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The skin also serves as a site for exchange of water and electrolytes (through sweating), and for exchange of heat, which is a major byproduct of cellular metabolism that must be removed from the body. Increasing blood flow through the skin enhances heat loss from the body, while decreasing blood flow diminishes heat loss.
The viscera, when they are healthy, give rise to minimal conscious sensation. Fullness, gurgles, and a sensation of gas are the consequences of ingestion or sources of a need for elimination. In day-to-day activities, these sensations often increase to levels of mild discomfort, but when viscera become diseased or inflamed, the same stimuli that produce innocuous sensations can become an overwhelming source of sensations that can stop all activity and can demand complete attention. Nausea occurs commonly with visceral pains as do other autonomic responses such as sweating to the point of diaphoresis, piloerection, and dyspnea. It is clinical lore that visceral pains produce strong emotional responses to the point that they may appear out of proportion to the perceived intensity of the pain. Strong emotions are not only evoked by visceral sensations but also serve to evoke further visceral sensations such that a positive
Hypernatremia is caused by renal and nonrenal disorders. A common nonrenal cause is hypotonic dehydration from severe diarrhea, extensive burns, or excessive sweating without proper fluid replacement. Infants, the elderly, and other patients not able to ingest sufficient amounts of water, and who are not properly hydrated, will also experience hypernatremia. Renal loss of water, such as in nephrogenic diabetes insipidus, can also cause hypernatremia. Serum osmolality and urinary sodium levels can help to differentiate renal loss of water versus nonrenal causes.14
The respiratory problems might lead to pneumonia with high fever. Then the cord-injured patient is faced with another effect of autonomic disturbances that is the inability to lose excess heat by sweating. This inability might be life threatening during high fever or in an extremely warm climate. Several years ago a young man was treated at Sa-hlgrenska University Hospital. He had sustained a C4 spinal cord injury and had an aspiration of fluid into his lungs during the transport to hospital. He developed pneumonia and his temperature increased from 41.0 to 42.4 C and, at this high temperature, he died of a cardiac arrest.
Integumentary loss sweating, burns To determine the cause of the hypotonic hyponatremia, the physician must clinically assess the volume status of the patient by history and physical examination. A history of vomiting, diarrhea, or other losses, such as profuse sweating, suggests hypovolemia, as do flat neck veins, dry oral mucous membranes, and diminished urine output. In cases of significant hypovolemia, there is a physiologic increase in ADH in an attempt to retain free water to maintain circulating volume, even at the expense of hypotonicity. In these cases, the excess ADH is not inappropriate as in SIADH, but extremely appropriate. At this point, one can check the urinary sodium levels. In hypovolemia, the kidney should be avidly retaining sodium, so the urine sodium level should be 20 mmol L, the kidneys do not have the ability to retain sodium normally. Either kidney function is impaired by the use of diuretics, or the kidney is lacking necessary hormonal stimulation, as in...
Pilocarpine, from a South American plant (Pilocarpus spp.), acts directly on end-organs innervated by postganglionic nerves (parasympathetic system plus sweat glands) it also stimulates and then depresses the central nervous system. The chief clinical use of pilocarpine is to lower intraocular pressure in chronic simple glaucoma, as an adjunct to a topical beta-blocker it produces miosis, opens drainage channels in the trabecular network and improves the outflow of aqueous humour. Oral pilocarpine is available for the treatment of xerostomia (dry mouth) in Sjogren's syndrome, or following irradiation of head and neck tumours. The commonest adverse effect is sweating adverse cardiac effects have not been reported.
Local application also reduces sweating and may allay itching. As a skin antiseptic 70 by weight (76 by volume) is most effective. Stronger solutions are less effective. Alcohol injections are sometimes used to destroy nervous tissue in cases of intractable pain (trigeminal neuralgia, carcinoma involving nerves).
Pheochromocytomas are tumors that produce excess catecholamines. The majority of pheochromocytomas arise from the adrenal medulla. The classic symptoms of pheochomocytomas are those attributable to excess hormone production, which include recurring episodes of sweating, headache, and a feeling of heightened anxiety. Although the disease is rare, any patient with hypertension that is difficult to control should be assessed for pheochromocytoma. The peak incidence for the disorder is in the third to fifth decades of life.
Summary An 18-year-old G2 PI at 35 weeks' gestation is taking PTU for Graves' disease. She has a 1-day history of palpitations, nervousness, sweating, and diarrhea. On examination, her blood pressure is 150 110, heart rate 140 bpm, respiratory rate 25 min. and temperature 100.8 F. The patient appears anxious, disoriented, and somewhat confused. The thyroid is mildly tender and enlarged. Deep tendon reflexes are 4+ with clonus. She has leukocytosis.
The diagnosis of cystic fibrosis is made by clinical symptoms and positive sweat chloride test. People with cystic fibrosis have unusually large amounts of chloride in their sweat when compared to reference ranges of healthy individuals, due to the CFTR defect. Iontophoresis is used to facilitate sweating with the drug pilocarpine. The sweat is collected on sterile gauze over a period of a few minutes and later analyzed for the amount of chloride present.27 Genetic analysis can be used to pilocarpine - a muscarinic alkaloid drug that can induce sweating
There is some evidence of a lessened awareness of hypoglycaemia with human insulin, i.e. the counter-regulatory physiological responses to animal and human insulin may differ. It is claimed that with human insulin patients experience less adrenergic symptoms (sweating, tremor, palpitations), which are such a useful warning, although the neurological (neuroglycopenic) symptoms (dizziness, headache, inability to concentrate) are unchanged. It now seems likely that the reduced awareness is a paradoxical response to improved glycaemic control. Thus patients with a normal level of glycosylated haemoglobin (HbAlc) show no reduction in glucose uptake in the brain during episodes of hypoglycaemia that trigger a symptomatic and neuroendocrine response in patients with elevated levels of HbAlc (see Boyle et al 1995, in Guide to Further Reading).
Fi-adrenoceptor blocking drugs impair the sympathetic mediated (p2-receptor) release of glucose from the liver in response to hypoglycaemia and also reduce the adrenergic-mediated symptoms of hypoglycaemia (except sweating). Insulin hypoglycaemia is thus both more prolonged and less noticeable. A diabetic needing P-adrenoceptor blocker should be given a Pj-selective member, e.g. bisoprolol.
The activity of the nephron in the kidney is controlled by a person's choices and environment as well as hormones. For example, if a person consumes large amounts of protein, much urea will be in the blood from the digestion of the protein. Also, on a hot day, a body will retain water for sweating and cooling, so the amount of urine is reduced.
Weight loss in PCC patients is usual, although obesity cannot exclude the diagnosis. The weight reduction is partly due to increased metabolic rate, excessive sweating, and heat intolerance. Fever may also be present 31-33 . Weight loss is sustained by an activation of lipolysis in white adipose tissue. An activation of brown fat is also evident in patients with PCC 34 . It is noteworthy that, while adipose tissue constitutes the bulk of body fat stores and primarily has as an energy storage function, brown adipose tissue functions principally to generate heat in humans and many other species 34 .
Find out whether the patient has used a thermometer to measure the temperature. (Errors in technique can lead to unreliable information.) Has the patient felt feverish or unusually hot, noted excessive sweating, or felt chilly and cold Try to distinguish between subjective chilliness and a shaking chill, with shivering throughout the body and chattering of teeth. Feeling cold, goosebumps, and shivering accompany a rising temperature, while feeling hot and sweating accompany a falling temperature. Normally the body temperature rises during the day and falls during the night. When fever exaggerates this swing, night sweats occur. Malaise, headache, and pain in the muscles and joints often accompany fever. Feelings of heat and sweating also accompany menopause. Night sweats occur in tuberculosis and malignancy.
You see, when in public, I worry more than the average person about being scrutinized and negatively judged. My anxiety about this is manifest through sweating, constant worry about being inadequate, and avoidance of most, but not all, social situations. What I'd like to do in therapy is build my self-confidence, increase my positive self-talk, and learn to calm myself down when I'm starting to get upset.
The clinical presentation of patients with PV can be nonspecific, and may include headaches (48 ), weakness (47 ), dizziness (43 ,) pruritus (43 ), and excessive sweating (33 ). Most patients are asymptomatic and come to a hematologist's attention based on a routine complete blood count (CBC).
Chronic cough represents a common complaint and a large portion of health care dollars. Ironically, the complications from the cough, including subjective perceptions of exhaustion and self-consciousness, along with symptoms of hoarseness, musculoskeletal pain, sweating, and urinary incontinence, usually drive the patient to the doctor's office. Physiologically, the cough serves two main functions (a) to protect the lungs against aspiration and (b) to clear secretions or other material into more proximal airways to be expectorated from the tracheobronchial tree. Patients with hemoptysis, immunocompromised stales, comorbidities such as COPD or cystic fibrosis, current or previous infections such as tuberculosis or HIV. and significant symptoms such as weight loss, night sweats, and chills are beyond the scope of this discussion.
Diminished by inhibition of peristalsis and increase of sphincter tone, glycogenolysis takes place in the liver, the supradrenal medulla is stimulated to secrete, and there is cutaneous sweating and pilo-erection. The sympathetic pelvic nerves inhibit bladder contraction and are motor to the internal vesical sphincter.
The drugs are well tolerated but headache, dizziness, reversible confusion, constipation and diarrhoea may occur. In addition, urticaria, sweating and somnolence are reported with nizatidine. The drugs do not inhibit hepatic microsomal enzymes and do not block androgen receptors.
A panic attack is a discrete period of intense fear or discomfort that develops abruptly and peaks within 10 minutes. It involves at least four of the following symptoms (1) palpitations, pounding heart, or accelerated heart rate, (2) sweating, (3) trembling or shaking, (4) shortness of breath or a sense of smothering, (5) a feeling of choking, (6) chest pain or discomfort, (7) nausea or abdominal distress, (8) feeling dizzy, unsteady, lightheaded, or faint, (9) feelings of unreality or depersonalization, (10) fear of losing control or going crazy, (11) fear of dying, (12) paresthesias (numbness or tingling), (13) chills or hot flushes.
Symptoms of hypoglycaemia were first reported in relation to tumours of the pancreas (Wilder 1927). As early as 1927, the symptoms of hypoglycaemia were recognised as forming two groups the first occurring during mild reactions comprising anxiety, weakness, sweating, hunger, tremor and palpitations and the second more severe group including mood changes, speech and visual disturbances, drowsiness, convulsions and coma (Harrop 1927). It was also noted that some patients did not experience the usual symptoms of hypoglycaemia until their blood glucose had reached much lower concentrations (Lawrence 1941). Symptom profiles provoked by hypoglycaemia are idiosyncratic and vary in character, pattern and intensity between individuals and even within individuals over time (Pennebaker et al. 1981). Sweating
A 55-year-old postal worker presents to the emergency room with chest pain. On a scale of 1 to 10, he rates the pain a 9. It started 30 minutes ago and hasn't gone away. He has never had it before. He denies any injury or trauma he has no medical conditions that are being treated. Nothing makes the pain better or worse. When questioned further, he has noticed nausea and increased sweating with the pain. Based on this description, which of the seven attributes of this symptom have not been addressed
The essential feature of social phobia is a marked and persistent fear of performance situations when patients feel they will be the centre of attention and will do something humiliating or embarrassing. The situations that provoke this fear can be quite specific, for example public speaking, or be of a much more generalised nature involving fear of most social interactions, for example initiating or maintaining conversations, participating in small groups, dating, speaking to anyone in authority. Exposure to the feared situation almost invariably provokes anxiety with similar symptoms to those experienced by patients with panic attacks but some seem to be particularly prominent and difficult i.e. blushing, tremor, sweating and a feeling of 'drying up' when speaking.
Nerve agents bind to the active site of the AChE enzymes, thus preventing them from hydrolyzing ACh. The enzyme is inhibited irreversibly, and the return of esterase activity depends on the synthesis of new enzyme ( 1-3 per day in humans). All agents are highly lipophilic and readily penetrate the CNS. Acetylcholine is the neurotransmitter at the neuromuscular junction of skeletal muscle, the preganglionic nerves of the autonomic nervous system, the postganglionic parasympathetic nerves, as well as muscarinic and nicotinic cholinergic synapses within the CNS. Following nerve agent exposure and the inhibition of 60 of the AChE enzyme pool, levels of ACh rapidly increase at the various effector sites resulting in continuous overstimulation. It is this hyperstimulation of the cholinergic system at central and peripheral sites that leads to the toxic signs of poisoning with these compounds. The signs of poisoning include miosis (constriction of the pupils), increased tracheobronchial...
In contrast to uncomplicated starvation, where the energy expenditure is decreased as compensation, an elevated metabolic rate was recognised. Several symptoms such as tachycardia, hyperp-noea, sweating and a rise in body temperature indicated an increase of the metabolic rate that was in sharp contrast to the reduced energy supply in these patients 25 . In 1916, the increase in the basal metabolic rate was directly documented 26, 27 . Increased metabolic demands of several specific tissues were discussed as one underlying reason for this finding. Decreased efficiency of the respiratory system due to reduced compliance 28 and capacity of the lungs, together with hyperventilation, result in higher energy demands of the respiratory muscles 29 . In the case of patients with congestive heart failure it was also suggested that the hypertrophic myocardium may contribute to the hypermetabolism in chronic heart failure 30, 31 . The combination of an increase in total energy consumption of the...
A 49-year-old woman complains of irregular menses over the past 6 months, feelings of inadequacy, vaginal dryness, difficulty sleeping, and episodes of warmth and sweating at night. On examination, her blood pressure is 120 68, heart rate 90 bpm, and temperature 99 F. Her thyroid gland is normal to palpation. Cardiac and lung examinations are unremarkable. Breast examination reveals symmetrical breasts, without masses or discharge. Examination of the external genitalia does not reveal any masses.
This 49-year-old woman complains of irregular menses, feelings of inadequacy, and intermittent sensations of warmth and sweating. This constellation of symptoms is consistent with the perimenopause, or climacteric. Between the ages of 40 and 51 years, the majority of women begin to experience symptoms of hypoestrogenemia, primarily hot Hushes. Hot Hushes, which are the typical vasomotor change due to decreased estrogen levels, are associated with skin temperature elevation and sweating lasting for 2 to 4 min. The low estrogen concentration also has an effect on the vagina by decreasing the epithelial thickness, leading to atrophy and dryness. Elevated serum FSH and LH levels are helpful in confirming the diagnosis of the perimenopause. Treatment for hot Hushes includes estrogen replacement therapy with progestin. When a woman still has her uterus, the addition of progestin to estrogen replacement is important for preventing endometrial cancer.
Though GH exerts a lipolytic effect, patients affected by acromegaly generally do not show significant weight loss. However, a decreased fat mass has been reported 39 . The most common somatic findings include acral growth (gigantism if acromegaly has a prepubertal onset), facial changes, voice reduction, arthralgias, excessive sweating, weakness, and malocclusion. Hypertension, reduced glucose tolerance or diabetes mellitus, and dyslipidaemia (hyper-trygliceridaemia) commonly occur. Although GH exerts an anabolic effect on muscle, patients with acromegaly often suffer from myopathy, with muscular weakness 36 .
The cystic fibrosis transmembrane regulator (CFTR). CFTR appears to be part of a cyclic AMP-regulated chloride channel, which regulates chloride and sodium transport across epithelial membranes. The disease causes the exocrine glands to become obstructed by viscous material. The blockage leads to cellular damage within the tissue. Blockage of the pulmonary bronchi with thick mucus is associated with recurrent or chronic pulmonary infections. Pancreatic insufficiency leads to poor digestion and poor growth pattern with a deficiency of fat-soluble vitamins. Excessive sweating leads to episodes of hypotonic dehydration and circulatory failure. In arid climates, infants may present with chronic metabolic alkalosis. Salt crystal formation on the skin is an indicator of cystic fibrosis.28
This tumour of chromaffin tissue, usually arising in the adrenal medulla, secretes principally noradrenaline, but also variable amounts of adrenaline. Symptoms are related to this. Hypertension may be sustained or intermittent. If the tumour secretes only noradrenaline, which stimulates a and Pj adrenoceptors, rises in blood pressure are accompanied by reflex bradycardia due to vagal activation this is sufficient to overcome the chronotropic effect of p., receptor stimulation. The recognition of bradycardia at the time of catecholamine-induced symptoms (e.g. anxiety, termor or sweating) is useful in alerting the physician to the possibility of this rare syndrome, since physiological sympathetic nervous activation causes is coupled to vagal withdrawal, and causes tachycardia. If the tumour also secretes adrenaline, which stimulates a, p and p2 adrenoceptors, blood pressure and heart rate change in parallel. This is because stimulation of the vasodilator P2 receptor in resistance...
Phencyclidine, known as angel dust, is usually smoked, although it can be taken orally, intravenously, or by nasal inhalation. It is commonly used as an additive to other drugs, such as cannabis or LSD, and the symptoms and signs may vary greatly (49). At low doses, euphoria, relaxation, and an altered body image may occur, but at higher doses, there may be agitation, bizarre behavior, and a paranoid psychosis (50). Analgesia occurs, which may lead to self-injury. Physical effects include nystagmus (lateral and vertical), and with severe intoxication there is adrenergic stimulation with hypertension, tachycardia, flushing, hyperthermia, and cholinomimetic stimulation with sweating, hypersalivation, miosis, dystonia, ataxia, and myoclonus eventually resulting in coma, respiratory arrest, and circulatory collapse (51). Death may also result from intoxication or from violent behavior. Chronic effects of phen-cyclidine abuse include memory impairment, personality changes, and depression...
Tolerance develops to many effects of cannabis, including the high with chronic use, and an abstinence syndrome has been described with disturbed sleep, decreased appetite, restlessness, irritability, and sweating. Withdrawal symptoms are usually mild and short-lived, although they may be more severe in heavy regular users (82).
A few seconds after the injection (which was given as rapidly as possible, to avoid total destruction in the blood) the patient sat up 'with knees drawn up to the chest, the arms flexed and the head bent forward. There were repeated violent coughs, sometimes with flushing. Forced swallowing and loud peristaltic rumblings could be heard'. Respiration was laboured and irregular. 'The coughing abated as the patient sank back in the bed. Forty seconds after the injection the radial and apical pulse were zero and the patient became comatose.' The pupils dilated, and deep reflexes were hyperactive. In 45 seconds the patient went into opisthotonos with brief apnoea. Lachrymation, sweating and borborygmi were prominent. The deep reflexes became diminished. The patient then relaxed and 'lay quietly in bed cold moist and gray. In about 90 seconds, flushing of the face marked the return of the pulse'. The respiratory rate rose and consciousness returned in about 125 seconds. The patients...
Different areas of the body begin sweating earlier than others, but soon the whole body is involved. If sweat evaporation occurs on the skin surface, then the full cooling power of evaporating sweat (670 W h kg) is felt. If the sweat is absorbed by clothing, then the full benefit of sweat evaporation is not realized at the skin. If the sweat falls from the skin, no benefit accrues. Sweating for a long time causes loss of plasma volume (plasma shift), resulting in some hemoconcentration (2 or more). This increased concentration increases blood viscosity, and cardiac work becomes greater.
Adverse effects include constipation, dry mouth and insomnia which occur in 10 of users. Less commonly, nausea, tachycardia, palpitations, raised blood pressure, anxiety, sweating and altered taste may occur. Blood pressure should be monitored closely throughout its use (twice weekly in the first 3 months). Contraindications include severe hypertension, peripheral occlusive arterial or coronary heart disease, cardiac arrhythmia, prostatic hypertrophy and those with severe hepatic or renal impairment. It should not be used to treat obesity of endocrine origin or those with a history of major eating disorder or psychiatric disease. Concomitant use with tricyclic antidepressants should be avoided (CNS toxicity).
Based on early observations of sweating, tachycardia, venoconstriction and systemic increased vascular resistance with reduced cutaneous and renal blood flow, an overactivity of the sympathetic nervous system was recognised. The finding of high norepinephrine levels in chronic heart failure patients by Chidsey, Harrison and Braunwald in 1962 supported this hypothesis 15 . The authors recognised this as a compensatory mechanism to improve cardiac performance.
Water is a critical nutrient for the athlete in training and competition. Working muscles produce heat, and water is lost during exercise as the body attempts to keep cool and dissipates heat through sweating. Ninety minutes of strenuous exercise in a 70-kg athlete will produce sweat water losses of 1.5-3.0 kg, depending on air temperature and hu-midity.5 lost, heavy sweating for periods of up to 2-3 hours has no significant effects on electrolyte concentrations in the body.5 Although salt (sodium chloride) tablets are often promoted for athletes, only in ultra-long endurance events do electrolyte losses in sweat become significant. A single post-exercise meal replaces all the electrolytes lost in moderate exercise.
This patient has symptoms and signs consistent with hyperthyroidism, including warm, moist skin caused by excessive sweating and cutaneous vasodilation a resting tremor an enlarged thyroid gland weight loss and tachycardia. Her irregular heart beat may be a manifestation of atrial fibrillation, which occurs in approximately 10 of hyperthyroid patients. Eye abnormalities are common in hyperthyroid states. Retraction of the upper lid, resulting in the thyroid stare is common. Graves disease has a unique ophthalmopathy that may cause a prominent exophthalmos (Fig. 15-1). The most common cause of noniatrogenic hyperthyroidism is Graves disease, an autoimmune thyroid disorder. Autoantibodies to the TSH receptors on the thyroid gland result in hyperfunctioning of the gland, with the result that the thyroid gland functions outside the usual control of the hypothalamic-pituitary axis. Graves disease commonly occurs in reproductive-age females and is much more common in women than men. The...
Palpation (3) With the patient standing, slide the fingers down the lumbar spine on to the sacrum. A palpable step at the lumbosacral junction is a feature of spondylolisthesis. Note any other curve irregularity (e.g. gibbus). Note also any change in friction (due to alterations in sweating patterns), which may help in the localization of any pathology.
Thyroxine or free thyroxine levels are not always necessary for diagnosis if hyper-thyroid symptoms of increased respiratory rate and pulse, weight loss, enlarged thyroid gland, fatigue, sweating, and exophthalmos are present and if TSH is less than 0.1 mU L (reference range of 0.4 to 4.2 mU L in an adult
Clinical features of overdose reflect the pharmacology of TCAs. Antimuscarinic effects result in warm, dry skin from vasodilatation and inhibition of sweating, blurred vision from paralysis of accommodation, pupillary dilatation and urinary retention. Adverse effects include postural hypotension (especially in the elderly) and dizziness. Less common are headache, irritability, apathy, insomnia, fatigue, ataxia, gastrointestinal disturbances including dry mouth and constipation, sexual dysfunction (especially anorgasmia), blurred vision, difficult micturition, sweating, peripheral oedema, tremu-lousness, restlessness and hyperthermia. Appetite may increase inappropriately, causing weight gain.
Cholinergic (muscarinic) syndromes comprise salivation, lachrymation, abdominal cramps, urinary and faecal incontinence, vomiting, sweating, miosis, muscle fasciculation and weakness, bradycardia, pulmonary oedema, confusion, CNS depression and fitting. Common causes include organophos-phorus and carbamate insecticides, neostigmine and other anticholinesterase drugs, and some fungi (mushrooms). Sympathomimetic syndromes include tachycardia, hypertension, hyperthermia, sweating, mydriasis, hyperreflexia, agitation, delusions, paranoia, seizures and cardiac arrhythmias. These are commonly caused by amphetamine and its derivatives, cocaine, proprietary decongestants, e.g. ephedrine, and theophylline (in the latter case, excluding psychiatric effects). Dinitro-compounds. Dinitro-orthocresol (DNOC) and dinitrobutylphenol (DNBP) are used as selective weed killers and insecticides, and cases of poisoning occur accidentally, e.g. when safety precautions are ignored. These substances can be...
SYMPTOMS Some symptoms of leukemia are fever, chills, and other flulike symptoms weakness and fatigue frequent infections loss of appetite and or weight swollen or tender lymph nodes, liver, or spleen easy bleeding or bruising tiny red spots under the skin swollen or bleeding gums sweating, especially at night and or bone or joint pain. Leukemia metastasizing to the brain may cause headaches, vomiting, confusion, loss of muscle control, and seizures. Leukemia cells can also colonize the testicles, where they cause pain and swelling the skin and eyes, where they produce sores and many other organs and tissues of the body.
However, during orientation week at college, Pam found it difficult to maintain her usual routine. She forgot to take pancreatic supplements at several meals and started to experience symptoms of stomach pain and vomiting. She also had a slight temperature and was sweating. She immediately saw her physician, who ordered laboratory tests to evaluate pancreatic function. The tests showed diminished pancreatic function, as evidenced by decreased amy-lase, and defective fat absorption, as evidenced by decreased serum cholesterol and increased stool fats.
Hyperhidrosis is a disorder ersulting in debilitating, excess sweating on one, or more commonly both sides of the body due to overactivity of the upper thoracic sympathetic chain. It usually involves the upper extremities, frequently coexistent with hyperhidrosis of the feet, and frequently has a hereditary component. In severe cases conservative measures including topical aluminum chloride compounds (Drysol), oral anticholinergics, iontophoresis (electrcial current transmission via tap water) and Botulinum toxin injections are wholly unsatisfactory. The single most effective treatment is thoracic sympathectomy which is curative for palmar hyperhidrosis and frequently markedly improves hyperhidrosis of the feet as well. The approach for thoracic sympathectomy for either hyperhidrosis or causal-gia can be done open under direct vision through the transaxillary approach. Alternatively, the entire ganglia and rami at the level of the second and third sympathetic ganglia are...
The signs and symptoms of malaria illness are variable, but most patients experience fever. Other symptoms often include headache, back pain, chills, muscle ache, increased sweating, malaise, nausea, and sometimes vomiting, diarrhea, and cough. Early stages cf malaria may resemble the onset of the flu. Between paroxysms, the patient may remain febrile or may become asymptomatic. Early in an infection, the cyclic patterns of fever may not be noticeable, but later, a clear cyclic trend with symptoms recurring at regular intervals occurs. Of the four species of parasite, only falciparum malaria can progress rapidly to the cerebral stage, where infected red cells obstruct the blood vessels in the brain. Cerebral malaria is a medical emergency best managed in an intensive care unit. Untreated cases can progress to coma, renal failure, liver failure,
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