Metoda kožní termometriev diagnostice onemocnění cév z vibrací

Method of Skin Thermometry in the Diagnosis of Vascular Diseases Caused by Vibrations

In a group of 107 workers (98 exposed to vibrations and 12 controls) the state of peripheral vessels was investigated by means ofdigital skin thermometry, digital plethysmography, the manoeuvre of dynamic compression of whole fingers and the cold water test.95 subject exposed to vibrations were divided into a group of 11 patients with vascular disease caused by vibrations, stage 2 and 3and 84 subjects without clinical manifestations of the disease. The skin temperature was assessed on the bellies of the lastphalanges of all fingers of both hands before and after the cold test.Temperature was assessed by means of a contact-free apparatus ALMEMO 2230-8 closely before the cold test and after the coldtest at time intervals of 2-15 minutes for 90 minutes. The following important facts were revealed:• In healthy subjects and in vascular disease due to vibrations stage 1 the skin temperature returns to the normal level beforecooling within 15-45 minutes, in healthy subjects the rise of the curve is more rapid.• In vascular disease caused by vibrations stage 2 the skin temperature starts to return after 45 minutes, in exceptional instancessooner, in severe stages of the disease the skin temperature is restored after one hour or later. In sick subjects the skin temperatureremains for a long time between 22-25 degrees C, depending on the room temperature.• Statistically significant differences in the times of return of blood in different groups were found between the control group andthe group with vascular disease caused by vibrations stage 2 and 3.• In acrohypothermia the rise of the thermometric curve is also slower than in healthy subjects. In patients with acrocyanosis orRaynaud’s syndrome cold hands and a temperature below 27 degrees C is found as a rule already before cooling and there areconsiderable fluctuation and irregularities in the course of the thermometric curve after cooling.• In every subject the skin temperature curves on all finger incl. thumbs have a similar character in response to the exposure tovibrations.• The method of digital plethysmography provides evidence of spasms of peripheral vessels. The method of skin thermometryprovides also reliable evidence of spasms of peripheral vessels and at the same time it provides information on individualcharacteristics of skin temperature reactions.• The authors recommend to use during prevention in subjects exposed to vibrations digital plethysmography as a mandatorymethod.• In diagnostically difficult and complex cases they recommend to supplement the examination by dermal digital thermometry.A combination of all four methods described by the authors is optimal. • The conclusions of examination methods in subjects exposed to vibrations may contribute to improvement of the diagnosis ofdiseases associated with the working process in such fundamental fields as occupational preventive care. This may influenceenlistment at work and monitoring of the health status. The impotance of preventive approach is emphasized not only by contemporary legislation - no. 20/1966 (in particular §§ 6, 35 and 40) but also the new law no. 258/2000 on public health protection.

Key words:
vascular diseases caused by vibrations, digital skin thermometry, cold water test, manoeuvre of repeated dynamic compression according to Hůzl