Cutaneous apocrine cystomatosis in three slaughter-aged pigs.

Apocrine cystomatosis is a rare condition characterized by clusters of cystically dilated sweat glands or other specialized apocrine glands. Cystic dilation of cutaneous sweat glands has been described in humans, dogs, and cats, but not in pigs, to our knowledge. We describe herein linear, brown, colloid-filled cavities < 1 cm diameter within the subcutaneous fat of the entire dorsal region of carcasses of three 6-mo-old pigs. These incidental findings were detected during meat inspection in 3 different slaughterhouses in Catalonia, Spain. Histopathology revealed multiple cystic cavities lined by flattened glandular epithelium, filled with proteinaceous material, and corresponding to cystic hyperplasia of sweat glands.

Spontaneous extracranial hemorrhagic phenomena in primary headache disorders: A systematic review of published cases.

Background Head pain is a cardinal feature of primary headache disorders (PHDs) and is often accompanied by autonomic and vasomotor symptoms and/or signs. Spontaneous extracranial hemorrhagic phenomena (SEHP), including epistaxis, ecchymosis, and hematohidrosis (a disorder of bleeding through sweat glands), are poorly characterized features of PHDs. Aim To critically appraise the association between SEHP and PHDs by systematically reviewing and pooling all reports of SEHP associated with headaches. Methods Advanced searches using the PubMed/MEDLINE, Web of Science, Cochrane Library, Google Scholar, and ResearchGate databases were carried out for clinical studies by combining the terms "headache AND ecchymosis", "headache AND epistaxis", and "headache AND hematohidrosis" spanning all medical literature prior to October 10, 2015. Preferred Reporting Items for Systematic Reviews and Meta-analyses and Meta-analysis of Observational Studies in Epidemiology guidelines were applied. Results A total of 105 cases of SEHP associated with PHDs (83% migraine and 17% trigeminal autonomic cephalgias) were identified (median age 27 years, male to female ratio 1:2.3); 63% had epistaxis, 33% ecchymosis, and 4% hematohidrosis. Eighty-three percent of studies applied the International Classification of Headache Disorders diagnostic criteria. Eighty percent of the reported headaches were episodic and 20% were chronic. Twenty-four percent of studies reported recurrent episodes of SEHP. Conclusions Our results suggest that SEHP may be rare features of PHDs. Future studies would benefit from the systematic characterization of these phenomena.

Sudomotor dysfunction in autoimmune autonomic ganglionopathy: a follow-up study.

OBJECTIVE: We have previously shown that sudomotor dysfunction in autoimmune autonomic ganglionopathy is severe, widespread, and predominantly post-ganglionic. However, the long-term changes in sudomotor function have not been studied in detail. Our objective was to characterize the long-term changes in sudomotor dysfunction in patients with autoimmune autonomic ganglionopathy. METHODS: Changes in sudomotor function were compared in a cohort of nine α3 nAChR antibody positive autoimmune autonomic ganglionopathy patients over an approximate 5-year period. Standard measurements of sudomotor function were used including the thermoregulatory sweat test and quantitative sudomotor axon reflex test. RESULTS: Total body anhidrosis on thermoregulatory sweat testing showed improvement in four of nine patients. Quantitative sudomotor axon reflex testing for both forearm and foot sites was variable with four of nine patients showing improvement in total sweat output. Distribution of sudomotor dysfunction at follow-up was post-ganglionic in seven of nine patients at the foot site and three of nine patients at the forearm site. Overall, sudomotor dysfunction was post-ganglionic in seven of nine patients throughout the follow-up period (62.4 ± 19.4 months). INTERPRETATION: Sudomotor dysfunction in autoimmune autonomic ganglionopathy was severe and widespread throughout the follow-up period for the majority of patients studied. Sudomotor dysfunction was predominantly post-ganglionic throughout the follow-up period.

Paroxysmal sympathetic hyperactivity in the neurological intensive care unit.

OBJECTIVE: To assess the incidence and associations of paroxysmal sympathetic hyperactivity (PSH) among febrile patients in the neurological intensive care unit (NICU). METHODS: Prospective data collection of consecutive patients admitted to an academic NICU for >48 hours. Fever was defined as body temperature >38.3 degrees C (101.0 degrees F) on at least one measurement for two consecutive days. PSH was defined by the transient presence of four of the following six criteria: fever, tachycardia, hypertension, tachypnea, excessive diaphoresis and extensor posturing or severe dystonia in the absence of other potential causes for these clinical signs. Methods: Ninety-three patients were included. Traumatic brain injury (TBI) was the primary diagnosis in 43 patients (46%). PSH were diagnosed in 17 patients (18%). It occurred in 14/43 patients (33%) with TBI but only 3/50 patients (6%) with other primary disorders (p = 0.01). Patients with PSH were younger (mean age: 35 +/- 14 versus 51 +/- 18 years old in the rest of the population) (p = 0.01), although the difference did not reach statistical significance when only TBI patients were included in the analysis (mean age: 35 +/- 15 years old in TBI patients with PSH versus 46 +/- 19 years old in TBI patients without PSH; p = 0.07). Duration of fever in patients with PSH (mean: 10.5 +/- 7 days; median: 9 days) was significantly longer than in the rest of the population (mean: 5.1 +/- 3 days) (p<0.001); the difference remained significant when the analysis was restricted to TBI patients (p = 0.001). CONCLUSION: Episodes of PSH occur in one-third of TBI patients but are rare in other acute neurological conditions. They are more frequent in younger patients and are associated with prolonged duration of fever.