VAGINAL CYTOLOGY—Results in 3,000 Consecutive Women with “Normal” Cervices

Cytologic examination of 9,000 specimens of mucoid material taken from the cervices of 3,000 women who had no clinically observable vaginal abnormality was carried out. Sixteen of them had carcinoma, later proved by tissue examination. In 15 cases the lesion was epidermoid carcinoma of the cervix and in one was adenocarcinoma of the endometrium. Routine use of examination of mucoid specimens easily and painlessly obtained from the vagina should contribute substantially to a lower mortality from pelvic carcinoma.     

Vogt-Koyanagi syndrome

Cytologic examination of 9,000 specimens of mucoid material taken from the cervices of 3,000 women who had no clinically observable vaginal abnormality was carried out. Sixteen of them had carcinoma, later proved by tissue examination. In 15 cases the lesion was epidermoid carcinoma of the cervix and in one was adenocarcinoma of the endometrium. Routine use of examination of mucoid specimens easily and painlessly obtained from the vagina should contribute substantially to a lower mortality from pelvic carcinoma.     

Diagnosis of urogenital Chlamydia trachomatis infection in women based on mailed samples obtained at home: multipractice comparative study.

OBJECTIVE: To compare urine and vaginal flush samples collected by women at home with endocervical and urethral swabs obtained by general practitioners for their efficacy in the diagnosis of urogenital Chlamydia trachomatis infection. DESIGN: Multipractice comparative study. SETTING: 33 general practices and a central department of clinical microbiology in Aarhus County, Denmark. SUBJECTS: 222 women aged 18-25 years who for any reason had a gynaecological examination. INTERVENTIONS: Endocervical and urethral swabs were obtained by the women''s general practitioners. The same women when at home then collected a first void urine sample, a midstream urine sample, and a vaginal flush sample (using a vaginal pipette) and mailed them to the laboratory. MAIN OUTCOME MEASURES: C trachomatis defected by the polymerase chain reaction and the ligase chain reaction. Eight tests for C trachomatis were performed for every woman. When two of the eight yielded positive results the patient was considered infected. RESULTS: The overall prevalence of C trachomatis infection was 11.2% (23/205 women). Test sensitivities in samples obtained by general practitioners, samples obtained at home subjected to polymerase chain reaction, and samples obtained at home subjected to ligase chain reaction were 91%, 96%, and 100% respectively. The corresponding specificities were 100%, 92.9%, and 99.5%. CONCLUSIONS: The diagnostic efficacy of samples obtained by women at home and mailed to the laboratory was as good as for samples obtained by a general practitioner when using the ligase chain reaction. This may have important implications for the practicability of screening for this common, often asymptomatic, and treatable infection.     

Bacterial communities of the coronal sulcus and distal urethra of adolescent males

Lactobacillus-dominated vaginal microbiotas are associated with reproductive health and STI resistance in women, whereas altered microbiotas are associated with bacterial vaginosis (BV), STI risk and poor reproductive outcomes. Putative vaginal taxa have been observed in male first-catch urine, urethral swab and coronal sulcus (CS) specimens but the significance of these observations is unclear. We used 16 S rRNA sequencing to characterize the microbiota of the CS and urine collected from 18 adolescent men over three consecutive months. CS microbiotas of most participants were more stable than their urine microbiotas and the composition of CS microbiotas were strongly influenced by circumcision. BV-associated taxa, including Atopobium, Megasphaera, Mobiluncus, Prevotella and Gemella, were detected in CS specimens from sexually experienced and inexperienced participants. In contrast, urine primarily contained taxa that were not abundant in CS specimens. Lactobacilllus and Streptococcus were major urine taxa but their abundance was inversely correlated. In contrast, Sneathia, Mycoplasma and Ureaplasma were only found in urine from sexually active participants. Thus, the CS and urine support stable and distinct bacterial communities. Finally, our results suggest that the penis and the urethra can be colonized by a variety of BV-associated taxa and that some of these colonizations result from partnered sexual activity.     

Curschmann's spirals in cervicovaginal smears. Prevalence, morphology, significance and origin

A retrospective examination of 172,119 cervical and vaginal smears was undertaken to study the prevalence, morphology, significance and origin of Curschmann's spirals in such specimens. Spirals morphologically identical to those seen in sputum were found in 101 specimens from 100 patients, for a prevalence of 1 in 1,704 smears. Spirals were found only in patients who had not had their cervices removed. The presence of the spirals could not be correlated with any particular gynecologic or nongynecologic abnormality. Most of the patients had no gynecologic abnormality. The literature contains suggestions that Curschmann's spirals in cervicovaginal smears are a manifestation of orogenital sexual contact or are formed in endocervical mucus, particularly in cigarette smokers. To investigate whether such spirals have an extraneous origin, we examined the smears for dust-containing histiocytes, vegetable cells, skeletal muscle fibers and other extraneous material, none of which was found. We found no correlation between the presence of spirals and cigarette smoking. Moreover, histologic sections of the uterine cervices from some of the patients who had spirals in their smears showed evidence of spiral formation in endocervical mucus. We conclude that Curschmann's spirals in cervicovaginal smears are an uncommon finding with no clinical significance, that they are formed from endocervical mucus and that their presence has nothing to do with orogenital sexual contact or cigarette smoking.     

Cytomorphology of the variants of small-cell carcinoma of the lung

Cytologic classification of subtypes of small-cell carcinoma of the lung (SCCL) was retrospectively performed on respiratory material of 90 cases of lung carcinoma cytologically diagnosed as SCCL. Additionally, the cytologic material was reexamined for the presence of variants of SCCL in 68 cases of lung carcinoma whose types had not been conclusively defined by cytology. The type of lung cytology specimens reviewed were sputa, bronchial washings and brushings and fine needle aspirations. The study included review of pretreatment tumor histology, when present, and examination of the ultrastructure of the tumor in selected cases whose type had not been well defined by histology. Subtype recognition depended on the adequacy of the specimens rather than on the type of cytologic material examined. The cytologic subtyping was generally in agreement with the histologic subtyping of the tumor, except for cases in which SCCL was combined with other types of lung carcinoma, where certain discrepancies were noted.     

Effect of vaginal distension on blood flow and hypoxia of urogenital organs of the female rat.

Vaginal delivery of children causes traumatic injury to tissues of the pelvic floor and is correlated with stress urinary incontinence; however, the exact mechanism of organ and tissue injury leading to incontinence development is unknown. The purpose of this project was to test the hypothesis that vaginal distension results in decreased blood flow to, and hypoxia of, the urogenital organs responsible for continence, which would suggest an ischemic and/or reperfusion mechanism of injury. Thirteen female rats underwent vaginal distension for 1 h. Thirteen age-matched rats were sham-distended controls. Blood flow to the bladder, urethra, and vagina were determined using a microsphere technique. Hypoxia of these organs was determined by immunohistochemistry. Blood flow to all three organs was significantly decreased just before release of vaginal distension. Bladder blood flow decreased further immediately after release of vaginal distension and continued to be significantly decreased 15 min after the release. Blood flow to both the urethra and vagina tripled immediately after release, inducing a rapid return to normal values. Vaginal distension resulted in extensive smooth muscle hypoxia of the bladder, as well as extensive hypoxia of the vaginal epithelium and urethral hypoxia. Bladders from sham-distended rats demonstrated urothelial hypoxia as well as focal hypoxic areas of the detrusor muscle. We have clearly demonstrated that vaginal distension results in decreased blood flow to, and hypoxia of, the bladder, urethra, and vagina, supportive of hypoxic injury as a possible mechanism of injury leading to stress urinary incontinence.     

COXSACKIE VIRUS IN SOUTHERN CALIFORNIA—Isolation of a Strain from Stools of a Patient

Thirty-three stool specimens from 29 patients were examined for Coxsackie virus by the inoculation of suckling mice. Such a virus, designated “California I,” was obtained from two stool specimens collected on successive days from a patient with so-called nonparalytic poliomyelitis.Neutralizing antibodies for the California I strain of Coxsackie virus could not be demonstrated in serum obtained from the patient early in the illness, but were present in convalescent serum.Serum from the patient''s daughter, who previously had had a similar illness, neutralized the strain of virus isolated from the father.In pathologic examination of the skeletal muscles of mice infected with the California I virus, lesions typical of those produced by Coxsackie virus, group A, were noted.California I strain of the virus was not neutralized by immune serum prepared from several other strains of Coxsackie virus.     

Prevalence of Gardnerella vaginalis: an estimate

To assess the prevalence of Gardnerella vaginalis in the community 300 women aged 16-59 were randomly selected from a general practice''s age-sex register and invited to attend for a health check. Out of 282 women who were eligible to attend, 192 did so. They were asked whether they had any vaginal symptoms, and swabs were taken from 182 women for culture for G vaginalis. Sixty women were positive for G vaginalis, of whom 26 had symptoms.Infections with G vaginalis may be present in women who have no symptoms. By careful questioning, examination, and side room testing general practitioners may be able to diagnose these infections in such women consulting them for other reasons.     

Protein-Coated Nanoparticles Are Internalized by the Epithelial Cells of the Female Reproductive Tract and Induce Systemic and Mucosal Immune Responses

The female reproductive tract (FRT) includes the oviducts (fallopian tubes), uterus, cervix and vagina. A layer of columnar epithelium separates the endocervix and uterus from the outside environment, while the vagina is lined with stratified squamous epithelium. The mucosa of the FRT is exposed to antigens originating from microflora, and occasionally from infectious microorganisms. Whether epithelial cells (ECs) of the FRT take up (sample) the lumen antigens is not known. To address this question, we examined the uptake of 20–40 nm nanoparticles (NPs) applied vaginally to mice which were not treated with hormones, epithelial disruptors, or adjuvants. We found that 20 and 40 nm NPs are quickly internalized by ECs of the upper FRT and within one hour could be observed in the lymphatic ducts that drain the FRT, as well as in the ileac lymph nodes (ILNs) and the mesenteric lymph nodes (MLNs). Chicken ovalbumin (Ova) conjugated to 20 nm NPs (NP-Ova) when administered vaginally reaches the internal milieu in an immunologically relevant form; thus vaginal immunization of mice with NP-Ova induces systemic IgG to Ova antigen. Most importantly, vaginal immunization primes the intestinal mucosa for secretion of sIgA. Sub-cutaneous (s.c) boosting immunization with Ova in complete Freund''s adjuvant (CFA) further elevates the systemic (IgG1 and IgG2c) as well as mucosal (IgG1 and sIgA) antibody titers. These findings suggest that the modes of antigen uptake at mucosal surfaces and pathways of antigen transport are more complex than previously appreciated.     

Congenital hypertrophy of retinal pigment epithelium: a sign of familial adenomatous polyposis.

Families of people known to have familial adenomatous polyposis are screened for signs of the disease by yearly examination of the bowel. Multiple areas of congenital hypertrophy of the retinal pigment epithelium have been described in patients with familial adenomatous polyposis. To assess the reliability of this marker 40 patients with familial adenomatous polyposis, representing all 25 pedigrees with living affected members in the Northern region''s polyposis registry, were examined for hypertrophy of the retinal pigment epithelium. All had multiple lesions, ranging in number from two to over 40. None of the 35 controls had more than two lesions. Ocular examination is valuable for detecting carriers of the gene for familial adenomatous polyposis before their symptoms develop.     

Problems in cervicovaginal cytology: fine structure as an aid to diagnosis

The ultrastructure of cytologically abnormal, thick cell groups and epithelial fragments in cervical and vaginal scrape material was investigated and found to be useful in differentiating between carcinoma in situ, invasive nonkeratinizing squamous carcinoma and adenocarcinoma of the endocervix and also in confirming the presence of cytologically suspected vault deposits of recurrent endometrial adenocarcinoma. It was demonstrated that although accurate evaluation of these thick groups in smear preparations is often not possible, thick sections of similar, plastic-embedded material showed some features which enabled a distinction to be made between squamous and glandular lesions and that these differences were more pronounced at the ultrastructural level. The squamous lesions were characterized by wide intercellular spaces with microvilli and tonofibrils within the cytoplasm while glandular lesions showed narrow intercellular spaces, prominent Golgi zones and endoplasmic reticulum together with mucus droplets in some cells.     

Further Evaluation of Immunofluorescence Techniques for Detection of Shigellae in Fecal Specimens

The fluorescent antibody (FA) tests for group B and group D Shigella were reevaluated. Duplicate swab specimens from patients suspected of having shigellosis were cultured shortly after collection and after transport in a soft-agar holding medium. Smears for FA examination were made at the same time. Results obtained for the group D Shigella agree closely with those obtained in previous studies. The percentage of isolations of group B Shigella from transported specimens which were positive by FA was 59.6% as compared to 39.3 and 53.3% in previous studies. S. flexneri was isolated from 76.7% of the FA-positive specimens when they were examined shortly after collection. More isolates of Shigella were obtained when specimens were examined by both methods than when either method was used alone. The results indicated that FA tests for both group B and group D Shigella are practical and may be useful to laboratories engaged in Shigella isolation.     

Asepsis in the Operating Theatre

In the investigation of several blood stream infections following open-heart surgery, sutures and other material that had been exposed and handled in the sterile field were examined bacteriologically. One hundred and seventy-five open-heart operations were carried out during the study period and a high percentage of the specimens cultured yielded viable staphylococci and diphtheroids. Glove powder, textile fibres, and skin squames were found in the dust that collected in the room during the operations and staphylococci were frequently recovered from this source, and from the floor. Although the air supply to the theatre appeared to be of good quality, it is suggested that air currents within the room had caused dissemination of this foreign material and had probably contributed to wound infections.     

Pathologic guidelines for orthotopic urinary diversion in women with bladder cancer: a review of the literature

Orthotopic lower urinary tract reconstruction to the native intact urethra following radical cystectomy for bladder cancer was slower to gain clinical acceptance for women than for men. Until the 1990s, little was known about the natural history of urethral involvement by urothelial carcinoma in women with primary bladder cancer. The increasing availability of pathologic data to define the incidence of and risks for urethral involvement in women sparked an increasing interest in orthotopic diversion in female patients. Pathologic guidelines have been suggested to identify women suitable for orthotopic diversion. Preoperative involvement of the bladder neck is a significant risk factor for secondary tumor of the urethra, but is not an absolute contraindication, as long as full-thickness, intraoperative frozen-section analysis demonstrates no tumor involvement of the proximal urethra. Although less common, anterior vaginal wall tumor involvement may be a significant risk factor for urethral tumor involvement. Other pathologic parameters, including tumor multifocality, carcinoma in situ of the bladder, and tumor grade and stage, do not seem to be absolute contraindications. Long-term follow-up is critical for all patients. Women undergoing orthotopic reconstruction, if appropriately selected, should be assured of an oncologically sound operation and good function with their neobladder.     

Immunological microenvironments in the human vagina and cervix: mediators of cellular immunity are concentrated in the cervical transformation zone

Cell-mediated immunity (CMI) is key to defense against intracellular pathogens such as Chlamydia trachomatis and viruses that infect the lower female genital tract, but little is known about CMI at this site. Recent studies indicate that there are immunological microenvironments within the female genital tract, and that immune functions are affected by hormones as well as infections and inflammatory processes. To determine the distribution of mediators of CMI within the lower female genital tract, we have enumerated and characterized T-lymphocyte subsets and natural killer and antigen presenting cells (APCs; macrophages and dendritic cells) in the introitus, vagina, ectocervix, endocervix and cervical transformation zone (TZ) from healthy women, and have examined the effects of the menstrual cycle, menopause and inflammation on these parameters. In women without inflammation, T cells and APCs were most prevalent in the cervical TZ and surrounding tissue. Intraepithelial lymphocytes were predominantly CD8+ T cell+; most CD8+ cells in the TZ and endocervix, and a proportion of cells in the ectocervix, expressed T-cell internal antigen-1, a marker of cytotoxic potential. In contrast, the normal vaginal mucosa contained few T cells and APCs. Cervicitis and vaginitis cases had increased numbers of intraepithelial CD8+ and CD4+ lymphocytes and APCs. The menstrual cycle and menopause had no apparent effect on cellular localization or abundance in any of the lower genital tract tissues. These data indicate that the cervix, especially the TZ, is the major inductive and effector site for CMI in the lower female genital tract. Because CD4+ T cells and APCs are primary host cells for human immunodeficiency virus type 1 (HIV-1), these data also provide further evidence that the cervix is a primary infection site of HIV-1, and that inflammation increases the risk of HIV transmission.     

Endoscopic vaginoscopy in the dog

Vaginoscopy is a useful diagnostic procedure for evaluating the nature and extent of disease in the vestibule and vagina of female dogs. Using flexible or rigid endoscopes improves the operator's capability to detect disease because of improved illumination and magnification while facilitating vaginal distension. The size of the scope should be appropriate for the size of the patient. Although a variety of positions are suitable, we place anesthetized dogs in dorsal recumbency to minimize inadvertent contamination of the operative field with feces. If the urinary tract will also be examined, evaluate the urethra and urinary bladder first and then the vagina. After the reproductive tract is examined, tissue biopsies can be obtained for microscopic evaluation.     

Carcinome urothélial de l’urètre: une nouvelle observation et revue de la littérature

Urothelial carcinoma of the male urethra is a rare tumour. We report a new case of urothelial carcinoma of the urethra in a 64-year old man who was examined due to a dysuria. Retrograde and voiding urethrocystography carried out had shown images of bulbopenile urethral stricture treated by urethroplasty. Histological examination of the urethrectomy part revealed a urothelial carcinoma of the urethra. The patient refused any additional treatment and survived 14 months after diagnosis.     

Diagnostic applications of ultrasonography to stallion's reproductive tract

Although ultrasound evaluation of the reproductive tract of stallions was introduced to veterinary practice long ago, this examination is not always conducted during routine breeding soundness evaluation. The objective of this study was to investigate the clinical relevance of routine ultrasound evaluation of the stallion's reproductive tract. Breeding soundness evaluation of 113 stallions was performed, including ultrasonography of external and internal genitalia. Various pathological conditions were detected using this technique, with the most frequent being varicocele, thickened vaginal tunics and cystic structures. Varicocele and thickened vaginal tunics were associated with decreased quality of semen, while cysts of the epididymal head, urethra and uterus masculinus were frequently associated with ejaculatory problems. These findings suggested that routine ultrasound evaluation of breeding stallions may be very helpful in detecting pathological conditions that may impact their reproductive career.