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Cyphers E, Gaballah M, Acord M, Worede F, Srinivasan A, Vatsky SE, Escobar F, Krishnamurthy G, Cahill AM. Percutaneous Nephrostomy in Neonates and Young Infants. J Vasc Interv Radiol 2023; 34:1815-1821. [PMID: 37336489 DOI: 10.1016/j.jvir.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/26/2023] [Accepted: 06/10/2023] [Indexed: 06/21/2023] Open
Abstract
PURPOSE To describe a single-center experience of placing percutaneous nephrostomy (PCN) tubes in neonates and young infants aged ≤3 months. MATERIALS AND METHODS This retrospective study evaluated PCN placement during a 19-year period. Medical records were reviewed for patient demographics, indications, procedure details, catheter-related adverse events, and outcomes. A total of 45 primary PCN insertions were attempted in 29 children (median age, 11 days [range, first day of life to 3 months]; median weight, 3.5 kg [range, 1.4-7.0 kg]). Salvage procedures resulted in 13 secondary catheters in 6 children. The most common indication was ureteropelvic junction obstruction (40.0%), and the most common urinary tract dilation classification was P3 (88.9%). RESULTS Technical success for primary placements was 95.6%; both technical failures were due to loss of access in the same patient. Of primary placements, 76.7% were electively removed, 6.9% were dislodged but not replaced, and the remaining 16.3% required salvage procedures. Mechanical adverse events occurred in 20.9% of primary and 53.8% of secondary catheters, including partial retraction, complete dislodgement, and occlusion. Urinary tract infections (UTIs) occurred in 18.6% of primary and 15.4% of secondary catheters. Urosepsis occurred in 2.3% of primary and 7.7% of secondary catheters. Median primary catheter dwell time was 41 days (range, 1-182 days) and median secondary catheter dwell time was 31 days (range, 10-107 days). CONCLUSION PCN placement in neonates and young infants has a high technical success rate, although not without particular procedural and management challenges of catheter malfunction and UTI.
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Affiliation(s)
- Eric Cyphers
- Division of Interventional Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Marian Gaballah
- Division of Interventional Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael Acord
- Division of Interventional Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fikadu Worede
- Department of Medicine, Mercy Catholic Medical Center, Darby, Pennsylvania
| | - Abhay Srinivasan
- Division of Interventional Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Seth E Vatsky
- Division of Interventional Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fernando Escobar
- Division of Interventional Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ganesh Krishnamurthy
- Division of Interventional Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anne Marie Cahill
- Division of Interventional Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Lory A, Stubbs C, Wolstenhulme S, Khan A. Urinary tract obstruction: Ultrasound-guided intervention. ULTRASOUND (LEEDS, ENGLAND) 2022; 30:264-272. [PMID: 36969536 PMCID: PMC10034656 DOI: 10.1177/1742271x211049495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/06/2021] [Indexed: 11/17/2022]
Abstract
Introduction Urinary tract obstruction (UTO) is a common clinical problem of which there are many potential causes. The aim of this feature article is to explore the role of ultrasound in diagnosing UTO, during guided interventional procedures and the potential procedural complications.Topic description and discussion: Ultrasound is an integral imaging modality throughout the management pathway of a patient with UTO and is often utilised as a first-line test in diagnosis and treatment. Percutaneous nephrostomy is an interventional technique, usually performed by radiologists or interventional sonographers, as either a short- or long-term management strategy. It can either be used in isolation or to gain access to the renal collecting system prior to more complex interventional or surgical techniques. Ultrasound-guided interventional techniques to relieve UTO can be employed in a number of clinical scenarios each with their own indications, contraindications and complications. Conclusion Ultrasound plays a unique role in the planning and active stages of intervention with the provision of dynamic imaging which is crucial for providing safe and effective patient management.
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Affiliation(s)
- Alexander Lory
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, St James’ University Hospital, Leeds Teaching Hospitals NHS
Trust, Leeds, UK
| | - Christopher Stubbs
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, St James’ University Hospital, Leeds Teaching Hospitals NHS
Trust, Leeds, UK
| | - Stephen Wolstenhulme
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, St James’ University Hospital, Leeds Teaching Hospitals NHS
Trust, Leeds, UK
| | - Atif Khan
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, St James’ University Hospital, Leeds Teaching Hospitals NHS
Trust, Leeds, UK
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Cahill AM, Annam A, Baskin KM, Caplin D, Cramer HR, Connolly B, Crowley J, Heran M, Himes EA, Hogan MJ, Josephs S, Pabon-Ramos W, Prajapati H, Shivaram G, Towbin R, Vaidya SS. Society of Interventional Radiology Quality Improvement Standards for Percutaneous Nephrostomy in the Pediatric Population. J Vasc Interv Radiol 2021; 32:146-149. [PMID: 33388108 DOI: 10.1016/j.jvir.2020.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 01/25/2023] Open
Affiliation(s)
- Anne Marie Cahill
- Department of Interventional Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Aparna Annam
- Department of Radiology, University of Colorado, School of Medicine, Aurora, Colorado; Interventional Radiology, Children's Hospital Colorado, Aurora, Colorado
| | - Kevin M Baskin
- Department of Interventional Radiology, Sharon Regional Medical Center, Hermitage, Pennsylvania
| | - Drew Caplin
- Division of Interventional Radiology, Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Harry R Cramer
- Section of Inverventional Radiology, Coastal Vascular and Interventional, PLLC, Pensacola, Florida
| | - Bairbre Connolly
- Image Guided Therapy, Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - John Crowley
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Manraj Heran
- Pediatric Interventional Radiology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada; Diagnostic and Therapeutic Neuroradiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Mark J Hogan
- Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio
| | - Shellie Josephs
- Department of Radiology, Stanford Medicine, Palo Alto, California
| | - Waleska Pabon-Ramos
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Hasmukh Prajapati
- Division of Interventional Radiology, Department of Pediatric Radiology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Giridhar Shivaram
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington
| | - Richard Towbin
- Department of Radiology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Sandeep S Vaidya
- Department of Interventional Radiology, University of Washington Medical Center, Seattle, Washington
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Şeker M, Çiftçi TT, Akıncı D, Akhan O. Radiologically guided percutaneous nephrostomy: A 6-year single-center experience. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2019. [DOI: 10.25000/acem.605006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Hwang J, Shin J, Lee Y, Yoon H, Cho Y, Kim K. Percutaneous nephrostomy placement in infants and young children. Diagn Interv Imaging 2018; 99:157-162. [DOI: 10.1016/j.diii.2017.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 07/07/2017] [Accepted: 07/11/2017] [Indexed: 12/15/2022]
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Pediatric Percutaneous Nephrostomy: A Multicenter Experience. J Vasc Interv Radiol 2018; 29:328-334. [DOI: 10.1016/j.jvir.2017.09.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/20/2017] [Accepted: 09/20/2017] [Indexed: 11/20/2022] Open
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Use of cone-beam CT and live 3-D needle guidance to facilitate percutaneous nephrostomy and nephrolithotripsy access in children and adolescents. Pediatr Radiol 2016; 46:570-4. [PMID: 26637320 DOI: 10.1007/s00247-015-3499-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 09/05/2015] [Accepted: 11/01/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Gaining access into non-dilated renal collecting systems for percutaneous nephrolithotripsy, particularly in patients with prohibitive body habitus and/or scoliosis, is often challenging using conventional techniques. OBJECTIVE To evaluate the feasibility of cone-beam CT for percutaneous nephrostomy placement for subsequent percutaneous nephrolithotripsy in children and adolescents. MATERIALS AND METHODS A retrospective review of percutaneous nephrostomy revealed use of cone-beam CT and 3-D guidance in 12 percutaneous nephrostomy procedures for 9 patients between 2006 and 2015. All cone-beam CT-guided percutaneous nephrostomies were for pre-lithotripsy access and all 12 were placed in non-dilated collecting systems. RESULTS Technical success was 100%. There were no complications. CONCLUSION Cone-beam CT with 3-D guidance is a technically feasible technique for percutaneous nephrostomy in children and adolescents, specifically for nephrolithotripsy access in non-dilated collecting systems.
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Sancaktutar AA, Bozkurt Y, Tüfek A, Söylemez H, Önder H, Atar M, Penbegül N, Bodakçı MN, Hatipoğlu NK, Oktar T. Radiation-free percutaneous nephrostomy performed on neonates, infants, and preschool-age children. J Pediatr Urol 2013; 9:464-71. [PMID: 22763106 DOI: 10.1016/j.jpurol.2012.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 06/08/2012] [Indexed: 10/28/2022]
Abstract
AIM The aim of this study was to evaluate the effectiveness and safety of high-frequency linear probe ultrasonographic (US) guidance percutaneous nephrostomy (PN) in terms of diagnostic and therapeutic approach in preschool-age children with urological problems. MATERIALS AND METHODS PN was performed on 40 kidneys in 33 patients (13 girls, 20 boys) aged 3 days - 7 years (mean 4.1 years). All procedures were performed with US guidance utilizing a Shimadzu SDU 2200 Xplus 5-10 mHz probe. Complete blood count, urinalysis, bladder urine culture, blood urea, and creatinine values were obtained before PN placement on the same day. Urine cultures were obtained by nephrostomy tube and compared to bladder urine culture. RESULTS PN procedures were technically successful in 39 kidney units (97.5%). Two major complications were macroscopic hematuria requiring blood transfusions (1 case) and sepsis (1 case). Minor complications were displacement of the catheter (4), urinary tract infection (4), urine extravasation (1), early dislocation of the catheter (1). In three cases, the catheter was replaced. Analysis of bladder urine showed that 13 patients (39.4%) had positive cultures, but analysis of PN urine showed that 25 patients (78.1%) had positive cultures. CONCLUSIONS PN is an easy, safe and efficient diagnostic and therapeutic procedure with few complications even in preschool-age children. The antibiotic regimen should be revised in order to avoid sepsis and urinary tract infection.
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Abstract
Interventional radiologists are playing an increasingly important role in pediatric urologic intervention, working closely with the pediatric urologist. Interventional radiologists are frequently asked to establish percutaneous access to the renal collecting system prior to nephrolithotomy. Additionally, procedures such as percutaneous nephrostomy, ureteral stent placement and exchange, and renal parenchymal biopsy are frequently encountered requests. This article will review these common procedures and highlight techniques and pathology that are unique to the pediatric population.
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Affiliation(s)
- Luke Linscott
- Section of Vascular and Interventional Radiology, Mallinckrodt Institute of Radiology, St. Louis, Missouri
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Percutaneous Nephrostomy, Antegrade Stent Placement, and Radiological Control of Post-PCNL Bleeding. Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Barnacle AM, Wilkinson AG, Roebuck DJ. Paediatric Interventional Uroradiology. Cardiovasc Intervent Radiol 2011; 34:227-40. [DOI: 10.1007/s00270-010-0090-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Accepted: 10/20/2010] [Indexed: 10/18/2022]
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Abstract
The role of interventional radiology in paediatric nephrology and urology is gradually increasing. Some procedures (such as renal biopsy) are best performed using radiological techniques, some (such as ureteric stenting) by either radiologists or urologists, depending on clinical circumstances, and some (such as percutaneous nephrolithotomy) are usually performed jointly by urologists and interventional radiologists. This paper briefly reviews the main non-vascular interventional radiology techniques used in the genitourinary tract in children. Common procedures such as renal biopsy and nephrostomy and related procedures are emphasised.
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Affiliation(s)
- Derek J Roebuck
- Department of Radiology, Great Ormond Street Hospital, London, WC1N 3JH, UK.
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Barnacle AM, Roebuck DJ, Racadio JM. Nephro-Urology Interventions in Children. Tech Vasc Interv Radiol 2010; 13:229-37. [DOI: 10.1053/j.tvir.2010.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Coley BD, Hogan MJ. Image-guided interventions in neonates. Eur J Radiol 2006; 60:208-20. [PMID: 16962732 DOI: 10.1016/j.ejrad.2006.07.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2006] [Revised: 07/10/2006] [Accepted: 07/12/2006] [Indexed: 01/28/2023]
Abstract
Minimally invasive interventional radiological procedures can be invaluable in the care of neonates and infants. These procedures have proven to be useful in a wide variety of clinical situations, improving patient care, comfort and safety. Most techniques in adult interventional radiology have been adapted for use in pediatric patients, covering the spectrum of diagnostic and therapeutic intervention. Procedural techniques are similar, but require considerations of patient size, sedation, and support personnel in order to render optimal care. Proper physician training is imperative to provide the necessary confidence and expertise, and post-procedural follow-up is required to maximize positive outcomes. This paper discusses many of the procedures that may be performed in neonates, and offers suggestions and techniques for successful outcomes.
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Affiliation(s)
- Brian D Coley
- Department of Radiology, Columbus Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
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Yavascan O, Aksu N, Erdogan H, Aydin Y, Kara OD, Kangin M, Kanik A. Percutaneous nephrostomy in children: diagnostic and therapeutic importance. Pediatr Nephrol 2005; 20:768-72. [PMID: 15856323 DOI: 10.1007/s00467-005-1845-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2004] [Revised: 12/14/2004] [Accepted: 01/20/2005] [Indexed: 10/25/2022]
Abstract
The aim of this study was to evaluate the effectiveness and safety of percutaneous nephrostomy (PN) in terms of diagnostic and therapeutic approach in children with urological problems. PN was performed on 39 kidneys in 28 patients (12 girls, 16 boys) aged 4.5 months to 13 years (average 5.38+/-3.41 years) during the period from January 1996 to December 2003. Underlying abnormalities were ureteropelvic junction obstruction (UPJO) in 14 patients (17 kidneys), ureterovesical junction obstruction (UVJO) in six patients (eight kidneys), supravesical obstruction due to tumour or hydatid cyst or ureteral stone in three patients (five kidneys), and severe vesicoureteral reflux (VUR) with/without neurogenic bladder associated with pyonephrotic kidneys in five patients (nine kidneys). The duration of catheter insertion was between 2 and 160 days (average 80+/-65.01 days). The complications were haematuria (six cases), infection (five cases) and displacement of catheter (four cases). Radical surgical management was performed in 25 patients (33 kidneys): pyeloplasty in eight cases (ten kidneys), UVJO correction in six cases (eight kidneys), nephrectomy in five cases (five kidneys), ureteroneocystostomy in four cases (seven kidneys), hydatid cyst operation in one case (two kidneys) and stone extraction in one case (one kidney). PN is an easy, safe and efficient diagnostic and therapeutic procedure with few complications in childhood.
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Affiliation(s)
- Onder Yavascan
- Department of Paediatric Nephrology, SSK Tepecik Teaching Hospital, Yenisehir-Izmir, Turkey.
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Patel U, Abubacker MZ. Ureteral stent placement without postprocedural nephrostomy tube: experience in 41 patients. Radiology 2003; 230:435-42. [PMID: 14688404 DOI: 10.1148/radiol.2302030078] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate one-stage antegrade ureteral stent placement without postprocedural nephrostomy tube. MATERIALS AND METHODS Tubeless ureteral stent insertion was attempted in 41 (30 men, 11 women; eight, benign obstruction; nine outpatients) of 97 adults (56 excluded). Patients were clinically stable with known ureteral obstruction and had been referred for antegrade ureteral stent insertion. Exclusion criteria were infection, coagulopathy, or emergency cases. After renal access was achieved, ureteral stents were inserted. If drainage was satisfactory and there was no marked procedural bleeding, all access was removed without leaving a nephrostomy tube behind. Technical and clinical success rates and complications were assessed with review of radiologic and clinical notes. If one-stage stent insertion was unsuccessful, a nephrostomy tube was inserted and two-stage stent placement was performed. All 56 patients excluded from this study underwent two-stage stent placement. Major complication rate was assessed (Fisher test). RESULTS One-stage stent insertion was technically successful in 36 (88%) patients; two with an identifiable risk factor (recent bladder operation, retrograde ureteral instrumentation) developed septicemia that required repeat nephrostomy tube insertion and 2-8 extra days of hospitalization. Clinical success rate was 83% (34 of 41). No major bleeding occurred. In 13 (36%) of 36 patients, hematuria lasted longer than 24 hours but resolved without further intervention or blood transfusion. In those who underwent two-stage stent placement (n = 61), technical success rate was 100%, but clinical success rate was 98%; one patient developed septicemia, and no major hemorrhage occurred. Difference in major complication rate between groups was not significant (6% [two of 36] vs 2% [one of 61]; P =.55). CONCLUSION One-stage tubeless antegrade ureteral stent insertion in selected cases showed 88% technical success rate and 83% clinical success rate, with no major hemorrhage.
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Affiliation(s)
- Uday Patel
- Department of Radiology, St James' Wing, St George's Hospital, Blackshaw Rd, London SW17 0QT, England.
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