The secretory clear cell of the eccrine sweat gland as the probable source of excess sweat production in hyperhidrosis.

Primary hyperhidrosis is characterized by excessive sweating in palmar, plantar and axillary body regions. Gland hypertrophy and the existence of a third type of sweat gland, the apoeccrine gland, with high fluid transporting capabilities have been suggested as possible causes. This study investigated whether sweat glands were hypertrophied in axillary hyperhidrotic patients and if mechanisms associated with fluid transport were found in all types of axillary sweat glands. The occurrence of apoeccrine sweat glands was also investigated. Axillary skin biopsies from control and hyperhidrosis patients were examined using immunohistochemistry, image analysis and immunofluorescence microscopy. Results showed that glands were not hypertrophied and that only the clear cells in the eccrine glands expressed proteins associated with fluid transport. There was no evidence of the presence of apoeccrine glands in the tissues investigated. Preliminary findings suggest the eccrine gland secretory clear cell as the main source of fluid transport in hyperhidrosis.

Perception of risk: a study of A&E nurses and NHS managers.

This exploratory study investigates perceptions of two groups of NHS staff, of a range of risks, topical and relevant to accident and emergency (A&E). Literature suggests that the effectiveness of a risk management strategy is lessened if staff exposed to risk, and managers, have different perceptions of the nature and severity of the risk. A self-administered questionnaire was distributed to registered A&E nurses and to Trust managers at directorate level and above, working in five large inner-city NHS Trusts. Managers and nurses were asked to quantify their perceptions of nine defined adverse events. They were also asked to identify the jobholder with day-to-day responsibility for managing four specific risks. Completed forms were obtained from 38 per cent of managers and nurses. Results showed broadly that managers tended to quantify risks of violence and stress to A&E nurses less highly than did nurses. By contrast, they tended to quantify risks to patients more highly than did nurses. Overall, a coherent pattern of difference in risk perception between the two groups was identified. It is argued that identification of differences of perception is an essential part of the risk management process. Illustrations are given of ways in which these differences can undermine the effectiveness of a risk management strategy.

Analyzing free-living physical activity of older adults in different environments using body-worn activity monitors.

This study measured objectively the postural physical activity of 4 groups of older adults (> or =65 yr). The participants (N = 70) comprised 3 patient groups--2 from rehabilitation wards (city n = 20, 81.8 +/- 6.7 yr; rural n = 10, 79.4 +/- 4.7 yr) and the third from a city day hospital (n = 20, 74.7 +/- 7.9 yr)--and a healthy group to provide context (n = 20, 73.7 +/- 5.5 yr). The participants wore an activity monitor (activPAL) for a week. A restricted maximum-likelihood-estimation analysis of hourly upright time (standing and walking) revealed significant differences between day, hour, and location and the interaction between location and hour (p < .001). Differences in the manner in which groups accumulated upright and sedentary time (sitting and lying) were found, with the ward-based groups sedentary for prolonged periods and upright for short episodes. This information may be used by clinicians to design appropriate rehabilitation interventions and monitor patient progress.

The effect of varying pulse duration, wavelength, spot size, and fluence on the response of previously treated capillary vascular malformations to pulsed-dye laser treatment.

Modern lasers allow different parameters to be altered in an effort to gain further improvement in otherwise resistant capillary vascular malformations (CMs). The aim of this study was to examine the effect of changing the pulse duration, wavelength, spot size, and fluence on the color and capillary architecture of 585-nm pulsed-dye, laser-resistant CMs. Eighteen patients were assessed with a depth measurement videomicroscope (DMV) before and after 12 test patches with ScleroPlus and V-Beam lasers at specified parameters. In the majority of the test patch areas, there was little improvement after treatment. However, 44% of patients had greater than 75% clearance in at least 1 test patch site. This study demonstrates that both lasers can achieve further lightening in 585 nm 0.45 msec pulsed-dye laser-resistant CMs. However, in CMs consisting of small-diameter deep vessels, further improvement is unlikely.