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1.
Anat Histol Embryol ; 53(1): e12996, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38018271

RESUMO

This study aimed to describe sonographic features of the liver, gallbladder and hepatic histogram from grey-scale ultrasound in three species of healthy non-venomous snakes. Twenty-eight adult snakes were enrolled in the study, including 10 common boas (Boa constrictor), eight black-tailed pythons (Python molurus) and 10 rainbow boas (Epicrates crassus). The snakes fasted for 30 days and were manually restrained while conscious. For B. constrictor and P. molurus the liver and gallbladder were best visualized in ventral recumbency, and E. crassus in dorsal recumbency. A single elongated hepatic lobe was identified in all snakes. The gallbladder was positioned caudal and separated from the liver, with an oval shape and homogeneous anechoic content in the lumen, and thin and regular walls. A region of interest by pixel number was chosen for the liver, fat bodies, left kidney, and splenopancreas. The mean grey level (G) of the organs had significant differences within each species. Standard deviation of grey levels (SG ) had significant differences within B. constrictor and E. crassus. P. molurus had no significant difference among organs. The comparison among snakes showed that E. crassus had G of liver and splenopancreas lower than B. constrictor and P. molurus. The SG of the liver in E. crassus was lowest compared to B. constrictor and P. molurus. P. molurus showed the highest values in mean of G and SG . In conclusion, despite the liver and gallbladder having similar sonographic features, the grey-level histogram showed that liver echotexture and echogenicity differ among species.


Assuntos
Boidae , Vesícula Biliar , Animais , Vesícula Biliar/diagnóstico por imagem , Fígado/diagnóstico por imagem , Rim , Serpentes
2.
PeerJ ; 11: e14777, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36987457

RESUMO

Background: Ligamentum teres (LT) has traditionally been considered a vestigial or redundant structure in humans; however, based on new studies and the evolution of hip arthroscopy, the LT injury has been viewed as a source of hip pain. Therefore, LT reconstruction can be beneficial in some cases. Rabbits have been frequently used as a model for cranial cruciate ligament reconstruction but few studies are available for ligamentum teres reconstruction. Objective: To evaluate the semitendinosus tendon to replace ligamentum teres with the toggle technique, using rabbits as an experimental model. Methods: Twenty-six female Norfolk rabbits with approximately 3 months of age were divided into two equal groups after excision of ligamentum teres (LT) from the right hip joint: G1-no reconstruction of LT and capsulorrhaphy; G2-double-bundle reconstruction of the LT using semitendinosus tendon autograft. In both groups, the LT was removed from the right hip joint. In G2 the autograft was harvested from the left hind limb of the same rabbit. The rabbits were evaluated clinically at different time intervals; before surgery (M1), 48 h (M2), 15 days (M3), 30 days (M4) and 90 days (M5) after surgery. Results: The rabbits supported their limbs on the ground in both the groups. As complications of the procedure, four hip joints showed subluxations in the radiographic evaluation of G1; three at M4 and one at M5. In G2; two luxations of hip joints at M3 and one subluxation at M4 were seen. On ultrasound, irregular articular surface was seen in 30.8% of the rabbits that had subluxation of hip joints. Gross evaluation identified tendon graft integrity in 76.92% of the rabbits. Histological analysis revealed graft adhesion to the bone in the early phase comprised of sharpey-like collagen fibers. Conclusion: The double-bundle reconstruction of the LT using autologous semitendinosus tendon associated with the toggle rod shows an early phase of tendon graft ligamentization at 90 days post-operatively in young rabbits, but biomechanical bias suffered by the tendon during gait must be considered.


Assuntos
Tendões dos Músculos Isquiotibiais , Luxações Articulares , Ligamentos Redondos , Humanos , Animais , Coelhos , Feminino , Ligamento Cruzado Anterior/cirurgia , Articulação do Quadril/diagnóstico por imagem , Artroscopia/métodos
3.
Acta Cir Bras ; 37(4): e370405, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35766671

RESUMO

PURPOSE: To evaluate in-vivo degradation of two bioabsorbable interference screws. METHODS: Twenty-two crossbred Santa Inês ewes were used. A poly-DL-lactide (PDLLA) screw (70%/30%) was inserted in the right pelvic limb, and a PDLLA screw (70%) + ß-tri-calcium phosphate (ß-TCP) (30%) in the left pelvic limb. Animals were euthanized at one, four, seven and a half and 18 months after surgery. Plain radiography, computed tomography (CT), microCT, and histological analysis were accomplished. RESULTS: PDLLA screw was hypodense at all evaluation moments, but with progressive density increase along the central axis, whereas PDLLA/ß-TCP was initially hyperdense and progressively lost this characteristic. No adverse reactions were observed on histological evaluation. CONCLUSIONS: The inclusion of ß-TCP favors screw degradation since the PDLLA/ß-TCP screws evidenced a more intense degradation process than the PDLLA screws at the last evaluation. PDLLA screws showed higher bone production, evident around the screw thread, inside the lateral perforations, and in the central canal, whereas the PDLLA/ß-TCP screws presented less bone tissue at the implantation site.


Assuntos
Implantes Absorvíveis , Parafusos Ósseos , Animais , Feminino , Poliésteres , Ovinos , Tomografia Computadorizada por Raios X
4.
Anat Histol Embryol ; 51(1): 112-118, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34854110

RESUMO

This study aimed to perform quantitative and qualitative evaluations of the lateral and third ventricles, and brain parenchyma, in healthy dogs of different skull conformations on CT scans. Forty-five adult client-owned dogs were divided into three groups according to skull conformation: G1 (dolichocephalic)-15 German Shepherds; G2 (mesaticephalic)-15 Rottweilers; G3 (brachycephalic)-15 Boxers. Transverse plane images were used for quantitative and qualitative evaluations of the lateral ventricles and third ventricle, and pre- and post-contrast brain parenchyma. The height of both ventricles and brain was measured at the level of the interthalamic adhesion. Ventricle height, brain height, and ventricle/brain height ratio were statistically higher in G3 compared with G1 and G2 that were similar. The third ventricle was visible but unmeasurable in five dogs from G1 and three from G2. In G3, all dogs had third ventricle visible and measurable in all images. Asymmetric ventricles were seen in five dogs in Group 1 and Group 2, and seven in Group 3. Brain parenchyma had homogenous density in 80% of the dogs in all groups. Contrast enhancement of the rostral midline was visualized in all dogs. In conclusion, brain CT scans of healthy dogs showed that the qualitative data were similar among groups, but lateral ventricle and brain measurements in brachycephalic dogs differed from the dolichocephalic and mesaticephalic dogs.


Assuntos
Encéfalo , Crânio , Animais , Encéfalo/diagnóstico por imagem , Cães , Cabeça , Ventrículos Laterais/diagnóstico por imagem , Crânio/diagnóstico por imagem , Tomografia Computadorizada por Raios X/veterinária
5.
Acta Cir Bras ; 36(12): e361201, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34932655

RESUMO

PURPOSE: To evaluate the effects of the intra-articular application of hyaluronic acid associated with triamcinolone acetonide, and ozone gas in the treatment of induced osteoarthritis in rabbit's stifles. METHODS: Twenty-one Norfolk rabbits were submitted to cranial cruciate ligament transection of the left stifle. After six weeks of the surgery, the rabbits were randomized assigned into three groups: G1 (control) - saline solution (0.9%); G2 - hyaluronic acid associated with triamcinolone; G3 - ozone gas, submitted to three intra-articular applications every seven days. RESULTS: Significant differences occurred: osteophytes at medial femoral condyle (G2 > G1, G2 > G3) on radiography exam; thickening of the medial condyle (G1 > G3, G2 > G3) on ultrasound exam; osteophytes at lateral tibial condyle (G2 > G1, G2 > G3), and medial femoral condyle (G1 > G2, G3 > G1) on computed tomography. Histologically, mean values of chondrocytes in the femur and tibia in G3 and G2 were statistically lower. CONCLUSIONS: The intra-articular injection of hyaluronic acid associated with triamcinolone accentuated degenerative joint disease by imaging and macroscopic evaluations, and by histological findings, this treatment and the ozone gas treatment showed similar effects and were inferior to the saline solution (0.9%).


Assuntos
Osteoartrite , Ozônio , Animais , Ligamento Cruzado Anterior , Ácido Hialurônico/uso terapêutico , Injeções Intra-Articulares , Osteoartrite/induzido quimicamente , Osteoartrite/tratamento farmacológico , Ozônio/uso terapêutico , Coelhos , Triancinolona Acetonida/uso terapêutico
6.
Acta cir. bras ; 36(12): e361201, 2021. ilus
Artigo em Inglês | LILACS, VETINDEX | ID: biblio-1456246

RESUMO

Purpose: To evaluate the effects of the intra-articular application of hyaluronic acid associated with triamcinolone acetonide, and ozone gas in the treatment of induced osteoarthritis in rabbit’s stifles.Methods: Twenty-one Norfolk rabbits were submitted to cranial cruciate ligament transection of the left stifle. After six weeks of the surgery, the rabbits were randomized assigned into three groups: G1 (control) – saline solution (0.9%); G2 – hyaluronic acid associated with triamcinolone; G3 – ozone gas, submitted to three intra-articular applications every seven days. Results: Significant differences occurred: osteophytes at medial femoral condyle (G2 > G1, G2 > G3) on radiography exam; thickening of the medial condyle (G1 > G3, G2 > G3) on ultrasound exam; osteophytes at lateral tibial condyle (G2 > G1, G2 > G3), and medial femoral condyle (G1 > G2, G3 > G1) on computed tomography. Histologically, mean values of chondrocytes in the femur and tibia in G3 and G2 were statistically lower. Conclusions: The intra-articular injection of hyaluronic acid associated with triamcinolone accentuated degenerative joint disease by imaging and macroscopic evaluations, and by histological findings, this treatment and the ozone gas treatment showed similar effects and were inferior to the saline solution (0.9%).


Assuntos
Animais , Coelhos , Osteoartrite do Joelho/tratamento farmacológico , Ozônio , Triancinolona Acetonida/uso terapêutico , Ácido Hialurônico/análise , Ácido Hialurônico/uso terapêutico , Polissacarídeos
7.
Anat Histol Embryol ; 49(4): 541-549, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32266741

RESUMO

This study aimed to evaluate normal features of the heart and lower respiratory tract in toco toucans by means of radiography and helical computed tomography (CT) scanner. Fifteen healthy adult toco toucans (Ramphastos toco), 10 females and 5 males, average body mass of 650 g were studied. CT examination as well as right lateral and ventrodorsal radiographic examinations of the coelomic cavity were performed under chemical restraint. Heart, lungs, air sacs, trachea and syrinx were analysed. The mean values of heart length, heart width and thoracic cavity in radiographs were, respectively, 23.76 mm, 25.94 mm and 48.87 mm. In both X-rays and CT scans, the lung parenchyma had honeycomb-like pattern. The topographic areas of the anterior and posterior air sacs were visualized as dark and air-filled spaces in X-rays. On CT evaluation, the air sacs occupied a larger area in the coelomic cavity compared to X-ray. In the lateral radiographic view, the cervical part of the trachea was positioned more ventrally in the transition from cervical to thoracic regions showing a V-shaped appearance. In all CT planes was visible division of the trachea into the right and left main bronchi at the level of 3rd thoracic vertebra. The syrinx was difficult to visualize in X-rays, but on CT it was easily identified in axial slice. In conclusion, the normal features of toco toucan's heart and lower respiratory tract that were determined on X-rays and CT scans are useful to compare with sick toco toucans, as well as other bird species.


Assuntos
Aves/anatomia & histologia , Coração/diagnóstico por imagem , Sistema Respiratório/diagnóstico por imagem , Cavidade Torácica/diagnóstico por imagem , Sacos Aéreos/diagnóstico por imagem , Animais , Feminino , Fígado/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Masculino , Radiografia/veterinária , Tomografia Computadorizada Espiral/veterinária , Traqueia/diagnóstico por imagem
8.
J Avian Med Surg ; 34(1): 26-31, 2020 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-32237679

RESUMO

The objective of this investigation was to determine radiographic measurements, without chemical restraint, of the cardiac silhouette in 34 healthy, adult blue-fronted Amazon parrots (Amazona aestiva) of unknown sex with a mean body weight of 393 g. The birds were fasted 3 hours before the radiographic examinations. Three thoracic radiographic views (ventrodorsal, right lateral, and left lateral) were obtained from each bird for assessment. There was no significant statistical difference between right and left radiographic measurements. The mean values of the measurements in the ventrodorsal views were heart width of 21.04 mm and coelomic cavity width of 50.61 mm. The mean values of the measurements in the lateral views were left heart length of 23.44 mm, right heart length of 23.40 mm, left sternal length of 65.69 mm, and right sternal length of 65.03 mm. A strong correlation and ratio of 43% between the heart width and coelomic cavity width and a moderate correlation and ratio of 36% between the heart length and sternal length were observed. In conclusion, the radiographic measurements of the cardiac silhouette in healthy blue-fronted Amazon parrots can be obtained without chemical restraint. The values obtained can be used to assist in the detection of cardiomegaly or microcardia in blue-fronted Amazon parrots.


Assuntos
Amazona/anatomia & histologia , Coração/anatomia & histologia , Animais , Coração/diagnóstico por imagem , Radiografia/veterinária , Valores de Referência
9.
Artigo em Inglês | MEDLINE | ID: mdl-31723344

RESUMO

BACKGROUND: Bone tissue repair remains a challenge in tissue engineering. Currently, new materials are being applied and often integrated with live cells and biological scaffolds. The fibrin biopolymer (FBP) proposed in this study has hemostatic, sealant, adhesive, scaffolding and drug-delivery properties. The regenerative potential of an association of FBP, biphasic calcium phosphate (BCP) and mesenchymal stem cells (MSCs) was evaluated in defects of rat femurs. METHODS: Adult male Wistar rats were submitted to a 5-mm defect in the femur. This was filled with the following materials and/or associations: BPC; FBP and BCP; FBP and MSCs; and BCP, FBP and MSCs. Bone defect without filling was defined as the control group. Thirty and sixty days after the procedure, animals were euthanatized and subjected to computed tomography, scanning electron microscopy and qualitative and quantitative histological analysis. RESULTS: It was shown that FBP is a suitable scaffold for bone defects due to the formation of a stable clot that facilitates the handling and optimizes the surgical procedures, allowing also cell adhesion and proliferation. The association between the materials was biocompatible. Progressive deposition of bone matrix was higher in the group treated with FBP and MSCs. Differentiation of mesenchymal stem cells into osteogenic lineage was not necessary to stimulate bone formation. CONCLUSIONS: FBP proved to be an excellent scaffold candidate for bone repair therapies due to application ease and biocompatibility with synthetic calcium-based materials. The satisfactory results obtained by the association of FBP with MSCs may provide a more effective and less costly new approach for bone tissue engineering.

10.
J. venom. anim. toxins incl. trop. dis ; 25: e20190027, 2019. tab, graf, ilus
Artigo em Inglês | LILACS, VETINDEX | ID: biblio-1040382

RESUMO

Bone tissue repair remains a challenge in tissue engineering. Currently, new materials are being applied and often integrated with live cells and biological scaffolds. The fibrin biopolymer (FBP) proposed in this study has hemostatic, sealant, adhesive, scaffolding and drug-delivery properties. The regenerative potential of an association of FBP, biphasic calcium phosphate (BCP) and mesenchymal stem cells (MSCs) was evaluated in defects of rat femurs. Methods: Adult male Wistar rats were submitted to a 5-mm defect in the femur. This was filled with the following materials and/or associations: BPC; FBP and BCP; FBP and MSCs; and BCP, FBP and MSCs. Bone defect without filling was defined as the control group. Thirty and sixty days after the procedure, animals were euthanatized and subjected to computed tomography, scanning electron microscopy and qualitative and quantitative histological analysis. Results: It was shown that FBP is a suitable scaffold for bone defects due to the formation of a stable clot that facilitates the handling and optimizes the surgical procedures, allowing also cell adhesion and proliferation. The association between the materials was biocompatible. Progressive deposition of bone matrix was higher in the group treated with FBP and MSCs. Differentiation of mesenchymal stem cells into osteogenic lineage was not necessary to stimulate bone formation. Conclusions: FBP proved to be an excellent scaffold candidate for bone repair therapies due to application ease and biocompatibility with synthetic calcium-based materials. The satisfactory results obtained by the association of FBP with MSCs may provide a more effective and less costly new approach for bone tissue engineering.(AU)


Assuntos
Animais , Ratos , Biopolímeros , Matriz Óssea , Fibrina , Células-Tronco Mesenquimais , Produtos Biológicos
11.
Am J Vet Res ; 77(9): 976-82, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27580109

RESUMO

OBJECTIVE To characterize a population of Brazilian minipigs with naturally occurring syndactyly by use of plain radiographs and CT images and to evaluate kinetic and temporospatial variables by use of a pressure-sensing walkway. ANIMALS 10 Brazilian minipigs from 6 to 8 months of age (group 1, 5 healthy pigs [body weight, 10.5 to 18.5 kg]; group 2, 5 pigs with syndactyly [body weight, 7.5 to 18.0 kg]). PROCEDURES Forelimbs and hind limbs of all pigs were assessed by use of radiography and CT. Gait was analyzed by use of a pressure-sensing walkway. RESULTS All limbs of all pigs of group 2 had syndactyly. Two forelimbs had complex-1 syndactyly, and 8 forelimbs had complex-2 syndactyly. Four hind limbs had simple syndactyly, 1 hind limb had complex-1 syndactyly, and 5 hind limbs had complex-2 syndactyly. Kinetic and temporospatial values and symmetry indices did not differ between groups. Plantar and palmar surfaces of healthy pigs had 2 areas of maximum pressure, whereas plantar and palmar surfaces of pigs with syndactyly had only 1 area of maximum pressure. CONCLUSIONS AND CLINICAL RELEVANCE In this population of pigs, the most common type of syndactyly was complex-2, and comparison with the healthy group revealed no alteration in kinetic and temporospatial variables. Therefore, results suggested that syndactyly in young minipigs did not cause locomotor disturbances.


Assuntos
Marcha , Doenças dos Suínos/diagnóstico por imagem , Porco Miniatura , Sindactilia/veterinária , Animais , Peso Corporal , Extremidades , , Cinética , Radiografia , Suínos , Doenças dos Suínos/fisiopatologia , Sindactilia/diagnóstico por imagem , Sindactilia/fisiopatologia , Tomografia Computadorizada por Raios X , Caminhada
12.
Acta Vet Scand ; 57: 68, 2015 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-26438541

RESUMO

BACKGROUND: This study aimed to evaluate dogs with pelvic fractures and treated conservatively during locomotion on a pressure-sensing walkway. The hypothesis was that dogs may present changes in kinetic and temporospatial parameters because of the fractures, which may interfere with the symmetry index. Thirty dogs were selected and divided into two groups: Group 1-healthy group (n = 15) and Group 2-conservatively treated group (n = 15). The dogs were of similar body size. The body weight distribution percentages and symmetry indices of the peak vertical force, vertical impulse, stance time, swing time, percentage of stance time, and percentage of swing time of the hind limbs were evaluated. RESULTS: In Group 2, the time interval between fracture occurrence and patient evaluation was between 4 and 87 months (mean of 20 months). Four dogs had lower percentage of body weight distribution on one of the hind limbs while three dogs had greater weight distributed toward both hind limbs. Four of these dogs had alterations in the temporospatial and/or kinetic symmetry indices. CONCLUSIONS: Dogs with pelvic fractures treated conservatively may present changes in percentage of body weight distribution and symmetry indices of the kinetic and temporospatial parameters. The conservative treatment can cause persistent abnormal gait.


Assuntos
Doenças do Cão/terapia , Fraturas Ósseas/veterinária , Marcha , Locomoção , Pelve/lesões , Animais , Fenômenos Biomecânicos , Cães , Feminino , Fraturas Ósseas/terapia , Membro Posterior/fisiologia , Masculino
13.
BMC Vet Res ; 9: 195, 2013 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-24094043

RESUMO

BACKGROUND: Doppler ultrasound (DUS) examination provides quantitative and qualitative information concerning the blood flow in veins and arteries, enabling their morphological evaluation and the collection of hemodynamic data. Dogs and cats as well as humans may display neurological signs of brain hypoperfusion secondary to common carotid alterations. Hence, DUS examination might aid in the differential diagnosis of neurological disorders of ischemic origin, among other causes. The objective of this study was to register normal values for systolic peak velocity, minimum diastolic velocity, diameter and resistance index of both common carotid arteries of 12 healthy Labrador retriever dogs between 2 and 5 years of age. By gathering these values, we might be able to improve the sensitivity of hemodynamic studies in clinically important brain disorders. RESULTS: There were no statistical differences between the values for the right and left vessels: the systolic peak velocity was 75.8 ± 16 cm/s, minimum diastolic velocity was 12.2 ± 4 cm/s, common carotid diameter was 0.545 ± 0.063 cm, and resistance index was 0.83 ± 0.07. CONCLUSIONS: The results of this study might be used to establish normal parameters for Labrador retriever dogs and thus help in the diagnosis of neurological disorders associated with alterations of the carotid arteries. Similar studies must be performed to evaluate the same parameters in other dog breeds of different sizes and skull conformations.


Assuntos
Velocidade do Fluxo Sanguíneo/veterinária , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/fisiologia , Animais , Velocidade do Fluxo Sanguíneo/fisiologia , Cães , Feminino , Masculino , Ultrassonografia
14.
Ciênc. rural ; 41(7): 1252-1254, jul. 2011. ilus, tab
Artigo em Português | LILACS | ID: lil-595914

RESUMO

A ausência completa do bulbo ocular é muito rara em cães e gatos, enquanto a hidrocefalia é comumente observada como distúrbio congênito em cães de raças miniatura ou braquicefálicas, com menos de um ano de idade. O presente trabalho relata a ocorrência de anoftalmia clínica bilateral associada à hidrocefalia congênita em um cão da raça poodle, sendo este o primeiro relato de caso da associação dessas alterações no Brasil.


The complete absence of the eyeball is rare in dogs and cats, and hydrocephalus is commonly seen as a congenital disorder in toy or brachycephalic dogs before one year old. This paper describes for the first time in Brazil the occurrence of bilateral clinical anophthalmia associated to congenital hydrocephalus in a dog.

15.
Acta Vet Scand ; 52: 20, 2010 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-20214816

RESUMO

BACKGROUND: Accurate early diagnosis of lung metastases is important for establishing therapeutic measures. Therefore, the present study aimed to compare survey thoracic radiographs and computerized tomography (CT) scans to specifically identify lung metastases in female dogs with mammary tumors. METHODS: Twenty-one female dogs, weighing 3 to 34 kg and aged from 5 years to 14 years and 10 months, with mammary tumors were studied. In all dogs before the imaging examinations, fine-needle aspiration cytology of the mammary tumors was performed to confirm the diagnosis. Three-view thoracic radiographs were accomplished: right lateral, left lateral and ventrodorsal views. Sequential transverse images of the thorax were acquired on a spiral Scanner, before and after intravenous bolus injection of nonionic iodine contrast. Soft-tissue and lung windows were applied. All the mammary tumors were surgically removed and examined histologically. RESULTS: The correlation between the cytological and histological results regarding presence of malignancy was observed in only 17 cases. In radiographic examinations, no dog displayed signs of lung metastases or thorax chest lesions. CT detected lung metastasis in two cases, while small areas of lung atelectasis located peripherally were found in 28.57% of the dogs. CONCLUSION: In this study population, spiral CT showed higher sensitivity than chest radiographies to detect lung metastasis; this indicates that CT should be performed on all female dogs with malignant mammary tumors.


Assuntos
Doenças do Cão/diagnóstico por imagem , Neoplasias Pulmonares/veterinária , Neoplasias Mamárias Animais/diagnóstico por imagem , Tomografia Computadorizada por Raios X/veterinária , Animais , Cães , Feminino , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/secundário
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