Cystic Endometrial Hyperplasia-pyometra Research Articles

Does hyperbaric oxygen therapy positively change organic dysfunctions in bitches with sepsis caused by cystic endometrial hyperplasia-pyometra

Experimental models have shown positive outcomes associated with hyperbaric oxygen therapy (HO) when it comes to reducing mortality rates in sepsis patients. The aim of the present study is to assess HO impact on the microperfusion of sepsis bitches with Cystic Endometrial Hyperplasia-Pyometra (CEH-P) based on SOFA SCORE (Sequential Organ Failure Assessment) to quantify and monitor organic dysfunction degree. Eight (8) bitches diagnosed with CEH-P were included in the study; they were randomly split into two groups: G1 (ovariohysterectomy + clinical therapy) and G2 (ovariohysterectomy + clinical therapy + HO). All bitches in G2 were subjected to three HO sessions, at 24-h time interval between sessions. All animals showed at least one organic dysfunction due to sepsis. Animals in G2 presented significant improvement in clinical conditions and initial 51% reduction in SOFA scoring. On the other hand, animals in G1 recorded 29% reduction in this variable. Hyperbaric therapy was effective in reducing bitches’ organic dysfunction with sepsis caused by CEH-P; however, it did not have significant reflex on Central Venous Oxygen Saturation (SvcO2).

Evaluation of uterine antioxidants in bitches suffering from cystic endometrial hyperplasia-pyometra complex.

Cystic endometrial hyperplasia-pyometra complex (CEH-P) is a common disease in sexually mature bitches. Disease progression leads to oxidative stress, resulting in the depletion of uterine antioxidants and lipid peroxidation of associated cells, which further aggravates the condition. The concentration of antioxidant enzymes, the level of lipid peroxidation within the uterine tissue, and its reflection in the serum and urine need to be elucidated. The aim of this study was to analyze the concentration of antioxidants such as superoxide dismutase (SOD), catalase (CAT), glutathione (GSH), glutathione peroxidase (GPx), and the lipid peroxidation marker malonaldehyde (MDA) in three types of samples, i.e., serum, urine, and uterine tissue. For this purpose, 58 pyometra-affected and 44 healthy bitches were included in the present study. All animals underwent ovariohysterectomy (OVH). Our data indicated highly significant difference (p<0.01) in the antioxidant concentrations of uterine, serum and urine samples. Furthermore, there was a highly significant (p<0.01) difference in the serum levels of ferric reducing antioxidant power (FRAP) and free radical scavenging activity (FRSA) indicated poor capacity to overcome oxidative stress in the CEH-Pyometra condition. We showed that CEH-P induces oxidative stress, which further depletes the antioxidant enzyme reserves in the uterus. Thus, the weak antioxidant defence predisposes to uterine damage and disease progression. The simultaneous depletion of antioxidants and an increase in lipid peroxidation in the serum and urine may also act as early indicators of uterine pathology.

Renal biomarkers, clinical parameters, and renal Doppler velocimetry in bitches with cystic endometrial hyperplasia-pyometra complex.

Cystic endometrial hyperplasia (CEH)-pyometra complex is the most common uterine infection in adult and elderly bitches and can cause renal dysfunction. The aim of this study was to measure and compare urinary creatinine, urea, symmetric dimethylarginine (SDMA), urinary protein-creatinine ratio (UPC), measurement of systolic blood pressure (SBP), and Doppler velocimetry of renal arteries in patients with CEH-pyometra complex before and after an average of 6 months of treatment, evaluating the possibility of the changes persisting. The evaluation was conducted at two moments: M1 (at the diagnosis of CEH-pyometra, n = 36) and M2 (after an average of six months of treatment, n = 16). For the control group, eight bitches with no changes in blood tests or history of conditions underwent Doppler ultrasound evaluation of the renal arteries. At both M1 and M2, we measured creatinine, urea, and serum SDMA, UPC, SBP, and Doppler ultrasound of the renal arteries. Patients were evaluated according to the following groups: azotemic (AZO) and non-azotemic (NAZO), and open and closed cervix pyometra. The parameters were compared between animals present in both moments presented as M1R (bitches that were in M1 and M2) and M2. Statistical significance was considered when p < .05. The medians found for creatinine in M1 were as follows: 1.15 mg/dL, being 1.8 mg/dL for AZO (12/36) and 0.95 mg/dL for NAZO (24/36); and in M2: 0.85 mg/dL (16/16), being 1.15 mg/dL for AZO (4/16) and 0.8 mg/dL for NAZO (12/36). For urea, in M1 it was 36 mg/dL (32/36), with AZO being 103 mg/dL (11/32) and 33 mg/dL in NAZO (21/32); and in M2 32 mg/dL (16/ 16), being 29 mg/dL for AZO (4/36), and 31 mg/dL for NAZO (3/15). The median SDMA measured in M1R was 17 μg/dL (15/16), with AZO being 31 μg/dL (3/15), and NAZO being 16.5 μg/dL (12/15); and in M2, SDMA was 12 μg/dL (16/16), with AZO being 12.5 μg/dL (4/16), and NAZO being 12 μg/dL (12/16). The median UPC measured in M1 was 1.15 (10/36), with AZO being 0.25 (1/10), and NAZO being 1.38 (9/10); and in M2, it was 0.2 (13/16), being 0.1 in AZO (4/13), and 0.2 (9/16) in NAZO. For SBP, in M1, it was 118 mmHg (30/36), with AZO being 102 mmHg (10/30) and 133 mmHg in NAZO (20/30); and in M2 142.5 mmHg (12/16), being 155 mmHg for AZO (4/12), and 140 mg/dL for NAZO (8/12). When comparing animals with open and closed cervixes, a difference was found between SDMA measurements (p = .001). There was a distinction between PI and RI of the left and right kidneys consecutively (p = .007; p = .033; p = .019; p = .041). Correlations found in M1: SDMA × PI RIM DIR (r = 0.873; p = .002), SDMA × PSV RIM ESQ (r = 0.840; p = .004), SDMA × EDV RIM ESQ (r = 0.675; p = .046). With this study, we conclude a return to normality of renal biomarkers and clinical parameters after six months. Yet, there is a persistence of Doppler velocimetric measurements between the two moments. Thus, this parameter is not suitable for identifying and classifying chronic kidney injury in bitches with pyometra.

Cystic endometrial hyperplasia-pyometra syndrome impairs the preantral follicle reserve in domestic bitches (Canis familiaris)

Cystic endometrial hyperplasia (CEH)-pyometra syndrome is the most common uterine pathological condition reported in breeding bitches, however, their described effects on fertility are limited to uterine disorders and conception rates. As the preantral follicle population represents the available reserve of gametes recruited during the lifespan, the aim of this study was to evaluate the effects of CEH-pyometra syndrome on the: (i) preantral follicle morphology, (ii) developing follicle rates, and (iii) preantral follicle and stromal cell densities. Ovarian fragments from bitches subjected to elective or therapeutic ovariohysterectomy were allocated according to uterine diagnosis as follows: control (n = 7, clinically healthy), CEH-mucometra (n = 8, uterine lumen filled with a sterile mucus), and pyometra (n = 17, presence of a purulent mucus) groups. Overall, the control group had 3.4 and 4.1-fold higher probability (P < 0.0001) of the presence of normal preantral follicles compared with CEH-mucometra and pyometra groups, respectively. Moreover, ovarian fragments from the pyometra group showed an increase in the percentage of developing follicles (P < 0.05) compared to the control. Both CEH-mucometra and pyometra groups showed lower (P < 0.05) preantral follicle and stromal cell densities (P < 0.05) compared to the control. In summary, the CEH-pyometra syndrome decreased the percentage of morphologically normal follicles and enhanced the developing follicle rates. Additionally, a reduction of preantral follicle and stromal cell densities suggests that the inappropriate uterine environment induced by CEH-pyometra syndrome can lead to premature depletion of ovarian reserve.

Panhysterectomy: A surgical intervention for cystic endometrial hyperplasia-pyometra complex in Great Dane

Panhysterectomy: A surgical intervention for cystic endometrial hyperplasia-pyometra complex in Great Dane

Differential expression of inflammatory cytokines, prostaglandin synthases and secretory leukocyte protease inhibitor in the endometrium and circulation in different graded CEH-pyometra in bitch

Cystic endometrial hyperplasia (CEH)-pyometra (CEH-P) is one of the most common reproductive disorders in bitches, posing a risk to both future fertility and life. The aims of the current study were to elucidate the differential expression patterns of inflammatory mediators at transcript and protein levels in the endometrium and to assess the concentrations of key inflammatory mediators in the peripheral circulation of bitches with different graded CEH-P. A total of 25 client-owned intact mixed breed bitches of 3–10 years presented to the outpatient department of RVP-TVCC of the institute were considered for the study. Of which, 22 cases suggestive of pyometra and 3 cases of CEH obtained during routine elective ovariohysterectomy were subjected to histopathological examination. Uteri were categorized into CEH (n = 3), moderate CEH-P (mCEH-P, n = 9), severe CEH-P (sCEH-P, n = 6) and atrophic pyometra (AT-P, n = 7). A group of age matched (n = 12) bitches without pyometra served as control. Endometrial transcripts such as IL6, IL8, PTGS2, PGFS, and SLPI were expressed differentially in the CEH and CEH-P bitch. In addition, a strong immunoreactivity (IR) of IL6, IL8, PTGS2, and mPGES1 was recorded in the sCEH-P uterus, while expression of IL10 was noticed in AT-P. In circulation, serum IL6 was the most relevant marker with high sensitivity of 96.2% and specificity of 84.6% at a cut off concentration 8.5 pg/mL followed by SLPI with 95.2% sensitivity, and 84.6% specificity at cut off concentration of 1.3 ng/mL. Serum IL10, PGFM and SLPI concentration in the peripheral circulation were 1.5–2.23 fold higher in mCEH-P, 0.87–2.5 fold higher in sCEH-P and 2.9–3.5 fold higher in AT-P than that of control. It is concluded that monitoring the serum concentration of IL6, IL10 and SLPI would be useful adjunct to the established hematobiochemical parameters in the management of pyometra in the bitch with critical illness.

Doppler Velocimetry of Uterine Artery in Bitches with Cystic Endometrial Hyperplasia-Pyometra Complex

Doppler ultrasound is a useful diagnostic tool to evaluate uterine blood flow in different canine reproductive states. The aim of this study was to describe and compare uterine blood flow in bitches suffering from pyometra according to the ultrasonographic appearance of uterus. Seventy-five bitches with pyometra confirmed clinically, haematologically and ultrasonographically were included in the study. Ten healthy bitches with no haematological and ultrasonographic abnormality of uterus were also included in the study as control group. The bitches with pyometra were divided into four groups based on the sonographic characterization of uterus and its luminal contents, viz., B (few small cysts, normal endometrial surface, anechoic uterine content, n=11), C (many large cysts, irregular surface and hypertrophic endometrium, n=24), DH (many large cysts, irregular surface and hypertrophic endometrium, hyperechoic content, n=31) and DA (many large cysts, irregular surface and atrophic endometrium, hyperechoic content, n=9). The uterine horn diameter and uterine wall thickness was measured with two-dimensional ultrasonography. With the use of pulsed-wave Doppler, flow velocity waveforms of uterine artery were obtained. Parameters of blood flow velocity such as peak systolic velocity (PSV), end diastolic velocity (EDV), as well as haemodynamic parameters such as resistance index (RI), pulsatility index (PI) and systolic-diastolic ratio (S/D) were calculated electronically. Peak systolic velocity and end diastolic velocity were significantly higher in pyometra group than control with highest velocities recorded in DA group (P&lt;0.05). The RI, PI and S/D were significantly lower in pyometra group than in control (P&lt;0.05). The RI was significantly lower in group C and DA compared to groups B and DH (P&lt;0.05). However, no significant difference was reported in PI and S/D among the groups of pyometra (P&gt;0.05). It was concluded that the uterine artery blood flow velocity of bitches suffering from pyometra differs, not only from normal bitches, but also varies with the type of pyometra with varying pathological nature. Furthermore, haemodynamic parameters appear as useful markers to differentiate uterine pathologic conditions and to understand the pathological type of pyometra.

Peroxisome proliferator-activated receptor expression in the canine endometrium with cystic endometrial hyperplasia-pyometra complex.

The most common uterine diseases in bitches occurring during diestrus are cystic endometrial hyperplasia (CEH) and pyometra. These diseases can coexist as CEH-pyometra complex (CEH-P). Their pathogenesis has not been fully explained. Peroxisome proliferator-activated receptors (PPARs) are important factors regulating mammalian reproductive function and inflammatory processes. Although there is a lack of data concerning the expression of PPARs in the canine endometrium during CEH and CEH-P, we hypothesized that they might be involved in the development of pathological disorders of the canine endometrium. Therefore, the current study was conducted to evaluate and compare PPARα, PPARδ and PPARγ mRNA expression using quantitative real-time PCR (qPCR) and their immunolocalization using immunohistochemistry (IHC) staining in the endometrium of clinically healthy bitches (control group; n=8) and those with CEH (n=8) or CEH-P (n=8). For quantification, the arithmetic means of all intensities of immunostaining from the cells were measured with the optical density. PPARα, PPARδ and PPARγ were detected in the luminal epithelium, glandular epithelium and stromal cells. The mRNA transcription of PPARα was higher in the CEH group than in the control group (p<.05). Additionally, the mRNA expression and immunostaining intensities of PPARδ and PPARγ in the endometrium in the CEH-P group were downregulated relative to those in the control group (p<.05). Moreover, the serum progesterone concentration measured by direct radioimmunoassay was decreased in the CEH-P group compared to the control group (p<.001) and CEH group (p<.05). The obtained results indicate that PPARs are present in the canine endometrium and that their mRNA profile and intensity levels change under pathological conditions such as CEH and CEH-P. This finding may suggest a correlation between changes in the PPAR expression profile and hormonal disturbances, as well as the potential involvement of PPARs in signal transduction during inflammatory processes occurring in the endometrium during CEH-P. These results pave the way to further research into the role of PPARs in the pathogenesis of CEH and CEH-P in female dogs.

Doppler ultrasonographic evaluation of medically treated female dogs with cystic endometrial hyperplasia–pyometra complex

Monitoring the treatment outcome of canine cystic endometrial hyperplasia-pyometra complex (CEH-P) is essential to identify nonresponding patients who might require a rapid intervention to avoid life-threatening conditions. Uterine artery Doppler characterization may contribute to monitoring medically treated CEH-P, but published studies are currently lacking. Therefore, the aim of this longitudinal prospective observational study was to evaluate uterine artery resistance changes in the medical treatment of female dogs with CEH-P. Twelve diestrous female dogs suffering from CEH-P were treated with a combined protocol of cabergoline, cloprostenol, and antibiotics. The animals were clinically and ultrasonographically evaluated before the beginning of treatment (day 0) and on days 3, 7, 14, 21, and 28. The widest transverse diameter and luminal diameter of uterine horns were measured, as well as the peak systolic velocity (PSV) and end diastolic velocity (EDV) of uterine arteries. The resistance index (RI), pulsatility index (PI), and notch deep index (NDI) were calculated. On day 3, nine of 12 animals showed clinical improvement. In all these female dogs, the widest transverse sectional diameter (P<0.01), luminal diameter (P<0.01), PSV (P<0.01), and EDV (P<0.01) progressively decreased, while RI (P<0.01), PI (P<0.01), and NDI (P<0.01) increased up to day 21. In nonresponding dogs (3/12),Dopplerparameters remained unchanged. Although comparisons of PSV, EDV, and NDI were significantly different, these results should be cautiously interpreted due to the low statistical power. female dogs that responded to this treatment showed an increase in uterine artery resistance, along with clinical and ultrasonographic improvement.

A Novel Protocol for Medical Management of Cystic Endometrial Hyperplasia-Pyometra in White Tiger

Background: Successful medical management of a serious form of Cystic Endometrial Hyperplasia-Pyometra (CEH-P) in a white tiger, with a combination of mifepristone, misoprostol, cloprostenol, cabergoline and enrofloxacin is discussed. Methods: A 14-year-old white tiger (Panthera tigris) belonging to the Zoological Garden, Thiruvanathapuram showed symptoms of gradual discomfort, dyspepsia and polydipsia for two weeks. There were no signs of oestrus for the previous two months and a serosanguinous vaginal discharge was also noticed. On ultrasonographic examination, uterine sacculations filled with fluid could be found which was suggestive of pyometra. Leukocytosis, neutrophilia, increased level of serum progesterone, anaemia, high ESR, persistent hyperproteinaemia and hyperglobulinaemia were evident on haematological examination. Considering the risks associated with performing OHE in large felids, medical management was planned. A combination of mifepristone, misoprostol, cloprostenol, cabergoline, enrofloxacin and supportive therapy were given along with strict and close monitoring by different experts on site or by utilizing telemedicine communication technologies. Periodic hematological examination, serum biochemistry, progesterone estimation and ultrasonographic evaluation were done to evaluate the progress of treatment. The progesterone values during the period of study ranged from 45.6 ng/ml at the commencement of treatment to a basal level of 0.73 ng/ml towards the end of treatment. Result: The animal had an uneventful clinical recovery. Considering the risks associated with performing OHE in large felids, medical management can be considered as a valuable option in treating CEH-Pyometra in wild felids. This being the first report of successful medical treatment of CEH-P in a large captive felid with a combination of antiprogestins, prolactin antagonists, prostaglandins and antibiotics, it is suggested that due consideration of such a treatment regimen is of great importance in large felids.

Cystic endometrial hyperplasia-pyometra complex in a mastectomized Boerboel bitch following tamoxifen administration

&#x0D; &#x0D; &#x0D; &#x0D; Tamoxifen is a non-steroidal, anti-estrogenic and selective estrogen receptor modulator commonly used as adjuvant chemotherapy in humans with breast cancer and occasionally in dogs following mastectomy. This report presents a case of cystic endometrial hyperplasia-pyometra in a dog following oral administration of the tamoxifen. A 4-year-old intact nulliparous Boerboel bitch presented at Veterinary Teaching Hospital, Federal University of Agriculture, Abeokuta. It was diagnosed with mammary carcinoma of the right cranial lumbar mammary gland. Mastectomy was performed followed by oral administration of Tamoxifen (10mg daily) for six weeks as adjunct chemotherapy. Eight weeks after, the owner reported that the bitch was lethargic, anorexic and had a purulent vaginal discharge. Abdominal ultrasound revealed cystic endometrial hyperplasia. Results of complete blood counts showed neutrophilic (absolute neutrophil count = 19.5×103/L) leukocytosis (total leukocyte count = 24.9X103/L), while bacterial culture yielded moderate growth of Staphylococcus aureus, which was sensitive to Ciprofloxacin, Ofloxacin, Sparfloxacin and Gentamycin. The bitch was treated with 400μg of Misoprostol and 500mg of Ciprofloxacin twice daily for two weeks. Ovariohysterectomy (OVH) was performed using a ventral midline approach when no significant improvement was observed from medical treatment. The dog improved significantly after ovariohysterectomy and was discharged one week after OVH. It was concluded that, although tamoxifen is routinely used as adjuvant chemotherapy following mastectomy, more research is required to evaluate its safety in intact bitches.&#x0D; &#x0D; &#x0D; &#x0D;

Expression of Transforming Growth Factor Beta Isoforms in Canine Endometrium with Cystic Endometrial Hyperplasia-Pyometra Complex.

Simple SummaryPathomorphological changes and functional disorders of the uterus have long been a significant problem in the reproduction of dogs. The most commonly identified uterine disorders leading to permanent loss of fertility in dogs include cystic endometrial hyperplasia (CEH) and pyometra. These diseases may occur jointly as a CEH–pyometra complex. Despite numerous studies, the etiology of this disease remains unclear. TGF-β is considered to be one of the key factors in pathophysiological uterine disorders. The results indicate the significant expression of TGF-β1 in endometrial tissues in bitches affected by CEH–pyometra complex. Consequently, among all TGF-β isoforms, TGF-β1 is a potential biomarker involved in the regulation of a dog’s endometrium with proliferative and degenerative changes.Cystic endometrial hyperplasia (CEH) and pyometra are the most frequently diagnosed uterine diseases affecting bitches of different ages. Transforming growth factor beta (TGF-β) has been classified in females as a potential regulator of many endometrial changes during the estrous cycle or may be involved in pathological disorders. The aim of this study was to determine the expression of TGF-β1, -β2 and -β3 in the endometrium of bitches suffering from CEH or a CEH–pyometra complex compared to clinically healthy females (control group; CG). A significantly increased level of TGF-β1 mRNA expression was observed in the endometrium with CEH–pyometra compared to CEH and CG. Protein production of TGF-β1 was identified only in the endometrium of bitches with CEH–pyometra. An increase in TGF-β3 mRNA expression was observed in all the studied groups compared to CG. The expression of TGF-β2 mRNA was significantly higher in CEH and lower in CEH–pyometra uteri. The results indicate the presence of TGF-β cytokines in canine endometrial tissues affected by proliferative and degenerative changes. However, among all TGF-β isoforms, TGF-β1 could potentially be a key factor involved in the regulation of the endometrium in bitches with CEH–pyometra complex.

CYSTIC ENDOMETRIAL HYPERPLASIA PADA KUCING DOMESTIK

Cats have their own charms because of the shape of the body, eyes and the color of the fur are diverse with advantages. One of the diseases that can occur in the reproductive tract of cats is cystic endometrial hyperplasia-pyometra complex (CEH-pyometra complex). The purpose of writing the report of the results of the dependent case is to know the premedication and anesthesia used in ovariohysterectomy surgery and can perform the operation. Ovariohysterectomy surgery method resulting from the presence of lumps in the uterus.

Plasma concentration and uterine and ovarian expressions of insulin-like growth factor-2 in dogs with cystic endometrial hyperplasia–pyometra

The objective of this study was to investigate the plasma concentrations of insulin-like growth factor-2 (IGF-2) as well as its expression in the uterus and ovary of healthy dogs and those with cystic endometrial hyperplasia (CEH)-pyometra complex. Group 1 (n = 10) included bitches with open cervix pyometra, while Group 2 (n = 7) consisted of clinically healthy bitches in dioestrus. The number of IGF-2 immunopositive interstitial cells was significantly higher in Group 1, whereas in Group 2 there were only two cases in which a few cells were IGF-2 immunopositive. IGF-2 immunopositivity was observed in the endometrial glandular epithelium in both groups. Additionally, interstitial fibroblasts and macrophages in the endometrium were also positive in Group 1. The concentration of plasma IGF-2 was higher in Group 1 than in Group 2 (P < 0.05). The concentration was positively correlated with IGF-2 expression in the endometrial glands (r = 0.926; P < 0.001) in Group 1. However, a negative correlation was present between plasma IGF-2 concentration and IGF-2 expression in the interstitial endocrine cells of the ovary in Group 1 (r = -0.652; P < 0.05). The results suggest that IGF-2 plays an important role during the inflammatory process occurring in bitches with CEH-pyometra complex as well as in the endometrium of healthy bitches in dioestrus.

Immunohistochemical expression of HER - 2 and Ki - 67 in granulosa cell tumor in bitches.

Granulosa cell tumour, an ovarian neoplasm of stromal origin, is an important tumour related to oestrogenic dominance syndrome and cystic endometrial hyperplasia-pyometra complex. In order to analyse ovarian tumour´s malignant potential, immunohistochemical markers can be used, such as anti-HER2 and anti-Ki-67. The aim of this study was to evaluate the expression of immunohistochemical markers HER-2 and Ki-67 in granulosa cell tumour from bitches´ ovaries. In HER-2 immunomarker analysis using the HercepTest® method, most tumours were classified as 2+ (moderate labelling). Concerning Ki-67 immunomarker, only one case was described as having a high proliferative index. An association was found between immunostained cell percentage by anti-HER-2 antibodies and high pleomorphism, represented by the pattern of follicular/trabecular tumour arrangement. There was no correlation between anti-Ki-67 and anti-HER-2 antibody immunostaining intensities, probably due to only one case with a high Ki-67 index. With an effective protocol for HER-2 and Ki-67 immunohistochemical identification in granulosa cell tumours in bitches, it was possible to characterize this neoplasm proliferation profile.

Clinical Changes and Uterine Hemodynamic in Pyometra Medically Treated Bitches.

Simple SummaryPyometra is an infectious uterine disorder marked by important clinical alterations and uterine contamination and blood flow changes in bitches. Although uterine removal is the most common mode of treatment, conservative therapy is an alternative. However, the success of medical treatment in restoring both clinical and uterine alterations has not yet been attested. Thus, we aimed to analyze the effects of both aglepristone alone or in combination with prostaglandin (associative) on clinical, laboratory and uterine hemodynamic features. Bitches were clinically and ultrasonographically (uterine blood flow) evaluated and medically followed-up throughout treatment (8 days) and castrated for local uterine analysis after 9 days of therapy onset. Associative therapy led to altered respiratory rate and decreased body temperature. Both treatments resolved bitches’ clinical condition and laboratory changes, and reduced uterine size. However, associative protocol was more effective in decreasing uterine vascularization and modulating uterine blood flow. Nevertheless, uterus remained microscopically altered soon after both therapy ending, thus not fully restoring local uterine changes in a short-term evaluation.Cystic endometrial hyperplasia–pyometra complex is a canine endometrial disorder, considered the most common and important among uterine diseases. The treatment of choice is ovariohysterectomy, but medical treatments have become an alternative. However, no studies have been performed in order to evaluate uterine hemodynamic changes during medical treatment for pyometra bitches. Therefore, the aim of this study was to compare the effectiveness of two medical protocols by means of clinical (heart rate, respiratory rate and body temperature), medullar response (complete blood count (CBC)) and uterine hemodynamic evaluation in pyometra bitches. For such purpose, 10 bitches with pyometra were assigned to two groups: Aglepristone Group (n = 5) and Associative Group (aglepristone + prostaglandin; n = 5). The Associative Group had altered respiratory rate and decreased body temperature. The Aglepristone Group had decreased plasma protein, however, leukocyte count reduced over time for both therapeutic protocols. Uterine area and vascularization score decreased throughout treatment. There was a significant reduction in uterine perimeter, area and vascularization score. The Associative Group had lower final diastolic velocity and higher systole:diastole ratio (S/D), pulsatility index (PI) and resistance index (RI). In conclusion, both medical treatments are effective in reversing clinical and CBC changes of pyometra, especially aglepristone, however they cannot fully restore local uterine changes in a short-term evaluation. Conversely, associative therapy was more effective in decreasing uterine vascularization and modulating uterine blood flow.

Association of Pseudoplacentational Endometrial Hyperplasia and Pyometra in Dogs

Uterine inflammation is the most common and clinically relevant genital change in bitches. The aim of this study was to evaluate the association between uterine hyperplasic lesions and uterine inflammation. Uteri and ovaries from 200 bitches were sampled after elective or pathological ovariohysterectomy and histologically evaluated. Endometrial hyperplastic lesions were classified as cystic endometrial hyperplasia (CEH) or pseudoplacentational endometrial hyperplasia (PEH), whereas cases of uterine inflammation were subdivided into endometritis or pyometra. The frequency of PEH (79.4%) was significantly higher (P<0.05) than CEH (20.6%), whereas 17.5% of the animals did not have any endometrial hyperplasic lesions. There was a statistically significant association between the frequency of PEH and uterine inflammation (P<0.0001) and PEH was also significantly associated with pyometra (P<0.05). There was no significant association between CEH and uterine inflammation. There was a significant association between dioestrus and the frequencies of PEH, CEH, uterine inflammation and pyometra. However, there was no significant association between endometritis and dioestrus. These results support the recommendation that the terms 'cystic endometrial hyperplasia', 'pseudoplacentational endometrial hyperplasia' and 'pyometra' should be used separately, instead of the classical term 'cystic endometrial hyperplasia-pyometra complex'.

Contrast-Enhanced Ultrasound in Cystic Endometrial Hyperplasia-Pyometra Complex in the Bitch: A Preliminary Study.

Simple SummaryIn canine cystic endometrial hyperplasia–pyometra (CEH) syndrome, toxic factors and endometrial inflammatory reactions are responsible of increased blood flow and lower vascular resistance in uterine arteries. Color Doppler ultrasound is regarded as an adjunctive tool for quantitative assessment of endometrial vascularization during uterine disorders. The aim of this study was to assess, through contrast-enhanced ultrasound (CEUS) exam, the vascularization in endometrial microvessels in CEH-pyometra in order to evaluate the possibility of application in this syndrome. In twelve female dogs with clinical symptoms related to pyometra, echographic, Color Doppler and CEUS exams were performed. Histopathological examination revealed severe CEH and pyometra, immunohistochemical stain with CD 34 confirmed the presence of angiogenesis. CEUS exam revealed a widespread, intense and rapidly developing homogeneous enhancement of the hyperplastic endometrium with absence of signal only in cystic areas. All parameters of the quantitative analysis were not significantly influenced by region of interest dimension and position. CEUS may improve not invasive evaluations in the CEH-pyometra syndrome and virtually in CEH-mucometra.In cystic endometrial hyperplasia (CEH)–pyometra syndrome, toxic factors and endometrial remodeling culminate in changes characterized by exudative and degenerative inflammatory reaction. Recent studies on hemodynamic found an increased blood flow and lower vascular resistance in uterine arteries, suggesting color Doppler ultrasound as an adjunctive tool for quantitative assessment of endometrial vascularization during pyometra. The aim of this study was to assess, through contrast-enhanced ultrasound (CEUS) exam, the vascularization in endometrial microvessels in CEH-pyometra in order to evaluate the possibility of application in this syndrome. In twelve female dogs with clinical symptoms related to pyometra, B-mode, color Doppler and CEUS exams were performed. In CEH-pyometra uteri, histopathological examination revealed severe CEH and pyometra, immunohistochemical stain with CD 34 confirmed the presence of angiogenesis. CEUS exams revealed a widespread, intense and rapidly developing homogeneous enhancement of the hyperplastic endometrium, with absence of signal only in cystic areas. All parameters of the quantitative analysis were not significantly influenced by region of interest dimension and position. CEUS has the potential to improve clinical not invasive evaluations in the CEH-pyometra syndrome and virtually in CEH-mucometra.

Endometrial mineralisation in a bitch with ovarian granulosa cell tumour and cystic endometrial hyperplasia-pyometra complex

Granulosa cell tumour is a common ovarian pathology in bitches. Depending on its hormonal production, this tumour often induces persistent oestrus signs and uterine disorders. Chronic treatment with progesterone contraceptives...

Current perceptive on canine cystic endometrial hyperplasia-pyometra syndrome-A review

Current perceptive on canine cystic endometrial hyperplasia-pyometra syndrome-A review