Thermoregulation and rheological properties of blood in primary Raynaud’s phenomenon and the vibration-induced white-finger syndrome

Objective: Frequent use of vibrating tools may lead to typical attacks of Raynauds phenomenon (RP). The present study assesses the feasibility of the use of thermographic measurements of blood rheometry in the diagnosis of vibration-induced white-finger (VWF) syndrome. Subjects and methods: We studied 38 patients that were suffering from RP (primary RP, n=29; VWF, n=9) and 13 controls (six men and 45 women; mean age 49.1±11.6 years). Superficial finger skin blood flow was assessed with an infrared thermocamera before and after exposure to heat and cold. Fibrinogen, whole-blood viscosity and erythrocyte aggregation at different shear rates and plasma viscosity were measured. Main results: In patients with RP finger temperatures after re-warming were lower than those in controls [right hand digit (DIG) I P<0.02; DIG II–V P<0.01; left hand DIG I P<0.01; DIG II-V p<0.02], male patients with primary RP had higher Fg-values (P<0.02) and a trend to higher plasma viscosity. Patients with VWF had a trend to lower plasma viscosity than controls. Whole-blood viscosity at each shear rate was highest in patients with VWF. Conclusion: Provocation manoeuvres are essential in the diagnosis of RP. We speculate that the decreased plasma viscosity in VWF is a compensatory physiological mechanism, probably counteracting the chronic effects of vasospasm. The rise in whole-blood viscosity could be due to endothelial injury or to a reduction in the venous blood pH level. The abnormal cold reactivity of patients with RP may be partly related to rheological factors.     

Raynaud's phenomenon in common rheumatic diseases

Raynaud's phenomenon (RP) is caused by a reversible spasm of the smallest arteries and the arterioles of the fingers and toes. Two forms of RP have been described: primary and secondary. Secondary RP is often present in patients with rheumatic diseases. This review presents the characteristics of the clinical pattern, the immunological profile and the capillaroscopic pattern in patients with primary and secondary RP in common rheumatic diseases. Attention is paid to standard examinations usually used in RP patients. Primary RP appears to be more common in women beginning usually at puberty. This disorder is caused by vasospasm; no abnormalities of the endothelium are observed. Primary RP shows benign progression. Laboratory tests - erythrocyte sedimentation rate (ESR) and antinuclear antibody test (ANA) - are normal. Capillaroscopy is normal too. Secondary RP tends to begin later in life. Of the rheumatic diseases, scleroderma is the one that is the most often associated with RP (in 90-95% of all cases). The pathogenesis of secondary RP in scleroderma is explained with abnormalities of the endothelium through different mechanisms. Motor ulcerations are frequently observed. Anticentromeric and antitopoizomeric antibodies get positive. Capillaroscopy appears to be very important for the early diagnosis and prognosis of scleroderma. The capillaroscopic pattern is abnormal - enlarged capillaries, hemorrhages and avascular areas are observed. Part of the patients with systemic lupus erythematosus, Sjogren's syndrome and polymyositis / dermatomyositis develops secondary RP and it usually shows benign progression. RP is the main symptom in mixed connective tissue disease and trophic abnormalities of the fingers are frequently observed. Elevated anti-U1-RNP antibody titers and an abnormal capillaroscopic pattern are specific for the condition. In older patients isolated RP may represent a paraneoplastic manifestation. RP is frequently found in the rheumatologic practice. The differentiation of the primary form from the secondary one is essential because of the differences concerning the heaviness of the disorder, the prognosis and the therapeutic approach.     

灯盏花对脑梗塞患者血液流变学的影响

目的探讨灯盏花对脑梗塞患者血液流变学的影响。方法将７６例病人随机分为两组，治疗组４０例，对照组３６例。治疗组应用云南灯盏花注射液，对照组应用复方丹参注射液，１５天为１个疗程。治疗前后分另行血液流变学检测。结果治疗组疗效优于对照组，灯盏花能改善脑梗塞患者血液流变学异常。结论灯盏花是改善脑梗塞患者血液流变学异常的有效药物。     

Visually-evoked P300 and NOGO potentials as indicators of central nervous system function in patients with vibration syndrome

OBJECTIVE: The present study aimed at clarifying the effects of vibration syndrome (VS) on recognition, memory, and selective attention as well as suppression of hand movement in the central nervous system (CNS). METHODS: Sixty-four patients with VS due to previous exposure to vibration from chain-saw work (Ch) or rock drilling work (RD) and 53 age-matched controls were examined for visually evoked P300 (V-P300) and NOGO potentials (NOGO-P). The patient group was divided into two subgroups, one with VS due to Ch work (Ch group, N = 17) and the other with VS due to RD work (RD group, N = 44). RESULTS: ANOVA of latencies of V-P300 between three groups including two subgroups by vibration tools and controls was significant (P < 0.001), with significant difference between the control and RD subgroup (P < 0.001) and between the Ch and RD subgroups (P < 0.001). ANOVA of V-P300 amplitude was also significant (P < 0.001), with significant difference between the control group and RD subgroup (P = 0.042). NOGO-P was recorded in 28 of 37 controls (75.7%). Latencies of NOGO-P among VS patients were significantly delayed compared with those of controls (P = 0.0152). The proportions of subjects with abnormal values of V-P300 and NOGO-P among VS patients and RD operators were significantly higher than those in the control. CONCLUSION: These findings suggest that VS affects CNS function as represented by V-P300 and NOGO-P.     

Serum endothelin concentrations in workers exposed to vibration.

OBJECTIVES: Endothelin 1 (ET1) is one of a newly discovered family of potent naturally occurring vasoconstrictors produced by the endothelium. A few publications indicated that the peptide may have a role in idiopathic Raynaud's phenomenon and Raynaud's phenomenon secondary to connective tissue disease. The aim of this study was to compare serum endothelin concentrations in people with vibration induced white finger (VWF) with those of controls exposed to vibration, and unexposed (pure) controls. SUBJECTS AND METHODS: Male volunteers from a stonemasonry, two quarries, and an insurance company were classified by questionnaire and clinical examination into men with VWF (cases, n = 31), exposed controls (n = 22), or pure controls (n = 36). All subjects were asked to provide two venous blood specimens: a baseline sample after a period of warm equilibration (30 minutes seated in a warm room and 20 minutes with both hands immersed in a water bath at 37 degrees C); and again after cold challenge (both hands immersed in a water bath at 6 degrees C for six minutes). Serum concentrations of the 21 amino acid peptide endothelin ET1-21 were measured by radioimmunoassay. RESULTS: Baseline concentrations of ET1-21 were found to be lower in cases (mean = 12.2 pmol/l) than in the two control groups (mean = 14.7 pmol/l in exposed controls; mean = 14.3 pmol/l in pure controls). Among cases there was a broad inverse relation between severity, as measured by the Griffin blanching score, and baseline ET1-21 (Spearman rank correlation coefficient -0.58, P < 0.001). Cold challenge provoked an overall rise in ET1-21 in all groups, but larger and significant mean absolute and percentage rises were found in cases (4.1 pmol/l and 54%) than in the control groups (2.6 pmol/l and 21% in exposed controls; 1.5 pmol/l and 20% in pure controls). Similar but more obvious differences occurred when controls were compared with those cases who gave a more severe history of disease (Griffin blanching score > or = 24) and those cases found to blanch after cold challenge. In these case subsets baseline ET1-21 was nearly 50% lower than for controls and a four and a half to fivefold greater percentage rise in ET1-21 occurred upon cold challenge. Differences were significant. Close matching for age and smoking did not alter the principal findings. No significant differences, whether in baseline or cold response, were found between unexposed and exposed controls. CONCLUSIONS: Baseline findings seem to contradict various published series and attempts are made to reconcile the differences. It is suggested that a lower baseline ET1-21 in cases may result from a disease compensation mechanism or damage effect. The large relative rise in serum ET1-21 when cases are cold challenged may contribute directly or indirectly to vasospasm, but a simple mechanism is unlikely and interpretation is limited by the absence of measurements of forearm blood flow.     

Diagnostic tests in Raynaud's phenomena in workers exposed to vibration: a comparative study

Four objective tests to evaluate Raynaud's phenomena (RP) in workers exposed to handarm vibrations were applied on 23 exposed men with RP (vibration induced white finger 18, primary Raynaud's phenomenon 5), 56 exposed men without RP, and 15 male controls. Finger systolic blood pressure was measured by a cuff and strain gauge technique after combined body cooling and finger cooling during five minute ischaemia to 30 degrees, 15 degrees, and 6 degrees C. An attack of RP was detected as a zero pressure, FSP(0) test, whereas a pressure, reduced to a value below the normal 95% confidence limit at 6 degrees C, was regarded as an abnormal response, FSP(A) test. A hand cooling, preceded by 30 minute body precooling, was performed in water at 10 degrees C during five minute ischaemia. The finger colours after hand cooling were evaluated by a directly visual inspection, FCV test, and by a blind assessment of slides of the photographed hand, FCS test. A medical interview was used as a method of reference. The sensitivity did not differ significantly between FSP(0) (74%), FCS (61%), and FCV (57%) (p greater than 0.10). FSP(A) had a significantly higher sensitivity (96%) and lower specificity (64%) than those of FCV and FCS (p less than 0.0005) and of FSP(0) (p less than 0.05). Six of the seven men with a false positive FSP(0) had a positive FCV or FCS, and the seventh had a history of previously active RP. The six false negative FSP(0) test results did not correspond significantly to milder cases of RP (p greater than 0.20). The results indicate that a finger colour test may be as valuable as a FSP(0) test for diagnostic purposes. FSP(A) only indicates if a cold response is exaggerated and does not diagnose RP. The pressure measurements may further be of guidance in evaluating preventive measures and effects of treatments for RP.     

Blood rheology in vegetarians

1. Blood rheology has been quantified by measuring blood and plasma viscosity, packed cell volume (PCV), erythrocyte filterability and erythrocyte aggregation in forty-eight voluntary vegetarians and compared with matched controls. 2. Results show that in vegetarians, values for PCV were lower than those in controls, leading to reduced native blood viscosity. In addition PCV-standardized blood viscosity was also decreased. This was brought about mostly by lower plasma viscosity. Erythrocyte rheology seemed to be unaltered. Stricter avoidance of animal products was associated with even lower values for these indices. 3. These observations are in agreement with the fact that other low-cardiovascular-risk groups show better than average blood fluidity. They are consistent with the hypothesis that in vitro measurements of blood rheology may provide signs of early atherosclerotic changes in vivo.     

Diagnostic tests in Raynaud''s phenomena in workers exposed to vibration: a comparative study.

Four objective tests to evaluate Raynaud's phenomena (RP) in workers exposed to handarm vibrations were applied on 23 exposed men with RP (vibration induced white finger 18, primary Raynaud's phenomenon 5), 56 exposed men without RP, and 15 male controls. Finger systolic blood pressure was measured by a cuff and strain gauge technique after combined body cooling and finger cooling during five minute ischaemia to 30 degrees, 15 degrees, and 6 degrees C. An attack of RP was detected as a zero pressure, FSP(0) test, whereas a pressure, reduced to a value below the normal 95% confidence limit at 6 degrees C, was regarded as an abnormal response, FSP(A) test. A hand cooling, preceded by 30 minute body precooling, was performed in water at 10 degrees C during five minute ischaemia. The finger colours after hand cooling were evaluated by a directly visual inspection, FCV test, and by a blind assessment of slides of the photographed hand, FCS test. A medical interview was used as a method of reference. The sensitivity did not differ significantly between FSP(0) (74%), FCS (61%), and FCV (57%) (p greater than 0.10). FSP(A) had a significantly higher sensitivity (96%) and lower specificity (64%) than those of FCV and FCS (p less than 0.0005) and of FSP(0) (p less than 0.05). Six of the seven men with a false positive FSP(0) had a positive FCV or FCS, and the seventh had a history of previously active RP. The six false negative FSP(0) test results did not correspond significantly to milder cases of RP (p greater than 0.20). The results indicate that a finger colour test may be as valuable as a FSP(0) test for diagnostic purposes. FSP(A) only indicates if a cold response is exaggerated and does not diagnose RP. The pressure measurements may further be of guidance in evaluating preventive measures and effects of treatments for RP.     

The tridimensional personality questionnaire in eating disorder patients

The Tridimensional Personality Questionnaire (TPQ) was developed to measure a variety of personality variants on three biosocial dimensions, harm avoidance (HA), novelty seeking (NS), and reward dependence (RD), which are thought to be related to serotonin (5-HJ), dopamine (DA), and norepinephrine (NE) function, respectively. Patients with eating disorders have been reported to have abnormalities in all of these systems, as well as personality variants described by these dimensions. We therefore administered the TPQ to 147 patients with DSM-III-R defined eating disorders (110 bulimia nervosa [BN], 27 with anorexia nervosa [AN], and 10 with BN±AN) and compared their scores to those of 350 female controls. When significant, post hoc Bonferroni t tests were performed using alpha = 0.05. All subtypes of eating disorder patients scored significantly higher on HA than controls (p ≤ .0001, analysis of variance. Only patients with BN (±AN) had significantly higher degrees of NS (p ≤ .0001), particularly on the impulsiveness subscale (NS2), although this may, in part, be due to age. No significant differences in total RD were found, although BN patients scored lower on RD3 (attachment vs. detachment) and higher on RD4 (dependence vs. independence) than controls. In addition, AN patients had significantly higher RD2 (persistence vs. irresoluteness) subscale scores. These data support a theory of 5-HT dysregulation in both types of eating disorders and suggest that further research be done on the role of DA and NE in BN. A© 1993 by John Wiley & Sons, Inc.     

Abnormalities of haemostasis in myocardial infarction with normal coronary artery

Myocardial infarction with normal coronary artery is ussually inaugural, with electric and clinical characteristics similar to those with atheroma. The role of constitutional or acquired abnormalities of haemostasis has been more incriminated in the pathogenesis of myocardial infarction with normal coronary. The aim of our study was to research abnormalities of haemostasis in patients with myocardial infarction and angiographically absolutely normal coronary arteries. PATIENTS AND METHODS: Thirty nine patients with myocardial infarction and normal coronary arteries where included in our study. They were 33 males and 6 females aged between 22 and 75 years (44 + 13 years), in whom the deficiency in protein C and S. antithrombin, activated protein C resistance and antiphospholipid antibodies were assessed. RESULTS: Concurrent abnormalities of haemostasis were found in 10 patients: Antiphospholipid antibodies, found in 5 patients constitute the most frequent abnormality. The other abnormalities were deficiency in protein C in two cases, deficiency in protein S 2 cases, deficiency in antithrombin in 2 ceses and activated protein C resistance in 3 cases . CONCLUSION: In our study. in face of the high prevalence of these abnormalities, it seems reasonable to research them, especially in young patients with myocardial infarction with normal coronary artery. This should have an impact on the management of these patients.     

Diminished phospholipid incorporation of essential fatty acids in peripheral blood leucocytes from patients with Crohn's disease: correlation with zinc depletion

Peripheral blood leucocytes from patients with Crohn's disease have been shown to have lower zinc content than those from a normal population. Since zinc influences essential fatty acid metabolism, incorporation of 14C-linoleic and 3H-arachidonic acids was studied in peripheral blood leucocytes from controls and patients with Crohn's disease. The zinc content of the leucocytes was also measured. After incubation for 2 h, content of 3H-arachidonic acid, but not 14C-linoleic acid, was greater in Crohn's disease leucocytes than in controls. In the Crohn's disease leucocytes, incorporation of both labelled fatty acids into the phosphatidylcholine fraction was significantly lower than in controls, whereas the amount of both fatty acids remaining in the leucocytes as free fatty acids was increased by 70%. In Crohn's disease, leucocyte zinc level was positively associated with the percentage of 3H-arachidonic acid incorporation into phosphatidylcholine. We conclude that peripheral blood leucocytes from patients with Crohn's disease have abnormal essential fatty acid metabolism and that 3H-arachidonic acid incorporation into the phosphatidylcholine fraction of leucocyte lipids in Crohn's disease varies as the zinc content of the leucocytes.     

Cutaneous nerve fibre depletion in vibration white finger.

Vibration white finger or hand-arm vibration syndrome is the episodic blanching of the fingers in response to cold occurring in those who work with hand held vibrating tools. Clinically the condition differs from primary Raynaud's phenomenon as persistent paraesthesiae and pain are common in the hands and arms and these occur independently from the 'white attacks'. Symptoms can become severe enough to warrant a change of occupation. Industrial compensation may be awarded for vibration white finger but, at present, no simple or reliable objective diagnostic test is available. Calcitonin gene-related peptide (CGRP) is a neuropeptide with powerful vasodilator properties. A deficiency of immunoreactive CGRP nerve fibres has been previously demonstrated in the digital cutaneous microvasculature of patients with primary and secondary Raynaud's phenomenon with the distribution and quantity of other types of nerve fibres not being significantly altered. To determine if the innervation of the cutaneous microvasculature in vibration white finger was also abnormal skin biopsy samples from the fingers of 15 patients with vibration white finger, six healthy age matched controls who worked with vibrating machinery and 26 healthy age matched controls who were heavy manual workers without exposure to vibrating machinery were examined by immunohistochemistry. To try to correlate any histological abnormalities with clinical neurological deficit sensory nerve conduction studies have so far been performed in six patients with vibration white finger.(ABSTRACT TRUNCATED AT 250 WORDS)     

广西地区15 413例产前诊断中异常核型的分析性研究

目的：分析产前诊断中异常核型与指征的关系及异常核型胎儿的调查随访,为遗传咨询提供可靠的依据。方法：对15 413例具有产前诊断指征的妊娠妇女在知情同意的情况下,经B型超声引导行羊膜腔穿刺或脐带血穿刺,经培养处理后进行染色体核型分析。有220对胎儿核型异常的父母在知情同意的情况下进行外周血染色体核型分析,之后进行电话随访。结果：细胞培养成功率为99.6%（15 349/15 413）,其中羊水细胞培养成功率99.76%（11 299/11 326）,脐带血细胞培养成功率99.1%（4 050/4 087）。培养成功者染色体异常占11.20%（1 719/15 349）,其中正常多态性占8.70%（1 335/15 349）,染色体数目异常占1.72%（264/15 349）,结构异常占0.79%（121/15 349）。按产前诊断指征分布筛查高危的核型异常率,唐氏综合征为10.67%（879/8 236）,高龄妊娠为9.76%（128/1 312）,不良孕产史为12.27%（138/1 125）,超声异常为11.41%（124/1 087）,胎儿畸形引产为23.91%（132/552）。异常核型的胎儿中有108例来自母亲,69例来自父亲,43例为新发生。结论：高危妊娠妇女行产前诊断染色体分析有助于减少出生缺陷。     

中老年2型糖尿病患者血糖血脂的监测与分析

目的监测分析中老年糖尿病患者血脂血糖水平。方法选择419例社区中老年2型糖尿病患者进行血脂、血糖监测,并与同期528名健康者的资料进行对比分析。结果中老年2型糖尿病组总胆固醇(TC)、甘油三酯(TG)水平明显高于正常对照组;60岁以下组TG、TC水平均显著高于60岁以上组;TC、TG、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)4项指标同时异常率达15.51%;空腹血糖水平与TC、TG水平呈正相关,与HDL-C、LDL-C无明显相关性。结论 2型糖尿病患者糖代谢异常并伴随血脂代谢紊乱,对中老年2型糖尿病患者除控制血糖外,更应重视对血脂异常的治疗,以减少各种并发症的发生。     

门静脉高压症患者巨脾组织CD细胞的变化

目的研究门静脉高压症（PHT）脾功能亢进患者巨脾组织CD细胞的变化，探讨PHT患者的免疫功能特点。方法切除的巨脾组织制成石蜡切片，检测CD3^＋、CD8^＋、CD20^＋、CD68^＋阳性细胞数量及分布，与正常脾组织进行比较。结果（1）PHT巨脾与正常脾脏比较，CD3^＋、CD8^＋、CD20^＋、CD68^＋细胞数均减少。（2）正常脾脏的CD68^＋（Mφ）主要分布在脾小体和红髓（RP）；PHT脾脏CD68^＋主要分布在脾小体和动脉周围淋巴鞘（PALS）。PHT脾脏脾小体、红髓及边缘区（MZ）3个部位单位面积的CD68^＋数量较正常减少，以脾小体和红髓明显。结论PHT患者CD细胞数量及分布均有改变，脾切除术可能使其免疫功能得到一定恢复，并能纠正血常规及肝功能的异常。本研究所检测的免疫指标并不能完全说明患者全身的免疫状态，对门静脉高压症脾功能亢进患者的免疫状态应长期随访。     

Standardization of finger systolic blood pressure (FSBP) cooling tests

A finger systolic blood pressure (FSBP) cooling test was introduced in 1977 and standardized during the following years for the optimal provocation and best characterization of an attack of vasospastic Raynaud's phenomenon (RP). The purpose of the present review is to compare and analyse some different techniques used in FSBP cooling tests from different countries and described in the final draft of the international standard, ISO/DIS 14835-2 (2004). The selected FSBP test results indicate to some extent that the tests are reliable and have acceptable diagnostic values despite the use of different techniques to obtain them. However, only a few studies used a zero-pressure FSBP%(0) to verify an ongoing attack of vasospastic RP. Most studies used an abnormal cold reaction FSBP%(A) located below the lower limit of controls, to make the anamnestic diagnosis of RP probable. According to the ISO draft, different types of finger cooling and body thermostating can be used together in the seated or supine position, and FSBP%(A) is indicated to be used for diagnostic purposes. Further studies are recommended to solve future standardization problems not included in the upcoming ISO standard. An international agreement on the presentation and comparison of test results is needed as a supplement to ISO/DIS 14835-2.     

广西地区15413例产前诊断中异常核型的分析性研究

目的：分析产前诊断中异常核型与指征的关系及异常核型胎儿的调查随访,为遗传咨询提供可靠的依据。方法：对15413例具有产前诊断指征的妊娠妇女在知情同意的情况下,经B型超声引导行羊膜腔穿刺或脐带血穿刺,经培养处理后进行染色体核型分析。有220对胎儿核型异常的父母在知情同意的情况下进行外周血染色体核型分析,之后进行电话随访。结果：细胞培养成功率为99.6%（15349/15413）,其中羊水细胞培养成功率99.76%（11299/11326）,脐带血细胞培养成功率99.1%（4050/4087）。培养成功者染色体异常占11.20%（1719/15349）,其中正常多态性占8.70%（1335/15349）,染色体数目异常占1.72%（264/15349）,结构异常占0.79%（121/15349）。按产前诊断指征分布筛查高危的核型异常率,唐氏综合征为10.67%（879/8236）,高龄妊娠为9.76%（128/1312）,不良孕产史为12.27%（138/1125）,超声异常为11.41%（124/1087）,胎儿畸形引产为23.91%（132/552）。异常核型的胎儿中有108例来自母亲,69例来自父亲,43例为新发生。结论：高危妊娠妇女行产前诊断染色体分析有助于减少出生缺陷。     

A comprehensive assessment of exposures to respirable dust and silica in the taconite mining industry

This study assessed the present-day levels (year 2010–2011) of exposure to respirable dust (RD) and respirable silica (RS) in taconite mines and evaluated how the mining process influences exposure concentrations. Personal samples (n = 679) were collected to assess exposure levels of workers to RD and RS at six mines in the Mesabi Iron Range of Minnesota. The RD and RS concentrations were measured using the National Institute for Occupational Safety and Health (NIOSH) 0600 and NIOSH 7500, respectively. Between-mine, between-SEG (similar exposure groups), within-SEG, and within-worker components of variability for RD and RS exposures were estimated using a two- or three-way nested random-effects ANOVA model. The majority of RD concentrations across all mines were below the Mine Safety and Health Administration (MSHA) Permissible Exposure Limit (PEL). The highest concentrations of RD were often observed in either the Pelletizing or Crushing departments, which are inherently dusty operations. With a few exceptions, the concentrations of RS in the crushing and concentrating processes were higher than those in the other mining processes, as well as higher than the American Conference of Governmental Industrial Hygienists (ACGIH) Threshold Limit Value (TLV) for RS. The magnetic separation and flotation processes in the concentrating department reduced the levels of RS significantly, and lowered the percentage of quartz in RD in the pelletizing department. There was little variability among the six mines or between the two mineralogically distinct zones for either RD or RS exposures. The between-SEG variability for RS did not differ substantially across most of the mines and was a major component of exposure variance. The within-SEG (or between-worker) variance component was typically the smallest because in many instances one worker from a SEG within a mine was monitored multiple times. Some of these findings were affected by the degree of censoring in each SEG and mine, characteristics of the taconite rock, seasonal effects during sampling, or the tasks assigned to each job in that mine.     

Diminished phospholipid incorporation of essential fatty acids in peripheral blood leucocytes from patients with Crohn's disease: correlation with zinc depletion.

Peripheral blood leucocytes from patients with Crohn's disease have been shown to have lower zinc content than those from a normal population. Since zinc influences essential fatty acid metabolism, incorporation of 14C-linoleic and 3H-arachidonic acids was studied in peripheral blood leucocytes from controls and patients with Crohn's disease. The zinc content of the leucocytes was also measured. After incubation for 2 h, content of 3H-arachidonic acid, but not 14C-linoleic acid, was greater in Crohn's disease leucocytes than in controls. In the Crohn's disease leucocytes, incorporation of both labelled fatty acids into the phosphatidylcholine fraction was significantly lower than in controls, whereas the amount of both fatty acids remaining in the leucocytes as free fatty acids was increased by 70%. In Crohn's disease, leucocyte zinc level was positively associated with the percentage of 3H-arachidonic acid incorporation into phosphatidylcholine. We conclude that peripheral blood leucocytes from patients with Crohn's disease have abnormal essential fatty acid metabolism and that 3H-arachidonic acid incorporation into the phosphatidylcholine fraction of leucocyte lipids in Crohn's disease varies as the zinc content of the leucocytes.     

Objective testing for vasospasm in the hand-arm vibration syndrome.

Since vibration white finger (VWF) became a prescribed industrial disease in 1985, objective testing for the diagnosis and grading of the severity of the condition has become desirable. Measurements have been made of finger blood flow and finger systolic pressure before and after cold challenge in 22 healthy control subjects and 34 men presenting for medical examination in connection with compensation claims for VWF. This type of testing has previously produced one false negative result in 35 patients with an established clinical diagnosis of Raynaud's syndrome and no false positives in 40 control subjects. Finger blood flow was not significantly different in the claimants and controls in either warm or cool environments at local finger temperatures from 32 degrees C down to 20 degrees C. Finger systolic pressure in the claimants was not significantly different from that in the controls when the fingers were warm at 32 degrees C. After five minutes middle phalangeal cooling to 15 or 10 degrees C, finger systolic pressure was 0 mm Hg in 22 of the claimants indicating that vasospasm had occurred. No vasospasm occurred in the remaining 12 claimants or in any of the 22 control subjects. By clinical assessment alone, 26 of the 34 claimants had been thought to have VWF and 21 (81%) of these exhibited vasospasm in the laboratory. Of the eight considered not to have VWF, only one exhibited vasospasm in the laboratory.