title: A novel bFGF-GH injection therapy for two patients with severe ischemic limb pain.
abstract: Severe ischemic pain is difficult to treat with a single therapy. Although modern angiogenic therapies have been used in patients with peripheral arterial occlusive diseases, a regimen combining novel angiogenic therapy and classic nerve blocks, including sympathectomy, has not been discussed to date. In this case report, we present two patients with peripheral arterial occlusive disease who were first treated with medication and lumbar sympathectomy, and then with a novel gelatin hydrogel drug-delivery system loaded with basic fibroblast growth factor. The gelatin hydrogel combined with recombinant basic fibroblast growth factor was injected intramuscularly into the ischemic limbs. In the first patient, with arteriosclerosis obliterans, a foot ulcer was healed, and the original score for resting pain (visual analogue scale, 5/10) was decreased to 0/10. In the second patient, with Buerger's disease, a large toe ulcer was healed, and his resting pain (visual analogue scale, 8/10) was decreased to 1/10. Some other parameters, such as skin surface temperature, transcutaneous oxygen partial pressure, and pain-free walking distance, were also improved in both patients after the combined therapy. A multimodal approach is necessary to treat severe ischemic pain. Novel angiogenic therapy combined with nerve blocks seems to be a promising option in patients with severe pain.
authors.affiliation: Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511, Japan.
authors.forename: Naomi
authors.initials: N
authors.lastname: Ito
authors.forename: Shigeru
authors.initials: S
authors.lastname: Saito
authors.forename: Makiko Hardy
authors.initials: MH
authors.lastname: Yamada
authors.forename: Shiro
authors.initials: S
authors.lastname: Koizuka
authors.forename: Hideaki
authors.initials: H
authors.lastname: Obata
authors.forename: Koichi
authors.initials: K
authors.lastname: Nishikawa
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Tabata
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D001162:Arteriosclerosis Obliterans / Q000150:complications / Q000188:drug therapy; D005121:Extremities / Q000098:blood supply; D016222:Fibroblast Growth Factor 2 / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016523:Foot Ulcer / Q000150:complications; D013006:Growth Hormone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007511:Ischemia / Q000150:complications*; D008297:Male; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D010148:Intractable Pain / Q000188:drug therapy; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012039:Regional Blood Flow; D013562:Sympathectomy
chemical_list: D011994:Recombinant Proteins; D016222:Fibroblast Growth Factor 2; D013006:Growth Hormone