A new automated toe blood pressure monitor for assessment of limb ischemia.
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OBJECTIVE: toe blood pressure (TBP) is an important method to assess peripheral arterial disease especially in patients with diabetes, but remains difficult to measure. We have developed a simple portable device for TBP measurements. METHODS AND RESULTS: first, TBP was determined in 40 ischemic legs with both laser Doppler and photoplethysmography for perfusion monitoring, to assess if laser Doppler can be used for measurements. The median values recorded were identical, but slightly higher values were obtained with laser Doppler (p=0.03). Secondly, a computer based algorithm for automatic TBP readings with laser Doppler was compared to manual assessment in 28 legs of 20 patients. The median values differed 3mmHg (p=0.10). Finally the applicability of the new device was tested in eight legs of six patients by two nurses. CONCLUSION: laser Doppler is appropriate for perfusion monitoring during TBP measurements and automatic pressure readings seem accurate. The automatic portable device is simple to use and can probably determine TBP. (+info)
Mice lacking endogenous major histocompatibility complex class II develop arthritis resembling psoriatic arthritis at an advanced age.
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OBJECTIVE: To describe and characterize a novel inflammatory toe disease with severe bone destruction that developed spontaneously in "humanized" (HLA transgenic) mice lacking their own major histocompatibility complex (MHC). METHODS: We studied 5 different HLA transgenic mouse lines (HLA-DR2.Ab(0), DR3.Ab(0), DR4.Ab(0), DQ6.Ab(0), and DQ8.Ab(0)) in similar genetic background for an extended period of time (>14 months). Clinical, radiologic, and histologic abnormalities were monitored, and the MHC-related major immunologic parameters in affected and resistant mice were compared. RESULTS: Animals of 4 transgenic lines (HLA-DR2.Ab(0), DR4.Ab(0), DQ6.Ab(0), and DQ8.Ab(0)) developed severe toe inflammation accompanied by progressive bone resorption, hyperkeratosis, alopecia, loss of nails, and shortening and thickening of the distal phalanges. HLA-DR3.Ab(0) transgenic mice were resistant to inflammation. The disease manifested only at advanced ages (6 months or older) and affected 70-100% of the mice, with a female preponderance. The clinical signs and the radiographic and histopathologic features of the affected toes were not similar to those of any disease previously described in mice but did resemble those described for human psoriatic arthritis (PsA). Mice from the 4 susceptible lines expressed lower levels of the HLA transgene and exhibited significantly fewer CD4+ cells in the peripheral blood and reduced natural killer cell activity compared with mice from the resistant HLA-DR3.Ab(0) line. CONCLUSION: This novel, spontaneously developing PsA-like toe disease in MHC-manipulated mice seems to be related to the absence of endogenous MHC class II. Replacement with HLA transgene expression that is insufficient (or no replacement at all) may result in imbalanced MHC class I and class II functions and lead to development of the disease. (+info)
Age-related changes in peripheral pulse timing characteristics at the ears, fingers and toes.
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It is accepted that older subjects have increasing arterial stiffness, which results in increasingly faster pulse transmission to the periphery. However, this age association is less clear in younger subjects and for different peripheral measurement sites. The aims of this study were to determine the association between age and pulse timing characteristics over a five decade age range at the ears, fingers and toes, and to compare these with any additional effects associated with differences in subject height, systolic blood pressure and heart rate. Photoplethysmography pulse wave-forms were recorded noninvasively from the right and left sides at the ears, fingers and toes of 116 normal healthy human subjects. Their median age was 42 years (range 13-72 years). Systolic blood pressure, height and heart rate were also measured. Pulse transit times (PTTs) were determined and referenced to the electrocardiogram R wave. The results revealed that age was the strongest contributor to PTT differences at all sites (P<0.0001). The decrease with ageing was greatest at the toes: -1.6, -0.6, -0.4 ms/year for the toes, fingers, and ears, respectively. Changes for the right and left body sides at each level were highly similar. Blood pressure was also an important contributor to PTT at all sites (P<0.0001); -1.0, -0.4, -0.3 ms/mm Hg, respectively, with approximately half of the effect explained by age. Height was significantly and independently related to PTT at the fingers and toes (P<0.0001); +1.1, +0.7 ms/cm, respectively. The fraction of PTT variability explained by these relationships was 0.65, 0.48, 0.26 for the toes, fingers and ears, respectively (P<0.0001). Finally, we concluded that the age effect decreased linearly from the second to the seventh decades, demonstrating that the effect of changes in arterial stiffness can be detected noninvasively from an early age at three main peripheral sites. Age is the dominant factor in contributing to PTT, and is greatest at the toes, followed by the fingers and then the ears. (+info)
Concomitant acral necrosis and haemolytic uraemic syndrome following ingestion of quinine.
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Thrombotic microangiopathy, which broadly includes thrombotic thrombocytopaenic purpura (TTP) and haemolytic uraemic syndrome (HUS), is a multisystemic disorder that is characterised by thrombocytopaenia, microangiopathic haemolytic anemia and ischaemic manifestations, resulting from platelet agglutination in the arterial microvasculature. Acral necrosis (distal necrosis of fingers and toes) occurs usually as a sequel to severe Raynaud's phenomenon, a vasculospastic disorder frequently related to endothelial cell dysfunction. We report a case of quinine induced TTP-HUS and acral necrosis, two distinct clinical abnormalities which have not yet been reported together in association with quinine. Both of these conditions in this case resolved promptly to treatment with corticosteroids. (+info)
Toenail nicotine levels as a biomarker of tobacco smoke exposure.
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Currently used biomarkers of tobacco smoke exposure have several disadvantages, including that they reflect short-term exposure and can therefore be affected by day-to-day variations. The aim of this study was to assess the validity of toenail nicotine levels as a biomarker of exposure to tobacco smoke for use in epidemiological studies. Toenails were collected in 1982 from 62,641 women participating in the Nurses' Health Study, whereas questionnaire data at that time provided information on active and passive smoke exposure. A stratified random sample of stored toenails from 106 women were selected according to their reported exposure category. Toenails were analyzed for nicotine levels by high-performance liquid chromatography. Toenail nicotine levels differed significantly according to tobacco smoke exposure (P < 0.0001). Among nonactive smokers, there was a significant difference in toenail nicotine levels between passive smokers (mean = 0.28 ng/mg) and nonexposed women (mean = 0.08 ng/mg; P = 0.0006). Among active smokers, there was also a significant difference (P = 0.04) in mean nicotine levels according to categories of cigarettes smoked (means for smokers of 1-14, 15-24, and 25 or more cigarettes/day were 0.94, 1.81, and 2.40 ng/mg). An overlap of the distribution of nicotine levels among passive and active smokers was found. Among all women, the correlation between nail nicotine levels and smoking exposure categories was r = 0.80 (P < 0.0001). The results of this study indicate that toenail nicotine level measurement is a valid biomarker for assessment of active and passive exposure to tobacco smoke. Nail nicotine levels may reflect aspects of active and passive exposure not captured by standard questionnaires and, thus, have the potential to provide better assessment of associations with health risk. (+info)
Basic principles on toe-to-hand transplantation.
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Within the last three decades, toe-to-hand transplantation has become a well-established method for function and appearance reconstruction after trauma and in congenital hand anomalies. An otherwise healthy and cooperative patient is the ideal candidate for toe transplantation after trauma. In such patient, even primary toe transplantation is possible, if the stump is clean and viable. If secondary reconstruction after completed wound healing is considered, emphasis should be laid on tissue sacrifice during the acute management of non-replantable amputations at the hand. Specific considerations regarding selection of toe(s) to be transplanted, technique of toe harvest and inset, sequence of transplantations if more than one digit is to be reconstructed such as in the metacarpal hand, and postoperative regimen are important to achieve satisfying functional and aesthetic results on both recipient and donor sites. A trimmed great toe is ideal for thumb reconstruction if the amputaiton is located at or distal to the middle metacarpal shaft. However, in more proximal amputations a second toe may be more suitable as it allows transmetatarsal harvest without increasing donor site morbidity. Distal finger reconstruction with partial toe or second toe warp around flap gives most gratifing result to those patients who are critically concerned about their body images and also those who need distal fingers for jobs or recreation activities. Combined second and third toe or third and fourth toe transplantations are particular useful in metacarpal hand reconstruction to provide tripod pinch. The role of toe-to-hand transplantation in the new millenium assuming progress in tissue engineering, gene transfer, and the development of new immunosuppressive drugs is discussed. (+info)
Cigarette smoking as a significant risk factor for digital vascular disease in patients with systemic sclerosis.
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OBJECTIVE: Patients with systemic sclerosis (SSc) are at high risk for digital vascular complications, including amputation and gangrene. Cigarette smoking is an important risk factor for vascular disease in the general population. We investigated the influence of cigarette smoking on digital ischemia in patients with SSc. METHODS: We studied 101 patients with SSc (87 women and 14 men, median age 53 years, median disease duration 13 years). Smoking history was defined in terms of current smoking status and total number of pack-years. Digital ischemic events were classified as debridement, hospital admission for intravenous (IV) administration of vasodilators, and digital amputation. The influence of smoking on digital ischemic events was examined using logistic regression, adjusting for age, sex, and disease duration. Results are expressed as the odds ratio (OR) and 95% confidence interval (95% CI). RESULTS: Of the 101 patients, 21 (21%) were current smokers, 37 (37%) were ex-smokers, and 43 (43%) had never smoked. After adjusting for age, sex, and disease duration, current smokers were significantly more likely than never-smokers to have had debridement (OR 4.5, 95% CI 1.1-18.3) or admission for IV vasodilators (OR 3.8, 95% CI 1.1-12.9). Patients smoking at higher intensity were more likely to require admission for IV vasodilators. CONCLUSION: Among patients with SSc, current smokers are 3-4 times more likely than never-smokers to incur digital vascular complications. Resources should be directed to supporting smoking cessation in patients with SSc. (+info)
Foot, hand, face and eye representation in the human striatum.
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The present study aimed at determining the three-dimensional organization of striatal activation during foot, hand, face and eye movements. Seven right-handed, healthy volunteers were studied at 1.5 T using blood oxygen level dependent (BOLD) contrast. The tasks consisted of self-paced flexion/extension of the right and left fingers and right toes, contraction of the lips and saccadic eye movements. For foot, hand and face movements, striatal activation was mainly found in the putamen with a somatotopical organization, the foot area being dorsal, the face area more ventral and medial, the hand area in between. Overlap between somatotopic territories was present, more prominent for hand-face than for foot-face or foot-hand areas. In the putamen, the activated areas of the ipsi- and contralateral hand areas were not identical, suggesting a partial segregation of the ipsi- and contralateral striatal sensorimotor projections. For saccadic eye movements, bilateral activation was observed at the junction between the body and the head of the caudate nucleus and in the right putamen. These data present evidence for a somatotopic organization of the human striatum which corresponds with the topography of corticostriatal projections described in the non-human primates. (+info)