A Simple Color Filter as an Aid in Evaluating the Superficial Venous Pattern*

A Simple Color Filter as an Aid in Evaluating the Superficial Venous Pattern*

A SIMPLE COLOR FILTER AS AN AID IN EVALUATING THE SUPERFICIAL VENOUS PATTERN* EUGENE M. FARBER, M.D., JACK MCCLEARY, M.D. AND ELMER E. BATTS, MD. In ...

411KB Sizes 0 Downloads 2 Views

A SIMPLE COLOR FILTER AS AN AID IN EVALUATING THE SUPERFICIAL VENOUS PATTERN* EUGENE M. FARBER, M.D., JACK MCCLEARY, M.D. AND ELMER E. BATTS, MD.

In a number of skin diseases the relationship of the underlying vascular network is important but often difficult to determine by direct inspection. Infra-red photographs (1, 2), are of value, but often are unavailable to the examining physician. As a readily available substitute we have used the fluoroscopist's dark adapter goggle as a color filter in the examination of dermatoses where the vascular network may play a contributing role. An example of such a filter is the "Wilson Monogoggle" which permits the passage of 12 % of the visible light in the red portion of the spectrum and 72 % of the infra-red light. A fairly good examination of the vascular network can be obt.ained with such a color filter. The infra-red portion of the spectrum (wave lengths above 7000 Angstrom units) is of little value (3) in the use of these goggles since the visible spectrum ranges from 3200 to 7500 Angstrom units (4), and without long dark adaptation the human is only able to see down to the red, not infra-red portion of the spectrum.

It has been shown that the lower end of the spectrum from 5500 to 11500 Angstrom units has an increasing percentage of transmission through tissue layers 5 mm. thick (5). With the largely reflected blue light filtered from the viewer's eye by the red filter, he can see the more penetrating, less reflected red light. This factor, plus the contrast between the veins and skin due to the absorption of the lower wave lengths by the venous blood (6) offers an adequate explanation of the effectiveness of the color filter. This effectiveness in demonstrating the superficial venous pattern is dependent on several factors including the thickness of the skin (7), the degree of venous engorgement (8), the nearness of the veins to the surface, and the condition of the vein walls (9). We have found the simple color filter particularly useful in differentiating those dermatoses of the lower extremities in which there is altered vascular pathology. In stasis dermatitis, examination with the color filter reveals a striking accentuation of the venous pattern which is not fully apparent to the unaided eye. In the presence of a stasis ulcer several dilated veins may be seen passing beneath the ulcerated area (10). In stasis ulcers of longer duration or those that are healing one may see an accentuated venous pattern about the periphery of the ulcer. In other ulcers of the lower extremity, while varicosities may be present, there is usually no distinct relationship with the ulceration, especially in those cases where arteriosclerosis plays a role (11). In localized neurodermatitis, eczematous patches are often seen overlying the greater saphenous vein or a dilated tributary (11). This varicosity is readily ap* From

the Division of Dermatology, Department of Medicine, Stanford University

School of Medicine, San Francisco. Received for publication December 14, 1953. 253

254

THE JOURNAL OF INVESTIGATIVE DERMATOLOGY

G

$1

Fj.

1.

The "Wilson Monogoggle" is a simple color filter

parent if the color filter is used and the "neurodermite" may be cured by the elimination of the underlying incompetent vein. The demonstration of an accentuated venous pattern is of special importance in the presence of pigmented purpuric eruptions of the lower extremities. These conditions are usually a direct result of venous or venular stasis. Hypertrophic lichen planus of the lower extremity occasionally occurs over dilated venules. This occurrence is readily appreciated in an examination with the color filter. In livedo reticularis the characteristic purplish mottling is easily distinguished with the unaided eye if the room is chilled; the color filter examination reveals clearly a reticulated pattern at room temperature. While the color filter has its greatest use in the examination of the venous pattern of the lower extremities, its use is in no way restricted to this area. It may be used similarly in those conditions in which infra-red photography would be applicable. The altered superficial venous pattern of the female breast in cases of tumors (12) or in the diagnosis of pregnancy (13), an aid in the differentiation of lymphangioma and hemangioma (14), and the study of the collateral venous circulation of the portal vein (15) present problems in which routine examination with the color filter offers diagnostic assistance. When the injection treatment of a hemangioma or the varicose vein is considered, preliminary examination with the color filter offers aid in the selection of the proper injection site. In no way is the use of the color filter to be considered as a comp'ete substitute for the more detailed picture furnished by the infra-red photograph. Often the superficial venous pattern is not fully appreciated as an aid in identifying vascu-

255

SIMPLE COLOR FILTER

a Fin. 2.

b

Stasis dermatitis of the lower leg. a) Standard photograph. b) Photograph

taken with color filter held over the lens of the camera.

lar disorders and this very simple technic quickly permits the examiner to obtain a picture in which the venous network is the most prominent feature and permits him to decide upon further investigation of this pattern at that moment. REFERENCES 1. ZIMMERMAN, L. M. AND RATTNEB, H.: Infra-red photography of subcutaneous veins.

Am.

J. Surg., 27: 502—522, 1935.

2. GIBSON, H. L.: Infra-red photography of patients. 21: 1945. 3.

Radiography & Clin.

Photography,

DONAVAX, G. E.: Infra-red and ultravio1et light and their medical application. Brit.

J. Physical Med., 8: 62—66, 1945. 4. Basr AND TAYLOR: Physiological Basis of Medical Practice. Williams and Wilkins, 4th edition. 5. CARTWRIGHT, C. H.: Infra-red transmission of the flesh. J. Optic. Soc. America, 20 81—84, 1930. 6. ZIMMERMAN, L. M.

AND RATTNER, H.: Infra-red photography of subcutaneous veins.

Am. J. Surg., 27: 502—522, 1935.

7. PAYNE, H. T.: Infra-red photography of the superficial venous system. Lancet, 1: 235—236, 1934.

8. BARKER, N. W. AND JLIN, L. A.: Demonstration of superficial veins by infra—red photography. Proc. Staff Meet., Mayo Clinic, 9: 68—70, 1934.

9. Wji.sox, E. E.: The changes in infra-red photographs taken during the treatment of varicose veins. Am. J. Surg., 37: 470—474, 1937.

256

THE JOURNAL OF INVESTIGATIVE DERMATOLOGY

10. ZIMMERMAN, L. M. Pathogenesis of the cutaneous complications of varicose veins. Arch. Dermat., 34: 97—102, 1936.

with the Veins. Arch. Dermat. 52: 376—383, 1945. 11. WOLF', M.: Cutaneous and subcutaneous lesions of the lower limbs in connection with

the veins. Arch. Dermat., 52:

376—383,

1945.

12. MASSOPUST, L. C.: Infra-red photographic study of the superficial veins of the thorax in relation to breast tumors. Surg., Gynec., & Obst., 86: 54—58, 1948. 13. BOWES, K., RITERBAND, S. H., ANDREWS, J. E.: Demonstration by infra-red photography of the superficial veins in the pregnant and non-pregnant woman. J. Obst. & Gynaec. Brit. Emp., 55: 285—292, 1948.

14. MASSOPTJST, L. C.: An application of infra-red photography. Med. Radiography & Photography, 23: 23, 1947. l& Gooi,, E. G.: Varicose veins of the abdominal wall, report of a case demonstrated by infra-red photography. Am. J. Surg., 64: 135—138, 1944.

PRIZES AWARDED IN THE FOURTH ANNUAL ESSAY CONTEST of the AMERICAN DERMATOLOGICAL ASSOCIATION

Close competition again marked the annual Essay Prize Contest sponsored by the American Dermatological Association to stimulate younger investigators to original work in the field of Dermatology and Syphilology. A total of eleven manuscripts were submitted to the Research Aid Committee of the Association. The high quality of these made it difficult to arrange them in order of merit. In

the opinion of the judges, only a few points separated the three outstanding contributions. The winner of the First Prize is Doctor Albert L. Kligman of Philadelphia. His thesis is entitled The Patho genesis of Tinea Capitis Due to Microsporon Audouini and Mwrosporon Canis. II. Histopathologic Findings. Doctor Kligman will receive a cash award of $500 and will present his thesis at the next meeting of the

American Dermatological Association, to be held at The Greenbrier, White Sulphur Springs, April 14 to 17, 1954. Doctor Nicholas Nicolaides of Chicago receives a cash award of $300 and Second Place Honorable Mention for his paper on Application of Some Newer il[ethods of Chemical Analysis to Lipids of the Human Skin Surface. Doctor Peter Flesch and Doctor E. S. Van Scott of Philadelphia receive a cash award of $200 and Third Place Honorable Mention for their paper on Sulfhydryl Groups and Disulftde Linkages in Normal and Pathological Keratinization. The sponsors of this project are encouraged by the number who participated

and they extend heartiest congratulations to the winner. Details of the next contest will be forthcoming soon.

THE JOURNAL OF INVESTIGATIVE DERMATOLOGY

94

linolenic acid extract. Arch. This pdf is a scanned copy UV of irradiated a printed document.

24. Wynn, C. H. and Iqbal, M.: Isolation of rat

skin lysosomes and a comparison with liver Path., 80: 91, 1965. and spleen lysosomes. Biochem. J., 98: lOP, 37. Nicolaides, N.: Lipids, membranes, and the 1966.

human epidermis, p. 511, The Epidermis

Eds., Montagna, W. and Lobitz, W. C. Acascopic localization of acid phosphatase in demic Press, New York. human epidermis. J. Invest. Derm., 46: 431, 38. Wills, E. D. and Wilkinson, A. E.: Release of 1966. enzymes from lysosomes by irradiation and 26. Rowden, C.: Ultrastructural studies of kerathe relation of lipid peroxide formation to tinized epithelia of the mouse. I. Combined enzyme release. Biochem. J., 99: 657, 1966. electron microscope and cytochemical study 39. Lane, N. I. and Novikoff, A. B.: Effects of of lysosomes in mouse epidermis and esoarginine deprivation, ultraviolet radiation and X-radiation on cultured KB cells. J. phageal epithelium. J. Invest. Derm., 49: 181, 25. Olson, R. L. and Nordquist, R. E.: Ultramicro-

No warranty is given about the accuracy of the copy.

Users should refer to the original published dermal cells. Nature, 216: 1031, 1967. version of1965. the material. vest. Derm., 45: 448, 28. Hall, J. H., Smith, J. G., Jr. and Burnett, S. 41. Daniels, F., Jr. and Johnson, B. E.: In prepa1967.

Cell Biol., 27: 603, 1965.

27. Prose, P. H., Sedlis, E. and Bigelow, M.: The 40. Fukuyama, K., Epstein, W. L. and Epstein, demonstration of lysosomes in the diseased J. H.: Effect of ultraviolet light on RNA skin of infants with infantile eczema. J. Inand protein synthesis in differentiated epi-

C.: The lysosome in contact dermatitis: A ration. histochemical study. J. Invest. Derm., 49: 42. Ito, M.: Histochemical investigations of Unna's oxygen and reduction areas by means of 590, 1967. 29. Pearse, A. C. E.: p. 882, Histochemistry Theoultraviolet irradiation, Studies on Melanin, retical and Applied, 2nd ed., Churchill, London, 1960.

30. Pearse, A. C. E.: p. 910, Histacheini.stry Thearetscal and Applied, 2nd ed., Churchill, London, 1960.

31. Daniels, F., Jr., Brophy, D. and Lobitz, W. C.: Histochemical responses of human skin fol-

lowing ultraviolet irradiation. J. Invest. Derm.,37: 351, 1961.

32. Bitensky, L.: The demonstration of lysosomes by the controlled temperature freezing section method. Quart. J. Micr. Sci., 103: 205, 1952.

33. Diengdoh, J. V.: The demonstration of lysosomes in mouse skin. Quart. J. Micr. Sci., 105: 73, 1964.

34. Jarret, A., Spearman, R. I. C. and Hardy, J. A.:

Tohoku, J. Exp. Med., 65: Supplement V, 10, 1957.

43. Bitcnsky, L.: Lysosomes in normal and pathological cells, pp. 362—375, Lysasames Eds., de Reuck, A. V. S. and Cameron, M. Churchill, London, 1953.

44. Janoff, A. and Zweifach, B. W.: Production of inflammatory changes in the microcirculation by cationic proteins extracted from lysosomes. J. Exp. Med., 120: 747, 1964.

45. Herion, J. C., Spitznagel, J. K., Walker, R. I. and Zeya, H. I.: Pyrogenicity of granulocyte lysosomes. Amer. J. Physiol., 211: 693, 1966.

46. Baden, H. P. and Pearlman, C.: The effect of ultraviolet light on protein and nucleic acid synthesis in the epidermis. J. Invest. Derm.,

Histochemistry of keratinization. Brit. J. 43: 71, 1964. Derm., 71: 277, 1959. 35. De Duve, C. and Wattiaux, R.: Functions of 47. Bullough, W. S. and Laurence, E. B.: Mitotic control by internal secretion: the role of lysosomes. Ann. Rev. Physiol., 28: 435, 1966. the chalone-adrenalin complex. Exp. Cell. 36. Waravdekar, V. S., Saclaw, L. D., Jones, W. A. and Kuhns, J. C.: Skin changes induced by

Res., 33: 176, 1964.