David Sauer

Oregon Health and Science University, Portland, OR, United States

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Publications (17)46.46 Total impact

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    ABSTRACT: Mechanical ventilation is necessary for patients with acute respiratory failure, but can cause or propagate lung injury. We previously identified cyclooxygenase-2 as a candidate gene in mechanical ventilation-induced lung injury. Our objective was to determine the role of cyclooxygenase-2 in mechanical ventilation-induced lung injury and the effects of cyclooxygenase-2 inhibition on lung inflammation and barrier disruption. Mice were mechanically ventilated at low and high tidal volumes, in the presence or absence of pharmacologic cyclooxygenase-2-specific inhibition with 3-(4-methylsulphonylphenyl)-4-phenyl-5-trifluoromethylisoxazole (CAY10404). Lung injury was assessed using markers of alveolar-capillary leakage and lung inflammation. Cyclooxygenase-2 expression and activity were measured by Western blotting, real-time PCR, and lung/plasma prostanoid analysis, and tissue sections were analyzed for cyclooxygenase-2 staining by immunohistochemistry. High tidal volume ventilation induced lung injury, significantly increasing both lung leakage and lung inflammation relative to control and low tidal volume ventilation. High tidal volume mechanical ventilation significantly induced cyclooxygenase-2 expression and activity, both in the lungs and systemically, compared with control mice and low tidal volume mice. The immunohistochemical analysis of lung sections localized cyclooxygenase-2 expression to monocytes and macrophages in the alveoli. The pharmacologic inhibition of cyclooxygenase-2 with CAY10404 significantly decreased cyclooxygenase activity and attenuated lung injury in mice ventilated at high tidal volume, attenuating barrier disruption, tissue inflammation, and inflammatory cell signaling. This study demonstrates the induction of cyclooxygenase-2 by mechanical ventilation, and suggests that the therapeutic inhibition of cyclooxygenase-2 may attenuate ventilator-induced acute lung injury.
    American Journal of Respiratory Cell and Molecular Biology 05/2012; 47(3):387-94. · 4.15 Impact Factor
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    ABSTRACT: Lymphoceles are benign neck cysts that are important to differentiate from congenital, infectious, and malignant cystic neck masses because they require unique surgical treatment and follow-up. We reviewed a series of surgically proven lymphoceles to delineate the radiologic characteristics of lymphoceles that differentiate them from other cystic neck masses. A search of radiology report impressions for the terms "lymphocele" and "lymphatic cyst" was performed on all neck CT, MRI, and sclerotherapy studies from January 2003 to December 2009 at our institution. Clinical and pathology records were searched for the same terms to identify additional cases. Medical records confirmed diagnosis. Study images were reviewed on PACS to assess cyst location and imaging characteristics. There were nine patients (six women and three men; age range, 22-85 years; mean age, 50.1 years) with 12 pathologically proven lymphoceles on six contrast-enhanced CT and three contrast-enhanced MRI examinations. Lymphoceles were located in the posterior cervical space in 12 of 12 and supraclavicular in 10 of 12 cases. Lymphoceles were unilocular nonseptated cysts in 12 of 12, fluid density or signal in 11 of 12, nonenhancing in 12 of 12, and lacked a cyst wall in eight of 12. Lymphoceles are rare unilocular cystic neck masses that may mimic other congenital, infectious, and malignant neck cysts. When enhanced CT or MRI shows a unilocular, nonseptated, fluid density or intensity, and nonenhancing supraclavicular cyst in the posterior cervical space, lymphocele is an important part of the differential diagnosis. Atypical features warrant fine-needle aspiration or follow-up for confirmation.
    American Journal of Roentgenology 12/2011; 197(6):1431-5. · 2.90 Impact Factor
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    ABSTRACT: Partial anomalous pulmonary venous drainage (PAPVD) to the azygous vein and benign posterior mediastinal hemangioma in adults are both rare entities in isolation. The coexistence of these two lesions in the same patient has not been reported. We describe a unique case of PAPVD to the azygous vein in an adult woman, where the anomalous left inferior pulmonary vein transited first through a large hemangioma, and then eventuated in the azygous vein.
    Annals of Vascular Surgery 05/2011; 25(4):559.e13-7. · 0.99 Impact Factor
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    ABSTRACT: Le drainage veineux pulmonaire anormal partiel (PAPVD) dans la veine azygos et les hémangiomes médiastinaux postérieurs bénins de l'adulte sont deux entités rares isolées. La coexistence de ces deux lésions chez le même patient n'a pas été rapportée. Nous décrivons un cas unique de PAPVD dans la veine azygos chez une femme adulte, où la veine pulmonaire inférieure gauche anormale transitait d'abord par un grand hémangiome, avant d'aboutir à la veine azygos.
    Annales de Chirurgie Vasculaire. 05/2011; 25(4):601.e13–601.e17.
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    ABSTRACT: BACKGROUND:: Populations at risk for esophageal adenocarcinoma remain poorly defined. Laryngeal symptoms can be secondary to laryngopharyngeal reflux (LPR) and can occur without associated gastroesophageal reflux symptoms such as heartburn and regurgitation. GOAL:: We sought to determine the prevalence of Barrett esophagus (BE) in otolaryngology patients with laryngeal symptoms±typical gastroesophageal reflux disease (GERD) symptoms. STUDY:: We performed a cross-sectional study of otolaryngology clinic patients who reported laryngeal symptoms. Symptoms, medications, and exposure histories were obtained. Unsedated transnasal endoscopy was performed. Suspected BE was biopsied and confirmed histologically. Risk factors and prevalence of BE were assessed. RESULTS:: Two hundred ninety-five patients were enrolled [73% male, median age 60 y (interquartile range 51 to 68 y)]. The overall prevalence of BE was 11.8% (n=33). Antisecretory medication use was present in 56% (n=156) of patients at enrollment. Compared with patients without BE, patients with BE were more likely to be male (P=0.01) and to report occupational lung injury (P=0.001). Duration, but not severity of laryngeal symptoms, significantly increased the odds of BE (odds ratio, 5.64; 95% confidence interval, 1.28-24.83; for a duration of symptoms >5 y). Of patients with BE, 58% (n=19) had coexisting LPR and GERD symptoms and 30% (n=10) had only LPR symptoms. Presence and size of hiatal hernia and length of columnar-lined esophagus were significant risk factors for BE. CONCLUSIONS:: Long-standing laryngeal symptoms are associated with the presence of BE in otolaryngology patients. Patients with chronic laryngeal symptoms and no identifiable ear, nose, or throat etiology for those symptoms may benefit from endoscopic screening regardless of whether typical GERD symptoms are present.
    Gastroenterology 01/2011; 140(5). · 12.82 Impact Factor
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    ABSTRACT: To determine the risk of nodal metastases to the central compartment from differentiated papillary thyroid carcinoma (PTC) relative to known prognostic variables. A 7-year single-institutional retrospective review. Tertiary academic center. A total of 115 patients undergoing central neck dissection (CND) for PTC or follicular variant PTC (FVPTC). Number, location, and positivity of lymph nodes for malignant disease in the central compartment based on patient age, sex, extrathyroidal extension, and primary tumor size, histologic type, and focality. Eighty-seven percent of patients had PTC, and 13% had FVPTC. Bilateral (64%) or ipsilateral (36%) CND was performed in patients with PTC. Patients with FVPTC underwent only ipsilateral CND. There was no significant difference in the number of lymph nodes retrieved based on patient age or sex, histologic type of the primary tumor, size or focality, or surgeon or pathologist. Seventy-eight percent of patients with PTC had malignant lymph nodes in the ipsilateral (75%) or bilateral/contralateral (69%) central compartment. Ipsilateral nodal metastases directly correlated with tumor multifocality (r = 0.93; P = .001) and size (r = 0.89; P = .001). Bilateral nodal metastases directly correlated with tumor multifocality (r = 0.92; P = .001) but was independent of size (r = 0.56; P = .001). No malignant lymph nodes were identified in the central compartment of FVPTC. Malignant central nodal metastases occur with high frequency in PTC but not in FVPTC. The risk of metastases correlated with the size and multifocality of the primary tumor. Additional studies are warranted to determine the extent of CND in patients with and without known multifocal disease and to determine the role of CND in patients with FVPTC.
    Archives of otolaryngology--head & neck surgery 07/2010; 136(7):692-6. · 1.92 Impact Factor
  • Otolaryngology - Head and Neck Surgery. 06/2010; 142(6):921.
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    ABSTRACT: Histological inflammation correlates with the degree of baseline olfactory dysfunction in patients with chronic rhinosinusitis (CRS); however, factors associated with improvement in olfactory status after endoscopic sinus surgery (ESS) remain elusive. Our purpose was to compare histopathological findings in CRS patients with olfactory loss and evaluate whether inflammatory markers can predict long-term olfactory improvement after ESS. Adult (> or = 18 years) patients with CRS were prospectively enrolled after electing ESS due to failed medical management. Mucosal tissue specimens were collected at the time of surgery and underwent pathological review in a blinded fashion. Subjects completed the 40-item Smell Identification Test (SIT) preoperatively and at least 6 months postoperatively. Multivariate logistic regression was used to identify histological factors associated with postoperative improvement in SIT score. The final cohort was comprised of 101 patients with a mean follow-up of 16.7 +/- 6.0 months. Mean mucosal eosinophil count was higher in patients with hyposmia and anosmia (p < 0.001). Patients with preoperative anosmia were more likely to have greater severity of basement membrane (BM) thickening compared with subjects with hyposmia or normosmia (p = 0.021). In patients with olfactory dysfunction, 54.7% reported olfactory improvement of at least 4 points on postoperative SIT scores. After controlling for nasal polyposis, histological variables were not associated with postoperative improvement in olfaction. Patients with severe olfactory dysfunction were more likely to have mucosal eosinophilia and BM thickening on ethmoid histopathological examination compared with normosmic patients. The presence of specific histological inflammatory findings did not, however, predict olfactory improvement after surgery.
    American Journal of Rhinology and Allergy 01/2010; 24(4):281-5.
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    ABSTRACT: Assess whether the presence of mucosal eosinophilia correlates with surgical outcomes in patients with chronic rhinosinusitis. Prospective cohort. Tertiary medical center. Adult patients with chronic rhinosinusitis were prospectively enrolled, and demographic data and medical comorbidities were recorded. Preoperative quality of life (QOL) was measured by the Chronic Sinusitis Survey (CSS), Rhinosinusitis Disability Index (RSDI), and Short Form-36 General Health Survey (SF-36). Sinus mucosal specimens were collected at the time of surgery and the degree of eosinophilia quantified. Postoperative QOL was measured, and differences in QOL improvement were compared between those with and without eosinophilia. A total of 102 patients had both histopathological and QOL outcome data available for review. Follow-up averaged 16.5 months. Patients with eosinophilia showed significantly less improvement in the RSDI total (17.9 vs 25.0; P = 0.044), RSDI functional (5.7 vs 8.8; general health subscale; P = 0.018), CSS medication (3.6 vs 17.3; P = 0.013), SF-36 general health (0.6 vs 9.6; P = 0.008), SF-36 physical role (16.1 vs 34.7; P = 0.036), and SF-36 vitality (11.9 vs 21.2; P = 0.034) scales than those without eosinophilia. The greatest improvement in QOL was seen in patients without eosinophilia or polyps, with the least improvement seen in those with eosinophilia but without polyps. The presence of mucosal eosinophilia at the time of surgery consistently predicted less improvement in both disease-specific and general QOL compared with patients without eosinophilia. The impact of eosinophilia on outcomes was greatest for patients without nasal polyposis, a group that demonstrated the least improvement in QOL measures.
    Otolaryngology Head and Neck Surgery 01/2010; 142(1):64-71. · 1.73 Impact Factor
  • Otolaryngology Head and Neck Surgery 10/2009; 141(4):545-6. · 1.73 Impact Factor
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    ABSTRACT: Describe detailed histopathologic findings from a cohort of patients with chronic rhinosinusitis and evaluate whether histologic measures correlate with baseline clinical factors. Cross-sectional study with planned data collection. Tertiary medical center. Adult patients with chronic rhinosinusitis were prospectively enrolled and demographic data and medical comorbidities recorded. Disease severity was measured by computed tomography (CT), endoscopy, Smell Identification Test (SIT), the Chronic Sinusitis Survey, Rhinosinusitis Disability Index, and SF-36 General Health Survey. Mucosal specimens were assessed for the presence of mucosal inflammation, including cellular (eosinophils, neutrophils, lymphocytes, mast cells, plasma cells, macrophages), epithelial (squamous metaplasia, basement membrane thickening, goblet cells), and stromal markers (subepithelial edema, fibrosis). Histopathologic findings were correlated to baseline clinical factors. A total of 147 subjects were enrolled with histologic samples available for review. Presence of inflammatory markers was diverse, with lymphocytes present in 100 percent of subjects, eosinophils in 49.7 percent, and neutrophils found in 0.7 percent. Total eosinophil counts correlated with the presence of nasal polyposis (r = -0.367; P < 0.001), asthma (r = 0.264; P = 0.001), and aspirin intolerance (r = 0.279; P = 0.001). Mucosal eosinophilia correlated with worse disease severity on CT (r = 0.414; P < 0.001), endoscopy (r = 0.376; P < 0.001), and SIT (r = -0.253; P = 0.002), with the highest correlations seen in subgroups without nasal polyps. Histopathologic findings did not significantly correlate with any quality-of-life measure. Mucosal eosinophilia correlates with objective disease severity as defined by CT, endoscopy, and SIT scores. Although other histologic markers of inflammation are present, none show similar correlations. The presence of mucosal eosinophils does not correlate with quality-of-life scores.
    Otolaryngology Head and Neck Surgery 10/2009; 141(4):454-61. · 1.73 Impact Factor
  • Archives of otolaryngology--head & neck surgery 08/2009; 135(7):720, 722. · 1.92 Impact Factor
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    ABSTRACT: Malakoplakia is a rare, chronic inflammatory condition characterized by defective macrophage function. The majority of cases involve the genitourinary tract, but isolated cases have been reported from other organ systems including one prior report involving the maxillary sinus. We present a case of malakoplakia expanding the frontal and ethmoid sinuses mimicking a mucocele at presentation. The diagnosis was made at the time of surgery based on the histopathologic finding of von Hasemann cells and Michaelis-Guttmann bodies. Sinus-specific clinical aspects will be discussed including diagnostic and treatment considerations. Laryngoscope, 2009
    The Laryngoscope 05/2009; 119(6):1233 - 1235. · 1.98 Impact Factor
  • The Laryngoscope 01/2009; 119(S3). · 1.98 Impact Factor
  • Rachel E Sanborn, David A Sauer
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    ABSTRACT: Chemotherapeutic and molecularly targeted agents are associated with a wide array of cutaneous toxicities. Despite the variety of toxicities, surprisingly little is understood regarding the pathogenesis underlying these reactions. This article reviews the most common cutaneous toxicities of cytotoxic chemotherapy and molecularly targeted systemic therapy, including extravasation of chemotherapy, with a discussion of the known and postulated underlying mechanisms of action. The need for developing a greater understanding of the basis of these reactions through more detailed study is evident.
    Dermatologic Clinics 02/2008; 26(1):103-19, ix. · 1.52 Impact Factor
  • Thyroid 09/2007; 17(8):799-800. · 3.54 Impact Factor
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    ABSTRACT: A major limitation to screening and surveillance of Barrett's esophagus is the complexity, expense, and risk associated with sedation for upper endoscopy. This study examines the feasibility, accuracy, and patient acceptability of office-based unsedated endoscopy as an alternative. Of 274 eligible adults scheduled for endoscopic screening for gastroesophageal reflux symptoms or surveillance of Barrett's esophagus at a tertiary care center, 121 underwent unsedated small-caliber endoscopy and conventional endoscopy in a randomized crossover study. The two procedures were compared with regard to histological detection of Barrett's esophagus and dysplasia and biopsy size. Patients answered questionnaires assessing the tolerability of the procedures. The prevalence of Barrett's esophagus was 26% using conventional endoscopy and 30% using unsedated endoscopy (P= 0.503). The level of agreement between the two approaches was "moderate" (kappa= 0.591). Each modality detected four cases of low-grade dysplasia with concordance on one case. The tissue samples collected with unsedated endoscopy were smaller than with conventional endoscopy (P < 0.001). The majority of subjects rated their experience with both procedures as being well tolerated with minimal or no difficulty. When asked which procedure they would prefer in the future, 71% (81/114) chose unsedated small-caliber endoscopy. Office-based unsedated small-caliber endoscopy is technically feasible, well tolerated, and accurate in screening for Barrett's esophagus, despite yielding a smaller biopsy specimen. This approach bears the potential to eliminate the infrastructure and cost required for intravenous sedation in this application.
    The American Journal of Gastroenterology 01/2007; 101(12):2693-703. · 7.55 Impact Factor