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Liao YH, Chu SH, Hsiao GH, Chou NK, Wang SS, Chiu HC. Majocchi's granuloma caused by Trichophyton tonsurans in a cardiac transplant recipient. Br J Dermatol 1999; 140:1194-6. [PMID: 10354110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Wu HC, Shih LY, Chen TC, Chu SH, Tsai CC. A patient with bilateral primary adrenal lymphoma, presenting with fever of unknown origin and achieving long-term disease-free survival after resection and chemotherapy. Ann Hematol 1999; 78:289-92. [PMID: 10422633 DOI: 10.1007/s002770050517] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Primary adrenal lymphoma is extremely rare. We describe a 64-year-old female patient who presented with fever of unknown origin. Imaging studies demonstrated bilateral bulky adrenal masses. She underwent bilateral adrenalectomy and the pathological diagnosis was large cell immunoblastic (B-cell) lymphoma. She received adjuvant combination chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisolone in the following 6 months. She has been relapse free for 52 months. To the best of our knowledge, this case has the longest disease-free survival among those reported. The present case indicated that primary adrenal lymphoma should be included in the differential diagnosis of fever of unknown origin and/or suprarenal mass. Chemotherapy following surgical resection may be considered the treatment of choice.
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Chen CS, Chen Y, Chu SH. Application of the holmium yttrium-aluminum-garnet laser for complicated impacted ureteral stones: a preliminary report. CHANGGENG YI XUE ZA ZHI 1999; 22:259-64. [PMID: 10493032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND Minimally invasive surgery is a current trend in all kinds of surgical fields. Endoscopic stone manipulation with electrohydraulic lithotripsy (EHL) is the preferred method for treating lower ureteral stones or calculi which cannot be resolved with extracorporeal shock wave lithotripsy (SWL). We evaluated the efficiency and safety of holmium yttrium-aluminum-garnet (YAG) laser for treatment of large impacted ureteral stones. METHODS In a clinical trial period including April and May 1998, 13 patients with ureteral stones underwent holmium YAG lasertripsy. Six patients had large impacted ureteral stones (1.3 to 3.8 cm). We conducted lasertripsy with a 6.5-Fr. rigid tapered ureteroscope and a 550-nm SlimLine laser fiber under the guidance of a 3-Fr. ureteral catheter. The irrigation pump was set at 300 mmHg to increase the surgeon's visual clearance and to help keep the operative field ston-free. RESULTS The postoperative stone-free rate was 100%. There were no intraoperative complications, even in the treatment for a 3.8-cm steinstrasse in the upper ureter. All preoperative hydronephrosis improved. In general, the operative time, not including anesthesia, was less than 30 minutes. There was no intraoperative or postoperative flank pain or fever when the procedure was combined with pressure irrigation for visual clearance and keeping the area stone-free. CONCLUSION Holmium YAG lasertripsy is an excellent treatment modality, especially for a large impacted ureteral stone or steinstrasse. The treatment is efficient and safe. Furthermore, there is no learning curve necessary for an experienced endo-urologist. It helps the urologist to carry out a minimally invasive lithotripsy instead of an open surgery for large impacted ureteral stones.
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Chen Y, Chuang CK, Chu SH, Ng KF, Liao SK. Partial nephrectomy for incidental primary renal neuroendocrine carcinoma: case report. CHANGGENG YI XUE ZA ZHI 1999; 22:277-81. [PMID: 10493035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Here we present an 83-year-old woman who was referred to our hospital and had had left flank pain and oligouria for 3 days. Plain abdominal film and ultrasonography revealed left ureteropelvic junction stone with obstructive uropathy. The serum level of creatinine fell to 3.1 mg/dl from 7.6 mg/dl after ureteral catheter drainage was given 5 days after admission. Then a left pyelolithotomy was performed and a tumor of 2 x 1 x 1 cm over the lower pole of the left kidney was found incidentally. Partial nephrectomy was performed in consideration of her age and poor renal function although the biopsy result showed it to be carcinoma. The final pathological report and immunohistochemical study results proved that it was neuroendocrine carcinoma. To our knowledge, this is the first case of primary renal neuroendocrine carcinoma to be treated using conservative surgery. The clinical course was acceptable, since she had been found to be free of disease during regular follow-up of 2.5 years with the creatinine level of about 2.5 mg/dl.
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Hsu RB, Chu SH, Wang SS, Ko WJ, Chou NK, Lee CM, Chen MF, Lee YT. Low incidence of transplant coronary artery disease in Chinese heart recipients. J Am Coll Cardiol 1999; 33:1573-7. [PMID: 10334426 DOI: 10.1016/s0735-1097(99)00060-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES This study sought to assess the incidence of transplant coronary artery disease (CAD) in Chinese heart recipients. BACKGROUND The prevalence of transplant CAD detected by angiography at 1, 2 and 4 years after heart transplantation was 11%, 22% and 45%, respectively. The incidence of transplant CAD in Chinese heart recipients has not been reported. METHODS For those recipients surviving for more than 1 year after transplantation, coronary angiography was performed annually for surveillance of transplant CAD. The recipient characteristics, donor characteristics, rejection episodes, medication and human leukocyte antigen (HLA) mismatches were recorded. RESULTS Fifty patients were included in this study. Thirteen (26%) recipients had ischemic heart disease. Two patients (4%) had active cytomegalovirus (CMV) infection after transplantation. The mean number of rejection episodes in the 1st year after transplantation was 1.15. Among 47 patients with complete data of donor and recipient histocompatibility antigens, there were seven patients (14.9%) with two or fewer HLA mismatches. Among 74 angiograms of 50 patients reviewed, only one patient had discrete stenosis less than 50% in the middle portion of the left anterior descending artery at 1 year after transplantation. The cumulative incidence of transplant CAD was 2% at 1 year and 2% at 2 and 4 years after transplantation. CONCLUSIONS The incidence of transplant CAD was low in Chinese heart transplant recipients. Low percentage of ischemic heart disease in recipients, low occurrence of active CMV infection and rejection episodes after transplantation, less racial disparity, and lower HLA mismatches may be the important factors.
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Chen YS, Yu HY, Ko WJ, Chu SH. Unpreconditioned free revascularized dynamic cardiomyoplasty. Is it feasible? THE JOURNAL OF CARDIOVASCULAR SURGERY 1999; 40:217-22. [PMID: 10350105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND Cardiomyoplasty is a new ventricular bioassist device for myocardial failure. But there are some limitations in standard cardiomyoplasty, such as the orientation of the muscle and fiber and the efficiency of the contractile segment of the flap. Free revascularized latissimus dorsi flap may be a good idea for solving these problems. METHODS We designed a canine free latissimus dorsi flap by revascularizing the flap with the left internal thoracic vessels by micro-surgical technique. Group I (n = 3) as control was performed by standard cardiomyoplasty, and the Group II (n = 10) was performed by the revascularized method. The heart was then wrapped by the revacularized flap. Group II was divided into IIa (n = 6, no pre-treatment before revascularization) and IIb (n = 4, normal saline pre-treatment before revascularization) by the different preservation methods. Hemodynamic data were recorded. RESULTS Group I all survived the 8-week training period. But Group II, Group IIa and IIb, all died in 3 days, but survived more than 12 hours. The hemodynamic analysis in Group I did not show any significant change except left ventricular end diastolic pressure. It showed elevated left ventricular pressure when the cardiostimulator was ON. CONCLUSIONS According to the result of this experiment, it seemed impossible to get a satisfactory result of more than 3 days for free revascularized cardiomyoplasty at present. There were a lot of problems waiting to be solved, such as preservation method during ischemia, bulky mass of the flap, and the potential problem of neuromuscular atrophy.
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Chen SY, Lan C, Ko WJ, Chou NK, Hsu RB, Chen YS, Chu SH, Lai JS. Cardiorespiratory response of heart transplantation recipients to exercise in the early postoperative period. J Formos Med Assoc 1999; 98:165-70. [PMID: 10365534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
In this study, we evaluated the cardiorespiratory function of orthotopic heart transplantation (OHT) recipients during exercise. Seventeen male OHT recipients, ranging in age from 22 to 60 years, participated in this study 47 +/- 21 days after surgery. The control group consisted of 17 sedentary healthy men. Breath-by-breath measurement of cardiorespiratory function was obtained during the incremental exercise of leg cycling. At peak exercise, the oxygen (O2) uptake (16.5 +/- 3.3 vs 33.9 +/- 8.2 mL.kg-1.min-1), work rate (82 +/- 19 vs 169 +/- 42 watts), heart rate (HR), O2 pulse, and blood lactate level of the OHT recipients were significantly lower than the respective values of the control group. At the ventilatory threshold, the OHT group also showed a significantly lower O2 uptake (10.7 +/- 1.6 vs 18.3 +/- 5.1 mL.kg-1.min-1), work rate (39 +/- 12 vs 89 +/- 33 watts), HR, O2 pulse, ventilatory equivalent for O2, and ventilatory equivalent for carbon dioxide. The OHT recipients showed a high resting HR (97 +/- 7 beats/min) and a low peak HR (123 +/- 14 beats/min) during exercise, and their HR continued to increase for 1 to 3 minutes after cessation of exercise. Our data revealed a low level of cardiorespiratory endurance in OHT recipients during the early postoperative stage. A multidisciplinary cardiac rehabilitation program should be considered to enhance physical functional capacity and quality of life, and promote return to work.
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Chen CS, Liu KL, Chen HW, Chou CC, Chuang CK, Chu SH. Prognostic factors and strategy of treatment in Fournier's gangrene: a 12-year retrospective study. CHANGGENG YI XUE ZA ZHI 1999; 22:31-6. [PMID: 10418207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND Fournier's gangrene (FG) is a fulminant and fatal infection of the genitalia. However, the clinical course is unpredictable. This study retrospectively analyzed the possible prognostic factors of FG. METHODS Data obtained from 57 patients treated for FG from January 1985 through December 1996 were retrospectively analyzed. Possible prognostic factors including age, diagnostic delay, hospital stay, underlying diseases, clinical symptoms, origins, extents, bacteriologic findings, diverting colostomy and mortality rate were all considered in the analysis. RESULTS Patients with extensive or localized FG had mortality rates of 31.3% and 16.0%, respectively (p = 0.227). The mortality rates of patients with FG of anorectal, urogenital and non-specific origin were 30.3%, 0% and 40.0%, respectively (p = 0.712). The mortality rates of patients with FG of anorectal origin who received primary or secondary diverting colostomy were 16.7% and 40.0%, respectively. However, the mortality rate of patients with FG of anorectal origin who did not undergo diversion was 29.4%. The mortality rate of patients with FG presenting with septic shock at emergency was 53.8% as compared with 0% in those without septic shock (p < 0.001). CONCLUSION Fournier's gangrene is a rapidly progressive and life threatening infection of the genitalia. Age, underlying diseases, origin, extent and fecal diversion can not be regarded as prognostic factors of FG. Early primary diverting colostomy may reduce the mortality rate in those with severe infection of anorectal origin. Presence of septic shock in those with FG is the most important and the only factor related to death.
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Ko WJ, Chen YS, Luh SP, Lee YC, Chu SH. Extracorporeal membrane oxygenation support for single-lung transplantation in patients with primary pulmonary hypertension. Transplant Proc 1999; 31:166-8. [PMID: 10083060 DOI: 10.1016/s0041-1345(98)01486-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Shih FJ, Chu SH. Comparisons of American-Chinese and Taiwanese patients' perceptions of dyspnea and helpful nursing actions during the intensive care unit transition from cardiac surgery. Heart Lung 1999; 28:41-54. [PMID: 9915930 DOI: 10.1016/s0147-9563(99)70042-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare perceptions by American-Chinese and Taiwanese patients who received ventilatory assistance of acute episodes of dyspnea and the related helpful nursing actions in the intensive care unit (ICU) after cardiac surgery. DESIGN A descriptive qualitative design. SETTING Two medical hospitals in northern California and Taiwan. PATIENTS A purposive sample consisting of 30 adult Chinese patients who experienced acute episodes of dyspnea while receiving assistance from a volume-cycled ventilator following cardiac surgery in the ICU from one study site in the United States (n = 10) and one study site in Taiwan (n = 20). OUTCOME MEASURES The perceptions, natures, helpful nursing actions, and conceptual definition of the acute episode of dyspnea from the patients' perspective. INTERVENTION Data were gathered through semi-structured interviews and analyzed by qualitative content analysis. RESULTS All American-Chinese and Taiwanese subjects experienced physical discomforts, including tightness and congestion in the chest, labored breathing, sweating, palpitations, pain, and loss of vitality. Seventy percent of American-Chinese subjects and 90% of Taiwanese subjects reported having a mortal fear of death during and after the acute episode of dyspnea. The nature of the patients' perceptions of dyspnea revealed in this study can be categorized as unpredictability, sequence, intercorrelation, and exhaustion. Data analysis shows that the acute dyspneic process includes the immediate, following, later, and final transitions. Helpful nursing actions were identified as comforting, companionship, allowing self-concentration, and providing information. CONCLUSION Both American-Chinese and Taiwanese patients' perceptions of acute episodes of dyspnea and helpful nursing actions were identified and compared. Finally, the conceptual definition of patients' perceptions of acute dyspnea and a conceptual framework for this phenomenon were further tentatively developed to depict and delineate this phenomenon.
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Li JY, Wang SS, Lin FY, Tsai CH, Chu SH. Video-assisted endoscopic saphenous vein harvesting for coronary artery bypass grafting. J Formos Med Assoc 1998; 97:819-25. [PMID: 9884483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Saphenous vein grafts for coronary artery bypass can be harvested by means of the traditional long incision method, the skin bridge method, or a newly developed endoscopic technique. We applied the endoscopic technique to reduce the length of leg incision and to decrease the frequency of complications. Between September and December 1996, 47 patients underwent coronary artery bypass grafts, 17 of whom volunteered to undergo saphenous vein harvest with the Endopath video-assisted endoscopic saphenous vein harvest (ESVH) system; the other 30 patients underwent the traditional long incision harvest procedure. A total of 22 saphenous veins were harvested from the 17 patients who underwent ESVH. The mean length of the leg wound was 5.8 +/- 1.3 cm and the mean length of the vein harvested was 32.9 +/- 3.4 cm (wound/vein length ratio 17.6%). The wound/vein length ratio of the 30 patients who underwent the traditional open harvest method was 91.5% (30.8 +/- 2.2 cm/34.1 +/- 3.0 cm). ESVH failed and was converted to the conventional method in two cases. The mean time required to harvest the saphenous vein was 72.7 +/- 20.8 minutes in the ESVH group and 45.8 +/- 12.5 minutes in the open surgery group. No wound complications were noted in the ESVH group, except for ecchymosis in three cases. Five patients in the open surgery group had wound discharge (17%). The length of hospital stay was shorter (10.5 +/- 2.6 days vs 15.8 +/- 4.2 days) and fewer analgesics were used in the ESVH group. The rate of cardiac complications was not different between the two groups. Examination of the vein graft under light microscopy also did not reveal any differences. We conclude that the endoscopic technique can provide adequate vein grafts for use in coronary artery bypass grafting and reduce the leg wound complication rate, hospital stay, and use of analgesics.
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Ko WJ, Chou NK, Chen YS, Hsu RB, Wang SS, Chu SH. Clinical trial of FK506 in heart transplant patients in Taiwan: report of 7 cases with immunosuppression switch from cyclosporine to FK506. Transplant Proc 1998; 30:3339-41. [PMID: 9838474 DOI: 10.1016/s0041-1345(98)01053-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Shu KH, Cheng CH, Wu MJ, Lian JD, Huang CC, Chu SH, Chiang YJ, Lai MK, Lee PH. A multicenter trial of FK506 as rescue therapy for renal transplant recipients in Taiwan. Transplant Proc 1998; 30:3584-6. [PMID: 9838570 DOI: 10.1016/s0041-1345(98)01146-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Lee JM, Hu CY, Hsieh RP, Lee YC, Lee PH, Luh SP, Chu SH, Lee CJ. Variation of microchimerism in long-term renal allograft transplantation and progression of immune tolerance. Transplant Proc 1998; 30:3888-9. [PMID: 9838701 DOI: 10.1016/s0041-1345(98)01277-9] [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: 10/17/2022]
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Lee YC, Luh SP, Lee JM, Huang CC, Chang YL, Wu HD, Kuo SH, Chu SH. Lung transplantation--the NTUH surgical experience. Transplant Proc 1998; 30:3391-2. [PMID: 9838494 DOI: 10.1016/s0041-1345(98)01073-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Chao SH, Chang KJ, Lee PH, Chu SH. Two-year results of pancreas transplantation in Taiwan. Transplant Proc 1998; 30:3414-5. [PMID: 9838504 DOI: 10.1016/s0041-1345(98)01082-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wang SS, Chu SH, Ko WJ, Chen YS, Chou NK. Heterotopic heart transplantation for severe pulmonary hypertension. Transplant Proc 1998; 30:3408-9. [PMID: 9838502 DOI: 10.1016/s0041-1345(98)01081-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chu SH, Pang ST, Chiang YJ, Chuang CK, Chen HW, Chen CS, Chou CC, Huang CC. Converting renal transplant patients maintained on Sandimmune to a new microemulsion formulation, Sandimmune Neoral. Transplant Proc 1998; 30:3521-3. [PMID: 9838543 DOI: 10.1016/s0041-1345(98)01121-x] [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: 11/30/2022]
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Ko WJ, Chu SH, Lee YH, Lee PH, Lee CJ, Chao SH, Chang SC. Successful prevention of syphilis transmission from a multiple organ donor with serological evidence of syphilis. Transplant Proc 1998; 30:3667-8. [PMID: 9838609 DOI: 10.1016/s0041-1345(98)01185-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chu SH, Tay SK, Chiang YJ, Chuang CK, Chen HW, Chen CS, Chou CC, Huang CC. Male sexual performance and hormonal studies in uremic patients and renal transplant recipients. Transplant Proc 1998; 30:3062-3. [PMID: 9838349 DOI: 10.1016/s0041-1345(98)00930-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Tsai MK, Huang HF, Hu RH, Lee PH, Lee CJ, Chao SH, Hsu HC, Ko WJ, Chu SH. Fatal Kikuchi-Fujimoto disease in transplant recipients: a case report. Transplant Proc 1998; 30:3137-8. [PMID: 9838387 DOI: 10.1016/s0041-1345(98)01292-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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