Sütçü İneklerde Rektal Palpasyon, Ultrasonografik ve Endokrinolojik Muayene (Plazma Progesterin) Yöntemleri ile Ovaryum Kistlerinin Ayırıcı Tanısı
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2000
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info:eu-repo/semantics/openAccess
Özet
Sunulan çalışmada sütçü ineklerde ovaryum kistlerinin ayırıcı tanısı amacıyla uygulanan rektal palpasyon ve ultrasonografık muayene yöntemlerinin etkinliği plazma progesteron düzeyleri esas alınarak değerlendirildi.Çalışmanın materyalini, tamamı bir doğum yapmış, postpartum dönemin 45-150. günleri arasında bulunan Holstein ırkı 270 baş inekte, rektal palpasyon ve ultrasonografık muayene yöntemleriyle ovaryum kisti tanısı konulan 14 baş inek oluşturdu. Sürüde bulunan tüm hayvanlara önce 10 gün arayla iki kez rektal palpasyon uygulandı. Ovaryumlar üzerinde çapları tahmini olarak 2.5 cm ve daha büyük çaplı, içi sıvı dolu düzgün dışbükey yapılar ile ovaryum üzerinde çok sayıdaki daha küçük çaplı, fazla sayıda kompartımanlı olarak algılanan, ince çeperli, fluktuan dışbükey yapılar ovaryum kisti olarak değerlendirildi. İnce çeperli, bir veya birden fazla sayıda kompartımanlı dışbükey fluktuan yapılar folliküler; kalın çeperli dışbükey fluktuan yapılar ise luteal kist olarak değerlendirildi.Ultrasonografık muayeneler, rektal muayeneleri takiben B-model, linear array, 5 MHz'lik rektal probu bulunan real-time ultrason (Scanner 480 Vet, Pie Data Medical, Maastrich, Netherlands) ile gerçekleştirildi. Ultrasonografık muayenelerde ovaryum üzerindeki 2.5 cm ve daha büyük çaplı, çeperi ekojen, antrumu ise nonekojen ya da nonekojen alanda hipoekojen odakların bulunduğu görüntü elde edilen yapılar ile fazla sayıda kompartımanlı ve antrumları nonekojen görüntü veren oluşumlar ovaryum kisti olarak değerlendirildi. Olguların ayırımları ise, ekojen görüntü veren çeper kalınlığı ile antruınların ekojenitesine göre yapıldı. Çeper kalınlığı 0.30 cm'den daha küçük ve antrumları nonekojen olanlar folliküler. çeper kalınlığı 0.30 cm'den daha büyük ve/veya nonekojen antrumda hipoekojen görüntü alınanlar ise luteal kist olarak değerlendirildi.Endokrinolojik muayenede plazma progesteron düzeyleri 0.5 ng/ml olanlar folliküler, 0.5 ng/ml olanlar luteal, kist olarak değerlendirildi. Endokrinolojik muayene bulguları esas alınarak rektal palpasyonda % 57, ultrasonografık muayenede % 64 doğru tanı konuldu. Rektal palpasyon ve ultrasonografik muayene yöntemlerinin birbirine uygunluğu % 78.5 olarak bulundu. Rektal palpasyon ve ultrasonografik muayene yöntemlerinin duyarlılık ve özgüllük oranlan da sırasıyla % 83, 37.5 ve % 83, 50 olarak belirlendi (p 0.05).Sonuç olarak; ineklerde kistik ovaryum olgusu tanısının pratik ve eski bir yöntem olan rektal palpasyon ve son yıllarda sık olarak yararlanılan ultrasonografik muayene yöntemi ile ortaya konulabildiği, ancak ayırıcı tanıda rektal palpasyonun yetersiz olduğu belirlenmiştir. Buna karşın ultrasonografik muayene sonuçlan da operatör, kullanılan frekans, çevre ve hayvana bağlı olarak değişebilmektedir. Dolayısıyla ovaryum kistlerinin ayırıcı tanısının plazma progesteron düzeyi ile desteklenmesi gerektiği kanısına varılmıştır.
The accuracy of rectal palpation and ultrasonographic examination for differential diagnosis of ovarian cysts based on progesterone levels in dairy cows were determined.A total of 270 Holstein cows which gave a birth once were examined twice in a 10 day interval by rectal palpation and transrectal ultrasonography for the presence of ovarian cysts. Of which fourteen cows, between 45-150 days of postpartum with one or more follicle-like fluid filled structures larger than 2.5 cm one of the ovaries were diagnosed as ovarian cysts. The cysts which consist of thin walled one or more follicle-like structures were classified as follicular, however, firm and thick walled ones were regarded as luteal cysts.The ultrasonographic examinations were performed by a real-time, B-mode, linear-array, 5-7.5 MHz rectal probe (Scanner 480 Vet, Pie Data Medical, Maastrich, Netherlands). The circular structures larger than 2.5 cm in diameter with echogenic, nonechogenic or hypoechogenic character in sonograms were regarded as ovarian cysts. The multiple structures smaller than 2.5 cm in diameter with nonechogenic and hypoechogenic foci in the antrum were diagnosed as cystic ovaries. The differential diagnosis of follicular and luteal cysts were done based on the echogenic thickness of the cyst wall and presence or absence of nonechogenic, echogenic and hypoechogenic foci in the cyst antrum. The cysts with a cyst wall thinner than 0.30 cm with hypoechogenic antrum were diagnosed as follicular cysts. The cysts which is surrounded by a cyst wall thicker than 0.30 cm with nonechogenic or echogenic foci in the nonechogenic antrum were diagnosed as luteal cysts.Based on the results of endochrinologic examinations, plasma progesterone levels lower than 0.5 ng/ml were classified as with follicular cysts, however, those which has progesterone levels higher than 0.5 ng/ml were diagnosed as with luteal cystic degeneration. Accuracy rates of rectal palpation and ultrasonographic examination for the differential diagnosis of follicular and luteal cysts (based on endochrinologic examinations) were 57 and 64 % respectively. Seventyfive percent of confirmation was found between the rectal palpation and ultrasonographic examinations on the diagnosis of ovarian cysts. Sensitivity and spesifity of the rectal palpation and ultrasonography were 83, 37.5 and 83, 50 % respectively (p>0.05)..As a result, both diagnostic methods employed in the present study as rectal palpation and trans-rectal ultrasonography was concluded that rectal palpation was found to be insufficient for the differential diagnosis of follicular and luteal cysts. However ultrasonographic results could be affected by operator, frequency of the device along with animal and environmental factors. Therefore differential diagnosis of ovarian cyst should be supported by evaluation of progesterone levels.
The accuracy of rectal palpation and ultrasonographic examination for differential diagnosis of ovarian cysts based on progesterone levels in dairy cows were determined.A total of 270 Holstein cows which gave a birth once were examined twice in a 10 day interval by rectal palpation and transrectal ultrasonography for the presence of ovarian cysts. Of which fourteen cows, between 45-150 days of postpartum with one or more follicle-like fluid filled structures larger than 2.5 cm one of the ovaries were diagnosed as ovarian cysts. The cysts which consist of thin walled one or more follicle-like structures were classified as follicular, however, firm and thick walled ones were regarded as luteal cysts.The ultrasonographic examinations were performed by a real-time, B-mode, linear-array, 5-7.5 MHz rectal probe (Scanner 480 Vet, Pie Data Medical, Maastrich, Netherlands). The circular structures larger than 2.5 cm in diameter with echogenic, nonechogenic or hypoechogenic character in sonograms were regarded as ovarian cysts. The multiple structures smaller than 2.5 cm in diameter with nonechogenic and hypoechogenic foci in the antrum were diagnosed as cystic ovaries. The differential diagnosis of follicular and luteal cysts were done based on the echogenic thickness of the cyst wall and presence or absence of nonechogenic, echogenic and hypoechogenic foci in the cyst antrum. The cysts with a cyst wall thinner than 0.30 cm with hypoechogenic antrum were diagnosed as follicular cysts. The cysts which is surrounded by a cyst wall thicker than 0.30 cm with nonechogenic or echogenic foci in the nonechogenic antrum were diagnosed as luteal cysts.Based on the results of endochrinologic examinations, plasma progesterone levels lower than 0.5 ng/ml were classified as with follicular cysts, however, those which has progesterone levels higher than 0.5 ng/ml were diagnosed as with luteal cystic degeneration. Accuracy rates of rectal palpation and ultrasonographic examination for the differential diagnosis of follicular and luteal cysts (based on endochrinologic examinations) were 57 and 64 % respectively. Seventyfive percent of confirmation was found between the rectal palpation and ultrasonographic examinations on the diagnosis of ovarian cysts. Sensitivity and spesifity of the rectal palpation and ultrasonography were 83, 37.5 and 83, 50 % respectively (p>0.05)..As a result, both diagnostic methods employed in the present study as rectal palpation and trans-rectal ultrasonography was concluded that rectal palpation was found to be insufficient for the differential diagnosis of follicular and luteal cysts. However ultrasonographic results could be affected by operator, frequency of the device along with animal and environmental factors. Therefore differential diagnosis of ovarian cyst should be supported by evaluation of progesterone levels.
Açıklama
Anahtar Kelimeler
ovarian cysts, rectal palpation, ultrasonography, plasma progesterone, cows, Ovaryum kisti, rektal pal pas yon, ultrasonografi, plazma progesteron, İnek
Kaynak
Hayvancılık Araştırma Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
10
Sayı
1-2
Künye
Yenice, M., Tekeli, T., Erdem, H., (2000). Sütçü İneklerde Rektal Palpasyon, Ultrasonografik ve Endokrinolojik Muayene (Plazma Progesterin) Yöntemleri ile Ovaryum Kistlerinin Ayırıcı Tanısı. Hayvancılık Araştırma Dergisi, 10(1-2), 57-62.
