Isthmus Region Research Articles

Distribution of adrenomedullin-like immunoreactivity in the brain of the adult sea lamprey

Adrenomedullin (AM) is a neuropeptide widely distributed in vertebrates. In jawed vertebrates it has been localized in distinct regions of the central nervous system by means of antisera against human AM because the molecule seems to be well conserved across species. In this study, we have analyzed the localization of AM-like immunoreactive (AM-ir) cell bodies and fibers throughout the brain of the adult sea lamprey Petromyzon marinus, by using immunohistochemistry. Several AM-ir cell populations were found in the basal plate of the secondary prosencephalon, being more numerous in the hypothalamus, as well as two in the diencephalon and one in the mesencephalon; in addition two cell populations were found in the rhombencephalic alar plate, one in the isthmic region and other in the nucleus of the solitary tract. Immunolabeled fibers were widespread throughout the lamprey brain, but were more abundant in the basal plate. Of particular interest was the conspicuous innervation of the striatum by AM-ir fibers. In addition, our results indicate that AM-ir cells and fibers are present in the lamprey hypothalamo-neurohypophyseal system, suggesting that AM plays some important role in the control of pituitary gland function.

Endovascular Treatment of Acute and Chronic Thoracic Aortic Injury

Our aim is to present midterm results after endovascular repair of acute and chronic blunt aortic injury. Between December 1999 and December 2005, 13 patients were endovascularly treated for blunt aortic injury. Ten patients, 8 men and 2 women, mean age 38.7 years, were treated for acute traumatic injury in the isthmus region of thoracic aorta. Stent-graftings were performed between the fifth hour and the sixth day after injury. Three patients (all males; mean age, 66 years; range, 59-71 years) were treated due to the presence of symptoms of chronic posttraumatic pseudoaneurysm of the thoracic aorta (mean time after injury, 29.4 years, range, 28-32). Fifteen stent-grafts were implanted in 13 patients. In the group with acute aortic injury one patient died due to failure of endovascular technique. Lower leg paraparesis appeared in one patient; the other eight patients were regularly followed up (1-72 months; mean, 35.6 months), without complications. In the group with posttraumatic pseudoaneurysms all three patients are alive. One patient suffered postoperatively from upper arm claudication, which was treated by carotidosubclavian bypass. We conclude that the endoluminal technique can be used successfully in the acute repair of aortic trauma and its consequences. Midterm results are satisfactory, with a low incidence of neurologic complications.

Morphometric and Ultrastructural Changes in Ciliated Cells of the Oviductal Epithelium in Prolific Chinese Meishan and Large White Pigs during the Oestrous Cycle

There are some differences in reproductive features between the Chinese Meishan (CM) pig and Large White (LW) pig. The aim of the present study was to investigate the quantitative changes and ultrastructural features of ciliated cells in the various regions of the CM and LW pig oviduct during the follicular and luteal phases of the oestrous cycle. In the fimbrial and ampullar epithelia at the follicular phase, the ciliated cells were more plentiful than in the isthmic region in both pigs. In the CM pigs, there was a striking decrease in the percentage and cell height of ciliated cells in the luteal phase compared with the follicular phase. Although similar quantitative changes were observed in the LW pig oviduct, these changes were less dramatic than that in the CM pig oviduct. In both pigs, the percentage and cell height of ciliated cells in the isthmus were unchanged between the follicular and luteal phases. The ultrastructure of ciliogenic and ciliated cells was observed. In the fimbrial and ampullar epithelia during the follicular phase, most of the ciliated cells showed normal morphology, having many elongated cilia and mitochondria, but in the CM pig oviduct during the luteal phase many of the ciliated cells possessed immature cilia and swollen mitochondria. Cells undergoing ciliogenesis were frequently observed in the fimbriae and ampulla, and occasionally in the isthmus. Cytoplasmic protrusions containing variable numbers of ciliary axonemal complexes occurred in the fimbrial and ampullar epithelium in the CM pigs at the luteal phase, suggesting that deciliation of cells occurs by membrane-bound cilia packets forming at the apices of cells and pinching off. These results demonstrate that there are regional variations in the cyclic changes associated with the oviductal ciliated cells of the pigs, while there are marked morphometrical and ultrastructural changes in oviductal ciliated cells of the CM pigs compared with that of the LW pigs.

Origins of spinal cholinergic pathways in amphibians demonstrated by retrograde transport and choline acetyltransferase immunohistochemistry

The existence of propriospinal cholinergic pathways and the origin of supraspinal cholinergic descending projections have been investigated in anuran and urodele amphibians. Retrograde tract tracing techniques with dextran amines injected in the spinal cord at different levels were combined with immunohistochemistry for choline acetyltransferase (ChAT). The analysis of the brachial, thoracic and lumbar spinal cord demonstrated that doubly labeled cells were present only close to the injection site. Thus, the participation of the spinal cholinergic cells in distant intersegmental connections is not present, or is very limited, in amphibians. In anurans, tracer applications to the brachial cord revealed cholinergic cells of origin of spinal projections located in four distinct brain nuclei. The most rostrally located cells were found bilaterally in the preoptic area, among the magnocellular cells. In the ipsilateral isthmic region, the laterodorsal tegmental nucleus also showed doubly labeled cells. Throughout the brainstem, abundant codistribution was observed but actual coexistence of the tracer and ChAT was only found in the nucleus of the solitary tract and the inferior reticular nucleus. In the case of the urodele, abundant codistribution between retrogradely labeled cells and ChAT-positive neurons in zones like the suprachiasmatic nucleus, the isthmic region and the rhombencephalic reticular formation was observed, but the only doubly labeled cells were the Mauthner neurons. The present results in amphibians contrast with previous data in mammals in which is striking the presence of a widespread intrinsic cholinergic innervation of the spinal cord and the virtual absence of cholinergic projections descending from the brainstem.

Development of the serotonergic system in the central nervous system of the sea lamprey

Lampreys belong to the most primitive extant group of vertebrates, the Agnathans, which is considered the sister group of jawed vertebrates. Accordingly, characterization of neuronal groups and their development appears useful for understanding early evolution of the nervous system in vertebrates. Here, the development of the serotonergic system in the central nervous system of the sea lamprey, Petromyzon marinus, was investigated by immunohistochemical analysis of specimens ranging from embryos to adults. The different serotonin-immunoreactive (5-HT-ir) neuronal populations that are found in adults were observed between the embryonic and metamorphic stages. The earliest serotonergic neurons were observed in the basal plate of the isthmus region of late embryos. In prolarvae, progressive appearance of new serotonergic cell groups was observed: firstly in the spinal cord, then in the pineal organ, tuberal region, zona limitans intrathalamica, rostral isthmus, and the caudal part of the rhombencephalon. In early larvae a new group of serotonergic cells was observed in the mammillary region, whereas in the pretectal region and the parapineal organ the first serotonergic cells were seen in the middle and late larval stages, respectively. The first serotonergic fibres appeared in early prolarvae, with fibres that ascend and descend from the isthmic cell group, and the number of immunoreactive fibres increased progressively until the adult stage. The results reveal strong resemblances between lampreys and other vertebrates in the spatio-temporal pattern of development of brainstem populations. This study also reveals a shared pattern of early ascending and descending serotonergic pathways in lampreys and jawed vertebrates.

Specialist Maps of the Geological Section, Inter-Service Topographical Department: Aids to British Military Planning During World War II

Between November 1943 and May 1946, geologists assisted the Inter-Service Topographical Department (ISTD) to prepare reports and maps to guide planning of British military operations in Europe and the Far East. Early reports were illustrated by pre-war geological maps reprinted by the Geographical Section, General Staff, (GSGS), later reports by new simplified geological maps, usually accompanied by one or more thematic maps. An airfield suitability map for Bulgaria and soils maps for both the Middle Danube region (Hungary) and Austria were printed as part of the GSGS Miscellaneous map series, and groundwater and soils maps prepared as tracing overlays for use with topographical maps for parts of Germany. Simplified geological maps were prepared by ISTD and printed by GSGS for Sumatra, Borneo, Formosa, the Kra Isthmus region of the Burma/Thailand peninsula, Siam (Thailand) and Indo-China, Java, Hainan, and the Hong Kong to Canton region of China. These were mostly at a scale of 1:1000 000 but in varying styles, to innovatively indicate terrain features of specific military significance. Airfield suitability maps were printed at scales between 1:250 000 and 1:1000 000 for many of these regions, based on ground features and predicted soil permeability. All these specialist maps were printed in small numbers, and few copies have survived the war – notably in the British Library, the National Archives, or the library of the Royal Geographical Society. The ISTD Geological Section constituted the larger of only two teams of British military geologists to be established in either World War, exercising a role in military intelligence that is seldom acknowledged.

Immunohistochemical Studies on Cytokeratin 8 and 18 Expressions in Canine Cutaneous Adnexus and Their Tumors

The expressions of cytokeratin 8 and 18 (CK8 and CK18) in the normal canine skin (2 cases) and cutaneous adnexal tumors (127 cases) were investigated immunohistochemically. In the normal skin, co-expression of CK8/18 was found in the glandular epithelium of apocrine sweat glands, and single CK8-immunoreactivity was detected occasionally in the external root sheath at the isthmus and suprabulbar regions of the hair follicles. Neoplastic glandular epithelial cells in all apocrine gland tumors (21/21 cases, 100%) had co-expression of CK8/18. In trichoblastomas (27/28 cases, 96%), most neoplastic cells were diffusely positive for CK8, but those were negative for CK18. Single CK8-expression was also observed in basaloid neoplastic cells in several cases of trichoepitheliomas (7/19 cases, 37%) and pilomatricoma (1/7 cases, 14%). In several cases of trichoblastomas (4/28 cases, 14%) and trichoepitheliomas (2/19 cases, 11%), tumor cells forming glandular structures had co-expression of CK8/18. There were no positive reactions for both CK8 and 18 in infundibular keratinizing acanthomas, and sebaceous and hepatoid gland tumors. The present findings indicate that co-expression of CK8/18 is a specific feature of apocrine sweat glands and single CK8-expression represents the natures of external root sheath or pluripotential stem cells. Thus, the combination of CK8- and 18-immunostainings may have the utility to confirm the directions of differentiation in canine cutaneous adnexal tumors providing a reliable hallmark for histopathological diagnoses.

149 LAPAROSCOPIC EMBRYO TRANSFER IN PIGS

In an effort to optimize the number of live offspring from cloned and transgenic pig embryos, embryos are surgically transferred into the isthmus region of the oviduct soon after micromanipulation. Surgical embryo transfer in pigs is successful but still an invasive process. Laparoscopic embryo transfer (Besenfelder et al. 1997 Theriogenology 47, 1051–1060) is much less invasive than surgery and is more adaptable to a variety of commercial embryo transfer conditions. Our goal was to develop the use the laparoscope as an alternative method of embryo transfer for micromanipulated embryos. Naturally cycling maternal white line donor and recipient females were used for laparoscopic embryo transfer. Donors were selected to be in estrus 0 to 24 h before recipients. Two- to four-cell embryos were surgically recovered via mid-ventral laparotomy and immediately prepared for laparoscopic transfer into the oviduct through the infundibulum or through puncture of the oviduct into the ampulla. Sixty-nine embryos (range, 13–20) were transferred into the oviduct via the infundibulum of four recipients. Two recipients farrowed (50%), one recipient spontaneously aborted on Day 27, and one returned to estrus on Day 25 of the estrous cycle. Twenty-one pigs were born (10.5 pigs/farrowed sow) resulting in 30% (21/69) of transferred embryos becoming live offspring. Ninety-seven embryos (range, 10-21) were transferred into the ampulla of the oviduct of six recipients. Four recipients farrowed (67%) and 2 returned to estrus on Day 20 and Day 28. Thirty-nine pigs were born (9.5/sow farrowed) resulting in 39% (38/97) of transferred embryos becoming live offspring. Observations indicate that it is much easier to find the oviduct and deliver embryos via puncture into the ampulla than find and insert the transfer catheter into the infundibulum. Using the efficiencies generated from these data, 1.1 more pigs can be expected per transfer by transferring embryos to the oviduct via puncture than into the oviduct via the infundibulum. These data demonstrate the effective use of the laparoscope for oviductal embryo transfer. Further work is needed to determine if the laparoscope improves the production of live offspring compared to surgical embryo transfer.

Thyroid isthmusectomy: a critical appraisal

Thyroid lobectomy with isthmusectomy is the standard surgical technique for removal of unilateral thyroid nodules, and it involves the exposure of the tracheoesophageal grooves. Thyroid isthmusectomy is a surgical procedure that excises only the thyroid isthmus. It allows excision of a lesion without the exposure of the tracheoesophageal grooves. We aimed to demonstrate that isthmusectomy could be a safe alternative to thyroid lobectomy with isthmusectomy in patients with nodules confined to the isthmus or the pyramidal lobe. This was a prospective study performed over a five year period from 1999 to 2004. Inclusion criteria for thyroid isthmusectomy were: patients with a single lesion located in the region of the thyroid isthmus or the pyramidal lobe; maximum lesion diameter of 30 mm; and cytological reports of non-diagnostic appearance, follicular cells or suspicion of malignancy. Nine patients were identified with these criteria. Histology included two colloid nodules, three benign follicular adenomas, two Hurthle cell adenomas and two papillary thyroid carcinomas. There were no recorded complications. Thyroid isthmusectomy is a safe alternative to thyroid lobectomy with isthmusectomy in patients who have nodules confined to the isthmus and pyramidal lobe. Leaving a cuff of normal thyroid tissue has the advantage of not exposing the tracheoesophageal grooves, thus minimising potential damage to the recurrent laryngeal nerves and parathyroids. Surgeons performing isthmusectomies should be experienced in more complex thyroid surgical procedures.

BMI-1: a protein expressed in stem cells, specialized cells and tumors of the gastrointestinal tract.

Recently, BMI-1 was identified as a protein downregulating p16ink4a and mandatory for the continued existence of several stem cell compartments like hematopoietic and neural stem cells. In this study we investigated BMI-1 expression as a potential stem cell marker of the gastrointestinal tract. We found weak expression in the isthmus region of the stomach, and moderate expression in crypts of the intestines, whereas intestinal surface epithelial cells were weakly positive or negative for BMI-1. In addition, a variety of highly differentiated cells such as parietal cells, neuroendocrine cells of the pylorus, Paneth cells and a subset of goblet cells were moderately to strongly positive for BMI-1. Furthermore, we detected strong expression in gastrointestinal neoplasias. This expression pattern indicates a correlation of BMI-1 expression with gastrointestinal stem cells as well as numerous specialized cell types and points to a role of this protein in cellular differentiation in addition to that of stem cell maintenance. Besides, our results imply a role for BMI-1 in the tumorigenesis of gastrointestinal cancer.

Three enhancer regions regulate gbx2 gene expression in the isthmic region during zebrafish development

In vertebrate embryos, positioning of the boundary between the midbrain and hindbrain (MHB) and subsequent isthmus formation are dependent upon the interaction between the Otx2 and Gbx genes. In zebrafish, sequential expression of gbx1 and gbx2 in the anterior hindbrain contributes to this process, whereas in mouse embryos, a single Gbx gene ( Gbx2) is responsible for MHB development. In the present study, to investigate the regulatory mechanism of gbx2 in the MHB/isthmic region of zebrafish embryos, we cloned the gene and showed that its organization is conserved among different vertebrates. Promoter analyses revealed three enhancers that direct reporter gene expression after the end of epiboly in the anterior-most hindbrain, which is a feature of the zebrafish gbx2 gene. One of the enhancers is located upstream of gbx2 (AMH1), while the other two enhancers are located downstream of gbx2 (AMH2 and AMH3). Detailed analysis of the AMH1 enhancer showed that it directs expression in the rhombomere 1 (r1) region and the dorsal thalamus, as has been shown for gbx2, whereas no expression was induced by the AMH1 enhancer in other embryonic regions in which gbx2 is expressed. The AMH1 enhancer is composed of multiple regulatory subregions that share the same spatial specificity. The most active of the regulatory subregions is a 291-bp region that contains at least two Pax2-binding sites, both of which are necessary for the function of the main component (PB1-A region) of the AMH1 enhancer. In accordance with these results, enhancer activity in the PB1-A region, as well as gbx2 expression in r1, was missing in no isthmus mutant embryos that lacked functional pax2a. In addition, we identified an upstream conserved sequence of 227 bp that suppresses the enhancer activity of AMH1. Taken together, these findings suggest that gbx2 expression during the somitogenesis stage in zebrafish is regulated by a complex mechanism involving Pax2 as well as activators and suppressors in the regions flanking the gene.

CD34 glycoprotein identifies putative stem cells located in the isthmic region of canine hair follicles

It is widely documented that a pool of multipotent stem cells located in humans and mice hair follicle outer root sheath (bulge region) is involved in the restoration of the whole follicular unit during each anagen phase. To the authors' knowledge, data regarding the location and characterization of hair follicle stem compartment in dogs have not been reported in the recent relevant literature. In this study, we investigated the haematopoietic stem and progenitor cell antigen CD34 as a marker of putative stem cells located in a bulge-like region of canine hair follicles. The presence of CD34 mRNA and glycoprotein was assessed on formalin-fixed, paraffin-embedded canine skin samples by in situ hybridization technique and by standard immunohistochemistry, respectively. A strong expression of CD34 mRNA and glycoprotein was observed in a well-defined area of the hair follicle isthmic region and appeared uniformly concentrated at the level of the basal layer of the outer root sheath. These findings provide compelling support to the hypothesis that in dogs, a subpopulation of basal keratinocytes located in the hair follicle isthmic region and characterized by the selective expression of CD34 is potentially associated with the stem cell compartment of this skin appendage.

Distribution of neuropeptide FF‐like immunoreactivity in the brain of the lizard Gekko gecko and its relation to catecholaminergic structures

The present study provides a detailed description of the distribution of neuropeptide FF (NPFF)-like immunoreactivity in the brain of the lizard Gekko gecko. NPFF is found to be involved in nociception, cardiovascular regulation, and endocrine function. Because of its known relationship with catecholamines in mammals, double staining with tyrosine hydroxylase (TH) antibodies was used to corroborate this for reptiles. The present study revealed that NPFF-like-immunoreactive (NPFF-ir) cells and fibers were widely distributed throughout the brain. Major NPFF-ir cell groups were observed in the diagonal band nucleus of Broca, hypothalamus, and dorsal horn of the spinal cord. Additional cells were found in the anterior olfactory nucleus, lateral and dorsal cortices, dorsolateral septum, and diencephalic intergeniculate leaflet formation. Dense plexuses of NPFF-ir fibers were identified in the diagonal band nucleus of Broca, septum, preoptic and hypothalamic areas, isthmic region, ventrolateral tegmentum, solitary tract nucleus, and dorsolateral funiculus of the spinal cord. Extensive fiber staining also occurred in the nucleus accumbens and the midbrain tectum. Although an intimate relationship between NPFF-ir and TH-ir structures was obvious at many places in the brain, colocalization of these two substances was not observed. In conclusion, the distribution of NPFF in the brain of Gekko shares more features with anamniotes in terms of number of cell groups, more elaborate networks of fibers, and lack of colocalization with catecholamines than with mammals, suggesting a decrease in the distribution of this peptide in the latter vertebrate group.

Isthmus‐Preserving Total Bilobectomy: An Adequate Operation for C‐Cell Hyperplasia

Autopsy studies show that C cells deriving from the ultimobranchial body and migrating into the thyroid do not reach the isthmus region and are distributed along the vertical axes of thyroid lobes. This was confirmed in a surgical series of 58 patients (34 with preoperatively normal and 24 with elevated serum calcitonin) where no calcitonin-positive cells were demonstrable immunohistochemically within separately investigated isthmi. Consequently, isthmus-preserving total bilateral lobectomy (IPTB) may be regarded as an adequate surgical procedure for C-cell hyperplasia (CCH). IPTB was performed from October 2001 to December 2004 in 64 patients, 59 patients with nodular goiter and slightly to moderately elevated serum calcitonin (stimulated under 500 pg/ml) (group A, apparently sporadic cases) and in 5 patients undergoing prophylactic surgery for hereditary medullary thyroid carcinoma (MTC) with intermediate- or low-risk RET mutations (non-634) (group B). The surgical procedure focused on meticulous total extracapsular resection of both thyroid lobes, preservation of an isthmus remnant of about 3 ml (smaller in children), and histologic workup of the border zones of resection in addition to that of the completely removed lobes. When malignancy could be proven intraoperatively (7 patients) or when the isthmus turned out to contain nodular lesions (4 patients), completion total thyroidectomy (plus lymphadenectomy) was performed as a one-stage procedure. Second-stage total thyroidectomy was performed in 3 cases. Thus, IPTB was the definitive surgical procedure in 50 patients (45 of group A and all 5 of group B). In all of the 50 definite IPTB cases, postoperative serum calcitonin was below the measurable limit (2 pg/ml); stimulated calcitonin was below the measurable limit in 47 (including all of group B) and was measurable in 3 sporadic cases in a lower-normal range between 2.4 and 3.5 pg/ml. Genetic screening of the apparently sporadic cases with CCH was positive in one (codon 791). The risk of recurrent laryngeal nerve paralysis seems not to be elevated (0% permanent); permanent hypocalcemia occurred in 1 patient (2%). Follow-up data of 37 patients, median 18 (6-36) months, showed continuously nonmeasurable serum calcitonin with one exception, where it was in the normal range after 18 months. All IPTB patients are still under substitution therapy with L-thyroxine (median 125 mug/day) with decreasing tendency in all 3 children after prophylactic operation, the latter also showing an increasing volume of well-vascularized isthmi (from 1.5 to 2.5 ml). IPTB reliably removes all C cells. There may not be need for total thyroidectomy (TTx) in cases with CCH. When necessary, completion TTx can be performed easily without additional risk. IPTB leaves a functionally relevant remnant, corresponding to that of a subtotal resection. This might be of importance especially for prophylactic surgery in children where the isthmus can compensate for the loss of thyroid function with time.

Acute Traumatic Aortic Tear: Open Versus Stent-graft Repair

Acute traumatic aortic tear (ATAT) is the second most common cause of deaths in trauma patients (about 8,000 deaths/year in the USA). Due to circumferential aortic disruption, up to 90% die at the scene. Responsible trauma mechanisms are: penetrating (gunshot/stab wounds), iatrogenic (interventional catheterization) and, most frequently, blunt chest trauma (high-speed motor vehicles, falls from heights, crushes, explosions) resulting in injury at the aortic isthmus region (loco typico, about 90%). Severe multiple system injuries (polytrauma), especially to intracranial and intraabdominal organs, are characteristic and prognostically predicitive. Immediate transthoracic open repair of ATAT has a mortality risk of 8% to 33% and paraplegia risk of 2% to 26%. Contrast enhanced CT scan has replaced the classical angiography as the diagnostic tool of choice. Patients with life-threatening multisystem injuries are scheduled for delayed repair after initial stabilization. Currently, the use of endovascular stent-grafts (EVAR) is being investigated. Our personal series confirms that EVAR for ATAT is a viable alternative to open repair while minimizing the morbidity and mortality of the open procedure and having a limited impact on trauma destabilization. The assessment of long-term durability of EVAR is one of the key issues to consider EVAR as the first choice of treatment.

Transversal crista terminalis conduction suggests ineffective bidirectional isthmus block

Catheter ablation of the posterior isthmus is an effective tool to cure typical atrial flutter. In some cases, however, bidirectional block cannot be obtained despite extensive RF applications. Anatomic obstacles or abnormalities are thought to be the most common reasons for failed or prolonged procedures. We present a case of recurrent typical atrial flutter that seemed to be refractory to all ablation attempts in the region of the posterior isthmus although no anatomic abnormalities could be detected. Despite extensive RF application, bidirectional conduction was unchanged. Using a novel noncontact mapping system (En-Site 3000) the existence of a fast conducting gap in the region of the inferior terminal crest was revealed. Rapid conduction over this gap to the opposite side of the isthmus led to the impression that bidirectional isthmus block was not established. As a result no further RF applications were necessary because isthmus block was complete at that time. This is the first time that transverse conduction across the terminal crest could be detected by this novel noncontact mapping system masquerading as unchanged bidirectional isthmus conduction.

Ratio of mRNA expression of progesterone receptor isoforms AB is to B in human oviduct mucosal cells during the ovulatory cycle.

The ratio of the active progesterone receptor B isoform is higher in the ampullary region of the oviduct. To examine mRNA expression of progesterone receptor isoforms AB and B in oviduct mucosal tissue during the ovulatory cycle and in the different functional regions of the human oviduct. The mucosal layer was isolated from human oviduct tissue and semi-quantitative RT-PCR for progesterone isoforms AB and B was performed. The RT-PCR results were verified by immunohistochemistry. The isthmic region showed no mRNA expression of either progesterone receptor isoform while the relative ratio of the B isoform was significantly higher in the ampullary region compared to the fimbrial region. There was a significant increase in the ratio of PRB to PRAB in the ampullary region compared to the fimbrial region in all samples. We found an increase in the relative abundance of the progesterone receptor B isoform in the ampullary region which is the site of fertilization and early embryo cleavage. Our results indicate that progesterone responsive genes are more likely to be activated in the ampullary region of the oviduct due to the difference in PRAB to PRB ratio. Providing support for the hypothesis that progesterone may play a specific role in providing an appropriate environment for sperm capacitation, fertilization and early embryo cleavage.

Coarctation of the aorta: pre and postoperative evaluation with MRI and MR angiography; correlation with echocardiography and surgery

To compare MRI and MRA with Doppler-echocardiography (DE) in native and postoperative aortic coarctation, define the best MR protocol for its evaluation, compare MR with surgical findings in native coarctation. 136 MR studies were performed in 121 patients divided in two groups: Group I, 55 preoperative; group II, 81 postoperative. In group I, all had DE and surgery was performed in 35 cases. In group II, DE was available for comparison in 71 cases. MR study comprised: spin-echo, cine, velocity-encoded cine (VEC) sequences and 3D contrast-enhanced MRA. In group I, diagnosis of coarctation was made by DE in 33 cases and suspicion of coarctation and/or aortic arch hypoplasia in 18 cases. Aortic arch was not well demonstrated in 3 cases and DE missed one case. There was a close correlation between VEC MRI and Doppler gradient estimates across the coarctation, between MRI aortic arch diameters and surgery but a poor correlation in isthmic measurements. In group II, DE detected a normal isthmic region in 31 out of 35 cases. Postoperative anomalies (recoarctation, aortic arch hypoplasia, kinking, pseudoaneurysm) were not demonstrated with DE in 50% of cases. MRI is superior to DE for pre and post-treatment evaluation of aortic coarctation. An optimal MR protocol is proposed. Internal measurement of the narrowing does not correspond to the external aspect of the surgical narrowing.

Endoscopic Examination of the Eustachian Tube: A Step-by-Step Approach

The aim of this study was to develop a step-by-step approach for endoscopic examinations of the eustachian tube on awake patients and to report anatomic and functional findings. Prospective study. University hospital. Convenience sample of seven individuals without a history of ear disease. Diagnostic transnasal-transpharyngeal videoendoscopy of the eustachian tube with 30- and 70-degree rigid Hopkins rod endoscopes, 2.5- and 0.8-mm, 0-degree flexible fiber endoscopes performed under local anesthesia in 12 eustachian tubes. Utility of the various endoscopes for the diagnosis in the different parts of the eustachian tube; quality of vision and the patient's comfort during the procedure. The 2.5-mm flexible endoscope was most useful for examination of the pharyngeal ostium and the cartilaginous lumen of the tube. The isthmus region could only be passed using an 0.8-mm fiberscope. In all cases, it was possible to insert the endoscope into the middle ear cavity. Eleven of the 12 tube examinations showed normal findings. The mobility of the tubal cartilage could be visualized with sufficient quality. In 50% of all examinations, application of local anesthesia via a tube catheter was necessary to make the procedure tolerable. The presented approach allows an assessment of both anatomic and functional changes to the eustachian tube in awake patients. The assessment of middle ear structures is limited. To ensure a comfortable and safe procedure, the use of topical anesthesia in a supine position and, in certain cases, additional anesthesia via eustachian tube catheter is recommended.

Uterine innervation after hysterectomy for chronic pelvic pain with, and without, endometriosis

Chronic pelvic pain is associated with a wide range of clinical conditions that include endometriosis. The precise cause, mechanisms of pain, and natural history are imprecise. Patterns of uterine innervation have been studied after hysterectomy for chronic pelvic pain with and without endometriosis. Tissue blocks were taken from the lower one half of the uterus after hysterectomy for advanced endometriosis (n = 16 specimens; group 1) and for chronic pelvic pain without endometriosis (n = 15 specimens; group 2). The control group consisted of uteri that were removed for painless gynecologic conditions (n = 25 specimens; group 3). Tissue sections from the lower one half of the uterus were stained with anti-S100 to demonstrate patterns of innervation, and nerve fiber profiles were counted by standardized techniques; qualitative differences were also recorded. In uteri from women with advanced endometriosis, there were increased numbers of nerve fiber profiles compared with control specimens (group 1 vs group 3; P = .0013, Mann Whitney U test). There were also increased numbers of nerve fiber profiles in uteri that were associated with chronic pelvic pain without endometriosis (group 2 vs group 3; P = .04, Mann Whitney U test). There were no differences in nerve fiber count in uteri from groups 1 and 2 (P = .35, Mann Whitney U test). Comparing both groups of uteri with controls (groups 1 and 2 vs 3) demonstrated marked differences in nerve fiber counts (P = .002, Mann Whitney U test). Two distinctive patterns of reinnervation that were observed: disruption of nerve bundles (collateral sprouting with microneuroma formation) and ingrowth around blood vessels (perivascular nerve fiber proliferation). There were increased numbers of microneuromas (groups 1 and 2 vs 3; P = .001, chi-squared test with Yates correction) and perivascular nerve fiber proliferation (groups 1 and 2 vs 3; P = .008, chi-squared test with Yates correction) in the myometrium in chronic pelvic pain with, and without, endometriosis compared with the control group. Nerve fiber proliferation and other features of reinnervation have been observed in the isthmic regions of uteri that were removed at hysterectomy for chronic pelvic pain with and without endometriosis. There were no quantitative differences between the groups with chronic pelvic pain and endometriosis. These observations provide an alternative explanation for the source of pain and other clinical symptoms in these clinical settings.