Parahydrogen-Induced 13C Hyperpolarizer Using a Flow Guide for Magnetic Field Cycling to Evoke 1H-13C Spin Order Transfer Toward Metabolic MRI.

OBJECTIVE: The pair-wise addition of parahydrogen, the singlet form of molecular hydrogen, to unsaturated precursors evokes the hyperpolarization of two parahydrogen-derived 1H nuclear spins through a process known as parahydrogen-induced polarization (PHIP). Subsequent spin order transfer (SOT) from the 1H to the surrounding 13C nuclear spins via magnetic field cycling (MFC) results in substantial signal enhancement in 13C magnetic resonance imaging (MRI). Here, we report the development of a unique PHIP 13C hyperpolarizer system using a flow guide for MFC. METHODS: The optimal MFC scheme for 1H to 13C spin order transfer was quantum-chemically simulated using the J-coupling values of 13C-labeled metabolic tracers. The flow guide system was three-dimensionally designed based on the simulated MFC scheme and pre-measured magnetic field distribution in a zero-field chamber. RESULTS: The system efficiently transfers the spin order of hyperpolarized 1H to a particular 13C spin when the parahydrogenated tracer passes through the flow guide at a designated flow rate. The 13C MRI signal is enhanced more than 40,000 times in 13C-labeled pyruvate and fumarate, compared to the thermal equilibrium level at 1.5 T, was achieved for conducting in vivo metabolic MRI of mice. CONCLUSION: A fully automated PHIP-based 13C polarizer was developed using a unique flow guide to conduct the MFC for 1H to 13C SOT. SIGNIFICANCE: The PHIP hyperpolarizer with a flow guide can conduct efficient 1H-13C SOT without a MFC magnetic field sweep system and offers a cost-effective alternative to conventional dynamic nuclear polarization.

Thymic Neuroblastoma within a Thymic Cyst in an Adult.

CASE PRESENTATION: A 65-year-old female patient with no clinical manifestations was hospitalized for examination and treatment of an anterior mediastinal tumor found at the time of a regular health checkup. Enhanced computed tomography (CT) and magnetic resonance imaging revealed a cystic lesion containing a solid tumor. Positron emission tomography-CT demonstrated increased uptake in the solid lesion. Tumor resection with total thymectomy was performed. A pathological diagnosis of thymic neuroblastoma within a thymic cyst was made. Micorscopic examination revealed that tumor cells of the solid component were lined with thymic epithelial cells of the inner cyst wall. Furthermore, some tumor cells of the solid component had melanin granules. These findings suggest that this tumor arose from progenitors of the thymic epithelial cells with the potential to differentiate along neural lines. CONCLUSIONS: Neuroblastoma commonly occurs in children. However, the diagnosis of neuroblastoma in adults has been reported in several case reports. We report an adult case of histogenetically informative thymic neuroblastoma within a thymic cyst. There are no standard treatment strategies and chemotherapy protocols. Complete surgical resection might be important for a better outcome.

Video-assisted mediastinoscopic resection of ectopic parathyroid adenoma.

Hyperparathyroidism can induce fatal complications in long-term hemodialysis patients. Approximately 20% of patients with hyperparathyroidism have ectopic mediastinal parathyroid glands, and the locations of 2% require a median sternotomy or thoracotomy. A 68-year-old man with an ectopic parathyroid gland in the thymus, underwent total resection via a video-assisted mediastinoscopic approach, which provides a less invasive surgical approach.

[A case of complete resection of a squamous cell lung cancer invading diaphragm after neoadjuvant chemotherapy of nedaplatin and irinotecan].

The treatment for squamous cell lung cancer has remained unclear, while that for lung cancer according to each pathology type has advanced. This is a case of complete response of a squamous cell lung cancer invading the diaphragm which could be resected completely after neoadjuvant chemotherapy of nedaplatin (CDGP) and irinotecan (CPT-11). CDGP and CPT-11 might be effective for squamous cell lung cancer.

Spontaneous regression of an invasive thymoma.

Although there are many reports of spontaneous regression of noninvasive thymoma, there are no reports of spontaneous regression of an invasive thymoma. Moreover, the mechanism of the spontaneous regression is still unknown. The present case concerns a 47-year-old man who presented with chest pain. Computed tomography (CT) showed a large anterior mediastinal mass with left pleural effusion that occluded the innominate vein. The tissue obtained by video-assisted thoracic surgery suggested a diagnosis of invasive thymic carcinoma. One month later CT showed prominent regression of the tumor, and the tumor was completely resected. On pathology, the diagnosis was thymoma type B3.

Phase II study of weekly paclitaxel for advanced or metastatic breast cancer in Japan.

BACKGROUND: The efficacy and safety of weekly paclitaxel was evaluated in Japanese women with advanced or metastatic breast cancer. PATIENTS AND METHODS: Paclitaxel was given by single weekly intravenous infusion at 100 mg/m2 on days 1, 8, 15, 22, 29 and 36 of a 49-day cycle to women with advanced or metastatic breast cancer not responding to other chemotherapy. RESULTS: A total of 69 enrolled patients received a median of 3 (range 1-13) cycles of treatment. The overall response rate was 44.9%, comprising 3 complete responses (CRs) and 28 partial responses (PRs). Median durations of CR and PR were 64.0 (range 57-499) and 113.0 (range 29-590) days, respectively. Grade 3 or greater adverse reactions included neutropenia in 37.7%, leukopenia in 31.9% and neuropathy in 5.8%. CONCLUSION: A weekly regimen of paclitaxel was well tolerated and achieved a relatively high response rate in Japanese breast cancer patients with advanced or metastatic disease.

Treatment of primary melanoma of the lung monitored by 5-S-cysteinyldopa levels.

Malignant melanoma originating outside the skin is very rare, whereas primary malignant melanoma of the lung is extremely rare. 5-S-Cysteinyldopa (5-S-CD), a melanin metabolite, has been reported to be a prognostic marker for cutaneous malignant melanoma. This is the first report in the English language literature dealing with primary malignant melanoma of the lung using serum 5-S-Cysteinyldopa levels to monitor the effects of surgery and chemotherapy.

Bronchopulmonary foregut malformation in an adult.

A 50-year-old man with repeated episodes of right epigastric pain was seen in our hospital. Chest computed tomography and angiography revealed several arteries feeding an enhanced large mass located in the right lower lobe region. A right lower lobectomy was done with a provisional diagnosis of an intralobar sequestration. A 5-mm duct that was lined with esophageal mucous membrane that tracked from the lower esophagus toward the sequestrated lung was detected. A bronchopulmonary foregut malformation (BPFM) was diagnosed based on the histological finding that the duct was composed of ciliated epithelium and smooth muscle layers. BPFM is a subgroup of pulmonary sequestrations that communicate with the gastrointestinal tract. In contrast to pulmonary sequestrations, 75% of BPFMs are located on the right side. Thus, a BPFM should be considered in patients with right-sided pulmonary sequestrations, and their gastrointestinal tracts should be examined.

Benign acquired bronchoesophageal fistula in an adult.

A 45-year-old woman was admitted to our hospital with a diagnosis of bronchoesophageal fistula, after a barium esophagography performed in an annual medical check-up had demonstrated an esophageal diverticulum in the middle of the thoracic esophagus, having a narrow bridge between the right intermediate bronchi. The patient had a history of tuberculosis in her childhood, and chest radiography showed multiple calcified hilar lymph nodes. The fistula was observed on gastroenteroscopy and on bronchofiberscopy. The patient was treated surgically, with ligation and resection of the fistula. The fistulous tract was attached to a calcified hilar lymph node, and both the diverticulum and fistula were concluded to have been caused by the tuberculous lymphadenitis in her childhood. It is very uncommon to have bronchoesophageal fistula, caused by tuberculosis in childhood, diagnosed and treated surgically at more than forty years later.

Prospective study of extended segmentectomy for small lung tumors: the final report.

BACKGROUND: Minimal resection of small lung tumors is still controversial. This study was conducted to clarify whether this type of operation is acceptable. METHODS: From January 1992 to December 1994, 73 patients were registered in a multiinstitutional trial of limited resection for peripheral lung tumors less than 2 cm in diameter. The operative procedure consisted of extended segmentectomy in which the cut line of the lung was beyond the burdened segment, confirming N0 disease by intraoperative lymph node examination of frozen sections. The operation was changed to other procedures if the report was positive. RESULTS: All the patients were observed more than 5 years. There were no perioperative deaths and no major complications. A total of 55 patients were finally enrolled in this study. Ten patients died postoperatively, 4 of lung cancer and the remaining 6 died of other diseases, with no signs of recurrence. The 5-year survival rate, excluding these 6 patients, was 91.8%; for all patients including those who died it was 81.8%. A total of 18 patients were not included in this study for various reasons. The decrease in forced vital capacity was 11.3% +/- 9.8% compared with the preoperative value. CONCLUSIONS: Extended segmentectomy is an alternative method as a standard operation for patients with small peripheral lung tumors, and the loss of lung function is minimal. However, patient selection must be strict, with intraoperative pathologic examination, and a wide margin to the lesion beyond the burdened segment is mandatory.

Integrin alpha3 expression as a prognostic factor in colon cancer: association with MRP-1/CD9 and KAI1/CD82.

Recently, we established that a murine monoclonal antibody (MAb) MH8-4 inhibits the motility of the colon cancer cell line RPMI4788 and that it recognizes integrin alpha3. In addition, we have also cloned the motility-related protein-1 (MRP-1)/cluster of differentiation 9 (CD9) as a metastasis suppressor molecule. We investigated integrin alpha3 expression in 114 resected colon cancers using immunohistochemistry and reverse transcription-polymerase chain reaction (RT-PCR) to evaluate whether these experimental results are of relevance in the prognosis of actual colon cancers. Furthermore, we investigated the correlation of integrin alpha3 with MRP-1/CD9 and KAI1/CD82. Sixty patients (52.6%) were evaluated as integrin alpha3-positive and 54 patients (47.4%) as integrin alpha3-negative. Integrin alpha3 expression was associated with tumor status, lymph node status and pathologic stage. The overall and disease-free survival rates for patients whose tumors were positive for integrin alpha3 were significantly higher than for those with integrin alpha3-negative tumors (p < 0.001 and p < 0.001, respectively). This same tendency was observed in node-negative patients (p = 0.007 and p = 0.001, respectively). Integrin alpha3 was found to be the significant prognostic factor in a multivariate analysis using the Cox proportional hazards model (p = 0.036). A correlation was found between integrin alpha3 with MRP-1/CD9 and KAI1/CD82 for stage I tumors. However, no correlation was found in stage III tumors. Our data seem to suggest that low expression of integrin alpha3 is a useful indicator of a poor prognosis for colon cancer patients and that colon cancer progresses following collapse of the complex formed by integrin alpha3 with MRP-1/CD9 and KAI1/CD82.