SummaryDespite the fact that, nowadays, hysteroscopy is performed routinely, in equine gynecology, for diagnostic and minimally invasive surgical treatment, certain aspects should be considered in order to gain optimal conditions and results for the mare and for those carrying out the examination. These include thorough ascertainment of indication, careful uterine distension, choice of the correct stage of cycle and establishment of an adequate follow-up treatment and management. In order to monitor possible changes in the health of the genital tract following diagnostic hysteroscopy the clinical, microbiological (uterine swab) and pathohistological (endometrial biopsy) state of eight diestrous mares were examined before performance of a hysteroscopy, five days later and after the estrus which followed. Uterine distension was established by insufflation of filtered air. No follow-up treatment was carried out. At the outset all eight mares were clinically healthy, without evidence of pathogenic microbes in the uterine swabs or inflammatory alterations in the endometrial samples. Five days after hysteroscopy pathogenic microbes were detected in 50% of the mares (in three cases: slight amount of Pseudomonas aeruginosa, in one case: moderate amount of E.coli and slight amount of β-haemolytic Streptococcus). This last mare revealed a clinically discernable endometritis. Endometrial biopsy enabled a diagnosis of moderate, acute, superficial endometritis in this mare. A further five of the eight mares developed slight acute inflammatory endometrial reaction which was only detected through pathohistology, though only two of them showed the presence of pathogenic microbes. Following the subsequent estrus all mares were clinically healthy. In two mares Pseudomonas aeruginosa persisted, the others were not contaminated with pathogenic microbes. Two further mares still showed slight, acute, inflammatory endometrial reactions. A remarkable finding in the endometrial biopsies was the striking rise in the number of eosinocytes in the superficial layers of the endometrium five days after hysteroscopy, seen in six of eight mares. After the following estrus the number of eosinocytes was still obviously elevated in four mares.A contamination rate of 50% shows that a prevention of endometrial infection is indicated after hysteroscopy, for example through the infusion of mild antiseptic solutions into the uterus. Additional induction of estrus can advance uterine clearance. Independent of intrauterine contamination, 75% of the mares showed inflammatory endometrial reactions on pathohistology. It might therefore be recommendable not to use the following estrus for insemination. The aetiology of the endometrial eosinophilia following uterine distension through insufflation of filtered air is to date unknown. A correlation between poor vulvovestibular conformation and eosinophilic infiltration of the endometrium has been established by other authors in the past and a connection here seems likely. Keywords:mare, hysteroscopy, contaminat...
Summary222 barren mares of different breeds underwent operative hysteroscopy for the treatment of uterine cysts during an eleven year period. Hysteroscopy was performed under sedation. Mares were in di-or anoestrus. Uterine distension was standardized with an intrauterine pressure between 20-30 mm Hg. Thermical preparation was achieved with high-frequency electrosurgery using micro instruments through the working channel of the endoscope. All visible cysts were resected with an electrosurgical loop. The loop was tightened around the base of the cyst and the cyst pulled towards the uterine lumen before resection. Small cysts which could not be fixed with the loop were coagulated. With the standard procedures, operative hysteroscopy could be completed with resection of all visible cysts in all the mares without complications. Therefore, the technique described here proved to be safe and efficient in a large number of treated mares. Compared to other preparation techniques, risk of recurrence is minimized, trauma of the tissue is only superficial and the wound healing is uncomplicated. The results of patho-histological examination of endometrial biopsies and of clinical follow-up with high rates of treated mares conceiving and foaling are presented in the second part of this study by Köllmann et al. (2008).
EinleitungButorphanol gehört momentan zu den meist genutzten Opioiden in der Pferdemedizin und ist nun auch in Deutschland für die Anwendung beim Pferd und beim Hund zugelassen (Clark und Clark 1999 Schlüsselwörter: Detomidin, Butorphanol, Sedationsgrad, Narkoseverbrauch, Blutdruck, AnästhesiologieInfluence of the combination of butorphanol and detomidine within premedication on the preoperative sedations score, the intraoperative cardiovascular situation and the early recovery period in horses To examine the influence of a preanaesthetic sedation with butorphanol and detomidine on the degree of sedation, consumption of isoflurane and cardiovascular parameters as well as on the recovery period, patients of the Clinic for Horses, University of Veterinary Medicine Hannover, (n = 40) were randomised and blinded assigned to two groups. One half received 0.01 mg/kg bw detomidine and additionally 0.025 mg/kg bw butorphanol and the other half of the horses received detomidine in a dose of 0.025 mg/kg bw. Introduction (0.05 mg/kg diazepam and 2.2 mg/kg ketamine) and maintenance (isoflurane in oxygene) of anaesthesia were standardised in both groups. The analysed period of the anaesthesia started 20 minutes after induction and the data processed by analysis of the variance were collected up to the end of anaesthesia. The following parameters were recorded during general anaesthesia: arterial blood pressure, heart frequency, breathing frequency, inspiratory oxygen and expiratory isoflurane concentration. The preoperatively scored sedation degree was positively influenced by combination of butorphanol and detomidine in contrast to detomidine alone, even though the dosage of the sedative detomidine was considerably reduced for the combination with butorphanol. The arterial blood pressure was over the whole period of anaesthesia higher in horses receiving the combination of butorphanol and detomidine (p = 0.08) and a significant decreased consumption of isoflurane (p = 0.04) was detected in the same group. The duration and quality of recovery period were recorded postoperatively. Horses of the butorphanol/detomidine group showed a slightly shorter recovery period of equal quality probably due to less isoflurane consumption and lower dose of detomidine preoperatively. If combined with butorphanol the dosage of detomidine can be considerably reduced for premedication. The results of this study show that in equine elective surgery the combination of butorphanol with detomidine may improve the intraoperative cardiovascular situation and decrease the consumption of inhalant anaesthetics in contrast to premedication with detomidine alone. There were no significant differences between the sedation scores or quality and duration of the recovery periods between both groups.
SummaryUterine cysts are a common finding during routine transrectal ultrasound examination, often associated with reduced fertility. The aim of this study was to analyse long term fertility of mares after hysteroscopic cyst removal regarding to patho-histological findings. In this study 251 transendoscopic intrauterine surgeries have been performed in 222 barren mares with uterine cysts during the last 11 years. Postoperative endometrial biopsy samples were taken in 83.6% (210/251) of the cases and were analysed and classified according to Kenney and Doig (1986). Pregnancy outcome of 74% of treated mares is known. A postoperative pregnancy rate of 79% (146/184) could be achieved. Especially in mares having biopsy category II b and III good pregnancy rates (70%/69%) could be reached. Cyst recurrence rate in years following treatment was 33.8% (60/177). We conclude that long term fertility can be improved after endouterine surgery, especially in mares having biopsy category II b and III.
ZusammenfassungInnerhalb eines Zeitraums von vier Jahren (1999)(2000)(2001)(2002) Laparoscopic adhesiolysis at the urogenital tract in horsesDuring a four year period (1999)(2000)(2001)(2002), intraabdominal adhesions with participation of the urogenital organs were diagnosed in eight horses. Horses were referred with a history of acute or recurrent colic or for surgical procedures at the urogenital tract. Seven horses had a history of previous surgery. Initially, adhesions were diagnosed on the basis of transrectal palpation. Attached organs included ovary, mesovary, mesorchium, bladder, abdominal wall and intestine. Laparoscopy was performed following conservative treatment and complete resolution of acute colic symptoms. The majority of the laparoscopic procedures were performed in the standing horse through a flank approach. During laparoscopy, adhesions were successfully identified in seven horses and dissected sharply, electrosurgically or with endo staplers in six horses. Endo staplers were used to avoid iatrogenic intestinal perforation when adhesions were judged to be tightly attached to intestine. A uterus/body wall adhesion had to be converted to laparotomy. Neither elevated temperature nor other signs of postoperative local or systemic infection or other complications were evident intra-and postoperatively. No complications or recurrency of colic symptoms have been reported in any of these horses after one year follow-up. Laparoscopy in the standing position offered excellent visualisation of the urogenital organs in the pelvic cavity and was found to be an effective and safe therapeutic measure for minimal invasive adhesiolysis.
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