Piometra é uma patologia infecciosa, potencialmente fatal, que acomete o endométrio de cadelas, caracterizada pelo acúmulo de pus no lúmen uterino. Em geral, esta patologia ocorre no período do diestro, devido à infecção bacteriana ascendente que encontra ambiente propício para sua multiplicação no endométrio que sofreu hiperplasia cística em decorrência do estímulo cumulativo e prolongado dos hormônios femininos. Normalmente, não possui predisposição racial e acomete mais animais de meia-idade e idosos, a partir do 4o ciclo estral. Animais jovens raramente apresentam esta patologia e, quando ocorre, geralmente está associada ao uso de progestágenos exógenos. O objetivo deste trabalho é relatar o caso de uma cadela, da raça Bulldog inglês, de 10 meses, que não fazia uso de progestágenos exógenos diagnosticada com piometra. A paciente foi atendida pelo Hospital Veterinário da Universidade Federal Rural do Rio de Janeiro com secreção vulvar muco-hemorrágica há 24 horas. De acordo com o tutor, a cadela havia apresentado o primeiro cio 13 dias antes do atendimento. No exame físico geral a paciente apresentou parâmetros clínicos dentro da normalidade, com exceção da temperatura (febre), frequência respiratória (taquipneia), frequência cardíaca (taquicardia), e do lactato sanguíneo (aumentado). Devido a presença de síndrome da resposta inflamatória sistêmica (taquipneia, taquicardia e febre) associado a possível foco infeccioso, solicitou-se hemograma e bioquímica sérica renal e hepática. No hemograma foi avaliado leucocitose neutrofílica, indicando processo inflamatório/infeccioso, na bioquímica sérica observou-se disfunção hepática. Realizou-se também ultrassonografia abdominal que avaliou presença de conteúdo anecóico dentro dos cornos uterinos, sugestivo de piometra. A paciente foi então encaminhada para o serviço de cirurgia para realização da ovariohisterectomia onde retirou-se o foco infeccioso. Na sequência, foi coletado material uterino, de forma estéril, para realização de cultura e antibiograma obtendo-se resultado positivo para dois tipos de bactéria, Streptococcus sp e Bastonete Gram negativo não fermentador. Foi prescrito no pós-operatório antibiótico, anti-inflamatório não esteroidal e analgésico, além de curativo diário, roupa cirúrgica e colar protetor. Não houve qualquer intercorrência no trans ou no pós-operatório da paciente, que não teve recidiva dos sinais clínicos, recebendo alta cirúrgica 10 dias após a cirurgia.
This retrospective study evaluated the impact of the clinical presentation of pyometra on the morbidity and mortality of the affected bitches. The medical records of 47 bitches surgically treated for pyometra between May and December 2017 were evaluated. The admission data were analyzed to classify the animals according to the clinical presentation of pyometra, presence of systemic inflammatory response syndrome (SIRS) and organic dysfunctions (cardiovascular, neurological, renal, and hemostatic). The outcomes were recorded for up to 14 days. The overall mortality rate was 13%. Open and closed pyometra were identified in 62% (n= 29) and 38% (n= 18) of the cases, respectively. The SIRS was present in 44 (94%) bitches, and 27 (57%) had at least one organ dysfunction. The most prevalent dysfunction was hemostatic, followed by neurological, cardiovascular, and renal dysfunction. The clinical presentation of pyometra and the presence of SIRS did not correlate with each other, or with the presence of organ dysfunction and mortality. However, cumulative organ dysfunction (r=0.532, P=<0.001) and the presence of neurological (r= -0.371; P=0.012) and renal dysfunction (r=0.303; P=0.041) were correlated with mortality. Thus, the identification of organ dysfunction through physical examination and routine laboratory analysis proved to be more effective in identifying and predicting the critically ill patients than the SIRS criteria or clinical presentation of the disease.
This randomized clinical trial aimed to evaluate different fluid therapy protocols associated with inhalational or total intravenous anesthesia in the cardiorespiratory stability of bitches with sepsis subjected to a surgical procedure to control the infectious focus. Thirty-two bitches diagnosed with pyometra and sepsis and treated at the University Veterinary Hospital between 2018 and 2019 were recruited. After admission, diagnosis, clinical, and laboratory evaluation, patients were randomly distributed into the following groups: propofol 5 (P[5]: preoperative restrictive fluid therapy-5mL/kg/h and intravenous general anesthesia); propofol 10 (P[10]: preoperative liberal fluid therapy-10mL/kg/h and intravenous general anesthesia); and isoflurane 5 (I[5]: preoperative restrictive fluid therapy-5mL/kg/h and inhalational general anesthesia). Lactate on admission (LAC1) and release (LAC2), heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), rectal temperature (RT), oxygen saturation (SpO 2 ), and carbon dioxide extraction rate (EtCO 2 ) were analyzed at PRE, T10, T20, T30, T40, T50, TEXT, and TDIS. Clearance of 20% of lactate occurred in 18 dogs, with the P[10] group displaying the best performance. There was no statistical difference in vasopressor requirements among the groups. Liberal fluid therapy showed greater cardiovascular stability than restrictive therapy in the perioperative period. Regarding general anesthesia, isoflurane showed greater cardiorespiratory stability than propofol during anesthetic maintenance. In conclusion, although the three proposed protocols are safe and there is no difference in their superiority, some observed changes may be relevant and considered when it is possible to individualize the therapy for the patient.
The inverted ovariosalpingohysterectomy (OSH) technique involves initial uterine removal, followed by ovarian disinsertion. The objective of this study was to compare the inverted technique with the traditional technique, characterized by initial removal of the ovaries followed by uterine resection, for evaluating the performance of the inverted OSH technique in cats. For this, 24 healthy, female cats, aged between 7 months and 5 years, with a body condition score of up to 6 points (9-point scale), divided into two equal groups: the traditional technique (TT) and the inverted technique (IT). Procedures were performed by the same veterinarians (surgeon and their assistant) as well as semi-quantitative analysis of the techniques (questionnaire related to the ease of uterine and ovarian manipulation as well as of intestinal and urinary vesicle manipulation) and descriptive qualitative analysis (technical report with the opinion of surgeons and an external evaluator). In addition, the total surgical time and positive pain response were evaluated, indicated by the changes in vital parameters observed by the anesthesiologist during surgery. Inverted technique it promoted greater ovarian exposure, allowing uterine cranial flexion to perform the ligatures, thus facilitating their manipulation, hemostasis, and section of the pedicle. Free the uterus from its ligaments to the abdominal cavity allowed greater mobilization of the conjoint. Both techniques required short operation time (average time of 16’± 1.321’ in the IT group and 15’± 0.525’ in the TT group). The presence of algetic stimulus was similar in the techniques, three animals in each group suffered analgesic rescue.
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