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Pinelli F, Balsorano P, Mura B, Pittiruti M. Reconsidering the GAVeCeLT Consensus on catheter-related thrombosis, 13 years later. J Vasc Access 2020; 22:501-508. [PMID: 32772785 DOI: 10.1177/1129729820947594] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Catheter-related thrombosis represents one of the most common complications following central venous access insertion. Despite the amount of available studies, many aspects surrounding catheter-related thrombosis remain controversial. Thirteen years ago, the Italian Study Group for Long Term Central Venous Access (GAVeCeLT) developed a nationwide Consensus in order to clarify some key aspects on this topic. Despite most of them still remain valid, however, knowledge around catheter-related thrombosis has greatly evolved over the last decade, with a natural evolution in terms of catheter technologies, insertion techniques, and management bundles. Aims of this editorial are to readdress conclusions of the 2007 GAVeCeLT Consensus in the light of the new relevant evidences that have been added in the last 13 years and to analyze some unsolved issues that still remain debated.
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Affiliation(s)
- Fulvio Pinelli
- Department of Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy
| | - Paolo Balsorano
- Department of Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy
| | - Benedetta Mura
- School of Human Health Science, University of Florence, Florence, Italy
| | - Mauro Pittiruti
- Department of Surgery, Catholic University Hospital, Rome, Italy
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2
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Katyal N, Korzep A, Newey C. Inadvertent Central Arterial Catheterization: An Unusual Cause of Ischemic Stroke. J Neurosci Rural Pract 2019; 9:155-158. [PMID: 29456363 PMCID: PMC5812144 DOI: 10.4103/jnrp.jnrp_460_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Central venous catheter (CVC) insertion is extensively utilized in Intensive Care Units for evaluation of hemodynamic status, administration of intravenous drugs, and for providing nutritional support in critically ill patients. Unfortunately, CVC use is associated with complications including lung injury, bleeding, infection, and thrombosis. We present a patient with an acute ischemic stroke from an inadvertently placed CVC into the right common carotid artery. A 57-year-old male presented to our institution for left hemiplegia and seizures 2 days after a CVC was placed. He was found to have a right frontal ischemic stroke on computed tomography (CT). CT angiography noted that the catheter was arterial and had a thrombosis around it. He was started on a low-dose heparin infusion. A combination of cardiothoracic surgery and interventional cardiology was required to safely remove the catheter. Central arterial catheterization is an unusual cause for acute ischemic stroke and presents management challenges.
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Affiliation(s)
- Nakul Katyal
- Department of Neurology, University of Missouri, Columbia 63511, MO, USA
| | - Amanda Korzep
- Department of Emergency Medicine, University of Missouri, Columbia 63511, MO, USA
| | - Christopher Newey
- Department of Neurology, University of Missouri, Columbia 63511, MO, USA
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3
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A case of paradoxical cerebral infarction by spraying thrombus in the catheter for dialysis. RENAL REPLACEMENT THERAPY 2017. [DOI: 10.1186/s41100-017-0124-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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4
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Ghandour A, Karuppasamy K, Rajiah P. Congenital Anomalies of the Superior Vena Cava: Embryological Correlation, Imaging Perspectives, and Clinical Relevance. Can Assoc Radiol J 2017; 68:456-462. [PMID: 28716333 DOI: 10.1016/j.carj.2016.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/15/2016] [Accepted: 11/30/2016] [Indexed: 11/25/2022] Open
Abstract
There is a wide spectrum of congenital anomalies of the superior vena cava, which are more increasingly recognized in cross-sectional imaging. Although some of these anomalies are asymptomatic, others have important clinical and interventional implications. Imaging modalities such as computed tomography and magnetic resonance imaging play an important role in the accurate characterization of these anomalies, which is essential for mapping prior to surgeries or interventions. In this article, we review a wide range of anomalies of the superior vena cava, including the embryological basis, cross-sectional imaging findings, and clinical implications, particularly from an interventional radiology perspective. We also discuss the treatments and complications of these anomalies.
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Affiliation(s)
- Abed Ghandour
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Prabhakar Rajiah
- Cardiothoracic Imaging, Radiology Department, UT Southwestern Medical Center, Dallas, Texas, USA.
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Wąsek WC, Samul W, Ryczek R, Skrobowski A. Unique case of ST-segment-elevation myocardial infarction related to paradoxical embolization and simultaneous pulmonary embolization: clinical considerations on indications for patent foramen ovale closure in no-guidelines land. Circulation 2015; 131:1214-23. [PMID: 25825398 DOI: 10.1161/circulationaha.114.009846] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | - Robert Ryczek
- From the Military Institute of Medicine, Warsaw, Poland
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6
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Hill J, Preminger T. Percutaneous PFO closure for paradoxical stroke in 8-kg twins. Catheter Cardiovasc Interv 2014; 84:110-3. [PMID: 23996963 DOI: 10.1002/ccd.25183] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 07/31/2013] [Accepted: 08/25/2013] [Indexed: 11/09/2022]
Abstract
Patent foramen ovale (PFO) is a known risk factor for paradoxical embolus, especially in the presence of other risk factors such as hypercoagulable states or central lines. A PFO is a common incidental finding in infants and children. However, paradoxical emboli are not common in infants, and so PFO closure is rarely indicated in this age group. We present two cases of PFO closures in identical 8 kg twin boys with Hurler's syndrome who had central lines for planned bone marrow transplants, with embolic stroke in one. We discuss the treatment options as well as the specific challenges based on the patients' age, size, and diagnoses. We also discuss the technical aspects and safety of percutaneous PFO closure.
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Affiliation(s)
- James Hill
- Department of Pediatric Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio
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Shaikh N, Saif AS, Nayeemuddin M, Kokash O. Patent foramen ovale: Its significance in anesthesia and intensive care: An illustrated case. Anesth Essays Res 2012; 6:94-7. [PMID: 25885513 PMCID: PMC4173424 DOI: 10.4103/0259-1162.103387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Patent foramen ovale (PFO) is defined as a valve-like opening at the level of foramen ovale or between septum primum and secundum without evidence of the anatomical defect. Paradoxical embolism (PDE) is an embolus passing through a defect PFO leading to end-organ dysfunction. PDE in septic shock is not yet reported in the literature. A 49-year male presented to the emergency department with shortness of breath since one day and pain in the left side of the chest. Chest x0 -ray revealed middle-left lobe pneumonia with pleural effusion; he was started on Co-amoxiclav, and admitted to the ward. After 6 h, his chest pain suddenly significantly increased difficulty in breathing and his oxygen saturation dropped. X-ray of the chest showed left pneumothorax, chest drain was inserted and he was intubated. He became hemodynamically unstable with maximum ventilatory support and noradrenalin. On day 4, he was found to have new pansystolic murmur in the tricuspid area. An echocardiogram revealed global hypokinesia, two mobile thrombi in the right atrial cavity, and PFO. It was noticed that his right toe had blackish discoloration. An angiogram showed occlusion of the right superficial femoral artery and immediately an embolectomy. On day 11, he was transferred to the ward. PDE needs a high index of suspicion in septic shock patients with ARDS. PDE requires PEEP adjustment, early anticoagulation, and thromboprophylaxis.
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Affiliation(s)
- Nissar Shaikh
- Department of Anesthesia & Intensive Care, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abdel Salam Saif
- Department of Medical Intensive Care, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Nayeemuddin
- Department of Anesthesia & Intensive Care, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ousama Kokash
- Department of Anesthesia & Intensive Care, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Povoski SP, Khabiri H. Persistent left superior vena cava: review of the literature, clinical implications, and relevance of alterations in thoracic central venous anatomy as pertaining to the general principles of central venous access device placement and venography in cancer patients. World J Surg Oncol 2011; 9:173. [PMID: 22204758 PMCID: PMC3266648 DOI: 10.1186/1477-7819-9-173] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 12/28/2011] [Indexed: 12/11/2022] Open
Abstract
Persistent left superior vena cava (PLSVC) represents the most common congenital venous anomaly of the thoracic systemic venous return, occurring in 0.3% to 0.5% of individuals in the general population, and in up to 12% of individuals with other documented congential heart abnormalities. In this regard, there is very little in the literature that specifically addresses the potential importance of the incidental finding of PLSVC to surgeons, interventional radiologists, and other physicians actively involved in central venous access device placement in cancer patients. In the current review, we have attempted to comprehensively evaluate the available literature regarding PLSVC. Additionally, we have discussed the clinical implications and relevance of such congenital aberrancies, as well as of treatment-induced or disease-induced alterations in the anatomy of the thoracic central venous system, as they pertain to the general principles of successful placement of central venous access devices in cancer patients. Specifically regarding PLSVC, it is critical to recognize its presence during attempted central venous access device placement and to fully characterize the pattern of cardiac venous return (i.e., to the right atrium or to the left atrium) in any patient suspected of PLSVC prior to initiation of use of their central venous access device.
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Affiliation(s)
- Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G, James Cancer Hospital and Richard J, Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, Ohio 43210, USA.
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Ye X, Ma T, Wang T, Ge M, Wang C, Gao J, Li X. TEE monitoring for RA-horizontal paradoxical arterial air embolism during sitting-position surgery. SCIENCE CHINA-LIFE SCIENCES 2010; 53:1405-9. [PMID: 21181341 DOI: 10.1007/s11427-010-4093-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 10/18/2010] [Indexed: 11/29/2022]
Abstract
A 36-year-old woman suffered meningioma in her right cerebellopontine angle. Air embolisms often complicate sitting-position surgeries. Because TEE guides the localization of central venous catheters and promptly locates air embolisms promptly enough for effective treatment, TEE is an effective monitoring method for sitting-position surgeries.
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Affiliation(s)
- Xin Ye
- Department of Anesthesiology, Beijing Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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Lange MC, Zamproni LN, Braatz V, Fernandes AF, Zetola VF, Nóvak EM. Ischemic stroke in a patient with Crohn's disease: a confirmed paradoxical embolism mechanism. ARQUIVOS DE NEURO-PSIQUIATRIA 2010; 68:651-2. [DOI: 10.1590/s0004-282x2010000400033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Modayil PC, Panthakalam S, Howlett DC. Metastatic carcinoma of unknown primary presenting as jugular venous thrombosis. Case Rep Med 2010; 2009:938907. [PMID: 20069128 PMCID: PMC2804116 DOI: 10.1155/2009/938907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2009] [Accepted: 10/20/2009] [Indexed: 11/17/2022] Open
Abstract
Jugular venous thrombosis is unusual and is associated with central venous catheterisation, intravenous drug abuse and head and neck sepsis. It is rarely associated with malignancy. We report a case of metastatic carcinoma of unknown primary in a forty year old female which presented with jugular venous thrombosis. The discussion includes investigation and treatment options for this condition.
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Affiliation(s)
| | | | - David C. Howlett
- Department of Radiology, Eastbourne DGH, East Sussex BN21 2UD, UK
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13
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Sukernik MR, Bennett-Guerrero E. The Incidental Finding of a Patent Foramen Ovale During Cardiac Surgery: Should It Always Be Repaired? A Core Review. Anesth Analg 2007; 105:602-10. [PMID: 17717210 DOI: 10.1213/01.ane.0000278735.06194.0c] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
With the increased use of intraoperative transesophageal echocardiography, patent foramen ovale (PFO) has become a common finding during heart surgery. This finding presents a difficult dilemma for cardiac surgeons, since the impact of intraoperatively diagnosed PFOs on postoperative outcome is unknown. Changes in the surgical plan required for closure of a PFO subject the patient to the possibility of additional risk. On the other hand, a decision to not close a PFO exposes the patient to unclear immediate and long-term consequences. Deciding whether or not to close a PFO currently depends on the clinicians' personal preferences, the probability of intraoperative and postoperative hypoxemia, and any anticipated deviation from the initial surgical plan. Most clinicians agree that an intraoperatively diagnosed PFO must be closed when surgery leads to a high risk of hypoxemia (e.g., left ventricular assist devices placement, heart transplantation); should be closed in most cases when minimal deviation from the initial surgical plan is needed for PFO closure (e.g., mitral valve or tricuspid valve surgeries); and probably, should be closed during heart surgeries performed without atriotomy and bicaval cannulation when the risk of perioperative or remote PFO-related complications is increased. The recent development of percutaneous methods of PFO closure provides a valuable backup for those cases when PFO is not closed and postoperative hypoxemia or other complications may be attributable to the uncorrected PFO.
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Affiliation(s)
- Mikhail R Sukernik
- Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA.
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14
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Lee ACW. Elective removal of cuffed central venous catheters in children. Support Care Cancer 2007; 15:897-901. [PMID: 17103194 DOI: 10.1007/s00520-006-0182-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2006] [Accepted: 10/10/2006] [Indexed: 02/05/2023]
Abstract
BACKGROUND Subcutaneously tunneled, cuffed central venous catheters (CVCs) are commonly used in children undergoing cytotoxic chemotherapy or hematopoietic stem-cell transplantation. When their use is no longer indicated or precluded by mechanical or infectious complications, CVCs have to be removed. General instructions on how cuffed CVC should be removed are available in the medical texts but none is adapted for use in children. MATERIALS AND METHODS A literature search from the MEDLINE and EMBASE to identify articles describing the procedure of removing CVC or complications arising from the procedure was carried out. RESULTS Specific guidance on the removal of CVC in children was not found. Venous air embolism appeared to be the most common complication associated with catheter removal but none involved pediatric patients. On the other hand, three out of the five incidents of catheter fracture with or without embolization happened in children. CONCLUSION Further studies are needed to define the optimal management of CVC removal in pediatric patients. A sequence of positioning the child, use of sedation, dissecting out the cuff, pulling off the catheter, closing the exit wound, and handling of the removed catheter is suggested.
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Affiliation(s)
- Anselm C W Lee
- Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, New Territories, Hong Kong, China.
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15
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Campisi C, Biffi R, Pittiruti M. Catheter-Related Central Venous Thrombosis: The Development of a Nationwide Consensus Paper in Italy. ACTA ACUST UNITED AC 2007. [DOI: 10.2309/java.12-1-10] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Abstract
Catheter-related central venous thrombosis is a serious complication in patients who need long-term venous access. Though scientific data and clinical experience are steadily increasing, many uncertainties still exist about several aspects of this complication, including etiology, pathogenesis, diagnosis, management, and prevention of this complication. The GAVeCeLT (the Italian Study Group for Long Term Central Venous Access) promoted a nationwide consensus, and 12 experts reviewed systematically all the available literature. A preliminary document was presented and discussed during a specific Consensus Meeting, in front of a panel of more than 80 experts (representing different health professions and disciplines). This led to a prefinal document, which was presented to more than 800 health professionals. After peer review by an external board of experts, the final document was prepared. In this article, methodology and results of the consensus are presented.
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Haghi D, Sueselbeck T, Papavassiliu T, Haase KK, Borggrefe M. Paradoxical coronary embolism causing non-ST segment elevation myocardial infarction in a case of pulmonary embolism. ACTA ACUST UNITED AC 2004; 93:824-8. [PMID: 15492899 DOI: 10.1007/s00392-004-0130-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2004] [Accepted: 06/04/2004] [Indexed: 11/27/2022]
Abstract
We describe the case of a 61-year-old woman who simultaneously suffered a pulmonary embolism and a myocardial infarction due to paradoxical coronary artery embolism. Transesophageal echocardiography with injection of agitated hydroxyethyl starch revealed a patent foramen ovale. Thrombophlebistis of the left saphenous vein with extension of thrombus into the femoral vein could be identified as the source of embolism. Paradoxical coronary embolism is an underrecognized cause of MI. Diagnosis is particularly difficult, when MI and PE coincide, because of the similarity in clinical signs and symptoms of both entities. A high level of clinical suspicion and echocardiography, especially if performed soon after presentation, can be the clue to early diagnosis of PDE.
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Affiliation(s)
- D Haghi
- I. Medizinische Klinik, Universitätsklinikum Mannheim, 68167, Mannheim, Germany.
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Reilly BK, Friedman A, Nasrallah EJ, Elkind MSV. Bihemispheric Stroke Complicating Right Pulmonary Angiography. J Vasc Interv Radiol 2003; 14:1211-3. [PMID: 14514817 DOI: 10.1097/01.rvi.0000086537.86489.cb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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18
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Sukernik MR, Mets B, Bennett-Guerrero E. Patent foramen ovale and its significance in the perioperative period. Anesth Analg 2001; 93:1137-46. [PMID: 11682383 DOI: 10.1097/00000539-200111000-00015] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- M R Sukernik
- Department of Anesthesiology, College of Physicians & Surgeons, Columbia University, New York, New York 10032, USA.
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