Sternal Lymphadenopathy Research Articles

CT features of primary bone neoplasia of the thoracic wall in dogs.

Primary thoracic wall neoplasia is uncommon in dogs and the prognosis depends on tumor type. The aims of this retrospective, multi-center, observational study were to describe CT features of primary thoracic wall neoplasia in dogs and to test the hypothesis that CT features would differ among tumor types. Dogs with a diagnosis of primary thoracic wall bone neoplasia and thoracic CT study were included. CT findings recorded were as follows: dimensions, location, invasiveness, grade and type of mineral attenuation, periosteal reaction, contrast enhancement, and presence of presumed pulmonary metastases, pleural effusion, and sternal lymphadenopathy. Fifty-eight cases were included (54 ribs and four sternum). Fifty-six were malignant (sarcomas - SARC) and two were benign (chondromas - CHO). Out of the 56 malignant tumors, 41 had histological confirmation of the tumor type: 23 (56%) osteosarcomas (OSA), 10 (24%) chondrosarcomas (CSA), and eight (20%) hemangiosarcomas (HSA). The majority of rib tumors were right-sided (59%) and ventrally located (72%). Malignant masses showed severe invasiveness, mild/moderate contrast enhancement, and different grades of mineral attenuation. Sternal lymphadenopathy was significantly more frequent in dogs with OSA and HSA compared to dogs with CSA (p = 0.004 and p = 0.023). Dogs with HSA showed significantly lower mineral attenuation grades compared to dogs with OSA (p = 0.043). Primary thoracic wall bone neoplasias were more frequently arising from the ribs, with only a few cases of sternal masses. Findings can be used to help prioritize differential diagnoses for CT studies of dogs with thoracic wall neoplasia.

Sternal lymphadenopathy in dogs with malignancy in different localizations: A CT retrospective study of 60 cases.

Sternal lymph nodes (SLNs) drain a multitude of regions in dogs, including the pectoral and shoulder region, the thoracic wall and mammary glands, the mediastinum, thymus, diaphragm, and the ventral abdominal wall and peritoneal cavity. Neoplastic conditions of these regions can lead to sternal lymphadenopathy. The aim of this study was to assess the most frequent localizations of the primary neoplasia and the most frequent tumor types in dogs with sternal lymphadenopathy. Computed tomographic (CT) characteristics of SLNs in dogs with confirmed neoplasia were also described. For this single-center retrospective descriptive study, dogs with sternal lymphadenopathy and cytological or histological diagnosis of neoplasia were included. Sixty dogs fulfilled the inclusion criteria: 30 (50%) with thoracic neoplasia, 19 (32%) with abdominal neoplasia, 6 (10%) with neoplasia of the front limbs and 5 (8%) with generalized neoplasia. Based on the cytological/histological diagnosis of the primary neoplasia, 31/60 (52%) dogs presented with a sarcoma, 15/60 (25%) with carcinoma, and 14/60 (23%) with round cell tumor. The presence of heterogeneous contrast enhancement was more frequent in dogs with sarcoma, while the concomitant presence of other abnormal lymph nodes was more frequent in dogs with round cell neoplasia. Tumors of different types and in different location can result in sternal lymphadenopathy in dogs. The most frequent in this study were thoracic and abdominal neoplasia, followed by neoplasia of the shoulder region. Sarcoma was the most common tumor type detected in this study, and the main CT characteristic of the SLNs in case of sarcoma was heterogeneous contrast enhancement.

Prognostic value of sternal lymphadenopathy on malignancy and survival in dogs undergoing splenectomy

The purpose of this retrospective cohort study was to determine prevalence of sternal lymphadenopathy in a population of dogs undergoing splenectomy, and to evaluate if the prevalence was associated with splenic malignancy. In addition, the study investigated if survival in dogs diagnosed with hemangiosarcoma (HSA) differed between those with or without sternal lymphadenopathy at the time of surgery. Digital radiographs and medical records for dogs who underwent splenectomy from 2013 to 2016 where retrospectively reviewed. One hundred ninety-five dogs underwent splenectomy during the study period. The overall prevalence of sternal lymphadenopathy was 12.8%. The prevalence of sternal lymphadenopathy in dogs with hemangiosarcoma was 16.2% (12/74), other malignancy was 15.8% (3/19), and with a benign process 9.8% (10/102). There was no significant association between sternal lymphadenopathy with hemoperitoneum (p=.20) or between sternal lymphadenopathy and presence of neoplasia (p=.37). There was no significant difference in survival probability in all dogs with or without sternal lymphadenopathy (p=.073). However, sternal lymphadenopathy was associated with lower survival in 74 dogs with HSA (p=.036) and 19 with other splenic malignancies (p=.039). The presence of sternal lymphadenopathy should not be considered a negative prognostic indicator if present in dogs presenting with a hemoperitoneum. Although the presence of sternal lymphadenopathy at the time of initial presentation was not significantly associated with survival time in all dogs with splenic disease, it may have predictive value related to survival of dogs with splenic malignancy.

Biliary Dilation: An Unusual Presentation of Histoplasma capsulatum in a Dog

ABSTRACT A 4 mo old intact male Labrador retriever was referred to the authors’ institution for a 3 wk history of weight loss and progressive abdominal distension. Thoracic radiographs revealed sternal lymphadenopathy and a diffuse unstructured interstitial and bronchial pulmonary pattern. An abdominal ultrasound revealed multifocal lymphadenopathy, hepatosplenomegaly, and biliary duct dilation. Fine-needle aspirates of the spleen and liver revealed Histoplasma capsulatum organisms. Antifungal therapy was initiated with itraconazole and terbinafine. Repeat ultrasound examinations revealed resolving hepatosplenomegaly and resolving cystic duct dilation. Ultrasonographic findings mirrored a decrease in urine H capsulatum antigen levels. Histoplasmosis should be considered as a differential for unexplained biliary duct dilation or obstruction in dogs. Dogs with disseminated histoplasmosis should be monitored for this potential complication.

Vaccine strain Listeria monocytogenes abscess in a dog: a case report

BackgroundListeria monocytogenes is a promising therapeutic vaccine vector for cancer immunotherapy. Although highly attenuated, three cases of systemic listeriosis have been reported in people following treatment with Listeria-based therapeutic vaccines. This complication has thus far not been reported in canine patients.Case presentationA dog previously diagnosed with osteoblastic osteosarcoma was presented for care following administration of three doses of the Canine Osteosarcoma Vaccine-Live Listeria Vector. On routine staging chest radiographs, mild sternal lymphadenopathy and a right caudoventral thoracic mass effect were noted. Further evaluation of the mass effect with computed tomography and ultrasound revealed a cavitated mass associated with the 7th right rib. Aspirates of the mass cultured positive for Listeria monocytogenes. The mass and associated ribs were surgically removed. Histopathology was consistent with metastatic osteoblastic osteosarcoma. Treatment was continued with doxorubicin chemotherapy and at the time of publication, the dog was alive over 1 year following diagnosis with no evidence of further disease progression. Genotyping of the abscess-derived L. monocytogenes was consistent with the vaccine strain.ConclusionsThis case represents the first veterinary case to describe development of a Listeria abscess following administration of a Listeria-based therapeutic vaccine.

Nodules and masses are associated with malignant pleural effusion in dogs and cats but many other intrathoracic CT features are poor predictors of the effusion type.

Thoracic CT may be used in the workup of patients with pleural effusion. In humans, certain pleural features on CT aid in diagnosing an underlying cause for pleural effusion, whereas this is not well studied in veterinary medicine. This retrospective cross-sectional analytical study assessed pleural and other intrathoracic abnormalities on CT in dogs and cats with pleural effusion and explored potential discriminatory features between effusion types. Eighty-nine dogs and 32 cats with pleural cytology and/or histopathology were categorized into malignant pleural disease (15 dogs and 11 cats), pyothorax (34 dogs and 7 cats), chylothorax (20 dogs and 11 cats), transudative (11 dogs and 2 cats), and hemorrhagic effusion (9 dogs and 1 cat). Multivariable logistic regression analysis comparing malignancy to other effusions found that older patient age (dogs: odds ratio 1.28, P=0.015; cats: odds ratio 1.53, P=0.005), nodular diaphragmatic pleural thickening (dogs: odds ratio 7.64, P=0.021; cats: odds ratio 13.67, P=0.031), costal pleural masses (dogs: odds ratio 21.50, P=0.018; cats: odds ratio 32.74, P=0.019), and pulmonary masses (dogs: odds ratio 44.67, P=0.002; cats: odds ratio 18.26, P=0.077) were associated with malignancy. In dogs, any costal pleural abnormality (odds ratio 47.55, P=0.002) and pulmonary masses (odds ratio 10.05, P=0.004) were associated with malignancy/pyothorax, whereas any costal pleural abnormality (odds ratio 0.14, P=0.006) and sternal lymphadenopathy (odds ratio 0.22, P=0.040) were inversely associated with transudates. There were, however, many overlapping abnormalities between effusion types, so further diagnostic testing remains important for diagnosis.

Abstract LB-201: Durable remission of lethal canine hemangiosarcoma

Abstract Background: Angiosarcoma is an uncommon but deadly malignant neoplasm of the vascular endothelium. Primary disease may present at any vascularized site but often occurs in the dermis on the neck and scalp or in the radiation field of women previously-treated for breast cancer. Metastases are often present at first diagnosis, and five-year survival is an abysmal 10-30%. In contrast to the relative paucity of human diagnoses, angiosarcoma is a major killer in the companion canine population, responsible for an estimated 120,000 deaths per year in the United States. The canine disease (termed HSA) closely mimics the human disease in both pathology and genetics. It frequently presents in the dog as acute hemoabdomen secondary to splenic rupture. Even if life-saving splenectomy is performed, median OS is a scant 48 days, and one-year OS hovers at 0%. Given the lack of an analogous rodent model and the accelerated timeline of the canine disease, the outbred companion canine is an ideal system in which to translate novel therapeutic approaches. Here we report an interim analysis of a phase I multi-site, open-label veterinary trial of chemo-immunotherapy performed on consecutively-presenting splenectomized companion canines with histopathologically-verified HSA. Methods: In addition to two cycles of 20 mg/m2 (low-dose) doxorubicin, enrolled study subjects received an autologous cell-therapy reported to generate durable CD8+ memory similar to that of physiologic viral infection. Vaccine was generated from mobilized peripheral blood and cryopreserved tumor antigen and was administered in four doses given in conjunction with type I interferon. Disease burden was monitored monthly by abdominal ultrasound, chest x-ray, and echocardiogram. Results: At the time of abstract submission, median OS had not yet been reached in the per protocol population, with 75% of animals alive and healthy (NED or ongoing PR) at up to one year post-splenectomy (p<0.0002). Abdominal ultrasound documented the resolution of local mesenteric disease in one animal, sternal lymphadenopathy in another, and hepatic metastases in a third. In the intent-to-treat population, median OS was 109 days with 43% of animals alive and healthy at up to one year post-splenectomy. A single incidence of grade 1/2 uveitis resolved promptly with administration of ophthalmic corticosteroids. Conclusions: Administration of autologous cell therapy in conjunction with low-dose doxorubicin is feasible, safe, and highly efficacious in the companion canine population. Generally, if subjects survived long enough to begin treatment, the prognosis became quite favorable. The results suggest that additional clinical studies in both canines and humans are warranted. Citation Format: Matthew M. Halpert, Vanaja Konduri, Yunyu Chen, Dan Liang, Jonathan M. Levitt, Brittany Neal, Caleb Hudson, Heidi Hottinger, Sindy Piscoya, Nicola Wilson, Lisa DiBernardi, Shonda Stallings, Zharkyn Omarbekov, Lori Seelhof, Oscar Ramirez, Qizhi C. Yao, Ratan D. Bhardwaj, Vinod Ravi, Laurel Douglass, William K. Decker. Durable remission of lethal canine hemangiosarcoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr LB-201. doi:10.1158/1538-7445.AM2017-LB-201

Active specific immunotherapy for lethal canine hemangiosarcoma: A model system for the treatment of angiosarcoma with curative intent.

e14539 Background: Angiosarcoma is a deadly malignant neoplasm of the vascular endothelium. Metastases are often present at diagnosis, and 5-year survival is only 10-30%. Though it comprises only 1% all soft tissue sarcoma diagnoses, it is a major killer among companion canines, responsible for an estimated 120,000 deaths per year in the US. The canine disease (termed HSA) closely mimics the human disease in both pathology and genetics. It frequently presents in the dog as acute hemoabdomen secondary to splenic rupture. Even if life-saving splenectomy is performed, median OS is only 48 days, and 1 year OS hovers at 0%. Given the accelerated timeline of the canine disease, the outbred dog is an ideal system in which to translate novel therapeutic approaches. Here we report an analysis of a phase I multi-site, open-label veterinary trial of chemo-immunotherapy performed on consecutively-presenting splenectomized companion canines with histopathologically-verified HSA. Methods: Subjects were administered two cycles of 20 mg/m2 (low-dose) doxorubicinand an autologous cell-therapy reported to generate durable CD8+ memory similar to that of physiologic viral infection. Vaccine was generated from mobilized peripheral blood and cryopreserved tumor antigen and was administered with type I interferon. Disease burden was monitored monthly by abdominal ultrasound, chest x-ray, and echocardiogram. Results: At the time of submission, median OS had not been reached in the per protocol population, with 75% of animals alive and healthy (NED or ongoing PR) at up to 1 year post-splenectomy (p < 0.0002). Ultrasound documented resolution of local mesenteric disease in one animal, sternal lymphadenopathy in another, and hepatic metastases in a third. In the intent-to-treat population, median OS was 109 days with 43% of animals alive and healthy at up to 1 year post-splenectomy. Conclusions: Administration of autologous cell therapy with low-dose doxorubicin is feasible, safe, and highly efficacious in the companion canines. If subjects survived long enough to begin treatment, prognosis became favorable. The results suggest that additional clinical studies in both canines and humans are warranted.

Active Specific Immunotherapy plus Doxorubicin Chemotherapy Mediates Durable Remission of Lethal Canine Hemangiosarcoma

Abstract Angiosarcoma is a deadly neoplasm of the vascular endothelium. Metastases are often present at diagnosis, and 5-year survival is only 10–30%. While the disease is uncommon in humans, angiosarcoma is a major killer of companion dogs, responsible for 120,000 deaths per year in the US. The canine disease (HSA) presents as acute hemoabdomen secondary to splenic rupture. Even if life-saving splenectomy is performed, median OS is only 48 days, and one-year survival is 0%. Here we report an interim analysis of a phase I multi-site, open-label trial of chemo-immunotherapy performed on consecutively-presenting splenectomized canines with verified HSA. Subjects received doxorubicin plus an autologous cell-therapy that generates durable CD8+ memory. Disease was monitored monthly by abdominal ultrasound, chest x-ray, and echocardiogram. At the time of this submission, median OS had not yet been reached in the per protocol population, with 75% of animals alive and healthy at up to one year post-splenectomy (p<0.0002). Abdominal ultrasound documented resolution of local mesenteric disease in one animal, sternal lymphadenopathy in another, and hepatic metastases in a third. No significant adverse events were reported. Administration of this therapy appears feasible, safe, and highly efficacious in dogs. If subjects survived long enough to begin treatment, prognosis became highly favorable. The results suggest additional clinical studies in both canines and humans are warranted.

Computed Tomographic Evaluation of Presumptively Normal Canine Sternal Lymph Nodes.

The sternal lymph nodes receive drainage from a wide variety of structures in the thoraco-abdominal region. Evaluation of these lymph nodes is essential, especially in cancer patients. Computed tomography (CT) can detect sternal lymph nodes more accurately than radiography or ultrasonography, and the criteria of the sternal lymphadenopathy are unknown. The purpose of this retrospective study was to describe the CT characteristics of the sternal lymph nodes in dogs considered unlikely to have lymphadenopathy. The ratio of the short axis dimension of the sternal lymph nodes to the thickness of the second sternebra was also investigated. At least one sternal lymph node was identified in each of the 152 dogs included in the study. The mean long axis and short axis dimensions were 0.700 cm and 0.368 cm, respectively. The mean ratio of the sternal lymph nodes to the second sternebrae was 0.457, and the 95% prediction interval ranged from 0.317 to 0.596 (almost a fixed value independent of body weight). These findings will be useful when evaluating sternal lymphadenopathy using CT.

Computed tomography, radiology and echocardiography in cats naturally infected with Aelurostrongylus abstrusus.

Objectives The aims of the study were to describe the radiographic and computed tomographic features in cats naturally infected with Aelurostrongylus abstrusus, and to identify signs of pulmonary hypertension with echocardiography. Methods Fourteen cats positive on Baermann test for A abstrusus were included in the study. All cats underwent thoracic radiography, CT and echocardiography. Results The most common clinical signs were coughing (10/14) and dyspnoea (5/14). Radiographic findings included a generalised unstructured interstitial pulmonary pattern (8/14), mixed bronchointerstitioalveolar pattern (3/14) and bronchointerstitial pattern with bronchial wall thickening (3/14). Sternal lymphadenopathy was detected on thoracic radiographs in six cats. On CT, features were mixed bronchointerstitioalveolar pattern with ground-glass appearance in six cats, interstitioalveolar with multiple pulmonary nodules in five, interstitial ground-glass infiltrates in three, regional lymph node enlargement in 11 (10 sternal, three cranial mediastinal and three tracheobronchial lymph nodes) and subpleural thickening in four. None of the thoracic radiographs revealed subpleural thickening. In all cases, pulmonary vessels were normal in terms of size, shape and attenuation on both radiography and CT. Pulmonary hypertension and cardiac abnormalities were not observed in any cat during echocardiography. Conclusions and relevance CT provided a more thorough characterisation of pulmonary and mediastinal lesions compared with thoracic radiographs in cats naturally infected with A abstrusus. Although feline aelurostrongylosis has been previously associated with histopathological lesions in lung arteries, in this cohort clinical evidence of pulmonary hypertension was not documented.

Preoperative thoracic radiographic findings in dogs presenting for gastric dilatation‐volvulus (2000–2010): 101 cases

To identify the incidence of clinically significant findings on preoperative thoracic radiographs in dogs with gastric dilatation-volvulus (GDV) and to determine if those findings are associated with survival. Retrospective study from 2000 to 2010. Urban university small animal teaching hospital. One hundred and one dogs diagnosed with GDV that had thoracic radiographs obtained preoperatively, and medical records available with the following information available: signalment, time of presentation, respiratory status, plasma lactate, presence of cardiac arrhythmias, reason for thoracic radiographs, radiographic findings, and outcome. None. Findings on preoperative thoracic radiographs included small vena cava (40%), esophageal dilation (39%), microcardia (34%), aspiration pneumonia (14%), cardiomegaly (5%), pulmonary nodule (4%), pulmonary edema (2%), sternal lymphadenopathy (1%), and pulmonary bullae (1%). Eighty-four percent of dogs (85 out of 101) survived to discharge. Dogs without cardiomegaly on presenting thoracic radiographs had a 10.2 greater odds of surviving to discharge. The most common findings on preoperative thoracic radiographs include esophageal dilation, microcardia, and a small vena cava while the incidence of pulmonary nodules was low. A negative association between survival and presence of cardiomegaly on preoperative thoracic radiographs in dogs with GDV supports the need to obtain these images for prognostic information in spite of the emergency surgical nature of the GDV. The main limitations of this study include the possibilities of type I and type II errors, the retrospective nature of the study, and the lack of well-defined criteria for obtaining thoracic radiographs.

Radiographic Characterization of Enlarged Sternal Lymph Nodes in 71 Dogs and 13 Cats

In this retrospective study, radiographically enlarged sternal lymph nodes (LNs) were evaluated in 71 dogs and 13 cats for average size, location, and most representative radiographic view. Concurrent clinical diagnoses were also noted and grouped into one of three following categories: neoplastic, inflammatory, or hematologic. There were no statistically significant differences in LN size between lateral views within each species. Enlarged sternal LNs were more cranially positioned in dogs than cats. No statistical difference was noted between right and left laterals, as to on which projection the enlarged sterna lymph nodes was seen best. Neoplastic disease (78.9%) was the most prevalent condition seen in association with LN enlargement in dogs, followed by primary infectious or inflammatory diseases (14.1%) and various hematologic conditions (7.0%). In cats, neoplasia was also most common (69.2%), followed by inflammatory diseases (30.8%). No hematologic conditions were noted in cats. The most common etiologic agent seen concurrently with enlarged sternal LNs in both dogs (33.8%) and cats (38.5%) was malignant lymphoma. The results of this study provide a clinically useful representation of the average size and location of radiographically enlarged sternal LNs for dogs and cats. The diseases represented demonstrate the wide spectrum of potential causes of sternal lymphadenopathy.

Radiographic findings in cats with mycobacterial infections

This study describes radiographic changes associated with mycobacterial infection in 33 domestic cats confirmed by culture or interferon-gamma testing. Infection was seen most frequently in adult (average age 5.7 years; range 1.5-12 years), non-pedigree (87%; 27/31), neutered male cats (69%; 22/32). The most common infections were Mycobacterium microti (60%; 18/30) and Mycobacterium bovis (37%; 11/30); Mycobacterium avium and Mycobacterium malmoense were infrequently cultured (3% of each; 1/30). Radiographs were available for the thorax (24 cats), abdomen (eight), appendicular skeleton (11) and head (three). Radiographic changes affected the thorax most commonly, consisting of bronchial (46%; 11/24), alveolar (38%; 9/24), nodular unstructured interstitial (38%; 9/24) or unstructured interstitial (25%; 6/24) lung patterns, which were often mixed. Perihilar or sternal lymphadenopathy were common (42%; 10/24), particularly perihilar lymphadenopathy (25%; 6/24). Skeletal changes were found in the distal antebrachium (three), pes (two), maxilla, scapula, spine, manus, femur, and tarsus (one each). Changes were typically osteolytic (73%; 8/11), often permeative osteolytic (64%; 7/11). Osteoproliferative changes were seen in three cats and soft tissue swelling in five cats, which were adjacent to the bony abnormality in four cats. Other changes included submandibular soft tissue swelling, marked aortic, aortic root and brachiocephalic trunk calcification, and soft tissue swelling with calcification in the distal antebranchium which was not involving bone. Abdominal changes were uncommon (seen in 2/8 cats) and consisted of hepatomegaly and hepatosplenomegaly. In summary, radiographic changes were varied, no lesion was pathognomic for mycobacterial infection, and pathology was seen most commonly in the thorax.

Lymphoma‐Associated Polymyositis in Dogs

Lymphoma‐Associated Polymyositis in Dogs

Systemic infection with Geomyces organisms in a dog with lytic bone lesions

A 5-year-old neutered male mixed-breed dog was evaluated by a veterinarian because of a 4-week history of progressive lethargy and poor appetite; the dog was then examined at a referral hospital. Hyperglobulinemia was identified via serum biochemical analyses performed before and after arrival at the hospital. Lysis of sternebrae 1 and 2 and sternal lymphadenopathy were detected radiographically. Fine-needle aspirates were collected from the affected sternebrae and lymph node for cytologic examination; findings were consistent with pyogranulomatous inflammation associated with fungal infiltrates. Geomyces organisms were identified via microbial culture of sternebral aspirates. Treatment consisted of oral administration of itraconazole. After 6 months, remodeling of the affected sternebrae and resolution of sternebral lysis were evident radiographically. Geomyces organisms and pyogranulomatous infiltrates persisted despite clinical improvement. Treatment with itraconazole was continued for an additional 3 months. Infection with Geomyces organisms is typically localized to the skin and nail beds. In the dog of this report, systemic dissemination of Geomyces organisms resulted in lysis of the first 2 sternebrae. Cytologic examination of fine-needle aspirates and microbial culture of samples of the affected sternebrae were important diagnostic tests for successful identification of the organism. Despite 6 months of itraconazole administration and evidence of clinical improvement, fungal organisms persisted in the dog's affected sternebrae. Practitioners should include Geomyces infection among the differential diagnoses for suspected systemic mycosis and should perform cytologic examination and microbial culture of affected tissue throughout treatment of affected dogs.

Diagnostic imaging appearance and significance of sternal lymphadenopathy

Companion AnimalVolume 11, Issue 1 p. 29-31 Diagnostic imaging appearance and significance of sternal lymphadenopathy Avi Avner BSc BVSc CertVR MRCVS, Avi Avner BSc BVSc CertVR MRCVS QUEEN'S VETERINARY SCHOOL HOSPITAL, MADINGLEY ROAD, CAMBRIDGE. CB3 0ESSearch for more papers by this author Avi Avner BSc BVSc CertVR MRCVS, Avi Avner BSc BVSc CertVR MRCVS QUEEN'S VETERINARY SCHOOL HOSPITAL, MADINGLEY ROAD, CAMBRIDGE. CB3 0ESSearch for more papers by this author First published: 30 September 2010 https://doi.org/10.1111/j.2044-3862.2006.tb00004.xAboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume11, Issue1January 2006Pages 29-31 RelatedInformation