Search PubMed⌕ Search

Biomedical subjects

A S Lew

Publications and source records attributed to A S Lew.

43 records · Page 3Linked to original sources
PubMed1985

Thrombolytic therapy with intracoronary or intravenous streptokinase during acute myocardial infarction.

This report compares the results of intracoronary (IC) and intravenous (IV) streptokinase in a sequential series of 200 patients (IC = 81 and IV = 119) admitted within 3 hours of the onset of an acute myocardial infarction. Reperfusion was achieved in 71 of 81 (88%) patients in the IC group and in 113 of 119 (95%) patients in the IV group (p = NS) 35 +/- 27 and 42 +/- 33 minutes after commencement of treatment respectively (p = NS). The interval from onset of symptoms to reperfusion was significantly longer in the IC than in the IV group, 235 +/- 62 versus 175 +/- 61 minutes (p less than 0.001). Mean values of peak creatine kinase-MB were 152 +/- 117 IU/L in the IC group and 117 +/- 79 IU/L in the IV group (p less than 0.05). Three patients in the IC group and 16 patients in the IV group suffered major hemorrhagic complications. In-hospital mortality was 7 of 81 (8.7%) in the IC group and 10 of 119 (8.4%) in the IV group (p = NS). We conclude that IV administration of streptokinase in patients with an acute myocardial infarction is at least as efficacious as IC administration.

Aged↗
PubMed1984

Intravenous streptokinase in evolving acute myocardial infarction.

Eighty-one consecutive patients presenting within 3 hours of the onset of acute myocardial infarction (AMI) and without contraindications to thrombolytic or anticoagulant therapy received a 15- to 30-minute intravenous infusion of 750,000 or 1.5 million units of streptokinase (STK) followed by anticoagulation. Treatment was instituted 130 +/- 41 minutes after the onset of symptoms and reperfusion was achieved 36 +/- 26 minutes later. Reperfusion of the "infarct artery" was recognized by indirect clinical criteria in 78 patients (96%). In all 66 patients who underwent coronary angiography 3 to 7 days later, there was complete concordance between indirect and angiographic evidence of reperfusion. In 6 patients there was early reocclusion within 24 hours of treatment; in 4 of these patients, the artery was reopened with an additional dose of STK. Two elderly patients suffered an intracranial hemorrhage and there were 8 other major hemorrhagic complications, of which 7 were related to procedural trauma. Five patients (6.2%) died in the hospital. The results of intravenous STK thrombolytic therapy are compared with those of our previous study using intracoronary STK.

Aged↗
PubMed1984

Clinical failure of streptokinase due to an unsuspected high titer of antistreptokinase antibody.

Neutralization of streptokinase by an unsuspected high titer of antistreptokinase antibody prevented activation of the fibrinolytic system and induction of a lytic state in a 62 year old man with an acute inferior myocardial infarction. There was no decrease in serum fibrinogen, minimal decrease in serum plasminogen and only a small increase in serum fibrin degradation products after intravenous administration of 1.5 million units of streptokinase. A high titer of antistreptokinase antibody, sufficient to neutralize 1.5 million units of streptokinase, was demonstrated by semiquantitative counterelectrophoresis . There was no clinical evidence of coronary artery reperfusion, and coronary angiography confirmed complete occlusion of the left circumflex artery.

Antibodies, Bacterial↗
PubMed1983

Recent experience with transeptal catheterization.

We report our recent experience of 207 consecutive transeptal catheterizations performed in the following groups of patients: aortic valve disease in 152, mitral valve disease in 20, combined aortic and mitral valve disease in 11, hypertrophic obstructive cardiomyopathy in 11, assessment of prosthetic cardiac valves in nine, and four miscellaneous. Transeptal catheterization failed in 20 patients. There was no attempt to advance the transeptal catheter from the left atrium into the left ventricle in 18 patients, and failure to advance the transeptal catheter from the left atrium into the left ventricle occurred in 13 patients. Transeptal catheterization was achieved in a mean time of 9.7 +/- 4.6 SD min. There were no deaths, two major and four minor complications. We conclude that transeptal catheterization remains a useful technique that in experienced hands is both rapid and safe.

Adult↗