Nailfold biopsy in scleroderma and related disorders

Thompson, Robert P.; Harper, Frank E.; Maize, John C.; Ainsworth, Sterling K.; LeRoy, E. Carwile; Maricq, Hildegard R.

doi:10.1002/art.1780270116

Cited by 28 publications

(3 citation statements)

References 13 publications

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“…However, based on the work of investigators studying inflammation and wound repair (7-10), one may speculate that both plasma-derived and newly synthesized FN may be present in the SD nailfold. Increased capillary permeability of nailfold capillaries in SD has been suggested by several earlier studies (17,18). The FN associated with fibrinogen in the apex portion of the nailfold could thus be considered as plasma-derived and may reflect a considerable increase in capillary leakage and/or disruption of capillary wall.…”

Section: Discussionsupporting

confidence: 52%

Fibronectin distribution in nailfold biopsies of scleroderma (systemic sclerosis) patients

Chen,

Maricq,

Pilia

et al. 1985

Acta Derm Venereol

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The distribution of fibronectin (FN) was studied in skin biopsies of 13 patients with scleroderma (SD), 7 patients with dermatomyositis (D), and 10 normal controls (NC) by direct immunofluorescence. In normal tissues, continuous or segmental linear staining of the dermal-epidermal junction (DEJ) was seen. Papillary, subpapillary dermis, and papillary capillary loops showed a reticular pattern of deposition with fibronectin. Scleroderma patients revealed similar staining in the dermis and DEJ. The reticular distribution of FN appeared to stain more intensely in the dermis than in controls, especially in deeper layers. The amount of FN in walls of blood vessels from SD patients was markedly increased; all dermal vessels stained with FN and revealed considerably thicker walls and larger lumens. FN distribution in DM patients was similar to that seen in SD with an increased amount of FN staining in capillary walls.

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Section: Discussionsupporting

confidence: 52%

Fibronectin distribution in nailfold biopsies of scleroderma (systemic sclerosis) patients

Chen,

Maricq,

Pilia

et al. 1985

Acta Derm Venereol

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“…In addition, an increase in capillary permeability was detected by fluorescence videomicroscopy, indicating a functional impairment of transcapillary filtration (Bollinger et al, 1986). This is accompanied by histopathologic changes with thinning of the basement membrane, endothelial swelling, and proliferation (Thompson et al, 1984).…”

mentioning

confidence: 99%

Hemodynamics in Nailfold Capillaries of Patients with Systemic Scleroderma: Synchronous Measurements of Capillary Blood Pressure and Red Blood Cell Velocity

Hahn¹,

Heubach²,

Steins³

et al. 1998

Journal of Investigative Dermatology

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There is increasing evidence that endothelial damage occurs at a very early stage during the course of systemic scleroderma. Endothelial damage is accompanied by impaired microvascular function, which has clearly failed in patients with systemic scleroderma, as evidenced by necrosis of the fingertips in severe cases. We investigated two important determinants of microvascular function, namely capillary blood pressure and capillary red blood cell velocity, simultaneously in the same capillary. In patients with systemic scleroderma and in healthy volunteers matched for age and sex, capillary blood pressure was measured by direct cannulation and capillary red blood cell velocity by video microscopy. Capillary blood pressure and capillary red blood cell velocity were significantly lower in patients (14.27 +/- 4.34 mmHg, 230 +/- 310 microm per s) than in healthy controls (19.06 +/- 3.69 mmHg, p < 0.008, and 910 +/- 240 microm per s, p < 0.003) at an ambient temperature of 22 degrees C, whereas no significant difference in skin temperature was observed (23.7 +/- 0.9 degrees C vs 24.7 +/- 1.9 degrees C) and no occlusion of finger arteries was detected. Capillary blood pressure in enlarged capillaries did not differ from that in normal-shaped capillaries in the patients (correlation of diameter and capillary blood pressure, R2 = 0.04), which was also the case with capillary red blood cell velocity (R2 = 0.13). Capillary pulse pressure amplitude and capillary red blood cell velocity showed a strong correlation (R2 = 0.81), suggesting that the pressure gradient across the capillary loop, which is the driving force for capillary red blood cell velocity, was mainly dependent on precapillary resistance. These observations reflect the inadequate microvascular function in systemic scleroderma, which may be due mainly to a pathophysiologic functional increase in precapillary resistance, even at comfortable ambient temperatures.

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“…A CPU panorâmica tem boa reprodutibilidade e espelha adequadamente os achados anatomopatológicos 9,10,[12][13][14] . Entretanto, deve-se ter em mente que a CPU fornece uma imagem indireta do capilar, pois com as fontes de luz disponíveis visualiza-se apenas o fluxo sanguíneo moldado pelas paredes dos capilares 8 .…”

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Capilaroscopia panorâmica periungueal e sua aplicação em doenças reumáticas

Silva

Lima

Pucinelli

et al. 1997

Rev. Assoc. Med. Bras.

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zido em 1987 mediante um amplo estudo de padronização da normalidade para nossa população 11 . A CPU panorâmica tem boa reprodutibilidade e espelha adequadamente os achados anatomopatológicos 9,10,[12][13][14] . Entretanto, deve-se ter em mente que a CPU fornece uma imagem indireta do capilar, pois com as fontes de luz disponíveis visualiza-se apenas o fluxo sanguíneo moldado pelas paredes dos capilares 8 . MÉTODO DE EXECUÇÃO DO EXAMEO instrumento óptico mais adequado é a lupa estereomicroscópica, embora possam ser empregados, a título de triagem, outros instrumentos de magnificação, como a lupa de mão, oftalmoscópio e microscopia convencional. A epiiluminação deve provir de fonte de baixa irradiação térmica, incidindo a 45º sobre a superfície da pele.A aplicação de um meio oleoso e transparente (óleo de imersão, glicerina) sobre a região a ser examinada nivela a superfície irregular da pele, o que permite a entrada e saída homogênea dos raios luminosos e torna a pele translúcida 8,11 . Embora os dedos anular e mínimo ofereçam, em geral, melhor visibilidade, todos os dedos das mãos devem ser examinados, pois alterações microangiopáticas podem ser focais e restritas a apenas alguns dedos. Para melhores resultados, deve-se orientar o paciente a não retirar a cutícula por no mínimo três semanas antecedendo a avaliação. O edema resultante da retirada da cutícula prejudica acentuadamente o estudo dos capilares periungueais.A CPU permite a visualização do plexo venoso subpapilar (PVS) e capilares das papilas dér-micas. As observações feitas restringem-se aos capilares da fileira distal, ou seja, imediatamente proximais à borda ungueal e à cutícula. Esses capilares são, normalmente, bem visualizados de forma longitudinal em seus três segmentos, aferente, transição e eferente. Os capilares das fileiras proximais são usualmente visualizados como pequenos pontos correspondendo ao topo do segmento de transição ( fig. 1). INTRODUÇÃOA capilaroscopia periungueal (CPU) consiste na visualização in vivo da rede microvascular da região periungueal. Trata-se de um exame não-invasivo e de fácil execução, que tem encontrado grande aplicação no estudo das acro-síndromes vasculares e de doenças auto-imunes reumáticas sistêmicas.Aparentemente, a primeira descrição de capilaroscopia microscópica data de 1663, tendo sido realizada por Johan Christophorous Kohlhaus. Estudos subseqüentes utilizaram diversos sistemas de magnificação óptica para a visualização de capilares em diferentes locais do organismo humano, tais como a conjuntiva ocular, lábios, região periungueal e polpa digital [1][2][3][4][5]

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Nailfold biopsy in scleroderma and related disorders

Cited by 28 publications

References 13 publications

Fibronectin distribution in nailfold biopsies of scleroderma (systemic sclerosis) patients

Fibronectin distribution in nailfold biopsies of scleroderma (systemic sclerosis) patients

Hemodynamics in Nailfold Capillaries of Patients with Systemic Scleroderma: Synchronous Measurements of Capillary Blood Pressure and Red Blood Cell Velocity

Capilaroscopia panorâmica periungueal e sua aplicação em doenças reumáticas

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