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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Chlorpropamide-alcohol flushing may be due to sensitivity to endogenous opiates. To investigate this possibility the plasma met-enkephalin and beta-endorphin responses to sherry with and without chlorpropamide were studied in six patients with non-insulin dependent diabetes and in six normal subjects. After chlorpropamide all patients showed a rise in met-enkephalin concentrations from a basal level of 50 7-2 ng/l to a peak of 754 8-1 ng/l (p <0 001). In contrast, before chlorpropamide treatment was started met-enkephalin values did not change after alcohol. No significant changes in beta-endorphin values were observed. In six normal subjects pretreated with chlorpropamide the met-enkephalin concentration also rose from a basal level of 72 -1 15 ng/l to a peak of 103 9-4 ng/l (p <0 002). Again, the met-enkephalin rise was not observed after placebo. Neither beta-endorphin concentrations nor facial temperature changed significantly.These data suggest that endogenous opiates may be implicated in CPAF. Furthermore, this is the first study in which a significant change in circulating metenkephalin values has occurred.

Photoelectric plethysmography (PPG) was used to investigate blood flow changes close to superficial subcutaneous injection sites. As a validation procedure, the PPG response to subcutaneous injection of a known hyperemic agent, prostaglandin E1 (10(-5) M), was shown to correlate strongly with subcutaneous blood flow changes estimated by the established technique of 133Xe washout. Changes in blood flow over the subcutaneous injection sites of insulin (Actrapid) and insulin diluent were measured by photoelectric plethysmography in six nondiabetics and in six stable and seven brittle insulin-dependent diabetics. In all subject groups, an acute increase in local blood flow was seen within 2 min of both insulin and diluent injections, probably caused by injection trauma. At diluent injection sites, this acute hyperemia faded rapidly, blood flow returning to preinjection levels within 15-20 min, and there was no further increase in blood flow in any of the subjects. Insulin injected into the nondiabetics and stable diabetics caused a pronounced increase in local blood flow, sustained for at least 60 min after injection. In the brittle diabetics, however, there was no prolonged local hyperemia, the response being significantly less than that seen in both the nondiabetics and the stable diabetics. Insulin-related hyperemia close to injection (or infusion) sites may be important in subcutaneous insulin absorption. Its near-absence in brittle diabetics may contribute to the impaired response to subcutaneous insulin characteristic of these patients.