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Durrani S, Ahmed S. Case report: a unique presentation of memantine overdose causing echolalia and hypertension. BMC Geriatr 2024; 24:123. [PMID: 38302876 PMCID: PMC10835811 DOI: 10.1186/s12877-024-04658-2] [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] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Since 2003 when memantine was first approved for use in the management of moderate-severe Alzheimer's dementia, its use has become more widespread and is being explored in other diseases like neuropathic pain, epilepsy, and mood disorders. Our case uniquely highlights two important adverse effects in a patient who overdosed on memantine. One is hypertension, which is easy to overlook as a medication side effect. The other is echolalia which is the repetition of words and phrases spoken by another person. It is commonly seen in children with autism spectrum disorder and has been reported in older adults with head injuries, delirium, and neurocognitive disorders. The aim of this patient story is to highlight the importance of medication reconciliation with caregivers and knowledge of adverse drug reactions in patient management. This case report has been presented previously in the form of an abstract at the American Geriatrics Society Presidential poster session in May 2023. CASE PRESENTATION Our patient is an 86-year-old man with mild dementia and hypertension, who was brought to the emergency department (ED) due to abrupt onset of altered mental status and auditory hallucinations. Investigations including blood work, CT head and an electroencephalogram (EEG) did not reveal an etiology for this change in his condition. Due to elevated blood pressure on presentation, a nicardipine drip was started, and he was given IV midazolam to assist with obtaining imaging. While reviewing medications with his daughter, it was noted that sixty memantine pills were missing from the bottle. Poison control was contacted and they confirmed association of these features with memantine. With supportive care, his symptoms resolved in less than 100 h, consistent with the half-life of memantine. Notably, our patient was started on Memantine one month prior to this presentation. CONCLUSIONS Hypertensive urgency and echolalia were the most striking symptoms of our patient's presentation. Though hypertension is a known sign of memantine overdose, it can easily be contributed to medication non-compliance in patients with dementia, being treated for hypertension. According to our literature review, this the first case of memantine overdose presenting with echolalia, a sign that is not commonly associated with adverse reactions to medications. This highlights the importance of an early medication review, especially with caregivers of people with dementia.
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Affiliation(s)
- Sana Durrani
- Division of Geriatrics and Gerontology, Johns Hopkins School of Medicine, 5200 Eastern Avenue, Mason F Lord Building, Center Tower, Suite 2200, 21224, Baltimore, MD, USA.
| | - Shaista Ahmed
- Division of Geriatrics and Gerontology, Johns Hopkins School of Medicine, 5200 Eastern Avenue, Mason F Lord Building, Center Tower, Suite 2200, 21224, Baltimore, MD, USA
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Mohamed-Yassin MS. When was the last time you cried? Malays Fam Physician 2023; 18:67. [PMID: 38111834 PMCID: PMC10726754 DOI: 10.51866/mol.508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Affiliation(s)
- Mohamed-Syarif Mohamed-Yassin
- MBBS, FRACGP, DipPallMed(Clin.), Department of Primary Care Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Sungai Buloh, Selangor, Malaysia.
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Fusaroli R, Weed E, Rocca R, Fein D, Naigles L. Repeat After Me? Both Children With and Without Autism Commonly Align Their Language With That of Their Caregivers. Cogn Sci 2023; 47:e13369. [PMID: 37905374 DOI: 10.1111/cogs.13369] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 10/02/2023] [Accepted: 10/10/2023] [Indexed: 11/02/2023]
Abstract
Linguistic repetitions in children are conceptualized as negative in children with autism - echolalia, without communicative purpose - and positive in typically developing (TD) children - linguistic alignment involved in shared engagement, common ground and language acquisition. To investigate this apparent contradiction we analyzed spontaneous speech in 67 parent-child dyads from a longitudinal corpus (30 minutes of play activities at 6 visits over 2 years). We included 32 children with autism and 35 linguistically matched TD children (mean age at recruitment 32.76 and 20.27 months). We found a small number of exact repetitions in both groups (roughly 1% of utterances across visits), which increased over time in children with autism and decreased in the TD group. Partial repetitions were much more frequent: children reused caregivers' words at high rates regardless of diagnostic group (24% of utterances at first visit), and this increased in frequency (but not level) over time, faster for TD children (at final visit: 33% for autism, 40% for TD). The same happened for partial repetition of syntax and semantic alignment. However, chance alignment (as measured by surrogate pairs) also increased and findings for developmental changes were reliable only for syntactic and semantic alignment. Children with richer linguistic abilities also displayed a higher tendency to partially re-use their caregivers' language (alignment rates and semantic alignment). This highlights that all children commonly re-used the words, syntax, and topics of their caregivers, albeit with some quantitative differences, and that most repetition was at least potentially productive, with repeated language being re-contextualized and integrated with non-repeated language. The salience of echolalia in ASD might be partially explained by slight differences in frequency, amplified by lower semantic alignment, persistence over time, and expectations of echolalia. More in-depth qualitative and quantitative analyses of how repetitions are used and received in context are needed.
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Affiliation(s)
- Riccardo Fusaroli
- Department of Linguistics, Cognitive Science and Semiotics, School of Communication and Culture, Aarhus University
- Interacting Minds Center, School of Culture and Society, Aarhus University
- Linguistic Data Consortium, University of Pennsylvania
| | - Ethan Weed
- Department of Linguistics, Cognitive Science and Semiotics, School of Communication and Culture, Aarhus University
- Interacting Minds Center, School of Culture and Society, Aarhus University
| | - Roberta Rocca
- Department of Linguistics, Cognitive Science and Semiotics, School of Communication and Culture, Aarhus University
- Interacting Minds Center, School of Culture and Society, Aarhus University
| | - Deborah Fein
- Department of Psychological Sciences, University of Connecticut
| | - Letitia Naigles
- Department of Psychological Sciences, University of Connecticut
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Hamlin D, Mahgoub Y. A unique presentation of echo phenomena in a patient with catatonia: a case report and literature review. BMC Psychiatry 2023; 23:364. [PMID: 37226149 DOI: 10.1186/s12888-023-04821-w] [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: 03/14/2023] [Accepted: 04/26/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Catatonia is a complex syndrome notable for a highly variable presentation. Standardized exam and criteria can enumerate possible presentations, but recognition of novel catatonic phenomenon may facilitate better understanding of catatonia's core features. CASE PRESENTATION A 61 year-old divorced pensioner with history of schizoaffective disorder was hospitalized for psychosis in the setting of medication noncompliance. While hospitalized, she developed multiple classic catatonia signs such as staring and grimacing, as well as a bizarre echo phenomenon while reading text that improved alongside other catatonic symptoms with treatment. CONCLUSION Echo phenomenon are a component of catatonia often recognized when presenting as echopraxia or echolalia, but other echo phenomenon are well established in the literature. Recognition or novel catatonic symptoms like this can lead to improved recognition and treatment of catatonia.
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Affiliation(s)
- Dallas Hamlin
- Department of Psychiatry and Behavioral Health, Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA.
| | - Yassir Mahgoub
- Department of Psychiatry and Behavioral Health, Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
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Cohn EG, McVilly KR, Harrison MJ. Echolalia as defined by parent communication partners. Autism Dev Lang Impair 2023; 8:23969415231151846. [PMID: 36726967 PMCID: PMC9884957 DOI: 10.1177/23969415231151846] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUNDS AND AIMS Echolalia, the repetition of previous speech, is highly prevalent in Autism. Research into echolalia has historically assumed a clinical standpoint, with two opposing paradigms, behaviourism and developmentalism, offering differing support and intervention programs. These paradigms offer a multitude of clinical operationalised definitions; despite attempts, there continue to be challenges regarding how echolalia is to be defined. Stepping out of the dichotomous clinically orientated literature, we examined how parents summarise and formalise their understanding of echolalia as a communication partner. The objectives of this study were three-fold: (1) to investigate how echolalia is described and defined by parents; (2) to examine if existing clinical definitions align with those of parents; and (3) to begin to consider the implications of such findings for a collaborative approach between clinical perspectives and the parent experience. We bring to the fore the voices of parents, who have historically remained absent from echolalia literature. That is to say, we step outside of the clinical realm and listen to parents: something which has been previously unconsidered but represents a new vital addition to the echolalia literature. METHODS We employed a Grounded Theory approach to document the definitions of 133 parents. RESULTS We found that parents reported a multiplicity of important elements that are key to their understanding of echolalia. CONCLUSIONS AND IMPLICATIONS Additionally, we found that clinical definitions do not resonate within the parent experience; parents experience echolalia in a different way to that of clinicians and parents can offer insight into our understanding of the phenomena. Our findings show that while some parents might align themselves with either a behavioural or developmental positionality, sometimes there is an overlap depending upon the context in which their child repeats and some parents advance interpretations that are not readily aligned with either of the traditional clinical schools of thought. We present implications for both clinicians and parents in ways that point towards a collaborative approach to support the person with echolalia.
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Affiliation(s)
- Eli G Cohn
- Eli G Cohn, Faculty of Arts, The University
of Melbourne, School of Social and Political Sciences, Grattan Street,
Parkville, Melbourne 3010, Australia.
| | - Keith R McVilly
- Faculty of Arts, The University of
Melbourne, School of Social and Political Sciences, Parkville,
Melbourne, Australia
| | - Matthew J Harrison
- Melbourne Graduate School of
Education, The University of
Melbourne, Parkville, Melbourne, Australia
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McFayden TC, Kennison SM, Bowers JM. Echolalia from a transdiagnostic perspective. Autism Dev Lang Impair 2022; 7:23969415221140464. [PMID: 36451974 PMCID: PMC9703477 DOI: 10.1177/23969415221140464] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND & AIMS Echolalia, the repetition of one's or others' utterances, is a behavior present in typical development, autism spectrum disorder, aphasias, Tourette's, and other clinical groups. Despite the broad range of conditions in which echolalia can occur, it is considered primarily through a disorder-specific lens, which limits a full understanding of the behavior. METHOD Empirical and review papers on echolalia across disciplines and etiologies were considered for this narrative review. Literatures were condensed into three primary sections, including echolalia presentations, neural mechanisms, and treatment approaches. MAIN CONTRIBUTION Echolalia, commonly observed in autism and other developmental conditions, is assessed, observed, and treated in a siloed fashion, which reduces our collective knowledge of this communication difference. Echolalia should be considered as a developmental, transdiagnostic, and communicative phenomenon. Echolalia is commonly considered as a communicative behavior, but little is known about its neural etiologies or efficacious treatments. CONCLUSIONS This review is the first to synthesize echolalia from a transdiagnostic perspective, which allows for the direct comparisons across and within clinical groups to inform assessment, treatment, conceptualization, and research recommendations. IMPLICATIONS Considering echolalia transdiagnostically highlights the lack of consensus on operationalization and measurement across and within disorders. Clinical and research future directions need to prioritize consistent definitions of echolalia, which can be used to derive accurate prevalence estimates. Echolalia should be considered as a communication strategy, used similarly across developmental and clinical groups, with recommended strategies of shaping to increase its effectiveness.
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Affiliation(s)
- Tyler C McFayden
- Tyler C McFayden, Carolina Institute for Developmental Disabilities, University of North Carolina-Chapel Hill, 101 Renee Lynne Court, Carrboro, NC 27510, USA.
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Cohn EG, McVilly KR, Harrison MJ, Stiegler LN. Repeating purposefully: Empowering educators with functional communication models of echolalia in Autism. Autism Dev Lang Impair 2022; 7:23969415221091928. [PMID: 36382082 PMCID: PMC9620688 DOI: 10.1177/23969415221091928] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND AIMS Echolalia, the repetition of speech, is highly prevalent in school aged children with Autism. Prior research has found that individuals with echolalia use their repetitions to engage in communicatively functional speech, in the absence of self-generated speech. Educators are the natural audience for a wide vary of echoed utterances across environments and in differing contexts. The objectives of this paper were three-fold: (1) to systematically investigate how researchers identify and ascribe communicative function to echoed utterances; (2) to gather and evaluate the evidence that might assist teachers to identify and better understand echoed utterances as being communicatively purposeful; and (3) to provide teachers with evidence-informed response strategies they can use to assist their students on their journey towards more self-generated speech. MAIN CONTRIBUTION Prior research in the field of echolalia has generally been segmented into opposing viewpoints. A paucity of work in the echolalia field has meant that there is limited work that has sought to view how a communicative function to echolalia has been ascribed from across multiple disciplines and fields. As such, there is limited literature to guide the practice of classroom educators. This review combines communicative models from across various disciplines with the view to supporting classroom educators by providing guidance on how they might assist their students with echolalia. This review represents the first contribution to the research literature in this area. CONCLUSIONS AND IMPLICATIONS Research into echolalia did not originally emanate from the field of education; however, anecdotes from classroom educators were cited as the primary impetus for the creation of some of the communicatively functional models. We found that although there are many techniques that researchers have used to attribute a communicative function to echolalia, some of these can be easily employed by educators in their practice. By adopting these techniques, educators are placed in a position that may assist with the identification of communicative echolalia; subsequently they are better placed to acknowledge and respond to their students.
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Affiliation(s)
- Eli G. Cohn
- Eli G. Cohn, The University of Melbourne,
Faculty of Arts, School of Social and Political Sciences, Grattan Street,
Parkville, 3010, Melbourne, Australia.
| | - Keith R. McVilly
- Faculty of Arts, School of Social and Political
Sciences, The University of
Melbourne, Grattan Street, Parkville, 3010, Melbourne,
Australia
| | - Matthew J. Harrison
- Melbourne Graduate School of Education, The University of
Melbourne, Queensberry Street, Parkville, 3010, Melbourne,
Australia
| | - Lillian N. Stiegler
- Communication, Southeastern Louisiana
University, Hammond, Louisiana, United States
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Edelstein ML, Sloman K, Selver K. Effects of Demand Complexity on Echolalia in Students With Autism. Behav Anal Pract 2021; 14:984-90. [PMID: 34868811 DOI: 10.1007/s40617-020-00535-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 10/22/2022] Open
Abstract
Echolalia is a linguistic phenomenon common in individuals with autism spectrum disorder. We examined the relationship between demand complexity and immediate echolalia in four students with an autism diagnosis in a university-based academic setting. Mastered and novel antecedent verbal demands that required an intraverbal response were systematically alternated using a multielement design to test whether participants' immediate echolalia was socially mediated. Results showed that immediate echolalia was more likely to occur during complex novel intraverbal tasks than in any other condition. Implications for function-based treatment strategies are discussed. Supplementary Information The online version contains supplementary material available at 10.1007/s40617-020-00535-7.
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Abstract
In this article, we leverage theoretical insights and methodological guidelines of discourse analytic scholarship to re-examine language phenomena typically associated with autism. Through empirical analysis of the verbal behavior of three children with autism, we engage the question of how prototypical features of autistic language-notably pronoun atypicality, pragmatic deficit, and echolalia-might conceal competencies and interactional processes that are largely invisible in mainstream research. Our findings offer a complex picture of children with autism in their use of language to communicate, interact and experience others. Such a picture also deepens our understanding of the interactional underpinnings of autistic children's speech. Finally, we describe how our findings offer fruitful suggestions for clinical intervention.
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Affiliation(s)
- Laura Sterponi
- Institute of Human Development, University of California, Berkeley, 5643 Tolman Hall, Berkeley, CA, 94720-1670, USA.
- Graduate School of Education, University of California, Berkeley, Berkeley, CA, USA.
| | - Kenton de Kirby
- Graduate School of Education, University of California, Berkeley, Berkeley, CA, USA.
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Schuch JB, Muller D, Endres RG, Bosa CA, Longo D, Schuler-Faccini L, Ranzan J, Becker MM, dos Santos Riesgo R, Roman T. The role of β3 integrin gene variants in Autism Spectrum Disorders--diagnosis and symptomatology. Gene 2014; 553:24-30. [PMID: 25280596 DOI: 10.1016/j.gene.2014.09.058] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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: 06/19/2014] [Revised: 09/12/2014] [Accepted: 09/29/2014] [Indexed: 11/15/2022]
Abstract
Autism Spectrum Disorders (ASDs) represent a group of very complex early-onset neurodevelopmental diseases. In this study, we analyzed 5 SNPs (rs2317385, rs5918, rs15908, rs12603582, rs3809865) at the β3 integrin locus (ITGB3), which has been suggested as a possible susceptibility gene, both as single markers and as part of haplotypes in 209 ASD children and their biological parents. We tested for association with the following: a) DSM-IV ASD diagnosis; b) clinical symptoms common in ASD patients (repetitive behaviors, echolalia, seizures and epilepsy, mood instability, aggression, psychomotor agitation, sleep disorders); and c) dimensional scores obtained with the Autism Screening Questionnaire and the Childhood Autism Rating Scale. These hypotheses were investigated using family-based tests, logistic regression models and analysis of covariance. The family-based tests showed an association with the H5 haplotype (composed by GTCGA alleles, the order of SNPs as above), which was transmitted less often than expected by chance (P=0.006; Pcorr=0.036). The analyses of the clinical symptoms showed a trend for an association with rs12603582 (P=0.008; Pcorr=0.064) and positive results for the haplotype composed of rs15908 and rs12603582 (Pglcorr=0.048; Pindcorr=0.015), both in symptoms of echolalia. Other nominal associations with different variants were found and involved epilepsy/seizures, aggression symptoms and higher ASQ scores. Although our positive results are not definitive, they suggest small effect associations of the ITGB3 gene with both ASD diagnosis and symptoms of echolalia. Other studies are nonetheless needed to fully understand the involvement of this locus on the etiology of ASDs and its different clinical aspects.
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Affiliation(s)
- Jaqueline Bohrer Schuch
- Department of Genetics, Biosciences Institute, Federal University of Rio Grande do Sul, Avenida Bento Gonçalves, 9500, 91501-970 Porto Alegre, Brazil.
| | - Diana Muller
- Department of Genetics, Biosciences Institute, Federal University of Rio Grande do Sul, Avenida Bento Gonçalves, 9500, 91501-970 Porto Alegre, Brazil
| | - Renata Giuliani Endres
- Department of Psychology, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos 2600, 90035-003 Porto Alegre, Brazil
| | - Cleonice Alves Bosa
- Department of Psychology, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos 2600, 90035-003 Porto Alegre, Brazil.
| | - Dânae Longo
- Department of Genetics, Biosciences Institute, Federal University of Rio Grande do Sul, Avenida Bento Gonçalves, 9500, 91501-970 Porto Alegre, Brazil
| | - Lavinia Schuler-Faccini
- Department of Genetics, Biosciences Institute, Federal University of Rio Grande do Sul, Avenida Bento Gonçalves, 9500, 91501-970 Porto Alegre, Brazil
| | - Josiane Ranzan
- Child Neurology Unit, Clinics Hospital of Porto Alegre, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2350, 90035-903 Porto Alegre, Brazil
| | - Michele Michelin Becker
- Child Neurology Unit, Clinics Hospital of Porto Alegre, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2350, 90035-903 Porto Alegre, Brazil
| | - Rudimar dos Santos Riesgo
- Child Neurology Unit, Clinics Hospital of Porto Alegre, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2350, 90035-903 Porto Alegre, Brazil.
| | - Tatiana Roman
- Department of Genetics, Biosciences Institute, Federal University of Rio Grande do Sul, Avenida Bento Gonçalves, 9500, 91501-970 Porto Alegre, Brazil.
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McPherson SE, Kuratani JD, Cummings JL, Shih J, Mischel PS, Vinters HV. Creutzfeldt-Jakob disease with mixed transcortical aphasia: insights into echolalia. Behav Neurol 2014; 7:197-203. [PMID: 24487337 DOI: 10.3233/ben-1994-73-415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aphasia is a common manifestation of Creutzfeldt-Jakob disease (CJD), and investigation of the linguistic disorders of CJD patients may provide insights into the neurobiological mechanisms of language and aphasia. We report an autopsy-confirmed case of CJD in which the presenting symptom was change in language abilities. The patient ultimately evidenced mixed transcortical aphasia (MTA) with echolalia. Disruption of frontal-subcortical circuits with environmental dependency accounts for the symptoms in MTA, including intact repetition and echolalia. Observation in this patient and a review of the literature suggest that frontal-subcortical circuit dysfunction may contribute to the syndrome of echolalia. This hypothesis offers an alternative explanation to "isolation" of the speech area as the cause of MTA.
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Affiliation(s)
- S E McPherson
- Department of Psychiatry and Biobehavioral Sciences, UCLA
| | | | - J L Cummings
- Department of Psychiatry and Biobehavioral Sciences, UCLA Department of Neurology, UCLA Behavioral Neuroscience Section, Psychiatry Service, West Los Angeles Veteran Affairs Medical Center
| | - J Shih
- Department of Neurology, University of New Mexico
| | - P S Mischel
- Department of Pathology and Laboratory Medicine, UCLA School of Medicine, Los Angeles, CA,USA
| | - H V Vinters
- Department of Pathology and Laboratory Medicine, UCLA School of Medicine, Los Angeles, CA,USA
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