Use of Dynamic Capillaroscopy for Studying Cutaneous Microcirculation in Patients with Diabetes Mellitus

Chang, Chung‐Hsing; Tsai, Rong‐Kung; Wu, Wen-Chuan; Kuo, Song-Ling; Yu, Hsin‐Su

doi:10.1006/mvre.1996.2003

Cited by 61 publications

(45 citation statements)

References 9 publications

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“…To be eligible, participants had to be: male (due to the male dominance in this workforce), retired, aged over 60 years, with at least a 5-year occupational exposure to VCM, a time after VCM exposure of at least 5 years, and no exposure to chemicals other than VCM. Moreover, participants with diabetes mellitus were also excluded as it might interfere with microcirculation, [16][17][18][19][20][21] as well as individuals declaring the use or previous use of treatments that might alter microcirculation.…”

Section: Methods Participantsmentioning

confidence: 99%

“…Selection criteria for this group also included no occupational or leisure chemical exposure, and no diabetes mellitus. [16][17][18][19][20][21] Capillaroscopy A nailfold capillaroscopy was performed on all fingers of each patient, excluding the thumbs. 23 The nailfold capillaroscopies of the fingers were captured in images and electronically stored.…”

Section: Methods Participantsmentioning

confidence: 99%

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The long-term effects of occupational exposure to vinyl chloride monomer on microcirculation: a cross-sectional study 15 years after retirement

et al. 2013

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ObjectivesTo assess residual long-term microcirculation abnormalities by capillaroscopy, 15 years after retiring from occupational exposure to vinyl chloride monomer (VCM).DesignCross-sectional study.SettingAllier, one of the major areas of polyvinyl chloride production in France.ParticipantsWe screened 761 (97% men) retired workers exposed to chemical toxics. Exposure to chemicals other than VCM excluded potential participants.Primary and secondary outcome measuresThese participants underwent a medical examination including a capillaroscopy, symptoms of Raynaud and comorbidities, as well as a survey to determine exposure time, direct or indirect contact, type of occupation, smoking status and time after exposure. A double blind analysis of capillaroscopic images was carried out. A control group was matched in age, sex, type of occupation.Results179/761 retired workers were only exposed to VCM at their work, with 21 meeting the inclusion criteria and included. Exposure time was 29.8±1.9 years and time after exposure was 15.9±2.4 years. Retired workers previously exposed to VCM had significantly higher capillaroscopic modifications than the 35 controls: enlarged capillaries (19% vs 0%, p<0.001), dystrophy (28.6% vs 0%, p=0.0012) and augmented length (33% vs 0%, p<0.001). Time exposure was linked (p<0.001) with enlarged capillaries (R2=0.63), dystrophy (R2=0.51) and capillary length (R2=0.36). They also had higher symptoms of Raynaud (19% vs 0%, p=0.007) without correlation with capillaroscopic modifications.ConclusionsAlthough VCM exposure was already known to affect microcirculation, our study demonstrates residual long-term abnormalities following an average of 15 years’ retirement, with a time-related exposure response. Symptoms of Raynaud, although statistically associated with exposure, were not related to capillaroscopic modifications; its origin remains to be determined.

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Section: Methods Participantsmentioning

confidence: 99%

Section: Methods Participantsmentioning

confidence: 99%

The long-term effects of occupational exposure to vinyl chloride monomer on microcirculation: a cross-sectional study 15 years after retirement

et al. 2013

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“…They found no differences in basal areas of transverse segments, but there was a significant increment between basal and maximum area among diabetic patients when compared to control group 22 . Chang et al studied microcirculation in patients with diabetes mellitus using dynamic capillaroscopy and evaluated peak blood cell velocity (pCBV) after post occlusive reactive hyperemia response and found that pCBV was slowed down in diabetic patients with or without retinopathy when compared with controls 23 .This functional parameter shows more sensitivity and detects changes earlier than morphologic abnormalities; this response is independent of neural mechanisms and the deviation of normal response curve in diabetic patients may be due to impaired myogenic mechanism 23 . The time to reach MAI was different among TS and controls in our study.…”

Section: Discussionmentioning

confidence: 99%

“…This impairment of cutaneous microcirculation in TS with a 1-minute digital arterial occlusion may be compared with the slow blood cell velocity found by Chang et al in diabetic patients. This difference in MAIt is very important because studies of microcirculation consider that the time-to-peak velocity after a 1-minute occlusion of the flow to one of the fingers is the most stable variable during PRH [23][24][25] . The prolonged maximum vasodilatation in response to ischemia among TS patients suggests abnormal adaptation to hypoxia event and this fact is concordant with studies that show the same characteristics in diabetes mellitus and a reduced increment of flow velocity during reperfusion.…”

Section: Discussionmentioning

confidence: 99%

Endotelium in Turner syndrome with capillaroscopy

Coelho¹,

Guimarães²,

Fernandes³

2011

J. vasc. bras.

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Objective: The aim of this study was to assess the endothelium function in patients with Turner syndrome using videocapillaroscopy and to compare the results with healthy control. Methods: Subjects and controls were studied in a temperature-controlled room, 20 days after no nailfold manipulations. The capillaries were visualized by a microscope connected to a television and a computer. The test of post-occlusive reactive hyperemia was performed using a sphygmomanometer attached to the fourth left finger, 20mmHg above maximum arterial pressure during 1 minute, and the following patterns were studied: area of transverse segment, maximal post-ischemia area and time to reach maximal post-ischemia area. Results: The value of measure of transverse segment projected area , the maximal postischemia area of hand nailfold capillary loops using computerized videophotometry and the time to reach maximal post ischemia area were studied in 40 patients with Turner syndrome and 26 healthy women controls of comparable age (20±7.5 versus 18±8.1 years old; p=0.57). There were differences between transverse segment area (706.8±139.1 versus 548.8±117.2; p=0.001). Maximal post-ischemia area (891.3±226.1 versus 643.5±134.3; p=0.001) and the time to reach it (10.8±4.3 versus 5.5±2.5; p=0.001) were different between patients and controls. Conclusions: Changes of capillary response to ischemia could be observed in patients with Turner syndrome using videocapillaroscopy when they were compared to a healthy control group.Keywords: Turner syndrome; microscopic angioscopy; endothelium. ResumoObjetivos: O objetivo deste estudo foi avaliar a função endotelial de pacientes com síndrome de Turner, utilizando a videocapilaroscopia e comparar os resultados com grupo controle saudável. Métodos: Pacientes e controles foram estudados em sala com temperatura controlada, após 20 dias, sem a manipulação das cutículas. Os capilares foram visualizados por microscópio conectado a televisão e computador. O teste de hiperemia reativa pós-oclusiva foi realizado utilizando-se esfigmomanômetro fixado no quarto quirodáctilo da mão esquerda, 20mmHg acima da pressão arterial máxima durante 1 minuto, e os seguintes parâmetros foram estudados: área do segmento transverso, área máxima pós-hiperemia e tempo para alcançar a área máxima pós-hiperemia. Resultados: O valor da área do segmento transverso, área máxima pós-hiperemia dos capilares da região da mão usando-se a videocapilaroscopia computadorizada e o tempo para alcançar a área pós-hiperemia foram estudadas em 40 pacientes com síndrome de Turner e 26 controles do sexo feminino pareados para idade (20±7,5 versus 18±8,1 anos; p=0,57). Houve diferenças nos grupos quanto à área do segmento transverso (706,8±139,1 versus 548,8±117,2; p=0,001). A área máxima pós-hiperemia (891,3±226,1 versus 643,5±134,3; p=0,001) e o tempo para alcançá-la (10,8±4,3 versus 5,5±2,5; p=0,001) foram significativamente diferentes entre pacientes e controles. Conclusão: Houve alterações na resposta do capilar à isquemia em pacientes...

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“…It is known that hyperglycemia induces intensified metabolism, increased oxygen consumption, causes relative tissue hypoxia, and as a result a dilation of blood vessels. In addition, an abnormal interstitial diffusion of fluorescein of nail-fold vessels in diabetes mellitus has been found and is thought to develop prior to capillary dilation [51,52].…”

Section: Diabetes Mellitusmentioning

confidence: 98%

The specificity of capillaroscopic pattern in connective autoimmune diseases. A comparison with microvascular changes in diseases of social importance: arterial hypertension and diabetes mellitus

Lambova¹,

Müller‐Ladner²

2009

Mod Rheumatol

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Capillaroscopy is a method with substantial value for diagnosis and differentiation of primary and secondary Raynaud's phenomenon in rheumatic diseases. The most specific finding is in systemic sclerosis--the so-called "scleroderma pattern." which is characterized by the presence of dilated capillaries, hemorrhages, avascular areas, and neoangiogenesis. Similar changes are found in patients with dermatomyositis, overlap syndromes, and others and are termed "scleroderma-like pattern." For the development of these patterns, the most specific finding in the early phase is appearance of dilated capillaries. Capillaroscopic changes in connective autoimmune diseases are specific and differ significantly from those of that can be found in other diseases. Diseases of social importance such as diabetes mellitus and arterial hypertension often present as comorbidity in patients with rheumatic diseases. In diabetes mellitus, the capillaroscopic examination does not show dilated capillaries until the advanced stages of the disease. In the late stages of connective tissue disease, a loss of capillaries is typical. In addition, in diabetes mellitus, the diabetic stiff-hand syndrome and sclerodactyly are common complications, which have to be differentiated from similar signs in rheumatic diseases, and capillaroscopic examination appears to be useful in these situations. In arterial hypertension, a reduced capillary density in different body regions has been observed in patients with established disease as well as in preclinical stages. Analogous phenomenon of reduction in the nail-fold area has also been observed in a group of patients with essential hypertension, none of whom previously received hypertensive drugs.

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Use of Dynamic Capillaroscopy for Studying Cutaneous Microcirculation in Patients with Diabetes Mellitus

Cited by 61 publications

References 9 publications

The long-term effects of occupational exposure to vinyl chloride monomer on microcirculation: a cross-sectional study 15 years after retirement

The long-term effects of occupational exposure to vinyl chloride monomer on microcirculation: a cross-sectional study 15 years after retirement

Endotelium in Turner syndrome with capillaroscopy

The specificity of capillaroscopic pattern in connective autoimmune diseases. A comparison with microvascular changes in diseases of social importance: arterial hypertension and diabetes mellitus

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