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PubMed1988

Temperature-dependent skin disorders.

The skin is important in preserving homeostasis between man and his environment. One main role of the skin is in thermoregulation, where cutaneous blood flow, and hence skin temperature, vary widely in order to help preserve core body temperature. Under extreme conditions, frostbite or burns may occur. Prolonged exposure to moderate degrees of heat or cold can result in erythema ab igne and chilblains. Temperature plays a direct role in some of the physical urticarias and is one of several important pathogenic factors in conditions such as Raynaud's syndrome, cold panniculitis, and cryoglobulinemia. These and other temperature-dependent skin disorders are reviewed.

Animals↗
PubMed1987

Multicenter hypothermia survey.

A multicenter survey evaluated the clinical presentation, treatment, and outcome of accidental hypothermia. Data were collected from 13 emergency departments, with 401 of the 428 cases presenting during a two-year study period. Core temperatures ranged from 35 C to 15.6 C (mean, 30.57 C +/- 3.53) with 272 cases (63.6%) less than or equal to 32.2 C. There were no significant differences by age in presenting temperature, rewarming strategies, or mortality. The first hour rewarming rate was significantly (P less than .05) faster in the population less than or equal to 59 years (1.08 +/- 1.39 C/hr) than in those greater than or equal to 60 years (0.75 +/- 1.16 C/hr). Male core temperatures averaged 30.27 +/- 3.44 C versus female temperatures of 31.1 +/- 3.61 C. There were no clinically significant differences in male (N = 296) versus female (N = 132) profiles. High ethanol levels (315 to 800 mg%) did not affect outcome. Nine of 27 (33%) patients who received CPR initiated in the field survived, versus six of 14 (43%) with CPR begun in the ED. The profile of the CPR versus non-CPR population differed significantly (P less than .05) in location (outdoors), initial temperature (24.8 +/- 3.77 C vs 30.94 +/- 3.12 C), third-hour rewarming rate (2.28 +/- 1.53 C vs 1.17 +/- 1.18 C/hr), and numerous laboratory parameters. Tracheal intubation was performed without incident in 117 cases, of which 97 were less than or equal to 32.2 C. There were 73 fatalities (17.1%). Of these, 84.9% (N = 62) were less than or equal to 32.2 C. Predisposing conditions in this group included "serious" illness (30), systemic infection (28), trauma (15), immersion (ten), frostbite (seven), and overdose (two). The initial pulse, hemoglobin, and first-hour rewarming rate was lower in the deceased population, while the potassium, urea nitrogen, creatinine, and phosphorus were elevated. Excluding treatment combinations, outcome with exclusive use of a single rewarming strategy was passive external rewarming, 14 deaths below 32.2 C, 13 above; active external rewarming, six deaths below 32.2 C, two above; active core rewarming, 38 deaths below 32.2 C, none above. Refinements of the American Heart Association's CPR standards in hypothermia and a Hypothermia Survival Index are proposed.

Age Factors↗
PubMed1977

Glomus tumor of the digits.

Eight cases of glomus tumor of the digits seen during an 8-year period are reviewed. This number comprised 1.2% of all hand tumors encountered. Symptoms of cold intolerance and exquisite tenderness were common to all. The average duration of symptoms prior to diagnosis and treatment was 7 years. Five patients gave a history of either frostbite (two) or trauma (three) prior to onset of symptoms. The tumor was subungual in six of the eight patients, with a relatively even distribution among all digits. Roentgenographic changes of erosion of the distal phalanx were present in 50% of the tumors. Surgical excision was curative in all instances.

Adolescent↗
PubMed2002

The influence of ethanol on the level of ketone bodies in hypothermia.

Presently available possibilities of macro- and microscopic diagnosis of death from hypothermia are very limited as the changes observed are either weakly specific (ecchymoses in the mucous membrane of the stomach, histological features of haemorrhagic pancreatic necrosis, cardiomyocyte necrosis or decreased content of glycogen in hepatocytes) or represent only local action of low temperatures (frostbites, violet patches in the region of knees and elbows, red livores) and they may not be present in cases of death from cooling at environmental temperature close to zero or higher. The study evaluated the usefulness of acetoacetic acid (Ac-Ac), beta-hydroxybutyric acid (beta-HBA) and acetone determinations in blood, urine and vitreous humour for diagnosis of death from hypothermia. These three substances called ketone bodies, are easily assimilated energetic substrates that get oxidized preferentially before glucose and fatty acids. In hypoglycaemia (also hypothermia-induced one), the tissues dependent on glucose (e.g. the brain) cover most of their energetic needs from oxidation of these compounds. The analysis of 16 cases of death in circumstances suggesting hypothermia (mainly of the alcohol abusers) showed that the degree of ketosis was inversely proportional to the blood ethanol concentration. This relation may result from stimulation of insulin release and a decrease in the release of its antagonists by ethanol, as well as from inhibition of free fatty acid (FFA) beta-oxidation due to increase in the NADH/NAD ratio. So, the antiketonaemic effects of ethanol (together with its influence on the dilatation of the peripheral vessels and inhibition of shivering thermogenesis by muscle relaxation), explain increased sensitivity of intoxicated persons to low temperatures.

Adult↗
PubMed1999

Environmental skin diseases and the impact of common dermatoses on medical readiness.

The environmental extremes in which soldiers exercise and fight, like the environmental extremes in which many civilians encounter occupationally and recreationally, can prove to be a significant cause for morbidity and decreased effectiveness. A variety of skin diseases are related to occupational exposure to dusts and ultraviolet radiation as a well known cause of cutaneous damage. As more is understood about the biochemical factors involved in frostbite injury, treatment recommendations have changed. Too much water, hot or cold, is a continued source of cutaneous misery to the soldier in the field. Finally, even common minor skin ailments can incapacitate the sufferer when confronted with unfavorable environments.

Humans↗
PubMed2003

Postoperative cryotherapy: risks versus benefits of continuous-flow cryotherapy units.

Continuous-flow cryotherapy units have been proved to decrease pain, inflammation, swelling, blood loss, and narcotic usage in the postoperative setting. Complications related to cryotherapy are extremely rare (estimated at 0.00225%) but can be devastating. Complications include frostbite, chronic pain, and loss of digits. Caution should be exercised when prescribing continuous-flow cryotherapy units to patients with known risk factors for cold injury. All members involved with care of the patient, including the physician, nursing staff, patient, and patient's family and caregivers, should take an active roll in monitoring the foot for signs and symptoms of cold injury. Continuous-flow cold therapy should be discontinued when capillary refill time is greater than 5 seconds.

Adult↗
PubMedDate not supplied

Distribution of pedal burns by source and depth.

The source and depth relationships of both isolated burns to the feet and pedal burns as part of multifocal thermal trauma are evaluated. Five years of cases at the University of Chicago Burn Center were selected at random and retrospectively reviewed. There were 33 isolated burns of the foot, with a source distribution of 70% scald, 9% grease, 9% hot solid, 6% flame, and 6% other. In patients with multifocal burns that included that foot, there were 89 cases, with a source distribution of 42% scald burns, 5% grease, 2% hot solid, 39% flame, 5% electrical, 1% frostbite, and 6% other. Source versus depth and grafting needs are presented. Admission to hospital which was delayed from the date of burn showed an increased need for grafting and a longer hospitalization than those admitted on the same day. Immediate admission for compliance of proper treatment protocol is advocated. Isolated pedal burns were most commonly sustained at home, indoors, and in the kitchen. A significant number of isolated burns to the feet were from a scald source, partial thickness in depth, and required no grafting. Much of the wound management involved treating elements found in traumatic, dysvascular, and diabetic pedal lesions.

Adolescent↗
PubMed2004

[Edema and the tropics].

People visiting or living in tropical or subtropical regions are exposed to various factors, which can lead to edema. Tourists staying for only a short time in the tropics are exposed to different risks, with other disease patterns, than people living in the tropics or immigrants from tropical regions. The differential diagnosis of edema and swelling is extensive and it can sometimes be difficult to distinguish classical edema with fluid retention in the extravascular interstitial space, from lymphedema or swelling due to other aetiologies. The patients often connect the edema to their stay in the tropics although it may have been pre-existing with no obvious relation to their travels. Already the long trip in the plane can lead to an "economy class syndrome" due to deep venous thrombosis. Contacts with animal or plant toxins, parasites or parasitic larvae can produce peripheral edema. The diagnosis can often only be made by taking a meticulous history, checking for eosinophilia and with the help of serological investigations. Chronic lymphedema or elephantiasis of the limbs is often due to blocked lymph vessels by filarial worms. It has to be distinguished from other forms as e.g. podoconiosis due to blockage by mineral particles in barefoot walking people. The trend to book adventure and trekking holidays at high altitude leads to high altitude peripheral edema or non-freezing cold injuries such as frostbites and trench foot. Edema can be an unwanted side effect of a range of drugs e.g. nifedipine, which is used to prevent and treat high altitude pulmonary edema. Protein malnutrition, (Kwashiorkor), and vitamin B6 deficiency, (Beri-Beri) are very rarely observed in immigrants and almost never in tourists. A very painful swelling of fingers and hands in children and young adults of African origin can be observed during a sickle cell crisis. Many protein loosing nephropathies connected with plant and animal toxins but also bacterial, viral or parasitic agents, can lead to edema. But very often edema in tourists or immigrants from the tropics is not related to their stay abroad. To take an accurate history of the itinerary, eating habits and exposure to water etc. is very important. Knowledge of the precise epidemiology and geographic distribution of diseases are essential.

Adult↗
PubMed1993

Prevention of lung reperfusion injury in rabbits by a monoclonal antibody against interleukin-8.

Re-establishing blood flow to ischaemic tissues causes greater injury than that induced during the ischaemic period. This type of tissue injury, reperfusion injury, is involved in frostbite, multiple organ failure after hypovolaemia and in myocardial infarction. Depletion of neutrophils alleviates reperfusion injury, implying a causal role of neutrophil infiltration. Among members of the recently discovered family of chemotactic cytokines (chemokines), interleukin-8 (IL-8) is a major neutrophil chemotactic and activating factor produced by various types of human cells. We investigated its pathophysiological role in a rabbit model of a lung reperfusion injury. Reperfusion of ischaemic lung caused neutrophil infiltration and destruction of pulmonary structure, as well as local production of IL-8. Furthermore, the administration of a neutralizing monoclonal antibody against IL-8 prevented neutrophil infiltration and tissue injury, proving a causal role of locally produced IL-8 in this model.

Animals↗
PubMed1992

Vascularized tendon grafting in the rabbit.

Using a conventional free tendon graft, adhesion formation, with a consequent loss of gliding ability, occurs if the surrounding soft tissue is heavily scarred. An animal experiment was conducted, to evaluate whether a free vascularized tendon graft provides a better gliding surface, with minimal adhesion formation. In order to scar the gliding floor, the lateral aspect of the legs of 40 adult rabbits, including the peroneus tendon and its surrounding soft tissue, was exposed to liquid nitrogen. Two weeks after this induction of frostbite, all the rabbits were randomly divided into two groups: a vascularized tendon graft group and a free tendon graft group. Histologic examination revealed less adhesion of the tendon to the surrounding soft tissues in the vascularized tendon graft group. The tendon pull-out test demonstrated that less pull-out weight was required for vascularized tendons. A microangiographic study disclosed better circulation through the tendon graft and the surrounding soft tissues in the vascularized tendons. These results suggest that, even if scarring is heavy, the free vascularized tendon graft is less likely to adhere to the surrounding soft tissue than the conventional free tendon graft and, consequently, it provides a better gliding surface.

Animals↗
PubMed1992

Microcirculation and high altitude edema.

Physiological functions are a conglomeration of cell functions, and all cells are regulated by information processing and energy distributing systems. The former consists of nervous systems and the latter consists of respiro-circulatory systems. Defensive reactions appear in response to local cold stress which can induce frostbite or edema. We analyzed the cold vasoreaction time course in which rhythmical changes and trends were found using rabbit's ear blood vessels. In sheep, hypobaric hypoxia corresponding to 6600 m altitude was applied for 3 hrs. Lung lymph volume increased in response to this stress. Most sheep exposed recovered later. The factors influencing the increase in lung lymph flow and the conditions to induce interstitial edema were analyzed. Simulated-altitude symptoms were, then, analyzed by Sampson's method. In eight subjects exposed to 3700 m condition, the nervous system symptoms were well correlated with the respiro-circulatory symptoms. Thus we concluded that the distinction between system-specific diseases, viz., that between acute mountain sickness cerebral type (AMS-C) and respiratory type (AMS-R) was somewhat fuzzy. A common AMS condition, AMS-general, exists. Lastly, a case of 22-year-old male who died of lung and cerebral edema on a winter mountain was reported. The lung weighed 1506 g and the brain 1610 g.

Adult↗
PubMed1999

On the role of the weather in the deaths of R. F. Scott and his companions.

Robert Falcon Scott and his companions reached the South Pole in January of 1912, only to die on their return journey at a remote site on the Ross Ice Shelf, about 170 miles from their base camp on the coast. Numerous contributing causes for their deaths have been proposed, but it has been assumed that the cold temperatures they reported encountering on the Ross Ice Shelf, near 82-80 degrees S during their northward trek toward safety, were not unusual. The weather in the region where they perished on their unassisted trek by foot from the Pole remained undocumented for more than half a century, but it has now been monitored by multiple automated weather stations for more than a decade. The data recorded by Scott and his men from late February to March 19, 1912, display daily temperature minima that were on average 10 to 20 degrees F below those obtained in the same region and season since routine modern observations began in 1985. Only 1 year in the available 15 years of measurements from the location where Scott and his men perished displays persistent cold temperatures at this time of year close to those reported in 1912. These remarkably cold temperatures likely contributed substantially to the exhaustion and frostbite Scott and his companions endured, and their deaths were therefore due, at least in part, to the unusual weather conditions they endured during their cold march across the Ross Ice Shelf of Antarctica.

Journal Article↗
PubMed1998

Chilblains and Raynaud phenomenon are usually not a sign of hereditary protein C and S deficiencies.

Hereditary protein C and S deficiencies are risk factors for thrombosis. They are associated with purpura fulminans and coumarin-induced skin necrosis. Recently, necrotic livedo of the extremities, severe chilblains and severe frostbite have been observed in protein C or S deficient patients. Our study was designed to evaluate the prevalence of cold-induced acral manifestations in patients with protein C or S deficiency. One-hundred-and-six patients with protein C or S deficiency and controls matched for sex and age were studied by questionnaire. Data included any history of acral manifestation possibly related to cold exposure, i.e. chilblains, Raynaud phenomenon, acrocyanosis and possible associated factors. Assessment of the diagnosis by a dermatologist was recorded. No difference was found in the prevalence of acral manifestations between patients and controls. This study suggests that protein C and S deficiencies are not risk factors for cold-induced acral manifestations.

Adult↗
PubMed1999

Thermophysical effects of ointments in cold: an experimental study with a skin model.

The use of emollients on the face is a traditional way to protect the skin against cold injuries in cold climate countries like Finland, but their preventive effect against frostbite has been questioned. The purpose of this investigation was to define the thermal insulation and occlusivity of ointments in cold by using a skin model with a sweating hot plate. The properties of four different emollients were studied in both dry and humid conditions simulating transepidermal water loss, sweating, and a combination of sweating and drying. The thermal insulation of ointments applied on a dry surface was minimal. Evaporation of water from an oil-in-water cream caused significant cooling for 40 min after its application. The diffusion of water through the applied emollients changed their thermal effects depending on their composition and on the amount of water. Low input of water increased and high input diminished slightly the thermal resistance of ointments. The minimal or even negative thermal insulation of emollients in varying conditions gives them at best only a negligible and at worst a disadvantageous physical effect against cold.

Cold Temperature↗
PubMed2006

Temperature limit values for touching cold surfaces with the fingertip.

OBJECTIVES: At the request of the European Commission and in the framework of the European Machinery Directive, research was performed in five different laboratories to develop specifications for surface temperature limit values for the short-term accidental touching of the fingertip with cold surfaces. METHODS: Data were collected in four laboratories with a total of 20 males and 20 females performing a grand total of 1655 exposures. Each touched polished blocks of aluminium, stainless steel, nylon-6 and wood using the distal phalanx of the index finger with a contact force of 1.0, 2.9 and 9.8 N, at surface temperatures from +2 to -40 degrees C for a maximum duration of 120 s. Conditions were selected in order to elicit varying rates of skin cooling upon contact. Contact temperature (TC) of the fingertip was measured over time using a T-type thermocouple. RESULTS: A database obtained from the experiments was collated and analysed to characterize fingertip contact cooling across a range of materials and surface temperatures. The database was subsequently used to develop a predictive model to describe the contact duration required for skin contact temperature to reach the physiological criteria of onset of pain (15 degrees C), onset of numbness (7 degrees C) and onset of frostbite risk (0 degrees C). CONCLUSIONS: The data reflect the strong link between the risk of skin damage and the thermal properties of the material touched. For aluminium and steel, skin temperatures of 0 degrees C occurs within 2-6 s at surface temperatures of -15 degrees C. For non-metallic surfaces, onset of numbness occurs within 15-65 s of contact at -35 degrees C and onset of cold pain occurs within 5 s of contact at -20 degrees C. The predictive model subsequently developed was a non-linear exponential expression also reflecting the effects of material thermal properties and initial temperature. This model provides information for the protection of workers against the risk of cold injury by establishing the temperature limits of cold touchable surfaces for a broad range of materials, and it is now proposed as guidance values in a new international standard.

Adolescent↗
PubMed1993

Environmental hazards and health.

Significant health hazards to the traveller arise from altitude, heat, cold and water. Altitude-induced illness encompasses the benign but common syndrome of acute mountain sickness and also life-threatening pulmonary and cerebral oedema; inadequate acclimatization and rapid ascent are important precipitating factors in each case. Prophylaxis and up to date choices of treatment are discussed in the context of underlying physiological changes. Heat illnesses include exhaustion and heat stroke; they result from increased core temperature and/or physiological responses including peripheral vasodilation and sweating. Preventive measures include acclimatization, ample water without added salt, and matching dress and exercise to the environment. Cold environments pose risk of hypothermia and local cold injury which include frostbite and non-freezing cold injury; as frostnip is only diagnosed after treatment, it is a category of limited usefulness. Prevention of each disorder requires correct clothing and equipment and good training. Other hazards include immersion, and flying too soon after diving.

Altitude Sickness↗
PubMedDate not supplied

Primary closure of fasciotomy incisions with a skin-stretching device in patients with burn and trauma.

Closure of fasciotomy wounds is often a clinical problem after successful management of compartment syndrome. Commonly, split-thickness skin grafts or regional composite grafts are used for fasciotomy closure. However, functional and cosmetic results would be improved if primary reapproximation of these wounds were more practical. The main obstacle that must be overcome is excessive tension on the wound edges. A recently developed skin-stretching device (Sure-Closure, Life Medical Sciences, Princeton, N.J.) allows large tissue defects to be closed with approximation of the wound edges. In this report we describe two patients in whom closure of the fasciotomy incisions was successfully accomplished with the skin-stretching device. These patients included an 11-month-old girl with a circumferential burn of the left arm, and a 42-year-old woman involved in a motor vehicle accident who sustained frostbite and crush injury to her left upper extremity without bone fractures. The skin-stretching device produced excellent functional and cosmetic wound closure results and eliminated the need for additional operative procedures.

Adult↗
PubMed1981

Nosocomial Aeromonas hydrophila cellulitis and bacteremia in a nonimmunocompromised patient.

An elderly man, without heat in his home for two days, presented with cold, painful, swollen feet. Second-degree frostbite was present. After having moist packs applied to his feet for five days, the patient became febrile and hypotensive, and wet gangrene necessitated left below-knee and right above-knee amputations. Aeromonas hydrophila was isolated from the patient's blood and cultures of the pedal wounds. An etiologic role of the moist pack therapy is postulated.

Aeromonas↗