SPECTROSCOPIC ANALYSIS OF TISSUES FROM PATIENTS WITH CYSTIC FIBROSIS AND CONTROLS.
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Sclerosing sweat-duct carcinoma or malignant syringoma is a rare eyelid tumor. The authors report the first patient with sclerosing sweat-duct carcinoma involving the upper eyelid and present its immunohistochemical and ultrastructural features. The clinical features and the histopathologic and ultrastructural findings that distinguish this tumor from its benign counterparts are discussed. Sclerosing sweat-duct carcinomas are slow growing but locally invasive neoplasms that have a propensity to recur. Wide and deep surgical excision with frozen section evaluation of margins is recommended.
BACKGROUND: Sentinel lymph node mapping and biopsy (SLNB) has become a standard staging procedure for patients with cutaneous neoplasms of known metastatic potential. In the current study, the authors explored the use of SLNB in patients with primary sweat gland carcinomas (SGCs). METHODS: Six patients with SGC underwent SLNB. The tumors and lymph nodes were examined using routine hematoxylin and eosin (H&E) stained sections and by immunohistochemistry using antibodies against epithelial membrane antigen and cytokeratins. RESULTS: Metastases were detected in the SLNs of four of the six patients with SGC. One patient with a primary tumor of the neck was found to have bilateral positive SLNs. Tumor deposits were detected by H&E stained sections alone in all but two SLNs, in which the metastatic cells were recognized only with the aid of immunohistochemical stains. Positive non-SLNs were found in two patients after complete regional lymph node dissection was performed. CONCLUSIONS: The high frequency of positive SLNs in this small series suggests that SLNB is a useful staging tool for patients with SGC. As in SLNBs of other tumors, immunohistochemistry appears to facilitate the recognition of small microscopic metastases.
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A sensitive and practical method is described for the analysis of the proteins contained in human sweat and urine which does not require pre-concentration of the sample. Technical details are provided of the agarose-gel isotachophoresis and the proteinograms of normal and pathological urine samples, as well as proteinograms of human sweat. The method can also be applied as an electro-concentration system in a field-strength gradient. By means of this electro-concentration system, and in combination with immunodiffusion against monospecific antisera, a detection limit of albumin of 50 ng/ml has been obtained.
BACKGROUND: Evolving diagnostic criteria for cystic fibrosis, broadening of the populations being tested and the need to interpret intermediate sweat test results have imposed a much greater need to standardize the collection and analysis of sweat. AIM: To identify variations in sweat testing in New Zealand laboratories and compare these with guidelines from the UK and the USA. METHODS: All laboratories in New Zealand offering sweat testing were identified and data collected from these laboratories by structured questionnaire. RESULTS: There were no New Zealand laboratories that conformed to either set of guidelines. Inconsistencies were observed in minimum sweat quantities, the nature of the iontophoresis solution, the sweat electrolytes analysed, quoted reference ranges and recommendations made as a consequence of the result. CONCLUSIONS: Conformity to the guidelines would help to minimize variation in sweat testing in New Zealand. Performance of a sufficient number of tests to maintain expertise is critical, but geographical constraints make patient travel to distant centres difficult in a small, scattered population. A possible solution, where numbers permit, may be the collection of sweat locally, with referral to a major laboratory for analysis. This is only possible with adequate training in collection and follow-up audit of the sweat testing procedure both in the collection and in the analytical phase.
Anhidrosis has been recognised for over half a century, but despite some excellent epidemiological studies, there has been little progress in understanding the aetiology of the condition. Using a modified ventilated capsule, we obtained dynamic, quantitative data on sweating responses in anhidrotic horses and normal sweating controls from the same environment. Ten horses with current seasonal anhidrosis and 10 matched normal sweating controls were selected. Each horse was given two 10 min infusions of 1 and 2 micrograms/kg/min adrenaline, separated by at least 6 h. Sweating responses and skin temperatures on the neck and gluteal region were measured. Plasma and sweat for analysis of total protein and electrolytes and plasma for analysis of adrenaline were collected. Anhidrotic horses produced significantly less sweat, had lower initial and peak sweat rates and a greater neck:gluteal ratio for sweat production. Plasma adrenaline at rest or at the time of peak sweating rate was not different between groups. In nearly three-quarters of the anhidrotic horses, the shape of the sweat rate against time curve was different compared to controls. Volume of sweat produced was significantly correlated with skin temperature on the neck of controls and anhidrotic horses and on the gluteal region of controls, but not anhidrotic horses. Plasma total protein and electrolyte concentrations were not different between groups. There were significant differences in sweat electrolyte concentrations between controls and anhidrotic horses. These differences were reduced when sweat electrolytes were expressed per g of total protein, and no differences existed when expressed as g/m2. This study has provided insight into the response of anhidrotic horses to beta 2 adrenergic stimulation and may be a useful technique to investigate this condition.
The authors have checked the correctness and accuracy of the total index of microclimate evaluation, using an analog calculator to process the measurements. Information on the measurements of climate was analysed basing on the total index of climate evaluation qtr, Predicted -- 4 -- Hour -- Sweat -- Rate P4SR, Index of Thermal Stress ITS, Wet Bulb Globe Temperature WBGT, Globe -- Temperature tg, Heat Stress Index HSI, Humid Operative Temperature toH and Effective Temperature ET. In addition, under standard conditions, with differentiated degree of physical effort, the following physiological parameters have been determined in 37 subjects: heart rate, internal body temperature, skin temperature and sweat loss. The obtained data have undergone regression and correlation analysis, stating, among others, that the index of climate evaluation qtr and P4SR -- Index correlate best with all physiological parameters.
A straightforward technique was developed for sweat collection applicable to tissues subjected to external load without introducing distortion of underlying tissues, and for analysis of six metabolites in the collected sweat. Chloride was measured colorimetrically and lactate, urea and urate by enzymatic methods on a centrifugal analyser. Sodium and potassium were measured by flame photometry. The methods showed good precision, recovery and linearity. To assess the technique sweat was collected: (i) from the sacrum, ischium, forearm and calf in healthy individuals at 32 degrees C for 1 h; (ii) from the sacrum of healthy subjects at ambient temperature for 9 h; (iii) at ambient temperature from the sacrum of a patient with a history of pressure sores. Sweat rates were greater at the sacrum and ischium than the calf or forearm. There were differences in the concentrations of lactate and urea between sites but these were smaller when expressed as amount secreted. Sweat rates were significantly lower in groups (ii) and (iii), but sweat could be collected reliably. This technique has potential clinical application to the investigation of susceptibility to pressure sores.
Gas-chromatographic analysis of fatty acid composition of sweat lipids in children and adults with neurodermatitis, atopic dermatitis, and eczema showed that sweat can be used as a new noninvasive biological object for evaluation of lipid metabolism disorders.
Measurements of local sweat rate (back) determined with a closed-pouch collector made of polyethylene (110 cm2) were compared with those obtained from a ventilated capsule using an infrared photometric hygrometer technique. Eight young male subjects underwent three exercise sessions each for 60 min at 45% VO2max on a cycle ergometer at an ambient temperature of 35 degrees C and 35% relative humidity. When the onset and transient sweating periods (0-20 min) are excluded from calculations, the difference between the mean values obtained by the collector and the sweat capsule during the 20-60 time period is only 0.06 +/- 0.04 mg x cm-2 x min-1 (5%). Although a significant correlation (r = .74, p < .05) was obtained between methods, individual differences in sweat-rate measurements varied on average +/-0.22 mg x cm-2 x min-1 (+/-19%). Designed more specifically for sweat-content analysis, the pouch collector may serve as a satisfactory field method to approximate the local sweat rate and excretion induced by prolonged exercise in a hot environment.
Cystic fibrosis is the most common life-limiting recessive genetic disorder in Caucasian. It is caused by mutations of CFTR gene (cystic fibrosis transmembrane conductance regulator); at present over 500 mutations are known. Cystic fibrosis as a cause of respiratory distress in the neonate is quite rare. In neonatal period the most important clinical manifestations are meconium ileum and much rarely cholestatic jaundice. We present two cases of cystic fibrosis in newborns. In the first one, we point out the strict association between meconium ileum and cystic fibrosis. The patient underwent a surgical treatment for meconium ileum and the diagnosis was rapidly confirmed by genetic analysis and sweat test. The second one had intestinal obstruction from birth caused by meconium ileum associated with ileal atresia; besides, he developed cholestatic jaundice, severe and rapidly progressive respiratory disease. He died at 102 degrees day of age for cardiac failure. The diagnosis of cystic fibrosis, supported by typical clinical features and high level of serum trypsin, unfortunately wasn't confirmed by genetic analysis (lambda F508/neg), in addition, the sweat test wasn't reliable because an inadequate quantity of sweat was collected.
A well produced evidence based guideline has been developed in response to a national audit that demonstrated wide variations in the performance of sweat tests. Accurate and reliable sweat test results will be particularly important with the advent of neonatal screening. The guideline recommendations include the collection and analysis of sweat samples, and interpretation of results. It emphasises the importance of sweat chloride as the best discriminator.
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