ESVM guidelines - the diagnosis and management of Raynaud's phenomenon.

Regarding the clinical diagnosis of Raynaud's phenomenon and its associated conditions, investigations and treatment are substantial, and yet no international consensus has been published regarding the medical management of patients presenting with this condition. Most knowledge on this topic derives from epidemiological surveys and observational studies; few randomized studies are available, almost all relating to drug treatment, and thus these guidelines were developed as an expert consensus document to aid in the diagnosis and management of Raynaud's phenomenon. This consensus document starts with a clarification about the definition and terminology of Raynaud's phenomenon and covers the differential and aetiological diagnoses as well as the symptomatic treatment.

Spinal cord stimulation: predictive parameters of outcome in patients suffering from critical lower limb ischemia. A preliminary study.

INTRODUCTION: The aim of our study is to identify the assessment of metabolic and dynamic capillaroscopy parameters that may be predictive of the outcome of spinal cord stimulation in patients affected with non-revascularisable chronic critical limb ischemia. MATERIALS AND METHODS: Forty patients, 16 female and 24 male, average age 69 ± 8, underwent microcirculatory screening with transcutaneous oximetry and dynamic capillaroscopy. Microcirculatory assessment was performed before temporary implantation of the spinal cord stimulation stimulator and after one month. The following metabolic parameters were considered: TcPO2-TcPCO2 and with dependent limb, difference between dependent limb and supine values (Δ TcPO2, Δ TcPCO2), change in TcPO2-TcPCO2 after stimulation. Dynamic capillaroscopy parameters were recorded. Follow-up visits were scheduled at three, six, and twelve months after implantation. The procedure was performed placing an Octrode (St. Jude Medical, St. Paul, MN, USA) on the dorsal columns of the spinal cord. RESULTS: Two groups were identified on the basis of transcutaneous oximetry measurements: group A (22 patients) and group B (18 patients), responding differently to the postural test. After one month of home testing period, there was an improvement in metabolic parameters, differing from one group to the other. The morphofunctional data provided by capillaroscopy highlighted the percentage of open capillaries poststimulation as being a significant parameter, although not mentioned in previous studies. CONCLUSIONS: Spinal neuromodulation is an effective therapy option in the management of patients affected by non-reconstructable chronic critical limb ischemia.