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Topic:Hemorrhage

Hemorrhage in horses refers to the escape of blood from blood vessels into surrounding tissues or outside the body, which can occur due to trauma, surgical procedures, or underlying health conditions. It presents in various forms, such as internal bleeding, external bleeding, or bleeding into body cavities. Hemorrhage can affect different systems within the horse, including the respiratory, gastrointestinal, and musculoskeletal systems, depending on the location and severity of the bleeding. The management of hemorrhage involves identifying the source of bleeding, controlling blood loss, and providing supportive care to maintain the horse's physiological stability. This page compiles peer-reviewed research studies and scholarly articles that explore the causes, mechanisms, and management strategies of hemorrhage in equine medicine.
Complete upper airway collapse and apnoea during tethered swimming in horses.
Equine veterinary journal    October 8, 2019   Volume 52, Issue 3 352-358 doi: 10.1111/evj.13177
Jones S, Franklin S, Martin C, Steel C.There is limited knowledge of the breathing strategy and impact on the patency of the upper respiratory tract (URT) in swimming horses. Objective: To describe the respiratory responses and endoscopic appearance of the URT during tethered swimming in horses. Methods: Prospective descriptive study. Methods: Ten race-fit horses, with no history of URT obstruction, were examined during tethered swimming. Endoscopic examination, heart rate, sound recordings and above and below water video recordings were obtained. Plasma lactate concentration was measured before and 5 min after swimming and trache...
Fatal lancehead pit viper (Bothrops spp.) envenomation in horses.
Toxicon : official journal of the International Society on Toxinology    September 6, 2019   Volume 170 41-50 doi: 10.1016/j.toxicon.2019.09.002
Machado M, Wilson TM, Ribeiro de Sousa DE, Lopes Câmara AC, Furlan FH, Silva Almeida E Macêdo JT, Pupin RC, Amaral de Lemos RA, Armién AG....Snake bite envenomations in farm animals are generally overestimated as the cause of mortality in rural areas in Latin America. However, most cases are based only on anecdotal information and assumptions, and lack diagnostic evidence. There are few proven reports of envenomation and death in horses caused by snakebites from members of the Bothrops genus (lancehead pit vipers). This study presents epidemiological and clinical-pathological findings of fatal bothropic envenomation in horses from Central Western Brazil in order to contribute to the correct diagnosis of this condition. A survey of ...
Prevalence of exercise-induced pulmonary hemorrhage in competing endurance horses.
Journal of the American Veterinary Medical Association    September 4, 2019   Volume 255, Issue 6 710-715 doi: 10.2460/javma.255.6.710
Tarancón I, Armengou L, Melendez-Lazo A, Pastor J, Ríos J, Jose-Cunilleras E.To assess the prevalence of exercise-induced pulmonary hemorrhage (EIPH) among elite endurance horses after competition in a long-distance race. 20 endurance horses and 12 nonexercised or minimally exercised age-, breed-, and trainer-matched horses from the same environment (control horses). Bronchoalveolar lavage fluid samples collected from endurance horses at 3 to 8 days (sample A) and 36 to 38 days (sample B) after the race (100 km in 1 day [n = 3], 70 km/d for 2 days [12], or 100 km/d for 2 days [5]) were cytologically examined for the presence of hemosiderophages. Samples from control ho...
Ceratohyoidectomy in standing sedated horses.
Veterinary surgery : VS    August 30, 2019   Volume 48, Issue 8 1391-1398 doi: 10.1111/vsu.13319
Racine J, O'Brien T, Bladon BM, Cruz AM, Stoffel MH, Haenssgen K, Rodgerson DH, Livesey MA, Koch C.To investigate the feasibility and complications associated with ceratohyoidectomy (CHE) in standing sedated horses unaffected (experimental horses) and standing sedated horses affected (clinical cases) with temporohyoid osteoarthropathy (THO). Methods: Case series. Methods: Six experimental horses and four clinical cases. Methods: Standing CHE was performed in six experimental horses euthanized 30 minutes (n = 3) and 7 days (n = 3) postoperatively. The four clinical cases were presented because of central facial nerve paralysis (n = 3), vestibular ataxia (n = 3), auricular hemorrhage (n =...
Effect of different protocols on the mitigation of exercise-induced pulmonary hemorrhage in horses when administered 24 hours before strenuous exercise.
Journal of veterinary internal medicine    August 9, 2019   Volume 33, Issue 5 2319-2326 doi: 10.1111/jvim.15574
Bayly W, Lopez C, Sides R, Bergsma G, Bergsma J, Gold J, Sellon D.Public pressure exists in the United States to eliminate race-day furosemide administration despite its efficacy in decreasing the severity of equine exercise pulmonary hemorrhage (EIPH). No effective alternative prophylaxis strategies have been identified. Objective: To investigate alternative protocols to race-day furosemide that might mitigate EIPH. Methods: Seven fit Thoroughbreds with recent EIPH. Methods: Double-blinded placebo-controlled Latin square crossover using a treadmill followed by a blinded placebo-controlled crossover study at a racetrack. First, horses exercised supramaximall...
Malignant Mesothelioma of the Vaginal Tunic and Peritoneum in a Young Stallion.
Journal of equine veterinary science    July 19, 2019   Volume 80 76-79 doi: 10.1016/j.jevs.2019.07.008
MacMillan KM, Martinson SA, Smith M, Lofstedt J.Mesothelioma is a rare malignancy in horses. This report describes a case in which marked hemoperitoneum, moderate anemia, and moderate dependent edema were the presenting clinical signs in a 2-year-old Standardbred stallion with mesothelioma of the vaginal tunic. On necropsy, approximately 40 L of dark red fluid distended the abdomen. A dark red mass infiltrated and effaced the right pampiniform plexus, and red nodular masses were present multifocally on the parietal and visceral peritoneal surfaces. Histopathologically, the masses were composed of malignant spindle cells with a sarcomatoid ...
Surgical corrections and postsurgical complications of epiglottic entrapment in Thoroughbreds: 12 cases (2009-2015).
Journal of equine science    July 3, 2019   Volume 30, Issue 2 41-45 doi: 10.1294/jes.30.41
Lee SK, Lee I.Twelve Thoroughbred racehorses were diagnosed as epiglottic entrapment at the Korea Racing Authority equine hospital. Four different surgical correction techniques were used to treat epiglottic entrapment: the transnasal hook bistoury, transoral unshielded hook bistoury, transnasal shielded hook bistoury, and transendoscopic laser techniques. Eleven cases were surgically resolved eventually, with one case of recurrence. Five complications related to surgical correction occurred: a severe nasal passage laceration and bleeding (n=1), epiglottic laceration (n=1), epiglottis tip burns (n=2), and m...
Hydroxyethyl starches in equine medicine.
Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)    June 22, 2019   Volume 29, Issue 4 349-359 doi: 10.1111/vec.12854
van Galen G, Hallowell G.To review and discuss the use of hydroxyethyl starches (HES) in equine veterinary medicine, and to provide recommendations for its use. Methods: Veterinary and human peer-reviewed medical literature including scientific reviews, meta-analyses, and original research articles. Results: Increasing evidences on adverse effects after HES use and decreasing support for beneficial effects with regards to volume expansion and colloid osmotic pressure (COP) support in critically ill subjects have led to a recent guideline to limit the use of HES in critically ill people. Unassigned: The rationale for H...
Fatal pulmonary hemorrhage in a horse during bronchoalveolar lavage – single case report.
BMC veterinary research    May 24, 2019   Volume 15, Issue 1 169 doi: 10.1186/s12917-019-1922-9
Varegg MS, Kløverød KM, Austnes MK, Siwinska N, Słowikowska M, Zak A, Madej JA, Kandefer-Gola M, Ciaputa R, Nowak M, Niedzwiedz A.Pulmonary hemorrhage is a rare cause of death in horses. Hemorrhage within the respiratory tract has many causes, including mycosis of the guttural pouch, invasive procedures causing serious trauma to nasal conchae, or lung biopsy. We report on a rare case of a fatal pulmonary hemorrhage in a horse after a severe cough during bronchoalveolar lavage. To the best of our knowledge, this is the first report of spontaneous hemorrhage in a horse during bronchoalveolar lavage. Methods: A 21-year-old mare which belonged to the didactic herd of The Faculty of Veterinary Medicine underwent BAL procedure...
Surgical enlargement of the nasomaxillary aperture and transnasal conchotomy of the ventral conchal sinus: Two surgical techniques to improve sinus drainage in horses.
Veterinary surgery : VS    April 9, 2019   Volume 48, Issue 6 1019-1031 doi: 10.1111/vsu.13207
Bach FS, Böhler A, Schieder K, Handschuh S, Simhofer H.To evaluate 2 surgical techniques for establishing and/or improving paranasal sinus drainage in cadaver heads and horses with sinusitis and evaluate the feasibility of postoperative transnasal sinus endoscopy. Methods: Ex vivo study (equine cadaver heads) and case series. Methods: Nine adult equine cadaver heads and 8 horses with recurrent sinusitis. Methods: For the ex vivo study, the following procedures were performed on 9 cadaver heads: preoperative and postoperative computed tomography (heads 1-6), endoscopy-guided transnasal conchotomy of the ventral conchal sinus (TCVCS) and surgical en...
Equine Idiopathic Hemorrhagic Cystitis: Is It Idiopathic or More Likely to Be Exercise-Associated?
Journal of equine veterinary science    April 4, 2019   Volume 78 6-9 doi: 10.1016/j.jevs.2019.03.212
Barton AK, Kershaw O, Gruber AD, Gehlen H.Recently, a syndrome called "equine idiopathic hemorrhagic cystitis" was described and clinical features compared with bladder neoplasia. In this case report, we describe a case of hemorrhagic cystitis with a favorable outcome in a high-performance dressage horse, in which exercise intensity might be the etiologic factor for the development of bladder-wall hyperplasia and hematuria. A 14-year-old Warmblood gelding was presented with a history of hematuria of 2-day duration. The high-level dressage horse had performed on the previous 3 weekends and was trained at least three times a week at per...
Theriogenology Question of the Month.
Journal of the American Veterinary Medical Association    April 3, 2019   Volume 254, Issue 8 925-928 doi: 10.2460/javma.254.8.925
Gunn AJ.This study involves the case of a young Thoroughbred filly who exhibited symptoms like reluctance to stand and vulva hemorrhagic discharge. The physical examination revealed normal physiological parameters, but an [...]
First Report of Acute Bilateral Hyphema in a Theileria equi-Infected Kathiawari Horse.
Journal of equine veterinary science    March 6, 2019   Volume 77 72-74 doi: 10.1016/j.jevs.2019.02.021
Prasad A, Kumar V, Kumar B.Theileria equi is a tickborne hemoparasite that can cause severe illness in equids. In this report, we are describing a condition of acute bilateral hyphema in a 4-month-old Kathiawari filly infected with T. equi. The horse showed clinical signs such as fever, lethargy, icterus, tachycardia, tachypnea, and bilateral hyphema. Laboratory diagnosis revealed anemia and thrombocytopenia. Atypical clinical manifestation of bilateral hyphema, to our knowledge, has never been reported so far in equids infected with T. equi. The diagnosis was confirmed by microscopic examination of Geimsa-stained blo...
Surgical treatment of epiploic foramen entrapment in 142 horses (2008-2016).
Veterinary surgery : VS    January 21, 2019   Volume 48, Issue 3 291-298 doi: 10.1111/vsu.13161
van Bergen T, Haspeslagh M, Wiemer P, Swagemakers M, van Loon G, Martens A.To report the clinical features, outcomes, and prognostic factors associated with the surgical treatment of epiploic foramen entrapment (EFE). Methods: Retrospective study at a single referral hospital. Methods: Horses (n = 142) undergoing surgery (n = 145) for EFE. Methods: Preoperative, perioperative, and postoperative data of surgeries on horses that underwent exploratory laparotomy for EFE were obtained. The postoperative outcome was assessed by follow-up telephone calls with the owners/caregivers. Factors associated with postoperative reflux (POR), relaparotomy, hospital discharge...
Bronchoalveolar lavage fluid from both lungs in horses: Diagnostic reliability of cytology from pooled samples.
Veterinary journal (London, England : 1997)    December 6, 2018   Volume 244 28-33 doi: 10.1016/j.tvjl.2018.12.002
Hermange T, Le Corre S, Bizon C, Richard EA, Couroucé A.Cytology of bronchoalveolar lavage fluid (BALF) from one lung may not predict findings in the contralateral lung of the same horse. The aim of this study was to determine whether a pooled BALF from both lungs was representative of corresponding individual samples. Fifty-one horses referred for poor performance and/or respiratory signs and for which a BALF was collected from both lungs, were included in the study. Cytology of pooled and individual BALF samples were performed using a masked protocol. Based on clinical signs and individual BALF cytologies, horses were classified as control (CTL),...
A prospective multicentre survey of complications associated with equine castration to facilitate clinical audit.
Equine veterinary journal    November 22, 2018   Volume 51, Issue 4 435-439 doi: 10.1111/evj.13035
Hodgson C, Pinchbeck G.Despite the regularity with which castration is performed, the types of complications and current best practice are unknown. Objective: The objective of this study was to perform a prospective audit of routine equine castrations performed in general practice to determine complication rates and factors associated with them. Methods: Multicentre, prospective audit of castrations. Methods: Data on castrations were collected on the day of surgery from 18 veterinary practices; 30-days post-operatively follow-up was obtained and complications recorded. Frequency of complications was reported, and mu...
Wound Management: Wounds with Special Challenges.
The Veterinary clinics of North America. Equine practice    November 19, 2018   Volume 34, Issue 3 511-538 doi: 10.1016/j.cveq.2018.07.003
Eggleston RB.Distal limb wounds in horses heal substantially different than trunk wounds, commonly resulting in exuberant granulation tissue and exposed and sequestered bone. Surgical intervention of severe rectovaginal lacerations in the mare should be delayed until the tissues have heeled and scar tissue has remodeled. Wounds resulting in severe hemorrhage require appropriate emergent fluid therapy and potentially transfusion therapy.
Complications associated with closed castration using the Henderson equine castration instrument in 300 standing equids.
Veterinary surgery : VS    October 27, 2018   Volume 48, Issue 1 21-28 doi: 10.1111/vsu.12960
Racine J, Vidondo B, Ramseyer A, Koch C.To describe a closed castration technique in standing equids, report associated complications, and identify potential risk factors. Methods: Prospective cohort study of 300 standing equids that were castrated with the Henderson Equine Castrating Instrument. Methods: Thirteen participating veterinarians recorded intraoperative difficulties and postoperative complications. Descriptive statistics, univariate analyses with Fisher's exact tests, and logistic regressions were used to evaluate intraoperative difficulties and postoperative complications and to assess risk factors for postoperative com...
Surgical management of postcastration spermatic cord stump infection in horses: A retrospective study of 23 cases.
Veterinary surgery : VS    September 28, 2018   Volume 47, Issue 8 1016-1020 doi: 10.1111/vsu.12954
Claffey EF, Brust K, Hackett RP, Fubini S.To report the surgical management and the short- and long-term follow-up of postcastration spermatic cord infection in horses. Methods: Retrospective case series. Methods: Twenty-three client-owned horses. Methods: Medical records (2001-2017) of horses that had been surgically treated for spermatic cord stump infection after castration were reviewed. Time from castration to presentation, diagnostic procedures, surgical complications, bacterial culture and ancillary testing, and survival to discharge were collected. Long-term follow-up was obtained by owner survey when possible. Descriptive sta...
Equine pericardium-covered stenting in post-traumatic pseudoaneurysm of cavernous internal carotid artery.
Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences    July 5, 2018   Volume 24, Issue 6 635-638 doi: 10.1177/1591019918785150
Gonzalez-Cantero JL, Del Valle Diéguez M, Monteserín Matesanz C, Saura Lorente J, Villoria Medina F, Fortea Gil F, Castro Reyes E.We report a case of traumatic intracranial carotid artery pseudoaneurysm treated with an equine pericardium-covered stent. The patient was admitted to the Emergency Department after sustaining severe polytrauma in a motor vehicle accident. A cavernous carotid pseudoaneurysm was detected after an episode of massive epistaxis that required emergent nasal packing. Treatment with parent vessel sacrifice was ruled out after an unfavourable balloon test occlusion. We opted for an equine pericardium-covered stent as a means to immediately seal the wall defect in the setting of massive bleeding second...
Exercise-induced pulmonary haemorrhage in Thoroughbred racehorses: a longitudinal study.
Equine veterinary journal    May 25, 2018   Volume 51, Issue 1 45-51 doi: 10.1111/evj.12957
Crispe EJ, Secombe CJ, Perera DI, Manderson AA, Turlach BA, Lester GD.Exercise-induced pulmonary haemorrhage (EIPH) is considered a progressive disease based on histopathology, but it is unknown if tracheobronchoscopic EIPH severity worsens over time. Objective: The aim of this study was to examine tracheobronchoscopic EIPH changes over time in a population of Thoroughbred racehorses. A secondary aim was to identify factors that affect changes in tracheobronchoscopic EIPH severity between observations. Methods: Prospective, longitudinal, observational cross-sectional study. Methods: Thoroughbred racehorses were examined with tracheobronchoscopy no earlier than 3...
Coagulation parameters following equine herpesvirus type 1 infection in horses.
Equine veterinary journal    May 17, 2018   Volume 51, Issue 1 102-107 doi: 10.1111/evj.12843
Wilson ME, Holz CL, Kopec AK, Dau JJ, Luyendyk JP, Soboll Hussey G.Equine herpesvirus type 1 (EHV-1) is the cause of respiratory disease, abortion storms, and outbreaks of herpesvirus myeloencephalopathy (EHM). Infection of the spinal cord is characterised by multifocal regions of virally infected vascular endothelium, associated with vasculitis, thrombosis and haemorrhage that result in ischaemia and organ dysfunction. However, the mechanism of thrombosis in affected horses is unknown. Objective: To evaluate tissue factor (TF) procoagulant activity and thrombin-antithrombin complex (TAT) levels in horses following infection with EHV-1. Methods: In vitro and ...
Ultrasonographic Reference Values of Kidney Dimensions and Clinicopathological Findings Associating the Transcutaneous Ultrasound-Guided Renal Biopsy in Donkeys (Equus asinus).
Journal of equine veterinary science    April 21, 2018   Volume 68 1-11 doi: 10.1016/j.jevs.2018.04.001
Hussein HA, Ibrahim A, Ali MF.This study aimed to establish normal ultrasonographic reference values of kidney dimensions in donkeys (Equus asinus) and to describe and evaluate the clinicopathological variations associated with ultrasound-guided renal biopsy. The ultrasonographic dimensions of the right and left kidneys were conducted on 16 donkeys, which were then divided into two groups; eight each for biopsy of the right kidney (RK) and left kidney (LK). Three ultrasonographic cineloops were obtained at 17th intercostal space daily for 3 consecutive days. Renal length, width, and dimensions of the cortex, medulla, and p...
Equine idiopathic hemorrhagic cystitis: Clinical features and comparison with bladder neoplasia.
Journal of veterinary internal medicine    March 31, 2018   Volume 32, Issue 3 1202-1209 doi: 10.1111/jvim.15121
Smith FL, Magdesian KG, Michel AO, Vaughan B, Reilly CM.A new syndrome of hematuria in horses has been documented. Objective: Hemorrhagic cystitis is a novel cause of stranguria and hematuria in horses. This syndrome may be difficult to differentiate from bladder neoplasia because they share several clinical features. Methods: Eleven horses with idiopathic hemorrhagic cystitis and 7 horses with bladder neoplasia. Methods: Retrospective cohort study. Results: Hemorrhagic cystitis was detected on cystoscopy of affected horses, with hemorrhagic and thickened apical bladder mucosa. Clinical signs and endoscopic appearance of the bladder resolved within...
New Treatment for Urethral Rent in Stallions.
Journal of equine veterinary science    February 20, 2018   Volume 64 89-95 doi: 10.1016/j.jevs.2018.02.014
Sancler-Silva YFR, Silva-Junior ER, Fedorka CE, Scheeren VFC, Cavalero TS, Papa PM, Alvarenga MA, Dell'Aqua JA, Papa FO.The aim of this report is to describe a new methodology to successfully treat stallions diagnosed with urethral rent. Four stallions of ages ranging from 7 to 12 years (median 9) with hemospermia were admitted for clinical evaluation, breeding soundness examination, and urethroscopy for inspection of the urethra and vesicular glands. Once the presence of urethral rent was identified and/or other sources of hemorrhage were excluded, a topical treatment was performed with 4% Policresulen solution (Albocresil). The treatment was carried out by infusing 100 mL of the solution into the lumen of t...
An experience in the clinical use of specific immunoglobulin from horse blood serum for prophylaxis of Ebola haemorrhagic fever.
Voprosy virusologii    January 13, 2018   Volume 62, Issue 1 25-29 
Borisevich IV, Chemikova NK, Markov VI, Krasnianskiy VP, Borisevich SV, Rozhdestvenskiy EV.The aim of this work was to estimate the efficacy and safety of single intramuscular introduction of specific heterologous immunoglobulin as prophylactic drug against Ebola hemorrhagic fever. Materials and methods. The specific heterologous immunoglobulin was introduced as a special prophylactic drug to 28 patients in epidemic situations, after skin hurt with infectious materials or contact with infectious blood. Clinico-laboratory observation was performed in 24 subjects after single intramuscular introduction of heterologous immunoglobulin Ebola. The samples of blood serum were investigated ...
Equine renal hemangiosarcoma: clinical presentation, pathologic features, and pSTAT3 expression. Hughes K, Scott VHL, Blanck M, Barnett TP, Spanner Kristiansen J, Foote AK.Hemangiosarcoma is an uncommon tumor in horses. We characterized 3 cases of equine renal hemangiosarcoma, focusing on clinical and pathologic features, and describe occurrence of the epithelioid variant of hemangiosarcoma in one of these cases. Nuclear expression of phosphorylated STAT3 (pSTAT3) was assessed to analyze potential inappropriate STAT3 activation as a component of tumor pathogenesis. Clinical signs in the 3 horses included insidious weight loss, followed in one case by serosanguineous nasal discharge and terminal epistaxis, and nonspecific signs of abdominal pain. Two of the heman...
Effectiveness of furosemide in attenuating exercise-induced pulmonary haemorrhage in horses when administered at 4- and 24-h prior to high-speed training.
Equine veterinary journal    November 3, 2017   Volume 50, Issue 3 350-355 doi: 10.1111/evj.12760
Knych HK, Wilson WD, Vale A, Kass PH, Arthur RM, Jones JH.Due to the high prevalence of EIPH in racehorses and its potential impact on the horse's health, furosemide administration is permitted up to 4-h prior to post time in most North American racing jurisdictions. Anecdotal reports suggest that administration of furosemide 24-h prior to strenuous exercise may be equally effective in decreasing the severity of EIPH. Objective: To 1) compare the efficacy of furosemide in reducing the presence and severity of EIPH when administered 4- or 24-h prior to strenuous exercise 2) characterise electrolyte and blood parameters following administration of furo...
Pharmacokinetics of furosemide administered 4 and 24 hours prior to high-speed exercise in horses.
Journal of veterinary pharmacology and therapeutics    October 22, 2017   Volume 41, Issue 2 224-229 doi: 10.1111/jvp.12458
Knych HK, Vale A, Wilson WD, Kass PH, Arthur RM, Jones JH.Furosemide is a diuretic agent used commonly in racehorses to attenuate the bleeding associated with exercise-induced pulmonary hemorrhage (EIPH). The current study describes serum and urine concentrations and the pharmacokinetics of furosemide following administration at 4 and 24 hrs prior to maximal exercise. Eight exercised adult Thoroughbred horses received a single IV administration of 250 mg of furosemide at 4 and 24 hrs prior to maximal exercise on a high-speed treadmill. Blood and urine samples were collected at time 0 and at various times for up to 72 hrs and furosemide concentrat...
Neurotoxicosis in horses associated with consumption of Trema micrantha.
Equine veterinary journal    September 7, 2017   Volume 50, Issue 2 192-195 doi: 10.1111/evj.12741
Lorenzett MP, Pereira PR, Bassuino DM, Konradt G, Panziera W, Bianchi MV, Argenta FF, Hammerschmitt ME, Caprioli RA, de Barros CSL, Pavarini SP....Trema micrantha is a tree widely distributed throughout the Americas. The tree produces highly palatable leaves that have been associated with natural poisoning in goats, sheep and horses, in which hepatic necrosis and hepatic encephalopathy have been observed. Objective: This study describes malacia and haemorrhage in the central nervous system (CNS) due to T. micrantha consumption, with minimal to absent hepatic lesions. Methods: Retrospective case series. Methods: A total of 14 horses with a history of neurological signs and spontaneous consumption of T. micrantha leaves were submitted to...