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المؤلفون: José Haba-Rubio, Jean-Pierre Venetz, Valentina Forni Ogna, Délaviz Golshayan, Maurice Matter, Raphael Heinzer, Adam Ogna, Grzegorz Nowak, Manuel Pascual, Michel Burnier
المصدر: American Journal of Transplantation. 20:1659-1667
مصطلحات موضوعية: medicine.medical_specialty, Polysomnography, Body water, Renal function, 030230 surgery, Gastroenterology, 03 medical and health sciences, Sleep Apnea Syndromes, 0302 clinical medicine, Internal medicine, medicine, Humans, Immunology and Allergy, Pharmacology (medical), Prospective Studies, Prospective cohort study, Kidney transplantation, Hydration status, Transplantation, Kidney, business.industry, Sleep apnea, medicine.disease, Kidney Transplantation, medicine.anatomical_structure, Kidney Failure, Chronic, business, Kidney disease
الوصف: Fluid overload has been associated with a high prevalence of sleep apnea (SA) in patients with end-stage kidney disease (ESKD). In this prospective study, we hypothesized that improvement in kidney function and hydration status after kidney transplantation (Tx) may result in an improvement in SA severity. A total of 196 patients on the kidney Tx waiting list were screened for SA using home nocturnal polysomnography (PSG) to measure the apnea-hypopnea index (AHI) and underwent bioimpedance to assess body composition. Of 88 participants (44.9%) with SA (AHI ≥ 15/h), 42 were reassessed 6 months post-Tx and were compared with 27 control patients. There was a significant, but small, post-Tx improvement in AHI (from 44.2 ± 24.3 to 34.7 ± 20.9/h, P = .02) that significantly correlated with a reduction in fluid overload (from 1.8 ± 2.0 to 1.2 ± 1.2 L, P = .02) and body water (from 54.9% to 51.6%, P = .003). A post-Tx increase in body fat mass (from 26% to 30%, P = .003) possibly blunted the beneficial impact of kidney Tx on SA. All parameters remained unchanged in the control group. In conclusion, SA is a frequent condition in ESKD patients and partially improved by kidney Tx. We suggest that SA should be systematically assessed before and after kidney Tx. ClinicalTrials.gov Identifier: NCT02020642.
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المؤلفون: Michael Montemurro, Maurice Matter, Hannes A. Rüdiger, Igor Letovanec, Laurent Mustaki, Andre D. Durham, Patrick Omoumi, Pietro G. di Summa, Stéphane Cherix, Fabio Becce, Boris Morattel
المصدر: European Journal of Surgical Oncology. 46:898-904
مصطلحات موضوعية: Adult, Leiomyosarcoma, Male, medicine.medical_specialty, Adolescent, Soft Tissue Neoplasms, Subgroup analysis, Myxosarcoma, Resection, Sarcoma, Synovial, Young Adult, 03 medical and health sciences, 0302 clinical medicine, MUSCULOSKELETAL/SOFT TISSUE, Humans, Medicine, In patient, Child, Aged, Retrospective Studies, Aged, 80 and over, 030222 orthopedics, business.industry, Significant difference, Distant recurrence, Soft tissue, Sarcoma, Health Care Costs, Liposarcoma, Recovery of Function, General Medicine, Length of Stay, Middle Aged, medicine.disease, Tumor Burden, Surgery, Survival Rate, Treatment Outcome, Oncology, Surgical Procedures, Operative, 030220 oncology & carcinogenesis, Female, Neoplasm Recurrence, Local, business
الوصف: Treatment of soft tissue sarcomas (STS) should only be initiated once the diagnosis is fully established. Resection of tumors of unknown nature should be avoided. Nevertheless, specialized centers continue to face numbers of unplanned excisions (UPE) in STS.To compare oncologic and functional outcomes, number of surgeries, length of hospital stay and treatment costs of UPE versus planned excision (PE) in STS.A retrospective single tertiary center study was performed on 201 patients. Survival, local and distant recurrence rates were compared between PE (n = 137) and UPE (n = 64). In a subgroup analysis of 60 patients, functional outcome (MSTS and TESS scores), and socio-economic impact (number of surgeries, length of hospital stay and treatment costs) in "functional planned excision" (fPE) group (n = 30) and "functional unplanned excision" (fUPE) group (n = 29) were compared.There was no significant difference in oncological outcome between PE and UPE. In the subgroup analysis, we found a non-significant difference in functional outcome. Patients in the fUPE had significantly more surgeries (3.5 vs. 1.4; p 0.00001) and costs of their management was 64% higher than fPE (p = 0.048). Hospital stay was longer after fUPE but not statistically significant (18.3 days vs. 11.8 days; p = 0.13).Even though oncological and functional outcomes are comparable after PE and UPE of STS, the number of surgeries, length of hospital stay and treatment costs were higher in patients with UPE. Our data underscore the importance of specialized STS treatment centers including multidisciplinary management.
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المؤلفون: Olivier Spertini, Maurice Matter, Laura E. Rothuizen, Sabine Blum, Gisèle Locher, Natacha Dewarrat, Monika Nagy, Diego de Goycoechea
المصدر: Leukemia & Lymphoma. 61:2530-2532
مصطلحات موضوعية: Cancer Research, Vincristine, business.industry, Injections, Subcutaneous, macromolecular substances, Hematology, Antineoplastic Agents, Phytogenic, Extravasation, 03 medical and health sciences, Subcutaneous injection, 0302 clinical medicine, Oncology, 030220 oncology & carcinogenesis, Anesthesia, medicine, Humans, Chemotherapeutic drugs, business, Severe complication, 030215 immunology, medicine.drug
الوصف: The extravasation of chemotherapeutic drugs is a potentially severe complication that has to be considered an oncological emergency. Consequences depend on a variety of factors, especially whether ...
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المؤلفون: Aymeric Auger, Laura Santambrogio, Patricia Corthésy, Davide Demurtas, Emanuela Romano, Melody A. Swartz, Lambert Potin, Maurice Matter, Cristina C. Clement, Romain Hamelin, Alexandre Harari, Daniel E. Speiser, Natacha Bordry, Lea Maillat, Maria A. S. Broggi
المصدر: The Journal of Experimental Medicine
The Journal of experimental medicine, vol. 216, no. 5, pp. 1091-1107مصطلحات موضوعية: 0301 basic medicine, Proteomics, Skin Neoplasms, medicine.medical_treatment, pathways, Exosomes, Mice, 0302 clinical medicine, Immunology and Allergy, Melanoma, Research Articles, S100 Proteins, Extracellular vesicle, Exudates and Transudates, proteomic analysis, invasion, macrophages, Lymphatic system, 030220 oncology & carcinogenesis, Lymphatic Metastasis, Cytokines, Lymph, medicine.symptom, Exudate, Immunology, Article, 03 medical and health sciences, Extracellular Vesicles, Animals, Biomarkers, Tumor/analysis, Cell Line, Tumor, Cytokines/analysis, Exosomes/metabolism, Extracellular Vesicles/metabolism, Exudates and Transudates/metabolism, Humans, Lymph/metabolism, Lymph Node Excision, Lymphatic Vessels/metabolism, Melanoma/blood, Melanoma/pathology, Melanoma/secondary, Melanoma/surgery, Mice, Inbred C57BL, MicroRNAs/analysis, Proteomics/methods, S100 Proteins/analysis, Skin Neoplasms/blood, Skin Neoplasms/pathology, Skin Neoplasms/secondary, Skin Neoplasms/surgery, medicine, Biomarkers, Tumor, Lymphatic Vessels, business.industry, Cancer, medicine.disease, cancer progression, proteins, MicroRNAs, 030104 developmental biology, Cancer research, peptides, cells, Lymphadenectomy, Cancer biomarkers, business
الوصف: Identifying cancer biomarkers is of great interest for patient prognosis and monitoring. However, tumor-associated factors are diluted in blood and challenging to detect. Broggi et al. show that lymphatic exudate, accessible at the time of lymphadenectomy, is highly enriched in tumor-associated factors and therefore a promising source for biomarker discovery.
Liquid biopsies allow monitoring of cancer progression and detection of relapse, but reliable biomarkers in melanoma are lacking. Because secreted factors preferentially drain to lymphatic vessels before dilution in the blood, we hypothesized that lymph should be vastly enriched in cancer biomarkers. We characterized postoperative lymphatic exudate and plasma of metastatic melanoma patients after lymphadenectomy and found a dramatic enrichment in lymphatic exudate of tumor-derived factors and especially extracellular vesicles containing melanoma-associated proteins and miRNAs, with unique protein signatures reflecting early versus advanced metastatic spread. Furthermore, lymphatic exudate was enriched in memory T cells, including tumor-reactive CD137+ and stem cell–like types. In mice, lymph vessels were the major route of extracellular vesicle transport from tumors to the systemic circulation. We suggest that lymphatic exudate provides a rich source of tumor-derived factors for enabling the discovery of novel biomarkers that may reflect disease stage and therapeutic response.
Graphical Abstractوصف الملف: application/pdf
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::18f6806c0790a1e5f776aeca52a5a9a1
http://europepmc.org/articles/PMC6504224 -
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المؤلفون: Arnaud Doerfler, A. Costa, Maurice Matter, Jean Pierre Venetz, Manuel Pascual
المصدر: Progrès en Urologie. 29:166-172
مصطلحات موضوعية: Gynecology, 03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, business.industry, Urology, 030232 urology & nephrology, medicine, business, Living donor
الوصف: Titre Variations et anomalies nephrologiques, vasculaires et urologiques chez les candidats au don vivant renal. Introduction Cette etude consiste a determiner I.a prevalence des variations anatomiques (renales, vasculaires et urologiques) ainsi que des pathologies renales acquises dans une population de candidats au don vivant de rein (CDVR). Materiel et methodes Il s'agit d'une etude retrospective de tous les CDVR referes dans notre centre en vue d'une transplantation renale entre avril 2003 et se pt embre· 2014. Sur les 491 CDVR, 189 ont ete initialement exclus pour des raisons medicales (n=140) ou autres (n=49), sans avoir effectue de bilan radiologique. 302 ont beneficie d'un bilan radiologique (angio-CT ou IRM) en prevision du don et 226/302 (73.5%) ont pu donner un rein. Resultats Une ou plusieurs variations anatomiques et/ou anomalies acquises ont ete constatees chez 178/302 (58.9%) des CDVR, dont les plus frequentes concernaient les anomalies et variations arterielles (arteres multiples, fibrodysplasie, anevrisme, stenose 70%), presentes chez . 39.3% des CDVR, suivies par les variations veineuses (27.8%). Des calculs ont ete observes chez 5.6% des C:DVR et les anomalies des voies urinaires (duplicite/bifidite ureterale) ont concerne 3.0% des CDVR. Aucune tumeur maligne n'a ete diagnostiquee alors que 4 tumeurs benignes (1.3%) ont ete identifiees, dont un cas necessitant des investigations supplementaires. Conclusion Nous constatons une haute prevalence de variations anatomiques et anomalies acquises dans une population de CDVR. Cependant, ces variantes et anomalies constatees ont conduit a exclure seulement 4 % des candidats. Ceci soit parce que les anomalies ne contre indiquaient pas le prelevement, soit parce que dans la majorite des cas le. rein controlateral a pu etre utilise.
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المؤلفون: Maurice Matter, Stéphane Cherix, Karl Sörelius, William Watfa, Melissa Ryan, Pietro G. di Summa, Wassim Raffoul, Corrado Campisi
المصدر: Annals of plastic surgery. 85(6)
مصطلحات موضوعية: medicine.medical_specialty, Wound Breakdown, 030230 surgery, Anastomosis, 03 medical and health sciences, Lymphocele, 0302 clinical medicine, medicine, Lymphatic vessel, Humans, Surgery, Plastic, Vein, Lymphatic Vessels, business.industry, medicine.disease, Plastic surgery, Lymphatic system, medicine.anatomical_structure, Lymphedema, Thigh, 030220 oncology & carcinogenesis, Surgery, Neoplasm Recurrence, Local, business, Algorithm, Algorithms
الوصف: BACKGROUND Surgical procedures interfering with the draining nodes in the inguinal region carry the intrinsic risk of lymphatic complications. Lesions of the inguinal lymphatic network can lead to lymphocele or lymphocutaneous fistulas and can eventually be associated to limb lymphedema with consequent high morbidity. OBJECTIVES This article describes a new surgical algorithm based on wound properties to properly address lymphatic complications of the inguinal area. Based on our experience, surgical solutions ranged from selective lymphatic vessel ligation to microsurgical lymphatic fistula treatment and free tissue transfer. METHODS Fourteen consecutive patients underwent surgery in our department following failed attempts to address persistent lymphatic leaks. Patient characteristics such as smoking, previous surgeries, comorbidities, and wound properties were considered. Identification of the leak was performed using blue patent dye and indocyanine green fluorescence. Surgical reconstruction occurred, according to our algorithm. RESULTS Lymphatic leaks were visualized in 11 of 14 patients. Direct closure of the wound after leak ligation could be performed in 4 of 14 patients. Multilymphatic into vein anastomosis was performed in 3 of 14 patients, and the remaining patients benefited from flap surgery based on the wound defects. All 14 patients had successful outcomes (100%) with early drain removal (average, 6 [SD, 6] days) and definitive wound healing 2 weeks postoperatively. After a mean follow-up of 12 (SD, 2.9) months, no clinical infection, lymphatic complication, or wound breakdown occurred. One patient had a partial recurrence that did not require surgical intervention. CONCLUSIONS A stepwise approach, combining lymphatic surgery principles and plastic surgery flap techniques, can lead to an effective treatment algorithm where surgical options are wound tailored to guarantee the best functional outcomes.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::162badcc4ef34148d2c6c9fede6a0057
https://pubmed.ncbi.nlm.nih.gov/32118638 -
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المؤلفون: Olivier Bonny, Youssef El-Housseini, Martin Hübner, Maurice Matter, Jan Bruegger, Ariane Boubaker
المصدر: Journal of Medical Case Reports, Vol 11, Iss 1, Pp 1-8 (2017)
Journal of medical case reports, vol. 11, no. 1, pp. 333
Journal of Medical Case Reportsمصطلحات موضوعية: Adult, medicine.medical_specialty, Adenoma, endocrine system diseases, Thyroid Gland, Parathyroid hormone, lcsh:Medicine, 030209 endocrinology & metabolism, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, Case report, medicine, Humans, Hyperparathyroidism, PTH, Parathyroid cyst, Aged, 80 and over, Past medical history, Cysts, business.industry, Thyroid, lcsh:R, General Medicine, Hyperparathyroidism, Primary, medicine.disease, Dysphagia, Surgery, Parathyroid Neoplasms, medicine.anatomical_structure, Head and Neck Neoplasms, 030220 oncology & carcinogenesis, Female, medicine.symptom, Differential diagnosis, Tomography, X-Ray Computed, business, Neck, Primary hyperparathyroidism, hormones, hormone substitutes, and hormone antagonists
الوصف: Background Cysts of parathyroid origin are sometimes encountered and can easily be mistaken as thyroidal cysts. Functional parathyroid cysts, with symptoms and signs of hyperparathyroidism, are rare and may be a diagnostic challenge to clinicians. We report here on three cases of functional parathyroid cysts that illustrate diagnosis difficulties related to unusual clinical presentations in three Caucasian women, including negative parathyroid scintigraphy. Case presentations Patient 1, an 87-year-old Caucasian woman presented with confusion and dysphagia. She had hypercalcemia and elevated parathyroid hormone levels suggesting primary hyperparathyroidism. Parathyroid scintigraphy did not reveal any focal uptake, but a computed tomography scan of her neck identified a large cyst in the upper right thyroid region. At cervicotomy, a parathyroid cystic adenoma was removed. Patient 2, a 31-year-old Caucasian woman was investigated after a hypertensive crisis related to primary hyperparathyroidism. Cervical ultrasound identified a large cystic lesion in the lower left thyroid lobe that was removed by minimally invasive cervicotomy. Patient 3, a 34-year-old Caucasian woman presented with an indolent growing mass of the neck and a past medical history of kidney stones. Primary hyperparathyroidism was diagnosed. Ultrasound showed a cystic mass, but parathyroid scintigraphy was negative. Cervical exploration revealed a large cystic adenoma, containing high parathyroid hormone levels. Conclusions Diagnosis of functional parathyroid cysts can be challenging due to various clinical presentations and negative parathyroid scintigraphy. Surgery, but not fine-needle sclerotherapy, appears to be the safest treatment option. Despite its rarity, differential diagnosis of cystic lesion of the neck should include primary hyperparathyroidism due to functional parathyroid cysts.
وصف الملف: application/pdf
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المؤلفون: Maurice Matter, Emmanuel Melloul, Nicolas Demartines, Fadia Dib, Jean-Pierre Venetz, Manuel Pascual, Daniel Gero
المصدر: World journal of surgery, vol. 41, no. 11, pp. 2940-2948
مصطلحات موضوعية: Male, medicine.medical_specialty, medicine.medical_treatment, 030232 urology & nephrology, Renal function, 030230 surgery, Single Center, Nephrectomy, Body Mass Index, 03 medical and health sciences, chemistry.chemical_compound, Sex Factors, 0302 clinical medicine, Internal medicine, Living Donors, Humans, Medicine, Prospective Studies, Prospective cohort study, Kidney transplantation, Aged, Retrospective Studies, Creatinine, business.industry, Retrospective cohort study, Middle Aged, medicine.disease, Kidney Transplantation, chemistry, Female, Glomerular Filtration Rate, Hypertension/complications, Laparoscopy, Tissue and Organ Harvesting, Hypertension, Surgery, business, Cohort study
الوصف: To evaluate outcomes and post-donation kidney function of older living kidney donors (LKD). Retrospective analysis of prospective database including all consecutive LKD undergoing laparoscopic nephrectomy in a single center (09/1998-12/2013). LKD aged ≥60 years were compared to younger LKD. Renal function assessed by creatinine levels and estimated glomerular filtration rates (eGFR). Surgical complications classified according to the Clavien-Dindo classification. Bivariate and multivariate analyses using linear mixed effect models were performed to determine factors (age, gender, hypertension status, BMI, choice of better functioning kidney for donation) that might impinge on renal function after donation. 213 LKD were identified: 49 older (median age: 66 years, range: 60-79) and 164 younger (median age: 46, range: 25-59). Mean operative time (149 vs. 152 min, p = 0.69), conversion to laparotomy (n = 1 vs. 3, p = 0.92), grade III-IV complications (n = 4 vs. 2, p = 0.36) were similar. Older had more grade I-II complications (n = 18 vs. 4, p < 0.001). Despite similar pre-donation eGFR (80 vs. 84 ml/min/1.73 m 2 ), older donors presented significantly lower eGFR during inpatient period (46 vs. 51 ml/min/1.73 m 2 , p = 0.0003), at 1 month (51 vs. 58 ml/min/1.73 m 2 , p = 0.002) and at 1 year (54 vs. 62 ml/min/1.73 m 2 , p = 0.001). Multivariate analysis adjusted to gender, hypertension status, BMI and choice of better functioning kidney for donation showed that at 1 year, age ≥60 affected renal function by a coefficient of 0.91 (p < 0.001). Despite renal function improvement after discharge, LKD ≥ 60 years presented lower eGFR than younger at one year and had more grade I-II surgical complications.
وصف الملف: application/pdf
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المؤلفون: Igor Salvade, Vincent Aubert, Samuel Rotman, Maurice Matter, Anne-Catherine Saouli, Dela Golshayan, Giuseppe Pantaleo, Manuel Pascual, Jean-Pierre Venetz
المصدر: Human Immunology. 77:483-489
مصطلحات موضوعية: Adult, Graft Rejection, Male, Risk, medicine.medical_specialty, Immunology, 030232 urology & nephrology, Human leukocyte antigen, 030230 surgery, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, HLA Antigens, Isoantibodies, Predictive Value of Tests, Outcome predictor, Internal medicine, medicine, Humans, Immunology and Allergy, Hla antibodies, Risk factor, Kidney transplantation, Aged, biology, business.industry, Histocompatibility Testing, Mean fluorescence intensity, Incidence (epidemiology), General Medicine, Middle Aged, Reference Standards, Prognosis, medicine.disease, Kidney Transplantation, body regions, biology.protein, Female, Antibody, business
الوصف: Pretransplant anti-HLA donor-specific antibodies (DSA) are recognized as a risk factor for acute antibody-mediated rejection (AMR) in kidney transplantation. The predictive value of C4d-fixing capability by DSA or of IgG DSA subclasses for acute AMR in the pretransplant setting has been recently studied. In addition DSA strength assessed by mean fluorescence intensity (MFI) may improve risk stratification. We aimed to analyze the relevance of preformed DSA and of DSA MFI values.280 consecutive patients with negative complement-dependent cytotoxicity crossmatches received a kidney transplant between 01/2008 and 03/2014. Sera were screened for the presence of DSA with a solid-phase assays on a Luminex flow analyzer, and the results were correlated with biopsy-proven acute AMR in the first year and survival.Pretransplant anti-HLA antibodies were present in 72 patients (25.7%) and 24 (8.6%) had DSA. There were 46 (16.4%) acute rejection episodes, 32 (11.4%) being cellular and 14 (5.0%) AMR. The incidence of acute AMR was higher in patients with pretransplant DSA (41.7%) than in those without (1.6%) (p0.001). The median cumulative MFI (cMFI) of the group DSA+/AMR+ was 5680 vs 2208 in DSA+/AMR- (p=0.058). With univariate logistic regression a threshold value of 5280 cMFI was predictive for acute AMR. DSA cMFI's ability to predict AMR was also explored by ROC analysis. AUC was 0.728 and the best threshold was a cMFI of 4340. Importantly pretransplant DSA5280 cMFI had a detrimental effect on 5-year graft survival.Preformed DSA cMFI values were clinically-relevant for the prediction of acute AMR and graft survival in kidney transplantation. A threshold of 4300-5300 cMFI was a significant outcome predictor.
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المؤلفون: Daniel F. Kalbermatten, Pietro G. di Summa, Olivier Bauquis, Maurice Matter, Wassim Raffoul
المساهمون: Matter, Maurice, Kalbermatten, Daniel F
المصدر: Journal of Plastic, Reconstructive and Aesthetic Surgery, vol. 2016, no. 69, pp. 359-367
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Operative Time, 030230 surgery, Thigh, Perineum, Risk Assessment, Cohort Studies, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Fascia lata, medicine, Humans, reconstructive surgery. flap, Pelvis, Aged, Retrospective Studies, Wound Healing, Pelvic floor, Pelvic exenteration, Abdominoperineal resection, business.industry, Wound dehiscence, Length of Stay, Middle Aged, Plastic Surgery Procedures, medicine.disease, Magnetic Resonance Imaging, Myocutaneous Flap, Pelvic Exenteration, Surgery, body regions, Treatment Outcome, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Quality of Life, Female, business, Follow-Up Studies
الوصف: Summary Background Abdominoperineal resection (APR) following radiotherapy is associated with a high rate of perineal wound complications. The anterolateral thigh (ALT) flap, combined with the vastus lateralis (VL) muscle, can cover complex perineal and pelvic anteroposterior defects. This is used for the first time transabdominally through the pelvis and the perineum (TAPP) in the infero-posterior directions; this technique has been described and illustrated in this study. Methods Among over 90 patients who underwent perineal reconstruction between May 2004 and June 2011, six patients presented high-grade tumours invading perineum, pelvis and sacrum, thereby resulting in a continuous anteroposterior defect. ALT + VL TAPP reconstructions were performed after extended APR and, subsequently, sacrectomy. Patients were examined retrospectively to determine demographics, operative time, complications (general and flap-related), time to complete healing and length of hospital stay. Long-term flap coverage, flap volume stability and functional and aesthetic outcomes were assessed. Results Mean operating time of the reconstruction was 290 min. No deaths occurred. One patient presented partial flap necrosis. Another patient presented a novel wound dehiscence after flap healing, due to secondary skin dissemination of the primary tumour. Following volumetric flap analysis on serial post-operative CT scans, no significant flap atrophy was observed. All flaps fully covered the defects. No late complications such as fistulas or perineal hernias occurred. Donor-site recovery was uneventful with no functional deficits. Conclusions The use of the ALT + VL flap transabdominally is an innovative method to reconstruct exceptionally complex perineal and pelvic defects extending up to the lower back. This flap guarantees superior bulk, obliterating all pelvic dead space, with the fascia lata (FL) supporting the pelvic floor.
وصف الملف: application/pdf
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