Abstract WE ARE presenting our experience with the enzymatic agent fibrinolysin in the treatment of several surgical complications. One hundred instances in which the material was used are reviewed in order to evaluate its worth. The proenzyme, profibrinolysin, occurs naturally and circulates in human and animal plasma. The proenzyme becomes activated under certain circumstances during life and also post mortem. It has been shown that an extract of a Streptococcus culture, Lancefield A., possesses an enzyme activator which changes profibrinolysin to active fibrinolysin. This activator is streptokinase, which has itself been used in enzymatic débridement.1 Epinephrine and chloroform also have the ability to activate profibrinolysin. As early as 1893 a Frenchman, Dastre,2 called attention to the proteolytic activity of the blood serum. Fibrinolysin was first isolated in almost pure form in 1946 by E. C. Loomis and his associates.1a The material used in this study was obtained from References 1. (a) Loomis, E. C.; George, C., Jr., and Ryder, A.: Fibrinolysin: Nomenclature, Unit, Assay, Preparation and Properties , Arch. Biochem. 12:1-5 ( (Jan.) ) 1947. 2. (b) Christensen, L. R., and MacLeod, C. M.: Proteolytic Enzyme of Serum: Characterization, Activation, and Reaction with Inhibitors , J. Gen. Physiol. 28:559-583 ( (July) ) 1945.Crossref 3. (c) Tillett, W. S., and Garner, R. L.: Fibrinolytic Activity of Hemolytic Streptococci , J. Exper. Med. 58:485-502 ( (Oct.) ) 1933.Crossref 4. (d) Milstone, H.: Factor in Normal Human Blood Which Participates in Streptococcal Fibrinolysis , J. Immunol. 42:109-116 ( (Oct.) ) 1941. 5. Dastre, A.: Fibrinolyse dans le sang , Arch. de physiol. norm. et path. (Ser. 5) 5:661, 1893 6. Fibrinolyse: Digestion de la fibrine fraîche par les solutions salines faibles , Arch. de physiol. norm. et path. (Ser. 7) 5:408, 1895 7. Loomis, E. C.: Personal communication to the authors. 8. Seegers, W. H., and Loomis, E. C.: Prothrombin and Fibrinolysin , Science 104:461-462 ( (Nov. 15) ) 1946.Crossref 9. Curtis, G.: Personal communication to the authors. 10. Tillett, W. S.; Sherry, S.; Christensen, L. R.; Johnson, A. J., and Hazlehurst, G.: Streptococcal Enzymatic Debridement , Ann. Surg. 131:12 ( (Jan.) ) 1950.Crossref 11. Christensen, L. R.: Streptococcal Fibrinolysis: Proteolytic Reaction Due to Serum Enzyme Activated by Streptococcal Fibrinolysin , J. Gen. Physiol. 28:363-383 ( (March) ) 1945.Crossref 12. Daly, B. M.; Johnston, C. G., and Penberthy, G. C.: The Management of Patients with Bleeding from the Upper Gastrointestinal Tract with Buffer and Thrombin Solution , Ann. Surg. 129:832-839 ( (June) ) 1949.Crossref 13. Christensen, L. R., and Smith, D. H., Jr.: Plasminogen Purification by Acid Extraction , Proc. Soc. Exper. Biol. & Med. 74:840-844 ( (Aug.) ) 1950. 14. Biggs, R.; Macfarlane, R. G.; and Pilling, J.: Observations on Fibrinolysis: Experimental Activity Produced by Exercise or Adrenaline , Lancet 1:402-405 ( (March 29) ) 1947. 15. Margulis, R. R., and Pratt, J. P.: Use of a Naturally Circulating Fibrinolytic Enzyme in Surgical Diseases, in Surgical Forum: Proceedings of the Clinical Congress of the American College of Surgeons, 1952, Philadelphia, W. B. Saunders Company, to be published.
A.M.A. Archives Surgery – American Medical Association
Published: Oct 1, 1952
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