt to maintain a lowered body temperature set point. The exact cause of episodic hypothermia with hyperhidrosis is not known.CASE: A multigravida at 35 weeks' gestation presented with symptoms consistent with hypothermia, although she was diaphoretic. Her basal body temperature was 91.2F, with a lowered blood pressure and heart rate. The fetal heart rate was 130 beats per minute and reassuring. Assisted rewarming occurred over a period of 3 hours, after which her temperature stabilized at 97.9F. The remainder of the pregnancy was uneventful, and the patient delivered a term infant with no apparent adverse effects from this episode.CONCLUSION: Episodic hypothermia with hyperhidrosis should be considered as a potential cause of hypothermia during pregnancy.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/8. Treatment of pachyonychia congenita with plantar injections of botulinum toxin.pachyonychia congenita (PC) is a rare genodermatosis which may be associated with painful, focal hyperkeratosis on the soles. Plantar sweating at high ambient temperatures increases the blistering of the callosities. We report three patients with PC who had great problems in walking, especially during summer time. They were treated with intracutaneous plantar injections of botulinum toxin type A (Dysport, 100 U mL(-1); Ipsen, Slough, U.K.) after prior intravenous regional anaesthesia of the foot with a low tourniquet and 25 mL prilocaine (5 mg mL(-1)). Within a week all three patients experienced dryness and a remarkable relief of pain from plantar pressure sites. The effect duration was 6 weeks to 6 months. Repeated injections over a 2-year period confirmed the good results, with no side-effects or tachyphylaxis noted.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/8. Management of reflex sweating in spinal cord injured patients.reflex sweating can be a problem for cervical spinal cord injured patients. Patient comfort and skin breakdown have been the major concerns. Five patients were studied prospectively, using a patch containing 1.5mg of scopolamine. Patches were changed every third day. Each patient was carefully monitored before and after application of the patch for signs and symptoms of anticholinergic side effects such as dizziness, blurred vision and dry mouth. patients were also monitored for changes in patch signs before and after use, including residual urine volumes, blood pressure, heart rate, and mental status. Our study indicates that topical scopolamine successfully controlled reflex sweating in 5 patients without anticholinergic side effects.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/8. hypertension after brain injury: case report.hypertension after brain injury requires comprehensive evaluation and management. Focal brain injury to centers of blood pressure regulation, high levels of circulating catecholamines from generalized trauma or intracranial lesions, increased intracranial pressure, pheochromocytomas unmasked after trauma, and occult spinal cord injury with hyperreflexia represent possible causes of hypertension after brain injury. This case of a brain-injured patient who had episodes of hypertension and diaphoresis with catecholamine elevations in plasma and urine, and evidence of hypothalamic-pituitary dysfunction, demonstrates the importance of a thorough neuroendocrine evaluation in brain-injured patients with hypertension. When high levels of catecholamines are found, without further evidence of a pheochromocytoma, treatment with a beta blocker is appropriate.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
5/8. Symmetrical lividity of the palms and soles.Symmetrical lividity (SL) was the term coined by Pernet in 1925 for symmetrical, bluish-red plaques on the soles of the feet, accompanied by hyperhidrosis and not corresponding to areas of pressure or patterns of innervation. We report two patients with a persistent eruption of the palms analogous to that described by Pernet on the feet. Unlike most reported cases of SL, our patients did not respond to topical drying treatments, but one patient partially responded to tretinoin. There appear to be two forms of SL: transient, which responds to drying; and persistent which does not respond to drying. The hyperhidrosis studied in one of our two patients was significantly greater within the plaques of SL than the normal palm. While we could suppress the hyperhidrosis with topical therapy, this failed to clear his hyperkeratosis or eliminate the livid color.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/8. Reversible diencephalic dysfunction: episodic hyperhidrosis due to a trapped third ventricle.We present a patient with episodic hyperhidrosis (EH) who had 15 attacks per day for 3 years following placement of a lateral ventricular shunt. MRI revealed that she had an isolated third ventricle. Stereotactic shunting of the third ventricle resulted in immediate and complete resolution of her symptoms. We suggest that this patient had periodic rises in third ventricular pressure resulting in episodic diencephalic dysfunction and EH.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/8. Paroxysmal sympathetic storms ("diencephalic seizures") after severe diffuse axonal head injury.We describe a patient with a severe traumatic head injury who exhibited paroxysmal sympathetic storms, similar to those described in "diencephalic seizures." No epileptiform activity was evident on electroencephalography, and therapeutic levels of anticonvulsants failed to alter the spells; however, use of morphine sulfate abolished them. The features of this and several previously reported cases refute the primary roles of the diencephalon and seizures in this syndrome. Rather, in the setting of already compromised autonomic neuronal integrity, subtle fluctuations in intraventricular pressure or activation of reflexes triggered from muscle mechanoreceptors or chemoreceptors during episodes of hypertonia are more likely. "Paroxysmal sympathetic storms," a more appropriate descriptive term for these phenomena, should be recognized; thus, unnecessary diagnostic evaluations can be minimized, and appropriate therapy can be initiated.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/8. Negative pressure pulmonary oedema induced by direct suctioning of endotracheal tube adapter.PURPOSE: Negative pressure pulmonary oedema (NPPE) is a well-recognized but rare complication secondary to upper airway obstruction such as laryngeal spasm during emergence from general anaesthesia. Cauterization of the second and third thoracic sympathetic ganglia is a treatment for hyperhidrosis of the hands. We report a case of NPPE induced by direct suctioning of the endotracheal tube adapter during thoracic sympathetic ganglionectomy without recognized upper airway obstruction. CLINICAL FEATURES: A 19-yr-old otherwise healthy, non-smoking man was scheduled for elective bilateral chest endoscopic ablation of the second and third thoracic sympathetic ganglion for hyperhidrosis of the hands under general anaesthesia. To view and cauterize the ganglion with the endoscope, the surgeon requested cessation of positive pressure ventilation. As the surgeon could not satisfactorily visualize the target ganglia, he requested brief application of wall suction via the ETT tube adapter. A pressure of -100 mmHg was generated which lasted for three to four seconds. The goal was to reduce further the lung volume by increasing the pneumothorax produced by the endoscope. The patient developed negative pressure pulmonary oedema without upper airway obstruction. CONCLUSION: This case demonstrated that intrathoracic negative pressure generated by direct ETT adapter suctioning may produce pulmonary oedema similar to that induced by laryngeal spasm during the emergence of general anaesthesia.- - - - - - - - - - ranking = 9keywords = pressure (Clic here for more details about this article) |