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1.
Eighteen clinically normal horses were used to study the characteristics of normal thoracic fluid. Thoracic fluid was obtained from each horse and was found to be similar to equine abdominal fluid. Total leukocytes averaged 3994/ul, total protein 1.8 g/dl, and specific gravity 1.015. Analysis of thoracic fluid from 16 horses with clinical signs of thoracic disease showed abnormalities in every case. Thoracic fluid analysis alone determined a specific diagnosis in 50% of the cases.  相似文献   

2.
Incarceration of the small intestine through a rent in the gastrosplenic ligament was diagnosed in five horses. Three affected horses were mature males and two were mature females. Persistent moderate to severe abdominal pain, elevated heart rate, congested mucous membranes, serosanguineous peritoneal fluid, and distended small intestine on rectal examination were consistent findings.
Exploratory celiotomy or gross necropsy examination showed the incarcerated intestine to be distal jejunum or ileum. In all horses, the intestine had herniated cranially through the rent in the gastrosplenic ligament. The incarcerated intestine was situated lateral to the stomach and craniolateral to the spleen. Three horses underwent exploratory celiotomy, and the incarcerated small intestine was reduced by gentle traction and then resected. Two of these horses were alive more than 2 years postoperatively without recurrence of signs of abdominal pain, and one was euthanized because of dehiscence of the abdominal incision. Two horses were euthanized without surgical intervention, and necropsy examination revealed a recent rent in the gastrosplenic ligament. This condition should be considered in the differential diagnosis of causes of small intestinal strangulation and obstruction in the horse.  相似文献   

3.
Volvulus of the small intestine was diagnosed as a complication of acquired inguinal herniation in 2 horses. One of the horses continued to have signs of pain after reduction of the hernia. The volvulus was diagnosed at a second surgery, but the intestine was devitalized, and the horse was euthanatized. Ventral midline exploratory surgery was performed on the second horse, in conjunction with an inguinal approach. The small-intestinal volvulus was diagnosed and corrected at this time. It is suggested that ventral midline abdominal exploration be performed when acquired inguinal herniation causes acute small-intestinal obstruction in horses.  相似文献   

4.
OBJECTIVE: To report on the outcome of surgical treatment of acute abdominal crises in miniature breed horses. DESIGN: Retrospective case series of miniature horses presented to the University Veterinary Centre, Camden with an acute abdominal crisis. METHODS: Hospital records of all miniature horses that underwent ventral midline laparotomy for acute abdominal crisis between 1997 and 2001 were reviewed. The signalment, history, clinical signs, results of ancillary diagnostic procedures, location and type of intestinal lesion, treatment and outcome were retrieved from each case record. Long-term survival was determined by telephone interview of owners. RESULTS: Eleven miniature horses including five females and six males underwent ventral midline laparotomies for acute abdominal crisis during the study period. Ages ranged between 1 month and 19 years. Surgical findings included faecalith obstruction (seven horses), enterolith (one horse), strangulating lipoma of the descending colon (one horse), jejunal infarction (one horse), and caecal infarction (one horse). Long-term survival rate (minimum 12 months post surgery) was 55%. Six of eight horses with simple intraluminal obstructions survived, while the three horses with gastrointestinal lesions associated with vascular compromise were euthanased either at surgery (caecal infarction), or postoperatively, due to complications (strangulating lipoma of the descending colon, jejunal infarction). Postoperative complications in this study included impaction of the descending colon (two horses), diarrhoea (two horses), peritonitis (one horse), hyperlipaemia (two horses), incisional infection (two horses) and abdominal adhesions (one horse). Hyperlipidaemia was present in five of seven horses in which serum triglycerides were measured at presentation. CONCLUSIONS: Simple intraluminal obstructions of the large intestine were frequently encountered during exploratory laparotomy in miniature horses presented for acute abdominal crises, and their surgical treatment was associated with a good prognosis. In contrast, this study suggested that abdominal pain associated with vascular compromise of gastrointestinal tissues in miniature horses was associated with a poorer prognosis, consistent with reports in other horse breeds. Possible contributing factors to faecalith formation, including poor quality roughage, dental disease, and inadequate water consumption, should be recognised and avoided in miniature horses. Serum triglyceride concentrations should be measured in miniature horses presented for acute abdominal pain. If elevated, nutritional supplementation should be provided.  相似文献   

5.
A one‐year‐old, Thoroughbred colt presented for evaluation due to a one month history of fever of unknown origin and progressive weight loss. On initial presentation, the horse was febrile and showed signs localised to the respiratory tract. These included bilaterally increased bronchovesicular sounds and a moderate, diffuse interstitial pattern on thoracic radiographs. A transtracheal wash yielded mucopurulent debris, culture of which grew small numbers of Staphylococcus epidermidis and Aspergillus spp. The horse was discharged with a diagnosis of bronchointerstitial pneumonia and placed on antibiotic therapy. Ten days after initial presentation, he developed abdominal pain that was unresponsive to on‐farm treatment. The horse was febrile, displayed increased respiratory rate and effort, and showed moderate signs of abdominal pain. On rectal examination, a firm, 8–10 cm mass was palpated on midline. The colt was admitted to the hospital and scheduled for exploratory laparotomy, but died a short time later before surgery could be performed. This report describes the clinical, diagnostic and histopathological findings of a case of alimentary lymphoma in a yearling colt.  相似文献   

6.
OBJECTIVE: To determine the predictive values, sensitivity and specificity of abdominal fluid variables associated with the need for surgery in horses with an acute abdominal crisis. DESIGN: Retrospective study. ANIMALS: Two-hundred and thirty-six horses examined for signs of abdominal pain between January 1993 and June 1999. METHODS: Breed, age and gender of the horse and colour, total protein concentration and total nucleated cell count of an abdominal fluid sample were recorded. Colour of the abdominal fluid was classified as normal if it was yellow and transparent. Turbid fluid or fluid that was serosanguinous or other colours was classified as abnormal. Protein concentration < or = 20 g/L and a total nucleated cell count < or = 5 x 10(9) cells/L were considered normal and values above these were considered abnormal. An abdominal fluid sample was classified as abnormal if one or more of the three variables were considered abnormal. Cases were defined as surgical when lesions identified at surgery or necropsy examination would not have resolved with medical treatment alone. Cases were defined as medical in horses that survived without surgical intervention, and those with a lesion found at surgery or necropsy that would have resolved with medical treatment alone. A third category was identified during the study as those diagnosed with Actinobacillus equuli--induced peritonitis. These horses were included in the study but not in the data analysis. DATA ANALYSIS: The association between the sensitivity, specificity and positive and negative predictive value of colour, total protein, and total nucleated cell count in the abdominal fluid and the need for surgery was calculated. RESULTS: There were 100 females and 136 males of mixed breeds, ranging from 3 days to 26 years of age that had an abdominocentesis performed during the specified period. There were 97 horses with a lesion classified as surgical, 91 horses with a lesion classified as medical and 48 horses with a diagnosis of A equuli-induced peritonitis. Colour of the abdominal fluid was recorded in all horses, protein concentration was recorded in 194 horses and total nucleated cell count was recorded in 179 horses. Abnormal abdominal fluid colour had a sensitivity, specificity, positive and negative predictive value of 92%, 74%, 79% and 89% respectively, associated with the need for surgery. Sensitivity, specificity, positive and negative predictive values for a serosanguinous abdominal fluid sample associated with the need for surgery were 48%, 99%, 98% and 64% respectively. Abnormal abdominal fluid protein concentration had a sensitivity, specificity, positive and negative predictive value of 86%, 75%, 77% and 85% respectively, associated with the need for surgery. The sensitivity, specificity, positive and negative predictive value associated with the need for surgery in horses with an abnormal total nucleated cell count in the abdominal fluid were 59%, 75%, 67% and 67%, respectively. An abdominal fluid sample classified as abnormal had a sensitivity, specificity, positive and negative predictive value of 92%, 74%, 79% and 89% respectively, associated with the need for surgery. CONCLUSION: Results of this study suggest that abdominal fluid sample analysis contributes to the decision to proceed to surgery, but is not a diagnostic panacea. Colour and protein concentration of abdominal fluid were the most useful variables in abdominal fluid for differentiating medical and surgical lesions. Colour and protein had a greater value in horses with a disease likely to respond to medical treatment (negative predictive value) than those with a lesion requiring surgery (positive predictive value) except when the fluid was serosanguinous. Abdominal fluid colour and protein are clinically relevant and easily measured in the field, providing immediate information without the need for sophisticated laboratory techniques.  相似文献   

7.
An 8-month-old filly (No. 2) developed an acute vulvo-vaginitis and respiratory disease following inoculation of equine herpesvirus (EH virus) type 1 (EH 39 virus; equine rhinopneumonitis virus) into the vestibule of the vagina. The same virus produced acute respiratory disease but not balanoposthitis following intranasal, intravenous and intrapreputial inoculation of a 12-month-old colt (No. 3). A second 8-month-old filly (No. 1) developed a mild respiratory disease but not vulvo-vaginitis following intravestibular inoculation of EH 39 virus. EH viruses that were slowly cytopathic for equine foetal kidney cell cultures and serologically unrelated to the inoculated EH 39 virus were isolated from the buffy coat cells at 3 days and from the nasal cavity at 6 days after inoculation of horse No. 1. EH virus that was slowly cytopathic and serologically unrelated to EH 39 virus was isolated at 16 days from the vagina of the filly (No. 2) that developed acute vulvovaginitis and was frequently isolated from the nasal cavities of 2 of the 3 horses for 83 days and from the nasal cavity of the third horse for 57 days under conditions that precluded reinfection from other equidae except from each other. EH viruses were recovered from the 3 horses for a further 58 days under conditions where contact with other equidae may, although was not known to, have occurred between 83 and 141 days postinoculation. It was concluded that these viruses represented a single virus type that was present in the nasal cavity (designated EH 1–6 virus) perhaps also the blood stream of filly No. 1 at the time the 3 horses were purchased and that this virus was subsequently transmitted to the vagina of 1 and the nasal cavities of the other 2 horses. Accordingly a carrier state for EH 39 virus was not shown to occur. These findings are discussed in relation to the natural history of EH virus infections. Attempts to reactivate the EH viruses to cause clinical respiratory disease, by a series of injections of adrenalin and cortisone, were inconclusive. The 3 horses showed no clinical evidence of respiratory disease when they were reinfected intranasally with EH 39 virus 360 days (1 horse) and 412 days (2 horses) after the initial infection with this virus. Abortion was produced when EH 39 virus was inoculated directly into the allantoic or amniotic cavity of a pregnant mare although naturally occurring EH virus abortion remains unrecognised in Australia.  相似文献   

8.
This report describes caecal intussusception in two young half-sibling Standardbred horses. Both horses presented showing signs of low-grade abdominal pain. The horses remained haemodynamically stable despite signs of abdominal pain and associated tachycardia. Exploratory celiotomy was undertaken in both horses due to persistent abdominal pain and a poor response to administration of analgesic medications. Exploration of the abdomen revealed caeco-caecal intussusception in one horse and caeco-colic intussusception in the other horse. An underlying cause for caecal dysfunction and subsequent intussusception was not identified in either patient. Manual reduction of the intussusception was successful in both cases. The horses recovered uneventfully from surgery.  相似文献   

9.
Strangulated umbilical hernias in horses: 13 cases (1974-1985)   总被引：1，自引：0，他引：1  
The medical records of 13 horses with strangulated umbilical hernias were reviewed. Typical history included increased swelling, warmth, and firmness of the hernial sac. Enterocutaneous fistulas had developed in 2 horses. Four horses had signs of abdominal pain. Surgery was performed on all horses, and the hernia was reduced by an open reduction technique. Incarcerated tissue included omentum (1 horse), jejunum (5), ileum (4), cecum (1), and ventral colon (2). All horses survived and were discharged from the hospital. Follow-up information on 9 horses (5 to 52 months after discharge) revealed no complications in 6 horses. Of the remaining 3 horses, one horse was euthanatized 5 months after discharge because of laminitis. One horse had persistent drainage from the skin incision requiring removal of nonabsorbable suture material 8 months after discharge. One foal required a second surgery because of signs of abdominal pain 17 days after the initial surgery. The foal was euthanatized during surgery because of severe peritonitis secondary to anastomotic leakage.  相似文献   

10.
To determine the reliability with which inorganic phosphorus (phosphate) concentrations can be used to predict major intestinal injury associated with equine colic, phosphate concentrations were measured in serum, peritoneal fluid, or both from 9 clinically normal adult horses (group A), 37 horses successfully managed medically for signs of abdominal pain (group B), 26 horses with signs of abdominal pain and undergoing exploratory laparotomy without intestinal resection (group C), and 26 horses undergoing intestinal resection or euthanasia for extensive intestinal lesions (group D). Peritoneal fluid phosphate concentration was significantly greater in horses in group D (mean, 4.58 +/- 0.34 mg/dl) than in horses in group A (mean, 2.78 +/- 0.21 mg/dl), group B (mean, 2.92 +/- 0.27 mg/dl), and group C (mean, 2.98 +/- 0.28 mg/dl; P less than or equal to 0.01). Serum phosphate concentration was significantly greater in horses in group D (mean, 3.87 +/- 0.30 mg/dl) than in horses in group A (mean, 2.73 +/- 0.22 mg/dl), group B (mean, 2.80 +/- 0.21 mg/dl), and group C (mean, 2.78 +/- 0.22 mg/dl); P less than or equal to 0.05). There was significant (P less than or equal to 0.001) correlation between serum and peritoneal fluid phosphate concentrations within each group and when pairs from all groups were pooled. When peritoneal fluid phosphate concentrations exceeded 3.6 mg/dl, intestinal lesions requiring resection or euthanasia were predicted with sensitivity of 77% and specificity of 76%. When serum phosphate concentrations exceeded 3.3 mg/dl, such lesions were predicted with sensitivity of 60% and specificity of 73%.(ABSTRACT TRUNCATED AT 250 WORDS)  相似文献   

11.
We retrospectively evaluated the medical records and obtained follow-up information for nine horses which had been treated for cecocolic intussusception (CCI) between January 1982 and April 1998. During the 16-year study period, CCI was diagnosed in nine of 748 horses in which exploratory celiotomy was undertaken for abdominal pain, representing an incidence of 1.2%. Most affected horses (78%) were less than four years of age (median age was 12 months, age range was five months to 15 years). Cecocolic intussusception affected male horses (78%) more commonly than female horses. The most common clinical presentation was abdominal pain of a severe, acute nature or milder but recurrent signs of abdominal pain persisting in spite of conservative treatment for several days. Correction of CCI by either simple reduction or reduction followed by partial typhlectomy was successful if compromise of the intestine by devitalization and adhesion formation was not found at surgery. Definitive diagnosis of CCI necessitates exploratory celiotomy, although an ultrasonographic examination of the abdomen may confirm the diagnosis in some cases. When recognized early during the course of disease, surgical correction of CCI is associated with a favorable outcome; of the eight horses which underwent surgery in our series, five horses (63%) survived surgical correction of CCI. Handling of compromised gut during reduction of CCI necessitates extreme caution because the risk of intestinal tearing is quite high.  相似文献   

12.
Objective —To determine if omentectomy would decrease the frequency of postoperative intraabdominal adhesions. Study Design —Retrospective study. Animals or Sample Population—44 horses that had either two ventral median celiotomies or a ventral median celiotomy and a necropsy more than 4 days later; 19 of these horses had their omentum removed at the initial surgery. Methods —Data retrieved from the records included location and type of intraabdominal adhesions; location of the surgical lesion; relationship of adhesions to the surgical lesion; surgical procedures; duration of initial surgery; time interval between procedures; age, gender, and breed of the horse; and clinical outcome. Fisher's exact test was used to evaluate the association between categorical explanatory and outcome variables. The effect of potential risk factors on the incidence rate of adhesion formation was estimated using a proportional hazards regression model. Results —Of 25 horses in the nonomentectomy group, 15 (60%) had postoperative adhesions that resulted in the need for a second surgical intervention, whereas of 19 horses that had omentectomy initially, only 4 (21%) had postoperative adhesions that required a second procedure. Rate of adhesion formation was higher in horses that did not have omentectomy initially (incidence ratio rate [IRR], 0.46; 90% confidence interval [CI], 0.18 to 1.19). At initial surgery, 24 horses had a small intestinal lesion, and 20 horses had a large intestinal lesion. Fifteen horses (63%) with small intestinal lesions subsequently developed adhesions compared with four horses (20%) with an initial large intestinal lesion (P= .006). At the second procedure, small intestine lesions were identified in 32 horses and large intestine lesions in 12 horses (1 horse had both small and large intestine lesions), and 1 horse had a gastric lesion. Adhesions were identified as the cause of colic signs in 19 (61%) horses with small intestinal lesions and in none of the horses with large intestine lesions. The frequency of adhesion development leading to colic associated with only the small intestine at the second surgery or necropsy was significantly greater (P= .001) than the frequency only in the large intestine. Conclusions —Omentectomy reduced the rate of postoperative adhesion formation. Adhesions are more likely to occur after small intestinal surgery and if they do occur likely involve the small intestine. Clinical Relevance —Omentectomy is a safe procedure and should be considered prophylactically for reduction of adhesion formation after abdominal surgery in horses.  相似文献   

13.
Records of 75 horses with ileal impactions were examined retrospectively. There was a sex predilection towards mares. Arabians were over-represented compared to the hospital population. The average age was 8.3 years. Abdominal pain was observed in 96% of horses. Nasogastric reflux was present in 56% of horses, small intestinal distention was found on rectal palpation in 96% and an ileal impaction in 25%. Exploratory celiotomy was performed in 69 horses, the mass was reduced by extramural massage in 67 horses, and ingesta was removed via enterotomy in 2. Jejunocecostomies were performed in 47 horses. Twenty-five horses developed postoperative ileus, and 11 developed laminitis. Twenty-seven horses survived. Significant differences (p less than 0.05) between survivors and non-survivors were found for rectal temperature (37.7 and 38.2 degrees C, respectively), plasma protein concentration (7.8 and 8.9 g/dl, respectively) and anion gap (15 and 21.3 mEq/l, respectively). Survival decreased with increasing duration of clinical signs. Enterotomy, enterectomy, and/or jejunocecostomy performed during surgery had a deleterious effect on survival.  相似文献   

14.
Twelve cases of ileal impaction in the horse were reviewed. Clinical features of the disease included evidence of mild abdominal pain, reduced or absent intestinal sounds, rectally palpable distended small intestine, gastric reflux, and in the early stages, normal peritoneal fluid. Surgical correction of the impaction was accomplished in 10 horses. Of 8 horses discharged from the hospital, 7 returned to full function. It was concluded that the shorter the duration of colic before surgical intervention, the better the prognosis.  相似文献   

15.
Four horses operated on for left dorsal displacement of the large colon (LDDLC) had major intraoperative or postoperative complications. One horse was euthanatized during surgery because of extensive necrosis of the large colon. Three horses that were discharged after surgical correction of LDDLC were readmitted with signs of abdominal pain between 5 weeks and 13 months after surgery. Two horses had recurrence of LDDLC, and the third horse had an omental adhesion attached to and obstructing the pelvic flexure. The displacements were corrected, the adhesion was broken down, and the horses were discharged. One horse was readmitted a third time 16 months after the second surgery and required a third surgical correction of LDDLC.  相似文献   

16.
Postoperative abdominal fluid changes were compared in 2 groups of horses; those undergoing double small-colon resection and anastomosis (n = 10) and those undergoing exploratory celiotomy alone (n = 5). Peritoneal fluid was collected before surgery and on postoperative days 1, 3, 5, and 7. Total and differential nucleated cell counts, RBC numbers, and total protein and fibrinogen concentrations were evaluated. In both groups, all values were significantly higher than normal on the first postoperative day (after small-colon resection and anastomoses, WBC = 130,350 +/- 23,310 cells/microliters, RBC = 7,389,000 +/- 6,234,000 cells/microliters, total protein = 3.63 +/- 0.16 g/dl; after exploratory celiotomy alone, WBC = 166,620 +/- 34,340 cells/microliters, RBC = 295,000 +/- 86,070 cells/microliters, total protein 4.38 +/- 0.54 g/dl). The number of total peritoneal nucleated cells and RBC significantly decreased after the first postoperative day, whereas total protein and fibrinogen concentrations, percent neutrophils, and percent mononuclear cells remained unchanged. None of the values had returned to normal by postoperative day 7 (after small-colon resection and anastomoses, WBC = 45,600 +/- 8,765 cells/microliters, RBC = 95,390 +/- 53,380 cells/microliters, total protein = 4.39 +/- 0.23 g/dl; after exploratory celiotomy alone, WBC = 43,340 +/- 7,746 cells/microliters, RBC = 12,860 +/- 11,790 cells/microliters, total protein = 3.92 +/- 2.20 g/dl.) The resection and anastomosis group had a significantly lower total protein concentration on the first postoperative day and a significantly higher mean total RBC count over the entire 7-day postoperative evaluation than did horses that underwent celiotomy alone. Other values in the 2 groups of horses did not differ significantly.(ABSTRACT TRUNCATED AT 250 WORDS)  相似文献   

17.
Two horses with cerebrospinal nematodiasis (Micronema deletrix) had signs similar to those of other neurologic diseases resulting from parasitic (fly larvae, protozoa, or other helminths) migration through the central nervous system (CNS). In one horse (horse 1), a 13-year-old Paso Fino stallion, the cerebrospinal fluid (CSF) was slightly xanthochromic (1+), with a pleocytosis (25 nucleated cells/microliter) and a normal protein level (69 mg/dl). A CSF differential cell count showed 15% neutrophils, 56% lymphocytes, 22% macrophages, 5% eosinophils, and 2% basophils. In the other horse (horse 2), a 19-year-old Tennessee Walking Horse stallion, the CSF was modestly xanthochromic (2+), with pleocytosis (81 nucleated cells/microliter) and a modestly elevated protein concentration (114 mg/dl). A CSF differential cell count showed 9% neutrophils, 41% lymphocytes, and 50% macrophages. The CSF changes were consistent with those described for equine protozoal myeloencephalitis and verminous encephalitis. The microscopic lesions in both brains contained multifocal areas of malacia and granulomatous inflammation. Meningeal vessels throughout the brain were greatly thickened and inflamed, and they contained parasites. The CSF changes were not specific and histopathologic examination was required for a definitive diagnosis.  相似文献   

18.
Leukoencephalomalacia in two horses induced by oral dosing of fumonisin B1   总被引：17，自引：0，他引：17  
Leukoencephalomalacia (LEM) was induced by the oral administration of fumonisin B1 (FB1) to 2 horses: a filly received 59.5 mg/kg of a 50% preparation of FB1, administered in 21 doses of 1.25-4 mg/kg over 33 days; a colt, 44.3 mg/kg of 95% pure FB1 in 20 doses of 1-4 mg/kg in 29 days. Both animals developed nervous signs such as apathy, changes in temperament, inco-ordination, walking into objects, and one showed paralysis of the lips and tongue. Characteristic lesions of LEM were present in the brains. These trials proved conclusively that FB1 can induce LEM in horses.  相似文献   

19.
Six horses, which had a foreign body obstruction of the small colon showed abdominal pain of progressing severity and intestinal tympany. On rectal examination the caecum and large colon were distended with ingesta and gas but the obstructing mass could be palpated in only 3 cases. All horses had elevated indirect blood pressure and in 3 there was also fluid distension of the stomach. Only one horse had known access to foreign material in the diet, but a further 3 were related to an exceptionally dry climate period. Five of the 6 horses recovered following surgery.  相似文献   

20.
Packed cell volume, total plasma protein, serum sodium, potassium, and ionized Ca2+ concentrations, and blood pH were determined at the time of admission and following surgery in 147 horses with acute abdominal crisis. Horses were allotted to 3 categories on the basis of the surgical lesion: (1) nonstrangulating obstruction of the ascending or descending colon (category A, n = 76), (2) strangulating and nonstrangulating infarction of the cecum or ascending colon (category B, n = 37), and (3) strangulating and nonstrangulating infarction of the small intestine (category C, n = 25). Horses with low serum ionized Ca2+ concentration following surgery were given 23% calcium gluconate (100 to 300 ml) IV to effect, and ionized Ca2+ concentration was determined following treatment. The serum ionized Ca2+ concentrations of horses in categories A, B, and C before and after surgery were lower than our normal laboratory reference range. Prior to surgery, serum ionized Ca2+ concentration measured from horses in category B and C was lower than that in horses in category A. There was no difference in ionized Ca2+ concentration in serum samples obtained before surgery in horses from category B and C, and in serum samples obtained following surgery. There was a decrease in ionized Ca2+ concentration during surgery in horses in category A. There was no change between preoperative and postoperative ionized Ca2+ concentration in the samples obtained from horses in category B and C. After calcium gluconate administration, all horses with low serum ionized Ca2+ after surgery had concentrations within our normal range. Measurement of serum ionized Ca2+ in horses with an acute abdominal crisis is recommended.(ABSTRACT TRUNCATED AT 250 WORDS)  相似文献   

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