7 Synergetic Interpretation of Patterned Vasomotion Activity …
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determinants of microvascular perfusion patterns. They were disclosed by results
obtained under pathological conditions by way of comparative measurements of
mucosal blood flow on the one hand, and by comparison between normal and pathologically altered perfusion in the lower extremity in patients with obliterative vascular
disease. Interestingly, both experimental series disclosed an added “attractor” for the
cutaneous perfusion, namely the arterial pressure on the one hand, and the influence
of respiration on the other. Moreover, these measurements showed that independent
(non-invasive) measurement of the ventilatory movements (by simple strain gauge
or thermometric techniques) will have to be implemented in the future in order to
identify the absence or presence of influences passively altering blood content and/or
movement patterns of RBC in the microvasculature.
A set of typical examples reflecting this important physiological fact is shown in
Fig. 7.6, taken from the gingiva of healthy subjects. As shown in the compressed
time series displayed in Fig. 7.6, in each cases we found a remarkable coherency of
the perfusion pattern in the hyperemic glabella region and that in the gingiva: even
when either an involuntary inspiration gasp occurred or when the subjects were asked
to inspirate, the “gasp” activity, (see Mück-Weymann) was found in both cases. We
stress that when such measurements were taken in a cold environment and without
vasoparalysing the cutaneous vessels, a complete dissociation between cutaneous
and mucosal activity patterns were found. Even more interesting were the data on
the perfusion of the inflamed gingiva: while there is a first glance difference between
the healthy (pale pink) mucosa and the inflamed one (deep red), the magnitude of
the LDA signal was not significantly different, in some cases even lower than in the
healthy controls. However, there was markedly enhanced flow pulsatility (intuitively
visible in the compressed time series in the width of the fluctuations under identical
recording conditions) and, most conspicuously, a clear respiration-related activity,
i.e. spontaneously occurring fluctuations of mucosal perfusion in the range between
0.25 Hz and 0.3 Hz (Fig. 7.7). Taken in combination, these two qualitative “pattern”,
objectively recordable by the measurement of the pulsatility index (difference of the
peak and the minimum voltage of the LDA output) divided by the instantaneous
mean) and the normalised power in the ca 0.3 Hz band range (power of the ca 1 Hz
band taken as 1.0) allow to clearly separate between the healthy and the inflamed
microcirculation of the gingival mucosa, see Fig. 7.8.
There are several conclusions to be drawn from these mucosal measurements:
• it is obvious that the normal gingiva seems to be influenced almost entirely by the
activity patterns governing arterial blood pressure,
• this fact can be easily detected non-invasively by simply taking simultaneous
measurements of the perfusion of the hyperemic glabella area, and
• gingivitis with marked macroscopically visible hyperaemie is not associated with
accelerated blood cell displacement, but with a unique combination of enhanced
flow pulsatility (obtainable by LDA measurement) and respiration-associated
fluctuations of the blood content (measureable by PPG).
A closely related finding was early recorded in severe cases of peripheral obliterative occlusive arterial disease (POAD), which had originally been called “small
129
determinants of microvascular perfusion patterns. They were disclosed by results
obtained under pathological conditions by way of comparative measurements of
mucosal blood flow on the one hand, and by comparison between normal and pathologically altered perfusion in the lower extremity in patients with obliterative vascular
disease. Interestingly, both experimental series disclosed an added “attractor” for the
cutaneous perfusion, namely the arterial pressure on the one hand, and the influence
of respiration on the other. Moreover, these measurements showed that independent
(non-invasive) measurement of the ventilatory movements (by simple strain gauge
or thermometric techniques) will have to be implemented in the future in order to
identify the absence or presence of influences passively altering blood content and/or
movement patterns of RBC in the microvasculature.
A set of typical examples reflecting this important physiological fact is shown in
Fig. 7.6, taken from the gingiva of healthy subjects. As shown in the compressed
time series displayed in Fig. 7.6, in each cases we found a remarkable coherency of
the perfusion pattern in the hyperemic glabella region and that in the gingiva: even
when either an involuntary inspiration gasp occurred or when the subjects were asked
to inspirate, the “gasp” activity, (see Mück-Weymann) was found in both cases. We
stress that when such measurements were taken in a cold environment and without
vasoparalysing the cutaneous vessels, a complete dissociation between cutaneous
and mucosal activity patterns were found. Even more interesting were the data on
the perfusion of the inflamed gingiva: while there is a first glance difference between
the healthy (pale pink) mucosa and the inflamed one (deep red), the magnitude of
the LDA signal was not significantly different, in some cases even lower than in the
healthy controls. However, there was markedly enhanced flow pulsatility (intuitively
visible in the compressed time series in the width of the fluctuations under identical
recording conditions) and, most conspicuously, a clear respiration-related activity,
i.e. spontaneously occurring fluctuations of mucosal perfusion in the range between
0.25 Hz and 0.3 Hz (Fig. 7.7). Taken in combination, these two qualitative “pattern”,
objectively recordable by the measurement of the pulsatility index (difference of the
peak and the minimum voltage of the LDA output) divided by the instantaneous
mean) and the normalised power in the ca 0.3 Hz band range (power of the ca 1 Hz
band taken as 1.0) allow to clearly separate between the healthy and the inflamed
microcirculation of the gingival mucosa, see Fig. 7.8.
There are several conclusions to be drawn from these mucosal measurements:
• it is obvious that the normal gingiva seems to be influenced almost entirely by the
activity patterns governing arterial blood pressure,
• this fact can be easily detected non-invasively by simply taking simultaneous
measurements of the perfusion of the hyperemic glabella area, and
• gingivitis with marked macroscopically visible hyperaemie is not associated with
accelerated blood cell displacement, but with a unique combination of enhanced
flow pulsatility (obtainable by LDA measurement) and respiration-associated
fluctuations of the blood content (measureable by PPG).
A closely related finding was early recorded in severe cases of peripheral obliterative occlusive arterial disease (POAD), which had originally been called “small