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Summary:A 49 year old man with systemic sclerosis developed ischaemia of his extremities with massive peripheral gangrene. High levels ofcirculating cryofibrinogen were detected in the plasma and the significance of these findings is discussed.

Summary:A case is presented of a glomangioma with typical history and clinical findings, proven by operation and histology. Unique radiographic features are demonstrated including visualization of the tumour on a soft tissue radiograph and associated hyperaemic bone changes, continuous wave Doppler results indicating hyperaemia and an arterio-venous malformation, and the clear demonstration of the tumour in both frontal and lateral views was possible by intra-arterial digital subtraction angiography (DSA) under local anaesthesia. Fibrous dysplasia of a femur was an incidental finding.

The effect of local controlled cooling on the digital systolic blood pressure in the hand was studied in 25 In an effort to make objective measurements in patients with primary or secondary Raynaud's syndrome, several workers have studied blood flow in the hand ( I , 2) before and after local cooling, blood viscosity ( 3 ) changes at low temperatures and photoelectric measurement of pulse amplitude (4) during stepwise cooling. Nielsen ( 5 ) suggested that photoplethysmography was unsuitable for detecting pulsation when finger systolic pressure was less than 30-40mmHg. He described a method (5,6) of indirectly measuring finger systolic pressure at different temperatures using a proximal occluding cuff and a proximal cooling cuff, and strain gauge plethysmography to detect distal pulsation. However, although Nielsen achieved objective pressure measurements that separated normals from patients with primary Raynaud's disease (5,7), he found it necessary to use body cooling with a cooling blanket at an ambient room temperature of 22°C to achieve this separation. We have adopted his method of local finger cooling, using photoplethysmography instead of strain gauge plethysmography to detect distal pulsation. and a lower ambient room temperature of 17.5-18 "C instead of total body cooling. The aim of our study was to measure and attempt to identify any difference in the response to cooling in controls and patients with Raynaud's syndrome. Patients and methodsTwenty-five normal volunteers (21 women, 4 men: age 20-40 years) acting as controls and 25 patients (20 women, 5 men: age 22-67 years) with Raynaud's syndrome were studied. Seven patients had systemic sclerosis. 2 had Buerger's disease and in 14 the diagnosis was unknown. In each subject the brachial systolic blood pressure and the systolic blood pressure of the cooled middle finger and of the noncooled (reference) index finger were measured. This was achieved using a thermostatically controlled culT, which could be pressurized and simultaneously perfused with water at 30°C or 10°C. on the middle digit. a non-cooled cuff pressurized by air at ambient room temperature on the index finger and photoplethysmographic (PPG) probes to detect the distal pulse on the tip of each finger. A commercially available digit cooling machine (Medimatic, Copenhagen, Denmark) was used. Both cuffs were capable of being pressurized and deflated simultaneously; cuff pressure was monitored via an Akers transducer (AE 840) and amplifier and recorded on a pen recorder (Watanabe MC611). The PPG probes (Medasonics PH77). placed on the pulp of each digit, were connected via a Photo Pulse Adaptor (Medasonics PA13) and the tracings were recorded on the same pen recorder. Thus, there were simultaneous recordings of cuff pressure and distal pulses.The pre-test conditions for all subjects involved no tobacco or alcohol (in the preceding 2 hours) and a light meal only, and for the test all were rested for 20 minutes in light clothing at a room temperature maintained at 17.5-18 "C. Cuffs on both fing...

Eleven healthy dogs were subjected to haemorrhagic shock for 90 min. after which shed blood was reinfused. Detailed studies were made of cardiopulmonary function. Samples of blood were taken at frequent intervals for the measurement of glucagon, insulin and glucose. Three dogs had samples taken for catecholamine levels. The glucagon level rose during haemorrhagic shock but there was no relationship between this rise and the change in cardiorespiratory measurement, but there was a relationship between the plasma glucagon level, the blood glucose and the catecholamine level. It is suggested that the release of glucagon in haemorrhagic shock is mediated by sympathetic stimulation of the alpha cell and that the rise in glucagon is in part responsible for the hyperglycaemia which is found in shock.