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Topic:Clinical Study

Clinical studies in equine research involve the systematic investigation of health and disease in horses through structured scientific methods. These studies aim to evaluate the safety and efficacy of treatments, understand disease mechanisms, and improve veterinary care practices. Clinical studies can include randomized controlled trials, observational studies, and case-control studies. They may focus on various aspects such as pharmacokinetics, therapeutic interventions, and diagnostic techniques. This page compiles peer-reviewed research studies and scholarly articles that explore the design, implementation, and findings of clinical studies in equine medicine, providing insights into their impact on horse health and veterinary practices.
Osteoclasts are recruited to the subchondral bone in naturally occurring post-traumatic equine carpal osteoarthritis and may contribute to cartilage degradation.
Osteoarthritis and cartilage    October 24, 2015   Volume 24, Issue 3 555-566 doi: 10.1016/j.joca.2015.10.008
Bertuglia A, Lacourt M, Girard C, Beauchamp G, Richard H, Laverty S.The role of osteoclasts in osteochondral degeneration in osteoarthritis (OA) has rarely been investigated in spontaneous disease or animal models of OA. Objective: The objectives of the current study were to investigate osteoclast density and location in post-traumatic OA (PTOA) and control specimens from racehorses. Methods: Cores were harvested from a site in the equine third carpal bone, that undergoes repetitive, high intensity loading. Histological and immunohistochemical (Cathepsin K and Receptor-activator of Nuclear Factor kappa-β ligand (RANKL)) stained sections were scored (global an...
Microdialysis measurements of equine lamellar perfusion and energy metabolism in response to physical and pharmacological manipulations of blood flow.
Equine veterinary journal    October 24, 2015   Volume 48, Issue 6 756-764 doi: 10.1111/evj.12511
Medina-Torres CE, Underwood C, Pollitt CC, Castro-Olivera EM, Hodson MP, Richardson DW, van Eps AW.A suitable method for evaluating lamellar perfusion changes and their metabolic consequences is currently lacking. Objective: To examine perfusion changes in lamellar tissue using serial microdialysis measurements of urea clearance and energy metabolites. Methods: Randomised, controlled (within subject) experimental trial. Methods: Nine Standardbred horses were instrumented with microdialysis probes in the foot lamellar tissue and skin (over the tail base). Urea (20 mmol/l) was added to the perfusate and its clearance was used to estimate local perfusion. Samples were collected every 15 min fo...
Intravenous infusion of H2-saline suppresses oxidative stress and elevates antioxidant potential in Thoroughbred horses after racing exercise.
Scientific reports    October 23, 2015   Volume 5 15514 doi: 10.1038/srep15514
Yamazaki M, Kusano K, Ishibashi T, Kiuchi M, Koyama K.Upon intensive, exhaustive exercise, exercise-induced reactive oxygen species may exceed the antioxidant defence threshold, consequently resulting in muscular damage or late-onset chronic inflammation. Recently, the therapeutic antioxidant and anti-inflammatory effects of molecular hydrogen (H2) for human rheumatoid arthritis have been demonstrated. However, it is also important to clarify the effects of administrating H2 in large animals other than humans, as H2 is thought to reach the target organ by passive diffusion upon delivery from the blood flow, indicating that the distance from the a...
Cell-based cartilage repair strategies in the horse.
Veterinary journal (London, England : 1997)    October 23, 2015   Volume 208 1-12 doi: 10.1016/j.tvjl.2015.10.027
Ortved KF, Nixon AJ.Damage to the articular cartilage surface is common in the equine athlete and, due to the poor intrinsic healing capabilities of cartilage, can lead to osteoarthritis (OA). Joint disease and OA are the leading cause of retirement in equine athletes and currently there are no effective treatments to stop the progression of OA. Several different cell-based strategies have been investigated to bolster the weak regenerative response of chondrocytes. Such techniques aim to restore the articular surface and prevent further joint degradation. Cell-based cartilage repair strategies include enhancement...
Pharmacokinetics and pharmacodynamics of ramipril and ramiprilat after intravenous and oral doses of ramipril in healthy horses.
Veterinary journal (London, England : 1997)    October 23, 2015   Volume 208 38-43 doi: 10.1016/j.tvjl.2015.10.024
Serrano-Rodríguez JM, Gómez-Díez M, Esgueva M, Castejón-Riber C, Mena-Bravo A, Priego-Capote F, Serrano Caballero JM, Muñoz A.The pharmacokinetics and pharmacodynamics (PK/PD) of the angiotensin-converting enzyme inhibitor (ACEI) ramiprilat after intravenous (IV) and oral (PO) administration of ramipril have not been evaluated in horses. This study was designed to establish PK profiles for ramipril and ramiprilat as well as to determine the effects of ramiprilat on serum angiotensin converting enzyme (ACE) and to select the most appropriate ramipril dose that suppresses ACE activity. Six healthy horses in a cross-over design received IV ramipril 0.050 mg/kg, PO at a dose of 0 (placebo), and 0.050, 0.10, 0.20, 0.40 ...
Tenogenically Induced Allogeneic Mesenchymal Stem Cells for the Treatment of Proximal Suspensory Ligament Desmitis in a Horse.
Frontiers in veterinary science    October 22, 2015   Volume 2 49 doi: 10.3389/fvets.2015.00049
Vandenberghe A, Broeckx SY, Beerts C, Seys B, Zimmerman M, Verweire I, Suls M, Spaas JH.Suspensory ligament injuries are a common injury in sport horses, especially in competing dressage horses. Because of the poor healing of chronic recalcitrant tendon injuries, this represents a major problem in the rehabilitation of sport horses and often compromises the return to the initial performance level. Stem cells are considered as a novel treatment for different pathologies in horses and humans. Autologous mesenchymal stem cells (MSCs) are well known for their use in the treatment of tendinopathies; however, recent studies report a safe use of allogeneic MSCs for different orthopedic ...
Splanchnic extraction of phenylalanine in mature mares was not affected by threonine supplementation.
Veterinary journal (London, England : 1997)    October 22, 2015   Volume 207 190-192 doi: 10.1016/j.tvjl.2015.10.009
Mastellar SL, Barnes T, Cybulak K, Urschel KL.This study determined splanchnic extraction of phenylalanine at two intakes of threonine. Six Thoroughbred mares were supplemented with isonitrogenous amounts of either threonine or glutamate. Dietary threonine intakes were 119 (+Thr) and 58 (Basal) mg/kg/day, respectively. Each horse received each diet twice and each was studied once with an oral and once with an intravenous (IV) infusion of [1-(13)C]phenylalanine. A 2-h primed, constant IV infusion of [(13)C]sodium bicarbonate and a 4-h primed, constant infusion of [1-(13)C]phenylalanine, either orally or IV, were used to measure isotopic en...
Coenzyme Q10 and α-Tocopherol Prevent the Lipid Peroxidation of Cooled Equine Semen.
Reproduction in domestic animals = Zuchthygiene    October 22, 2015   Volume 50, Issue 6 1003-1010 doi: 10.1111/rda.12627
Nogueira BG, Sampaio BF, Souza MI, Costa E Silva EV, Zúccari CE.Biotechnology applied for equine semen increases the levels of reactive oxygen species and reduces the natural antioxidant defence, by both dilution and removal of seminal plasma. Therefore, the aims of this study were to evaluate the effect of adding coenzyme Q10 (CoQ10) and α-tocopherol (α-TOH) to the cooling extender, singly or in combination, on sperm parameters, and their effectiveness in preventing lipid peroxidation (LPO) of equine semen during cooling at 5°C for 72 h. Ten adult stallions of proven fertility were used, using two ejaculates each, subjecting them to the treatments with...
Comparison of the larvicidal efficacies of moxidectin or a five-day regimen of fenbendazole in horses harboring cyathostomin populations resistant to the adulticidal dosage of fenbendazole.
Veterinary parasitology    October 21, 2015   Volume 214, Issue 1-2 100-107 doi: 10.1016/j.vetpar.2015.10.003
Reinemeyer CR, Prado JC, Nielsen MK.Despite widespread acknowledgement of cyathostomin resistance to adult icidal dosages of benzimidazole (BZD) anthelmintics, many strongyle control programs continue to feature regularly scheduled larvicidal treatment with fenbendazole (FBZ). However, no studies have been conducted to evaluate the efficacy of larvicidal regimens against encysted cyathostomins in a BZD-resistant (BZD-R) population. A masked, randomized, controlled clinical study was conducted with 18 juvenile horses harboring populations of cyathostomins that were considered BZD-R on the basis of fecal egg count reduction (FECR)...
What Is Your Diagnosis? Acute, severe trauma resulting in multiple fractures and complete luxation of the thoracic vertebral column.
Journal of the American Veterinary Medical Association    October 21, 2015   Volume 247, Issue 9 1011-1013 doi: 10.2460/javma.247.9.1011
Liepman RS, Burns TA, Mulligan KA, Drost WT.No abstract available
Accuracy and precision of oscillometric blood pressure in standing conscious horses.
Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)    October 21, 2015   Volume 26, Issue 1 85-92 doi: 10.1111/vec.12411
Olsen E, Pedersen TL, Robinson R, Haubro Andersen P.Arterial blood pressure (BP) is a relevant clinical parameter that can be measured in standing conscious horses to assess tissue perfusion or pain. However, there are no validated oscillometric noninvasive blood pressure (NIBP) devices for use in horses. Methods: Seven healthy horses from a teaching and research herd. Objective: To evaluate the accuracy and precision of systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and mean arterial pressure (MAP) in conscious horses obtained with an oscillometric NIBP device when compared to invasively measured arterial BP. Methods: An ...
The cardiovascular status of isoflurane-anaesthetized horses with and without dexmedetomidine constant rate infusion evaluated at equivalent depths of anaesthesia.
Veterinary anaesthesia and analgesia    October 21, 2015   Volume 43, Issue 4 412-423 doi: 10.1111/vaa.12315
Risberg ÅI, Ranheim B, Krontveit RI, Lervik A, Haga HA.To compare cardiac index and oxygen extraction at equivalent depths of anaesthesia between isoflurane-anaesthetized horses and horses anesthetized with isoflurane and dexmedetomidine CRI. Methods: Sequential, blinded, randomized, balanced, crossover study. Methods: Eight horses weighing a mean ± standard deviation of 478 ± 58 kg. Methods: Horses were premedicated with 0.03 mg kg(-1) acepromazine intramuscularly (IM) and 8 μg kg(-1) dexmedetomidine intravenously (IV). Anaesthesia was induced with 2.5 mg kg(-1) ketamine and 0.1 mg kg(-1) midazolam IV and maintained with isofluran...
Effects of administration of a synthetic low molecular weight/low molar substitution hydroxyethyl starch solution in healthy neonatal foals.
The Canadian veterinary journal = La revue veterinaire canadienne    October 21, 2015   Volume 56, Issue 10 1069-1074 
Hepworth-Warren KL, Wong DM, Hay-Kraus BL, Wang C, Sun Y.This study compared the effects of IV administration of isotonic fluid therapy and colloidal fluid therapy in healthy neonatal foals. Fifteen healthy neonatal foals were used in a randomized blinded prospective clinical study. Foals were randomly assigned to receive a bolus of 20 mL/kg of tetrastarch (TES) or balanced crystalloid solution. Vital parameters, colloid osmotic pressure (COP), and various clinicopathologic variables were assessed prior to infusion and at various time points up to 120 h after infusion. The treatment group (TES) had a significant increase in both COP and percentage i...
A Novel Algorithm for Movement Artifact Removal in ECG Signals Acquired from Wearable Systems Applied to Horses.
PloS one    October 20, 2015   Volume 10, Issue 10 e0140783 doi: 10.1371/journal.pone.0140783
Lanata A, Guidi A, Baragli P, Valenza G, Scilingo EP.This study reports on a novel method to detect and reduce the contribution of movement artifact (MA) in electrocardiogram (ECG) recordings gathered from horses in free movement conditions. We propose a model that integrates cardiovascular and movement information to estimate the MA contribution. Specifically, ECG and physical activity are continuously acquired from seven horses through a wearable system. Such a system employs completely integrated textile electrodes to monitor ECG and is also equipped with a triaxial accelerometer for movement monitoring. In the literature, the most used techn...
Preliminary investigation comparing a detomidine continuous rate infusion combined with either morphine or buprenorphine for standing sedation in horses.
Veterinary anaesthesia and analgesia    October 19, 2015   Volume 43, Issue 2 189-194 doi: 10.1111/vaa.12316
Potter JJ, MacFarlane PD, Love EJ, Tremaine H, Taylor PM, Murrell JC.To compare sedative and analgesic properties of buprenorphine or morphine for standing procedures combined with a detomidine continuous rate infusion (CRI). Methods: Blinded, prospective, randomized clinical pilot study. Methods: Ten horses presented for dental or sinus procedures. Methods: Horses received 0.02 mg kg(-1) acepromazine intravenously (IV), followed 30 minutes later by detomidine 10 μg kg(-1) IV. Five minutes later, buprenorphine 0.01 mg kg(-1) (n = 6) or morphine 0.1 mg kg(-1) (n = 4) was administered IV. Detomidine was administered by CRI (0.2 μg kg(-1) minute(-1)) and adjuste...
Arrhythmogenic right ventricular cardiomyopathy secondary to adipose infiltration as a cause of episodic collapse in a horse.
Irish veterinary journal    October 19, 2015   Volume 68 24 doi: 10.1186/s13620-015-0052-3
Raftery AG, Garcia NC, Thompson H, Sutton DG.A 15-year-old Clydesdale cross gelding was investigated and managed over a 2-year period for intermittent collapse. The horse presented initially after an observed episode of collapse at rest, and had a resting tachycardia, elevated Cardiac Troponin I and polycythaemia. Multiple dysrhythmias were detected on telemetric electrocardiography. Vital parameters, cardiac rhythm and red cell count returned to reference range with prolonged rest but further resting syncopal episodes were observed, and due to safety concerns and limited treatment options the horse was euthanased. Post mortem evaluation...
Stimulation of LH, FSH, and luteal blood flow by GnRH during the luteal phase in mares.
Theriogenology    October 19, 2015   Volume 85, Issue 4 740-746 doi: 10.1016/j.theriogenology.2015.10.019
Castro T, Oliveira FA, Siddiqui MA, Baldrighi JM, Wolf CA, Ginther OJ.A study was performed on the effect of a single dose per mare of 0 (n = 9), 100 (n = 8), or 300 (n = 9) of GnRH on Day 10 (Day 0 = ovulation) on concentrations of LH, FSH, and progesterone (P4) and blood flow to the CL ovary. Hormone concentration and blood flow measurements were performed at hours 0 (hour of treatment), 0.25, 0.5, 1, 2, 3, 4, and 6. Blood flow was assessed by spectral Doppler ultrasonography for resistance to blood flow in an ovarian artery before entry into the CL ovary. The percentage of the CL with color Doppler signals of blood flow was estimated from videotapes of real-t...
Biological variation of thromboelastrography variables in 10 clinically healthy horses.
Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)    October 19, 2015   Volume 26, Issue 1 80-84 doi: 10.1111/vec.12410
Scruggs JL, Flatland B, McCormick KA, Reed A.To assess the utility of population-based reference intervals (PRIs) for interpreting thromboelastography (TEG) variables in horses using biological variation data. Methods: Prospective cohort biologic variation study conducted over a 5-week period. Methods: Veterinary teaching hospital and research facility. Methods: Ten clinically healthy horses randomly selected from a veterinary school research and teaching herd. Methods: Horse health was determined using physical examination, CBC, and biochemical and coagulation profiles prior to the start of the study. Subsequently, once weekly blood sam...
Survival Time of Cross-Match Incompatible Red Blood Cells in Adult Horses.
Journal of veterinary internal medicine    October 18, 2015   Volume 29, Issue 6 1683-1688 doi: 10.1111/jvim.13627
Tomlinson JE, Taberner E, Boston RC, Owens SD, Nolen-Walston RD.There is a markedly reduced half-life of transfused RBCs when donor and recipient cats or humans are cross-match incompatible. Only 10-20% of horses have naturally occurring alloantibodies. Therefore, cross-match testing before blood transfusion is not always performed. Objective: Cross-match incompatibility predicts shortened RBC survival time as compared to that of compatible or autologous blood. Methods: Twenty healthy adult horses. Methods: Prospective trial. Blood type, anti-RBC antibody screen (before and 1 month after transfusion) and major and minor cross-match determined 10 donor-reci...
Surgical site infections: What do we know?
Equine veterinary journal    October 18, 2015   Volume 47, Issue 6 753-755 doi: 10.1111/evj.12480
Verwilghen D.No abstract available
Effects of Functional Electrical Stimulation on Denervated Laryngeal Muscle in a Large Animal Model.
Artificial organs    October 17, 2015   Volume 39, Issue 10 876-885 doi: 10.1111/aor.12624
Cheetham J, Perkins JD, Jarvis JC, Cercone M, Maw M, Hermanson JW, Mitchell LM, Piercy RJ, Ducharme NG.Bilateral vocal fold paralysis (BVCP) is a life-threatening condition that follows injury to the Recurrent Laryngeal nerve (RLn) and denervation of the intrinsic laryngeal musculature. Functional electrical stimulation (FES) enables restoration and control of a wide variety of motor functions impaired by lower motor neuron lesions. Here we evaluate the effects of FES on the sole arytenoid abductor, the posterior cricoarytenoid (PCA) muscle in a large animal model of RLn injury. Ten horses were instrumented with two quadripolar intramuscular electrodes in the left PCA muscle. Following a 12-wee...
Peripheral Airway Smooth Muscle, but Not the Trachealis, Is Hypercontractile in an Equine Model of Asthma.
American journal of respiratory cell and molecular biology    October 17, 2015   Volume 54, Issue 5 718-727 doi: 10.1165/rcmb.2015-0180OC
Matusovsky OS, Kachmar L, Ijpma G, Bates G, Zitouni N, Benedetti A, Lavoie JP, Lauzon AM.Heaves is a naturally occurring equine disease that shares many similarities with human asthma, including reversible antigen-induced bronchoconstriction, airway inflammation, and remodeling. The purpose of this study was to determine whether the trachealis muscle is mechanically representative of the peripheral airway smooth muscle (ASM) in an equine model of asthma. Tracheal and peripheral ASM of heaves-affected horses under exacerbation, or under clinical remission of the disease, and control horses were dissected and freed of epithelium to measure unloaded shortening velocity (Vmax), stress...
Plasma Procalcitonin Concentration in Healthy Horses and Horses Affected by Systemic Inflammatory Response Syndrome.
Journal of veterinary internal medicine    October 16, 2015   Volume 29, Issue 6 1689-1691 doi: 10.1111/jvim.13640
Bonelli F, Meucci V, Divers TJ, Jose-Cunilleras E, Corazza M, Tognetti R, Guidi G, Intorre L, Sgorbini M.The diseases most frequent associated with SIRS in adult horses are those involving the gastrointestinal tract. An early diagnosis should be the goal in the management of horses with SIRS. Objective: The objective of this study was to evaluate the plasma procalcitonin (PCT) concentration in healthy and SIRS horses to assess differences between the two groups. Methods: Seventy-eight horses (30 healthy and 48 SIRS). Methods: Prospective in vivo multicentric study. Horses were classified as SIRS if at least 2 of the following criteria were met: abnormal leukocyte count or distribution, hypertherm...
A review of traditional and contemporary assays for direct and indirect detection of Equid herpesvirus 1 in clinical samples. Balasuriya UB, Crossley BM, Timoney PJ.Equid herpesvirus 1 (EHV-1) is one of the most economically important equine viral pathogens. Its clinical manifestations in horses vary from acute upper respiratory tract disease, abortion, or neonatal death, to neurological disease termed equine herpesviral myeloencephalopathy, which may lead to paralysis and a fatal outcome. Successful identification of EHV-1 infection in horses depends on a variety of factors such as suitable case selection with emphasis on timing of sample collection, selection of appropriate sample(s) based on the clinical manifestations, application of relevant diagnost...
Discontinuities in the endothelium of epiphyseal cartilage canals and relevance to joint disease in foals.
Journal of anatomy    October 15, 2015   Volume 228, Issue 1 162-175 doi: 10.1111/joa.12391
Hellings IR, Ekman S, Hultenby K, Dolvik NI, Olstad K.Cartilage canals have been shown to contain discontinuous blood vessels that enable circulating bacteria to bind to cartilage matrix, leading to vascular occlusion and associated pathological changes in pigs and chickens. It is also inconsistently reported that cartilage canals are surrounded by a cellular or acellular wall that may influence whether bacterial binding can occur. It is not known whether equine cartilage canals contain discontinuous endothelium or are surrounded by a wall. This study aimed to examine whether there were discontinuities in the endothelium of cartilage canal vessel...
The Effect of Different Types of Musculoskeletal Injuries on Blood Concentration of Serum Amyloid A in Thoroughbred Racehorses.
PloS one    October 14, 2015   Volume 10, Issue 10 e0140673 doi: 10.1371/journal.pone.0140673
Turło A, Cywińska A, Czopowicz M, Witkowski L, Niedźwiedź A, Słowikowska M, Borowicz H, Jaśkiewicz A, Winnicka A.Training-induced muscle, skeletal and joint trauma may result in acute phase response reflected by the changes in the blood concentration of serum amyloid A (SAA) in racehorses. It remains yet unclear if such systemic reaction could be triggered by sport injuries and what is the impact of different types of musculoskeletal trauma on SAA concentrations in racehorses. This study aimed to determine changes in the SAA blood concentration in racehorses with different types of injuries of musculoskeletal system. Methods: The study involved 28 racehorses diagnosed after the race with bone fractures (...
Radiographic measurements of the hooves of normal ponies.
Veterinary journal (London, England : 1997)    October 13, 2015   Volume 206, Issue 3 332-337 doi: 10.1016/j.tvjl.2015.10.005
Thieme K, Ehrle A, Lischer C.Knowledge of the normal radiographic anatomy of the equine foot and the relationship between the distal phalanx and the hoof capsule is imperative for objective assessment of hoof health. Little information is available for the hooves of ponies. The aim of this study was to establish a database of reference values for normal ponies and to investigate the relationship between the height at the withers and radiographic measurements of the hooves. Radiographic examinations were performed on 81 ponies, ranging from 81.5 to 148.0 cm height at the withers, immediately after foot trimming. Eighteen p...
A test of the universal applicability of a commonly used principle of hoof balance.
Veterinary journal (London, England : 1997)    October 13, 2015   Volume 207 169-176 doi: 10.1016/j.tvjl.2015.10.003
Caldwell MN, Allan LA, Pinchbeck GL, Clegg PD, Kissick KE, Milner PI.This study used a UK trimming protocol to determine whether hoof balance is achieved (as defined by equivalence of geometric proportions) in cadaver limbs (n = 49) and two cohorts of horses (shod, n = 6, and unshod, n = 20; three trimming cycles). To determine equivalence, dorsal hoof wall length (DHWL), distance from the heel buttress to the centre of pressure (HBUT-COP) and distance from dorsal toe to centre of rotation (DT-COR) were calculated as a proportion of bearing border length (BBL) using digital photography. Geometric proportions were tested using Fieller's test of equiv...
Risk Factors Associated With Survival to Hospital Discharge of 54 Horses With Fractures of the Radius.
Veterinary surgery : VS    October 12, 2015   Volume 44, Issue 8 1036-1041 doi: 10.1111/vsu.12412
Stewart S, Richardson D, Boston R, Schaer TP.To determine (1) survival to discharge of horses with radial fractures (excluding osteochondral fragmentation of the distal aspect of the radius and stress fractures); and (2) risk factors affecting survival to hospital discharge in conservative and surgically managed fractures. Methods: Case series. Methods: Horses (n = 54). Methods: Medical records (1990-June 2012) and radiographs of horses admitted with radial fracture were reviewed. Horses with osteochondral fragmentation of the distal aspect of the radius or stress fractures were excluded. Evaluated risk factors were age, fracture configu...
Cheek Tooth Extraction Via a Minimally Invasive Transbuccal Approach and Intradental Screw Placement in 54 Equids.
Veterinary surgery : VS    October 12, 2015   Volume 44, Issue 8 1012-1020 doi: 10.1111/vsu.12409
Langeneckert F, Witte T, Schellenberger F, Czech C, Aebischer D, Vidondo B, Koch C.To describe (1) preoperative findings and surgical technique, (2) intraoperative difficulties, and (3) postoperative complications and long-term outcome of equine cheek tooth extraction using a minimally invasive transbuccal screw extraction (MITSE) technique. Methods: Retrospective case series. Methods: Fifty-four equids; 50 horses, 3 ponies, and 1 mule. Methods: Fifty-eight MITSE procedures were performed to extract cheek teeth in 54 equids. Peri- and intraoperative difficulties, as well as short- (6 months) postoperative complications were recorded. Followup information was obtained through...