Intermittent regional therapy with rt-PA is not superior to systemic thrombolysis in deep vein thrombosis (DVT)--a German multicenter trial.

In a prospective and randomized multicenter trial the efficacy of intermittent regional and systemic thrombolytic therapy for DVT was evaluated. 137 patients with phlebographically confirmed acute DVT above the calf region were treated with 20 mg of rt-PA for 4 h each day. Thrombolysis was applied either locally via a dorsal pedal vein of the firmly bandaged affected leg or systemically using a cubital vein. Treatment lasted for 4-7 days, and during this time unfractionated heparin was applied continuously with the dosage adjusted according to aPTT (1.5-2.0 times the normal value). A second phlebography was performed within 24 h after the end of treatment. Results were evaluated by an independent radiologist who was unaware of the treatment given. Significant thrombolytic results (e.g. lysis of more than 50% of the original thrombus and complete recanalization of all affected veins) were reached in only 1/3 of all patients. Rates of recanalization did not differ in both groups and bleeding complications occurred in 26.5%. We conclude that intermittent local or systemic application of 20 mg rt-PA seems to be ineffective in the treatment of DVT.

[Topic-centered discussions in ambulatory coronary groups--a report of experiences]. / Themenzentrierte Gespräche in ambulanten Koronargruppen--Ein Erfahrungsbericht.

Based on an introductory discussion of aspects involved in the nature of counselling in coronary patients and the problem of linkage between theoretical information and day-to-day living, a concept is set out for theme-centered counselling in the framework of out-patient coronary groups. Coping with the disease experience, reflecting the physical and psychosocial impact of the disease and its sequels, developing revised patterns of behaviour in dealing with stress and strain, as well as reassessing personal philosophies are suggested as essential objectives. Counselling techniques and contents of the approach implemented are outlined on the example of a group in existence for two years. The hitherto most important experience is that support within and by the group is the more effective, the more the group counselling process is pertinent to the social reality experienced by the various participants.