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Marya S, Elmalky M, Schroeder A, Tambe A. Correction of Thoracic Hypokyphosis in Adolescent Scoliosis Using Patient-Specific Rod Templating. Healthcare (Basel) 2023; 11:healthcare11070980. [PMID: 37046907 PMCID: PMC10094168 DOI: 10.3390/healthcare11070980] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/07/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023] Open
Abstract
The emphasis of surgical correction in adolescent idiopathic scoliosis (AIS) has been given to coronal plane correction of deformity without addressing the sagittal plane thoracic hypokyphosis. Thoracic hypokyphosis has been implicated in cervical malalignment, increased incidence of proximal and distal junctional kyphosis, spinopelvic incongruence, and increased incidence of low back pain. The surgeon, variability in surgical technique, and difference in rod contouring have been implicated as factors resulting in less-than-adequate restoration of thoracic kyphosis. We hypothesised that predictable correction of hypokyphosis could be achieved by using a reproducible surgical technique with patient-specific rod templating. We describe a technique of correction of AIS with dual differential rod contouring (DDC) using patient-specific rod templating to guide intraoperative rod contouring. The pre- and post-operative radiographs of 61 patients treated using this technique were reviewed to compare correction of hypokyphosis achieved with that predicted. Analysis revealed that we achieved a kyphosis within +/− 5.5 of the predicted value. The majority of patients had a post-operative kyphosis within the optimal range of 20–40 degrees. We concluded that patient-specific rod templating in DDC helps surgeons to consistently achieve sagittal correction in AIS close to a predicted value while achieving a very good coronal plane correction.
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Borton Z, Shivji F, Simeen S, Williams R, Tambe A, Espag M, Cresswell T, Clark D. Diabetic patients are almost twice as likely to experience complications from arthroscopic rotator cuff repair. Shoulder Elbow 2020; 12:109-113. [PMID: 32313560 PMCID: PMC7153207 DOI: 10.1177/1758573219831691] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/25/2019] [Indexed: 11/15/2022]
Abstract
AIMS Large population-based studies have demonstrated increased prevalence of rotator cuff disease amongst diabetics. Recent studies have suggested comparable clinical outcomes from rotator cuff repair despite suggestions of increased complication rates amongst diabetics. However, there is a relative paucity of studies considering the effect of diabetes upon complication rate. We aim to report and quantify the effect of diabetes on complication rates following arthroscopic rotator cuff repair. MATERIALS AND METHODS A retrospective review of a consecutive series of patients undergoing arthroscopic rotator cuff repair between January 2011 and December 2014 was performed. Diabetic status and complication data defined as infection, frozen shoulder, re-tear or re-operation were collected and interrogated. RESULTS A total of 462 patients were included at median follow-up of 5.6 years. Diabetics were significantly more likely to experience frozen shoulder (15.8% vs. 4.4%, p = 0.001), re-tear (26.3% vs. 15.6%, p = 0.042) or at least one complication following surgery (35.1% vs. 22.7%, p = 0.041) compared to non-diabetics. These equated to odds ratios of 4.03, 1.94 and 1.84, respectively. CONCLUSIONS Diabetic patients are almost twice as likely to experience complications following arthroscopic rotator cuff repair, including double the risk of repair failure and more than four times the risk of frozen shoulder.
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Affiliation(s)
- Z Borton
- Z Borton, C/o Mr D Clark, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK.
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Aljawadi A, Sethi G, Imo E, Arnall F, Choudhry MN, George KJ, Tambe A, Verma R, Yasin MN, Mohammed S, Siddique I. Medium-term outcome of posterior surgery in the treatment of non-tuberculous bacterial spinal infection. J Orthop 2019; 16:569-575. [PMID: 31680747 DOI: 10.1016/j.jor.2019.06.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 06/16/2019] [Indexed: 12/17/2022] Open
Abstract
Objective to evaluate the outcome of posterior spinal stabilization surgery for the management of bacterial spinal infection. Methods 21 patients with bacterial infection were managed surgically with posterior stabilization. Outcome measures included neurological status. Follow-up data collected using Spine Tango COMI questionnaires and Euro Qol EQ-5D. Results The mean improvement in neurological deficits was 0.91 Frankel grade. Residual symptoms of pain had no or minor effect on the work or usual activities in 52% of subjects, with 88% reported having either no or mid problems with mobility. Conclusion Posterior surgery can improve neurological outcome in approximately half of the patients.
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Affiliation(s)
- Ahmed Aljawadi
- Trauma and Orthopaedics, University of Salford, Salford, Manchester, M5 4WT, UK
| | - Gagan Sethi
- Trauma and Orthopaedics - Spinal, University of Salford, Manchester, UK
| | - Eze Imo
- Trauma and Orthopaedics, Arrowe Park Hospital, Wirral University Teaching Hospital NHS Foundation Trust, Merseyside, CH49 5PE, UK
| | - Frances Arnall
- School of Health Sciences, Allerton Building C711, University of Salford, Fredrick Road Campus, M6 6PU, UK
| | | | | | - Anant Tambe
- Department of Spinal Surgery, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK
| | - Rajat Verma
- Department of Spinal Surgery, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK
| | - Mohammed Naveed Yasin
- Department of Spinal Surgery, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK
| | - Saeed Mohammed
- Department of Spinal Surgery, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK
| | - Irfan Siddique
- Department of Spinal Surgery, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK
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Rauen KA, Alsaegh A, Ben-Shachar S, Berman Y, Blakeley J, Cordeiro I, Elgersma Y, Evans DG, Fisher MJ, Frayling IM, George J, Huson SM, Kerr B, Khire U, Korf B, Legius E, Messiaen L, van Minkelen R, Nampoothiri S, Ngeow J, Parada LF, Phadke S, Pillai A, Plotkin SR, Puri R, Raji A, Ramesh V, Ratner N, Shankar SP, Sharda S, Tambe A, Vikkula M, Widemann BC, Wolkenstein P, Upadhyaya M. First International Conference on RASopathies and Neurofibromatoses in Asia: Identification and advances of new therapeutics. Am J Med Genet A 2019; 179:1091-1097. [PMID: 30908877 DOI: 10.1002/ajmg.a.61125] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 03/03/2019] [Indexed: 12/31/2022]
Abstract
The neurofibromatoses, which include neurofibromatosis type I (NF1), neurofibromatosis type II (NF2), and schwannomatosis, are a group of syndromes characterized by tumor growth in the nervous system. The RASopathies are a group of syndromes caused by germline mutations in genes that encode components of the RAS/mitogen-activated protein kinase (MAPK) pathway. The RASopathies include NF1, Noonan syndrome, Noonan syndrome with multiple lentigines, Costello syndrome, cardio-facio-cutaneous syndrome, Legius syndrome, capillary malformation arterio-venous malformation syndrome, and SYNGAP1 autism. Due to their common underlying pathogenetic etiology, all these syndromes have significant phenotypic overlap of which one common feature include a predisposition to tumors, which may be benign or malignant. Together as a group, they represent one of the most common multiple congenital anomaly syndromes estimating to affect approximately one in 1000 individuals worldwide. The subcontinent of India represents one of the largest populations in the world, yet remains underserved from an aspect of clinical genetics services. In an effort to bridge this gap, the First International Conference on RASopathies and Neurofibromatoses in Asia: Identification and Advances of New Therapeutics was held in Kochi, Kerala, India. These proceedings chronicle this timely and topical international symposium directed at discussing the best practices and therapies for individuals with neurofibromatoses and RASopathies.
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Affiliation(s)
- Katherine A Rauen
- Department of Pediatics, Division of Genomic Medicine, University of California Davis, Sacramento, California
| | - Abeer Alsaegh
- Genetics Department, Sultan Qaboos University and Hospital, Muscat, Oman
| | - Shay Ben-Shachar
- Genetics Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Illinois
| | - Yemima Berman
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, Australia
| | - Jaishri Blakeley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Ype Elgersma
- Department of Neuroscience, Erasmus University Medical Center, Rotterdam, Netherlands
| | - D Gareth Evans
- Manchester Center for Genomic Medicine, University of Manchester, Manchester, United Kingdom
| | - Michael J Fisher
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ian M Frayling
- Institute of Medical Genetics, Cardiff University, Cardiff, United Kingdom
| | - Joshi George
- Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Susan M Huson
- Manchester Center for Genomic Medicine, University of Manchester, Manchester, United Kingdom
| | - Bronwyn Kerr
- Manchester Center for Genomic Medicine, University of Manchester, Manchester, United Kingdom
| | - Uday Khire
- Allomek Therapeutics, Farmington, Connecticut
| | - Bruce Korf
- Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Eric Legius
- Center for Human Genetics, University Hospitals Leuven and KULeuven, Belgium
| | - Ludwine Messiaen
- Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rick van Minkelen
- Department of Neuroscience, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Joanne Ngeow
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Luis F Parada
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Shubha Phadke
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ashok Pillai
- Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Scott R Plotkin
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Ratna Puri
- Sir Ganga Ram Hospital, New Delhi, India
| | - Anup Raji
- Manchester Center for Genomic Medicine, University of Manchester, Manchester, United Kingdom
| | - Vijaya Ramesh
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Nancy Ratner
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Suma P Shankar
- Department of Pediatics, Division of Genomic Medicine, University of California Davis, Sacramento, California
| | | | - Anant Tambe
- Royal Manchester Children's Hospital, Manchester, United Kingdom
| | | | | | | | - Meena Upadhyaya
- Institute of Medical Genetics, Cardiff University, Cardiff, United Kingdom
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Barbosa F, Titchener A, Tambe A, Espag M, Cresswell T, Clark D. Outcomes of Arthroscopic Revision Rotator Cuff Repair. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Theivendran K, Varghese M, Large R, Bateman M, Morgan M, Tambe A, Espag M, Cresswell T, Clark DI. Reverse total shoulder arthroplasty using a trabecular metal glenoid base plate. Bone Joint J 2016; 98-B:969-75. [DOI: 10.1302/0301-620x.98b7.37688] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/10/2016] [Indexed: 11/05/2022]
Abstract
Aim We present the medium-term clinical results of a reverse total shoulder arthroplasty with a trabecular metal glenoid base plate. Patients and Methods We reviewed 125 consecutive primary reverse total shoulder arthroplasties (RTSA) implanted in 124 patients for rotator cuff arthropathy. There were 100 women and 24 men in the study group with a mean age of 76 years (58 to 89). The mean follow-up was 32 months (24 to 60). No patient was lost to follow-up. There were statistically significant improvements in the mean range of movement and Oxford Shoulder Score (p < 0.001). Kaplan-Meier survivorship at five years was 96.7% (95% confidence interval 91.5 to 98.7) with aseptic glenoid failure as the end point. Radiologically, 63 shoulders (50.4%) showed no evidence of notching, 51 (40.8%) had grade 1 notching, ten (8.0%) had grade 2 notching and one (0.8%) had grade 4 notching. Radiolucency around the glenoid base plate was found in one patient (0.8%) and around the humeral stem in five (4.0%). In all, three RTSA (2.4%) underwent revision surgery for aseptic mechanical failure of the glenoid within 11 months of surgery due to malseating of the glenosphere. Conclusion The clinical results of this large independent single unit series are comparable to those from previous series of RTSA reported in the literature. A trabecular metal base plate is safe and effective in the medium-term. Cite this article: Bone Joint J 2016;98-B:969–75.
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Affiliation(s)
| | - M. Varghese
- Royal Derby Hospital, Derby, Derbyshire, DE22
3NE, UK
| | - R. Large
- Royal Derby Hospital, Derby, Derbyshire, DE22
3NE, UK
| | - M. Bateman
- Royal Derby Hospital, Derby, Derbyshire, DE22
3NE, UK
| | - M. Morgan
- Royal Derby Hospital, Derby, Derbyshire, DE22
3NE, UK
| | - A. Tambe
- Royal Derby Hospital, Derby, Derbyshire, DE22
3NE, UK
| | - M. Espag
- Royal Derby Hospital, Derby, Derbyshire, DE22
3NE, UK
| | - T. Cresswell
- Royal Derby Hospital, Derby, Derbyshire, DE22
3NE, UK
| | - D. I. Clark
- Royal Derby Hospital, Derby, Derbyshire, DE22
3NE, UK
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Abstract
Medium-term results of the Discovery elbow replacement are presented. We reviewed 51 consecutive primary Discovery total elbow replacements (TERs) implanted in 48 patients. The mean age of the patients was 69.2 years (49 to 92), there were 19 males and 32 females (37%:63%) The mean follow-up was 40.6 months (24 to 69). A total of six patients were lost to follow-up. Statistically significant improvements in range movement and Oxford Elbow Score were found (p < 0.001). Radiolucent lines were much more common in, and aseptic loosening was exclusive to, the humeral component. Kaplan-Meier survivorship at five years was 92.2% (95% CI 74.5% to 96.4%) for aseptic loosening. In four TERs, periprosthetic infection occurred resulting in failure. A statistically significant association between infection and increased BMI was found (p = 0.0268). Triceps failure was more frequent after the Mayo surgical approach and TER performed after previous trauma surgery. No failures of the implant were noted. Our comparison shows that the Discovery has early clinical results that are similar to other semi-constrained TERs. We found continued radiological surveillance with particular focus on humeral lucency is warranted and has not previously been reported. Despite advances in the design of total elbow replacement prostheses, rates of complication remain high.
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Affiliation(s)
- R Large
- Mornington Orthopaedics, Beleura Private Hospital, 925 Nepean Highway, Mornington, Victoria, 3931, Australia
| | - A Tambe
- Royal Derby Hospital, Department of Orthopaedics, Uttoxeter New Road, Derby DE22 3NE, UK
| | - T Cresswell
- Royal Derby Hospital, Department of Orthopaedics, Uttoxeter New Road, Derby DE22 3NE, UK
| | - M Espag
- Royal Derby Hospital, Department of Orthopaedics, Uttoxeter New Road, Derby DE22 3NE, UK
| | - D I Clark
- Royal Derby Hospital, Department of Orthopaedics, Uttoxeter New Road, Derby DE22 3NE, UK
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Whitehouse S, Stephenson J, Sinclair V, Gregory J, Tambe A, Verma R, Siddique I, Saeed M. A validation of the Oswestry Spinal Risk Index. Eur Spine J 2014; 25:247-251. [PMID: 25391625 DOI: 10.1007/s00586-014-3665-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 11/03/2014] [Accepted: 11/03/2014] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study was to validate the Oswestry Spinal Risk Index (OSRI) in an external population. The OSRI predicts survival in patients with metastatic spinal cord compression (MSCC). METHODS We analysed the data of 100 patients undergoing surgical intervention for MSCC at a tertiary spinal unit and recorded the primary tumour pathology and Karnofsky performance status to calculate the OSRI. Logistic regression models and survival plots were applied to the data in accordance with the original paper. RESULTS Lower OSRI scores predicted longer survival. The OSRI score predicted survival accurately in 74% of cases (p = 0.004). CONCLUSIONS Our study has found that the OSRI is a significant predictor of survival at levels similar to those of the original authors and is a useful and simple tool in aiding complex decision making in patients presenting with MSCC.
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Affiliation(s)
- S Whitehouse
- ST7 Orthopaedics, North West Deanery, Manchester, UK.
| | - J Stephenson
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - V Sinclair
- ST7 Orthopaedics, North West Deanery, Manchester, UK
| | - J Gregory
- University of Manchester, Manchester, UK
| | - A Tambe
- Salford Royal Foundation Trust, Salford, UK
| | - R Verma
- Salford Royal Foundation Trust, Salford, UK
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Tambe A, Patil SB, Bhat S, Badadare MM. Andrew's bridge system: an aesthetic and functional option for rehabilitation of compromised maxillary anterior dentition. Case Reports 2014; 2014:bcr-2014-203988. [DOI: 10.1136/bcr-2014-203988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Tambe A, Ali F, Trail I, Stanley J. Is radiolunate fusion a viable option in advanced Kienböck disease? Acta Orthop Belg 2007; 73:598-603. [PMID: 18019915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The management of Kienböck's disease in the advanced stages (Lichtman stages 3B and 4) remains controversial. The aim of this study was to report the results of radiolunate fusion (Chamay) in patients with advanced Kienböck with localised radiolunate chondral changes. There were six patients. The average age was 40 years and the mean follow-up was 67 months. The average postoperative visual analogue pain score was 6, which was not a significant improvement on the preoperative score. The average postoperative carpal height achieved using the Modified Bauman's Index was 1.32, significantly less than normal. The average postoperative DASH score was 41.02, not significantly better than the preoperative score. The average grip strength and satisfaction rating were 0.55 and 3.83 respectively. Three of the six patients who had radiolunate fusions were clinically defined as failures and underwent total wrist fusion. Based on these findings, although radiolunate fusion appears as an attractive proposition in patients with localised chondral changes, we do not recommend its routine use in advanced Kienböck's disease.
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Affiliation(s)
- Anant Tambe
- Wrightington Hospital, Wrightington, Wigan, UK.
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Abstract
STUDY DESIGN Case report. A hitherto unreported finding of a bony loose body found lying in the spinal canal causing spinal canal stenosis is presented. SUMMARY OF CLINICAL DETAILS A 68-year-old, fit man presented with a history of progressive neurologic claudication and neurologic deficit in both his lower limbs. Clinical examination revealed excellent range of movements in his lumbar spine and bilaterally normal straight leg raising. He had no significant pain in his back. Neurologic examination showed affection of L5 and S1 dermatomes and myotomes bilaterally. Magnetic resonance imaging scan showed severe localized lumbar spinal stenosis at L4-L5. In the absence of any obvious pathology on the scan, it was presumed that the stenosis was the result of infolding of the redundant ligamentum flavum. His walking distance and neurologic deficit continued to deteriorate, although sphincters were not involved. He underwent a posterior spinal decompression of L4-L5. On performing the laminectomy an ovoid and well-defined pearly white loose body was discovered lying loose in the spinal canal causing stenosis. Histologically, the loose body consisted of trabecular bone with areas of cartilage. The patient made a speedy recovery after surgery and was back to his previous level of activity within a month. DISCUSSION Several different types of foreign body have been identified in the spinal canal. However, this case of an autologous loose body in the spinal canal causing symptomatic canal stenosis is unique. Because the authors could not identify the source of this loose body, they have termed it "spinolith."
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Affiliation(s)
- A Tambe
- Department of Orthopaedics, Derbyshire Royal Infirmary, London, United Kingdom.
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Tambe A, Zimmerman HA. Diseases of the aortic valve. Geriatrics (Basel) 1967; 22:180-9. [PMID: 6033213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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