犬子宫蓄脓症诊断与治疗方法的研究

为了研究犬子宫蓄脓症的诊断与治疗方法。收集来自合肥动物保健中心、池州贝乐康宠物医院的20例子宫蓄脓症患犬病例,并通过分析上述病例的临床症状、实验室检查、仪器检查探究了子宫蓄脓症最为有效、最合理的诊断与治疗方法。研究结果表明,血常规、血液生化、B超、X线对于子宫蓄脓的诊断有着重要的应用价值,在针对该病的预防与治疗上应尽早实施卵巢子宫摘除术。     

Intravaginal prostaglandin F2 alpha for the treatment of metritis and pyometra in the bitch

The purpose of this study was to determine whether intravaginal prostaglandin F2 alpha (PGF2 alpha) would be effective for the treatment of metritis or pyometra in the bitch. Seventeen bitches with metritis or pyometra were treated with PGF2 alpha. Prostaglandin F2 alpha (150 micrograms/kg body weight) was administered once or twice daily by infusing 0.3 ml per 10 kg body wt into the vaginal lumen. Bitches were also treated with amoxicillin (15 mg/kg body wt/48 h) and/or gentamicin (4 mg/kg body wt/day) administered as intramuscular (i.m.) injections. Fifteen bitches were treated successfully with intravaginally administered PGF2 alpha for 3 to 12 days and with intramuscularly administered antibiotics for 4 to 12 days. Success of treatment was judged by cessation of vaginal discharge, the absence of fluid in the uterus as determined by ultrasonography, and the overall health status of the animal. As two bitches with pyometra showed clinical deterioration in spite of medical treatment, ovariohysterectomy was performed after the first and the second treatment, respectively. No side effects (salivation, vomiting, diarrhoea, hyperpnoea, ataxia, urination, anxiety, pupillary dilatation followed by contraction) were observed after PGF2 alpha treatment. The disease did not recur during the subsequent oestrous cycles within 12 months after the initial treatment. The results demonstrate that intravaginal administration of PGF2 alpha was effective in 13 dogs (86.6%) with metritis or pyometra, and caused no side effects. Although the study was based on a relatively small number of cases, it is concluded that prostaglandin F2 alpha can be a useful means of treating bitches with metritis or pyometra. However, in severe cases of pyometra ovariohysterectomy is needed.     

Prostaglandin F2 alpha treatment of canine pyometra

Immediate and long-term outcomes of prostaglandin F2 alpha treatment for canine pyometra were studied in 10 bitches. Examination of pretreatment uterine biopsy specimens, taken for histopathologic diagnosis and classification of disease severity, revealed either type III or IV pyometra. Dinoprost tromethamine (0.25 or 0.5 mg/kg of body weight, SC) was given once daily for 3 days. Bitches were bred at the first posttreatment estrus and monitored for a minimum of one year. When pure cultures of Escherichia coli (n = 3) or Staphylococcus aureus (n = 1) were obtained from the vagina, these bacteria also were found in the uterus. Pretreatment WBC counts often did not reflect the severity of histopathologic findings in the uterus, but posttreatment WBC counts were useful in monitoring response to treatment. Four bitches produced a litter within one year of treatment. Four bitches (40%) had recurrence of pyometra within one year of treatment, and these same bitches had another recurrence after an additional prostaglandin treatment. Three additional bitches had a recurrence by 27 months after therapy, establishing a total recurrence rate of 77% (7/9). Results suggested that subclinical disease may persist after treatment, with clinical recurrence during diestrus. Despite the high recurrence rate, it was concluded that this treatment is a practical treatment for canine pyometra when reproduction is desired.     

Bilateral ovariectomy as a treatment for chronic pyometra in four horses

The objective of this retrospective study was to describe the use of bilateral laparoscopic ovariectomy without hysterectomy for chronic pyometra in horses. Four client-owned horses were included, each having chronic pyometra that was unresponsive to treatment. Bilateral laparoscopic ovariectomy was performed on the horses under standing sedation. A final uterine lavage was performed either 24 hours before or after surgery, with no further treatment of the uterus. No complications were encountered during surgery or post-operatively, and each horse had resolution of the pyometra without recurrence of clinical signs over at least 3 years. All owners were satisfied with the procedure. Following histopathology, one horse was found to be a true hermaphrodite, with one vestigial testis and one ovotestis. Ovariectomy alone was an effective treatment for four horses with chronic pyometra, without complications. Ovarian steroids and abnormal uterine or cervical conformation are important influences in the pathogenesis of pyometra, and removal of the hormone source via ovariectomy should be considered to avoid a more invasive surgery and the potential complications associated with ovariohysterectomy in horses.     

Age‐Related Pregnancy Results and Further Examination of Bitches after Aglepristone Treatment of Pyometra

The cystic endometrial hyperplasia and pyometra complex is one of the most common uterine diseases in bitches. The appearance of pharmacological preparations containing anti‐progestagens created new possibilities for pyometra treatment. The aim of this study was to evaluate the curative effect of the anti‐progestagen aglepristone treatment of pyometra in bitches of different ages. Twenty four bitches of different breeds, aged from 0.8 to 9.5 years (21–48 kg) exhibiting clinical pyometra symptoms (two groups – I ≤ 5 years, n = 14 and II >5 years, n = 10) were evaluated. Information about the general reproductive health was collected up to 54 months after anti‐progestagen treatment. Remission of clinical symptoms and return of blood chemistry results and total leucocyte count to referential values were achieved in all cases within 14 days of treatment. Bitches were naturally mated at the first, and when unsuccessful, the second oestrus after treatment. In group I, no recurrence of pyometra symptoms was observed during following cycle(s). Eight bitches (57.1%) had a full‐term pregnancy and the number of newborn pups ranged from 1 to 12. None of the bitches from the group II became pregnant. In conclusion, the basic indication for conservative pharmacological treatment of pyometra is preserving female fertility and obtaining offspring. The important conditions for successful aglepristone treatment are: the young age (up to 5 years) and the lack of detectible ovarian cysts. It seems necessary to mate bitches in the first or second oestrus after finishing treatment. The efficacy of treatment can be measured by the after‐treatment pregnancy rate.     

1例犬子宫蓄脓的诊治

2014年2月5日,江西农业大学动物科学技术学院宠物兴趣小组接诊该小组自养的1条金毛犬病例.该犬为6岁母犬,体重约8 kg,临床表现精神委顿、食欲不振、呕吐、排尿频繁（偶尔排出几滴红色尿液及少量稀粪）、呼吸急促等症状.根据临床症状和影像学分析将该病例确诊为子宫蓄脓.手术疗法治疗后,病犬逐渐恢复至痊愈.主要对该病例的治疗过程进行了介绍,以期能为临床治疗犬子宫蓄脓提供参考.     

1例犬子宫蓄脓的诊治

2014年2月5日,江西农业大学动物科学技术学院宠物兴趣小组接诊该小组自养的1条金毛犬病例.该犬为6岁母犬,体重约8 kg,临床表现精神委顿、食欲不振、呕吐、排尿频繁（偶尔排出几滴红色尿液及少量稀粪）、呼吸急促等症状.根据临床症状和影像学分析将该病例确诊为子宫蓄脓.手术疗法治疗后,病犬逐渐恢复至痊愈.主要对该病例的治疗过程进行了介绍,以期能为临床治疗犬子宫蓄脓提供参考.     

Pyometra in the dog. II.--A pathophysiological investigation. II. Anamnestic, clinical and reproductive aspects

The article deals with the anamnesis and clinical status of pyometra patients at the time of admission for treatment. The average age of 119 pyometra bitches was 7.8 years. About 80 patients were examined for clinical signs of dehydration and hypoperfusion. Such signs were present in up to 80% of the patients, although only about 1/3 seemed weak and in a poor condition. Previous treatment with oral gestagens did not seem to influence the pyometra incidence. However, 14% of the bitches had been given oestrogens (stillbestrol) during the pyometra-associated season.     

Use of low dose prostaglandin for the treatment of canine pyometra

Ten bitches with pyometra were treated with prostaglandin F_2α at a dose of 20 μg/kg bodyweight three times daily on consecutive days. Diagnosis was based on clinical signs and radiographic findings. Venous blood samples were collected for haematology and measurement of plasma progesterone levels. The response to treatment was monitored by repeated ultrasonic examinations. The treatment was continued for up to eight days. Seven out of 10 bitches responded well to treatment. The remaining three bitches underwent ovariohysterectomy and a cystic hyperplasia of the endometrium was diagnosed histologically. The results indicated that prostaglandin F_2α used at the low dose is sufficient for medical treatment of certain cases of pyometra. The treatment seems to be most effective in bitches without obvious hormonal imbalance. The aetiology of pyometra is discussed.     

Vasopressin secretion in response to osmotic stimulation and effects of desmopressin on urinary concentrating capacity in dogs with pyometra

OBJECTIVE: To determine vasopressin (VP) secretory capacity during osmotic stimulation and the response to desmopressin treatment in dogs with pyometra and control dogs. ANIMALS: 6 dogs with pyometra before and after ovariohysterectomy and 6 control dogs. PROCEDURE: Urine osmolality (Uosm) was measured during 12 hours. Values measured on the first day defined the basal Uosm pattern. On the second day, dogs were given desmopressin to induce a desmopressin-stimulated Uosm pattern. On day 3, the VP response to osmotic stimulation was examined. RESULTS: Median Uosm on day 1 was 340 mOsm/kg (range, 104 to 1,273 mOsm/kg) and 807 mOsm/kg (range, 362 to 1,688 mOsm/kg) in dogs with pyometra before and after surgery, respectively, and 1,511 mOsm/kg (range, 830 to 1,674 mOsm/kg) in control dogs. Median Uosm during desmopressin treatment was 431 mOsm/kg (range, 168 to 1,491 mOsm/kg) and 1,051 mOsm/kg (range, 489 to 1,051 mOsm/kg) in dogs with pyometra before and after surgery, respectively, and 1,563 mOsm/kg (range, 1,390 to 2,351) in control dogs. In dogs with pyometra, threshold for VP secretion was lower before surgery (median, 340 mOsm/kg; range, 331 to 366 mOsm/kg) than after surgery (median, 358 mOsm/kg; range, 343 to 439 mOsm/kg) or in control dogs (median, 347 mOsm/kg; range, 334 to 360 mOsm/kg). Highest maximum plasma VP values were found in dogs with pyometra. CONCLUSIONS AND CLINICAL RELEVANCE: Dogs with pyometra had increased urine concentration in response to desmopressin but not to the degree of control dogs, whereas VP secretory ability was not reduced.     

一例犬子宫蓄脓的诊断及手术治疗

本试验对一例患有子宫蓄脓的西施犬通过询问病史、临床检查、血常规检测、X光及B超检查进行确诊,采用手术法治疗。结果显示,血常规检查发现白细胞、中性粒细胞均增多,X光检测到明显膨大的子宫,B超影像可观察到子宫角为圆腔状的黑色暗区,子宫壁增生变厚产生无回声液性暗区。对于子宫蓄脓的诊断,血常规检查显示体内有炎症变化,X光和B超确诊病犬为开放性子宫蓄脓,对病犬采取手术疗法,彻底切除卵巢和子宫。病犬术后恢复良好。     

Surgical uterine drainage and lavage as treatment for canine pyometra

Pyometra is a common post-oestral syndrome in bitches. Classical treatment consists of either ovariohystorectomy or medical intervention. Surgical uterine drainage and lavage via direct trans-cervical catheterisation using a 5% povidone-iodine in saline solution was performed successfully in 8 bitches with pyometra. All bitches conceived and whelped without complications subsequent to this treatment. It is concluded that this method offers an effective alternative treatment for canine pyometra with shorter recovery times as well as good clinical recovery and pregnancy rates in bitches destined for further breeding.     

Risk of pyometra in bitches treated for mismating with low doses of oestradiol benzoate

A review of the literature concerning the effect of oestrogens for treating mismating in bitches on the occurrence of pyometra indicated that low doses of oestradiol benzoate substantially increase the incidence of pyometra. A retrospective study of the clinical records of a UK general practice found that the incidence of pyometra in the four months after administration of low doses of oestradiol benzoate was 8.7 per cent, whereas the incidence in the practice's untreated at-risk population was estimated to be less than 1.32 per cent per interoestrus interval, suggesting that more than 85 per cent of pyometras occurring within four months of treatment are iatrogenic.     

Pyometra with inguinal herniation of the left uterine horn and omentum in a Beagle dog

Objective: To describe a unique case of pyometra with inguinal herniation of the left uterine horn and omentum. Case summary: A 7‐year‐old, 19 kg, intact female Beagle dog presented for surgical treatment of presumptive pyometra and biopsy of a caudal abdominal mass in the left inguinal mammary gland region. Ventral midline celiotomy was performed, and a distended, fluid‐filled uterus with passage of the distal aspect of the left uterine horn through the left vaginal process into the inguinal canal was identified. The patient recovered uneventfully following ovariohysterectomy and left inguinal herniorrhaphy. New or unique information provided: This is the first documented report of inguinal herniation of a uterine horn associated with a pyometra.     

Use of a low dose prostaglandin F2 alpha in bitches

The dosage of Prostaglandin F2 alpha used until the present (100, 250 and 1000 micrograms/kg bw), in order to treat pyometra in the bitch, was accompanied with side effects such as salivation, vomiting and diarrhea. In the present work, the efficiency of low dose Prostaglandin (20 micrograms/kg bw) was examined in two different groups of patients: Group 1: Included 9 bitches pregnant for a period of 5-7 weeks duration. Initially the bitches were treated 3 or 4 times per day with Prostaglandin F2 alpha. In these cases abortion took place within 4 to 11 days. Group 2: 12 dogs, suffering from pyometra, were treated 3 times per day with PGF2 alpha for 8 days. In 9 dogs the pyometra resolved and the bitches came in estrus 2-5 months after treatment. 7 bitches have been mated and 6 of these gave birth to healthy litters. During a follow-up period of at least 10 months there has not been a reoccurrence of pyometra. In 3 out of the 12 dogs the uteri were still enlarged after 8 days of treatment. These bitches underwent ovariohysterectomy and a cystic hyperplasia of the endometrium was diagnosed histologically. The low dose (20 micrograms/kg BW) Prostaglandin F2 alpha induced in all dogs the expulsion of the uterine contents. Side effects during the treatment were not observed.     

Lactoferrin in Canine Sera: A Pyometra Study

The concentration of lactoferrin was measured in canine sera from groups of healthy male dogs as well as pregnant and non-pregnant female dogs and was compared with that of bitches with pyometra. Lactoferrin concentrations were higher in bitches with pyometra. The role of elevated lactoferrin concentrations in the suppression of lymphocyte activity was examined in sera from bitches with pyometra in a series of investigations. Although the sera from bitches with pyometra were capable of suppressing lymphocyte activity, lactoferrin was not found to be involved in this action.     

犬子宫蓄脓的病因及诊治

犬子宫蓄脓是临床上常见的产科疾病,主要发生在犬发情后期,根据临床症状可将其分为开放型子宫蓄脓和闭锁型子宫蓄脓。犬子宫蓄脓是在子宫内膜囊性增生、孕酮浓度增加、雌激素浓度降低和细菌感染等因素作用下子宫发生的炎性病变。作者对犬子宫蓄脓的病因、诊断及治疗进行了综述。     

Laboratory diagnosis of canine pyometra.

The principal laboratory test used to confirm the pyometra diagnosis in the bitch has been the determination of the total white blood cell count in venous blood. A marked elevation is known to be a characteristic of the disease.In the present study, the white blood cell count was determined as well as the γ-globulin level. An elevation of the γ-globulin level and the total white blood cell count was very characteristic to the pyometra patients. The increase in the number of white blood cells nor the high γ-globulin level cannot be regarded specific for pyometra, therefore it was regarded important to find out a more specific test for pyometra.When sonicated E. coli bacteria were tested against sera from pyometra patients in electroimmunodiffusion, the precipitation was almost always detected when E. coli had been isolated from the uterus. This technique provides a quick method in detecting the causative E. coli infection.The present study suggests that whenever laboratory tests are used to confirm the pyometra diagnosis by the total white blood cell count, it is advantageous to analyze the total γ-globulin level in the serum as well as specific antibodies against a common E. coli antigen.Because of the reliability of the glutaraldehyde coagulation test and the simple technique, this can be suggested as the method of choice for an average small animal practice.     

Pyometra

Pyometra is a relatively uncommon diestral uterine disorder seen primarily in older bitches and queens. The incidence of pyometra appears to be increasing, especially in younger animals, as a result of increasing use of estrogen and progesterone for mismating and for certain medical disorders. The clinical signs of pyometra and abnormalities on physical examination are dependent on the patency of the cervix and how quickly the client recognizes the problem. Ovariohysterectomy is still the treatment of choice; however, prostaglandin F2 alpha as a medical alternative in the management of pyometra is gaining more and more acceptance. The goal of prostaglandin F2 alpha therapy is to salvage the reproductive tract in the young breeding bitch or queen in the hopes of obtaining future litters. The results have been very promising, especially for bitches or queens with open-cervix pyometra. Prostaglandin F2 alpha appears to offer the owner a reasonable alternative in the management of pyometra.     

Treatment of pyometra in cats, using prostaglandin F2 alpha: 21 cases (1982-1990).

Treatment with prostaglandin F2 alpha (PGF2 alpha) was evaluated in 21 queens with open-cervix pyometra. The PGF2 alpha was administered (0.1 or 0.25 mg/kg of body weight, sc, q 12 to 24 h) for 3 or 5 days. Transient postinjection reactions caused by PGF2 alpha administration included vocalization, panting, restlessness, grooming, tenesmus, salivation, diarrhea, kneading, mydriasis, emesis, urination, and lordosis. Reactions began as quickly as 30 seconds after PGF2 alpha administration and lasted as long as 60 minutes. All queens improved clinically after PGF2 alpha treatment. One month after completion of the initial series, 1 queen required a second series of PGF2 alpha injections before pyometra resolved. Of 21 queens, 20 (95%) resumed normal estrous cycles without further treatment and 17 (81%) delivered normal litter(s). Use of PGF2 alpha is an acceptable treatment for open-cervix pyometra in queens.