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compensatory responses from the autonomic nervous system preclude major changes in either pulse or blood pressure55 Orthostatic hypotension is frequently de ned as a drop in either systolic blood pressure of 20 or diastolic blood pressure of 10 mm Hg Typically, symptoms do not develop until systolic blood pressure drops of 30 or diastolic pressures of 15 mm Hg occur Orthostatic hypotension usually occurs either immediately or within a few minutes of standing A drop in blood pressure with an associated tachycardia suggests hypovolemia of whatever cause A drop in blood pressure without compensatory tachycardia implicates dysautonomia due to either disease or drugs Symptomatic tachycardia with a heart rate greater than 30 bpm above baseline without a significant drop in blood pressure is the signature of the postural orthostatic tachycardia syndrome Finally, prolonged tilt table monitoring is done in an attempt to reproduce symptoms in patients believed to suffer from neurocardiogenic syncope (vasovagal syncope) In these patients, symptoms of impaired CNS blood ow are accompanied by hypotension and paradoxical bradycardia QSART is a means to assess cholinergic, postganglionic sympathetic small ber function It is particularly attractive as a test for SFN and other LDPN with dysautonomic components, as it can be applied in numerous topographical locations and may provide support for a length-dependent pattern of abnormality Typically, QSART is performed by placing sweat capsules in four standardized locations: the dorsum of the foot, shin, thigh, and forearm These capsules measure the humidity produced by sweat production emanating from the tested skin surface in response to an injected intrader-

mal cholinergic stimulus The sensitivity of QSART in the detection of SFN has been quoted as being 60 80%, similar to QST26,31,54,56 58 In diabetic patients, there are similar rates of both sensitivity and concordance regarding results of the heart rate response to deep breathing, the Valsalva maneuver, and QSART59 Normative data for QSART also varies by gender, age and area tested Reference 45 Mean values range between 1 and 3 microliters/centimeter squared ANST, perhaps more than any other testing modality, requires adequate control of environmental variables that may readily confound the accuracy of test results Normative data vary considerably with patient age Ideally, testing would be performed in some who is adequately hydrated, has not eaten for 8 hours, smoked tobacco, drank ethanol or caffeine, and has not been recently physically or emotionally stressed Drugs that potentially react with adrenergic or cholinergic receptors are to be avoided if possible, including those with indirect autonomic effects such as insulin Extremes of temperature or pressure stockings can adversely affect the outcome of testing procedure45

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e) Now click the WINDOWS (or WINNT) folder icon Look at Figure 13-9 for a sample of what you should see at this point if you re running Windows XP

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