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Topic:Veterinary Procedure

Veterinary procedures in horses encompass a range of medical and surgical interventions performed to diagnose, treat, and manage equine health conditions. These procedures are designed to address various health issues, from routine care to emergency interventions. Common veterinary procedures include vaccinations, dental care, lameness evaluations, reproductive services, and surgical interventions such as colic surgery or fracture repair. This page compiles peer-reviewed research studies and scholarly articles that explore the methodologies, outcomes, and advancements in veterinary procedures for horses, providing insights into their application and efficacy in equine medicine.
Modified Medial Canthoplasty for Correction of Euryblepharon in Two Horses.
Veterinary ophthalmology    March 8, 2026   Volume 29, Issue 2 e70165 doi: 10.1111/vop.70165
Letourneau AR, Butler BA, Martinez PS, da Costa Martins B, Monk CS, Plummer CE.To describe a medial canthoplasty surgical procedure in two horses for correction of euryblepharon, secondary to microphthalmia, and following excision of retrobulbar fat prolapse. Methods: A 1 year old thoroughbred mare was presented for small globes and chronic ocular discharge bilaterally. Ophthalmic examination revealed microphthalmos, euryblepharon, medial canthal pocket syndrome, and dacryocystitis bilaterally with no visual impairments. A 2 year old Appaloosa gelding was presented for evaluation of a smooth, subconjunctival mass anterior to the right globe in the medial canthus. Oph...
The effect of botulinum toxin injection into the deep digital flexor muscle on foot biomechanics in healthy horses.
American journal of veterinary research    February 26, 2026   1-10 doi: 10.2460/ajvr.25.12.0452
Slavik K, Underwood C, Lowndes C, Skelton G, van Eps A.To examine the effects of botulinum toxin inoculation into the deep digital flexor (DDF) muscle on foot biomechanics. Unassigned: 6 healthy horses were injected with botulinum toxin in the DDF of 1 forelimb. The opposite forelimb was untreated. Ground reaction forces (GRF) were measured using a pressure sensor in regions of interest, including the dorsal hoof wall (toe). The location of the center of pressure (COP) was measured relative to the dorsal hoof wall during static standing and at peak stance during walking. Repeat measurements 3, 7, 14, 28, and 42 days after injection were compared t...
Ectopic eruption of a permanent mandibular tooth in a miniature horse: case report.
Veterinary research communications    February 25, 2026   Volume 50, Issue 3 173 doi: 10.1007/s11259-026-11119-1
Mendes RP, Gonzaga MS, Matheus MM, Bittar MJ, Doria RGS, Corrêa RR.Developmental and eruption abnormalities are common and can result in progressive dental diseases. Ectopic eruption of the affected tooth may be the result of these processes. This study aims to report the occurrence of a permanent mandibular tooth in a horizontal position, with retention of the corresponding deciduous tooth, in a miniature horse. A 2-year-old female miniature horse was admitted to the veterinary hospital with a hard swelling on the left mandibular ramus, which had been growing continuously for three months. After a complete evaluation, it was concluded that the swelling was t...
Environmental Occurrence of Potentially Pathogenic Bacteria in the Equine Anesthetic Induction and Recovery Box: A Single-Center Study.
Animals : an open access journal from MDPI    February 25, 2026   Volume 16, Issue 5 712 doi: 10.3390/ani16050712
Rinnovati R, Meistro F, Ralletti MV, D'Angelo P, Spadari A, Zingariello E, Pollera C, Stancampiano L.In horses, surgical site infections (SSIs) are multifactorial complications influenced by patient-related, procedural, and environmental factors. While perioperative contamination has been extensively studied in the operating theater, the anesthetic induction and recovery environment has received limited attention. The aim of this study was to characterize bacterial contamination within an equine anesthetic induction and recovery stall and to evaluate its spatial and temporal distribution. Environmental samples were collected from four predefined locations within the stall at three time points...
Effects of rectal examination on intraocular pressure and behavioral responses in pregnant and non-pregnant mares.
Journal of equine veterinary science    February 24, 2026   Volume 160 105821 doi: 10.1016/j.jevs.2026.105821
Çortu A, Çınar H.Rectal examination is routine in equine reproduction but may trigger acute stress affecting welfare and safety. Intraocular pressure (IOP) responds rapidly to autonomic changes and may capture short-lived stress responses. Objective: To evaluate whether rectal examination acutely affects IOP and behavioral responses in mares, and whether reactions differ by reproductive status. Methods: Twenty Rahvan mares (10 pregnant, 30-40 days' gestation; 10 non-pregnant; 4-7 years) underwent transrectal examination without sedation. IOP was measured bilaterally at six time points: 2 min pre-exam (T1), dur...
Unilateral vision loss associated with corneal opacity and posterior lens luxation in the right eye of a Thoroughbred gelding: Case report.
Journal of equine veterinary science    February 21, 2026   Volume 159 105813 doi: 10.1016/j.jevs.2026.105813
Imai S, Sato R, Fujiwara R, Terui S, Kimura A, Ichijo T, Kasashima Y, Miyazaki T.A 15-year-old Thoroughbred gelding was presented for examination due to chronic corneal opacity in the right eye, which had been noted for several years. An ophthalmic evaluation revealed dense, irregular corneal opacity; an absence of the direct pupillary light reflex; and a positive dazzle reflex. Fluorescein staining was negative and cytology of a corneal conjunctival swab identified nucleated squamous epithelial cells, but no inflammatory cells. Slit-lamp examination failed to visualize intraocular structure, and the lesion was deemed to be chronic and irreversible. An obstacle-avoidance t...
Manual graphic roadmap for transarterial coil embolization of guttural pouch arteries in horses: A technical note.
Veterinary surgery : VS    February 18, 2026   doi: 10.1111/vsu.70088
Mählmann K, Lischer CJ.This technical note describes the use of a manual graphic roadmap (MGR) to assist fluoroscopic guidance during transarterial coil embolization (TACE) for guttural pouch (GP) arterial hemorrhage. Horses underwent MGR-assisted TACE at the Equine Clinic, Free University of Berlin, between 2012 and 2024. Surgery was performed under general anesthesia with fluoroscopic guidance. Following the initial angiogram, a transparent foil was secured to the fluoroscopy monitor, and an assistant traced the vascular anatomy with a waterproof marker to create the MGR, which then served as a guide for catheter ...
3D printed aiming device for equine proximal interphalangeal joint arthrodesis: Ex vivo study.
Veterinary surgery : VS    February 18, 2026   doi: 10.1111/vsu.70085
Aimonetti E, Genton M, Lischer CJ, Rossignol F.To determine the benefit of using a three-dimensional (3D)-printed titanium aiming device for placing two 5.5-mm transarticular screws during proximal interphalangeal joint (PIPJ) arthrodesis in equine species. Methods: Ex vivo study. Methods: A total of 40 cadaveric forelimbs from adult horses. Methods: A senior surgeon and a first-year resident each performed 20 constructs: 10 using the device and 10 using a freehand technique. Procedure duration and number of intraoperative radiographs were recorded. Final radiographs were evaluated by an ECVS-certified surgeon unaware of treatment group, b...
Proctectomy with coloanal anastomosis in horses – a cadaveric study.
Journal of equine veterinary science    February 18, 2026   Volume 159 105814 doi: 10.1016/j.jevs.2026.105814
Strugava L, Serighelli-Júnior G, Stadler LM, Flores LADS, Minozzo GA, Dornbusch LPTC, Moreno JCD, Dornbusch PT.Rectal amputation is a surgical approach indicated for the management of severe rectal lacerations or extensive rectal prolapse when transmural compromise or primary repair is unfeasible. These conditions, although uncommon, present substantial challenges in equine practice due to the anatomical complexity of the pelvic region and the potential for life-threatening complications if not adequately addressed. This study aimed to describe and standardize a reproducible surgical technique for rectal amputation in horse cadavers. Six equine cadavers (mean body mass, 441.83± 66.84 kg) were position...
Short- and Long-Term Outcomes in Horses Following Laparoscopic Nephrosplenic Space Ablation.
Veterinary sciences    February 17, 2026   Volume 13, Issue 2 196 doi: 10.3390/vetsci13020196
Cerullo A, Scilimati N, Di Nicola MR, Colla L, Mazza S, Bertoletti A, Nannarone S, Gialletti R.Left dorsal displacement of the large colon (LDDLC) is a common cause of colic in horses and it is frequently associated with recurrent episodes, with significant implications for horse management, athletic performance, and owner satisfaction. Laparoscopic nephrosplenic space (NSS) ablation is a preventive surgical technique aimed at reducing recurrence in horses with a history of medically or surgically treated LDDLC. This retrospective study evaluated 48 horses that underwent laparoscopic NSS ablation in two Italian Veterinary Teaching Hospitals between 2016 and 2024. Short-term outcomes, in...
Hemithyroidectomy due to a large, solid follicular thyroid adenoma in a 19-year-old thoroughbred mare.
Journal of equine veterinary science    February 16, 2026   Volume 159 105810 doi: 10.1016/j.jevs.2026.105810
Bramall LM, Hinnigan GJ, Wattam AD, Owen KR.This case report describes the successful hemithyroidectomy of the largest equine solid follicular adenoma described in the veterinary literature to date. A 19-year-old thoroughbred mare was referred to Oakhill Veterinary Centre for the surgical removal of a large, left-sided thyroid gland measuring 26cm in diameter. Pre-operative considerations, the hemithyroidectomy surgical technique as well as the intra- and post-operative complications encountered, are discussed. Following surgery the horse had no long-term complications and continues to thrive four and a half years post-operatively.
Comparative Evaluation of Follicular Flushing Frequency and Scraping Time During Ovum Pick-Up in Mares: Effects on Oocyte Recovery Rate and Technical Considerations.
Reproduction in domestic animals = Zuchthygiene    February 12, 2026   Volume 61, Issue 2 e70183 doi: 10.1111/rda.70183
Márquez-Moya A, Carreras-Vico N, Sala-Ayala L, Martínez-Boví R, Cuervo-Arango J.Transvaginal ultrasound-guided follicular aspiration or ovum pick-up (OPU) has become the standard technique for oocyte collection in mares for intracytoplasmic sperm injection (ICSI). Although repeated follicular flushes and wall scraping are commonly used to improve oocyte recovery rate (ORR), the relative contribution of each remains unclear. This study aimed to compare the effects of multiple flushes versus controlled scraping time on ORR in mares. A controlled trial was conducted in two phases: (1) an ex vivo phase using slaughterhouse ovaries (n = 32), and (2) an in vivo phase in c...
Current and Future Central Nervous System Surgery-Part 1: Cervical Spinal Cord Compression.
The Veterinary clinics of North America. Equine practice    February 6, 2026   S0749-0739(25)00074-4 doi: 10.1016/j.cveq.2025.12.006
Nelson BB, Easley JT.Ventral cervical stabilization remains the primary surgical approach, in general, for horses with spinal cord compression. Advancements in volumetric imaging offer a more comprehensive understanding of central nervous system dysfunction elucidating that other modes of compression exist. Minimally invasive instrumentation and computer-assisted surgery are expanding therapeutic possibilities for cervical vertebral compressive myelopathy, radiculopathy, vertebral fractures, and intracranial or intraspinal masses. Emerging techniques-such as articular process joint fixation, targeted decompression...
Current and Future Central Nervous System Surgery-Part 2: Radiculopathy, Vertebral Fractures, and Intracranial Surgery.
The Veterinary clinics of North America. Equine practice    February 6, 2026   S0749-0739(25)00075-6 doi: 10.1016/j.cveq.2025.12.007
Nelson BB, Easley JT.Equine neurosurgery is a challenge for many surgeons, particularly when central nervous system (CNS) disease is not addressed through ventral cervical stabilization, the most performed neurosurgical procedure. Advances in diagnostic imaging, minimally invasive instrumentation, and computer-assisted surgery are expanding therapeutic possibilities beyond cervical vertebral compressive myelopathy, including radiculopathy, vertebral fractures, and intracranial or intraspinal masses. Emerging techniques-such as percutaneous foraminotomy, facet fixation, targeted decompression, novel implant systems...
Pharmacopuncture with low-dose dexmedetomidine and saline aquapuncture at acupoint Governing Vessel 24 provides sedation in healthy adult horses.
American journal of veterinary research    February 5, 2026   1-7 doi: 10.2460/ajvr.25.08.0283
Faugier C, Snyder LBC, Hyun M, Schroeder C.To evaluate sedation in horses following pharmacopuncture with dexmedetomidine at acupoint Governing Vessel 24 (GV-24) compared to aquapuncture at GV-24 or an equivalent dose of dexmedetomidine administered via IV or SC routes. Unassigned: 10 adult mares received 4 treatments in a blinded, randomized, crossover design: (1) dexmedetomidine administered at GV-24 (DexmedGV24; 1 μg/kg); (2) saline administered at GV-24 (SalineGV24; 1.5 mL); (3) dexmedetomidine administered SC on the lateral neck (DexmedSC; 1 μg/kg); or (4) dexmedetomidine administered IV (DexmedIV; 1 μg/kg). Sedation scores (fa...
Maggot therapy in horses with traumatic wounds caused by wire fences: Case reports.
Journal of equine veterinary science    February 4, 2026   Volume 158 105802 doi: 10.1016/j.jevs.2026.105802
Dos Santos TS, Dillmann JB, Giovelli M, Elias GO, Lima RK, Cescon S, Stainki DR, Dos Santos RC, Corrêa C, Monteiro SG.This study reports the successful use of maggot therapy in four horses with traumatic wounds caused by wire fences, treated in veterinary clinics and under field conditions in southern Brazil. All lesions showed tissue necrosis, purulent discharge, and foul odor, indicating infection and delayed healing. Sterile Lucilia cuprina larvae (L1 stage) were applied directly to the wounds for 48 hours. Rapid improvement was observed, with marked reduction of necrotic tissue, exudate, and odor, and stimulation of granulation tissue in three cases. Complete wound closure occurred between 10 and 60 days ...
Biomechanical assessment of dressage Spanish horses through accelerometry and the immediate effects of a single capacitive resistive electrical transfer session.
BMC veterinary research    January 31, 2026   Volume 22, Issue 1 148 doi: 10.1186/s12917-026-05319-9
Calle-González N, Rivero JL, Argüelles D, Requena F, Muñoz A.Capacitive resistive electrical transfer (CRET) is a non-invasive electromagnetic diathermic technique. The effect of its application 24 h prior to exercise, compared to a sham application performed with the device off, was evaluated in 8 Spanish Purebred dressage stallions. CRET was applied bilaterally on the neck, back, and croup. The horses wore an accelerometer fixed on the sternal area during a dressage test, and spatiotemporal stride parameters, total and dorsoventral (DVAA), longitudinal (LAA), and mediolateral accelerometric activities, as well as dorsoventral displacement, were recor...
How to perform a venogram of the equine foot.
Journal of the American Veterinary Medical Association    January 30, 2026   1 doi: 10.2460/javma.25.11.0755
Santonastaso A, Burns T, Claffey E.The objective of this video is to demonstrate a reliable technique for obtaining diagnostic venogram images of the equine foot. Venogram studies are indicated to assess vascular contrast filling of the equine digit, primarily in cases of laminitis. Unassigned: A healthy university-owned horse was used for demonstration purposes. The protocol was approved by the Virginia Polytechnic Institute and State University IACUC. Unassigned: The horse's shoes are removed, and the foot is cleaned of debris. The horse is sedated and a medial and lateral abaxial nerve block performed. The pastern is clipped...
Development of an Explainable Machine Learning Computational Model for the Prediction of Severe Complications After Orchiectomy in Stallions.
Animals : an open access journal from MDPI    January 25, 2026   Volume 16, Issue 3 377 doi: 10.3390/ani16030377
Tyrnenopoulou P, Kalatzis D, Kiouvrekis Y, Flouraki E, Folias L, Loukopoulos E, Starras A, Chalvatzis P, Tsioli V, Mavrogianni VS, Fthenakis GC.The objective of the present study was to apply supervised Machine Learning to predict severe complications after equine orchiectomy. A dataset of 612 cases of orchiectomies in stallions was used for the development of a computational model, among which in 8.5% of cases severe complications (colic, continued stallion-like behaviour, evisceration, funiculitis, haemorrhage, and scrotal infection) were diagnosed post-orchiectomy. Three supervised Machine Learning tools were employed: Logistic Regression (12 different models evaluated), Random Forest (64 models), and Gradient Boosting (8 models). ...
Equine water treadmill.
Journal of the American Veterinary Medical Association    January 23, 2026   1 doi: 10.2460/javma.25.11.0777
Vargas J.To describe the application of water treadmill exercise for equine fitness and/or rehabilitation in a scientific and clinically reasonable manner. Unassigned: Horses owned by Spy Coast Farm were used for video content. Unassigned: A literature review was performed and compiled in this brief video to provide veterinarians with a comprehensive, evidence-based guide for implementing water treadmill exercise within fitness and rehabilitation programs. Unassigned: Equine water treadmill exercise is an aerobic modality that increases distal limb flexion and range of motion, with no reported adverse ...
Comparison of a Single-Shot Antibiotic Protocol Compared to a Conventional 5-Day Antibiotic Protocol in Equine Diagnostic Laparotomy Regarding Pre- and Postoperative Colonization with Multi-Drug-Resistant Indicator Pathogens.
Antibiotics (Basel, Switzerland)    January 21, 2026   Volume 15, Issue 1 106 doi: 10.3390/antibiotics15010106
Stöckle SD, Kannapin DA, Merle R, Lübke-Becker A, Gehlen H. The emergence and spread of multi-drug-resistant (MDR) bacteria pose a growing threat in veterinary medicine, particularly in equine hospitals. This study investigated the colonization and infection dynamics of horses undergoing emergency laparotomy with two distinct antibiotic protocols (single-shot versus 5-day protocol) during hospitalization. Nasal swabs and fecal samples were collected from 67 horses undergoing emergency laparotomy at clinic admission as well as on postoperative days 3 and 10. These were screened for multi-drug-resistant indicator pathogens. As multi-drug-resistant indi...
Wrong turns, right career: an accidental journey into equine surgery.
The Veterinary record    January 16, 2026   Volume 198, Issue 2 i-ii doi: 10.1002/vetr.70318
Cramp P.From average school reports to a surgical residency in the USA and running a 17-vet practice, this is the unplanned route Phil Cramp took to finding a career he loves.
Effect of a Constant Rate Infusion of Ketamine on a Variable Rate Infusion of Xylazine in Standing Horses Undergoing Ventriculocordectomy and Laryngoplasty.
Veterinary sciences    January 12, 2026   Volume 13, Issue 1 77 doi: 10.3390/vetsci13010077
Medina-Bautista F, Morgaz J, Quirós-Carmona S, Caravaca-Paredes ME, Navarrete-Calvo R, Medina ALS, Gómez-Villamandos R, Granados MDM.Standing sedation in horses provides immobilization and analgesia for surgery while avoiding the high risks of general anesthesia. Ketamine at subanesthetic doses may enhance sedation and reduce xylazine requirements, but evidence in clinical settings is limited. In a randomized blinded trial, we evaluated whether adding a low-dose ketamine infusion could reduce the xylazine dose required for effective sedation during standing ventriculocordectomy and laryngoplasty. Fifty-one horses were randomly assigned to sedation with xylazine alone (SX group) or xylazine plus ketamine (KX group) in a cont...
Parasympathetic tone, cardiovascular variables, and behavioral alterations in conscious horses before and after castration and during anesthesia: A pilot study.
Journal of equine veterinary science    January 9, 2026   Volume 158 105781 doi: 10.1016/j.jevs.2026.105781
Mendoza Flores JE, Terrazas A, Lara Sagahon AV, Aleman M.Parasympathetic tone activity (PTA) and its association with behavior in conscious versus anesthesia in horses are unknown. Objective: To study PTA, heart rate (HR), minimum alveolar concentration (MAC), and mean arterial pressure (MAP) during castration under anesthesia. To study PTA, HR, Horse Grimace Scale (HGS), locomotor activity (LA), and behavior in conscious horses before and after castration. Methods: Pilot study including seven healthy adult horses. After habituation (days 1, 2, and 3), PTAm, HR, HGS, LA, and behavior were investigated during pre-surgery (days 4-, 5-, and one-hour pr...
Laparoscopically assisted cecal cannulation in standing horses.
Frontiers in veterinary science    January 9, 2026   Volume 12 1717140 doi: 10.3389/fvets.2025.1717140
Carvalho BVL, de Souza MCN, Avanza MFB, Teixeira RBC, Silva JRB, da Silva Cardoso T, Novais LGES, de Oliveira Monteiro FD, Viana RB, Monteiro BM....Access to the equine cecum is required for various therapeutic and experimental procedures, including decompression, fluid therapy, and transfaunation. Traditional approaches via laparotomy are highly invasive. This study aimed to describe a minimally invasive, laparoscopically assisted technique for cecal cannulation in standing horses. Unassigned: Seven horses underwent the procedure under sedation and paravertebral anesthesia. Two right flank accesses were created: a 10-mm laparoscopic port for visualization and a 2-cm minilaparotomy for cecal exteriorization. A Foley catheter was inserted ...
Surgical Removal of a Large Maxillary Sinus Mass Containing Three Dental Structures in a Standing Horse.
Journal of veterinary dentistry    January 9, 2026   8987564251407977 doi: 10.1177/08987564251407977
de Chaisemartin C, Belluco S, Nottrott K.Dental masses such as odontogenic masses, heterotopic polydontia, or ectopic supernumerary teeth have been documented in the equine head. This is the first case report of a large maxillary sinus mass with 3 ectopic teeth in an adult horse. A 14-year-old warmblood gelding was presented for evaluation of chronic right-sided nasal discharge. After imaging exploration, surgery was performed on the standing horse with a conchofrontal sinus trephination and a large maxillary bone (MB) sinusotomy. The examinations revealed a sinusal mass in the right maxillary sinus covered by sinusal mucosa and surr...
Bacterial contamination of covered versus non-covered plates in a sterile operating room in an equine referral center.
Journal of equine veterinary science    January 7, 2026   Volume 157 105775 doi: 10.1016/j.jevs.2026.105775
Dersch K, Kreuder A, Wang C, Troy J.Surgical site infections (SSI) are a common postoperative complication of equine orthopedic surgery and often increase morbidity and mortality. Objective: This study aimed to determine if covering surgical instruments during surgery decreased bacterial environmental air contamination during early opening of surgical packs (EOSP). The authors hypothesized that covering instruments with sterile surgical towels would reduce the total number of bacterial colonies to which the instruments were exposed. Methods: Blood agar plates (BAP) were allocated into two groups (non-covered vs. covered with a s...
Effects of intrauterine ozone insufflation in eleven subfertile mares: a case series.
Journal of equine veterinary science    January 7, 2026   Volume 157 105778 doi: 10.1016/j.jevs.2026.105778
Moroni R, Fanelli D, Maltinti S, Orefice M, Rota A, Camillo F, Melanie P, Cantile C, Miragliotta V, Pirone A, Lazzarini G, Passamonti F, Marmorini P....Equine persistent breeding-induced endometritis can lead to chronic uterine inflammation and fibrosis, reducing fertility. Intrauterine ozone (O₃) has recently been proposed as a potential treatment for mares unresponsive to conventional therapies. This case series describes O₃ treatment in eleven mares barren for at least one year despite multiple inseminations attempts. During the first oestrous cycle, low-volume uterine lavage and endometrial biopsy were performed, followed by 3 consecutive days of intrauterine O₂-O₃ gas insufflation. In the subsequent cycle, both procedures were re...
Intra-rater and inter-rater reliability of ultrasonographic intestinal wall thickness measurements in healthy horses.
Equine veterinary journal    January 4, 2026   doi: 10.1002/evj.70147
Hansen T, Kendall A, Finne R, Law E, Ringdahl A, Nostell K.Abdominal ultrasound is widely used to evaluate the intestinal tract of horses. Despite being a routine examination, there is limited data on the reliability of this diagnostic procedure. Objective: To investigate intra- and inter-rater reliability of ultrasonographic intestinal wall thickness measurements in healthy horses. A second aim was to assess variance within repeated measurements to determine threshold values that distinguish whether differences between repeated examinations are true findings versus solely due to measurement variation. Methods: In vivo reliability study. Methods: Eigh...
Long-term assessment of nephrosplenic space closure in horses. Cantarelli C, Cribb NC, Delli-Rocili M, Brisson B, Zur Linden A, Caswell JL.Long-term assessment of nephrosplenic space (NSS) closure and comparisons with ultrasonography and rectal palpation are lacking. The objective was to evaluate NSS closure in 12 research horses 5 y following laparoscopic ablation, using a novel adhesion scoring system, and to assess whether rectal examination and ultrasonographic findings could predict adhesion adequacy. The NSS was examined rectal palpation and ultrasonography prior to surgery, and at 30 d and 5 y after surgery. Ultrasonographic measurements of the distances between the renal fascia and spleen were recorded. The NSS adhesions...
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