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The Relevant Problems Research of Bitch Pyometra
The diagnosis of pyometra
本研究收集台灣中部地區88年8月至89年9月母犬臨床子宮蓄膿症(Pyometra)病例共100例，收集的病例做細菌、病變、病原藥物敏感性試驗及檢驗分析。臨床病例分析發現，當子宮內膜僅有Cystic endometrial hyperplasia(CEH)之病變，子宮內膜表面覆蓋上皮正常時，其子宮內膜無炎症反應，血檢值無變化，動物體無臨床症狀。當子宮內膜覆蓋上皮受細菌侵入破壞其完整性，或子宮腔蓄積大量黏液壓迫子宮內膜覆蓋上皮，使子宮內膜覆蓋上皮脫落，子宮內膜間質直接裸露，組織炎症反應增加，動物體的臨床症狀亦愈嚴重。100個臨床病例及不完全卵巢子宮摘除術之動物實驗結果，將子宮蓄膿症分為五大類。第一類：輕度之子宮蓄膿症，子宮內膜囊腫性增生為主。第二類：中度之子宮蓄膿症，子宮內膜覆蓋上皮受損，間質顯著炎症反應。第三類：重度之子宮蓄膿症，子宮肌層變薄，子宮內膜覆蓋上皮脫落。第四類：醫源性不完全卵巢子宮摘除術。A：初期引起子宮積水；B：末期慢性子宮蓄膿症，子宮內膜上皮及間質組織之間有鱗狀化生(Squamous metaplasia)；C：子宮內膜出血。第五類：Stump Pyometra。而放射線免疫分析法(RIA)測定卵巢激素結果，懷孕母犬於妊娠兩週血清Progesterone(P4)濃度為37.99+1.75 ng/mL，未發情犬隻其P4<0.1 ng/mL，但不完全卵巢子宮切除術犬隻於發情後8週P4達18.73+2.19 ng/mL，5-10年後犬隻未發情但P4為2.09+0.78 ng/mL。臨床子宮蓄膿病例其血清P4介於3.37-27.12 ng/mL，其範圍太大，仍需超音波及血液檢查輔助診斷。因此於發情期後一至兩個月測血清P4濃度及超音波檢查可區別發情期、假懷孕、懷孕、子宮積水症及子宮蓄膿症。|
Abstract This research collected totally one hundred cases of Bitch Pyometra at central area in Taiwan since August, 1999 to September, 2000. All these cases were analyzed by bacteria isolation, pathology examination, and antibiotics sensitivity test. Through examining those, it was found while the endometrium only occurred the symptom of the cystic endometrial hyperplasia (CEH) and the surface of epithelium of the endometrial was normal, the endometrial of the bitches would have no inflammatory response, no clinical signs, and no change in blood examination data. On the other hand, when the surface of epithelium was broken its completeness by bacterial invasion or when the uterus gathering the great amount of mucous which stress the surface epithelium, and make them fall down, the interstitial of endometrial expose directly, the inflammatory response of the tissue increased, and the clinical signs of bitches were getting more severe. According to the result of the one hundred cases and the experiment of subtotal hysterectomy animals. The pyometra can be classified into five categories. 1st category- Slight Pyometra. The main symptom is the occurrence of the cystic endometrial hyperplasia. 2nd category- Middle Pyometra. The surface of the endometrial was damaged and the interstital revealed the significant inflammatory response. 3rd category- Severe Pyometra. The myometrium would become thinner and the surface epithelium of the endometrium would be exfoliated. 4th category - Iatrogenic subtotal hysterectomy. A- The symptom of hydrometra in early period. B- The symptom of pyometra in later period. Squamous metaplasia occurred between the endometrial epithelium and interstium . C- Endometrium hemorrhage. 5th category - Stump Pyometra. Secondly, according to the Radioimmunoassay (RIA) testing result, the progesterone (P4) concentration for a two-week pregnant bitch is about 37.99+1.75 ng/mL, and the P4 for anestrus bitches was less than 0.1 ng/nL, however, after eight weeks of estrus, the progesterone (P4) concentration for subtotal hysterectorny cases was about 18.73+2.19 ng/mL. In five to ten years, the progesterone (P4) concentration for the anestrus bitches was 2.09+0.78 ng/mL. Due to the range of the progesterone (P4) concentration was too big for bitch pyometra, which is about 3.37-27.12 ng/mL, we somehow need to diagnose by proceeding ultrasound and the blood examination. Hence, the estrus period for about one to two months later, the progesterone of serum test and ultrasound examinations can discriminate the estrus, the pseudopragnant, the pregnancy, the hydrometra, and the pyometra.
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