Analyze Diet

Topic:Equine Medicine

Equine Medicine encompasses the study and application of medical practices specifically related to the health and well-being of horses. This field involves the diagnosis, treatment, and prevention of diseases and disorders affecting equine species. It covers a wide range of topics, including internal medicine, surgery, reproduction, and pharmacology. Research in equine medicine often focuses on understanding the physiological and pathological processes unique to horses, as well as developing effective therapeutic interventions. This page aggregates peer-reviewed research studies and scholarly articles that explore various aspects of equine medicine, providing insights into the latest advancements and methodologies in the care and management of horse health.
Cheek tooth extraction in geriatric versus non-geriatric horses.
Equine veterinary journal    May 31, 2026   doi: 10.1002/evj.70199
Mair E, Nekouei O, Trummer-Schug P, Haralambus R, Biermann NM.Age-related dental changes are major contributors to dental disorders in older horses, and cheek tooth extractions are often required to maintain masticatory function and oral comfort. However, limited information is available on clinical and treatment characteristics in this older patient population. Objective: To describe clinical features, treatments, complication rates and short-term outcomes of horses undergoing oral cheek tooth extraction and treatment of odontogenic sinusitis, and to compare findings between geriatric and non-geriatric horses. Methods: Retrospective analysis of clinical...
Laser neoureterocystostomy to treat ectopic ureters.
Equine veterinary journal    May 31, 2026   doi: 10.1002/evj.70201
Smith C, Parente EJ.Ureteral ectopia is an uncommon but clinically important congenital abnormality in horses. If left untreated, it can lead to persistent dermatitis, urinary tract infections, and failure to thrive. Surgical correction is necessary, but traditional approaches have produced mixed results with high morbidity. Identification of a minimally invasive, effective technique would significantly improve prognosis. Objective: To describe the procedure and outcomes of cystoscopic guided laser neoureterocystostomy in three fillies. Methods: Case series. Methods: Retrospective review of three cases treated wi...
Management of Equine Post-Extraction Cheek Tooth Alveoli: Application of Alveolar Plugs.
Animals : an open access journal from MDPI    May 30, 2026   Volume 16, Issue 11 1678 doi: 10.3390/ani16111678
Śmich J, Górski K, Maśko M, Borowska M, Turek B, Domino M.Preservation of dentition remains the primary goal of equine dentistry; however, cheek tooth extraction is required in cases of severe dental pathology. Following tooth extraction, management of the post-extraction alveolus remains a significant clinical challenge due to its large size and susceptibility to contamination with feed material and bacteria. To mitigate these risks, alveolar plugs are commonly used to protect the alveolus, stabilize the blood clot, and support granulation tissue formation. This review summarizes the current case reports and research articles regarding the use of al...
Pilot Study of an Alpha-2-Macroglobulin-Enriched Plasma-Derived Orthobiologic Preparation in Sport Horses with Chronic Degenerative Joint Disease.
Veterinary sciences    May 29, 2026   Volume 13, Issue 6 536 doi: 10.3390/vetsci13060536
Gugliandolo E, Biondi V, De Luca M, Nangano E, Strozzi G, Tosto F, Franco GA, Van Reusel Y, Catone G, Spaas JH.Chronic joint disease is a major cause of lameness and reduced performance in sport horses and is characterized by persistent synovial inflammation and protease-mediated matrix degradation. This exploratory prospective pilot study investigated clinical outcomes and synovial biomarker changes following intra-articular administration of an α-2-macroglobulin plasma-derived preparation. Twenty client-owned sport horses were observed in the treatment group (n = 10) or a comparison group (n = 10) and monitored for up to 180 days under field conditions. Clinical outcomes were assessed longitudinally...
Positive Reinforcement (R+) Horse Training in Practice: Evaluation of Online Trailer-Training Demonstrations.
Animals : an open access journal from MDPI    May 29, 2026   Volume 16, Issue 11 1667 doi: 10.3390/ani16111667
Harris HG, McDonnell SM.Operant conditioning that includes primarily positive reinforcement (R+) has been shown to be an effective and welfare-friendly method of training horses. Despite this, operant conditioning and R+ are not fully understood by many horse trainers who claim to advocate for its use. Anecdotal observations suggest that some professional trainers who claim to use R+ do not use R+ primarily, even in publicly offered educational demonstrations. To better understand readily available training materials regarding the use of R+ with horses, we reviewed a sample of 20 online trailer-training demonstration...
Do Polish Konik Horses Find Soaked Hay to Be Palatable?
Animals : an open access journal from MDPI    May 29, 2026   Volume 16, Issue 11 1663 doi: 10.3390/ani16111663
Tkaczyk E, Gazda IE, Humięcka M, Łuszczyński J, Basińska K, Kaczmarek B, Barłowska J, Tkaczyk P, Janczarek I.Frequently, equine diseases necessitate the moistening or soaking of hay for the horses. It was assumed that this treatment would not reduce the willingness of the Polish Konik horses with low nutritional requirements to consume the hay. Furthermore, it was believed that moistening would increase the palatability of this feed. The aim of this study was to determine time and frequency parameters and the amount of unconsumed dry, moist, or soaked hay. The research material comprised 12 Polish Konik horses consuming either 1 kg of dry hay, 2.1 kg of moist hay, or 3.3 kg of soaked hay on three sub...
Thoracic electrical impedance tomography using a two-plane electrode configuration in horses.
Equine veterinary journal    May 28, 2026   doi: 10.1002/evj.70188
Studer N, Byrne D, Raisis A, Adler A, Cheong J, Secombe C, Schramel JP, Mosing M.Traditional one-plane (oneP) electrical impedance tomography (EIT) electrode configurations limit evaluation to a convex lens-shaped lung slice, prone to overrepresentation of central areas. Two-plane (twoP) EIT is expected to refine this technique and result in more representative lung imaging. Objective: To compare ventilation distribution using single slice reconstructions, obtained with twoP or oneP. Methods: Computational modelling and in vivo exploratory randomised experimental trial. Methods: A finite element simulation model of oneP and twoP was calculated to estimate captured lung fie...
Biliary Disorders in Horses.
The Veterinary clinics of North America. Equine practice    May 28, 2026   S0749-0739(26)00020-9 doi: 10.1016/j.cveq.2026.04.005
Peek SF, Sebastian K.This review will mainly focus on the presentation, diagnosis, and treatment of cholangiohepatitis in adult horses. The condition is often accompanied by some degree of intrahepatic and/or extrahepatic biliary obstruction with "sludgy" bile or actual choleliths. In horses, these calculi are typically composed of calcium bilirubinate, rather than cholesterol. There is a propensity for cholangiohepatitis to become a recurrent, chronic condition and patient management should reflect this. Although much rarer, foreign body obstruction, neoplasia and, in some parts of the world, liver flukes can als...
Topical betulinic acid for treatment of equine melanoma and sarcoid.
Frontiers in veterinary science    May 28, 2026   Volume 13 1821503 doi: 10.3389/fvets.2026.1821503
Moreno C, Mudge M, Horne R, Yardley J.Betulinic acid, a natural pentacyclic triterpenoid, has demonstrated anti-inflammatory and anti-tumor properties in vitro, including activity against equine melanoma and sarcoid. However, there is limited in vivo evidence evaluating its clinical efficacy. The objective of this study was to assess the safety and efficacy of a compounded 1% betulinic acid cream for the treatment of equine cutaneous melanoma and sarcoid. Unassigned: This prospective, randomized, double-blinded, placebo-controlled clinical trial enrolled client-owned horses with melanoma or sarcoid tumors. Horses received either a...
Equine Liver Histopathology.
The Veterinary clinics of North America. Equine practice    May 28, 2026   Volume 42, Issue 2 249-266 doi: 10.1016/j.cveq.2026.04.003
Jager MC.This review summarizes best practices for equine liver biopsy, including when to perform a biopsy, techniques for sample collection and handling, and strategies to optimize diagnostic yield. It discusses the interpretive framework used by pathologists, common diagnostic challenges, and prognostic scoring systems. Limitations such as sampling error and variability among observers are considered alongside ancillary testing, immunohistochemistry, and in situ hybridization. Emphasis is placed on the importance of communication between clinicians and pathologists to maximize diagnostic and prognost...
Feasibility of a hand-held myotonometry device for measuring biomechanical muscle parameters in horses.
American journal of veterinary research    May 27, 2026   1-7 doi: 10.2460/ajvr.26.02.0050
Ribeiro G, Agrícola R, Sanchez MMF, Ramos FR, Borges J, Abrantes J, Prazeres J.To evaluate the feasibility of a hand-held myotometry device for measuring the biomechanical parameters (frequency, stiffness, and decrement) of the longissimus dorsi muscle in the thoracolumbar region of healthy horses. Unassigned: Data were obtained from 50 adult horses. The biomechanical parameters were measured using a MyotonPRO device in triple-scan mode. Measurements were recorded on both sides, with the horses standing square. The analysis focused on whether there were differences between the sides and correlations between the variables. Unassigned: The mean muscle frequency (hertz) was...
Evaluation of doppler indexes of the lateral palmar digital artery in lame sport horses.
Research in veterinary science    May 27, 2026   Volume 209 106276 doi: 10.1016/j.rvsc.2026.106276
de Chiara M, De Matteis A, Del Prete C, Costanza D, Montano C, Auletta L, Marinelli VG, Buono F, Pasolini MP.Although lateral palmar digital artery (LPDA) flow velocity does not differ between forelimbs, horses with lameness typically reduce loading of the affected limb during the weight-bearing phase. This study aimed to assess whether Pulsed-Wave (PW) Doppler indices of the (LPDA) blood flow differ between the two forelimbs in horses with unilateral forelimb lameness, and whether these differences correlate with lameness severity. Twenty-seven lame and 15 healthy horses were enrolled. All Doppler ultrasonographic examinations were performed by a single operator, blinded to both the presence or abse...
Derivatisation-free FIA-MS/MS assay for rapid simultaneous screening of atypical myopathy biomarkers and acylcarnitine profiles from dried blood spots.
Analytical and bioanalytical chemistry    May 27, 2026   doi: 10.1007/s00216-026-06566-3
Kadláčková M, Dobešová D, Ivanovová E, Masař R, Jahn P, Šamonilová E, Friedecký D, Brumarová R.Atypical myopathy (AM) is a frequently fatal, toxin-induced disease in horses, characterised by acute progression and mortality rates exceeding 70% within 72 h. The disease is caused by ingestion of seedlings or seeds of certain maple species that contain the toxins hypoglycin A (HGA) and methylenecyclopropylglycine (MCPrG). Early diagnosis depends on reliable detection of these compounds and their metabolites. However, most available LC-MS/MS assays are limited by derivatisation requirements and dependence on serum and urine matrices. Here, a rapid derivatisation-free flow injection analysis...
Anatomical distribution of meconium detected by focused abdominal ultrasound in hospitalized healthy and sick neonatal foals.
Journal of equine veterinary science    May 27, 2026   Volume 165 105945 doi: 10.1016/j.jevs.2026.105945
Maggi A, Ellero N, Busoni V, Imposimato I, Castagnetti C, Lanci A, Mariella J, Freccero F.Meconium impaction is a common cause of neonatal colic in foals, yet its ultrasonographic appearance and distribution remain poorly characterized. Objective: This study aimed to describe the frequency, distribution, and ultrasonographic appearance of meconium in hospitalized neonatal foals using a standardized focused ultrasound (FUS) abdominal protocol. Methods: The FUS protocol included 9 acoustic windows (3 left-sided, 3 ventral, 3 right-sided) and was performed once during hospitalization by a single operator using a curvilinear transducer. Results: Thirty-six foals (16 healthy and 20 sick...
Derivation of Equine Mesenchymal Stem/Stromal Cells from Induced Pluripotent Stem Cells via the Neural Crest Pathway and Characterisation by Immunophenotype and Tri-Lineage Differentiation.
Animals : an open access journal from MDPI    May 26, 2026   Volume 16, Issue 11 1618 doi: 10.3390/ani16111618
Bernad E, Serrano B, Vitoria A, Fuente S, Romero A, Vázquez FJ, Zaragoza P, Rodellar C, Cequier A, Barrachina L.Mesenchymal stem/stromal cells (MSCs) hold promise for treating different equine conditions but enter senescence during culture. Using induced pluripotent stem cells (iPSCs) to derive MSC-like cells (iMSCs) can increase cell availability and diminish the need for invasive and repeated tissue harvesting. While human iMSCs are intensively studied, research on equine iMSCs (eqiMSCs) is very limited and has focused on strategies for spontaneous differentiation to obtain these cells. The aim of this study was to obtain MSC-like cells from equine iPSCs (eqiPSCs) by directing their differentiation vi...
Use of Intraperitoneal Lidocaine in Horses Undergoing Laparotomy for Colic.
Animals : an open access journal from MDPI    May 26, 2026   Volume 16, Issue 11 1616 doi: 10.3390/ani16111616
Giulivi F, Nannarone S.Perioperative lidocaine is widely used in horses with acute abdomen for its analgesic, prokinetic, anti-inflammatory, and anti-endotoxic effects, although evidence of its visceral analgesic efficacy remains inconclusive. Given the potential of alternative routes of administration for local anaesthetics, this prospective, randomised, unblinded clinical trial evaluated whether intraperitoneal (IP) lidocaine improves early postoperative recovery, including recovery from anaesthesia and the first 24 h after laparotomy for colic. A Multifactorial Numerical Rating Composite Pain Scale for equines wa...
The effect of romifidine on endoscopic grading of laryngeal function in horses.
The Veterinary record    May 22, 2026   doi: 10.1002/vetr.70804
Murphy C, Baglioni M, Lepage OM, Schumacher J, Kelleher L, Burke J, Gangl M.To our knowledge, the effect of sedation with romifidine on the grading of laryngeal function in horses has not been studied. Our objective was to examine the effects of romifidine on the grading of laryngeal function and the cross-sectional area of the rima glottis (CSARG). Methods: Ten horses underwent three endoscopic examinations of the larynx: once while unsedated (group R1), once after being sedated with romifidine (0.04 mg/kg intravenously; group R2) and once again, while still sedated, after receiving a repeat dose of romifidine (0.08 mg/kg intravenously, total dose; group R3). The r...
Activity of 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6′-methylresorufin) ester lipase in peritoneal fluid may be associated with strangulating lesions, pancreatic fibrosis, and negative outcome in horses with colic.
Journal of the American Veterinary Medical Association    May 22, 2026   1-8 doi: 10.2460/javma.25.11.0720
Greer HR, Whitfield-Cargile C, Sebastian D, Berghaus L, Stanton JB, Coleman MC.To compare plasma and peritoneal 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6'-methylresorufin) ester (DGGR) lipase activity between horses with and without colic signs and document pancreatic histopathology in a subset of horses. Unassigned: This prospective, cross-sectional study included university-owned or donated healthy horses and client-owned horses presenting to the veterinary teaching hospital for colic. Peritoneal WBC and lactate concentrations and plasma and peritoneal DGGR lipase activity were measured. Pancreatic tissue was collected via convenience sampling. Pancreatic fibrosis ...
Near-Term Extrauterine Pregnancy Secondary To Uterine Rupture In A Mare.
Journal of equine veterinary science    May 22, 2026   105943 doi: 10.1016/j.jevs.2026.105943
Palmieri V, Catone G, Conte A, Di Palma T, Liguori P, Izzo I, Vullo C.Uterine rupture is an uncommon but life-threatening complication of equine reproduction, typically associated with dystocia, uterine torsion, fetal manipulation, or hydrops. Tears may occur in either the uterine horns or body, although involvement of the ventral uterine body is rare. This case report describes an 11-year-old Arabian mare at 350 days of gestation that developed abdominal pregnancy secondary to uterine torsion and full-thickness ventral uterine rupture, resulting in fetal death and the free presence of the fetus within the peritoneal cavity. Surgical removal of the fetus and pri...
A Genetic Algorithm-Based Approach for Quantitative Prediction of Drug-Drug Interactions Caused by Cytochrome P450 3A Inhibition or Induction in Horses.
Pharmaceuticals (Basel, Switzerland)    May 22, 2026   Volume 19, Issue 6 815 doi: 10.3390/ph19060815
Di Paolo V, Ferrari FM, Poggesi I, Dacasto M, Quintieri L, Capolongo F. A genetic algorithm (GA)-based approach was designed to predict drug-drug interactions (DDIs) triggered by cytochrome P450 3A (CYP3A) inhibition or induction in horses. Area under the concentration-time curve ratios (AUCRs), obtained from published in vivo DDI studies in horses, were used to compute the following parameters: (1) the contribution ratio (CR), i.e., the fraction of the substrate dose metabolized via the CYP3A pathway, and (2) the interacting drug's inhibitory potency or inducing efficacy (IR or IC, respectively). AUCRs for 9 substrates, 12 inhibitors, and 1 inducer of equine C...
Owner satisfaction and animal welfare after bilateral enucleation in horses.
Equine veterinary journal    May 21, 2026   doi: 10.1002/evj.70190
Gasco J, Sauvage A, Monclin SJ, Narinx F.Bilateral enucleation in horses represents a challenging decision for owners, undertaken to relieve chronic, untreatable ocular pain. Emotional distress and uncertainty regarding postoperative welfare often lead to euthanasia instead of surgery. Objective: To evaluate owner perceptions of equine quality of life before and after bilateral enucleation, and to assess satisfaction with the procedure. Methods: Retrospective case series. Methods: Medical records from 21 horses that underwent bilateral enucleation between 2016 and 2024 were reviewed. Owners completed a structured survey assessing sat...
Use of strain and shear wave elastography in the ultrasonographic evaluation of the intermediate patellar ligament in horses: comparison and consistency of data.
Frontiers in veterinary science    May 20, 2026   Volume 13 1817578 doi: 10.3389/fvets.2026.1817578
Straticò P, Bandera L, Guerri G, Agosta A, Paolacci I, Petrizzi L, Vignoli M, Varasano V.The clinical significance and ultrasonographic features of intermediate patellar ligament (IPL) desmopathy in horses are still debated and considered nonspecific. Elastosonography allows assessment of tissue elasticity in response to an external stimulus. The aim of the study was to describe the elastosonographic characteristics of the equine IPL, evaluate the feasibility of both strain (SE) and two-dimensional shear wave elastography (2D-SWE), and assess the consistency of the data obtained from these techniques. 20 adult horses of mixed breed, sex and athletic use were selected and allocated...
Evaluation of Circadian Variations of Central Corneal Thickness and Its Correlation With Intraocular Pressures in Healthy Horses.
Veterinary ophthalmology    May 20, 2026   Volume 29, Issue 4 e70194 doi: 10.1111/vop.70194
Iturregui C, Liu CC, Carter RT, Camacho-Luna P.Circadian variations in central corneal thickness (CCT) and their correlation with intraocular pressure (IOP) have not been reported in horses. This information may be clinically relevant when interpreting IOP readings. Methods: Twenty-four eyes of 6 healthy adult gelded males and 6 healthy adult intact mares were evaluated. Rebound tonometry (TonoVet, Jorgensen Laboratories) followed by ultrasonic pachymetry (iPac Pachymeter, Reichert technologies) was performed in both eyes every 3 h over 24 h during the natural 14-h daylight summer photoperiod. Results: Central corneal thickness varied ...
Bronchoalveolar lavage changes the ultrasonographic and radiographic appearances of lungs in adult horses.
Journal of the American Veterinary Medical Association    May 20, 2026   1-8 doi: 10.2460/javma.26.03.0161
Hepworth-Warren KL, Harbor K, Nelson NC, Kurihara M, Qu Y.To describe the effect of bronchoalveolar lavage (BAL) on the ultrasonographic and radiographic appearances of lungs of horses being evaluated for equine asthma syndrome (EAS). Unassigned: Prospective observational study enrolling 32 adult horses evaluated for EAS. Ultrasonographic and radiographic examinations of the thorax were performed before and within 3 hours following BAL and scored using previously validated systems. The differences in scores between groups (normal, mild EAS, moderate/severe EAS) were evaluated through the Kruskal-Wallis test, and the differences in scores before and f...
Farm Atmosphere: Calm Attention and Mobility Characterise Positive Horse Welfare.
Animals : an open access journal from MDPI    May 20, 2026   Volume 16, Issue 10 1557 doi: 10.3390/ani16101557
Hausberger M, Lerch N, Grandgeorge M.On-farm welfare assessment of equines is a challenge given the large diversity of management practices, especially in terms of housing and activities. In our study, we tested time budget measures as a complementary tool to more conventional welfare indicators (e.g., stereotypic behaviours, ear position while foraging, neck shape). We observed 174 horses living in eight facilities (in their home environment) for which data on management practices and welfare were available. Time budget was assessed using the scan sampling method (1 min scan sampling over 30 min; 33 scans), while welfare assessm...
Myofascial trigger points as a primary cause of equine lameness: a biomechanical, neurophysiological, and fascial review.
Frontiers in veterinary science    May 20, 2026   Volume 13 1852775 doi: 10.3389/fvets.2026.1852775
Scheibenpflug M, Haussler KK.Equine lameness diagnosis is dominated by a joint- and tendon-centric paradigm. The standard diagnostic algorithm relies on gait observation, perineural and intrasynovial anesthesia, and cross-sectional imaging. It is directed almost exclusively at skeletal and articular structures. Myofascial trigger points (MTrPs) are hypersensitive, hyperirritable loci within taut bands of skeletal muscle. They produce local and referred pain on compression or contraction. In horses, MTrPs are a clinically relevant but systematically overlooked source of primary lameness. This review synthesises evidence fr...
Ultrasound guidance aids in determining the success of equine temporomandibular joint arthrocentesis.
Frontiers in veterinary science    May 20, 2026   Volume 13 1812140 doi: 10.3389/fvets.2026.1812140
Lopez DE, Carmalt JL.The equine temporomandibular joint (TMJ) is divided into two non-communicating joint (discotemporal DTJ and discomandibular DMJ) compartments. Ultrasound has been extensively used as a diagnostic tool in the horse, but previous work has reported that ultrasound-guidance did not improve the success rate of TMJ arthrocentesis. However, this research focused only on the larger, easily accessed, DTJ compartment. However, most of the osseous pathology of the equine TMJ has been reported to be in the smaller DMJ. Unassigned: To determine whether using ultrasound-guidance would reduce the number of a...
Protective effects of adiponectin receptor agonists against equine lamellar endoplasmic reticulum stress.
Equine veterinary journal    May 20, 2026   doi: 10.1002/evj.70195
Barnabé MA, Elliott J, Menzies-Gow NJ, Bailey SR, Bamford NJ, Chang YM, Gage MC.Lamellar endoplasmic reticulum (ER) stress occurs in hyperinsulinemia-associated and sepsis-related laminitis. Adiponectin is associated with reduced laminitis risk and inhibits ER stress in other species. Objective: To induce ER stress in ex vivo equine lamellar cells using pharmacological agents. To determine whether co-treatment with adiponectin receptor agonists (ARAs) reduces ER stress. Methods: In vitro. Methods: Lamellar cells from n = 4-5 horses were treated with tunicamycin or thapsigargin (10-1000 nM) for 2-24 h. ER-stressed cells were co-treated with full-length adiponectin ...
Comparison of Two Different Finite Element Modeling Pipelines for Virtual Mechanical Testing of The Distal Third Metacarpal Bone In Thoroughbred Racehorses.
Journal of biomechanical engineering    May 20, 2026   1-21 doi: 10.1115/1.4071974
Irandoust S, Malekipour F, Whitton C, Muir P, Lee PVS, Henak C.Condylar stress fracture of the third metacarpal bone (MC3) in Thoroughbred racehorses is a common catastrophic injury and identification of horses at heightened risk remains subjective. Standing computed tomography (sCT) is a practical screening tool that enables patient-specific finite element analysis (FEA) of the distal MC3 and prediction of subchondral bone strain, as a potential objective classifier of racehorses at heightened risk. The goal of this study was to compare two independently developed sCT-based subject-specific FEA pipelines for virtual mechanical testing of the distal MC3. ...
Venous blood lactate concentration as a predictor of intestinal viability in horses with acquired indirect inguinal hernia.
Equine veterinary journal    May 19, 2026   doi: 10.1002/evj.70193
Rivero-García R, Andreu-Vázquez C, Fuentes-Romero B, Fernández-Hernández P, Rodríguez-Pozo ML, Sebastián IA, Soto ST, Gallardo MM....Background: Acquired indirect inguinal hernia represents a life-threatening emergency. Therapeutic decision-making largely depends on intestinal viability, for which specific predictive parameters (such as venous lactate) have not been evaluated.Objectives: Investigating the predictive performance of venous blood lactate and other laboratory results on intestinal viability in horses with acquired indirect inguinal hernias.Study designRetrospective multicentre observational study.Methods: Seventy-four horses diagnosed with acquired indirect inguinal hernia (treated surgically) at two referral h...
1 5 6 7 8 9 91