| Profiles of local fibrinolytic activity before and after urokinase injection into the human empyema cavity. |
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Yong Hoon Kim, Jong Bong Kim, Jong Ho Moon, Dong Who Song, Hyeon Tae Kim, Dong Ho Yang, Sang Moo Lee, Soo Taek Uh, Choon Sik Park |
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Department of Internal Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital, Chunan & Seoul, Korea |
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| Abstract |
Background
In recent repoπs， it has been reported that increased coagulation and decreased fibrinolytic activity has been responsible for abnormal fibrin tumover in exudative pleural effusion.
In the cases of empyema, the fibrinopurulent stage is characterized by the fibrin deposition resulting in formation of limiting membranes in the visceral and parietal pleura. Recently attention has been focused on intrapleural fibrinolytic therapy capable of removing intrapleural fibrin deposits by urokinase (UK) in the treatment of empyema. However, these clinical trials have provided the clinical evidences for resolution of pleuralloculation after intrapleural urokinase injection (UK.injection), the profiles of fibrinolytic activity following the treatment were sti ll not investigated. Therefore in order to demonstrate the fibrinolytic evidences behind the clinical efficacy of intracavitary UK-injection,
we examined intrapleural plasminogen activator activity (PA-activity) and D-dimer (D-Di) concentrations before and after each repeated UK-injection into the pleura in subjects with loculated empyema cavlty.
Methods
In a group of 14 patients with multiple loculated empyema cavity, PA-activity and D-Di concentrations were measured before and after repeated UK-injection. One hundred thousand IU of UK was injected at each time and all sujects had at least two times of UK injection accoring to clinical decisions. Nine out of 14 sujects had three times of UK-injection.
Results
The mean (± SE) PA-activity prior to treatment was 10. 5 ± 7.0 and it was increased to 91.
9 ± 27.0, 432.3 ± 177.1, 170.0 ± 85 .3 IU tPA/ ml after first, second and third time of UK-injection respectively (p<0.01). D-Di concentrations were also increased from 4.16 ± 1. 06x105 to 9.62 ± 1. 54X 105 , 12.31 ± 1. 89 X 105 , 8.54 ± 1. 56 X 105 ng/ml in the same order as above (p < 0.05).
Conclusion
The suppressed fibrinolytic activity in the empyema cavity get removed significantly after intracavitary injection of urokinase by generation of additional intrapleural plasmin. |
| Key Words:
Urokinase, Empyema, Fibrinolysis |
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