Preoperative gabapentin for acute post-thoracotomy analgesia: a randomized, double-blinded, active placebo-controlled study

BACKGROUND

The role of preoperative gabapentin in postoperative pain management is not clear, particularly in patients receiving regional blockade. Patients undergoing thoracotomy benefit from epidural analgesia but still may experience significant postoperative pain. We examined the effect of preoperative gabapentin in thoracotomy patients.

METHODS

Adults undergoing elective thoracotomy were enrolled in this prospective, randomized, double-blinded, placebo-controlled study, and randomly assigned to receive 600 mg gabapentin or active placebo (12.5 mg diphenhydramine) orally within 2 hours preoperatively. Standardized management included thoracic epidural infusion, intravenous patient-controlled opioid analgesia, acetaminophen and ketorolac. Pain scores, opioid use and side effects were recorded for 48 hours. Pain was also assessed at 3 months.

RESULTS

One hundred twenty patients (63 placebo and 57 gabapentin) were studied. Pain scores did not significantly differ at any time point (P = 0.53). Parenteral and oral opioid consumption was not significantly different between groups on postoperative day 1 or 2 (P > 0.05 in both cases). The frequency of side effects such as nausea and vomiting or respiratory depression was not significantly different between groups, but gabapentin was associated with decreased frequency of pruritus requiring nalbuphine (14% gabapentin vs. 43% control group, P < 0.001). The frequency of patients experiencing pain at 3 months post-thoracotomy was also comparable between groups (70% gabapentin vs. 66% placebo group, P = 0.72).

CONCLUSIONS

A single preoperative oral dose of gabapentin (600 mg) did not reduce pain scores or opioid consumption following elective thoracotomy, and did not confer any analgesic benefit in the setting of effective multimodal analgesia that included thoracic epidural infusion.

Possible subclinical hepatopathy after copper supplementation in farmed red deer

AIM

To determine the effect of parenteral supplementation with Cu on the activities of hepatic enzymes in deer with adequate concentration(s) of Cu in liver and serum.

METHODS

Male red deer aged 12 months were given either 0.8 or 1.6 mg of Cu/kg of a S/C injectable Cu formulation or no Cu (n=10/group) on 03 December 2007 (Day 0). Concentration of Cu in liver was measured in biopsies taken on Days -13 and 17, and that in serum on Days 0, 1, 3 and 17. Liver enzymes, gamma-glutamyl transferase (GGT) and glutamate dehydrogenase (GDH), were measured in serum on Days 3 and 7. Deer were weighed on Days 0 and 17.

RESULTS

The mean concentration of Cu in liver was 203 (range 50-460) μmol/kg fresh weight (FW) on Day -13 and that in serum was 14.8 (range 7.8-25.0) μmol/mL on Day 0. Concentrations of Cu in liver were adequate (>100 μmol/kg FW) in 25/30 deer. Injection with 0.8 mg of Cu/kg resulted in elevated mean concentrations of Cu in serum to 20.3 (range 14-26) and 17.4 (range 12-26) μmol/mL on Days 1 and 3 respectively, whereas 1.6 mg/kg resulted in mean concentrations of Cu in serum of 26.7 (range 20-42) and 19.3 (range 16-25) μmol/mL on Days 1 and 3 respectively (p<0.05). The mean concentration of Cu in liver on Day 17 was 1,460 (range 1,000-2,300) after injection with 0.8 mg/kg, 1,666 (range 1,100-2,200) after 1.6 mg/kg, and 280 (range 75-420) μmol/kg FW in controls. Injection with 1.6 mg Cu/kg, but not 0.8 mg/kg, resulted in an increase in the activity of GGT (p=0.05), and in 4/10 deer a marked change in the activity of GDH, between Day 3 and Day 7, indicating that injection of copper induced a moderate degree of subclinical hepatopathy. Mean liveweight gain (g/day) to Day 17 was 105.9 (range -176 to 411) in control animals and 64.7 (range -59 to 176) 64.7 and -61.7 (range -294 to 117) in deer given 0.8 and 1.6 mg/Cu/kg respectively (p=0.003).

CONCLUSIONS

S/C administration of 1.6 mg of Cu/kg in deer which had adequate Cu status pre-treatment resulted in elevated activities of GGT and GDH in serum, indicating hepatopathy, and both this dose rate and 0.8 mg/kg resulted in reduced liveweight gain post-treatment compared with untreated controls.

CLINICAL SIGNIFICANCE

Cu supplementation should not be administered when the Cu status of deer is adequate or unknown.

Evaluation of a SYTO9 real-time polymerase chain reaction assay to detect and identify pathogenic Leptospira species in kidney tissue and urine of New Zealand farmed deer

A SYTO9 real-time polymerase chain reaction assay for detection of pathogenic Leptospira spp. based on amplification of DNA gyrase subunit B (gyrB) gene has been optimized and evaluated for sensitivity and specificity on kidney and urine samples of New Zealand farmed deer. The detection limit was 10(3) cells/ml (2-10 copies/reaction). Comparison of the assay on deer kidneys (n = 268) with culture as the gold standard revealed a sensitivity and specificity of 85% and 99.2%, respectively. For deer urine (n = 113), the assay was compared with known inoculated samples and revealed a sensitivity and specificity of 96.7% and 100%, respectively. The assay was applied for quantifying pathogenic leptospires shed naturally in deer urine and revealed a detectable concentration of 3.7 × 10(3) to 1.7 × 10(6) cells/ml. To assess the assay's capability for identifying pathogenic Leptospira spp., 14 field isolates of L. borgpetersenii serovar Hardjo-bovis and L. interrogans serovar Pomona were amplified for polymerase chain reaction (PCR) product, purified, and sequenced. When compared with the National Center for Biotechnology Information database, sequence data matched with L. borgpetersenii serovar Hardjo-bovis in 13 samples and L. interrogans serovar Pomona in 1 sample, which was consistent with the microscopic agglutination test (MAT). Sequence analysis of purified PCR product amplified directly from kidney and urine samples also yielded serovar-comparable MAT results. Results suggest that the assay is rapid, sensitive, and specific for detection of pathogenic leptospires in deer clinical samples. The developed assay can also be used for estimating the concentration of leptospires and identifying Leptospira spp. in combination with DNA sequencing.

Blood constituents of farmed red deer (Census elaphus). II: biochemical values

Approximately 80 farmed male and female red deer aged three months and over were blood sampled and biochemical parameters measured. The deer were sampled by jugular venepuncture without tranquillization. Mean values recorded were serum gamma-glutamyltransferase (19.5 IU/l), glutamic oxaloacetic transaminase (43.0 IU/l), creatine phosphokinase (197.9 IU/l), plasma pepsinogen (0.91 IU/i), blood urea nitrogen (8.56 mmol/l), serum glucose (6.9 mmol/l), phosphorus (1.75 mmol/l), calcium (2.13 mmol/l), magnesium (0.74 mmol/l), potassium (4.43 mmol/l) and sodium (138.5 mmol/l). There were no significant differences in any parameter between sexes or between age groups 3-8 months, 9-18 months, or older.

Serological responses of farmed red deer to a vaccine againstLeptospira interrogansserovarshardjoandpomona

Six adult, female, red deer were vaccinated with a hardjo-pomona vaccine followed by a second vaccination four weeks later and thereafter, at yearly intervals for two years. Serological responses were determined at intervals using a standard microscopic agglutination test. Increased responses to hardjo were observed in two deer which were seropositive to this serovar before vaccination compared to those which were initially seronegative. Some initially seronegative deer developed titres to hardjo and pomona ranging from 1:24 to 1:48 following the first dose of vaccine, and all deer produced a serological response to both serovars ranging from 124 to 1:96 following the second vaccination except one animal which failed to produce a pomona titre of 124 or greater. Responses to annual revaccinations were more variable both within and between years. Most deer produced titres which ranged from 1:24 to 1:96 for three to live months, although some deer failed to seroconvert following the annual revaccinations. Peak responses were similar to those recorded in cattle following an identical vaccination programme with the same vaccine but titres fell to undetectable levels after three to live months whereas titres reported in cattle generally persisted for at least 12 months.

Observations of a long-acting formulation of oxytetracycline in red deer (Cervus elaphus)

Six nine-month-old red deer were injected intramuscularly with a long-acting injectable solution of oxytetracycline (Terramycin-LA, Pfizer Ltd) at a dose rate of 20 mg/kg. Four similar control deer were injected with saline. There was no significant pain response to injection, and only minor palpable swellings at the injection site were observed in three oxytetracycline-treated and one control animal. No statistically significant changes in white blood cell numbers, blood fibrinogen, creatine phosphokinase or glutamic oxaloacetic transaminase concentrations occurred as a result of oxytetracycline administration up to seven days after injection. Mean plasma oxytetracycline concentration reached a peak (4.68 mg/l) two hours after injection and declined to levels below assay sensitivity (0.3 mg/l) in five deer 72 hours after injection, and in all deer by 96 hours after injection. No gross lesions at the injection site were observed at slaughter 30 days after injection. There were traces of oxytetracycline at the injection site muscle of two deer after 30 days, but residues were not detected in injection site muscle from the other four deer, or in any of the liver, kidney or other muscle specimens.

Chronic malignant catarrhal fever: a case in a sika deer (Cervus nippon)

A condition resembling chronic malignant catarrhal fever was seen in a 9-month-old pet sika hind (Cervus nippon). From an initial acute depression, pyrexia, and anorexia, the condition progressed to include hypopyon, keratitis, lethargy, loss of condition, sloughing of one hoof and eventually death after seven weeks. There were multiple, 5 to 8mm diameter dark-red nodules throughout the mesenteries and mediastinum, along abdominal organ ligaments, and about the uterus and kidneys. Histopathology showed the nodules to be organising vascular thrombi. Concurrent perivascular mononuclear infiltrations and intravascular thrombi in many tissues confirmed that the condition was malignant catarrhal fever.

Blood constituents of farmed red deer (Cervus elaphus): I. Haematological values

Approximately 100 farmed male and female red deer aged three months and over were blood-sampled and haematological parameters were measured. The deer were sampled by jugular venepuncture without tranquilization. Mean values were haemoglobin (16.0 g/dl), packed cell volume (44.6%), mean corpuscular haemoglobin concentration (35.8 g/dl), total plasma protein (66.0 g/l). fibrinogen (4.8 g/l) and white blood-cell numbers (5.80 x 10(9)/l). Differential white blood-cell counts were neutrophils (53.9%), eosinophils (4.8%), basophils (3.0%), lymphocytes (37.2%) and monocytes (1.1%). There were no significant differences in any parameter measured between sexes or between age groups three to eight months, nine to eighteen months, or older.

Sedation and chemical restraint of deer

This review examines the properties of chemical immobilising agents of use or potential use in deer for velvet antler removal. The alpha-2-adrenergic agonist, xylazine, is the most commonly used agent for chemical restraint of stags for this purpose in New Zealand. This compound is often combined with an opioid or ketamine to enhance its effectiveness. Concerns about the carcinogenic potential of a xylazine metabolite have led to a call by the deer industry to limit the use of this drug and stimulated enquiry into alternatives. The potent pure opioid agonists, fentanyl, carfentanil and etorphine, are less effective than xylazine when used alone, and their use presents greater risk to operators and animals and is subject to more stringent legal restrictions. Newer alpha-2-adrenergic agonists, detomidine and medetomidine, are more potent than xylazine and unlikely to result in carcinogenic metabolites. Availability of specific alpha-2-adrenergic antagonists further enhances the usefulness of these drugs. The dissociative agent, ketamine, has proven useful for immobilisation of various domestic and wildlife species and captive species of deer but undesirable side effects and the low concentration, relative to the effective dose, of currently available formulations limit its usefulness. Combination of a dissociative agent with an alpha-2-adrenergic agent reduces the required dose of both and enhances their efficacy. A commercially available combination of the dissociative anaesthetic agent, tiletamine, and the benzodiazepine, zolazepam, is more potent than ketamine and induction times are faster. This combination can be manipulated to varying concentrations by dissolution with alpha-2-adrenergic agents. A long-acting neuroleptic agent, zuclopenthixol, has recently been investigated for calming deer and may be an alternative to classical sedative-immobilising agents. Most chemical immobilisation agents used alone or in combination produce respiratory depression and supplemental oxygen has been recommended. All would likely result in some form of chemical residues in velvet antler.

Trace element metabolism, dietary requirements, diagnosis and prevention of deficiencies in deer

The first deer farms were established in New Zealand about 30 years ago. Extensive studies on trace elements in sheep and cattle have resulted in clarification of the requirements of those species and the development of protocols to diagnose and prevent deficiencies. In contrast, there have been very few studies conducted with deer. This review summarises information available on trace element nutrition of deer and concludes that, in New Zealand, cobalt (Co), vitamin B12, selenium (Se) and iodine (I) deficiencies are of lesser importance than copper (Cu), which can have a significant impact on deer health and performance. However, on individual farms, Se and I deficiency may cause significant production losses if not managed appropriately. There are no reports of production limitations caused by Co deficiency. Copper deficiency manifests itself as clinical disease, namely enzootic ataxia and osteochondrosis. Growth responses to Cu supplementation have only been reported in 2/11 trials and were not predicted from low serum and/or liver Cu concentrations. On the basis of clinical signs of Cu deficiency, the proposed reference ranges used to predict Cu status from serum Cu concentrations (micromol/l) are: 5, deficient; 5-8, marginal and; 8, adequate; and for liver Cu concentrations (micromol/kg fresh tissue) are: 60, deficient; 60-100, marginal and; 100, adequate. Copper supplementation strategies based on Cu-EDTA injections, Cu-oxide needles or the application of Cu to pasture are effective at increasing Cu status for varying periods. More recent research suggests that alternative forage species that have a high Cu content (10 mg/kg dry matter (DM), may play a role in the prevention of Cu deficiency.

Chemical analgesia for velvet antler removal in deer

There is a legal requirement to provide analgesia for velvet antler removal in New Zealand. Currently, this is achieved using local anaesthetic blockade, with or without systemically administered sedative/analgesic agents, or by compression in 1-year-old stags. Lignocaine hydrochloride 2% is most commonly used and is most effective when administered as a high-dose ring block. Combinations of various amino-amide local anaesthetic agents can achieve rapid onset and prolonged duration of analgesia, though concerns about drug residues and carcinogenic potential of a lignocaine metabolite have led to consideration of the amino-ester family of local anaesthetics as alternatives. Systemically administered analgesics, including opioids, alpha-2-adrenergic agents and ketamine provide dose-dependent sedation and analgesia. However, none are sufficient, alone or in combination, to produce surgical analgesia at currently recommended dose rates and when reversal agents are given, analgesic effects are usually reversed as well as sedation. Thus, local anaesthetic blockade is still indicated, though the potential for drug or drug-metabolite residues in velvet antler remains a concern. The need for and effectiveness of non-steroidal anti-inflammatory drugs (NSAIDs) for post-operative analgesia requires investigation. Amitriptyline, locally administered opioid agonists, tramadol and other systemically administered agents may warrant future investigation for surgical and post-operative analgesia for velvet antler removal.

The effect of long-acting injectable selenium formulations on blood and liver selenium concentrations and liveweights of red deer (Cervus elaphus)

AIM

To evaluate the efficacy of a new long acting injectable selenium ( Se ) formulation to increase the Se status and prevent Se deficiency in red deer.

METHODS

Groups of weaned red deer (four stags and six hinds/group) grazing pastures containing <30 mg Se/kg DM were injected subcutaneously with either 0.5, 1.0 or 2.0 mg Se/kg as a new formulation of BaSeO4 (Deposel Multidose), 1.0mgSe/kg of a current formulation (Deposel), or not treated. Blood Se concentrations and liveweight were measured nine times at intervals over 377 and 270 days, respectively.

RESULTS

Both formulations of Se elevated blood Se concentrations from 105 nmol/l pre-injection for at least 377 days with peak levels of 1894, 1395 and 818 nmol/l for high, medium and low doses of Deposel Multidose, respectively, at 73141 days, and 1508 nmol/l at 73-141 days for the medium dose of Deposel, which persisted at similar levels for the duration of the study. Deposel Multidose produced fewer and less severe subcutaneous tissue reactions than Deposel. Pastures contained 10 to 30 mg Se/kg DM. There was no significant difference in growth rate between treated and control deer. There was a significant (p<0. 01) linear relationship (y = 1.25x + 71.6, R2=0.86) between blood (x) and liver (y) Se concentrations in the range of 120 - 2100 nmol/l for blood concentrations, and 200 - 3000 nmol/kg for liver concentrations.

CONCLUSION

Injections of BaSeO4 in both formulations studied were effective in increasing the Se status of deer but the new formulation produced fewer and less-severe tissue reactions. Young growing red deer appear less sensitive to Se deficiency as measured by weight gain, than sheep and cattle, suggesting that reference ranges for those species are not appropriate for deer. There was a linear correlation between blood and liver selenium concentrations.

Welfare of farmed deer in New Zealand. 1. Management practices

This review summarises research of management practices that potentially impact on the welfare of farmed deer. The processes of capture and initial domestication of feral deer caused many welfare problems but are now essentially complete in New Zealand. The health and production status of farmed deer, and readily visible indicators of their welfare are generally good, although preventive medicines and optimum management practices have not been universally adopted. Research into social behaviour, effects of yarding, weaning, mating, calving, shelter, shade and nutrition has identified ways of improving the welfare of farmed deer and has provided recommendations for deer industry quality assurance programmes. Research has identified transport design and practices that minimise the impact of transport on deer welfare and reduce carcass wastage caused by bruising during transport. Time in lairage prior to slaughter should be minimised and electrical stunning is a humane method of slaughter. Ongoing research is needed on management practices and farm environments to further improve the welfare of farmed deer, consistent with the goals of the New Zealand deer industry and its proactive approach to date.

Novel forages for growth and health in farmed deer

AIMS

This paper reviews recent research on the use of new forages in deer farming that may be useful for increasing growth in weaner deer for venison production, increasing the trace element status of deer, and for developing systems less reliant on chemical inputs, notably of anthelmintics used to control internal parasites.

GROWTH

Grazing on pure swards of red clover (Trifolium pratense) or chicory (Chicorium intybus) increased weaner growth during autumn by 26-47% and during spring by 10-14%, relative to red deer (Cervus elaphus) grazed on perennial ryegrass (Lolium perenne) /white clover (Trifolium repens) pasture (0.8/0.2). Pre-weaning growth during lactation was increased by approximately 20%. These increases were due to increased rate of degradation of feed particles in the rumen, leading to higher digestibility and higher voluntary feed intakes (VFI). Red clover and chicory produce a greater proportion of their total dry matter (DM) during late summer and autumn than perennial ryegrass/white clover pastures, and are therefore better aligned with the seasonal feed requirements of deer. Grazing on the legume, sulla (Hedysarum coronarium), in autumn and spring increased the growth of weaner deer by 33% and 10%, respectively, relative to pasture-fed animals.

PARASITES

Plants containing substantial concentrations of secondary compounds such as condensed tannins (CT) show promise for reducing problems caused by internal parasites. CT present in some legumes and the presence of low concentrations of both CT and sesquiterpene lactones in chicory are reviewed. Feeding sulla containing 35g CT /kg DM reduced abomasal nematode establishment and tended to reduce lungworm (Dictyocaulis eckerti) larval counts in faeces. Relative to weaner deer grazing pasture, weaner deer grazing chicory during autumn required fewer anthelmintic treatments without depressing growth rates. CT extracted from a range of legumes, and CT and sesquiterpene lactones extracted from chicory reduced the in vitro motility of both lungworm and gastrointestinal nematode larvae. The beneficial effects of CT-containing forages on the ability of young deer to manage internal parasite infections could be due to: indirect effects of CT resulting in increased amino-acid absorption, better meeting demands of the immune system; direct inhibitory effects of CT on parasite larvae and; taller plant morphology, reducing the ingestion of infective larvae. The effects of CT depend upon both their structure and CT Condensed tannins DM Dry matter L1 First-stage larvae L3 Infective third-stage larvae LWG Liveweight gain ME Metabolisable energy OM Organic matter OMD Organic matter digestibility VFIVoluntary food intake concentration in the plant, which vary between growing conditions, plant varieties and species.

TRACE ELEMENTS

Chicory contained higher concentrations of copper and cobalt than perennial ryegrass/white clover pasture grown on the same farm, and deer grazing chicory had higher liver concentrations of both copper and vitamin B12. These forages may contribute to maintaining adequate trace element status in deer.

CONCLUSIONS

Grazing systems that include legumes and herbs such as sulla, red clover and chicory can be used to substantially increase the growth of weaner deer for venison production whilst maintaining deer health and reducing requirements for chemical inputs. For maximum plant persistence and animal responses, these plants should be grown and managed as special-purpose forages and not used in seed mixtures with perennial grasses.

Regional seroprevalence of leptospirosis on deer farms in New Zealand

AIM

To undertake a seroprevalence survey to estimate the distribution of infection by Leptospira spp. serovars Hardjobovis, Pomona and Copenhageni in farmed deer herds regionally throughout New Zealand.

METHODS

Between March 2003 and February 2005, 111 red and red x wapiti deer herds not using a leptospiral vaccine were selected from nine regions from Northland to Southland. Eighty-three herds were selected for on-farm collection of 12-20 blood samples from hinds predominantly 9-30 months of age, by jugular venepuncture, while similar numbers, predominantly males 9-30 months of age, per farm were collected from 28 herds at sticking at deer slaughter premises (DSP). Serum was stored frozen until analysed using the microscopic agglutination test (MAT). Titre cut-points of 1:24 for serovar Hardjobovis and 1:48 for serovars Pomona and Copenhageni were considered positive at the individual animal level. Herds were considered seropositive if there were at least three animals per herd seropositive to any serovar.

RESULTS

Eighty-one percent of herds were seropositive for Leptospira spp. Hardjobovis was the predominant serovar at the herd (78%) and individual animal (60.8%) levels. The seroprevalence of Pomona was 20% and 8.4% at the herd and animal levels, respectively. Dual seroreactivity to both Hardjobovis and Pomona was observed in 16% of herds and 6.6% of individuals; within-herd seroprevalence for both serovars ranged from 0 to 100%. No herds and 1.2% of animals were seropositive for serovar Copenhageni. There was a regional difference in the prevalence of herds seropositive to both Hardjobovis and Pomona (p=0.02), but no difference between regions in the prevalence of herds seropositive to either Hardjobovis or Pomona alone.

CONCLUSION

The seroprevalence of Leptospira spp. serovars is high, and distributed in farmed deer herds throughout New Zealand.

CLINICAL SIGNIFICANCE

Results confirm the risk of disease and potential loss of production in deer, and exposure of infection to humans and other livestock from deer is widespread, demonstrating that control of the disease needs to be considered at a national rather than regional level.

Working less to gain more: when breeding quality relates to foraging efficiency

In animal populations, a minority of individuals consistently achieves the highest breeding success and therefore contributes the most recruits to future generations. On average, foraging performance is important in determining breeding success at the population level, but evidence is scarce to show that more successful breeders (better breeders) forage differently than less successful ones (poorer breeders). To test this hypothesis, we used a 10-year, three-colony, individual-based longitudinal data set on breeding success and foraging parameters of a long-lived bird, the Adélie Penguin, Pygoscelis adeliae. Better breeders foraged more efficiently than poorer breeders under harsh environmental conditions and when offspring needs were higher, therefore gaining higher net energy profit to be allocated to reproduction and survival. These results imply that adverse "extrinsic" conditions might select breeding individuals on the basis of their foraging ability. Adélie Penguins show sufficient phenotypic plasticity that at least a portion of the population is capable of surviving and successfully reproducing despite extreme variability in their physical and biological environment, variability that is likely to be associated with climate change and, ultimately, with the species' evolution. This study is the first to demonstrate the importance of "extrinsic" conditions (in terms of environmental conditions and offspring needs) on the relationship between foraging behavior and individual quality.

Comparison of concentrations of copper in plasma and serum from farmed red deer (Cervus elaphus)

AIM

To determine the relationship between the concentrations of Cu in plasma and serum in red deer, and to compare this relationship with those previously reported in cattle and sheep.

METHODS

Paired serum and heparinised plasma samples from 114 red deer from 10 herds (n=6-20 per herd) were analysed for concentrations of Cu. Samples were collected either at slaughter (n=84; eight herds) or by jugular venepuncture (n=30; two herds). Thirty-nine of the samples taken at slaughter were from adult hinds from four herds, while other samples were taken from 10-14-month-old males, except for one herd (10 samples) where an equal number of 8-9-month-old males and females were sampled. The effect of age, gender and herd on the relationship between concentrations of Cu in plasma and serum was assessed using univariate ANOVA. The individual results for concentrations of Cu in serum were compared with those in plasma, using limits-of-agreement plotting.

RESULTS

The mean concentration of Cu in plasma was not significantly different from that of serum (0.048; 95% CI=-0.14 to 0.24 micromol/L). There was no effect of age, sex or herd on this relationship.

CONCLUSIONS

In deer, there was no significant difference between concentrations of Cu in plasma and serum regardless of age, sex or herd of origin.

CLINICAL RELEVANCE

In contrast to the situation in cattle and sheep, the concentration of Cu in serum can be used interchangeably with that in plasma for the estimation of concentration of Cu in blood of red deer.

Leptospirosis in farmed deer in New Zealand : a review

Current knowledge of leptospirosis in farmed deer in New Zealand is reviewed. Over the past 25 years, leptospirosis has been reported to occur in individual cases as well as in herd outbreaks in farmed deer and in human cases linked to farmed deer. Serological studies and evidence from bacterial culture suggest infection is widespread. Mixing of young stock from several sources appears to be a significant risk factor for outbreaks. The culture of Leptospira interrogans serovars Hardjobovis, Pomona and Copenhageni has been reported. Infection with serovar Hardjobovis had the highest prevalence, either individually or mixed with serovar Pomona. Infection with serovar Copenhageni appears uncommon and its pathogenicity in deer is unproven. Titres to serovars Australis, Ballum, Balcanica and Tarassovi have been reported. Deer appear to be maintenance hosts for serovar Hardjobovis, incidental or accidental hosts and probably a maintenance population for serovar Pomona, since some infections persist for several months, and accidental hosts for serovar Copenhageni. Serovar Pomona appears to produce clinical and probably subclinical disease, whereas serovar Hardjobovis appears to cause only subclinical disease, although the relative risk of disease causation has not been determined. Clinical disease is usually manifested by haemolysis, jaundice, renal lesions, haemoglobinuria and often by sudden death. Renal lesions are commonly observed at slaughter and many are associated with leptospiral infections. Occupationally, slaughterhouse workers appear to be at greatest risk of contracting the disease from deer. Vaccination produces serological responses, but its effectiveness in protecting against disease, and prevention or reduction of shedding in urine, has not yet been confirmed in deer. More robust knowledge of the epidemiology of leptospiral infections in deer, and the effectiveness of vaccines and vaccination regimes, is needed to assist the deer industry to develop a strategy to manage this disease.

Proposed new diagnostic criteria for complex regional pain syndrome

This topical update reports recent progress in the international effort to develop a more accurate and valid diagnostic criteria for complex regional pain syndrome (CRPS). The diagnostic entity of CRPS (published in the International Association for the Study of Pain's Taxonomy monograph in 1994; International Association for the Study of Pain [IASP]) was intended to be descriptive, general, and not imply etiopathology, and had the potential to lead to improved clinical communication and greater generalizability across research samples. Unfortunately, realization of this potential has been limited by the fact that these criteria were based solely on consensus and utilization of the criteria in the literature has been sporadic at best. As a consequence, the full potential benefits of the IASP criteria have not been realized. Consensus-derived criteria that are not subsequently validated may lead to over- or underdiagnosis, and will reduce the ability to provide timely and optimal treatment. Results of validation studies to date suggest that the IASP/CRPS diagnostic criteria are adequately sensitive; however, both internal and external validation research suggests that utilization of these criteria causes problems of overdiagnosis due to poor specificity. This update summarizes the latest international consensus group's action in Budapest, Hungary to approve and codify empirically validated, statistically derived revisions of the IASP criteria for CRPS.