Clinical Investigation of the Microcirculation

In 1628 William Harvey published his discovery of the existence of the microcirculation which he deduced from careful anatomical and physiological study. Thirty-three years later, Malpighi confirmed the presence of capillaries through direct microscopical observation. Subsequent scientific advance has been slow, and in view of the fact that microvascular in the genesis and expression of many pathophysiology may be implicated diseases, our know ledge of human microvascular function is surprisingly limited. This ignorance attests to the difficulty of studying something that is both minute and inaccessible without disturbing the quantity that is being measured. In the last fifteen years, however, direct techniques have been developed for studying human microvascular pressure, flow and permeability. These methods have provided new insights into human microvascular function in health and disease. At the same time there has been a steady growth of new indirect techniques based on a w ide range of physical principles that reflect some or other aspect of microvascular function.

Inhalt

I. The Direct Techniques.- 1. The Study of Human Capillary Pressure.- 2. Capillary Flow Measurements in Human Skin.- 3. Fluorescence Videomicroscopy for Studying Transcapillary and Interstitial Diffusion.- II. Indirect Methodologies.- 4. The Laser Doppler Flowmeter: Clinical and Physiological Application.- 5. The use of Transcutaneous Oxygen Tension Measurements for the Assessment of the Cutaneous Microcirculation.- 6. Quantitative Measurement of Cutaneous Blood Flow Using Radioactive Tracers.- 7. The Measurement of Fluid Filtration in Human Limbs.- III. Clinical Applications.- 8. Microvascular Haemodynamics in Hypertension.- 9. Clinical Application of Microvascular Measurements - Venous and Lymphatic Disease.- 10. Microvascular Measurements in Patients with Arteriosclerosis.- 11. Measurement of the Microcirculation in Raynaud's Phenomenon.- 12. Clinical Investigation of the Diabetic Microcirculation.- 13. Assessment and Monitoring of Micro-Vascular Free Tissue Transfers.