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1.
Int J Surg Case Rep ; 29: 44-46, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27815991

RESUMO

BACK GROUND: Metastatic deposits in spleen are rare owing to its physiological functions and sharp angle of splenic artery with coelic axis. CASE REPORT: We report a case of a 53year old male with clear cell carcinoma of left kidney. Isolated splenic metastasis was detected on a follow up PET CT scan 2 months post radical nephrectomy. Splenectomy was performed; histopathology confirmed multiple metastatic lesions within the spleen CONCLUSION: Timely treatment of isolated metastasis in case of renal cell carcinoma carries good prognosis.

2.
Int J Surg Case Rep ; 7C: 64-5, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25590647

RESUMO

Abdominal cocoon or sclerosing peritonitis refers to a rare cause of intestinal obstruction due to formation of a membrane encasing the bowel. We report a case of abdominal cocoon post blunt trauma abdomen. The patient presented with a history of subacute intestinal obstruction and a mobile abdomen lump. Abdominal cocoon was diagnosed on computed tomography. He underwent adhesiolysis with excision of membrane.

3.
Am J Case Rep ; 13: 14-6, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23569475

RESUMO

BACKGROUND: Central venous access devices for chemotherapy are being used extensively in patients with cancer. Spontaneous fracture and migration of the catheter is uncommon. We present the uncommon occurrence of a fracture and spontaneous migration of the fragment into the internal jugular vein as a delayed complication of a central venous access catheter implanted for chemotherapy administration. CASE REPORT: A patient with Ewing's sarcoma of the humerus with metastasis in the lungs underwent placement of a totally implantable venous access device. The port was in place for 1 year. The patient presented with pain in the right side of the neck. A chest X-ray demonstrated complete transection of the catheter and migration of the catheter fragment in the internal jugular vein. Both the migrated catheter fragment and the proximal part of the catheter were retrieved surgically. He had an uneventful recovery. CONCLUSIONS: Catheter fracture remains a potential complication, which must be recognized and treated promptly. Periodic chest imaging is recommended for detection and timely removal of the catheter.

4.
Am J Case Rep ; 13: 47-50, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23569486

RESUMO

BACKGROUND: Biliary tract involvement in acute necrotizing pancreatitis is rare. CASE REPORT: We report a case of a 53-year-old man who had a pancreatic choledochal fistula complicating acute necrotizing pancreatitis. The fistula was suspected at computed tomography and confirmed at surgery. The patient underwent necrosectomy, cholecystectomy and proximal biliary diversion. He is well at 1-year follow-up. CONCLUSIONS: Simultaneous presence of air in the biliary tree and pancreatic collection is highly suggestive of a pancreaticobiliary fistula. Pancreatic necrosectomy and proximal biliary diversion resulted in closure of the fistula.

5.
Int J Surg ; 9(4): 297-301, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21262396

RESUMO

BACKGROUND: Adult intussusception is infrequently encountered in Asians. The diagnosis is often late because of the variable presentation. The optimal treatment is not universally agreed upon. PURPOSE: To determine the causes and management of this uncommon entity in India. METHODS: A retrospective review of patients with postoperative diagnosis of intussusception between March 2003 and March 2008 was conducted in a tertiary care centre in North India. Data relating to diagnosis, treatment and histopathology was analyzed. RESULTS: Twenty-seven patients, aged 15-72 years with 28 intussusceptions were studied. Four patients (14.29%) had acute presentation, 16 (57.14%) subacute and 7 (25%) had chronic symptoms. The most common type of intussusception was enteroenteric. A diagnosis of intussusception on contrast enhanced computed tomogram was made in 84% and a lead point was identified in 89%. A causative factor could be identified in 89% (25 out of 28 intussusceptions) which was malignant in 37% and benign in 48%. The most common underlying malignant lesions were adenocarcinoma (50%), and lymphoma (25%). Among benign lesions, small bowel polyps were the most common (57%). All cases underwent surgical intervention. Bowel resection was performed in 89%. There was no mortality. CONCLUSION: Our series highlights a high frequency of a demonstrable cause of intussusception in a tropical country. Overall our results are similar to those reported from other countries. Resection of the involved bowel is recommended because of high incidence of underlying pathology.


Assuntos
Doenças do Colo , Duodenopatias , Intussuscepção , Adolescente , Adulto , Idoso , Doenças do Colo/diagnóstico , Doenças do Colo/etiologia , Doenças do Colo/mortalidade , Doenças do Colo/cirurgia , Duodenopatias/diagnóstico , Duodenopatias/etiologia , Duodenopatias/mortalidade , Duodenopatias/cirurgia , Feminino , Humanos , Índia , Neoplasias Intestinais/complicações , Intussuscepção/diagnóstico , Intussuscepção/etiologia , Intussuscepção/mortalidade , Intussuscepção/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
6.
Clin J Gastroenterol ; 4(6): 387-90, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26189741

RESUMO

BACKGROUND: Spontaneous intramural intestinal hematoma in patients on oral anticoagulation therapy is rare. MATERIALS AND METHODS: Case report. RESULTS: We report a spontaneous intramural jejunal hematoma presenting with small bowel obstruction in a patient who was on oral anticoagulation therapy with acitrom following aortic valve replacement. Contrast-enhanced computed tomography of the abdomen showed findings of intramural hematoma. The patient was successfully managed conservatively. CONCLUSION: Abdominal pain and abnormal coagulation profile in patients on oral anticoagulants should alert the clinician to consider intramural hematoma. Early diagnosis is essential, as patients are successfully managed conservatively with good outcome.

7.
JOP ; 11(6): 553-9, 2010 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-21068486

RESUMO

CONTEXT: Non-operative strategies are gaining preference in the management of patients with severe acute pancreatitis. OBJECTIVE: The present study was undertaken to evaluate the efficacy of a non-operative approach, including percutaneous drainage, in the management of severe acute pancreatitis. DESIGN: Prospective study. SETTING: Tertiary care centre in India. PATIENTS: Fifty consecutive patients with severe acute pancreatitis were managed in an intensive care unit. INTERVENTIONS: The patients were initially managed conservatively. Those with 5 cm, or more, of fluid collection having fever, leukocytosis or organ failure underwent percutaneous catheter drainage using a 10 Fr catheter. Those not responding underwent a necrosectomy. Depending on the outcome of their supportive care, the patients were divided into three groups: those responding to intensive care, those needing percutaneous catheter drainage and those requiring surgical intervention. Twelve patients were managed conservatively (Group 1) while 24 underwent percutaneous catheter drainage (Group 2), 9 of whom were not operated (Group 2a) and 15 of whom underwent necrosectomy (Group 2b). Fourteen patients were operated on directly (Group 3). MAIN OUTCOME MEASURES: Hospital stay, intensive care unit stay, and mortality. RESULTS: Among patients requiring surgery, the patients in Group 2b had a shorter intensive care unit stay (22.1±11.1 days) as compared to the patients in Group 3 (25.0±15.6 days) and a longer interval to surgery, 30.7±8.9 days versus 25.4±8.5 days. However, these differences did not reach statistical significance (P=0.705 and P=0.133, respectively). The two groups did not differ in terms of mortality (5/15 versus 3/14; P=0.682). CONCLUSION: The use of percutaneous catheter drainage helped avoid or delay surgery in two-fifths of the patients with severe acute pancreatitis.


Assuntos
Cuidados Críticos/métodos , Pancreatite/terapia , Doença Aguda , Adolescente , Adulto , Idoso , Algoritmos , Catéteres , Drenagem/métodos , Feminino , Humanos , Índia , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Pancreatite/epidemiologia , Pancreatite/etiologia , Índice de Gravidade de Doença , Adulto Jovem
8.
Gastroenterology Res ; 3(2): 79-85, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27956990

RESUMO

BACKGROUND: To assess the feasibility and safety of a pancreas preserving operative technique in the management of isolated complete pancreatic neck transection following blunt abdominal trauma. METHODS: Two patients with isolated blunt fracture of the pancreatic neck underwent pancreas preserving procedure comprising of oversewing of the proximal pancreas and Roux-en-Y pancreatico jejunostomy to the distal remnant. A feeding jejunostomy tube was placed for postoperative nutritional support in these patients. Both patients received subcutaneous octreotide 300 µg/day. RESULTS: Their ages ranged from 15 years to 20 years, mode of injury was bicycle handle-bar injury (n = 2). Both had pancreatic transection at neck in the line of superior mesenteric vessels. One had ascites. These patients had pancreas parenchyma preserving surgery - internal drainage of the left remnant in a Roux-en-Y jejunal loop. The postoperative course was uneventful in these and both are well on follow-up. CONCLUSIONS: Pancreas preserving strategy - suture of head side of pancreas and an internal drainage of left remnant with a Roux-en-Y jejunal loop is feasible and safe and should be considered in selected cases. Substantial amount of normal pancreatic parenchyma is preserved.

9.
JOP ; 10(4): 425-8, 2009 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-19581749

RESUMO

CONTEXT: To assess the feasibility and safety of a pancreas-preserving total duodenectomy in the management of severe duodenal injury caused by abdominal trauma. CASE REPORT: Two patients with both extensive injury of the duodenum and diffuse peritonitis underwent pancreas preserving total duodenectomy at our tertiary care centre. These two young male patients (age 20 and 22 years) presented 2 days and 6 hours respectively following blunt abdominal trauma. The duodenum was almost completely separated from the pancreas. Ampulla was seen as a button on the pancreas. Following total duodenectomy, reconstruction was performed by suturing the jejunum to the head of the pancreas anteriorly and posteriorly away from the ampulla (invagination of the pancreas into the jejunum). There were no complications attributable to the procedure. Both patients are well on follow up. CONCLUSION: A Pancreas-preserving total duodenectomy offers a safe alternative to the Whipple procedure in managing complex duodenal injury. This procedure avoids unnecessary resection of the adjacent pancreas and anastomosis to undilated hepatic and pancreatic ducts.


Assuntos
Duodeno/lesões , Duodeno/cirurgia , Pâncreas/cirurgia , Pancreaticoduodenectomia/métodos , Estudos de Viabilidade , Seguimentos , Humanos , Masculino , Resultado do Tratamento , Adulto Jovem
10.
JOP ; 10(3): 271-5, 2009 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-19454818

RESUMO

CONTEXT: The clinical course of severe acute pancreatitis may be complicated by organ failure. OBJECTIVE: We studied the incidence of organ failure and the correlation of the extent of necrosis and infective necrosis with organ failure. METHODS: The medical records of 161 patients with severe acute pancreatitis and persistent organ failure over a 4-year period were studied. MAIN OUTCOME MEASURES: Pancreatic necrosis on CT was graded as <30%, 30-50% and >50% necrosis. Infected necrosis was diagnosed on the basis of a positive culture of fine needle aspiration or of a surgical specimen. Organ failure was defined according to the Atlanta criteria. Patient demographics, extent of pancreatic necrosis and presence of infection were correlated with organ failure. INTERVENTION: All patients were managed by a predefined treatment protocol. RESULTS: Of the 161 patients (124 males, 37 females, mean age 41.5+/-15.0 years), 52.2% had organ failure. In patients with organ failure, 48.8% had one, 33.3% two and 17.8% had multiple organ failure. Pulmonary failure was the most common organ dysfunction (76.2%). A more advanced age of patients and a higher APACHE II score were significant risk factors for the development of organ failure. Pancreatic necrosis on CT scan in patients with one, two and three organ failures was 48.8%, 51.8% and 83.3%, respectively while, in patients without organ failure, only 28.6% had more than 50% necrosis (P<0.001). No correlation was found between infected necrosis and organ failure. Overall mortality was 47.8% and mortality increased with an increasing number of organ failures. CONCLUSION: Persistent organ failure occurred in 52.2% of our patients with severe acute pancreatitis. The advanced age of the patients, a higher APACHE II score and the extent of necrosis, but not infected necrosis, emerged as significant correlates of organ failure.


Assuntos
Insuficiência de Múltiplos Órgãos/mortalidade , Insuficiência de Múltiplos Órgãos/patologia , Pancreatite/mortalidade , Pancreatite/patologia , Índice de Gravidade de Doença , APACHE , Doença Aguda , Adulto , Distribuição por Idade , Biópsia por Agulha Fina , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Necrose , Pancreatite/cirurgia , Pancreatite/terapia , Fatores de Risco
11.
JOP ; 10(2): 157-62, 2009 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-19287109

RESUMO

CONTEXT: There is controversy concerning the merits of enteral and parenteral nutrition in the management of patients with severe acute pancreatitis. OBJECTIVE: This study was undertaken to evaluate the effect of enteral nutrition versus parenteral nutrition on serum markers of inflammation and outcome in patients with severe acute pancreatitis. SETTING: Tertiary care centre in North India. DESIGN: A prospective clinical trial. METHODS: Fifty consecutive patients with severe acute pancreatitis were randomized in a prospective trial to receive total enteral nutrition (n=25) or total parenteral nutrition (n=25). Enteral nutrition was delivered distal to the ligament of Treitz. Serum C-reactive protein, transferrin levels, albumin, surgical intervention, infections, duration of hospital stay and mortality were compared in the two groups. RESULTS: The mean age in the enteral nutrition group was 38.4+/-13.8 years and in the total parenteral nutrition group 41.1+/-11.3 years. The etiological factors were alcohol (n=19), gallstones (n=23), idiopathic (n=7) and drug-induced (n=1). There was a significant decrease in serum C-reactive protein values in both the enteral nutrition group and the total parenteral nutrition group at one week and two weeks (P<0.001 for both). Serum albumin rose from a prenutritional value of 2.82+/-0.51 g/dL to 3.34+/-0.45 g/dL on day 14 of nutritional support in the enteral nutrition group (P=0.003); in the total parenteral nutrition group, the level rose from 3.10+/-0.59 g/dL to 3.21+/-0.30 g/dL (P=0.638). A significant rise in transferrin value was observed from day 0 to day 14 in enteral nutrition group (169+/-30 to 196+/-36 mg/dL; P<0.001) whereas, in the total parenteral nutrition group, a less significant difference (191+/-41 to 201+/-29 mg/dL; P=0.044) was observed. There was no significant difference in surgical intervention (56.0% versus 60.0%; P=1.000), infective complications (64.0% versus 60.0%; P=1.000), hospital stay (42 days, 15-108 days, versus 36 days, 20-77 days; median, range; P=0.755), or mortality (20.0% versus 16.0%; P=1.000) in enteral nutrition versus total parenteral nutrition, respectively. CONCLUSION: Enteral nutrition and total parenteral nutrition are comparable in the management of severe acute pancreatitis in terms of hospital stay, need for surgical intervention, infections and mortality.


Assuntos
Nutrição Enteral/métodos , Pancreatite/terapia , Nutrição Parenteral/métodos , Doença Aguda , Adolescente , Adulto , Idoso , Infecções Bacterianas/etiologia , Biomarcadores/sangue , Proteína C-Reativa/análise , Candidíase/etiologia , Terapia Combinada , Nutrição Enteral/efeitos adversos , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Pancreatite/sangue , Pancreatite/mortalidade , Nutrição Parenteral/efeitos adversos , Albumina Sérica/análise , Procedimentos Cirúrgicos Operatórios , Taxa de Sobrevida , Transferrina/análise , Resultado do Tratamento , Adulto Jovem
12.
JOP ; 9(2): 160-6, 2008 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-18326923

RESUMO

CONTEXT: Emphysematous pancreatitis is a rare, potentially fatal variant of severe acute pancreatitis with gas in the pancreatic bed. There are isolated case reports describing this condition. OBJECTIVE: This report summarizes our experience with the management of this condition in order to compare its clinical characteristics, microbiological and radiological features, surgical management and the outcome of patients with emphysematous pancreatitis and non-emphysematous infected pancreatic necrosis. SETTING: The hospital records of the patients who underwent necrosectomy for infected pancreatic necrosis between 2002 and 2006 were reviewed. PATIENTS: Fifty-seven patients were identified: 11 of them (19.3%) had gas in and around the pancreas on computed tomography and 46 (80.7%) had non-emphysematous infected pancreatic necrosis. MAIN OUTCOME MEASURES: The clinical characteristics and the hospital course of the two groups of patients were compared. RESULTS: The mean age of 11 patients with emphysematous pancreatitis was 34.0+/-11.5 years and alcohol was the most common etiology (54.5%). The median computed tomography severity index was 10. All 11 patients with emphysematous pancreatitis had growth of organisms on culture of fine needle aspiration or pancreatic tissue obtained at surgery, with Escherichia coli in all of them. Polymicrobial infection was seen in 5 (45.5%) of them. In comparing patients having emphysematous pancreatitis with those having non-emphysematous infected necrosis, there was no significant difference in the severity of the disease (P=0.319), time to surgical intervention (P=0.553), incidence of organ failure (P=0.297), hospital stay (P=0.580) or mortality rate (P=0.739). The total number of locoregional complications was significantly higher in patients with emphysematous pancreatitis (P=0.049). However, when compared separately, the incidence of enteric fistula, bleeding, intra-abdominal collections and wound complications were similar in the two groups (P>0.250). CONCLUSION: Emphysematous pancreatitis is easily diagnosed on computed tomography and all patients require surgical intervention. The clinical course and prognosis is not different from that of infected pancreatic necrosis.


Assuntos
Enfisema/diagnóstico por imagem , Pancreatite Necrosante Aguda/diagnóstico por imagem , Adulto , Enfisema/microbiologia , Enfisema/cirurgia , Humanos , Pessoa de Meia-Idade , Pancreatite Necrosante Aguda/microbiologia , Pancreatite Necrosante Aguda/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
13.
JOP ; 8(5): 564-72, 2007 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-17873460

RESUMO

CONTEXT: Experimental models of acute pancreatitis have been developed in order to understand its pathophysiology and extrapancreatic manifestations. OBJECTIVE: The objective of our study was to study sequential changes in the pancreas and distant organs in sodium taurocholate-induced acute pancreatitis in a rat model. ANIMALS: Sixteen male Wistar rats weighing 250-300 g. DESIGN: The rats were distributed into two groups: induced acute pancreatitis (study group: 8 rats) and a control group (8 rats). Within each group, the animals were divided into subgroups: those who were sacrificed early (24 h and 72 h; two each) and those who were sacrificed late (120 h and 240 h; two each). INTERVENTION: Acute pancreatitis was induced in the rats by multiple intraparenchymal injections of 10% sodium taurocholate solution. In the controls, the same amount of normal saline was injected into the pancreatic parenchyma. MAIN OUTCOME MEASURES: Pathological examination of the pancreas, lungs, kidneys, intestine and liver was done. RESULTS: In this model of taurocholate-induced acute pancreatitis, the early changes observed in the pancreas were focal hemorrhages, parenchymal necrosis and neutrophil infiltration. At 72 hours, the changes observed were acinar necrosis, edema, fibrin deposition and inflammatory cell infiltration. Late changes were fibrinoid necrosis and fibroblast proliferation. In the acute phase, the histological changes in the lungs were congestion, focal pulmonary edema and intra-alveolar hemorrhages while, in the late stage, there was persistence of vascular congestion. The changes observed in the kidneys were vacuolization of tubular epithelium in the subcapsular region and areas of hemorrhage in the interstitium. Intestinal changes included degenerative changes in the villous epithelium in the acute phase with normalization of the histology in the late phase. CONCLUSION: Our findings correlate with the clinical observation of multisystem organ failure in acute pancreatitis. Early changes in these organs suggest that careful observation is mandatory in patients with acute pancreatitis in order to institute supportive treatment.


Assuntos
Colagogos e Coleréticos , Insuficiência de Múltiplos Órgãos/patologia , Pancreatite/induzido quimicamente , Pancreatite/patologia , Ácido Taurocólico , Doença Aguda , Animais , Modelos Animais de Doenças , Progressão da Doença , Intestinos/patologia , Rim/patologia , Fígado/patologia , Pulmão/patologia , Masculino , Insuficiência de Múltiplos Órgãos/etiologia , Pâncreas/patologia , Pancreatite/complicações , Ratos , Ratos Wistar
14.
JOP ; 8(2): 177-85, 2007 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-17356240

RESUMO

CONTEXT: Severe acute pancreatitis has long been known to be a cause of pulmonary dysfunction and multisystem organ failure. OBJECTIVE: We evaluated the spectrum of pulmonary dysfunction in acute pancreatitis. METHODS: Over a period of one year, 60 patients referred to us with a diagnosis of acute pancreatitis on the basis of clinical findings, CT and elevated serum amylase level were studied prospectively. The computed tomography severe index (CTSI) was used to assess the severity of the pancreatitis. Arterial blood gas analysis and chest X-rays were performed in all patients at admission and at intervals, when clinically indicated. RESULTS: The mean age was 42.9+/-15.9 years (range: 18-80 years) and the etiology of the pancreatitis was gallstones in 29 patients, alcohol in 22 patients while no cause could be ascertained in 9. At presentation to our hospital, 48.3% had mild hypoxemia while 18.3% had moderate to severe hypoxemia (PaO2 less than 60 mmHg). The patients who were hypoxemic at presentation had a higher incidence of organ failure during the course of the disease. Pleural effusion at admission was noticed in 50%, atelectasis in 25%, and pulmonary infiltrates in 6.7%. Respiratory failure developed in 48.3% and the mean+/-SD CTSI in these patients was 8.20+/-2.29. Patients with more than 50% necrosis had more pulmonary dysfunction and needed ventilatory support. The development of consolidation during the course of the disease correlated with the occurrence of respiratory failure (P=0.068) but not with mortality (P=0.193). Similarly, the onset of adult respiratory distress syndrome also correlated with respiratory failure (P<0.001) but, unlike consolidation, adult respiratory distress syndrome correlated with mortality (P<0.001). On logistic regression analysis, the development of respiratory failure and other organ dysfunctions were independent risk factors for mortality. CONCLUSION: Our study on patients who were referred to a tertiary care center points out that hypoxemia at presentation predicts a poor outcome which could be due to the high incidence of associated cardiac and renal failure. At presentation, the presence of pleural effusion but not atelectasis and consolidation correlates with the development of respiratory failure and mortality. Among the respiratory complications developing during the course of acute pancreatitis, consolidation and adult respiratory distress syndrome correlate with respiratory failure while adult respiratory distress syndrome alone leads to poor survival.


Assuntos
Pneumopatias/etiologia , Pneumopatias/mortalidade , Pancreatite/complicações , Pancreatite/mortalidade , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Amilases/sangue , Feminino , Humanos , Incidência , Pneumopatias/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pancreatite/diagnóstico por imagem , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/etiologia , Derrame Pleural/mortalidade , Pneumonia/diagnóstico por imagem , Pneumonia/etiologia , Pneumonia/mortalidade , Estudos Prospectivos , Atelectasia Pulmonar/diagnóstico por imagem , Atelectasia Pulmonar/etiologia , Atelectasia Pulmonar/mortalidade , Síndrome do Desconforto Respiratório/diagnóstico por imagem , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/mortalidade , Insuficiência Respiratória/diagnóstico por imagem , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/mortalidade , Fatores de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
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