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Diaz GM, Webb LT, Rabil MJ, Lokeshwar SD, Choksi AU, Leapman MS, Sprenkle PC. Risk Factors and Contemporary Management Options for Pain and Discomfort Experienced During a Prostate Biopsy. Curr Urol Rep 2024; 25:243-252. [PMID: 38896314 DOI: 10.1007/s11934-024-01220-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE OF REVIEW Prostate fusion biopsy, an innovative imaging modality for diagnosing prostate cancer, presents certain challenges for patients including discomfort and emotional distress, leading to nonadherence to treatment and follow-ups. To inform clinicians and offer pain relief alternatives to patients, this review delves into the risk factors for increased pain and modern management options to alleviate pain during prostate biopsy. RECENT FINDINGS Individual responses to pain vary, and the overall experience of pain during a prostate biopsy has been contributed to numerous factors such as patient age, prostate volume, previous biopsy experience, and more. As a result, several strategies aim to mitigate pain during in-office procedures. Notably, techniques including pharmacological analgesics, hand holding, heating pads, entertainment/virtual reality, and distraction have shown significant efficacy. Existing studies explore risk factors influencing pain intensity during prostate biopsy and effective pain management strategies. This review consolidates available information to guide clinicians in enhancing patient comfort and thus, encourage surveillance adherence.
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Affiliation(s)
- Gabriela M Diaz
- Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | - Lindsey T Webb
- Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | | | - Soum D Lokeshwar
- Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | - Ankur U Choksi
- Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | | | - Preston C Sprenkle
- Department of Urology, Yale School of Medicine, New Haven, CT, USA.
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.
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Deivasigamani S, Adams ES, Kotamarti S, Mottaghi M, Taha T, Aminsharifi A, Michael Z, Seguier D, Polascik TJ. Comparison of procedural anxiety and pain associated with conventional transrectal ultrasound prostate biopsy to magnetic resonance imaging-ultrasound fusion-guided biopsy: a prospective cohort trial. Prostate Cancer Prostatic Dis 2024; 27:294-299. [PMID: 38001362 DOI: 10.1038/s41391-023-00760-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/07/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Prostate cancer (PCa) diagnosis relies on biopsies, with transrectal ultrasound (TRUS) biopsies being common. Fusion biopsy (FB) offers improved diagnostic accuracy, but the pain and anxiety experienced by patients during biopsies is often overlooked. This study aims to compare pain and anxiety levels between standard TRUS-guided biopsy (STB) and systematic plus MRI/US fusion biopsy (STB + FB). MATERIALS AND METHODS The study involved adult men undergoing biopsies, receiving identical peri-procedural care, including 2% lidocaine jelly in the rectum and subsequent 1% lidocaine injections (10cc per side) into the prostate-seminal vesicle junction and prostatic apical areas bilaterally. The biopsy technique was chosen based on clinical and imaging findings. Pre- and post-biopsy anxiety levels were assessed using the State-Trait Anxiety Inventory (STAI) questionnaire, categorized as mild (20-37), moderate (38-44), or severe (45-80). Post-biopsy pain was evaluated on a numerical rating scale, ranging from 0 to 10. RESULTS Of the 165 patients, 99 underwent STB, and 66 underwent STB + FB. No significant differences were observed in age, race, prostate-specific antigen, prostate volume, or prior biopsies between the groups. The STB + FB group had more biopsy cores taken (16.2 vs. 12, p = 0.001) and a longer procedure time (23 vs. 10 min, p = 0.001). STB biopsy patients experienced lower post-procedural anxiety compared to STB + FB, with a mean difference of -7 (p = 0.001, d = 0.92). In the STB + FB group, 89% experienced severe post-procedural anxiety compared to 59% in STB (p = 0.002). There was no significant difference in post-procedural pain (p = 0.7). Patients with prior biopsies had significantly higher STAI(S) anxiety scores (p = 0.005), and the number of prior biopsies correlated with anxiety severity (p = 0.04) in STB + FB group. CONCLUSION In summary, STB + FB group demonstrated higher post-procedural anxiety levels than the STB group, with no difference in pain levels. Additionally, patients with a history of repeat biopsies were more likely to exhibit higher STAI(S) anxiety scores.
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Affiliation(s)
| | - Eric S Adams
- Department of Urology, Duke University Medical Center, Durham, NC, 27710, USA
| | - Srinath Kotamarti
- Department of Urology, Duke University Medical Center, Durham, NC, 27710, USA
| | - Mahdi Mottaghi
- Section of Urology, Department of Surgery, Durham Veterans Affairs Medical Center, Durham, NC, 27710, USA
| | - Terek Taha
- Department of Urology, Duke University Medical Center, Durham, NC, 27710, USA
- Ziv Medical Center, Safed, Israel
| | - Ali Aminsharifi
- Department of Urology, Duke University Medical Center, Durham, NC, 27710, USA
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Zoe Michael
- Department of Urology, Duke University Medical Center, Durham, NC, 27710, USA
- Section of Urology, Department of Surgery, Durham Veterans Affairs Medical Center, Durham, NC, 27710, USA
| | - Denis Seguier
- Department of Urology, Lille University, Lille, France
| | - Thomas J Polascik
- Department of Urology, Duke University Medical Center, Durham, NC, 27710, USA
- Section of Urology, Department of Surgery, Durham Veterans Affairs Medical Center, Durham, NC, 27710, USA
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Liu M, Xie Z, Tang W, Liang G, Zhao Z, Wu T. Advanced prostate cancer diagnosed by bone metastasis biopsy immediately after initial negative prostate biopsy: a case report and literature review. Front Oncol 2024; 14:1365969. [PMID: 38800391 PMCID: PMC11116681 DOI: 10.3389/fonc.2024.1365969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Prostate cancer (PCa) is a prevalent male malignancy that originates in the epithelial cells of the prostate. In terms of incidence and mortality of malignant tumors in men, PCa ranks second and fifth globally and first and third among men in Europe and the United States, respectively. These figures have gradually increased in recent years. The primary modalities used to diagnose PCa include prostate-specific antigen (PSA), multiparametric magnetic resonance imaging (mpMRI), and prostate puncture biopsy. Among these techniques, prostate puncture biopsy is considered the gold standard for the diagnosis of PCa; however, this method carries the potential for missed diagnoses. The preoperative evaluation of the patient in this study suggested advanced PCa. However, the initial prostate puncture biopsy was inconsistent with the preoperative diagnosis, and instead of waiting for a repeat puncture of the prostate primary, we performed a biopsy of the rib metastasis, which was later diagnosed as advanced PCa.
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Affiliation(s)
| | | | | | | | - Zeju Zhao
- Department of Urology, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Tao Wu
- Department of Urology, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
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Rempega G, Rajwa P, Kępiński M, Ryszawy J, Wojnarowicz J, Kowalik M, Krzempek M, Krzywon A, Dobrakowski M, Paradysz A, Bryniarski P. The Severity of Pain in Prostate Biopsy Depends on the Biopsy Sector. J Pers Med 2023; 13:jpm13030431. [PMID: 36983612 PMCID: PMC10057203 DOI: 10.3390/jpm13030431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/08/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND: The pain experienced by a patient during a prostate fusion biopsy is cumulative and can also be modulated by many factors. The aim of the study was to assess the association between the degree of pain intensity during prostate biopsy and the region of the biopted organ. MATERIALS AND METHODS: The study included a group of 143 patients who underwent prostate fusion biopsy under local analgesia followed by blockage of the periprostatic nerve. After a biopsy, the patients completed the original questionnaire about the pain experienced during the procedure. RESULTS: There was a statistically significant difference in pain score between cores taken in the apex (median 5 (IQR 2–5)), medium level (median 1 (IQR 1–2)), and prostate base (median 1 (IQR 1–3)) (p < 0.001). The malignancy scale ISUP ≥ 2 (p = 0.038) and lower PSA value (r = −0.17; p = 0.046) are associated with higher pain during procedure. Biopsy time was correlated with discomfort (r = 0.19; p = 0.04). Age (p = 0.65), lesion size (p = 0.29), PI-RADS score (p = 0.86), prostate volume (p = 0.22), and the number of cores (p = 0.56) did not correspond to the pain scale. CONCLUSIONS: The apex is the most sensitive sector of the prostate. ISUP ≥ 2 and patients with low PSA levels more often indicated higher values on the pain rating scale.
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Affiliation(s)
- Grzegorz Rempega
- Department of Urology, Division of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland
- Correspondence:
| | - Paweł Rajwa
- Department of Urology, Division of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria
| | - Michał Kępiński
- Department of Urology, Division of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland
| | - Jakub Ryszawy
- Department of Urology, Division of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland
| | - Jakub Wojnarowicz
- Department of Urology, Division of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland
| | - Maksymilian Kowalik
- Department of Urology, Division of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland
| | - Marcela Krzempek
- Department of Biostatistics and Bioinformatics, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-100 Gliwice, Poland
| | - Aleksandra Krzywon
- Department of Biostatistics and Bioinformatics, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-100 Gliwice, Poland
| | - Michał Dobrakowski
- Department of Biochemistry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, ul. Jordana 19, 41-808 Zabrze, Poland
- Department of Radiology and Radiodiagnostics, Public Clinical Hospital, Medical University of Silesia in Katowice, ul. 3-go Maja 13-15, 41-800 Zabrze, Poland
| | - Andrzej Paradysz
- Department of Urology, Division of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland
| | - Piotr Bryniarski
- Department of Urology, Division of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland
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Prospective analysis of pain expectancy and experience during MR-fusion prostate biopsy: does reality match patients' expectancy? World J Urol 2022; 40:2239-2244. [PMID: 35833972 PMCID: PMC9427866 DOI: 10.1007/s00345-022-04083-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/21/2022] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Multiparametric magnetic resonance imaging fusion targeted prostate biopsy (MR-TB) has emerged to the biopsy technique of choice for evaluation of patients with suspected prostate cancer (PCA). The study aimed to determine expected and experienced pain during MR-TB depending on patients' psychological state. METHODS We prospectively enrolled 108 men with suspicion of PCA who underwent MR-TB. All patients completed self-reported validated questionnaires assessing pain, stress, self-efficacy, anxiety and study-specific questionnaires on expected and experienced pain before, during and after MR-TB. Patient characteristics and survey scores were obtained. RESULTS Overall, pain levels during MR-TB were low (mean 2.8/10 ± 2.5 Numerical Rating Scale, NRS). 10/86 (11.6%) participants reported severe pain (≥ 7/10 NRS). Pain correlated significantly with anxiety (r = 0.42), stress (r = 0.22) and pain expectancy (r = 0.58). High self-efficacy did not show increased pain resilience. Participants anticipated more pain than experienced during each step of MR-TB with significant differences concerning local anesthesia and core sampling (both p < 0.001), among others. Expectancy and actual pain did not match regarding severity and impact of the total amount of cores taken (p < 0.05). Independent predictors of increased pain at biopsy were prostate volume > 50 ml (p = 0.0179) and expected pain during rectal manipulation (p < 0.001). CONCLUSION Pain during MR-TB can be positively influenced by reducing men's anxiety, stress and pain expectancy. To meet the needs of the audience, clinicians should address concrete pain levels of each procedural step and consider special treatment for patients with prostate volume > 50 ml and men reporting on increased rectal sensitivity.
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Yoo JW, Koo KC, Chung BH, Lee KS. Pain control according to the periprostatic nerve block site in magnetic resonance imaging/transrectal targeted prostate biopsy. Sci Rep 2022; 12:772. [PMID: 35031671 PMCID: PMC8760249 DOI: 10.1038/s41598-022-04795-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/24/2021] [Indexed: 11/18/2022] Open
Abstract
We analyzed the intensity of pain at each site of systemic prostate biopsy (SBx) and compared the intensity of pain among magnetic resonance (MRI)-targeted transrectal biopsies according to the periprostatic nerve block (PNB) site. We collected data from 229 consecutive patients who had undergone MRI-targeted biopsy. Patients were stratified into two groups according to the site of PNB (base versus base and apex PNB). Pain was quantified at the following time points: probe insertion, injection at the prostate base, injection at the prostate apex, MRI cognitive biopsy (CBx), MRI/transrectal ultrasound fusion biopsy (FBx), SBx, and 15 min after biopsy. For all biopsy methods, the average pain were significantly higher in the base PNB group than in the base and apex PNB group (CBx, p < 0.001; FBx, p = 0.015; SBx, p < 0.001). In the base and apex PNB group, FBx was significantly more painful than SBx (p = 0.024). Overall, regardless of the PNB site, pain at the anterior sites was more than that at the posterior sites in FBx (p = 0.039). Base and apex PNB provided better overall pain control than base-only PNB in all biopsy methods. In the base and apex PNB group, FBx was more painful than CBx and SBx.
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Affiliation(s)
- Jeong Woo Yoo
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Kyo Chul Koo
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Byung Ha Chung
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Kwang Suk Lee
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea.
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Yoo JW, Koo KC, Chung BH, Lee KS. Efficacy of additional periprostatic apex nerve block on pain in each of 12 transrectal prostate core biopsies: a retrospective study. BMC Urol 2021; 21:132. [PMID: 34530801 PMCID: PMC8447510 DOI: 10.1186/s12894-021-00898-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/09/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND We identified pain variation according to prostate biopsy sites and compared differences in pain relief according to the site of periprostatic nerve block (PNB). METHODS This retrospective study collected data from 312 patients who underwent transrectal prostate biopsies between January 2019 and August 2020. Patients were stratified into two groups according to the site of local anesthesia (base vs. base and apex PNB), with each block achieved with 2.5 cm3 of 2% lidocaine. Pain scores were assessed using the visual analog scale at the following time points: probe insertion, PNB at base, PNB at apex, each of the 12 core biopsy sites, and 15 min after biopsy. The results were analyzed using a linear mixed model. RESULTS The average pain scores were significantly higher in the base-only PNB group than were those in the base and apex PNB group (3.88 vs 2.82, p < 0.001). In the base-only PNB group, the pain scores increased from base to apex (p < 0.001), and the pain at each site also gradually increased as the biopsy proceeded (p < 0.001). In contrast, in the base and apex PNB group, there was minor change in pain scores throughout the procedure. CONCLUSIONS The pain scores varied at each site during the prostate biopsy. The provision of a base and apex PNB provided greater pain relief than does base-only PNB during prostate biopsy.
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Affiliation(s)
- Jeong Woo Yoo
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Kyo Chul Koo
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Byung Ha Chung
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Kwang Suk Lee
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea.
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Nakai Y, Tanaka N, Matsubara T, Anai S, Miyake M, Hori S, Fujii T, Ohbayashi C, Fujimoto K. Effect of Prolonged Duration of Transrectal Ultrasound-Guided Biopsy of the Prostate and Pre-Procedure Anxiety on Pain in Patients without Anesthesia. Res Rep Urol 2021; 13:111-120. [PMID: 33692969 PMCID: PMC7939514 DOI: 10.2147/rru.s297703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/12/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate factors correlated with pain during prostate biopsy and willingness to undergo transrectal ultrasound-guided prostate biopsy (TR-PBx) again without anesthesia in patients undergoing TR-PBx without anesthesia. Methods This retrospective, single-center study evaluated 624 patients who underwent TR-PBx without anesthesia. Based on a nomogram using patient age and prostate volume, 6-12 core biopsy samples were allocated. Anxiety was evaluated using the Faces Anxiety Scale before the TR-PBx. Pain was evaluated using the Faces Pain Scale at each puncture and immediately after confirmation of cessation of bleeding from the rectum after the transrectal probe was pulled out. The question "If this operation must be repeated, would you agree to undergo it again under same conditions?" was asked after the procedure was completed. The change in pain at each puncture and factors correlated with post-procedural pain were calculated using multiple regression analysis, and factors predicting an answer of "yes" to the question using binary logistic analysis were evaluated. Results Scores on the Faces Pain Scale significantly increased from the first core sample to last as the number of samples increased. However, the number of samples did not show significant correlation with pain evaluated after the procedure was complete. Time during the biopsy and the anxiety score had a significant correlation with the pain scale score for the completed procedure. Short duration of TR-biopsy and a low anxiety score predicted a reply of "Yes" to the question. Conclusion A long operative time during the TR-PBx procedure and strong pre-procedure anxiety can increase pain for patients undergoing the procedure without anesthesia and cause patients to be unwilling to undergo TR-PBx again without anesthesia.
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Affiliation(s)
- Yasushi Nakai
- Department of Urology, Nara Medical University, Nara, Japan
| | | | | | - Satoshi Anai
- Department of Urology, Nara Medical University, Nara, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Nara, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, Nara, Japan
| | - Tomomi Fujii
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Chiho Ohbayashi
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
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Diniz ALL. Editorial Comment: Comparison of pain levels in fusion prostate biopsy and standard TRUS-Guided biopsy. Int Braz J Urol 2020; 46:563-565. [PMID: 32374122 PMCID: PMC7239299 DOI: 10.1590/s1677-5538.ibju.2019.0154.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Andre Luiz Lima Diniz
- Instituto Nacional do Cancer - INCA, Rio de Janeiro, RJ, Brasil.,Hospital Federal da Lagoa, Rio de Janeiro, RJ, Brasil
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