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Skin blood flow in reflex sympathetic dystrophy (RSD) patients has been reported to develop from an increase at an early stage to a decrease at later stages. So far, it remains unclear whether these abnormalities are solely of microcirculatory origin, and result from functional vasospasm or structural vessel wall changes. Eighty-seven RSD patients were categorized as follows: stage I in case of a stationary warmth sensation; stage II in case of an intermittent warmth and cold sensation; and stage III in case of a stationary cold sensation. Laser Doppler flowmetry (LDF) was used as a measure of total skin blood flow and transcutaneous oximetry (TCPO2) as a measure of vascular reactivity in the more superficial skin layers. Local skin heating and reactive hyperaemia were used to study the relative reserve capacity of skin microvessels. Finapres was used to assess digital arterial pressures. As compared to healthy volunteers (n = 16), LDF under control conditions demonstrated an increase in skin blood flow at stage I (P < 0.01). A decrease in skin blood flow under control conditions was seen at stages II (P < 0.05) and III (P < 0.05), but the relative flow reserve capacity, as measured with LDF, was not impaired at these stages. Regression analysis did not show a relation between LDF parameters and duration of the syndrome. TCPO2 revealed no differences between patient groups and controls. Regression analysis did not demonstrate a relation between TCPO2 parameters and duration of the syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

To determine whether vasodilator prostaglandins are involved in the peripheral hyperperfusion observed in patients with short-term insulin-dependent diabetes mellitus (IDDM), forearm and skin blood flow were studied before and after cyclooxygenase inhibition. Skin nutritive (CBV: capillary blood-cell velocity) and thermoregulatory (LDF: laser-Doppler fluxmetry), and forearm (muscle) blood flow (FBF) were measured before and after 500 mg acetylsalicylic acid (ASA) infused intravenously in 14 short-term IDDM patients and 22 healthy control subjects. In the IDDM patients, baseline LDF (median: 27 (19-35); interquartile range) vs. 17 (15-23) pu) and FBF (3.4 (2.5-4.1) vs. 2.6 (2.2-2.9) ml 100 ml-1 min-1) were increased, while CBV (0.70 (0.40-1.33) vs. 0.69 (0.41-0.96) mm s-1) was unchanged compared to healthy controls. ASA infusion had similar effects on baseline CBV, LDF, and FBF in patients and controls. In eight of the control subjects the role of prostaglandins in the regulation of basal peripheral blood flow was studied before and after ASA and placebo infusion. The changes in baseline CBV, LDF, and FBF were similar after ASA and placebo infusion in healthy controls. In conclusion, in short-term IDDM patients, increased skin thermoregulatory and forearm (muscle) blood flow are probably not related to vasodilator prostaglandins. Furthermore, prostaglandins are not likely to be involved in regulating basal peripheral blood flow in healthy man.

We studied the relationship of retinal and/or renal microvascular complications and duration of disease with altered finger skin microcirculation in insulin-dependent diabetic (IDDM) subjects. Short-term and long-term IDDM subjects without complications or with proliferative retinopathy or incipient nephropathy were investigated with laser-Doppler fluxmetry. An increased resting flux in skin microcirculation was found in short-term (median: 34 perfusion units, PU) and uncomplicated long-term IDDM subjects (25 PU) as compared with age-matched healthy controls (18 PU), which suggests a generalized dilatation of the microcirculation throughout the body. In long-term IDDM subjects with retinopathy we also observed an increased resting flux (37 PU), but in subjects with incipient nephropathy resting flux was decreased (17 PU) relative to the other diabetic subjects, to a level not different from the healthy control group. Post-occlusive hyperaemic peak flux was decreased in patients with incipient nephropathy relative to the other diabetic patients, which suggests a defect in maximal arteriolar vasodilatation. No differences were found between the groups in the venoarteriolar reflex during venous occlusion. In conclusion, IDDM patients demonstrated increased red blood cell flux. However, with the occurrence of incipient nephropathy the resting flux and the maximal post-occlusive vasodilatation decreased, which suggests that development of nephropathic changes in diabetes is representative of a more generalized alternation of microvascular flow regulation. Local neurogenic microvascular control appears to be unaffected in these patients.