Impaired skin vasomotor reflexes in patients with erythromelalgia

1999 ◽  
Vol 96 (5) ◽  
pp. 507-512 ◽  
Author(s):  
Roberta C. LITTLEFORD ◽  
Faisel KHAN ◽  
Jill J. F. BELCH
Keyword(s):  
Vascular Tone ◽  
Sympathetic Innervation ◽  
Vasoactive Agents ◽  
Doppler Flowmetry ◽  
Burning Pain ◽  
Control Subjects ◽  
Chronic Disorder ◽  
Vasoconstrictor Response ◽  
Vasomotor Reflexes ◽  
Cold Challenge

Erythromelalgia (EM) is a chronic disorder characterized by intermittent burning pain, warmth and erythema of the extremities. Increasing the local temperature and dependency of the affected limb(s) precipitates the symptoms, whereas direct cooling and elevation of the limb(s) can provide partial relief. Our previous findings showed that patients with EM have enhanced cutaneous vascular tone at rest and during stimulation, which may be due to an increase in sympathetic neural activity. To test this, we measured skin vasoconstrictor responses to contralateral arm cold challenge (CC) and inspiratory gasp (IG) using laser Doppler flowmetry at the toe pulp and fingertip. These areas were chosen because of their dense sympathetic innervation. An index of the vasoconstrictor response (between 0 and 1) was calculated from the change in skin perfusion from baseline following CC and IG. In control subjects, vasoconstrictor responses to CC at the toe and fingertip were both 0.70±0.02 (mean±S.E.M.), which were significantly greater (P < 0.001) than corresponding values in patients with EM (0.37±0.04 and 0.45±0.04 respectively). Similarly, vasoconstrictor responses to IG were significantly greater (P < 0.001) at the toe and fingertip in control subjects (0.70±0.03 and 0.70±0.02 respectively) compared with values in EM patients (0.27±0.03 and 0.45±0.15 respectively). These data show that, in contrast with control subjects, patients with EM have diminished sympathetic vasoconstrictor responses to both CC and IG. Denervation supersensitivity may play a part by increasing vasoconstrictor responses to circulating catecholamines, leading to a reduction in skin blood flow. Therefore an interplay between neural and vasoactive agents may be involved in the pathophysiology of EM.

Cutaneous vascular responses and thermoregulation in relation to age

1992 ◽  
Vol 82 (5) ◽  
pp. 521-528 ◽  
Author(s):  
F. Khan ◽  
V. A. Spence ◽  
J. J. F. Belch
Keyword(s):  
The Elderly ◽  
Elderly Group ◽  
Cold Weather ◽  
Elderly Subjects ◽  
Diabetic Patients ◽  
Doppler Flowmetry ◽  
Vasoconstrictor Response ◽  
Cold Challenge ◽  
Young Subjects ◽  
Body Cooling

1. Sympathetic vasoconstrictor responses to inspiratory gasp and contralateral arm cold challenge were assessed in fingertip skin in relation to age and were correlated with vasoconstrictor ability during body cooling. The above relationship was also examined in diabetic patients in whom vasoconstrictor responses to inspiratory gasp and contralateral arm cold challenge had been shown previously to be markedly impaired. 2. Vasoconstrictor responses to inspiratory gasp and contralateral arm cold challenge, measured by laser Doppler flowmetry, were significantly reduced in the elderly group, although individual responses varied from normal to absent, and they also had a considerably greater variability as measured on three separate occasions than seen in young subjects. Discriminant analysis showed that, from each of three occasions, 65% of vasoconstrictor responses were abnormal in the elderly group. 3. Body cooling was performed by reducing the environmental temperature from 40°C to 12°C, and the time taken for blood flow to fall to 75%, 50% and 25% of the pre-cooling level (VC75, VC50, VC25, respectively) was calculated. Vasoconstriction was rapid in young subjects and was consistent with good vasoconstrictor responses to inspiratory gasp and contralateral arm cold challenge. In the elderly group, vasoconstriction was slower, but only the VC25 value differed significantly [elderly group, 13.3(7.9–31.0) min, young group, 5.7(2.7–15.5) min; median (interquartile range); P < 0.05]. A poor vasoconstrictor response to contralateral arm cold challenge did not always correlate with an impaired response to body cooling in the elderly group, but, importantly, a diminished vasoconstrictor response to body cooling, with no spontaneous sympathetic vasoconstrictor bursts, was associated with an impaired vasoconstrictor response to contralateral arm cold challenge. Diabetic patients all had markedly reduced vasoconstrictor responses to inspiratory gasp, contralateral arm cold challenge and body cooling. 4. It is concluded that elderly subjects have diminished sympathetic vasoconstrictor responses. This may be a significant factor contributing to thermoregulatory impairment in the elderly, thereby rendering them more susceptible to the harmful effects of cold weather.

Criteria for assessing severity of oral lichen planus

MedAlliance ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 73-81
Keyword(s):  
Lichen Planus ◽  
Oral Mucosa ◽  
Severity Score ◽  
Oral Lichen Planus ◽  
Unknown Etiology ◽  
Altered Level ◽  
Doppler Flowmetry ◽  
Serum Free ◽  
Control Subjects ◽  
Oral Lichen

Introduction. Oral lichen planus (OLP) is an autoim- mune disease of unknown etiology, manifested in vari- ous clinical forms. A correlation between intensity of OLP local manifestations and severity of general disturbances predisposing to altered oral mucosa have been poorly investigated. The aim of our study was to identify criteria for assessing OLP severity score. Methods. OLP patients and control subjects (not OLP) matched by hepatobiliary disease and type IIa dyslipidemia were examined. Samples collected during the study were as- sessed by way clinical examination, gas chromatographic analysis of serum free fatty acids (FFA), oral fluid, serum and fecal microbial marker analysis by gas chromatogra- phy/mass spectrometry, laser Doppler flowmetry of the oral mucosa, immunohistochemistry staining with an- ti-CD68 monoclonal antibody specific to apolipoprotein B-100-bearing macrophages. Results. It was found that OLP patients significantly differed from control subjects in the three FFA levels (lauric acid, eicosopentaenoic/ lauric and eicosopentaenoic/linoleic ratios), displayed four pathologic factors matching the altered level of mi- crobial markers. In addition, OLP patients were found to differ in oral mucosa blood filling both inside and outside lesions paralleled with oxidative changes immediately in oral mucosa highlighted as elevated amount of apo- lipoprotein B-100-bearing CD68-positive macrophages. Conclusion. OLP severity score is an integrate parameter which reflects oxidative changes and alterations in oral mucosa microhemocirculation primarily in serum free fat- ty acid composition, altered oral and gut microbiota as well as intensity score of clinical picture.

Modulation of vascular tone in renal microcirculation by erythrocytes: role of EDRF

1993 ◽  
Vol 264 (1) ◽  
pp. H190-H195 ◽  
Author(s):  
J. D. Imig ◽  
D. Gebremedhin ◽  
D. R. Harder ◽  
R. J. Roman
Keyword(s):  
Vascular Tone ◽  
Physiological Salt Solution ◽  
Nitric Oxide Synthase Inhibitor ◽  
Renal Microcirculation ◽  
Vasoconstrictor Response ◽  
A Cell ◽  
Afferent Arterioles ◽  
Synthase Inhibitor

The effect of erythrocytes (red blood cells, RBC) on vascular tone in the renal microcirculation was examined using the juxtamedullary nephron microvascular preparation perfused in vitro with a physiological salt solution containing 5% albumin. The basal diameters of the arcuate, interlobular, proximal, and distal afferent arterioles averaged 444 +/- 24, 74 +/- 3, 29 +/- 1, and 19 +/- 1 micron, respectively, when perfused with a cell-free solution at a pressure of 80 mmHg. The diameters of the arcuate and interlobular arteries increased by 14 +/- 4 and 13 +/- 4%, respectively, whereas the diameter of the proximal and distal portions of the afferent arterioles decreased by 7 +/- 2% when perfusion pressure was elevated from 80 to 160 mmHg. The addition of RBC to the perfusate reduced the basal diameters of interlobular and afferent arterioles by 11 +/- 4 and 15 +/- 3%, respectively. The maximal vasoconstrictor response was seen after the addition of only 1% RBC to the perfusate. Removal of platelets did not block the vasoconstrictor response to addition of RBC to the perfusate. The role of endothelium-derived relaxing factor (EDRF) in the vasoconstrictor response to RBC was studied by addition of nitric oxide synthase inhibitor, N omega-nitro-L-arginine (L-NNA, 100 microM) to the perfusate. L-NNA reduced the basal diameters of interlobular and afferent arterioles by 7 +/- 3 and 9 +/- 3%, respectively, and abolished the vasoconstrictor response to RBC. L-NNA had no effect on the pressure-diameter relationships of the preglomerular vasculature when added to perfusates already containing RBC.(ABSTRACT TRUNCATED AT 250 WORDS)

scholarly journals EvidenceIn VivoShowing Increase of Baseline Nitric Oxide Generation and Impairment of Endothelium-Dependent Vasodilation in Normotensive Patients on Chronic Hemodialysis

2000 ◽  
Vol 11 (9) ◽  
pp. 1726-1734 ◽  
Author(s):  
JENS PASSAUER ◽  
ECKHART BÜSSEMAKER ◽  
URSULA RANGE ◽  
MARIA PLUG ◽  
PETER GROSS
Keyword(s):  
Nitric Oxide ◽  
Vascular Tone ◽  
Forearm Blood Flow ◽  
Matched Control ◽  
Venous Occlusion ◽  
Chronic Hemodialysis ◽  
Invasive Technique ◽  
Vascular Effects ◽  
Control Subjects ◽  
Pharmacologic Agents

Abstract.Cardiovascular mortality is excessive in hemodialyzed patients. Observations in atherosclerosis suggest that endothelial dysfunction and impaired nitric oxide (NO) may be involved. However, the relation of endothelial NO to its vascular effects has not been studied conclusively in uremia. Therefore, to study these questions an invasive technique was used in normotensive patients who were on hemodialysis (HD;n= 11) and in matched control subjects (n= 11). Pharmacologic agents were infused into the brachial artery to test the chain of events from NO generation to smooth muscle cell relaxation, measuring forearm blood flow by venous occlusion plethysmography. Glyceroltrinitrate (GTN 1:2.2 nmol/min; GTN 2:4.4; GTN 3:8.8), infused to establish the reaction of the vessel wall to defined doses of NO, caused a reduced response in HD patients (control subjects: 183 ± 20 [SEM], 246 ± 26, and 338 ± 29%; HD patients: 161 ± 7, 206 ± 12, and 262 ± 24%; baseline = 100% for each group,P= 0.032 by ANOVA). All subsequent data were corrected for this decreased response to defined doses of NO in HD patients. L-arginine (10 mg/min), given to exclude substrate deficiency of NO synthase (NOS), caused no significant changes (control subjects: 108 ± 4%; HD patients: 103 ± 4%;P= NS). Acetylcholine (ACH 1:55 nmol/min; ACH 2:110; ACH 3:220), infused to stimulate endothelial NOS, had a significantly reduced effect in HD patients (control subjects: 246 ± 32, 340 ± 40, and 465 ± 52%; HD patients: 251 ± 55, 244 ± 36, and 318 ± 50%;P= 0.002).N-monomethyl-L-arginine (LMA 1:1 μmol/min; LMA 2:2; LMA 3:4), given to block baseline NO generation, showed an enhanced response in HD patients (control subjects: 90 ± 2, 83 ± 2, and 74 ± 4%; HD patients: 84 ± 3, 73 ± 3, and 64 ± 4%;P= 0.037). Vascular response to three doses of norepinephrine (60, 120, and 240 pmol/min) was comparable in both groups, which indicated similar endothelium-independent vasoconstriction. In summary, in normotensive HD patients, (1) vasodilation to defined doses of exogenous NO was reduced, (2) there was no evidence of substrate deficiency of NOS, and (3) stimulation of NOS was impaired; however, (4) baseline NO generation was increased. It is concluded that in HD patients, the NO system has a reduced capacity to regulate vascular tone and this impairment is most significant under conditions of NOS stimulation.

PULSE-WAVEFORM AND LASER-DOPPLER INDICES FOR IDENTIFYING COLORECTAL-CANCER PATIENTS

2020 ◽  
pp. 2150005
Author(s):  
Chao-Tsung Chen ◽  
Chin-Tsing Ting ◽  
Chun-Yeh Chen ◽  
Zong-Jhe Lyu ◽  
Chien-Cheng Chen ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Blood Flow ◽  
Pulse Wave ◽  
Skin Surface ◽  
Laser Doppler ◽  
Waveform Analysis ◽  
Arterial Pulse ◽  
Doppler Flowmetry ◽  
Control Subjects ◽  
Arterial Pulse Wave

This study aimed to determine the effectiveness of using noninvasive arterial pulse-wave and laser-Doppler flowmetry (LDF) measurements to discriminate between colorectal-cancer (CC) patients and healthy control subjects. Radial-artery blood pressure waveform (BPW), finger photoplethysmography (PPG), and skin-surface LDF signals were measured noninvasively in 12 CC patients and 25 control subjects. Beat-to-beat, spectral, and variability analyses were applied to 20-minute-long recorded signals. Significant intergroup differences were found. In BPW, [Formula: see text]–[Formula: see text] amplitude indices were significantly larger while [Formula: see text]–[Formula: see text] phase-angle indices were significantly smaller in the CC patients than in the controls. The PPG and LDF variability indices were significantly larger and smaller, respectively, in CC patients. The relative energy contributions of the endothelial-, neural-, and myogenic-related frequency bands in LDF were significantly smaller in CC patients. The present findings indicate that pulse and LDF waveform analysis can be used to evaluate the arterial pulse-wave transmission condition, the responses of the blood-flow perfusion, and its regulatory activities in CC patients. There could be some similarities and differences in the present indices for different types of cancer. These findings could be utilized in the development of a rapid, noninvasive, and objective technique for evaluating the CC-induced blood-flow responses.

Reflex sympathetic dystrophy syndrome

1993 ◽  
Vol 83 (5) ◽  
pp. 276-283 ◽  
Author(s):  
LS Osher ◽  
GJ Young ◽  
AA Edwards ◽  
P Usewicz ◽  
JE Lichniak
Keyword(s):  
Soft Tissue ◽  
Bone Resorption ◽  
Motor Function ◽  
Reflex Sympathetic Dystrophy ◽  
Vascular Tone ◽  
Skin Changes ◽  
Burning Pain ◽  
Complex Disorder ◽  
Reflex Sympathetic Dystrophy Syndrome ◽  
Vasomotor Reflex

Reflex sympathetic dystrophy syndrome is a troublesome, complex disorder that presents with chronic, unexplained aching or burning pain, the intensity of which is incommensurable with the original injury. Six diagnostic criteria have been described by Genant et al: pain and tenderness in the extremities; swelling of soft tissue; diminished motor function; trophic skin changes; vasomotor instability; and patchy osteoporosis. Currently, the most widely accepted etiology is an initial vasomotor reflex spasm occurring after an injury to the extremity, followed by a loss of vascular tone, persistent vasodilation, and rapid bone resorption.

Inhibitory effect of hypertonic mannitol on vasoconstrictor and vasodilator responses of isolated coronary arteries

1978 ◽  
Vol 235 (6) ◽  
pp. H728-H735 ◽  
Author(s):  
V. S. Krishnamurty ◽  
H. R. Adams ◽  
G. H. Templeton ◽  
J. T. Willerson
Keyword(s):  
Coronary Arteries ◽  
Perfusion Pressure ◽  
Inhibitory Effect ◽  
Vasoactive Agents ◽  
Future Studies ◽  
Beta Adrenoceptor ◽  
Vasoconstrictor Response ◽  
Pressor Responses ◽  
Vascular Responsiveness

The effect of hypertonic mannitol on pressor responses to vasoactive agents was studied in isolated canine coronary arteries perfused with physiologic salt solution at a constant flow. When perfusion pressure was increased with 60 mM KCl, mannitol (50 mosM) consistently caused a decrease in perfusion pressure that lasted for at least 1 h. Withdrawal of mannitol from the perfusion media was associated with a vasoconstrictor response that was not prevented by alpha- or beta-adrenoceptor blockade or by the presence of either nitroglycerin or norepinephrine. Hypertonic mannitol also reduced the responsiveness of the isolated smooth muscle preparations to several different mechanistically unrelated vasodilator agents. The mechanism(s) responsible for the paradoxical ability of hypertonic mannitol to reduce vascular responsiveness to both vasoconstrictor and vasodilator interventions in isolated canine coronary arteries is not known, but future studies should be directed at elucidating it as well as determining whether similar phenomena occur in vivo.

scholarly journals Research of adaptation mechanisms of regulation of microcirculatory beds in patients with hemophilia

2019 ◽  
Vol 6 (3) ◽  
pp. 54-58
Author(s):  
I. L. Davydkin ◽  
Yu. A. Gergel ◽  
D. A. Kudlay ◽  
I. V. Kurtov ◽  
E. O. Danilova ◽  
...  
Keyword(s):  
Vascular Tone ◽  
Tissue Perfusion ◽  
Severe Form ◽  
Stress Factor ◽  
Control Group ◽  
Short Term ◽  
Doppler Flowmetry ◽  
Cardiovascular Pathology ◽  
Adaptation Mechanisms

Introduction. Frequent bleeding with hemophilia significantly worsens the quality of life of patients. The pathogenesis of hemorrhage in hemophilia has not been studied enough, especially at the vascular level, so it is necessary to study microcirculation in this disease. The purpose of the study is to assess the mechanisms of regulation of blood tissue perfusion and the adaptive reserves of the microcirculation system in patients with hemophilia. Materials and methods. Total microcirculation was assessed by laser Doppler flowmetry in 44 patients with hemophilia A between the ages of 14 and 20 years. Severe form of the disease was in 59 % of patients, the average – in 32 %, light – in 9 % of patients. The control group included 26 healthy men aged 14 to 19 years. The sensors recorded blood flow in the index fingers on both sides. In 20 patients with hemophilia А, an occlusion test was performed. The results of the study. In patients with hemophilia, asymmetric changes in microcirculation parameters were detected when measured in the area of the index fingers. At rest in patients with hemophilia, the prevalence of vasospasm was revealed: a decrease in the perfusion index M, an increased blood bypass due to the predominance of myogenic tone. However, neurogenic tone indicators tended to decrease. During occlusive ischemia, vasospasm is slowed down in the first seconds after the onset of exposure to the stress factor. Conclusion. The study revealed a dysregulation of the vascular tone of the microvasculature in young hemophilia patients at rest and under the influence of a stress factor in the form of short-term ischemia. Therefore, with hemophilia from a young age, control of microcirculation is necessary for the timely prevention of both bleeding and cardiovascular pathology associated with vasospasm.

scholarly journals Correlation and spectral analysis of microcirculatory changes in symmetric areas of human head in short-term hypoxic exposure

2022 ◽  
Vol 20 (4) ◽  
pp. 62-69
Author(s):  
L. V. Mezentseva ◽  
E. N. Dudnik ◽  
E. V. Nikenina ◽  
M. A. Zapara ◽  
V. G. Samartseva ◽  
...  
Keyword(s):  
Vascular Tone ◽  
Human Head ◽  
Test Method ◽  
Hypoxic Exposure ◽  
Circulation System ◽  
Short Term ◽  
Doppler Flowmetry ◽  
Left And Right ◽  
Correlation And Spectral Analysis ◽  
Areas Of Interest

Purpose. To study the effect of short-term hypoxic exposure on correlation between microcirculatory parameters (MCR) of symmetric areas of the human head. Materials and methods. MCR parameters of 10 healthy male volunteer were measured by laser Doppler flowmetry method. Short-term hypoxic exposure was produced according to the hypoxic test method using the ReOxy Cardio unit (S. A. Aimediq). We assessed the perfusion metrics left and right areas of interest, neurogenic, myogenic, respiratory and cardiac contributors to vascular tone and correlations between baseline parameters and after hypoxic exposure. Results. We revealed the specificity of regional circulation system rearranging induced by hypoxic load. The specificity is caused by functional asymmetry of correlations between different vascular tone contributors in symmetrical head areas. Strong correlation declining under the hypoxic loads between baseline perfusion on left/right was found. The perfusion changes of symmetrical temporal areas under the hypoxic loads correlate negatively with the baseline perfusion of both the same and the opposite side. Conclusion. Short-term hypoxic load rearranges the balance of different vascular tone contributors regulatory role in MCR of symmetric head areas to maintain the sustainable activity of the whole MRC.

Regulation of arteriolar tone and responses via L-arginine pathway in skeletal muscle

1992 ◽  
Vol 262 (4) ◽  
pp. H987-H992 ◽  
Author(s):  
G. Kaley ◽  
A. Koller ◽  
J. M. Rodenburg ◽  
E. J. Messina ◽  
M. S. Wolin
Keyword(s):  
Skeletal Muscle ◽  
Vascular Tone ◽  
Topical Administration ◽  
Systemic Blood Pressure ◽  
Vasoactive Agents ◽  
Skeletal Muscle Microcirculation ◽  
Arteriolar Tone ◽  
Dose Dependent ◽  
Arteriolar Diameter

With in vivo television microscopy, changes in arteriolar diameter to topical administration of various vasoactive agents were examined in the absence or in the presence of NG-monomethyl-L-arginine (L-NMMA, topical 100 microM) or NG-nitro-L-arginine (L-NNA, 2.5 microM, 20 microliters/min ia), specific inhibitors of endothelium-derived relaxing factor (EDRF) biosynthesis. In cremaster muscle arterioles (15-22 microns) of rats (n = 6-11), dilations to acetylcholine (1-100 ng) were significantly inhibited (60-70%) by either of the arginine analogues. This inhibition was reversed by subsequent administration of 1 mM L-arginine. Dose-dependent constriction to norepinephrine was enhanced by L-NMMA. Indomethacin treatment reduced arteriolar dilation to bradykinin (BK, 1-100 ng), which was significantly inhibited by additional administration of L-NNA. Application of L-NNA first, followed by additional indomethacin, elicited similar results. Dilations to sodium nitroprusside and adenosine were not reduced in the presence of the inhibitors. L-NMMA or L-NNA caused no change in systemic blood pressure but elicited a significant reduction in arteriolar diameter; this effect was not reversed by 1 mM L-arginine. These data demonstrate the presence of an L-arginine pathway to produce EDRF (nitric oxide) in skeletal muscle microcirculation that mediates and/or modulates arteriolar responses to vasoactive agents and could contribute to the regulation of basal vascular tone.

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