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Occupational Medicine 2004;54:261-264
Occupational Medicine, Vol. 54 No. 4 © Society of Occupational Medicine; all rights reserved

Case Report

Effectiveness of therapy with iloprost in hand–arm vibration syndrome

Michele Meloni1, Mario Torrazza2 and Roberto Ledda3

1 Department of Public Health, University of Cagliari, Italy.
2 Department of Internal Medicine, University of Cagliari, Italy.
3 Occupational Health Service, St Bartholomew’s Hospital, London, UK.

Aim

To evaluate the efficacy and tolerance of therapy with iloprost in hand–arm vibration syndrome.

Methods

We describe a clinical case of a male aged 53 years, who was a heavy smoker for 30 years and a mason working with vibrating tools since 1962. He presented with a history of 10 years of attacks of vasospasm, functional impairment and digital ulceration. He was diagnosed as having hand–arm vibration syndrome vascular stage 4 on the Stockholm Workshop 1986 Scale. Besides suspension from work and abstention from smoking, we began intravenous infusion of iloprost for 6 h in cycles of 3–6 consecutive days, arriving at a dose of 1.5–2.0 ng/kg/min.

Results

After eight cycles, he reported significant symptomatic and functional improvement. Iloprost was seen to be efficacious: the trophic skin lesions disappeared and his microcirculatory perfusion tests improved. There were no significant side effects.

Conclusions

We suggest that the use of iloprost in the treatment of the most advanced stages of vascular hand–arm vibration syndrome warrants further study

Keywords      Hand–arm vibration syndrome; iloprost; prostacyclin; vibration white finger

Received       13 May 2003
Revised          4 November 2003
Accepted       12 January 2004

Correspondence to: Michele Meloni, Dipartimento di Sanità Pubblica, Sezione di Medicina del Lavoro, Via San Giorgio 12, I-019124, Cagliari, Italy. Tel: +39 0706 028 5349; fax: +39 0706 54350; e-mail: melonim{at}pacs.unica.it. Roberto Ledda, Occupational Health Service, Third Floor, Queen Mary Wing, St Bartholomew’s Hospital, West Smithfield, London EC1 7BE, UK. Tel: +44 207 601 8070; fax: +44 207 601 7017; e-mail: Roberto.Ledda{at}bartsandthelondon.nhs.uk


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