Lytic therapy

Efforts to decrease the time until therapy was initiated to maximize both the rate of success of lytic therapy [fresher clots are more susceptible to lysis, especially with nonfibrin-specific agents (5)] and the impact of reperfusion on myocardial salvage led to a shift to intravenous administration of these drugs, which could be performed in the coronary care unit (CCU) or the emergency department (ED), saving 1-2 hours between diagnosis and the initiation of therapy. Trials performed with angiographic assessment after the initiation of thrombolytic therapy are patency studies infarct-related vessels found to be patent will include those that contained clot that was successfully dissolved by the therapy delivered, those that contained clot that resolved because of the body s own fibrinolytic mechanisms before therapy was instituted, and those that never had intracoronary thrombus as an occlusive event. 

Even as we continue to evolve better therapeutic approaches to reperfusion therapy in AMI, the most important factor in the short term may be ensuring that as many eligible patients as possible receive this potentially life-saving therapy. In a recent study from the NRMI data base, approximately 25% of patients who met the criteria for thrombolysis and had no apparent contraindications did not receive lytic therapy or primary PCI (60). An even more impressive finding from this study was that it was often the sickest patients who were not treated. 

Replication-competent viral HSV-l mutants (HSV-1716) lytic therapy Herpes simplex thymidine kinase Tumor-restricted viral replication and cytotoxicity Protocol pending... 

The primary goal in the treatment of multiple myeloma is to decrease tumor burden and minimize complications associated with the disease. A watch and wait approach is an option for asymptomatic patients who have no lytic lesions in the bone. Once symptoms occur, treatment is required. Chemotherapy can be used to reduce tumor burden in patients with symptomatic disease, but increasingly, immunomodula-tors such as thalidomide and dexamethasone are initial therapy. Almost all patients will become refractory to initial treatment and will require the use of salvage therapies such as bortezomib. Autologous stem cell transplantation prolongs overall survival in patients who can tolerate high-dose chemotherapy and may be the treatment of choice for many patients. 

Feng, W. H., Hong, G., Delecluse, H. J., and Kenney, S. C. (2004) Lytic induction therapy for Epstein-Barr virus-positive B-ceU lymphomas. J Virol. 78, 1893-1902. 

Drugs that decrease the coagulability of blood, such as coumarins andhep-arin (A), are employed for the prophylaxis of thromboses. In addition, attempts are directed at inhibiting the aggregation of blood platelets, which are prominently involved in intra-arterial thrombogenesis (p. 148). For the therapy of thrombosis, drugs are used that dissolve the fibrin meshwork->fibrino-lytics (p. 146). 

Tepes et al. reported the first clinical experience with abcix-imab and urokinase combination therapy in the peripheral circulation (44). Schweizer et al. used abciximab and rt-PA versus rt-PA with ASA in an 84 patient trial and found a significantly shorter duration of thrombolytic infusion was required to achieve lytic success in the combination group as well as improved clinical endpoints of less re-hospitalization, re-intervention, and amputation compared to ASA and heparin (45),... 

Corticosteroids are widely used throughout medical practice. In cancer therapy, prednisone and dexamethasone are the most frequently used. They have a lytic effect on lymphoma and myeloma cells, reduce the edema associated with brain metastases, reduce immunological and allergic reactions and exert an antiemetic effect alone and with 5-HT3 blockers. The many side effects of corticosteroids are often the consequence of the desired effect on the disease process being treated also impacting the normal tissues adversely. These toxicities are well known as they are seen throughout clinical medicine. 

Nafcillin (IV 3 to 6 g/24 hours in severe infections) is indicated for the treatment of infections due to penicillinase-producing staphylococci. It may be used to initiate therapy when a staphylococcal infection is suspected (see also Table 23). Like penicillins, nafcillin, inhibits the formation of cell walls and hence is bactericidal in nature. Penicillin binds to cellular receptors, now identified as transpeptida-tion enzymes, and, by binding to and inhibiting the transpeptidation reactions, the synthesis of cell wall pep-tidoglycan is interrupted. In addition, penicillin removes or inactivates an inhibitor of the lytic enzymes (autolysin). 

In the prefibrinolytic era, antithrombins were principally administered to patients with STEMI to reduce the risks of pulmonary embolism, stroke, and reinfarction. The theoretical benefits of conjunctive use of unfractionated heparin (UFH) with a fibrinolytic include the possibility of augmentation of the initial lytic effect, reduction of the risk of reocclusion of an initially successfully reperfused infarct artery (with attendant risk of reinfarction), and reduction of the risk of early mural thrombus formation (28). Despite the logic of these arguments, clinical trials of conjunctive use of UFH with fibrinolytic therapy produced confusing results that continue to impact on clinical practice. Synthesis of a large body of information on studies with UFH leads to several conclusions ... 

The clinical response to intravenous thrombolytic therapy in patients with acute myocardial infarction is often limited by failure to reperfuse the occluded coronary artery, despite evidence of a systemic lytic effect . Even in... 

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