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[PMID]:29384879
[Au] Autor:Jung KJ; Nho JH; Cho HK; Hong S; Won SH; Chun DI; Kim B
[Ad] Endereço:Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan-si.
[Ti] Título:Amputation of multiple limbs caused by use of inotropics: Case report, a report of 4 cases.
[So] Source:Medicine (Baltimore);97(5):e9800, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: We present 4 cases of symmetrical peripheral gangrene (SPG) associated with use of inotropic agent to elevate blood pressure. SPG is a relatively rare phenomenon characterized by symmetrical distal ischemic damage that leads to gangrene of 2 or more sites in the absence of large blood vessel obstruction, where vasoconstriction rather than thrombosis is implicated as the underlying pathophysiology. We present 4 SPG cases of the multiple limbs amputation, associated with inevitable use of inotropic agents. PATIENT CONCERNS: Inotropic agents including dopamine and norepinephrine are used frequently in the treatment of hypotension, and its effectiveness in treating shock is firmly established. However, it can be caused peripheral gangrene by prolonged administration of high dose inotropics, inducing the constant contraction of the peripheral blood vessels. DIAGNOSIS: These 4 patients had different clinical histories and background factors, but each experienced sepsis. The level of amputation is determined by the line of demarcation in concert with considerations of the biomechanics of stump stability, weight bearing, and ambulation. INTERVENTIONS: After recovering of general conditions and completion of demarcation, these 4 patients underwent the amputation of multiple limbs.(bilateral amputations of upper extremities or bilateral amputations of lower extremities). OUTCOMES: In each patient, there was no additional amputation caused by extension of SPG, and the rehabilitation with appropriate orthosis was performed. Treatment of underlying disease were continued too. LESSONS: It is important to alert the possibility of amputations, according to the use of inevitable inotropics. We recommended the careful use of the inotropic agents to the physicians in treating septic shock.
[Mh] Termos MeSH primário: Amputação
Cardiotônicos/efeitos adversos
Dopamina/efeitos adversos
Extremidades/irrigação sanguínea
Extremidades/patologia
Norepinefrina/efeitos adversos
[Mh] Termos MeSH secundário: Adulto
Idoso
Extremidades/cirurgia
Feminino
Gangrena
Seres Humanos
Masculino
Meia-Idade
Vasoconstritores/efeitos adversos
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Cardiotonic Agents); 0 (Vasoconstrictor Agents); VTD58H1Z2X (Dopamine); X4W3ENH1CV (Norepinephrine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009800


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[PMID]:28475443
[Au] Autor:Kawai M; Mihara S; Takahagi S; Iwamoto K; Hiragun T; Hide M
[Ad] Endereço:Department of Dermatology, Integrated Health Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
[Ti] Título:Evaluation of skin perfusion pressure to assess refractory foot ulcers.
[So] Source:J Wound Care;26(5):267-270, 2017 May 02.
[Is] ISSN:0969-0700
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The number of patients with foot gangrene caused by critical ischaemia and severe infection is increasing significantly in developed countries. The measurement of perilesional skin blood flow by skin perfusion pressure (SPP) is useful to select the appropriate treatment of gangrenous lesions, in that it is not affected by calcifications of blood vessels. However, the prognosis of a foot ulcer may also be affected by the level of blood sugar and infections. This study aimed to validate the use of SPP in cases of foot gangrene and ulcers in patients with and without diabetes mellitus (DM) and infection. METHOD: Clinical symptoms, ankle-brachial pressure index (ABPI) and SPP were assessed to evaluate the condition of each foot ulcer. Every foot ulcer was treated as independent, even if a participant had multiple ulcers. All ulcers for which we measured SPP were subject to the analysis. All ulcers were purely ischaemic in nature and were exclusively located on the foot or toes. RESULTS: Data were collected from 117 foot ulcers on 91 toes and feet from 65 patients. Almost all SPP values in healed cases were > 27 mmHg. There were three patients whose ulcers failed to heal by conservative treatments were complicated with severe infection. However, no effect of DM on the relationship between SPP values and prognosis was observed. Logistic regression analysis of all ulcers except for the 5 cases complicated with infection revealed that those with 30 mmHg or lower SPP values are likely to heal by conservative treatment with 23% or lower probability, whereas any ulcer with more than 50 mmHg SPP value and without severe infection may heal without the need for further operations with 80% or higher probability. CONCLUSION: The combination of SPP and careful evaluation of infection may be a good parameter to decide the appropriate treatment for ischaemic skin ulcers, regardless of the complication of DM.
[Mh] Termos MeSH primário: Diabetes Mellitus
Pé Diabético/fisiopatologia
Doenças Vasculares Periféricas/fisiopatologia
Pele/irrigação sanguínea
Cicatrização
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Angioplastia
Índice Tornozelo-Braço
Pé Diabético/etiologia
Pé Diabético/cirurgia
Feminino
/patologia
Úlcera do Pé/fisiopatologia
Úlcera do Pé/cirurgia
Gangrena
Seres Humanos
Modelos Logísticos
Masculino
Meia-Idade
Doenças Vasculares Periféricas/cirurgia
Pressão
Prognóstico
Fluxo Sanguíneo Regional
Estudos Retrospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170713
[Lr] Data última revisão:
170713
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:170506
[St] Status:MEDLINE
[do] DOI:10.12968/jowc.2017.26.5.267


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[PMID]:28272221
[Au] Autor:Zhang XT; Jin WW; Ma XH; Yu HF; Tang XH
[Ad] Endereço:aDepartment of Dermatology bDepartment of Urology, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang cDepartment of Dermatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.
[Ti] Título:Ecthyma gangrenosum in a 3-month-old, previously healthy infant: A Case Report.
[So] Source:Medicine (Baltimore);96(10):e6244, 2017 Mar.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Ecthyma gangrenosum (EG) is an aggressive cutaneous disease caused by local or systemic infection with Pseudomonas aeruginosa. EG is characterized by cutaneous manifestations ranging from nodule and papule, to necrotic ulceration with surrounding erythema, especially with black eschar or central crust. EG presents with characteristic skin lesions which is important to establish diagnosis of sepsis caused by P aeruginosa, a serious condition that can be treated efficiently if diagnosed early. PATIENT CONCERNS: A 3-month-old female infant was presented with characteristic skin lesions of EG and developed sepsis 3 days later. DIAGNOSES: Ecthyma gangrenosum and sepsis caused by Pseudomonas aeruginosa. INTERVENTIONS: Meropenem was used in combination with ceftazidime at first and excision of necrotic skin lesions was performed later. OUTCOMES: Cure. LESSONS: Early recognition of EG plays an important role in providing appropriate empiric antibiotic treatment at early stage of sepsis, and improves the prognosis. Surgical excision may be helpful if no improvement was achieved via antibiotic treatment.
[Mh] Termos MeSH primário: Gangrena/microbiologia
Infecções por Pseudomonas/tratamento farmacológico
Pseudomonas aeruginosa/isolamento & purificação
Pioderma Gangrenoso/microbiologia
Sepse/microbiologia
[Mh] Termos MeSH secundário: Antibacterianos/uso terapêutico
Ceftazidima/uso terapêutico
Feminino
Gangrena/tratamento farmacológico
Gangrena/cirurgia
Seres Humanos
Lactente
Infecções por Pseudomonas/cirurgia
Pioderma Gangrenoso/tratamento farmacológico
Pioderma Gangrenoso/cirurgia
Sepse/tratamento farmacológico
Sepse/cirurgia
Tienamicinas/uso terapêutico
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 0 (Thienamycins); 9M416Z9QNR (Ceftazidime); FV9J3JU8B1 (meropenem)
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170324
[Lr] Data última revisão:
170324
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170309
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000006244


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[PMID]:28222457
[Au] Autor:Rahnama-Moghadam S; Motazedi T; Krejci-Manwaring J
[Ad] Endereço:Indiana University, Indianapolis, IN, USA. Email: srahnama@iupui.edu.
[Ti] Título:Hemodialysis patient with finger ulcerations.
[So] Source:J Fam Pract;66(2):107-110, 2017 Feb.
[Is] ISSN:1533-7294
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The patient reported pain and paresthesias of his left ring finger, and his left hand was cooler than his right. An angiogram helped us recognize the cause of his symptoms.
[Mh] Termos MeSH primário: Fístula Arteriovenosa/complicações
Constrição Patológica/cirurgia
Gangrena/cirurgia
Neuropatia Mediana/cirurgia
Parestesia/etiologia
Diálise Renal/efeitos adversos
Úlcera/etiologia
[Mh] Termos MeSH secundário: Amputação
Artéria Braquial/fisiopatologia
Constrição Patológica/diagnóstico
Dedos
Gangrena/etiologia
Seres Humanos
Falência Renal Crônica/terapia
Masculino
Neuropatia Mediana/etiologia
Meia-Idade
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170619
[Lr] Data última revisão:
170619
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170222
[St] Status:MEDLINE


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[PMID]:28110761
[Au] Autor:Lee JH; Kwon HJ; Park JH; Kim HJ; Kang C; Song SH; Bok SK
[Ad] Endereço:Department of Cardiology, Diabetic Foot Care Clinic of Chungnam National University Hospital, Chungnam National University School of Medicine, 282, Munhwa-ro, Jung-gu, Daejeon, Korea, 35015.
[Ti] Título:Endovascular Intervention for Foot Necrosis Caused by an Inadvertent Intraarterial Injection.
[So] Source:J Vasc Interv Radiol;28(2):302-304, 2017 Feb.
[Is] ISSN:1535-7732
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Angioplastia com Balão
/irrigação sanguínea
Injeções Intra-Arteriais/efeitos adversos
Isquemia/terapia
Mamoplastia
Erros Médicos
[Mh] Termos MeSH secundário: Adulto
Amputação
Angiografia
Feminino
/patologia
Gangrena
Seres Humanos
Isquemia/diagnóstico por imagem
Isquemia/fisiopatologia
Necrose
Recuperação de Função Fisiológica
Fluxo Sanguíneo Regional
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; LETTER
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170124
[St] Status:MEDLINE


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[PMID]:28099058
[Au] Autor:Slater BJ; Rothenberg SS
[Ad] Endereço:Rocky Mountain Hospital for Children , Denver, Colorado.
[Ti] Título:Two-Site Appendectomy in Children: Description of Technique and Outcomes.
[So] Source:J Laparoendosc Adv Surg Tech A;27(4):438-440, 2017 Apr.
[Is] ISSN:1557-9034
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: Laparoscopic appendectomy is one of the most common operations. Single-site appendectomy has been gaining popularity; however, it has certain disadvantages. The purpose of this study was to review the results of an essentially scarless laparoscopic appendectomy technique. METHODS: A retrospective review of all patients who underwent two-site appendectomy for appendicitis between January 2015 and February 2016 was performed. For all cases, a 4 mm trocar and a 5 mm trocar were placed through an infraumbilical incision and a 3 mm trocar was placed in the suprapubic region. RESULTS: Fifty patients underwent appendectomy using this technique. The average age was 9.7 years (5-16 years) and average weight was 40 kg (15.7-73.3 kg). The classifications of appendicitis consisted of 32 simple, 5 suppurative, 4 gangrenous, and 8 perforated. The average operative time was 29 minutes (6-53 minutes) and average length of stay was 1.9 days (1-6 days). There were three minor complications, and all cases were completed with this technique, including in obese patients and for perforated appendicitis. All patients reported satisfaction with their postoperative cosmetic outcome. CONCLUSIONS: This technique allows for the main incision to be hidden at the umbilicus, creating an essentially scarless cosmetic result. The addition of a 3 mm suprapubic port leads to increased maneuverability of the instruments and better retraction of the appendix. It is also feasible in obese children and cases of perforated appendicitis.
[Mh] Termos MeSH primário: Apendicectomia/métodos
Apendicite/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Apendicite/complicações
Apêndice/patologia
Apêndice/cirurgia
Criança
Pré-Escolar
Feminino
Gangrena/cirurgia
Seres Humanos
Laparoscopia/métodos
Masculino
Obesidade/complicações
Duração da Cirurgia
Estudos Retrospectivos
Resultado do Tratamento
Umbigo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170602
[Lr] Data última revisão:
170602
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170119
[St] Status:MEDLINE
[do] DOI:10.1089/lap.2016.0243


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[PMID]:28092221
[Au] Autor:Jain A; Misra DP; Ramesh A; Basu D; Jain VK; Negi VS
[Ad] Endereço:1 Senior Resident, Department of Clinical Immunology, JIPMER, Puducherry, India.
[Ti] Título:Tuberculosis mimicking primary systemic vasculitis: not to be missed!
[So] Source:Trop Doct;47(2):158-164, 2017 Apr.
[Is] ISSN:1758-1133
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Infections are an important differential diagnosis in patients presenting with features of systemic vasculitis. We report a young lady with constitutional features, leg ulcers, digital gangrene and absent peripheral pulses with cervical adenopathy. Chest imaging revealed multiple necrotic lung lesions and involvement of left subclavian artery at its origin from the aorta, Histopathology from cervical lymph nodes showed multiple caseated lymph nodes, which in the context of a positive Mantoux test led us to diagnose tuberculosis and institute appropriate therapy. This is only the second report of tuberculosis presenting as peripheral gangrene, cutaneous ulcers and absent pulses, and serves to educate rheumatologists regarding the need to consider infections as mimics of vasculitis, especially in the developing countries.
[Mh] Termos MeSH primário: Vasculite Sistêmica/diagnóstico
Tuberculose/diagnóstico
[Mh] Termos MeSH secundário: Adulto
Diagnóstico Diferencial
Feminino
Gangrena/diagnóstico
Seres Humanos
Úlcera/diagnóstico
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170620
[Lr] Data última revisão:
170620
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170117
[St] Status:MEDLINE
[do] DOI:10.1177/0049475516687432


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[PMID]:28062430
[Au] Autor:Jagwani AV; Fathi NQ; Jailani RF; Zakaria AD
[Ad] Endereço:Department of Surgery, Pusat Perubatan Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia.
[Ti] Título:Rare and unusual case of polyarteritis nodosa involving the gastrointestinal tract leading to bowel gangrene.
[So] Source:BMJ Case Rep;2017, 2017 Jan 06.
[Is] ISSN:1757-790X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Polyarteritis nodosa (PAN) is a systemic necrotising vasculitis preferentially targeting medium-sized arteries and not related with glomerulonephritis or small vessel involvement. Clinical manifestations of PAN are multisystem. The gastrointestinal, renal, cardiac, musculoskeletal, skin and central nervous systems may be involved. The aetiology remains unknown, and the ensuing vasculitis may lead to aneurysm formation and thrombosis in any organs of the body with resultant ischaemia. PAN of the intestines is a relatively common manifestation of this disease but rarely causes bowel ischaemia resulting in necrosis. Here we report a case of a young Chinese patient who presented with an acute abdomen requiring surgery and made good recovery post operatively. He remains free of symptoms while on steroid therapy.
[Mh] Termos MeSH primário: Ceco/patologia
Colo/patologia
Poliarterite Nodosa/complicações
[Mh] Termos MeSH secundário: Adulto
Assistência ao Convalescente
Ceco/irrigação sanguínea
Colectomia/métodos
Colo/irrigação sanguínea
Gangrena/etiologia
Seres Humanos
Infarto/etiologia
Masculino
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170306
[Lr] Data última revisão:
170306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170108
[St] Status:MEDLINE


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[PMID]:28056319
[Au] Autor:Xu B; Yang CZ; Wu SB; Zhang D; Wang LN; Xiao L; Chen Y; Wang CR; Tong A; Zhou XF; Li XH; Guan XH
[Ad] Endereço:Department of Endocrinology, Air Force General Hospital of PLA, Beijing 100142, China.
[Ti] Título:[Risk factors for lower extremity amputation in patients with diabetic foot].
[So] Source:Zhonghua Nei Ke Za Zhi;56(1):24-28, 2017 Jan 01.
[Is] ISSN:0578-1426
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To explore the risk factors for lower extremity amputation in patients with diabetic foot. The clinical data of 1 771 patients with diabetic foot at the Air Force General Hospital of PLA from November 2001 to April 2015 were retrospectively analyzed. The patients were divided into the non-amputation and amputation groups. Within the amputation group, subjects were further divided into the minor and major amputation subgroups. Binary logistic regression analyses were used to assess the association between risk factors and lower extremity amputation. Among 1 771 patients with diabetic foot, 323 of them (18.24%) were in the amputation group (major amputation: 41; minor amputation: 282) and 1 448 (81.76%) in the non-amputation group. Compared with non-amputation patients, those in the amputation group had a longer hospital stay and higher estimated glomerular filtration rate(eGFR)levels. Fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), C-reaction protein (CRP), ESR, ferritin, fibrinogen and WBC levels of the amputation group were higher, while hemoglobin albumin, transferrin, TC, TG, HDL-C and LDL-C were lower than those of the non-amputation group (all <0.05). The proportion of hypertension(52.48% vs 59.98%), peripheral vascular disease (PAD)(68.11% vs 25.04%), and coronary heart disease(21.33% vs 28.71%)were different between the amputation and non-amputation groups (all <0.05). Multivariable logistic regression analyses showed that Wagner's grade, PAD and CRP were the independent risk factors associated with lower extremity amputation in hospitalized patients with diabetic foot. Wagner's grade, ischemia of lower limbs and infection are closely associated with amputation of diabetic foot patients.
[Mh] Termos MeSH primário: Amputação/estatística & dados numéricos
Diabetes Mellitus Tipo 1/complicações
Diabetes Mellitus Tipo 2/complicações
Pé Diabético/cirurgia
/cirurgia
[Mh] Termos MeSH secundário: Idoso
China/epidemiologia
Doença da Artéria Coronariana/complicações
Diabetes Mellitus Tipo 2/sangue
Pé Diabético/sangue
Pé Diabético/epidemiologia
Feminino
Gangrena/complicações
Hemoglobina A Glicada/metabolismo
Seres Humanos
Incidência
Masculino
Meia-Idade
Receptor do Fator de Crescimento Epidérmico/sangue
Estudos Retrospectivos
Medição de Risco
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Glycated Hemoglobin A); EC 2.7.10.1 (EGFR protein, human); EC 2.7.10.1 (Receptor, Epidermal Growth Factor)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170106
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.0578-1426.2017.01.007


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[PMID]:27981610
[Au] Autor:Ang MY; Shender MA; Ross SR
[Ad] Endereço:Lester E. Fisher Center for the Study and Conservation of Apes, Lincoln Park Zoo, Chicago, Illinois.
[Ti] Título:Assessment of behavior and space use before and after forelimb amputation in a zoo-housed chimpanzee (Pan troglodytes).
[So] Source:Zoo Biol;36(1):5-10, 2017 Jan.
[Is] ISSN:1098-2361
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Primates possess great manual dexterity, and their limbs are integral to many aspects of normal functioning (e.g., climbing, feeding). As such, the loss of a limb carries the risk of significant disability and potentially harmful impairment of species-typical functioning. Limb loss is known to occur in some wild primate populations due to entanglement in hunting snares, but can also occur in captive settings due to injury that necessitates therapeutic amputation. In this study, we conducted a detailed evaluation of the behavior, travel, and space use expressed by a female zoo-housed chimpanzee (Pan troglodytes) before and following surgical amputation of her right forelimb. Overall, our results suggest that the injury did not substantively affect her daily activities. She showed no change to her vertical space use, spending equivalent proportions of her time on the ground and high in the enclosure. There was a decrease in the frequency of locomotion on the ground (P = 0.006) but also a significant increase in the overall distance travelled (P = 0.0015) following the removal of the limb. This case study provides evidence that individual chimpanzees are able to successfully adjust to significant anatomical changes when provided adequate environments in which to stay active, and highlights the importance of an effective post-surgical monitoring period-a comprehensive recovery evaluation that includes input from both veterinary and behavioral research staff is likely to provide the most holistic assessment of animal health and long-term wellbeing. Zoo Biol. 36:5-10, 2017. © 2016 Wiley Periodicals, Inc.
[Mh] Termos MeSH primário: Amputação/veterinária
Animais de Zoológico
Comportamento Animal
Antebraço/cirurgia
Gangrena/veterinária
Pan troglodytes
[Mh] Termos MeSH secundário: Animais
Feminino
Gangrena/cirurgia
Abrigo para Animais
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1702
[Cu] Atualização por classe:170221
[Lr] Data última revisão:
170221
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161217
[St] Status:MEDLINE
[do] DOI:10.1002/zoo.21345



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