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Topics in Companion Animal Medicine Mar 2021Pyometra management in the high quality, high volume spay-neuter (HQHVSN) environment is not well documented. The goal of this study was to identify pyometra management...
Pyometra management in the high quality, high volume spay-neuter (HQHVSN) environment is not well documented. The goal of this study was to identify pyometra management practices and patient outcomes in the HQHVSN environment. An electronic survey was piloted and distributed to HQHVSN clinics using Survey Monkey via email lists and social media. A total of 118 responses were received from June to July 2020. Respondents were distributed across the United States with the majority of clinics associated with a shelter (75%). Clinics performed a median of 25 spays and neuters per day and 5000 per year. Most clinics (86%) were willing to treat nonincidental pyometras at least sometimes, and nearly all of these clinics (97%) were willing to accept pyometra referrals. Of these clinics, nearly all (95%) felt they had the necessary resources to treat most pyometras that presented and that a pyometra case was only modestly disruptive to their surgery flow. Most clinics (70%) charged a fee for treatment, charging a median of $200 for dogs and $125 for cats. This is much lower as compared to the estimated ranges for private practice ($600-$2500) and emergency hospitals ($1500-$3579). The majority of patients that HQHVSN clinics accepted for treatment were seen the same day (50%) or next day (42%). These clinics estimated that of the animals who presented, 76% were BAR or QAR, 20% were depressed or nonambulatory, and 4% were obtunded and lateral. Estimated survival for these treated groups were 98%, 80%, and 38%, respectively. HQHVSN clinics may represent a resource for treating pyometras when treatment is disruptive to the schedule of a private practice or clients present with financial limitations. There is an opportunity for HQHVSN and private practice to form a partnership to leverage the strengths of both models and improve access to care for pets.
Topics: Anesthesia; Animals; Cat Diseases; Cats; Dog Diseases; Dogs; Female; Hysterectomy; Postoperative Care; Pyometra; Surveys and Questionnaires; United States; Uterus; Veterinary Medicine
PubMed: 33249239
DOI: 10.1016/j.tcam.2020.100499 -
Domestic Animal Endocrinology Jul 2021Diestrus is associated with insulin resistance in bitches and pyometra can further impair insulin sensitivity. This study aimed to compare insulin sensitivity, insulin...
Diestrus is associated with insulin resistance in bitches and pyometra can further impair insulin sensitivity. This study aimed to compare insulin sensitivity, insulin binding, and tyrosine kinase activity in bitches in anestrus, diestrus, or with pyometra. Patients submitted to elective ovariohysterectomy were divided into anestrus (n = 11) or diestrus (n = 13) according to reproductive history, vaginal cytology, and uterine histology. The group pyometra (n = 8) included bitches diagnosed with the disease based on clinical presentation and abdominal ultrasound findings and further confirmed by uterine histopathology. All patients were submitted to an intravenous glucose tolerance test (IVGTT) before ovariohysterectomy, and rectus abdominis muscle samples were collected during surgery for plasmatic membrane suspension preparation. Muscle-membranes were submitted to cold saturation insulin binding assay for dissociation constant (Kd) and maximum binding capacity (Bmax) determination, as well as exogenous substrate Poly (Glu: Tyr 4:1) phosphorylation assay for basal tyrosine kinase evaluation. Bitches with pyometra showed higher basal insulin (P < 0.001) and higher area under the curve (AUC) for insulin (P = 0.01) and glucose (P < 0.001) response during the IVGTT in comparison with bitches in anestrus or diestrus. Diestrus (P < 0.0001) and pyometra (P = 0.001) were associated with reduced tyrosine kinase activity in comparison with anestrus. No differences were documented in Kd and Bmax results for the low-affinity/high-capacity insulin receptors; however, high-affinity/low-capacity insulin receptors showed higher Kd and Bmax results in bitches in diestrus or with pyometra (P < 0.05) in comparison with anestrus. Despite the pyometra group showed the highest Kd values (P < 0.01), its Bmax results did not differ from the diestrus group (P > 0.05). Diestrus' higher Kd values and reduced tyrosine kinase activity in muscle tissue were compensated by increased total insulin binding capacity. Absent differences in IVGTT results between diestrus and anestrus bitches corroborate this finding. However, in bitches with pyometra, the highest Kd values were not compensated by increased total insulin binding capacity. This finding was associated with insulin resistance and glucose intolerance in IVGTT results. Moreover, pyometra resolution restored insulin sensitivity and glucose tolerance. These features can play a key role in pyometra-associated CDM, as well as in diabetic remission after pyometra resolution.
Topics: Animals; Dog Diseases; Dogs; Female; Insulin Resistance; Insulins; Muscles; Phosphorylation; Protein-Tyrosine Kinases; Pyometra
PubMed: 33866106
DOI: 10.1016/j.domaniend.2021.106626 -
Anaerobe Jun 2022We report on a 47-year-old woman with jejunal adenocarcinoma and concurrent endometrial cancer, admitted with sepsis. Uterine fluid and blood cultures were positive for... (Review)
Review
We report on a 47-year-old woman with jejunal adenocarcinoma and concurrent endometrial cancer, admitted with sepsis. Uterine fluid and blood cultures were positive for Robinsoniella peoriensis. This is the first case report of Robinsoniella peoriensis in Canada. We encourage clinicians to publish their experience treating gynecologic infections caused by Robinsoniella peoriensis. Failure to recognize this pathogen as causative for pyometra, may result in insufficient antimicrobial treatment, and death.
Topics: Anti-Bacterial Agents; Clostridiales; Female; Humans; Middle Aged; Pyometra; Sepsis
PubMed: 35526662
DOI: 10.1016/j.anaerobe.2022.102581 -
Clinical and Experimental Nephrology Sep 2020
Topics: Aged, 80 and over; Constipation; Female; Humans; Pyometra; Tomography, X-Ray Computed
PubMed: 32415378
DOI: 10.1007/s10157-020-01900-0 -
Theriogenology Aug 2008Cystic endometrial hyperplasia (CEH) in the bitch can result in either pyometra, hematometra, or hydrometra, and many facets of these uterine diseases can make them... (Review)
Review
Cystic endometrial hyperplasia (CEH) in the bitch can result in either pyometra, hematometra, or hydrometra, and many facets of these uterine diseases can make them difficult to differentiate. The conditions differ in their systemic effects, since pyometra, particularly closed-cervix pyometra, can be a life-threatening condition that must be recognized, managed, and treated expeditiously. Mucometra is an accumulation of sterile intraluminal mucoid fluid, hematometra is an accumulation of sterile, bloody fluid, and hydrometra is an accumulation of sterile, watery fluid; none of which have any significant systemic outward clinical signs. This paper will describe the definitions, signalment, historical findings, incidence, clinical signs, physical exam findings, and diagnostic findings in canine pyometra and mucometra, and hematometra and hydrometra.
Topics: Animals; Dog Diseases; Dogs; Female; Uterine Diseases
PubMed: 18513791
DOI: 10.1016/j.theriogenology.2008.04.028 -
BMC Veterinary Research Jun 2022Accumulation of lipid droplets (LDs) was recently observed in pyometra-affected uteri. As data about their nature and function are missing we intended to compare the...
BACKGROUND
Accumulation of lipid droplets (LDs) was recently observed in pyometra-affected uteri. As data about their nature and function are missing we intended to compare the localization, quality and quantity of LDs in canine healthy and pyometra-affected tissues and in an in vitro model.
METHODS AND RESULTS
We characterized LDs in healthy and pyometra uterine tissue samples as well as in canine endometrial epithelial cells (CEECs) in vitro by means of histochemistry, immunohistochemistry, transmission electron microscopy, western blot, and RT-qPCR. Oil Red O (ORO) staining and quantification as well as p-phenylenediamine staining showed a higher number of LDs in epithelial cells of pyometra samples. Immunohistochemistry revealed that the amount of LDs coated by perilipin2 (PLIN2) protein was also higher in pyometra samples. Transmission electron microscopy showed an increase of LD size in surface and glandular epithelial cells of pyometra samples. In cell culture experiments with CEECs, supplementation with oleic acid alone or in combination with cholesterol lead to an increased LD accumulation. The expression of PLIN2 at protein and mRNA level was also higher upon oleic acid supplementation. Most LDs were double positive for ORO and PLIN2. However, ORO positive LDs lacking PLIN2 coating or LDs positive for PLIN2 but containing a lipid class not detectable by ORO staining were identified.
CONCLUSIONS
We found differences in the healthy and pyometra-affected endometrium with respect to LDs size. Moreover, several kinds of LDs seem to be present in the canine endometrium. In vitro studies with CEECs could show their responsiveness to external lipids. Since epithelial cells reacted only to oleic acid stimulation, we assume that the cyclic lipid accumulation in the canine endometrium is based mainly on triglycerides and might serve as energy provision for the developing early embryo. Further studies are necessary to verify the complex role of lipids in the healthy and pyometra-affected canine endometrium.
Topics: Animals; Dog Diseases; Dogs; Endometrium; Female; Lipid Droplets; Oleic Acid; Pyometra; Uterus
PubMed: 35689217
DOI: 10.1186/s12917-022-03321-5 -
German Medical Science : GMS E-journal 2022Pyometra is a rare gynecological condition and is characterized by pus accumulation in the uterine cavity. It occurs more frequently in postmenopausal women than...
BACKGROUND
Pyometra is a rare gynecological condition and is characterized by pus accumulation in the uterine cavity. It occurs more frequently in postmenopausal women than tubo-ovarian abscesses, which constitute a more common gynecological complication among premenopausal women.
OBJECTIVE
A 72-year-old woman was admitted to our emergency department with lower abdominal pain, diarrhea and fever for the last three days. The laboratory results were indicative to sepsis. The clinical examination revealed sensitivity by palpation of the lower abdomen without any signs of acute abdomen. The gynecological assessment showed pus outflow through the cervix and a pus culture was done. The ultrasound examination found an enlarged uterus, full of hypoechoic fluid, unclear borders between endometrium-myometrium, a mixed echogenicity adnexal mass and no free fluid in the pouch of Douglas. A computed tomography (CT) of the abdomen showed the presence of pyometra and a tubo-ovarian abscess of the right adnexa.
METHOD
The patient was treated with intravenous antibiotic therapy. When the patient was hemodynamically stable and afebrile, she underwent ultrasound-guided dilatation and curettage of the cervical canal and the endometrium in order to exclude an underlying malignancy, under general anesthesia.
RESULTS
The patient responded promptly to the intravenous antibiotic therapy which was adapted to the pus culture result. The laboratory results withdrew to normal values and the patient was discharged after fifteen days of hospitalization in an afebrile and hemodynamically stable condition.
CONCLUSION
Pyometra and tubo-ovarian abscess in postmenopausal women could be a lethal complication of pelvic inflammatory disease. The key in treatment is the dilatation of the cervix and drainage of the pyometra. The administration of intravenous antibiotics and drainage through the cervix could be a suitable method of treatment for pyometra in older patients or those with poor performance status if only the histological examination is negative for malignancy.
Topics: Abdominal Abscess; Abscess; Aged; Anti-Bacterial Agents; Female; Humans; Oophoritis; Postmenopause; Pyometra; Salpingitis
PubMed: 35875245
DOI: 10.3205/000311 -
Pyometra and Pyogenic Spondylitis with Suspected Involvement of Diverticulitis of the Sigmoid Colon.Internal Medicine (Tokyo, Japan) Apr 2023Pyometra is a rare disease in which pus accumulates in the uterus and is typically caused by stenosis of the cervix. Only a few case reports have indicated that...
Pyometra is a rare disease in which pus accumulates in the uterus and is typically caused by stenosis of the cervix. Only a few case reports have indicated that diverticular disease causes pyometra. We herein report an 83-year-old woman presented to our hospital with a fever, loss of appetite, general fatigue and back pain. After some inspections, she was diagnosed with pyometra and lumbar pyogenic spondylitis secondary to diverticulitis of the sigmoid colon. We performed transvaginal drainage and continued antibiotic administration for about three months. The pyometra and pyogenic spondylitis successfully resolved, and she did not experience any recurrence.
Topics: Female; Humans; Aged, 80 and over; Colon, Sigmoid; Pyometra; Diverticulitis; Spondylitis; Drainage
PubMed: 36104192
DOI: 10.2169/internalmedicine.0064-22 -
Pyometra in a sugar glider (Petaurus breviceps): surgical treatment and postoperative complications.The Journal of Veterinary Medical... Nov 2023A 7-year-old female sugar glider showed a well-defined, homogeneous, hypoechoic mass in the caudal abdominal cavity on ultrasound. Exploratory laparotomy revealed both...
A 7-year-old female sugar glider showed a well-defined, homogeneous, hypoechoic mass in the caudal abdominal cavity on ultrasound. Exploratory laparotomy revealed both uteri were severely dilated by viscous, purulent exudate. The patient underwent ovariohysterectomy with removal of bilateral vaginal canals. Antibiotic therapy was initiated postoperatively. Histopathological findings were consistent with suppurative metritis, leading to a clinical diagnosis of pyometra. Despite abscess formation in the uterine stump or central vaginal canal and bilateral renal pelvic/ureter dilations postoperatively, the sugar glider survived more than 270 days. Unfortunately, surgical and medical treatments performed in this case did not prove curative. The outcome of this case highlights the importance of further accumulation of cases to define more appropriate therapies for pyometra in sugar gliders.
Topics: Animals; Female; Pyometra; Postoperative Complications; Uterus; Suppuration; Sugars
PubMed: 37793836
DOI: 10.1292/jvms.23-0117 -
The Journal of Reproductive Medicine Nov 2001To evaluate the clinical outcomes of pyometra.
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.
Topics: Adult; Age Factors; Aged; Aged, 80 and over; Dilatation and Curettage; Drainage; Female; Humans; Middle Aged; Recurrence; Retrospective Studies; Risk Factors; Treatment Outcome; Uterine Diseases; Uterine Neoplasms; Uterine Rupture
PubMed: 11762150
DOI: No ID Found