Background: Fibrinogen is mainly responsible for determining the viscosity of whole blood. In peripheral arterial disease (PAD) the fibrinogen concentration seems to affect the microcirculation flow. Aim: To study the effects of an abrupt reduction of fibrinogen on the hemodynamics of the lower extremities and the clinical picture of patients with PAD. Methods: Ten patients affected by various stages of PAD underwent 1 session of fibrinogen apheresis (TheraSorb, Miltenyi Biotec, Germany). Laboratory parameters of endothelial activation were assessed before and after the session, as well as walking distance (WD), the ankle-brachial index and laser Doppler flowmetry. Results: A significant reduction in the laboratory parameters was observed: fibrinogen (50%), total cholesterol (18%), LDL cholesterol (24%), sE-selectin (23%), sICAM-1 (19%) and sVCAM-1 (10%). The procoagulant factors, factor VIII and von Willebrand factor, did not vary significantly. Both pain-free and total WD were significantly improved (p < 0.003 and p <0.006, respectively), the ankle-brachial index remained unchanged, and laser Doppler flowmetry showed a modest but not significant increase. Conclusions: Fibrinogen apheresis allowed us to study the effects of an acute modification of fibrinogen in PAD, on both some aspects of the endothelial function and on the hemodynamics, demonstrating an improvement of WD and a minimal increase in the skin microcirculation.

Clostridiopeptidase A, also called collagenase 1, is a proteolytic enzyme capable of digesting collagen. Preparations containing clostridiopeptidase A are used topically for the debridement of dermal ulcers, burns and other necrotic lesions to facilitate the formation of granulation tissue and subsequent epithelization. We observed 4 patients with a periulcerative eczema after repeated applications of Noruxol ointment (Smith & Nephew Ltd, L Hull, UK). Patch testing with Noruxol ointment as is and its excipients (soft paraffin and white petrolatum), as well as scaled dilutions of the main ingredient of this topical preparation, clostridiopeptidase A (Firma, Florence, Italy), showed doubtful reactions to Noruxol ointment in 3 patients and a positive reactions only in 1 patient. All patients showed positive reactions to clostridiopeptidase A 1% in pet. This study shows the sensitizing capacity of clostridiopeptidase A that should be tested in all patients with suspect sensitization to Noruxol ointment.

Background/Aims: An endothelial dysfunction has been described in autosomal dominant polycystic kidney disease (ADPKD) before the development of hypertension and renal impairment. The aim of this work was to verify the existence of a microvascular reactivity in the early stages of ADPKD. Methods: Fifteen ADPKD normotensive patients with normal renal function underwent laser Doppler examination of the cutaneous microcirculation in basal conditions and after the warm test, as well as evaluation of plasma concentrations of some endothelial activation parameters [total cholesterol and fractions, fibrinogen, von Willebrand factor, Lp(a)]. The results were compared with those in 15 healthy subjects, 15 essential hypertensive patients and 15 hypertensive ADPKD patients with normal renal function. Results: Both basal and post-warm-test values were significantly lower in normotensive ADPKD subjects than controls (3.2 ± 1 vs. 5.8 ± 1.3 AU, p = 0.0001; 35.2 ± 10.9 vs. 50.5 ± 10.8 AU, p = 0.005, respectively). All evaluated parameters were within normal limits and comparable between normotensive ADPKD subjects and controls, except for LDL cholesterol (125 ± 18 vs. 101 ± 22 mg/dl, p = 0.01) and Lp(a), which was significantly higher in the ADPKD subjects (52.2 ± 36 vs. 6.0 ±4 mg/dl, p = 0.0006). Conclusion: Our study confirms the existence of a systemic microcirculation defect in ADPKD. The presence of high levels of Lp(a) could contribute to causing the high incidence of cardiovascular events in ADPKD.

HHT can induce morphological changes in microcirculation that are more easily detectable on the dorsum of the hands than in the nailfold. Microscopic lesions without macroscopic telangiectases were also noted, suggesting the need for further research. Capillaroscopy may provide an additional non-invasive diagnostic criterion for HHT.

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