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1.
Ann Vasc Surg ; 12(5): 405-11, 1998 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-9732416

RESUMO

The purpose of this study was to implement and evaluate a clinical protocol for following longitudinally the luminal responses of microvessel cell seeded expanded polytetrafluoroethylene (ePTFE) vascular grafts implanted for hemodialysis access. Half of the patients enrolled in the study were randomized to receive grafts that were "seeded" with transplanted microvessel cells derived from autologous subcutaneous fat; the other half of the patients received nonseeded grafts. The patients agreed to scheduled biopsies of their grafts at three postoperative times. All biopsy samples were evaluated by routine histologic and electron microscopy techniques. Three men and six women were enrolled in the study. All operative procedures were tolerated well. However, only two of the nine patients agreed to 1-year postimplantation biopsies; one of these patients had been randomized to receive a "nonseeded" ePTFE graft and one randomized to receive a "seeded" graft. The "seeded" graft at 3 months showed endothelial cells on the luminal surface as well as some intimal thickening. By 20 months, the same "seeded" graft showed significant concentric intimal thickening and by 24 months, this "seeded" graft thrombosed. The "nonseeded" graft at 16 months had irregular areas of intimal thickening which were quite patchy in nature. The flow contacting surface of the "nonseeded" graft remained thin. The intima of the "seeded" graft was twice as thick as that of the "nonseeded" graft. The methodologies implemented in the study design were appropriate. Biopsy samples were obtained without complication and were easily processed for analysis. Patient compliance with the biopsy protocol was problematic however. The study was terminated because of the development of significant concentric intimal hyperplasia in a "seeded" graft.


Assuntos
Derivação Arteriovenosa Cirúrgica , Cateteres de Demora , Politetrafluoretileno , Próteses e Implantes , Diálise Renal , Túnica Íntima/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
2.
Transplantation ; 57(7): 1115-9, 1994 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-8165710

RESUMO

A total of 159 patients received renal cadaveric grafts under 2 different allocation systems. System 1, a local variance (i.e., a point system different from that of United Network for Organ Sharing [UNOS]), and system 2, the current UNOS point system, differed in the relative emphasis on waiting time and HLA match. The racial composition of the donor pools and recipient waiting lists was the same for both periods examined. The percentage of African-Americans transplanted did not differ significantly under the 2 allocation systems and, in fact, increased slightly, from 29.4% to 33.8%, under system 2, which attributed more weight to HLA match. A difference in the allocation of kidneys from African-American donors was seen. Under system 1, only 2 of 8 kidneys from African-American donors went to African-American recipients, while under system 2, 6 of 8 kidneys from African-American donors went to African-American recipients. These data suggest that the current UNOS point system does not provide any added disadvantage to non-whites and may, in fact, provide an incentive for minority groups to donate organs, in that HLA matching appears to promote intraracial transplantation.


Assuntos
População Negra , Antígenos HLA/análise , Transplante de Órgãos/estatística & dados numéricos , População Branca , Antígenos de Grupos Sanguíneos , Teste de Histocompatibilidade , Humanos , Estados Unidos
3.
J Vasc Surg ; 17(5): 877-87, 1993 May.
Artigo em Inglês | MEDLINE | ID: mdl-8487356

RESUMO

PURPOSE: The purpose of this study was to evaluate the efficacy of three drugs (cilazapril, cyclosporine, and aspirin) in modulating the progression of intimal hyperplasia during short postoperative times in short-segment, autogenous vein bypass grafts in a canine model. The relative effects of the drugs on the progression of intimal hyperplasia were compared with the Gilman parameter, a measure used extensively as a wound healing descriptor. To our knowledge this is the first use of the Gilman parameter in assessing vascular disease. METHODS: Seventy-two conditioned mongrel dogs were randomly and equally divided according to a three-factor analysis of variance. The factors included (1) drug treatments (cilazapril [10 mg/kg/day], cyclosporine [4 mg/kg/day], aspirin [325 mg/day], and control [nonmedicated]), (2) implantation sites (femoral and carotid arteries), and (3) postoperative times of graft harvest (1, 3, and 6 weeks). Each dog had 2 cm segments of autogenous jugular vein interpositioned bilaterally into each of the paired carotid and femoral arteries. Quantitative data on luminal narrowing over time from intimal hyperplasia were compared from calculated Gilman parameters after image analysis of retrieved, histologically processed graft sections. RESULTS: The observed variability in the data was attributed to drug treatments and time. At 1 week after operation the mean Gilman parameters did not differ significantly among the treatment groups in either midgraft or distal graft segments. At 3 weeks the mean Gilman parameters of midgraft and distal graft sections of cyclosporine-treated dogs differed significantly (p < 0.05) from those of the control group and the cilazapril and aspirin-treated groups, which did not differ from each other. At 6 weeks after operation, mean Gilman parameters from aspirin- and cyclosporine-treated dogs differed statistically from control and cilazapril-medicated dogs and from each other (p < 0.001). CONCLUSIONS: These data support the efficacy of aspirin and cyclosporine in reducing intimal hyperplasia in short-segment arterialized vein grafts during short postoperative periods. Additional studies are required to ascertain whether the beneficial effects of aspirin and cyclosporine persist long-term.


Assuntos
Aspirina/uso terapêutico , Prótese Vascular , Cilazapril/uso terapêutico , Ciclosporina/uso terapêutico , Oclusão de Enxerto Vascular/prevenção & controle , Veias Jugulares/transplante , Túnica Íntima/patologia , Animais , Artérias Carótidas/cirurgia , Cães , Feminino , Artéria Femoral/cirurgia , Hiperplasia , Veias Jugulares/patologia , Masculino , Fatores de Tempo , Grau de Desobstrução Vascular/fisiologia
4.
J Laparoendosc Surg ; 2(4): 151-5, 1992 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-1388066

RESUMO

Laparoscopic surgery impacted the surgical world in the United States in 1990. This report reviews the initial experience of 34 surgeons in 8 teaching hospitals of the Northeastern Ohio Universities College of Medicine. There were 538 cases reported from May 1, 1990 to January 31, 1991. There was no mortality and the morbidity rate was 4.8%, including three bile duct injuries. The conversion rate to an open procedure was 6.1%. The criteria for credentialing, training, and resident and faculty education are included. The data reported by the Surgery Department of Northeastern Ohio Universities College of Medicine are very similar to reported series from the current literature.


Assuntos
Educação Médica Continuada , Cirurgia Geral/educação , Laparoscopia , Adulto , Humanos , Internato e Residência , Laparoscopia/efeitos adversos , Pessoa de Meia-Idade
6.
J Vasc Surg ; 12(5): 531-7, 1990 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-2231964

RESUMO

Saphenous vein patch rupture after carotid endarterectomy is an infrequent but devastating complication. This study was undertaken to evaluate the material and structural properties of fresh human saphenous veins to understand the causes of this complication. Segments of saphenous veins were obtained from 22 patients from vein harvested during coronary artery bypass surgery. Ninety-three specimens, oriented in both circumferential (n = 45) and longitudinal (n = 48) directions, were prepared from the available vein segments for testing. Specimens were mounted on specially designed grips and then subjected to uniaxial tension testing. For each specimen the following material and structural parameters were determined: vessel diameter, tensile stiffness, failure and ultimate forces, and tensile modulus, failure stress, and strain. The physical properties of specimens evaluated in longitudinal orientations and thus limit the inherent strength of the vein. The physical properties of circumferentially tested vein specimens were negatively correlated to age, female gender, diabetes, and hypertension. The data obtained in this investigation suggest that age, hypertension, as well as diabetes and gender may adversely influence the circumferential tensile strength of human saphenous veins used as patch grafts.


Assuntos
Veia Safena/fisiologia , Idoso , Fenômenos Biomecânicos , Feminino , Humanos , Técnicas In Vitro , Masculino , Pessoa de Meia-Idade , Veia Safena/anatomia & histologia , Estresse Mecânico , Resistência à Tração
8.
J Invest Surg ; 3(4): 357-64, 1990.
Artigo em Inglês | MEDLINE | ID: mdl-2291893

RESUMO

High failure rates (10-40% at 1 year and 2-6% per year thereafter) of autologous vein grafts in peripheral bypass surgery due to progressive intimal hyperplasia (IH) have prompted researchers to search for an animal model that develops IH in a relatively short period of time. This study summarizes our experiences in promoting IH in a canine model. Eight to ten centimeters of both jugular veins were exposed in 40 adult mongrel conditioned dogs. After division into 4-5-cm lengths, the segment of jugular vein most proximal was ballooned at 800-900 mm Hg with a modified 8F Fogarty catheter to induce intimal and medial layer injury. The distal segment was left nonballooned. Segments of these autologous vein grafts, 1.5 cm in length, both ballooned and nonballooned, were then anastomosed, end to end, into the carotid and femoral circulations. Six weeks postoperatively the grafts were perfusion-fixed, harvested, and histologically processed, and the amount of the lumen in midgraft sections occupied by IH was determined by image analysis. In all dogs, the degree of IH was significantly greater in the balloon catheterized vs noncatheterized graft segments. IH was more severe in the femoral than in the carotid arteries. The grafts that developed the most severe intimal hyperplasia were femoral grafts that had been balloon catheterized. We conclude that these protocols are effective in inducing IH in a canine model in short postoperative times.


Assuntos
Veias/patologia , Veias/transplante , Animais , Modelos Animais de Doenças , Cães , Hiperplasia , Complicações Pós-Operatórias/patologia
9.
Surg Gynecol Obstet ; 169(5): 400-2, 1989 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-2814749

RESUMO

The Kimray-Greenfield venal caval filter is widely accepted as a means of preventing pulmonary embolism when medical anticoagulation has failed or complications have developed. When indicated, anticoagulants are usually resumed after placement of the filter. A retrospective study was performed comparing the thromboembolic and postphlebitic complications in patients who continued to receive anticoagulants after placement of the filter versus those who did not. Sixty-eight Kimray-Greenfield filters were placed in 68 patients (43 men and 25 women) during a four year period. After placement of the filter, 26 patients received anticoagulants and 42 did not. Three of those receiving anticoagulants and six of those who did not had significant swelling of the leg; two of those receiving anticoagulants and two of those who did not had a recurrent deep venous thrombosis. There were no instances of recurrent pulmonary embolism. There were no significant differences in the results of these two groups of patients. These results are consistent with those reported in the literature in that no correlation has been found between the use of anticoagulants after placement of the filter and recurrent thromboembolism or stasis sequelae. In view of the complications associated with medical anticoagulation, we recommend its discontinuation in all patients after placement of the Kimray-Greenfield filter.


Assuntos
Anticoagulantes/uso terapêutico , Filtração/instrumentação , Embolia Pulmonar/prevenção & controle , Edema/etiologia , Feminino , Humanos , Perna (Membro) , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Tromboflebite/epidemiologia
10.
J Vasc Surg ; 9(5): 704-8; discussion 708-9, 1989 May.
Artigo em Inglês | MEDLINE | ID: mdl-2657117

RESUMO

Ten mongrel dogs underwent left lower extremity in situ femoropopliteal bypass with femoral vein. A 20 to 25 cm myocutaneous bridge was left between femoral and popliteal anastomoses. A 2.8 mm angioscope was introduced intraluminally to visualize venous tributaries (VT). A balloon occlusion catheter was placed alongside the angioscope and directed in each VT. Prolamine was injected into each VT to effect occlusion. Seven dogs were followed up for 1 week and three dogs for 1 month. A total of 34 VT (range one to five per dog) were available for attempted occlusion. Twenty-nine of 84 (85%) VT were able to be occluded based on comparison of pre-VT and post-VT occlusion angiograms. Poor visualization of VT or VT too small to admit the 5F catheter were reasons for failure. We conclude that (1) in the canine model studied angioscope-assisted occlusion of femoropopliteal during bypass is technically feasible, (2) this technical detail makes unnecessary medial thigh dissection for exposure of the vein graft, and (3) during short-term observation prolamine appeared to be a suitable occluding substance.


Assuntos
Cateterismo , Embolização Terapêutica/instrumentação , Artéria Femoral/cirurgia , Cuidados Intraoperatórios/métodos , Artéria Poplítea/cirurgia , Proteínas/uso terapêutico , Adesivos Teciduais/uso terapêutico , Anastomose Cirúrgica/métodos , Animais , Cateterismo/instrumentação , Cães , Embolização Terapêutica/métodos , Endoscópios , Veia Femoral/transplante , Seguimentos , Géis/uso terapêutico , Técnicas de Sutura
11.
Ann Vasc Surg ; 3(2): 104-7, 1989 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-2548555

RESUMO

This report summarizes our techniques and experiences deriving microvascular endothelial cells from fat for vascular graft seeding in 17 patients. Microvascular endothelial cells were derived from abdominal wall fat by collagenase incubation. The mean number of cells obtained using the described procedure was 6.83 x 10(5) cells/gram of fat processed. Histologic evaluation of the harvested cells revealed significant numbers of contaminating cell types in addition to Factor VIII-positive microvascular endothelial cells. These cells were seeded onto 6 mm ID PTFE vascular grafts in patients undergoing peripheral vascular arterial revascularization. The mean number of seeded cells was 8.04 x 10(6) cells/graft. Approximately 90 minutes were required to harvest and isolate the microvascular cells from the fat samples. We feel there are significant technical advantages to deriving endothelial cells from microvessels of human fat for vascular graft seeding.


Assuntos
Tecido Adiposo/citologia , Prótese Vascular , Endotélio Vascular/citologia , Endotélio/citologia , Arteriopatias Oclusivas/terapia , Contagem de Células , Humanos , Métodos , Colagenase Microbiana/metabolismo , Politetrafluoretileno , Desenho de Prótese
12.
J Vasc Surg ; 7(5): 625-30, 1988 May.
Artigo em Inglês | MEDLINE | ID: mdl-3130495

RESUMO

In the first part of this experiment, the effects of pharmacotherapy on the neurologic consequences of transient global ischemia were examined in Wistar rats. The control and four experimental groups each contained six rats. In comparison to the control group receiving normal saline (NS) solution, in which no rats survived, all rats given naloxone (Nx) (23 mg/kg), superoxide dismutase (SOD) (10,000 U/kg), or allopurinol (APL) (35 mg/kg), 15 minutes before interruption of cerebral blood flow, survived the 20-minute period of global ischemia (p less than 0.01, p less than 0.01, p less than 0.01, respectively). No rat receiving deferoxamine (DEF) (20 mg/kg) survived the same ischemic period. In the second part of the experiment, the arachidonic acid (AA) content of brain samples was determined by gas chromatography and was used as an indicator of cerebral ischemia. Two control and four experimental groups consisted of six rats each. An ischemia control group received NS, whereas experimental groups were given Nx, SOD, APL, or DEF with the same previous dosage schedule. The animals were decapitated 15 minutes after drug infusion and cerebral ischemia was simulated by incubation of the heads in a 37 degrees C water bath for 60 minutes. AA content of ischemic brain treated with NS was markedly elevated (60.0 +/- 24.1 micrograms/gm of brain tissue), whereas in comparison the AA content of brain treated with Nx (5.1 +/- 3.0 micrograms/gm of brain tissue, p less than 0.05), SOD (3.5 +/- 2.7 micrograms/gm of brain tissue, p less than 0.05), or APL (2.9 +/- 1.5 micrograms/gm of brain tissue, p less than 0.05) all demonstrated much lower levels.(ABSTRACT TRUNCATED AT 250 WORDS)


Assuntos
Alopurinol/farmacologia , Encéfalo/efeitos dos fármacos , Desferroxamina/farmacologia , Ataque Isquêmico Transitório/fisiopatologia , Naloxona/farmacologia , Superóxido Dismutase/farmacologia , Animais , Ácido Araquidônico , Ácidos Araquidônicos/metabolismo , Encéfalo/metabolismo , Ataque Isquêmico Transitório/metabolismo , Masculino , Ratos , Ratos Endogâmicos
13.
J Biomed Mater Res ; 22(3): 163-77, 1988 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-3283132

RESUMO

The purpose of this study was to determine the effects of endothelial cell seeding and graft internodal distance upon the performance of 4-mm-ID e-PTFE grafts during acute reduced blood flow conditions. PTFE grafts especially manufactured with three different mean internodal distances (28, 40, and 52 microns) were evaluated. Fifteen dogs (n = 5 for each design of PTFE graft) underwent bilateral carotid artery replacements with 6 cm lengths of 4-mm-ID PTFE grafts. In each dog one graft was seeded with enzymatically derived endothelial cells; the contralateral graft was nonseeded. All grafts were evaluated 5 weeks postoperatively. Dogs with bilaterally patent grafts were subsequently subjected to flow conditions through the graft that were maintained at 30% of the initial flow rates for 4 hr. Following controlled low flows the grafts were excised and assessed for patency, thrombus-free surface area, inner capsule thickness and prostacyclin production. Endothelial cell seeding of these small-diameter e-PTFE vascular grafts improved patency and thrombus-free surface areas in grafts of all pore sizes, with these parameters being greatest in the 40-microns grafts. Inner-capsule healing in these grafts was controlled and related to the pore size. PGI2 production was improved in endothelial cell seeded grafts of all pore sizes. However, neither endothelial cell seeding nor graft pore size affected the performance of these e-PTFE grafts under conditions of reduced blood flows.


Assuntos
Materiais Biocompatíveis , Prótese Vascular , Animais , Velocidade do Fluxo Sanguíneo , Cães , Endotélio Vascular/citologia , Epoprostenol/biossíntese , Teste de Materiais , Politetrafluoretileno , Propriedades de Superfície , Trombose/prevenção & controle
14.
J Invest Surg ; 1(1): 35-44, 1988.
Artigo em Inglês | MEDLINE | ID: mdl-2978983

RESUMO

One obstacle to the clinical implementation of endothelial cell seeding of vascular prostheses is the difficulty in derivation of large numbers of autologous endothelial cells from blood vessels of patients requiring vascular grafting. Capillary endothelial cells obtained from fat have been suggested as an abundant alternative to large-vessel endothelium for graft seeding. The object of this study was to evaluate the performance of 4-mm internal diameter (ID) Dacron Microvel grafts seeded with omentally derived microvascular endothelial cells. Six-cm lengths of the test grafts were implanted bilaterally into canine carotid arteries. One of each pair of grafts was seeded with endothelial cells (means = 8.4 x 10(6)) derived from collagenase digestion of autologous omental fat samples. The contralateral graft of each pair was nonseeded. At 5 weeks postoperatively, the grafts were harvested and evaluated. The mean patencies of both the seeded and nonseeded grafts were 89 percent. The mean thrombus-free surface area for seeded grafts was 95 +/- 11 percent. This value was significantly different statistically from the mean thrombus-free surface area of nonseeded grafts, which was 43 +/- 19 percent (P less than .05). Histologically, midgraft regions of seeded grafts were cellular, stained positive for collagen, and were characterized by inner capsules ranging in thickness between 35-94 microns. Luminal cells were identified as endothelial by peroxidase antiperoxidase staining techniques. Midgraft regions of nonseeded grafts demonstrated thrombus accumulation, limited cellularity, and inner capsules between 59-194 microns thick. Scanning electron microscopy of seeded grafts revealed smooth luminal surfaces with tight junctions between adjacent cells; surface cells were not present on midgraft regions of nonseeded grafts. In conclusion, endothelial cells derived from omental fat successfully surfaced on Dacron grafts and imparted characteristics to the graft that would predict long-term graft success.


Assuntos
Prótese Vascular , Endotélio Vascular/citologia , Animais , Cães , Estudos de Avaliação como Assunto , Polietilenotereftalatos , Trombose/prevenção & controle
15.
J Vasc Surg ; 6(4): 365-71, 1987 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-3656584

RESUMO

Despite being of fundamental importance, the late results of major arterial reconstruction rarely have been documented throughout a large metropolitan area. In this study of 932 patients entered into the computer registry of the Cleveland Vascular Society, 19 surgeons representing 13 community hospitals and referral centers in Cleveland and Akron report the intermediate-term outcome during a mean interval of 35 months after infrainguinal lower extremity revascularization performed in northeastern Ohio from 1978 through 1982. Operative risk (5%), the early amputation rate (7%), and actuarial 5-year survival (48% to 55%) for patients with rest pain or tissue necrosis were significantly worse (p less than 0.05) than comparable figures (0.6%, 0%, and 77%, respectively) for others who underwent procedures for disabling claudication. Although both materials had similar success above the knee, the cumulative 3-year patency rate of autogenous vein bypass to the distal popliteal (69% to 88%; p less than 0.05) and tibioperoneal arteries (43%; 0.05 less than p less than 0.1) was superior to the results of polytetrafluoroethylene grafts (32% to 50% and 19%, respectively). Moreover, polytetrafluoroethylene grafts required reoperations at three times the rate of vein grafts to maintain limb salvage.


Assuntos
Prótese Vascular , Claudicação Intermitente/cirurgia , Isquemia/cirurgia , Perna (Membro)/irrigação sanguínea , Veia Safena/transplante , Idoso , Amputação Cirúrgica , Aneurisma/cirurgia , Angiopatias Diabéticas/complicações , Feminino , Seguimentos , Oclusão de Enxerto Vascular , Humanos , Perna (Membro)/cirurgia , Masculino , Métodos , Pessoa de Meia-Idade , Artéria Poplítea/cirurgia , Complicações Pós-Operatórias/mortalidade , Reoperação
18.
J Cardiovasc Surg (Torino) ; 28(3): 270-3, 1987.
Artigo em Inglês | MEDLINE | ID: mdl-3584226

RESUMO

Experience with retroperitoneal approach to the abdominal aorta for aortic reconstruction in 30 cases is reported. The authors' interest in this exposure stemmed from observations made at the time of scoliosis surgery. The technique was modified and used in poor risk patients and resulted in a significant decrease in operative morbidity and hospitalization. A literature review revealed that several modifications have been described dating back as far as 1836. The authors emphasize technical features and advantages and disadvantages of this approach.


Assuntos
Aorta Abdominal/cirurgia , Doenças da Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Humanos , Métodos
19.
Artery ; 14(3): 137-53, 1987.
Artigo em Inglês | MEDLINE | ID: mdl-3592999

RESUMO

The ideal prosthetic vascular graft for the replacement or bypass of small vessels has not yet been developed. Many studies have documented the success of endothelial cell seeding in small-diameter Dacron grafts, but few have reported the application of this protocol to small-diameter PTFE grafts, and none have reported seeding small-diameter PTFE grafts in antiplatelet medicated dogs. The present study was undertaken to assess the efficacy of endothelial cell seeding of small-diameter (4 mm ID) PTFE (Gore-Tex) carotid artery interposition grafts in the antiplatelet medicated dog. Twenty-five male mongrel dogs were included in this study. In each dog one carotid artery was replaced with an endothelial cell seeded PTFE graft; the contralateral artery was replaced with a nonseeded graft. The in vivo progress of graft performance was evaluated from 1 to 4 weeks postoperatively. The endothelial cell seeded grafts achieved significantly higher patencies and mean thrombus-free surfaces than nonseeded grafts. Midgraft endothelium was identified only on the seeded grafts at 3 and 4 weeks, with a maximal luminal coverage of 10-12%. The measurements of prostacyclin (PGI2) production indicated that the antiplatelet agent therapy did inhibit endothelial cell cyclooxygenase. The presence of outer capsule vasa vasora, anastomotic pannus ingrowth, transinterstitial cellular ingrowth, and thin inner capsules characterized the endothelial cell seeded grafts in contrast to the nonseeded grafts. We conclude that enhancement of graft performance is achieved by combining both an antiplatelet regimen and endothelial cell seeding in small-diameter PTFE vascular grafts.


Assuntos
Prótese Vascular/métodos , Endotélio/citologia , Oclusão de Enxerto Vascular/prevenção & controle , Sobrevivência de Enxerto , 6-Cetoprostaglandina F1 alfa/metabolismo , Animais , Aspirina/farmacologia , Plaquetas/efeitos dos fármacos , Dipiridamol/farmacologia , Cães , Masculino , Microscopia Eletrônica , Politetrafluoretileno/farmacologia , Grau de Desobstrução Vascular/efeitos dos fármacos
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