ORIGINAL ARTICLES   

Panminerva Medica 2002 June;44(2):123-7

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Nailfold capillaroscopy and laser Doppler flowmetry during standardised cold challenge to evaluate capillary pattern and digital flow in idiopathic acrocyanosis

Cannas F., Binaghi F.

From the Geriathry School Internal Medicine Science Department University of Cagliari, Cagliari, Italy

Quantitative cor­re­la­tion ­between cap­il­lary mor­pho­log­ic pat­terns and dig­i­tal ­pulp ­flow in idiopathic acrocyanosis (IA) is as yet unex­plained. We stud­ied cap­il­lary pat­tern, ­scored accord­ing main­ly to cap­il­lary dil­a­ta­tion and tor­tu­os­ity. Digital ­flow was record­ed by ­laser Doppler flow­me­try dur­ing a stan­dar­dised cool­ing and rewarm­ing ther­mal chal­lenge in a con­trolled ther­mo­stat­ic cham­ber. A neg­a­tive cor­re­la­tion was ­found by lin­e­ar regres­sion anal­y­sis ­between increas­ing cap­il­lary abnor­mal­ities and decreas­ing ­flow ­rates ­both at ­rest and dur­ing cool­ing, ­while a pos­i­tive cor­re­la­tion was ­observed ­among the pres­ence and inten­sity of the ­flow ­stop reac­tion dur­ing ­cold chal­lenge and the ­decrease of hyper­aem­ic re-­flow in the rewarm­ing ­phase. Further inves­ti­ga­tions may be jus­ti­fied to ­assess the ­nature of ­these abnor­mal­ities, wheth­er con­sti­tu­tion­al or ­induced by pro­longed ­cold expo­sure. For ­this pur­pose, a stan­dar­dised meth­od, as the ''cool­ing- rewarm­ing” chal­lenge, ­could ver­i­fy the sev­er­al path­o­phy­sio­log­i­cal hypoth­e­ses pro­posed for vas­cu­lar acro­syn­dromes. We ­need to use a sub­jec­tive meth­od ­such as capil­la­ros­co­py-­based scor­ing (as in our ­study ­endorsed by an objec­tive tech­nique) to ­acquire the nec­es­sary reli­abil­ity and repro­du­cibil­ity in the func­tion­al diag­no­sis. In ­fact IA ­patients ­with low­er mor­pho­log­ic ­scores ­show bet­ter ­flow prop­er­ties.