Streptokinase therapy for deep vein thrombosis: a comprehensive review of the English literature
Article Abstract:
Streptokinase (SK), an enzyme produced by particular strains of streptococci, has been shown to be effective as a thrombolytic agent (dissolves blood clots). It is effective in the treatment of deep vein thrombosis (DVT), but is often not used because of the possibility of serious hemorrhage. A review of the current English language literature is presented which discusses SK treatment for deep vein thrombosis of the leg. SK has been shown to be effective in many clinical trials. Complete or substantial thrombolysis has been documented in 20 to 70 percent of patients treated, compared with clinical success in 0 to 28 percent of patients treated with heparin. Four main factors were identified that may alter the effectiveness of SK: duration of symptoms, amount of vein occlusion, location of the thrombus or clot, and evidence of a plasma proteolytic state as determined by coagulation studies. The recommended treatment protocol includes: monitoring SK administration in the intensive care unit or other closely regulated environment; baseline coagulation studies prior to treatment initiation; acetaminophen to prevent fever; a three-day limit of treatment; and following normalization of coagulation studies, heparin should be administered and continued for 6 to 10 days, along with daily doses of warfarin. SK patients did not have a higher rate of serious hemorrhage than patients treated with heparin. It is concluded that SK is helpful in the treatment of DVT, and provides a greater and more direct thrombus breakdown compared with heparin treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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Varicella hepatitis in the immunocompromised adult: a case report and review of the literature
Article Abstract:
Varicella, or chickenpox, is a highly contagious infection by the varicella-zoster virus, characterized by the development of skin lesions within 24 hours of exposure. It occurs as primary chickenpox, usually during childhood, and as zoster, or shingles, following activation of the latent virus. Although it is common in children, varicella in adults is severe, producing a more prominent rash and fever, and interstitial pneumonitis, the inflammation of the lungs. Pneumonitis occurs in 15 percent of adults, resulting in a death rate of 10 to 30 percent of those who develop this complication. Hepatitis, the inflammation of the liver, has been associated with primary varicella in children and in adults with varicella pneumonitis, and also with zoster in adults. This report is the first of an adult with fatal primary varicella hepatitis in the absence of pneumonitis. A 29-year-old diabetic man, who previously had a kidney transplant and surgery to remove his spleen, was admitted to the hospital with severe abdominal pain. He was taking drugs to suppress his immune system, so as not to reject the transplanted organ. The patient developed a skin rash and had signs of hepatitis. After developing severe complications, such as liver damage and gastrointestinal bleeding, he died three days after admission. Blood, throat and skin cultures were positive for varicella. The patient apparently acquired the infection from a nurse who was caring for a patient with zoster. This case also emphasizes the dangers of hospital-acquired infections by patients with deficient immune systems.
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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Acute renal failure associated with the use of intraperitoneal carboplatin: a report of two cases and review of the literature
Article Abstract:
The drug carboplatin is a new analogue, or form, of the anti-cancer agent cisplatin. Treatment with carboplatin has not been previously associated with the development of renal (kidney) failure. The cases are described of two patients who developed renal failure after treatment for ovarian cancer with carboplatin, which was administered into the abdomen. The patients had been treated previously with cisplatin. Blood levels of creatinine, a component of the blood which increases during advanced kidney disease, rose from 0.9 to 9.0 milligrams per deciliter (mg/dL) in patient one and from 1.1 to 9.5 mg/dL in patient two within a week of starting carboplatin treatment. No other causes of renal failure could be identified. One patient required short-term treatment with hemodialysis, filtering of the blood through a machine that performs the functions of a kidney. Samples of kidney tissue were obtained from both patients. Patient one had inflammation and formation of fiber-like tissue in portions of the kidney, whereas patient two had accumulation of fluid, widespread collections of white blood cells, bleeding, and toxic changes in portions of the kidney. Treatment with the steroid prednisone decreased blood creatinine levels. This is the first report of kidney tissue inflammation and renal failure in patients treated with carboplatin. The pathophysiology of carboplatin-associated toxic effects on the kidney is reviewed. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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