Search Results
Results 251 - 300 of 1103
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DePorto R - - 2000
A case involving spinal epidural hematoma following tissue plasminogen activator and intravenous heparin therapy administered after acute myocardial infarction is reported here. The symptoms of spinal epidural hematoma following thrombolytic therapy are outlined and a recommended course of action for arriving at a definitive diagnosis of suspected epidural hematoma is ...
Nanke Y - - 2000
A 25-year-old Japanese woman with systemic lupus erythematosus (SLE) had myocardial dysfunction. Heart catheterization showed normal coronary anatomy. Left ventricular cineangiography demonstrated hypokinesis in the anterior and posterior segments. Myocardial scintigraphy revealed patchy defects in the regions unrelated to coronary arteries. These data suggested that the myocardial dysfunction was due ...
Yigla M - - 2000
We describe a 66-year-old patient with hemoptysis, a drop in hematocrit, hypoxemia and new bilateral alveolar infiltrates after receiving streptokinase for acute myocardial infarction. Markedly increased carbon monoxide diffusion capacity suggested a diagnosis of alveolar hemorrhage. Underlying conditions included congestive heart failure. The patient recovered uneventfully within 7 days of ...
Goodman D - - 2000
The optimal therapy for non-ST-segment-elevation acute coronary syndromes is the subject of considerable debate: is early catheterization and revascularization (early-invasive strategy) or continued medical therapy unless symptoms are refractory (early-conservative strategy) best? Although several clinical trials have sought to answer this question, the methodologies they employed have been widely criticized, ...
Bell S J - - 2000
Because the electrocardiograms (ECGs) of patients with symptoms suggesting an acute thrombotic coronary occlusion are typically read by physicians relatively inexperienced in this skill, it is important to develop automated decision support. A Thrombolytic Predictive Instrument (TPI) is now available along with the standard diagnostic software in a commercially available ...
White Harvey D - - 2000
Thrombolysis and primary angioplasty are both recommended reperfusion strategies for elderly patients presenting with myocardial infarction (MI). Primary angioplasty is most beneficial in high-risk patients. While the elderly have a high absolute risk of dying or developing complications after MI, they also have an increased risk of intracranial haemorrhage if ...
Constantine G R - - 1999
The study was designed to evaluate the management of acute myocardial infarction in the general medical wards of the National Hospital of Sri Lanka. All patients with acute myocardial infarction admitted from September 1996 to August 1997, were evaluated with regard to the time delay in admission and drug treatment. ...
Baron E M - - 1999
We report a case of tissue plasminogen activator-associated spinal epidural hematoma in a patient who underwent treatment for myocardial infarction. Diagnostic magnetic resonance imaging was used within 24 hr of coronary artery stent implantation. We review the literature on thrombolytic-associated epidural spinal hematoma and discuss its management. Cathet. Cardiovasc. Intervent. ...
Ishihara M - - 1999
BACKGROUND: Early reperfusion improves left ventricular (LV) function and survival after acute myocardial infarction (MI). Thrombolytic therapy achieves early patency of the infarct artery in about two-thirds of patients. In nearly half of the remaining patients, in whom early reperfusion was not achieved with thrombolytic therapy, the infarct artery might ...
Moser M - - 1999
BACKGROUND:Changes in platelet aggregation (PA) and platelet surface receptor expression induced by thrombolytic therapy for acute myocardial infarction may influence the rate of initial reperfusion and early reocclusion. METHODS AND RESULTS:In the RAPID-1 (Reteplase Angiographic Phase II International Dose-finding study), RAPID-2 (Reteplase vs Alteplase Patency Investigation During myocardial infarction), INJECT ...
Holmgren E B - - 1999
We propose a procedure for establishing equivalence that determines whether a specified percentage of the treatment effect of a known active agent over placebo is maintained. This procedure accounts for the error in the estimates from the historical studies of the known active agent and placebo as well as the ...
Patel S C - - 1999
Thrombolytic therapy is well established in the management of a select group of atherothrombotic and thromboembolic diseases at the expense of definite but increased risk of intracranial hemorrhage. The incidence of intracranial hemorrhage is higher (6.4% to 20%) in the thrombolytic treatment of acute ischemic stroke, whereas the cerebral hemorrhagic ...
Griffin H - - 1999
OBJECTIVE: The purpose of this study was to determine treatment times at a community hospital that does not receive prehospital electrocardiogram (ECG) transmission and to determine the effect of time to first hospital ECG on overall door-to-drug time. DESIGN: Descriptive. SETTING: 238-bed Regional Medical Center in Burlington, North Carolina. SAMPLE: ...
Cannon C P - - 1999
We sought to review the emerging data and the clinical rationale for combining glycoprotein (GP) IIb/IIIa inhibitors with thrombolytic therapy for acute myocardial infarction (AMI). Although thrombolytic therapy has been a major advance in the treatment of acute ST segment elevation MI, new single-bolus thrombolytic agents have been unable to ...
Gomez C R - - 1999
The field of neuroendovascular therapy is rapidly growing. New technology and operators' expertise is developing at a pace that will make this discipline progressively more available and successful. For the intensive care of patients who have acute brain ischemia, new techniques of recanalizing occluded arteries are progressively being introduced. Thus, ...
Brophy J M - - 1999
Little is known about how physicians make decisions when the evidence is incomplete or controversial. While thrombolysis improves survival following acute myocardial infarction (AMI), conflicting evidence exists as to any specific agent's superiority, particularly if cost-effectiveness is considered. Using a Bayesian hierarchical model, the authors examined the patient, physician, and ...
Paolini R - - 1999
We report the case of a 65-year-old man affected by idiopathic thrombocytopenic purpura, who developed an acute myocardial infarction after 2 years of steroid therapy. Thrombocytopenia was initially recognized 11 years earlier, and became severe during the past 2 years [platelets (PLTS) 10000-30000/microl]. He was treated with steroids, initially to ...
Rosengart T K - - 1999
To summarize the 6-month follow-up of a cohort of patients with clinically significant coronary artery disease who received direct myocardial injection of an E1-E3- adenovirus (Ad) gene transfer vector (Ad(GV)VEGF121.10) expressing the human vascular endothelial growth factor (VEGF) 121 cDNA to induce therapeutic angiogenesis. Therapeutic angiogenesis describes a novel approach ...
Hoffmeister H M - - 1999
Several alterations of the coagulation, of the fibrinolysis and of inflammation are known in patients with acute coronary syndromes. To extent current knowledge of the pathophysiology and to optimize therapeutical strategies, the new molecular markers can be used in clinical studies. Furthermore, several studies were undertaken to assess the prognostic ...
Mahaffey K W - - 1999
BACKGROUND: Intracranial hemorrhage is an uncommon but very dangerous complication in patients receiving thrombolytic therapy for acute myocardial infarction. Neurosurgical evacuation is often an available treatment option. However, the association between neurosurgical evacuation and clinical outcomes in these patients has yet to be determined. METHODS: The GUSTO-I trial randomly assigned ...
Nordt T K - - 1999
In acute myocardial infarction rapid, complete, and sustained reperfusion of the infarct-related coronary artery is the most important therapeutic principle. Lanoteplase or n-PA, a third-generation plasminogen activator consisting of a deletion and point mutant of tissue-type plasminogen activator (t-PA), is a promising agent to approach this therapeutic goal. The molecule ...
French J K - - 1999
Thrombolytic therapy aims to achieve rapid and sustained infarct-related artery patency, although this results in a procoagulant state. Heparin has limitations as an antithrombin agent, which has led to clinical investigation of alternative agents. Direct thrombin inhibitors, as adjuncts to thrombolytic therapy, have been shown to increase 90 minute Thrombolysis ...
Vorchheimer D A - - 1999
More than 200,000 people have been enrolled into clinical trials examining different reperfusion strategies for patients with acute myocardial infarction. Each year approximately 1 million people in the United States experience acute myocardial infarction. Thrombolytic agents, including streptokinase and tissue-type plasminogen activator, activate plasminogen. These agents are often divided into ...
Pislaru S V - - 1999
Thrombolytic therapy has become the mainstay of treatment for acute transmural myocardial infarction. Present fibrinolytic regimens have a number of shortcomings, including the failure to induce early and sustained reperfusion in as many as 40-50% of the patients, and to prevent reocclusion in another 10-20% of the patients. The efforts ...
Rosengart T K - - 1999
BACKGROUND: Therapeutic angiogenesis, a new experimental strategy for the treatment of vascular insufficiency, uses the administration of mediators known to induce vascular development in embryogenesis to induce neovascularization of ischemic adult tissues. This report summarizes a phase I clinical experience with a gene-therapy strategy that used an E1(-)E3(-) adenovirus (Ad) ...
Gersh B J - - 1999
At the dawn of the next millennium, the optimal management of acute myocardial infarction will have been defined by multiple clinical trials of acute reperfusion strategies, in conjunction with adjunctive pharmacotherapy. Reperfusion therapy with thrombolytic agents or primary angioplasty is the standard of care for many patients examined with ST-segment ...
Cannon C P - - 1999
Although thrombolytic therapy has been a major advance in the treatment of acute ST-segment elevation myocardial infarction (MI), new thrombolytic agents have been unable to improve early reperfusion. Because aspirin has been shown to be a very effective adjunctive agent in patients with acute MI, it has been hypothesized that ...
Van de Werf F - - 1999
Current thrombolytic therapy fails to induce early, complete, and sustained reperfusion in +/-50% of the patients with ST-segment elevation acute coronary syndromes. There are two complementary approaches to improve thrombolytic therapy: the development of new fibrinolytics with enhanced fibrin specificity and/or reduced plasma clearance and the coadministration of new antithrombotic ...
Paganelli F - - 1999
BACKGROUND: Type 1 plasminogen activator inhibitor (PAI-1) is considered to be risk factor for acute myocardial infarction (AMI). A rebound of circulating PAI-1 has been reported after rt-PA administration. We investigated the relationships between PAI-1 levels before and after thrombolytic therapy with streptokinase (SK) as compared to rt-PA and the ...
Comeau-Luis O Y - - 1999
This case, in many ways, represents the ideal: a timely and effective administration of thrombolytic agents. The rarity of this situation reinforces the need for earlier recognition and treatment of infarction. In an analysis of time delays in thrombolytic therapy, 38% were attributed to in-hospital issues, 22% to patients' delays, ...
Reikvam A - - 1999
The objective of this study was to investigate how the introduction of thrombolytics and aspirin has affected hospital mortality (case fatality) among patients with acute myocardial infarction. The study design was the application of the therapeutic effects found in the clinical trials in a nonselected myocardial infarction population characterized in ...
Salame M - - 1999
Thrombolytic therapy has proved useful in the treatment of acute myocardial infarction but is frequently associated with limited vessel reperfusion and early reocclusion. Local platelet aggregation and activation play a role in these pathological processes, explaining the benefit of aspirin, a weak antiplatelet agent. Recent interest has turned to GPIIbIIIa ...
Maas A C - - 1999
AIMS: To investigate whether the benefit of thrombolytic therapy was sustained beyond the first decade. We report the 10-14 year outcome of 533 patients who were randomized to treatment with intracoronary streptokinase or to conventional therapy during the years 1980-1985. METHODS AND RESULTS: Details of survival and cardiac events were ...
Maksimenko A V - - 1999
Increased efficacy of thrombolytic therapy requires a comprehensive search for new and novel therapeutic strategies. Many new modified forms of plasminogen activators have been obtained by means of chemical and biological synthesis. However, clinical findings demonstrate that the reperfusion level achieved during thrombolysis remains the same for various thrombolytic agents, ...
Rotstein Z - - 1999
AIMS: The purpose of our study was to examine and compare the prognosis of acute myocardial infarction patients hospitalized in an intensive coronary care unit and in an internal medicine ward, in the era of reperfusion therapy, and to identify factors associated with the observed outcomes. METHODS AND RESULTS: Patients ...
Sundlof D W - - 1999
The use of abciximab after full-dose failed thrombolytics within 15 hours of acute myocardial infarction significantly increases the risk of major bleeding complications.
Barron H V - - 1999
The National Registry of Myocardial Infarction 2 (NRMI-2) provides a unique opportunity to evaluate the practice patterns among participating cardiology and emergency medicine departments involved in the care of patients with acute myocardial infarction. The data from NRMI-2 suggest that almost 1/3 of all non-transfer-in and non-transfer-out patients are eligible ...
Fox K A - - 1999
In the 13 years since the publication of the GISSI-1 study in 1986, and the incorporation of thrombolysis into the standard management of myocardial infarction, this treatment has, apparently, fulfilled its promise. Short-term mortality gains are accompanied by improvements in ventricular function and a reduction in major cardiovascular complications. Follow-up ...
Ozmen D - - 1999
The role of reactive oxygen products in myocardial damage caused by ischemia-reperfusion has been established in a number of studies performed in animals models. However, studies showing the development of increased free radicals following effective myocardial reperfusion in humans are scarce. In the present study, both the increase of lipid ...
Verstraete M - - 1999
Several lines of research towards improvement of thrombolytic agents are being explored, including the construction of mutants of plasminogen activators, chimeric plasminogen activators, conjugates of plasminogen activators with monoclonal antibodies, and plasminogen activators from animal or bacterial origin. Some of these new thrombolytic agents have shown promise in animal models ...
Rosamond W - - 1999
Few studies have evaluated between-country differences in medical care and survival after acute myocardial infarction, and none have compared the US with countries from Eastern Europe. Comparable data from the US (Atherosclerosis Risk in Communities Study [US-ARIC]) and Poland (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease project [Pol-MONICA]) ...
Zerwic J J - - 1999
Patient delay before seeking treatment for the symptoms of acute myocardial infarction has a significantly negative effect on morbidity and mortality. Most patients delay 2 or more hours before accessing the emergency medical system, which limits the ability to use reperfusion strategies. This article reviews variables that have been implicated ...
McErlean E S - - 1999
The quest to identify the acute interventional approach that will achieve the lowest mortality rate with the fewest adverse events has led to a continued controversy surrounding the relative merits of thrombolytic therapy compared with primary angioplasty in the setting of acute myocardial infarction. This article summarizes the benefits and ...
Ergin A - - 1999
AIM: The purpose of this study was to document treatment profiles in 850 patients surviving acute myocardial infarction at 17 academic hospitals in Turkey. METHODS AND RESULTS: Pharmacological management data of acute myocardial infarction survivors were collected and divided into three categories: drugs which patients received before hospitalization, during the ...
Verheugt F W - - 1999
The treatment of acute myocardial infarction consists of pain and anxiety relief, anti-ischaemic treatment and antithrombotic therapy. Due to its bleeding complications and, in some cases, procoagulant effects, antithrombotic therapy has consequences for coronary procedures in the setting of acute myocardial infarction. Antiplatelet therapy has no procoagulant effects, and its ...
Wooster M B - - 1999
OBJECTIVE: To summarize the published data on reteplase, the most recent thrombolytic agent approved by the Food and Drug Administration for use in the management of acute myocardial infarction in adults. DATA SOURCES: Published data on reteplase identified by MEDLINE searches (January 1985-June 1997), as well as other pertinent literature. ...
Breuer M - - 1999
OBJECTIVE: Acute graft occlusion early postoperatively after coronary artery bypass grafting (CABG) is a rare but dramatic complication, frequently making resuscitation necessary. Emergency reoperation with reanastomosing of the concerning grafts is the normal procedure to restrict the otherwise unavoidable myocardial damage. Mortality in these cases is up to 50%. Due ...
Ross A M - - 1999
Rapid restoration of patency of the infarct-related artery is the key to preserving myocardium and improving survival. This understanding has led to the application of genetic engineering to develop new plasminogen activators with specific clinical features. These novel activators may provide faster and more complete reperfusion in a greater number ...
Lange R A - - 1999
For the patient with acute myocardial infarction (MI), both primary percutaneous transluminal coronary angioplasty (PTCA) and intravenous thrombolytic therapy are effective in restoring antegrade coronary blood flow, improving left ventricular systolic function, and reducing mortality. Primary PTCA is effective when performed quickly by experienced operators. It is the preferred therapy ...
O'Connor G T - - 1999
CONTEXT: Quality indicators for the treatment of acute myocardial infarction include pharmacologic therapy, reperfusion, and smoking cessation advice, but these therapies may not be administered to all patients who could benefit from them. OBJECTIVE: To assess geographic variation in adherence to quality indicators for treatment of acute myocardial infarction. DESIGN: ...
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