Biomedical subjects

R Vincent

Publications and source records attributed to R Vincent.

At least 73 records · Page 4Linked to original sources

PubMed1996

Advances in the early diagnosis and management of acute myocardial infarction.

The effective early diagnosis of acute myocardial infarction still rests primarily on the clinical history and the electrocardiogram. ST segment elevation is specific though sometimes short lived and less than ideally sensitive; but with bundle branch block it defines a population that benefits importantly from thrombolysis. Novel electrode configurations can further enhance diagnosis but have not become popular. Biochemical markers are rarely of help in the first four hours and cardiac scanning is impractical for routine care. Computerised diagnostic systems show promise in prototype but are not widely available. Early management involves reestablishing coronary flow by thrombolytic and antithrombotic agents and reducing myocardial oxygen requirement by analgesics and beta blockers. Nitrates and magnesium have limited roles. Immediate access to defibrillation and advanced life support is mandatory. Diagnosis and management can only begin after help has been sought. Public alertness to the symptoms of myocardial infarction and a coordinated response by health care personnel are fundamental to successful care.

Biomarkers↗

PubMed1996

Sensitivity of lungs of aging Fischer 344 rats to ozone: assessment by bronchoalveolar lavage.

Biological effects indicators in bronchoalveolar lavage fluid were studied in Fischer 344 rats of different ages after exposure to 0.4-0.8 ppm ozone for periods of 2-6 h on a single day or on 4 consecutive days. The magnitude of alveolar protein transudation induced by ozone was not different between age groups, but the interindividual variability of protein changes was higher in senescent (24-mo-old) rats. By comparison to juvenile (2-mo-old) and adult (9-mo-old) rats, senescent animals had higher increases of interleukin-6 (up to 10-fold higher) and N-acetyl-beta-D-glucosaminidase (NAGA; 2-fold higher) in lung lavage after ozone. Ascorbic acid was lower in lungs of senescent rats (one-half of juvenile values), and acute ozone exposure brought a further decrease in lung ascorbate. Whereas alveolar protein transudation was attenuated after ozone exposure on 4 days, persistent elevation of NAGA in senescent rats suggested only partial adaptation. Injection of endotoxin did not modify the patterns of effects. Incorporation of 18O-ozone into macrophages and surfactant was not different between age groups, indicating that the magnified biological responses in senescent rats were not dominated by differences in internal dose of ozone. The results indicate that senescent rats respond differently than juvenile and adult rats to lung injury.

Acetylglucosaminidase↗

PubMed1996

Hydroxylation of salicylate in lungs of Fischer 344 rats: effects of aging and ozone exposure.

The formation of 2,3-dihydroxybenzoic acid (DHBA) from salicylate was measured in the lungs and plasma to assay for the .OH in juvenile (2 mo), adult (9 mo), and senescent (24 mo) Fischer 344 male rats exposed to clean air, 1 part/million (ppm) ozone, or 2 ppm ozone for 2 h. Similar rates of distribution of salicylic acid in plasma and to the lungs were observed among air control animals of all age groups. Levels of 2,3-DHBA were about twice as high in the lungs of air control senescent rats compared with juvenile and adult rats (P < 0.05). Exposure to ozone resulted in 1.5- to 2-fold elevation of 2,3-DHBA in lungs and plasma of all age groups (P < 0.05), whereas levels of 2,5-DHBA were not changed significantly. There was no effect of age on the magnitude of 2,3-DHBA increase in the lungs or plasma after ozone exposure. The postulated source of .OH is chemical reduction of H2O2, which could be generated from increased age-dependent endogenous oxidant production or the age-independent reaction of ozone or macrophage-derived oxidants with the surfactant lining.

Aging↗

PubMed1996

Spin trapping study in the lungs and liver of F344 rats after exposure to ozone.

Fischer 344 rats were injected with the spin traps C-phenyl N-tert-butyl nitrone (PBN, 150 mg/kg bw, ip) or 4-pyridine-N-oxide N-tert-butyl nitrone (POBN, 775 mg/kg bw, ip), and exposed to clean air or 2 ppm ozone for two hours. The presence of spin adducts was determined by electron paramagnetic resonance (EPR) spectroscopy of chloroform extracts of lung and liver homogenates. No significant levels of adducts were detected in the lungs of air control animals. Benzoyl N-tert-butyl aminoxyl, attributed to direct reaction of ozone with PBN, and tert-butyl hydroaminoxyl, the scission product of the hydroxyl adduct of PBN, were detected in the lungs of ozone exposed rats. EPR signals for carbon-centred alkoxyl and alkyl adducts were also detected with PBN in the lungs and liver of animals exposed to ozone. With POBN, only carbon-centred alkyl radicals were detected. Senescent, 24 months old rats were found to retain about twice more 14C-PBN in blood, heart and lungs by comparison to juvenile, 2 months old animals. Accordingly, the EPR signals were generally stronger in the lungs of the senescent rats by comparison to juvenile rats. Together, the observations were consistent with the previously proposed notion that a significant flux of hydrogen peroxide produced from the reaction of ozone with lipids of the extracellular lining, or from activated macrophages in the lungs could be a source of biologically relevant amounts of hydroxyl radical.

Animals↗

PubMed1996

Surgery and Tinnitus for Otosclerotic Patients.

In our experience, tinnitus for otosclerosis may be due to the following: poor vibration of the inner ear fluids, fixation of the footplate, destruction of the Corti hair cells by the proteolytic enzymes, acoustic trauma, or to poor inner ear blood supply due to the hyalinization of the spiral ligament of the stria vascularis. The aim of this article is to suggest some explanations to enhance future research work carried out by other authors on this important issue, and to show what are the results of surgery in our experience, as far as tinnitus is concerned. Only complete release of the tinnitus one year after surgery is taken into account to assess the results.

Journal Article↗

PubMed1996

Assessing the estrogenic and dioxin-like activities of chemicals and complex mixtures using in vitro recombinant receptor-reporter gene assays.

In vitro recombinant receptor-reporter gene assays have been used to assess and rank the potency of chemicals and complex mixtures suspected of possessing estrogen and (or) aryl hydrocarbon receptor (AhR) mediated activity. The environmental estrogen (E2) bioassay consists of a Gal4-human estrogen receptor chimeric construct (Gal4-HEGO) and a Gal4-regulated luciferase reporter gene (17m5-G-Luc) that have been stably integrated into HeLa cells. The assay exhibits 10-fold induction in luciferase reporter gene activity following treatment with 1 nM 17 beta-estradiol and has a detection limit of approximately 5 pg of 17 beta-estradiol/mL. The AhR bioassay uses Hepa 1c1c7 wild-type cells transiently transfected with a dioxin response element regulated luciferase reporter gene. These assays were used to assess the estrogen and dioxin-like activities of naringenin, atrazine, and simazine and complex mixtures such as pulp and paper mill black liquor and urban air particulates. The activities of these chemicals and complex mixtures are confirmed using the pure antiestrogen ICI 164,384 and in in vitro gel retardation assays. Results of this study demonstrate the utility of in vitro recombinant receptor-reporter gene assays in identifying and assessing the estrogenic and dioxin-like activities of chemicals and complex mixtures.

Air Pollutants↗

PubMed1996

Argon laser and Gherini-Causse Endo-Otoprobe in otologic surgery.

The authors describe the various surgical indications and techniques of the argon laser and Gherini-Causse Endo-Otoprobe in otologic surgery, from otosclerosis to chronic otitis. The advantages are numerous, permitting the surgeon to vaporize or coagulate tissue with optimal effect, avoiding excessive mobilization of the ossicular chain and diminishing the risk of damage to the facial nerve and inner ear structures.

Argon↗

PubMed1995

Associations between ambient particulate sulfate and admissions to Ontario hospitals for cardiac and respiratory diseases.

The association of daily cardiac and respiratory admissions to 168 acute care hospitals in Ontario, Canada, with daily levels of particulate sulfates was examined over the 6-year period 1983-1988. Sulfate levels were recorded at nine monitoring stations in regions of southern and central Ontario spanned by three monitoring networks. A 13-micrograms/m3 increase in sulfates recorded on the day prior to admission (the 95th percentile) was associated with a 3.7% (p < 0.0001) increase in respiratory admissions and a 2.8% (p < 0.0001) increase in cardiac admissions. Increases were observed for all age groups examined. Admissions for cardiac diseases increased 2.5% for those under 65 years and 3.5% for those 65 years and older. After adjusting for ambient temperature and ozone, similar increases in respiratory admissions were observed in the period from April to September (3.2%) and in the period from October to March (2.8%). A 3.2% increase was observed for cardiac admissions in the period from April to September, and a 3.4% increase was observed in the period from October to March after adjusting for ambient temperature and ozone.

Adult↗

PubMed1995

Hybrid time-frequency adaptive filtering for the recovery of ventricular late potentials.

Ventricular late potentials are small ECG components that have significant diagnostic importance. Temporal averaging is used to recover these signals from high levels of background noise, but is not the optimum approach. A new form of hybrid time-frequency adaptive filtering is introduced that is based on signal division into a series of frequency bands. This technique is able to process the averaged data further and to reduce significantly the noise levels beyond that achieved by simple averaging. Examples of the processing are shown and its applicability is discussed.

Algorithms↗

PubMed1995

The medical and economic impact of laparoscopically assisted vaginal hysterectomy in a large, metropolitan, not-for-profit hospital.

OBJECTIVE: Our purpose was to evaluate the medical and economic impact of of operative laparoscopy on the surgical approach to hysterectomy for benign disease in a large, metropolitan, not-for-profit hospital. STUDY DESIGN: Retrospective analyses were performed on 2563 hysterectomies (without vaginal or bladder repair) for benign disease, performed by 37 gynecologists between January 1991 and December 1993. Disposable laparoscopic instruments and stapling devices were not used at any time during the study period. Electrosurgery and sutures were used for hemostasis. Parameters analyzed included surgical approach (total abdominal hysterectomy, vaginal hysterectomy, laparoscopically assisted vaginal hysterectomy, and failed laparoscopically assisted vaginal hysterectomy), operative time, postoperative diagnosis, operative blood loss, length of stay, complications, uterine weight, and hospital changes. Charges in each of these parameters were analyzed and compared in 6-month increments. RESULTS: During the study period the percent of hysterectomies performed abdominally declined from 65% to 36%. Laparoscopically assisted vaginal hysterectomy increased from 12% to 45%, and vaginal hysterectomy varied from 23% to 19%. Average operative time was 82 minutes (+/- 2 minutes) for total abdominal hysterectomy, 102 minutes (+/- 2.3 minutes) for laparoscopically assisted vaginal hysterectomy, and 63 minutes (+/- 2 minutes) for vaginal hysterectomy. Hospital stay was 68 hours (+/- 1.5 hours) for total abdominal hysterectomy, 44 hours (+/- 1.2 hours) for laparoscopically assisted vaginal hysterectomy, and 43 hours (+/- 4.1 hours) for vaginal hysterectomy. The average hospital charge was $6552 (+/- $108) for total abdominal hysterectomy, $6431 (+/- $100) for laparoscopically assisted vaginal hysterectomy, and $5869 (+/- $116) for vaginal hysterectomy. CONCLUSIONS: Contrary to previously published studies, our study demonstrates (1) laparoscopically assisted vaginal hysterectomy is a cost-effective procedure when performed with reusable instruments, (2) laparoscopically assisted vaginal hysterectomy is a safe procedure, even when performed by a variety of gynecologists with different skill levels, and (3) the number of hysterectomies performed abdominally was decreased by 29% without incurring more complications or reducing the number of vaginal cases.

Blood Loss, Surgical↗

PubMed1995

Delay times in the administration of thrombolytic therapy: the Brighton experience.

We reviewed the effectiveness of a strategy involving paramedic ambulances and community education to reduce the delay to thrombolytic therapy in patients admitted with acute myocardial infarction, by analysing delay times recorded during routine treatment. Rapid identification and treatment of patients with acute myocardial infarction who were eligible for thrombolysis was carried out in the Accident and Emergency and Cardiac Care Units. Two hundred seventy-four patients were admitted with acute myocardial infarction over an 18-month period and treated with anistreplase (168) or streptokinase (106). The following median times were recorded: symptom onset to administration of thrombolytic therapy, 142 min (range 43-980 min); symptom onset to ambulance arrival, 60 min; ambulance with patient to arrival in hospital, 35 min; time to treatment in hospital ('door to needle time'), 25 min; in-hospital delays were notably shorter for patients given anistreplase as opposed to streptokinase. Shortened delays for the delivery of thrombolytic therapy can be achieved by a strategy involving public education, the availability of resuscitation ambulances, and close liaison with the Accident and Emergency Department.

Ambulances↗

PubMed1995

Frequency analysis of the P wave: comparative techniques.

Frequency domain analysis of the signal-averaged P wave (SAPW) may provide additional information over time domain analysis in patients with paroxysmal atrial fibrillation (PAF), but an optimum method has not yet been defined. We compared two different approaches using SAPW and test signals. We analyzed the frequency spectrum of the entire P wave (method A) or of only its terminal 100 msec (method B) using SAPW from 24 patients with idiopathic PAF and 34 normal controls. Absolute powers in frequency bands above 20, 30, 40, 60, and 80Hz (P20, P30, P40, P60, and P80) and power ratios about these frequencies (PR20, PR30, PR40, PR60, and PR80) were calculated. Patients had greater P30, P60, and P80 using method A (P30: 28.6 [+/- 2.2] vs 22.8 [+/- 1.6] microV2.s; P = 0.04; P60: 4.7 [+/- 0.5] vs 3.4 [+/- 0.3] microV2.s; P = 0.03; P80: 1.9 [+/- 0.2] vs 1.3 [+/- 0.09] microV2.s; P = 0.01) but differences were smaller with method B. Moving the P wave endpoint 10 msec into the P wave had no effect on frequency domain parameters using method A but produced important changes using method B. Both methods were also applied to test signals of different durations but equal powers and power ratios. Method A gave predicted values for power and PR40 at all signal durations, but method B produced variable results. Frequency domain analysis of the SAPW shows significant increases in P wave energy in patients with PAF compared to controls. Analysis of the entire P wave is influenced less by signal duration and variations of the P wave endpoint than analysis of the terminal P wave alone and may define patient and control populations more precisely.

Algorithms↗

PubMed1995

Signal-averaged electrocardiography of the sinus and paced P wave in sinus node disease.

The detection of paroxysmal atrial fibrillation (AF) in patients requiring a permanent pacemaker for sinus node disease may influence the choice of both pacemaker and programmed mode. While signal-averaged ECG of the P wave (SAEP) during sinus rhythm may detect patients with paroxysmal AF, the value of SAEP in the presence of sinus node disease is unknown. We therefore evaluated SAEP in patients with sinus node disease during sinus rhythm and atrial pacing. We investigated 10 patients with sinus node disease alone (SND), 10 with sinus node disease and paroxysmal AF (SND-PAF), and 20 normal controls (NC) using a P wave specific, signal-averaging system. In sinus rhythm, duration and energy were greater in SND-PAF than in SND and NC (mean [SEM] duration: 153 [4] msec, 140 [4] msec, and 134 [2] msec, P < 0.001; energy from 20-150 Hz: 76 [18] muV2.sec, 48 [7] muV2.sec, and 36 [3] muV2.sec, P = 0.006). Atrial pacing in SND-PAF produced an 11% prolongation of atrial activation but little further abnormality in P wave characteristics. In SND, atrial pacing caused a 20% prolongation of the P wave and increased P wave energy to a greater extent than in SND-PAF. We conclude that in patients with SND, atrial activation appears similar to normal controls during sinus rhythm but changes significantly on pacing. In patients with SND-PAF, atrial activation is abnormal during sinus rhythm with little further change when the atrium is paced. SAEP may be useful in detecting a predisposition to paroxysmal AF in the presence of sinus node disease and might help optimize pacemaker prescription.

Adult↗

PubMed1995

Effect of bran particle size on gastric emptying and small bowel transit in humans: a scintigraphic study.

Bran is an effective treatment for constipation but its use is often limited by heartburn and bloating. This study examined the effect of fine and coarse bran (15 g) on the gastric emptying and small bowel transit of a 325 kcal rice test meal. Twelve healthy volunteers underwent a three way cross over study, ingesting the technetium-99m labelled rice meal with or without 15 g of indium-111m labelled fine or coarse bran, in random order. Serial scintigraphic images were obtained to define gastric emptying and colonic arrival of label. Compared with control values (99 (9) minutes) (mean (SEM)), the time to 50% gastric emptying was significantly delayed by coarse but not fine bran, being 121 (6) and 104 (9) minutes respectively, p < 0.05, n = 12. Fundal emptying was unchanged but both brans seemed to increase the proportion of isotope in the antrum at 90 minutes. Small bowel transit was slightly faster with both bran types but in this study the difference was not significant. Both the bran and rice labels moved down the gut without significant separation. Fine bran causes less disturbance of gastric physiology than coarse bran.

Adult↗

PubMed1995

Optimal analysis of the signal averaged P wave in patients with paroxysmal atrial fibrillation.

OBJECTIVE: To define the ability of analysis of the signal averaged P wave to identify patients with paroxysmal atrial fibrillation (AF) and establish whether differences in quantitative variables between patients and controls are due to concurrent cardiopulmonary disease, greater atrial dimension, or to unrelated changes in atrial electrophysiology. DESIGN: An observational parallel group study. SETTING: Cardiac department of a busy district general hospital. PATIENTS: 58 participants without cardiopulmonary disease (24 with paroxysmal AF and 34 controls, group A) and 57 with cardiac or respiratory conditions (31 with paroxysmal AF and 26 controls, group B). Mean (range) age of patients was 54 (25-71) and controls 53 (34-78) for group A and 65 (45-81) and 62 (36-78) respectively for group B. Left atrial size was similar in patients and controls in each group (mean (SEM)) group A: 2.39 (0.1) v 2.19 (0.07) cm; group B: 2.51 (0.10) v 2.71 (0.12) cm). MAIN OUTCOME MEASURES: Analysis of the P wave after P-wave-specific signal averaging. Filtered P wave duration and spatial velocity were calculated. Energies contained in frequency bands from 20, 30, 40, 60, and 80 to 150 Hz after spectral analysis were expressed as absolute values (P20, P30 etc) and ratios of high to low frequency energy (PR20, PR30, etc). RESULTS: Duration and peak spatial velocity were increased in patients with paroxysmal AF (median (interquartile range) duration group A: 144 (137-155) v 136 (129-143) ms, P = 0.007; group B: 155 (144-159) v 142 (136-151) ms, P = 0.002; peak spatial velocity group A: 16.5 (14.1-21.2) v 14.5 (11.7-18.1) mV/s, P = 0.02; group B: 18.9 (14.8-21.8) v 14.3 (12.6-17.6) mV/s, P = 0.01). Energy contained in frequency bands from 20, 30, 40, 60 and 80 to 150 Hz was expressed as absolute values (P20, P30, P40, P60, and P80) and percentage energy ratios. P30, P60, and P80 were significantly greater in patients with AF in group A (for example P60: 3.9 (3.0-5.3) v 3.1 (2.0-4.3) microV2.s, P = 0.02) and P20, P30, and P40 were increased in those with AF in group B (for example P40: 16.7 (9.9-20.8) v 10.8 (8.1-14.8) microV2.s, P = 0.02). A score developed from logistic regression analysis of duration and P60 identified patients with paroxysmal AF with a sensitivity of 81% and specificity of 73%. CONCLUSIONS: Increased P wave duration and magnitude are associated with paroxysmal AF with and without additional cardiopulmonary disease. The discriminant ability of the signal averaged P wave is improved by analysis of duration and a magnitude variable. These results invite prospective assessment of the ability of the signal averaged P wave to predict paroxysmal AF in unselected patients.

Adult↗

PubMed1995

Effect of low dose sotalol on the signal averaged P wave in patients with paroxysmal atrial fibrillation.

OBJECTIVE: To investigate the effects of low dose sotalol on the signal averaged surface P wave in patients with paroxysmal atrial fibrillation. DESIGN: A longitudinal within patient crossover study. SETTING: Cardiac departments of a regional cardiothoracic centre and a district general hospital. PATIENTS: Sixteen patients with documented paroxysmal atrial fibrillation. The median (range) age of the patients was 65.5 (36-70) years; 11 were men. MAIN OUTCOME MEASURES: Analysis of the signal averaged P wave recorded from patients not receiving antiarrhythmic medication and after 4-6 weeks' treatment with sotalol. P wave limits were defined automatically by a computer algorithm. Filtered P wave duration and energies contained in frequency bands from 20, 30, 40, 60, and 80 to 150 Hz of the P wave spectrum expressed as absolute values (P20, P30, etc) and as ratios of high to low frequency energy (PR20, PR30, etc) were measured. RESULTS: No difference in P wave duration was observed between the groups studied (mean (SEM) 149 (4) without medication and 152 (3) ms with sotalol). Significant decreases in high frequency P wave energy (for example P60: 4.3 (0.4) v 3.3 (0.3) microV2.s, P = 0.003) and energy ratio (PR60: 5.6 (0.5) v 4.7 (0.6), P = 0.03) were observed during sotalol treatment. These changes were independent of heart rate. CONCLUSIONS: Treatment with low dose sotalol reduces high frequency P wave energy but does not change P wave duration. These results are consistent with the class III effect of the drug and suggest that signal averaging of the surface P wave may be a useful non-invasive measure of drug induced changes in atrial electrophysiology.

Adult↗

PubMed1995

Immunocytochemical localization of the sites of superoxide dismutase induction by hyperoxia in rat lungs.

BACKGROUND: Rats exposed to 85% O2 can survive subsequent exposures to 100% O2. The development of this tolerance to oxygen toxicity is associated with an increase in total pulmonary content of both CuZn and Mn superoxide dismutases (SOD). It is not known, however, in which cells increases in these antioxidant enzymes occur. We carried out an electron microscopic immunocytochemical study to define the distribution of CuZnSOD and MnSOD and their sites of induction in rat lungs. EXPERIMENTAL DESIGN: The lungs of rats exposed to either air or 85% O2 were fixed by instillation of fixative 7 and 14 days after the exposures were started. Cryoultrathin sections were prepared from randomly selected, frozen tissue blocks and were immunolabeled for either CuZnSOD or MnSOD. The labeling densities of the two enzymes in the major alveolar parenchymal cells (type I and type II epithelial cells, interstitial fibroblasts, and endothelial cells), were evaluated. RESULTS: All of the alveolar septal cells studied displayed similar concentrations of CuZnSOD. After 7 or 14 days of exposure to 85% O2, the total lung content of CuZnSOD was increased because of cell hyperplasia and hypertrophy, but the intracellular concentrations of CuZnSOD did not increase. MnSOD was present in the mitochondria of all lung cells in control rat lungs but was highest in alveolar type II epithelial cells. Exposure to 85% O2 increased the concentration of MnSOD in the mitochondria of interstitial fibroblasts by 197 and 139% after O2 exposure of 7 days and 14 days, respectively. A significant induction of MnSOD also occurred in the mitochondria of alveolar type II cells after 7 days of hyperoxia exposure. Biochemical analyses showed that a significant fraction of the hyperoxia-induced MnSOD was in the form of an enzymatically inactive protein. CONCLUSIONS: Hyperoxia induced total lung CuZnSOD in proportion to lung cell hypertrophy and hyperplasia. Total lung MnSOD was increased in association with specific inductions of MnSOD protein expression in the mitochondria of type II alveolar epithelial cells and interstitial fibroblasts. Hyperoxia appeared to result in inactivation and accumulation of the inactive MnSOD as well as induction of enzymatically active MnSOD. The ability of fibroblasts and alveolar type II cells to replace inactive MnSOD or to augment active MnSOD in the mitochondria appears to play important roles in the development of tolerance to hyperoxia by rats.

Animals↗

PubMed1995

Assessment of the practicality and safety of thrombolysis with anistreplase given by general practitioners.

BACKGROUND: Recent guidelines recommend that patients with obvious acute myocardial infarction receive thrombolysis, unless contraindicated, within 60-90 minutes of summoning assistance. If this target is to be achieved, an increasing number of general practitioners are likely to be involved in the administration of thrombolytic agents. AIM: This study aimed to assess the practicality and safety of thrombolysis with anistreplase when given by general practitioners. METHOD: An observational study was conducted in 805 general practices throughout the United Kingdom. Between March 1991 and September 1992, a total of 3383 patients with a clinical diagnosis of myocardial infarction were recruited--888 by 344 general practitioners who wished to include anistreplase in their management of myocardial infarction ('user' group) and 2495 by 776 general practitioners who did not wish to use anistreplase but who were willing to provide information about their cases ('comparison' group). RESULTS: More than half the patients were seen within two hours of onset of symptoms. A high frequency of contra-indications to thrombolysis, diagnostic uncertainty, and other, mainly practical, reasons limited the number of occasions on which anistreplase was administered. Thus, only 310 patients were given anistreplase in the community. The general practitioners in the study used anistreplase safely. Their diagnostic accuracy was high (of the 310 patients given anistreplase 69% had a definite, possible or probably myocardial infarction, 4% a definite non-cardiac diagnosis), the number of patients given anistreplase in spite of a documented contraindication was small (seven patients), and the doctors appeared to be aware of potential bleeding problems associated with thrombolysis. In all cases, the complications of acute myocardial infarction appeared to be managed appropriately. CONCLUSION: General practitioners can use anistreplase both appropriately and safely in the early management of acute myocardial infarction. Recognized contraindications to thrombolysis and practicalities of diagnosis and drug administration may, however, limit the number of occasions on which anistreplase is used.

Adult↗