Clinical outcomes of suspected ischemic myelopathy in cats

Ischemic myelopathy is a disorder of acute onset that is characterized by nonprogressive paresis/plegia. Magnetic resonance imaging (MRI) is particularly helpful in supporting the antemortem diagnosis of ischemic myelopathy. Cats, which were suspected to have ischemic myelopathy between 2005 and 2008, were reviewed retrospectively. The acute onset of nonprogressive and nonpainful myelopathy, the conduct of spine MRI, and the availability of complete medical records were included in the inclusion criteria. The presumptive diagnosis was based on medical history as well as clinical, cerebrospinal fluid, and MRI findings. Six cats met the inclusion criteria based on medical records that had been made for about 3 years, and had relatively good prognoses. The less number of patients with ischemic myelopathy has been reported in cats than in dogs. However, the number of cats with ischemic myelopathy in clinical settings appears to be greater than previously considered.

Fibrocartilaginous embolism of the spinal cord diagnosed by characteristic clinical findings and magnetic resonance imaging in 26 dogs

Fibrocartilaginous embolism (FCE) is a disorder of acute onset that presents with nonprogressive ataxia. We performed a retrospective examination of FCE of the spinal cord diagnosed by characteristic clinical findings and magnetic resonance imaging (MRI) in 26 dogs. In the present study, treatment consisting of physiotherapy alone, or this in combination with corticosteroid administration, was initiated immediately following diagnosis of FCE. Age at onset and the gender ratio in the present study closely correlated with those previously reported. In the present study, 88% of the dogs that developed FCE were small- to medium-sized, which is different from previously reported studies. There is a possibility that FCE also develops relatively frequently in small- to medium-sized dogs. No significant difference was observed between the physiotherapy alone and the physiotherapy and corticosteroids groups of dogs. FCE development has been reported predominantly at the vertebral levels C6-T2 and L4-S3 and less frequently at C1-5 and T3-L3. However, in the present study, FCE developed predominantly at T3-L3. FCE developed at T3-L3 or C1-5 in 69% of the cases in the present study, suggesting that there is relatively frequent development of FCE at these vertebral levels. The recovery time of T3-L3 was the shortest (10.2 +/- 7.4 days), and that of C1-5 was next-shortest (15.8 +/- 5.4) in this study. This suggested the possibility that the detection ratio of cases was low, because the symptoms in cases of FCE that has developed in C1-5 and T3-L3 would have improved before inspection in the secondary institution, where the MRI and diagnosis were performed.

Usefulness of an early diagnosis for the favorable prognosis of fibrocartilaginous embolism diagnosed by magnetic resonance imaging in 10 small- to middle-sized dogs

Fibrocartilaginous embolism (FCE), a disorder of rapid onset featured by nonprogressive paralysis and paresis of four legs, shows clinical symptoms very similar to those of other disorders, e.g., disk herniation. We examined 10 animals diagnosed with FCE based on clinical symptoms and magnetic resonance imaging (MRI) findings in a retrospective study to examine the relationship between onset-to-diagnosis/treatment initiation time and prognosis of FCE. Statistical procedures, including Fisher's exact probability test, were conducted. All animals in a group, in which the diagnosis was made and treatment was initiated after an elapse of <15 days after onset, showed improved symptoms; the group showed a positive correlation (r = 0.76) between "onset-to-symptom improvement time" and "onset-to-diagnosis/treatment initiation time". Furthermore, the mean onset-to-diagnosis/ treatment initiation times were 2.67 days and 10.25 days in groups without and with sequelae, respectively; the time was significantly (P < 0.02) shorter in the group without sequelae. A significant difference was found between the groups in early diagnosis and treatment initiation. Our study indicates that the early precise diagnosis for acutely developed paralysis and paresis of four legs through testings including MRI, as well as the early onset of their treatment are important to obtain a favorable prognosis.

[The relationships of sex hormone binding globulin (SHBG) with high density lipoprotein cholesterol and fasting insulin in healthy men]

The relationships of sex hormone binding globulin (SHBG) with high density lipoprotein cholesterol (HDL-C) and fasting insulin (IRI) were investigated in healthy employed men (n = 235). In simple correlation analysis, the SHBG was positively related to total cholesterol and HDL-C, and negatively related to IRI. There were no relationships among SHBG, triglyceride and fasting blood glucose. In multiple linear regression analysis, SHBG was one of determinant of HDL-C, but not IRI. From these results, it was suggested that SHBG was one of the determinants of HDL-C level in healthy men.

[An unusual association of transient resolving thyrotoxicosis due to painless thyroiditis, hypopituitarism and central diabetes insipidus associated with spontaneous pituitary apoplexy]

Pituitary apoplexy is characterized by a wide spectrum of clinical features. A quite rare case of painless thyroiditis, hypopituitarism and central diabetes insipidus (DI) followed by pituitary apoplexy was presented. A 61-year-old woman was admitted to our hospital in May, 1986 because of marked general malaise, polydipsia and weight loss which became progressively worse. Four months earlier she had experienced episodes of abrupt onset of severe headache associated with nausea and blurring vision. Physical examinations revealed a fine tremor, dry skin and nervousness. The thyroid gland was not palpable. Visual fields were intact. Her blood pressure was 105/64 mmHg with variable tachycardia. The routine laboratory studies were normal or negative except for hypoalbuminemia, hypocholesterolemia and hypernatremia. Erythrocyte sedimentation rate was 12 mm/hr. An impairment in corticotropin secretion was suspected from the low plasma cortisol and the low urinary excretion of 17-OHCS and the sufficient response to ACTH. Basal levels of GH and gonadotropin were also low, and responses to the stimulation tests (Insulin-stress, L-DOPA, and LH-RH) were all blunted. Brain computed tomographic scan and magnetic resonance imaging demonstrated a suprasellar mass that, after infusion, developed peripheral ring-like enhancement and large hyperintense pituitary mass, respectively. A diagnosis of pituitary apoplexy with anterior pituitary failure was made. However, the initial levels of thyroid hormones showed elevated as follows: Free T3 7.6 pg/ml, Free T4 3.3 ng/dl and T3-resin uptake 41.1%. TSH responses to TRH were all suppressed. TSH receptor antibody (TBII) was negative. Both antithyroglobulin and antimicrosomal antibodies were repeatedly positive. A thyroid scan with 99mTc revealed no uptake in the thyroid area. These findings led us to the diagnosis of "painless autoimmune thyroiditis". She had become hypothyroid without any medication. At that time radioactive 99mTc and 123I uptakes increased significantly. When hydrocortisone was substituted, daily urine output abruptly increased to about 10 liters with low osmolality, and the presence of DI was suspected. This diagnosis was confirmed by water deprivation and hypertonic saline infusion tests and subsequent pitressin test. She is currently quite well on L-thyroxine, hydrocortisone and desmopressin (1988). This association with pituitary apoplexy must be a rare occurrence, as a literature search has failed to find a similar case. The pathogenetic trigger of "painless thyroiditis" in this case may be responsible for some immunological change due to secondary adrenal insufficiency after pituitary apoplexy.

Topical application of the hypoglycemic agent glibenclamide and changes in blood glucose, plasma insulin (IRI) levels and plasma concentration of glibenclamide in normal rats

This study was done to determine whether an oral hypoglycemic agent would be absorbed through the skin and consequently lower blood glucose levels. We applied 250 mg or 500 mg of 5% glibenclamide ointment (GO) to the cleanly shaved dorsa (5 x 10 cm) of overnight-fasted male Wistar rats, weighing 250-300 g. Blood samples were collected at 1, 3, 6, 12 and 24 h after the application of GO and blood glucose, plasma insulin (IRI) and the plasma concentration of glibenclamide were determined. The plasma concentration of glibenclamide reached a high level as early as 1 h after application and the level was maintained for 24 h. The plasma concentration of glibenclamide in the 500-mg GO group was higher than in the 250-mg GO group, but even 24 h after application the 250-mg GO group showed a mean value of 206 ng/ml. Mean blood glucose levels in both GO groups at every time point after application were significantly lower than in the control group; with respect to mean IRI levels the opposite was found. Thus, glibenclamide is absorbed through the skin and reaches a level of plasma concentration which induces significant changes in blood glucose and IRI levels. This may well be a new approach to controlling blood glucose levels in patients with diabetes mellitus.