Impact of hydrotherapy on skin blood flow: How much is due to moisture and how much is due to heat?

Hydrotherapy and whirlpool are used to increase skin blood flow and warm tissue. However, recent evidence seems to show that part of the increase in skin blood flow is not due to the warmth itself but due to the moisture content of the heat. Therefore, two series of experiments were accomplished on 10 subjects with an average age of 24.2 +/- 9.7 years and free of diabetes and cardiovascular disease. Subjects sat in a 37 degrees C hydrotherapy pool under two conditions: one in which a thin membrane protecting their skin from moisture while their arm was submerged in water and the second where their arm was allowed to be exposed to the water for 15 minutes. During this period of time, skin and body temperature were measured as well as skin blood flow by a Laser Doppler Imager. The results of the experiments showed that the vapor barrier blocked any change in skin moisture content during submersion in water, and while skin temperature was the same as during exposure to the water, the blood flow with the arm exposed to water increased from 101.1 +/- 10.4 flux to 224.9 +/- 18.2 flux, whereas blood flow increased to only 118.7 +/- 11.4 flux if the moisture of the water was blocked. Thus, a substantial portion of the increase in skin blood flow associated with warm water therapy is probably associated with moisturizing of the skin rather than the heat itself.

Arteriotomy closure device application following percutaneous coronary intervention may prevent bleeding complications in patients with acute myocardial infarction.

The current study was performed to determine whether application of arteriotomy closure devices (ACDs) affect bleeding complications as compared to manual compression in patients with ST-elevated acute myocardial infarction (STEMI) who undergo primary or rescue percutaneous intervention (PCI). 314 consecutive cases of STEMI treated with PCI were retrospectively evaluated. Overall, 82.8% of patients received ACDs with total bleeding rate of 4.2% vs. 11.1% in patients who had manual compression, p=0.042. This difference in bleeding rates did not correlate with any clinical characteristic or utilization of GPIIb/IIIa inhibitors. Accordingly, ACDs can improve the acute results of PCI in STEMI patients.

The conversion in application of percutaneous coronary intervention following the introduction of drug eluting stents.

In order to determine the changes in the pattern of techniques applied during elective coronary intervention, data from 688 patients prior to Sirolimus. Drug-Eluting Stents (DES) approval was compared to 438 patients who underwent coronary intervention after DES approval. There was increased intervention to higher risk lesions, including smaller vessels and re-stenotic lesions after DES approval. Total number of stents per patient significantly decreased, despite longer stent length per patient or per lesion after DES approval. No significant difference was found in multivessel interventions.