Department of Cardiology, Section of Angiology, Acireale Hospital, Provincial Health Centre of Catania, Catania, ItalyItaly
Department of Cardiology, Acireale Hospital, Provincial Health Centre of Catania, Catania, ItalyItaly
Department of Medicine, Laboratori Baldacci SpA, Via San Michele degli Scalzi 73, 56124 Pisa, Italy Capillaroscopy is a method of recognized value in the study of morphological and functional abnormalities of the microcirculation. Its use in the clinical field dates from the early twentieth century
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Capillaroscopy is a method of recognized value in the study of morphological and functional abnormalities of the microcirculation. Its use in the clinical field dates from the early twentieth century,1 extending the clinical applications gradually over the years,2,3 to be considered a “routine investigation” in (nowadays) rheumatological practice. The introduction of videocapillaroscopy with optical probes in contact resulted in a significant leap forward in the study of microcirculation.4,5 Videocapillaroscopy is indicated in all diseases whose pathogenesis recognizes anatomical and/or functional abnormalities in microcirculation.6 The advantages of capillaroscopy can be identified in the absence of invasiveness, in its remarkable sensitivity and specificity together with ease procedure and speed execution time. The relatively videocapillaroscopy low cost could be considered another big advantage of this procedure.
Editorial Videocapillaroscopy in Diabetes * *Corresponding author 1* 2 2 3 Concetta Romano , Martino Costa , Marco Messina and Marco Bertini Concetta Romano, MD Department of Cardiology Section of Angiology 1 Department of Cardiology, Section of Angiology, Acireale Hospital, Provincial Health Centre Acireale Hospital of Catania, Catania, Italy Provincial Health Centre of Catania Catania, Italy 2 Department of Cardiology, Acireale Hospital, Provincial Health Centre of Catania, Catania, Tel. + 39 339 8690692 Italy E-mail: immaromano65@gmail.com 3Department of Medicine, Laboratori Baldacci SpA, Via San Michele degli Scalzi 73, 56124 Pisa, Italy Volume 1 : Issue 2 Article Ref. #: 1000DROJ1e002 Capillaroscopy is a method of recognized value in the study of morphological and functional abnormalities of the microcirculation. Its use in the clinical field dates from the early Article History 1 2,3 th twentieth century, extending the clinical applications gradually over the years, to be consid- Received: April 15 , 2015 th Accepted: April 24th, 2015 ered a “routine investigation” in (nowadays) rheumatological practice.
th Published: April 28th, 2015 The introduction of videocapillaroscopy with optical probes in contact resulted in a 4,5 significant leap forward in the study of microcirculation.4,5 Citation Romano C, Costa M, Messina M, Ber- tini M. Videocapillaroscopy in diabe- Videocapillaroscopy is indicated in all diseases whose pathogenesis recognizes ana- tes. Diabetes Res Open J. 2015; 1(2): tomical and/or functional abnormalities in microcirculation.
e3-e6. doi: 10.17140/DROJ-1-e002 The advantages of capillaroscopy can be identified in the absence of invasiveness, in its remarkable sensitivity and specificity together with ease procedure and speed execution time. The relatively videocapillaroscopy low cost could be considered another big advantage of this procedure.
Videocapillaroscopy allows clinicians to acquire informations on morphological and hemodynamic parameters that could be useful like predictive value of extension, gravity and evolution of disease. In this sense videocapillaroscopy could be considered a double profile examination, with diagnostic and prognostic values in the same time.7 Among the many diseases related with abnormal capillaries there is diabetes mellitus. The interest of the microcirculation being altered glucose metabolism is well documented both in the course of diabetes type I and type II.
Chronic hyperglycemia is responsible for the metabolic alterations in endothelial cells, and also of the smooth muscle of the vessel walls, resulting in impairment of contractile properties together with permeability and hemodynamic modifications. Parietal elasticity alteration transforms the vases in rigid ducts by thickened walls, partly due to the non-enzymatic glycosylation of proteins and partly due to the altered metabo- lism of myo-inositol.8 Decreased of parietal compliance cause the appearance of ectasia, with microaneu- Copyright rysms related to pressor stress.
©2015 Romano C. This is an open access article distributed under the In the context of diabetic angiopathy we can distingue nonspecific changes especially Creative Commons Attribution 4.0 International License (CC BY 4.0), at the level of the arteries of large- and medium-caliber, and more specific, also if not exclusive, which permits unrestricted use, changes usually localized in the microvessel. distribution, and reproduction in any medium, provided the original Microvessel videocapillaroscopy study seems to be very interesting in diabetes be- work is properly cited.
cause it seems that the alterations of cutaneous microvessels and Other capillaroscopic alterations consist of sacculare of the fundamental substance of connective constitute the earli- aneurysm apical and lateral of the loops. (Figures 3 and 4) Ar- est manifestations of the disease.
borescent aspects, expression of neo-vascularization, and micro- haemorrhages more or less pronounced, associated with slowing Modifications of cutaneous microvessel results in thick- and grain flow, (Figures 5-7) are interpreted as an expression of ening of the capillary basement membrane, endothelial cells pro- greater severity of microangiopathy.11 liferation and vascular leakage.
Vascular leakage, detectable by fluorescence videocap- illaroscopy , only in part seems to be related to an increase in the amplitude of the system to “small pores”, responsible for the trans-capillary diffusion. In fact, the accumulation of mucopoly- saccharides, to which depends the thickening of the basal mem- brane, also change the selectivity of the process of filtration.9 The capillary flow appears grainy and slowed by the presence of microaggregates which often interrupt the continuity of the blood stream. This dynamic alteration is the consequence
of an increased friction, in part connected to the marked tortuos- ity of the capillaries, in part to the increase of blood viscosity and platelet adhesiveness.10 The data so far in the literature about the capillaroscop- ic characteristics of diabetic microangiopathy are discordant. It ‘was reported a provision of the capillaries to “shoal of fish” in diabetes mellitus type I and increased morphological variability of the loops with increasing diameter.
A further and interesting capillaroscopic modification consists in a progressive dilation of efferent portion of the loop, homogeneous and centripetal, such as to give the appearance
to capillary classic “elephant nose,” (Figures 1 and 2) provided that the diameter exceeds at least 5 times the physiological value (7-18 microns according Grassi) and that it is repetitive.
Although not yet encoded a capillaroscopic pattern These anomalies, although not of specific diagnostic characteristic, in patients with diabetes mellitus can detect mor- value, can play a significant role in the characterization of dia- phological expression of microangiopathy such as, for example, betic microangiopathy.12 the homogeneous increase of the diameter of the capillaries (es- pecially at the level of the stretch venular) and the presence of With the use of fluorescenze capillaroscopy was de- loops of look convoluted. (Figures 8-11).
tected a difference between the permeability alterations typical of diabetes mellitus and those features of systemic sclerosis.13 In the first case, in fact, the alteration of the permeability is homo- geneously distributed throughout the course of the loop capillary (venular and arteriolar tract).
In scleroderma, however, the defect is asymmetric and is accompanied by loss of focal tracer.14 The analogy between two seemingly distant disease, such as diabetes and systemic sclerosis, supports the hypothesis already advanced from the Jordan (“diabetes as a disease of the connective deposit”) of a final common pathway of damage microcirculatory unit, regard- less of the initial pathogenic noxa.15