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Izadi S, Zendejas B, Meisner J, Kamran A, Mohammed S, Demehri F, Staffa S, Zurakowski D, Hseu A, Cunningham M, Choi S, Barnewolt C. Diagnostic Accuracy of Laryngeal Ultrasound for Evaluating Vocal Fold Movement Impairment in Children. J Pediatr Surg 2024; 59:109-116. [PMID: 37845124 DOI: 10.1016/j.jpedsurg.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/06/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE Vocal fold movement impairment (VFMI) secondary to recurrent laryngeal nerve (RLN) injury is a common source of morbidity after pediatric cervical, thoracic, and cardiac procedures. Flexible laryngoscopy (FL) is the gold standard to diagnose VFMI yet can be challenging to perform and/or risks possible clinical decompensation in some children and is an aerosolizing procedure. Laryngeal ultrasound (LUS) is a potential non-invasive alternative, but limited data exists in the pediatric surgical population regarding its efficacy. We aimed to investigate the diagnostic accuracy of LUS compared to FL in evaluating VFMI. METHODS A prospective, single-center, single-blinded (rater) cohort study was undertaken on perioperative pediatric patients at risk for RLN injury. Patients underwent FL and LUS. Cohen's kappa was used to determine chance-corrected agreement. RESULTS Between 2021 and 2023, 85 paired evaluations were performed with patients having a median (IQR) age of 10 (4, 42) months and weight of 7.5 (5.4, 13.4) kilograms. The prevalence of VFMI was 27.1%. Absolute agreement between evaluations was 98.8% (kappa 0.97, 95% CI: 0.91-1.00, P < 0.001). The sensitivity and specificity of LUS in detecting VFMI was 95.7% and 100%, yielding a positive predictive value (PPV) of 100% and negative predictive value (NPV) of 98.4% (95% CI: 90-100%). Diagnostic accuracy was 98.8% (95% CI: 93-100%). CONCLUSION LUS is a highly accurate modality in evaluating VFMI in children. While FL remains the gold standard for diagnosis, LUS offers a low-risk screening modality for children at risk for VFMI such that only those with an abnormal LUS or presence of clinical symptoms discordant with LUS findings should undergo FL. TYPE OF STUDY Prospective, single-center, single blinded (rater), cohort study. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Shawn Izadi
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | | | - Jay Meisner
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Ali Kamran
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Somala Mohammed
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Farokh Demehri
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Steven Staffa
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - David Zurakowski
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Anne Hseu
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Michael Cunningham
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Sukgi Choi
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Carol Barnewolt
- Department of Radiology, Boston Children's Hospital, Boston, MA, USA.
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Scalise PN, Durgin JM, Staffa SJ, Wynne N, Meisner J, Ngo P, Zendejas B, Kim HB, Demehri FR. Pediatric button battery ingestion: A single center experience and risk score to predict severe outcomes. J Pediatr Surg 2023; 58:613-618. [PMID: 36646540 DOI: 10.1016/j.jpedsurg.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The purpose of this study was to analyze the management and outcomes of primary button battery ingestions and their sequelae at a single high-volume center, and to propose a risk score to predict the likelihood of a severe outcome. METHODS The medical record was queried for all patients under 21 years old evaluated at our institution for button battery ingestion from 2008 to 2021. A severe outcome was defined as having at least one of the following: deep/circumferential mucosal erosion, perforation, mediastinitis, vascular or airway injury/fistula, or development of esophageal stricture. From a selection of clinically relevant factors, logistic regression determined predictors of a severe outcome, which were incorporated into a risk model. RESULTS 143 patients evaluated for button battery ingestion were analyzed. 24 (17%) had a severe outcome. The independent predictors of a severe outcome in multivariate analysis were location of battery in the esophagus on imaging (96%), battery size >/ = 2 cm (95%), and presence of any symptoms on presentation (96%), with P < 0.001 in all cases. Predicted probability of a severe outcome ranged from 88% when all three risk factors were observed, to 0.3% when none were present. CONCLUSION We report the presentation, management, and complication profiles of a large cohort of BB ingestions treated at a single institution. A risk score to predict severe outcomes may be used by providers initially evaluating patients with button battery ingestion in order to allocate resources and expedite transfer to a center with pediatric endoscopic and surgical capabilities. LEVEL OF EVIDENCE Level IV. TYPE OF STUDY Clinical Research Paper.
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Affiliation(s)
- P Nina Scalise
- Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Fegan 3, Boston, MA, 02115, United States
| | - Jonathan M Durgin
- Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Fegan 3, Boston, MA, 02115, United States
| | - Steven J Staffa
- Boston Children's Hospital, Department of Anesthesiology, Critical Care and Pain Medicine, Boston, MA, United States
| | - Nicole Wynne
- Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Fegan 3, Boston, MA, 02115, United States
| | - Jay Meisner
- Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Fegan 3, Boston, MA, 02115, United States
| | - Peter Ngo
- Boston Children's Hospital, Division of Gastroenterology, Hepatology and Nutrition, Boston, MA, United States
| | - Benjamin Zendejas
- Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Fegan 3, Boston, MA, 02115, United States
| | - Heung Bae Kim
- Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Fegan 3, Boston, MA, 02115, United States
| | - Farokh R Demehri
- Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Fegan 3, Boston, MA, 02115, United States.
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Yasuda JL, Taslitsky GN, Staffa SJ, Ngo PD, Meisner J, Mohammed S, Hamilton T, Zendejas B, Manfredi MA. Predictors of enteral tube dependence in pediatric esophageal atresia. Dis Esophagus 2023; 36:6692452. [PMID: 36065605 DOI: 10.1093/dote/doac060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 12/11/2022]
Abstract
Children with esophageal atresia (EA) may require enteral tube feedings in infancy and a subset experience ongoing feeding difficulties and enteral tube dependence. Predictors of enteral tube dependence have never been systematically explored in this population. We hypothesized that enteral tube dependence is multifactorial in nature, with likely important contributions from anastomotic stricture. Cross-sectional clinical, feeding, and endoscopic data were extracted from a prospectively collected database of endoscopies performed in EA patients between August 2019 and August 2021 at an international referral center for EA management. Clinical factors known or hypothesized to contribute to esophageal dysphagia, oropharyngeal dysphagia, or other difficulties in meeting caloric needs were incorporated into regression models for statistical analysis. Significant predictors of enteral tube dependence were statistically identified. Three-hundred thirty children with EA were eligible for analysis. Ninety-seven were dependent on enteral tube feeds. Younger age, lower weight Z scores, long gap atresia, neurodevelopmental risk factor(s), significant cardiac disease, vocal fold movement impairment, and smaller esophageal anastomotic diameter were significantly associated with enteral tube dependence in univariate analyses; only weight Z scores, vocal fold movement impairment, and anastomotic diameter retained significance in a multivariable logistic regression model. In the current study, anastomotic stricture is the only potentially modifiable significant predictor of enteral tube dependence that is identified.
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Affiliation(s)
- Jessica L Yasuda
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Gabriela N Taslitsky
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Peter D Ngo
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Jay Meisner
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Somala Mohammed
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Thomas Hamilton
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | | | - Michael A Manfredi
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
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Andelfinger G, Zenker M, Norrish G, Russell M, Meisner J, Peng D, Prendiville T, Kleinmahon J, Kantor P, Sen DG, Human D, Ewert P, Krueger M, Reber D, Donner B, Hart C, Odri-Komazec I, Rupp S, Hahn A, Hanser A, Hofbeck M, Draaisma J, Udink ten Cate F, Mussa A, Ferrero G, Vaujois L, Raboisson M, Delrue M, Marquis C, Théorêt Y, Kaski J, Gelb B, Wolf C. MAPK AND AKT/MTOR INHIBITION IMPROVES CHILDHOOD RASOPATHY-ASSOCIATED CARDIOMYOPATHY. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.056] [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: 11/25/2022] Open
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Thompson K, Zendejas B, Kamran A, Svetanoff WJ, Meisner J, Zurakowski D, Staffa SJ, Ngo P, Manfredi M, Yasuda JL, Jennings RW, Smithers CJ, Hamilton TE. Predictors of anti-reflux procedure failure in complex esophageal atresia patients. J Pediatr Surg 2022; 57:1321-1330. [PMID: 34509283 DOI: 10.1016/j.jpedsurg.2021.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/02/2021] [Accepted: 08/09/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anti-reflux procedures (ARP) in esophageal atresia (EA) patients can be challenging and prone to failure. These challenges become more evident with increasing complexity of EA. We sought to determine predictors of ARP failure in complex EA patients. METHODS Single-institution retrospective review of complex EA patients (e.g. long-gap EA, esophageal strictures, hiatal hernia, and reoperative ARP) who underwent an ARP from 2002 to 2019. ARP failure was defined as hiatal hernia recurrence, wrap migration/loosening, or need for reoperation. Predictors of failure were evaluated using univariate and multivariable time-to-event analysis. RESULTS 121 patients underwent 140 ARP at a median age of 13.5 months (IQR 7, 26.5). Nissen fundoplication (89%) was the most common ARP. Mesh (bovine pericardium) reinforcement was used in 41% of the patients. Median follow-up was 3.2 years (IQR 0.9, 5.8); 44 instances of ARP failure occurred (31%), though only 20 (14%) required reoperation. Median time to failure was 8.7 months (IQR 3.2, 25). Though fewer mesh-reinforced ARP failed (21% with vs 39% without, p = 0.02), on multivariable analysis only partial fundoplication (aHR 2.22 [95% CI 1.01-4.78]) and minimally invasive repair (aHR 2.57 [95% CI 1.12-6.01]) were significant predictors of ARP failure. CONCLUSION In our practice of complex EA patients, where ARP fail in nearly one third of cases, a Nissen fundoplication performed via laparotomy provided the lowest risk of ARP failure.
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Key Words
- ARP, Anti-reflux procedure
- ARPF, Anti-reflux procedure failure
- Abbreviations: EA, Esophageal atresia
- Anti-reflux procedure
- EGD, esophagogastric duodenoscopy
- Esophageal atresia
- GEJ, gastroesophageal junction
- HH, hiatal hernia
- Hiatal hernia
- LGEA, Long gap esophageal atresia
- MFOIS, Modified functional oral intake scale
- MIS, minimally invasive surgery
- Nissen fundoplication
- SSI, surgical sight infection
- UGI, upper gastrointestinal series
- gerd, Gastroesophageal reflux disease
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Affiliation(s)
- Kyle Thompson
- Department of General Surgery, Boston Children's Hospital, Boston, MA USA
| | - Benjamin Zendejas
- Department of General Surgery, Boston Children's Hospital, Boston, MA USA
| | - Ali Kamran
- Department of General Surgery, Boston Children's Hospital, Boston, MA USA
| | - Wendy Jo Svetanoff
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO USA
| | - Jay Meisner
- Department of General Surgery, Boston Children's Hospital, Boston, MA USA
| | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA USA
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA USA
| | - Peter Ngo
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA USA
| | - Michael Manfredi
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA USA
| | - Jessica L Yasuda
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA USA
| | - Russell W Jennings
- Department of General Surgery, Boston Children's Hospital, Boston, MA USA
| | - C Jason Smithers
- Department of General Surgery, Boston Children's Hospital, Boston, MA USA; Department of Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL USA.
| | - Thomas E Hamilton
- Department of General Surgery, Boston Children's Hospital, Boston, MA USA.
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Foust AM, Zendejas B, Mohammed S, Meisner J, Zurakowski D, Staffa SJ, Jennings RW, Hamilton TE, Callahan MJ. Radiographic assessment of traction-induced esophageal growth and traction-related complications of the Foker process for treatment of long-gap esophageal atresia. Pediatr Radiol 2022; 52:468-476. [PMID: 34845501 DOI: 10.1007/s00247-021-05228-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/19/2021] [Accepted: 10/12/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Radiographic assessment of esophageal growth in long-gap esophageal atresia while on traction and associated traction-related complications have not been described. OBJECTIVE To demonstrate how chest radiography can estimate esophageal position while on traction and to evaluate radiography's utility in diagnosing certain traction system complications. MATERIALS AND METHODS In this retrospective evaluation of portable chest radiographs obtained in infants with long-gap esophageal atresia who underwent the Foker process between 2014 and 2020, we assessed distances between the opposing trailing clips (esophageal gap) and the leading and trailing clips for each esophageal segment on serial radiographs. Growth during traction was estimated using longitudinal random-effects regression analysis to account for multiple chest radiograph measurements from the same child. RESULTS Forty-three infants (25 male) had a median esophageal gap of 4.5 cm. Median traction time was 14 days. Median daily radiographic esophageal growth rate for both segments was 2.2 mm and median cumulative growth was 23.6 mm. Traction-related complications occurred in 13 (30%) children with median time of 8 days from traction initiation. Daily change >12% in leading-to trailing clip distance demonstrated 86% sensitivity and 92% specificity for indicating traction-related complications (area under the curve [AUC] 0.853). Cumulative change >30% in leading- to trailing-clip distance during traction was 85% sensitive and 85% specific for indicating traction complications (AUC 0.874). CONCLUSION Portable chest radiograph measurements can serve as a quantitative surrogate for esophageal segment position in long-gap esophageal atresia. An increase of >12% between two sequential chest radiographs or >30% increase over the traction period in leading- to trailing-clip distance is highly associated with traction system complications.
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Affiliation(s)
- Alexandra M Foust
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
| | | | - Somala Mohammed
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Jay Meisner
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - David Zurakowski
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Steven J Staffa
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | | | | | - Michael J Callahan
- Department of Radiology, Boston Children's Hospital, Boston, MA, 02115, USA
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Lawlor CM, Meisner J, Jennings RW, Zendejas B, Choi SS. Comparative Effectiveness of Recurrent Laryngeal Nerve Monitoring Techniques in Pediatric Surgery. Laryngoscope 2021; 132:889-894. [PMID: 34432299 DOI: 10.1002/lary.29837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/13/2021] [Accepted: 08/09/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS The recurrent laryngeal nerve (RLN) is at risk during pediatric cervical, thoracic, and cardiac surgery. We aim to determine the feasibility and effectiveness of RLN monitoring techniques in all pediatric patients. STUDY DESIGN Retrospective case series. METHODS Retrospective review of patients/procedures with RLN(s) at risk and RLN monitoring at Boston Children's Hospital July 2019-October 2020. Primary outcomes: pre/postoperative vocal fold mobility by awake flexible fiberoptic laryngoscopy (FFL). RESULTS One hundred one patients (median [interquartile range, IQR] age 14.6 months [4.6-49.7 months], weight 10 kg [5.2-16.2 kg]) underwent 122 procedures with RLN(s) at risk. RLN monitoring attempted 111 cases, successful 96 (84%). Surgical indications: esophageal atresia/tracheoesophageal fistula, and tracheobronchomalacia. Sixty-two (56%) procedures in reoperative field. Median follow-up 112 days (IQR 41-230). Pre/postoperative FFL performed 84 procedures (69%), 19 new postoperative RLN injuries (16%), median age 12 months, reoperative fields 11 (18%). Prass probes: 34 cases (28 successful, 82%), 6 injuries (18%), age 12.2 (5.8-23.6) months. Dragonfly electrodes: 45 cases (37 successful, 82%), 8 injuries (18%), age 7.5 (3.8-19) months. Nerve integrity monitoring (NIM) integrated electrode endotracheal tube: 33 cases (33 successful, 100%), 5 injuries (15%), age 90 (58.8-136.7) months. Automatic periodic stimulation (APS): 16 cases, 13 successful (81%), four injuries (25%), age 7.2 (5.3-20.6) months. NIM RLN monitoring is significantly more successful than Prass, Dragonfly (95%CI -0.3 to 0.02, P = .02; and 95%CI 0.05-0.31, P = .008). Rates of injury are not different between types of RLN monitoring (P = .94), with APS use (P = .47), or with monitoring success (95%CI -0.36 to 0.09, P = .28). CONCLUSIONS RLN monitoring is feasible in pediatric patients of all ages. Although NIM type RLN monitoring success is superior, all forms offer similar rates of nerve protection. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Claire M Lawlor
- Department of Otolaryngology, Children's National Health System, Washington, District of Columbia, USA
| | - Jay Meisner
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Russell W Jennings
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Benjamin Zendejas
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sukgi S Choi
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
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Lawlor CM, Zendejas B, Julian CMS, Meisner J, Jennings RW, Choi SS. Recurrent Laryngeal Nerve Monitoring in Pediatric Surgery Using a Modified Dragonfly Electrode. Laryngoscope 2021; 131:2586-2589. [PMID: 33720399 DOI: 10.1002/lary.29505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/11/2021] [Accepted: 02/20/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Claire M Lawlor
- Department of Otolaryngology, Children's National Health System, Washington, District of Columbia, USA
| | - Benjamin Zendejas
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Carlos Munoz-San Julian
- Department of Anesthesiology. Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jay Meisner
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Russell W Jennings
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sukgi S Choi
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
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Kamran A, Zendejas B, Meisner J, Choi SS, Munoz-San Julian C, Ngo P, Manfredi M, Yasuda JL, Smithers CJ, Hamilton TE, Jennings RW. Effect of Posterior Tracheopexy on Risk of Recurrence in Children after Recurrent Tracheo-Esophageal Fistula Repair. J Am Coll Surg 2021; 232:690-698. [PMID: 33556502 DOI: 10.1016/j.jamcollsurg.2021.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/14/2021] [Accepted: 01/14/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND A recurrent tracheo-esophageal fistula can complicate esophageal atresia and tracheo-esophageal fistula (TEF) repair in children. Therapeutic approaches and the rate of recurrence vary widely. Most reports are limited by small cohorts and short-term follow-up, and rates of re-recurrence are substantial, making it difficult to select the treatment of choice. We aimed to review our experience with the treatment of recurrent TEF using posterior tracheopexy, focusing on operative risks and long-term outcomes. STUDY DESIGN We conducted a retrospective review of patients with esophageal atresia TEF with recurrent TEF treated at 2 institutions from 2011 to 2020. We approach recurrent TEFs surgically. Once the TEF is divided and repaired, the membranous trachea is sutured to the anterior longitudinal ligament of the spine (posterior tracheopexy) and the esophagus is rotated into the right chest (rotational esophagoplasty), separating the suture lines widely. To detect re-recurrence, patients undergo endoscopic surveillance during follow-up. RESULTS Sixty-two patients with a recurrent TEF were surgically treated (posterior tracheopexy/rotational esophagoplasty) at a median age of 14 months. All had significant respiratory symptoms. On referral, 24 had earlier failed endoscopic and/or surgical attempts at repair. Twenty-nine required a concomitant esophageal anastomotic stricturoplasty or stricture resection. Postoperative morbidity included 3 esophageal leaks, and 1 transient vocal cord dysfunction. We have identified no recurrences, with a median follow-up of 2.5 years, and all symptoms have resolved. CONCLUSIONS The surgical treatment of recurrent TEFs that incorporates a posterior tracheopexy and rotational esophagoplasty is highly effective for preventing re-recurrence with low perioperative morbidity.
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Affiliation(s)
- Ali Kamran
- Departments of General Surgery, Boston Children's Hospital, Boston, MA
| | - Benjamin Zendejas
- Departments of General Surgery, Boston Children's Hospital, Boston, MA
| | - Jay Meisner
- Departments of General Surgery, Boston Children's Hospital, Boston, MA
| | - Sukgi S Choi
- Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA
| | | | - Peter Ngo
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA
| | - Michael Manfredi
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA
| | - Jessica L Yasuda
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA
| | - C Jason Smithers
- Department of Surgery, Johns Hopkins All Children's Hospital, St Petersburg, FL
| | - Thomas E Hamilton
- Departments of General Surgery, Boston Children's Hospital, Boston, MA
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Lyo S, Miles J, Meisner J, Guelfguat M. Case report: adult-onset manifesting heterozygous glycogen storage disease type IV with dilated cardiomyopathy and absent late gadolinium enhancement on cardiac magnetic resonance imaging. Eur Heart J Case Rep 2020; 4:1-6. [PMID: 32617483 PMCID: PMC7319828 DOI: 10.1093/ehjcr/ytaa078] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/26/2019] [Accepted: 03/17/2020] [Indexed: 11/17/2022]
Abstract
Background Glycogen storage disease type IV (GSD IV; Andersen’s disease) is a rare autosomal recessive disease caused by mutation in the GBE1 gene. Presentation of GSD IV varies on a continuum of severity and symptomatology ranging from neonatal death to mild adult-onset disease with variable involvement of hepatic, muscular, neurologic, dermatologic, and cardiac systems. Cardiomyopathy seen in GSD IV is also heterogeneous and its appearance on cardiac magnetic resonance imaging (CMR) is rarely described. Case summary A 29-year-old man without previous medical history was admitted to our facility multiple times over 2 years for focal sensorimotor deficits, gout arthropathy, chronic hyperlactataemia and hyperuricaemia, and severe decompensated non-ischaemic cardiomyopathy complicated by episodes of thromboembolic organ infarction. Echocardiography and CMR showed severe biventricular failure with the presence of intraventricular thrombi with increased right ventricular trabeculation and absent late gadolinium enhancement. He underwent muscle biopsy which showed prominent glycogen in skeletal muscle followed by genetic testing showing a single heterozygous splicing mutation c.993-1G>T found at the junction of intron 7 and exon 8 of the GBE1 gene which had not previously been reported and was predicted to be pathologic. He was referred to a tertiary care centre with glycogen storage disease specialists but expired prior to establishing care at that facility. Discussion Discovery of GSD IV in our patient was unexpected due to a highly variant clinical presentation. Our case stresses the clinical heterogeneity of GSD IV and the importance of genetic sequencing studies in the evaluation of potential glycogen storage disease.
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Affiliation(s)
- Shawn Lyo
- Department of Internal Medicine, Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY 10461, USA
| | - Jeremy Miles
- Department of Internal Medicine, Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY 10461, USA
| | - Jay Meisner
- Department of Cardiology, Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY 10461, USA
| | - Mark Guelfguat
- Department of Radiology, Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY 10461, USA
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Burnett GW, Meisner J, Hyman JB, Levin EJ. Bacitracin irrigation leading to anaphylaxis and cardiovascular collapse in the ambulatory surgery center setting. J Clin Anesth 2018; 46:35-36. [DOI: 10.1016/j.jclinane.2018.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 12/22/2017] [Accepted: 01/04/2018] [Indexed: 10/18/2022]
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Meisner J, Ascher KRS, Lavie D. Factors influencing the attraction to oviposition of the potato tuber moth, Gnorimoschema operculella Zell.1. ACTA ACUST UNITED AC 2009. [DOI: 10.1111/j.1439-0418.1974.tb03245.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
We report on a 42-year-old female who underwent right pneumonectomy for hemoptysis from an aspergilloma cavity. Several years postoperatively she complained of increasing shortness of breath, wheezing, and dyspnea upon exertion. Chest computed tomography showed a counterclockwise rotation of the mediastinum with obstruction of the left lower lobe bronchus. Minimally invasive repair was carried out using an intrapleural tissue expander for dissection and an adjustable saline prosthesis for mediastinal centralization. Intraoperative bronchoscopy showed complete resolution of the left lower lobe bronchial obstruction, and postoperatively her symptoms resolved completely. This is the first reported case of a minimally invasive approach for the treatment of post-pneumonectomy syndrome in the United States.
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Affiliation(s)
- D V Avgerinos
- Department of Surgery, Beth Israel Medical Center, Albert Einstein College of Medicine, New York, New York, United States.
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Meisner J. Sensationalist claims must be stopped. Br Dent J 2000; 188:471. [PMID: 10859843] [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: 02/16/2023]
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Hemming AW, Cattral MS, Greig PD, Meisner J, Turcotte L, Lilly LB, Levy GA. A pharmacoeconomic analysis of Neoral without intravenous cyclosporine in liver transplantation in Canada. Clin Transplant 1998; 12:425-9. [PMID: 9787952] [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: 02/09/2023]
Abstract
Neoral, a microemulsion formulation of cyclosporin A (CsA), has improved absorption compared to Sandimmune and has allowed induction of immunosuppression in liver transplantation (LT) without the use of intravenous (i.v.) CsA. The improved bioavailability with less inter- and intra-patient dosing variability coupled with the lack of requirement for i.v. CsA may provide a mechanism for cost savings when Neoral is used for induction immunosuppression. This retrospective case-control study compares the relative costs associated with Neoral induction without i.v. CsA versus induction with i.v. CsA followed by oral CsA in adult liver transplant recipients. Twenty consecutive patients receiving Neoral 12-15 mg/kg per d were compared to a control group of 21 patients receiving i.v. CsA followed by oral CsA for induction. Both groups received the same rapidly tapered dose of methyl-prednisilone. Health care resource utilization was assigned based on days in hospital and acute rejection episodes (ARE). Hospital per diem rates at specified care levels were used to assign costs associated with hospital stay, while a previously developed case-costing model was used to assign costs to episodes of acute rejection. All patients were followed for a 3-month period post-transplant. Although there was a trend towards shorter hospital stay in the Neoral group the majority of cost savings were achieved by reducing costs associated with episodes of acute rejection. There were seven and 19 episodes of ARE in the Neoral and i.v. CsA groups respectively (p < 0.05.) A separate cost effective assessment of the effect of reducing rejection by decision tree analysis demonstrated a cost reduction of $2162 per patient. The savings achieved with Neoral proved robust on sensitivity analysis. The change of practice to an induction immunosuppression regimen of Neoral without i.v. CsA has achieved a cost savings in adult liver transplantation at our center.
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Affiliation(s)
- A W Hemming
- Department of Surgery, Toronto Hospital, University of Toronto, Canada.
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Abstract
The trend of tongue piercing is becoming more popular. A patient with Ludwig's angina, secondary to recent tongue piercing, is presented. The management of the patients and the implications of tongue piercing are discussed.
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Affiliation(s)
- C S Perkins
- Department of Oral and Maxillofacial Surgery, Cheltenham General Hospital, Gloucesterhire
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Weissenberg M, Meisner J, Klein M, Schaeffler I, Eliyahu M, Schmutterer H, Ascher KRS. Effect of Substituent and Ring Changes in Naturally Occurring Naphthoquinones on the Feeding Response of Larvae of the Mexican Bean Beetle, Epilachna varivestis. J Chem Ecol 1997. [DOI: 10.1023/b:joec.0000006342.51040.90] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Copeland M, Meisner J. Maxillary antral bone grafts for repair of orbital fractures. J Craniofac Surg 1991; 2:18-21. [PMID: 1807409] [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: 12/28/2022] Open
Abstract
Use of bone from the maxillary antrum to repair defects in the orbital floor was described more than 20 years ago but has not been reported for correction of orbital rim fractures. The method is appealing because the source is contiguous with the recipient site; enhanced exposure might allow better fracture reduction and evacuation of debris and hematoma from the maxillary sinus. The intraoral approach also avoids an external incision and scar, prevents such complications as pneumothorax or dural perforation, and reduces postoperative pain. In 60 cases of orbital and zygomatic complex fractures seen between 1985 and 1990, less than 8% required more extensive graft material than the maxillary antra could provide. To assess the potential advantages of local over extraanatomical bone grafts, we evaluated maxillary antral bone grafts obtained through buccal sulcus incisions in 14 patients for restoration following fractures of the orbit. Several of these patients are described. Bone union was complete in all patients and there was no morbidity related to infection, oroantral fistula formation, dehiscence, or disfigurement. Sufficient bone was available from the uninvolved contralateral side to repair even severely comminuted fractures. In zygomatic complex fractures, maxillary antral grafts appeared to provide additional strength in the region of the fractured maxillary buttress. The success of the procedure in our experience, coupled with the safety of bone harvesting from this source, and the avoidance of an external scar make maxillary antral bone well suited to reconstruction of all areas of the orbit.
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Affiliation(s)
- M Copeland
- Division of Plastic and Reconstructive Surgery, Mount Sinai School of Medicine of the City University of New York, New York
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te Velde ER, Boer-Meisel ME, Meisner J, Schoemaker J, Habbema JD. The significance of preoperative hysterosalpingography and laparoscopy for predicting the pregnancy outcome in patients with a bilateral hydrosalpinx. Eur J Obstet Gynecol Reprod Biol 1989; 31:33-45. [PMID: 2523828 DOI: 10.1016/0028-2243(89)90024-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [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: 01/01/2023]
Abstract
We analyzed the importance of 3 factors derived from the HSG (nature of the mucosal pattern, diameter of the hydrosalpinx, expandability of the ampulla) and of four factors from the findings at laparoscopy (extent of adhesions, nature of adhesions, thickness of tubal wall and diameter of the hydrosalpinx) for predicting the pregnancy outcome in 98 patients with bilateral hydrosalpinx. Each factor was categorized into 3 scores and each patient was scored for both the right and the left tube, resulting in 6 score-combinations. An association between the pregnancy prospects based on the score-combinations and the actual pregnancy outcome seemed to be present for all factors evaluated, except for the extent of adhesions and the diameter of the hydrosalpinx (laparoscopy). The results further indicate that a favourable score on the nature of mucosal pattern in one or both tubes concurs with good pregnancy prospects. In contrast, the presence of an unfavourable score for most of the other factors in at least one tube is associated with a poor fertility prognosis, regardless of the condition of the other tube.
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Affiliation(s)
- E R te Velde
- Department of Obstetrics and Gynaecology, University Hospital, Utrecht, The Netherlands
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Lazar HL, Haasler GB, Spotnitz WD, Collins RH, Dubroff JM, Meisner J, Spotnitz HM. Compliance, mass, and shape of the canine left ventricle after global ischemia analyzed with two-dimensional echocardiography. J Surg Res 1985; 39:199-208. [PMID: 4033104 DOI: 10.1016/0022-4804(85)90143-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
End-diastolic pressure (EDP)-volume (EDV) curves were constructed for the left ventricle (LV) in 10 dogs on cardiopulmonary bypass before and after 45 min of normothermic ischemic arrest. LVEDV and mass were calculated from three perpendicular two-dimensional echocardiographic sections using a Simpson's rule algorithm. The echocardiographic method employed was specially developed in earlier work for physiologic studies in dogs. Postmortem pressure-volume curves were measured for comparison by direct saline infusion into sealed ventricles. LVEDV was plotted against LVEDP (0-20 mm Hg) and data were analyzed by two-way analysis of variance and also by exponential curve fitting to the relation EDP = alpha e beta EDV, where beta is the derived exponential constant reflecting slope and thereby ventricular stiffness. Postischemic EDP-EDV curves shifted to the left and the beta constant increased (beta = 0.02 +/- 0.005 (SE) vs 0.05 +/- 0.01, P less than 0.05). LV eccentricity, the ratio between long- and short-axis measurements, was unchanged (1.43 +/- 0.05 vs 1.46 +/- 0.06 postischemia, NS), but LV mass increased (105 +/- 7 vs 128 +/- 9 g postischemia, P less than 0.001). Postischemic LV mass by echo was not significantly different from measured postmortem LV mass (r = 0.87). The nonparallel alteration in the EDP-EDV curves, lack of change in LV shape (eccentricity), and increase in LV mass in the postischemic ventricle suggest that increased ventricular stiffness rather than direct encroachment by the edematous endocardium on chamber volume is responsible for postischemic changes in LV diastolic properties.
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Lazar HL, Haasler GB, Collins RH, Dubroff JM, Meisner J, Spotnitz HM. Mechanisms of altered ventricular compliance following ischemia using two-dimensional echocardiography. Curr Surg 1982; 39:253-5. [PMID: 7116920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Meisner J, Demirmen F. The Creaming Method: A Bayesian Procedure to Forecast Future Oil and Gas Discoveries in Mature Exploration Provinces. ACTA ACUST UNITED AC 1981. [DOI: 10.2307/2982158] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Krukowska H, Meisner J. [Comparison of the course and prognosis in bronchiectasis caused by tuberculosis and of other etiology]. Pediatr Pol 1979; 54:1299-302. [PMID: 316127] [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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Flowers HM, Meisner J, Ascher KR. The feeding response of the larva of the egyptian cotton leafworm, Spodoptera littoralis Boisd., to sugars and related compounds--IV. Ingestion and excretion of some phagostimulatory weak or inactive carbohydrates. Comp Biochem Physiol A Comp Physiol 1975; 51:145-9. [PMID: 236862 DOI: 10.1016/0300-9629(75)90427-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Meisner J, Flowers HM, Ascher KR, Ishaaya I. The feeding response of the larva of the Egyptian cotton leafworm, Spodoptera littoralis boisd., to sugars and related compounds. 3. Biochemical and enzymological aspects of sucrose consumption. Comp Biochem Physiol A Comp Physiol 1973; 44:793-806. [PMID: 4145425 DOI: 10.1016/0300-9629(73)90143-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Ishaaya I, Meisner J. Physiological effect of sugars on various digestive enzymes ofSpodoptera littoralis larvae. J Comp Physiol A Neuroethol Sens Neural Behav Physiol 1973. [DOI: 10.1007/bf00702532] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Meisner J, Ascher K, Flowers H. The feeding response of the larva of the egyptian cotton leafworm, Spodoptera littoralis boisd., to sugars and related compounds—I. Phagostimulatory and deterrent effects. ACTA ACUST UNITED AC 1972. [DOI: 10.1016/0300-9629(72)90396-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mijnlieff PF, Coumou DJ, Meisner J. Reply to the Comments of D. K. Carpenter on ``Particle Scattering Factor and Segment—Segment Distribution of Macromolecules in Solution''. J Chem Phys 1972. [DOI: 10.1063/1.1677208] [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: 11/14/2022] Open
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Mijnlieff PF, Coumou DJ, Meisner J. Particle Scattering Factor and Segment–Segment Distance Distribution of Macromolecules in Solution. J Chem Phys 1970. [DOI: 10.1063/1.1674255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Meisner J, Ascher KR. A method to assay the phagostimulatory effect towards insects of plant extracts applied to Styropor disks. Riv Parassitol 1968; 29:74-77. [PMID: 5744492] [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: 05/21/2023]
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Meisner J. Estimation of the distribution of diameters of spherical particles from a given grouped distribution of diameters of observed circles formed by a plane section. STAT NEERL 1967. [DOI: 10.1111/j.1467-9574.1967.tb00542.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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