Comparison of various noninvasive techniques for evaluating deep venous thrombosis.

A series of noninvasive vascular tests was performed on groups of normal individuals (Group I) and on patients with chronic deep vein thrombophlebitis (Group II) to determine the relative specificity and sensitivity of the tests. Results indicate that the simpler tests, requiring a minimum of equipment and technique are as effective as certain of the more sophisticated procedures.

Thoracic outlet syndromes--application of microcirculation techniques and clinical review.

The thoracic outlet syndromes of the upper extremities consist of many disorders. The most important two are the costoclavicular syndrome (compression of neurovascular structures between the clavicle and the first rib) and the scalenus anticus syndrome (compression of these structures within the scalene triangle). Congenital abnormalities of the clavicle, congenital small thoracic outlet, high first rib, cervical ribs of all configurations, pectoralis minor and pectoralis major syndromes, and others may occur. The costoclavicular syndrome and scalenus anticus syndrome have been considered the most prevalent compression syndromes and are amenable to surgical or medical treatment. Quantitative measurements of the microcirculation of the fingertip were examined with the shoulders and head in various positions to provide quantitative information relative to the costoclavicular and scalenus anticus syndromes. A laser instrument was ideal for this purpose, for results were quantitative and no counterpressure was applied during the measurement. The technic applied was highly successful in separating quantitatively the normal individuals from those with either costoclavicular syndrome or scalenus anticus syndrome.

Computerized segmental plethysmography and laser flowmetry.

A new computerized plethysmograph allows segments of the vascular system to be examined accurately and automatically. Laser flowmetry allows blood flow measurements to be made of digital circulation for vascular abnormalities. With the 2 new instruments, large and small vessel circulations can be measured quickly and easily. Disease of these vessels can be readily detected. Thus, appropriate medical or surgical therapy can be investigated.

Influence of local and environmental temperatures on cutaneous circulation with use of laser Doppler flowmetry.

The purpose of this study was to determine a standard set of conditions for detecting peripheral arteriosclerosis with ischemia. One series of studies was done to determine the influence of room temperature on peripheral flow in healthy subjects and patients with peripheral vascular disease. The room temperature was varied from 30 degrees to 35 degrees C. The temperature from 24 degrees to 30 degrees C had only minor effects on the circulation. Thus, it seemed appropriate to use a room temperature in the lower range, usually 23 degrees C. Another series of studies showed the effect of changing skin temperatures locally at the finger tip or toe tip on the plantar and volar surfaces in healthy subjects and in patients with peripheral vascular disease. Results showed that as temperature was increased from 10 degrees to 45 degrees, there was a marked increase in the finger and toe circulations, which was considerably greater in the normal subjects as compared with those with digital disease. The ideal temperature at which to work as a routine is 40 degrees C as opposed to the lower temperatures, which did not separate healthy subjects from patients with peripheral vascular disease. A third experiment was done to study normal subjects and patients by using the finger circulation as control against the toe circulation when the conditions were a local skin temperature of 40 degrees C and a room temperature of 23 degrees C. A toe-finger index was established to detect abnormalities in the circulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical application of laser Doppler flowmetry for measurement of cutaneous circulation in health and disease.

The cutaneous laser Doppler device (LDF) was employed to determine its usefulness in differentiating the circulation of the feet in normal subjects from that in patients with arteriosclerosis obliterans. It is shown that the laser Doppler frequencies correlated well with results from venous occlusion plethysmography, which measured volume rate of flow. Thus, one can determine volume rate of flow by the simple Doppler method. There was a linear relationship between these two methods of measurements. Using the LDF method, it was determined that normal individuals have toe flows that on the average are 42% of finger flows in supine resting subjects. In peripheral vascular disease of the lower extremities, the LDF measurements showed a decreased circulation in the large toes when the patients are supine and the lower extremities flat. The results between health and disease are exaggerated by elevating the feet, at which time the diseased circulation falls to extremely low values compared with those of normal subjects. A similar decrease in skin oxygen tension in the diseased lower extremities was observed when the limbs were elevated.

Plethysmography: history and recent advances.

A short historical note on plethysmography is given and the development of the modern computerized pneumoplethysmograph is described. The computer-aided pneumoplethysmogram (CAP), with proper programming, makes possible numerous computations that give new, useful, and rapid information about the patient. New applications of the CAP will quickly develop and the data collected will be quickly analyzed and displayed.

The noninvasive laboratory--history and future of thermography.

A brief history of thermography and recent developments in instrumentation have been reviewed. Important applications are related to thrombophlebitis, the cerebral circulation, peripheral arterial abnormalities and medical-legal situations.

The noninvasive laboratory: history and future of thermography.

A brief history of thermography and recent developments in instrumentation have been reviewed. Important applications are related to thrombophlebitis, the cerebral circulation, peripheral arterial abnormalities and medical-legal situations.

Plethysmography: history and recent advances.

A short historical development of pneumoplethysmography and its clinical usefulness has been given and the older instruments have been compared with a modern computerized pneumoplethysmograph. The computer aided plethysmogram, with proper programming, makes possible numerous computations which give new and useful information about the circulation. New applications of the CAP will quickly develop and the data collected will be only limited by the imagination.

Velocity detection of Korotkoff sounds.

High-speed oscillograms were made showing the time relationships between the ECG and arterial pressure waves detected by three microphones successively placed beneath a standard blood pressure cuff along the brachial artery. As the cuff was deflated through the systolic/diastolic range, the indicated propagation velocity of the Korotkoff waves changed from approximately 1 m/sec near systolic pressure to about 2.5 m/sec near diastolic pressure. Non-Korotkoff waves (noise artifacts), on the other hand, were observed to propagate at much higher velocities, on the order of 5-10 m/sec. This phenomenon can be utilized to identify Korotkoff waves in the presence of other disturbances, particularly in exercise situations, and to determine diastolic pressure in the presence of arterially conducted valve and turbulence noise.

Pharmacologic effects of a nitrate coronary vasodilator on cardiac perfusion and function, measured semiquantitatively.

Peritrate (pentaerythritol tetranitrate), a nitrate coronary vasodilator, was capable of significantly increasing perfusion and function in ischemic heart muscle. The A2 image-processing computer with software developed by Burow was used to evaluate regional perfusion and segmental wall motion in six patients with ischemic areas in the myocardium. These image-processing techniques were satisfactory for evaluation of ischemic heart muscle.

Effect of coronary vasodilating drug on myocardial work.

The purpose of this paper is to show, by noninvasive measurements, previously undocumented effects on cardiac work of the nitrate coronary vasodilator Pentaerythritol Tetranitrate (Peritrate). The chew-and-swallow 40-mg tablets of this drug were given to 10 patients of type II AHA classification. The Diastolic Time Tension Index/Systolic Time Tension Index Ratio increased significantly from 1.15 (+/- 0.11 SEM) to 1.46 (+/- 0.13), p less than 0.05. The Double Product decreased significantly from 9813 (+/- 606) to 8336 (+/- 497), p less than 0.01. The Triple Product also decreased significantly from 3223 (+/- 235) to 2425 (+/- 206), p less than 0.01. The percent diastole of the R-R interval increased significantly from 65% (+/- 2.44) to 70% (+/- 1.73) p less than 0.05, while no significant change in heart rate occurred (63.2 bts/min to 62.4 bts/min). Correspondingly, there was a decrease of systolic time interval, from 0.33 second (+/- 0.2) to 0.29 second (+/- .01) p less than 0.01. A significant decrease in blood pressure was also noted. Systolic BP dropped from 155 (+/- 8.0) to 134 (+/- 7.2), p less than 0.01. Diastolic BP dropped from 89.2 (+/- 2.8) to 79.2 (+/- 2.2), p less than 0.01. This study shows that Peritrate produced significantly favorable changes in all the cited indicators of cardiac work.

Plethysmographic comparison of sublingual and intramuscular ergotamine.

The peripheral vasoconstrictive effects of ergotamine, 0.25 mg intramuscularly and 2 mg sublingually, and a sublingual placebo were compared plethysmographically in 12 normal subjects. Both forms of ergotamine induced greater reductions than placebo in venous occlusion blood flow, systolic early ejection rate, systolic midtemporal ejection rate, systolic late runoff rate before aortic valve closure, diastolic runoff rate after aortic valve closure, and maximum and secondary pulse amplitudes. There were no significant differences between the ergotamine forms. The results indicate that the peripheral vasoconstrictive effects of ergotamine are equal after 0.25 mg intramuscularly and 2 mg sublingually. The two forms at those doses should be equally effective in migraine.

Cardiac function and hemodynamic parameters after pentaerythritol tetranitrate. Assessment by new noninvasive radionuclide technique.

The availability of a relatively small computer with programming providing multiple gated acquisition capability (MUGA) permits the measurement of ejection fraction and evaluation of ventricular wall motion without the need for invasive techniques. It is probable that the various nitrates available--nitroglycerin, PETN and isosorbide dinitrate--have somewhat different hemodynamic effects and that the radionuclide technique can assist in determining these differences and may help to predict which agents might be most appropriate in specific situations.

A systems approach to the diagnosis of venous thrombosis and insufficiency.

This systems approach to the diagnosis of venous vascular obstruction and venous insufficiency relies on use of the segmental pneumoplethysmograph. The method is a useful diagnostic tool when evaluating these diseases. The drainage test indicates deep, large venous thrombosis. The dependency test indicates either thrombosis or venous insufficiency. And the tourniquet test differentiates the presence of deep from superficial vein insufficiency.

Cardiac function and hemodynamic parameters after pentaerythritol tetranitrate: assessment by a noninvasive radionuclide technique.

The availability of a relatively small computer with programming providing multiple-gated acquisition capability (MUGA) permits the measurement of ejection fraction and evaluation of ventricular wall motion without the need for invasive techniques. It is probable that the various nitrates available--nitroglycerin, PETN, and isosorbide dinitrate--have somewhat different hemodynamic effects, and that the radionuclide technique can assist in determining these differences and may help to predict which agents might be most appropriate in specific situations.

The natural course of arteriosclerosis in animals and man.

A thorough search for the natural history of arteriosclerosis involving the cerebrum, aorta, and peripheral vessels has been made. The disease's rate of progress has been studied anatomically, clinically, radiologically, and plethysmographically. We conclude that arteriosclerosis is usually associated with other diseases such as diabetes, high blood cholesterol, and hypertension. Heart disease in particular is often the cause of the patient's death, rather than the peripheral arteriosclerotic disease itself. The usually slow development and course of arteriosclerosis indicate that its treatment is largely a medical problem. It seems important to control the various risk factors and to utilize surgical therapy to attack specific lesions which threaten the tissues. A thorough cardiovascular profile of the patient should be compiled and should include a glucose tolerance test and lipoprotein phenotyping.