Streptococcal enzymatic debridement

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morrhagic hydrocephalus. Arch DisChild 1992;67:12-4.

3. Hudgins RJ, Boydston WR, HudginsPA, Adler SR. Treatment of intraven-tricular hemorrhage in the prematureinfant with urokinase. Pediatr Neuro-surg 1994;20:190-7.

4. Hansen A, Whitelaw A, Lapp C,Brugnara C. Cerebrospinal fluid plas-minogen activator inhibitor-l: a prog-nostic factor in posthemorrhagic hy-drocephalus. Acta Paediatr 1997;86:995-8.

5. Hansen AR. CNS fibrinolysis: a re-view of the literature with a pediatricemphasis. Pediatr Neurol 1998;18:15-21.

6. Hinderson P, Heidrich R, Endler S.Haemostasis in cerebrospinal fluid.Basic concept of antifibrinolytic thera-py of subarachnoid haemorrhage. ActaNeurochir Suppl 1984;34:1-77.

7. Whitelaw A, Creighton L, Craffney P.Fibrinolysis in cerebrospinal fluid afterintraventricuiar hemorrhage. Arch DisChild 1991;66:808-9.

8. Rao JS, Chen M, Festoff BW. Plas-minogen activator inhibitor 1, the pri-mary regulator of fibrinolysis, in nor-mal human cerebrospinal fluid. JNeurosci Res 1993;34:340-5.

9. Wood B, Katz V, Bose C, Goolsby R,Kraybill E. Survival and morbidity ofextremely premature infants based onobstetric assessment of gestational age.Obstet Gynecol 1989;74:889-92.

10. Pagano M, Gauvreau K. Principles ofbiostatistics. Belmont: Duxbury; 1993.p. 21.

50 Years Ago in The Journal of PediatricsSTREPTOCOCCAL ENZYMATIC DEBRIDEMENT

Blattner RJ. J Pediatr 1950;36:827-9

Dr Blattner penned this “Comment on Current Literature,” chronicling the then recent laboratory and clinical experi-ence with use of partially purified filtrates of broth cultures of hemolytic streptococci to reduce viscosity of fibrinousexudates. The preparations appeared to have modest efficacy in pleural exudates caused by infection, malignancy, andhemorrhage, with modest reactogenicity. The bacterial enzyme streptokinase and the kidney enzyme urokinase are nowpurified and neatly packaged for a wide variety of uses, an important one being the dissolution of occluding clots in crit-ical vascular structures.

For the microorganism, the enzymes are virulence factors, allowing tissue spread. They also account for some clinicalmanifestations that typify infection, such as the rapid progression of cellulitis, suppurative otitis media, and pneumoniawith hemorrhagic pleural effusion associated with group A streptococci. Medicine has stolen some streptococcal thun-der for its own uses.

Sarah S. Long, MDSection of Infectious Diseases

St. Christopher’s Hospital for ChildrenPhiladelphia, PA 19134-1095