Comparison of cytological and histological examinations in different locations of the equine uterus-an in vitro study.

Endometritis constitutes a major problem in managing broodmares. The histological occurrence of polymorphonuclear neutrophils (PMNs) in the stratum compactum of the endometrium is accepted as the reference standard to diagnose endometritis in mares. The objective of this study was to determine the distribution of PMNs within different sampling locations of the uterus by cytological examinations and to compare it with PMN numbers in endometrial biopsies of the corresponding location. Cytological and endometrial samples were obtained from 37 uteri within 2 ± 1 hours after slaughter through small incisions from five different, predefined locations of each uterus. The cytological samples were smeared on microscopic slides, stained, and classified as negative (<2% PMNs) or positive (≥2% PMNs) for endometritis. Histologically, the numbers of PMNs were counted in three high power fields by an experienced pathologist and classified as positive for this type of endometritis if ≥5 PMNs occurred in three high power fields (×40 magnification). The biopsies were also evaluated for lymphoplasmacellular endometritis, periglandular fibrosis (endometrosis), and angiosclerosis. The prevalence of positive cytological and histological samples was 14.6% and 17.8%, respectively. A fair agreement between the two diagnostic methods could be detected (k = 0.29; P < 0.01). The numbers of PMNs differed between the sampling locations, resulting in positive and negative locations within a positive scored uterus, in both cytologically positive scored uteri (8/10) and histologically positive scored uteri (13/14). No significant differences were found in PMN numbers in the different locations, either the cytological (P = 0.78) or histological (P = 0.79) examination. Additionally, no significant differences were observed in the assessment of endometrosis (P = 0.96) and angiosclerosis (P = 0.67) within the locations. In conclusion, PMN numbers of a cytological examination of the endometrium showed fair agreement to the occurrence of PMN in the stratum compactum of the histological examination at the same sampling location. Although variations were found in the number of PMN using both methods (cytology and histology), statistically significant differences were not detected within the different locations (P = 0.78; P = 0.79), implyingies that the decision to take more than one sample should be critically considered. Additional research is warranted to determine the number of sampling locations necessary for reliable examination results.

Comparison of three diagnostic methods to identify subclinical endometritis in mares.

The objective of this study was to compare the accuracy of a uterine swab (US), a cytological brush (CB) and an endometrial biopsy (EB) to detect subclinical endometritis in mares. Cytological and bacteriological results of all three techniques were related to histological occurrence of polymorphonuclear neutrophils (PMNs) in the stratum compactum, commonly known as 'best standard'; to diagnose endometritis. Samples were taken from 55 mares of different breeds without clinical signs of endometritis. Samples for US, CB and EB were collected, smeared on a microscopic slide and cultured for bacterial growth. Endometrial biopsy samples were additionally stored in 4% formaldehyde for histological analysis. Bacteriological cultures and cytological samples of all techniques were classified as negative (no uterine pathogens in monoculture; < 2% PMNs) or positive (uterine pathogens in > 90% of the grown colonies; > 2% PMNs) for endometritis. Uterine pathogens were diagnosed in 20.0% of the mares. Isolation of pathogens was not associated with positive cytological findings (r = -0.23; P = 0.87). None of the six mares with an Escherichia coli infection (10.9%) showed a positive cytological result. In contrast, two of five mares infected with Streptococcus zooepidemicus had a positive cytological result. Histologically, the presence of PMNs in the stratum compactum was regarded as positive for endometritis when the mare was in diestrus at time of sampling. Compared to the 'best standard', sensitivity for cytology of CB, US and EB was 0.17, 0.00 and 0.25, respectively. Specificity for cytology of CB, US and EB was 0.83, 0.93 and 0.85, respectively. Sensitivity of uterine culture was 0.25, 0.33 and 0.25 for CB, US and EB, respectively. Specificity for culture of CB, US and EB was 0.80, 0.83 and 0.95, respectively. In conclusion, cytological or bacteriological examinations alone provide a high incidence of false negative results. Sensitivity of cytology combined with bacteriology of CB was 0.42. A combination of a bacteriological and a cytological examination of a CB sample improved the diagnostic performance in subfertile mares. Based on these results, we can recommend the CB to improve the diagnosis of subclinical endometritis in the mare compared to the US alone as currently used routine method.

[Characteristics of alcohol withdrawal delirium in surgical patients and recommendations for treatment]. / Besonderheiten des Alkoholentzugsdelirs beim chirurgischen Patienten und Hinweise zur Behandlung.

An alcohol withdrawal syndrome affects the patient in a 'vulnerable phase' either after an operation or posttraumatically. It can be shown pathophysiologically, that the symptoms are caused by a hyperactivity of the central sympathetic nervous system and a disbalance of the neurotransmitters. As for these complex symptoms, a multi-layered treatment is required. We report on our experiences with 23 patients who were treated in our intensive care unit. The treatment included a benzo-diazepine and a drug effecting central alpha 2-receptors. Only three of these patients had to be intubated or ventilated. Because of the induced bradycardia monitor observation was required in all cases. The patients could be wakened up at any time and thus were co-operative for basic care. One patient died of pulmonary embolism, a second patient died of cardiovascular failure as a consequence of cardiac insufficiency.

Highly sensitive assays of autoantibodies to thyroglobulin and to thyroid peroxidase.

These highly sensitive assays are based on the interaction between thyroid autoantibodies and 125I-labeled autoantigens. Serum samples are incubated with labeled thyroid peroxidase (TPO) or thyroglobulin (Tg) to allow the formation of antibody-labeled antigen complexes. The complexes are then precipitated by addition of solid-phase Protein A. In the presence of high concentrations of TPO antibody or Tg antibody, more than 50% of the respective labeled antigen was precipitated, whereas only 1-2% was precipitated in the absence of autoantibody. Interassay CVs were 3.2% and 5.7%, respectively, for the anti-TPO and anti-Tg assays. There was no cross-reactivity between Tg antibody and TPO antibody. Results correlated highly significantly with results from other assay systems based on antigen-coated cells or plastic supports, but the assays described here were considerably more sensitive. Scatchard analysis of the assay data provided information on the affinity and serum concentration of TPO autoantibodies (ka approximately 10(9) L/mol and concentrations up to 1 g/L) and Tg autoantibodies (ka approximately 4 x 10(10) L/mol and concentrations up to 1 g/L). Overall, these assays provide a sensitive, precise, and convenient system for measuring and investigating the properties of thyroid autoantibodies.