[Contribution to the treatment of pyometra with special reference to late pyometra after actinotherapy of uterine cancer].
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Disease↗
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Pyometra in the dog -- a pathophysiological investigation. I. The pyometra syndrome, a review.
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Animals↗
Uropathogenic virulence factors in isolates of Escherichia coli from clinical cases of canine pyometra and feces of healthy bitches.
Escherichia coli is commonly isolated in canine pyometra, but little is known of the virulence factors that may be involved in the precipitation of this disease. The aim of this study was to compare the prevalence of uropathogenic virulence factor (UVF) genes in E. coli isolates from canine pyometra and from feces of healthy bitches to evaluate their role in the pathogenesis of pyometra. E. coli from 23 cases of canine pyometra and from the feces of 24 healthy bitches were analyzed, by polymerase chain reaction, for UVF genes associated with canine and human urinary tract infections (UTIs). The prevalences of UVFs in E. coli from canine pyometra were similar to that in canine and human uropathogenic E. coli. The prevalence of pap was greater (P=0.036) for E. coli from pyometra (52%) than for fecal isolates (21%), and the papGIII allele was present in all pap-containing isolates. The prevalences of genes for alpha-haemolysin and cytotoxic necrotising factor 1 were not significantly higher (P=0.075) in E. coli from pyometra than from feces. The proportion of pyometra strains with >or=3 UVFs was higher (P=0.039) than that of fecal strains, suggesting that possession of >or=3 UVF genes enhances the pathogenicity of the strain. Our findings demonstrate that E. coli associated with canine pyometra are similar to uropathogenic strains, and that operons that encode P fimbriae, alpha-haemolysin and cytotoxic necrotising factor 1 probably enhance the virulence and pathogenicity of the strain in the canine genital tract.
Adhesins, Escherichia coli↗
Induction of canine pyometra by inoculation of Escherichia coli into the uterus and its relationship to reproductive features.
To characterize oestrus-related factors affecting the induction of and recovery from pyometra in bitches, 60 clinically healthy beagle bitches were used for induction of pyometra by inoculation of Escherichia coli into the uterus during oestrous and metoestrous stages. The animals were classified into the following six groups according to inoculation time: Days 1-10, 11-20, 21-30, 31-40, 41-50 and 51-60 after LH surge. The incidence of pyometra during the periods Days 11-20 and 21-30 after LH surge was 90.9% and 78.9% respectively, while that during Days 1-10 and 51-60 after LH surge was less than 20%, and the patterns of the incidence of pyometra and the serum progesterone levels were similar. There was no difference in the incidence of pyometra induced in bitches less than 5 years old compared to bitches over 6 years old. Oestrus in all of the bitches with pyometra induced by E. coli returned with or without PGF 2alpha treatment, unlike in bitches with spontaneous pyometra. The duration of the oestrous cycle in the non-treated and PGF 2alpha-treated groups was 231.4+/-55.2 days and 162.1+/-40.6 days (P < 0.001), respectively, and there was no difference in the rate of return of oestrus between the two groups. The conception rate in all of the bitches in which oestrus had returned was 81.8%. The above findings indicate that the period during which severe pyometra could be induced was limited to the early stage in metoestrus.
Animals↗
Canine pyometra: a study of the urinary proteins by SDS-PAGE and Western blot.
Canine pyometra often causes glomerulonephritis by immune complex deposition in the glomeruli. Proteinuria, ranging from moderate to severe, may be present secondary to renal damage. To determine urinary protein excretion due to pyometra, sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) was conducted on urine from 15 bitches with pyometra and 10 healthy bitches. To characterize urinary immunoglobin excretion, Western blot analysis of the urine samples using antibodies to canine IgG and IgA was also performed. Nine bands were detected by electrophoresis in bitches with pyometra, while only four were detected in the healthy animals. The urinary proteins from bitches with pyometra were primarily of glomerular origin; 58% were of medium-high molecular weight (MW), and the remainder were low MW. None of the healthy dogs had IgG or IgA in their urine, whereas three bitches with pyometra had IgG in their urine and another bitch with pyometra had both IgG and IgA. The low proportion of bitches with urinary immunoglobins was probably be due to early diagnosis of the disease. Although only a limited number of dogs was used, this study is apparently the first to characterize the electrophoretic pattern of urinary proteins and to quantify urinary excretion of IgG and IgA in bitches with pyometra.
Animals↗
Differentiation between pyometra and cystic endometrial hyperplasia/mucometra in bitches by prostaglandin F2alpha metabolite analysis.
Bitches with pyometra are potential emergency cases which may be clinically difficult to differentiate from cases of cystic endometrial hyperplasia (CEH) in combination with mucometra. In the present study plasma prostaglandin F(2alpha), as measured by its main metabolite 15-keto-13,14-dihydro-PGF(2alpha) (PG-metabolite) concentrations, blood biochemical and hematological parameters were measured in 59 bitches with pyometra, 10 bitches with CEH and nine controls to determine if PG-metabolite could differentiate between the three uterine conditions. Bitches with pyometra had significantly higher plasma levels of PG-metabolite than bitches with CEH (P=0.002) and the controls (P=0.002). PG-metabolite analysis alone had a high sensitivity (98.3%) and a high specificity (80.0%) for the differentiation of pyometra versus CEH in bitches where fluid in the uterus was diagnosed. When a combination of PG-metabolite and percentage band neutrophils (PBN) was used for differentiation of the two diagnoses, a sensitivity of 100% and specificity of 90.0% was obtained. This means that the combination of PG-metabolite and PBN analysis allows for differentiation between cases of pyometra and CEH. If the PG-metabolite level in a bitch is >or=4,524 pmol l(-1), there is a 99% probability of the diagnosis pyometra versus CEH. Levels of PG-metabolite >or=3,054 pmol l(-1), >or=2,388 pmol l(-1) or>or=1,666 pmol l(-1) indicates a 95%, 90% or 80% probability of pyometra, respectively. At high PG-metabolite levels (above about 3,000 pmol l(-1)), PG-metabolite alone is enough for differentiation of pyometra versus CEH. The results of the present study showed that PG-metabolite analysis is valuable in the diagnosis and prediction of severity of uterine diseases.
Animals↗
Biochemical phenotypes of Escherichia coli in dogs: comparison of isolates isolated from bitches suffering from pyometra and urinary tract infection with isolates from faeces of healthy dogs.
Escherichia coli from dogs suffering from pyometra and/or urinary tract infection (UTI) were compared with faecal E. coli. We studied 79 isolates from pyometra, 96 from UTI, 91 from faeces of healthy dogs and 60 from faeces of bitches with pyometra. The isolates included 16 bitches with pyometra where E. coli were isolated from both the uterus and the urinary tracts. All isolates were typed with the aid of an automated typing system for biochemical fingerprinting (the PhP-EC system). The PhP types of uterine E. coli isolates from bitches with pyometra showed higher homogeneity, calculated as the mean of similarity between isolates (rmean = 0.79) than epidemiologically unrelated isolates, such as those isolated from faeces (rmean = 0.69) or UTI (rmean = 0.70). This finding suggests that many of the pyometra isolates derives from related clones. Mucoid and nonmucoid uterine isolates from the same sample were generally of the same PhP type. In all 10 cases uterine E. coli isolates were identical or very similar to isolates from faeces of the same bitch. Furthermore, E. coli isolates from both UTI and the infected uterus in the same bitch were identical or very similar in 88% of the cases. It was concluded that E. coli associated with canine pyometra derive from the faecal flora and that the urinary tract is infected by the same E. coli clone as the uterus of a bitch with pyometra.
Animals↗
Effect of Actinomyces pyogenes and gram-negative anaerobic bacteria on the development of bovine pyometra.
Fifteen lactating Holstein cows were used in a trial designed to evaluate the effectiveness of intrauterine inoculation (challenge) of Actinomyces pyogenes (A) alone or in combination with Fusobacterium necrophorum (F) and Bacteroides melaninogenicus (B) to induce pyometra. Cows were assigned to one of five groups: A (n = 3), AB (n = 3), AF (n = 3), ABF (n = 3) or C (control, broth medium alone; n = 3). All cows exhibited estrus 12 or 13 d prior to challenge (Day 0=first day of challenge). During the prechallenge period, the reproductive tract of each cow was palpated per rectum and uterine fluid aspirates for culture and uterine biopsies were also obtained. All cows received an intravenous injection of 5,000 IU of human chorionic gonadotropin (hCG; Day 5) and an intrauterine infusion of 40 ml of 0.7% iodine solution (Day 1). Cows were then inoculated on Days 0, 1 and 2 of the experiment. Sequential palpations of the reproductive tracts, samples of uterine fluid for culture and uterine biopsies were performed for a total of 30 d after the first inoculation. A cow was diagnosed as having pyometra when purulent uterine fluid and a corpus luteum were detected by palpation per rectum. The number of cows that developed pyometra in Group A was 2 of 3, in Group AB 3 of 3, in Group AF 3 of 3, in Group ABF 3 of 3 and in Group C 0 of 3. Cows with pyometra did not exhibit estrus. In 7 of 11 cows, pyometra persisted for more than 21 d. In cows that developed pyometra, the same species of bacteria infused into the uterus were usually recovered one or more times during the postchallenge period. When clinical pyometra was diagnosed, histologic endometritis was invariably present. Histologic endometritis and concurrent isolation of A . pyogenes alone or A . pyogenes with gram-negative anaerobic bacteria occurred in 91.7% of samples during the postchallenge period. Regardless of bacterial treatment, gram-negative anaerobic bacteria were frequently isolated with A . pyogenes during this period.
Journal Article↗
Cystic endometrial hyperplasia-pyometra complex in the bitch: should the two entities be disconnected?
The uteri of 26 clinically healthy bitches and 42 bitches with a clinical suspicion of pyometra were examined histologically using a computerized image analysis system. Histologic lesions were characterised mainly by thickening or atrophy of the endometrium and by varying degrees of cystic changes of the glands. These lesions were observed in most of the clinically healthy bitches as well as in all of the clinically ill animals. In most of the ill bitches a variable degree of inflammation also was found. Some bitches with clinical signs indicative for pyometra had no inflammatory reaction in the uterus. These bitches were misdiagnosed as suffering from pyometra, confirming the difficulty of diagnosing pyometra by simple clinical examination. Determination of sex hormone serum levels revealed that all dogs in both groups were either in metestrus or in anestrus. Based on the results of this study the cystic endometrial hyperplasia-pyometra complex can be divided in two entities: a cystic endometrial hyperplasia-mucometra complex and an endometritis-pyometra complex. Both entities bear many similarities with each other, except for the inflammatory reaction in the endometritis-pyometra complex. It is concluded from this study that the latter complex probably does not necessarily follow the former, but that both can arise de novo.
Animals↗
Breed risk of pyometra in insured dogs in Sweden.
An animal insurance database containing data on over 200,000 dogs was used to study the occurrence of pyometra with respect to breed and age during 1995 and 1996 in Swedish bitches <10 years of age. A total of 1,803 females in 1995 and 1,754 females in 1996 had claims submitted because of pyometra. Thirty breeds with at least 800 bitches insured each year were studied using univariate and multivariate methods. The crude 12-month risk of pyometra for females <10 years of age was 2.0% (95% confidence interval = 1.9-2.1%) in 1995 and 1.9% (1.8-2.0%) in 1996. The occurrence of pyometra differed with age, breed, and geographic location. The risk of developing pyometra was increased (identified using multivariate models) in rough Collies, Rottweilers, Cavalier King Charles Spaniels, Golden Retrievers, Bernese Mountain Dogs, and English Cocker Spaniels compared with baseline (all other breeds, including mixed breed dogs). Breeds with a low risk of developing the disease were Drevers, German Shepherd Dogs, Miniature Dachshunds, Dachshunds (normal size), and Swedish Hounds. Survival rates indicate that on average 23-24% of the bitches in the databases will have experienced pyometra by 10 years of age. In the studied breeds, this proportion ranged between 10 and 54%. Pyometra is a clinically relevant problem in intact bitches, and differences related to breed and age should be taken into account in studies of this disease.
Age Factors↗
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.
Animals↗
Pyometra. What is its clinical significance?
OBJECTIVE: To evaluate the clinical outcomes of pyometra. STUDY DESIGN: Retrospective study conducted between 1993 and 1999 in two regional hospitals. RESULTS: Pyometra represented 0.038% of gynecologic admissions. Of the 27 women with pyometra, 6 (22.2%) cases were associated with malignancy, 1 (3.7%) was associated with genital tract abnormality, and 20 (74.1%) were idiopathic. Patients with idiopathic pyometra tended to be older and had a higher incidence of concurrent medical conditions. Five (18.5%) women experienced spontaneous perforation of pyometra. A preoperative diagnosis was correctly made in 17 of 22 (77.3%) patients without spontaneous perforation. Most women were treated with dilatation of the cervix and drainage. Nine women (33.3%) had persistent or recurrent pyometra; three of them were asymptomatic. CONCLUSION: Pyometra is an uncommon condition, but the incidence of associated malignancy is considerable, and the risk of spontaneous perforation is higher than previously thought. Dilatation and drainage is the treatment of choice, and regular monitoring after initial treatment is warranted to detect persistent and recurrent disease.
Adult↗
[Clinico-statistical study on pyometra in high-aged outpatients].
We clinico-statistically studied outpatients with pyometra aged 60 or older who visited our outpatient clinic during the past four years. 1. Pyometra was diagnosed in 48 cases (13.6%) of 353 in which the uterine cavity could be examined. The incidence became significantly higher with age (p less than 0.01). 2. Thirty-two patients with pyometra were found to require a wheelchair or to be in an immobilized state (bedridden). These patients with poor activity in daily living amounted to 76.2% of 42 cases which were not a complication of malignant uterine tumor or tuberculous endometritis. 3. Pyometra was diagnosed in 29 patients of 96 with urinary and/or rectal incontinence (30.2%). This incidence was significantly higher than that in our patients without incontinence (5.5%) (p less than 0.01). 4. Hematological and blood chemistry study revealed abnormality of the peripheral leucocyte count in 34.5% and CRP abnormality in 70.4% of all the cases of pyometra. 5. Mixed infection by both aerobic and anaerobic bacteria was observed in 16 cases of 36 in which strain could be determined by pus culture. Streptococcus sp. and Bacteroides sp. were predominant as aerobic and anaerobic bacteria, respectively. The present study on pyometra cases of aged people demonstrated that poor activity in daily living and incontinence were significant factors causing this disease. It also revealed the various features of pyometra in aged people.
Aged↗
[Pyometra and radiotherapy of cancer of the uterine cervix--analysis of 282 patients].
From March 1958 to December 1980, 11284 patients with cancer of uterine cervix were treated with radiotherapy in our hospital. Among them, 282 were complicated with pyometra with an incidence of 2.5%. The incidence of pyometra was higher in patients treated by combined intracavitary with external irradiation than by other radiation methods. 74.1% was diagnosed during the manipulation of intracavitary therapy. Escherichia coli comprised 46.5% by culture. The 5 year survival rate was lower in patients with pyometra than without it. The patients who had a temperature over 38 degrees C and uterus enlarged to more than 6 weeks of pregnancy had a bad prognosis. It was even worse for patients whose pyometra did not heal or developed at the end of radiation. Endometrial biopsy was done in 36 patients with pyometra and cancer cells were seen in 55.6% of them. Endometrial biopsy positive rate reached to 77.8% in the patients whose pyometra was not cured or occurred after radiotherapy. This is the main reason of the poor prognosis. The authors believe that endometrial and cervical biopsy should be taken for cancer of uterine cervix complicated with pyometra; for biopsy positive patients during the treatment, the intracavitary dose should be increased; for positive patients after radiotherapy, operation is strongly indicated.
Brachytherapy↗
Effect of induced pyometra on luteal lifespan and uterine fluid concentrations of prostaglandins and interferons in cows.
The objective was to determine whether occurrence of persistent corpora lutea in cows with pyometra could be explained by accumulation of prostaglandins and interferons in the uterus. Pyometra was induced by treatment with hCG, followed by intrauterine infusions of iodine and Actinomyces pyogenes . Five of the seven treated cows developed pyometra as indicated by extended estrous cycles (30-37 + d) and presence of purulent uterine exudate at slaughter (Day 37 after estrus). Mean (+/- standard error) concentrations of prostaglandins E(2) and F(2alpha) for the cows with pyometra were 34.7 +/- 14.4 and 96.3 +/- 28 ng/ml, while the concentrations in uterine flushings in the remaining 2 cows averaged 1.85 +/- 0.7 and 0.9 +/- 0.2 ng/ml, respectively. Based on Western blotting, none of the cows had detectable concentrations of either interferon-alpha or interferon-tau in uterine secretions. In conclusion, pyometra results in increased uterine prostaglandin secretion. While increased secretion of cytokines associated with bacterial infection may be contribute to this effect, there was no evidence in this study to suggest that interferons are involved in the mechanism which causes persistence of the corpus luteum in bovine pyometra.
Journal Article↗
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.
Animals↗
The diagnostic significance of increased urinary and serum amylase activity in bitches with pyometra.
The serum amylase and the serum lipase activities determined simultaneously were normal in 92 bitches with pyometra (group A). To determine the usefulness of the information provided by the measurement of urinary amylase activity in pyometra dogs, the relation of serum and urinary amylase activity to urinary protein and serum lipase activity in paired serum and urine samples was investigated in 39 control bitches and in a second group of 66 bitches with pyometra (group B). The 39 control bitches and 18 pyometra bitches (group B1) had normal urinary amylase activity and showed neither a change in urinary protein nor in serum amylase or lipase activities. There was no relationship between the urinary amylase activity and the urinary protein level or the serum amylase activity. The remaining forty-eight pyometra bitches (group B2) had normal serum lipase activity and increased urinary amylase activity (amylasuria), which correlated highly with the increased urinary protein concentration and to a lesser degree with the increased serum amylase activity. Renal failure in 15 of those bitches had no influence on the degree of increase in the urinary or serum amylase activity. It was concluded that, in the absence of any significant indication of pancreatic disease, amylasuria and amylasaemia in bitches with pyometra are a strong indication of renal glomerular disease. Amylasuria was indicative to some degree of an increased serum amylase activity, but was unrelated to renal failure.
Amylases↗
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.
Abortifacient Agents, Nonsteroidal↗