Use of Streptokinase-Dornase in Certain Surgical Conditions

Wright, Louis T.; Smith, David H.; Rothman, Milton; Metzger, William I.; Quash, Eugene T.

doi:10.1097/00006534-195207000-00027

Cited by 5 publications

(7 citation statements)

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“…This feature is well described in case reports. Persistence of PP is associated with occurrence of pericardial adhesions and loculation of pericardial effusion due to the presence of thick fibrin clots preventing complete evacuation of pus through pericardial drains or pericardiostomy [ 12 - 17 ]. Purulent discharge persists during several weeks and may lead to death due to septic shock or tamponade.…”

Section: Complicationsmentioning

confidence: 99%

“…At the stage of persistent PP, pericardiectomy is challenging and associated with high morbidity because of pericardial adherences and areas of fusion. Moreover, patients present with impaired general status [ 12 - 17 ]. Interestingly, this entity has not been previously defined or classified as a late complication of PP, resulting in a lack of epidemiological data.…”

Section: Complicationsmentioning

confidence: 99%

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Clinical review: Intrapericardial fibrinolysis in management of purulent pericarditis

et al. 2011

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Purulent pericarditis (PP) is a potentially life-threatening disease. Reported mortality rates are between 20 and 30%. Constrictive pericarditis occurs over the course of PP in at least 3.5% of cases. The frequency of persistent PP (chronic or recurrent purulent pericardial effusion occurring despite drainage and adequate antibiotherapy) is unknown because this entity was not previously classified as a complication of PP. No consensus exists on the optimal management of PP. Nevertheless, the cornerstone of PP management is complete eradication of the focus of infection. In retrospective studies, compared to simple drainage, systematic pericardiectomy provided a prevention of constrictive pericarditis with better clinical outcome. Because of potential morbidity associated with pericardiectomy, intrapericardial fibrinolysis has been proposed as a less invasive method for prevention of persistent PP and constrictive pericarditis. Experimental data demonstrate that fibrin formation, which occurs during the first week of the disease, is an essential step in the evolution to constrictive pericarditis and persistent PP. We reviewed the literature using the MEDLINE database. We evaluated the clinical efficacy, outcome, and complications of pericardial fibrinolysis. Seventy-four cases of fibrinolysis in PP were analysed. Pericarditis of tuberculous origin were excluded. Among the 40 included cases, only two treated by late fibrinolysis encountered failure requiring pericardiectomy. No patient encountered clinical or echocardiographic features of constriction during follow-up. Only one serious complication was described. Despite the lack of definitive evidence, potential benefits of fibrinolysis as a less invasive alternative to surgery in the management of PP seem promising. Early consideration should be given to fibrinolysis in order to prevent both constrictive and persistent PP. Nevertheless, in case of failure of fibrinolysis, pericardiectomy remains the primary option for complete eradication of infection.

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Section: Complicationsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

Clinical review: Intrapericardial fibrinolysis in management of purulent pericarditis

et al. 2011

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“…This requires frequent irrigation of the pericardial cavity with the above agents using large catheters, which liquifies the exudate. Streptokinase acts by dissolving blood clots and fibrinous exudate, and streptodornase liquefies the nucleoprotein of pus [17, 18]. Upon liquefaction, penetration to antibiotics can also be enhanced.…”

Section: Discussionmentioning

confidence: 99%

Staphylococcal Pericarditis Causing Pericardial Tamponade and Concurrent Empyema

Kondapi

Markabawi

Chu

et al. 2019

Case Reports in Infectious Diseases

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Bacterial pericarditis is a rare presentation and is usually due to secondary infection from a hematogenous cause or can occur secondary to trauma, intrathoracic surgery, or due to spread of infection from a contiguous focus via ligaments that anchor the pericardium to its surrounding structures. Its course is fulminant characterized by a high mortality rate from sepsis, tamponade, and constriction. We describe a rare case of Staphylococcus aureus pericarditis with concurrent unilateral empyema. The patient rapidly developed tamponade and was successfully treated with antibiotics and urgent percutaneous pericardial drainage with placement of a temporary catheter. Treatment for bacterial pericarditis typically is 4–6 weeks long. Thoracic surgery should be consulted as soon as possible to determine need for surgical intervention, as fibrin deposition may occur, making percutaneous drainage incomplete and leading to complications of persistent purulent pericarditis or constrictive pericarditis.

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“…Pericardial irrigation with streptokinase and streptodornase was first documented more than 40 years ago 3 . Despite its well documented success the method was rarely used in the management of purulent pericarditis.…”

Section: Discussionmentioning

confidence: 99%