Angiology

Calcium dobesilate was studied in a double-blind trial in 30 normal subjects and in 30 patients with chronic venous insufficiency (CVI). There were no sig nificant alterations in the normal subjects. In patients with CVI the active drug gave significant improvements (p < 0.01) in the measured volume of the foot and lower limb, in clinical tenderness (p < 0.05), and in most of the symptoms (in cluding feelings of heaviness, swelling, tiredness, and aching in the lower ex tremities). Even though the chronic venous insufficiency had existed for an av erage of fifteen years, a relatively short course of the drug caused considerable, and significant, improvements in a number of signs and symptoms of the dis ease.

The reactions of the subpapillary venous plexus were observed by analyzed fractional blood volume of tissue (Vb) in patients with arterial occlusive dis eases, Fontaine's stage I-II, using the reflective spectrophotometer.

The sole skin of 11 normal subjects, 17 patients with arteriosclerosis obli terans (ASO), and 14 patients with thromboangiitis obliterans (TAO) were scanned by the light reflectance of four specially selected wavelengths, including isobestic points (586 and 569 nm) and peaks in the spectra of oxyhemoglobin and deoxyhemoglobin (577 and 560 nm) in referring to time. Sampling area was the subpapillary venous plexus histologically because the depth for receiving reflectance is about 1.0 mm from the sole skin surface. One series observations was divided into five steps depending on the modes of combination of the ap plied pressure to ankle cuff and tilting. The Kubelka-Munk equation was uti lized to calculate blood volume (Vb).

It is concluded that the patients with ASO might have a dysfunction, not of the subpapillary venous plexus, but of the venular valve, whereas patients with TAO might have a dysfunction of both the subpapillary venous plexus and venu lar valve.

To evaluate the effect of hypocalcemia on myocardial creatine kinase (CK) depletion after brief coronary artery occlusion and reperfusion, dogs were ren dered hypocalcemic via systemic hemodialysis for eighty minutes in the absence of Ca. Control animals were hemodialysed in the presence of Ca. The left ante rior descending coronary artery was then occluded for six minutes and reperfu sion for eighty minutes occurred at low flow of dialysate. A 50% decrease in serum Ca of the hypocalcemic animals during the eighty minutes of hemodialy sis resulted in a significant (about 35%) decrease of myocardial Ca. Comparison of the myocardial creatine kinase activity following reperfusion showed preser vation of the enzyme in the ischemic areas of the hypocalcemic animals, whereas the CK activities of the ischemic areas of the normocalcemic animals were much lower (p < 0.005). During the reperfusion period serum Ca of the hypocalcemic group increased to 75% of that of the normocalcemic group while myocardial Ca of both ischemic and nonischemic areas reequilibrated to normocalcemic values. Hemodynamic parameters during the various phases of the experiment were not altered significantly. It is concluded that transient decrease of myocar dial Ca produced by hypocalcemia prior to occlusion leads to protection against myocardial damage after brief coronary ligation.

Transcutaneous oxygen tension (TcPO₂) was measured through Clark's elec trode at the dorsum of the foot in 52 healthy controls whose ages ranged from twenty to sixty-five years (mean 45.05 ±14.09) and 36 nondiabetic patients with peripheral vascular disease (PVD) (5 stage I, 16 stage II, 4 stage III, 11 stage IV), under standardized conditions at rest and during recovery from limb ische mia obtained with pneumatic cuff compression for 3 minutes.

At rest the TcPO₂ averaged 71.20±14.26 mm Hg (range 46-92) in the con trols and 51.56±26.38 in the PVD patients (p < .01). A wide overlap was ob served between the two groups and among the different stages of the disease, and consequently, the diagnostic value of TcPO₂ at rest was limited (sensitivity equal to 32%). During the recovery from ischemia the time constant (recovery half-time, T½) averaged 38.01±7.23 sec in the controls and 55.84 ± 19.82 in the PVD patients (p < .01). The T½ added to the diagnostic value of the method, making it more sensitive (55%), especially for stage II patients. The TcPO₂ at rest was lower with increasing severity of the disease; both the TcPO₂ at rest and the T½ correlated with the ankle-arm pressure index in the diseased limbs (r = .48 and - .41 respectively, p < .001).

The method showed a limited degree of reproducibility in the controls when the right and the left lower extremity were compared in each subject; in fact, the intrasubject variance of TcPO₂ and T½ was of the same magnitude as the intersubject variance (F=1.73 and 1.26 respectively), and the standard devia tions of the difference between lower extremities was elevated (13.32 mm Hg for TcPO₂ and 7.80 sec for T½). Moreover, the T½ decreased with increasing age in the controls (r = - .47, p < .001).

The authors conclude that, although it is a good indicator of the severity of PVD, the TcPO₂ has a limited diagnostic value in this kind of patients, owing to the wide range of normalcy, to the low degree of reproducibility in a single individual, and to the influence of the age factor.

This study, using C3a, C4a, and C5a assay and crossed immunoelec trophoresis in vitro and in vivo, was designed to determine whether vascular prostheses activate the complement system. The degree of complement activa tion and the pathway of activation were also studied. The complement levels (C3, C4, CH50) in different arterial diseases were measured, and the relation ship of complement levels to serum lipids in patients with arteriosclerosis obli terans (ASO) was also investigated, in order to clarify a relationship between the complement system and arteriosclerosis or other arterial diseases.

Bovine graft, dacron, and PTFE activated the complement system in vitro. In order of the degree of complement activation, bovine graft ranked first, followed by dacron and PTFE. The patient group with acute arterial occlusion showed high C3 and C4 levels. The healthy elderly group showed higher C3 and C4 levels than the healthy persons in their twenties. In ASO patients, C3 levels correlated with serum lipid levels.

Judged from the relation of complement activation by vascular prostheses to the progression of arteriosclerotic changes, vascular prostheses should be as sessed with regard to complement activation.

Forty patients with clinically and electromyographically proven carpal tun nel syndrome were examined for the frequency of concomitantly occurring Ray naud's phenomenon. The angiologic work-up was based on a detailed vascular history and examination, Doppler sonography to determine systolic digital ar tery pressures before and after exposure to the cold (10 ° C for one minute), and thermoplate tests for recording heat convection of the hands at normal room temperature and measuring rewarming time after standardized cold exposure. Only 10% of the patients were found to have manifest Raynaud's phenomenon. The incidence was thus the same as in the general population. In addition, Ray naud's phenomenon and the carpal tunnel syndrome were poorly correlated with respect to their preliminary symptom appearances.

Consequently, the carpal tunnel syndrome can no longer be regarded as a disease underlying Raynaud's phenomenon.

The value of echocardiography in the evaluation of dizziness was studied in 151 consecutive patients. Twenty-two patients, on further review, were found to have related complaints, seizures and syncope mainly, but not dizziness. Twenty-four patients had vertigo, 67 had nonvertiginous dizziness, and in 38 patients, there was insufficient information to categorize the dizziness as being vertigo or nonvertiginous dizziness. When the 22 nondizzy patients were com pared with the 129 dizzy patients, the only statistically significant differences were that there were more blacks in the nondizzy group and that the aortic root dimension was, on average, 0.4 cm larger in the nondizzy group. These find ings, although statistically significant, appeared to be clinically insignificant. There was, however, a high prevalence of valvular heart disease in both the nondizzy and two of the three dizzy subgroups. In most cases, the valvular abnormality had not been suspected clinically. But in no case was significant information added by echocardiography that helped in patient management. Thus, in the dizzy patient, echocardiography should be reserved for specific cardiac indications and not used as a routine screening test.

The utility of upper extremity ra dionuclide venography (RNV) in the assessment of suspected catheter-re lated central venous thrombosis (CRVT) was evaluated in 40 patients with subclavian venous catheters. Twenty normal patients (Group A) served as controls and their veno graphic patterns were analyzed by using four criteria: (1) delayed tracer transit time, (2) nonuniformity of flow and venous pooling, (3) jugular venous reflux, and (4) collateral ve nous filling. Control studies dis played no collaterals as a distinguishing characteristic but demonstrated the other three fea tures to a variable degree. Of 106 ex tremities suspected of CRVT, 67 (Group B) were initially considered to have normal RNV findings (no col laterals). Contrast venography con firmed a normal pattern in 3 but identified CRVT with collaterals in 3 others. Retrospective review of the RNV studies confirmed faint collat erals in these latter 3. The 39 remain ing extremities (Group C) showed abnormal RNV findings; contrast venography and postmortem studies confirmed the presence of venous dis ease in 5 patients. The authors be lieve that RNV is a reliable, noninvasive procedure for early diag nosis of venous occlusion associated with subclavian venous catheters.

A patient with evidence of both heparin-related thrombocytopenia and coumarin-induced skin necrosis is presented. Etiology, diagnostic evaluation, histopathology, and therapeutic options are discussed.

This is the case report of a thirty-one-year-old woman who presented with a large skin lesion on a breast that was first thought to be a malignant or inflam matory process. After a biopsy, the lesion was diagnosed as nonspecific vascu litis. No similar case has been found in a review of the literature.