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Abstract
Posterior fossa extra-dural hematoma is rare and early diagnosis and management is associated with good outcome. Twenty four year male presented with somnolence and soft tissue swelling of occipital region following road traffic accident. CT scan revealed bilateral posterior fossa with bilateral temporo-occipital Extradural Hematoma (EDH) with mass effect. He was operated through a trifoliate incision and craniotomies leaving a strip of bone over the transverse and occipital sinus. The blood loss with such technique was minimal and the control of sinus tear was easier as the dura on either sides of the sinus can to tied to each other to hitch the sinus up to the bone thereby, providing a good tamponade. Early diagnosis of posterior fossa EDH and prompt surgical evacuation especially in patients with mass effect provide excellent recovery. However, the surgery may be associated with significant blood loss due to venous sinus injury increasing the morbidity and mortality. We have described a novel technique that minimizes the blood loss for patients with PFEDH straddling across the venous sinuses.
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Affiliation(s)
- Ashish Aggarwal
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pravin Salunke
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Futane
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harsimrat Bir Sodhi
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Ansari I, Futane S, Ansari A. Endoscope-assisted, minimally invasive evacuation of sub-acute/chronic epidural hematoma: Novelty or paradox of Theseus? Acta Neurochir (Wien) 2016; 158:1473-8. [PMID: 27255655 DOI: 10.1007/s00701-016-2851-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 12/23/2015] [Accepted: 05/17/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Sub-acute/chronic epidural hematoma (EDH) may present with nagging symptoms of headache, nausea, vomiting, lethargy, etc. We attempted to offer a minimally invasive, single burr hole, endoscope-assisted evacuation of EDHs instead of a conventional craniotomy. METHODS Seven patients with sub-acute/chronic EDH (six supratentorial and one infratentorial) presented to us 3 to 7 days after low-velocity road traffic accidents with complaints of headache and lethargy. The EDH volumes measured between 20 to 50 ml, and the patients were operated on using a single burr hole made through a small incision. We used 0-, 30- and 70-degree, angulated, rigid, high-definition endoscopes to identify and evacuate the organized clots in the extradural space. Flexible catheters were used for suction and irrigation. After achieving hemostasis, the dura was hitched back to the burr hole site. The wound was closed over a negative suction drain. RESULTS All patients had prompt recovery from symptoms. Postoperative CT scans showed complete or near complete evacuation of the hematomas. The hospital stay and analgesic requirements were minimal. There was no infective complication or conversion to conventional open surgery. The average time for surgery was 77.8 min, and average blood loss was 328.5 ml. CONCLUSION Endoscope-assisted evacuation of sub-acute/chronic EDH is a novel concept, which offers quick relief from symptoms in a minimally invasive fashion and a cosmetically acceptable way. None of the standard principles of surgery are hampered. It avoids extensive dissection of the temporalis or sub-occipital muscles. However, achieving hemostasis can be difficult. Further study and better equipment will validate the procedure.
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Affiliation(s)
- Ishtyaque Ansari
- Department of Neurosurgery, MGM Medical College and Hospital, Aurangabad, 431005, Maharashtra, India
| | - Sameer Futane
- Department of Neurosurgery, MGM Medical College and Hospital, Aurangabad, 431005, Maharashtra, India.
| | - Ashfaque Ansari
- Department of Otolaryngology, MGM Medical College and Hospital, Aurangabad, 431005, Maharashtra, India
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Borde D, Futane S, Asegaonkar B, Puranik M, Sargar S. Effect of perioperative pregabalin on post- operative quality of recovery in patients undergoing off pump coronary artery bypass grafting (OPCABG - prospective, randomized, double blind study. J Cardiothorac Vasc Anesth 2016. [DOI: 10.1053/j.jvca.2016.03.122] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Borde D, Asegaonkar B, Apsingekar P, Khade S, Futane S, Annachhatre A, Puranik M, Belapurkar Y, Deodhar A, George A, Joshi S. Intraoperative conversion to on pump CABG is independently associated with higher mortality in patients undergoing off pump CABG - a propensity matched analysis. J Cardiothorac Vasc Anesth 2016. [DOI: 10.1053/j.jvca.2016.03.065] [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: 11/11/2022]
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Salunke P, Sahoo SK, Futane S, Deepak AN, Khandelwal NK. 'Atlas shrugged': congenital lateral angular irreducible atlantoaxial dislocation: a case series of complex variant and its management. Eur Spine J 2016; 25:1098-108. [PMID: 26758289 DOI: 10.1007/s00586-015-4370-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 12/26/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The commonly described congenital atlanto-axial dislocation and Basilar-Invagination is antero-posterior or rotational or vertical plane. However, congenital dislocation in lateral plane has received scant attention. The purpose of this manuscript is to describe this unusual entity and discuss its management. MATERIALS AND METHODS The clinic-radiological feature of seven patients with congenital lateral angular AAD (CLAAAD) were studied and managed. The unilateral C1 facet had subluxed lateral to C2-3 complex. The C1 and C2 facets were drilled comprehensively and repositioned with distraction, placement of metallic spacers and facet manipulation after insertion of screws. The post operative outcome was studied. RESULTS The presentation is usually with neck tilt (progressive in 3) and/or progressive spastic quadriparesis. The mean C1-2 tilt was 25.2°. C1 was bifid in six patients. C1 lateral mass was assimilated with occipital condyle on dislocated side in and the other side was normal (6 patients). The dislocated C1-2 joint was abnormally oblique as compared to contralateral side. The relationship of occiput and C1 was normal. Correction of dislocation and lateral tilt was achieved in all patients with subsequent correction of neck tilt and deficits. One patient required reoperation. CONCLUSIONS The acute angulation of joint on one side and near normal on other side leads to differential vertical movement, further accentuated by splaying of bifid C1. The entity is seen in young patients and often present with neck tilt and spastic quadriparesis. Management requires reshaping the joints and facet manipulation. If the reshaping is inappropriate, the joint is likely to redislocate before fusion occurs.
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Affiliation(s)
- Pravin Salunke
- Department of Neurosurgery, PGIMER, Sector 12, Chandigarh, 1600l2, India.
| | - Sushanta K Sahoo
- Department of Neurosurgery, PGIMER, Sector 12, Chandigarh, 1600l2, India
| | - Sameer Futane
- Department of Neurosurgery, MGM Hospital & Medical College, Aurangabad, India
| | - A N Deepak
- Department of Neurosurgery, PGIMER, Sector 12, Chandigarh, 1600l2, India
| | - N K Khandelwal
- Department of Radiodiagnosis, PGIMER, Sector 12, Chandigarh, 1600l2, India
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Abstract
Bone formation within meningioma is secondary to metaplasia of the meningothelial cells into osteoblastic cells. This needs to be differentiated form the commonly seen calcification. We describe a rare case of osteobalstic meningioma in which bony trabeculae were seen within meningothelial cells.
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Affiliation(s)
| | | | - Sameer Futane
- Department of Neurosurgery, PGIMER, Chandigarh, India
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Abstract
Olfactory region schwannomas are rare, but when they occur, they commonly arise from the meningeal branches of the trigeminal nerve and may present without involvement of the olfaction. A 24 year old lady presented with hemifacial paraesthesias. Radiology revealed a large olfactory region enhancing lesion. She was operated through a transbasal with olfactory preserving approach. This manuscript highlights the importance of olfactory preservation in such lesions.
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Affiliation(s)
- Pravin Salunke
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Devi Prasad Patra
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Futane
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritambhara Nada
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Salunke P, Patra DP, Futane S, Nada R. Olfactory region schwannoma: Excision with preservation of olfaction. J Neurosci Rural Pract 2014. [DOI: 10.1055/s-0039-1700333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
ABSTRACTOlfactory region schwannomas are rare, but when they occur, they commonly arise from the meningeal branches of the trigeminal nerve and may present without involvement of the olfaction. A 24 year old lady presented with hemifacial paraesthesias. Radiology revealed a large olfactory region enhancing lesion. She was operated through a transbasal with olfactory preserving approach. This manuscript highlights the importance of olfactory preservation in such lesions.
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Affiliation(s)
- Pravin Salunke
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Devi Prasad Patra
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Futane
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritambhara Nada
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Salunke P, Sahoo S, Futane S. Successful excision of a pontomesencephalic cavernoma through anterior subtemporal route without mapping: Anatomical landmarks as a road map. Surg Neurol Int 2014; 5:15. [PMID: 24678431 PMCID: PMC3942592 DOI: 10.4103/2152-7806.126044] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 09/19/2013] [Indexed: 11/04/2022] Open
Affiliation(s)
- Pravin Salunke
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sushant Sahoo
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Futane
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Aggarwal A, Salunke P, Futane S, Mathuriya SN, Kumar A, Mukherjee KK, Radotra BD. Ruptured venous aneurysm of cervicomedullary junction. Surg Neurol Int 2014; 5:2. [PMID: 24575317 PMCID: PMC3927081 DOI: 10.4103/2152-7806.124977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Received: 07/18/2013] [Accepted: 12/11/2013] [Indexed: 11/30/2022] Open
Abstract
Background: Ruptured venous aneurysm is often seen with arterio-venous malformation (AVM) or developmental venous anomaly (DVA). However, isolated venous aneurysm is unusual. Case Description: We present a case of ruptured venous aneurysm that presented with subarachnoid hemorrhage (SAH) and intraventricular hemorrhage (IVH). Digital substraction angiography (DSA) revealed a saccular contrast filling pouch in the left lateral aspect of cervicomedullary junction (CMJ). Endovascular intervention was not a viable option. During surgery, a saccular pliable structure approx. 1.5 × 1 cm was found in the subarachnoid space that was clipped and excised. There were no arterial feeders, no evidence of surrounding AVM, and no dilated perimedullary vein. Conclusion: This is perhaps the first reported case of ruptured venous aneurysm (without associated AVM) of CMJ, which was successfully managed surgically. The possible etiologies remain an unnoticed head trauma or a congenital vessel wall abnormality. Surgically clipping and excision remains the treatment of choice for such lesion.
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Affiliation(s)
| | | | - Sameer Futane
- Department of Neurosurgery, PGIMER, Chandigarh, India
| | - S N Mathuriya
- Department of Neurosurgery, PGIMER, Chandigarh, India
| | - Ajay Kumar
- Department of Radiodiagnosis, PGIMER, Chandigarh, India
| | - K K Mukherjee
- Department of Neurosurgery, PGIMER, Chandigarh, India
| | - B D Radotra
- Department of Pathology, PGIMER, Chandigarh, India
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Salunke P, Futane S, Sahoo SK, Ghuman MS, Khandelwal N. Operative nuances to safeguard anomalous vertebral artery without compromising the surgery for congenital atlantoaxial dislocation: untying a tough knot between vessel and bone. J Neurosurg Spine 2014; 20:5-10. [DOI: 10.3171/2013.9.spine13491] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Stabilization of the craniovertebral junction (CVJ) by using lateral masses requires extensive dissection. The vertebral artery (VA) is commonly anomalous in patients with congenital CVJ anomaly. Such a vessel is likely to be injured during dissection or screw placement. In this study the authors discuss the importance of preoperative evaluation and certain intraoperative steps that reduce the chances of injury to such vessels.
Methods
A 3D CT angiogram was obtained in 15 consecutive patients undergoing surgery for congenital atlantoaxial dislocation. The course of the VA and its relationship to the C1–2 facets was studied in these patients. The anomalous VA was exposed intraoperatively, facet surfaces were drilled in all, and the screws were placed according to the disposition of the vessel.
Results
A skeletal anomaly was found in all 10 patients who had an anomalous VA. Four types of variations were noted: 1) the first intersegmental artery in 5 patients (bilateral in 1); 2) fenestration of VA in 1 patient; 3) anomalous posterior inferior cerebellar artery crossing the C1–2 joint in 1 patient; and 4) medial loop of VA in 5 patients. The anomalous vessel was dissected and the facet surfaces were drilled in all. The C-1 lateral mass screw was placed under vision, taking care not to compromise the anomalous vessel, although occipital screws or sublaminar wires were used in the initial cases. A medial loop of the VA necessitated placement of transpedicular or C-2 lateral mass screws instead of pars interarticularis screws. The anomalous vessel was injured in none.
Conclusions
Preoperative 3D CT angiography is a highly useful method of imaging the artery in patients with CVJ anomaly. It helps in identifying the anomalous VA or its branch and its relationship to the C1–2 facets. The normal side should be surgically treated and distracted first because this helps in opening the abnormal side, aiding in dissection. In the posterior approach the C-2 nerve root is always encountered before the anomalous vessel. The defined vascular anatomy helps in choosing the type of screw. The vessel should be mobilized so as to aid the drilling of facets and the placement of screws and spacers under vision, avoiding its injury (direct or indirect) or compression. With these steps, C1–2 (short segment) rigid fusion can be achieved despite the presence of anomalous VA.
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Affiliation(s)
| | | | | | - Mandeep S. Ghuman
- 2Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Niranjan Khandelwal
- 2Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Salunke P, Futane S. Anomalous posterior inferior cerebellar artery crossing the C1-2 facet in patient with atlanto-axial dislocation associated with down's syndrome. Acta Neurochir (Wien) 2013; 155:1953-4. [PMID: 23740181 DOI: 10.1007/s00701-013-1783-0] [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] [Received: 03/31/2013] [Accepted: 05/22/2013] [Indexed: 10/26/2022]
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Aggarwal A, Salunke P, Mathuriya SN, Futane S. Intraventricular hemorrhage in a patient with chronic myeloid leukemia and anterior communicating artery aneurysm. Neurol India 2013; 61:308-10. [PMID: 23860156 DOI: 10.4103/0028-3886.115076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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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Futane S, Salunke P. Klippel-Feil syndrome with atlanto-axial dislocation, anomalous vertebral artery, dextrocardia and situs inversus. Clin Neurol Neurosurg 2013; 115:2304-6. [PMID: 23998718 DOI: 10.1016/j.clineuro.2013.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 08/03/2013] [Accepted: 08/11/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Sameer Futane
- Department of Neurosurgery, PGIMER, Chandigarh, India.
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Abstract
Calcified chronic subdural collection (armoured brain) is a known long-standing complication of shunt overdrainage. We report a young male who became symptomatic eleven years after a shunt surgery. Radiology showed bilateral calcified subdural collections. Drainage of these collections did not help, but shunt revision did. Patients with armoured brain syndrome who suddenly become symptomatic should possibly undergo shunt revision before the more extensive and morbid procedure of drilling the membranes.
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Affiliation(s)
- P Salunke
- Department of Neurosurgery, PGIMER , Chandigarh , India
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Futane S, Salunke P, Kapoor A, Veiphei K. Calcified rock-like medulloblastoma. Pediatr Neurosurg 2013; 49:60-1. [PMID: 24192031 DOI: 10.1159/000355564] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 09/06/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Sameer Futane
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Salunke P, Futane S. Incarcerated spinal cord: A preventable surgical debacle. Surg Neurol Int 2013; 4:108. [PMID: 24032083 PMCID: PMC3768169 DOI: 10.4103/2152-7806.117042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 06/24/2013] [Indexed: 11/30/2022] Open
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Salunke P, Futane S. Is empirical therapy for craniovertebral junction tuberculosis justified? Endemicity negating rarity! A missed case of craniovertebral junction plasmacytoma. Clin Neurol Neurosurg 2012. [PMID: 23182177 DOI: 10.1016/j.clineuro.2012.10.024] [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: 10/27/2022]
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Salunke P, Futane S, Khandelwal NK, Mukherjee KK. Complete segmentation failure causing non-dysjunction of os odontoideum and hypertrophic C1 arch: a case report. Clin Neurol Neurosurg 2012; 115:1128-30. [PMID: 23010613 DOI: 10.1016/j.clineuro.2012.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Revised: 08/27/2012] [Accepted: 09/03/2012] [Indexed: 10/27/2022]
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Salunke P, Futane S, Jain V. Aneurysmal bone cyst of cervical spine: true 360° resection with emphasis on lateral masses. Neurol India 2012; 60:113-5. [PMID: 22406800 DOI: 10.4103/0028-3886.93610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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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