Ultrasonographic evaluation of thoracic and abdominal neoplasia in domestic ruminants: A systemic review.

There is a lack of literature on the usefulness of ultrasonography in the diagnosis and prognosis of thoracic and abdominal neoplasia in domestic ruminants, such as cattle, camels, sheep, and goats. This review aims to shed light on the current applications and prospects of ultrasonography in the diagnosis of thoracic and abdominal neoplasia in domestic ruminants. The scientific literature on ultrasonographic evaluation of the thoracic and abdominal neoplasia in domestic ruminants has been systematically reviewed to verify the potential role of ultrasonography in diagnosing such neoplasia. Based on the literature results, cattle (71.03%) were the most affected animals by thoracic and abdominal neoplasia, followed by sheep (11.86%), goats (11.57%), and camels (5.54%). In all included species, the abdominal neoplasia was more frequent (6.18%) than the thoracic neoplasia (2.97%), and the most frequent neoplasms were forestomach neoplasia. It is concluded that ultrasonography is not widely used in diagnosing thoracic and abdominal neoplasia in ruminant practice. Using ultrasonography in conjunction with guided needle aspiration and biopsy can offer veterinarians the opportunity for more precise diagnosis and treatment decisions guidance of thoracic and abdominal neoplasia in domesticated ruminants.

Diagnosing and treating esophageal obstruction in camels (Camelus dromedarius).

Background and Aim: Esophageal obstruction is a common occurrence and a serious condition in camels. This study aimed to assess the effects of mineral deficiency on esophageal obstruction rates in dromedary camels and describe their clinical presentation and treatment outcomes. Materials and Methods: Twenty-eight camels were allocated to two groups. Group 1 (control) was composed of 10 sound camels. Group 2 included 18 camels with esophageal obstruction which were based on clinical and imaging evaluations. Hematobiochemical examinations in control and affected camels were compared and statistically analyzed. Results: In camels with esophageal obstruction when compared with controls, hematological analyses showed significant increases (p < 0.05) in neutrophils, lymphocytes, and monocytes, along with significantly decreased total white blood counts. Aspartate transaminase, alanine transaminase, alkaline phosphatase, creatine phosphokinase, glucose, albumin, creatinine, and blood urea nitrogen concentrations were significantly higher in affected camels when compared with controls. Furthermore, gamma-glutamyl transferase, globulin, sodium, chloride, cobalt, iron, manganese, and selenium concentrations were significantly reduced. Affected camels were treated by stomach tube or surgery and were completely recovered, except for one camel with an esophageal fistula. Conclusion: A lack of trace elements could have a significant role in esophageal obstruction in dromedaries. Clinical, ultrasonographic, and hematobiochemical evaluations are useful for the accurate diagnosis, prognosis, and treatment of esophageal obstruction in camels.

A Descriptive Study of the Carpal Joint of Healthy Donkeys Using Ultrasonography, Computed Tomography, and Magnetic Resonance Imaging.

This study was conducted to establish a detailed anatomic reference for the carpal joint of apparently healthy donkeys using ultrasonography (US), computed tomographic (CT), and magnetic resonance imaging (MRI). Ten orthopedically sound adult donkeys were used for US examination of the carpal joint in each forelimb. Additionally, the carpi of ten donkey cadavers were subjected to CT and MRI examinations. The carpal joint was divided into four zones to simplify examination. US assessment of the carpal joint included transverse and longitudinal sonograms. CT was performed using three planes: axial, sagittal, and coronal. MRI was performed using axial and sagittal planes with two sequences: gradient-echo T1-weighted and proton density. The donkeys' carpus US, CT, and MRI images were labeled and serially interpreted based on references and anatomical cross-sections. The anatomical characteristics of the carpal joint and the surrounding soft tissue structures were thoroughly described and precisely differentiated on US, CT, and MRI scans. It can be concluded that US, CT, and MRI are effective noninvasive diagnostic imaging tools for evaluating the carpal joint in donkeys. Moreover, these imaging modalities can aid in establishing a reference database for the carpal joint of donkeys, which differs from that of horses.

Odontoameloblastoma in the posterior maxilla of a -6-years-old Ardi goat (Capra aegagrus hircus).

A 6­year­old female Ardi goat was presented for evaluation of an expansile firm painless maxillary ovoid mass. Clinical and diagnostic imaging examination revealed a well­ demarcated extensive mass occupying the left posterior maxilla and altering its anatomical features. Surgical excision was not deemed feasible with this apparently extensive infiltrative features of the tumor and the owner elected to euthanize the goat. Gross examination of the mass showed a grayish­brown, multiloculated firm and gritty mass measuring 21 x 11 x 19 cm located on the left posterior maxilla. Histopathological examination revealed plexiform and follicular arranged, ameloblast ­like odontogenic epithelium. Follicular epithelium was disintegrated leaving spaces, identical to solid multicystic ameloblastoma, intermingled with primitive myxoid stroma resembling dental papilla, teeth like hard structure as enamel and dentine, and osteodentine matrix. Based on these findings, the tumor was diagnosed as odontoameloblastoma (OA) and to our knowledge this is the first report of OA in goats.

Phenytoin: A promising non-antibiotic drug for the topical treatment of digital dermatitis in dairy cows.

BACKGROUND AND AIM: Digital dermatitis (DD) is one of the most common causes of lameness in dairy cattle. It is seen in nearly all dairy herds across the world and has substantial welfare and economic implications. In this study, we aimed to investigate the efficacy of phenytoin sodium topical treatment on painful ulcerative stage of bovine digital dermatitis (BDD). MATERIALS AND METHODS: In total, 45 Holstein-Friesian dairy cows with DD were randomly assigned to one of the three topical treatment trials (15 each): Saline solution (first treatment, negative control), chlortetracycline spray (second treatment, positive control), or phenytoin sodium powder (third treatment, positive control) (third treatment). On day 0 (pre-treatment) and on days 7, 14, 21, and 28 post-treatment, the response of DD-affected cows to the medications used was evaluated by measuring lesion depth and size, as well as the total clinical score (lameness, pain, and discomfort). RESULTS: The cure rate in cows treated with phenytoin (86.66%) on day 28 was significantly improved compared to cows treated with either chlortetracycline (60%) or normal saline (6.66 %). CONCLUSION: Our findings highlight the superiority of phenytoin over the commonly used antibacterial agent, chlortetracycline, in the topical treatment of BDD, and subsequently suggest that phenytoin should be considered a suitable alternative treatment option for the treatment of BDD.

Reconstruction of third-degree perineal lacerations in female camels (Camelus dromedarius) using a modified Goetz one-stage repair technique.

This study was designed to evaluate the modified Goetz-one-stage repair technique for reconstruction of third-degree perineal lacerations (TDPLs) in female camels. Fifteen female dromedary camels with TDPL were surgically reconstructed using the modified Goetz one-stage repair using the three-line closure technique. The surgical outcomes, the interval between repair and breeding, and the postoperative conception of the operated female camels were recorded and analyzed. During the 12-month postoperative follow-up period, TDPLs in 14 female camels (93.33%) healed completely by the first intention with mild inflammatory edema and infection in 2 female camels. One camel (6.67%) had a rectovaginal fistula, which was successfully repaired with suturing through the vaginal approach. Of the 15 female camels, 13 (86.67%) subsequently became pregnant through natural mating within 3 to 6 months postoperatively; however, 2 (13.33%) were one was immature and the other was barren which referred for gynecological treatment. The modified Goetz one-stage repair technique was successful in 14 of the 15 female camels after a single surgery, with a low incidence of postoperative complications. This technique is efficient for the repair of TDPLs in female camels, with promising results for subsequent fertility.

Can bone marrow aspirate improve mandibular fracture repair in camels (Camelus dromedarius)? A preliminary study.

BACKGROUND: Mandibular fractures are common in camels, leading to considerable economic losses. This study explored methods of improving mandibular fractures repair, adjuvant with interdental wire, or bone plate fixation. Autologous bone marrow (BM) injection enhances osteogenesis and rapid healing. OBJECTIVES: To investigate the effect of autologous BM aspirate as an adjuvant treatment for repairing mandibular fractures in camels with interdental wire, or bone plate fixation. METHODS: Thirty dromedary camels aged 5-8 years and of both sexes were randomly divided into 4 treatment groups: group 1 (n = 10) treated with stainless steel wire fixation and BM injection at the fracture line, group 2 (n = 10) treated with plate fixation and BM injection at the fracture line, group 3 (n = 5) treated with stainless steel bone wire fixation and placebo saline injection at the fracture line, and group 4 (n = 5) treated with plate fixation and placebo injection at the fracture line. The mandibular fractures were followed weekly for 12 weeks postoperatively to assess improvement and healing based on clinical evaluation, radiographic union scale, and bone turnover markers (i.e., bone alkaline phosphatase, osteocalcin, pyridinoline, and deoxypyridinoline). RESULTS: Compared to other groups, elevated bone turnover markers in group 1 were demonstrated (p < 0.05) on the seventh postoperative day. Likewise, compared to other groups, both clinical findings and radiographic union scale significantly improved (p < 0.05) in group 1 on the 56th postoperative day. CONCLUSIONS: BM aspirate has a promising beneficial osteogenic effect on mandibular fracture repair in camels, most notably when combined with interdental wire fixation.

Intra-articular injection techniques of the buffalo (Bubalus bubalis) hindlimb digit using anatomical and contrast arthrography-guided landmarks.

This study was designed to evaluate and compare the optimal sites for intra-articular (IA) injection into the digits of buffalo by discrimination of the injection criteria. Forty-eight cadaveric hind digits of adult buffalos and nine live ones were assigned for three trial investigations. In the first division, eighteen sound cadaveric limbs were used to describe the anatomical features of the hind digit. In the second division, thirty cadaveric limbs (ten for each approach) were injected with an equal volume of iopamidol through relevant joint pouches to compare the dorsal, lateral and plantar IA approaches for each joint. The former technique was applied to nine live, healthy adult buffaloes to evaluate the accuracy of IA injection of the hind digit in vivo. Injection criteria were assessed, scored and statistically compared among the three approaches. The summation of injection criteria scores showed a significant increase (P < 0.05) in the dorsal and lateral approaches for IA injection of the fetlock, pastern and coffin joints in the buffalo digit compared to the plantar one. However, median and range of injection criteria scores between the dorsal and lateral approaches were slightly less significant. In conclusion, the present study established a reference for IA injection of the buffalo digit that could aid the diagnosis and treatment of digit-related lameness.

Superficial swellings in camels (Camelus dromedarius): Clinical and ultrasonographic findings.

This study describes the clinical and ultrasonographic features of superficial swellings in dromedary camels (Camelus dromedarius) and evaluates the role of ultrasonography (US) in diagnosing and surgical planning or making treatment decisions for such swellings. One hundred and twenty-three camels of both sexes were included in this study based on the clinical and US evidence of superficial swellings varying in type, stage, content, and site. Clinical and US evaluation of these superficial swellings resulted in diagnoses of abscess (30.08%), hernia (26.83%), cyst (16.26%), tumor (13.01%), hematoma (6.50%), bursitis (3.25%), aneurysm (2.44%), and grade III muscle strain (1.63%). US yielded a higher sensitivity (91-100%) and specificity (97-100%) than clinical examination (75-91%) in differentiating the superficial swellings. The highest specificity value for US in evaluating the swellings was 100% for hernias, cysts, and tumors, while the lowest specificity values were recorded for hematomas (97%), followed by aneurysms (98%). In conclusion, US is a reliable and accurate tool providing rapid differential diagnosis, thus enabling treatment options for different superficial swellings in camels when clinical examinations are inconclusive.

Diagnosis and treatment of foreign bodies swallowing syndrome in camels (Camelus dromedarius) with special reference to the role of mineral deficiency.

This study describes the clinical presentation of ruminal and reticular foreign body syndrome (RRFBS), and evaluates the effect of mineral deficiency on its occurrence in dromedary camels. Thirty dromedary camels were divided into two groups. Group 1 (control) included 10 apparently healthy she-camels. Group 2 consisted of twenty dromedary camels diagnosed with RRFBS on the basis of clinical, ultrasonographic, hematological, and biochemical examinations. Clinical findings showed decreased appetite and milk yield, tympany, and gradual body weight loss. Ultrasonographic examinations revealed the presence of hyperechoic material with variable degrees of shadowing. Hematological evaluation showed a significant (P<0.05) decrease of the total erythrocyte and lymphocyte count and a significant increase of neutrophils in the camels with RRFBS compared to the controls. Biochemical tests showed a significant elevation in the activity of serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), creatine kinase (CK), glucose, creatinine, and blood urea nitrogen and a significant decrease of sodium, chloride, potassium, cobalt, iron, and selenium in the camels with RRFBS compared to the controls. Rumenotomy was performed on the 20 camels as a surgical intervention for treating the RRFBS. By the 6th month postoperatively, all surgically treated camels had completely recovered except for one with tympany and slight swelling in situ. In conclusion, trace element deficiency might play an important role in the occurrence of foreign body ingestion syndrome in dromedary camels. Moreover, clinical, ultrasonographic, hematological, and biochemical examinations are considered as tools assisting in the accurate diagnosis, prognosis, and treatment stratagem for RRFBS in camels.

Evaluation of Sevoflurane Anesthesia in Donkeys (Equus asinus) Premedicated With Xylazine and Induced With Thiopental.

Sevoflurane is a volatile anesthetic agent that has become popular in the field of large animal anesthesia. The aim of this study was to evaluate the use of sevoflurane in adult healthy donkeys. Six male, adult, healthy donkeys were premedicated with xylazine (1 mg/kg IV), induced with thiopental (5 mg/kg IV), and then maintained for 90 minutes with sevoflurane in 100% oxygen at a flow rate of 6 L/min with spontaneous breathing. Rectal temperature (RT), respiratory rate, heart rate (HR), oxygen hemoglobin saturation (OHS), and mean arterial blood pressure (MBP) were measured before and 20 minutes after the administration of xylazine, 10 minutes after the injection of thiopental, and then continuously every 10 minutes until recovery. Times for various signs of recovery, total duration of recovery, and quality of recovery were recorded. Jugular blood samples were collected from each donkey and complete blood counts and venous blood gases including concentrations of oxygen (PO2) and carbon dioxide (PCO2) were measured. In addition, the concentrations of sodium, potassium, calcium, lactate, bicarbonate, and glucose in venous blood were measured. Results showed that during the anesthesia maintained with sevoflurane, there was a significant decrease in HR, MBP, RT, red blood corpuscles, hematocrit, total white blood cells, neutrophils, and lymphocytes, whereas the levels of OHS and glucose significantly increased. The concentrations of PO2, PCO2, and lactate in venous blood significantly increased, whereas the pH significantly decreased. The levels of calcium significantly decreased immediately following the recovery. Sternal recumbency and standing occurred 15.8 ± 2.6 minutes and 28.2 ± 2.2 minutes, respectively, after turning off the vaporizer. Overall, the quality of recovery was good and relatively quick. It was concluded that sevoflurane appears to provide safe and effective anesthesia in donkeys, with relatively rapid induction and recovery.

Abdominal hernias in camel (Camelus dromedaries): Clinical findings and treatment outcomes.

The present study was designed to describe the clinical presentation of abdominal hernias and to evaluate the efficacy of polypropylene mesh in repair of such affection in camels. Twenty-six dromedary camels were included in this study on the basis of clinical and ultrasonographic evidence of abdominal hernia. Factors associated with prevalence and clinical findings of hernia were presented and hernioplasty using polypropylene mesh was evaluated as a surgical intervention. Out of 26 studied camels, abdominal hernia was prevalent in Wadeh camels than other breeds (17 vs. 9, P<0.01). Camels <6 years of age exhibited more hernias than other age groups (18 vs. 8, P<0.01). Moreover, females showed a significantly higher prevalence (19 vs. 7, P<0.01) of abdominal hernia compared to males (26.9%, n=7). The sensitivity (96.8%) and specificity (93.1%) of ultrasonography (US) for diagnosing hernia were higher in comparison to clinical examination (88.3%). At 3 weeks postoperatively, the clinical index score of 26 operated camels was significantly reduced in comparison with pretreated (22 vs. 4, P<0.005). However, only 2 cases had recurrence of the hernia and 2 camels had slight swelling in situ. By the 6th month post treatment, all treated camels were completely recovered. In conclusion, the polypropylene mesh is a viable and consistent alternative effective treatment for abdominal hernias in camels. In addition, the clinical index scores and US provide a precise paradigm for diagnosis and preoperative planning for abdominal hernias in dromedary camels.

Normal magnetic resonance anatomy of the hind foot of Egyptian buffalo (Bubalus bubalis): A correlative low-field T1- and T2-weighted MRI and sectional anatomy atlas.

Buffaloes represent a major source of milk production, especially in developing countries including Egypt. The buffalo foot is frequently involved in a large proportion of lameness cases. The relatively small size and complexity of its structures often render the radiographic evaluation of the foot challenging. Magnetic resonance imaging (MRI) is a noninvasive imaging technique that is regarded as both safe and accurate for assessment of the foot disorders in both man and animals. The purpose of the current investigation was to describe the MRI anatomy of buffalo foot using cadaveric hind feet. The feet were subjected to consecutive MRI scanning using a 0.3 Tesla scanner. Both T1-weighted (T1-W) and T2-weighted (T2-W) spin-echo pulse sequences were applied in dorsal, sagittal and transverse planes. The heterogeneity of signal intensities noted amongst foot components allowed for clear differentiation of bones, tendons, ligaments, adipose tissue and synovial fluid. The T1-W images provided an excellent overview of the foot. They were valuable for visualizing the bones and the alignment of tendons and ligaments. The T2-W images were particularly useful for the evaluation of synovial structures such as tendon sheaths and joint cavities. A communication between the two plantar sacs of the metatarsophalangeal (fetlock) joints was evident in T2-W images. MRI findings were further confirmed using relevant gross anatomical sections. The present study establishes a detailed MRI anatomic reference of buffalo foot that could help veterinary researchers, clinicians and surgeons for increasing the accuracy of interpretation of foot MRI scans of both healthy and diseased animals.

Bilateral renal abscessation and chronic active pyelonephritis in a male camel (Camelus dromedarius) caused by Escherichia coli.

This report summarizes the clinical, hematobiochemical, ultrasonographic, histopathological and bacteriological findings in a male Arabian camel (Camelus dromedarius) with bilateral renal abscessation and chronic active pyelonephritis. Owner complaint included a decreased appetite and loss of body condition with occasionally voiding red urine. In the right kidney, ultrasonographic changes included a hypoechoic fluid surrounding the renal parenchyma. Within the left kidney, a large volume of hypoechoic contents were imaged. Bacteriological examination yielded only Escherichia coli. To the authors' knowledge this is the first reported case of bilateral renal abscessation and chronic active pyelonephritis in dromedary camels. In conclusion, renal ultrasonography provides a precise and non-invasive technique for diagnosis and subsequent clinical decision making of renal abscessation and chronic pyelonephritis camels.

Single Nucleotide Polymorphisms in IL8 and TLR4 Genes as Candidates for Digital Dermatitis Resistance/Susceptibility in Holstein Cattle.

Relatedness between single nucleotide polymorphisms in IL8 and TLR4 genes and digital dermatitis resistance/susceptibility was investigated in seventy Holstein dairy cows. Animals were assigned into two groups, affected group (n = 35) and resistant group (n = 35) based on clinical signs and previous history of farm clinical records. Blood samples were collected for DNA extraction to ampliy fragments of 267-bp and 382-bp for IL8 and TLR4 genes, respectively. PCR-DNA sequencing revealed three SNPs in each of IL8 and TLR4 genes. The identified SNPs associated with digital dermatitis resistance were C94T, A220G, and T262A for IL8 and C118T for TLR4. However, the G349C and C355A SNPs in TLR4 gene were associated with digital dermatitis susceptibility. Chi-square analysis for comparison the distribution of all identified SNPs in both IL8 and TLR4 genes between resistant and affected animals showed no significant variation among the identified SNPs in IL8 gene. Meanwhile, there was a significant variation in case of TLR4 gene. As a pilot study, the present results revealed that identified SNPs in IL8 and TLR4 genes can be used as a genetic marker and predisposing factor for resistance/susceptibility to digital dermatitis in dairy cows. However, TLR4 gene may be a potential candidate for such disease.

Utility of ultrasonography for diagnosis of superficial swellings in buffalo (Bubalus bubalis).

We studied 72 buffalo with superficial swellings in the head (n=4), neck (n=5), chest wall (n=4), abdominal wall (n=28), limbs (n=16), gluteal region (n=8), perineal region (n=6) and udder (n=1). Ultrasonographically, the swellings varied according to type, duration, content and location. The clinical use of ultrasound to assess these superficial swellings allowed diagnosis of abscesses (n=21), hematomas (n=11), hernias (n=17), bursitis (n=13), urethral diverticula (n=6) and tumors (n=4). Ultrasonography could precisely discriminate each lesion type (sensitivity, 71-100%; specificity, 75-100%; odds ratio, 1.0-8.4; Confidence Interval, 74.2-20; and P value 0.001). The specificity for ultrasonographic evaluation of superficial swellings was 100% for hernias, urethral diverticula and tumors, whilst the lowest specificity was recorded for hematomas (75%) and abscesses (92%). In conclusion, ultrasonography provides a precise, non-invasive and fast technique for the evaluation, classification and subsequent treatment of a variety of superficial swellings in buffalo.

Can platelet-rich plasma shorten the consolidation phase of distraction osteogenesis? An experimental study.

PURPOSE: The purpose of this study was to evaluate the effects of platelet-rich plasma (PRP) on distraction osteogenesis. MATERIALS AND METHODS: Tibias of 36 New Zealand white rabbits were distracted at a rate of 0.25 mm/8 h for 20 days with a circular external fixator. The animals were randomly divided into a control group that did not receive PRP therapy and an experimental group, with PRP injection into the distracted area. Radiographic examinations were performed at the 10th, 20th, 30th, 40th and 50th days after end of distraction. By the 50th day after distraction, all animals were sacrificed, the external fixator was removed and the tibia was dissected. After that, each group was subdivided into two subgroups: one for pathological study and another one for mechanical study. RESULTS: Radiologic scores were statistically similar at the 10th, 20th and 30th days. However, the experimental group demonstrated higher radiologic scores at the 40th and 50th days. Histopathologic examination revealed a statistically significant higher score in the experimental group. The PRP injected group showed an improvement of their mechanical properties. CONCLUSION: The results of this study show that PRP has beneficial effects on new bone formation during distraction osteogenesis.

Pilot study of bovine interdigital cassetteless computed radiography.

Twenty-one limbs of bovine cadavers (42 digits) were exposed to interdigital cassetteless imaging plate using computed radiography. The radiographic findings included exostosis, a rough planta surface, osteolysis of the apex of the distal phalanx and widening of the laminar zone between the distal phalanx and the hoof wall. All these findings were confirmed by computed tomography. The hindlimbs (19 digits) showed more changes than the forelimbs (10 digits), particularly in the lateral distal phalanx. The cassetteless computed radiography technique is expected to be an easily applicable method for the distal phalanx rather than a conventional cassette-plate and/or the film-screen cassetteless methods.

Clinical and biomechanical evaluation of three bioscaffold augmentation devices used for superficial digital flexor tenorrhaphy in donkeys (Equus asinus): An experimental study.

The present study was designed to carry out an in vivo and in vitro comparative evaluation of three bio-scaffold augmentation devices used for superficial digital flexor tenorrhaphy in donkeys. Twenty-four clinically healthy donkeys were assigned for three treatment trials (n = 8) using one of three bioscaffold materials (glycerolized bovine pericardium xenograft, tendon allograft and allograft with glycerolized by bovine pericardium). In addition, eight clinically healthy donkeys were selected to serve as control. Clinical signs of each animal were scored and the sum of all clinical indexes was calculated at each time point of the experiment. Four donkeys from each group were euthanized at 45 and 90 days postoperatively, respectively, for biomechanical and histopathological evaluation of treated superficial digital flexor tendon (SDFT). The failure stress in allograft shielding group significantly increased compared to the corresponding values of the other groups at 45 (62.7 ± 6.5 N mm(-2)) and 90 (88.8 ± 3.5 N mm(-2)) days postoperatively. The fetlock angle in the allograft shielding group at both 45 (112.8° ± 4.4) and 90 (123.8° ± 1.1) days postoperatively showed a significant increase (p < 0.05) relative to the values of the other groups and a significant decrease (p < 0.05) when compared to normal angle (125° ± 0). However, the histomorphological findings revealed no remarkable changes between the treatment groups. In conclusion, the failure stress, fetlock angle and histomorphological findings may provide useful information about the healing characteristics of SDFT tenorrhaphy. The bio-scaffold augmentation devices, either xenogenic or allogenic, provide good alternative techniques accelerating SDFT healing with minimal adhesions in donkeys.