Analyze Diet

Topic:Disease Treatment

Disease treatment in horses encompasses a range of medical interventions and management strategies aimed at addressing various health conditions affecting equine species. These treatments can include pharmacological approaches, such as the administration of antibiotics, anti-inflammatory drugs, and antiparasitic medications, as well as non-pharmacological methods like physical therapy, dietary adjustments, and surgical procedures. The selection of appropriate treatments depends on the specific disease, its severity, and the individual needs of the horse. This topic brings together peer-reviewed research studies and scholarly articles that explore the efficacy, safety, and advancements in therapeutic options for equine diseases, providing insights into best practices and emerging trends in equine veterinary medicine.
An Overview of Equine Enteric Clostridial Diseases.
The Veterinary clinics of North America. Equine practice    February 1, 2023   Volume 39, Issue 1 15-23 doi: 10.1016/j.cveq.2022.11.012
Kuttappan DA, Mooyottu S, Sponseller BA.The understanding of the pathogenesis of equine enteric clostridial organisms is an active, evolving field. Advances will improve our knowledge both from the animal welfare and human health perspectives. The zoonotic nature of this group of diseases makes them relevant in the age of One health, as a significant amount of close human-equine interactions occurs for business and pleasure. Economic and welfare reasons prompt a better understanding of enteric clostridial pathogenesis, treatment, and control of the infection in horses and ongoing efforts are needed to advance clinical outcomes.
Equine Granulocytic Anaplasmosis.
The Veterinary clinics of North America. Equine practice    February 1, 2023   Volume 39, Issue 1 133-145 doi: 10.1016/j.cveq.2022.11.011
Oliver A, Conrado FO, Nolen-Walston R.Equine granulocytic anaplasmosis is a clinically significant and common disease of equids that has a broader prevalence than was once thought. The most common clinical signs include high fever and edema, with mild to mderate thrombocytopenia and lymphopenia typically noted on complete blood count. Subclinical cases are reported and many are self-limiting. Rare clinical presentations include neurologic disease, vasculitis, dysphagia, rhabdomyolysis, or bicavitary effusion. Most cases resolve rapidly with appropriate antimicrobial intervention.
Equine Granulocytic Anaplasmosis.
The Veterinary clinics of North America. Equine practice    February 1, 2023   Volume 39, Issue 1 133-145 doi: 10.1016/j.cveq.2022.11.011
Oliver A, Conrado FO, Nolen-Walston R.Equine granulocytic anaplasmosis is a clinically significant and common disease of equids that has a broader prevalence than was once thought. The most common clinical signs include high fever and edema, with mild to mderate thrombocytopenia and lymphopenia typically noted on complete blood count. Subclinical cases are reported and many are self-limiting. Rare clinical presentations include neurologic disease, vasculitis, dysphagia, rhabdomyolysis, or bicavitary effusion. Most cases resolve rapidly with appropriate antimicrobial intervention.
Plasma Creatine Kinase and Aspartate Aminotransferase Activities Before, During, and After 5 Days of Intramuscular Penicillin Administration in Sedentary Horses.
Journal of equine veterinary science    February 1, 2023   Volume 122 104231 doi: 10.1016/j.jevs.2023.104231
Foreman-Hesterberg CR, Foreman JH.Muscle damage can result in leakage of intracellular enzymes such as creatine kinase (CK) and aspartate transaminase (AST) into plasma. There are no controlled documentations of the effects of intramuscular antibiotic drug administration on plasma CK and AST activities in horses. The objective of this experiment was to test the hypothesis that 5 days of intramuscular procaine penicillin G injection in normal horses would result in increased plasma activities of CK and AST. Nine healthy adult horses were sampled for 7 days preceding, 5 days during, and 32 days following procaine penicillin G (2...
Monorchidism in a Phenotypic Mare With a 64,XY, SRY-Positive Karyotype.
Journal of equine veterinary science    February 1, 2023   Volume 126 104232 doi: 10.1016/j.jevs.2023.104232
Middlebrooks B, McCue P, Nelson B, May E, Divine C, Barton C, Conley A.Disorders of sexual development (DSD) are associated with atypical chromosomal, gonadal, or phenotypic sex. It is likely that the number of cases of DSD are underestimated in the equine population. Monorchidism in the horse is very rare. This case report describes the clinical assessment of a phenotypic mare with stallion-like behavior which led to the diagnosis of a DSD. A 4-year-old Quarter Horse mare presented in good body condition, with normal external genitalia for a mare, and normal mammary glands with two bilaterally symmetric teats. No uterus, cervix, or gonads were detected on transr...
Infectious Causes of Equine Placentitis and Abortion.
The Veterinary clinics of North America. Equine practice    February 1, 2023   Volume 39, Issue 1 73-88 doi: 10.1016/j.cveq.2022.11.001
Ruby RE, Janes JG.A variety of infectious agents including viral, bacterial, and fungal organisms can cause equine abortion and placentitis. Knowledge of normal anatomy and the common pattern distribution of different infectious agents will assist the practitioner in evaluating the fetus and/or placenta, collecting appropriate samples for further testing, and in some cases, forming a presumptive diagnosis. In all cases, it is recommended to confirm the diagnosis with molecular, serologic, or microbiological testing. If a causative agent can be identified, then appropriate biosecurity and vaccination measures ca...
Advances in the Development of Small Molecule Antivirals against Equine Encephalitic Viruses.
Viruses    February 1, 2023   Volume 15, Issue 2 413 doi: 10.3390/v15020413
Ogorek TJ, Golden JE.Venezuelan, western, and eastern equine encephalitic alphaviruses (VEEV, WEEV, and EEEV, respectively) are arboviruses that are highly pathogenic to equines and cause significant harm to infected humans. Currently, human alphavirus infection and the resulting diseases caused by them are unmitigated due to the absence of approved vaccines or therapeutics for general use. These circumstances, combined with the unpredictability of outbreaks-as exemplified by a 2019 EEE surge in the United States that claimed 19 patient lives-emphasize the risks posed by these viruses, especially for aerosolized V...
Changes in equine intestinal stem/progenitor cell number at resection margins in cases of small intestinal strangulation.
Equine veterinary journal    January 30, 2023   doi: 10.1111/evj.13927
Veerasammy B, Gonzalez G, Báez-Ramos P, Schaaf CR, Stewart AS, Ludwig EK, McKinney-Aguirre C, Freund J, Robertson J, Gonzalez LM.Intestinal epithelial stem cells (ISC) are responsible for epithelial regeneration and are critical to the intestine's ability to regain barrier function following injury. Evaluating ISC biomarker expression in cases of small intestinal strangulation (SIS) may provide insight into clinical progression. Objective: Intestinal resection margins from cases of SIS were evaluated to determine if (1) evidence of injury could be identified using histomorphometry, (2) ISC biomarker expression was decreased in the proximal resection margin compared to control and distal resection margin, and (3) the ISC...
Voluntary Surveillance Program for Equine Influenza Virus in the United States during 2008-2021.
Pathogens (Basel, Switzerland)    January 27, 2023   Volume 12, Issue 2 192 doi: 10.3390/pathogens12020192
Chappell DE, Barnett DC, James K, Craig B, Bain F, Gaughan E, Schneider C, Vaala W, Barnum SM, Pusterla N.A voluntary upper respiratory biosurveillance program in the USA received 9740 nasal swab submissions during the years 2008-2021 from 333 veterinarians and veterinary clinics. The nasal swabs were submitted for qPCR testing for six common upper respiratory pathogens:equine influenza virus (EIV), equine herpesvirus-1 (EHV-1), equine herpesvirus-4 (EHV-4), subspecies (), equine rhinitis A virus (ERAV), and equine rhinitis B virus (ERBV). Additional testing was performed for equine gamma herpesvirus-2 (EHV-2) and equine gamma herpesvirus-5 (EHV-5) and the results are reported. Basic frequency s...
Comparison of systemic trimethoprim-sulfadimethoxine treatment and intrauterine ozone application as possible therapies for bacterial endometritis in equine practice.
Frontiers in veterinary science    January 27, 2023   Volume 10 1102149 doi: 10.3389/fvets.2023.1102149
Köhne M, Hofbauer L, Böttcher D, Tönissen A, Hegger A, Görgens A, Ulrich R, Sieme H.Bacterial endometritis is one of the major problems in equine reproduction and usually treated with antimicrobial drugs. The study aimed to compare the effects of intrauterine ozone application and systemic antibiotic treatment (trimethoprim-sulfadimethoxine) on intrauterine bacterial growth and possible side effects on the endometrium in a clinical setting. Mares ( = 30) with signs of endometritis (positive uterine bacterial culture and cytological findings) were assigned randomly to different treatments: intrauterine insufflation of an ozone-air-mix (240 ml, 80 μg ozone/ml) twice at a 48 h-...
Buprenorphine has a concentration-dependent cytotoxic effect on equine chondrocytes in vitro.
American journal of veterinary research    January 26, 2023   Volume 84, Issue 3 ajvr.22.08.0143 doi: 10.2460/ajvr.22.08.0143
Castro-Cuellar G, Cremer J, Liu CC, Queiroz-Williams P, Hampton C, Leise BS.To investigate the cytotoxic effects of 2 different concentrations of buprenorphine and compare them with bupivacaine and morphine on healthy equine chondrocytes in vitro. Methods: Primary cultured equine articular chondrocytes from 3 healthy adult horses. Methods: Chondrocytes were exposed for 0 and 2 hours to the following treatments: media (CON; negative control); bupivacaine at 2.2 mg/mL (BUPI; positive control); morphine at 2.85 mg/mL (MOR); buprenorphine at 0.12 mg/mL (HBUPRE); or buprenorphine at 0.05 mg/mL (LBUPRE). Chondrocyte viability was assessed using live/dead staining, water-sol...
Papillomavirus-like Particles in Equine Medicine.
Viruses    January 25, 2023   Volume 15, Issue 2 345 doi: 10.3390/v15020345
Hainisch EK, Jindra C, Kirnbauer R, Brandt S.Papillomaviruses (PVs) are a family of small DNA tumor viruses that can induce benign lesions or cancer in vertebrates. The observation that animal PV capsid-proteins spontaneously self-assemble to empty, highly immunogenic virus-like particles (VLPs) has led to the establishment of vaccines that efficiently protect humans from specific PV infections and associated diseases. We provide an overview of PV-induced tumors in horses and other equids, discuss possible routes of PV transmission in equid species, and present recent developments aiming at introducing the PV VLP-based vaccine technology...
A Human Case of an Infection by the Pathogenic Streptococci that Causes “Strangles” in Horses.
European journal of case reports in internal medicine    January 23, 2023   Volume 10, Issue 1 003719 doi: 10.12890/2023_003719
Gosai F, Gosai N.Strangles is a contagious upper respiratory tract infection primarily affecting equines. It is rare disease with zoonotic transmission. It is caused by the bacterium, . We present the rare case of strangles in an elderly patient complicated by bacteraemia, osteomyelitis and native valve endocarditis. The patient was treated successfully with appropriate antibiotics and no surgical intervention was needed. In an age of accelerated emerging zoonosis, this is an important entity clinicians should be aware of to prevent delay in diagnosis and poor outcome. Conclusions: Strangles is a disease of eq...
In Vitro Generated Equine Hepatic-Like Progenitor Cells as a Novel Potent Cell Pool for Equine Metabolic Syndrome (EMS) Treatment.
Stem cell reviews and reports    January 20, 2023   Volume 19, Issue 4 1124-1134 doi: 10.1007/s12015-023-10507-3
Marycz K, Bourebaba N, Serwotka-Suszczak A, Mularczyk M, Galuppo L, Bourebaba L.Equine metabolic syndrome (EMS) is recognized as one of the leading cause of health threatening in veterinary medicine worldwide. Recently, PTP1B inhibition has been proposed as an interesting strategy for liver insulin resistance reversion in both equines and humans, however as being a multifactorial disease, proper management of EMS horses further necessities additional interventional approaches aiming at repairing and restoring liver functions. In this study, we hypothesized that in vitro induction of Eq_ASCs hepatogenic differentiation will generate a specialized liver progenitor-like cell...
Voluntary Biosurveillance of Streptococcus equi Subsp. equi in Nasal Secretions of 9409 Equids with Upper Airway Infection in the USA.
Veterinary sciences    January 20, 2023   Volume 10, Issue 2 78 doi: 10.3390/vetsci10020078
Jaramillo-Morales C, James K, Barnum S, Vaala W, Chappell DE, Schneider C, Craig B, Bain F, Barnett DC, Gaughan E, Pusterla N.This study aimed to describe selected epidemiological aspects of horses with acute onset of fever and respiratory signs testing qPCR-positive for and to determine the effect of vaccination against on qPCR status. Horses with acute onset of fever and respiratory signs from all regions of the United States were included in a voluntary biosurveillance program from 2008 to 2020 and nasal secretions were tested via qPCR for and common respiratory viruses. A total of 715/9409 equids (7.6%) tested qPCR-positive for , with 226 horses showing coinfections with EIV, EHV-1, EHV-4, and ERBV. The median...
Selection signatures for local and regional adaptation in Chinese Mongolian horse breeds reveal candidate genes for hoof health.
BMC genomics    January 19, 2023   Volume 24, Issue 1 35 doi: 10.1186/s12864-023-09116-8
Han H, Randhawa IAS, MacHugh DE, McGivney BA, Katz LM, Dugarjaviin M, Hill EW.Thousands of years of natural and artificial selection since the domestication of the horse has shaped the distinctive genomes of Chinese Mongolian horse populations. Consequently, genomic signatures of selection can provide insights into the human-mediated selection history of specific traits and evolutionary adaptation to diverse environments. Here, we used genome-wide SNPs from five distinct Chinese Mongolian horse populations to identify genomic regions under selection for the population-specific traits, gait, black coat colour, and hoof quality. Other global breeds were used to identify r...
Approach to the pruritic horse.
Journal of the American Veterinary Medical Association    January 19, 2023   Volume 261, Issue S1 S66-S74 doi: 10.2460/javma.22.10.0444
White SD.Pruritus in the horse may be due to several causes, the most common being a hypersensitivity response to salivary proteins in the Culicoides genera, which may coexist with atopic dermatitis, also known as an environmental allergy to pollens, molds, dust, storage mites, etc. Less common etiologies are food allergy and contact allergy, the latter often caused by owners applying various products to the skin. Other ectoparasites, such as Chorioptes mites, may also initiate pruritus. Secondary bacterial infections (usually Staphylococcus spp) may be pruritic in and of themselves. This article revie...
Evolution of the Prevalence of Antibiotic Resistance to Staphylococcus spp. Isolated from Horses in Florida over a 10-Year Period.
Veterinary sciences    January 18, 2023   Volume 10, Issue 2 doi: 10.3390/vetsci10020071
Marshall K, Marsella R.Previous studies documented antibiotic resistance in horses but did not focus on skin specifically. We investigated antibiotic resistance and correlations between resistance patterns in skin infections. Records from 2009 to 2019 were searched for Staphylococcal infection and susceptibility results. Seventy-seven cases were included. Organisms identified were S. aureus (48/77), S. pseudintermedius (7/77), non-hemolytic Staphylococcus (8/77), beta-hemolytic Staphylococcus (6/77), and other species (8/77). Samples included pyoderma (36/77), wounds (10/77), abscesses (15/77), incision sites (5/77)...
Evaluation of Bacterial Composition and Viability of Equine Feces after Processing for Transplantation.
Microorganisms    January 17, 2023   Volume 11, Issue 2 doi: 10.3390/microorganisms11020231
Loublier C, Taminiau B, Heinen J, Lecoq L, Amory H, Daube G, Cesarini C.Fecal microbiota transplantation (FMT) has been used empirically for decades in equine medicine to treat intestinal dysbiosis but evidence-based information is scarce. This in vitro study aimed at assessing the effect of a commonly used pre-FMT processing method on the bacterial composition and viability of the fecal filtrate. Three samples of fresh equine manure (T0) were processed identically: the initial manure was mixed with 1 L of lukewarm water and chopped using an immersion blender to obtain a mixture (T1), which was left uncovered during 30 min (T2) and percolated through a sieve to ob...
Effect of Volumes of Solutions on Intraocular Pressure During Intravitreal Injection of Low Dose Gentamicin in Horses With Recurrent Uveitis: A Randomized Controlled Study.
Journal of equine veterinary science    January 17, 2023   Volume 122 104228 doi: 10.1016/j.jevs.2023.104228
Launois T, Hontoir F, Dugdale A, Dedieu M, Vandeweerd JM.Horses with recurrent uveitis can be treated by intravitreal injection of low dose gentamicin under sedation and after local anesthetic techniques including the retrobulbar nerve block. Since it is reported that retinal degeneration can be secondary to an acute increase of intraocular pressure (IOP), the current randomized controlled study was carried out in order to investigate the changes in IOP following retrobulbar anesthesia, with two different volumes of local anesthetic (lidocaine) solution (10 and 5 mL), and intravitreal injection of 6 mg gentamicin in two different volumes of solution...
Does colonization with MRSA, ESBL – producing Enterobacteriaceae, and/or Acinetobacter baumannii – increase the risk for postoperative surgical site infection?
Veterinary medicine and science    January 16, 2023   Volume 9, Issue 2 729-737 doi: 10.1002/vms3.1073
Gehlen H, Klein KS, Merle R, Lübke-Becker A, Stoeckle SD.Evaluation of the role of indicator pathogens in equine surgical site infection (SSI) and other infection-promoting factors. Cross-sectional study. Horses presenting with an open injury or surgical colic during 1.5 years. A nasal swab and a faecal sample were collected from every patient upon admission. Furthermore, a wound swab was collected from wounds of injured horses. Details on the wounds and procedures were documented. Laparotomy incisions and injuries were monitored for signs suggesting infection. In total, 156 horses presented because of a surgical colic (n = 48) or open injuries (n...
Treatment of racehorse superficial digital flexor tendonitis: A comparison of stem cell treatments to controlled exercise rehabilitation in 213 cases.
Equine veterinary journal    January 16, 2023   Volume 55, Issue 6 979-987 doi: 10.1111/evj.13922
Salz RO, Elliott CRB, Zuffa T, Bennet ED, Ahern BJ.Overstrain of the superficial digital flexor tendon (SDFT) is a common Thoroughbred racehorse limb injury requiring treatment. Objective: To determine whether treatment of SDFT lesions in flat Thoroughbred racehorses with autologous bone marrow-derived mesenchymal stem cells (BM-MSCs) or allogenic adipose-derived mesenchymal stem cells (A-MSCs) is associated with improved likelihood of returning to racing, when compared to racehorses managed with a controlled exercise rehabilitation program (CERP) alone. Methods: Retrospective cohort study combining clinical treatment records with race records...
Use of a new device for inversion of the necrotic ileal stump in the caecum in four horses.
Equine veterinary journal    January 16, 2023   doi: 10.1111/evj.13926
Gandini M, Giusto G.In jejunocaecal anastomosis leaving a necrotic ileal stump has been implicated in complications and poor outcomes. Elective inversion of the necrotic stump using a nasogastric tube has been previously described, although this procedure can be cumbersome and can cause caecocolic orifice occlusion. Objective: To describe the use of a new device for elective inversion of necrotic ileal stumps. Methods: Case report. Methods: Details of the four horses that underwent intestinal resection and anastomosis with elective inversion of the ileal stump were retrieved from their medical records. For each c...
Development of a laparoscopic technique for inguinal hernioplasty in standing horses.
The Veterinary record    January 15, 2023   Volume 192, Issue 8 e2584 doi: 10.1002/vetr.2584
Vitoria A, Romero A, Barrachina L, Fuente S, Gil L, de Blas I, Vázquez Bringas FJ.Most previously described techniques for laparoscopic inguinal hernioplasty (IH) in horses require advanced laparoscopic skills. Our objective was to describe a new laparoscopic IH technique using a surgical anchoring system. Methods: Standing laparoscopic IH was performed unilaterally in eight experimental stallions, using the contralateral inguinal canal (IC) as a control. A polyether ether ketone harpoon was anchored in the craniolateral aspect of the vaginal ring, and an extracorporeal knot was used to fix the device. Clinical evaluation, including testicular palpation and lameness examina...
Molecular Investigation of Theileria and Babesia Species in Domestic Mammals from Sardinia, Italy.
Veterinary sciences    January 14, 2023   Volume 10, Issue 1 59 doi: 10.3390/vetsci10010059
Chisu V, Serra E, Foxi C, Chessa G, Masala G.Piroplasmoses are tick-borne diseases caused by hemoprotozoan parasites of veterinary and public health significance. This study focuses on the molecular identification and characterization of species belonging to the genera in 152 blood samples, collected from 80 horses and 72 cattle from several farms in Sardinia, by targeting the 18S rRNA gene. The PCR results highlighted that 72% of the samples were positive for spp., with a rate of infection of 68% and 75% for the horses and cattle, respectively. Sequencing and the BLASTn analysis showed that the 18S rRNA generated in this study has 99-...
Standing equine cheek tooth extraction: A multivariate analysis of the effect of antibiotics on the risk of post-operative complications.
Equine veterinary journal    January 12, 2023   Volume 55, Issue 6 968-978 doi: 10.1111/evj.13905
Christiansen MS, Rosenmeier JG, Jensen DB, Lindegaard C.Commonly, cheek tooth extraction performed in standing horses using perioperative prophylactic antibiotics, results in low post-operative complication rates. However, no studies have documented the relevance of perioperative antibiotics to the risk of post-operative complications. Objective: To examine the association between perioperative antibiotics and post-operative complications after standing cheek tooth extraction. Methods: Retrospective cohort study. Methods: Information from clinical records and follow-up questionnaires relating to horses subjected to cheek tooth extractions between S...
Synopsis of the pharmacokinetics, pharmacodynamics, applications, and safety of firocoxib in horses.
Veterinary and animal science    January 11, 2023   Volume 19 100286 doi: 10.1016/j.vas.2023.100286
Fadel C, Giorgi M.According to in vitro and in vivo investigations, firocoxib (FX), a second-generation coxib, is a highly selective COX-2 inhibitor in horses. With a COX-1/COX-2 IC50 ratio of 643 in horses, FX spares the COX-1 inhibitory effects. It is approved for the treatment of musculoskeletal problems and lameness in horses and dogs with osteoarthritis (OA). For the treatment of OA in horses, both an injectable formulation for IV administration at a dose of 0.09 mg/kg for five days and an oral paste formulation at a dose of 0.1 mg/kg for 14 days are licensed. Numerous analytical methods were reported in...
Molecular Features and Antimicrobial Susceptibilities of Streptococcus equi ssp. equi Isolates from Strangles Cases in Indonesia.
Veterinary sciences    January 10, 2023   Volume 10, Issue 1 49 doi: 10.3390/vetsci10010049
Rotinsulu DA, Ewers C, Kerner K, Amrozi A, Soejoedono RD, Semmler T, Bauerfeind R.Strangles, caused by ssp. (), is a highly infectious and frequent disease of equines worldwide. No data are available regarding the molecular epidemiology of strangles in Indonesia. This study aimed to characterize isolates obtained from suspected strangles cases in Indonesia in 2018. Isolates originated from seven diseased horses on four different farms located in three provinces of Indonesia. Whole genome sequences of these isolates were determined and used for typing, multilocus sequence typing (MLST), and core genome MLS typing (cgMLST). Genomes were also screened for known antimicrobi...
Percutaneous full endoscopic foraminotomy for treatment of cervical spinal nerve compression in horses using a uniportal approach: Feasibility study.
Equine veterinary journal    January 10, 2023   Volume 55, Issue 5 788-797 doi: 10.1111/evj.13919
Swagemakers JH, Van Daele P, Mageed M.Cervical spinal nerve insult can be a sequel of osteoarthropathy in horses due to enlargement of the articular processes (AP). Objective: To describe the percutaneous endoscopic cervical foraminotomy procedure in horses. Methods: Ex vivo experimental study and clinical case report. Methods: The technique was performed in three equine cadavers and in two clinical cases with history of forelimb lameness located in the caudal cervical region. Briefly, the horse was positioned in lateral recumbency, with the affected AP joint uppermost. Under fluoroscopic guidance, the endoscopic instruments (Ø 6...
Ex vivo evaluation of a percutaneous thread-transecting technique for desmotomy of normal palmar/plantar annular ligaments in horses.
Veterinary surgery : VS    January 10, 2023   Volume 52, Issue 3 388-394 doi: 10.1111/vsu.13932
De Gasperi D, Guo D, Guo D, Lu Y, Brounts SH.To develop and describe a minimally invasive, ultrasound-guided, percutaneous technique for the desmotomy of equine palmar/plantar annular ligaments (PALs) using a transecting thread. Methods: Ex vivo study. Methods: Twenty-one normal equine distal limb specimens. Methods: Under ultrasonographic guidance, a surgical thread was percutaneously placed around the PAL through 2 skin punctures (proximal and distal) using a 18 gauge spinal needle in equine limbs (11 forelimbs, 10 hindlimbs) with normal PALs. The ligament was transected by a back-and-forth motion of the thread until the loop emerged...
1 8 9 10 11 12 570