Postocclusive reactive hyperemia and postural vasoconstriction in different kinds of leg ulcers--investigations with laser Doppler.

Laser-Doppler fluxmetry was performed in 42 patients with leg ulcers (18 venous, 8 arterial, 12 diabetic-arteriolar and 4 mixed arterio-venous) and in 9 healthy controls. Using a bipolar probe measurement was carried out at the ulcer border and on the dorsum of the foot in the supine and in the sitting position. Reactive hyperemia after three minute arterial occlusion was produced in both body-positions. In every ulcer-group resting and peak fluxes showed a statistically significant increase in the ulcer region as compared to normal skin of the lower leg in the control group, the quotient between peak and resting flux ("reactive hyperemia index" RHI) being significantly lower. The RHI values for four ulcer-patients with a dramatic deterioration worsening eight months later were close to one, while the unchanged and improved cases showed median values above 1,2. Sitting up was followed by a decrease of flux in all ulcer-groups as well as in the control group. On the dorsum of the foot there was an increase of the laser Doppler flux in patients with arterial occlusive disease, i.e. in the group with arterial and mixed ulcers. This study shows that the kind of microcirculatory flow damage is not different in various causes of ulcerations. The reduced reactive hyperemic response compared to the increased resting fluxes (amount of RHI-decrease) might be a useful predictor for healing or non-healing of the ulcer.

[Retrograde intravenous perfusion: technique and different variants]. / Retrograde intravenöse Perfusion: Technik und verschiedene Varianten.

A retrograde intravenous infusion into an arterially occluded segment of an extremity is the most effective method to achieve maximal tissue concentrations of a drug. By application of contrast-medium it was shown that the injected fluid penetrates in retrograde direction into the foot inspite of primarily intact valves. Favourable clinical results were obtained with antibiotics in infected gangrene of the feet in diabetics and with urokinase in resistant leg ulcers.

[Urokinase in refractory lower leg ulcers: therapy with retrograde intravenous pressure infusion]. / Urokinase bei resistenten Unterschenkelgeschwüren: Therapie mit retrograder intravenöser Druckinfusion.

20 patients with large, resistant leg ulcers were treated by retrograde local intravenous pressure infusions containing 100,000 to 200,000 I.U. of urokinase 3 times per week for a total of up to 12 weeks. Laser-Doppler flowmetry and transcutaneous oxygen measurement at the ulcer borders showed highly pathological findings before therapy demonstrating a severe disturbance of local microcirculation in every case. After therapy the clinical condition was markedly improved in 17 cases. There was an increase of Laser-Doppler indices (peak flux/resting flux) and of tc pO2 and a statistically significant decrease of plasma viscosity and of plasma fibrinogen. The beneficial effects may be explained by fibrinolysis of intra- and extracapillary fibrin and by hemodynamic changes caused by repeated limb occlusions.

[Varicose ulcer: healing in conservative therapy. A prospective study]. / Ulcus cruris: Abheilung unter konservativer Therapie. Eine prospektive Studie.

In a prospective study 105 consecutive patients with leg ulcers were recruited (causes: 77% venous, 4% arterial, 9.5% mixed, 9.5% other). 70 (67%) had a history of previous ulceration. 83 patients could be followed for 1 year. The healing rate for the whole group was 41 (49%) after 3 months and 61 (73%) after 1 year. The corresponding figures for the 67 venous patients are 44 (66%) and 52 (78%) respectively. From 61 healed ulcers 18 (30%) reoccurred during the 1st year. At the primary examination several factors were investigated which might have influenced the healing rate. Age, ulcer-size, the duration of the ulcer, lateral localization, absence of foot-pulses and lymphoedematous skin changes on the forefoot could be shown to have negative influence on healing.

[Tobacco and the skin]. / Tabak und Haut.

Various skin changes are undoubtedly caused or at least promoted by smoking. The present literature seems to concentrate mainly on active cigarette smokers, rather than on other kinds of nicotine consumption or on the effects of passive smoking. Unquestionable sequelae of cigarette smoking are the occurrence of yellow fingers, enhanced wrinkling especially in the faces of females, precancerous lesions and squamous cell carcinomas on lips and oral mucosa, vasospasms and obliterations of large arteries as well as of small skin vessels. The toxicomania is often associated with other addictions as e.g. alcoholism. The main emphasis in medical care of our population should lie in facilitating smoking cessation as well as in an effective prevention.

[Nuclear medicine studies of tissue concentration and hemodynamic effects of retrograde intravenous pressure infusions]. / Nuklearmedizinische Untersuchungen zur Gewebekonzentration und hämodynamische Effekte von retrograden intravenösen Druckinfusionen.

In 12 patients with trophic foot-lesions (diabetic feet) retrograde intravenous pressure infusions (150 ml) containing radioactive tracers (99m Tc, 99m Tc labelled human serum albumin) were carried out. With the veins emptied time-activity curves over the legs reflect tissue concentrations after release of the occlusion. Tissue-concentration is about 3 times higher than after intraarterial and 7 times higher than after intravenous injection of the same dose. The high count-rates which can be measured in the wound-secretion demonstrate the "rinsing effect" of the injected fluid. Hemodynamic investigations have been performed in a double blind study. 8 patients received buflomedil and 9 got placebo 3 times per week by retrograde intravenous pressure infusions. After 3 weeks there was an increase of the peak-flow on the lower leg (venous occlusion plethysmography), an increase of transcutaneous oxygen pressure and a fall of peak flow-time and of plasma-viscosity, both for buflomedil and for placebo (without statistical significance). Preliminary investigations after an arterial occlusion for 1 hour showed an increase of flow-values measured by venous occlusion plethysmography which reached a maximum after 4 to 5 days.