Benign neonatal hemangiomatosis is a condition in which multiple cutaneous hemangiomas appear at birth or shortly thereafter; visceral complications are absent. Here, we report a case of a consumption hypothyroidism in an Egyptian baby with benign neonatal hemangiomatosis.An 8-month-old Egyptian boy with benign neonatal hemangiomatosis was referred to our institution for evaluation of developmental delay. Initial examination revealed a quiet baby who was able to sit only with support. He had hypotonia, a large anterior fontanelle, puffy eyes, cold extremities, hypothermia, bradycardia, and abdominal distension. An examination of his skin revealed more than 100 dome-shaped red-purple cutaneous hemangiomas that varied in size from 5 to 10mm on the back, the abdomen and the extremities without mucus membrane involvement. He had low serum free thyroxine concentration and triiodothyronine levels and high thyroid-stimulating hormone and reverse-triiodothyronine levels. A work-up that involved appropriate imaging ruled out visceral involvement. Based on the above mentioned data, a diagnosis of consumptive hypothyroidism due to benign neonatal hemangiomatosis was made. He was started on oral thyroid medication which was gradually increased to 90μg L-thyroxine daily (15μg/kg/day). After three months of treatment, he was able to sit alone without support and he had normal levels of thyroid-stimulating hormone and serum free thyroxine.Thyroid function should be assessed periodically in babies with benign neonatal hemangiomatosis, especially if symptoms of hypothyroidism appear or the size and number of hemangiomatosis increase rapidly. Moreover, high doses of L-thyroxine may be needed to achieve euthyroidism during the infancy.

To summarize the clinical experience of stented elephant trunk with femoral artery bypass grafting procedure to treat severe aneurysmal dilation of Stanford A aortic dissection or aortic aneurysm. To study the surgical indication and surgical strategy of chronic Stanford A aortic dissection and aneurysmal dilation, also to summarize the early follow-up results.From February 2006 to November 2011, 19 patients with Stanford A aortic dissection or aortic aneurysm with extented aneurysmal dilation (megaaorta) received stented elephant trunk with femoral artery bypass grafting procedure. There were 3 acute cases and 16 chronic cases with 14 male patients and 5 female patients. Average age of this group was (42 ± 8) years and average body weight was (70 ± 15) kg. One patient was aortic aneurysm and all the other were Stanford A aortic dissection. Eight patients were Mafan's syndrome. Ascending aorta replacement or Bentall's operation was done first and total arch replacement and stented elephant trunk operation was done under deep hypothermia and circulatory arrest. After the patient was weaned from cardiopulmonary bypass, bypass from ascending aorta to femoral artery was done subcutaneously using the 10 mm graft in the same femoral incision.There was no operative mortality. One patient had chylothorax which recovered with medical treatment and one patient got paraplegia after surgery. The cardiopulmonary bypass time was (176 ± 42) minutes, aortic cross clamping time was (88 ± 25) minutes and deep hypothermia and low flow rate time was (23 ± 8) minutes. The blood pressure of the lower extremities were normal after operation. Follow-up time was (22 ± 19) months. All patients survived. False lumen closure rate at the stent level was 100%. CT scan at 3 to 6 months after operation showed no obvious dilation of the descending aorta. Two patient successfully received second stage operation of total (subtotal) thoracoabdominal aorta replacement.Stented elephant trunk and aorta to femoral artery bypass is a safe procedure to treat aortic dissection or aortic aneurysm with extended aneurysmal dilation. This procedure can effectively increase the blood supply of the lower extremities due to small true lumen of the descending aorta, and may decrease the speed of dilation of the false lumen. It is also a practical procedure to lay the foundation for the second stage operation of normothemia thoracoabdominal aorta replacement.

Both extreme heat and cold can be challenging for athletes during training and competition. One role of the team physician is to educate coaches and athletes on the risks of exposure to these conditions and how to best prevent and manage their adverse effects. Heat illness varies in degree from mild to severe, with the most severe forms being potentially fatal. Cold exposure can result in systemic effects and peripheral injury to the extremities.

Infrared thermography or thermovision is increasingly applicable in sport and sport rehabilitation. Thermic forms, thermic imprints, temperature and isotherm distribution, temperature gradient change are the terms that are more and more often met in sport medicine and medicine, in general.We presented two examples of thermovision application: in detection of muscle injury and changes of the feet exposed to low temperature. In the first example the thermovision method was used for analysing heat distribution in an athlete with back muscles injury. With a special original method of local cooling the place and degree of injury was precisely localized and determined, respectively, regardless high environmental temperature. In the second case the thermovision method was for the first time applied in a runner whose feet was exposed to low temperature. Significant hypothermia of the feet was detected by the method and appropriate treatment was performed. Thanks to this the athlete had no harmful consequences.Thermovision is fast and efficient in detecting different kind of injuries, so its increased use in the future can be expected.

Arterial entrapment syndrome (AES) at elbow level is very rare and to our knowledge no case of AES by lacertus fibrosus in the cubital fossa in presence of brachial artery duplication has been described to date. We describe a rare case of acute arterial thrombosis of one of two brachial arteries highlighted in the cubital fossa which developed after strenuous right elbow flexor muscle activity and hyper-extensions presumably related to AES by lacertus fibrosus at elbow level. A 43-year-old right-handed woman, experienced paleness, coldness and numbness of the right hand, after 8 consecutive hours of gardening. As she worked, her ipsilateral flexor elbow muscles remained in prolonged and inappropriate tension. Clinical examination evidenced the absence of radial artery pulse in the wrist and mild hypothermia in the second and third finger. During surgical exploration two anastomosed brachial arteries were detected in the cubital fossa under the lacertus fibrosus. The lateral superficial brachial artery was occluded. Intraoperative arteriography evidenced brachial artery duplication at the third superior of the arm and normal vascular pattern at the forearm level. In cases of unexplained atypical intermittent upper extremity claudication or acute ischemic symptoms an AES should always be ruled out, particularly when symptoms are exacerbated by strenuous upper extremity activity or when upper limb muscular hypertrophy is evident. In these cases a thorough dynamic clinical and instrumental examination is mandatory to confirm a diagnosis of AES and to avoid possible future ischemic complications.

Lower body water immersion (LBWI) is experienced in the marine industry but the physiological responses to LBWI are unclear. The purpose of the current experiment was to test the effects of water temperature and immersion duration on rectal temperature, heart rate, stroke volume, blood pressure, metabolic rate, and thermal sensation in healthy subjects.Nine young men underwent two 60-min trials of seated LBWI to the iliac crest in a counterbalanced fashion. On one occasion, the water was 35 degrees C (LBWI-Neutral) and on the other it was 13 degrees C (LBWI-Cold); the upper body remained thermoneutral and dry throughout.As expected, exposure to cold water reduced mean skin temperature and individuals reported cold thermal sensation. Mean arterial pressure was significantly higher at 60 min of LBWI-Cold (86 +/- 7 mmHg) compared to LBWI-Neutral (76 +/- 5 mmHg) while heart rate tended to be lower. The change in rectal temperature from baseline to 30 min of LBWI-Cold (delta = -0.01 +/- 0.21degrees C) was significantly smaller than the change in T(re) from 30 to 60 min of LBWI-Cold (delta = -0.46 +/- 0.16 degrees C). Despite this accelerated drop in core temperature during minutes 30-60, metabolic rate did not increase significantly.LBWI-Cold reduces core temperature and increases arterial blood pressure via an increase in total peripheral resistance. This experimental model may help scientists better understand the body during cold stress. Further, people who are occupationally exposed to cold water (when the torso, hands, and arms remain thermoneutral) may be at increased risk for hypothermia.

The arteriovenous anastomoses (AVAs) in the distal parts of the extremities play a significant role in the heat exchange with the environment. The aim of the study was to examine the thermal responses to whole-body cooling in air, and especially the behaviour of finger skin temperature (T(f) , rich in AVAs). Eight young men sat in minimal clothing at 32°C air temperature (T(a) ), which was then lowered gradually to 13°C in 100 min. In the beginning of cooling, T(f) was high and fluctuating, and then suddenly exhibited a rapid fall, while temperatures in other skin sites fell fairly linearly along decreasing T(a) to the end of cooling. During the period from start to the rapid fall in T(f) , rectal temperature decreased from 37·4°C (SD 0.2) to 37·2°C (0·2), mean skin temperature (T(sk) ) from 34·6°C (0·5) to 31·2°C (2·0) and whole-body thermal sensation from 'slightly warm/warm' to 'slightly cool/cold'. The start of the steep fall in T(f) varied considerably between individuals in terms of time (2-75 min), T(a) (16·7 - 32·0°C) and T(sk) (28·8 - 34·7°C). On the other hand, the range of T(f) at that point was narrower (32·1 - 35·8°C). The findings stress the importance of taking into account the distal skin temperatures in thermoregulatory studies in addition to the ordinarily used more proximal and central skin sites. Also, it might be advisable to start such experiments with relatively high and fluctuating T(f) to guarantee that the thermal state of the subject is well defined.

Local heating induces biphasic cutaneous vasodilation in non-glabrous skin of the forearm. However, little data exist in other skin regions, despite the prevalence of facial flushing disorders. We hypothesized that facial skin will have greater initial peak responses to local heating than forearm skin because of neural differences between sites and, furthermore, axon reflex vasodilation will be eliminated in facial sites with sensory blockade.Skin blood flow (laser-Doppler flowmetry) responses of healthy, non-obese subjects to local heating (32-42°C in ~5 min, held 40 min) in the forehead (n = 22), cheek (n = 22), forearm (n = 22) and palm (n = 13) were expressed as percentage of maximum cutaneous vascular conductance (CVC; flux/mean arterial pressure). In an additional group (n = 7), sensation was blocked (topical prilocaine-lidocaine) prior to the local heating protocol.Prior to heating, CVC differences were noted (forearm = 10 ± 3, cheek = 19 ± 3, forehead = 16 ± 1 and palm = 65 ± 11%CVC; P<0·05). Initial peak CVC was similar between forehead, cheek and forearm (85 ± 3, 92 ± 2, and 91 ± 6%CVC, respectively), but elevated in the palm (120 ± 8%CVC; P<0·05). Compared to facial control sites, sensory blockade delayed increases in both cheek and forehead (P<0·05) CVC but did not change magnitude of the biphasic response (P>0·05).These data indicate that facial skin initial CVC peaks to local heating are similar to non-glabrous skin. In contrast to forearm responses, facial topical sensory blockade does not abate axon reflex responses to local heating. Palm skin data indicate that maximal skin blood flow is not obtained during local heating as it is in non-glabrous skin.

Hypothermia is becoming a common treatment for newborns with hypoxic ischaemic encephalopathy. Cerebral metabolic effects have been studied extensively. However, acute effects on peripheral microcirculation are unknown. The effects of therapeutic hypothermia on peripheral microcirculation assessed by side-stream dark field (SDF) imaging technique are presented.Peripheral microcirculation was assessed in seven newborns undergoing selective head-cooling treatment with SDF imaging video recordings during core temperature 34°C, and then after re-warming at 37°C, and also in seven control patients with rectal temperature 37°C. Microvascular flow index (MFI) and per cent of vessels with sluggish flow were determined by using appropriate software.Sluggish microcirculation was observed during hypothermia compared with controls. MFI and per cent of vessels with sluggish flow returned to normal after re-warming.The results of this small group of newborns going through therapeutic hypothermia suggests that microcirculation is effected with this treatment. Whether this finding has other clinical impacts requires further research.

Exaggerated cardiovascular reactivity to mental stress (MS) and cold pressor test (CPT) has been linked to increased risk of cardiovascular disease. Recent epidemiological studies identify sleep deprivation as an important risk factor for hypertension, yet the relations between sleep deprivation and cardiovascular reactivity remain equivocal. We hypothesized that 24-h total sleep deprivation (TSD) would augment cardiovascular reactivity to MS and CPT and blunt the MS-induced forearm vasodilation. Because the associations between TSD and hypertension appear to be stronger in women, a secondary aim was to probe for sex differences. Mean arterial pressure (MAP), heart rate (HR), and muscle sympathetic nerve activity (MSNA) were recorded during MS and CPT in 28 young, healthy subjects (14 men and 14 women) after normal sleep (NS) and 24-h TSD (randomized, crossover design). Forearm vascular conductance (FVC) was recorded during MS. MAP, FVC, and MSNA (n = 10) responses to MS were not different between NS and TSD (condition × time, P > 0.05). Likewise, MAP and MSNA (n = 6) responses to CPT were not different between NS and TSD (condition × time, P > 0.05). In contrast, increases in HR during both MS and CPT were augmented after TSD (condition × time, P ≤ 0.05), and these augmented HR responses persisted during both recoveries. When analyzed for sex differences, cardiovascular reactivity to MS and CPT was not different between sexes (condition × time × sex, P > 0.05). We conclude that TSD does not significantly alter MAP, MSNA, or forearm vascular responses to MS and CPT. The augmented tachycardia responses during and after both acute stressors provide new insight regarding the emerging links among sleep deprivation, stress, and cardiovascular risk.