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1.
Ophthalmologe ; 117(1): 62-65, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31037408

RESUMO

Steroid-induced ocular hypertension (SIOH), which cannot be regulated by topical antiglaucoma agents, is a rare complication after intravitreal implantation of diverse cortisone derivatives. This case report presents a therapeutic approach for treatment-refractory SIOH after intravitreal implantation of fluocinolone acetonide using various minimally invasive glaucoma surgery (MIGS) techniques.


Assuntos
Hipertensão Ocular , Cirurgia Filtrante , Glaucoma , Humanos , Pressão Intraocular , Uso Off-Label
3.
4.
Rev Med Suisse ; 15(670): 2058-2061, 2019 Nov 06.
Artigo em Francês | MEDLINE | ID: mdl-31696682

RESUMO

N-of-1 trials therapeutic tests allow an objective evaluation of treatment efficacy in a single patient. Thereby, they can support off-label prescriptions, or promote treatment safety and efficiency in chronic patients through the deprescription of useless drugs. They also encourage active participation of patients in their medical care. Practically a treatment is compared to a placebo in double blind during a series of randomly alternating periods. Statistical analysis comparing measurements performed in the patient throughout the test enable to evaluate objectively treatment efficacy. The performance of this type of test is now offered to patients and practitioners by the Service of Clinical Pharmacology in the University Hospital of Lausanne.


Assuntos
Ensaios Clínicos como Assunto/métodos , Prática Clínica Baseada em Evidências/métodos , Método Duplo-Cego , Humanos , Uso Off-Label , Suíça , Resultado do Tratamento
6.
Fortschr Neurol Psychiatr ; 87(10): 577-589, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31627240

RESUMO

Tic disorders typically start in early childhood and can be classified into provisional tic disorder (tics last <12 months) and chronic tic disorders (tics last > 12 months). The widely known chronic tic disorder Tourette's syndrome is featuring multiple motor and vocal tics. Tics are typically waxing and waning in frequency and intensity. Concentration and relaxation might decrease tics, whereas stress and excitement might increase tics. Psychiatric comorbidities, like obsessive-compulsive disorder, ADHD, depression and anxiety are common. The etiology is multifactorial with genetic and environmental interactions leading to a dysregulation of cortico-striato-pallido-thalamo-cortical networks.A correct diagnosis and psychoeducation are essential for patients as well as their relatives. Additional therapies are needed for patients with severe tics that cause physical impairment or great psychosocial stress. It is crucial to also treat psychiatric comorbidities. Psychotherapeutic interventions for tics include progressive muscle relaxation, habit reversal training, exposure and response prevention and comprehensive behavioral intervention for tics. First-line psychopharmacological treatment in Europe contains aripiprazole, tiapride and risperidone, which are all used off-label for tic disorders. Haloperidol remains the only approved medication for the pharmacotherapy of tics in Germany, but is rarely used due to its side effects. Cannabinoids gain interest as a new pharmacological option, but are mainly offered within the frame of studies.


Assuntos
Transtornos de Tique , Tiques , Europa (Continente) , Haloperidol/uso terapêutico , Humanos , Uso Off-Label , Transtornos de Tique/terapia , Tiques/terapia , Síndrome de Tourette/terapia
7.
Einstein (Sao Paulo) ; 18: eAO4745, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31664322

RESUMO

OBJECTIVE: To estimate the prevalence of and factors associated with the use of methylphenidate for cognitive enhancement among undergraduate students. METHODS: Simple random sample of students of the Universidade Federal de Minas Gerais (n=438), invited to answer an online questionnaire about the use of methylphenidate. Data collection occurred from September 2014 to January 2015. The sample was described by means of proportions, means and standard deviations. A multivariate analysis was performed using the Classification and Regression Tree algorithm to classify the cases of use of methylphenidate for cognitive enhancement in groups, based on the exposure variables. RESULTS: Out of 378 students included, 5.8% (n=22) reported using methylphenidate for cognitive enhancement; in that, 41% (9/22) in the 4 weeks prior to the survey. The housing situation was the variable most often associated with the use of methylphenidate for cognitive enhancement. Eleven students reported using methylphenidate for cognitive enhancement and other purposes 4 weeks prior to the survey, 27% of whom had no medical prescription to purchase it. CONCLUSION: The use of methylphenidate for cognitive enhancement is frequent among Brazilian undergraduate students and should be considered a serious public health problem, especially due to risks of harm and adverse effects associated with its use.


Assuntos
Estimulantes do Sistema Nervoso Central/administração & dosagem , Nootrópicos/administração & dosagem , Nootrópicos/uso terapêutico , Estudantes/estatística & dados numéricos , Universidades/estatística & dados numéricos , Adulto , Brasil/epidemiologia , Estudos Transversais , Árvores de Decisões , Exercício/psicologia , Feminino , Humanos , Masculino , Metilfenidato/administração & dosagem , Uso Off-Label/estatística & dados numéricos , Prevalência , Características de Residência/estatística & dados numéricos , Fatores de Risco , Fatores Socioeconômicos , Estudantes/psicologia , Inquéritos e Questionários , Adulto Jovem
8.
J Drugs Dermatol ; 18(10)2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31603635

RESUMO

Dupilumab inhibits the interleukin-4 receptor subunit α and is FDA approved for treatment of moderate-to-severe atopic dermatitis. It is a relatively new drug, and whether it is efficacious for other diseases in dermatology is an area of increasing interest. We searched the literature and ClinicalTrials.gov database for uses of dupilumab beyond atopic dermatitis in dermatology and for ongoing studies on new uses for dupilumab. Off-label reports identified described use of dupilumab for several different dermatologic conditions, including allergic contact dermatitis, hand dermatitis, chronic spontaneous urticaria, prurigo nodularis, and alopecia areata. Overall, there is limited but promising data for dupilumab use beyond atopic dermatitis in dermatology. The relatively safe adverse effect profile of dupilumab may make it an option for certain recalcitrant diseases in dermatology, but further studies will be needed to assess its efficacy and determine its best possible use. J Drugs Dermatol. 2019;18(10):1053-1055.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Uso Off-Label , Dermatopatias/tratamento farmacológico , Anticorpos Monoclonais/farmacologia , Anticorpos Monoclonais Humanizados , Humanos , Subunidade alfa de Receptor de Interleucina-4/antagonistas & inibidores , Dermatopatias/imunologia , Células Th2/efeitos dos fármacos , Células Th2/imunologia , Resultado do Tratamento
9.
Laryngorhinootologie ; 98(10): 718-721, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31610598

RESUMO

BACKGROUND: Lymphocytic esophagitis (LyE) is a rare chronic inflammatory disease of the esophagus, which shares clinical characteristics with the eosinophilic esophagitis. The most important part of its treatment is proton pump inhibitors (PPIs). Referring to locally acting steroids, evidence-based treatment strategies are missing. CASE REPORT: A 62-year-old patient presented for evaluation of his chronic dysphagia with previously diagnosed multiple oesophageal stenoses. Endoscopy revealed diffusely distributed esophageal rings and furrows and the diagnosis of LyE was established after immunohistochemical analysis of multiple mucosal biopsies. We initiated therapy with budesonide in the form of capsules (Entocort 3 × 3 mg Hartkapseln® once daily). During the course of the treatment, we initiated the off-label use of suspensions (Budenobronch® 0.5 mg twice daily) routinely used in the treatment of patients with asthma or COPD to increase the patient΄s acceptance of this therapy which was diminished because of his dysphagia. Under this therapy, clinical and later histological remission was achieved. CONCLUSION: Our case report is meant to describe an empirical therapeutic concept, which led to clinical and histological remission of chronic LyE.


Assuntos
Budesonida/uso terapêutico , Esofagite Eosinofílica , Humanos , Pessoa de Meia-Idade , Uso Off-Label
10.
Scand J Immunol ; 90(6): e12821, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31589347

RESUMO

As a result of the cancer immunotherapy revolution, more than 2000 immuno-oncology agents are currently being tested or are in use to improve responses. Not unexpectedly, the 2018 Nobel Prize in Physiology or Medicine was awarded to James P. Allison and Tasuku Honjo for their development of cancer therapy by the blockade of co-inhibitory signals. Unfortunately, manipulation of the co-inhibitory receptors has also resulted in a safety issue: widespread iatrogenic immune-related adverse events (irAEs). Autoimmunity is emerging as the nemesis of immunotherapy. Originally, it was assumed that CTLA-4 blockade selectively targets T cells relevant to the antitumour immune response. However, an uncontrolled pan T cell activation was induced compromising tolerance to healthy self-tissues. The irAEs are very similar to that of a chronic graft-versus-host-disease (GVHD) reaction following allogeneic bone marrow transplantation (BMT). We hypothesized that ipilimumab induced a graft-versus-malignancy (GVM) effect, which eradicated metastatic melanoma in a minority of patients, but also involved an auto-GVHD reaction that resulted in widespread autoimmunity in the majority. Therefore, we argued for a profound theoretical point against the consensus of experts. The task is not to desperately put the genie back in the bottle by immune-suppressive treatments, but instead to harness the autoimmune forces. In this way, the same goal could be achieved by an antibody as by the adoptive transfer of alloreactive donor lymphocytes, but without severe GVHD. The proof-of-principle of a low-dose-combination immune checkpoint therapy, consisting only of approved drugs and treatments, was demonstrated in 111 stage IV cancer patients.


Assuntos
Antineoplásicos Imunológicos/uso terapêutico , Autoimunidade/efeitos dos fármacos , Biomarcadores Tumorais/antagonistas & inibidores , Terapia de Alvo Molecular , Neoplasias/tratamento farmacológico , Neoplasias/imunologia , Antineoplásicos Imunológicos/administração & dosagem , Antineoplásicos Imunológicos/efeitos adversos , Antígeno CTLA-4/antagonistas & inibidores , Antígeno CTLA-4/genética , Antígeno CTLA-4/metabolismo , Humanos , Ativação Linfocitária/efeitos dos fármacos , Ativação Linfocitária/imunologia , Metástase Neoplásica , Estadiamento de Neoplasias , Neoplasias/genética , Neoplasias/patologia , Uso Off-Label , Estudo de Prova de Conceito , Transdução de Sinais/efeitos dos fármacos , Linfócitos T/efeitos dos fármacos , Linfócitos T/imunologia , Linfócitos T/metabolismo , Resultado do Tratamento
12.
Rinsho Ketsueki ; 60(9): 1100-1107, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31597833

RESUMO

In 2017, The British Society of Haematology published new guidelines for the diagnosis and management of autoimmune hemolytic anemia (AIHA). Usually this is diagnosed using a combination of clinical and laboratory findings of hemolysis using the direct antiglobulin test (DAT). The revised guidelines propose several steps to evaluate and diagnose patients with unexplained hemolysis and a negative DAT, and they recommend screening for cold agglutinin disease (CAD) using a direct agglutination test (DAggT) before evaluating the cold agglutinin titer. Rituximab is becoming the preferred second-line choice for steroid-refractory warm AIHA and the first-line choice for primary CAD. Rituximab is an off-label drug for use in AIHA treatment in Japan, but in future will be used as standard therapy. Anti-C1s antibody is a new drug for CAD that has entered phase 3 trials.


Assuntos
Anemia Hemolítica Autoimune/diagnóstico , Anemia Hemolítica Autoimune/terapia , Testes de Aglutinação , Ensaios Clínicos Fase III como Assunto , Hemólise , Humanos , Uso Off-Label , Guias de Prática Clínica como Assunto , Rituximab/uso terapêutico
13.
Br J Nurs ; 28(17): 1154-1155, 2019 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-31556745

RESUMO

Richard Griffith, Senior Lecturer in Health Law at Swansea University, discusses the law relating to the supply and administration of unlicensed medicines to meet the special need of a patient.


Assuntos
Legislação de Medicamentos , Uso Off-Label/enfermagem , Humanos , Reino Unido
14.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31527173

RESUMO

BACKGROUND: Off-label drug use in children is common and potentially harmful. In most previous off-label use research, authors studied hospitalized children, specific drug classes, or non-US settings. We characterized frequencies, trends, and reasons for off-label systemic drug orders for children in ambulatory US settings. METHODS: Using nationally representative surveys of office-based physicians (National Ambulatory Medical Care Surveys, 2006-2015), we studied off-label orders of systemic drugs for children age <18 based on US Food and Drug Administration-approved labeling for age, weight, and indication. We characterized the top classes and diagnoses with off-label orders and analyzed factors and trends of off-label orders using logistic regression. RESULTS: Physicians ordered ≥1 off-label systemic drug at 18.5% (95% confidence interval: 17.7%-19.3%) of visits, usually (74.6%) because of unapproved conditions. Off-label ordering was most common proportionally in neonates (83%) and in absolute terms among adolescents (322 orders out of 1000 visits). Off-label ordering was associated with female sex, subspecialists, polypharmacy, and chronic conditions. Rates and reasons for off-label orders varied considerably by age. Relative and absolute rates of off-label orders rose over time. Among common classes, off-label orders for antihistamines and several psychotropics increased over time, whereas off-label orders for several classes of antibiotics were stable or declined. CONCLUSIONS: US office-based physicians have ordered systemic drugs off label for children at increasing rates, most often for unapproved conditions, despite recent efforts to increase evidence and drug approvals for children. These findings can help inform education, research, and policies around effective, safe use of medications in children.


Assuntos
Instituições de Assistência Ambulatorial/tendências , Uso Off-Label/estatística & dados numéricos , Adolescente , Distribuição por Idade , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Intervalos de Confiança , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Psicotrópicos/uso terapêutico , Estudos Retrospectivos , Estados Unidos
16.
Expert Opin Drug Saf ; 18(11): 1043-1053, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31498687

RESUMO

Introduction: Proton pump inhibitors (PPIs) are among the most commonly prescribed drugs worldwide. However, concerns are growing about the serious adverse events and mortality linked to their long-term use. Areas covered: The authors review the main approved clinical indications and adverse events associated with PPIs, including, among others, pneumonia, Clostridium difficile infection, cardiovascular diseases, bone fractures, kidney diseases, and several nutrient deficiencies. Recent studies have reported that patients taking PPIs displayed increased mortality, linked to cardiovascular diseases, gastrointestinal malignancies, and chronic kidney diseases. Expert opinion: PPIs represent an important advance in the medical treatment of acid-related diseases. PPIs have contributed to profound reductions in hospitalizations and mortality due to upper GI complications. However, concern is growing about the wide range of potentially serious adverse events and mortality linked to chronic PPI use. Nevertheless, the level of evidence on adverse events is low; it is based on observational studies, and most findings have not been confirmed in the limited number of clinical trials available. PPI overuse and off-label prescriptions must be eradicated, but long-term PPI use for clear indications must continue, until we have stronger evidence to support claims of serious adverse events and mortality.


Assuntos
Uso Off-Label/estatística & dados numéricos , Uso Excessivo de Medicamentos Prescritos/prevenção & controle , Inibidores da Bomba de Prótons/efeitos adversos , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/mortalidade , Neoplasias Gastrointestinais/epidemiologia , Neoplasias Gastrointestinais/etiologia , Neoplasias Gastrointestinais/mortalidade , Humanos , Inibidores da Bomba de Prótons/administração & dosagem , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/mortalidade
17.
Cad. Ibero Am. Direito Sanit. (Impr.) ; 8(3): 27-47, jul.-set. 2019. tab
Artigo em Português | LILACS | ID: biblio-1022851

RESUMO

Objetivos: o registro sanitário garante minimamente a segurança nas indicações de bula. Com o julgamento do Recurso Extraordinário (RE) nº 657.718/2019, essa questão não está pacificada. O objetivo desse estudo é comparar as indicações aprovadas nas agências sanitárias americana, europeia e brasileira e analisar dados referentes à indicação de medicamentos imunoterápicos para o tratamento de câncer, em demandas judiciais contra a Secretaria de Estado da Saúde de São Paulo (SES/SP). Métodos: foi realizada uma pesquisa documental nas bulas de seis medicamentos imunoterápicos, disponíveis em julho de 2019 nos websites das agências sanitárias elegidas para o estudo, e comparada a indicação desses medicamentos em demandas judiciais no Estado de São Paulo, utilizando os dados de relatórios ou documentos escaneados disponíveis no sistema S-Codes. Resultados: todos os medicamentos têm registro sanitário para, ao menos, uma indicação em bula nas três agências sanitárias, porém, com diferenças nas indicações aprovadas, muitas delas sendo aprovações aceleradas (fast track). O tempo médio entre a aprovação na Food and Drug Administration (FDA) e na Agência de Vigilância Sanitária (Anvisa) foi de 464,5 ± 170,8 dias; e 278 (98%) das demandas judiciais ocorreram pós-registro na Anvisa. Há pouca informação disponível nos documentos escaneados, mas foi possível identificar situações envolvendo indicações de medicamentos, além de resultados de testes genéticos. Discussão e conclusão: a análise mostra que a FDA tende a ser menos rigorosa na aprovação de novas indicações, e que a maioria das demandas não se enquadraria nos critérios do RE nº 657.718/2019. Apesar do avanço, faz-se necessária a discussão do uso off-label desses medicamentos e sua especificidade. (AU).


Objectives: The drug approval minimally guarantees the safety in the label directions. With the judgment of Extraordinary Appeal No. 67718, this issue is not pacified. The aim of this study is to compare the indications approved by the American (FDA), European (EMA) and Brazilian (Anvisa) health agencies and to analyze data regarding the indication of immunotherapeutic drugs for cancer treatment, in lawsuits against the Secretary of State of Health of São Paulo (SES/SP). Methods: Documentary research was performed on the package leaflets of six immunotherapeutic drugs available in July 2019 on the websites of the health agencies eligible for the study, and comparing the indication of these drugs in lawsuits in the state of São Paulo, using data from reports. or scanned documents available on the S-Codes system. Results: All drugs are registered for at least one indication in the 3 health agencies, but with differences in the approved indications, many of them being conditional approvals (fast track). The average time between FDA and Anvisa approval was 464.5 ± 170.8 days, and 278 (98%) of the demands occurred post-registration with Anvisa. There is little information available in the scanned documents, but it was possible to identify situations involving indications as well as genetic test results. Discussion and Conclusion: analysis shows that the FDA tends to be less rigorous in approving new indications, and that most demands would not meet the criteria of RE 657718/2019. Despite the progress in discussions involving the judicialization of health, it is necessary to discuss the off-label use of these drugs and their specificity. (AU).


Objetivos: el registro sanitario garantiza mínimamente la seguridad de las instrucciones de etiquetado. Con la sentencia de Apelación Extraordinaria (RE) No. 657,718 / 2019, este asunto no se pacifica. El objetivo de este estudio es comparar las indicaciones aprobadas por las agencias de salud estadounidenses, europeas y brasileñas y analizar datos sobre la indicación de medicamentos de inmunoterapia para el tratamiento del cáncer, en demandas contra el Departamento de Salud del Estado de São Paulo (SES / SP). Métodos: se realizó una investigación documental en los prospectos de seis medicamentos inmunoterapéuticos, disponibles en julio de 2019, en los sitios web de las agencias de salud elegibles para el estudio. documentos escaneados disponibles en el sistema S-Codes. Resultados: todos los medicamentos tienen un historial médico para al menos una indicación de etiqueta en las tres agencias de salud, pero con diferencias en las indicaciones aprobadas, muchas de ellas son aprobaciones aceleradas. El tiempo promedio entre la aprobación de la Food and Drug Administration (FDA) y la Agencia de Vigilancia de la Salud (Anvisa) fue de 464.5 ± 170.8 días; y 278 (98%) de las demandas ocurrieron después de registrarse con Anvisa. Hay poca información disponible en los documentos escaneados, pero fue posible identificar situaciones que implican indicaciones de drogas, así como resultados de pruebas genéticas. Discusión y conclusión: el análisis muestra que la FDA tiende a ser menos rigurosa en la aprobación de nuevas indicaciones, y que la mayoría de las demandas no se ajustan a los criterios de RE 657.718/2019. A pesar del progreso, es necesario discutir el uso fuera de etiqueta de estos medicamentos y su especificidad. (AU).


Assuntos
Uso Off-Label , Judicialização da Saúde , Acesso a Medicamentos Essenciais e Tecnologias em Saúde
18.
Hematol Oncol ; 37(4): 487-489, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31465531

RESUMO

We describe the use and value of a lenalidomide/bortezomib/dexamethasone regimen for the treatment of three patients with blastic plasmacytoid dendritic cell neoplasm (BPDCN, a disease that lacks a consensus treatment). After five cycles of chemotherapy, we observed two complete responses and one clinical remission. Together with the encouraging literature data on the effects of lenalidomide and bortezomib on BPDCN cells, our results might prompt further investigations of this regimen's value in BPDCN.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Epiteliais e Glandulares/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Idoso de 80 Anos ou mais , Aloenxertos , Bortezomib/administração & dosagem , Neoplasias da Mama , Terapia Combinada , Células Dendríticas , Dexametasona/administração & dosagem , Sinergismo Farmacológico , Evolução Fatal , Feminino , Transplante de Células-Tronco Hematopoéticas , Humanos , Imunofenotipagem , Lenalidomida/administração & dosagem , Masculino , Pessoa de Meia-Idade , Neoplasias Epiteliais e Glandulares/terapia , Segunda Neoplasia Primária/tratamento farmacológico , Uso Off-Label , Neoplasias Cutâneas/terapia
19.
J Dermatol ; 46(10): 898-901, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31373046

RESUMO

Kaposiform hemangioendothelioma (KHE) and tufted angioma (TA) are rare infiltrative vascular tumors. Currently, no standard treatment regimens exist for KHE/TA. The purpose of our study was to evaluate the efficacy and safety of topical application of tacrolimus for superficial KHE/TA. We examined six patients with superficial KHE/TA. All patients were treated with tacrolimus 0.1% ointment twice daily for at least 12 months. The response rate was 100%, including three nearly complete remissions. Only one patient experienced local pruritus during treatment. The data constituted an intriguing rationale for clinical trials of topical tacrolimus in the treatment of superficial KHE/TA.


Assuntos
Hemangioendotelioma/tratamento farmacológico , Hemangioma/tratamento farmacológico , Síndrome de Kasabach-Merritt/tratamento farmacológico , Sarcoma de Kaposi/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Tacrolimo/administração & dosagem , Administração Cutânea , Biópsia , Pré-Escolar , Feminino , Hemangioendotelioma/diagnóstico por imagem , Hemangioendotelioma/patologia , Hemangioma/diagnóstico por imagem , Hemangioma/patologia , Humanos , Lactente , Síndrome de Kasabach-Merritt/diagnóstico por imagem , Síndrome de Kasabach-Merritt/patologia , Masculino , Uso Off-Label , Pomadas , Fotografação , Prurido/induzido quimicamente , Sarcoma de Kaposi/diagnóstico por imagem , Sarcoma de Kaposi/patologia , Pele/diagnóstico por imagem , Pele/efeitos dos fármacos , Pele/patologia , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/patologia , Tacrolimo/efeitos adversos , Resultado do Tratamento
20.
J Vasc Surg ; 70(3): 1013-1014, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31445634
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