Salvage reconstruction of the esophagus using the left colon with microscopic supercharge following failed ileocolic reconstruction: A case report.

INTRODUCTION: Ileocolic interposition is often used for the reconstruction of patients with esophageal cancer with a history of gastrectomy. However, graft failure due to conduit necrosis has been reported in 0-5 % of patients. Salvage reconstruction surgery for this situation is considered challenging, and only a few cases of successful salvage operations following failure of ileocolic interposition have been reported. PRESENTATION OF CASE: A 70s year-old male patient with a history of distal and total gastrectomy underwent subtotal esophagectomy for esophageal cancer. Reconstruction using a pedicled ileocolic interposition was performed; however, the ileocolic graft failed. After recovery of the nutritional status, salvage reconstruction was planned. Due to a history of Roux-en-Y reconstruction for gastric cancer, jejunal reconstruction was not considered feasible. Therefore, salvage reconstruction was performed using left colon interposition with microscopic supercharge and superdrainage anastomosis. The graft was pedicled by the left colic artery and the inferior mesenteric vein, and microscopic anastomosis was performed between the intrathoracic and middle colic vessels. The patient recovered without major complications and retained the ability to consume normal food. DISCUSSION: Microscopic supercharge and superdrainage vascular anastomosis have been reported to ensure augmented blood flow. This is the first case report of successful salvage reconstruction using the left colon interposition technique following failure of ileocolic interposition for esophageal cancer. CONCLUSION: We report a case of salvage reconstruction using left colon interposition with microscopic supercharge and superdrainage anastomosis following failure of ileocolic reconstruction for esophageal cancer.

Aldolase C is a novel molecular marker for folliculo-stellate cells in rodent pituitary.

The anterior pituitary gland is composed of five types of hormone-producing cells and folliculo-stellate cells. Folliculo-stellate cells do not produce anterior pituitary hormones but they are thought to play important roles as stem cells, phagocytes, or supporting cells of hormone-producing cells in the anterior pituitary. S100ß protein has been used as a folliculo-stellate cell marker in some animals, including rats. However, since no reliable molecular marker for folliculo-stellate cells has been reported in mice, genetic approaches for the investigation of folliculo-stellate cells in mice are not yet available. Aldolase C/Zebrin II is a brain-type isozyme and is a fructose-1,6-bisphosphate aldolase. In the present study, we first used immunohistochemistry to verify that aldolase C was produced in the anterior pituitary of rats. Moreover, using transgenic rats expressing green fluorescent protein under the control of the S100ß gene promoter, we identified aldolase C-immunoreactive signals in folliculo-stellate cells and marginal cells located in the parenchyma of the anterior pituitary and around Rathke's cleft, respectively. We also identified aldolase C-expressing cells in the mouse pituitary using immunohistochemistry and in situ hybridization. Aldolase C was not produced in any pituitary hormone-producing cells, while aldolase C-immunopositive signal co-localized with E-cadherin- and SOX2-positive cells. Using post-embedding immunoelectron microscopy, aldolase C-immunoreactive products were observed in the cytoplasm of marginal cells and folliculo-stellate cells of the mouse pituitary. Taken together, aldolase C is a common folliculo-stellate cell marker in the anterior pituitary gland of rodents.