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1.
Eur J Appl Physiol ; 120(2): 505-512, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31912227

RESUMO

PURPOSE: Adaptations during voluntary breath-hold diving have been increasingly investigated since these athletes are exposed to critical hypoxia during the ascent. However, only a limited amount of literature explored the pathophysiological mechanisms underlying this phenomenon. This is the first study to measure arterial blood gases immediately before the end of a breath-hold in real conditions. METHODS: Six well-trained breath-hold divers were enrolled for the experiment held at the "Y-40 THE DEEP JOY" pool (Montegrotto Terme, Padova, Italy). Before the experiment, an arterial cannula was inserted in the radial artery of the non-dominant limb. All divers performed: a breath-hold while moving at the surface using a sea-bob; a sled-assisted breath-hold dive to 42 m; and a breath-hold dive to 42 m with fins. Arterial blood samples were obtained in four conditions: one at rest before submersion and one at the end of each breath-hold. RESULTS: No diving-related complications were observed. The arterial partial pressure of oxygen (96.2 ± 7.0 mmHg at rest, mean ± SD) decreased, particularly after the sled-assisted dive (39.8 ± 8.7 mmHg), and especially after the dive with fins (31.6 ± 17.0 mmHg). The arterial partial pressure of CO2 varied somewhat but after each study was close to normal (38.2 ± 3.0 mmHg at rest; 31.4 ± 3.7 mmHg after the sled-assisted dive; 36.1 ± 5.3 after the dive with fins). CONCLUSION: We confirmed that the arterial partial pressure of oxygen reaches hazardously low values at the end of breath-hold, especially after the dive performed with voluntary effort. Critical hypoxia can occur in breath-hold divers even without symptoms.

2.
Undersea Hyperb Med ; 46(5): 577-579, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683355

RESUMO

Immersion pulmonary (IPE, also known as swimming-induced pulmonary edema, SIPE) is a condition in which pulmonary edema develops rapidly during a dive or vigorous swim. Symptoms include dyspnea and hemoptysis. Physical exam reveals typical signs of bilateral pulmonary edema, which can be confirmed radiographically or with bedside ultrasound.


Assuntos
Mergulho , Afogamento , Edema Pulmonar , Humanos , Oceania , Natação
3.
Undersea Hyperb Med ; 46(5): 673-683, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683367

RESUMO

Gas can enter arteries (arterial gas embolism, AGE) due to alveolar-capillary disruption (caused by pulmonary over-pressurization, e.g. breath-hold ascent by divers) or veins (venous gas embolism, VGE) as a result of tissue bubble formation due to decompression (diving, altitude exposure) or during certain surgical procedures where capillary hydrostatic pressure at the incision site is subatmospheric. Both AGE and VGE can be caused by iatrogenic gas injection. AGE usually produces stroke-like manifestations, such as impaired consciousness, confusion, seizures and focal neurological deficits. Small amounts of VGE are often tolerated due to filtration by pulmonary capillaries; however VGE can cause pulmonary edema, cardiac "vapor lock" and AGE due to transpulmonary passage or right-to-left shunt through a patient foramen ovale. Intravascular gas can cause arterial obstruction or endothelial damage and secondary vasospasm and capillary leak. Vascular gas is frequently not visible with radiographic imaging, which should not be used to exclude the diagnosis of AGE. Isolated VGE usually requires no treatment; AGE treatment is similar to decompression sickness (DCS), with first aid oxygen then hyperbaric oxygen. Although cerebral AGE (CAGE) often causes intracranial hypertension, animal studies have failed to demonstrate a benefit of induced hypocapnia. An evidence based review of adjunctive therapies is presented.


Assuntos
Embolia Aérea/terapia , Oxigenação Hiperbárica/métodos , Algoritmos , Altitude , Artérias , Pressão Atmosférica , Descompressão/efeitos adversos , Doença da Descompressão/complicações , Mergulho/efeitos adversos , Embolia Aérea/diagnóstico , Embolia Aérea/etiologia , Forame Oval Patente/complicações , Humanos , Embolia Intracraniana/etiologia , Embolia Intracraniana/terapia , Posicionamento do Paciente/métodos , Veias
4.
Undersea Hyperb Med ; 46(5): 685-693, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683368

RESUMO

Decompression sickness (DCS, "bends") is caused by formation of bubbles in tissues and/or blood when the sum of dissolved gas pressures exceeds ambient pressure (supersaturation). This may occur when ambient pressure is reduced during any of the following: ascent from a dive; depressurization of a hyperbaric chamber; rapid ascent to altitude in an unpressurised aircraft or hypobaric chamber; loss of cabin pressure in an aircraft [2] and during space walks.


Assuntos
Doença da Descompressão/terapia , Oxigenação Hiperbárica/métodos , Doença da Descompressão/diagnóstico , Doença da Descompressão/etiologia , Humanos , Tempo para o Tratamento
5.
J Perianesth Nurs ; 34(1): 51-59, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30025663

RESUMO

PURPOSE: Obstructive sleep apnea (OSA) is a breathing disorder found in surgical patients and associated with complications in the postoperative period. The implementation of a preoperative universal screening process using the STOP-BANG questionnaire to identify patients at high risk for OSA provides opportunities for improved management. DESIGN: A pre-post design was used to evaluate screening compliance rates. METHODS: This initiative included staff education, which included the process for evaluating and documenting STOP-BANG scores. The data were collected via a chart review of the electronic medical record (EMR). FINDINGS: The rate of screening for OSA doubled after implementation of this initiative, and compliance with STOP-BANG questionnaire screening was 66.1%. High-risk designation in the EMR was 73.0%. Nearly half of the patients screened were found to be at high risk for OSA. CONCLUSIONS: Implementation of a universal screening initiative for patients and design for the EMR improves compliance with screening and identification of patients at high risk for OSA.

6.
Front Physiol ; 9: 1558, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30455649

RESUMO

The present study aimed to evaluate the partial pressure of arterial blood gases in breath-hold divers performing a submersion at 40 m. Eight breath-hold divers were enrolled for the trials held at "Y-40 THE DEEP JOY" pool (Montegrotto Terme, Padova, Italy). Prior to submersion, an arterial cannula in the radial artery of the non-dominant limb was positioned. All divers performed a sled-assisted breath-hold dive to 40 m. Three blood samplings occurred: at 10 min prior to submersion, at 40 m depth, and within 2 min after diver's surfacing and after resuming normal ventilation. Blood samples were analyzed immediately on site. Six subjects completed the experiment, without diving-related problems. The theoretically predicted hyperoxia at the bottom was observed in 4 divers out of 6, while the other 2 experienced a reduction in the partial pressure of oxygen (paO2) at the bottom. There were no significant increases in arterial partial pressure of carbon dioxide (paCO2) at the end of descent in 4 of 6 divers, while in 2 divers paCO2 decreased. Arterial mean pH and mean bicarbonate ( HCO 3 - ) levels exhibited minor changes. There was a statistically significant increase in mean arterial lactate level after the exercise. Ours was the first attempt to verify real changes in blood gases at a depth of 40 m during a breath-hold descent in free-divers. We demonstrated that, at depth, relative hypoxemia can occur, presumably caused by lung compression. Also, hypercapnia exists at depth, to a lesser degree than would be expected from calculations, presumably because of pre-dive hyperventilation and carbon dioxide distribution in blood and tissues.

7.
A A Pract ; 11(10): 279-281, 2018 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-29851690

RESUMO

There have been many complications associated with transurethral resection of the prostate (TURP), known as TURP syndrome. Of the various irrigation fluids used for TURP, glycine irrigant has been historically popular given its relatively low cost. It is also a nonconductive solution and only slightly hypoosmolar, reducing the risk of burn injury or significant hemolysis. However, there have been many case reports of central nervous system toxicity such as transient blindness and encephalopathy related to glycine toxicity. Here, we report blue vision (cyanopsia), which has never been reported as a symptom of TURP syndrome.


Assuntos
Glicina/efeitos adversos , Hiponatremia/induzido quimicamente , Complicações Pós-Operatórias/induzido quimicamente , Irrigação Terapêutica/efeitos adversos , Ressecção Transuretral da Próstata/efeitos adversos , Transtornos da Visão/induzido quimicamente , Idoso , Humanos , Masculino , Hiperplasia Prostática/cirurgia , Síndrome
9.
Front Psychol ; 9: 72, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29456518

RESUMO

Man's experience and exploration of the underwater environment has been recorded from ancient times and today encompasses large sections of the population for sport enjoyment, recreational and commercial purpose, as well as military strategic goals. Knowledge, respect and maintenance of the underwater world is an essential development for our future and the knowledge acquired over the last few dozen years will change rapidly in the near future with plans to establish secure habitats with specific long-term goals of exploration, maintenance and survival. This summary will illustrate briefly the physiological changes induced by immersion, swimming, breath-hold diving and exploring while using special equipment in the water. Cardiac, circulatory and pulmonary vascular adaptation and the pathophysiology of novel syndromes have been demonstrated, which will allow selection of individual characteristics in order to succeed in various environments. Training and treatment for these new microenvironments will be suggested with description of successful pioneers in this field. This is a summary of the physiology and the present status of pathology and therapy for the field.

10.
JAMA Otolaryngol Head Neck Surg ; 144(3): 252-258, 2018 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-29450472

RESUMO

Importance: Scuba diving is becoming increasingly popular. However, scuba diving is associated with specific risks; 80% of adults and 85% of juvenile divers (aged 6-17 years) have been reputed to have an ear, nose, or throat complaint related to diving at some point during their diving career. Divers frequently seek advice from primary care physicians, diving physicians, and otorhinolaryngologists, not only in the acute setting, but also related to the long-term effects of diving. Observations: The principles underpinning diving-related injuries that may present to the otorhinolaryngologist rely on gas volume and gas saturation laws, and the prevention of these injuries requires both that the diver is skilled and that their anatomy allows for pressure equalization between the various anatomical compartments. The overlapping symptoms of middle ear barotrauma, inner ear barotrauma, and inner ear decompression sickness can cause a diagnostic conundrum, and a thorough history of both the diver's symptoms and the dive itself are required to elucidate the diagnosis. Correct diagnosis and appropriate treatment result in a more timely return to safe diving. Conclusions and Relevance: The aim of this review is to provide a comprehensive overview of otorhinolaryngological complications during diving. With the increasing popularity of diving and the frequency of ear, nose, or throat-related injuries, it could be expected that these injuries will become more common and this review provides a resource for otorhinolaryngologists to diagnose and treat these conditions.


Assuntos
Mergulho/efeitos adversos , Otorrinolaringopatias/etiologia , Barotrauma/etiologia , Doença da Descompressão/etiologia , Epistaxe/etiologia , Paralisia Facial/etiologia , Humanos
11.
JAMA Otolaryngol Head Neck Surg ; 144(3): 259-263, 2018 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-29450499

RESUMO

Importance: Self-contained underwater breathing apparatus (scuba) diving has become increasingly popular with millions of people diving each year. Otorhinolaryngologists are often consulted either by patients or diving physicians regarding fitness to dive, and at present, the guidelines do not provide comprehensive information regarding the evaluation of this patient cohort. The aim of this review is to provide a comprehensive overview of existing otorhinolaryngological guidelines for fitness to dive recreationally. Observations: There is a paucity of guidelines for assessing otorhinolaryngological fitness to dive in the recreational diver. Comprehensive guidelines exist from US, European, and UK regulatory bodies regarding fitness for commercial diving; however, not all of these can be directly extrapolated to the recreational diver. There are also a variety of conditions that are not covered either by the existing fitness for recreational diving guidelines or the commercial regulatory bodies. Conclusions and Relevance: With the paucity of recreational fitness to dive guidelines we must draw on information from the commercial diving regulatory bodies. We have provided our own recommendations on the conditions that are not covered by either of the above, to provide otorhinolaryngologists with the information they require to assess fitness for recreational diving.


Assuntos
Mergulho , Guias como Assunto , Otolaringologia , Aptidão Física , Humanos , Fatores de Risco
12.
Clin Pharmacol Ther ; 104(3): 553-563, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29238951

RESUMO

Disruption of microvascular blood flow is a common cause of tissue hypoxia in disease, yet no therapies are available that directly target the microvasculature to improve tissue oxygenation. Red blood cells (RBCs) autoregulate blood flow through S-nitroso-hemoglobin (SNO-Hb)-mediated export of nitric oxide (NO) bioactivity. We therefore tested the idea that pharmacological enhancement of RBCs using the S-nitrosylating agent ethyl nitrite (ENO) may provide a novel approach to improve tissue oxygenation. Serial ENO dosing was carried out in sheep (1-400 ppm) and humans (1-100 ppm) at normoxia and at reduced fraction of inspired oxygen (FiO2 ). ENO increased RBC SNO-Hb levels, corrected hypoxia-induced deficits in tissue oxygenation, and improved measures of oxygen utilization in both species. No adverse effects or safety concerns were identified. Inasmuch as impaired oxygenation is a major cause of morbidity and mortality, ENO may have widespread therapeutic utility, providing a first-in-class agent targeting the microvasculature.


Assuntos
Eritrócitos/efeitos dos fármacos , Hipóxia/tratamento farmacológico , Nitritos/administração & dosagem , Oxigênio/sangue , Vasodilatação/efeitos dos fármacos , Vasodilatadores/administração & dosagem , Adolescente , Adulto , Animais , Biomarcadores/sangue , Modelos Animais de Doenças , Eritrócitos/metabolismo , Feminino , Hemoglobinas/metabolismo , Humanos , Hipóxia/sangue , Hipóxia/fisiopatologia , Masculino , Óxido Nítrico/sangue , Nitritos/efeitos adversos , Carneiro Doméstico , Fatores de Tempo , Vasodilatadores/efeitos adversos , Adulto Jovem
13.
Undersea Hyperb Med ; 44(6): 569-580, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29281194

RESUMO

Rebreather diving has one of the highest fatality rates per man hour of any diving activity in the world. The leading cause of death is hypoxia, typically from equipment or procedural failures. Hypoxia causes very few symptoms prior to causing loss of consciousness. Additionally, since the electronics responsible for controlling oxygen levels in rebreathers often control their alarm systems, frequently divers do not receive any external warnings. This study investigated the use of a forehead pulse oximeter as an independent warning device in the event of rebreather failure. Ten test subjects (seven male, three female, median age 29, range 26-35) exercised at a targeted rate of 2 L/minute oxygen consumption while on a non-functional rebreather breathing loop (mean consumption achieved 2.09 ± 0.36 L/minute). Each subject was tested both at the surface and at pressurized depth of 77 fsw (starting pO2=0.7 atm). The data show that a pulse oximeter could be used to provide an Mk 16 rebreather diver with a minimum mean of 49 seconds (± 17 seconds SD) of warning time after a noticeable change in blood oxygen saturation (SpO2 ≤ 95%) but before any risk of loss of consciousness (calculated SpO2 ≤ 80%), so that the diver may take mitigating actions. No statistical difference in warning time was found between the tests at surface and at 77 fsw (P=0.46).


Assuntos
Mergulho/efeitos adversos , Mergulho/fisiologia , Hipóxia/diagnóstico , Hipóxia/etiologia , Monitorização Fisiológica/instrumentação , Oximetria/instrumentação , Adulto , Dióxido de Carbono , Desenho de Equipamento , Falha de Equipamento , Feminino , Humanos , Masculino , Oxigênio/sangue , Consumo de Oxigênio , Respiração
14.
Case Rep Anesthesiol ; 2017: 5796409, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29163991

RESUMO

Paragangliomas and pheochromocytomas are rare neuroendocrine tumors that can have high morbidity and mortality if undiagnosed. Here we report a case of an undiagnosed paraganglioma in a 58-year-old female who underwent tumor resection. The patient became severely hypertensive intraoperatively with paroxysmal swings in blood pressure and then later became acutely hypotensive after tumor removal. She was managed in the surgical intensive care unit (SICU) postoperatively and discharged from the hospital without acute complications. We briefly discuss the epidemiology, clinical presentation, perioperative management, and possible complications of these tumors to assist healthcare providers if one were to encounter them.

15.
Front Physiol ; 8: 652, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28912730

RESUMO

Swimming induced pulmonary edema (SIPE) is a complication that can occur during exercise with the possibility of misdiagnosis and can quickly become life threatening; however, medical literature infrequently describes SIPE. Therefore, the aim of this review was to analyse all individual cases diagnosed with SIPE as reported in scientific sources, with an emphasis on the diagnostic pathways and the key facts resulting in its diagnosis. Due to a multifactorial and complicated pathophysiology, the diagnosis could be difficult. Based on the actual literature, we try to point out important findings regarding history, conditions, clinical findings, and diagnostic testing helping to confirm the diagnosis of SIPE. Thirty-eight cases from seventeen articles reporting the diagnosis of SIPE were selected. We found remarkable differences in the individual described diagnostic pathways. A total of 100% of the cases suffered from an acute onset of breathing problems, occasionally accompanied by hemoptysis. A total of 73% showed initial hypoxemia. In most of the cases (89%), an initial chest X-Ray or chest CT was available, of which one-third (71%) showed radiological signs of pulmonary edema. The majority of the cases (82%) experienced a rapid resolution of symptoms within 48 h, the diagnostic hallmark of SIPE. Due to a foreseeable increase in participation in swimming competitions and endurance competitions with a swimming component, diagnosis of SIPE will be important, especially for medical teams caring for these athletes.

16.
Perioper Med (Lond) ; 6: 13, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28948012

RESUMO

BACKGROUND: While enhanced recovery protocols (ERPs) reduce physiologic stress and improve outcomes in general, their effects on postoperative renal function have not been directly studied. METHODS: Patients undergoing major colorectal surgery under ERP (February 2010 to March 2013) were compared with a traditional care control group (October 2004 October 2007) at a single institution. Multivariable regression models examined the association of ERP with postoperative creatinine changes and incidence of postoperative acute kidney dysfunction (based on the Risk, Injury, Failure, Loss, and End-stage renal disease criteria). RESULTS: Included were 1054 patients: 590 patients underwent surgery with ERP and 464 patients without ERP. Patient demographics were not significantly different. Higher rates of neoplastic and inflammatory bowel disease surgical indications were found in the ERP group (81 vs. 74%, p = 0.045). Patients in the ERP group had more comorbidities (ASA ≥ 3) (62 vs. 40%, p < 0.001). In unadjusted analysis, postoperative creatinine increase was slightly higher in the ERP group compared with control (median 0.1 vs. 0 mg/dL, p < 0.001), but levels of postoperative acute kidney injury were similar in both groups (p = 0.998). After adjustment with multivariable regression, postoperative changes in creatinine were similar in ERP vs. control (p = 0.25). CONCLUSIONS: ERP in colorectal surgery is not associated with a clinically significant increase in postoperative creatinine or incidence of postoperative kidney injury. Our results support the safety of ERPs in colorectal surgery and may promote expanding implementation of these protocols. TRIAL REGISTRATION: Not applicable, prospective data collection and retrospective chart review only.

17.
Undersea Hyperb Med ; 44(1): 73-77, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28768088

RESUMO

Arterial gas embolism (AGE) can be clinically devastating, and is most often associated with exposure to changes in ambient pressure, medical procedure or congenital malformation. Here we report a case of AGE in a 78-year-old male without these traditional risk factors. Rather, the patient's history included chronic obstructive pulmonary disease, necrotizing pneumonia, bullous disease and coughing. He was safely treated with hyperbaric oxygen (HBO2) therapy for AGE, with initial clinical improvement, but ultimately died from his underlying condition. Pathophysiology is discussed. This case illustrates the possibility that AGE can occur due to rupture of lung tissue in the absence of traditional risk factors. HBO2 therapy should be considered in the management of such patients.


Assuntos
Vesícula/complicações , Tosse/complicações , Embolia Aérea/etiologia , Pneumonia Necrosante/complicações , Idoso , Doença Crônica , Embolia Aérea/diagnóstico por imagem , Embolia Aérea/terapia , Evolução Fatal , Humanos , Oxigenação Hiperbárica , Masculino , Pneumonia Necrosante/diagnóstico por imagem , Doença Pulmonar Obstrutiva Crônica/complicações
18.
Undersea Hyperb Med ; 44(3): 191-209, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28779577

RESUMO

Carbon dioxide (CO2) retention, or hypercapnia, is a known risk of diving that can cause mental and physical impairments leading to life-threatening accidents. Often, such accidents occur due to elevated inspired carbon dioxide. For instance, in cases of CO2 elimination system failures during rebreather dives, elevated inspired partial pressure of carbon dioxide (PCO2) can rapidly lead to dangerous levels of hypercapnia. Elevations in PaCO2 (arterial pressure of PCO2) can also occur in divers without a change in inspired PCO2. In such cases, hypercapnia occurs due to alveolar hypoventilation. Several factors of the dive environment contribute to this effect through changes in minute ventilation and dead space. Predominantly, minute ventilation is reduced in diving due to changes in respiratory load and associated changes in respiratory control. Minute ventilation is further reduced by hyperoxic attenuation of chemosensitivity. Physiologic dead space is also increased due to elevated breathing gas density and to hyperoxia. The Haldane effect, a reduction in CO2 solubility in blood due to hyperoxia, may contribute indirectly to hypercapnia through an increase in mixed venous PCO2. In some individuals, low ventilatory response to hypercapnia may also contribute to carbon dioxide retention. This review outlines what is currently known about hypercapnia in diving, including its measurement, cause, mental and physical effects, and areas for future study.


Assuntos
Dióxido de Carbono/sangue , Mergulho/efeitos adversos , Hipercapnia/etiologia , Respiração , Adulto , Dióxido de Carbono/administração & dosagem , Anidrases Carbônicas/metabolismo , Transtornos Cognitivos/etiologia , Feminino , Humanos , Hiperóxia/complicações , Masculino , Pressão Parcial , Troca Gasosa Pulmonar/fisiologia , Ventilação Pulmonar/fisiologia , Espaço Morto Respiratório/fisiologia , Avaliação de Sintomas
19.
Undersea Hyperb Med ; 44(2): 89-92, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28777898

RESUMO

The American College of Emergency Physicians (ACEP) recently published its official policy on the evaluation and management of patients with acute carbon monoxide (CO) poisoning [1], an update of the policy previously published in 2008. Three questions regarding CO poisoning were posed to a 30-person ACEP subcommittee, which employed a comprehensive literature review to attempt to draw conclusions. While this is a major step forward, we feel that their conclusions warrant comment.


Assuntos
Intoxicação por Monóxido de Carbono , Oxigenação Hiperbárica , Adulto , Monóxido de Carbono , Serviço Hospitalar de Emergência , Humanos
20.
BMJ Case Rep ; 20172017 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-28559286

RESUMO

Pneumatosis intestinalis (PI), or the presence of air in the bowel wall, is a rare disorder that is associated with a variety of underlying diseases, including connective tissue disorders. PI presents on a spectrum from asymptomatic to bowel obstruction and acute abdomen. In general, treatment of PI consists of treating the underlying disease. Both normobaric and hyperbaric oxygen have been used to treat PI directly. Here we report a symptomatic scleroderma-related case of PI that responded clinically to hyperbaric oxygen therapy. This report adds to a growing body of literature supporting a role for hyperbaric oxygen therapy in symptomatic PI.


Assuntos
Oxigenação Hiperbárica/métodos , Íleus/complicações , Pneumatose Cistoide Intestinal/complicações , Pneumoperitônio/complicações , Doenças do Tecido Conjuntivo/complicações , Feminino , Humanos , Íleus/etiologia , Achados Incidentais , Pessoa de Meia-Idade , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Pneumatose Cistoide Intestinal/etiologia , Pneumatose Cistoide Intestinal/terapia , Pneumoperitônio/etiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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