[Microcirculation: possibility of non-invasive diagnosis].
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Diagnostic Imaging↗
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Staphylococcal enterotoxin B applied on intact normal and intact atopic skin induces dermatitis.
BACKGROUND AND DESIGN: Colonization of inflammatory skin diseases with Staphylococcus aureus is a frequent phenomenon and may cause exacerbation of the skin disease. Staphylococcus aureus strains present on atopic dermatitis are capable of releasing staphylococcal enterotoxins, a group of superantigens that are very potent T-cell activators. To determine whether the superantigen staphylococcal enterotoxin B can induce inflammation when applied on the skin, staphylococcal enterotoxin B was applied with and without occlusion on the volar aspect of the skin on the forearm of 10 subjects without skin disease and six subjects with atopic dermatitis of minimal activity and no eczema on the volar aspect of the skin on their forearm. The main outcome measures were clinical rating; determination of the increase of the thickness of the skin-fold; and determination of skin blood flow. RESULTS: Clinically, staphylococcal enterotoxin B induced skin changes of erythema and induration in 10 of 10 healthy volunteer subjects and six of six subjects suffering from atopic dermatitis, while the vehicle induced clinically evident skin changes in only one of 10 healthy subjects and none of six subjects with atopic dermatitis. On day 3 after the application of an occluded patch containing 10 micrograms/cm2 of staphylococcal enterotoxin B in the healthy subjects, the thickness of the skinfold increased 0.47 +/- 0.49 mm (mean +/- SD) (n = 9; P < .02) relative to the increase in the thickness of the skinfold following application of the vehicle. The Doppler laser-measured skin blood flow index had increased from 1.0 +/- 0.4 to 5.3 +/- 3.7 (mean +/- SD) (n = 10; P < .002). On day 3 after the application of occluded patchs containing 10 micrograms/cm2 of staphylococcal enterotoxin B in the subjects suffering from atopic dermatitis, the increase in the thickness of the skinfold increased 0.20 +/- 0.24 mm (n = 6; P, not significant) relative to the increased thickness in the skinfold following application of the vehicle. The Doppler laser-measured skin blood flow index had increased from 1.1 +/- 0.4 to 3.7 +/- 2.2 (n = 6, P, not significant). Three of six subjects suffering from atopic dermatitis experienced a flare of their disease in the elbow flexure ipsilaterally to where the staphylococcal enterotoxin B patch was applied. CONCLUSIONS: The superantigen staphylococcal enterotoxin B applied on intact skin from both normal subjects and patients with atopic dermatitis induces an inflammatory reaction. This finding suggests that superantigens released from S aureus present on the skin in inflammatory skin diseases may exacerbate and sustain the inflammation.
Adult↗
[Fetal endoscopic surgery in a case of twin pregnancy complicated by reversed arterial perfusion sequence (TRAP sequence)].
We present the first report in our country of endoscopic fetal surgery in a patient with a twin pregnancy and twin reversal arteral perfusion (TRAP sequence). We performed fetoscopic ligation of the umbilical cord of an acardiac twin at 26 week's gestation.
Adult↗
[Comparative value of Doppler graphic indices of blood flow rate and pressure in the assessment of the degree of lower limb ischemia].
The authors studied the dependence of Doppler graphic indices of blood flow and pressure at rest on the degree of ischemia of the lower limbs determined by the multistep treadmill test. They examined 50 patients with angiographically detected occluding lesions of the lower-limb arteries. The indices of pressure reflected the degree of the severity of lower-limb ischemia well, but the indices of linear blood flow rate did not correlate with it.
Adult↗
[Study of anti-tumor effects of hyperthermia combined with hydralazine on experimental tumor].
We analyzed tumor growth delay in experimental tumors after hyperthermia alone, hydralazine (HDZ) injection alone and the combination of these modalities. We also analyzed the energy parameter (ATP/Pi ratio) obtained by 31P-MRS (magnetic resonance spectroscopy). The purpose of this study was to evaluate the usefulness of 31P-MRS as an index of anti-tumor effect. FM3A tumor cells were transplanted subcutaneously in the hind legs of C3H/He mice. We dipped the tumors into a heated circulating water bath. 31P-MRS was performed with a CSI spectrometer. The anti-tumor effect obtained with HDZ alone was insignificant, but combined treatment with hyperthermia and HDZ had a significant synergistic effect. The ATP/Pi ratios for all groups treated separately with HDZ or hyperthermia were not different from the control, but the ATP/Pi ratio decreased after combined use of these agents. There was a significant correlation between the decrease in ATP/Pi ratio and tumor growth delay. We observed a direct relation between the delay in tumor growth and the decline in ATP/Pi ratio after combined treatment with HDZ and hyperthermia. The ATP/Pi ratio 24 hr after treatment may be useful in predicting the efficacy of the combined use of HDZ and hyperthermia.
Adenosine Triphosphate↗
[Doppler echographic criteria in determination of the aerobic threshold and ischemia of the lower limbs].
Doppler echographic criteria were developed to define the anaerobic threshold and to detect lower extremity ischemia. Multi-stage treadmill test provided the criteria involving impairments in the time course of recovery of continuous diastolic blood flow in the lower extremity arteries. The criteria allow the anaerobic threshold to be defined in the range of low and high exercises and the severity of ischemia of the saved and amputated limb to be assessed in arterial occlusions. The diagnostic sensitivity of the criteria is 82-87%, its specificity and predictive value are 95-100%.
Adult↗
Retinal blood flow changes in type I diabetes. A long-term follow-up study.
PURPOSE: The authors previously reported that blood speeds in the retinal arteries were significantly lower in patients with type I diabetes than in controls without diabetes. The purpose of this long-term, follow-up study was to characterize the natural course of changes in blood speed and blood flow in these patients. METHODS: Twenty-four patients were followed up with serial annual measurements of the blood flow in a temporal retinal artery using the bidirectional laser Doppler technique and monochromatic photography. The follow-up period ranged from 2 to 6 years (mean, 3.8 years). Using standardized color fundus photography and fluorescein angiography, a retinopathy score was generated for each eye studied. Linear regression analysis was used to compute the slope of the change in retinal blood flow for each patient during the follow-up period. RESULTS: Retinal blood flow slopes were negative in 15 patients and positive in 9 patients. Multiple linear regression analysis showed that the retinal blood flow slopes were significantly related to the retinal blood flow measured at entry to the study and to the median duration of diabetes during the follow-up period (R2 = 0.56; P = 0.0002). There was a positive correlation between the retinal blood flow slopes and the median retinopathy score during the follow-up period (P = 0.47; P = 0.02). CONCLUSIONS: As duration of diabetes becomes longer and retinopathy becomes more severe, there is a transition from negative to positive retinal blood flow slopes. This bimodal relationship between the change in retinal blood flow and the duration of diabetes reflects the complex pathologic alterations that occur in the diabetic retina.
Adult↗
[Blood circulation in retarded and normal offspring of hypertonic pregnant women].
Doppler velocimetry was carried out on 62 women with hypertensive disorders in pregnancy. From this group, 19 infants with intrauterine growth retardation (IUGR, defined as gestational age related birth weight of < 10.percentile) were born. The rest 43 were appropriate for gestational age (AGA, > 10. percentiled). Blood flow velocity studies were performed in maternal uterine vessels, and fetal umbilical, cerebral and renal arteries. Patients with IUGR exhibited a not always significant increase of indices in uterine, umbilical and renal arteries, and a non significant decrease in middle cerebral arteries. The difference was more marked when the ratio of cerebral/umbilical indices were calculated and compared. In this case the ratio of IUGR fetuses were half of the AGA, fetuses with significant differences. The value same reflective of IUGR were obtained in the ratio between arteria umbilicalis/middle cerebral artery indices. These ratios more clearly separate the IUGR from AGA fetuses, than any other indice of the investigated artery alone. There were in the study material one case of cerebral hemorrhage and one case of intrauterine death. Both belonged to the IUGR group.
Adult↗
Digital particle image velocimetry (DPIV) measurements of the velocity profiles through bileaflet mechanical valves: in vitro steady.
Although velocity profiles downstream of mechanical valves have been measured in-vitro using Laser Doppler Anemometry (LDA), these studies have not measured velocities in the immediate proximity of the leaflets since the LDA technique prevents velocities from being measured in the immediate vicinity of any structure. Laser based Digital Particle Image Velocimetry (DPIV) is a new technique that allows for accurate measurement of an entire two-dimensional velocity field with no beam angulation. DPIV was used to measure two-component velocity vectors immediately proximal and distal to a 25 mm bileaflet mechanical valve (St. Jude) mounted in a transparent steady flow in-vitro model. Measurements of flow similar in Reynolds number (Re) to mitral inflow (Re = 2000-4000) showed clear hemi-elliptical isovelocity convergence zones proximal to each of the three orifices. DPIV measurements of flow distal to the orifice revealed clear vortex rollups generated from the internal ring of the valve with separate velocity profiles immediately distal to the leaflets. These studies prove the feasibility of the DPIV technique to provide accurate velocity measurements of flow profiles through mechanical valves.
Blood Flow Velocity↗
Cold extremities: investigation and management of Raynaud's phenomenon.
Since Raynaud's description in 1862 of triphasic color changes in the digits, little progress has been made in diagnosis and treatment of this entity. Recent technologic advances such as laser Doppler fluxmetry and isolated cold stress testing offer promise in diagnosis and measuring response to various drugs. We review the pathophysiology and the clinical and laboratory evaluation of Raynaud's phenomenon, as well as medical and nondrug management.
Adult↗
Clinical-anamnestic and instrumental data in outpatients suffering from venous disease.
The authors studied 200 consecutive outpatients with symptoms due to venous disease of the lower limbs. All the patients underwent anamnestic, clinical and instrumental evaluation (c.w. Doppler velocimetry and strain-gauge plethysmography). The results of this study showed that some anamnestic and clinical data are significantly related to venous disease detected by instrumental techniques. The superficial and deep vein hypertension were, instead, correlated to oral contraceptive use.
Adolescent↗
[Functional evaluation of an experimental model of cutaneous microcirculation and pO2 after surgical excision: traditional method vs laser CO2].
Within an experimental study project about the interaction between Laser and biological tissues, the authors utilized a Laser Doppler Flowmeter device and a Polarographic method to study the cutaneous microcirculation and the tissue pO2. Under standardized conditions, the experimental model considered the microcirculation measurement and the ptiO2 before and after the exsection of a cutaneous lozenge on the animals back realized with traditional surgical methods (scalpel and electrotome) or with a last generation CO2 Laser in continuous and in pulsed mode. The Laser Doppler Flowmeter showed that the largest perturbation of the microcirculatory flux occurred after the exsection realized with the scalpel and the electrotome. The CO2 Laser utilized in continuous mode showed an influence slightly lower on the microcirculation while in pulsed mode the perturbation was absent. The ptiO2 measurement showed similar results emphasizing that the CO2 surgical Laser technique is less invasive than the traditional. To sum up, these functional methods allowed a careful microcirculation an ptiO2 evaluation and provided useful information about vasal and metabolic alterations, showing that the CO2 surgical Laser utilized in pulsed mode appears to be the less harmful surgical technique for the tissues surrounding the exsection site.
Laser-Doppler Flowmetry↗
[Significance of middle cerebral artery doppler velocimetry based on behavioral states in intrauterine growth retarded fetuses--prediction of development of fetal distress].
Middle cerebral artery resistance indices (MCARI) based on fetal behavioral states were calculated in 60 normal and 20 intrauterine growth retarded (IUGR) fetuses between 33 and 40 weeks of gestational age. Fetal behavioral states were determined by recording fetal actocardiograms. The results obtained were as follows: 1. MCARI was significantly lower in the active phase than in the resting phase in normal fetuses. 2. Of the 20 IUGR fetuses, 9 subsequently developed fetal distress. Seven of 11 fetuses who did not develop fetal distress had abnormally low MCARI (less than M-2.0 SD) in the active phase. On the other hand, seven of the fetuses that subsequently developed fetal distress had abnormal MCARI not only in the active phase but also in the resting phase. The fetuses that did not develop fetal distress had different MCARIs in the two phase, but the fetuses that developed fetal distress exhibited no such difference. 3. The sensitivity and specificity in predicting the development of fetal distress in IUGR fetuses with abnormal MCARI in the resting phase were 77.8% and 81.8%, respectively. This study showed that in normal fetuses MCARI differs according to the behavioral state, and that resting phase MCARI is useful for predicting fetal distress in IUGR fetuses.
Adult↗
Mechanisms of allodynia: interactions between sensitive mechanoreceptors and nociceptors.
We examined whether stimulation of sensitive mechanoreceptors from an area of allodynia evokes nociceptor activity expressed as axon reflexes. Experiments were conducted on human volunteers. Cutaneous blood flow was measured with a laser Doppler flowmeter. Allodynia was induced with mustard oil (25-100%) or by intradermal injections of capsaicin (25-50 micrograms) in the skin of the forearm or the hand. Tactile stimulation of normal skin or outside zones of allodynia did not evoke axon reflexes. The same stimulation in areas of allodynia evoked pain as well as axon reflexes. Cooling the area of primary hyperalgesia or blocking the A fibres in the nerve that innervated the allodynia area abolished the allodynia and the axon reflex. These results demonstrate central interactions between sensitive mechanoreceptors and nociceptors concomitant with the development of allodynia.
Adult↗
A comparison of techniques to assess skin blanching following the topical application of glucocorticoids.
Glucocorticoid-induced dermal blanching provides a useful research tool to study steroid potency and sensitivity. Conventional measurement of the intensity of blanching relies on subjective assessment by a trained observer using a visual score. Several objective techniques have recently been reported to detect skin blanching, but their sensitivity has not been compared previously with subjective visual recordings. In this report we aimed to establish whether objective methods offer sufficient sensitivity to be employed in epidemiological studies of glucocorticoid responsiveness. In healthy subjects we applied beclomethasone dipropionate at three concentrations (1, 10 and 100 micrograms/ml) under an occluded dressing overnight. The following morning we measured blanching using a visual score, laser Doppler velocimetry with the MBF 3D monitor (Moor Instruments Ltd, U.K.) and a perfusion imager (Lisca, Sweden), and reflectance spectrophotometry with the Dia-Stron 'erythemameter'. Using the visual score, blanching was detected at all concentrations of steroid. Neither laser Doppler instrument detected vasoconstriction at any concentration. By contrast, the reflectance spectrophotometer successfully recorded blanching at 10 and 100 micrograms/ml, but not at 1 microgram/ml. We conclude that laser Doppler instruments, including the novel scanning perfusion imager, do not detect glucocorticoid-induced skin blanching, perhaps because it reflects venular rather than arteriolar vasoconstriction. By contrast, the Dia-Stron reflectance spectrophotometer has sufficient sensitivity to be used as an alternative to visual assessment in epidemiological studies of human glucocorticoid-induced dermal blanching.
Administration, Topical↗
[Microcirculatory changes in mitral prolapse as an expression of a systemic change in the connective tissue].
Many authors hypothesize that mitral valve prolapse (MVP) can be, in most cases, only a clinical sign of a primitive and systemic disorder of the connective tissue, like in Marfan Syndrome (MS). In our previous works we supported the presence of morphological and functional alterations of the microcirculation in patients affected by MS. In order to characterize a possible common denominator between these pathologies we have studied the cutaneous microcirculation in a group of patients affected by MVP, divided into 2 groups: anatomic MVP (MVP) and MVP syndrome (MVPS). The morphologic parameters have been investigated by nailfold capillaroscopy while digital laser-Doppler was used to study skin flowmetry. The results have been compared with a control group. Capillaroscopic remarkers showed an architecturally disorganized microvasculature with aspects related to a reduced compactness of the microvasculature unit with a significatively higher score compared with controls (7.3 +/- 2.9 vs 3.6 +/- 1 p less than 0.0005). Laser-Doppler flowmetry showed a significatively reduced rest flow; ischemic test showed: spike time 48.9 +/- 36.9 vs 15.3 +/- 7.7 s (p less than 0.0005), hyperemic acme 6.6 +/- 2.7 vs 12.5 +/- 8.4 UP (p less than 0.002); % increase 32.1 +/- 20.2 vs 51.5 +/- 15.4 (p less than 0.002). Thermic test showed a significatively higher thermic acme 8.7 +/- 4.2 vs 12.6 +/- 9.11 UP (p less than 0.05). These results appeared to be correlated with stage pathology as it was observed a severe microvasculature disorders in MVPS. Therefore we suppose that a phenotypic continuum may exist between MS and MVP.
Adult↗
Effects of neural blockade and general anesthesia on the laser-Doppler skin blood flow waves recorded from the finger or toe.
Effects of neural blockade and general anesthesia on the basic wave (BW) and the reflex wave (RW) among the laser-Doppler (L-D) skin blood flow waves recorded on the finger or toe were studied in 2 volunteers and 42 patients. The BW was continuous, rhythmic and independent of respiratory movements. The RW, which was induced by a deep inspiration or a snapping sound, was a transient marked reduction in blood flow. The BW was almost flattened and the RW was no longer induced at the finger under complete wrist block (n = 2), or under cervical or upper thoracic epidural anesthesia extended caudally over T7 (n = 2). On the other hand, the BW was still detected with reducing frequency and the RW could be provoked with one exception at the finger on the side with a sympathetic ganglion block at the C6 vertebral level (n = 14). The BW and RW at the toe were retained under lumbar subdural anesthesia (n = 6) as well. However, under the combination of lumbar subdural anesthesia and lower thoracic epidural anesthesia extending rostrally over T4 (n = 6), both the BW and the RW disappeared at the toe. In the course of deepening nitrous oxide/enflurane anesthesia (n = 10), the BW gradually reduced in frequency until it was almost flattened, and it became difficult to provoke the RW. L-D flowmetry of the finger or toe could be a useful clinical measure for detecting the presence or absence of sympathetic function controlling cutaneous vasomotion.
Adult↗
Current status of noninvasive tests in the diagnosis of peripheral arterial disease.
In this review of the current status of the vascular laboratory, the major emphasis has been upon those tests that have become well-established and documented, including resting pressure, pulse volume measurements, velocity studies, and three stress measurements--exercise ankle pressure, postocclusive reactive hyperemia, and the toe pulse reappearance time. Additional technology that may have application to peripheral arterial disease includes photoplethysmography, transcutaneous oxygen tension, laser-Doppler velocimetry, fluorescein angiography, infrared thermography, and transcutaneous electromagnetic flowmetry. These techniques, which are currently in development and experimental trial, were not discussed but are likely to provide significant additional information. The future role of the vascular diagnostic laboratory in the area of peripheral arterial occlusive disease appears clear. It has already become a standard resource of the community hospital and tertiary referral center. Its functions will become more and more generally accepted with time as newly graduating physicians who have been exposed to this technology enter the practice of medicine. It should permit obtaining an evaluation of all patients at the expert level, aid in the education of all physicians concerned with peripheral arterial disease, and play an important part in guaranteeing a higher level of patient care than has heretofore been available.
Arterial Occlusive Diseases↗