A New Cold Test for the Diagnosis of Raynaud's Phenomenon

Giedrius Kviecinskas1, Artūras Razbadauskas2, Rimvydas Gutauskas21 Klaipėdos jūrininkų ligoninės Chirurgijos klinika,Liepojos pl. 45, LT-5809 KlaipėdaEl paštas: [email protected] Klaipėdos universitetas,H. Manto g. 84, LT-5800 KlaipėdaKlaipėdos jūrininkų ligoninės Chirurgijos klinika,Liepojos pl. 45, LT-5809 Klaipėda Įvadas / tikslas Teigiama, kad Raynaud fenomenas būdingas apie 22% pasaulio žmonių. Moterims jis pasitaiko penkis kartus dažniau nei vyrams. Darbo tikslas – išsiaiškinti Raynaud fenomeno chirurginio gydymo ankstyvuosius rezultatus. Metodas Darbo pobūdis retrospektyvus. Nagrinėtos 1997–2003 m. Klaipėdos jūrininkų ligoninėje nuo Raynaud sindromo gydytų ligonių, kuriems buvo atliktos krūtininės simpatektomijos, ligos istorijos ir ambulatorinės kortelės. Naudojant šalčio mėginį, lyginti priešoperaciniai duomenys ir ankstyvieji krūtinės simpatektomijos rezultatai. Šalčio mėginys – tai kraujo įsotinimo deguonimi matavimas didžiajame rankos piršte, palaikius plaštaką penkias minutes +2, +3 °C temperatūros tekančiame vandenyje. Nustatant operacijos indikacijas atsižvelgta į ligos trukmę, gretutines ligas. Ligoniai tirti ieškant galimo krūtinės atvaros sindromo, taip pat jiems atlikta žvaigždinio mazgo blokada. Rezultatai 1997–2003 metais Klaipėdos jūrininkų ligoninėje 22 ligoniams atliktos 23 torakalinės simpatektomijos operacijos. Visiems jiems prieš operaciją ir antrą pooperacinę parą atliktas šalčio mėginys, siekiant įvertinti operacijos veiksmingumą. Atliekant šalčio mėginį prieš operaciją, kraujo įsotinimas deguonimi buvo neišmatuojamas ir pasiekdavo normalią ribą (95–99% SaO2) po 30–36 minučių. Antrą pooperacinę parą kraujo įsotinimas deguonimi sunormalėdavo per 1–2 minutes. Išvados Tyrimai rodo, kad chirurgiškai gydant Raynaud fenomeną, gaunami geri rezultatai ankstyvuoju pooperaciniu laikotarpiu. Prasminiai žodžiai: Raynaud fenomenas, torakalinė simpatektomija, mažai invazyvi chirurgija, saturacija The Raynaud phenomenon: early results of surgical treatment Giedrius Kviecinskas1, Artūras Razbadauskas2, Rimvydas Gutauskas2 Background / Objective The Raynaud disease phenomenon is found in about 22% of the world's population. This syndrome affects women more frequently than men. The study reports on the effectivity of thoracic sympathectomy in 1997–2003. This effectivity was valuated by a new method – oxygen saturation repair after "cold test" in the middle finger of the operated on side. Methods This work is a retrospective survey of the investigation and treatment of patients with Raynaud syndrome. We established the indications of the surgical treatment of Raynaud's phenomenon. The "cold test" was employed to observe short-term results of this treatment. The "cold test" is the measurement of O2 saturation in the middle finger of the hand after keeping it for 5 minutes in water at (+2)–(+3) C. The "cold test" was used to test patients before operation and on the second postoperative day after thoracic sympathectomy. To determine the indications of surgical treatment, we considered the concomitant diseases and the duration of Raynaud's phenomenon. The patients were investigated for the possibility of thoracic outlet syndrome. Before surgery, for all patients the ganglion stellatum blockade was performed. Results During 1997–2003, 23 sympathectomies for 22 patients were performed. All patients were tested with the "cold method" before surgery and on the second postoperative day. Before operation, O2 saturation was unmeasurable and restored till the normal range after 30–36 minutes. On the second postoperative day the saturation was unmeasurable too, but it restored to the normal range in 1–2 minutes. Conclusions The surgical treatment of Raynaud's phenomenon is effective in a short postoperative period. The "cold method" is effective for evaluating effectivity of thoracic sympathectomy. Keywords: Raynaud's phenomenon, thoracic sympathectomy, minimal invasive surgery, saturation

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A new cold test for the diagnosis of Raynaud’s phenomenon

Annals of Vascular Surgery ◽

10.1007/bf02732674 ◽

1987 ◽

Vol 1 (4) ◽

pp. 474-478

Author(s):

Michel Vayssairat ◽

Philippe Evenou ◽

Nathalie Baudot ◽

Pascal Priollet ◽

Martine Gilard

Keyword(s):

Raynaud’S Phenomenon ◽

Cold Test ◽

Raynaud's Phenomenon

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Intra-arterial administration of reserpine. Its use in patients with Raynaud's disease or Raynaud's phenomenon

Archives of Internal Medicine ◽

10.1001/archinte.125.5.825 ◽

1970 ◽

Vol 125 (5) ◽

pp. 825-829 ◽

Cited By ~ 6

Author(s):

S. G. Romeo

Keyword(s):

Raynaud’S Phenomenon ◽

Raynaud's Phenomenon ◽

Raynaud's Disease ◽

Raynaud’S Disease

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Ascorbic Acid does not Improve Endothelium-Dependent Flow-mediated Dilatation of the Brachial Artery in Patients with Raynaud’s Phenomenon Secondary to Systemic Sclerosis

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831.73.1.3 ◽

2003 ◽

Vol 73 (1) ◽

pp. 3-7 ◽

Cited By ~ 22

Author(s):

M. E. Mavrikakis ◽

J. P. Lekakis ◽

M. Papamichael ◽

K. S. Stamatelopoulos ◽

Ch. C. Kostopoulos ◽

...

Keyword(s):

Ascorbic Acid ◽

Smooth Muscle ◽

Systemic Sclerosis ◽

Endothelial Dysfunction ◽

Brachial Artery ◽

Raynaud’S Phenomenon ◽

Raynaud's Phenomenon ◽

Water Soluble ◽

Placebo Administration ◽

Flow Mediated Dilatation

Previous studies have shown that patients with Raynaud’s phenomenon secondary to systemic sclerosis present abnormal endothelial function; the mechanisms responsible for the endothelial dysfunction are unknown but increased vascular oxidative stress could be a possible cause. The hypothesis that a potent water-soluble antioxidant can reverse endothelial dysfunction in these patients was tested in the present study. We examined 11 female patients with Raynaud’s phenomenon secondary to systemic sclerosis and ten healthy control women by ultrasound imaging of the brachial artery to assess flow-mediated (endothelium-dependent) and nitrate-induced (endothelium-independent) vasodilatation. Flow-mediated dilatation and nitrate-induced dilatation were significantly reduced in patients with Raynaud’s phenomenon, indicating abnormal endothelial and smooth muscle cell function. Patients with Raynaud’s phenomenon entered a double-blind, randomized, crossover placebo-controlled trial and received orally 2 g of ascorbic acid or placebo; vascular studies were repeated two hours after ascorbic acid or placebo administration. Flow-mediated dilatation did not improve after ascorbic acid (1.6 ± 2.2% to 2.2 ± 2.5%, ns) or placebo administration (1.2 ± 1,9% to 1.7 ± 1.4%, ns); also nitrate-induced dilatation was similar after ascorbic acid or placebo (16 ± 7.4% vs 17 ± 8%, ns), suggesting no effect of ascorbic acid on endothelial and vascular smooth muscle function. In conclusion, ascorbic acid does not reverse endothelial vasomotor dysfunction in the brachial circulation of patients with Raynaud’s phenomenon secondary to systemic sclerosis. The use of different antioxidants or different dosing of ascorbic acid may be required to show a beneficial effect on endothelial vasodilator function.

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The response of skin perfusion and of rheological and immunological variables to intravenous prostanoid administration in Raynaud’s phenomenon secondary to collagenosis

VASA ◽

10.1024/0301-1526.34.4.243 ◽

2005 ◽

Vol 34 (4) ◽

pp. 243-249 ◽

Cited By ~ 2

Author(s):

Drinda ◽

Neumann ◽

Pöhlmann ◽

Vogelsang ◽

Stein ◽

...

Keyword(s):

Laser Doppler Flowmetry ◽

Raynaud’S Phenomenon ◽

Raynaud's Phenomenon ◽

Plasma Viscosity ◽

Laser Doppler ◽

Erythrocyte Aggregation ◽

Control Group ◽

Long Term Effects ◽

Doppler Flowmetry

Background: Prostanoids are used in the treatment of Raynaud’s phenomenon and acral perfusion disorders secondary to collagenosis. In subjective terms, intravenous administration of these agents produces success in more than 50% of patients. The therapeutic outcome of clinical administration of alprostadil or iloprost may vary from individual to individual. Patients and methods: The following variables were analysed in a cross-over study in 27 patients with collagenosis and Raynaud’s phenomenon: plasma viscosity and erythrocyte aggregation (rheological variables), partial pressure of oxygen and laser Doppler flowmetry in the finger region, and lymphocyte phenotyping and interleukin (IL) determinations (immunological variables). Results: Laser Doppler flowmetry revealed significant differences between patients with secondary Raynaud’s phenomenon and a control group of 25 healthy subjects. Laser Doppler readings did not change significantly as a result of the treatments. Therapy with iloprost produced a reduction in IL-1beta, L-selectin (CD 62 L) and IL-6. Conclusion: The change in immunological variables due to iloprost may explain the long-term effects of prostaglandins in the treatment of Raynaud’s phenomenon. From our results it is not possible to infer any preference for iloprost or alprostadil.

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Raynaud’s phenomenon and digital ischaemia - pharmacologic approach and alternative treatment options

VASA ◽

10.1024/0301-1526/a000526 ◽

2016 ◽

Vol 45 (3) ◽

pp. 201-212 ◽

Cited By ~ 13

Author(s):

Birgit Linnemann ◽

Matthias Erbe

Keyword(s):

Quality Of Life ◽

Angiotensin Receptor Blockers ◽

Raynaud’S Phenomenon ◽

Treatment Options ◽

Raynaud's Phenomenon ◽

Tissue Loss ◽

Receptor Antagonists ◽

Skin Ulcers ◽

Digital Ischaemia

Abstract. The primary goal of therapy is to reduce the frequency and intensity of Raynaud’s attacks and to minimize the related morbidity rather than to cure the underlying condition. Treatment strategies depend on whether Raynaud’s phenomenon (RP) is primary or secondary. All patients should be instructed about general measures to maintain body warmth and to avoid triggers of RP attacks. Pharmacologic intervention can be useful for patients with severe and frequent RP episodes that impair the patient’s quality of life. Calcium channel blockers are currently the most prescribed and studied medications for this purpose. There has been limited evidence for the efficacy of alpha-1-adrenergic receptor antagonists, angiotensin receptor blockers, topical nitrates or fluoxetine to treat RP. The intravenously administered prostacyclin analogue iloprost can reduce the frequency and severity of RP attacks and is considered a second-line therapy in patients with markedly impaired quality of life, critical digital ischaemia and skin ulcers who are at risk for substantial tissue loss and amputation. Phosphodiesterase inhibitors (e.g., sildenafil) can also improve RP symptoms and ulcer healing whereas endothelin-1 receptor antagonists (e.g., bosentan) are mainly considered treatment options in secondary prevention for patients with digital skin ulcers related to systemic sclerosis. However, their use in clinical practice has been limited by their high cost. Antiplatelet therapy with low-dose aspirin is recommended for all patients who suffer from secondary RP due to ischaemia caused by structural vessel damage. Anticoagulant therapy can be considered during the acute phase of digital ischaemia in patients with suspected vascular occlusive disease attributed to the occurrence of new thromboses. In patients with critical digital ischaemia, consideration should be given to hospitalisation, optimisation of medical treatment in accordance with the underlying disease and evaluation for a secondary, possibly reversible process that is causing or aggravating the clinical symptoms.

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