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1.
Neurol India ; 69(5): 1371-1373, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34747816

RESUMO

The management of established pulmonary thromboembolism (PTE) coexisting with acute ischemic stroke (AIS) is quite challenging. We report the case of a 52-year-old man with concurrent massive right middle cerebral artery AIS and acute PTE, who was successfully managed despite the contradictory guidelines to manage them simultaneously. The patient underwent decompression craniotomy followed by anticoagulant therapy. The current case report demonstrates that full-dose heparin, despite being relatively contraindicated in an AIS, can achieve a good outcome when given under close monitoring. The transesophageal echo with bubble contrast during the Valsalva maneuver demonstrated patent foramen ovale with a right to left shunt as a cause of AIS and PTE in this patient.


Assuntos
Isquemia Encefálica , Forame Oval Patente , Embolia Pulmonar , Acidente Vascular Cerebral , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico por imagem , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Manobra de Valsalva
3.
Arch Soc Esp Oftalmol (Engl Ed) ; 96(8): 442-445, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34340784

RESUMO

We describe a case report of a spontaneous suprachoroidal hemorrhage, in which the enhanced depth imaging optical coherence tomography (OCT-EDI) is extremely useful in establish the differential diagnosis with a choroidal tumor. A 70 year-old woman was referred with a central scotoma after a Valsalva maneuver. In the posterior pole we observed a grey bilobed subretinal mass with the appearance of a choroidal tumor. OCT-EDI revealed an optically dark region with a scalloped anterior tumor contour and subretinal fluid, the choroicapillaris appeared to be intact and displaced anteriorly. The diagnosis was a suprachoroidal hemorrhage and it resolved in 12 weeks. Spontaneous suprachoroidal hemorrhage is a rare condition and it can resemble choroidal tumor. OCT-EDI is a very valuable tool in the differentiation of hemorrhage from tumors.


Assuntos
Hemorragia da Coroide , Neoplasias da Coroide , Manobra de Valsalva , Idoso , Hemorragia da Coroide/diagnóstico , Hemorragia da Coroide/etiologia , Neoplasias da Coroide/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Tomografia de Coerência Óptica
4.
Eur J Emerg Med ; 28(6): 432-439, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34406136

RESUMO

BACKGROUND AND IMPORTANCE: Cardiac arrhythmia, specifically paroxysmal supraventricular tachycardia (SVT), accounts for a substantial proportion of emergency medical services resources utilisation. Reconversion requires increasing the atrioventricular node's refractoriness, which can be achieved by vagal manoeuvres, pharmacological agents or electrical cardioversion. There are multiple variants of vagal manoeuvres, including the Valsalva manoeuvre (VM). While the effectiveness of the standard VM has already been systematically reviewed, there has been no such analysis for the modified VM. OBJECTIVES: Compare the effectiveness of the modified VM versus the standard VM in restoring the normal sinus rhythm in adult patients with supraventricular tachycardia. DESIGN: Systematic review with meta-analysis of published randomised controlled trials. OUTCOME MEASURES: The primary outcome was the reconversion to a sinus rhythm. Secondary outcomes included: medication use, adverse events, length of stay in the emergency department and hospital admission. MAIN RESULTS: Five randomised controlled trials were included, with a combined total of 1181 participants. The meta-analysis demonstrated a significantly higher success rate for reconversion to sinus rhythm when using the modified VM compared to the standard VM in patients with an SVT (odds ratio = 4.36; 95% confidence interval, 3.30-5.76; P < 0.001). More adverse events were reported in the modified VM group, although this difference is NS (risk ratio = 1.48; 95% confidence interval, 0.91-2.42; P = 0.11). The available evidence suggests that medication use was lower in the modified VM group than the standard VM group. However, medication use could not be generalised across the different studies. None of the included studies showed a significant difference in length of stay in the emergency department. Only one study reported on hospital admission, with no significant difference between the two groups. CONCLUSIONS: The available evidence is highly suggestive to support the use of the modified VM compared to the standard VM in the treatment of adult patients with SVT. Meta-analysis showed a higher success rate, required less medication use, and resulted in an equal number of adverse events. However, these results cannot be regarded as definitive in the absence of higher-quality studies.


Assuntos
Serviços Médicos de Emergência , Taquicardia Supraventricular , Adulto , Cardioversão Elétrica , Serviço Hospitalar de Emergência , Humanos , Taquicardia Supraventricular/terapia , Manobra de Valsalva
5.
BMJ Case Rep ; 14(7)2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34257127

RESUMO

The hyoid bone fracture has traditionally been attributed to strangulation and hanging. Although rare, ensuing its vague presentation, hyoid bone fracture is oftentimes overlooked and missed, leading to delayed complications. Herein, we are reporting an overlooked hyoid bone fracture in a man who attempted suicide by strangulating himself, whereby Valsalva manoeuvre performed during bedside flexible nasopharyngolaryngoscopy revealed the fractured segment. As the patient was stable and asymptomatic, he was successfully managed conservatively. We would like to highlight the awareness of the Valsalva manoeuvre, which could elicit hyoid bone fracture as missing or overlooking the fracture may lead to devastating complications which may ensue, such as respiratory distress.


Assuntos
Fraturas Ósseas , Lesões do Pescoço , Fraturas Ósseas/diagnóstico por imagem , Humanos , Osso Hioide/diagnóstico por imagem , Osso Hioide/lesões , Masculino , Faringe/diagnóstico por imagem , Manobra de Valsalva
6.
BMJ Case Rep ; 14(6)2021 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-34167982

RESUMO

Primary cough headaches (PCHs) are mainly observed in people aged >40 years, but cough-induced headaches are potentially symptomatic in children. We report a case of a child diagnosed with PCH without an intracranial disease. A 7-year-old boy presented with cough due to pertussis and powerful cough-induced headaches. No brain abnormalities were detected, but the right side of his neck was observed to swell. Echo examination confirmed right internal jugular vein dilatation during a Valsalva manoeuvre, and the patient was diagnosed with PCH with internal jugular phlebectasia. PCHs are normally reported in adults, but they can also occur in children. PCHs and internal jugular vein abnormalities may be related. Thus, tests assessing internal jugular vein morphology and function should be considered for PCH cases.


Assuntos
Transtornos da Cefaleia Primários , Varizes , Criança , Dilatação Patológica/diagnóstico por imagem , Humanos , Veias Jugulares/diagnóstico por imagem , Masculino , Manobra de Valsalva
7.
Eur J Contracept Reprod Health Care ; 26(6): 503-506, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34114522

RESUMO

OBJECTIVES: This study investigated whether the Valsalva manoeuvre (VM) could be an alternative to use of the tenaculum for intrauterine device (IUD) insertion. The aims were to establish whether VM could provide good patient comfort and enable the insertion to be performed successfully with adequate pain control in cases where the cervix could not be passed spontaneously. METHODS: Women who attended the outpatient clinic of Alanya Education and Research Hospital between November 2017 and December 2020 for IUD insertion were randomly assigned to the VM (n = 52) or tenaculum (n = 55) group. Insertion in the latter group was carried out by grasping the cervix with a single-toothed tenaculum. In the VM group, no tenaculum was used to grasp the cervix; instead, the woman was asked to perform VM during insertion. RESULTS: IUD insertion success rates were similar between the groups. Procedural anxiety scores were slightly higher in the tenaculum group. Pain scores measured during the procedure were significantly higher in the tenaculum group compared with the VM group. Severe pain was reported by 58.2% of women in the tenaculum group, whereas 57.7% of women in the VM group reported no pain. CONCLUSION: In cases where an IUD cannot be passed through the cervical canal spontaneously, the procedure should be attempted using VM before using a tenaculum. The use of VM may lead to lower pain and anxiety levels as well as increased patient comfort.


Assuntos
Anestésicos Locais , Dispositivos Intrauterinos , Feminino , Humanos , Dor/etiologia , Percepção da Dor , Manobra de Valsalva
8.
J Clin Neurophysiol ; 38(4): 262-273, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34009848

RESUMO

SUMMARY: The autonomic nervous system is a complex neural network that controls several organ systems. Its assessment includes a detailed history of autonomic functions, clinical examination, and autonomic tests. Most widely used is a battery of tests that assess cardiovascular reflex autonomic and sudomotor tests, which include deep breathing (assesses parasympathetic function), Valsalva maneuver, tilt test (both assess parasympathetic and adrenergic functions), and sudomotor testing for the evaluation of postganglionic sudomotor fibers. These basic tests represent a foundation of autonomic testing. Nevertheless, the autonomic nervous system also controls organ systems not directly assessed by basic tests. This review describes a number of auxiliary autonomic tests that can be used in addition to basic autonomic tests or can be used independently to explore particular autonomic functions or to answer a specific clinical question. The auxiliary tests described in this review evaluate cardiovascular, thermoregulatory, gastrointestinal, genitourinary, eye, and exocrine functions. These tests are cold pressor test, sustained handgrip maneuver, reverse tilt test, venoarteriolar reflex, laser Doppler flare imaging, microneurography, neck suction, lower body negative pressure, venous occlusion plethysmography, pharmacologic assessment of postganglionic sympathetic outflow, plasma norepinephrine, sympathetic skin response, video cinefluoroscopic swallowing test, esophageal manometry test, small bowel manometry test, wireless motility capsule test, urodynamic studies, penile plethysmography, intracavernosal papaverine injection, infrared video pupillography, corneal confocal microscopy, pupillary response to dilute pilocarpine and hydroxyamphetamine, Schirmer test, tear osmolarity test, and salivary secretion test. The protocol of each test is described in detail. This review can be used as a quick reference for the auxiliary autonomic tests.


Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico , Sistema Nervoso Autônomo/fisiologia , Técnicas de Diagnóstico Neurológico , Força da Mão , Frequência Cardíaca/fisiologia , Humanos , Reflexo , Teste da Mesa Inclinada , Manobra de Valsalva/fisiologia
9.
J Clin Neurophysiol ; 38(4): 252-261, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34009852

RESUMO

SUMMARY: Over the past 3 decades, tests of autonomic function have become increasingly standardized across most laboratories, particularly with commercially available equipment similar to other neurophysiologic tests. Most neurologically based laboratories perform four or five tests of autonomic function. Two of these, the sudomotor axon reflex response and the thermoregulatory sweat test (which some laboratories do not perform because it requires extensive equipment), examine sudomotor autonomic function. The remaining three, the cardiovascular response to a tilt table test, the cardiovascular response to the Valsalva maneuver, and the cardiac response to deep breathing examine cardiovascular autonomic function. Tests of sweating typically localize the lesion in the neuraxis, differentiating between central nervous system pathways, the spinal cord, or pre- or postganglionic roots or nerves. Tests of cardiovascular function delineate specific autonomic subsystem involvement, whether vagal parasympathetic as reflected in the deep breathing response and specific phases of the Valsalva maneuver or sympathetic adrenergic as reflected in the tilt table test and the other phases of the Valsalva. This review details the basic performance, analysis, and interpretation of these and a few other tests, with illustrative patient cases.


Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico , Sistema Nervoso Autônomo/fisiologia , Técnicas de Diagnóstico Neurológico , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neurofisiologia/métodos , Reflexo/fisiologia , Teste da Mesa Inclinada , Manobra de Valsalva , Adulto Jovem
10.
Artigo em Chinês | MEDLINE | ID: mdl-34010994

RESUMO

Objective: In order to assess ET more comprehensively, sonotubometry (STM)combined with CT images were applied to investigate the opening features of eustachian tube (ET) in normal subjects. STM was also used as a monitor training ET opening maneuver and optimizing CT scan parameters. Methods: Following ET opening training monitored by STM, STM data of ET opening duration and maximum sound pressure from 13 healthy volunteers (10 males and 3 females, 22 to 26 years old) were acquired using maneuvers of swallowing and Valsalva in standing and supine positions. Two trials of CT scan, setting A (slice thickness 6.0 mm, manually simulated to 0.6 mm, reconstruction thickness 0.6 mm) for normal and Valsalva scans and setting B(slice thickness 0.4 mm,reconstruction thickness 0.4 mm)for Valsalva scan, were conducted in each subject. The bone area and cartilage area of ET were measured respectively in reconstructed CT images. Statistical software SPSS 19.0 was employed in data analysis. Results: The duration of ET opening and maximum sound pressure by Valsalva were longer and stronger than those by swallowing in both positions. For Valsalva maneuver, standing position resulted in longer ET opening duration compared to supine position (P<0.05). Under setting A, ET cartilage area was measured larger by Valsalva scan than by normal scan (P<0.05). By Valsalva scan, setting A captured larger ET cartilage area compared to setting B (P<0.05). CT setting B resulted in longer scan time in comparison to setting A (P<0.05). Conclusions: Techniques of STM in supine position plus CT scan under setting A can be combined by Valsalva passive ET opening. Not only the invisible ET lumen through routine CT scan can be illustrated, but also relevant ET open-close process is shown, therefore, this study provides the technique for ET research of function and structure.


Assuntos
Tuba Auditiva , Adulto , Deglutição , Tuba Auditiva/diagnóstico por imagem , Feminino , Humanos , Masculino , Tomografia Computadorizada Espiral , Tomografia Computadorizada por Raios X , Manobra de Valsalva , Adulto Jovem
12.
J Theor Biol ; 526: 110759, 2021 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-33984355

RESUMO

In this study, we develop a methodology for model reduction and selection informed by global sensitivity analysis (GSA) methods. We apply these techniques to a control model that takes systolic blood pressure and thoracic tissue pressure data as inputs and predicts heart rate in response to the Valsalva maneuver (VM). The study compares four GSA methods based on Sobol' indices (SIs) quantifying the parameter influence on the difference between the model output and the heart rate data. The GSA methods include standard scalar SIs determining the average parameter influence over the time interval studied and three time-varying methods analyzing how parameter influence changes over time. The time-varying methods include a new technique, termed limited-memory SIs, predicting parameter influence using a moving window approach. Using the limited-memory SIs, we perform model reduction and selection to analyze the necessity of modeling both the aortic and carotid baroreceptor regions in response to the VM. We compare the original model to systematically reduced models including (i) the aortic and carotid regions, (ii) the aortic region only, and (iii) the carotid region only. Model selection is done quantitatively using the Akaike and Bayesian Information Criteria and qualitatively by comparing the neurological predictions. Results show that it is necessary to incorporate both the aortic and carotid regions to model the VM.


Assuntos
Manobra de Valsalva , Teorema de Bayes , Pressão Sanguínea , Frequência Cardíaca
13.
J Urol ; 206(4): 1001-1008, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34032502

RESUMO

PURPOSE: We assessed the role of standing vs supine scrotal ultrasound (SUS) for varicocele assessment by evaluating differences in clinical outcomes. MATERIALS AND METHODS: We retrospectively reviewed men from 2008-2020 diagnosed with varicocele who had documented SUS with both supine and standing assessments with and without Valsalva. Clinical outcomes (semen parameters, TUNEL and serum testosterone [T]) after microsurgical varicocelectomy were compared among men who had varicoceles diagnosed by standing SUS (vein size >2.5 mm, vein size >3.0 mm or reversal of flow) to those who would have been missed on supine SUS only. RESULTS: A total of 349 men underwent varicocelectomy (right: 5 [1.4%]; left: 118 [33.8%]; bilateral: 226 [64.8%]). Disagreement between those with abnormal standing vs normal supine for vein size >2.5 mm was: 56 men (16.1%) on the right and 31 men (8.9%) on the left, for vein size >3.0 mm was: 64 men (18.3%) on the right, and 56 men (16.1%) on the left, and for flow reversal was: 36 (14.0%) on the right and 40 (15.4%) on the left. For those >2.5 mm, only T had significant improvements on the left (p=0.05). For those >3.0 mm significant differences were seen for sperm motility on the right (p=0.04), and TUNEL (p=0.04) and T (p <0.01) on the left. For flow reversal, significant differences were seen for sperm concentration (p <0.01), morphology (p=0.03) and volume (p=0.05) on the right and TUNEL on the left (p=0.02). CONCLUSIONS: Standing SUS identifies a greater number of men who would have been missed using supine SUS only.


Assuntos
Escroto/irrigação sanguínea , Posição Ortostática , Varicocele/diagnóstico , Veias/diagnóstico por imagem , Adulto , Humanos , Masculino , Microcirurgia , Diagnóstico Ausente/prevenção & controle , Estudos Retrospectivos , Escroto/diagnóstico por imagem , Escroto/cirurgia , Decúbito Dorsal , Ultrassonografia/métodos , Procedimentos Cirúrgicos Urológicos Masculinos , Manobra de Valsalva , Varicocele/cirurgia , Veias/cirurgia
15.
Medicine (Baltimore) ; 100(17): e25674, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33907136

RESUMO

BACKGROUND: In hyperbaric oxygen therapy (HBOT), a patient is exposed to pure oxygen in a chamber. While HBOT is a long-standing and well-established treatment for a wide variety of medical conditions, one of the main complications is middle ear barotrauma (MEB), which can lead to complaints of ear discomfort, stuffiness or fullness in the ear, and difficulties in equalizing ear pressure. The aim of this study is to evaluate the efficacy of self-acupressure in preventing and reducing the degree of MEB associated with HBOT. METHODS: This is a prospective nonrandomized controlled study. A sample of 152 participants will be assigned to 2 groups in a 1:1 ratio. The participants in the control group will receive conventional Valsalva and Toynbee maneuvers, while those in the experimental group will be given additional self-acupressure therapy. The acupoints used will be TE17 (Yifeng), TE21 (Ermen), SI19 (Tinggong), and GB2 (Tinghui). The Modified Teed Classification, symptoms of MEB, and overall ear discomfort levels will be assessed. Data will be analyzed using the Chi-Squared test or t test. OBJECTIVES: This study aims to evaluate the efficacy of self-acupressure for preventing and reducing the degree of MEB associated with HBOT. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04311437. Registered on 17 March, 2020.


Assuntos
Acupressão/métodos , Barotrauma/terapia , Orelha Média/lesões , Oxigenação Hiperbárica/efeitos adversos , Autocuidado/métodos , Pontos de Acupuntura , Adulto , Barotrauma/etiologia , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Estudos Prospectivos , Resultado do Tratamento , Manobra de Valsalva , Adulto Jovem
16.
Nord J Psychiatry ; 75(7): 547-552, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33825660

RESUMO

BACKGROUND: Cardiovascular autonomic neuropathy (CAN) is an independent predictor of cardiovascular disease (CVD) in patients with diabetes as well as in patients with pre-diabetes and metabolic syndrome. Patients with schizophrenia have an increased rate of metabolic syndrome, pre-diabetes and diabetes as compared to the general population. Despite of this, occurrence CAN has not been investigated in patient with schizophrenia. Therefore, the aims of this study were (1) to evaluate the feasibility testing for CAN with a new clinical tool and (2) report the prevalence of early and manifest CAN in patients with schizophrenia. METHODS AND RESULTS: Patients with diagnosed schizophrenia and with a disease duration ≥10 years were matched 1:1 on age and gender at screening with psychiatric healthy controls. CAN was defined as ≥ two abnormal standard cardiovascular autonomic reflex tests (lying-to-standing, deep breathing, and Valsalva maneuver) using the VagusTM device. A total of 46 patients with schizophrenia were included and matched to psychiatric healthy controls. Manifest CAN were more frequently presented in patients with schizophrenia (39% vs. 6% for controls, p<.0001). Sensitivity analysis of 41 subjects with schizophrenia without diabetes matched to 41 psychiatric healthy controls, showed similar results (37% vs. 5% for controls, p<.0001). CONCLUSION: CAN is highly prevalent in patients with schizophrenia. Testing for CAN is feasible and might be a new clinically tool for detecting early stages of CVD in patients with schizophrenia.


Assuntos
Doenças do Sistema Nervoso Autônomo , Doenças Cardiovasculares , Esquizofrenia , Sistema Nervoso Autônomo , Doenças do Sistema Nervoso Autônomo/diagnóstico , Doenças do Sistema Nervoso Autônomo/epidemiologia , Doenças do Sistema Nervoso Autônomo/etiologia , Doenças Cardiovasculares/epidemiologia , Frequência Cardíaca , Humanos , Esquizofrenia/complicações , Esquizofrenia/epidemiologia , Manobra de Valsalva
17.
Neurourol Urodyn ; 40(4): 1021-1026, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33792955

RESUMO

INTRODUCTION: To ensure quality, the International Continence Society recommends asking the patient to cough every minute or 50 ml of infused volume. However, on occasions, it was noticed that if cough transmission was poor, Valsalva maneuvers could show pressure transmission was satisfactory. Hence, a study was designed to compare the two methods. METHODS: Cough and Valsalva maneuver pressures were compared in 40 patients, 20 consecutive men and 20 consecutive women, undergoing urodynamics at three time points: baseline (20 ml filling), prevoid and postvoid. RESULTS: At baseline, the percentage difference between pabd and pves was significantly lower for Valsalva maneuvres compared with coughs for all patients (median 5.1% vs. 10.2%). This association was consistent in male patients, but not for female. At prevoid, this was reversed with coughs providing more consistent pressure spikes than Valsalva maneuvers (median 7.0% vs. 24.1%), for all patients. Postvoid, no difference was noted in either men or women. CONCLUSIONS: Quality control during urodynamics is important to ensure diagnostic accuracy. This is the first study to compare two methods of quality control, coughs, and Valsalva maneuvers. Coughs are a useful indicator of pressure transmission quality at all time points throughout urodynamic studies. However, at low volumes, Valsalva maneuvers give a better indication of quality, with lower variability, whereas at cystometric capacity coughs performed better. Therefore, if poor pressure transmission occurs with cough during urodynamics, particularly at low volumes, it is recommended that a Valsalva maneuver is used to further assess whether pressure transmission and thus urodynamic quality is satisfactory.


Assuntos
Tosse , Incontinência Urinária por Estresse , Urodinâmica , Tosse/diagnóstico , Feminino , Humanos , Masculino , Pressão , Bexiga Urinária , Manobra de Valsalva
18.
Pediatr. aten. prim ; 23(89): 87-90, ene.-mar. 2021. ilus
Artigo em Espanhol | IBECS | ID: ibc-202620

RESUMO

La hiperplasia endotelial papilar intravascular (IPEH) es una lesión vascular benigna poco frecuente que se presenta habitualmente como una neoformación subcutánea eritemato-violácea inespecífica. El estudio histopatológico, necesario para el diagnóstico de confirmación, muestra proliferación papilar de células endoteliales asociada con material trombótico. La IPEH puede simular otras lesiones como el angiosarcoma, por lo que el diagnóstico correcto de esta entidad es esencial para evitar tratamientos agresivos. La resección con márgenes amplios suele ser suficiente


Intravascular papillary endothelial hyperplasia (IPEH) is a rare benign vascular lesion that usually presents as a nonspecific erythematous-violaceous subcutaneous neoformation. The histopathological study, necessary for the confirmatory diagnosis, shows papillary proliferation of endothelial cells associated with thrombotic material. IPEH can simulate other lesions such as angiosarcoma, so the correct diagnosis of this entity is essential to avoid aggressive treatments. The resection with wide margins is usually enough


Assuntos
Humanos , Masculino , Criança , Hiperplasia/diagnóstico , Hiperplasia/patologia , Neoplasias Vasculares/diagnóstico , Neoplasias de Tecido Vascular/patologia , Dermatopatias/patologia , Endotélio Vascular/patologia , Hiperplasia/cirurgia , Neoplasias Vasculares/patologia , Proliferação de Células , Manobra de Valsalva/fisiologia , Biópsia
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