Isthmic Portion Research Articles

Successful Laparoscopic Treatment of a Ruptured Primary Ovarian Pregnancy

A 26-year-old woman had classic symptoms of primary ovarian pregnancy. Ultrasound examination disclosed a cystic mass surrounded by a complex mass that was compatible with hematoma in the pouch of Douglas, as well as an intrauterine device (IUD) displaced near the isthmic portion of the uterine cavity. Laparoscopy revealed a ruptured gestational sac in the cul-de-sac that was encapsulated by a hematoma originating from the right ovary. All deep-seated products of conception were excised from the ovary, and the IUD was removed. Treatment was successful and avoided more invasive intervention.

C-type natriuretic peptide system in rabbit oviduct

C-type natriuretic peptide (CNP), a third member of the natriuretic peptide family, is known to be distributed mainly in brain and vascular endothelium and is considered to act as a local regulator in many tissues. The purpose of this study was to determine the presence of CNP system and its biological function in rabbit oviduct. The serial dilution curve of tissue extracts was parallel to the standard curve of CNP (1–22) and a major peak of molecular profile of tissue extracts by HPLC was CNP (1–53). mRNA of CNP which was the same size as positive control was also detected by Southern blot analysis. CNP increased the production of 3′,5′-cyclic guanosine monophosphate (cGMP) in the purified membrane of oviduct, which was more in membranes derived from the isthmic portion than in the ampullar portion. The presence of mRNAs of natriuretic peptide receptor-A (NPR-A) and NPR-B was demonstrated by RT-PCR. Synthetic CNP (1–22) inhibited both frequency and amplitude of basal motility of oviduct in a dose-dependent manner. The inhibitory effect of CNP on the basal motility was more potent in the isthmic portion than in the ampullar portion. These results demonstrate the presence of CNP system in the oviduct and regional differences in motility inhibition by CNP between isthmic and ampullar portions. Therefore, these findings suggest the possible existence of a CNP system that may exert a local regulator of basal motility, either alone or in concert with other hormones.

148Blood flow changes after uterine artery embolization in the treatment of adenomyosis and myomis: preliminary report

BackgroundThe aim of this study was to evaluate prospectively the changes of blood flow following permanent embolization of uterine arteries using polyvinyl alcohol in the treatment of uterine adenomyosis or myomas.MethodsFrom August 1998 to May 1999, 114 cases of uterine artery embolization were performed for the patients having symptomatic adenomyosis (n = 63) or myomas (n = 51). They were underwent baseline (n = 114) and follow‐up ultrasound on 1 week (n = 106), 3 (n = 102) and 6 months (n = 23) after embolization. The peak systolic velocity (PSV) and resistive index (RI) were calculated in the isthmic portion of uterine arteries and intratumoral vessels.ResultsOne week after embolization, uterine blood flow was markedly decreased comparing with pre‐embolization status. After 3 months, blood flow was recovered up to 56% of pre‐embolization state but not increased significantly on 6 months examination. Color flow was not detected within the myomas after embolization. Changes in PSV and RI Pre 1 week 3 month 6 month PSV (cm s−1) 54.7 23.0 30.5 32.0 RI 0.76 0.84 0.80 0.79 ConclusionUterine blood flow was markedly decreased immediately after embolization and increased up to the half level of pre‐embolization status on 3 months examination.

Oviductal plasminogen activator inhibitor-1 (PAI-1): mRNA, protein, and hormonal regulation during the estrous cycle and early pregnancy in the pig.

Recent identification of plasminogen activator inhibitor-1 (PAI-1) in the pig oviduct has prompted an evaluation of its mRNA, protein synthesis, and hormonal regulation during the estrous cycle and early pregnancy, defined as time prior to and after maternal recognition of pregnancy. To examine PAI-1 protein synthesis, oviductal tissue was collected from European Large White and Chinese Meishan gilts on days 0, 2, and 5 of early pregnancy, divided into three functional segments, and cultured. Culture media was collected and de novo synthesized PAI-1 analyzed by 2D-SDS-PAGE, fluorography, and densitometry. To determine hormonal regulation of PAI-1 synthesis and secretion, four groups of ovariectomized (OVX) cross-bred gilts were each treated with one of four steroid regimens (corn oil, estrogen, progesterone, or estrogen + progesterone) and tissue collected for RNA or cultured. Steady-state mRNA levels of PAI-1 were evaluated throughout the estrous cycle in cross-bred gilts. To compare steady-state PAI-1 mRNA levels between cyclic and pregnant cross-bred gilts, tissue was collected on days 0, 2, and 12. Quantitative analysis of steady-state levels of PAI-1 mRNA were analyzed by dot-blot hybridization and densitometry. A greater (P < 0.01) synthesis and secretion of PAI-1 protein was found in the isthmus portion of the oviduct relative to either the ampulla or infundibulum regardless of day of pregnancy or breed. No difference could be detected for PAI-1 protein between breeds. The Large White had a greater (P < 0.05) secretion of PAI-1 on day 2 of early pregnancy relative to other days examined. Whole oviductal tissue from cross-bred gilts was found to have a significantly greater amount of PAI-1 mRNA on days 1 and 2 compared to other days examined, while the isthmus had significantly greater levels of mRNA on days 2 and 12. A significant effect of day and segment was detected for levels of PAI-1 mRNA from cyclic and early pregnant cross-bred gilts. PAI-1 mRNA was found to be significantly greater in the isthmus than other segments, regardless of day of the estrous cycle or pregnancy. An interaction was detected for estrogen and progesterone on PAI-1 mRNA (P < 0.05) and protein (P = 0.09). Estrogen was found to inhibit PAI-1 protein synthesis and also inhibited progesterone-mediated stimulation of PAI-1 mRNA. Our results demonstrate expression of PAI-1 mRNA and protein are highest on day 2 of early pregnancy, which is consistent with its proposed function of protecting the oocyte/embryo from enzymatic degradation and/or extracellular matrix remodeling of both oviduct and early cleavage-stage embryo.

Magnetic resonance imaging features and classification of central nervous system malformations in Joubert syndrome.

This article examines the magnetic resonance imaging features that typify the Joubert malformation. Specific morphologic features include: (1) dysgenesis of the isthmic portion of the brain stem at the pontomesencephalic junction, (2) abnormally thick superior cerebellar peduncles perpendicular to the brain stem, (3) hypoplasia of the cerebellar vermis with consequent enlargement of the 4th ventricle and rostral shift of the fastigium, and (4) sagittal vermic clefting. At least two of these features were present in every patient and all were present in some. The only cerebral anomaly identified was mild prominence of the ventricles and subarachnoid spaces. The "Joubert-plus anomaly" has been defined as the Joubert malformation plus additional anomalies of either the mesencephalon or the caudal 4th ventricle; this likely represents a similar but more extensive embryologic defect. By placing a relative numeric value on each morphologic feature, a classification scheme has been created that can quantitate the extent of the Joubert malformation in any individual case.

Investigation of ovum transport in the oviduct: the dynamics of oviductal fluids in domestic rabbits.

Ova are captured by the oviductal fimbria and rapidly transported to the ampullary-isthmic junction of the fallopian tube. Fertilized ova and oviductal fluids are then carried medially in the fallopian tube, while undergoing maturation in preparation for entering the uterine cavity, where nidation and further development take place. This movement of oviductal fluids was visualized in a rabbit model with human chorionic gonadotropin-induced ovulation, by injection of a contrast medium into the ampulla region of the oviduct. In the ampulla, the opaque medium was observed to oscillate at 0-85.4 mm/s. This medial transport of the fluid towards the uterus decreased to 0-9.6 mm/s in the isthmic portion of the tube. This decrease substantiates previous findings that the transport of material in the isthmic portion of the oviduct is more strongly under the control of ciliary action than under peristaltic activity.

Fimbrial capture of the ovum and tubal transport of the ovum in the rabbit, with emphasis on the effects of beta 2-adrenoreceptor stimulant and prostaglandin F2 alpha on the intraluminal pressures of the tubal ampullae.

Our purpose was to elucidate the roles of the ampullar and isthmic portions of the oviduct and the effects of drugs on oviductal contractility. Prostaglandin F2 alpha (PGF2 alpha; Ono Pharmaceuticals, Osaka) and oxytocin (Atonin-O; Teikoku Hormone Manufacturing Co. Ltd., Tokyo) were used to stimulate oviductal contractility, and ritodrine hydrochloride (Utemerin; Solvay-Duphar Corp., Denmark) to inhibit the contractility. Both PGF2 alpha and Atonin-O were involved in ovum capture by the ampullar oviduct by stimulating contractility, thus altering the intraductal pressures. Utemerin is effective in inhibiting the enhanced contractility induced by PGF2 alpha and Atonin-O. Variations in pressure of the ampullar portion of the oviduct seem necessary for the capture of ova expelled from the ovary. Once in the isthmic portion of the oviduct, transport appears to be under the influence of ciliary activity rather than variations in contractility.

Evidence for nitric oxide mediation of contractile activity in isolated strips of the human Fallopian tube.

Endogenously produced nitric oxide (NO) induces relaxation in smooth muscle in various organs. The purpose of this study was to investigate whether a NO-mediated relaxation system exists in the human Fallopian tube. To study contractility, the isthmic portion of the tube was obtained from 23 fertile women during operations due to benign non-tubal diseases. Tubal smooth muscle strips were mounted in tissue chambers containing HEPES buffer and connected to a Grass transducer for the isometric registration of contractile activity. By adding L-arginine (the substrate for NO synthesis) or N-nitro-L-arginine methyl ester (L-NAME; an inhibitor of NO synthesis) to the tissue chambers, changes in tubal contractility were monitored. The addition of L-NAME caused increased tubal contractility, while L-arginine, after an initial transient increase in tonus, caused relaxation of the strips. Using immunohistochemistry, NO synthase, the enzyme that catalyses the production of NO from L-arginine, was identified in tubal tissue cells. These results indicate that a NO-dependent relaxation system exists in the Fallopian tube and that NO may play a role as a mediator of tubal contractility.

Regional differences in uteroglobin biosynthesis along the rabbit oviduct: immunohistochemical and biochemical studies.

The biosynthesis of uteroglobin in three regions of the rabbit oviduct was assessed by means of immunocytochemical studies, radioimmunoassay measurements of the protein, and quantitative determinations of its mRNA. Immunocytochemical observations suggested that the number of immunopositive cells and the intensity of their immunolabelling were similar in the distal (infundibular) and the middle regions. In contrast, the isthmic portion appeared to contain less positive cells and weaker immunolabelling. In agreement with these findings, biochemical studies demonstrated that the tissue contents of uteroglobin and its mRNA were similar in the distal and the middle regions whereas the concentrations of both were about three-to four-fold lower in the isthmic portion. The results are discussed in relation to a possible role for uteroglobin in maintaining appropriate environmental conditions for the gametes and the early embryo.

A novel monoclonal antibody to the outer root sheath cells

A novel monoclonal antibody to hair keratins (TYHF-1) which recognized a doublet of 43 44 - kDa hair keratins in the immunoblot analysis was developed. TYHF-1 strongly reacted with the outer root sheath cells at the region of prekeratinization, the keratogeneous zone and the lower part of the isthmus portion in the indirect immunofluorescent examination. The cells of the inner root sheath and cuticle in the upper bulbar portion were also stained with this antibody. In addition, the tongue and nail matrix were also reacted with TYHF-1. However, TYHF-1 reacted with no epidermal keratins either in the indirect immunofluorescent examination or by immunoblot analysis using plantar epidermis. In addition, the cells of the eccrine and apocrine sweat glands, the epithelia of the buccal mucosa, larynx, tonsil, oesophagus, liver, intestine, gallbladder and urinary bladder demonstrated no positive reaction.

Mucosal Folds of Eustachian Tube in Young Children

Differences in the extent of mucosal folding in the superior versus the inferior half of the human Eustachian tube (ET) were studied in young children by measuring the length of the mucosal margin and counting the number of mucosal folds, as they appeared in histological cross-sections, in the pharyngeal, midcartilaginous, isthmus, and osseous portions of each half of the ET in 12 normal ET/temporal bone specimens from 12 individuals aged 1 day to 2 years. The mucosal margin of the ET was significantly longer in the inferior half than in the superior half in the pharyngeal, midcartilaginous, and isthmus portions (paired t-test, pharyngeal portion: t[11] = 3.71, p < 0.01; midcartilaginous portion: t[11] = 4.52, p < 0.01; isthmus portion: t[11] = 3.40, p < 0.01). However, there was no significant difference between in the inferior half and in the superior half at the osseous portion. Also there were significantly more mucosal folds in the inferior half than in the superior half in all four portions (paired t-test, pharyngeal portion: t[11] = 3.46, p < 0.01; midcartilaginous portion: t[11] = 7.40, p < 0.01; isthmus portion: t[11] = 5.03, p < 0.01; osseous portion: t[11] = 4.49, p < 0.01). These results indicate that the surface area of the mucosa in the inferior half of the ET is larger than that of the superior half.(ABSTRACT TRUNCATED AT 250 WORDS)

Mucosal Folds in Human Eustachian Tube: A Hypothesis regarding Functional Localization in the Tube

Differences in the extent of mucosal folding in the superior versus the inferior half of the human eustachian tube (ET) lumen were studied by measuring, as it appeared in histologic cross section, the length of the mucosal margin in the pharyngeal portion, the midcartilaginous portion, the isthmus portion, and the osseous portion of each half of the ET in 16 normal ET temporal bone specimens from 16 individuals 12 to 70 years of age. The mucosal margin of the ET was significantly longer in the inferior half than in the superior half in all four portions (paired t test: pharyngeal portion t[15] = 3.59, p < .01; midcartilaginous portion t[15] = 3.52, p < .01; isthmus portion t[15] = 4.15, p < .01; osseous portion t[15] = 2.24, p < .05). These results indicate that the inferior half of the ET mucosa has more folds than the superior half, and that the surface area of the inferior half of the ET is larger than that of the superior half. This, together with the finding previously reported that secretory components of the ET such as glands and goblet cells are more richly distributed in the inferior (floor) portion than in the superior (roof) portion of the ET, may be related to the fact that the floor of the ET has an active role in clearance function. A hypothesis regarding localization of the ventilatory and clearance functions within the ET is proposed.

Regional differences of phospholipase A 2 activity in the rabbit oviductal epithelium

To evaluate the biosynthesis of prostaglandins in the oviducts, phospholipase A 2 (EC 3.1.1.4) activities were first measured in the epithelial cells obtained from rabbit oviducts. At least four kinds of phospholipase A 2 (PLA 2) activities with respect to calcium dependency and pH requirement were observed. There were two calcium-dependent, pH optima of 7.5 and 8.5 activities, and two calcium-independent, pH optima of 4.0 and 8.0 activities. One of those activities, a calcium-dependent and alkaline active PLA 2 activity of the epithelial cells was then compared between the ampullary portion and the isthmic portion of the oviducts. The activity was significantly higher in the ampullary epithelium than in the isthmic epithelium (223.2±57.2 or 103.8±32.3 pmol/min/mg, p<0.05). These results support the idea that the production of prostaglandins, which is dependent upon the activity of the arachidonate cascades, was higher in the ampullary portion of oviduct than that in the isthmic portion. The PLA 2 activity of the ampullary epithelium may thus play an important role in the regulation of smooth muscle contractility and ciliary movement.

Three-dimensional architecture of the human myosalpinx isthmus

The three-dimensional architecture of the human isthmic myosalpinx is directly visualized by means of scanning electron microscopy after removal of interstitial connective tissue through NaOH maceration and ultrasound microdissection. These investigations show that the myosalpinx is composed of irregularly running bundles of smooth muscle cells, changing their orientation within the myosalpinx and displaying longitudinal, oblique and circular directions. The muscular bundles anastomose and intermingle with other bundles running at different levels in the oviduct wall, and actually give rise to a wide and complex muscular network in which no distinct layers are readily discernible. These morphological data are consistent with the physiological findings that the transport of gametes and embryo in very early stages in the isthmic portion of the oviduct tube is the result of a discontinuous pattern of forward and backward movements.

Role of superoxide dismutase in the fallopian tube function: Immunohistochemical assessment of superoxide dismutase in the fallopian tube.

We carried out an immunohistochemical analysis to determine the localization of CuZn superoxide dismutase (SOD) in the human fallopian tube throughout the menstrual cycle and after menopause. CuZn-SOD immunoreactivity was shown in the columnar epithelium of the fallopian tube. Immunoreactivity was more intense in the ciliated epithelial cells than in the non-ciliated epithelial cells of both the ampulla and the isthmus portions. Immunoreactivity was observed not only in the cytoplasm but also in the nucleus of the ciliated epithelial cells. In comparison, stromal cells showed none or weak immunoreactivity. These immunoreactive patterns of intensity and localization remained unchanged throughout the menstrual cycle and after menopause. Collectively, the present immunohistochemical results suggest that CuZn-SOD may play an important role in fallopian tube function such as the protection of developing embryos from superoxide anion radicals and the local defense mechanisms against infection or inflammation in the fallopian tube.

Three-dimensional Anatomy of the Human Endolymphatic Sac

Computerized and graphic three-dimensional reconstruction of a human endolymphatic duct and sac (ES) showed the ES to be a fusiform and flattened structure with marked tubularity, especially in the extraosseous region. The specimen was 18.2 mm long. It measured 60 X 200 microns at the isthmus portion of the endolymphatic duct and 200 X 7000 microns at the broadest part of the ES. The volume of the endolymphatic duct was 0.03 mm3 and of the ES, 1.85 mm3. The extraosseous ES volume represented more than two thirds of the total ES volume.

Biologic roles of the innermost cell layer of the outer root sheath in human anagen hair follicle: further electron microscopic study.

To elucidate the biologic roles and further cytologic characteristics of the innermost cell (IMC) layer of the outer root sheath (ORS), human anagen hair follicles were ultrastructurally examined. In the lower follicle, the transeversely running tonofilaments in the inner side of the cytoplasm of the IMCs showed a massive accumulation, facing the keratinized part of a Huxley's cell protruding through a Henle's pore. In a rare instance, a spindle-shaped cell was seen between the IMC layer and the keratinized Henle's layer. At the lower isthmus portion, some of the IMCs containing a large number of tonofilaments showed a partial degeneration of the inner side of the cytoplasm. More distally, intercellular spaces between the keratinized IMCs and keratinized Henle's cells were partly dilated and contained amorphous substances. It is suggested that the IMCs in the lower follicle may play a role to support and cover the inner hair structures, tightly as hoops of a barrel. In the isthmus portion, the IMCs may loosely support and guide the keratinized Henle's cells undergoing degeneration.

Analysis of anti-implantational action of norethisterone-3-oxime

Mature rabbits received norethisterone-3-oxime (NETO) 2 mg/kg/day from day 2 through day 4 of pregnancy by gavage. Control rabbits were given vehicle. All animals were sacrified on day 5. The oviducts were removed and sections stained with HE. Morphological changes were evaluated. The outer and inner diameters of tubes, and the thickness of circular muscle layers were measured. The layers of the circular muscle cells and the mean thickness occupied by the cytoplasmic mass of the muscle cells were estimated. The fertilized ova flushed out from the oviduct were stained together with the section of ampullary-isthmic junction (AIJ) and isthmus by PAS. The intensity of the staining was observed microscopically and quantified with a microspectrophotometer. NETO treatment led to tortuosity of oviducts showing hyperplasia of epithelial cells and a mucosal edema. The circular muscle layer was thickened but no increase in the number of muscle cells was observed, indicating muscular contraction. Dilatated and congested capillaries appeared in the muscular and subserous layers. All these manifestations were so prominent that the lumen of AIJ and isthmus portion were significantly narrowed as shown by a decreased percentage of inner diameter to outer diameter at AIJ and isthmus. The amount of mucin secreted into the lumen was decreased, but there was an accumulation of mucin in the epithelial cells. The above-mentioned morphological changes lead to the suggestion that the anti-implantational action of NETO is exhibited by its effect on the oviduct in rabbits. Most probably, the action is mainly related to the estrogenic and anti-progestational activity Of NETO.

Anti‐keratin Monoclonal Antibody against Basal Cell Epithelioma Keratin: BKN‐1

AbstractA BALB/c mouse was immunized with fibrous proteins (FP) extracted from basal cell epithelioma (BCE) and anti‐keratin monoclonal antibodies were produced by a hybridoma technique with a mouse myeloma cell line. One monoclonal antibody was designated as BKN‐1.Immunohistochemically, in 17 cases of BCE, the cytoplasm of all the tumor cells was always stained by BKN‐1. In the normal human skin tissue, BKN‐1 specifically reacted with the basal cells in the epidermis and in the infundibular epithelium of the hair follicle, the entire follicular cells below the isthmus portion in the anagen hair follicle, the peripheral cells of sebaceous glands, and sweat gland cells. The reaction of BKN‐1 was immunoelectron microscopically located on the tonofilaments in the cytoplasm. By immunoblot analysis, BKN‐1 stained either a band of 56–56.5K in FP from BCE or several bands in normal epidermal FP.These results suggest that the keratin expression of BCE may resemble that of the follicular epithelium below the isthmus portion.

Segmental distribution and gestational changes of GABA-transaminase activity in the rat oviduct.

The occurrence and the localization of 4-aminobutyrate:2-oxoglutarate transaminase (GABA-transaminase) in the non-pregnant and pregnant rat oviduct were examined using biochemical and enzyme histochemical techniques. Specific GABA-transaminase activity was detected in the ampullary and isthmic portions of the oviduct as well as in the utero-tubal junction. The enzymic activity was lower in the ampullary than in the isthmic or intramural segments of the oviduct. Pregnancy induced a significant increase of GABA-transaminase activity in each portion of the oviduct. Enzyme histochemistry showed the highest GABA-transaminase reactivity at the level of the epithelial cells of the oviduct irrespective of the portion of the tube examined. A faint specific activity was demonstrated in the smooth muscle of the oviduct while the serosa did not show specific staining. Our findings indicate that: the observed increase of GABA-transaminase activity in the oviduct of the pregnant rat may be responsible for the reduced GABA levels in the oviduct during gestation; and the extraneuronal localization of GABA-transaminase activity does not seem to support the suggestion of a possible GABAergic innervation of the oviduct.