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Topic:Complications

Complications in horses refer to unexpected medical or surgical issues that arise during the course of treatment or recovery. These complications can affect various systems within the horse's body and may result from underlying conditions, medical interventions, or environmental factors. Common complications in equines include laminitis, colic, infections, and respiratory issues. Each complication presents distinct clinical challenges and requires careful management to mitigate adverse outcomes. This section compiles peer-reviewed research studies and scholarly articles that explore the incidence, etiology, management strategies, and outcomes associated with complications in equine health.
Percutaneous Ultrasound-Guided Carotid Access and Puncture Closure with Angio-Seal in Horses.
Animals : an open access journal from MDPI    June 7, 2022   Volume 12, Issue 12 1481 doi: 10.3390/ani12121481
Vitoria A, Laborda A, Serrano-Casorrán C, Fuente S, Romero A, Vázquez FJ. There are different indications for endovascular surgery in horses, mainly the treatment of guttural pouch mycosis. Traditionally, these procedures are carried out by open arteriotomy of the common carotid artery (CCA), although less invasive percutaneous ultrasound-guided carotid access (PUGCA) has been described in experimental horses. In human medicine, commercial closure systems are used to seal these arterial puncture sites and reduce complications. The aims of this study are to retrospectively describe our experience with PUGCA in clinical cases and to report, for the first time, the us...
Traumatic avulsion of the tricuspid valve: an unusual cardiac complication of an equine accident.
BMJ case reports    May 20, 2022   Volume 15, Issue 5 e248580 doi: 10.1136/bcr-2021-248580
White A, Cullen P, Hinchion J.A stablehand in his 20s presented with increasing dyspnoea on exertion and chest pain months after being kicked directly in the chest by a horse. Further investigations revealed severe isolated, primary tricuspid regurgitation due to partial avulsion of the anterior leaflet. Open surgical repair was successfully performed from which he recovered uneventfully with resolution of his symptoms and minimal residual tricuspid regurgitation. Although uncommon, blunt force trauma to the chest is becoming increasingly recognised as a rare cause of tricuspid regurgitation. Symptoms may be insidious, and...
[Venous catheters in horses – early ultrasonographic venous abnormalities and evidence of biofilms].
Tierarztliche Praxis. Ausgabe G, Grosstiere/Nutztiere    May 6, 2022   Volume 50, Issue 2 101-114 doi: 10.1055/a-1809-6477
Doerffel A, Reinert A, Böttcher D, Winter K, Brehm W, Gittel C.Complications associated with indwelling intravenous catheters vary from minor to severe. Changes in tissue architecture and vein structure may be detectable prior to clinical alterations. The aim of the study was to characterize and compare changes in a catheterized vein and surrounding tissue by clinical and ultrasonographic examination. Microbiological infestation of catheter specimens was assessed. Methods: In this prospective, observational, clinical study 55 horses with an indwelling intravenous catheter have been included. Subsequent to catheter placement, vein and surrounding tissue we...
Success rate in a clinical equine in vitro embryo production program.
Theriogenology    April 24, 2022   Volume 187 215-218 doi: 10.1016/j.theriogenology.2022.04.019
Claes A, Stout TAE.In vitro embryo production (IVEP) via Ovum Pick-Up (OPU) and Intracytoplasmic Sperm Injection (ICSI) has become a popular breeding technique in Warmblood mares because of the high success rate and several practical advantages. IVEP offers a solution for a variety of reproductive issues including, but not limited to, sub-fertility in stallions or mares, poor quality or scarce frozen semen, difficulty in synchronizing donor and recipient mares, and inefficient use of recipient mares. In 515 OPU-ICSI sessions performed in our facility in 2021, a mean of 25.9 antral follicles were aspirated yield...
Dorsally placed commercially available subpalpebral lavage systems have low complication rates in horses.
Journal of the American Veterinary Medical Association    April 15, 2022   Volume 260, Issue 9 1057-1062 doi: 10.2460/javma.22.01.0007
Stewart RM, Lack AC, Telle MR, Ellis JK, Betbeze CM.To retrospectively evaluate the complication rate following dorsal placement of a commercially available 1-hole subpalpebral lavage system (SPL) at a veterinary teaching hospital. 102 client-owned horses with ophthalmic disease. Medical records of horses (2010 to 2020) with ophthalmic disease were reviewed to determine whether a commercially available SPL system was dorsally placed. Data collected from the medical record included signalment, presenting complaint(s), diagnosis, ophthalmic procedures performed, SPL laterality, hospital service that placed the SPL, anesthetic technique for placem...
Factors Affecting Survival and Future Foaling Rates in Thoroughbred Mares with Hydrops.
Journal of equine veterinary science    March 31, 2022   Volume 113 103941 doi: 10.1016/j.jevs.2022.103941
Lemonnier LC, Wolfsdorf KE, Kreutzfeldt N, Fedorka C, Chigerwe M, Bozorgmanesh R.Prognosis for life and future fertility in broodmares following hydrops is reportedly good, but evidence to support these reports is limited. The objective of this case series was to describe the prognosis for survival and fertility in mares presented to a referral hospital following diagnosis of hydrops. Medical records were reviewed to identify mares diagnosed with hydrops. Data collected included history (gestation, sire of the foal), clinical findings at presentation and throughout hospitalization (complications, treatments, survival to discharge) and future foaling rates. Thirty mares wer...
Collection and administration of blood products in horses: Transfusion indications, materials, methods, complications, donor selection, and blood testing.
Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)    January 20, 2022   Volume 32, Issue S1 108-122 doi: 10.1111/vec.13119
Radcliffe RM, Bookbinder LC, Liu SY, Tomlinson JE, Cook VL, Hurcombe SDA, Divers TJ.Blood transfusion is a lifesaving treatment for horses with acute hemorrhage and other causes of anemia. Transfusions improve oxygen delivery to the tissues via increased blood volume and hemoglobin concentration. Certain aspects of equine blood transfusion are challenging, especially in the field situation, and practitioners may be unfamiliar or feel overwhelmed with the process. An understanding of the indications, materials, methods, and techniques as well as donor selection and possible complications will help practitioners successfully implement blood transfusion in clinical practice. Met...
Comparing Blind and Ultrasound-Guided Retrobulbar Nerve Blocks in Equine Cadavers: The Training Effect.
Animals : an open access journal from MDPI    January 9, 2022   Volume 12, Issue 2 154 doi: 10.3390/ani12020154
Hermans H, Lloyd-Edwards RA, Ferrão-van Sommeren AJH, Tersmette AA, Schouten JCM, Serra Bragança FM, van Loon JPAM.In standing ophthalmic surgery in horses, a retrobulbar nerve block (RNB) is often placed blindly for anesthesia and akinesia. The ultrasound (US)-guided RNB may have fewer complications, but the two techniques have only been compared once in equine cadavers. This study compares the techniques for success and complication rates and analyzes the effect of training on US guidance. Twenty-two equine cadavers were divided into three groups: blind RNBs were performed bilaterally in eight cadavers, US-guided RNBs were performed bilaterally in seven cadavers, and after US-guided training, blind RNBs ...
Fragment size is associated with post-operative complications following elective arthroscopy of the tibiotarsal joint of horses.
The Canadian veterinary journal = La revue veterinaire canadienne    January 4, 2022   Volume 63, Issue 1 74-80 
Merchán A, Koenig J, Côté N, Cribb N, Monteith G.The objective of this retrospective study was to determine the occurrence of joint-related complications after elective arthroscopy of the tibiotarsal joint (TTJ) in 329 horses, and the association with specific clinical parameters. Data were collected from medical records of horses undergoing elective tibiotarsal joint arthroscopy for fragment removal. Exact conditional univariate regression was used to determine significant risk factors for joint-related post-operative complications. Of 485 joints, 2 (0.4%) developed surgical site infection, 4 (0.8%) developed septic arthritis, 1 (0.2%) deve...
Complications and Comorbidities in Foals Undergoing Surgical Repair for Uroperitoneum.
Journal of equine veterinary science    December 24, 2021   Volume 110 103852 doi: 10.1016/j.jevs.2021.103852
Ford MG, Nelson BB, Ford TS, Souza CRS, Easley JT, Hackett ES.Surgical repair is frequently effective at resolving uroperitoneum in foals, though complications occur. Despite their occurrence, management strategies used to address these complications, and their impact on survival are not clearly defined. To better describe the complications following surgical correction of uroperitoneum and to document treatment strategies and outcomes after intervention, a multi-center retrospective case series was performed. Medical record data of foals undergoing surgical treatment for uroperitoneum were retrieved from three surgical centers, and cases identified with...
Partial parotid sialoadenectomy in a horse with parotid ductal carcinoma: Surgical description and case report.
Veterinary surgery : VS    December 1, 2021   Volume 51, Issue 2 296-302 doi: 10.1111/vsu.13750
Zetterström SM, Matz BM, Neto RLALT, Lindley SES, Cole RC, Wilhite R, Boone LH.To describe the surgical findings, histopathological features, and long-term outcome for a horse with parotid salivary carcinoma. Methods: Case report ANIMALS: Twelve year old American Quarter Horse gelding. Methods: The gelding was presented for a 10 × 10 cm swelling below the base of the right ear. Ultrasonographic examination revealed a mass involving the right parotid salivary gland. Incisional biopsy was consistent with parotid carcinoma. The tumor was marginally excised. The lateral wall of the guttural pouch was excised with the mass and was reconstructed with a porcine small int...
Evaluation of totally implantable catheters in healthy horses.
BMC veterinary research    October 26, 2021   Volume 17, Issue 1 339 doi: 10.1186/s12917-021-03052-z
de Souza Garcia AF, Ribeiro G, de Assis Arantes J, Reginato GM, Xavier NV, Carregaro AB, Silva TJF, Grigoletto R, de Freitas SH, Dória RGS.For horses requiring prolonged daily cephalic intravenous regional limb perfusion (IVRLP), the use of a totally implantable catheter (TIC) could be indicated to reduce complications associated with frequent venipuncture or external catheterization. This study aims to evaluate the implantation technique of the TIC in the cephalic vein of horses for IVRLP, describe the complications associated with the device's placement and use, and assess its viability up to 60 days after implantation. Totally implantable catheters, cut to 15 cm (n = 5) and 46 cm (n = 5) in length, were implanted...
Comparison of liberal and goal-directed fluid therapy after small intestinal surgery for strangulating lesions in horses.
The Veterinary record    October 16, 2021   Volume 188, Issue 3 e5 doi: 10.1002/vetr.5
Giusto G, Vercelli C, Gandini M.There are few guidelines for the appropriate mode of fluid administration during and after colic surgery, and is challenging to reach the right balance while avoiding overhydration. This study aimed to compare goal-directed fluid therapy (GDFT) and 'liberal' fluid regimens (LFRs) in horses undergoing small intestinal surgery. Methods: Eighteen horses subjected to small intestinal surgery were matched according to the surgical lesion, type of anastomosis, length of resection, and duration of clinical signs. Horses in the LFR group were administered intravenous (IV) fluids for at least 24 h. In ...
Acute abdominal dehiscence following laparotomy: A multicentre, international retrospective study.
Equine veterinary journal    August 21, 2021   doi: 10.1111/evj.13498
Hann MJ, Mair TS, Gardner A, Mudge M, Southwood LL, Dechant JE, Barton MH, Garcia-Macias J, Parker RA, Hassel D, Archer DC.Incisional complications are a common cause of morbidity following laparotomy. Although uncommon, acute abdominal dehiscence (AAD) is a potentially fatal post-operative complication. However, few AAD cases are described in the literature. Objective: To describe common features of cases of AAD following ventral midline laparotomy, management and outcomes. Methods: Retrospective case series. Methods: Hospital records of horses that underwent a ventral midline laparotomy at nine hospitals in the UK, Ireland and USA over a 10-year period (2009-2019) were reviewed. Data were collected for pre-, int...
Outcomes following single, caudally based bilateral versus unilateral frontonasal sinusotomy for treatment of equine paranasal sinus disease.
Veterinary medicine and science    August 17, 2021   Volume 7, Issue 6 2209-2218 doi: 10.1002/vms3.607
Pezzanite LM, Hackett ES, McCready E, Easley JT.Bilateral sinus disease is relatively uncommon in horses, accounting for 3%-4.5% of horses with sinonasal disease, but may require bilateral paranasal surgery for complete resolution. Complications and recurrence following bilateral sinusotomy have not been reported or compared to those following unilateral procedures. To describe clinical features and outcomes in horses undergoing standing single, caudally based bilateral frontonasal sinusotomy compared to unilateral frontonasal surgery. Records of horses (n = 37) undergoing surgical treatment for sinus disease (five bilateral, 32 unilatera...
Mycobacterial Cell Wall Stimulant in the Treatment of Squamous Cell Carcinoma: A Case Series Regarding Treatment in Equine, Bovine and Caprine Patients.
Frontiers in veterinary science    August 5, 2021   Volume 8 635800 doi: 10.3389/fvets.2021.635800
Halleran J, Yau K, Paegelow J, Streeter R, Foster D.Squamous cell carcinoma (SCC) is a common dermatological neoplasia found in large animal species. Treatment options, such as surgery and cryotherapy may be difficult or not feasible. Alternative therapies, such as immunomodulating drugs, can potentially be used for companion large animals. The hypothesis of the following retrospective study is: following multiple intravenous and intralesional injections of a mycobacterial cell wall stimulant (MCW) regression of SCC in equine, bovine and caprine patients will be observed. In this observational-retrospective case series, patients included are 2 ...
Use of Tubo-Ovarian Ligation Via Colpotomy as A Potential Method for Sterilization in Mares.
Journal of equine veterinary science    June 11, 2021   Volume 104 103683 doi: 10.1016/j.jevs.2021.103683
Dini P, Weiland A, Boakari Y, Scoggin KE, Esteller-Vico A, Daels P, Ball BA.The goal of this study was to develop a safe, effective, and economical method for permanent sterilization of mares based upon tubo-ovarian ligation performed via colpotomy. In this study, we evaluated the application of a nylon cable tie (zip-tie) to the ovarian pedicle and oviduct of mares to induce ovarian ischemia and tubal ligation without removal of ovaries. Initially, efficiency of zip-ties on the ovarian pedicle was tested in vitro and in vivo. Based on the absence of leakage through the zip-tie ligated vessels in anatomic specimens, we confirmed the potential efficacy of the technique...
Removal of equine cryptorchid testes through an enlarged umbilical portal in dorsally recumbent horses after intra-abdominal laparoscopic castration.
Equine veterinary journal    June 10, 2021   doi: 10.1111/evj.13483
Finley CJ, Fischer AT.Laparoscopic removal of cryptorchid testes has been routinely reported through enlarged parainguinal incisions in dorsally recumbent horses. Outcomes following removal through an extended umbilical incision have not been previously reported. Objective: To describe the surgical technique of removing cryptorchid testes in dorsally recumbent horses through an enlarged umbilical portal after laparoscopic intra-abdominal castration. Methods: Retrospective case series. Methods: Medical records were reviewed for horses that underwent laparoscopic removal of unilateral or bilateral cryptorchid testes ...
Castration Complications: A Review of Castration Techniques and How to Manage Complications.
The Veterinary clinics of North America. Equine practice    June 9, 2021   Volume 37, Issue 2 259-273 doi: 10.1016/j.cveq.2021.04.002
Kilcoyne I, Spier SJ.Castration is one of the most common surgical procedures performed in equine practice. Open, closed, and semiclosed techniques are described for castration of horses, and the procedure may be performed in a standing, sedated animal or in a recumbent animal under general anesthesia. Although a relatively routine procedure, complications can occur, with reported complication rates ranging from 10.2% to 60%. Most complications are mild and resolve rapidly with appropriate treatment, but more serious or life-threatening complications can also occur. A thorough knowledge of male reproductive anatom...
Computed tomographic guidance for internal fixation of type II distal phalangeal fractures in 51 horses.
Equine veterinary journal    June 9, 2021   doi: 10.1111/evj.13481
Smanik LE, Stefanovski D, Reilly PT, Richardson DW.Type II distal phalanx (P3) fractures are a well-described cause of lameness in horses. Reports on outcome following internal fixation of type II P3 fractures are lacking, and with little emphasis on complications. Objective: To describe a technique for internal fixation of type II P3 fractures, and evaluate whether specific variables influenced post-operative complications or a horse's ability to return to work. Methods: Retrospective case series. Methods: Medical records of 51 horses with CT-guided internal fixation of type II P3 fractures were reviewed. Outcome data were acquired from race ...
Proximal interphalangeal locking compression plate for pastern arthrodesis in horses.
Equine veterinary journal    June 1, 2021   doi: 10.1111/evj.13476
Hicks RB, Glass KG, Watkins JP.Outcomes following proximal interphalangeal joint (PIPJ) arthrodesis by a variety of surgical methods are available. Reports detailing clinical outcomes following PIPJ arthrodesis utilising the proximal interphalangeal joint locking compression plate (PIP-LCP) and abaxial transarticular lag screws technique are limited. Objective: To report survival, radiographic and clinical outcomes following PIPJ arthrodesis with PIP-LCP and abaxial transarticular lag screw fixation. Methods: Retrospective case series. Methods: Medical records of all horses undergoing pastern arthrodesis from 2009 to 2018 w...
A Pilot Randomised Clinical Trial Comparing a Short-Term Perioperative Prophylaxis Regimen to a Long-Term Standard Protocol in Equine Colic Surgery.
Antibiotics (Basel, Switzerland)    May 16, 2021   Volume 10, Issue 5 doi: 10.3390/antibiotics10050587
Stöckle SD, Kannapin DA, Kauter AML, Lübke-Becker A, Walther B, Merle R, Gehlen H.For surgical interventions classified as clean or clean-contaminated, including laparotomy, guidelines in human and veterinary medicine recommend a short-term perioperative antibiotic prophylaxis (PAP). In equine colic surgery, however, PAP commonly exceeds 24 h. Objective: The aim of this study was to compare a single-shot to a 5-day lasting PAP considering surgical site infections (SSI) and other adverse effects probably associated with the particular antimicrobial regimen. Methods: The study was designed as a randomised non-inferiority pilot study including horses subjected to colic surgery...
Outcomes after cervical vertebral interbody fusion using an interbody fusion device and polyaxial pedicle screw and rod construct in 10 horses (2015-2019).
Equine veterinary journal    May 3, 2021   Volume 54, Issue 2 347-358 doi: 10.1111/evj.13449
Pezzanite LM, Easley JT, Bayless R, Aldrich E, Nelson BB, Seim HB, Nout-Lomas YS.Further development of surgical techniques for equine cervical stabilisation is necessary to make the procedure less technically demanding, reduce complications and improve outcomes. Objective: To describe clinical outcomes and owner reports in horses undergoing placement of an interbody fusion device and polyaxial pedicle screw and rod construct for cervical vertebral fusion in horses with cervical vertebral compressive myelopathy. Methods: Retrospective case series. Methods: Data were retrieved from medical records of 10 horses undergoing cervical vertebral fusion (2015-2019). Records were e...
Dynamic Changes in Microbiome Composition Following Mare’s Milk Intake for Prevention of Collateral Antibiotic Effect.
Frontiers in cellular and infection microbiology    April 21, 2021   Volume 11 622735 doi: 10.3389/fcimb.2021.622735
Kushugulova A, Löber U, Akpanova S, Rysbekov K, Kozhakhmetov S, Khassenbekova Z, Essex M, Nurgozhina A, Nurgaziyev M, Babenko D, Markó L....Probiotics and prebiotics are widely used for recovery of the human gut microbiome after antibiotic treatment. High antibiotic usage is especially common in children with developing microbiome. We hypothesized that dry Mare's milk, which is rich in biologically active substances without containing live bacteria, could be used as a prebiotic in promoting microbial diversity following antibiotic treatment in children. The present pilot study aims to determine the impacts of dry Mare's milk on the diversity of gut bacterial communities when administered during antibiotic treatment and throughout ...
Comparison of Mesh and Barbed Suture for Laparoscopic Nephrosplenic Space Ablation in Horses.
Animals : an open access journal from MDPI    April 12, 2021   Volume 11, Issue 4 doi: 10.3390/ani11041096
Gialletti R, Nannarone S, Gandini M, Cerullo A, Bertoletti A, Scilimati N, Giusto G.Nephrosplenic space (NSS) ablation has been demonstrated to be an effective technique for prevention of left dorsal displacement of the large colon and multiple laparoscopic techniques, among which ablation with mesh or with a barbed suture, have been proposed. Our objective was to compare two laparoscopic techniques for closure of the NSS in twenty-eight horses diagnosed with nephrosplenic entrapment. Medical records of horses that had laparoscopic NSS ablation in two referral centers between 2017-2019 were retrieved. Duration of surgery, complications, and short- and long-term follow-up info...
Subconjunctival enucleation with orbital implant placement in standing horses: 20 cases (2014-2017).
Journal of the American Veterinary Medical Association    March 9, 2021   Volume 258, Issue 6 661-667 doi: 10.2460/javma.258.6.661
Betbeze CM, Dray SM, Fontenot RL.To develop a protocol for subconjunctival enucleation and orbital implant placement in standing horses and to document short- and long-term complications, cosmesis, and client satisfaction. Methods: 20 horses with nonneoplastic ocular disease requiring enucleation. Methods: A standardized protocol of surgical suite cleaning, patient preparation, sedation, local nerve blocks, surgical procedure, and postoperative care was performed. Owners were required to provide follow-up information at 1 year after surgery during a phone questionnaire. Additionally, some owners provided follow-up information...
Single-Chamber Cardiac Pacemaker Implantation in a Donkey with Complete AV Block: A Long-Term Follow-Up.
Animals : an open access journal from MDPI    March 9, 2021   Volume 11, Issue 3 746 doi: 10.3390/ani11030746
Sedlinská M, Kabeš R, Novák M, Kološ F, Melková P.A five-month-old African jenny was presented with a history of exercise intolerance and syncopal episodes. Severe bradycardic arrhythmia due to a high-grade second-degree atrioventricular (AV) block with progression to complete AV block was diagnosed. The jenny underwent a transvenous single-chamber pacemaker implantation. The implantation procedure was performed in a lateral recumbency and the ventricular lead was inserted through the jugular vein. Positioning of the lead was guided by echocardiography. The pacemaker was programmed to VVI mode with a minimal ventricular rate of 40 pulses per ...
A retrospective multicenter study on the use of locking compression plates for scapulohumeral arthrodesis in small equids.
Veterinary surgery : VS    March 8, 2021   Volume 50, Issue 5 954-965 doi: 10.1111/vsu.13618
Somm F, Suárez Sánchez-Andrade J, Martens A, Zedler ST, Klopfenstein MD, Boswell JC, Bladon BM, Lischer CJ, Richardson DW, Auer JA, Fürst AE....To report on technical aspects and outcomes after scapulohumeral arthrodesis (SHA) with a locking compression plate (LCP) in small equids. Methods: Retrospective multicenter case series. Methods: Client-owned Shetland Ponies, Miniature Shetlands, and American Miniature Horses (n = 15). Methods: Inclusion criteria were completed SHA with an LCP to treat scapulohumeral osteoarthritis/subluxation and availability of postoperative radiographs. Contributing surgeons completed a questionnaire to collect data. All radiographs were reviewed for this study. Follow-up information was obtained via re-a...
Complications following equine sacroiliac region analgesia are uncommon: A study in 118 horses.
PloS one    March 2, 2021   Volume 16, Issue 3 e0247781 doi: 10.1371/journal.pone.0247781
Offord SCJ, Read RM, Pudney CJ, Bathe AP.Diagnosis of sacroiliac region pain is supported by a positive response to sacroiliac region analgesia (SIRA). Varying techniques have been described for SIRA; with clinician preference often dictating method. Potential complications following SIRA include ataxia and recumbency. No study has specifically evaluated the prevalence of complications. To describe the complication prevalence following SIRA in a referral clinic. Retrospective cohort study. Review of records from horses presented to two of the authors at Rossdales, Newmarket, between January 2014 and December 2018, that underwent SIRA...
Transendoscopic Ventriculocordectomy Using Monopolar Electrosurgical Instrumentation for Conjunctive Treatment of Laryngeal Hemiplegia in Horses: 24 Cases (2017-2019).
Frontiers in veterinary science    March 1, 2021   Volume 8 628410 doi: 10.3389/fvets.2021.628410
Caspers MK, Bell CD, Tatarniuk DM.Objective: The objective of this study is to evaluate the safety, efficacy, and owner satisfaction following electrosurgical ventriculocordectomy (EVC), in conjunction with prosthetic laryngoplasty, in equine clinical cases affected with left- or right-sided recurrent laryngeal neuropathy. Methods: Retrospective data analysis of clinical signalment, surgery, athletic outcome, intra- and postoperative complications, and postoperative examinations from clinical cases wherein EVC was performed in conjunction with traditional prosthetic laryngoplasty from one practice. Owners were contacted by pho...
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