Cutaneous Microcirculation In Patients Research Articles

Cutaneous microcirculation reactivity in patients with arterial hypertension, taking into account intake of anti-hypertensive drugs.

The aim of the study was to assess the reactivity of the cutaneous microcirculation in patients with arterial hypertension (AH), taking into account the intake of anti-hypertensive drugs, using laser doppler flowometry (LDF) and the post-occlusive reactive hyperaemia (PORH) test. The analysis included 44 patients with well-controlled AH, and 22 subjectively healthy volunteers aged 23 - 74 years, matched with the study group. During the study period, 22 patients in the study group were taking ACEI drugs, also in combination with other drug groups in terms of gender and age. 19 patients were taking other groups of drugs, including: ARB, beta-blockers, alpha-blockers, CCB, diuretics, also in combination, while 3 patients were not taking medication for AH; they were recommended non-pharmacological treatment. Blood biochemical tests, ambulatory blood pressure monitoring (ABPM) and PORH test using LDF were performed. The study showed that the PORH flow parameters were not differ statistically significantly between the study and control groups (p> 0.05). Statistically significant differences were shown in the PORH maximum level (ML) on the skin forearm between the study group not taking ACEI drugs and the control group. No statistically significant differences were shown between the study group taking ACEI and the control group. The pathogenesis of AH is multifactorial and depends, inter alia, on disturbances at the level of microcirculation. Proper treatment, especially with the use of ACEI, can improve the microcirculation in AH patients.

Abnormalities in Cutaneous Microcirculation in Patients with Alzheimer's Disease, Mild Cognitive Impairment, and Chronic Insomnia Disorder.

Impaired sympathetic response is frequently observed in neurodegenerative diseases, such as Alzheimer’s disease (AD). On the other hand, chronic insomnia disorder (CID) is also often accompanied by activation of sympathetic nerves. Considering that cutaneous microcirculation reflects sympathetic tone, we hypothesized that baseline cutaneous microcirculation in fingers, as detected by laser Doppler flowmetry (LDF), differs among patients with mild cognitive impairment (MCI), AD, and CID. As light therapy is one of the adjunctive treatments for AD and CID, we designed a randomized controlled cross-over trial of light therapy through eyes for 12 weeks with red light as treatment and green light as control limb, and examined if light therapy has an impact on cutaneous microcirculation. Before light therapy, patients with AD had significantly lower baseline cutaneous perfusion than those with CID in left and right first to fourth fingers. After red light therapy, however, cutaneous perfusion of fingers in CID patients significantly decreased (right fingers, before vs. after = 227.25 ± 62.00 vs. 162.00 ± 49.34, p = 0.007; left fingers, before vs. after = 228.99 ± 58.80 vs. 177.41 ± 59.41, p = 0.003) while cutaneous perfusion of fingers in CID patients did not significantly change after green light therapy. Light therapy with red light also significantly increased cutaneous finger perfusion in patients with AD (right fingers, before vs. after = 130.13 ± 49.82 vs. 172.38 ± 38.32, p = 0.043). Our results suggest that cutaneous perfusion is a useful tool to detect sympathetic dysfunction in patients with CID and AD, and that light therapy with red light is a potential therapeutic intervention to reverse impaired sympathetic function in patients with CID and patients with AD.

STATE OF CUTANEOUS MICROCIRCULATION IN PATIENTS WITH OBESITY

The aim: To determine the influence of obesity on cutaneous microcirculation in patients with different stages of obesity and without cardio-vascular pathologies. Materials and methods: The 67 eligible patients with obesity were enrolled into the main group in this research. 20 healthy patients with normal body weight were included in the control group in this study. The mean age and gender were similar among the groups. Each patient underwent a clinical evaluation during the consultation, biological tests, electrocardiogram, Laser Doppler flowmetry. Results: There was a significant decrease in IM and σ in patients with class II obesity and class III obesity compared with control group. IV was decreased in all groups, but the significant differences were recorded only among patients with obesity and not among overweight patients. During wavelet analysis a significant decrease of the AmaxE was detected in all 4 groups (by 14,7%, 37,7%, 52,4%, 57,4% respectively, P < 0,05). The most significant changes were recorded in the heart spectrum (AmaxC). Conclusions: Overweight patients and patients with obesity without cardio-vascular pathology have initial manifestations of microcirculatory disorders, which deteriorate with an increase of BMI. Changes in microcirculation in patients with obesity characterized by the significant decrease of microvessels perfusion, decreasing endothelial and increasing heart specter modulations. Only high BMI was found to be associated with impaired microcirculation endothelial function (AmaxE B=0.446, 95% CI [0,15, 0,92]) according to the results of regression analysis.

Cutaneous microcirculation in patients with peripheral arterial occlusive disease: Comparison of capillary blood circulation in the nail fold of finger and toe.

In patients with peripheral arterial occlusive disease (PAOD) a restricted circulation in cutaneous microvessels has been reported. In this study the velocity of erythrocytes (very) in finger nailfold capillaries - a vascular area without upstream macroangiopathy - and also in toe nailfold capillaries - a post-stenotic area -was investigated using capillary microscopy in apparently healthy subjects and patients with PAOD. Already in finger nailfold capillaries very of patients with PAOD under resting conditions was significantly lower than in capillaries of healthy subjects. This was also true for the circulation in toe capillaries. In addition, the erythrocyte velocities under resting conditions in the toe capillaries were significantly lower than in the finger capillaries. Similar results were found for the duration and the maximum velocity of postocclusive hyperemia. It is concluded that the resting blood flow in the skin microcirculation is impaired in PAOD patients, both under resting conditions and during postocclusive hyperemia in finger as well in toe nailfold capillaries.

Indicators of microcirculation in patients with type 2 diabetes with diabetic peripheral neuropathy during therapy with various doses of vitamin D

Aim of the study. To study the effect of therapy with prophylactic and supraphysiological doses of cholecalciferol on skin microcirculation (MC) indicators in patients with type 2 diabetes mellitus with diabetic peripheral neuropathy (T2DM with DPN).Material and methods. The study included 62 participants with T2DM with DPN (according to the Neuropathy Disability Score (NDS) scale, more than 4 points). By the method of consecutive numbers, patients were randomized into two groups: Group I (n=31, 15 men/16 women, 52.4±5.7 years) and Group II (n=31, 16 men/15 women, 51.4±6.1 years). Antihyperglycemic treatment was stable during the study. For 24 weeks, cholecalciferol participants from Group I received once a week at a dose of 5,000 IU, and from Group II - once a week at a dose of 40,000 IU. Body mass index (BMI), serum levels of 25(OH)D (25-hydroxycalciferol) and serum glycated hemoglobin (HbA1c) were evaluated before and after 24 weeks of taking cholecalciferol. The method of laser Doppler flowmetry (LDF) compared the initial and final indicators of the baseline level of blood flow and microcirculation indicators against the background of functional tests (postural and occlusive). Control measurements of LDF parameters were performed on 16 subjects without revealed diabetes mellitus (8 men/8 women, 51.8±3.7 years).Results. Patients from Group II, after 24 weeks of taking supraphysiological doses of cholecalciferol, against the background of 100% normalization of the serum 25(OH)D level, significantly improved the parameters of skin MC and functional tests, HbA1c and BMI decreased.Conclusions. Acceptance of high doses of cholecalciferol for 24 weeks has been associated with an improvement in the parameters of glycaemia and indicators of cutaneous MC in patients with T2DM with DPN.

Monitoring cutaneous microcirculation in patients with obesity during a rehabilitation stay

Monitoring cutaneous microcirculation in patients with obesity during a rehabilitation stay

Aged garlic extract preserves cutaneous microcirculation in patients with increased risk for cardiovascular diseases: A double‐blinded placebo‐controlled study

Laser Doppler velocimetry estimates tissue perfusion providing a record of microvascular blood flow. Patients with heart disease or diabetes mellitus have impaired microvascular perfusion leading to impaired wound healing. Aged garlic extract (AGE) has a positive effect on vascular elasticity. This study aimed to assess the effect of long-term treatment with AGE on cutaneous tissue perfusion. A total of 122 patients with Framingham Risk Score ≥ 10 were randomised in a double-blinded manner to placebo or 2400 mg AGE daily for 1 year and monitored. Cutaneous microcirculation was measured at 0 and 12 months using laser Doppler velocimetry. A repeated measures analysis of variance (ANOVA) with a Greenhouse-Geisser correction determined that mean post-occlusive reactive hyperaemia differed significantly between time points. The mean percent change between the two time points 0 and 12 months was 102, 64 (174, 15)% change for AGE and 78, 62 (107, 92)% change for the placebo group (F[1, 120] = 5. 95, P < 0.016), 12 months of AGE increases the microcirculation in patients with an increased risk for cardiovascular events estimated using the Framingham risk score. Increased microcirculation could hypothetically facilitate wound healing.

Effect of Ioxaglate on the cutaneous microcirculation in patients with coronary artery disease: Randomized, double blind, placebo-controlled study

Radiographic contrast media (RCM) can initiate microcirculatory disorders. This study was performed to investigate effects of Ioxaglate on the cutaneous microcirculation. The investigation was carried out as prospective randomized double-blind comparison in parallel-group design on two groups of n = 10 patients each who had to undergo a diagnostic coronary angiography.The confirmatory parameter of the study was mean erythrocyte capillary velocity [vRBC in mm/sec]. VRBC in the ipsilateral nail-fold capillaries was recorded continuously for 3 min before and 6 min after injection of RCM or isotonic saline solution in the A. axillaris respectively, and was evaluated off-line.VRBC in nailfold capillaries was found to be decreased by Ioxaglate by 34% 150 seconds after injection, while isotonic NaCl solution immediately induced a slight increase of 14%.

Factor XIII Val34Leu polymorphism is associated with increased factor XIII activation and decreased transcutaneous oxygen readings in patients with diabetic foot ulcers

To investigate the relationship between the factor XIII Val34Leu polymorphism, plasma factor XIII activation and transcutaneous oxygen readings in patients with diabetic foot ulcers. Methods Ninety-two consecutive patients with Type diabetes and active foot ulcers were investigated. Plasma factor XIII activation was assessed by ELISA. Genetic polymorphism was detected using the ABI PRISM® SNaPshotTM Multiplex Kit. Results are expressed as median (minimum-maximum). Differences between groups were calculated by Mann-Whitney U-test or χ(2) -test where appropriate. A P-value < .05 was considered significant. e Val34Leu polymorphism was found in 50 subjects (54%) with 42 being heterozygous (Val/Leu) and eight being homozygous (Leu/Leu). The rate of plasma factor XIII activation was increased in patients with Val/Leu or Leu/Leu [Val/Leu or Leu/Leu 152 (55-283) % vs. Val/Val 103 (33-282) %; P < 0.0001]. Transcutaneous oxygen readings were lower in the Val/Leu or Leu/Leu group [Val/Leu or Leu/Leu 16 (0-58) mmHg vs. Val/Val 35 (1-65) mmHg; P = 0.008]. Similarly, plasma factor XIII activation negatively correlated with transcutaneous oxygen readings (r(2) = -0.314; P = 0.014). Val34Leu polymorphism is associated with increased plasma factor XIII activation and seems to be linked with impaired cutaneous microcirculation in patients with diabetic foot ulcers.

Influence of xantinole nicotinic acid on cutaneous microcirculation in patients with coronary artery disease and hyperlipoproteinemia

Xantinole nicotinic acid (NA) dose dependently lowers plasma levels of atherogenic lipoproteins and increases blood flow through vasodilation. The aim of this study was to evaluate the effect of NA on cutaneous microcirculation in patients with coronary artery disease and hyperlipidemia. In this open pilot study, five men and three women (74.2+/-9.1 yrs; 81.4+/-7.9 kg; 171.6+/-7.0 cm) with angiographically proven coronary artery disease and hyperlipidemia were included. Nailfold capillary microscopy was used for measurements of erythrocyte velocities at rest and after three minutes of ischemia, before and one hour after intake of 1000 mg of NA. The blood pressure (120+/-12/73+/-8 mmHg vs. 113+/-10/72+/-5 mmHg; p=0.19/0.83) and the heart rate (72+/-8/min vs. 70+/-7/min; p=0.38) remained unchanged. The mean capillary red blood cell velocity at rest (v(RBC); 0.27+/-0.23 mm/s vs. 0.32+/-0.18 mm/s; p=0.089) and the time to maximal post ischemia erythrocyte velocity (t(peak); 21.0+/-7.9 s vs. 24.3+/-15.5 s; p=0.49) did not change. The maximal post ischemic erythrocyte velocity (v(maxRBC); 0.93+/-0.33 mm/s vs. 1.19+/-0.19 mm/s; p=0.0096) raised slightly but significantly, the duration of post-ischemia hyperemia (DpH; 101+/-16 s vs. 127+/-15 s; p=0.0005) increased markedly. One patient reported about flush in the whole body. The administration of 1000 mg of NA resulted in a significant improvement of the cutaneous microcirculation in patients with coronary artery disease and hyperlipidemia.

731: Sildenafil (Viagra®) Improves Cutaneous Microcirculation in Patients with Coronary Artery Disease: A Prospective Randomized Double-Blind Placebo-Controlled Cross-Over Study

You have accessJournal of UrologyPodium, Monday, May 23, 2005, 10:00 am - 12:00 pm1 Apr 2005731: Sildenafil (Viagra®) Improves Cutaneous Microcirculation in Patients with Coronary Artery Disease: A Prospective Randomized Double-Blind Placebo-Controlled Cross-Over Study Jai-Wun Park, Christof Mrowietz, Ulrich Gerk, and Friedrich Jung Jai-Wun ParkJai-Wun Park More articles by this author , Christof MrowietzChristof Mrowietz More articles by this author , Ulrich GerkUlrich Gerk More articles by this author , and Friedrich JungFriedrich Jung More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)35963-9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "731: Sildenafil (Viagra®) Improves Cutaneous Microcirculation in Patients with Coronary Artery Disease: A Prospective Randomized Double-Blind Placebo-Controlled Cross-Over Study." The Journal of Urology, 173(4S), p. 199 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 173Issue 4SApril 2005Page: 199 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Jai-Wun Park More articles by this author Christof Mrowietz More articles by this author Ulrich Gerk More articles by this author Friedrich Jung More articles by this author Expand All Advertisement PDF DownloadLoading ...

Endothelium-Dependent Regulation of Cutaneous Microcirculation in Patients with Systemic Scleroderma

The microinjection method used for the first time in this study makes it possible to measure in vivo the endothelium-dependent vasomotion in the nailfold capillaries of systemic scleroderma patients. Aceylcholine (blood concentration of 10(-5) M) and sodium nitroprusside (blood concentration of 1.6 microg per kg per min) were used as test substances to examine capillary vasomotion. Defined quantities of medication in the range of microliters were administered as a bolus using the Panomat V-3 medicine pump. The boluses were injected into the capillaries at the capillary loop in 10 scleroderma patients and 10 randomized healthy volunteers. Blood flow velocity and the diameter of the skin capillaries at the venous loop were measured and tested for correlation with the effects of injections of test substances. The intracapillary administration of sodium nitroprusside brought about a significant decrease in capillary blood flow velocity and a significant increase in vascular diameter in comparison with baseline values, both in systemic scleroderma patients (p<0.005 and p<0.0001) and in the healthy volunteers (p<0.001 and p<0.0001). The intracapillary administration of acetylcholine led to a significant decrease in blood flow velocity (p<0.001) and increase in vascular diameter (p<0.0001) only in the healthy volunteers. In systemic sclerosis patients capillary diameter and blood flow velocity were unaffected. In two systemic scleroderma patients this procedure was repeated in identical fashion at the end of a 1 wk infusion therapy cycle with prostacyclin. The infusion therapy led to a normalization of endothelium-dependent vasomotion in the two scleroderma patients. The microinjection technique used in this study for the first time made it possible to establish in vivo that endothelium-dependent vasomotion is disturbed in systemic scleroderma patients.

Lipid Lowering Does Not Improve Endothelial Function in Subjects With Poorly Controlled Diabetes

Cutaneous microangiopathy is suspected to play a role in the pathogenesis of diabetic foot ulcers (1). Because microcirculatory flow is regulated in part by the endothelium and prior studies of the coronary microcirculation showed significant improvement in endothelium-dependent vasodilatory responses with lipid-lowering therapy (2), we examined the effect of lipid lowering on endothelial function in cutaneous microcirculation in patients with type 2 diabetes. Patients aged 21–80 years with diabetes and LDL cholesterol >3.4 mmol/l were randomized in a double-blind fashion to treatment with either simvastatin 40 mg daily or placebo and followed for 3 months after randomization. All patients received dietary counseling with regard to lowering LDL, but no attempt was made to alter glycemic control. The study was approved by the Institutional Review Board of the Mount Sinai School of Medicine, and informed consent was obtained before enrollment. Cutaneous microcirculatory flow from the same site of the dorsum of the foot was measured with the Periflux System PF3 (Perimed, Jarfalla, Sweden) at every visit in all patients. The flow response to heating was recorded …

Activity of cardiopulmonary baroreceptors, peripheral resistance and cutaneous microcirculation in patients with peripheral obstructive arterial disease.

To assess the effects of cardiopulmonary baroreceptors on the haemodynamics of the humeral and common carotid arteries in patients suffering from peripheral artery disease (PAD) and to discover whether the stimulation of these receptors modifies the cutaneous microcirculation in the forearm. We studied a group of patients suffering from peripheral artery disease and two groups as controls. Patients were examined at the ambulatory for Vascular Research, Division of Vascular Medicine and Rehabilitation, University of Verona. We studied 15 patients with peripheral artery disease of the lower limbs at Fontaine stage II (group C), 10 free of arterial pathologies (group B) and 10 young people (group A). We subjected the patients to passive elevation of the legs and the trunk in a horizontal position with pressure monitoring and measurement of the calibre and flow in the brachial and common carotid arteries using a colourDoppler ultrasound. We also studied the cutaneous microcirculation with laserDoppler flowmetry. During the test, arterial pressure and cardiac frequency remained constant in group A, systolic pressure values showed a slight, but statistically significant increase in group B, whilst the increase in systolic pressure values at this stage was marked in group C. Diastolic pressure values and cardiac frequency remained unchanged in all groups. The calibre of the humeral artery increased in the control groups. Carotid resistance was unchanged in the three groups. Humeral resistance during the test decreased in the two control groups whilst it increased in group C. The number of perfusion units felt in the control groups; no variations in group C. Our study demonstrates, in patients with peripheral artery disease, a reduction in the activity of the cardiopulmonary baroreceptors with an increase in the humeral resistance during the test and impairment of the mechanisms of cutaneous microcirculatory vasoregulation in the forearm.

Acute effects of haemodialysis on cutaneous microcirculation in patients with peripheral arterial occlusive disease.

Peripheral arterial occlusive disease (PAOD) is an increasing problem in patients on maintenance haemodialysis. Alterations in microvascular perfusion accompany and complicate arteriosclerosis of large vessels and might contribute to the disease process. The aim of the study was to investigate the acute effects of haemodialysis on the cutaneous microcirculation in 26 patients with and without intermittent claudication. Cutaneous perfusion was assessed by measuring transcutaneous oxygen pressure (tcPO2) and skin temperature at the dorsum of the foot. After standardized cooling to 15 degrees C of a 2cm2 skin area, the time to reach baseline skin temperature was evaluated as an indirect parameter of reactive hyperaemia. During haemodialysis, tcPO2 dropped significantly in both groups. The decrease in tcPO2 was more pronounced in patients with PAOD (20% vs 15% n.s.). The reactive hyperaemia response was reduced significantly in patients with intermittent claudication indicated by a prolonged time to reach baseline skin temperature after cooling. Values of tcPO2 and reactive hyperaemia did not reach baseline values at the end of haemodialysis in either group. Nutritive skin perfusion is impaired during haemodialysis. These changes are more pronounced in patients with PAOD and persist after dialysis. These findings are relevant for the treatment of patients with vascular disease on maintenance haemodialysis.

Use of Dynamic Capillaroscopy for Studying Cutaneous Microcirculation in Patients with Diabetes Mellitus

[is0p9]To investigate the relationship between cutaneous microcirculation and retinopathy in diabetes mellitus, we studied by dynamic capillaroscopy 35 diabetes mellitus patients, including 10 patients without retinopathy, 10 patients with background retinopathy, and 15 patients with proliferative retinopathy. We found that (1) cutaneous and retinal microcirculation in diabetes mellitus in long-term diabetes mellitus, regressional rather than proliferational changes occurred in skin vasculature as compared to that in retina; (2) functional impairments of cutaneous microcirculation, that is, decreased resting capillary blood cell velocity, peak blood cell velocity, and prolonged time to peak capillary blood cell velocity by dynamic capillaroscopy, could be detected in diabetes mellitus patients without retinopathy; (3) the degree of tortouosity of capillaries, impairment in peak capillary blood cell velocity, and time to peak capillary blood cell velocity of cutaneous microcirculation were significantly correlated with the gravity of retinopathy in diabetes mellitus patients; (4) abnormal leakage of fluorescence in cutaneous microcirculation appeared in diabetes mellitus patients with or without abnormal fluorescein angiography in retina. In conclusion, dynamic capillaroscopy used in concert with ophthalmoscopy and fluorescein angiography can facilitate a comprehensive examination of vasculopathy in diabetes mellitus.

Comparison of the effects of picotamide and aspirin on renal albumin excretion and cutaneous microcirculation in patients with type II diabetes mellitus: a pilot study

We compared the effects of two antiplatelet agents, picotamide, a dual antithromboxane inhibitor, and aspirin, a nonselective cyclooxygenase inhibitor, on microalbuminuria and cutaneous microcirculation in diabetic patients. Twenty patients with type II diabetes mellitus with micro- or macroalbuminuria (urinary albumin excretion rate ⩾ 30 mg/24 h) (8 men, 12 women; mean age, 62 ± 3 years) were enrolled in an open-label, 3-month pilot study and randomly assigned to receive picotamide 300 mg twice daily (10 patients), or aspirin 325 mg/day (10 patients). The 24-hour urinary albumin excretion rate was measured at baseline and after 3 months using a commercial radioimmunoassay kit. Cutaneous microcirculation was assessed at the same time by means of laser-Doppler flowmetry. Supine resting flow (RF) and standing flow (SF) (after 3 minutes in the upright position) were also measured. The arteriovenous response (AVR) was calculated as (RF — SF)/RF × 100. The microangiopathy index (MI) was expressed as the ratio AVR:RF. Urinary albumin excretion rate increased significantly ( P < 0.05) as compared with baseline in the aspirin group (from 920 to 1073 mg/24 h), whereas it decreased slightly in the picotamide group (from 766 to 722 mg/24 h; P = not significant). Urinary albumin excretion rate increased in 6 patients in the aspirin group and in 1 patient in the picotamide group ( P < 0.05, chi-square test). MI worsened significantly ( P < 0.05) in the aspirin group (from −1275 at baseline to −1723 at month 3; in the picotamide group, MI improved significantly ( P < 0.01) from −1675 at baseline to −230 at month 3. As compared with aspirin, picotamide appears to halt the progression of renal albumin excretion and to improve cutaneous circulation in patients with type II diabetes mellitus who have incipient or overt nephropathy.

Effects of Monoionic and Nonionic Radiographic Contrast Media on Cutaneous Microcirculation in Patients with Peripheral Arterial Occlusive Disease

The purpose of the study was to compare the in vivo effects of two low-osmolar radiographic contrast media, a monoionic (sodium/-meglumine ioxaglate, Hexabrix) and a nonionic one (iopromide, Ultravist 300) on the cutaneous microcirculation in patients with peripheral arterial occlusive disease in a prospective randomised double-blind study. In 20 patients with peripheral arterial occlusive disease scheduled for percutaneous transluminal angioplasty skin microcirculation was assessed by laser Doppler fluxmetry and transcutaneous oxygen tension measurements at the foot dorsum for continuous recordings of the cutaneous microvascular perfusion and skin oxygenation. Before angioplasty 10 ml nondiluted contrast medium was injected intraarterially and the acute effect on transcutaneous oxygen tension and laser Doppler flux was registered. Mean laser Doppler flux and oxygen tension were evaluated initially, after arterial puncture and after contrast medium injection. In addition, flux motion was analysed with respect to frequency and amplitudes changes. No significant changes in laser Doppler flux and fluxmotion patterns were found between both groups after contrast medium injection. However, mean transcutaneous oxygen tension of the patients receiving monoionic ioxaglate dropped significantly (P = 0.01). The differences of both contrast media on red blood cell aggregation shown in vitro do not correlate to intravital microcirculatory measurements in patients with arterial occlusive disease of the lower limb. Microvascular skin blood flow and flux motion at the foot in these patients do not change significantly after intraarterial injection of ioxaglate and iopromide. However, oxygen supply of the skin is transient impaired after interarterial injection of the anionic contrast agent ioxaglate, which was not associated with clinical symptoms.

Disturbances of cutaneous microcirculation in patients with diabetic legs: additional parameters for a new therapeutic concept?

Keratinocyte growth in vitro and DNA synthesis by epidermal cells in vivo are inhibited by therapeutic doses of cyclosporin A (CsA). This effect may be potentialized by topical treatment with ketoconazole, since this drug has been shown to inhibit CsA metabolism. Normal human skin grafts on nude mice receiving intraperitoneal injections of CsA were treated with ketoconazole cream or its placebo for 3 weeks. The keratinocyte DNA synthesis rate was evaluated through the rates of bromodeoxyuridine (BrdU) incorporation, and the trough blood levels of CsA were checked at the end of the experiment. Counting of the BrdU-labelled nuclei in human tissue sections confirmed a dose-dependent inhibition of BrdU incorporation by keratinocytes exposed to CsA. This CsA-induced inhibition was further increased in the animals treated with ketoconazole cream. This effect was best seen in the groups treated with the low-to-medium doses of CsA (12.5 and 25 mg/kg/day). However, the simultaneous increase in the circulating CsA levels was also observed in these animals. Based on our results, we speculate that the potentializing effect of ketoconazole on CsA-induced inhibition of keratinocyte DNA synthesis is systemic rather than local.

Pathophysiological Characteristics of Cutaneous Microcirculation in Patients with Liver Cirrhosis: Relationships to Cardiovascular Hemodynamics and Plasma Neurohormonal Factors

To elucidate pathophysiological characteristics of the peripheral circulation in liver cirrhosis, cutaneous microcirculation was analyzed at the finger, palm, toe, and arch of the foot using laser Doppler spectroscopy in 19 patients with liver cirrhosis, and the results were correlated with cardiovascular hemodynamics ( n = 10) and plasma neurohormonal factors ( n = 8). Cutaneous blood flow at each area was all significantly reduced ( P < 0.001, < 0.05, < 0.01, < 0.001, respectively) in patients with liver cirrhosis compared to those in normals ( n = 20). Cutaneous blood mass was also significantly reduced ( P < 0.05, < 0.01, < 0.001, respectively) except at the arch of foot in patients with liver cirrhosis. There were significant correlations between finger cutaneous blood flow and systemic vascular resistance ( r = -0.73, P < 0.05), plasma norepinephrine level ( r = -0.84, P < 0.01), plasma renin activity ( r = -0.77, P < 0.01), plasma concentrations of aldosterone ( r = -0.76, P < 0.05) and angiotensin II ( r = -0.76, P < 0.05), between palm blood flow and plasma vasoactive intestinal polypeptide concentration ( r = 0.83, P < 0.05). From these results and our previous data demonstrating increased forearm muscular blood flow in patients with liver cirrhosis, increases in arteriovenous anastomotic flow and the contribution of neurohormonal factors will represent pathophysiological mechanisms for these changes.