In thoracic endovascular aneurysm repair (TEVAR), the common femoral artery is typically used as the standard vascular access. However, in some cases, alternative vascular accesses must be considered, or endovascular treatment may need to be abandoned due to vascular diameter or characteristics. A female in her 70 s presented with saccular aortic aneurysms located at the distal arch and descending aorta, possibly secondary to bacteremia. She had a history of partial arch replacement and ascending aorto-bi-iliac artery bypass for ascending aortic aneurysm, as well as calcified abdominal aortic stenosis, performed five years prior. In this case, we successfully treated the aneurysms with antegrade TEVAR, accessing through the extra-anatomical bypass graft, which was exposed in the epigastric preperitoneal space. This is the first case report of TEVAR using access from an extra-anatomical bypass graft connecting the ascending aorta to the lower extremity.

A 77-year-old woman underwent endovascular abdominal aortic repair (EVAR) for an abdominal aortic aneurysm (AAA)．Five years after surgery, she visited the hospital with the chief complaint of a fever. Enhanced computed tomography (CT) showed enlargement of the AAA around the stent-graft and a mass, which was suspected to be an abscess, outside the aneurysm. A blood test revealed a high level of inflammatory response. The patient was diagnosed with infectious AAA. She received antibiotics; however, the inflammatory response did not completely improve. A second CT scan revealed that the suspected abscess had a spreading tendency. The patient was referred to our hospital for a highly suspected stent-graft infection. We performed Y-graft replacement using a rifampicin-immersed graft, and as much as possible of the wall around the aortic aneurysm was removed. The inflammatory response improved rapidly after the operation, and the patient was discharged 15 days later. According to the results of a pathological examination, a diagnosis of xanthogranulomatous inflammation and fibrosis was made. Here, we report a rare case of xanthogranulomatous inflammation of the aortic aneurysm wall after EVAR.

This article describes the end of life of seven people with amyotrophic lateral sclerosis (ALS) under the care of a hospice. The reasons for admission to hospice were for the management of distressing symptoms and the support of families who were unable to continue care at home because of the increased burden of care and/or illness of families. The sufferings experienced by the patients with ALS included disability due to muscle weakness(100%), pain(100%), discomfort (100%), dyspnea (71%), difficulties in communication (71%), drooling (43%), insomnia (43%), loneliness (43%), swallowing difficulties (28%), clenching the mucosa inside the cheek (28%), anxiety (28%), the perception of being a burden to the family (28%), and concerns as to why they had developed ALS (28%). Opioid medication was effective in the management of dyspnea, pain and discomfort. The results showed that special attention should be paid to frequent changing of the patient's position during nursing care, including the passive movement of joints and massage. The use of communication aids was essential to allow people with ALS to communicate effectively and, together with support of joy of the patients and family, the quality of life could be improved. End of life care within a hospice is a useful alternative option for persons with ALS, extending hospice care in Japan from people with advanced cancer to other disease groups. Palliat Care Res 2010; 5(2): 137-143

Intrinsic or acquired resistance to cisplatin (CDDP) is a problem for its use in cancer chemotherapy. This resistance has been reported to correlate with expression of the human copper transporter 1 and two copper export pumps, ATP7A and ATP7B. In the current study, we investigated the correlation between the expression of these transporters and sensitivity to CDDP using four cell lines derived from each of high invasive oral squamous cell carcinoma (OSCC) and low invasive OSCC. We found that the amount of CDDP accumulated in high invasive OSCC cell lines (Yamamoto-Kohama criteria: grade 4C and 4D) with strong intrinsic tolerance was lower than in low invasive OSCC cell lines (grade 3) with weak intrinsic tolerance. Additionally, overexpression of ATP7B mRNA in cell lines derived from high invasive OSCC conferred low sensitivity to CDDP. Furthermore, the accumulation and sensitivity of CDDP was higher in HOC313 cells transfected with the ATP7B siRNA than in cells transfected with the nonsense siRNA. These results suggest that the overexpression of ATP7B results in the export of and, therefore, resistance to CDDP. Furthermore, ATP7B may be a key determinant of the intrinsic resistance to CDDP.

The aim of this study was to examine the effects of fibroblast growth factor-2 (FGF-2) on cancer cell invasion and on fibroblast proliferation in an in vitro model of invasion. Three kinds of human oral squamous cell carcinoma cell lines with different invasive activity were used: OSC-20, OSC-19 (lower invasive type), and HOC313 (higher invasive type). FGF-2 and its high-affinity receptors FGFR-1 and FGFR-2 were detected by western blotting. The expression of FGF-2 and FGFRs mRNA was examined in cultured human oral squamous cell carcinoma cells by reverse transcriptase polymerase chain reaction (RT-PCR). Furthermore, recombinant human FGF-2 (rhFGF-2) was reacted with each cell line, and the invasion rate was determined by invasion assay. We also observed the behavior of cancer cell invasion in the collagen gel invasion model in the presence or absence of FGF-2-neutralizing antibody (anti-FGF-2). HOC313 cells showed higher expression of FGF-2 than OSC-20 and OSC-19 cells. The addition of rhFGF-2 promoted not only the proliferation of fibroblasts, but also the invasion of all cancer cell lines. In contrast, the addition of anti-FGF-2 completely inhibited the invasion of OSC-20 and OSC-19 cells. These results suggest that a higher invasiveness of squamous carcinoma cells is associated with higher production of FGF-2, which acts in an autocrine fashion to promote cancer cell invasion, and in a paracrine fashion to promote fibroblast proliferation.