AIMS: Raynaud's phenomenon (RP) is a relatively common disease. There are two distinct forms of RP - primary (PRP), where no other associated diseases are present, and secondary (SRP), where RP is associated with other diseases. It can be challenging to differentiate between RP and other diseases through medical history alone, due to the episodic nature of RP. Objective analysis of anamnestic data was performed in our study using infrared thermography (IRT) and a cold pressor test (CPT). Capillaroscopy was performed to assess morphological changes in the acral circulation. METHODS: Patients with a history of cold hands were included in the study. IRT was performed before and after the CPT, and then capillaroscopy was performed. The results (including epidemiologic data) were statistically evaluated. RESULTS: A total of 150 patients were included in the study. Summarisation of the results from the IRT and capillaroscopy determined the final diagnosis - 4.7% acrocyanosis, 10.7% physiologic findings, 31.3% PRP, 29.3% borderline SRP and 24% SRP. The coldest fingers following the CPT were, in most patients, the 2nd and 3rd fingers. The correlation between the presence of connective tissue disease and the diagnosis of borderline SRP and SRP was significant (P=0.0001). CONCLUSIONS: Using the combination of the IRT and capillaroscopy in the diagnostic algorithm for RP has its justification. IRT distinguishes healthy patients from patients with RP, and capillaroscopy can then be used to differentiate PRP from SRP. IRT can also detect which fingers are more affected, and then these can direct the focus of capillaroscopy.
- Klíčová slova
- Raynaud's phenomenon, capillaroscopy, cold pressor test, connective tissue disease, infrared thermography,
- MeSH
- dospělí MeSH
- infračervené záření MeSH
- lidé středního věku MeSH
- lidé MeSH
- mikroskopická angioskopie * MeSH
- Raynaudova nemoc diagnóza MeSH
- termografie * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Systemic sclerosis is classed as a diffuse (systemic) disease of connective tissue. It is a heterogeneous disease significantly shortening life expectancy. Its etiology is unknown. Pathogenetic interplay is assumed to involve a triad of pathological autoimmune inflammation, vasculopathy and fibrosis. Clinical manifestations can be classed based on the preponderant pathogenetic process. Vasculopathy is manifested by secondary Raynauds phenomenon with abnormal findings on the nailfold capillaroscopy, skin telangiectasias, gastric antral vascular ectasia, life threatening scleroderma renal crisis, digital ulcerations and prognostically severe pulmonary arterial hypertension. The treatment of vascular manifestations uses medicines with vasodilation effect. The manifestation of inflammation is accentuated by pleurisy, pericarditis, myositis, synovitis/arthritis and alveolitis. Finally, the manifestation of fibrosis predominates in association with dermatosclerosis, interstitial lung disease and fibrotic impairment of the gastrointestinal tract. Medicines with immunomodulatory or immunosupressive effects are used to affect the inflammation and fibrosis. Despite the aforementioned, there is still no universally effective treatment available. The pharmacological therapy of this disease is organ specific and symptomatic.Key words: capillaroscopy - digital ulcers - interstitial lung disease - pulmonary arterial hypertension - scleroderma renal crisis - systemic sclerosis.
OBJECTIVES: To develop recommendations for investigation and monitoring of children with Raynaud's syndrome, based on paediatric evidence collated by a systematic review. METHODS: A systematic review was undertaken to establish the paediatric evidence for assessment and monitoring of Raynaud's syndrome. An expert panel including members of the Paediatric Rheumatology European Society (PRES) Scleroderma Working Group, were invited to a consensus meeting where recommendations were developed based on evidence graded by the systematic review and where evidence was lacking, consensus opinion. A nominal technique was used where 75% consensus was taken as agreement. RESULTS: The expert panel recommended testing anti-nuclear antibody (ANA), more specific antibodies associated with connective tissue disease and nail-fold capillaroscopy in all children presenting with Raynaud's syndrome as data suggests these can be risk factors for evolution into a connective tissue disease. The frequency of follow-up recommended depends on presence of these risk factors with the aim to detect evolving connective tissue disease early in high risk individuals. Those with no abnormalities on capillaroscopy and negative autoantibodies were deemed low risk of progression, whereas those with ANA positivity, specific autoantibodies and/or nailfold capillary changes were deemed high risk and more frequent follow-up was recommended. CONCLUSIONS: Recommendations, primarily based on consensus opinion, were agreed regarding investigation and monitoring of children who present with Raynaud's syndrome. Further prospective studies are needed to better define the risk factors for progression to connective tissue disease.
- MeSH
- antinukleární protilátky krev MeSH
- biologické markery krev MeSH
- dítě MeSH
- konsensus MeSH
- lidé MeSH
- mikroskopická angioskopie normy MeSH
- mladiství MeSH
- pediatrie normy MeSH
- prediktivní hodnota testů MeSH
- prognóza MeSH
- progrese nemoci MeSH
- Raynaudova nemoc krev diagnóza terapie MeSH
- revmatologie normy MeSH
- rizikové faktory MeSH
- sérologické testy normy MeSH
- věkové faktory MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- směrnice pro lékařskou praxi MeSH
- systematický přehled MeSH
- Názvy látek
- antinukleární protilátky MeSH
- biologické markery MeSH
OBJECTIVE: Qualitative capillaroscopy patterns in juvenile- and adult-onset systemic sclerosis (SSc) were studied in adulthood using data from the EULAR Scleroderma Trials and Research (EUSTAR) database. METHODS: Data collected between June 2004 and April 2013 were examined with focus on capillaroscopy. In this retrospective exploratory study, series of patients with juvenile-onset SSc were matched with series of adult-onset SSc having the same gender and autoantibody profile. RESULTS: 30 of 123 patients with juvenile-onset and 2108 of 7133 with adult-onset SSc had data on capillaroscopy. Juvenile-onset SSc showed scleroderma pattern more frequently than adult-onset SSc (93.3% and 88%). The OR was 2.44 and 95% CI 0.57-10.41. An active scleroderma pattern was present in 58% of juvenile- and 61% of adult-onset SSc. The OR was 0.91 and 95% CI 0.28-2.93. The late scleroderma pattern was present in 61% of juvenile- and 55.5% of adult-onset SSc. The OR was 1.06 and 95% CI 0.34-3.56. CONCLUSION: This is the first exploratory study on the comparison of capillaroscopy between juvenile- and adult-onset SSc in adulthood. Juvenile-onset SSc had an increase prevalence of scleroderma pattern, but a similar distribution of the three patterns was suggested. Further studies are needed to define this issue.
- Klíčová slova
- Capillaroscopy, EUSTAR, Juvenile systemic sclerosis, Microcirculation, Nailfold capillaroscopy, Systemic sclerosis, Videocapillaroscopy,
- MeSH
- dítě MeSH
- dospělí MeSH
- kapiláry patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lokalizovaná sklerodermie patologie MeSH
- mikroskopická angioskopie MeSH
- mladiství MeSH
- mladý dospělý MeSH
- retrospektivní studie MeSH
- senioři MeSH
- systémová sklerodermie patologie MeSH
- věk při počátku nemoci MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- srovnávací studie MeSH
Microcirculation plays an important role in pathophysiology of a number of severe diseases. At present there exist many techniques that enable evaluation of microvascular perfusion. Some of them found their scientific and clinical use even in the Czech Republic. In last decade, articles referring about individual methods can be found even on the pages of Vnitřní lékařství journal. The aim of this work is to provide a comprehensive overview of methods that have been used for examination of the microcirculation to date. After a short review of the anatomy and physiology of the microcirculation, the article provides synopsis of the theoretical and practical use of individual methods including their advantages and disadvantages.
- MeSH
- kůže krevní zásobení MeSH
- laser doppler flowmetrie MeSH
- lidé MeSH
- mikrocirkulace * MeSH
- mikroskopická angioskopie MeSH
- oxymetrie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
OBJECTIVES: To develop an objective method of nailfold capillaroscopy (NFC), applicable to a wide age range of paediatric patients. To compare the morphological characteristics of the nailfold capillaries in different rheumatology patient groups and controls. METHODS: A colour digital video camera attached to a stereomicroscope was used to capture nailfold capillary images. Computerised image processing was used to analyse and store data. Subsequent quantitative and qualitative morphological analysis was performed in the following paediatric patient and control groups: 18 children with connective tissue diseases (CTD: juvenile dermatomyositis, systemic sclerosis, and undifferentiated connective tissue disease), eight with systemic lupus erythematosus, nine with primary Raynaud's disease, three with primary vasculitis, 15 with juvenile idiopathic arthritis, 17 healthy children and 20 healthy adults. Images were analysed by a single assessor who was unaware of the patient details. RESULTS: The NFC technique was simple to perform and gave reproducible results, although some intra- and intersubject variation was noted. Capillary density and width was age related, with younger children having fewer and wider capillaries than older children and adults. Linear capillary density was significantly higher in healthy adults (mean (SD) 8.6 (1.6) capillaries/mm) compared with healthy children (HC 6.9 (0.9) capillaries/mm). The group with CTD had the most abnormal findings, with lower linear density (4.9 (1.7) capillaries/mm) and increased capillary loop width (10.7 (7.3) mm) compared with HC (3.5 (1.7) mm). In addition, 11/18 (61%) patients in the CTD group had more than two definitely abnormal capillaries in at least two nailfolds, an abnormality not seen in other subjects. Two qualitative measures, the degree of avascularity and general disarrangement of capillary pattern, were more commonly observed in the CTD group than in HC. The proportion of tortuous capillaries did not differ significantly between study groups. CONCLUSIONS: This study is unique in measuring objective quantitative and qualitative parameters of the nailfold vasculature across a wide spectrum of age and disease. Differences in capillary morphology and frequency in children with CTD compared with other paediatric diseases and healthy controls were demonstrated. In the clinical situation, an assessment of the general degree of disarrangement may offer a fast tool for assessment of the nailfold vasculature which correlates well with NFC data.
- MeSH
- dítě MeSH
- jednoduchá slepá metoda MeSH
- kapiláry patologie MeSH
- lidé MeSH
- mikroskopická angioskopie metody MeSH
- mladiství MeSH
- nehty krevní zásobení MeSH
- nemoci cév patologie MeSH
- nemoci pojiva patologie MeSH
- předškolní dítě MeSH
- prospektivní studie MeSH
- Raynaudova nemoc patologie MeSH
- reprodukovatelnost výsledků MeSH
- revmatické nemoci patologie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- srovnávací studie MeSH
Aiming to observe directly the microcirculation after total artificial heart (TAH) implantation, we performed a long-term follow-up in 2 goats using conjunctival angioscopy. A short segment of parallel arteriole and venule was photographed and analyzed on computer picture program (magnification 40x). Three main parameters were measured: arteriole diameter, venule diameter, and arteriovenous ratio (A/V ratio). The intrathoracically implanted TAH was the undulation pump total artificial heart (UPTAH) with cardiac output of 100 ml/kg/min. To stabilize the peripheral hemodynamics a 1/R biofeedback control system was used. Our results provided only elementary data about morphology of bulbar microvessels. The main finding was the tendency to general vasoconstriction, more intensive on the venous side (*P < 0.05 in one goat). We did not observe any pathological shapes (e.g., tortuosities, varicosities, or sludge); this result could be attributed to the high effectivity of 1/R control method. These preliminary results should be considered only as an attempt to apply the widely used clinical method of conjunctival angioscopy to the conditions of TAH.
- MeSH
- arterioly patologie patofyziologie MeSH
- časové faktory MeSH
- hemodynamika fyziologie MeSH
- implantace protézy škodlivé účinky MeSH
- konjunktiva krevní zásobení patologie patofyziologie MeSH
- kozy MeSH
- mikrocirkulace fyziologie MeSH
- mikroskopická angioskopie * MeSH
- modely nemocí na zvířatech MeSH
- následné studie MeSH
- pooperační komplikace * MeSH
- umělé srdce škodlivé účinky MeSH
- vazokonstrikce fyziologie MeSH
- venuly patologie patofyziologie MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- Klíčová slova
- CAPILLARIES *, PREGNANCY/physiology *,
- MeSH
- kapiláry * MeSH
- kardiovaskulární systém * MeSH
- lidé MeSH
- mikroskopická angioskopie * MeSH
- porodnictví * MeSH
- těhotenství fyziologie MeSH
- Check Tag
- lidé MeSH
- těhotenství fyziologie MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
