Nailfold Capillaries Research Articles

Knowledge-based approach to image interpretation

This paper presents an automatic interpretation system to support diagnostic biomedical image analysis. The system is organized in three modules: image segmentation; low level object interpretation; and high level biomedical object interpretation, in terms of clinical finding using a semantic model. The domain-specific knowledge used concerns the nailfold capillaries of the human finger, and is organized in a semantic network. User-defined semantic networks may be supplied to extend the system to other problem domains.

Nailfold capillary circulation in osteoarthritis.

Nailfold capillaries in 28 patients with OA affecting the distal interphalangeal joints were compared to 23 age- and sex-matched controls without OA. Patients with OA showed a significantly lower density of capillaries in their nailfolds and significantly more capillary morphological abnormalities including haemorrhage, 'drop out', dilatation and irregularity. There was a trend for OA patients to have warmer fingers with reduced finger to brachial blood pressure ratios. There were significant correlations between nailfold capillary numbers and average joint tenderness and between capillary morphological changes and joint swelling. These results reveal a relationship between interphalangeal joint OA and nailfold capillary abnormalities and density. As changes in microcirculation may be pertinent to the pathogenesis of OA, further studies which could explore possible causal relationships are warranted.

Overlapping syndromes, undifferentiated connective tissue disease, and other fibrosing conditions.

Connective tissue diseases (CTDs) frequently present as undifferentiated disorders that may or may not develop into one of the well defined CTDs. The natural evolution of the early undifferentiated CTDs is not well known. Some years ago a cooperative study was started on 410 patients with early CTD; within this group, 48 patients had early scleroderma. Raynaud's phenomenon has been recognized as an early sign of CTD. Several studies on Raynaud's phenomenon patients have shown that abnormal nailfold capillary patterns have prognostic significance for evolution to a CTD, particularly scleroderma. Mixed connective tissue disease (MCTD) is the prototype of an overlap syndrome. The relevance of defining MCTD as a separate disease entity has been challenged. Follow-up studies show that many patients originally diagnosed with MCTD develop a definite CTD, particularly scleroderma or systemic lupus erythematosus, within a few years. In patients with MCTD, primary pulmonary hypertension is an important cause of death. This condition seems to be associated with anticardiolipin antibodies. A number of case reports suggest that immunosuppressive treatment is of benefit in this almost always fatal condition. The main reason for describing MCTD as a separate entity is its association with antibodies to U1-RNP. Recent studies have suggested that the production of anti-U1-RNP is an antigen-driven process, but the nature of the trigger for its production has not been elucidated. Retroviral proteins do not appear to be involved. Antibodies to the protein part of the U1-RNP complex and antibodies to the RNA component have been described. Levels of anti-RNA antibodies seem to parallel disease activity in MCTD patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Pulmonary function in systemic lupus erythematosus is related to distinct clinical, serologic, and nailfold capillary patterns

purpose: The purpose of this study was to investigate whether systemic lupus erythematosus (SLE) patients with interstitial lung disease represent a particular subset of patients characterized by the presence of clinical, serologic, and nailfold capillary patterns overlapping scleroderma. patients and methods: In 57 consecutive patients with SLE, a standardized detailed history was obtained and a physical examination performed, directed at signs and symptoms of connective tissue diseases, in particular scleroderma. Additionally, pulmonary function testing, chest radiography, radionuclide transit studies of the esophagus, nailfold capillary microscopy, and detailed serologic studies directed at the antigenic specificities of antinuclear antibodies were performed. Patients were divided into three groups based on the results of pulmonary function testing, i.e., normal lung function, restriction, or isolated impairment of diffusion. Clinical, serologic, and nailfold capillary microscopic findings were compared among these three groups. results: Twenty patients had normal lung function, 19 had restrictive lung function loss, and 9 had an isolated impairment of the diffusing capacity (T 1,CO). Patients with obstructive lung disease (n = 9) were excluded from analysis. Sclerodermatous changes of the hands were associated with a restrictive lung function pattern. Interstitial changes on chest radiograph were associated with isolated impairment of T 1,CO- Nailfold capillary abnormalities correlated with decreased T 1,CO and Dm, the component of T 1,CO representing the diffusing capacity of the alveolocapillary membrane. Antibodies to U1-RNA were associated with restrictive lung function and decreased T 1,CO. conclusion: We conclude that interstitial lung disease is present in a subset of SLE patients characterized by an increased prevalence of scleroderma traits and anti-(U1)RNA antibodies. Microvascular changes may contribute to the development of interstitial lung disease in SLE as well as in scleroderma.

SKIN CAPILLARY BLOOD FLOW DETERMINATIONS IN NEONATES – EVALUATION OF A VIDEOPHOTOMETRIC MICROSCOPY METHOD

This investigation evaluates the accuracy of television microscopy when applied to studies of skin capillary hemodynamics in newborn infants. Microscopic videorecordings of 16 nailfold capillaries in 5 healthy neonates were analyzed by a computerized videophotometric system (Capiflow®, Capiflow AB, Kista, Sweden). In each capillary, the skin capillary blood cell velocity (CBV) and the capillary erythrocyte column diameter were simultaneously determined at an average of four different locations, equally distributed on the arteriolar and venular side of the capillary. At each measuring site (n = 64), repeated determinations of the CBV (x 4) and capillary dimension (x 8) were performed by re-analyzing the same 2-min videotape sequence.The coefficient of variation (CV = ISD/mean × 100 %) for repeated CBV measurements, was 3.4 (0.9 — 13) %. The corresponding CV value for diameter measurements was 6.7 (0.5 — 12) %. The method's validity was tested by calculating capillary blood cell flow values, which were assumed to be the same in simultaneously studied but different sections of the capillary. A high correlation was found between arteriolar and venular side capillary blood cell flow (r = 0.94, p < 0.001).Conclusion: Videophotometric microscopy give reliable and valid measurements of neonatal nailfold CBV and capillary dimensions.

Relation of skin capillary pressure in patients with insulin-dependent diabetes mellitus to complications and metabolic control.

Microvascular disease is a major problem in patients with diabetes mellitus. It has been suggested that diabetic microangiopathy may result from an increase in capillary blood flow and capillary hypertension, but direct evidence of capillary hypertension in such patients is lacking. We measured capillary pressure at the summit of the capillary loop by direct microcannulation of skin nail-fold capillaries and a dynamic method of pressure measurement in 29 patients with insulin-dependent (Type I) diabetes and 29 normal subjects matched for age and sex. Among the diabetic patients, 7 had had diabetes for less than one year, 12 had incipient nephropathy (albumin excretion, 20 to 200 micrograms per minute), and 10 had overt nephropathy (albumin excretion, greater than 200 micrograms per minute). In addition, seven patients with no evidence of nephropathy were studied before and after three months of improved glycemic control. The median capillary pressure in the diabetic patients was 20.4 mm Hg (range, 13.6 to 25.3), as compared with 16.7 mm Hg (range, 12.8 to 22.8; P less than 0.001) in the normal subjects. The values were higher in each subgroup of diabetic patients than in the corresponding group of normal subjects, but the values did not differ among the three subgroups of diabetic patients. In the seven patients who were studied before and after three months of improved glycemic control, the median capillary pressure fell from 20.0 mm Hg (range, 18.5 to 21.7) to 17.8 mm Hg (range, 14.1 to 20.3; P = 0.02). Nail-fold capillary hypertension may develop early in the course of diabetes, before the emergence of microvascular disease, and may be influenced by changes in metabolic control.

An evaluation of skin capillary blood flow determinations in neonates using a computerized videophotometric method

Dynamic capillaroscopy has been shown to give valid measurements of skin capillary blood flow in adults. The aim of this investigation is to evaluate the accuracy of the method when applied to studies in newborn infants. A computerized videophotometric technique was used to measure the skin capillary blood cell velocity (CBV) and the capillary erythrocyte column diameter at 64 standardized locations in 16 nailfold capillaries in five subjects. To estimate the method's reliability, we calculated the coefficient of variation (CV = 1 SD/mean × 100%) for repeated measurements at each location. The CV for CBV determinations was found to be 3.4% (0.9–13%) and the corresponding value for capillary diameter measurements was 6.7% (0.5–12%) (median and range). Although the CBV and diameter values were found to vary along the course of the capillary, the volume flow of blood cells was assumed to be the same in simultaneously studied but different sections of the capillary. The paired CBV and diameter observations were therefore used to calculate blood cell flow values at an average of four different intracapillary locations. To estimate the method's validity, the CV for these repeated flow calculations was determined and found to be 7.5% (3.2–26%). We conclude that the age-specific characteristics in neonates, mainly a high hematocrit and short, irregular skin capillary loops, do not limit the feasibility and accuracy of videophotometric microscopy for dynamic microcirculatory studies in neonates.

Evaluation of the severity of systemic sclerosis by nailfold capillary microscopy in 112 patients.

The authors used nailfold capillary microscopy (NCM) to evaluate 112 patients with systemic sclerosis spectrum disorders (SSc). Patients were classified as S1 if they had skin involvement proximal to the metacarpo-phalangeal joints. S2 if they had at least two minor SSc American Rheumatism Association criteria, and S3 if they had at least two CREST criteria (calcinosis, Raynaud's, esophageal motility disorder, sclerodactyly, telangiectases), without S1 or S2 criteria. Disease duration from the first symptom was similar in all groups (7.17 +/- 8.98 years). Disease severity was determined by a total score of seven target organ involvements. S1 patients had a greater degree of skin and pulmonary involvement, with a mean score of 26.2 +/- 17.3. S2 patients had a mean score of 13.8 +/- 12.4, and had mostly vascular and digestive involvement, in comparison with S3 patients (7.2 +/- 7.2; p less than 0.001 and p less than 0.01 respectively). NCM sensitivity for S1 and S2 was 93.6%. NCM correlated with the degree of target organ involvement (p less than 0.01). Three NCM profiles established were: "mild," normal or borderline capillaries; "moderate," other abnormalities with no capillary telangiectases; and "severe," abnormalities other than those of the mild profile, with capillary telangiectases.

NaitFold Capillary Permeability in Psoriatic Arthritis

This study is the first report of the permeability status of nailfold capillaries in psoriatic arthritis (PA). "Traditional" nailfold capillary microscopy and intravital fluorescence videomicroscopy were carried out at the nailfold of 13 patients with PA. Twenty five healthy subjects served as controls for nailfold capillary microscopy, and 15 out of these for fluorescence videomicroscopy. The following parameters were assessed: capillary length, apex width, maximum loop width, maximum limb width, loop density, visibility of subpapillary venular plexus, loop tortuosity, transcapillary diffusion, and interstitial concentration at different sites and times of Na-fluorescein given in intravenous bolus. Morphometric analysis of capillaroscopic findings showed a significant increase of loop length (mean +/- SD: 290.1 +/- 73.5 microns) when compared to healthy controls (223.3 +/- 51.9 microns) (P < 0.02). Transcapillary passage of Na-fluorescein was homogeneous and symmetric both in PA patients and in controls. Mean transcapillary and interstitial diffusion was not significantly enhanced at the nailfold in PA patients. Our data support the view that PA is not characterized by a specific capillaroscopic pattern and/or significant abnormalities of microvascular dynamics at the nailfold.

Increased collagen around deformed finger nailfold capillaries in type I diabetes mellitus

Quantitative finger nailfold capillary microscopy was performed in 25 patients with type I diabetes and in 27 healthy control subjects. In the last consecutive 6 patients and 7 controls of these populations, finger nailfold biopsies were taken. Measurements of loop width as an in vivo parameter for deformities of the capillary loops showed significantly higher values in diabetic patients than in controls. Histopathological examination showed markedly and significantly increased deposition of collagen in nailfold dermal papillae of the diabetic patients. The deposition of collagen was positively correlated with the number of capillary endothelial cells in the nailfold dermal papillae and with the size of the papillae in diabetic patients. It is concluded that, in addition to deformity of nailfold capillaries, collagen deposition may also be a sign of metabolic disturbance and perhaps of proliferation of capillary endothelial cells in diabetic microangiopathy.

Valeur diagnostique de la capillaroscopie péri-unguéale dans les maladies systémiques. A propos de l'analyse statistique en insu d'une série continue de 354 examens

About a continous seria of 354 exams, nailfold capillary microscopy diagnostic value is redefined after stastical analysis.

Dermatoniyositis and polymyositis

Dermatoniyositis and polymyositis

The role of nailbed vasospasm in Crohn's disease

Local cooling of the nailfold capillaries produces a typical blood flow stop reaction in patients with Raynaud's phenomenon. We applied the same test to 35 patients with Crohn's disease and compared the results with the findings in a control group of 35 healthy subjects matched for age and sex by nailfold videomicroscopy. We found a flow stop with cold exposure in 27 of the 35 patients with Crohn's disease (mean duration 38 s) in contrast to 2 of the 35 control subjects only (mean duration 12 s). There was no significant difference in skin temperature between the two groups. Intravital microscopy of nailfold capillaries revealed an evident reduction of the capillary density (p = 0.001) and crest diameter of the capillary loop (p = 0.02) compared to normal subjects. The strong association of a vasoconstrictive reaction in finger microcirculation in patients with Crohn's disease suggests a vasospastic tendency in this disorder that might manifest in the mesenteric capillaries also. This new finding of microcirculatory disturbance may play a role in the pathophysiology of Crohn's disease and be related to a general vasospastic syndrome.

Quantitative nailfold capillary microscopy in cutaneous and systemic lupus erythematosus and localized and systemic scleroderma

Quantitative television microscopy of nailfold capillaries of the fingers was performed in 12 patients with cutaneous lupus erythematosus (six with discoid type and six with disseminated type), in six patients with localized scleroderma (two with circumscribed type, two with linear types, and two with atrophic type), in 10 patients with systemic lupus erythematosus, and in eight patients with systemic scleroderma. The following features were analyzed and compared with a control group (n = 15) of similar age: venous plexus visibility; density of capillaries; avascular fields; hemorrhages; giant capillaries; diameters of the transitional segment, the arterial, and the venous limbs; loop width; and flow stop caused by local cooling test. The patient groups with cutaneous lesions only showed no essential differences as compared with the controls. Patients with systemic scleroderma differed in almost every finding from the controls and from patients with localized scleroderma. Patients with systemic lupus erythematosus exhibited significant differences in several findings as compared with the controls and the cutaneous lupus erythematosus group, but there was overlap.

Blood-Cell Velocity in the Nailfold Capillaries of Patients with Normal-Tension and High-Tension Glaucoma

We compared the capillary blood-cell velocity in the fingertips of 30 patients with high-tension glaucoma, 30 patients with normal-tension glaucoma, and 30 control subjects by nailfold capillaroscopy. There were no measurable differences in the morphologic findings. The blood-flow velocity, however, was reduced significantly in the patients with normal-tension glaucoma compared with the control subjects (P less than .05). This difference was especially pronounced after cold provocation (P less than .0005). After cooling, 25 of 30 patients with normal-tension glaucoma had a blood standstill of 12 seconds or more, whereas only three of 30 control subjects and four of 30 patients with high-tension glaucoma had a measurable blood standstill.

Nail-fold capillary microscopy and chemotherapy-induced vascular toxicity

Nail-fold capillary microscopy and chemotherapy-induced vascular toxicity

Finger Microcirculation in Classical Migraine

We assessed microcirculation in nailfold capillaries of 22 patients with classical migraine and 22 normal subjects matched for age and sex using video-microscopy. Blood flow measurements were performed under standardized room temperature, after a 3-min warm water bath and after local cooling. Under standardized conditions, skin temperature at the fingertip was significantly lower in patients with migraine. Morphological differences, however, could not be found between patients and controls. After cooling of the nailfold area, blood flow stop due to vasospasm occurred in 18 of the 22 migraine patients in contrast to 1 of the 22 control subjects only. Capillary blood cell velocity was significantly decreased in the migraine group under all test conditions. Drug treatment did not account for the different prevalences of vasospasm in migraine patients and normal controls. Our findings demonstrate that patients with migraine often have subclinical microcirculatory disorders of the upper limbs.

Microvascular Hemodynamics in Hypertension and Diabetes

Microvascular damage occurs in both diabetes and hypertension and hypertension is a risk factor for diabetic microangiopathy. In both conditions, indirect evidence suggests that capillary pressure might be raised. A servonulling pressure measuring technique has been used in conjunction with direct micropuncture of finger nailfold capillaries to determine capillary pressure dynamically. In patients with essential hypertension, capillary pressure is raised compared to matched normotensive controls. In insulin-dependent diabetic patients, capillary pressure is also raised, to a degree that correlates with recent diabetic control. In a pilot study of hypertensive diabetic patients, elevated capillary pressure has been normalized using an angiotensin-converting enzyme inhibitor. Manipulation of microvascular hemodynamics in diabetes and hypertension may provide a means of protecting against the microvascular complications of these two conditions.

Reaction of Capillary Blood Cell Velocity in Nailfold Capillaries to Nifedipine and Ketanserin in Patients with Vasospastic Disease

By using nailfold videomicroscopy in conjunction with local exposure of 60 s to cold air, the acute haemodynamic responses in capillary blood cell velocity 60 min after a single oral dose of 20 mg sustained-released nifedipine and 20 mg ketanserin were evaluated for each substance in 12 patients with vasospastic disease. The results obtained showed that the cold-induced flow stop duration was significantly (P less than 0.05) decreased and capillary blood cell velocity significantly (P less than 0.05) increased after local cooling. Systolic and diastolic blood pressure, heart rate and skin temperature did not differ significantly before and after treatment with either nifedipine or ketanserin. It is concluded that nifedipine and ketanserin are useful agents in the treatment of digital vasospastic disease. Furthermore, in vivo videomicroscopy is one of the few non-invasive and clinically useful direct methods for evaluating the effect of a drug on the microcirculation of normal and ischaemic skin areas.

Microvascular Hemodynamics in Hypertension and Diabetes

Microvascular damage occurs in both diabetes and hypertension and hypertension is a risk factor for diabetic microangiopathy. In both conditions, indirect evidence suggests that capillary pressure might be raised. A servonuiling pressure measuring technique has been used in conjunction with direct micropuncture of finger nailfold capillaries to determine capillary pressure dynamically. In patients with essential hypertension, capillary pressure is raised compared to matched normotensive controls. In insulin-dependent diabetic patients, capillary pressure is also raised, to a degree that correlates with recent diabetic control. In a pilot study of hypertensive diabetic patients, elevated capillary pressure has been normalized using an angiotensin-converting enzyme inhibitor. Manipulation of microvascular hemodynamics in diabetes and hypertension may provide a means of protecting against the microvascular complications of these two conditions.