Selective thrombolysis with rt-PA: a promising approach for the management of embolic cerebrovascular complications during left heart catheterization?
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Aged↗
Biomedical subjects
C Ozbek
Publications and source records attributed to C Ozbek.
Modern strategies for treatment of acute myocardial infarction: significance of haemostaseological and rheological findings.
In spite of equivalent clinical efficacy of various thrombolytic agents for the treatment of acute myocardial infarction there is evidence of different drug-depending influences on the haemostatic and fibrinolytic system. In the present study 40 patients with acute myocardial infarction have been investigated. 20 patients received 750,000 and 1.5 mio U streptokinase (SK), respectively, 10 patients 30 mg anisoylated plasminogen streptokinase activator complex (BRL 26921) and 10 patients a combination of 200,000 U urokinase (UK) and 4.5 mio U pro-urokinase (PUK) as a short-term intravenous treatment. Reperfusion of coronary arteries has been achieved in 70 to 100 percent. Major not fatal bleedings occurred in 2 patients. One patient died within 72 hours after beginning of the myocardial infarction. The longest duration of fibrinolytic activity was observed in the BRL 26921 group (half-disappearance time close to 2 h). It was significantly shorter in the SK groups showing a dose-dependency. Plasma concentration of fibrinogen dropped beyond normal levels following SK and BRL 26921, but not under UK/PUK. Plasma viscosity correlated with fibrinogen decrease and displayed a dose-depending relationship with the presence of SK. Haemorheological effects are suggested to be important for the clinical efficacy of thrombolytic therapy in myocardial infarction.
Anistreplase↗
Electrophysiological effects of nicainoprol in patients with paroxysmal supraventricular tachycardias.
The electrophysiological effects of nicainoprol, a new class I antiarrhythmic drug, were evaluated in 29 patients with supraventricular reentrant tachycardias, due to accessory pathways in 15 and dual atrioventricular nodal pathways in 14 patients. Nicainoprol was administered intravenously as a bolus followed by continuous infusion of 1.5 mg/kg in two and of 2 mg/kg in 27 patients over one hour. Nicainoprol was given as a bolus of 1.5-2 mg/kg during sinus rhythm in 11 patients or during induced supraventricular tachycardia in 18. The drug successfully terminated the tachycardia in 17 patients due to block in the retrograde tachycardia limb in 15 and the antegrade limb in 2 patients. Prolongation of the cycle length preceded the termination in each case. In one case, the termination could not be achieved despite the administration of 3 mg/kg. The sinus cycle length, heart rate corrected QT interval as well as right atrial and right ventricular effective refractory periods remained unchanged. In contrast, the intranodal and infranodal conduction times, as well as QRS duration, were prolonged significantly. In patients with dual atrioventricular nodal pathways, there was a significant (P less than 0.05) increase of the effective refractory periods of the anterograde slow pathways. The changes of the anterograde fast pathways, however, did not reach significance level. More pronounced effects were found on effective refractory periods of the retrograde pathways, which were blocked in 4 patients and significantly (P less than 0.05) prolonged in the remainder. Similarly, in patients with accessory pathways the effect on the retrograde conduction was more marked with complete block in 5 patients and significant prolongation of effective refractory periods and shortest paced cycle lengths in the remainder.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Optimised function for determining time to peak creatine kinase and creatine kinase-MB as non-invasive reperfusion indicators after thrombolytic therapy in acute myocardial infarction.
STUDY OBJECTIVE: The aim of the study was to investigate the use of an optimised function to approximate and interpolate the time course of serum creatine kinase and creatine kinase-MB values after thrombolytic therapy in acute myocardial infarction. DESIGN: A three parameter interpolating function was developed which approximates the time course of serum enzyme levels. In the proposed function, time to peak creatine kinase and maximum of creatine kinase determined from raw data were used as starting parameters of the non-linear interpolation routine, thus providing ideal starting conditions for the iteration. The efficacy of the function was compared with that of three other functions cited in published reports (log-normal distribution function, modified gamma density function, three compartment function). SUBJECTS: Serum enzyme data from 20 patients with acute myocardial infarction were used in the comparisons. The patients have all been treated with anisoylated plasminogen streptokinase activator complex. RESULTS: In comparison with the other models, deviations of the experimental model function from the raw data were minimal. The fit remained stable for time intervals between blood samples of up to 6 h. CONCLUSIONS - Due to its numerical stability, the function outlined in this study is suitable for large clinical reperfusion trials. In the case of uncomplicated infarctions without thrombolytic therapy, the area under the creatine kinase activity curve could be directly calculated in terms of maximum activity and time to peak.
Anistreplase↗
Rapid high dose streptokinase in severe pulmonary embolism.
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Adult↗
High-dose systemic streptokinase and acylated streptokinase-plasminogen complex (BRL 26921) in acute myocardial infarction: alterations of the fibrinolytic system and clearance of fibrinolytic activity.
We report the results of two consecutive studies using intravenous bolus injections of streptokinase (SK) or acylated plasminogen-SK complex (BRL 26921) in patients with acute myocardial infarction (AMI). In the first study, 20 patients received either 750,000 units (U) SK (group IA, n = 10) or 1,500,000 U SK (group IB, n = 10) within 5-10 min intravenously. In the second study 10 consecutive patients received 750,000 U SK within 15 min (group IIA) intravenously. The following 10 consecutive patients received 30 mg BRL 26921 within 2 min (group IIB). Early reperfusion was found in 16 patients in the first study (8 in each group) and in 18 patients in the second study (9 in each group). The decrease of fibrinolytic activity was biphasic with a half-disappearance time of 112.5 min for BRL 26921 and 31 (IA) and 18 (IB) min for SK. alpha 2-Antiplasmin depletion and a decrease of fibrinogen was observed with no differences after bolus injections of SK and of BRL 26921.
Aged↗
Intravenous bolus application of streptokinase and of anisoylated plasminogen streptokinase activator complex in acute myocardial infarction. Clinical and haemostaseological findings.
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Adult↗
[Thrombolytic therapy with ultra-high doses of streptokinase].
Two pilot studies were carried out in patients suffering from acute myocardial infarction. They received high doses of streptokinase and acylated streptokinase-plasminogen activator complex intravenously as a bolus injection. Furthermore, the possibility of using streptokinase bolus therapy was examined in patients with acute vascular occlusion. Due to the limited number and the heterogenicity of cases the results obtained in patients with acute myocardial infarction are to evaluate with some reservation. In patients with acute vascular occlusion streptokinase bolus therapy at high doses proved to be a promising alternative to the conventional therapy.
Coronary Angiography↗
Myocardial perfusion measured by dual-isotope acquisition of 81rubidium/81mkrypton: an experimental verification of the method.
PURPOSE: The purpose of the study was to verify that the 81Rubidium/81mkrypton (81Rb/81mKr) method allows the quantitative measurement of myocardial perfusion. PRINCIPLE: The potassium analogous cation 81Rb is accumulated in the myocardium by the cell membrane-bound Na-K-ATPase. After accumulation an intracellular equilibrium establishes between 81Rb and its radioactive daughter nuclide 81mKr. The flow-sensitive method evaluates the disturbance of this equilibrium by perfusion which washes out the short-lived diffusable daughter nuclide 81mKr while the mother nuclide 81Rb remains cell-bound. METHODS: Isolated rabbit hearts were prepared in a modified Langendorff technique which allowed quantitative collection of the coronary sinus efflux. The myocardium was labeled with pure 81Rb by bolus injection into the aortic cannula. Spectroscopic measurements of 81Rb and 81mKr gamma radiation were performed using a germanium detector. Perfusion was varied in the range between 0 and 4 ml/min/g. The activity ratio 81Rb/81mKr was determined and compared with coronary sinus effusion. RESULTS: 81Rb/81mKr activity ratio was closely related (r = 0.98) to perfusion as described by the predicted equation Rb/Kr = (F/2.96 P) + 1. (Rb/Kr = activity ratio between 81Rb and 81mKr in the myocardium; F = myocardial perfusion (ml/min/g); P = partition coefficient (myocardium/perfusate) for Krypton gas). The constant P was found to be 1.14 +/- 0.06 (mean +/- SEM). No saturation of this ratio at high flow rates was observed. CONCLUSION: The activity ratio 81Rb/81mKr is a valid quantitative measure for myocardial perfusion in isolated hearts. The main limitation of the method before application in man is the correction of the different gamma ray tissue absorption of both nuclides.
Animals↗
Electrophysiological effects of a new antiarrhythmic agent, nicainoprol, in humans.
The electrophysiological effects of nicainoprol, a new antiarrhythmic drug, were evaluated in a heterogeneous group of 23 patients aged 59 +/- 15 (mean +/- standard deviation) years. Nicainoprol was administered intravenously as a bolus of 1-2 mg/kg followed by continuous infusion at two dose levels. Electrophysiologic study was performed before and during the infusion at a steady-state drug level on each dose. The sinus node recovery time was unaltered in patients with normal sinus node function and was markedly prolonged in three of six patients with sinus node dysfunction. The intranodal conduction time (p less than 0.01) and the infranodal conduction time (p less than 0.001) increased, and the QRS duration (p less than 0.05) lengthened significantly even during 1 mg/kg/h. During 2 mg/kg/h, these times were further prolonged and, in addition, the intra-atrial conduction time (p less than 0.05), atrioventricular nodal effective and functional refractory periods (p less than 0.01), as well as the Wenckebach cycle length (p less than 0.001) also increased significantly. Similar depressant effects on the retrograde ventriculoatrial conduction system were also produced by nicainoprol. Retrograde His-atrioventricular nodal conduction was blocked in six of eight patients with this condition and was prolonged in the remaining two. Sustained supraventricular tachycardia was induced in seven patients, five of whom received nicainoprol during the tachycardia. The termination of supraventricular tachycardia was exclusively due to ventriculoatrial block in all five subjects, three with orthodromic circus movement tachycardia and two with atrioventricular nodal reentrant tachycardia of the slow-fast type. The reinducibility of supraventricular tachycardia could be prevented in five of seven patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗