Disease etiology in horses refers to the study of the causes and development of diseases within equine populations. It encompasses various factors, including genetic predisposition, environmental influences, infectious agents, and nutritional imbalances, that contribute to the onset and progression of diseases in horses. Understanding disease etiology is essential for identifying risk factors and implementing preventative measures in equine health management. This topic includes research on pathogen-host interactions, the impact of management practices on disease incidence, and the role of genetic and environmental factors in disease susceptibility. This page compiles peer-reviewed research studies and scholarly articles that explore the mechanisms, contributing factors, and implications of disease etiology in horses.
Bogaert L, Martens A, De Baere C, Gasthuys F.The purpose of the present study was to examine whether bovine papillomavirus (BPV) DNA can be detected on the normal skin and in the habitual surroundings of horses with and without equine sarcoids by means of superficially taken swabs. In affected horses, no significant difference in presence of BPV-DNA could be observed between samples obtained from the equine sarcoid surface, from normal skin close to the tumour and from a normal skin site in direct contact with the tumour. From the group of healthy horses living in contact with affected horses, 44% were BPV-DNA positive. The surroundings ...
Perkins NR, Reid SW, Morris RS.To describe and enumerate conditions that interrupted training and racing in a population of Thoroughbred racehorses in New Zealand. Methods: A longitudinal study design was used to collect data on horses training under the care of 20 licensed racehorse trainers from venues in the mid to lower regions of the North Island between October 1997 and July 2000. Incidence rates were reported for first and second occurrences for different categories of musculoskeletal injury (MSI), and first occurrences of upper and lower respiratory tract disease, using training days as time-at-risk. The proportion ...
Ward MP, Brady TH, Couëtil LL, Liljebjelke K, Maurer JJ, Wu CC.An outbreak of salmonellosis in a population of hospitalized horses resulted in the closure of a teaching hospital for a period of 10 weeks. Fecal samples were collected from suspected cases and cultured for Salmonella. Salmonella isolates were characterized using antimicrobial susceptibility testing, pulsed-field gel electrophoresis (PFGE) and phage typing. Thirty-three cases of infection by a multidrug-resistant strain of S. typhimurium were detected. The index case was admitted on 26 August 1999. Fifteen (45%) cases occurred between April and June 2000. PFGE results suggested that this stra...
Sánchez A, Couëtil LL, Ward MP, Clark SP.Inflammatory Airway Disease (IAD), exercise-induced pulmonary hemorrhage (EIPH), and upper airway obstruction (UAO) are common respiratory tract diseases that can decrease performance. The purpose of this retrospective study was to compare bronchoalveolar lavage fluid cytology and arterial blood gas analysis during a treadmill test by poorly performing racehorses presented to Purdue University. One hundred thirty-two horses with a history of poor performance were included in this study. Ten horses with no history or diagnosis of EIPH, IAD, or UAO served as controls. Horses were evaluated by rh...
Saville WJ, Dubey JP, Oglesbee MJ, Sofaly CD, Marsh AE, Elitsur E, Vianna MC, Lindsay DS, Reed SM.Sarcocystis neurona and Sarcocystis fayeri infections are common in horses in the Americas. Their antemortem diagnosis is important because the former causes a neurological disorder in horses, whereas the latter is considered nonpathogenic. There is a concern that equine antibodies to S. fayeri might react with S. neurona antigens in diagnostic tests. In this study, 4 ponies without demonstrable serum antibodies to S. neurona by Western immunoblot were used. Three ponies were fed 1 x 10(5) to 1 x 10(7) sporocysts of S. fayeri obtained from dogs that were fed naturally infected horse muscles. A...
Saulez MN, Cebra CK, Heidel JR, Walker RD, Singh R, Bird KE.A 17-year-old gelding was evaluated because of dysuria, inappetence, and weight loss. Cystoscopy revealed severe mucosal ecchymoses with luminal hemorrhage and accumulations of crystalloid sludge. Analysis of a urine sample revealed isosthenuria, an alkaline pH, pyuria, hematuria, bacteriuria, and numerous calcium carbonate crystals. Histologic examination of bladder mucosa biopsy specimens revealed severe neutrophilic infiltration with mineralization. A diagnosis of encrusted cystitis exacerbated by sabulous urolithiasis was made. A Corynebacterium sp susceptible to penicillin, sulfonamide, a...
Bradbury LA, Archer DC, Dugdale AH, Senior JM, Edwards GB.A horse which had had a caecal impaction for 10 days was treated by means of an ileocolostomy [corrected] but failed to respond satisfactorily. Before a second laparotomy was performed it was observed to have dislodged the extension set from a jugular catheter and air was heard being sucked into the vein. It became very agitated but was anaesthetised again and the impaction was removed through an incision in the apex of the colon [corrected] After recovering from the anaesthesia it developed severe signs of pruritus which subsided only after 12 hours. These signs were considered most likely to...
Janicek JC, Dabareiner RM, Honnas CM, Crabill MA.To determine clinical history, structures involved, treatment, and outcome of lacerations of the heel bulb and proximal phalangeal region (pastern) in horses. Methods: Retrospective study. Methods: 101 horses. Methods: Medical records of horses with lacerations of the heel bulb and pastern were reviewed, and follow-up information was obtained. Results: 75 horses were Quarter Horses. Most horses were not treated with antimicrobial drugs prior to referral. Mean +/- SD time from injury to referral was 24 +/- 45 hours (range, 1 to 168 hours). Lacerations were most frequently caused by contact with...
Benninger MI, Deiss E, Ueltschi G.We describe the clinical findings and radiographic abnormalities of a horse with a bipartite distal phalanx and a bipartite navicular bone of the right forelimb. Associated findings including suspected keratoma and degenerative joint disease of the distal interphalangeal joint are described and possible etiologies are discussed.
Little CB, Flannery CR, Hughes CE, Goodship A, Caterson B.To determine whether the focal susceptibility to cartilage degeneration in joints is related to a differential response to cytokine stimulation. Methods: Compare aggrecan and collagen catabolism in in-vitro models of cartilage degradation induced by retinoic acid (RA), interleukin-1 (IL-1), tumor necrosis factor alpha (TNF) and IL-1 plus oncostatin M (OSM). Glycosaminoglycan (GAG) and hydroxyproline (HyPro) quantification and Western immunoblot analyses of aggrecan and collagen degradation products were undertaken in explant cultures of normal cartilage from regions of equine joints with a kno...
Benders NA, Dyer J, Wijnberg ID, Shirazi-Beechey SP, van der Kolk JH.To confirm whether the plasma glucose concentration curve obtained during oral glucose tolerance tests (OGTTs) in horses with equine motor neuron disease (EMND) is decreased, compared with that obtained in clinically normal horses, and determine whether that decrease is a result of defective glucose metabolism or intestinal glucose transport dysfunction. Methods: 8 horses with EMND and 44 matched control horses. Methods: Electromyography and OGTTs were performed in all 8 affected horses and 10 control horses. Intravenous GTTs (IVGTTs) were performed in 6 affected horses and another 11 control ...
Bolin DC, Donahue JM, Vickers ML, Harrison L, Sells S, Giles RC, Hong CB, Poonacha KB, Roberts J, Sebastian MM, Swerczek TW, Tramontin R, Williams NM.During the spring and summer of 2001 and in association with the mare reproductive loss syndrome, 22 terminal and 12 clinical cases of equine pericarditis were diagnosed in central Kentucky. Actinobacillus species were the principal isolates from 8 of 10 nontreated, terminally affected and 3 of 10 clinically affected horses. Enterococcus faecalis and Streptococcus zooepidemicus were cultured from the remaining 2 nontreated terminal cases. No viruses were isolated in tissue culture. Nucleic acid of equine herpesvirus-2 was detected in pericardial and tracheal wash fluids of 3 and 1 individuals,...
Thompson JA, Brown SE, Riddle WT, Seahorn JC, Cohen ND.To estimate spatial risks associated with mare reproductive loss syndrome (MRLS) during 2001 among horses in a specific study population and partition the herd effects into those attributable to herd location and those that were spatially random and likely attributable to herd management. Animals-Pregnant broodmares from 62 farms in 7 counties in central Kentucky. Methods: Veterinarians provided the 2001 abortion incidence proportions for each farm included in the study. Farms were georeferenced and data were analyzed by use of a fully Bayesian risk-mapping technique. Results: Large farm-to-fa...
Schlacher C, Peham C, Licka T, Schobesberger H.Mechanical properties of the equine back are the bases for realistic modelling of the back, which is recognised as an important step towards improved understanding of the pathogenesis of equine back conditions. Objective: The stiffness of the equine back depends on the direction of the applied force and on the position of the spine. Methods: Fourteen dissected spines were tested in a tensile testing machine. In 3 different positions, simulating dorsoventral, laterolateral and dorsoventral-30 degree rotated movement, force was applied on the dorsal spinous process of T12 to reach an excursion o...
Ensink JM, Voermans M, Bartels JH, Passon-Vastenburgen MH, Loeb E.A 14-year-old Haflinger mare was presented with a wound on the right metatarsus which it had sustained 3 years earlier. The wound had never completely healed but had only recently become a problem. Over a period of several months, the wound became larger, produced a lot of exudate, and the horse became lame on the affected limb. Clinical examination and radiographs failed to reveal the cause of the deterioration. Histological evaluation of tissue removed during debridement of the wound revealed squamous cell carcinoma. Because the tumour had already invaded the bone, the prognosis was unfavour...
Peham C, Schobesberger H.Knowledge of load effects is crucial for the understanding of the aetiology and pathogenesis of equine back problems. Objective: To investigate different load scenarios of the equine back, such as being ridden or increased muscle tone, using biomechanical simulations. Methods: Kinetic and kinematic data of 15 sound horses and the electromyelograph of their long back muscles were recorded. A biomechanical simulation model was used for simulations under different biomechanical scenarios (ridden/unridden, localised increased stiffness) using ADAMS. Results: The vertical forces acting through a ri...
Arai K, Misumi K, Carter SD, Shinbara S, Fujiki M, Sakamoto H.Cartilage oligomeric matrix protein (COMP) is abundant within cartilage; its turnover and/or degradation have been investigated in various equine joint diseases and it has been suggested that COMP fragmentation might be useful for monitoring such conditions. Objective: To determine whether COMP metabolism is compromised in equine osteoarthritis (OA) and whether COMP degradation is a useful joint marker representing cartilage destruction. Objective: A monoclonal antibody (mAb) with a higher affinity for degraded COMP allows discrimination of diseased joints by quantifying COMP levels and fragme...
Jackson BF, Lonnell C, Verheyen KL, Dyson P, Pfeiffer DU, Price JS.Dorsal metacarpal disease (DMD) is a common problem in 2-year-old racehorses and results in loss of a significant number of days from training. Biochemical markers of bone cell activity measured early in the training season could have value for identifying 2-year-old Thoroughbred racehorses that develop DMD. Objective: To determine the association between serum concentrations of osteocalcin, the carboxyterminal propeptide of type I collagen (PICP) and the carboxyterminal cross-linked telopeptide of type I collagen (ICTP) measured early in the training season and the risk of DMD. Methods: Blood...
Thomas GW, Bell SC, Carter SD.Fell pony foals are affected by a congenital fatal disease that leads to profound anaemia and immunodeficiency. Previous studies comparing healthy and affected foals have shown normal T-cell populations, but a severe B-lymphopenia. Objective: To measure the levels of individual immunoglobulin subisotypes in normal and affected Fell ponies and correlate these levels with the number of peripheral B-lymphocytes. Methods: Serum levels of individual immunoglobulin subisotypes were measured by ELISA and correlated with the number of peripheral B-lymphocytes (measured by flow cytometry). Results: Aff...
Ekman S, Skiöldebrand E, Heinegård D, Hultenby K.One of the most common causes of lameness in racehorses is osteoarthritis (OA). Pathogenesis is not clear and pathological processes of the different joint tissues interact in often progressive events. The interface between cartilage and newly synthesised bone has been shown to be particularly enriched in bone sialoprotein (BSP), a cell-binding matrix protein. Objective: To establish whether changes in the concentration of BSP may serve as a marker for early biochemical changes of the subchondral bone. Methods: Articular cartilage, cartilage/bone interface and subchondral bone of the proximal ...
Seki Y, Seimiya YM, Yaegashi G, Kumagai S, Sentsui H, Nishimori T, Ishihara R.During the period from 2001 to the following year, progenital diseases had been epidemic among the draft stallions and mares pastured together in Iwate Prefecture, the northeastern district of Japan. A stallion and 8 of 31 mares were affected in 2001, and 1 of 2 stallions and 10 of 36 mares in 2002. The clinical symptoms consisted of the formation of papules, pustules, ulcers and scabs on the progenital skin and mucosa in stallions and mares. In 2002, Equine herpesvirus 3 (EHV3) was isolated from 2 mares and the glycoprotein G gene of the virus detected from a stallion and 4 mares by polymeras...
Grewal JS, McClure SR, Booth LC, Evans RB, Caston SS.To characterize the normal ultrasonographic appearance of the podotrochlear apparatus in horses by use of standardized measurements and identify soft tissue changes associated with navicular syndrome. Methods: Prospective study. Methods: 7 clinically normal horses and 28 horses with navicular syndrome. Methods: The feasibility of identifying and measuring the soft tissue structures of the podotrochlear apparatus ultrasonographically via the transcuneal approach was assessed in 2 additional horses without navicular syndrome; both horses were euthanatized, and the structures identified ultrasono...
Stick JA, Jann HW, Scott EA, Robinson NE.We reviewed 91 cases of laminitis in horses admitted to the Michigan State University Veterinary Clinical Center between Jan 1, 1973 and Dec. 30, 1978. From information in the case records and from the results of a telephone questionnaire, cases were classified into 4 categories on the basis of return to athletic function. The degree of pedal bone rotation was inversely correlated with return to athletic performance. Horses with less than 5.5 degrees rotation returned to former athletic function, whereas horses with more than 11.5 degrees rotation lost their use as performance animals. Ponies ...
Malone ED, Kannan MS.To determine whether intestinal ischemia would alter activity of the jejunum in vitro or alter staining characteristics for certain types of enteric neurotransmitters. Methods: Jejunal samples obtained from 10 ponies. Methods: Jejunal samples were obtained from locations proximal and distal to an area of small intestine made ischemic for 60 minutes. A portion of each sample was stained to detect substance P-like immunoreactivity, cholinergic and adrenergic neurons, and nitric oxide synthase. Portions of the remaining samples were suspended in muscle baths. General activity patterns (frequency ...
Kirkwood NC, Hughes KJ, Stewart AJ.Poor recognition of subtle clinical abnormalities and equivocal ACTH concentrations make early diagnosis of PPID difficult. Progressive clinical findings and corresponding ACTH concentrations in horses transitioning to PPID over time have not been documented. Seven horses with ACTH concentrations equivocal for PPID (utilizing locally derived, seasonally adjusted diagnostic-cut off values (DCOV)) and no clinical signs of PPID were selected. Sequential measurement of basal and thyrotropin-releasing hormone (TRH)-stimulated ACTH concentrations and recording of clinical findings occurred from Octo...
Rütten M, Lehner A, Pospischil A, Sydler T.Listeria monocytogenes infection, although rare in horses, can lead to septicaemia, gastroenteritis and abortion or stillborn foals. Equine cerebral listeriosis has been reported, but only in newborn animals. This report describes a Freiberger gelding with severe neuronal symptoms of sudden onset. The animal collapsed within 24 h and was humanely killed. Necropsy revealed multiple small brown to reddish foci within the brain stem and pons. Histopathology demonstrated multifocal suppurative meningoencephalitis with microabscesses and occasional intra-lesional, coccoid to rod-shaped, bacteria. T...
Mahmoud AL.From 60 horses showing skin lesions, 42% were positive for fungal infection. Horses less than 2-year old were more susceptible to this infection. Fourteen species belonging to nine genera of keratinophilic and cycloheximide-resistant fungi were recovered from collected specimens. Trichophyton was the dominant genus of which T. equinum was the most common. This species proved to be the main causative agent of ringworm in horses. In addition to dermatophytes, many species of the isolated fungi were keratinophilic. The presence of such fungi on hairs and skin of horses may create an opportunity f...
Leach DH.The future directions of navicular disease research are unclear. Often researchers investigate only one of the multitude of factors likely to be important in understanding the disease. Two exceptions to this is work done by Wright in this issue of EVJ and by MacGregor (1988) who compared a number of the treatment regimens (e.g. rest, warfarin, isoxsuprine, shoeing with egg bars) and found that approximately 75% of the horses improved in their performance. Perhaps this percentage of 'recovered' horses from this disease is what can be realistically expected, as often horses with navicular diseas...
Terio KA, Stalis IH, Allen JL, Stott JL, Worley MB.Coccidioidomycosis is a rare, often subclinical infection in domestic animals caused by the fungus Coccidioides immitis. Because of an apparent high incidence of coccidioidomycosis in Przewalski's horses (Equus przewalskii) housed at a single facility, necropsy records and biomaterials from animals that died between 1984 and 2000 were reviewed (n = 30, 15 males, 15 females). Coccidioidomycosis was the leading cause of death (33%) in this population with lesions in the lungs and tracheobronchial lymph nodes of all animals and variable involvement of the skeletal muscle, heart, kidney, liver, sk...
Falco MJ, Whitwell K, Palmer AC.Sixty-seven TB horses in Britain suffering from clinical wobbler disease were divided into 5 groups, based on the presence or absence of pathological lesions and their nature. These groups were compared genetically with a control group of 67 TBs known not to exhibit signs of wobbling. Though analysed for both simple and complex modes of inheritance no evidence of a genetic basis was found in any group. The high breed incidence in TBs may be real or apparent. Considerably more male than female wobblers are reported. Other forms of possibly inherited ataxia in equidae are reviewed and reference ...
Broquist HP, Mason PS, Hagler WM, Harris TM.When infested with the fungus Rhizoctonia leguminicola, certain forages, e.g., red clover hay, can cause a "slobber syndrome" of varying severity when consumed by ruminants. The causative agent has been presumed to be slaframine [(1S,6S,8aS)-1-acetoxy-6-aminooctahydroindolizine], which is produced by R. leguminicola. In one serious outbreak of the slobber syndrome in horses, the red clover forage involved was carefully examined and found to contain R. leguminicola and slaframine. An identical hay sample is shown here by ion-exchange chromatographic and gas chromatographic-mass spectrometric an...
Klei TR, Torbert B, Chapman MR, Foil L.Microfilariae of Onchocerca cervicalis were detected in midventral skin biopsy samples in 64 of 84 (76%) mixed-breed ponies greater than 2 years old from the Gulf Coast area and in 42 of 51 (82.4%) horses from Louisiana breeding herds. The number of microfilariae per 8 mm of biopsied skin (ponies) ranged from 1 to 21,570. The number of microfilariae per 6 mm of biopsied skin (horses) ranged from 8 to 55,600.
Szeredi L, Tenk M, Schiller I, Révész T.In six healthy mares and 24 mares showing reproductive disorders swab samples were taken from the fossa clitoridis to isolate Taylorella equigenitalis, and from the uterus to isolate mycoplasmas, ureaplasmas and other aerobic bacteria. Swab samples were also taken from the uterus for Chlamydia antigen ELISA and Chlamydia PCR studies. The uterus of 27 mares was examined cytologically, and biopsy samples were taken from the endometrium for histological examinations and for immunohistochemical examinations aimed at the detection of chlamydiae. T. equigenitalis, mycoplasmas, ureaplasmas and chlamy...
Bistner S, Campbell RJ, Shaw D, Leininger JR, Ghobrial HK.A nine-year-old horse was presented with severe exophthalmos of the right eye and a large mass in the vitreal cavity. The affected globe was enucleated and two months following surgery the horse was euthanized because of spread of the tumor into the calvarium producing compression of the brain stem and neurologic signs. Examination of tumor tissue by light and electron microscopic examination showed a mixed neoplasm of primitive neuroepithelium.
Cassotis NJ, Schiffman P.A 12-year-old Paso Fino mare was evaluated for a chronic nasal and ocular discharge. A calcification was identified eroding through the nasal mucosa of the middle meatus. Differential considerations for this mass included dacryolith, nasal calculus, or calcified tooth root abscess. Anatomical location and case history and progression supported a dacryolith. Following removal, the calculus was submitted for mineralogic analysis. The calculus was primarily carbonate hydroxylapatite (Ca10(PO4)3(CO3)3(OH)2) with a minor NaCl halite constituent. Dacryoliths, or nasolacrimal calculi, are an uncommon...
Malark JA, Nixon AJ, Haughland MA, Brown MP.The medical records of 17 horses with coxofemoral luxation were examined. Ponies and miniature horses were overrepresented. The mean age at the time of diagnosis was 7 years (range 1 month to 25 years). Seventy percent were female. Severe trauma, such as a fall or being kicked by another horse, was a common etiology. Thirty-five percent had other orthopedic injuries associated with the luxation. Closed reduction, with the use of a mechanically assisted calving device, was attained in 5 cases but reluxation occurred shortly afterward in 4 of these. Varying surgical techniques were used in 3 cas...
Storms N, Medina Torres C, Franck T, Sole Guitart A, de la Rebière G, Serteyn D.Laminitis is a pathology of the equine digit leading to a failure of the dermo-epidermal interface. Neutrophil activation is recognized as a major factor in SIRS-associated laminitis. Less is known about the role of neutrophil activation in laminitis associated with metabolic disorders. The aim of this descriptive study was to observe whether myeloperoxidase is increased in the laminae during early stage laminitis in three horses subjected to a prolonged euglycemic hyperinsulinemic clamp (pEHC). After 48 h of pEHC-treatment, horses were subjected to euthanasia. Two healthy horses are used as c...
Byrne BA, Rand CL, McElliott VR, Samitz EM, Brault SA.Dermatophilosis caused by Dermatophilus congolensis causes exudative dermatitis in a variety of species. The infection is generally limited to the cutaneous tissues, where infection is acquired from the environment and bacteria penetrate into keratinized epithelium through epithelial disruption. A 3-year-old pony filly was examined for enlarging mandibular lymph nodes during the preceding 10 months. Biopsy of the node revealed mixed and granulomatous inflammation and thick, filamentous Gram-positive bacteria. Dermatophilus congolensis, confirmed by biochemical testing and sequencing of the rib...
Ojala M, Ala-Huikku J.From 1974 to 1979, seven stillborn foals with internal hydrocephalus were encountered from one Standardbred trotter stallion which sired 239 registered foals. An hydrocephalic foal was also aborted by a daughter of the same stallion. One affected foal from Standardbred trotters and one from a Finnish Horses were also reported. In some cases, the condition caused severe dystocia. Based on field data, possible causes of the defect could neither be proved nor specifically overruled in individual cases. Hydrocephalus was obviously not an autosomal recessive single-locus defect, nor was it X-linked...
Scholes SF, Vaillant C, Peacock P, Edwards GB, Kelly DF.Ileal biopsies were obtained from 18 horses with grass sickness, 15 horses with other alimentary disease and three horses without gastrointestinal disease. Samples of small intestine were also obtained from nine cases of obstruction due to small intestinal strangulation. Histological examination revealed that severe enteric neuropathy in the absence of other significant morphological changes was confined to the horses with grass sickness.
Weiss DJ, Geor RJ, Johnston G, Trent AM.The hypothesis that equine laminitis is caused by thrombosis of vessels in the laminar corium (dermis) was investigated. Hemostatic alterations were evaluated by determining platelet count, platelet survival, platelet adhesiveness to vascular subendothelium, activated clotting time, and whole blood recalcification time. Thrombosis of vessels in the hoof wall was evaluated by scintigraphic studies of the hoof wall after administration of indium-111 (111In)-labeled platelets, contrast arteriography, and histologic examination. Platelet count remained constant before and at the onset of lameness;...
Bisgard GE, Orr JA, Will JA.Hemodynamic measurements were made in 6 ponies at low altitude (Madison, WI, altitude, 250 m) and after 1, 2, 4, and 6 weeks at high altitude (Climax, CO, altitude, 3,400 m). The salient findings were that ponies maintain an increased heart rate and cardiac output and develop significant pulmonary hypertension at high altitude. The average control resting mean pulmonary artery pressure (BPpul) was 25.1 mm of Hg at 250 m; this value increased to 56.3 mm of Hg after 6 weeks at 3,400 m. An additional finding was that the pulmonary vascular response to acute hypoxia seemed to increase with time at...
Muñoz E, Leiva M, Naranjo C, Peña T.A 4-year-old Andalusian horse was presented for examination following a 3-month history of exophthalmos of the right eye and a soft swelling of the right supraorbital fossa noted after blunt head trauma. Ultrasonographic examination of the swelling showed an anecogenic mass of 5 cm in diameter involving the retrobulbar space. Centesis of the mass through the supraorbital fossa was performed and yielded a serous fluid with 7.2 g/dL of total protein and density of 1040. No cells were seen in the sample. A tentative diagnosis of cyst was made. The cyst was surgically removed and the definitive hi...
