Development and evaluation of polydioxanone-based microspheres as temporary embolization material for transarterial embolization in a rabbit kidney model
The objective/aim of the present animal study was to investigate the in-vivo behavior of novel temporary embolization microspheres made of polydioxanone. It is a hypothesis-generating primary study in which the basic properties (feasibility, safety, efficacy, resorbability and biocompatibility) of the newly developed material were examined in a renal embolization model in 16 clinically healthy New Zealand White.
For this purpose, newly size-calibrated (100-150 μm and 90-315 μm) and biodegradable microspheres made of polydioxanone were developed. The selective unilateral embolization of the kidney poles was performed randomized and under fluoroscopic control. The effectiveness of the embolization was confirmed by means of digital subtraction angiography (DSA) and magnetic resonance imaging (MRI).
Three animals (group 0) were euthanized immediately after embolization in order to assess the acute behavior of the particles. The remaining 13 animals were subjected to control imaging (DSA and MRT) after 1, 4, 8, 12 or 16 weeks to assess resorbability and reperfusion. This was followed by euthanasia and laboratory processing of the target organs for the histopathological examination of the resorbability and biocompatibility of the microspheres.
Renal embolization with polydioxanone microspheres was safe to perform in all rabbits. The injection through conventional catheter systems was moderately easy. The embolization resulted in an effective vascular occlusion, which was confirmed by DSA and MRI as well as in histopathology. The DSA and MRT controls after 1, 4, 8, 12, or 16 weeks showed partial to complete reperfusion as an indication of resorbability of the microspheres. The histopathological examination confirmed the resorbability through a microscopically visible and progressive particle degradation over time. The degradation of the microspheres was accompanied by a mild to moderate inflammatory / foreign body reaction with no evidence of tissue intolerance.
In conclusion the novel temporary embolization microspheres made of polydioxanone are characterized by good applicability and safety in the rabbit kidney embolization model, as well as reliable efficacy, resorbability and biocompatibility. In order to enable clinical application, biochemical modifications to the particles with the aim of accelerated degradation behavior and improved injectability are necessary.
Aktualisiert: 2022-05-05
> findR *
The application of preventive negative pressure wound therapy on midline laparotomy incisions in horses
Human studies identified vacuum therapy (VAC therapy) on both - wounds and surgical incisions as a beneficial factor for wound healing and the reduction of wound healing disorders. Veterinary publications on VAC therapy mainly focus on wound treatment but not of preventive use. The aim of this study was to evaluate the preventive use of negative pressure wound therapy (NPWT) on surgical incisions in horses. In addition, factors effecting the short and long-term outcome of wound healing of the midline incisions as well as the return to athletic function after convalescence were evaluated.
In total, the data from 201 horses were included in the study. The incisions of 57 horses were treated using sterile vacuum wound coverings (Prevena ™ Peel & Place ™ Dressing, Prevena ™ Customizable ™, Incision Management System, KCI Medizinprodutkte GmbH, Wiesbaden). The control group consisted of 144 incisions treated with standard wound coverings (dry, nonadhesive wound dressing). Factors such as breed, gender, age, weight, vital and laboratory parameters, intraoperative diagnosis, number of laparotomies performed, as well as the surgery and anesthesia time and wound healing disorders were associated to outcome. Outcome parameters such as wound infection after the hospitalization, abdominal hernia, colic after convalescence, postoperative use and level of performance were collected from owners via standardized telephone questionnaire.
Results indicated that preventive application of vacuum therapy to laparotomy incisions was not different to the control group. Significant correlations were found between wound infection and heart rate on arrival in the clinic, internal body temperature on the 5th and 10th day after the laparotomy, white blood cell count on the 5th day after surgery, diagnosis and duration of surgery and general anesthesia. Horses with small intestinal disease in combination with colonic enterotomy and horses that required repeated laparotomy developed significantly more often an abdominal hernia compared to the rest of this population.
Preventive NPWT cannot be recommended for the reduction of wound healing disorders after midline laparotomy in horses.
Aktualisiert: 2021-09-30
> findR *
Retrospective analysis of diaphyseal and distal metaphyseal radius/ulna fractures in dogs after plate osteosynthesis and osteosynthesis with external fixator
The aim of the retrospective study was to analyse the treatment of diaphyseal and distal metaphyseal antebrachial fractures with angle-stable and non-angle-stable methods of osteosynthesis, their healing and possible complications, taking into account patient- and fracture-dependent influencing factors.
A total of 91 diaphyseal or distal metaphyseal radius/ulna fractures (88 dogs, 3 of them with bilateral fractures) were evaluated. The fractures were stabilized with plate osteosynthesis or external fixator in the Small Animal Clinic of the Free University of Berlin in the years 2009-2015.
The 88 dogs belonged to 39 different breeds or hybrids of these breeds. The age of the dogs varied between 2 and 186 months and corresponded to an average age of 3.17 years. 52.3% of the dogs were female and 47.7% male. Light-weight breeds (< 5 kg; toy breeds) were represented with 31.8%, low- (5-15 kg) with 23.9%, medium- (> 15-30 kg) with 26.1% and heavy-weight (> 30 kg) with 18.2%.
Fractures were caused by road traffic accidents (42.9%), falls from low heights (24.2%), minor trauma (getting stuck, trapped or playing, kicking; 9.9% each), dog bite (5.5%) or wild boar injuries (2.2%). In 5.5% of the dogs the cause was unknown.
In 96.7% of cases both radius and ulna were fractured, in 3.3% only the radius was fractured. A total of 74.7% of the fractures affected the diaphysis and 25.3% affected the distal metaphysis. The distal metaphysis was fractured more frequently (46.7%) in the lightweight dogs (< 5 kg) than in the heavier dogs (6.3-18.2%).
Overall, transverse fractures (79.1%) were the most common fracture type, followed by comminuted (12.1%) and oblique fractures (8.8%). Even when considering the localization separately, transverse fractures accounted for the largest share in each case (diaphysis: 77.9%; distal metaphysis: 82.6%). 14.3% of fractures were open.
The fractures were treated after an average of 1.07 days. The average duration of surgery was 67.7 minutes. 46.2% of the operations were performed by highly experienced surgeons and 53.8% by less experienced surgeons.
83.5% of the fractures were stabilized angle-stable (73.6% NCP; 9.9% external fixator) and 16.5% non-angle-stable (DCP). Plate osteosynthesis (90.1%) was overall more common than external skeletal fixation (9.9%). The external fixator (17.4%) was used more frequently in the distal metaphyseal region than in the diaphyseal region (7.4%).
78% of the fractures were radiographed at least once at the clinic after the day of surgery. Fracture healing was confirmed radiographically for 52 fractures, at an average time of 15.58 ± 7.9 weeks post-operatively. Patient- (age, gender, body weight) and fracture-dependent (fracture localization, type, open vs. closed) factors did not significantly influence healing time. Fractures treated with external fixator tended to heal faster (11.33 ± 7.89 weeks) than after plate osteosynthesis (16.13 ± 7.87 weeks), but this difference was not significant.
No significant differences in healing time were observed between fractures treated with nonangle-stable (DCP) and angle-stable plate osteosynthesis (NCP). This also applied to the comparison of non-angle-stable osteosynthesis (DCP) with angle-stable osteosynthesis (NCP and external fixator).
The implants were removed from 54 fractures at the clinic. The calculated times until implant removal were significantly shorter for the external fixator cases (10.88 ± 5.08 weeks; p =0.036) than for plate osteosynthesis cases (16.69 ± 8.58 weeks). The detailed analyses did not reveal any significant differences in time until implant removal for non-angle-stable vs. angle-stable plate osteosynthesis and non-angle-stable vs. angle-stable osteosynthesis.
The healing process was checked in 84 dogs (95.5%) with 84 fractures (92.3%) in the clinic. In 33 (39.3%) fractures (= patients), healing was accompanied by complications (some of them with multiple complications; 57 complications). The most common complications were osteomyelitis and bone resorption (13.1% each; n = 11), followed by fracture healing disorders (malunion, nonunion, delayed union; 10.7%; n = 9), implant failure (8.3%; n = 7), ankylosis of the carpal joint (2.4%; n = 2) and transient radial paralysis (1.2%; n = 1).
In cases with osteomyelitis, antibiotic treatment was administered (n = 11), loose implants were removed (n = 2), autologous cancellous bone graft was packed into the fracture site and/or the construct was modified (n = 1). To treat bone resorption and non- or delayed union, the fractures were dynamized (n = 6), the construct was modified (n =1) and/or a cast bandage was applied after implant removal (n = 2). Wound infections were treated with antibiotics. In cases with implant failure, the construct was modified (n = 3), loose implants were removed (n = 2) or refixed (n = 1). For refractures after implant removal a new osteosynthesis procedure (n = 6) was performed. Ankylosis of the carpal joint and radial nerve paralysis were treated with physiotherapy. Malunions (all minor axial deviations) were not treated with corrective osteotomy and synostoses were not resected, as they did not cause any functional impairment.
No significant correlations were found between patient-dependent factors (breed, age, gender, body weight) and the general risk of complications. However, the weight of the patients had a significant effect on the risk of developing osteomyelitis (p = < 0.001).
Fracture-dependent (fracture localization, fracture type, open vs. closed) and treatmentdependent factors (time interval between trauma and osteosynthesis, duration of surgery, level of experience of the surgeon) were not significantly correlated with the complication rate.
Likewise no significant differences in the risk of complication could be found in the analysis of the osteosynthesis procedures (plate vs. external fixator; DCP vs. NCP; DCP vs. NCP / external fixator) This also applied to dogs < 5 kg with distal metaphyseal fractures, which have previously been described in the literature as being particularly prone to complications. The functional outcome was evaluated for 88.6% of the dogs with 85.7% of the fractures. Limb function was evaluated as good (93.6%), satisfactory (5.1%) or unsatisfactory (1.3%) based on the degree of lameness (no lameness, low-, medium-, high-grade lameness).
A good functional result was achieved in 92.8% of the plate osteosyntheses and in 100% of the external fixator osteosyntheses.
In conclusion, angle-stable (NCP / fixator external) and non-angle-stable (DCP) osteosyntheses are ideally suited for the treatment of diaphyseal and distal metaphyseal radius/ulna fractures. However, decision making with regards to the most appropriate repair must be made individually on the basis of already available recommendations in the literature and the results of the present study, taking into account as many influencing factors as possible (patient, fracture, surgeon, owner compliance, costs), and any complications must be detected and treated early on if possible.
Aktualisiert: 2021-06-17
> findR *
Evaluation of heart rate variability measurement as perioperative pain control in castration model in pigs
Measurement of heart rate variability (HRV) is a non-invasive technique visualizing the functionality of the autonomic nervous system at the heart (von Borell 2007). HRV analysis is used besides various clinical applications of human and veterinary medicine in anesthesiology and pain research in pigs. For instance, the sympathovagal balance describing parameter LF/HF changes in pigs after tail biting (Zupan et al. 2012). Frequency-related parameters in pigs are equally affected by surgical manipulations during general anesthesia (Martin-Cancho et al. 2006).
HRV measurement in pigs has so far been conducted using invasive measurement methods in addition to non-invasive telemetric measurement methods in order to also perform measurements on non-restrained pigs. Telemetric measurements in pigs are achievable on the one hand by the means of telemetric ECG devices (Suzuki et al. 1998, Kuwahara et al. 1999, Kuwahara et al. 2004, Olmstead et al. 2005) or by telemetric chest strap systems primarily designed for humans (Marchant-Forde and Marchant-Forde 2004, Marchant-Forde et al. 2004, Düpjan et al. 2011, Zupan et al. 2012, Mahnhardt et al. 2014, Leliveld et al. 2016). The chest strap BioHarnessTM 3 utilized in this study (Zephyr Technology, Medtronic, Annapolis, USA; below called: BioHarness chest strap) has not yet been used on pigs before.
The aims of this study were to evaluate the BioHarness chest strap’s measurement accuracy with an established telemetric ECG device (Televet® 100, Engel Engineering GmbH, Heusenstamm, Germany; below called: Televet 100) and after assessing the suitability of the BioHarness chest strap, to determine whether HRV-analysis allows for a valid analgesia monitoring in the castration model. For this purpose, HRV parameters at the time of intraoperative pain reactions (based on a pain scoring) were compared with pre- and postoperative base values.
To evaluate the BioHarness chest strap in the pilot study, simultaneous measurements were carried out on five male rearing pigs (German Landrace/German Large White x Piétrain/Duroc; 28 – 58 kg) with the BioHarness chest strap and Televet 100.
For the HRV-analysis with the BioHarness chest strap in the main study, 30 male rearing pigs (genetics see above; 36 – 48 kg) were castrated for imminent fattening and slaughtering. One day before castration, the pigs in waking state were kept in temporary separate housing and recorded by BioHarness chest strap in their lying resting position. Castration at Regio Pubis was conducted under ketamine-azaperone general anesthesia customary in practice.
Each intraoperative step (measurements in parts of 3 minutes) was assessed with a pain scoring, where score 0 describes no defense reaction (surgical tolerance) and score 1 or higher the presence and intensity of defense reactions. 24 hours after surgery, HRV was recorded like one day before surgery and a clinical examination of pain symptoms was performed.
The evaluation of BioHarness chest strap resulted in a comparable measuring accuracy to the Televet 100 ECG-device. Results of the HRV analysis with the BioHarness chest strap related to intraoperative steps or manipulations compared to the base value before castration in main study were an increase of meanRR parameter and decrease of SDNN and RMSSD parameters. There was an increase of parameter LF (n.u.) and LF/HF that reflects sympathetic activity at the time of skin incision, incision of vaginal process and traction of spermatic cord. The mainly by vagal activity affected parameter HF (n.u.) decreased at the time of skin incision and incision of vaginal process. Pertaining to the pain scoring, there was a significant rise of LF (n.u.) when Score 1 to 3 occurred compared to surgical tolerance (Score 0). The parameters HF (n.u.) and LF/HF narrowly missed out the significance level (p < 0,05). Only two pigs had postoperative potentially pain-related symptoms (fever or wound irritation), so it is not possible to make a conclusive statement. In general, pigs tolerated the chest strap very well, species-specific habits of eating, resting and activity were not influenced by it.
In this study, it is recognizable that pain specific defense reactions correlate positively with LF, which is also described in the literature with intraoperative pain stimuli and other painful conditions in pigs (see above). Both somatic (skin incision) and visceral pain components (incision of vaginal process and traction of spermatic cord) influence LF (n.u.), HF (n.u.) and LF/HF parameters. For an effective and predictive management of analgesia, further studies should be conducted with a greater number of animals or number of data records establishing a threshold value for LF (n.u.) or possibly other parameters which allows for detecting pain due to decreasing anesthesia before the onset of defense reactions. Prospectively, the BioHarness chest strap could also be used to examine animal welfare impairments in other clinicals contexts or zootechnical interventions in pigs.
Aktualisiert: 2021-04-16
> findR *
Die Behandlung segmentaler Knochendefekte kritischer Größe, die durch Traumata, Tumorresektion oder Infektionen hervorgerufen werden, sowie die mechanobiologische Wiederherstellung der Gliedmaße, stellen nach wie vor eine Herausforderung in der Unfallchirurgie dar. Aufgrund dessen werden alternative Behandlungsmethoden von kritischen Knochendefekten zunehmend erforscht. Mit Hilfe der Laser-Sinterungstechnik hergestellte dreidimensionale Titan Mesh Scaffolds stellen eine vorteilhafte Alternativmethode zu den bekannten ,,Gold Standards“ dar und ließen beim klinischen Einsatz am humanen Patienten vielversprechende Rückschlüsse zu. In der vorliegenden Studie wurden mittels der Laser-Sinterungstechnik zwei Titan Mesh Scaffolds hergestellt, die strukturell gleich waren, sich jedoch in ihren Steifigkeiten voneinander unterschieden. Die Titan Mesh Scaffolds besaßen eine Honigwabenform und bildeten ein makro-poröses Netzwerk mit einer zentralen Pore. Durch die Veränderung des Strebendurchmessers der Titan Strut Elemente, entstanden zwei Titan Mesh Scaffolds mit unterschiedlichen Steifigkeiten. In der vorliegenden Studie erfolgte die Durchführung der 40 mm großen Osteotomie an der Tibia von zwölf Merino-Mix-Schafen. Es wurden zwei Gruppen mit jeweils sechs Tieren gebildet. In der einen Gruppe wurde der weiche Titan Mesh Scaffold mit einem Strebendiameter von 1.2 mm mit 0,84 GPA eingesetzt und bei der anderen Gruppe der 3,5-fach steife Titan Mesh Scaffold mit einem Strebendiameter von 1.6 mm mit 2,88 GPa eingesetzt. Die mit autologer Spongiosa befüllten Titan Mesh Scaffolds wurden in Kombination mit einem experimentellen winkelstabilen Plattensystem (AO-Platte), welches ausschließlich eine axiale Belastung der Gliedmaße zuließ, in den kritischen Osteotomiedefekt von 40 mm Größe in die Schafstibia eingesetzt. Während der Versuchszeit von 24 Wochen wurden monatliche Röntgenkontrollen durchgeführt. In der 24. Woche wurden ex vivo zusätzlich zu den konventionellen Röntgenaufnahmen, Aufnahmen im Faxitron angefertigt. Histologische und histomorphometrische Untersuchungsergebnisse wurden erfasst und evaluiert.
Der Einsatz des weichen und des 3,5-fach steiferen Titan Mesh Scaffolds in Kombination mit der experimentellen winkelstabilen AO-Platte erwies sich als eine adäquate Stabilisierungsmethode für einen kritischen Defekt von 40 mm Größe im Schafmodel. Die Hypothese, dass eine mechanisch-biologische Optimierung des Titan Mesh Scaffolds zu einer Förderung der endogenen Knochendefektregeneration führt, konnte histomorphologisch vermutet werden, da der Einsatz des weicheren Titan Mesh Scaffolds deskriptiv zu einer vermehrten Kallusbildung im Vergleich zu dem steiferen Titan Mesh Scaffold, zu beobachten war. Das Ergebnis konnte histomorphometrisch nicht bestätigt werden, da im Vergleich der beiden Gruppen kein statitisch signifikanter Unterschied vorlag.
Die AO-Platte wurde speziell für das Schaf entwickelt, stabilisierte den Fakturspalt ohne den Einsatz weiterer Stabilisierungsverfahren und gewährleistete zusätzlich eine artgerechte Haltung der Schafe. Die Titan Mesh Scaffolds füllten den Defekt gut aus und erwiesen sich als stabil, sie verhinderten einen Muskel- und Weichteilprolaps in den Defekt und dienten darüberhinaus als Leitstruktur für das wachsende Gewebe. Da nach 24 Wochen keine komplette Überbrückung des Defektspaltes zu beobachten war, lag eine verzögerte Heilung vor. Die mechanische Belastung im Frakturspalt wurde durch die Titan Mesh Scaffolds in Kombination mit der AO-Platte minimiert, sodass die Kallusformatinon gering war. Dennoch zeigte die Gewebezusammensetzung eine noch aktive Knochenheilung. Die in dieser Studie gewonnenen Erkenntnisse können genutzt werden, um die Kombination des Titan Mesh Scaffolds mit einer anderen Platte, die mehr mechanische Bewegung im Frakturspalt ermöglicht und demnach zu einer vermehrten Kallusbildung führen könnte, zu untersuchen.
Aktualisiert: 2019-12-31
> findR *
Wound healing and cosmetic aspects after enucleation of the bulb considering various surgical procedures in dogs and cats
The enucleation of the eyeball is a common practice in veterinary medicine and can be done not only by ophthalmologic specialized facilities, but also by general veterinary practices. The removal of the most painful and/or blind eye is curative for the affected animal. The pet owner's decision for the medically necessary operation is often associated with difficulties in which, above all, the external appearance plays an important role. Over time, various prosthesis and implant replacement materials have been developed to improve cosmetics, yet associated with complications and disadvantages for the animal. According to the current state of knowledge, there is no satisfactory method both from a medical point of view for the animal and the operating ophthalmologically unspecialized veterinarian and from a cosmetic point of view for the pet owner.
The aim of this dissertation was to determine whether a simple variation of the bilayer wound closure can reduce the postoperative sinking of the eyelids over the anophthalmic orbit. The integration of the orbital fascia into the subcutaneous suture and the resulting tissue tightening and void reduction formed the basis of the modification. In the randomized blinded, prospective study, 32 dogs and 14 cats were enrolled in the period from January 2016 to August 2017. In all animals a bulbus extirpation was performed due to different end-stage diseases. The animals were monitored for 24 weeks after the operation and the orbit was measured with an analog measuring scale. The hypothesis that the modified suture technique leads to less postoperative sinking of the eyelids over the orbit and thus to an improved cosmetic image for the pet owner was checked and refuted. Animals that were treated with a classic wound closure show a significantly lower sinking than animals with a modified suture technique (p horizontal=0,023, vertical=0,018). Furthermore, the skull shape, intraoperative measured orbital depth and body weight affect synergistically the sinking level in the dogs. Postoperatively, the wound areas of the modified suture technique were significantly more dolent, resp. palpation was more frequently questionable (p=0,009), in the case of the classic suture technique there were significantly more secretions (p=0,002) and swelling. With exception of a dog with orbital emphysema and increased pruritus during the resorptive phase of the suture in four cats, wound healing in both animals was uncomplicated.
Although the modified suture technique was not suitable for improving orbital sinking, the postoperative prospective owner survey (questionnaire) showed in both groups a high level of cosmetic satisfaction of about 70% and the postulated dissatisfaction following enucleation in the literature could not be confirmed. Furthermore, the prospective (n=46) and retrospective (n=78) survey showed that more than three quarters of the owners could immediately decide for the necessary procedure, almost no one considered a silicone prosthesis instead of enucleation and about 96% of the owners would opt for this form of surgery again. A crucial role in the emotional and serious decision for the pet owner on the medically necessary removal of the eye takes the veterinarian and he ultimately provides for the increased satisfaction of the owners as whole.
In summary, this work proved that classical enucleation fulfills the requirements of animal welfare, general veterinarian and at the same time pet owner and should be the treatment of choice in the case of non-ocular preserving diseases, especially for cats, as well as brachycephalic and smaller dog breeds.
Pre-emptive multimodal peri- and postoperative analgesia management, involving systemic and local techniques, was developed for enucleation of the globe. The local retro- resp. peribulbar anesthesia injection was feasible easy and complication-free. The postoperative pain assessment showed a therapeutic success of over 90% at all time points and provided good analgesia for at least six hours after surgery. Proven effective pain management with the dosages and techniques used is recommended for everyday use in the practice of bulbus extirpation.
Aktualisiert: 2019-12-31
> findR *
MEHR ANZEIGEN
Bücher zum Thema surgical operations
Sie suchen ein Buch über surgical operations? Bei Buch findr finden Sie eine große Auswahl Bücher zum
Thema surgical operations. Entdecken Sie neue Bücher oder Klassiker für Sie selbst oder zum Verschenken. Buch findr
hat zahlreiche Bücher zum Thema surgical operations im Sortiment. Nehmen Sie sich Zeit zum Stöbern und finden Sie das
passende Buch für Ihr Lesevergnügen. Stöbern Sie durch unser Angebot und finden Sie aus unserer großen Auswahl das
Buch, das Ihnen zusagt. Bei Buch findr finden Sie Romane, Ratgeber, wissenschaftliche und populärwissenschaftliche
Bücher uvm. Bestellen Sie Ihr Buch zum Thema surgical operations einfach online und lassen Sie es sich bequem nach
Hause schicken. Wir wünschen Ihnen schöne und entspannte Lesemomente mit Ihrem Buch.
surgical operations - Große Auswahl Bücher bei Buch findr
Bei uns finden Sie Bücher beliebter Autoren, Neuerscheinungen, Bestseller genauso wie alte Schätze. Bücher zum
Thema surgical operations, die Ihre Fantasie anregen und Bücher, die Sie weiterbilden und Ihnen wissenschaftliche
Fakten vermitteln. Ganz nach Ihrem Geschmack ist das passende Buch für Sie dabei. Finden Sie eine große Auswahl
Bücher verschiedenster Genres, Verlage, Autoren bei Buchfindr:
Sie haben viele Möglichkeiten bei Buch findr die passenden Bücher für Ihr Lesevergnügen zu entdecken. Nutzen Sie
unsere Suchfunktionen, um zu stöbern und für Sie interessante Bücher in den unterschiedlichen Genres und Kategorien
zu finden. Unter surgical operations und weitere Themen und Kategorien finden Sie schnell und einfach eine Auflistung
thematisch passender Bücher. Probieren Sie es aus, legen Sie jetzt los! Ihrem Lesevergnügen steht nichts im Wege.
Nutzen Sie die Vorteile Ihre Bücher online zu kaufen und bekommen Sie die bestellten Bücher schnell und bequem
zugestellt. Nehmen Sie sich die Zeit, online die Bücher Ihrer Wahl anzulesen, Buchempfehlungen und Rezensionen zu
studieren, Informationen zu Autoren zu lesen. Viel Spaß beim Lesen wünscht Ihnen das Team von Buchfindr.