Oral Body Temperature Research Articles

Fever in general practice. I. Frequency and diagnoses.

Although fever is a common symptom, few studies have broadly addressed this as a clinical problem in general practice. The aims of this study were to determine the frequency of fever among general practice patients in two rural municipalities in Norway, the diagnoses (according to ICHPPC-2-def.) of conditions causing fever, and the receptionist's role in the management of these problems. All the general practitioners and their receptionists within the study area participated. During 4 weeks throughout 1988 all individuals attending their general practitioner had their body temperature measured with an electronic thermometer (orally > or = 7 years, rectally < 7 years). Fever was defined as an oral body temperature > or = 37.5 degrees C (rectally > or = 38.0 degrees C in those < 7 years). All telephone applications, including telephone encounters for fever, were recorded. Fever was detected in 80 (5%) of a total of 1610 direct encounters: 36% of those below 7 years of age (n = 70) were febrile. One-third of the total encounters for fever were telephone encounters (n = 36), of which 30% were managed by the receptionists. A wide range of diagnoses were made, most of which were associated with infectious diseases. The distribution of the diagnoses of primary care patients with fever is different from those admitted to hospital for fever of unknown origin. General practitioners and their receptionists should consider fever a diagnostic challenge, especially when the patient is handled over the telephone.

Core Body Temperature in the Elderly and Factors Which Influence Its Measurement

Several studies have reported that core body temperature decreases with age and has greater variability in older populations. Furthermore, oral measurement, the most frequently used clinical method for determining fever, may not accurately reflect core body temperature. This study was designed to compare accurate measurements of oral and core body temperatures in a group of 93 healthy subjects, aged 62-96, under controlled conditions. Increasing age, presence of dentures, and type of thermometer were examined to determine if they affect body temperature measurements. Core temperatures did not show a negative relationship with advancing age (r = -0.02) nor did variation in temperatures increase with age. Neither the type of thermometer nor the presence of dentures significantly affected the measurement of temperature.

Effect of a single oral dose of ascorbic acid on body temperature and trace mineral fluxes in healthy men and women.

Several metabolic changes characteristic of the acute-phase response were examined in healthy men and women following a single 1 g dose of ascorbic acid. Utilizing a placebo-controlled, double-blind protocol, oral body temperatures were recorded in rested, fasted subjects (0900 hr) prior to the consumption of 1 g L-ascorbic acid or placebo (n = 10/group). Temperatures were recorded hourly for the next 8 hours, and again the next morning in the rested, fasted state (0900 hr). Blood samples, collected at 0, 4, and 24 hours post-dose, were analyzed for plasma ascorbate, iron, and zinc. Mean oral body temperature was significantly elevated 2 hours post-dose in the experimental subjects compared to controls (+0.7 degrees F, p = 0.03). In the vitamin-dosed subjects, mean plasma ascorbate rose 32% over the control value after 4 hours (1.11 +/- 0.08 and 0.84 +/- 0.06 mg/100 ml, ns). Serum iron levels were similar in the two groups at 0 and 4 hours post-dose, but at 24 hours post-dose mean serum iron of the vitamin-dosed subjects fell to 73% of that recorded for the control subjects (77 +/- 8 and 105 +/- 10 micrograms/100 ml, p = 0.04). Plasma zinc levels were similar for both groups at 0, 4, and 24 hours post-dose. These data indicate that ascorbate administration, at a level commonly supplemented in the US diet, elicits several host metabolic responses similar to those observed following exposure to infectious or inflammatory agents. These metabolic changes are most likely due to the reducing potential of the vitamin and may factor in the reported prophylactic success of vitamin C supplementation.

Circadian rhythms in depression: Part I: Monitoring of the circadian body temperature rhythm

In order to develop a sampling strategy and a method for analyzing the circadian body temperature pattern, we monitored estimates of the temperature in four ways using rectal, oral, axillary and deep body temperature from the skin surface every hour for 72 consecutive hours in 10 normal control subjects. Data obtained were analyzed with the least-squares method to estimate the circadian rhythm. Deep body temperature from the skin surface correlated better with rectal temperature than with either oral or axillary temperature in all subjects. The correlation coefficient between rectal and deep body temperature from the skin surface ranged between 0.66 and 0.89. The acrophases calculated from the deep body temperature from the skin surface every 2 h for 48 h were consistent with those based on the rectal temperature every 10 min for 72 h. We believe that monitoring of the deep body temperature from the skin surface, in this manner, at intervals of 2 h for a period of 2 days, is a promising method for investigating circadian body temperature rhythm, because it causes less discomfort than other measures and has greater statistical validity for data computation.

Single-dose cefotetan versus multiple-dose cefoxitin as prophylaxis in colorectal surgery

The safety and effectiveness of a single 2 g preoperative dose of cefotetan to reduce postoperative infectious complications after colorectal surgery was compared with multiple 2 g perioperative doses of cefoxitin in 289 patients enrolled in a multicenter trial; of the 239 evaluable patients, 164 received cefotetan and 75, cefoxitin. No statistically significant difference was detected in the successful clinical response rates for cefotetan and cefoxitin (88 percent and 92 percent, respectively). The difference in median increase in oral body temperature before and after the study (2.5 degrees F for cefotetan and 2 degrees F for cefoxitin) was statistically but not clinically significant (p = 0.03). Although nearly four times as many cefotetan patients as cefoxitin patients had surgery lasting 4 hours or more, the satisfactory bacteriologic response rates for cefotetan and cefoxitin were similar (88 percent and 93 percent, respectively). Nonobese patients and patients whose surgical procedures lasted less than 4 hours treated with either drug had significantly higher success rates (p less than 0.01). The incidence of major wound infection was approximately 8 percent for both treatment groups. Mean concentrations of cefotetan in plasma, specimens of colon, and subcutaneous fat were 128 +/- 61.8 micrograms/ml, 57.2 +/- 40.4 micrograms/g, and 26.8 +/- 19.4 micrograms/g, respectively. The incidence of adverse reactions was 12 percent for each group, and no reaction was considered treatment-related, including changes in results of clinical laboratory tests. A single 2 g preoperative dose of cefotetan was as safe and effective as multiple doses of cefoxitin in the reduction of postoperative wound infections after colorectal surgery.

Comparative effectiveness and safety of cefotetan and cefoxitin as prophylactic agents in patients undergoing abdominal or vaginal hysterectomy

In a multicenter, randomized clinical trial, 282 women who underwent abdominal or vaginal hysterectomy were given a single preoperative 2 g dose of cefotetan (171 evaluable patients) or three perioperative 2 g doses of cefoxitin (84 evaluable patients) as antibiotic prophylaxis. A successful clinical response occurred in 92 percent of those receiving cefotetan and 90 percent of those receiving cefoxitin who underwent abdominal hysterectomy, and in 94 percent of those receiving cefotetan and 93 percent of those receiving cefoxitin who underwent vaginal hysterectomy. The incidence of vaginal cuff cellulitis was 3.4 percent and 5 percent for cefotetan and cefoxitin patients, respectively, who underwent abdominal hysterectomy, and 4.8 percent and 4.5 percent, respectively, for those who underwent vaginal hysterectomy. The incidence of major wound infection was 3.4 percent and 2.5 percent for cefotetan and cefoxitin, respectively, in the abdominal hysterectomy group. Postoperative changes in oral body temperature, duration of hospitalization, and postoperative grading of surgical wounds were similar. Both drugs were well tolerated. These results suggest that a single dose of cefotetan is equally effective and as safe as multiple-dose cefoxitin for prophylaxis in patients undergoing hysterectomy.

Neuroleptic-induced hypothermia associated with amelioration of psychosis in schizophrenia

Body temperature is a regulatory function of the hypothalamus. Recently, DeMet et al. (Society for Neuroscience Abstracts Vol 12, 1986) reported that apomorphine stimulation of dopamine autoreceptors caused a significant decrease in metabolic rate in the posterior heat-conserving area of the hypothalamus. The logical hypothesis to follow is that apomorphine administration should induce a decrement in body temperature; this in fact was demonstrated by Cutler et al. (Commun Psychopharmacol 3:375-382, 1979) in humans. It is well known that neuroleptics also disrupt thermoregulation (Clark: Neurosci Biobehav Rev 3:179-231, 1979) and affect dopamine autoreceptors. Therefore, eight chronic treatment-resistant schizophrenics underwent a 6-week single-blind trial of haloperidol and then a subsequent 6-week double-blind trial of clozapine. Both haloperidol and clozapine significantly lowered oral body temperatures relative to baseline washout temperatures. More interestingly, clozapine relative to haloperidol was found to induce a greater decrement in body temperature and was associated with greater clinical improvement. Possible confounding variables are discussed, as is the possible neurochemical basis for the amelioration of psychosis associated with hypothermia.

Body Temperature in General Population Samples

Oral body temperature was measured in 816 men, 57 and 67 years old, sampled from the general population of Göteborg, Sweden, and 22 physically highly active men, sampled on clinical grounds. The measurements were taken in the morning for 14 months. After adding 0.3 degrees C to the readings to make them comparable with rectal readings, the mean body temperature was 36.8 +/- 0.4 degrees C. There was a seasonal variation with a peak during the winter and a trough during the summer. Body temperature was inversely correlated with height and positively correlated with weight and body fat but not with lean body mass. High physical activity and sensitivity to heat were associated with a higher than average body temperature. Sensitivity to cold was associated with a lower than average body temperature. Smoking prior to the measurements did not appear to affect body temperature.

A study of weekly and rapidly rotating shiftworkers

Diary sleep and oral body temperature data are presented for two groups of experienced rotating shiftworkers (2 or 3, and 5 successive night shifts).

Thermoregulation of the Human Testis

Intrascrotal temperature was compared with oral body temperature in six subjects with fever. When the body temperature reached 37.6 to 37.9 degrees C, the testicular thermoregulatory mechanism appeared to fail and the intrascrotal temperature rose.

Variation in body temperature, perceived duration and perceived personal space

This investigation sought to examine the relationship between variation in body temperature, perceived duration and perceived personal space. Three hypotheses were tested based on the theory that changes in biological activity, in this case normal body temperature variation, would be associated with changes in individuals' perceptions of duration and personal space. Fifty males and fifty females between the ages of eighteen and thirty years comprised the sample. Each subject was tested twice. One testing session occurred in the early morning while the other occurred in the late afternoon. A measurement of oral body temperature, the production of two forty second intervals and a judgment of perceived personal space were taken on each subject during both testing sessions. The findings in regard to the three hypotheses suggest the following. Body temperature variation as measured in this study does not appear to affect significantly individuals' perceptions of duration and perceived personal space. Body temperature may have an effect different from that hypothesized on perceived personal space. Correlation coefficients for the total sample and in males were significant ( p < 0·05). Partial correlations confirmed the relationship hypothesized between perceived duration and perceived personal space in the total sample ( p < 0·05) and in males ( p < 0·01).

Ovulatory plasma amine (epinephrine and norepinephrine) surge in the woman

Two normally cycling women were studied through one complete menstrual cycle with daily oral basal body temperature recordings and daily 24 hour urine collections. Blood was drawn in the basal state beginning with one patient on Day 9 and with the other patient on Day 12 of the menstrual cycle. Blood determinations were for follicle-stimulating hormone, luteinizing hormone (LH), and plasma epinephrine and norepinephrine. Urinary determinations were for creatinine, epinephrine, and norepineprine. Results indicate that a gradual rise in urinary norepinephrine occurs following ovulation which is greater than the preovulatory excertion. Urinary epinephrine does not significantly vary during the stages of the menstrual cycle. One patient showed a significant plasma amine surge on the same day as the LH surge. The other patient showed a plasma amine surge on the day of the LH peak and also on the 2 preceding days. These observations of a plasma amine surge in the woman that coincide with or precede the LH surge have not been previously reported. They indicate an increased sympathetic response around the time of ovulation and are most likely associated with a central phenomenon.

INFECTION, TISSUE TEMPERATURES, AND DRESSINGS

Most people believe that the site of a pyogenic tissue infection is markedly warmer than the uninvolved tissues of the body. In the same tradition, heated wet dressings have been used for the treatment of local infections since the beginning of recorded medical history. These ideas persist, although the medical literature contains little specific information pertaining to either impression. Recently Waterman and associates¹investigated the effects of temperature changes on the sensitivity of a pathogenic staphylococcus to different antibiotics. It was found that the temperature of peripheral tissue infections usually varied between 35 and 37 C. Most pyogenic tissue infection-site temperatures were below the oral, rectal, and central body temperatures. Though the site of infection appeared to be quite hot, it was in fact only relatively warmer than the adjacent uninfected soft tissues. In another study, on the effects of various dressings on the skin and subcutaneous temperature, Waterman

PULSE RATE, RESPIRATORY RATE, AND BODY TEMPERATURE OF CHILDREN BETWEEN TWO MONTHS AND EIGHTEEN YEARS OF AGE

Pulse rates, respiratory rates, and body temperature values have been obtained under uniform conditions on children of the Child Research Council at the time of the basal metabolism determinations (4). An analysis of these data is presented here since the literature has given inconsistent values for the range of pulse rate and body temperature of children and no range for the respiratory rate. METHOD The data for pulse rates, respiratory rates, and oral or rectal body temperatures were obtained on Child Research Council children immediately following the routine basal metabolism determinations (4). From 3 to I8 years of age the measurements were taken in the morning when the children were fasting, quiet, and apparently relaxed. On the other hand, from 2 to 18 months the heat production was obtained under sleeping, fed conditions at varying times during the day. In this group the pulse rates and body temperatures were measured as soon as the infants awakened after the completion of the test. The pulse rates were not taken while the children were asleep in the closed chamber because the necessary procedure was found to be too disturbing. The respiratory rates, however, were counted while the children slept quietly. From 18 months to 3 years, some of the measurements were made under these sleeping, fed circumstances, while more than half were obtained under the awake, fasting conditions described above for children from 3 to 18 years. At no time were values used for this analysis when there was any evidence of illness. The pulse rates were obtained on the children by palpation of the wrist and on infants by the use of a stethoscope placed over the heart, or occasionally by palpation of the ankle. An effort was always made to find the lowest possible rate under the previously described conditions. The length of time the pulse was counted varied according to the cooperation of the subject, and was never less than 30 seconds. The respiratory rates were determined by observation of the subjects for at least half a minute.