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[Immunohistochemical studies of normal sweat glands, sweat gland tumors and extramammary Paget's disease. I. Immunohistochemical studies of normal sweat glands].

Localizations of 18 antigens in normal sweat glands were analyzed. The antigens were roughly classified into 8 antigens: 1) distributed throughout the epithelial cells; 2) localized in whole sweat glands; 3) localized only in the secretory portion of sweat glands; 4) localized only in the inner cells of ductal portion of sweat glands; 5) localized in the myoepithelial cells; 6) localized only in the outer cells of dermal ducts of eccrine glands; 7) localized only seen in some of apocrine glands; 8) seen in the inflamed sweat glands. Based on these findings, I discussed about the forms and meanings of localization of those antigens.

Adult

[Immunohistochemical studies of normal sweat glands, sweat gland tumors and extramammary Paget's diseases. II. Immunohistochemical studies of sweat gland tumors and extramammary Paget's diseases].

Localizations of 18 antigens were analyzed in 41 cases with benign sweat gland tumors (13 with eccrine acrospiroma, 4 with eccrine spiradenoma, 2 with hidroacanthoma simplex, 9 with chondroid syringoma, 4 with syringocystadenoma papilliferum, 1 with tubular apocrine adenoma, 1 with papillary eccrine adenoma, 1 with apocrine cystadenoma, 1 with cylindroma, 5 with syringoma), 14 with malignant sweat gland tumors (7 with eccrine porocarcinoma, 3 with eccrine duct carcinoma, 3 with apocrine gland carcinoma, 1 with mucinous carcinoma) and 13 with extramammary Paget's disease. The results I obtained were compared with those in the normal sweat glands for determination of a differentiation of each tumor.

Antigens, Neoplasm

Cysteine proteinase inhibitor in eccrine sweat is derived from sweat gland.

Although cysteine proteinases have been reported to be present in human eccrine sweat, their endogenous inhibitors, cysteine proteinase inhibitors (CPIs), have remained unstudied. We now present evidence that CPIs are indeed a true ingredient of human eccrine sweat. Sweat induced in sauna was collected over a Vaseline barrier placed on the skin to minimize epidermal contamination. The absence of major epidermal contamination of the sweat was further ensured by monitoring an epidermal marker, high-molecular-mass aminopeptidase. Sweat CPI was purified sequentially by chromatography with Sephacryl S-200, carboxymethylated papain-Sepharose, and anion-exchange Mono Q fast-protein liquid chromatography columns. Sweat CPI has a molecular mass of approximately 15 kDa, is stable for temperature (up to 80 degrees C) and pH (from 3 to 10), and inhibits papain, ficin, and sweat cathepsin B- and H-like enzymes. Sweat CPI may be of sweat gland origin because 1) the rate of CPI output in sweat (CPI concentration x sweat rate) is constant over 45 min; 2) antibody against epidermal CPI, which cross-reacts with sweat CPI, localized immunoreactivity in the sweat duct; 3) CPI activity was present in the glandular extracts of control and methacholine-stimulated (for 1 h in vitro) human sweat glands; and 4) the peaks of CPI activity in the glandular extract and sweat CPI were both eluted (by high-pressure liquid chromatography) at around 15 kDa. Sweat CPI may be very similar to epidermal CPI (which belongs to the stefin family of CPIs) because of many shared characteristics. The identity and function of sweat CPI remain to be studied.

Cysteine Proteinase Inhibitors

Thermal influence on palmar sweating and mental influence on generalized sweating in man.

Sweat rates on the forearm and on the palm were simultaneously recorded by resistance hygrometry and the mode of sweating in these areas in response to thermal and non-thermal stimuli were compared with each other. In Series A, periodic infrared irradiation (1 min on, 1 min off) was done to the back of the trunk, and reflex responses in sweat rate were recorded on both test areas. A high correlation was noted between the mean changes in the palmar sweat rate and those in the forearm one during the irradiation cycle in a majority of cases. However the magnitude of the sweat response was much less on the palm than on the forearm. These observations reveal that the central mechanism of palmar sweating may be affected to some extent by the thermoregulatory mechanism. Series B was concerned with the pattern of response in forearm sweating to various non-thermal stimuli. Careful observations showed that the forearm sweating responded diversely to various mental stimuli, unlike the palmar sweating whose response was always an increase. Mental arithmetic, mental testing and physical exercise caused an immediate increase in the palmar sweating but often elicited a transient decrease in the forearm sweating, whereas pain, noise, and emotional stimuli consistently provoked an increase of sweating on the forearm as well as on the palm. These observations suggest that the activities of higher centers, presumably involving neocortex and limbic cortex, exert various influences on the central mechanisms of palmar and generalized sweating.

Acoustic Stimulation

Experiment studies on sweating for exercise prescription: total body sweat rate in relation to work load in physically trained adult males.

This study was designed to examine whether or not the total body sweat rate can be used as a practical index for prescribing exercise. The sweat rate was experimentally studied in relation to factors such as intensity of exercise, the secretory capacity of sweating mechanism, and body temperature. After determining the maximum sweating rate on the whole body surface, regarded as the secretory capacity of the sweating mechanism, each physically trained subject was made to pedal a bicycle ergometer for 60 min at each of several kinds of mechanical work rates under fixed hot climatic conditions in summer. Total body sweat rate, rectal temperature, and RMR were measured during the experiment. The sweat secreting index (SSI), which is ratio of total body sweat rate to maximum sweat rate, was calculated, and was presumed to indicate the functioning rate of sweat secretory capacity. The total body sweat rate responded to factors such as RMR, SSI, and rectal temperature with a high correlation coefficient. From these results it was concluded that the total body sweat rate can be used as a practical index for prescribing exercise.

Adult

Biology of sweat glands and their disorders. I. Normal sweat gland function.

The basic mechanisms of sweat gland function and an updated review of some relatively common disorders of sweat secretion, are presented. Although sweat secretion and ductal absorption are basically biophysical and biologic cellular processes, a detailed description of the basic biophysical principles of membrane transport has been avoided to make the discussion more readable. The cited references will, however, help those readers primarily interested in the basic details of sweat gland function. Part I of this article includes a discussion of morphologic characteristics, central and peripheral nervous control of sweat secretion, neurotransmitters, intracellular mediators and stimulus secretion coupling, Na-K-Cl cotransport model for the ionic mechanism of sweat secretion, ingredients of sweat, ductal function, the pathogenesis of abnormal sweat gland function in cystic fibrosis, and the discovery of the apoeccrine sweat gland. Part II, to be published in the May issue of the Journal, reviews reports of all those major disorders of hyperhidrosis and hypohidrosis that have appeared in the literature during the past 10 years. It is hoped that this review will serve as a resource for clinicians who encounter puzzling disorders of sweating in their patients, as well as for investigators who wish to obtain a quick update on sweat gland function.

Humans

Relationship between evaporation rate of sweat and mean sweating rate.

The rate of evaporation of sweat under a step change of ambient temperature (30-45 degrees C) was compared with the mean sweating rate (MSR) computed from five simultaneous resistance hygrometric measurements. Empirical equations derived for the conditions studied enabled a direct conversion from hygrometric measurements into real evaporative sweat losses and skin wetness for all phases of sweat evaporation. From five chosen skin areas, forehead, forearm, chest, thigh, and calf, it was found that none of these sites gave a local sweating response close to the MSR. In the subjects with a forehead sweating rate within +/- 39% of the MSR, at least four hygrometric sensors were needed to predict the rate of sweat evaporation. For subjects with higher forehead sweating rates, at least five sensors were necessary to calculate the evaporative sweat loss.

Adult

An improved method for measurement of sweat expulsions during profuse sweating.

We present an improved ventilated-capsule method of recording for clear sweat expulsion patterns using nitrogen gas as a carrier gas heated to promote sweat evaporation. With this method, sweat expulsion patterns were more clearly recorded than with the conventional ventilated-capsule method. Taking the derivatives of these recordings of sweating expulsions could eliminate slow fluctuation components in the patterns of sweating. The results indicate that this method is useful in providing more-accurate measurements of sweat expulsion frequencies during profuse sweating.

Adult

Effects of subcutaneously administered adrenaline on human eccrine sweating, with special reference to the physiological significance of the adrenergic sweating mechanism.

The effects of a small dose (3-6 mug/kg) of subcutaneously administered adrenaline on thermal sweating were studied while subjects were at rest and during or after excerise by means of continuous monitoring by resistance hygrometry of the sweat rate in the forearm area. In most cases, the sweat rate either decreased or did not change significantly following the adrenaline injection, however, among athletic subjects it showed a mild increase in a few cases, mostly during or after exercise. In the area receiving the intradermal injection of an alpha-adrenergic blocking agent, tolazoline, phentolamine or dihydroergotoxine, subcutaneous adrenaline consistently caused an increase in sweat rate. Adrenaline (15 mug) was injected intravenously with similar results. Noradrenaline was used in place of adrenaline in some cases, and the results were essentially the same as, but less distinct than, those with adrenaline. The results indicate that a small dose of subcutaneous adrenaline has dual effects, with the sweat-inhibitory effect generally predominating over the sweat-facilitatory one, with occasional exceptions in association with exercise and/or physical training. The former effect is largely secondary to its vasconstrictive effect, whereas the latter appears to be secondary to its systemic effects, such as central and calorigenic ones. It is concluded that adrenaline within a physiological range exerts no direct action on human eccrine sweat glands.

Adrenergic alpha-Antagonists

The ultrastructure of the sweat glands of the ox, sheep and goat during sweating and recovery.

The ultrastructure of the sweat glands of cattle, sheep and goats was studied before, during, and after, exposure of the animals to controlled warm environments. In cattle, sweating induced little ultrastructural change in the gland, although fluid-filled spaces appeared between the myo- and secretory epithelial layers. The mechanism appears to be one of fluid transport and exocytosis of secretory vesicles, which in this species seem to be derived from the Golgi apparatus and/or mitochondria. The glands of the sheep and goat also displayed signs of vesicle exocytosis and of fluid transport during sweating. The sweating 'fatigue' in these species was apparently due to failure of the secretory cells, some of which ruptured and were extruded into the lumen. The evidence during subsequent recovery indicates that neighbouring cells spread to make contact, encase remnants of atretic cells between them and the underlying myoepithelium, and engulf them. Sweat in these species appears to be formed (a) by secretion and (b) from cells which can no longer meet the demands of stimulation. The role in sweating of cell replacement, and of undifferentiated cells found between the myo- and secretory epithelia, is discussed.

Animals

Effects of ageing and physical training on the peripheral sweat production of the human eccrine sweat gland.

Epidemiological studies suggest that thermoregulatory function declines with ageing. Therefore, it was the purpose of this study to examine the effects of physical training and ageing on the peripheral sweat rate of the human sweat gland. Maximum oxygen uptake and peripheral sweat rate (pilocarpine iontophoresis) were determined in 40 male volunteers (10 sedentary younger men, 10 endurance-trained younger men, 10 sedentary older men, and 10 endurance-trained older men). Maximum oxygen uptake and peripheral sweat rate were significantly (p less than 0.05) greater in the two endurance-trained groups compared to their sedentary counterparts. Furthermore, when matched for maximum oxygen uptake, younger and older men had similar mean peripheral sweat rate values. These results suggest that participation in lifelong aerobic exercise may retard the decrease in peripheral sweat production usually associated with ageing. Further work is needed, however, to determine if such changes can improve overall thermoregulatory function in elderly people.

Adult

Sweat lead levels in persons with high blood lead levels: lead in sweat of lead workers in the tropics.

Samples of blood, sweat and urine were collected from eight control subjects and 19 lead workers in a battery manufacturing factory in the tropics. Sweat samples were collected while workers cycled on a bicycle ergometer at room temperature (27-31 degrees C). All samples were analysed by atomic absorption spectrophotometry. Workers with blood lead levels of 13-36 micrograms dl-1 had sweat levels of 72-256 micrograms l-1 and urinary levels of 28-288 micrograms/g creatinine, while controls had levels of 9-12.2 micrograms dl-1, 9-30 micrograms l-1 and 9-19.6 microgram/g creatinine, respectively. Estimations of sweat lead in lead workers can be masked by skin contamination.

Humans

'Rusters'. The corrosive action of palmar sweat: I. Sodium chloride in sweat.

Sweat from 8 'rusters' and 8 control persons was examined for its sodium concentration. Sweating was induced by iontophoresis of pilocarpine on the distal forearm. In no case did the concentrations exceed the normal upper limit for this procedure, and no difference was found between the two groups. In this way the study failed to confirm earlier reports of elevated sodium chloride concentrations in sweat from 'rusters'. Proposals of a relationship between 'rusters' and patients with pancreatic cystic fibrosis were not substantiated. Hyperhidrosis of the palms and volar surfaces of the fingers was present in all 'rusters'. This seemed to be the main cause of the corrosive tendency, and patients referred for palmar hyperhidrosis were found to produce corrosion similar to the 'rusters'. Topical application of aluminium chloride hexahydrate in a 25% solution in absolute ethyl alcohol proved effective against both hyperhidrosis and the corrosive tendency.

Administration, Topical

Immunohistochemical demonstration of ferritin in sweat gland and sweat gland neoplasms.

Using a rabbit anti-human liver ferritin antibody, we examined the binding patterns of this reagent in normal skin and observed a unique binding pattern limited to the outermost layer of the eccrine duct. Examination of a variety of sweat gland neoplasms revealed 2 distinct patterns. One was the binding of this antibody to the outermost layer of cells in the epithelial cords of syringoma, producing a characteristic ring when seen in cross-section. This pattern of binding did not occur in other neoplasms known to be related to the eccrine duct such as dermal duct tumor and eccrine poroma. Only sparse sporadic binding occurred in other eccrine and apocrine neoplasms. A second characteristic binding pattern, not related to that noted in syringoma and diffuse in pattern, was seen in acrospiroma and in a number of adnexal carcinomas. Diffuse ferritin expression has been described in malignant neoplasms in tissues other than skin. Diffuse ferritin staining of certain sweat gland neoplasms may be an indication of biologic activity and potential aggressivity of these neoplasms.

Biopsy

Biology of sweat glands and their disorders. II. Disorders of sweat gland function.

Part I of this article (J Am Acad Dermatol 1989; 20:537-63) focused on normal sweat gland function. Part II provides a discussion of hyperhidrosis and hypohidrosis. Hyperhidrotic disorders affect the palms and soles and the axillae and are associated with previous spinal cord injuries, peripheral neuropathies, brain lesions, intrathoracic neoplasms, systemic illness, and gustatory sweating. Hypohidrotic disorders include anhidrotic ectodermal dysplasia, hereditary sensory neuropathy, Holmes-Adie syndrome, and generalized anhidrosis.

Humans

[The number of active sweat glands (PSI, palmar sweat index) in stress caused by blood donation].

The number of active sweat glands (PSI), heart rate, systolic (SBP) and diastolic blood pressure (DBP) were assessed every 2 minutes in 109 male blood donors. Three measurements were taken at the beginning (adaptation phase), three later but before blood donation (baseline), one during the venous puncture (phase 3), three thereafter but still during donation (phase 4), and four after removal of the cannula (phase 5). Analysis of variance yielded significant differences between phases; PSI and SBP behaved similarly, decreasing from adaptation to baseline, rising during puncture, and decreasing again thereafter. Mean within-subject correlations between variables were significantly above 0. Between-subjects correlations were significantly negative for PSI and DBP. This is best explained by the influence of age on both variables. Correlations of PSI values as determined by three raters had a mean of 0.90. The study shows that the PSI is a very sensitive indicator of stress that is easily accessible also in field studies.

Adult

Sweat testing for cystic fibrosis: errors associated with the in-situ sweat test using chloride ion selective electrodes.

The in-situ sweat test is prone to errors from various sources. This paper examines errors due to evaporation, absorption of water into the skin, and pressure of the electrode on the skin. Only evaporation caused serious errors. The accuracy and precision when measuring small chloride/sweat samples on the skin are not significantly worse than when measuring bulk solutions.

Chlorides