Ulcers, diabetic neuropathic

Regranex Becaplermin Ortho-McNeil Lower extremity diabetic neuropathic ulcers... 

Indications Treatment of lower extremity diabetic neuropathic ulcers that extend into the subcutaneous tissue or beyond, and have adequate blood supply... 

G. Other applications Whether Regranex Gel provides significant benefit in the treatment of superficial diabetic neuropathic ulcers or nondiabetic ulcers has not been determined. 

Becaplermin Diabetic neuropathic ulcers See also Chapter 41. 

Regranex (rhPDGF produced in S. cerevisiae) Ortho-McNeil Pharmaceuticals (US) and )anssen-Cilag (EU) lower extremity diabetic neuropathic ulcers 1997 (US), 1999 (EU)... 

Direct laser-assisted myocardial revascularization (DMR) is an approved technique in the US, Europe, and parts of Asia to create numerous myocardial channels. This results in the induction of a massive inflammatory reaction, which in turn induces angiogenesis. The other FDA-approved pro-angiogenic therapy is the use of recombinant human platelet-derived growth factor (Regranex) for use in the treatment of diabetic neuropathic foot ulcer s. 

Diabetic neuropathy may be associated with neuropathic ulcer, ptosis, diplopia, strabismus, loss of deep tendon reflexes, ankle drop, wrist drop, paresthesia, hyperalgesia, hyperesthesia, and orthostatic hypotension (because of autonomic dysfunction). 

Veves A, Falanga V, Armstrong DG, Sabolinski ML. Apligraf Diabetic Foot Ulcer Smdy. Graftskin, a human skin equivalent, is effective in the management of nonin-fected neuropathic diabetic foot ulcers a prospective randomized multicenter clinical trial. Diabetes Care 2001 24 290-5. 

Regranex (becaplermin, rPDGF) Neuropathic diabetic ulcers Janssen Ortho-McNeil... 

Becaplermin is a recombinant human platelet derived growth factor . It is used to promote the granulation of diabetic, primarily neuropathic, chronic ulcers. Despite the low absorption and short elimination half-life, use during pregnancy and lactation is advised against. 

Unlabeled Uses Relief of neuropathic pain, such as that experienced by patients with diabetic neuropathy or postherpetic neuralgia treatment of anxiety, bulimia nervosa, migraine, nocturnal enuresis, panic disorder, peptic ulcer, phantom limb pain... 

Neuropathy of the sensory, motor and autonomic nerves, along with micro-vascular and macrovascular disease and impaired neutrophil function all contribute to the development of foot ulcers in diabetic patients. This patient has a neuropathic rather than an ischaemic ulcer. 

Neuropathic changes to the autonomic nervous system as a consequence of diabetes may affect the motor nerve supply of small intrinsic muscles of the foot, resulting in muscular imbalance, abnormal stresses on tissues and bone, and repetitive injuries. Diminished sensory perception causes an absence of pain and unawareness of minor injuries and ulceration. Also, the sympathetic nerve supply may be damaged and can result in an absence of sweating this leads to dry cracked skin, which can become secondarily infected. ... 

Chantelau E, Tanudjaja T, Altenhofer F, Ersanb Z, Lacigova S, Metzeger C. Antibiotic treatment for uncomplicated neuropathic forefoot ulcers in diabetes. Diabet. Med. 1996 13 156-159. 

Researchers [5, 6 and 7] have highlighted that lower-extremity amputation in people with diabetes continues to be a major public health problem. More than 65,000 amputations are performed annually on diabetic patients in the United States, and, despite recent efforts, this number is increasing. Ulceration in the neuropathic foot is a major precursor of amputation, and thus identification of risk factors, together with primary and secondary prevention of foot ulceration, are key goals of this research. 

---