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Cooperative study comparing three methods of performing sweat tests to diagnose cystic fibrosis.

Directors of cystic fibrosis centers in the United States have noted an increasing number of patients with histories of either false-positive or false-negative sweat tests. These inaccuracies were attributed to the use of rapid test methods which avoided actually weighing the sweat collected. These rapid tests have inherent difficulties which, theoretically at least, could lead to mistaken diagnoses. To evaluate methods of performing the sweat test, the National Cystic Fibrosis Foundation organized a combined study comparing the older Quantitative pilocarpine iontophoretic test (QPIT) method of performing the test with two newer and more rapid methods, the Orion skin electrode, and the Medtherm conductivity apparatus. Five cystic fibrosis centers participated in the study. Although two centers obtained considerably more accurate results with the Orion and the Medtherm than did the other three centers, the combined results of the study indicate that these procedures can be considered to be little more than screening tests.

Child↗

Analysis of sweat during soft tissue breakdown following pressure ischaemia.

This paper examines the nature of tissue metabolites collected in thermally induced sweat following the application of different loading regimes on the soft tissues of able-bodied subjects. Loading was produced by 1) external application on the forearm via both a tourniquet and a uniaxial indenter system, and 2) ischial support on a wheelchair and sacral support on an examination bed. In each case sweat pads were attached to the tissue areas of a group of able-bodied subjects and interface pressures were recorded. After a prescribed period, the pads were removed and a quantitative analysis of a range of metabolites was performed. Results indicated that tissues subjected to pressure ischemia produced a general increase in concentrations of lactate, chloride, urea, and urate associated with a decreased sweat rate. In the reperfusion phase, some of these metabolites returned to unloaded levels. It is proposed that specific metabolites may be used as an indicator of soft tissue damage.

Adult↗

The application of saliva, sweat and tear fluid for diagnostic purposes.

Despite anatomical and biochemical similarities, salivary, sweat and lacrimal glandulas differ in their physiological functions. Salivary and tear fluid are required for the proper function of the epithelial layer from which they are secreted. The physiological function of sweat is the elimination of excess heat. The products of the three glandulas can be used to measure indicators either of glandula or of non-glandular diseases. In the latter case the indicator must be transported from the particular organ to the glandula where it is then secreted. In sweat, only one example has reached well accepted clinical importance. The measurement of electrolyte concentrations is the classical laboratory test for cystic fibrosis. The use of tears for diagnostic purposes has been proposed for drug monitoring, to verify the dry eye syndrome (Schirmer test), to detect lysosomal storage diseases (eg Morbus Gaucher) and hyperglycemia. The major domains for the application of saliva are hormone analyses (especially of steroids) and drug monitoring. Furthermore, the application of saliva has been proposed for the detection of several other analytes (eg secretory IgA, peptide hormones, HIV antibodies).

Adrenal Gland Diseases↗

'Rusters'. The corrosive action of palmar sweat: II. Physical and chemical factors in palmar hyperhidrosis.

When measuring sweating rates, close correspondence was found with the clinical estimation of hyperhidrosis. Corrosion was seen to increase with increasing sweat rates, reaching its maximum after an assumed rise in the actual sodium chloride concentration on the skin surface due to evaporation of water. The findings confirm that hyperhidrosis is of primary importance in the constitution of a 'ruster', and are also in good agreement with experimental reports. The small variations in palmar skin pH had no influence on the degree of corrosion; nor had the character of the metal surface. Of the two types of metal studied. corrosion was much more severe on the type having the lowest concentration of copper, thus confirming that increasing copper concentrations have a positive effect in reducing corrosion rates. At 50--60% relative humidity (RH) corrosion increased as time elapsed, whereas at 40% RH no corrosion developed on a sweat-contaminated plate. When exposed to 75% RH, metal samples became severely corroded in the course of a few days. Protective methods for the avoidance of rust are mentioned, with special emphasis on frequent handwashing.

Adolescent↗

Cardiotrophin-1 is not the sweat gland-derived differentiation factor.

Sympathetic neurons innervating sweat glands undergo a target-directed switch in neurotransmitter properties. Although the factor responsible for inducing this switch has not been identified, it appears to be a member of the neuropoietic cytokine family. Cardiotrophin-1 (CT-1), a new family member, was analyzed to determine whether it was a relevant factor. CT-1 induced choline acetyl-transferase and vasoactive intestinal peptide in cultured sympathetic neurons, and RT/PCR amplified CT-1 mRNA from footpad total RNA. The differentiation activity of CT-1 was blocked by CT-1 antiserum. The activity in sweat gland extracts and cultures was not, however, suggesting that CT-1 is not the sweat gland-derived factor.

Animals↗

Sweat duct milia--immunohistological analysis of structure and three-dimensional reconstruction.

The fine structure of sweat duct milia and the pathomechanism in their aetiology are still unknown. To examine the relationship and connection of milia to the sweat ducts as well as to the overlying epidermis, nine sweat duct milia, six incomplete and three complete, were studied by three-dimensional reconstruction (3DR) analysis based on photomicrographs obtained after histological and immunohistochemical staining with antibodies against carcinoembryonic antigen (CEA), cancer antigen (CA 50) and human cytokeratin 19 (CK 19). In both incomplete and complete milia, an eccrine duct expressing the antigens penetrated into the cyst wall at the centre of its base, formed a circular path within the wall, and opened into the inner cavity. The eccrine duct was mature in eight milia and immature in one. In the cyst wall, CA 50 and CK 19 were detected throughout the entire cyst except for the most apical portion of incomplete milia, where the cyst wall fused with the overlying epidermis which did not express any of the antigens. CEA was distributed mainly in the basal half of the milia. The finding that the path of the eccrine duct within the cyst wall is circular conflicts with the currently accepted concept of simple penetration of the eccrine duct into the wall, suggesting an acrosyringeal origin of the milia. An incomplete milium is the result of fusion between cells derived from an eccrine duct and those derived from the surrounding epidermis, while the formation of a complete milium does not involve this fusion.

Aged↗

Pathogenesis of solar urticaria. Sweat droplet in testing for photosensitivity.

It was impossible to replicate solar urticaria lesions by irradiation in the laboratory, until the role of sweating was recognized. We found that the sweat droplet, acting as a lens, serves as a photointensifier. As such, sweat would appear to play a meaningful role in the pathogenesis of cutaneous photosensitivity reactions, as well as be an adjuvant in phototesting.

Adult↗

An electron microscopic study of eccrine sweat glands of the catfoot and toe pads--evidence for ductal reabsorption in the human.

The eccrine sweat glands of the cat foot and toe pads have been studied by light and electron microscopy before and after stimulation with mecholyl. The ultrastructure of these glands in the cat is found to be entirely comparable to that in the human (13). The ultrastructure and staining properties of the secretory segment of the two species are identical. The ductal part of the feline gland is shorter and the ductal cells have only scant mitochondria as compared with the human. Since Brusilow et al. (1) have observed that the secretion of the cat foot pad is isotonic as compared with human sweat, which is hypotonic, and since the secretory segments of the two species are structurally identical, the striking difference in the morphology of the duct is regarded as being responsible for the difference in the chemistry of the secretion of the two species. Thus the duct in the human is capable of reabsorbing sodium and chloride.

Animals↗

Immunolocalization of keratin proteins in sweat gland tumours by the use of monoclonal antibody.

A total of 34 cases (eccrine poroma: 2, cylindroma: 2, eccrine spiradenoma: 4, syringocystadenoma papilliferum: 1, hydroadenoma papilliferum: 1, clear cell hydroadenoma: 7, mixed tumour: 16) of sweat gland tumours of the skin were described in terms of immunohistochemical distribution of keratins using polyclonal anti-keratin antiserum (TK, detecting 41-56 KDa keratins) and monoclonal antibodies (KL1, 55-57 KDa; PKK1, 40, 45, 52.5 KDa). Keratin expression in eccrine poroma, spiradenoma and syringocystadenoma was similar to that in the ductal segment of normal sweat glands. Cylindroma showed usually slight staining for kertins. Tumour cells of hydroadenomas showed not so prominent staining for any of the keratins; however, histologically, tumour cells indicated marked variation, and the degree of keratin proteins also was different among these histological variants. Mixed tumours of the skin were strongly decorated with anti-keratin antibodies along the luminal surface cells of typical structures, while no staining occurred in outer side cells. Luminal tumour cells may be differentiated from secretory coil cells, whereas outer side cells may have a myoepithelial origin, as outer layer cells found in pleomorphic adenoma of salivary glands.

Adenoma, Sweat Gland↗

The ultrastructure and histophysiology of human eccrine sweat glands.

The electron microscopy of human eccrine sweat glands has been studied before and after stimulation by pilocarpine iontophoresis. The identity of the dark and clear cells in the secretory segment as defined by Montagna et al. (23) was determined by studying serial sections, thin for electron microscopy and thick for light microscopy. Cells with numerous apical secretory vacuoles are termed mucoid (dark) cells, since these vacuoles stain positively for acid mucopolysaccharide. Clear cells are intimately associated with intercellular canaliculi. The "cuticular border" of surface cells of the duct is a condensation of tonofilaments and granules. Numerous mitochondria are concentrated in basal cells of the duct. The presence of mucoid cells in the secretory segment may bear on the interpretation of the pathologic findings in the disease cystic fibrosis of the pancreas, and suggests that this disease may be due to a basic disorder of mucopolysaccharide production. The possible roles of the various cellular components in the elaboration of sweat are discussed.

Cell Membrane↗

Immunohistochemical staining patterns of sweat glands and their neoplasms using two monoclonal antibodies to keratins.

The staining patterns of normal sweat glands and sweat gland-derived neoplasms using 2 monoclonal antibodies to keratins (Dako-CK1, Cam 5.2) has been assessed. Based on findings in normal glands, the differentiation of these benign neoplasms is considered, with positive evidence for apocrine and eccrine differentiation, and in the latter, differentiation to ductal or secretory type epithelia. This easily applied technique (indirect immunoperoxidase) is suitable for use in routinely processed tissue and employs 2 commercially available monoclonal antibodies. The findings may be of assistance in general surgical reporting of problematic cases.

Adenoma, Sweat Gland↗

Origin of periodic acid-Schiff-reactive glycoprotein in human eccrine sweat.

To evaluate the possible involvement of ductal blockade with periodic acid-Schiff (PAS)-positive materials in the mechanism of hidromeiosis in humans, skin slices were incubated with methacholine for 2 h and PAS-positive materials localized histologically in the ductal lumen. In 20% of the glands complete ductal blockade with PAS-positive materials was noted. The characteristics and origin of such PAS-positive glycoproteins in human sweat were then studied using various electrophoretic techniques. One-dimensional sodium dodecylsulfate-polyacrylamide gel electrophoresis (1-D SDS-PAGE) demonstrated considerable individual variation in the electrophoretic pattern; however, four major bands at 45, 28, 20, and 18K shared by different individuals, were PAS positive. Further studies using two-dimensional SDS-PAGE, immunodiffusion and immunoaffinity chromatography demonstrated that the PAS-positive glycoproteins are not derived directly from serum because they are electrophoretically and antigenically distinct from serum proteins, including alpha 1-glycoprotein, alpha 2-HS-glycoprotein, and alpha 1-antitrypsin. Since only dark cell granules are densely stained in the histochemical PAS staining, and because antiserum produced against the PAS-positive band selectively stained cells facing the secretory coil lumen (which are most likely dark cells), it is suggested that PAS-positive sweat glycoproteins are derived predominantly from the dark cells.

Adult↗

Human T-cell lymphotropic virus type I infects eccrine sweat gland epithelia.

Human T-cell lymphotropic virus type I (HTLV-I) is known to be associated with several non-neoplastic inflammatory disorders such as HTLV-I-associated myelopathy/tropical spastic paraparesis, arthropathy, uveitis and lymphadenitis, in addition to neoplastic adult T-cell leukemia/lymphoma (ATLL). A strong relation between HTLV-I infection and Sjögren's syndrome (SS) has been reported, and impaired sweating in SS is well known. We have often encountered dry skin in patients with ATLL. On the basis of these observations, we aimed to determine whether HTLV-I infection is present in isolated sweat glands. Eccrine gland epithelia were isolated from full thickness skin biopsies from 8 HTLV-I-seropositive and 7 seronegative individuals using dispase in Eagle's minimum essential medium supplemented with 13% fetal calf serum. We detected HTLV-IpX sequences in samples of eccrine sweat gland epithelia from 4 samples of the 8 seropositive individuals using nested polymerase chain reaction, but all 7 samples from the seronegative donors had no signal corresponding to the sequence. Our results were confirmed by dot blot hybridization. Our results suggest that eccrine epithelium is one of the target organs of HTLV-I infection.

Adult↗

Muscarinic receptors on human eccrine sweat gland in aging and Alzheimer's disease.

Age and Alzheimer's disease-related changes have been reported in the peripheral cholinergic system controlling sweating. We present (1) evidence of a high affinity muscarinic receptor localized on human eccrine sweat gland and (2) muscarinic receptor concentrations on eccrine gland samples from 22 patients with probable Alzheimer's disease of various degrees of dementia, 8 age-matched controls, and 11 young controls. Muscarinic receptors were measured using autoradiography with 3H-NMS as ligand. We found no evidence of changes related to aging or Alzheimer's disease in the overall concentration of receptors or in the amount of gland showing binding. Nor was there any correlation between the degree of dementia as measured by the Global Deterioration Scale or the Mini-Mental State Exam and 3H-NMS binding. In conclusion, we find no evidence that previously reported sweat gland functional changes associated with aging and Alzheimer's disease are reflected in changes in eccrine gland muscarinic receptor density.

Adult↗

Keratinocytes can differentiate into eccrine sweat ducts in vitro: involvement of epidermal growth factor and fetal bovine serum.

BACKGROUND: in addition to formation of an epidermal sheet and dermal substitution, reconstruction of skin that possesses functionality is an important goal for dermatologists. OBJECTIVE: we attempted to regenerate eccrine sweat glands in vitro. METHODS: we constructed skin equivalent models with various combination of normal human keratinocytes and fibroblasts and also examined the effect of various growth factors. RESULTS: we found that keratinocytes invaded the collagen gels and formed eccrine duct-like structures, only when (i) the culture media contained at least 15 ng/ml of epidermal growth factor (EGF) and fetal bovine serum (FBS), (ii) the keratinocytes were derived from young donors, and (iii) fibroblasts were present in the gel. Interestingly, when cultured under the same conditions eccrine gland duct cells were unable to invade the gel. Immunohistochemical analyses revealed induction of carcinoembryonic antigen by EGF at the inner part of the eccrine duct-like structures. Proliferating cell nuclear antigen was expressed mainly in basal layers of the epithelia but was not observed in the deeply invaded part. Cytokeratin profiles of the reconstructed epithelia were consistent with those of the regenerating epidermis and partly with the eccrine sweat duct. CONCLUSIONS: although not perfect model, these results indicate that 'young' keratinocytes could differentiate into/toward eccrine sweat ducts in vitro in the presence of EGF and FBS in cooperation with dermal fibroblasts.

Adolescent↗

The friction sweat test as a new method for detecting facial anhidrosis in patients with Horner's syndrome.

Forty-eight patients with Horner's syndrome documented by cocaine test were examined with the friction sweat test, a method of detecting a mild sweating asymmetry using alcohol and a standard office prism bar. In all but one patient, the results of the friction test corresponded with the results predicted by the history, physical examination, and Paredrine testing, or with the results of a starch-iodine sweat test. The test is a quick, simple, and reproducible procedure that allows a more accurate determination of the location of the Horner's syndrome at the initial office visit, and therefore assists in determining what tests need to be performed in the further examination of the patient.

Face↗

Sweating in the guanaco (Lama guanicoe).

Sweat glands are present all over the skin, where sweat production varies from 4.98 to 73.36gm(-2)h(-1) of skin. Ambient temperatures between 20 and 33 degrees C are the main stimuli for activation of sweat glands, generating a heat loss ranging from 11.9 to 37% of standing basal metabolic rate. Respiratory water loss is not an important mechanism for heat dissipation. Water loss is controlled by postural changes in the guanaco.

Journal Article↗

[Compensatory sweating after upper thoracic sympathectomy. Prospective study of 123 cases].

OBJECTIVE: The most unpleasant consequence of upper thoracic sympathectomy is compensatory sweating (CS). De-pending on the series, the incidence of CS ranges from 24% to 85%. The aim of this study was to determine the relation between CS and the following factors: distribution of hyperhidrosis, procedure performed (unilateral, synchronic bilateral, or sequential bilateral), and number of sympathetic ganglia eliminated. In addition, the degree of patient satisfaction was recorded as objectively as possible. PATIENTS AND METHODS: Prospective study of 123 patients who underwent upper thoracic sympathectomy for palmar and/or axillary hyperhidrosis between 1 January, 1996 and 1 June, 2002 at our unit. All patients completed a questionnaire on symptoms 8 weeks before and after surgery to deter-mine postoperative changes in distribution of the hyperhidrosis and the overall degree of satisfaction on a scale of 0 to 4. RESULTS: The sensation of CS was reported by 86.1% of the patients. When asked to relate this sensation to changes in sweating intensity in specific parts of the body, 46.54% reported CS and 48.37% no change. The trunk was the only region where statistically significant increases in CS occurred; in the feet, a decrease in sweating was noted. No differences in CS were observed with respect to the type of surgery or the number of sympathetic ganglia eliminated. The overall results were considered very satisfactory or quite satisfactory by 84.55% of the patients, while 4.88% were very dissatisfied. CONCLUSIONS: Although CS is a side effect of upper thoracic sympathectomy, not all patients are affected by it. Significant CS occurs mainly in the back, chest, and abdomen. Neither the type of intervention nor the number of ganglia eliminated has an effect on CS. This side effect notwithstanding, overall satisfaction with the treatment is very satisfactory given that the palmar hyperhidrosis is eliminated.

Adolescent↗