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Infertility due to abnormalities of the ovaries in cattle.

A careful physical examination of a cow or heifer suspected of having an ovarian problem often results in a specific diagnosis (e.g., freemartinism) or a workable list of differentials. When the diagnosis is uncertain, techniques such as rapid progesterone assays, ultrasonographic imaging, ova or embryo recovery, and cytogenetic evaluation can provide critical information for a well-based diagnosis and prognosis. Despite the wide array of problems that can afflict the bovine ovary, cystic ovaries probably are the most commonly diagnosed and treated ovarian abnormality. Cysts have a variable life span and sometimes occurs together with a CL. Hormonal therapy with either GnRH followed by PG approximately 9 to 14 days later, or GnRH alone, followed by good heat detection is the treatment of choice for cows with cysts. Other conditions associated with ovarian dyfunction and infertility include adhesions, developmental anomalies, and tumors. The life span of a CL in the cow can be shortened unintentionally by attempting to correct other problems (e.g., multiple injections of oxytocin for milk let-down), or lengthened by uterine pathology (e.g., pyometra, or uterus unicornis). The administration of GnRH or hCG to improve ovarian function and pregnancy rates in cows may be beneficial in selected herds.

Animals↗

Abnormalities of the tubular genital organs.

Abnormalities of the tubular reproductive tract are responsible for decreased fertility in the cow. Typically, these are related to congenital defects such as segmental aplasia or to acquired conditions resulting from infections or trauma caused during breeding or parturition. Infection of the tubular tract may result in vaginitis, cervicitis, metritis, endometritis, pyometra, or salpingitis. Trauma to the tract may result in urovagina, pneumovagina, or prolapse of the vagina or uterus. Retained placenta may result in metritis. Potentially, all of these conditions, unless properly treated, may result in reduced fertility or, in the extreme, sterility. Judicial and properly timed use of antibiotics and ecbolic agents should return the tract to proper function with little or no reduction in fertility. Some conditions, such as prolapse, retained placenta, and pneumovagina, may call for manual or surgical intervention for successful resolution.

Animals↗

Use of ultrasonography in reproductive management of sheep and goat herds.

Real-time ultrasound evaluation of small ruminants offers an unparalleled range of information regarding pregnancy status, number of fetuses, and gestational age. The advantages of real-time ultrasonography are its sensitivity and accuracy of various diagnoses, its speed, and its safety. Overall flock reproductive management is facilitated through the timely acquisition of information with ewes culled, rebred, or preferentially fed, according to pregnancy status. Breeding dates of pasture-bred does can be assigned with sufficient accuracy to allow parturition induction at term without risk of severe immaturity in kids. Diagnoses other than pregnancy, such as pyometra, nydrometra, fetal resorption, and fetal mummification also can be made using real-time ultrasonography.

Animals↗

Preliminary experience with uterine artery embolization for uterine fibroids.

PURPOSE: To evaluate the potential usefulness of transcatheter uterine artery embolization as a treatment for fibroid-related vaginal bleeding and pelvic pain refractory to hormonal therapy and myomectomy. MATERIALS AND METHODS: Eleven patients (aged 27-55 years; mean, 44.2 years; none desiring future pregnancy) with refractory vaginal bleeding and/or chronic pelvic pain related to uterine leiomyomata underwent uterine artery embolization with use of polyvinyl alcohol (PVA) particles. Clinical improvement was assessed by detailed questionnaire at 2-9 months (mean, 5.8 months) after the procedure. Sonographic measurements of the uterus and dominant masses were obtained before and at 2 months after the procedure. RESULTS: All 11 patients underwent technically successful embolization. Eight of nine women who completed the follow-up questionnaire reported noticeable symptomatic improvement, including three women with complete resolution of symptoms. One woman (the only patient undergoing unilateral embolization) exhibited no clinical response. Another patient developed endometritis and pyometra 3 weeks after the procedure, necessitating hysterectomy. Large reductions in uterine volume (average, 40%) and dominant fibroid size (average, 60%-65%) were sonographically demonstrated. CONCLUSION: Uterine artery embolization represents a promising new method of treating fibroid-related menorrhagia and pelvic pain. Further investigation will be required to assess clinical response and durability, identify appropriate candidates, and define the optimal angiographic technique and PVA particle size.

Adult↗

Complications and concurrent disease associated with diabetes mellitus.

Many animals with diabetes mellitus are severely ill on clinical presentation. The spectrum of disease is quite variable and includes diabetic ketoacidosis (DKA), ketosis without acidosis, hyperosmolar nonketotic syndrome (HNKS), and other nonketotic variants (negative urine ketones, serum osmolality < 340 mOsm/kg with or without acidosis). These more severe forms of diabetes are often precipitated by concurrent diseases such as pyelonephritis, pancreatitis, pyometra, hyperadrenocorticism, renal failure, and heart failure. To make matters worse, in-hospital treatment of diabetic dogs and cats is commonly associated with serious complications, including hypoglycemia, hypokalemia, and hypophosphatemia.

Animals↗

A preliminary comparison of plasma fibrinogen concentrations, leukocyte numbers and erythrocyte sedimentation rate as non-specific indicators of inflammatory conditions in buffalo (Bubalis bubalis).

The plasma fibrinogen concentration (Fib), total leukocyte count (TLC), neutrophil, lymphocyte and monocyte numbers, and the erythrocyte sedimentation rate (ESR) were determined in 153 buffaloes suffering from different clinical conditions. Fib increased significantly (p < 0.05) in chronic mastitis, pyrexia, pyometra, cutaneous abscesses, tail gangrene and acute indigestion, whereas in most of the other conditions studied it varied non-significantly. TLC increased significantly in chronic mastitis, pyrexia, endometritis, cutaneous abscesses and infected skin wounds. An increase in neutrophils was associated with an increased TLC. Numbers of lymphocytes varied non-significantly in most of the conditions. Monocytes decreased significantly in most of the acute conditions. ESR was significantly elevated in all clinical conditions. Significantly increased mean Fib values in the different conditions varied from 703 +/- 119 to 725 +/- 140 mg/dl, while the maximum individual value was 1510 mg/dl in a case of cutaneous myiasis. The significantly increased mean TLC ranged from 9.48 +/- 2.91 to 11.1 +/- 3.5 x 10(3)/microliter, while it was 21.7 x 10(3)/microliter in a case of meningitis. ESR values in sick buffaloes varied from 57 to 111 mm in the first hour.

Animals↗

Is mechanically induced cystic endometrial hyperplasia (CEH) a suitable model for study of spontaneously occurring CEH in the uterus of the bitch?

CONTENTS: Cystic endometrial hyperplasia (CEH) was experimentally reproduced by the intraluminal insertion of a silk wire in the uterus of metestral bitches to obtain a model for the study of spontaneously occurring CEH in the bitch. This mechanically reproduced CEH corresponded histologically very well to spontaneously occurring CEH. With respect to sex hormone receptor expressions, however, there was no similarity. In the mechanically induced CEH, progesterone receptor expression was reduced in the epithelial cells (surface epithelium and endometrial glands) and slightly increased in the stromal fibroblasts and myometrium as compared with the normal metestrus uterus. The oestrogen receptor expression in mechanically induced CEH was reduced in the epithelial cells (surface epithelium and endometrial glands) and more or less unchanged in the stromal fibroblast and myometrium as compared with the normal metestrus uterus. This is in contrast to the increased sex hormone receptor expressions in all uterine cell types, observed in spontaneously occurring CEH. The mechanically induced CEH model corresponds immunohistochemically more to early placentation and to pyometra in the bitch. Thus this experimental CEH model is not suitable for pathogenic studies of spontaneously occurring CEH in the bitch.

Animals↗

A comparison of preoperative tramadol and morphine for the control of early postoperative pain in canine ovariohysterectomy.

OBJECTIVE: To compare morphine with tramadol for the management of early postoperative pain following ovariohysterectomy after pyometra in dogs. STUDY DESIGN: Prospective randomized blinded clinical trial. ANIMALS: Thirty female dogs, 2-14 years old. METHODS: Animals were randomly divided into two equal groups. Group 1 received 0.2 mg kg-1 of morphine IV and group 2 received 2 mg kg-1 of tramadol IV after the induction of anesthesia. The dogs were premedicated with acepromazine, and anesthesia was induced with intravenous midazolam and ketamine. Isoflurane was used for the maintenance of anesthesia. The variables measured were: analgesia; sedation; cardiac and respiratory rates; arterial blood pressure; end-tidal isoflurane and carbon dioxide (Pe'CO2); oxyhemoglobin saturation (SpO2); plasma catecholamines; serum cortisol and glucose concentrations; pH and blood gases. The animals were monitored for 6 hours after the administration of the analgesic agent. RESULTS: There were no differences between the two groups with regard to analgesia, sedation, SpO2, pH and blood gases, cardiovascular variables, glucose, catecholamine and cortisol concentrations. Forty minutes postopioid administration, the end-tidal isoflurane concentration was significantly lower in the morphine-treated group as compared to the tramadol group. At 30 minutes following opioid injection, Pe'CO2 was significantly higher in the morphine group than in the tramadol group. Two dogs in the tramadol group and one in the morphine group were given morphine postoperatively because of increasing pain scores. CONCLUSION AND CLINICAL RELEVANCE: Morphine and tramadol, administered preemptively can be used safely in dogs to control early pain after ovariohysterectomy without significant adverse effects.

Analgesics, Opioid↗

[Discovery of a protist parasite, apparently akin to Acrasiae, in the genital tract and various organs of primates].

Microcysts were first observed in histological sections of the placenta of a gibbon, the uterus of a Microcebus, showing a pyometra, the placenta, spleen and lung of a new born mangabey which died soon after birth from an interstitial pneumonia. Plasmodial forms were also discovered in the sections, either encysted or infiltrating the tissues. Cultures from all the above mentioned pathological material were attempted on a special medium, the composition of which will be given later. All cultures shew myxamoeba-like organisms aggregating and merging into pseudoplasmodial forms that produced microcysts. Attention is drawn to the pathogenic rôle of this new kind of parasites in order that they should be searched for, in every case of genital troubles not ascribable to other causes.

Animals↗

An automated spectrophotometric method for measuring canine ceruloplasmin in serum.

An automated method for the determination of ceruloplasmin activity was developed and validated in canine serum. The method is based on the in vitro oxidase activity that this protein shows with substances such as p-phenylenediamine. In order to determine optimum assay conditions, the effects of the substrate concentration, buffer pH, reaction time and EDTA on the reaction were evaluated. The precision of the assay was good with within-run and between-run coefficients of variation lower than 10%. The method measured the ceruloplasmin values in a proportional and linear manner (r = 0.99) with a limit of detection of 0.0007 +/- 0.0001 Delta Abs/min. A temperature of -20 degrees C kept the reagent stable for 30 days. The method is cheap and easy to adapt to any automated biochemical analyser, considerably decreasing the processing time required with the manual method. Additionally it allows to differentiate dogs with pyometra and trauma from clinically healthy dogs.

Animals↗

Obstetrical emergencies.

This article discusses different techniques that can be used in the diagnosis and treatment of obstetrical emergencies. Female reproductive emergencies commonly encountered by small animal practitioners include pyometra, dystocia, cesarean section, mastitis, eclampsia, uterine torsion, and uterine prolapse. A thorough knowledge of normal and abnormal reproductive behavior will aid the emergency veterinarian in successfully managing such cases. Timely diagnosis and treatment of these emergencies will often give a good outcome.

Animals↗

[Gynecologic interventions in the 10th decade of life].

We report on 28 surgical procedures performed between 1978 and 1992 performed on patients aged 90 years or older. 18 of them had a malignant tumour (11 mamma, 2 corpus, 3 vulva and 2 ovarian cancer), one had an ovarian cystoma. Three patients suffered from pelvic relaxation, four had postmenopausal bleeding, one vulvar dystrophy and one patient suffered from pyometra. Four laparotomies, three vaginal hysterectomies with colporrhaphy, four minor operations of the vulva, six curettages and eleven mammary operations were performed. During the surgical procedures, none of the patients died, whereas two patients died some time after the operation: so-called hospital mortality. The survival of the other patients was comparable to that of their age group. Two patients died of gynaecological diseases. After the surgical procedure, 21 patients reattained their preoperative level of health. 23 were satisfied with the result of the operation because of improvement of their complaints. If surgery in the aged allows the patients to lead a comfortable life, the operational risks can be justified.

Aged↗

Postinflammatory sarcoma in cats.

Histological examination of 38 nodular formations extirpated from the site of vaccine administration to cats disclosed 25 cases of sarcoma and 13 of granuloma. Average age of the cats bearing sarcoma was 8.75 years whereas granuloma occurred at average age of 1.9 year. This age-relationship of the lesions, as well as their similar morphologic features indicated a progression of chronic inflammatory changes to tumors. Similar tumors were diagnosed in one cat with "posttraumatic ocular sarcoma" and in the uterus of female-cat with long-standing pyometra. These two cats were 15 and 8 years old, respectively. Experimental study of local reaction 21 days after administration of commercial, lipid-adjuvanted vaccine revealed in young cats (age 9 months) a reaction to immunogen, whereas in old animals (age 10 to 15 years) there was a reaction to foreign material. The data suggest that chronic inflammation and age-related immunodeficiency are instrumental in pathogenesis of the vaccine-associated sarcoma.

Acid Phosphatase↗

Findings in women with postmenopausal bleeding investigated with hysteroscopy.

Most reports on histopathological findings of postmenopausal bleeding were published before hysteroscopy was widely used. Recent studies have shown that hysteroscopic examination is better than dilatation and curettage alone in detecting intrauterine pathology. The aim of this study is to assess histopathological findings of patients presented with postmenopausal bleeding after incorporation of hysteroscopic examination. Between 1 January 1996 and 31 December 1996, a total of 199 consecutive patients presenting with postmenopausal bleeding to a regional hospital were reviewed. Patients were investigated with cervical biopsy, endometrial aspiration or hysteroscopy and curettage. Excluding patients who had hysterectomy and cervical cancer, 97% of the patients had hysteroscopic examination. The majority of patients with postmenopausal bleeding had atrophic vaginitis and/or atrophic endometrium (58.8%). Other common diagnoses were endometrial polyp (9.4%), endometrial carcinoma (9.4%) and carcinoma of the cervix (6%). Other diagnoses included submucous fibroid, endometrial hyperplasia, pyometra, ovarian cancer and urethral caruncle. Pathologies found were similar to early reports, except that incidences of submucous fibroids and endometrial polyps were higher (13.4%). We concluded that all patients with postmenopausal bleeding should be investigated thoroughly as 22% have significant pathology. Hysteroscopy is the preferred investigation because of high incidences of endometrial polyps and submucous fibroids.

Journal Article↗

Problems in evaluating chronic toxicity of contraceptive steroids in dogs.

The long-term effects of oral contraceptive steroids including a combination of norethindrone and ethynylestradiol, a sequential regimen of dimethisterone and ethynylestradiol, and daily administration of megestrol acetate were studied in female beagle dogs at dose levels of 1, 10, or 25 times the projected human dose levels. The major findings included cystic endometrial hyperplasia and pyometra requiring hysterectomies and alopecia for the norethindrone-ethynylestradiol and dimethisterone-ethynylestradiol treated dogs. These groups did not have accentuated mammary development or treatment-related hyperplastic or neoplastic changes. For dogs given dimethisterone-ethynylestradiol, numerous acne-like lesions occurred in the skin of the mammary areas. Dogs given the higher dose levels of megestrol acetate had marked mammary stimulation, hyperplastic and neoplastic changes in the mammary glands, and clinical and pathologic changes typical of diabetes mellitus. Mammary changes of nodular hyperplasia, benign mixed tumor, and adenocarcinoma appeared as distinct entities although constant and intense mammary stimulation may be a common denominator. Such mammary changes have not been found in long-term studies in monkeys or rats with megestrol acetate, and the relevance of the canine mammary changes to projecting potential tumorigenesis in women is questioned.

Alopecia↗

In vitro and in vivo antibacterial activities of a new injectable carbapenem, S-4661, against gynaecological pathogens.

Carbapenems are often used to treat infections in obstetrics and gynaecology because of their activity against anaerobes. S-4661, a new injectable carbapenem antibiotic, has favourable pharmacokinetic properties and is not hydrolysed by dehydropeptidase I. We investigated the in vitro and in vivo antibacterial activities of S-4661 against strains of Streptococcus agalactiae, Escherichia coli, Peptostreptococcus magnus, Bacteroides fragilis and Prevotella bivia, which are major pathogens in the fields of obstetrics and gynaecology. The MIC(50) and MIC(90) of S-4661 for these strains were 0.25 and 1 mg/L, respectively. The in vivo efficacy of S-4661 was evaluated in a rat model of intrauterine infection, namely pyometra caused by E. coli and B. fragilis. The accumulation of neutrophils in the uterus in the S-4661-treated group was less marked and the number of bacteria significantly lower than those in the untreated group. These results suggest that S-4661 may be useful for treating polymicrobial infections in the fields of obstetrics and gynaecology.

Animals↗

Endometrioid endometrial adenocarcinoma with psammoma bodies.

Since the wide acceptance of serous carcinoma as a distinct subtype of endometrial carcinoma, almost all endometrial carcinomas with psammoma bodies have been classified as such. We describe eight cases of endometrioid endometrial adenocarcinoma with psammoma bodies and discuss their clinicopathologic features. The patients ranged in age from 37 to 79 years. Psammoma bodies were present in the curettage material in three and in the hysterectomy specimens in all cases. The tumors were well to moderately differentiated with at least focal squamous metaplasia. Four of eight cases also showed a focal villoglandular architecture. Inflammation and necrosis were present in all cases, and four had features of pyometra. Deep myometrial invasion was present in six cases. Diffuse lymphatic invasion was present in six, and one showed perivascular lymphocytic infiltrate in the absence of myometrial invasion. The tumors metastasized to lymph nodes in four of eight cases. One case showed intranodal psammoma bodies in the absence of endosalpingiosis or tumor. Intra-abdominal recurrence was present in only one case and was endometrioid with rare psammoma bodies. All patients are alive, six with no evidence of disease, one with stable periaortic lymphadenopathy, and one with progressive disease. This report suggests that endometrioid endometrial carcinoma may rarely be associated with psammoma bodies, the formation of which is most likely due to inflammation and necrosis. It also suggests that endometrioid carcinoma with psammoma bodies has a higher surgical stage and is more likely to have lymphatic invasion and lymph-node metastases and hence require surgical staging. The pattern of spread appears to be different from uterine papillary serous carcinoma, and the rate of survival is similar to stage-matched endometrioid carcinoma without psammoma bodies.

Adenocarcinoma↗

Transcatheter uterine artery embolization for the management of symptomatic uterine leiomyomas.

UNLABELLED: Transcatheter arterial embolization has been applied traditionally in obstetrics and gynecology for the emergency control of pelvic hemorrhage, usually after failure of conventional surgical measures. Pelvic trauma is the most common, nongynecologic etiology of uncontrollable pelvic hemorrhage requiring use of this hemostatic technique. Recently, elective transcatheter arterial embolization of uterine leiomyomas has been performed to decrease related symptomatology in an attempt to avoid surgical intervention. Our objective was to review current pertinent data regarding this new therapeutic modality. To this goal, all manuscripts published in the literature regarding this topic obtained from a MEDLINE search for 1966 through September 1998 were selected and reviewed. Additional sources were identified through cross-referencing. Currently, approximately 193 patients worldwide have been managed with this investigational procedure. Main indications include symptomatic uterine leiomyomata with menometrorrhagia, anemia, or pain. Success rates seem promising with a very low failure rate. This procedure results in significant (uterine and leiomyoma) volume reduction of between 20 and 80 percent. Postprocedural pain is common during the first day after the procedure, often requiring intravenous nonsteroidal antiinflammatory drugs and narcotic analgesia. Rare complications include endometritis, pyometra, and uterine necrosis, which may require hysterectomy. Reported follow-up time ranges between 6 and 60 months. Implications on subsequent fertility have not been established. Although successful pregnancies subsequent to this procedure have been reported, because of the unknown long-term effect of this procedure on fertility or perinatal outcome, this technique should not be performed when future fertility is desired. This review suggests that although not currently accepted as standard of care, transcatheter embolization of the uterine arteries can be considered as a nonsurgical technique for the management of appropriately selected patients. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES: After completion of this article, the reader will be able to explain the current indications and contraindications of transcatheter uterine artery embolization of leiomyomas; to identify the various complications of the procedure and the type of embolic materials used; and to estimate the success rate of this procedure in the current literature.

Adult↗