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Article ; Online: Bone histomorphometry: a concise review for endocrinologists and clinicians.

Kulak, Carolina A Moreira / Dempster, David W

Arquivos brasileiros de endocrinologia e metabologia

2010 Volume 54, Issue 2, Page(s) 87–98

Abstract: Bone histomorphometry is a quantitative histological examination of an undecalcified bone biopsy performed to obtain quantitative information on bone remodeling and structure. Labeling agents taken before the procedure deposit at sites of bone formation ... ...

Abstract	Bone histomorphometry is a quantitative histological examination of an undecalcified bone biopsy performed to obtain quantitative information on bone remodeling and structure. Labeling agents taken before the procedure deposit at sites of bone formation allowing a dynamic analysis. Biopsy is indicated to make the diagnosis of subclinical osteomalacia, to characterize the different forms of renal osteodystrophy and to elucidate cases of unexplained skeletal fragility. Bone histomorphometric parameters are divided into structural and remodeling subgroups, with the latter being subdivided into static and dynamic categories. Metabolic bone disorders such as osteomalacia, hyperparathyroidism, hypothyroidism, osteoporosis and renal osteodystrophy display different histomorphometric profiles. Antiresorptive and anabolic drugs used for the treatment of osteoporosis also induce characteristic changes in the bone biopsy. Bone histomorphometry is an important research tool in the field of bone metabolism and provides information that is not available by any other investigative approach.
MeSH term(s)	Biopsy ; Bone Diseases, Metabolic/etiology ; Bone Diseases, Metabolic/pathology ; Bone Remodeling/physiology ; Bone and Bones/metabolism ; Bone and Bones/pathology ; Bone and Bones/ultrastructure ; Humans ; Medical Illustration ; Osteoporosis/pathology ; Osteoporosis/therapy
Language	English
Publishing date	2010-05-19
Publishing country	Brazil
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	603919-4
ISSN	1677-9487 ; 0004-2730
ISSN (online)	1677-9487
ISSN	0004-2730
DOI	10.1590/s0004-27302010000200002
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Article ; Online: Osteoporosis after transplantation.

Kulak, Carolina A Moreira / Borba, Victoria Z Cochenski / Kulak, Jaime / Custódio, Melani Ribeiro

Current osteoporosis reports

2011 Volume 10, Issue 1, Page(s) 48–55

Abstract: Transplantation is an established therapy for end-stage diseases of kidney, lung, liver, and heart among others. Osteoporosis and fragility fractures are serious complications of organ transplantation, particularly in the first post-transplant year. Many ...

Abstract	Transplantation is an established therapy for end-stage diseases of kidney, lung, liver, and heart among others. Osteoporosis and fragility fractures are serious complications of organ transplantation, particularly in the first post-transplant year. Many factors contribute to the pathogenesis of osteoporosis following organ transplantation. This review addresses the mechanisms of bone loss that occurs both in the early and late post-transplant periods, including the contribution of the immunosuppressive agents as well as the specific features to bone loss after kidney, lung, liver, cardiac, and bone marrow transplantation. Prevention and treatment for osteoporosis in the transplant recipient are also discussed.
MeSH term(s)	Animals ; Bone Marrow Transplantation/adverse effects ; Glucocorticoids/adverse effects ; Glucocorticoids/therapeutic use ; Heart Transplantation/adverse effects ; Humans ; Hyperparathyroidism, Secondary/complications ; Immunosuppressive Agents/administration & dosage ; Kidney Transplantation/adverse effects ; Liver Transplantation/adverse effects ; Lung Transplantation/adverse effects ; Organ Transplantation/adverse effects ; Osteoporosis/complications ; Osteoporosis/etiology ; Osteoporotic Fractures/etiology ; Tacrolimus/pharmacology ; Vitamin D Deficiency/etiology
Chemical Substances	Glucocorticoids ; Immunosuppressive Agents ; Tacrolimus (WM0HAQ4WNM)
Language	English
Publishing date	2011-12-14
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2186581-4
ISSN	1544-2241 ; 1544-1873
ISSN (online)	1544-2241
ISSN	1544-1873
DOI	10.1007/s11914-011-0083-y
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Bone histomorphometry

Carolina A. Moreira Kulak / David W. Dempster

Arquivos brasileiros de Endocrinologia e Metabologia, Vol 54, Iss 2, Pp 87-

a concise review for endocrinologists and clinicians Histomorfometria óssea: uma revisão concisa para endocrinologistas e clínicos

2010 Volume 98

Abstract	Bone histomorphometry is a quantitative histological examination of an undecalcified bone biopsy performed to obtain quantitative information on bone remodeling and structure. Labeling agents taken before the procedure deposit at sites of bone formation allowing a dynamic analysis. Biopsy is indicated to make the diagnosis of subclinical osteomalacia, to characterize the different forms of renal osteodystrophy and to elucidate cases of unexplained skeletal fragility. Bone histomorphometric parameters are divided into structural and remodeling subgroups, with the latter being subdivided into static and dynamic categories. Metabolic bone disorders such as osteomalacia, hyperparathyroidism, hypothyroidism, osteoporosis and renal osteodystrophy display different histomorphometric profiles. Antiresorptive and anabolic drugs used for the treatment of osteoporosis also induce characteristic changes in the bone biopsy. Bone histomorphometry is an important research tool in the field of bone metabolism and provides information that is not available by any other investigative approach. Histomorfometria óssea é uma avaliação histológica quantitativa de uma biópsia óssea calcificada realizada para obter informação sobre a remodelação e a estrutura óssea. Uma análise dinâmica é possível quando substâncias que fazem a marcação do osso são tomadas antes do procedimento e se depositam no local de formação óssea. A biópsia é indicada para diagnóstico de osteomalácia, diferentes formas de osteodistrofia renal e nos casos não explicados de fragilidade esquelética. O preparo e a análise das amostras necessitam de um laboratório especializado. A histomorfometria avalia parâmetros estruturais e de remodelação óssea, sendo o último subdividido em estático e dinâmico. Doenças osteometabólicas como osteomalácia, hiperparatireoidismo, hipoparatireoidismo, osteoporose e osteodistrofia renal apresentam parâmetros histomorfométricos distintos. Medicações antirreabsortivas e anabólicas usadas no tratamento da osteoporose também induzem alterações características na biópsia óssea. A histomorfometria óssea é uma ferramenta importante no metabolismo ósseo e oferece informação que não é possível por nenhum outro método diagnóstico.
Keywords	Histomorfometria óssea ; biópsia óssea ; microestrutura óssea ; doenças osteometabólicas ; terapias para osteoporose ; Bone histomorphometry ; metabolic bone diseases ; bone biopsy ; bone structure ; osteoporosis drugs ; Diseases of the endocrine glands. Clinical endocrinology ; RC648-665 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Internal medicine ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Language	Portuguese
Publishing date	2010-03-01T00:00:00Z
Publisher	Sociedade Brasileira de Endocrinologia e Metabologia
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Post-transplantation osteoporosis.

Kulak, Carolina A Moreira / Borba, Victória Z Cochenski / Kulak Júnior, Jaime / Campos, Denise Jonhsson / Shane, Elizabeth

Arquivos brasileiros de endocrinologia e metabologia

2010 Volume 54, Issue 2, Page(s) 143–149

Abstract: Transplantation is an established therapy for many hematologic disorders as well as for end-stage diseases of the kidney, lung, liver, heart among others. Osteoporosis and a high incidence of fragility fractures have emerged as a complication of organ ... ...

Abstract	Transplantation is an established therapy for many hematologic disorders as well as for end-stage diseases of the kidney, lung, liver, heart among others. Osteoporosis and a high incidence of fragility fractures have emerged as a complication of organ transplantation. Many factors contribute to the pathogenesis of osteoporosis following organ transplantation. In addition, most patients have some form of bone disease prior to transplantation, which is usually related to adverse effects of end-stage organ failure on the skeleton. This chapter reviews the mechanisms of bone loss that occur both in the early and late post-transplant periods including the contribution of immunosuppressive agents as well as the specific features of bone loss after kidney, lung, liver, cardiac and bone marrow transplantation. Prevention and treatment for osteoporosis in the transplant recipient will also be addressed.
MeSH term(s)	Bone Density ; Bone Marrow Transplantation/adverse effects ; Bone Resorption/metabolism ; Humans ; Osteoporosis/etiology ; Osteoporosis/prevention & control
Language	English
Publishing date	2010-05-19
Publishing country	Brazil
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	603919-4
ISSN	1677-9487 ; 0004-2730
ISSN (online)	1677-9487
ISSN	0004-2730
DOI	10.1590/s0004-27302010000200009
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Post-transplantation osteoporosis Osteoporose pós-transplante

Carolina A. Moreira Kulak / Victória Z. Cochenski Borba / Jaime Kulak Júnior / Denise Jonhsson Campos / Elizabeth Shane

Arquivos brasileiros de Endocrinologia e Metabologia, Vol 54, Iss 2, Pp 143-

2010 Volume 149

Abstract	Transplantation is an established therapy for many hematologic disorders as well as for end-stage diseases of the kidney, lung, liver, heart among others. Osteoporosis and a high incidence of fragility fractures have emerged as a complication of organ transplantation. Many factors contribute to the pathogenesis of osteoporosis following organ transplantation. In addition, most patients have some form of bone disease prior to transplantation, which is usually related to adverse effects of end-stage organ failure on the skeleton. This chapter reviews the mechanisms of bone loss that occur both in the early and late post-transplant periods including the contribution of immunosuppressive agents as well as the specific features of bone loss after kidney, lung, liver, cardiac and bone marrow transplantation. Prevention and treatment for osteoporosis in the transplant recipient will also be addressed. Transplante de órgãos ou medula óssea é uma terapia conhecida para muitas doenças hematológicas e para estágios finais de doenças renais, pulmonares, hepáticas, cardíacas, entre outras. A osteoporose e o aumento da prevalência de fraturas por fragilidade óssea têm se mostrado como uma complicação do transplante. Muitos fatores contribuem para a patogênese da osteoporose relacionada ao transplante. Além disso, a maioria dos pacientes apresenta doença óssea antes do transplante, a qual é secundária à doença grave de base. Este artigo revisa os mecanismos da perda óssea que ocorrem tanto na fase precoce quanto na fase tardia após o transplante, incluindo o uso das drogas imunossupressoras, como também os fatores específicos envolvidos na perda óssea relacionados ao transplante renal, pulmonar, hepático, cardíaco e de medula óssea. A prevenção e o tratamento da osteoporose após transplante também são abordados nesta revisão.
Keywords	Osteoporose secundária ; transplante ; drogas imunossupressoras ; perda óssea ; Secondary osteoporosis ; transplantation ; immunosuppressive agents ; bone loss ; Diseases of the endocrine glands. Clinical endocrinology ; RC648-665 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Internal medicine ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Language	Portuguese
Publishing date	2010-03-01T00:00:00Z
Publisher	Sociedade Brasileira de Endocrinologia e Metabologia
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Níveis baixos de 25-hidroxivitamina D (25OHD) em pacientes com doença inflamatória intestinal e sua correlação com a densidade mineral óssea.

Souza, Hevelyn Noemberg de / Lora, Fabiana Lígia / Kulak, Carolina A Moreira / Mañas, Nádila Cecyn Pietszkowski / Amarante, Heda M B / Borba, Victória Z Cochenski

Arquivos brasileiros de endocrinologia e metabologia

2008 Volume 52, Issue 4, Page(s) 684–691

Abstract: Unlabelled: Patients with inflammatory bowel disease (IBD) are at risk of having vitamin D deficiency (25-OHD) and low bone mineral density (BMD).: Objectives: To measure 25OHD in a young group of IBD patients submitted to a clinical evaluation, ... ...

Title translation	Low levels of 25-hydroxyvitamin D (25OHD) in patients with inflammatory bowel disease and its correlation with bone mineral density.
Abstract	Unlabelled: Patients with inflammatory bowel disease (IBD) are at risk of having vitamin D deficiency (25-OHD) and low bone mineral density (BMD). Objectives: To measure 25OHD in a young group of IBD patients submitted to a clinical evaluation, routine biochemistry and BMD measurement (lumbar spine and proximal femur). Results: 39 Crohn disease (CD) and 37 ulcerative colitis (UC) patients had lower serum levels of 25OHD compared to the control group (CD p = 0.003; UC p < 0.001), and 48.5% of the UC patients were 25OHD deficient. Lumbar spine BMD was lower in patients than controls (CD p = 0.001; UC p = 0.008). In CD patients, serum levels of 25OHD were significantly correlated with total femur (r = 0.391; p = 0.027) and femoral neck (r = 0.384; p = 0.03) BMD. Conclusion: It was found lower levels of 25OHD and BMD in young IBD patients compared to normal controls, suggesting an important role of 25OHD deficiency in the pathogenesis of the IBD bone disease.
MeSH term(s)	Adult ; Bone Density ; Case-Control Studies ; Colitis, Ulcerative/blood ; Colitis, Ulcerative/complications ; Crohn Disease/blood ; Crohn Disease/complications ; Female ; Humans ; Male ; Vitamin D/analogs & derivatives ; Vitamin D/blood ; Vitamin D Deficiency/diagnosis ; Vitamin D Deficiency/etiology ; Vitamin D Deficiency/physiopathology
Chemical Substances	Vitamin D (1406-16-2) ; 25-hydroxyvitamin D (A288AR3C9H)
Language	Portuguese
Publishing date	2008-06-11
Publishing country	Brazil
Document type	Journal Article
ZDB-ID	603919-4
ISSN	1677-9487 ; 0004-2730
ISSN (online)	1677-9487
ISSN	0004-2730
DOI	10.1590/s0004-27302008000400015
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Article ; Online: SERMs in the prevention and treatment of postmenopausal osteoporosis: an update.

Kulak Júnior, Jaime / Kulak, Carolina Aguiar Moreira / Taylor, Hugh S

Arquivos brasileiros de endocrinologia e metabologia

2010 Volume 54, Issue 2, Page(s) 200–205

Abstract: Selective estrogen receptor modulators (SERMs) have the ability to bind the estrogen receptor (ER) and are known to confer ER agonist or antagonist effects depending on the target tissue. A number of newer SERMs, including bazedoxifene, lasofoxifene and ... ...

Abstract	Selective estrogen receptor modulators (SERMs) have the ability to bind the estrogen receptor (ER) and are known to confer ER agonist or antagonist effects depending on the target tissue. A number of newer SERMs, including bazedoxifene, lasofoxifene and ospemifene, are currently under clinical development for the prevention and treatment of postmenopausal osteoporosis and for other indications. Although the possibility of developing a single agent that has all of the desired characteristics of an ideal SERM seems to be unlikely, progress in the clinical development of SERMs targeted to the ER suggests that these newer compounds may have attributes that represent an improvement relative to existing SERMs. A new approach to menopausal therapy is the tissue selective estrogen complex or the pairing of a selective estrogen receptor modulator with estrogens. Further investigation will help to clarify relative benefits/risks of novel SERMs in development within specific indications.
MeSH term(s)	Female ; Humans ; Osteoporosis, Postmenopausal/drug therapy ; Osteoporosis, Postmenopausal/prevention & control ; Selective Estrogen Receptor Modulators/administration & dosage ; Selective Estrogen Receptor Modulators/therapeutic use
Chemical Substances	Selective Estrogen Receptor Modulators
Language	English
Publishing date	2010-05-14
Publishing country	Brazil
Document type	Journal Article ; Review
ZDB-ID	603919-4
ISSN	1677-9487 ; 0004-2730
ISSN (online)	1677-9487
ISSN	0004-2730
DOI	10.1590/s0004-27302010000200016
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Article ; Online: Controle neuroendócrino da massa óssea

Borba Victória Z.C. / Kulak Carolina A.Moreira / Lazaretti-Castro Marise

Arquivos brasileiros de Endocrinologia e Metabologia, Vol 47, Iss 4, Pp 453-

mito ou verdade?

2003 Volume 457

Abstract: O remodelamento ósseo é um processo fisiológico e altamente regulado pela interação entre as células ósseas e uma variedade de hormônios sistêmicos, citoquinas, fatores de crescimento e mediadores inflamatórios. O sistema nervoso está sendo proposto como ...

Abstract	O remodelamento ósseo é um processo fisiológico e altamente regulado pela interação entre as células ósseas e uma variedade de hormônios sistêmicos, citoquinas, fatores de crescimento e mediadores inflamatórios. O sistema nervoso está sendo proposto como um novo elemento regulador, que, agindo através da liberação de mensageiros neuronais, promoveria a ligação entre este sistema e o esqueleto. Existe, na literatura, evidência do controle neuroendócrino da massa óssea, tanto a nível clínico como experimental, com várias substâncias tendo sido relacionadas a este controle, incluindo neuropeptídeos, neurotransmissores, leptina e outros. As evidências clínicas para o controle neuroendócrino do metabolismo ósseo provêm das disfunções hipotálamo-hipofisárias que levam a perda óssea. Mais recentemente, os estados de deficiência de leptina e de leptino-resistência também se mostraram envolvidos com o metabolismo ósseo. Novos estudos são ainda necessários para melhorar o entendimento da integração destes dois importantes sistemas e, principalmente, estabelecer se a participação neuroendócrina no metabolismo ósseo é apenas local ou sistêmica.
Keywords	Metabolismo ósseo ; Leptina ; Hormônio de crescimento ; Neurotransmissores ; Neuropeptídeos ; Diseases of the endocrine glands. Clinical endocrinology ; RC648-665 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Internal medicine ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Language	Portuguese
Publishing date	2003-01-01T00:00:00Z
Publisher	Sociedade Brasileira de Endocrinologia e Metabologia
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Controle neuroendócrino da massa óssea

Victória Z.C. Borba / Carolina A.Moreira Kulak / Marise Lazaretti-Castro

Arquivos brasileiros de Endocrinologia e Metabologia, Vol 47, Iss 4, Pp 453-

mito ou verdade? Neuroendocrine control of bone mass: myth or reality?

2003 Volume 457

Abstract	O remodelamento ósseo é um processo fisiológico e altamente regulado pela interação entre as células ósseas e uma variedade de hormônios sistêmicos, citoquinas, fatores de crescimento e mediadores inflamatórios. O sistema nervoso está sendo proposto como um novo elemento regulador, que, agindo através da liberação de mensageiros neuronais, promoveria a ligação entre este sistema e o esqueleto. Existe, na literatura, evidência do controle neuroendócrino da massa óssea, tanto a nível clínico como experimental, com várias substâncias tendo sido relacionadas a este controle, incluindo neuropeptídeos, neurotransmissores, leptina e outros. As evidências clínicas para o controle neuroendócrino do metabolismo ósseo provêm das disfunções hipotálamo-hipofisárias que levam a perda óssea. Mais recentemente, os estados de deficiência de leptina e de leptino-resistência também se mostraram envolvidos com o metabolismo ósseo. Novos estudos são ainda necessários para melhorar o entendimento da integração destes dois importantes sistemas e, principalmente, estabelecer se a participação neuroendócrina no metabolismo ósseo é apenas local ou sistêmica. Bone remodeling is a physiologic process regulated by the interaction between the bone cells and a variety of hormones, cytokines, growth factors and inflammatory mediators. The central nervous system (CNS) has been proposed as a new regulatory element, acting through the release of neuronal messengers, which create a link between CNS and skeleton. There have been experimental and clinical evidence of neuroendocrine control of bone mass, with several factors implicated in this mechanism, including neuropeptides, neurotransmitters, leptin and others. Clinically, participation of neuroendocrine mechanisms comes from observation of bone loss in hypothalamic-pituitary disorders. More recently, leptin deficiency and leptin resistance have also been involved with bone metabolism. New studies are necessary to improve our knowledge on the relationships between these two important systems, and to establish if there is a local or systemic participation of the neuroendocrine system in bone metabolism.
Keywords	Metabolismo ósseo ; Leptina ; Hormônio de crescimento ; Neurotransmissores ; Neuropeptídeos ; Bone metabolism ; Leptin ; Growth hormone ; Neurotransmitters ; Neuropeptides ; Diseases of the endocrine glands. Clinical endocrinology ; RC648-665 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Internal medicine ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Language	Portuguese
Publishing date	2003-08-01T00:00:00Z
Publisher	Sociedade Brasileira de Endocrinologia e Metabologia
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Safety, Efficacy and Patient Acceptability of Bazedoxifene Acetate in the Management of Postmenopausal Osteoporosis

Tayane Muniz Fighera / Carolina Aguiar Moreira Kulak / Jaime Kulak Júnior

Clinical Medicine Insights : Women's Health, Vol 2012, Iss 5, Pp 9-

2012 Volume 16

Keywords	Medicine (General) ; R5-920 ; Medicine ; R ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Language	English
Publishing date	2012-03-01T00:00:00Z
Publisher	Libertas Academica
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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