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To examine whether cardiac transplantation would reverse morphologic and hemodynamic changes in peripheral circulation in idiopathic dilated cardiomyopathy, the structure of terminal arterioles and minimal vascular resistance were measured in skin at the dorsum of the foot in the same 14 patients before and 80 ± 21 (mean ± SD) days and 387 ± 46 days after transplantation. The results were compared with data from a group of 16 healthy subjects. Blood flow was measured by the local technetium-99m pertechnetate washout method in a vascular bed relaxed with histamine. Structural microangiopathy (enhanced thickening of the basement membranes) in the arterioles was disclosed in skin biopsies in 11 of 14 patients before transplant, but in none of the 16 control subjects (p < 0.002). These abnormalities were unchanged 80 days after cardiac transplantation. However, arteriolar wall thickening was significantly reduced over the 1-year period after transplantation (p < 0.05), but this was not complete. Transplantation also led to a significant delayed decrease in minimal vascular resistance: before transplantation, 10.1 ± 3.2 mm Hg · ml−1 · 100 g · min (mean ± SD); 80 days after transplantation, 9.3 ± 3.1 mm Hg · ml−1 · 100 g · min (p = NS), and 1 year after transplantation 7.6 ± 2.4 mm Hg · ml−1 100 g · min (p < 0.01). Minimal vascular resistance before and 80 days after transplantation was significantly increased compared with that in healthy control subjects (6.3 ± 1.7 mm Hg · ml−1 100 g · min [p < 0.0003 and p < 0.003, respectively]). However, 1 year after transplantation, minimal vascular resistance was reduced to comparable levels when compared with that in control subjects (p = NS). These results indicate that structural microangiopathy and minimal vascular resistance in skin are improved slowly and gradually within the first year after orthotopic cardiac transplantation in patients with idiopathic dilated cardiomyopathy, however, the remodeling of histopathology is not accompanied by complete normalization.

Some data have demonstrated a substantial subdermal accumulation of topically applied drugs in animals. The aim of this study was to evaluate a possible effect of epicutaneously applied clobetasol propionate on blood flow in human subcutaneous adipose tissue. Nine healthy subjects were studied. The 133Xenon wash-out method was used for the measurement of subcutaneous blood flow. Resting blood flow and the local blood flow regulatory mechanisms, autoregulation of blood flow and the veno-arteriolar reflex, were assessed prior to treatment and were measured following 24, 48 and 72 h of treatment. The results demonstrated no effect of clobetasol propionate on resting subcutaneous blood flow or the local regulatory mechanisms.

Subcutaneous adipose tissue blood flow rate, together with systemic arterial blood pressure and heart rate under ambulatory conditions, was measured in the lower legs of 15 normal human subjects for 12-20 h. The 133Xe-washout technique, portable CdTe(Cl) detectors, and a portable data storage unit were used for measurement of blood flow rates. An automatic portable blood pressure recorder and processor unit was used for measurement of systolic blood pressure, diastolic blood pressure, and heart rate every 15 min. The change from upright to supine position at the beginning of the night period was associated with a 30-40% increase in blood flow rate and a highly significant decrease in mean arterial blood pressure and heart rate (P less than 0.001 for all). Approximately 100 min after the subjects went to sleep an additional blood flow rate increment (mean 56%) and a simultaneous significant decrease in mean arterial blood pressure (P less than 0.001) were observed. The duration of this hyperemic phase was 116 min. A highly significant reduction of the subcutaneous vascular resistance (50%) was demonstrated during the hyperemic blood flow rate phase compared with the surrounding phases (P less than 0.0001). The synchronism of the nocturnal subcutaneous hyperemia and the decrease in systemic mean arterial blood pressure point to a common, possibly central nervous or humoral, eliciting mechanism.

Summary. Possible sources of error during long-term measurements of subcutaneous blood flow rate with the portable CdTe(Cl) detector system were ruled out in the present study. Local blood flow rates were recorded in the lower legs of normal human subjects by means of the 133Xe wash-out technique. A good correlation was found between the portable CdTe(Cl) and stationary NaI(Tl) detector systems both prior to (r = 0·88, P

The blood flow in the subcutaneous adipose tissue of the lower leg of eight normal subjects and 19 patients with chronic venous insufficiency was measured. The 133Xe-washout technique was used with portable CdT1(C1) detectors and a data storage unit. Only those patients with ulcers and a systolic blood pressure at the toe of greater than or equal to 60 mm were investigated. In the controls the relative blood flow during sitting was 0.61 (range 0.35-0.80). In the patients it was 0.46 (range 0.22-0.87). This difference was not significant. During walking the blood flow increased in controls as well as in the patients compared to the value determined in the sitting position (P = 0.0078 and P = 0.0028, respectively, Wilcoxon matched-pairs test). The relative blood-flow rate during walking was 0.96 (range 0.60-1.58) in the controls, and 1.04 (range 0.49-1.46) in the patients. The difference between the normal subjects and the patients was not significant (P = 0.79). We conclude from our studies that patients with venous insufficiency are able to increase their blood flow during walking to the same extent as normal controls.

The excretion of collagen metabolites and circulating androgens was measured in ten males suffering from progressive systemic sclerosis. Significantly higher levels of sex hormone-binding globulin, total testosterone and dihydrotestosterone (DHT) (P less than 0.01), and total oestradiol (P less than 0.05), were found in patients when compared with age-matched controls. Urinary excretion of hydroxyproline in patients was found to correlate significantly with total testosterone (P = 0.035), with DHT (P = 0.005) and dehydroepiandrosterone-sulphate (DHEAS) (P = 0.034). Similarly the hydroxyproline peptide fraction was found to correlate significantly with total testosterone (P = 0.037), with DHT (P = 0.005) and with DHEAS (P = 0.008). Hydroxylysine peptide in the urine correlated significantly with free testosterone (P = 0.035) and DHT (P = 0.040). Oestrogens did not correlate with urinary excretion of collagen metabolites. These findings suggest that androgens may play a role in the pathogenesis of scleroderma in male patients.

Forty-three patients with venous leg ulcers were randomized into treatment with either a long- or a short-stretch compression bandage. Subbandage pressure was regularly measured during rest and walking for a period of up to 1 year. The long-stretch bandage was kept on as long as possible, often up to 1 week. It maintained a significantly higher subbandage pressure in the upright position and during passive dependency as well as during walking than the short-stretch bandage after both 2 and 24 h. The difference between maximum and minimum subbandage pressures during walking did not differ between the two groups. Thus, in contrast to general opinion, the short-stretch bandage did not produce a higher peak working pressure than the long-stretch bandage. The pressure decreased in the supine position in both groups.

Background : Subcutaneous blood flow increases during sleep and we evaluated if this increase is affected by epidural anaesthesia. Methods : Lower leg subcutaneous blood flow was determined by 133 Xenon clearance in ten subjects during continuous epidural anaesthesia at L 2 -L 3 including eight hours of sleep, while the upper abdominal subcutaneous blood flow served as control. Results : Epidural anaesthesia to the level of the umbilicus was followed by an increase in the lower leg subcutaneous blood flow from 3.4 (1.8-6.3) to 7.8 (3.6-16.9) ml min -1 100 g -1 (median and range ; P

The aim of this study was to investigate the possible relationship between variations in local skin and body temperatures, and a subcutaneous hyperaemia response during sleep in humans. Nocturnal subcutaneous blood flow (SBF) was measured in the lower legs of 9 subjects for 8-12 h under outpatient conditions. The core temperature was measured by a tympanic membrane temperature sensor, and the local skin temperature was measured by a skin temperature sensor. The 133Xe wash-out technique with portable CdTe(Cl) detectors was used for measurement of the SBF. The SBF increased significantly (P < 0.0001) after 1 h sleep, with the hyperaemia persisting for 2 h. During the hyperaemic phase, the local skin temperature increased significantly (P < 0.0001) and then decreased again in the post-hyperaemic phase (P < 0.01). The core temperature decreased significantly during the measurement period (P < 0.01). Separate ordinary linear regression analyses revealed no significant correlations between the measured temperature parameters and the blood flow levels during sleep. The results indicate no governing role of the local skin or body temperatures on the local SBF. The local skin temperature increased significantly secondary to the nocturnal subcutaneous hyperaemia (i.e. active vasodilatation), which is believed to be involved in a thermoregulatory effector mechanism.

1. The local subcutaneous adipose tissue blood flow was measured simultaneously in the right and left lower legs of 10 normal human subjects under outpatient nocturnal conditions. The 133Xe-wash-out technique, portable CdTe(Cl) detectors and a portable data-storage unit were used for the measurement of blood flow. 2. The purpose of the study was to unveil the possible role of centrally controlled nerve fibres to the measurement area as mediators of a previously described nocturnal subcutaneous hyperaemia of 2 h duration. Therefore, before the sleeping period, a local nervous blockade was applied immediately proximal to the isotope depot on the right lower leg by the injection of approximately 15 ml of bupivacaine (5 mg/ml) subcutaneously. 3. Control experiments revealed blockade of the baroreceptor vasoconstrictor reflex activity 4 h after application of the local nervous blockade in three subjects examined. 4. Identical nocturnal isotope-wash-out curves were recorded from the two legs. Subcutaneous blood flow was found to increase significantly (P 5. A significant positive correlation was detected between the latency periods from going to bed until the onset of the hyperaemia in the right and left lower legs (P 6. No significant difference could be detected between the relative blood flow increase during the hyperaemic phase in the right and left lower legs (P = 0.83). 7. It is concluded that the present data seem to rule out a central nervous factor(s) as the eliciting mechanism of the nocturnal subcutaneous hyperaemia. A circulating humoral factor(s) might be involved, although modification by local metabolic factors cannot be excluded. The possible physiological significance of the nocturnal hyperaemia is discussed.

Nocturnal subcutaneous adipose tissue blood flow rate was measured in the lower legs of 10 normal human subjects together with systemic arterial blood pressure, heart rate, and registration of sleep stages under ambulatory conditions. The 133Xe washout technique, portable CdTe(Cl) detectors, and a portable data storage unit were used for measurement of blood flow rates. The sleep recordings were performed with a portable computerized sleep analysis system. In accordance with the results of previous studies, a hyperemic blood flow rate phase (mean increase 140%) for 100 min was observed approximately 60 min after the subjects went to bed. The moment of onset of the hyperemic phase was closely related to the moment of onset of the first episode of deep sleep (stages 3 and 4). There was a significant (P < 0.01) overrepresentation of deep sleep in the hyperemic phase compared with adjacent phases, and rapid-eye-movement sleep predominantly occurred in the latter part of the night, when the subcutaneous blood flow rate was stable. The results of the present study are in accordance with current theories of the interrelationship between the thermoregulatory and the arousal state control systems and, thus, might suggest that the nightly subcutaneous hyperemia represents a thermoregulatory effector mechanism.

Nocturnal fluctuations in subcutaneous blood flow in the lower leg and foot were measured during sleep in Type 1 diabetic patients without autonomic neuropathy. Subcutaneous blood flow was measured, simultaneously, 100 mm above the malleolus on the medial aspect of the right lower leg and at the dorsum of the left foot in 10 diabetic patients, and on the right lower leg only in 10 normal human subjects over 12-20 h. The 133Xe wash-out technique, portable CdTe (Cl) detectors and a portable data storage unit were used. The tracer depots were applied by means of the epicutaneous, atraumatic labelling technique. In diabetic patients, subcutaneous blood flow increased 102 +/- 68% in the lower leg and 111 +/- 98% in the foot at 113 +/- 32 min and 107 +/- 37 min, after going to sleep. The hyperaemic phase lasted 128 +/- 43 min and 150 +/- 42 min, respectively. The hyperaemic response was not different from that in the control subjects (89 +/- 61%). There was no significant correlation between the absolute hyperaemia in the leg and that in the foot. In conclusion, Type 1 diabetic patients without autonomic neuropathy have normal nocturnal hyperaemia during sleep.

1. Lower-leg subcutaneous adipose tissue blood flow rates were measured over 12-20 h under ambulatory conditions by means of the 133Xe-washout technique in nine paraplegic men, all with complete spinal cord lesions at or below the Th 6 level, and in nine age-matched healthy men. Portable CdTe(Cl) detectors and datastorage units were used. 2. The central and local sympathetic vasoconstrictive activity at the lower leg was measured under laboratory conditions by means of the l33Xe-washout technique and a stationary NaI(TI) detector system. 3. The paraplegic men were found to have intact central and local sympathetic vasoconstrictive activity in their lower legs. Moreover, they all had a nocturnal hyperaemic blood flow phase of the same magnitude and duration as the control subjects. 4. The possibility that the somaesthetic nerves play a role in the hyperaemic response could be excluded, as all the paraplegic men suffered from complete lower-leg somaesthetic denervation. 5. A significant correlation was found between the time of going to bed and the nightly hyperaemic response in the right and left lower legs (P < 0.01). 6. It is concluded that the present data are in accordance with the concept of a central nervous or humoral elicitation of nocturnal hyperaemia, although local metabolic and other factors might participate as well. Paraplegic men have an intact regulation of the postural and nocturnal changes in peripheral blood flow whether of central sympathetic or humoral origin.

Summary The blood flow rate in subcutaneous adipose tissue was measured on the lower legs of 11 patients with chronic lower-leg venous insufficiency and ulceration and in eight age-matched control subjects for 12–20 h, under ambulatory conditions, using the 133Xe wash-out technique with portable Cadmium telluride (CdTe(Cl)) detectors. In both groups, the change from an upright to a supine position at the beginning of the night period elicited an instantaneous increment in the blood flow rate of 30–40% with a decrease in the central and local postural sympathetic vasoconstrictor activity. After approximately 1 h of sleep, a considerable increase in blood flow rate was seen in both patient and control groups which persisted for nearly 100 min. In the patient group, the mean increase was 137% compared to a mean increase of 68% in the control group (P

SUMMARY The purpose of the study was to investigate possible regional variations in recently discovered nocturnal fluctuations in subcutaneous blood flow rates. Approximately 90 min after going to sleep, a 100% blood flow rate increment, lasting about 100 min, has been demonstrated in the distal and medial aspect of the right lower leg of normal human subjects. In the present study subcutaneous adipose tissue blood flow rates were measured simultaneously in the right and left lower legs of 16 normal human subjects over 12–20 h ambulatory conditions. The 133Xe wash-out technique, portable CdTe(Cl) detectors and a portable data storage unit were used. The tracer depots were applied on the medial aspects of the right lower leg and on the medial (series 1) and lateral (series 2) aspect of the left lower leg 10 cm proximal to the malleolar level by means of the epicutaneous, atraumatic labelling technique. A nocturnal hyperaemic response was demonstrated at both the medial and lateral aspect of the leg. As for the degree of hyperaemia and the absolute blood flow rates in the different phases, there were some deviations between the medial and the lateral locations. However, a highly significant positive correlation was observed in both series concerning the duration of the period from going to bed until the hyperaemia phase (P< 0·001). The mechanisms involved in the nightly subcutaneous hyperaemia are at present unknown. The sudden, synchronized increase in nocturnal subcutaneous blood flow points to a central nervous or humoral elicitation, although local metabolic factors might participate as well.

Possible sources of error during long-term measurements of subcutaneous blood flow rate with the portable CdTe(Cl) detector system were ruled out in the present study. Local blood flow rates were recorded in the lower legs of normal human subjects by means of the 133Xe wash-out technique. A good correlation was found between the portable CdTe(Cl) and stationary NaI(Tl) detector systems both prior to (r = 0.88, P less than 0.0001) and after (r = 0.68, P = 0.07) day over night (12 h) measurements. Identical post-ischaemic reactive hyperaemia could be demonstrated by both detector systems 12 h after the application of the isotope depot. This indicates that blood flow rates and vascular reactivity can be measured over 12 h by the portable CdTe(Cl) detector. Identical results were obtained during the 12-h measurements performed with the portable CdTe(Cl) detector attached directly to the skin surface and with the detector elevated above the skin surface. Therefore, geometrical changes were without any influence on our measurements. We conclude that measurements of subcutaneous blood flow rates in the lower leg of human subjects can be performed under out-patients conditions by means of the 133Xe wash-out technique and portable CdTe(Cl) detectors. A skin area greater than or equal to 4 cm should be labelled by means of the atraumatic, epicutaneous labelling technique and the detector attached directly to the skin surface with a single layer of a 20-micron thick gas-tight Mylar membrane interposed between the skin surface and the detector. The investigation of the subcutaneous blood flow rate should not be initiated until at least 90 min after labelling.(ABSTRACT TRUNCATED AT 250 WORDS)

Subcutaneous adipose tissue blood flow rate was measured in the lower leg of 22 normal human subjects over 12- to 20-h ambulatory conditions. The 133Xe washout technique, portable CdTe(Cl) detectors, and a portable data storage unit were used. The tracer depot was applied on the medial aspect of the right lower leg 10 cm proximal to the malleolar level by means of the epicutaneous, atraumatic labeling technique. The change from upright to supine position from day 1 in the beginning of the night period elicited an instantaneous blood flow rate increment of 30-40% in accordance with a decrease in central and local postural sympathetic vasoconstrictor activity. During sleep, characteristic variations in subcutaneous blood flow were disclosed. The 133Xe washout curve could be divided into three segments with significantly different slopes. Approximately 90 min after the subject went to sleep, an additional blood flow rate increment of considerable magnitude was observed. The mean increase was 84%, but in several cases a greater than 200% increment was measured (maximum 244%). The intra-individual coefficient of variation for the nocturnal blood flow response was in triplicate measurements 25% (n = 9). The hyperemic phase lasted approximately 100 min after which the blood flow rate returned to the level measured at the beginning of the night period. The blood flow rates measured on the second day did not differ from those on the first day. Control measurements performed under similar thermal conditions, but with the subjects kept awake, did not reveal any hyperemic phases. This points toward changes in cardiovascular regulatory mechanisms during sleep.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood flow in subcutaneous tissue of the lower leg decreased by 45% on changing from recumbency to the sitting position in patients suffering from chronic venous insufficiency. When walking, blood flow increased significantly to values near those measured during resting recumbency. A conventional elastic compression bandage (Weromedium) had no effect on these parameters, indicating that therapeutic gain through compression is not mediated by an improvement in subcutaneous blood flow.

In a consecutive series of patients with ulceration of the lower leg referred to the dermatological in-patient department during a 9-month period, a systolic digital blood pressure level (SDBP) below 60 mmHg was used to identify patients with complicating arterial occlusive disease (AOD) of the legs. AOD was diagnosed in 25 patients and stasis ulcers from venous disease (SDBP greater than or equal to 60 mmHg) in 38 patients of the same ages. Patients with ulceration from other causes were excluded. After 1 year, 48% of the patients with AOD and 5% of those with stasis ulcers had died. In the AOD group, 11 legs were amputated. Our figures show that the SDBP is valuable in identifying high-risk patients.

The validity of Laser Doppler Flowmetry for measurements of changes in skin blood flow rates during orthostatic manoeuvres was evaluated. Fifteen healthy subjects were investigated. Relative skin blood flow rates on the dorsum of the hand were measured during stepwise raising and lowering of the arm in 10 cm increments to an extreme position of 40 cm below respectively above heart level. All measurements at test levels were preceded and followed by measurements at reference level, i.e. heart level. At all levels of arm elevation, relative blood flow rates were significantly increased compared with the corresponding reference level (p = 0.0005). This was unexpected in view of the auto-regulatory mechanism. Highly significant blood flow rate reductions were found at all levels of arm lowering. This is in contrast to previous findings of unchanged skin blood flow rate to a point of approximately 35 cm below heart level, where the veno-arteriolar reflex is elicited.

Summary Ninety-four consecutive patients with lower leg stasis ulcers (LSU) were examined for coexistence of arterial occlusive disease. The average age of the patients was 77 years. Two-thirds of the patients were women. Eleven of the patients had diabetes mellitus. Systolic arm, ankle and toe blood pressures were measured. Indices of ankle/arm (AI) and toe/arm pressure (TI) were calculated. In about half of the patients obstructive leg artery disease was found, defined as an AI of less than 0.9. Fifteen patients were at risk from developing gangrene, having a TI lower than 014. Surprisingly, in the non-diabetics there was no significant difference between the blood pressure in ulcerated and non-ulcerated legs. In the diabetics there was a significant difference between ulcerated and non-ulcerated legs (P

The study included 40 patients with clinically venous leg ulcer(s) in one leg only and with a systolic toe blood pressure above 50 mmHg in both legs. Transcutaneous oxygen tension was measured on both lower legs at equivalent sites, on the affected leg immediately proximal to the ulcer(s). Similarly, skin blood flow was measured in both legs at a skin temperature of 32 degrees C and 44 degrees C by means of laser Doppler velocimetry, and for each leg the index of blood flow 44 degrees C/flow 32 degrees C was calculated to express the degree of blood flow increment following local hyperthermia. Transcutaneous oxygen tension measurements were significantly lower on affected legs (p less than 0.01) as was flow increment (p less than 0.01), mainly due to a high flow measurement at 32 degrees C on affected legs rather than to a low measurement at 44 degrees C. The results of our flow measurements suggest a state of (relative) hyperemia in the vicinity of venous leg ulcers, also confirmed by the clinical findings. This could be interpreted as an arteriolar response to lowered oxygen tension or (it could) be part of reactive reparative processes leading to increased O2 consumption in the tissues.

During a 6-month-period, 150 patients infected with Human Immunodeficiency Virus (HIV) were repeatedly examined by dermatologists and dentists for lesions of skin and oral mucosa. The most frequently encountered diseases were: oral hairy leukoplakia (21%), dermatophytosis (including tinea unguium/tinea pedis et inguinalis) (20%), seborrheic dermatitis (19%), viral infections (10%), oral candidiasis (7%), acne vulgaris (6%), and folliculitis (5%). A variety of other manifestations were seen, with frequencies less than 5%. Herpes zoster was seen in 3% of the patients, indicating a rate of 60/1,000 per annum. The presence of seborrheic dermatitis was statistically associated with low T-helper lymphocyte count. Patients with low T-helper lymphocyte count had on average twice as many mucocutaneous lesions as patients with a normal or moderately decreased count. Any one of the manifestations seborrheic dermatitis, oral candidiasis or oral hairy leukoplakia was associated with a greater average number of additional mucocutaneous changes than seen in patients exhibiting none of these three conditions. The high proportion of HIV-infected patients with cutaneous and oral lesions underlines the importance of referring the patients to dermatologists and dentists for examination. Prospective examinations of the study population remain to elucidate the prognostic significance of mucocutaneous manifestations of HIV-infected patients.

1,182 males and 155 females attending an STD clinic from June 1984 to October 1985 were investigated for the presence of antibodies to human immunodeficiency virus (HIV). 348 (29.5%) of the males and 5 (3.2%) of the females were antibody positive (ab+). 237 of the males were initially antibody negative (ab-) and were tested more than once, and during a 16-month period 40 of these seroconverted from ab- to antibody positive. The mean follow-up period of these 40 patients was 7.1 months, and thus the seroconversion rate is estimated to be 2.4% per month. Samples from 37 of these were available for HIV antigen testing. 19 of the patients were antigen positive in the latest ab- sample and accordingly, 18 patients were antigen negative in the latest ab- sample. No difference was found between the mean follow-up periods of those with and those without HIV antigen in the latest ab- serum and the presence of HIV antigen in serum was not associated with symptoms of acute HIV infection. After 20 months of follow-up, none (0.0-8.8%, 97.5% confidence limits) of the 40 patients have developed AIDS or AIDS-related complex.

Mucocutaneous diseases are common in HIV-infected patients. The aim of the present study was to determine the observed frequency of skin diseases and their prognostic significance for the progression of HIV infection. In a cohort of 150 HIV-infected patients diagnosed from 1986 to 1987 the number of mucocutaneous diseases, the CD4+ cell count, time to development of AIDS and survival time were registered for a period of 5 years. Eight patients were lost for follow-up. In the remaining 142 patients the number of mucocutaneous findings increased markedly during the observation period. The most frequent registered diseases and these with the highest increase were oral candidiasis, hairy leukoplakia, seborrhoeic dermatitis and herpes simplex. On average, 5.2 different diagnoses were registered per patient at the end of the follow-up period. The study showed that the total number of mucocutaneous diseases and the CD4+ cell count were significantly correlated to survival time and time to development of AIDS. The number of mucocutaneous diseases, like the CD4+ count, is an indicator of the immune system and the prognosis of HIV infection.