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Topic:Clinical Findings

Clinical findings in horses encompass a range of observable signs and symptoms identified during veterinary examinations that contribute to diagnosing and managing equine health conditions. These findings can include physical observations, such as changes in behavior, posture, or gait, as well as physiological measurements like heart rate, respiratory rate, and temperature. Diagnostics may also involve laboratory tests, imaging, and other diagnostic procedures to assess organ function and detect abnormalities. Recognizing and interpreting clinical findings are essential components of veterinary practice, aiding in the identification of diseases, monitoring treatment progress, and guiding therapeutic interventions. This page brings together peer-reviewed research studies and scholarly articles that explore the methodologies, interpretations, and implications of clinical findings in the context of equine health care.
Detomidine reduces isoflurane anesthetic requirement (MAC) in horses.
Veterinary anaesthesia and analgesia    November 15, 2016   Volume 29, Issue 4 223-227 doi: 10.1046/j.1467-2995.2002.00107.x
Steffey EP, Pascoe PJ.To quantitate the dose- and time-related magnitude of the anesthetic sparing effect of, and selected physiological responses to detomidine during isoflurane anesthesia in horses. Methods: Randomized cross-over study. Methods: Three, healthy, young adult horses weighing 485 ± 14 kg. Methods: Horses were anesthetized on two occasions to determine the minimum alveolar concentration (MAC) of isoflurane in O and then to measure the anesthetic sparing effect (time-related MAC reduction) following IV detomidine (0.03 and 0.06 mg kg). Selected common measures of cardiopulmonary function, blood glucos...
Propofol anaesthesia for surgery in late gestation pony mares.
Veterinary anaesthesia and analgesia    November 15, 2016   Volume 28, Issue 4 177-187 doi: 10.1046/j.1467-2987.2001.00044.x
Taylor PM, White KL, Fowden AL, Giussani DA, Bloomfield M, Sear JW.To characterize propofol anaesthesia in pregnant ponies. Methods: Fourteen pony mares, at 256 ± 49 days gestation, undergoing abdominal surgery to implant fetal and maternal vascular catheters. Methods: Pre-anaesthetic medication with intravenous (IV) acepromazine (20 µg kg), butorphanol (20 µg kg) and detomidine (10 µg kg) was given 30 minutes before induction of anaesthesia with detomidine (10 µg kg) and ketamine (2 mg kg) IV Maternal arterial blood pressure was recorded (facial artery) throughout anaesthesia. Arterial blood gas values and plasma concentrations of glucose, lactate, cort...
An evaluation of apnea or spontaneous ventilation in early recovery following mechanical ventilation in the anesthetized horse.
Veterinary anaesthesia and analgesia    November 15, 2016   Volume 28, Issue 1 26-33 doi: 10.1046/j.1467-2995.2001.00015.x
Wright BD, Hildebrand SV.To compare arterial oxygen and carbon dioxide tensions in apneic and spontaneously ventilating horses recovering from anesthesia. Methods: Randomized clinical trial. Methods: Forty-two healthy horses averaging 466 ± 106 kg and 6 ± 5 years of age. Methods: Anesthetized horses undergoing a variety of surgical procedures and receiving positive pressure ventilation (IPPV) were divided into two equal groups. One group was allowed to return to spontaneous ventilation prior to disconnection from the anesthetic circuit (weaned). The other group remained apneic during transport to a recovery stall. A...
The cardiopulmonary effects of severe blood loss in anesthetized horses.
Veterinary anaesthesia and analgesia    November 15, 2016   Volume 30, Issue 2 80-86 doi: 10.1046/j.1467-2995.2003.00102.x
Wilson DV, Rondenay Y, Shance PU.To characterize the acute cardiopulmonary effects of severe hemorrhage in anesthetized horses. Methods: Prospective experimental study. Methods: Three geldings and six mares, aged 14.4 ± 2.7 years, weighing 486 ± 41 kg (range: 425-550 kg). Methods: Horses were anesthetized using xylazine, guaifenesin, ketamine and halothane or isoflurane. Cardiovascular variables, hematocrit, total solids, capillary refill time (CRT) and color of mucous membranes were measured as blood was collected from the carotid artery into sterile plastic bags. Arterial blood gas analysis was also performed. Results: Th...
Complications associated with intrauterine glass marbles in five mares.
Journal of the American Veterinary Medical Association    November 9, 2016   Volume 249, Issue 10 1196-1201 doi: 10.2460/javma.249.10.1196
de Amorim MD, Chenier T, Nairn D, Green J, Manning S, Card C.CASE DESCRIPTION 5 mares were evaluated because of reproductive complications following long-term (> 1 year) use of intrauterine glass marbles for estrus suppression. CLINICAL FINDINGS 3 mares had 1 intrauterine glass marble, and 2 mares had 2 intrauterine glass marbles. On examination, 2 mares had signs of chronic endometritis, and 3 had signs of pyometra. Marbles or glass shards adhered to the endometrium were identified by means of hysteroscopy in 3 of 5 mares. Five of 7 marbles had surface imperfections or were broken. TREATMENT AND OUTCOME All patients were treated with uterine lavage and...
Use of manual alveolar recruitment maneuvers to eliminate atelectasis artifacts identified during thoracic computed tomography of healthy neonatal foals.
American journal of veterinary research    November 3, 2016   Volume 77, Issue 11 1276-1287 doi: 10.2460/ajvr.77.11.1276
Lascola KM, Clark-Price SC, Joslyn SK, Mitchell MA, O'Brien RT, Hartman SK, Kline KH.OBJECTIVE To evaluate use of single manual alveolar recruitment maneuvers (ARMs) to eliminate atelectasis during CT of anesthetized foals. ANIMALS 6 neonatal Standardbred foals. PROCEDURES Thoracic CT was performed on spontaneously breathing anesthetized foals positioned in sternal (n = 3) or dorsal (3) recumbency when foals were 24 to 36 hours old (time 1), 4 days old (time 2), 7 days old (time 3), and 10 days old (time 4). The CT images were collected without ARMs (all times) and during ARMs with an internal airway pressure of 10, 20, and 30 cm HO (times 2 and 3). Quantitative analysis of CT...
What is your diagnosis? Peritoneal effusion in a 10-year-old horse.
Veterinary clinical pathology    October 23, 2016   Volume 45, Issue 4 723-724 doi: 10.1111/vcp.12418
McLaren PJ, Jocelyn NA.No abstract available
Comparison of Tube, Gel, and Immunochromatographic Strip Methods for Evaluation of Blood Transfusion Compatibility in Horses.
Journal of veterinary internal medicine    October 22, 2016   Volume 30, Issue 6 1864-1871 doi: 10.1111/jvim.14604
Luethy D, Owens SD, Stefanovski D, Nolen-Walston R, Giger U.Assessment of blood compatibility, typically by tube agglutination (TUBE) and hemolysis crossmatch or, less commonly, by blood typing and alloantibody screening, often is performed before blood transfusion in horses. In contrast, gel column (GEL) and immunochromatographic strip (STRIP) techniques are preferred for compatibility testing in dogs and cats. Objective: To determine the accuracy of novel and standard crossmatch and typing methods. Methods: Thirty-eight healthy horses, previously blood typed and alloantibody screened. Methods: TUBE and GEL crossmatches were performed on 146 different...
Clinical, Ultrasonographic, and Arthroscopic Characteristics of Hair Shafts Within Synovial Structures of Seven Horses. Partlow JL, Lustgarten M, Redding WR.To the authors' knowledge, the ultrasonographic appearance of hair shafts within a synovial structure of the horse has not been described previously. The purpose of this descriptive study was to illustrate the clinical, ultrasonographic, and arthroscopic characteristics of confirmed hair shafts within synovial structures of seven horses. A review of medical records of the Farm and Equine Veterinary Medical Center at North Carolina State University College of Veterinary Medicine identified seven horses with clinical signs suspicious for inflammatory or septic synovitis/tenosynovitis that had ha...
Advances in Diagnostics and Therapeutic Techniques in Breeding Behavior Disorders in Stallions.
The Veterinary clinics of North America. Equine practice    October 8, 2016   Volume 32, Issue 3 513-519 doi: 10.1016/j.cveq.2016.07.008
McDonnell SM.Despite the suboptimal aspects of domestic breeding conditions compared with the natural conditions under which their reproductive behavior evolved, most domestic stallions can adapt to management and breeding programs. Most respond adequately or quickly learn to safely abide the restraint and direction of a human handler, and can adapt to changes in methods of breeding for semen collection. If not, the problems can range from inadequate or variable sexual interest and response to overenthusiastic or aggressive response beyond the ability of the handlers to safely direct and control. This arti...
[Heart disease in sports horses: Current recommendations of the 2014 ACVIM / ECEIM consensus statement].
Schweizer Archiv fur Tierheilkunde    October 7, 2016   Volume 158, Issue 10 677-689 doi: 10.17236/sat00086
Schwarzwald C.Heart murmurs and arrhythmias are common in horses. Assessment of their clinical relevance concerning health, performance, safety and longevity of sports horses is of highest importance. A comprehensive cardiovascular examination is crucial for diagnosis and assessment of the severity of disease. Recently, an expert panel of the American College of Veterinary Internal Medicine (ACVIM) and the European College of Equine Internal Medicine (ECEIM) developed a consensus statement containing recommendations for sports horses with heart disease. This article summarizes the most relevant recommendati...
Electrochemotherapy as a single or adjuvant treatment to surgery of cutaneous sarcoid tumours in horses: a 31-case retrospective study.
The Veterinary record    October 7, 2016   Volume 179, Issue 24 627 doi: 10.1136/vr.103867
Tozon N, Kramaric P, Kos Kadunc V, Sersa G, Cemazar M.The aim of our study was to evaluate the efficacy of electrochemotherapy (ECT) with cisplatin as a single or adjuvant treatment for sarcoids in equids. Different treatment options with different success rates were proposed. Thirty-one horses and one donkey with different clinical type, size and location of tumours were treated with ECT as a single treatment (18 animals with 52 tumour nodules) or as adjuvant treatment with marginal surgical excision (14 animals with 18 tumour nodules). In animals treated only with ECT with cisplatin, complete response was obtained in 48/52 (92.3 per cent) nodul...
Defining Trends in Global Gene Expression in Arabian Horses with Cerebellar Abiotrophy.
Cerebellum (London, England)    October 7, 2016   Volume 16, Issue 2 462-472 doi: 10.1007/s12311-016-0823-8
Scott EY, Penedo MCT, Murray JD, Finno CJ.Equine cerebellar abiotrophy (CA) is a hereditary neurodegenerative disease that affects the Purkinje neurons of the cerebellum and causes ataxia in Arabian foals. Signs of CA are typically first recognized either at birth to any time up to 6 months of age. CA is inherited as an autosomal recessive trait and is associated with a single nucleotide polymorphism (SNP) on equine chromosome 2 (13074277G>A), located in the fourth exon of TOE1 and in proximity to MUTYH on the antisense strand. We hypothesize that unraveling the functional consequences of the CA SNP using RNA-seq will elucidate the m...
Acute myeloid leukemia with basophilic differentiation in a 3-year-old Standardbred gelding.
The Canadian veterinary journal = La revue veterinaire canadienne    October 7, 2016   Volume 57, Issue 10 1067-1071 
Furness MC, Setlakwe E, Sallaway J, Wood D, Fromstein J, Arroyo LG.A 3-year-old Standardbred gelding with a history of pyrexia, persistent hemorrhage from the oral cavity, and a large, soft swelling at the junction of the caudal aspect of the mandibular rami and proximal neck was evaluated. The horse had neutropenia and anemia, with atypical granulated cells in a blood smear. Additional tests confirmed acute myeloid leukemia with basophilic differentiation, which has been reported in humans, cats, dogs, and cattle but not horses. Nous avons évalué un hongre Standardbred âgé de 3 ans avec une anamnèse de pyrexie, d’hémorragie persistante de la cavité...
Development and Evaluation of a Molecular Diagnostic Method for Rapid Detection of Histoplasma capsulatum var. farciminosum, the Causative Agent of Epizootic Lymphangitis, in Equine Clinical Samples.
Journal of clinical microbiology    October 5, 2016   Volume 54, Issue 12 2990-2999 doi: 10.1128/JCM.00896-16
Scantlebury CE, Pinchbeck GL, Loughnane P, Aklilu N, Ashine T, Stringer AP, Gordon L, Marshall M, Christley RM, McCarthy AJ.Histoplasma capsulatum var. farciminosum, the causative agent of epizootic lymphangitis (EZL), is endemic in parts of Africa. Diagnosis based on clinical signs and microscopy lacks specificity and is a barrier to further understanding this neglected disease. Here, a nested PCR method targeting the internal transcribed spacer (ITS) region of the rRNA operon was validated for application to equine clinical samples. Twenty-nine horses with signs of EZL from different climatic regions of Ethiopia were clinically examined. Blood samples and aspirates of pus from cutaneous nodules were taken, along ...
Four cases of equine motor neuron disease in Japan.
Journal of equine science    September 30, 2016   Volume 27, Issue 3 119-124 doi: 10.1294/jes.27.119
Sasaki N, Imamura Y, Sekiya A, Itoh M, Furuoka H.In this study, fasciculation of the limbs and tongue was observed in four horses kept by a riding club. Neurogenic muscle atrophy was also observed in biopsy of pathological tissues. In addition, in two cases that subjected to autopsy, Bunina-like bodies of inclusion in the cell bodies of neurons in the spinal cord ventral horn were confirmed, leading to a diagnosis of equine motor neuron disease (EMND). Serum vitamin E concentrations varied between 0.3 and 0.4µg/ml, which is significantly lower than the levels in normal horses. Although lack of vitamin E is speculated to be a contributory fa...
Frequency of Undetected Glove Perforation and Associated Risk Factors in Equine Surgery.
Veterinary surgery : VS    September 29, 2016   Volume 45, Issue 8 1066-1070 doi: 10.1111/vsu.12562
Elce YA, Laverty S, Almeida da Silveira E, Piat P, Trencart P, Ruzickova P, Reardon RJ.To estimate the frequency of undetected perforations in surgical gloves during equine surgery and to identify risk factors associated with occurrence. Methods: Observational cohort study. Methods: Surgical gloves-292 pairs. Methods: Water leak tests were performed on gloves after equine surgery to detect perforations. Fifty pairs of unused gloves were also tested. Potential risk factors were recorded. Logistic regression was used to explore associations between putative risk factors and perforation. Results: No perforations were detected in the unused gloves. Of 292 pairs of used gloves tested...
Fatal Oleander Toxicosis in Two Miniature Horses.
Journal of the American Animal Hospital Association    September 29, 2016   Volume 52, Issue 6 398-402 doi: 10.5326/JAAHA-MS-6433
Butler J, Khan S, Scarzella G.Two young American miniature horses from the same farm were evaluated by a veterinarian due to presence of lethargy, anorexia, and cardiac arrhythmias. Both horses were treated aggressively with IV fluids and other supportive measures. The first horse died approximately 72 hr after the start of clinical signs and the second horse was humanely euthanized due to poor response to treatment. Oleander toxicosis was suspected based on the types of clinical signs present and due to several oleander plants and dried leaves present on the property. Oleander toxicosis was confirmed by the presence of ol...
Conservative Management of Unilateral Fractures of the Mandibular Rami in Horses.
Veterinary surgery : VS    September 29, 2016   Volume 45, Issue 8 1063-1065 doi: 10.1111/vsu.12561
Jansson N.To report the outcome of conservative management of unilateral fractures of the mandibular rami in horses. Methods: Retrospective case series. Methods: 24 client-owned horses with unilateral mandibular fractures METHODS: Medical records (January 2000-January 2014) of horses with unilateral mandibular ramus fractures were retrieved. Only conservatively managed horses with follow-up information were included. Follow-up information on clinical outcome was retrieved from the medical records (n=11) or obtained by telephone interviews with the owners or trainers (n=13). Results: Twenty-three horses ...
Efficacy of intravenous administration of hyaluronan, sodium chondroitin sulfate, and N-acetyl-d-glucosamine for prevention or treatment of osteoarthritis in horses.
American journal of veterinary research    September 27, 2016   Volume 77, Issue 10 1064-1070 doi: 10.2460/ajvr.77.10.1064
Frisbie DD, McIlwraith CW, Kawcak CE, Werpy NM.OBJECTIVE To evaluate the efficacy of IV administration of a product containing hyaluronan, sodium chondroitin sulfate, and N-acetyl-d-glucosamine for prevention or treatment of osteoarthritis in horses. ANIMALS 32 healthy 2- to 5-year-old horses. PROCEDURES The study involved 2 portions. To evaluate prophylactic efficacy of the test product, horses received 5 mL of the product (n = 8) or saline (0.9% NaCl) solution (8; placebo) IV every fifth day, starting on day 0 (when osteoarthritis was induced in the middle carpal joint of 1 forelimb) and ending on day 70. To evaluate treatment efficacy, ...
In vitro biomechanical evaluation of four surgical techniques for fusion of equine centrodistal and tarsometatarsal joints.
American journal of veterinary research    September 27, 2016   Volume 77, Issue 10 1071-1081 doi: 10.2460/ajvr.77.10.1071
Biedrzycki AH, Grant BG, Nemke B, Morello SL, Markel MD.OBJECTIVE To evaluate the biomechanical properties of 4 methods for fusion of the centrodistal and tarsometatarsal joints in horses and compare them among each other and with control tarsi. SAMPLE 24 sets of paired tarsi without substantial signs of osteoarthritis harvested from equine cadavers. PROCEDURES Test constructs (n = 6/type) were prepared from 1 tarsus from each pair to represent surgical drilling; 2 medially to laterally placed kerf-cut cylinders (MLKCs); a single large, dorsally applied kerf-cut cylinder (DKC); and a dorsomedially applied locking compression plate (DMLCP). Construc...
Multiple congenital cardiovascular defects including type IV persistent truncus arteriosus in a Shetland pony – Short communication.
Acta veterinaria Hungarica    September 23, 2016   Volume 64, Issue 3 360-364 doi: 10.1556/004.2016.033
Taulescu M, Palmieri C, Leach J, Nagy A, Ober C, Cernea M, Catoi C.This case report describes the pathological findings of multiple congenital cardiac defects in a 2-year-old female Shetland pony with clinical signs of chronic respiratory distress. Persistent truncus arteriosus (PTA) type IV, interventricular septal defect, overriding aorta, pulmonary trunk agenesis, pulmonary arteries arising from the descending aorta, and compensatory right ventricular hypertrophy were observed.
Are horse age and incision length associated with surgical site infection following equine colic surgery?
Veterinary journal (London, England : 1997)    September 22, 2016   Volume 217 3-7 doi: 10.1016/j.tvjl.2016.09.004
Darnaud SJ, Southwood LL, Aceto HW, Stefanovski D, Tomassone L, Zarucco L.It is our clinical impression that age and incision length are more strongly associated with surgical site infection (SSI) following colic surgery than skin closure or wound protection method. Therefore, the objective of this observational clinical cohort study was to identify the risks for SSI in horses undergoing colic surgery. Data collection included pre-, intra-, and postoperative variables. Variables with P < 0.2 following univariable analysis were used in a logistic regression multivariable model. Variables with P <0.05 were included in the final model. Odds ratios (OR; 95% confid...
Equine Pulmonary Cryptococcosis: A Comparative Literature Review and Evaluation of Fluconazole Monotherapy.
Mycopathologia    September 21, 2016   Volume 182, Issue 3-4 413-423 doi: 10.1007/s11046-016-0065-9
Secombe CJ, Lester GD, Krockenberger MB.Cryptococcus is the most common fungal respiratory pathogen in Australian horses, manifesting primarily as pulmonary granulomas. Disease severity at presentation is dependent on the athletic use of the horse. The diagnosis and estimation of disease severity are centred around clinical findings, cytological evaluation of respiratory tract secretions, diagnostic imaging, and antigen titre testing. Both the lateral flow assay and the latex cryptococcal antigen titre are used, and important similarities and differences between species are discussed. Cryptococcus gattii occurs with greater frequenc...
Combined use of platelet rich plasma & micro-fat in sport and race horses with degenerative joint disease: preliminary clinical study in eight horses.
Muscles, ligaments and tendons journal    September 17, 2016   Volume 6, Issue 2 198-204 doi: 10.11138/mltj/2016.6.2.198
Bembo F, Eraud J, Philandrianos C, Bertrand B, Silvestre A, Veran J, Sabatier F, Magalon G, Magalon J.To assess the safety and potential efficacy of a standardized technique consisting of intra-articular injection of 10 cc of a homogeneous mixed product using autologous micro-fat and platelet rich plasma (PRP) (ratio 1:1) in the carpus or the fetlock joint of sport horses presenting degenerative joint disease (DJD). Methods: Eight sport horses with DJD confirmed by radiography and ultrasonography and causing lameness and the impossibility to compete were treated. PRP was prepared after a double centrifugation whereas micro-fat was harvested and purified using a closed system. The two products ...
Laparoscopic Closure of the Nephrosplenic Space in Horses with Nephrosplenic Colonic Entrapment: Factors Associated with Survival and Colic Recurrence.
Veterinary surgery : VS    September 13, 2016   Volume 45, Issue S1 O60-O69 doi: 10.1111/vsu.12549
Nelson BB, Ruple-Czerniak AA, Hendrickson DA, Hackett ES.1) To identify factors associated with short-term survival and time to death after hospital discharge in horses with nephrosplenic entrapment (NSE). 2) To compare the frequency of recurrent colic episodes in horses with and without laparoscopic closure of the nephrosplenic space. Methods: Historical cohort with a nested case control. Methods: Client-owned horses. Methods: Medical records of horses treated for NSE from January 1, 2002 to June 1, 2014 were reviewed. Data collected included signalment, physical examination parameters, laboratory results, diagnostic findings, and treatments. Facto...
Retrospective Evaluation of Hemithyroidectomy in 14 Horses.
Veterinary surgery : VS    September 6, 2016   Volume 45, Issue 7 949-954 doi: 10.1111/vsu.12540
Troillet A, Böttcher D, Brehm W, Scharner D.To describe the presentation, presurgical diagnostic findings, treatment, and outcome of horses with histologically confirmed, unilateral thyroid neoplasia. The complications, particularly laryngeal hemiplegia, were investigated. Retrospective case series. Client-owned horses (n=14). Medical records of horses presenting with a unilateral thyroid mass due to neoplasia from 2003-2015 were reviewed. Horses must have undergone preoperative clinical evaluations that included ultrasound examination of the mass and upper airway endoscopy. Short-term follow-up at 2 weeks after surgery and owner questi...
Comparison of clinical findings and short-term survival between horses with intestinal entrapment in the gastrosplenic ligament and horses with intestinal entrapment in the epiploic foramen.
Journal of the American Veterinary Medical Association    September 2, 2016   Volume 249, Issue 6 660-667 doi: 10.2460/javma.249.6.660
Kilcoyne I, Dechant JE, Nieto JE.OBJECTIVE To compare clinical findings and short-term outcome for horses with intestinal entrapment in the gastrosplenic ligament (GLE) with those of horses with intestinal entrapment in the epiploic foramen (EFE). DESIGN Retrospective case-control study. ANIMALS 43 horses with GLE (cases) and 73 horses with EFE (controls). PROCEDURES Medical records of horses examined because of colic at a veterinary teaching hospital between 1992 and 2012 were reviewed. Signalment was extracted from medical records for all horses with colic (colic population), and additional information regarding colic histo...
Isolation and molecular characterization of Mycobacterium bovis causing pulmonary tuberculosis and epistaxis in a Thoroughbred horse.
BMC veterinary research    September 2, 2016   Volume 12, Issue 1 179 doi: 10.1186/s12917-016-0813-6
Hlokwe TM, Sutton D, Page P, Michel AL.Tuberculosis caused by Mycobacterium bovis (M. bovis) is very uncommon in horses worldwide. Methods: In the current study, an eight-year-old male Thoroughbred in good body condition was admitted to the Equine Clinic at the Onderstepoort Veterinary Academic Hospital in 2005 due to bilateral epistaxis accompanied by coughing. Routine examinations were conducted to determine the cause of the condition. Endoscopic examination revealed the major source of the epistaxis as the trachea, whereas thoracic radiography indicated the presence of a primary pulmonary mass. M. bovis was isolated from a bronc...
Dynamic Sonography of the Equine Metacarpo(tarso)phalangeal Digital Flexor Tendon Sheath. DiGiovanni DL, Rademacher N, Riggs LM, Baumruck RA, Gaschen L.Palmar/plantar annular desmitis is a common disease that may be associated with adhesions and structures affecting the flexor tendons, which requires tenoscopy to diagnose. The purpose of this descriptive study was to develop a dynamic sonographic technique for evaluating the motion of normal equine flexor tendons in relation to the palmar/plantar annular ligament and to compare findings with horses previously diagnosed with palmar/plantar annular desmitis. Ten healthy adult horses were examined prospectively and the images of four horses diagnosed with palmar/plantar annular desmitis were ret...
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