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Swain S, Debta P, Sahu M. Rhinoscleroma: Our experiences at a tertiary care teaching hospital of Eastern India. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_15_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Popadyuk VI, Kirichenko IM, Rogov KA. [Widespread of Scleroma. A rare clinical case]. Vestn Otorinolaringol 2021; 86:93-98. [PMID: 33929160 DOI: 10.17116/otorino20218602193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Scleroma is a chronic infectious disease characterized by developing inflammation nye granulomas, mainly of the upper respiratory tract, with subsequent scarring. The reasons for the development of scleroma remain unclear, but it is generally accepted that the gram-negative coccal bacterium Klebsiella rhinoscleromatis (pas-Volkovich's loch - Frisch) is the causative agent of this disease. Endemic in the spread of scleroma is considered There are tropical and temperate zones such as Africa, Asia, Eastern Europe, South America and Central America. Features of development scleroma in the present case and the complexity of the diagnosis caused by atypical, the rapid development of the disease, the greater prevalence of the process (including the orbit), with the transition to the soft tissues of the cheek bone and upper jaw, which is not typical for scleroma. The process was primarily localized in the left maxillary sinus and mimicked sinusitis. The presence of radicular cysts and darkening of the left maxillary sinus on radiographs, taking into account the clinical picture of the disease, were interpreted incorrectly, which led to the establishment of an incorrect diagnosis and subsequent surgical interventions. More targeted and consistent examination of histo-the logical material obtained after three surgical interventions made it possible to identify the characteristic signs scleroma, establish the correct diagnosis and prescribe effective treatment. In our case, we applied Ciprofloxacin course for 3 months at a maximum daily dose of 2000 mg in combination with probiotics. During treatment, it was noted a significant improvement in the patient's well-being, facial pains became less intense, a decrease in the volume of ma tissues of the left cheek and improved nasal breathing.
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Affiliation(s)
- V I Popadyuk
- Peoples' Friendship University of Russian, Moscow, Russia
| | - I M Kirichenko
- Peoples' Friendship University of Russian, Moscow, Russia.,International Medical Center «ON-Clinics», Moscow, Russia
| | - K A Rogov
- Peoples' Friendship University of Russian, Moscow, Russia.,Federal State Budget Scientific Institution «Research Institute of Human Morphology», Moscow, Russia
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Abstract
Rhinoscleroma is a rare chronic granulomatous disease caused by Klebsiella rhinoscleromatis, which is a Gram-negative bacilli. Scleroma primarily affects the upper respiratory airway, preferably the nasal cavity, but the pharynx and larynx may also be involved. The term scleroma is preferred over the term rhinoscleroma because this disease affects not only the nose. Scleroma is endemic in countries of East Europe, Africa, South-East Asia and in sporadic areas worldwide. Scleroma usually begins at the nose and may progress to involve the larynx, pharynx or other regions of the neck. Scleroma generally progresses in three stages: the catarrhal or exudative phase, the proliferative or granulomatous phase, the sclerotic stage. Diagnosis of Rhinoscleroma depends on identification of the pathognomonic Mickulicz cells which is most prominent during granulomatous phase but spares or absent during catarrhal or sclerotic phases of the disease. We report a case of 11-year-old girl with the sclerotic stage of scleroma. This diagnose was proved by Mikulich cells histological detecting. We review the history, epidemiology, pathology, diagnosis, and treatment of scleroma. We report the case of a 11-year-old girl, hospitalize in our institute, diagnosed with rhinoscleroma in the context of recurrent breathlessness, wheezes and cough. The diagnosis difficulty caused by changes of nasal laryngeal mucous membrane after septoplasty 3 months ago and bronchial asthma diagnosed 2 years ago. The patient was given a six-month regimen of ciprofloxacin, and a dramatic improvement was observed.
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Recent advances in mastocytosis and neoplasms of probable monocytic/dendritic cell lineage. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.mpdhp.2009.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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de Pontual L, Ovetchkine P, Rodriguez D, Grant A, Puel A, Bustamante J, Plancoulaine S, Yona L, Lienhart PY, Dehesdin D, Huerre M, Tournebize R, Sansonetti P, Abel L, Casanova JL. Rhinoscleroma: a French national retrospective study of epidemiological and clinical features. Clin Infect Dis 2008; 47:1396-402. [PMID: 18947330 DOI: 10.1086/592966] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Rhinoscleroma (RS) is a rare, chronic, granulomatous disease of the upper respiratory tract that is associated with infection with Klebsiella rhinoscleromatis. RS is more common in certain geographic regions than in others, but other risk factors and the pathogenesis of RS remain unclear. METHODS We sent a standardized questionnaire to all pathologists and otolaryngology specialists in French University Hospitals and asked whether they had seen patients with RS in the previous 16 years (1990-2005). We then retrospectively reviewed the files of all patients identified. RESULTS We collected 11 cases of RS, with a median patient age at diagnosis of 35.7 years (range, 5-72 years). The 3 patients with a familial history of RS presented with early-onset forms of RS; 1 had an uncommon aggressive presentation of the disease with ischemic stroke. Two unrelated consanguineous families were identified, 1 of which included 2 affected siblings. Two patients with sporadic disease were positive for HIV infection. All patients were living in France, but most were immigrants from areas where RS is endemic (North Africa, 3 of the 11 patients; West Africa, 4 patients; and Turkey, 1 patient). The probable duration of exposure to K. rhinoscleromatis in endemic areas varied widely: 0-28 years. Clinical features and outcome also varied considerably among cases. Biopsies had been performed for all patients and revealed granulomas containing Mikulicz cells. Cultures of biopsy tissue were positive for K. rhinoscleromatis in 5 of the 11 cases. Prolonged antibiotic treatment was administered to all patients, as follows: ciprofloxacin (7 patients), third-generation cephalosporins (2), tetracycline (2), and clofazimine (2). Eight of the 11 patients did not experience relapse during extended periods of follow-up (1.3-12 years). Relapses in 3 patients were confirmed by a second biopsy. CONCLUSIONS The occurrence of early-onset RS in multiplex and/or consanguineous families suggests that genetic control of the host response to K. rhinoscleromatis may be involved in the pathogenesis of RS in endemic areas.
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Affiliation(s)
- Loïc de Pontual
- Assistance Publique-Hôpitaux de Paris, Service de Pédiatrie, Université Paris 13, Hôpital Jean Verdier, Bondy, France
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Kasper HU, Hegenbarth V, Buhtz P. Rhinoscleroma associated with Rosai-Dorfman reaction of regional lymph nodes. Pathol Int 2008; 54:101-4. [PMID: 14720140 DOI: 10.1111/j.1440-1827.2004.01597.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Rhinoscleroma is an uncommon chronic, destructive infection of the respiratory mucosa caused by Klebsiella rhinoscleromatis. This coccobacillus can be found in the typical histiocytes, the Mikulicz cells. Extranasal and nodal involvement in this disease is rare, but documented. Rosai-Dorfman disease or sinus histiocytosis with massive lymphadenopathy is also a rare, non-hereditary disorder. Bilateral cervical lymphadenopathy with emperipolesis, as the main histological characteristic, is the most common presentation. It can also occur extranodally. We report a case of rhinoscleroma occurring in a 62-year-old woman since 1984, who developed parotid gland and lymph node involvement. The changes in the nasal mucosa and the parotid gland showed chronic inflammation with Mikulicz cells. In the lymph nodes, features characteristic of Rosai-Dorfman disease were seen. Taking into consideration the literature dealing with both of these diseases, we discuss that Rosai-Dorfman disease could be a special type of lymph node reaction and is not necessarily an entity of its own. Therefore, it should be known as Rosai-Dorfman lymph node reaction. Furthermore, there seems to be an interconnection between Rosai-Dorfman disease and rhinoscleroma.
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Affiliation(s)
- Hans-Udo Kasper
- Institute of Pathology and CMMC, University of Cologne, Germany.
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Stone M, McGuire L, Moore M, Hamilton D, Weinstein S. Test and teach. Number 39. Diagnosis: Rhinoscleroma. Pathology 2007; 39:516-8. [PMID: 17886103 DOI: 10.1080/00313020701569931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Michael Stone
- Queensland Health Pathology Service, Gold Coast Hospital, 118 Nerang Street, Southport, Queensland 4215, Australia.
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Oztürk E, Otterbach F, Werner M, Neumann A. [Bone damaging swelling of the side of the nose]. HNO 2007; 54:958-61. [PMID: 16823571 DOI: 10.1007/s00106-006-1443-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- E Oztürk
- Universitäts-Hals-Nasen-Ohren-Klinik, Universitätsklinikum Essen
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Shapiro M, Werth VP. Cutaneous infections of the head and neck. Facial Plast Surg Clin North Am 2004; 11:165-73. [PMID: 15062271 DOI: 10.1016/s1064-7406(02)00028-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Michael Shapiro
- Department of Dermatology, University of Pennsylvania Health System, 2 Rhoads Pavilion, 34(th) & Spruce Streets, Philadelphia, PA 19104, USA
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Abstract
Rhinoscleroma is a chronic, granulomatous infectious disease that responds poorly to treatment. In recent years an increasing number of cases have been reported in nonendemic areas, explained largely by major migratory movements. We describe rhinoscleroma in three siblings. They had ulcerated but painless lesions, which bled spontaneously, and hemorrhagic scabs or crusts in their noses. In one child, the lesions had destroyed the entire left nasal ala and alar cartilage and most of the right. Dermatopathologic study identified the Mikulicz macrophages that contained organisms. It is possible that disposing factors could have been the neutropenia common to the three children and their poor living conditions. They were treated with a combination of trimethoprim-sulfamethoxazole and cefalexin, for a period of 3 months. We present this unusual case history of three siblings affected by a process that is relatively infrequent in our area of practice and is not considered very contagious. It is important to recognize the clinical signs characteristic of this disease, the diagnosis of which is not easy. Improvements in living conditions, hygiene, and health standards are essential prerequisites for its control and prevention.
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Canalis RF, Zamboni L. An interpretation of the structural changes responsible for the chronicity of rhinoscleroma. Laryngoscope 2001; 111:1020-6. [PMID: 11404614 DOI: 10.1097/00005537-200106000-00016] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify the structural changes of the proliferative phase of rhinoscleroma which could be responsible for the chronicity of the disease. STUDY DESIGN Observational research. METHODS Samples of friable tissue taken from the nasal mucosa of nine untreated patients were processed for light and ultrastructural microscopy. RESULTS The majority of changes contributing to the chronicity of the disease occurred in the subepithelium and followed three closely related but distinct events. In the first (infiltrative), subepithelial invasion by the Klebsiella was followed by its active multiplication and proliferation of capillaries. In the second (neutrophilic), large numbers of neutrophils were delivered into this space. Neutrophils actively phagocytized the Klebsiella but appeared to die at an accelerated rate without completing digestion of the microorganisms. In the third event (histiocytic), histiocytes entered the subepithelium and engaged in unrestrained phagocytosis of decaying neutrophils, Klebsiella, and debris. During this process, the histiocytes' phagosomes underwent massive dilation, thus becoming Mikulicz cells. Mikulicz cells were unable to consistently destroy the Klebsiella and eventually ruptured, releasing them into the interstitium. Evidence was found that an autophagic process might contribute to phagosome distention and to the rupture of the vacuolar membranes and cell wall. CONCLUSIONS Several critical changes responsible for the chronicity of rhinoscleroma occur during the proliferative phase of the disease. The majority of these take place in the subepithelium and include: 1) factors leading to the transformation of histiocytes into Mikulicz cells, 2) the inability of these cells to consistently destroy the Klebsiella, 3) their rupture releasing viable Klebsiella, and 4) the intrinsic resistance of the pathogen.
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Affiliation(s)
- R F Canalis
- Division of Head and Neck Surgery, Department of Surgery, Harbor-UCLA Medical Center and the UCLA School of Medicine, Los Angeles, California 90509, USA
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Kwong KY, Stotts CL, Jones CA. Persistent sinusitis and refractory asthma in a 10-year-old boy. Ann Allergy Asthma Immunol 1996; 77:21-6. [PMID: 8705630 DOI: 10.1016/s1081-1206(10)63474-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- K Y Kwong
- Department of Pediatrics, Women's and Children's Hospital, Los Angeles, California, USA
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Sedano HO, Carlos R, Koutlas IG. Respiratory scleroma: a clinicopathologic and ultrastructural study. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1996; 81:665-71. [PMID: 8784898 DOI: 10.1016/s1079-2104(96)80072-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Respiratory scleroma (rhinoscleroma) is a chronic granulomatous infection produced by Klebsiella rhinoscleromatis, a gram-negative aerobic coccobacillus. This disease is endemic to Africa, Central and South America, South Central and Eastern Europe, the Middle East, and China. Sporadic cases have been reported in the United States, especially in persons who migrated from the aforementioned areas. The majority of cases affect the nose, but extension to the soft and hard palate, upper lip, and maxillary sinuses also is frequent. This study comprises 11 patients (6 females and 5 males) with respiratory scleroma identified over a 6-year period in Guatemala. Their ages ranged from 16 to 60 years. Light microscopy showed a dense plasmacytic infiltrate, Mikulicz histiocytes, and Russell bodies within the plasma cells. Ultrastructural study revealed Mikulicz histiocytes, cytoplasmic vacuoles containing bacilli, and so-called A and B granules. We favor the term respiratory scleroma for this lesion because it affects not only the nose but also the upper and lower respiratory tracts as well as the mouth.
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Affiliation(s)
- H O Sedano
- School of Dentistry, University of Minnesota, Minneapolis, USA
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Abstract
Scleroma, more commonly known as rhinoscleroma, is a progressive, chronic, granulomatous disease of the respiratory tract and adjacent tissues. Early diagnosis and prolonged therapy are critical in avoiding its late sequelae. We describe an unusual case of scleroma presenting as worsening chronic lung disease. The variety of clinical presentations and treatment modalities is reviewed.
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Armstrong WB, Peskind SP, Bressler KL, Crockett DM. Airway Obstruction Secondary to Rhinoscleroma during Pregnancy. EAR, NOSE & THROAT JOURNAL 1995. [DOI: 10.1177/014556139507401109] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Dyspnea is a fairly common complaint during pregnancy. However, if one excludes allergic nasal congestion of pregnancy, upper airway obstruction is a distinctly uncommon cause of dyspnea in the pregnant patient. Three cases of laryngeal rhinoscleroma in pregnant women requiring tracheostomy for airway management are reported. All three delivered healthy infants vaginally. Postpartum, two of the three were successfully decannulated, while the third became pregnant again before decannulation was accomplished. Treatment options and a review of the literature are presented.
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Affiliation(s)
- William B. Armstrong
- Los Angeles, California
- Department of Otolaryngology—Head and Neck Surgery, University of Southern California School of Medicine, Los Angeles, California
| | - Steven P. Peskind
- Los Angeles, California
- Department of Otolaryngology—Head and Neck Surgery, University of Southern California School of Medicine, Los Angeles, California
| | - Kyle L. Bressler
- Chicago, Illinois
- Department of Otolaryngology—Head and Neck Surgery, University of Southern California School of Medicine, Los Angeles, California
| | - Dennis M. Crockett
- Los Angeles, California
- Department of Otolaryngology—Head and Neck Surgery, University of Southern California School of Medicine, Los Angeles, California
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Abstract
Rhinoscleroma, a chronic progressive infection of the nose and associated structures caused by Klebsiella rhinoscleromatis, has posed a therapeutic dilemma since its identification in the late 1800s. Although a number of antibiotics have been found to be effective in this relapsing disorder, the lengthy duration of treatment can lead to problems with adverse effects and compliance, especially with the traditional therapies of streptomycin and tetracycline. We report on a patient with extensive nasal rhinoscleroma who achieved pathologic and bacteriologic resolution during treatment with oral ciprofloxacin after previous courses of tetracycline and trimethoprim-sulfamethoxazole. Ciprofloxacin may prove to be useful in the therapy of rhinoscleroma because it is convenient for oral administration, achieves good tissue levels, is concentrated in macrophages, and is generally well tolerated as long-term therapy. As mentioned in a recent review of patients with rhinoscleroma at the Mayo Clinic, the fluoroquinolones deserve further study as potentially highly effective agents for this uncommon but significant infectious condition.
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Affiliation(s)
- R K Avery
- Infectious Disease Unit, Massachusetts General Hospital, Boston 02114, USA
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Abstract
Rhinoscleroma is a chronic, progressive, granulomatous infection of the upper airways caused by the bacterium Klebsiella rhinoscleromatis. Although most cases occur in developing countries, recent immigration patterns have led to an increasing number of patients with rhinoscleroma in the United States. Rhinoscleroma may mimic various inflammatory and neoplastic processes, including leprosy, paracoccidioidomycosis, sarcoidosis, basal cell carcinoma, and Wegener's granulomatosis. Current therapy consists of a combination of surgical débridement and prolonged antimicrobial therapy. Rhinoscleroma should be added to the list of opportunistic infections that can occur in patients with human immunodeficiency virus.
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Affiliation(s)
- R Andraca
- Department of Otorhinolaryngology, Mayo Clinic Rochester, Minnesota 55905
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Abstract
For North American otolaryngologists, rhinoscleroma and rhinosporidiosis are moving more into the differential diagnosis of chronic inflammatory diseases of the upper airway, particularly the nasal cavity. This change is occasioned by the influx of immigrants from parts of the world to which the diseases are endemic. Diagnosis is established by identification of the causal organisms, the readily seen Rhinosporidium seeberi for rhinosporidiosis and the more elusive Klebsiella rhinoscleromatis for rhinoscleroma.
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Affiliation(s)
- J G Batsakis
- Dept. of Pathology, University of Texas M.D. Anderson Cancer Center, Houston 77030
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Perkins BA, Hamill RJ, Musher DM, O'Hara C. In vitro activities of streptomycin and 11 oral antimicrobial agents against clinical isolates of Klebsiella rhinoscleromatis. Antimicrob Agents Chemother 1992; 36:1785-7. [PMID: 1416867 PMCID: PMC192049 DOI: 10.1128/aac.36.8.1785] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We tested in vitro the activities of streptomycin and tetracycline--antibiotics that have long been used to treat rhinoscleroma--as well as several newer oral agents by using 23 isolates of the causative organism Klebsiella rhinoscleromatis. All isolates were inhibited by clinically achievable concentrations of trimethoprim-sulfamethoxazole, amoxicillin-clavulanate, chloramphenicol, ciprofloxacin, cephalexin, cefuroxime, and cefpodoxime.
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Affiliation(s)
- B A Perkins
- Section of Infectious Diseases, Medical Service, Department of Veterans Affairs Medical Center, Houston, Texas
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