Orthostatic vasoconstrictor response in patients with occlusive arterial disease assessed by laser Doppler flux and transcutaneous oximetry

Compressed air massage hastens healing of the diabetic foot

BACKGROUND

The management of diabetic foot ulcers remains a problem. A treatment modality that uses compressed air massage has been developed as a supplement to standard surgical and medical treatment. Compressed air massage is thought to improve local tissue oxygenation around ulcers. The aim of this study was to determine whether the addition of compressed air massage influences the rate of healing of diabetic ulcers.

METHODS

Sixty consecutive patients with diabetes, admitted to one hospital for urgent surgical management of diabetic foot ulcers, were randomized into two groups. Both groups received standard medical and surgical management of their diabetes and ulcer. In addition, one group received 15-20 min of compressed air massage, at 1 bar pressure, daily, for 5 days a week, to the foot and the tissue around the ulcer. Healing time was calculated as the time from admission to the time of re-epithelialization.

RESULTS

Fifty-seven patients completed the trial; 28 received compressed air massage. There was no difference in the mean age, Wagner score, ulcer size, pulse status, or peripheral sensation in the two groups. The time to healing in the compressed air massage group was significantly reduced: 58.1 +/- 22.3 days (95% confidence interval: 49.5-66.6) versus 82.7 +/- 30.7 days (95% confidence interval: 70.0-94.3) (P = 0.001). No adverse effects in response to compressed air massage were noted.

CONCLUSIONS

The addition of compressed air massage to standard medical and surgical management of diabetic ulcers appears to enhance ulcer healing. Further studies with this new treatment modality are warranted.

Laser Doppler-recorded venoarteriolar reflex in Raynaud's phenomenon

The aim of the study was to assess whether Laser Doppler-recorded venoarteriolar reflex (VAR) response to hand lowering can contribute to differentiate primary from secondary Raynaud's phenomena.

MATERIALS AND METHODS

Skin fingerpulp perfusion (PU) of each hand of 60 persons was investigated: 15 healthy controls; 15 primary Raynaud's phenomenon (RP) patients; 15 patients with Raynaud's phenomenon secondary to systemic sclerosis (SSc); 15 patients with Raynaud's phenomenon secondary to vibration exposure. Blood perfusion was monitored by Laser Doppler flowmetry (LDF) as initial values and at a temperature of 32 degrees C with hands on the sternum (PUh) and in dependency (PUd). VAR indices were analyzed: delta VAR (DeltaVAR) calculated as (PUd-PUh); percent change of perfusion--[(DeltaVAR/PUh) x 100]; and vasoconstriction response--(PUd/PUh).

RESULTS

Initial mean superficial skin temperatures and perfusions in Raynaud's phenomenon groups were significantly lower compared to healthy controls but with wide overlap of the values in individual cases. Venoarteriolar indices were significantly different between secondary Raynaud's phenomenon groups and healthy controls and between secondary and primary Raynaud's phenomenon groups. Percent changes were significantly higher in control and primary RP groups compared to secondary RP groups. Vasoconstriction indices between primary and secondary RP patients (p<0.0001) and between controls and secondary RP patients (p<0.0001) also differed. A loss of venoarteriolar reflex (DeltaPU>or=0) was established in 10.0% of primary, 53.3% of sclerodermic, and 36.7% of vibration-induced Raynaud's phenomenon patients. The significantly higher prevalence rate of impaired venoarteriolar reflex in secondary Raynaud's phenomenon patients proves local vasomotor dysfunction and reflects either postganglionar sympathetic insufficiency with vascular tone failure or altered smooth muscle cells' responses.

CONCLUSIONS

Laser Doppler flowmetry is a valuable noninvasive method for investigation of the very early skin venoarteriolar dysfunctions, for evaluation of focal autonomic dysregulation and skin vasomotor abnormalities in RP patients. Laser Doppler-recorded venoarteriolar reflex testing is a simple procedure and an adequate additional diagnostic tool, which contributes to diagnose RP and differentiate primary from secondary RP.

Activity of cardiopulmonary baroreceptors, peripheral resistance and cutaneous microcirculation in patients with peripheral obstructive arterial disease

OBJECTIVES

To assess the effects of cardiopulmonary baroreceptors on the haemodynamics of the humeral and common carotid arteries in patients suffering from peripheral artery disease (PAD) and to discover whether the stimulation of these receptors modifies the cutaneous microcirculation in the forearm.

DESIGN

We studied a group of patients suffering from peripheral artery disease and two groups as controls.

SETTING

Patients were examined at the ambulatory for Vascular Research, Division of Vascular Medicine and Rehabilitation, University of Verona.

PATIENTS

We studied 15 patients with peripheral artery disease of the lower limbs at Fontaine stage II (group C), 10 free of arterial pathologies (group B) and 10 young people (group A).

MAIN OUTCOME MEASURES

We subjected the patients to passive elevation of the legs and the trunk in a horizontal position with pressure monitoring and measurement of the calibre and flow in the brachial and common carotid arteries using a colourDoppler ultrasound. We also studied the cutaneous microcirculation with laserDoppler flowmetry.

RESULTS

During the test, arterial pressure and cardiac frequency remained constant in group A, systolic pressure values showed a slight, but statistically significant increase in group B, whilst the increase in systolic pressure values at this stage was marked in group C. Diastolic pressure values and cardiac frequency remained unchanged in all groups. The calibre of the humeral artery increased in the control groups. Carotid resistance was unchanged in the three groups. Humeral resistance during the test decreased in the two control groups whilst it increased in group C. The number of perfusion units felt in the control groups; no variations in group C.

CONCLUSIONS

Our study demonstrates, in patients with peripheral artery disease, a reduction in the activity of the cardiopulmonary baroreceptors with an increase in the humeral resistance during the test and impairment of the mechanisms of cutaneous microcirculatory vasoregulation in the forearm.

Posturally induced leg vasoconstrictive responses: relationship to standing duration, impedance and volume changes

Shifting legs to a gravity-dependent position provokes a physiological vasoconstrictive response that forms the basis of several diagnostic tests based on initial (< 5 min) blood perfusion decreases. However, it is not known if responses are maintained over longer duration and if they depend on the volume shifted to the limb during the manoeuvre. These issues were investigated by measurements of blood perfusion changes on foot and ankle (laser Doppler) and below-knee volume and impedance changes induced by 30 min of standing in 10 healthy volunteers. Initial perfusion decreases were 66.4% +/- 2.6% and 49.3% +/- 3.8% for ankle and foot dorsum, respectively, and were fully maintained during sustained standing without evidence of 'vasodilator escape'. Response magnitudes were not dependent on leg volume changes using geometric or impedance measures. A close correlation (r2 = 0.78) between impedance and volume changes suggests the former as a useful way of assessing dynamic limb volume changes. Sustained vasoconstrictive responses make it unlikely that extending the duration of such tests would offer more, diagnostic information than is currently available.