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Topic:Histopathology

Histopathology in horses involves the microscopic examination of tissue samples to study the manifestations of disease. This field provides insights into the structural and cellular changes that occur in equine tissues as a result of various pathological conditions. Common applications of histopathology in equine medicine include the diagnosis of neoplastic, inflammatory, and degenerative diseases. Techniques such as tissue staining and immunohistochemistry are employed to identify specific cellular components and pathological markers. This page aggregates peer-reviewed research studies and scholarly articles that explore the methodologies, findings, and implications of histopathological investigations in equine health.
Myxochondroid metaplasia of the plantar foot: a distinctive pseudoneoplastic lesion resembling nuchal fibrocartilaginous pseudotumor and the equine digital cushion.
Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc    June 14, 2013   Volume 26, Issue 12 1561-1567 doi: 10.1038/modpathol.2013.116
Shon W, Folpe AL.Cartilaginous tumors of soft tissue are uncommon, with benign chondromas of soft parts greatly outnumbering rare soft-tissue chondrosarcomas. Over the past several years, we have seen in consultation a distinctive, benign-appearing chondroid soft-tissue lesion of the plantar foot that differs in a number of respects from chondroma of soft parts. Herein we report our experience with this distinctive lesion. A retrospective review of all cases from the foot in our soft-tissue consultation and institutional surgical pathology archives identified 9 similar cases, most often previously coded as 'fi...
Readability and histological biocompatibility of microchip transponders in horses.
Veterinary journal (London, England : 1997)    June 12, 2013   Volume 198, Issue 1 103-108 doi: 10.1016/j.tvjl.2013.04.028
Wulf M, Wohlsein P, Aurich JE, Nees M, Baumgärtner W, Aurich C.Identification of horses by microchip transponder is mandatory within the European Union with only a few exceptions. In this study, the readability of such microchips in 428 horses with three different scanners (A, B and C) and the histological changes at the implantation site in 16 animals were assessed. Identification of microchips differed between scanners (P<0.001), and with 'side of neck' (P<0.001). Scanners A, B and C identified 93.5%, 89.7% and 100% of microchips, respectively, on the 'chip-bearing' side of the neck. From the contralateral side, scanners A, B a...
Colour analysis of the equine endometrium: comparison of spectrophotometry and computer-assisted analysis of photographs within the L*a*b* colour space system.
Veterinary journal (London, England : 1997)    May 23, 2013   Volume 197, Issue 3 753-760 doi: 10.1016/j.tvjl.2013.04.013
Neuhauser S, Handler J.The aims of this study were to compare two different methods of quantifying the colour of the luminal surface of the equine endometrium and to relate the results to histopathological evidence of inflammation and fibrosis. The mucosal surfaces of 17 equine uteri obtained from an abattoir were assessed using a spectrophotometer and by computer-assisted analysis of photographs. Values were converted into L(*)a(*)b(*) colour space. Although there was significant correlation between the two methods of quantification, variations in 'brightness', 'red' and 'yellow' values were noted. Within a given u...
Jejunal intussusception associated with lymphoma in a horse.
The Journal of veterinary medical science    April 30, 2013   Volume 75, Issue 9 1253-1256 doi: 10.1292/jvms.13-0060
Matsuda K, Shimada T, Kawamura Y, Sakaguchi K, Tagami M, Taniyama H.A 2-year-old Thoroughbred horse presented with acute onset of colitis, and the intussuscepted jejunum was surgically resected. A transmural mass protruding into the lumen was found at the leading edge of the intussusceptum. Based on histological and immunohistochemical examinations, the mass was diagnosed as diffuse large B-cell lymphoma with metastasis to the mesenteric lymph nodes. Anatomical localization of the mass in the intussusception and absence of other obvious underlying diseases indicated that the intussusception had occurred in association with the mass. To our knowledge, this case...
Vacuolar myopathy in an adult Warmblood horse.
Neuromuscular disorders : NMD    April 23, 2013   Volume 23, Issue 6 473-477 doi: 10.1016/j.nmd.2013.03.007
Massey CA, Walmsley GL, Gliddon TP, Piercy RJ.Histopathological interpretation of semimembranosus muscle samples from an adult Warmblood mare with clinical signs suggestive of exertional rhabdomyolysis and intermittent mild elevations in muscle enzyme activities revealed abundant sarcoplasmic vacuoles in all fibre-types containing fine, apparently proteinaceous debris. Vacuolar contents stained lightly with PAS, but did not appear to contain amylopectate, lipid or acid phosphatase and their periphery was unstained with dystrophin immunohistochemistry. Electron microscopy revealed that vacuoles were not membrane bound. No vacuoles were det...
A histomorphological analysis of human and non-human femora.
International journal of legal medicine    April 21, 2013   Volume 128, Issue 2 369-377 doi: 10.1007/s00414-013-0854-3
Brits D, Steyn M, L'Abbé EN.Histology is used to describe post-mortem bone alterations, trauma, pathology and age estimation and to separate human and non-human bones. Many scholars are however not familiar with the intricate and variable microstructure of bone, and due to the complex nature of some classification systems, bone histomorphology is often incorrectly described or identified. Little information is available on the histomorphology of non-human bones found in southern Africa, and therefore, the aim of this study was to describe the histomorphology of non-human species commonly found in southern Africa, namely,...
Histopathologic findings in the sacrocaudalis dorsalis medialis muscle of horses with vitamin E-responsive muscle atrophy and weakness.
Journal of the American Veterinary Medical Association    April 4, 2013   Volume 242, Issue 8 1127-1137 doi: 10.2460/javma.242.8.1127
Bedford HE, Valberg SJ, Firshman AM, Lucio M, Boyce MK, Trumble TN.To characterize clinical findings, outcomes, muscle characteristics, and serum or muscle concentrations of α-tocopherol for horses with vitamin E-responsive signs of muscle atrophy and weakness consistent with signs of equine motor neuron disease (EMND). Methods: Retrospective case-control study. Methods: 8 affected (case) adult horses with acute (n = 3) or chronic (5) gross muscle atrophy that improved with vitamin E treatment and 14 clinically normal (control) adult horses with adequate (within reference range; 8) or low (6) muscle concentrations of α-tocopherol. Methods: Medical records w...
Vascular abnormalities of the distal deep digital flexor tendon in 8 draught horses identified on histological examination.
Research in veterinary science    March 30, 2013   Volume 95, Issue 1 23-26 doi: 10.1016/j.rvsc.2013.03.006
Crişan MI, Damian A, Gal A, Miclăuş V, Cernea CL, Denoix JM.The purpose of this study was to provide a detailed description of the vascular changes in the distal part of deep digital flexor tendon (DDFT). Eight isolated forelimbs were collected from 8 horses with DDF tendinopathy diagnosed post-mortem by ultrasound and gross anatomopathological examination. The samples were fixed in 10% neutral buffered formalin, softened in 4% phenol and dehydrated with ethylic alcohol. Goldner's Trichrome staining method was used. The histopathological examination revealed vascular proliferation associated with structural disorders of blood vessels. Angiogenesis, fib...
Histomorphometric evaluation of the effect of early exercise on subchondral vascularity in the third carpal bone of horses.
American journal of veterinary research    March 28, 2013   Volume 74, Issue 4 542-549 doi: 10.2460/ajvr.74.4.542
Kim W, McArdle BH, Kawcak CE, McIlwraith CW, Firth EC, Broom ND.To investigate histomorphometric changes in the cartilage and subchondral bone of the third carpal bone associated with conditioning exercise in young Thoroughbreds. Methods: Nine 18-month-old Thoroughbreds. Procedures-Both third carpal bones of 9 horses (4 exercised spontaneously at pasture only and 5 given additional conditioning exercise beginning at a mean age of 3 weeks) were evaluated. Histomorphometric variables (hyaline and calcified cartilage thickness and collagen orientation; vascular channel area, number, and orientation; and osteochondral junction rugosity) of the third carpal bon...
Expression of 11β-HSD in steroid-induced avascular necrosis of the femoral head.
Molecular medicine reports    March 28, 2013   Volume 7, Issue 5 1482-1486 doi: 10.3892/mmr.2013.1401
Wang L, Luo DK, Pan ZY.The aim of the present study was to investigate the association between glucocorticoid receptors and steroid‑induced avascular necrosis of the femoral head (SANFH). Healthy New Zealand rabbits were randomly divided into 3 groups (n=16/group); the normal (no treatment), control (horse serum injections) and treatment (horse serum and methylprednisolone injections) groups. Methylprednisolone and horse serum injections were used to establish a SANFH model in rabbits; magnetic resonance imaging (MRI) and histopathological analysis were used to evaluate the SANFH rabbit model. Total cholesterol an...
Equine multisystemic eosinophilic epitheliotropic disease: a case report and review of literature.
New Zealand veterinary journal    February 27, 2013   Volume 61, Issue 3 177-182 doi: 10.1080/00480169.2012.753569
Bosseler L, Verryken K, Bauwens C, de Vries C, Deprez P, Ducatelle R, Vandenabeele S.A 2-year-old Standardbred gelding presented with a history of fever over 1 week, anorexia and skin lesions on all four legs. The lesions were associated with severe pruritus and oedema, and there was no response to therapy. Results: The horse was in poor body condition, was lethargic and severely pruritic. Skin lesions consisted of diffuse alopecia and crusting of the distal extremities. Initially it was slightly febrile, but subsequently its temperature increased up to 40°C. Ten days after admission it developed profuse watery diarrhoea and the skin lesions progressed. Skin biopsies revealed...
Equestrian chilblain: another outdoor recreational hazard.
Journal of cutaneous pathology    February 22, 2013   Volume 40, Issue 5 485-490 doi: 10.1111/cup.12082
Yang AY, Schwartz L, Divers AK, Sternberg L, Lee JB.Herein, we describe two cases and review 14 cases of equestrian chilblain or 'equestrian cold panniculitis' in the literature. The first, a 23-year-old healthy female horse trainer, presented with burning nodular swelling on her lateral thighs. The second was a 34-year-old healthy woman with recurrent nodular eruption on the lateral thighs after horseback riding in the winter. Physical examination of both patients revealed erythematous to violaceous nodules with eczema craquelé-like changes. Laboratory workup for systemic and autoimmune connective tissue disease was negative. Punch biopsies f...
In equine grass sickness, serum amyloid A and fibrinogen are elevated, and can aid differential diagnosis from non-inflammatory causes of colic.
The Veterinary record    February 21, 2013   Volume 172, Issue 15 395 doi: 10.1136/vr.101224
Copas VE, Durham AE, Stratford CH, McGorum BC, Waggett B, Pirie RS.Equine grass sickness (EGS) is a debilitating and often fatal neurodegenerative disease. A presumptive diagnosis of EGS may be made on the basis of clinical signs and subjective ancillary tests, but a definitive antemortem diagnosis can only be made following histopathological examination of intestinal biopsies. It has previously been reported that horses with EGS may show clinical and clinicopathological signs of systemic inflammation. The objective of this study was to (a) quantify acute inflammatory markers in blood samples collected from acute, subacute and chronic EGS cases, and (b) compa...
Histiocytic sarcoma of the nasal cavity in a horse.
Research in veterinary science    February 8, 2013   Volume 94, Issue 3 648-650 doi: 10.1016/j.rvsc.2013.01.005
Paciello O, Passantino G, Costagliola A, Papparella S, Perillo A.Histiocytic diseases in veterinary medicine have been revised in the last few decades, but these are considered relatively rare in horses. This report describes a 9-year-old female horse, Dutch Warmblood, presented for investigation of severe nasal bleeding. A multinodular bilateral mass of 5 cm, reddish to white in color, that invaded and destroyed the surrounding tissues, was observed during a clinical examination of the nostril The morphological features of the tumor cells were represented by cytologically bizarre, highly phagocytic, multinucleated giant cells. These findings, together with...
Distribution of venous remodeling in exercise-induced pulmonary hemorrhage of horses follows reported blood flow distribution in the equine lung.
Journal of applied physiology (Bethesda, Md. : 1985)    January 31, 2013   Volume 114, Issue 7 869-878 doi: 10.1152/japplphysiol.01170.2012
Williams KJ, Robinson NE, Defeijter-Rupp H, Millerick-May M, Stack A, Hauptman J, Derksen FJ.Exercise-induced pulmonary hemorrhage (EIPH), which has been reported in humans and a variety of domestic animals following strenuous exercise, is most often documented in racehorses. Remodeling of pulmonary veins (VR) in equine EIPH was recently described, suggesting that it contributes to the pathogenesis of the disease. The cause of VR is unknown. We tested the hypothesis that the development of VR follows pulmonary blood flow distribution, preferentially occurring in the caudodorsal lung region. Furthermore, we hypothesized that VR underpins development of the other lesions of EIPH patholo...
The feral horse foot. Part B: radiographic, gross visual and histopathological parameters of foot health in 100 Australian feral horses.
Australian veterinary journal    January 30, 2013   Volume 91, Issue 1-2 23-30 doi: 10.1111/avj.12017
Hampson BA, de Laat MA, Mills PC, Walsh DM, Pollitt CC.It has been proposed that the feral horse foot is a benchmark model for foot health in horses. However, the foot health of feral horses has not been formally investigated. Objective: To investigate the foot health of Australian feral horses and determine if foot health is affected by environmental factors, such as substrate properties and distance travelled. Methods: Twenty adult feral horses from five populations (n = 100) were investigated. Populations were selected on the basis of substrate hardness and the amount of travel typical for the population. Feet were radiographed and photographed...
Pemphigus vulgaris in a Welsh pony stallion: case report and demonstration of antidesmoglein autoantibodies.
Veterinary dermatology    January 25, 2013   Volume 24, Issue 2 269-e60 doi: 10.1111/vde.12002
Winfield LD, White SD, Affolter VK, Renier AC, Dawson D, Olivry T, Outerbridge CA, Wang YH, Iyori K, Nishifuji K.To describe the clinical, histological and immunological findings of an equine case of pemphigus vulgaris, including the demonstration of antidesmoglein (anti-Dsg) autoantibodies. Methods: The diagnosis of pemphigus vulgaris was confirmed in a 9-year-old Welsh pony stallion with both direct and indirect immunofluorescence and immunoprecipitation studies, the latter identifying circulating anti-Dsg3 IgG. Treatment with immunosuppressive medications was initiated. Lesions were seen in the perineal area, sheath, mane, tail, eyelids, coronary bands and mucosa of the mouth and oesophagus. Initial c...
Equine sarcoidosis: clinical signs, diagnosis, treatment and outcome of 22 cases.
Veterinary dermatology    January 22, 2013   Volume 24, Issue 1 218-24.e48 doi: 10.1111/j.1365-3164.2012.01108.x
Sloet van Oldruitenborgh-Oosterbaan MM, Grinwis GC.Equine sarcoidosis may present as a generalized or localized exfoliative dermatitis and/or as a granulomatous inflammation of multiple organs. Objective: To report the clinical signs, diagnosis, treatment and outcome for 22 horses with histologically confirmed sarcoidosis. Methods: Twenty-two horses of different breeds, between 3 and 17 years of age. Methods: Diagnosis was based on clinical signs and histopathological findings. Results: The following three forms of equine sarcoidosis were identified: generalized (13.6%), partially generalized (18.2%) and localized (68.2%). High-dose systemic c...
Histopathological features in subsequent muscle biopsies in a warmblood mare with myotonic dystrophy.
The veterinary quarterly    December 12, 2012   Volume 32, Issue 3-4 187-192 doi: 10.1080/01652176.2012.749548
Ludvikova E, Lukas Z, Vondracek P, Jahn P.No abstract available
Investigation of a progressive facial deformity and stridor in an adult horse with a bone sequestrum and subsequent sinonasal abscess.
The Canadian veterinary journal = La revue veterinaire canadienne    December 4, 2012   Volume 53, Issue 6 653-658 
Marqués FJ, Sharma A, Wilson DG.Advanced diagnostic imaging and histopathological investigation were performed in an adult horse with chronic facial swelling due to a bone sequestrum and abscessation. In contrast to other cases, there were no draining tracts, difficulty eating, weight loss, head shaking, or fistula formation between the oral cavity and the maxillary sinus. Une investigation d’imagerie diagnostique avancée et un examen histopathologique ont été réalisés chez un cheval adulte présentant de l’enflure faciale chronique attribuable à un séquestre osseux et à une abcédation. Par contraste à d’aut...
A histological study of peripheral dental caries of equine cheek teeth.
Journal of veterinary dentistry    December 1, 2012   Volume 29, Issue 3 150-156 doi: 10.1177/089875641202900303
Erridge ME, Cox AL, Dixon PM.Peripheral caries of equine cheek teeth is a poorly described disorder and, in particular little is known of its histopathology. Histological examinations of decalcified sections of 21 equine peripheral caries-affected cheek teeth showed two different patterns of cemental lesions; including progressive enlargement of focal, flask-like lesions leading to breakdown of the adjacent cementum, and secondly; a more generalized flaking-off of thin layers of under-run, surface cementum. A thick layer of plaque and food material usually lay on the surface of affected cementum and also within cemental d...
Use of a deslorelin implant for influencing sex hormones and male behaviour in a stallion – Case report.
Acta veterinaria Hungarica    November 20, 2012   Volume 60, Issue 4 511-519 doi: 10.1556/AVet.2012.045
Schönert S, Reher M, Gruber AD, Carstanjen B.This case report describes the use of a subcutaneously applied 4.7-mg deslorelin acetate implant in a three-year-old Arabian crossbred stallion showing unwanted strong male behaviour. Following deslorelin acetate implantation the stallion showed a short transitional increase in male behaviour. A 'gelding-like' behaviour was noted 15 days (D15) after treatment. The horse was surgically castrated at the owners request at D52 after treatment. Serum testosterone, oestradiol-17β and oestrone sulphate values decreased after deslorelin acetate implantation, but serum LH and FSH levels remained uncha...
Seasonal differences in cytokine expression in the skin of Shetland ponies suffering from insect bite hypersensitivity.
Veterinary immunology and immunopathology    November 19, 2012   Volume 151, Issue 1-2 147-156 doi: 10.1016/j.vetimm.2012.11.007
Meulenbroeks C, van der Meide NM, Zaiss DM, van Oldruitenborgh-Oosterbaan MM, van der Lugt JJ, Smak J, Rutten VP, Willemse T.Insect bite hypersensitivity (IBH) in horses is a seasonal, IgE-mediated, pruritic skin disorder primarily caused by Culicoides spp. We hypothesize that a mixed Th2/Th1-type immune status, off season, alters into Th2-dominated immune reactivity in the skin of IBH-affected ponies in the IBH season. To study these immune response patterns Culicoides-specific IgE levels, skin histopathology and cytokine and transcription factor mRNA expression (IL4, IL10, IL13, IFNγ, FoxP3 and CD3(ζ)) in lesional and non-lesional skin of ponies affected by IBH in the IBH season were compared with those of the s...
Benign intraocular teratoid medulloepithelioma causing glaucoma in an 11-year-old Arabian mare.
Veterinary ophthalmology    October 1, 2012   Volume 16, Issue 4 297-302 doi: 10.1111/j.1463-5224.2012.01067.x
Leiva M, Felici F, Carvalho A, Ramis A, Peña T.An 11-year-old Arabian mare was presented for investigation of a visible, pale-colored intraocular mass in the right eye. Results: An intraocular mass was detected clinically and ultrasonographically as originating from the superior temporal quadrant of the ciliary body and iris and causing secondary glaucoma. The echodense mass was occupying the majority of the vitreous chamber and extended into the anterior chamber. The left eye appeared normal. Results: Enucleation was recommended for therapeutic and diagnostic purposes. No adjuvant treatment was given. Histopathological examination demonst...
Effects of the addition of endotoxin during perfusion of isolated forelimbs of equine cadavers.
American journal of veterinary research    August 29, 2012   Volume 73, Issue 9 1462-1468 doi: 10.2460/ajvr.73.9.1462
Patan-Zugaj B, Gauff FC, Licka TF.To examine the effect of endotoxins on metabolism and histopathologic changes of isolated perfused equine forelimbs. Methods: Forelimbs (comprising the metacarpus and digit) were collected from cadavers of 12 healthy adult horses after slaughter at an abattoir (14 limbs; 1 forelimb of 10 horses and both forelimbs of 2 horses). Methods: Forelimbs were perfused for 10 hours with autologous blood, with and without the addition of endotoxin (80 ng of lipopolysaccharide [LPS]/L). Two limbs of the endotoxin exposure group and 2 nonperfused limbs were loaded to failure of the suspensory apparatus of ...
Hepatoencephalopathy syndrome due to Cassia occidentalis (Leguminosae, Caesalpinioideae) seed ingestion in horses.
Equine veterinary journal    July 12, 2012   Volume 45, Issue 2 240-244 doi: 10.1111/j.2042-3306.2012.00599.x
Oliveira-Filho JP, Cagnini DQ, Badial PR, Pessoa MA, Del Piero F, Borges AS.Cassia occidentalis is a bush from the Leguminosae family, subfamily Caesalpinoideae, and is a toxic plant of veterinary interest due to the occasional contamination of animal rations. This report describes the clinical and histopathological findings of an outbreak of C. occidentalis poisoning in horses. Twenty mares were poisoned after consuming ground corn contaminated with 8% of C. occidentalis seeds. Of the 20 animals affected, 12 died: 8 mares were found dead, 2 died 6 h after the onset of clinical signs compatible with hepatic encephalopathy and the 2 other animals were subjected to euth...
Determination of serum anti-Müllerian hormone concentrations for the diagnosis of granulosa-cell tumours in mares.
Equine veterinary journal    July 11, 2012   Volume 45, Issue 2 199-203 doi: 10.1111/j.2042-3306.2012.00594.x
Ball BA, Almeida J, Conley AJ.Endocrinological assays are important for evaluation of mares with granulosa-cell tumours (GCTs), and our research in mares indicates that anti-Müllerian hormone (AMH) may be a good biomarker for this type of ovarian tumour. Objective: To evaluate the use of serum AMH concentrations for endocrine diagnosis of GCTs in mares. Methods: Archived serum samples (n = 403) previously assayed for determination of serum inhibin, testosterone and progesterone concentrations (GCT panel) were assayed for serum AMH concentrations using a heterologous enzyme-linked immunosorbent assay previously validated b...
Time-related Pathological Changes in Horses Experimentally Inoculated with Equine Influenza A Virus.
Journal of equine science    July 6, 2012   Volume 23, Issue 2 17-26 doi: 10.1294/jes.23.17
Muranaka M, Yamanaka T, Katayama Y, Niwa H, Oku K, Matsumura T, Oyamada T.To investigate the pathology of equine influenza, necropsy of 7 horses experimentally infected with equine influenza A virus (EIV) subtype H3N8 was conducted on post-infection days (PID) 2, 3, 7, and 14. Histopathologically, rhinitis or tracheitis including epithelial degeneration or necrosis with loss of ciliated epithelia and a reduction in goblet cell numbers, was observed in the respiratory tracts on PIDs 2 and 3. Epithelial hyperplasia or squamous metaplasia and suppurative bronchopneumonia with proliferation of type II pneumocytes were observed on PIDs 7 and 14. Viral antigen was detecte...
Ocular manifestations of a metastatic adenocarcinoma in a horse.
Veterinary ophthalmology    July 5, 2012   Volume 16, Issue 3 214-218 doi: 10.1111/j.1463-5224.2012.01042.x
Matheis FL, Birkmann K, Ruetten M, Pot SA, Spiess BM.A 10-year-old German Warmblood gelding was referred to the Equine Department of the Vetsuisse Faculty, University of Zurich, Switzerland, for an iris mass OD, lethargy, intermittent fever, and coughing. Ophthalmic examination revealed a 7 × 9 mm raised, fleshy, whitish to pinkish, vascularized iris mass at the 2 o`clock position OD. Fundic examination showed multifocal round, brown to black, slightly raised lesions with indistinct margins and a surrounding hyperreflective zone OU. Physical examination revealed a temperature of 39.2 °C, sinus tachycardia, preputial and ventral edema, and an e...
Equine multiple acyl-CoA dehydrogenase deficiency (MADD) associated with seasonal pasture myopathy in the midwestern United States.
Journal of veterinary internal medicine    June 18, 2012   Volume 26, Issue 4 1012-1018 doi: 10.1111/j.1939-1676.2012.00957.x
Sponseller BT, Valberg SJ, Schultz NE, Bedford H, Wong DM, Kersh K, Shelton GD.Seasonal pasture myopathy (SPM) is a highly fatal form of nonexertional rhabdomyolysis that occurs in pastured horses in the United States during autumn or spring. In Europe, a similar condition, atypical myopathy (AM), is common. Recently, a defect of lipid metabolism, multiple acyl-CoA dehydrogenase deficiency (MADD), has been identified in horses with AM. Objective: To determine if SPM in the United States is caused by MADD. Methods: Six horses diagnosed with SPM based on history, clinical signs, and serum creatine kinase activity, or postmortem findings. Methods: Retrospective descriptive ...
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