Pulmonary adenocarcinoma in two alpacas (Vicugna pacos)

We describe here two cases of pulmonary neoplasia in alpacas: case 1 was a 19‐year‐old female huacaya alpaca that was submitted to investigate sudden death with possible previous weight loss. Gross and histological examination revealed changes consistent with primary lepidic‐type pulmonary adenocarcinoma (previously bronchioalveolar carcinoma) with metastases to the thorax and abdomen. Case 2 was a six‐year‐old male castrated Suri alpaca with a 3‐week history of weight loss and inappetance that was euthanased following a short period of recumbency and respiratory signs. Gross and histological features in this case were consistent with a diagnosis of metastatic adenocarcinoma affecting the lungs and lymph nodes. Masses from both alpacas were further characterised using immunohistochemistry for thyroid transcription factor 1 (TTF‐1), pan cytokeratin AE1/AE3 and vimentin. We show that histological subtype and TTF‐1 and AE1/AE3 immunoreactivity can be used to differentiate primary and metastatic pulmonary adenocarcinomas in the lungs of alpacas

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes