Signs and symptoms of reflex sympathetic dystrophy: prospective study of 829 patients.

The pathogenesis of reflex sympathetic dystrophy--variously known as Sudeck's atrophy, causalgia, algodystrophy, and peripheral trophoneurosis--is not yet understood, and diagnosing and treating patients is difficult. We have prospectively studied 829 patients, paying particular attention to early signs and symptoms. In its early phase, reflex sympathetic dystrophy is characterised by regional inflammation, which increases after muscular exercise. Pain was present in 93% of patients, and hypoaesthesia and hyperpathy were present in 69% and 75% respectively. With time, tissue atrophy may occur as well as involuntary movements, muscle spasms, or pseudoparalysis. Tremor was found in 49% and muscular incoordination in 54% of patients. Sympathetic signs such as hyperhidrosis are infrequent and therefore have no diagnostic value. We found no evidence consistent with the presence of three consecutive phases of the disease. Early symptoms are those of an inflammatory reaction and not of a disturbance of the sympathetic nervous system. These data support the concept of an exaggerated regional inflammatory response to injury or operation in reflex sympathetic dystrophy.

Quantitative assessment of vasospasm by Doppler spectrum analysis in patients with primary Raynaud's phenomenon.

The aim of the study was to investigate whether increased peripheral resistance which is supposed to exist in patients with primary Raynaud's phenomenon, can be quantified by using parameters of Doppler spectra of flow in the ulnar and radial arteries. A group of 24 patients with this abnormality were compared with a matched group of 24 normal subjects. Doppler spectra were analysed according to the methods of Fronek, Gosling and by Fast Fourier Transform analysis. The Doppler spectra obtained from patients at room temperature were very different from those in normal subjects, showing characteristic wave-forms with multiple oscillations in 92% of the patients. All three analysing techniques demonstrated significant differences between the two groups, which can be attributed to increased peripheral vascular resistance in the patient group. The results of this study emphasize the value of analysis of Doppler spectra obtained from ulnar and radial arteries in the assessment of peripheral vascular resistance in vasospastic disease.

Asymptomatic carotid bruit in patients who undergo coronary artery surgery.

The clinical significance of the presence of carotid bruit was evaluated in 643 patients who underwent coronary artery surgery alone or in combination with other cardiac procedures. Carotid bruit was heard in 31 patients (5%) who were neurologically asymptomatic. All of them underwent coronary artery surgery without additional carotid procedures, and none of them developed neurological deficits during the postoperative period. Of the remaining 612 patients, 18 were identified as having a history of focal neurological disorders, and 9 of them had carotid bruit. All were analyzed by means of noninvasive tests and angiography. Five underwent carotid endarterectomy prior to (2 patients) and simultaneously with (3 patients) a coronary bypass procedure. Seven patients developed neurological deficits postoperatively. Most of the deficits were not lateralized or focal but diffuse, which suggests global cerebral ischemia not related to carotid disease. Only 1 patient had proven carotid obstructive disease and underwent successful carotid thrombendarterectomy 10 days postoperatively. This study, although based on limited material, supports the hypothesis that patients with asymptomatic carotid bruit can safely undergo coronary artery surgery. In the group of patients without neurological symptomatology, postoperative neurological deficits were rarely caused by occlusive carotid disease. However, patients with asymptomatic carotid bruit should be closely followed with the goal of identifying those who are at risk of developing neurological deficits.