Bronchial artery embolization in the management of hemoptysis: technical aspects and long-term results

Seventy-five patients with hemoptysis were treated with bronchial artery embolization (BAE). The procedure was performed with Hexabrix (sodium methylglucamine ioxaglate), Mikaelson catheters, and Gelfoam particles. Angiographic evaluation of the bronchial artery anatomy revealed ten different configurations, which are described. The embolization attempt failed in three cases (4%); eight additional patients (10.7%) were excluded from the series because of inadequate data. In the remaining 64 patients, 41 underwent BAE alone and 23 underwent either chemotherapy or surgery in addition to embolization. Immediate control of hemoptysis was achieved in 49 of 64 patients (76.6%). Long-term control of hemoptysis was achieved in 46 of the 56 patients included in the long-term follow-up (82.1%). Eight of the 64 patients were lost to follow-up, which ranged from one to 47 months (mean 24.8 months). Hemoptysis recurred in 12 of 56 patients (severe in 10, mild in 2) (21.4%). Twelve patients died (21.4%), five of them due to hemoptysis (8.9%). None of the patients who died of hemoptysis had responded to initial BAE. It is concluded that BAE is an effective treatment for immediate control of life-threatening hemoptysis, allowing long-term control of bleeding in the majority of patients.     

Comparison of the performance of serum and urine hCG immunoassays in the evaluation of gynecologic patients

We conducted a study to compare the performance of serum and urine pregnancy tests in the evaluation of gynecologic patients presenting to our ED. The overall efficiency of the two tests was very similar: 99.5% for the serum test, and 97.6% for the urine test. In patients proven to have ectopic pregnancies, however, the serum test was positive in 100%; the urine test was positive in only 60%. The serum test misclassified (gave false-negative or false-positive results) in three of 607 patients (0.5%). The urine test misclassified 14 of 607 patients (2.3%). Moreover there were 18 inconclusive or invalid urine test results. Thus the urine test provided misinformation or no information in 32 of 607, or 5.3%, of the total study population.     

A nitrogen index — total body protein normalized for body size — for diagnosis of protein status in health and disease

Total body nitrogen (TBN) was measured in 121 volunteers. TBN depends on body size, with the best simple relationship being TBN α (HAS) ^2.6 for both men and women, where HAS is a mean of height and arm span. This relationship was used as a predictor of normal TBN. Weight and total body potassium (TBK) were considered for improving normalization, but rejected. Five patients with anorexia nervosa had only 71% of predicted nitrogen. Twelve patients with malabsorption syndrome initially had 68% of normal, but after a year of total parenteral nutrition this increased to 95%. On the other hand, 14 patients with renal failure initially had near normal nitrogen but after a year on continuous ambulatory peritoneal dialysis, nitrogen fell by 20%. TBN, when normalized for body size, provides a reliable index of protein status in clinical investigation and cannot be accurately predicted by weight or TBK.