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Biomedical subjects

A A Wouda

Publications and source records attributed to A A Wouda.

At least 37 records · Page 2Linked to original sources
PubMed1986

Diagnostic significance of nailfold capillary patterns in patients with Raynaud's phenomenon. An analysis of patterns discriminating patients with and without connective tissue disease.

Nailfold capillary patterns were systematically evaluated in 51 controls and 107 patients with Raynaud's phenomenon (RP) by 2 observers. Fifty patients had primary RP, 18 RP with minor signs of connective tissue disease, and 39 secondary RP (scleroderma, CREST syndrome or mixed connective tissue disease [MCTD]). Nailfolds of all 10 fingers were photographed and blindly evaluated. Qualitative and quantitative scoring of patterns was reproducible. The 4th finger showed the fewest nonevaluable photomicrographs and best distinguished primary from secondary RP. Capillary morphology in primary RP did not differ from controls. A decrease in capillary loops best distinguished primary from secondary RP. Addition of the scores for bushy patterns, extravasates, or giant loops led to better discrimination. No item allowed distinction between different connective tissue diseases. The number of enlarged loops was inversely related to the total number of capillary loops (r = 0.55; p less than 0.01).

Adult↗
PubMed1985

Effects of atenolol, labetalol and propranolol on the peripheral circulation in hypertensive patients without obstructive vascular disease.

In an observer-blind, randomised cross-over trial, in 12 patients, the effects on the peripheral circulation of antihypertensive doses of atenolol, labetalol and propranolol and placebo were compared. After a placebo period of at least 4 weeks, patients were allocated at random to one of the three active drug treatments. After active treatment for at least 6 weeks and a fall in diastolic pressure (DP) to less than 90 mmHg subjects were switched to the next medication. At the end of each period, photo-electric plethysmography (PHELP) was done on all fingers of one hand cooled over 4 min in water in steps of 3 degrees C from 33 degrees to 12 degrees C, and subsequently warmed in room air (20 degrees C) for a period of 10 min. Blood flow changes during cooling were expressed as a percentage of the initial PHELP value (% PHELP). Areas under the curves, representing the % PHELP/cooling period and % PHELP/warming-up period, showed that within the temperature range normally encountered in daily life, labetalol preserved finger blood flow significantly better than propranolol and marginally better than placebo. With atenolol, finger blood flow was not significantly different from that during the three other regimens, but there were significantly fewer other side-effects. It is concluded that labetalol may be the drug of choice for hypertensive patients treated with beta-blocking agents whose peripheral arterial circulation seems inadequate at low temperatures.

Adolescent↗
PubMed1985

Decreased nailfold capillary density in Raynaud's phenomenon: a reflection of immunologically mediated local and systemic vascular disease?

Nailfold capillary patterns were studied in 107 patients with Raynaud's phenomenon (RP), including patients wih (n = 39) and without (n = 68) connective tissue disease (CTD). Capillary density was decreased in patients with sclerodactyly, digital ulcers, tuft resorption, and telangiectasia, compared with patients without these symptoms. In addition, an inverse relationship was found between the severity of RP at first presentation (as graded by photoelectric plethysmography during cooling) and the capillary density in patients with CTD (r = -0.45; p less than 0.05). In the total group of patients nailfold capillary density was inversely related to organ system involvement (r = -0.52; p less than 0.01). Decreased nailfold capillary density was observed, in particular, in patients with oesophageal hypomotility and in patients with chest x-rays compatible with interstitial fibrosis. As to factors supposedly involved in the pathogenesis of vascular changes in CTD, the presence of autoantibodies, increased levels of circulating immune complexes, and increased levels of acute phase reactants were all associated with a decreased number of nailfold capillaries. We conclude that loss of nailfold capillaries as observed by microscopy is a reflection of local and systemic vascular disease.

Adult↗
PubMed1982

Antinuclear antibodies in patients with Raynaud's phenomenon: clinical significance of anticentromere antibodies.

Antinuclear antibodies (ANA) were detected in the sera of 73 out of 138 patients (53%) referred to us because of Raynaud's phenomenon. When ANA were found, systemic manifestations were likely to be present. The use of human fibroblast monolayers as a nuclear substrate allowed differentiation of several fluorescence patterns, including the discrete speckled variety produced by anticentromere antibodies. These antibodies were detected in the sera of 7 out of 10 patients with CRST syndrome (70%), in 7 out of 40 patients with scleroderma (18%), all without kidney-involvement, in one patient with Sjögren's syndrome and severe Raynaud's phenomenon, and in 7 patients with Raynaud's phenomenon associated with a few symptoms of a connective tissue disease (especially scleroderma). ANA testing on tissue culture monolayers in Raynaud's phenomenon appears to be of value in predicting systemic disease manifestations and the presence or possible future development of distinct clinical patterns, especially the CRST syndrome.

Adolescent↗
PubMed1981

Sublingual and oral isoxsuprine in patients with Raynaud's phenomenon.

Oral and sublingual isoxsuprine 20 mg were compared with placebo in double blind randomised cross over trial in 7 patients with Raynaud's phenomenon. Skin thermography, plethysmography of the finger tips and direct temperature measurements showed that sublingual isoxsuprine was slightly but consistently superior to the oral form and to placebo; no significant difference was observed between the latter two treatments. It is concluded that sublingual administration of isoxsuprine has advantages over their routes of administration, and that thermography is a suitable technique for qualitative, but less appropriate for quantitative, measurement of drug effects in patients with Raynaud's phenomenon.

Administration, Oral↗
PubMed1980

Systemic involvement and immunologic findings in patients presenting with Raynaud's phenomenon.

Systemic involvement and spectrum of autoantibodies were evaluated in 91 patients presenting with Raynaud's phenomenon. Decreased pulmonary diffusing capacity was observed in 23 percent, esophageal hypomotility in 14 percent and renal involvement in 5 percent of the patients, all without clinical symptoms. Arthralgia or a history of arthritis was present in 27 percent and skin abnormalities in 30 percent. Extent of systemic involvement was correlated with the severity of Raynaud's phenomenon, as measured by photoelectric plethysmography (r = 0.38; p < 0.01). In addition, both the variety of different autoantibodies in the serum of individual patients and the titer of antinuclear antibodies were positively correlated with the number of affected organ systems (r = 0.63; p < 0.01 and r = 0.65; p < 0.01, respectively). Raynaud's phenomenon is an important clinical sign of asymptomatic systemic disease. Measurements of its severity and serologic parameters are helpful in predicting the extent of systemic involvement.

Adult↗
PubMed1979

Immune complexes in peripheral blood polymorphonuclear leucocytes of patients with Raynaud's phenomenon.

Phagocytosed immune complexes in polymorphonuclear (PMN) leucocytes of sixty-nine patients with Raynaud's phenomenon were studied by scoring the cells for IgG and complement inclusions. The results were compared with the degree of vasospasm, as measured by photoelectric plethysmography of the fingers after cooling. Median IgG and complement scores of PMN cells were significantly elevated in patients with Raynaud's phenomenon when compared with those of the control group (P less than 0.01). Patients with a positive (n = 35) or a strongly positive (n = 11) plethysmographic test showed significantly higher median IgG and complement scores than those with a negative plethysmorgraphic test (n = 23). They also showed elevated IgG and complement scores in a greater proportion (89 and 100%, respectively, vs 48%).Thus, a positive relationship was shown to exist between the degree of vasospasm and the levels of phagocytosed immune complexes in circulating PMN leucocytes. In secondary Raynaud's phenomenon high levels of phagocytosed immune complexes were found. In primary Raynaud's, patients with some clinical or laboratory signs of an auto-immune disease (n = 12), who were classified as "suspected secondary", had higher IgG and complement scores than those without such signs (n = 37). This suggests that the test for immune complex detection may distinguish patients with connective tissue disease-associated Raynaud's phenomenon from those with truly primary Raynaud's, in an early stage of the disease. The clinical and patho-physiological implications of these findings with regard to the Raynaud phenomenon are discussed.

Antigen-Antibody Complex↗
PubMed1977

Raynaud's phenomenon. Photoelectric plethysmography of the fingers of persons with and without Raynaud's phenomenon during cooling and warming up.

A study has been made of the changes in the amplitudes shown on photoelectric plethysmographs of the fingers of one hand of controls (17 men and 17 women without Raynaud's phenomenon) during cooling and warming up of the hand. This is called the cooling and warming up test. The hands of the women appeared to cool more quickly than of the men, besides getting warm more quickly and remaining warm for a longer period. This difference is already apparent at the lowest water temperatures (6 and 3 degrees C) and may be ascribed to a difference in hand volume, with a hunting reaction due to extreme cold. The lowest values of controls appear to be useful for the clinical differentiation of patients with a serious Raynaud's phenomenon. The test is said to be positive when the values are below the lowest values of the controls. The test was performed on 50 of 58 out-patients suffering from Raynaud's phenomenon. In serious cases the severity of the disease could be assessed objectively. In less serious cases the test was sometimes negative.

Adult↗