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Mediators of Inflammation
Volume 2008, Article ID 680981, 5 pages
http://dx.doi.org/10.1155/2008/680981
Case Report

Expression of Endothelial Nitric Oxide Synthase and Endothelin-1 in Skin Tissue from Amputated Limbs of Patients with Complex Regional Pain Syndrome

1Pain Treatment Center, Department of Anesthesiology, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
2Experimental Anesthesiology, Department of Anesthesiology, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands

Received 25 May 2008; Accepted 4 July 2008

Academic Editor: Philipp Lepper

Copyright © 2008 J. George Groeneweg et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background and Objectives. 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.