Transesophageal pulmonary nodule biopsy using endoscopic ultrasonography.

OBJECTIVE: Parenchymal pulmonary nodules located in proximity to the mediastinum, vertebral column, major vessels, or behind the heart can be technically challenging and dangerous to biopsy using traditional image-guided techniques. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) can be used to access some of these difficult to reach lesions. The purpose of the present study was to report our experience with this technique in a consecutive cohort of selected patients. METHODS: This was a retrospective cohort study. Eligible patients were identified from a prospective database. A transesophageal approach under real-time EUS guidance was performed using a 22-gauge needle. All patients underwent postprocedural chest radiography and were followed up at 30 days. RESULTS: During a 31-month period, 55 patients underwent EUS-guided lung biopsy. Confirmatory visual correlation of nodule localization within the lung parenchyma between computed tomography and EUS was possible in 100% of cases. The lung nodule distribution was 41.5% right upper lung, 18.9% right lower lung, 28.3% left upper lung, and 11.3% left lower lung. Histologic and cytologic sampling was adequate in 52 of the 55 procedures (94.5%). In all patients with adequate biopsy sampling, accurate pathocytologic diagnoses of the target parenchymal nodules were obtained. The accuracy and sensitivity of EUS-FNA were both 94.5% and consistent with the diagnosis on pathologic resection or clinical progression of disease, or both. No morbidity resulted from the procedure nor was observed at 30 days. CONCLUSIONS: EUS-FNA of parenchymal pulmonary nodules is safe and accurate and allows for biopsy of perimediastinal lung lesions not attainable using traditional techniques.

Uterine artery as an arterial conduit for coronary artery bypass graft (CABG) surgery in women: A role for estrogen-receptor alpha (ER-α) in the prevention of post-CABG accelerated atherosclerosis and graft disease.

Coronary artery bypass graft (CABG) surgery is the standard of care in the treatment of advanced coronary artery disease (CAD). In order to bypass coronary occlusions, CABG surgery traditionally employs grafts from the left internal thoracic/mammary artery (LITA/IMA), radial artery (RA), and greater saphenous vein (SV). The risk of CABG failure is reported to be higher, or at best similar, for women than for men, and it relates primarily to post-operative accelerated atherosclerosis leading to graft stenosis and recurrent angina, a phenomenon known as "coronary artery bypass graft disease". In this paper, the authors hypothesize that employing an alternative arterial conduit may help reduce the rate of post-CABG accelerated atherosclerosis in women, and propose that a uterine artery specimen be used instead. Given its greater density of estrogen-receptor alpha (ER-α) relative to other mammalian endothelial cells in the vasculature, uterine arteries may exhibit important anti-atherosclerotic properties. Theoretically, this effect may be amplified with the adjuvant administration of low-dose selective ER-α agonist modulator (SERM) therapy.

The Montreal Criteria for the Ethical Feasibility of Uterine Transplantation.

Absolute uterine factor infertility (UFI) refers to the refractory causes of female infertility stemming from the anatomical or physiological inability of a uterus to sustain gestation. Today, uterine factor infertility affects 3-5% of the population. Traditionally, although surrogacy and adoption have been the only viable options for females affected by this condition, the uterine transplant is currently under investigation as a potential medical alternative for women who desire to go through the experience of pregnancy. Although animal models have shown promising results, human transplantation cases have only been described in case reports and a successful transplant leading to gestation is yet to occur in humans. Notwithstanding the intricate medical and scientific complexities that a uterine transplant places on the medical minds of our time, ethical questions on this matter pose a similar, if not greater, challenge. In light of these facts, this article attempts to present the ethical issues in the context of experimentation and standard practice which surround this controversial and potentially paradigm-altering procedure; and given these, introduces "The Montreal Criteria for the Ethical Feasibility of Uterine Transplantation", a set of proposed criteria required for a woman to be ethically considered a candidate for uterine transplantation.