Citations

Plethysmography can be used to detect and assess venous incompetence in the lower extremities. The authors recently evaluated a new device designed for this purpose that uses strain gauges to determine changes in lower extremity cir cumference occurring with (and immediately after) exercise. The device plots a curve of volume against time for each limb and automatically calculates key values such as the volume of blood expelled from the lower limb veins during exercise and the time required for the veins to refill following exercise. The ap paratus was incorporated into their noninvasive vascular laboratory and used (along with other standard tests) to study patients referred for suspected venous incompetence. They observed the following: (1) A shortened postexercise refilling time ac curately identified limbs with venous incompetence. (2) The clinical severity of venous incompetence was inversely related to the refilling time. (3) Exercise- induced changes in lower extremity volume correlated well with simultaneously determined changes in venous pressure. (4) Valvular incompetence could be local ized to the deep or superficial veins based upon the improvement in refilling times seen following placement of elastic tourniquets around the lower limb. (5) The type of exercise performed (knee bends while the patient was standing versus ankle reflexes while sitting) had little effect on results. The authors conclude that exercise venous plethysmography is a useful noninvasive tool for assessing low er limb venous incompetence.

Thromboangiitis obliterans (Buerger's disease) is an occlusive vascular disease that occurs almost exclusively in young male tobacco users. A unique case is documented here in which Buerger's disease affecting the upper limbs was diagnosed in a sixty-two-year-old man who was a cigarette smoker but had stopped smoking fifteen years earlier.