Sudor Anglicus: an epidemic targeting the autonomic nervous system.

Renaissance England witnessed a series of brief epidemics of a rapid and often fatal illness, the predominant feature of which was a disturbance of the autonomic nervous system. Profuse sweating was both an emblematic and ominous sign of this Sudor Anglicus. Its story is medically fascinating as well as historically noteworthy. Possible sites of pathological involvement include the hypothalamus, serotonergic neurons in the brainstem or spinal cord, autonomic ganglia, peripheral sympathetic nerves, neuroeffector junctions, or eccrine glands. Of candidate etiologic agents, a virus is most likely, given the seasonal variation, geographic clustering, and pattern of spread of the epidemics. Hantaviruses, enteroviruses, influenza, and others provide clinical comparisons, but a definitive match with known viruses has remained elusive.

[Anno 1529 - the "English Sweating Sickness" in Vienna, the Turkish troops around Vienna]. / Anno 1529 ­ der "Englische Schweiß" in Wien, die Türken um Wien.

After the battle of Bosworth in 1485 London was frightened by a severe epidemic of Sweating Disease. Until 1551 four more followed of which only the 1525 epidemic invaded Central and Northern Europe harassing Vienna during its "First Turkish Siege".People abruptly fell ill with headache, tachycardia, fever and secretion of stinking sweat. They were afflicted with anxiety, deliria and somnolence. The illness mostly lasted for 24 h, but death although could occur earlier. At the beginning of epidemics the lethality was particularly high. The treatment with distinct medicaments had to be started instantly. The patients must be kept warm and sleepless ("Dutch Regiment"). The thus caused high lethality was lowered by omitting the hyperthermia ("English Regiment").I suppose that the Sweating Disease was an "Emerging Disease" of the 15th/16th century, as nowadays AIDS, Ebola, SARS, MERS and influenza variants are.

Impact of primary hyperhidrosis on the life of physical education academics of a university in the Brazilian Northeast

Abstract Aim: To assess the prevalence, quality of life (QoL), and the damages caused by PH, in the professional and personal scope of Physical Education academics with Primary Hyperhidrosis (PH). Methods: A descriptive, exploratory, qualitative and quantitative cross-sectional study was carried out. Twenty-five students from the physical education course at Tiradentes University, Aracaju-SE, were interviewed from August to November 2017. Validated questionnaires were used on PH's influence in academic activities and QoL. absolute and relative frequencies in the case of categorical variables and measures of trend and central variability in the case of numerical variables. Results: The prevalence of PH in students of Physical Education was 11.11%, mainly in combined sites, such as palmoplantar, and with no difference between the sexes. The symptoms started mostly during childhood and adolescence. Most of the interviewees (92%) reported difficulties with activities such as sports, use of personal protective equipment, handling of work equipment and instruments, and exacerbation in stress situations. They reported significant harm to QoL in situations of greeting people with handshakes, writing, wearing socks and dancing socially. Conclusion: Although PH is a disease that negatively impacts the QoL, it is still little known in the academic world with little demand for medical help. Therefore, it is necessary greater dissemination of the disease for its early diagnosis, related to the intensity of the sweating for a better therapeutic approach.

The English Sweating Sickness: Out of Sight, Out of Mind?

In this paper we aim to add additional knowledge regarding the occurrence, origin and epidemiological features of the English sweating sickness. The English sweating sickness raged in five devastating epidemics with mortality rates between 30 and 50% between 1485 and 1551 throughout England, and on one occasion also affected mainland Europe, in 1529. The Picardy sweat, generally considered as the English sweating sickness' lesser deadly successor, flared up in France in 1718 and caused 196 localized outbreaks with varying severity all over France and neighboring countries up to 1861. The English sweating sickness has been the subject of numerous attempts to define its origin, but so far all efforts have failed due to lack of material, DNA or RNA, that - using modern techniques and knowledge - could shed light on its cause. Although the time frame in which the English sweating sickness occurred and the geographical spread of the outbreaks is generally known, we will demonstrate here that there was more to it than meets the eye. We found reports of cases of sweating sickness in years before, after and between the 1485, 1508, 1517, 1529 and 1551 epidemics, as well as reports of sweating sickness in Italy and Spain. CONCLUSION: In spite of the fact that the English sweating sickness apparently has not caused casualties for a more than a century now, we suggest that -given the right circumstances- the possibility of re-emergence might still exist. The fact that up until today we have no indication concerning the causal pathogen of the English sweating sickness is certainly not re-assuring.

[Effect of Ronghuang Granule on serum FGF23, FGFRs and Klotho in non-dialysis patients with CKD-MBD and kidney deficiency and damp-heat syndrome].

OBJECTIVE: To observe the effect of Ronghuang granule on serum fibroblast growth factor 23 (FGF23), fibroblast growth factor receptor (FGFRs) and Klotho protein levels in non-dialysis patients with chronic kidney disease-mineral and bone disorder (CKD-MBD) and kidney deficiency and damp heat syndrome. METHODS: Seventy non-dialysis CKD-MBD patients with kidney deficiency and dampness-heat syndrome were randomized into control group (n=35) and treatment group (n=35). All the patients were given routine treatment combined with traditional Chinese medicine retention enema, and the patients in the treatment group received additional Ronghuang granule treatment (3 times a day). After the 12-week treatments, the patients were examined for changes of TCM syndromes. Serum levels of Ca, P, parathyroid hormone (iPTH), FGF23, FGFRs and Klotho proteins were detected before and after treatment. These parameters were also examined in 20 healthy volunteers. RESULTS: Sixty-five patients completed the study, including 33 in the control group and 32 in the treatment group. The patients in the treatment group showed significantly better treatment responses than those in the control group (P < 0.05 or 0.01). At 4, 8, and 12 weeks of treatment, the patients in the treatment group had significantly lowered scores of TCM syndromes compared with the score before treatment (P < 0.05 or 0.01), while in the control group, significant reduction of the scores occurred only at 12 weeks (P < 0.05); at each of the time points, the treatment group had significantly greater reductions in the score than the control group (P < 0.01). Significant improvements in serum Ca, P and iPTH levels were observed at 4, 8, and 12 weeks in the treatment group (P < 0.05) but only at 12 weeks in the control group (P < 0.05). The patients in the control and treatment groups all showed elevated serum levels of FGF23, FGFRs and Klotho protein compared with the normal subjects (P < 0.01); FGF23, FGFRs and Klotho levels were significantly reduced in the treatment group (P < 0.05) but remained unchanged in the control group (P>0.05), showing significant differences between the two groups. CONCLUSIONS: Ronghuang granule improves the clinical symptoms of non-dialysis CKD-MBD patients with kidney deficiency and dampness heat syndrome by reducing serum levels of FGF23, FGFRs and Klotho, improving calcium and phosphorus metabolism disorder, and inhibiting secondary hyperparathyroidism.

Effect of Ronghuang Granule on serum FGF23, FGFRs and Klotho in non-dialysis patients with CKD-MBD and kidney deficiency and damp-heat syndrome / 南方医科大学学报

OBJECTIVE@#To observe the effect of Ronghuang granule on serum fibroblast growth factor 23 (FGF23), fibroblast growth factor receptor (FGFRs) and Klotho protein levels in non-dialysis patients with chronic kidney disease-mineral and bone disorder (CKD-MBD) and kidney deficiency and damp heat syndrome.@*METHODS@#Seventy non-dialysis CKD-MBD patients with kidney deficiency and dampness-heat syndrome were randomized into control group (=35) and treatment group (=35). All the patients were given routine treatment combined with traditional Chinese medicine retention enema, and the patients in the treatment group received additional Ronghuang granule treatment (3 times a day). After the 12-week treatments, the patients were examined for changes of TCM syndromes. Serum levels of Ca, P, parathyroid hormone (iPTH), FGF23, FGFRs and Klotho proteins were detected before and after treatment. These parameters were also examined in 20 healthy volunteers.@*RESULTS@#Sixty-five patients completed the study, including 33 in the control group and 32 in the treatment group. The patients in the treatment group showed significantly better treatment responses than those in the control group ( < 0.05 or 0.01). At 4, 8, and 12 weeks of treatment, the patients in the treatment group had significantly lowered scores of TCM syndromes compared with the score before treatment ( < 0.05 or 0.01), while in the control group, significant reduction of the scores occurred only at 12 weeks ( < 0.05); at each of the time points, the treatment group had significantly greater reductions in the score than the control group ( < 0.01). Significant improvements in serum Ca, P and iPTH levels were observed at 4, 8, and 12 weeks in the treatment group ( < 0.05) but only at 12 weeks in the control group ( < 0.05). The patients in the control and treatment groups all showed elevated serum levels of FGF23, FGFRs and Klotho protein compared with the normal subjects ( < 0.01); FGF23, FGFRs and Klotho levels were significantly reduced in the treatment group ( < 0.05) but remained unchanged in the control group (>0.05), showing significant differences between the two groups.@*CONCLUSIONS@#Ronghuang granule improves the clinical symptoms of non-dialysis CKD-MBD patients with kidney deficiency and dampness heat syndrome by reducing serum levels of FGF23, FGFRs and Klotho, improving calcium and phosphorus metabolism disorder, and inhibiting secondary hyperparathyroidism.

Tratamento cirúrgico da bromidrose / Surgical treatment of bromhidrosis

INTRODUÇÃO:A bromidrose ou osmidrose é um problema que leva inúmeros pacientes a procurar tratamento médico especializado. A remoção das glândulas sudoríparas da região axilar por meio de exérese e lipoaspiração complementar é um procedimento de pequeno porte, tecnicamente simples e com poucas complicações. O objetivo deste trabalho é mostrar a aplicação da cirurgia neste problema, suas complicações e o grau de satisfação dos pacientes. MÉTODO: Trinta e dois pacientes foram submetidos à lipoaspiração e retirada dos tecidos da axila, sob anestesia local e sedação. Acompanhou-se por no mínimo 6 meses estes pacientes no pós-operatório, avaliando a evolução e possíveis complicações e aplicou-se o questionário CSQ-8 para o grau de satisfação no sexto mês. RESULTADOS: Após 6 meses de acompanhamento, poucas foram as complicações e as respostas ao questionário demonstraram alto grau de satisfação. CONCLUSÃO: Além de ser facilmente exequível, o procedimento se mostrou seguro e com poucas complicações.

INTRODUCTION: Bromhidrosis or osmidrosis causes many patients to seek specialized medical treatment. Removal of the sweat glands from the axillary region through excision and complementary liposuction is a minor, technically simple procedure, with few complications. The objective of this study is to review the role of surgery in bromhidrosis, complications of treatment, and the degree of patient satisfaction. METHOD: Thirty-two patients underwent liposuction and removal of axillary tissue under local anesthesia and sedation. The patients were followed up for at least 6 months postoperatively, to evaluate the outcome and possible complications. The Client Satisfaction Questionnaire was completed after 6 months. RESULTS: After 6 months of follow-up, there were few complications and the questionnaire revealed a high degree of satisfaction. CONCLUSION: In addition to being easily performed, the procedure was safe, with few complications.

Caracterización de los pacientes con fibrosis quistica diagnosticados por cloruros en sudor / Characterization of patients with Cystic Fibrosis diagnosed through sweat chloride test

Antecedentes y Objetivo: La Fibrosis Quística (FQ) es una enfermedad genética de herencia autosómica recesiva, caracterizada por disfun- ción de las glándulas de secreción exocrina. En Honduras no hay ningún tipo de revisión sobre este tema, por lo que se realizó este estudio con el objetivo de caracterizar los pacientes diagnosticados con FQ mediante prueba de Cloruros en Sudor. Pacientes y Métodos: Estu- dio descriptivo con enfoque cuantitativo, se revisaron expedientes clínicos y se aplicó un instrumento de 20 preguntas a pacientes en control médico, durante enero 2010 a junio 2015. Resultados: Se presentan cinco pacien- tes con diagnóstico de brosis quística. La edad al momento del diagnóstico varió de Recién nacido a 5 años; 2 de ellos con antecedentes familiares para dicha enfermedad. Al inicio de la enfermedad 3 tenían sintomatología respira- toria y digestiva. En relación a talla/edad al momento del diagnóstico, 4 se encontraban por debajo del percentil Z-3. La totalidad repor- tó cultivos positivos para Pseudomona auregi- nosa. Respecto al manejo terapéutico de los pacientes en la totalidad de ellos se indicó nebulizaciones con Salino hipertónico al 7%, Beta-2-agonistas, antibióticos sistémicos y suplementación enzimática y de vitaminas liposoluble. En 2 pacientes, se encontró la mutación ΔF508 en el gen CFTR. Conclusio- nes: La Fibrosis Quística todavía es una patolo- gía en gran medida desconocida. Se recomien- da implementar el tamizaje neonatal para ayudar al diagnóstico temprano y la prueba de cloruros en sudor en pacientes de mayor edad y con alta sospecha clínica de esta enfermedad...(AU)

Síndrome de Ross: una causa infrecuente neurológica de trastorno de la sudoración / Ross syndrome: an infrequent neurological cause of sweating disorders

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Latanoprost y crisis de sudoración / Latanoprost and sweating episodes

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[A surgical fenestration of an arachnoid cyst in the cerebellomedullary cistern].

Arachnoid cysts originating from the cerebellomedullary cistern are very rare, and their indications for surgical treatment remain controversial. A 41-year-old man with a cystic lesion in the left cerebellomedullary cistern presented with sudden perspiration, palpitations, and vertigo. Subsequently, he complained of numbness of the left extremities and a dull headache. Otolaryngological evaluation revealed no abnormality. Physical examination on admission showed no neurological manifestations, except for left sensory disturbance. MRI revealed a cyst in the left cerebellomedullary cistern. Radiological examination did not reveal direct compression of the brain stem by the cyst, but the left cerebellum was compressed by the cyst. The patient underwent surgical fenestration of the arachnoid cyst via the midline suboccipital approach. The symptoms immediately disappeared after surgery. Patients with an arachnoid cyst in the cerebellomedullary cistern usually present lower cranial nerve dysfunction as a symptom. In our case, there was no cranial nerve dysfunction, but anatomically unexplainable symptoms, such as perspiration, palpitations, dizziness, and numbness of the left limbs, were observed. In conclusion, even if a patient with an arachnoid cyst in the posterior cranial fossa presents unexplainable symptoms, surgical intervention, including fenestration, is one of the therapeutic options.

Were the English sweating sickness and the Picardy sweat caused by hantaviruses?

The English sweating sickness caused five devastating epidemics between 1485 and 1551, England was hit hardest, but on one occasion also mainland Europe, with mortality rates between 30% and 50%. The Picardy sweat emerged about 150 years after the English sweat disappeared, in 1718, in France. It caused 196 localized outbreaks and apparently in its turn disappeared in 1861. Both diseases have been the subject of numerous attempts to define their origin, but so far all efforts were in vain. Although both diseases occurred in different time frames and were geographically not overlapping, a common denominator could be what we know today as hantavirus infections. This review aims to shed light on the characteristics of both diseases from contemporary as well as current knowledge and suggests hantavirus infection as the most likely cause for the English sweating sickness as well as for the Picardy sweat.

Uso do retalho toracodorsal para tratamento de hidradenite supurativa / Use of the thoracodorsal flap for the treatment of hidradenitis suppurativa

INTRODUÇÃO: A hidradenite é uma doença cutânea crônica, que acomete as regiões que abrigam as glândulas apócrinas. Tem uma prevalência estimada de 1% da população, com predileção pelo sexo feminino. MÉTODO:LMN, 48 anos, sexo feminino. Ao exame, a paciente apresentava nodulações palpáveis, coalescentes, dolorosas e uma área de fibrose e retração cicatricial circunjacente em ambas as axilas, principalmente em axila esquerda. Submetida a exérese ampla das lesões em axila e região torácica esquerda, sendo necessária a realização de um retalho fasciocutâneo de rotação, habitualmente usado em pacientes submetidas à quadrantectomia lateral. RESULTADOS: Obteve-se um resultado estético satisfatório associado à preservação dos movimentos. CONCLUSÃO:Apesar de existirem poucos casos relatando o uso do retalho fasciocutâneo toracodorsal lateral, essa técnica mostrou ser excelente alternativa na reconstrução axilar, devido à facilidade de ressecção, boa cobertura da área receptora além de um resultado estético satisfatório.

INTRODUCTION:Hidradenitis suppurativa is a chronic skin disease that affects the regions harboring the apocrine sweat glands. It has an estimated prevalence of 1% of the population and a preference for the female sex. METHOD: LMN, a 48-year-old female patient, presented, on examination, palpable, coalescent, painful nodules and a circumjacent area of fibrosis and scar retraction in both axillae, mainly in the left axilla. She was subjected to wide excision of the lesions at the axilla and left thoracic region, with a need for a rotational fasciocutaneous flap, usually used in patients who undergo lateral quadrantectomy. RESULTS: A satisfactory aesthetic result was attained, together with the preservation of movements. CONCLUSION: Although there are few reported cases of the use of the lateral thoracodorsal fasciocutaneous flap, this technique is an excellent alternative in axillary reconstruction, owing to the ease of resection, good coverage of the receiving area, and the satisfactory aesthetic result.

Reactividad simpática al estrés inducido experimentalmente en la alexitimia / Sympathetic reactivity to experimentally induced stress in alexithymia

Alexithymia refers to a specific disturbance in emotional processing that is manifested through difficulties in identifying and verbalizing feelings. The main objective of this research has been the study the relationship between sympathetic reactivity patterns, measured by electrodermal activity, and the alexithymia level, in a stressful laboratory situation. The subjects were high- or low-alexithymic young females (separated by TAS-20). The experiment involved six phases and the sympathetic reactivity was assessed in each one of them, using the Palmar Sweat Index (PSI), a sensitive indicator of the number of active sweat glands. The results show that both alexithymic and nonalexithymic subjects showed significant increases in PSI during stress phases and systematic decreases in all relaxation phases. We also obtained significant differences between TAS-20 low and high scores and between aggregated experimental phases, but no evidence of interaction TAS-20 x experimental phases. The results provide little support with the hypothesis that alexithymic subjects are more physiologically reactive to stress (AU)

La alexitimia describe un trastorno específico del procesamiento emocional que se manifiesta mediante una marcada dificultad para identificar y expresar emociones. El objetivo principal de este trabajo ha sido valorar la relación entre los patrones de activación simpática, medidos mediante la actividad electrodermal, y el nivel de alexitimia, en una situación de estrés inducido experimentalmente en el laboratorio. Se emplearon mujeres jóvenes con niveles altos y bajos de alexitimia, clasificadas mediante las puntuaciones que obtuvieron en el TAS-20. El experimento comprendió seis fases, en las que se evaluó su reactividad simpática en cada una de ellas mediante el empleo del Índice de Sudoración Palmar, un indicador sensible al numero de glándulas ecrinas activas. Los resultados mostraron que en ambos grupos se produjeron incrementos significativos en el número de glándulas sudoríparas activas durante las fases de estrés, así como reducciones en las fases de relajación. Se obtuvieron también diferencias significativas en los que obtuvieron puntuaciones altas y bajas en el TAS-20 durante las distintas fases experimentales, pero no se apreciaron evidencias de intereación entre las fases y los niveles de alexitimia. Los resultados proveen un moderado apoyo a la hipótesis que sostiene que los alexitímicos son más reactivos fisiológicamente al estrés (AU)

A propósito del enigmático sudor inglés / Concerning the enigmatic English sweating disease

El sudor inglés fue una enfermedad de gran impacto sicológico y moral en la Inglaterra medieval y en el continente europeo, y misteriosa por su comienzo repentino, brevedad y súbita desaparición. En esta investigación se analizan diversos aspectos de esta enfermedad, otrora emergente, con base en documentos clásicos y en otros poco conocidos; se incluyen aspectos históricos, descripción de las epidemias, enfermedades afines, especulaciones sobre la etiología incluyendo los posibles agentes infecciosos responsables y los cambios conceptuales acerca de la enfermedad; se relacionan las dificultades de este tipo de ejercicio retrospectivo con los problemas de comunicación inherentes a la cultura médica de aquella época y con la incipiente semiología.

English sweating disease (Sudor anglicus) had a strong moral and psychological impact on medieval England and Europe. It was a mysterious and terrific illness because of its sudden onset, brevity and abrupt disappearance. Based on classical and less well-known documents, different aspects of this once-emergent disease are analyzed, among them: its history, the description of its epidemics, similar diseases, probable etiology including infectious agents, and conceptual changes about it. Communication problems inherent to mediaeval culture, and the incipient semiotics are among the reasons for the difficulties of this retrospective analytical exercise.

Manejo de la hiperhidrosis por videotoracoscopia / Hyperhidrosis management by videothoracoscopy

La hiperhidrosis o sudoración excesiva de las palmas de las manos, las axilas, la cara y las plantas de los pieses una afección que condiciona al paciente en su relaciónpsico-bio-social, dificultando sus relaciones sociales y sentimentales, así como en su aspecto laboral, por lo que surge la necesidad de un tratamiento efectivo con el fin de conseguir la disminución del sudor a niveles aceptables ola supresión del mismo.El objetivo de este trabajo es presentar nuestra experiencia en el tratamiento de la hiperhidrosis por videotoracoscopia.En este estudio fueron incluidos todos aquellos pacientes sometidos cirugía por hiperhidrosis desde enero del año 1999 hasta enero del 2009 por este equipo. Fueron realizadas 80 simpatectomías en 40 pacientes, resecandola cadena simpática desde T2 a T4, con un tiempo operatorio entre 15 y 50 minutos, siendo dadas de alta en promedio a las 24 hs, con mínima morbilidad.Los resultados para el paciente fueron óptimos, constatándose la desaparición de la sudoración ya en sala de operaciones.Considerando los resultados obtenidos en nuestros pacientes con el abordaje videotoracoscópico de la cadena simpática, esta es una técnica mínimamente invasiva,eficaz, segura, estéticamente aceptable y que lleva a una cura definitiva en casi el 100% de los casos.