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PubMed2004

Thoracoscopic sympathectomy in the management of vasomotor disturbances and complex regional pain syndrome of the hand.

Complex regional pain syndrome, vasospastic disorders, and hyperhidrosis are chronic and debilitating upper extremity problems. Twenty-nine consecutive patients treated with thoracoscopic sympathectomy are presented. Diagnoses included complex regional pain syndrome, hyperhidrosis, Buerger's disease, Raynaud's disease, and peripheral vascular disease. All patients with hyperhidrosis had complete symptom resolution. Patients with Buerger's and Raynaud's disease had excellent/good results. Six patients with complex regional pain syndrome had excellent or good relief; the remaining six patients had varying degrees of recurrence. A statistically significant association was noted between duration of complex regional pain syndrome prior to sympathectomy and outcome. Thoracoscopic sympathectomy is an effective treatment for hyperhidrosis and vasospastic disorders. Although the results for complex regional pain syndrome are not uniformly excellent, this technique offers promise in the treatment of this difficult problem.

Adolescent↗
PubMed2005

Contribution of prostanoids to endothelium-dependent vasodilatation in the digital circulation of women with primary Raynaud's disease.

In 15 women with PR (primary Raynaud's) disease and in 15 matched control women, ACh (acetylcholine) was delivered by iontophoresis to the dorsum of the finger (seven 20 s pulses of 0.1 mA, followed by one 20 s pulse of 0.2 mA, applied at 60 s intervals). Cutaneous RCF (red cell flux) was recorded from the same site by the laser Doppler technique. ACh evoked progressive increases in RCF that were comparable in pre- and post-menopausal women with PR [maxima of 294+/-113 and 259+/-59 pu (perfusion units) respectively, n = 7 and 8 respectively], and in pre-menopausal controls (225+/-92 pu, n = 7), but smaller in post-menopausal controls (140+/-63 pu, n = 8; P < 0.05). Aspirin (600 mg, orally), a COX (cyclo-oxygenase) inhibitor, potentiated the ACh-evoked dilator responses in pre- and post-menopausal women with PR (343+/-129 and 311+/-48 pu respectively) and post-menopausal controls (277+/-124 pu; P < 0.05), but had no effect in pre-menopausal controls (225+/-92 pu). These results suggest that vasoconstrictor COX products limit ACh-evoked endothelium-dependent cutaneous dilatation in the digits in pre- and post-menopausal women with PR and in post-menopausal, but not pre-menopausal, control women. We propose that PR disease is associated with abnormality in the ability of oestrogen to modulate the synthesis of endothelium-dependent vasodilator and/or vasoconstrictor COX products.

Acetylcholine↗
PubMed1999

Cardiovascular responses evoked by mild cool stimuli in primary Raynaud's disease: the role of endothelin.

In control subjects and in subjects with primary Raynaud's disease, sudden sound evokes the pattern of the alerting response, which includes cutaneous vasoconstriction and vasodilatation in forearm muscle. However, whereas this pattern of response habituates on repetition of the sound stimulus in control subjects, both cutaneous vasoconstriction and muscle dilatation persist in subjects with primary Raynaud's disease. The aim of the present study was to test whether a similar disparity exists between control subjects and those with primary Raynaud's disease for the response to mild cool stimuli, and whether the cutaneous response is accompanied by the release of endothelin-1 (ET-1). In nine subjects with primary Raynaud's disease and in nine matched controls, the left hand was placed in cool water at 16 degrees C for 2 min five times on each of three experimental sessions on days 1, 3 and 5, with blood being taken from the venous drainage of the cooled hand before and at the end of the second session. In response to the first cool stimulus in Session 1, the subjects with primary Raynaud's disease showed a decrease in digital cutaneous vascular conductance (DCVC) in both the right and left hands, as indicated by a laser Doppler recording of erythrocyte (red cell) flux divided by arterial pressure, and six of the nine subjects showed an increase in forearm vascular conductance (FVC), as indicated by forearm blood flow measured by plethysmography divided by arterial pressure. On repetition of the stimulus in Session 1, there was no change in the magnitude of the increase in FVC, but the evoked decreases in DCVC became more prolonged in both the right and the left hand. Similar responses occurred in Sessions 2 and 3; in Session 2, the ET-1 concentration increased from a baseline value of 2.15+/-0.26 fM to 2.72+/-0.37 fM after five stimuli. There was no habituation of the increase in FVC over Sessions 1, 2 and 3, judging from the mean changes in each session. Control subjects also showed a decrease in DCVC in both hands, and in eight out of nine subjects there was an increase in FVC in response to the first cool stimulus in Session 1. However, on repetition of the stimulus in Session 1, the increase in FVC habituated, while there was no prolongation of the decrease in DCVC; in addition, the ET-1 concentration did not change in Session 2 in response to the stimulus (2.07+/-0.28 compared with 2.29+/-0.30 fM). Further, the increase in FVC habituated over the three sessions, such that there was a mean decrease in FVC in Session 3. These results indicate that, in subjects with primary Raynaud's disease, there is impairment of the ability of the central nervous system to allow habituation of the cardiovascular components of the alerting response evoked by mild cooling, as with the response to sound. We propose that persistence of the cutaneous vasoconstriction of the alerting response, coupled with increased release of ET-1 secondary to vasoconstriction, prolongs such vasoconstriction and eventually leads to vasospasm.

Adult↗
PubMed1989

[Results of electrostimulation of the spinal cord in Raynaud's disease and syndrome].

Out of 1,048 Raynaud patients followed for 10 years, only 7.48% underwent surgery. This fact also results from the recent utilization of high-level epidural spinal stimulation, which we perform first, before surgery, in all "critical" Raynaud patients. We treated 40 Raynaud patients with SCS and the results were always positive: excellent in 18, good in 6 and moderate in 6. Various modes of stimulation were used (continuous, intermittent, cyclical). The results were found to be better in Raynaud's disease, and to depend on the level of stimulation (excellent at T1), and on duration of the disease (clinical history of less than five years). Regular monitoring was carried out both clinically and with noninvasive and hemorheological tests. SCS appears to act like cervicothoracic surgical sympathectomy, but in contrast to the latter, it does not inhibit perspiration. Its mechanism in therefore different but the data is as yet insufficient to allow for more than personal hypotheses.

Adolescent↗
PubMed1984

Fine structural capillary changes and basal lamina thickening in scleroderma (progressive systemic sclerosis) and Raynaud's disease.

Capillary abnormalities were found by electron microscopy in labial salivary gland biopsies obtained from 20 patients with progressive systemic sclerosis (PSS). They consisted of marked thickening and multilayering of basal lamina, degenerative and adaptative endothelial cell changes, alterations of pericytes and perivascular mononuclear cell infiltration. There was no correlationship between the intensity of the capillary abnormalities and the duration of the disease. In 12 patients with Raynaud's disease (RD) such changes were not found. Thus capillaries displayed normal-looking ultrastructural appearances. Mean capillary basal lamina width was consistently thicker in the PSS group than in the RD group (p less than 0.001). These observations are consistent with the hypothesis that the primary event in PSS occurs in the microvessels. It is suggested that labial salivary gland biopsy may be helpful for early recognition of PSS among subjects with Raynaud's syndrome.

Adolescent↗
PubMedDate not supplied

Plasma catecholamines during behavioral treatments for Raynaud's disease.

We have previously demonstrated that the vasospastic attacks of Raynaud's disease can be induced despite blockade of efferent digital nerves and that feedback-induced vasodilation is mediated through a non-neural, beta-adrenergic mechanism. Here, we sought to determine the role of sympathetic activity, as measured by plasma epinephrine and norepinephrine, during finger temperature feedback and autogenic training. Thirty-one female patients with idiopathic Raynaud's disease were randomly assigned to receive finger temperature feedback or autogenic training over 28 days. Half of each group began and finished training during the follicular phase of the menstrual cycle, the other half during the luteal phase. During training, significant temperature elevations were shown by feedback patients but not by autogenic patients. There were no significant effects for norepinephrine and epinephrine for either group. Cycle phase did not interact with training effects or with catecholamines. These findings do not support the role of decreased sympathetic activation in behavioral treatments for Raynaud's disease.

Adult↗
PubMed1987

Hyperventilation and Raynaud's disease.

A 42 year old woman with long standing Raynaud's disease, unresponsive to medical and surgical treatment, was noted to have a typical history of the hyperventilation syndrome. Rewarming of the hands following cold challenge was markedly prolonged in the presence of hypocapnia. It is suggested that hyperventilation may have an aetiological role in maintaining digital artery spasm in Raynaud's disease, which would benefit from recognition and treatment.

Adult↗
PubMed1999

[The determination of the thermal threshold in subjects with Raynaud's disease. A preliminary report of 2 clinical cases].

BACKGROUND: The onset of Raynaud's phenomenon is mainly provoked by cold stimuli which, in patients affected by Raynaud's disease, are milder than those able to provoke the same phenomenon in healthy subjects. Therefore, it is reasonable to theorize the existence of a "thermal threshold", below which it is more likely for a Raynaud's phenomenon to be provoked. The aim of this investigation is to determine whether a thermal threshold in Raynaud's disease exists and if it can be used as a practical tool for preventing the complications of Raynaud's disease (digital gangrene and ulcers), whose onset is strictly related to the frequency of the phenomena. METHODS: Two patients affected, respectively, by slight Raynaud's phenomenon secondary to peripheral neuropathy (Case 1), by severe Raynaud's phenomenon associated with mixed connective tissue disease (Case 2), were asked to write a note about the phenomena and the days of their onset, within a period of three months. Afterwards, all data were related to the daily ground maximum temperature occurred in the period of study. RESULTS AND CONCLUSIONS: These preliminary results show an interesting correlation between this new parameter and the clinical data, the thermal threshold being higher in more severe cases. It was equal to 22 degrees C in the patient affected by slight phenomenon (Case 1), and equal to 27 degrees C in the severe phenomenon (Case 2). This method for evaluating the thermal threshold in these two cases of Raynaud's disease (the greater the figure, the more severe the case) allowed both the clinical assessment of the pathology and the prevention of secondary complications.

Adult↗