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[PMID]:28701263
[Au] Autor:Brady JT; Althans AR; Neupane R; Dosokey EMG; Jabir MA; Reynolds HL; Steele SR; Stein SL
[Ad] Endereço:Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. Electronic address: Justin.Brady@UHhospitals.org.
[Ti] Título:Treatment for anal fissure: Is there a safe option?
[So] Source:Am J Surg;214(4):623-628, 2017 Oct.
[Is] ISSN:1879-1883
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Surgeons often approach anal fissure with chemical denervation (Botulinum toxin, BT) instead of initial lateral internal sphincterotomy (LIS) due to concerns for long-term incontinence. We evaluated the characteristics and outcomes of patients who received BT or LIS. METHODS: We performed a retrospective chart review of patients undergoing LIS and BT for anal fissure between 2009 and 2015. In 2015, a telephone survey was performed to evaluate durability, long-term incontinence and patient satisfaction. RESULTS: Ninety-four patients met criteria: 73 LIS and 21 BT. Age (BT 49 vs. LIS 52) was similar between groups (p = 1.0). Cleveland Clinic Fecal Incontinence (CCFI) score pre-intervention was higher in BT than LIS patients (2.1 vs. 0.4, p = 0.007) with fewer BT patients with perfect continence (50% vs. 88%). Telephone survey response was 61%. Fissure recurrence was significantly higher for BT than LIS patients (36% vs. 9%, p = 0.03). CONCLUSION: Patients undergoing LIS were less likely to recur. Both LIS and BT patients had some durable changes in continence raising the question of whether there is a safe technique.
[Mh] Termos MeSH primário: Toxinas Botulínicas Tipo A/uso terapêutico
Fissura Anal/tratamento farmacológico
Fissura Anal/cirurgia
Fármacos Neuromusculares/uso terapêutico
Satisfação do Paciente
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Masculino
Meia-Idade
Padrões de Prática Médica/estatística & dados numéricos
Estudos Retrospectivos
Inquéritos e Questionários
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Neuromuscular Agents); EC 3.4.24.69 (Botulinum Toxins, Type A)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170714
[St] Status:MEDLINE


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[PMID]:28514300
[Au] Autor:Hang MTH; Smith BE; Keck C; Keshavarzian A; Sedghi S
[Ad] Endereço:aDivision of Gastroenterology, Department of Internal Medicine, Mercer University School of Medicine, Macon, GA bDivision of Medicine, Medical University of South Carolina, Charleston, SC cDivision of Digestive Diseases, Rush University Medical Center, Chicago, IL.
[Ti] Título:Increasing efficacy and reducing side effects in treatment of chronic anal fissures: A study of topical diazepam therapy.
[So] Source:Medicine (Baltimore);96(20):e6853, 2017 May.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This is a single institution nonexperimental study intended to analyze the therapeutic efficacy of topical diazepam in treating symptoms of chronic anal fissures.Anal fissures are a common cause of anal pain. Conventional treatments include nonsteroidal anti-inflammatory drugs, topical creams, such as nitroglycerin and nifedipine, and surgery. However, these treatments are usually suboptimally efficacious or have deterring side effects.Patients at an outpatient community center with a diagnosis of a chronic anal fissure were prescribed either topical 2% (n = 19) or 4% (n = 18) diazepam cream between January 2013 and February 2015. We retrospectively analyzed their responses to treatment.All 19 patients using 2% diazepam cream experienced a positive response in pain, whereas 47.4% experienced a complete response, with a numerical rating scale (NRS) score of 0 (0-10). Eighty-eight percent of patients using 4% dose had a positive response in pain, whereas 23.5% experienced a complete response. Ninety-four percent of patients using 2% dose had a positive response in anal bleeding, whereas 68.8% experienced a complete response with an anal bleeding score (ABS) of 2 (2-9). Ninety-four percent of patients using 4% dose had a positive response in anal bleeding, whereas 64.7% experienced a complete response. Only 1 patient reported a side effect from diazepam cream-perianal pruritus.Both 2% and 4% topical diazepam provided significant pain and bleeding relief from chronic anal fissures that were refractory to conventional therapies. There were insignificant differences when assessing independent comparisons for pain and bleeding between the doses.
[Mh] Termos MeSH primário: Analgésicos/administração & dosagem
Diazepam/administração & dosagem
Fissura Anal/tratamento farmacológico
[Mh] Termos MeSH secundário: Administração Tópica
Analgésicos/efeitos adversos
Doença Crônica
Diazepam/efeitos adversos
Relação Dose-Resposta a Droga
Resistência a Medicamentos
Feminino
Fissura Anal/fisiopatologia
Seguimentos
Hemorragia/tratamento farmacológico
Hemorragia/fisiopatologia
Seres Humanos
Masculino
Meia-Idade
Pacientes Ambulatoriais
Dor/tratamento farmacológico
Dor/fisiopatologia
Medição da Dor
Melhoria de Qualidade
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Analgesics); Q3JTX2Q7TU (Diazepam)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170613
[Lr] Data última revisão:
170613
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170518
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000006853


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[PMID]:28473039
[Au] Autor:Cotter TG; Buckley NS; Loftus CG
[Ad] Endereço:Department of Internal Medicine, Mayo Clinic, Rochester, MN.
[Ti] Título:Approach to the Patient With Hematochezia.
[So] Source:Mayo Clin Proc;92(5):797-804, 2017 May.
[Is] ISSN:1942-5546
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:The evaluation of the patient with hematochezia can be complex because of the broad differential diagnosis and the number of management strategies available. In this article, a simplified approach to the history and physical examination is presented, with management illustrated in a case-oriented manner.
[Mh] Termos MeSH primário: Dor Abdominal
Colonoscopia
Exame Retal Digital
Hemorragia Gastrointestinal
Dor Pélvica
Exame Físico/métodos
[Mh] Termos MeSH secundário: Dor Abdominal/diagnóstico
Dor Abdominal/etiologia
Adulto
Idoso
Idoso de 80 Anos ou mais
Transtornos Relacionados ao Uso de Álcool/complicações
Transtornos Relacionados ao Uso de Álcool/diagnóstico
Transtornos Relacionados ao Uso de Álcool/terapia
Malformações Arteriovenosas/complicações
Malformações Arteriovenosas/diagnóstico
Tumor Carcinoide/complicações
Tumor Carcinoide/diagnóstico
Tumor Carcinoide/cirurgia
Colo/irrigação sanguínea
Colonoscopia/métodos
Doença de Crohn/complicações
Doença de Crohn/diagnóstico
Diagnóstico Diferencial
Exame Retal Digital/métodos
Diverticulose Cólica/complicações
Diverticulose Cólica/diagnóstico
Diverticulose Cólica/terapia
Feminino
Fissura Anal/complicações
Fissura Anal/diagnóstico
Fissura Anal/terapia
Hemorragia Gastrointestinal/diagnóstico
Hemorragia Gastrointestinal/etiologia
Hemorragia Gastrointestinal/terapia
Seres Humanos
Isquemia/complicações
Isquemia/diagnóstico
Isquemia/terapia
Masculino
Divertículo Ileal/complicações
Divertículo Ileal/diagnóstico
Anamnese/métodos
Meia-Idade
Dor Pélvica/diagnóstico
Dor Pélvica/etiologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170807
[Lr] Data última revisão:
170807
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170506
[St] Status:MEDLINE


  4 / 1805 MEDLINE  
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[PMID]:27926567
[Au] Autor:Emile SH
[Ad] Endereço:Mansoura, Egypt.
[Ti] Título:Indications and Technical Aspects of Internal Anal Sphincterotomy: Highlighting the Controversies.
[So] Source:Dis Colon Rectum;60(1):128-132, 2017 Jan.
[Is] ISSN:1530-0358
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Canal Anal/cirurgia
Procedimentos Cirúrgicos do Sistema Digestório/métodos
Fissura Anal/cirurgia
Hemorroidas/cirurgia
Megacolo/cirurgia
[Mh] Termos MeSH secundário: Doenças do Ânus/cirurgia
Constrição Patológica
Incontinência Fecal/epidemiologia
Seres Humanos
Complicações Pós-Operatórias/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161208
[St] Status:MEDLINE


  5 / 1805 MEDLINE  
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[PMID]:27926561
[Au] Autor:Ruiz-Tovar J; Llavero C
[Ad] Endereço:Department of Surgery, Clinica Garcilaso, Madrid, Spain.
[Ti] Título:Percutaneous Posterior Tibial Nerve Stimulation vs Perianal Application of Glyceryl Trinitrate Ointment in the Treatment of Chronic Anal Fissure: A Randomized Clinical Trial.
[So] Source:Dis Colon Rectum;60(1):81-86, 2017 Jan.
[Is] ISSN:1530-0358
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Current therapeutic guidelines for the treatment of chronic anal fissure establish a medical approach as the first step. Glyceryl trinitrate ointment is the most popular of the available topical treatments in Spain but it is associated with the appearance of headache. OBJECTIVE: The purpose of this study was to compare the compliance rate among patients receiving glyceryl trinitrate treatment for chronic anal fissure with that among patients receiving percutaneous posterior tibial nerve stimulation. DESIGN: This was a prospective randomized study. SETTINGS: The study was conducted at Garcilaso Clinic (Madrid, Spain). PATIENTS: Subjects with persistent anal fissure despite hygiene and dietary measures applied over at least a 6-week period were included. INTERVENTIONS: Study interventions were perianal application of glyceryl trinitrate ointment (twice daily for 8 weeks) and percutaneous posterior tibial nerve stimulation (30-minute session 2 days per week for 8 weeks). MAIN OUTCOME MEASURES: Compliance with the treatment and healing rate of chronic anal fissure in patients receiving glyceryl trinitrate ointment or undergoing percutaneous posterior tibial nerve stimulation were evaluated. RESULTS: Forty patients were included in each group. In the glyceryl trinitrate ointment group, 15% of the patients discontinued treatment because of disabling headaches. There were no adverse effects or treatment withdrawals in the percutaneous posterior tibial nerve stimulation group (p = 0.033). After 8 weeks of treatment, the healing rate in the percutaneous posterior tibial nerve stimulation group was 87.5% vs 65.0% in the glyceryl trinitrate ointment group (p = 0.018). LIMITATIONS: Because the patients were not blinded to the treatment, we cannot rule out a placebo effect derived from the needle insertion in the percutaneous posterior tibial nerve stimulation group. CONCLUSIONS: Percutaneous posterior tibial nerve stimulation is a safe and effective alternative that is in some ways superior to glyceryl trinitrate ointment for the treatment of chronic anal fissure.
[Mh] Termos MeSH primário: Terapia por Estimulação Elétrica/métodos
Fissura Anal/terapia
Nitroglicerina/uso terapêutico
Nervo Tibial
Vasodilatadores/uso terapêutico
[Mh] Termos MeSH secundário: Administração Tópica
Adulto
Doença Crônica
Feminino
Seres Humanos
Masculino
Meia-Idade
Pomadas
Cooperação do Paciente
Resultado do Tratamento
Cicatrização
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Ointments); 0 (Vasodilator Agents); G59M7S0WS3 (Nitroglycerin)
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161208
[St] Status:MEDLINE


  6 / 1805 MEDLINE  
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[PMID]:27926552
[Au] Autor:Stewart DB; Gaertner W; Glasgow S; Migaly J; Feingold D; Steele SR
[Ad] Endereço:Prepared on behalf of the Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons.
[Ti] Título:Clinical Practice Guideline for the Management of Anal Fissures.
[So] Source:Dis Colon Rectum;60(1):7-14, 2017 Jan.
[Is] ISSN:1530-0358
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Inibidores da Liberação da Acetilcolina/uso terapêutico
Canal Anal/cirurgia
Bloqueadores dos Canais de Cálcio/uso terapêutico
Procedimentos Cirúrgicos do Sistema Digestório/métodos
Fissura Anal/terapia
Doadores de Óxido Nítrico/uso terapêutico
[Mh] Termos MeSH secundário: Administração Tópica
Toxinas Botulínicas/uso terapêutico
Tratamento Conservador
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; PRACTICE GUIDELINE
[Nm] Nome de substância:
0 (Acetylcholine Release Inhibitors); 0 (Calcium Channel Blockers); 0 (Nitric Oxide Donors); EC 3.4.24.69 (Botulinum Toxins)
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161208
[St] Status:MEDLINE


  7 / 1805 MEDLINE  
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[PMID]:27840356
[Au] Autor:Julianto I; Rindastuti Y
[Ad] Endereço:Dermato Venereology Department Medical Faculty Sebelas Maret, University dr. Moewardi General Hospital, Surakarta. dr_inyuda@yahoo.com.
[Ti] Título:Topical Delivery of Mesenchymal Stem Cells "Secretomes" in Wound Repair.
[So] Source:Acta Med Indones;48(3):217-220, 2016 Jul.
[Is] ISSN:0125-9326
[Cp] País de publicação:Indonesia
[La] Idioma:eng
[Ab] Resumo:Wound healing requires a coordinated interplay among cells, growth factors, and extracellular matrix proteins. Central to this process is the endogenous mesenchymal stem cell (MSC), which coordinates the repair response by recruiting other host cells and secreting growth factors and matrix proteins. MSCs are self-renewing multipotent stem cells that can differentiate into various lineages of mesenchymal origin such as bone, cartilage, tendon, and fat. In addition to multilineage differentiation capacity, MSCs regulate immune response and inflammation and possess powerful tissue protective and reparative mechanisms, making these cells attractive for treatment of different diseases. The beneficial effect of exogenous MSCs on wound healing was observed in a variety of animal models and in reported clinical cases. Specifically, they have been successfully used to treat chronic wounds and stimulate stalled healing processes. Recent studies revealed that human placental membranes are a rich source of MSCs for tissue regeneration and repair. This review provides a concise summary of current knowledge of biological properties of MSCs and describes the use of MSCs for wound healing. In particular, the scope of this review focuses on the role MSCs have in each phase of the wound-healing process, and clinical reports transplatation MSCs - secretomes in chronical ulcer.
[Mh] Termos MeSH primário: Fissura Anal/terapia
Transplante de Células-Tronco Mesenquimais
Células Mesenquimais Estromais/citologia
Cicatrização/fisiologia
[Mh] Termos MeSH secundário: Adulto
Seres Humanos
Masculino
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1701
[Cu] Atualização por classe:170123
[Lr] Data última revisão:
170123
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161115
[St] Status:MEDLINE


  8 / 1805 MEDLINE  
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[PMID]:27824697
[Au] Autor:Vogel JD; Johnson EK; Morris AM; Paquette IM; Saclarides TJ; Feingold DL; Steele SR
[Ad] Endereço:Prepared on behalf of The Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons.
[Ti] Título:Clinical Practice Guideline for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula.
[So] Source:Dis Colon Rectum;59(12):1117-1133, 2016 Dec.
[Is] ISSN:1530-0358
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Fissura Anal
Fístula Retal
Fístula Retovaginal
[Mh] Termos MeSH secundário: Gerenciamento Clínico
Feminino
Fissura Anal/diagnóstico
Fissura Anal/terapia
Seres Humanos
Fístula Retal/diagnóstico
Fístula Retal/terapia
Fístula Retovaginal/diagnóstico
Fístula Retovaginal/terapia
[Pt] Tipo de publicação:JOURNAL ARTICLE; PRACTICE GUIDELINE
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161109
[St] Status:MEDLINE


  9 / 1805 MEDLINE  
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[PMID]:27723447
[Au] Autor:Chang J; Mclemore E; Tejirian T
[Ad] Endereço:General Surgery Resident completing his training at the Los Angeles Medical Center. jason.s.chang@kp.org.
[Ti] Título:Anal Health Care Basics.
[So] Source:Perm J;20(4):74-80, 2016.
[Is] ISSN:1552-5775
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Despite the fact that countless patients suffer from anal problems, there tends to be a lack of understanding of anal health care. Unfortunately, this leads to incorrect diagnoses and treatments. When treating a patient with an anal complaint, the primary goals are to first diagnose the etiology of the symptoms correctly, then to provide an effective and appropriate treatment strategy.The first step in this process is to take an accurate history and physical examination. Specific questions include details about bowel habits, anal hygiene, and fiber supplementation. Specific components of the physical examination include an external anal examination, a digital rectal examination, and anoscopy if appropriate.Common diagnoses include pruritus ani, anal fissures, hemorrhoids, anal abscess or fistula, fecal incontinence, and anal skin tags. However, each problem presents differently and requires a different approach for management. It is of paramount importance that the correct diagnosis is reached. Common errors include an inaccurate diagnosis of hemorrhoids when other pathology is present and subsequent treatment with a steroid product, which is harmful to the anal area.Most of these problems can be avoided by improving bowel habits. Adequate fiber intake with 30 g to 40 g daily is important for many reasons, including improving the quality of stool and preventing colorectal and anal diseases.In this Special Report, we provide an overview of commonly encountered anal problems, their presentation, initial treatment options, and recommendations for referral to specialists.
[Mh] Termos MeSH primário: Canal Anal/patologia
Doenças Retais/terapia
Reto/patologia
[Mh] Termos MeSH secundário: Abscesso/diagnóstico
Abscesso/terapia
Doenças do Ânus/diagnóstico
Doenças do Ânus/terapia
Defecação
Fibras na Dieta
Incontinência Fecal/diagnóstico
Incontinência Fecal/terapia
Fissura Anal/diagnóstico
Fissura Anal/terapia
Hemorroidas/diagnóstico
Hemorroidas/terapia
Seres Humanos
Exame Físico
Prurido Anal/diagnóstico
Prurido Anal/terapia
Doenças Retais/diagnóstico
Fístula Retal/diagnóstico
Fístula Retal/terapia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161011
[St] Status:MEDLINE
[do] DOI:10.7812/TPP/15-222


  10 / 1805 MEDLINE  
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[PMID]:27539490
[Au] Autor:Bobkiewicz A; Francuzik W; Krokowicz L; Studniarek A; Ledwosinski W; Paszkowski J; Drews M; Banasiewicz T
[Ad] Endereço:Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznan, Poland. bobofon007@gmail.com.
[Ti] Título:Botulinum Toxin Injection for Treatment of Chronic Anal Fissure: Is There Any Dose-Dependent Efficiency? A Meta-Analysis.
[So] Source:World J Surg;40(12):3064-3072, 2016 Dec.
[Is] ISSN:1432-2323
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Chronic anal fissure (CAF) is a linear split of the anoderm. The minimally invasive management of CAF such as botulinum toxin (BT) injection is recommended. However, the exact efficient dose of BT, number of injections per session and the injection sites are still debatable. The aim of this analysis was to assess the dose-dependent efficiency of botulinum toxin injection for CAF. METHODS: PubMed and Web of Science databases were searched for terms: "anal fissure" AND "botulinum toxin." Studies published between October 1993 and May 2015 were included and had to meet the following criteria: (1) chronic anal fissure, (2) prospective character of the study, (3) used simple BT injection without any other interventions and (4) no previous treatment with BT. RESULTS: A total of 1577 patients from 34 prospective studies used either Botox or Dysport formulations were qualified for this meta-analysis. A total number of BT units per session ranged from 5 to 150 IU, whereas the efficiency across analyzed studies ranged from 33 to 96 %. Surprisingly, we did not observe a dose-dependent efficiency (Spearman's rank correlation coefficient, ρ = 0.060; p = 0.0708). Moreover, there were no BT dose-dependent postoperative complications or fecal incontinence and significant difference in healing rates compared BT injection into the anal sphincter muscles. CONCLUSIONS: BT injection has been an accepted method for the management of CAF. Surprisingly, there is no dose-dependent efficiency, and the postoperative incontinence rate is not related to the BT dosage regardless the type of formulation of botulinum neurotoxin used. Moreover, no difference in healing rate has been observed in regard to the site and number of injections per session.
[Mh] Termos MeSH primário: Inibidores da Liberação da Acetilcolina/administração & dosagem
Toxinas Botulínicas Tipo A/administração & dosagem
Fissura Anal/tratamento farmacológico
[Mh] Termos MeSH secundário: Canal Anal
Toxinas Botulínicas Tipo A/efeitos adversos
Doença Crônica
Relação Dose-Resposta a Droga
Incontinência Fecal/induzido quimicamente
Seres Humanos
Injeções Intramusculares
Cicatrização
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Acetylcholine Release Inhibitors); E211KPY694 (onabotulinumtoxinA); EC 3.4.24.69 (Botulinum Toxins, Type A); EC 3.4.24.69 (abobotulinumtoxinA)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160820
[St] Status:MEDLINE



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