bluuebunny/crossref_metadata_2025_split huggingface dataset:
INTRA-ARTERIAL UROKINASE INFUSION IN ACUTE ARTERIAL OCCLUSION OF THE LIMBS
Authors: Martínez-Brotóns F , Calderón A , Cairols M A , Reynaldo C , Capdevila J M 
Published: August 2018

20 patients with acute arterial occlusion of the limbs have been treated with a continuous urokinase (UK) infusion through an intra-arterial catheter placed as close as possible to the occlusion. A loading dose of 4400 IU/Kg was given over a period of 15 minutes. Subsequently an infusion of 4400 IU/Kg per hour was administered during the following 12 hours. Blood samples were drawn pre- and post-therapy to see the state of coagulation and fibrinolysis, including α2-antiplasmin (α2-AP), plasminogen (PLG) (chromogenic methods) and fibrinogen degradation products (FDP) (Merskey) determinations.RESULTS: There was a mild decrease of the plasma fibrinogen level from 306 ± 75 mg/lOOml previous to treatment to 195 ± 64 mg/lOOml post UK infusion and the FDP raised up to 330 ± 274 μg/ml. After terminating the UK infusion, Thrombin time ratio was 1.8 ± 0.5 and Reptilase time ratio was 2.0 ± 0.9. α2-AP activity was near 0 % in all cases and PLG fell to 33.7 ± 14.4 % of its initial concentration. Factor V activity was 63.6±19.9 %. In two out of three patients with severe ischaemia amputation was avoided. 17 patients suffered a less severe limb ischaemia. When the estimated occlusion time was less than 7 days a 60 % of complete lysis and a 20 % of partial lysis was obtained. In occlusions of more than a week the figures were 14 % and 28 % respectively. Bleeding around the insertion site of the catheter or local hematoma occurred in 5 cases.We conclude that intra-arterial infusion of UK in acute arterial ischaemia of the limbs is an effective treatment in occlusions of less than 7 days. According to our previous experience the bleeding risk seems to be less than during systemic or local streptokinase therapy.(All data are expressed as mean ± SD.)
FIBRINOLYTIC THERAPY WITH STREPTOKINASE AND UROKINASE IN DEEP VEIN THROMBOSIS
Authors: Trübestein G , Ludwig M , Wilgalis M , Trübestein R , Popov S 
Published: August 2018

336 patients with acute 1-6 day old, and subacute, 1-3 week old deep vein thrombosis were treated with streptokinase (SK) or urokinase (UK) up to April 1, 1985. 175 patients were included in the SK group, 161 patients in the UK group. A standardized SK-heparin and the standardized UK-heparin dosage scheme with 100.000 IU SK/h or 100.000 IU UK/ h were used. In patients with acute deep vein thrombosis a complete recanalisation could be achieved in 67% and a partial recanalisation in 25% with the standardized SK scheme; a complete recanalisation could be achieved in 46%, and a partial recanalisation in 30% with the standardized UK scheme.Since April 1, 1985 we use the ultra high SK dosage scheme, with an initial dose of 250.000 IU SK/h and a maintenance dose of 1.500.000 IU SK/h over.6 hours. So far 28 patients were treated in this way. The results show, that with an ultra high SK-dosage scheme a complete recanalisation could be achieved in 46% and a partial recanalisation in 25% in 1-6 day old deep vein thromboses. The results of both the SK schemes and the UK scheme are discussed in accordance with the haemostaseologica1 parameters.
IS IT POSSIBLE TO PREDICT THE EFFICIENCY OF THE FIBRINOLYTIC AND SURGICAL TREATMENT OF DEEP VEIN THROMBOSIS BY ULTRASOUND IMAGING AND DOPPLER ?
Authors: Elias A , Bouvier J L , Le Corff G , Serradimigni A 
Published: August 2018

The sucess of the fibrinolytic or surgical treatment of venous thrombosis depends largely on how old the thrombosis is.To study the therapeutic predictibility of the ultrasonographic signs,their pretherapeutic aspects were compared to the results of the fibrinolytic treatment during 3 days or to the anatomic aspects intra-operatively. This prospective study was carried out on 21 patients presenting an isolated venous thrombosis confirmed by venography. 65 involved venous segments from the popliteal to the inferior vena cava were studied.The following are analyzed : 1) The C.W. Doppler signal when there is a complete obstruction of the femoral iliac junction : absence or presence of flow (MEDAS0NICS BF4A 5.3MHZ).2)The morphological and dynamic aspects of the vein, the thrombus and the flow using echographic test (DIASONICS DRF 400. 10-7.5-5MHZ) were retained as predictible signs of sucessfull treatment a hypodens^homogeneous thrombus with major venous dilation (about twice the controlateral vein) where there is a total obstruction, and a free floating thrombus or even “elastic”,soft,compressible when there is a partial obstruction.The opposite signs were interpreted as predicting a therapeutic failure : a dense heterogeneous adherent and hard thrombus.The criteria for thrombolysis efficiency is the total disappearance of the thrombus when there was a partial obstruction,or a recanalization (>50%)where there was a complete occlusion.The ultrasonographic predictible signs compared with the effective results are indicated in the following tables.Ultrasonography enables most cases tne recognition or a “recent” thrombus from an “old” one and allows talcing thus a cal-lated risk. If the evaluation of the echotexture of the thrombus is subjective and technique dependant, and if an objective measurement of the density distribution insight the clot as reported is preferable, a combined study of the other ultrasonographic parameters seems to be essential.
THE EFFECT OF HEPARIN ON THERAPEUTIC SUCCESS OF LOCAL STREPTOKINASE TREATMENT OF PERIPHERAL ARTERIAL OCCLUSIONS
Authors: Poredoš P , Videčnik V 
Published: August 2018

In some cases the thrombolytic treatment is not successfull inspite the fact, that lysis of the thrombus occured. This could be the consequence of ascending thrombosis and early reocclusion due to prevailing thrombogenic potential (decreased floow endothelial damage, presence of intraarterial catheter). The aim of the present study was to established if simultaneous heparin administration improves local thrombolytic treatment of arterial occlusions. The study encompassed three groups of patients with acute and subacute arterial occlusions of the lower limbs. In the first group there were 31 patients treated with streptokinase only (SK group). The second group (33 patients) received heparin (450 IU/hour) simultaneously with SK through the proximal opening of the coaxial catheter. Heparin so poured over the distal part of the catheter (SK-H group). In patients of the third group (22 patients) treated as SK-H group, thrombi were before treatment enriched with 7,5 ug of plasminogen (SK-H-Plg group). Patients of all three groups received SK as continuous intraarterial infusion (3750 IU/hour) until recanalisation occured but at most for 3 days. The results of the treatment are shown in the table.Heparin significantly reduced the number of ascending thrombosis along the intraarterial catheter (p<0,05). Although the difference between the number of successfully and unsuccessfully treated patients of the three groups was not statistically significant (the reason for this were probably too small groups) the results suggested that heparin contributed to greater therapeutic success.
HEPARIN AND ACETYLSALICYLIC ACID (ASA) 75 MG/DAY IN UNSTABLE CORONARY ARTERY DISEASE - EFFECTS ON PLATELET REACTIVITY
Authors: Wallentin Lars , Nyman Ingyar , Berglund ULF , Swahn Eva 
Published: August 2018

In unstable coronary artery disease (UCAD), i.e. unstable angina pectoris (UAP) or non-Q-myocardial infarction (NMI), treatment with heparin or ASA have given encouraging results. The present study attempts to verify the effects of i.v. heparin (5 days) and to evaluate the utility of ASA 75 mg/day (one year). Patients, admitted because of chest pain, who either develops NMI or signs of ischemia in resting or exercise ECG.s are included. Within 72 hours patients are randomized to obtain Heparin+ASA, Heparin+Placebo, Placebo + ASA or Placebo+Placebo . Platelet reactivity is studied in vitro in platelet rich plasma (PRP) in a subgroup of patients.The aggregation response is studied after addition of collagen and ADP and after preincubation with prostacyclin before aggregation with ADP. The figures present results from 85 randomized patients tested before, 5 days, one month and one year after start of therapy.Conclusion: In patients with unstable CAD long term treatment with ASA 75 mg/day inhibits collagen induced platelet aggregation and hampers the ADP response. I.v. heparin tends to raise platelet reactivity and reduce the inhibitory effect of prostacyclin. Heparin induced platelet activation is reduced by simultaneous ASA therapy.
THROMBOLYTIC THERAPY IN UNSTABLE ANGINA: EFFECTS OF SHORT TERM HIGH DOSE INTRAVENOUS UROKINASE
Authors: Foresti A , Ambrosini F , Gentile G , Repetto S , Lotto A 
Published: August 2018

20 Pts with U.A. admitted to CCU within 3 hours from onset of pain and ECG evidence of acute ischemia were studied. In 10 of them (UK Group) a bolus of high dose i.v. Urokinase (1500000 U) was added to conventional therapy -nitrates, ca-antagonist, heparin i.v.-. In the control group (C) no fibrinolytic drug was administered. Remission of pain was observed in 5/10 pts in UK and in 3/10 in C group in the first 3 hours. In the same time ECG markers of ischemia were virtually suppressed in 9/10 in UK and in 5/10 pts in C group. IIo pts in both groups had patological Q waves or CK elevation greater than twice normal, but in the first week 4/10 in UK and 5/10 in C group experienced one or more new acute ische mic attacks. Coronary angiography was performed:During follow-up (3 months) revascularization procedures (PTCA or CABPS) were performed in 5/10 pts in UK and in 5/10 pts in C groups.This study enphasizes the lack of difference from the anatomic point of view and the clinical course between the two groups of pts; nevertheless systemic fibrinoly sis performed in pts with U.A. may lead to an improvement of “very short term morbidity” and might be consi dered (as in acute myocardial infarction) a useful and safe treatment to offer these patients, often with impending M.I. to further and rapid revascularization procedures.
CHANGES IN t-PA ACTIVITY AND INHIBITION AS PART OF THE ACUTE PHASE REACTION IN ACUTE MYOCARDIAL INFARCTION
Authors: Gram J , Kluft C , Jespersen J 
Published: August 2018

Acute myocardial infarction (AMI) is accompanied by sequential fluctuations in several plasma proteins indicative of an acute phase reaction. Global screening tests (ECLT and WBCLT) have revealed temporary depression of systemic fibrinolysis. However, such tests do not allow definite conclusions regarding the specific variables involved.In a prospective study of 34 patients with AMI we determined selected variables involved in fibrinolysis, and in addition we investigated whether any fluctuation was related to the development of leg vein thrombosis (isotope-technique) or due to AMI. Blood samples were collected on days 1,2,4,6,8 after admission and eight weeks (recovery) after discharge. Euglobulin fibrinolytic activity was determined on fibrin plates. The measured activity was lower in the initial acute period (≤ 48 h after AMI) than in the recovery period (p<0.05). The intrinsic fibrinolytic proactivators (representing more than 95% of the total activator potential of plasma) did not change during the period of study. Levels in the euglobulins of C1-inactivator (the main inhibitor of the intrinsic system) were constant during the first 48 hours. This suggests that the observed reduction represents t-PA activity and this was verified by specific assay of t-PA. The t-PA inhibition capacity in plasma was elevated in the initial acute period compared to the recovery period (week 8; p<0.05). C-reactive protein and fibrinogen followed another pattern with the highest plasma level at day 4 and day 6, respectively. Plasma levels of C1-inactivator increased slowly with a peak at day 8. There was no difference of the determined variables between the DVT negative and positive group, suggesting that the observed changes were due to myocardial injury. Our findings show that components of the fibrinolytic system take part in the acute phase reaction following AMI, and that this involves a brief, initial period of reduced fibrinolytic potential (<48h). The initial, high levels of t-PA inhibition deserve consideration in regard to the institution of thrombolytic therapy with t-PA. (Undertaken within the frame of ECAT).
INVERSE CORRELATIONS BETWEEN PLASMA BETA-THROMBOGLOBULIN LEVEL AND: (1) TIME FROM ONSET OF ACUTE MYOCARDIAL INFARCTION (2) MEAN TIME TO CLOT LYSIS FOLLOWING SYSTEMIC STREPTOKINASE
Authors: Nelson S D , Moriarty A J , McLoughlin M , Balnave K 
Published: August 2018

The platelet specific protein, beta-thromboglobulin (²-TG) is released into the circulation when blood platelets undergo the release reaction as in platelet aggregation and clotting. This paper describes a study of a cohort of patients (N = 40) in which ²-TG was serially assayed by a radioimmunassay technique at various times from the onset of acute myocardial infarction.It shows a negative correlation (R = -0.76, p = 0.01) between initial ²-TG level and time elapsed since the onset of symptoms. Furthermore, patients fell into two groups - those with high initial or rising levels, and those in whom the levels were not elevated and did not rise. Both groups underwent thrombolytic therapy with intravenous streptokinase, the former manifesting significantly earlier ECG evidence of re-perfusion. Respective mean lysis times and standard errors of the mean (hours) were 0.798 (0.139) and 3.490 (0.498) with p = 0.001 on t-testing. Clearly when the clotting process is well established it is much more difficult to lyse the clot. ²-TG is a marker for the age of the clot in that it reflects the platelet secretion in vivo that accompanies the early stages of clot formation.We conclude that ²-TG assay is not purely an esoteric research technique but has everyday clinical application in differentiating between early streptokinase-induces lysis, when some at-risk myocardium is still viable, and later spontaneous recanalization. Angiography cannot make this distinction.
PREACTIVATION AND INHIBITION OF EXTRINSIC COAGULATION PATHWAY IN ACUTE CORONARY DISEASE
Authors: Sandset P M , Sirnes P A , Abildgaard U , Petterson M 
Published: August 2018

It has recently been shown that plasma from individuals with a high risk score for developing AMI shows an abnormal depression of factor VII (EVII) coagulant activity after treatment with phospholipase C (PLC), (Dalaker, K.& Prydz, H., Br . J . Haematol. 61,315, 1985) revealing the presence of “preactivated” FVII in complex with lipid. We have studied this phenomenon in patients in a coronary unit, by serial determinations of Normotest (NT) + PLC pretreatment (which correlates with FVII clotting) assay ± PLC) and EVII amidolytic assay (EVIIram) (OswaldsBn et al., Tromb.Haemostas. 54,26,1985). The newly described inhibitor of FVII-Tissue thromboplastin (EPI) was also measured. Mean patient values day 2 are listed:More than 20% depression of NT by PLC treatment was found in 2/14 controls, 9/19 AMI patients, 3/17 angina patients and 2/15 patients with other heart disease. The EVII:am values correlated better with NT (r = 0.81) than with PLC+NT (r=0.62). It has been suggested that FVII:am correlates with the molar concentration of FVII. If correct, our data precludes two chain FVII as contributing much to preactivation. EPI values were in the high normal range for all three groups of heart patients. The individual variation in EPI values was great, particularly in AMI patients. Apparently, EPI did not correlate to any of the FVII assays. Three patients with more then 50% reduced NT after PLC had EPI values 67, 149, and 130%. In conclusion, lipid activation was frequent in AMI patients, and was not related to EPI activity.
RELEVANCE OF FREE PLATELET COUNT RATIO (PCR) TO CIRCULATING PLATELET AGGREGATES (CPA) AND TO THE RELEASE OF B-THROMBOGLOBULIN(β-tg) INDUCED BY EXERCICE IN PATIENTS WITH CORONARY HEART DISEASE (CHD). EFFECTS OF TICLOPIDINE (T) TREATMENT
Authors: David J L , Legrand V , Kulbertus H E 
Published: August 2018

CPA are considered as a possible cause of blood flow impairment and as a risk factor of sudden death in patients with CHD. The relevance of a low PCR to the presence of CPA is still debated. Indeed in a critical and well designed evaluation of this index, Sanibaldi et al.(1986) have shown that PCR obtained by counting free platelets in diluted whole blood was not lowered in patients with “thrombotic tendency”. They suggested that low CPA reported in other clinical studies may result from an artifact of blood sampling or from ex-vivo procedures.In order to reevalute the meaning of a low PCR, selected patients with CHD have been submitted to an exercice resulting in platelet stimulation. Free platelets were counted, whole blood and plasma β-tg were simultaneously determined by RIA after careful blood sampling performed before the exercice, at its end and 30 min later. Patients were previously treated by Placebo (P)or by T 500 mg per day given in a cross-over double blind manner.It was shown that : 1) after P treatment, PCR was lowered and β-tg was increased, both significantly, at the end of exercice; 30 min later, PCR was normalized whereas β-tg remained high presumably because β-tg is not cleared from plasma within 30 min. 2) T treatment significantly inhibited both platelet responses.In conclusion, when platelets are submitted to systemic and sustained stimuli occurring during exercice stress, lowered PCR reflects the presence of circulating platelet aggregates which can be dispersed ex-vivo by EDTA. In these conditions, the meaning of this index is strongly confirmed by the simultaneous release of βtg. T treatment significantly reduces platelet reactivity to exer cice stress and may reduce the effects of platelet aggregation and release on compromised microcirculation.
EPIDEMIOLOGICAL ASPECTS OF ANTITHROMBIN-III, SELENIUM AND LIPOPROTEIN COMPONENTS IN CORONARY DISEASE
Authors: Aursnes I , Smith P , Arnesen H 
Published: August 2018

The known risk factors for coronary disease can only “explain” a proportion of the incidence of the disease. Looking for supplementary risk factors we thus selected for detailed study both a group of patients with normal levels of risk factors (normo-tensives, non-smokers with normal serum cholesterol) and a group with high conventional risk factors, comparing both groups with an age and sex matched control group. Subgroups were formed by individuals aged below (young) and above (old) 60 years.Total- and HDL-cholesterol, apo-lipoproteins A-I and B and triglycerides showed co-variation with each others and with fatty acids in serum. With "factor analysis" seven "factors" were extracted and the factor scores for sub-groups were calculated. Two factors discriminated between young, high risk patients and controls. One was a positive risk factor and the other a negative one. The factors may be dependent on the existence of two unknown sub-groups of serum lipoproteins which were characterized by high concentrations of certain fatty acids.Coronary patients were found to have 9.1% higher antithrombin-III (AT-III) activity in their plasma than controls (p=0.037). Plasma selenium levels were slightly less in patients than in controls. There was a slight, but significant (r = 0.29 , p = 0.01 5) positive correlation between selenium and AT-III concentrations. Multivariate statistical anlysis indicated that selenium was significantly negatively correlated with disease.It is concluded that antithrombin-III tend to be high and that plasma selenium levels are relatively sub-normal in some coronary patients. It is also suggested that fatty acid analysis may be useful in the characterization of lipoproteins that are involved in the development of atherosclerosis.
SHORT-TERM LYSIS BY ULTRAHIGH STREPTOKINASE TREATMENT IN CHRONIC ARTERIAL OCCLUSIONS AND ACUTE DEEP VENOUS THROMBOSIS
Authors: Martin M , Fiebach B J O 
Published: August 2018

171 chronic arterial occlusions and 86 acute venous thromboses were treated by systemic ultrahigh streptokinase (UHSK) infusions. 38% of the patients were over 65, 27% over 70 years of age. The UHSK scheme consisted of a 1.5 million units SK per hour maintenance infusion over a period of 6 hours. 46% of the patients received one, 47% two, 6% three, and 1% four series (one series per day). 81% of the arterial patients had a history of less than 3 months. In 54% of the cases PTA followed UHSK treatment for dilation of a residual stenosis or removal of occlusion residues still persistent. In the venous patients the most proximal location was distributed as follows: calf veins 1%, femoral vein 57%, iliac vein 28%, subclavian vein 14%. The average thrombosis history was 8 days.Clearance rates of chronic arterial occlusionsBy setting up of sub-groups more favorable results were calculated. For exemple, a femoral occlusion group consisting of cases with a history shorter than 6 weeks and 2 or 3 calf arteries patent displayed a clearance rate of 77%, a figure much higher than the overall femoral resultClearance rates of deep venous thrombosisThe thrombosis duration played a significant role for thrombosis dissolution. The average occlusion history was 6 days in the total clearance group compared with 12 days in the unsuccessful cohort.
FAMILY STUDIES OF PATIENTS WITH RECURRENT VENOUS THROMBOSES AND INHERITED DISORDERS OF BLOOD COAGULATION OR FIBRINOLYSIS
Authors: Hach-Wunderle V , Walter-Fincke R , Beck H K , Scharrer I 
Published: August 2018

Several defects of the coagulation and/or fibrinolytic system have been found to be associated with venous thromboembolism. In young patients with recurrent thromboses or a positive family history, an inherited disorder should be excluded535 young patients with venous thromboses, phlebitis and/or pulmonary embolism were investigated from 1980 until 1986. The first thrombotic event had occurred at an age of less than 45 years.An inborn disorder of the blood coagulation or fibrinolytic system was found in 18 families. Most of them (n=13/18) had a positive family history. In all families either thromboses had occurred in at least one member (n=12/18) and/or the defect could be detected in one of them (n=12/18)Most often we found a deficiency of antithfombin III (n=6). A deficiency of protein C (type I) was detected in 3 and a deficiency of protein S in 5 families. In one patient a combined deficiency of anti thrombin III, protein C and protein S was found. Extensive family studies revealed a deficiency of antithrombin III in the grandmother of the patient, who suffered from arterial thrombosis. A deficiency of plasminogen and an abnormal plasminogen molecule were detected in 2 other families. Defective release of t-PA could be demonstrated in 3 members of one investigated family up to nowSeme family members with either defects of protein C, protein S or plasminogen as well as a defective release of t-PA lack thrombotic events. Furthermore thromboses of mesenteric veins occurred in 2 of 6 patients with anti thrombin III deficiency and in 1 of 5 patients with protein S deficiency. Superficial vein thromboses were mainly found in patients with protein C- or protein S-deficiency