[Evaluation of sudomotor function]

From the aspect of physiological roles, sweating on the hairy skin is an important for thermoregulation of body, and that on glabrous skin (the palm or sole) works as an anti-skid material when gripping something or performing a delicate task using the fingertips (emotional sweating). Abnormal sweating, which can be global or localized, is classified into hyperhidrosis and hypohidrosis, and detection of abnormal sweating, such as Horner's syndrome and Harlequin syndrome, is clinically useful for regional diagnosis of neurological lesions. In addition, sudomotor function tests, where sweat secretion is induced by physiological or pharmacological stimuli, are useful for diagnosis of neurological disorders. In this manuscript, clinical evaluation of abnormal sweating from the aspect of neurological diagnosis is reviewed.

Crisponi syndrome: a new mutation in CRLF1 gene associated with moderate outcome

Crisponi syndrome (CS) is a rare, autosomal recessive disorder, characterized by hyperthermia, extensive muscular contractions in the face after even minimal stimuli or crying, hypertonia, opisthotonus, camptodactyly, and typical facial features. Recently, it has been demonstrated that CRLF1 (cytokine receptor-like factor 1) gene mutation is associated with CS. Here we report a case of CS with a new mutation in the CRLF1 gene associated with moderate clinical phenotype.

Failed metal-on-metal total hip arthroplasty presenting as painful groin mass with associated weight loss and night sweats

We report an unusual case of a failed metal-on-metal total hip arthroplasty presenting as a groin mass with associated weight loss, night sweats, and raised inflammatory markers. After a malignant process was ruled out, the patient was found to have a loose acetabular component. Histopathologic results revealed features of an aseptic lymphocytic vasculitic associated lesion. All symptoms resolved completely after the metal-on-metal bearing was revised to metal-on-polyethylene.

Aquagenic syringeal acrokeratoderma: Report of a case with histologic findings

Aquagenic syringeal acrokeratoderma is a rare acquired condition characterized by painful symmetric swelling and hypopigmentation of the palms and lateral fingers, which develops after brief exposure to water. Histopathologic examination suggests that an aberration in the eccrine sweat gland apparatus may be the underlying cause of this condition. The "hand-in-the-bucket sign," in which patients arrive in their physician's office with their hand in a bucket of water to more readily demonstrate their lesions, is such a common presentation that it almost can be regarded as pathognomonic. All 12 cases reported to date have been in young females. We report a case of aquagenic syringeal acrokeratoderma in a male with unique histologic findings.

[Do you have a good nose? Small lexicon of bromhidroses and other body odors]

Body odours have a semiological significance in dermatology and in internal medicine and pediatrics as well. Most of them are brought by the eccrine or apocrine sweat. The term bromhidrosis refers to such conditions. Body odours originate from metabolic disorders, ingestion of food, toxic elements and drugs, and from contact with various xenobiotics. Specific bacterial infections and contaminations also release volatile smelling compounds without the intervention of sweat.

The Illness Intrusiveness Rating Scale: a measure of severity in individuals with hyperhidrosis

OBJECTIVE

We estimated the reliability and validity of the Illness Intrusiveness Ratings Scale (IIRS) in hyperhidrosis, using an electronic mail form of administration.

METHODS

Recent contributors to an electronic mail discussion group on hyperhidrosis responded to the IIRS, questions about surgical history, items designed to assess severity, and demographic questions, on two occasions four weeks apart. A variety of hypotheses regarding the relationships between these variables were constructed a priori.

RESULTS

Sixty-eight people replied on two occasions. Internal consistency was high (Cronbach's alpha 0.88), as was test-retest reliability (kappa 0.89). The total IIRS score correlated with a global severity question (0.61; p < 0.001). Total IIRS score was lower in participants who had previously had surgery for hyperhidrosis, compared with those who had not (47 vs. 36; p = 0.02), and changed dramatically in the direction of diminished severity in four patients who underwent surgery during the course of the study (54 vs. 17; p = 0.01). Weak-to-moderate correlations were observed between total score and use of topical preparations, use of medications, number of clothing changes during a day, and limitations in choice of wardrobe.

CONCLUSIONS

The IIRS is both reliable and valid in the assessment of patients with hyperhidrosis. A novel form of administration does not appear to affect its properties.

Sudden infant death syndrome in a twin: a comparison of sibling histories

To determine possible characteristics of infant victims of sudden death, we examined 114 items related to the pre- and postnatal histories of 42 pairs of twins one of whom died of sudden infant death syndrome (SIDS) leaving a surviving sibling. Interviews with the parents were conducted after the occurrence of SIDS, and the data were checked with records held by gynecologists and pediatricians. To evaluate the specificity of any factors, we studied a control group of 42 age- and sex-matched pairs of twins, both of whom survived the first year of life. Only 11 of 114 characteristics were significantly related to SIDS: future victims had a smaller weight and height at birth, stayed longer in the nursery, and followed a moving object with their eyes, had head control, and smiled at a later age than their surviving siblings. They also fatigued more often during feeding (11/42) and had reduced arm and neck tonus (9/42). They were described as longer sleepers than their surviving siblings. During sleep, some SIDS twins, but no surviving twin, were found to be cyanotic at least once or pale (4/42) and were repeatedly covered with abundant sweat (8/42). In the control group of normal twins, the occurrence of most of these characteristics was found with a frequency comparable to that seen in the SIDS infants; the specificity of these characteristics is thus considered doubtful. The mean birth weight and height were significantly greater in the control group, and no control infant had an episode of cyanosis or pallor or repeated episodes of profuse sweating observed during their sleep.(ABSTRACT TRUNCATED AT 250 WORDS)

Congenital, hypotonic-sclerotic muscular dystrophy

Four cases of congenital, hypotonic-sclerotic muscular dystrophy are presented. The patients showed clinically prominent features described by Ullrich, i.e. congenital muscle weakness, hypotonia, and hyperextensibility of distal joints, contractures of proximal joints, high-arched palate, hyperhidrosis, posterior protrusion of calcaneus, and no progression. Muscle biopsies revealed dystrophic changes. Ullrich suggested that this condition was a new entity, but the disease has received little attention. In the present cases superior intelligence and tendency to recurrent upper respiratory tract infections were stressed as characteristics of this disorder. Insufficient cellular immunity was suspected and this may contribute to the recurrent upper respiratory tract infections and pneumonia often observed. This disease is considered a distinct entity of multisystemic involvement inherited as an autosomal recessive trait.

Bone scan artifact caused by hyperhidrosis: case report

An unusual unilateral axillary concentration of radioactivity was observed in a bone scan. The cause was contamination of the patient's undershirt due to localized hyperhidrosis.