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PubMed2003

Detection of apoptosis using in situ markers for DNA strand breaks in the failing human heart. Fact or epiphenomenon?

The role of apoptosis and the methods used for its detection in failing human hearts are controversial. Recent data have challenged the hypothesis that in situ markers for DNA strand breaks mirror apoptotic (TUNEL and Taq in situ ligation assay) and/or necrotic (Pfu in situ ligation assay) cell death, and thus provide evidence that apoptotic cell loss contributes to the progression of heart failure. Experimental data cast doubt not only upon the specificity of the TUNEL technique but also the Taq in situ ligation assay as a reliable method for the detection of apoptotic cell death and provide compelling new evidence that the occurrence of cardiomyocyte cell death as defined by the detection of DNA strand breaks using either TUNEL or Taq and Pfu in situ ligation assays is an epiphenomena that is not related to the evolution of heart failure. Cardiomyocyte positivity for in situ markers of DNA strand breaks is a feature of hypertrophic cardiomyopathic hearts, irrespective of the underlying pathology or the presence or absence of heart failure. These data raise concerns regarding the extent of apoptosis in cardiomyopathy and the contribution of this process to the progression of heart failure.

Animals↗

PubMed1991

Birthweight, early passive respiratory system mechanics, and ventilator requirements as predictors of outcome in premature infants with respiratory failure.

Early respiratory mechanics have been reported to predict outcome in newborns with respiratory failure. However, it remains unknown whether measurements of pulmonary function add significantly to the predictive value of more readily available variables The present study was designed to answer this question. Passive respiratory system mechanics were measured by an airway occlusion technique in 104 ventilator-dependent premature infants between 6 and 48 hours of life and corrected for infant size. A ventilation index [FiO2 x mean airway pressure (MAP)] was calculated at the time of pulmonary function testing. Poor outcome was defined as death from respiratory failure or need for supplemental oxygen at 28 days. Stepwise logistic function regression examined whether ventilation index and respiratory mechanics added predictive power over and above birthweight. Five infants died, and 45 patients required supplemental oxygen at 28 days. Birthweight was a strong predictor and would have entered the logistic model first in any case. Ventilation index added significantly to the predictive model (P = 0.038). Respiratory system conductance (P = 0.15) and compliance (P = 0.93) entered on the third and last step, respectively. We conclude that in premature infants with respiratory failure, birthweight is a strong predictor of outcome. Early ventilator requirements but not respiratory system mechanics, add significantly to this predictive model.

Birth Weight↗

PubMed2003

Gastroschisis: can prenatal sonography predict neonatal outcome?

OBJECTIVE: Gastroschisis is associated with significant neonatal morbidity, and occasionally mortality. Previous studies looking at ways to prognosticate this condition by antenatal ultrasound have shown conflicting results. The aim of this study was to evaluate the usefulness of prenatal sonographic parameters to predict neonatal outcome of gastroschisis. METHODS: The charts, photographs, and videotapes of all fetuses with gastroschisis who were assessed during pregnancy at the Mater Mothers' Hospital, Brisbane over an 8.5-year period (Jan 1993-May 2001) were reviewed. Adverse neonatal outcome was defined as death, severe bowel complications (atresia, perforation, necrotic segments), need for multiple bowel operations, or a combination of these. Various sonographic parameters assessed included: gestation at first diagnosis, maximum bowel diameter, maximum bowel wall thickness, presence of other anomalies, evidence of growth restriction, and polyhydramnios. RESULTS: Forty-five patients met the entry criteria during the study period. Six neonates died, 12 had severe bowel complications, and 15 had a combination of the adverse outcomes. Polyhydramnios was most significantly associated with severe bowel complications, with a likelihood ratio of 11.7 (P = 0.001). Other ultrasound parameters were not significantly correlated with neonatal outcome. CONCLUSION: Most standard ultrasound parameters assessed antenatally in fetal gastroschisis were not significantly associated with adverse neonatal outcome, except for polyhydramnios, which was strongly predictive of severe bowel complications in the neonatal period. This information is important both for parents and for health professionals managing pregnancies with fetal gastroschisis.

Adolescent↗

PubMed1997

Extracellular matrix of retinal pigment epithelium regulates choriocapillaris endothelial survival in vitro.

The role of extracellular matrix of retinal pigment epithelial cells (RPE-ECM) in the regulation of the survival of choriocapillaris endothelial cells (CCE) was investigated in vitro. The CCE survival was evaluated by trypan blue staining, neutral red uptake, and the counting of viable cells. Results showed that CCE cells survived on RPE-ECM. Pre-treatment of RPE-ECM individually with neutralizing antibodies to acidic fibroblast growth factor, vascular endothelial growth factor, platelet-derived growth factor, or transforming growth factor beta(pan specific to TGFbeta1, TGFbeta1.2, TGFbeta2 and TGFbeta5), did not alter the survival rate of CCE cells on RPE-ECM, as compared to that of the control (CCE survival rates on RPE-ECM pretreated with normal rabbit IgG). However, the treatment of RPE-ECM with neutralizing antibody to basic fibroblast growth factor (bFGF) caused CCE death by 77.1+/-15.7%. The CCE death was defined as apoptosis based on the morphological markers (shrinkage in cell size with blebbing of plasma membranes, condensation and fragmentation of nuclei, and DNA fragmentation in multiples of approximately 200 bp). The addition of phorbol 12-myristate 13-acetate (PMA) (2 nM) to the culture medium was effective for complete prevention of CCE apoptosis; the protecting effect of PMA on CCE apoptosis can be abolished by H7 (25 microM), but not HA1004 (50 microM), suggesting the involvement of PKC in protecting CCE from apoptosis. The inhibition of protein synthesis of CCE cells by cycloheximide (0.1 microM) did not affect the apoptotic process of the cells. In a separate experiment, when CCE cells were cultured in a medium saturated with bFGF (5 ng ml-1) without RPE-ECM, the cells also died by apoptosis. However, this apoptotic process was not affected by PMA. Cycloheximide also failed to affect the apoptotic process. These results suggest that both RPE-ECM insoluble molecules and RPE-ECM-bound bFGF modulate choriocapillaris survival by suppressing CCE apoptosis.

Animals↗

PubMed1995

Clinical Utility of Electrocardiographic ST-Segment Area for Predicting Unsatisfactory Outcomes Following Thrombolytic Therapy.

The bedside surface 12-lead electrocardiogram is a mainstay in the early diagnostic evaluation of patients with suspected acute myocardial infarction. The presence of ST-segment elevation exceeding 1.0 mm in two or more anatomically associated leads is a reliable marker of myocardial injury and, when considered along with concomitant ST-segment depression, reflects the extent of myocardial injury. Mounting evidence also suggests that prolonged repolarization is a marker of injury and predicts the likelihood of malignant ventricular arrhythmias. We questioned whether a measure of both ST-segment duration and deviation (ST-deviation area) would offer additional prognostic information. Methods/Results: Admission electrocardiograms from 200 consecutive patients with ischemic chest pain accompanied by ST-segment elevation in whom thrombolytic therapy was given within 6 hours from symptom onset were analyzed. The sum of ST-segment elevation (Sigma ST elevation) and ST-segment deviation (Sigma ST deviation) were calculated, as was the sum of ST-segment deviation area (Sigma ST deviation area). All ST measurements were performed 60 msec after the J point. Computerized planimetry was used to calculate ST-segment area. Sigma ST deviation and Sigma ST deviation area remained constant over time. Patients with large deviations (Sigma ST elevation > 20 mm (odds ratio 2.14, p = 0.02) and Sigma ST deviation area > 150 (odds ratio 1.92, p = 0.02) had a higher incidence of in-hospital unsatisfactory clinical outcome (defined as death, congestive heart failure, cardiogenic shock, recurrent myocardial infarction, or the need for coronary revascularization). These relationships were present for both inferior and anterior infarctions. Sigma ST deviation area correlated closely with Sigma ST elevation (r = 0.92; p = 0.0001) and significantly but much less strongly with the sum of Q waves (r = 0.18; p = 0.01). By univariate analysis, only site of infarction (p = 0.01), Sigma ST deviation area (p = 0.04), and the sum of Q waves (p = 0.005) were identified as predictors of a poor clinical outcome. The sum of Q waves was identified by multivariate analysis as the best independent predictor of an unsatisfactory clinical outcome. Conclusions: A clinician's ability to provide optimal care is influenced strongly by the availability of diagnostic and prognostic information. In the evaluation of patients with acute myocardial infarction, ST-segment deviation area derived from the admission surface electrocardiogram can be used to risk-stratify patients. The full clinical potential of this measure is unknown and will require further evaluation.

Journal Article↗

PubMed1994

Correlation between clinical course and quantitative analysis of the ischemia related artery in patients with unstable angina pectoris, refractory to medical treatment. Results of two randomized trials. The European Cooperative Study Group.

Patients with unstable angina, refractory to intensive medical therapy, are at high risk for developing thrombotic complications, such as recurrent ischemia, myocardial infarction and coronary occlusion during coronary angioplasty. As both platelet aggregation and/or thrombus formation play an important role in this ongoing ischemic process, a monoclonal platelet GPIIb/IIIa receptor antibody (c7E3) or thrombolytic therapy (alteplase) might be able to modify the clinical course and underlying coronary lesion morphology. To evaluate whether alteplase or c7E3 could influence the incidence of complications, we randomized 36 and 60 patients, respectively to alteplase or placebo, or c7E3 or placebo. All patients exhibited dynamic ECG changes and recurrent pain attacks, despite maximal tolerated medical therapy. Patients were randomized in both studies after initial angiography had demonstrated a culprit lesion amenable for angioplasty. After study drug infusion quantitative angiography was repeated and angioplasty performed. Recurrent ischemia during study drug infusion occurred in 5, 6, 9 and 16 patients from the alteplase, placebo, c7E3 and placebo group, respectively. Major events defined as death, myocardial infarction or urgent intervention occurred in 7, 3, 1 and 7 patients, respectively. Two patients died: one in the alteplase group and one in the placebo group from the c7E3 study. The first patient due to retroperitoneal hemorrhage, the second as a result of recurrent infarction. Qualitative angiography showed resolution of clots in the c7E3 group only, while the same group of patients showed in 20% an improvement in TIMI flow grade, without deterioration in any patient from this group.(ABSTRACT TRUNCATED AT 250 WORDS)

Abciximab↗

PubMed1996

Operations and re-operations for chronic subdural haematomas during a 25-year period in a well defined population.

In this retrospective study the hospital records of all patients being operated on for chronic subdural haematomas (CSD) at the Neurosurgical clinic in Lund in the years 1969, 1979, 1989, and 1993 were examined. 218 patients were operated on, 25 of whom had bilateral haematomas. During the 25-year period the incidence of surgically treated CSD rose from 2 to 5.3 per 100,000 inhabitants per year. The mean age (70.5 years) and the relationship males: females (2:1) did not significantly change. The clinical condition of the patients on admission steadily improved during the period. The relative proportion of patients with known chronic alcoholism decreased over the years, but the proportion of patients suffering from other complicating diseases increased, as did the proportion of patients treated with anticoagulants. There was no mortality directly related to surgery, but if defined as deaths within one month after surgery, the overall mortality rate was 3.2%. 84.2% of the patients improved following the first operation, in a majority of cases back to the premorbid state. The relative frequency of re-operations for CSD was 12.3% and did not significantly change during the period. No pre- or peri-operative variable could be identified which could predict who of the patients was at higher risk of re-operation. Surprisingly, the data suggest that the less experienced neurosurgeons had better operative results compared with their older collegues.

Adolescent↗

PubMed1994

What might be the impact on neurology of the analysis of brain metabolism by in vivo magnetic resonance spectroscopy?

In vivo nuclear magnetic resonance spectroscopy (MRS) of the human brain is a recently developed technique which allows to assay noninvasively in vivo key molecules of brain metabolism. After a review of the origin of the signals detected by phosphorus and proton MRS of human brain, the impact of MRS on clinical neurology is examined. MRS of the brain does not purport to be a metabolic "biopsy", but unique applications for brain MRS are (1) quantitating the oxidative state of the brain and defining neuronal death, (2) assessing and mapping neuron damage, (3) evaluating membrane alterations, and (4) characterizing encephalopathies. In the near future brain MRS will be performed routinely after conventional MRI, as a valuable metabolic (and functional) complement to the anatomical evaluation of cerebral pathologies, particularly the toxic, metabolic and infectious encephalopathies.

Brain↗

PubMed2004

Short term outcome and risk factors for mortality in adults with critical severe acute respiratory syndrome (SARS).

The independent risk factors to predict mortality of critical severe acute respiratory syndrome (SARS) were investigated. One hundred and two patients diagnosed with critical SARS were admitted to hospitals of Shanxi Province, from March 7, 2003 to June 4, 2003. The patients were prospectively studied after admission to access their short term outcomes and the risk factors associated with adverse outcomes, defined as death. All the demographic and clinical characteristics were studied and univariate and multivariate Logistic regression were employed to access the risk factors. The results showed that of the 102 cases, 23 patients died, with a crude mortality rate of 22.5%. Multivariate Logistic regression revealed that age above 50 [odds ratio (OR) 1.10, 95% confidence internal (CI) 1.03 to 1.16, P=0.004], lymphopenia at early stage (OR 14.62, 95% CI 1.78 to 11.97, P=0.01) were independently associated with mortality. On the other side, psychotherapy (OR 0.01, 95 % CI 0.00 to 0.06, P<0.001) was independently associated with aliveness. It was concluded that critical SARS is a new disease entity that carries significant mortality and morbidity. Specific clinical and laboratory parameters predicting unfavorable and favorable outcomes have been identified.

Adult↗

PubMed2001

Multiple organ dysfunction syndrome: a narrative review.

PURPOSE: To review multiple organ dysfunction syndrome with respect to: 1) clinical measurement systems; 2) molecular mechanisms; and 3) therapeutic directions based upon molecular mechanisms. METHODS: The Medline, Cochrane, and Best Evidence databases (1996 to 2000), conference proceedings, bibliographies of review articles were searched for relevant articles. Key index words were multiple organ failure, multiple system organ dysfunction, sepsis, septic shock, shock, systemic inflammatory response syndrome. Outcomes prospectively defined were death and physiological reversal of end organ failure. RESULTS: Multiple organ dysfunction/failure (MODS) is the most common cause for death in intensive care units. The recognition of this syndrome in the last 30 yr may be due to advances in early resuscitation unmasking these delayed sequelae in those that would have died previously. Multiple organ dysfunction occurs after shock of varied etiologies and may be the result of unbridled systemic inflammation. As yet, therapy directed to prevent or improve MODS has not dramatically altered outcomes. CONCLUSION: Multiple organ dysfunction may serve as useful measure of disease severity for risk adjustment and outcome marker for quality of care and therapy provided. Anesthesiologists treating shock patients will note the subsequent development of MODS in the critical care unit and may be required to provide anesthetic support to these patients.

Humans↗

PubMed2004

Short-term outcome of critically ill patients with severe acute respiratory syndrome.

OBJECTIVE: To document the outcome and determine prognostic factors for patients with severe acute respiratory syndrome who require admission to an intensive care unit. DESIGN: Observational cohort study involving retrospective analysis of demographic, clinical, laboratory and radiological data. SETTING: Adult intensive care unit in a tertiary referral university hospital involved in a major outbreak of severe acute respiratory syndrome (SARS). PATIENTS: The first 54 patients admitted with SARS to an intensive care unit (ICU). All were treated with corticosteroids, ribavirin, broad spectrum antimicrobials and supportive therapy. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: All patients were admitted for respiratory failure. The median APACHE II score was 11 (interquartile range 8-13). At 28 days 34 patients (63%; 95% CI 49.6-74.6) were alive and not mechanically ventilated. Six patients were alive but ventilated (11.3%; 95% confidence interval 5.3-22.6) and 14 had died (25.9%; CI 16.1-38.9). Seven of 27 ventilated patients developed evidence of barotrauma (25.9%; 95% CI 13.2-44.7). Median maximal multiple-organ dysfunction score was 5 (interquartile range 3.3-9). Median maximal respiratory dysfunction score was 3 (interquartile range 3-4). Increased age, severity of illness, lymphocyte count, decreased steroid dose, positive fluid balance, chronic disease or immunosuppression and nosocomial sepsis were associated with poor outcome on univariate analysis. Poor outcome was defined as death or need for mechanical ventilation at 28 days after ICU admission. CONCLUSIONS: Mortality amongst critically ill patients with SARS is high. It causes predominantly severe respiratory failure, with little other organ failure, and a high incidence of barotrauma amongst those requiring mechanical ventilation.

Adult↗

PubMed2006

Intensive care course after stage 1 Norwood procedure: are there early predictors of failure?

OBJECTIVE: The purpose of this study was to review the early postoperative course of stage 1 Norwood with Blalock-Taussig shunt (BTS) or right ventricle-to-pulmonary artery conduit (RVPA) and to identify early predictors of failure. MATERIAL AND METHODS: A retrospective analysis was conducted in 33 consecutive neonates who underwent BTS (n=19) or RVPA (n=14) stage 1 Norwood procedure between 2000 and 2005. Pre-, peri-, and postoperative data included: hourly hemodynamics and blood gases, pulmonary to systemic flow ratio, duration of mechanical ventilatory and inotrope support, intensive care and hospital stay. Failure was defined as death or transplantation. RESULTS: Thirteen patients failed the procedure (39.4%): 10 BTS (52.6%) and 3 RVPA (21.4%). Failure decreased from 61.1% in 2000-2002 to 13.3% in 2003-2005 and was associated with: low systolic, mean and diastolic blood pressure, urine output, pH, base excess, bicarbonates, and high pulmonary to systemic flow ratio within 24 h postoperatively. Arterial oxygen and CO2 pressure, and oxygen saturation did not differ with failure. RVPA had higher diastolic blood pressure and more stable hemodynamics despite similar pulmonary to systemic flow ratio. Duration of mechanical ventilation, inotrope support, intensive care stay were shorter in RVPA. Postoperative echographic ventricular dysfunction and tricuspid regurgitation grade were correlated with failure. CONCLUSIONS: Excessive pulmonary to systemic flow ratio and low blood pressure are associated with failure. High diastolic blood pressure more than low pulmonary to systemic flow ratio seems to account for more favorable outcomes in RVPA compared to BTS procedure.

Anastomosis, Surgical↗

PubMed2006

Severe outcome of children following trauma resulting from road accidents.

OBJECTIVE: The aim of the study was to determine the risk factors of a severe outcome for children severely injured [killed or with an Injury Severity Score (ISS)>or=16] in a road accident. MATERIALS AND METHODS: Casualties that occurred between 1996 and 2001 which involved children under 14 years of age were assessed in a population-based study based on data included in a French road trauma Registry. A severe traumatic brain injury (TBI) was defined as a head injury with an Abbreviated Injury Scale (AIS) severity score>or=3. A multivariate logistic regression was performed to quantify the risk of a "severe outcome" defined as death or an expected serious impairment 1 year later. RESULTS: The annual incidence of an ISS of 16+ was 7.7 per 100,000 children. Among the 126 severely injured children included in this study, 40 died (including 16 immediate deaths), and a severe outcome was expected for 54 of the 86 survivors. Children with an "isolated severe TBI" and those with "multiple injuries including TBI" were more likely to have a severe outcome than those who had an "isolated severe injury without TBI" (OR: 7.91; 95%CI: 1.43-43.77 and OR: 8.37; 95%CI: 1.52-46.13, respectively). Age was inversely linked to a severe outcome. The unprotected motor vehicle occupants (MVO) had an odds ratio of 7.56 (95%CI: 1.07-53.56) compared to the protected MVO. Only 30% of children who survived a severe TBI were admitted to rehabilitation. CONCLUSION: The mechanism of the injury, an injury pattern involving the head and a young age were associated with a severe outcome following a road accident. A majority of children severely injured were not referred to inpatient rehabilitation.

Abbreviated Injury Scale↗

PubMed2004

Intravenous cyclophosphamide--resistant systemic lupus erythematosus in Arizona.

Systemic lupus erythematosus (SLE) tends to be severe and to have a variable response in childhood. We undertook this retrospective study to assess response rates and outcome in 14 children with SLE. Mean age at onset was 12.8+/-3.1 years. Ten patients were female and 4 were male, and 12 patients (86%) were Hispanic. Creatinine clearance prior to therapy was 104+/-36 ml/min. All had hematuria and proteinuria with a protein/creatinine ratio of 3.9+/-4.8. WHO classification of renal biopsies revealed class IV in 64%, class III in 21%, and class V in 14%. Patients were treated with 6-monthly pulses of intravenous cyclophosphamide (IVCY) followed by longer-duration pulses. The mean duration of follow-up was 3.7+/-3.3 years. Of the 14 patients, 3 (21%) achieved systemic remission but all relapsed subsequently; 7 of 14 achieved renal remission, although 6 relapsed. Six (42%) had adverse outcomes, defined by death, dialysis, or need for bone marrow transplant. All 6 had failed 6 months of IVCY, suggesting that patients who demonstrate resistance to initial IVCY therapy have an unfavorable outcome and a high likelihood of complications. In summary, we report a poor response to standard therapeutic protocols with higher relapse rates, as well as significant adverse outcomes.

Adolescent↗

PubMed2000

A 16-year follow-up of a child inpatient population.

The purpose of this study was to evaluate long-term outcomes of children who had been inpatients in a child psychiatry unit. Fifty children, who were consecutive admissions to a Dublin inpatient child psychiatry unit between November 1978 and July 1980, were followed up 16 years later. We obtained some direct information on 33 subjects; of these, 4 subjects had died and 11 subjects (33%) were living abroad. A poor outcome as defined by death, imprisonment, adult psychiatric disorder or unemployment was present in 18 of the 24 subjects (79%) on whom this information was available. We conclude that more support and increased availability of services post discharge are needed.

Adolescent↗

PubMed2005

Use of convalescent plasma therapy in SARS patients in Hong Kong.

In order to evaluate the efficacy of convalescent plasma therapy in the treatment of patients with severe acute respiratory syndrome (SARS), 80 SARS patients were given convalescent plasma at Prince of Wales Hospital, Hong Kong, between 20 March and 26 May 2003. Good outcome was defined as discharge by day 22 following the onset of SARS symptoms. Poor outcome was defined as death or hospitalization beyond 22 days. A higher day-22 discharge rate was observed among patients who were given convalescent plasma before day 14 of illness (58.3% vs 15.6%; P<0.001) and among those who were PCR positive and seronegative for coronavirus at the time of plasma infusion (66.7% vs 20%; P=0.001).

Blood Component Transfusion↗

PubMed1991

Positive and negative exercise test results with and without exercise-induced angina in patients with one healed myocardial infarction: analysis of baseline variables and long-term prognosis.

The prognostic implications of exercise test results with and without exercised-induced angina are not completely understood. In the Program On the Surgical Control Of the Hyperlipidemias (POSCH), 838 subjects with hyperlipidemia who had one healed myocardial infarction were studied and followed for 6 to 13 years (mean 8.6). Of the 417 control subjects, 279 had a treadmill exercise test result that was definitely positive or negative. Angina was also induced by exercise in 30% (45/150) and 8% (10/129) of those with a positive and a negative test result, respectively (p less than 0.0001). The data showed no difference between subjects with a positive or a negative test result with or without angina as regards levels of blood lipids, type of myocardial infarction (Q or non-Q wave), left ventricular function, or prognosis as defined by death, atherosclerotic coronary heart disease death, or myocardial infarction.

Angina Pectoris↗

PubMed1992

Management and immediate outcome of patients with intracoronary thrombus during percutaneous transluminal coronary angioplasty.

A retrospective analysis of our experience with intraprocedural thrombus complicating percutaneous transluminal coronary angioplasty (PTCA) was undertaken. Of 983 PTCA procedures reviewed, 62 (6.3%) were complicated by thrombus. Patients were managed conservatively (group I, n = 18), with redilation (group II, n = 17), or with intracoronary urokinase and redilation (group III, n = 27). The three groups did not differ with respect to demographic or baseline angiographic variables, but complications, defined as death, myocardial infarction, bypass surgery, or threatened occlusion requiring emergency stenting, occurred in 11% of patients in group I, 24% in group II, and 48% in group III. Occlusive thrombus behavior was observed in 80% of these 62 patients. Patients with complications were less likely to have received antecedent antiplatelet therapy (79% vs 95% of patients without complications), had more complex baseline lesion morphology, more often had thrombus present at baseline (42% vs 19%), and more often had a low activated clotting time at the start of PTCA (53% vs 8%). Thrombi that led to complications more frequently exhibited occlusive behavior before therapy was begun (95% vs 71%) and more often occurred in the setting of intimal dissection (42% vs 14%). Patients undergoing PTCA at the time of diagnostic catheterization were more likely to have complications than those in whom PTCA was delayed. A successful outcome was more likely (83% vs 27%, p = 0.03) in group III if at least 140,000 U of urokinase were administered within 50 minutes of the appearance of thrombus. Thus intracoronary thrombus formation during PTCA remains a significant source of morbidity.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗