Trato sinusal por reação ao fio de algodão em ovariohisterectomia de cadela / Sinusal tract due to cotton yarn reaction in canine ovariohysterectomy / Tracto sinusal por reacción del hilo de algodón en ovario histerectomía de perra

A castração em fêmeas pode ser feita pela ovariectomia (retirada dos ovários), ou ovariohisterectomia (retirada dos ovários e do útero). Essa última técnica é a mais recomendada em cães e gatos, devido à prevenção de afecções que podem ocorrer posteriormente no útero. Dentre essas complicações pode-se encontrar sangramento por ligadura mal feita em coto, hidroureter, hidronefrose, piometra de coto, formação de tratos sinusais, aderência, obstrução crônica, incontinência urinária, retenção abdominal de compressas cirúrgicas, transcecção de parte do ureter e ovário remanescente. Em cadelas castradas, a causa mais comum da formação de tratos sinusais é a presença de reação tecidual ao redor do fio de sutura. O presente estudo teve como objetivo relatar um caso de uma cadela sem raça definida, 8,7 kg, seis anos, que deu entrada no Hospital Veterinário de Uberaba, MG com queixa principal a presença de ferida no flanco direito sendo tratada há nove meses, porém sem sucesso. Já haviam feito uso de vários antibióticos sistêmicos e antinflamatorios esteroidais e não esteroidais. Diante do caso observado, foram realizados exames laboratoriais e de imagem. Perante o resultado do exame de imagem, a principal suspeita foi a formação de trato sinusal com comunicação com a cavidade abdominal devido a uma reação ao fio de algodão utilizado na ovariohisterectomia.(AU)

Female animals can be castrated by ovariectomy (removal of the ovaries), or ovariohysterectomy (removal of the ovaries and uterus). The latter is the most recommended in dogs and cats due to the prevention of conditions that may subsequently occur in the uterus. Among these complications, one can find bleeding by poor ligation in the stump, hydroureter, hydronephrosis, stump pyometra, formation of sinus tracts, adherence, chronic obstruction, urinary incontinence, abdominal retention of surgical compresses, transection of part of the ureter and remaining ovary. In castrated bitches, the most common cause of the formation of sinus tracts is the presence of tissue reaction around the suture thread. This study aimed at reporting a case of a mixed breed, six-year-old dog, 8.7 kg that was admitted to the Veterinary Hospital of Uberaba with the main complaint of the presence of a wound on the right flank being unsuccessfully treated for nine months. Several systemic antibiotics and steroidal and non-steroidal anti-inflammatory drugs had already been used. In view of the observed case, laboratory and imaging exams were performed. In view of the result of the imaging examination, the main suspicion was the formation of a sinus tract with communication to the abdominal cavity due to a reaction to the cotton thread used in the ovariohysterectomy.(AU)

La castración en hembras se puede realizar mediante ovariectomía (extirpación de los ovarios) u ovario histerectomía (extirpación de los ovarios y del útero). Esa última técnica es la más recomendada en perros y gatos, debido a la prevención de afecciones que pueden presentarse posteriormente en el útero. Entre estas complicaciones se puede encontrar hemorragias por ligadura mal realizada en muñón, hidruréter, hidronefrosis, piometra de muñón, formación de tractos sinusales, adherencia, obstrucción crónica, incontinencia urinaria, retención abdominal de compresas quirúrgicas, transección de parte del uréter y ovario remanente. En las perras castradas, la causa más común de formación de trayectos sinusales es la presencia de reacción tisular alrededor del hilo de sutura. El presente estudio tuvo como objetivo reportar el caso de una perra sin raza definida, de 8,7 kg, de seis años de edad, que ingresó en el Hospital Veterinario de Uberaba, MG con el principal síntoma de presencia de una herida en el flanco derecho siendo tratada durante nueve meses, pero sin éxito. Ya habían usado varios antibióticos sistémicos y medicamentos antiinflamatorios esteroides y no esteroides. A la vista del caso observado, se realizaron exámenes de laboratorio y de imagen. A la vista del resultado del examen de imagen, la principal sospecha fue la formación de un tracto sinusal con comunicación con la cavidad abdominal debido a una reacción al hilo de algodón utilizado en el ovario histerectomía.(AU)

Piometra secundario a estenosis cervical en una adolescente / Pyometra secondary to cervical stenosis in an adolescent

INTRODUCCIÓN: El piometra es una afección infrecuente, pero grave, que en general se diagnostica en mujeres posmenopáusicas. En adolescentes es sumamente raro, y si se acompaña de amenorrea primaria hay que tener en mente las anomalías congénitas. CASO CLÍNICO: Adolescente de 13 años, sin antecedentes personales de interés salvo amenorrea primaria, que acude con abdomen agudo y es intervenida por una peritonitis difusa causada por un piometra secundario a disgenesia (estenosis) cervical congénita. Se realizó dilatación cervical y se dejó una sonda vesical intrauterina para prevenir la reestenosis. CONCLUSIONES: Un diagnóstico precoz y un tratamiento conservador con dilatación cervical y colocación temporal de un catéter urinario son esenciales para un manejo seguro y efectivo de la estenosis cervical en adolescentes.

INTRODUCTION: Pyometra is an uncommon but serious condition that is generally diagnosed in postmenopausal women. In adolescents it is extremely rare; if accompanied by primary amenorrhea, consider congenital abnormalities. CASE REPORT: A 13-year-old adolescent, with no relevant personal history except primary amenorrhea, who presented with an acute abdomen and was operated on for diffuse peritonitis caused by pyometra secondary to congenital cervical dysgenesis (stenosis). Cervical dilation was performed and a urinary catheter was temporarily placed inside the uterus to prevent restenosis. CONLUSIONS: An early diagnosis and conservative treatment with cervical dilation and temporary placement of a urinary catheter are essential for the safe and effective management of cervical stenosis in adolescents.

Canine pyometra: interferences of age and type in blood count and serum biochemistry / Piometra canina: interferências da idade e tipo sobre o hemograma e a bioquímica sérica

Hematological and serum biochemical characteristics and prevalence of microorganisms in the uterine content of bitches with pyometra were described, according to type and age. This study was carried out at the Veterinary Medicine Hospital Renato Rodenburg de Medeiros Netto of the UFBA with 132 patients diagnosed with pyometra through imaging and laboratory tests, divided into two groups: Group 1 - less than eight years (n=72) and Group 2 - more than eight years (n=60). Both groups were submitted to Ovariohysterectomy (OH), in which blood and uterine lumen secretion samples were collected. The highest incidence of pyometra was found in bitches under 8 years (54.5%), Poodle breed (31.8%) and mixed-breed (27.3%). Open pyometra represented 80.3% of all cases. The death rate (6.0%) did not show significant difference between the types. Anemia (73.0%), thrombocytopenia (41.2%) and leukocytosis (77.0%) were observed. Urea and ALP were above the reference values in 41.8% and 52.2% of each group, respectively, while ALT (94.0%) and creatine (82%) remained normal in most animals. Serum biochemistry did not show significant differences (P<0.05). Escherichia coli and Klebsiella sp. grew in 33.3% and 16.7% of the samples, respectively. Therefore, no significant hematological and serum biochemical differences were observed in bitches with pyometra in both age categories.

Descreveu-se características hematológicas, bioquímicas séricas e prevalência de microrganismos no conteúdo uterino de cadelas com piometra, de acordo com o tipo e idade. Realizou-se este estudo no Hospital de Medicina Veterinária Renato Rodenburg de Medeiros Netto da UFBA com 132 pacientes diagnosticadas com piometra, por exames de imagem e laboratoriais, divididas em dois grupos: Grupo 1 – menos de oito anos (n=72) e Grupo 2 – mais de oito anos (n=60), submetidas a Ovariectomia (OH), quando se coletou amostras de sangue e secreção do lúmen uterino. A incidência maior deu-se em cadelas abaixo de 8 anos (54,5%), da raça Poodle (31,8%) e sem raça definida (SRD) (27,3%), sendo 80,3% de piometra aberta. A taxa de óbito (6,0%) não apresentou diferença significativa entre os tipos. Observou-se a ocorrência de anemia (73,0%), trombocitopenia (41,2%) e leucocitose (77,0%). Os valores de ureia e FA estiveram acima dos valores de referência em 41,8% e 52,2% das cadelas respectivamente, enquanto a ALT (94,0%) e a creatina (82%) mantiveram-se dentro dos valores de referência na maioria dos animais. A bioquímica sérica não apresentou diferenças significativas (P<0,05). Observou-se crescimento de Escherichia coli e Klebsiella sp. em 33,3% e 16,7% das amostras, respectivamente. Sendo assim, não se observou diferenças significativas hematológicas e na bioquímica sérica de cadelas com piometra nas categorias de idade.

Canine pyometra: interferences of age and type in blood count and serum biochemistry / Piometra canina: interferências da idade e tipo sobre o hemograma e a bioquímica sérica

Hematological and serum biochemical characteristics and prevalence of microorganisms in the uterine content of bitches with pyometra were described, according to type and age. This study was carried out at the Veterinary Medicine Hospital Renato Rodenburg de Medeiros Netto of the UFBA with 132 patients diagnosed with pyometra through imaging and laboratory tests, divided into two groups: Group 1 - less than eight years (n=72) and Group 2 - more than eight years (n=60). Both groups were submitted to Ovariohysterectomy (OH), in which blood and uterine lumen secretion samples were collected. The highest incidence of pyometra was found in bitches under 8 years (54.5%), Poodle breed (31.8%) and mixed-breed (27.3%). Open pyometra represented 80.3% of all cases. The death rate (6.0%) did not show significant difference between the types. Anemia (73.0%), thrombocytopenia (41.2%) and leukocytosis (77.0%) were observed. Urea and ALP were above the reference values in 41.8% and 52.2% of each group, respectively, while ALT (94.0%) and creatine (82%) remained normal in most animals. Serum biochemistry did not show significant differences (P<0.05). Escherichia coli and Klebsiella sp. grew in 33.3% and 16.7% of the samples, respectively. Therefore, no significant hematological and serum biochemical differences were observed in bitches with pyometra in both age categories.

Descreveu-se características hematológicas, bioquímicas séricas e prevalência de microrganismos no conteúdo uterino de cadelas com piometra, de acordo com o tipo e idade. Realizou-se este estudo no Hospital de Medicina Veterinária Renato Rodenburg de Medeiros Netto da UFBA com 132 pacientes diagnosticadas com piometra, por exames de imagem e laboratoriais, divididas em dois grupos: Grupo 1 ­ menos de oito anos (n=72) e Grupo 2 ­ mais de oito anos (n=60), submetidas a Ovariectomia (OH), quando se coletou amostras de sangue e secreção do lúmen uterino. A incidência maior deu-se em cadelas abaixo de 8 anos (54,5%), da raça Poodle (31,8%) e sem raça definida (SRD) (27,3%), sendo 80,3% de piometra aberta. A taxa de óbito (6,0%) não apresentou diferença significativa entre os tipos. Observou-se a ocorrência de anemia (73,0%), trombocitopenia (41,2%) e leucocitose (77,0%). Os valores de ureia e FA estiveram acima dos valores de referência em 41,8% e 52,2% das cadelas respectivamente, enquanto a ALT (94,0%) e a creatina (82%) mantiveram-se dentro dos valores de referência na maioria dos animais. A bioquímica sérica não apresentou diferenças significativas (P<0,05). Observou-se crescimento de Escherichia coli e Klebsiella sp. em 33,3% e 16,7% das amostras, respectivamente. Sendo assim, não se observou diferenças significativas hematológicas e na bioquímica sérica de cadelas com piometra nas categorias de idade.

Evaluation of barbed suture for celiorrhaphy and subcutaneous closure in bitches with pyometra submitted to ovariohysterectomy

ABSTRACT Purpose To evaluate the use of barbed sutures over the surgical time, the leukogram, the tissue thickness in which the sutures were employed (ultrasonography), the costs, and the possible complications in bitches with pyometra submitted to ovariohysterectomy (OH). Methods Convectional 2.0 polyglyconate suture was used in the control group (CG n = 10) and 2.0 barbed polyglyconate suture in the barbed group (BG n = 10) to perform celiorrhaphy (simple continuous pattern) and subcutaneous closure (continuous intradermal pattern). Data were assessed using paired (leukogram between 24 and 48 h within the same group) and unpaired (leukogram, surgical time, tissue thickness, and costs) Student's t-test. The Fisher exact test was used to assess the occurrence of seroma between groups (p < 0.05). Results are shown as mean ± standard error of mean. Results The time spent to perform the celiorrhaphy (195.30 ± 17.37 s vs. 204 ± 16.00 s), subcutaneous closure (174.0 ± 15.86 s vs. 198.0 ± 15.62 s), and the total surgical time (24.30 ± 1.44 min vs. 23.00 ± 1.30 min) did not differ between BG and CG, respectively (p > 0.05). Leukogram at 48 h post-surgery did not differ between groups (p = 0.20). No differences were observed in the subcutaneous and the abdominal wall thickness (cm) assessed by ultrasonography at 48 h in BG (0.31 ± 0.04, 0.80 ± 0.05) and CG (0.34 ± 0.03, 0.72 ± 0.06), respectively. Similarly, 15 days post-surgery the same structures did not differ between BG (0.26 ± 0.02, 0.74 ± 0.08) and CG (0.26 ± 0.03, 0.64 ± 0.05) (p > 0.05). In one bitch from each group, a mild seroma was observed on one side of the surgical wound 48 h after surgery (p = 1.00). The procedures in which barbed sutures were used had an average additional cost of R$ 200.00 ± 11.66 (p < 0.0001). Conclusions Barbed suture has proven to be efficient and safe for abdominal and subcutaneous closure. However, considering its current high cost in addition thatthe surgical time of bitches with pyometra undergone OH was not reduced, no advantages were observed with theuse of barbed sutures for this type of surgery.

Detection of resistance genes in pyometra isolated bacteria in bitches / Detecção de genes de resistência em bactérias isoladas de piometra em cadelas

Pyometra has several immunological and molecular changes that are responsible for uterine inflammation and the disease may or may not have infections. This study aimed to isolate and identify bacteria in the uterine content of bitches with pyometra, to analyze the susceptibility profile to antibiotics, detect ß-lactamase enzyme production by phenotypic tests, and resistance genes to ß-lactams. Eighteen samples of uterine content were collected by aspiration puncture. The samples were inoculated in bacteriological media and identified by biochemical tests. Subsequently, antibiogram tests, screening for detection of ß-lactamases, and Real-Time PCR for detection of resistance genes was performed. Escherichia coli, Klebsiella spp., Enterobacter aerogenes, Citrobacter spp., Staphylococcus spp., and Streptococcus spp. were identified in the analyzed samples of uterine content. In the antibiogram test, 90.5% of the isolates showed resistance to at least one antibiotic, and of these, 36.8% were considered MDR, with three Staphylococcus spp., three E. coli, and one Klebsiellaspp. Concerning bacterial resistance to the groups of antibiotics tested, 38.1% of the isolates were resistant to at least one type of ß-lactam, 33.3% to tetracycline, 19.0% to aminoglycosides, and 14.3% to fluoroquinolones, macrolides, and trimethoprim-sulfamethoxazole. In the phenotypic test to detect ß-lactamase production, E. coli samples were negative and Klebsiella spp. was positive for the production of AmpC, which presented the blaCMY, blaSPM, and blaSIM genes. Bacteria that are resistant to antibiotics represent a great challenge and laboratory support is therefore essential, without which therapeutic success decreases and death may be inevitable.(AU)

A piometra apresenta diversas alterações imunológicas e moleculares que são responsáveis pela inflamação uterina, e a doença pode ser infecciosa ou não. O objetivo deste estudo foi isolar e identificar bactérias no conteúdo uterino de cadelas com piometra, analisar o perfil de suscetibilidade aos antibióticos, detectar a produção de enzimas ß-lactamase por testes fenotípicos e genes de resistência aos ß-lactâmicos. Dezoito amostras de conteúdo uterino foram coletadas por punção aspirativa. As amostras foram inoculadas em meio bacteriológico e identificadas por testes bioquímicos. Posteriormente, foram realizados testes de antibiograma, triagem para detecção de ß-lactamases e PCR em tempo real para detecção de genes de resistência. Escherichia coli, Klebsiella spp., Enterobacter aerogenes, Citrobacter spp., Staphylococcus spp. e Streptococcus spp. foram identificados nas amostras de conteúdo uterino analisadas. No teste de antibiograma, 90,5% dos isolados apresentaram resistência a pelo menos um antibiótico, e destes, 36,8% foram considerados MR, sendo três Staphylococcus spp., três E. coli e uma Klebsiella spp. Sobre a resistência bacteriana aos grupos de antibióticos testados, 38,1% dos isolados foram resistentes a pelo menos um tipo de ß-lactâmico, 33,3% à tetraciclina, 19,0% aos aminoglicosídeos e 14,3% às fluorquinolonas, macrolídeos e trimetoprim-sulfametoxazol. No teste fenotípico para detecção da produção de ß-lactamase, as amostras de E. coli foram negativas, e Klebsiella spp. foi positiva para a produção de AmpC, que apresentou os genes blaCMY, blaSPM e blaSIM. As bactérias resistentes aos antibióticos representam um grande desafio e, portanto, o suporte laboratorial é essencial, sem o qual o sucesso terapêutico diminui e a morte pode ser inevitável.(AU)

Disfunção miocárdica secundária a sepse em cão: relato de caso / Myocardial dysfunction secondary to sepsis in dog: case report

A redução do empenho do miocárdio é um achado frequente em casos de sepse ou choque séptico, sendo a piometra uma das principais causas de sepse em cães. No presente trabalho relata-se um caso de sepse secundária à piometra levando à disfunção miocárdica em um canino, fêmea, da raça White West Highland Terrier, de dez anos de idade com histórico de prostração e hiporexia. Ao exame físico foi observada presença de secreção vulvar purulenta, abdômen abaulado e tenso à palpação. Foram realizados exames complementares, incluindo hemograma com resultado compatível com quadro infeccioso, bioquímica revelando hipocalemia e hipocalcemia, e exames de imagem. Observou-se por meio do exame ultrassonográfico presença de grande quantidade de líquido com celularidade em cornos e corpo uterino, compatível com piometra. Alterações compatíveis com sepse foram observadas durante o atendimento e estabilização do animal. No exame ecocardiográfico foi observado aumento dos diâmetros sistólico e diastólico do ventrículo esquerdo com diminuição da fração de encurtamento e ejeção, compatível com disfunção sistólica do ventrículo esquerdo. A referida paciente recebeu alta médica após correção cirúrgica e estabilização dos parâmetros clínicos, incluindo a disfunção sistólica, sendo relatado óbito sete dias após. Sugere-se que a causa mortis tenha sido a disfunção sistólica causada pela sepse. Conclui-se que a disfunção miocárdica é um fator determinante de prognóstico em casos de sepse, o que ressalta a importância de seu diagnóstico e tratamento precoce.

The reduction of myocardial commitment is a frequent finding in cases of sepsis or septic shock, and piometra is one of the main causes of sepsis in dogs. In the present study, the case of sepsis secondary to piometra is reported leading to myocardial dysfunction in a canine, female, of the 10-year-old White West Highland Terrier with a history of prostration and hyporexia. On physical examination, the presence of purulent vulvar secretion, bulging abdomen and taut palpation was observed. Complementary tests were performed, including blood count, biochemistry and imaging tests. It was observed through ultrasound examination the presence of a large amount of fluid with cellularity in horns and uterine body, compatible with piometra. Alterations compatible with sepsis were observed during the care and stabilization of the animal. On echocardiographic examination, an increase in systolic and diastolic diameters of the left ventricle was observed with decreased shortening and ejection fraction, compatible with systolic dysfunction of the left ventricle. The patient received medical discharge after surgical correction and stabilization of clinical parameters, and died seven days later. It is suggested that the cause of death was systolic dysfunction caused by sepsis. It is concluded that myocardial dysfunction is a prognostic determinant factor in cases of sepsis, emphasizing the importance of its diagnosis and early treatment.

Protein-to-creatinine urinary in the early diagnosis of renal injury in canine pyometra / Relação proteína-creatinina-urinária no diagnóstico precoce de lesão renal em cadelas com piometra

Kidney disease that affects bitches with pyometra may lead patients to develop chronic renal failure even after pyometra treatment. Therefore, several studies have sought to clarify the gaps in the understanding of the pathogenesis of renal injury in pyometra. Identification of early detection markers for renal damage, which can predict and identify the prognosis of the disease, is very important. Proteinuria analysis can diagnose kidney damage, since proteins such as albumin are not filtered through the glomerulus and those that undergo glomerular filtration are almost completely reabsorbed by tubular cells. The objective of this study was to evaluate whether the urinary protein-to-creatinine ratio (UPC) can detect renal injury in bitches with pyometra before development of azotemia. For this, 44 bitches with pyometra were divided into two groups: bitches with azotemic piometra (A, n=15, creatinine >1.7) and bitches with non-azotemic pyometra (NA, n=29). The two groups were compared to the control group (CG, n=12), which had no signs of systemic disease. All animals underwent blood and urine tests. Leukocytosis was more evident in bitches in the A group than in the other groups. This shows that the inflammatory response may be associated with the pathogenesis of renal injury. The median UPC in bitches with pyometra was significantly higher than in the CG, with a median above the reference values. In conclusion, the UPC can be used in bitches with pyometra to detect renal damage before the development of azotemia. It has been suggested that the UPC of bitches with pyometra should be followed through during the postoperative period so that permanent renal lesions secondary to pyometra can be diagnosed and treated properly before the development of azotemia.(AU)

A doença renal que afeta cadelas com piometra pode levar a insuficiência renal crônica mesmo após o tratamento. Portanto, vários estudos procuraram esclarecer as lacunas na compreensão da patogênese da lesão renal na piometra. A identificação de marcadores de lesão renal precoce, que podem prever e identificar o prognóstico da doença é muito importante. A análise da proteinúria pode diagnosticar lesão renal, uma vez que proteínas como a albumina não são filtradas através do glomérulo e aquelas que sofrem filtração glomerular são quase completamente reabsorvidas pelas células tubulares. O objetivo deste estudo foi avaliar se a relação proteína-creatinina urinária (UPC) pode detectar lesão renal em cadelas com piometra antes do desenvolvimento de azotemia. Para isso, 44 cadelas com piometra foram divididas em dois grupos: cadelas com piometra azotêmica (A, n=15, creatinina >1,7) e cadelas com piometra não azotêmica (NA, n=29). Os dois grupos foram comparados ao grupo controle (CG, n=12), que não apresentaram sinais de doença sistêmica. Todos os animais foram submetidos a exames de sangue e urina. A leucocitose foi mais evidente nas cadelas do grupo A do que nos outros grupos. Isso mostra que a resposta inflamatória pode estar associada à patogênese da lesão renal. A mediana da UPC em cadelas com piometra foi significativamente maior que no CG, com uma mediana acima dos valores de referência. Em conclusão, a UPC pode ser usada em cadelas com piometra para detectar lesões renais antes do desenvolvimento de azotemia. Sugeriu-se que a UPC de cadelas com piometra deve ser acompanhada durante o pós-operatório, de modo que as lesões renais permanentes secundárias à piometra possam ser diagnosticadas e tratadas adequadamente antes do desenvolvimento de azotemia.(AU)

Thick “Swiss Cheese” Appearance of Uterine Endometrium in Postmenopausal Women with Different Gynecologic Conditions

OBJECTIVES: To uncover gynecologic conditions with similar transvaginal sonographic findings of thick uterine endometrium with honeycomb appearance in pre-and postmenopausal women.METHODS: We retrospectively reviewed cases of patients with endometrial tissue biopsy from January 2010 to December 2016. We also collected office flexible hysteroscopic findings and surgical pathologic results. We analyzed data from 393 patients with confirmed endometrial pathology. Among these patients, 69 had transvaginal ultrasonographic images with thick uterine endometrium and honeycomb or “Swiss cheese” appearance.RESULTS: We found gynecologic conditions such as submucosal leiomyoma with degeneration, endometrial polyp, pseudocystic endometrial change associated with tamoxifen use, progesterone associated endometrial change, pyometra, retained placenta, and uterine synechiae manifested with similar thick endometrium with “Swiss cheese” appearance in transvaginal sonographic images. The most common diagnosis in postmenopausal women was atrophic endometritis, followed by endometrial cancer and endometrial polyps. The most common diagnosis in premenopausal women was abnormal uterine bleeding without pathologic conditions.CONCLUSIONS: Sonographic findings of thick uterine endometrium with “Swiss cheese” appearance need to be considered together with a thorough review of the patient's history and chief complaint before making a tentative diagnosis due to the various conditions sharing the feature.

Fertility outcome after medically treated pyometra in dogs

Cystic endometrial hyperplasia-pyometra complex (CEH/P) is a challenge in canine reproduction. Present study aimed to assess fertility after medical treatment. One-hundred-seventy-four bitches affected by CEH/P received aglepristone on days 1, 2, 8, then every 7 days until blood progesterone < 1.2 ng/mL; cloprostenol was administered on days 3 to 5. Records were grouped according to bodyweight (BW): small (< 10 kg, n = 33), medium (10 ≥ BW < 25 kg, n = 44), large (25 ≥ BW < 40 kg, n = 52), and giant bitches (BW ≥ 40 kg, n = 45). Age; success rate; aglepristone treatments number; relapse, pregnancy rates; diagnosis-relapse,

Herlyn-werner-wünderlich syndrome: case report

ABSTRACT Introduction: The Herlyn-Werner-Wünderlich (HWW) syndrome is the association of three urogenital anatomic alterations of low incidence. Müllerian alterations are rare and are usually incidental findings; consequently, they are underdiagnosed and their genesis and correlation with having a higher probability of expression on the right side are unknown. Case Report: This is the case of a 17-year-old patient who consulted for severe hypogastric abdominal pain linked to foul-smelling bleeding. On physical examination, a vaginal septum was found, while complementary images showed uterus didelphys and renal agenesis, leading to diagnose HWW syndrome. Furthermore, pyometra and hematocolpus were also documented and managed with antibiotic therapy. Given the adequate response to treatment, hospital discharge was authorized with follow-up by external consultation, since the definitive management could not be provided during hospital stay. Discussion: One of the causes of recurrent abortions is the presence of this syndrome; however, when properly diagnosed, definitive treatment can be provided to reduce con-ceptional losses and urogenital hematopuru-lent collections. Conclusions: HWW syndrome is a rare malformation that increases the risk of suffering from gynecological infectious diseases or blood collections. Surgical management of the vaginal septum is a definitive treatment that improves quality of life and reduces the risk of morbidities associated with the pathology.

RESUMEN Introducción. El síndrome de Herlyn-Werner-Wünderlich (HWW) es una asociación de tres alteraciones anatómicas urogenitales de baja incidencia. Las alteraciones müllerianas son poco comunes y suelen ser hallazgos incidentales, por lo que se encuentran subdiag-nosticadas y poco se conoce su génesis o su relación con tener más probabilidad de expresión en el lado derecho. Reporte de caso. Se trata de una paciente de 17 años quien consultó por dolor abdominal hipogástrico de fuerte intensidad ligado a sangrado fétido. En el examen físico se encontró tabique vaginal y en las imágenes complementarias se evidenció útero didelfo y agenesia renal, diagnosticando así síndrome HWW. Igualmente, se documentó piómetra y hematocolpos que se manejaron con terapia de antibióticos; dada la adecuada respuesta al tratamiento, se dio egreso hospitalario con seguimiento por consulta externa, pues el manejo definitivo no se pudo proporcionar durante la estancia hospitalaria. Discusión. Una causa de abortos a repetición es la presencia de síndrome HWW; sin embargo, al ser correctamente diagnosticado, se puede dar un tratamiento definitivo que disminuya las perdidas concepcionales y colecciones hematopurulentas urogenitales. Conclusiones. El síndrome HWW es una malformación poco común que aumenta el riesgo de padecer cuadros infecciosos ginecológicos o colecciones hemáticas. El tratamiento definitivo consiste en el manejo quirúrgico del tabique vaginal que mejora la calidad de vida y disminuye el riesgo de morbilidades asociadas a la patología.

Tumor da célula da granulosa associado à piometra em uma gata de sete meses / Granulosa-cell tumor associated with pyometra in a seven months old cat

As neoplasias ovarianas em gatas são raras e, quando relatadas, estão associadas a animais senis, assim como a piometra de causa não iatrogênica. O objetivo deste trabalho foi relatar o caso de uma gata jovem com neoplasia ovariana, tumor de células da granulosa associado ao complexo hiperplasia endometrial cística/piometra (HECP). O animal foi atendido no setor de Reprodução Animal e Obstetrícia Veterinária (RAOV) de um Hospital Veterinário Escola, com histórico de monta natural recente, anorexia, êmese, polidipsia, poliúria e descarga vaginal purulenta. Ao exame físico, observou-se apatia, mucosas ictéricas, aumento de volume da região abdominal e presença de secreção vaginal purulenta. À ultrassonografia, foi visibilizado conteúdo ecogênico no útero diagnóstico de HECP e estrutura ecogênica na cavidade abdominal, na região ovariana, confirmado pelo exame histopatológico como sendo tumor das células da granulosa. A conduta terapêutica adotada foi a cirurgia de ovariossalpingo-histerectomia (OSH).(AU)

Ovarian neoplasias in cats are rare, and are associated with advanced ages, as well as non-iatrogenic pyometra. The objective of the present study was to report a case of a young cat showing signs of a rare neoplasia, the granulosa-cell tumor, associated with complex cystic endometrial hyperplasia/pyometra (HECP). The animal was attended in the Animal Reproduction and Veterinary Obstetrics sector of a Teaching Veterinary Hospital with a history of natural breeding, anorexia, emesis, polydipsia, polyuria, and purulent vaginal discharge. During clinical examination, apathy, icterus, swelling of the abdomen, and purulent vaginal discharge were observed. On the ultrasonographic exam, an echogenic content inside the uterus was observed, leading to diagnosis of HECP and an echogenic structure in the abdominal cavity, in ovarian region, confirmed by histopathology as being of granulosa cells. The therapeutic conduct adopted was salpingo-oophorectomy and hysterectomy surgery (OSH).(AU)

Spontaneous uterine rupture secondary to pyometra in a cervical cancer patient: A case report / Philippine Journal of Obstetrics and Gynecology

Pyometra, an accumulation of pus within the uterine cavity, is a rare gynecologic disease with an incidence of 0.01-0.5% among all gynecologic patients and 13.6% among elderly gynecologic patients. Pyometra in itself is rare, much so is uterine rupture occurring secondary to it. No local data reporting incidence of ruptured pyometra in the Philippines has been published. This is a case of a 63-year-old Gravida 5 Para 5 (5-0-0-4), with Cervical Endometrioid Adenocarcinoma Stage IIIB, presented with abdominal pain. Whole abdominal Computed Tomography scan revealed pneumoperitoneum. Initial assessment was pneumoperitoneum probably secondary to ruptured viscus. The patient underwent exploratory laparotomy which revealed ruptured pyometra. Subsequent management included drainage, culture guided antibiotics, radiotherapy and brachytherapy. Spontaneous rupture of pyometra is a serious medical condition which requires an accurate diagnosis in order to arrive in appropriate surgical and medical management. However, pre-operative diagnosis is difficult despite the presence of advanced imaging techniques, hence high level of suspicion is warranted in identifying this condition.

Sterile Pyometra in Two Dogs

Two young dogs were referred to the Veterinary Medical Teaching Hospital of Konkuk University, one for examination of vaginal discharge and the other after being hit by a car. Dog 1 exhibited a high neutrophil count on Gram-stained vaginal smears, marked leukocytosis on a complete blood count, and uterine enlargement on ultrasonography. In dog 2, a markedly enlarged right uterine horn containing echogenic debris was found incidentally on ultrasonography. A tentative diagnosis of pyometra was made in both cases and ovariohysterectomy was performed. Purulent material was collected from each uterine horn and submitted separately for aerobic and anaerobic bacterial culture; all culture results were negative. The white blood cell count revealed normal limits 2 days post operation in dog 1 and 4 days post operation in dog 2. Positive bacterial cultures are usually obtained from dogs with pyometra, and antibiotic selection is based on the results of culture and sensitivity testing in the event of failure of empiric antibiotic therapy. However, in the cases reported here, no bacterial growth was identified from the uterine samples despite the presence of purulent material. A short course of empiric antibiotic therapy was administered. This is the first known report describing sterile pyometra in dogs.

Adenomiose uterina em gata associada à piometra / Uterine adenomyosis in a queen associated to pyometra

Adenomyosis, a non-neoplastic myometrial proliferation, is a rare pathologic condition in domestic animals, of unknown etiology. There is a lack of information about the clinical and pathological features of this disease in cats, therefore just a few reports in that species. The study describes a case of adenomyosis in a feline female. A cat, six years old, undefined breed, not spayed, had abdominal swelling history and vaginal discharge. Clinically, upon abdominal palpation, a diffuse increase suggesting a uterine change was found. The vulva had sanguine-purulent exudates. The choice was for the neutering surgical. Uterine macroscopy revealed cystic endometrial hyperplasia/pyometra in uterine horns, and the presence of a diffuse mass on uterine corpus. Fragments of the mass were sent for histopathological analysis, which revealed adenomyosis of the uterine corpus. The patient exhibited adequate post-operative recovery. The adenomyosis should be considered as a differential diagnosis of uterine neoformation in domestic cats.(AU)

Pyometra and Pregnancy with Herlyn-Werner-Wunderlich Syndrome / Piometria e gravidez com síndrome de Herlyn-Werner-Wunderlich

ABSTRACT We describe a Herlyn-Werner-Wunderlich syndrome (HWWS) patient with previous history of infertility who got pregnant without treatment and presented a pyometra in the contralateral uterus throughout the gestational period, despite multiple antibiotic treatments. Due to the uterus' congenital anomaly and the possibility of ascending infection with subsequent abortion, this pregnancy was classified as high-risk. We believe that the partial horizontal septum in the vagina may have contributed to the closure of the gravid uterus cervix, thus ensuring that the pregnancy came to term, with an uneventful vaginal delivery.

RESUMO Os autores descrevem uma paciente com síndrome de Herlyn-Werner-Wunderlich (SHWW) e história prévia de infertilidade, que engravidou espontaneamente. Durante todo o período gestacional apresentou, apesar da instituição de antibioticoterapia, um piometra localizado ao útero não gravídico. Devido à anomalia congênita uterina e ao risco de infeção ascendente, com possível desfecho obstétrico desfavorável, esta gravidez foi classificada de alto risco. O septo vaginal horizontal e parcial poderá ter contribuído para ausência de disseminação da infecção, permitindo que a gravidez tenha chegado a termo, com um parto vaginal, sem intercorrências.

Avaliação da depressão miocárdica por meio do feature tracking bidimensional em cadelas com sepse / Assessment of myocardial depression by two-dimensional feature tracking in dogs with sepsis

O objetivo deste estudo prospectivo foi analisar a função do ventrículo esquerdo de cadelas que apresentavam sepse ou não e diagnosticar a depressão miocárdica de forma precoce, por meio do feature tracking imaging bidimensional (FTI-2D).Vinte e nove cadelas diagnosticadas com piometra, patologia usada como modelo experimental para sepse, foram avaliadas. Os animais foram submetidos ao exame ecocardiográfico convencional e ao FTI-2D e divididos em três grupos: grupo I (controle), grupo II (piometra sepse) e grupo III (piometra não sepse). Em relação aos parâmetros da ecocardiografia convencional, não houve diferença estatística entre os grupos avaliados. Quanto ao strain radial, os grupos II e III apresentaram função ventricular inferior no momento do diagnóstico (22,805,80 grupo I; 18,455,96 grupo II; 18,719,45 grupo III; P=0,032) e o grupo III manteve essa redução no retorno. Já no strain rate radial, apenas o grupo III obteve função ventricular inferior no momento do diagnóstico (1,900,57 grupo I; 1,910,70 grupo II, 1,570,53 grupo III; P=0,021). Para o strain longitudinal, observou-se função ventricular mais baixa nos grupos II e III no momento do diagnóstico (11,043,38 grupo I; 8,593,97 grupo II; 8,211,99; P=0,048) e após 10 dias de pós-cirúrgico (11,043,38 grupo I; 9,002,16 grupo II; 8,122,27 grupo III; p=0,048). O FTI-2D foi capaz de detectar alterações precoces da função ventricular esquerda, que não foram observadas no exame ecocardiográfico convencional, sugerindo quadro de depressão miocárdica, até mesmo em cadelas com piometra sem quadro clínico evidente de sepse. Assim, essa modalidade pode ser útil no diagnóstico, pois pode detectar alterações cardíacas precoces, possibilitando uma intervenção terapêutica rápida.(AU)

The aim of this prospective study was to analyze the left ventricular function of dogs who had sepsis or not and diagnose myocardial depression early on through the two-dimensional feature tracking imaging (2D-FTI). Twenty-nine dogs diagnosed with pyometra, a pathology used as an experimental model for sepsis were evaluated. The animals were subjected to conventional echocardiography and 2D-FTI, and divided into three groups: Group I (control), group II (sepsis pyometra) and group III (no sepsis pyometra). Regarding the parameters of conventional echocardiography, there was no statistical difference between the groups. As for the radial Strain, group II and III had lower ventricular function at diagnosis (22.805.80 Group I; 18.455.96 Group II; 18.719.45 Group III; P = 0.032) and group III maintained this reduction in return. Regarding the radial Strain rate, only the III group had lower ventricular function at diagnosis (1.900.57 Group I; 1.910.70 Group II, 1.570.53 Group III; P = 0.021). For the Longitudinal Strain we observed lower ventricular function in groups II and III at diagnosis (11.043.38 Group I, Group II 8.593.97, 8.211.99; P = 0.048) and ten days after surgery (11.043.38 Group I; 9.002.16 Group II; 8.122.27 Group III; P = 0.048). The 2D-FTI was able to detect early changes in left ventricular function, suggesting myocardial depression frame, even in female dogs with pyometra without clear clinical picture of sepsis, which were not seen in conventional echocardiography. Thus, this model can be useful in diagnosis, because it can detect early cardiac changes, enabling a rapid therapeutic intervention.(AU)

Troponina I como biomarcador de lesão cardíaca em cães com sepse / Troponin I as a biomarker of cardiac injury in dogs with sepsis

Avaliou-se a troponina I como biomarcador de lesão cardíaca na sepse, além de outros parâmetros hematológicos, em cadelas com piometra. Os grupos avaliados não diferiram estatisticamente na avaliação da concentração sérica da troponina I cardíaca. A quantidade total de leucócitos (mm3) e a porcentagem de bastonetes foram significativamente maiores no grupo sepse (23.221,74±16.848,80mm3 e 5,91±10,18%) quando comparado ao grupo não sepse (14.492,86±6.828,26mm3 e 1,93±1,64%) e ao grupo controle (10.320,00±3.999,02mm3 e 1,65±2,05%). Houve diferença significativa nas concentrações séricas da proteína C reativa (mg/dL) no grupo sepse (19,57±41,69md/dL) se comparado ao grupo não sepse (10,29±12,02mg/dL) e ao grupo controle (3,60±3,53mg/dL). Na avaliação da concentração sérica do lactato, houve diferença significativa entre cães com piometra e cães saudáveis, porém não houve diferença significativa entre os grupos sepse e não sepse. Os resultados do presente estudo indicam que a troponina I cardíaca não pôde ser considerada um biomarcador precoce para injúria miocárdica nos casos de cadela com piometra, pois os resultados das mensurações foram semelhantes entre os grupos, o que indica que pode não ter ocorrido lesão dos cardiomiócitos nessa fase. Já a proteína C reativa e o lactato são possíveis marcadores para inflamação sistêmica, uma vez que demonstraram concentrações séricas significativamente maiores em cadelas com piometra.(AU)

Troponin I as a biomarker of cardiac injury in sepsis, and other hematological parameters in female dogs with pyometra were evaluated. The groups did not differ in the assessment of serum cardiac troponin I. The total amount of leukocytes (mm3) and percentage of band cells was significantly higher in the sepsis group (23,221.74±16,848.80mm3 and 5.91±10.18%) compared to the non-sepsis group (14,492.86±6,828.26mm3 and 1.93±1.64%) and the control group (10,320.00±3,999.02mm3 and 1.65±2.05% respectively). There were significant differences in serum concentrations of C-reactive protein (mg / dL) in the sepsis group (19.57±41.69md / dL) compared to the non-sepsis group (10.29±12.02mg / dL) and control group (3.60±3.53mg / dL). In the evaluation of serum lactate concentration, there was a significant difference between dogs with pyometra and healthy dogs, but there was no significant difference between the sepsis and non-sepsis groups. The results of this study indicate that troponin I could not be considered an early biomarker of myocardial injury in cases of dogs with pyometra, because the results of the measurements were similar between groups, inferring that there may not have been an cardiomyocytes injury at this stage. C-reactive protein and lactate are potential markers for systemic inflammation, as demonstrated by significantly higher serum concentrations in dogs with pyometra.(AU)

Alterações patológicas do sistema genital de cutias (Dasyprocta aguti Linnaeus, 1758) fêmeas criadas em cativeiro / Pathological changes of the genital system of agoutis (Dasyprocta aguti Linnaeus, 1758) females bred in captivity

Este artigo apresenta relatos de sete distintas patologias de origem reprodutiva ainda não descritas em cutias (Dasyprocta aguti Linnaeus, 1758) fêmeas, que afetaram a fertilidade ou resultaram na morte do animal. Descreveu-se a natureza, a localização e a frequência das alterações patológicas macroscópicas e histológicas dos órgãos que compõem o sistema reprodutivo de cutias fêmeas, criadas sob condições de cativeiro no semiárido do Brasil. Foram avaliados através do exame anatomopatológico o aparelho reprodutivo de trinta e nove cutias mortas naturalmente e encaminhadas ao Laboratório de Patologia Veterinária, no período de fevereiro de 2010 a maio de 2015. Destas, constatou-se alterações patológicas no sistema reprodutivo de 10 (25,6 %). No total, 13 alterações foram observadas, sendo que, em alguns animais haviam a coexistência de mais de uma alteração. Assim, as alterações patológicas encontradas foram: endometrite (n=4; 30,8%), piometra (n=3; 23%), retenção de placenta (n=2; 15,4%), maceração fetal (n=1; 7,7%), mumificação fetal (n=1; 7,7%), parto distócico (n=1; 7,7%) e ovários afuncionais (n=1; 7,7%).(AU)

This paper presents seven distinct reports diseases with reproductive origins that are not yet described in females agoutis (Dasyprocta aguti Linnaeus, 1758), affecting fertility or resulted in the animal's death. The nature, location and frequency of macroscopic and histological pathological changes of the organs that compose the reproductive system of female agoutis, created under conditions of captivity in the semiarid region of Brazil, are described in this article. Were evaluated by pathological examination of the reproductive tract of thirty-nine naturally dead agoutis and sent to the Veterinary Pathology Laboratory in February 2010 to May 2015. From these, it was found pathological alterations in the reproductive system of 10 (25.6%). A total of 13 abnormalities were observed, and in some animals had the coexistence of more than one alteration. Thus, the pathological changes were: endometritis (n=4, 30.8%), pyometra (n=3; 23%), retained placenta (n=2; 15.4%), fetal maceration (n=1, 7.7%), fetal mummification (n=1, 7.7%), dystocia (n=1, 7.7%) and afuncionais ovary (n=1, 7.7%).(AU)

Pyometra in Elderly Patients and Its Clinical Characteristics

BACKGROUND: Pyometra should be treated with caution in elderly patients because it may indicate a malignancy in the post-menopausal period and can result in life-threatening complications such as septicemia or pan-peritonitis. METHODS: We retrospectively analyzed the clinical features of 30 patients aged ≥65 years who received treatment for pyometra between January 2010 and December 2014. RESULTS: The 30 patients (age: median, 74 years; range, 66-88 years) were evaluated. They presented with vaginal discharge (n=17), vaginal bleeding (n=8), abdominal pain (n=6), or fever (n=3). The most common accompanying systemic disease was hypertension (n=15), followed by diabetes mellitus (n=10). Of the 30 cases, seven were associ- ated with gynecologic malignancy (cervical cancers, n=3; endometrial cancers, n=3; and ovarian cancer, n=1); and 14, with gynecologic benign diseases (uterine myoma, n=5; cervical intraepithelial neoplasia, n=4; tubo-ovarian abscess, n=3; endometrial polyp, n=1; uterine prolapse, n=1). All the patients were treated with cervical dilatation and drainage. Fifteen patients underwent gynecologic surgery with antibiotic therapy, and 15 received empirical antibiotic treatment alone. Two women experienced spontaneous perforation of pyometra. Pyometra is considered a complication of benign and malignant gynecologic disease, until proven otherwise. CONCLUSION: In elderly patients with comorbidities, pyometra might induce severe complications such as pan-peritonitis or sepsis. Early accurate diagnosis is important to determine an appropriate individualized treatment to reduce morbidity and mortality.