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Abstract
OBJECTIVES To review the notification rate and characteristics of tertiary and neurosyphilis cases in Alberta, Canada in the postantibiotic era. METHODS A retrospective review of all neurosyphilis and tertiary syphilis cases reported in Alberta from 1973 to March 2017 was undertaken and cases classified into early neurosyphilis, late neurosyphilis and cardiovascular (CV) syphilis. Variables collected included demographics, sexual partners, HIV status, clinical parameters, symptoms and treatment and distributions were compared between early versus late neurosyphilis and asymptomatic versus symptomatic cases (stratified by early versus late stage). Data were analysed using IBM SPSS Statistics V.19.0. RESULTS 254 cases were identified; 251 were neurosyphilis and 3 were CV. No cases of gummatous syphilis were reported. Early neurosyphilis accounted for 52.4% (n=133) and 46.1% (n=117) were late neurosyphilis cases; one (0.4%) case with unknown duration. Three outbreaks of infectious syphilis were identified during the study period and a concurrent rise in both early and late neurosyphilis was observed during the outbreak periods. The most common manifestation of symptomatic neurosyphilis was ocular involvement which was more likely in early neurosyphilis. Relative to late neurosyphilis cases, early neurosyphilis cases were more likely to be younger, Caucasian, born in Canada, HIV positive and reporting same sex partners. CONCLUSIONS Our review of tertiary and neurosyphilis cases found that early and late neurosyphilis cases continue to occur in the context of cycling syphilis outbreaks. CV syphilis cases were extremely rare. Ongoing identification of new cases of syphilis and clinical evaluation of cases for complications continues to be important in the context of global resurgence of syphilis.
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Affiliation(s)
- Takaaki Landry
- Immunology and Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
| | - Petra Smyczek
- Department of Medicine/Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
| | - Ryan Cooper
- Department of Medicine/Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Ron Read
- Alberta Health Services, Calgary, Alberta, Canada
| | - Barbara Romanowski
- Department of Medicine/Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
| | - Ameeta E Singh
- Department of Medicine/Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
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Carrada-Bravo T. [Cardiovascular syphilis: diagnosis, treatment]. Arch Cardiol Mex 2006; 76 Suppl 4:S189-96. [PMID: 17469346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
Cardiovascular tertiary syphilis may lead to aortitis, aortic aneurism, coronary stenosis, aortic insufficiency and, rarely, to myocarditis. The physician must be familiar with the clinical presentations of this process, including the asymptomatic variety and must be able to have an organized plan for the diagnosis and evaluation to establish or exclude the presence of cardiovascular pathology and the differential diagnosis with other entities. Once the etiologic and topographic diagnosis is established, the patient should be treated with penicillin, doxicycline and other antibiotics, and the consequences of the disorder, both actual and potential, should be considered before deciding weather to recommend surgical intervention. Although late syphilis can be prevented by appropriate therapy of early syphilis, this is a cardiovascular disease that most likely will continue to be diagnosed lately. Understanding of the pathology and pathophysiology of the disease, is most important for its prompt recognition and subsequent management. This paper reviews the natural history, diagnosis and therapy of cardiovascular syphilis.
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MESH Headings
- Administration, Oral
- Adult
- Age Factors
- Anti-Bacterial Agents/administration & dosage
- Anti-Bacterial Agents/therapeutic use
- Diagnosis, Differential
- Doxycycline/administration & dosage
- Doxycycline/therapeutic use
- Female
- Humans
- Injections, Intramuscular
- Magnetic Resonance Imaging
- Male
- Myocardium/pathology
- Penicillin G Benzathine/administration & dosage
- Penicillin G Benzathine/therapeutic use
- Phonocardiography
- Prevalence
- Radiography, Thoracic
- Sex Factors
- Syphilis Serodiagnosis
- Syphilis, Cardiovascular/diagnosis
- Syphilis, Cardiovascular/diagnostic imaging
- Syphilis, Cardiovascular/drug therapy
- Syphilis, Cardiovascular/epidemiology
- Syphilis, Cardiovascular/pathology
- Syphilis, Cardiovascular/surgery
- Time Factors
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Affiliation(s)
- Teodoro Carrada-Bravo
- Infectólogo, Jefe Regional de Educación Médica e Investigación, Hospital General de Zona y Medicina Familiar 2, Instituto Mexicano del Seguro Social, Irapuato, Guanajuato, Mexico.
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Maharajan M, Kumaar GS. Cardiovascular syphilis in HIV infection: a case-control study at the Institute of Sexually Transmitted Diseases, Chennai, India. Sex Transm Infect 2005; 81:361. [PMID: 16061553 PMCID: PMC1745015 DOI: 10.1136/sti.2004.013599] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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5
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Dwivedi S, D'Souza C. Surgical treatment of ascending aortic pathology. J Card Surg 1989; 4:190. [PMID: 2519999 DOI: 10.1111/j.1540-8191.1989.tb00279.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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6
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Abstract
A steady decline in the incidence of positive results to the Kahn test is reported in Malawian patients during the period 1968-75. Other studies have shown that the incidence of early and late syphilis in sub-Saharan Africa has dropped considerably over the past few decades. The number of reported cases of early syphilis in certain urban areas, however, appears to be high. It is suggested that the downward trend in the incidence of syphilis in Africa is related to the increased and often indiscriminate use of penicillin.
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Kudejko J, Krzewicka L. [Cardiovascular syphilis in the Lublin province in the years 1953-1973]. Przegl Dermatol 1978; 65:287-91. [PMID: 704942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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8
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Abstract
Sera from various groups were tested for syphilis by cardiolipin, fluorescent treponemal antibody-absorbed (FTA-ABS), and treponemal haemagglutination (TPHA) tests. The proportion of positive results, 12.7%, obtained from an unselected urban population suggested that the prevalence of the disease had declined since 1953. The probable explanation is the widespread use of penicillin. Late manifestations of syphilis are much rarer in Ethiopia than would be predicted from the high incidence at the infectious stage and, if present, they affect the cardiovascular system. These findings confirm old observations. Llymphocytes from Ethiopians with early syphilis did not proliferate when cultured with Treponema pallidum in vitro, in contrast with cells from patients with cardiovascular syphilis. These findings differed from observations made previously on patients in England with early syphilis.
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Rubisz-Brzezińska J, Zarebska D, Rechowicz E, Wereta-Kubek M, Rasiewicz D. [Late syphilis in the records of the Department of Dermatology of the Silesian Academy of Medicine, 1965-1975]. Przegl Dermatol 1977; 64:173-8. [PMID: 854592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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10
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Towpik J, Ziebowicz W, Zieliński H, Kamiński A. [Syphilis of the central nervous and cardiovascular systems in Poland in the light of epidemiological data of the Institute of Venerology in Warsaw]. Neurol Neurochir Pol 1977; 11:25-30. [PMID: 840360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The authors describe the epidemiological situation with regard to late syphilis in the period of 25 years with particular reference to the last decade (1965--1974). The activities of consultation services for late syphilis and their role in prevention of late organ involvement are discussed.
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Burda A, Wojtowicz M, Raszeja-Kotelba B, Janicka D, Neumann E, Borczyńska M, Stepień B, Machońko T. [Analysis of cases of late syphilis in Poznań and the Poznań Province in the years 1965-1974 as a function of previous treatment]. Przegl Dermatol 1976; 63:609-14. [PMID: 1005751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Shibata H, Matsuzaki T, Shichida K, Hiraoka K, Sugiura M. Syphilis and its cardiovascular complications in the elderly. Jpn Heart J 1976; 17:452-8. [PMID: 966381 DOI: 10.1536/ihj.17.452] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The prevalence of syphilis and its cardiovascular complications were investigated in the living population more than 60 years of age. The prevalence of positive serologic test for syphilis (STS) were 16.9% (124/736) in males and 17.1% (236/1380) in females, which were not statistically different. Aortic regurgitation (AR) was significantly more frequent in those with positive STS (9.68% in males, 5.08% in females) compared with negative STS (0.98% in males, 1.75% in females) in both sexes (p less than 0.01) and it was marked in males. AR with positive STS had a significantly lower minimal blood pressure than AR with negative STS (p less than 0.05). Calcifications in the ascending aorta were noticed in 5 out of 24 syphilitic AR. Myocardial infarctions were almost equally found among those with positive STS (1.67%) and negative STS (1.65%), and 2 out of 6 syphilitic cases were complicated by AR. The measurement of the aortic width was not valuable for the diagnosis of uncomplicated syphilitic aortitis.
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13
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De Cesare BL, Simini P. [Social importance of cardiovascular diseases]. Minerva Med 1975; 66:4499-501. [PMID: 1196539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The continual increase in such cardiovascular diseases as rheumatic and sclerotic cardiopathy and cardiovascular syphilis over the last 30 yr is noted. The social and economic effects of these diseases is stressed and the hope is expressed that more active and effective measures will be taken by the State, especially with respect to worthwhile and radical prophylaxis.
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Brown KG, Willis WH. Cardiac disease in Malawi. S Afr Med J 1975; 49:926-30. [PMID: 1135727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
A prospective clinical study of 114 Malawian patients with cardiac disease seen at Queen Elizabeth Central Hospital, Blantyre, is presented. Rheumatic and hypertensive heart disease, cardiorenal failure and severe anaemia were the most common causes. Pericardial disease, mainly due to tuberculosis, was an important treatable cause of cardiac disease. Endomyocardial fibrosis was not diagnosed with certainty and cardiomyopathy was relatively uncommon. Ischaemic heart disease was not seen.
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Rini GB, Di Fede G. [On the diverse etiological incidence of peripheral obliterating arteriopathy. Studies in western Sicily]. Minerva Med 1974; 65:4524-33. [PMID: 4548173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Somers K. Cardiology in Papua New Guinea. P N G Med J 1974; 17:235-41. [PMID: 4534151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Reddy DB, Raju GC, Parvathi G, Suvarnakumari G. Syphilitic heart disease. An autopsy study of 13 cases. Indian Heart J 1974; 26:61-4. [PMID: 4421226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Bukharovich MN, Samokhin AI. [Visceral syphilis mortality based on 15 years of autopsy material (1951-1965)]. Vestn Dermatol Venerol 1973; 47:54-6. [PMID: 4709898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Weremowicz J. [Cardiovascular syphilis and nervous system syphilis]. Pol Arch Med Wewn 1972; 49:455-62. [PMID: 4643101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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21
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Banaszkiewicz H. [Clinical and social aspects of late syphilis]. Przegl Dermatol 1972; 59:537-40. [PMID: 5070468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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22
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el-Hassan AM, Wasfi A. Cardiovascular disease in Khartoum. Post-mortem and clinical evidence. Trop Geogr Med 1972; 24:118-23. [PMID: 5037682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Quenum C, Abondo A. [Vascular aneurysms in the Africans: anatomical documentation]. Afr J Med Sci 1972; 3:41-4. [PMID: 5061269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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25
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Towpik J, Nowakowska E. Changing patterns of late syphilis. Br J Vener Dis 1970; 46:132-4. [PMID: 5428705 PMCID: PMC1048046 DOI: 10.1136/sti.46.2.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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26
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Vukotich D, Giel R. Cardiovascular and neurological findings in Ethiopians with syphilitic heart disease. Trop Geogr Med 1970; 22:45-52. [PMID: 5435936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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27
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Venereal diseases. Extract from the Annual Report of the Chief Medical Officer of the Department of Health and Social Security for the year 1968. Br J Vener Dis 1970; 46:76-83. [PMID: 5467201 DOI: 10.1136/sti.46.1.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Aravanis C. The use of acetyldigoxin in the aged with congestive heart failure. Geriatrics (Basel) 1969; 24:75-81. [PMID: 5811749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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30
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Venereal diseases in England and Wales. Extract from the annual report of the Chief Medical Officer for the year 1967. Br J Vener Dis 1969; 45:67-75. [PMID: 5818528 DOI: 10.1136/sti.45.1.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Restrepo C, Tejeda C, Correa P. Nonsyphilitic aortitis. Arch Pathol 1969; 87:1-12. [PMID: 5782433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Barondess JA, Sande M. Some changing aspects of aortic regurgitation: an autopsy stud. Trans Am Clin Climatol Assoc 1969; 80:23-36. [PMID: 5808210 PMCID: PMC2440996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Graur I, Ciubotaru C, Vasilescu A. [Considerations on the evolution of cardio-aortic and nervous syphilis in the city of Bîrlad in the past 15 years (1953-1967)]. Rev Med Chir Soc Med Nat Iasi 1969; 73:127-31. [PMID: 5799855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Friedman B. Syphilitic aortic insufficiency. Some observations on a vanishing disorder. Ala J Med Sci 1969; 6:8-17. [PMID: 4975137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Reddy DB, Ranganayakamma I. Syphilitic aortitis. Indian Heart J 1967; 19:86-95. [PMID: 6079826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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36
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Zlatkina AR. [Visceral syphilis based on the data of the Moscow District Scientific-Research Institute]. Vestn Dermatol Venerol 1966; 40:27-31. [PMID: 4233574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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37
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Venereal diseases in England and Wales. Extract from the annual report of the chief medical officer for the year 1964. Br J Vener Dis 1966; 42:50-7. [PMID: 5952272 DOI: 10.1136/sti.42.1.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Enachescu M, Gartner A, Marinov M. Latent cardiac failure in the aged. Gerontol Clin (Basel) 1966; 8:134-142. [PMID: 5928987 DOI: 10.1159/000244944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Huriez C, Agache P. [Current status of visceral tertiarism, especially with reference to 642 cases observed in Lille from 1945 to 1964]. Maroc Med 1965; 44:743-63. [PMID: 5855338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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DE BARROS JM, AVILA MB. [The problem of cardiovascular syphilis in industry in São Paulo]. Rev Paul Med 1953; 43:56-9. [PMID: 13112763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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GARCIA CARRILLO E. [Studies on the incidence of syphilitic aortitis in Costa Rica]. Rev Med Costa Rica 1952; 11:107-8. [PMID: 13027820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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