Poul Ebbe Nielsen

Intra-arterial infusion of prostaglandin E1 in normal subjects and patients with peripheral arterial disease

Acute vasodilatation was produced by infusion of prostaglandin E1 (PGE1) in the femoral artery in 6 patients with occlusive arterial disease of the legs and in 3 normal subjects. The effect on blood flow and on blood pressure was measured at different segments of the leg with the strain gauge technique, isotope clearance technique, and photoelectric technique. Skin temperature was measured at different levels by using thermocouples. The blood pressure on the legs decreased at all segments during vasodilatation as well in patients as in controls. The blood flow increased in all segments in normal controls. In patients the blood flow increased proximally in the legs. Distally, however, no increase could be demonstrated. As a good effect of PGE1, on ischaemic rest pains has been reported, mechanisms other than vasodilatation should probably be considered.

Digital Blood Pressure in Patients with Peripheral Arterial Disease Reproducibility and Influence of Change in Posture

Reproducibility of indirect measurements of systolic blood pressure at ankle and toes by means of the strain gauge technique has been assessed in 20 patients with peripheral arterial disease. S.D difp between first and second determinations in double measurements lies between 4 and 6 mm Hg. The variation in gradient arm-leg was a little higher (S.D.difp about 7 mm Hg). In spite of very accurate procedure, day-to-day variation was between 7 and 10 mm Hg according to both distal pressures and arm-leg gradients. No difference in reproducibility was demonstrated, when patients with very low distal pressures and patients with moderately reduced pressures were compared. During measurements on a tilt table in several positions, it was demonstrated in 5 patients with severe peripheral arterial disease that the measured systolic toe blood pressures in the different positions deviated only a few mm Hg from the expected blood pressures, calculated from the changes in hydrostatic levels of arm and toe, and the change...

Digital Blood Pressure in Normal Subjects and Patients with Peripheral Arterial Disease Effect of Change in Temperature

Systolic toe blood pressure was measured in 10 normal subjects and 17 patients with peripheral arterial disease during a warming and a cooling period, in which the skin temperature on the first toe was changed from 33 degrees C to 24 degrees C. In normal subjects systolic toe blood pressure increased from an average of 110 mm Hg to 120 mm Hg during cooling (P less than 0.01), while the systolic arm blood pressure was unchanged during the study (125 mm Hg). Among the patients systolic toe blood pressure increased from an average of 56 mm Hg to an average of 70 mm Hg (P less than 0.01), while arm blood pressure increased from an average of 167/79 mm Hg during warming to 175/83 mm Hg during the cooling period. It is emphazised that despite the small, but significant, increase in digital blood pressure during the cooling period, changes in distal temperature will only have a small influence on the digital blood pressure, when one is evaluating patients with suspected or manifest peripheral arterial disease. In general, measurement during vasodilatation is to be preferred, since curves are easily obtainable.

Indirect measurement of systolic blood pressure by strain gauge technique at finger, ankle and toe in diabetic patients without symptoms of occlusive arterial disease

SummaryThe systolic blood pressure has been measured at the first finger, ankle and first toe, using the strain gauge technique, in 22 diabetic patients aged 40 to 59 years, with diabetes of 11 to 42 years duration, and in 14 non-diabetics in the same age group — all without clinical evidence of occlusive arterial disease in the legs and with palpable pulses in the feet. — The mean systolic gradients (arm-finger, arm-ankle, arm-toe) were equal in the diabetics and nondiabetics. Using mean ± 2.5 x S.D. as normal limits, a significantly elevated systolic blood pressure at the given sites was found in 12 observations among 6 diabetics; 5 of these patients had arterial calcification shown by radiography. In only one observation, a significant pressure drop suggesting arterial stenosis was demonstrated.

Skin perfusion pressure on the legs measured as the external pressure required for skin reddening after blanching: a photo-electric technique compared to isotope washout

The skin perfusion on the calf was measured photo-electrically and by isotope washout technique using external counter pressure by a blood pressure cuff. By the photocell the skin blanching threshold external pressure (BTEP) was recorded on histamine flared red skin. By isotope washout technique the skin blood flow cessation external pressure (FCEP) was recorded using intra-dermal [131I-]-antipyrine mixed with histamine in estimating the skin blood flow. The external pressure was measured with an airfilled plastic cushion connected to a mercury manometer. Over a wide range of pressures as obtained from twenty patients with occlusive arterial disease of the legs, five normal subjects and eleven patients treated for arterial hypertension the values of the two different methods were highly significantly correlated (r = 0.97, P < 0.001). On average the BTEP was equal to the FCEP: 83.9 mmHg (range 18-187) compared to 80.8 mmHg (range 18-158) (P > 0.1). A normal material was obtained from twenty-four subjects measured on the thigh, calf and ankle; the average gradients between the auscultatory brachial mean blood pressure and the BTEP were: thigh 10.7 mmHg (SD 12.7); calf 4.0 mmHg (SD 12.1); ankle 5.1 mmHg (SD 8.7). As compared to the intra-arterial blood pressure the BTEP was found to lie close to the mean blood pressure in normal subjects as well as in hypertensive subjects. The present data indicate that the skin perfusion pressure on the legs can be measured by the rapid photo-electric technique. The clinical application and sources of error are discussed.

Skin Blood Pressure in the Forehead in Patients With Internal Carotid Lesions

The skin blood pressure was measured in the forehead using a photoelectric method in 12 subjects with occlusion and 16 subjects with arteriosclerotic stenosis of the internal carotid artery and compared to 18 normal subjects. The skin blood pressure was in average 37 mm Hg (SD 15) in the patients with occlusion, 44 mm Hg (SD 16) in the patients with stenosis, and 46 mm Hg (SD 10) in the normal subjects. During interruption of the blood supply from the external carotid artery (manual compression of the ipsilateral superficial temporal artery), the skin blood pressure was reduced in average 14 mm Hg in the patients with internal carotid occlusion, 8 mm Hg in the patients with stenosis, and not at all in the normal subjects. Skin blood pressure measured on the arm was in all groups 10 to 20 mm Hg higher than the diastolic arm blood pressure. It is emphasized that this method, as well as other methods using extracerebral registration in an attempt to evaluate the intracerebral arteries, is interesting from a hemodynamic point of view, but is of less diagnostic value in the single patient when compared to the arteriographical investigation.