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1.
Vet J ; 300-302: 106031, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37778652

RESUMO

Bovine respiratory disease (BRD) is one of the leading causes of mortality and morbidity in calves across diverse management systems. Despite expert opinion often citing the influence of housing environment on the level of respiratory disease in calf groups, there have been few reviews of environmental factors that predispose to BRD. This systematic review was undertaken to identify the measurable environmental variables associated with respiratory disease in housed preweaned calves. To achieve this Pubmed, CAB Direct and Scopus databases were searched. To be considered for inclusion, publications had to be fully published in English, published before 24 November, 2022 and include at least one measurable/ manipulated environmental variable and a standardized method of BRD detection. Twelve publications were included in this review. These examined a wide range of risk factors including air microbial count (four publications), air particulate matter (one publication); air endotoxins (one publication) and air ammonia (four publications). From the included publications, a statistically significant relationship to BRD was identified in 2/4 examining air microbial count, 1/1 examining air particulate matter, 1/1 examining air endotoxins and 2/4 examining air ammonia. This review indicated a paucity of evidence from the peer-review literature demonstrating a significant association between the many investigated exposure factors and BRD occurrence. An optimal environment for housed calves could not be clearly identified in this review.


Assuntos
Complexo Respiratório Bovino , Doenças dos Bovinos , Transtornos Respiratórios , Doenças Respiratórias , Animais , Bovinos , Amônia , Habitação , Doenças dos Bovinos/epidemiologia , Doenças Respiratórias/veterinária , Fatores de Risco , Transtornos Respiratórios/veterinária , Complexo Respiratório Bovino/epidemiologia , Complexo Respiratório Bovino/etiologia
2.
Vet J ; 300-302: 106032, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37757972

RESUMO

Bovine respiratory disease (BRD) is a challenge in all housed farming systems that raise calves. Farm to farm variation in BRD prevalence can be partially attributed to variation in host immunity, pathogens and housing environment. Unlike host immunity and BRD pathogens, housing environment has not been well investigated. The objective of this systematic review was to identify the measurable environmental variables associated with BRD in housed preweaned calves. Pubmed, CAB Direct and Scopus databases were searched. To be considered for inclusion publications had to be published in English, before 24 November, 2022 and include at least one measurable/ manipulated environmental variable and a standardized method of BRD detection. In total 12 publications were included in this review. In this second part of the systematic review the environmental variables identified were; temperature (9 publications); relative humidity (8 publications); bedding (5 publications); ventilation (1 publication); air CO2 concentration (1 publication) and air velocity (4 publications). Of the publications that were examined a statistically significant relationship to BRD was identified in 4/9 publications examining temperature, 3/8 examining relative humidity, 2/4 examining air velocity, 2/5 examining bedding, 0/1 examining ventilation rates and 0/1 examining CO2 concentration. From this review it is clear high airspeed at calf level should be avoided as should deep, wet pack bedding. The relationship between BRD prevalence and both high and low temperature requires more investigation to identify temperature thresholds associated with increased risk of BRD as well as the most influential modifiers. An optimal environment for housed calves could not be clearly identified in this review.


Assuntos
Complexo Respiratório Bovino , Doenças dos Bovinos , Transtornos Respiratórios , Doenças Respiratórias , Animais , Bovinos , Umidade , Habitação , Temperatura , Dióxido de Carbono , Doenças dos Bovinos/epidemiologia , Doenças dos Bovinos/etiologia , Doenças Respiratórias/veterinária , Transtornos Respiratórios/veterinária , Complexo Respiratório Bovino/epidemiologia , Complexo Respiratório Bovino/etiologia
3.
Traffic Inj Prev ; 21(sup1): S66-S71, 2020 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-33206553

RESUMO

OBJECTIVE: Highly automated vehicles may permit alternative seating postures, which could alter occupant kinematics and challenge current restraint designs. One predicted posture is a reclined seated position. While the spine of upright occupants is subjected to flexion during frontal crashes, the orientation of reclined occupants tends to subject the spine to high compressive loads followed by high flexion loads. This study aims to investigate kinematics and mechanisms of loading in the thoracolumbar spine for a reclined seated posture through the use of postmortem human subjects (PMHS). METHODS: Frontal impact sled tests (50 kph delta-v) were conducted on five adult midsize male PMHS seated with the torso reclined to 50 degrees with respect to the vertical. The PMHS were seated on a semi-rigid seat and restrained by a seat-integrated three-point belt with dual lap-belt pretensioners and a shoulder-belt pretensioner with a 3 kN load-limiter. 3-D kinematic trajectories of five chosen vertebrae, and the pelvis were measured relative to the vehicle buck. Intervertebral pressure transducers were installed at three locations in the lumbar column to detect load timing. RESULTS: Three PMHS suffered fractures at L1. Combined compression and flexion of the thoracolumbar spine occurred in all tests, but the magnitude of peak flexion varied across the PMHS. During the PMHS' forward excursion, the pelvis rotated anteriorly in two tests and posteriorly in two tests (lap-belt submarining occurred in one). In one test, the pelvis mount interacted with the seat, but did not affect kinematics. CONCLUSIONS: Anterior rotation of the pelvis caused increased extension of the lumbar spine, which exacerbated lumbar compression in two of the PMHS; the one subject whose pelvis kinematic tracking was lost exhibited similar compression kinematics. Posterior rotation of the pelvis enabled lumbar flexion, which decreased lumbar compression, but lead to lap-belt submarining in one case. Lumbar kinematics for these reclined frontal impacts were sensitive to changes in initial posture of the spine (magnitude of lordosis or kyphosis) and pelvis (pitch angle). To our knowledge, this study is the first to analyze thoracolumbar kinematics and resulting injuries of a reclined seating posture using PMHS.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Vértebras Lombares/fisiopatologia , Postura Sentada , Traumatismos da Coluna Vertebral/epidemiologia , Vértebras Torácicas/fisiopatologia , Adulto , Fenômenos Biomecânicos , Cadáver , Humanos , Masculino
5.
Int J Med Robot ; 1(2): 40-7, 2005 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17518377

RESUMO

Medical practice continues to move toward less invasive procedures. Many of these procedures require the precision placement of a needle in the anatomy. Over the past several years, our research team has been investigating the use of a robotic needle driver to assist the physician in this task. This paper summarizes our work in this area. The robotic system is briefly described, followed by a description of a clinical trial in spinal nerve blockade. The robot was used under joystick control to place a 22 gauge needle in the spines of 10 patients using fluoroscopic imaging. The results were equivalent to the current manual procedure. We next describe our follow-up clinical application in lung biopsy for lung cancer screening under CT fluoroscopy. The system concept is discussed and the results of a phantom study are presented. A start-up company named ImageGuide has recently been formed to commercialize the robot. Their revised robot design is presented, along with plans to install a ceiling-mounted version of the robot in the CT fluoroscopy suite at Georgetown University.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Agulhas , Robótica , Biópsia/métodos , Cadáver , Desenho de Equipamento , Fluoroscopia , Humanos , Pulmão/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Bloqueio Nervoso/instrumentação , Bloqueio Nervoso/métodos , Imagens de Fantasmas , Ensaios Clínicos Controlados Aleatórios como Assunto , Robótica/instrumentação , Nervos Espinhais , Tomografia Computadorizada por Raios X
6.
Toxicon ; 39(7): 1021-7, 2001 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-11223091

RESUMO

There is an urgent need for an alternative to the mouse bioassay for the detection of algal toxins in shellfish on both analytical and animal welfare grounds. Several alternative methodologies have been described, but have not gained widespread acceptance to date, because each assay measures only one or a small number of related phycotoxins out of the increasing range that needs to be detected. A simple cytotoxicity assay using either the HepG2 or ECV-304 cell lines is described with two end-point measurements, which can detect and distinguish between two unrelated classes of phycotoxins. Morphological examination following 3h exposure to the sample enables the detection of the diarrhetic shellfish poisons, including okadaic acid and related toxins. Viability testing using MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide), following 24h exposure of the same cells to the sample, reveals a second class of toxin, which is most probably the newly-described toxin, azaspiracid. This assay should play an important role in shellfish monitoring in the future.


Assuntos
Antineoplásicos/toxicidade , Toxinas Marinhas/toxicidade , Frutos do Mar/análise , Animais , Bivalves/química , Linhagem Celular , Cromatografia Líquida , Indicadores e Reagentes , Toxinas Marinhas/química , Espectrometria de Massas , Camundongos , Fosfoproteínas Fosfatases/antagonistas & inibidores , Especificidade da Espécie , Compostos de Espiro/química , Compostos de Espiro/toxicidade , Células Tumorais Cultivadas
7.
Biologicals ; 28(2): 57-66, 2000 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-10885613

RESUMO

This paper describes use of a new technology of hybridization with a micro-array of immobilized oligonucleotides for detection and quantification of neurovirulent mutants in Oral Poliovirus Vaccine (OPV). We used a micro-array consisting of three-dimensional gel-elements containing all possible hexamers (total of 4096 probes). Hybridization of fluorescently labelled viral cDNA samples with such microchips resulted in a pattern of spots that was registered and quantified by a computer-linked CCD camera, so that the sequence of the original cDNA could be deduced. The method could reliably identify single point mutations, since each of them affected fluorescence intensity of 12 micro-array elements. Micro-array hybridization of DNA mixtures with varying contents of point mutants demonstrated that the method can detect as little as 10% of revertants in a population of vaccine virus. This new technology should be useful for quality control of live viral vaccines, as well as for other applications requiring identification and quantification of point mutations.


Assuntos
Mutação , Análise de Sequência com Séries de Oligonucleotídeos , Vacina Antipólio Oral , Poliovirus/genética , RNA Viral/genética , Análise Mutacional de DNA , DNA Complementar/genética , Microscopia de Fluorescência , Fotomicrografia , Mutação Puntual , Poliovirus/patogenicidade , Vacina Antipólio Oral/efeitos adversos , Vacina Antipólio Oral/normas , Reação em Cadeia da Polimerase , Controle de Qualidade , Reprodutibilidade dos Testes , Segurança , Software , Virulência/genética
8.
Dev Biol Stand ; 101: 21-5, 1999.
Artigo em Inglês | MEDLINE | ID: mdl-10566770

RESUMO

Biological products are complex molecules and their testing presents unique technical challenges. Furthermore, there are certain expectations for the validation of methods applied for regulatory purposes. A few recent CBER policy initiatives which have an impact on the use of animal tests for biological products will be discussed, followed by an exposé of the MAPREC test for polio virus neurovirulence as an example of alternative test development and the validation process. Finally, some general comments about the validation process will be made.


Assuntos
Produtos Biológicos/normas , Animais , Produtos Biológicos/química , Humanos , Poliovirus/patogenicidade , Vacina Antipólio de Vírus Inativado/efeitos adversos , Vacina Antipólio de Vírus Inativado/normas , Controle de Qualidade , Reprodutibilidade dos Testes , Virulência
9.
Int J Biochem Cell Biol ; 30(9): 1047-54, 1998 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-9785468

RESUMO

Hepatic phenylalanine hydroxylase is reported to be more abundant in experimentally-diabetic rats; whereas livers of animals fed a high protein diet, where gluconeogenesis also prevails, have normal amounts of this enzyme. In this study, in addition to seeking an explanation for this effect of experimental diabetes, we also examined the effects of providing alternative dietary gluconeogenic substrates. In rats fed a diet composed of 40% (w/w) glycerol, the specific activities of hepatic phenylalanine hydroxylase are decreased to about 60% of control values. There is no effect on the apparent state of phosphorylation of the enzyme. However, studies on the incorporation of radiolabelled leucine into liver phenylalanine hydroxylase suggested that there was a decreased rate of synthesis. Similarly, animals fed a diet containing 85% (w/w) fructose also have diminished phenylalanine hydroxylase activities. Under all of the above circumstances and also in streptozotocin-induced diabetic animals, alterations in the concentrations of the hydroxylase cofactor, tetrahydrobiopterin and of GTP closely correlate with the effects on the enzyme activities. They are elevated in livers of diabetic animals and significantly diminished in livers of rats fed diets rich in glycerol or fructose. These observations suggest that in adult rat both liver tetrahydrobiopterin concentrations and the expression of hepatic phenylalanine hydroxylase are regulated by GTP [210].


Assuntos
Biopterinas/análogos & derivados , Guanosina Trifosfato/metabolismo , Fígado/enzimologia , Fígado/metabolismo , Fenilalanina Hidroxilase/metabolismo , Animais , Biopterinas/metabolismo , Diabetes Mellitus Experimental/enzimologia , Diabetes Mellitus Experimental/metabolismo , Sacarose Alimentar/administração & dosagem , Frutose/administração & dosagem , Glicerol/administração & dosagem , Cinética , Masculino , Nucleotídeos/metabolismo , Fenilalanina Hidroxilase/biossíntese , Ratos , Ratos Sprague-Dawley
12.
Arch Biochem Biophys ; 345(2): 193-8, 1997 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-9308889

RESUMO

The C-terminal alpha-amidation of peptides is one of the most important events in prohormone and neuropeptide processing. Peptide amidation is a two-step process catalyzed by peptidylglycine (hydroxylating) monooxygenase (B. A. Eipper et al., 1983, Proc. Natl. Acad. Sci. USA 80, 5144-5148) followed by dismutation of the resultant hydroxylated peptide to peptide amide and glyoxylate, stimulated by alpha-hydroxyglycine amidating dealkylase (K. Takahashi et al., 1990, Arch. Biochem. Biophys. 169, 524-530). Previous reports on peptidylglycine monooxygenase from bovine pituitary have generated substantial disagreement as to its molecular size. We have reinvestigated the purification of this enzyme and we find that peptidylglycine monooxygenase activity from fresh bovine pituitary is entirely due to a previously unrecognized catalytic function of growth hormone (somatotropin).


Assuntos
Hormônio do Crescimento/metabolismo , Oxigenases de Função Mista/metabolismo , Complexos Multienzimáticos , Hipófise/enzimologia , Sequência de Aminoácidos , Animais , Especificidade de Anticorpos , Bovinos , Hormônio do Crescimento/imunologia , Hormônio do Crescimento/isolamento & purificação , Oxigenases de Função Mista/imunologia , Oxigenases de Função Mista/isolamento & purificação , Dados de Sequência Molecular , Peso Molecular , Processamento de Proteína Pós-Traducional , Análise de Sequência
13.
Anesth Analg ; 85(3): 538-45, 1997 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-9296406

RESUMO

UNLABELLED: This randomized, double-blind, parallel-group, multicenter study evaluated the safety and efficacy of ondansetron (0.1 mg/kg to 4 mg intravenously) compared with placebo in the prevention of postoperative vomiting in 429 ASA status I-III children 1-12 yr old undergoing outpatient surgery under nitrous oxide- and halothane-based general anesthesia. The results show that during both the 2-h and the 24-h evaluation periods after discontinuation of nitrous oxide, a significantly greater percentage of ondansetron-treated patients (2 h 89%, 24 h 68%) compared with placebo-treated patients (2 h 71%, 24 h 40%) experienced complete response (i.e., no emetic episodes, not rescued, and not withdrawn; P < 0.001 at both time points). Ondansetron-treated patients reached criteria for home readiness one-half hour sooner than placebo-treated patients (P < 0.05). The age of the child, use of intraoperative opioids, type of surgery, and requirement to tolerate fluids before discharge may also have affected the incidence of postoperative emesis during the 0- to 24-h observation period. Use of postoperative opioids did not have any effect on complete response rates in this patient population. We conclude that the prophylactic use of ondansetron reduces postoperative emesis in pediatric patients, regardless of the operant influential factors. IMPLICATIONS: Postoperative nausea and vomiting often occur after surgery and general anesthesia in children and are the major reason for unexpected hospital admission after ambulatory surgery. Our study demonstrates that the prophylactic use of a small dose of ondansetron reduces postoperative vomiting in pediatric patients.


Assuntos
Antieméticos/administração & dosagem , Ondansetron/administração & dosagem , Complicações Pós-Operatórias/prevenção & controle , Pré-Medicação , Vômito/prevenção & controle , Anestesia Geral , Anestésicos Inalatórios , Antieméticos/efeitos adversos , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Halotano , Humanos , Tempo de Internação , Masculino , Óxido Nitroso , Ondansetron/efeitos adversos
16.
J Clin Anesth ; 7(1): 54-7, 1995 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-7772360

RESUMO

STUDY OBJECTIVE: To determine if acquired long QT syndrome following right or left, radical or modified, neck dissections result in malignant arrhythmias or deaths. DESIGN: Prospective study. SETTING: Inpatient head and neck service of the Massachusetts Eye and Ear Infirmary. PATIENTS: 69 patients who underwent extensive neck surgery, without congenital long QT syndrome, medications known to prolong the QT interval, preoperative ventricular arrhythmias, or electrolyte abnormalities. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Preoperative and postoperative electrolytes were evaluated. Preoperative and postoperative electrocardiograms and QT intervals were evaluated. Continuous intraoperative and 10- to 12-hour postoperative monitoring of lead II or V5 were evaluated. Twenty-six patients (Group 1) underwent either right radical neck dissection or modified right radical neck dissection, 25 patients (Group 2) underwent either left radical neck dissection or modified left neck dissection, and 18 patients (Group 3) underwent extensive neck surgery without radical or modified neck dissection. Postoperatively, 38 patients (19 Group 1, 11 Group 2, and 8 Group 3 patients) developed a QT interval corrected for heart rate (QTc) of greater than 440 milliseconds. Repeated measures analysis of variance, comparing preoperative and postoperative QTc showed a statistically significant preoperative to postoperative change, but no significant difference among the three groups. No malignant arrhythmias or deaths were recorded in any of the three groups. CONCLUSIONS: Acquired long QT syndrome following radical neck dissection, without congenital, metabolic, or pharmacologic disturbance, is unlikely to trigger malignant arrhythmias, as previously reported for right radical neck dissection.


Assuntos
Eletrocardiografia , Síndrome do QT Longo/etiologia , Excisão de Linfonodo/efeitos adversos , Esvaziamento Cervical/efeitos adversos , Pescoço/cirurgia , Análise de Variância , Período de Recuperação da Anestesia , Arritmias Cardíacas/etiologia , Cálcio/análise , Causas de Morte , Eletrocardiografia Ambulatorial , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Cuidados Pós-Operatórios , Potássio/análise , Estudos Prospectivos
17.
Vaccine ; 12(6): 542-50, 1994 May.
Artigo em Inglês | MEDLINE | ID: mdl-8036829

RESUMO

Immunizations against most vaccine-preventable diseases will be needed indefinitely unless the disease is eradicated. Public acceptance of immunizations may be threatened as vaccine coverage increases and disease decreases, however, due to the increase in both causally and coincidentally related vaccine adverse events. The post-marketing surveillance for such events in the USA in response to the mandatory reporting requirements of the National Childhood Injury Act of 1986. While VAERS has many methodological limitations intrinsic to such systems, it can play an important role in helping to monitor vaccine safety and maintain public confidence in immunizations.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos , Vacinas/efeitos adversos , Humanos
18.
Anesth Analg ; 75(3): 351-4, 1992 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-1510255

RESUMO

The efficacy of intravenous metoclopramide in controlling vomiting in children after tonsillectomy was determined in a prospective randomized, double-blind investigation. One hundred two unpremedicated, ASA physical status I or II children between the ages of 1 and 15 yr who were undergoing surgical removal of the tonsils, with or without adenoidectomy, were studied. Anesthesia was induced either with halothane, nitrous oxide, and oxygen by mask or by intravenous thiopental and was maintained with halothane, nitrous oxide, oxygen, and intravenous morphine (0.1 mg/kg). Each child randomly received either 0.15 mg/kg of metoclopramide or saline solution placebo intravenously after transfer to the postanesthesia care unit. All episodes of vomiting were recorded for 24 h after completion of surgery. The incidence of vomiting in the saline solution group was 70%, compared with 47% in the metoclopramide group (P = 0.026). The authors conclude that the administration of intravenous metoclopramide in a dose of 0.15 mg/kg on arrival in the postanesthesia care unit significantly decreases the incidence of vomiting in children after tonsillectomy.


Assuntos
Metoclopramida/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Tonsilectomia/efeitos adversos , Vômito/prevenção & controle , Adolescente , Criança , Pré-Escolar , Método Duplo-Cego , Esquema de Medicação , Feminino , Humanos , Incidência , Lactente , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Vômito/epidemiologia , Vômito/etiologia
19.
J Clin Anesth ; 4(2): 93-6, 1992.
Artigo em Inglês | MEDLINE | ID: mdl-1562343

RESUMO

STUDY OBJECTIVE: To compare the efficacy of propofol, methohexital, and midazalom in providing adequate sedation during administration of retrobulbar block and satisfactory postoperative amnesia. DESIGN: Retrospective chart review over a 4-month period. SETTING: Ambulatory patients in the main operating room of a university-affiliated hospital. PATIENTS: One hundred forty-seven ambulatory patients undergoing ophthalmologic surgery of less than 2 hours' duration under regional anesthesia consisting of retrobulbar or peribulbar block and intravenous (IV) sedation. INTERVENTIONS: One of three drugs--propofol 0.47 +/- 0.06 mg/kg, midazolam 0.02 +/- 0.005 mg/kg, or methohexital 0.45 +/- 0.16 mg/kg--was administered IV. Patients were observed for a minimum of 60 seconds or until adequate sedation was achieved, after which a retrobulbar or peribulbar block was performed. MEASUREMENTS AND MAIN RESULTS: Blood pressure, electrocardiogram, and oxygen saturation were monitored and recorded. Patients were observed for apnea, hiccups, pain on injection, excitement, tremor, grimacing, or verbal response during the block. The requirement for additional sedation intraoperatively was noted. Patients were questioned postoperatively in the ambulatory recovery room for recall of needle insertion or discomfort during the block, as well as about their satisfaction with the overall experience. CONCLUSIONS: Grimacing or verbal response during the retrobulbar or peribulbar block did not predict or correlate with patient recall. Propofol was equal to both midazolam and methohexital in providing adequate sedation and postoperative amnesia but possesses the added advantages of reduced postoperative vomiting, lower intraocular pressure, and earlier return-to-home readiness.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Hipnóticos e Sedativos/administração & dosagem , Metoexital/administração & dosagem , Midazolam/administração & dosagem , Bloqueio Nervoso , Procedimentos Cirúrgicos Oftalmológicos , Propofol/administração & dosagem , Custos e Análise de Custo , Humanos , Hipnóticos e Sedativos/economia , Injeções Intravenosas , Metoexital/economia , Midazolam/economia , Propofol/economia
20.
Aust N Z J Surg ; 61(11): 855-7, 1991 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-1661112

RESUMO

We present the case of an 85 year old woman who was found to have a type III choledochal cyst with cholangiocarcinoma. The case is unusual because of the advanced age of the patient, the presence of both stones and a carcinoma in a type III cyst, and the associated congenital abnormalities.


Assuntos
Adenoma de Ducto Biliar/complicações , Neoplasias dos Ductos Biliares/complicações , Cisto do Colédoco/complicações , Adenocarcinoma/complicações , Adenocarcinoma/patologia , Adenoma de Ducto Biliar/patologia , Idoso , Idoso de 80 Anos ou mais , Neoplasias dos Ductos Biliares/patologia , Colelitíase/complicações , Humanos , Masculino
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