CARDIOTHORACIC SURGERY II

Laparoscopic diaphragm plication: An objectiveevaluation of short-term resultsShaJonMiUn

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2008 by the American College of Surgeons ISSN 1072-7515/08/$34.00Pub S30lished by Elsevier Inc.wn S Groth MD, Amy Klopp RN, Teri Kast RN,athan DCunha MD, PhD, Hassan Tetteh MD,chael A Maddaus MD, FACS, R afael S Andrade MDiversity of Minnesota, Minneapolis, MN

RODUCTION: Laparoscopic diaphragm plication (LDP) is ael approach to treat hemidiaphragm paralysis or eventrationPE). Objective outcomes after LDP for HPE have not been as-sed. The aim of our study was to objectively evaluate our results ofP for HPE using 2 simple, practical tools: the St. Georges Respi-or y Questionnaire (SGRQ) and pulmonar y function tests (PFT ).

THODS: We per formed a prospective cohor t study of all HPEients who under went LDP at our institution from April 2005 totober 2007. We objectively evaluated patients with the SGRQ, adardized questionnaire that measures the health impact of respi-

or y disease (higher scores reflect increasing impairment), and PFT- and (1 and 12 months) postoperatively. We used matched pairssts to compare pre- and postoperative results (alpha0.05).

SULTS: Fifteen patients under went LDP for HPE. Comparedh preoperative scores, 1 month postoperative SGRQ scores wereificantly improved ( Table). At 12 months postoperatively, SGRQres were similar to 1-month scores (n3).

le. SGRQ and PFT in patients undergoing LDP

SGRQ (n7) PFT Results (n11)

Total Score FVC% FEV1% FIFMAX (L)

operative 73.8 12.3 48.8 12.1 53.5 12.8 3.3 1.2toperative1 month)

42.8 16.8 57.1 10.2 60.5 10.0 4.1 1.3

alue 0.001 0.02 0.002 0.02

ults are mean standard deviation; p-value: pre- vs. postoperative.

mpared with preoperative results, 1 month postoperative valuespercent-predicted forced vital capacity (FVC%), percent-

dicted forced expiratory volume in 1 second (FEV1%), and max-um forced inspiratory flow (FIFMAX) were significantly im-ved ( Table). At 12 months postoperatively, FIFMAX continuedimprove significantly, as compared with 1 month values (n7;0.01).

NCLUSIONS: LDP is a novel minimally invasive surgical ap-ach for HPE and our practical objective evaluation revealed ex-lent short-term results.

sal cells in lung canceretta Erhunmwunsee MD, Yun Lu PhD, Xiaoyan Luo PhD,vid H Harpole Jr MD, FACS, Brigid L M Hogan PhD,rkW Onaitis MDke University Medical Center, Durham, NC

RODUCTION: Basal cells are putative stem cells in the proximalcheobronchial tree and are thought to represent the cells of originquamous cell lung cancer (SCC). However, although most SCCes proximally, many occur peripherally. We hypothesize that dis-THODS: Immunohistochemistry of normal human lung speci-ns was performed using antibodies to basal cell markers p63 andatin5 (K5). Tracheal epithelial cells from mice expressing green fluo-ent protein (GFP) downstream of the K5 promoter were harvestedsorted for GFP expression. RNAwas isolated fromK5-positive and-negative cells and arrayed on mouse microarray chips. Bayesian bi-y regression analysis created abasal cell profilewhichwas then applied6 resected human lung cancer specimen arrays. Using this, a proba-ty score for basal cell phenotype was created.

SULTS: By K5 and p63 expression, basal cells extend to thenchoalveolar duct junction. Not surprisingly, the mean probabil-of SCC to express a basal phenotype was .614 whereas the meanbability for AC was .38 (p.0001). Despite this, almost a fourthC express a basal-like transcriptome profile.

rrelation of SCC and ACwith Basal Cells viaTranscriptome Array

SCC AC

ith score 0.6 27 (60%) 9 (22%)ith score 0.6 18 (40%) 32 (78%)tal # 45 41an Score 0.614 0.253 0.382 0.212

NCLUSIONS: Basal cells are located more distally than previ-ly thought. They most likely represent the cell of origin of SCCa subset of AC.Mousemodels expressing oncogenes in basal cellscurrently being developed.

essure-induced inhibition of TIMP-1 expression inphenous vein grafts may contribute to negativescular remodeling and graft failure after coronaryery bypass graftingob Lily MD, Armin Kiankhooy MD, Lucy Trombley MS,drew Stanley MD, Joseph Schmoker MDiversity of Vermont College of Medicine, Burlington, VT

RODUCTION: Pressure-induced vascular remodeling after cor-ry artery bypass operation (CABG) limits the long-term patencysaphenous vein grafts (SV) when compared to radial (RA) andernal mammary (IMA) grafts. Matrix metalloproteinases (MMPs)their inhibitors (TIMPs) contribute to vascular remodeling;ever, their role in pressure-induced SV, RA, and IMA graft re-deling is unknown. We evaluated the effect of pressure on MMPTIMP expression in vessels used for CABG.

THODS: Human SV, RA, and IMA segments from 7 patientsergoing CABGwere cultured at simulated arterial pressure for 14s. Vessels were assayed for MMP-2/9 activity by antibody captureTIMP-1/2 levels by ELISA. Results were standardized to totaltein (ng MMP or TIMP/mg protein). MMP/TIMP ratios wereculated. ANOVA and paired Student t test were utilized for com-isons.

SULTS: Pressure induced MMP-2 activity in arterial segmentssuppressed activity in SV (Day 14: IMA 8247, RA 5721, SV4, P0.06). Pressure caused induction ofMMP-9 activity in SV