Posted on Saturday, September 10, 2011 - 10:37 pm:
My friend with the mare that was in foal at the 15 days was not in foal at the 30 day scan (did the same thing a few years ago with frozen semen) brought her over to tease to my boys a few days ago. He wants to make sure she clean and ready to breed in the spring. The mare is coming into heat so he made an appointment with the vet's office for Monday to have a cytology/culture done, office manager says yes they can do a cytology.
The vet texted mare owner and says "No, but I would say let's do an ultra sound followed by a low-volume lavage and culture of recovery fluid (industry standard for diagnosing low-grade infection). If we don't get any growth on the culture, I would say the next step would be to do a uterine biopsy to see if we are losing embryos due to periglandular fibrosis."
Does this sound like the right thing to do? The mare has not had a cytology yet, should he skip the cytology and go a head and do the low-volume lavage/culture? Or cancel the appointment and take the mare to the UF vet school?
Posted on Saturday, September 10, 2011 - 11:43 pm:
I like cytologies (or biopsies). The low-volume lavage is a good idea too, as that has been demonstrated as being more accurate in identifying pathogenic presence than a swab, but I'd still run a cytology on some of the harvested cellular material as well if possible. Following up with a biopsy is not a bad idea, although loss at 30 days or less is a little early to be specifically related to fibrosis, as issues related to that problem usually manifest around the time of placentation or later (>~40 days) - but never say never!!
With cytology you are looking for inflammatory cells - especially neutrophils. Although endometritis (inflammation of the lining of the uterus) is brought about by pathogen presence, which would be likely to be picked up in the culture of the centrifuged lavage fluid, it may also be caused by non-infection activity. The finding of inflammatory cells in the cytology with the absence of pathogen in the culture would therefore suggest the presence of some other irritant that needs to be sought out and dealt with. For example the tip of a culture swab might have come off in the uterus during a prior swabbing, which would cause irritation, but would not show up on a culture (although it might be caught in the lavage fluid!! ).
The way I see it, you're already in there, you already have the sample, and it takes only a few minutes and minimal equipment and cost to run a cytology smear, so why not gather all the diagnostic information you can?
The fluid from the low volume lavage was sent to UF Vet School on 9/16, finally got the results today (9/27) of the culture but still waiting for the expert to read the biopsy.
Text from the vet: "The culture resulted in growth of Corynebacterium, may easily be a contaminate so hesitant to interpret without the biopsy results."
They decided to do the cytology from the tissue taken for the biopsy instead of centrafuging the cells out of the fluid from the lavage. How big of a sample do they usually take for a biopsy, this sample was about an inch across, is that normal?
Over at UF vet school they don't seem to be in a hurry to let us know what is going on, it has been 11 days and only have the culture results, very disappointed. Hope we get all the result back soon so if she needs treating we don't miss her next heat cycle.
If they're doing a biopsy, it is perfectly reasonable to not do the cytology, as the biopsy results will show the same as the cytology, and more.
I agree with the summary on the Corynebacterium. It is commonly present in nature, so a likely contaminant.
An endometrial biopsy sample is usually taken with alligator forceps, which will remove a piece of endometrium that is only about a ¼" - ½" cubed. It doesn't take very much.
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