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PubMed1991

[Mental disorders in women during menopause].

Altogether 126 patients with mental disorders of the non-psychotic nature, that occurred for the first time during menopause were examined. Different vegetative disorders (hot flush, hyperhidrosis, blood pressure fluctuations, asphyxia sensation, numbness of the limbs, skin burning, chill, pruritus) played the leading part in the clinical picture. The mental disorders manifested in the form of extensive age-related , asthenic, hysteric, phobic and depressive disorders. The long-term climacteric was likely to give rise to the formation of a pathological personality.

Adult↗
PubMed1991

[Electrophysiological analysis of the functions of the sweat gland fibers in various diseases].

The authors relate the data on vegetative sweating fibers studied by the method of evoked skin sympathetic potentials in patients with diabetes mellitus, Charcot-Marie atrophy, spinal amyotrophy, Guillain-Barre syndrome, essential hyperhidrosis, and in those with Raynaud's phenomenon and thyrotoxicosis. A remarkable decrease of conduction by sweating fibers was revealed in patients with diabetes mellitus, Charcot-Marie atrophy and Raynaud's phenomenon; a moderate decrease was shown by the patients with Guillain-Barre syndrome and by those with spinal amyotrophy. The conclusion is made about the high information content of the method.

Adult↗
PubMed1991

[Evaluation of the autonomic innervation of the pupil].

The purpose of the study was to examine vegetative innervation of the pupil in different diseases associated and not associated with vegetative disorders. In addition to the ++clinico-neurological method, the main method of examination was to study the pupillary cycle (determination of the time of the pupillary cycle (TPC) with the aid of a slit lamp). Fifty healthy test subjects and 262 patients suffering from different somatic and neurologic diseases were examined. The patients were divided in 9 clinical groups: spinal amyotrophy, neural Charcot-Marie amyotrophy, Guillain-Barre syndrome, diabetes mellitus, thyrotoxicosis, hemicrania, Raynaud's disease, idiopathic hyperhidrosis, vegetative crises. The data obtained demonstrate varying grades of the rise of the TPC in the indicated diseases, which reflects varying degrees of vegetative innervation of the pupil insufficiency. However, no well-defined correlation was obtained between the intensity of the psychovegetative syndrome and the TPC. Therefore, it has been shown that the method of determining the TPC is unsophisticated and noninvasive and can be successfully used in different forms of pathology to identify vegetative insufficiency at different stages of the disease.

Autonomic Nervous System Diseases↗
PubMed2006

Clinical manifestations of primary hyperthyroidism in the elderly patients at the out-patient clinic of Srinagarind Hospital.

The authors reviewed the outpatient charts diagnosed as hyperthyroidism at Srinagarind Hospital from June 1998-June 2004. The objective was to compare the clinical features of hyperthyroidism in patients older and younger than 60 years old. There were 922 cases enrolled, 84 cases (9.11%) were 60 years old and above. The female: male ratio was 3.4:1 and 4:1 and the mean ages were 64.2 +/- 3.7 and 37.4 +/- 11.2 years old in the elder and younger group, respectively. The common presentations were dyspnea (94.1, 96.5%), weight loss (93.8, 87.9%) and palpitation (83.3, 93.1%) in the elder and younger, respectively. The more significant clinical presentations in the elder group were atrial fibrillation, weakness and anorexia whereas exophthalmos, goiter, heat intolerance and hyperhidrosis were not as frequent. Thus, the classic presentations often lacked in the elder group. Therefore, unexplained AF, weakness and anorexia should not exclude hyperthyroidism even with paucity of typical clinical features.

Age Factors↗
PubMed2006

[Mal de Meleda. 16 cases].

Mal de Meleda is a recessive transgression palmoplantar keratoderma. We report the epidemiological, clinical and progressiveness aspects of the disease in 16 patients of a large consanguineous tunisian family. The age ranged from 3 to 90 years. Nine were male and 7 female patients. Onset in early infancy was characterized by erythema of the palms and soles, followed by a diffuse yellowish hyperkeratosis. Thickness of the dorsal aspect of the fingers started in childhood. Extension of hyperkeratosis to the dorsal of the hand were reported only in adults and usually precede the involvement of the feet Palmoplantar hyperhidrosis with fetid odor between the toes was frequently seen as well as conical distal phalanges. In some adults keratoderma gave contracture of the fingers leading to limitation of movements Mal de Meleda must be differentiated from other recessive palmoplantar keratoderma such as Papillon-Lefévre syndrome and Mal de Naxos. the remaining inherited palmoplantar keratoderma being autosomal dominant. Mal de Meleda is a rare disease but is still relatively frequent in some tunisian regions, due to the high rate of consanguinity Mal de Meleda remains an afflicting and disabling disease.

Adolescent↗
PubMed2006

Pharmacotherapy of social anxiety disorder: what does the evidence tell us?

The treatment goals for social anxiety disorder (SAD) are to reduce fear, avoidance, physical distress, disability, and comorbidity. This review illustrates some of the primary studies used to evaluate efficacy of treatments for SAD. The selective serotonin reuptake inhibitors (SSRIs) paroxetine, sertraline, fluoxetine, fluvoxamine, and escitalopram and the serotonin-norepinephrine reuptake inhibitor venlafaxine are effective treatments. They have the additional benefit of being able to treat comorbid conditions. For people who do not respond to serotonin reuptake inhibitors, treatment options include benzodiazepines (clonazepam, alprazolam, and bromazepam), alpha2delta calcium-channel blockers (gabapentin and pregabalin), reversible inhibitors of monoamine oxidase A (moclobemide, although agents in this class are not available in the United States), antiepileptics (levetiracetam), and atypical antipsychotics (olanzapine). The irreversible monoamine oxidase inhibitor phenelzine can be considered an effective third-line therapy. Combination treatments may be beneficial, but more research is needed. Benefits of beta-blockers (propranolol and atenolol) are limited to performance anxiety. Botulinum toxin A may be an effective augmentation treatment option for severe axillary hyperhidrosis in patients with SAD. Studies show that patients with SAD who are maintained on paroxetine, sertraline, or clonazepam have a low relapse rate.

Clonazepam↗
PubMed2006

Botulinum toxin in primary care medicine.

Clostridium botulinum, a gram-positive anaerobic bacterium, produces a potent neurotoxin that causes muscle paralysis. The therapeutic use of botulinum toxin was discovered in the 1970s and has since been used to treat patients with a broad range of medical complaints. Botulinum toxin (BTX) is used in the primary care setting to treat conditions such as allergic rhinitis, hyperhidrosis, lichen simplex chronicus, migraine, myofascial pain syndrome, and certain task-specific idiopathic focal dystonias (eg, writer's cramp)--in addition to its more publicized use for cosmetic enhancement of the face. The expanding range of therapeutic applications for BTX make it necessary for primary care physicians to understand the biochemistry, preparation, indications, and interactions of BTX.

Botulinum Toxins, Type A↗
PubMed2006

[A case of Parkinson's disease with neuroleptic malignant syndrome induced by paroxetine].

We present a first case of Parkinson's disease with neuroleptic malignant syndrome by Paroxetine, one of the selective serotonin reuptake inhibitor (SSRI). The patient was a 73-year-old woman who had been diagnosed as Parkinson's disease for one and half year. The severity of her disease was categorized as Hoehn & Yahr 2nd degree and she had taken 0.25 mg/day of Pramipexole. Four days after the addition of 10 mg/day of Paroxetine for the treatment of her depression, she developed consciousness disturbance, severe muscular rigidity, tremor, fever, hyperhidrosis, incontinence and elevated serum creatine kinase level. According to diagnostic criteria, she was diagnosed as neuroleptic malignant syndrome probably induced by Paroxetine. Her clinical symptoms and laboratory data were improved seven days after intravenous drip infusion. We should recognize that SSRI could induce neuroleptic malignant syndrome in patients with Parkinson's disease.

Aged↗
PubMed1991

[Two cases of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) associated with Graves' disease].

We have reported two cases of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) associated with Graves' disease. Case 1: a 45-year-old woman noticed a diffuse goiter, palpitation and emaciation in 1977. Laboratory studies confirmed that she had Graves' disease, and she was treated with antithyroid drug. In 1986, when the hyperthyroidism was subsided, she showed progressive symmetrical weakness and numbness in her limbs, and she was almost in tetraplegia at 1987. Markedly slowed motor and sensory nerve conductions and elevated CSF proteins as well as clinical manifestations confirmed the diagnosis of CIDP. Following corticosteroid-pulse therapy and plasmapheresis resulted in good recovery in both motor and sensory impairment, though two-times of relapses were observed. Case 2: a 33-year-old man first noticed weakness in his legs in 1977, motor and sensory disturbances progressed for 12 years. Slowed nerve conduction, high CSF proteins and two-times of relapses in early phase indicated that the CIDP was the diagnosis. In 1989 he complained general fatigue, hyperhidrosis and body-weight loss. The serum thyroid hormone levels were high, and other laboratory studies confirmed the presence of Graves' disease. The cases with both CIDP and Graves' disease has rarely been reported. The background mechanism of this association is not well understood, but the susceptibility to CIDP and Graves' disease may be related to the HLA antigens and immunoglobulin Gm allotypes of which are the genes linked to the major histocompatibility complex and controlling immune responses. The present two cases commonly shared several HLA-DR antigens, but their significance should be confirmed by examining many cases.

Adult↗
PubMedDate not supplied

[Reflex sympathetic dystrophy following electric shock: description of a clinical case].

The acute effects of electrical injuries are well known. However, the occurrence and the mechanisms of the delayed sequelae are still unclear. The effects on peripheral nerves and the sympathetic system in particular are poorly documented. A 47-year old man was injured on the left arm by contact with a 380 V tension switch in January 1990. A few hours after the accident he complained of burning pain, dysesthesia, weakness and motor impairment of the arm. Allodynia and anhidrosis without cutaneous trophic lesions were observed. During the subsequent months the symptoms did not change except for the appearance of signs of autonomous nervous system hyperactivity (hyperhidrosis, edema, atrophy of the skin and nails, excessive sweating). One year later thermographic evidence and the effect of anesthetic blockade of the sympathetic chain on the burning pain, stiffness of joints and weakness of the arm confirmed the clinical diagnosis of reflex sympathetic dystrophy. Analgesia and motility improvement were achieved by means of sympathetic blockades although the patient's hand grip force and thumb-little finger grip were still weakened. Any known etiology besides electric shock could be associated with these clinical signs. The cause of the reflex sympathetic dystrophy may be multifactorial. In this patient the electric shock might have damaged peripheral sympathetic fibres or cervical ganglia. Lesions of the peripheral nerves and sympathetic hyperactivity can contribute to the development of such syndrome.

Electric Injuries↗
PubMedDate not supplied

Neurotrophic trigeminal syndrome after pontine stroke.

The present study describes a patient, aged 72 yrs, with pontine crossed syndrome, displaying ipsilateral to the lesion a syndrome of cranial nerves V, VI, VII, VIII, on the right; a right neocerebellar syndrome; anhidrosis in the right hemibody; contralateral to the lesion: thermoalgic anesthesia with hyperhidrosis in the left hemibody. Concomitant with the pontine lesion, the patient developed torpid trophic ulcerations all over the right hemiface which, in the course of one year, became deformed, retractile, depigmented of hyperpigmented scars, the erosion being so deep at the level of the right nasal wing that the latter disappeared. This clinical picture developed in a patient with basilar invagination of 3 mm and left humeral micromelia. Eight cases of trigeminal torpid trophic ulceration associated with lesions of the brain stem are known till now, but association with vascular pontine lesion has not been described as yet. Etiopathogenic considerations are made.

Aged↗
PubMed1991

[Pachydermoperiostosis--report of a case and review of 121 Japanese cases].

A case of 23 years old man with idiopathic pachydermoperiostosis is reported. He showed cutis verticis gyrata, clubbed fingers and periosteal new bone formation without any causative basic disorder. His serum level of FSH, LH, estradiol and estriol were elevated, but their significance was not clear. Histological examination of the skin from the forehead revealed sebaceous hyperplasia and dermal thickening, where deposit of alcian blue and colloidal iron positive substance were detected. The deformed forehead and eyelids were corrected by plastic surgery. One hundred and twenty one cases of pachydermoperiostosis reported so far in Japan are briefly reviewed. Most of them were male (94.1%), about one fourth had a family history. The principal features are: clubbing of the digits (88.4%), periosteal new bone formation (94.1%), coarsening of the facial features with furrowing of the skin of the face (72.7%) and cutis verticalis gyrata (59.5%). Arthralgia (40.5%), hyperhidrosis of the feet and hands (44.6%), gastric hypertrophy (8 cases), gastric ulcers (5 cases) and endocrine abnormalities (17 cases) were also reported.

Adult↗
PubMed1991

Iontophoresis--is there a future for clinical application?

Transdermal application of drugs is a field of great importance in medical therapy. The application is painless and may be controlled at any time. Iontophoresis is one method for transdermal application of substances, especially for larger or charged molecules which cannot be administered by a simple transdermal route. The problems arise from the complex equipment and the electrical properties of the skin. A better understanding of skin structure and electric transmission through human skin has led to renewed interest in iontophoresis as an administration mode. Iontophoresis is the method of choice in administration of certain local anesthetics and has had its greatest success in therapy of hyperhidrosis. New applications are to be expected, particularly in administration of peptide and protein drugs.

Administration, Cutaneous↗
PubMed1990

[Surgical thoracoscopy].

UNLABELLED: Thoracoscopic adhesiolysis since 1913 (Jacobaeus). Thoracoscopic targets: Sympathetic system, vagus system, lymphatic system, lung. INDICATIONS: Arterial circulation disturbances, posttraumatic reflexdystrophy ("Sudeck"), Hyperhidrosis syndromes, erythrodermy syndromes; pain syndromes: causalgiform, splanchnicotomy for chronic pancreatitis. For peptic jejunal ulcer thoracoscopic splanchnico-vagotomy. For bronchial asthma selective vagotomy of bronchial rami. Operative techniques. Hemostasis: low-frequency thermocoagulation, unipolar and bipolar high-frequency coagulation, with thermostabilisation. Videoendoscopy with minicameras. Electronic frame freezing for colour slides.

Electrocoagulation↗
PubMedDate not supplied

[Variation of the anhidrotic activities of anticholinergics with different routes of administration (author's transl)].

Anhidrotic concentrations 50 of four anticholinergics were determined in mice using an original skin palmar conductance method. Intra-peritoneal, intra-palmar and topical routes were compared. Relative anhidrotic activities according to the mode of administration of the different anticholinergics showed definite differences, e.g. hydroxyzine, which was the less active per i.p. route, was the most active per topical route. The method is likely to be a useful test for selecting the most active anticholinergic and its most efficient route of administration for the treatment of hyperhidrosis.

Administration, Topical↗
PubMedDate not supplied

[Anhidrotic activity of anticholinergics in mice. Influence of mode of administration].

Anhidrotic concentrations 50 of four anticholinergics were determined in mice using an original skin palmar conductance method. Intra-peritoneal, intra-palmar and topical routes were compared. Relative anhidrotic activities according to the mode of administration of the different anticholinergics showed definite differences, e.g. hydroxyzine, which was the less active per i.p. route, was the most active per topical route. The method is likely to be a useful test for selecting the most active anticholinergic and its most efficient route of administration for the treatment of hyperhidrosis.

Administration, Topical↗
PubMed1990

[Crow-Fukase syndrome (POEMS syndrome). The first Italian presentation of a case and review of the literature].

A 42-year-old Italian man affected with a multisystemic disease is presented. The main features were: polyneuropathy, organomegaly (liver, spleen and lymph nodes enlargement), endocrinopathy (loss of libido, low plasmatic levels of testosterone), monoclonal protein (k-light chains only in 100-fold-concentrated urine sample, without other signs of plasmocytic proliferation), skin changes. Clinical skin alterations were striking: diffuse thickening, hyperpigmentation, hyperhidrosis , hypertrichosis, while histo- and immunopathological examination of skin biopsies showed proliferation of dermal collagen fibers and deposition of melanin in the epidermis. These findings were suggestive for the diagnosis of Crow-Fukase (POEMS) syndrome, associated with peculiar angiofollicular lymph node hyperplasia (Castleman's disease). The patient was followed up for 15 months with steroids, systemic chemotherapy, plasma-exchange and immunomodulating drugs. A massive anasarca complicated the picture leading him to death. Actually the pathomechanisms of this rare disease have not been fully elucidated. The relations between this syndrome and some malignant lymphoproliferative diseases (i.e. osteosclerotic myeloma) are controversial; at least a part of its features could be either reactive or tissue-specific-antibody mediated. A genetic influence should be suggested from the Japanese reports.

Adult↗
PubMed1990

Blunt dissection for the treatment of plantar verrucae.

The treatment of plantar verrucae has always been a challenging and perplexing problem to physicians. Due to the inherent nature of verrucae, response to various forms of treatment has been extremely unpredictable. It is believed that hyperhidrosis and abnormal pressure to the plantar aspects of the feet are contributing factors predisposing one to developing verrucae. This article describes a painless and effective approach to the treatment of plantar verruca through the use of blunt dissection. Following anesthesia obtained with a posterior tibial nerve block, the plantar verruca can be successfully dissected with an 80 percent cure rate.

Adolescent↗