Copyright © 1987 by the European Society of Cardiology.
© 1987 The European Society of Cardiology
Raynaud's phenomenon in chain saw users. Hot and cold finger systolic pressures and nailfold capillary findings
*Department of Internal Medicine and Vascular Pathology, Université de Paris VI, Hôpital Broussais 96, rue Didot, 75674 Paris
Department of Internal Medicine, Université de Paris V, Hôpital Boucicaut 78, rue de la Convention, 75730 Paris, France
Received 28 May 1986; revised 2 September 1986; .
Professor M. Vayssairat, Hópital Broussais, 96, rue Didot, 75674 Paris Cedex 14, France
Abstract
To gain insight into the physiopathology of Raynaud's phenomenon of occupational origin, finger systolic pressures under heat and cold, and results of nailfold capillary microscopy, were examined in 29 lumberjacks with Raynaud's phenomenon vibration syndrome (pathological group) and 24 lumberjacks without it (non-pathological group), and compared with the same values in 26 healthy matched manual workers not using a vibrating tool (controls).
Vibration syndrome physiopathology seemed multifactorial, combining 5 features: (1) a rise in brachial diastolic and systolic pressures in the pathological group compared with the two other groups. In lumberjacks with Raynaud's phenomenon, these rises seemed to be acquired, since they were not found when the workers were engaged; (2) a reduction in the number of nailfold capillaries (9.4 ± 2 per mm in the pathological group vs 11 ± 2.5 in the controls, P <0.025); (3) a rise in the brachial digital systolic gradient (P < 0.025) in the pathological versus the non-pathological lumberjack group (4) abnormal cold vascular tone, since at 15°C finger systolic pressures in the pathological group were lower than pressures in both the control and non-pathological groups (P <0.05 and P <0.01, respectively), and at 10°C, they were lower in the pathological than in the control group (P <0.01); (5) Within the pathological group, individual paired comparisons between the most and least symptomatic finger revealed a rise in the cold vascular tone, and a reduction in the number of nailfold capillaries in the most symptomatic finger compared to the least symptomatic finger.
These results indicate that Raynaud's phenomenon vibration syndrome may include both a central nervous system dysregulation due to cold and vibration, and an abnormal cold vascular tone of the digital arteries caused by a local defect leading to an increased wall/lumen ratio. The implications of this new hypothesis for preventive medicine and research are discussed.
Key Words: Vibrating tool disease • digital artery • lumberjacks • plethysmography • microangiopathy