[A case of sunstroke with elevation of multiple serum emzymes (author's transl)].
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A survey of van Gogh's work from 1886 to 1890 indicated that paintings with a yellow dominance were numerous, episodic, and multi-regional. His underlying illness, by his own admission, affected his life and work; furthermore, episodes of malnutrition, substance abuse, environmental exposure, and drug experimentation (all evident from correspondence) exacerbated his condition. Accordingly, we reviewed plausible agents that might have modified the artist's colour perception. Xanthopsia due to overdosage of digitalis or santonin is well documented elsewhere, but evidence of useage of either drug by van Gogh cannot be substantiated. It is unlikely that ageing of the human lens was an influence because of the artist's youth. Sunstroke is too restrictive to fit the multiplicity of regions and motifs. Hallucinations induced by absinthe, the popular liqueur of the period, may explain particular canvases but not the majority of 'high yellow' paintings. Van Gogh's proclivity for exaggerated colours and his embrance of yellow in particular are clear from his letters and, in contradistinction to chemical or physical insults modifying perception, artistic preference is the best working hypothesis to explain the yellow dominance in his palette.
Summary--Because of the topography of the perilymphatic vascular network, the cochlear microcirculation is especially sensitive to the effect of vasoactive substances reaching the perilymphatic space. The cochlear microcirculation is mainly controlled humorally, via the activity of the metarterioles and changes in the flow properties of the blood. Intracochlear histamine reduces the cochlear circulation even more markedly than after intracarotid administration. No systematic effects of parenteral administration of vasoactive substances can be expected on the cochlear circulation. Reversible auditory disorders after stapedectomy may be explicable by the intracochlear release of histamine. The internal release of histamine after sunstroke and cold stress may play a part in sudden dusturbances of hearing.
BACKGROUND: The presence of a seasonal variation in serum lipids and blood pressure is often described in the literature. METHODS: With the aim of analyzing this seasonal influence blood pressure and lipid (total cholesterol and cholesterol corresponding to different lipoprotein, triglycerides and AI and B apolipoprotein families) values were studied over 12 months in 36 normotense healthy males (mean age 36 +/- 6 years), a third of whom presented diverse base lipid alterations. A variance analysis of the relative intraindividual values (to study monthly differences) was carried out and a Student's t test was performed for the absolute values and grouped into two periods (summer and winter) and according to two categories (normal and hyperlipemic). RESULTS: No significant modification was observed in any of the parameters studied with the exception of the intrapersonal variation coefficient of the triglycerides which was significantly higher in the hyperlipemic individuals. CONCLUSIONS: In the population studied no seasonal modification was observed in blood pressure or different lipid concentrations analyzed. The slight variation of temperature observed and the elevated sunstroke in Spain in addition to the youth of the population studied may explain the lack of seasonal variation.
A patient developed generalized anhidrosis, probably following sunstroke. Light microscopy showed an atrophic, deeply lobulated or elongated configuration of the eccrine sweat glands, most of them containing many vacuoles that possessed strong acid phosphatase activity. Electron microscopy revealed that the vacuoles were bound by a unit membrane and that the contents varied. Fusion of the vacuoles and accumulation of cellular debris in the lumen were also seen. It was concluded that the vacuoles showed areas of autolysis and were classified in the group of lysosomes. In addition, it is postulated that the anhidrosis resulted from a critical rise in body temperature with subsequent changes in the secretory cells.
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Heat injury is a threat to athletes performing in a hot, humid environment. High metabolic rate, dehydration, and hidromeiosis all interfere with regulation of core body temperature and compromise athletic performance. Precautions can be taken to prepare athletes for these adverse conditions and to minimize potentially serious consequences. Physicians working closely with coaching staffs and athletes can establish a sound medical program aimed at prevention of heat-related injuries and, when injury does occur, at immediate, decisive management.
Heat illness varies in severity from mild to life-threatening. Basic treatment includes rapid cooling and restoration of fluid and electrolyte balance. Most patients can be treated definitively in the field. Some require additional therapy in a hospital emergency department, and a few need hospitalization. Not all hyperthermic patients have heatstroke. Neuroleptic malignant syndrome is a possibility, or a patient with a febrile illness may also present on a hot day. Careful evaluation is therefore necessary before the diagnosis of simple heatstroke is considered acceptable.
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Fifty two consecutive patients with heat stroke were examined for evidence of adult respiratory distress syndrome (ARDS) and disseminated intravascular coagulation (DIC). Twelve patients were found to have ARDS (incidence of 23 percent) of whom nine (75 percent) died. All of these 12 patients had DIC as compared to only one among the 40 patients without ARDS. Review of the evidence in literature linking ARDS and DIC and our own observations in this study lead to the conclusion that the coagulopathy may be an essential mediator of lung damage in heat stroke and is a reliable marker of its occurrence. This suggests the possibility that screening of heat stroke victims for DIC may identify patients at increased risk of developing overt ARDS and allow early institution of measures which may possibly improve survival.
Heat stroke is reviewed in detail. Particular attention is paid to diagnosis and current emergency department treatment, and a brief overview of pathophysiology is included. Early complications, with recommendations for prevention and management, are described. Minor heat related syndromes are also mentioned.
We study the clinical characteristics of 21 heat strokes at admittance, to analyze the clinical features in relationship with prognosis. 15 patients (71%) suffered a classical heat stroke and 6 (29%) an active heat stroke. Global mortality was 33%. Sun exposition was more frequent in patients who survived (p less than 0.05), fact that we relate with earlier withdrawal from noxa. Patients with worse prognosis were showing more frequently coma (p less than 0.05); photomotor (p less than 0.01), oculocephalic (p less than 0.01) and corneal (p less than 0.01) reflexes abolition; together with disorders in spontaneous and induced motility of members (p less than 0.05); areflexia (p less than 0.01) and plantar extensor response (p less than 0.05). However the most discriminatory parameter between the two groups was the response to cooling, because the outcome was always fatal when cooling did not take place (p less than 0.01). From the analytical standpoint, serum bicarbonate was lower in the patients who died (p less than 0.05). We insist in the need to start prevention and treatment programs in those communities with high incidence of this syndrome.
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