Raynaud's disease and nifedipine

Influence of vasospasm on visual function

In a number of patients with etiologically unexplained visual field loss, a vasospastic syndrome could be found with the help of a capillaroscopic local cooling test on the fingers. In the patients with proven vasospastic syndrome, the visual field defects were increased after a cold water test and decreased after a therapy with calcium entry blockers. General aspects of the physiology and pathophysiology of the circulation and especially of the circulation in the eye are presented.

Vibration syndrome in industry: dermatological viewpoint

Long-term use of hand-held vibratory tools has been implicated in the development of a clinical condition known under several names including occupational Raynaud's phenomenon, vibration-induced white finger (VWF) disease, and "dead" or "wax" finger. The syndrome is characterized in its early stages by tingling, numbness, or blanching of the finger tips provoked usually by exposure to cold temperatures; later these symptoms may extend to the base of all of the digits on both hands. As vibration exposure continues, the attacks become more frequent and cause manual impairment and social disability. This complex of VWF and associated arterial and related complications is now termed vibration syndrome (VS). Although epidemiologic studies indicate that large percentages of the population of workers at greatest risk are affected, the acceptance of VS as an industrial disease is only recent. This paper reviews some of the salient features of VS from the point of view of the dermatologist, since he may be the first health professional to see patients with this syndrome. Terminology, risk factors, preventative measures, therapy, and occupational guidelines are discussed.

Promising uses of calcium-channel blocking agents

It is not surprising that calcium-channel blocking agents, which have numerous effects on various physiologic systems, have been employed for several "unapproved" uses. This manuscript reviews reports that have appeared within the last two years describing unapproved cardiovascular and noncardiovascular uses of the three available calcium-channel blocking agents. The cardiovascular uses discussed include hypertensive emergencies, pulmonary hypertension, congestive heart failure, aortic insufficiency, Raynaud's phenomenon, migraine headaches, antiplatelet effects and cardiac surgery. Areas of noncardiovascular use include muscular dystrophy, achalasia, esophageal spasm, dysmenorrhea, preterm labor, asthma, hyperuricemia, mania and depression and endocrinologic and oncologic conditions. While some of the data appear promising, other reports are conflicting and contradictory. Furthermore, because much of the information comes from poorly controlled trials or anecdotal reports, even the more promising uses must be studied further and compared with conventional therapy.

Nifedipine: two new uses

Nifedipine, a calcium channel blocker currently indicated for vasospastic and chronic stable angina, undoubtedly will have many other uses because of its potent peripheral vasodilatory activity and minimal effects on cardiac contractility. These effects of the drug have proved beneficial in treatment of malignant hypertension and Raynaud's phenomenon. Single oral doses of nifedipine 10-20 mg have rapidly and smoothly reduced blood pressure in malignant hypertension, suggesting its use in the emergency room or office setting. Continuous monitoring of the patient is not required. Studies also have demonstrated the efficacy of nifedipine in Raynaud's phenomenon, and the drug should be considered as an initial agent of choice.