Nailfold capillaroscopy and laser Doppler flowmetry during standardised cold challenge to evaluate capillary pattern and digital flow in idiopathic acrocyanosis.

Quantitative correlation between capillary morphologic patterns and digital pulp flow in idiopathic acrocyanosis (IA) is as yet unexplained. We studied capillary pattern, scored according mainly to capillary dilatation and tortuosity. Digital flow was recorded by laser Doppler flowmetry during a standardised cooling and rewarming thermal challenge in a controlled thermostatic chamber. A negative correlation was found by linear regression analysis between increasing capillary abnormalities and decreasing flow rates both at rest and during cooling, while a positive correlation was observed among the presence and intensity of the flow stop reaction during cold challenge and the decrease of hyperaemic re-flow in the rewarming phase. Further investigations may be justified to assess the nature of these abnormalities, whether constitutional or induced by prolonged cold exposure. For this purpose, a standardised method, as the cooling-rewarming challenge, could verify the several pathophysiological hypotheses proposed for vascular acrosyndromes. We need to use a subjective method such as capillaroscopy-based scoring (as in our study endorsed by an objective technique) to acquire the necessary reliability and reproducibility in the functional diagnosis. In fact IA patients with lower morphologic scores show better flow properties.

[Association between carotid lesions evaluated by Doppler color echocardiography and cardiovascular risk factors in the elderly. Preliminary results]. / Associazione tra lesioni carotidee valutate mediante eco color-Doppler e fattori di rischio cardiovascolari, in una casistica di soggetti in età geriatrica. Risultati preliminari.

BACKGROUND: The valuation of the extracranial carotid by echo color-Doppler takes on an extraordinary importance for the prevention of cerebral ictus at geriatric age. In this "naturalistic" study a population of old people (> 65 yrs) of Cagliari's province was considered in order to: 1) discriminate the lesions of the carotid that are imputed to atherosclerotic disease by anatomic changes of the arterial wall caused by aging; 2) study relations between lesions of the carotid and cardiovascular risk factors. METHODS: The carotids of 50 old subjects were studied by echo color-Doppler and the lesion classified in different classes of severity, according to the hemodynamic standard, comparing them with the presence of the most important cardiovascular risk factors. Hypercholesterolemia was the most frequent risk factor (76%), followed by hypertension (62%), over-weight (54%) and smoking (42%). Moreover a diffused intima-media thickening (IMT) was constant in all the subjects with values > 0.75 mm; athero-sclerotic plaques were even present in 39 subjects which only in 4 cases could be considered at risk of cerebral ischemia. RESULTS: A significant correlation between the severity of the lesions and levels of total cholesterol and LDL cholesterol for the male sex emerged, while for smoking only a trend of correlation has been obtained. CONCLUSIONS: Considering this experience it is suggested that in old subjects the presence of a diffused IMT with values > 0.75 mm must be considered as a marker of aging of the arterial wall of the carotid and not as a cardiovascular risk factor as reported in the literature for the middleaged.

Prevalence of peripheral arterial occlusive disease and associated risk factors in a sample of southern Sardinian population.

We studied a sample of adult population over 20 years old of Donori (totally 2049 inhabitants), a small town near Cagliari, South Sardinia, to: (1) Evaluate the prevalence of peripheral arterial occlusive disease of lower limbs (PAOD) diagnosed by standard questionnaire and US CW Doppler examination and associated risk factors in South Sardinia. (2) Compare the reliability of these two diagnostic methods. Our study included the answers to a standard anamnestic questionnaire (according to the WHO recommendations), physical examination and CW Doppler study of the lower limb arteries, the determination of the arterial systolic and diastolic pressure, ankle/arm pressure ratio, Body Mass Index, blood glucose, total and HDL-cholesterol, triglycerides and fibrinogen (the hematochemical examination only on 50% of the sample). The surveyed sample was of 577 subjects (37.96% of 1520, the eligible subjects over 20 years old), 237 males and 340 females. An arteriopathy was diagnosed by means of CW Doppler in 27 subjects, 20 M and 7 F. The overall prevalence of PAOD was 4.67% of the sample (2.06% of females, 8.43% of males). Prevalence steadily increased with age, and, surprisingly, the disease was not absent in young people (2 cases within males with age < or = 40 years). Conversely only 18.5% of PAOD patients were symptomatic. The overall prevalence of associated risk factors was: diabetes 3.6%, hypercholesterolaemia 59.1%, smoking 21.3%, arterial hypertension 21.6%, obesity 17.9%, hypertriglyceridaemia 9.3%, hyperfibrinogenaemia 4.67%. Among the males a significant correlation has been found, among the values of BMI vs age and total cholesterol, age vs total cholesterol, systolic blood pressure, diastolic pressure, fibrinogenaemia. Among the females, the systolic and diastolic pressure, BMI, total cholesterol, LDL-cholesterol, triglycerides and fibrinogen are significantly correlated with age; BMI correlates with systolic and diastolic blood pressure, fibrinogen; a nearly significant correlation has been found between BMI and triglycerides.

[Relation between changes in the microcirculation in the capillaries supplying the toenails and the degree of chronic venous insufficiency]. / Le alterazioni del microcircolo nutritizio della plica ungueale dei piedi sono correlate al grado dell'insufficienza venosa cronica.

Chronic venous insufficiency (CVI) is characterised by stasis which may lead to an imbalance in the cutaneous microcirculation resulting in a wide spectrum of complications. The use of capillaroscopy on the toenail folds of patients with CVI allows the morphological and microhemorrheological aspects of microcirculatory disorders to be studied. The aim of this study was to clarify the correlation between the extent of abnormalities of the nutritional capillary and the degree of severity of CVI according to Widmer's classification. Capillaroscopy of the toenail fold was used to study 100 patients suffering from essential varicose disease (EVD) and post-thrombotic syndrome (PTS) with CVI of various degrees, giving a total of 110 limbs grouped as follows: 30 limbs at stage 0; 49 at stage 1; 20 at stage 2 and 12 at stage 3. In addition, a further 30 limbs of normal subject without a family history of varicose disease were included in the study. All patients and control subjects were examined clinically and using ultrasound c.w. Doppler and eco-color-Doppler of the lower limbs. The results highlighted a progressive deterioration of the capillaroscopic conditions in relation to the severity of CVI. In particular, during stage 1 microcirculatory alterations found in patients with primary varicose syndromes appeared to be more severe than those with PTS. This apparent contradiction may be attributed to the unique topography of this hemodynamic disorders since the subpapillary circulation in EVD is topographically in direct continuity with the site of venous hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

Correlations among capillaroscopic abnormalities, digital flow and immunologic findings in patients with isolated Raynaud's phenomenon. Can laser Doppler flowmetry help identify a secondary Raynaud phenomenon?

Thirty subjects with a diagnosis of isolated Raynaud's phenomenon, according to anamnestic and objective criteria, were cross-evaluated by various methods: laser Doppler flowmetry (LDF) during a standardized cold and rewarming test, nailfold capillaroscopy, immunological and other laboratory parameters, to assess the diagnostic and prognostic significance of each method. Correlations were also assessed among disease duration, capillaroscopic pattern score, quantitative digital flow values and laboratory parameters. Nearly 30% of patients showed immunologic abnormalities (ANA positivity at variable titres, ENA, hypocomplementemia, immunocomplexes); 16% of patients had a pathologic capillaroscopic pattern, not well correlated with immunologic findings; a characteristic cold stop reaction of digital flow (partial or total) was detected in 86% of the subjects; in ANA+ pts., ANA titers were positively correlated with the intensity and length of stop reaction (Trec). A significant correlation between digital flow parameters and the capillaroscopic score was also found in each considered group. Our results outline the relevance of LDF, during a standardized thermic test, to evaluate apparently primary RP, because even if a definite scleroderma-like capillaroscopic pattern is absent, this flowmetric method may detect potentially secondary RP patients.

[Laser Doppler flowmetry. Principles and clinical applications in vascular acro-syndromes]. / La flussimetria Doppler laser. Principi ed applicazioni cliniche nelle acrosindromi vascolari.

Twenty-seven subjects with vasospastic diseases: 13 primary and 5 secondary Raynaud phenomenon (RP), 3 primary RP treated with raubasin 60 mg/day, 6 acrocyanosis and 9 normal subjects were studied in a standardized experimental set (thermostatic chamber), recording cutaneous digital micro-vascular reactions to cold and heat exposure by laser Doppler flowmetry, a relatively new method for the objective and reliable assessment of blood flow in the cutaneous microvasculature. The data suggest that patients with vasospastic disease have a defect in local microvascular flow regulation, that is revealed by low temperature exposure. The major difference between primary and secondary RF was recovery time (stop reaction) after cold test, that is easily recorded by this instrumental set. The morphology of the recording and the flow recovery time of acrocyanosis were found to be similar to those of secondary RF.