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At least 19 recordsLinked to original sources
PubMed2002

Angioscopy and ischemic heart disease.

Angioscopy allows direct visualization of the coronary artery lumen and provides detailed information regarding the surface characteristics of the vessel wall and specific lesions causing acute coronary syndromes. Disruption of a plaque, ulceration, tears, fissures, lipid-rich or fibrous lesions, and luminal or mural thrombus can be readily detected in vivo. Characterization of culprit lesions in various coronary syndromes reveals the different mechanisms of ischemia. The predominant lesion in acute myocardial infarction is an ulcerated, yellow plaque with thrombus. In unstable angina, different substrates can be seen, from the lipid-rich lesion with thrombus to the fibrous smooth plaque, reflecting a varied physiopathology. Because of its ability to detect superficial lipid pools, angioscopy may be valuable for the detection of vulnerable plaques.

Acute Disease↗
PubMed2003

Microvessels of bulbar conjunctiva in UPTAH goats.

Aiming to observe directly the microcirculation after total artificial heart (TAH) implantation, we performed a long-term follow-up in 2 goats using conjunctival angioscopy. A short segment of parallel arteriole and venule was photographed and analyzed on computer picture program (magnification 40x). Three main parameters were measured: arteriole diameter, venule diameter, and arteriovenous ratio (A/V ratio). The intrathoracically implanted TAH was the undulation pump total artificial heart (UPTAH) with cardiac output of 100 ml/kg/min. To stabilize the peripheral hemodynamics a 1/R biofeedback control system was used. Our results provided only elementary data about morphology of bulbar microvessels. The main finding was the tendency to general vasoconstriction, more intensive on the venous side (*P < 0.05 in one goat). We did not observe any pathological shapes (e.g., tortuosities, varicosities, or sludge); this result could be attributed to the high effectivity of 1/R control method. These preliminary results should be considered only as an attempt to apply the widely used clinical method of conjunctival angioscopy to the conditions of TAH.

Animals↗
PubMed2000

Value of capillary microscopy in the diagnosis of hereditary hemorrhagic telangiectasia.

BACKGROUND: Hereditary hemorrhagic telangiectasia (HHT) is a hereditary disorder, leading to easily bleeding telangiectases on the skin and mucosal surfaces. The disease is associated with arteriovenous malformations in multiple organs. Potentially serious complications warrant an early diagnosis. Telangiectases are the hallmark of the disease, but may be difficult to distinguish. OBJECTIVES: To evaluate the value of capillary microscopy in the diagnosis of HHT and to compare the capillary pattern of the fingernail folds in patients with HHT and healthy persons. SETTING: Outpatient department of a general hospital. PARTICIPANTS: A random sample of 54 patients with HHT and a volunteer sample of 40 healthy persons. MAIN OUTCOME MEASURE: The difference in the capillary pattern between patients with HHT and healthy volunteers. RESULTS: Forty-five (83%) of 54 patients with HHT had giant loops between the normal capillaries in the nail fold. Two patients had only enlargement of the draining limb of the capillary. Seven patients (13%) had no vascular abnormalities in the nail fold. Seven of 9 patients with HHT but without cutaneous telangiectases had microvascular abnormalities. None of the volunteers had vascular abnormalities. The difference between both groups was significant (chi2, P<.001). CONCLUSION: Capillary microscopy can be a valuable tool in diagnosing HHT.

Adolescent↗
PubMed2003

The handheld dermatoscope as a nail-fold capillaroscopic instrument.

BACKGROUND: The presence of nail-fold capillary abnormalities may be useful in diagnosing several connective tissue disorders, including scleroderma, dermatomyositis, and mixed connective tissue disease, and in differentiating primary Raynaud phenomenon from Raynaud phenomenon due to scleroderma and mixed connective tissue disease. Capillaroscopy, however, usually requires special equipment and may be time consuming. Purpose To investigate the potential use of the unmodified common handheld dermatoscope as a capillaroscopic instrument. Subjects The study included 106 patients who were consecutively referred and a control group of 170 healthy subjects or patients with unrelated skin disorders. METHODS: A nail-fold capillaroscopic examination using a standard handheld dermatoscope was performed on all fingers of each subject. A scleroderma-dermatomyositis pattern was defined as the presence of 2 or more of the following findings in at least 2 nail folds: enlargement of capillary loops, loss of capillaries, disorganization of the normal distribution of capillaries, "budding" ("bushy") capillaries, twisted enlarged capillaries, and capillary hemorrhages (extravasates). RESULTS: A scleroderma-dermatomyositis pattern was found in 19 (70.4%) of 27, 7 (63.6%) of 11, and 4 (50%) of 8 patients with scleroderma, dermatomyositis, and mixed connective tissue disease, respectively. These frequencies were statistically significantly higher than a null percentage of scleroderma-dermatomyositis pattern in the control group (P<.001) and a scleroderma-dermatomyositis pattern in only 1 (4.5%) of 22 patients with systemic lupus erythematosus as well as in 2 (5.3%) of 38 patients with Raynaud phenomenon but without evidence of a connective tissue disorder (P<.01). CONCLUSIONS: The capillaroscopic results obtained with the dermatoscope are comparable to those described with other instruments. Therefore, the unmodified hand-held dermatoscope may be used as a capillaroscopic instrument to detect a scleroderma-dermatomyositis pattern and to help the dermatologist in the clinical diagnosis of connective tissue disorders.

Adolescent↗
PubMed2001

N-acetylcysteine improves microcirculatory flow during smoking: new effects of an old drug with possible benefits for smokers.

BACKGROUND: Cigarette smoking provokes marked acute changes in the microcirculatory vasculature, including a reduced blood flow velocity. In accordance with the hypothesis that the reduced blood flow is due to an imbalance between pro-oxidants and oxidants, we recently showed that most of the reduction could be reversed by a high dose of vitamin C. HYPOTHESIS: In the present work we tested the hypothesis that N-acetylcysteine, a mucolyticum and an antioxidant, may have an effect on the smoking-induced changes observed by vital capillary microscopy of the nailfold. METHODS: In all, 37 healthy volunteers of both genders and with varied smoking habits were treated with N-acetylcysteine 200 mg t.i.d. for 2 weeks. In vivo investigation of the microcirculation by capillaroscopy was performed before and after treatment. RESULTS: Treatment with N-acetylcysteine significantly reduced the smoking-induced relative decrease in capillary blood flow velocity in a group of volunteers with varied smoking habits (p = 0.0016). The preventive effect was clearly significant in smokers (p = 0.003). CONCLUSION: Treatment with N-acetylcysteine has a positive impact on microcirculatory flow during smoking, particularly in habitual smokers.

Acetylcysteine↗
PubMed2001

[Assessment of diabetic alterations of microcirculation by means of capillaroscopy and laser-Doppler anemometry].

BACKGROUND: Only minor changes of skin capillary morphology have been described in diabetic patients by means of capillaroscopy, whereas cutaneous microvascular dysfunction is well known. We examined correlations between functional and morphological abnormalities of the capillaries in Type 1 and 2 diabetic patients and the influence of diabetes duration on capillary morphology. PATIENTS AND METHODS: Density, diameters and morphology of nailfold capillaries were investigated in diabetic patients, 16 Type 1 and 19 Type 2, and compared to age- and sex-matched control groups. Capillary blood cell velocities (CBV) during rest and after 3-minute arterial occlusion were measured in the dorsal middle phalangeal area of the left ring finger by means of laser Doppler anemometry. RESULTS: Capillary density, width and arterial limb diameter were similar in Type 1 and 2 diabetic patients compared to their controls. Capillary diameters of the apical part and the venous limb were enlarged in the combined analysis of Type 1 and 2 diabetic patients compared to the control group (apex: 19.2 +/- 0.6 microns vs 17.4 +/- 0.6 microns, p = 0.0243; venous limb: 17.3 +/- 0.5 microns vs 15.9 +/- 0.4 microns, p = 0.0238). Tortuous capillaries were more often observed in Type 1 (n = 13 vs n = 7, p = 0.028) and 2 diabetic patients (n = 16 vs n = 9, p = 0.019) than in controls. In Type 1 diabetic patients an inverse correlation (r = -0.52; p = 0.019) was found between capillary density and resting CBV. In Type 2 diabetic patients capillary apex diameter correlated positively with peak CBV (r = 0.49; p = 0.017). Disease duration correlated inversely with arterial limb diameter (r = -0.48; p = 0.020) and width of the capillaries (r = -0.48; p = 0.018) in Type 2 diabetic patients. CONCLUSION: Tortuous and dilated capillaries, indicating microangiopathy, were found in the skin of diabetic patients by means of capillaroscopy. Using laser Doppler anemometry it is possible to assess impairment of postocclusive reactive hyperemia, due to diabetic microvascular dysfunction, in single capillaries. Correlations between morphological and functional microcirculatory alterations in diabetes may be explained by hemodynamic changes, depending on diabetes duration.

Adult↗
PubMed2004

[Noninvasive methods in the diagnosis of macro- and microangiopathy of peripherial and carotid arteries].

PURPOSE: Indications and diagnostic value of the most important noninvasive procedures for the diagnosis of peripheral arterial disease and diseases of the supraaortic arteries are reviewed in this article with particular emphasis on cardiologic questions. PERIPHERAL ARTERIAL DISEASE: As compared to coronary artery disease, peripheral arterial disease has long been addressed as being negligible in number and importance, a view that had to be reassessed in recent years. The prevalence of claudication and critical leg ischemia has increased. Earlier diagnosis and specific therapeutic regimens will be able to prevent or at least slow progression of the disease and, thereby, major amputation. The patient's history and physical examination in addition to measurement of the ankle-brachial index (ABI; determined by dividing the systolic pressure measured by Doppler ultrasonography of the A. dorsalis pedis or A. tibialis posterior by that of the A. brachialis) usually allows for the diagnosis of peripheral arterial disease (ABI < 0.9). If in doubt (ABI > 0.9, but presence of typical claudication), a treadmill test or additional tests such as pressure-pulse recording (mechanical oscillography), toe pressure measurements, or duplex ultrasonography should be performed. When peripheral arterial disease has been diagnosed, duplex ultrasonography or treadmill testing aids in planning additional diagnostic procedures and the adequate therapeutic regimen. Transcutaneous oxymetry is of prognostic value in assessing the tendency of wound healing in distal limb ulceration and can distinguish between critical limb ischemia and complicated claudication. Thermography is used to document functional and organic peripheral arterial occlusions and capillaroscopy to directly view nail fold capillaries in order to distinguish between primary and secondary Raynaud's phenomenon. Noninvasive radiologic techniques in the diagnosis of peripheral arterial disease are also discussed in this journal. SUPRAAORTIC ARTERIES: Noninvasive diagnostic procedures in assessing disease of the supraaortic arteries include history-taking, physical examination, continuous-wave-(cw-)Doppler and color-coded ultrasonography. Cw-Doppler ultrasonography is still widely used and sufficient in diagnosing moderate to severe stenosis or occlusion of the carotid artery. B-mode and color-coded ultrasonography has several advantages over cw-Doppler ultrasonography through direct visualization of the vascular membrane, perivascular structures, and intravascular blood flow. Carotid stenosis < 50% and plaque morphology can be assessed, inflammatory processes, aneurysms, and dissections diagnosed. Increase in intima-media thickness and echolucent plaques are associated with cerebral ischemic events and can be diagnosed via duplex sonography. These findings have great implications in the consultation of patients with atherogenic risk factors.

Arterial Occlusive Diseases↗
PubMed1999

[Microcirculation of cutaneous melanoma].

The microcirculation of human skin tumours can be visualized with noninvasive methods from clinical microcirculation research (capillaroscopy and laser Doppler fluxmetry (LDF). The latter can also be used to measure the blood flow in such tumours. This prospective study was designed to evaluate melanoma-associated cutaneous neoangiogenesis. We studied the microcirculation of 114 pigmented skin tumours in 103 patients (63 women, 40 men) averaging 38.8 +/- 21.1 years of age. On the basis of histological findings, we diagnosed melanocytic naevus in 86 cases and malignant melanoma in 28. The malignant melanoma was characterized by a chaotic arrangement of the capillaries, which were dilated and formed corkscrew-shaped or glomerular structures. In the transitional area between healthy and cancerous areas there was hypervascularization. The capillaries of the melanoma appeared to be more permeable towards the low-molecular-weight, water-soluble sodium fluorescein. Laser Doppler flux, a measure of cutaneous circulation in the upper 2 mm of the skin, is higher in the center of the melanoma than in either the middle of melanocytic naevus (p < 0.0005) or in neighbouring healthy skin areas (P < 0.005). In the future, antiangiogenetic therapy strategies could play a significant role in the treatment of malignant melanoma. These methods provide a reliable means of evaluating the specific antiangiogenetic efficacy of treatments for cutaneous melanoma.

Adolescent↗
PubMed2004

Physiological hyperinsulinaemia increases intramuscular microvascular reactive hyperaemia and vasomotion in healthy volunteers.

AIMS/HYPOTHESIS: Insulin possesses vasodilatory actions that may be important in regulating its access to insulin-sensitive tissues. Our study aims to directly measure changes in response to insulin in the human skeletal muscle microcirculation. Measurement was by an implanted laser Doppler probe. METHODS: We investigated changes in intramuscular and skin microvascular perfusion in 12 healthy individuals during a hyperinsulinaemic and a control clamp. We determined leg blood flow with plethysmography, finger skin functional capillary recruitment with capillaroscopy, endothelium-(in)dependent vasodilation by iontophoresis of acetylcholine and sodium nitroprusside, and leg intramuscular reactive hyperaemia and vasomotion with laser Doppler measurements. RESULTS: Compared to the control study, hyperinsulinaemia (416+/-82 pmol/l) caused: (i) an increase in leg blood flow (1.0+/-1.0 vs 0.1+/-0.6 ml.min(-1).100 ml, p<0.05); (ii) an increase in finger skin capillary recruitment (14.9+/-10.1 vs -5.6+/-11.0%, p<0.01); (iii) no change in baseline laser Doppler perfusion either in finger skin or leg muscle; (iv) a tendency to increase acetylcholine-mediated vasodilation (475+/-534 vs 114+/-337%, p=0.07) with no change in sodium-nitroprusside-mediated vasodilation ( p=0.2) in finger skin; (v) an increase in intramuscular reactive hyperaemia (423+/-507 vs 0+/-220%, p<0.01); and (vi) a decrease in time needed to reach peak intramuscular perfusion (-3.6+/-3.0 vs 1.1+/-3.1 s, p<0.01). In addition, hyperinsulinaemia induced an increase in intramuscular vasomotion by increasing the contribution of frequencies between 0.01 and 0.04 Hz ( p<0.05 for all), which probably represents increased endothelial and neurogenic activity. CONCLUSIONS/INTERPRETATION: Physiological hyperinsulinaemia not only stimulates total blood flow and skin microvascular perfusion, but also augments human skeletal muscle microvascular recruitment and vasomotion as detected directly by laser Doppler measurements.

Adult↗
PubMed2004

Nailfold video-capillaroscopy in systemic sclerosis.

The Raynaud's phenomenon (RP) is the most common and significant clinical condition supporting microvascular analysis as soon as possible. Microvascular involvement is a key feature of RP, and several rheumatic diseases are characterized by the presence of the RP. Nailfold capillary microscopy shows an impressive cost/effectiveness ratio: it is simple, noninvasive and inexpensive.Well-recognized videocapillaroscopic patterns (NVC) have been described mainly in scleroderma (SSc) patients complaining of a secondary RP. The peripheral microvascular damage in SSc is characterized by increasing structural alterations of the capillaries (giant capillaries and microhemorrhages) with progressive decrease of their density. The detection of the scleroderma NCV allows early differentiation between primary RP (functional, not disease associated), and secondary RP (disease associated). Other major NVC patterns have been described in the field of rheumatic diseases. Interestingly, correlations are evident between the NCV and the clinical symptoms, severity of the disease and the laboratory findings. Further clinical and epidemiological studies, as well as a standardized and computerized quantitation of the observed damages are required.

Capillaries↗
PubMed2006

[Systemic sclerosis - diagnosis and classification].

Systemic sclerosis (SSc) is a polymorphic and heterogenic systemic disorder with inflammation, fibrosis and vascular damage. Early diagnosis and classification may be difficult if disease expression is oligosymptomatic (undifferentiated), presenting with only Raynaud's phenomenon or limited scleroderma. Scleroderma specific antinuclear autoantibodies, which are present early and persistently in about 90% of the patients with SSc, play an important taxonomic role. Scleroderma specific findings in nailfold capillary microscopy are sensitive and predictive for evolving SSc. An algorithm will be presented for the diagnosis and classification of SSc using clinical, capillaroscopic and serologic criteria, which are also useful for mixed or special forms of SSc. The 6th Outcome Measures in Rheumatology Clinical Trials (OMERACT) conference proposed different outcome measurements for clinical studies, however, for daily clinical practice there is as yet no consensus on status indices for disease activity, disease related damage or suitable prognostic criteria.

Algorithms↗
PubMed2006

[Capillaroscopy and rheumatic diseases: state of the art].

Nailfold capillaroscopy (NVC) represents the best method for analyzing microvascular abnormalities in rheumatic diseases. Raynaud's phenomenon (RP) represents the most frequent clinical aspect of microvascular involvement and is a key feature of several such diseases. Under normal conditions or in primary RP (exclusion by the cold-exposure test), the normal nailfold capillaroscopic pattern shows a regular disposition of the capillary loops within the nail bed. However, in subjects suffering from secondary RP, one or more alterations in the capillaroscopic findings should alert the physician to search for an underlying connective tissue disease. Architectural disorganization, giant capillaries, hemorrhages, loss of capillaries and avascular areas characterize more than 95% of patients with overt systemic sclerosis (scleroderma, SSc). Therefore, the term "scleroderma pattern", includes all capillaroscopic changes typical of the microvascular involvement in SSc. The capillaroscopic aspects observed in dermatomyositis and in undifferentiated connective tissue disease are generally reported as "scleroderma-like patterns". This peripheral microangiopathy can be effectively detected early in the course of the disease and studied in detail by nailfold capillaroscopy or, better, with NVC. In addition, early differential diagnosis between primary and secondary RP is the greatest advantage NVC has to offer. In addition, interesting capillaroscopic changes have been observed in systemic lupus erythematosus, antiphospholipid syndrome and Sjögren's syndrome. However, further epidemiological and clinical studies are needed to better standardize NVC patterns.

Antiphospholipid Syndrome↗