Bilateral sertoli and interstitial cell tumours in abdominal testes of a goat with polled intersex syndrome (PIS).

An 8-year-old, mixed breed, polled goat was presented for evaluation of male-like behaviour. Clinical findings included clitoromegaly, a heavily muscled neck, pronounced beard, and erect dorsal guard hairs, which are phenotypic characteristics commonly observed in intersex animals. Transrectal ultrasonography revealed the presence of two abdominal masses caudolateral to the uterine horns. Serum concentration of estradiol was elevated. Genetic evaluation was compatible with polled intersex syndrome defined by an XX karyotype without a Y chromosome or SRY gene. Based on gross and histologic evaluation, the abdominal masses were determined to be intra-abdominal testes, each of which was effaced by Sertoli cell and interstitial (Leydig) cell tumours. The Sertoli cell tumours (SCTs) represented two unique histologic patterns. Regardless of pattern, neoplastic Sertoli cells were consistently lipid laden and positive for vimentin. Interstitial cell tumours (ICTs) were negative for vimentin. Clinical and histopathologic findings suggest that prolonged exposure to steroids secreted by neoplastic Sertoli cells contributed to virilization. In addition, results from immunohistochemistry indicated that vimentin may be a valuable immunodiagnostic tool for differentiation between interstitial and Sertoli cell tumours in goats.

Modified parainguinal approach for cystic calculus removal in five equids.

This report describes a modification of the parainguinal approach for removal of cystic calculi: a ventral midline laparotomy-guided parainguinal laparocystotomy. The ventral midline approach to the abdomen is rapid and routinely used by equine surgeons. With an arm introduced to the abdomen via the ventral midline, the surgeon is able to select the ideal parainguinal laparotomy incision location that allows bladder exteriorisation with the minimum amount of tension. Because the surgeon's hand is introduced via the ventral midline incision, the parainguinal incision can be sized to just allow exteriorisation of the urinary bladder and urolith, increasing extra-abdominal bladder security during cystotomy while reducing incision size in the parainguinal region. Finally, an assistant's hand via the ventral midline incision can maintain bladder stability within the parainguinal incision during cystotomy closure.

The effects of methylprednisolone on normal and monocyte-conditioned medium-treated articular cartilage from dogs and horses.

OBJECTIVE: To study in vitro (1) the dose-response relationships between proteoglycan metabolism in normal and corticosteroid-treated articular cartilage; (2) long-term proteoglycan metabolism after treatment of articular cartilage with corticosteroids; and (3) the effect of corticosteroids on proteoglycan metabolism in articular cartilage treated with monocyte-conditioned medium (MCM). STUDY DESIGN: Equine and canine articular cartilage explants were treated with corticosteroids and MCM. Proteoglycan synthesis and degradation were measured by radioactive labeling in short-term culture, and the long-term effect of corticosteroid treatment on proteoglycan metabolism was studied in normal explants. ANIMALS: Two young cross-breed horses and 3 young Labrador retrievers. METHODS: Equine articular cartilage explants were incubated in medium containing methylprednisolone sodium succinate (MPS) at 0, .001, .01, .1, 1, and 10 mg/mL (final concentration) for 1 day and then in fresh medium without MPS. Proteoglycan synthesis was measured by incorporation of sodium [35S]sulfate at 1, 3, 7, 10, and 13 days after initial treatment with MPS. Proteoglycan release was measured from separate explants prelabeled with sodium [35S]sulfate and treated similarly. Equine articular cartilage explants were treated with equine MCM simultaneously with, and 24 hours before MPS, at 0, 0.01, 0.1, 1, or 5 mg/mL for 72 hours. Proteoglycan synthesis and degradation in these explants was compared. Proteoglycan synthesis and degradation were measured similarly in canine articular cartilage explants treated simultaneously with canine MCM and MPS at 0, 0.001, 0.01, 0.1, 1 and 10 mg/mL for 72 hours. Equine articular cartilage explants treated with 0, 0.01, 0.1, 1, and 5 mg/mL of MPS for 72 hours were evaluated histologically. RESULTS: Proteoglycan synthesis in normal equine articular cartilage was severely depressed by 10 mg/mL MPS for 24 hours, and proteoglycan synthesis failed to recover after 13 days of culture in medium without MPS. Cartilage treated with 5 mg/mL MPS had pyknotic chondrocyte nuclei and empty lacunae. Concentrations of 1 and 0.1 mg/mL MPS depressed proteoglycan synthesis in normal equine cartilage explants. For these 2 concentrations, proteoglycan synthesis recovered 2 days after MPS removal and increased significantly (P < .05) 7 days after treatment with MPS compared with controls without MPS. Concentrations of 0.001 and 0.01 mg/mL MPS did not significantly affect proteoglycan synthesis in normal equine cartilage explants. Cumulative proteoglycan loss over 13 days in culture from normal equine explants treated for 24 hours with different concentrations of MPS was not significantly different between treatment groups at any time point. MCM significantly depressed proteoglycan synthesis in both canine and equine articular cartilage explants and significantly increased proteoglycan release. These effects were prevented in the canine explants by simultaneous treatment with MPS at 1 and 0.1 mg/mL, and proteoglycan release induced by MCM in equine articular cartilage was inhibited by 1 mg/mL MPS. CONCLUSIONS: Concentrations of 1.0 and 0.1 mg/mL MPS alleviated articular cartilage degradation in MCM-treated articular cartilage in vitro. These concentrations of MPS in contact with normal cartilage explants for 24 hours are unlikely to be detrimental in the long term to proteoglycan synthesis. The response of articular cartilage to MPS was affected by treatment with MCM so that results of experiments with normal articular cartilage explants may not reflect results obtained with abnormal cartilage. CLINICAL RELEVANCE: It may be possible to find an intraarticular concentration of corticosteroid that protects articular cartilage against cytokine-induced matrix degradation yet not have prolonged or permanent detrimental effects on chondrocyte matrix synthesis.

Prognostic factors affecting survival of 507 horses with joint disease: (1983 to 1990).

Between July 1, 1983 and December 31, 1990, risk factors were determined for all horses with joint disease presented to a referral center, of being discharged, of ever becoming sound, or of being alive at 3 mo follow-up. Logistic multiple-regression models were done separately for foals (< or = 4 mo), yearlings (> 4-24 mo) and racing or nonracing adult horses (> 24 mo). The breakdown in this study was 53 foals, 87 yearlings, 141 nonracing adults, and 226 racing adults. Thirty-one foals (58%), 68 yearlings (78%), 119 non-racing adults (84%), and 213 racing adults (94%) were discharged. Foals with a less severe lameness, duration of illness of > 1 d, and infectious arthritis had increased odds of discharge. At follow-up, 12 of 18 (67%) were alive, 10 (56%) of which were sound. Yearlings with osteochondrosis had higher odds of discharge; at follow-up, 38 of 49 (78%) were alive, 32 (65%) of which were sound. For non-racing adults, horses with less severe lameness, without a miscellaneous diagnosis, or intended for pleasure use had increased odds of discharge. At follow-up, 55 of 78 (70%) were alive and 33 of 58 (57%) with soundness data became sound. Risk factors for higher odds of being alive at follow-up were carpal lameness, arthroscopic surgery, a prognosis other than poor, became sound, above-median hospitalization costs, and duration of follow-up. The 161 racing adults (76% of discharges), with follow-up, were more likely to have had osteoarthritis, higher hospital costs, hospitalization > 1 d, and arthroscopy. Sixty-four (60%) of these became sound; the odds increased if the horse was not severely lame at admission or was hospitalized for > 1 d. Risk factors and prognosis differed by age-use group among horses seen at our hospital.

Contrast radiography of the lower urinary tract in the management of obstructive urolithiasis in small ruminants and swine.

Contrast radiographic visualization of the small ruminant and porcine lower urinary tract is an infrequently used modality for the evaluation and management of obstructive urolithiasis. The administration of contrast medium through a tube cystostomy catheter used to divert urine flow until the resolution of the obstruction may provide an easy method to evaluate the status of the urethral obstruction. Contrast fluoroscopy is utilized to monitor and visualize therapeutic flushing of the urethra. A review of 26 patients seen at the Veterinary Medical Teaching Hospital suggested that among the radiographic techniques used, positive contrast normograde cystourethrography through the tube cystostomy catheter allowed the best visualization of the lower urinary tract structures and enabled assessment of the resolution of the obstructive lesion.

Concurrent abomasal displacement and perforating ulceration in cattle: 21 cases (1985-1996).

OBJECTIVE: To evaluate the association of physical examination and clinicopathologic findings with surgical findings in cattle with concurrent abomasal displacement and perforating ulceration, to determine short- and long-term survival rates in these cattle, and to determine whether degree of peritonitis (focal vs diffuse) influences survival rates. DESIGN: Retrospective study. ANIMALS: 21 cattle with concurrent abomasal displacement and perforating ulceration and 42 cattle with uncomplicated abomasal displacement. PROCEDURE: Information on signalment, stage of lactation, physical examination findings, clinicopathologic data, surgical diagnosis, procedure(s) performed, and necropsy findings were retrieved from medical records of all cattle included in this study. Differences between physical examination findings of cattle with concurrent disease and those of cattle with uncomplicated displacements were evaluated, as were differences between survival rates in cattle with focal versus diffuse peritonitis. RESULTS: Cattle with concurrent disease had a greater probability of having pneumoperitoneum and signs of abdominal pain identified on physical examination than did cattle with uncomplicated diseases. There was no relationship between clinicopathologic data and survival time. Short-term survival rate was 38%, and degree of peritonitis significantly influenced survival time in cattle with concurrent abomasal displacement and perforating ulceration. Long-term survival rate in these cattle was 14%. CLINICAL IMPLICATIONS: Cattle with concurrent displaced abomasum and perforating ulceration have a poor chance for survival. In addition to detection of displaced abomasum, physical examination findings that can help lead to a presurgical diagnosis of this syndrome are pneumoperitoneum and signs of abdominal pain.

Abdominal surgery in foals: a review of 119 cases (1977-1994).

The case records of 119 young horses (all less than age one year) that underwent an exploratory celiotomy during a 17 year period were examined to determine the surgical findings, short- and long-term outcome, and prevalence of small intestinal disease compared to previous reports in the mature horse. Physical and laboratory values were compared for long-term survivors vs. nonsurvivors and the frequency of post operative intra-abdominal adhesions was determined. The most common cause for exploratory celiotomy was small intestinal strangulation, followed by enteritis and uroperitoneum. Six horses died during surgery, 23 were subjected to euthanasia at the time of surgery due to a grave prognosis, and 17 horses died or were destroyed after surgery, prior to discharge from the hospital; the short-term survival was 61%. Nine horses were lost to follow-up. Forty-one horses survived long-term (at least 6 months after surgery), 15 died or were subjected to euthanasia after discharge for reasons related to the prior abdominal surgery, and 8 died or were destroyed after discharge due to unrelated reasons, making the long-term survival 45%. Fifty-three (45%) of the horses presented as neonates, and 66 (55%) presented age 3-12 months. Uroperitoneum and meconium impaction were the most common disease in the neonate. Intussusception and enteritis were the most common diseases in older foals. The overall prevalence of small intestinal disease was 44%. Significant elevations in packed cell volume, heart rate, nucleated cell counts and total protein in abdominal fluid and rectal temperature were observed in nonsurvivors compared to survivors. Nonsurvivors had significantly decreased serum bicarbonate, chloride, sodium, and venous pH values. There was no evidence that location of the lesion affected long-term survival. Horses with a simple obstruction had a higher survival percentage than those with a strangulating obstruction, and horses that underwent an intestinal resection had a lower long-term survival than those horses undergoing only intestinal manipulation. Nineteen (33%) of the foals examined after the original surgery had evidence of intra-abdominal adhesions. Nine of these (16%) had adhesions that caused a clinical problem.

The diagnosis and surgical correction of congenital portosystemic vascular anomalies in two calves and two foals.

Two calves and two foals presented with episodic clinical signs of diffuse central nervous system disease. Portosystemic anomalies were tentatively diagnosed based on the history, clinical signs and increased serum concentrations of blood ammonia and total serum bile acids with normal concentrations of liver derived enzymes. one calf died before intraoperative contrast portography, whereas the other calf and both foals had marked clinical improvement after intensive medical therapy. Surgical correction was attempted in these three animals and was successful in one foal. A right paracostal celiotomy was superior to a ventral median approach for exposure to the portal vascular system and shunt access.

Tube cystostomy for treatment of obstructive urolithiasis in small ruminants.

Tube cystostomy was used to treat 13 goats and two sheep with obstructive urolithiasis. The cystostomy tube was intermittently occluded 3 to 4 days after placement to determine if urine could be voided through the urethra. If the animal showed no discomfort during urination after the cystostomy tube had been occluded for several days, the tube was removed. This procedure was successful in relieving urethral obstruction in 12 animals. The mean time until the animal could urinate freely and until the cystostomy tube was removed was 11.5 and 14.4 days respectively. Follow-up was available for 10 animals; seven were alive with no recurrence of urinary obstruction. One goat died from unrelated to urinary obstruction 1 year postoperatively. One goat died from unknown causes, and one goat died after urinary obstruction recurred.

Repeat laparotomy for gastrointestinal disorders in cattle: 57 cases (1968-1992).

A study was conducted to investigate indications for, typical findings during, and outcome of repeat laparotomies in 57 cattle with gastrointestinal disorders. Cattle were grouped according to the reason the initial laparotomy had been performed. Group-1 cattle (n = 46) had had left or right displacement of the abomasum (LDA or RDA) or right volvulus of the abomasum. Group-2 cattle (n = 10) had had ruminal, reticular, or abomasal obstruction or perforation. Group-3 cattle (n = 7) had had obstruction, volvulus, distention, or perforation of the small or large intestine. Median interval between laparotomies was 1 month (range, 1 day to 38 months). Intraoperative findings during repeat laparotomy in group-1 cattle included LDA (n = 18), RDA (9), right volvulus of the abdomen (5), pneumoperitoneum (1), diffuse abdominal adhesions (1), cecal adhesions (1), adhesions of the rumen to the body wall (1), abscess in the cranial portion of the abdomen (1), reticular adhesions (1), localized necrosis (1), and idiopathic rumen distention (1). Intraoperative findings during repeat laparotomy in group-2 cattle included abscess in the cranial portion of the abdomen (4), no abnormalities (1), distended rumen (1), ruptured abomasum (1), recurrent abomasal impaction (1), diffuse abdominal adhesions (1), and pyloric fat necrosis (1). Intraoperative findings during repeat laparotomy in group-3 cattle included LDA (3), RDA (1), cecal volvulus (1), anastomotic rupture (1), and impacted colocolostomy (1). Seven cows and 1 calf underwent additional repeat laparotomies. Forty-four (77%) of the 57 cattle were discharged following final laparotomy. Fourteen of the 20 group-1 cattle, 1 of the 6 group-2 cattle, and 2 of the 3 group-3 cattle for which follow-up information was available were productive after repeat laparotomy.

A one-stage marsupialization procedure for management of infected umbilical vein remnants in calves and foals.

Five Holstein calves and two foals with omphalophlebitis were treated by surgical marsupialization of the umbilical vein remnant because complete resection of the infected tract was not possible. The infected umbilical stalk was resected, and the umbilical vein remnant was marsupialized in a one-stage procedure by suturing it into the abdominal wall lateral to the abdominal incision. Antimicrobial drugs were administered, and the marsupialized tract was irrigated until closure by second intention healing. Cellulitis associated with the marsupialization site occurred in two calves but resolved with antimicrobial therapy. Owners reported that, 9 to 60 months after surgery, there were no complications associated with the procedure.

Partial typhlectomy and ileocolostomy for treatment of nonreducible cecocolic intussusception in a horse.

Cecocolic intussusception was detected in a 2-year-old male Standardbred horse with a 3-day history of signs of intermittent colic. The entire cecum, which was located within the lumen of the right ventral colon, was edematous and necrotic, and could not be manually reduced. A colotomy was made, and partial typhlectomy was performed. An ileocolostomy also was performed. To prevent eversion of the cecal base, the site of invagination into the colon was oversewn. Several postoperative complications were treated, including peritonitis, thrombophlebitis, anemia, and hypoproteinemia, and 1 year after surgery, the horse was healthy and in training.

Primary repair of abomasal fistulae resulting from right paramedian abomasopexy in eight adult dairy cattle.

Abomasal fistulae resulting from right paramedian abomasopexy in eight adult dairy cattle were treated by primary closure of the abdominal wall after surgical resection of the fistulae. The median elapsed time from the abomasopexy to recognition of fistula formation was 16 days (range, 10 to 90 days). All cows had normal electrolyte values, and five cows had mildly increased base excess values (range = 4.0 to 7.8 mEq/L). Surgery was performed with the cows in dorsal recumbency using general anesthesia. The fistulated tissue was resected and the abomasum and body wall were closed primarily. One or two layers of appositional sutures using #2 or #3 polyglactin 910 were used to close the body wall. Mean surgical time was 2.2 hours (range, 1.8 to 2.9 hours). Two cows were lost to follow-up. Five of the remaining six cows returned to production (range, 5 to 30 months). Primary closure of the abdominal wall should be considered in the surgical repair of abomasal fistulae in cows that do not have diffuse peritonitis.

A comparison in 101 dairy cows of right paralumbar fossa omentopexy and right paramedian abomasopexy for treatment of left displacement of the abomasum.

Right paramedian abomasopexy and right paralumbar fossa omentopexy appear to be the most widely used means of correcting left displacement of the abomasum in dairy cattle. We compared these two procedures in a prospective study of 101 cows with uncomplicated left displaced abomasum. The surgical treatment (right paramedian abomasopexy, n = 48; or right paralumbar fossa omentopexy, n = 53) was assigned randomly. Follow-up information was obtained, at regular intervals, from one week through six months following discharge from the hospital. Milk production, reproductive performance, surgical complications, and length of time retained in the herd after surgery were obtained for each animal. There was a trend in favor of the abomasopexy group in the one-month milk yield. There were no differences between procedures either in incisional complications, other problems noted at follow-up, or in the proportion dead/culled. Based on the milk yield at one month after surgery, we concluded that there may be a slight advantage to right paramedian abomasopexy in cows with uncomplicated left displaced abomasum.

Thoracotomy in adult dairy cattle: 14 cases (1979-1991).

Fourteen cows were subjected to thoracotomy as an aid in the treatment of either septic pericarditis (n = 7) or unilateral pleuritis (fibrous or purulent; n = 7). Thoracic lesions were primary in 4 cows, secondary to traumatic reticuloperitonitis in 9 cows, and secondary to extension of a liver abscess in 1 cow. Thoracotomy was performed on 9 cows under local anesthesia. Surgery was performed on 5 cows under general anesthesia; 2 died during anesthesia, and 2 others were euthanatized. Of the 10 cows allowed to recover from surgery, 4 had pericarditis and 6 had pleuritis. Four cows with pleuritis had thoracic abscesses. All but 1 cow with pericarditis died or were euthanatized, and 5 of the 6 cows with pleuritis were discharged from the hospital. A year after surgery, 1 cow was culled because of infertility, and the other 5 cows were returned to production.

Clinical management and surgical repair of atresia coli in calves: 66 cases (1977-1988).

The medical records of 66 calves with atresia coli were reviewed; 64 calves were examined at the New York State College of Veterinary Medicine, and 2 calves were examined at the New Bolton Center. In each case, the site of the atresia was within the spiral loop of the ascending colon. In 1 of these calves, a segment of jejunum was also atretic. Absence of feces, progressive weakness, and abdominal distension were the most common clinical signs observed. Other congenital abnormalities were detected in 12 (18%) of 66 calves. Of the 66 calves examined, 5 were euthanatized or died on admission, and 61 had an exploratory celiotomy performed. Eight calves were euthanatized or died during the surgery. In the remaining 53 calves, surgical treatment consisted of enterotomy followed by meconium evacuation, resection of the proximal blind end (in 30 calves), and restoration of intestinal continuity. Restoration of intestinal continuity was done either by side-to-side anastomosis of the proximal to distal blind ends (5 calves), or by side-to-side or end-to-side anastomosis of the proximal blind end to the descending colon (48 calves). Of the 66 calves seen, 27 (41%) were discharged from the hospital, and 11 of these reached reproductive age (11 calves were lost to follow-up before they were 2 years old). From the 11 calves reaching reproductive age, 33 calves were born, one of which may have had atresia coli. The owners should anticipate that long-term survivors likely will have loose feces and normal offspring, but may not grow as well as otherwise expected.

The reliability of endoscopic examination in assessment of arytenoid cartilage movement in horses. Part I: Subjective and objective laryngeal evaluation.

Videorecordings of the laryngeal activity of 108 unsedated horses were obtained at rest by passing a flexible videoendoscope into the nasopharynx through the right ventral meatus. All videotaped images were reviewed once, and 72 were reviewed twice, by three veterinarians. Laryngeal cartilage movement was assessed subjectively with a five-tier grading system. The mean intraobserver agreement was 83.3% (range, 75.0%-90.2%) with a kappa statistic of .65 to .98. The mean interobserver agreement was 79.0% (range, 70.4%-80.6%) with a kappa statistic of .51 to .90. A computer program was developed to measure the left:right ratio of the rima glottidis. The mean left:right ratio for horses assigned a median laryngeal grade of I was 0.84 (range, 0.55-1.03); for grade II, 0.82 (0.50-1.12); for grade III, 0.59 (0.39-0.91); and for grade IV, 0.24 (0.07-0.35).

The reliability of endoscopic examination in assessment of arytenoid cartilage movement in horses. Part II. Influence of side of examination, reexamination, and sedation.

Twenty Thoroughbred and Standardbred horses underwent endoscopic evaluation of arytenoid cartilage movement twice within 1 week. Each time, a flexible endoscope was passed without sedation through the right nostril and the left nostril, and through the right nostril 5 minutes after administration of xylazine hydrochloride (0.55 mg/kg or 1.1 mg/kg intravenously). Laryngeal cartilage movement was videorecorded. All videotaped images were reviewed by three veterinarians and subjectively placed in one of four grades. The intraobserver agreement rate varied from 52.6% for examination under sedation with 1.1 mg/kg of xylazine to 89.5% for unsedated reexamination through the left nostril. The effect of the various observations on median laryngeal grade was calculated. Examination under xylazine hydrochloride at either dosage yielded a change in median laryngeal grade from the unsedated examination in 45% of the evaluations. Reevaluation through the right or left nostril resulted in a different median laryngeal grade in 21% and 5% of the examinations, respectively. Objective measurements of the rima glottidis obtained by computer-assisted morphometric analysis of the recorded laryngeal images allowed laryngeal images to be dichotomized regardless of the condition of endoscopic examination. Endoscopic evaluation of laryngeal cartilage movement is subjective and is influenced by sedation with xylazine, evaluation through the alternate nostril, and different day of examination. The most consistent evaluation was obtained during repeated examination through the left nostril.

Formation of N-trimethyl-N-nitrosourea in the gastric lumen of the fistulated pig.

The formation of N-trimethyl-N-nitrosourea (TMNU) in the stomach of full-sized gastric-fistulated pigs was determined. Nitrite was added to the stomach in amounts that have been reported to occur in the human stomach (25-375 mumol). The vehicle was an 'artificial meal' made up of synthetic gastric juice. The total amount of TMNU formed (not concentration) was estimated by determining the concentration and gastric volume using multiple additions of a nonabsorbable marker (polyethylene glycol). At an initial pH of 3, 23-1000 micrograms of TMNU were found after 10-25 min. The rate of loss of polyethylene glycol and TMNU from the stomach were the same, indicating that TMNU was not directly absorbed. These data suggest that formation of TMNU under conditions similar to those found in the human stomach is possible.

Use of a multiple logistic regression model to determine prognosis of dairy cows with right displacement of the abomasum or abomasal volvulus.

Data at admission and at surgery were collected on 458 cows with right displacement of the abomasum or abomasal volvulus, to derive multiple logistic regression models for predicting postsurgical outcome (productive, salvaged, or terminal). The derived models contained few and easily obtained variables. The weight associated with each variable was determined objectively. Three admission variables (heart rate, base excess, and plasma chloride concentration), and 5 surgical variables (heart rate, base excess, diagnosis, method of decompression used, and appearance of abomasal serosa) were used in the final models. Predicted outcomes that used the admission and surgical models were closely related with actual outcomes. Total correct classification for satisfactory (productive) versus unsatisfactory outcome (salvaged and terminal) was 78.2% for the admission model and 82.7% for the surgical model. Combining data on cows with productive and salvaged outcomes as satisfactory outcome, and terminal as unsatisfactory outcome, total correct classification was 90.7% for the admission model and 93.2% for the surgical model. Using predicted probabilities, the market value of productive and salvaged cows, and the medical and surgical costs, one can calculate the expected economic value of each outcome. Treatment can be justified if the sum of the expected value of productive and salvaged outcome exceeds the sum of the medical and surgical costs and the expected salvaged value of the cow that was not treated surgically.