By a spectrophotometrical method, the oxygenation and relative concentration of hemoglobin in the skin of the forefoot was determined in 40 patients with advanced peripheral arterial occlusive disease. While the Hb-saturation at rest was hardly different from normals, leg elevation provoked a marked decrease of both parameters, especially in patients with critical ischemia. In these patients, reactive hyperemia was markedly delayed and impaired. External heat application failed to cause a hyperemic saturation increase in 14 patients and produced a decrease in 8 patients, 6 of whom experienced an infavourable clinical outcome. The method seems specially suited to assess states of severe ischemia.

Aged↗

PubMed1991

[Therapy of peripheral arterial occlusive disease with special reference to prostaglandins].

Therapy of chronic arterial occlusive disease primarily includes evaluation and treatment of risk factors as prophylaxis for preventing progression of arteriosclerosis. When patients suffer from claudication walking exercise is the therapy of choice. Only in cases with severe claudication (walking distance under 100 m) and rest pain or ischemic ulcers reopening procedures are necessary. Bypass surgery is supported by the different transluminal angioplasty techniques, which are suited even for older and multimorbid patients. A pharmacological treatment of peripheral arterial occlusive disease should be introduced only for preventing progression of the disease or re-occlusions following surgery or angioplasty or in those cases in whom reopening techniques are not possible or not successful. Here prostaglandin E1 has been proven to be effective in many clinical trials. The combination of surgery, angioplasty and pharmacological treatment allows to avoid major amputations in most patients with critical limb ischemia.

Alprostadil↗

PubMed1991

[Correlation of the change of duplex sonographic parameters with dilatation success following percutaneous transluminal angioplasty of the lower extremities].

Explore the source record for details and available documents.

Angioplasty, Balloon↗

PubMed1991

[The instrumental diagnosis of arterial diseases especially of arterial occlusive diseases].

Ultrasound Doppler sonography is the most important tool in the assessment of peripheral arterial occlusive disease. The determination of systolic ankle pressure gives an useful overview of the degree of the disease. In a normotensive patient with a systolic blood pressure of 140 mm Hg systolic ankle pressures between 100 and 140 mm Hg are present when the occlusive disease is in the stage of good compensation. Severe claudication will appear with ankle pressures between 70 and 95 mm Hg, lower values are indicating a critical limb ischaemia. Treadmill exercise is helpful for documentation of painfree and maximal walking distances. When a patient is suggested to be treated by percutaneous transluminal angioplasty or bypass surgery a duplex sonography or angiography is mandatory. In evaluating the Raynaud's phenomenon under the noninvasive techniques capillaroscopy of the nailfold is a useful tool. The diagnosis of thromboangiitis obliterans is usually established by clinical criterias. The radiographic findings may give important hints. In many cases of acute arterial occlusions angiography is necessary for finding the optimal therapy. The aneurysm of the abdominal aorta will be evaluated by ultrasound and computer tomography.

Angiography↗

PubMed1991

Skin surface oxygen pressure in healthy volunteers and patients with arterial occlusive disease.

When measuring transcutaneous oxygen pressure at an electrode core temperature of 37 degrees C autoregulating mechanisms of skin microcirculation can be studied. Because of poor reproducibility of a single PO2 measurement we determined skin surface oxygen pressure fields out of 50 or more PO2 values. At the forefeet and calves of healthy volunteers the histograms were slightly left-shifted with median PO2 of 4 mm Hg. Patients with multilevel arterial occlusive disease and low systolic ankle pressure presented with a disturbed PO2 distribution with very low PO2 values close to zero. About 16% of measurements were above 10 mm Hg. In contrast, diabetics had significantly higher PO2 (median 8 mm Hg) at the forefoot level when compared with healthy volunteers or patients without diabetes.

Adult↗

PubMed1991

Alterations of the nailfold capillary morphology associated with Raynaud phenomenon in patients with systemic lupus erythematosus.

Quantitative analysis of nailfold capillary morphology was performed in age and sex matched groups of 29 patients with systemic lupus erythematosus (SLE) presenting Raynaud phenomenon (RP), 29 RP negative patients with SLE with the same duration of the disease, and 29 healthy controls. Percentages of tortuous, meandering and bushy capillaries were significantly increased in both groups of patients without influence of RP. Capillary density was lower, mean diameters of the capillary loops were higher in patients, especially when RP was present (at the venular branch in microns, mean +/- SD: controls: 15.0 +/- 2.0, RP negative patients with SLE: 17.6 +/- 3.6, RP positive patients with SLE: 20.5 +/- 6.3). In a subgroup of 13 patients with frequent Raynaud's attacks (more than 1/week), diameters were still higher (22.1 +/- 7.1, p to controls less than 0.0005; p to RP negative patients less than 0.05). In patients with SLE, the prevalence of RP seems not to be associated with the increased number of abnormal capillaries but with capillary enlargement, correlating with the frequency of attacks.

Adult↗

PubMed1990

[Duplex sonography: accuracy, reproducibility and possibilities for error. Checking quantitative flow measurements against an in vitro model].

Using a pulsatile model of tubes, duplex-sonographic measurements of flow were compared with actual flow. The correlation coefficient between actual and duplex-sonographically obtained flow was 0.975, mean percentage deviation being -18.1% (P less than 0.0001). The obvious scatter (margin of error -69.2 to +50%) is to be explained by the simulation closely imitating a real situation: the transducer was hand-held and tubes were placed in muscle or fat tissue. Accuracy was increased by multiple measurements, especially when taking into account only the maximal value of any series of measurements. Vessel diameter was easy to measure accurately (mean error less than 0.01% [-18.7 to +9.4%]). Repeated measurements of flow velocity had only a small scatter (coefficient of variance 0.064). In muscle or fat the Doppler signal was attenuated and the error the greater the deeper the level at which measurements were made. Low flow (common in patients with obstructive vascular disease) can also cause faulty results.

Analysis of Variance↗

PubMed1990

Skin surface oxygen pressure fields during administration of prostaglandin E1 in patients with arterial occlusive disease.

Prostaglandin E1 is offered as a new therapeutic agent in the treatment of severe peripheral arterial occlusive disease. Especially when treating patients with ulcers or gangrene, the oxygen tension of the skin should improve during PGE1 administration. The new technique of assessing skin surface oxygen pressure histograms allows study of the skin microcirculation in vivo. Oxygen histograms were determined on the forefeet of 19 patients with different degrees of disease and different occlusion levels before and during a single intraarterial infusion of PGE1 at a dosage of 1.5 ng/kg body weight/min. Only 9 patients showed improvement during the infusion period. Skin oxygen pressure was increased to a large extent only in patients assumed to suffer from diabetic microangiopathy. The effect of a long-term therapy with PGE1 on skin microcirculation remains to be settled.

Adult↗

PubMed1990

Livedo racemosa generalisata: an evaluation of thirty-four cases.

The results of investigations in 34 patients (28 women, 6 men) with livedo racemosa generalisata are presented. Neurologic or psychiatric symptoms were present in 28 patients. Nineteen patients had had one or more cerebral infarctions, and epilepsy (Sneddon's syndrome) developed in six. In most cases livedo preceded the neurologic disorder. In addition, many patients with livedo racemosa generalisata had Raynaud's phenomenon, cardiac abnormalities, or vascular changes in the ocular fundus.

Adult↗

PubMed1990

Long-term effects of treatment with recombinant human erythropoietin on haemodynamics and tissue oxygenation in patients with renal anaemia.

Regional peripheral vascular resistance, transcutaneous oxygen pressure and blood pressure were studied in seven normotensive, chronically haemodialysed patients with renal anaemia before and after 3 and 12 months of rHuEpo therapy. Haematocrit increased from 21% to 33% within 3 months of commencing therapy, and remained stable throughout the following observation time. Though regional blood flow of the calf was markedly reduced after 3 and 12 months of rHuEpo compared to pretreatment values, transcutaneous oxygen pressure was significantly increased after 3 months and remained constantly elevated after 12 months. Mean arterial blood pressure increased significantly by 7.3 mmHg after 3 months of rHuEpo treatment but did not reach hypertensive values and was no longer different from pretreatment values 12 months after the start of rHuEpo. Results of peripheral haemodynamic studies were compared to those obtained by measurement of central haemodynamics in four further normotensive anaemic patients. In these patients cardiac output decreased, total peripheral vascular resistance increased and blood pressure increased slightly (by 5.5 mmHg) when a haematocrit of 37% was reached after 8 weeks of rHuEpo therapy. These effects were partly reversed when the maintenance haematocrit decreased to 32% (after 16 weeks of rHuEpo). In summary rHuEpo treatment induced a long-term increase of the total and regional peripheral resistance, an increase of blood pressure within the normal range, and a decrease in cardiac output. Despite these changes tissue oxygenation improved.

Adult↗

PubMed1990

Skin microcirculation and regional peripheral resistance in patients with chronic renal anaemia treated with recombinant human erythropoietin.

Skin microcirculation and regional peripheral resistance were studied in 14 patients with renal anaemia during therapy with recombinant human erythropoietin. Haematocrit was raised from 20.0 to 31.3% after 10-12 weeks of treatment and remained stable over another period of 12 weeks. Antihypertensive treatment had to be intensified in five patients. Regional calf blood flow decreased significantly; accordingly, calculated peripheral vascular resistance was increased by more than 100%. However, transcutaneous oxygen pressure (37 degrees C and 44 degrees C) increased significantly. The pathological vasoconstrictor response of skin capillaries was not influenced. There were no significant differences of any parameter between the patients requiring reinforced antihypertensive therapy and those with stable blood pressure. In conclusion skin oxygenation may be improved by erythropoietin treatment to a large extent despite an increase in calculated total limb vascular resistance.

Adult↗

PubMed1990

[Duplex ultrasound measurement of morphologic parameters before and following repeated puncture of the femoral artery for intermittent infusion therapy].

In order to estimate morphologic changes of the femoral artery after an intermittent intraarterial infusion therapy duplex scanning was performed before therapy, immediately after a series of 26 (10 to 52) infusions, and 30 weeks after hospital discharge. Minimum and maximum values of internal and external vessel diameter and thickness of wall were estimated in the common femoral artery, superficial femoral artery, and deep femoral artery. The external diameter values and the thickness of wall increased significantly after therapy. After 30 weeks these values decreased but did not reach the initial values.

Alprostadil↗

PubMed1989

[Portal hypertension and chronic arsenic exposure. A differential diagnostic challenge].

We are reporting on a 62 year old female patient with portal hypertension (splenomegaly, esophageal varicosis) without signs of liver cirrhosis, who was hospitalized for sclerotherapy of her esophageal varices. Physical examination showed up palmar- and plantar hyperkeratosis and Morbus Bowen or basalioma-like skin lesions++. Anamnestic evaluation revealed, that the patient's psoriasis had been treated with arsenic for many years. This kind of treatment may have induced intraluminal proliferation and obliteration of the portal vein's endothelium, thus being the etiologic factor responsible for noncirrhotic portal hypertension in this patient.

Arsenates↗