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3.
Food Chem ; 286: 160-169, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-30827590

RESUMO

In this study, variations in basic chemical constitutes, organic acids (OAs), free amino acids (FAAs) and free fatty acids (FFAs) during ripening of raw sheep's milk Tulum cheeses in goat's skin bag (GST) or plastic barrel (PBT) were investigated. Ripening in goat's skin caused the differences in chemical compositions of Tulum cheese. Moisture loss, salt-in-moisture, fat and protein contents increased. No residual lactose was observed after 90 day. Lactic acid was principal organic acid, followed by propionic acid, acetic acid, formic acid, succinic acid and citric acid. The majority of amino acids were composed of Val, Pro, Tyr, Met, Leu, Trp, Phe, Lys and Glu. Hexadecanoic acid was the most abundant free fatty acid in the cheeses, which followed by cis-9-octadecenoic, octadecanoic, tetradecanoic, decanoic and trans-9-octadecenoic acids. The levels of total FFA and total OA were higher in GST-cheese in comparison to PBT-cheese but total FAAs were lower.


Assuntos
Queijo , Tecnologia de Alimentos/métodos , Ovinos , Aminoácidos/análise , Animais , Queijo/análise , Ácidos Graxos não Esterificados/análise , Tecnologia de Alimentos/instrumentação , Formiatos , Glicólise , Cabras , Lactose/análise , Lipólise , Leite/química , Proteínas do Leite/análise , Proteólise
4.
Ultrasound Q ; 2019 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-30855419

RESUMO

We aimed to emphasize which method should be prioritized by comparing the ultrasound and computed tomography (CT) guidance for percutaneous transthoracic biopsy of pleural-based lung lesions in terms of comorbidity, diagnostic success, time, and costs.Approximately 700 biopsy procedures performed between 2014 and 2018 were retrospectively reviewed. The files of these patients and picture archiving and communication system were scanned.Size and localization of the lesion, pathological diagnosis, comorbidity status, pneumothorax complications at the end of the procedure, and whether or not a thoracic tube was placed due to pneumothorax were recorded. Fisher exact test and Pearson χ test were used for statistical analysis.A total of 181 patients who underwent the pleural-based biopsy procedure, the subject of study, were included in the study. One hundred (55.2%) of the biopsy procedures of these patients were performed under the guidance of tomography, and 81 (44.8%) were performed under the guidance of ultrasound (US). Median size of the lesions is 38 mm (25%-75%, 33-55 mm). Pneumothorax complications were observed in 6 patients (6%) who had CT-guided procedures and 4 patients (4.9%) who had US-guided procedures. Of the patients who developed pneumothorax, 2.8% were inserted thoracic tubes owing to the complication. Diagnostic efficacy of our procedures is 99.8% in US-guided procedures and 97% in CT-guided transthoracic biopsy. The average duration of US-guided transthoracic biopsy procedures is 17 minutes, and the average duration of CT-guided biopsy procedures is 35 minutes.

5.
Braz J Cardiovasc Surg ; 34(1): 114-117, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30810686

RESUMO

Buerger's disease, vasculitis of small and medium-sized blood vessels, is a non-atherosclerotic and progressive occlusive condition which frequently involves the distal part of the limbs. The occlusion of coronary arteries in Buerger's disease is a rare condition; however, coronary artery dissection has not been reported previously. Therefore, this paper presents a 45-year-old man who developed coronary artery dissection associated with Buerger's disease. The patient was treated successfully with coronary artery bypass grafting with the left internal mammary artery to the left anterior descending artery, and saphenous vein graft to the right coronary artery.


Assuntos
Doença da Artéria Coronariana/etiologia , Oclusão Coronária/etiologia , Tromboangiite Obliterante/complicações , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/cirurgia , Humanos , Masculino , Artéria Torácica Interna/cirurgia , Pessoa de Meia-Idade , Veia Safena/transplante , Tromboangiite Obliterante/cirurgia
6.
Rev. bras. cir. cardiovasc ; 34(1): 114-117, Jan.-Feb. 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-985245

RESUMO

Abstract Buerger's disease, vasculitis of small and medium-sized blood vessels, is a non-atherosclerotic and progressive occlusive condition which frequently involves the distal part of the limbs. The occlusion of coronary arteries in Buerger's disease is a rare condition; however, coronary artery dissection has not been reported previously. Therefore, this paper presents a 45-year-old man who developed coronary artery dissection associated with Buerger's disease. The patient was treated successfully with coronary artery bypass grafting with the left internal mammary artery to the left anterior descending artery, and saphenous vein graft to the right coronary artery.

7.
Radiol Case Rep ; 14(2): 168-170, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30416638

RESUMO

Hydatid cyst disease is very rare in pregnancy having an incidence of 1 in 20,000 pregnancies and there is no recommended standard treatment. Both surgical and medical modalities have been tried. Modalities that do not use ionizing radiation such as ultrasound and magnetic resonance imaging should be preferred for diagnosis and evaluating acute conditions in a pregnant patient. In this article, a rare pelvic cyst hydatid case surrounding the uterus and MRI findings in a young pregnant patient who was coincidentally determined is represented.

8.
Turk J Pediatr ; 61(3): 436-439, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31916725

RESUMO

Tekin A, Yagmur I, Ergün O, Ayik MF, Atay Y, Ulman I, Avanoglu A. Excision of the atrial Wilms` tumor thrombus without sternotomy, atriotomy and cardiovascular By-pass. Turk J Pediatr 2019; 61: 436-439. The treatment of atrial-extention Wilms` tumor thrombus is surgical excision after chemotherapy. Atriotomy with cardiovascular by-pass is the one of the most common method for this procedure. Herein, we aimed to present a case of Wilms` tumor with a tumor thrombus extending into the right atrium totally excised with retrohepatic cavatomy. A 3.5 year-old girl was admitted with the symptom of dysuria. The examinations revealed a mass consistent with Wilms` tumor in the middle and lower poles of the left kidney. Doppler ultrasound and Echocardiographic examinations showed a tumor thrombus extending into the right atrium and some pulmonary nodules which were interpreted to be metastasis. Wilms` tumor was histopathologically diagnosed by an open biopsy. After three courses of chemotherapy imaging studies revealed that the atrial axtention of the tumor thrombus persisted. The tumor thrombus was found to be fibrotic on the magnetic resonance imaging scan of the patient. Therefore, nephroureterectomy along with the excision of the tumor thrombus from the inferior vena cava was done with intraoperative continuous trans-esophageal echocardiography (TEE). The suprarenal and retrohepatic vena cava were exposed by dissecting and ligating all short hepatic veins and completely mobilizing the right lobe of the liver. The thrombus was dissected out via Vertical cavatomy at the retrohepatic level. TEE confirmed complete removal of the thrombus from the atrium; Vena cava was then repaired. There was no need for a blood transfusion, or cardiovascular by-pass (CPB) during the operation. Total exposure of the retrohepatic and subdiaphragmatic vena cava using transplantation techniques is an effective method for the excision of a tumor thrombus without sternotomy, atriotomy and CPB, avoiding possible intra- and postoperative complications in selected cases of Wilms` tumor with intraatrial thrombus extension. The case emphasises the importance of multidisciplinary communication and collaboration.

9.
Int. braz. j. urol ; 44(6): 1194-1199, Nov.-Dec. 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-975658

RESUMO

ABSTRACT Introduction: Various bulking agents were utilized for endoscopic correction of VUR. A study reviewing multi-institutional data showed that the amount of injection material has increased over time with the purpose of improving success rates, which also resulted in costs. We noticed an opposite trend in our center since we started using a new bulking agent. The aim of this study was to evaluate evolution of our practice with different bulking agents. Patients and Methods: Records of VUR patients who underwent subureteric injection with polyacrylate polyalcohol copolymer (PPC) and dextronomere hyaluronic acide (DxHA) between 2005 and 2014 were reviewed. Variation of different parameters throughout the study period was evaluated along with the success rate. Success was defined as complete resolution of reflux. Results: A total of 260 patients with 384 refluxing units were included. The success rate was higher in PPC group compared to DxHA group. There was no statistically significant difference between years regarding distribution of VUR grade, body weight, patient height, and age in PPC group. Despite significant reduction in injection volume, success rate did not decrease through the years with PPC. Conclusion: Different bulking agents may require different injection volumes to achieve the same success rate in endoscopic treatment of vesicoureteral reflux. Habits gained with previous experience using other materials should be revised while using a new agent.

10.
Int Braz J Urol ; 44(6): 1194-1199, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30325612

RESUMO

INTRODUCTION: Various bulking agents were utilized for endoscopic correction of VUR. A study reviewing multi-institutional data showed that the amount of injection material has increased over time with the purpose of improving success rates, which also resulted in costs. We noticed an opposite trend in our center since we started using a new bulking agent. The aim of this study was to evaluate evolution of our practice with different bulking agents. PATIENTS AND METHODS: Records of VUR patients who underwent subureteric injection with polyacrylate polyalcohol copolymer (PPC) and dextronomere hyaluronic acide (DxHA) between 2005 and 2014 were reviewed. Variation of different parameters throughout the study period was evaluated along with the success rate. Success was defined as complete resolution of reflux. RESULTS: A total of 260 patients with 384 refluxing units were included. The success rate was higher in PPC group compared to DxHA group. There was no statistically significant difference between years regarding distribution of VUR grade, body weight, patient height, and age in PPC group. Despite significant reduction in injection volume, success rate did not decrease through the years with PPC. CONCLUSION: Different bulking agents may require different injection volumes to achieve the same success rate in endoscopic treatment of vesicoureteral reflux. Habits gained with previous experience using other materials should be revised while using a new agent.


Assuntos
Resinas Acrílicas/administração & dosagem , Materiais Biocompatíveis/administração & dosagem , Dextranos/administração & dosagem , Ácido Hialurônico/administração & dosagem , Polímeros/administração & dosagem , Refluxo Vesicoureteral/terapia , Criança , Pré-Escolar , Seguimentos , Humanos , Resultado do Tratamento , Ureteroscopia
11.
Medicine (Baltimore) ; 97(35): e12146, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30170456

RESUMO

BACKGROUND: We aimed to compare off-pump technique with on-pump technique on renal function in patients with nondialysis-dependent renal dysfunction who underwent coronary artery bypass grafting. METHODS: The 94 patients with renal dysfunction undergoing isolated coronary artery bypass grafting were retrospectively analyzed. No patient was receiving dialysis. Patients were randomly assigned to conventional revascularization with cardiopulmonary bypass and beating heart. Both groups were compared in terms of renal dysfunction parameters and dialysis requirement. The logistic regression models were constructed to identify risk factors associated with dialysis requirement. RESULTS: Renal dysfunction requiring dialysis developed in 9 patients in the on-pump group. The measures analysis of variance was performed on the data that showed worsening of renal function in the on-pump group compared with the off-pump group. Cardiopulmonary bypass is significant as independent predictor for the development of postoperative dialysis. CONCLUSION: These results suggest that off-pump coronary revascularization offers a superior renal protection and has a significantly lower risk for renal complications in patients with nondialysis-dependent renal dysfunction when compared with conventional coronary revascularization with cardiopulmonary bypass.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Complicações Pós-Operatórias/etiologia , Insuficiência Renal Crônica/fisiopatologia , Ponte de Artéria Coronária/métodos , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Doença da Artéria Coronariana/complicações , Feminino , Humanos , Rim/patologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/cirurgia , Estudos Retrospectivos , Fatores de Risco
12.
Radiol Case Rep ; 13(3): 697-701, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29682142

RESUMO

Hydatid disease is caused by the larvae of Echinococcus granulosus. Domestic dogs and cats are the primary carriers of echinococcal organisms. In some particular regions of the world, this parasitic infection is still endemic. Despite the fact that hydatid disease is most frequently located in the liver (50%-70% of cases) and the lungs (20%-30% of cases), it can occur in any organ or tissue. However, intracardiac localization of hydatid cyst is very rare and it is found in less than 2% of the cases. Cardiac involvement can be caused by systemic or pulmonary circulation or direct spread from adjacent structures. After the cardiac hydatid cyst remained asymptomatic for many years, the cyst opens into the pericardium, causes cardiac tamponade, and mimics acute coronary syndrome, or it may get into the circulation and cause anaphylactic shock, which happens rarely. Because clinical signs and symptoms of cardiac hydatid cyst are not specific and varied, it may be difficult to diagnose this disease. It is critical to diagnose cardiac involvement early and perform prompt surgical intervention. Imaging findings of a patient who had a left ventricular wall cardiac hydatid disease are presented here.

13.
J Clin Res Pediatr Endocrinol ; 10(3): 216-222, 2018 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-29595517

RESUMO

Objective: Disorders of sex development (DSD) is a nomenclature intended to defeat the discomfort of families and patients and has found worldwide usage. The aim of this study was to address the perception and usage of terminology among the parents of DSD patients in a tertiary center in western Turkey. Methods: The records of the DSD council (multidisciplinary team where each patient with DSD is discussed) between years 2008-2015 were reviewed retrospectively. Data including details of the management process, patient characteristics and follow-up details were noted. Then inquiries reflecting parental perception about terminology were implemented during clinical visits. Results: In total, 121 patients were evaluated in monthly meetings of the DSD council and 79 inquiries were completed. Fifty-one percent of the families admitted knowing the terms DSD, ambiguous genitalia, "dubious genitals" and intersex. However, only 2% preferred using DSD, 6% intersex and 14% ambiguous genitalia. Fifty-two percent of the parents used a disease name in Latin (mostly hypospadias) addressing the disorder. The offspring of 69% of the parents who were familiar with the name "dubious genitals" were diagnosed in the neonatal period. The preferred terminology used by parents was strongly associated with the terminology used most commonly in the medical speciality their child most often attended. Conclusion: Each country has its own social norms. We suggest therefore that local committees including medical professionals, patients and families should be employed to develop proper terminology.


Assuntos
Transtornos do Desenvolvimento Sexual , Conhecimentos, Atitudes e Prática em Saúde , Pais , Terminologia como Assunto , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Inquéritos e Questionários , Turquia
17.
J Knee Surg ; 31(3): 277-283, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28561157

RESUMO

The posterior tibial slope (PTS) is important for performing a tibial cut that does not injure the posterior cruciate ligament (PCL). In this study, the amount of PCL fibers sacrificed under simulated tibial cuts with varying posterior inclinations was evaluated using magnetic resonance images (MRIs) of osteoarthritic varus knees. Knee X-rays, orthoroentgenograms, and MRIs of 113 Kellgren and Lawrence grades 3 to 4 osteoarthritic knees were included. Four different simulated tibial cuts were performed at 0, 3, 5 degrees and parallel to the tibia plateau 3 mm below of the most defective part of the cartilage in the medial plateau. Correlations between the PCL avulsion amount and the PTS and varus alignment of the lower extremity were analyzed for all four simulated tibial cut levels. The maximum amount of PCL was preserved with a 0-degree tibial cut in patients with a PTS of more than 8 degrees. With increased tibial cut angles, the posterior slope resulted in an increased amount of avulsed PCL. Although the amount of avulsed PCL was proportional with the varus alignment, it was inversely proportional with the sagittal slope. The number of injured PCLs also increased as the slope of the tibial cuts increased. Patients with mild varus alignments and high PTSs are more suitable for cruciate retaining total knee arthroplasty.


Assuntos
Artroplastia do Joelho/métodos , Mau Alinhamento Ósseo/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Ligamento Cruzado Posterior/lesões , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/efeitos adversos , Mau Alinhamento Ósseo/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Ligamento Cruzado Posterior/diagnóstico por imagem
18.
Wideochir Inne Tech Maloinwazyjne ; 12(3): 285-290, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29062450

RESUMO

INTRODUCTION: Surgical treatment of isolated left anterior descending coronary artery disease can be performed with either minimally invasive direct coronary artery bypass via a left anterior thoracotomy (MIDCAB) or off-pump coronary artery bypass via a median sternotomy (OPCAB). AIM: To compare the perioperative outcomes of patients undergoing MIDCAB or OPCAB surgery. MATERIAL AND METHODS: Patients who underwent either MIDCAB or OPCAB for isolated left anterior descending (LAD) coronary artery disease between October 2013 and December 2015 were retrospectively evaluated. Operations were carried out by the same surgical team. Preoperative, intraoperative and postoperative data of the patients were recorded for analyses. RESULTS: Twenty-three patients (7 females, 16 males) underwent MIDCAB surgery, and 24 patients (4 female, 20 males) underwent OPCAB surgery. The two groups were comparable regarding preoperative patient characteristics. Duration of mechanical ventilation (5.1 ±0.7 h vs. 6.6 ±0.9 h), intensive care unit stay (19.4 ±2.5 h vs. 45.8 ±5.4 h) and hospital stay (4.3 ±0.4 days vs. 5.6 ±0.8 days) were significantly shorter in the MIDCAB group (p < 0.01). Patients in the OPCAB group required significantly more blood transfusions (1.83 ±0.38 units vs. 0.17 ±0.38 units) and fresh frozen plasma use (2.33 ±0.96 units vs. 0.69 ±0.76 units) (p < 0.01). Conversion to sternotomy was not required in the MIDCAB group. There was no mortality, conversion to cardiopulmonary bypass or serious complication in either group. CONCLUSIONS: We believe that the MIDCAB technique is more advantageous than the OPCAB technique in the treatment of patients with a critical LAD lesion.

19.
J Orthop Surg (Hong Kong) ; 25(3): 2309499017727949, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28862100

RESUMO

PURPOSE: The aim of this study was to assess applicability of arthroscopic technique in intramedullary nail fixation of humerus shaft fractures and to compare with conventional nailing in terms of its effects on perioperative and postoperative intra-articular complication rates as well as on clinical and functional outcomes. METHODS: This prospective randomized controlled clinical trial included 40 patients (12 females and 28 males) indicated for surgery between either undergo arthroscopy-assisted (Arthroscopy-assisted intramedullary nailing [AIMN]; n = 20) or conventional (Intramedullary nailing [IMN]; n = 20) anterograde intramedullary nailing. Two groups were compared in terms of mean number of fluoroscopic shootings until the guide wire was inserted, time for union, length of hospital stay, and complication rates. Shoulder functions were assessed by Constant and American Shoulder and Elbow Surgeons (ASES) score. RESULTS: Groups did not significantly differ in terms of age, gender, and mechanism of injury, length of hospital stay, union rate, and mean union time ( p > 0.05). Mean ASES and Constant scores were found to be statistically significantly higher in AIMN group than that in IMN group ( p = 0.000 and p = 0.002, respectively). Mean number of fluoroscopic shootings until the guide wire was inserted was 2.15 in AIMN group, which was significantly lower compared to 4.2 of IMN group ( p = 0.000). CONCLUSIONS: Arthroscopy-assisted technique may be an applicable and safe method owing to its cosmetic advantages and more satisfactory postoperative shoulder functions subsequent to less injury to deltoid, rotator cuff, and other soft tissue, as compared to conventional anterograde approach.


Assuntos
Artroscopia , Fixação Intramedular de Fraturas/métodos , Fraturas do Úmero/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Articulação do Cotovelo , Feminino , Fluoroscopia , Fixação Intramedular de Fraturas/efeitos adversos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recuperação de Função Fisiológica , Resultado do Tratamento , Adulto Jovem
20.
Ann Vasc Surg ; 45: 166-172, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28647634

RESUMO

BACKGROUND: Varices and venous insufficiency are common and serious health problems in the general population which affect the quality of life. Endothermal treatment of the great saphenous vein has become the first line of treatment for superficial venous reflux, and the endovenous laser ablation (EVLA) method has been widely accepted all over the world. In this method, ablation is provided by a laser fiber inserted into the lumen of the vein. Initially, the fibers were 810 nm, but today the fibers are usually 940, 980, or 1470 nm. METHODS: The study included 400 patients (419 procedures) who were diagnosed with venous insufficiency and underwent 980 and 1470 nm EVLA. Patients were followed up for 48 months. A 980-nm bare-tip laser catheter in Group A and a 1470-nm radial-tip laser catheter in Group B were inserted until they were 2 cm below the saphenofemoral junction. An EVLA catheter was drawn slowly at the rate of 1-3 cm/sec (2.08 ± 0.6). The energy applied to the saphenous vein was 60-120 J/cm (84.65 ± 13.03) and 45-120 J/cm (76.95 ± 15.06) in Group A and Group B, respectively (P < 0.001), with 15 W in the continuous mode. Follow-up visits included a physical examination and Doppler ultrasonography performed at the following time points: day 1, week 1, and months 1, 6, 12, 24, 36, and 48. Saphenous vein occlusion rates and postprocedure saphenous vein diameters were evaluated at each follow-up visit. Pain levels were evaluated using the Wong-Baker FACES® pain scale (0-10). Postoperative complications were recorded. RESULTS: Group A (980 nm laser) consisted of 200 patients with a mean age of 37.84 ± 12.2 years. Group B (1470 nm laser) consisted of 200 patients with a mean age of 38.38 ± 12.1 years. The mean duration of the procedure was 32.2 ± 9.7 min in Group A and 31.7 ± 8.8 min in Group B, respectively (P = 0.47). Induration, ecchymosis, and paresthesia rates were significantly higher in the bare-tip laser group. The most important complication, deep vein thrombosis, was observed in 4 patients in Group A. Recanalization rates were found to be increased by prolonged follow-up periods. At the 48-month follow-up, this rate was 15.9% in Group A and 8.3% in Group B (P = 0.017). This rate showed that the 1470-nm wavelength laser treatment was more successful in Group B than in Group A over the long term. CONCLUSIONS: Both the 980 and 1470 nm wavelength laser-assisted EVLA procedures appear to be effective in treating saphenous vein insufficiency. The 1470-nm radial-tip fiber is preferred due to lower energy levels, lower complication rates, early return to daily life, and the successful long-term occlusion rate.


Assuntos
Procedimentos Endovasculares/instrumentação , Terapia a Laser/instrumentação , Veia Safena/cirurgia , Insuficiência Venosa/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Endovasculares/efeitos adversos , Desenho de Equipamento , Feminino , Humanos , Terapia a Laser/efeitos adversos , Lasers/efeitos adversos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/etiologia , Veia Safena/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler , Insuficiência Venosa/diagnóstico por imagem , Adulto Jovem
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