A model of genital Chlamydia trachomatis infection using human xenografts in severe combined immunodeficiency mice

We developed a new model of human genital Chlamydia trachomatis infection in order to characterize the pathogen-host relationship in a clinically relevant system using a human strain of C. trachomatis instead of the commonly employed mouse biovar (MoPn). Human endometrial tissue was xenografted into the skin of mice homozygous for the mutation severe combined immunodeficiency and inoculated with C. trachomatis serovar K. C. trachomatis efficiently infected the endometrium as shown by cell culture and immunofluorescence microscopy and persisted for more than 6 weeks. Chlamydial inclusions detected by direct immunofluorescence and electron microscopy appeared to be smaller than those produced by in vitro cell culture-grown chlamydiae. A pattern of localized mild infection prevailed, and infiltrative uncontrolled spread of chlamydiae was observed in only 1 of 10 infected grafts. This might correspond to the well-known tendency of the agent to cause asymptomatic infections. This model allows the study of a human genital infection resembling the clinical situation and offers the possibility to better characterize the host-parasite relationship with respect to pathogenicity and therapy.

Safety of transvaginal fine needle puncture of gynecologic masses: a report after 500 consecutive procedures

Transvaginal sonographically guided puncture may be used for diagnostic and therapeutic purpose in general gynecology and in oncology. To define the complication rate of this technique, 500 consecutive procedures were reviewed; 289 procedures were on cystic masses, 146 on solid tumors, 34 on mixed tumors, and 31 on other lesions. No life-threatening complications occurred. Early mild and self-limited complications developed in eight procedures (1.6%). Short-term complications occurred in four cases (0.8%; two infections, one pelvic pain, one hemorrhage); two of these required surgery. Transvaginal sonographically guided puncture is safe and does not entail a higher risk of infection than transabdominal punctures.

Behçet's disease. Report of twenty-five patients from the United States with prominent mucocutaneous involvement

BACKGROUND

Behçet's disease is a multisystem disease that is rare in the United States.

OBJECTIVE

The purpose of our study was to assess the characteristics and treatment of a series of patients with Behçet's disease in the United States.

METHODS

A retrospective clinical review of 25 patients with Behçet's disease was performed, and histopathologic findings and therapeutic modalities were reviewed.

RESULTS

All patients had oral and genital aphthae, and 22 of 25 patients had cutaneous lesions consistent with Behçet's disease. Eight of 25 patients had relatively severe systemic disease. Nine of 14 biopsy specimens showed a neutrophilic vascular reaction. Our therapeutic "ladder" included aggressive topical and intralesional corticosteroids, colchicine, dapsone, methotrexate, and thalidomide; we reserved systemic corticosteroids and immunosuppressive medications for severe ocular or severe systemic disease.

CONCLUSION

This series of patients with Behçet's disease was characterized by patients with prominent mucocutaneous involvement and a low prevalence of ocular involvement. These findings may be attributed to patient selection from referral to a university dermatology clinic.

[Genital hematoma--local obstetrical trauma or pregnancy disorder?]

The general haematoma is a disease which appears during labour and affects the vulvar, vaginal or the parametrial tissues. The study of this affection implies the discussions of some special aspects, as the distinction between this disease and the traumatic complications of the labour; the observation that the genital haematoma is frequently associated with proteinuria and primiparity which leads to the possible inclusion of this disease among pregnancy toxaemias; the clinical importance of this affection, the severe forms prejudicing the mother's life. In the genital haematoma pathogenesis it is important to notice that this disease is the consequence of a vascular rupture, most frequently affecting the small vessels or the capillaries, and it is favoured by the increased vascular flow during gravidity and by the tissues' slip on the gravidic inhibition background. After mentioning the predisposing factors, details about the pathological anatomy are given and a new classification is proposed, mostly based on clinical and less on anatomical features. The clinical symptoms and the treatment are presented on a large scale, discussing the latest informations in the specialty literature.

Social support and adherence behavior among women with abnormal Pap smears

BACKGROUND

Studies of hypertension, diabetes, and diet have indicated a relationship between social support and adherence to treatment regimens. Estimates of nonadherence following abnormal Pap test results range as high as 40%. In this study, the relationship between social support and adherence behavior was examined in a population of low-income, public-health-department patients with abnormal Pap smears.

METHODS

Medical record reviews ascertained adherence behavior and interviews determined receipt of social support for 498 women.

RESULTS

Related to adherence were: receipt of any social support; receipt of each of three types of support (informational, emotional, and tangible support); amount of support received; satisfaction with support; and source of support. Reported need for support was not related to adherence behavior. Receipt of social support was more strongly related to adherence when the woman's emotional response to the notification of the abnormal Pap smear was greater, and when acculturation was higher (among Latinas). Knowledge of the results of the Pap test was found to be an intervening variable between receipt of informational support and adherence. Knowledge of the purpose of the Pap smear was found to be independently related to adherence. Among black women, emotional support was most strongly related to adherence, while among Latinas, tangible support was most strongly related to adherence. In a multivariate model, Pap-test knowledge and the interaction between emotional response and receipt of any social support were significantly related to adherence.

CONCLUSIONS

Findings suggest that supportive interventions, including provision of medical information, emotional support, child care, and transportation, could help to reduce nonadherence.

Experimental infection of SPF piglets with porcine reproductive and respiratory syndrome (PRRS) viruses isolated from two farms

Porcine reproductive and respiratory syndrome (PRRS) viruses were isolated from pig samples obtained from two farms characterized by an increased number of stillbirth and high mortality in new-born piglets (farm A), and respiratory distress with high mortality in weaning and growing pigs (farm B) in 1993, respectively. When primary specific pathogen-free piglets, 5-day-old or 13-day-old, were experimentally inoculated with the isolates, they showed clinical signs of depress, anorexia, pyrexia, diarrhea, sitting posture and periocular edema. Rate of the weight gain was reduced in the inoculated piglets compared with the non-inoculated pig. There were no apparent differences in clinical signs between the piglets inoculated with the virus samples derived from farms A and B. Microscopically, the most prominent changes observed in experimentally inoculated piglets were interstitial pneumonia, nonpurulent myocarditis and catarrhal lymphnoditis post inoculation day (PID) 28. Viruses were recovered from tissues collected from the inoculated piglets on PID 7 or 28. Furthermore, the viruses were continuously recovered from the sera from PID 7 to PID 28. Antibodies measured by indirect immunofluorescence assay to PRRS virus were first detected in sera on PID 14, and the antibody titer rose to 1:1280 on PID 28.

Protective efficacy of major outer membrane protein-specific immunoglobulin A (IgA) and IgG monoclonal antibodies in a murine model of Chlamydia trachomatis genital tract infection

The protective efficacy of immunoglobulin A (IgA) and IgG monoclonal antibodies (MAbs) specific for the major outer membrane protein of Chlamydia trachomatis MoPn was evaluated in a murine genital tract infection model. MAbs were delivered into serum and vaginal secretions of naive mice by using the backpack hybridoma tumor system, and protective efficacy was assessed over the first 8 days following challenge by quantitative determination of chlamydial recovery from cervicovaginal swabs, histopathological evaluation of genital tract tissue, and immunohistochemical detection of chlamydial inclusions. IgA and IgG significantly reduced the incidence of infection following vaginal challenge with 5 50% infectious doses, but such protection was overwhelmed by 10- and 100-fold higher challenge doses. Both MAbs also consistently reduced vaginal shedding from infected animals with all three challenge doses compared with the negative control MAb, although the magnitude of this effect was marginal. Blinded pathological evaluation of genital tract tissues at 8 days postinfection showed a significant reduction in the severity of the inflammatory infiltrate in oviduct tissue of infected IgA- and IgG-treated animals. Immunohistochemical detection of chlamydial inclusions revealed a marked reduction in the chlamydial burden of the oviduct epithelium; this finding is consistent with the reduced pathological changes observed in this tissue. These studies indicate that the presence of IgA or IgG MAbs specific to major outer membrane proteins has a marginal effect in preventing chlamydial colonization and shedding from the genital tract but has a more pronounced effect on ascending chlamydial infection and accompanying upper genital tract pathology.

Gene knockout mice establish a primary protective role for major histocompatibility complex class II-restricted responses in Chlamydia trachomatis genital tract infection

Mice with disrupted beta 2-microglobulin (beta 2m-/-), I-A (class II-/-), or CD4 (CD4-/-) genes were examined for their capacity to resolve Chlamydia trachomatis genital tract infection. C57BL/6 and beta 2m-/- mice resolved infection similarly and were culture negative by 4 to 5 weeks following infection. Conversely, major histocompatibility complex (MHC) class II-/- mice failed to resolve infection, and CD4-/- mice showed a significant delay (2 weeks). Secondary challenge of C57BL/6, beta 2m-/-, and CD4-/- mice established that acquired protective immunity, which was characterized by an infection of shortened duration and reduced shedding of infectious organisms, developed. Serological analysis of C57BL/6 and beta 2m-/- mice by enzyme-linked immunosorbent assays revealed no striking differences in the immunoglobulin subclass specificity of the anti-Chlamydia response, although some differences were observed in the magnitude of the immunoglobulin G2a (IgG2a) and IgG2b responses. Class II-/- mice produced lower-titered serum anti-Chlamydia antibodies of all isotypes. The serum antibody responses of CD4-/- mice were similar to those of C57BL/6 mice, except that the anti-Chlamydia IgA response was delayed by approximately 3 weeks. Analysis of vaginal washes for Chlamydia-reactive antibodies revealed the presence of IgG2a, IgG2b, and IgA in C57BL/6 and beta 2m-/- mice and primarily of IgA in CD4-/- mice. Vaginal washes from class II-/- mice were consistently antibody negative. Interestingly, the Chlamydia-specific IgA response in the vaginal washes of CD4-/- mice was delayed, but its appearance coincided with decreased shedding of infectious organisms and resolution of infection. Our results demonstrate that MHC class II-restricted T-cell responses are necessary for the development of protective immunity to Chlamydia genital tract infection and that local (vaginal) anti-Chlamydia IgA antibody coincides with the resolution of infection. A substantive role for MHC class I-restricted T-cell responses in protective immunity to Chlamydia genital tract infection was not confirmed.

Giant Gartner duct cyst: magnetic resonance imaging findings

Gartner duct cysts derive from remnants of the vaginal portion of the mesonephric (Wolffian) ducts. In cases of incomplete regression of these ducts, cysts can develop due to secretory activity [1]. Clinically, those cysts are usually asymptomatic, their size not exceeding 2 cm in diameter. In rare cases with larger cysts, the presence of dyspareunia and problems in obstetric delivery are described [2, 3]. We present a case of a histologically proven symptomatic Gartner duct cyst with a size of 16 x 15 x 8 cm. To my knowledge, this is the largest Gartner duct cyst ever reported in the imaging literature.

Simultaneous polymerase chain reaction detection and restriction typing for the diagnosis of human genital papillomavirus infection

A polymerase chain reaction method has been developed which allows the simultaneous detection of the majority of clinically relevant HPV types. Degenerate HPV-specific primers direct the one-step amplification of a DNA region spanning E1 and E7 genes. This enables an immediate distinction between the two groups of papillomaviruses, characterized by high or low oncogenic potential, simply from the size of amplified DNA. The PCR product can be subjected to a second round of amplification with internal primers, which are specific for 7 high-risk HPV types, HPV-16, -18, -31, -33, -35, -45 and -58. Precise identification of one-step or two-step amplified DNA is done by endonuclease digestion with one or two enzymes. The detection sensitivity, which has been assessed using cloned HPV genomes and HeLa and CaSki cell lines, varies from a few tens to a few hundreds of viral genome equivalents. The accuracy of the method has been confirmed by examining cervical scrapings of 44 patients.

Major outer membrane protein variants of Chlamydia trachomatis are associated with severe upper genital tract infections and histopathology in San Francisco

Cervical and endometrial samples from 33 women with lower genital tract infection (LGTI) or pelvic inflammatory disease (PID) were evaluated for Chlamydia trachomatis major outer membrane protein gene (omp1) polymorphism. Polymorphism was correlated with symptoms, clinical findings, and histopathology. F, E, I, D, H, K, and G genotypes were represented. Thirty-seven genotyped samples (66%) displayed omp1 mutations compared with prototype sequences. Significantly, 7 of 7 women with variant F infections had PID compared with 6 non-variant F infections in women with LGTI (P = .003). PID was defined by clinical findings or plasma cells on endometrial biopsy. Of interest, F variants were associated with histopathology. Eleven women (92%) with E genotypes were asymptomatic. Our data suggest that F variants are associated with symptomatic, severe endometrial disease, whereas E genotypes are associated with asymptomatic, milder infections. Detection of virulent genotypes may provide a prognostic indicator for serious sequelae. Larger studies are required to evaluate the molecular, immunologic, and epidemiologic basis for these findings.

Frequency and histogenesis of pelvic retroperitoneal lymph node inclusions of the female genital tract. An immunohistochemical study of 34 cases

Heterotopic tissue in lymph nodes is rare. Benign glandular lymph node inclusions (BGI) occur in 11.4% on average. Their histogenesis is still obscure. We studied 34 out of 1,039 cases of retroperitoneal lymph nodes with BGI (3.35%) of women who were treated by radical hysterectomy by Wertheim-Meigs of a cervical carcinoma. The nodes were reexamined by light microscopy and in 19 cases the antibodies MAK 6 (cytokeratine cocktail), HEA 125, Ber EP-4 (for differentiation between mesothelium and glandular differentiation), vimentin and CEA were additionally used. All BGI showed a strong expression of MAK 6 and in 57.9% and 73.7% to HEA 125 and Ber EP-4, respectively. Positive reaction against vimentin occured in 47.3%, but often only single cells were positive. None but one metastasis of an endometrioid adenocarcinoma of the cervix uteri of BGI expressed CEA. The BGI showed a capsular, trabecular or interfollicular location in more than 80% and in 44.1% an admixture of several cells at the lining epithelium was noted. No features usually associated with endometriosis, such as periglandular stroma or evidence of recent or old hemorrhage were seen. The results suggest that the BGI represent an endosalpingiosis and is therefore of secondary Müllerian origin. Some light microscopic features favoring the benign origin (location in the nodes, lining cells of multiple types, lack of mitoses and cellular atypism, no desmoplastic stroma reaction, presence of periglandular basement membrane) may be helpful in distinguishing metastasis of serous ovarian borderline tumors. Negative reaction against CEA and the cellular morphology can preclude metastases of an endometrioid adenocarcinoma of the cervix uteri as well as of a mucinous ovarian borderline tumor.

Pathobiology of human papillomavirus

Human papillomavirus (HPV) has long been recognized as the etiologic agent of skin and genital warts, and only recently has an oncogenic role been attributed to the virus. This article discusses the classification, genetics, and pathogenesis of HPV. HPV detection, epidemiology of HPV and cervical neoplasia, and HPV infections in the genital tract are also reviewed.

Inflammatory signs in wet smear and Pap-smear compared with the histopathology from the female lower genital tract

In order to define the relationship between various criteria of female lower genital tract inflammation, we examined wet smears, cervical smears and biopsies from 131 patients. The presence of clue cells in rehydrated dry smears showed a positive correlation to the presence of clue cells in Papanicolaou stained smears, and to some extent with cytological evidence of inflammation (Kappa 0.48). Cytological inflammatory findings correlated well with the presence of clue cells in rehydrated dry smears, but signs of inflammation diagnosed by histopathology did not correspond to findings in cytological smears, probably because these methods reveal inflammation at different sites.

Localized amyloidosis of the genito-urinary tract

Localized amyloidosis of the uro-genital tract is uncommon. It often simulates a neoplastic process. We describe our experience with three cases of localized amyloid of the bladder and one each of the ureter, prostate and corpora spongiosa.

Gynecologic cytology from the perspective of the Laboratory Proficiency Testing Program, Ontario, Canada

The accumulated test results from annual proficiency testing of approximately 150 cytology laboratories during the period 1977-1992 were analyzed. Several features of the test program are presented, including the adaptability of the uniform diagnostic terminology that was in use throughout. Observations include the impact of screening by a technologist; the better diagnostic performance generally, but not exclusively, in larger-volume laboratories; the degree of reproducibility of reporting in the laboratory; the ease of diagnosis in some diagnostic categories; and patterns observed in "false negative" and "false positive" rates. The follow-up analysis of suboptimal performance is recorded, and remedial and educational aspects are emphasized. The impact of levels of performance on the specific population being screened is correlated with the data on laboratory caseloads and with hospital vs. nonhospital laboratories.

Lichen sclerosus

Lichen sclerosus, usually appearing in the dermatologic literature under the names of lichen sclerosus et atrophicus, balanitis xerotica obliterans, and kraurosis vulvae, is an inflammatory disease with a multifactorial origin. A past association of lichen sclerosus and genital squamous cell carcinoma is not as close as once thought. Once considered primarily a surgical problem, especially when the genitals were involved, lichen sclerosus will respond to a variety of systemic and topical therapies.

Clinical presentation of gynecologic infections among Indian women

OBJECTIVE

To study the clinical presentation of different gynecologic infections among Indian women.

METHODS

This was a cross-sectional study of 257 women that included clinical, cytologic, colposcopic, and microbiologic screening for various gynecologic infections.

RESULTS

Human papillomavirus (HPV) was the leading infection, affecting 127 (49.4%) women; however, overt warts were only seen in seven (2.7%) patients. Women infected with HPV had a 60.3-fold higher risk of developing a bleeding ectopia compared to those with other infections; women with an unhealthy cervix and cervical ectopias also had an increased risk of HPV infection (7.6- and 2.8-fold, respectively). Bacterial vaginosis, detected in 33.5% of the women studied, had an increased risk of bleeding ectopia (9.3-fold), cervical ectopia (3.1-fold), cervicitis (2.9-fold), vaginitis (6.9-fold), and cervical hypertrophy (2.1-fold). Chlamydial infection, detected in 23.3% of the patient population, was associated with an eightfold increase in the risk of an unhealthy cervix and a fourfold increase in risk of a hypertrophied cervix. Immunoglobulin-A antibodies to the herpes simplex virus were detected in 53 (20.6%) women. More than half (55.2%) of the women had two or more infections, and the mean delay of seeking medical treatment was 7-13 months.

CONCLUSION

The specific finding of bleeding cervices was associated with HPV and bacterial vaginosis, hypertrophied cervices with chlamydia and bacterial vaginosis, and unhealthy cervices with chlamydia and HPV infections.

[Pathological changes in the urogenital tract and mammae of culled sows from an industrial pig production unit]

In an industrial pig production unit 101 sows were culled because of reproduction failure. All the sows had a previous history of MMA, PHS, SUGD. All the sows were crosses of the two breeds Large White and Landrace. 101 sows were examined postmortem for pathologic changes. Changes were found in the kidney (38.6%), pyelum (49.5%), ureter (52.5%), bladder (100%), urethra (100%), uterus (50.5%), cervix (31.7%), vagina (28.7%), ovaries (51.5%), mammary gland (100%). Since 100% of the pathologic findings happened simultaneously in the urinary tract as well as in the mammary gland and just over 50% of the investigated cases had pathologic changes in the genital organs as well, the results suggest that MMA, PHS, and SUGD must be regarded as different manifestations of the same pathological entity of the urogenital organs of the sow. The authors introduce the term SUGD to denominate the conflicting terminology around the periparturient reproductive failure syndrome complex.