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.
Wilkins PA, Boston RC, Gleed RD, Dobson A.To compare cardiac output measured in the pulmonary artery and a carotid artery by use of thermal and electrical impedance dilution. Animals-7 fit, clinically normal Standardbreds between 2 and 5 years of age. Methods: Transient changes in electrical impedance and temperature of blood were induced by bolus injections of ice-cold saline hypertonic (6% and 9% NaCl) solutions. Cardiac output was calculated by applying Stewart-Hamilton principles to the indicator dilution transients. Measurements were made during sequential exercise episodes on a level treadmill over approximately an 8-fold range ...
Caminoto EH, Alves AL, Amorim RL, Thomassian A, Hussni CA, Nicoletti JL.To evaluate the effects of extracorporeal shock wave therapy (ESWT) on affected ligaments in the hind limbs of horses with experimentally induced suspensory ligament desmitis by use of ultrasonographic, ultrastructural, and immunocytochemical techniques. Methods: 10 horses. Methods: Suspensory ligament desmitis was induced in both hind limbs of each horse by use of 2 collagenase injections (administered 2 weeks apart) in each suspensory ligament. Two weeks after the second injection, the right hind limb of each horse was treated with ESWT (3 treatments at 3-week intervals); the left hind limb ...
Knopp U, Christmann F, Reusche E, Sepehrnia A.Numerous types of materials have been evaluated over the past decades in the quest for the ideal dural replacement, but no product fully meets all the applicable criteria. This paper presents the long-term results of an animal trial of a collagen biomatrix (TISSUDURA, Baxter AG, Vienna/Austria) for the repair and regeneration of dural defects. This product provides a matrix with a special layer structure and consists of pure naturally cross-linked collagen of equine origin. The comparable material is Tutoplast Dura, a human cadaveric-derived dural graft preserved in a multiple stage chemical p...
Soma LR, Uboh CE, Guan F, Luo Y, Moate PJ, Boston RC, Driessen B.Hemoglobin-glutamer-200 (HBOC-200) is a hemoglobin (Hb)-based oxygen carrier (HBOC) comprising glutaraldehyde-polymerized bovine Hb. In this study, we sought to determine the pharmacokinetics of this first generation HBOC after IV infusion of 32.5 g of HBOC-200 solution in horses. Quantification of HBOC-200 in equine plasma and urine was performed using a method recently developed by our laboratory. The elimination from plasma was based on size distribution of the bovine Hb polymer. The decline of plasma concentration-time curve of HBOC-200 was described by a noninterchanging 2-compartmental m...
Kaps S, Richter M, Philipp M, Bart M, Eule C, Spiess BM.A 12-year-old Haflinger gelding was presented to the veterinary medical teaching hospital of the University of Zurich with a light-pink raised mass on the temporal limbus and conjunctiva of the left eye. Squamous cell carcinoma was confirmed histologically after keratectomy and cryotherapy. Seven months later, a smooth pink, progressively enlarging mass was observed within the cornea of the left eye. Ultrasonographically, the mass was not only infiltrating the corneal stroma but seemed to protrude into the anterior chamber. The globe was surgically removed and submitted for pathology. A histol...
Grogan EH, McDonnell SM.To evaluate behavioral compliance of horses and ponies with simulated intranasal vaccination and assess development of generalized aversion to veterinary manipulations. Methods: Clinical trial. Methods: 28 light horse mares, 3 pony geldings, 2 light horse stallions, and 3 pony stallions that had a history of compliance with veterinary procedures. Methods: Behavioral compliance with 2 intranasal vaccine applicators was assessed. Compliance with standard physical examination procedures was assessed before and after a single experience with either of the applicators or a control manipulation to e...
Anderson D, Kollias-Baker C, Colahan P, Keene RO, Lynn RC, Hepler DI.The liposomal cream formulation of diclofenac, an NSAID, is an effective, safe, and convenient way to treat localized areas of inflammation in horses. The results of this study reveal urinary and serum concentrations of diclofenac following topical administration of 1% liposomal diclofenac cream for 10 days at the labeled dose and at 2X and 4X the labeled dose. These results demonstrate the slow absorption and elimination of 1% liposomal diclofenac cream and may be useful when estimating the withdrawal time needed before a competition in order to prevent an inadvertent positive drug test.
Meyer C, Guthrie AJ, Stevens KB.Haematological variables and selected serum indices, particularly those affected by changes in renal and hepatic function, were examined in 6 healthy ponies following 4 intramuscular doses of 4 mg/kg imidocarb dipropionate administered every 72 hours. This treatment regime has been reported to sterilise experimental Babesia equi infections in horses and may have value in preventing the spread of this disease during exportation of possible carrier horses to non-endemic countries. Serum bile acids and serum gamma glutamyltransferase activity were measured to evaluate the effect of this treatment...
Lammers TW, Roussel AJ, Boothe DM, Cohen ND.To evaluate the effect of an indwelling nasogastric tube on gastric emptying of liquids in horses. Methods: 9 healthy adult horses. Methods: A randomized block crossover design was used. For treatment group horses, a nasogastric tube was placed and 18 hours later, acetaminophen was administered; the nasogastric tube remained in place until the experiment was complete. For control group horses, a nasogastric tube was passed into t stomach, acetaminophen was administered, and the nasogastric tube was removed immediately. Serial blood samples were collected 15 minutes before and after administrat...
Kelmer G, Keegan KG, Kramer J, Wilson DA, Pai FP, Singh P.To characterize compensatory movements of the head and pelvis that resemble lameness in horses. Methods: 17 adult horses. Methods: Kinematic evaluations were performed while horses trotted on a treadmill before and after shoe-induced lameness. Lameness was quantified and the affected limb determined by algorithms that measured asymmetry in vertical movement of the head and pelvis. Induced primary lameness and compensatory movements resembling lameness were assessed by the Friedman test. Association between induced lameness and compensatory movements was examined by regression analysis. Results...
Steffey EP, Woliner MJ, Puschner B, Galey FD.To quantitate the effects of desflurane and mode of ventilation on cardiovascular and respiratory functions and identify changes in selected clinicopathologic variables and serum fluoride values associated with desflurane anesthesia in horses. Methods: 6 healthy adult horses. Methods: Horses were anesthetized on 2 occasions: first, to determine the minimum alveolar concentration (MAC) of desflurane in O2 and second, to characterize cardiopulmonary and clinicopathologic responses to 1X, 1.5X, and 1.75X desflurane MAC during both controlled and spontaneous ventilation. Results: Mean +/- SEM MAC ...
Sánchez Bruni SF, Fusé LA, Moreno L, Saumell CA, Alvarez LI, Fiel C, McKellar QA, Lanusse CE.The study of novel pharmacological strategies to control parasitism in horses is required since many parasite species have developed resistance to anthelmintic drugs. Objective: To evaluate the effects of piperonyl butoxide (PB) (a metabolic inhibitor) on the plasma availability and enantiomeric behaviour of oxfendazole (OFZ) given orally to horses, and to compare the clinical efficacy of OFZ given either alone or co-administered with PB in naturally parasitised horses. Methods: Fifteen naturally parasitised crossbred male ponies were allocated into 3 groups (n = 5) and treated orally as follo...
Kawaguchi K, Church S, Slocombe RF.A donkey developed abdominal discomfort and distension together with cardiovascular collapse and gastric reflux 24 to 36 hours after ingesting a large amount of poultry feed. Rectal findings prompted a laparotomy that identified extensive gastric dilation, an empty, atonic small intestine, dry colonic content and an easily corrected caecal displacement. These findings were not consistent with the severity of the signs, which were attributed to endotoxaemia. The donkey was euthanased during recovery. Necropsy revealed acute necrotising pancreatitis with massive gastric dilation and right dorsal...
Christie JL, Hewson CJ, Riley CB, McNiven MA, Dohoo IR, Bate LA.An equine abuse policy was developed as an adjunct to an equine management survey. If at least 3 of 5 categories caused concern, a report to the authorities was indicated. The policy was not used but, in the absence of other guidelines, it might assist veterinarians considering potential abuse cases. Dans une enquête sur la gestion équine, un volet portant sur une politique concernant les mauvais traitements infligés aux chevaux a été développée. Lorsqu’au moins 3 des 5 éléments étudiés semblaient problématiques, un rapport aux autorités compétentes était recommandé. La poli...
Garcia-Seco E, Wilson DA, Kramer J, Keegan KG, Branson KR, Johnson PJ, Tyler JW.To determine the prevalence of pedunculated lipomas and identify risk factors affecting postoperative complications and survival in horses at a veterinary teaching hospital undergoing surgery for colic caused by pedunculated lipomas. Methods: Retrospective study. Methods: 102 horses with a diagnosis of pedunculated lipoma. Methods: Age, breed, weight, and sex of horses with pedunculated lipomas were compared with the total equine hospital population and the population of horses admitted for abdominal surgery during the same period. Follow-up information was obtained by reevaluation or contact ...
Piccot-Crézollet C, Cauvin ER, Lepage OM.To compare accuracy of 2 methods for injection of the podotrochlear bursa in horses. Methods: Observational study. Methods: 17 French Standardbreds. Methods: In each horse, contrast medium was injected into the podotrochlear bursa of 1 foot by use of a distal palmar approach with the needle inserted parallel to the sole (DPPS) and into the podotrochlear bursa of the other foot by use of a distal palmar approach to the navicular position (DPNP). Podotrochlear bursa injection was evaluated by means of radiographic examination in all horses and postmortem examination in 6. Results: Contrast mediu...
Jansson N.To evaluate the use of carbon dioxide (CO(2)) gas for joint distention during arthroscopy for removal of osteochondral (OC) fragments of the palmar/plantar aspect of the metacarpo (MCP)/metatarsophalangeal (MTP) joints in horses. Methods: Clinical study. Methods: Horses (26) with OC fragment(s) of palmar/plantar aspect of 1 or 2 MCP/MTP joint(s). Methods: OC fragments were removed using arthroscopic technique. Joint distention was maintained by isotonic Ringer's acetate at the beginning and at the end of the procedure but during fragment removal, CO(2) was used for joint distention. After surg...
Barr ED, Clegg PD, Mark Senior J, Singer ER.To describe focal destructive lesions of the proximal sesamoid bones (PSBs) as a complication of dorsal metatarsal artery catheterization performed for direct blood pressure monitoring during equine general anesthesia. Methods: Retrospective study. Methods: Three client-owned horses. Methods: A dorsal metatarsal artery was catheterized in each of 3 horses for direct blood pressure monitoring during anesthesia. Radiography, ultrasonography, synoviocentesis, and arthroscopy were used to diagnose postoperative lameness that occurred in the limb used for blood pressure monitoring. Results: Horses ...
Read EK, Chandler D, Wilson DG.To compare the biomechanical characteristics and mode of failure of 2 techniques using parallel 5.5 mm screws for pastern joint arthrodesis in horses. Methods: Randomized block design, for horse (1-5), method of fixation (two 5.5 mm screws versus three 5.5 mm screws), side (right, left), and end (front, hind). Constructs were tested to failure in 3-point bending. Methods: Twenty limbs (5 cadavers). Methods: A combined aiming device was used to facilitate screw placement. Two parallel 5.5 mm screws were inserted in lag fashion in 1 limb of a pair, and three 5.5 mm screws were inserted in the co...
Doyle AJ, Freeman DE.To describe a surgical technique for, and report outcome after, extensive nasal septum resection in horses with congenital or acquired septal diseases. Methods: Retrospective study. Methods: Horses (5) with nasal septal deformity. Methods: Under general anesthesia, obstetrical wires were preplaced around the ventral, caudal, and dorsal aspects of the nasal septum by combinations of manual guidance (ventral and caudal wires) and use of a trephine hole on the dorsal mid-line (dorsal and caudal wires). The rostral part of the septum was incised with a scalpel and the ventral, dorsal, and caudal s...
Pollock PJ, Prendergast M, Schumacher J, Bellenger CR.The serum concentrations of serum amyloid A, haptoglobin and fibrinogen were measured in a group of horses before and at intervals after elective and non-elective surgery, and in a control group of normal horses. There was a significant, rapid and repeatable increase in the concentration of serum amyloid A in response to both elective and non-elective surgery. In the control horses its serum concentration was within the normal range, from 0 to 0.2 microg/ml. Twenty-four hours after elective surgery its mean peak concentration was 16.4 microg/ml, and after non-elective surgery it was 27.3 micro...
Mills PC, Hills Y, Hills BA.To investigate the presence of surface-active phospholipid (SAPL, or surfactant) in equine tendon and tendon sheath fluid. Methods: The left front flexor tendon and sheath were removed from five Thoroughbred horses. Phospholipid was extracted from tendon sheath fluid using Folch reagent and quantified using spectroscopy. Transmission electron microscopy (TEM) was used to observe the tendon surfaces. Results: The presence of phospholipid (90.6 (SD 4.3) microg/ml) in tendon sheath fluid, plus the appearance of oligolamellar layers and lamellar bodies on the tendon surface were indicative of SAPL...
Horteloup MP, Threlfall WR, Funk JA.The horse early conception factor (ECF) test is designed for qualitative determination of the ECF glycoprotein in the mare that has conceived. The objectives of this study were to determine the performance of the horse ECF test for the detection of the non-pregnant mare, and to determine the agreement among subjects or "readers" regarding the interpretation of the test. Blood samples from 60 mares were collected on Days 0, 5, 8, 11 and 18 following ovulation. Pregnancy status diagnosed with the ECF test was compared (2 x 2 table) to pregnancy status diagnosed by palpation per rectum and ultras...
The heart surgery forumApril 1, 2005
Volume 7, Issue 5 E498-E502 doi: 10.1532/HSF98.20041087
Eckstein FS, Tevaearai H, Keller D, Schmidli J, Immer FF, Seiler C, Saner H, Carrel TP.This study details a single-center experience with the 3F Therapeutics stentless aortic bioprosthesis(investigational device) and is part of a prospective,nonrandomized worldwide multicenter study. We assessed the implantation procedure and the valve's efficacy in terms of early mortality and morbidity and early echocardiographic valve performance. Methods: Between June 2001 and March 2004, 24 patients (14 men/10 women) underwent aortic valve replacement(AVR) with a 3F valve. Mean age was 72 +/- 13 years(range, 31-88 years). Combined revascularization was performed in 12 patients; 1 patient re...
Braun S, Lafrenz R.In recent years extracorporeal shock wave therapy (ESWT) is used in veterinary medicine especially in equine orthopedics. Different ESWT generators are commonly used in equine medicine with varying energy density and depth of penetration. The presented case report described the treatment of a ligamentum nuchae calcification with focused extracorporeal shock wave therapy with SONOCUR Plus generator combined with SONOLINE Prima ultrasound. Negligible adverse effects, the non-invasive character of the treatment, the time-saving therapy, and the positive results make the focused extracorporeal sho...
Archer RM, Parsons JC, Lindsay WA, Wilson JW, Smith DF.Three pairs of longitudinal enterotomies were performed in the small colon of 10 ponies. Each pair consisted of one enterotomy through the antimesenteric band and one through the sacculation. The ponies were destroyed 96 h after surgery. The enterotomies in the two sites were compared for: speed of surgery, adhesions, bursting wall tension, neovascularisation by micro-angiography, and histological reaction. Enterotomies made through the antimesenteric band were superior because they were quicker to perform, stronger, more accurately apposed, and had less inflammation than those made through th...
Carson-Dunkerley SA, Hanson RR.To describe the short- and long-term survival rates in horses undergoing ovariectomy for granulosa cell tumors by use of the diagonal paramedian approach. Methods: Retrospective case study. Methods: 12 horses with granulosa cell tumors. Methods: A diagonal paramedian approach for unilateral ovariectomy was used for removal of each mare's granulosa cell tumor. Information about complications and outcomes was analyzed. Results: Only minimal complications were detected postoperatively when the diagonal paramedian approach was used, regardless of the preferred technique for ovarian pedicle ligatio...
Lenoir A, Perrin BRM, Lepage OM.Resection and anastomosis of small intestine during colic can lead to adhesions and recurrent colic. Several methods are available to reduce the rate of adhesions in the postoperative period, such as the use of serosal barriers. Surgical glues form a smooth surface, are fast to apply, and could reduce surgery time when performing anastomosis. A recently developed UV-polymerizable methacrylate adhesive (UV-PMA) is designed to anchor into the biological tissues' top surface offering sealant and a smooth cover over the anastomosis site. This adhesive was used ex vivo on fifteen samples of equine ...
Hogan PM, Bramlage LR, Pierce SW.A 14-year-old Thoroughbred broodmare was evaluated for signs of mild to moderate abdominal pain of 5 hours' duration. Exploratory celiotomy revealed a 20 x 8-cm subserosal hematoma associated with a focal serosal perforation overlying a muscular tear along the parietal surface of the stomach. The odor of intestinal tract gas was detected, but gross contamination of the abdomen was not evident. Concurrent partial volvulus of the small intestine was evident. Removal of the large colon from the abdomen appeared to coincide with propagation of the serosal perforation to a full-thickness gastric re...
Palmer SE, McGill LD.Freshly harvested equine skin incised with an electrosurgical unit, a radiosurgical device, or a carbon dioxide (CO2) laser was examined by light microscopy to determine the extent of thermal injury caused by each instrument. There was no significant difference between the thermal injury caused by the electrosurgical unit in the pure-cut mode and the CO2 laser in the superpulse mode, or between the electrosurgical unit and the radiosurgical device in the fully filtered cut mode. However, thermal injury caused by the CO2 laser was significantly less than that caused by the radiosurgical device....
Yovich JV.Fractures of the distal phalanx are an important cause of lameness referrable to the foot. Depending on the fracture configuration and articular involvement, conservative or surgical treatment may be required. Fractures of the distal phalanx have been divided into six categories based on fracture configuration. Discussion of clinical features, management, and prognosis for horses with distal phalangeal fractures is presented for each fracture type.
Quattrini C, Scalco R, Vernau W, Dini P, Aleman M.Cerebrospinal fluid (CSF) is highly labile and delayed processing might alter results of analysis. Objective: To determine the effects of time and addition of autologous serum on cytological evaluation of CSF. Methods: Ten client-owned adult horses requiring euthanasia. Methods: Prospective study. Serum and CSF were collected from each horse before and within 10 minutes after euthanasia. CSF samples were divided into 15 aliquots (2 mL each); 1 aliquot was submitted for routine CSF analysis within 60 minutes of collection. Four drops of autologous serum were added to 7 of the aliquots, and ...
Gronwall R, Engelking LR, Anwer MS, Erichsen DF, Klentz RD.Surgically placed bile duct cannulas allowed collection of secreted bile from nonanesthetized ponies. UNINTERRUPTED ENTEROPHEPATIC CIRCULATION WAS PERMITTED BETWEEN COLLECTIONS. Deleterious effects of cannulation were not observed. Average bile flow was 18.6 plus or minus 1.72 (standard error) mul/minute/kg, bile acid excretion was 0.179 plus or minus 0.0212 mumole/minute/kg, and bilirubin excretion averaged 1.22 plus or minus 0.136 mug/minute/kg.
Betteridge KJ, Mitchell D.An efficient surgical technique of collecting eggs from the oviducts of mares is described. Within 6 days after ovulation recovery was successful in 22/29 mares. The technique has been used to investigate the retention and ageing of eggs in the oviducts and to determine the origin and the nature of the accessory CL during pregnancy.
Reeves MJ, Trotter GW, Kainer RA.The anatomical and functional communications of the synovial sacs of the equine stifle joint were evaluated in 50 stifle joints of 25 horses. Femoropatellar joint (FPJ) sacs were injected with 50 ml of gelatin-based dye and horses were then walked for 50 m. Horses were subsequently killed, the stifle joints dissected and the location of the dye recorded. Twenty-three horses (46 joints) had clinically normal stifle joints and in this group, anatomical communications of the stifle joints were bilaterally symmetrical in each horse. In 15 of these 23 horses (65 per cent), direct anatomical communi...
Golenz MR, Carlson GP, Madigan JE, Craychee T.Six normal foals between the ages of 2 and 7 days were used in this study to develop a technique for intraosseous infusion in equine neonates. A 14-gauge 1/2-inch needle was placed intraosseously in the right proximal medial one-third aspect of the radius and tibia of each foal. A maximum of 1 L of isotonic fluids was administered intraosseously at these sites. Radiographs were taken at the time of intraosseous needle placement, and at days 10, 30, and 60 following the procedure. The mean time for needle placement was 33 seconds for the tibia and 63 seconds for the radius. The mean fluid flow ...
MacAllister CG, Perdue BD.Unilateral ectopic ureter was diagnosed by endoscopic examination in an 18-month-old filly examined because of chronic urine dribbling. Intramuscular administration of azosulfamide discolored the urine and enhanced visualization of the ectopic ureter. Endoscopy proved valuable in determining that only one ureter entered the urinary bladder and in locating the ectopic ureter in the ventral portion of the vagina.
Kolding SA, Sørensen JN, Kramer J, McCracken MJ, Reed SK, Keegan KG.Some horses increase in forelimb lameness, measured as vertical head height asymmetry, or differences in maximums and minimums of head heights (HDmax, HDmin), after a palmar digital nerve (PDN) block. The prevalence of this finding, or what it means clinically, has not been reported in peer-reviewed literature. Objective: To estimate the prevalence of increasing head height asymmetry after a PDN block and determine if this is associated with cause of forelimb lameness. Methods: Retrospective case series. Methods: Head height asymmetry, normalised to expected vertical head displacement, from in...
Hurtig MB, Fretz PB.The radiocarpal and middle carpal joints of 4 clinically normal horses and 24 necropsy specimens were examined with an arthroscope to describe the topographic anatomy of these joints. The carpal bones of the radiocarpal joint had congruent articular surfaces in extension, but carpal flexion resulted in a stairstep between the radial and intermediate carpal bones. The variable surface anatomy, as well as the restricted synovial space and the technical limitations of the arthroscope, contributed to the need for more than one arthroscopic approach to the radiocarpal joint to ensure a thorough exa...
Hilbert BJ, Farrell RK, Grant BD.Squamous cell carcinoma around the eyes of 3 horses was treated with liquid nitrogen, using cryotherapy probes as the method of application. In 2 cases, there was complete regression of the tumor; in the 3rd case, remission and relief of discomfort were temporary.
Cock G, Darby S, Freeman DE, Gomez DE.Esophageal obstruction is a common disorder in equids usually caused by intraluminal impaction with roughage and/or other feed material. Esophageal obstructions can also be caused by foreign bodies, but they are rarely reported and information regarding diagnosis and management is lacking. This report describes an esophageal obstruction in a donkey caused by a metallic foreign body removed using endoscopic guidance. Recognition of the foreign body facilitated treatment and underscores the importance of imaging in such cases to prevent dislodgement of the object to more aboral sites where acces...
McClure JJ, Muscoplat CC, Johnson DW, Senogles DR.A miniaturized method for the mixed lymphocyte culture test in the horse is described. The test is performed in either round- or flat-bottom microtitration tissue culture plates. Concentrations of responsing and stimulating cells are varied, depening on the experiment. Significant discrimination between isogeneic and allogenic mixtures is possible after 120 hours' culture when cells are labeled ([3H]thymidine) for the last 16 to 18 hours of the test.
Gaughan EM, Fubini SL, Dietze A.Over an 8-year period, 14 horses were admitted to the New York State College of Veterinary Medicine for evaluation of fistulous withers. Of the 14 horses, 11 were treated surgically and 3 were not treated. Surgical techniques involved radical excision of the affected soft tissue and spinous processes of affected vertebrae. Recurrence rate was 30%, and these horses required additional surgery to resolve the problem.
Davidson GS.Anesthetization of large animals, such as the horse, is a challenge for veterinarians and compounding pharmacists. This article discusses the technique of intravenous anesthesia by using a combination of xylazine and ketamine in the horse for short-term unconsciousness; a combination of xylazine, diazepam, and ketamine, for improved sedation and muscle relaxation; and a combination of xylazine, ketamine, and guaifenesin, referred to as Triple Drip, for the maximum 1-hour duration of unconsciousness. Compounding pharmacists that have the facilities and training required to prepare sterile compo...
Santschi EM, Juzwiak JS, Slone DE.Three monorchid colts were admitted for castration as cryptorchids. Two colts each had one normal descended testis, and the third colt had a small testis in the abdomen. Monorchidism was diagnosed at surgery by locating an incomplete epididymis without a testis. After the incomplete epididymis and other testis were removed, the absence of testicular tissue was confirmed by results of a human chorionic gonadotropin response test.