1
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Dayma K, David A, Omer A, Abdel-Dayam H, Tawil A, Socci N, Ahmed L, Gilet A, Haddad D. Routine Upper Gastrointestinal Series Post-bariatric Surgery: Predictors, Usage, and Utility. Obes Surg 2024; 34:1552-1560. [PMID: 38564172 DOI: 10.1007/s11695-024-07125-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To investigate usage and utility of routine upper gastrointestinal (UGI) series in the immediate post-operative period to evaluate for leak and other complications. METHODS Single institution IRB-approved retrospective review of patients who underwent bariatric procedure between 01/08 and 12/12 with at least 6-month follow-up. RESULTS Out of 135 patients (23%) who underwent routine UGI imaging, 32% of patients were post-gastric bypass (127) versus 4% of sleeve gastrectomy (8). In patients post-gastric bypass, 22 were found with delayed contrast passage, 3 possible obstruction, 4 possible leak, and only 1 definite leak. In patients post-sleeve gastrectomy, 2 had delayed passage of contrast without evidence of a leak. No leak was identified in 443 patients (77%) who did not undergo imaging. The sensitivity and specificity of UGI series for the detection of leak in gastric bypass patients were 100% and 97%, respectively, and the positive and negative predictive values were 20% and 100%, respectively. On univariate and multivariate analysis, sleeve gastrectomy patients (OR 0.4 sleeve vs bypass; P < 0.01) and male patients (OR 0.4 M vs F; P 0.02) were less likely to undergo routine UGI series (OR 0.4 M vs F; P 0.02). CONCLUSION Routine UGI series may be of limited value for the detection of anastomotic leaks after gastric bypass or sleeve gastrectomy and patients should undergo routine imaging based on clinical parameters. Gastric bypass procedure and female gender were factors increasing the likelihood of routine post-operative UGI. Further larger scale analysis of this important topic is warranted.
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Affiliation(s)
- Ketan Dayma
- Department of Radiology, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| | - Aruna David
- Department of Radiology, Harlem Hospital Center, New York, NY, 10037, USA
| | - Adil Omer
- Department of Radiology, Harlem Hospital Center, New York, NY, 10037, USA
| | - Haneen Abdel-Dayam
- Department of Radiology, Harlem Hospital Center, New York, NY, 10037, USA
| | - Anan Tawil
- Department of Surgery, Harlem Hospital Center, New York, NY, 10037, USA
| | - Nicholas Socci
- Department of Bioinformatics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10021, USA
| | - Leaque Ahmed
- Department of Radiology, Harlem Hospital Center, New York, NY, 10037, USA
| | - Anthony Gilet
- Department of Radiology, Harlem Hospital Center, New York, NY, 10037, USA
- Department of Radiology, Westchester Medical Center, Westchester, NY, 10595, USA
| | - Dana Haddad
- Department of Radiology, Harlem Hospital Center, New York, NY, 10037, USA.
- School of Medicine, Mohammed Bin Rashid University, Dubai, United Arab Emirates.
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2
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Canastar M, Okumura K, Bodin R, Gilet A, Dhand A. Cirrhosis and COVID-19: Diffuse venous thrombosis and its clinical implication. J Liver Transpl 2022; 8:100105. [PMID: 38013900 PMCID: PMC9213027 DOI: 10.1016/j.liver.2022.100105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/21/2022] Open
Abstract
A 60-year-old woman with Hepatitis C infection, cirrhosis, recurrent hepatic hydrothorax, and hepatocellular carcinoma was hospitalized with Coronavirus disease-2019 (COVID-19). After her initial discharge, she was re-admitted three weeks later with decompensated liver disease. Imaging revealed extensive thrombosis in the portal vein, superior mesenteric vein, splenic vein and bilateral brachial veins. Given the acute onset and extent of the thrombosis, the patient received therapeutic anticoagulation despite elevated prothrombin time/ international normalized ratio, thrombocytopenia and low fibrinogen. Cirrhotic patients with COVID-19 maybe at high risk of thrombosis, which can present with significant hepatic decompensation.
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Affiliation(s)
- Mehtap Canastar
- Gastroenterology and Hepatology, Westchester Medical Center / New York Medical College, Valhalla, United States
| | - Kenji Okumura
- Surgery, Westchester Medical Center / New York Medical College, Valhalla, United States
| | - Roxana Bodin
- Gastroenterology and Hepatology, Westchester Medical Center / New York Medical College, Valhalla, United States
- Surgery, Westchester Medical Center / New York Medical College, Valhalla, United States
| | - Anthony Gilet
- Radiology, NY IMAGING Specialists, Port Jefferson Station, United States
| | - Abhay Dhand
- Surgery, Westchester Medical Center / New York Medical College, Valhalla, United States
- Medicine/Infectious Diseases, Westchester Medical Center / New York Medical College, Valhalla, United States
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3
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Shilagani C, Lansman S, Gilet A, Flusberg M. IgG4 aortitis of the ascending thoracic aorta: A case report and literature review. J Radiol Case Rep 2021; 15:1-9. [PMID: 34276873 DOI: 10.3941/jrcr.v15i5.3985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
IgG4 aortitis is a recently recognized entity that can have clinical and imaging features that mimic acute aortic syndrome. Therefore, it is imperative for radiologists to be aware of how to potentially differentiate the two. Although this entity has been previously described via case reports and meta-analysis in the context of inflammatory abdominal aortic aneurysm, very few cases of ascending aortic involvement have been reported. In this case report, we present a case of a 60-year-old female transferred from another facility for an initial diagnosis of intramural hematoma of the ascending aorta and later found to have IgG4 aortitis post aortic root repair. This is a histologically confirmed case of multi-segmented IgG4 aortitis with rare involvement of both ascending and infra-renal aorta. We will briefly discuss the pathophysiology of IgG4 aortitis, along with review of literature.
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Affiliation(s)
- Chaitanya Shilagani
- Department of Diagnostic Radiology, Westchester Medical Center, Valhalla, NY, USA
| | - Steven Lansman
- Department of Cardiothoracic Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Anthony Gilet
- Department of Diagnostic Radiology, Westchester Medical Center, Valhalla, NY, USA
| | - Milana Flusberg
- Department of Diagnostic Radiology, Westchester Medical Center, Valhalla, NY, USA
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4
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Kobi M, Veillette G, Narurkar R, Sadowsky D, Paroder V, Shilagani C, Gilet A, Flusberg M. Imaging and Management of Pancreatic Cancer. Semin Ultrasound CT MR 2020; 41:139-151. [PMID: 32446428 DOI: 10.1053/j.sult.2019.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Pancreatic cancer is an aggressive disease with rising incidence and high mortality despite advances in imaging and therapeutic options. Surgical resection is currently the only curative treatment, with expanding roles for adjuvant and neoadjuvant chemoradiation. Accurate detection, staging, and post-treatment monitoring of pancreatic cancer are critical to improving survival and imaging plays a central role in the multidisciplinary approach to this disease. This article will provide a broad overview of the imaging and management of pancreatic cancer with a focus on diagnosis and staging, operative and nonoperative treatments, and post-therapeutic appearances after surgery and chemoradiation therapy.
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Affiliation(s)
- Mariya Kobi
- Department of Radiology, Montefiore Medical Center, Bronx, NY
| | | | - Roshni Narurkar
- Department of Hematology and Oncology, Westchester Medical Center, Valhalla, NY
| | - David Sadowsky
- Department of Radiology, Westchester Medical Center, Valhalla, NY
| | - Viktoriya Paroder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Anthony Gilet
- Department of Radiology, Westchester Medical Center, Valhalla, NY
| | - Milana Flusberg
- Department of Radiology, Westchester Medical Center, Valhalla, NY.
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5
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Kobi M, Veillette G, Narurkar R, Sadowsky D, Paroder V, Shilagani C, Gilet A, Flusberg M. DUPLICATE: Imaging and Management of Pancreatic Cancer. Semin Ultrasound CT MR 2019. [DOI: 10.1053/j.sult.2019.12.001] [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: 11/11/2022]
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6
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Sadowsky D, Li T, Hasan U, Harnain C, Gilet A, Gerard P. Making Sense of MACRA: A Guide for Diagnostic Radiologists. Curr Probl Diagn Radiol 2019; 48:1-3. [DOI: 10.1067/j.cpradiol.2018.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/02/2018] [Accepted: 05/18/2018] [Indexed: 11/22/2022]
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7
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Tong A, Veillette G, Budhai A, Gilet A. Intraductal oncocytic papillary neoplasm: a benign hepatic cystic neoplasm. BMJ Case Rep 2017; 2017:bcr-2016-218139. [PMID: 28438794 DOI: 10.1136/bcr-2016-218139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 61-year-old Asian man presented with severe right upper quadrant pain which had been worsening for several months. Laboratory results indicated elevated aspartate aminotransferase and alanine aminotransferase. The subsequent ultrasound, CT and MRI showed a large cystic mass with solid components and severe intrahepatic and extrahepatic biliary ductal dilatation. The mass was resected and pathology showed a well-demarcated mucinous cystic lesion with polygonal cells containing ovoid nuclei and abundant pink oncocytic cytoplasm. These findings are characteristic of intraductal oncocytic papillary neoplasm (IOPN), a rare subtype of intraductal papillary neoplasm of the liver. IOPN occurs most frequently in the Asian regions endemic to clonorchiasis and hepatolithiasis; however, cases have been reported in the Western world as well. Patients with IOPN are male or female and typically middle-aged. Treatment is typically resection. Prognosis is favourable and recurrence is rare. The 5-year survival rate is upwards of 80%.
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Affiliation(s)
- Angela Tong
- Radiology, Westchester Medical Center, New York Medical Center, Valhalla, New York, USA
| | - Gregory Veillette
- Transplant Surgery, Westchester Medical Center, New York Medical Center, Valhalla, New York, USA
| | | | - Anthony Gilet
- Radiology, Westchester Medical Center, Valhalla, New York, USA
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8
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Khan MH, Khera S, Schnittman S, Love A, Shareef A, Ojo A, Ahmad H, Kaple R, Undemir C, Cohen M, Bennett J, Dutta T, Gilet A, Rozenshtein A, Poniros A, Kearns A, Feng C, Lansman S, Tang G. PREDICTORS OF NEW PERSISTENT LEFT BUNDLE BRANCH BLOCK AFTER EDWARDS SAPIEN 3 TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34727-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Zhang Y, Shilagani C, Maddineni S, Gilet A, Zhang Y. Revisiting traumatic splenic injuries: the role of CT grading and splenic artery embolization. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.1036] [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: 11/29/2022] Open
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10
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Zaid S, Raza A, Michev I, AHMAD HASAN, Kaple R, Undemir C, Poniros A, Kearns A, Bennett J, Feng C, Dutta T, Shah A, Gilet A, Cohen M, Lansman S, Tang G. TCT-712 “Cusp Overlap” View Facilitates Accurate Fluoro-Guided Implantation of Self-Expanding Valve in TAVR. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.125] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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11
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Gnerre J, Sun Y, Jedynak A, Gilet A. Case Report: Gallbladder Varices in a Patient with Portal Vein Thrombosis Secondary to Hepatocellular Carcinoma. J Radiol Case Rep 2016; 10:22-28. [PMID: 27761177 DOI: 10.3941/jrcr.v10i5.2416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Gallbladder varices are a rare form of collateralization that develop in patients with portal hypertension. We present here a case of gallbladder varices accurately diagnosed by contrast enhanced CT imaging of the abdomen and confirmed by Color Doppler Sonography. A 76-year-old patient with hepatocellular carcinoma developed portal vein thrombosis due to tumor extension during the course of treatment and was incidentally discovered to have gallbladder varices. While most commonly asymptomatic, gallbladder varices are associated with increased risk of massive bleeding, either spontaneously or during cholecystectomy. As a result, the existence of such varices should be well documented if the patient is to undergo any abdominal surgical procedures. In addition, because of a particular association with portal vein thrombosis, patients with portal hypertension that are found to possess gallbladder varices should be evaluated for portal vein thrombosis.
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Affiliation(s)
- Jeffrey Gnerre
- Department of Radiology, Westchester Medical Center, Valhalla, USA
| | - Yankai Sun
- Department of Radiology, Westchester Medical Center, Valhalla, USA
| | - Andrzej Jedynak
- Department of Radiology, Westchester Medical Center, Valhalla, USA
| | - Anthony Gilet
- Department of Radiology, Westchester Medical Center, Valhalla, USA
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12
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Zhang Y, Gnerre JM, Jedynak A, Gilet A. Unilateral absence of the pulmonary artery and cavernous transformation of portal vein: a rare combination. BMJ Case Rep 2016; 2016:bcr-2015-212275. [PMID: 26823350 DOI: 10.1136/bcr-2015-212275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Yachao Zhang
- Department of Radiology, Westchester Medical Center, Valhalla, New York, USA
| | | | - Andrzej Jedynak
- Department of Radiology, Westchester Medical Center, Valhalla, New York, USA
| | - Anthony Gilet
- Department of Radiology, Westchester Medical Center, Valhalla, New York, USA
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13
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Shaish H, Gilet A, Gerard P. 'It's all foreign to me': how to decipher gastrointestinal intraluminal foreign bodies. Abdom Imaging 2015; 40:2173-2192. [PMID: 25952573 DOI: 10.1007/s00261-015-0434-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In evaluating the gastrointestinal tract, whether in the emergency room setting, the inpatient setting or the outpatient setting, the radiologist may encounter a myriad of intraluminal radio-opaque, non-anatomic entities. It is the radiologist's role to distinguish between true foreign bodies and medical paraphernalia. Further, the later must be evaluated for proper positioning vs. improper, potentially detrimental positioning. While many foreign bodies from the community may be distinctly familiar to the radiologist, the large variety of medical tools in existence may not be. Furthermore, many medical devices are designed to transiently traverse, or interact with the gastrointestinal tract, requiring the radiologist to become familiar with their natural history. We explore a select group of common and uncommon intraluminal foreign bodies and will divide them into medical paraphernalia that are properly positioned; medical paraphernalia that are in abnormal locations and miscellaneous foreign bodies from the community. For each medical tool, we will discuss its development and medical utility, natural history as it relates to the gastrointestinal tract, optimal positioning as assessed radiologically, malpositioning, and subsequent complications. A small selection of unusual foreign bodies from the community will be presented. Finally, a selection of medical conditions which produce symptoms due to acquired intraluminal objects will be reviewed.
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Affiliation(s)
- Hiram Shaish
- Department of Radiology, Westchester Medical Center, 100 Woods Rd., Valhalla, NY, 10595, USA.
| | - Anthony Gilet
- Department of Radiology, Westchester Medical Center, 100 Woods Rd., Valhalla, NY, 10595, USA
| | - Perry Gerard
- Department of Radiology, Westchester Medical Center, 100 Woods Rd., Valhalla, NY, 10595, USA
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14
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Tank J, Knoll A, Gilet A, Kim S. Imaging characteristics of androgen insensitivity syndrome. Clin Imaging 2015; 39:707-10. [DOI: 10.1016/j.clinimag.2015.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/22/2015] [Accepted: 02/06/2015] [Indexed: 10/24/2022]
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15
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Rosenkrantz AB, Chandarana H, Gilet A, Deng FM, Babb JS, Melamed J, Taneja SS. Prostate cancer: Utility of diffusion-weighted imaging as a marker of side-specific risk of extracapsular extension. J Magn Reson Imaging 2012; 38:312-9. [DOI: 10.1002/jmri.23972] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 10/31/2012] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Hersh Chandarana
- Department of Radiology; NYU Langone Medical Center; New York; New York; USA
| | - Anthony Gilet
- Department of Radiology; NYU Langone Medical Center; New York; New York; USA
| | - Fang-Ming Deng
- Department of Pathology; NYU Langone Medical Center; New York; New York; USA
| | - James S. Babb
- Department of Radiology; NYU Langone Medical Center; New York; New York; USA
| | - Jonathan Melamed
- Department of Pathology; NYU Langone Medical Center; New York; New York; USA
| | - Samir S. Taneja
- Division of Urologic Oncology; Department of Urology; NYU Langone Medical Center; New York; New York; USA
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16
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Affiliation(s)
- Jinchun Yan
- Department of Radiology, University of Washington Medical Center, Seattle, Washington, USA.
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17
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Wu GS, Gilet A, Kirshbaum M, Bilfinger T, Ferretti J. Inferior Vena Cava Filter Migration with Severe Deformity of Filter. J Vasc Interv Radiol 2009; 20:1257-9. [DOI: 10.1016/j.jvir.2009.05.040] [Citation(s) in RCA: 2] [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] [Received: 12/06/2008] [Revised: 05/17/2009] [Accepted: 05/20/2009] [Indexed: 10/20/2022] Open
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18
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Boumenir M, Walczak C, Hanriot D, Gilet A, Poitevin G, Thornton S, Lacolley P, Ropars A. K009 Aldosterone plays a role in tissue repair by enhancing MMP-9 activity in immune cells. Arch Cardiovasc Dis 2009. [DOI: 10.1016/s1875-2136(09)72412-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Azencott A, Besson F, Rutkiewicz S, Gilet A. [Home assisted ventilation for patients suffering from silicosis (author's transl)]. Rev Fr Mal Respir 1979; 7:360-2. [PMID: 398553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
One hundred and seventy-five patients suffering from silicosis benefitted from home assisted ventilation at the rate of 5 minutes per hour every hour. This treatment led to a decrease in hospitalizations and increased the comfort of the patients.
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