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1.
Megaesophagus was diagnosed in 15 llamas on the basis of survey and contrast radiography. Age of onset ranged from 13 months to 9.5 years. Clinical signs varied, with salivation being the most common; regurgitation or dysphagia were noted in only 33% of the cases. Duration of the disorder ranged from 1 week to 5 years. Organophosphate toxicity was the cause of megaesophagusin 1 llama. While most cases were of unknown etiology, the 3 with histological abnormalities included 1 with vagal neuropathy and 2 with a degenerative myopathy of esophageal muscles. The causes in most were undetermined.  相似文献   

2.
Background: Feline nasal lymphoma (NLSA) is a condition for which no standard of care exists.
Hypothesis: There is no difference in survival times of cats with NLSA treated with single or multimodality therapy.
Animals: Records from 97 cats diagnosed with NLSA were examined.
Methods: The purpose of this retrospective study was to compare the survival times of cats with NLSA treated with radiation therapy (RT) alone, chemotherapy alone, or RT + chemotherapy and identify potential prognostic variables that affected survival. Cats were grouped according to therapy: RT + chemotherapy (n = 60), RT alone (n = 19), or chemotherapy alone (n = 18).
Results: Survival was calculated with 2 methods. The 1st survival analysis (method A) included all cats, but counted only deaths caused by progressive NLSA. The median survival time (MST), regardless of therapy modality, was 536 days. The 2nd survival analysis (method B) also included all cats and counted all deaths, regardless of cause, as events. The overall MST calculated for all deaths was 172 days. A negative independent prognostic variable identified was anemia ( P < .001), and positive independent prognostic variables were a complete response to therapy ( P < .001) and total radiation dose >32 Gy ( P = .03).
Conclusions and Clinical Importance: There were no significant differences in survival times among the 3 treatment groups but these results suggest that the addition of higher doses of RT to a cat's treatment protocol may control local disease and therefore influence survival.  相似文献   

3.
Right dorsal colitis in horses has been associated with administration of phenylbutazone. Although reports of right dorsal colitis in this species have described surgical treatment associated with a poor prognosis, we have had success treating this condition medically. This report describes 5 horses with right dorsal colitis confirmed during celiotomy that were initially managed medically. All horses had a history of intermittent abdominal pain; weight loss was noted in only 1 horse. The doses (2.0 to 4.6 mg/kg PO bid) and duration (5 to 30 days) of administration of phenylbutazone were not unusually high relative to those recommended (4.4 mg/kg PO bid). Hypoproteinemia and hypoalbuminemia were observed in all horses at the time of admission; packed cell volume was low in 4 horses, and hypocalcemia was also observed in 4 horses. Three of 5 horses (60%) appeared to respond to dietary management and discontinuation of administration of nonsteroidal anti-inflammatory drugs. Dietary management consisted of feeding pelleted feed, and restricting or eliminating roughage for a period of at least 3 months. Two horses developed strictures of the right dorsal colon. One horse that developed a colonic stricture, possibly because its owners did not comply with recommendations for management, was subsequently treated surgically. The remaining horse that developed a stricture of the right dorsal colon was euthanized. These data indicate that some horses with right dorsal colitis can be successfully managed with medical treatment.  相似文献   

4.
The physical, clinicopathologic, and survival rates of 77 cats with severe spontaneous hepatic lipidosis are detailed in this report. Cats were subdivided into groups designated as idiopathic lipidosis if no other disease process was recognized, or secondary lipidosis if another disease process was diagnosed. Cats were also subdivided into groups designated as survivors or nonsurvivors on the basis of successful recuperation at 4 months after initial diagnosis. Differences between disease and survival groups were evaluated for significance. Overall, more female cats and middle-aged cats were affected. Presenting complaints of vomiting, anorexia, weakness, and weight loss were common. Physical assessment of most cats showed obvious hepatomegaly, jaundice, dehydration, and a weight loss ≥ 25% of usual body weight. Neurobehavioral signs indicative of hepatic encephalopathy, other than ptyalism and depression, were rare. Clinicopathologic features are characterized by hyperbilirubinemia and increased activities of serum ALT, AST, and ALP, with only small if any increase in γGT activity. Clinical features distinguishing cats with hepatic lipidosis from those with other serious cholestatic disorders include absence of hyperglobulinemia and low γGT activity relative to ALP activity. Although coagulation tests were abnormal in 45% of cats tested (n = 44), few cats showed clinical bleeding tendencies. Most cats received prophylactic vitamin K1 therapy. Forty two cats received aggressive nutritional and supportive care and of these 55% survived. Cats with idiopathic disease were significantly younger, had significantly higher ALP activity and bilirubin concentration, and had a slightly better survival rate than cats with secondary lipidosis. Low PCV, hypokalemia, and an older age were significantly related to nonsurvival. Because of the variety of diets and food supplements used in case management, the influence of nutritional factors on survival could not be evaluated. (Journal of Veterinary Internal Medicine 1993; 7:349–359. Copyright © 1993 by the American College of Veterinary Internal Medicine.)  相似文献   

5.
The prevalence of feline thrombocytopenia (<200,000 platelets/L) at North Carolina State University, College of Veterinary Medicine Teaching Hospital, from January 1985 to March 1990, was 1.2% (41/3300). Cats were divided into six categories based on clinical diagnoses: 29% (12/41) had infectious disease, 20% (8/41) had neoplasia, 7% (3/41) had cardiac disease, 2% (1/41) had primary immune-mediated disease, 22% (9/41) had multiple diseases, and 20% (8/41) had disorders of unknown etiology. The mean platelet count for all thrombocytopenic cats was 52,000/μL ± 46,000/μL (1 SD) with a range of 1000–190,000/μL. No significant differences were found between groups with respect to platelet count, packed cell volume, or white blood cell count, though anemia and leukopenia were common among the cats as a whole. Bleeding disorders (hemorrhage or thrombosis) were observed in 29% (12/41) of thrombocytopenic cats and were more likely to be associated with neoplasia, cardiac disease, and platelet counts less than or equal to 30,000/μL. Disseminated intravascular coagulopathy was diagnosed in 12% (5/41) of the cats. Infections and/or neoplasia affecting the bone marrow were the most common diseases associated with thrombocytopenia. Feline leukemia virus and myeloproliferative neoplasia accounted for approximately 44% (18/41) of the specific diagnoses in thrombocytopenic cats. (Journal of Veterinary Internal Medicine 1993; 7:261–265. Copyright © 1993 by the American College of Veterinary Internal Medicine.)  相似文献   

6.
Background: Serum hypercalcemia in dogs has been reported in association with a variety of diseases. Serum-ionized calcium (iCa) concentration is a more accurate measure of hypercalcemia than total serum calcium or corrected serum calcium concentrations. The severity of hypercalcemia has been utilized to suggest the most likely differential diagnosis for the hypercalcemia.
Hypothesis: Diseases causing ionized hypercalcemia may be different than those that cause increases in total or corrected serum calcium concentrations. The severity of ionized hypercalcemia in specific diseases cannot be used to determine the most likely differential diagnosis for ionized hypercalcemia.
Animals: One-hundred and nine client-owned dogs with a definitive cause for their ionized hypercalcemia evaluated between 1998 and 2003 were included in this study.
Methods: Retrospective, medical records review.
Results: Neoplasia, specifically lymphosarcoma, followed by renal failure, hyperparathyroidism, and hypoadrenocorticism were the most common causes of ionized hypercalcemia. Dogs with lymphoma and anal sac adenocarcinoma have higher serum iCa concentrations than those with renal failure, hypoadrenocorticism, and other types of neoplasia. The magnitude of serum-ionized hypercalcemia did not predict specific disease states.
Conclusions and Clinical Importance: Serum-ionized hypercalcemia was most commonly associated with neoplasia, specifically lymphosarcoma. Although dogs with lymphosarcoma and anal sac adenocarcinoma had higher serum iCa concentrations than dogs with other diseases, the magnitude of the serum iCa concentration could not be used to predict the cause of hypercalcemia. Total serum calcium and corrected calcium concentrations did not accurately reflect the calcium status of the dogs in this study.  相似文献   

7.
Background: Little is known about etiology, disease progression, treatment outcome, survival time, and factors affecting prognosis in dogs with primary hepatitis (PH).
Objectives: To review retrospectively different forms of hepatitis in a referral population, by the World Small Animal Veterinary Association Standardization criteria.
Animals: One-hundred and one dogs examined for histologically confirmed PH between 2002 and 2006. Dogs with nonspecific reactive hepatitis were excluded.
Methods: Retrospective study. Medical records were reviewed for prevalence, signalment, clinical and clinicopathologic manifestation, outcome, survival time, and prognostic factors for shortened survival.
Results: PH occurred in 0.5% of dogs in this referral population. Acute (AH) and chronic hepatitis (CH) were diagnosed in 21 and 67 dogs, respectively. Progression from AH to CH occurred in 5/12 of the repeatedly sampled dogs. CH was idiopathic in 43 (64%) dogs, and was associated with copper accumulation in 24 (36%) dogs. Median survival time was longer in dogs with AH than in dogs with CH (either idiopathic or copper associated), and dogs with lobular dissecting hepatitis had the shortest survival time. Prognostic factors predicting shortened survival were associated with decompensated liver function and cirrhosis at initial examination.
Conclusions and Clinical Importance: The majority of PH in dogs is CH. Previous studies appear to have underestimated the etiologic role of copper in both AH and CH. Prognosis is reduced in dogs with hepatic cirrhosis or cirrhosis-related clinical findings. Further research into etiology and treatment effectiveness in all PH forms is needed.  相似文献   

8.
Background: Portal vein thrombosis (PVT) in cats is sparsely reported.
Purpose of Study: To evaluate the clinical signs and diseases associated with PVT in cats.
Animals: 6 client-owned cats.
Methods: Medical records for cats with a portal vein thrombus diagnosed on abdominal ultrasound or at necropsy were reviewed. Signalment, historical data, underlying disorders, clinical findings, clinicopathologic and histopathologic data, diagnostic imaging findings, treatment, and outcome were recorded.
Results: All 6 cats identified with PVT also had hepatic disease. Evidence of a congenital portosystemic shunt was present in 3/6 cats. Two cats had primary or metastatic hepatic neoplasia. One cat had acute cholangitis, acute pancreatitis, and locally extensive acute centrilobular hepatic necrosis. Two cats were suspected to have acute thrombi and 4 cats had chronic thrombi.
Conclusion and Clinical Significance: PVT might be an important concurrent finding in cats with hepatic disease.  相似文献   

9.
This report presents the clinical, laboratory, imaging, and pathologic findings in 61 dogs with pheochromocytoma by retrospective evaluation of medical records. Pheochromocytomas were diagnosed by histopathologic examination of tissue specimens in all dogs. Special stains (chromogranin A and synaptophysin) also were used to confirm the chromaffin cell origin of the tumors. Epidemiologic findings were in agreement with previous studies, indicating that pheochromocytomas affect middle-aged to older dogs with no apparent gender or breed predilection. The tumor was considered clinical in 21 dogs (34%), was responsible for abnormalities related to a space-occupying mass in 7 dogs (11%), and was an incidental finding in 35 dogs (57%). The hematologic and biochemical findings were nonspecific. Hypertension was detected in 10 of 23 (43%) dogs tested, but all hypertensive dogs had concurrent diseases that may have contributed to hypertension. Abdominal ultrasonography was the most commonly used imaging procedure, with a mass detected in the region of the adrenal glands in 20 of 40 (50%) dogs examined. In 4 of the 20 dogs (20%), invasion of the caudal vena cava was identified. Surgery was performed in 17 dogs (28%) with immediate death or euthanasia of 5 dogs. Survival after surgery ranged from 1 day to 3.25 years. Pheochromocytomas were locally invasive in 39% of affected dogs and produced metastases in 13% of the cases. Common sites for metastases included regional lymph nodes, liver, lung, kidney, spleen, and bone. A high frequency of concurrent neoplasia (54%), including endocrine neoplasia, was identified.  相似文献   

10.
One hundred and fifteen dogs with neoplasms of the lower urinary tract (bladder and/or urethra) were retrospectively evaluated at five referral institutions participating in ongoing studies by the Veterinary Cooperative Oncology Group. Most tumors were malignant (97%) and of epithelial origin (97%). Lower urinary tract tumors were more common in older dogs weighing greater than 10 kg. The following significant (P less than 0.05) statistical associations were found using the University of Guelph hospital population as control; there was no sex predisposition although the female:male ratio was 1.95:1. Neutered dogs were predisposed as were Airedale Terriers, Beagles, and Scottish Terriers, whereas German Shepherds were significantly under-represented among dogs with lower urinary tract tumors. These statistical associations should be interpreted cautiously because of possible demographic differences in hospital populations among the University of Guelph and other cooperating institutions. There were no significant correlations between age, gender, weight, breed, response to therapy, and survival time. Clinical signs were indicative of lower urinary tract disease and included hematuria, stranguria, and pollakiuria. The laboratory data were nonspecific except for urinalysis test results. Hematuria and inflammatory urinary sediments were most commonly reported; neoplastic cells were identified in the urine sediment of 30% of dogs with lower urinary tract tumors. Contrast cystography was a useful noninvasive diagnostic method since 96% of the dogs had a mass or filling defect in the lower urinary tract demonstrated by this technique.(ABSTRACT TRUNCATED AT 250 WORDS)  相似文献   

11.
Silica-containing urinary calculi obtained from 773 dogs and submitted by veterinarians throughout the United States were analyzed by quantitative crystallographic analysis to determine mineral composition. Specimens were composed of either multiple mineral layers (535 specimens) or 1 mineral layer (238 specimens). Most multiple-layer calculi were composed of 80% or greater silica (300 of 535, 56%) or 20% to 79% silica (184 of 535, 34%) in any mineral layer. Most 1–layer calculi were composed of 100% silica (212 of 238, 89%). Most dogs forming silica-containing calculi were of male gender (679 of 773, 88%). Bacterial cultures of calculus or urine or both were performed on 49% (376 of 773) of the specimens, and bacterial growth was obtained from 37% (139 of 376) of samples cultured. The prevalence of calculus-associated urinary tract infection was 35% (113 of 321) in males and 47% (26 of 55) in females. The gender prevalence for infection with Staphylococcus species was 16% (51 of 321) in males and 33% (18 of 55) in females. The breed and gender of dogs that formed calculi (silica population) were compared with the hospital population (Veterinary Medical Teaching Hospital [VMTH] population) and with a population of calculus-forming dogs (Stonelab population) to determine risk factors for silica calculus formation. For all breeds compared, the ratio of males to females was higher in the silica population. The German Shepherd Dog and Old English Sheepdog were significantly overrepresented when the silica population was compared with either the VMTH population or the Stonelab population. We conclude that male German Shepherd Dogs and Old English Sheepdogs are at increased risk for formation of silica-containing urinary calculi.  相似文献   

12.
Hemostasis profiles from 101 cats presented for medical or surgical evaluation to The Ohio State University Veterinary Teaching Hospital from 1986 through 1991 were reviewed retrospectively; 69% were abnormal. Commonly identified abnormalities included a mixed hemostatic defect compatible with disseminated intravascular coagulation, thrombocytopenia, isolated prolongation of the activated partial thromboplastin time (APTT), and prolongation of both the APTT and one-stage prothrombin time. The most common disorders associated with abnormal hemostasis profiles in this study were liver disease, neoplasia, and feline infectious peritonitis.  相似文献   

13.
Background: Diarrhea is common in foals but there are no studies investigating the relative prevalence of common infectious agents in a population of hospitalized diarrheic foals.
Objectives: To determine the frequency of detection of infectious agents in a population of hospitalized foals with diarrhea and to determine if detection of specific pathogens is associated with age, outcome, or clinicopathologic data.
Animals: Two hundred and thirty-three foals ≤ 10 months of age with diarrhea examined at a referral institution.
Methods: Retrospective case series. Each foal was examined for Salmonella spp., viruses, Clostridium difficile toxins, Clostridium perfringens culture, C. perfringens enterotoxin, Cryptosporidium spp., and metazoan parasites in feces collected at admission or at the onset of diarrhea.
Results: At least 1 infectious agent was detected in 122 foals (55%). Rotavirus was most frequently detected (20%) followed by C. perfringens (18%), Salmonella spp. (12%), and C. difficile (5%). Foals < 1 month of age were significantly more likely to be positive for C. perfringens (odds ratio [OR] = 15, 95% confidence interval [CI] = 3.5–66) or to have negative fecal diagnostic results (OR = 3.0, 95% CI = 1.7–5.2) than older foals. Foals > 1 month of age were significantly more likely to have Salmonella spp. (OR = 2.6, 95% CI = 1.2–6.0), rotavirus (OR = 13.3, 95% CI = 5.3–33), and parasites (OR = 23, 95% CI = 3.1–185) detected compared with younger foals. Overall 191 of the 223 foals (87%) survived. The type of infectious agent identified in the feces or bacteremia was not significantly associated with survival.
Conclusions and Clinical Importance: In the population studied, foals with diarrhea had a good prognosis regardless of which infectious agent was identified in the feces.  相似文献   

14.
Abstract— Forty-three cases of cutaneous melanocytic neoplasia in cats were reviewed. Twenty-eight of the 43 neoplasms were histologically benign and 15 were malignant. Behavior was independent of site except that tumors of the eyelid were malignant. Histologic findings of epidermal ulceration, cleanliness of tissue borders, degree of melanization, tumor cell type, and the presence or absence of theques did not differentiate benign from malignant tumors. Junctional activity indicated a high probability of benign behavior while malignant behavior was predicted by a high mitotic index and infiltration of the tumor by lymphoid cells. Résumé— Quarante trois cas de tumeurs mélaniques félines ont été revus. Vingt huit de ces 43 tumeurs étaient histologiquement bénignes et 15 malignes. Le comportement était indépendant de la localisation de la tumeur, à l'exception des tumeurs des paupières, toujours malignes. L'observation histologique d'ulcération épidermique, de propreté des bords des tissus, du degré de mélanisation, du type cellulaire et de la presence ou de l'absence de thèques ne différait pas qu'il s'agisse de tumeur bénigne ou maligne. L'activité jonctionnelle indiquait une forte probabilité de bénignité, alors qu'un comportement malin était prédit par un index mitotique élevé et une infiltration de la tumeur par des cellules lymphoïdes. Zusammenfassung— Es wird ein überlick über 43 Fälle von kutanen melanozytären Neoplasien bei Katzen gegeben. Achtundzwanzig der 43 Neoplasmen waren histologisch gutartig, 15 waren bösartig. Das Verhalten der Tumore war unabhängig von der Lokalisation, abgesehen von Tumoren der Augenlider, die stets maligne waren. Histologische Befunde wie epidermale Ulzeration, scharfe Begrenzung der Gewebsränder, Grad der Melanisierung, Tumorzelltyp und Vorhandensein oder Fehlen von Thequen unterschieden die benignen von den malignen Tumoren nicht. Verbindungsaktivität bedeutete eine hohe Wahrscheinlichkeit für gutartiges Verhalten, während bösartiges Verhalten durch einen hohen Mitoseindex und Infiltration des Tumors mit lymphoiden Zellen vorhersagbar war. Resumen En éste artículo se analizan cuarenta y tres casos de neoplasia melanocítica cutánea en gatos. Veintiocho de loa cuarenta y tres casos, resultaron cánceres benignos histológicamente y quince, malignos. El grado de malignidad no tenia relación con el sitio de procedencia con la excepción de que los tumores de párpados que resultaron malignos. Las características histológicas de las ulceraciones epidérmicas, limpieza de tejidos circundantes, grado de melanización, tipo de célula tumoral, y presencia o ausencia de the zeques, no sirvió para la diferenciación entre maligno y benigno. La actividad de la zona delimitante fué un indicador de alta probabilidad de benignidad, mientras que la el tipo maligno se predijo por un índice mitótico alto e infiltración del tumor por celulas de tipo linfoide.  相似文献   

15.
The medical records of 57 horses that had palmar digital neurectomy performed between 1984 and 1990 were reviewed. Neurectomies were performed either by transection and elec-trocoagulation (47 horses) or by the guillotine technique (10 horses). Middle-aged geldings, Quarter Horses, and Thoroughbreds were significantly over-represented when compared with the hospital population. Horses used as hunter/jumpers also appeared to be over-represented. Complications occurred in 17 (34%) of the 50 horses for which follow-up information was obtained. Recurrence of heel pain was the most common complication (14 horses). Palpable painful neuromas were detected in three horses. One year after neurectomy, 74% of the horses were sound; this decreased to 63% after 2 years.  相似文献   

16.
Objective: Determine the efficacy and safety of a linear-accelerator-based single fraction radiosurgical approach to the treatment of pituitary tumors in cats.
Design: Retrospective study.
Animals: Eleven client-owned cats referred for treatment of pituitary tumors causing neurological signs, or poorly controlled diabetes mellitus (DM) secondary either to acromegaly or pituitary-dependent hyperadrenocortism.
Procedures: Cats underwent magnetic resonance imaging (MRI) of the brain to manually plan radiation therapy. After MRI, modified radiosurgery was performed by delivering a single large dose (15 or 20 Gy) of radiation while arcing a linear-accelerator-generated radiation beam around the cat's head with the pituitary mass at the center of the beam. Eight cats were treated once, 2 cats were treated twice, and 1 cat received 3 treatments. Treated cats were evaluated for improvement in endocrine function or resolution of neurological disease by review of medical records or contact with referring veterinarians and owners.
Results: Improvement in clinical signs occurred in 7/11 (63.6%) of treated cats. Five of 9 cats with poorly regulated DM had improved insulin responses, and 2/2 cats with neurological signs had clinical improvement. There were no confirmed acute or late adverse radiation effects. The overall median survival was 25 months (range, 1–60), and 3 cats were still alive.
Conclusions and Clinical Importance: Single fraction modified radiosurgery is a safe and effective approach to the treatment of pituitary tumors in cats.  相似文献   

17.
A retrospective study of pathologically confirmed cases of feline spinal lymphosarcoma (FSL) admitted to the Colleges of Veterinary Medicine at the University of Georgia and North Carolina State University from 1973 to 1988 was conducted. Two hundred fourteen cases of feline lymphosarcoma were diagnosed histopathologically; involvement of the central nervous system (CNS) was identified in 26 (12.1%). Twenty-three of these tumors involved the spinal cord, and 22 of the 23 were solitary. A predilection for the thoracic and lumbar vertebral canal was noted. Most cats with spinal disease were young, with mean and median ages of 43 and 24 months, respectively; 67 cats were 36 months of age or younger. In most cases, affected cats had acute neurological deterioration after an initial insidious course. Extraneural abnormalities were not consistently present. Neoplastic lymphocytes diagnostic of FSL were identified on cerebrospinal fluid (CSF) analysis in 6 of 17 cats evaluated. Sixteen of 17 cats evaluated had serologically positive test results for feline leukemia virus (FeLV) p27 antigen, and all cats tested for feline immunodeficiency virus (FIV) antibodies had negative test results.  相似文献   

18.
Cavernous sinus syndrome (CSS) is characterized by deficits in more than one of the cranial nerves (CN) that traverse the cavernous sinus at the base of the cranial vault: CN III (oculomotor), IV (trochlear), VI (abducens), and the first two branches of CN V (trigeminal). Records from 4 dogs and 8 cats with CSS diagnosed over a 14-year period were reviewed. The most common clinical signs were ophthalmoparesis or ophthalmoplegia, mydriasis with no direct or consensual pupillary light reflexes, ptosis, decreased corneal sensation, and decreased retractor oculi reflex. All cats had initial signs referable to a left CSS lesion (one had bilateral CSS), whereas in all dogs the lesions were localized to the right cavernous sinus. Median ages at diagnosis were 9 and 10 years of age for dogs and cats, respectively. Cerebel lomedullary cisternae cerebrospinal fluid analysis in 6 animals was useful as a sensitivebut nonspecific diagnostic test of an intracranial inflammatory or neoplastic lesion. Magnetic resonance imaging scans provided a more definitive diagnostic test in all dogs, revealing a contrast-enhancing mass on T1 weighted scans in the region of the cavernous sinus. A definitive pathological diagnosis was obtained in 2 dogs: a primary intracranial neoplasm and a metastatic intracranial neoplasm. A definitive diagnosis was obtained in 6 cats: metastatic neoplasm (n =1), primary intracranial neoplasm (n = I), primary intracranial infectious disease (n = 2). and associated systemic infectious disease (n = 2). The prognosis associated with CSS in dogs and cats was considered guarded to poor. J Vet Intern Med 1996;10:65–71. Copyright © 1996 by the American College of Veterinary Internal Medicine .  相似文献   

19.
20.
Case histories of 130 dogs and cats with humeral fractures were reviewed. The different types of fractures were classified. Most animals with proximal, shaft, and supracondylar fractures had excellent results. The poor prognosis associated with distal articular fractures was due most often to failure of the fixation device in the supracondylar area; best results were achieved with a plate on the caudal and medial surface of the distal humerus.  相似文献   

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