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Topic:Biopsy

Biopsy in horses involves the collection of tissue samples for diagnostic purposes, often to identify the presence of disease, evaluate tissue abnormalities, or monitor treatment responses. This procedure can be performed on various tissues, including skin, muscle, liver, and other organs, depending on the clinical indications. Biopsies are typically obtained using specialized instruments and techniques to ensure minimal discomfort and accurate sample collection. The analysis of biopsy samples can provide detailed histological information that aids in diagnosing conditions such as neoplasia, inflammatory diseases, and infectious processes. This page compiles peer-reviewed research studies and scholarly articles that explore the methodologies, applications, and outcomes of biopsy procedures in equine veterinary practice.
Fibrosarcoma over the tarsal groove of a 14-month-old Quarter horse.
Veterinary and comparative orthopaedics and traumatology : V.C.O.T    April 6, 2006   Volume 18, Issue 2 115-118 
Story MR, Gaughan EM, Andrews GA, Balch S.A 14-month-old male Quarter horse was presented for evaluation of a grade 3 out of 5 (grade 0 = sound; grade 5 = non-weight bearing) right rear lameness. A firm, 8 x 16 cm mass was palpable at the caudal medial aspect of the distal tibia and proximal tarsal region of the right hind limb. A percutaneous needle aspirate contained mesenchymal cells that were moderate to large in size with single, oblong nuclei. Differential diagnoses included fibrous hyperplasia, fibroma, or well-differentiated fibrosarcoma. Excisional biopsy for both definitive diagnosis and treatment was offered and selected by...
Potential role of multiple rectal biopsies in the diagnosis of equine grass sickness.
The Veterinary record    March 21, 2006   Volume 158, Issue 11 372-377 doi: 10.1136/vr.158.11.372
Wales AD, Whitwell KE.Two samples were taken postmortem from the rectum of each of 14 horses with grass sickness and 10 control horses, and four sections stained with haematoxylin and eosin were examined. By using as a criterion of grass sickness the presence of three chromatolytic neurons, 10 of the 14 cases were positive and none of the control horses was positive, giving a sensitivity of 71 per cent and a specificity of 100 per cent. No other histological features appeared to be of diagnostic value, and staining for Nissl substance in neurons with cresyl fast violet and methyl green-pyronin did not improve the s...
Equine endometrial fibrosis correlates with 11beta-HSD2, TGF-beta1 and ACE activities.
Molecular and cellular endocrinology    January 9, 2006   Volume 248, Issue 1-2 104-108 doi: 10.1016/j.mce.2005.12.008
Ganjam VK, Evans TJ.Endometrial periglandular fibrosis (EPF) contributes to embryonic and fetal loss in mares. Equine EPF correlates inversely with conception and successful gestation. In the modified Kenney endometrial biopsy classification system, EPF categories I, IIA, IIB, and III correspond to minimal, mild, moderate, and severe fibrosis (+/-inflammation), respectively. Paraffin sections of biopsy specimens were stained with H&E, and picrosirius red (specific for fibrillar collagens types I and III), to determine %EPCVF. Endometrial ACE-binding activity, TGF-beta1 and 11beta-HSD2 activities were also measure...
Prevalences and clinical signs of polysaccharide storage myopathy and shivers in Belgian draft horses.
Journal of the American Veterinary Medical Association    December 29, 2005   Volume 227, Issue 12 1958-1964 doi: 10.2460/javma.2005.227.1958
Firshman AM, Baird JD, Valberg SJ.To determine prevalences of polysaccharide storage myopathy (PSSM) and shivers in Belgian Draft Horses (BDHs) and determine whether there was an association between these 2 conditions. Methods: Prospective cohort study. Methods: 103 BDHs > 1 year old. Methods: Owners were questioned regarding clinical signs of PSSM, shivers, and hindquarter weakness, defined as poor hindquarter muscling and lack of propulsion. Blood samples were collected for determination of serum creatine kinase and aspartate transferase activities and serum selenium and vitamin E concentrations. A biopsy sample from the ...
Alterations of epidermal proliferation and cytokeratin expression in skin biopsies from heavy draught horses with chronic pastern dermatitis.
Veterinary dermatology    December 20, 2005   Volume 16, Issue 6 373-384 doi: 10.1111/j.1365-3164.2005.00482.x
Geburek F, Ohnesorge B, Deegen E, Doeleke R, Hewicker-Trautwein M.We report the historical, clinical and histopathological characteristics of skin lesions in biopsies from 37 heavy draught horses with chronic pastern dermatitis. The skin lesions were divided into four macroscopic groups: scaling (group I, n=5), hyperkeratotic and hyperplastic plaque-like lesions (group II, n=14), nodular skin masses (group III, n=16) and verrucous skin lesions (group IV, n=2). The principal histological findings were hyperkeratosis and epidermal hyperplasia. There was a gradual increase in epidermal hyperplasia from groups I to IV, suggesting that the lesions represent diffe...
Changes in steady-state concentrations of messenger ribonucleic acids in luteal tissue during prostaglandin F2alpha induced luteolysis in mares.
Animal reproduction science    November 22, 2005   Volume 90, Issue 3-4 273-285 doi: 10.1016/j.anireprosci.2005.02.008
Beg MA, Gastal EL, Gastal MO, Ji S, Wiltbank MC, Ginther OJ.Transvaginal ultrasound-guided luteal biopsy was used to evaluate the effects of prostaglandin (PG)F2alpha on steady-state concentrations of mRNA for specific genes that may be involved in regression of the corpus luteum (CL). Eight days after ovulation (Hour 0), mares (n=8/group) were randomized into three groups: control (no treatment or biopsy), saline+biopsy (saline treatment at Hour 0 and luteal biopsy at Hour 12), or PGF2alpha+biopsy (5mg PGF2alpha at Hour 0 and luteal biopsy at Hour 12). The effects of biopsy on CL were compared between the controls (no biopsy) and saline+biopsy group. ...
Functional adaptation through changes in regional biochemical characteristics during maturation of equine superficial digital flexor tendons.
American journal of veterinary research    November 3, 2005   Volume 66, Issue 9 1623-1629 doi: 10.2460/ajvr.2005.66.1623
Lin YL, Brama PA, Kiers GH, DeGroot J, van Weeren PR.To quantify and compare biochemical characteristics of the extracellular matrix (ECM) of specimens harvested from tensional and compressive regions of the superficial digital flexor tendon (SDFT) of horses in age classes that include neonates to mature horses. Methods: Tendon specimens were collected on postmortem examination from 40 juvenile horses (0, 5, 12, and 36 months old) without macroscopically visible signs of tendonitis. Methods: Central core specimens of the SDFT were obtained with a 4-mm-diameter biopsy punch from 2 loaded sites, the central part of the mid-metacarpal region and th...
The challenge of assessing inflammatory and structural changes in lower equine airways: a chance for thoracoscopic-guided pulmonary biopsy?
Veterinary journal (London, England : 1997)    October 24, 2005   Volume 172, Issue 2 202-203 doi: 10.1016/j.tvjl.2005.08.009
Kirschvink N.No abstract available
Synovial membrane microarthroscopy of the equine midcarpal joint.
Veterinary surgery : VS    October 11, 2005   Volume 34, Issue 4 310-317 doi: 10.1111/j.1532-950X.2005.00048.x
Serena A, Hanson RR, Kincaid SA.To evaluate the value of microarthroscopy in the equine midcarpal joint using the vital stains methylene blue, trypan blue, neutral red, and Janus green B to observe components of the synovial lamina propria, vascular architecture, and synoviocytes. Methods: Experimental. Methods: Ten horses. Methods: Microarthroscopy of left and right midcarpal joints was performed with and without vital staining of the synovium. Four vital stains (methylene blue, trypan blue, neutral red, and Janus green B) were evaluated, with each stain used in 5 joints. Synovial biopsy specimens were collected from the do...
Comparative study on microvascular occlusion and apoptosis in body and limb wounds in the horse.
Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society    September 24, 2005   Volume 13, Issue 5 520-529 doi: 10.1111/j.1067-1927.2005.00073.x
Lepault E, Céleste C, Doré M, Martineau D, Theoret CL.Wound repair in horse limbs is often complicated by exuberant granulation tissue, a condition characterized by excessive fibroplasia and scarring and that resembles hypertrophic scars and keloids in man. The aim of this study was to compare microvascular occlusion and apoptosis in wounds of the limb with those of the body, which heal normally. Five 6.25 cm(2) wounds were created on both forelimbs and on the body of six horses. One limb was bandaged to stimulate excessive fibroplasia. Weekly biopsies were evaluated histologically and immunohistochemically for mutant p53 protein by terminal deox...
[Farmer’s lung disease caused by straw or hay? Case report].
Laeknabladid    September 13, 2005   Volume 91, Issue 7-8 587-589 
Gudmundsson G, Olafsson L, Nikulásson S, Jónsdóttir B.A young woman was admitted to Akranes Regional Hospital because of dyspnea, fatigue and fever. She was found to have bilateral pneumonia but etiology was not found. She was treated with antibiotics with good resolution and was discharged after eight days from the hospital. Four weeks later she noticed rapidly progressive dyspnea and was found to be hypoxemic, and to have restrictive spirometry and diffuse interstitial changes on chest radiography. Computerized tomography of the lungs showed diffuse ground glass changes. Transbronchial biopsies from the lungs showed numerous small granulomas. S...
Oxygen radical absorbance capacity (ORAC) and exercise-induced oxidative stress in trotters.
European journal of applied physiology    August 31, 2005   Volume 95, Issue 5-6 550-556 doi: 10.1007/s00421-005-0034-3
Kinnunen S, Hyyppä S, Lehmuskero A, Oksala N, Mäenpää P, Hänninen O, Atalay M.Strenuous exercise is a potent inducer of oxidative stress, which has been suggested to be associated with disturbances in muscle homeostasis, fatigue and injury. There is no comprehensive or uniform view of the antioxidant status in horses. We have previously shown that moderate exercise induces protein oxidation in trotters. The aim of this study was to measure the antioxidative capacity of the horse in relation to different antioxidant components and oxidative stress markers after a single bout of moderate exercise to elucidate the mechanisms of antioxidant protection in horses. Eight clini...
Effect of a silicone-containing dressing on exuberant granulation tissue formation and wound repair in horses.
American journal of veterinary research    August 23, 2005   Volume 66, Issue 7 1133-1139 doi: 10.2460/ajvr.2005.66.1133
Ducharme-Desjarlais M, Céleste CJ, Lepault E, Theoret CL.To determine the effect of a silicone dressing on the rate and quality of repair of limb wounds and compare microvascular occlusion and apoptosis in wounds treated with the silicone dressing and those treated with a conventional dressing in horses. Methods: 5 horses. Methods: Horses received two 6.25-cm2 wounds on each metacarpus. Ten wounds were treated with a silicone dressing; the other 10 were treated with a control dressing. Quality of repair and wound size were evaluated at each bandage change. Time to healing and the number of excisions of exuberant granulation tissue were recorded. Bio...
Macroscopical and histopathological changes in regressing primary and recurrent equine sarcoids during active specific bio-immunotherapy.
In vivo (Athens, Greece)    July 8, 2005   Volume 19, Issue 4 761-767 
Hallamaa RE, Saario E, Tallberg T.Healing sarcoids were followed in 18 horses which had taken part in previous clinical studies on a total of 29 horses suffering from either primary or recurrent sarcoids, treated with bio-immunotherapy. In the present study, attention was paid to changes observed in these fibroblastic skin tumours during their regression. The tumours were surgically debulked leaving the base in the skin. The horses were immunized according to bio-immunotherapy at 2- to 4-week intervals with an autogenous vaccine made from the excised part of the tumour until the base had visibly regressed. Healing was followed...
Septic arthritis and granulomatous synovitis caused by infection with Mycobacterium avium complex in a horse.
Journal of the American Veterinary Medical Association    July 2, 2005   Volume 226, Issue 12 2035-2002 doi: 10.2460/javma.2005.226.2035
Hewes CA, Schneider RK, Baszler TV, Oaks JL.A 12-year-old American Saddlebred gelding was referred to a veterinary teaching hospital for evaluation of a chronic lameness problem in the right radiocarpal joint. The horse had been treated for osteoarthritis of the right radiocarpal joint with multiple injections of cortisone during the past 3 years. The horse was severely lame on the right forelimb at a trot. Radiography and computed tomography revealed a 3 x 2-cm lytic defect in the distal portion of the radius and periarticular bone proliferation around the right radiocarpal joint. Ultrasonography of the distal portion of the radius rev...
Endometritis in the mare: a diagnostic study comparing cultures from swab and biopsy.
Theriogenology    June 28, 2005   Volume 64, Issue 3 510-518 doi: 10.1016/j.theriogenology.2005.05.034
Nielsen JM.The objective of this study was to compare results from endometrial culture swabs with results from culturing of endometrial biopsies. The culture results were related to cytological findings (polymorphonuclear; PMN-cells) and histological observations (PMN-cells). Biopsy and swab samples were smeared on the surface of a blood agar petri dish, and examined for growth of bacteria. Cytology samples were obtained from endometrial biopsies, stained and examined under microscopy for the presence of PMN-cells. Endometrial biopsies were examined for the presence of PMN-infiltration of the endometrial...
Myosin heavy chain isoforms in equine gluteus medius muscle: comparison of mRNA and protein expression profiles.
The journal of histochemistry and cytochemistry : official journal of the Histochemistry Society    June 27, 2005   Volume 53, Issue 11 1383-1390 doi: 10.1369/jhc.4A6609.2005
Eizema K, van den Burg MM, de Jonge HW, Dingboom EG, Weijs WA, Everts ME.The major structural protein in skeletal muscle, myosin heavy chain (MyHC), is primarily transcriptionally controlled. We compared the expression of MyHC isoforms on the mRNA and protein level in biopsies from the m. gluteus medius from adult untrained horses. In transverse sections, the majority of fibers showed qualitatively identical mRNA and protein expression patterns. However, coexpression of 2a and 2d/x MyHCs was substantially more common at the protein than at the mRNA level, suggesting a fine-tuning of these two genes in normal muscle not subjected to any training protocol. Because tr...
Detection and comparison of nitric oxide in clinically healthy horses and those with naturally acquired strangulating large colon volvulus. Mirza MH, Seahorn TL, Oliver JL, Hosgood G, Moore RM.The objective of the study was to determine whether nitric oxide (NO) is present in clinically healthy horses (control) under basal conditions, and if it increases secondary to naturally acquired strangulating large colon volvulus (affected). Eleven affected horses and 10 controls were studied. Jugular venous blood, abdominal fluid, and urine were collected. The NO concentrations were standardized to the creatinine concentration in the respective samples. A biopsy specimen collected from the large colon pelvic flexure at surgery was divided into subsections for processing for inducible nitric ...
Comparison of topical lidocaine/prilocaine anesthetic cream and local infiltration of 2% lidocaine for episioplasty in mares.
Journal of veterinary pharmacology and therapeutics    June 15, 2005   Volume 28, Issue 3 299-304 doi: 10.1111/j.1365-2885.2005.00657.x
Erkert RS, Macallister CG, Campbell G, Payton ME, Shawley R, Clarke CR.Local anesthesia and tissue inflammation associated with lidocaine infiltration and lidocaine/prilocaine topical anesthetic cream for episioplasty in mares were compared. Twenty-two mares were randomly assigned to lidocaine or lidocaine/prilocaine topical anesthetic cream treatment groups. Perineum and vulva were cleaned, 8-12 g (approximately 1 g/cm per side of vulva) of topical anesthetic cream was applied, and the area was covered by plastic wrap 30 min prior to beginning procedure. Alternately, lidocaine was injected (1 mL) every centimeter just prior to the procedure. Episioplasty was con...
Leucocytoclastic vasculitis associated with Staphylococcus intermedius in the pastern of a horse.
The Veterinary record    June 7, 2005   Volume 156, Issue 23 740-743 doi: 10.1136/vr.156.23.740
Risberg AI, Webb CB, Cooley AJ, Peek SF, Darien BJ.A pregnant quarterhorse mare became acutely lame as a result of severe swelling of its right hind leg, thought to have been caused by a fracture or a muscle tear. Diagnostic procedures ruled out a traumatic musculoskeletal cause and a physical examination revealed chronic pastern dermatitis ('scratches'/'grease heel'). Histopathological evaluation of biopsy samples from the right hind leg was consistent with a leucocytoclastic vasculitis, and culture yielded Staphylococcus intermedius. The treatment and infectious causes of pastern dermatitis are discussed.
Ultrastructural and immunocytochemical evaluation of the effects of extracorporeal shock wave treatment in the hind limbs of horses with experimentally induced suspensory ligament desmitis.
American journal of veterinary research    June 7, 2005   Volume 66, Issue 5 892-896 doi: 10.2460/ajvr.2005.66.892
Caminoto EH, Alves AL, Amorim RL, Thomassian A, Hussni CA, Nicoletti JL.To evaluate the effects of extracorporeal shock wave therapy (ESWT) on affected ligaments in the hind limbs of horses with experimentally induced suspensory ligament desmitis by use of ultrasonographic, ultrastructural, and immunocytochemical techniques. Methods: 10 horses. Methods: Suspensory ligament desmitis was induced in both hind limbs of each horse by use of 2 collagenase injections (administered 2 weeks apart) in each suspensory ligament. Two weeks after the second injection, the right hind limb of each horse was treated with ESWT (3 treatments at 3-week intervals); the left hind limb ...
[Pemphigus foliaceus in a Haflinger gelding].
Schweizer Archiv fur Tierheilkunde    June 3, 2005   Volume 147, Issue 5 213-217 doi: 10.1024/0036-7281.147.5.213
Stähli P, Grest P, Favrot C, Feige K.A 10-year-old Haflinger gelding was presented with severe generalized chronic dermatitis characterized by scales, crusts and widespread alopecia with a partially diffuse and partially circumscribed pattern. Pemphigus foliaceus was diagnosed based on history, clinical signs and histological examination of skin biopsies. Typical histological findings were subcorneal pustules with accumulations of intact neutrophil granulocytes and acantholytic keratinocytes. The gelding was treated with glucocorticoids and gold salts. The skin lesions resolved completely after 8 weeks of treatment. No recurrence...
Airway inflammation is associated with mucous cell metaplasia and increased intraepithelial stored mucosubstances in horses.
Veterinary journal (London, England : 1997)    May 31, 2005   Volume 172, Issue 2 293-301 doi: 10.1016/j.tvjl.2005.04.018
Lugo J, Harkema JR, deFeijter-Rupp H, Bartner L, Boruta D, Robinson NE.This study was performed to determine if a peripheral sample of lung from the site where biopsy is conducted is representative of the rest of the lung and to investigate the relationship between airway inflammation and intraepithelial mucous production in the peripheral airways. Lung parenchyma samples were collected from five different regions of the lung in five control and five heaves-affected horses. Horse groups were defined by clinical response to stabling. Tissue sections were used for semi-quantitative scoring of lesions, to count the number of airways, to quantify the amount of stored...
Profiling of differentially expressed genes in wound margin biopsies of horses using suppression subtractive hybridization.
Physiological genomics    May 3, 2005   Volume 22, Issue 2 157-170 doi: 10.1152/physiolgenomics.00018.2005
Lefebvre-Lavoie J, Lussier JG, Theoret CL.Disturbed gene expression may disrupt the normal process of repair and lead to pathological situations resulting in excessive scarring. To prevent and treat impaired healing, it is necessary to first define baseline gene expression during normal repair. The objective of this study was to compare gene expression in normal intact skin (IS) and wound margin (WM) biopsies using suppression subtractive hybridization (SSH) to identify genes differentially expressed during wound repair in horses. Tissue samples included both normal IS and biopsies from 7-day-old wounds. IS cDNAs were subtracted from ...
Fungal isolation and identification in 21 cases of guttural pouch mycosis in horses (1998-2002).
Veterinary journal (London, England : 1997)    April 26, 2005   Volume 169, Issue 3 457-461 doi: 10.1016/j.tvjl.2004.06.005
Ludwig A, Gatineau S, Reynaud MC, Cadoré JL, Bourdoiseau G.This aetiological study of guttural pouch mycosis (GPM) in the horse was based on the retrospective study of 21 horses brought into the National Veterinary School of Lyon (France) between 1998 and 2002. Biopsies were taken from the lesions caused by GPM during endoscopic examination. In 87% of the cases, direct examination gave positive results, whereas 43% of the cultures were found to be negative. The main fungi observed were Aspergillus fumigatus (in three cases), A. versicolor (in two cases, together with other fungi), and A. nidulans and A. niger (one case each). In six cases, the Aspergi...
Immunoglobulin E-bearing cells and mast cells in skin biopsies of horses with urticaria.
Veterinary dermatology    April 22, 2005   Volume 16, Issue 2 94-101 doi: 10.1111/j.1365-3164.2005.00440.x
Rüfenacht S, Marti E, von Tscharner C, Doherr MG, Forster U, Welle M, Roosje PJ.The pathogenesis of equine urticaria is not well understood. In man, urticaria has been associated with immunological and nonimmunological mechanisms leading to the release of various mediators by mast cells. Skin biopsies of 32 horses with a history of urticaria were stained with toluidine blue, a double-labelling method for chymase and tryptase, and immunohistochemistry for immunoglobulin (Ig)E. These horses were compared with horses with pemphigus foliaceus, insect bite hypersensitivity and control horses with healthy skin. Neither formalin fixation time nor biopsy site influenced the stain...
Nitric oxide levels and nitric oxide synthase expression in uterine samples from mares susceptible and resistant to persistent breeding-induced endometritis.
American journal of reproductive immunology (New York, N.Y. : 1989)    April 19, 2005   Volume 53, Issue 5 230-237 doi: 10.1111/j.1600-0897.2005.00270.x
Alghamdi AS, Foster DN, Carlson CS, Troedsson MH.Breeding-induced endometritis (BIE) in the mare is resolved by 36 hr after insemination in resistant mares. However, 10-15% susceptible broodmares fail to do so because of impaired uterine contractility between 7 and 19 hr after exposure to seminal or bacterial challenge, which reduces their fertility. Methods: Nitric oxide (NO) in uterine secretions, and expression of nitric oxide synthase (NOS) in uterine biopsies were compared between susceptible and resistant groups 13 hr after insemination. Results: Susceptible mares had a higher NO in their uterine secretions and greater inducible NOS (i...
Effects of Carolina rinse solution, dimethyl sulfoxide, and the 21-aminosteroid, U-74389G, on microvascular permeability and morphology of the equine jejunum after low-flow ischemia and reperfusion.
American journal of veterinary research    April 13, 2005   Volume 66, Issue 3 525-536 doi: 10.2460/ajvr.2005.66.525
Dabareiner RM, White NA, Snyder JR, Feldman BF, Donaldson LL.To evaluate effects of Carolina rinse solution, dimethyl sulfoxide (DMSO), and 21-aminosteroid, U-74389G, on microvascular permeability and morphology of the equine jejunum after low-flow ischemia and reperfusion. Methods: 20 healthy adult horses. Methods: Under anesthesia, full-thickness biopsy specimens of a distal portion of the jejunum were obtained for baseline measurements. In addition to a control segment, 2 jejunal segments were identified as sham-operated or experimental segments. Experimental segments underwent 60 minutes of low-flow ischemia and 3.5 hours of reperfusion. Treatments ...
Neuronal nitric oxide synthase is heterogeneously distributed in equine myofibers and highly expressed in endurance trained horses. Gondim FJ, Modolo LV, Campos GE, Salgado I.Mammalian skeletal muscle expresses splice variants of neuronal nitric oxide synthase (nNOS). Skeletal muscles have a metabolically heterogeneous population of myofibers, and fiber composition in equine skeletal muscle is correlated with athletic ability in endurance events. In this study, we investigated whether nNOS expression in equine skeletal muscle is related to fiber type and endurance training. Biopsy samples obtained from the gluteus medius of sedentary- (SH) and endurance-trained (TH) horses were examined for the electrophoretic mobility of myosin heavy chain (MHC) and NOS activity. ...
Muscle metabolic changes associated with long-term inhalation anaesthesia in the horse analysed by muscle biopsy and microdialysis techniques.
Journal of veterinary medicine. A, Physiology, pathology, clinical medicine    March 2, 2005   Volume 52, Issue 2 99-107 doi: 10.1111/j.1439-0442.2004.00685.x
Edner A, Essén-Gustavsson B, Nyman G.During anaesthesia in the horse, muscle blood flow has been found to be reduced, possibly leading to hypoxia or ischaemia in the muscle. The aim of this study was to use the muscle biopsy and microdialysis techniques to determine whether long-term inhalation anaesthesia in laterally recumbent horses induces metabolic changes in gluteal muscle indicative of anaerobic metabolism. Muscle biopsies and plasma samples were taken from seven horses at the start and end of halothane anaesthesia. In six isoflurane-anaesthetised horses, given three pharmacological provocations (dobutamine, detomidine, ac...
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