Hemangiosarcoma, hemangioma, transitional cell carcinoma, and chronic cystitis were diagnosed in the urinary bladder of six captive fallow deer (Dama dama). Hematuria and thin body condition were observed in the advanced cases. These findings were compatible with chronic enzootic hematuria and were suspected to have been induced by chronic ingestion of bracken fern (Pteridium aquilinum) present on the premises. These lesions were similar to those described in bovine enzootic hematuria in cattle. Hemangiosarcoma metastases, hydronephrosis, and renal carcinoma were also associated in some cases. This is the first report of hemangioma, hemangiosarcoma, transitional cell carcinoma, and renal carcinoma of the urinary bladder in fallow deer and the first indication of bracken fern intoxication in deer.

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A captive juvenile little bustard ( Tetrax tetrax ) was presented for acute onset of right head tilt and right circling. The bird failed to respond to supportive care and systemic antibiotic therapy. A bilateral granulomatous and fibrinoheterophilic otitis interna due to Pseudomonas aeruginosa was diagnosed postmortem by histopathologic examination and bacterial culture. In bustards, Pseudomonas species have been documented in the normal bacterial flora of the oropharynx and are frequently reported in upper respiratory tract infections. This is the first report of a peripheral vestibular syndrome due to P aeruginosa otitis interna in a bustard species. Pseudomonas aeruginosa should be included as a possible cause of otitis and peripheral vestibular syndrome in bustards.

OBJECTIVES: To examine and compare costs and cost drivers for various metastatic renal cell carcinoma (mRCC) drugs. METHODS: This retrospective cohort study used administrative healthcare claims from MarketScan® Commercial and Medicare Supplemental Databases to identify patients newly diagnosed with mRCC (index event) from 1/1/2006 to 3/31/2014, with continuous health plan enrollment at least 6 months prior to and 30 days following the index date. Treatment with approved mRCC products on or after the index date was required. Patients were followed until death, health plan enrollment end, initiation of non-mRCC chemotherapy, or study end. Healthcare costs reflect paid amounts to providers and out-of-pocket costs to patients. Bootstrapping was used to determine differences between costs of drugs. RESULTS: The study population included 3060 mRCC patients. Total per-patient-per-month costs for pazopanib ($14,486) and sorafenib ($13,841) were not statistically lower at an alpha level of 0.05 than sunitinib ($15,808). However, temsirolimus ($19,431) and IL-2 ($96,619) were significantly more costly than sunitinib. For inpatient and patient out-ofpocket costs, IL-2 was significantly more costly than sunitinib. Outpatient costs of pazopanib and temsirolimus were both significantly more costly than sunitinib while sorafenib was significantly less costly. Multivariate modeling found that year of index date, number of metastatic sites, NCI comorbidity index score, and evidence of an adverse event during first line treatment were significantly associated with greater costs for all patients. In general, approximately 46% of total costs were specific to mRCC drug costs while 30% were due to inpatient stay. CONCLUSIONS: This study demonstrates that there may be significant cost differences between mRCC drugs and that mRCC drug costs represent the largest driver of total healthcare costs in this patient population. Further research on comparative effectiveness, weighing costs relative to clinical benefit, is needed.