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PubMedDate not supplied

[Pyometra as a result of placement of an intrauterine device for 40 years and chronic endometritis].

Pyometra is the accumulation of pus in the uterine cavity, thus stretching its walls and thinning and enlarging the uterus. This change is characteristic of the senium period of life, when the uterus is atrophic with a stenotic cervical canal. It most frequently occurs as a result of secondary infection of the cancerogenic tissue of the uterus and additional stenosation and clogging up of cervical canal by a malignant process. Apart from carcinomas of the body and uterus cervix, pyometra less often can occur in other illnesses such as senile endometritis and senile colpitis. As pyometra most frequently occurs in uterine carcinomas, in detection of this state, we must think of malignancy and direct our examination to this direction. In this paper we present a patient in whom pyometra developed because she carried an intrauterine device for forty years that resulted in chronic endometritis. The main symptoms for which the patient was admitted to hospital were abdominal pain and intensive suppurative vaginal excretion a month after removal of intrauterine device. The diagnosis of pyometra was made by gynaecological and ultrasound examinations, and also on the basis of gynaecological and ultrasound examinations one month after chronic endometritis was confirmed. On the basis of this finding we suspected that chronic endometritis was caused by this state. By cytological, PAP and histopathological examinations of samples obtained by explorative curettage and biopsy of the uterine cervix, malignant changes were eliminated a possible cause. By laboratory analysis and bacteriological examination of the uterine cavity and vaginal excretion, inflammatory changes of the uterine mocous membrane were confirmed as a cause of the pyometra. This conditions was due to carrying the intrauterine device for more decades. The therapy consisted of dilatation of the cervical canal and evacuation of accumulated suppurative contents and irrigation of uterine cavity with 3% solution of hydrogen peroxide and Povidon. Also wide spectrum antibiotics and uterotonics were given. Such treatment contributed to a fast and effectious recovery.

Aged↗

PubMed1984

Aspects of bacteriology and endocrinology of cows with pyometra and retained fetal membranes.

In an effort to clarify the pathogenesis of pyometra, 20 cows with retained fetal membranes and 20 without, but with contemporary calving dates were studied. They were palpated and their uteri were subjected to sample collections for bacteriologic cultural examinations twice weekly for 4 weeks. Blood samples were obtained each day and evaluated for serum progesterone concentration. Three cows without and 3 with retained fetal membranes developed pyometra during the study, resulting in 3 groups designated control (CON), cows with retained fetal membranes (RFM), and cows with pyometra (PYO). Bacterial isolations occurred less frequently in the CON group than in the PYO and RFM groups. Growth patterns of bacteria also varied between groups. Coliform and incidental bacteria disappeared from the uterus of the PYO group by the end of the 3rd week. In contrast, heavy growth of Corynebacterium pyogenes and gram-negative anaerobic bacteria developed during this same period in the PYO group. In cows with pyometra, the significant persistent pathogenic bacteria recovered were C pyogenes and gram-negative anaerobic bacteria, especially Fusobacterium necrophorum and Bacteroides melaninogenicus. Anaerobic bacteria were isolated simultaneously with C pyogenes in most cows of the PYO group, but less often in CON and RFM groups, and highest growth levels were present near the time of ovulation. Clinically, pyometra usually developed about 10 days after observation of concurrent ovulation and high growth levels of C pyogenes and gram-negative anaerobic bacteria. A hypothesis is presented for development of pyometra in the cow.

Animals↗

PubMed1997

Hormonal state and effects of the use of an antiprogestin in bitches with pyometra.

The pathogenic significance of progesterone in pyometra in bitches was investigated by evaluating the stages of the oestrous cycles of 369 bitches with pyometra. Concentrations of progesterone and oestradiol were determined in 100 bitches with pyometra before ovariohysterectomy. Six bitches with pyometra with progesterone > 5 ng ml-1 and oestradiol < 25 pg ml-1 were treated with the antigestagen RU 46534 (6 mg kg-1, s.c.) twice on day 1 and once on days 2, 3 and 4; ovariohysterectomy was performed on day 6. Six control bitches that met the same criteria were ovariohysterectomized and uterine morphology was compared with that of the treated bitches. The effects of treatment were monitored by hormone, ultrasonographic imaging and histomorphological studies. The results confirm that pyometra may occur at any stage of the reproductive cycle and that most animals are in the phase of dioestrus. Uterine mass (g kg-1 bodymass) with versus without content was not different in treated bitches and was significantly lower (P < 0.01) than in the control bitches. In all six dogs general clinical conditions improved during the observation period; 23.5 +/- 11.1 h after the start of antiprogestin treatment a profuse, purulent vulval discharge was observed. The effusion was nearly complete at day 6. The maximal detectable uterine lumen varied between 23 and 39 mm in diameter, it was no longer detectable on day 6. Oestradiol concentrations remained constant while progesterone decreased with distinct individual variations. Morphometrical examination of the endometrium revealed no differences between groups. The data suggest that antigestagen treatment is a promising approach for treatment of pyometra in bitches.

Animals↗

PubMed1999

Generalized peritonitis with pneumoperitoneum caused by the spontaneous perforation of pyometra without malignancy: report of a case.

Spontaneous perforation is a very rare complication of pyometra. We report herein the case of an 88-year-old woman who presented with muscular rigidity and free air on abdominal X-ray films. Perforation of the gastrointestinal tract was diagnosed preoperatively, and an emergency laparotomy was performed. A total hysterectomy with bilateral salpingo-oophorectomy was carried out under the diagnosis of generalized peritonitis caused by the spontaneous perforation of pyometra. The culture of purulent fluid from the abdominal cavity showed only Escherichia coli, with no anaerobic bacteria. Histological examination revealed pyometra with necrosis of the endometrium and no evidence of malignancy. The patient was discharged on postoperative day 68 without any major complications. Pyometra is an unusual cause of peritonitis, but it must be considered as a possible diagnosis in elderly women presenting with an acute abdomen. Following this case report, we discuss the problems associated with establishing a correct preoperative diagnosis of generalized peritonitis caused by the spontaneous perforation of pyometra.

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PubMed2006

Clinical evaluation of the use of aglepristone, with or without cloprostenol, to treat cystic endometrial hyperplasia-pyometra complex in bitches.

The aim of the study was to evaluate the efficacy of aglepristone (10 mg/kg on days 1, 2 and 8) for the treatment of metritis or pyometra in bitches (n = 67) either alone for cases of metritis (n = 15), or in cases of pyometra (n = 52) with (n = 32) or without (n = 20) the addition of low doses (1 microg/kg) of cloprostenol for 5 days (days 3-7). Examinations performed on day 90, in addition to days 8, 14 and 28, determined that treatments had been curative in the long term in 54/67 bitches (80.6%). Bitches in whom pyometra did not resolve, were given additional aglepristone on day 14 (n = 38) and day 28 (n = 20). Aglepristone alone was curative in 15/15 bitches with metritis. In 17/17 bitches with closed pyometra, cervical opening occurred within 48 h of aglepristone administration. Amongst the 52 bitches with open (n = 35) or closed (n = 17) pyometra, the additional treatment with cloprostenol from days 3 to 7, significantly improved the overall success rate at day 90, which was 27/32 (84.4%), compared to 12/20 (60.0%) in bitches without cloprostenol (P < 0.05). The leucocyte count and plasma progesterone concentrations significantly decreased over the course of treatment. Thirteen of 15 bitches in whom plasma progesterone concentrations were initially low (< 3.18 nmol/L) were cured. The recurrence rate after 12 and 24 months was 13.0% (3/23) and 19.0% (4/21), respectively.

Animals↗

PubMed2002

Escherichia coli strains isolated from the uterus and urinary bladder of bitches suffering from pyometra: comparison by restriction enzyme digestion and pulsed-field gel electrophoresis.

Pyometra (uterine inflammation with accumulation of pus in the uterus) is regarded as one of the most common illnesses in bitches. The ethiology and pathogenesis are complex with both hormonal and bacterial elements. The bacteria most frequently isolated from the uterine content is Escherichia coli. In this study, 84 E. coli strains from the uteri of 70 bitches suffering from the disease were examined and their DNA-profiles compared by restriction enzyme analysis and pulsed-field gel electrophoresis (PFGE). Through variations in DNA-profiles of the E. coli isolates, this study indicates that pyometra is caused by E. coli originating from the normal flora of the dogs and not by certain clones spread between animals.E. coli strains from the urinary bladder and the uterus of six of the bitches suffering from simultaneous urinary tract infection and pyometra were examined and compared as above. The DNA-profiles of the isolates from each of the six bitches were 100% identical. This study supports the theory suggesting that in cases of simultaneous urinary tract infection and E. coli pyometra, the urinary tract and uterus are infected with the same bacterial strain. To evaluate whether the uterus was infected with a single clone of E. coli or if multiple clones were present, eight to 16 colonies of E. coli isolated from pyometra samples from a further 10 bitches were examined. All bacterial colonies from the culture of the same bitch showed identical DNA-profiles. In 14 of the 70 bitches, two macroscopically different but biochemically identical E. coli colony types were isolated. The two colony types from the same bitch proved to have identical DNA-profiles in 13 cases and almost identical in the remaining bitch.

Animals↗

PubMedDate not supplied

Effects of long-term/low-dose clarithromycin on neutrophil count and interleukin-8 level in pyometra.

We investigated the effects of clarithromycin (CAM) on clinical and endometrial immune responses in chronic intrauterine infection (pyometra). CAM was orally administered in a dose of 200 mg once a day for 4 months (long-term/low-dose treatment) in patients with pyometra. Lavage fluid of the uterine endometrial cavity was obtained from 5 healthy women (controls) and 5 patients with pyometra to investigate the levels of neutrophil and interleukin-8 (IL-8), which is a neutrophil chemotactic factor. All patients showed clinical improvement at the end of treatment. In the assessment of the immune responses, neutrophils were accumulated in the lavage fluid of the uterine endometrial cavity in pyometra (p < 0.001, versus controls) and decreased by CAM treatment (p < 0.001). The level of IL-8 was significantly higher in the lavage fluid of patients with uterine endometritis than in the controls (p < 0.001), and decreased by CAM treatment (p < 0.01). There was a close correlation (r = 0.982) between neutrophil count and IL-8 level in the endometrial lavage of patients with pyometra. The reduction of the uterine endometrial neutrophil migration in chronic inflammatory sites may partially be a direct effect of CAM.

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PubMed1996

Spontaneous perforated pyometra presenting as pneumoperitoneum.

BACKGROUND: Spontaneous perforated pyometra presenting as pneumoperitoneum is extremely rare. CASE REPORT: An 80-year-old Japanese female with spontaneous perforating pyometra presenting as pneumoperitoneum is reported. The patient came to our institute with severe abdominal pain. Routine abdominal examination showed muscular defense, and plain chest roentgenograms revealed infradiaphragmatic free gas. Subsequent computed tomography also demonstrated pneumoperitoneum. Laparotomy was performed on the basis of a tentative diagnosis of perforation of the gastrointestinal tract but revealed a perforated pyometra. A simple hysterectomy was performed. The histological diagnosis of the surgical specimen was acute endometritis without neoplasm. The present report is the third case of spontaneous perforated pyometra with pneumoperitoneum to date. CONCLUSION: Although uterine disease presenting as pneumoperitoneum is rare in elderly patients with an acute abdomen, the possibility of a perforated pyometra should be considered in the differential diagnosis.

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PubMed2006

Pyometra in bitches induces elevated plasma endotoxin and prostaglandin F2alpha metabolite levels.

Endotoxemia in bitches with pyometra can cause severe systemic effects directly or via the release of inflammatory mediators. Plasma endotoxin concentrations were measured in ten bitches suffering from pyometra with moderately to severely deteriorated general condition, and in nine bitches admitted to surgery for non-infectious reasons. Endotoxin samples were taken on five occasions before, during and after surgery. In addition, urine and uterine bacteriology was performed and hematological, blood biochemical parameters, prostaglandin F2alpha metabolite 15-ketodihydro-PGF2alpha (PG-metabolite), progesterone and oestradiol (E2-17beta) levels were analysed. The results confirm significantly increased plasma levels of endotoxin in bitches with pyometra and support previous reports of endotoxin involvement in the pathogenesis of the disease. Plasma concentrations of PG-metabolite were elevated in pyometra bitches and provide a good indicator of endotoxin release since the concentrations were significantly correlated to the endotoxin levels and many other hematological and chemistry parameters. The gamma-globulin serum protein electrophoresis fraction and analysis of PG-metabolite can be valuable in the diagnosis of endotoxin involvement if a reliable, rapid and cost-effective test for PG-metabolite analysis becomes readily available in the future. Treatment inhibiting prostaglandin biosynthesis and related compounds could be beneficial for bitches suffering from pyometra.

Animals↗

PubMed2003

Lectin binding patterns in normal canine endometrium and in bitches with pyometra and cystic endometrial hyperplasia.

Cystic endometrial hyperplasia (CEH) and pyometra in the bitch are dioestral syndromes, supposed to be caused by hormonal disturbances and changes in endometrial steroid hormone receptor levels. Histologically, the endometria show cystic dilated glands and, if bacteria succeed in invading the uterus, pyometra may develop in the following metoestrus. In this study, lectin histochemistry was performed on paraffin sections to compare carbohydrate expression of uterine glands and surface epithelium in healthy dogs and in dogs with CEH and pyometra. Lectin binding is a useful tool to identify glycoconjugates, especially of the glycocalyx, which has essential functions in the endometrium during reproduction. Uterine tissue was obtained from 18 healthy bitches in metoestrus or anoestrus and 18 bitches with a clinical diagnosis of CEH or pyometra. Normal endometria showed cycle-dependent changes in SBA, PNA, HPA and UEA binding during metoestrus and anoestrus. LCA did not show cycle-dependent changes and WGA bound to Golgi regions in the apical parts of surface epithelial cells only in metoestrous. Endometria with inflammatory alterations lost cycle-specific lectin binding patterns and, with increasing severity of pathological changes, showed a marked decrease in binding intensity to the glandular and surface epithelial glycocalyx and secretions. In dogs with CEH, unaltered glands with generally strong lectin binding to the glycocoalyx and Golgi regions were found adjacent to altered glands. The decrease of lectin binding in pyometra cases is supposed to be a result of glandular exhaustion after cystic hyperplasia. In addition, bacterial adhesion to sugar residues on the uterine surface epithelium might impede lectin binding.

Animals↗

PubMedDate not supplied

C-reactive protein in the differentiation of pyometra from cystic endometrial hyperplasia/mucometra in dogs.

Hematological parameters, plasma C-reactive protein (CRP), and tumor necrosis factor alpha were analyzed in 64 dogs with a presumptive diagnosis of pyometra. Final diagnosis (i.e., pyometra or cystic endometrial hyperplasia [CEH]) was determined by histopathology. As a single test, the percentage of band neutrophils had the highest sensitivity in the prediction of pyometra (sensitivity, 94%). The combination of percentage of bands and CRP had the highest sensitivity (97.7%; specificity, 75%) in predicting the presence of pyometra. The most common clinical signs noted in the study were vaginal discharge, polyuria, polydipsia, lethargy, and gastrointestinal signs. A combination of three or more of these clinical signs was significantly associated with pyometra.

Animals↗

PubMed2000

Spontaneous uterine perforation of pyometra. A report of three cases.

BACKGROUND: Spontaneous perforation of pyometra is a rare cause of generalized peritonitis; only 17 cases have been reported. CASES: Three cases of spontaneous perforation of pyometra occurred; two were associated with carcinoma of the cervix. All were treated with exploratory laparotomy and drainage. The first patient died of recurrent carcinoma of the cervix five months after laparotomy. The second patient died of septic shock shortly after the operation. The third patient made a good postoperative recovery. CONCLUSION: Pyometra is a serious medical condition, because of both its association with malignant disease and the danger of spontaneous perforation, which carries significant morbidity and mortality. Although rare, ruptured pyometra should be considered in the differential diagnosis of acute abdomen in elderly women, especially those with malignant disorders of the genital tract. The treatment of pyometra rupture is immediate laparotomy, peritoneal lavage and drainage, or simple hysterectomy.

Abdomen, Acute↗

PubMed2006

[Plasma concentrations of folic acid, vitamin B12 and progesterone of cyclic bitches, bitches during pregnancy and induced abortion and bitches with pyometra].

The aim of this study was to investigate the plasma concentrations of folic acid, vitamin B12 and progesterone at different stages of the sexual cycle and pregnancy, during induced abortion and in bitches with pyometra. Bitches (n = 97) were assigned to groups as follows: a) oestrous cycle (n = 42) b) pregnancy (n = 25) c) induction of abortion (n = 10 and d) pyometra (n = 20). Oestrous cycle stages were determined by vaginal inspection and cytology. Pregnancies were estimated by ultrasound (5.0 Mhz; linear transducer; Schimadzu) at days 15-25, 35-45 and 46-63 of pregnancy. Treatments for the induction of abortion were started between days 25 and 35 after mating (5 microg/kg cabergoline daily, Galastop; 5-10 microg/kg Alfaprostol every other day, Gabbrostim). Diagnosis of pyometra was confirmed by ultrasound and vaginoscopy. Folic acid and vitamin B12 concentrations did not differ among different stages of the oestrous cycle. The mean concentration of folic acid during early pregnancy (days 15-25) exceeded levels of later stages (days 46-63): 9.4 +/- 3.7 microg/ml and 4.7 +/- 1.8 microg/ml, respectively (p < 0.01). A positive correlation between folic acid and vitamin B12 was determined in pregnant dogs ( r = 0.925; p < 0.02). Before the induction of abortion, the concentration of folic acid was 9.6 +/- 5.2 microg/ml; during abortion it decreased to 5.0 +/- 3.2 microg/ml (p < 0.01). A significant correlation (r = 0.925; p < 0.02) between progesterone and folic acid was obtained in bitches with abortion. The mean concentration of folic acid in bitches with pyometra significantly differed from that of bitches at different stages of the oestrous cycle (p < 0.05). The mean concentration of folic acid was significantly lower in metoestrous bitches when compared to bitches with pyometra (p < 0.05). The decrease of serum concentrations of folic acid during pregnancy and induced abortion show that fetal growth and abortion caused higher consumption of folic acid. Concerning bitches did not show any deficiency symptoms, which is why it can be concluded that this decrease is physiological.

Abortion, Veterinary↗

PubMed1991

Clinical and pathologic features of endometrial hyperplasia, pyometra, and endometritis in cats: 79 cases (1980-1985).

Records of 79 cats determined to have endometrial hyperplasia (EH) with or without pyometra or endometritis were studied. Forty-eight cats (61%) were spayed or died because of complications relating to reproductive tract disease. All other cats were free of clinical signs of disease, and lesions were found incidentally during routine ovariohysterectomy or at necropsy. Prevalence of uterine lesions was greater in cats greater than or equal to 5 years old. Breeding, age at first breeding, and queening could not be correlated with clinical or pathologic signs of disease. Seventy-one percent (34/48) of cats with clinical signs referable to the reproductive tract had histologic evidence of pyometra or endometritis, whereas only 19% (6/31) of cats without clinical signs had histologic evidence of either disease. Only 23% (9/39) of cats without pyometra or endometritis had corpora lutea (CL) in at least one ovary, whereas 40% (16/40) of cats with either pyometra or endometritis had CL. We concluded that the prevalence of EH in cats increases with age in sexually intact female cats, and that most cases of pyometra or endometritis, but not EH, in cats are associated with retained CL.

Age Factors↗

PubMed1998

Studies on the pathogenicity of anaerobes, especially Prevotella bivia, in a rat pyometra model.

OBJECTIVE: Prevotella bivia is one of the anaerobic bacteria that resides in the flora of the female genital tract. We studied the pathogenicity of P. bivia in a rat pyometra model. METHODS: The experimental animal (rat) model of pyometra was developed to investigate the pathogenicity of P. bivia in a rat pyometra model. RESULTS: In the groups inoculated with aerobes alone, the infection rate was 10% (1/10) in the Staphylococcus aureus- or Staphylococcus agalactiae-inoculated group and 20% (2/10) in the Escherichia coli-inoculated group. Infection was not established in the groups inoculated with anaerobes alone. High infection rates were observed in all the mixed-infection groups. In the S. agalactiae- and Bacteroides fragilis-, S. agalactiae- and P. bivia-, F. coli- and B. fragilis-, and E. coli- and P. bivia-inoculated groups, an infection rate of 100% (10/10) was demonstrated. The efficacy of antibiotics such as flomoxef (FMOX) could be determined using a rat pyometra model. In relation to the alteration of vaginal microbial flora during the menstrual cycle, estrogen increased the growth of P. bivia. CONCLUSION: Mixture of aerobic bacteria and P. bivia increased the pathogenicity of P. bivia. Estrogen would be useful for raising up the inflammatory change of the uterus in experimental models of genital tract infection due to P. bivia.

Animals↗

PubMed1994

Spontaneously perforated pyometra presenting as diffuse peritonitis: report of a case.

We report herein a rare case of spontaneously perforated pyometra found in a 72-year-old woman who was admitted to our hospital with abdominal pain and vomiting. A distended abdomen with muscular rigidity, a positive Blumberg sign, and a WBC count of 11,900/mm3 indicated diffuse peritonitis, although a plain abdominal X-ray film revealed no free air in the peritoneal cavity. An emergency laparotomy was performed, which revealed a lot of pus, and perforation in the fundus of a distended uterus. The patient was therefore diagnosed as having suffered uterine perforation associating with a pyometra, and a total hysterectomy with bilateral salpingo-oophorectomy was carried out. Histological examination revealed a pyometra with inflammation and destruction of the endometrium and myometrium, and cervical occlusion with no evidence of malignancy. Postoperatively, the patient developed a subcutaneous abscess and pneumonia, but recovered and was discharged on the 74th day after her operation. Thus, although rare, spontaneously perforated pyometra should be considered when elderly women present with acute abdominal symptoms.

Aged↗

PubMed2006

Pyometra and recurrent prolapse after Le Fort colpocleisis.

The Le Fort colpocleisis is a surgical option for advanced pelvic organ prolapse in elderly and infirm women who no longer desire coital function. It is thought that the creation of adequate lateral drainage channels will prevent the occurrence of a pyometra. The author describes the occurrence of a pyometra, despite adequate vaginal channels, necessitating hysterectomy. A 78-year-old woman presented with a 3-year history of purulent vaginal discharge that began shortly after an uncomplicated Le Fort colpocleisis. She also complained of recurrent symptomatic prolapse. Radiologic evaluation revealed a pyometra, which was confirmed at the time of laparotomy. At the time of hysterectomy, she benefitted from total colpocleisis, vaginectomy, and levator plication. The approach to recurrent prolapse after Le Fort colpocleisis is discussed. The occurrence of pyometra despite adequate drainage should affect how patients undergoing obliterative procedures for pelvic organ prolapse are counseled.

Aged↗

PubMed2004

Recovery, morphological quality, and in vitro maturation of follicular oocytes from bitches with pyometra.

The objective of this study was to collect oocytes from ovaries of bitches with pyometra and to characterize the quality of the oocytes recovered. In 10 of 12 cases of pyometra, follicles with a diameter of 500 microm to 1mm were observed in the ovaries. A total of 710 oocytes were collected from 10 bitches by puncturing individual follicles after slicing the ovarian tissues. Oocyte recovery was successful from a bitch with severe clinical signs of pyometra. Of the oocytes collected, 53.5% were surrounded by > or =2 layers of cumulus cells, and 55.0% of these cumulus-oocyte complexes (COCs) had a darkly pigmented ooplasm >110 microm in diameter (large-dark COCs). The number of large-dark COCs per bitch varied from 1 to 72. A germinal vesicle with fine filaments of chromatin (Type A) was observed in 51.8% (range 21.1-100%) of the oocytes of large-dark COCs. Out of 50 oocytes cultured for 72 h, 6.0% developed to Metaphase II. In conclusion, there were many follicles with a diameter of 500 microm to 1mm in ovaries of bitches with pyometra, and many oocytes recovered from these follicles underwent meiotic maturation in vitro. The number of oocytes and COCs, and the morphological quality of the germinal vesicles varied among individual bitches.

Animals↗