Esophageal Cancer Initially Thought to be Accompanied by a Solitary Metastasis to an Intrathoracic Paraaortic Lymph Node

Esophageal cancers usually exhibit lymph-node metastases. Although a solitary lymph-node metastasis is occasionally found, the involvement of an intrathoracic paraaortic node is rare. We present here an intrathoracic mid-esophageal cancer case in which an accompanying solitary retroaortic mass was found within the posterior mediastinum by integrated positron emission tomography/computed tomography. For diagnosis, thoracoscopic resection of the mass was performed from a left thoracic approach, and histology revealed it to be a squamous cell carcinoma metastasized from the esophageal cancer. Upon radical esophagectomy after neoadjuvant therapy as a T3N1M0 Stage IIIa (AJCC/UICC) cancer, the esophageal cancer was found to have invaded unexpectedly deeply in the vicinity of the descending aorta. Another lymph node within the paraaortic region was also involved (T4N1M0 Stage IIIc). The present case and other cases we review here inform our understanding of metastasis to intrathoracic paraaortic nodes as follows:1) its existence may indicate extensive lymph-node metastasis or direct tumor invasion nearby, and 2) it may be accompanied by other lymph-node involvements in this region, even if it appears solitary upon preoperative investigation. Thus, for radical esophagectomy, sufficient lymph-node dissection is required, even at locations not reached by the usual right thoracic approach. Definitive chemoradiotherapy may be a better choice for preoperatively recognized T3 esophageal cancer when the cancer is accompanied by paraaortic lymph node metastasis

Efficacy of fragmin/protamine microparticles containing fibroblast growth factor-2 (F/P MPs/FGF-2) to induce collateral vessels in a rabbit model of hindlimb ischemia

ObjectivesThe localized delivery of exogenous, angiogenic growth factors such as fibroblast growth factor (FGF)-2 has become a promising alternative treatment of peripheral artery disease (PAD) and critical limb ischemia (CLI). The present study describes the efficacy of fragmin/protamine microparticles containing FGF-2 (F/P-MPs/FGF-2) to promote vessel growth in a rabbit model of hindlimb ischemia.MethodsA total of 24 rabbits were used to construct a model of hindlimb ischemia by resection of the left femoral artery. The rabbits were randomly divided into four groups 10 days after surgery (day 0); group A: control (non-treated; 1 mL of phosphate-buffered saline [PBS]); group B: FGF-2 (100 μg FGF-2 in 1 mL PBS)-treated; group C: F/P-MPs (12 mg dried F/P MPs in 1 mL PBS)-treated; and group D; F/P MPs/FGF-2 (100 μg FGF-2 and 12 mg dried F/P MPs in 1 mL PBS)-treated (n = 6 each). The drugs were administered intramuscularly to each group. Blood flow and blood pressure were measured in each group on days 0, 14, and 28. Angiography was performed to assess arteriogenesis on day 28. The number of capillaries on day 28 was determined by direct counting CD31− and α-smooth muscle antibody (α-SMA)-positive vessels.ResultsNeither death nor wound infection was observed throughout the experiment. The F/P MPs/FGF-2-treated group showed marked improvement in the blood flow ratio, blood pressure ratio, and capillary number in comparison to the control group, FGF-2-treated group, and F/P MPs-treated group. The F/P MPs-treated group showed intermediate improvement in blood flow ratio and capillary number in comparison to the control group and FGF-2-treated group.ConclusionsThe F/P MPs/FGF-2-treated group strongly induced functional collateral vessels in the rabbit model of hindlimb ischemia, indicating a possible therapy for PAD.Clinical RelevancePAD due to atherosclerotic vascular disease is a major health problem. Despite recent advances in surgical and radiologic vascular techniques, certain patients with CLI are not suitable for revascularization. A variety of strategies have been tried to promote development of collateral vessels. F/P MPs can act as carriers for controlled release of FGF-2. The purpose of this study was to evaluate the efficacy of F/P MPs/FGF-2 to induce functional collateral vessels in a rabbit model of hindlimb ischemia. This study will lead to F/P MPs/FGF-2-therapy which is an effective therapeutic strategy for treating PAD patients in clinic

Improvement of Hydrodynamics-Based Gene Transfer of Nonviral DNA Targeted to Murine Hepatocytes

The liver is an important organ for supporting the life of an individual. Gene transfer toward this organ has been attempted in many laboratories to date; however, there have been few reports on improved liver-targeted gene delivery by using a nonviral vector. In this study, we examined the effect of various types of gene delivery carriers on enhancing the uptake and gene expression of exogenous DNA in murine hepatocytes when a hydrodynamics-based gene delivery (HGD) is performed via tail-vein injection. Mice were singly injected with a large amount of phosphate-buffered saline containing reporter plasmid DNA and/or with a gene delivery carrier. One day after the gene delivery, the animals' livers were dissected and subjected to biochemical, histochemical, and molecular biological analyses. The strongest signal from the reporter plasmid DNA was observed when the DNA was mixed with a polyethylenimine- (PEI-) based reagent. Coinjection with pCRTEIL (a loxP-floxed reporter construct) and pTR/NCre (a liver-specific Cre expression vector) resulted in the liver-specific recombination of pCRTEIL. The combination of PEI with HGD would thus be a valuable tool for liver-specific manipulation to examine the function of a gene of interest in the liver and for creating liver disease models

Case Report - Successful surgical removal of Palmaz stent stuck in the left superficial femoral artery

This report describes a case of the successful surgical removal of a Palmaz stent accidentally stuck in the left superficial femoral artery. A 58-year-old man was referred to us with complaints of intermittent claudication in his left leg after walking 500 metres. Diagnostic angiography of the lower extremity showed 90% stenosis with a short segment at the left superficial femoral artery and percutaneous transluminal angioplasty (PTA) was performed. The angiogram just after PTA revealed a dissection of the artery. A Palmaz stent implant was attempted in order to seal off the dissection. The balloon used to dilate the stent burst, resulting in insufficient stent expansion, and it became stuck. Surgical operation to remove the stuck stent and reconstruct the blood flow through the left superficial femoral artery by artificial prosthesis grafting proved successful

Case Report - Successful surgical removal of Palmaz stent stuck in the left superficial femoral artery

This report describes a case of the successful surgical removal of a Palmaz stent accidentally stuck in the left superficial femoral artery. A 58-year-old man was referred to us with complaints of intermittent claudication in his left leg after walking 500 metres. Diagnostic angiography of the lower extremity showed 90% stenosis with a short segment at the left superficial femoral artery and percutaneous transluminal angioplasty (PTA) was performed. The angiogram just after PTA revealed a dissection of the artery. A Palmaz stent implant was attempted in order to seal off the dissection. The balloon used to dilate the stent burst, resulting in insufficient stent expansion, and it became stuck. Surgical operation to remove the stuck stent and reconstruct the blood flow through the left superficial femoral artery by artificial prosthesis grafting proved successful