Ketamine by continuous infusion in status asthmaticus

ZusammenfassungAsthma bronchiale stellt in Deutschland die häufigste chronische Erkrankung bei Kindern dar. 10% aller Kinder in Deutschland sind betroffen. Von diesen leiden 5% an einem schweren persistierenden Asthma bronchiale. Die Prävalenz hat in den letzten Jahren erheblich zugenommen und die Tendenz ist weiter steigend. Trotz deutlicher Fortschritte in der Therapie hat die Zahl schwerer Asthmaanfälle nicht abgenommen. Die Therapie des Status asthmaticus umfasst den intensiven Einsatz von inhalativen oder systemischen Sympathomimetika (β-adrenoceptoren-Agonisten), inhalativen Anticholinergika sowie antiinflammatorisch wirksamen Kortikosteroiden. Die Indikation zur Beatmung sollte zurückhaltend gestellt werden und nur Extremfällen vorbehalten sein. In dieser Arbeit sollen diagnostische Möglichkeiten und therapeutische Mittel aktuell dargestellt werden.

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Feasibility Study of Catheter-directed Thrombolysis with Recombinant Staphylokinase in Deep Venous Thrombosis

Thrombosis and Haemostasis ◽

10.1055/s-0037-1614936 ◽

1998 ◽

Vol 79 (03) ◽

pp. 517-519 ◽

Cited By ~ 13

Author(s):

Stephane Heymans ◽

Raymond Verhaeghe ◽

Luc Stockx ◽

Désiré Collen

Keyword(s):

Deep Vein Thrombosis ◽

Continuous Infusion ◽

High Speed ◽

Minor Bleeding ◽

Vein Thrombosis ◽

Catheter Directed Thrombolysis ◽

Long Term Follow Up ◽

Valve Function ◽

Rotating Impeller ◽

Deep Vein

SummaryThe feasibility of catheter-directed thrombolysis with recombinant staphylokinase was evaluated in six selected patients with deep vein thrombosis. The patients underwent intrathrombus infusion of recombinant staphylokinase (2 mg bolus followed by a continuous infusion of 1 mg/h). Heparin was given via the catheter as a bolus (5000 U) and as a continuous infusion (1000 U/h). Complete lyis was obtained in five patients and partial lysis in one patient. Complications consisted of minor bleeding in four subjects. Symptomatic reocclusion occurred in one. Debulking of the thrombus mass by a high speed rotating impeller (n = 1) and stenting (n = 3) were used as additional interventions. An underlying anatomical abnormality was present in two patients. Long term follow up revealed normal patency in all patients and normal valve function in four patients. Symptomatic venous insufficiency with valve dysfunction was present in the two with a second thrombotic episode.Thus catheter-directed infusion of recombinant staphylokinase in patients with deep vein thrombosis appears feasible and may be associated with a high frequency of thrombolysis. Larger studies to define the clinical benefit of this treatment appear to be warranted.

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Effects of Ellagic Acid upon the Rabbit Fibrinolytic System

Thrombosis and Haemostasis ◽

10.1055/s-0038-1649010 ◽

1972 ◽

Vol 27 (01) ◽

pp. 063-071

Author(s):

S. G Iatridis ◽

P. G Iatridis

Keyword(s):

Continuous Infusion ◽

Ellagic Acid ◽

Animal Experimentation ◽

Inhibitory Effect ◽

In Vivo Studies ◽

Clot Lysis ◽

Hageman Factor ◽

Lysis Activity ◽

Site Of Action

SummaryThe present investigation deals with in vivo studies of possible relations of active Hageman factor (HFa) to the problems of thrombolysis. The study is based upon animal experimentation in which 40 normal, 5 dicumarolized and 5 heparinized rabbits each received ellagic acid (Elac 10-2 M) by intravenous continuous infusion at a rate of 1 ml/min for a period of 25 min. The data suggest that the Elac infusion induced in vivo activation of HF. Streptokinase (SK) injection 25 min from the start of Elac i. v. infusion failed to induce clot lysis in blood drawn one min after its injection. The phenomenon was more prominent with low (SK 250 U or 500 U) concentrations of SK. With higher concentrations, SK-induced clot lysis activity was not affected by Elac infusion.In dicumarolized and heparinized rabbits Elac infusion still counteracted the fibrinolysis activating effect of low concentration of SK. The possibility that the above described phenomenon was due to either hypercoagulability or to a non-specific inhibitory effect of Elac upon SK was explored and excluded.It is concluded that HFa and SK have the same site of action. Thus it seems that HFa may block the precursor upon which SK acts by forming a complex with it. It is stressed that activation of this precursor by HFa requires a suitable surface.

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