The clinical thermoregulatory sweat test induces maximal seating

2001 ◽  
Vol 11 (4) ◽  
pp. 227-234 ◽  
Author(s):  
Caleb Hsieh ◽  
Kevin McNeeley ◽  
Thomas C. Chelimsky
Keyword(s):  
Sweat Test ◽  
Thermoregulatory Sweat Test

Standardized Autonomic Testing in Patients With Probable Radiation-Induced Afferent Baroreflex Failure

Hypertension ◽  
2021 ◽  
Author(s):  
Guillaume Lamotte ◽  
Elizabeth A. Coon ◽  
Mariana D. Suarez ◽  
Paola Sandroni ◽  
Eduardo Benarroch ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Sweat Test ◽  
Plasma Norepinephrine ◽  
Pressure Monitoring ◽  
Autonomic Testing ◽  
Baroreflex Failure ◽  
Radiation Induced ◽  
Thermoregulatory Sweat Test ◽  
Blood Pressure Lability

Injury of the afferent limb of the baroreflex from neck radiation causes radiation-induced afferent baroreflex failure (R-ABF). Identification and management of R-ABF is challenging. We aimed to investigate the pattern of autonomic dysfunction on standardized autonomic testing in patients with probable R-ABF. We retrospectively analyzed all autonomic reflex screens performed at Mayo Clinic in Rochester, MN, between 2000 and 2020 in patients with probable R-ABF. Additional tests reviewed included ambulatory blood pressure monitoring, plasma norepinephrine, and thermoregulatory sweat test. We identified 90 patients with probable R-ABF. Median total composite autonomic severity score (range, 0–10) was 7 (interquartile range, 6–7). Cardiovascular adrenergic impairment was seen in 85 patients (94.4%), increased blood pressure recovery time after Valsalva maneuver in 71 patients (78.9%; median 17.4 seconds), and orthostatic hypotension in 68 patients (75.6%). Cardiovagal impairment was demonstrated by abnormal heart rate responses to deep breathing (79.5%), Valsalva ratio (87.2%), and vagal baroreflex sensitivity (57.9%). Plasma norepinephrine was elevated and rose appropriately upon standing (722–1207 pg/mL). Ambulatory blood pressure monitoring revealed hypertension, postural hypotension, hypertensive surges, tachycardia, and absence of nocturnal dipping. Blood pressure lability correlated with impaired vagal baroreflex function. Postganglionic sympathetic sudomotor function was normal in most cases; the most frequent thermoregulatory sweat test finding was focal neck anhidrosis (78.9%). Standardized autonomic testing in R-ABF demonstrates cardiovascular adrenergic impairment with orthostatic hypotension, blood pressure lability, and elevated plasma norepinephrine. Cardiovagal impairment is common, while sudomotor deficits are limited to direct radiation effects.

Thermoregulatory Sweat Test

2016 ◽  
pp. 643-657
Author(s):  
Robert D. Fealey
Keyword(s):  
Body Surface ◽  
Sweat Rate ◽  
The Body ◽  
Sweat Test ◽  
Report Generation ◽  
The Core ◽  
Before And After ◽  
Anterior Body ◽  
Total Body ◽  
Thermoregulatory Sweat Test

The thermoregulatory sweat test (TST) consists of giving a controlled heat and humidity stimulus to produce a generalized sweat response. The TST assesses the integrity of efferent sympathetic sudomotor pathways. The entire anterior body surface is tested for both pre- and post-ganglionic lesions. The TST can evaluate patients with symptoms of small-fiber neuropathy and demonstrate autonomic involvement in disorders such as multiple system atrophy, hyperhidrosis, and some skin disorders. An indicator powder placed on the body surface before heating provides visualization of sweating and non-sweating skin. The patient’s weight (before and after heating) and height allows calculation of total body sweat rate, and the slope of the core temperature rise with time provides an estimate of heat tolerance. Normal and abnormal TST patterns, report generation, and difficulties and pitfalls in test interpretation are described.

scholarly journals Novel methods of imaging and analysis for the thermoregulatory sweat test

2018 ◽  
Vol 125 (3) ◽  
pp. 755-762 ◽  
Author(s):  
Michael S. Carroll ◽  
David W. Reed ◽  
Nancy L. Kuntz ◽  
Debra E. Weese-Mayer
Keyword(s):  
Thermal Imaging ◽  
Neurological Disorders ◽  
Evaporative Cooling ◽  
Autonomic Nerve ◽  
Sweat Test ◽  
Standard Testing ◽  
Testing Protocol ◽  
Widespread Adoption ◽  
Sweat Testing ◽  
Thermoregulatory Sweat Test

The thermoregulatory sweat test (TST) can be central to the identification and management of disorders affecting sudomotor function and small sensory and autonomic nerve fibers, but the cumbersome nature of the standard testing protocol has prevented its widespread adoption. A high-resolution, quantitative, clean and simple assay of sweating could significantly improve identification and management of these disorders. Images from 89 clinical TSTs were analyzed retrospectively using two novel techniques. First, using the standard indicator powder, skin surface sweat distributions were determined algorithmically for each patient. Second, a fundamentally novel method using thermal imaging of forced evaporative cooling was evaluated through comparison with the standard technique. Correlation and receiver operating characteristic analyses were used to determine the degree of match between these methods, and the potential limits of thermal imaging were examined through cumulative analysis of all studied patients. Algorithmic encoding of sweating and nonsweating regions produces a more objective analysis for clinical decision-making. Additionally, results from the forced cooling method correspond well with those from indicator powder imaging, with a correlation across spatial regions of −0.78 (confidence interval: −0.84 to −0.71). The method works similarly across body regions, and frame-by-frame analysis suggests the ability to identify sweating regions within ~1 s of imaging. Although algorithmic encoding can enhance the standard sweat testing protocol, thermal imaging with forced evaporative cooling can dramatically improve the TST by making it less time consuming and more patient friendly than the current approach. NEW & NOTEWORTHY The thermoregulatory sweat test (TST) can be central to the identification and management of several common neurological disorders, but the cumbersome nature of the standard testing protocol has prevented its widespread adoption. In this study, images from 89 clinical TSTs were analyzed retrospectively using two novel techniques. Our results suggest that these improved methods could make sweat testing more reliable and acceptable for screening and management of a range of neurological disorders.

Sudomotor Dysfunction

2020 ◽  
Vol 40 (05) ◽  
pp. 560-568
Author(s):  
William P. Cheshire
Keyword(s):  
Diagnostic Marker ◽  
Heat Stroke ◽  
Sympathetic Skin Response ◽  
Sweat Test ◽  
Axon Reflex ◽  
Sudomotor Function ◽  
Small Fiber ◽  
Skin Response ◽  
Patient At Risk ◽  
Thermoregulatory Sweat Test

AbstractDisorders of sudomotor function are common and diverse in their presentations. Hyperhidrosis or hypohidrosis in generalized or regional neuroanatomical patterns can provide clues to neurologic localization and inform neurologic diagnosis. Conditions that impair sudomotor function include small fiber peripheral neuropathy, sudomotor neuropathy, myelopathy, α-synucleinopathies, autoimmune autonomic ganglionopathy, antibody-mediated hyperexcitability syndromes, and a host of medications. Particularly relevant to neurologic practice is the detection of postganglionic sudomotor deficits as a diagnostic marker of small fiber neuropathies. Extensive anhidrosis is important to recognize, as it not only correlates with symptoms of heat intolerance but may also place the patient at risk for heat stroke when under conditions of heat stress. Methods for assessing sudomotor dysfunction include the thermoregulatory sweat test, the quantitative sudomotor axon reflex test, silicone impressions, and the sympathetic skin response.

Thermoregulatory Sweat Test

2009 ◽  
pp. 645-660
Author(s):  
Robert D. Fealey
Keyword(s):  
Body Surface ◽  
Sweat Test ◽  
Neural Pathways ◽  
Anterior Body ◽  
Thermoregulatory Sweat Test

The TST assesses the integrity of central and peripheral efferent sympathetic sudomotor neural pathways. A controlled heat and humidity stimulus is given to produce a generalized sweating response in all skin areas capable of sweating. Sweating is visualized by placing an indicator powder on the skin beforehand. The entire anterior body surface can be examined and abnormalities can usually be detected at a glance.

Specimen Preparation for Clinical Applications of X-Ray Microanalysis

1990 ◽  
Vol 48 (2) ◽  
pp. 328-329
Author(s):  
J.D. Shelburne ◽  
G.M. Roomans
Keyword(s):  
Carbon Coating ◽  
Clinical Applications ◽  
Point Of View ◽  
Practical Significance ◽  
Sweat Test ◽  
Specimen Preparation ◽  
Tissue Preparation ◽  
X Ray ◽  
Gallbladder Stones ◽  
Clinical Problems

Proper preparative procedures are a prerequisite for the validity of the results of x-ray microanalysis of biological tissue. Clinical applications of x-ray microanalysis are often concerned with diagnostic problems and the results may have profound practical significance for the patient. From this point of view it is especially important that specimen preparation for clinical applications is carried out correctly.Some clinical problems require very little tissue preparation. Hair, nails, and kidney and gallbladder stones may be examined and analyzed after carbon coating. High levels of zinc or copper in hair may be indicative of dermatological or systemic diseases. Nail clippings may be analyzed (as an alternative to the more conventional sweat test) to confirm a diagnosis of cystic fibrosis. X-ray microanalysis in combination with scanning electron microscopy has been shown to be the most reliable method for the identification of the components of kidney or gallbladder stones.A quantitatively very important clinical application of x-ray microanalysis is the identification and quantification of asbestos and other exogenous particles in lung.

scholarly journals Cystic fibrosis in disguise – the wolf in sheep’s clothing, a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Friederike Wilbert ◽  
Sarah C. Grünert ◽  
Andrea Heinzmann ◽  
Sebastian F. N. Bode
Keyword(s):  
Cystic Fibrosis ◽  
Systemic Disease ◽  
Gastrointestinal Symptoms ◽  
Chloride Concentration ◽  
Failure To Thrive ◽  
Sweat Test ◽  
Upper Airways ◽  
Inborn Errors ◽  
Hepatic Involvement ◽  
Number Of Patients

Abstract Background Childhood hypoglycemia in combination with hepatomegaly is suspicious for inborn errors of metabolism. Cystic fibrosis typically presents with failure to thrive, pulmonary and gastrointestinal symptoms. Hepatic involvement and hypoglycemia can occur in a significant number of patients, although hepatomegaly is uncommon. Case presentation A 28 months old boy was presented with recurrent upper airways infections, progressive lethargy and weight loss. Clinically hepatomegaly was the main presenting feature and hypoglycemia (minimum 1.4 mmol/l) was noted as were elevated transaminases. The patient did not produce enough sweat to analyze it. Infectious causes for hepatitis were excluded and a broad metabolic work-up initiated. A therapy with starch was initiated to control hypoglycemia. In further course loose stools were reported and pancreatic elastase was found to be reduced. A further sweat test yielded pathological chloride concentration and genetic testing confirmed the diagnosis of cystic fibrosis. Conclusions Cystic fibrosis is a systemic disease and less common presentations need to be considered. Even in the age of CF-newborn screening in many countries CF needs to be ruled out in typical and atypical clinical presentations and diagnostics need to be repeated if inconclusive.

scholarly journals Disposition of MDMA and Metabolites in Human Sweat Following Controlled MDMA Administration

2009 ◽  
Vol 55 (3) ◽  
pp. 454-462 ◽  
Author(s):  
Allan J Barnes ◽  
Bruno S De Martinis ◽  
David A Gorelick ◽  
Robert S Goodwin ◽  
Erin A Kolbrich ◽  
...  
Keyword(s):  
Solid Phase ◽  
Random Order ◽  
Research Unit ◽  
Sweat Test ◽  
Test Results ◽  
Double Blind ◽  
Scientific Database ◽  
Sweat Testing ◽  
Clinical Research Unit ◽  
Sweat Tests

Abstract Background: Understanding the excretion of 3,4-methylenedioxymethamphetamine (MDMA) and metabolites in sweat is vital for interpretation of sweat tests in drug treatment, criminal justice, and workplace programs. Methods: Placebo, low (1.0 mg/kg), and high (1.6 mg/kg) doses of oral MDMA were given double-blind in random order to healthy volunteers (n = 15) with histories of MDMA use. Participants resided on the closed clinical research unit for up to 7 days after each dose. Volunteers wore PharmChek® sweat patches (n = 640) before, during, and after controlled dosing. Patches were analyzed by solid phase extraction and GC-MS for MDMA, methylenedioxyamphetamine (MDA), 4-hydroxy-3-methoxyamphetamine (HMA), and 4-hydroxy-3-methoxymethamphetamine (HMMA). Limits of quantification (LOQ) were 2.5 ng/patch for MDMA and 5 ng/patch for HMA, HMMA, and MDA. Results: MDMA was the primary analyte detected in 382 patches (59.7%), with concentrations up to 3007 ng/patch. MDA was detected in 188 patches (29.4%) at <172 ng/patch, whereas no HMMA or HMA was detected; 224 patches (35.0%) and 60 patches (9.4%) were positive for MDMA and MDA, respectively, at the 25-ng/patch threshold proposed by the Substance Abuse and Mental Health Services Administration. Conclusions: Sweat testing was shown to be an effective and reliable method for monitoring MDMA use in this controlled MDMA administration study. However, variability in sweat excretion suggests that results should be interpreted qualitatively rather than quantitatively. These data provide a scientific database for interpretation of MDMA sweat test results.

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