Objective-To compare the long term effects of short term intravenous infusions of iloprost with those of oral nifedipine in patients with Raynaud's phenomenon associated with systemic sclerosis.Design-Double blind, placebo controlled, randomised group comparison.Setting-Dermatology outpatient clinic.Patients-Twenty three patients with Raynaud's phenomenon associated with well documented systemic sclerosis (American Rheumatism Association criteria) and with typical abnormalities in fingernail folds on capillaroscopy.Interventions-Twelve patients were randomised to receive intravenous infusions of iloprost starting at 0 5 ng/kg/min and increased by 0 5 ng/kg/min every 15 minutes to a maximum of 2-0 ng/kg/min for eight hours on three consecutive days with a further single infusion at week 8. Placebo capsules were given concurrently. Eleven patients were randomised to receive nifedipine, starting at 30 mg daily and increased to 60 mg daily after four weeks for another 12 weeks. Infusions of placebo were given in the same manner as the infusions of iloprost. One patient from each group withdrew because of social reasons and three patients receiving nifedipine withdrew because of side effects.End point-Reduction in number, duration, and severity of attacks of Raynaud's phenomenon, reduction in number of digital lesions, increase in digital blood flow.Measurements and main results-Measurements were taken at 0, 4, 8, 12, and 16 weeks. Both regimens produced a reduction in the number, duration, and severity of attacks of Raynaud's phenomenon. The mean (SE) number of digital lesions was reduced with iloprost (from 3-5 (1-6) to 0-6 (0-3)) and with nifedipine (from 4-3 (0.8) to 1-4 (0.5)) after 16 weeks. Hand temperature and digital and microcirculatory blood flow were increased with iloprost but not with nifedipine.Conclusion-Both iloprost and nifedipine are beneficial in the treatment of Raynaud's phenomenon. With nifedipine, however, side effects are common. Short term infusions of iloprost provide longlasting relief of symptoms, and side effects occur only during the infusions and are dose dependent.

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The study objective was to compare vibration perception and patterns of blood flow in outpatients with diffuse upper limb pain disorder (ULPD), carpal tunnel syndrome (CTS) and age and sex matched healthy controls. Vibration perception and discrimination thresholds were compared in subjects with ULPD (n=27), CTS (n=27) and healthy matched controls (n=54). Vibration measurements were taken bilaterally at three sites: (a) over the dorsum of the second and (b) fifth metacarpals and (c) the palmar aspect of the first and second metacarpals, corresponding to the innervation territories of the radial, ulnar and median nerves, respectively. Non-invasive assessments of peripheral blood flow were also performed in both limbs. When compared to healthy controls, subjects with ULPD had widespread elevation of vibration thresholds both ipsilateral and contralateral to the symptomatic limb. Subjects with CTS had similarly elevated vibration thresholds at sites both adjacent to and distant from the site of peripheral nerve injury. The responses to cold pressor testing of the upper limbs were physiologically normal in both the CTS and ULPD patient groups. Furthermore, there were no significant differences in the haemodynamic responses between the patient groups. The global elevation of vibration thresholds in subjects with both ULPD and CTS is consistent with altered central nervous system mechanisms, common to both conditions, which may be either adaptive to or maintaining the perception of pain.

In larger (older) patients, from whom fewer blood volumes were collected, there is a trend toward intra-apheresis recruitment, although less than reported previously. In the smaller (younger) patients, from whom more blood volumes were collected, no trend was observed. Lack of (or submaximal) prior mobilization in previously reported studies may have facilitated intracollection recruitment. Alternatively, the larger number of blood volumes collected from the smaller (younger) patients may have masked intra-apheresis recruitment. The study documents the feasibility of large-volume, 4-hour leukapheresis in pediatric patients.

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Twenty five patients with Raynaud's phenomenon due to systemic sclerosis were infused with prostacyctin (PGI^). In 88",, of the patients there was objective improvement, monitored by thermography or radiometry.The pathogenesis of Raynaud's phenomenon is obscure. Therapy directed at over-activity of the sympathetic system produces only limited or short-lived improvement.Prostaglandins I2 and E, are potent vasodilators and inhibitors of platelet aggregation atid might be expected to produce improvement in peripheral blood fiow. The results of recent studies (Carlson & Eriksson, 1973;Carlson & Olsson, 1976;Szczeklik et al., 1979) suggest that these drugs may help in the management of peripheral vascular disease and ischaemic ulceration.In a previous controlled study of prostaglandin E, in patients with Raynaud's phenomenon and systemic sclerosis, we showed that the drug had a significantly better effect than placebo (Martin et al., I98ia,b).The efficacy of intravenous infusions of prostacyclin (PGI3), a potent vasodilator and more potent inhibitor of platelet aggregation, has now been assessed. PATIENTS AND METHODSThe investigation was performed during the winter months, 1979-1980. Twenty-five patients (twenty-four female, one male) with symptomatic Raynaud's phenomenon and systemic sclerosis were treated with intravenous infusions of prostacyclin.The mean age of the patients was 51 years (range 24-73 years). The mean duration of the Raynaud's phenomenon was I2 years (range 9 months-30 years) and that of other clinical evidence of systemic sclerosis 6 years (range 4 months-i6 years). ooo7-0963/82/oioo-oo8i$02.oo ((J) 1982 British Association of Dermatologists 81

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