The validity and reproducibility of the skin vasomotor test—studies in normal subjects, after spinal anaesthesia, and in diabetes mellitus (original) (raw)
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Sympathetic skin response in diabetic neuropathy
Muscle & Nerve, 1987
The sympathetic skin response (SSR) was studied in 47 diabetic patients selected for the presence of symptoms and clinical signs of peripheral neuropathy and in 24 normal control subjects. The SSR was present in all controls but was absent at the foot in 66% and at the hand in 27.7% of the diabetic patients. Absence of the SSR failed to correlate with other electrophysiologic parameters on routine nerve conduction and electromyographic studies. Although absent SSR was more often found in patients with symptoms of autonomic dysfunction (P < 0.05), there was no correlation with any specific symptoms of autonomic involvement. The SSR was frequently absent, at least in the foot, in those patients with abnormal cardiac beat-tobeat variability (expiratoty:inspiratoy, E: I, ratio) and pupil cycle time (PCT). In addition there was a good correlation between the amplitude of the SSR and the value of the E:l ratio (r = 0.81, P < 0.001). The SSR may be a valuable adjunct in the assessment of autonomic involvement in diabetic neuropathy, but its sensitivity requires further evaluation.
Cutaneous thermal sensitivity in diabetic neuropathy
Foot & Ankle International
The goal of this investigation was to determine if cutaneous thermal sensitivity could be used as a discriminator of peripheral neuropathy in diabetic subjects who were sensate to the Semmes-Weinstein 5.07 monofilament. Methods: Sixty adult subjects were separated into two groups. The control group (A) was composed of 30 young healthy individuals without a history of diabetes. The focus group (B) was composed of 26 individuals with adult onset diabetes and four with juvenile onset. All of the subjects underwent thermal sensitivity testing in peripheral nerve root dermatomes of their hands and feet. Testing was performed with custom devices fabricated from materials with different thermal conduction capacities (copper, steel, glass, and plastic). Similar tests were performed with glass tubes containing heated or cooled water to develop a range of thermal sensitivity for the subjects. Results: There was a strong relationship between cold perception and stimulation with the copper probe in dermatomes of the radial nerve of the upper limb and the superficial peroneal dermatome of the lower limb. Conclusions: Thermal sensitivity to copper and cold stimulation may be more discriminative and have a higher threshold than sensitivity to the Semmes-Weinstein monofilament. This simple method may have a role in the early detection of peripheral neuropathy in adult-onset diabetes mellitus.
Skin nerve sympathetic activity during insulin-induced hypoglycaemia
Diabetologia, 1986
Microclectrode recordings of skin nerve sympathetic activity, consisting of sudomotor and vasoconstrictor signals, were performed in the peroneal nerve in seven healthy subjects during insulin-induced hypoglycaemia. The nerve activity was recorded at rest and for 90 min after intravenous injection of 0.15 IIJ insulin/kg body weight. The net outflow of skin nerve sympathetic activity was increased during hypoglycaemia, with the exception of one subject who exhibited a high initial level of activity. In all subjects a change of the temporal pattern of the outflow was found, suggesting a shift from mixed (sudomotor and vasoconstrictor) to pure sudomotor activity. This change coincided with a sensation of warmth, sweating and varying degrees of cutaneous vasodilatation, and was followed by a fall in body temperature. It is concluded that hypoglycaemia has a differential effect on sympathetic activity in skin nerves, with a strong increase of sudomotor impulses and simultaneous inhibition of vasoconstrictor signals. Thus, neurally mediated thermoregulatory adjustment contributes to heat loss during hypoglycaemia.
Clinical Hemorheology and Microcirculation, 2017
The study aimed to investigate local thermally induced microvascular reactivity in patients with type 1 (T1DM) or type 2 diabetes mellitus (T2DM) and polyneuropathy and to compare it with healthy controls. A hundred and fourteen subjects were investigated divided into 3 groups: 1st group-20 patients with T1DM; 2nd group-50 patients with T2DM; 3rd group-44 healthy controls. The skin perfusions of the first tiptoe were monitored by laser Doppler flowmetry during thermal test. The initial (PUi) and basal perfusions at 32 • C (PUb) tended to be higher in the DM groups and the PUb of T1DM group was higher compared with the healthy subjects. The perfusion responses to heating were attenuated in the patients compared with the controls. The calculated vasodilator heat-induced indices were significantly lower and the vasoconstrictor indices during relative cooling in the recovery period were significantly higher in DM patients related to the healthy subjects. The reduced cutaneous microvascular responses to local thermal stimulation in the plantar sides of the toes of both T1DM and T2DM patients with polyneuropathy were similar to those found by previous studies in other investigated sites of glabrous and nonglabrous skin of patients with DM.
Diabetes/Metabolism Research and Reviews, 2010
To evaluate possible differences in distal polyneuropathy (PN) characteristics and degree of abnormalities for various small and large fibre parameters in diabetes type 1 (DM1) and type 2 (DM2). Sixty-six DM1 and 57 DM2 patients with or without PN symptoms were included. Nerve conduction studies (NCS), quantitative sensory testing (QST) and quantification of intraepidermal nerve fibres (IENFs) were performed. Z-scores were calculated from reference materials. In both groups, 42% had abnormal NCS classification, 42% (DM1) and 39% (DM2) abnormal QST, as well as 40% (DM1) and 32% (DM2) abnormal IENF density. Seventy percent (DM1) and 65% (DM2) had one of the three tests abnormal (differences not significant). Correlations were found between most Z-score parameters and disease duration and HbA1c in DM1, but fewer in DM2. In multivariate analysis, some NCS and QST Z-scores were more abnormal in DM2. Symptom scoring correlated better with NCS and QST parameters in DM1. The differences could be referred to disease duration, glycaemic control and possibly patient age. The various parameters from NCS, QST and IENF analysis contribute differently in the assessment of polyneuropathy.
Skin Temperature Changes following Sciatic Nerve Injury in Rats
Journal of Neurotrauma, 2012
In the clinical setting, skin temperature is both easily evaluated and useful in assessments of sympathetic dysfunction. The present study purposed to observe the serial skin temperature changes of both hindlimbs following several types of sciatic nerve injury (complete transection and ligation model [CTL], crush injury model [CRI], and chronic constriction injury model [CCI]) in Sprague-Dawley rats and, further, to delineate the possible mechanisms through various evaluation methods. The temperature differences between the intact and injured areas (DT) on the plantar surface and toes varied among the CTL, CRI, and CCI injury models during the acute stage (7 days post-injury). During the subacute to chronic stages (7-28 days post-injury), DT on the plantar area and toes of the CCI model were higher than those of the CTL and CRI models. The sciatic functional index was gradually restored in the CRI and CCI models, but was unchanged in the CTL model. The CTL model showed constant hypoesthesia; the CRI model, contrastingly, was restored to normal, and the CCI model showed gradual hyperesthesia until 28 days post-injury. The latency and amplitude of the compound muscle action potential (CMAP) in the involved plantar muscle was not found in the CTL group 4 weeks post-injury, but showed gradual restoration in the CRI and CCI models. Regression analysis revealed that the DT in the plantar area and toes were affected only by the CMAP amplitude in the involved plantar muscle; therefore, it can be said that the skin temperature on the injured area after sciatic nerve injury was influenced by the functional status of the involved muscle. Measurement of skin temperature can differentiate mild peripheral nerve injury from moderate-to-severe injuries, although its clinical significance might be limited.
Journal of Clinical Anesthesia, 2000
Study Objective: To investigate if paravertebral lumbar sympathetic ganglion block and lumbar epidural anesthesia result in comparable cutaneous temperature changes in the lower extremity. Design: Nonrandomized comparison study. Setting: Operating rooms and pain clinic procedure rooms in a tertiary care hospital. Patients and Interventions: 18 patients undergoing lumbar sympathetic ganglion blocks for the diagnosis and/or treatment of chronic pain, and 13 patients undergoing lumbar epidural anesthesia for radical prostatectomy. Measurements: Cutaneous temperatures were measured over the great toe, calf, and thigh in all patients. Mean maximum temperature (Tmax), rate of change of skin temperature (from 5% to 95% of maximum temperature change), and mean time to 1°C increase, and 50% and 95% of maximum temperature change for each group were compared. Temperature changes for the epidural and lumbar sympathetic block patients were compared. Main Results: Epidural and lumbar sympathetic block resulted in similar Tmax (34.1 Ϯ 0.2 and 33.8 Ϯ 0.9°C, respectively, mean Ϯ SEM; p ϭ 0.18) and rate of temperature change (0.64 Ϯ 0.09 and 0.49 Ϯ 0.07°C/min; p ϭ 0.2) in the great toe. The onset of cutaneous temperature change after lumbar sympathetic block was slower than after epidural anesthesia (1°C increase: 17 and 11 min, respectively, 50% of Tmax: 25 and 17 min, respectively, and 95% of Tmax: 40 and 31 min, respectively; p Ͻ 0.05 for each). Conclusions: The similar rate and magnitude of cutaneous temperature change in the distal lower extremity suggests the degree of sympathetic blockade is similar with lumbar sympathetic blockade and epidural anesthesia. Either technique should provide adequate sympathectomy for treating sympathetically maintained pain once the diagnosis has been confirmed using selective sympathetic blockade.
Diabetologia, 1992
Transcutaneous oxygen, laser Doppler flowmetry, peroneal nerve motor conduction velocity and skin temperature were assessed in both legs of 34 diabetic patients, who had a mean age of 41 (range 29-77) years, and diabetes duration of 21 (3-34) years. Transcutaneous oxygen significantly correlated with peroneal nerve motor conduction velocity (r = 0.59 p < 0.001) and laser Doppler flowmetry (r = 0.7 p < 0.001). Laser Doppler flowmetry correlated weakly with peroneal motor conduction velocity, (r = 0.34 p < 0.05). In each patient the leg with the higher transcutaneous oxygen (mean 70.2 +9.3 (SD)mmHg) had a significantly higher peroneal motor conduction velocity (45.3_+7.1 vs 41.5+ 6.3 m/s, p < 0.01), than the leg with the lower transcutaneous oxygen (61.0+ 11.9 mmHg), though no difference in skin temperature was observed, 31.4 + 0.4 vs 31.1+ 0.5 ~ We then assessed the potential for reversibility of conduction velocity deficits in ten non-diabetic patients, aged 59 (52-77) years, undergoing unilateral femoro-popliteal bypass, measuring transcutaneous oxygen, peroneal nerve motor conduction velocity and skin temperature pre-and 6 weeks post-surgery. In the control leg (unoperated) there was no significant change in transcutaneous oxygen (63.2 + 8.8 vs 63.0+4.6mmHg), peroneal nerve motor conduction velocity (45.1 + 7.8 vs 43.4 + 7.2 m/s) or skin temperature (30.8 + 1.3 vs 30.2 + 1.2 ~ after surgery (all NS). In the operated leg, transcutaneous oxygenincreased from 59.3 + i0.7 to 70.7 + 7.2 mmHg (p < 0.01), and peroneal nerve motor conduction velocity from 42.6 + 6.1 to 46.7 + 3.2 m/s (p < 0.01), but skin temperature was unchanged 30.3 + 0.4 vs 30.4 + 1.3 ~ (NS). These studies provide further evidence that peripheral nerve function is associated with tissue hypoxia and that improving tissue oxygenation can significantly improve nerve conduction over a short period of time.
General physiology and biophysics, 2018
This study investigated the noradrenergic contribution during the cutaneous vasoconstrictor response to local cooling in the leg and forearm. On each limb, one site was perfused with Yoh/Prop to block the postsynaptic adrenoceptors and another with Lactated Ringer's (control) using microdialysis. Blood flow was measured by Laser-Doppler flowmetry (LDF). Cutaneous vascular conductance (CVC) was calculated as LDF units divided by the mean arterial pressure. After baseline measures, skin was locally cooled to 24°C. Basal CVC was similar at all sites in the leg and forearm (all p > 0.1). During the first 10 min of local cooling, CVC was reduced in the leg (p < 0.005) and unchanged in the forearm control sites (p = 0.2). Yoh/Prop induced an increased CVC in the leg and forearm to a similar level (39.2 ± 11.5, and 41.3 ± 3.3%CVC, respectively; p < 0.35). Late during local cooling, the vasoconstriction was attenuated in the leg and forearm at Yoh/Prop (-38.2 ± 5.3 -37.1 ± 5.3%...