Objective—To determine whether short-term amitriptyline
administration would be efficacious in the treatment
of acute, nonobstructive, idiopathic lower urinary tract
disease in cats.
Design—Randomized controlled trial.
Animals—31 untreated male and female cats with acute,
nonobstructive, idiopathic lower urinary tract disease.
Procedures—Cats were treated with amitriptyline (5
mg/d; n = 16) or a placebo (15) for 7 days and monitored
for pollakiuria, hematuria, and adverse events.
Cats were reexamined 1 month after treatment, and
owners were interviewed by telephone 6, 12, and 24
months after treatment.
Results—2 amitriptyline-treated cats were excluded
from analyses because of acquired urinary tract infection.
Clinical signs resolved by day 8 in 8 amitriptylinetreated
and 10 control cats. There were no apparent differences
in likelihood or rate of recovery from pollakiuria
or hematuria between groups. Overall, clinical signs
recurred significantly faster and more frequently in
amitriptyline-treated than control cats. However, after
excluding recurrences within 21 days of treatment, risk
of recurrence was similar in both groups. Increasing age
was significantly associated with increased likelihood
and rate of recovery from hematuria and with decreased
risk of recurrence of signs.
Conclusions and Clinical Relevance—Results suggest
that short-term amitriptyline treatment has no
benefit in terms of resolution of pollakiuria and hematuria
in cats with idiopathic lower urinary tract disease
and may be associated with an increased risk of
recurrence. (J Am Vet Med Assoc 2003:222:749–758)
A client-owned 12-year-old 10.3-kg (22.7-lb) female shusui koi (Cyprinus carpio) was evaluated because of an ulcerated mass on the left body wall, hyporexia, and decreased activity.
The patient was anesthetized with a solution of eugenol in water for all examinations and procedures. An approximately 7 × 5-cm smooth, raised, ulcerated, and firm mass was present ventral and lateral to the dorsal fin on the left body wall. Whole-body CT images obtained before and after contrast administration revealed an encapsulated, homogeneous, fat-opaque mass within the muscle. The mass was fat echoic with poor vascularity on ultrasonographic examination. Histologic evaluation of an ultrasound-guided needle biopsy specimen was suggestive of a lipoma.
TREATMENT AND OUTCOME
The mass was excised, and the fish was placed in water with 0.3% salinity for 3 weeks after surgery. Postoperative antimicrobial administration was not indicated, and additional postoperative analgesic administration was considered impractical. The patient had noticeable improvement in appetite and activity with no indication of discomfort immediately following surgery. Five weeks after surgery, the incision site had healed with minimal scarring, and evaluation of CT images revealed no evidence of mass regrowth or regional osteomyelitis.
Antemortem evaluation and diagnosis of a lipoma in a teleost with subsequent excision was described. This report highlighted the logistic challenges associated with anesthesia, advanced diagnostic imaging, and surgery in fish and showed that they can be successfully overcome so that high-level medical care can be provided to such patients.
3 dogs were examined because of a sudden onset of signs of pain (1 dog) or paraparesis (2 dogs).
Neurologic findings consisted of myelopathy affecting the lumbar intumescence (1 dog) and T3-L3 myelopathy (2 dogs). In all dogs, MRI revealed spinal cord compression caused by L3-4 disk herniation. All dogs underwent routine surgical decompression of the intervertebral disk herniation. During MRI and decompressive surgery, physiologic variables were monitored. Immediately after surgery, all dogs were paraplegic with pelvic limb neurologic dysfunction consistent with myelopathy affecting the L4 through caudal spinal cord segments.
TREATMENT AND OUTCOME
Within 24 hours after surgery, repeated MRI in all dogs revealed hyperintensity in the spinal cord gray matter of the lumbar intumescence on T2-weighted images. In the absence of neurologic improvement, dogs were euthanized at 3, 91, and 34 days after surgery. Postmortem microscopic examination of each dog's spinal cord at the lumbar intumescence revealed necrosis of the gray matter with relative white matter preservation suggestive of an ischemic injury.
Dramatic neurologic deterioration following decompressive surgery for intervertebral disk herniation in dogs may be associated with the development of poliomyelomalacia secondary to ischemia. In these 3 dogs, ischemia developed despite probable maintenance of normal spinal cord blood flow and perfusion during anesthesia. To exclude other causes, such as compression or hemorrhage, MRI was repeated and revealed hyperintensity of the spinal cord gray matter on T2-weighted images, which microscopically corresponded with ischemic neurons and neuronal loss.