[Functional venous diseases of the extremities].
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Most patients with vascular insufficiency in the legs suffer from atherosclerosis. Thus, it is easy to miss the diagnosis in occasional patients with disease due to other causes. Mechanical and functional disorders which affect major arteries or arterioles are described.
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Report in a 68 years old man of the association of erythermalgia and malignant thymoma. Improvement of erythermalgia after resection of the thymoma is demonstrative of paraneoplasic syndrome. Tumoral secretion of serotonine is suggested by ultrastructural features of the tumour and increasement of urinary 5 HIAA.
We observed the autonomic nerve plexuses in the skin of an erythermalgic patient and a normal individual using the methods of acetylcholinesterase (AChE) histochemistry, catecholamine histofluorescence, and electron microscopy. The density of both AChE-positive and catecholamine-containing nerve terminals in the periarterial and sweat glandular plexuses was greatly reduced in the erythermalgic foot skin compared with those in unaffected skin from the same patient and in the foot skin of a normal individual. Ultrastructurally, the terminal axons containing either agranular (cholinergic) or small dense-cored (adrenergic) vesicles were present in the periarterial and periglandular regions of the erythermalgic skin, but the occurrence of these nerve terminals in the involved skin appeared to be much reduced in frequency compared with uninvolved skin and the skin of a normal individual.
Diseases of the terminal vascular system are of particular diagnostic and differential-diagnostic importance in clinical angiology. While in the functional microangiopathies of the skin as a rule disturbances of the vasomotor function without an essential value of the disease are concerned, secondary organic changes of the wall of the vessel not infrequently determine the course and the prognosis of the basic disease (rheumatoid arthritis, collagenoses, hypertension and diabetes). Vasomotor trophic disturbances are observed also post-traumatically, post-operatively, after exposition to cold, in a lesion of the central nervous system and vertebra nerve irritations. For the allergic hyperergic vasculitides, which show an extraordinary polymorphism in the clinical picture in characteristic histological findings, an auto-immune pathogenesis is to be supposed. The chronic arterial hypertension leads to arteriolosclerosis and necrosis with adequate organic symptoms. In the diabetic microangiopathy we may demarcate functional pre-stages from irreversible structural changes of the vessels, in which case apart from the peripheral microangiopathy of the skin the retinopathy and nephropathy are to be classified as particularly important clinical manifestations.
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