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Alvi MA, Ali RMA, Khan S, Saqib M, Qamar W, Li L, Fu BQ, Yan HB, Jia WZ. Past and Present of Diagnosis of Echinococcosis: A Review (1999-2021). Acta Trop 2023; 243:106925. [PMID: 37080264 DOI: 10.1016/j.actatropica.2023.106925] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/17/2023] [Accepted: 04/08/2023] [Indexed: 04/22/2023]
Abstract
The larval forms of taeniid cestodes belonging to the genus Echinococcus are the source of the zoonotic infection known as echinococcosis. Alveolar and cystic echinococcosis are caused by Echinococcus multilocularis and Echinococcus granulosus (s. s) respectively. It is endemic in several regions of the world. In this systematic review, we describe diagnosis, and the species (human, canids, livestock, and small rodents) affected by cystic (CE) and alveolar echinococcosis (AE). From 1999 to 2021, we searched the online directory through PubMed, SCOPUS, Web of Science, and google scholar. Among the 37,700 records found in the online databases, 187 publications met our eligibility requirements. The majority of investigations employed a range of diagnostic methods, such as ELISA, imaging, copro-PCR, necropsy or arecoline hydrobromide purgation, morphological cestode confirmation, and fecal sieving/flotation to detect and confirm Echinococcus infection. ELISA was the most commonly used method followed by PCR, and imaging. The research team retrieved data describing the incidence or assessment of the diagnostic test for E. multilocularis in humans (N = 99), canids (N = 63), small ruminants (N = 13), large ruminants (N= 3), camel (N= 2), pigs (N=2) and small mammals (N= 5). This study was conducted to explore the diagnostic tools applied to detect echinococcosis in humans as well as animals in prevalent countries, and to report the characteristic of new diagnostic tests for disease surveillance. This systematic review revealed that ELISA (alone or in combination) was the most common method used for disease diagnosis and diagnostic efficacy and prevalence rate increased when recombinant antigens were used. It is highly recommended to use combination protcols such as serological with molecular and imaging technique to diagnose disease. Our study identified scarcity of data of reporting echinococcosis in humans/ animals in low-income or developing countries particularly central Asian countries. Study reports in small rodents indicate their role in disease dissemination but real situation in these host is not refected due to limited number of studies. Even though echinococcosis affects both public health and the domestic animal sector, therefore, it is important to devise new and strengthe implementation of the existing monitoring, judging, and control measures in this estimate.
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Affiliation(s)
- Mughees Aizaz Alvi
- State Key Laboratory of Veterinary Etiological Biology, College of Veterinary Medicine, Lanzhou University, National Para-reference Laboratory for Animal Echinococcosis, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China; Department of Clinical Medicine and Surgery, University of Agriculture, Faisalabad, Pakistan
| | - Rana Muhammad Athar Ali
- Department of Clinical Medicine and Surgery, University of Agriculture, Faisalabad, Pakistan
| | - Sadiq Khan
- Department of Clinical Medicine and Surgery, University of Agriculture, Faisalabad, Pakistan
| | - Muhammad Saqib
- Department of Clinical Medicine and Surgery, University of Agriculture, Faisalabad, Pakistan
| | - Warda Qamar
- Department of Parasitology, University of Agriculture, Faisalabad, Pakistan
| | - Li Li
- State Key Laboratory of Veterinary Etiological Biology, College of Veterinary Medicine, Lanzhou University, National Para-reference Laboratory for Animal Echinococcosis, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China
| | - Bao-Quan Fu
- State Key Laboratory of Veterinary Etiological Biology, College of Veterinary Medicine, Lanzhou University, National Para-reference Laboratory for Animal Echinococcosis, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China
| | - Hong-Bin Yan
- State Key Laboratory of Veterinary Etiological Biology, College of Veterinary Medicine, Lanzhou University, National Para-reference Laboratory for Animal Echinococcosis, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China.
| | - Wan-Zhong Jia
- State Key Laboratory of Veterinary Etiological Biology, College of Veterinary Medicine, Lanzhou University, National Para-reference Laboratory for Animal Echinococcosis, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China; Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, China.
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Schweizer M, Schmidberger J, Schlingeloff P, Kratzer W. Contrast-enhanced ultrasound (CEUS) in patients with metastasis-like hepatic alveolar echinococcosis: a cohort study. J Ultrasound 2022; 26:129-136. [PMID: 35597873 PMCID: PMC10063733 DOI: 10.1007/s40477-022-00688-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/15/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Hepatic alveolar echinococcosis (HAE) of the metastasis-like pattern, according to the Echinococcus Ulm classification, is usually discovered as an incidental finding, and the diagnostic differentiation from "true metastases" is difficult. The aim of this study was to investigate whether lesions of the "metastasis-like pattern" in HAE show a typical contrast behavior that can be used for differentiation from metastasis in malignancies. METHODS This prospective clinical study included 11 patients with histologically confirmed HAE of the metastasis-like pattern (7 female and 4 male; mean age, 57.1 years; mean disease duration, 59.5 months), who had been examined by B-scan sonography and CEUS, from the National Echinococcosis Registry Germany. RESULTS On contrast-enhanced sonography, 11/11 reference lesions showed annular rim enhancement in the arterial and portal venous phases. Throughout the entire 4-min study period, none of the reference lesions showed central contrast enhancement-i.e., all exhibited a complete "black hole sign". A small central scar was seen in 81.8% of cases. CONCLUSION In clinically unremarkable patients with incidentally detected metastasis-like lesions of the liver, contrast-enhanced sonographic detection of rim enhancement without central contrast uptake (black hole sign) should be considered evidence supporting a diagnosis of hepatic alveolar echinococcosis with a rare metastasis-like pattern. This can help to differentiate HAE from metastases, especially in high-endemic areas.
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Affiliation(s)
- Melissa Schweizer
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Julian Schmidberger
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Patrycja Schlingeloff
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Wolfgang Kratzer
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
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Cai D, Li Y, Jiang Y, Wang H, Wang X, Song B. The role of contrast-enhanced ultrasound in the diagnosis of hepatic alveolar echinococcosis. Medicine (Baltimore) 2019; 98:e14325. [PMID: 30702614 PMCID: PMC6380766 DOI: 10.1097/md.0000000000014325] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
To evaluate the value of contrast-enhanced ultrasound (CEUS) compared with ultrasound (US) in the diagnosis of hepatic alveolar echinococcosis (AE).Thirty-one patients with 43 hepatic AE lesions between January 2010 and September 2017 were included in the study. All lesions which were histopathologically proven to be hepatic AE were retrospectively reviewed. Features of the lesions by CEUS were retrospectively studied.All lesions were detected by US and CEUS in the 31 patients (17 males and 14 females) with a mean age of 38.5 ± 10.6 years (range: 16-58 years). The size of the lesions ranged from 1.5 × 0.7 cm to 15 × 18 cm. By US, 3 lesions (7%, 3/43) were hypoechoic nodules, 21 (48.8%, 21/43) were hyperechoic, and 19 lesions (44.2%, 19/43) were of mixed echogenicity type (solid-cystic). 27 lesions (62.8%, 27/43) had calcifications. Only 1 lesion was detected blood-flow signals. With CEUS, 23 lesions (53.5%, 23/43) displayed no enhancement in the arterial phase, portal phase and delayed phase on CEUS. 11 lesions (25.6%, 11/43) displayed a slight ring-like hyper-enhancement in the arterial phase and displayed hypo-enhancement in the portal and delayed phase. 6 lesions (14%, 6/43) displayed hyper-enhancement in the arterial phase and hypo-enhancement in the portal and delayed phase. 2 lesions (4.7%, 2/43) showed iso-enhancement in the arterial, portal, and delayed phase. 1 lesion (2.3%, 1/43) showed slight hypo-enhancement in the arterial, portal, and delayed phase.CEUS is a more valid technique for diagnosing AE than US. It could be a reliable tool in the diagnosis of hepatic AE.
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Affiliation(s)
| | | | | | | | | | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Bulakçı M, Kartal MG, Yılmaz S, Yılmaz E, Yılmaz R, Şahin D, Aşık M, Erol OB. Multimodality imaging in diagnosis and management of alveolar echinococcosis: an update. Diagn Interv Radiol 2017; 22:247-56. [PMID: 27082120 DOI: 10.5152/dir.2015.15456] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Alveolar echinococcosis is a parasitic disease limited to the northern hemisphere. The disease occurs primarily in the liver and shows a profile mimicking slow-growing malignant tumors. Echinococcus multilocularis infection is fatal if left untreated. It can cause several complications by infiltrating the vascular structures, biliary tracts, and the hilum of the liver. As it can invade the adjacent organs or can spread to distant organs, alveolar echinococcosis can easily be confused with malignancies. We provide a brief review of epidemiologic and pathophysiologic profile of alveolar echinococcosis and clinical features of the disease. This article focuses primarily on the imaging features of alveolar echinococcosis on ultrasonogra-phy, computed tomography, magnetic resonance imaging, diffusion-weighted imaging and positron emission tomography-computed tomography. We also reviewed the role of radiology in diagnosis, management, and follow-up of the disease.
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Affiliation(s)
- Mesut Bulakçı
- Department of Radiology, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey.
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Liu W, Delabrousse É, Blagosklonov O, Wang J, Zeng H, Jiang Y, Wang J, Qin Y, Vuitton DA, Wen H. Innovation in hepatic alveolar echinococcosis imaging: best use of old tools, and necessary evaluation of new ones. ACTA ACUST UNITED AC 2014; 21:74. [PMID: 25531446 PMCID: PMC4273719 DOI: 10.1051/parasite/2014072] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 12/11/2014] [Indexed: 12/12/2022]
Abstract
Hepatic Alveolar Echinococcosis (HAE), caused by larvae of Echinococcus multilocularis, is a rare but potentially lethal parasitic disease. The first diagnostic suspicion is usually based on hepatic ultrasound exam performed because of abdominal symptoms or in the context of a general checkup; HAE diagnosis may thus also be an incidental finding on imaging. The next step should be Computed Tomography (CT) or Magnetic Resonance Imaging (MRI). They play an important role in the initial assessment of the disease; with chest and brain imaging, they are necessary to assess the PNM stage (parasite lesion, neighboring organ invasion, metastases) of a patient with AE. Performed at least yearly, they also represent key exams for long-term follow-up after therapeutic interventions. Familiarity of radiologists with HAE imaging findings, especially in the endemic regions, will enable earlier diagnosis and more effective treatment. Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) is currently considered to be the only noninvasive, albeit indirect, tool for the detection of metabolic activity in AE. Delayed acquisition of images (3 hrs after FDG injection) enhances its sensitivity for the assessment of lesion metabolism and its reliability for the continuation/withdrawal of anti-parasite treatment. However, sophisticated equipment and high cost widely limit PET/CT use for routine evaluation. Preliminary studies show that new techniques, such as contrast-enhanced ultrasound (US), Dual Energy CT or Spectral CT, and Diffusion-Weighted MRI, might also be useful in detecting the blood supply and metabolism of lesions. However, they cannot be recommended before further evaluation of their reliability in a larger number of patients with a variety of locations and stages of AE lesions.
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Affiliation(s)
- Wenya Liu
- Imaging Center, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, PR China
| | - Éric Delabrousse
- Department of Visceral Radiology, University Hospital Jean Minjoz, 25030 Besançon, France - WHO-Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University of Franche-Comté and University Hospital, 25030 Besançon, France
| | - Oleg Blagosklonov
- WHO-Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University of Franche-Comté and University Hospital, 25030 Besançon, France - Department of Nuclear Medicine, University Hospital Jean Minjoz, 25030 Besançon, France
| | - Jing Wang
- Imaging Center, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, PR China
| | - Hongchun Zeng
- Department of Ultrasonography, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, China
| | - Yi Jiang
- Imaging Center, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, PR China
| | - Jian Wang
- Imaging Center, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, PR China
| | - Yongde Qin
- Imaging Center, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, PR China
| | - Dominique Angèle Vuitton
- WHO-Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University of Franche-Comté and University Hospital, 25030 Besançon, France
| | - Hao Wen
- Department of Hepatic surgery, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, China
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Defining the percentage of intra-abdominal hemorrhage in abdominal computerized tomography using stereology in patients with blunt liver injury and determining its relationship with outcomes. J Trauma Acute Care Surg 2013; 74:224-9. [DOI: 10.1097/ta.0b013e318270df0e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Zeng H, Wang J, Xie W, Liu W, Wen H. Assessment of early hepatic echinococcus multilocularis infection in rats with real-time contrast-enhanced ultrasonography. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:1982-1988. [PMID: 22929653 DOI: 10.1016/j.ultrasmedbio.2012.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 07/08/2012] [Accepted: 07/13/2012] [Indexed: 06/01/2023]
Abstract
The aim of this study was to demonstrate characteristic imaging and accurate evaluation of blood perfusion in early stage of hepatic alveolar echinococcosis (HAE) by contrast-enhanced ultrasonography (CEUS). The early stage of experimentally induced secondary HAE in 45 rats was studied. Thirty-six HAE lesions in 33 rats, confirmed by pathologic examination, were examined by ultrasound (US), color Doppler flow imaging (CDFI) and then CEUS. Thirty-three lesions were found in 30 rats by US, and 30 lesions were detected in 27 rats by CEUS. The sensitivity of US and CEUS was 92% (95% CI 76%-98%) and 82% (95% CI 65%-93%), respectively. US imaging characteristics were categorized into four types: hyperechoic spot (type 1, 45.5%, 15/33), granular hyperechoic spots (type 2, 12.1%, 4/33), hyperechoic lesion (type 3, 30.3%, 10/33) and mixed pattern (type 4, 12.1%, 4/33). CDFI failed to detect blood flow signals in any lesions. CEUS results for 30 lesions showed ring enhancement in the peripheral area during the arterial phase and no filling effect in either the portal or the delayed phase (46.7%, 14/30); ring enhancement combined with central septa enhancement during the arterial phase and portal venous phase (46.7, 14/30), and no enhancement (6.6%, 2/30). The enhanced area, confirmed by pathologic examination, was an inflammatory reaction belt surrounding the lesion. The results of this study suggest that US, with high sensitivity, can be used as a screening method for early HAE lesions in the animal model, while CEUS can be used for displaying the peripheral blood perfusion and vesicle structure.
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Affiliation(s)
- Hongchun Zeng
- Department of Ultrasonography, First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang, P.R. China
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Tao S, Qin Z, Hao W, Yongquan L, Lanhui Y, Lei Y. Usefulness of gray-scale contrast-enhanced ultrasonography (SonoVue®) in diagnosing hepatic alveolar echinococcosis. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:1024-1028. [PMID: 21640477 DOI: 10.1016/j.ultrasmedbio.2011.04.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Revised: 04/12/2011] [Accepted: 04/26/2011] [Indexed: 05/30/2023]
Abstract
Hepatic alveolar echinococcosis (HAE) is a parasitic infection with an infiltrative growth pattern that has the appearance of a hepatic malignant tumor. Ultrasound (US) has been used for screening of HAE in epidemic areas. However, it has been very difficult to evaluate the clear boundary and microvessel perfusion of the lesions. The aim of this study was to demonstrate the characteristic imaging and clinical significance of HAE lesions by contrast-enhanced ultrasonography (CEUS). Seventeen patients with 19 HAE lesions were examined in sequence with US, color Doppler flow imaging (CDFI) and then CEUS before any treatment. All the data were compared before surgery. Examined by fundamental US, 47.4% of HAE lesions showed irregular hyperechoic substantive areas and 52.6% appeared as having a mixed echotype with irregular anechoic areas in the central portion of the lesions. The CDFI method indicated no blood flow signals inside any of the 19 lesions. By CEUS, all 19 lesions displayed circular rim enhancement in the peripheral segments and absent enhancement within the central areas of the lesions (a "black hole" effect). As a result, the lesions' margins were clear, irregular and distinct. In general, the sizes of all the HAE lesions observed by CEUS were larger than those obtained by fundamental US. Therefore, CEUS is a simple imaging method and can be a helpful tool for more accurate sizing of HAE lesions and their surrounding invasion range and the proper cut-off margin when radical hepatectomy is needed.
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Affiliation(s)
- Song Tao
- Department of Ultrasonography, First Affiliated Hospital, Xinjiang Medical University, Urumqi, PR China
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Hidaka N. Sonographic Appearance of Fetal Structural Heart Diseases Determined Using Wide-band Doppler. J Med Ultrasound 2008. [DOI: 10.1016/s0929-6441(09)60006-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Aydinli B, Kantarci M, Polat KY, Unal B, Atamanalp SS, Durur I, Unal D, Akgun M. Stereological evaluation of treatment response in patients with non-resectable hepatic alveolar echinococcosis using computed tomography via the Cavalieri method. Liver Int 2006; 26:1234-40. [PMID: 17105589 DOI: 10.1111/j.1478-3231.2006.01363.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
INTRODUCTION The purposes of this study were to describe and adapt the relevant methods of computed tomography (CT) and stereology to estimate parasitic volume in the liver, to compare the efficiency of benzimidazole treatment in hepatic alveolar echinococcosis (AE), and to determine whether the response rates measured by the stereological method are correlated with those measured by simple volumetric measurements (SVM). METHODS Nine eligible patients with non-resectable AE were included in the study. By using their abdominal CT at the baseline and after a year of treatment, treatment responses of the cases were evaluated both by the stereological method via a software and by SVM, retrospectively. The volume estimation was performed in our study using a different approach that consisted of three separate stages combined with the Cavalieri method of modern design stereology. RESULTS The response rates were -17 +/- 55% and -12 +/- 37% by the Cavalieri method and SVM, respectively; however, they were not statistically significant (P = 0.59 and 0.21 for the Cavalieri method and SVM, respectively). Although some cases had comparable results, others had different response rates, and the two methods showed no significant correlation (r = -0.31, P = 0.41). CONCLUSIONS Because this modified method provides accurate results by reducing margin of errors, even in case of bizarre shape of AE, a correct, unbiased, and reliable management of the cases with AE via this method may be possible. Owing to lack of a correlation with SVM, it is suggested that a measurement via SVM may be wrong and its use in the evaluation of the treatment response in such cases will not be sufficient and completely true.
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Affiliation(s)
- Bulent Aydinli
- Department of General Surgery, Medical Faculty, Atatürk University, Erzurum, Turkey.
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