Intravenous Infusion Of Prostaglandin E1 Research Articles

Experience of Intravenous infusion of prostaglandin E1 for cessation of rest pain and further ischemic changes in patients with PVD

Prostaglandins are potent vasoactive agents with wide variety of other actions - vasodilatation, fibrinolysis and inhibition of platelet aggregation. Prostaglandin E1( PGE1) was the agent used since 1973 for cardiovascular diseases, mainly in patients with advanced peripheral vascular disease. PGE1 intra venous infusion has shown to be beneficial in limb threatening ischemia, especially when reconstructive procedures are not feasible. The original research of benefitted 28 cases in last 5 years is presented here.

Ductus arteriosus banding to regulate excessive pulmonary blood flow in a neonate with necrotizing enterocolitis and complex congenital heart disease, including pulmonary atresia and total anomalous pulmonary venous return: a case report

BackgroundPatients with right isomerism have accompanying complex congenital heart disease, which is characterized by pulmonary atresia and total anomalous pulmonary venous return. Balanced regulation of the systemic and pulmonary circulation is essential for successful management, especially for cases complicated with necrotizing enterocolitis (NEC).Case presentationA 6-day-old male neonate with a single ventricle, pulmonary atresia, patent ductus arteriosus (DA), and total anomalous pulmonary venous return associated with right isomerism was admitted because of dyspnea, cyanosis, and melena. The patient presented circulatory incompetence due to excessive pulmonary blood flow, resulting in NEC. The patient underwent DA banding and colectomy following continuous intravenous infusion of prostaglandin E1 at six days. Subsequently, his condition improved, reaching a systemic oxygen saturation of around 80%. He underwent a bidirectional Glenn procedure and closure of colectomy at the ages of 5 and 6 months, respectively.ConclusionDA banding can be an alternative to placing an aortopulmonary shunt, which is conventional in patients with ductus-dependent pulmonary circulation, because DA banding is feasible without cardiopulmonary bypass.

Critical coarctation of the aorta in newborn - A case presentation

Background: Heart defects are the most popular congenital disease noticed among infants. Aortic Coarctation (CoA) forms 5 - 10 % of congenital heart diseases. The heart defect consist on aortic coarctation between inlet of the left subclavian artery and origin of the arterial ligament. In the during neonatal and early infantile period, in case of delayed diagnosis, it may lead to acute heart failure and the death of the child. 
 Case report: A female infant born at 37 weeks of gestation, by caesarean section, in good condition, was admitted to the Neonatal Department. There was a suspicion of CoA in the fetus in the pregnancy history. The Echocardiography showed a narrowing of the carpal tunel, prostin was included in the treatment. In the second day of life, the child was transferred to the Cardiology Department. Four-extremity blood pressures test showed higher values in the upper limbs than in the lower limbs. Echocardiography revealed hypoplasia of the aortic arch in the section below the exit of the second cephalic vessel with coarctation at the isthmus site. Laboratory tests showed a high level of pro-BNP. The control echocardiography showed the anatomy of the defect as before, an unobstructed wide arterial duct with a dominant R-L flow, a flow in the descending aorta of 2.7 m/s, with a coartable flow spectrum. The child was transported to the Department of Cardiac Surgery, Heart Transplantation and Mechanical Circulatory Support for Children in Zabrze for surgical treatment. 
 Conclusions: In neonates and infants with critical aortic stenosis, ensure the patency of the ductus arteriosus with continuous intravenous infusion of prostaglandin E1. Currently, echocardiography is the basic method in the diagnosis of aortic stenosis. 

Intravenous infusion of prostaglandin E1 in ischemic ulcer and rest pain for extremities due to peripheral vascular disease

Prostaglandins are potent vasoactive agents with wide variety of other actions - vasodilatation, fibrinolysis and inhibition of platelet aggregation. PGE1 was the agent used since 1973 for cardiovascular diseases, mainly in patients with advanced PVD. PGE1 intra venous infusion has shown to be beneficial in limb threatening ischemia, especially when reconstructive procedures are not feasible. The original research of benefitted 35 cases in last 5 years is presented here. Background: As a General surgeon we use only analgesics and anti-platelet agent aspirin for severe ischaemic limbs with rest pain. We could not improve patient’s quality of life with these medications. Enough of medicine literature says prostaglandins E1 improves microcirculation, stop tissue damage due to ischemia and relief from rest pain. Methods: In this study we included both gender patients above age of 34 years who had ischemic changes associated with peripheral vascular disease and rest pain. We infused intravenous prostaglandins E1 and studied them for improvement in soft tissue ischemic changes and in rest pain. Results: clinical success was evaluated according subjective grading and relief of pain. Patients in these studies had a pain score from 6 onwards as per Wong-Baker FACES pain rating scale improved to 2-4. We also studied them for Fontain and Rutherford staging and scoring system, which improved from III b to II-I and from 4 to 2-1 respectively. Conclusions: Intravenous infusion of PGE1 alprostadil on 5 days a cycle basis, in selected patients with severe rest pain and ischemia seems to be very effective, without any serious complications.

Staged surgical repair for infants with interrupted aortic arch

BackgroundInterrupted aortic arch (IAA) is a rare congenital cardiac anomaly, which necessitates surgical treatment. There are several surgical strategies for corrective repair of IAA, such as one-stage repair, rapid two-stage repair and two-stage repair. Here, we reported our surgical result of staged-repair policy for the patients with IAA. MethodFrom November 2003 to July 2015, there were 14 patients (8 boys, 6 girls) with IAA treated by us. Except one teenager patient, we routinely used intravenous infusion of prostaglandin E1 for all the infant patients (n = 13) to keep adequate end organ perfusion before the first surgical intervention. Surgical repair was performed after the perfusion of end organs recovered. ResultTwo patients (1 teenager and 1 infant with one-stage surgery) were excluded from this study. At the time of the first surgery, we did the first-stage surgery with anastomosis in between aortic arch and descending aorta, division of patent ductus arteriosus and banding of pulmonary trunk through left thoracotomy. The overall surgical survival rate of the first surgery was 100% (12/12). At the time of the second surgery, corrective repair was done under cardiopulmonary bypass through median sternotomy. The surgical survival rate of the corrective surgery was also 100%. There is no late death during follow-up for 9 years (range 4.2–15.0 years). ConclusionOut of several surgical strategies for the infants with IAA, staged repair still could be a treatment option to achieve satisfied surgical result.

Intravenous Prostaglandin E1 Infusion for Acute Central Retinal Artery Occlusion.

To evaluate the efficacy of systemic prostaglandin E1 (PGE1) infusion within the first 24 hours of acute central retinal artery occlusion (CRAO). Best corrected visual acuity (BCVA) was analyzed in a case series of six eyes from six patients (mean age: 69.33 years) with acute CRAO who were treated with twice-daily intravenous infusion of 40 μg PGE1. Therapy continued until the patient no longer experienced visual acuity improvements for 24 hours. Average time to presentation was 8.33 hours (range: 2 to 12 hours). The logMAR BCVA at presentation was 2.73. BCVA at the final visit 1 month after initial presentation was 1.48 (P = .025). All patients experienced vision improvement. No systemic adverse events were experienced. Intravenous PGE1 infusion resulted in significant visual improvement in patients presenting with acute CRAO and is well tolerated with few adverse effects. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:S5-S8.].

MODIFIED HYBRID METHOD FOR TREATING HYPOPLASTIC LEFT HEART SYNDROME IN NEONATES

A «modified» hybrid method for treating hypoplastic left heart syndrome (HLHS) has been started in the Republican Scientific andPractical Center for Pediatric Surgery to stabilize neonates with «high risk». This method consists of bilateral pulmonary artery banding (BPAB) with continuous intravenous infusion of prostaglandin E1 to patent ductus arteriosus (PDA) until Norwood operation. Objective of the study was to evaluate the results of BPAB in «high-risk» neonates with HLHS. Material and methods. BPAB was performed in 155 «high-risk» children with HLHS in the Republican Scientific and Practical Center for Pediatric Surgery from January 2014 to February 2018. Operative age of the patients was 5.0 (3.0–11.8) days, weight – 2.9 (2.3–3.5) kg. After BPAB all children underwent continuous intravenous infusion of prostaglandin E1 to PDA until Norwood operation. Results. After BPAB 1 patient (6.7%) died in the early postoperative period (up to 7 days). Endovascular stenting of the PDA after BBLA was performed in 2 children (13.3%). 1 patient (6.7%) died in 6 months after BBLA. Norwood operation was performed in 13 children (86.7%) in 35.0 (27.0–57.0) days after BBLA. Pulmonary artery augmentation after debanding was needed in 1 patient (6.7%). Early postoperative mortality (up to 7 days) after Norwood operation was 20.0%, 30-days mortality – 26.7%. Conclusion. BPAB with continuous intravenous infusion of prostaglandin E1 may be successfully used in «high-risk» neonates with HLHS to improve the results of surgical treatment.

Perioperative management with phosphodiesterase type 5 inhibitor and prostaglandin E1 for moderate portopulmonary hypertension following adult-to-adult living-donor liver transplantation: a case report

BackgroundPortopulmonary hypertension (PPH) is a relatively rare but well-recognized complication of end-stage liver disease. Moderate or severe PPH (mean pulmonary artery pressure [mPAP] ≥ 35 mmHg) is usually a contraindication for liver transplantation due to high operation-related mortality. Here, we report on a patient with moderate PPH whose condition was successfully managed with a phosphodiesterase type 5 (PDE5) inhibitor (tadalafil) and prostaglandin E1, who experienced rapid improvement of PPH after living-donor liver transplantation (LDLT).Case presentationA 63-year-old woman with alcoholic decompensated cirrhosis was referred to our hospital for LDLT. She had mild dyspnea on exertion as well as fatigue. Echocardiography and subsequent cardiac catheterization revealed a high mPAP (35 mmHg), and she was diagnosed with moderate PPH. We commenced treatment with oral tadalafil for the PPH. A second preoperative echocardiography demonstrated improved PPH, and she underwent LDLT. An intravenous infusion of prostaglandin E1 was introduced instead of tadalafil during and after the operation.The mPAP value showed a rapid decrease in mPAP value to 22 mmHg in 2 days. After discontinuation of the prostaglandin E1, the mPAP value remained 23 mmHg. Postoperative catheterization 2 months after LDLT showed no exacerbation of PPH. She was discharged on foot 70 days after LDLT in good condition and has shown a good clinical condition more than 2 years after LDLT.ConclusionLDLT could be a radical treatment for PPH with careful management and adequate patient selection. PDE5 inhibitor and PGE1 is effective and feasible for perioperative management of the patient with moderate portopulmonary hypertension in LDLT.

Prostaglandin E2 induces immediate migraine-like attack in migraine patients without aura

Background: Prostaglandin E2 (PGE2) has been suggested to play an important role in the pathogenesis of migraine. In the present experiment we investigated if an intravenous infusion of PGE2 would induce migraine-like attacks in patients with migraine.Methods: Twelve patients with migraine without aura were randomly allocated to receive 0.4 µg/kg/min PGE2 (Prostin®E2, dinoprostone) or placebo over 25 minutes in a two-way, crossover study. Headache intensity was recorded on a verbal rating scale, middle cerebral artery blood flow velocity (VMCA) was measured by transcranial Doppler (TCD) and diameter of the superficial temporal artery (STA) was obtained by c-series scan (Dermascan C).Results: In total, nine migraine patients (75%) experienced migraine-like attacks after PGE2 compared to none after placebo (p = 0.004). Seven out of 9 (58%) patients reported the migraine-like attacks during the immediate phase (0–90 min) (p = 0.016). Only two patients experienced the delayed migraine-like attacks several hou...

Prostaglandin E2 induces immediate migraine-like attack in migraine patients without aura

Prostaglandin E(2) (PGE(2)) has been suggested to play an important role in the pathogenesis of migraine. In the present experiment we investigated if an intravenous infusion of PGE(2) would induce migraine-like attacks in patients with migraine. Twelve patients with migraine without aura were randomly allocated to receive 0.4 µg/kg/min PGE(2) (Prostin(®)E2, dinoprostone) or placebo over 25 minutes in a two-way, crossover study. Headache intensity was recorded on a verbal rating scale, middle cerebral artery blood flow velocity (V(MCA)) was measured by transcranial Doppler (TCD) and diameter of the superficial temporal artery (STA) was obtained by c-series scan (Dermascan C). In total, nine migraine patients (75%) experienced migraine-like attacks after PGE(2) compared to none after placebo (p = 0.004). Seven out of 9 (58%) patients reported the migraine-like attacks during the immediate phase (0-90 min) (p = 0.016). Only two patients experienced the delayed migraine-like attacks several hours after the PGE(2) infusion stop (p = 0.500). The V(MCA) decreased during the PGE(2) infusion (p = 0.005) but there was no significant dilatation of the STA (p = 0.850). The migraine-like attacks during, and immediately after, the PGE(2) infusion contrast with those found in previous provocation studies, in which the other pharmacological compounds triggered the delayed migraine-like attacks several hours after the infusion. We suggest that PGE(2) may be one of the important final products involved in the generation of migraine attacks.

Postoperative changes of blood flow in free microvascular flaps transferred for reconstruction of oral cavity: Effects of intravenous infusion of prostaglandin E1

This study is addressed to define postoperative pattern of blood flow in free microvascular flaps by using a laser Doppler flowmetry (LDF) and to reveal effects of the prostaglandin E1 (PGE1) administration on the blood flow. Postoperative blood flows in the flaps were monitored with LDF in 14 patients, who were administrated PGE1 twice a day for 7 days after the operation. The average blood flow rates in the flaps gradually increased after the operation, reached peak at 7 days after the operation, and then become stable until 21 days after the operation. After the PGE1 administration, the blood flow rates in all of the patients increased within 15 min and reached the peak between 75 min and 105 min. These results suggest that PGE1 is useful to increase the blood flow in the flap. Furthermore, the present study revealed these postoperative patterns of the changes in the blood flow in the flaps, careful monitoring of the flaps with LDF as performed in the present study will provide significant information to identify a disturbance of circulation in the flaps as soon as possible.

Clinical efficacy of IV prostaglandin E1and IV pentoxifylline in patients with arterial occlusive disease of fontaine stage IIb: A multicenter, randomized comparative study

The IV infusions of both prostaglandin E1 (PGE1) and pentoxifylline showed good efficacy in prolonging the claudication distance and maximum walking range of patients with intermittent claudication, and the Doppler pressures were used as parameters of efficacy. IV PGE1 was significantly superior after 4 weeks' therapy as to both claudication distance and maximum walking range. The ankle pressure indices were significantly elevated in both groups at the end of therapy. The therapeutic effect proved to persist in both groups after a 12 month follow-up, with adverse reactions occurring in two patients treated with PGE1 and in six patients treated with pentoxifylline. The study supports the view that the intravenous infusion of PGE1 is an efficacious and well-tolerated therapy for intermittent claudication.

Cardiopulmonary effects and safety of prostaglandin E1: A review

Intraarterial and intravenous infusion of prostaglandin E1 (PGE1) is established treatment for severe peripheral arterial occlusive disease, particularly in Europe and Japan. In this critical appraisal, experimental and clinical studies are reviewed, with special emphasis on cardiopulmonary effects and drug safety. The pulmonary data all indicate dose-dependent dilation of the pulmonary vessels with a reduction in pulmonary resistance. The known hemodynamic effects of PGE1 on the heart include an increase in stroke volume, cardiac index, and left ventricular ejection fraction, and a reduction in left ventricular filling pressure. Analysis of clinical trials shows a low rate of adverse effects, in particular a low incidence of cardiopulmonary side effects. If the recommendations for high-risk patients are observed, PGE1 is both an efficacious and safe therapeutic principle.

Continuous intravenous infusion of prostaglandin E1 improves myocardial perfusion reserve in patients with ischemic heart disease assessed by positron emission tomography: a pilot study

Recent investigation has demonstrated that prostaglandin E(1) (PGE(1)) therapy increased capillary density in explanted hearts. Dynamic (13)N-ammonia positron emission tomography (PET) is reliable for non-invasive measurement of myocardial blood flow and myocardial perfusion reserve (MPR). The aim of this study was to investigate the effects of PGE(1) therapy during 4weeks on reduction of myocardial perfusion abnormalities and increase of MPR in the patients with ischemic heart disease. In this double-blind, placebo-controlled trial, we randomly assigned 11 patients who had symptomatic heart failure and documented myocardial ischemia to 4weeks intravenous infusion of PGE(1) (2.5ng/kg/min; 8 patients, age 60±13years) or saline (3 patients, age 57±13years). Dynamic (13)N-ammonia PET scans at rest and during adenosine stress were obtained at baseline and 12weeks after treatment completion. Quantitative size/severity of perfusion defects and MPR change from baseline to follow-up PET were determined using a 17-segment model. Compared with the control group, baseline MPR in the PGE(1) group was significantly lower (1.96±0.78 vs. 2.71±0.73; P<0.001). MPR significantly improved 12weeks after completion of PGE(1) infusion (1.96±0.78 to 2.16±0.77; P<0.001). In contrast, MPR declined significantly in the placebo group (2.71±0.73 to 2.01±0.58, P<0.001). Four weeks of PGE(1) infusion sustained MPR improvement in patients with ischemic heart disease. This may be an attractive therapeutic approach for no-option patients with severe ischemic cardiomyopathy.

Constant Intravenous Infusions of Prostaglandin E1 in Severe Peripheral Vascular Disease

Constant Intravenous Infusions of Prostaglandin E1 in Severe Peripheral Vascular Disease

Benefit of prostaglandin infusion in severe heart failure

Prostaglandin E1 (PGE1) is a potent vasodilating drug, which has been used in treatment of primary pulmonary hypertension. However intravenous PGE1 infusion may be of benefit and also has been proposed as a therapeutic tool in patients with end-stage heart failure. The aim of this prospective not randomized study was to assess the clinical and instrumental effects of this agent in patients with severe heart failure and pulmonary hypertension. To investigate the effects of PGE1 in congestive heart failure we selected 22 consecutive patients (16 males, 6 females, mean age 63±2 years) in the mean NYHA class III, because they had pulmonary hypertension (PAPs>3 m/s and left ventricular ejection fraction (LVEF) ≤35% by echocardiography. A control group of 23 patients (19M, 4F mean age 62±5 years; 9 patients were in the NYHA class IV and 14 in the NYHA class III), with the same instrumental and clinical data, received an optimized oral treatment with beta-blockers, ACE-inhibitors, furosemide and digitalis. Right heart catheterization was performed to confirm and determine the type of pulmonary hypertension, before starting the PGE1 infusion. Clinical and echocardiography evaluation was performed during follow-up. PGE1 was infused at a mean dose of 10 ng/kg/min for a total of 24 h over three consecutive days every three months. Right heart catheterization confirmed a high systolic pulmonary pressure in all patients; pre-capillary pulmonary hypertension (mean PAP>25 mm/Hg) was 25%. During a mean follow-up of 36±6 months, 16 patients died (10 in the control group and 6 in the PGE1 group). The Kaplan-Meier 3-years survival analysis was not statistically significant (Log-rank test), but at 2 months survival rates began to diverge; 36 months survival: 72.7% in the PGE1 group and 56% in the control group. The mean LVEF increased from 25.78% to 32.1% in the PGE1 group and from 23.38% to 26.15 in the control group (p<0.001); the NYHA mean class improved from 3.18 to 2.24 in the PGE1 group and from 3.46 to 3.38 in the control group (p<0.05). The PAP decreased from 57.65 to 40.82 mm/Hg (p<0.001). An AICD was implanted in 3 patients in the first group and in 5 patients in the control group. Two patients were added to the heart transplantation list. These preliminary data suggest that intermittent PGE1 infusion in patients with advanced congestive heart failure and high pulmonary pressure is able to improve NYHA mean class (p<0.05), ventricular contractility (LVEF p<0.001), pulmonary pressure and clinical data. It hasn't been associated to morbid events or increased risk of death.

Preoperative management of hypoplastic left heart syndrome

Pediatricians are frequently involved in the care of cyanotic newborns in the labor and delivery room, as well as in the well baby nursery. Causes of hypoxia and cyanosis in the term newborn can be found within all physiological systems. Congenital heart structural diseases account for the largest diagnostic category. There have been significant advances during the past years in the diagnosis and treatment of neonates with critical congenital heart disease, especially in the field of pre- and post-operative intensive care. The term hypoplastic left heart syndrome (HLHS) describes a spectrum of cardiac structural abnormalities characterized by marked hypoplasia of the left ventricle and ascending aorta. Prenatal diagnosis, initial resuscitation and optimal preoperative management are key elements that allow the best opportunity for low mortality and normal neurodevelopment in affected newborns. Preoperatively, the goal is to achieve adequate systemic oxygen delivery. Patency of the ductus arteriosus (DA) is critical for survival until surgery. Blood flow to the pulmonary and systemic circulations should be nearly balanced (goal Q p /Q s ratio of 1). The immediate therapy for all infants with HLHS is an intravenous infusion of prostaglandin E 1 (PGE 1 ) in order to manipulate the DA and maintain ductal patency. Oxygen saturations of 75% to 85% by pulse oximetry suggest an adequate balance between systemic and pulmonary blood flow. Judicious use of inotropic support is initiated if evidence of low cardiac output is detected. Diuretics may be necessary to help alleviate the increased volume load on the right ventricle. The goal of respiratory management is to increase pulmonary vascular resistance and decrease systemic vascular resistance. Infants with HLHS who are born with a severely restricted or no inter-atrial communication, a rare occurrence, have profound hypoxemia. The severe restriction of blood flow across the atrial septum results in a life-threatening situation and these patients, which present with severe cyanosis and hemodynamic instability, require urgent postnatal cardiac catheterization to relieve the septal obstruction and improve oxygenation. Special attention should be paid to the prevention of brain injury and poor neurodevelopmental outcome. Care for infants with HLHS is complex, and often multiple specialists are involved. Despite an increase in the number of newborns with complex congenital heart disease and a growing percentage of patients with single-ventricle physiology, it is possible to care for this particular group of patients and achieve acceptable mortality risks, even in centres with no pediatric cardiac surgery facilities, if good preoperative management protocols are followed.

Improvement of microcirculation after percutaneous transluminal angioplasty in the lower limb with Prostaglandin E1

Objective The aim of the study was to investigate prospectively the microcirculation after angioplasty and its improvement with additional Prostaglandin E1 (PGE1) therapy assessed by transcutaneous pressure of oxygen. Patients and methods 45 patients with intermittent claudication eligible for angioplasty were enrolled in a prospective randomised controlled clinical trial. Patients received either intra-arterial bolus of 40 μg PGE1 in addition to angioplasty or a 40 μg PGE1 intravenous infusion. Control group received no trial medication. Additional 15 patients undergoing intra-arterial angiography were also investigated. tcpO 2 values were recorded distal to the PTA region before, during the intervention, 24 h, 2 and 4 weeks after intervention. Clinical endpoint was the change of tcpO 2 values 4 weeks after intervention. Results During the 4 week follow-up tcpO 2 values decreased in patients treated with angioplasty. At the same time tcpO 2 increased significantly in those patients additionally treated with intra-arterial PGE1 bolus injection as well as with intravenous PGE1 infusion. Conclusions Impaired microcirculation after angioplasty can be improved with additional intravenous as well as intra-arterial PGE1 administration.

Midterm Results of Prostaglandin E1 Treatment in Patients With Lumbar Spinal Canal Stenosis Accompanied by Intermittent Claudication

The midterm results of prostaglandin E1 (PGE1) treatment in patients with lumbar spinal canal stenosis, and discuss the factors influencing the improvement rate by using multivariable analysis. We report the clinical results of PGE1 treatments in patients with lumbar spinal canal stenosis. Neurogenic intermittent claudication, a prominent symptom of lumbar spinal canal stenosis, poses a substantial impairment of quality of life in patients. A variety of approaches to treatment for lumbar spinal canal stenosis have been reported. However, general systemic complications make it difficult for many elderly people to undergo surgical treatment. Sometimes the only reasonable option is to receive conservative treatment. The subjects were 63 patients with lumbar spinal canal stenosis. After admission, patients were given an intravenous infusion of PGE1 (60 microg/d) for approximately 2 weeks. To obtain the spinal canal stenosis rate, the area of the dural canal observed on magnetic resonance imaging and CT myelography was measured by using image analysis software (NIH image). The correlation of improvement rates to ages, JOA scores, claudication distances, and stenosis rate obtained through magnetic resonance imaging was evaluated using multivariable analysis. Regardless of stenosis type, JOA scores significantly improved after PGE1 administration (the mixed type: P < 0.0001, the nerve root type: P < 0.01, and the cauda equina type: P < 0.01), and claudication distance was significantly improved. Multivariable analysis showed that JOA scores before PGE1 administration significantly contributed to the improvement rates. Our midterm results showed that PGE1 was useful for treating intermittent claudication in patients with lumbar spinal canal stenosis. The effect of PGE1 was not related to the degree of stenosis obtained with images, age, or claudication distance, but was correlated with baseline disease severity (JOA scores before administration).

脳幹部血流に対するプロスタグランディンＥ１の影響

Posterior circulation disturbance, commonly known as vertebrobasilar insufficiency (VBI), is often associated with symptoms such as vertigo and instability. These various symptoms are thought to be due to hemodynamic disorders of the vertebrobasilar circulation that temporarily damage the vestibular nucleus (VN) and/or the cochlear nucleus (CN) within the brainstem. In this study, using a Laser-Doppler approach, we investigated the brainstem blood flow (BBF) feeding the vertebrobasilar system in order to estimate the influence of continuous intravenous infusion of prostaglandinE1 (PGE1), which acts as a microvascular dilator, in normal rats in this study. The following results were obtained. 1. During continuous intravenous infusion of PGE1 (at doses of 5 and 10ng/min/kg), no significant fluctuations of physiological parameters (PaO2, PaCO2, pH, saturation, body temperature, mean arterial blood pressure) were observed. However, the mean arterial blood pressure showed a tendency to decline after 45 minutes of continuous infusion of the higher dose (10ng/min/kg). 2. The BBF in the rats increased significantly to about 120% of the initial level after 30 minutes of continuous infusion of PGE1, compared to control infusion of saline. 3. Dose-dependent increases in the BBF were apparent after 60 minutes' continuous infusion. Considering the particular construction of the perforating vessels within the brainstem in both the VN and CN, the BBF measured in this investigation sensibly reflects is considered to reliably reflect the blood flow in these two nuclei. Therefore, we conclude that continuous intravenous infusion of PGE1 might be efficacious in cases of vertigo, equilibrium dysfunction and hearing impairment which directly result from circulation disturbances of the brainstem, because PGE1 would increase the blood flow to the VN and CN via improvement of the microvascular circulation within the brainstem.