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PubMed2006

Lactoferrin expression in the canine uterus during the estrous cycle and with pyometra.

The expression of lactoferrin, a non-specific antimicrobial defence, in the canine uterus during the normal estrous cycle and in bitches with pyometra was examined. Using polymerase chain reaction analysis, lactoferrin gene transcripts were detected in the endometrium at all stages of the estrous cycle, with the highest levels in estrus. In normal bitches, endometrial lactoferrin mRNA increased from proestrus to estrus (P<0.05). Thereafter, it dramatically decreased from estrus to Day 10 of diestrus (P<0.05), and stayed low at Day 35 of diestrus and anestrus; this was consistent with blood estrogen concentrations. Levels of lactoferrin mRNA were higher in bitches with pyometra than in normal diestrus (P<0.05). With immunohistochemistry, distinct staining of lactoferrin was detected in the luminal and glandular epithelial cells of the endometrium at proestrus and estrus, but little staining was detected at Day 10 of diestrus. At Day 35 of diestrus and anestrus, a partial and weak reaction was present in the same region. In bitches with pyometra, the glandular epithelial cells and many cells in the uterine stroma were strongly stained. Staining cells in the stroma were morphologically similar to neutrophils. No lactoferrin staining was seen in the uterine stromal cells or myometrium in any section. These results suggest that, in the canine uterus, lactoferrin expression is related to the blood concentration of estrogen, and that the dramatic reduction in lactoferrin observed at the early stage of diestrus may impair antimicrobial defense. Also, enhanced expression of lactoferrin mRNA in the endometrium with pyometra may be associated with neutrophil invasion into the uterus to combat the infection.

Amino Acid Sequence↗

PubMed2004

Ultrasonography and cystic hyperplasia-pyometra complex in the bitch.

Cystic endometrial hyperplasia-pyometra complex is the most frequent and important endometrial disorder encountered in bitches. The pathogenesis of the disease is related to the activity of progesterone [Feldman and Nelson, Canine and Feline Endocrinology and Reproduction (1996) W.B. Saunders, Philadelphia]. Cystic endometrial hyperplasia (CEH) is an abnormal response of the bitch's uterus to ovarian hormones [De Bosschere et al. Theriogenology (2001) 55, 1509]. CEH is considered by many authors to be an exaggerated response of the uterus to chronic progestational stimulation during the luteal phase of the oestrous cycle, causing an abnormal accumulation of fluid within the endometrial glands and uterine lumen (De Bosschere et al. 2001). The resulting lesions of pyometra are due to the interaction between bacteria and hormones. The aim of this study was to evaluate if transabdominal uterine ultrasonography can be a useful and reliable diagnostic method to confirm Dow's [Veterinary Record (1958) 70, 1102] and De Bosschere's histopathological classification of CEH-pyometra complex. The study was carried out on 45 bitches with pyometra, 10 purebreds and 35 crossbreeds, 1-15 years old, 20% of which had whelped at least once. None of these animals had received exogenous oestrogen or progesterone treatment. On admission the 45 animals were in the luteal phase of the oestrus cycle. Clinical signs, blood parameters, uterine ultrasonography, bacterial swabs and uterine histopathological results were recorded. Results suggest that ultrasonographic examination is a useful and reliable tool for the diagnosis of cystic endometrial hyperplasia.

Animals↗

PubMed2001

Immunosuppression in bitches with pyometra.

The function of the immune system was studied in 34 bitches affected by pyometra. The mean age of the animals was 8.1 +/- 2.8 years. Samples of peripheral blood were examined using a battery of immunological tests. Data obtained from four sets of animals, grouped according to the severity of their disease, were compared. Leucocytosis (neutrophilia and partial monocytosis) and lymphopenia were detected in 62 per cent and 35 per cent of the bitches, respectively. The increase in the number of leucocytes was higher in the severely affected bitches. Inhibition of mitogen-driven lymphocyte proliferation was the characteristic feature of the immunological profile in bitches affected by pyometra, and this corresponded with the impairment of the general state of health. Sera from bitches showing functional inhibition of lymphocytes suppressed the activity of lymphocytes isolated from normal dogs. Sera from bitches affected by pyometra also had higher levels of immunoglobulins, lysozyme and circulating immune complexes. It can be concluded that pyometra is associated with an inflammatory response, but also with a marked suppression of immune system activity.

Animals↗

PubMed1998

Associations between age, parity, hormonal therapy and breed, and pyometra in Finnish dogs.

A case-control study of 953 dogs with pyometra and 10,660 unmatched control dogs was used to investigate the relationships between age, parity, hormonal therapy and breed, and pyometra in Finnish dogs. Cases were reported in animals between nine months and 18 years of age, with a median age at diagnosis of nine years. Nulliparous bitches had a moderately higher risk of developing pyometra than primiparous and multiparous animals (adjusted odds ratio point estimate, 6.63). The administration of oestrogen increased the risk of pyometra in bitches up to four years of age (odds ratio point estimate > 6). No significant risk-enhancing effect of progestin treatment was detected and it is unlikely that such a risk, if present, is high (likelihood of the odds ratio exceeding 2 < 0.18). Seventeen breeds had an increased risk, and the wire-haired dachshund and mongrels had a decreased risk of developing the condition.

Aging↗

PubMed2005

Antimicrobial resistance in Escherichia coli isolated from bitches with pyometra and from urine samples from other dogs.

To assess whether the rates of antimicrobial susceptibility in bacteria isolated from the urine of dogs with urinary tract infections are similar to those of bacteria isolated from bitches with pyometra, the antimicrobial resistance of Escherichia coli isolated from the two groups were determined and compared. The samples were collected in Sweden between April 2002 and March 2003, and potential changes over time were assessed by comparing the results with corresponding data from 1991 to 1993. Among 80 isolates of E coli from cases of pyometra, the proportions that were resistant to the antimicrobials used in canine practice were generally low (ampicillin 10 per cent, enrofloxacin 4 per cent, gentamicin 0 per cent, streptomycin 5 per cent, sulfamethoxazole 8 per cent, tetracycline 4 per cent and trimethoprim 2 per cent) and similar to the proportions reported previously. Significantly lower proportions of resistance were recorded among the pyometra isolates than among 92 isolates from urine samples submitted by animal hospitals to ampicillin (P=0.04), streptomycin (P=0.002) and tetracycline (P=0.03), but there were no differences between the pyometra isolates and 113 isolates from urine samples submitted by animal clinics.

Animals↗

PubMed2006

Spontaneous perforation of pyometra.

Pyometra is the accumulation of purulent material in the uterine cavity. Its reported incidence is 0.01-0.5% in gynecologic patients; however, as far as elderly patients are concerned, its incidence is 13.6% [3]. The most common cause of pyometra is malignant diseases of genital tract and the consequences of their treatment (radiotherapy). Other causes are benign tumors like leiomyoma, endometrial polyps, senile cervicitis, cervical occlusion after surgery, puerperal infections, and congenital cervical anomalies. Spontaneous rupture of the uterus is an extremely rare complication of pyometra. To our knowledge, only 21 cases of spontaneous perforation of pyometra have been reported in English literature since 1980. This paper reports an additional case of spontaneous uterine rupture.

Abdominal Pain↗

PubMedDate not supplied

Effects of long-term administration of roxithromycin on neutrophil count and interleukin-8 level in endometrial cavity subjected to pyometra.

We investigated the effect of long-term administration of roxithromycin (RXM) on clinical responses and immune responses to chronic intrauterine infection, pyometra. One hundred and fifty milligrams of RXM were orally administered once a day for 3 months to patients with pyometra. Neutrophils and interleukin-8 (IL-8), which is a neutrophil chemotactic factor, in the lavage fluid of the uterine endometrial cavity obtained from 5 normal women and 18 patients with pyometra were investigated. Sixteen (88.9%) of the 18 patients showed a clinical improvement at the end of treatment. The immune responses occurred in the lavage fluid from the uterine endometrial cavity. Neutrophils accumulated in the lavage fluid of the uterine endometrial cavity before RXM treatment (p < 0.001 vs. normal subjects and decreased after RXM treatment (p < 0.001). The levels of IL-8 were significantly higher in the lavage fluid of pyometra patients than in normal women (p < 0.001), and tended to decrease after RXM treatment (p < 0.01). These results indicate that RXM decreases uterine endometrial cavity inflammation through reduction of neutrophil migration in inflammatory sites and is effective in treating chronic intrauterine infection.

Aged↗

PubMed1989

Pneumoperitoneum and an acute abdominal condition caused by spontaneous perforation of a pyometra in an elderly woman: a case report.

Pyometra, a collection of purulent material in the uterus, is an uncommon gynecologic entity. Spontaneous perforation of the uterus is an infrequent complication of pyometra, most often the result of malignant conditions in the uterus. We report the case of an elderly woman who had an acute abdominal condition and pneumoperitoneum due to a ruptured pyometra resulting from a degenerative and infected leiomyoma. Although uterine disease is a rare cause of an acute abdominal condition and pneumoperitoneum in the elderly, a perforated pyometra must be considered in the differential diagnosis.

Abdomen, Acute↗

PubMed1986

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.

Animals↗

PubMed1979

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.

Age Factors↗

PubMed1998

Uterine androgen receptor mRNA expression in metestrous and anestrous bitches being healthy or suffering from Pyometra.

The importance of androgens for the female reproductive system has been investigated for decades and a number of androgen sensitive processes has now been identified in female reproductive organs. For carnivore species no data were available so far about uterine androgen sensitivity and its regulation. The present study therefore aimed to investigate whether androgen receptors (AR) are present in the dog uterus, whether they are regulated throughout the ovarian cycle and whether pyometra affects their expression rate. Uterine tissue samples were collected from 28 bitches of different ages and various breeds. The samples were grouped according to the stage of estrous cycle (metestrus ME or anestrus AE) and the pathological status of the uterus (i.e. suffering from pyometra or not). Androgen receptor mRNA (AR mRNA) was quantified from 500 ng of total RNA isolated from the tissue samples using an internally standardized reverse transcription polymerase chain reaction (RT-PCR) described previously. The amount of total RNA extractable per g tissue was elevated during pyometra. The successful amplification of the expected 172 bp fragment from canine uterine RNA together with the confirmation of the identity of this fragment by sequence analysis, demonstrates that AR is expressed in this particular tissue. Comparing the expression rates in uteri from bitches during ME or AE being healthy (H) or suffering from pyometra (P), the only significant (p < 0.01) difference was found between H and P uteri during ME with 3.5-fold lower expression rates in P. Although the same seems true for AE bitches, a significant difference could not be demonstrated due to the low number (n = 2) of diseased animals in the AE group. There was no evident effect of the stage of ovarian cycle on uterine AR mRNA levels.

Anestrus↗

PubMed2000

Generalized peritonitis due to spontaneously perforated pyometra presenting as pneumoperitoneum: report of a case.

We report a rare case of generalized peritonitis due to a ruptured pyometra in an 86-year-old woman, and also conduct a review of the previous Japanese literature. The patient presented with muscle guarding and rebound tenderness. Computed tomography (CT) disclosed a cystic mass in the peritoneal cavity, in which an air-fluid level was noted. Pneumoperitoneum around the uterus due to gas production of anaerobic bacteria was noted on a CT. At laparotomy, the uterus was markedly enlarged with a necrotic area on the uterine fundus, which was found to be perforated. A supravaginal hysterectomy and drainage were performed. We found only eight cases of a ruptured pyometra presenting as pneumoperitoneum in the Japanese literature between 1977 and 1999. The most common cause of pneumoperitoneum is a perforation of the gastrointestinal tract. However, other possible causes, as seen in our patient, should also be taken into consideration. Although it is rare, a perforated pyometra should therefore also be considered when elderly women present with acute abdominal pain.

Aged↗

PubMed1980

Comparison of treatment of pyometra with estradiol cypionate or cloprostenol followed by infusion or non-infusion with nitrofurazone.

One hundred-fifty-two dairy cows affected with pyometra were treated either with cloprostenol (CLP) or with estradiol cypionate (ECP). The cows which failed to respond within 7-10 days were re-treated with the same drug used in the first treatment. Half of the cows which responded to these treatments received intrauterine infusions with 50 cc nitrofurazone solution. After two treatments, 72 (94.9%) of 79 cows in the CLP group had evacuated the purulent exudate from their uteri whereas only 57 (78.1%) of 73 cows in the ECP group had responded (P<0.005). Treatment-to-breeding and treatment-to-conception intervals were not different between the ECP and CLP groups. The number of services/conception was not different up to the 4th service (3.16 vs 3.57, respectively, P>0.1). Eight (9.3%) of 86 CLP treated and 3 (5.1%) of 59 ECP treated cows had recurrence of pyometra (P>0.1). Incidence of follicular cysts within 30 days after treatment was 16.4% (13 79 ) and 7.0% (4 57 ) among CLP and ECP groups, respectively (P>0.1). Two of 106 CLP (1.9%) and 5 of 107 ECP treatments (4.7%) were associated with subsequent perimetritis and adhesions. Intrauterine infusion of nitrofurazone increased the number of services/ conception (3.57 vs 2.21, P<0.01). Cloprostenol was superior to ECP as an initial treatment of bovine pyometra. Intrauterine infusion of nitrofurazone following evacuation of the uterus appeared not to be effective in prevention of relapses and had a negative effect on conception rates.

Journal Article↗

PubMed1986

Prevalence of postservice pyometra in a herd of beef cows infected with trichomoniasis: A case report.

Trichomoniasis was detected in a herd of beef cows during a routine yearly reproductive examination. The examination revealed that 12.6% of the cows (75 597 ) were not pregnant. Of these, 65.3% (49 75 ) had a normal uterus and a functional corpus luteum, suggesting that they were cyclic; 21.3% (16 75 ) had pyometra; 6.7% had inactive ovaries and uterine atrophy and were not cyclic; 4% (3 75 ) had an involuting uterus, suggestive of a recent abortion; and 2.7% (2 75 ) had a mummified fetus. The herd had been on a reproductive herd health program for the past 10 years and had averaged 92-99% pregnant cows during this time. Pyometra was diagnosed by rectal palpation, and trichomonads were detected in the pyometra exudate.

Journal Article↗

PubMed2006

Canine pyometra.

Pyometra, literally meaning pus in the uterus, is a common disease entity of intact bitches. Similar conditions occur, including hydrometra and mucometra [De Bosschere H, Ducatelle R, Vermeirsch H, Van Den Broeck W, Coryn M. Cystic endometrial hyperplasia-pyometra complex in the bitch: should the two entities be disconnected? Theriogenology 2001;55:1509-19]. The exact etiology is unknown; however the repeated and prolonged response to estrogen followed by long intervals of progesterone dominance in the intact bitch leads to hormonally mediated changes in the endometrium. The endometrium changes when impacted by bacterial infiltration; changes in endometrial steroid receptors can result in the clinical syndrome described as pyometra. This paper will describe the signalment, risk factors, prevalence, proposed etiologic events, and both medical and surgical therapies. In addition, the prognosis for successful outcome and effects on future reproduction will also be described.

Animals↗

PubMed2003

Ultrasound detection of pyometra at the time of embryo transfer after ovum retrieval for in vitro fertilization.

OBJECTIVE: To report the detection of pyometra after ovum retrieval for IVF with the routine use of ultrasound-guided embryo transfer. DESIGN: Case report. SETTING: Tertiary fertility center. PATIENTS: A 29-year-old woman who developed pyometra after ovum retrieval for IVF detected at the time of ultrasound-guided embryo transfer. INTERVENTION(S): Cancellation of the embryo transfer, cryopreservation of the embryos, treatment of the pyometra, and a successful frozen-embryo transfer. MAIN OUTCOME MEASURE(S): Normal uterine cavity after treatment and a delivered twin pregnancy. RESULT(S): A successful delivered twin pregnancy. CONCLUSION(S): Routine use of ultrasound-guided embryo transfer resulted in the rescue of the patient's embryos for cryopreservation, with a resulting ongoing pregnancy.

Adult↗

PubMed2003

A study of two protocols combining aglepristone and cloprostenol to treat open cervix pyometra in the bitch.

To compare the efficacy and safety of two protocols using a combination of aglepristone and cloprostenol for the treatment of open cervix pyometra in the bitch and to describe the progesterone (P4) serum profiles before and during treatments, 15 bitches were randomly allocated into two treatment groups: I (n = 8): aglepristone was administered at 10mg/kg, s.c., on Days 1, 3, 8, and 15 (if not cured), combined with cloprostenol at the dose of 1 microg/kg, s.c., on Days 3 and 8, and II (n = 7): received the same treatment with aglepristone as Treatment I but cloprostenol on Days 3, 5, 8 10, 12, and 15 (if not cured). Before the beginning of the treatments and then on Days 8, 15, and 29 all bitches were evaluated for clinical signs, side effects, hemogram, serum P4 concentrations, and uterus diameters. Bitches in both treatment groups, with (n = 6) or without (n = 9; > or =1.2 ng/ml) initial basal P4 serum concentrations, achieved treatment success without side effects and no significant differences, either on Day 15 (6/8 for Treatment I and 4/7 for Treatment II) or on Day 29 (2/8 for Treatment I and 3/7 for Treatment II). In both treatments groups, clinical signs, blood parameters, and uterine diameters improved to normal values throughout the experiments. A significant interaction between day and treatment was found for percentage change in P4 when all bitches were considered together. Redevelopment of pyometra in the next estrous cycle occurred in 20% of the bitches. One nonrecurrent bitch was mated and whelped a normal litter. It is concluded that these two combined protocols proved to be efficient and safe in reversing clinical signs of open cervix pyometra independently of initial P4 concentrations and that the number of cloprostenol administrations seemed to have an effect on P4 serum changes throughout treatments.

Amoxicillin-Potassium Clavulanate Combination↗

PubMed2003

Follow-up examinations of bitches after conservative treatment of pyometra with the antigestagen aglepristone.

The aim of this study was to determine the therapeutic success of the medical treatment of canine pyometra with the antigestagen aglepristone and to document the recurrence rate in relation to the time interval after treatment with antigestagens. In 48 (92.8%) of the 52 treated bitches, healing could be achieved within the first 3 weeks after the treatment had been started. One bitch died as a result of renal insufficiency; in three bitches there was no emptying of the uterus, so ovariohysterectomy became necessary. In these three patients, ovarian and endometrial cysts were present. Forty-one bitches could be followed up for 3 months. Four animals developed a recurrence (9.8%). In three bitches ovarian cysts and cystic endometrial hyperlasia could be found intra operationem. The development of 37 bitches could be followed for at least 1 year. Seven animals developed a pyometra again (18.9%). Two received a repeated treatment with aglepristone and have been free from recurrence for over 12 months. In 37 animals data on the subsequent sex cycles are available. In 22 bitches next heat started at the expected time, in seven animals heat started too early. In eight bitches the period of anoestrus was prolonged. Five of the six bred bitches delivered at least one litter. The presented data show that treatment of pyometra by aglepristone results in a high healing rate. The recurrence rate can be minimized by the selection of bitches without ovarian cysts and cystic endometrial hyperplasia.

Animals↗