Light and electron microscopic studies of perineural invasion by esophageal carcinoma.

Light and electron microscopic findings on perineural invasion by human esophageal squamous cell carcinoma are reported. Perineural invasion was observed histologically in 30 of a total of 129 cases (23%) of esophageal squamous cell carcinoma and in 11 of the 24 cases (46%) in which tumors infiltrated other organs by passing through the esophageal adventitial layer. Electron microscopic observation showed that the perineurium of peripheral nerves was completely surrounded by carcinoma cells and that marked degeneration and loss of perineural cells occurred. Irregularly thickened basal laminae were detected in the perineurium. For nerves incompletely surrounded by carcinoma tissue, the free portion of the perineurium revealed degenerative findings similar to those for completely surrounded nerves. Cytoplasmic projections of the leading margin of the invading cancer tissue were located in the degenerated perineurium, contained many lysosomes, and were not always surrounded by basal laminae. These observations suggest that invading carcinoma tissue actively contributes to the degeneration of the perineural sheath and that the special pattern of carcinoma tissue surrounding the peripheral nerves results from infiltration along the degenerated sheath of the perineurium.

Induction of the acrosome reaction in human spermatozoa by human zona pellucida and effect of cervical mucus on zona-induced acrosome reaction.

OBJECTIVES: To investigate the induction of the acrosome reaction in human spermatozoa by the zona pellucida (ZP), cumulus oophorus, and cervical mucus (CM), and to examine the effect of cumulus oophorus and CM on the zona-induced acrosome reaction. DESIGN, PATIENTS, MAIN OUTCOME MEASURES: The acrosome status of spermatozoa from healthy donors that were cultured with salt-stored human ZP, cumulus oophorus, and/or cervical mucus was assessed using fluoresceinated pisum sativum agglutinin. RESULTS: The acrosome reaction rate after sperm attachment to the zona for 6 hours was 35.7% +/- 17.7%, which was higher than controls (2.8% +/- 1.9%). The acrosome reaction was not observed after passage through cumulus oophorus or CM; however, the acrosome reaction rate of spermatozoa passed through CM after the attachment to zona was 51.6% +/- 6.8%, a higher value in comparison with spermatozoa that had not passed through CM (25.6% +/- 9.4%). CONCLUSION: These data indicate that human ZP are capable of inducing the acrosome reaction in human spermatozoa; however, cumulus oophorus and CM are unable to do so. The data further provide evidence that CM promotes the zona-induced acrosome reaction in human spermatozoa.

[Changes in catecholamine and immunoglobulin during anesthesia for cardiac surgery--a comparison of valve replacement and aorto-coronary bypass surgery].

During a period of extracorporeal circulation, which represents a massive invasion for the body, the patient is in a state of controlled shock. In this study, we examined changes in catecholamines and immunoglobulins in patients grouped according to whether they underwent valve replacement or aorto-coronary bypass surgery. Anesthesia was induced with fentanyl, and cardiopulmonary bypass in all patients was carried out using a bubble-type heart-lung machine. The epinephrine and norepinephrine levels increased during the procedures, but those patients having aorto-coronary bypass surgery showed milder rises than valve replacement patients. IgA, IgG and IgM all dropped as well, but the change in IgG was the greatest, and the decreases were more marked in valve replacement patients than in aorto-coronary bypass patients. It was concluded that, since reactions were different according to the disorder present and were reflected in the variations in catecholamine and immunoglobulin levels, great care is necessary when the patient is removed from the heart-lung machine.

[Hemodynamic changes before and after anesthesia for renal transplantation].

Renal transplantation has come into use as a treatment for renal insufficiency, but infusion management before and after anesthesia for this operation is important. In order to prevent acute necrosis of the uriniferous tubules and to obtain urine outflow in early postoperative stage, a recent practice has been to give rapid infusions of large amounts of fluid, starting during the anastomosis of the renal vessels. We gave a large amount of intraoperative fluid to six patients undergoing transplantation of cadaver kidneys. A Swan-Ganz catheter was inserted into the pulmonary artery and infusion management was performed so as to maintain the pulmonary arterial pressure above 15 mmHg and the pulmonary capillary wedge pressure above 10 mmHg. The cardiac output increased as a result, and no pulmonary edema was seen. We believe that our method of infusion management using a Swan-Ganz catheter is a useful technique in such cases.

[A comparison of induced hypotensive anesthesia using trimetaphan, prostaglandin E1 and nicardipine for neurosurgery].

We performed hypotensive anesthesia using trimetaphan, prostaglandin E1, or nicardipine for eighteen patients undergoing cerebral aneurysm clipping. We measured the hemodynamic parameters (systolic arterial pressure, diastolic arterial pressure, and heart rates), concentration of catecholamines in blood (epinephrine, norepinephrine), blood platelet counts, and aggregation of blood platelets, before induction of anesthesia, before induced hypotension, during hypotension, after hypotension, and at the end of operation. Hypotension was produced rapidly, and hemodynamics was stable with any of the three drugs. In trimetaphan group, however, recovery time of arterial pressure was longer than in other two groups. There was no significant change of catecholamine during induced hypotension in prostaglandin E1 and nicardipine groups. However, in trimetaphan group, concentration of norepinephrine in blood decreased significantly during hypotension. No significant change was observed in either platelet count or platelet aggregation. These results suggest that trimetaphan has an effect to suppress excretion of stress hormones, and prostaglandin E1 and nicardipine have no influence on blood catecholamine levels and aggregation of platelet. We consider that nicardipine is useful as a hypotensive drug for neurosurgery.

[Three case reports of the use of stellate ganglion block for the climacteric psychosis].

There are many reports of the use of stellate ganglion block (SGB) for the climacteric psychosis, which is considered to be sympathicotonic response to stress. We experienced three cases of the SGB therapy for the climacteric psychosis. We performed SGB three times per week by 1% lidocaine 5 ml, and observed improvements of the symptoms after doing SGB for five times. The patients reported psychological relaxation after receiving SGB therapy. We examined the changes of the serum concentrations of ACTH, LH, FSH, and catecholamines (epinephrine, norepinephrine) before and after SGB in 8 patients who were suffering from climacteric psychosis, because we wanted to know the endocrinological response to SGB. We observed a significant decrease in norepinephrine concentration after SGB, which is reasonable considering the sympathetic blockage. There were no significant changes of ACTH, LH, FSH, and epinephrine. We conclude that SGB therapy must be effective for the climacteric psychosis because of sympathetic blockade. But we could not clarify the influence of endocrinological response to SGB.

[Cardiovascular effects of, and catecholamine response to, high dose fentanyl or NLA in patients for valve replacement].

We measured the cardiovascular effect of, and catecholamine and other hormonal responses to, anesthetic doses of fentanyl and original NLA in 25 patients for open heart surgery. The patients were randomly divided into three groups (group N, F30, F75). During induction, in group N; droperidol 0.25 mg.kg-1 and fentanyl 5 micrograms.kg-1, in group F30; fentanyl 30 micrograms.kg-1, and in group F75; fentanyl 75 micrograms.kg-1 were administered intravenously. Additional fentanyl was administered at a rate of 100 to 200 micrograms.h-1. Droperidol 0.25 mg.kg-1 was administered in group N when cardiopulmonary bypass (CPB) was disconnected. Plasma samples were assayed for norepinephrine, epinephrine, ACTH and cortisol before and after induction, during sternotomy, 60 minutes after institution of CPB, after weaning from CPB, and before as well as after extubation. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and rate pressure product (RPP) were calculated simultaneously at the blood samplings. In all groups, no remarkable change in cardiovascular dynamics was observed. CPB was associated with marked increases in catecholamines, but high dose fentanyl in dose of 75 micrograms.kg-1 was able to suppress epinephrine level more than in group N. In high dose fentanyl group (F30, F75) ACTH was within normal ranges, even during CPB. The results suggest that high dose fentanyl is a complete anesthetic in patients for cardiac surgery. But a large dose of fentanyl causes small decreases in heart rate and arterial blood pressure. Our data indicate that group F30 is an attractive anesthetic technique for patients with valvular disease.

[Hemodynamic changes secondary to overload infusion during cadaveric renal transplantation--comparison between nitrous oxide-isoflurane anesthesia and continuous epidural anesthesia].

The hemodynamic status of renal transplant patients is important for achieving early diuresis. Many reports have demonstrated that overload infusion can reduce the frequency of acute tubular necrosis (ATN). We studied the effect of overload fluid infusion using pulmonary arterial pressure (PAP) and pulmonary wedge pressure (PCWP) monitoring on forty patients undergoing cadaveric renal transplantation. Patients were divided into two groups. Group 1 received general anesthesia by nitrous oxide-isoflurane. Group 2 received continuous epidural anesthesia. Mean PAP > 15 mmHg and mean PCWP > 10 mmHg were achieved with the infusions of normosmotic saline, colloid solution and human albumin. Systolic arterial pressure (SAP) > 150 mmHg was achieved by intravenous administration of dopamine when required. Hemodynamic stability and diuresis in the early postoperative period were maintained in both groups. Group 1 required lower doses of dopamine than Group 2. Blood loss and infusion requirements were lower in group 1 than in group 2. No patient in either group developed pulmonary edema. We conclude that overload infusion using PAP and PCWP monitoring during general anesthesia can achieve safe diuresis immediately after cadaveric renal transplantation.

[The influence of ulinastatin on renal function during anesthesia for renal transplantation].

The purpose of this study was to evaluate the influence of ulinastatin (UST) on renal function and changes in granulocyte elastase during anesthesia in 10 living related and 10 cadaveric renal transplantations. UST (300,000 units) was administered after the induction of anesthesia and renal vessel anastomosis, respectively. The living patients who received UST had greater urine volume during the operative and postoperative periods. In addition, the granulocyte elastase values of these patients showed relative suppressive changes during the intraoperative and postoperative periods. In cadaveric renal transplant patients, UST did not influence serum BUN or creatinine, although urine volume was greater in the UST-treated patients than in the patients who did not receive. We could not conclude that the intraoperative administration of UST affected the renal function of renal transplants, but we did find that UST is useful to suppress granulocyte elastase which is concerned with the index of stress or inflammation. It is necessary to investigate further the method of administration of UST for renal transplantation.

Zonae pellucidae of salt-stored hamster and human eggs: their penetrability by homologous and heterologous spermatozoa.

Zonae pellucidae of unfertilized hamster and human eggs remain penetrable by homologous spermatozoa when they are stored in highly concentrated salt solutions [Yanagimachi et al., 1979]. Neutralization of salt solutions with the appropriate pH buffers is recommended for long-term storage of the eggs (zonae), because zonae may gradually swell or even dissolve in acidic or alkaline solutions. At least for the hamster, 2 M ammonium sulfate solution containing 40 mM Hepes and 0.5% dextran (pH 7.0) seems to serve the purpose satisfactorily. Thorough rinsing of salt-stored zonae prior to insemination is important, but inclusion of protease inhibitors in the rinsing medium does not appear to be essential. A dialysis method is recommended when a large number of salt-stored eggs must be rinsed at one time. Salt-stored hamster zonae, like fresh (control) zonae, permit attachment and penetration of hamster spermatozoa, but not human spermatozoa. Salt-stored human zonae, on the other hand, allow penetration by not only human spermatozoa, but also hamster spermatozoa.

Comparison of the action of epinephrine and a respiratory chain uncoupler, 2,4-dinitrophenol, on Ca2+-mobilization in isolated hepatocytes and perfused livers.

The effects of epinephrine and dinitrophenol (DNP) on Ca2+-fluxes and energy metabolism were compared in isolated rat hepatocytes and perfused rat livers. Epinephrine increased the cytosolic free Ca2+ concentration ([Ca2+]i), with Ca2+ being extruded into the extracellular space. DNP also increased [Ca2+]i, but did not cause Ca2+ extrusion into the extracellular space. The maximal change of [Ca2+]i caused by DNP was much larger than that by epinephrine. In the absence of extracellular Ca2+, the transient increase of [Ca2+]i due to epinephrine declined rapidly, while the DNP-induced increase was not affected. Although increased oxygen consumption was detected after the addition of epinephrine or DNP, tissue ATP contents decreased markedly by DNP, but not by epinephrine, suggesting that the Ca2+ extrusion is energy-dependent. DNP could activate glycogenolysis even after the depletion of the epinephrine-responsive Ca2+ store in isolated perfused liver, indicating that this intracellular Ca2+ store differed from the DNP-responsive store.

Zona-induced acrosome reaction of hamster spermatozoa.

It is well established that the zonae pellucidae of mature unfertilized eggs have the ability to induce the acrosome reaction of capacitated spermatozoa. To determine if this capacity of the zona is species-specific, hamster spermatozoa were allowed to attach to the zonae of homologous and heterologous eggs and examined for the acrosome reaction. The zonae of eggs from six different species were tested and the zona of hamster egg was found to have the strongest capacity to induce the acrosome reaction of hamster spermatozoa, followed by human and rat zonae. The zonae and mouse, guinea pig, and domestic fowl eggs were incapable of inducing the acrosome reaction of hamster spermatozoa. The acrosome reaction-inducing ability of the hamster zona was found to increase during maturation in the ovary. The zona of mature unfertilized hamster eggs maintained their acrosome reaction-inducing ability even after aldehyde fixation or storage in a highly concentrated solution of ammonium sulfate.

[Effect of cervical mucus on zona induced acrosome reaction of human spermatozoa].

Zona induced acrosome reaction of human spermatozoa was examined by FITC labelled PSA staining. When human spermatozoa were incubated with salt stored human eggs for 6 hours, the percentage of acrosome reacted spermatozoa was 35.7 +/- 17.7%. The zona induced acrosome reaction rate was significantly higher than that of the spontaneous acrosome reaction (2.8 +/- 1.9%). These date indicate that the zona pellucida of the human egg have the ability to induce the acrosome reaction as in other mammalian zona. Additionally the effect of cervical mucus on the acrosome reaction was examined. Spermatozoa which passed through the cervical mucus were collected and examined for the rate of spontaneous and zona induced acrosome reaction. The rate of spontaneous acrosome reaction was almost the same as the control, but the rate of zona induced acrosome reaction (51.6 +/- 6.8%) was significantly higher than that of the control (25.6 +/- 9.4%). These data suggest that spermatozoa appear to complete capacitation by passing through cervical mucus.

Correlation of semen characteristics with acrosin, hyaluronidase, tubulin, dynein, and actin of spermatozoa.

The distribution of acrosin (AC), hyaluronidase (HY), tubulin (TU), dynein (DY), and actin (ACT) has been examined by indirect immunofluorescent measurement in sperm preparations from infertile patients to investigate the sperm fertilizing ability. The fluorescence scores were determined by the chromatically positive rates of each antibodies. In cases in which semen showed lower concentration (oligozoospermia and oligoasthenozoospermia), the scores of these proteins were all significantly lower than those of normozoospermia. In cases in which semen showed lower motility (asthenozoospermia and oligoasthenozoospermia), the scores of AC, HY, TU, and ACT were significantly less. In semen that contained numerous morphologically abnormal spermatozoa, TU and ACT exhibited a significant reduction. These results indicate that sperm productibility may be involved in all proteins and that less-motile and morphologically abnormal spermatozoa are involved in structural or functional disorder of the proteins constituting the tail. The normality of these fluorescence scores showed a good correlation with pregnancy rate, but semen analysis did not show any correlation with pregnancy rate. It would appear that this immunofluorescent procedure has an advantage over semen analysis and yields useful information on sperm fertilizing ability.

Effects of alcohol-metabolizing enzyme inhibitors and beta-lactam antibiotics on ethanol elimination in rats.

The in vivo effects of alcohol-metabolizing enzyme inhibitors and beta-lactam antibiotics upon the ethanol elimination rate were examined in rats. Intravenous administration of ethanol caused a dose-dependent increase in blood ethanol level, and the ethanol elimination could be well described by a two compartment model. Pretreatment of rats with enzyme inhibitors caused a marked decrease in the ethanol elimination rate associated with the depression of the enzyme activities. Fasting of the animals caused a decrease in the ethanol elimination rate per animal associated with a decrease in the liver weight. However, no alteration was evident when the rate was expressed as the rate per g of liver. When animals were pretreated with a high dose of N-methyltetrazolethiol (NMTT)- containing beta-lactam antibiotics or NMTT itself, which causes a disulfiram-like reaction, the ethanol elimination rate per animal was depressed concomitant with an increase in the blood acetaldehyde level. The ethanol elimination rate in these animals showed lower values even when expressed as the rate per g liver. On the other hand, administration of cephems without NMTT, which cause no disulfiram-like reaction, led to a slight decline in the elimination rate per animal, although no alteration was detected when the rate was expressed as the rate per g liver. The findings indicated that the ethanol elimination in vivo per animal is regulated by the total capacity of the alcohol-metabolizing enzyme activities in the whole liver.

[The significance of alpha-fetoprotein-negativity in the interstitial area of total hydatidiform mole tissue].

UNLABELLED: The presence of the fetal component is an important factor in explaining the mechanism of the occurrence of the hydatidiform mole. But we have not confirmed in which phase the fertilized becomes a fetus. Therefore the mechanism of the occurrence of hydatidiform mole was investigated, using alpha-fetoprotein (AFP) produced in the fetal liver and the yolk sac, as a parameter. Total hydatidiform moles, partial hydatidiform moles, chorionic villi obtained from normal pregnancy artificially terminated and spontaneous abortion, and also the fetal liver, umbilical cord, and intestine were examined. Paraffin sections of these materials were examined for the presence of AFP by a peroxidase-anti-peroxidase method. RESULTS: In the fetal liver, the gelatinous area of the umbilical cord the lamina propria mucosae of the intestine, and the AFP were stained positive. In the interstitial area of the chorionic villi of normal pregnancy, the AFP was positive (78.3% n = 23). But in the villous epithelium, the AFP was negative. In the interstitial area of the chorionic villi of spontaneous abortion, the AFP was positive (88.9% n = 9). But in the villous epithelium, the AFP was negative. In the interstitial area of the partial hydatidiform mole, the AFP was positive (100% n = 6). In the epithelial area, the AFP was negative. No localization of the AFP was found in either the interstitial area or the epithelial area of the cyst of total hydatidiform mole (100% n = 7). We concluded that the AFP exuded to tissues derived from mesoblast by feto-chorionic circulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Changes in the motility pattern of human spermatozoa during in vitro incubation.

Suspensions of capacitating human spermatozoa were analyzed for movement characteristics using high-speed videomicrography. The status of the acrosome reaction was also assessed by the zona-free hamster ova penetration test. (1) Movement characteristics of human spermatozoa were classified into 4 types (A, B, C, D). Type A: The movement was active, but its progressive orientation was irregular. Type B: The spermatozoa moved with a wide amplitude of the end of tail. Type C: The amplitude of the tail decreased, and the linear velocity of progression increased. Type D: The whole part of tail showed wavelike rhythmical movements, and the velocity more increased. (2) Movement characteristics of human spermatozoa in vitro gradually changed from Type A to B, C and D. As the spermatozoa classified Type D moved very powerfully and this motility pattern was obviously different from the other types, it was considered hyperactivation of human spermatozoa. The Type D was found from 2 or 3 hr of incubation, and after 3 or 4 hr most of the spermatozoa showed Type D. (3) The motility pattern of human spermatozoa changed to the Type D before the spermatozoa penetrate into zona-free hamster oocytes. It suggested that the hyperactivation occurred before the acrosome reaction takes place.

Variation in the cholesterol/phospholipid ratio in human spermatozoa and its relationship with capacitation.

The cholesterol/phospholipid (C/PL) ratio was determined for spermatozoa from eight men with normal semen parameters. There was a close correlation between the C/PL ratio and the rate of sperm capacitation as assessed by the hamster egg penetration test. A lower C/PL ratio correlated with a faster capacitation time. This supports the notion that the loss or reduction of membrane cholesterol constitutes an important step of capacitation in human spermatozoa.