STOP PRESS: YUNNAN BAIYAO 95% effective Canine Pyometra Grade 1 and 2

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Hi All,

 

Great congratulations to Hector Sumano DVM, MD, PhD and his team.in

Mexico City Vet School for their research on AP and TCM! Bravo and Brava to

all!

 

In 2000, Hector's team published the results of a controlled trial of electro-AP

in

wobbler syndrome in dogs. Even though one might query the economics of

treating dogs with AP on 18-34 occasions, their clinical success was excellent

(85% from electro-AP versus 25% from conventional treatment!). See:

 

Dtsch Tierarztl Wochenschr. 2000 Jun;107(6):231-5. Treatment of wobbler

syndrome in dogs with Electro-AP. Sumano H, Bermudez E, Obregon K.

Department of Physiology and Pharmacology, School of Veterinary Medicine,

National Autonomous University of Mexico, Mexico-City, Mexico. Based on

favorable experiences with AP for the treatment of hind limbs paralysis, lumbo-

sacral alterations, and other spinal cord problems; a clinical trial, involving

40

dogs affected with wobbler syndrome was carried out. Patients were graded in

three categories according to the severity of each case and then randomly

divided in two groups. Both groups contained all three grades. Group 1 (20

dogs) was treated using orthodox medical and surgical interventions, while

Group 2 (20 dogs) were treated mainly with Electro-AP, and in few cases with

surgical intervention as well. The study was carried out in a three-year period.

AP treatments were given every other day delivering 150-300 mVolts at 125 Hz,

equivalents to approximately 20 microAmps, in ten AP points per treatment.

Deep needle insertion was used. Overall per cent success in Group I was only

20%, while in group II the corresponding value was 85%. The number of AP

treatments required to achieve full recovery in Group II was dependent upon the

severity of the case, as follows: Grade I: 18.5 +/- 2.5; Grade II: 25 +/- 5.4;

and

Grade III: 34 +/- 6.7 (r = 0.962). No adverse effects were observed with AP. The

use of this technique is proposed for large-scale clinical trials. Publication

Types: Clinical Trial Randomized Controlled Trial PMID: 10916938 [PubMed -

indexed for MEDLINE]

 

Now, Hector's group have struck gold again, this time with herbal medicine. A

paper in press to the Vet Record from his team will report spectacular results

(clinical recovery in 95% of cases) from Yunnan Baiyao oral powder in

pyometra in bitches.

 

This will be the FIRST scientific paper in print to show that Yunnan Baiyao is a

highly effective therapy in metritis/pyometra. It has implications for HUMAN

medicine also. PCOS?, salpingitis, metritis, etc?

 

There is no precedent for that in the human or animal literature! This will be

GREAT publicity for the value of herbal medicine in animals.

 

I understand that the abstact will be something like the following:

 

Veterinary Record 2004 (in preparation for publication): Successful treatment of

canine pyometra with Yun-Nan-Pai-Yao, a Chinese Herbal Preparation. Salgado

Brenda, Paramo Rosa & Sumano Hector. Sch Vet Med., National Autonymous

Univ of Mexico, Mexico City 04510, Mexico. SUMMARY: Considering that no

effective medical treatment for pyometra in bitches has been described to date,

and that the Chinese herbal preparation known as Yun-Nan-Pai-Yao could

possess some favourable pharmacological properties to resolve cases of

pyometra, a clinical trial was carried out. Patients were graded in three

severity

categories: (1) mild, (2) severe, and (3) very severe.Only patients graded 1 and

2 (20 cases) were included in this trial. Spontaneous remission of pyometra

does not occur. Hence, control groups with patients affected with pyometra and

treated with a placebo or left untreated, were regarded as unethical and,

therefore, were not included. The herbal preparation was administered orally at

an empirical dose, extrapolated from the manufacturer's recommendation for

humans and based on bodyweight as follows: 250 mg/bitch bid, tid, or qid, in

small, medium or large breeds, respectively. Giant breedsreceived 2 X 250 mg

capsules tid. All patients but one (19/20) recovered. Thus the overall clinical

efficacy was 95%. Time needed to full recovery was as follows: 3 weeks in 15

cases (75%) and 5 weeks in 4 cases (20%). There was a good correlation

between severity grading and number of weeks needed to full cure (r=0.975). No

side-effects could be detected. These results are unique and give clinicians the

rare opportunity to avoid ovariohysterectomy in pyometra-affected patients

 

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These are quite amazing results! Congratulations again! But I have one small

criticism, or query: Would Hector like to respond to this::

 

Is it accurate to say " Considering that NO EFFECTIVE medical treatment for

pyometra in bitches has been described to date ... " ?

 

I agree that canine pyometra, especially a severe closed case, usually has

been regarded as an obstetrical emergency (Biddle & Macintire, 2000). Such

cases usually are treated by surgical ovariohysterectomy (Nelson et al., 1982;

Hubler et al., 1991; Gabor et al., 1999; Trasch et al., 2003).

 

However, some workers suggest that hormonal treatment may be effective in a

high percentage of pyometra cases, especially mild cases, or those with an

open cervix. Hormonal treatments said to be effective included luteolytic drugs

-

PGF2-alpha - (Nelson et al., 1982; Hubler et al., 1991; Gabor et al., 1999; ),

aglepristone, an antigestagen (Hoffmann & Schuler, 2000; Trasch et al., 2003)

or combination of aglepristone + cloprostenol (Gobello eo al., 2003). However,

some side-effects of treatment were reported and pyometra recurred in some

bitches after the next oestrus.

 

I would be very interested to hear Hector's reply to my minor criticism.

Comments Hector?

 

Regardless of my nit-picking, Hector and his group deserve great praise for

their

work to bring AP and herbal medicine into mainstream Vet Med.

 

Best regards,

Phil

 

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REFERENCES ON WHICH MY COMMENTS WERE BASED:

 

Biddle D, Macintire DK. | Obstetrical emergencies. | Clin Tech Small Anim

Pract. 2000 May;15(2):88-93. | Department of Small Animal Surgery and

Medicine, Auburn University College of Veterinary Medicine, AL 36849, USA.

biddlde | This article discusses different techniques that

can be used in the diagnosis and treatment of obstetrical emergencies. Female

reproductive emergencies commonly encountered by small animal practitioners

include pyometra, dystocia, cesarean section, mastitis, eclampsia, uterine

torsion, and uterine prolapse. A thorough knowledge of normal and abnormal

reproductive behavior will aid the emergency veterinarian in successfully

managing such cases. Timely diagnosis and treatment of these emergencies

will often give a good outcome. | Publication Types: Review Review, Tutorial

PMID: 10998821 [PubMed - indexed for MEDLINE]

 

Gabor G, Siver L, Szenci O. | Intravaginal PGF2-alpha for the treatment of

metritis and pyometra in the bitch. | Acta Vet Hung. 1999;47(1):103-8. |

Research Institute for Animal Breeding and Nutrition, Gesztenyes u., Hungary. |

The purpose of this study was to determine whether intravaginal PGF2-alpha

would be effective for the treatment of metritis or pyometra in the bitch. 17

bitches with metritis or pyometra were treated with PGF2 alpha. PGF2-alpha

(150 ug/kg BW) was administered once or twice daily by infusing 0.3 ml/10 kg

body wt into the vaginal lumen. Bitches were also treated with amoxicillin (15

mg/kg body wt/48 h) and/or gentamicin (4 mg/kg body wt/day) administered as

intramuscular (i.m.) injections. 15 bitches were treated successfully with

intravaginal PGF2-alpha for 3 to 12 days and with intramuscular antibiotics for

4

to 12 days. Success of treatment was judged by cessation of vaginal

discharge, the absence of fluid in the uterus as determined by ultrasonography,

and the overall health status of the animal. As 2 bitches with pyometra showed

clinical deterioration in spite of medical treatment, ovariohysterectomy was

performed after the first and the second treatment, respectively. No side

effects

(salivation, vomiting, diarrhoea, hyperpnoea, ataxia, urination, anxiety,

pupillary

dilatation followed by contraction) were observed after PGF2-alpha treatment.

The disease did not recur during the subsequent oestrous cycles within 12

months after the initial treatment. Conclusion: Intravaginal administration of

PGF2-alpha was effective in 13 dogs (86.6%) with metritis or pyometra, and

caused no side effects. Although there were relatively few cases, PGF2-alpha

can be useful to treat bitches with metritis or pyometra. However,

ovariohysterectomy is needed in severe cases of pyometra. | PMID: 10213934

[PubMed - indexed for MEDLINE]

 

Gobello C, Castex G, Klima L, Rodriguez R, Corrada Y. | A study of two

protocols combining aglepristone and cloprostenol to treat open cervix

pyometra in the bitch. | Theriogenology. 2003 Sep 15;60(5):901-8. | Small

Animal Clinic, Faculty of Veterinary Medicine, National University of La Plata,

CC 296, La Plata B1900 AVVW, Argentina. cgobello | To

compare the efficacy and safety of two protocols using a combination of

aglepristone and cloprostenol for the treatment of open cervix pyometra in the

bitch and to describe the progesterone (P4) serum profiles before and during

treatments, 15 bitches were randomly allocated into two treatment groups:

Group 1 (n = 8): aglepristone was administered at 10mg/kg, s.c., on Days 1, 3,

8, and 15 (if not cured), combined with cloprostenol at the dose of 1 ug/kg,

s.c.,

on Days 3 and 8, and II (n = 7): : Group 2 received the same treatment with

aglepristone as Treatment I but cloprostenol on Days 3, 5, 8 10, 12, and 15 (if

not cured). Before the beginning of the treatments and then on Days 8, 15, and

29 all bitches were evaluated for clinical signs, side effects, hemogram, serum

P4 concentrations, and uterus diameters. Bitches in both treatment groups,

with (n = 6) or without (n = 9; > or =1.2 ng/ml) initial basal P4 serum

concentrations, achieved treatment success without side effects and no

significant differences, either on Day 15 (6/8 for Treatment I and 4/7 for

Treatment II) or on Day 29 (2/8 for Treatment I and 3/7 for Treatment II). In

both

treatments groups, clinical signs, blood parameters, and uterine diameters

improved to normal values throughout the experiments. A significant interaction

between day and treatment was found for percentage change in P4 when all

bitches were considered together. Pyometra recurred in the next estrous cycle

in 20% of the bitches. One nonrecurrent bitch was mated and whelped a normal

litter. Combined treatment with aglepristone and cloprostenol was efficient and

safe in reversing clinical signs of open cervix pyometra independently of

initial

P4 concentrations and that the number of cloprostenol administrations seemed

to have an effect on P4 serum changes throughout treatments. | Publication

Types: Clinical Trial Randomized Controlled Trial PMID: 12935867 [PubMed -

indexed for MEDLINE]

 

Hoffmann B, Schuler G. | Receptor blockers - general aspects with respect to

their use in domestic animal reproduction. | Anim Reprod Sci. 2000 Jul 2;60-

61:295-312. | Klinik fur Geburtshilfe, Gynakologie und Andrologie der Gross-und

Kleintiere mit Tierarztlicher Ambulanz der Justus-Liebig-Universitat Giessen,

Frankfurter Strasse 106, D-35392, Giessen, Germany.

bernd.hoffman | Receptor blockers compete with the

respective agonist for binding to a given receptor without inducing complete

signal transduction. In recent years, major interest has focused on sex-steroid

hormone receptor blockers (antagonists). Indications have been obtained that

inadequate changes in receptor conformation and subsequent failure of

transcriptional activation are major events preventing hormonal activity.

However, various subtypes and variants of receptors and receptor mutations

have also been identified. Expression of antihormonal effects may vary

depending on the type of receptor the blocker is bound to. Hence, receptor

blockers may also have an inherent agonistic activity. Aglepristone is the first

antiprogestin registered for veterinary use with the indication " interruption or

prevention of pregnancy " ; similarly, these types of compounds were

successfully used for induction of parturition in the dog and cat and for

conservative treatment of pyometra in the dog. Moreover, application of

antiprogestins has clearly demonstrated the role of progesterone as a major

factor controlling overt pseudopregnancy in dogs. With respect to farm animals,

parturition was induced in cows without an increased incidence of retained fetal

membranes. Other than antiprogestins, antioestrogens and antiandrogens are

still in a more experimental phase. In particular for use in humans,

high-affinity

blockers binding to the oxytocin/vasopressin receptor are in development; they

exert distinct tocolytic activities. Also, the release of GnRH can be inhibited

by

respective antagonists; however, their use in reproduction is still hampered by

the high dose requirement and the side effects observed. | Publication Types:

Review Review, Tutorial PMID: 10844202 [PubMed - indexed for MEDLINE]

 

Hubler M, Arnold S, Casal M, Fluckiger M, Hauser B, Corboz L, Rusch P. |

[use of a low dose PGF2-alpha in bitches] [Article in German] | Schweiz Arch

Tierheilkd. 1991;133(7):323-9. | Klinik fur Geburtshilfe, Jungtier- und

Euterkrankheiten, Universitat Zurich. | Up to now, the dose of PGF2-alpha (100,

250 and 1000 ug/kg BW) to treat pyometra in the bitch caused with side effects

such as salivation, vomiting and diarrhea. In the present work, the efficiency

of

low dose PGF2-alpha (20 ug/kg BW) was examined in two different groups of

patients: Group 1: Included 9 bitches pregnant for a period of 5-7 weeks

duration. Initially the bitches were treated 3-4 times/d with PGF2-alpha. In

these cases abortion took place within 4-11 days. Group 2: 12 dogs, suffering

from pyometra, were treated 3 times/d with PGF2-alpha for 8 days. The

pyometra resolved in 9/12 cases and the bitches came in estrus 2-5 months

after treatment. 7 bitches have been mated and 6 of these gave birth to healthy

litters. During a follow-up period of at least 10 months there has not been a

reoccurrence of pyometra. The uteri were still enlarged in 3/12 dogs after 8

days of treatment. These bitches underwent ovariohysterectomy and a cystic

hyperplasia of the endometrium was diagnosed histologically. The low dose (20

ug/kg BW) PGF2-alpha induced in all dogs the expulsion of the uterine

contents. Side effects during the treatment were not observed. | PMID: 1962176

[PubMed - indexed for MEDLINE]

 

Nelson RW, Feldman EC, Stabenfeldt GH. | Treatment of canine pyometra and

endometritis with PGF2-alpha. | J Am Vet Med Assoc. 1982 Nov 1;181(9):899-

903. | | 17 bitches with pyometra or postpartum endometritis were treated with

PGF2-alpha. Response to treatment included cessation of uterine discharge,

decrease in uterine diameter, reduction in plasma progesterone concentration,

and return of a normal leukogram. Treatment was successful in 14/17 bitches,

and 13 subsequently experienced estrus. Of those, 11/13 were bred and 9/11

became pregnant. In 2 bitches, pyometra developed again, within 6 weeks of

the following estrus, illustrating that bitches so affected are susceptible to

recurrence of the disease. Of bitches with closed cervix, 1/4 failed to respond

to

treatment, and 2/4 bitches with closed cervix required ovariohysterectomy

shortly after instituting treatment. | PMID: 7141988 [PubMed - indexed for

MEDLINE]

 

Trasch K, Wehrend A, Bostedt H. | Follow-up examinations of bitches after

conservative treatment of pyometra with the antigestagen aglepristone. | J Vet

Med A Physiol Pathol Clin Med. 2003 Sep;50(7):375-9. | Clinic for Obstetrics,

Gynaecology and Andrology of Large and Small Animals, Justus-Liebig

University, Giessen, Germany. katjatrasch | The aim of this study

was to determine the therapeutic success of the medical treatment of canine

pyometra with the antigestagen aglepristone and to document the recurrence

rate in relation to the time interval after treatment with antigestagens. In 48

(92.8%) of the 52 treated bitches, healing could be achieved within the first 3

weeks after the treatment had been started. One bitch died as a result of renal

insufficiency; in three bitches there was no emptying of the uterus, so

ovariohysterectomy became necessary. In these three patients, ovarian and

endometrial cysts were present. Forty-one bitches could be followed up for 3

months. 4 animals developed a recurrence (9.8%). In three bitches ovarian

cysts and cystic endometrial hyperlasia could be found intra operationem. The

development of 37 bitches could be followed for at least 1 year. 7 animals

developed a pyometra again (18.9%). Two received a repeated treatment with

aglepristone and have been free from recurrence for over 12 months. In 37

animals data on the subsequent sex cycles are available. In 22 bitches next

heat started at the expected time, in 7 animals heat started too early. In 8

bitches the period of anoestrus was prolonged. 5/6 bred bitches delivered at

least one litter. Treatment of pyometra by aglepristone results in a high

healing

rate. The recurrence rate can be minimized by the selection of bitches without

ovarian cysts and cystic endometrial hyperplasia. | PMID: 14633233 [PubMed -

indexed for MEDLINE]

 

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Best regards,

 

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