[The reliability of conventional arrhythmia detection in acute myocardial infarction and the significance of prophylactic lidocaine treatment].
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Biomedical subjects
Publications and source records attributed to H Arnesen.
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In a prospective trial, 99 patients with a history of AMI of less than 12 hours were allocated at random to treatment with subcutaneous heparin, 5 000 IU twice daily, (51 patients) or warfarin (48 patients). In a subsample of 21 patients, 11 in the warfarin group and 10 in the heparin group, fasting FFA analyses were performed before and 2 hours after administration of anticoagulants on days 1 and 2. No measurable increase in FFA concentrations was demonstrated in the heparin-treated patients, in spite of a significant influence on the thrombin clotting time. The frequency of ventricular arrhythmias as detected by continuous tape recordings was equal in the two groups. It is concluded that subcutaneous heparin, 5 000 IU every 12 hours, can be administered to patients with AMI without increasing the risk of arrhythmias as compared with warfarin.
For the estimation of fibrinolytic activity in euglobulin precipitates after venous stasis, the euglobulin clot lysis time (ECLT) proved to be as reproducible and probably even more sensitive than the fibrin plate method (FP). Furthermore, when euglobulin precipitates from 55 healthy individuals and 36 patients with thromboembolic disease were examined, a good correlation between the two methods was observed. The present observations indicate that the ECLT is suitable for routine screening of fibrinolytic activity after venous stasis.
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In a prospective trial, 42 medical patients with a history of deep vein thrombosis of less than five days were allocated at random to treatment with streptokinase or heparin. Only patients with extensive thromboses were included. Streptokinase was given in a loading dose of 250 000 IU and a maintenance dose of 100 000 IU/hour for 4 days as a mean. Heparin was given in a loading dose of 15 000 IU and a maintenance dose of 20 000-50 000 IU/day. The therapeutic results were evaluated by phlebography. Significant thrombolysis occurred in 71.4% of 21 patients treated with streptokinase and in 23.8% of the 21 heparin-treated patients. Using the chi2-test for overall association, this difference was statistically highly significant (p = 0.002). Three patients in each treatment group experienced major bleeding, two in each group requiring blood transfusions. Minor bleeding and slight rise in temperature were encountered more often in the streptokinase than in the heparin group. It is concluded that patients with acute deep vein thrombosis with proximal extension of the thrombus beyond the calf veins should be offered a therapeutic trial with streptokinase.
Treatment with streptokinase or heparin was allocated randomly to 20 patients with major pulmonary embolism verified by angiography. In addition, 4 patients treated with streptokinase and 1 patient treated with heparin were included in the trial prior to the start of treatment. Streptokinase of heparin was given for 72 hours and pulmonary angiography was repeated. The angiographic evidence of thrombolysis was significantly greater (p less than 0.01) in the 14 patients treated with streptokinase than in the 11 treated with heparin. In the heparin group, 1 patient died from massive embolism 15 hours after the start of treatment. In another patient who died 4 weeks later from cerebral glibolastoma, persistent massive embolism contributed to the fatal outcome. In the streptokinase group, 1 patient with a metastatic pulmonary carcinoma died 3 weeks after the start of treatment from gangrene of both legs following thrombotic occlusion of the inferior vena cava. Bleeding was more common after treatment with streptokinase than with heparin, but was not a serious problem in any patient. It is concluded that patients with life-threatening pulmonary embolism should be offered the benefits of streptokinase.
Coagulation studies in 55 healthy pregnant women indicated that in spite of high coagulation activity, a positive ethanol gelation test for fibrin in plasma is not a normal feature of pregnancy. The four case reports presented stress the value of the ethanol test in monitoring treatment of thromboembolic disease in pregnancy.
Normotest (sample volume: 25 micronl) and Thrombotest were performed in parallel on 150 consecutive capillary blood samples from patients on long term oral anticoagulant therapy. The ratio of Normotest to Thrombotest decreased from 2.50 at a Thrombotest level of 5-5.5% to 1.95 at a Thrombotest level of 13-13.5%, indicating that the effects of PIVKA were more pronounced at lower levels of coagulation activity. The influence of varying sensitivity of the thromboplastin reagents to PIVKA is discussed. The therapeutic range of Thrombotest (5-10%) corresponded to a Normotest level of 12-20%.
The streptokinase titrated initial dose (TID) was estimated in 31 2 patients consecutively admitted to a medical department in Oslo. 93% had a TID below 250,000 IU, 97% below 425,000 IU and 98.5% below 650,000 IU. No differences were found between the two sexes. The highest values were found in patients 50--60 years old. Otherwise, no differences were found between different age groups from 10 to 90 years of age. Two patients with extremely high TID values were both anamnestically prone to streptococcal infections. It is concluded that our standard initial dose of 250,000 IU of streptokinase is sufcient for the great majority of our patients. Pre-treatment test for TID is recommended only when recent streptococcal infections are suspected.
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The presence of FDP in the urine, known to be a sensitive indicator of various kidney disorders, was studied in 14 well-trained men participating in a 70-km cross-country ski race. None of the urine samples contained FDP on the day before the race. Immediately after the race, 4 samples contained FDP. High molecular weight FDP were found in 2 of them, whereas 2 others contained low molecular weight products only. 2 days after the race, 1 of these subjects still had FDP in the urine. In addition, 2 newly FDP positives were observed. Serum FDP were slightly elevated in 2 subjects before the race, and in another subject immediately after the race. The presence of urinary FDP did not correlate either with urinary albumin or uromucoid, or with serum FDP. A drop in plasma fibrinogen immediately after the race was noted in all subjects. It is suggested that the present observations may reflect a transient hyperproteolysis (coagulation and fibrinolysis) in the glomerular circulation, including fibrin formation and dissolution, associated with a transient damage of glomerular capillaries.
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