Granulomatous endometritis associated with histologically occult cytomegalovirus in a healthy patient.

This report describes the case of a 32-year-old female with chronic pelvic pain who was otherwise in good health. Endocervical curettings contained rare cells with intranuclear and cytoplasmic inclusions characteristic of cytomegalovirus (CMV) infection. Endometrial curettings demonstrated a stromal lymphocytic and plasmacytic infiltrate as well as numerous small, non-necrotizing granulomas, but no CMV by microscopic examination. However, CMV was identified by the polymerase chain reaction in DNA extracted from a paraffin section of the endometrial tissue. In conjunction with previous reports, the clinical and pathologic features of this case suggest that CMV can cause chronic endometritis in nonimmunocompromised patients. Furthermore, CMV infection should be considered in the differential diagnosis of granulomatous endometritis. This case demonstrates the usefulness of using the polymerase chain reaction to detect CMV in paraffin-embedded material.

Absence of cytomegalovirus in gestational tissue in recurrent spontaneous abortion.

There have been conflicting reports regarding the association of cytomegalovirus (CMV) and recurrent spontaneous abortions. It is difficult to assess the role of CMV in the endometrium by histology alone, since the characteristic cytomegalic virocytes are often scarce or absent in this site. Our purpose was to use the polymerase chain reaction (PCR) to detect cytomegalovirus in gestational tissue of women with recurrent spontaneous abortions. DNA was extracted from 25 samples of paraffin-embedded, formalin-fixed gestational tissue from 21 women with at least three unexplained spontaneous abortions (mean, 3.4). DNA from an unstained paraffin section of each specimen was amplified using nested, multiplex PCR specific for the late antigen and the major immediate early genes of CMV. The assay used has a demonstrated level of sensitivity on the order of 10(-2) virocytes per square centimeter of 4-microM paraffin section. Intact DNA was successfully isolated from 21 specimens in 18 patients. Histologic features of CMV infection were completely absent from these cases, and none of these specimens contained evidence of cytomegalovirus DNA. These findings suggest that CMV infection of gestational tissue is not a common direct cause of recurrent spontaneous abortions.

Inhibition of adhesion reformation in the rabbit model by meclofenamate: an inhibitor of both prostaglandin and leukotriene production.

OBJECTIVE: To determine the relative ability of meclofenamate sodium, a water-soluble inhibitor of both prostaglandin and leukotriene synthesis, to inhibit adhesion reformation. DESIGN: Prospective, randomized study in a rabbit model. INTERVENTIONS: Laparotomies were performed on mature New Zealand White rabbits, and each uterine horn was devascularized and traumatized with unipolar electrocautery. One week later, adhesions were microsurgically lysed. Each rabbit was randomly assigned to one of five different groups, and different solutions or an adhesion barrier were placed into the peritoneal cavities before closure: [1] control, 40 mL of normal saline (n = 8); [2] meclofenamate, 1.75 mg/mL in 40 mL of normal saline (n = 7); [3] Hyskon, 40 mL of 32% dextran-70 (n = 6); [4] meclofenamate 1.75 mg/mL in 40 mL of 32% dextran-70 (n = 6); and [5] TC-7, 40 mL of normal saline plus oxidized regenerated cellulose fabric, Interceed, placed over the site of adhesion lysis (n = 6). Two weeks later, adhesion reformation was scored according to percent involvement of each uterine horn (0 to 4), and adhesion density (0 to 1) and compared using a one-factor analysis of variance. RESULTS: Adhesion reformation was greatest in the control group (mean score +/- SEM, 3.7 +/- 0.4) and was decreased, but not significantly, in the Hyskon group (2.7 +/- 0.4). Compared with the control group, reformation was significantly decreased in the meclofenamate group (2.3 +/- 0.2), the TC-7 group (2.0 +/- 0.5), and the meclofenamate/Hyskon group (1.1 +/- 0.3). This last group was also decreased compared with the meclofenamate and Hyskon groups. CONCLUSION: Meclofenamate significantly inhibits adhesion reformation in the rabbit model, especially when used in combination with a 32% dextran-70 solution.

Etiology of closure-related adhesion formation after wedge resection of the rabbit ovary.

Adhesion formation after closure after ovarian wedge resection of the rabbit ovary may be related to the use of polyglactin suture rather than to the closure itself.