6 March 1965
Erythrodermic Skin Diseases-Fox et al.
has shown that this can stimulate non-shivering thermogenesis
calorigenic action of noradrenaline (Joy, 1962 ; Davis, 1963),
so that the slightly raised V.M.A. excretions found in this
study may be important. Shivering tends to disappear in the
cold-adapted subject, and this may explain why all except one
of our patients with a relative hypothermia failed to shiver.
These observations emphasize certain aspects of the manage-
ments of these patients.
Because of the reduced capacity to
thermoregulate, with its attendant dangers of hypothermia or
hyperthermia, body temperature must be accurately observed,
using a low-temperature thermometer when indicated.
usually require more clothes and a warmer room than the aver-
age person, and the risk of hypothermia is obviously greatest
during winter months and when they are treated at home, but
even in hospital care is needed during treatment periods. If the
patient develops a high body temperature steps should be taken
to reduce it in order to avoid an excessive increase in the cardiac
load. The aim should be to steer a course between the two
extremes and keep body temperature close to normal.
patient is seen to be shivering, complains of the cold, or has a
subnormal temperature, the room temperature or his clothing
should be promptly increased. The temperature at which he
becomes comfortable and shivering ceases should be recorded
and used as a guide to adjust his environment. Prompt treatment
of the skin condition, usually with corticosteroids, is the best
way of avoiding heart failure. The unexplained high mortality
of patients with erythrodermic skin diseases may in large part
be due to the haemodynamic and thermoregulatory problems
we have discussed.
also showed an increased
erythrodermic skin conditions have shown marked increases in
skin blood-flow equivalent to up to two-thirds of that seen in
normal subjects when fully vasodilated by heat ; there was a
considerable further increase in skin blood-flow when the body
temperature was raised.
All had a raised venous pressure with
hypervolaemia, and in two patients the cardiac output was
Body-temperature regulation was grossly disturbed.
out of five patients had either a fever or an elevation of the
set point for temperature regulation with body temperatures
below the fever level.
The capacity to thermoregulate is greatly
diminished in these patients, and hypothermia, which is an
inability of the skin blood-vessels to constrict fully.
The basal metabolic rate was raised considerably in 9 out
of 11 patients.
Radioactive iodine studies showed no evidence
of hyperthyroidism, but there was a slight increase in vanillyl
mandelic acid excretion.The hypermetabolism
mainly due to the abnormal skin metabolism, but the develop-
ment of non-shivering thermogenesis may also play a part.
is related to the high skin blood-flow and
Two of us (S. S. and J. M.) were supported by a grant from the
Medical Research Council.
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and Wilkinson, P. (1963).
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Acute Infections of the Urinary Tract and the Urethral Syndrome
in General Practice
D. J. A. GALLAGHER,* M.B., M.MED.SC.; J. Z. MONTGOMERIEt M.B., M.R.A.C.P.;
J. D. K. NORTH,t M.B., D.PHIL., M.R.C.P., F.R.A.C.P.
Brit. med. J., 1965, 1, 622-626
What is the significance of single or repeated attacks, of infection
of the urinary tract ?
Our knowledge of these infections comes
mainly from studies of patients in hospitals (Wharton et al.,
1937; Jackson et al., 1957 ; Winberg and Barr, 1960) and from
post-mortem studies (Weiss and Parker, 1939 ; MacDonald
et al., 1957).
In contrast, most infections of the urinary tract
are diagnosed and treated at home by the general practitioner.
It is therefore important to examine the natural history of these
infections. We report a prospective study planned to investi-
gate the type of infection occurring in general practice, the
response to treatment with sulphafurazole (Gantrisin), and the
incidence of recurrent infections.
Urologists often see patients who complain of frequency and
dysuria without evidence of infection in the urine. The aetio-
attributed to an anxiety neurosis (Gray and Pingelton, 1956;
In this study we found that the urethral
syndrome was common in general practice; many patients
presenting with symptoms of infection had sterile urine.
assess the urethral syndrome these patients have been compared
with the remaining patients with definite infection in the urine
seen in the survey.
is obscure and has been
In New Zealand patients with acute infections in the urinary
tract are often treated with a sulphonamide by general practi-
tioners who do not have facilities for bacteriological examina-
tion of the urine.
This study was designed to determine the
deficiencies of treating patients in this way.
*Auckland Faculty, College of General Practitioners.
t Medical Unit, Auckland Hospital, Auckland, New Zealand.