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[Value of laboratory diagnosis in thrombolytic therapy]. 【实验室诊断在溶栓治疗中的价值】。
Zeitschrift fur die gesamte innere Medizin und ihre Grenzgebiete Pub Date : 1993-06-01
M E Sosada, D C Gulba
{"title":"[Value of laboratory diagnosis in thrombolytic therapy].","authors":"M E Sosada,&nbsp;D C Gulba","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Today, profound insight into the clotting and fibrinolytic systems during therapeutic thrombolysis is offered by a variety of laboratory assays. While the purpose of scientific investigations is to increase the knowledge on changes imposed by the mechanism of thrombolysis, the rationale for performing coagulation assays during thrombolytic therapy is to increase the safety of treatment. To make laboratory monitoring of thrombolytic therapy most effective, the main issues which should be solved should be defined. The main reasons for performing coagulation assays during and after thrombolytic therapy are: 1. To monitor the adjunctive anticoagulant therapy. 2. To detect potential bleeding hazards early, and 3. in case bleeding complications occur, to help to optimise of the therapeutic strategies to avoid excessive diagnostics. Most of the methods affording an insight into coagulation and fibrinolysis are not very helpful in terms of improved therapeutic safety. Too frequent repetition of assays is likewise superfluous. In our opinion, clinical routine monitoring should consist of red blood cell count, aPTT, and fibrinogen according to Clauss' method which should be repeated during the first 48 hours after initiation of therapy at 8- to 12-hour intervals. It must be mentioned in this respect that fibrinogen according to Clauss' method during thrombolytic therapy must be regarded an assay to estimate the global coagulation potential of the blood rather than to quantify fibrinogen levels. In our opinion, it is this that makes the Clauss' method superior to other methods of fibrinogen determination.</p>","PeriodicalId":23901,"journal":{"name":"Zeitschrift fur die gesamte innere Medizin und ihre Grenzgebiete","volume":"48 6-7","pages":"289-95"},"PeriodicalIF":0.0,"publicationDate":"1993-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19320645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Thrombolytic therapy of arterial occlusions]. [动脉闭塞的溶栓治疗]。
Zeitschrift fur die gesamte innere Medizin und ihre Grenzgebiete Pub Date : 1993-06-01
K Rauber
{"title":"[Thrombolytic therapy of arterial occlusions].","authors":"K Rauber","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Systemic as well as local applications of thrombolytic agents can both be used in the treatment of arterial occlusive disease. Systemic thrombolysis yields the best results in recent arterial occlusions, while local intrathrombotic infusion of thrombolytic agents is also effective in chronic occlusions. In Germany the ultra-high-dose short-term infusion of streptokinase is widely used in systemic thrombolytic therapy. Urokinase and rt-PA are used in local thrombolytic therapy, because they show fewer side effects than streptokinase. The advantages of local thrombolytic therapy as compared to systemic infusions are a higher success rate, immediate angioplasty of underlying arterial stenoses during one procedure, and the demand for lower doses of thrombolytic agents. Despite the broad application of both techniques in current clinical practice there are virtually no comparative studies of both methods, nor are there studies that compare thrombolytic therapy with other revascularisation procedures (i.e. angioplasty, surgery).</p>","PeriodicalId":23901,"journal":{"name":"Zeitschrift fur die gesamte innere Medizin und ihre Grenzgebiete","volume":"48 6-7","pages":"344-50"},"PeriodicalIF":0.0,"publicationDate":"1993-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19320541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[The fibrinolytic system and its activators]. [纤溶系统及其激活剂]。
Zeitschrift fur die gesamte innere Medizin und ihre Grenzgebiete Pub Date : 1993-06-01
E Seifried
{"title":"[The fibrinolytic system and its activators].","authors":"E Seifried","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The human fibrinolysis system is a proteolytic enzymatic process in the blood. Its purpose is to locally limit intravascular thrombotic processes and to reopen vessels closed by thrombosis. The main enzyme of the fibrinolysis system is the active protease plasmin produced by activation of the inactive first step plasminogen by means of plasminogen activators via limited proteolysis. Thrombolytic therapy with plasminogen mimics and enhances physiological fibrinolysis. The following substances are presently available for clinical use: the non-physiological thrombolytics streptokinase and APSAC (acylated plasminogen-streptokinase activator complex), as well as the physiological plasminogen activators urokinase and tissue plasminogen activator (t-PA). Whereas the first three systemically activate the fibrinolysis system, t-PA possesses relative fibrin selectivity. The fibrin-selective active prourokinase and a recombinant mutant of t-PA with prolonged in vivo half-life have not yet been officially approved for the treatment of thromboembolytic diseases but are being clinically tested. In the development stage are mutants, hybrid enzymes and conjugates aiming at further improvement of this therapeutic concept by means of changing the half-life, thrombus affinity and thrombolytic activity. The development of highly effective antithrombotics will help to further improve the results of thrombolytic therapy.</p>","PeriodicalId":23901,"journal":{"name":"Zeitschrift fur die gesamte innere Medizin und ihre Grenzgebiete","volume":"48 6-7","pages":"272-82"},"PeriodicalIF":0.0,"publicationDate":"1993-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19320644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Thrombolytic therapy in pulmonary embolism. Indications and therapeutic strategies]. 肺栓塞的溶栓治疗。适应症和治疗策略]。
Zeitschrift fur die gesamte innere Medizin und ihre Grenzgebiete Pub Date : 1993-06-01
J Niedermeyer, E Meissner, H Fabel
{"title":"[Thrombolytic therapy in pulmonary embolism. Indications and therapeutic strategies].","authors":"J Niedermeyer,&nbsp;E Meissner,&nbsp;H Fabel","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The absence of significant symptoms and signs makes the diagnosis of pulmonary embolism difficult. Sensitivity and specificity of laboratory tests, chest X-ray, ECG, echocardiography and venous studies is low. Ventilation-perfusion scanning is also often not diagnostic. The combination of several diagnostic techniques, however, and pulmonary angiography confirm the diagnosis. Heparin remains the standard therapy for patients with stable haemodynamics. Thrombolytic therapy is recommended in haemodynamically compromised patients, since it yields accelerated clot lysis and pulmonary reperfusion. In standard dose regimes streptokinase, urokinase and t-PA are equally efficient. t-PA, however, acts more rapidly than the other agents. So far there is no study to prove that thrombolytic therapy significantly reduces mortality in pulmonary embolism.</p>","PeriodicalId":23901,"journal":{"name":"Zeitschrift fur die gesamte innere Medizin und ihre Grenzgebiete","volume":"48 6-7","pages":"332-43"},"PeriodicalIF":0.0,"publicationDate":"1993-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19320650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Anticoagulation in thrombolytic therapy: importance and future perspectives]. [抗凝在溶栓治疗中的重要性和未来展望]。
Zeitschrift fur die gesamte innere Medizin und ihre Grenzgebiete Pub Date : 1993-06-01
J Harenberg, D L Heene
{"title":"[Anticoagulation in thrombolytic therapy: importance and future perspectives].","authors":"J Harenberg,&nbsp;D L Heene","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The present overview describes the mode of action of direct and indirect anticoagulants. Furthermore it presents well-accepted and potential indications for the different anticoagulants as concomitant treatment during thrombolysis of deep vein thrombosis, pulmonary embolism and myocardial infarction. The new antithrombotics dermatansulfate, hirudine, synthetic peptide thrombin inhibitors, activated protein C, inhibitors of glycoprotein IIb/IIIa are reviewed. Many small and large studies on the thrombolytic treatment of myocardial infarction demonstrate the benefit of simultaneous application of heparins.</p>","PeriodicalId":23901,"journal":{"name":"Zeitschrift fur die gesamte innere Medizin und ihre Grenzgebiete","volume":"48 6-7","pages":"283-8"},"PeriodicalIF":0.0,"publicationDate":"1993-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19320646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Thrombolytic therapy in the past, present and future]. 【过去、现在和将来的溶栓治疗】。
Zeitschrift fur die gesamte innere Medizin und ihre Grenzgebiete Pub Date : 1993-06-01
D C Gulba, P R Lichtlen
{"title":"[Thrombolytic therapy in the past, present and future].","authors":"D C Gulba,&nbsp;P R Lichtlen","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>During the last decade, thrombolysis has developed in a unique and unprecedented way from an outsider method to a well-established standard treatment in acute myocardial infarction. Since the use of thrombolytic techniques in other entities of thromboembolic disease has been prompted by this success. As an introduction into this intriguing and inspiring field in clinical science, the present paper tries to summarise briefly the development of thrombolysis since 1933 when \"fibrinolysin\" was discovered in the culture medium of beta-haemolysing streptococci, as well as the presence and future of thrombolytic therapy.</p>","PeriodicalId":23901,"journal":{"name":"Zeitschrift fur die gesamte innere Medizin und ihre Grenzgebiete","volume":"48 6-7","pages":"267-71"},"PeriodicalIF":0.0,"publicationDate":"1993-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19320647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Undesirable side effects in thrombolytic therapy]. 【溶栓治疗的不良副作用】。
Zeitschrift fur die gesamte innere Medizin und ihre Grenzgebiete Pub Date : 1993-06-01
G Claus, D C Gulba
{"title":"[Undesirable side effects in thrombolytic therapy].","authors":"G Claus,&nbsp;D C Gulba","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Even with the new fibrin-specific plasminogen activators thrombolytic therapy remains burdened with numerous side effects, some of them being severe or even life threatening, therapists being horrified if in rare cases the patient dies from severe haemorrhage subsequent to thrombolysis. The incidence and severity of bleeding increase with increasing aggressiveness of the therapeutic regimen and with increasing time during which the thrombolytic state is maintained. Furthermore, side effects related either to the plasminogen activator used (allergic reactions and systemic fibrinogen breakdown e.g.) or related to the underlying disease (pulmonary embolism and reperfusion arrhythmias e.g.) have to be considered. In order not to let thrombolysis become a double-edged sword, the risks of thrombolytic therapy should carefully be weighted against the benefits before thrombolysis is commenced.</p>","PeriodicalId":23901,"journal":{"name":"Zeitschrift fur die gesamte innere Medizin und ihre Grenzgebiete","volume":"48 6-7","pages":"296-303"},"PeriodicalIF":0.0,"publicationDate":"1993-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19320651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Thrombolytic therapy of acute myocardial infarct--current status and new developments]. 【急性心肌梗死的溶栓治疗——现状与新进展】。
Zeitschrift fur die gesamte innere Medizin und ihre Grenzgebiete Pub Date : 1993-06-01
C Bode, G Schuler, E von Hodenberg, T Nordt, W Kübler
{"title":"[Thrombolytic therapy of acute myocardial infarct--current status and new developments].","authors":"C Bode,&nbsp;G Schuler,&nbsp;E von Hodenberg,&nbsp;T Nordt,&nbsp;W Kübler","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Timely initiation of thrombolytic therapy can achieve coronary reperfusion, a reduction in infarct size, a preservation of left ventricular function and a reduction in mortality. It is therefore an established procedure in acute myocardial infarction. The major drawback is an increased rate of bleeding. As a consequence thrombolytic therapy is at present withheld from many patients with contraindications. Other problems include relative inefficacy of presently available thrombolytic agents and early reocclusion of primarily successfully reperfused vessels. New approaches to optimize the risk/benefit ratio for the patient and to make thrombolytic therapy available to more patients include new antithrombin and antiplatelet agents as adjunctive therapy, synergistic combinations of plasminogen activators, mutants of t-PA and prourokinase, chimeric molecules and antibody-targeted thrombolysis.</p>","PeriodicalId":23901,"journal":{"name":"Zeitschrift fur die gesamte innere Medizin und ihre Grenzgebiete","volume":"48 6-7","pages":"304-15"},"PeriodicalIF":0.0,"publicationDate":"1993-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19320848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Sauna therapy in coronary heart disease with hypertension after bypass operation, in heart aneurysm operation and in essential hypertension]. 【冠心病合并高血压搭桥术后、心动脉瘤术后及原发性高血压的桑拿治疗】。
Zeitschrift fur die gesamte innere Medizin und ihre Grenzgebiete Pub Date : 1993-05-01
H J Winterfeld, H Siewert, D Strangfeld, J Bohm, R Aurisch, U Engelmann, R Frenzel
{"title":"[Sauna therapy in coronary heart disease with hypertension after bypass operation, in heart aneurysm operation and in essential hypertension].","authors":"H J Winterfeld,&nbsp;H Siewert,&nbsp;D Strangfeld,&nbsp;J Bohm,&nbsp;R Aurisch,&nbsp;U Engelmann,&nbsp;R Frenzel","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>It is reported about the influence of the sauna therapy on blood pressure, heart frequency, peripheric hemodynamics (Xenon-133-muscle-clearance) and the reaction of the cardiac output or left ventricular ejection fraction with hypertonia patients, patients with coronary heart disease (CHD) and hypertension and after aneurysm resection after heart infarction. It was shown that sauna therapy has a positive effect on hypertonic regulations troubles. One of the reasons of lowering blood pressure is the significant improvement of the peripheral hemodynamics. Sauna therapy does not result in any improvement of the left ventricles pumping function after operation. All described groups of patients showed a good tolerance and compliance with sauna therapy.</p>","PeriodicalId":23901,"journal":{"name":"Zeitschrift fur die gesamte innere Medizin und ihre Grenzgebiete","volume":"48 5","pages":"247-50"},"PeriodicalIF":0.0,"publicationDate":"1993-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19499106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[250 years ago: the origin of electrotherapy exemplified by Halle]. [250年前:以哈雷为例的电疗的起源]。
Zeitschrift fur die gesamte innere Medizin und ihre Grenzgebiete Pub Date : 1993-05-01
A Völker
{"title":"[250 years ago: the origin of electrotherapy exemplified by Halle].","authors":"A Völker","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Experiments started in 1743 by a working group at the university of Halle marked the beginning of efforts to incorporate electricity into clinical therapy. Very soon this resulted in knowledge that was also taken up elsewhere, leading to a period of intensive research. The creative suggestions that originated in Halle were authored, among others, by Johann Gottlob Krüger, Christian Gottlieb Kratzenstein and Johann Joachim Lange. Their experimental and clinical findings were accompanied by deliberations on the mechanism of action of electrotherapy on which they reported in detail. Due to adverse circumstances this initially leading position occupied by Halle faded out already shortly after the middle of the century.</p>","PeriodicalId":23901,"journal":{"name":"Zeitschrift fur die gesamte innere Medizin und ihre Grenzgebiete","volume":"48 5","pages":"251-8"},"PeriodicalIF":0.0,"publicationDate":"1993-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19499107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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