Capillary refill test--a possible auxiliary diagnostic method in obliterative arteriosclerosis.

Values of capillary refill time (CRT) were used for evaluation of skin microcirculation in the lower extremities severed by arteriosclerotic disease. The authors examined 133 extremities in 83 arteriosclerotic patients and 84 extremities of 50 healthy volunteers as a control group. To define the stage of the disease, walking distance, rest pain, level of arterial occlusion and the ankle/arm Doppler index (AAI) were considered. On each leg CRT was measured three times on the foot dorsum and pulp of the hallux. The mean value was calculated. The capillary refill index (CRI) was defined from the values of CRT as a proportion of compression time and time of skin recolouration. Twenty three extremities were examined before and after surgical treatment. The results suggest that values of CRI lower than 0.80 may be considered pathological. In advanced forms of the disease, low values of CRI were found in a significant number of extremities (p less than 0.01). A correlation was found among AAI, walking distance and CRI (r = 0.50). An extremely low CRI (under 0.55) was found on extremities without palpable femoral pulsations. After operation, a significant increase of CRI was observed (p less than 0.01).     

Clinical evaluation of renovascular hypertension and therapeutic decisions

The renal arteriogram alone, useful as an anatomic guide for the surgeon or radiologist, is inadequate to predict potential blood pressure reversal by correction of the obstructing lesion. A patient must be identified as having functionally significant renal arterial disease before intervention can be recommended. The authors discuss uncovering functionally significant renal artery stenosis, the pathophysiology of experimental Goldblatt hypertension, and criteria to identify renovascular hypertension, including peripheral plasma renin activity and differential renal-vein renin determinations.     

Serum cholesterol esterifying and cholesteryl ester hydrolyzing activities in liver diseases: relationships to cholesterol, bilirubin, and bile salt concentrations

Patients with acute hepatitis and chronic alcoholic liver disease had decreased net serum cholesterol esterifying activity (CEA) which correlated positively with the percentages and concentrations of cholesteryl esters in their serum. These cholesterol parameters also correlated negatively with serum bilirubin concentrations, but bilirubin added to sera in vitro failed to influence CEA. The decreased net CEA in the patients was not due to its inhibition by serum bile salts. The sera from five patients catalyzed a net hydrolysis of cholesteryl esters rather than a net esterification of free cholesterol. Since serum cholesteryl ester hydrolase activity may also have been present in the patients with decreased CEA, net CEA cannot be equated with the activity of lecithin-cholesterol acyl transferase (LCAT) in patients with liver disease. The relative contributions of LCAT and cholesteryl ester hydrolase activities to CEA in disease states remain to be evaluated by mutually independent assays. Nevertheless, the correlations found between net CEA and the concentrations and percentages of cholesteryl esters support the concepts that serum cholesterol esterifying activity is physiologically important in the formation of serum cholesteryl esters and that decreased CEA is one mechanism for the decreased level of cholesteryl esters seen in patients with liver diseases.     

Thoracic wall involvement by Hodgkin disease and non-Hodgkin lymphoma: CT evaluation

Thoracic computed tomographic (CT) scans of 250 patients with newly diagnosed or recurrent lymphoma revealed thoracic wall involvement in 24 patients (11 with Hodgkin disease, 13 with non-Hodgkin lymphoma). Thoracic wall involvement occurred without contiguous mediastinal or parenchymal involvement in 17 patients. Of these, 13 patients had masses beneath the pectoralis muscles or within the breast, and four had masses arising from the ribs. Five additional patients had mediastinal masses with thymic involvement and parasternal extension through the thoracic wall. Pulmonary parenchymal lymphoma with thoracic wall invasion was noted in the remaining two patients. In five of nine patients receiving radiation therapy, treatment plans were modified by CT demonstration of thoracic wall lymphoma.