Equine diseases encompass a wide range of health conditions that can affect horses, including infectious diseases, metabolic disorders, and genetic conditions. These diseases can impact the overall health, performance, and well-being of horses. Common equine diseases include equine influenza, equine herpesvirus, laminitis, and equine metabolic syndrome. Diagnosis and management of these diseases often require a combination of clinical evaluation, laboratory testing, and appropriate treatment strategies. This page gathers peer-reviewed research studies and scholarly articles that explore the etiology, pathophysiology, diagnosis, and treatment options for various equine diseases, providing valuable insights for veterinarians and researchers in the field.
Knowles EJ, Mair TS, Butcher N, Waller AS, Wood JL.Thirty horses with no external signs of strangles were tested for exposure to Streptococcus equi subspecies equi (S equi) using a new, commercially available serological test. The horses were also tested for persistent carriage of S equi by endoscopy of the guttural pouches and PCR analysis of lavage samples. The owners were questioned about the recent medical history of the horses. Serology suggested that four horses had been recently exposed to S equi. None of the horses had a known history of strangles but three of the four seropositive horses had recently shown non-specific signs of respir...
Toutain PL.In racing and other equine sports, it is possible to increase artificially both the physical capability and the presence of a competitive instinct, using drugs, such as anabolic steroids and agents stimulating the central nervous system. The word doping describes this illegitimate use of drugs and the primary motivation of an equine anti-doping policy is to prevent the use of these substances. However, an anti-doping policy must not impede the use of legitimate veterinary medications and most regulatory bodies in the world now distinguish the control of illicit substances (doping control) from...
Hosaka YZ, Uratsuji T, Ueda H, Uehara M, Takehana K.This aim of this study was to determine the characteristic differences in tendinocytes derived from three sites of the equine superficial digital flexor tendon (SDFT)-proximally the myotendinous junction (MTJ), mid-metacarpal (mM) and osteotendinous junction (OTJ)-in morphology, proliferation, and ability for synthesis of collagen and matrix metalloproteinases (MMPs). Little difference was observed in cell proliferation. Addition of tumor necrosis factor (TNF) alpha to the culture medium resulted in increased collagen synthesis by tendinocytes from all three sites. The amount of collagen synth...
Reinemeyer CR, Prado JC, Nichols EC, Marchiondo AA.The expanding prevalence of Parascaris equorum populations that are resistant to macrocyclic lactone (ML) anthelmintics makes it desirable to identify dewormers which remain effective. The objective was to evaluate the efficacy of pyrantel pamoate in 14 suckling foals that had been infected orally with approximately 600 larvated eggs of a P. equorum isolate selected for ML resistance (ML-R). Seventy days after inoculation, foals were weaned, housed individually, and fecal samples were examined frequently to detect the onset of patency. Between 73 and 80 days post-inoculation, all 14 foals deve...
Zhang J, Stein DA, Timoney PJ, Balasuriya UB.A significant consequence of equine arteritis virus (EAV) infection of horses is persistence of the virus in a variable percentage of infected stallions. We recently established an in vitro model of EAV persistence in cell culture for the purpose of furthering our understanding of EAV biology in general and viral persistence in the stallion in particular. In this study we investigated whether persistently infected HeLa cells could be cured of EAV infection by treatment with an antisense peptide-conjugated phosphorodiamidate morpholino oligomer (PPMO) designed to target the 5'-terminal region o...
Preziuso S, Laus F, Tejeda AR, Valente C, Cuteri V.Streptococcus (S.) dysgalactiae subsp. equisimilis is responsible for severe diseases in humans, including primary bacteraemia, pneumonia, endocarditis, and toxic shock syndrome. Infection in some animal species can also occur, although a few studies have looked into cross-species infectivity. In horses, S. equisimilis is generally considered infrequent or opportunistic, but has recently been isolated from cases of strangles-like disease. Rapid and sensitive diagnostic techniques could enable epidemiological studies and effective investigation of outbreaks involving these bacteria. In this stu...
Reinemeyer CR, Prado JC, Nichols EC, Marchiondo AA.In recent years, numerous veterinary practitioners have reported anecdotal episodes in which anthelmintic treatment did not appear to deliver the expected efficacy against equine pinworms (Oxyuris equi). Anthelmintic resistance has not been demonstrated formally in equine pinworms, so a clinical study was designed to evaluate the efficacy of paste formulations of pyrantel pamoate or ivermectin against naturally acquired infections with O. equi. Twenty-one horses (>4 months to 15 years of age) with patent, naturally acquired pinworm infections were blocked by source of origin and allocated rand...
Chaucheyras-Durand F, Durand H.The use of probiotics for farm animals has increased considerably over the last 15 years. Probiotics are defined as live microorganisms which can confer a health benefit for the host when administered in appropriate and regular quantities. Once ingested, the probiotic microorganisms can modulate the balance and activities of the gastrointestinal microbiota, whose role is fundamental to gut homeostasis. It has been demonstrated that numerous factors, such as dietary and management constraints, can strongly affect the structure and activities of the gut microbial communities, leading to impaired...
Jarrett M, Hibbert DB, Osborne R, Young EB.The analysis of total carbon dioxide (TCO(2)) in equine plasma is conventionally done in Australia and elsewhere using Beckman Synchron EL-ISE(R) analysers. This instrument is no longer being manufactured and has not been supported by the supplier since December 2008. For testing for TCO(2) to continue, it is necessary to evaluate and commission alternative instrumentation. In this paper, we compare the Beckman Synchron EL-ISE, the Beckman Synchron CX5, the Beckman UniCel DxC 600 and the Randox Daytona instruments. Results indicate that all four instruments perform in accordance with the manuf...
Heller MC, Jackson KA, Watson JL.Rhodococcus equi is a facultative intracellular bacterial pathogen of horses; infected foals develop pyogranulomatous pneumonia, however adult horses are largely unaffected. R. equi infects and proliferates within host macrophages and dendritic cells (DCs). DCs initiate the appropriate adaptive immune response, thereby playing a critical role in determining the outcome of infection. Our aim was to identify genes that are differentially expressed in R. equi infected monocyte-derived DCs (mdDCs). Peripheral blood monocytes from mares and foals were used to derive mdDCs by culturing with recombin...
White SD, Affolter VK, Dewey J, Kass PH, Outerbridge C, Ihrke PJ.Cutaneous vasculitis was identified by histopathological findings in 72 equines. The most frequent clinical findings were crusts/scales and oedema of the legs with the most common underlying disease being photo-aggravated dermatitis. Common laboratory findings were anaemia, neutrophilia, hyperglycaemia and hyperglobulinaemia. Histopathological patterns were most commonly cell-poor and lymphocytic/histiocytic. While statistically supported treatment recommendations could not be made due to the large numbers of confounding factors, trimethoprim-sulfa antibiotics, corticosteroids, and/or resoluti...
Sloet van Oldruitenborgh-Oosterbaan MM, van Poppel M, de Raat IJ, van den Boom R, Savelkoul HF.Intradermal tests using a Culicoides nubeculosus extract have proven unreliable for diagnosis of equine insect bite hypersensitivity (IBH) in the Netherlands. The aim of this study was to evaluate the diagnostic value of an extract derived from the Dutch species C. obsoletus and C. pulicaris. Thirteen pairs of horses were tested, each pair consisting of one horse with IBH and the other a healthy control. Each horse was injected intradermally with 0.1 mL of three concentrations of Culicoides whole body extract (1 : 1000 w/v, 1 : 10,000 w/v and 1 : 25,000 w/v), histamine solution (0.01 mg/mL, po...
Paterson S, Coumbe K.Chorioptic mange caused by Chorioptes bovis is a common pruritic skin condition of the horse. This surface-browsing parasite usually affects the lower legs (leg mange) but can present as a generalized skin disease. Numerous anecdotal reports exist in the literature about the benefit of lime sulphur as a treatment for surface ectoparasites in the horse. This report studies the use of lime sulphur when applied as a 5% solution, some with and some without prior shampooing and clipping, to treat confirmed cases of chorioptic mange in 22 horses. Horses included in the trial had clinical signs indic...
Flauger B, Krueger K, Gerhards H, Möstl E.Glucocorticoids or their metabolites can be measured in several body fluids or excreta, including plasma, saliva, urine and faeces. In recent years the measurement of glucocorticoid metabolites (GCMs) in faeces has gained increasing attention, because of its suitability for wild populations. In horses, however, the group-specific enzyme immunoassay described so far has a limited practicability due to its complex extraction procedure. Therefore, we tested the applicability of other enzyme immunoassays for glucocorticoid metabolites. The present study clearly proved that an enzyme immunoassay (E...
Hayama Y, Kobayashi S, Nishida T, Nishiguchi A, Tsutsui T.For determining surveillance programs or infectious disease countermeasures, risk evaluation approaches have been recently undertaken in the field of animal health. In the present study, to help establish efficient and effective surveillance and countermeasures for equine infectious diseases, we evaluated the potential risk of equine infectious disease transmission in non-race horses from the viewpoints of horse movements and health management practices by conducting a survey of non-race horse holdings. From the survey, the non-race horse population was classified into the following five secto...
Matsuda K, Suzuki H, Tsunoda N, Taniyama H.A 22-year-old Thoroughbred stallion had severe left jugular thrombophlebitis. Macroscopic and microscopic examinations revealed extension of the lesions from a penetrating ulcer on the left buccal mucosa to the underlying muscle and local vein, and sequentially to the left jugular vein. This was a rare case of equine jugular thrombophlebitis caused by direct extension of infection from a traumatic oral lesion.
Innes JF, Clegg P.Examples of naturally occurring musculoskeletal disorders are extremely common in veterinary species and provide a valuable comparative research resource, which can provide compelling comparative data on the aetiopathogenesis and treatment of many common human musculoskeletal diseases. In particular, orthopaedic diseases are a common morbidity in both dogs and horses. In this review, we give an overview of the common musculoskeletal diseases encountered in these species: for instance, tendon and ligament injuries, arthropathies and stress fractures, as well as an insight into the basic biology...
Güiris AD, Rojas HN, Berovides AV, Sosa PJ, Pérez EM, Cruz AE, Chávez HC, Moguel AJ, Jimenez-Coello M, Ortega-Pacheco A.A cross sectional survey was performed to identify gastrointestinal helminths and protozoans in naturally infected horses from the biosphere reserve known as "La Sierra Madre de Chiapas", Mexico (El Triunfo and La Sepultura). During a three-year survey, fecal samples from 90 horses and parasites from 2 necropsied animals were collected. Five families from the Nematoda class: Ascaridae, Kathlanidae, Oxyuridae, Strongylidae and Trichostrongylidae were found, whereas, only one family from the class Cestoda, was observed: Anoplocephalidae. One family from the class Insecta, was observed: Gasteroph...
Sigg L, Gerber V, Gottstein B, Doherr MG, Frey CF.In Switzerland, the prevalence and incidence of equine piroplasma parasite (EPP) infections are unknown. In order to obtain a first insight into the prevalence, a representative sample of 689 sera of horses from Switzerland was serologically tested for the presence of antibodies directed against T. equi and B. caballi using the Indirect Fluorescence Antibody Test (IFAT). A total of 50 (7.3%) horses were seropositive for EPP: overall, the seroprevalence of T. equi was significantly higher than that of B. caballi (p=0.002). The seropositivities in indigenous horses (animals bred and raised in Sw...
Katić I, Bajt VV.Transport of animals by water is a very old way of transport because it is relatively cheap and safe, with a minimum loss of animals. Waterways have been used for the transport of living animals and various goods from ancient times, for example in Ancient Egypt and the Roman Empire. Later, Vikings were so successful in their conquests because they always had trained horses aboard. It is believed that the colonization of America was possible because Spaniards were also bringing many horses with them. Danish possessions in the Caribbean owe much of their economic success in the period between 18...
White C, Dixon PM.There is limited knowledge on the thickness of subocclusal secondary dentine in equine cheek teeth (CT). Objective: Subocclusal secondary dentine is of consistent thickness above different pulp horns in individual horses and its thickness increases with age. Methods: 408 permanent CT were extracted post mortem from 17 horses aged 4-30 years, with no history of dental disease. The CT were sectioned longitudinally in the medio-lateral (bucco-palatal/lingual) plane through each pulp horn, and the thickness of the secondary dentine overlying each pulp horn was measured directly. Results: The suboc...
de Laat MA, McGowan CM, Sillence MN, Pollitt CC.Hyperinsulinaemia is known to induce laminitis experimentally in healthy ponies with no history of the condition. Horses are more insulin sensitive than ponies and whether prolonged hyperinsulinaemia and euglycaemia would have a similar laminitogenic effect requires study. Objective: To determine if laminitis results when the prolonged euglycaemic hyperinsulinaemic clamp technique (p-EHC) is applied to clinically normal Standardbred horses, and to monitor hoof wall temperature seeking an association between vascular activity and laminitis development. Methods: Eight young, clinically normal St...
Ramzan PH, Palmer L.Fissures of the occlusal surface of the equine cheek tooth are poorly understood and their association with dental disease is unknown. Objective: To describe the prevalence and location of occlusal fissures in the cheek teeth (CT) of a group of horses referred for dental investigation/treatment, and determine association with intercurrent dental disease. Methods: Digital video recordings of oral endoscopic examinations for all horses referred to the Rossdales Equine Hospital for dental investigation from November 2006 to June 2009 were reviewed. Location of occlusal fissures in relation to bot...
Keegan KG, Dent EV, Wilson DA, Janicek J, Kramer J, Lacarrubba A, Walsh DM, Cassells MW, Esther TM, Schiltz P, Frees KE, Wilhite CL, Clark JM....Previous studies have suggested that agreement between equine veterinarians subjectively evaluating lameness in horses is low. These studies were limited to small numbers of horses, evaluating movement on the treadmill or to evaluating previously-recorded videotape. Objective: To estimate agreement between equine practitioners performing lameness evaluations in horses in the live, over ground setting. Methods: 131 mature horses were evaluated for lameness by 2-5 clinicians (mean 3.2) with a weighted-average of 18.7 years of experience. Clinicians graded each limb using the AAEP lameness scale ...
Wright A, Beard L, Bawa B, Bras J.Equine dysautonomia, also known as equine grass sickness (EGS), is a well documented disease in several countries. To the authors' knowledge, EGS has not been reported previously in North America. This report describes EGS in a 6-year-old female mule in the USA. Failure initially to consider EGS resulted in a delayed diagnosis. EGS should be considered as a differential diagnosis and appropriate diagnostic tests performed in similar cases in North America.
Collins JA, Hanlon A, More SJ, Wall PG, Kennedy J, Duggan V.Significant potential threats to the health and welfare of horses exist in Ireland when supply exceeds demand and the identification system for horses is not yet robust. Objective: To secure engagement with stakeholder groups and determine their perception of equine welfare in Ireland and encourage the development of inclusive, rather than imposed, policy solutions. Methods: A 3 round, web-based Policy Delphi incorporating novel vignette methodology was conducted from November 2007-March 2008 to canvass opinion (in both quantitative and qualitative forms) on the perceived most significant equi...
Thorpe CT, Clegg PD, Birch HL.Tendon injury is one of the most common causes of wastage in the performance horse; the majority of tendon injuries occur to the superficial digital flexor tendon (SDFT) whereas few occur to the common digital extensor tendon. This review outlines the epidemiology and aetiology of equine tendon injury, reviews the different functions of the tendons in the equine forelimb and suggests possible reasons for the high rate of failure of the SDFT. An understanding of the mechanisms leading to matrix degeneration and subsequent tendon gross failure is the key to developing appropriate treatment and p...
Saveraid TC, Judy CE.The use of intravenous gadolinium contrast during equine magnetic resonance imaging (MRI) is a new technique that has been infrequently used in clinical imaging. This article describes the development of an effective contrast dose and the use of gadolinium contrast in clinical equine MRI. Gadolinium contrast improves lesion conspicuity across a broad range of lesion types. Contrast-enhanced MRI is potentially a valuable imaging tool in the assessment of the equine athlete.
Kinobe RT.Cobalt is an essential trace element for many vital physiological functions. Cobalt is also known to stabilise hypoxia-inducible transcription factors leading to increased expression of erythropoietin which activates production of red blood cells. This implies that cobalt can be used to enhance aerobic performance in racing horses. If this becomes a pervasive practice, the welfare of racing animals would be at risk because cobalt is associated with cardiovascular, haematological, thyroid gland and reproductive toxicity as observed in laboratory animals and humans. It is expected that similar e...
Atiba A, Ghazy A, Hamad MH.Cutaneous pythiosis in horses is a chronic ulcerative granulomatous disease caused by the oomycete Pythium insidiosum. Objective: The objective of the present study was to evaluate the response of cutaneous pythiosis in horses to surgical excision and topical dimethyl sulphoxide (DMSO). Methods: Thirty horses were presented clinically with pruritus, fistulae discharging serosanguineous fluid, and output kunkers in different body areas (limb, abdomen, neck, and face). The clinical diagnosis was confirmed by isolation of the causative agent and histopathology. All animals were treated by surgica...
Barrowman PR.To establish the ability of Trypanosoma equiperdum to cross the blood-brain-barrier in the horse, a susceptible stallion was infected via the cerebrospinal fluid of the subarachnoid space by lumbosacral puncture. Cerebrospinal fluid with low detectable levels of trypanosomes removed from a dourine-infected mare by lumbosacral puncture was used for infecting the animal. The parasite was detected in blood smears of the recipient 13 days after infection and the subsequent parasitaemia and clinical course of the disease followed that of naturally infected horses.
Jørgensen E, Pirone A, Jacobsen S, Miragliotta V.The re-epithelialization process in equine wound healing is incompletely described. For epithelial cells to migrate during embryogenesis they undergo epithelial-to-mesenchymal transition (EMT); this phenotypic transition occurs during wound healing in humans and rodents, but it has not been investigated in horses. Objective: To investigate keratinocyte differentiation and EMT in equine experimental excisional limb and body wounds healing by second intention. Methods: Six adult research horses. Methods: Immunohistochemical analysis was used to detect expression of the differentiation markers cy...
Alonso BB, La Rosa L, Carregaro AB, Gasthuys F, Schauvliege S.To examine the influence of detomidine or romifidine on recovery quality from isoflurane anesthesia, 78 anesthetic records were reviewed, from horses that had received romifidine (group R) during premedication [80-120 μg kg IV], anesthetic maintenance (40 μg kg hour IV), and recovery (20 μg kg IV) or detomidine (group D), at doses of 10-20 μg kg IV, 5 μg kg hour IV, and 2.5 μg kg IV, respectively. Duration of the different recovery phases, the number of attempts to sternal and standing, scores for transition to standing (TrSta), balance and coordination once standing (BC), and fina...
Sponseller BA, Sponseller BT, Alcott CJ, Kline K, Hostetter J, Reinertson EL, Fales-Williams A.Syringomyelia and hydromyelia are cavitary lesions of the spinal cord that may be acquired or congenital. These lesions are not frequently reported in large animal species. The presenting complaints, clinical, gross pathological, and histopathologic findings of 2 cases of syringomyelia and 1 case of hydromyelia in horses are described. La syringomyélie et l’hydromyélie sont des lésions cavitaires de la colonne vertébrale qui peuvent être acquises ou congénitales. Ces lésions ne sont pas fréquemment signalées chez les espèces de grands animaux. Les plaintes de présentation et les ...
Ellis DR.The common spontaneous fractures of the third metacarpus and
metatarsus of young racehorses are split cannons or condylar
fractures. Meagher (1976) described a series of 45 cases involving
the lateral condyle and Richardson (1984) detailed 15 cases involving
the medial metatarsal condyle. Rick et al. (1983) published a clinical
and pathological study of 75 cases of third metacarpal and metatarsal
condylar fracture. In the United Kingdom, Barr et al. (1989) recorded
8 cases with long fractures, 3 lateral and 5 medial condylar. This
paper reports 124 cases of medial or lateral condylar f...
Cavalero TMS, Segabinazzi LGTM, Scheeren VFC, Canuto LEF, Gobato MLM, Papa FF.A 7-year-old Quarter Horse stallion was admitted at the hospital with a history of ejaculatory failure for 12 months. The stallion revealed no physical or psychological abnormalities, as well as, normal libido and erection. In addition, there were no abnormalities in accessory sex glands or the aorta artery detected by transrectal ultrasonography. Based on clinical findings, the stallion was diagnosed with an idiopathic ejaculatory dysfunction; therefore, alternative attempts of semen collection were performed. Thermal compress on the basis of the stallion's penis, semen collection on the gro...
Song J, Song R, Wang P, Zhang Y, Yan Y, Zhou J, Chahan B, Liao M.The erythrocytic-stage surface protein equi merozoite antigen 1 (EMA-1) of Theileria equi is a major candidate for the development of a diagnostic antigen for equine piroplasmosis. In this study, BALB/c mice were immunized with purified recombinant EMA-1 to prepare monoclonal antibody (mAb) against T. equi EMA-1, and 1 mAb 5H2 was obtained that showed good reaction with infected red blood cells (RBC) in the indirect immunofluorescence assay (IFA). To develop a rapid serological detection method for T. equi infection in Xinjiang Uygur Autonomous Region, China, recombinant EMA-1 originating from...
The Journal of heredityNovember 1, 1975
Volume 66, Issue 6 318-326 doi: 10.1093/oxfordjournals.jhered.a108640
Gardner EJ, Shupe JL, Leone NC, Olson AE.Comparative studies are being conducted on hereditary multiple exostosis in man and the horse. In both, there is an unquestionable inheritance pattern of a typical single, dominant, autosomal gene. Those who carry the gene have a one-half chance of transmitting it to each offspring, whereas, those who do not carry the gene do not transmit this abnormality to their progeny. The lesions are clinically and histologically similar; no persistent chromosomal irregularities have been associated with the abnormality in either man or the horse and no single evidence of malignancy in either man or anima...
Martin GS, McIlwraith CW.Arthroscopic anatomy of the equine intercarpal and radiocarpal joints was documented in six cadaver limbs and on observations made during surgical treatment of horses with carpal osteochondral fractures. Instrument positions and arthroscopic visualisation were recorded. The cadaver limbs were dissected and iatrogenic lesions recorded. A single arthroscopic portal examination was adequate in both joints; however, a second arthroscopic portal improved visualisation. The intercarpal joint was more easily examined than the radiocarpal joint because of anatomical differences. Iatrogenic lesions wer...
Lester GD, Alleman AR, Raskin RE, Meyer JC.Pancytopenia was observed in two 3-year-old geldings and one 11-year-old mare. All horses had a brief history (2 days to 4 weeks) of fever, anorexia, and depression. One of the three horses had blast cells present on a peripheral blood smear. Examination of the bone marrow showed substantial infiltration with neoplastic lymphoid cells. At necropsy, neoplastic cells were restricted to the bone marrow in one horse, present in bone marrow, liver, and spleen in the second horse, and reported in multiple tissues in the third horse, including bone marrow, kidneys, lung, myocardium and lymph nodes. T...
Walbornn SR, Love CC, Blanchard TL, Brinsko SP, Varner DD.Breeding records were analyzed from 24 Thoroughbred stallions that were subjected to dual-hemisphere breeding (DH), including novice (first-year; NOV; n = 11) and experienced (EXP; n = 13) stallions. Fertility variables included seasonal pregnancy rate, pregnancy rate per cycle, and first-cycle pregnancy rate. In addition, values for book size, total number of covers, distribution of mare type (maiden, foaling, and barren) within a stallion's book, cycles per mare, and mare age were examined. Some data were also categorized by mare type (maiden-M, foaling-F, and barren-B). Five separate an...
Nixon J.Equine consultant, Jane Nixon, attended the first equine biosecurity course at the British Racing School in November last year, organised by Whorl Publishing. Here, she reports on some of the issues covered.
Schembri MA, Major DA, Suttie JJ, Maxwell WM, Evans G.Chlortetracycline (CTC) fluorescence staining analysis was used to investigate cryopreservation-induced capacitation-like changes in equine spermatozoa. Freshly ejaculated spermatozoa were found to display a high proportion of F pattern cells (uncapacitated; 93.6%) and a lower proportion of B pattern (capacitated; 5.4%) and AR pattern (acrosome-reacted; 1%) cells. Following cryopreservation in modified Kenney's medium, capacitation-like changes were observed. There was a significant increase in the proportion of spermatozoa displaying the B pattern (64.8%; P<0.001) and AR pattern (32.8%; P&...
Valentine BA, de Lahunta A, Divers TJ, Ducharme NG, Orcutt RS.Two Belgian geldings, 4 and 14 years old, respectively, with muscle atrophy, weakness, and abnormal gait characteristic of severe advanced shivers were examined clinically and on necropsy. Neurologic examination revealed no evidence of ataxia, and the clinical diagnosis was neuromuscular weakness and shivers. Necropsies of both horses, including examination of pituitary, brain, spinal cord, spinal roots and ganglia, and peripheral nerves, revealed no gross or histologic abnormalities. Examination of multiple skeletal muscle specimens revealed chronic myopathic changes and periodic acid-Schiff ...