New epidemiological aspects of patients with severe hyperhidrosis presenting for sympathetic surgery.

BACKGROUND: Epidemiological data on individuals suffering from severe primary hyperhidrosis are scarce. OBJECTIVE: This study aims to prospectively assess disease-specific characteristics of patients with severe, mostly therapy-resistant hyperhidrosis presenting for sympathetic surgery. METHODS: We evaluated a total of 227 patients (69.6% women) with a mean age of 30 years (standard deviation, 9.5 years) using a standardized questionnaire. Severity of disease was rated on a visual analogue scale (VAS) graded between 0 (no symptoms) and 10 (worst symptom). Age, sex, previous therapies, hormonal therapies and body mass index were analysed for their possible influence on severity of the disease and on hyperhidrosis sites. In addition, allergies were investigated for the first time in this patient population. RESULTS: There was a positive correlation between age of onset and sites of hyperhidrosis. The most commonly affected areas were palmar-axillary-plantar (51.1%) and palmar-plantar (15.0%), with sex-specific differences. Two hundred and twelve patients (93.4%) had previous conservative therapies; 219 patients (96.5%) reported VAS scores between 8 and 10. Female patients stated higher VAS scores for palmar (P = 0.009) and axillary (P = 0.012) sites. Type IV allergies were found to be much higher than in the general Austrian female population. Hormonal therapies and the body mass index had no influence on severity of hyperhidrosis after analysis of VAS scores. CONCLUSION: Sex-dependent aspects can be found in patients strongly affected by primary upper limb hyperhidrosis.

Mortality trends of lung cancer in Austria and the Czech Republic.

This paper concerns itself with possible reasons for differences in lung cancer (ICD9-162) mortality rates in Austria and the Czech Republic. Lung cancer mortality in Austrian men reached its peak in 1973 and decreased gradually after a plateau by 23% since then, while the Czech mortality rate in men was constantly increasing till 1986 and then started to decline by 21% till 1998. As far as women in both countries are concerned, the risk of dying from lung cancer has risen dramatically for the last 20 years. In Czech men the mortality rate between 1970-1998 was significantly higher than in Austrian men while in women the death rates were closely similar. Differences cannot be explained by different smoking habits. In the past occupational exposure to cancerogenic agents in the Czech Republic was certainly one of the futile factors for the different lung cancer mortality rates. However, nowadays, Austria and the Czech Republic have to cope with similar problems particularly with an increasing number of children and adolescents (especially females) starting smoking very early. Activities to prevent children and adolescents from starting or stopping to smoke will be the only way to control lung cancer epidemic in the 21st century.

Changes of biochemical and biomechanical properties in Dupuytren disease.

BACKGROUND: The major biochemical characteristic of Dupuytren disease is the progressive and irreversible deposition of excess fibrous collagen characterized by an enhanced type III collagen proportion. OBJECTIVE: To investigate the influence of changes of the collagen spectrum on the biophysical properties of the palmar aponeurosis. DESIGN: Variably affected palmar regions from 30 individuals with Dupuytren disease were classified according to histologic test results and clinical stage. Biochemical, biomechanical, and thermal contracture studies were performed. RESULTS: The relative type III collagen content increased with increasing tissue involvement and was found to correlate with calorimetric and biomechanical properties with the exception of the Young modulus. In experiments on the thermal isometric contracture, the collagen denaturation temperature decreased with increasing type III collagen content, ie, increasing involvement. To study the dependence of biophysical properties from the collagen type distribution independent of structural changes, as seen in Dupuytren disease, we investigated rat skins from animals of an age range characterized by dramatic changes in type III collagen content (0-18 months). Biomechanical data also correlated significantly with type III collagen content in rat skin with the exception of the time constant of stress relaxation. CONCLUSION: In light of these results, we suggest that structural changes, such as reduced collagen fibril diameters, associated with alterations in the type III collagen proportion may influence biophysical properties of connective tissues in the involved palmar aponeurosis in addition to alterations of the cross-linking pattern.

Measurement and distribution of various heavy metals in the Danube River and Danube Canal aquatic communities in the vicinity of Vienna, Austria.

Samples of mud, water, algae and fish were collected from the Danube River and Danube Canal and analysed by neutron activation techniques for various trace metals. The study was conducted over a ten-months time period. Results show no significant variation in levels of Cr, Co, Sb, Zn, Fe and Sc during the period of study. Comparison of the results obtained for the river with those obtained for the canal indicate that, with the exception of one sampling site, there are no statistically significant differences. Generally the values lie in the range accepted as normal for most fresh water systems. One site in the canal was found to have high Cr content in the mud samples at a point where the Vienna River joins the canal.

An anatomical variant of the extensor carpi radialis brevis muscle.

BACKGROUND: Variations in musculature are of interest not only to the anatomist but also to the surgeon, insofar as they can be a source of error in both diagnosis and treatment. Muscular anomalies in the lower arm and in the hand have frequently been described in the literature; some of the lesions they can be confused with are ganglia and other soft tissue tumors. CASE REPORT: In the course of preparation of a small, fine-jointed right upper extremity, an accessory muscle was discovered in the forearm and hand region; it branched off from the extensor carpi radialis brevis (ECRB) muscle. Its tendon crossed over the extensor retinaculum and attached to the dorsal digital expansion of the index finger. Both muscles were innervated by a branch of the deep branch of the radial nerve. The observations made here supplement our knowledge of variations in the antebrachial and dorsal regions of the arm and hand, which should be quite useful in hand surgery.

Decreased trace element contents in chromatin of patients with pemphigus.

Three trace elements, manganese, copper and zinc, selected as normal constituents were measured in the chromatin fraction of peripheral blood mononuclear cells from four pemphigous patients and compared with values form 4 matching control cases treated with corticosteroid. Manganese and copper were decreased in pemphigous patients significantly against controls whereas zinc was decreased slightly without statistical significance. Decreased trace element levels in chromatin revealed an unique pattern characteristic only for pemphigus as compared with earlier data of this group and of others in different pathological states. Decrease in chromatin zinc content might reflect the fact of corticosteroid treatment rather than a pathognomic feature which has to be taken into consideration while working with samples from patients on long-term steroid therapy. The theory of trace element depletion in pemphigus is confronted with known reports of penicillamine--a chelating agent--induced cases of the disease.

Rare variant of the brachial artery: superficial lateral inferior type VII EAB.

This study concerns a variant of the brachial artery with a modified origin and course. The artery was studied in 418 upper limbs removed from cadavers. In one upper limb the left brachial artery bifurcated into: (1) a superficial brachial a. (the variant) crossing superficially to the bicipital aponeurosis in the cubital region and assuming the course, position, and supply area of the radial artery, and (2) the deep brachial a. (another variant). An embryologic interpretation of this anomaly is based on a variant vascular development derived from the eighth intersegmental artery. The variant is termed according to Adachi's classification schedule as arteria brachialis superficialis lateralis inferior Type VII with the addition EAB (epiaponeurosis bicipitalis, i.e., superficial to the bicipital aponeurosis). Accurate information concerning unusual patterns of the arteries in the upper limbs is clinically relevant, especially in the avoidance of accidental intra-arterial injection with reflectory vascular occlusion leading to necrosis.

Biomechanical stability of abductor pollicis longus muscles with variable numbers of tendinous insertions.

BACKGROUND: In the course of a study of different variants of the tendon of the abductor pollicis longus (APL) muscle, the unusual finding of a tendon with six subdivisions was observed in the first compartment. Using this preparation and others with various numbers of tendons (2, 3, 4, and 6), we intended to establish whether the multitendoned muscles increased the strength of the thumb. METHODS: Fifty-two upper extremities were examined with attention to the tendons of the APL muscle. The strain on each tendon was biomechanically determined using a microcomputer and potentiometer. The stress was measured continuously and plotted against strain. RESULTS: Following treatment with elastase, it is seen that the significance of changes in stability and Young's modulus is inversely proportional to the number of tendons arising from the APL. CONCLUSIONS: Division of the tendon into several parts leads to better mechanical distribution of stress and extension on thumb abduction. In addition, palmar-flexion in the wrist may be supported.

Differential scanning calorimetry, biochemical, and biomechanical analysis of human skin from individuals with diabetes mellitus.

The aim of this work was to compare biochemical, two-dimensional biomechanical and calorimetric parameters of diabetic skin vs. control skin. Skin specimens taken from the palms and backs of the hands of aged persons with non-insulin-dependent diabetes mellitus (NIDDM) and of controls (CO) were compared (age range 68-85 years). Only skin specimens from individuals with diabetes mellitus (DM) showed an increased fluorescence specific for the formation of advanced glycation end-products (AGEs) and the presence of tissue AGEs, such as N(e)-(Carboxymethyl)lysine (CML). Differential scanning calorimetry (DSC) revealed an elevation of the heat flow per unit mass during collagen denaturation in diabetic skin samples. However, the temperatures of the heat flow maximum and the onset of the phase transformation were not uniformly altered. Young's moduli were found to be increased in diabetic skin and correlated with AGE-fluorescence and tissue AGEs. The ratio between the Young's moduli, which defines a measure for the degree of anisotropy, was higher for dorsal skins from hands. In dorsal skin specimens from diabetic subjects the degree of anisotropy was more pronounced than in healthy controls. In general, neither of the measured parameters showed any correlation with age. However, E(1) moduli were clearly associated with the duration of diabetes.

Comparison of palmar aponeuroses from individuals with diabetes mellitus and Dupuytren's contracture.

It is well known that Dupuytren's contracture is often associated with diabetes mellitus. Palmar fascia from individuals with diabetes mellitus and/or Dupuytren's contracture as well as controls were subjected to differential scanning calorimetry, biomechanical and biochemical analysis. The collagen denaturation temperature of the palmar aponeurosis from individuals with diabetes mellitus in the presence (71.0 degrees C) or absence of Dupuytren's contracture (70. 6 degrees C) was increased as compared with controls (68.5 degrees C), while this parameter was significantly reduced (about 3.5 degrees C) in contracture bands of Dupuytren's contracture. Stress relaxation experiments revealed that the viscous fraction was slightly reduced in diabetes mellitus (6.5%) vs. controls (8.3%), whereas in Dupuytren's contracture, irrespective of additional diabetes mellitus, a pronounced increase of this parameter was seen (36.5% vs. 24.5%) in the presence of diabetes mellitus. The time constants were significantly elevated by both disorders, this increase being more pronounced in Dupuytren's contracture. Taken together, these changes can be explained by increased cross-linking in diabetes mellitus, while in Dupuytren's contracture other structural changes, such as increased collagen type III content and loss of fascicular organization, play an additional role besides the finding of reduced cross linking.

Atomic force microscopy imaging of the human trigeminal ganglion.

This paper describes an investigation of gangliocytes via imaging semithin sections of two human trigeminal ganglia with an atomic force microscope (AFM). Whereas semithin sections are usually employed for transmission electron microscopy, we adopted this special type of sample preparation for our AFM studies to extract topographical data from the gangliocyte itself and from the nucleus, the nucleolus, the crystal-arranged lipofuscin granules, and the cell-surrounding mantle cells; simultaneously we characterized the samples with error signal mode. This AFM-related technique revealed no information concerning friction force and elasticity due to the presence of the embedding material (epoxy), but it gave additional topographical contrast. These are the first images of the human trigeminal ganglion by AFM.