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Raciti P, Sue J, Retamero JA, Ceballos R, Godrich R, Kunz JD, Casson A, Thiagarajan D, Ebrahimzadeh Z, Viret J, Lee D, Schüffler PJ, DeMuth G, Gulturk E, Kanan C, Rothrock B, Reis-Filho J, Klimstra DS, Reuter V, Fuchs TJ. Clinical Validation of Artificial Intelligence-Augmented Pathology Diagnosis Demonstrates Significant Gains in Diagnostic Accuracy in Prostate Cancer Detection. Arch Pathol Lab Med 2023; 147:1178-1185. [PMID: 36538386 DOI: 10.5858/arpa.2022-0066-oa] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 09/29/2023]
Abstract
CONTEXT.— Prostate cancer diagnosis rests on accurate assessment of tissue by a pathologist. The application of artificial intelligence (AI) to digitized whole slide images (WSIs) can aid pathologists in cancer diagnosis, but robust, diverse evidence in a simulated clinical setting is lacking. OBJECTIVE.— To compare the diagnostic accuracy of pathologists reading WSIs of prostatic biopsy specimens with and without AI assistance. DESIGN.— Eighteen pathologists, 2 of whom were genitourinary subspecialists, evaluated 610 prostate needle core biopsy WSIs prepared at 218 institutions, with the option for deferral. Two evaluations were performed sequentially for each WSI: initially without assistance, and immediately thereafter aided by Paige Prostate (PaPr), a deep learning-based system that provides a WSI-level binary classification of suspicious for cancer or benign and pinpoints the location that has the greatest probability of harboring cancer on suspicious WSIs. Pathologists' changes in sensitivity and specificity between the assisted and unassisted modalities were assessed, together with the impact of PaPr output on the assisted reads. RESULTS.— Using PaPr, pathologists improved their sensitivity and specificity across all histologic grades and tumor sizes. Accuracy gains on both benign and cancerous WSIs could be attributed to PaPr, which correctly classified 100% of the WSIs showing corrected diagnoses in the PaPr-assisted phase. CONCLUSIONS.— This study demonstrates the effectiveness and safety of an AI tool for pathologists in simulated diagnostic practice, bridging the gap between computational pathology research and its clinical application, and resulted in the first US Food and Drug Administration authorization of an AI system in pathology.
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Affiliation(s)
- Patricia Raciti
- From Paige (Raciti, Sue, Retamero, Ceballos, Godrich, Kunz, Casson, Thiagarajan, Ebrahimzadeh, Viret, Lee, Schüffler, Gulturk, Kanan, Rothrock, Klimstra, Fuchs), New York, New York
| | - Jillian Sue
- From Paige (Raciti, Sue, Retamero, Ceballos, Godrich, Kunz, Casson, Thiagarajan, Ebrahimzadeh, Viret, Lee, Schüffler, Gulturk, Kanan, Rothrock, Klimstra, Fuchs), New York, New York
| | - Juan A Retamero
- From Paige (Raciti, Sue, Retamero, Ceballos, Godrich, Kunz, Casson, Thiagarajan, Ebrahimzadeh, Viret, Lee, Schüffler, Gulturk, Kanan, Rothrock, Klimstra, Fuchs), New York, New York
| | - Rodrigo Ceballos
- From Paige (Raciti, Sue, Retamero, Ceballos, Godrich, Kunz, Casson, Thiagarajan, Ebrahimzadeh, Viret, Lee, Schüffler, Gulturk, Kanan, Rothrock, Klimstra, Fuchs), New York, New York
| | - Ran Godrich
- From Paige (Raciti, Sue, Retamero, Ceballos, Godrich, Kunz, Casson, Thiagarajan, Ebrahimzadeh, Viret, Lee, Schüffler, Gulturk, Kanan, Rothrock, Klimstra, Fuchs), New York, New York
| | - Jeremy D Kunz
- From Paige (Raciti, Sue, Retamero, Ceballos, Godrich, Kunz, Casson, Thiagarajan, Ebrahimzadeh, Viret, Lee, Schüffler, Gulturk, Kanan, Rothrock, Klimstra, Fuchs), New York, New York
| | - Adam Casson
- From Paige (Raciti, Sue, Retamero, Ceballos, Godrich, Kunz, Casson, Thiagarajan, Ebrahimzadeh, Viret, Lee, Schüffler, Gulturk, Kanan, Rothrock, Klimstra, Fuchs), New York, New York
| | - Dilip Thiagarajan
- From Paige (Raciti, Sue, Retamero, Ceballos, Godrich, Kunz, Casson, Thiagarajan, Ebrahimzadeh, Viret, Lee, Schüffler, Gulturk, Kanan, Rothrock, Klimstra, Fuchs), New York, New York
| | - Zahra Ebrahimzadeh
- From Paige (Raciti, Sue, Retamero, Ceballos, Godrich, Kunz, Casson, Thiagarajan, Ebrahimzadeh, Viret, Lee, Schüffler, Gulturk, Kanan, Rothrock, Klimstra, Fuchs), New York, New York
| | - Julian Viret
- From Paige (Raciti, Sue, Retamero, Ceballos, Godrich, Kunz, Casson, Thiagarajan, Ebrahimzadeh, Viret, Lee, Schüffler, Gulturk, Kanan, Rothrock, Klimstra, Fuchs), New York, New York
| | - Donghun Lee
- From Paige (Raciti, Sue, Retamero, Ceballos, Godrich, Kunz, Casson, Thiagarajan, Ebrahimzadeh, Viret, Lee, Schüffler, Gulturk, Kanan, Rothrock, Klimstra, Fuchs), New York, New York
| | - Peter J Schüffler
- From Paige (Raciti, Sue, Retamero, Ceballos, Godrich, Kunz, Casson, Thiagarajan, Ebrahimzadeh, Viret, Lee, Schüffler, Gulturk, Kanan, Rothrock, Klimstra, Fuchs), New York, New York
| | | | - Emre Gulturk
- From Paige (Raciti, Sue, Retamero, Ceballos, Godrich, Kunz, Casson, Thiagarajan, Ebrahimzadeh, Viret, Lee, Schüffler, Gulturk, Kanan, Rothrock, Klimstra, Fuchs), New York, New York
| | - Christopher Kanan
- From Paige (Raciti, Sue, Retamero, Ceballos, Godrich, Kunz, Casson, Thiagarajan, Ebrahimzadeh, Viret, Lee, Schüffler, Gulturk, Kanan, Rothrock, Klimstra, Fuchs), New York, New York
| | - Brandon Rothrock
- From Paige (Raciti, Sue, Retamero, Ceballos, Godrich, Kunz, Casson, Thiagarajan, Ebrahimzadeh, Viret, Lee, Schüffler, Gulturk, Kanan, Rothrock, Klimstra, Fuchs), New York, New York
| | - Jorge Reis-Filho
- The Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York (Reis-Filho, Reuter)
| | - David S Klimstra
- From Paige (Raciti, Sue, Retamero, Ceballos, Godrich, Kunz, Casson, Thiagarajan, Ebrahimzadeh, Viret, Lee, Schüffler, Gulturk, Kanan, Rothrock, Klimstra, Fuchs), New York, New York
| | - Victor Reuter
- The Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York (Reis-Filho, Reuter)
| | - Thomas J Fuchs
- From Paige (Raciti, Sue, Retamero, Ceballos, Godrich, Kunz, Casson, Thiagarajan, Ebrahimzadeh, Viret, Lee, Schüffler, Gulturk, Kanan, Rothrock, Klimstra, Fuchs), New York, New York
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Mahmoud Halabi J, Al-Handawi MB, Ceballos R, Naumov P. Intersectional Effects of Crystal Features on the Actuation Performance of Dynamic Molecular Crystals. J Am Chem Soc 2023. [PMID: 37235774 DOI: 10.1021/jacs.3c02184] [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: 05/28/2023]
Abstract
Despite being researched for decades, shape-shifting molecular crystals have yet to claim their spot as an actuating materials class among the primary functional materials. While the process for developing and commercializing materials can be lengthy, it inevitably starts with building an extensive knowledge base, which for molecular crystal actuators remains scattered and disjointed. Using machine learning for the first time, we identify inherent features and structure-function relationships that fundamentally impact the mechanical response of molecular crystal actuators. Our model can factor in different crystal properties in tandem and decipher their intersectional and combined effects on each actuation performance. This analysis is an open invitation to utilize interdisciplinary expertise in translating the current basic research on molecular crystal actuators into technology-based development that promotes large-scale experimentation and prototyping.
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Affiliation(s)
- Jad Mahmoud Halabi
- Smart Materials Lab, New York University Abu Dhabi, P.O. Box 129188, Abu Dhabi, UAE
| | - Marieh B Al-Handawi
- Smart Materials Lab, New York University Abu Dhabi, P.O. Box 129188, Abu Dhabi, UAE
| | | | - Panče Naumov
- Smart Materials Lab, New York University Abu Dhabi, P.O. Box 129188, Abu Dhabi, UAE
- Center for Smart Engineering Materials, New York University Abu Dhabi, P.O. Box 129188, Abu Dhabi, UAE
- Research Center for Environment and Materials, Macedonian Academy of Sciences and Arts, Bul. Krste Misirkov 2, Skopje MK-1000, Macedonia
- Molecular Design Institute, Department of Chemistry, New York University, 100 Washington Square East, New York, New York 10003, United States
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da Silva LM, Pereira EM, Salles PG, Godrich R, Ceballos R, Kunz JD, Casson A, Viret J, Chandarlapaty S, Ferreira CG, Ferrari B, Rothrock B, Raciti P, Reuter V, Dogdas B, DeMuth G, Sue J, Kanan C, Grady L, Fuchs TJ, Reis-Filho JS. Independent real-world application of a clinical-grade automated prostate cancer detection system. J Pathol 2021; 254:147-158. [PMID: 33904171 PMCID: PMC8252036 DOI: 10.1002/path.5662] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [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: 10/05/2020] [Revised: 02/23/2021] [Accepted: 03/05/2021] [Indexed: 01/19/2023]
Abstract
Artificial intelligence (AI)‐based systems applied to histopathology whole‐slide images have the potential to improve patient care through mitigation of challenges posed by diagnostic variability, histopathology caseload, and shortage of pathologists. We sought to define the performance of an AI‐based automated prostate cancer detection system, Paige Prostate, when applied to independent real‐world data. The algorithm was employed to classify slides into two categories: benign (no further review needed) or suspicious (additional histologic and/or immunohistochemical analysis required). We assessed the sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs) of a local pathologist, two central pathologists, and Paige Prostate in the diagnosis of 600 transrectal ultrasound‐guided prostate needle core biopsy regions (‘part‐specimens’) from 100 consecutive patients, and to ascertain the impact of Paige Prostate on diagnostic accuracy and efficiency. Paige Prostate displayed high sensitivity (0.99; CI 0.96–1.0), NPV (1.0; CI 0.98–1.0), and specificity (0.93; CI 0.90–0.96) at the part‐specimen level. At the patient level, Paige Prostate displayed optimal sensitivity (1.0; CI 0.93–1.0) and NPV (1.0; CI 0.91–1.0) at a specificity of 0.78 (CI 0.64–0.89). The 27 part‐specimens considered by Paige Prostate as suspicious, whose final diagnosis was benign, were found to comprise atrophy (n = 14), atrophy and apical prostate tissue (n = 1), apical/benign prostate tissue (n = 9), adenosis (n = 2), and post‐atrophic hyperplasia (n = 1). Paige Prostate resulted in the identification of four additional patients whose diagnoses were upgraded from benign/suspicious to malignant. Additionally, this AI‐based test provided an estimated 65.5% reduction of the diagnostic time for the material analyzed. Given its optimal sensitivity and NPV, Paige Prostate has the potential to be employed for the automated identification of patients whose histologic slides could forgo full histopathologic review. In addition to providing incremental improvements in diagnostic accuracy and efficiency, this AI‐based system identified patients whose prostate cancers were not initially diagnosed by three experienced histopathologists. © 2021 The Authors. The Journal of Pathology published by John Wiley & Sons, Ltd. on behalf of The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Sarat Chandarlapaty
- Department of Medicine and Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | | | - Victor Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | | | | | | | - Jorge S Reis-Filho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Dogdas B, Kanan C, Raciti P, Tian SK, Brookman-May SD, Wetherhold L, Smith A, Rooney OB, McCarthy SA, Alvarez JD, Lopez-Gitlitz A, Casson A, Godrich R, Kunz JD, Ceballos R, Leibowitz C, Grady L, Fuchs TJ. Computational pathological identification of prostate cancer following neoadjuvant treatment. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e14052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14052 Background: The need for accurate pathological identification and quantitation of prostate cancer (PC) following neoadjuvant treatment with androgen deprivation therapy (ADT) and androgen receptor antagonists is increasing as PC treatment continues to evolve. In clinical practice, pathological assessment of residual tumor is a tedious and time-consuming process due to the volume of tissue from radical prostatectomy (RP). In addition, neoadjuvant treatments can greatly alter both benign and neoplastic prostate tissue morphology making the pathology assessment difficult for even specialized pathologists. Paige Prostate 1.0 is a clinical-grade artificial intelligence (AI) system for PC detection. It was trained and evaluated in over 50,000 prostate biopsy slides with validation across more than 800 institutions worldwide using multiple slide scanners. Methods: We evaluated the performance of Paige Prostate 1.0 at identifying prostatic tumor on 64 hematoxylin and eosin stained slides exhibiting neoadjuvant treatment effect from apalutamide, enzalutamide, and/or ADT. Results: Analysis of the receiver operating characteristic curve demonstrated an area under the curve of 0.96. Using the Paige Prostate 1.0 operating point, it achieved a sensitivity of 91% and a specificity of 94%, corresponding to the correct identification of challenging treated morphology in 59/64 slides using expert pathologists as the reference. False negative cases were typically represented by atypical small acinar proliferation that required expert pathological consensus confirmation. Conclusions: To our knowledge, this is the first AI based evaluation of residual disease in PC with hormone neoadjuvant therapy. Paige Prostate 1.0 effectively identified tumor despite treatment effects. Future work will include optimization of Paige Prostate 1.0 by training with RP specimens from a larger cohort of appropriate samples, as well as precise measurement of residual tumor burden to further improve its accuracy and reproducibility. Paige prostate residual disease detection 1.0 has the potential to impact emerging clinical practice at the patient level and to complement the pathological assessment of RPs in global phase 3 clinical trials, such as PROTEUS, in a standardized, reproducible, and robust way.
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Myren J, Ceballos R, Luketic GC. Colchicine effects on the mouse liver. Scand J Gastroenterol 2010; 2:7-17. [PMID: 20184462 DOI: 10.3109/00365526709180042] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
With histochemical methods an instantaneous and marked inhibitory effect of a single dose of colchicine on the activity of succinic-, lactic-, glucose-6-phosphate-, NADH- and NADPH-dehydrogenase in the mouse liver was observed. This effect was essentially the same as that previously described in the intestinal mucosa and not dependent on or a consequence of the inhibitory effect of colchicine on cell division. The enzymatic inhibitory effect of colchicine was qualitatively similar regardless of the dose of the drug given, although a single large dose (1.5 mg/kg body weight) produced alterations and depression of dehydrogenase activity more marked and not so rapidly repaired as those appearing after a small dose of colchicine (0.24 mg/kg body weight). Following repeated doses of colchicine the degree of histochemically demonstrable depression of dehydrogenase activity was not obviously different from that found after a single dose. After large repeated doses morphological alterations and prolonged depression of dehydrogenase activity of liver cells were found and many of the animals died. After repeated administration of the small dose (0.24 mg/kg body weight) no morphological alterations were found and the activity of dehydrogenases was normalized, although the injection of colchicine was continued.
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Affiliation(s)
- J Myren
- Division of Gastroenterology, Department of Medicine and Pathology, University of Alabama Medical Center, Birmingham, Alabama, USA
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6
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Ceballos R, Gomez-Lopez M, Gasca R, Del Valle C. An integration of model-based techniques for determining the minimal diagnosis. Int Artif 2006. [DOI: 10.4114/ia.v10i31.936] [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: 11/20/2022] Open
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7
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Garcia D, Alaez C, Ceballos R, Reyes R, Bertaud E, Rodriguez A, Flores H, Gorodezky C. Retrospective analysis of CDC (-) kidney transplanted patients: Comparison of HLA class I/II alloantibodies by ELISA and Luminex beads. Hum Immunol 2004. [DOI: 10.1016/j.humimm.2004.07.102] [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: 10/26/2022]
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Albuquerque Junior DMD, Ceballos R, Hallewell L. Urban trails, human traps: the construction of territories of pleasure and pain in the lives of male homosexuals in the Brazilian northeast in the 1970s and 1980s. Lat Am Perspect 2002; 29:139-162. [PMID: 15551523] [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: 05/24/2023]
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Bini RM, Nath PH, Ceballos R, Bargeron LM, Kirklin JK. Pericardial cyst diagnosed by two-dimensional echocardiography and computed tomography in a newborn. Pediatr Cardiol 2001; 8:47-50. [PMID: 3601737 DOI: 10.1007/bf02308385] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A one-day-old full-term female infant with massive "cardiomegaly" developed marked respiratory distress soon after birth. The two-dimensional (2D) echocardiogram demonstrated a 4 X 5-cm cystic mass adjacent to the left ventricular free wall. Computed tomography (CT) confirmed the presence and dimension of the cyst and CT number indicated the fluid within the cyst to be serous. A pericardial cyst was successfully removed at thoracotomy. Two-dimensional echocardiography and CT, both noninvasive procedures, are fully adequate tools in the diagnosis of pericardial cysts in the neonate, so that invasive investigations may be avoided.
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Burke AP, Anderson PG, Virmani R, James TN, Herrera GA, Ceballos R. Tumor of the atrioventricular nodal region. A clinical and immunohistochemical study. Arch Pathol Lab Med 1990; 114:1057-62. [PMID: 2222148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Autopsy specimens of 17 tumors of the atrioventricular nodal region were studied. Sudden death occurred in 14 children and adults; seven of these patients had a history of atrioventricular block or syncope. Three tumors were incidental findings in infants with other congenital anomalies; diaphragmatic agenesis, pulmonary hypoplasia, and Meckel's diverticulum in one patient; mitral atresia in one; and congenital hydrocephalus, ventricular septal defect, patent ductus arteriosus, coarctation of the aorta, and patent omphalovitelline duct in the third. Immunohistochemical stains demonstrated strong positivity for carcinoembryonic antigen in 13 of 13 cases, B72.3 antigen in 5 of 7 cases, and cytokeratin in 11 of 11 cases. Twenty control cases of mesothelioma and mesothelial hyperplasia were all negative for B72.3; one showed focal carcinoembryonic antigen staining. Ultrastructural analysis of one case demonstrated short rudimentary microvilli not characteristic of mesothelial cells. We conclude that so-called mesotheliomas of the atrioventricular nodal region are not of mesothelial origin, because of strong carcinoembryonic antigen positivity and occasional positivity with B72.3, as these antibodies react with glycoproteins found in endodermally derived tissue and generally not with mesothelial tissue. Conduction system tumors are most likely congenital rests of endodermal origin, can be associated with other congenital anomalies, and often cause symptoms of heart block and sudden death.
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Affiliation(s)
- A P Burke
- Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000
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Abstract
Seventy-six cardiac autopsy specimens with ventricular septal defects were studied from a surgical viewpoint. The defects were classified as being conoventricular (n = 25), in the right ventricular outlet (n = 21), in the inlet septum (n = 11) or in the trabecular septum (n = 19) with each category having several subcategories. The left ventricular outflow tract relations of the defects are emphasized. The borders of the ventricular septal defects are described in detail, with use of the prefix "juxta" to indicate the immediate adjacency of the defect to a structure such as the tricuspid valve.
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Affiliation(s)
- B Soto
- Department of Radiology, University of Alabama, Birmingham 35294
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Jones JM, Ceballos R. Neoplastic angioendotheliomatosis and prostatic carcinoma coexisting in a patient. A case report. Ala J Med Sci 1986; 23:318-21. [PMID: 3752409] [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: 01/07/2023]
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Abstract
Presentation of aortic dissection (AD) typically includes chest and/or abdominal pain. Gastrointestinal (GI) symptoms other than abdominal pain are uncommon. Two patients with AD are described in whom the dominant presenting symptom was GI hemorrhage. Mesenteric infarction complicated acute Type I dissection in one patient whose clinical manifestations simulated ulcerative colitis. In the other patient an old, small asymptomatic Type III AD resulted in a false aneurysm in the retroperitoneum which ruptured into the duodenum. In the latter case an antemortem diagnosis was not made as angiography was limited to the visceral arteries and the abdominal aorta without appreciation of the significance of a focal compression of the abdominal aorta. The possibility of AD thus should also be considered in the evaluation of a patient with acute GI bleeding.
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Abstract
An analysis of 6 patients with overriding atrioventricular valve was performed in order to correlate the anatomic and angiographic features of this malformation. The atrial arrangement was usual (situs solitus) in each patient. The ventricular chambers were normally related in 4 and the mirror image of normal in 2. The atrioventricular connexion was concordant in parallel fashion in 4, discordant in 1 and double inlet left ventricle in 1 heart. In 2 of 4 hearts with concordant atrioventricular connexion, the right atrioventricular valve (tricuspid) overrode the septum and connected partially to the left ventricle. In 2, the left atrioventricular valve (mitral) overrode the septum and partially connected with the right ventricle. One heart with discordant atrioventricular connexion had its right atrioventricular valve (mitral) overriding the septum. The remaining heart with double inlet left ventricle had an overriding left atrioventricular valve. Each overriding atrioventricular valve had its "septal" leaflet (the one committed to the contralateral ventricle) divided into 2 segments by a large cleft. Ventricular septal defects at different locations were present in all cases. The ventriculoarterial connexion was double outlet right ventricle in 5 patients and was discordant in 1. Malalignment of the atrial and ventricular septa was present to some degree in all cases. This was well depicted on ventriculograms in four chamber view in those with an overriding tricuspid valve. It was not detected in those with an overriding mitral valve. The displaced leaflets of the overriding and/or stradding valve had a vertical motion on cineangiograms similar to those observed in atrioventricular septal defects. Abnormal morphology and motion of the septal leaflet of the overriding atrioventricular valve and malalignment of the atrial and ventricular septal structures were the most important angiographic findings in this series.
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Abstract
Following surgery for pituitary adenoma, radiation therapy is an accepted treatment in reducing tumor recurrence. However, a potential therapeutic complication is delayed radionecrosis of perisellar neural structures, including the optic nerves and chiasm. This particular cause of visual loss, radiation optic neuropathy (RON), has not been emphasized in the ophthalmologic literature. Four cases of RON seen in the past five years are reported. Diagnostic criteria include: (1) acute visual loss (monocular or binocular), (2) visual field defects indicating optic nerve or chiasmal dysfunction, (3) absence of optic disc edema, (4) onset usually within three years of therapy (peak: 1-1 1/2 years), and (5) no computed tomographic evidence of visual pathway compression. Pathologic findings, differential diagnosis and therapy will be discussed in outlining the clinical profile of RON.
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Dean D, Ceballos R. Congenital malformation: dental features of acardia--case report. J Oral Med 1985; 40:106-7. [PMID: 3861808] [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: 01/07/2023]
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Abstract
Angiographic study of the motion of the septal and left marginal arteries was performed in patients with restriction in ventricular diastolic filling in order to separate patients with constrictive pericarditis from those with restrictive cardiomyopathy. Twelve patients with constrictive pericarditis (group I) and 10 patients with restrictive cardiomyopathy (group II) were evaluated and compared with 21 patients with normal coronary angiograms (group III). The displacement of the septal arteries (23 +/- 2.04 mm) was abnormally exaggerated in group I and normal (9 +/- 0.81 mm) in groups II and III. The displacement of the left marginal arteries as seen by the "corrugating index" was similar in all groups. We conclude that study of the displacement of the septal arteries is a useful angiographic sign that helps to separate constrictive pericarditis from restrictive cardiomyopathy and normals.
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Abstract
Congenital pulmonary vein stenosis is a rare and serious form of congenital heart disease. Between 1969 and 1982 10 patients with this lesion were studied. In 2 patients the condition was diagnosed at autopsy; these patients died before the presence of congenital heart disease was suspected. Of the 8 in whom the condition was diagnosed during life, it was suspected clinically in 6 and found unexpectedly at cardiac catheterization in 2. All underwent operation, and 5 were hospital survivors. In all survivors rapid and progressive restenosis of the pulmonary veins occurred over the next several months. Three of the 5 underwent reoperation, but progressive restenosis recurred and all eventually died of this condition. Thus, despite partial surgical relief of pulmonary vein stenosis, the lesion is apparently one of relentless progression. No surgical repair has been successful in the cure or long-term palliation of this lethal lesion.
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Abstract
Radionuclide assessment of ejection fraction was determined early and late postoperatively following cardiac transplantation in 16 patients. In 11 patients, ejection fraction was determined within 48 hours of an endocardial biopsy. There was no relationship between the severity of histologically evident rejection and the ejection fraction (Pearson correlation coefficient [r] = -0.11; p = 0.47). In 2 patients, severe graft fibrosis developed with consequent diminution in ejection fraction. There was no relationship between severity and duration of rejection or the amount of immunosuppression required to treat acute rejection and the development of graft fibrosis. The mean resting ejection fraction in 7 patients in follow-up ranging from 6 to 21 months after transplantation was 0.59 +/- 0.06 (standard deviation), and the mean exercise ejection fraction in 6 of these patients was 0.72 +/- 0.08. Radionuclide-determined ejection fraction is not predictive of rejection early after operation. During short-term late follow-up, systolic left ventricular function at rest and exercise has been retained at normal levels.
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Santamaria H, Soto B, Ceballos R, Bargeron LM, Coghlan HC, Kirklin JW. Angiographic differentiation of types of ventricular septal defects. AJR Am J Roentgenol 1983; 141:273-81. [PMID: 6603117 DOI: 10.2214/ajr.141.2.273] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A retrospective study of 40 patients with 41 surgically repaired ventricular septal defects was performed in order to correlate the anatomic findings with the angiographic features seen by axial angiography. In 39 patients there were 32 perimembranous, three muscular, and four subarterial defects. One patient had both perimembranous and inlet muscular ventricular septal defects. Perimembranous defects as seen on left ventriculograms on long axial view are in continuity with the aortic valve. The relation of the defect to the tricuspid valve allows distinction of the extension of the perimembranous defect toward the inlet, trabecular, or infundibular zones. This relation was determined angiographically, using the course of the contrast medium from the left ventricle through the ventricular septal defect opacifying the right ventricle. Muscular defects are separated from the semilunar and atrioventricular valves. Subarterial defects are related to both semilunar valves, and they are best demonstrated by the elongated right anterior oblique view of the left ventriculogram. This study demonstrated that with axial views an experienced angiographer can define the location, size, and relations of the ventricular septal defects with high accuracy. In only two of the 41 defects there were differences between the retrospective angiographic prediction and the previous surgical findings.
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Abstract
A series of 25 cases of truncus arteriosus communis examined post mortem was studied retrospectively. Fifteen of them had had angiographic studies, enabling anatomo-radiographic correlative analysis to be made. All cases had situs solitus of the atria and concordant connections between atria and ventricles. The three main components of the malformation, present in all 25 cases, were: (a) ventricular septal defect, (b) single semilunar valve, (c) anomalies of the aortopulmonary septum. The ventricular septal defect was always subarterial but its size and its relation to mitral and tricuspid valves were extremely variable. The truncal valve varied greatly also in the number of its cusps and its relation to right and left ventricles. Above valvular level the presence or absence of residual aortopulmonary septum was reflected by the presence or absence of a main pulmonary artery. Additional supratruncal malformations produced variations of the anatomy of the aorta and pulmonary arteries. The angiographic demonstration of all these components was obtained best by selective angiography using special projections. From this study it appears that there is a wide degree of variability in all of the three main components of truncus arteriosus. Such anatomical variations should be identified angiographically in each patient in order to provide enough information before corrective surgery, but they do not alter the basically homogeneous anatomy of the category of truncus arteriosus and therefore do not justify complex classifications.
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Abstract
A 17-year-old patient with tricuspid atresia, palliatively corrected by a right Glenn and a left Potts anastomosis during his early childhood and a banding of the left pulmonary artery 6 years ago, developed a false aneurysm of the left pulmonary artery secondary to the erosion of the band fabric through the vascular wall with subsequent thrombosis, infection, and leakage. The diagnosis was confused by both chest roentgenography and angiography but was accurately made by postcontrast computed tomography (CT). We stress the importance and usefulness of CT in the diagnosis of a false aneurysm, not demonstrated by angiography.
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Volpi A, Whitley RJ, Ceballos R, Stagno S, Pereira L. Rapid diagnosis of pneumonia due to cytomegalovirus with specific monoclonal antibodies. J Infect Dis 1983; 147:1119-20. [PMID: 6304205 DOI: 10.1093/infdis/147.6.1119] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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24
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Abstract
We present seven cases of progressive ataxia with onset in childhood along with pathological findings in three patients. One patient showed pure cerebellar degeneration and had no visual changes. His brother had classic changes of olivopontocerebellar atrophy with profound amyotrophy but no visual changes. A third family member had similar findings with pathological findings intermediate in severity between the first two. The mother and daughter, who are living, are ataxic and have macular degeneration. In a second pedigree, all patients affected in three generations were male, but the disease began during adulthood in the first two generations. Myoclonic seizures occurred in the majority of patients.
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25
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Abstract
The anatomic abnormalities observed by cineangiographic axial techniques of 12 patients with tetralogy of Fallot were correlated with anatomic details noted at necropsy. Right ventricular angiograms made in the right anterior oblique view best demonstrated the severity and type of infundibular obstruction and also permitted differentiation of the perimembranous, infundibular muscular and subarterial types of ventricular septal defects. The degree of aortic overriding was best displayed in the long-axis view. Comparison of the intracardiac anatomy of each postmortem specimen with the respective premortem cineangiogram has provided further clarification of the angiographic anatomy displayed by these axial techniques.
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Abstract
We sectioned a series of hearts in a manner similar to that seen on angiographic axial views. A correlation with normal angiograms to identify the anatomic components of the four cardiac chambers showed that the components of the normal cardiac anatomy can be identified accurately through axial angiography in a manner not show previously.
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Abstract
A case of X/XXX mosaicism in a neonate with dysgenetic gonads is presented because of the rarity of the X/XXX karyotype and the presence of dysgenetic ovaries and congenital heart anomalies. We suggest that the X/XXX mosaicism may not have a protective effect on the gonads as does X/XX mosaicism in some cases.
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Abstract
The authors present a case of disseminated emboli originating in a thrombotic, aneurysmal ductus arteriosus in a neonate. In a critically ill neonate, the arteriographic appearance of ectatic, elongated, and tortuous vessels proximal to a stenotic segment is suggestive of multiple arterial emboli.
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Yanagida H, Corssen G, Ceballos R, Strong E. Alcohol-induced pituitary adenolysis: how does it control intractable cancer pain?--An experimental study using tooth pulp-evoked potentials in rhesus monkeys. Anesth Analg 1979; 58:279-87. [PMID: 110174 DOI: 10.1213/00000539-197907000-00004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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30
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Yanagida H, Corssen G, Ceballos R, Strong E. [Alcohol-induced hypophysectomy--its effect on tooth pulp evoked potentials in the rhesus monkey (author's transl)]. Masui 1979; 28:466-71. [PMID: 109646] [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: 12/13/2022]
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31
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32
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Montes LF, Ceballos R. Pityriasis rosea (Herald spot). J Cutan Pathol 1977; 4:354-5. [PMID: 753853 DOI: 10.1111/j.1600-0560.1977.tb00929.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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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33
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Corssen G, Holcomb MC, Moustapha I, Langford K, Vitek JJ, Ceballos R. Alcohol-induced adenolysis of the pituitary gland: a new approach to control of intractable cancer pain. Anesth Analg 1977; 56:414-21. [PMID: 559444 DOI: 10.1213/00000539-197705000-00021] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In exploring new modalities to control or ameliorate unbearable intractable pain associated with invasive cancer, the authors studied the effectiveness and safety of a new method involving the destruction of the pituitary by injection of absolute alcohol into the gland. Of a series of 24 patients undergoing pituitary adenolysis for control of cancer pain, 13 patients experienced complete and lasting relief and 10 showed significant improvement. The authors hope that the encouraging results obtained in this preliminary study will stimulate other investigators also to employ the transnasal, transphenoidal approach to alcohol-induced hypophysectomy for the control of intractable pain due to advanced cancer.
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Ceballos R, Soto B. Aortocaval fistula in abdominal aortic aneurysm: report of a case mimicking dissecting aneurysm. Ala J Med Sci 1977; 14:21-5. [PMID: 848690] [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: 12/24/2022]
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35
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Soyer MT, Ceballos R, Aldrete JS. Reversibility of severe hepatic damage caused by jejunoileal bypass after re-establishment of normal intestinal continuity. Surgery 1976; 79:601-4. [PMID: 1265672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This case report attempts to document the reversibility of advanced hepatic anatomical and clinical alterations compatible with advanced hepatic cirrhosis that occasionally develop in patients with jejunoileal bypass performed for morbid obesity. The advanced stage of this complication can be fatal unless the intestinal continuity is returned to normal.
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Ceballos R, Ch'ien LT, Whitley RJ, Brans YW. Cerebellar hypoplasia in an infant with congenital cytomegalovirus infection. Pediatrics 1976; 57:155-7. [PMID: 174055] [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: 12/13/2022] Open
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37
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Augustine JR, Ceballos R. A partial Klüver-Bucy syndrome in man. Ala J Med Sci 1975; 12:378-86. [PMID: 1200323] [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: 12/26/2022]
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38
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Ermocilla R, Cassady G, Ceballos R. Otitis media in the pathogenesis of neonatal meningitis with group B beta-hemolytic streptococcus. Pediatrics 1974; 54:643-4. [PMID: 4453469] [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: 01/10/2023] Open
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40
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MESH Headings
- Autopsy
- Birth Weight
- Central Nervous System Diseases/complications
- Female
- Humans
- Hyaline Membrane Disease/complications
- Infant, Newborn
- Infant, Premature, Diseases/blood
- Infant, Premature, Diseases/cerebrospinal fluid
- Infant, Premature, Diseases/drug therapy
- Infant, Premature, Diseases/etiology
- Infant, Premature, Diseases/mortality
- Infant, Premature, Diseases/pathology
- Infant, Premature, Diseases/urine
- Kanamycin/therapeutic use
- Male
- Meningitis/pathology
- Penicillin G/therapeutic use
- Pregnancy
- Pregnancy Complications, Infectious
- Pulmonary Alveoli/pathology
- Retrospective Studies
- Streptococcal Infections/blood
- Streptococcal Infections/cerebrospinal fluid
- Streptococcal Infections/drug therapy
- Streptococcal Infections/mortality
- Streptococcal Infections/pathology
- Streptococcal Infections/urine
- Streptococcus agalactiae
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Ceballos R, Ermocilla R. Extralobar lung sequestration and hyaline membrane in the newborn: anatomo-pathologic findings and implications in the etiology of hyaline membrane disease. Ala J Med Sci 1974; 11:178-80. [PMID: 4451255] [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: 01/10/2023]
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42
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Brans YW, Ceballos R, Cassady G. Umbilical catheters and hepatic abscesses. Pediatrics 1974; 53:264-6. [PMID: 4812011] [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: 01/12/2023] Open
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43
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44
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Montes LF, Ceballos R, Cooper MD, Bradley MN, Bockman DE. Chronic mucocutaneous candidiasis, myositis, and thymoma. A new triad. JAMA 1972; 222:1619-23. [PMID: 4564702] [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: 01/11/2023]
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45
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Soto B, Harman MA, Ceballos R, Barcia A. Angiographic diagnosis of dissecting aneurysm of the aorta. Am J Roentgenol Radium Ther Nucl Med 1972; 116:146-54. [PMID: 5055632 DOI: 10.2214/ajr.116.1.146] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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46
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Ch'ien LT, Wilborn WH, Carey JH, Ceballos R, Benton JW, Alford CA. The simultaneous occurrence of subacute sclerosing panencephalitis in two brothers. I. Clinical, virologic, and histopathologic studies. J Infect Dis 1972; 125:123-8. [PMID: 5007550 DOI: 10.1093/infdis/125.2.123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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47
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Alves AM, Ceballos R. The syndrome(s) of akinetic mutism. Extent of the concept based on clinical, anatomical and physiopathological grounds. Int Surg 1971; 56:392-401. [PMID: 5129711] [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: 01/14/2023] Open
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48
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49
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Ceballos R, Ronderos A. Shotgun pellet embolus of the middle cerebral artery. Ala J Med Sci 1971; 8:410-3. [PMID: 5156244] [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: 01/14/2023]
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50
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Blum AL, Shah GT, Wiebelhaus VD, Brennan FT, Helander HF, Ceballos R, Sachs G. Pronase method for isolation of viable cells from Necturus gastric mucosa. Gastroenterology 1971; 61:189-200. [PMID: 4104963] [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: 12/02/2022]
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