Betty M. and the seven dwarfs: a contrapuntal, essay on Raynaud's disease.
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Two local cold provocation tests were carried out in 25 healthy volunteers and in 14 patients with Raynaud's disease, using finger systolic pressure (FSP) and digital blood flow measurements. Mean FSP was significantly lower in Raynaud's patients compared to healthy volunteers at 15 degrees C and 10 degrees C (cuff temperature). Maximal digital flow (at skin temperature of 38 degrees C) was slightly though not significantly lower in Raynaud's patients as compared to normals (27 +/- 3 versus 36 +/- 4 ml/100 ml/min). Upon cooling, statistical significance was reached starting from finger skin temperature of 24 degrees C. Overlap between the two groups was considerable but only 1 out of 13 patients with Raynaud's disease had both tests normal. Ten of the patients participated in a double-blind cross-over trial with naftidrofuryl (200 mg t.i.d.) versus placebo. Significant (p less than 0.05) subjective improvement was noted after 6 weeks with naftidrofuryl but this was not necessarily substantiated by an increased digital flow or pressure in the test situation.
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This often painful disease may be primary or secondary. Simple preventive measures sometimes provide symptomatic control. When such efforts fail, the most effective agents available are calcium channel blockers.
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In a follow-up study of 35 patients with Raynaud's disease attacks of multilocalized vascular disorders were detected in every case, which made the different etiologic definitions of this disease doubtful. We beleive, that a further improvement of our diagnostic facilities, such as pharmacoangiography, will contribute to finding-morphologic disorders in every case of Raynaud's attacks.
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OBJECTIVE: To determine the effects of local cooling on alpha-adrenergic responses in the fingers of patients with idiopathic Raynaud's disease. METHODS: Clonidine HCl and phenylephrine HCl were administered through a brachial artery catheter while blood flow was measured by plethysmography in cooled and uncooled fingers. RESULTS: Cooling potentiated alpha 2-adrenergic vasoconstriction in the patients but depressed this response in the controls. Vasoconstrictive responses to phenylephrine were not significantly affected by cooling but were significantly greater in the patients than in the controls. CONCLUSION: Cold-induced sensitization of peripheral vascular alpha 2-adrenoceptors may be involved in the mechanism by which cooling triggers the vasospastic attacks of Raynaud's disease.
Cold-induced vasodilation (CIVD or hunting reaction) was studied in eight subjects with Raynaud's disease, an idiopathic vasospastic disorder of the peripheral vasculature, and in nine normal subjects using 5, 10, 15 +/- 1 degree C water bath immersions of the right middle finger. Differences between Raynaud's and normal subjects were only marginal at 5 degrees C; at 10 degrees C, Raynaud's subjects showed a longer time to the first rise of skin temperature, had lower mean digital skin temperature, and a lower amplitude of their digital skin temperature during CIVD; at 15 degrees C, Raynaud's subjects had a longer time to first rise, lower number of CIVD cycles, and a lower recovery temperature.
Forty patients with clinically and electromyographically proven carpal tunnel syndrome were examined for the frequency of concomitantly occurring Raynaud's phenomenon. The angiologic work-up was based on a detailed vascular history and examination, Doppler sonography to determine systolic digital artery pressures before and after exposure to the cold (10 degrees 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, Raynaud'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.
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This report describes a case of necrotizing sialometaplasia (NS) in a patient diagnosed as having Buerger's disease with secondary Raynaud's phenomenon. The danger of misdiagnosing NS as a malignant lesion is emphasized. Possible causal relationships between the patient's medical condition and the lesion are discussed.