The effect of propranolol on the occurrence of hypoglycaemic symptoms was assessed in insulin-dependent diabetic patients with hypoglycaemia unawareness. A double-blind, randomised parallel group study (2:1 fashion) was conducted over 4-week period. The propranolol group (n = 9) received 20 mg (week 1 and 2) and 30 mg (week 3 and 4) twice daily, and the other group (n = 5) a matched placebo for 4 weeks. Patients included had experienced at least two severe hypoglycaemic episodes (coma or seizures) during the previous year, which were characterised by a lack of adrenergic symptoms and required the assistance of another person. The mean number of hypoglycaemias during the study period was similar in both groups (placebo: 13 +/- 2 propranolol: 11 +/- 1), whereas the number of totally asymptomatic hypoglycaemias (< 0.6 g/l) was lower on propranolol than on placebo (3 +/- 1 vs 8 +/- 3, NS) and the number of symptomatic hypoglycaemias was higher (7.2 +/- 2 vs 4.6 +/- 1, NS). Subjective evaluation of treatment by the investigators showed 0/5 successes in the placebo group and 5/9 in the propranolol group (chi2 = 4.32, p = 0.038). The main advantage of propranolol over placebo was an increased incidence of sweating. The ratio [number of hypoglycaemias with sweating/total number of hypoglycaemias] being higher with propranolol (0.28 +/- 0.08 vs 0.06 +/- 0.02, p = 0.06). This pilot study suggests that beta-blockers may be useful in restoring adrenergic symptoms during hypoglycaemia in insulin-dependent diabetic patients without warning symptoms of hypoglycaemia. This beneficial effect seems to be predominantly related to an increase in hypoglycaemia-induced sweating. A larger study is needed to confirm or invalidate these preliminary results. (+info)
The effect of pyrogen administration on sweating and vasoconstriction thresholds during desflurane anesthesia.
(10/499)
BACKGROUND: General anesthetics increase the sweating-to-vasoconstriction interthreshold range (temperatures not triggering thermoregulatory defenses), whereas fever is believed to only increase the setpoint (target core temperature). However, no data characterize thresholds (temperatures triggering thermoregulatory defenses) during combined anesthesia and fever. Most likely, the combination produces an expanded interthreshold range around an elevated setpoint. The authors therefore tested the hypothesis that thermoregulatory response thresholds during the combination of fever and anesthesia are simply the linear combination of the thresholds resulting from each intervention alone. METHODS: The authors studied eight healthy male volunteers. Fever was induced on the appropriate days by intravenous injection of 30 IU/g human recombinant interleukin 2 (IL-2), followed 2 h later by an additional 70 IU/g. General anesthesia consisted of desflurane 0.6 minimum alveolar concentration (MAC). The volunteers were randomly assigned to the following groups: (1) control (no desflurane, no IL-2); (2) IL-2 alone; (3) desflurane alone; and (4) desflurane plus IL-2. During the fever plateau, volunteers were warmed until sweating was observed and then cooled to vasoconstriction. Sweating was evaluated from a ventilated capsule and vasoconstriction was quantified by volume plethysmography. The tympanic membrane temperatures triggering significant sweating and vasoconstriction identified the respective response thresholds. Data are presented as the mean +/- SD; P < 0.05 was considered significant. RESULTS: The interthreshold range was near 0.40 degrees C on both the control day and during IL-2 administration alone. On the IL-2 alone day, however, the interthreshold range was shifted to higher temperatures. The interthreshold range increased significantly during desflurane anesthesia to 1.9+/-0.6 degrees C. The interthreshold range during the combination of desflurane and IL-2 was 1.2+/-0.6 degrees C, which was significantly greater than on the control and IL-2 alone days. However, it was also significantly less than during desflurane alone. CONCLUSION: The combination of desflurane and IL-2 caused less thermoregulatory inhibition than would be expected based on the effects of either treatment alone. Fever-induced activation of the sympathetic nervous system may contribute by compensating for a fraction of the anesthetic-induced thermoregulatory impairment. (+info)
Shivering and shivering-like tremor during labor with and without epidural analgesia.
(11/499)
BACKGROUND: Effective treatment and prevention of hyperthermia and shivering-like tremor during labor is hindered by a poor understanding of their causes. The authors sought to identify the incidence of nonthermoregulatory shivering-like tremor and the factors associated with this activity. METHODS: The authors studied women in spontaneous full-term labor who chose epidural analgesia (n = 21) or opioid sedation (n = 31). Shivering-like tremor and sweating were evaluated by observation. Core temperature was recorded in the external auditory canal using a compensated infrared thermometer. Arteriovenous shunt tone was evaluated with forearm minus fingertip skin temperature gradients; gradients less than 0 were considered evidence of vasodilation. Tremor was considered nonthermoregulatory when core temperature exceeded 37 degrees C and the arms were vasodilated. Pain was evaluated using a visual analog scale. RESULTS: Shivering-like tremor was observed in 18% of 290, 30-min data-acquisition epochs before delivery. The patients were both normothermic and vasodilated during 15% of these epochs. Shivering was observed in 16% of 116 postdelivery epochs and was nonthermoregulatory in 28%. Sweating was observed in 30% of predelivery epochs, and the patients were both hypothermic and vasoconstricted during 12%. The mean core temperature in patients given epidural analgesia was approximately 0.2 degrees C greater than in those given sedation. Hyperthermia was observed during 10 epochs (38.4+/-0.3 degrees C) during epidural analgesia and during 10 epochs (38.4+/-0.3 degrees C) with sedation. The patients were vasoconstricted in more than 50% of these epochs in each group. Multivariate mixed-effects modeling identified high pain scores and vasoconstriction as significant predictors of shivering. There were no predictors for shivering epochs in patients who were simultaneously normothermic and vasodilated. Significant predictors of sweating were time before delivery, high pain scores, hypothermia with vasoconstriction, high thermal comfort, and low mean skin temperature. There were no predictors for sweating epochs in patients who were simultaneously hypothermic and vasoconstricted. CONCLUSIONS: This study confirms the clinical impression that some peripartum shivering-like tremor is nonthermoregulatory. The authors also identified nonthermoregulatory sweating. These data indicate that shivering-like tremor and sweating in the peripartum period is multifactorial. (+info)
Can gender differences during exercise-heat stress be assessed by the physiological strain index?
(12/499)
A physiological strain index (PSI) based on rectal temperature (Tre) and heart rate (HR) was recently suggested to evaluate exercise-heat stress. The purpose of this study was to evaluate PSI for gender differences under various combinations of exercise intensity and climate. Two groups of eight men each were formed according to maximal rate of O2 consumption (VO2 max). The first group of men (M) was matched to a group of nine women (W) with similar (P > 0.001) VO2 max (46.1 +/- 2.0 and 43.6 +/- 2.9 ml. kg-1. min-1, respectively). The second group of men (MF) was significantly (P < 0. 001) more fit than M or W with VO2 max of 59.1 +/- 1.8 ml. kg-1. min-1. Subjects completed a matrix of nine experimental combinations consisting of three different exercise intensities for 60 min [low, moderate, and high (300, 500, and 650 W, respectively)] each at three climates (comfortable, hot wet, and hot dry [20 degrees C 50% relative humidity (RH), 35 degrees C 70% RH, and 40 degrees C 35% RH, respectively]). No significant differences (P > 0.05) were found between matched genders (M and W) at the same exposure for sweat rate, relative VO2 max (%VO2 max), and PSI. However, MF had significantly (P < 0.05) lower strain than M and W as reflected by %VO2 max and PSI. In summary, PSI applicability was extended for exercise-heat stress and gender. This index continues to show potential for wide acceptance and application. (+info)
The free-convective anomaly.
(13/499)
Persons exposed to high temperature, or to equivalent environmental factors, have quantifiable reactions, such as reducing the resistance to both heat and moisture flow in skin tissues and clothing needed to maintain thermal equilibrium. The one-to-one relationship between this resistance in the walking person and temperature, with the other factors neutral, is the basis for the apparent temperature scale and the derived heat index. When this approach is taken to assess the thermal environment for a still person exposed to heat in still air, there is a zone of ambient conditions in which there are three solutions to the heat-balance equation. Extraordinary thermal stress occurs, depending slightly on other conditions, at ambient temperatures near 41 degrees C, especially at high humidity, because of the difficulty in carrying sweat vapor from the person when free convection is minimal. This anomaly is examined for a range of ambient vapor pressures and extra radiation. The rapid rise in heat stress when ambient temperature just exceeds body temperature in still conditions may explain the severity of some observed distress. (+info)
Evaluating physiological strain during cold exposure using a new cold strain index.
(14/499)
A cold strain index (CSI) based on core (T(core)) and mean skin temperatures (T(sk)) and capable of indicating cold strain in real time and analyzing existing databases has been developed. This index rates cold strain on a universal scale of 0-10 and is as follows: CSI = 6.67(T(core t) - T(core 0)). (35 - T(core 0))(-1) + 3.33(T(sk (t)) - T(sk 0)). (20 - T(sk 0))(-1), where T(core 0) and T(sk 0) are initial measurements and T(core t) and T(sk t) are simultaneous measurements taken at any time t; when T(core t) > T(core 0), then T(core t) - T(core 0) = 0. CSI was applied to three databases. The first database was obtained from nine men exposed to cold air (7 degrees C, 40% relative humidity) for 120 min during euhydration and two hypohydration conditions achieved by exercise-heat stress-induced sweating or by ingestion of furosemide 12 h before cold exposure. The second database was from eight men exposed to cold air (10 degrees C) immediately on completion of 61 days of strenuous outdoor military training, 48 h later, and after 109 days. The third database was from eight men repeatedly immersed in 20 degrees C water three times in 1 day and during control immersions. CSI significantly differentiated (P < 0.01) between the trials and individually categorized the strain of the subject for two of these three databases. This index has the potential to be widely accepted and used universally. (+info)
Heat tolerance of Boran and Tuli crossbred steers.
(15/499)
Experiments were conducted to evaluate the heat tolerance of the following breeds: Hereford (H), Brahman (B), H x B, H x Boran (H x Bo), and H x Tuli (H x T). Heat tolerance was evaluated in a climatically controlled room (Exp. 1) and under summer environmental conditions (Exp. 2) by comparing rectal temperatures (RT), respiration rates (RR), and sweating rates (SW). In Exp. 1, under extremely hot conditions (mean temperature-humidity index [THI] > 90), purebred B had significantly (P < .05) lower RT and RR than other genotypes, which may be indicative of greater surface area per mass to dissipate heat and a lower metabolic rate than other genotypes. Boran and Tuli crosses had RT (39.5 degrees C) that were intermediate to those of B (39.0 degrees C) and H x B (40.0 degrees C). The H genotype had the greatest RT at 40.3 degrees C. Among the breeds, trends in RR were similar to RR observed at THI < 77; B had the lowest RR, and H x B were intermediate. However, in these extreme conditions, RR did not differ among the purebred H and the Boran and Tuli crossbred steers, but H x B steers had lower RR than the other H crossbred steers. Sweating rates were significantly greater for the Bos indicus x Bos taurus crosses (H x B and H x Bo) than for the purebred genotypes (H and B) and the Bos taurus cross (H x T). In Exp. 2, mean RT for B, H x B, H x Bo, and H x T were very similar to those recorded under the moderate heat stress conditions found in Exp. 1. There were no differences in RT among B, H x Bo, and H x T genotypes. The RR increased over time for H only, and RR for other genotypes tended to be elevated only slightly over time. Among genotypes, SW was significantly greater for the H x Bo steers. The ability of the Bos indicus crosses to dissipate heat through enhanced SW and associated evaporative cooling was evident. However, the heat-tolerant nature of the Bos taurus cross (H x T) was not evident through enhanced RR or SW in either experiment. Compared with other genotypes, the lower RR of B steers was clearly evident and is assumed to be due to greater surface area and other skin characteristics that allow them to dissipate heat to maintain lower RT. These data suggest that the H x Bo and H x T are similar to H x B and intermediate to H and B genotypes in maintaining homeostasis when exposed to a high heat load. (+info)
A case of traumatic high thoracic myelopathy presenting dissociated impairment of rostral sympathetic innervations and isolated segmental sweating on otherwise anhidrotic trunk.
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A 3 year-old boy developed flaccid paraplegia, anesthesia below T3 and impaired vesical control immediately after a car accident. Three months later, the pupils and their pharmacological reactions were normal. Thermal sweating was markedly reduced on the right side of the face, neck, and shoulder and on the bilateral upper limbs, and was absent below T3 except for band like faint sweating on T7 sensory dermatome. The left side of the face, neck and shoulder showed compensatory hyperhidrosis. Facial skin temperature was higher on the sweating left side. Cervico-thoracic MRI suggested almost complete transection of the cord at the levels of T2 and T3 segments. We discussed the pathophysiology of the dissociated impairment of rostral sympathetic innervations and isolated segmental sweating on otherwise anhidrotic trunk. (+info)