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Ross D, Venkatesulu B, Yoo R, Block AM, Welsh JS, Baldea K, Farooq A, Gupta G, Showalter TN, Garant A, Harkenrider MM, Solanki AA. The Importance of Multi-Parametric MRI, PET/CT, and Biopsy for Identifying and Delineating the Extent of Locally Radiorecurrent Prostate Cancer: A Multi-institutional Analysis of the F-SHARP Clinical Trial. Int J Radiat Oncol Biol Phys 2023; 117:e432. [PMID: 37785409 DOI: 10.1016/j.ijrobp.2023.06.1598] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Up to 50% of clinical recurrences after curative-intent radiation are intraprostatic local radiorecurrences (LRR), with improved detection through the recent incorporation of multi-parametric MRI and PET/CT in workup. Salvage local therapy (SLT) is increasingly being offered, particularly focal SLT to try to reduce toxicity due to prior radiation. Limited data exist on the incremental value of each imaging modality and biopsy in defining LRR. The objective of this study is to compare the findings of MRI, PET/CT and biopsy in patients with LRR prostate cancer, and the impact each modality has on identifying recurrence and defining the extent of prostate involvement. MATERIALS/METHODS This is a secondary analysis of 58 patients enrolled on the ongoing F-SHARP phase I/II clinical trial of salvage HDR brachytherapy from 3 institutions who underwent PSMA or fluciclovine PET/CT, MRI, and biopsy prior to enrollment. Recurrent tumor was delineated on each imaging modality and by inclusion of involved regions on biopsy. Descriptive statistics were used to compare the imaging-defined tumor with biopsy findings to assess the congruence between the imaging modalities and generate the percentage of patients with disease involvement on biopsy outside of the image-defined targets. RESULTS Initial therapy was conventional/moderately hypofractionated photons in 35 patients, LDR in 13, proton therapy in 7, SBRT in 2, and neutrons in 1. Recurrence Gleason grade groups included 1 (n = 3), 2 (17), 3 (12), 4 (8), 5 (9), and uninterpretable (9). MRI/TRUS sextant + fusion biopsy was performed in 40 patients, TRUS saturation biopsy in 4, and TRUS systematic biopsy in 14. The median number of cores involved and obtained were 6 and 14. The median number of discrete lesions on biopsy in different quadrants of the prostate was 3 (1-6). The median number of discrete lesions seen on MRI was 1 (0-4). MRI did not identity a discrete lesion in 4 patients. The sensitivity of MRI for detection of the LRR was 92.8%. The false negative rate for not detecting the focus of LRR on MRI was 7.2%. 68.4% of patients had biopsy-proven cancer outside of the MRI-defined target. Fluciclovine PET/CT was used in 45 patients, and 13 had PSMA PET/CT. The median number of lesions on PET/CT was 1 (0-2). PET/CT did not identify a discrete lesion in 8 patients. The pooled sensitivity of PET/CT in detecting the focus of LRR was 86.2% (Fluciclovine: 82.2%, PSMA: 100%). PET/CT false negative rate of PET/CT for not detecting the focus of LRR was 13.8% (Fluciclovine: 17.8%, PSMA 0%). 72.41% of patients had biopsy-proven cancer outside of the PET/CT-defined target (Fluciclovine: 77.8%, PSMA: 53.8%). CONCLUSION Although mpMRI and PET/CT are valuable tools for identifying LRR and delineating the extent of prostate/SV involvement, a thorough biopsy is mandatory if pursuing focal SLT. Such treatment should optimally be performed on a clinical trial with robust integration of all imaging and histopathologic data.
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Affiliation(s)
- D Ross
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL
| | - B Venkatesulu
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL; Loyola University Medical Center, Maywood, IL
| | - R Yoo
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL
| | - A M Block
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL; Loyola University Medical Center, Maywood, IL
| | - J S Welsh
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL; Loyola University Medical Center, Maywood, IL
| | - K Baldea
- Loyola University Medical Center, Maywood, IL; Department of Urology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - A Farooq
- Loyola University Medical Center, Maywood, IL; Department of Urology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - G Gupta
- Loyola University Medical Center, Maywood, IL; Department of Urology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | | | - A Garant
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - M M Harkenrider
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL; Loyola University Medical Center, Maywood, IL
| | - A A Solanki
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL; Loyola University Medical Center, Maywood, IL
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Affiliation(s)
- J S Welsh
- Stritch School of Medicine Loyola University - Chicago, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Maywood, IL, USA
| | - T L Traum
- UW Cancer Center (retired), Aurora, IL, USA
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Abstract
BACKGROUND Dissecting cellulitis of the scalp can be an extremely painful and disfiguring dermatological condition. The associated pain can be severe enough in some cases to require opioid analgesics, and this pain in conjunction with the disfigurement can induce significant emotional distress. Conservative treatments often fail to provide relief. Radiation therapy has been successfully used in the past but with outdated equipment and techniques. OBJECTIVES To evaluate the efficacy and toxicity of modern external beam radiation therapy techniques for the treatment of dissecting cellulitis of the scalp. METHODS Four patients with intractable dissecting cellulitis of the scalp were treated with electrons or a combination of electrons and photons to the entire scalp. Daily fraction sizes were 2.5 or 3 Gy and initially prescribed to 15-21 Gy. Patients were re-evaluated 3-4 weeks after completion of therapy. Any residual hair growth was treated with additional radiation treatments to ensure full epilation, up to a maximum dose of 35 Gy. RESULTS Rapid resolution of pain was seen in all patients with pain. Regression of nodules and decreased discharge was seen in all patients following treatment and cosmesis was subjectively improved. No long-term toxicity has been observed. CONCLUSIONS Using modern techniques and equipment, radiation therapy appears to be a reasonable option for patients with severe/refractory dissecting cellulitis of the scalp. Acute effects are mild and well tolerated. Aside from alopecia, which was present to some extent in all patients before treatment, no long-term complications have been observed.
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Affiliation(s)
- P Chinnaiyan
- Department of Human Oncology, University of Wisconsin Medical School, Madison, WI 53792, USA
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Song DY, Jones RJ, Welsh JS, Haulk TL, Korman LT, Noga S, Goodman S, Herman M, Mann R, Marcellus D, Vogelsang G, Ambinder RF, Abrams RA. Phase I study of escalating doses of low-dose-rate, locoregional irradiation preceding Cytoxan-TBI for patients with chemotherapy-resistant non-Hodgkin's or Hodgkin's lymphoma. Int J Radiat Oncol Biol Phys 2003; 57:166-71. [PMID: 12909229 DOI: 10.1016/s0360-3016(03)00508-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE In patients in whom bone marrow transplantation (BMT) fails, recurrence often occurs at sites known to have contained disease before initiating BMT. The purpose of this study was to find the maximal tolerable dose of locoregional irradiation (LRT) between 1000 and 2000 cGy that could be integrated with our Cytoxan-total body irradiation (TBI) BMT conditioning regimen in the treatment of lymphoma. METHODS AND MATERIALS Patients had Hodgkin's or non-Hodgkin's lymphoma in chemotherapy-refractory relapse. All patients received LRT to a maximum of three sets of fields encompassing either all current or all previously known sites of disease. Cytoxan-TBI consisted of cyclophosphamide 50 mg/kg daily for 4 days followed by TBI of 1200 cGy given in four fractions. RESULTS Twenty-one patients were enrolled. Radiation Therapy Oncology Group Grade 3 in-field acute toxicity was observed in 1 patient at each dose level up to 1500 cGy and in 3 of 6 patients receiving 2000 cGy. Clinically evident late toxicities were limited to hypothyroidism and one second malignancy occurring outside the LRT fields. CONCLUSION Low-dose-rate, LRT with concurrent Cytoxan-TBI before BMT has acceptable rates of in-field toxicity for doses up to 1500 cGy in five fractions. This regimen safely permits the use of a total combined radiation dose of up to 2700 cGy during 2 weeks, with encouraging in-field response rates in treatment-refractory patients.
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Affiliation(s)
- D Y Song
- Division of Radiation Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Oncology Center, Baltimore, MD 21231, USA
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Song DY, Lawrie WT, Abrams RA, Kafonek DR, Bayless TM, Welsh JS, DeWeese TL. Acute and late radiotherapy toxicity in patients with inflammatory bowel disease. Int J Radiat Oncol Biol Phys 2001; 51:455-9. [PMID: 11567821 DOI: 10.1016/s0360-3016(01)01629-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To evaluate the incidence of gastrointestinal complications in patients with inflammatory bowel disease (IBD) receiving radiotherapy (RT) and to identify possibly avoidable factors associated with these complications. METHODS AND MATERIALS Twenty-four patients were identified and their records reviewed; all had a history of IBD before receiving RT to fields encompassing some portion of the gastrointestinal tract (Crohn's disease) or to the abdomen or pelvis (ulcerative colitis or IBD not otherwise specified). RESULTS Five of 24 patients (21%) experienced Grade > or =3 acute gastrointestinal toxicity; all 5 received concurrent chemotherapy. Two of 24 patients (8%) experienced Grade > or =3 late gastrointestinal toxicity. There were no significant correlations between complications and IBD type, prior IBD-related surgery, use of medications for IBD, or status of IBD. CONCLUSION Patients with IBD may have an increased risk for severe acute RT-related gastrointestinal complications that is more modest than generally perceived, because all patients who had Grade > or =3 acute complications in this study had received concurrent chemotherapy (p = 0.04). Further study is needed to assess this risk, as well as the impact of RT on these patients' future gastrointestinal morbidity.
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Affiliation(s)
- D Y Song
- Division of Radiation Oncology, Johns Hopkins Hospital, Baltimore, MD, USA
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Welsh JS, Howard SP. Acute myelogenous leukemia after exposure to strontium-89 for the treatment of adenocarcinoma of the prostate. Cancer 2000; 89:226-7. [PMID: 10897031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Affiliation(s)
- J S Welsh
- Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
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Affiliation(s)
- J S Welsh
- Division of Radiation, Johns Hopkins Oncology Center, Baltimore, MD, USA.
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Abstract
PURPOSE This report illustrates the utility of ventilation-perfusion scintigraphy in differentiating radiation pneumonitis from other causes of dyspnea, including pulmonary embolism, heart failure, obstructive tumor, and chronic obstructive pulmonary disease. METHODS AND RESULTS A nonsegmental mismatched perfusion abnormality, which exactly conformed to a radiation port, was diagnostic of radiation pneumonitis. CONCLUSION In patients with lung tumors presenting with dyspnea, ventilation-perfusion scintigraphy may be useful in diagnosing radiation pneumonitis and effectively excluding other causes of dyspnea.
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Affiliation(s)
- B B Chin
- Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
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Welsh JS. Taking health to the airwaves. Am Pharm 1980; NS20:25. [PMID: 7457344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Welsh JS. Reaching out through NMAT. Am Pharm 1980; NS20:30-1. [PMID: 7457345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Welsh JS. OTCs under review: an update on what's in and what's out. Am Pharm 1980; NS20:11-5. [PMID: 7424784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Welsh JS. Stepping up to positive health--consumers and professionals take the lead. Am Pharm 1980; NS20:16-8. [PMID: 7395712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Welsh JS. APhA aids for the self-medicating patient. Am Pharm 1980; NS20:21. [PMID: 7395714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Welsh JS. Keeping prescription drug advertising honest. FDA's watchful eye. Am Pharm 1980; NS20:40-4. [PMID: 7395709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Welsh JS. Drug addiction in pregnancy. Preventing a second generation of junkies. Am Pharm 1980; NS20:13-5. [PMID: 7386372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Welsh JS. APhA joins 'Project Sleep'. Am Pharm 1980; NS20:10-1. [PMID: 7386371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Welsh JS. Pharmacy health questionnaire. Latest in the line of professional counseling tools from APhA. Am Pharm 1980; NS20:35-7. [PMID: 7386375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Welsh JS. Better aim on poison prevention: pharmacists increase efforts. Am Pharm 1980; NS20:10-11. [PMID: 7355704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Welsh JS. Pharmacists in FDA. Am Pharm 1980; NS20:28-32. [PMID: 7369115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Welsh JS. FDA to revise drug review process. Am Pharm 1980; NS20:45. [PMID: 7369119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Welsh JS. Drink and drugs: deadly duo. Am Pharm 1979; 19:11-5. [PMID: 517419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Welsh JS. Where do we stand with PPIs? Am Pharm 1979; 19:12-5. [PMID: 517403 DOI: 10.1016/s0160-3450(15)32194-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Welsh JS. Drug product selection in Florida--all it could be? Am Pharm 1979; 19:12-3. [PMID: 539530 DOI: 10.1016/s0160-3450(15)32286-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Welsh JS. Target: adverse drug reactions. Am Pharm 1979; 19:30-3. [PMID: 506916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Welsh JS. New antihypertensive diuretic approved and marketed. Am Pharm 1979; 19:49. [PMID: 474404 DOI: 10.1016/s0160-3450(15)32345-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Welsh JS. Consultative services: they work in Minnesota. 1979 Arnold and Marie Schwartz Award winners. Am Pharm 1979; 19:26-31. [PMID: 474400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Welsh JS. Three generations of pharmacists. Am Pharm 1979; 19:36-41. [PMID: 380314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Welsh JS. COSTEP--more than just a summer job. Am Pharm 1979; 19:46-7. [PMID: 474394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Welsh JS. The trial pharmacist. Am Pharm 1979; 19:16-7, 33. [PMID: 382816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Welsh JS. Goals and standards of health planning. Am Pharm 1979; 19:22. [PMID: 425897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Welsh JS. Sign of a new era. Mary Munson Runge steps up. Am Pharm 1979; 19:8-10. [PMID: 371381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Crowder VH, Welsh JS, Bornside GH, Cohn I. Bacteriological comparison of hexachlorophene and polyvinylpyrrolidone-iodine surgical scrub soaps. Am Surg 1967; 33:906-11. [PMID: 6061284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Bornside GH, Welsh JS, Crowder VH, Cohn I. Disposable hexachlorophene impregnated polyurethane scrub sponges: a clinical bacteriologic study. Ann Surg 1967; 166:129-36. [PMID: 6028833 PMCID: PMC1477345 DOI: 10.1097/00000658-196707000-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Bornside GH, Welsh JS, Cohn I. Bacterial flora of the human small intestine. JAMA 1966; 196:1125-7. [PMID: 5952513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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