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Article ; Online: Lending a hand: The utility of hand-assisted laparoscopic surgery in diverticulitis with fistula.

Drezdzon, Melissa K / Calata, Jed F / Peterson, Carrie Y / Otterson, Mary F / Ludwig, Kirk A / Ridolfi, Timothy J

2023 Volume 175, Issue 3, Page(s) 776–781

Abstract: Background: Current guidelines recommend elective colectomy for the management of diverticulitis-associated fistulas. These cases present considerable operative challenges, and surgical approaches and fistula tract management vary widely. Hand-assisted ... ...

Abstract	Background: Current guidelines recommend elective colectomy for the management of diverticulitis-associated fistulas. These cases present considerable operative challenges, and surgical approaches and fistula tract management vary widely. Hand-assisted laparoscopic surgery offers the benefits of minimally invasive surgery while maintaining the tactile advantages of open surgery. This study aims to evaluate outcomes of hand-assisted laparoscopic surgery colectomy for diverticulitis-associated fistulas, fistula tract, and urinary catheter management. Methods: A retrospective review of patients with diverticulitis-associated fistula who underwent elective hand-assisted laparoscopic surgery colectomy between January 2, 2008, and September 8, 2022, was performed. Patients with Crohn disease or who underwent emergency surgery were excluded. Results: Seventy patients were included; the mean patient age was 64.1 ± 14.8 years, and the mean body mass index was 30.9 ± 9.1 kg/m Conclusion: The challenges of colectomy for diverticulitis-associated fistulas can be mitigated using the hand-assisted laparoscopic surgery technique. We found a low conversion-to-open rate, falling below rates reported for laparoscopic colectomy. There were no cases of postoperative urine leak, suggesting that no intervention or omental coverage is a safe approach to fistula tract management.
MeSH term(s)	Humans ; Middle Aged ; Aged ; Hand-Assisted Laparoscopy ; Diverticulitis, Colonic/complications ; Diverticulitis, Colonic/surgery ; Laparoscopy/methods ; Treatment Outcome ; Diverticulitis/complications ; Diverticulitis/surgery ; Colectomy/methods ; Intestinal Fistula/etiology ; Intestinal Fistula/surgery ; Retrospective Studies ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/surgery
Language	English
Publishing date	2023-10-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	202467-6
ISSN	1532-7361 ; 0039-6060
ISSN (online)	1532-7361
ISSN	0039-6060
DOI	10.1016/j.surg.2023.08.034
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Article: Effects of radiation upon gastrointestinal motility.

Otterson, Mary F

World journal of gastroenterology

2007 Volume 13, Issue 19, Page(s) 2684–2692

Abstract: Whether due to therapeutic or belligerent exposure, the gastrointestinal effects of irradiation produce symptoms dreaded by a majority of the population. Nausea, vomiting, diarrhea and abdominal cramping are hallmarks of the prodromal phase of radiation ... ...

Abstract	Whether due to therapeutic or belligerent exposure, the gastrointestinal effects of irradiation produce symptoms dreaded by a majority of the population. Nausea, vomiting, diarrhea and abdominal cramping are hallmarks of the prodromal phase of radiation sickness, occurring hours to days following radiation exposure. The prodromal phase is distinct from acute radiation sickness in that the absorptive, secretory and anatomic changes associated with radiation damage are not easily identifiable. It is during this phase of radiation sickness that gastrointestinal motility significantly changes. In addition, there is evidence that motor activity of the gut contributes to some of the acute and chronic effects of radiation.
MeSH term(s)	Anal Canal/physiology ; Anal Canal/radiation effects ; Gastrointestinal Motility/physiology ; Gastrointestinal Motility/radiation effects ; Humans ; Muscle Contraction/physiology ; Muscle Contraction/radiation effects ; Muscle, Smooth/physiology ; Muscle, Smooth/radiation effects ; Radiation Injuries/physiopathology ; Rectum/physiology ; Rectum/radiation effects
Language	English
Publishing date	2007-01-24
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Review
ZDB-ID	2185929-2
ISSN	2219-2840 ; 1007-9327
ISSN (online)	2219-2840
ISSN	1007-9327
DOI	10.3748/wjg.v13.i19.2684
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Article ; Online: Impact of Auricular Neurostimulation in Patients Undergoing Colorectal Surgery with an Enhanced Recovery Protocol: A Pilot Randomized, Controlled Trial.

Blank, Jacqueline J / Liu, Ying / Yin, Ziyan / Spofford, Christina M / Ridolfi, Timothy J / Ludwig, Kirk A / Otterson, Mary F / Peterson, Carrie Y

Diseases of the colon and rectum

2021 Volume 64, Issue 2, Page(s) 225–233

Abstract: Background: Narcotics are the cornerstone of postoperative pain control, but the opioid epidemic and the negative physiological and psychological effects of narcotics implore physicians to utilize nonpharmacological methods of pain control.: Objective! ...

Abstract	Background: Narcotics are the cornerstone of postoperative pain control, but the opioid epidemic and the negative physiological and psychological effects of narcotics implore physicians to utilize nonpharmacological methods of pain control. Objective: This pilot study investigated a novel neurostimulation device for postoperative analgesia. We hypothesized that active neurostimulation would decrease postoperative narcotic requirements. Design: This was a placebo-controlled, double-blinded trial. Settings: This trial was conducted at an academic medical center and a Veterans Affairs hospital. Patients: This trial included adult patients who underwent elective bowel resection between December 2016 and April 2018. Interventions: Patients were randomly assigned to receive an active or inactive (sham) device, which was applied to the right ear before surgery and continued for 5 days. Main outcome measures: The primary outcome was total opioid consumption. The secondary outcomes included pain, nausea, anxiety, return of bowel function, complications, 30-day readmissions, and opioid consumption at 2 weeks and 30 days. Results: A total of 57 patients participated and 5 withdrew; 52 patients were included in the analysis. Twenty-eight patients received an active device and 24 received an inactive device. There was no difference in total narcotic consumption between active and inactive devices (90.79 ± 54.93 vs 90.30 ± 43.03 oral morphine equivalents/day). Subgroup analyses demonstrated a benefit for patients after open surgery (p = 0.0278). When patients were stratified by decade, those aged 60 to 70 and >70 years derived a benefit from active devices in comparison with those aged 30 to 40, 40 to 50, and 50 to 60 years old (p = 0.01092). No serious adverse events were related to this study. Limitations: This study was limited by the small sample sizes. Conclusions: No difference in opioid use was found with auricular neurostimulation. However, this pilot study suggests that older patients and those with larger abdominal incisions may benefit from auricular neurostimulation. Further investigation in these high-risk patients is warranted. See Video Abstract at http://links.lww.com/DCR/B452.ClinicalTrials.gov identifier: NCT02892513. Impacto de la neuroestimulacin auricular en pacientes sometidos a ciruga colorrectal con un protocolo de recuperacin mejorada un ensayo piloto aleatorizado y controlado: ANTECEDENTES:Los narcóticos son la piedra angular del control del dolor postoperatorio, pero la epidemia de opioides y los efectos fisiológicos y psicológicos negativos de los narcóticos incentivan a los médicos a que utilicen métodos no farmacológicos de control del dolor.OBJETIVO:Este estudio piloto investigó un nuevo dispositivo de neuroestimulación para analgesia postoperatoria. Hipotetizamos que la neuroestimulación activa disminuiría los requerimientos narcóticos postoperatorios.DISEÑO:Este fue un ensayo doble ciego controlado con placebo.ESCENARIO:Esto se llevó a cabo en un centro médico académico y en un hospital de Asuntos de Veteranos (Veterans Affairs hospital).PACIENTES:Este ensayo incluyó pacientes adultos que se sometieron a resección intestinal electiva entre diciembre de 2016 y abril de 2018.INTERVENCIONES:Los pacientes fueron asignados al azar para recibir un dispositivo activo o inactivo (falso), que se aplicó al oído derecho antes de la cirugía y se mantuvo durante 5 días.PRINCIPALES MEDIDAS DE RESULTADO:El resultado primario fue el consumo total de opioides; los resultados secundarios incluyeron dolor, náusea, ansiedad, retorno de la función intestinal, complicaciones, reingresos a 30 días y consumo de opioides a 2 semanas y a 30 días.RESULTADOS:Participaron un total de 57 pacientes y 5 se retiraron; Se incluyeron 52 pacientes en el análisis. Veintiocho pacientes recibieron un dispositivo activo y 24 recibieron un dispositivo inactivo. No hubo diferencias en el consumo total de narcóticos entre los dispositivos activos e inactivos (90.79 ± 54.93 vs 90.30 ± 43.03 equivalentes de morfina oral [OME] / día). Los análisis de subgrupos demostraron un beneficio para los pacientes después de cirugía abierta (p = 0.0278). Cuando los pacientes se estratificaron por década, aquellos de 60-70 y > 70 años obtuvieron un beneficio de los dispositivos activos en comparación con los de 30-40, 40-50 y 50-60 años (p = 0.01092). No hubo eventos adversos graves relacionados con este estudio.LIMITACIONES:Este estudio estuvo limitado por los pequeños tamaños de muestra.CONCLUSIONES:No se encontró diferencia en el uso de opioides con la neuroestimulación auricular. Sin embargo, este estudio piloto sugiere que los pacientes mayores y aquellos con incisiones abdominales más grandes pueden beneficiarse de la neuroestimulación auricular. Está justificada la investigación adicional en estos pacientes de alto riesgo. Consulte Video Resumen en http://links.lww.com/DCR/B452. (Traducción-Dr. Jorge Silva Velazco).
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Analgesics, Opioid/therapeutic use ; Colectomy ; Combined Modality Therapy ; Double-Blind Method ; Ear Auricle ; Electric Stimulation Therapy/methods ; Female ; Humans ; Male ; Middle Aged ; Pain, Postoperative/therapy ; Pilot Projects ; Proctectomy ; Prospective Studies ; Treatment Outcome
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2021-01-07
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Video-Audio Media
ZDB-ID	212581-x
ISSN	1530-0358 ; 0012-3706
ISSN (online)	1530-0358
ISSN	0012-3706
DOI	10.1097/DCR.0000000000001752
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Article ; Online: Pouch Volvulus in Patients Having Undergone Restorative Proctocolectomy for Ulcerative Colitis: A Case Series.

Landisch, Rachel M / Knechtges, Paul M / Otterson, Mary F / Ludwig, Kirk A / Ridolfi, Timothy J

Diseases of the colon and rectum

2018 Volume 61, Issue 6, Page(s) 713–718

Abstract: Background: Restorative proctocolectomy with IPAA improves quality of life in patients with medically refractory ulcerative colitis. Although bowel obstruction is common, pouch volvulus is rare and described only in case reports. Diagnosis can be ... ...

Abstract	Background: Restorative proctocolectomy with IPAA improves quality of life in patients with medically refractory ulcerative colitis. Although bowel obstruction is common, pouch volvulus is rare and described only in case reports. Diagnosis can be challenging, resulting in delayed care and heightened morbidity. Objective: The purpose of this study was to delineate the symptoms and successful management strategies used in patients with IPAA volvulus that result in pouch salvage. Design: This study was a case series. Settings: The study was conducted at a tertiary referral center for ulcerative colitis in Milwaukee, Wisconsin. Patients: Patients included those with volvulus of the IPAA. Main outcome measures: Over the study period (2010-2015), 6 patients were diagnosed with IPAA volvulus. The primary outcomes were symptom manifestation, diagnostic practices, and treatment of pouch volvulus. Results: Six patients with ulcerative colitis were identified with pouch volvulus. The majority (n = 4) underwent a laparoscopic pouch creation and had early symptom manifestation after surgery. Complications preceding volvulus included pouch ulceration (n = 5) and pouchitis (n = 4). The most common presenting symptoms of volvulus were abdominal pain (n = 4) and obstipation (n = 4). Multiple imaging modalities were used, but volvulus was most frequently identified by CT scan. Management was primarily operative (n = 5), composed of excision of the pouch (n = 3), pouch-pexy (n = 1), and detorsion with defect closure (n = 1). Both operative and nonoperative treatment with endoscopic detorsion resulted in low morbidity and improved patient symptoms. Limitations: This single-institution study is limited by its retrospective design and small number of patients. Conclusions: IPAA volvulus is a rare and challenging cause of bowel obstruction in ulcerative colitis. Heralding signs and symptoms, such as pouch ulceration and acute obstipation, should initiate a workup for a twisting pouch. Diagnosis, which is multimodal, must occur early to avert necrosis and allow for preservation of a well-functioning pouch. See Video Abstract at http://links.lww.com/DCR/A561.
MeSH term(s)	Adenomatous Polyposis Coli/surgery ; Adult ; Anastomosis, Surgical/methods ; Colitis, Ulcerative/surgery ; Colonic Pouches/adverse effects ; Colonic Pouches/utilization ; Female ; Humans ; Intestinal Volvulus/complications ; Intestinal Volvulus/diagnostic imaging ; Intestinal Volvulus/surgery ; Laparoscopy/adverse effects ; Male ; Middle Aged ; Pouchitis/etiology ; Proctocolectomy, Restorative/methods ; Proctocolectomy, Restorative/psychology ; Quality of Life ; Retrospective Studies ; Tomography, X-Ray Computed ; Wisconsin/epidemiology ; Young Adult
Language	English
Publishing date	2018-06
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	212581-x
ISSN	1530-0358 ; 0012-3706
ISSN (online)	1530-0358
ISSN	0012-3706
DOI	10.1097/DCR.0000000000001050
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Article ; Online: Acute Onset of Nausea and Vomiting, Diffuse Abdominal Pain, and Profound Metabolic Acidosis 3 Years After Total Gastrectomy.

Pagel, Paul S / Thorsen, Thomas N / Kugler, Nathan W / Haberman, Kathryn M / Haasler, George B / Otterson, Mary F

Journal of cardiothoracic and vascular anesthesia

2019 Volume 33, Issue 11, Page(s) 3214–3216

MeSH term(s)	Abdominal Pain/diagnosis ; Abdominal Pain/etiology ; Acidosis/diagnosis ; Acidosis/etiology ; Diagnosis, Differential ; Follow-Up Studies ; Gastrectomy/adverse effects ; Gastrectomy/methods ; Hernia, Hiatal/complications ; Hernia, Hiatal/diagnosis ; Humans ; Intestinal Obstruction/complications ; Intestinal Obstruction/diagnosis ; Intestine, Small ; Laparoscopy/adverse effects ; Male ; Middle Aged ; Nausea/diagnosis ; Nausea/etiology ; Postoperative Complications ; Stomach Neoplasms/surgery ; Time Factors ; Tomography, X-Ray Computed ; Vomiting/diagnosis ; Vomiting/etiology
Language	English
Publishing date	2019-04-19
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	1067317-9
ISSN	1532-8422 ; 1053-0770
ISSN (online)	1532-8422
ISSN	1053-0770
DOI	10.1053/j.jvca.2019.04.015
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Article ; Online: Consequences of gastrointestinal surgery on drug absorption.

Titus, Rachel / Kastenmeier, Andrew / Otterson, Mary F

Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition

2013 Volume 28, Issue 4, Page(s) 429–436

Abstract: Gastrointestinal (GI) surgery associated with resection or bypass can affect the absorption and kinetics of certain drugs. The goal of this article is 3-fold: (1) highlight the physiologic changes associated with selected GI surgeries (specifically ... ...

Abstract	Gastrointestinal (GI) surgery associated with resection or bypass can affect the absorption and kinetics of certain drugs. The goal of this article is 3-fold: (1) highlight the physiologic changes associated with selected GI surgeries (specifically gastric, small intestine, and colon), (2) review the implications for drug and nutrient absorption, and (3) suggest modifications of the pharmacologic agents, dosing regimens, and routes of delivery. Few large trials are available to use as references, but there is a wealth of individual reports and small series. Understanding the predictable challenges of drug administration in these patients will improve care.
MeSH term(s)	Digestive System Surgical Procedures/adverse effects ; Gastric Bypass/adverse effects ; Gastrointestinal Tract/metabolism ; Gastrointestinal Tract/surgery ; Humans ; Intestine, Small/metabolism ; Pharmaceutical Preparations/metabolism ; Postoperative Complications
Chemical Substances	Pharmaceutical Preparations
Language	English
Publishing date	2013-08
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	645074-x
ISSN	1941-2452 ; 0884-5336
ISSN (online)	1941-2452
ISSN	0884-5336
DOI	10.1177/0884533613490740
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Article ; Online: Aortic Graft Infection Secondary to Iatrogenic Transcolonic Graft Malposition.

Blank, Jacqueline J / Rothstein, Abby E / Lee, Cheong Jun / Malinowski, Michael J / Lewis, Brian D / Ridolfi, Timothy J / Otterson, Mary F

Vascular and endovascular surgery

2018 Volume 52, Issue 5, Page(s) 386–390

Abstract: Aortic graft infections are a rare but devastating complication of aortic revascularization. Often infections occur due to contamination at the time of surgery. Iatrogenic misplacement of the limbs of an aortobifemoral graft is exceedingly rare, and ... ...

Abstract	Aortic graft infections are a rare but devastating complication of aortic revascularization. Often infections occur due to contamination at the time of surgery. Iatrogenic misplacement of the limbs of an aortobifemoral graft is exceedingly rare, and principles of evaluation and treatment are not well defined. We report 2 cases of aortobifemoral bypass graft malposition through the colon. Case report: Case 1 is a 54-year-old male who underwent aortobifemoral bypass grafting for acute limb ischemia. He had previously undergone a partial sigmoid colectomy for diverticulitis. Approximately 6 months after vascular surgery, he presented with an occult graft infection. Preoperative imaging and intraoperative findings were consistent with graft placement through the sigmoid colon. Case 2 is a 60-year-old male who underwent aortobifemoral bypass grafting due to a nonhealing wound after toe amputation. His postoperative course was complicated by pneumonia, bacteremia thought to be secondary to the pneumonia, general malaise, and persistent fevers. Approximately 10 weeks after the vascular surgery, he presented with imaging and intraoperative findings of graft malposition through the cecum. Conclusions: Aortic graft infection is usually caused by surgical contamination and presents as an indolent infection. Case 1 presented as such; Case 2 presented more acutely. Both grafts were iatrogenically misplaced through the colon at the index operation. The patients underwent extra-anatomic bypass and graft explantation and subsequently recovered.
MeSH term(s)	Anti-Infective Agents/therapeutic use ; Aorta/diagnostic imaging ; Aorta/microbiology ; Aorta/surgery ; Aortography/methods ; Blood Vessel Prosthesis/adverse effects ; Blood Vessel Prosthesis Implantation/adverse effects ; Blood Vessel Prosthesis Implantation/instrumentation ; Colectomy ; Colon/diagnostic imaging ; Colon/surgery ; Computed Tomography Angiography ; Device Removal ; Diverticulitis, Colonic/surgery ; Humans ; Male ; Medical Errors ; Middle Aged ; Prosthesis-Related Infections/diagnostic imaging ; Prosthesis-Related Infections/microbiology ; Prosthesis-Related Infections/surgery ; Treatment Outcome
Chemical Substances	Anti-Infective Agents
Language	English
Publishing date	2018-03-19
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2076272-0
ISSN	1938-9116 ; 1538-5744
ISSN (online)	1938-9116
ISSN	1538-5744
DOI	10.1177/1538574418764037
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Article: Novel method for recolonoscopy after percutaneous cecostomy.

Berger, William L / Kounev, Venelin / Otterson, Mary F

Gastrointestinal endoscopy

2008 Volume 67, Issue 6, Page(s) 1005–1006

MeSH term(s)	Aged ; Cecostomy/methods ; Colonic Diseases, Functional/therapy ; Colonoscopes ; Colonoscopy/methods ; Equipment Design ; Humans ; Male
Language	English
Publishing date	2008-05
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	391583-9
ISSN	1097-6779 ; 0016-5107
ISSN (online)	1097-6779
ISSN	0016-5107
DOI	10.1016/j.gie.2007.10.009
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Article: Consequences of Gastrointestinal Surgery on Drug Absorption

Titus, Rachel / Andrew Kastenmeier / Mary F. Otterson

Nutrition in clinical practice. , v. 28, no. 4

2013

Abstract	Gastrointestinal (GI) surgery associated with resection or bypass can affect the absorption and kinetics of certain drugs. The goal of this article is 3-fold: (1) highlight the physiologic changes associated with selected GI surgeries (specifically gastric, small intestine, and colon), (2) review the implications for drug and nutrient absorption, and (3) suggest modifications of the pharmacologic agents, dosing regimens, and routes of delivery. Few large trials are available to use as references, but there is a wealth of individual reports and small series. Understanding the predictable challenges of drug administration in these patients will improve care.
Keywords	colon ; drugs ; intestinal absorption ; nutrient uptake ; patients ; pharmacokinetics ; resection ; small intestine
Language	English
Dates of publication	2013-08
Size	p. 429-436.
Publishing place	SAGE Publications
Document type	Article
ZDB-ID	645074-x
ISSN	1941-2452 ; 0884-5336
ISSN (online)	1941-2452
ISSN	0884-5336
DOI	10.1177/0884533613490740
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Article ; Online: The vascular renin-angiotensin system contributes to blunted vasodilation induced by transient high pressure in human adipose microvessels.

Durand, Matthew J / Phillips, Shane A / Widlansky, Michael E / Otterson, Mary F / Gutterman, David D

American journal of physiology. Heart and circulatory physiology

2014 Volume 307, Issue 1, Page(s) H25–32

Abstract: Increased intraluminal pressure can reduce endothelial function in resistance arterioles; however, the mechanism of this impairment is unknown. The purpose of this study was to determine the effect of local renin-angiotensin system inhibition on the ... ...

Abstract	Increased intraluminal pressure can reduce endothelial function in resistance arterioles; however, the mechanism of this impairment is unknown. The purpose of this study was to determine the effect of local renin-angiotensin system inhibition on the pressure-induced blunting of endothelium-dependent vasodilation in human adipose arterioles. Arterioles (100-200 μm) were dissected from fresh adipose surgical specimens, cannulated onto glass micropipettes, pressurized to an intraluminal pressure of 60 mmHg, and constricted with endothelin-1. Vasodilation to ACh was assessed at 60 mmHg and again after a 30-min exposure to an intraluminal pressure of 150 mmHg. The vasodilator response to ACh was significantly reduced in vessels exposed to 150 mmHg. Exposure of the vessels to the superoxide scavenger polyethylene glycol-SOD (100 U/ml), the ANG II type 1 receptor antagonist losartan (10(-6) mol/l), or the angiotensin-converting enzyme inhibitor captopril (10(-5) mol/l) prevented the pressure-induced reduction in ACh-dependent vasodilation observed in untreated vessels. High intraluminal pressure had no effect on papaverine-induced vasodilation or ANG II sensitivity. Increased intraluminal pressure increased dihydroethidium fluorescence in cannulated vessels, which could be prevented by polyethylene glycol-SOD or losartan treatment and endothelial denudation. These data indicate that high intraluminal pressure can increase vascular superoxide and reduce nitric oxide-mediated vasodilation via activation of the vascular renin-angiotensin system. This study provides evidence showing that the local renin-angiotensin system in the human microvasculature may be pressure sensitive and contribute to endothelial dysfunction after acute bouts of hypertension.
MeSH term(s)	Adipose Tissue/blood supply ; Adipose Tissue/physiology ; Arterioles/physiology ; Blood Flow Velocity/physiology ; Blood Pressure/physiology ; Female ; Humans ; Male ; Microcirculation/physiology ; Middle Aged ; Nitric Oxide/metabolism ; Renin-Angiotensin System/physiology ; Superoxides/metabolism ; Vasodilation/physiology
Chemical Substances	Superoxides (11062-77-4) ; Nitric Oxide (31C4KY9ESH)
Language	English
Publishing date	2014-04-28
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	603838-4
ISSN	1522-1539 ; 0363-6135
ISSN (online)	1522-1539
ISSN	0363-6135
DOI	10.1152/ajpheart.00055.2014
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Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito