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Wessell AP, Carvalho HDP, Le E, Cannarsa G, Kole MJ, Stokum JA, Chryssikos T, Miller TR, Chaturvedi S, Gandhi D, Yarbrough K, Satti SR, Jindal G. A Critical Assessment of the Golden Hour and the Impact of Procedural Timing in Stroke Thrombectomy. AJNR Am J Neuroradiol 2020; 41:822-827. [PMID: 32414902 DOI: 10.3174/ajnr.a6556] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 03/04/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies in acute ischemic stroke have demonstrated the importance of minimizing delays to endovascular treatment and keeping thrombectomy procedural times at <30-60 minutes. The purpose of this study was to investigate the impact of thrombectomy procedural times on clinical outcomes. MATERIALS AND METHODS We retrospectively compared 319 patients having undergone thrombectomy according to procedural time (<30 minutes, 30-60 minutes, and >60 minutes) and time from stroke onset to endovascular therapy (≤6 or >6 hours). Clinical characteristics of patients with postprocedural intracranial hemorrhage were also assessed. Logistic regression was used to determine independent predictors of poor outcome at 90 days (mRS ≥3). RESULTS Greater age (OR, 1.03; 95% CI, 1.01-1.06; P = .016), higher admission NIHSS score (OR, 1.10; 95% CI, 1.04-1.16; P = .001), history of diabetes mellitus (OR, 1.96; 95% CI, 1.05-3.65; P = .034), and postprocedural intracranial hemorrhage were independently associated with greater odds of poor outcome. Modified TICI scale scores of 2c (OR, 0.11; 95% CI, 0.04-0.28; P < .001) and 3 (OR, 0.15; 95% CI, 0.06-0.38; P < .001) were associated with reduced odds of poor outcome. Although not statistically significant on univariate analysis, onset to endovascular therapy of >6 hours was independently associated with increased odds of poor outcome (OR, 2.20; 95% CI, 1.11-4.36; P = .024) in the final multivariate model (area under the curve = 0.820). Procedural time was not independently associated with clinical outcome in the final multivariate model (P > .05). CONCLUSIONS Thrombectomy procedural times beyond 60 minutes are associated with lower revascularization rates and worse 90-day outcomes. Procedural time itself was not an independent predictor of outcome. While stroke thrombectomy procedures should be performed rapidly, our study emphasizes the significance of achieving revascularization despite the requisite procedural time. However, the potential for revascularization must be weighed against the risks associated with multiple thrombectomy attempts.
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Affiliation(s)
- A P Wessell
- Departments of Neurosurgery (A.P.W., G.C., M.J.K., J.A.S., T.C.)
| | - H D P Carvalho
- From the Division of Interventional Neuroradiology (H.D.P.C., E.L., T.R.M., D.G., G.J.)
| | - E Le
- From the Division of Interventional Neuroradiology (H.D.P.C., E.L., T.R.M., D.G., G.J.)
| | - G Cannarsa
- Departments of Neurosurgery (A.P.W., G.C., M.J.K., J.A.S., T.C.)
| | - M J Kole
- Departments of Neurosurgery (A.P.W., G.C., M.J.K., J.A.S., T.C.)
| | - J A Stokum
- Departments of Neurosurgery (A.P.W., G.C., M.J.K., J.A.S., T.C.)
| | - T Chryssikos
- Departments of Neurosurgery (A.P.W., G.C., M.J.K., J.A.S., T.C.)
| | - T R Miller
- From the Division of Interventional Neuroradiology (H.D.P.C., E.L., T.R.M., D.G., G.J.)
| | - S Chaturvedi
- Neurology (S.C., K.Y.), University of Maryland Medical Center, Baltimore, Maryland
| | - D Gandhi
- From the Division of Interventional Neuroradiology (H.D.P.C., E.L., T.R.M., D.G., G.J.)
| | - K Yarbrough
- Neurology (S.C., K.Y.), University of Maryland Medical Center, Baltimore, Maryland
| | - S R Satti
- Department of Neurointerventional Surgery (S.R.S.), Christiana Care Health System, Newark, Delaware
| | - G Jindal
- From the Division of Interventional Neuroradiology (H.D.P.C., E.L., T.R.M., D.G., G.J.)
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Choksi A, Tsymbalyuk S, Tolaymat B, Li G, Gandhi D, Miller T, Jindal G, Chao C. Abstract No. 463 First Independent review of the vascade vascular closure device: the only device marketed as “proven” safer than manual compression. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.544] [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: 11/25/2022] Open
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Miller TR, Kole MJ, Le EJ, Cannarsa G, Jones S, Wessell AP, Jindal G, Aldrich EF, Simard JM, Gandhi D. Pipeline Diameter Significantly Impacts the Long-Term Fate of Jailed Side Branches during Treatment of Intracranial Aneurysms. AJNR Am J Neuroradiol 2018; 39:2270-2277. [PMID: 30385475 DOI: 10.3174/ajnr.a5863] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/28/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Although covered side branches typically remain patent acutely following Pipeline Embolization Device embolization of intracranial aneurysms, the long-term fate of these vessels remains uncertain. We therefore elected to investigate factors that may influence the long-term patency of these covered side branches. MATERIALS AND METHODS We retrospectively evaluated the long-term patency of side branches covered by the Pipeline Embolization Device at our institution during treatment of intracranial aneurysms with at least 6 months of conventional angiography follow-up. Procedural and anatomic factors that might influence the fate of covered side branches were explored. RESULTS One hundred forty-eight Pipeline Embolization Device treatments in 137 patients met the inclusion criteria. In 217 covered side branches, 29 (13.4%) were occluded on follow-up, and 40 (18.4%) were stenotic. All stenoses and occlusions were asymptomatic. In the entire cohort and in the largest subset of ophthalmic arteries, a smaller Pipeline Embolization Device diameter was associated with branch vessel occlusion (P = .001, P = .013). When we considered stenotic and occluded side branches together, smaller Pipeline Embolization Device size (P = .029) and administration of intraprocedural abciximab (P = .03) predicted side branch stenosis/occlusion, while anterior choroidal branch type (P = .003) was a predictor of gross side branch patency. CONCLUSIONS A smaller Pipeline Embolization Device diameter is associated with delayed side branch stenosis/occlusion following Pipeline Embolization Device treatment, likely due to the higher metal density of smaller caliber devices. Although hemodynamic factors, including the potential for collateral flow, are still paramount in determining the fate of covered side branches, the amount of metal coverage at the side branch orifice also plays an important role.
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Affiliation(s)
- T R Miller
- From the Departments of Diagnostic Radiology (T.R.M., G.J., D.G.)
| | - M J Kole
- Neurosurgery (M.J.K., E.J.L., G.C., S.J., A.P.W., G.J., E.F.A., J.M.S., D.G.), University of Maryland Medical Center, Baltimore, Maryland
| | - E J Le
- Neurosurgery (M.J.K., E.J.L., G.C., S.J., A.P.W., G.J., E.F.A., J.M.S., D.G.), University of Maryland Medical Center, Baltimore, Maryland
| | - G Cannarsa
- Neurosurgery (M.J.K., E.J.L., G.C., S.J., A.P.W., G.J., E.F.A., J.M.S., D.G.), University of Maryland Medical Center, Baltimore, Maryland
| | - S Jones
- Neurosurgery (M.J.K., E.J.L., G.C., S.J., A.P.W., G.J., E.F.A., J.M.S., D.G.), University of Maryland Medical Center, Baltimore, Maryland
| | - A P Wessell
- Neurosurgery (M.J.K., E.J.L., G.C., S.J., A.P.W., G.J., E.F.A., J.M.S., D.G.), University of Maryland Medical Center, Baltimore, Maryland
| | - G Jindal
- From the Departments of Diagnostic Radiology (T.R.M., G.J., D.G.).,Neuroradiology (G.J., D.G.).,Neurosurgery (M.J.K., E.J.L., G.C., S.J., A.P.W., G.J., E.F.A., J.M.S., D.G.), University of Maryland Medical Center, Baltimore, Maryland
| | - E F Aldrich
- Neurosurgery (M.J.K., E.J.L., G.C., S.J., A.P.W., G.J., E.F.A., J.M.S., D.G.), University of Maryland Medical Center, Baltimore, Maryland
| | - J M Simard
- Neurosurgery (M.J.K., E.J.L., G.C., S.J., A.P.W., G.J., E.F.A., J.M.S., D.G.), University of Maryland Medical Center, Baltimore, Maryland
| | - D Gandhi
- From the Departments of Diagnostic Radiology (T.R.M., G.J., D.G.).,Neuroradiology (G.J., D.G.).,Neurosurgery (M.J.K., E.J.L., G.C., S.J., A.P.W., G.J., E.F.A., J.M.S., D.G.), University of Maryland Medical Center, Baltimore, Maryland
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Gupta V, Jindal G, Serulle Y, Stoner J, Miller T, Gandhi D. Abstract No. 674 Recent technical advancements in endovascular stroke treatment are associated with a decrease in time to recanalization, contrast material volume, and incidence of contrast induced nephropahty. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.719] [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: 10/17/2022] Open
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Miller TR, Zhuo J, Jindal G, Shivashankar R, Beaty N, Gandhi D. The Efficacy of Shielding Systems for Reducing Operator Exposure during Neurointerventional Procedures: A Real-World Prospective Study. AJNR Am J Neuroradiol 2017; 38:450-454. [PMID: 28007766 DOI: 10.3174/ajnr.a5038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 10/12/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Neurointerventional surgery may expose patients and physician operators to substantial amounts of ionizing radiation. Although strategies for reducing patient exposure have been explored in the medical literature, there has been relatively little published in regards to decreasing operator exposure. The purpose of this study was to evaluate the efficacy of shielding systems in reducing physician exposure in a modern neurointerventional practice. MATERIALS AND METHODS Informed consent was obtained from operators for this Health Insurance Portability and Accountability Act-compliant, institutional review board-approved study. Operator radiation exposure was prospectively measured during 60 consecutive neurointerventional procedures from October to November 2013 using a 3-part lead shielding system. Exposure was then evaluated without lead shielding in a second 60-procedure block from April to May 2014. A radiation protection drape was randomly selected for use in half of the cases in each block. Two-way analysis of covariance was performed to test the effect of shielding systems on operator exposure while controlling for other covariates, including procedure dose-area product. RESULTS Mean operator procedure dose was 20.6 μSv for the entire cohort and 17.7 μSv when using some type of shielding. Operator exposure significantly correlated with procedure dose-area product, but not with other covariates. After we adjusted for procedure dose-area product, the use of lead shielding or a radiation protection drape significantly reduced operator exposure by 45% (F = 12.54, P < .0001) and 29% (F = 7.02, P = .009), respectively. The difference in protection afforded by these systems was not statistically significant (P = .46), and their adjunctive use did not provide additional protection. CONCLUSIONS Extensive lead shielding should be used as much as possible in neurointerventional surgery to reduce operator radiation exposure to acceptable levels. A radiation protection drape is a reasonable alternative when standard lead shielding is unavailable or impractical to use without neglecting strategies to minimize the dose.
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Affiliation(s)
- T R Miller
- From the Departments of Diagnostic Radiology, Neuroradiology (T.R.M., J.Z., G.J., R.S., D.G.)
| | - J Zhuo
- From the Departments of Diagnostic Radiology, Neuroradiology (T.R.M., J.Z., G.J., R.S., D.G.)
| | - G Jindal
- From the Departments of Diagnostic Radiology, Neuroradiology (T.R.M., J.Z., G.J., R.S., D.G.)
| | - R Shivashankar
- From the Departments of Diagnostic Radiology, Neuroradiology (T.R.M., J.Z., G.J., R.S., D.G.)
| | - N Beaty
- Neurosurgery (N.B.), University of Maryland Medical Center, Baltimore, Maryland
| | - D Gandhi
- From the Departments of Diagnostic Radiology, Neuroradiology (T.R.M., J.Z., G.J., R.S., D.G.)
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Metha R, Gahlot GPS, Das P, Jindal G, Mouli VP, Madhusudhan KS, Sharma R, Pal S, Ahuja V, DattaGupta S. Sclerosing mesenteric panniculitis in a young patient : common cause of diagnostic dilemma and treatment refractoriness. Acta Gastroenterol Belg 2016; 79:254-256. [PMID: 27382948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Sclerosing mesenteric panniculitis (SMP) is an idiopathic chronic fibroinflammatory disorder of the intra-abdominal fat. CASE PRESENTATION Herin, we report a case of SMP, involving the omentum, mesentery and peri-colic fat in a 18 year old male, who presented with significant and recurrent abdominal distension for 4.5 years. Computed tomogram revealed ascites, with nodular and irregular omental thickening and foci of calcification. Non-specific radiological and histological features made an accurate diagnosis extremely difficult. After a thorough work up and exclusion of other differentials, diagnosis of a nodular SMP (Weber Christian disease) was given. After showing resistance to chemotherapeutic agents, slow response was noted with cyclophosphamide, followed by rapid symptomatic improvement with mesenterectomy. CONCLUSION SMP is an uncommon benign mesenteric/ omental inflammation, and is a diagnosis of exclusion. As treatment refractoriness is common, management should be individualized and continued for along period. Surgical omentectomy may be helpful.
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Gandhi D, Jindal G, Shivashankar R, Miller T, Beaty N. O-027 Micro Vascular Plug (MVP) Assisted Vessel Occlusion in Neurovascular Pathologies: Technical Results and Initial Clinical Experience. J Neurointerv Surg 2014. [DOI: 10.1136/neurintsurg-2014-011343.27] [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: 11/04/2022]
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Moin A, Kirk M, Jindal G, Mitchell J, Swehla B, Moeslein F. Initial clinical experience with a novel microcatheter-deliverable vascular plug. J Vasc Interv Radiol 2014. [DOI: 10.1016/j.jvir.2013.12.409] [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: 11/15/2022] Open
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Setia S, Gambhir R, Kapoor V, Jindal G, Garg S, Setia S. Attitudes and Awareness Regarding Hepatitis B and Hepatitis C Amongst Health-care Workers of a Tertiary Hospital in India. Ann Med Health Sci Res 2013; 3:551-8. [PMID: 24380007 PMCID: PMC3868122 DOI: 10.4103/2141-9248.122105] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Hepatitis is an inflammatory disease of the liver. In sever cases, it may lead to permanent liver damage including liver cirrhosis or hepato-cellular carcinoma and may ultimately lead to death. Health-care workers (HCWs), due to their regular contact with patients are at a high-risk of acquiring this disease. Aim: The aim of this study was to assess the knowledge and attitude toward hepatitis B and C infection among the health-care interns and correlate the level of awareness to the attitude they behold toward the disease. Subjects and Methods: A closed ended questionnaire consisting of questions to evaluate the knowledge regarding hepatitis B and C infection and attitude of the (HCWs/interns) was duly filled by 255 participants including, 100 dental, 100 medical, and 55 nursing interns. Statistical analysis was carried out using the Chi-square test, ANOVA test, post-hoc test and Pearson's correlation. Results: Although most of the interns were aware of the existence of hepatitis B and C infection, the level of awareness regarding the modes of transmission and vaccination was found to be dissatisfactory. Awareness level regarding the infection among nursing interns was statistically significantly lower than the dental and medical interns. A direct positive correlation as found between awareness score and behavior score, which reveals that interns with better awareness level had better attitudes toward the infection and prevention of its transmission. Conclusion: There is an urgent need to increase the level and quality of training among HCWs to prevent the spread of hepatitis B virus and hepatitis C virus.
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Affiliation(s)
- S Setia
- Department of Public Health Dentistry, Gian Sagar Dental College and Hospital, Rajpura, Punjab, India
| | - Rs Gambhir
- Department of Public Health Dentistry, Gian Sagar Dental College and Hospital, Rajpura, Punjab, India
| | - V Kapoor
- Department of Oral Surgery, Gian Sagar Dental College and Hospital, Rajpura, Punjab, India
| | - G Jindal
- Department of Oral Surgery, Gian Sagar Dental College and Hospital, Rajpura, Punjab, India
| | - S Garg
- Department of Oral Surgery, Gian Sagar Dental College and Hospital, Rajpura, Punjab, India
| | - S Setia
- Department of Radiology, Government Multispeciality Hospital, Chandigarh, India
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Gandhi D, Miller T, Beaty N, Fortes M, Simard J, Aldrich E, Jindal G. E-063 Endovascular treatment of intracranial aneurysms using a new, low profile intracranial micro-catheter: Initial experience. J Neurointerv Surg 2013. [DOI: 10.1136/neurintsurg-2013-010870.121] [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: 11/03/2022]
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Prasad V, Jindal G, Gandhi D. E-016 Risk of Contrast-Induced Nephropathy Following High Dose of Contrast Media in Patients Undergoing Neuroendovascular Procedures. J Neurointerv Surg 2013. [DOI: 10.1136/neurintsurg-2013-010870.74] [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: 11/04/2022]
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Patel A, Gandhi D, Aldrich E, Simard M, Aarabi B, Jindal G. E-032 Multidisciplinary Treatment of Anterior Cerebral Artery Pseudoaneurysms: A Single Centre Experience. J Neurointerv Surg 2013. [DOI: 10.1136/neurintsurg-2013-010870.90] [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: 11/04/2022]
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Fortes M, Jindal G, Gomez J, Gandhi D. E-014 Endovascular occlusion of trigeminal artery-cavernous fistula following spontaneous rupture of a persistent trigeminal artery (PTA): technical considerations and case report: Abstract E-014 Figure 1. J Neurointerv Surg 2012. [DOI: 10.1136/neurintsurg-2012-010455c.14] [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]
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Fortes M, Polifka A, Jindal G, Gandhi D. P-008 Use of the axera neurovascular access device as a tool to promote patient comfort, faster recovery and turnover times without an arterial implant. J Neurointerv Surg 2012. [DOI: 10.1136/neurintsurg-2012-010455b.8] [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: 11/03/2022]
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Jindal G, Gandhi D, Polifka A. P-038 Stenting of traumatic cervical internal carotid artery pseudoaneurysms, 10 year experiences at a level I trauma center. J Neurointerv Surg 2012. [DOI: 10.1136/neurintsurg-2012-010455b.38] [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: 11/04/2022]
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Kapoor V, Jindal G, Kapoor U. Conservative surgical management of Odontogenic Keratocysts in Indian population: an evidence based pragmatic approach—a 30 years experience. Int J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.ijom.2011.07.160] [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]
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Jindal G, Rastogi R, Kachhawa S, Meena GL. CT findings of primary extra-intestinal gastrointestinal stromal tumor of greater omentum with extensive peritoneal and bilateral ovarian metastases. Indian J Cancer 2011; 48:135-7. [DOI: 10.4103/0019-509x.76648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kapoor V, Kumar M, Narula R, Jindal G, Kapoor U. Distraction osteogenesis in the adult mandible. Int J Oral Maxillofac Surg 2007. [DOI: 10.1016/j.ijom.2007.08.160] [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: 11/30/2022]
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Kapoor U, Kapoor V, Kumar M, Narula R, Jindal G. Intermaxillary fixation screws in mandibular trauma. Int J Oral Maxillofac Surg 2007. [DOI: 10.1016/j.ijom.2007.08.425] [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: 10/22/2022]
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