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To gain insight into the physiopathology of Raynaud's phenomenon of occupational origin, finger systolic pressures under heat and cold, and results of nailfold capillary microscopy, were examined in 29 lumberjacks with Raynaud's phenomenon vibration syndrome (pathological group) and 24 lumberjacks without it (non-pathological group), and compared with the same values in 26 healthy matched manual workers not using a vibrating tool (controls). Vibration syndrome physiopathology seemed multifactorial, combining 5 features: (1) a rise in brachial diastolic and systolic pressures in the pathological group compared with the two other groups. In lumberjacks with Raynaud's phenomenon, these rises seemed to be acquired, since they were not found when the workers were engaged; (2) a reduction in the number of nailfold capillaries (9.4 ± 2 per mm in the pathological group vs 11 ± 2.5 in the controls, P <0.025); (3) a rise in the brachial digital systolic gradient (P < 0.025) in the pathological versus the non-pathological lumberjack group (4) abnormal cold vascular tone, since at 15°C finger systolic pressures in the pathological group were lower than pressures in both the control and non-pathological groups (P <0.05 and P <0.01, respectively), and at 10°C, they were lower in the pathological than in the control group (P <0.01); (5) Within the pathological group, individual paired comparisons between the most and least symptomatic finger revealed a rise in the cold vascular tone, and a reduction in the number of nailfold capillaries in the most symptomatic finger compared to the least symptomatic finger. These results indicate that Raynaud's phenomenon vibration syndrome may include both a central nervous system dysregulation due to cold and vibration, and an abnormal cold vascular tone of the digital arteries caused by a local defect leading to an increased wall/lumen ratio. The implications of this new hypothesis for preventive medicine and research are discussed. [ABSTRACT FROM PUBLISHER]

Sixty-two patients with arterial disease of the lower limbs were treated with streptokinase by intermittent administration. All patients had experienced recent aggravation of their arterial disease, and 22 bad thrombolysis confirmed by arteriograpby. In 20 cases clinical study showed repermeation - in 8 cases during the first perfusion and in 8 cases during the third perfusion. During the first perfusion the fall in fibrinogen was significantly greater in the 8 patients with thrombolysis. Furthermore, the third perfusion corresponded to a new phase of fibrinogenolysis. These results support the possibility of the relationship between plasminemia and thrombolysis, and emphasize the limits of the classic theory of Sherry, Fletcher, and Alkjaersig. Permitting phases of repeated but limited plasminemia, the interruption method used here is a compromise between the risk of hemorrhage and the efficacy of treatment at low dosage. [ABSTRACT FROM AUTHOR]

The labeling index of endothelial cells as measured by in vitro autoradiography with H-thymidine and the electron microscopic structure of microvessels were studied in telangiectases. The telangiectases of eight patients with progressive systemic sclerosis (PSS) were compared with the cherry angiomas of six healthy controls subjects. The ultrastructural features of telangiectases were similar in the two groups and were characteristic of capillaries and postcapillary venules of the dermis, with multilayering of the vascular basement membrane. However, a significant difference existed between these two groups in an autoradiographic study: in PSS telangiectases, the average labeling index was 5.9%, whereas in cherry angiomas it was around 0.8%. Thus, the telangiectases in PSS are structures with accelerated endothelial proliferation, as are the other endothelial cells of microvessels anywhere in dermis in this disease. However, the great heterogeneity of the labeling index (varying from 0.5% to 27%) must be emphasized in telangiectases. [ABSTRACT FROM AUTHOR]

Selective intra-arterial urokinase (UK) is effective in treating recent arterial thromboembolism. However, usually only partials lysis is achieved and this treatment seems less effective than intravenous streptokinase. At a dose of 37,500 UCTA/hour it does not produce systemic fibrinolysis. This protocol substantially reduces the risk of systemic bleeding and embolism and extends its applicability to operative patients. The combination of surgery and UK seems particularly promising in patients with atherosclerotic arterial thrombosis. [ABSTRACT FROM AUTHOR]

Thirty subjects with Raynaud's phenomenon admitted for determination of its cause underwent psychological examination. Raynaud's phenomenon was regarded as primary in 14 cases, secondary (usually to scleroderma) in 13 cases and eluding classification in 3 cases. The mean age of patients with primary Raynaud's phenomenon was higher than in the other groups. Interviews and psychological tests were carried out with all but 2 patients and all investigators being totally unaware of the aetiological category. Patients with secondary Raynaud's phenomenon significantly differed from those with primary Raynaud's phenomenon in their personality patterns, attitudes towards interlocutors and way of coping with conflicts. Patients with primary Raynaud's phenomenon were characterized by a relatively frequent hysterical personality and by their dodging behaviour when faced with their own aggressiveness. Patients with secondary Raynaud's phenomenon were found to be more distant, more conformist, more able to control their emotions and seemed to be less inclined to seek help when in trouble. Such findings suggest that Raynaud's phenomenon has a "psychosomatic" component: a psychic vulnerability which might contribute to the progress of the disease, and more clearly so in patients with secondary Raynaud's phenomenon than in patients with primary Raynaud's phenomenon, as confirmed by the so-called psychic fragility" score used to quantify the efficiency of mental functioning. These psychological features were unrelated to age. The profile of patients with secondary Raynaud's phenomenon is close to pattern C described as possibly having a prognostic value in proliferative or autoimmune diseases.

The efficacy of a minimal aetiological investigation program was tested in a population with Raynaud's phenomenon. The program had been devised to fulfill the following criteria: non invasive, simple and relatively cheap methods capable of detecting systemic scleroderma at an early stage. These methods turned out to be physical examination, screening for antinuclear antibodies, capillaroscopy and radiography of the hands and chest. After investigations which, in addition to the minimal program, included exploration of the digestive and respiratory tracts, heart, kidneys, articulations and eyes, 102 consecutive cases of Raynaud's phenomenon were studied and divided into 3 groups: idiopathic (n = 15); secondary (n = 50, including 36 cases of collagen disease, 29 of which were systemic scleroderma), and suspected idiopathic or pre-collagen disease (37 cases of undetermined origin but not considered idiopathic in view of clinical and/or paraclinical abnormalities). In non idiopathic Raynaud's phenomenon, physical examination, capillaroscopy and screening for antinuclear antibodies gave abnormal results in 96.5% of the cases. This figure was raised to 98.8% when radiography of the hands and chest was added to these 3 examinations, but the difference was not significant. Since 96.5% of non idiopathic Raynaud's phenomena could be diagnosed by physical examination, capillaroscopy and screening for antinuclear antibodies, it is suggested that all patients presenting with the phenomenon should be subjected to these three simple examinations; negative results then dispense from supplementary investigations.

The authors study 86 cases of ischaemic problems affecting the upper limb associated with digital necrosis. They emphasise the wide range of aetiologies encountered and discuss the relationship between this syndrome and the main forms of arterial disease, principally inflammatory, scleroderma appearing to be the dominant though not sole aetiology. The aetiological results are also studied in relation to the extent of the necrosis and the sex of the patient. These data are compared with those found in the literature.

A spontaneous and asymptomatic pneumoperitoneum was observed in two women presenting with pseudoileus resulting from severe gastrointestinal involvement in progressive systemic sclerosis. In the first case, pneumoperitoneum was associated with pneumatosis cystoides intestinalis and remained unchanged during 3 years. As obstruction resisted to medical management, surgery was performed; however at laparotomy neither perforation nor obstruction of the bowel could be found; the patient died during the postoperative course. In the second case, pneumoperitoneum disappeared after medical management of low-grade intestinal ileus but the patient died 6 months later because of cardiac failure. Autopsy revealed major distention of the bowel but failed to show any signs of perforation. These findings show that, in progressive systemic sclerosis, pneumoperitoneum can occur in the absence of digestive perforation and that surgery is not required. However this complication seems to carry a very poor prognosis.