Embolización bronquial en bronquiectasias / Bronchial artery embolization for bronchiectasias

Se presenta nuestra experiencia en el tratamiento de la hemoptisis con embolización bronquial en pacientes con bronquiectasias, desde el 2001 al 2008, en el Hospital Italiano de Buenos Aires. Veinte pacientes fueron tratados con este método: 12 mujeres y 8 hombres con una edad media de 51 años (15-83 años). Las causas de bronquiectasias fueron secundarias a infecciones inespecíficas en el 40%; otro 40% secuelas de tuberculosis y 20% por enfermedad fibroquística. La indicación de embolización fue hemoptisis mayor a 300 ml/24 hs o hemoptisis persistentes durante más de 3 días consecutivos con requerimiento de hospitalización. En el 85% de los casos se efectuó embolización bronquial y en el resto (15%) bronquial y mamaria. Este procedimiento fue bilateral en el 60% de los pacientes, 20% solo en el lado derecho y 20% del lado izquierdo. En 18 pacientes se logró oclusión vascular completa de todos los territorios pulmonares patológicos. Control agudo del sangrado fue obtenido en todos los pacientes (100%) y sólo dos presentaron nuevo sangrado a los 8 y 12 meses respectivamente. Como efecto colateral al tratamiento se observó dolor torácico leve y transitorio en dos pacientes. Concluimos que la embolización de las arterias bronquiales constituye un tratamiento adecuado y seguro para el control agudo de la hemoptisis en pacientes con bronquiectasias.

We present our experience on arterial embolization for the treatment of hemoptysis in patients with bronchiectasis between 2001 and 2008 at the Hospital Italiano in Buenos Aires. Twenty patients were treated with this method: 12 women and 8 men with a median age of 51 years (15-83 years). Bronchiectasis was secondary to bacterial infections in 40% and secondary to tuberculosis infection in 40% of the patients; 20% of the patients had cystic fibrosis. Embolization was prescribed when the hemoptysis was above 300 ml/24 hours or the hemoptysis was persistent for more than 3 consecutive days and the patient’s hospitalization was required. In 85% of the cases embolization was done only in bronchial arteries and in the remaining 15% in bronchial and mammary arteries. The procedure was bilateral in 60% of the patients, only on the right side in 20% and only on the left side in 20%. In 18 patients complete occlusion was achieved. Complete control of the bleeding was obtained in 100% of patients. Only two patients had a new bleeding, 8 and 12 months later respectively. The treatment side effects were slight and transitory thoracic pain in two patients. We concluded that the embolization of the bronchial arteries is a suitable and safe treatment to control hemoptysis in patients with bronchiectasis.

Association of BLV infection profiles with alleles of the BoLA-DRB3.2 gene.

Bovine leukaemia virus (BLV) causes lymphosarcoma and persistent lymphocytosis (PL). Some MHC class II gene polymorphisms have been associated with resistance and susceptibility to the development of lymphosarcoma and PL, as well as with a reduced number of circulating BLV-infected lymphocytes. Previously, 230 BLV-infected Holstein cattle were classified into two infection profiles characterized by low and high proviral loads (LPL and HPL respectively). Here, the influence of the polymorphism at the BoLA-DRB3.2* gene of these animals was examined. After genotyping, the association between the BoLA-DRB3.2* alleles and the BLV infection profile was determined as the odds ratio (OR). Two subtypes of allele *11 were identified (ISAG*0901 and *0902). Allele ISAG*0902 showed a stronger association with the LPL profile (OR = 8.24; P < 0.0001) than allele *11 itself (OR = 5.82; P < 0.0001). Allele ISAG*1701 (*12) also showed significant association with the LPL profile (OR = 3.46; P < 0.0055). Only one allele, ISAG*1501 or 03 (*16), showed significant association with HPL (OR = 0.36; P < 0.0005). The DRB3.2* alleles were assigned to three categories: resistant (R), susceptible (S) and neutral (N). Based on their DRB3 genotypes, cattle were classified as homozygous or heterozygous. The RR and RN genotypes were associated with the LPL profile, while the SS and NS genotypes were associated with the HPL profile. The RS genotype could not be associated with any particular profile. Our results show that allele ISAG*0902 appears to be the best BLV resistance marker in Holstein cattle.

Two-step (culture and PCR) diagnostic approach for differentiation of non-T. foetus trichomonads from genitalia of virgin beef bulls in Argentina.

Preputial fluids from 567 virgin Angus and Hereford bulls, 1-2 years old, were inoculated into Sutherland medium, and approximately 8.4% produced cultures with a protozoan suggestive of Tritrichomonas foetus. Under brightfield microscopy, large numbers of single-celled motile organisms with multiple anterior flagellae, a posterior flagellum, axostyle, and a visible undulating membrane were detectable. Motility was jerky and rolling, as described for T. foetus. Air-dried smears of cultures stained with Giemsa or Diff-Quick + iodine revealed an organism similar to T. foetus, although somewhat more rounded. Several organisms appeared to have four anterior flagellae. Scanning electron microscopy (5000x) of representative samples revealed four anterior flagellae on most organisms, and an axostyle that was consistently longer than that seen in T. foetus. Using pan-trichomonal primers and T. foetus-specific primers in a polymerase chain reaction (PCR) assay, amplification products of 372bp were detected in all virgin bull isolates, but only with the pan-trichomonal primers. Positive control isolates of T. foetus yielded amplification products of the expected size (372 and 347bp) with the two sets of primers, respectively. We conclude that these protozoa are not T. foetus, and note the similarity of these findings with those reported earlier in North American beef cattle. Because in several countries there is no legal treatment for bovine trichomonosis, veterinarians recommend slaughter of bulls with positive preputial cultures. The existence of easily mis-identified non-T. foetus trichomonads in the bovine prepuce suggests that the current "gold standard" diagnostic test (culture of preputial scrapings or washings) should be augmented with a more specific confirming test, such as the PCR employed in this study.

Development and evaluation of a highly sensitive and specific blocking enzyme-linked immunosorbent assay and polymerase chain reaction assay for diagnosis of bovine leukemia virus infection in cattle.

OBJECTIVE: To develop a blocking ELISA for detection of bovine leukemia virus (BLV) antibodies that is comparable to a radioimmunoprecipitation (RIP) assay, to evaluate use of this ELISA for identification of BLV-infected herds, and to develop a polymerase chain reaction (PCR) assay for direct diagnosis of infection with BLV. SAMPLE POPULATION: Serum samples and pooled bulk-tank milk samples from cattle. PROCEDURE: The blocking ELISA was developed, using BLV gp51 as antigen, captured by a selected bovine polyclonal serum. A nested PCR was conducted with primers specific for a segment of the pol region of the BLV genome. RESULTS: Sensitivity and specificity of the ELISA were comparable to those of the RIP assay. Use of the ELISA on pooled milk samples allowed identification of herds in which prevalence of BLV infection among lactating cows was as low as 2.5%. Pooled milk samples from BLV-free herds did not react in the ELISA. All cattle that had positive results for the nested PCR had BLV antibodies, but cattle with consistantly low antibody titers required examination of sequential DNA samples to detect viral sequences. None of the 63 antibody-negative cattle had positive results for the PCR. CONCLUSIONS AND CLINICAL RELEVANCE: This ELISA is a highly specific and sensitive assay for the detection of BLV antibodies in serum and milk samples of cattle. Examination of pooled milk samples with the ELISA provides a reliable, practical, and economic procedure for identification of BLV-infected herds. The nested PCR also constitutes a specific procedure for direct diagnosis of infection with BLV.

[pH-metric variables in gastroesophageal reflux in asthmatic patients]. / Variables pH-métricas en el reflujo gastro-esofágico del paciente asmático.

As there is an increased incidence of gastroesophageal reflux (GER) in asthmatic patients compared with the normal population, in the present trial we have tried to establish the following: 1) Possible differences in pH-metric variables between patients with GER and asthma, and asthmatic patients with or without GER 2) The usefulness of simultaneous evaluation and correlation of reflux episodes with the respiratory peak flow (EPF) in asthmatic patients. 31 patients divided in four groups were compared. A) 16 patients with typical symptoms of GER without respiratory symptoms. B) 10 asthmatic patients with GER symptoms. C) 5 asthmatic patients without GER symptoms. D) 15 asthmatic patients who represents the sum of B and C. In all patients ambulatory computerized, four hours pH recordings were obtained after standard meal. The study was divided in two equal periods (upright and recumbent). The EPF was measured before starting the study and every 20 min during the recumbent period. From de following pH-metrics variables: total number of reflux episodes, percentage of recording time when intra-oesophageal pH < 4 in the upright position or recumbent position and for the total period, duration of longest reflux episode, number of episodes longer than five minutes, and correlation between reflux episodes and patients symptoms. Only differences were seen when the time of the longer period with GER and the number of patients with more than five minutes episodes were compared between groups A and D. From the results we conclude that the GER in asthmatic patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Variables pH-métricas en el reflujo gastro-esofágico del paciente asmático. / [pH-metric variables in gastroesophageal reflux in asthmatic patients]

As there is an increased incidence of gastroesophageal reflux (GER) in asthmatic patients compared with the normal population, in the present trial we have tried to establish the following: 1) Possible differences in pH-metric variables between patients with GER and asthma, and asthmatic patients with or without GER 2) The usefulness of simultaneous evaluation and correlation of reflux episodes with the respiratory peak flow (EPF) in asthmatic patients. 31 patients divided in four groups were compared. A) 16 patients with typical symptoms of GER without respiratory symptoms. B) 10 asthmatic patients with GER symptoms. C) 5 asthmatic patients without GER symptoms. D) 15 asthmatic patients who represents the sum of B and C. In all patients ambulatory computerized, four hours pH recordings were obtained after standard meal. The study was divided in two equal periods (upright and recumbent). The EPF was measured before starting the study and every 20 min during the recumbent period. From de following pH-metrics variables: total number of reflux episodes, percentage of recording time when intra-oesophageal pH < 4 in the upright position or recumbent position and for the total period, duration of longest reflux episode, number of episodes longer than five minutes, and correlation between reflux episodes and patients symptoms. Only differences were seen when the time of the longer period with GER and the number of patients with more than five minutes episodes were compared between groups A and D. From the results we conclude that the GER in asthmatic patients.(ABSTRACT TRUNCATED AT 250 WORDS)