Background: Laser Doppler fl uxmetry (LDF) is an extraordinary sensitive noninvasive method of examination. It can be used for monitoring changes in the cutaneous peripheral microcirculation 15 . It uses a monochromatic low-energy laser beam. This beam penetrates the tissue and, depending on individual tissue penetration, it is refl ected, recorded by a sensitive sensor and subsequently analyzed using the Doppler. Laser Doppler fl uxmetry detects movement of cells in the peripheral circulation and microcirculation.Methods: The light from the laser source is delivered via optical fi bers to the tissue. In the tissue the light collides with moving blood elements; after a collision, the wave length of the light changes -this phenomenon is called Doppler shift. Our own method of measurement has already been fully developed. We have a group of patients with physiological fi ndings and also groups of patients with vasoneurosis, patients with type 1 diabetes mellitus, vasculitis patients, and other patient groups. We examine the blood fl ow on the dorsal side of fi ngers or toes. There are many protocols for laser Doppler examination. For all the patient groups we used a protocol evaluating an algorithm, developed in the training department of the Perimed company, using provocation tests for the assessment of the vascular wall function in addition to records at rest. Use of laser Doppler:We have developed a method of use of laser Doppler examination in about 8 years. We have examined several groups of patients. First a patient group with physiological fi ndings was examined, and subsequently groups of patients with vasculitis, vasoneurosis, and a group of patients with type l diabetes mellitus. Recently, monitoring has been performed in patients after cardioversion in chronic atrial fi brillation with sinus rhythm restitution, and also data obtained before and after a varicose vein operation on lower limbs have been compared. Conclusion: Clear diagnostic criteria for this method do not exist so far. For the time being this is a rather theoretical method that we used even in practice for the above mentioned diseases. The method provides enough data even for more detailed analyses. The information valu of the curve arises after statistical data analysis with the t-test.

The objective of this study was to assess the efficacy and safety of liposomal heparin spray-a new formula of topical heparin delivery. This was a randomized, multicenter, controlled open clinical trial with 2 parallel groups. Forty-six outpatients with clinical signs of superficial venous thrombosis (SVT) were treated with either topical liposomal heparin spraygel (LHSG) (Lipohep Forte Spraygel, 4 puffs of 458 IU tid (n = 22) or with low-molecular-weight heparin (LMWH) (Clexane 40 mg once a day (n = 24), administered subcutaneously (sc). Main outcome measures were efficacy parameters (improvement of local symptoms-pain control and planimetric evaluation of erythema size, duplex Doppler assessment of thrombus regression) and safety parameters (documentation of adverse events, with particular reference to deep vein thrombosis [DVT] by duplex sonography, and patients' and investigators' assessment of drug tolerance). Patients' and investigators' subjective assessment of efficacy of treatment and change in basic biochemical parameters were defined as secondary outcome measures. Statistical analysis was performed with use of Wilcoxon test, Mann-Whitney U-test and Chi-square test. Regression of SVT-related symptoms, including pain, erythema, and thrombus presence, was shown as comparable in LHSG and LMWH groups. These results were corroborated by efficacy assessment by investigators and patients. Three cases of deep venous thrombosis in heparin spraygel and 1 in heparin sc group were reported. No significant adverse reactions were observed in the spraygel group, but 1 serious allergic reaction was observed in the LMWH group. Tolerance of new formula heparin was assessed as good. Heparin spraygel-a new topical mode of heparin application, seems a promising method of heparin delivery. This initial study has demonstrated comparable efficacy and safety of LHSG and LMWH in local treatment of SVT. These findings should be confirmed by further extensive study that will reach appropriate statistical power to support such conclusion, for despite heparin treatment, significant risk of DVT was demonstrated in both groups.

Cíl: Cílem práce bylo pilotní prospektivní vyhodnocení kapilaroskopických nálezů u pacientů s Raynaudovým fenoménem a jejich případného vztahu se základními imunologickými parametry. Metodika: V roce 2010 bylo vyšetřeno 51 pacientů (37 žen, 14 mužů) s poruchami periferního prokrvení typu Raynaudova fenoménu s trváním projevů onemocnění ≤ 48 měsíců. Pacienti měli vedle standardních cévních vyšetřeních provedenu kapilaroskopii na přístroji Leica S6D. Kapilaroskopické nálezy byly rozděleny do tří stupňů (bez postižení až výrazně patologický nález). Po cévním a kapilaroskopickém vyšetření následovalo vyšetření na přítomnost autoprotilátek. Výsledky: Metodou lineární regrese byl nalezen vztah mezi zhoršujícími se kapilaroskopickými nálezy a zvyšující se pravděpodobností výskytu autoprotilátek (p = 0,023). Vztah k typům protilátek prokázán nebyl. Nebyl prokázán ani vztah mezi kapilaroskopickými nálezy a věkem pacientů a délkou trvání Raynaudova fenoménu. Závěr: V pilotním souboru pacientů se prokázal vztah mezi kapilaroskopickými nálezy a pravděpodobností výskytu autoprotilátek u pacientů s Raynaudovým fenomeném. Kapilaroskopické vyšetření je vhodnou metodou pro vyšetření pacientů s vasoneurózami a může sloužit k vytypovávání pacientů pro vyšetření autoprotilátek.