Reflex Sympathetic Dystrophy: Result of Autonomic Denervation?

1. To investigate the nature of sympathetic dysfunction in the pathogenesis of reflex sympathetic dystrophy, the microcirculatory vasoconstrictive responses to dependency were investigated in the skin of the hand of 76 reflex sympathetic dystrophy patients with unilateral disease by means of laser Doppler flowmetry (in perfusion units) and capillary microscopy. The patients were divided into three stages according to their perception of skin temperature (stage I in the case of a stationary warmth sensation, stage II in the case of an intermittent warmth and cold sensation, and stage III in the case of a stationary cold sensation). The vasoconstrictive responses were induced by lowering of the affected hand. 2. As compared to controls, the mainly sympathetically mediated vasoconstrictive response at thermoregulatory level of the skin microcirculation, as measured by laser Doppler flowmetry, was attenuated at stage I (1.82 versus 1.41, P < 0.05), stage II (1.82 versus 1.09, P < 0.0001) and stage III (1.82 versus 1.14, P < 0.01), suggesting the involvement of sympathetic denervation at all stages of the reflex sympathetic dystrophy syndrome. This sympathetic denervation may also account for the observed increase in thermoregulatory skin blood flow at stage I as compared to controls (152 versus 81, P < 0.01). 3. Since sympathetic denervation has been reported to cause increased sensitivity of vascular structures to catecholamines, the decrease in thermoregulatory skin blood flow at stages II (54 versus 81, P < 0.05) and III (31 versus 81, P < 0.05), both as compared to controls, may result from hypersensitivity to catecholamines of skin microvessels. 4. The sympathetically independent vasoconstrictive response at the nutritive level of skin microcirculation, as measured by capillary microscopy, was impaired only at stage III as compared to controls (1.04 versus 2.06, P < 0.05). This divergence in microvascular reactivity upon dependency of the nutritive and thermoregulatory subsystems also supports the hypothesis of sympathetic dysfunction. 5. The disturbed vasoconstrictive responses to dependency may give rise to raised capillary pressures, contributing to the formation of oedema. 6. These findings suggest that sympathetic denervation and consequent hypersensitivity to catecholamines play an important role in the pathophysiology of reflex sympathetic dystrophy.

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Low-pressure sequential compression of lower limbs enhances forearm skin blood flow

Clinical & Investigative Medicine ◽

10.25011/cim.v39i6.27488 ◽

2016 ◽

Vol 39 (6) ◽

pp. 204 ◽

Cited By ~ 1

Author(s):

Guy Amah ◽

Sebastian Voicu ◽

Philippe Bonnin ◽

Nathalie Kubis

Keyword(s):

Blood Flow ◽

Skin Blood Flow ◽

Cardiac Cycle ◽

Low Pressure ◽

Lower Limbs ◽

Test Results ◽

Skin Microcirculation ◽

Doppler Flowmetry ◽

Non Invasive ◽

Forearm Skin

Purpose: We investigated whether forearm skin blood flow could be improved when a multilayer pulsatile inflatable suit was applied at a low pressure to the lower limbs and abdomen. We hypothesized that a non-invasive purely mechanical stimulation of the lower limbs could induce remote forearm blood flow modifications. Methods: The pulsatile suit induced a sequential compartmentalized low compression (65 mmHg), which was synchronized with each diastole of the cardiac cycle with each phase evolving centripetally (lower limbs to abdomen). Modifications of the forearm skin blood flow were continuously recorded by laser Doppler flowmetry (LDF) at baseline and during the pulsatile suit application. Endothelium-dependent and endothelium-independent vasodilations of the forearm skin microcirculation were measured by LDF in response to a local transdermal iontophoretic application of acetylcholine (ACh-test) and to hyperthermia (hyperT- test). Results: Twenty-four healthy volunteers, 12 men and 12 women (43±14 years) were included in the study. LDF responses increased 1) under pulsatile suit (97±106%, p

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Responses in Skin Microcirculation to Vestibular Stimulation Before and During Motion Sickness

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100021090 ◽

1997 ◽

Vol 24 (1) ◽

pp. 53-57 ◽

Cited By ~ 7

Author(s):

Ognyan I. Kolev ◽

Claes Möller ◽

Gert Nilsson ◽

Lita Tibbling

Keyword(s):

Blood Flow ◽

Motion Sickness ◽

Skin Blood Flow ◽

Vertical Axis ◽

Vestibular Stimulation ◽

Laser Doppler ◽

Skin Microcirculation ◽

Doppler Flowmetry ◽

The Difference ◽

Axis Rotation

ABSTRACT:Background:Observation of physiological changes during motion sickness is required to quantify the degree of sickness. The review of the literature does not show unifying results. An objective symptom of motion sickness is facial pallor. It reflects changes in skin microcirculation which have not been measured so far.Methods:Eleven healthy volunteers susceptible to motion sickness were subjected to eccentric vertical axis rotation. The dynamics and the correspondence of the changes in skin blood flow in two segments, forehead and finger, were measured by laser Doppler flowmeter.Results and Conclusions:The difference in the microcirculatory skin blood flow across the phases of motion sickness is significant for the forehead but not for the fingertip; the established dynamics of the forehead blood flow during motion sickness will be of benefit in quantifying the degree of sickness; there is no correlation between the blood flow changes in both measured areas; the rhythmic blood flow fluctuation increases during motion sickness; there is a difference between the blood flow responses to vestibular stimulation before the appearance of motion sickness and in the course of the sickness. Laser Doppler flowmetry is a reliable method in quantifying the degree of motion sickness.

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Using reactive hyperemia to investigate the effect of cupping sizes of cupping therapy on skin blood flow responses

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-200120 ◽

2021 ◽

pp. 1-7

Author(s):

Xiangfeng He ◽

Xueyan Zhang ◽

Fuyuan Liao ◽

Li He ◽

Xin Xu ◽

...

Keyword(s):

Blood Flow ◽

Laser Doppler Flowmetry ◽

Skin Blood Flow ◽

Repeated Measures ◽

Recovery Time ◽

Reactive Hyperemia ◽

Cupping Therapy ◽

Doppler Flowmetry ◽

Healthy Participants ◽

Hyperemic Response

BACKGROUND: Various cupping sizes of cupping therapy have been used in managing musculoskeletal conditions; however, the effect of cupping sizes on skin blood flow (SBF) responses is largely unknown. OBJECTIVE: The objective of this study was to compare the effect of three cupping sizes of cupping therapy on SBF responses. METHODS: Laser Doppler flowmetry (LDF) was used to measure SBF on the triceps in 12 healthy participants in this repeated measures study. Three cup sizes (35, 40 and 45 mm in diameter) were blinded to the participants and were tested at -300 mmHg for 5 minutes. Reactive hyperemic response to cupping therapy was expressed as a ratio of baseline SBF. RESULTS: All three sizes of cupping cups resulted in a significant increase in peak SBF (p< 0.001). Peak SBF of the 45 mm cup (9.41 ± 1.32 times) was significantly higher than the 35 mm cup (5.62 ± 1.42 times, p< 0.05). Total SBF of the 45 mm cup ((24.33 ± 8.72) × 103 times) was significantly higher than the 35 mm cup ((8.05 ± 1.63) × 103 times, p< 0.05). Recovery time of the 45 mm cup (287.46 ± 39.54 seconds) was significantly longer than the 35 mm cup (180.12 ± 1.42 seconds, p< 0.05). CONCLUSIONS: Our results show that all three cup sizes can significantly increase SBF. The 45 mm cup is more effective in increasing SBF compared to the 35 mm cup.

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Minimal role for H1 and H2 histamine receptors in cutaneous thermal hyperemia to local heating in humans

Journal of Applied Physiology ◽

10.1152/japplphysiol.00902.2005 ◽

2006 ◽

Vol 100 (2) ◽

pp. 535-540 ◽

Cited By ~ 18

Author(s):

Brett J. Wong ◽

Sarah J. Williams ◽

Christopher T. Minson

Keyword(s):

Blood Flow ◽

Receptor Antagonist ◽

Skin Blood Flow ◽

Local Heating ◽

Histamine Receptor ◽

Receptor Activation ◽

Control Site ◽

Doppler Flowmetry ◽

Histamine Receptor Antagonist ◽

And Control

The precise mechanism(s) underlying the thermal hyperemic response to local heating of human skin are not fully understood. The purpose of this study was to investigate a potential role for H1 and H2 histamine-receptor activation in this response. Two groups of six subjects participated in two separate protocols and were instrumented with three microdialysis fibers on the ventral forearm. In both protocols, sites were randomly assigned to receive one of three treatments. In protocol 1, sites received 1) 500 μM pyrilamine maleate (H1-receptor antagonist), 2) 10 mM l-NAME to inhibit nitric oxide synthase, and 3) 500 μM pyrilamine with 10 mM NG-nitro-l-arginine methyl ester (l-NAME). In protocol 2, sites received 1) 2 mM cimetidine (H2 antagonist), 2) 10 mM l-NAME, and 3) 2 mM cimetidine with 10 mM l-NAME. A fourth site served as a control site (no microdialysis fiber). Skin sites were locally heated from a baseline of 33 to 42°C at a rate of 0.5°C/5 s, and skin blood flow was monitored using laser-Doppler flowmetry (LDF). Cutaneous vascular conductance was calculated as LDF/mean arterial pressure. To normalize skin blood flow to maximal vasodilation, microdialysis sites were perfused with 28 mM sodium nitroprusside, and control sites were heated to 43°C. In both H1 and H2 antagonist studies, no differences in initial peak or secondary plateau phase were observed between control and histamine-receptor antagonist only sites or between l-NAME and l-NAME with histamine receptor antagonist. There were no differences in nadir response between l-NAME and l-NAME with histamine-receptor antagonist. However, the nadir response in H1 antagonist sites was significantly reduced compared with control sites, but there was no effect of H2 antagonist on the nadir response. These data suggest only a modest role for H1-receptor activation in the cutaneous response to local heating as evidenced by a diminished nadir response and no role for H2-receptor activation.

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Skin blood flow responses during sleep by laser Doppler flowmetry

Psychiatry and Clinical Neurosciences ◽

10.1046/j.1440-1819.1999.00502.x ◽

1999 ◽

Vol 53 (2) ◽

pp. 117-119 ◽

Cited By ~ 1

Author(s):

Yasufumi Shiihara ◽

Akihisa Hirota ◽

Yosinari Kobayashi ◽

Toshiyuki Nakamiya ◽

Masahisa Kodama

Keyword(s):

Blood Flow ◽

Laser Doppler Flowmetry ◽

Skin Blood Flow ◽

Laser Doppler ◽

Doppler Flowmetry

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Synchronous and baroceptor-sensitive oscillations in skin microcirculation: evidence for central autonomic control

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1997.273.4.h1867 ◽

1997 ◽

Vol 273 (4) ◽

pp. H1867-H1878 ◽

Cited By ~ 30

Author(s):

Luciano Bernardi ◽

Daniel Hayoz ◽

René Wenzel ◽

Claudio Passino ◽

Alessandro Calciati ◽

...

Keyword(s):

Blood Pressure ◽

Blood Flow ◽

Skin Blood Flow ◽

Muscle Sympathetic Nerve Activity ◽

Low Frequency ◽

Doppler Flowmetry ◽

Sympathetic Modulation ◽

Baroreflex Stimulation ◽

The Relationship ◽

Spontaneous Fluctuations

To determine whether skin blood flow is local or takes part in general regulatory mechanisms, we recorded laser-Doppler flowmetry (LDF; left and right index fingers), blood pressure, muscle sympathetic nerve activity (MSNA), R-R interval, and respiration in 10 healthy volunteers and 3 subjects after sympathectomy. We evaluated 1) the synchronism of LDF fluctuations in two index fingers, 2) the relationship with autonomically mediated fluctuations in other signals, and 3) the LDF ability to respond to arterial baroreflex stimulation (by neck suction at frequencies from 0.02 to 0.20 Hz), using spectral analysis (autoregressive uni- and bivariate, time-variant algorithms). Synchronous LDF fluctuations were observed in the index fingers of healthy subjects but not in sympathectomized patients. LDF fluctuations were coherent with those obtained for blood pressure, MSNA, and R-R interval. LDF fluctuations were leading blood pressure in the low-frequency (LF; 0.1 Hz) band and lagging in the respiratory, high-frequency (HF; ∼0.25 Hz) band, suggesting passive “downstream” transmission only for HF and “upstream” transmission for LF from the microvessels. LDF fluctuations were responsive to sinusoidal neck suction up to 0.1 Hz, indicating response to sympathetic modulation. Skin blood flow thus reflects modifications determined by autonomic activity, detectable by frequency analysis of spontaneous fluctuations.

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