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Raynaud's phenomenon as the initial manifestation
of hypothyroidism
Coleman C.E.; Sessoms S.L.; Gowin K.M.; Boston R.
Dr. S.L. Sessoms, 6550 Fannin Smith 1057, Houston, TX 77030
United States
Journal of Clinical Rheumatology (United States) 1998, 4/5
(270-273)
A 38-year-old man, who presented with Raynaud 's phenomenon
and no symptoms or signs of thyroid hormone deficiency, was
found to have hypothyroidism . The Raynaud 's phenomenon
disappeared after 11/2 months of thyroid hormone replacement
therapy. We review four case reports of Raynaud 's phenomenon
that disappeared after thyroid replacement therapy. We suggest
that thyroid deficiency should be considered a possible cause
of Raynaud 's phenomenon.
Drug options for vasospastic disease
Coffman J.D.
Department of Medicine, Boston University School of Medicine,
Boston, MA United States
Drug Therapy (United States) 1992, 22/10
(45-48+53-56)
Estimates of the prevalence of Raynaud 's phenomenon range
from 5% to 30% of the US population. Besides the primary
disease, possible causes of the condition include connective
tissue disease, carpal tunnel syndrome, arterial obstructions,
hypothyroidism , adverse drug reactions, and use of vibrating
tools. Although simple measures, such as keeping the hands,
feet, and body warm, are effective in most patients, drug
therapy may be necessary when vasospastic attacks interface
with a patient's work or daily activities. Calcium channel
blockers, sympatholytic agents, nitroglycerin,
triiodothyronine, captopril, and prostaglandins have been used
with varying degrees of success in symptomatic patients.
Nifedipine is the current drug of choice.
Effect of magnesium sulfate infusion on circulating
levels of noradrenaline and neuropeptide-Y-like
immunoreactivity in patients with primary Raynaud's
phenomenon
Leppert J.; Myrdal U.; Hedner T.; Edvinsson L.; Tracz Z.;
Ringqvist I.
Department of Research, University of Uppsala, Central
Hospital,S-721 89 Vasteras Sweden
Angiology (United States) 1994, 45/7 (637-645)
The effect of a short-term magnesium sulfate (MgSOinf 4)
infusion on venous plasma concentration of noradrenaline (NA)
and neuropeptide-Y-like immunoreactivity (NPY-LI) was
investigated in 12 women with primary Raynaud 's phenomenon
(PRP) and in 12 healthy matched controls. The Raynaud 's
patients did not demonstrate any significant changes in mean
basal plasma NA concentration (0.29 +/- 0.15 vs 0.37 +/- 0.09
ng/mL, ns) after MgSOinf 4 infusion. However, in the controls
there was more than twice the amount of circulating
noradrenaline (cNA) (0.21 +/- 0.14 vs 0.54 +/- 0.22 ng/mL, P
< 0.001) after MgSOinf 4 infusion, compared with the
preinfusion value. Measurements during the cold pressor test
prior to the MgSOinf 4 infusion showed a significant increase
of cNA in both the PRP group and the control group (from 0.29
+/- 0.15 to 0.33 +/- 0.16 ng/mL, P < 0.05, and from 0.21
+/- 0.14 to 0.29 +/- 0.16 ng/mL, P < 0.005, respectively).
After MgSOinf 4 infusion the levels of cNA during the cold
pressor test increased significantly only in the PRP group
(from 0.37 +/- 0.09 to 0.41 +/- 0.11 ng/mL, P < 0.05).
Circulating NPY-LI concentrations increased significantly
during MgSOinf 4 infusion in the Raynaud 's patients as well
as in the controls from 105 +/- 21 to 127 +/- 23 pmol/L, P
< 0.05, and from 107 +/- 17 to 132 +/- 27 pmol/L, P <
0.01, respectively. There were no detectable changes during
the cold pressor tests in either group. In healthy women
short-term MgSOinf 4 infusion induced a sympathetic response,
shown by the increased concentration of cNA and NPY-LI, while
in PRP patients there was only an increase in NPY-LI. The
discrepancy between PRP patients and healthy controls supports
the view of a so-called 'local fault' in the sympathetic nerve
terminal of arterial/arteriolar walls in Raynaud 's
patients.
Thromboxane metabolite excretion in patients with
hand-arm vibration syndrome.
Nowak J; Barregard L; Benthin G; Granung G; Wennmalm A
Department of Clinical Physiology, Huddinge University
Hospital, Karolinska Institute, Stockholm, Sweden
Clin Physiol (England) Jul 1996, 16 (4) p361-7
As chronic exposure to hand-held vibrating tools may cause
endothelial injury, a subsequent sustained platelet activation
with the increased release of vasoconstricting thromboxane A2
(TxA2) could be of pathophysiological importance in
vibration-induced Raynaud 's phenomenon. Therefore, the aim of
this study was to elucidate whether or not hand-arm vibration
syndrome is accompanied by increased endogenous TxA2
biosynthesis. The study involved 64 men, aged 23-61 years,
stratified according to the exposure to vibrating tools, the
presence of Raynaud 's phenomenon, and smoking habit. Forty of
them were car mechanics and 24 were age-matched healthy
volunteers who served as controls. The assessment of platelet
TxA2 formation in vivo was performed by quantification of the
urinary excretion of its major metabolite,
2,3-dinorthromboxane B2 (2,3-dinor-TxB2), employing gas
chromatography-mass spectrometry. The average urinary
excretion rate of 2,3-dinor-TxB2 in patients with Raynaud's
phenomenon was 296 +/- 42 pg/mg creatinine and did not differ
significantly from the corresponding values in controls (328
+/- 62 pg/mg creatinine) or individuals exposed to vibrating
tools, but without any signs of vasospastic disease (232 +/-
29 pg/mg creatinine). The only statistically significant
difference was found between smokers and non-smokers (P <
0.001), a finding confirming the existence of chronic platelet
dysfunction in cigarette smokers. The present data indicate
that chronic exposure to vibrating tools, with or without
Raynaud 's phenomenon, is not associated with an enhanced
platelet function as monitored by the urinary excretion of
2,3-dinor-TxB2. Hence, a possible vibration-induced vascular
injury does not seem to provide a stimulus sufficient to
induce a persistent platelet activation.
Raynaud's phenomenon: State of the art 1998
Ho M.; Belch J.J.F.
J.J.F. Belch, University Department of Medicine, Ninewells
Hosp. and Medical School, Dundee DD1 9SY United Kingdom
Scandinavian Journal of Rheumatology (Norway) 1998, 27/5
(319-322)
Raynaud 's Phenomenon (RP) is a relatively common problem
which may be troublesome and difficult to treat in a minority
of patients. The state of the art in 1998 focusses on three
key areas: the clinical spectrum of RP; its progression and
prognosis; and its treatment. RP is a systemic disease, with a
multifactorial aetiology and vasospasm affects not just the
digits and skin but also major organs including the heart,
lungs and kidneys. It is important to distinguish primary from
secondary RP. RP may predate an associated connective tissue
disease by many years and markers for this include severe RP
symptoms with trophic skin changes, serological abnormalities
and abnormal nailfold capillaries. Repeated attacks of
vasospasm may cause ischaemic reperfusion injury to the
endothelium, resulting in a vicious and self propagating cycle
of cause and effect. Nifedipine remains the 'gold standard' of
treatment but a number of new and promising drugs, eg relaxin,
are currently under investigation. 'Vasodilator-plus' drugs,
with the ability to also modulate some of the
haemorrheological abnormalities in RP, are the drugs that are
going to have a major clinical impact on the disease and hold
promise for the future.
Plasma catecholamines during behavioral treatments
for Raynaud's disease.
Freedman RR; Keegan D; Migaly P; Galloway MP; Mayes M
Lafayette Clinic, Detroit, MI 48207.
Psychosom Med (United States) Jul-Aug 1991, 53 (4)
p433-9
We have previously demonstrated that the vasospastic
attacks of Raynaud's disease can be induced despite blockade
of efferent digital nerves and that feedback-induced
vasodilation is mediated through a non-neural, beta-adrenergic
mechanism. Here, we sought to determine the role of
sympathetic activity, as measured by plasma epinephrine and
norepinephrine, during finger temperature feedback and
autogenic training . Thirty-one female patients with
idiopathic Raynaud 's disease were randomly assigned to
receive finger temperature feedback or autogenic training over
28 days. Half of each group began and finished training during
the follicular phase of the menstrual cycle, the other half
during the luteal phase. During training, significant
temperature elevations were shown by feedback patients but not
by autogenic patients. There were no significant effects for
norepinephrine and epinephrine for either group. Cycle phase
did not interact with training effects or with catecholamines.
These findings do not support the role of decreased
sympathetic activation in behavioral treatments for Raynaud s
disease.
Quantitative measurements of finger blood flow
during behavioral treatments for Raynaud's disease.
Freedman RR
Psychophysiology (United States) Jul 1989, 26 (4)
p437-41
Quantitative measurements of finger blood flow have not
been performed during temperature biofeedback or other
treatments for Raynaud 's disease. In the present
investigation, finger blood flow was determined with venous
occlusion plethysmography, in addition to measurements of
finger temperature, heart rate, blood pressure, and skin
conductance level. After a maximum vasodilation test, subjects
received 10 sessions of finger temperature biofeedback or
autogenic training . There were no group differences during
the maximum vasodilation test. During training, temperature
feedback subjects showed significant elevations in finger
blood flow, finger temperature, and skin conductance level,
whereas those who received autogenic training did not. These
findings could not be explained by group differences in other
cardiovascular measures and are consistent with previous
studies suggesting the involvement of an active vasodilating
mechanism in temperature feedback.
The behavioral treatment of Raynaud's disease: a
review.
Rose GD; Carlson JG
Department of Psychology, University of Hawaii, Honolulu
96822.
Biofeedback Self Regul (United States) Dec 1987, 12 (4)
p257-72
Raynaud 's disease is a peripheral vascular system disorder
characterized by episodes of vasoconstriction in the hands and
feet resulting in a lowering of skin temperature and pain.
Recent studies are reviewed that focus on the behavioral
treatment of Raynaud 's disease--in particular, biofeedback
and autogenic training . Methodological problems and other
difficulties include the measurement of skin temperature,
schedules of reinforcement/feedback, and characteristics of
the experimenter and subject. Studies in this area indicate
some promise for certain behavioral interventions, especially
finger temperature biofeedback under cold stress conditions.
On the other hand, further research is needed to clarify the
mechanisms, especially that of vasodilation, and the
applications of temperature biofeedback , as well as the role
of attitudinal, interpersonal, and cognitive factors. (43
Refs.)
Bringing the feet in from the cold: thermal
biofeedback training of foot-warming in Raynaud's
syndrome.
Crockett D; Bilsker D
Biofeedback Self Regul (United States) Dec 1984, 9 (4)
p431-8
The biofeedback -assisted treatment of a case of Raynaud 's
syndrome was examined in order to determine the relationship
between learning of the hand-warming response and the
subsequent ability to produce foot-warming responses. It was
found that fluctuations in dermal hand and foot temperatures
were not significantly related, either within or across
treatment sessions. The obtained hand-warming response was of
high magnitude and rapidly learned, while the foot-warming
response was more modest and took substantially more trials to
learn. These results indicate that an easy generalization of
the hand-warming response cannot be assumed.
Behavioral treatment of Raynaud's phenomenon in
scleroderma.
Freedman RR; Ianni P; Wenig P
J Behav Med (United States) Dec 1984, 7 (4)
p343-53
Twenty-four patients with Raynaud 's phenomenon and
scleroderma were randomly assigned to receive finger
temperature biofeedback , frontalis EMG biofeedback , or
autogenic training . Only those receiving temperature feedback
showed significant increases in finger temperature during
training and during a posttraining test of voluntary control,
effects not attributable to general relaxation. However, no
group demonstrated significant clinical improvement, assessed
by symptom reports and by ambulatory monitoring of finger
temperature. The need for careful classification of patients
with Raynaud 's disease and Raynaud 's phenomenon in
scleroderma is emphasized.
Biofeedback, autogenic training, and progressive
relaxation in the treatment of Raynaud's disease: a
comparative study.
Keefe FJ; Surwit RS; Pilon RN
J Appl Behav Anal (United States) Spring 1980, 13 (1)
p3-11
Twenty-one female patients suffering from diagnosed
idiopathic Raynaud's Disease were trained to raise digital
skin temperature using either autogenic training , progressive
muscle relaxation, or a combination of autogenic training and
skin temperature feedback. Patients were instructed in the
treatment procedures in three one-hour group sessions spaced
one week apart. All patients were instructed to practice what
they had learned twice a day at home. Patients kept records of
the frequency of vasospastic attacks occurring over a
four-week baseline period, and during the first four weeks and
the ninth week of training. In addition, patients underwent
four laboratory cold stress tests during which they were
instructed to maintain digital temperature as the ambient
temperature was slowly dropped from 26 degrees to 17 degrees
C. Cold stress tests were given during week 1 of baseline and
during weeks 1, 3, and 5 of training. No significant
differences between the three behavioral treatment procedures
were obtained. In addition, the ability of patients to
maintain digital temperature during the cold stress challenge
showed significant improvement from the first to the last
tests. Symptomatic improvement was maintained by all patients
nine weeks after the start of training. The implications of
these findings for the behavioral treatment of Raynaud 's
Disease are discussed.
Behavioral approaches to Raynaud's disease.
Surwit RS
Psychother Psychosom (Switzerland) 1981, 36 (3-4)
p224-45
No abstract.
A 1-year follow-up of Raynaud's patients treated
with behavioral therapy techniques.
Keefe FJ; Surwit RS; Pilon RN
J Behav Med (United States) Dec 1979, 2 (4)
p385-91
The purpose of this study was to assess to what degree
learned control of digital temperature and vasospastic attacks
can be retained by Raynaud 's patients over a full year
period. Subjects were 19 patients suffering from diagnosed
idiopathic Raynaud 's disease who had undergone behavioral
training. These patients had been trained to increase digital
temperature using either autogenic training , biofeedback , or
a combination of autogenic training and temperature
biofeedback . Results indicated that the mean number of
vasospastic attacks per day occurring 1 year after training
was approximately equal to the number occurring at the end of
the initial training (1.2-1.3 per day). Patient satisfaction
with the treatment program was above average (3.5 on a 5-point
scale). The patients' ability to maintain digital temperature
during the cold stress challenge was imparied, however. At
1-year follow-up, digital temperature readings taken in the
laboratory were identical to baseline levels.
Behavioral treatment of Raynaud's disease.
Surwit RS; Pilon RN; Fenton CH
J Behav Med (United States) Sep 1978, 1 (3)
p323-35
In order to assess the efficacy of a behavioral
intervention in the treatment of idiopathic Raynaud's disease,
30 female patients were trained to control their digital skin
temperature using autogenic training or a combination of
autogenic training and skin temperature feedback either in the
laboratory or at home. All trained subjects demonstrated a
significant ability to maintain digital skin temperature in
the presence of a cold stress challenge and reported
significant reductions in both frequency and intensity of
vasospastic attacks. The addition of skin temperature feedback
to autogenic training did not provide additional clinical
benefit.
Long-term effectiveness of behavioral treatments
for Raynaud's disease
Freedman R.R.
Lafayette Clinic, Wayne State University, Detroit, MI 48207
United States
Behavior Therapy (United States) 1987, 18/4
(387-399)
Raynaud 's disease is characterized by episodic digital
vasospasms of unknown etiology. Although surgical and
pharmacologic treatments have been problematic, behavioral
procedures have shown considerable efficacy. Temperature
biofeedback reduces reported symptom frequency and enables
patients to voluntarily incrfease finger temperature and
capillary blood flow for 1 year after treatment. Symptomatic
improvement persists for up to 3 years. This procedure is
mediated by a nonneural beta-adrenergic vasodilating mechanism
rather than through physiological relaxation. Relaxation-based
procedures, such as autogenic training , produce smaller
symptom reductions at one-year follow-up with no retention of
physiological effects. The effects of classically conditioned
vasodilation are retained for 1 year in normal persons and may
be of value in the treatment of Raynaud 's disease.
Biofeedback training in clinical cardiovascular
disease
Surwit R.S.
Dept. Med. Psychol., Duke Univ. Med. Cent., Durham, N.C.
United States
Primary Cardiology (United States) 1980, 6/9
(34-48)
Biofeedback mechanisms have been shown to be effective in
treating mild hypertension. Various forms include binary
feedback training to lower blood pressure and heart rate,
analogue feedback to control forearm and frontalis
electromyographic activity, and meditation-relaxation
procedures. The simple technique of having the patient take
his own blood pressure and consciously attempt to lower it by
whatever mechanism he can is quite effective. Thermal feedback
training to control migraine headaches and Raynaud 's disease
has been successful. Autogenic training to control skin
temperature is also an effective instrument.
[Esophageal motor abnormalities, gastroesophageal
reflux and duodenogastric reflux in patients with Raynaud's
disease]
Pucciani F; Bechi P; Pantalone D; Panconesi R; Paparozzi C;
Pagliai P; Cortesini C
Clin Ter (Italy) Dec 31 1989, 131 (6) p373-80
Twenty-four patients with Raynaud 's phenomenon, without
ARA criteria for classification, were examined, after clinical
history, by means of esophageal manometry, combined gastric
and esophageal pH-monitoring, endoscopy. The results showed in
these patients a high incidence of esophageal motor
abnormalities (66.6%), of gastroesophageal reflux (50%), and
of duodenogastric reflux (45.8%).
[Clinical studies on various therapy for the
intractable trauma of toes and fingers in cases of diabetes
mellitus and peripheral ischemic diseases]
Kuyama T; Umemura H; Sudo T; Kawamura M; Shobu R; Tsubakimoto
R; Nishimoro A
Second Department of Surgery, School of Medicine, Kinki
University, Osaka, Japan.
Nippon Geka Gakkai Zasshi (Japan) May 1988, 89 (5)
p763-70
In cases of ischemic extremities and diabetes mellitus, the
trauma on finger and toe is very intractable. For such
injuries amputation of extremity is indicated very often
because of severe necrosis. The number of such cases has been
increasing recently because many cases of these patients have
arteriosclerotic arterial occlusion and diabetes mellitus, and
these are correlated with the changes of aging. The number of
cases of Buerger's disease has been also increasing and it is
another etiology of intractable trauma in ischemic extremity.
The repeated hyperbaric oxygenation, sympathetic block,
warfarin therapy and insulin bath with bubbling of hyperbaric
oxygen , were applied to has been of such necrosis. By these
procedures, the rate of amputation of extremity decreasing. It
was concluded that the surgical reconstruction of artery for
ischemic extremity has never any meaning as the therapy of
such intractable injuries, if blood flow in the peripheral
tissue is not kept physiologically, before vascular
reconstruction. In order to increase peripheral tissue
circulation, the hyperbaric oxygenation, sympathetic block and
warfarin therapy wer performed in many cases and these methods
were very effective for intractable injuries with severe
necrosis.
'Phenomenon of hyperbaric accumulation of venous
partial pressure of oxygen' concerning the hyperbaric therapy
and lumbosacral sympathetic ganglionectomy Linf 2 and Linf 3
for healing of incurable wounding in patients with periphery
circulatory disturbances
Kuyama T.; Tanabe H.; Umemura H.; Yabumoto E.
II Dept. Surg., Kinki Univ. Sch. Med., Osaka Japan
Acta Medica Kinki University (Japan) 1976, Vol. 1/-
(1-16)
The authors reported the results of the hyperbaric therapy
for patients with the disease which may have a genetic origin
in part, namely certain forms of cancer and L.E.Raynaud 's
syndrome, and furthermore, thromboangiitis obliterans which
have a unclear origin and in addition Raynaud 's syndrome,
chronic stage of arteritis luetica and ulcus cruris. The
clinical results, finding, interpretations and implications
are discussed. The phenomena of hyperbaric accumulation of
venous partial pressure of oxygen are described and the
authors supposed that wound healing of ischemic ulcers caused
by successive hyperbaric oxygenation were due to subepithelial
and in granulations of ulcers revascularity of capillaries.
The above facts were assumed on the basis of the clinical
results of thermocamera, optical pulse wave calculation and
plasma ultra-centrifugation lipoprotein fraction, relating
with decrease in sympathetic irritation.
Micronutrient antioxidant status in patients with
primary Raynaud's phenomenon and systemic sclerosis.
Herrick AL; Rieley F; Schofield D; Hollis S; Braganza JM;
Jayson MI
University of Manchester Rheumatic Diseases Centre, Hope
Hospital, Salford, UK.
J Rheumatol (Canada) Aug 1994, 21 (8) p1477-83
OBJECTIVE. To investigate the possibility that
micronutrient antioxidant status is an important factor in
determining the severity of Raynaud 's phenomenon (RP) and in
differentiating between patients with primary Raynaud 's
phenomenon (PRP) and those in whom Raynaud 's is secondary to
systemic sclerosis (SSc).
METHODS. Four micronutrient antioxidants (selenium, vitamin
E , beta-carotene and ascorbic acid) and 2 "markers" of free
radical associated activity were assayed in peripheral blood
from 10 patients with PRP, 9 with limited cutaneous SSc
(ISSc), 9 with diffuse SSc (dSSc) and 15 healthy control
subjects.
RESULTS. Plasma ascorbic acid was reduced in all 3 groups
of patients: median level 10.6 mg/l in controls, 4.8 mg/l in
PRP (p < 0.01), 2.5 mg/l in ISSc (p < 0.01) and 6.8 mg/l
in dSSc (p < 0.05). A reduction in serum selenium was
especially found in dSSc (median 75 micrograms/l compared to
100 micrograms/l in controls, p < 0.05). In keeping with
these deficiencies, the serum concentration of 9, 11, linoleic
acid was elevated in RP patients: median values for the molar
ratio of the isomer to the parent fatty acid were 1.91% in
controls, 3.70% in ISSc (p < 0.05) and 3.85% in dSSc (p
< 0.01). Smoking patients showed lower levels of ascorbic
acid and higher levels of the linoleic isomer than
nonsmokers.
CONCLUSION. Deficiencies of ascorbic acid and selenium may
predispose towards irreversible tissue injury in RP patients
and cigarette smoke may be an independent risk factor.
Micronutrient antioxidant supplements may be of therapeutic
value.
[Thermographic assessment of Raynaud's phenomenon
in childhood mixed connective tissue disease]
Yokota S; Kuriyama T; Takahashi Y; Mori M; Shike H; Ibe M;
Mitsuda T; Aihara Y
Department of Pediatrics, Yokohama City University School of
Medicine.
Ryumachi (Japan) Dec 1994, 34 (6) p955-60
To assess Raynaud 's phenomenon objectively, thermographic
estimation of hands and fingers was performed before and after
the disease- and Raynaud 's phenomenon-directed therapy in 3
children with mixed connective tissue disease. All the cases
were positive in Raynaud 's phenomenon, and the surface
temperature of their hands and fingers were decreased even
before cold challenge. After the cold provocation test at 4
degrees C for 10 sec., the temperature of all or some of the
fingers were rapidly decreased, and the recovery of surface
temperature of these fingers were markedly delayed. Even after
methylprednisolone pulse therapy the pattern of the finger
temperature were essentially unchanged, suggesting that
steroids are not effective in the treatment of Raynaud's
phenomenon. The long-term administration of vitamin - E , oral
prostaglandin E1, and/or serotonin-receptor inhibitor were
also proved to be not beneficial in improving Raynaud 's
phenomenon. Thus, thermography is useful in diagnosing Raynaud
's phenomenon objectively, in determining the efficacy of
anti-Raynaud drugs, and in estimating long-term course of the
phenomenon.
Is vitamin E involved in the autoimmune
mechanism?
Ayres S Jr; Mihan R
Cutis (United States) Mar 1978, 21 (3) p321-5
Autoimmune diseases are characterized by an alteration of
the body's defense mechanism, designed for protection against
infections and toxic injuries, which for unknown reasons
attacks and destroys normal tissue. Some evidence strongly
suggests that such diseases are the result of hydrolytic
enzymes that escape from lysosomes whose membranes have been
damaged by lipid peroxidation or other causes and that combine
with and denature normal tissue proteins--in effect converting
them into foreign proteins--to which the body then reacts by
producing antibodies. During the past ten years, in a private
dermatologic practice, we have conducted clinical
investigations on the possible therapeutic value of vitamin E
in the management of a number of disabling skin diseases of
unknown etiology as well as several muscular disorders. Among
the diseases that were successfully controlled were a number
in the autoimmune category, including scleroderma, discoid
lupus erythematosus, porphyria cutanea tarda, several types of
vasculitis, and polymyositis. Since vitamin E is a physiologic
stabilizer of cellular and lysosomal membranes, and since some
autoimmune diseases respond to vitamin E , we suggest that a
relative deficiency of vitamin E damages lysosomal membranes,
thus initiating the autoimmune process.
Comparative double-blind trial of
dl-alpha-tocopheryl nicotinate on vibration disease.
Matoba T; Kusumoto H; Mizuki Y; Yamada K
Tohoku J Exp Med (Japan) Sep 1977, 123 (1)
p67-75
Sixty inpatients with vibration disease were examined on
the effect of dl-alpha-tocopheryl nicotinate by comparative
double-blind study. The observed period was 6 weeks and the
dose was 6 capsules a day (600 mg as dl-alpha-tocopheryl
nicotinate, Juvela Nicotinate, referred to as EN). The
physical exercise therapy was applied to all patients
throughout the test period. EN group became better with a
significant difference from P (placebo) group in the
subjective symptoms, the clinical examinations and the
collective improving rate (p less than 0.01, 0.05, 0.01),
respectively. The improvement of the subjective symptoms of
both groups was higher 6 weeks than 3 weeks after
administration. Most items in EN group became better
significantly (p less than 0.05) as compared with those in P
group. The examinations of the peripheral functions in EN
group showed a significant improvement 6 weeks after
administration in comparison with those in P group. Blood
chemistry, blood cell counts and serum electrolytes changed
within normal range. Thus, this preparation would be a
curative agent for patients with vibration disease.
[The effect of dimethyl sulfoxide on the
thromboelastographic indices and the microcirculation in
patients with rheumatic diseases]
Murav'ev IuV; Loskutova TT; Anikina NV; Shcherbakov AB;
Sokolov VB
Ter Arkh (USSR) 1989, 61 (12) p106-9
Using a blind method for assessing the results, a study was
made of the effect of dimethylsulfoxide (DMSO) on fibrin
formation and microcirculation in 42 patients with rheumatic
diseases (rheumatoid arthritis, systemic scleroderma, Raynaud
's syndrome). It has been shown that the therapeutic effect of
DMSO in rheumatic diseases is determined to a definite degree
by its normalizing action on fibrin formation and
microcirculation.
Pathophysiology of capillary circulation: Raynaud's
disease.
Arnot RS; Boroda C; Peacock JH
Angiology (United States) Jan 1978, 29 (1)
p48-52
Despite the frequency of Raynaud 's disease in cold
climates, the etiology of the condition remains uncertain.
This report reviews the literature since Raynaud 's original
description and Lewis and Pickering's addition to the concept,
and several recent observations which add to our understanding
of the disease are discussed. We investigated the effect of
posture and a vasodilator drug on the digital capillary
circulation; digital blood flow increases as the body moves
from a recumbent, through a sitting, ti an upright position.
Bradilan, a vasodilator drug, increases the circulation in the
recumbent and sitting positions, but has no effect in standing
patients, despite symptomatic relief.
Vasodilator drugs in peripheral vascular
disease
Coffman J.D.
Boston Univ. Sch. Med., Boston, Mass. United States
New England Journal of Medicine (United States) 1979, 300/13
(713-717)
In vasospastic diseases, vasodilator drugs that act upon
the sympathetic nervous system may have a beneficial effect in
many patients by increasing cutaneous capillary blood flow.
These agents may decrease persistent vasospasm or the number
and intensity of attacks in Raynaud 's phenomenon but usually
do not produce complete relief. Full benefit is often
prevented by unpleasant and sometimes severe side effects that
limit dosage. Reserpine or guanethidine is the drug of choice;
tolazoline long-acting tablets are added when further relief
is needed. Papaverine, niacin , isoxsuprine and cyclandelate
are representative of vasodilator drugs that directly relax
vascular smooth muscle. When administered by mouth, these
drugs are not potent peripheral vasodilators, and it may be
concluded that they are not of value in the treatment of
peripheral vascular diseases. Review of the clinical studies
of vasodilator drugs in obstructive vascular disease reveals
little substantive evidence to support their use. They are not
effective in the treatment of either intermittent claudication
or ischemic symptoms or signs at rest. They fail to increase
blood flow in most patients with ischemic limbs, even when
administered locally by the intra-arterial route. No drug has
been shown to increase muscle blood flow during exercise when
patients with intermittent claudication experience
symptoms.
Treatment of the Raynaud's phenomenon with
piracetam.
Moriau M; Lavenne-Pardonge E; Crasborn L; von Frenckell R;
Col-Debeys C
Department of Internal Medicine, University of Louvain, UCL,
Brussels Belgium.
Arzneimittelforschung (Germany) May 1993, 43 (5)
p526-35
Piracetam (Nootropil, CAS 7491-74-9) has been investigated
in the treatment of primary and secondary Raynaud 's
phenomenon in three sequential and complementary studies. The
first study in 20 patients with primary Raynaud 's phenomenon,
utilising clinical and ultrasound examination, capillaroscopy
and laboratory tests established a daily dose of 8 g as most
effective. The second study in 58 patients (47 primary, 11
secondary) confirmed the therapeutic efficacy of piracetam in
both primary and secondary Raynaud 's phenomenon. The third
study, of crossover design, in 30 patients with severe Raynaud
's syndrome, examined various agents given singly or in
combination. The results not only confirmed the efficacy of
piracetam but in addition allowed comparison of the efficacy
of the principal therapeutic agents or regimens used in the
treatment of Raynaud 's syndrome and the formulation of a list
of these therapies in decreasing order of efficacy, thus:
piracetam 4 g/d + buflomedil 600 mg/d; piracetam 8 g/d;
buflomedil 600 mg/d; piracetam 4 g/d + acetylsalicylic acid
100 mg/d; pentoxifylline 1200 mg/d; calcium antagonists;
ketanserin 120 mg/d. The particular efficacy of 8 g piracetam
daily in 3 divided doses at 8-hourly intervals can be
attributed to its unique dual mode of action; inhibition of
platelet function by inhibition of thromboxane A2 synthetase
or antagonism of thromboxane A2 and increased formation of
prostaglandin I2, together with a rheological effect involving
reduction in blood and plasma viscosity through an increase in
cell membrane deformability and a reduction of 30-40% in the
plasma concentrations of fibrinogen and von Willebrand's
factor. In addition, the administration of piracetam appears
to be devoided of adverse effects.
Comprehensive management of Raynaud's
syndrome
Merritt W.H.
Dr. W.H. Merritt, Plastic and Reconstructive Surgery, 2002
Bremo Road, Richmond, VA 23226 United States
Clinics in Plastic Surgery (United States) 1997, 24/1
(133-160)
Raynaud 's syndrome stands as a landmark to our ignorance
of the mechanisms involved in the interrelationship of the
central nervous system and peripheral circulatory physiology.
Proper management for these unfortunate patients demands an
integrated comprehensive effort of the pharmacologic, physical
medical, and surgical disciplines.
Raynaud's phenomenon in the emergency
department
Browne B.J.; Jotte R.S.; Rolnick M.
Division of Emergency Medicine, Department of Surgery,
Maryland University Medical Center, 22 S. Greene
St.,Baltimore, MD 21201-1595 United States
Journal of Emergency Medicine (United States) 1995, 13/3
(369-378)
Raynaud 's phenomenon manifests as triphasic color changes
of the digits, induced by exposure to low temperature or
emotional stress. It is a relatively common disorder,
estimated to affect 5% to 10% of the general population and
25% to 30% of otherwise healthy women. Although usually self-
limiting, it can be severely painful and debilitating, and
complicated by ulcerations and tissue necrosis. For the
emergency physician treating a patient with an acute
presentation of the phenomenon, the main challenges are to
achieve adequate pain control, reverse vasospasm, and maintain
viable tissue. Emergency treatment can also extend to patient
education and arrangement of appropriate referrals and
follow-up care.
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