Analyze Diet

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.
Articular / epiphyseal osteochondrosis in Thoroughbred foals at 5 months of age: influences of growth of the foal and prenatal copper supplementation of the dam.
New Zealand veterinary journal    December 1, 2005   Volume 53, Issue 6 448-456 doi: 10.1080/00480169.2005.36591
Gee EK, Firth EC, Morel PC, Fennessy PF, Grace ND, Mogg TD.To determine the influence of copper (Cu) supplementation by injection of mares in late gestation on the frequency and severity of osteochondrosis (OC) lesions in their foals at around 160 days of age. To determine if there was any influence of the concentration of Cu in the liver, growth rate, birthweight, weight at 160 days of age, fatness, sex, or year of birth of the foal on the frequency and severity of OC lesions. To determine the influence of dam's age, and sex and birthweight of the foal on the growth rate from birth to 160 days of age, and weight at 160 days of age. Methods: Thirty-th...
Incidence of polysaccharide storage myopathy: necropsy study of 225 horses.
Veterinary pathology    November 23, 2005   Volume 42, Issue 6 823-827 doi: 10.1354/vp.42-6-823
Valentine BA, Cooper BJ.Muscle samples were obtained at necropsy from 225 horses and ponies 1 year of age or older. Samples were processed in routine manner and were stained with hematoxylin and eosin and with periodic acid-Schiff for glycogen. Sections were examined for abnormal glycogen content and amylase-resistant complex polysaccharide and for chronic myopathic change (excessive fiber size variation, increase in number of internal nuclei). A total of 101 horses and ponies with lesions of polysaccharide storage myopathy were identified. Age of affected horses ranged from one to 30 years, with a mean of 14.7 years...
Cutaneous lymphosarcoma in a stallion.
Australian veterinary journal    November 1, 2005   Volume 83, Issue 10 609-611 doi: 10.1111/j.1751-0813.2005.tb13270.x
Epstein V, Hodge D.Multiple cutaneous lymphosarcomas were diagnosed in an 8-year-old Thoroughbred stallion presented for evaluation of lumps on its scrotum. Histological examination of skin biopsy samples showed a homogenous pattern of lymphoid tissue suggestive of a T-cell lymphosarcoma. Immuno-histochemical tests showed a positive reaction to Rabbit/Anti-Human T-Cell, CD3 antibodies confirming T-cell lymphosarcoma. The animal was not treated and was subsequently euthanased.
Review of 15 cases of pemphigus foliaceus in horses and a survey of the literature.
The Veterinary record    October 26, 2005   Volume 157, Issue 17 505-509 doi: 10.1136/vr.157.17.505
Zabel S, Mueller RS, Fieseler KV, Bettenay SV, Littlewood JD, Wagner R.The records of 15 horses with pemphigus foliaceus diagnosed on the basis of their history, clinical signs, histopathology and the exclusion of differential diagnoses were evaluated with respect to the age of onset, the clinical signs and the diagnostic tests used. There was no apparent breed predisposition. The horses' mean age was nine years, with a range from three months to 25.5 years, three were foals up to six months old and eight were nine years old or older. The most frequent lesions were scaling in 11, crusting in 10 and alopecia in 10, and they appeared most commonly on the face, neck...
Misregulated Wnt/beta-catenin signaling leads to ovarian granulosa cell tumor development.
Cancer research    October 19, 2005   Volume 65, Issue 20 9206-9215 doi: 10.1158/0008-5472.CAN-05-1024
Boerboom D, Paquet M, Hsieh M, Liu J, Jamin SP, Behringer RR, Sirois J, Taketo MM, Richards JS.Misregulation of the Wnt/beta-catenin signaling pathway is a hallmark of several forms of cancer. Components of the Wnt/beta-catenin pathway are expressed in ovarian granulosa cells; nevertheless, its potential involvement in granulosa cell tumorigenesis has not been examined. To this end, human (n = 6) and equine (n = 18) granulosa cell tumors (GCT) were analyzed for beta-catenin expression by immunohistochemistry. Unlike granulosa cells of normal ovaries, most (15 of 24) GCT samples showed nuclear localization of beta-catenin, suggesting that activation of the Wnt/beta-catenin pathway plays ...
Changes in structure of lymphatic organs in foals died due to Rhodococcus equi infection.
Polish journal of veterinary sciences    September 27, 2005   Volume 8, Issue 3 219-224 
Katkiewicz M, Witkowski L, Kita J.The aim of this study was to investigate the structure of lymphatic organs in foals which died due to Rhodococcus equi infection. The material for this study consisted of 9 foals, of both genders, various breeds, 6-14 weeks old. The routine histopathological examination and immunocytochemical reaction for cytokeratine-3 receptors revealed the disturbances in the thymus epithelial cells development. This was manifested by a complete lack of cells expressing cytokeratine-3 receptors, as well as absence of normal thymocytes differentiation. The supposed thymus epithelial cells were very few, expr...
Diagnosis and surgical removal of a granulosa-theca cell tumor in a mare.
The Canadian veterinary journal = La revue veterinaire canadienne    September 13, 2005   Volume 46, Issue 7 644-646 
Maurice KT.An 8-year-old mare showed stallion-like behavior and aggressiveness. A granulosa-theca cell tumor was tentatively diagnosed based on history, transrectal palpation, and ultrasonography, and surgically removed. Serological levels of testosterone and inhibin were elevated. Histopathological examination confirmed the diagnosis. The mare recovered and by day 45 could be turned out with other horses. Une jument de 8 ans a manifesté un comportement et de l’agressivité semblables à ceux d’un étalon. Une tumeur de cellule de la granulosa-theca a été provisoirement diagnostiquée, en se fond...
Funisitis associated with leptospiral abortion in an equine placenta.
Veterinary pathology    September 8, 2005   Volume 42, Issue 5 659-662 doi: 10.1354/vp.42-5-659
Sebastian M, Giles R, Roberts J, Poonacha K, Harrison L, Donahue J, Benirschke K.Funisitis, inflammation of the umbilical cord, is well recognized in human placentas. This report describes a case of funisitis associated with leptospiral infection in the placenta of a Thoroughbred foal born prematurely. The umbilical cord had diffuse superficial yellow discoloration along its entire length. Microscopic evaluation showed an exudate of neutrophils admixed with fibrin on the surface. Warthin-Starry staining showed spirochetes in the Wharton's jelly of the umbilical cord. A locally extensive, severe placentitis not involving the star and allantoic cystic hyperplasia were the ot...
First observation of an Hashimoto thyroiditis-like disease in horses from Eastern Europe: histopathological and immunological findings.
Immunopharmacology and immunotoxicology    August 24, 2005   Volume 27, Issue 2 241-253 doi: 10.1081/iph-200067743
Perillo A, Passantino G, Passantino L, Cianciotta A, Mastrosimini AM, Lacovazzi P, Venezia P, Jirillo E, Troncone A.Among 622 slaughtered horses from eastern Europe, 156 thyroid glands were selected on the basis of macroscopic alterations (e.g., determination of volume and weight). In the 80% of these thyroids, microscopic alterations consistent with a diagnosis of Hashimoto thyroiditis-like disease were found. In particular, a subverted architecture of the thyroid gland with colloid rarefaction, lymphocytic infiltration, and fibrosis was noted. The confirmation of the histopathological diagnosis of an equine Hashimoto thyroiditis-like disease was provided by the increased serum concentration of thyroglobul...
Hemangiosarcoma in 11 young horses.
Journal of veterinary internal medicine    August 13, 2005   Volume 19, Issue 4 564-570 doi: 10.1892/0891-6640(2005)19[564:hiyh]2.0.co;2
Johns I, Stephen JO, Del Piero F, Richardson DW, Wilkins PA.Hemangiosarcoma is a rare neoplasm of horses and hemangiosarcoma in young horses might behave differently than in mature horses. The purpose of this study was to identify the characteristics of hemangiosarcoma occurring in horses < or = 3 years of age. Medical records from 1982 to 2004 were searched for horses < or = 3 years of age with a histopathologic diagnosis of hemangiosarcoma. Eleven records were identified. Thoroughbred and Thoroughbred crosses predominated. Age ranged from 9 days to 3 years. All horses presented with cutaneous or leg swellings or joint effusion. Physical examina...
Sudden death due to thoracic lymphoma in a standardbred racing horse.
The Canadian veterinary journal = La revue veterinaire canadienne    July 29, 2005   Volume 46, Issue 6 528-529 
Lawn K.During training, a 6-year-old standardbred gelding collapsed, exhibiting severe epistaxis and agonal breathing and was euthanized. The horse had a recent history of poor performance, lethargy, and unilateral eyelid swelling with serous ocular discharge. Postmortem and histopathologic examination findings revealed thoracic lymphosarcoma and concurrent exercise-induced pulmonary hemorrhage. Résumé — Mort subite d’un cheval de course de race standardbred causée par un lymphome thoracique. En cours d’entraînement, un standardbred hongre âgé de 6 ans s’est effondré, présentant des s...
Immune-mediated keratitis in horses: 19 cases (1998-2004).
Veterinary ophthalmology    July 13, 2005   Volume 8, Issue 4 233-239 doi: 10.1111/j.1463-5224.2005.00393.x
Gilger BC, Michau TM, Salmon JH.The purpose of this study is to describe clinical and histologic findings, treatment, and outcome of horses with suspected immune-mediated keratitis (IMMK). Methods: Retrospective study. Methods: Nineteen horses that presented to NCSU-VTH from 1998 to 2004 with IMMK. Procedures Information retrieved from the medical records included signalment, duration of clinical signs, therapy prior to initial examination, ophthalmic abnormalities, diagnostics performed, therapy instituted, and long-term vision. Results: Nineteen horses (22 eyes) were diagnosed with IMMK. Three distinct clinical groups were...
Macroscopical and histopathological changes in regressing primary and recurrent equine sarcoids during active specific bio-immunotherapy.
In vivo (Athens, Greece)    July 8, 2005   Volume 19, Issue 4 761-767 
Hallamaa RE, Saario E, Tallberg T.Healing sarcoids were followed in 18 horses which had taken part in previous clinical studies on a total of 29 horses suffering from either primary or recurrent sarcoids, treated with bio-immunotherapy. In the present study, attention was paid to changes observed in these fibroblastic skin tumours during their regression. The tumours were surgically debulked leaving the base in the skin. The horses were immunized according to bio-immunotherapy at 2- to 4-week intervals with an autogenous vaccine made from the excised part of the tumour until the base had visibly regressed. Healing was followed...
Comparison of topical lidocaine/prilocaine anesthetic cream and local infiltration of 2% lidocaine for episioplasty in mares.
Journal of veterinary pharmacology and therapeutics    June 15, 2005   Volume 28, Issue 3 299-304 doi: 10.1111/j.1365-2885.2005.00657.x
Erkert RS, Macallister CG, Campbell G, Payton ME, Shawley R, Clarke CR.Local anesthesia and tissue inflammation associated with lidocaine infiltration and lidocaine/prilocaine topical anesthetic cream for episioplasty in mares were compared. Twenty-two mares were randomly assigned to lidocaine or lidocaine/prilocaine topical anesthetic cream treatment groups. Perineum and vulva were cleaned, 8-12 g (approximately 1 g/cm per side of vulva) of topical anesthetic cream was applied, and the area was covered by plastic wrap 30 min prior to beginning procedure. Alternately, lidocaine was injected (1 mL) every centimeter just prior to the procedure. Episioplasty was con...
Leucocytoclastic vasculitis associated with Staphylococcus intermedius in the pastern of a horse.
The Veterinary record    June 7, 2005   Volume 156, Issue 23 740-743 doi: 10.1136/vr.156.23.740
Risberg AI, Webb CB, Cooley AJ, Peek SF, Darien BJ.A pregnant quarterhorse mare became acutely lame as a result of severe swelling of its right hind leg, thought to have been caused by a fracture or a muscle tear. Diagnostic procedures ruled out a traumatic musculoskeletal cause and a physical examination revealed chronic pastern dermatitis ('scratches'/'grease heel'). Histopathological evaluation of biopsy samples from the right hind leg was consistent with a leucocytoclastic vasculitis, and culture yielded Staphylococcus intermedius. The treatment and infectious causes of pastern dermatitis are discussed.
[Pemphigus foliaceus in a Haflinger gelding].
Schweizer Archiv fur Tierheilkunde    June 3, 2005   Volume 147, Issue 5 213-217 doi: 10.1024/0036-7281.147.5.213
Stähli P, Grest P, Favrot C, Feige K.A 10-year-old Haflinger gelding was presented with severe generalized chronic dermatitis characterized by scales, crusts and widespread alopecia with a partially diffuse and partially circumscribed pattern. Pemphigus foliaceus was diagnosed based on history, clinical signs and histological examination of skin biopsies. Typical histological findings were subcorneal pustules with accumulations of intact neutrophil granulocytes and acantholytic keratinocytes. The gelding was treated with glucocorticoids and gold salts. The skin lesions resolved completely after 8 weeks of treatment. No recurrence...
Ectopic cilium in seven horses.
Veterinary ophthalmology    May 25, 2005   Volume 8, Issue 3 199-202 doi: 10.1111/j.1463-5224.2005.00369.x
Hurn S, Turner A, Mc Cowan C.Ectopic cilium was diagnosed by slit-lamp biomicroscopy and treated surgically by transconjunctival excision in seven adult horses. All cases presented with a common history of blepharospasm, ocular discharge and keratitis. Ophthalmic examination revealed a single translucent cilium in the upper eyelid palpebral conjunctiva, emerging approximately 5 mm from the eyelid margin. Corneal ulceration was not observed in any horse. Most horses responded well to transconjunctival surgical excision. There was recurrence of ectopic cilium 6 weeks postoperatively in one horse. Histopathologic examination...
Observations on the interstitial cells of Cajal and neurons in a recovered case of equine dysautonomia (grass sickness).
Journal of comparative pathology    May 21, 2005   Volume 133, Issue 1 33-40 doi: 10.1016/j.jcpa.2005.01.004
Milne EM, Fintl C, Hudson NP, Pearson GT, Mayhew IG, Hahn CN.This paper describes the histopathological and immunohistochemical changes in the central, autonomic and enteric nervous systems in a well-documented case of equine dysautonomia (ED), after the animal had recovered without significant residual clinical signs. Evidence of neuronal degeneration, such as neuronal chromatolysis, glial scars or a decrease in density of neurons, was not observed in the midbrain, pons, medulla oblongata or spinal cord, including the nuclei of cranial nerves III, V, VII, X and XII. In addition, no evidence of muscle denervation or re-innervation, such as group atrophy...
Post-anaesthetic myelomalacia in a horse.
Journal of the South African Veterinary Association    May 20, 2005   Volume 76, Issue 1 36-39 doi: 10.4102/jsava.v76i1.392
Jouber KE, Duncan N, Murray SE.This article describes a rare neurological complication of anaesthesia in a 2 year-old Clydesdale colt undergoing castration. Anaesthesia was induced with glyceryl guaiacol ether and ketamine and maintained with halothane. Following an uneventful anaesthetic of 40 minutes, the horse recovered from anaesthesia in a padded recovery stall. After approximately 70 minutes in the recovery stall, the horse attempted to stand and adopted a dog sitting position. One hundred and fifty minutes later, the horse became distressed and was sedated with xylazine. Clinical examination of the horse did not reve...
Hereditary equine regional dermal asthenia in three related Quarter horses in Brazil.
Veterinary dermatology    April 22, 2005   Volume 16, Issue 2 125-130 doi: 10.1111/j.1365-3164.2005.00431.x
Borges AS, Conceição LG, Alves AL, Fabris VE, Pessoa MA.Hereditary equine regional dermal asthenia belongs to a group of inherited, congenital connective tissue dysplasias usually described as hyperelastosis cutis, cutaneous asthenia, dermatosparaxis, or Ehlers-Danlos-like syndrome. This report presents the clinical and histological features of three related Quarter horses affected with regional dermal asthenia. These horses had bilateral asymmetric lesions of the trunk and lumbar regions, where the skin was hyperextensible. Handling of the skin elicited a painful response and superficial trauma led to skin wounds. The skin was thinner than normal ...
Immunohistochemical and ultrastructural detection of intestinal spirochetes in Thoroughbred horses. Shibahara T, Kuwano A, Ueno T, Katayama Y, Ohya T, Taharaguchi S, Yamamoto S, Umemura T, Ishikawa Y, Kadota K.Studies of equine intestinal spirochetes have long focused on intestinal contents alone, but intestinal spirochetosis has been reported recently in a 21-month-old Thoroughbred colt in Japan. To define the clinical and pathological significances of intestinal spirochetosis in several horses, an epizootiologic survey with histologic, immunohistochemical, and ultrastructural methods was conducted for Brachyspira antigen-containing intestinal spirochetes in 12 diseased or injured Thoroughbred horses, aged from 35 days to 17 years. Brachyspira antigen-containing spirochetes were found in 7 of 12 ho...
Bilateral nodular lymphocytic conjunctivitis in a horse.
Veterinary ophthalmology    March 15, 2005   Volume 8, Issue 2 129-134 doi: 10.1111/j.1463-5224.2005.00349.x
Stoppini R, Gilger BC, Malarkey DE, Ratto A, Brigati G.A Russian jumper horse presented because of an ocular perilimbal conjunctival mass and, on clinical examination, two bilateral conjunctival masses were found, of different size and conformation. Attempts at complete excision of the left eye mass and excisional biopsy of the right eye mass were performed. The left eye mass recurred rapidly, but resolved completely after topical corticosteroid therapy. The two lesions had similar histopathologic features, characterized by focal, chronic, primarily lymphocytic conjunctivitis with follicular lymphoid hyperplasia. Special histopathologic staining t...
Effect of acute sublethal endotoxaemia on in vitro digital vascular reactivity in horses.
Journal of veterinary medicine. A, Physiology, pathology, clinical medicine    March 2, 2005   Volume 52, Issue 2 67-73 doi: 10.1111/j.1439-0442.2004.00684.x
Zerpa H, Vega F, Vasquez J, Ascanio E, Campos G, Sogbe E, Romero E, Ascanio M, García H.Endotoxaemia is a syndrome linked to the development of equine laminitis; however, the relationship between them is uncertain. The aim of this experiment was to evaluate the effect of an experimental acute sublethal endotoxaemia model on in vitro equine palmar digital vascular reactivity. Rings of arteries and veins of each forelimb were obtained from 11 clinically healthy horses submitted to two surgical procedures, 3 weeks apart. Before the second surgery, 0.25 microg/kg of lipopolysaccharide from Escherichia coli O55:B5 in saline, was administered i.v. in 30 min. After 3 h, the vessels were...
Tail-base mass from a “horse of a different color”.
Veterinary clinical pathology    February 26, 2005   Volume 34, Issue 1 69-71 doi: 10.1111/j.1939-165x.2005.tb00014.x
LeRoy BE, Knight MC, Eggleston R, Torres-Velez F, Harmon BG.A 14-year-old bay Thoroughbred gelding was presented for evaluation of a mass at the base of the tail. The mass had been present for 1 year, and recently had begun to increase in size. Additional masses were found around the eye and shoulder. A fine-needle aspirate of the tail-base mass revealed highly anaplastic round to polyhedral cells containing dark green to black cytoplasmic granules interpreted to be melanin. Histologically, the mass was composed of pleomorphic, poorly pigmented, round to polyhedral cells interpreted to be neoplastic melanocytes. With immunohistochemistry, the cells wer...
Sarcoplasmic masses in equine skeletal muscle.
Neuromuscular disorders : NMD    January 11, 2005   Volume 15, Issue 2 147-153 doi: 10.1016/j.nmd.2004.10.014
Aleman M, Lecouteur RA, Nieto JE, Williams DC, Stanke NJ, Shelton GD.Sarcoplasmic masses in humans have been associated with various myopathies, although the significance remains elusive. Similar structures have also been observed in equine muscle. The aim of this study was to determine the frequency of such structures in normal and abnormal equine muscle, and to characterize these structures using histological, histochemical, immunohistochemical, ultrastructural, and morphometric analyses. The histological and histochemical appearance was similar to that of human sarcoplasmic masses with a central or subsarcolemmal distribution. Of interest was a predilection ...
Synaptophysin: an immunohistochemical marker for animal dysautonomias.
Journal of comparative pathology    January 8, 2005   Volume 132, Issue 2-3 223-227 doi: 10.1016/j.jcpa.2004.07.002
Hilbe M, Guscetti F, Wunderlin S, Ehrensperger F.Equine and feline dysautonomias are characterized histopathologically by degenerating neurons with chromatolysis, pyknotic and sometimes eccentric nuclei, and loss of Nissl substance in the peripheral autonomic ganglia. Because it may be difficult to distinguish pathological from post-mortem changes in affected ganglia by histopathological examination, synaptophysin was evaluated as an immunohistochemical marker. Degenerating neurons showed strong intracytoplasmic labelling indicating abnormal accumulation of synaptophysin. It was concluded that synaptophysin immunohistochemistry is a helpful ...
Evaluation of pituitary gland anatomy and histopathologic findings in clinically normal horses and horses and ponies with pituitary pars intermedia adenoma.
American journal of veterinary research    January 6, 2005   Volume 65, Issue 12 1701-1707 doi: 10.2460/ajvr.2004.65.1701
van der Kolk JH, Heinrichs M, van Amerongen JD, Stooker RC, in de Wal LJ, van den Ingh TS.To determine size and weight of the pituitary gland and associations between pituitary gland size and weight and sex and age in horses without clinical signs associated with pituitary pars intermedia adenoma (PPIA) and horses and ponies with PPIA. Methods: Pituitary glands from 100 horses without clinical signs of PPIA and 19 horses and 17 ponies with PPIA. Methods: Pituitary glands were weighed, measured, and examined histologically by use of H&E stain. Masson trichrome and periodic acid-Schiff staining were used, when appropriate. Histologic lesions in the pars intermedia, pars distalis,...
The prevalence of apoptotic keratinocytes in equine epidermis: a retrospective light-microscopic study of skin-biopsy specimens from 253 horses with normal skin or inflammatory dermatoses.
Journal of veterinary medicine. A, Physiology, pathology, clinical medicine    December 22, 2004   Volume 51, Issue 9-10 400-404 doi: 10.1111/j.1439-0442.2004.00665.x
Macleod KD, Scott DW, Erb HN.A retrospective study was performed to assess the prevalence of apoptotic epidermal keratinocytes in biopsy specimens from 226 horses with inflammatory dermatoses and from 27 normal specimens. One or more apoptotic keratinocytes were found in specimens from 28 of 226 (12%) horses with various dermatoses, and in one of 27 (4%) specimens from normal horses. The prevalence (proportion of cases with apoptotic epidermal keratinocytes) of apoptotic keratinocytes in the group composed of discoid lupus erythematosus, erythema multiforme, photodermatitis, and systemic lupus erythematosus was significan...
New insights into the skeletal muscle phenotype of equine motor neuron disease: a quantitative approach.
Acta neuropathologica    December 22, 2004   Volume 109, Issue 3 272-284 doi: 10.1007/s00401-004-0940-1
Palencia P, Quiroz-Rothe E, Rivero JL.Equine motor neuron disease (EMND) is a neurodegenerative disorder similar to the sporadic form of human amyotrophic lateral sclerosis. This study was conducted to quantify myofiber plasticity in response to EMND. Deep M. gluteus medius biopsy samples from eight horses with an ante mortem diagnosis of EMND, which in five cases was later confirmed by post mortem examination of spinal cord and peripheral nerves, were examined by combined methodologies of electrophoresis of myosin heavy chains (MyHC), muscle enzymes and substrate biochemistry, immunohistochemistry of MyHCs and sarcoendoplasmic Ca...
Surgical management of compound odontoma in two horses.
Journal of the American Veterinary Medical Association    November 24, 2004   Volume 225, Issue 9 1423-1393 doi: 10.2460/javma.2004.225.1423
Brounts SH, Hawkins JF, Lescun TB, Fessler JF, Stiles P, Blevins WE.Two horses were admitted for evaluation of mandibular swelling (horse 1) or maxillary distortion (horse 2). Both horses had radiographic evidence of tumors of dental origin that had the appearance of a compound odontoma. Extensive surgical resection was performed for treatment. Horse 1 was treated with 1-stage surgical resection, but an iatrogenic fracture occurred during surgery, which was managed successfully with a type I external fixator and extraoral alimentation. Horse 2 was treated in multiple stages to remove all portions of the tumor. To manage an extensive orosinal fistula, a custom-...
1 26 27 28 29 30 44