Outcome and complications of bronchial artery embolisation for life-threatening haemoptysis.

BACKGROUND: Bronchial artery embolisation (BAE) has been established as an effective technique in the emergency treatment of life-threatening haemoptysis. However, few data concerning outcome are available. AIMS: To evaluate the short-term and long-term results of BAE in patients treated for life-threatening haemoptysis. METHODS: A retrospective analysis of eight patients with life-threatening haemoptysis treated with BAE. RESULTS: BAE resulted in an immediate cessation of haemoptysis in 7 (88%) patients. Long-term control of bleeding was achieved in five of these patients. Rebleeding occurred within 24 h in one patient, and two patients had recurrence of haemoptysis at 6 months and 1 year, respectively. In these three patients, repeat embolisation succeeded in the immediate control of haemoptysis, and no rebleeding was reported at 1-year follow-up. CONCLUSIONS: BAE is an effective procedure with which to stabilize patients with massive haemoptysis in the acute phase, and to definitively treat some patients in the longer term.

Uterine relaxant effects of cyclooxygenase-2 inhibitors in vitro.

OBJECTIVE: To compare the effects of three cyclooxygenase-2 (COX-2) inhibitors: nimesulide, meloxicam, and celecoxib, which exhibit varying COX-2 selectivity, on contractile activity in pregnant (before and after labor) and nonpregnant human myometrial tissue in vitro. METHODS: Isometric tension recording was performed under physiologic conditions in isolated myometrial strips obtained from 33 women undergoing hysterectomy or either elective or emergency cesarean section. The effects of cumulative additions of nimesulide, meloxicam, and celecoxib (between 1 nmol/L and 100 micromol/L) on myometrial contractility were measured, and values for -log(10) EC(50) and mean maximal inhibition were compared. RESULTS: Nimesulide, meloxicam, and celecoxib exerted significant relaxant effects on contractility in nonpregnant, pregnant nonlabor, and pregnant labor myometrial strips. Values for -log(10) EC(50) values (+/- standard error of the mean) were as follows: nimesulide (nonpregnant) 5.14 +/- 0.93 (n = 6), (pregnant nonlabor) 4.91 +/- 0.75 (n = 6), and (pregnant labor) 5.84 +/- 0.35 (n = 6); meloxicam (nonpregnant) 6.53 +/- 0.57 (n = 6), (pregnant nonlabor) 4.80 +/- 0.71 (n = 6), and (pregnant labor) 5.62 +/- 0.21 (n = 6); celecoxib (nonpregnant) 6.15 +/- 0.99 (n = 6), (pregnant nonlabor) 7.08 +/- 0.98 (n = 6), and (pregnant labor) 7.25 +/- 0.99 (n = 3). Celecoxib exhibited greater potency than nimesulide or meloxicam (P < .01). The range of maximal relaxation values achieved in the three tissue types were as follows: nimesulide 68-70% (n = 18; P < .01), meloxicam 69-84% (n = 18; P < .01), and celecoxib 69-77% (n = 15; P < .01). CONCLUSION: COX-2 inhibitors exert significant relaxation in human myometrium with a similar potency in nonpregnant and pregnant (before and after labor onset) tissues. Celecoxib, a COX-2 specific inhibitor, was more potent than nimesulide or meloxicam, COX-2 preferential inhibitors.

Human chorionic gonadotrophin inhibition of pregnant human myometrial contractility.

OBJECTIVE: To evaluate the effect of human chorionic gonadotrophin (hCG) on pregnant human myometrial contractility in vitro and to determine whether the hCG-elicited effect was oestrogen dependant. METHODS: Isometric tension recording was performed under physiological conditions in isolated myometrial strips from biopsies obtained at elective caesarean section. The effect of cumulative additions of hCG (0.001, 0.01, 0.1, 1.0 and 10 iu/mL) on myometrial contractility was evaluated. Secondarily, the contractile activity of pregnant myometrium following hCG exposure was investigated in tissue pre-treated with beta-oestradiol. RESULTS: hCG exerted a statistically significant relaxant effect on pregnant human myometrial tissue. The relaxant effect increased with increasing concentrations of hCG from 8.96% (SEM 2.06) (0.001 iu/mL hCG: P < 0.01 ) to a net cumulative total of 58.50% (SEM 3.74) (10 iu/mL hCG; P < 0.01). The relaxant effect was also time-dependant, increasing in magnitude throughout the duration of experiments. Beta-oestradiol did not significantly affect the response of myometrial tissue to hCG. CONCLUSIONS: These results clearly demonstrate that hCG exerts a significant concentration-dependant relaxant effect on human myometrial tissue obtained rate in pregnancy. These findings outline an inhibitory physiological role of hCG on human myometrial contractility and raise the possibility of its potential use as a tocolytic.

Effect of parathyroid hormone-related peptide on human and rat myometrial contractility in vitro.

OBJECTIVES: The aims of this study were primarily to investigate the effects of parathyroid hormone-related peptide (human fragment 1-34) on human nonpregnant and pregnant (nonlabor and labor) myometrial contractility in vitro and secondarily to compare these effects with those of parathyroid hormone-related peptide on rat myometrial contractility. STUDY DESIGN: Isometric tension recording was performed under physiologic conditions in isolated myometrial strips obtained at hysterectomy and cesarean delivery and from Sprague-Dawley rats. The effect of cumulative additions of parathyroid hormone-related peptide (1, 10, and 100 nmol/L) on myometrial contractility was measured and the significance of results was assessed by 2-way analysis of variance. RESULTS: Parathyroid hormone-related peptide exerted a statistically significant net relaxant effect on myometrial contractility in human nonpregnant myometrium (34.71%; P<.01), in human pregnant myometrium obtained before (18.27%; P <.05) but not after (10.32%; P>.05) the onset of labor, and in rat tissue (31.60%; P<.01). CONCLUSIONS: Parathyroid hormone-related peptide exerts a relaxant effect on human and rat myometrial tissue. In human myometrium, sensitivity to parathyroid hormone-related peptide is reduced in pregnancy and abolished by the onset of labor.