Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 16.408
Filtrar
3.
Ther Umsch ; 77(6): 281-286, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32930076

RESUMO

The role of the reconstructive surgeon treating neuropathic pain after iatrogenic nerve lesions Abstract. Any surgical intervention bears the potential risk of iatrogenic nerve lesions with consecutive functional deficits and chronic neuropathic pain syndromes. These complications obviously result in patient dissatisfaction and frequently bear legal consequences. A broad experience in diagnosis and treatment of peripheral nerve lesions is needed to initiate the proper diagnostics and treatment modalities in an according time frame. The quick and appropriate response after any nerve trauma is an important criterion for success or failure of the reconstruction. Surgeons from other specialities, who do not deal with nerve lesions in their daily routine, need a distinct overview about diagnostics and treatment, to initiate the adequate therapy shortly after the injury. This review provides an overview of peripheral nerve lesions, the underlying pathomechanisms, the diagnosis and reconstructive treatment options. Even with highest accuracy and experience, nerve lesions are part of any surgical practice. However, we are convinced that with adequate and prompt action of the primary surgeon a good patient-doctor relationship may be maintained, often more favourable results may be achieved after reconstruction and legal trials avoided.


Assuntos
Neuralgia/diagnóstico , Neuralgia/etiologia , Cirurgiões , Humanos , Doença Iatrogênica , Nervos Periféricos
5.
Bone Joint J ; 102-B(10): 1324-1330, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32993324

RESUMO

AIMS: Inadvertent soft tissue damage caused by the oscillating saw during total knee arthroplasty (TKA) occurs when the sawblade passes beyond the bony boundaries into the soft tissue. The primary objective of this study is to assess the risk of inadvertent soft tissue damage during jig-based TKA by evaluating the excursion of the oscillating saw past the bony boundaries. The second objective is the investigation of the relation between this excursion and the surgeon's experience level. METHODS: A conventional jig-based TKA procedure with medial parapatellar approach was performed on 12 cadaveric knees by three experienced surgeons and three residents. During the proximal tibial resection, the motion of the oscillating saw with respect to the tibia was recorded. The distance of the outer point of this cutting portion to the edge of the bone was defined as the excursion of the oscillating saw. The excursion of the sawblade was evaluated in six zones containing the following structures: medial collateral ligament (MCL), posteromedial corner (PMC), iliotibial band (ITB), lateral collateral ligament (LCL), popliteus tendon (PopT), and neurovascular bundle (NVB). RESULTS: The mean 75th percentile value of the excursion of all cases was mean 2.8 mm (SD 2.9) for the MCL zone, mean 4.8 mm (SD 5.9) for the PMC zone, mean 3.4 mm (SD 2.0) for the ITB zone, mean 6.3 mm (SD 4.8) for the LCL zone, mean 4.9 mm (SD 5.7) for the PopT zone, and mean 6.1 mm (SD 3.9) for the NVB zone. Experienced surgeons had a significantly lower excursion than residents. CONCLUSION: This study showed that the oscillating saw significantly passes the edge of the bone during the tibial resection in TKA, even in experienced hands. While reported neurovascular complications in TKA are rare, direct injury to the capsule and stabilizing structures around the knee is a consequence of the use of a hand-held oscillating saw when making the tibial cut. Cite this article: Bone Joint J 2020;102-B(10):1324-1330.


Assuntos
Artroplastia do Joelho/instrumentação , Doença Iatrogênica , Lesões dos Tecidos Moles/etiologia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Desenho de Equipamento , Humanos , Fatores de Risco , Tomografia Computadorizada por Raios X
6.
Medicine (Baltimore) ; 99(33): e21727, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872054

RESUMO

INTRODUCTION: Reports pertaining to ureteral injury sustained during lumbar disc surgery are rare; most ureteral injuries in this setting involve laceration or transection. PATIENT CONCERNS: We report a rare case of a 55-year-old man who presented with complete left ureteral necrosis 20 days after sustaining ureteral transection during lumbar disc surgery. DIAGNOSIS: The patient presented with seroperitoneum caused by left ureteral injury; post-operative histopathological examination of surgical specimen after discectomy had revealed ureter-like tissue. Exploratory laparoscopic surgery revealed necrosis of a long segment of ureter, which was not amenable to treatment with conventional methods. INTERVENTION: We used a spiral bladder muscle flap with vascular pedicles to repair the ureteral defect. OUTCOMES: Post-operative period was uneventful and the patient showed good recovery. CONCLUSION: Spiral bladder muscle flap with vascular pedicles may be used to repair extensive ureteric injury.


Assuntos
Discotomia/efeitos adversos , Vértebras Lombares/cirurgia , Complicações Pós-Operatórias/etiologia , Ureter/lesões , Angiografia por Tomografia Computadorizada , Humanos , Doença Iatrogênica , Masculino , Pessoa de Meia-Idade , Necrose , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/cirurgia , Ureter/diagnóstico por imagem , Ureter/patologia , Ureter/cirurgia , Urografia
7.
Medicine (Baltimore) ; 99(36): e22013, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899052

RESUMO

BACKGROUND: Intensive care unit-acquired weakness (ICU-AW) is an acquired neuromuscular lesion and a common occurrence in patients who are critically ill. We will systematically summarize and incorporate the important risk factors and prevalence from previously published multivariate analyses for ICU-AW. METHODS: We will search the PubMed, Embase, Web of Science, and the Cochrane library to identify the relevant studies about the prevalence and risk factors for ICU-AW. Two reviewers will independently review the studies for eligibility according to the inclusion criteria. Two reviewers will independently assess the quality of studies by using the Newcastle-Ottawa scale for nonrandomized studies. Heterogeneity among studies will be estimated by the I statistic. RESULTS: This systematic review and meta-analysis will provide an evidence of prevalence and risk factors for the ICU-AW. CONCLUSION: We hope that our research will contribute to clinicians and public decision making about the ICU-AW.


Assuntos
Estado Terminal , Doença Iatrogênica/epidemiologia , Unidades de Terapia Intensiva , Debilidade Muscular/epidemiologia , Humanos , Metanálise como Assunto , Prevalência , Fatores de Risco , Revisões Sistemáticas como Assunto
8.
Rev. Asoc. Odontol. Argent ; 108(2): 63-67, mayo-ago. 2020. ilus
Artigo em Espanhol | LILACS | ID: biblio-1121413

RESUMO

Objetivo: Presentar un caso clínico de dos premolares inferiores con perforación radicular iatrogénica obturadas con Biodentine. Caso clínico: Una paciente de 54 años de edad fue derivada para realizar el tratamiento endodóntico en las piezas dentarias 44 y 45. Los exámenes clínico y radiográfico revelaron la presencia de perforaciones radiculares, cuya localización fue confirmada por medio de una tomografía computarizada de haz cónico. Luego de la desinfección y la instrumentación de los conductos radiculares, ambas perforaciones fueron selladas con Biodentine. Finalmente, los conductos fueron obturados, y las cavidades de acceso, restauradas con resina compuesta. Una semana después los dientes se encontraban asintomáticos y sin tumefacción. La paciente fue controlada nuevamente a los 20 meses postratamiento. Al examen clínico, ambos dientes estaban asintomáticos y funcionales. No hubo signos de infección, inflamación o sensibilidad a la percusión y la palpación. Las imágenes radiográficas y tomográficas revelaron espacio periodontal y cortical ósea normales. Conclusión: En el presente caso clínico, el Biodentine resultó un material adecuado para la obturación de perforaciones radiculares de origen iatrogénico ubicadas en la unión de los tercios medio y coronal (AU)


Aim: To present a clinical case of two lower premolars with iatrogenic root perforations in which both defects were repaired with Biodentine. Clinical case: A healthy 54-year old female was referred for endodontic treatment of teeth number 44 and 45. Clinical and radiographic examination revealed the presence of root perforations whose buccal localization was confirmed by a cone beam computed tomography scan. After the root canals were instrumented, both perforations were filled with Biodentine. The canals were obturated and the endodontic accesses were restored. A week later, the teeth were asymptomatic and without the presence of swelling. The patient was recalled 20-months after treatment and both teeth were asymptomatic and functional with no signs of infection, inflammation or sensitivity to percussion and palpation. Radiograph and cone beam computed tomography images showed a normal periodontal width and an intact lamina dura. Conclusion: Based on the outocome of this clinical case, Biodentine was an adequate material to repair iatrogenic root perforations (AU)


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Materiais Restauradores do Canal Radicular/uso terapêutico , Cimento de Silicato/uso terapêutico , Raiz Dentária/lesões , Doença Iatrogênica , Tratamento do Canal Radicular , Sinais e Sintomas , Dente Pré-Molar/diagnóstico por imagem , Resultado do Tratamento , Tomografia Computadorizada de Feixe Cônico
9.
Medicine (Baltimore) ; 99(31): e21474, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756170

RESUMO

RATIONALE: Tibial nerve injury is a sustainable but rare complication during total-ankle arthroplasty (TAA). We outlined 2 previously unreported cases of tibial nerve injury in TAA, including the prognoses and possible causes. PATIENT CONCERNS: First, a 63-year-old woman complained of a 5-month history of persistent tingling sensation and numbness on the medial and plantar aspects of her foot after TAA. Second, a 50-year-old woman complained of a 6-month history of tingling sensation and numbness on the plantar surface of her forefoot after TAA. DIAGNOSIS: Explorations were performed on suspicion of tarsal tunnel syndrome; however, both patients exhibited complete laceration of tibial nerve with neuroma formation. INTERVENTIONS: In both patients, we excised the neuroma and performed end-to-end nerve repair. OUTCOMES: The sensory disturbance of the sole considerably improved at long-term follow-up over 8 years after the neurorrhaphy procedures. LESSONS: Tibial nerve injury is rare following TAA, and is sometimes unrecognized or misdiagnosed. If tibial nerve injury is suspected, prompt surgical exploration should be performed; great precaution must also be taken to prevent injury of the tibial nerve during TAA.


Assuntos
Artroplastia de Substituição do Tornozelo/efeitos adversos , Neuroma/cirurgia , Parestesia/etiologia , Nervo Tibial/lesões , Assistência ao Convalescente , Feminino , Pé/fisiopatologia , Humanos , Hipestesia/etiologia , Doença Iatrogênica/epidemiologia , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Síndrome do Túnel do Tarso/diagnóstico , Nervo Tibial/patologia , Resultado do Tratamento
11.
Plast Reconstr Surg ; 146(3): 283e-291e, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32842101

RESUMO

BACKGROUND: As rhinoplasty techniques have evolved to more extensive dissections, the incidence of iatrogenic deformities, such as alar rim retraction, has risen. Its mechanism is presently unknown. This study examined the microscopic anatomy of the nasal ala to define architectural support elements at the histologic level to determine why rhinoplasty dissection creates such deformities. METHODS: Eight cadaveric noses were harvested and sectioned through the soft triangle and ala. Various tissue stains were performed. Slides were examined using light microscopy. Anatomical features pertaining to cartilage, skin, mucosa, elastic fibers, and muscle were documented. RESULTS: Four male and four female noses were sectioned. The median cadaver age was 64 years (range, 47 to 83 years). On Elastica van Gieson stain, distinct elastic fibers span from the vestibular lining to the caudal margin of the lower lateral cartilage, and from the caudal edge of the lower lateral cartilage to the external alar skin. In the nasal ala midsection, trichrome stains reveal that skeletal muscle is located far beyond the lower lateral cartilage, close to the free alar margin. The soft triangle shows a distinct microanatomical structure, with heavy longitudinal condensations of elastin. These histologic findings have not been previously reported. CONCLUSIONS: A distinct anatomical alar wall endoskeleton has been identified. It is obligatorily disrupted by specific rhinoplasty maneuvers when dissection is carried out over the lateral crura and into areas without cartilaginous support. This microanatomy may explain factors that contribute to postoperative alar wall retraction. Leaving this area undisturbed or performing adjunctive measures with rhinoplasty can provide structural support to the external valves, thus minimizing the risk of deformity.


Assuntos
Deformidades Adquiridas Nasais/etiologia , Nariz/anatomia & histologia , Complicações Pós-Operatórias/etiologia , Rinoplastia/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Doença Iatrogênica , Masculino , Pessoa de Meia-Idade
12.
J Am Acad Orthop Surg ; 28(16): 651-659, 2020 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-32769716

RESUMO

Hip arthroscopy is rapidly growing as a treatment with good outcomes for pathologic conditions such as femoroacetabular impingement syndrome and labral tears. At the same time, it is one of the most technically challenging and demanding procedures in orthopaedics with a technically demanding skill. The first challenge is to safely access the joint, which requires accurate anatomical knowledge, a strong sense of spatial orientation, and repeated practice. Iatrogenic chondrolabral injury has been reported as the most common complication in hip arthroscopy and most frequently occurs during hip joint access. As such, basic foundations cannot be overstated. These complications can be minimized with adequate patient positioning, reproducible hip joint access techniques, and proper portals placement. Nonetheless, these three points are perhaps the greatest hurdles that orthopaedic surgeons face when entering the hip arthroscopy field. In this review, we outlined a stepwise approach for a safe access to hip arthroscopy.


Assuntos
Artroscopia/métodos , Articulação do Quadril/cirurgia , Posicionamento do Paciente/métodos , Decúbito Dorsal , Artroscopia/efeitos adversos , Impacto Femoroacetabular/cirurgia , Articulação do Quadril/anatomia & histologia , Humanos , Doença Iatrogênica/prevenção & controle , Lesões do Manguito Rotador/cirurgia , Segurança
13.
Kyobu Geka ; 73(7): 547-551, 2020 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-32641676

RESUMO

BACKGROUND: Tracheobronchial injury is often operated urgently because of the risk of high mortality. However, small injuries can recover by conservative management. CASE: A 65-year-old man was treated for esophageal varix with transcatheter arterial embolization therapy. He vomited blood and endoscopic sclerotherapy was performed because a Sengstaken-Blake-more tube could not be inserted. Thereafter, computed tomography( CT) detected mediastinal emphysema and an injury to his left main bronchus. The patient consulted our department and bronchoscopy detected a laceration of the left main bronchus. Conservative management was chosen because the laceration was limited to the membranous portion, with the improvement of inflammatory reaction. Several weeks later, CT and bronchoscopy confirmed recovery from the injury of the left main bronchus without stricture. CONCLUSION: An operation is indicated for many tracheobronchial injuries. However, some injuries can recover with conservative management. It is important that indication for surgery should be considered based on bronchoscopic findings and the progress of inflammatory reaction.


Assuntos
Brônquios , Enfisema Mediastínico , Idoso , Broncoscopia , Humanos , Doença Iatrogênica , Masculino , Traqueia
15.
J Vasc Surg ; 72(4): 1184-1195.e3, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32682063

RESUMO

OBJECTIVE: During the COVID-19 pandemic, central venous access line teams were implemented at many hospitals throughout the world to provide access for critically ill patients. The objective of this study was to describe the structure, practice patterns, and outcomes of these vascular access teams during the COVID-19 pandemic. METHODS: We conducted a cross-sectional, self-reported study of central venous access line teams in hospitals afflicted with the COVID-19 pandemic. To participate in the study, hospitals were required to meet one of the following criteria: development of a formal plan for a central venous access line team during the pandemic; implementation of a central venous access line team during the pandemic; placement of central venous access by a designated practice group during the pandemic as part of routine clinical practice; or management of an iatrogenic complication related to central venous access in a patient with COVID-19. RESULTS: Participants from 60 hospitals in 13 countries contributed data to the study. Central venous line teams were most commonly composed of vascular surgery and general surgery attending physicians and trainees. Twenty sites had 2657 lines placed by their central venous access line team or designated practice group. During that time, there were 11 (0.4%) iatrogenic complications associated with central venous access procedures performed by the line team or group at those 20 sites. Triple lumen catheters, Cordis (Santa Clara, Calif) catheters, and nontunneled hemodialysis catheters were the most common types of central venous lines placed by the teams. Eight (14%) sites reported experience in placing central venous lines in prone, ventilated patients with COVID-19. A dedicated line cart was used by 35 (59%) of the hospitals. Less than 50% (24 [41%]) of the participating sites reported managing thrombosed central lines in COVID-19 patients. Twenty-three of the sites managed 48 iatrogenic complications in patients with COVID-19 (including complications caused by providers outside of the line team or designated practice group). CONCLUSIONS: Implementation of a dedicated central venous access line team during a pandemic or other health care crisis is a way by which physicians trained in central venous access can contribute their expertise to a stressed health care system. A line team composed of physicians with vascular skill sets provides relief to resource-constrained intensive care unit, ward, and emergency medicine teams with a low rate of iatrogenic complications relative to historical reports. We recommend that a plan for central venous access line team implementation be in place for future health care crises.


Assuntos
Cateterismo Venoso Central , Infecções por Coronavirus/terapia , Prestação Integrada de Cuidados de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Doença Iatrogênica/prevenção & controle , Controle de Infecções/organização & administração , Pneumonia Viral/terapia , Betacoronavirus/patogenicidade , Cateterismo Venoso Central/efeitos adversos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Estudos Transversais , Pesquisas sobre Serviços de Saúde , Interações Hospedeiro-Patógeno , Humanos , Doença Iatrogênica/epidemiologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Medição de Risco , Fatores de Risco
17.
J Med Microbiol ; 69(7): 999-1004, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32530394

RESUMO

Introduction. Bacillus cereus harbouring Ba813, a specific chromosomal marker of Bacillus anthtacis, is found in patients with severe manifestations and causes nosocomial outbreaks.Aim. We assessed the genetic characteristics and virulence of Ba813(+) B. cereus in a hospital setting.Methodology. Three neutropenic patients with haematological malignancy developed B. cereus bacteraemia within a short period. Fifteen B. cereus were isolated from different sites in a haematology ward. A total of 18 isolates were evaluated for Ba813- and B. anthracis-related virulence, food poisoning-related virulence, genetic diversity, bacteria motility and biofilm formation.Results. Ba813(+) B. cereus was detected in 33 % (1/3) of patients and 66 % (9/15) of the hospital environment. The 18 strains were divided into 2 major clusters (clade 1 and clade 2), and 14 strains were classified into clade 1. All Ba813(+) strains, including four sequence types, were classified into clade 1/the cereus III lineage, which is most closely related to the anthracis lineage. Two strains belonging to clade 1/non-cereus III carried the B. anthracis-associated cap gene, but not Ba813. B. cereus, including Ba813(+) strains, had significantly lower prevalence of enterotoxin genes than clade 2 strains. In clade 1, B. cereus, Ba813(+) strains showed significantly higher swimming motility and biofilm formation ability than Ba813(-) strains.Conclusion. Ba813(+) B. cereus, which are genetically closely related to B. anthracis, were abundant in a haematological ward. Ba813(+) B. cereus with high motility and biofilm formation abilities may spread easily in hospital environments, and could become a hospital-acquired infection.


Assuntos
Bacillus cereus/genética , Bacillus cereus/isolamento & purificação , Antraz/microbiologia , Bacillus anthracis/classificação , Bacillus anthracis/genética , Bacillus anthracis/isolamento & purificação , Bacillus cereus/classificação , Bacteriemia/genética , Proteínas de Bactérias/genética , Infecção Hospitalar , DNA Bacteriano/genética , Surtos de Doenças , Neoplasias Hematológicas/genética , Neoplasias Hematológicas/microbiologia , Hospitais de Ensino , Humanos , Doença Iatrogênica , Japão/epidemiologia , Filogenia , Reação em Cadeia da Polimerase/métodos , Virulência/genética
18.
Medicine (Baltimore) ; 99(24): e20283, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541452

RESUMO

RATIONALE: There is an increasing and compelling need for early recognition of features of osmotic demyelination syndrome (ODS), and a further attempt at correcting this even where presentation is late. PATIENT CONCERNS: A 49-year-old male admitted into the emergency department with a complaint of lethargy and severe hyponatremia, with subsequent ODS supervening on initial attempts at correction. DIAGNOSIS: Rapid rise in serum sodium concentration (121 mmol/L in 8 hours from a nadir of 101 mmol/L), concomitant deterioration in patient's conscious level support the diagnosis of ODS. INTERVENTION: Concomitant administration of 5% dextrose water with desmopressin with a therapeutic objective of gradual relowering of serum sodium concentration. OUTCOMES: Significant improvement in patients' conscious level and motor function with the commencement of sodium relowering therapy. The patient was eventually discharged home. LESSONS: Regardless of the temporal profile of neurologic sequelae following ODS due to hyponatremia, its worthwhile attempting initial sodium relowering with dextrose 5% and desmopressin and then monitoring of biochemical and neurologic markers.


Assuntos
Doenças Desmielinizantes/induzido quimicamente , Doenças Desmielinizantes/terapia , Hiponatremia/complicações , Antidiuréticos/administração & dosagem , Antidiuréticos/uso terapêutico , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Desamino Arginina Vasopressina/administração & dosagem , Desamino Arginina Vasopressina/uso terapêutico , Doenças Desmielinizantes/sangue , Doenças Desmielinizantes/diagnóstico , Quimioterapia Combinada/métodos , Glucose/administração & dosagem , Glucose/uso terapêutico , Humanos , Hiponatremia/terapia , Doença Iatrogênica , Letargia/etiologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Concentração Osmolar , Solução Salina Hipertônica/efeitos adversos , Sódio/sangue , Edulcorantes/administração & dosagem , Edulcorantes/uso terapêutico , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
19.
J Paediatr Child Health ; 56(7): 1010-1012, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32568444

RESUMO

Critical care management of patients with COVID-19 has been influenced by a mixture of public, media and societal pressure, as well as clinical and anecdotal observations from many prominent researchers and key opinion leaders. These factors may have affected the principles of evidence-based medicine and encouraged the widespread use of non-tested pharmacological and aggressive respiratory support therapies, even in intensive care units (ICUs). The COVID-19 pandemic has predominantly affected adult populations, while children appear to be relatively spared of severe disease. Notwithstanding, paediatric intensive care (PICU) clinicians may already have been influenced by changes in practices of adult ICUs, and these changes may pose unintended consequences to the vulnerable population in the PICU. In this article, we analyse several potential iatrogenic causes of the detrimental effects of the current pandemic to children and highlight the risks underlying a sudden change of clinical practice.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Estado Terminal/terapia , Medicina Baseada em Evidências , Doença Iatrogênica/prevenção & controle , Pneumonia Viral/terapia , Criança , Infecções por Coronavirus/epidemiologia , Cuidados Críticos , Humanos , Unidades de Terapia Intensiva Pediátrica , Erros Médicos , Pandemias , Pediatria , Pneumonia Viral/epidemiologia
20.
Arch Bronconeumol ; 56(10): 670-671, 2020 10.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32586703
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA