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Topic:Diagnostic Technique

Diagnostic techniques in equine medicine encompass a range of procedures and tools used to identify diseases, injuries, or other health conditions in horses. These techniques include imaging methods such as radiography, ultrasonography, and magnetic resonance imaging (MRI), as well as laboratory tests like blood work and tissue biopsies. Each diagnostic method provides specific information that can aid in the assessment and management of equine health issues. Radiography is commonly used for evaluating bone structures, while ultrasonography is useful for soft tissue examination. MRI offers detailed images of both soft and hard tissues, though its use is limited by cost and availability. Laboratory tests can detect biochemical and hematological changes indicative of disease. This page compiles peer-reviewed research studies and scholarly articles that explore the development, application, and efficacy of various diagnostic techniques in equine veterinary practice.
[Clinical evaluation of the new coat colour macchiato in a male Franches-Montagnes horse].
Schweizer Archiv fur Tierheilkunde    March 28, 2013   Volume 155, Issue 4 229-232 doi: 10.1024/0036-7281/a000451
Blatter M, Haase B, Gerber V, Poncet PA, Leeb T, Rieder S, Henke D, Janett F, Burger D.In April 2008 a Franches-Montagnes colt was born with an unusual coat colour phenotype which had never been observed in that population before. The foal showed extended white markings on body and legs, a white head and blue eyes. As both parents have an unremarkable bay coat colour phenotype, a de novo mutation was expected in the offspring and a candidate gene approach revealed a spontaneous mutation in the microphthalmia associated transcription factor gene (MITF). A detailed clinical examination in 2010 indicated an impaired hearing capacity. As in the American Paint Horse large white facia...
Equine laparoscopy: gonadectomy.
Compendium (Yardley, PA)    March 28, 2013   Volume 35, Issue 2 E4 
Caron JP.Laparoscopic removal of the gonads from male and female horses is regularly performed for a variety of reasons. In female horses, common indications for ovariectomy include behavioral problems and signs of abdominal pain that are linked to estrus. Another indication is an abnormal, enlarged ovary, typically due to ovarian neoplasia, the most common being granulosa thecal cell tumor. Ovariectomy is also a treatment option for ovarian hematomas and other abnormalities. In addition, ovariectomy is used to sterilize mares intended for artificial insemination or embryo transfer programs.
Is a diagnostic system based exclusively on agar gel immunodiffusion adequate for controlling the spread of equine infectious anaemia?
Veterinary microbiology    March 28, 2013   Volume 165, Issue 1-2 123-134 doi: 10.1016/j.vetmic.2013.02.027
Scicluna MT, Issel CJ, Cook FR, Manna G, Cersini A, Rosone F, Frontoso R, Caprioli A, Antognetti V, Autorino GL.To improve the efficiency of the National equine infectious anaemia (EIA) surveillance program in Italy, a three-tiered diagnostic system has been adopted. This procedure involves initial screening by ELISA (Tier 1) with test-positive samples confirmed by the agar gel immunodiffusion test (AGIDT) (Tier 2) and, in the case of ELISA positive/AGIDT negative results, final determination by immunoblot (IB) (Tier 3). During this evaluation, 74,880 samples, principally collected from two Regions of Central Italy (Latium and Abruzzo) were examined, with 44 identified as negative in AGIDT but positive ...
A real-time impedance based method to assess Rhodococcus equi virulence.
PloS one    March 28, 2013   Volume 8, Issue 3 e60612 doi: 10.1371/journal.pone.0060612
Miranda-CasoLuengo AA, Miranda-CasoLuengo R, Lieggi NT, Luo H, Simpson JC, Meijer WG.Rhodococcus equi is a facultative intracellular pathogen of macrophages and the causative agent of foal pneumonia. R. equi virulence is usually assessed by analyzing intracellular growth in macrophages by enumeration of bacteria following cell lysis, which is time consuming and does not allow for a high throughput analysis. This paper describes the use of an impedance based real-time method to characterize proliferation of R. equi in macrophages, using virulent and attenuated strains lacking the vapA gene or virulence plasmid. Image analysis suggested that the time-dependent cell response prof...
Repertoire of Theileria equi immunodominant antigens bound by equine antibody.
Molecular and biochemical parasitology    March 26, 2013   Volume 188, Issue 2 109-115 doi: 10.1016/j.molbiopara.2013.03.002
Silva MG, Graça T, Suarez CE, Knowles DP.Theileriosis in horses and cattle is caused by tick-borne Apicomplexa parasites and results in death or life-long infection in their respective hosts. Transmission risk associated with persistent infection severely limits movement of horses and cattle resulting in economic losses. The recent reemergence of Theileria equi infection in U.S. horses demonstrates the continual threat Apicomplexa parasites represent to global animal health. A paucity of data concerning equine immune responses to T. equi, including antigens recognized by antibodies in clinically asymptomatic, persistently infected ho...
Effect of breed, sex, age and body weight on echocardiographic measurements in the equine species.
Research in veterinary science    March 26, 2013   Volume 95, Issue 1 255-260 doi: 10.1016/j.rvsc.2013.02.014
Al-Haidar A, Farnir F, Deleuze S, Sandersen CF, Leroux AA, Borde L, Cerri S, Amory H.Little is known about the effect of various animal's signalment variables on echocardiographic reference values in the equine species. This study was performed to evaluate the effect of sex, breed, age and body weight (BW) on echocardiographic measurements in the equine species. Echocardiography was performed on 212 ponies or horses of various breeds, aged from 1 day to 37 years old (mean±SD: 7.8 ± 5.8 years), BW 38-890 kg (mean ± SD: 421 ± 133 kg), and free of cardiac disease. Fifty of those animals aged from 2 months to 35 years old (mean ± SD: 11.6 ± 6.4 years old); BW 77-662 kg (mean...
Comparison of sampling sites and laboratory diagnostic tests for S. equi subsp. equi in horses from confirmed strangles outbreaks.
Journal of veterinary internal medicine    March 25, 2013   Volume 27, Issue 3 542-547 doi: 10.1111/jvim.12063
Lindahl S, Båverud V, Egenvall A, Aspán A, Pringle J.Strangles is a contagious equine-specific disease caused by Streptococcus equi subsp. equi. Unfortunately, detection of S. equi can fail in up to 40% of horses with strangles. Whereas recent molecular biologic methods and sampling techniques have improved recovery of S. equi optimal sampling methods and laboratory analyses remain ill-defined. Objective: To determine the yield of S. equi from horses with acute strangles in confirmed outbreaks by field-sampling methods subjected to culture and biochemical identification, and real-time PCR directly and after culture. Methods: Fifty-seven horses o...
Seasonal and annual influence on insulin and cortisol results from overnight dexamethasone suppression tests in normal ponies and ponies predisposed to laminitis.
Equine veterinary journal    March 24, 2013   Volume 45, Issue 6 688-693 doi: 10.1111/evj.12053
Borer-Weir KE, Menzies-Gow NJ, Bailey SR, Harris PA, Elliott J.A simple, accurate test for identifying individual animals at increased risk of laminitis would aid prevention. Laminitis-prone ponies have a greater serum insulin response to dexamethasone administration than normal ponies in the summer, but the response during different seasons is unknown. Objective: To test the hypothesis that previously laminitic ponies have a greater insulin response to dexamethasone than normal ponies, which is present during all seasons. Methods: Prospective longitudinal study. Methods: Overnight dexamethasone suppression tests were performed on 7 normal ponies and 5 pr...
Uterine bacterial isolates from mares and their resistance to antimicrobials: 8,296 cases (2003-2008).
Journal of the American Veterinary Medical Association    March 23, 2013   Volume 242, Issue 7 977-983 doi: 10.2460/javma.242.7.977
Davis HA, Stanton MB, Thungrat K, Boothe DM.To describe bacteria isolated from reproductive tracts of mares and to examine the extent and patterns of resistance to antimicrobials commonly used for treatment of endometritis. Methods: Retrospective case series. Methods: 8,296 uterine swab, lavage, or biopsy samples obtained between January 2003 and December 2008 from 7,665 horses in central Florida. Methods: Results of bacterial culture and antimicrobial susceptibility testing were obtained for uterine swab, lavage, and biopsy samples collected from mares undergoing a routine breeding examination or examined because of a reproductive diso...
Fragmentation of the proximal tubercle of the talus in horses: 9 cases (2004-2010).
Journal of the American Veterinary Medical Association    March 23, 2013   Volume 242, Issue 7 984-991 doi: 10.2460/javma.242.7.984
Espinosa P, Lacourt M, Alexander K, David F, Laverty S.To identify the prevalence of fragmentation of the proximal tubercle of the talus (FPTT) in a hospital population of horses, characterize the anatomic features of the affected area and fragments, and describe clinical findings, diagnosis, treatment, and outcome for horses with FPTT. Methods: Retrospective case series. Methods: 9 horses with FPTT. Methods: 2,543 radiographic views of the tarsal region of 1,526 horses that were evaluated between June 2004 and December 2010 were reviewed. Medical case records for horses with detectable FPTT were retrieved, and signalment, history, clinical signs,...
Detection of two equine trisomies using SNP-CGH.
Mammalian genome : official journal of the International Mammalian Genome Society    March 21, 2013   Volume 24, Issue 5-6 252-256 doi: 10.1007/s00335-013-9450-6
Holl HM, Lear TL, Nolen-Walston RD, Slack J, Brooks SA.Chromosomal aberrations in the horse are known to cause congenital abnormalities, embryonic loss, and infertility. While diagnosed mainly by karyotyping and FISH in the horse, the use of SNP array comparative genome hybridization (SNP-CGH) is becoming increasingly common in human diagnostics. Normalized probe intensities and allelic ratios are used to detect changes in copy number genome-wide. Two horses with suspected chromosomal abnormalities and six horses with FISH-confirmed aberrant karyotypes were chosen for genotyping on the Equine SNP50 array. Karyotyping of the first horse indicated m...
Comparison of dynamic and resting endoscopy of the upper portion of the respiratory tract in 57 Thoroughbred yearlings.
Equine veterinary journal    March 21, 2013   Volume 45, Issue 6 700-704 doi: 10.1111/evj.12061
Kelly PG, Reardon RJ, Johnston MS, Pollock PJ.Endoscopic examination of Thoroughbred (TB) yearlings is performed routinely to determine the suitability of horses for racing and to ensure that the conditions of sale are satisfied. However, previous research has demonstrated that resting endoscopic examination can be inaccurate in the diagnosis of functional pathology of the upper portion of the respiratory tract (URT). Objective: To investigate the feasibility of performing dynamic overground endoscopy in a group of TB yearlings and to compare the results of resting and dynamic endoscopic examination of the URT. Methods: Prospective cohort...
Indirect fluorescent antibody test and surface antigen ELISAs for antemortem diagnosis of equine protozoal myeloencephalitis.
Journal of veterinary internal medicine    March 20, 2013   Volume 27, Issue 3 596-599 doi: 10.1111/jvim.12061
Johnson AL, Morrow JK, Sweeney RW.Recent research suggests that serum : CSF titer ratios could provide the most accurate antemortem diagnosis of equine protozoal myeloencephalitis (EPM) caused by Sarcocystis neurona. Objective: The purpose of this study was to assess the utility of two commercially available tests, the indirect fluorescent antibody test (IFAT) and the surface antigen 2, 4/3 ELISA (SAG2, 4/3 ELISA), using archived paired serum and CSF samples. Methods: Samples were obtained from 4 types of clinical patients. Confirmed positive cases (n = 9 horses; 11 sample sets) had neurologic deficits and postmortem lesions c...
Cloning and expression of candidate allergens from Culicoides obsoletus for diagnosis of insect bite hypersensitivity in horses.
Veterinary immunology and immunopathology    March 19, 2013   Volume 153, Issue 3-4 227-239 doi: 10.1016/j.vetimm.2013.03.005
van der Meide NM, Roders N, Sloet van Oldruitenborgh-Oosterbaan MM, Schaap PJ, van Oers MM, Leibold W, Savelkoul HF, Tijhaar E.Insect bite hypersensitivity (IBH) is an IgE-mediated (Type I) hypersensitivity reaction induced by allergens from biting midges of the Culicoides spp. The aim of the present study was to identify, clone and express recombinant allergens from C. obsoletus, the main species found feeding on horses in the Netherlands, by sequence homology searches on the C. obsoletus specific RNA database, with previously described allergens from C. nubeculosus and C. sonorensis. BLAST searches with these described allergens resulted in similarity hits with 7 genes coding for C. obsoletus allergens. These allerg...
Four novel papillomavirus sequences support a broad diversity among equine papillomaviruses.
The Journal of general virology    March 13, 2013   Volume 94, Issue Pt 6 1365-1372 doi: 10.1099/vir.0.052092-0
Lange CE, Vetsch E, Ackermann M, Favrot C, Tobler K.Papillomaviruses appear to be species-specific pathogens, and it was suggested that each animal species might harbour its own set of papillomaviruses. However, all approaches addressing the underlying evolutionary phenomena still suffer from very limited data about animal papillomaviruses. In case of the horse for example, only three equine papillomaviruses (EcPVs) have been identified. To further address the situation in this host, suspected papillomavirus-associated lesions were tested for EcPV DNA. Four novel EcPV types were detected and their genomes entirely cloned and sequenced. They dis...
Development and validation of an equine nerve block simulator to supplement practical skills training in undergraduate veterinary students.
The Veterinary record    March 13, 2013   Volume 172, Issue 17 450 doi: 10.1136/vr.101335
Gunning P, Smith A, Fox V, Bolt DM, Lowe J, Sinclair C, Witte TH, Weller R.Lameness is the most common presenting complaint in equine practice. Performing diagnostic nerve blocks is an integral part of any lameness work-up, and is therefore an essential skill for equine practitioners. However, the opportunities for veterinary students to practice this skill are limited. The aim of this study was to design and validate an equine nerve block simulator. It was hypothesised that the simulator would improve students' ability and enhance their confidence in performing nerve blocks. A simulator was built using an equine forelimb skeleton and building foam. Wire wool targets...
Venezuelan equine encephalitis replicon particles can induce rapid protection against foot-and-mouth disease virus.
Journal of virology    March 6, 2013   Volume 87, Issue 10 5447-5460 doi: 10.1128/JVI.03462-12
Diaz-San Segundo F, Dias CC, Moraes MP, Weiss M, Perez-Martin E, Owens G, Custer M, Kamrud K, de los Santos T, Grubman MJ.We have previously shown that delivery of the porcine type I interferon gene (poIFN-α/β) with a replication-defective human adenovirus vector (adenovirus 5 [Ad5]) can sterilely protect swine challenged with foot-and-mouth disease virus (FMDV) 1 day later. However, the need of relatively high doses of Ad5 limits the applicability of such a control strategy in the livestock industry. Venezuelan equine encephalitis virus (VEE) empty replicon particles (VRPs) can induce rapid protection of mice against either homologous or, in some cases, heterologous virus challenge. As an alternative approach ...
Detection of Theileria equi and Babesia caballi infections in Venezuelan horses using Competitive-Inhibition ELISA and PCR.
Veterinary parasitology    March 5, 2013   Volume 196, Issue 1-2 37-43 doi: 10.1016/j.vetpar.2013.02.004
Rosales R, Rangel-Rivas A, Escalona A, Jordan LS, Gonzatti MI, Aso PM, Perrone T, Silva-Iturriza A, Mijares A.The focus of this study was the detection of equine piroplasmosis in Distrito Capital, Miranda, Aragua, Guárico and Apure States from Venezuela, using two methods: Competitive-Inhibition ELISA and multiplex PCR and the analysis of the possible differences in occurrence in relation to the primary purpose of the horses, which is related to varied degrees of exposure to tick. Antibody levels to Babesia caballi and Theileria equi were assessed in 694 equine serum samples using Competitive-Inhibition ELISA, while PCR assays were performed in 136 horses, using two sets of oligonucleotides to establ...
Retrospective study investigating causes of abnormal respiratory noise in horses following prosthetic laryngoplasty.
Equine veterinary journal. Supplement    March 2, 2013   Issue 43 27-30 doi: 10.1111/j.2042-3306.2012.00612.x
Compostella F, Tremaine WH, Franklin SH.To investigate causes of respiratory noises in horses following prosthetic laryngoplasty (with or without a ventriculocordectomy) and to examine potential associations between degree of arytenoid abduction and the presence of other upper respiratory tract (URT) abnormalities, including right-sided collapse. Methods: Clinical records and dynamic videoendoscopic recordings were examined from horses presented between 1995 and 2010 for investigation of respiratory noise during exercise, following a prosthetic laryngoplasty (+/- a ventriculocordectomy). Relationships between the degree of left aryt...
Use of a wireless, inertial sensor-based system to objectively evaluate flexion tests in the horse.
Equine veterinary journal. Supplement    March 2, 2013   Issue 43 8-11 doi: 10.1111/j.2042-3306.2012.00611.x
Marshall JF, Lund DG, Voute LC.A wireless, inertial sensor-based system has previously been validated for evaluation of equine lameness. However, threshold values have not been determined for the assessment of responses to flexion tests. The aim of this investigation was to evaluate a sensor-based system for objective assessment of the response to flexion. Methods: Healthy adult horses (n = 17) in work were recruited prospectively. Horses were instrumented with sensors on the head (accelerometer), pelvis (accelerometer) and right forelimb (gyroscope), before trotting in a straight line (minimum 25 strides) for 2 consecutive...
Magnetic resonance and radiographic diagnosis of osseous resorption of the flexor surface of the distal phalanx in the horse.
Equine veterinary journal. Supplement    March 2, 2013   Issue 43 3-7 doi: 10.1111/j.2042-3306.2012.00675.x
Young AC, Dimock AN, Puchalski SM, Murphy B, Spriet M.Osseous resorption of the flexor surface of the distal phalanx of the horse has been identified previously using magnetic resonance (MR) imaging; however, little is known about the prevalence and characteristics of this lesion. Objective: To establish the MR prevalence of resorptive lesions in the flexor surface of the distal phalanx and identify concurrent lesions associated with this finding and associations between the MR and radiographic findings. Methods: Horses with distal extremity MR and radiographs performed within 2 weeks of each other were included in the study. The flexor surface o...
Effect of sample handling and storage time on the stability of total CO2 in equine plasma.
Equine veterinary journal. Supplement    March 2, 2013   Issue 43 57-61 doi: 10.1111/j.2042-3306.2012.00610.x
Tinkler SH, Couëtil LL, Constable PD.The stability of total CO2 concentration (ctCO2) in plasma is influenced by storage temperature and handling during sample processing. Conflicting information exists regarding the stability of ctCO2 in equine plasma over time, and the effect of centrifugation on the measured value for plasma ctCO2 is unclear. Objective: To determine plasma ctCO2 stability over 5 days when equine blood is collected into Vacutainer tubes, centrifuged within 30 min of collection, and stored at 4 degrees C; and to determine whether a delay in centrifugation increases the rate at which plasma ctCO2 decreases over t...
Effects of repeated transvaginal aspiration of immature follicles on mare health and ovarian status.
Equine veterinary journal. Supplement    March 2, 2013   Issue 43 78-83 doi: 10.1111/j.2042-3306.2012.00606.x
Velez IC, Arnold C, Jacobson CC, Norris JD, Choi YH, Edwards JF, Hayden SS, Hinrichs K.Transvaginal ultrasound-guided follicle aspiration (TVA) is performed clinically but there is little information available on complications associated with this procedure. Objective: It is possible that TVA is associated with damage to the ovary and may induce peritonitis or peritoneal adhesions. This study was conducted to determine the effect of repeated TVA on mare health and ovarian status. Methods: Thirty-two mares were used for oocyte recovery via repeated TVA over a 3 year period; different mares were used each year. In Year 1, ovarian status was monitored in 11 mares by transrectal pal...
B-mode and Doppler ultrasonography in pony mares with experimentally induced ascending placentitis.
Equine veterinary journal. Supplement    March 2, 2013   Issue 43 88-94 doi: 10.1111/j.2042-3306.2012.00658.x
Bailey CS, Heitzman JM, Buchanan CN, Bare CA, Sper RB, Borst LB, Macpherson M, Archibald K, Whitacre M.Early, accurate diagnosis of ascending placentitis in mares remains a key challenge for successful treatment of the disease. Doppler ultrasonography has shown promise as a tool to diagnose pregnancy abnormalities and is becoming more available to equine clinicians. However, to date, no studies have prospectively compared this technique to standard B-mode measurement of the combined thickness of the uterus and placenta (CTUP). Objective: The objective of the current study was to compare Doppler and B-mode ultrasonography for the detection of experimentally-induced ascending placentitis in mares...
Influence of head and neck position on radiographic measurement of intervertebral distances between thoracic dorsal spinous processes in clinically sound horses.
Equine veterinary journal. Supplement    March 2, 2013   Issue 43 21-26 doi: 10.1111/j.2042-3306.2012.00678.x
Berner D, Winter K, Brehm W, Gerlach K.Reductions in distances between dorsal spinous processes on radiographs are used as criteria for the diagnosis of impingement of the thoracic dorsal spinous processes in horses but are potentially altered by spine motion and different head and neck positions. Objective: To determine the influence of head and neck positions on intervertebral distances between dorsal spinous processes on radiographs of thoracic spines of clinically sound horses. Methods: Lateral-lateral radiographs were obtained from 23 horses in 3 head and neck positions. The width of the thoracic dorsal spinous processes and i...
Detection of anti-Toxoplasma gondii antibodies in carthorses in the metropolitan region of Curitiba, Paraná, Brazil. Finger MA, Villalobos EM, Lara Mdo C, Cunha EM, Barros Filho IR, Deconto I, Dornbusch PT, Ullmann LS, Biondo AW.Toxoplasma gondii, the agent for toxoplasmosis, has worldwide distribution. Horses normally play a secondary role in its life cycle, but movement around urban areas, feeding on grass and the increasing use of carthorses for gathering recyclable material in some urban areas of Brazil may increase their exposure to T. gondii infection. The aim of the present study was to investigate the frequency of anti-T. gondii antibodies in carthorses in the metropolitan region of Curitiba, PR. IgG antibodies against T. gondii were detected using the indirect fluorescence antibody test (IFAT) (titers ≥ 64)...
Combining two serological assays optimises sensitivity and specificity for the identification of Streptococcus equi subsp. equi exposure.
Veterinary journal (London, England : 1997)    March 1, 2013   Volume 197, Issue 2 188-191 doi: 10.1016/j.tvjl.2013.01.033
Robinson C, Steward KF, Potts N, Barker C, Hammond TA, Pierce K, Gunnarsson E, Svansson V, Slater J, Newton JR, Waller AS.The detection of anti-Streptococcus equi antibodies in the blood serum of horses can assist with the identification of apparently healthy persistently infected carriers and the prevention of strangles outbreaks. The aim of the current study was to use genome sequencing data to develop an indirect enzyme linked immunosorbent assay (iELISA) that targets two S. equi-specific protein fragments. The sensitivity and specificity of the antigen A and antigen C iELISAs were compared to an SeM-based iELISA marketed by IDvet - diagnostic Vétérinaire (IDvet). Individually, each assay compromised specifi...
Evaluation of a point-of-care portable analyzer for measurement of plasma immunoglobulin G, total protein, and albumin concentrations in ill neonatal foals.
Journal of the American Veterinary Medical Association    March 1, 2013   Volume 242, Issue 6 812-819 doi: 10.2460/javma.242.6.812
Wong DM, Giguère S, Wendel MA.To compare the diagnostic performance of a point-of-care (POC) analyzer with that of established methods for the measurement of plasma IgG, total protein, and albumin concentrations in neonatal foals. Methods: Evaluation study. Methods: 100 neonatal foals < 7 days of age. Procedures-Plasma IgG, total protein, and albumin concentrations were measured with a POC analyzer via an immunoturbidimetric method. Corresponding measurements of plasma IgG, total protein, and albumin concentrations were measured by means of automated biochemical analyzers via automated immunoturbidimetric, biuret, and b...
Comparison of efficacy and duration of effect on corneal sensitivity among anesthetic agents following ocular administration in clinically normal horses.
American journal of veterinary research    February 27, 2013   Volume 74, Issue 3 459-464 doi: 10.2460/ajvr.74.3.459
Pucket JD, Allbaugh RA, Rankin AJ, Ou Z, Bello NM.To compare efficacy and duration of effect on corneal sensitivity of 0.5% proparacaine hydrochloride, 0.5% bupivacaine hydrochloride, 2% lidocaine hydrochloride, and 2% mepivacaine hydrochloride solutions following ocular administration in clinically normal horses. Methods: 68 clinically normal horses. Methods: 60 horses were assigned to receive 1 anesthetic agent in 1 eye. For each of another 8 horses, 1 eye was treated with each of the anesthetic agents in random order with a 1-week washout period between treatments. Corneal sensitivity was assessed via corneal touch threshold (CTT) measurem...
Progressive control of equine infectious anaemia through more accurate diagnosis.
The Veterinary record    February 26, 2013   Volume 172, Issue 8 208-209 doi: 10.1136/vr.f1131
Maanen Cv.No abstract available