Regarding the clinical diagnosis of Raynaud's phenomenon and its associated conditions, investigations and treatment are substantial, and yet no international consensus has been published regarding the medical management of patients presenting with this condition. Most knowledge on this topic derives from epidemiological surveys and observational studies; few randomized studies are available, almost all relating to drug treatment, and thus these guidelines were developed as an expert consensus document to aid in the diagnosis and management of Raynaud's phenomenon. This consensus document starts with a clarification about the definition and terminology of Raynaud's phenomenon and covers the differential and aetiological diagnoses as well as the symptomatic treatment.

• Klíčová slova
• Raynaud’s, hand arm vibration, systemic sclerosis, vasospasm,
• MeSH
• konsensus MeSH
• lidé MeSH
• prediktivní hodnota testů MeSH
• Raynaudova nemoc klasifikace   diagnóza   epidemiologie   terapie   MeSH
• rizikové faktory MeSH
• terminologie jako téma MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• směrnice pro lékařskou praxi MeSH

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

Raynaud's phenomenon (RP) is a very common sign which can usually be seen across all medical specialties. It is characterized by episodic color changes of acral parts of the body (palor, cyanosis, rubor) lasting from a few minutes to hours, which are usually triggered by cold temperature and/or stress. The primary RP occurs alone, without concomitant diseases, is usually benign and has favorable prognosis. Secondary RP occurs in a variety of diseases with a very variable progression and prognosis, mostly unfavorable one due to the development of ischemic tissue necrosis and gangrene. This work provides a comprehensive overview of the history, current knowledge about the epidemiology and pathogenesis and the recommended evaluation and treatment of RP.

• Klíčová slova
• Raynaud's phenomenon, capillaroscopy treatment., primary, secondary,
• MeSH
• alfa blokátory terapeutické užití   MeSH
• antihypertenziva terapeutické užití   MeSH
• fyzikální vyšetření metody   MeSH
• lidé MeSH
• Raynaudova nemoc diagnóza   farmakoterapie   MeSH
• revmatické nemoci diagnóza   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• alfa blokátory MeSH
• antihypertenziva MeSH

INTRODUCTION: Raynaud's phenomenon (RP) is a paroxysmal and recurrent acral ischemia resulting from an abnormal arterial vasospastic response to cold or emotional stress. Homocysteine, a sulphured amino acid, has been linked to cardiovascular and neurodegenerative diseases, diabetes, thrombosis, and bone fragility. Homocysteine has been also linked to the pathogenesis of RP, as increased serum homocysteine (S-homocysteine) levels were observed in patients with RP. OBJECTIVE: As all publications concerning S-homocysteine in RP involved only adult patients, our aim was to evaluate S-homocysteine in children and adolescents with RP. METHODS: Nineteen patients (two boys and 17 girls; mean age 16.1 ± 2.2 SD) with primary RP were enrolled. The controls were 51 children and adolescents (21 boys and 30 girls; mean age 15.1 ± 1.8 SD). RESULTS: The S-homocysteine level was significantly higher in the RP group in comparison with controls (11.2 ± 2.4 vs. 8.0 ± 2.0 µmol/L; P = 0.00001). S-homocysteine levels in RP were not age-dependent. CONCLUSION: Paediatric patients with RP have increased S-homocysteine levels, suggesting that homocysteine plays an important role in the development of vascular dysfunction, even at an early age.

• MeSH
• dítě MeSH
• homocystein krev   MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• Raynaudova nemoc krev   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• homocystein MeSH

• Klíčová slova
• RAYNAUD'S DISEASE *,
• MeSH
• lidé MeSH
• Raynaudova nemoc * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Ketanserin was used in a randomized double-blind trial in 15 patients with Raynaud's phenomenon in progressive systemic sclerosis (PSS). Its effect on Raynaud's phenomenon was evaluated by IR-radiometry, Doppler ultrasound, nailfold capillaroscopy, frequency of finger ulcerations and patient complaints before and after a 3-month course of treatment with oral ketanserin in the dosage of 60 mg daily in the first month and 120 mg in the second and third months. Of the 8 patients treated with ketanserin, 5 showed improvement. In the other 2 patients with progression of skin sclerosis and multiorgan involvement, the peripheral vascular disorder was unchanged. Ketanserin treatment was discontinued in one patient owing to dizziness and anxiety. In one patient ketanserin was reduced to 60 mg daily because of fluid retention. There were no other adverse effects. In 7 control patients on placebo there was no significant improvement in Raynaud's phenomenon. Ketanserin, a selective, specific and pure antagonist of 5-hydroxytryptamine (serotonin) appears to be an effective agent in the treatment of Raynaud's phenomenon and digital ischaemic ulcers in PSS. Moreover, ketanserin could contribute to the understanding of the role of 5-hydroxytryptamine in PSS pathogenesis.

• MeSH
• dospělí MeSH
• dvojitá slepá metoda MeSH
• ketanserin terapeutické užití   MeSH
• klinické zkoušky jako téma MeSH
• lidé středního věku MeSH
• lidé MeSH
• náhodné rozdělení MeSH
• prsty ruky krevní zásobení   MeSH
• Raynaudova nemoc farmakoterapie   etiologie   patofyziologie   MeSH
• regionální krevní průtok účinky léků   MeSH
• systémová sklerodermie komplikace   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• ketanserin MeSH

Blood flow through the brachial and radial artery at different temperatures and during reactive hyperaemia was measured in 23 patients with Raynaud's phenomenon (9 patients with Raynaud's disease, 7 - Raynaud's syndrome with thoracic outlet syndrome (TOS), and 8 - Raynaud's syndrome and scleroderma), and 11 control subjects. Blood flow was determined by an ALVAR pulse-wave Doppler system enabling measurement of vessel diameter and blood flow rate. The measurements suggest that the blood flow through brachial artery reflects the changes of blood flow through the hand immersed in water of different temperatures. Maximum vasoconstriction was the same in all groups of Raynaud's phenomenon. The lowest blood flow at higher temperatures and during reactive hyperaemia was found in patients with scleroderma, whereas in the group of TOS and partly in patients with Raynaud's disease one can suspect only functional changes.

• MeSH
• arteria brachialis patofyziologie   MeSH
• dospělí MeSH
• lidé MeSH
• lokalizovaná sklerodermie komplikace   patofyziologie   MeSH
• mladiství MeSH
• ponoření MeSH
• Raynaudova nemoc komplikace   patofyziologie   MeSH
• regionální krevní průtok MeSH
• rychlost toku krve MeSH
• syndrom horní hrudní apertury komplikace   patofyziologie   MeSH
• teplota MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

The dose-effect relationship showed in the Annex A of the ISO standard 5349-1986 can be used for preventing vibration-induced white fingers (VWF) because it allows to calculate the latent period for the lowest risk of VWF. The aim of this study was to assess the risk of VWF in three different occupational groups of workers whose members operated the same vibrating power tools and the same industrial processes throughout the workday. Each occupational group was employed in two foundries and they were considered to be very stable with a low turnover rate. The mean frequency-weighted acceleration magnitudes measured from pneumatic rammers (25.3 +/- 3.3 ms-2) where three times higher than from chipping hammers (8.4 +/- 3.8 ms-2) and six times higher than from grinders (3.8 +/- 1.1 ms-2). Medical examinations were carried out in 102 men consisting of 22 chippers, 42 rammers and 38 grinders. The results of this study showed that the relationship between lifetime exposure to hand-arm vibration and the vascular disorders can be predicted quite well using the Annex A of ISO standard only in one occupational group, that is, in chippers. Thirty-six percent of chippers reported blanching symptoms, but only five percent of the rammers and three percent of the grinders had these vascular disturbances. Our results may be explained by the fact that vibration received by an operator depends on the manner in which the tool is used. In a foundry three following work processes are performed: preparing forms in ramming mix, cleaning and grinding of castings during which different forces are used by operators. It seems very likely that the energy absorbtion in the hands and arms of chippers must be stronger than in other studied groups.

• MeSH
• dospělí MeSH
• hutnictví MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci z povolání diagnóza   etiologie   MeSH
• prediktivní hodnota testů MeSH
• Raynaudova nemoc diagnóza   etiologie   MeSH
• ruka krevní zásobení   MeSH
• syndrom MeSH
• vibrace škodlivé účinky   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• Klíčová slova
• RAYNAUD'S DISEASE *, SCLERODERMA *,
• MeSH
• lidé MeSH
• Raynaudova nemoc * MeSH
• systémová sklerodermie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

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