ABSTRACT
AIMS: To establish whether the addition of enoxaparin (a low-molecular-weight heparin) to streptokinase therapy improves early and sustained coronary patency and clinical outcome in patients with evolving myocardial infarction. METHODS AND RESULTS: A total of 496 patients with acute myocardial infarction treated with streptokinase were randomized to an intravenous bolus (30 mg) and subcutaneous injections (1mg x kg(-1), twice daily) of enoxaparin (n=253), or placebo (n=243) for 3-8 days. The median duration of treatment in both groups was 5 days. ST-segment resolution at 90 min and 180 min measured by electrocardiogram was improved in patients receiving enoxaparin. Complete, partial and no ST-segment resolution at 180 min was observed in 36%, 44% and 19% in the enoxaparin group vs 25%, 44% and 31% in the placebo group, respectively (P=0.004). Assessment of the primary end-point revealed improved TIMI-3 flow with enoxaparin vs placebo (70% vs 58%, P=0.01). Combined TIMI-2 and -3 flow was also improved (88% vs 72%, P=0.001), as was TIMI frame count (P=0.003). The triple clinical end-point of death, reinfarction and recurrent angina at 30 days was reduced with enoxaparin (13% vs 21%, P=0.03). CONCLUSION: Streptokinase in combination with enoxaparin is associated with better ST-segment resolution and better angiographic patency at days 5-10, suggesting more effective reperfusion. This was associated with a significant reduction in clinical events, indicating less reocclusion.
Subject(s)
Enoxaparin/therapeutic use , Fibrinolytic Agents/therapeutic use , Myocardial Infarction/drug therapy , Streptokinase/therapeutic use , Thrombolytic Therapy/methods , Adult , Aged , Drug Therapy, Combination , Electrocardiography , Enoxaparin/adverse effects , Female , Fibrinolytic Agents/adverse effects , Humans , Male , Middle Aged , Myocardial Reperfusion/methods , Recurrence , Treatment OutcomeABSTRACT
Fulminant hepatitis was observed in a 44-year-old patient with cirrhosis, 38 days after the beginning of a treatment by disulfiram. Hepatitis was associated with fever and hypereosinophilia. Liver transplantation was performed with success. We reviewed 15 previously published cases of disulfiram-induced hepatitis. They occurred from 10 to 180 days after the beginning of the treatment by disulfiram, aminotransferases were increased whereas alkaline phosphatases were not markedly changed; there was either focal or widespread necrosis. Fulminant hepatitis was observed mainly in patients with alcoholic chronic liver disease or in patients who continued to ingest disulfiram while jaundice was already present. An immunoallergic mechanism is thought to be responsible for disulfiram-induced hepatitis.
Subject(s)
Chemical and Drug Induced Liver Injury/complications , Disulfiram/adverse effects , Liver Cirrhosis, Alcoholic/complications , Adult , Chemical and Drug Induced Liver Injury/metabolism , Chemical and Drug Induced Liver Injury/surgery , Disulfiram/therapeutic use , Humans , Liver Cirrhosis, Alcoholic/drug therapy , Liver Transplantation , MaleABSTRACT
Two men aged 28 and 33 were found to have subcapsular haematoma of the spleen secondary to chronic alcoholic pancreatitis. One of the patients presented with a pancreatic pseudo-cyst, left amylase pleural effusion and thrombosis of the splenic vein. Selective coeliac and mesenteric angiography and, chiefly, echotomography pointed to the diagnosis, which was confirmed on abdominal incision and histopathological study of the lesions. From these two cases and a review of 63 cases previously published the authors describe the clinical symptoms (acute anaemia with abdominal tumour), pathogeny (vascular or enzymatic) and diagnosis of the condition. Echotomography of the pancreas seems to be the best non invasive method to detect splenic complications of chronic pancreatitis.
Subject(s)
Hematoma/etiology , Pancreatitis/complications , Splenic Diseases/etiology , Adult , Chronic Disease , Hematoma/diagnosis , Humans , Male , Splenic Diseases/diagnosis , UltrasonographySubject(s)
Endoscopy , Intestinal Neoplasms/diagnosis , Polyps/diagnosis , Stomach Neoplasms/diagnosis , Adolescent , Adult , Female , Humans , Intestinal Polyps/diagnosisABSTRACT
The renal pedicles were identified in 83.5% of pancreases during echotomography. The horizontal relations together with the vertical relations represented by the abdominal aorta and inferior vena cava permit one to localise with precision the cephalic and corporeal parts of the pancreas for they are situated just in front. Analysis of the echostructure of the pancreas thus localised is greatly facilitated.
