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Infectious diseases can be a major problem in the shelter environment. This chapter provides a very brief overview of the infectious agents that can cause disease, how the pathogens of importance are transmitted, and how they might be managed and treated.

OVER the past two years, a consensus has been building among a number of vets working in the major animal welfare charities and in some universities that it would be desirable to form an Association of Charity Vets. A large number of vets and veterinary nurses work for animal welfare charities in the UK, providing subsidised or free veterinary care to owners unable to afford private veterinary fees or providing care …

Metastasis to the pituitary gland is very uncommon and a first presentation of any systemic tumour through pituitary metastasis is rare. The authors report an 82-year-old Caucasian woman, well-controlled hypertensive and moderate smoker who presented with worsening diplopia. On ocular motility examination she had partial right third nerve paralysis along with reduced vision in the right eye and headache. MRI brain showed a large growth in the pituitary gland consisting with radiological features of pituitary macroadenoma. The initial chest x-ray showed a non-specific shadow that raised some suspicions and a CT scan of her thorax confirmed a right central bronchial carcinoma. The authors suggest that pituitary gland metastases be considered as part of the differential diagnosis for any patient presenting with a pituitary lesion, as pituitary disease could be the first manifestation of an underlying malignancy.

Background Acute central retinal artery occlusion (CRAO) occurs as a sudden interruption of the blood supply to the retina and results in an almost complete loss of vision in the affected eye. There is no generally agreed treatment regimen although a number of therapeutic interventions have been proposed. Objectives The objective of this review was to examine the effects of treatments used for acute non-arteritic CRAO. Search strategy We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library, Issue 3, 2008), MEDLINE (January 1966 to September 2008), EMBASE (January 1980 to September 2008) and the reference lists of relevant papers. Selection criteria We included randomised controlled trials (RCTs) only in which one treatment aimed to re-establish blood supply to the retina in people with acute CRAO was compared to another treatment. Data collection and analysis Two authors independently assessed the search results for relevant trials. Discrepancies were resolved by discussion. Main results We found two RCTs that met our inclusion criteria. Authors' conclusions The included studies in this review were small and from single centres. Neither study was completely clear about it's method of treatment allocation. One study described the use of pentoxifylline tablets (three 600 mg tablets daily) and the other the use of enhanced external counterpulsation (EECP) combined with haemodilution. Both studies indicated improved retinal perfusion in the non-control group but neither showed an improvement in vision. Large, well-designed RCTs are still required to establish the most effective treatment for acute CRAO. These studies should be looking at factors important to the patient i.e. improved vision with acceptable risk/side-effects.

Aim: To attempt to validate two scoring systems for the prediction of intraoperative complication during phacoemulsification surgery. Methods: The study population was patients attending Sunderland Eye Infirmary who underwent phacoemulsification surgery between 1 January 2001 and 31 December 2003. The authors applied each scoring system to a control group of 300 patients from this study population and extrapolated the results to give an estimate of the spread of scores for the entire population. They then applied the same scoring systems to all complicated cases from the same study population. Using these results they were able to calculate the risk of a complication for a particular score on each scoring system. Conclusion: The application of these systems in clinical practice would allow appropriate selection of phacoemulsification cases for trainee surgeons, more accurate consent from patients for their phacoemulsification surgery, and the unbiased comparison of surgical outcomes from surgeons with differing case mix difficulties.

Background To examine whether variations in non-medical personnel influence the incidence of complications in a cataract theatre. Methods A retrospective Case-Control study was undertaken in a single-site, designated cataract theatre. Staffing variations within theatre were examined and the incidence of cataract complications was assessed. Results 100 complicated lists and 200 uncomplicated control lists were chosen. At least 7 nurses were present for every list. Mean experience of the nurses was 6.4 years for case lists and 6.5 years for control lists. Average scrub nurse experience in years was 7.6 years for complicated lists and 8.0 years for controls. 26% of complicated case lists were affected by unplanned leave and 17% in control lists. Odds ratio 1.7 (1.0 to 3.1) 95% CI. Conclusion Unplanned leave can have a detrimental effect on the operating list. The impact of this may be modifiable with careful planning.

HEAD AND NECK Fascial Compartments of the Neck What is the significance of the fascial compartments of the neck? They compartmentalise structures in the neck and form natural planes of cleavage through which tissues can be separated in surgery. They also form planes along which infections can spread. What are the different fascial layers? They are made up of superficial and deep cervical fascia. Superficial fascia lies between the skin and investing layer of deep fascia. As well as containing nerves, blood vessels and lymphatics, it encloses the platysma muscle anteriorly. The deep cervical fascia consists of four parts: investing; pretracheal; prevertebral; and the carotid sheath. Can you tell me the margins of the investing layer? The investing layer of fascia surrounds the neck deep to the superficial fascial layer. It splits to enclose the trapezius and sternocleidomastoid muscles on either side. The superior attachment of the investing layer extends from the superior nuchal line to the tip of the mastoid process. It extends to the zygomatic arch and the lower border of the mandible. Anteriorly, it attaches to the hyoid bone and posteriorly, it attaches to the ligamentum nuchae. Between the angle of the mandible and mastoid process, it splits to enclose the parotid and submandibular glands. Inferiorly, it attaches to the manubrium, clavicles and the spines and acromion of the scapulae. In attaching to the manubrium, the investing layer attaches to the anterior and posterior border forming a suprasternal space.

Chronic narrow angle glaucoma (CNAG) occurs when the anterior chamber drainage angle progressively narrows with a subsequent rise in intraocular pressure (IOP) and, if this rise is maintained, glaucomatous optic neuropathy. Although there may be a number of reasons for this narrowing, if the peripheral iris remains apposed to the trabecular meshwork for any length of time it is likely that a more permanent adhesion occurs (PAS). Thus even though the underlying cause for the narrowing is removed—for example, pupillary block after peripheral iridectomy (PI) or cataract extraction in lens induced disease, the angle remains closed and the IOP remains damagingly high. We have previously described a technique for use in acute angle closure glaucoma where the lens induced narrowing is removed by cataract extraction and the PAS broken with viscoelastic. This manoeuvre has been called viscogonioplasty (or VGP).1 This case series describes the results of this same technique in patients with chronic narrow angle glaucoma From April 2002 to March 2005 all patients with CNAG inadequately controlled on conventional therapy were enrolled. The inclusion criteria were as follows: An occludable angle was defined as the angle in which the posterior (usually pigmented) trabecular meshwork was seen for less than 90° of the angle circumference.2 Exclusion criteria included: The duration of increased IOP or synechial angle closure was not one of our inclusion or exclusion criteria. However, all patients …

FURTHER to our earlier correspondence ( VR , June 23, 2012, vol 170, p 652), we are pleased to announce the inaugural meeting of the Association of Charity Vets at the School …

‘Hyperacute’ unilateral anterior uveitis and secondary glaucoma following streptokinase infusion