New Insights into the Management of an EHV-1 (Equine Hospital) Outbreak

In May 2018, Wolvega Equine Hospital (WEH) experienced an EHV-1 outbreak. This outbreak caused significant economic losses and negative publicity for the hospital. How should hospitals prepare themselves for these outbreaks and prevent shedding of the virus on multiple neighboring premises? The hospital transformed most of its activities into mobile practice and the entire infected hospital population was moved to a separate remote location. The hospital was cleaned and disinfected according to the latest recommendations before reopening. Four neighboring professional equine businesses and three privately owned premises were affected by the spread of the virus from the hospital population and initiated quarantine restrictions. Equine hospitals should prepare themselves for EHV-1 outbreaks as the intake of the virus cannot be prevented. A management protocol should include public information protocols, swift client information and quarantine measures that ensure quick containment of the outbreak. Timely reopening of the hospital can be achieved by rehousing the contaminated population. It should also include good regulations with clients and a properly carried out release protocol. Equine sports organizations should establish sufficient vaccination coverage in order to decrease the frequency of EHV-1 outbreaks.     

Single‐port surgery: Current applications and limitations

Introduction: In an attempt to further enhance the benefits of cosmesis and reduced morbidity of minimally invasive surgery, single‐port (incision) laparoscopic surgery (SPS) has emerged as a bridge between conventional laparoscopy and natural orifice transluminal endoscopic surgery. As the expertise and instrumentation required are an extension of standard laparoscopic techniques, SPS has been adapted for a variety of procedures and specialties in a short span of time. Discussion: In this article, we discuss the various SPS techniques, as well as the new devices and instrumentation available for facilitating SPS. We also review current applications reported for SPS in various surgical specialties. We present a comprehensive review of the potential benefits, limitations and risks of these novel techniques. Conclusion: Initial reports have demonstrated the technical feasibility and safety of SPS for a wide range of surgical applications. With specialized instrumentation and refinement of technique, its role will increase in coming years. Future work is necessary to improve existing instrumentation, to increase clinical experience and to assess the benefits of this surgical approach.     

Control of EHV-1 viremia and nasal shedding by commercial vaccines

Equine herpesvirus-1 is a cause of outbreaks of abortion and neurological disease. The pathogenesis of both these diseases depends on establishment of viremia. An experiment was performed to determine the protective efficacy of two commercially available vaccines used with an optimized 3-dose vaccination regime: a modified-live viral (MLV) and a high antigen load killed vaccine licensed for abortion control. The study design was a blinded, randomized challenge trial. Three groups of 8 yearling ponies received one of three treatments: MLV vaccine (Rhinomune^®, Boehringer Ingelheim Vetmedica, Inc.); killed vaccine (Pneumabort-K^®, Pfizer Animal Health); or a placebo (control group). Three vaccinations were administered at intervals of 27 and 70 days followed by challenge infection 24 days later. Clinical disease after challenge was significantly reduced in both vaccine groups; the reduction was greater in the MLV vaccine group. Nasal shedding was reduced by at least 1–2 logs in both vaccine groups. The number of days of viremia was significantly reduced in the killed vaccine group only. This study demonstrated that both commercial vaccines significantly suppressed EHV-1 disease and nasal viral shedding, and one vaccine suppressed days of viremia.     

Oblique planes of section in MR imaging

Magnetic resonance (MR) imaging allows freedom in choosing oblique planes of section and rotation of the image plane with respect to the frequency-encoded (F) and phase-encoded (P) dimensions. A general method is described for understanding geometric relationships between the fixed magnetic coordinate system, patient positioning, and the flexible observer's coordinate system. Oblique planes of section are clinically useful in studying organs with an axis of symmetry that is oblique to the magnet coordinate system, such as the heart. Rotation of the image plane can be used to move motion artifacts away from anatomic regions of interest, such as the liver and spine. Appropriate use of oblique section selection and image rotation can improve MR image quality and diagnostic value of the patient study.     

Projection arteriography and venography: initial clinical results with MR

Motion currently limits the applications of magnetic resonance (MR) angiography in certain regions of the body. To overcome this problem, a series of breath-hold, two-dimensional, flow-compensated gradient-echo images were acquired. These images were then processed by means of the maximum intensity projection algorithm to produce projection angiograms. The method was evaluated in 10 healthy subjects and in 12 patients and validated by comparing conventional angiograms, contrast material-enhanced computed tomographic scans, and duplex sonograms with MR projection arteriograms and venograms of the chest, abdomen, and pelvis. The aorta and pulmonary arteries and their branches were demonstrated, as was detailed anatomy of the hepatic and portal venous systems and inferior vena cava. Renal arteries and veins could be studied in both native and transplanted kidneys. The method permits determination of flow direction and differentiation of arteries and veins and is superior to three-dimensional acquisition techniques for imaging slow blood flow. Initial results suggest that the method may have clinical applications for a variety of vascular disorders.     

Abdominal lymphoma in AIDS: evaluation with US

The sonographic findings in 38 patients with abdominal lymphomas related to acquired immunodeficiency syndrome (AIDS) were reviewed. Thirty-three patients had non-Hodgkin lymphoma, and five had Hodgkin disease. Abnormal masses were detected with sonography in 33 patients (87%). Focal hypoechoic liver lesions up to 10 cm in diameter were visible in 17 patients. Several lesions were anechoic and septated, mimicking fluid. Adenopathy (at the retroperitoneum, mesentery, or porta hepatis) was seen in 15 patients. Other involved areas included bowel, omentum, spleen, kidney, and adrenal gland. AIDS-related abdominal lymphomas frequently cause extranodal masses that can be readily imaged with ultrasound. Ultrasound-guided fine needle aspiration biopsy allows a specific diagnosis to be made in many cases.