[On several cases of unstable homophasic left branch block].
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Biomedical subjects
Publications and source records attributed to A Taccola.
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334 subjects all with anamnesis indicating a vascular acrosyndrome (mostly due to their working conditions) were studied using the pulsoplethysmographic method to evaluate whether a relationship exists between the absence of increases to physiological acral posture and the presence of Raynaud's disease successively induced by Cold Test. The results obtained showed marked correlation (which for some of the subgroups examined was also statistically significant) between the lack of postural regolation and abnormal or frankly phatological plethysmographic findings following the Cold Test. The results appeared to be of some relevance in the physiopathologic interpretation of vascular acrosyndromes. According to the authors, the findings constitutive further proof of the reole played by changes in the "balance of vessel motility" in maintaining district circulatory homeostasis and may indicate the prevalence of vasoconstriction over endotelially mediated vasodilation. Consequently, the adoption of a routine test to evaluate postural sphygmic changes, before the traditional Cold Test, would allow more precise diagnosis and prognosis, particularly in the area of professional angiopathies.
This paper presents a study of plethysmographic changes induced by methacholine (a derivative of acetylcholine) administered via iontophoresis in a population of 41 young women with apparently primary Raynaud's disease. All patients presented with a very clear statistically significant sphygmic increment, obviously connected with the vasodilatation caused by methacholine. Moreover, in nearly half of the 23 cases whose reaction to passive postural variations was successively examined by plethysmography, the district circulatory response was characterised by persistent neurogenous vasoconstriction due to methacholine or by inadequate vasomotor EDRF mediated modulation. The authors believe that their findings serve as further evidence of the pathogenetic mechanisms of Raynaud's disease. This is because they highlight the role played by "balance of vessel motility" which would guarantee district circulatory homeostasis. Concrete proof thus corroborates well known indirect evidence that a pathological vasospasm can be triggered and persist when two fundamental conditions are met: a) intense vasoconstriction initially of neurological origin and successively reinforced by biohumoural synergic stimuli; b) the breakdown of the capacity for EDRF mediated intrinsic vasomotor modulation. It is suggested that the prevalence of one or the other factor would lead to a variety of clinical pictures denoting vascular acrosyndromes of this type. The ability to single out such clinical pictures by adding the iontophoresis test with methacholine to routine screening procedures for the presence of Raynaud's disease, would allow physicians to make more accurate diagnosis and improve therapy.
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UNLABELLED: In 34 subjects (29 subjects vibrations exposed and 5 controls), the variations of seric levels of endothelin (Et) after Cold Test were investigated, while vasomotor modifications were monitored and recorded by forefinger volumetric pulsoplethismography. Blood sampling for Et dosage (from dorsal vein of the hand) was done in 17 subjects after 2' Cold Test and in 17 subjects after 5' Cold Test. RESULTS: 1) Et levels are always increased after Cold Test but level increase is statistically significant only after 5' Cold Test. 2) There is no evidence of relations between Et level increase and pulsoplethismographic alterations showing acral vasospasm. It is evident that in Raynaud phenomenon Et increase is not the only factor but takes part in the occurring of this acrosyndrome. When endothelium has a reduced activity opposing cold induced vasoconstriction, seric Et increased level may represent a biohumoral factor enhancing entity and duration of vasospasm.
In a phase IV study with clotiazepam 9 cardiologists were involved to treat 86 patients (52 female, 32 male, mean age 51 years) effected by cardiovascular diseases and anxiety. The dosage was 5-10 mg TID, and the treatment lasted for 3 weeks. Variations of the dosage were requested in 21% of patients and generally at the 2nd week of treatment. The safety of clotiazepam was good: only in the 14% of patients side-effects were observed (especially drowsiness 9.3% and asthenia 2.3%). Clotiazepam was judged to be effective in 75% of patients. The Hamilton psychiatric rating scale for anxiety showed a progressive decrease both of the total score and of the scores of every item; the cardiovascular symptoms particularly improved at both the controls.
A study was made on a group of workers occupationally exposed to tools producing medium-to-low frequency vibrations, and on a comparable control group. The subjects underwent a plethysmographic examination with the cold test, which revealed a greater number of sphygmic alterations in the exposed group; at the same time spontaneous platelet aggregation, blood levels of 6-K-PGF-1 alpha and TXB2 and urinary levels of BTGU were determined in basal conditions and after the cold test. Except for the slight, and not statistically significant, increase in TXB2, the results did not reveal any alterations in the constituents of the prostaglandin balance after the cold test. This therefore indicates that biohumoral changes of this type were not involved in producing cold-induced vasomotor alterations in the group under study. However, further investigations are recommended which will take account of the age and working history of the subjects, and particularly of the physical characteristics of the vibrations produced by the tools used, especially the Hz number.
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After briefly recalling the professional pathology characteristics of workers exposed to nitro derivatives and the perplexities surrounding the actual pathogenetic mechanism of the "Withdrawal hazard", the AA report the results of an investigation carried out among the workers of a dynamite producing plant. In the study, the NG and EGDN environmental levels were checked and the workers were submitted to ECG tracings, ECG D according to Holter, and monitoring of postural pressure changes both during exposure to the substances and during time-outs. The results obtained showed that the concentrations found in the plant were practically within the recommended TLV values, with no pathological modifications of the parameters examined. The AA put forward a pathogenetic hypothesis based on these findings and analyzing epidemiologic data on coronary sudden death as well as the mechanisms regarded as responsible for the disorders described in the literature in professionally exposed subjects. According to such hypothesis, the "Withdrawal hazard" (if any) would not be due to the cessation of the vasodilation effect of the nitro derivatives but would be a "rebound" phenomenon following the NG - and EGDN - inhalation induced stimulation to the production of endothelial prostaglandins, and of EDRF in particular, in exposed workers. The withdrawal of nitro derivatives inhalation would thus eliminate a vascular and coronary protection mechanism in the case of pathogenetic noxae at cardiovascular level. Such an interpretation would at last account for the time elapsing between cessation of work and occurrence of the disorders, which would not be justified by the cessation of the mere vasodilating action, since this wears out within a few hours.(ABSTRACT TRUNCATED AT 250 WORDS)
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The diagnostic utility of digital volumetric pulse plethysmography with the cold test in well known for the study of subjects vibrations exposed and symptomatic for acrosyndrome. In this study the authors show how to perform this test and how to analyse the results quantitatively (in particular the time-course of the vascular modifications during cold test) to improve the clinical interpretation and to allow a comparison during the years. The parameters studied are: the morphologic pattern of each wave; the entity, duration and the regression pattern of the modifications after cold test; the existence of hemorrheologic predisposing conditions to vasospasm. To each of these parameters it has attributed a score and all the scores together represent the sphygmic answer to the cold test.
Alterations of the microcirculation are, at our latitudes, the most common distal manifestations of the hand-arm syndrome, and of a number of other work-related diseases. Diagnostic investigations aimed at providing documentary evidence for microvascular damage or disfunction are, therefore, of particular importance. This paper discusses the currently available diagnostic approaches for professional acrosyndromes. The biohumoral alterations associated with cold-induced angiospasm are also described, but their diagnostic utilization is not recommended. The technical aspects of the "cold tests", as well as its advantages and drawbacks, are finally presented. On the basis of a personal experience with over 4.500 subjects, the authors conclude that, in the field of prevention, digital volumetric pulse plethysmography in association with the "cold test" should be adopted to evaluate the worker fitness for specific tasks.