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Abstract
Bilateral adrenal hemorrhage and acute adrenal insufficiency were diagnosed after coronary bypass grafting in a 65-year-old man. The symptoms were nonspecific and easily mistaken for other postoperative complications. Diagnosis was based on finding of adrenal hemorrhage on computed tomogram and confirmed biochemically with an adrenal stimulation test. Corticosteroid therapy was curative.
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Levy SS, Sherman RA, Nosher JL. Value of clinical screening for detection of asymptomatic hemodialysis vascular access stenoses. Angiology 1992; 43:421-4. [PMID: 1567066 DOI: 10.1177/000331979204300508] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Measurement of recirculation and intradialytic venous line pressures may aid in the detection of hemodialysis vascular access stenoses. The authors screened 29 consecutive asymptomatic patients for recirculation values exceeding 15% or venous pressures greater than 150 mmHg. All 13 patients requiring and agreeing to angiography on the basis of the screening protocol proved to have high-grade stenoses of their vascular access outflow or inflow. Asymptomatic vascular access pathology is common. High-risk asymptomatic populations may be detected by simple screening procedures.
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Amorosa JK, Miller RW, Laraya-Cuasay L, Gaur S, Marone R, Frenkel L, Nosher JL. Bronchiectasis in children with lymphocytic interstitial pneumonia and acquired immune deficiency syndrome. Plain film and CT observations. Pediatr Radiol 1992; 22:603-6; discussion 606-7. [PMID: 1491942 DOI: 10.1007/bf02015366] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In a review of 77 HIV positive children seen between 1981 and 1990, 32 were diagnosed as having lymphocytic interstitial pneumonitis). Four of the LIP group developed bronchiectasis, a finding not previously reported. The precise factors leading to the bronchiectasis are unclear. All patients had chronically consolidated lung with volume loss. A history of recurrent bacterial superinfection was not noted in any of the cases. With more cases of HIV positive children living longer, bronchiectasis, long known to occur in primary immunologic disorders, will probably be more frequently noted.
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Brolin RE, Flancbaum L, Ercoli FR, Milgrim LM, Bocage JP, Blum A, Needell GS, Nosher JL. Limitations of percutaneous catheter drainage of abdominal abscesses. SURGERY, GYNECOLOGY & OBSTETRICS 1991; 173:203-10. [PMID: 1925881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
During the past eight years, 119 patients with abdominal abscesses underwent percutaneous catheter drainage (PCD), including 76 who had successful treatment by the initial PCD, 19 who had recurrent abscesses after removal of drainage catheters and 24 who were outright failures and either died of sepsis or required surgical drainage. This study was designed to identify outcome variables that might be used prospectively to assess the therapeutic efficacy of PCD. Outcome variables included abscess size, daily drainage volume and location, presence of a gastrointestinal fistula, age, bacteriologic factors and response of the pulse rate, body temperature and leukocyte count of the patient to PCD. Ninety of 119 patients (76 per cent) ultimately had successful drainage of abscesses by PCD alone. The over-all mortality rate was 16 per cent (19 of 119), with a 75 per cent mortality rate in the failure group. Neither abscess size, bacteriologic findings nor pulse rate correlated with outcome. PCD failure was significantly greater in patients greater than or equal to 60 years (p less than or equal to 0.01) and in patients with pancreatic abscesses versus other locations (p less than or equal to 0.04). Drainage volume was significantly greater in PCD failures than among PCD successes at greater than or equal to 3 days after PCD (p less than or equal to 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)
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Amorosa JK, Schonfeld AR, Nosher JL, Giudici M, Martin EG. Computerized database for counseling medical students seeking a radiology residency program. Invest Radiol 1991; 26:104-6. [PMID: 2022446 DOI: 10.1097/00004424-199101000-00028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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31
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Amorosa JK, Nahass RG, Nosher JL, Gocke DJ. Radiologic distinction of pyogenic pulmonary infection from Pneumocystis carinii pneumonia in AIDS patients. Radiology 1990; 175:721-4. [PMID: 2343120 DOI: 10.1148/radiology.175.3.2343120] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Thirty-four episodes of pyogenic pulmonary infection in 30 patients infected with human immunodeficiency virus (HIV) and 30 episodes of Pneumocystis carinii pneumonia (PCP) in 30 AIDS patients were reviewed to determine if the radiologic features were more helpful than clinical and laboratory findings in the differential diagnosis. The radiologic features of pyogenic pulmonary infection included lobar consolidation, nodules, infiltrates with pleural effusions, round infiltrates, and pleural effusions alone. These features are uncommon in PCP. The chest radiograph may be highly suggestive of a pyogenic process, especially when it shows local consolidation or nodules. Since bacterial pneumonias have a more favorable outcome, it is concluded that the radiologic features should be the primary guide to prompt diagnosis and treatment.
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Nosher JL, Ericksen AS, Trooskin SZ, Needell GS, Harvey RA, Greco RS. Antibiotic bonded nephrostomy catheters for percutaneous nephrostomies. Cardiovasc Intervent Radiol 1990; 13:102-6. [PMID: 2117488 DOI: 10.1007/bf02577362] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A prospective controlled trial of the effectiveness of a cefoxitin-bonded nephrostomy catheter was undertaken to determine the effectiveness of an antibiotic bonded catheter in decreasing the infectious complications of percutaneous nephrostomy. The study concludes that bonding of the antibiotic cefoxitin to percutaneous nephrostomy catheters did not influence the incidence of bacteriuria or urinary tract infection. In addition, observations on the overall incidence of complications from percutaneous nephrostomy are made.
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Spain DA, Trooskin SZ, Flancbaum L, Boyarsky AH, Nosher JL. The adequacy and cost effectiveness of routine resuscitation-area cervical-spine radiographs. Ann Emerg Med 1990; 19:276-8. [PMID: 2106809 DOI: 10.1016/s0196-0644(05)82043-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Portable resuscitation-area cervical-spine radiographs (PCS) frequently constitute a routine part of the emergency evaluation of patients suffering from blunt trauma. Their adequacy and cost were evaluated by reviewing the records of 92 consecutive trauma patients. Forty-seven of 74 patients (63.5%) had adequate PCS in that all seven cervical vertebrae were visualized. In 27 patients (36.5), all seven cervical vertebrae were not adequately visualized. Inadequate studies were most likely to occur in patients with abnormal vital signs on admission (56%) (P less than .01) and in those subsequently requiring general anesthesia (34.5%). Fifteen patients were intubated without difficulty by maintaining neck immobilization because of uncertainty regarding cervical-spine injuries. The annual cost of inadequate cervical-spine studies was estimated to be $31,000.00. Although the four cervical-spine injuries were diagnosed by the portable technique, routine PCS were frequently inadequate in visualizing all seven cervical vertebrae. Major decisions concerning intubation and surgery frequently had to be made before adequate radiographic evaluation could be completed. It is suggested that time and money are lost by routinely doing a single lateral portable cervical radiograph. It is more appropriate to obtain complete radiographic studies after life-threatening injuries are addressed while patients are treated using the standard techniques of neck immobilization.
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Flancbaum L, Nosher JL, Brolin RE. Percutaneous catheter drainage of abdominal abscesses associated with perforated viscus. Am Surg 1990; 56:52-6. [PMID: 2294813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Improvements in radiologic localization have made percutaneous catheter drainage (PCD) the initial procedure of choice for many intra-abdominal abscesses (IAA). During the past seven years 154 patients underwent PCD for treatment of abdominal abscesses. Fourteen of these patients had PCD as the initial treatment for IAA secondary to a perforated viscus and subsequently underwent an elective one-stage operation to treat the underlying disease. Etiologies of the abscesses included perforated appendicitis in six patients, sigmoid diverticulitis in three patients, Crohn's ileitis in two patients, and one case each of perforated gastric ulcer, perforated sigmoid carcinoma, and perforated gallbladder. Initial localization of the abscess was achieved by either CT or ultrasound. Seven abscesses were localized in the right lower quadrant, four were localized in the liver, and one was localized each in the left flank, right flank, subhepatic space, and pelvis. All patients subsequently underwent a definitive elective operation for their primary disease including six interval appendectomies, four sigmoid colectomies, two small-bowel resections, one subtotal gastrectomy and one cholecystectomy. There were no complications due to PCD and no deaths occurred. We conclude that PCD can be successfully performed as the initial treatment for IAA associated with a perforated viscus, obviating the first stage of the traditional two-stage surgical approach.
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Ericksen AS, Krasna MJ, Mast BA, Nosher JL, Brolin RE. Use of gastrointestinal contrast studies in obstruction of the small and large bowel. Dis Colon Rectum 1990; 33:56-64. [PMID: 2295278 DOI: 10.1007/bf02053204] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Gastrointestinal contrast studies were performed in 96 (27 percent) of 342 patients with small-bowel obstruction including 57 upper gastrointestinal and 39 barium-enema examinations. In 34 patients, upper gastrointestinal examination disclosed either obstruction or failure of contrast to reach the cecum in 24 hours; all 34 patients required surgery. The remaining 23 patients who had upper gastrointestinal studies recovered with tube decompression. Barium enema demonstrated obstruction in 13 (33 percent) of 39 cases of suspected small-bowel obstruction and localized obstruction in the colon rather than small bowel in 9 of 13 cases. Barium enema was 100 percent predictive of surgery when obstruction was shown, but was not helpful in predicting surgery when obstruction was not demonstrated. Surgery was required in 42 percent of patients whose barium enema did not show obstruction. Barium enema also was performed in 19 of 23 patients with large-bowel obstruction and showed the level of obstruction in all cases. All patients with large-bowel obstruction required surgery except for three who recovered after barium-enema reduction of intussusception or volvulus. Barium upper gastrointestinal examination is recommended in small-bowel obstruction when plain films are nondiagnostic, and in selected cases of small-bowel obstruction that do not resolve with a short trial of tube decompression. Barium enema is not recommended in suspected small-bowel obstruction but should be performed in all cases of large-bowel obstruction, except when perforation is a possibility or when the cecum measures 10 cm or larger in diameter.
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Nosher JL, Needell GS, Bialy G, Zatina M. Catheter occlusion of a mycotic renal artery aneurysm with cure of associated renovascular hypertension. Cardiovasc Intervent Radiol 1989; 12:310-2. [PMID: 2516771 DOI: 10.1007/bf02575427] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We describe successful transcatheter occlusion of a mycotic renal artery aneurysm. The patient's hypertension resolved following occlusion of the aneurysm and infarction of the renal parenchyma in the distribution of the aneurysmal vessel.
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Ercoli FR, Milgrim LM, Nosher JL, Brolin RE. Percutaneous catheter drainage of abscesses associated with enteric fistulae. Am Surg 1988; 54:45-9. [PMID: 3337483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In the past six years, percutaneous catheter drainage (PCD) has been performed in the treatment of 99 patients with abdominal and retroperitoneal abscesses. Of these 99 patients, 15 had abscesses associated with an enteric fistula. Fistula sites included small bowel (five), colon (three), complex (three), duodenum (two) and one each for the stomach and common duct. Two of these 15 patients had an initially successful PCD, ten developed recurrent abscesses after the first PCD and the procedure failed in the remaining three patients. Of the ten patients with recurrent abscesses, eight were successfully treated by a second PCD while two required small-bowel resection. Of the three failures, all three required operation and eventually died of septic complications. The diagnosis of fistula was made at the initial PCD in only six of 15 cases. There was a significant correlation between PCD failure and presence of an enteric fistula (P less than 0.001 by chi-square test). These data suggest that the diagnosis of fistula associated with abdominal abscess is elusive, but once established, most recurrent abscesses can be successfully treated by a second PCD. Operative treatment of recurrent fistula-related abscesses should be reserved for persistent fistula drainage after a second PCD or for unresolved sepsis following the initial PCD.
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Abstract
Clinical and radiographic characteristics of 12 patients with acute focal bacterial nephritis (AFBN) are presented along with review of the literature. Most patients presented with symptoms of an inflammatory or infectious process. Fever and pyuria were the most frequently encountered clinical characteristics. Imaging modalities that were used to establish a definitive diagnosis of focal bacterial nephritis included ultrasound, computed tomography, and intravenous urography with nephrotomography. Ultrasound was found to be the most effective and least costly method of diagnosis. Misdiagnosis of AFBN as abscess or tumor, which it may stimulate, could lead to inappropriate surgical therapy.
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Weingarten MS, Nosher JL. Combined hepatic and gastric artery aneurysms: a case report and review of the literature. Ann Vasc Surg 1987; 1:598-603. [PMID: 3333010 DOI: 10.1016/s0890-5096(06)61449-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A patient is presented who was successfully managed with metasynchronous rupture of a hepatic and a left gastric artery aneurysm. The subject of visceral artery, hepatic artery, and gastric artery aneurysms is reviewed. The role and limitations of modern interventional radiologic procedures in treating this entity is illustrated.
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Abstract
Transvaginal catheter drainage of pelvic and intraabdominal abscesses with the use of real-time ultrasound guidance is described. The technique was successfully used in two patients to drain abscesses in the cul-de-sac. Transvaginal drainage is a safe, simple alternative to transabdominal, transgluteal, and transrectal drainage of these abscesses.
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Solomon MJ, Leiman S, Rosenfeld DL, Kron MS, Nosher JL. Imaging: urinary tract infections. NEW JERSEY MEDICINE : THE JOURNAL OF THE MEDICAL SOCIETY OF NEW JERSEY 1986; 83:731-4. [PMID: 3299159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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42
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Nosher JL, Trooskin SZ, Amorosa JK. Occlusion of a hepatic arterial aneurysm with gianturco coils in a patient with the Ehlers-Danlos syndrome. Am J Surg 1986; 152:326-8. [PMID: 3752386 DOI: 10.1016/0002-9610(86)90268-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Successful transcatheter occlusion of a proper hepatic arterial aneurysm in a patient with type IV Ehlers-Danlos syndrome is reported. This patient also had multiple, small intrahepatic arterial aneurysms, stenosis, and vascular occlusions. A spontaneous colonic perforation brought this patient to medical attention.
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Nosher JL, Needell GS, Amorosa JK, Krasna IH. Transrectal pelvic abscess drainage with sonographic guidance. AJR Am J Roentgenol 1986; 146:1047-8. [PMID: 3515877 DOI: 10.2214/ajr.146.5.1047] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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44
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Marsh MD, Amorosa JK, Abassi M, Nosher JL, Gross SC, Alcid DV. Salmonella mediastinitis--a rare disease. COMPUTERIZED RADIOLOGY : OFFICIAL JOURNAL OF THE COMPUTERIZED TOMOGRAPHY SOCIETY 1984; 8:375-7. [PMID: 6397327 DOI: 10.1016/0730-4862(84)90085-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A case report is presented of a young man who was seen because of pleuritic chest pain and fever. CT cross sectional imaging defined a mediastinal mass. Diagnosis of acute mediastinitis due to Salmonella java was made from culturing material at mediastonotomy.
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45
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Brolin RE, Nosher JL, Leiman S, Lee WS, Greco RS. Percutaneous catheter versus open surgical drainage in the treatment of abdominal abscesses. Am Surg 1984; 50:102-8. [PMID: 6703514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In the past 3 years, percutaneous catheter drainage (PCD) was performed for 24 abdominal and retroperitoneal abscesses while open surgical drainage (OSD) was used for treatment of 24 similar abscesses at the affiliated hospitals of UMDNJ-Rutgers Medical School. Although the method of treatment was arbitrarily selected by the attending physician, the two groups were similar with respect to abscess location, underlying illnesses, and previous operations. In the PCD group, 17 of 24 abscesses developed after operations versus 16 of 24 in the OSD group. Location of abscesses were: PCD group: abdominal (9), renal (5), pelvic (4), subphrenic (3), hepatic (2), pancreatic (1); OSD group: abdominal (10), renal (4), subphrenic (4), pelvic (3), hepatic (2), pancreatic (1). With PCD, the abscesses were localized by ultrasound or computerized tomography scan; a 20- or 22-gauge needle passed into the cavity, followed by progressively larger guide wires, dilators, and catheters; the pus evacuated; and abscess cavity thoroughly irrigated with sterile saline. Percutaneous catheter drainage was successful in 22 of 24 cases. There were two inconsequential complications. The mean post-PCD hospital stay was 11.7 days. With OSD, five patients developed major complications, including three deaths from sepsis. The mean post-OSD stay for surviving patients was 21.2 days. The advantages of PCD versus OSD are: 1) precise noninvasive localization of abscesses, 2) avoidance of general anesthesia, 3) avoidance of major complications, and 4) shorter postdrainage hospital stay. Open surgical drainage should be reserved for cases where PCD fails to control sepsis, close fistulae, or when noninvasive scanning either fails to demonstrate a discrete abscess in the face of intra-abdominal sepsis or identifies an abscess that cannot be percutaneously drained without traversing the bowel.
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Kemmann E, Brandeis VT, Shelden RM, Nosher JL. The initial experience with the use of a portable infusion pump in the delivery of human menopausal gonadotropins. Fertil Steril 1983; 40:448-53. [PMID: 6413260 DOI: 10.1016/s0015-0282(16)47352-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The initial experience with the use of a portable infusion pump for the delivery of human menopausal gonadotropins (hMG) in the therapy of ovulation dysfunction of women who failed to conceive following (1) either clomiphene citrate (five patients with polycystic ovary syndrome) or danazol (three patients with mild endometriosis) and (2) standard intramuscular hMG-human chorionic gonadotropin therapy is reported. In six of these patients this approach was used because of suboptimal response of serum estradiol levels to standard hMG therapy, and all six patients had an increase in estradiol response with infusion therapy; therapy duration and total dosage of hMG were similar in both treatment modalities. Sonography suggested stimulation of several follicles with infusion therapy. Advantages and disadvantages of the use of the infusion pump for hMG therapy are discussed. In conclusion, hMG therapy via the infusion pump is feasible. This mode of administration appears to lead to more satisfactory follicular development in selected patients. Multiple follicular stimulation is to be expected. Self-administration of medication is readily achieved by the educated patient. Further consideration and exploration of hMG infusion therapy is suggested.
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47
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Plafker J, Nosher JL. Fine needle aspiration of liver with metastatic adenoid cystic carcinoma. Acta Cytol 1983; 27:323-5. [PMID: 6306973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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48
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49
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Amorosa LF, Amorosa JK, Nosher JL, Donnelly B. Radiology of pheochromocytomas. THE JOURNAL OF THE MEDICAL SOCIETY OF NEW JERSEY 1982; 79:114-7. [PMID: 6950118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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50
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Greco RS, Kamath C, Nosher JL. Percutaneous drainage of peridiverticular abscess followed by primary sigmoidectomy. Dis Colon Rectum 1982; 25:53-5. [PMID: 7056141 DOI: 10.1007/bf02553549] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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