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Alkhatib RF, Chen RC, Sing BWH, Sanamandra SK. Unilateral abducens nerve avulsion injury following trauma. Singapore Med J 2023:389621. [PMID: 38037779 DOI: 10.4103/singaporemedj.smj-2022-222] [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: 12/02/2023]
Affiliation(s)
- Rugaiyah Fuad Alkhatib
- Department of Diagnostic and Interventional Radiology, Singapore General Hospital, Singapore
| | - Robert Chun Chen
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Benjamin Wei Heng Sing
- Department of Diagnostic and Interventional Radiology, Singapore General Hospital, Singapore
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Affiliation(s)
- Timothy Shao Ern Tan
- Manchester Medical School, The University of Manchester, Manchester, UK .,Department of Diagnostic Radiology, Singapore General Hospital, Singapore
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Ngeow AJH, Chan MY, Teoh OH, Sanamandra SK, Chan DKL. Non-immune hydrops fetalis secondary to congenital chylothorax with diffuse interstitial lung disease: a diagnostic conundrum. BMJ Case Rep 2021; 14:14/4/e240688. [PMID: 33863770 PMCID: PMC8055142 DOI: 10.1136/bcr-2020-240688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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 Chinese male infant was born at 35 weeks weighing 2935 g to a mother with polyhydramnios and prenatal hydrops fetalis. He developed marked respiratory distress secondary to bilateral congenital chylothorax and required pleural drainage, high frequency oscillation and inhaled nitric oxide therapy. He was extubated to non-invasive ventilation by day 14. There was no bacterial or intrauterine infection, haematologic, chromosomal or cardiac disorder. He was exclusively fed medium-chain triglyceride formula. High-resolution CT showed diffuse interstitial lung disease. He received a dexamethasone course for chronic lung disease to facilitate supplemental oxygen weaning. A multidisciplinary team comprising neonatology, pulmonology, haematology, interventional radiology and thoracic surgery considered congenital pulmonary lymphangiectasia as the most likely diagnosis and advised open lung biopsy, lymphangiography or scintigraphy for diagnostic confirmation should symptoms of chylothorax recur. Fortunately, he was weaned off oxygen at 5 months of life, and tolerated human milk challenge at 6 months of life and grew well.
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Affiliation(s)
- Alvin Jia Hao Ngeow
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - Mei Yoke Chan
- Haematology/Oncology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore
| | - Oon Hoe Teoh
- Respiratory Medicine Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | | | - Daisy Kwai Lin Chan
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
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Bharadwaj S, Chan C, Choo Tze Liang J, Sanamandra SK, Fortier MV, Koh AL, Sundararaghavan S. Neonatal Arterial Tortuosity and Adult Aortic Aneurysm-Is There a Missing Link?-A Case Report. Front Pediatr 2021; 9:814773. [PMID: 35372177 PMCID: PMC8964601 DOI: 10.3389/fped.2021.814773] [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: 11/14/2021] [Accepted: 12/31/2021] [Indexed: 12/03/2022] Open
Abstract
We report a novel case of a full term newborn with non-immune fetal hydrops and arterial tortuosity mimicking a double aortic arch, and cranial fractures in the immediate neonatal period. The infant had no classic features of neonatal arterial tortuosity syndrome or Loeys Dietz syndrome apart from bilateral inguinal hernia. He also had skeletal manifestations in the form of fractures in the neonatal period without any trauma during birth and without clinical evidence of Osteogenesis Imperfecta. A heterozygous missense variant of uncertain significance was detected in MYH11 gene which is increasingly recognized to be belonging to the familial/hereditary thoracic aneurysm and aortic dissection group of disorders. Fetal hydrops as an association with arterial tortuosity has not been reported in the literature. We hypothesize the possible mechanism behind developing fetal hydrops in this case and discuss the genetic and phenotypic heterogeneity of the Familial Thoracic Aortic Aneurysm and Dissection (FTAAD) group of conditions highlighting the unique phenotypic and genotypic presentations. We recommend a high index of suspicion and vigilance in the early detection of such potentially lethal conditions with sequelae also in adulthood.
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Affiliation(s)
- Srabani Bharadwaj
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, Singapore, Singapore.,Duke-NUS School of Medicine, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Charmaine Chan
- Cardiology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jonathan Choo Tze Liang
- Yong Loo Lin School of Medicine, Singapore, Singapore.,Duke-NUS School of Medicine, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore.,Cardiology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
| | | | | | - Ai Ling Koh
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Sreekanthan Sundararaghavan
- Yong Loo Lin School of Medicine, Singapore, Singapore.,Duke-NUS School of Medicine, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore.,Cardiology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
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Ern Tan TS, Leong S, Too CW, Sanamandra SK. Sonographic mimics of benign and malignant thyroid nodules: pictorial guide for radiologists. Clin Radiol 2020. [DOI: 10.1016/j.crad.2020.11.066] [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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Yong MH, Chan YFZ, Liu J, Sanamandra SK, Kheok SW, Lim KC, Sewa DW. A Rare Case of Acute Hemorrhagic Leukoencephalitis in a COVID-19 Patient. J Neurol Sci 2020; 416:117035. [PMID: 32738478 PMCID: PMC7362807 DOI: 10.1016/j.jns.2020.117035] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/06/2020] [Accepted: 07/10/2020] [Indexed: 01/12/2023]
Affiliation(s)
- Ming Hui Yong
- Department of Neurology, National Neuroscience Institute - Singapore General Hospital Campus, Singapore.
| | - Yvonne Fu Zi Chan
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Jiaxuan Liu
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Sarat Kumar Sanamandra
- Department of Diagnostic Radiology, Division of Radiological Sciences, Singapore General Hospital, Singapore
| | - Si Wei Kheok
- Department of Diagnostic Radiology, Division of Radiological Sciences, Singapore General Hospital, Singapore
| | - Kheng Choon Lim
- Department of Diagnostic Radiology, Division of Radiological Sciences, Singapore General Hospital, Singapore
| | - Duu Wen Sewa
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
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Tan TSE, Sanamandra SK. Multinodular and vacuolating neuronal tumour of the cerebrum: an incidental diagnosis in a child presenting with absence seizures. Postgrad Med J 2020; 97:125-126. [PMID: 32404494 DOI: 10.1136/postgradmedj-2020-137789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/25/2020] [Indexed: 11/03/2022]
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Shi H, Ong YT, Gogna A, Venkatanarasimha N, Sanamandra SK, Leong S, Irani FG, Lo RHG, Too CW. Perfluorobutane contrast-enhanced ultrasonography: a new standard for ultrasonography-guided thermal ablation of sonographically occult liver tumours? Singapore Med J 2020; 62:546-553. [PMID: 32299186 DOI: 10.11622/smedj.2020061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/18/2022]
Abstract
INTRODUCTION Image-guided thermal ablation, preferably with ultrasonography (US), is increasingly used for treatment of small liver tumours. Perfluorobutane-contrast enhanced US (pCEUS) is a promising tool that may allow for targeting of tumours that are otherwise imperceptible on greyscale US. Although pCEUS has been reported to be effective, the literature has been limited outside of Japan and South Korea. We aimed to provide data that supports the use of pCEUS in thermal ablation of sonographically occult liver tumours. METHODS We conducted a retrospective single-centre study of 35 consecutive patients who underwent pCEUS-guided ablation of 48 liver tumours with a median size of 1.2 cm. Periprocedural, one-month post-treatment, and relevant follow-up imaging studies were reviewed. Electronic records were also obtained, with long-term follow-up data of 12-28 months being available for 32 patients. RESULTS 36 (75%) of tumours that were imperceptible on greyscale US became visible with pCEUS. Overall, complete tumour ablation at one month was 89%. 1 (3%) patient developed a major complication following treatment, while 6 (17%) had minor post-treatment complaints. The local tumour progression rate was 17% with a median time of 14 months. CONCLUSION pCEUS has a role in US-guided thermal ablation of liver tumours, offering a high technical success rate that is comparable to reported data. Additional benefits may include improved procedural time and freedom from ionising radiation.
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Affiliation(s)
- Haiyuan Shi
- Department of Diagnostic Radiology, Changi General Hospital, Singapore
| | | | - Apoorva Gogna
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - Nanda Venkatanarasimha
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - Sarat Kumar Sanamandra
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - Sum Leong
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - Farah Gillan Irani
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - Richard Hoau Gong Lo
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - Chow Wei Too
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
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Shi H, Ong Y, Gogna A, Venkatanarasimha N, Sanamandra SK, Leong S, Irani FG, Lo RH, Too CW. Perfluorobutane contrast-enhanced ultrasonography: a new standard for ultrasonography-guided thermal ablation of sonographically occult liver tumours? Singapore Med J 2020. [DOI: 10.11622/smedj.2020061 10.11622/smedj.2020061] [Citation(s) in RCA: 1] [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: 11/18/2022]
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10
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Zhuang KD, Patel A, Tan BS, Irani FG, Gogna A, Chan SX, Sanamandra SK, Chong TT, Chng SP, Tay KH. Outcome and Distal Access Patency in Subintimal Arterial Flossing with Antegrade-Retrograde Intervention for Chronic Total Occlusions in Lower Extremity Critical Limb Ischemia. J Vasc Interv Radiol 2020; 31:601-606. [PMID: 32127314 DOI: 10.1016/j.jvir.2019.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 12/05/2019] [Accepted: 12/07/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To report the outcome and distal access patency of the Subintimal Arterial Flossing with Antegrade-Retrograde Intervention (SAFARI) technique for chronic total occlusion (CTO) in critical limb ischemia (CLI). MATERIALS AND METHODS From January 2009 to June 2015, 220 SAFARI procedures were performed for 200 limbs in 191 patients (108 males [56.5%]; median age, 70 years old; range, 36 to 97 years old) with CLI (9.4% were Fontaine classification 3; and 90.6% were Fontaine classification 4). Distal access was obtained from the distal superficial femoral artery (n = 6), popliteal artery (n = 49), anterior tibial artery (n = 56), dorsalis pedis (n = 51), peroneal artery (n = 12), posterior tibial artery (n = 45), and lateral plantar artery (n = 1). Distal access hemostasis was obtained with internal balloon tamponade in 71.4% (n = 157). Outcome measurements were technical success, freedom from major amputation and complications. Preprocedural angiograms of clinically driven repeat interventions were reviewed in 73 cases for distal access patency. RESULTS Technical success was achieved in 80.5% (n = 177). Reasons for technical failure include inability to obtain distal access (n = 3), cross the occlusion retrogradely (n = 16), re-enter the true lumen (n = 9), and achieve antegrade blood flow after the procedure (n = 15). Freedom from major amputation for technically successful procedures was 84.7%, 82.9%, and 81.9% at 6, 12, and 24 months, respectively. There were 3 cases of distal access bleeding with 1case that required coil embolization. The distal access remained patent in 80.8% of observable cases with repeated endovascular intervention. CONCLUSIONS Distal retrograde arterial access (SAFARI) technique is safe and effective in the treatment of CTOs in the context of CLI, after failure of antegrade revascularization.
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Affiliation(s)
- Kun Da Zhuang
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore.
| | - Ankur Patel
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - Bien Soo Tan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - Farah Gillan Irani
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - Apoorva Gogna
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - Shaun Xavier Chan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | | | - Tze Tec Chong
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Siew Ping Chng
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Kiang Hiong Tay
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
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Edison PE, Sanamandra SK, Shah VA, Baral VR, Yeo CL. Early entrapment of fourth ventricle following Pseudomonas meningitis in extreme prematurity: Case report. J Neonatal Perinatal Med 2019; 13:581-586. [PMID: 31796689 DOI: 10.3233/npm-190258] [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: 11/15/2022]
Abstract
Trapped fourth ventricle (TFV) as a complication of post-hemorrhagic hydrocephalus (PHH) is widely reported in the pediatric population with a prior history of ventriculo-peritoneal (VP) shunt placement. Characterized by disproportionate dilatation of the fourth ventricle on serial neuro-imaging, it is rarely encountered in the early course of preterm infants and the differentiating clinical features are subtle and non-specific. Clinical alertness and sonographic correlation hold the key to early diagnosis. We report an early emergence of TFV in an extremely low gestational age newborn (ELGAN) following fulminant Pseudomonas aeruginosa meningitis, approach to management, and the neurological outcome. Fourth ventricle entrapment as a complication of perinatally acquired Pseudomonas aeruginosa meningitis in a surviving ELGAN is extremely rare.
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Affiliation(s)
- P E Edison
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - S K Sanamandra
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - V A Shah
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - V R Baral
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - C L Yeo
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
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Abstract
Primary ciliary dyskinesia (PCD) is a rare disorder with impaired ciliary function resulting in a spectrum of clinical manifestations of varying severity. PCD affects approximately one in every 20,000 individuals with a reported prevalence between 1:4000 and 1:50,000. Due to its nonspecific clinical features, the condition is usually diagnosed late in its course, unless situs inversus (SI) or organ laterality defects are discovered at imaging. A small subset of patients with PCD display associated organ laterality defects, different from the classical SI totalis. We present here, the clinical and imaging findings in a young female with PCD along with left-sided isomerism, a variant of heterotaxy syndromes.
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Affiliation(s)
- Kumar Narahari Narahari
- Department of Respiratory Medicine, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Anu Kapoor
- Department of Radiology and Imaging, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Edison P, Chang PS, Toh GH, Lee LN, Sanamandra SK, Shah VA. Reducing radiation hazard opportunities in neonatal unit: quality improvement in radiation safety practices. BMJ Open Qual 2018; 6:e000128. [PMID: 29450287 PMCID: PMC5699129 DOI: 10.1136/bmjoq-2017-000128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 06/27/2017] [Revised: 09/15/2017] [Accepted: 09/21/2017] [Indexed: 11/04/2022] Open
Abstract
Aim Guided by the ALARA - "As Low As Reasonably Achievable" principle in radiation safety, a quality improvement project to optimise the bedside diagnostic imaging process to the best standards of care was conducted over a six month period. The goal was too reduce the radiation hazard opportunities in the neonatal intensive care unit by at least 75% from the existing level at Q2/2015, within 6 months. Methods The existing bedside imaging process was critically analysed and the following quality improvement initiatives were implemented namely, mandatory lead protective gear to healthcare staff, gonadal shield for neonates, guidelines for optimal collimation of X-ray beam and optimal positioning of neonates. Radiation dosimetry results, regular staff awareness sessions and strong collaboration between neonatologists, radiologists, radiographers and neonatal nurses helped to ensure compliance to the revised imaging process. Radiation hazard opportunities were measured by analysing all radiographs done during the period under baby exposure and healthcare staff exposure categories. Summary of results Radiation hazard opportunities were reduced by 100% to healthcare staff and 75% to neonates, and the overall reduction was 83%. The rate of discordance between radiograph request forms and images taken was measured as a surrogate marker for compliance to the project initiatives and it declined by 77%. Mandatory orientation of staff to the revised policy on the standardised diagnostic imaging process, regular radiation awareness talks and staff feedback sessions are among several measures taken to sustain the project.
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Affiliation(s)
- Priyantha Edison
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - Pi Sun Chang
- Department of Nursing, Singapore General Hospital, Singapore
| | - Guan Hong Toh
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Li Na Lee
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | | | - Varsha Atul Shah
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
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Abstract
Lipoma arborescens is a chronic, slowly progressive intra-articular lesion characterised by villous lipomatous proliferation of the synovium, usually involving the suprapatellar pouch of the knee joint. It is an uncommon cause of intra-articular masses that presents as slowly progressive painless swelling of the joint, which persists for many years and is accompanied by intermittent effusions. We highlight this condition to raise awareness of its clinical spectrum and imaging features, so that early diagnosis and appropriate treatment can be given, and misinterpretation of this condition as other more complex intra-articular masses is avoided. This pictorial essay aims to provide a brief yet comprehensive review of the clinical features, distribution, morphological types and imaging characteristics of lipoma arborescens, including its common differential diagnoses and management.
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Affiliation(s)
- Sarat Kumar Sanamandra
- Department of Diagnostic and Interventional Radiology, Singapore General Hospital, Outram Road, Singapore 169608.
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Chidambaram VA, Sanamandra SK. Medical image. Epiploic appendages. N Z Med J 2015; 128:68-70. [PMID: 25829041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Sanamandra SK, Leong MY, Fortier MV. Vaginal mass in a 13-year-old girl. Ann Acad Med Singap 2014; 43:127-129. [PMID: 24652436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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