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Intubation complication in a rabbit

15 Apr, 16 | by gmills

By Daniel Pang

A report of an unexpected and novel anaesthetic complication in a rabbit, the presence of faecal matter in the oropharynx impeding attempts at intubation, was recently published in Veterinary Record Case Reports.

The incidence of anaesthetic-­ and sedation-­related mortality in apparently healthy rabbits is 1.4 per cent, six to eight times greater than in dogs or cats, and respiratory complications represent a substantial fraction of these deaths.

Unfortunately, undiagnosed respiratory disease and hypoventilation due to anaesthetic agents can cause significant respiratory depression. Endotracheal intubation provides a secure airway, facilitating positive pressure ventilation, reducing the risk of fluid aspiration and limits workplace pollution with anaesthetic gases. However, many rabbits are maintained anaesthetised with a face mask, rather than secure airway, because they are challenging to intubate. They have a relatively large tongue, narrow oral cavity and small glottis, which combine to limit visibility of, and access to, the larynyx. Simpler, novel methods of securing an airway such as supraglottic airway devices (eg, Laryngeal Mask Airway, V­Gel) have shown promise in clinical use.

A healthy, adult New Zealand white rabbit was anaesthetised for a CT scan as part of a larger study evaluating different methods of providing a secure airway to facilitate ventilation. Following induction of general anaesthesia (intramuscular dexmedetomidine and midazolam, followed by intravenous alfaxalone), the rabbit was positioned in sternal recumbency and orotracheal intubation with an endotracheal tube was attempted with a blind technique. Initial attempts at intubation by an experienced anaesthetist were unsuccessful, with intubation finally achieved after five minutes. This contrasted with an average of two minutes to perform intubation in similar rabbits by the same anaesthetist.

The study protocol required CT scans of the oropharynx to be performed before and after intubation. These ‘pre’ and ‘post’ scans allowed us to identify the cause of the difficult intubation: faecal matter present in the oropharynx before intubation, which was pushed caudally to cause a physical obstruction during attempted intubation (Fig 1). This was also confirmed at postmortem examination.

pang pic

FIG 1: CT images (sagittal plane) of a three-month-old New Zealand White rabbit pre-intubation (top) and post-intubation (bottom) with a 2.5 mm ID endotracheal tube. The pre-intubation image shows two areas containing material of mixed gas and soft tissue attenuation. These were confirmed as faecal material at necropsy examination – a discrete faecal pellet in the oral cavity (orange arrow) and dispersed faecal material in the caudal oropharynx, immediately rostral to the larynx (orange arrowheads). The endotracheal tube (green arrowheads) is visible in the post-intubation scan (bottom) passing dorsal to the faecal pellet (orange arrow). The pellet visible in the pre-intubation scan in the oral cavity has migrated caudally to merge with, and compress, the dispersed faecal material in the laryngopharynx

The source(s) of failed orotracheal intubation attempts in rabbits are usually unknown, although there is a tendency to blame anaesthetist inexperience or anatomical impediments. This report identifies a previously undocumented source of a difficult intubation. A pre­anaesthetic examination of the oral cavity in rabbits may be warranted, but is unlikely to rule out the presence of foreign material in the oropharynx.

The full article is available here: http://vetrecordcasereports.bmj.com/content/4/1/e000265.full

Immaculate contraception

15 Feb, 16 | by gmills

By Marie Kubiak

Meerkats are a charismatic and popular exhibit in zoo collections and they are typically maintained in their natural family groups. One dominant pair in each group is responsible for breeding and can produce up to four litters of one to six pups a year. As such, successful breeding can quickly result in overpopulation of an animal with IUCN conservation status of ‘Least concern’, with limited opportunities to relocate animals within the zoo community. Additionally, if social structure of a group breaks down and the dominant pair are displaced then inbreeding between younger members of the group can result. In either scenario, contraception is useful in managing unwanted breeding. Deslorelin acetate implants are advocated for contraception in many mammalian species, including meerkats (Suricata suricatta) but recommendations are based entirely on anecdotal reports with no objective data to demonstrate efficacy or safety.

three_meerkats

This study followed two groups of meerkats: one group with contraception, using deslorelin 4.7 mg implants every 12 months to prevent inbreeding following social structure breakdown; and one group without contraception, to assess the efficacy of this treatment on breeding cessation. The group that used contraception produced no further litters for the entire 600-day observation period, while the control group continued to breed. Following control group expansion, the control group was also given deslorelin implants after 12 months for population management reasons, resulting in suppression of further conception, although one female successfully carried her litter to term. This litter was exceptionally large at seven pups and conception may have occurred in the hyperstimulatory stage in the two weeks following implantation.

No adverse effects on health or behaviour were associated during daily observation and annual clinical examination of all animals. Effective contraception appeared to result from implant placement in both sexes. As the meerkats were kept under the same dietary and management conditions, it would be expected that if environmental factors alone were responsible for the cessation in breeding in the group that received contraception, then a similar failure to reproduce would be seen in the group that did not receive contraception during the same time period. No disruption to the social hierarchy was noted following contraception and, interestingly, it appeared that the dominant pair in each group maintained their social status even when one received contraception and breeding was not occurring.

It was noted in this study that implanted males had a notable reduction in testicular size and this may be a useful criterion for assessing implant efficacy and monitoring duration of action. A duration of action of at least 12 months is expected based on the findings from this study.

More details about this case can be found here: http://vetrecordcasereports.bmj.com/content/4/1/e000281.full

 

CSI North Yorkshire

17 Dec, 15 | by gmills

By Tim Hopkins

Raptor persecution is an emotive issue in Britain. In an attempt to increase the population of gamebirds, some unscrupulous gamekeepers (sometimes directed by managers and employers) continue to illegally kill raptors. For conservationists and welfare groups, the shooting, trapping and poisoning of these wild birds represents the worst of the gamebird industry. Aside from the welfare concerns (for both game and raptor) and the disease risks from the release of many millions of captive birds annually, persecution continues to have a significant conservation impact on a number of species, in particular the hen harrier (Circus cyaneus) and golden eagle (Aquila chrysaetos). Historically, some British species were pushed to extinction due to such pressure, although all have since returned to breeding. Parts of the gamebird industry continue to dispute the scale and impact of raptor persecution and believe that the conservationists and welfare bodies are attempting to piecemeal outlaw their traditional hunting sport. For any given incident, the reliability and transparency of a postmortem investigation is paramount.

Veterinary pathologists, police and NGOs are hindered in confirming shooting by decomposition, scavenging and concealment of the carcase by the perpetrator. Furthermore, the identification of ballistic objects within a carcase is rarely enough to prove cause of death – it is often an incidental finding. An article published recently in Veterinary Record Case Reports details a confirmed shooting in an otherwise ambiguous postmortem examination of a hen harrier using advanced imaging techniques.

The bird was fitted with a tracking device as part of Natural England’s Hen Harrier Recovery Project, which enabled its recovery after death. Despite the advanced state of decomposition, a postmortem examination was performed at the Zoological Society of London’s Institute of Zoology. The bird had a broken tibiotarsus, which was radiographed, and minute metallic radio-opacities noted. Without an obvious gross ballistic remnant, the authors needed a diagnostic tool that would determine the composition of the foreign object and its effect on the surrounding tissue. Several modalities were considered but ultimately rejected as they failed to preserve both the foreign body and the microscopic structure of the bone. Histology, for instance, would have provided accurate descriptions of the bony trauma but no information about the chemistry of the object. Conversely, many spectroscopic techniques would have provided accurate descriptions of the metallic object atomic makeup but destroyed the surrounding bone in the process. Scanning Electron Microscopy with x-ray Dispersive Spectroscopy (SEM-EDX) was the only tool that fitted the bill.

 

Fig 1: Plain craniocaudal radiograph of the left tibiotarsus and tarsometatarsus showing three radiodense objects (white and black arrowheads)

Fig 1: Plain craniocaudal radiograph of the left tibiotarsus and tarsometatarsus showing three radiodense objects (white and black arrowheads)

 

SEM-EDX was carried out at the University College London’s Institute of Orthopaedic and Musculoskeletal Science. With great care, the bone was prepared for imaging, which included a thin coat of gold palladium to reduce scatter during scanning. The images were spectacular and conclusive. The fragment had tunnelled into the cortex of the tibiotarsus, fracturing the bone and trabeculae. On its way, it had disintegrated. The fragment was predominantly lead on EDX. The lack of any significant bone resorption or remodelling suggested this injury had resulted in rapid death. Case closed.

That was until we noticed that there were minute amounts of niobium on the spectrum. Niobium is not used in ammunition or firearms manufacture, so where had it come from? The explanation took several months. EDX, like any diagnostic tool, is subject to artefacts, operator error and sensitivity and specificity constraints. After consulting with the University of Bristol’s Department of Earth Sciences, the authors ran the scan data through third party software – DTSA II (Desktop Spectrum Analyser, National Institute for Standards and Technology). DTSA was able to discriminate the spectral peaks and showed that the aforementioned niobium was a misread of the peaks caused by the gold palladium coating. Additionally, it revealed the presence of arsenic and antimony, common additives in lead ammunition manufacture.

This case demonstrates the application of a novel forensic modality to the veterinary field. SEM-EDX has also been used in human forensic science to demonstrate gun shot residue (GSR) – microscopic remnants of the ammunition primer and propellant – on victims, shooters and firearms. This information often forms a vital piece of the investigative puzzle. In the future, it may be possible to determine that an animal was shot by a particular firearm or person by matching the GSR EDX data.

Novel modalities are increasingly important for NGOs and police seeking to stamp out illegal persecution. Confirmation of shooting in such ambiguous cases may increase pressure on the game industry to reform its practices. The imminent use of GSR EDX to match individuals with shooting incidents may be enough to dissuade gamekeepers too.

More details about this case can be found here

 

 

 

What is interprofessional working and how does it affect your working veterinary life?

30 Nov, 15 | by Kristy Ebanks

By Tierney Kinnison

Veterinary Record has recently published a number of papers that can give the detail; here I draw the strands together. Two papers (the practice effect and the personal effect) used Social Network Analysis (SNA) to map interactions between veterinary practice team members and to identify trends across practices in England. This formed the starting point of the empirical research for my PhD. The SNA produced a vast amount of data, which could be analysed in a number of different ways depending on the focus and questions being asked. This, I think, highlights the usefulness of SNA – relatively unheard of in many fields of work and study – in studying team interactions.

With all these data, we chose to focus the first paper on ‘the practice effect’ and the second on ‘the personal effect’. The practice effect deals with how interactions between staff are affected by the size of a practice and the presence of branches. Small practices were relatively cohesive, with interactions between most individuals, while the density of interactions tended to decrease with increasing team size. However, even in smaller practices, everyone was not connected to everyone else; hence, decisions about whom to interact with were made. In practices that do not rotate staff between branches there tended to be a lack of information/knowledge flow across branch sites, creating sub-teams. These results have implications for practices aiming to grow in size.

The second paper focused on ‘the personal effect’; the concepts of key people, interprofessional interactions and the links between social and work interactions. Key people were identified individuals through whom information/knowledge travels and who tend to link other groups together, as often they were appointed leaders, such as directors, practice managers and head nurses, but they could also be emergent and situational leaders. Analysis of interactions between professions identified a hierarchy with veterinary surgeons at the top. In order to create a well-functioning and informed team, we tentatively suggested that interactions should instead be based primarily on experience and knowledge, as opposed to purely what profession someone is. Social and work interactions were linked, suggesting that we interact at work with those people who we like (rather than on their expertise), or we become friends with those people whose work interactions we value. Crucially, higher order interactions were much more likely between those who socialised than those who did not.

The third paper (errors in veterinary practice) evolved from the second part of my research, case studies, which aimed to explore the trends identified through the SNA in more depth. During the case studies I spent several weeks with two practices and observed the teams as a whole, as well as observing and interviewing selected individuals, who were representatives of each profession. I was looking for good interprofessional working and learning and found many examples of this. However, on occasion, I also saw errors, defined in the most encompassing sense, to mean any behaviour that could lead to any potentially negative consequence for patients, clients, the practice or the team. These errors were primarily, though not exclusively, communication based and involved, for example, mistakes on records, missing information given face-to-face and mistakes in face-to-face communication. Identifying the systems nature of these errors (rather than placing blame on an individual) and using potential solutions may reduce error in veterinary practices, and is likely to be important in large organisations where information flows less easily as a function of their size.

We have had a very positive response from members of the veterinary professions towards these articles, as well as our Veterinary Record letter (VR 2015 177, 345). I hope through this brief piece that the background to the research will be better understood, and that the veterinary community will use this type of research to create a workplace where all professions and occupations are valued for their individual expertise, which when brought together, can form a complementary skills set, best placed to suit the evolving needs of our patients and clients in the 21st century.

Professor Stephen May from the Royal Veterinary College and Professor David Guile from the Institute of Education, University College London are co-authors in these series of articles.

We need to talk about error

3 Nov, 15 | by Kristy Ebanks

By Catherine Oxtoby

A paper that has recently appeared in Veterinary Record exploring the causes and types of error in veterinary practice is the first phase of a three year PhD into mistakes in veterinary practice – a hugely neglected area of research in our profession. It wasn’t until I started researching the background to errors and mistakes in other industries that I realised how little attention our profession has shown to a topic which is the driving force of policy and procedures in other sectors.

What we found, was that vets are no different to anyone else. Our brains are wired the same way – we make mistakes for the same reasons, it’s just that when a vet makes a slip during surgery the consequences are serious. It’s all about context, rarely about competence and almost never about a lack of care. Psychological limitations, system failures in the form of poor communication, poor teamwork and badly designed equipment or packaging were major causes of error, not simply a vet having a bad day. It is vital that we understand that mistakes don’t happen because someone was being careless – it’s much more complicated than that, and blaming the clinician does nothing to prevent it happening again. What we need are simple tools to support clinicians, and training in non-technical skills to help reduce mistakes.

Patient safety influences many areas of practice – not just the obvious example of ‘why things go wrong’. Reporting and discussing error, the reactions of our piers and seniors in the aftermath of mistakes and the way we look at our systems to prevent recurrences, all reflect the culture and ethos of a practice, its visons, values and leadership. Actively engaging with the concepts of patient safety drives quality, empowers staff and increases efficiency as well as saving lives and law suits. The final two years of the PhD study will be spent investigating safety culture in veterinary practice – the force which drives attitudes and behaviours. I believe that this is where efforts to improve should be targeted, as it is the culture of the place which determines its willingness to embrace the changes which may be required for interventions such as surgery checklists and reporting systems to really work.

I hope the paper will shine some light on a difficult and sensitive subject in the profession. The vast majority of veterinary surgeons and nurses are dedicated, compassionate people who care deeply about both their patients and their clients, but they are also human beings. We need to recognise the things which impair their performance and build resilience into our personnel and systems to ensure consistent quality of care, through a better understanding of the true causes of veterinary medical error.

More details can be found here

 

Dog gets a raw deal

21 Jul, 15 | by gmills

An article recently published in Veterinary Record Case Reports describes a case of small intestinal segmental volvulus in a dog secondary to dietary obstruction. Small intestinal volvulus is an infrequently encountered condition in small animal practice. Within the published literature, there are notable contrasts in the clinical history and examination findings described as well as the success of the surgical intervention itself. This cases serves to propose both a cause for the volvulus and also describe its successful management.

The case describes a four-year-old golden retriever that had been vomiting intermittently and had been lethargic for a few days. The owners described the diet which the dog was being fed as consisting of a chicken bones and raw food (BARF) diet along with boiled potatoes and pasta. There was no history of foreign bodies having been consumed.

On clinical examination, there was an area of mid-abdominal intestinal thickening within the abdomen, but no discrete foreign body was palpated. Biochemistry, electrolyte and haematology blood samples were unremarkable, while abdominal radiographs were consistent with an intestinal foreign body (Fig 1).

At exploratory coeliotomy, segmental small intestinal volvulus was identified, and successfully excised by enterectomy without previous derotation. The patient made a smooth recovery from anaesthesia and surgery. Upon dissection of the excised portion of intestine, bones that were anatomically typical of those contained in chicken legs were found.

BARF diets have been recently increasing in popularity among dog owners. This is not currently mirrored by the profession where the vast majority are still cautious on their use especially in regard to the food hygiene and nutritional imbalance risks. This having been said, there are increasing numbers of the profession now considering whether BARF diets can be used in dogs, and if so how they can be nutritionally balanced.

This case demonstrates that intestinal volvulus, which is often considered to have an acute onset, may have a more delayed presentation, and still be successfully surgically managed. Additionally, it demonstrates that intestinal obstruction with secondary volvulus can occur due to dietary obstruction when a dog is fed a BARF diet.

More details, images and discussion about this case can be found here

Fig 1: (a and b) Right lateral and dorsoventral abdominal radiographs showed gastric as well as intestinal dilation, increasing the suspicion of gastrointestinal obstruction

Fig 1: (a and b) Right lateral and dorsoventral abdominal radiographs showed gastric as well as intestinal dilation, increasing the suspicion of gastrointestinal obstruction

Lumbar pain presenting as praying position-like posture in a dog and a cat

30 Jun, 15 | by Assistant Editor

 

An article recently published in Veterinary Record Case Reports describes the case of a 10-year-old, male, intact Border collie presented with a 12-month history of progressive paraparesis and lumbar discomfort and a 5-year-old male neutered, domestic short-hair cat presented with a one-week rapid progressive history of unusual stance and gait. Both pets adopted a ‘praying position’-like posture and a gait characterised by raising the pelvis while keeping the elbows flexed.

Neurological examination indicated lumbosacral localisation in both patients. The dog adopted this unusual posture only intermittently and thus it was challenging to attribute the lumbosacral discomfort to the presenting posture. However, this unusual posture could be elicited later in the disease process by applying pressure on the lumbosacral junction. The cat presented acutely and continuously in this posture in addition to lumbosacral pain, plantigrade gait and a flaccid tail.

Advanced diagnostic imaging of the lumbar spine revealed caudal lumbar disc disease in both animals. MRI in the dog showed a focal bulging of the annulus fibrosus at the dorsal aspect of the L7-S1 intervertebral disc, which was causing compression of approximately 50% of the spinal canal. Both the left and right intervertebral foraminae of L7-S1 were filled with intermediate to low signal T2 weighted images (T2WI) and T1 after contrast (T1+C) material above the intervertebral disc. A CT scan of the cat revealed a large amount of hyperattentuated material within the spinal canal extending from the endplate of L6 vertebrae to the cranial third of L7 vertebra and occluding most of the vertebral canal.

 

Lateral and ventrodorsal radiographs (a and c, respectively) and sagittal and dorsal CT images (b and d, respectively) of the lumbar spine of case two. Lateral radiographs (a) show a subjectively narrowed L6-7 intervertebral disc space. Radiodense material is visible within the vertebral canal above the cranial third of L7 vertebrae (a, d, arrow). A large amount of hyperattenuated material within the spinal canal is located midline and ventrally occluding 80% of the height and 75% of the width of the vertebral canal extending from the caudal endplate of L6 vertebrae to the cranial third of L7 vertebra leaving only a rim of normal signal dorsally (b, d, arrow). L, left; R, right

Lateral and ventrodorsal radiographs (a and c, respectively) and sagittal and dorsal CT images (b and d, respectively) of the lumbar spine of case two. Lateral radiographs (a) show a subjectively narrowed L6-7 intervertebral disc space. Radiodense material is visible within the vertebral canal above the cranial third of L7 vertebrae (a, d, arrow). A large amount of hyperattenuated material within the spinal canal is located midline and ventrally occluding 80% of the height and 75% of the width of the vertebral canal extending from the caudal endplate of L6 vertebrae to the cranial third of L7 vertebra leaving only a rim of normal signal dorsally (b, d, arrow). L, left; R, right

 

The praying-position like posture and gait vanished with suitable treatment in both pets. The owner of the dog elected conservative treatment of exercise restriction and oral steroids leading to it being only mildly paraparetic. The cat underwent a L6-L7 dorsal laminectomy removing calcified intervertebral disc material resulting in resolution of nearly all neurological deficits.

It is suspected that the praying position-like posture resulted in greater pain relief for the dog and cat. Adopting a praying position-like posture results in ventroflexion of the caudal lumbar spine and decreased impingement of the nervous structures due to an increased distance between the dorsal aspects of the vertebral bodies of the adjacent vertebrae. A praying position-like posture has been previously described in different pathologies. For instance, acute abdominal pain can present with a prayer-type posture, abdominal distension, restlessness, vomiting, diarrhoea and collapse. Another report described severe cervical pain and an intermittent praying position-like posture and gait in a bulldog with C4-5 ventral cervical disc extrusion.

The two cases raise the importance of considering a praying position-like posture as clinical presentation for caudal lumbar disc disease in dogs and cats.

Thorn free

17 Jun, 15 | by Assistant Editor

 

In a recent case report, Marthinus Jacobus Hartman and colleagues report the successful laparoscopic removal of a thorn granuloma from the abdomen of a wild captive cheetah.

 

Image: Mark Probst

Image: Mark Probst

An 11-year-old cheetah was presented for routine laparoscopic ovariectomy during a cheetah sterilisation project in Namibia. While under anaesthesia, a mid-abdominal mass was palpated and visualised by ultrasonography as a highly vascularised round 6 cm diameter well-vascularised mass, not associated with any specific abdominal organ, in the mid right abdominal cavity (Fig 1). Ultrasound-guided fluid aspiration revealed a cloudy and turbid-appearing fluid, which on centrifugation had a sizeable cellular pellet.

FIG 1: Sagittal transabdominal ultrasound images of the thorn-induced granuloma. (a) The granuloma is seen between the measured callipers with the echogenic exudate caudal to the mass. (b) Image slightly more medially. Colour flow Doppler illustrates the vascularity of the mass

FIG 1: Sagittal transabdominal ultrasound images of the thorn-induced granuloma. (a) The granuloma is seen between the measured callipers with the echogenic exudate caudal to the mass. (b) Image slightly more medially. Colour flow Doppler illustrates the vascularity of the mass

 

The differential diagnoses considered before surgery were intraomental neoplasia or a foreign body granuloma.

The cheetah was prepared for laparoscopy for ovariectomy and surgical removal of the mass. A single incision laparoscopic surgery (SILS) port was placed immediately caudal to the umbilicus, and the mass embedded in omentum (Fig 2) was found, secured and freed using coagulation without major haemorrhage.

FIG 2: Ometalised granulomatous mass suspended by a Babcock forceps with some free blood in the peritoneal cavity

FIG 2: Ometalised granulomatous mass suspended by a Babcock forceps with some free blood in the peritoneal cavity

 

After introduction of the extraction bag through the SILS port (Fig 3) and intra-abdominal deployment (Fig 4), the mass was placed into the bag (Fig 5) and retrieved through the port. Ovariectomy was completed and the peritoneal cavity was lavaged before the surgical site was routinely closed.

FIG 3: Introduction of an extraction bag via the 5–12 mm single incision laparoscopic surgery port

FIG 3: Introduction of an extraction bag via the 5–12 mm single incision laparoscopic surgery port

 

FIG 4: Deployment of the extraction bag inside the peritoneal cavity

FIG 4: Deployment of the extraction bag inside the peritoneal cavity

 

FIG 5: Resected mass is placed into the extraction bag

FIG 5: Resected mass is placed into the extraction bag

 

The patient recovered uneventfully.

Subsequent macroscopic examination of the excised mass revealed a firm yellow-white soft tissue mass containing a 25 mm thorn-like structure (Fig 6) resembling that of the Sickle or Chinese lantern bush, a common thorn tree in Northern Namibia.

FIG 6: Thorn foreign body removed from the granuloma

FIG 6: Thorn foreign body removed from the granuloma

 

This is the first report to describe the laparoscopic removal of a foreign body-induced granuloma from the abdomen of a cheetah. Granuloma formation in this species has not been well described. Similarly, reports on laparoscopic surgery in this species are sparse, particularly those describing the laparoscopic excision of abdominal masses. They have, however, been used for laparoscopy in dogs, horses and tigers using three or four separate ports. The use of these bags or pouches has also not been described with SILS.

Entrance of the thorn into the abdominal cavity remains speculative, but it could have either entered percutaneously or via the gastrointestinal tract

This technique promises to be especially useful in wild carnivores, allowing rapid recovery and lowering the risk of postoperative surgical wound complications.

A much more detailed account with further pictures and a video clip of the procedure can be found here.

 

 

 

Treatment of a case of feline infectious peritonitis with cyclosporin A

1 Jun, 15 | by Assistant Editor

Feline infectious peritonitis (FIP), which is caused by certain strains of feline coronavirus, is a progressive and usually fatal disease for which there is currently no cure or effective treatment. It is a disease which continues to challenge vets and its diagnosis is a crushing blow to owners who will inevitably lose their cherished cats.

There is an important and unique immunological component to the pathology of the disease and there is evidence that some immunosuppressive drugs may offer hope. However, current treatments may induce short-term remission in a small percentage of cats.

Cyclosporin A (CsA) has recently been shown to exert potent antiviral activities in several in vitro systems, including against coronaviruses. However, whether CsA has clinically relevant activity against coronaviruses remains unknown.

Yoshikazu Tanaka and colleagues report a case of effusive FIP in which treatment with CsA resulted in a sustained reduction in viral copy number and pleural fluid volume and was accompanied by clinical improvement.

A 14-year-old female domestic shorthair cat was presented with persistent fever, anorexia and jaundice for a month. A general clinical examination showed a substantial pleural effusion, and laboratory investigation revealed a significant feline coronavirus antibody titre and a low packed-cell volume, as well as signs indicative of liver damage. Pleural fluid was yellowish, viscous and remarkably dense. Coronavirus antigen was demonstrated within macrophages in the pleural fluid and real-time quantitative reverse transcription PCR (RT-qPCR ) revealed 1.6×10 6 copies/ml in pleural fluid, which is higher than that in other cases of effusive FIP that the authors had encountered. The diagnosis of FIP was based on the clinical presentation and clinicopathological, cytological and RT-qPCR findings.

Type-I interferon treatment for two months did not result in improvement in pleural fluid volume and viral copy number and treatment was stopped. Following discussion with the owner, treatment with a daily dose of modified cyclosporin A (CsA) was started. The volume of pleural fluid decreased and became undetectable within four days of starting CsA therapy. The condition of the cat improved, it became more alert and regained a normal appetite, and therefore CsA administration was stopped. However, the pleural fluid accumulated within four days of stopping CsA treatment. Treatment was recommenced and again the pleural fluid levels disappeared and the viral load decreased substantially. Over a two-month period, during which a low dose of CsA was maintained, no clinical abnormalities were detected, the anaemia resolved and biochemical parameters returned to normal.

Unfortunately, about two months after CsA treatment was stopped, viral load gradually increased but no clinical abnormalities were detected until about seven months after treatment was stopped. The cat’s clinical condition deteriorated and it died shortly after.

The study suggests that the potential therapeutic effects of CsA in combination with other therapeutic agents should be evaluated.

Full details of the investigations carried out, treatment and outcome can be found here.

Nominations sought for Veterinary Record Innovation Award

18 May, 15 | by Assistant Editor

VR Innovation

Veterinary Record is launching a new award to recognise innovation in the veterinary sphere.

The Veterinary Record Innovation Award is open to individuals and veterinary teams whose innovation has brought about a change or improvement in any aspect of veterinary practice. This change might relate to a particular aspect of clinical practice or have had a broader impact on veterinary activity.

We welcome a broad range of nominations, which might include, for example, a clinical innovation in medicine or surgery, work that has influenced policymakers, a campaign to improve animal health and welfare, a practice educating owners on responsible ownership, or something that has changed how the business of veterinary practice is conducted.

Nominations can be made on behalf of a candidate but self-nominations will also be considered. Nominations should be between 500 and 800 words, and explain what the innovation is, what the impact has been and why it should be considered for the award. Evidence to substantiate the nomination should be included. In addition, video nominations can also be included. Entries should be entitled ‘Veterinary Record Innovation Award’ and e-mailed to editorial@bva-edit.co.uk. The closing date for nominations is July 1, 2015.

The award will be presented at the BVA Members’ Day in Edinburgh on September 24. The awards ceremony will also include the presentation of the Veterinary Record Impact Award (formerly the William Hunting Award;VR, November 23, 2013, vol 173, pp 497-498), which recognises the research paper published in Veterinary Record in the previous year that is considered to have had the most significant practical impact.

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