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Sweat gland carcinoma: a clinico-pathological reappraisal.

A case of sweat gland carcinoma arising from the right fifth finger which later metastasized to the regional lymph nodes and the lungs is the subject of this report which attempts to establish further the true characteristics of this definite pathological entity. The diagnosis of sweat gland carcinoma has been loosely applied to a variety of lesions, and it was not until recently that more exact and appropriate criteria were used to establish the diagnosis of sweat gland carcinoma. The case reported in this manuscript possesses most if not all the criteria necessary to make a diagnosis of sweat gland carcinoma. Further review of the literature shows that this is a rare and aggressive neoplasm as this case illustrates. Radical surgery of the primary lesions with radical regional lymph node dissection whenever possible is recommended for the initial treatment, and combination chemotherapy and radiotherapy may be employed in the palliative treatment of the more advanced forms of the disease.

Adenocarcinoma↗

Distal small fiber neuropathy: results of tests of sweating and autonomic cardiovascular reflexes.

The purpose of this study was to evaluate sweating and cardiovascular autonomic function in patients with distal small fiber neuropathy (DSFN). Sweat testing by the quantitative sudomotor axon reflex test was abnormal in 32 of 40 (80%) patients. The thermoregulatory sweat test was abnormal in 18 of 25 (72%) patients; one or both tests were abnormal in 36 of 40 (90%). Minor heart rate abnormalities were present in 11 of 40 (28%) patients. We conclude that, in patients with DSFN: (a) the sympathetic sudomotor fibers are frequently affected, and that evaluation of sweating is a useful diagnostic test; (b) that the autonomic nerves controlling heart rate are less affected.

Autonomic Nervous System Diseases↗

The sweat gland in graft versus host disease.

Sweat gland abnormalities occur much more frequently than hitherto described in cutaneous graft versus host disease (GVHD). Two patterns of abnormalities were identified in 80 per cent of cases of acute GVHD: a cytopathic pattern consisting of a combination of basal vacuolopathy with or without lymphocytic infiltration and basal cell degeneration, and a proliferative pattern consisting of basal cell hyperplasia. In chronic GVHD, complete sweat gland destruction with fibrosis was commonly observed. Squamous metaplasia and dilation of the sweat glands were less frequently identified. Ki67 immunostaining confirmed proliferative activity in the basal cells of the distal duct. HLA-DR antigens were expressed on the basal cells of the duct and secretory glands in acute GVHD but not in normal skin. Langerhans cells were absent in both normal and abnormal sweat glands. The role of HLA-DR or Langerhans cells in the initiation of GVHD is questioned in the light of the new data and the primary involvement of proliferating cells is confirmed.

Acute Disease↗

Identification of functioning sweat pores and visualization of skin temperature patterns in X-linked hypohidrotic ectodermal dysplasia by whole body thermography.

In this preliminary study, non-invasive infrared thermography has been used to visualize individual sweat pores and whole body skin temperature patterns in subjects with X-linked hypohidrotic ectodermal dysplasia (XHED) and normal controls. The findings in eight obligate heterozygotes and four affected males were compared to six normal female controls and to six non-manifesting females at risk for carrier status. Sweat secretion from individual pores in circumscribed areas was imaged using a high spatial resolution SPRITE infrared detector system working in the 8-14 microns band. In seven out of eight obligate heterozygotes, skin areas devoid of active sweat glands were found on the face, the hands or the trunk. Tear front movement over the cornea was also visualized and abnormal patterns were identified in obligate heterozygotes. Whole body skin temperature patterns, obtained with an Agema 780 Medical Thermovision system, identified abnormal skin temperature distributions, including characteristic aberrant "cascade" back patterns, in obligate carriers. Two out of six "at risk" females had skin temperature patterns comparable with obligate heterozygotes and we have tentatively concluded that they are carriers. Thermal imaging may be used for the examination of "at risk" non-manifesting females in families with a single affected male. The results of this study suggest that the random X-inactivation in females with XHED, as well as producing relatively large skin areas with sweat pore aplasia, is also associated with abnormal temperature patterns that are consistent with altered peripheral vascular perfusion.

Adolescent↗

Temperature and sweating responses in one-legged and two-legged exercise.

In looking at the thermoregulatory responses resulting from symmetrical or asymmetrical exercise, this paper has focused on the effect of local skin temperature (Tsk,local) on local sweat rates (msw,local) during one-legged (W1) and two-legged (W2) exercise on an ergocycle. Five subjects underwent four 3-h tests at 36 degrees C, each consisting of six 25-min exercise periods alternating with 5-min rest periods. The subjects performed W1 and W2 at 45 and 90 W, respectively, either dehydrated or rehydrated. Body temperatures and total sweat rate were measured as well as four msw,local (on chest and thighs), assessed from sweat capsules under which Tsk,local was maintained at predetermined levels (37.0 degrees C and 35.5 degrees C). The combinations of Tsk,local levels, capsule locations, exercise intensity and hydration level chosen in our protocol led to the following results. The hydration level affected rectal temperature but not total or msw,local. No specific effect of muscle activity was found; msw,local on thighs of resting and working legs were similar. The msw,local were only influenced by exercise intensity, msw,local being more elevated during the higher intensity. No significant effect of Tsk,local on msw,local was found, whatever the experimental condition and/or the location. It was concluded that local thermal effects on msw,local could have been masked by the strong central drive for sweating which has been found to exist in subjects exercising in a warm environment.

Adult↗

Three-dimensional architecture of the microvasculature in the rat foot-pad, with special reference to vasculature around the eccrine sweat glands. A scanning electron-microscopic study of corrosion casts.

The entire microvascular architecture in rat foot-pads including that of eccrine sweat glands was studied by scanning electron microscopy using a vascular corrosion-cast replication technique. In the central roofs of the pads, particularly elaborate capillary networks were arranged in rows perpendicular to the long axis of the foot. In the marginal regions of the pads, simple networks of capillaries were arranged in lamellar sheets parallel to the surface of the sole of the foot. Complex spongy networks of vascular trees were observed in the subcutaneous layer of the pads. These vessels were supplied by the pad artery, and then, after forming capillary networks in the roofs of the pads, they drained into the metatarsal vein. Rod-shaped cages of capillaries were observed around the eccrine sweat glands. One descending arteriole, arising from a connecting arteriole, and a few venules were connected with these capillary cages at their upper and lateral sides. Occasional arterio-venous and veno-venous anastomoses were also observed around the eccrine sweat glands. This microvascular architecture may adjust well to the mechanical and physiological conditions encountered in the foot-pads. The relation of the microvascular architecture around the eccrine sweat glands with their development is also discussed.

Animals↗

Efficiency of sweat evaporation in unacclimatized man working in a hot humid environment.

A method is devised where evaporation and dripping sweat rates can be continuously determined during work. 6 unacclimatized men performed work on a bicycle ergometer at 3 different workloads and in 3 humidities. Ambient temperatures were always equal to mean skin temperatures, thus eliminating all sensible heat transfer. Evaporation rates ranged between 6.8 and 11.2 g X min-1. Rates of dripping sweat ranged from a mean of 2.2 to 10.4 g X min-1. One subject dripped 20.3 g X min-1 in condition H3 (70% RH, 100 W). The fully wet skin in condition H3 corresponded to an evaporative heat transfer coefficient of 99 W X m-2 kPa. Efficiency of sweating, defined as the ratio between secreted and evaporated sweat, ranged from 87 (50% RH, 50 W) to 51% (70% RH, 100 W). Corresponding values of wettedness were 0.56 and 1.0. Efficiency fell to 51% for fully wet skin (H3), and in some subjects the efficiency values were remarkably low. One subject displayed an efficiency of 31% in condition H3. The reduction in efficiency at a given level of wettedness was higher than previously reported.

Acclimatization↗

[gamma-Glutamyl transpeptidase in human eccrine sweat (author's transl)].

UNLABELLED: The concentration of gamma-glutamyl transpeptidase was determined in eccrine, thermal sweat of 56 healthy men (ages 20--60 years) and 48 healthy women (ages 17--55 years). Samples of sweat were collected from the chest and back. RESULTS: The concentrations of gamma-glutamyl transpeptidase showed great individual variations. The sex specific comparison of the concentrations of gamma-glutamyl transpeptidase revealed that the women excreted in the sweat from the chest and the back nearly the double amount of this enzyme. The gamma-glutamyl transpeptidase concentrations determined in the sweat from the chest of the examined men and women were three times higher as compared with those excreted simultaneous from the back of the same persons. In the group of the women was this differences statistically significant.

Adult↗

Immunological studies on the proteins of human eccrine sweat.

Proteins present in the eccrine sweat collected from the skin surface of male volunteers were studied. The protein content ranged from 0.154--0.774 g per liter. A total 2282 ml sweat was concentrated until a final protein content of 25 mg/ml was reached. Paper electrophoresis revealed 3 fractions migrating like alpha-, beta-, and gamma-globulins. Eight different proteins were demonstrated by immunoelectrophoretic analyses using rabbit antisera directed against human sweat proteins. Three of these proteins were identified as blood serum proteins. One of the remaining 5 proteins could be of epidermal origin; another one which occurs in comedones as well as in sweat seems to be eluted from the sebum film present on the skin surface.

Animals↗

Alterations during postnatal period in the secretory responsiveness of the sweat glands in rats to mecholyl.

A study was made to know the alterations in the secretory responsiveness of the plantar and palmar sweat glands to local administration of mecholyl in rats during postnatal period. Nonresponsiveness of the plantar and palmar sweat glands to mecholyl was observed in 0- to 16-day-old and 0- to 10-day-old rats, respectively. After the nonresponsive period, a gradual increase in the responsiveness to mecholyl was observed in the plantar sweat glands. In the palmar sweat glands, however, a rapid increase followed by a temporary decrease and a subsequent gradual increase in the secretory responsiveness to mecholyl was found. This temporary decrease in the secretory responsiveness was observed on days soon after weaning.

Animals↗

Patch-clamp study of cultured human sweat duct cells: amiloride-blockable Na+ channel.

The reabsorptive duct of the eccrine sweat gland has a large transepithelial conductance consisting mainly of a high conductance to Cl- and a smaller, amiloride-blockable Na+ conductance (Bijman and Frömter 1986; Quinton 1986). Cells have been cultured from sweat ducts and their properties previously studied in Ussing chambers (Pedersen 1988) and with microelectrodes (Jones et al. 1988). We have now studied the ion channels present in excised, inside-out patches of human cultured sweat duct cells, and find a marked predominance of linear, 15 pS, amiloride-blockable, low selectivity, Na+ channels. Such channels were seen in 54/92 (59%) of the patches, with up to 7 channels recorded in a single patch. Other channel types were seen at much lower densities. The prevalence of an amiloride-blockable Na+ channel in cultured duct cells clearly distinguishes these cells from cultured sweat gland secretory cells, which lack such a channel.

Amiloride↗

Characterization of human sweat duct chloride conductance by chloride channel blockers.

To characterize the chloride conductance of human sweat duct the effect of various analogues of diphenylamine-2-carboxylate was investigated on the transepithelial potential difference (PDT) and resistance (RT) of isolated microperfused sweat ducts. Although the most powerful analogues which block Cl- channels in various secretory and absorptive epithelia were ineffective, a number of analogues (in particular Cl substituted ones) were found which at high concentrations significantly and reversibly increased PDT and RT. The data suggest that the main chloride conductance pathway of sweat duct epithelium resides in the cell membranes rather than in the tight junctions. In addition the different blocking spectra of the chloride conductances of sweat duct and tracheal epithelium (Welsh MJ, Science 232:1648, 1986) suggest that the combined impairment of both conductances in cystic fibrosis does not result from a molecular defect in the Cl- channels.

Chlorides↗

Influence of the menstrual cycle on the sweating response measured by direct calorimetry in women exposed to warm environmental conditions.

The whole body sweating response was measured at rest in eight women during the follicular (F) and the luteal (L) phases of the menstrual cycle. Subjects were exposed for 30-min to neutral (N) environmental conditions [ambient temperature (Ta) 28 degrees C] and then for 90-min to warm (W) environmental conditions (Ta, 35 degrees C) in a direct calorimeter. At the end of the N exposure, tympanic temperature (Tty) was 0.18 (SEM 0.06) degrees C higher in the L than in the F phase (P less than 0.05), whereas mean skin temperature (Tsk) was unchanged. During W exposure, the time to the onset of sweating as well as the concomitant increase in body heat content were similar in both phases. At the onset of sweating, the tympanic threshold temperature (Tty,thresh) was higher in the L phase [37.18 (SEM 0.08) degrees C] than in the F phase [36.95 (SEM 0.07) degrees C; P less than 0.01]. The magnitude of the shift in Tty,thresh [0.23 (SEM 0.07) degrees C] was similar to the L-F difference in Tty observed at the end of the N exposure. The mean skin threshold temperature was not statistically different between the two phases. The slope of the relationship between sweating rate and Tty was similar in F and L. It was concluded that the internal set point temperature of resting women exposed to warm environmental conditions shifted to a higher value during the L phase compared to the F phase of the menstrual cycle; and that the magnitude of the shift corresponded to the difference in internal temperature observed in neutral environmental conditions between the two phases.

Adult↗

Predictors of sweat loss in man during prolonged exercise.

Nineteen healthy male subjects, differing in training status and Vo2max (52 +/- 1 ml.min-1.kg-1, mean +/- SEM; 43-64 ml.min-1.kg-1, range), exercised for 1 h at an absolute workload of 192 +/- 8 W (140-265 W); this was equivalent to 70 +/- 1% Vo2max (66-74%). Each exercise test was performed on an electrically braked cycle ergometer at a constant ambient temperature (22.5 +/- 0.0 degrees C) and relative humidity (85 +/- 0%). Nude body weight was recorded prior to and after each exercise test. Absolute sweat loss (body weight loss corrected for respiratory weight loss) during each test was 910 +/- 82 g (426-1665 g); this was equivalent to 1.3 +/- 0.1% (0.7-2.2%) of pre-exercise body weight (relative sweat loss). Weighted mean skin temperature and rectal temperature increased after 5 min of exercise from 30.5 +/- 0.3 degrees C and 37.2 +/- 0.1 degrees C respectively to 32.5 +/- 0.2 degrees C and 38.8 +/- 0.1 degrees C respectively, recorded immediately prior to the end of exercise. Bivariate linear regression and Pearson's correlation demonstrated absolute sweat loss was related to Vo2max (r = 0.72, p less than 0.001), absolute exercise workload (r = 0.66, p less than 0.01), body surface area (r = 0.62, p less than 0.01), weight (r = 0.60, p less than 0.01) and height (r = 0.53, p less than 0.05). Relative sweat loss was related to VO2max (r = 0.77, P less than 0.001) and absolute exercise workload (R = 0.59, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Effect of aerobic capacity on sweat rate and fluid intake during outdoor exercise in the heat.

We measured the aerobic capacity, sweat rate and fluid intake of trained athletes during outdoor exercise and examined the relationship between aerobic capacity and thermoregulatory responses at high ambient temperatures. The maximal aerobic capacity (VO2max) of the subjects, nine male baseball players of college age, was determined by maximal exercise tests on a cycle ergometer. The subjects practised baseball regularly without drinking fluids from 1330 to 1530 hours. After 30 min rest, they played a baseball game with free access to a sports drink at 15 degrees C from 1600 to 1830 hours. At a mean ambient temperature of 36.7 (SEM 0.2) degree C, the mean percentage of body mass loss (delta mb) and increase of oral temperature (delta To) from 1330 to 1530 hours was 3.47 (SEM 0.12)% and 0.81 (SEM 0.14) degree C, respectively. The sweat loss from 1330 to 1830 hours was 56.53 (SEM 1.56)ml.kg-1 of body mass (mb) while the mean fluid consumption was 44.78 (SEM 2.39)ml.kg-1 of mb, with recovery of 76.08 (SEM 2.81)% of sweat loss. The VO2max was significantly inversely correlated with delta mb, fluid intake and rehydration amount, but showed no correlation with delta To. These results would suggest that at a given exercise intensity in subjects with a higher aerobic capacity body temperature is maintained with a lower sweating rate than that in subjects with a lower aerobic capacity.

Adult↗

Evaluation of vesico-urethral and sweating function in disorders presenting with parkinsonism.

Investigation of vesico-urethral and sweating function was performed in twelve patients with classical idiopathic Parkinson's disease and ten patients with parkinsonism associated with features suggestive of more extensive involvement of the nervous system, as in the Shy-Drager syndrome. The urodynamic studies revealed detrusor hyperreflexia with reduction of maximal cystometric capacity in only one patient with Parkinson's disease (8%), but in nine patients with parkinsonism associated with other features (90%). Urethral sphincter electromyography did not indicate denervation in any patient of either group. Delayed or incomplete relaxation of the urethral sphincter during micturition was observed in seven patients with Parkinson's disease (58%) and in two patients of the other group (20%). Decreased sweating responses were found in both groups of patients when compared with control subjects. Hypohidrosis was more pronounced in parkinsonism associated with other features than in Parkinson's disease. Differences in sweating between the two sides of the body were observed in both groups of patients. Although there are differences in vesico-urethral and sweating function, they do not precisely differentiate between patients with classical Parkinson's disease and those with parkinsonism associated with features suggestive of more extensive involvement of the nervous system.

Aged↗

Control of sweating during the human menstrual cycle.

Thermoregulatory responses were studied in seven women during two separate experimental protocols in the follicular (F, days 4-7) phase and during the luteal (L, days 19-22) phase of the menstrual cycle. Continuous measurements of esophageal temperature (Tes), mean skin temperature (Tsk), oxygen uptake and forearm sweating (ms) were made during all experiments. Protocol I involved both passive heat exposure (3 h) and cycle exercise at approximately 80% VO2 peak during which the environmental chamber was controlled at Ta = 50.0 degrees C, rh = 14% (Pw = 1.7 kPa). In protocol II subjects were tested during thirty-five minutes of exercise at approximately 85% VO2 peak at Ta = 35 degrees C and rh = 25% (Pw = 1.4 kPa). The normal L increase in resting Tes (approximately 0.3 degrees C) occurred in all seven subjects. Tsk was higher during L than F in all experiments conducted at 50 degrees C. During exercise and passive heat exposure, the Tes threshold for sweating was higher in L, with no change in the thermosensitivity (slope) of ms to Tes between menstrual cycle phases. This rightward or upward shift in Tes threshold for initiation of sweating averaged 0.5 degrees C for all experiments. The data indicate the luteal phase modulation in the control of sweating in healthy women is also apparent during severe exercise and/or heat stress.

Adult↗

Combined effects of vibration and noise on palmar sweating in healthy subjects.

The combined effects of vibration and noise on palmar sweating were studied experimentally in healthy subjects. Ten subjects were exposed to vibration at an acceleration of 100 m.sec-2 root mean square at a frequency of 125 Hz, a noise level of 105 dB(A) at a frequency of 1000 Hz and both stimuli together. Vibration was applied to the right hand and noise to both ears from headphones. Palmar sweating was measured by the ventilated capsule method. Vibration caused a marked increase in palmar sweating of the right hand directly exposed to vibration and also of the left hand not exposed to vibration. Simultaneous vibration and noise caused a greater increase in palmar sweating than by each of the factors separately. The combined effects tended to be greater in subjects who were more susceptible to vibration or noise.

Adult↗