RAYNAUD FENOMENİ
Transkript
7XUJXW g]DO 7ÕS 0HUNH]L 'HUJLVL 5$<1$8')(120(1ø +DPGL g=&$1 'U *UVR\ '2ö$1 'U (UVR\ +$=1(&ø 'U 5D\QDXG IHQRPHQL 5) VR÷XN YH HPRV\RQHO VWUHVOH WHWLNOHQHQ YH YFXGXQ Xo NÕVÕPODUÕQGD VROXNOXN VL\DQR] YH NÕ]DUÕNOÕNOD NDUDNWHUL]H YD]RVSDVWLN ELU QD UD÷PHQ oR÷X DUDúWÕUPDFÕ YDVRGLODWDV\RQGD \HWHUVL]OL÷LQ DúÕUÕ VHPSDWLN DNWLYLWHGHQ GDKD HWNLOL GXUXPGXU 5) JHOLúLPL KDNNÕQGD oRN oHúLWOL J|UúOHU ROPDVÕ ROGX÷X J|UúQGHGLU 0XKWHPHO PHNDQL]PDODUÕ GHVWHNOH\HQ oHúLWOL oDOÕúPDODU ROPDVÕQD UD÷PHQ 5) SDWRIL]\RORMLVL WDP RODUDN DQODúÕODPDPÕúWÕU 5) DOWWD \DWDQ ELU KDVWDOÕN YH\D QHGHQ RODELOHFHN ELU GXUXP \RNNHQ ROXúXUVD SULPHU 5) DOWWD \DWDQ ELU KDVWDOÕN YDUVD VHNRQGHU 5) WHULPL NXOODQÕOÕU 5) WHGDYLVLQGH oRN oHúLWOL LODoODU NXOODQÕODELOLU $QDKWDU NHOLPHOHU 5D\QDXG IHQRPHQL SDWRIL]\RORML WDQÕ WHGDYL 5D\QDXG¶V SKHQRPHQRQ 5D\QDXG¶V SKHQRPHQRQ 53 LV D YDVRVSDVWLF FRQGLWLRQ RIWHQ HOLFLWHG E\ FROG H[SRVXUH DQG HPRWLRQDO VWUHVV UHVXOWLQJ LQ SDOORU F\DQRVLV DQG UXERU RI DFUDO SDUWV $OWKRXJK WKHUH LV VWLOO PXFK FRQWURYHUV\ VXUURXQGLQJ WKH XQGHUO\LQJ PHFKDQLVP RI 53 PRVW LQYHVWLJDWRUV IHHO WKDW IDLOXUH RI YDVRGLODWDWLRQ UDWKHU WKDQ V\PSDWKHWLF RYHU DFWLYLW\ SOD\V WKH PDMRU UROH 7KH SDWKRSK\VLRORJ\ RI øQ|Q hQLYHUVLWHVL 7ÕS )DNOWHVL 'HUPDWRORML $QDELOLP 'DOÕ 0$/$7<$ 53 UHPDLQV SRRUO\ XQGHUVWRRG LQ VSLWH RI YDULRXV VXJJHVWHG SRVVLEOH PHFKDQLVLPV :KHQ 53 RFFXUV ZLWKRXW WKH GHYHORSPHQW RI DQ XQGHUO\LQJ GLVHDVH RU FRQGLWLRQ WKH WHUP SULPDU\ 53 LV PRVW FRPPRQO\ XVHG ,I WKHUH LV DQ XQGHUO\LQJ GLVHDVH WKH WHUP VHFRQGDU\ 53 LV XVHG ,Q WKH WUHDWPHQW RI 53 D ORW RI GUXJV FDQ EH XVHG .H\ ZRUGV 5D\QDXG¶V SKHQRPHQRQ SDWKRSK\VLRORJ\ GLDJQRVLV WUHDWPHQW 5D\QDXG IHQRPHQL 5) Xo NÕVÕPODUGD VROXNOXN VL\DQR] YH NÕ]DUÕNOÕN úHNOLQGH UHQN GH÷LúLNOL÷LQLQ J|UOG÷ VÕNOÕNOD VR÷X÷D PDUX]L\HW YH HPRV\RQHO ON RODUDN \ÕOÕQGD 0DXULFH JHUJLQOLNOH WHWLNOHQHQ YD]RVSDVWLN ELU GXUXPGXU ø 5D\QDXG <D]ÕúPD $GUHVL 'U +DPGL g]FDQ øQ|Q hQLYHUVLWHVL 7ÕS )DNOWHVL 'HUPDWRORML $QDELOLP 'DOÕ 0$/$7<$ WDQÕPODPÕúWÕU +XWFKLQVRQ \ÕOÕQGD SDUPDNWDNL YD]RVSDVWLN DWDNODU LoLQ oRN VD\ÕGD HW\RORMLN IDNW|U WDQÕPODQPDVÕ ]HULQH 5) WHULPLQLQ NXOODQÕOPDVÕQÕ |QHUPLúWLU 5) VÕQÕIODQGÕUÕOPDVÕQGD 5D\QDXG KDVWDOÕ÷Õ YH 5D\QDXG VHQGURPXQX LoHUHQ oHúLWOL LVLPOHQGLUPHOHU NXOODQÕOPÕúWÕU dR÷X DUDúWÕUPDFÕ LVLPOHQGLUPHOHUL GDKD DoÕN KDOH JHWLUPHN YH XQLIRUP ELU NXOODQÕP ROXúWXUPDN LoLQ KDVWDOÕ÷ÕQ VÕQÕIODQGÕUÕOPDVÕQGD SULPHU YH VHNRQGHU 5) WHULPLQLQ NXOODQÕOPDVÕ NRQXVXQGD ELUOHúPHNWHGLUOHU 7XUJXW g]DO 7ÕS 0HUNH]L 'HUJLVL g]FDQ YH DUN (3ø'(0ø<2/2-ø 9D]RGLODWDV\RQGD ORNDO \HWHUVL]OLN RODELOHFH÷L WHRULVLQL 3ULPHU 5) JHQHOOLNOH \DúODUÕQGD GHVWHNOHPHNWHGLU IDNDW oRFXNODUGD YH \DúÕQ ]HULQGHNL NLúLOHUGH YD]RNRQVWULNW|U GH ELOGLULOPLúWLU %D\DQODUGD G|UW NDW GDKD ID]OD PDGGH J|UOPHNWH RODELOHFH÷LQL YH GDKD NoN \DúODUGD HOGH HGLOPLúWLU 5)¶QLQ SUHYDODQVÕ DUDVÕQGD GH÷LúPHNWHGLU dHúLWOL ÕUNODU DUDVÕQGD IDUNOÕOÕNODU J|UOHELOLU 2OJXODUÕQ ¶XQGD SULPHU 5) ¶LQGH VHNRQGHU 5) J|UOU WURPERVLWOHUGH RODQ DúD÷ÕGDNL EDVÕQo ROXS øVNHPLN HWPHVLQL ORNDO RODUDN RODELOLU VR÷XWXOPDVÕ\OD VÕNOÕNOD YD]RNRQVWULNVL\RQ HOLQ UHIOHNV ORNDO DOIDDGUHQRVHSW|U LOH NDQ LOJLOL RODUDN LQWUDYDVNOHU DNÕPÕ LoLQ SRWDQVL\HO D\QÕ ]DPDQGD NDQ DNÕPÕQÕQ VD÷ODU 5)¶QLQ VHNRQGHU HQHUML GHYDP QHGHQOHULQLQ YDUGÕU %X úDUWODU DOWÕQGD QRUPDO ELU VHPSDWLN YD]RNRQVWULNW|U X\DUÕ GDPDUODUÕQ GDUDOPDVÕQD YH LVNHPLN DWD÷D QHGHQ SDUPDNODUÕQ 3ULPHU 5) RODQ YDNDODUÕQ HQVH YH ER\XQODUÕQÕQ ROXúDQ 5) RODQODUGD oR÷XQGD GúN GLVWDO NDQ DNÕPÕ ROXúWXUDELOHQ EXOJXODU VR÷XWXOPDVÕ\OD ROXúWXUXOXU PDGGH YDVNOHU REVWUNVL\RQ DWDNODU ELUH\OHUOH 5) DOIDDGUHQRVHSW|U LQWUDDUWHULDO VDGHFH VD÷ODPD] VDSWDQPÕúWÕU DUWPÕú YDNDODU '|UGQF ROPDGÕ÷ÕQÕ EHOLUOHPHN LoLQ QRUPDO GRODúÕP NRQWURO YH 6D÷OÕNOÕ ]DPDQ EHQ]HU \DQÕW ROXúPD] 5) YH\D HSL]RGLN YD]RVSDVWLN DWD÷ÕQ SDWRJHQH]L DUDúWÕUÕOPÕú HGHU NDUúÕODúWÕUÕOGÕ÷Õ øNLQFL G]H\LQGH FHYDS YHULUNHQ DOID DGUHQRVHSW|U DJRQLVWOHULQH (7<2/2-ø 9( 3$72*(1(= PHNDQL]PDVÕ RODELOLU UHVHSW|U DJRQLVWOHULQH DUWPÕú ELU GLJLWDO YD]RNRQVWULNW|U DQRPDOLQLQ VR÷XN G]H\OHUL EXOXQPXúWXU $\QÕ ]DPDQGD SULPHU 5) +DVWDODUGD QHGHQ FHYDEÕQ LúDUHW RODQODU NULWHUOHULQH ED÷OÕ RODUDN IDUNOÕ SUHYDODQV VRQXoODUÕ FHYDED EX EDúODPDNWDGÕU dDOÕúPDODUGD NXOODQÕODQ IDUNOÕ WDQÕ ELOLQPHPHNWHGLU /RNDO KDVVDVL\HWL 5)¶GH QRUPDO X\DUÕ\D DUWPÕú ELU J|UOU VHPSDWLN 5)¶GH VLVWROLN VR÷XWXOPDVÕ\OD GLJLWDO QRUPDO DUWHUOHU J|UOU EDVÕQFÕQ DUWHULRJUDPGD %XQXQOD QRUPDOGHQ ELUOLNWH GLJLWDO GúN ROGX÷X DUWWÕUÕOÕU IDNDW QRUPDO ELUH\OHUGH EX ROXúPD] E|OJHOHUGH 5) ROXúXU %X ROD\ EHúLQFL PDGGHGH 6R÷X÷D WDQÕPODQDQ EXOJXODUÕ DoÕNOD\DELOLU PDUX]L\HWOH DOIDDGUHQRVHSW|UOHUGH VHQVLWL]DV\RQ ROGX÷X |QH VUOPúWU 5) RODQ NLúLOHULQ YHQ|] GRODúÕPÕQGD NDWHNRODPLQOHULQ SOD]PD G]H\OHUL DUWPÕúWÕU 6R÷XN 6R÷XN ELU oHYUHGH EUDNLDO SDUPDN SURNVLPDOL \DUGÕP YH GLVWDO SDUPDN XFXQGD VLVWROLN EDVÕQo 5) RODQODUGD QRUPDO ELUH\OHUH J|UH DQODPOÕ YD]RNRQVWULNVL\RQ SDUPD÷D $]DOPÕú NDSLOOHU NDQ DNÕPÕ PDGGH D]DOÕU YFXGXQ IDNW|U VDOÕQPDVÕ VLVWHPL VLVWHPLN EDVÕQo VRUXPOX NDQ EDVÕQFÕ EHOLUOL UHVHSW|UOHULQ NDQ YLVNR]LWHVLQLQ WURPERNVDQ ER]XNOX÷X VUOPúWU ON o EXOJX VHPSDWLN VLQLU VLVWHPLQLQ DúÕUÕ UHDNWLYLWHVL WHRULVLQGHQ GDKD ]L\DGH VR÷X÷D DQRUPDO KDVVDV NDQ GDPDUODUÕQGD 6HNRQGHU ø VHURWRQLQ EHWDWURPERJOREOLQ IRQNVL\RQ 7XUJXW g]DO 7ÕS 0HUNH]L 'HUJLVL GúN GÕúDUÕGDQ DUWPDVÕ ÕVÕWÕOPDVÕ\OD QRUPDO ELUH\OHUH RUDQOD GDKD JHo QRUPDOH G|QHU VLQLU VR÷X÷D DúÕUÕ FHYDEÕ YH WURPERVLWOHUGHQ YD]RDNWLI LoLQ YFXGXQ VR÷XWXOPDVÕ HVQDVÕQGD 5) RODQ NLúLOHUOH VD÷OÕNOÕ ELUH\OHU NDUúÕODúWÕUÕOGÕ÷Õ ]DPDQ RUDQGD HVQDVÕQGD VHPSDWLN DNWLYLWH YH ORNDO VR÷XN QHGHQL\OH JHOLúHQ QRUPDO 5HIOHNV GLJLWDO YD]RNRQVWULNVL\RQ ROXúWXUPDN DQODPOÕ VR÷XWXOPDVÕ QHGHQ RODELOLU 3ULPHU 5) SDWRJHQH]LQGH UHIOHNV ELUH\OHUGH J|UOPH] DNÕPÕ NDSLOOHU g]HWOH oRN oHúLWOL IDNW|UOHULQ ELU NRPELQDV\RQX VR÷X÷D PDUX]L\HWWH GLJLWDO DUWHU NDSDQPDVÕQD & RNO]\RQ ROXúPDNWD YH GLVWDO VLVWROLN EDVÕQoWD NDQ 9FXGXQ VHPSDWLN VR÷XN VX\D GDOGÕUÕOPDVÕ\OD SDUPDNWD DUWHULHO NDSLOOHU D]DOPÕú WXWXODELOLU HGHU QHGHQL\OH GHUHFHGH NDSLOOHU NDQ DNÕPÕQÕQ NÕVPHQ QRUPDOH G|QHELOPHVL DQL ND\ÕS J|UOPHNWHGLU %X GXUXP LOHUL NDSLOOHU NDQ DNÕPÕ D]DOÕUNHQ YFXGXQ ÕVÕWÕOPDVÕ\OD RODUDN GúNWU 5)¶GH VR÷XN WHVWLQH FHYDS RODUDN SDUPDNWDNL NDQ EDVÕQFÕQÕQ GúN |OoOPHVL VHQVLWLYLWH\H VDKLSWLU YH WDQÕ LoLQ NXOODQÕúOÕ ELU \|QWHPGLU 5) RODQ oR÷X KDVWDGD ELU SDUPD÷ÕQ oHYUHGH DNÕP LVNHPLN DWD÷ÕQ SDWRJHQH]LQL DoÕNODPD\D YLEUDV\RQ YH 9RQ :LOOHEUDQG GDPDUODUGD JLEL HQGRWHO QHGHQOHU LOHUL 7DEOR 5) ED÷ HW\RORMLVLQGH GRNXVX WUDYPD KDVWDOÕNODUÕ YH YH\D YDVNOLW REVWUNWLI DUWHULHO KDVWDOÕNODU Q|URORMLN KDVWDOÕNODU 307 5D\QDXG IHQRPHQL 7DEOR 3ULPHU • • • • • • +RUPRQDO IDNW|UOHULQ 5) SDWRIL]\RORMLVLQGH URO R\QD\DELOHFH÷L GúQOHUHN oHúLWOL DUDúWÕUPDODU 5) SDWRJHQH]LQGH URO R\QD\DQ IDNW|UOHU \DSÕOPÕúWÕU 5HIOHNV VHPSDWLN DNWLYLWHGH DUWPD gVWURMHQH $OIDDGUHQRVHSW|UOHULQ VR÷X÷D PDUX]L\HWL VRQXFX J|VWHUGL÷L ELOGLULOPHNWHGLU +DVWDODU VR÷X÷D X\DUDQODUOD 9LEUDV\RQD PDUX]L\HW +LSRWHQDU KDPPHU VHQGURPX $UWHULRYHQ|] ILVWO øQWUDDUWHULDO LODo X\JXODQPDVÕ úLND\HW VÕQÕUOÕ HGHUOHU $WDN )L]LN PXD\HQHGH SULPHU KDVWDOÕ÷Õ RODQ NLúLOHUGH %D÷ GRNXVX KDVWDOÕ÷Õ YH YDVNOLW 6LVWHPLN VNOHUR]LV 0LNV ED÷ GRNXVX KDVWDO Õ÷Õ 6LVWHPLN OXSXV HULWLPDWR]XV 'HUPDWRPL\R]LW 5RPDWRLG DUWULW 7HPSRUDO DUWHULW 6M|JUHQ VHQGURPX +HSDWLW % DQWLMHQ YDVNOLWL JHQHOOLNOH DQRPDOL J|UOPH] $WDN VÕUDVÕQGD NODVLN RODUDN |QFH SDUPDNODUGD YD]RVSD]P VRQXFX EH\D]ODúPD SDOORU DUGÕQGDQ GRODúÕPÕQ \DYDúODPDVÕ YH NDQ RNVLMHQLQLQ D]DOPDVÕQD ED÷OÕ 2EVWULNWLI DUWHULHO KDVWDOÕN 7URPERDQMLLWLV REOLWHUDQV RODUDN PRUDUPD VL\DQR] YH UHDNWLI KLSHUHPL 1|URORMLN KDVWDOÕN .DUSDO WQHO DWDNODUGDQ HPRV\RQHO NHVNLQ WDEOR JHOLúLU YH D\DNODUGD GX\X ND\EÕ RODELOLU 7UDYPD YH\D YLEUDV\RQ 7RUDVLN RXWOHW VHQGURPX YH SDUPDNODUGD HVQDVÕQGD ELU YH\D GDKD ID]OD SDUPDNWD NOLQLN 6HNRQGHU 5) HW\RORMLVLQGH URO R\QD\DQ KDVWDOÕNODU $WKHURVNOHUR]LV PDUX]L\HW ROXúDQ EH\D] YH\D PDYL UHQN GH÷LúLNOL÷L LOH NDUDNWHUL]H 7DEOR HSL]RGLN 7DEOR ./ø1ø. %(/ø57ø/(5 KHPDWRORMLN KDVWDOÕNODU LODoODU YH WRNVLQOHU YH ED]Õ YD]RNRQVWULNW|U FHYDS SURJHVWHURQ LODYHVL\OH G]HOWLOHELOHFH÷L NRQXVXQGD oHOLúNLOL ELOGLULOHU YDUGÕU %D]Õ oDOÕúPDODUGD LVH KDVWDOÕ÷ÕQ PHQVWUHO VLNOXV LOH LOLúNLOL ROGX÷X YH JHEHOLNWH L\LOHúPH H÷LOLPL GX\DUOÕOÕNODUÕQGD DUWÕú 3HULIHULN GDPDUODU YH SDUPDN GLVWDOLQGH VLVWROLN NDQ EDVÕQFÕQGD GúNON 7URPERVLWOHUGHQ YD]RDNWLI PDGGHOHULQ VDOÕQPDVÕ 3ÕKWÕODúPD IDNW|UOHULQLQ YH WURPERNVDQÕQ HWNLOL ROPDVÕ 'DPDU HQGRWHO IRQNVL\RQXQXQ ER]XOPDVÕ GDKLOL KDVWDOÕNODU URO R\QDU DUWPÕú FHYDS GHQH\VHO ELU oDOÕúPD LOH J|VWHULOPLúWLU %X 5HIOHNV VHPSDWLN GLVWURIL VRQXFX NÕ]DUPD UXERU J|UOU 3DUPDN XFXQGDQ VHQGURPX SDUPD÷ÕQ GH÷LúLN G]H\OHULQH X]DQDQ NHVNLQ VÕQÕUOÕ +HPDWRORMLN KDVWDOÕN .ULRJOREOLQHPL 3DURNVLVPDO KHPRJORELQUL 6R÷XN DJOWLQLQOHU :DOGHQVWU|P VROXNOXN YH\D VL\DQR] YDUGÕU $WDNODU DUDVÕQGD SDUPDNODU QRUPDO J|UQU IDNDW VR÷XN KLVVHGLOLU PDNURJOREOLQHPLVL øODoODU YH WRNVLQOHU YH DúÕUÕ WHUOHPH\OH QHPOL RODELOLU 3ULPHU KDVWDOÕNWD (UJRW DONRORLGOHUL .ORQLGLQ %HWD EORN|UOHU 6LNORVSRULQ 0HWLVHUMLW øQWHUIHURQ DOID %OHRPLVLQ $PIRWHULVLQ % 9LQNULVWLQ 2UDO NRQWUDVHSWLIOHU UDGLDO YH XOQDU QDEÕ]ODU QRUPDOGLU $PIHWDPLQOHU 9LQLO NORULW øPLSUDPLQ 1LWURJOLVHULQ \RNVXQOX÷X %URPRNULSWLQ $÷ÕU PHWDOOHU +DVWDODUGD SWHULJLXP RODUDN ELOLQHQ WÕUQDN GH÷LúLNOLNOHUL DWURILN 'L÷HUOHUL J|UOHELOLU GHUL WÕUQDN 'L÷HU EHOLUWLOHU GHIRUPLWHOHUL JHUJLQ SDUPDNODUGD NÕVDOPD YH NRQWUDNVL\RQ VNOHURGDNWLOL JLEL WURILN 3DUDQHRSODVWLN VHQGURP +LSRWLURLGL]P .URQLN E|EUHN \HWPH]OL÷L $QRUHNVLD QHUYR]D GH÷LúLNOLNOHUGLU 3ULPHU SXOPRQHU KLSHUWDQVL\RQ SDUPDNODUÕQ *DQJUHQ Xo NÕVPÕQÕ QDGLUGLU HWNLOHU YH VDGHFH 3DUPDNODUGDNL SHUVLVWDQ UHQN GH÷LúLNOL÷L VHNRQGHU ELU QHGHQH ED÷OÕGÕU %D÷ GRNXVX KDVWDOÕNODUÕ VHNRQGHU 5)¶QLQ HQ VÕN QHGHQLGLU 6NOHURGHUPDOÕ KDVWDODUGD /$%25$789$5 9( g=(/ 08$<(1(/(5 RUDQÕQGD 5) YHYH\D SHUVLVWDQ YD]RVSD]P RUWD\D oÕNDU 3ULPHU KDVWDODUÕQ ¶LQGH GHUPDWRPL\R]LWOLOHULQ \DNODúÕN ¶XQGD J|UOU %D]HQ URPDWRLG DUWULW 5) VLVWHPLN OXSXV HULWHPDWR]XVOX YH\D YDVNOLWOL KDVWDODUGD GD PHYFXW RODELOLU 5) RODQ NLúLOHUGH NDQ YH LGUDU oDOÕúPDODUÕQÕQ VRQXoODUÕ QRUPDOGLU /RNDO VR÷XWPD VRQXFX LVNHPLN X\DUÕ 5) LoLQ WDQÕVDO WHVW RODUDN NXOODQÕODELOLU IDNDW SULPHUGHQ VHNRQGHU KDVWDOÕ÷Õ D\ÕUW HWPHGH ID\GDOÕ GH÷LOGLU 1RUPDO ELUH\OHUOH NDUúÕODúWÕUÕOGÕ÷Õ ]DPDQ 5) RODQ KDVWDODU VR÷XWPD\OD SDUPD÷ÕQ VLVWROLN EDVÕQFÕQGD GDKD \NVHN RUDQGD GúPH J|VWHULUOHU YH ELU oR÷XQGD EDVÕQoWD ELU ND\ÕS YH\D GLJLWDO DUWHU NDSDQPDVÕ 5) PHVOHNL RULMLQOL RODELOLU WDú YH\D RGXQ NHVPHN LoLQ NXOODQÕODQ YLEUDWXDU DOHWOHUL NXOODQDQ NLúLOHUGH RUDQÕQGD J|UOU YH PDUX] NDOPD VUHVL LOH |]HOOLNOH VÕNWÕU )HQRPHQ RUPDQGD D÷Do NHVLFLOHUGH LOLúNLOLGLU ROXúXU 308 7XUJXW g]DO 7ÕS 0HUNH]L 'HUJLVL g]FDQ YH DUN 7ÕUQDN \DWD÷Õ NDSLOOHU PLNURVNRSLVL 5)¶QLQ VHNRQGHU QHGHQOHULQLQ WDQÕVÕQGD GH÷HUOL RODELOLU DQFDN SULPHU KDVWDOÕ÷ÕQ WDQÕVÕQGD \DUGÕPFÕ øQIUDUHG WHUPRJUDIL ODVHU GH÷LOGLU $OOHQ |OoPHGH NXOODQÕODELOLU VR÷XN WHVWLQH NXOODQÕODELOHFHN \DUGÕPFÕ R\QD\DQ YH WDEOR ¶GH J|UOHQ KDVWDOÕNODUD \|QHOLN • ODERUDWXYDU LQFHOHPHOHUL \DSÕODELOLU • • • 7$1, 9( $<,5,&, 7$1, VR÷X÷D PDUX]L\HWOH SDUPDNODUGD \ÕOÕQGD ED÷ GRNXVX 7DEOR 7DEOR 3ULPHU 5) WDQÕVÕ LoLQ NXOODQÕODQ NULWHUOHU PHWRGODUGÕU $\UÕFD VHNRQGHU 5) HW\RORMLVLQGH URO 7DQÕ %X NULWHUOHU PRGLIL\H HGLOHUHN JQP]GH GH FHYDEÕ %UDZQ NR\DELOPHN LoLQ oHúLWOL NULWHUOHU LOHUL VUPúOHUGLU GRSSOHUOH NDQ DNÕPÕ |OoP YH KDVWDOÕNODUÕQÕ HNDUWH HWPHN LoLQ YH SULPHU 5) WDQÕVÕ NHVNLQ • • • NHQDUOÕ EH\D] YH\D PDYL UHQN GH÷LúLPL úHNOLQGH WLSLN HSL]RGLN DWDN KLND\HVLQH J|UH NRQXU <HWHUOL • EHOLUWLVL RODQODU VHNRQGHU QHGHQOHUL HNDUWH HWPHN (NVWUHPLWHOHUGHNL UHQN GH÷LúLNOL÷LQLQ LQWHUPLWWDQ DWDNODU úHNOLQGH ROPDVÕ 2UJDQLN SHULIHUDO DUWHULHO RNO]\RQ EXOJXODUÕQÕQ ROPDPDVÕ /H]\RQXQ ELODWHUDO YH VLPHWULN ROPDVÕ 9D]RVSDVWLN DQRPDOLOHUH QHGHQ RODELOHFHN KHU KDQJL ELU KDVWDOÕN PHVOHN WUDYPD YH\D LODo NXOODQÕPÕQÕQ ROPDPDVÕ øPPQRORMLN DQRPDOLOHULQ ROPDPDVÕ <LUPLEHú \DúÕQ DOWÕQGD ED\DQ ROPDVÕ dRFXNOXNWDQ EHUL VR÷XN LQWROHUDQVÕ KLND\HVLQLQ ROPDVÕ 7ÕUQDN \DWD÷Õ NDSLOOHUOHULQLQ QRUPDO ROPDVÕ LoLQ DUDúWÕUÕOPDOÕGÕU $\ÕUÕFÕ WDQÕGD %DúOÕFD FKLOEODLQV SHUQLR]LV YH 6HNRQGHU QHGHQOHUL HNDUWH HWPHN LoLQ KDVWDGDQ DNURVL\DQR]LV \HU DOÕU dR÷X KDVWD ED]HQ VR÷XNWD JHQLú ELU |\N DOÕQPDVÕ GRNWRUD ELUoRN LS XFX D÷UÕGDQ úLND\HW HGHU IDNDW UHQN GH÷LúLNOLNOHUL YHUHFHNWLU \RNWXU %X DPDoOD KDVWDGD DUWUDOML DUWULW GLVIDML J|÷VWH \DQPD JQHúWH \]GH NÕ]DUÕNOÕN NDOÕFÕ EURQ]ODúPD JLEL ED÷ GRNXVX KDVWDOÕ÷Õ )L]LN PXD\HQHGH YH QRUPDO VHPSDWLN VLQLU HSL]RGLN GH÷LO SHUVLVWDQGÕU 6ROXNOXN ID]Õ \RNWXU YH PLJUDWXDU WURPERIOHELW JLEL REVWUNWLI DUWHULHO KDVWDOÕN EHOLUWLOHUL VRUJXODQPDOÕ YH PHVOHNOHUL FLQVL\HW D\UÕPÕ J|VWHUPH] 7('$9ø ODERUDWXYDU LQFHOHPHOHULQGH \DSÕOPDVÕ JHUHNHQOHU WDEOR GXUXP KDVWDODUGD HOOHU YH D\DNODU WXWXOXU UHQN GH÷LúLNOL÷L EHOLUWLOHUL NXOODQGÕ÷Õ LODoODU LQWHUPLWWDQW NODGLNDVLR |÷UHQLOPHOLGLU %X DNWLYLWHVLQLQ Xo ELU QRNWDVÕ RODELOLU $NURVL\DQR]OX ¶WH %HQLJQ J|UOPHNWHGLU KDVWDOÕ÷Õ WXWXFX 5)¶OL ROJXODUGD IL]LN PXD\HQH YH ODERUDWXYDU LQFHOHPHOHULQGH \DSÕOPDVÕ JHUHNHQOHU 7DEOR RODQ 5)¶OL NÕ\DIHWOHU oR÷X KDVWD JL\LQHUHN VÕFDN DWDNODUGDQ 1LNRWLQ NWDQ|] YD]RNRQVWULNVL\RQ NRUXQDELOLUOHU ROXúWXUGX÷X LoLQ VLJDUD LoLPLQGHQ X]DN )L]LN PXD\HQHGH GXUXOPDOÕGÕU 6HNRQGHU 5) RODQODUGD DOWWD \DWDQ 7P QDED]DQODU SDOSH HGLOPHOL KDVWDOÕN WHGDYL HGLOPHOLGLU 7UDYPDWLN YD]RVSDVWLN +HU LNL NROGDQ NDQ EDVÕQFÕ |OoOPHOL (NOHPOHUGH úLúOLN YH\D GHIRUPLWH ROXS ROPDGÕ÷Õ DUDúWÕUÕOPDOÕ KDVWDOÕ÷Õ RODQODUGD QHGHQ RODQ GXUXPGDQ X]DN 'HULQ WHQGRQ UHIOHNVOHULQH EDNÕOPDOÕ GXUXOPDVÕ 7DP ELU Q|URORMLN PXD\HQH \DSÕOPDOÕ \DQÕW YHULUOHU 'HUPDWRORMLN PXD\HQHGH WHOHQMLHNWD]L VXENWDQ QRGO GHULGH JHUJLQOLN YH J|] NDSDNODUÕQGD UHQN L\LOHúPH VD÷OD\DFDNWÕU øODoOD ROXúDQ LVNHPLN DWDNODU VRUXPOX DMDQÕQ NHVLOPHVLQH ROXPOX 2UJDQRPHJDOL ROXS ROPDGÕ÷Õ DUDúWÕUÕOPDOÕ GH÷LúLNOL÷L ROXS ROPDGÕ÷Õ DUDúWÕUÕOPDOÕGÕU NXOODQÕODELOLU IDNDW \DOQÕ]FD YDNDGD øODo WHGDYLVL SULPHU YH VHNRQGHU 5)¶OL YDNDODUGD /DERUDWXYDU LQFHOHPHVLQGH 7DP NDQ VD\ÕPÕ 6HGLPHQWDV\RQ KÕ]Õ EDúDUÕOÕGÕU 6HUXP SURWHLQ HOHNWURIRUH]L .DOVL\XP YH EORNH VHNRQGHU HGLFL 5)¶OL DMDQ QLIHGLSLQ 5RPDWRLG IDNW|U \DNODúÕN ¶QGH DWDNODUÕQ VÕNOÕN VUH YH úLGGHWLQL .UHRJOREOLQOHU SULPHU NDQDO $QWLQNOHHU DQWLNRU NLúLOHULQ 6R÷XN DJOWLQLQOHU D]DOWÕU 9HUDSDPLO ID\GDOÕ ROPD]NHQ GLOWLD]HPLQ 7DP LGUDU WDKOLOL ID\GD VD÷ODGÕ÷Õ *|÷V ILOPL VHUYLNDO NRVWD LoLQ oHNLOPHOLGLU J|UOPúWU .DOVL\XP NDQDO EORN|UOHUL NDOVL\XP NDQDOODUÕQGDQ DNÕPÕ \DYDúODWÕU DUWHULRODU YD]RGLODWDV\RQ ROXúWXUXU YH SHULIHULN NDQ DNÕPÕQÕ DUWWÕUÕU $QHPQH] PXD\HQH YH WHVW VRQXoODUÕ KDVWD\D EX .DOVL\XP DQWDJRQLVWOHULQLQ GXUXPXQ EHQLJQ LGLRSDWLN ELU KDVWDOÕN ROGX÷XQX YDVNOHU V|\OHPHGHQ |QFH QRUPDO ROPDOÕGÕU 3DUPDNODUÕQ HWWL÷L LOHUL VUOPHNWHGLU DOIDDGUHQRVHSW|U ORNDO VR÷XWXOPDVÕQÕQ SDUPDN VLVWROLN EDVÕQFÕ NXOODQÕOÕU ]HULQH HWNLVL WDQÕVDO ELU WHVW RODUDN NXOODQÕODELOLU NXOODQÕPGDQ 7XUJXW g]DO 7ÕS 0HUNH]L 'HUJLVL 309 %LU JUXS ID\GD DNWLYLWHVLQL LQKLEH %X LODoODU LNL úHNLOGH KDVWD J|UUNHQ JQON G]HQOL GL÷HUOHUL VR÷X÷D 5D\QDXG IHQRPHQL .25810$ PDUX]L\HW |QFHVLQGH VXEOLQJXDO RODUDN SURIODNWLN WHGDYLGHQ ID\GD J|UHELOLU 5H]HUSLQ YH 'DKD VÕFDN LNOLPOHUH J|o KDVWDODUÕQ \DNODúÕN ¶VLQGH EHOLUWLOHUL L\LOHúWLULU %D]Õ VHNRQGHU JXDQHWLGLQLQ KHU LNLVL ELUOLNWH KDVWDODUGD VR÷X÷D PDUX]L\HW HVQDVÕQGD NDSLOOHU NDQ DNÕPÕQÕ DUWWÕUÕU YH JQON X\JXODPDODU LoLQ ID\GDOÕGÕU QHGHQOHU $÷UÕOÕ OVHUOHU YH\D JDQJUHQLQ LQWUDDUWHULDO UH]HUSLQH |QOHPOHU FHYDS WUDYPDWLN YHUGL÷L oDOÕúPDODUGD ELOGLULOPLúWLU ID\GDOÕ DGUHQRVHSW|U NRQWUROO EXOXQPDPÕúWÕU DJRQLVWL GHUHFHGH IDNDW RODQ ID\GD %LU RUWD VDOÕQÕP VD÷OD\DQ SODNODUÕ 5)¶GH DMDQODUOD WUDQVGHUPDO HWNLOLGLU NRPELQH JOLVHULO IDNDW SURVWRVLNOLQ¶QLQ HWNLQ ROGX÷X ELOGLULOPLúWLU IDNDW RUDO SUHSDUDWODUÕ \RNWXU %LU SURVWRVLNOLQ DQDOR÷X RODQ LORSURVW SDUHQWHUDO WHGDYLGH HWNLOLGLU VD÷ODPD] DQFDN 6WDELO FDUEDSURVWDF\FOLQ 5)¶GH RUDO NXOODQÕPGD SURVWRVLNOLQ HSRSURVWHQRO YH HWNLOL EXOXQPXúWXU ID\GD DQDOR÷X RODQ XPXW J|UOPHNWHGLU 1. 2. 3. $] ELU PLNWDU RWRORJ NDQÕQ ÕVÕWÕOPDVÕ R]RQD PDUX] EÕUDNÕOPDVÕ YH XOWUDYLROH X\JXODPDVÕ VRQUDVÕQGD 4. DQWLRNVLGDQODUÕQ KDVWD\D WHNUDU HQMHNWH HGLOPHVL NXOODQÕOPDVÕ SLFRWDPLGH ORVDUWDQ LQKLELW|UOHUL WURPERNVDQ $ DQJLRWHQVLQ DQJLRWHQVLQ LQKLELW|U UHVHSW|U FDOFLWRQLQ JHQHUHODWHG SHSWLGH 5. EORN|U HQ]LP 6. YH 7. 5) WHGDYLVLQGH 8. FRQYHUWLQJ PHWKDFKROLQH IOXR[HWLQ NXOODQÕODQ YH ROXPOX VRQXoODU ELOGLULOHQ LODoODUGÕU 9. 6ÕN DUDOÕNODUOD \DSÕODQ SOD]PDIHUH]LVLQ oRN úLGGHWOL HWNLOHQHQ KDVWDODUGD ELOGLULOPLúWLU G]HOWWL÷L KDVWDOÕ÷ÕQ EHOLUWLOHULQL %LRIHHGEDFN \D 10. GD 3DYORYLDQ úDUWODQPD KDVWDODUGD NÕVPL ID\GD VD÷OD\DELOLU hVW HNVWUHPLWH VHPSDWHNWRPLVL ID\GDOÕ ROPDNOD EHUDEHU KDVWDOÕ÷Õ YH\D IHQRPHQL 11. 12. NRQWURO HWPHGH GH÷HUH VDKLS GH÷LOGLU ID\GDVÕ D\ LOH \ÕO DUDVÕQGD VRQODQÕU .$<1$./$5 )LEULQROLWLN ELU DMDQ RODQ VWDQR]ROROQ HOGHNL NDQ DNÕPÕQÕ DUWWÕUGÕ÷Õ J|VWHULOPLúWLU DOHW GR]ODUGDQ HW NHVLFLOHUL HOOHULQL ELU oHNLo JLEL UD÷PHQ SURJQR] ROGXNoD L\LGLU 1DIWLGURIXU\O YHULFL 0HNDQLN \NVHN SDUPDNODUGD WURILN GH÷LúLNOLNOHU JHOLúHELOPHVLQH FLFDSURVW NHWDQVHULQ JLEL VHURWRQLQ DQWDJRQLVWOHUL\OH \DSÕODQ oDOÕúPDODU NXOODQÕOPDOÕGÕU LODoODU 3ULPHU 5) RODQ ROJXODUÕQ \DNODúÕN ¶LQGH ]DPDQOD EHOLUWLOHUGH GH÷LúLNOLN ROPD] ¶VÕ L\LOHúLU ¶VÕQGD oRN úLGGHWOL DWDNODU JHOLúLU YH ¶XQGD VHQGURP ND\EROXU 6NOHURGDNWLOL RUDQÕQGD JHOLúLU ¶GHQ D] RUDQGD GLJLWDO DPSWDV\RQ ROXúPDVÕQD UD÷PHQ WURILN GH÷LúLNOLNOHU RUDQÕQGD ROXúXU %LU oRN KDVWDGD 3DUHQWHUDO SURVWRJODQGLQOHU |]HOOLNOH 3*( YH 3*, PHYFXW oDOÕúÕOPDVÕ 6(<ø5 9( 352*12= GL÷HU NXOODQÕOPÕúWÕU DOHWOHULQGH NXOODQPDNWDQ NDoÕQPDOÕGÕU WULQLWUDW JHQHOOLNOH RODUDN VUH |QOHU NXOODQDQODU YH IHQRNVLEHQ]DPLQ YH WROD]ROLQ JLEL GL÷HU VHPSDWROLWLN LODoODU GD |QHULOPLúWLU .RQWUROO NÕVD KDVWDOÕ÷ÕQÕ NDoÕQÕODUDN 0HWLOGRSD 9LEUDV\RQ GDKD YD]RNRQVWULNVL\RQ 9D]RNRQVULNW|U DOID SUR]DVLQ VD÷ODU |QOHQHELOLU DOÕQPDVÕ /XPEDU 13. VHPSDWHNWRPL DOW HNVWUHPLWHGHNL 5) LoLQ VUHNOL ELU UDKDWODPD ROXúWXUXU IDNDW VW HNVWUHPLWHOHUGH DUWPÕú VHPSDWLN DNWLYLWH\H QHGHQ RODELOLU 14. +DVWDODUD WRUDVLN VHPSDWHNWRPL X\JXODPDVÕQGDQ VRQUD GD EDúDUÕOÕ VRQXoODU ELOGLULOPLúWLU Coffman JD. Raynoud’s disease and phenomenon. In: Fitzpatrick TB, Eisen AZ, Wolff K, Freedberg IM, Austen KF eds. Dermatology in General th Medicine. 4 eds. New York: McGraw-Hill, Inc.1993: 2085-9. Wingley FM. Raynaud’s phenomenon. Curr Opin Rheumatol 1993; 5: 77384. Brand FN, Larson MG, Kannel WB, McGuirk JM. The occurrence of Raynaud’s phenomenon in a general population: Framingham Study. Vasc Med 1997; 2: 296-301. Valter I, Maricq HR. Prevalence of Raynaud’s phenomenon in 2 ethnic groubs in the general population of Estonia. J Rheumatol 1998; 25: 697702. Riera G, Vilardell M, Vaque J, Fonollosa V, Bermejo B. Prevalence of Raynaud’s phenomenon in a healthy Spanish population. J Rheumatol 1993; 20: 66-9. Bartelink ML, Wollersheim H, van de Lisdonk E, Spruijt R, van Weel C. Prevalence of Raynaud’s phenomenon. Neth J Med. 1992; 41: 149-52. Kurozava Y, Nasu Y. Toe sistolic blood pressure after local cooling in primary Raynaud’s phenomenon. Int Angiol 1994; 13: 215-7. Bovenzi M. Digital arterial responsiveness to cold in healthy men, vibration white finger and primary Raynaud’s phenomenon. Scand J Work Environ Health 1993; 19: 271-6. Maricq HR, Diat F, Weinrich MC, Maricq JG. Digital pressure responses to cooling in patients with suspected early vs definite scleroderma (systemic sclerosis) vs Primary Raynaud’s phenomenon. J Rheumatol 1994; 21: 1472-6. O’Reilly D, Taylor L, el-Hadidy K, Jayson MI. Measurement of cold challenge responses in primary Raynaud’s phenomenon and Raynaud’s phenomenon associated with systemic sclerosis. Ann Rheum Dis 1992; 51: 1193-6. Hahn M, Klyscz T, Bohnenberger G, Junger M. A new tecnique for controlling the finger skin temparature in microcirculatory research demonstrated in a local cold stress test in healty controls and patients with Raynaud’s phenomenon. Int J Microcirc Clin Exp 1996; 16: 16-22. Jayenetti S, Smith CP, Moore T, Jayson MI, Herrick AL. Thermography and nailfold capillaroscopy as noninvasive measures of circulation in children with Raynaud’s phenomenon. J Rheumatol 1998; 25: 997-9. Herrick AL, Illingworth K, Blann A, Hay CR, Hollis S, Jayson MI. Von Willebrand factor, thrombomodulin, thromboxane, beta-thromboglobulin and markers of fibrinolysis in primary Raynaud’s phenomenon and systemic sclerosis. Ann Rheum Dis 1996; 55: 122-7. Dowd PM. Raynaud’s phenomenon. In: Champion RH, Burton JL, Burns th DA, Breathnach SM eds. Textbook of Dermatology. 6 ed. London: Blackwell Science 1998: 967-71. )DULD '7 )LYHQVRQ '3 *UHHQ + 5D\QDXG¶V SKHQRPHQRQ ,Q 0RVFKHOOD UG 6/ +XUOH\ +- HGV HGV :% 3KLODGHOSKLD 6DXQGHUV &RPSDQ\ 310 7XUJXW g]DO 7ÕS 0HUNH]L 'HUJLVL g]FDQ YH DUN 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. Reiser M, Bruns C, Hartmann P, Salzberger B, Diehl V, Fatkenheuer G. Raynaud’s phenomenon and acral necrosis after chemotherapy for AIDSrelated Kaposi’s sarcoma. Eur J Clin Microbiol Infec Dis 1998; 17: 58-60. Bachmeyer C, Farge D, Gluckman E, Miclea JM, Aractingi S. Raynaud’s phenomenon and digital necrosis induced by interferon-alpha. Br J Dermatol 1996; 135: 481-3. Zernikow B, Fleischhack G, Hasan C, Bode U. Cyanotic Raynaud’s phenomenon with conventional but not with liposomal amphotericin B: three case reports. Mycoses 1997; 40: 359-61. Arpaia G, Cimminiello C, Bellone M, Aloisio M, Rossi F, Bonfardeci G. Need to expand microvascular investigation of patients with Raynaud’s phenomenon of different etiology: clinical patterns of 106 consecutive patients. Int Angiol 1994; 13: 15-8. Grassi W, Blasetti P, Core P, Cervini C. Raynaud’s phenomenon in rheumatoid artritis. Br J Rheumatol 1994; 33: 139-41. Mirbod SM, Yoshida H, Komura Y, Fujita S, Nagata C, Miyashita K, Inaba R, Iwata H. Prevalence of Raynaud’s phenomenon in different groups of workers operating hand-held vibrating tools. Int Arch Occup Environ Health 1994; 66: 13-22. Fraenkel L, Zhang Y, Chaisson CE, Evans SR, Wilson PW, Felson DT. The association of estrogen replacement therapy and Raynaud’s phenomenon in postmenopausal woman. Ann Intern Med 1998; 129: 20811. Bartelink ML, Wollersheim H, Vemer H, Thomas CM, de Boo T, Thien T. The effects of single oral doses of 17 beta-oestradiol and progesterone on finger skin circulation in healthy woman and in woman with primary Raynaud’s phenomenon. Eur J Clin Pharmacol 1994; 46: 557-60. Greenstein D, Jaffcote N, Ilsley D, Kester RC. The menstrual cycle and Raynaud’s phenomenon. Angiology 1996; 47: 427-36. Bartelink ML, Wollersheim H, van de Lisdonk E, Thien T. Raynaud’s phenomenon: subjective influence of female sex hormones. Int Angiol 1992; 11: 309-15. Naidu S, Baskerville PA, Goss DE, Roberts VC. Raynaud’s phenomenon and cold stress testing: a new approach. Eur J Vasc Surg 1994; 8: 567-73. Lau CS, Khan F, Brown R, McCallum P, Belch JJ. Digital blood flow responses to body warming, cooling and rewarming in patients with Raynaud’s phenomenon. Angiology 1995; 46: 1-10. Creutzing A, Hiller S, Appiah R, Thum J, Caspary L. Nailfold capillaroscopy and laser Doppler fluxmetry for evaluation of Raynaud’s phenomenon: how valid is the local cooling test. Vasa 1997; 26: 205-9. Bukhari M, Herrick AL, Moore T, Manning J, Jayson MI. Increased nailfold capillary dimensions in primary Raynaud’s phenomenon and systemic sclerosis. Br J Rheumatol 1996; 35: 1127-31. Ohtsuka T, Yamakage A, Tamura T. Image analysis of nail fold capillaries in patients with Raynaud’s phenomenon. Cutis 1995; 56: 215-8. Mannarino E, Pasqualini L, Fedeli F, Scricciolo V, Innocente S. Nailfold capillaroscopy in the screening and diagnosis of Raynaud’s phenomenon. Angiology 1994; 45: 37-42. von Bierbrauer A, Schilk I, Lucke C, Schmidh JA. Infrared thermography in the diagnosis of Raynaud’s phenomenon in vibration-induced white finger. Vasa 1998; 27: 94-9. Hahn M, Klyscz T, Junger M, Rassner G. Local cold exposure test as therapy control in patients with Raynaud’s phenomenon: comparison between laser doppler fluxmetry and simultaneous red blood cell velocity measurements in nailfold capillaries. Br J Dermatol 1995; 133: 704-9. Fisher M, Grotta J. New uses for calcium channel blockers: Therapeutic implications. Drugs 1993; 46: 961-75. Hachulla E, Devulder B. Calcium antagonists and Raynaud’s phenomenon. Therapie 1993; 48: 707-11. Teh SL, Manning J, Moore T, Tully MP, O’Reilly D, Jayson MI. Sustainedrelease transdermal glyceryl trinitrate patches as a treatment for primary and secondary Raynaud’s phenomenon. Br J Rheumatol 1995; 34: 63641. 7XUJXW g]DO 7ÕS 0HUNH]L 'HUJLVL 38. 39. 40. 41. 42. Seemann J, Scholz J, Sielwicz M. Remission of secondary Raynaud’s phenomenon using intra-arterial prostaglandin E1 infusion. A case report. Int Orthop 1994; 18: 372-4. Katoh K, Kawai T, Narita M, Uemura J, Tani K, Okubo T. Use of prostaglandin E1 (lipo-PGE1) to treat Raynaud’s phenomenon associated with connective tissue disease: thermographic and subjective assessment. J Pharm Pharmacol 1992; 44: 442-4. Wigley FM, Wise RA, Seibold JR, McCloskey DA, Kujula G, Medsger TA Jr, et. al. Intravenous iloprost infusion in patients with Raynaud’s phenomenon secondary to systemic sclerosis. A multicenter, placebocontrolled, double-blind study. Ann Intern Med 1994; 120: 199-206. Wigley FM, Siebold JR, Wise RA, McCloskey DA, Dole WP. Intravenous iloprost treatment of Raynaud’s phenomenon and ischemic ulsers secondary to systemic sclerosis. J Rheumatol 1992; 19: 1407-14. Kyle MV, Belcher G, Hazleman BL. Placebo controlled study showing therapeutic benefit of iloprost in the treatmend of Raynaud’s phenomenon. J Rheumatol 1992; 19: 1403-6. Wigley FM, Korn JH, Csuka ME, Medsger TA Jr, Rothfield NF, Ellman M, et al. Oral iloprost treatment in patients with Raynaud’s phenomenon secondary to systemic sclerosis: a multicenter, placebo-controlled, doubleblind study. Arthritis Rheum 1998; 41: 670-7. 3ROD 3 7RQGL 3 6HUULFFKLR 0 )DYX]]L $ *HUDUGLQR / 1HZ SURVSHFWV IRU WKH WUHDWPHQW RI 5D\QDXG¶V SKHQRPHQRQ XVLQJ D VHURWRQLQHUJLF 6 UHFHSWRU DQWDJRQLVW NHWDQVHULQ DQG VWDEOH GHULYDWHV RI SURVWDF\FOLQ $QJLRORJ\ 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 311 Kingma K, Wollersheim H, Thien T. Double-blind, placebo-controlled study of intravenous prostacyclin on hemodynamics in severe Raynaud’s phenomenon: the acute vasodilatory effect is not sustained. J Cardiovasc Pharmacol 1995; 26:388-93. Lau CS, Belch JJ, Madhok R, Cappell H, Herrick A, Jayson M, Thompson JM. A randomised, double-blind study of cicaprost, an oral prostacyclin analogue, in the treatment of Raynaud’s phenomenon secondary to systemic sclerosis. Clin Exp Rheumatol 1993; 11: 35-40. Helfman T, Falanga V. Stanozolol as a novel therapeutic agent in dermatology. J Am Acad Dermatol 1995; 33 (2 PT 1): 254-8. Cooke ED, Pockley AG, Tucker AT; Kirby JD, Bolton AE. Treatment of severe Raynaud’s phenomenon by injection of autologous blood pretreated by heating, ozonation and exposure to ultraviolet light (H-O-U) therapy. Int Angiol 1997; 16:250-4. Cerinic MM, Generini S, Pignone A. New approaches to the treatment of Raynaud’s phenomenon. Curr Opin Rheumatol 1997; 9:544-56. Pancera P, Sansone S, Secchi S, Covi G, Lechi A. The effects of thromboxane A2 inhibition (picotamide) and angiotensin II receptor blockade (losartan) in primary Raynaud’s phenomenon. J Intern Med 1997; 242: 373-6. Challenor VF. Angiotensin converting enzyme inhibitors in Raynaud’s phenomenon. Drugs 1994; 48: 864-7. Khan F, Coffman JD. Enhanced cholinergic cutaneous vasodilation in Raynaud’s phenomenon. Circulation 1994; 89:1183-8. Bolte MA, Avery D. Case of fluoxetine-induced remission of Raynaud’s phenomenon-a case report. Angiology 1993; 44: 161-3. Bunker CB, Reavley C, O’Shaughnessy DJ, Dowd PM. Calcitonin generelated peptide in treatment of severe peripheral vascular insufficiency in Raynaud’s phenomenon. Lancet 1993; 342: 80-3. Adee AC. Managing Raynaud’s phenomenon: a practical approach. Am Fam Physician 1993; 47: 823-9. Koman LA, Smith BP, Pollock FE Jr, Smith TL, Pollock D, Russell GB. The microcirculatory effects of peripheral sympathectomy. J Hand Surg 1995; 20: 709-17. Greenstein D, Brown TF, Kester RC. Assessment of chemical lumbar sympathectomy in critical limb ischaemia using thermal imaging. Int J Clin Monit Comput 1994; 11: 31-4. Wilkinson HA. Percutaneous radiofrequency upper thoracic sympathectomy. Neurosurgery 1996; 38: 715-25.
Benzer belgeler
6 - 24SaatGazetesi
V|]ROD\LúGXUXPYEQLQ\HULQHNXOODQÕODQEHOLUVL]DQODPGDELUV|]%LUX\DUÕ\ÕELUWHKOLNH\LELOGLUPHNLoLQYHULOHQ
LúDUHW
Açık Açılı Glokom ve Tedavisi
x 1RUPDO úDUWODU DOWÕQGD 12 ELU SDWHQW YD]RGLODWDW|U YH HQGRWHOLQ ELU SDWHQW
YD]RNRQVWULNW|UGU gQ NDPDUD VÕYÕVÕ GÕúD DNÕPÕQÕQ G]HQOHQPHVLQGH \HU DODQ
WUDEHNOHU D÷ÕQ 12 ...
Husserl`in Fenomenolojisine Giris
+XVVHUO D SULRUL EHWLPOH\HQ ELU |] ELOLPL RODQ IHQRPHQRORML\OH WP ELOLPOHULQ WHPHOOHULQL
J|VWHUPH\HoDOÕúÕU%XDPDoOD+XVVHUOWHRULOHUDUDVÕQGD\HQLELUWHRULIHOVHIHOHUDUDVÕQGD\HQL...
uygulama alanlarımız
(British Standards), TSE (Türk Standartları Enstitüsü) ve ISRM (International Society for Rock
Mechanics) standartları çerçevesinde Çevre ve Şehircilik Bakanlığı ile ISO 9001:2008 (TüvSüd) kalite b...
Nitrik Oksit`in Etkileri ve Patolojik Rolleri
1LWULN RNVLW 12 LON NH] HQGRWHO ND\QDNOÕ JHYúHPH IDNW|U RODUDN WDQÕPODQPÕú YH JQP]GH ELU oRN
PHPHOL KFUH YH GRNXODUÕQÕQ IRQNVL\RQODUÕQÕ G]HQOHGL÷L DQODúÕOPÕúWÕU 12 DUJLQLQLQ QLWULN RNVLW...
Online Katalog
İkinci kısım ise ana kulenin iç kısmına yataklanmış ve hidrolik kontrolle yükseklik ayarı
yapılabilen teleskopik bir ek kuledir.
Ek kule üzerinde wire-line halat geçiş makaraları ve servis halat ma...
SARS Associated Corona Virus (SCV)
JLEL RUWD\D oÕNPÕúWÕU 6ROXQXP \HWPH]OL÷L VHEHEL\OH |OPOH VRQXoODQDQ YDND VD\ÕVÕ
KHU JHoHQ D\JLGHUHNDUWPÕúWÕU%XKDVWDOÕ÷DVHUWDNXWVROXQXPVHQGURPXDQODPÕQD
JHOHQ6HYHUH$FXWH5H...
BİR BİT DÖNÜŞÜMÜ TABANLI EL DAMARI BİYOMETRİ
DGÕPGD WDQÕQDFDN NLúLQLQ EL\RPHWULN YHULVL VLVWHPH
WDQÕWÕOPDN ]HUH DOJRULWPDODU LOH DQDOL] VRQXFX
oÕNDUÕOPDNWD YH YHULWDEDQÕQD ND\GHGLOPHNWHGLU H÷LWLP
YH\D GHYUH\H DOPD DúDPDV...