Presentazione a cura del Professor Angelo Cioppa - XII° Congresso Nazionale FIMeG 2018 - The Silver Tsunami: l'anziano fra appropriatezza e farmaeconomia
Ascending aortic dilatation associated with bav copyFereidoon Ashnaei
bicuspid aortic valve have heterogeneous presentation of phenotypes due to more complex matter related to congenital,genetic or connective tissue abnormality
Ascending aortic dilatation associated with bav copyFereidoon Ashnaei
bicuspid aortic valve have heterogeneous presentation of phenotypes due to more complex matter related to congenital,genetic or connective tissue abnormality
bentall, and 'old' procedures that still valid until present. Bail out for valve sparring & the patology of indonesian most present were best in this procedures
Is routine thromboprophylaxis warranted in all patients of tibial fracture ma...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
introduction, causes, risk factors, symptoms, examination, investigations and management of peripheral arterial disease.
how to assess the patient and what will be the complications of PAD, physiotherapy treatment for PAD
Carotid Endarterectomy in Stroke Prevention UpdateDenise Crute
Neurocritical Care lecture on the role of carotid artery surgery in stroke prevention, reviewing the latest studies and evidence-based updates, along with neurosurgical techniques.
bentall, and 'old' procedures that still valid until present. Bail out for valve sparring & the patology of indonesian most present were best in this procedures
Is routine thromboprophylaxis warranted in all patients of tibial fracture ma...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
introduction, causes, risk factors, symptoms, examination, investigations and management of peripheral arterial disease.
how to assess the patient and what will be the complications of PAD, physiotherapy treatment for PAD
Carotid Endarterectomy in Stroke Prevention UpdateDenise Crute
Neurocritical Care lecture on the role of carotid artery surgery in stroke prevention, reviewing the latest studies and evidence-based updates, along with neurosurgical techniques.
Patient with a toe gangrene coming to Emergency Department
Joel Arudchelvam
Atherosclerotic OAD – Risk factors
Presentation
FONTAINE CLASSIFICATION
Rutherford classification
SVS Lower Extremity Threatened Limb (WIFI) classification
PAD can be diagnosed in asymptomatic individuals by a combination of physical examination and simple, noninvasive Doppler ultrasonography to measure the ankle–brachial index
Study of 89 Cases of Peripheral Vascular Disease by CT AngiographyM A Hasnat
The purpose of this study was to observe the morphological pattern by CT angiography
and risk factors for development of peripheral vascular disease in Bangladeshi patient suffering
from peripheral vascular disease using a multidetector scanner in the evaluation of patients with
peripheral vascular disease.
Centralization of flow in aortic dissectionIvo Petrov
New concept of totally endovascular treatment of complex cases of type A and B aortic dissection.
Modern minimally invasive approach to treat aortic dissection.
Deep Vein Pathophysiology: Reflux & ObstructionVein Global
By: Peter J. Pappas, M.D.
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Preventing gangrene and amputation by Vascular InterventionsShoaib Padaria
Discussing the risk factors causing Gangrene, and the development of Peripheral Vascular Disease. Role of non surgical Vascular Interventions and Hyperbaric Oxygen treatment in treating Peripheral Arterial disease.
Similar to La rivascolarizzazione degli arti inferiori nel paziente anziano: rischi e vantaggi (20)
I meccanismi del danno gastrico e la patologia H. Pylori correlataASMaD
Presentazione a cura del Dottor Vincenzo De Francesco - "Malattia da reflussogastroesofageo e infezione da Helicobacter Pylori: old topics?" - Roma 11/05/2019
Ph impedenziometria nella MRGE: quando, come e perchèASMaD
Presentazione a cura della Dottoressa Francesca Galeazzi - "Malattia da reflussogastroesofageo e infezione da Helicobacter Pylori: old topics?" - Roma 11/05/2019
Presentazione a cura del Professor Enrico Corazziari - "Malattia da reflussogastroesofageo e infezione da Helicobacter Pylori: old topics?" - Roma 11/05/2019
Cambiamenti di popolazione e flussi migratori: cambiano anche le malattie met...ASMaD
Presentazione a cura della Dottoressa Migneco Maria Giuseppina - "Incontri endocrinologici AME LAzio - L'endocrinologia nel SSN: prospettive e nuove problematiche" - Roma 17/12/2018
Tiroide: chi decide quale intervento e per chi?ASMaD
Presentazione a cura del Dottor Bellotti Carlo - "Incontri endocrinologici AME LAzio - L'endocrinologia nel SSN: prospettive e nuove problematiche" - Roma 17/12/2018
Tiroide: Integrazione tra elementi nutriacetici e farmacologia: utile o inutile?ASMaD
Presentazione a cura del Dottor Roberto Cesareo - "Incontri endocrinologici AME LAzio - L'endocrinologia nel SSN: prospettive e nuove problematiche" - Roma 17/12/2018
L'ecografia tiroidea: strumento cruciale nella gestione clinica?ASMaD
Presentazione a cura del Dottor Guglielmi Rinaldo - "Incontri endocrinologici AME LAzio - L'endocrinologia nel SSN: prospettive e nuove problematiche" - Roma 17/12/2018
Il chirurgo e la tiroide oggi un rapporto in crisi?ASMaD
Presentazione a cura del Dottor Luca Piantoni e del Dottor Francesco Pedicini - "TIROIDE 2018 Nuovi approcci diagnostici e terapeutici" - Roma 24/11/2018
Presentazione a cura della Dottoressa Rosella Pasqualoni e del dottor Gregorio Reda - "TIROIDE 2018 Nuovi approcci diagnostici e terapeutici" - Roma 24/11/2018
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Are There Any Natural Remedies To Treat Syphilis.pdf
La rivascolarizzazione degli arti inferiori nel paziente anziano: rischi e vantaggi
1. La rivascolarizzazione degli arti
inferiori nel paziente anziano:
rischi e vantaggi
Angelo Cioppa, MD
Division of Invasive Cardiology
"Montevergine" Clinic, Mercogliano - Italy
2. PAOD in the Elderly
6450 patients
Prevalence of PAOD by the Age
Incidence of Intermittent
Claudication
Framingham Heart
Study Cohort
Rotterdam Study
3. Lesion Location by the age Symptoms by the age Procedural Succees
LESIONS LOCATION – CLINICAL PRESENTATON – RESULTS
PAOD in the Elderly
<70 >70 <80 >80
7880
patients
5. COMPLICATIONS
PAOD in the Elderly
Overall 18,5% vs 8,5% p=0,010
Major 11,1% vs 1,8% p<0,001
Access site 12,5% vs 4,9% p=0,009
Bleeeding 12,5% vs 2,2% p<0,001
682 patients
14. PAOD in the Elderly
AAA prevalence increased
with age
>80 ys
PAOD prevalence 25%
PAOD without claudication 50%
ABI can be falsely elevated
(> 1,00) in diseaed elderly
due to arterial stiffness
15. Revascularization
PAOD in the Elderly
Optimal Management
Medical Therapy
Amputation
No differences
between adults
and elderly
16. PAOD in the Elderly
MEDICAL THERAPY
No differences
between adults
and elderly
17. PAOD in the Elderly
MEDICAL THERAPY
Strongly Recomended in the Elderly!!
19. PAOD in the Elderly
MEDICAL THERAPY
Strongly Recomended in the Elderly!!
20.
21.
22. PAOD in the elderly
• High incidence and prevalence
• Male = Female
• BTK > femoral > Iliac
• Multilevel disease> focal stenosisCritical
• Critical Ischemia > Intermittens Claudication
• More co-morbidities
• More complications
• Optimal medical therapy strongly
recomended
• Endovascular preferred to surgery
23. CHRONIC CRITICAL LIMB ISCHEMIA (CLI)
One of the most common and difficult
problem encounted by vascular
surgeons and endovascular
specialists, and incidence increase
with the aging of the population.
24. CHRONIC CRITICAL LIMB ISCHEMIA (CLI)
• CLI is the clinical manifestation of an end-stage
PAOD
• In CLI blood flow is so inadequate that rest pain,
ulcerations and/or gangrene occur.
25. PAD Claudicant vs CLIPAD Claudicant vs CLI
• 10-35% have
claudication at initial
presentation
• 5 years
• 15-30% deceased or expired
• 20% nonfatal cardiovascular event
Hirsch et al, Circulation, 2006;113:e463-654.
• 1-2% have CLI
at initial presentation
• 1 year
• 20% continuing CLI
• 25% resolved CLI
• 30% alive amputated
• 25% deceased or expired
26. The PAD prescription
(Olin JW et al. J Am Coll Card 2016)
The PAD prescription
(Olin JW et al. J Am Coll Card 2016)
29. Clinical Fontaine
stage
Rutherford
category
asymptomatic I 0
claudicatio
- mild
- moderate
- severe
IIa
IIb
IIb
1
2
3
rest pain (CLI) Stage III 4
ulceration or
gangrene (CLI)
- minor tissue loss
- major tissue loss
IV
5
6
Clinical Evaluation of PAOD
Clinical Fontaine
stage
Rutherford
category
PAOD with
neuropathy
asymptomatic I 0 X
claudicatio
- mild
- moderate
- severe
IIa
IIb
IIb
1
2
3
rest pain (CLI) Stage III 4
ulceration or gangrene
(CLI)
- minor tissue loss
- major tissue loss
IV
5
6
X
Elderly /BTK PAOD
31. Ischemic Foot
PAOD evaluation
Limb revascularization
Limb salvage
Ability to walk
Treatment of trophic
lesions
Functional rehabilitation
Foot surgery
Treatment of trophic lesions
Adjuvant therapy
Treatment of trophic lesions
Ischemic Foot
Limb salvage and Ability to walk
32. 1. Macroangiopathy is most often seen in popliteal and tibial arteries
2. The lesions tend to be more extensive
3. Histopathological lesions
- Macroangiopathy
atherosclerosis
diffuse intimal fibrosis
medial calcific sclerosis
- Microangiopathy
no small artery or arteriolar occlusive lesion
4. Patency of the ankle and foot arteries LoGerfo FW
J Vasc Surg 1987; 5: 793-6
Elderly PAOD (+diabetes)
36. Incidence of CLI in controlateral limb
Follow up Holzenbein et al
J Vasc Surg 1996
Faglia et al
Diab Res and Clin Pract 2007
12 months 16% 17.9%
24 months 27.8% 28.8%
36 months 59.1% 34.4%
BTK - PAOD
37. R-R for all-cause mortality by DFU vs diabetes only
The association of ulceration of the foot with cardiovascular
and all-cause mortality in patients with BTK/Diabetes:
a Meta-Analysis Brownrigg JRW et al
Diabetologia 2012; 55: 2906-2912
BTK - PAOD
39. End-points
Imaging of femoro-popliteal-tibial axis
Imaging of foot arteries
• To define the presence of pathology
• To define the extension of pathology
• Run in, Run off (morphology and
haemodynamic aspects)
BTK - PAOD
Imaging
42. Artery Sensitivity (%) Specificity (%)
TPT 25-71 87-100
ATA 72-98 35-100
Peroneal a. 89-94 21-58
PTA 79-100 40-100
Dorsalis pedis 33-85 76-89
Plantar arteries 43-78 76-100
DUS assessment of tibial arteries in patients with arterial
disease: a Systematic Review
Bianchini Massoni C
BTK - PAOD
Imaging
43. Tibial arteries disease: Ultrasound evaluation
SFA
Popliteal A.
Anterior tibial A.
Dorsalis pedis A.
BTK - PAOD
Imaging
44. RUN OFFGOOD
RUN OFF
Tibial arteries disease in diabetic patients:
Can colour duplex mapping of the ankle and foot arteries improve the vascular
program?
M Gargiulo, A Stella, S Tarantini et al ESVS 2000
POOR
RUN OFF
BTK - PAOD
Imaging
45. Neuro-ischemic foot
Duplex ultrasound arterial mapping
from the EIA to the pedal arteries
Lower Extremity
Revascularization
Arteriography
Arterial wall calcification
Extensive ulcers
Edema
Very poor run in or run off
BTK - PAOD
Imaging
47. Clinical Fontaine
stage
Rutherford
category
Asymptomatic I 0
Claudicatio
- mild
- moderate
- severe
IIa
IIb
IIb
1
2
3
Rest pain Stage III 4
Ulceration or Gangrene
- minor tissue loss
- major tissue loss
Stage IV
5
6
C
L
I
Peripheral Arterial Occlusive Disease
(PAOD)
BTK
Revascularization
48. non-revascularized pts
BPG
PTA
Early and five year amputation and survival rate of diabetic patients
with critical limb ischemia: data of a Cohort study of 564 patients
Faglia E et al.
EJVES 2006; 32: 484-490
Above the ankle amputation
BTK
Revascularization
49. Long-term prognosis of Diabetic Patients with
Critical Limb Ischemia
Faglia E et al.l
Diabetes Care 2009; 32: 822-827
Survival
BPG - 114
PTA - 413
No REV - 27
Patients = 554
Mean follow up = 5.93 ± 1.28 years
BTK
Revascularization
50. GOALS of BTK PTA
• Clinical goals:
• Relief of ischemic rest pain
• Wound healing
• Avoidance of amputation
• Mobilization
• Improvement of survival
Primary goal
Re-establishment of
pulsatile, straight-line flow to the foot
51. BTK
Revascularization
Wound related artery concept
Christopher E. et Al. “Angiosomes of
the foot and ankle and clinical
implications for limb salvage”
”Plastic & ReconstructiveSurgery2006;117:
261s -293s
Acquiring direct flow based on the angiosome concept is
important in healing of the lesion and limb salvage
Ankle/Foot: 6 angiosomes
Posterior Tibial Artery (# 3)
. Calcanear artery
. Medial plantar artery
. Lateral plantar artery
Anterior Tibial Artery (#1)
. Dorsalis pedis artery
Peroneal Artery (#2)
. Calcanear artery
. Anterior perforating artery
52. BTK
Revascularization
“Willis like” foot circle
The first aim of PTA in CLI is to restore a direct blood flow to
the foot circle.
Treatment of foot arteries is essential in CLI patients
The lower leg
(tibialperoneal) vessels
usually connect in the foot
so that only one vessel is
usually necessary to be
open for foot
survival/salvage
53. Follow up 12
months
DR* IR
Wound healing 92% 73%
Limb salvage 93% 72%
* Direct revascularization of dorsalis pedis or plantar arteries
C. Varela et al
Vasc Endovascular Surg 2010 44(8) 654-660
The role of foot collateral vessels on ulcer healing and limb
salvage after successeful endovascular and surgical distal
procedures according to an angiosome model
Direct
Vs
Indirect
- Study: retrospective
- pts / legs: 70 /76
- revascularization: Endovascular 35
Bypass 41
BTK
Revascularization
54. Systematic Review and Meta-analysis of Direct versus Indirect
Angiosomal Revascularisation of infrapopliteal arteries
Bosanquet DC et al.
Eur J Vasc Endovasc Surg 2014; 48: 88-97
Limb Salvage
No of Studies
(total limbs)
Direct
(n)
Indirect
(n)
p
All studies 14 (1775) 991 784 <.0001
Endovascular revascularization 7 (1182) 672 510 .002
Bypass revascularization 6 (517) 274 243 .001
Larger studies 6 (1233) 686 547 .03
Propensity matched groups 3 (500) 250 250 .12
Newcastle-Ottawa 6 (948) 537 411 .06
1 year follow up 5 (663) 335 328 .08
BTK
Revascularization
55. BTK
Revascularization
Treament strategies in BTK
• Revascularisation First
►not infected ulcers
►dry gangrene
• Aggressive Surgical Debridment First
►infected foot
►wet gangrene
56. BTK
Revascularization
Therapeutic strategies
• The selection of the most appropriate
revascularization strategy has to be
determined on a case-by-case basis in a
specialized vascular centre in close
cooperation with an endovascular specialist
and a vascular surgeon.
• The main issues to be considered are the
anatomical suitability, co-morbidities, local
availability and expertise, and the patient’s
preference.
61. BTK
Revascularization
Patency rates of by-pass grafting in
CLI/Severe limb ischemia
Procedure 5-Year
Patency
Aortobifemoral bypass 87(80-88)%
Axillounifemoral bypass 51(44-79)%
Axillobifemoral bypass 71(50-76)%
Femoropopliteal vein 69(60-82)%
Femoropopliteal ATK (Dacron) 49(46-53)%
Femoropopliteal ATK (PTFE) 38(32-45)%
Femoropopliteal below-knee 47%
Data adapted from TASC; Norgen L, Hiatt WR, Dormandy JA, et al. TASCII; J.Vasc. Surgery
2007; 45(Suppl S): S5-S67; S54A for pts. With CLI.
62. Chapter IV: Treatment of Critical Limb Ischaemia
Management of Critical Limb Ischaemia and Diabetic Foot.
Clinical Practice Guidelines of the European Society for
Vascular Surgery
Setacci C et al
ESVS 2011; 4 Suppl 2, S43–S59
Infrapopliteal Disease - Recommendations
- Endovascular treatment of infrapopliteal arteries has the potential to
achieve similar limb salvage rates with less procedural morbidity and
mortality than surgical bypass. Angioplasty as the first-line therapeutic
modality for patients with CLI and infrapopliteal lesion is reasonable
in the majority of cases, considering that the interventional procedure
should not preclude future surgical intervention. (Level 4; Grade C)
- Surgical treatment should be considered for more complex
anatomical lesions of BTK vessels or in case of endovascular failure
and persisting clinical symptoms of CLI. (Level 4; Grade C)
BTK
Revascularization
68. 12-m Major Adverse Events
* only patients with CLI
12-month Clinical Outcome
Patients n = 70 Lesions = 90
Twelve-Month Target Lesion Revascularization was 11%.
8 symptomatic (RC> 3) patients (10 lesions) referred to revascularization
(7 re-PTA and 1 Surgery) with Secondary Patency of 94%.
Limb Salvage in patients was 96% (3 Major Amputation)
15,0%
8,0%
77,0%
worse same better
12m vs. baseline
“Montevergine” DEB-BTK Registry
70. The ongoing battle between infrapopliteal
angioplasty and bypass surgery for critical limb
ischemia
Schamp KBC et al
Ann Vasc Surg 2012; 26:1145-1153
……Angioplasty and surgery are clearly complementary and therapy
must be individualized by teams who are not vested in one theraphy or
the other. …….
Conte MD
Semin Vasc Surg 2012; 25:108-114
BTK
Revascularization
BTK revascularization:
endovascular versus open
bypass
Do we have the answer?
71. BTK Revascularization
Treatment of peripheral arterial disease in diabetes:
A consensus of the Italian Societies of Diabetes (SID,AMD), Radiology
(SIRM) and Vascular and Endovascular Surgery (SICVE)
Method of revascularization :
- the healing potential of the ulcer
- local condition of the foot
- vascular tree
- general condition of the patient
• Choice of revascularization technique
Aiello A et al.
Nutrition, Metabolism & Cardiovasc Disease 2014; 24: 355-369
72. Patency rates of by-pass grafting in
CLI/Severe limb ischemia
Is sustained patency necessary?
Wound Healing time ~ 6 M
Complete 6-month healing rate ~ 50%
75. - Conoscenza delle patologie associate
- Conoscenza della storia clinica del piede e del paziente
- Conoscenza della topografia della AOCP nell’ Anziano
- Accuratezza della diagnostica Ultrasonografica.
- Tecnica di Rivascolarizzazione in rapporto a differenti
variabili.
- Ruolo del lavoro in equipe
Prospettive nella gestione del paziente
Anziano con AOCP