Vasodilatation in the Lower Extremities in Response to Immersing the Forearms in Warm Water

Gibbon, John H.; Landis, Eugene M.

doi:10.1172/jci100456

Cited by 185 publications

(40 citation statements)

References 4 publications

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“…On two occasions immersing the forearms in warm water failed to produce vasodilator response, indicating marked organic obstruction, verified in the left foot by the absence of vasodilatation after anesthetizing the left posterior tibial nerve. This patient's history has already been summarized in another paper (3).…”

Section: Observationsmentioning

confidence: 83%

The Effects of Alternate Suction and Pressure on Blood Flow to the Lower Extremities

Landis

Gibbon²

1933

J. Clin. Invest.

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Section: Observationsmentioning

confidence: 83%

The Effects of Alternate Suction and Pressure on Blood Flow to the Lower Extremities

Landis

Gibbon²

1933

J. Clin. Invest.

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“…Indirect vasodilatation in the hands was induced by placing the legs in warm water at 43-44' C. up to the knees (8,9). Vasodilatation in the feet was induced by placipj the arms in warm water up to the elbows.…”

Section: Methodsmentioning

confidence: 99%

Vasodilator Fibers in the Human Skin

Sarnoff¹,

Simeone²

1947

J. Clin. Invest.

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Reports on vasodilator fibers in the human skin have not been in general agreement concerning either their existence or their relative functional significance (1)(2)(3)(4)(5)(6). In a recent review on sympathetic surgery (7), the interruption of vasodilator fibers was cited as a possible cause for the limited benefit that occurs after sympathectomy for certain types of peripheral vascular disease. It seemed worthwhile, therefore, to reexamine the available evidence and approach the problem of vasodilator activity from points of view other than those previously described.Lewis and Pickering (4) suggested that heating the body produces maximal vasodilatation in the skin of the extremities by inhibiting vasoconstrictor impulses and also by stimulating additional active dilatation by vasodilator impulses. If this is true, local nerve block performed during pronounced heating of the body or of the other extremities should interrupt these vasodilator impulses, exclude active vasodilatation, and produce a slight but definite fall of skin temperature. The magnitude of the reduction should be proportional to the postulated activity of the vasodilator mechanism at the time of the block. METHODPatients on the surgical wards of the Massachusetts General Hospital were studied. Before beginning the experiment, the patient was placed in the cold room and covered only by a loin cloth. Skin temperatures were determined by means of 8 iron-constantan thermocouples which led to an electronic, nongalvanometric, continuous balance potentiometer.' This recorder registered in rotation every 30 seconds so that each thermocouple registered every 4 minutes.When skin temperatures were determined on the band, the palmar surface of the distal phalanx of the second and fifth digits were used. The plantar surface of the distal phalanges of the toes and a point on the lateral aspect of the dorsum of the foot were used in obtaining skin temperatures of the lower extremity. The shielded wire proximal to the naked thermocouple was taped to the appropriate site at least 2.5 cm. away from the point of 'Brown Instrument Co., Boston, Mass. actual determination so that there was no interference with heat loss at the point of determination.Rectal temperatures, when obtained, were recorded by means of a resistance bulb and potentiometer recording on a circular chart readable to 0.020 centigrade.2 The values at 5-minute intervals were charted. Procaine or metycaine hydrochloride was used for the local blocks. The ulnar nerve was blocked at the elbow. Ankle block was achieved by combining the conventional posterior tibial block with complete ring block at the ankle. The spinal block and the ring block of the toe were performed in the conventional fashion. Care was taken to make certain that epinephrine was not added to the anesthetic agent. In those patients in whom a sympathectomy had been done, the blocks were always performed on the intact side.Indirect vasodilatation in the hands was induced by placing the legs in warm water at 43-44' C. up to the knee...

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“…Vasodilatation of this type has been called reflex, but the term 'indirect', which has also been applied to it, is preferable, since it does not imply the existence of a nervous afferent component. Indeed, the phenomenon is observed in the presence of diverse lesions in the nerve supply to the legs, and there is little doubt that the nervous afferent component, if present, is small (Uprus, Gaylor, Williams & Carmichael, 1935;Uprus, Gaylor & Carmichael, 1936;Gibbon & Landis, 1932).…”

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confidence: 99%