PROSTAGLANDIN-E1 IN SEVERE RAYNAUDS-PHENOMENON

  • 1 January 1982
    • journal article
    • research article
    • Vol. 92  (6) , 953-965
Abstract
Twenty-one patients with severe Raynaud''s phenomenon were treated on 29 occasions with prostaglandin E1 (PGE1), a potent vasodilator and pyrogen. A history of finger sepsis or necrosis was absent in 8 (group I) and present in 13 (group II). Three group I and 8 group II patients had an associated connective tissue disease, and previously 8 upper limbs were sympathectomized in 6 group I patients and 14 upper limbs in 8 group II patients. A total of 12 fingers were amputated in 6 group II patients. Treatment comprised antibiotics for sepsis, PGE1 i.v. for 72 h, and subsequent surgical debridement of septic and necrotic tissue in 30 fingers of 8 group II patients under general anesthesia. Finger skin temperature measured half-hourly in a temperature-controlled ward cubicle (23.7.degree. .+-. 0.7.degree. C), Doppler-detectable digital arterial flow, and finger/brachial systolic pressure index with local finger cooling to 10.degree. C were not improved by the administration of 0-.9% saline for 72 h, but were all significantly improved after PGE1 administration. Finger skin temperature was significantly elevated 11 wk after treatment. The symtoms did not improve after PGE1 administration in group I patients but did improve in 12 of 13 group II patients. No finger deteriorated and all debrided fingers healed after surgery. Nail bed removal in 11 fingers met with patient approval and prevented recurrent sepsis and necrosis. PGE1 provides a means of increasing finger blood flow during acute exacerbations of finger sepsis and necrosis; unlike sympathectomy, it is a minor procedure without prolonged side effects and is repeatable.

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