PURPOSE: To highlight the importance of detecting bronchial arteries of anomalous origin in patients with massive or recurrent hemoptysis. METHODS: In a series of 300 patients submitted to bronchial embolization in our hospital since 1986, we found 25 (8.3%) with 27 anomalous bronchial arteries. Eighteen patients presented with recurrent hemoptysis (10 massive) and seven with their first episode of massive hemoptysis. RESULTS: Of the 27 anomalous bronchial arteries demonstrated, 24 originated from the aortic arch, one from the left thyrocervical trunk, one from the right subclavian artery, and one from the lower descending thoracic aorta; two of the arteries demonstrated showed no pathological findings. Hemoptysis resolved following the first embolization in 14 patients (56%). In nine patients (36%) more than one procedure was necessary to arrest hemorrhage. In two patients surgical intervention was required. One patient died from bleeding. CONCLUSIONS: In cases of hemorrhage when the cause is not easily identified, or in cases of recurrence in spite of accurate embolization of pathological arteries, the presence of bronchial arteries of anomalous origin should be considered. Embolization is more difficult in these cases and there is an increased risk of complications.

Adolescent↗

PubMedDate not supplied

The serum level of xenoantibodies, and hDAF or alphaGAL expression on pig cells, modulate in vitro the protection given by hDAF to primate complement-mediated damage.

The ability of human complement regulatory molecules to prevent xenograft rejection following pig-to-primate xenotransplantation is limited. We assayed the efficacy of transgenic human decay accelerating factor (hDAF) expressed on porcine cells to inhibit the in vitro complement activity of primate sera. We measured the cytotoxic activity of baboon or human sera against peripheral blood lymphocytes (PBLs) from hDAF or nontransgenic pigs using a flow cytometry complement-mediated cytotoxicity assay (FCCA). We also analyzed the anti-Galalpha1-3Gal (alphaGal) antibody titer of the baboon sera by ELISA and the expression of hDAF and alphaGal on the PBL surface by immunofluorescence. Transgenic hDAF expression was capable of protecting pig cells against injury produced by both baboon and human serum. However, the hDAF molecule was more efficient against human than baboon sera. The humoral cytotoxicity capacity correlated with the level of both IgG and IgM anti-alphaGal antibodies. In addition, inhibition of complement-mediated cytotoxicity of hDAF pig cells correlated with the expression of hDAF and alphaGal molecules on target cells. These results confirm in vitro the protective role of hDAF in pig cells to heterologus complement mediated damage, but they also suggest that protection decreases in the presence of high levels of anti-porcine antibodies in serum, low expression of hDAF, or high expression of alphaGal on pig cells.

Animals↗

PubMedDate not supplied

Twice daily netilmicin therapy in paediatric patients with systemic infections.

This open investigation evaluated twice daily administration of netilmicin in infants and children with systemic infections. Thirty-four patients aged 2-41 months, were enrolled; 28 and 34 were evaluable for efficacy and safety, respectively. Netilmicin was administered intravenously or intramuscularly every 12 h at a dosage of 2.0-4.4 mg/kg (mean 3.5 mg/kg) for 5-15 days (mean 11 days). Throughout the trial, signs and symptoms of infection were evaluated in conjunction with laboratory data to determine patients' clinical response; specimens from appropriate sites were cultured to determine bacteriological response; and laboratory tests were performed to monitor haematopoietic, hepatic and renal functions. Peak and trough serum netilmicin levels were measured during treatment. Clinical responses included complete resolution in 26/28 (93%) patients, improvement in 1/28 (4%) and failure in 1/28 (4%). Bacteriological responses included elimination of 34/36 (94%) pathogens and persistence of 1/36 (3%); response was indeterminate for 1/36 (3%). Peak serum netilmicin levels of 5.1-14.1 micrograms/ml and trough serum netilmicin values of 0.1-1.5 micrograms/ml remained within acceptable ranges during treatment. No clinically significant changes in haematopoietic, hepatic and renal functions were evident during the trial. Untoward reactions were limited to redness and/or induration at the administration site in 4/34 (12%) patients.

Bacteria↗