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P Marco Fisichella,
Christopher S Davis,
Peter W Lundberg,
Erin Lowery,
Ellen L Burnham,
Charles G Alex,
Luis Ramirez,
Karen Pelletiere,
Robert B Love, Paul C Kuo,
Elizabeth J Kovacs
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ABSTRACT: The goal of this study was to determine, in lung transplant patients, if laparoscopic antireflux surgery (LARS) is an effective means to prevent aspiration as defined by the presence of pepsin in the bronchoalveolar lavage fluid (BALF).
Between September 2009 and November 2010, we collected BALF from 64 lung transplant patients at multiple routine surveillance assessments for acute cellular rejection, or when clinically indicated for diagnostic purposes. The BALF was tested for pepsin by enzyme-linked immunosorbent assay (ELISA). We then compared pepsin concentrations in the BALF of healthy controls (n = 11) and lung transplant patients with and without gastroesophageal reflux disease (GERD) on pH-monitoring (n = 8 and n = 12, respectively), and after treatment of GERD by LARS (n = 19). Time to the development of bronchiolitis obliterans syndrome was contrasted between groups based on GERD status or the presence of pepsin in the BALF.
We found that lung transplant patients with GERD had more pepsin in their BALF than lung transplant patients who underwent LARS (P = .029), and that pepsin was undetectable in the BALF of controls. Moreover, those with more pepsin had quicker progression to BOS and more acute rejection episodes.
This study compared pepsin in the BALF from lung transplant patients with and without LARS. Our data show that: (1) the detection of pepsin in the BALF proves aspiration because it is not present in healthy volunteers, and (2) LARS appears effective as a measure to prevent the aspiration of gastroesophageal refluxate in the lung transplant population. We believe that these findings provide a mechanism for those studies suggesting that LARS may prevent nonallogenic injury to the transplanted lungs from aspiration of gastroesophageal contents.
Surgery 10/2011; 150(4):598-606. · 3.10 Impact Factor
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ABSTRACT: The concept of the tumor microenvironment, developed from Paget's "seed and soil" theory is made up of the cancer cells, the stromal tissue, and the extracellular matrix. In this mini-review, each of the components of this dynamic network will be examined. We will show that there are a multitude of complex interactions and a host of molecules involved in tumorogenesis and metastasis. We will further illustrate this notion with examples from the tumor microenvironment of breast cancer. Lastly, we conclude with thoughts about how this will influence the surgical field with examples of therapeutic agents already in use that target aspects of this microenvironment.
Surgical Oncology 09/2011; 21(3):172-7. · 2.44 Impact Factor
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ABSTRACT: INTRODUCTION: Traditionally, epiphrenic diverticula have been managed through a left thoracotomy. With the advancement of minimally invasive techniques, a laparoscopic approach has gained widespread popularity. Unfortunately, the preoperative evaluation of patients with epiphrenic diverticula, and their surgical management, is still not well characterized. DISCUSSION: The goal of this article is to illustrate our approach to patients with epiphrenic diverticula in terms of preoperative evaluation and surgical technique. The final discussion will focus on the evidence-based rationale for our preoperative assessment and surgical approach.
Journal of Gastrointestinal Surgery 07/2011; 15(10):1866-71. · 2.83 Impact Factor
