Effectiveness of transvaginal colporrhaphy with porcine acellular collagen matrix in the treatment of moderate to severe cystoceles.

PURPOSE: The aim of this study was to determine the effectiveness of transvaginal anterior colporrhaphy with the use of porcine acellular collagen matrix in the treatment of moderate to severe cystocele. MATERIALS AND METHODS: This retrospective study included 95 patients who underwent anterior colporrhaphy with the use of porcine dermus from September 2003 through March 2008 at the Gynaecological Department of University General Hospital of Alexandroupolis in Greece. The inclusion criterion was a grade 2-4 cystocele by the Baden-Walker halfway system. Postoperatively patients were evaluated at one, six and 12 months. Objective cure was defined as no or grade 1 cystocele with an asymptomatic patient at 12 months postoperatively. Improved outcome was considered as an asymptomatic patient with a grade 2 cystocele and failure symptomatic patients or with grade 3 or 4 cystocele. RESULTS: All of the patients had a 12-month postoperative follow-up or were noted as a failure prior to the 12-month assessment. The majority of the women were menopausal (88.4%) and overweight (mean BMI 26.1). The overall cure rate was 81.1%, the improvement of the cystocele was 10.5% while the failure rate was 8.4%. The complications we noted were vaginal erosion in 2.01% and graft extrusion in 1.05% of the patients. CONCLUSION: Transvaginal anterior colporrhaphy using porcine dermal in the treatment of moderate to severe cystocele is simple, safe, easily learned and performed with a high success rate and low morbidity.

Two-year results of a new two-minute hot liquid balloon endometrial ablation system (Thermablate): a pilot study.

PURPOSE: To evaluate the feasibility, safety and clinical outcomes of a new 2-minute hot liquid balloon endometrial ablation system (Thermablate). MATERIAL AND METHOD: This prospective observational study included 72 premenopausal women with menorrhagia. All patients were treated from February 2005 through February 2008 under general anaesthesia in the Department of Obstetrics and Gynaecology at the University Hospital of Alexandroupolis, Greece. Thinning of the endometrium was achieved by sharp curettage immediately prior to the procedure. Pretreatment evaluation of menstrual blood flow, duration of menses and frequency of menses were recorded on all patients. Patient records were screened for adverse events, post procedure pain and required medication, dysmenorrhea, satisfaction and menstrual bleeding patterns. RESULTS: Follow-up at three months (n = 72), 6 months (n = 62), 12 months (n = 47) and 24 months (n = 17) showed a trend towards reduced monthly blood flow. Combined amenorrhea and hypomenorrhea rates at 3, 6, 12 and 24 months were 39%, 73%, 77% and 70%, respectively. The corresponding satisfaction rates were 86%, 93.5%, 93.5% and 82.4%, respectively. Dysmenorrhea rates increased from 37.5% prior to surgery, to 57% at three months and decreased to 23.5% at 24 months (p < 0.0001). CONCLUSION: Endometrial ablation with the Thermablate system is a safe and effective therapy for dysfunctional uterine bleeding when other therapies are contraindicated or have been tried and failed.

Results after hysteroscopic management of premenopausal patients with dysfunctional uterine bleeding or intrauterine lesions.

AIM: The purpose of this study was to evaluate the efficacy, safety and benefits of hysteroscopic surgery in the management of dysfunctional uterine bleeding or intrauterine lesions causing menstrual disorders in premenopausal women. METHODS: We enrolled in this study 228 patients who underwent operative hysteroscopy because of metrorrhagia due to endometrial polyps or submucous myomas diagnosed by hysterosalpingography, transvaginal ultrasound and diagnostic hysteroscopy. In addition, the study population included 27 patients who presented dysfunctional uterine bleeding resistant to medical therapy. These patients underwent total or partial transcervical resection of endometrium (TCRE). RESULTS: Operative hysteroscopy was a successful procedure in 250 of the 255 cases (98%) but it needed to be repeated in three cases with large submucous myomas of type I and II and after two polypectomies. Mean duration of the procedure was 26.1 min (range 4-58) and mean postoperative hospital stay was six hours (range 2-48 hours). There were two cases with fluid overload and five with postoperative uterine bleeding reported in this study. During postoperative follow-up (12-36 months) the majority of patients (246/255 or 96.5%) were free of symptoms. After total or partial TCRE, 23/27 patients (85.2%) reported eumenorrhea or hypomenorrhea, 2/27 (7.4%) amenorrhea and 2/27 (7.4%) metrorrhagia (due to adenomyosis). CONCLUSION: Hysteroscopic surgery is an effective and safe method for the management of benign intracavitary pathology or the treatment of dysfunctional uterine bleeding. In addition, it has the advantages of quick recovery, early return to normal activities and reduced hospital stay for the patient. Careful monitoring of the patients avoids serious complications.

A stromal myoid cell line provokes thymic T-cell immigration at the second and third gestational trimesters.

UNLABELLED: Once lymphoid precursors enter the thymus form the blood stream, they come into contact with thymic stromal cells that guide their maturation into functionally competent T cells. Thymic myoid cells are one such cell type. They have been described as a regular constituent of the thymus of embryonic and young vertebrates and express muscle proteins including myosin, desmin, acetylcholine receptor (AChR), C-protein, MyoD, troponin T, rapsyn, and utrophin. It has been emphasized recently that the thymic myoid cells play an important role in the protection of thymocytes from apoptosis, and in the process of T-cell differentiation and maturation. AIM: To provide a quantitative estimation of thymic myoid cells and T-cell population in different stages of development. A probable interaction between these two populations could explain an additional mechanism to the active T-cell migration from the thymus that is a direct contact to a specific myoid cell line. MATERIALS AND METHODS: Paraffin-embedded specimens from the thymus of forty five human embryos at the first, second and third trimester of gestation respectively, were investigated by conventional histology, and immunohistology for the presence in the stroma of the thymic medulla, of myosin in the myoid cells, and UCHL1 (pan T-cell) antigen in the medullary thymocytes. RESULTS: Our results demonstrated a quantitative difference in the second and third trimester of development concerning the expression of myosin in the stromal myoid cells of the thymic medulla over the equivalent expression of the protein in the first trimester. Similar changes in the above periods were found concerning the population of medullary thymocytes expressing UCHL1 antigen. CONCLUSIONS: Our results indicate that: (1) Thymic myoid cells play an important role in the thymic microenvironment as they are well conserved throughout species evolution. (2) The increased population of myoid cells in the medullary area during mid and late gestational age, in comparison with first trimester, probably reflects the increased demand of the growing fetus for mature T lymphocytes. Contractions of myoid cells mediated by their cytoplasmic structural proteins, including myosin which is well preserved during development, might aid the movement of thymocytes expressing UCHL1 antigen, across or out of the gland, suggesting a potential involvement of myoid cells in the thymic function. Further studies on larger series are needed to corroborate this.

Imbalance of mononuclear cell infiltrates in the placental tissue from foetuses after spontaneous abortion versus therapeutic termination from 8th to 12th weeks of gestational age.

Placental macrophages (Hofbauer cells) are located close to trophoblastic cells and foetal capillaries, which make them perfect candidates for involvement in regulatory processes within the villous core. Their capacity of producing several cytokines and prostaglandin-synthesising enzymes, and expressing vascular endothelial growth factor, indicate a possible role in placental development and angiogenesis in order to support pregnancy. Common cells to Hofbauer macrophages sharing similar cell surface markers (HLA-A, -B, -C and leukocyte common antigen) have been reported in the stroma, decidua and amnion, indicating additional foetal protection. Yet this is not always the case. Most spontaneous abortions occur before 12 weeks' gestation, and most are due to chromosomal errors in the conceptus. Relatively few truly spontaneous abortions take place between 12 and 20 weeks' gestation. Thereafter, between 20 and 30 weeks, another type of premature spontaneous termination becomes prevalent, which is due to ascending infection. The numbers of cells expressing the various markers of the monocytemacrophage lineage change throughout pregnancy. In the present study, we investigated the immunohistochemical expression of mononuclear infiltrations in paraffin-embedded placentas, from foetuses after spontaneous abortion (8th, 10th and 12th weeks of gestational age), and those after therapeutic abortion at the same time, using a panel of monoclonal antibodies for the identification of leukocytes (CD45/LCA), B-lymphocytes (CD20/L-26), T lymphocytes (CD45RO/UCHL1), CD68 and CD14 cells. Immunologic factors in human reproductive failure are plausible mechanisms of infertility and spontaneous abortion. Approximately 25% of cases of premature ovarian failure appear to result from an autoimmune aetiology. Unfortunately, current therapeutic options for these women are limited to exogenous hormone or gamete substitution. Local inflammations at the sites of endometriosis implants are postulated to mediate the pain and reduced fecundability associated with this clinical syndrome. The recruitment of immune cells, particularly monocytes and T-cells, neovascularisation around foci of invading peritoneal lesions, and the possible development of antiendometrial autoantibodies support an immunologic basis of this disorder. To date, treatment of pain and infertility associated with endometriosis is primarily surgical, although immune-based adjuvants are theoretical possibilities for the future. Finally, although hypotheses supporting immunologic mechanisms of recurrent pregnancy loss have been popular over the past decade, most clinical investigations in this area do not provide compelling evidence for this position. Reputable specialists in reproductive medicine use experimental immunotherapies judiciously in selected cases of repetitive abortion. For example, the use of anticoagulation therapy can be beneficial in cases with documented antiphospholipid antibodies. At present, however, efficacious immunotherapy protocols for general application have not been established. Despite these caveats, continued strides in our understanding of human reproductive immunology should yield considerable future progress in this field. During the physiological changes that occur in the first and in the beginning of the second trimester of pregnancy, spiral arteries of the placental bed are converted into the uteroplacental arteries. The essence of this conversion consists of losing the muscular elements in the vessel walls, making them unable to respond to vasomotor influences. Cells that infiltrate the walls of spiral arteries and replace their normal elements are called migratory, non-villous or intermediate trophoblastic cells. Besides infiltrating and replacing the anatomic structures of spiral arteries, intermediate trophoblastic cells also penetrate into the lumina of these vessels forming endovascular plugs. These plugs are one of the reasons why early uteroplacental blood flow cannot be visualised, even with transvaginal ultrasound, during the first 12 weeks of gestation. In uncomplicated pregnancies, the endovascular trophoblast is bound to disappear by the end of the second trimester of pregnancy, but the literature on this topic is scarce. Here we describe the detection, isolation and characterisation of CD45RO-, L26- and CD68/CD14-positive cells from human early pregnancy deciduas. These cells were found in close vicinity to endometrial glands, with preference to the basal layer of the decidua. We conclude that (1) maternal cells, apparently CD45RO/UCHL1-positive cells, cross the maternofoetal barrier and participate in spontaneous (involuntary) abortions, and (2) a small proportion of maternal cells (approximately 30%), apparently CD68/CD14-positive cells, also cross the maternal-foetal barrier and cause growth delay and recurrent reproductive failure. Further investigation of involvement of the intercellular adhesion molecules 1 and 2, platelet endothelial cell adhesion molecule, vascular cell adhesion molecule and E-selectin in leukocyte accumulation will be needed to support the passage of maternal cells to the foetus. The results were statistically significant (P<0.0001, Student's t-test).

Abdominal rectus muscle sheath abscess after spontaneous vaginal delivery. A case report.

Postpartum infections cause severe morbidity of the mother. Abdominal wound infection and abscess formation are common complications after cesarean delivery. We report a case with abscess formation inside the abdominal rectus muscle sheath after normal, spontaneous vaginal delivery. A 32-year-old woman, para 2, had a normal vaginal delivery at term. The second postpartum day she complained of lower abdominal pain and was unable to stand up or walk. The fourth day, cellulitis of the skin of the lower abdomen developed and was treated with broad-spectrum intravenous antibiotics. The seventh day the patient developed septic fever and an abdominal rectus muscle sheath abscess was diagnosed. The abscess was treated with incisions and evacuation and the patient was discharged the 12th postoperative day. The abscess in this case, as hematoma formation was not preceded, was referred to ascending contamination via the lymphatic vessels.

A stromal myoid cell line provokes thymic erythropoiesis between 16th to 20th weeks of intrauterine life.

BACKGROUND: The thymus provides an optimal cellular and humoral microenvironment for cell line committed differentiation of haematopoietic stem cells. The immigration process requires the secretion of at least one peptide called thymotaxine by cells of the reticulo-epithelial (RE) network of the thymic stromal cellular microenvironment. The thymic RE cells are functionally specialised based on their intrathymic location and this differentiation is modulated by various interaction signals of differentiating thymocytes and other non lymphatic haematopoietic stem cells. OBJECTIVES: To study the role of another cell line in fetal thymic haematopoietic proliferation and differentiation in different stages of development: the stromal myoid cells. DESIGN: Fifteen cases of fetal thymic specimens (4th to 8th weeks: five cases 16th to 20th weeks: five cases and 28th to 32nd weeks: five cases respectively) were studied. Tissue paraffin samples were stained immunohistochemically using (i) a monoclonal antibody recognising alpha-smooth muscle actin, a contractile microfilament expressed exclusively by smooth muscle cells, myofibroblasts and related cells, (ii) a monoclonal antibody glycophorin C recognising the erythropoietic cells. SETTING: Histology-Embryology Department of Democritus University of Thrace (Alexandroupolis) over ten year period (1991-2001). RESULTS: The number of alpha-smooth muscle actin-positive cells significantly increased during the late second and third trimester of gestation. In the above period a relevant increase in the number of glycophorin C positive cells were observed. CONCLUSION: Our data suggest that a myoid cell line is involved in the formation of an appropriate microenvironment for homing and proliferation of erythropoietic cells.

Evaluation during early puerperium of the low transverse incision after cesarean section through vaginal ultrasonography.

OBJECTIVE: This study was designed in order to determine the criteria of the natural healing of the low transverse cesarean incision through vaginal ultrasonography. METHODS: The uterine wound was examined with a vaginal scanner (5.5-7 MHz) in 75 asymptomatic patients with a normal postoperative course three days after the cesarean section. We compared our findings with those obtained in 21 patients with a complicated post-cesarean course. RESULTS: The uterine incision was identified as an oval, centrally located region between the bladder and the uterus. In 18 of the 75 cases, a hypoechoic area with indistinct limits, almost rounded and with a diameter of smaller than 1.5 cm in all cases was determined in the incision site. Possibly all these cases represented small hematomas or serous collections, with no clinical importance. Four of the 21 symptomatic patients had bladder flap or uterine incision hematomas. These were large (> 2 cm in all cases) hypoechoic areas inside or around the transverse incision site. CONCLUSION: The low transverse cesarean incision in the uterus can be visualized sonographically with a vaginal scanner and normal postoperative changes can be recognized.

Large granular lymphocytes (LGLS) activity in women with spontaneous abortions during the 1st trimester of gestation.

BACKGROUND: Despite increasing knowledge about the cell subsets that exist in the decidua in normal early pregnancy, little is known about the decidual cell subsets in women with spontaneous pregnancy failure. Decidual large granular lymphocytes (LGLs) are the most abundant lymphoid cell type found in 1st trimester maternal decidua. The function of LGLs remains controversial although freshly isolated LGLs have been shown to exert a weak natural killer cell (NK) activity. METHODS: Decidual leukocytes were investigated in 15 cases of spontaneous abortion and 15 cases of voluntary miscarriage, at 8th, 10th and 12th gestational week using a panel of monoclonal antibodies against Granzyme B (GRAN-B), CD2, CD38, CD56, and CD57 antigens and the immunoperoxidase technique. LGLs were demonstrated with the phloxine-tartazine stain. RESULTS: There was a statistically significant increase in the number of CD56 and CD57 positive cells (33.3%) to the advantage of spontaneous abortions (p<0.0001). No statistically significant difference was found in the number of GRAN-B, CD2 and CD38 positive cells in normal early pregnancy and in spontaneous abortion (overall gestational age p=0.22, 8th gestational week p=0.18, 10th and 12th gestational week, p=0.091). CONCLUSIONS: Our findings confirm previous studies referring that LGLs may have a cytotoxic activity similar to the NK activity and suggest an adverse pregnancy outcome.

The immunophenotypic profile of hepatic hemopoiesis in fetuses with Down's syndrome during the second trimester of development.

The yolk sac and aorto-gonad-mesonephros region are well recognized as the principal sites of hematopoiesis in the developing embryo, and the liver is the principal site of hematopoiesis in the fetus. In the present study, we investigated the immunohistochemical expression of Glycophorin C (erythrocytes), Neutrophilic elastase (granulocytes), and CD34 (progenitor hematopoietic stem cells, progenitor stromal cells, and vascular endothelial cells) in hepatic parenchyma from fetuses with Down's syndrome (DS) (16th, 20th, and 24th week of gestational age), and correlated the findings with the equivalent of the hepatic parenchyma from fetuses after spontaneous abortion. Our results did not demonstrate a quantitative difference at the level of erythropoiesis in all three periods examined. In contrast, an important numerical difference was shown in the expression of CD34 positive cells in liver parenchyma from fetuses with DS, in comparison with those found in liver parenchyma from fetuses after spontaneous abortion (p < 0.02). Furthermore, a modest but significant difference was demonstrated at the level of granulopoiesis between the 20th and 24th week (p < 0.01). Given that, the living newborns with Down's syndrome manifest diverse haematological abnormalities, including a transient leukemoid reaction that usually disappears after some weeks or months, a significantly increased number of CD34 positive and a less significantly increased number of neutrophilic elastase positive cells between the 20th and 24th gestational week could explain this phenomenon in combination with the respective results, if any, in the bone marrow. Regarding our finding of increased stromal CD34 positive cells in the hepatic portal triads, it raises the possibility that a process similar to fibrosis of the bone marrow may contribute to the hepatic fibrosis in DS.

Differential expression of Bcl-2 proto-oncogene in the trophoblast from embryos with Down's syndrome and those after spontaneous abortion.

Down's syndrome (trisomy 21) was the first human chromosomal syndrome to be recognized (in 1959 by Lejeune and colleagues). It is also the most frequent chromosomal aberration occurring in one out of 700 live newborns. In the present study we investigated the immunohistochemical expression of the apoptosis-suppressing protein Bcl-2 in placental trophoblastic cells from embryos with Down's syndrome (gestational age 12th, 15th and 22nd week) and correlated the findings with equivalent trophoblastic cells from embryos after spontaneous abortion. In our cases with Down's syndrome a weak Bcl-2 expression was noted in the cytotrophoblast and syncytiotrophoblast of chorionic villi in contrast to strong Bcl-2 staining of the same cells in the cases of spontaneous abortions (p < 0.0001). Although there are no specific findings that truly characterize a placenta with trisomy, obtaining a small piece of chorionic villus tissue (chorionic villus biopsy) and immunohistochemical control for Bcl-2 protein could be an additional prenatal examination available to the perinatologist to detect chromosomal abnormalities.

Expression of fibrillar proteins and vimentin in developing chorionic villi is related to fetal maturation.

Using an immunocytochemical technique, the extracellular matrix components fibronectin, vimentin, laminin and collagen type IV were investigated in human chorionic villi of various stages of development. Fibronectin and laminin were consistently positive throughout embryonic development. Vimentin and collagen type IV were negative in first and second trimester chorionic villi, but became positive in term placentas. With the exception of laminin, all extracellular matrix molecules were detected in the villous stroma and, with the exception of vimentin, they were localized in the basement membranes. Our data suggest that fibronectin and laminin are essential components of the villous structure, while the presence of vimentin and collagen type IV in the chorionic villi should be regarded as an indicator of fetal maturation.

Expression of laminin, type IV collagen and fibronectin molecules is related to embryonal skin and epidermal appendage morphogenesis.

Basement membrane zones are specialized sheets--like arrangements of extracellular matrix proteins and glycosaminoglycans, and act as an interface between parenchymal cells and support tissue. They separate epithelium, endothelium, muscle cells and Schwann cells from adjacent connective tissue stroma, and also from a limiting membrane in the central nervous system. They are involved in several cellular and biological processes, including adhesion, migration and cellular differentiation. Basement membranes have five major components: collagen type IV, laminin, heparan sulfate, entactin, and fibronectin. In addition, there are numerous minor and poorly characterized protein and glycosaminoglycan components. The various components of the basement membranes of the skin (collagen type IV, proteoglycans--heparan sulfate, laminin, entactin and fibronectin) are products of the epithelial (epidermal) cells. We studied immunohistochemically the origin, the first appearance and distribution of the adhesive extracellular glycoprotein laminin and the fibrillar proteins of the extracellular matrix collagen type IV and fibronectin in the basement membranes of fetal human skin between 12 to 21 weeks of gestational age. Additionally, we studied the expression of vimentin in the extracellular matrix of the epithelial/mesenchyme junction of the skin. This study demonstrates clearly that the expression of the antigens laminin, collagen type IV and fibronectin starts in the germinative epithelial cells of the skin at the bulbs of the hair follicles (12th week for fibronectin and 19th week for laminin and collagen type IV), and migrating progressively involves the epithelial epidermal cells of the covering skin, as well as, the basement membrane at the dermal-epidermal junction in that region (between 20 to 21 weeks of gestational age).

Expression of the intermediate filament vimentin and fibrillar proteins of the extracellular matrix related to embryonal heart development.

During organogenesis, the heart is one the first organs to develop and the earliest organ to function. The early appearance of cardiac activity in the tubular hearts of chick and rat embryos was noted many years ago. It arises from two plates of the splanchnic mesoderm which fuse to form a single tubular structure composed of endocardial and myocardial cells and, between them, the extracellular cardiac matrix. There is considerable variation in the formation of the extracellular matrix in the various regions of the heart during development. The endocardial lining cells of the vertebrate embryos show a regional specificity that remains an unexplained phenomenon in cardiac morphogenesis. The great majority of the endocardial lining cells remain epithlial. However, a restricted population of endothelial cells, lining the atrioventricular (AV) canal and the reputed proximal outflow tract (OT), transforms into mesenchyme; the latter being the reputed progenitor of the valves and membranous septa. The purpose of this study was to investigate the extracellular cardiac matrix of the human fetal heart in different regions and in various stages of development, and also the heterogeneity of the endocardial cell lining, in connection with the endothelial cells of other cardiac vessels. Identification of the mesenchymal cells/extracellular matrix was confirmed by immunohistochemical techniques using the following monoclonal antibodies: actin, desmin, vimentin, collagen IV and fibronectin. The present results provide evidence that the extracellular matrix of the heart is of mesodermal origin but at the level of the valves the mesenchyme is derived from the endothelial lining cells rather than the primitive mesenchyme.

K statistic as a measure of quality control in cervicovaginal cytology.

Quality assessment schemes are widespread in most branches of pathology but are uncommon in the more subjective areas of histopathology and cytology. Researchers in many fields have become increasingly aware of the observer as an important source of measurement error. The validity of any method of reporting evidence of an abnormal process in cellular material is based on the degree of correlation with the actual disease process as it exists in the tissue and its reproducibility. Correlations can be tested in retrospective studies in which diagnoses based on cellular evidence are matched against the disease process present in biopsy specimens. Correlations can also be tested by examination of a set of unknown cellular preparations obtained in the presence of proven disease. While reproducibility is indirectly related to correlation, it is meant to imply satisfactory utilization of the method by other groups of cytotechnologists and cytopathologists. While cytopathology will continue to play an important role as a screening technique for the detection of cancer of the uterine cervix, its usefulness in the study of the early manifestations of the disease process is yet to be realized on a universal basis.

Spontaneous abortions with increased CD5 positive cells in the placental tissue during the first trimester of gestation.

Most spontaneous abortions occur before 12 weeks' gestation, and most are due to chromosomal errors in the conceptus. Relatively few truly spontaneous abortions take place between 12 and 20 weeks' gestation. Thereafter, between 20 and 30 weeks another type of premature spontaneous termination due to ascending infection becomes prevalent. The number of cells expressing the various lymphocytic markers changes throughout pregnancy. In the present study, we investigated the immunohistochemical expression of mononuclear infiltrations in paraffin-embedded placentas, from fetuses after spontaneous abortion (8th, 10th, and 12th week of gestational age), and those after therapeutic abortion at the same time, using a panel of monoclonal antibodies for the identification of leukocytes (CD45/LCA), B-lymphocytes (CD20/L-26), T-lymphocytes (CD45RO/UCHL1) and CD5 cells. Immunologic factors in human reproductive failure are plausible mechanisms of infertility and spontaneous abortion. Approximately 25% of cases of premature ovarian failure appear to result from an autoimmune etiology. Unfortunately, current therapeutic options for these women are limited to exogenous hormone or gamete substitution. Local inflammation at the sites of endometriosis implants are postulated to mediate the pain and reduce fecundability associated with this clinical syndrome. The recruitment of immune cells, particularly monocytes and T cells, neovascularization around foci of invading peritoneal lesions, and the possible development of antiendometrial autoantibodies support an immunologic basis of this disorder. To date, treatment of pain and infertility associated with endometriosis is primarily surgical, although immune-based adjuvants are theoretical possibilities for the future. Finally, although hypotheses supporting immunologic mechanisms of recurrent pregnancy loss have been popular over the past decade, most clinical investigations in this area do not provide compelling evidence for this position. Reputable specialists in reproductive medicine use experimental immunotherapies judiciously in selected cases of repetitive abortion. For example, the use of anticoagulation therapy can be beneficial in cases with documented antiphospholipid antibodies. At present, however, efficacious immunotherapy protocols for general application have not been established. Despite these caveats, continued strides in our understanding of human reproductive immunology, should yield considerable future progress in this field. We conclude that, 1) maternal cells, probably CD45RO/UCHL1 positive cells, cross the maternofetal barrier and participate in spontaneous (involuntary) abortions, 2) a small proportion of maternal cells (approximately 30%), probably CD5 positive cells, also cross the maternal fetal barrier and cause growth delay and recurrent reproductive failure. The results were statistically significant (p < 0.0001, Student's t-test).

Cigarette smoking and the degree of maturation of the vaginal squamous epithelium in postmenopausal women.

To determine the effects of cigarette smoking on vaginal squamous epithelium in postmenopausal women, we studied the vaginal smear patterns of 199 healthy postmenopausal non-smokers and 41 healthy postmenopausal smokers, with a mean age of 56 years. A statistically significant difference to the hazard of smokers was found in the percentage of smears manifesting absence of maturation of vaginal squamous cells. A high incidence of atrophic-type vaginal smears in the group of smokers was also found independent of postmenopausal age. In the group of non-smokers, there was a statistically significant difference between the cytologic patterns of smears of women who were in the early postmenopausal age (<10 years) and those many years after (> or =10 years). Finally our data suggest that smokers had an earlier menopause, on average 2.4 years sooner than non-smokers. Cigarette smoking has an effect on vaginal squamous epithelium, but pathophysiology still remains unclarified.