Tc PO2 Research Articles

A New Grape Seed Extract Pharma Standard Supplement (ECOVITISTM) Prevents and Controls Borderline Hypertension and Endothelial Dysfunction

This registry evaluates the effect of ECOVITIS™ (grape seeds extract) in borderline hypertension (also evaluating endothelialmediated vasodilatation). The main targets of the registry were the normalization of blood pressure and of an altered endothelial function (EF); 3 groups of 15 subjects used: Standard Management (SM) (GROUP 1); GROUP 2: SM+ECOVITIS™ (150 mg/day); GROUP 3: SM+ECOVITIS™ (300 mg/day). Results. The groups were comparable. Tolerability/safety were optimal. Blood tests, urines and ECG were normal at 4 and 12 weeks. BMI showed, minimal variations (<26) in 3 months. Blood pressure (systolic, diastolic) and heart rate indicate a progressive improvement in Group 3 (p<0.05) with better values at 4 and 12 weeks. The lower dose improved (p<0.05) blood pressure and heart rate better than SM. Lipids and oxidative stress were improved better with the high dose (p<0.05). The lower dose resulted better than SM (<0.05). Other metabolic parameters (blood sugar and glycosylated hemoglobin) followed the same patterns (Group 3 resulted better that the other two groups) (p<0.05). Laser Doppler measurements (skin flux) and strain gauge plethysmography measured an improvement in post-occlusive flow (EF) at the level of the arm (p<0.65). This was confirmed by artery ultrasound measurements showing a larger increase in size in the brachial artery after occlusion with ECOVITIS TM (subjects in Group 3 had the best results (p<0.025); the lower dose (Group 2) was superior to SM (p<0.05). Tc PO2 increased more in group 3 (p<0.05); PCO2 was decreased. Results in the lower dose group were better (p<0.05) than results in the SM patients. In conclusion, this pilot registry shows that ECOVITIS™ is safe, well tolerated and may control and improve blood pressure and EF in borderline subjects. More studies may be needed for a longer period of time.

Feasibility and 1-Year outcomes of subintimal revascularization with supera® stenting of long femoropopliteal occlusions in critical limb ischemia: The "Supersub" Study.

Stent-based revascularization of long femoro-popliteal (FP) lesions has been mainly studied in claudicants and compromised by restenosis and stent fractures. The Supera® stent's biomimetic design allows enhanced fracture resistance. Data for Supera® stenting to treat long chronic total occlusions (CTOs) in patients with critical limb ischemia (CLI), are scarce. To assess long-term outcomes of subintimal revascularization with Supera® stenting, for long FP CTOs in patients with CLI. Prospective, single-center, single-arm study of 34 consecutive CLI patients with FP TASC C and D CTOs, who underwent Supera® stenting after subintimal crossing. Primary efficacy endpoint was 1-year patency and freedom from target lesion revascularization (TLR). Primary safety endpoint was the composite rate of freedom from death from any cause, major amputations, and TLR at a year. Secondary endpoints were stent integrity, clinical improvement, amputation free-survival, quality of life, and cost-efficiency. Mean lesion length was 27.9 ± 10.2 cm. Acute technical success was 100%. Primary patency was 94.1%. Freedom from TLR was 97.1%. Limb salvage was 100%. Clinical improvement was observed in 100% of patients: TC PO2 increased from 12.7 ± 6.2 to 54.8 ± 8.4 mm Hg (p < 0,0001); and 100% of patients experienced a shift in Rutherford to class 0 (p < 0.0001). There were no stents fractures. Amputation free-survival was 82.4%. Subintimal revascularization with Supera® stenting in CLI patients with long FP occlusions, is feasible and superior to validated efficacy performance goals. Larger multicenter studies are needed to validate the safety and efficacy of this novel alternative approach. © 2016 Wiley Periodicals, Inc.

AS-122 The Influence of Leg Horizontal or Down Position on Transcutaneous Oxygen Tension Level and the 6 month-Clinical Outcome in Critical Limb Ischemia Patients with Wound Undergoing Peripheral Transluminal Angioplasty

Transcutaneous oxygen tension (Tc PO2) monitoring was known to be an effective determinant for evaluating critical limb ischemia (CLI). However, Tc PO2 could be changed according to the pt's lower extremity position, either leg horizontal or down position. We evaluated whether there are differences in Tc PO2 results according to patient (pt)'s leg position and impact of TcPO2 results on procedural success, complications and midterm clinical outcomes in CLI pts undergoing percutaneous transluminal angioplasty (PTA).

Preoxygenation for tracheal suctioning in intubated, ventilated newborn infants.

Endotracheal suctioning for mechanically ventilated infants is routine practice in neonatal intensive care. However, this practice is associated with serious complications including lobar collapse, pneumothorax, bradycardia and hypoxemia. Increasing the inspired oxygen immediately prior to suction (preoxygenation) has been proposed as an intervention to minimise the risk of complications. To compare the effects of preoxygenation with no preoxygenation for endotracheal suctioning on ventilated newborn infants. To conduct sub group analyses by i) different populations of newborn infants; by gestational age <30 weeks, <34 weeks and <37 weeks and by disease; infants with chronic lung disease compared to those without and; ii) by different techniques of endotracheal suctioning; with or without disconnection from the ventilator, increased mechanical ventilation, use of manual ventilation and chest wall vibrations or percussion. The standard search strategy of the Neonatal Review Group was used. This included searches of electronic databases; Oxford Database of Perinatal Trials; Cochrane Controlled Trials Register (Cochrane Library Issue 1 2001); MEDLINE (1966 - April 2001); and CINAHL (1982-2001) using MeSH term infant-newborn and text terms oxygen* and suction*, preoxygenation, pre-oxygenation and premature and also previous reviews including cross references, abstracts in conferences and symposia proceedings, expert informants, journal hand searching in the English language. Random or quasi random controlled trials of mechanically ventilated neonates in which endotracheal suctioning with preoxygenation was compared to suctioning without preoxygenation. Standard methods of the Cochrane Collaboration and its Neonatal Review Group were used, including independent assessment of trial quality and extraction of data by the authors. Data were analysed using relative risk (RR) for dichotomous outcomes and mean difference (MD) for data measured on a continuous scale with the use of 95% confidence intervals. Meta-analysis was conducted using a fixed effects model. One cross-over trial involving outcomes for 16 preterm neonates was included in this review. Preoxygenation, prior to an endotracheal suctioning procedure involving two suctions, resulted in a statistically significant reduction in infants with hypoxemia (TcPO2 <40 mmHg) at the end of the first suction (RR 0.18, 95% CI 0.05, 0.69), at the end of the second suction (RR 0.23, 95% CI 0.08, 0.66) and also at 120 seconds after the second suction (RR 0.10, 95% CI 0.01, 0.69). Mean TcPO2 was statistically significantly higher in the preoxygenation group at the end of the first suction (MD 25.00 mmHg, 95%CI 14.20, 35.80), second suction (MD 24.80, 95% CI 14.80, 34.80) and also at 120 seconds after the second suction (MD 29.10, 95% CI 14.96, 43.24). The time taken to return to baseline oxygenation status was shorter than the group not receiving preoxygenation (MD -2.12 minutes, 95% CI -3.82, -0.42). No recommendations for practice can be confidently made from the results of this review. Although preoxygenation was shown to decrease hypoxemia at the time of suctioning, other clinically important short and longer-term outcomes including adverse effects were unable to be assessed. Further studies are needed to adequately assess the effects of this widely practiced procedure.

Dry development in an O2/SO2 plasma for sub-0.18 μm top layer imaging processes

Dry development using thin layer imaging (TLI) in either a bilayer approach or top surface imaging are currently investigated as viable alternatives to extend optical lithography to 0.13 μm and below. This article describes a systematic study of dry development in a LAM TCP9400SE inductively coupled plasma etcher for both a single layer TLI resist process and for a bilayer resist process using O2 and SO2/O2 chemistries. The effect of the important machine parameters such as TCP power, bias power, O2 and SO2 gas flows, on the process characteristics (etch rate, selectivity, uniformity, anisotropy) and on the lithographic performance (resolution, profile control, proximity) of a TSI process at 248 has been investigated by means of statistically designed experiments. As line edge roughness (LER) is a critical issue for TSI, the effect of the dry development conditions on LER have been quantified. The effect of temperature on profile control is also presented. In a second part of this article, these trends have been applied to the process optimization for a bilayer resist process at 193 nm. With an optimized dry development process, good profile control is demonstrated down to 0.12 μm L/S resolution.

Changes in Microcirculation in Patients with Atrophie Blanche Visualized by Laser Doppler Perfusion Imaging and Transcutaneous Oxygen Measurements

Objective: To quantify differences in microcirculation in atrophie blanche (AB) in patients with chronic venous insufficiency (CVI) and in healthy controls before and after venous occlusion. Design: Prospective study in a single patient group. Setting: Department of Dermatology, University Hospital Maastricht, The Netherlands. Patients and methods: Sixteen patients with CVI and large lesions of AB, 10 patients with CVI without AB and 10 healthy controls were enrolled in the study. Laser Doppler perfusion imaging (LDPI) measurements were performed in and outside large lesions of AB and in healthy controls. Transcutaneous oxygen (Tc Po2) measurements were performed in patients with CVI with and without AB and in healthy controls. Results: Median basal resting flow was higher in AB than in healthy controls (0.67 mV versus 0.21 mV, p = 0.002). The venoarteriolar response (VAR was increased significantly in AB (58% versus 43%, p = 0.04). A significant decrease in Tc Po2 values occurred in AB lesions with 40 mmHg, in CVI skin with 60 mmHg and in healthy controls with 80 mmHg. Conclusion: Basic resting flux in AB measured with LDPI is increased compared with clinically normal skin. The decrease in flux on venous occlusion is larger in AB than in healthy controls.

A Double-Blind Clinical Trial of Hydroxyethylrutosides in the Treatment of the Symptoms and Signs of Chronic Venous Insufficiency

Objective: To study the safety and efficacy of hydroxyethylrutosides (HR) in patients with chronic venous insufficiency (CVI) (Widmer grade II) and examine any correlation with objective measurements (plethysmography and Tc Po2). Design: Double-blind, randomized, placebo-controlled, multicentre trial. Setting: One outpatient university angiology clinic, one outpatient angiology clinic in a military hospital and one private angiological consultation, all in the Paris area. Patients: One hundred and nine patients with grade II Widmer CVI, confirmed by echo-Doppler and plethysmography. Elastic stockings were excluded. After five exclusions, 53 received HR and 51 placebo. Interventions: Patients randomized to one sachet of 1 g HR twice daily (or placebo) for 2 months, after a 1 month placebo run-in period. Examinations on entry to the trial (T–1), after 1 month run-in (T–0) and after 1 (T+1) and 2 months (T+2) treatment. Main outcome measures: These were measured at each of the four visits. Primary outcome: minimal ankle and maximal calf circumferences. Secondary outcomes: five individual leg symptoms and total symptom score, pitting oedema. Plethysmography (six calculated variables) and Tc Po2. Results: The reduction of both ankle and calf circumferences was significantly greater in the HR group ( p&lt;0.0001), as was pitting oedema ( p&lt;0.001), the five individual symptoms and the total symptom score ( p&lt;0.001). Of the plethysmographic findings, there was a significant reduction in maximum venous outflow ( p&lt;0.001 at T+1 and p&lt;0.05 at T+2). Overall there was no significant change in Tc Po2. Conclusions: HR is an effective and well-tolerated treatment for leg oedema and symptoms of patients with CVI.

Skin blood flow influences the transcutaneous PCO2 (tc PCO2) during stress in the guinea pig.

The transcutaneously measured carbon dioxide tension (tc PCO2) allows fetal monitoring in a continuous and non-invasive way. Though tc PCO2 is correlated well with the fetal acid-base balance, rather large variations in tc PCO2 exist. A decreased skin blood flow is known to influence the transcutaneous oxygen tension (tc PO2), and tc PCO2 might be affected in an equal way. During fetal asphyxia skin blood flow is extremely reduced. Thus, tc PCO2 might be affected by fetal asphyxia, which it is supposed to detect. To elucidate the role of reduced skin perfusion on tc PCO2, experiments on acutely instrumented guinea pigs were performed and skin perfusion was changed by injection of catecholamines. During control tc PCO2 was twice as high as the arterial PCO2 due to a reduced skin perfusion. After injection of catecholamines skin blood flow rose, tc PCO2 fell and the arterio-transcutaneous difference in PCO2 decreased. Then skin perfusion decreased and tc PCO2 increased. We conclude, that during stress situations with a low skin perfusion, as the acutely instrumented guinea pig, tc PCO2 is higher than the arterial PCO2 and can be influenced by changes in skin blood flow. These findings are relevant for the interpretation of tc PCO2 recordings during fetal asphyxia, where an extreme vasoconstriction exists.

Changes of Skin Microcirculation in Patients with Chronic Venous Insufficiency Assessed by Laser Doppler Fluxmetry and Transcutaneous Oxymetry

Objective: To evaluate whether microcirculatory disturbances of the skin in patients with chronic venous insufficiency are a generalized phenomenon or restricted to visible skin changes. Design: Open, prospective study in patients and healthy, age-matched subjects. Setting: Department of Angiology, Hannover Medical School. Patients: Seventy-one patients with chronic venous insufficiency. Measurements: Transcutaneous oxygen pressure (tc Po2) at electrode core temperatures of 37°C and 44°C and laser Doppler flux (LDF) were measured simultaneously in different regions of the legs. Results: On the forefoot, tc Po2 (37°C) at rest and tc Po2 (44°C) during arterial ischaemia were significantly higher in patients ( P&lt;0.05), increasing with the severity of chronic venous insufficiency. Conclusions: Cutaneous capillary flow on the forefoot is increased in patients with chronic venous insufficiency, demonstrating the general effect of venous hypertension.

169 LOW-DOSE INHALED NITRIC OXIDE (NO) IN INFANTS WITH BRONCHOPULMONARY DYSPLASIA (BPD)

BPD is characterised by severe maldistribution of ventilation, hypoxia, hypercapnia and pulmonary hypertension. Similar observations are made in adults with chronic obstructive lung disease (COLD), in whom impairment of endothelium-dependent pulmonary vascular relaxation has been demonstrated. Inhaled NO has recently been demonstrated to improve gas exchange in COLD. The effect of inhaled NO on gas exchange was therefore investigated in 6 infants (26-32 weeks gestation) with BPD receiving mechanical ventilation and with a fraction of inspired oxygen of >0.7. NO at doses of 5-40 parts per million (ppm) was administered into the inspiratory gas for 15 minute periods with 10 minute washout periods. NO administration was continued at the lowest most effective dose when marked improvements in oxygenation were observed. Oxygen saturation (Sa O2), transcutaneous oxygen/carbon dioxide tensions (tc pO2/tc pCO2) and systemic blood pressure (BP) were continuously monitored. Methaemoglobin (MetHB) and nitrogen dioxide (NO2) levels were also measured. Inhalation of NO at all doses produced consistent improvements in the Sa O2 and tc pO2 (confirmed by concurrent arterial blood gases). The tc pCO2 showed a tendency to fall. While 5ppm NO produced a smaller response in oxygenation parameters, 10-40 ppm NO produced similar responses. The percentage changes from baseline values (median and range) in tc pO2, tc pCO2 and Sa O2 at a dose of 10 ppm were +58.2% (25 - 261.5), -15.8% (+2.6 to -21) and +19.8% (5.5 - 52.5) respectively. NO was administered continuously for 9-52 days with no evidence of tachyphylaxis. BP was marginally improved or unchanged. MetHB levels were <2% and NO2 <1ppm. We conclude that inhaled NO improves gas exchange in BPD and speculate that NO synthesis and/or release may be impaired in BPD. (Supported by tne Royal Society).

Microangiopathy in Chronic Venous Insufficiency before and after Sclerotherapy and Compression Treatment: Results of a One-Year Follow-up Study

Objective: To characterize microangiopathy in patients with chronic venous insufficiency (CVI) of a moderate to severe stage and to evaluate improvement of the microcirculatory parameters after sclerotherapy of incompetent perforators and compression therapy. Design: Fluorescence videomicroscopy (Na-fluore-scein), laser Doppler fluxmetry and tc Po2 measurements (43°C) at the medial ankle in healthy controls and patients. Laser Doppler flux and tc Po2 were recorded in supine and sitting position in order to evaluate postural vasoconstriction. The measurements were repeated 6 and 12 months after sclerotherapy of incompetent perforators (Polidocanol 40 mg/ml) and compression therapy by below-knee class II or III stockings (Sigvaris®). Setting: Department of Internal Medicine, Angiology Division, University Hospital, Zurich, Switzerland. Patients, participants: 15 healthy subjects (15 legs, mean age 53.3 years) and 15 patients with CVI of a moderate to severe stage (17 legs, mean age 56.8 years). Results: Microangiopathy in CVI is characterized by significantly enlarged, elongated and dilated capillaries with increased diameters of the pericapillary spaces (‘halos’). Single capillaries may be thrombosed. Laser Doppler flux is increased and tc Po2 is decreased. After therapy, there was a trend to decreased laser Doppler flux and an increase in tc Po2, but the differences were not statistically significant. Capillary thromboses were no longer detected. Mean halo diameters tended to decrease, but this difference was not statistically significant. Conclusions: Microangiopathy in CVI is characterized by morphological and functional changes. Beneficial changes induced by therapy develop slowly and emphasize the importance of long-lasting treatment.

Impact of ischemia on tissue oxygenation and wound healing: intravital microscopic studies on the hairless mouse ear model.

To determine the effect of ischemia on tissue oxygenation and the healing of experimental wounds, chronic ischemia was induced in the ears of hairless mice by ligating 2 of the 3 main nutritional arteries. Tissue ischemia was verified by measurement of transcutaneous pO2 (tcpO2) prior to and on days 3, 6, 9, 12 and 15 after vessel ligation. TcpO2 values decreased from 24 to 6 mm Hg at day 2 after ligation, and slowly recovered to 12 mm Hg at day 12 after vessel ligation. In animals treated with the vasoactive drug buflomedil (3 mg/kg BW i.v., startling 2 days after vessel ligation) tcpO2 values were significantly higher on days 6 and 9 when compared to saline-treated control animals. In order to find out whether the enhanced tissue oxygenation resulted in enhancement of healing of wounds, we created circular wounds (diameter = 2.5 mm, depth 0.1 mm) on ischemic ears 2 days after vessel ligation. The wound surface area was measured by means of intravital fluorescence microscopy and digital planimetry at 3-day intervals until the time of wound closure. These experiments were performed on buflomedil-treated and control animals receiving equivalent amounts of saline. The reduction of wound surface area was accelerated and wound closure time was reduced from 15 days in control animals to 12 days in buflomedil-treated animals (p < 0.01). Functional capillary density as well as the microhemodynamic parameters microvessel diameter and red blood cell velocity were not different between buflomedil-treated and control animals.

Effects of oxygen inhalation on skin microcirculation in patients with peripheral arterial occlusive disease.

Oxygen administration is currently used in clinical medicine to improve peripheral oxygen delivery to tissues threatened by ischemia. However, conflicting results have been reported on the effects of oxygen in ischemic areas. This study was aimed at investigating the effects of 40% oxygen inhalation on the skin microcirculation in the feet of patients with peripheral arterial occlusive disease (PAOD). Transcutaneous oxygen tension (tc PO2) was measured on the dorsal skin of the foot, and the nailfold microcirculation was investigated by a combination of laser Doppler flowmetry (LDF) and dynamic capillaroscopy (CBV) in the great toes of 17 legs of 11 patients, with 13 legs of eight normal subjects as a control group. Inhalation of oxygen induced a significant decrease of both the total (delta LDF, -307%, p less than 0.02) and nutritional (delta CBV, -17%, p less 0.002) skin microcirculation in normal legs compared with baseline values. A similar response was observed in 10 legs of patients who showed a significant increase of the tc PO2 (greater than or equal to 10 mm Hg) (delta LDF, -14%, NS; delta CBV, -13%, p less than 0.005). By contrast, both the total (+21%, p less than 0.03) and nutritional (+52%, p less than 0.05) circulation significantly increased in the seven legs without significant tc PO2 increase. In addition, the flow motion, which was impaired in the patients, was significantly (p less than 0.05) improved by oxygen inhalation. Inhalation of 40% oxygen induces a vasoconstriction in the skin microcirculation of toes of the normal subjects and patients with moderate PAOD but induces an increase of the skin microcirculation in patients with severe PAOD.

31 THE EFFECT OF AMINOPHYLLINE ON CEREBRAL, HADDYNAMICS ASSESSED BY NEAR INFRA-RED (NIR) SPECTROSCOPY

NIR spectroscopy was used to measure the effect of aminophylline on cerebral blood flow (CBF) and volume (CBV). Mean arterial BP, heart rate, transcutanenus (tc) pO2 and μO2 and intracerebral concentrations of oxyhaemoglobin (oxyHb), deoxyhaemoglobin, and cytochrome aa3 were continuously recorded (Hamamatsu Photonics KK, NIR1000). CBF was estimated using change in oxyHb concentration as a tracer (ret.1). Twenty CBF measurements wore made on 4 preterm infants (birthweight 739-893g. gestation 25 - 28w, age 3-18d) receiving a loading infusion of 6.2 mgs/kg aminophylline. CBF was unchanged in one infant and fell in 3. Median reduction of CBF was 23% (median 3.8 mls/100g/min, range 0 - 9.8). There was no consistent change in CBV. All infants showed a slight fall in tcpCO2 (median 0.2 KPa range 0.14 - 0.7) and a rise in mean BP (median 3mmHg, range 2 - 4). Aminophylline may have effects on CBF independent of CO2 mediated changes.

Liposclerotic Skin: A Diffusion Block or a Perfusion Problem?

There is continued debate as to whether skin damage in venous disease results from an oxygen diffusion block or from abnormal perfusion. Transcutaneous oxygen pressure and laser-Doppler flux were measured in 15 patients with chronic venous insuffiency (CVI) and lipodermatosclerosis and in 15 normal controls. The time for Tc Po2 to regain resting values after 5 min of ischaemia was measured, as was the time taken for laser-Doppler flux to reach 95% of peak flow. Tc Po2 was reduced in patients with CVI (median 26 mmHg, interquartile range (IQR) 16–46) compared to controls (median 55 mmHg, IQR 40–65). Hyperaemic responsiveness, as assessed by calculating the ratio of peak laser-Doppler flux following 5 min of ischaemia, was also reduced (median (CVI) 1.5, IQR 1.1–2; median (control 3.3, IQR 1.8–4.8). However, following ischaemia Tc Po2 took no longer to regain resting levels in venous patients than in controls, whereas there was a trend towards delay in reaching peak skin blood flow. These findings suggest a primary perfusion deficit in skin damaged by venous hypertension rather than an oxygen diffusion block.

Surgical Enhancement of Skin Oxygenation in Patients with Venous Lipodermatosclerosis

Lipodermatosclerosis and venous ulceration may result from ***long-standing venous hypertension. Furthermore, venous ulceration is associated with reduced transcutaneous oxygen tension, (Tc Po2).This study investigates the effect of surgical removal of varicose veins upon skin oxygenation postoperatively, thereby influencing any subsequent venous ulceration.Patients with unilateral long saphenous vein incompetence, were studied consisting of 10 males and nine females, (mean overall age = 50 ± 3 years). Tc Po2measurements at rest and using 100% oxygen stress testing were performed 24 h preoperatively under standard test conditions, with the contralateral limb serving as control.Patients with lipodermatosclerosis were confirmed to have an oxygen diffusion block preoperatively in the affected limb, ( P = 0.02). Surgical correction of venous hypertension produced significant improvement in oxygen diffusion after stress testing ( P = 0.003) compared to control limbs or patients with uncomplicated varicose veins.Surgical correction of incompetent varicose veins in patients with lipodermatosclerosis resulted in the improvement of Tc Po2which may delay or prevent subsequent venous ulceration.

Caffeine and Cerebral Blood Flow Velocity in Preterm Infants

Continuous wave Doppler monitor was used to examine the effect on cerebral blood flow velocity (CBFV) of caffeine in 7 clinically stable preterm neonates suffering from apnea. Caffeine, as caffeine citrate at a loading dose of 20 mg.kg-1 BW, or saline were given intravenously. Every subject was his own control. Placebo (saline) was systematically injected prior to caffeine citrate. Simultaneous recording of heart rate, arterial blood pressure, respiratory rate, Tc PO2, and Tc PCO2 were made before, at the end of the injection, and 30, 60 and 120 min after the end of each administration of either placebo or caffeine. Compared with placebo, caffeine injection was not associated with significant changes in CBFV. An increase was found in both heart rate and respiratory rate (p less than 0.05). Mean arterial blood pressure, Tc PCO2 and Tc PO2 did not change significantly. Our data suggest that a caffeine citrate loading dose of 20 mg.kg-1 BW as currently used at the beginning of treatment of apnea in preterm neonates has no effect on CBFV.

Stanozolol and the Treatment of Severe Chronic Venous Insufficiency

A report on an analysis of an open (pilot) study is given for evaluating the effectiveness of stanozolol in the treatment of chronic venous insufficiency (CVI). Twelve patients with CVI grade II–III according to Widmer were treated for 6 months with the modified anabolic steroid stanozolol. Evaluation of the influence of this drug on CVI was monitored with transcutaneous oxygen tension measurements (Tc Po2), light reflection rheography (LRR), histopathology and immunofluorescence techniques. After 3 and 6 months a statistically significant extension of the refilling time by LRR was observed. There is also a significant change in Tc Po2measurements at 3 months but not at 6 months. With immunofluorescence and peroxidase techniques, fibrinogen and collagen IV deposits are found in the majority of cases around the capillaries. It is postulated that these deposits play an important role in the pathogenesis of CVI. After treatment with stanozolol a significant reduction of the dermal space was observed in the lipodermatosclerotic plaque. It is concluded that in the treatment of CVI grade II–III stanozolol can be useful. A randomised double blind clinical trial is necessary to confirm this effectiveness.

Comparison of Arterial Oxygen Tension with Continuous lranscutaneous and Intravascular PO2 Sensors and Intermittent Blood Samples Taken from the Sampling Port of a Bubble Oxygenator

Measurements of transcutaneous PO2 (tc PO2), intraarterial PO2(PiO2) and PO2 of blood samples taken from the sampling port of the oxygenator (PoO2) were compared with arterial blood PO2 (PaO2) in 16 adult patients undergoing cardiopulmonary bypass. tcPO2 and PiO2 were recorded continuously using Roche-Kontron electrodes. PoO2 and PaO2 were measured intermittently on a Radiometer ABL2 blood gas analyser. A total of 86 observations were made on the 16 patients. The correlation coefficient (r) between transcutaneous and arterial PO2 was 0.69 (p&lt;0.001). The relationship between PoO2 and PaO2 was poor (r = 0.45, p&lt;0.01). The intra-arterial electrode readings showed no significant difference with the PO2 measured on arterial blood samples (r=0.99, p&lt;0.001).

Multiple Physiological Indices in the Management of Chronic Leg Ulcers

Transcutaneous oximetry (Tc Po2), laser Doppler flowmetry (LDV) and arterial Doppler index (DI) have been used to predict healing in 20 patients with chronic leg ulcers. This study showed that patients with improving or healed ulcers had significantly higher Tc Po2 levels adjacent to the ulcer ( P &lt; 0.02) and lower LDV ( P &lt; 0.05) and a tendency to higher DI than worsening or static ones.