title: Neural blockade, urokinase and prostaglandin E1 combination therapy for acute digital ischemia of progressive systemic sclerosis.
abstract: To treat severe painful digital ulcers on progressive systemic sclerosis (PSS) patients, we developed a new combination therapy which included neural blockade, intravenous urokinase, and prostaglandin E1 infusion. All of these are already recognized treatments for circulatory disturbances in PSS. Although each of them alone has a limited effect on the painful ischemic attack in PSS; in stepwise combination, neural blockade for release of vascular spasm and pain, prostaglandin E1 for further vasodilatation, and urokinase for thrombolysis were effective in the treatment of digital ischemia in two PSS patients. This therapy reduced the necrotic areas predicted before therapy and saved fingers from amputation. It also relieved the intolerable digital pain and effected the recovery of digital function.
authors.affiliation: Department of Dermatology, Mie University, Faculty of Medicine, Tsu, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Shimizu
authors.forename: H
authors.initials: H
authors.lastname: Mizutani
authors.forename: S
authors.initials: S
authors.lastname: Inachi
authors.forename: T
authors.initials: T
authors.lastname: Tsuchibashi
authors.forename: M
authors.initials: M
authors.lastname: Shimizu
mesh_terms: D000328:Adult; D000527:Alprostadil / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006229:Hand Dermatoses / Q000150:complications*; D006801:Humans; D007511:Ischemia / Q000188:drug therapy* / Q000209:etiology*; D008475:Median Nerve / Q000187:drug effects; D008875:Middle Aged; D009407:Nerve Block; D010146:Pain / Q000517:prevention & control; D012595:Scleroderma, Systemic / Q000150:complications*; D012883:Skin Ulcer / Q000188:drug therapy; D015912:Thrombolytic Therapy; D013933:Thumb / Q000098:blood supply*; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*; D014661:Vasoconstriction / Q000187:drug effects
chemical_list: D014568:Urokinase-Type Plasminogen Activator; D000527:Alprostadil