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PubMed2004

Evaluation of the six-minute walk test in dogs.

OBJECTIVE: To determine the feasibility for use of a 6-minute walk test (6-MWT) in dogs with congestive heart failure (CHF) and document that the distance walked in 6 minutes decreases when a dog has CHF. ANIMALS: 16 young mature male hound-crossbred dogs weighing between 25 and 37 kg. PROCEDURE: An unobstructed path (22.73 m) was measured in a hallway. Each dog was walked on a leash for 6 minutes; each dog was allowed to set its own pace. At the end of 6 minutes (as measured by use of a stopwatch), the total distance walked was measured. Heart rate (HR) obtained by auscultation and mean systemic arterial pressure (MAP) obtained by oscillometry were recorded before and after the 6-MWT. Heart failure was induced by use of rapid ventricular pacing. Mean of the distance walked, HR, and MAP before and after the 6-MWT were compared between the control period and after dogs developed induced CHF. RESULTS: Dogs with CHF had a significant increase in resting HR, significant decrease in MAP, and a significant decrease in the distance walked in 6 minutes. The MAP increased slightly after exercise during the control period but decreased slightly after exercise during the CHF period. Fractional shortening decreased significantly when dogs had CHF. CONCLUSIONS AND CLINICAL RELEVANCE: Analysis of these results indicated that the distance walked in 6 minutes decreased significantly when a dog had CHF. The 6-MWT requires little time, space, or equipment and may replace the treadmill exercise test.

Analysis of Variance↗
PubMed1998

The ability of non-invasive physiological tests to detect arterial occlusions in the lower extremity. An ROC study with particular regard to recruitment of patients for clinical trials.

In the prerandomization phase of a clinical trial it is essential to be able to exclude, in a non-invasive way, patients who cannot be randomized into the trial. The ability of routine non-invasive physiological examinations to detect arterial occlusion in the lower extremities was investigated in 182 patients with hypercholesterolaemia. Ankle blood pressure measurement, pulse oscillometry, digital pulse plethysmography and treadmill and cycle exercise tests were performed as part of the prerandomization phase of the Probucol Quantitative Regression Swedish Trial (PQRST). The PQRST was designed to compare the antiatherosclerotic effect of two different lipid-lowering regimens. Before randomization the patients also underwent aorto-femoral arteriography, which was used as 'gold standard'. The results were analysed with ROC methodology. Ankle blood pressure measurement (ABP) and inclination time (IT), measured with digital pulse plethysmography, without significant mutual difference, were the variables, best able to detect occlusions. For ABP, the AZ-values were 0.85, 0.82 and 0.94 in detection of right-sided, left-sided and bilateral occlusion, respectively. The corresponding figures for IT were AZ = 0.86, 0.91 and 0.93. If a bilateral occlusion was predicted in a patient with an ABP value of < = or 0.98, a specificity of 0.90 and a sensitivity of 0.87 were obtained, using arteriography as reference method. For IT, with a critical value of 320 ms, sensitivity and specificity were 0.83 and 0.90, respectively.

Adult↗
PubMed2005

Effects of intravenous PD 123319 on haemodynamic and arterial stiffness indices in healthy volunteers.

Relatively little is known about the functional expression of cardiovascular angiotensin type 2 (AT2)-receptors in healthy young adult humans. We performed a randomised, placebo-controlled crossover study of the effects of intravenous administration of the selective AT2-receptor antagonist PD 123319 on haemodynamics and arterial stiffness in normal volunteers. Sixteen normal subjects aged 29.9+/-13.8 years (range 18-30 years) received an intravenous infusion of PD 123319 (10 mcg/minute for 5 minutes) and placebo, separated by one week. Haemodynamics (cardiac index, stroke index and systemic vascular resistance) were measured non-invasively using a BioZ.com thoracic impedance detection system. Blood pressure was measured from an arm cuff using oscillometry. Stiffness index, a measure of arterial stiffness, was measured using a Pulse Trace recorder. No significant changes in blood pressure (p=0.92), cardiac index (p=0.52), stroke index (p=0.61), systemic vascular resistance index (p=0.32) or stiffness index (p=0.57) was demonstrated following PD 123319 infusion, compared with placebo. The results of this study do not support the functional presence of cardiovascular AT2-receptors that mediate acute haemodynamic effects in healthy young adults. It remains possible that higher doses of PD 123319 may be required to demonstrate functional cardiovascular AT2-receptors in this population, if they are present.

Adolescent↗
PubMed1996

Auscultatory and oscillometric methods of ambulatory blood pressure monitoring, advantages and limits: a technical point of view.

Two methods of indirect blood pressure (BP) measurement are currently used for ambulatory blood pressure measurement (ABPM): the auscultatory and oscillometric methods. The auscultatory method is based on the detection of Korotkoff sounds issued from the acoustic transudcer signal. Its main advantages are (1) similarities with usual clinical measurement of BP; and (2) accurate detection of systolic and diastolic pressures on the appearance and disappearance of sounds. The main disadvantages of this method are (1) artefacts due to movements; and (2) difficulties in signal analysis due to physiological variations of the Korotkoff sound patterns or poor signals. Difficulties can be overcome by appropriate signal processing (K2 recognition), noise rejection and/or ECG gating. This may allow relatively accurate BP measurement during mild exercise. With the oscillometric method, air volume variations in the cuff are detected during deflation. The maximum oscillation is related to the mean arterial pressure. The systolic and diastolic BP are determined by an algorithmic interpretation of the shape of oscillometric amplitudes as well as the heart rate. The main advantages are (1) possibility of BP measurement when the Korotkoff signal is poor; (2) measurement of the mean arterial BP; and (3) no need of a microphonic sensor. The main disadvantages are (1) some oscillometric curves are difficult to read accurately; (2) oscillometry is very sensitive to movements due to the bandwidth of the signals, so the arm must be immobile; and (3) the accuracy of the systolic and diastolic BP depends on the algorithm used. These two methods are complementary and should ideally be associated in the same device.

Journal Article↗
PubMed1996

A comparison between the oscillometric and the auscultatory method for ambulatory 24 h blood pressure monitoring.

OBJECTIVES: To investigate the compatibility between oscillometric and auscultatory methods, and to determine whether one is preferable over the other for ambulatory 24 h blood pressure monitoring. METHODS: For the blood pressure monitoring system we used an A&D TM 2421 device (Takeda), which enabled us to measure the blood pressure simultaneously with the two methods on the same arm. Our investigation included 281 patients (122 women and 159 men, aged 18-85 years) with suspected hypertension or undergoing treatment for hypertension. RESULTS: We obtained 23 531 measurements by the oscillometric method, which was 98% of the maximal possible number, and 81% of the maximal possible number were obtained by the auscultatory methjod. We were able to compare 98% of the paired measurements. The auscultatory method showed a uniform distribution of errors throughout the 24 h. Compared to the auscultatory method, the oscillometry method had fewer errors in the evenings, but more when the subjects were at work. There was a difference in paired single readings between the two methods amounting to 1.4+/-19 mmHg (mean+/-SD) for systolic and -2.4+/-18 mmHg for diastolic readings (auscultatory - oscillometric). The differences in mean values for the 281 cases of 24 h monitoring amounted to 0.7+/- 4 mmHg for systolic and -2.2+/-6 mmHg for diastolic measurements. For the mean systolic blood pressure, we found a difference of 0.3+/-4 mmHg in the daytime and 0.3+/-8 mmHg during the night. The mean diastolic pressures differed by -2.0+/-6 mmHg in the daytime and -1.6+/-8 mmHg during the night. We found only a weak correlation between the differences in the readings by the two methods and systolic blood pressure levels, age, pulse pressure and body mass index, and no correlations between these differences and the diastolic blood pressure levels. CONCLUSION: Although we found a considerable SD on single readings by the two methods, there was a good agreement between the mean values of the 24 h monitoring for the two methods. We obtained a significantly higher success rate by the oscillometric method. The findings suggest that, for this equipment, the oscillometric method is preferable for 24 h ambulatory blood pressure monitoring because it provides a much higher rate of successful readings.

Journal Article↗
PubMed1996

Methods of measurement.

Four points, I feel, have dominated the session devoted to the methods of measurement; First, we all seem to be convinced that ambulatory measurement of blood pressure shows great promise, not only in clinical trials of drugs but also in routine practice. Further development of the technique will almost certainly encourage more manufacturers to produce machines, which by the operation of market forces should lead to lower prices. However, we need to be critical with respect to instrument quality and to the rigour of validation according to the guidelines of hypertension societies, especially for particular populations such as elderly patients. Second, two methods of indirect measurement of blood pressure are now being employed, namely auscultation and oscillometry, which are likely to remain the most widely exploited ones with the current technology. They should not be regarded as competing methods because both have their role to play in the measurement of ambulatory blood pressure, with their own advantages and limits. A possible development would be intelligent machines using both techniques, which could switch between methods depending on the actual conditions of each measurement. Third, desirable features of the new machines would be: more comfortable recording conditions for the patient with a lighter, quieter device giving a faster reading and thus reducing the cuff inflation time; and assistance with interpretation, which I believe is compatible with current technology such as automatic determination of the position of the patient (upright or supine) using some form of sensor and quantification of the degree of activity of the patient, which clearly affects blood pressure. Fourth, it is also likely that future development will include devices capable of measuring blood pressure together with other parameters the variations of which according to blood pressure changes may be of great interest, such as electrocardiographic data, oxygen saturation and the QKD interval. For all these reasons, the near future will certainly see much progress in the ambulatory measurement of blood pressure.

Journal Article↗
PubMed2000

Measurement of arterial compliance in vivo.

Measurement of arterial compliance is of interest in evaluating patients with atherosclerosis and other diseases which affect the vessels. Arterial compliance is the relation between changes in transmural pressure and volume of an arterial segment, where a high compliance signifies large changes in volume per change in transmural pressure. The relation between changes in transmural pressure and volume is far from linear as compliance increases progressively with decreases in blood pressure. A change in compliance could indicate static changes in arterial wall composition, i.e. the relation between elastic and collagen fibres and accumulation of disease related deposits or dynamic changes caused by alterations in muscular tone. The most used method reflecting arterial compliance is the measurement of pulse wave velocity. However, the pulse wave velocity method measures compliance at ambient transmural pressures and is affected both by the actual blood pressure and the rate of pressure change. Another commonly used method employs the echo-tracking technique to measure the arterial diameter simultaneously with continuous blood pressure monitoring. By this method it is possible to calculate arterial compliance for continuous pressure values between the diastole and the systole. The volume-oscillometry method is based on the fact that the artery can be made to collapse at the end of the diastole by an occlusive cuff while it remains open in a pressure dependent manner during the rest of the cardiac cycle. Changes in the arterial volume is transmitted to the cuff, where it induces a measurable change in pressure, and hence the volume of the artery can be calculated at different values of transmural pressures. Using this method on normal subjects has shown that the arterial compliance decreases with increasing age and that females have lower compliance than males primarily due to a smaller diameter of their arteries. It has also been shown that patients with essential (diastolic) hypertension have compliances which are higher or equal to those of normal subjects, and that patients with systolic hypertension have lower arterial compliances than normal subjects. The former finding is in contrast with pulse wave velocity measurements, where diastolic hypertension was associated with low arterial compliance.

Age Factors↗
PubMed1975

Xylose absorption test before and after surgical repair of coarctation of the aorta.

The aim of the study was to ascertain whether the acceleration of physical development in children after operation for coarctation of the aorta is due to the improved intestinal absorption. Lowered values of the oral xylose absorption test were found in all 9 patients before surgery. In all the patients who had been operated on, sphigmo-oscillometry revealed an increased pulsatile character of the blood flow, pulsatile volume in the lower extremities, and a rise of mean arterial blood pressure in this area. On the other hand, surgical repair had no influence on the renal blood flow as evidenced by PAH clearance and isotope renography. There was no correlation of diuresis and the xylose excretion test. Increased values of the xylose test after operation for coarctation of the aorta are due to the increased intestinal absorption rather than to improved renal function. Improved intestinal absorption may be a factor responsible for the accelerated physical development of children operated on for coarctation of the aorta.

Adolescent↗
PubMed2001

Non-invasive measurement of blood pressures in the Yucatan micropig (Sus scrofa domestica), with and without midazolam-induced sedation.

Current literature suggests that the effects of midazolam, a water-soluble benzodiazepine, on blood pressure in swine are minimal. The hypothesis of the study reported here was that a light sedative dose would induce a decrease in blood pressure in this species. Healthy female Yucatan Micropigs (n = 20), 16 to 30 (mean, 22) kg, aged four six months, were individually placed in a humane restraint sling and allowed to acclimate. Systolic (SBP), diastolic (DBP), and mean (MBP) blood pressures (mmHg) and heart rate (HR; beats per min [bpm]) were measured by use of oscillometry. The pressure cuff was placed at the base of the tail, and five sets of values were recorded at five-min intervals, beginning at 10 and ending 30 min after cuff placement. Following a three- to four-day rest period, this procedure was repeated with the addition of a dose of 0.5 mg of midazolam HCl/kg of body weight given intramuscularly at the time of cuff placement. A paired one-way Student's t-test was used to compare the means of the five measures between control and midazolam treatment. Mean (+/- SD) differences for SBP, DBP, MBP, and HR were 18.9 (+/- 3.97), 17.8 (+/- 5.27), and 18.6 (+/- 5.09) mmHg and 20.7 (+/- 3.73) bpm, respectively. All four parameters were significantly reduced in the midazolam-sedated group (P < 0.001). The maximal decrease in SBP, DBP, and MBP occurred at 15 and 20 min after dosing. Mean values based on the means of the five measures were 128 (+/- 12.6), 80 (+/- 9.4), and 99 (+/- 9.2) mmHg and 135 (+/- 17.4) bpm, and 109 (+/- 15.4), 63 (+/- 12.6), and 80 (+/- 13.6) mmHg and 115 (+/- 15.5) bpm for SBP, DBP, MBP, and HR in the control (n = 20) and midazolam (n = 20) groups, respectively. The control values can serve as normal oscillometric values for this age, sex, and breed of Micropig. We conclude that midazolam, given intramuscularly at a sedative dosage, negatively affects cardiovascular parameters measured by use of a blood pressure cuff, in sexually mature female Micropigs, compared with values in untreated pigs, which is similar to reports for humans.

Animals↗
PubMed2002

Effects of granulocyte colony stimulating factor on retinal leukocyte and erythrocyte flux in the human retina.

PURPOSE: The blue-field entoptic technique was introduced more than 20 years ago to quantify perimacular white blood cell flux. However, a final confirmation that the perceived corpuscles represent leukocytes is still unavailable. METHODS: The study design was randomized, placebo-controlled, and double masked with two parallel groups. Fifteen healthy male subjects received a single dose of granulocyte colony stimulating factor (G-CSF, 300 microg) and 15 other subjects received placebo. The following parameters were assessed at baseline and at 12 minutes and 8 hours after administration: retinal white blood cell flux, with the blue-field entoptic technique; retinal blood velocities, with bidirectional laser Doppler velocimetry; retinal venous diameter determined with a retinal vessel analyzer; and blood pressure and pulse rate determined by automated oscillometry and pulse oxymetry, respectively. RESULTS: After 12 minutes, G-CSF reduced total leukocyte count from 5.5 +/- 1.4 10(9)/L at baseline to 1.9 +/- 0.4 10(9)/L. This was paralleled by a 35% +/- 11% decrease in retinal white blood cell density. After 8 hours G-CSF increased total leukocyte counts to 20.0 +/- 4.4 10(9)/L. Again, this increase in circulating leukocytes was reflected by an increase in retinal white blood cell density (110% +/- 48%). All effects were significant at P < 0.001. By contrast, none of the other hemodynamic parameters was changed by administration of G-CSF. CONCLUSIONS: The results clearly indicate that the blue-field entoptic technique assesses leukocyte movement in the perimacular capillaries of the retina. Moreover, white blood cell density appears to adequately reflect the number of circulating leukocytes within the retinal microvasculature. Hence, an increase in retinal white blood cell density does not necessarily reflect retinal vasodilatation.

Adult↗
PubMed1975

[State of the peripheral circulation-in the postoperative period in children with surgical pathology of the lungs].

The results of studies on the state of the peripheral blood flow in 43 patients with surgical forms of pulmonary pathology are reported. Studies were conducted by means of photopletismography and oscillometry pre-and postoperatively. The patients' age ranged from 5 to 15 years. The investigation was performed before the operation and induction of narcosis (initial data), to the end of the operation and narcosis, during the first 2 days postoperatively, as well as in the next days of the first week after the operation. A high informative value of photopletismography and oscillography in estimating the state of the peripheral blood circulation in these patients has been emphasized.

Adolescent↗
PubMed2002

[Use of selective long-acting beta-blocker with vasodilating activity celiprolol in patients with essential hypertension].

Effects of 8 weeks therapy with long-acting selective b-blocker celiprolol (200 mg o.d.) on 24-hour blood pressure, central hemodynamics (oscillometry) and microcirculation (laser doppler flowmetry) were studied in 30 patients (17 women and 13 men, mean age 51.9 years), with stage I-II essential hypertension. Celiprolol lowered both systolic and diastolic blood pressure (BP) during all periods of 24-hour BP monitoring and improved BP circadian rhythm. Treatment with celiprolol was not associated with considerable heart rate decrease or changes of stroke volume and cardiac output. 24 hour monitoring of parameters of central hemodynamics during treatment with celiprolol revealed existence of significant direct correlation between mean BP and total peripheral vascular resistance. Thus, hypotensive effect of celiprolol was mostly attributed to its vasodilatory action. This activity of celiprolol was confirmed by its beneficial influence on parameters of microcirculation. After therapy normalization of peripheral blood flow was observed in 50%, and tendency to its improvement--in 83,3 % of patients.

Adrenergic beta-Antagonists↗
PubMed2003

Controlled trial of dexamethasone in neonatal chronic lung disease: an 8-year follow-up of cardiopulmonary function and growth.

AIM: To evaluate the long-term effects of postnatal dexamethasone treatment in high-risk infants of very low birthweight. METHODS: The study included 16 children aged 7.8 to 9.2 y who had been born very prematurely at gestational ages of 24-29 wk and with birthweights of < 1500 g and who had participated in a randomized study of dexamethasone or placebo treatment in ventilator-dependent infants at 10 d of age. Flow-volume spirometry, impulse oscillometry, skin-prick tests and Doppler echocardiography were carried out at school age, and respiratory morbidity and overall neurological outcome evaluated. Controls were 18 non-atopic children born at term, tested for lung function. RESULTS: No significant differences were found in respiratory morbidity at school age between the dexamethasone (n = 8) and placebo (n = 8) groups. Six of the 16 children had moderate to severe neurosensory impairments, but all were able to walk without support and attended primary school. In prematurely born children, standardized height was significantly less than that in controls, but between the two study groups, no significant differences existed in somatic growth. Atopy was uncommon: skin-prick tests were positive in only one child in the placebo group. In the dexamethasone group, forced vital capacity adjusted to height was significantly higher than that in the placebo group, but impairment of basic lung function and bronchial obstruction was evident in both study groups. No hypertrophic cardiomyopathy was apparent, and non-invasive measurements of pulmonary arterial pressure did not reveal any significant difference between the study groups. CONCLUSION: In very low-birthweight children, high respiratory morbidity and neurological impairment continued until school age. Neonatal dexamethasone treatment at school age was not associated with any detectable adverse effects on somatic growth, or pulmonary or cardiac function.

Anti-Inflammatory Agents↗
PubMed2003

[New techniques in the study of asthma].

Asthma is a chronic inflammatory disease of the airways that is functionally characterized by variability of lung function and bronchial hyper-responsiveness. Its diagnosis and management is commonly hampered by the lack of objective parameters. This article reviews additional techniques for evaluating both, lung function (bronchial challenge with adenosin-monophosphate, lung resistance measurement by either the impulse oscillometry system or whole body pletismography) and bronchial immuno-inflammatory response (induced sputum, condensates of exhaled air, monitoring of nitric oxide in exhaled air), as well as our experience with them.

Airway Resistance↗
PubMed1992

Raynaud's features in childhood. Clinical, immunological and capillaroscopic study.

Raynaud's phenomenon, uncommon in childhood, often heralds connective tissue disorder. Since microvascular abnormalities can be detected at an early stage of the connective tissue disease, especially in scleroderma, a specific diagnosis can be made in patients presenting with Raynaud's phenomenon alone or Raynaud's phenomenon associated with symptoms suggestive of connective tissue disease. Raynaud's phenomenon was studied in 11 consecutive children, 10 girls and 1 boy, ages 6 to 15. One child had a definite diagnosis of cutaneous polyarteritis nodosa. In 6 others connective tissue disease was suspected: 4 had arthritis, 2 has telangiectasia, leg ulcers and antinuclear antibodies. Of the remaining 4, one had hemiplegia and 3 Raynaud's phenomenon only. Oscillometry of the radial artery was reduced in 7 of 9. Decreased capillary resistance was found in 2 of 6, while abrupt thinning in conjunctival vessels was seen in 3 of 7. On nailfold capillaroscopy, reduced vascularity was noted in 5 of 11, dilated capillaries in 4 of 11, tortuousity in 2 of 11, capillary thinning in 1 of 11, capillary spasm in 1 of 11 and normal pattern in 3 of 11. Two patients presenting with Raynaud's phenomenon were found to have "scleroderma-like pattern" on nailfold capillaroscopy. One of them died 2 years later of cardiopulmonary sclerosis, and another developed esophageal stricture and Barrett's esophagus. Neither has sclerodermatous skin. In childhood Raynaud's phenomenon, nailfold capillaroscopy is a non-invasive examination enabling early diagnosis of "systemic scleroderma sine scleroderma".

Adolescent↗
PubMed2005

[The development and safety of cough provocation test by capsaicin inhalation].

OBJECTIVE: To assess the application and the safety of capsaicin cough provocation test by dosimeter method. METHODS: Capsaicin inhalation cough challenge test by dosimeter method was performed on 60 healthy volunteers (group A), 11 subjects with upper respiratory infection (group B), 10 patients with gastroesophageal reflux cough (group C) and 10 patients with asthma (group D). Each subject inhaled doubling concentrations of capsaicin (1.95, 3.90, 7.80, 15.6, 31.2, 62.5, 125, 250, 500, 1,000 micromol/L) by a breath-activated dosimeter until the concentration inducing five or more coughs (C(5)) was reached. The lg C(5) was calculated as the cough reflex sensitivity. General lung ventilation and impedance with impulse oscillometry were measured before and after the cough provocation test. RESULTS: There was no serious side effect of the test in all subjects; two subjects complained of slight nausea; one of heartburn, and three of hoarseness. Before the provocation the values of FEV(1) in group A, B, C and D were (3.6 +/- 0.5) L, (3.7 +/- 0.7) L, (2.7 +/- 0.8) L and (2.1 +/- 0.8) L, compared with (3.6 +/- 0.5) L, (3.7 +/- 0.8) L, (2.6 +/- 0.7) L and (2.1 +/- 0.8) L after the test, the differences being not significant (all P > 0.05). Compared with the measurements after provocation, Zrs was (2.6 +/- 0.8) mm Hg.L(-1).s(-1) vs (2.7 +/- 0.8) mm Hg.L(-1).s(-1) in group A, (2.5 +/- 0.5) mm Hg.L(-1).s(-1) vs (2.6 +/- 0.3) mm Hg.L(-1).s(-1) in group B, (2.7 +/- 0.7) mm Hg.L(-1).s(-1) vs (2.7 +/- 0.7) mm Hg.L(-1).s(-1) in group C, (3.3 +/- 1.5) mm Hg.L(-1).s(-1) vs (3.7 +/- 2.0) mm Hg.L(-1).s(-1) in group D, the differences showed no significance (all P > 0.05 respectively). The lg C(5) value was 2.45 +/- 0.46 in group A, 2.51 +/- 0.20 in group B, 1.52 +/- 0.70 in group C, 2.34 +/- 0.56 in group D. Compared with group A, B and D, the lg C(5) value in group C was significantly different (all P < 0.01 respectively). The lg C(5) value showed no significant difference among group A, group B and group D (all P > 0.05). CONCLUSION: Capsaicin inhalation cough provocation test by dosimeter method is a safe and specific tool for measuring cough reflex sensitivity.

Administration, Intranasal↗
PubMed1992

The vascular history and physical examination.

The value of the vascular examination cannot be over-estimated. Symptoms of vascular disease present in the foot and lower extremity may actually be manifestations of severe life-threatening disease. Symptoms, their location, and the frequency and quality of the patient's pain often provide valuable clues for the clinician's diagnosis. Central nervous system symptoms, ocular disturbances, cardiac symptoms, impotence, or constitutional disturbances may all indicate systemic arterial disease. Risk factors for this disease include smoking, hypertension, hyperlipidemia, genetic predisposition, diabetes, emotional stress, and physical inactivity. Those factors attributable to hypercoagulability and venous disease are birth control pill use, estrogen chemotherapy, obesity, prolonged immobilization, paralysis, previous thrombotic episodes, venous stasis disease, and varicose veins. An accurate bilateral assessment of blood pressure, pulses, and capillary perfusion is of critical importance. Careful inspection of the extremity for trophic changes, skin color, texture, temperature, edema, ulceration, atrophy, or paresis, will provide clues of vasculopathy. A relatively accurate assessment of circulatory status may be obtained without the use of exotic instruments. Simple tests such as the elevation and dependency tests, capillary bed return test, venous filling time test, along with blood pressure, pulse, and possibly oscillometry data are valuable in arterial evaluation. Such venous tests as inspection, percussion, Homan's sign, Trendelenburg, and Perthes' tourniquet are useful in the determination of the presence of venous disease. Fortunately, over the past few years tremendous advances have been made in the technology of the vascular laboratory. If symptoms are discovered during the vascular history and physical examination, the complete noninvasive study will provide impressive data to quantitate and specifically establish the diagnosis.

Humans↗
PubMed1991

The effect of smoking and menopause on the small blood vessels.

The small blood vessels were examined in 31 premenopausal and 31 postmenopausal women. In each group there were 14 non-smokers and 17 smokers of age groups 35-45 and 45-59. The women underwent full gynecological examination. Blood pressure was normal in each. The small blood vessels were examined by capillaroscopy of conjunctivae and nailfolds, by oscillometry of the radial artery, skin thermometry of the wrist and terminal phalanx, and by capillary fragility. When all abnormalities in non-smokers were compared with those in smokers in the menopausal groups, a significant difference was found, (Table 4), to the disadvantage of the smokers.

Adult↗