Digitized nailfold capillaroscopy.

An image processing system was developed to quantify the morphometry of nailfold capillaroscopy. Image acquisition was performed with a macrophotographic technique, and images are digitized using a video camera and an image processing system. After an image segmentation, the microcomputer determines in an interactively defined window, the following parameters: capillary loop width and length, capillary surface area, distance from the tip of the capillary loop to the dermal edge, distance between two adjacent capillaries. Other parameters can be computed from these: linear density, density and dispersion index of the distance between two adjacent capillaries (variation coefficient). A validation study, comparing 20 capillary fields from healthy subjects and 19 capillary fields with "SD-pattern", provided from patients with systemic sclerosis or dermatomyositis, reveals significant differences of all these parameters between the two groups, consistent with the literature. This study also isolates two parameters which are the best predictors of the "SD-pattern": the mean capillary surface and the capillary density (capillaries/mm2). The morphometric parameters obtained through this system are suitable for evaluation of microangiopathy and should be evaluated for diagnosis and follow-up of vascular acrosyndromes, systemic sclerosis, Raynaud phenomenon and allied conditions in clinical conditions.

[Influence of spray application of La Léchère mineral water on the cutaneous microcirculation in the lower limbs in healthy subjects]. / Influence de l'application locale d'eau thermale de la léchère en spray sur la microcirculation cutanée des membres inférieurs.

Spa treatment is commonly used in chronic venous diseases, to the satisfaction of many patients, but no scientific validation work has been performed up to now. This pharmaco-clinical study was designed to evaluate the specific influence of topical application of the mineral water of La Léchère on the cutaneous microcirculation. It was a controlled, randomized, double-blind study comparing the effects of the water of La Léchère to distilled water applied as a spray to the ankle in ten healthy subjects. Skin temperature and laser-Doppler perfusion index (mean and temporal variability) were the evaluated parameters. Under these conditions, the results show a cutaneous cooling with a mean value of 0.3 to 0.5 degrees C, whose duration is significantly longer with the thermal water (p<0.05). During this cooling, the laser-Doppler perfusion index remained stable when distilled water was applied, whereas an increase was observed when the thermal water was employed (p=0.005). No significant changes in vasomotion were observed with either treatment (p=ns). This study demonstrates the presence of a specific effect of topical application of the La Léchère mineral water on the cutaneous microcirculation. The explanation and the potential therapeutic interest of this effect were beyond the scope of this study and remain to be investigated.

[Incidence of erysipelas of the lower limbs in a spa resort. Efficacy of a strategy of sanitation education (La Lechere: 1992-1997)]. / Incidence de l'érysipèle des membres inférieurs en milieu thermal phlébologique. Efficacité d'une stratégie d'éducation sanitaire (La Léchère: 1992-1997).

OBJECTIVE: Erysipela is a common skin infection readily found in patients with venous insufficiency or lymphedema. The aim of this work was to measure the incidence of erysipela in a spa resort specialized in the treatment of venous and lymphatic diseases and to evaluate the influence of a preventive strategy principally based on education of patients at risk. PATIENTS AND METHODS: The measurement of incidence was based on the detection of the reasons for which the patients did not attend their thermal care sessions. Quality control was obtained from the reports of cases diagnosed by local private and public health care centers. RESULTS: The incidence of erysipela in this high risk population was 40.2 and 48.5 cases for 1000 persons per exposure-year in 1993 and 1994 respectively. The preventive strategy carried out was able to induce a reduction of 65% during the next years (p<0.01). CONCLUSION: This study confirms the high incidence of erysipela in subjects with severe venous insufficiency or lymphedema and the efficacy of an active educational preventive strategy.

["Vein School." A program of education for chronic venous insufficiency patients at the La Léchère Hotspring]. / "L'Ecole de la Veine". Un programme d'éducation pour les patients atteints d'insuffisance veineuse chronique à la station thermale de La léchère.

Chronic venous insufficiency is a frequent and invalidating condition, which also represents an important socio-economical burden. As it is a chronic disease with no effective curative therapy, the preventive and educational means are of particular interest. The present health policy insists on the education given to patients suffering from chronic disease, but contrasting with other chronic conditions (diabetes, asthma, chronic back pain), to our knowledge, there is no published structured educational training programme dedicated to people suffering from CVI. Such an educational programme was developed at the spa resort of La Léchère (Savoie, France), which is specialized in the treatment of CVI. Proposed to voluntary patients taking the waters and driven by a multidisciplinary team (doctors, nurses, pharmacists), the objective was to promote a better knowledge in venous disease by the patients and to make them adopt a more active behaviour in their treatment. Three topics were approached in interactive work-groups using a problem solving teaching technique: "anatomy and physiology of the circulatory system", "venous diseases", "practical aspects life with compression stockings". Comparison of pre and post-teaching evaluations was performed in 149 unselected patients, allowing a short-term appraisal of the knowledge improvement. It showed a 25 to 40% increase in right answers according to the tested topic. Further evaluation of long term beneficial effects is needed. However, the high interest of patients regarding this teaching method and the content of the programme provides good expectations regarding a real beneficial effect on health and quality of life.

[Chromametry, a promising technique for the quantification of skin changes in chronic venous disorders]. / La chromamétrie, une technique prometteuse pour la quantification de l'atteinte cutanée dans l'insuffisance veineuse chronique.

OBJECTIVE: The development and validation of new clinimetric tools is essential for the progress of clinical research in the field of chronic venous insufficiency. Chromametry is a simple, quick and non-invasive technique that measures the color of the skin. The aim of this study was to evaluate the ability of this technique to quantify skin pigmentation as a marker of severity of chronic venous disease and to assess the variability of measurements obtained in this condition. METHODS: Chomametry was performed on three different sites on each lower limb in 42 patients undergoing a spa treatment in La Léchère (Savoie) for chronic venous disorders (CVD). Four series of measurements were taken by two investigators for each patient, at two sessions two to four days apart. RESULTS: The chromameter readily measured the pigmentation index (PI). The PI increased with higher clinical class (CEAP classification) for measurements made at the malleolar level (r=0.48; P<0.001) and the supra-malleolar area (r=0.55; P<0.001), but not at the level of the anterior tibial tuberosity (r=-0.09; P=0.45). The repeatability and the intra- and inter-observer reproducibility of this PI index were 15%, 18% and 21% respectively of the mean of the observed difference at the malleolar level. The chromameter also provided an erythema index, which appears to be less relevant and more variable than the PI, but which might add potentially useful information regarding the characterization of skin inflammation related to the venous disease. CONCLUSION: This study shows that chromametry can be used in clinical research studies to quantify skin changes associated with CVD. Whether it can also be useful for early detection and follow-up of patients with venous trophic changes remains to be investigated.

Acceptability and practicability of elastic compression stockings in the elderly: a randomized controlled evaluation.

BACKGROUND: Compression stockings are the cornerstone of the treatment of chronic venous disorders, but practical acceptability is an important limitation in the elderly. OBJECTIVE: To evaluate the practicability of compression stockings in elderly patients. METHODS: Twenty women aged 68-85 years without major disability were asked to put on, wear for three hours and take off Solegg® and Solegg® Fine compressive stockings (15-20 mmHg) in random order on different days, and to rate through questionnaires the difficulties and discomfort they experienced in comparison with their usual non-compressive stockings (controls). RESULTS: Foot and heel insertions of the compression stockings, as well as their removal, were found significantly more difficult, whereas comfort when they were on was higher. In the whole, the compression stockings were found to be more agreeable than the controls. CONCLUSION: Difficulties regarding putting on and removal of the compression stockings remain significant but are counterbalanced by a better comfort when they are on.