Nerve Stimulator–Guided Sciatic-Femoral Block in Pet Rabbits (Oryctolagus cuniculus) Undergoing Hind Limb Surgery: A Case Series

This article describes the clinical applicability of a nerve stimulator–guided technique, previously described in dogs, to block the sciatic and the femoral nerves in 4 pet rabbits (Oryctolagus cuniculus) undergoing hind limb surgeries. Preanesthetic intramuscular doses of medetomidine (0.08 mg/kg), ketamine (15 mg/kg), and buprenorphine (0.03 mg/kg) were administered to the rabbit patients. The rabbits were intubated and general anesthesia was maintained using isoflurane in oxygen. The sciatic-femoral nerve block was performed with 2% lidocaine at a volume of 0.05 mL/kg/nerve. Sciatic-femoral block was feasible in rabbits, and the motoric responses following electrical stimulation of both nerves were consistent with those reported in dogs after successful nerve location. Iatrogenic complications, namely nerve damage and local anesthetic toxicity, did not occur. Based on these results, the authors conclude that the sciatic-femoral nerve block described in dogs can be safely performed in rabbits. Clinical trials are required to assess the analgesic efficacy of the combined sciatic-femoral nerve block in rabbits as a part of multimodal pain management.

Tumor control in birds

Neoplasia is common in pet birds, especially psittacines, and mainly involves the integument and urogenital system. Before treatment options are considered, a definitive diagnosis should be made and the extent of the disease determined. Treatment should initially be directed at tumor eradication and may involve using several modalities together or sequentially. Surgery, radiotherapy, and photodynamic therapy are used against localized tumors, while chemotherapy and biological response modification are also used against metastatic disease. In combination or adjunct therapy, surgery is used to excise or debulk the tumor, radiotherapy to sterilize local regional disease and chemotherapy and biological therapy to help prevent metastatic disease. The tumor control program should be rationally planned before application, rather than added on when one modality fails, as is commonly practiced. Tumor response to therapy should be regularly assessed both in the short and long term and wherever possible, assessment should be quantitated. Work place health and safety procedures for radiation and cytotoxic drugs should always be practiced. (C) 2004 Elsevier Inc. All rights reserved.

Estudo tomográfico encefálico de felinos hígidos adultos e idosos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Allergy to Uncommon Pets: New Allergies but the Same Allergens.

The prevalence of exotic pet allergies has been increasing over the last decade. Years ago, the main allergy-causing domestic animals were dogs and cats, although nowadays there is an increasing number of allergic diseases related to insects, rodents, amphibians, fish, and birds, among others. The current socio-economic situation, in which more and more people have to live in small apartments, might be related to this tendency. The main allergic symptoms related to exotic pets are the same as those described for dog and cat allergy: respiratory symptoms. Animal allergens are therefore, important sensitizing agents and an important risk factor for asthma. There are three main protein families implicated in these allergies, which are the lipocalin superfamily, serum albumin family, and secretoglobin superfamily. Detailed knowledge of the characteristics of allergens is crucial to improvement treatment of uncommon-pet allergies.

Identification of Hotspots in the European Union for the Introduction of Four Zoonotic Arboviroses by Live Animal Trade

Live animal trade is considered a major mode of introduction of viruses from enzootic foci into disease-free areas. Due to societal and behavioural changes, some wild animal species may nowadays be considered as pet species. The species diversity of animals involved in international trade is thus increasing. This could benefit pathogens that have a broad host range such as arboviruses. The objective of this study was to analyze the risk posed by live animal imports for the introduction, in the European Union (EU), of four arboviruses that affect human and horses: Eastern and Western equine encephalomyelitis, Venezuelan equine encephalitis and Japanese encephalitis. Importation data for a five-years period (2005-2009, extracted from the EU TRACES database), environmental data (used as a proxy for the presence of vectors) and horses and human population density data (impacting the occurrence of clinical cases) were combined to derive spatially explicit risk indicators for virus introduction and for the potential consequences of such introductions. Results showed the existence of hotspots where the introduction risk was the highest in Belgium, in the Netherlands and in the north of Italy. This risk was higher for Eastern equine encephalomyelitis (EEE) than for the three other diseases. It was mainly attributed to exotic pet species such as rodents, reptiles or cage birds, imported in small-sized containments from a wide variety of geographic origins. The increasing species and origin diversity of these animals may have in the future a strong impact on the risk of introduction of arboviruses in the EU.

Clínica de animais exóticos

O presente relatório tem como base o estágio curricular realizado na Clínica Veterinaria Exotics, em Barcelona, entre outubro 2015 e fevereiro de 2016, perfazendo um total de cinco meses. O estágio decorreu sob a orientação da Doutora Joana Reis e do Dr. Xavier Valls, estando inserido na área de medicina de animais exóticos. O relatório apresenta duas partes principais. Em primeiro, surge o relatório das atividades desenvolvidas durante o estágio, destacando o trabalho realizado nas diversas especialidades clínicas assim como a aprendizagem adquirida. De seguida, é apresentada uma revisão bibliográfica atualizada subordinada ao tema Insulinoma em furões destacando, para além das peculiaridades que envolvem esta espécie, as causas, o diagnóstico, as terapêuticas e os diversos desafios que esta doença origina no dia-a-dia da medicina veterinária: Abstract: Exotic animal medicine The internship, that originated this report, was conducted in an exotic animal medicine specialized clinic named Clínica Veterinaria Exotics, in Barcelona, from October 2015 to February 2016, with the supervision of professor Joana Reis and Dr. Xavier Valls. This report is comprised of two major sections: the first is a statistical study, where the clinical activities that were conducted in the many specialties of the exotic animal medicine are described, completing the analysis with a wide range of knowledge gotten from the daily routine of the clinic; as for the second part, it develops the current literature about, Insulinoma in ferrets, describing the animal’s particularities and the causes, diagnosis, therapies and challenges of this disease in the clinical veterinary medicine.

Clínica de animais exóticos

Este relatório de estágio descreve as atividades desenvolvidas no estágio curricular e desenvolve o tema ―Inseminação artificial em Python regius‖. O estágio de seis meses foi realizado na Exoclinic – clínica veterinária de aves e exóticos, permitindo consolidar conhecimentos através da prática clínica e agregar-lhes a área da medicina de animais exóticos, dedicando especial atenção à medicina de répteis. Desenvolvem-se os casos mais frequentes: medicina preventiva nas várias classes de animais, patologia dentária em roedores e lagomorfos, doença do bico e das penas dos psitacídeos e anorexia em répteis. Na monografia aborda-se a anatomofisiologia e o comportamento reprodutivos das cobras e a sua influência no maneio reprodutivo em cativeiro, métodos de avaliação de reprodutores e técnicas de inseminação artificial. Realizou-se um ensaio prático com seis animais, realizando colheitas de sémen, avaliação de alguns parâmetros do sémen, controlo folicular por ecografia e inseminação artificial. Apresentam-se os métodos, os resultados e respetiva discussão; Abstract: Exotic animal medicine This traineeship report describes the activities during the traineeship and develops the theme "Artificial insemination in Python regius." The six-month internship was held in Exoclinic - clínica veterinária de aves e exóticos, consolidating knowledge through clinical practice and adding the medical field of exotic animals, with special attention to reptiles. The most frequent clinical cases are developed: preventive medicine in the various classes of animals, dental pathology in rodents and lagomorphs, Psittacine Beak and Feather Disease in birds and anorexia in reptile. The monograph addresses the anatomy, physiology and reproductive behavior of snakes and their influence on reproductive management in captivity, methods for reproductors selection and evaluation and artificial insemination techniques. Implementation of a field trial with six animals, performing semen crops and evaluation of some of its parameters, follicular monitoring by ultrasound and artificial insemination. Methods and results are presented and discussed.

Polyester derived from recycled poly(ethylene terephthalate) waste for regenerative medicine

Despite advances in regenerative medicine, the cost of such therapies is beyond the reach of many patients globally in part due to the use of expensive biomedical polymers. Large volumes of poly(ethylene terephthalate) (PET) in municipal waste is a potential source of low cost polymers. A novel polyester was prepared by a catalyst-free, melt polycondensation reaction of bis(hydroxyethylene) terephthalate derived from PET post-consumer waste with other multi-functional monomers from renewable sources such as citric acid, sebacic acid and D-mannitol. The mechanical properties and degradation rate of the polyester can be tuned by varying the composition and the post-polymerization time. The polyester was found to be elastomeric, showed excellent cytocompatibility in vitro and elicited minimal immune response in vivo. Three-dimensional porous scaffolds facilitated osteogenic differentiation and mineralization. This class of polyester derived from low cost, recycled waste and renewable sources is a promising candidate for use in regenerative medicine.

Impacto orçamentário da incorporação da tomografia de emissão de pósitrons (PET scan) no estadiamento do câncer de pulmão na perspectiva do Sistema Único de Saúde

O aumento exponencial dos gastos em saúde demanda estudos econômicos que subsidiem as decisões de agentes públicos ou privados quanto à incorporação de novas tecnologias aos sistemas de saúde. A tomografia de emissão de pósitrons (PET) é uma tecnologia de imagem da área de medicina nuclear, de alto custo e difusão ainda recente no país. O nível de evidência científica acumulada em relação a seu uso no câncer pulmonar de células não pequenas (CPCNP) é significativo, com a tecnologia mostrando acurácia superior às técnicas de imagem convencionais no estadiamento mediastinal e à distância. Avaliação econômica realizada em 2013 aponta para seu custo-efetividade no estadiamento do CPCNP em comparação à estratégia atual de manejo baseada no uso da tomografia computadorizada, na perspectiva do SUS. Sua incorporação ao rol de procedimentos disponibilizados pelo SUS pelo Ministério da Saúde (MS) ocorreu em abril de 2014, mas ainda se desconhecem os impactos econômico-financeiros decorrentes desta decisão. Este estudo buscou estimar o impacto orçamentário (IO) da incorporação da tecnologia PET no estadiamento do CPCNP para os anos de 2014 a 2018, a partir da perspectiva do SUS como financiador da assistência à saúde. As estimativas foram calculadas pelo método epidemiológico e usaram como base modelo de decisão do estudo de custo-efetividade previamente realizado. Foram utilizados dados nacionais de incidência; de distribuição de doença e acurácia das tecnologias procedentes da literatura e de custos, de estudo de microcustos e das bases de dados do SUS. Duas estratégias de uso da nova tecnologia foram analisadas: (a) oferta da PET-TC a todos os pacientes; e (b) oferta restrita àqueles que apresentem resultados de TC prévia negativos. Adicionalmente, foram realizadas análises de sensibilidade univariadas e por cenários extremos, para avaliar a influência nos resultados de possíveis fontes de incertezas nos parâmetros utilizados. A incorporação da PET-TC ao SUS implicaria a necessidade de recursos adicionais de R$ 158,1 (oferta restrita) a 202,7 milhões (oferta abrangente) em cinco anos, e a diferença entre as duas estratégias de oferta é de R$ 44,6 milhões no período. Em termos absolutos, o IO total seria de R$ 555 milhões (PET-TC para TC negativa) e R$ 600 milhões (PET-TC para todos) no período. O custo do procedimento PET-TC foi o parâmetro de maior influência sobre as estimativas de gastos relacionados à nova tecnologia, seguido da proporção de pacientes submetidos à mediastinoscopia. No cenário por extremos mais otimista, os IOs incrementais reduzir-se-iam para R$ 86,9 (PET-TC para TC negativa) e R$ 103,9 milhões (PET-TC para todos), enquanto no mais pessimista os mesmos aumentariam para R$ 194,0 e R$ 242,2 milhões, respectivamente. Resultados sobre IO, aliados às evidências de custo-efetividade da tecnologia, conferem maior racionalidade às decisões finais dos gestores. A incorporação da PET no estadiamento clínico do CPCNP parece ser financeiramente factível frente à magnitude do orçamento do MS, e potencial redução no número de cirurgias desnecessárias pode levar à maior eficiência na alocação dos recursos disponíveis e melhores desfechos para os pacientes com estratégias terapêuticas mais bem indicadas.

Micro Insert: A Prototype Full-Ring PET Device for Improving the Image Resolution of a Small-Animal PET Scanner

A full-ring PET insert device should be able to enhance the image resolution of existing small-animal PET scanners. Methods: The device consists of 18 high-resolution PET detectors in a cylindric enclosure. Each detector contains a cerium-doped lutetium oxyorthosilicate array (12 x 12 crystals, 0.72 x 1.51 x 3.75 mm each) coupled to a position-sensitive photomultiplier tube via an optical fiber bundle made of 8 x 16 square multiclad fibers. Signals from the insert detectors are connected to the scanner through the electronics of the disabled first ring of detectors, which permits coincidence detection between the 2 systems. Energy resolution of a detector was measured using a Ge-68 point source, and a calibrated 68Ge point source stepped across the axial field of view (FOV) provided the sensitivity profile of the system. A Na-22 point source imaged at different offsets from the center characterized the in-plane resolution of the insert system. Imaging was then performed with a Derenzo phantom filled with 19.5 MBq of F-18-fluoride and imaged for 2 h; a 24.3-g mouse injected with 129.5 MBq of F-18-fluoride and imaged in 5 bed positions at 3.5 h after injection; and a 22.8-g mouse injected with 14.3 MBq of F-18-FDG and imaged for 2 h with electrocardiogram gating. Results: The energy resolution of a typical detector module at 511 keV is 19.0% +/- 3.1 %. The peak sensitivity of the system is approximately 2.67%. The image resolution of the system ranges from 1.0- to 1.8-mm full width at half maximum near the center of the FOV, depending on the type of coincidence events used for image reconstruction. Derenzo phantom and mouse bone images showed significant improvement in transaxial image resolution using the insert device. Mouse heart images demonstrated the gated imaging capability of the device. Conclusion: We have built a prototype full-ring insert device for a small-animal PET scanner to provide higher-resolution PET images within a reduced imaging FOV. Development of additional correction techniques are needed to achieve quantitative imaging with such an insert.

Progettazione e sintesi di nuovi antagonisti CB1 a struttura pirazolica come potenziali radiofarmaci per la PET imaging

Cannabinoid receptors are members of the large family of G-protein coupled receptors. Two types of cannabinoid receptor have been discovered: CB1 and CB2. CB1 receptors are localised predominantly in the brain whereas CB2 receptors are more abundant in peripheral nervous system cells. CB1 receptors have been related with a number of disorders, including depression, anxiety, stress, schizophrenia, chronic pain and obesity. For this reason, several cannabinoid ligands were developed as drug candidates. Among these ligands, a prominent position is occupied by SR141716 (Rimonabant), which is a pyrazole derivative with inverse agonist activity discovered by Sanofi-Synthelabo in 1994. This compound was marketed in Europe as an anti-obesity drug, but subsequently withdrawn due to its side-effects. Since the relationship between the CB1 receptors’ functional modification, density and distribution, and the beginning of a pathological state is still not well understood, the development of radio-ligands suitable for in vivo PET (Positron Emission Tomography) functional imaging of CB1 receptors remains an important area of research in medicine and drug development. To date, a few radiotracers have been synthesised and tested in vivo, but most of them afforded unsatisfactory brain imaging results. A handful of radiolabelled CB1 PET ligands have also been submitted to clinical trials in humans. In this PhD Thesis the design, synthesis and characterization of three new classes of potential high-affinity CB1 ligands as candidate PET tracers is described.

(18)F-FDG PET-CT simulation for non-small-cell lung cancer: effect in patients already staged by PET-CT.

Purpose: Positron emission tomography (PET), in addition to computed tomography (CT), has an effect in target volume definition for radical radiotherapy (RT) for non–small-cell lung cancer (NSCLC). In previously PET-CT staged patients with NSCLC, we assessed the effect of using an additional planning PET-CT scan for gross tumor volume (GTV) definition. Methods and Materials: A total of 28 patients with Stage IA-IIIB NSCLC were enrolled. All patients had undergone staging PET-CT to ensure suitability for radical RT. Of the 28 patients, 14 received induction chemotherapy. In place of a RT planning CT scan, patients underwent scanning on a PET-CT scanner. In a virtual planning study, four oncologists independently delineated the GTVon the CT scan alone and then on the PET-CTscan. Intraobserver and interobserver variability were assessed using the concordance index (CI), and the results were compared using the Wilcoxon signed ranks test. Results: PET-CT improved the CI between observers when defining the GTVusing the PET-CT images compared with using CTalone for matched cases (median CI, 0.57 for CTand 0.64 for PET-CT, p = .032). The median of the mean percentage of volume change from GTVCT to GTVFUSED was 5.21% for the induction chemotherapy group and 18.88% for the RT-alone group. Using the Mann-Whitney U test, this was significantly different (p = .001). Conclusion: PET-CT RT planning scan, in addition to a staging PET-CT scan, reduces interobserver variability in GTV definition for NSCLC. The GTV size with PET-CT compared with CT in the RT-alone group increased and was reduced in the induction chemotherapy group.

Personnel radiation dose considerations in the use of an integrated PET–CT scanner for radiotherapy treatment planning of an integrated PET-CT scanner for radiotherapy treatment planning

The acquisition of radiotherapy planning scans on positron emission tomography (PET)-CT scanners requires the involvement of radiotherapy radiographers. This study assessed the radiation dose received by these radiographers during this process. Radiotherapy planning F- fluorodeoxyglucose (F-FDG) PET-CT scans were acquired for 28 non-small cell lung cancer patients. In order to minimise the radiation dose received, a two-stage process was used in which the most time-consuming part of the set-up was performed before the patient received their F-FDG injection. Throughout this process, the radiographers wore electronic personal dosemeters and recorded the doses received at different stages of the process. The mean total radiation dose received by a radiotherapy radiographer was 5.1±2.6 mSv per patient. The use of the two-stage process reduced the time spent in close proximity to the patient by approximately a factor of four. The two-stage process was effective in keeping radiation dose to a minimum. The use of a pre-injection set-up session reduces the radiation dose to the radiotherapy radiographers because of their involvement in PET-CT radiotherapy treatment planning scans by approximately a factor of three.

The role of PET/CT scanning in radiotherapy planning

The introduction of functional data into the radiotherapy treatment planning process is currently the focus of significant commercial, technical, scientific and clinical development. The potential of such data from positron emission tomography (PET) was recognized at an early stage and was integrated into the radiotherapy treatment planning process through the use of image fusion software. The combination of PET and CT in a single system (PET/CT) to form an inherently fused anatomical and functional dataset has provided an imaging modality which could be used as the prime tool in the delineation of tumour volumes and the preparation of patient treatment plans, especially when integrated with virtual simulation. PET imaging typically using F-Fluorodeoxyglucose (F-FDG) can provide data on metabolically active tumour volumes. These functional data have the potential to modify treatment volumes and to guide treatment delivery to cells with particular metabolic characteristics. This paper reviews the current status of the integration of PET and PET/CT data into the radiotherapy treatment process. Consideration is given to the requirements of PET/CT data acquisition with reference to patient positioning aids and the limitations imposed by the PET/CT system. It also reviews the approaches being taken to the definition of functional/ tumour volumes and the mechanisms available to measure and include physiological motion into the imaging process. The use of PET data must be based upon a clear understanding of the interpretation and limitations of the functional signal. Protocols for the implementation of this development remain to be defined, and outcomes data based upon clinical trials are still awaited. © 2006 The British Institute of Radiology.

Does pre-operative estimation of oesophageal tumour metabolic length using F-18-fluorodeoxyglucose PET/CT images compare with surgical pathology length?

PURPOSE:
The aim of the study was to compare the pre-operative metabolic tumour length on FDG PET/CT with the resected pathological specimen in patients with oesophageal cancer.

METHODS:
All patients diagnosed with oesophageal carcinoma who had undergone staging PET/CT imaging between the period of June 2002 and May 2008 who were then suitable for curative surgery, either with or without neo-adjuvant chemotherapy, were included in this study. Metabolic tumour length was assessed using both visual analysis and a maximum standardised uptake value (SUV(max)) cutoff of 2.5.

RESULTS:
Thirty-nine patients proceeded directly to curative surgical resection, whereas 48 patients received neo-adjuvant chemotherapy, followed by curative surgery. The 95% limits of agreement in the surgical arm were more accurate when the metabolic tumour length was visually assessed with a mean difference of -0.05 cm (SD 2.16 cm) compared to a mean difference of +2.42 cm (SD 3.46 cm) when assessed with an SUV(max) cutoff of 2.5. In the neo-adjuvant group, the 95% limits of agreement were once again more accurate when assessed visually with a mean difference of -0.6 cm (SD 1.84 cm) compared to a mean difference of +1.58 cm (SD 3.1 cm) when assessed with an SUV(max) cutoff of 2.5.

CONCLUSION:
This study confirms the high accuracy of PET/CT in measuring gross target volume (GTV) length. A visual method for GTV length measurement was demonstrated to be superior and more accurate than when using an SUV(max) cutoff of 2.5. This has the potential of reducing the planning target volume with dose escalation to the tumour with a corresponding reduction in normal tissue complication probability.