0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Brief Reports |

Increased Venous Alpha-Adrenoceptor Responsiveness in Patients with Reflex Sympathetic Dystrophy

J. Malcolm O. Arnold, MD; Robert W. Teasell, MD; Arthur P. MacLeod, MD; James E. Brown, MD; and S. George Carruthers, MD
[+] Article and Author Information

Requests for Reprints: J. Malcolm O. Arnold, MD, Victoria Hospital, 375 South Street, London, Ontario N6A 4G5, Canada. Acknowledgment: The authors thank Gord Marchiori, PhD, and Amy Lui for assistance in data analysis. Grant Support: Dr. Arnold was supported by a Career Health Scientist Award of the Pharmaceutical Manufacturers Association of Canada.


Copyright 2004 by the American College of Physicians


Ann Intern Med. 1993;118(8):619-621. doi:10.7326/0003-4819-118-8-199304150-00008
Text Size: A A A

Reflex sympathetic dystrophy is a symptom complex characterized by vasomotor instability, hyperesthesia, and pain. Hypothesizing that these symptoms could reflect diminished sympathetic innervation with resultant -adrenoceptor hyper-responsiveness, we studied 11 patients who developed upper-limb reflex sympathetic dystrophy after hemiplegia or trauma and 11 normal controls who were similar in age to the study patients. The diameter of superficial hand veins was measured using a linear variable differential transformer during local infusion of saline and increasing concentrations of noradrenaline. The limbs affected with reflex sympathetic dystrophy showed marked -adrenoceptor hyper-responsiveness; that is, less noradrenaline was required to cause 50% venoconstriction (1.5 compared with 6.8 ng/min, P = 0.001). The unaffected limb in patients with reflex sympathetic dystrophy also showed hyper-responsiveness to noradrenaline when compared with values in normal controls (6.8 compared with 27.4 ng/min, P = 0.01), with such hyper-responsiveness being more marked in patients with hemiplegia. The findings provide the first direct evidence in humans of hyper-responsiveness of vascular -adrenoceptors to noradrenaline in reflex sympathetic dystrophy.

Figures

Grahic Jump Location
Figure 1.
Individual dose-response curves for hand vein distention at 45 mm Hg to local sequential graded infusions of noradrenaline, expressed as a percentage of distention observed during 0.9% saline infusion.

NS = not significant; RSD = reflex sympathetic dystrophy.

Grahic Jump Location
Grahic Jump Location
Figure 2.
The estimated dose of noradrenaline required to cause a 50% constriction of the dorsal hand vein in the left and right hands of normal controls and of the affected and unaffected hands of patients with reflex sympathetic dystrophy.50

ED = estimated effective dose of noradrenaline to cause a 50% constriction in the hand vein; RSD = reflex sympathetic dystrophy. = patients with reflex sympathetic dystrophy after trauma; = patients with reflex sympathetic dystrophy after hemiplegia.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Journal Club
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)