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Topic:Clinical Pathology

Clinical pathology in horses involves the study and analysis of biological samples to diagnose and monitor diseases and health conditions. This discipline encompasses various laboratory tests and procedures that assess the physiological and biochemical status of equines. Common analyses include hematology, biochemistry, urinalysis, and cytology, each providing insights into different aspects of equine health. Hematology evaluates blood components, such as red and white blood cells and platelets, to identify conditions like anemia or infection. Biochemistry tests measure enzymes, electrolytes, and metabolites to assess organ function and metabolic status. Urinalysis examines urine samples for indicators of renal function and systemic diseases. Cytology involves the microscopic examination of cells from tissues or fluids to detect abnormalities. This page aggregates peer-reviewed research studies and scholarly articles that explore the methodologies, applications, and diagnostic value of clinical pathology in equine medicine.
An application of the density standard and scaled-pixel-counting protocol to assess the radiodensity of equine incisor teeth affected by resorption and hypercementosis: preliminary advancement in dental radiography.
BMC veterinary research    August 9, 2023   Volume 19, Issue 1 116 doi: 10.1186/s12917-023-03675-4
Górski K, Borowska M, Turek B, Pawlikowski M, Jankowski K, Bereznowski A, Polkowska I, Domino M.Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH) syndrome is a dental disease where the radiographic signs may be quantified using radiographic texture features. This study aimed to implement the scaled-pixel-counting protocol to quantify and compare the image structure of teeth and the density standard in order to improve the identification of the radiographic signs of tooth resorption and hypercementosis using the EOTRH syndrome model. Results: A detailed examination of the oral cavity was performed in 80 horses and maxillary incisor teeth were evaluated radiographically, in...
A novel tension relief technique to aid the primary closure of traumatic equine wounds under excessive tension.
Equine veterinary journal    August 9, 2023   Volume 56, Issue 3 514-521 doi: 10.1111/evj.13987
Comino F, Pollock PJ, Fulton I, Hewitt-Dedman C, Handel I, Gorvy DA.To achieve an excellent functional and cosmetic result, primary closure is preferred over leaving wounds to heal by secondary intention. However, traumatic wounds are often under excessive tension during wound closure and incorrect suture technique can compromise microcirculation, leading to skin necrosis and impaired wound healing. Objective: To describe an inexpensive and effective tension relief technique that helps the successful primary closure of a variety of equine wounds at high risk of dehiscence. Methods: Retrospective case series. Methods: All wounds that were managed with the Tensi...
18F-sodium fluoride positron emission tomography provides pertinent additional information to computed tomography for assessment and management of tarsal pain in horses.
Journal of the American Veterinary Medical Association    August 9, 2023   1-8 doi: 10.2460/javma.23.03.0164
Espinosa-Mur P, Spriet M, Manso-Diaz G, Arndt S, Perez-Nogues M, Roman JL, Garcia-Mata R, Katzman SA, Galuppo LD.To assess the value of 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) for imaging the tarsus and proximal metatarsus and compare it with CT and lameness evaluation. Methods: 25 horses with lameness localized to the tarsal and proximal metatarsal regions that underwent 18F-NaF PET/CT between 2016 and 2021. Methods: 18F-NaF PET and CT images were retrospectively independently evaluated by 3 observers. Standardized uptake values (SUV) were used to characterize 18F-NaF uptake. Correlation between PET and CT findings with subjective and objective maximum (Max-D) and minimum pelvic...
Evaluation of real-time polymerase chain reaction for the diagnosis of protozoal myeloencephalitis in horses using cerebrospinal fluid.
Journal of veterinary internal medicine    August 7, 2023   Volume 37, Issue 5 1893-1898 doi: 10.1111/jvim.16826
Enriquez CK, Morrow JK, Graves A, Johnson A.Equine protozoal myeloencephalitis (EPM) caused by Sarcocystis neurona remains an antemortem diagnostic challenge in some horses. Recent work suggested the use of real-time PCR (rtPCR) on cerebrospinal fluid (CSF) as a promising diagnostic tool. Objective: To evaluate the sensitivity and specificity of S. neurona rtPCR on CSF for EPM diagnosis using horses with EPM and S. neurona-seropositive horses with other neurologic conditions. Methods: Ninety-nine horses with neurologic disease that underwent complete neurologic examination, CSF collection, and, if euthanized, necropsy including the cent...
Comparison of three methods of tonometry in horses presented for ophthalmic disease.
Veterinary ophthalmology    August 1, 2023   doi: 10.1111/vop.13135
Latham E, Scherrer NM, Stefanovski D.To compare the measurement of intraocular pressure in horses with clinical ocular disease using three tonometry devices. Conclusions: All three tonometers showed strong agreement, however, the TonoVet and the TonoVet Plus carried the strongest agreement with the TonoVet Plus having slightly higher measurements overall compared with the TonoVet. Due to small variations between devices, it is recommended that the same device be used for serial measurements of intraocular pressure. However, all three devices are appropriate to use in horses presented for ophthalmic evaluation.
Airway Hyperresponsiveness, but Not Bronchoalveolar Inflammatory Cytokines Profiles, Is Modified at the Subclinical Onset of Severe Equine Asthma.
Animals : an open access journal from MDPI    August 1, 2023   Volume 13, Issue 15 2485 doi: 10.3390/ani13152485
Frippiat T, Art T, Tosi I.Airway hyperresponsiveness (AHR) and inflammation are both observed in human and equine asthma. The aim of this study was to assess the timeline and relationship of both features at the subclinical onset of severe equine asthma (SEA). First, the repeatability of the pulmonary function test (PFT) using impulse oscillometry system, and the methacholine bronchoprovocation test (BPT) were assessed at a 1-day interval on six SEA horses in clinical remission and six control horses. Then, clinical and ancillary tests were performed before and after a 1-week low-dust environmental challenge, including...
Utility of serum amyloid A in monitoring clinical response to antimicrobial treatment in horses with bacterial pneumonia.
Journal of veterinary internal medicine    July 31, 2023   doi: 10.1111/jvim.16818
Hepworth-Warren KL, Estell K, Cowles B, Amodie D, Crisman M.Serum amyloid A (SAA) is a major acute phase protein in horses which could be a useful tool for assessing clinical response to treatment of bacterial pneumonia in adult horses.
Relationship between the Cycle Threshold Value (Ct) of a Salmonella spp. qPCR Performed on Feces and Clinical Signs and Outcome in Horses.
Microorganisms    July 30, 2023   Volume 11, Issue 8 1950 doi: 10.3390/microorganisms11081950
Amory H, Cesarini C, De Maré L, Loublier C, Moula N, Detilleux J, Saulmont M, Garigliany MM, Lecoq L.The objective of this retrospective study was to evaluate the clinical significance of fecal quantitative real-time polymerase chain reaction (qPCR) results when taking the cycle threshold values (Ct) into account. The study included 120 qPCR-positive fecal samples obtained from 88 hospitalized horses over a 2-year period. The mean Ct of the qPCR test was evaluated in regard to (1) clinical outcome and (2) systemic inflammatory response syndrome (SIRS) status (no SIRS, moderate SIRS, or severe SIRS) of the sampled horses. An ROC analysis was performed to establish the optimal cut-off Ct valu...
Equine Psittacosis and the Emergence of Chlamydia psittaci as an Equine Abortigenic Pathogen in Southeastern Australia: A Retrospective Data Analysis.
Animals : an open access journal from MDPI    July 28, 2023   Volume 13, Issue 15 2443 doi: 10.3390/ani13152443
El-Hage C, Legione A, Devlin J, Hughes K, Jenkins C, Gilkerson J. is an important zoonotic pathogen. Although primarily a pathogen of birds, from which infection can spillover into humans and other mammalian hosts, the importance of as a cause of equine reproductive loss and the risk of infection to humans in contact with infected horses are increasingly being recognised in Australia and elsewhere. Despite the risks to both human and equine health, infection in horses is incompletely understood. This study aimed to update and summarise cases of equine psittacosis in Australia in the period 2018-2022, thus addressing a knowledge gap relating to recent case...
Effect of dipotassium-ethylenediaminetetraacetic acid or lithium-heparin treatments and storage times on selected clinicopathologic analytes in equine synovial fluid.
Veterinary clinical pathology    July 26, 2023   doi: 10.1111/vcp.13287
Okolo CC, Emejuo NT, Udeagbala NG, Emeto UE, Ezema AS, Omeje OV, Nweze NE.Sample processing methods and storage time affect the outcome of biochemical analysis. Objectives: We aimed to assess the effects of dipotassium-ethylenediaminetetraacetic acid (K2-EDTA) and lithium-heparin treatments and storage times on selected analytes in equine synovial fluid (SF). Conclusions: The analytes-except for TP-became unstable within a few hours postcollection. Lithium-heparin and K2-EDTA treatments significantly altered ALP, LDH, TNCCs, and pH but not the TP concentrations of equine SF. Studies establishing reference intervals for these analytes based on the anticoagulant used ...
Performance of a manually operated salad spinner centrifuge for serum separation in the healthy domestic horse (Equus caballus) and southern white rhinoceros (Ceratotherium simum).
Veterinary clinical pathology    July 26, 2023   doi: 10.1111/vcp.13290
Cassady KR, Minter LJ, Gruber EJ.Field veterinarians and researchers studying wild species, such as the southern white rhinoceros, often work in remote areas with limited access to standard laboratory equipment, hindering the ability to measure serum analytes. Objectives: The first objective was to produce an inexpensive, manually operated centrifuge that could accept standard laboratory tubes by modifying a consumer-grade salad spinner with low-cost materials. The second objective was to compare biochemistry analysis results obtained from equine and southern white rhinoceros serum separated by traditional laboratory and m...
Tissue Specific Distribution and Activation of Sapindaceae Toxins in Horses Suffering from Atypical Myopathy.
Animals : an open access journal from MDPI    July 26, 2023   Volume 13, Issue 15 doi: 10.3390/ani13152410
Sander J, Terhardt M, Janzen N, Renaud B, Kruse CJ, François AC, Wouters CP, Boemer F, Votion DM.Equine atypical myopathy is caused by hypoglycin A (HGA) and methylenecyclopropylglycine (MCPrG), the known protoxins of sycamore maple (Acer pseudoplatanus). Various tissues from five atypical myopathy cases were analyzed but only HGA was found. Whether deamination of MCPrG has already occurred in the intestine as the first stage of metabolization has not been investigated. Activation of the protoxins to methylenecyclopropylacetyl (MCPA)-CoA and methylenecyclopropylformyl (MCPF)-CoA, respectively, occurred mainly in the skeletal muscles, as evidenced by very high concentrations of MCPA-carnit...
Effect of ambulation following 18F-fluorodeoxyglucose injection on standing positron emission tomography of the healthy equine digit.
American journal of veterinary research    July 25, 2023   Volume 84, Issue 9 doi: 10.2460/ajvr.23.04.0077
Oliver A, Wulster K, Stefanovski D, Spriet M, Ciamillo S, Ford M, Kulp J, van Eps A.Measure 18F-FDG uptake in digital tissues of healthy horses subjected to different ambulatory conditions between the time of injection and positron emission tomography (PET) scan acquisition. Methods: 8 healthy adult horses. Methods: Horses were walked (AMB) or tied in stalls (NONAMB) immediately after injection with ∼1.5 MBq/kg 18F-FDG until scan acquisition using a randomized crossover design. Steps were quantified using accelerometers. Standardized uptake values (SUV; mean and maximum) in digital tissues including the dorsal lamellae (proximal, middle, and distal), quarter lamellae (media...
Pharmacokinetics of multiple oral doses of acetaminophen in equine neonates.
American journal of veterinary research    July 25, 2023   1-8 doi: 10.2460/ajvr.23.04.0079
Faivre C, Wong DM, Villarino NF, Court M, Gold JR.To determine the pharmacokinetics and clinical safety of acetaminophen after oral administration of 40 mg/kg q 12 hours or 60 mg/kg q 24 hours for 14 days. Methods: 12 healthy light-breed neonatal foals. Methods: 6 foals received acetaminophen at 40 mg/kg q 12 hours and 6 foals received 60 mg/kg q 24 hours for 14 days. The study dates were January 31 to April 15, 2023. Physical examinations were performed daily. Plasma disposition of acetaminophen was determined after the first, mid-point drug administration. Hematology and biochemistry analysis was performed before the study, day 7, and the l...
Evaluation of frontal and infratrochlear nerve blocks for standing sedated frontonasal sinusotomy in horses.
Veterinary surgery : VS    July 22, 2023   Volume 53, Issue 1 38-44 doi: 10.1111/vsu.13997
Elliott SM, Giancola SC, Moorman V.To determine if targeted blocking of frontal and infratrochlear nerves provided anesthesia for the approach to a frontonasal sinusotomy. Methods: Two part study: Part 1 randomized crossover design; Part 2 proof of concept. Methods: N = 12; six each in Parts 1 and 2. Methods: Part 1: Each horse had either frontal and infratrochlear nerve blocks or a line block performed with 2% mepivacaine hydrochloride. Mechanical nociceptive thresholds (MNT) were obtained at five sites along a proposed frontonasal sinusotomy prior to injection, and at 10, 60, and 120 min after blocking. After a 4 day ...
Advances in Imaging Techniques to Guide Therapies and Monitor Response to the Treatment of Musculoskeletal Injuries.
The Veterinary clinics of North America. Equine practice    July 21, 2023   doi: 10.1016/j.cveq.2023.06.001
Horne CR, Tufts S.Continual advancements in diagnostic imaging have allowed for more accurate and complete diagnoses of injuries in the performance horse. The use of several different imaging tools has further allowed the equine sports medicine clinician to more carefully direct treatment options, monitor response to therapy and guide rehabilitation recommendations. The advancements in diagnostic imaging and novel treatment options have led to the improvement in the overall prognosis of many injuries that affect the horse and their performance. The purpose of this section is to review the advancements made in d...
Detection of Viable Streptococcus equi equi Using Propidium Monoazide Polymerase Chain Reaction.
Journal of equine veterinary science    July 20, 2023   Volume 128 104893 doi: 10.1016/j.jevs.2023.104893
Boyle AG, O'Shea K, Stefanovski D, Rankin SC.There is debate around the clinical significance of Streptococcus equi subsp. equi detection in low numbers using quantitative real-time PCR (qPCR). Propidium monoazide (PMA) qPCR has been used to differentiate DNA from viable and nonviable bacterial cells. The aim of this study was to evaluate the ability of PMA eqbE SEQ2190 triplex qPCR to differentiate DNA from viable and nonviable S. equi in positive and suspect positive clinical specimens. Fifty-seven stored (frozen and refrigerated) positive (36) or suspect positive (21) clinical specimens (determined via SeeI qPCR as the gold standard) ...
Pharmacokinetics and tolerability of multiple-day oral dosing of mycophenolate mofetil in healthy horses.
Journal of veterinary internal medicine    July 19, 2023   doi: 10.1111/jvim.16797
Bello K, Lorch G, Kim K, Toribio RE, Yan L, Xie Z, Hill K, Phelps M.Additional efficacious immunomodulatory treatment is needed for the management of immune-mediated disease in horses. Mycophenolate mofetil (MMF) is an immunosuppressive drug that warrants assessment as a viable therapeutic agent for horses. Objective: To evaluate the pharmacokinetics (PK) of multiple-day oral dosing of MMF in healthy horses and to determine the tolerability of this dosing regimen. Methods: Six healthy Standardbred mares. Methods: Horses received MMF 10 mg/kg PO q12h for 7 days in the fed state. Serial sampling was performed over 12 hours on Days 1 and 7 with trough sampl...
Assessment of calcium, phosphorus, magnesium, vitamin D and PTH levels in sera of lame horses.
Veterinary medicine and science    July 19, 2023   Volume 9, Issue 5 2070-2077 doi: 10.1002/vms3.1198
Etemadi F, Tabatabaei Naeini A, Aminlari M.Minerals play vital roles in physiologic processes. Calcium, phosphorus and magnesium are common minerals. Secretion, absorption and homeostasis of these minerals are affected by associations between the active vitamin D and parathyroid hormone (PTH). The aim of this study was to assess concentrations of vitamin D, PTH and minerals, such as calcium, phosphorus and magnesium in horse sera, as well as associations of these values with lameness in horses. In the references, the reasons for lameness can be deficiency and imbalance of minerals, and clinical observations also confirm this and there ...
Equine synovial sepsis laboratory submissions yield a low rate of positive bacterial culture and a high prevalence of antimicrobial resistance.
American journal of veterinary research    July 17, 2023   Volume 84, Issue 8 doi: 10.2460/ajvr.23.05.0085
Pearson GB, Papa B, Mosaddegh A, Cooper H, Aprea M, Pigott J, Altier C, Cazer CL, Reesink HL.To investigate (1) variables associated with the likelihood of obtaining a positive culture, (2) commonly isolated microorganisms, and (3) antimicrobial resistance patterns of isolates from horses with presumptive synovial sepsis. Methods: Synovial fluid, synovium, and bone samples from equine cases with presumptive synovial sepsis submitted to the Cornell University Animal Health Diagnostic Center from 2000 to 2020 for microbial culture and antimicrobial sensitivity testing. Methods: Univariable and multivariable analyses were performed to determine the effect of variables on the likelihood o...
Effect of Procaine Penicillin G and Flunixin Meglumine on Serum Amyloid A Response in Healthy Adult Horses.
Journal of equine veterinary science    July 13, 2023   Volume 129 104876 doi: 10.1016/j.jevs.2023.104876
Trsan J, Nottle BF, Pusterla N.This study was designed to determine the effect of PPG and/or flunixin meglumine on SAA response when used at clinical dosing regimens in healthy adult horses. Six healthy adult horses were enrolled in a crossover study design including one control and three treatment groups: no treatment (control); PPG alone (intramuscularly q12h for 72h); flunixin meglumine alone (intravenously q24h for 72h); and PPG (intramuscularly q12h for 72h) and flunixin meglumine (intravenously q24h for 72h). Whole blood was collected at 0, 24, 48, 72, 96 and 120 hours post-initial drug administration to measure SAA u...
Post-anesthetic CPS and EQUUS-FAP scores in surgical and non-surgical equine patients: an observational study.
Frontiers in pain research (Lausanne, Switzerland)    July 12, 2023   Volume 4 1217034 doi: 10.3389/fpain.2023.1217034
Reed RA, Krikorian AM, Reynolds RM, Holmes BT, Branning MM, Lemons MB, Barletta M, Quandt JE, Burns CC, Dantino SC, Sakai DM.Equine pain scoring may be affected by the residual effect of anesthetic drugs. Unassigned: To compare pain scores in the hours immediately following anesthetic recovery to baseline pre-anesthetic scores in equine patients undergoing surgical and non-surgical procedures. Unassigned: Clinical observational study. Unassigned: Fifty adult horses undergoing anesthesia for surgical or non-surgical procedures were enrolled. Horses underwent pain scoring using the Composite Pain Score (CPS) and Equine Utrecht University Scale for Facial Assessment of Pain (EQUUS-FAP) prior to anesthesia (T0) and foll...
Agreement between hematocrit values determined by the Cobas b121 blood gas analyzer and the microhematocrit method in dogs, cats, and horses.
Veterinary clinical pathology    July 12, 2023   doi: 10.1111/vcp.13245
Dallarosa P, Monteiro ER, Borenstein APS, Valle SF.Packed cell volume (PCV) is important for assessing a patient's health status. Some blood gas analyzers measure hematocrit, and the agreement with PCV varies among different analyzers. Objective: We aimed to determine the agreement between PCV measured by microcentrifugation and hematocrit measured by the Cobas b121 blood gas analyzer in dogs, cats, and horses. Methods: Whole blood samples for PCV and blood gas analysis were collected in lithium-heparin syringes and analyzed within 10 min of collection. Agreement and association between the PCV and Cobas b121 generated hematocrit were assess...
Preliminary evaluation of hepatitis A virus cell receptor 1/kidney injury molecule 1 in healthy horses treated with phenylbutazone.
Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)    July 12, 2023   Volume 33, Issue 4 481-486 doi: 10.1111/vec.13314
Costa LRR, Swiderski C, Palm C, Aleman M.To investigate if hepatitis A virus cell receptor 1/kidney injury molecule 1 (HAVCR1/KIM1) in urine is detectable concurrently with increases in serum creatinine concentrations in horses receiving a recommended dose of phenylbutazone (PBZ) for 7 days. Methods: Preliminary study. Methods: Ten clinically healthy horses with normal physical examination and laboratory work were randomly assigned to PBZ or placebo groups (5 each). The PBZ group received PBZ at 4.4 mg/kg mixed with corn syrup orally every 12 hours. The placebo group received corn syrup orally every 12 hours. Both groups were tre...
Transmural Ultrasonography in the Evaluation of Horse Hoof Internal Structures: Comparative Quantitative Findings-Part 2.
Animals : an open access journal from MDPI    July 11, 2023   Volume 13, Issue 14 doi: 10.3390/ani13142267
Castro-Mesa AF, Resende Faleiros R, Martínez-Aranzales JR.The transmural ultrasound allows for the definition of the normal appearance of the hoof tissues and internal structures. Determining such measurements and proportions could contribute to evaluations of the normal spatial distal phalanx-hoof relationship. The objective was to describe the hoof's dermis and epidermis measurements using the transmural technique, in comparison with DR and anatomical sections. Sixty-two healthy hooves without digital radiographic abnormalities, made up of 30 anatomical pieces (phase 1) and 32 alive horse hooves (phase 2), and 16 sagittal sections of the first ones...
Borna disease virus 1 infection in alpacas: Comparison of pathological lesions and viral distribution to other dead-end hosts.
Veterinary pathology    July 11, 2023   3009858231185107 doi: 10.1177/03009858231185107
Fürstenau J, Richter MT, Erickson NA, Große R, Müller KE, Nobach D, Herden C, Rubbenstroth D, Mundhenk L.Borna disease is a progressive meningoencephalitis caused by spillover of the Borna disease virus 1 (BoDV-1) to horses and sheep and has gained attention due to its zoonotic potential. New World camelids are also highly susceptible to the disease; however, a comprehensive description of the pathological lesions and viral distribution is lacking for these hosts. Here, the authors describe the distribution and severity of inflammatory lesions in alpacas ( = 6) naturally affected by this disease in comparison to horses ( = 8) as known spillover hosts. In addition, the tissue and cellular distribu...
Technical note: Cartilage imaging with sub-cellular resolution using a laboratory-based phase-contrast x-ray microscope.
Medical physics    July 11, 2023   doi: 10.1002/mp.16599
Esposito M, Astolfo A, Cipiccia S, Jones CM, Savvidis S, Ferrara JD, Endrizzi M, Dudhia J, Olivo A.Microscopic imaging of cartilage is a key tool for the study and development of treatments for osteoarthritis. When cellular and sub-cellular resolution is required, histology remains the gold standard approach, albeit limited by the lack of volumetric information as well as by processing artifacts. Cartilage imaging with the sub-cellular resolution has only been demonstrated in the synchrotron environment. Objective: To provide a proof-of-concept demonstration of the capability of a laboratory-based x-ray phase-contrast microscope to resolve sub-cellular features in a cartilage sample. Meth...
NC State finds compression device a promising treatment for horses.
American journal of veterinary research    July 8, 2023   Volume 84, Issue 8 ajvr.23.06.0126 doi: 10.2460/ajvr.23.06.0126
Wheeler BE.No abstract available
Cardiac Biomarker Responses to Acute Exercise in Show Jumping Horses.
Journal of equine veterinary science    July 6, 2023   Volume 128 104882 doi: 10.1016/j.jevs.2023.104882
Fazio F, Aragona F, Piccione G, Pino C, Giannetto C.Cardiac biomarkers are useful to identify cardiac muscle variations in human and equine medicine. The aim of this study was to investigate the acute effect of a bout of show jumping training on serum activity of cardiac and muscular biomarkers in healthy athletic horses to include cardiac troponin (cTnI), myoglobin (MB), aspartate amino transferase (AST), alanine amino transferase (ALT), creatine phosphokinase (CPK) and lactate dehydrogenase (LDH). Serum samples were collected from seven Italian Saddle horses (three geldings and four mares; 10 ± 3 years; mean body weight 480 ±70 kg), regular...
Pyelonephritic end-stage kidney and ureterocutaneous fistula in a Shetland pony. Schinköthe J, Gerlach K, Ulrich RG, Brehm W.A 12-y-old Shetland Pony was presented with a mucus-secreting fistula in the right paralumbar fossa. Surgery was performed to unravel the origin of the fistula. The horse died under anesthesia and was forwarded to autopsy. The right kidney was markedly atrophic and fibrotic, consistent with unilateral end-stage kidney. The right ureter was markedly thickened, but with luminal continuity leading into the urinary bladder where a partial obstruction caused by nodular para-ureteral fat necrosis was evident. The lumen of the cutaneous fistula was continuous with the right ureter; therefore, we diag...
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