title: Expression of endothelial nitric oxide synthase and endothelin-1 in skin tissue from amputated limbs of patients with complex regional pain syndrome.
abstract: OBJECTIVE
  Impaired microcirculation during the chronic stage of complex regional pain syndrome (CRPS) is related to increased vasoconstriction, tissue hypoxia, and metabolic tissue acidosis in the affected limb. Endothelial dysfunction is suggested to be the main cause of diminished blood flow. The aim of this study was to examine the distribution of endothelial nitric oxide synthase (eNOS) and endothelin-1(ET-1) relative to vascular density represented by the endothelial marker CD31-immunoreactivity in the skin tissue of patients with chronic CRPS.
  
  
  METHODS
  We performed immunohistochemical staining on sections of skin specimens obtained from the amputated limbs (one arm and one leg) of two patients with CRPS.
  
  
  RESULTS
  In comparison to proximal specimens we found an increased number of migrated endothelial cells as well as an increase of eNOS activity in distal dermis specimens.
  
  
  CONCLUSIONS
  We found indications that endothelial dysfunction plays a role in chronic CRPS.
authors.affiliation: Pain Treatment Center, Department of Anesthesiology, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. j.groeneweg@erasmusmc.nl
authors.forename: J George
authors.initials: JG
authors.lastname: Groeneweg
authors.forename: Claudia Heijmans
authors.initials: CH
authors.lastname: Antonissen
authors.forename: Frank J P M
authors.initials: FJ
authors.lastname: Huygen
authors.forename: Freek J
authors.initials: FJ
authors.lastname: Zijlstra
mesh_terms: D000328:Adult; D000671:Amputation, Surgical; D002908:Chronic Disease; D020918:Complex Regional Pain Syndromes / Q000378:metabolism* / Q000473:pathology; D019332:Endothelin-1 / Q000378:metabolism*; D005121:Extremities / Q000098:blood supply / Q000601:surgery; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008875:Middle Aged; D052250:Nitric Oxide Synthase Type III / Q000378:metabolism*; D019408:Platelet Endothelial Cell Adhesion Molecule-1 / Q000378:metabolism; D012867:Skin / Q000098:blood supply / Q000378:metabolism*
chemical_list: D019332:Endothelin-1; D019408:Platelet Endothelial Cell Adhesion Molecule-1; D052250:Nitric Oxide Synthase Type III