Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 30
Filter
1.
Lancet Microbe ; 4(9): e711-e721, 2023 09.
Article in English | MEDLINE | ID: mdl-37544313

ABSTRACT

BACKGROUND: In 2021, four patients who had received solid organ transplants in the USA developed encephalitis beginning 2-6 weeks after transplantation from a common organ donor. We describe an investigation into the cause of encephalitis in these patients. METHODS: From Nov 7, 2021, to Feb 24, 2022, we conducted a public health investigation involving 15 agencies and medical centres in the USA. We tested various specimens (blood, cerebrospinal fluid, intraocular fluid, serum, and tissues) from the organ donor and recipients by serology, RT-PCR, immunohistochemistry, metagenomic next-generation sequencing, and host gene expression, and conducted a traceback of blood transfusions received by the organ donor. FINDINGS: We identified one read from yellow fever virus in cerebrospinal fluid from the recipient of a kidney using metagenomic next-generation sequencing. Recent infection with yellow fever virus was confirmed in all four organ recipients by identification of yellow fever virus RNA consistent with the 17D vaccine strain in brain tissue from one recipient and seroconversion after transplantation in three recipients. Two patients recovered and two patients had no neurological recovery and died. 3 days before organ procurement, the organ donor received a blood transfusion from a donor who had received a yellow fever vaccine 6 days before blood donation. INTERPRETATION: This investigation substantiates the use of metagenomic next-generation sequencing for the broad-based detection of rare or unexpected pathogens. Health-care workers providing vaccinations should inform patients of the need to defer blood donation for at least 2 weeks after receiving a yellow fever vaccine. Despite mitigation strategies and safety interventions, a low risk of transfusion-transmitted infections remains. FUNDING: US Centers for Disease Control and Prevention (CDC), the Biomedical Advanced Research and Development Authority, and the CDC Epidemiology and Laboratory Capacity Cooperative Agreement for Infectious Diseases.


Subject(s)
Encephalitis , Organ Transplantation , Yellow Fever Vaccine , Humans , Blood Transfusion , Encephalitis/chemically induced , Organ Transplantation/adverse effects , United States/epidemiology , Yellow fever virus/genetics
2.
J Neurosurg Case Lessons ; 5(4)2023 Jan 23.
Article in English | MEDLINE | ID: mdl-36692061

ABSTRACT

BACKGROUND: Chordoid meningioma is a rare World Health Organization (WHO) grade 2 variant of meningioma with histological features resembling those of a chordoma. This tumor type is known for having an aggressive clinical course with a propensity for local recurrence. Most cases occur within the cranium, more specifically around the cerebral convexities. Although extracranial meningiomas of various subtypes have been documented, extracranial meningioma with a chordoid subtype is an extremely rare entity. OBSERVATIONS: The authors herein report the case of a 51-year-old female who presented with a chief complaint of dysphagia and was found to have a neck mass abutting the carotid sheath. The patient underwent resection and final pathology results revealed a WHO grade 2 chordoid meningioma. LESSONS: This case report demonstrates an atypical case of an extracranial chordoid meningioma adjacent to the carotid sheath. To the authors' knowledge, this is the first reported case of a chordoid meningioma occurring within the soft tissue of the neck.

3.
Am J Ophthalmol ; 226: 191-200, 2021 06.
Article in English | MEDLINE | ID: mdl-33529584

ABSTRACT

PURPOSE: To find immunohistochemical markers that distinguish adenocarcinoma of the nonpigmented ciliary epithelium (NPCE) from metastatic carcinoma, especially metastatic renal cell carcinoma. DESIGN: Retrospective case series. METHODS: Three cases of adenocarcinoma of the NPCE were examined histologically with hematoxylin-eosin stain and immunohistochemical stains including vimentin, AE1/AE3, Cam 5.2, CK7, PAX2, PAX8, AMACR, and CAIX. We also reviewed previously reported cases of this tumor. RESULTS: We found that the immunohistochemical profile of adenocarcinoma of the NPCE can overlap with renal cell carcinoma. Both tumors can express vimentin, cytokeratin AE1/AE3, Cam 5.2, PAX2, PAX8, and AMACR. One of the adenocarcinomas of the NPCE in our series also expressed CD10 and the renal cell carcinoma marker (RCC Ma). Carbonic anhydrase IX (CAIX) was not detected in any of the 3 tumors. CONCLUSIONS: Adenocarcinomas arising in phthisic eyes can be diagnostically challenging. We have found it particularly difficult to distinguish adenocarcinoma of the NPCE from metastatic carcinoma, especially metastatic clear cell renal cell carcinoma and papillary renal cell carcinoma. Because of the immunophenotypic overlap, most patients will require systemic workup including imaging of the kidneys to be certain of the diagnosis.


Subject(s)
Adenocarcinoma/diagnosis , Biomarkers, Tumor/metabolism , Carcinoma, Renal Cell/diagnosis , Ciliary Body/pathology , Kidney Neoplasms/diagnosis , Neoplasm Proteins/metabolism , Uveal Neoplasms/diagnosis , Adenocarcinoma/metabolism , Adult , Aged , Carcinoma, Renal Cell/metabolism , Ciliary Body/metabolism , Female , Humans , Immunohistochemistry , Kidney Neoplasms/metabolism , Male , Middle Aged , Pigment Epithelium of Eye/metabolism , Pigment Epithelium of Eye/pathology , Retrospective Studies , Uveal Neoplasms/metabolism
4.
Article in English | MEDLINE | ID: mdl-30057944

ABSTRACT

Lymphoma presenting as a scalp mass is a rare but serious medical condition mandating aggressive treatment and neurosurgical intervention. We report a case of 53-year-old male who presented with a large right sided frontal scalp mass and a smaller mass located on the left frontal scalp. After discussion with the patient, it was decided to resect the larger mass for definitive diagnosis. After subtotal resection of the mass, biopsy revealed WHO grade 1 follicular lymphoma (FL), diffuse pattern stage IV. The patient was subsequently treated with 4 grays (Gy) of palliative radiotherapy over 2 fractions to the right frontal scalp and systemic chemo-immunotherapy (6 cycles) followed by rituximab maintenance. Lumbar puncture to obtain cerebrospinal fluid was done a month after therapy began and the results were negative for spread of malignant cells. Approximately 3 months after initiation of therapy, PET/CT showed no evidence of active malignancy and MRI revealed a complete internal resolution of the enlarged right frontal scalp mass. We use this case to provide a detailed discussion regarding disease pathophysiology, early diagnosis, and management.

5.
Arch Pathol Lab Med ; 142(6): 706-710, 2018 06.
Article in English | MEDLINE | ID: mdl-29848037

ABSTRACT

CONTEXT: - Human papillomavirus (HPV) has a well-known role in the pathogenesis of squamous cell carcinoma and precursor lesions of the cervix, anogenital region, and head and neck, but its role in the development of squamous neoplasms of the eye, particularly the conjunctiva, remains unclear. OBJECTIVE: - To review recent evidence implicating HPV in the pathophysiology of ocular lesions. DATA SOURCES: - Published articles obtained from a PubMed search of the English literature were the primary sources for this review. CONCLUSIONS: - The low-risk HPV types 6 and 11 appear to play a role in the development of at least a subset of conjunctival squamous papillomas. The role of HPV in the pathogenesis of pterygium and ocular surface squamous neoplasia is less well defined. There is evidence to suggest that HPV may be a cofactor in the development of these lesions, acting in concert with ultraviolet radiation and/or human immunodeficiency virus infection in a subgroup of cases.


Subject(s)
Carcinoma, Squamous Cell/virology , Eye Neoplasms/virology , Papillomaviridae/physiology , Papillomavirus Infections/virology , Pterygium/virology , Carcinoma, Squamous Cell/physiopathology , Conjunctival Neoplasms/physiopathology , Conjunctival Neoplasms/virology , Eye Neoplasms/physiopathology , Human papillomavirus 11/physiology , Human papillomavirus 16/physiology , Humans , Papilloma/physiopathology , Papilloma/virology , Papillomavirus Infections/physiopathology , Pterygium/physiopathology , Ultraviolet Rays
6.
World Neurosurg ; 115: e59-e66, 2018 Jul.
Article in English | MEDLINE | ID: mdl-29631083

ABSTRACT

BACKGROUND: Glioblastoma is a fatal brain cancer with low median and yearly survival rates. Standard of care for treating glioblastoma is gross total resection (GTR) coupled with the Stupp protocol, but various factors influence the interventions undertaken and survival achieved. As health disparities exist in rural areas, survival in these areas needs to be assessed to understand which factors detract from the successes of these standard medical interventions. METHODS: We retrospectively determined impact of age at diagnosis, number of lesions, the molecular marker O6-methylguanine methyltransferase (MGMT), extent of surgery, and completion of the Stupp protocol on survival in patients treated at West Virginia University Hospitals. We also compared our findings with a pre-Stupp protocol study done in West Virginia in 1996. RESULTS: Age <60 years at diagnosis, having the MGMT gene methylated, having a unifocal tumor, receiving GTR, adhering to the Stupp protocol, and undergoing a treatment course of GTR followed by the Stupp protocol significantly increased survival. Comparison with the 1996 study showed that although overall median survival has not increased, all interventions involving GTR have resulted in a significantly higher survival. CONCLUSIONS: We can serve our patient population by offering GTR to all adult patients with glioblastoma when no contraindications exist and ensuring that patients follow the Stupp protocol. After discharge, the Stupp protocol may not be followed or completed for a variety of reasons. In the future, we aim to assess these reasons and analyze other significant interventional and socioeconomic factors that influence survival.


Subject(s)
Brain Neoplasms/mortality , Glioblastoma/mortality , Health Literacy/trends , Healthcare Disparities/trends , Tertiary Care Centers/trends , Adult , Aged , Aged, 80 and over , Antineoplastic Protocols , Appalachian Region/epidemiology , Biomarkers, Tumor/genetics , Brain Neoplasms/genetics , Brain Neoplasms/therapy , Cohort Studies , DNA Modification Methylases/genetics , DNA Repair Enzymes/genetics , Female , Glioblastoma/genetics , Glioblastoma/therapy , Humans , Male , Middle Aged , Retrospective Studies , Survival Rate/trends , Treatment Outcome , Tumor Suppressor Proteins/genetics , West Virginia/epidemiology , Young Adult
7.
Neurodegener Dis Manag ; 8(2): 81-88, 2018 04.
Article in English | MEDLINE | ID: mdl-29319406

ABSTRACT

We report a case of a 57-year-old male with clinically diagnosed and autopsy-confirmed early onset Alzheimer's disease who completed suicide by gunshot wound to the chest. This case has several unique aspects that have not been discussed in previous case reports of completed suicide in Alzheimer's disease. In particular, our patient's death was highly planned with successful compensation for his cognitive deficits. After all firearms had been removed from the home as a safety precaution, he obtained a new weapon, hid it and left himself cues to find and use it. The case is discussed in the context of literature differentiating the neural circuitry propagating impulsive versus planned suicidal acts.


Subject(s)
Alzheimer Disease/diagnosis , Alzheimer Disease/psychology , Suicide , Autopsy , Brain/diagnostic imaging , Brain/pathology , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Mental Status Schedule , Middle Aged
8.
J Pediatr Hematol Oncol ; 39(7): e381-e387, 2017 10.
Article in English | MEDLINE | ID: mdl-28562508

ABSTRACT

Constitutional mismatch repair deficiency syndrome is a cancer predisposition syndrome caused by autosomal recessive biallelic (homozygous) germline mutations in the mismatch repair genes (MLH1, MSH2, MSH6, and PMS2). The clinical spectrum includes neoplastic and non-neoplastic manifestations. We present the case of a 7-year-old boy who presented with T-lymphoblastic lymphoma and glioblastoma, together with non-neoplastic manifestations including corpus callosum agenesis, arachnoid cyst, developmental venous anomaly, and hydrocephalus. Gene mutation analysis revealed pathogenic biallelic mutations of PMS2 and heterozygous DICER1 variant predicted to be pathogenic. This report is the first to allude to a possible interaction of the mismatch repair system with DICER1 to cause corpus callosum agenesis.


Subject(s)
Agenesis of Corpus Callosum/etiology , DEAD-box RNA Helicases/genetics , DNA Mismatch Repair/genetics , Mismatch Repair Endonuclease PMS2/genetics , Mutation , Ribonuclease III/genetics , Child , Glioblastoma , Humans , Male , Precursor T-Cell Lymphoblastic Leukemia-Lymphoma
10.
Postgrad Med J ; 93(1101): 401-405, 2017 Jul.
Article in English | MEDLINE | ID: mdl-27920210

ABSTRACT

BACKGROUND: Sarcoidosis is a chronic, multisystem disease characterised by non-necrotising granulomatous inflammation of unknown aetiology. Most commonly, the lungs, lymph nodes, skin and eyes are affected in sarcoidosis; however, nervous system involvement occurs in approximately 5%-15% of cases. Any part of the nervous system can be affected by sarcoidosis. CASES: Herein we describe three unusual patient presentations of neurosarcoidosis, one with optic neuritis, a second with hydrocephalus and a third with cervical myelopathy. CONCLUSIONS: We include pertinent details about their presentations, imaging findings, pathology, management and clinical course.


Subject(s)
Central Nervous System Diseases/diagnosis , Hydrocephalus/diagnosis , Optic Neuritis/diagnosis , Sarcoidosis/diagnosis , Spinal Cord Diseases/diagnosis , Adult , Central Nervous System Diseases/therapy , Cervical Vertebrae , Diagnosis, Differential , Diagnostic Imaging , Female , Humans , Hydrocephalus/therapy , Male , Middle Aged , Optic Neuritis/therapy , Sarcoidosis/therapy , Spinal Cord Diseases/therapy
11.
Case Stud Surg ; 2(4): 58-61, 2016 Nov.
Article in English | MEDLINE | ID: mdl-27857981

ABSTRACT

Lipomatous meningiomas are a very rare form of brain meningiomas consisting of fat accumulation within the tumor. Magnetic resonance imaging (MRI) or computerized tomographic (CT) imaging can be utilized to visualize the fat accumulations, but histopathologic staining is necessary in order to make a definitive diagnosis. The key histopathologic feature is the identification of adipocyte-like cells within the tumor, but other markers have also been identified. In this case report and review of the literature, we discuss how to recognize the symptoms associated with lipomatous meningiomas and the definitive treatment approach for these rare tumors.

12.
J Surg Case Rep ; 2016(4)2016 Apr 13.
Article in English | MEDLINE | ID: mdl-27076621

ABSTRACT

Intraosseous angiolipomas are very rare tumors occurring most commonly in the ribs and mandible. Only two cases with intracranial involvement have been reported in the literature. We report a case of a giant calvarial angiolipoma and its surgical treatment in a 30-year-old female who presented with a slowly expanding skull mass and discuss relevant radiological, histological and surgical findings.

13.
Ann Vasc Med Res ; 3(4)2016.
Article in English | MEDLINE | ID: mdl-28191502

ABSTRACT

Patients with spinal vascular lesions present with unique symptoms and have important anatomical and physiologic changes that must be considered prior to treatment. In this mini-review, we provide an overview of normal spinal vascular anatomy and discuss several key spinal vascular lesions. We provide an overview of cavernous malformations, intradural arteriovenous malformations, perimedullary arteriovenous fistulas, and dural arteriovenous fistulas. Important considerations are addressed in terms of pathologic characterization, specific imaging findings, and treatment approaches.

14.
W V Med J ; 111(4): 38-41, 2015.
Article in English | MEDLINE | ID: mdl-26242031

ABSTRACT

Secondary, radiation-induced, supratentorial primitive neuroectodermal tumors (PNETs) are extremely rare entities which may present in survivors of childhood cancers after central nervous system radiation. These lesions have been described after a number of pediatric cancers and demonstrate unique treatment problems and an accelerated clinical course compared to primary PNETs. We present a case of a sixteen year old male with a history of non-Hodgkin's lymphoma who presented with a radiation-induced PNET, and describe our treatment for this lesion. These secondary, radiation-induced tumors increase in significance as the survival of childhood malignancy increases in West Virginia.


Subject(s)
Lymphoma, Non-Hodgkin/radiotherapy , Neoplasms, Radiation-Induced/pathology , Neuroectodermal Tumors, Primitive/etiology , Supratentorial Neoplasms/etiology , Adolescent , Humans , Male , Neuroectodermal Tumors, Primitive/pathology , Supratentorial Neoplasms/pathology
15.
W V Med J ; 108(4): 12, 14-5, 2012.
Article in English | MEDLINE | ID: mdl-22872959

ABSTRACT

Listeria monocytogenes is a known cause of meningitis, but cerebral abscess formation is exceedingly rare. We describe a patient who presented with an unsteady gait and a small ring-enhancing lesion in the right parietal lobe. Pathologic evaluation demonstrated an abscess with associated microglial nodules, and culture revealed Listeria. In spite of the rarity of this entity, immunosuppression has been noted to be a predisposing factor. Our patient had diabetes mellitus and chronic obstructive pulmonary disease with recent prednisone administration, both very common ailments in the population of West Virginia.


Subject(s)
Brain Abscess/microbiology , Meningitis, Listeria/complications , Meningitis, Listeria/diagnosis , Adult , Brain Abscess/diagnosis , Brain Abscess/etiology , Brain Abscess/pathology , Diabetes Mellitus/epidemiology , Diagnosis, Differential , Female , Gait , Humans , Immunosuppressive Agents/therapeutic use , Prednisone/therapeutic use , Pulmonary Disease, Chronic Obstructive/drug therapy , Pulmonary Disease, Chronic Obstructive/epidemiology
17.
J Neuropathol Exp Neurol ; 68(10): 1053-60, 2009 Oct.
Article in English | MEDLINE | ID: mdl-19918117

ABSTRACT

Since its introduction to the United States in 1999, West Nile virus (WNV) has become endemic in North America and has emerged as the most common cause of epidemic meningoencephalitis in North America and the leading cause of arboviral encephalitis in the United States. West Nile virus is maintained in nature by cycling between mosquito vectors and bird hosts; humans are incidental hosts. Transmission to humans occurs predominantly after a bite from an infected mosquito but has also occurred via transfusion of blood products, via organ transplantation from infected donors, transplacentally, and percutaneously through occupational exposure. Approximately one of 150 patients develops central nervous system manifestations, including meningitis, encephalitis, and acute flaccid paralysis/poliomyelitis. Risk factors for neuroinvasive disease include older age and immunosuppression. Imaging findings are nonspecific, and cerebrospinal fluid findings include pleocytosis, elevated protein, and normal to decreased glucose. The diagnosis is made in most patients on serological examination. Reverse transcription polymerase chain reaction tests are useful to screen blood products and for surveillance of birds and mosquitoes. The pathological findings are typical of a viral meningoencephalitis and include microglial nodules, perivascular chronic inflammation, and variable neuronal loss with necrosis or neuronophagia. Treatment is largely supportive, and control of the mosquito vectors may reduce the incidence of human infections.


Subject(s)
West Nile Fever/epidemiology , West Nile Fever/pathology , Animals , Humans , West Nile Fever/diagnosis , West Nile virus/genetics
18.
Epilepsia ; 50(12): 2593-8, 2009 Dec.
Article in English | MEDLINE | ID: mdl-19817804

ABSTRACT

PURPOSE: Malformations of cortical development (MCD) (cortical dysplasias) are well-recognized causes of intractable epilepsy. Although a histologic classification system for MCD has been proposed by Palmini et al. (Neurology; 2004; 62:S2), studies to date have not assessed reproducibility. The purpose of this study was to analyze inter- and intraobserver agreement among eight experienced neuropathologists (NPs) with respect to this classification system. METHODS: Sections from 26 epilepsy resections were selected to represent the range of pathologies described by Palmini et al. Recuts of single sections from each case were sent to the NPs to classify. The slides were resent at a later date for reclassification. Kappa analysis for both inter- and intraobserver concordance was performed. RESULTS: Interobserver agreement was moderate (kappa = 0.4968). There was > or =62.5% (5 of 8 NPs) agreement for 19 of 26 cases. The greatest concordance was present when making focal cortical dysplasia (FCD) types IIA/B classifications (12 of the 14 cases with > or =75% consensus). Mild MCD (types I/II) and FCD types IA/B classifications were the least reproducible, and used most frequently in cases without consensus. Intraobserver concordance was moderate to very good (range kappa = 0.4654-0.8504). The category with the fewest classification changes made on reevaluation was FCD type IIB (4.2%), whereas that with the most changes was mild MCD (types I/II) (52.9%). DISCUSSION: Interobserver concordance using this approach was moderate. The classification categories with the greatest concordance were FCD type IIA/B, and the least, mild MCD and FCD types IA/B. In addition, difficulty in differentiating Mild MCD/FCD type I lesions from normal and/or gliotic tissue was noted.


Subject(s)
Cerebral Cortex/pathology , Epilepsies, Partial/pathology , Malformations of Cortical Development/pathology , Cerebral Cortex/surgery , Consensus , Epilepsies, Partial/diagnosis , Epilepsies, Partial/surgery , Gliosis/pathology , Humans , Malformations of Cortical Development/classification , Malformations of Cortical Development/diagnosis , Malformations of Cortical Development/epidemiology , Neurons/pathology , Observer Variation , Pathology, Clinical , Reproducibility of Results , Terminology as Topic
19.
J Grad Med Educ ; 1(1): 37-44, 2009 Sep.
Article in English | MEDLINE | ID: mdl-21975705

ABSTRACT

OBJECTIVES: To determine whether a longitudinal, case-based evaluation system can predict acquisition of competency in surgical pathology and how trainees at risk can be identified early. DESIGN: Data were collected for trainee performance on surgical pathology cases (how well their diagnosis agreed with the faculty diagnosis) and compared with training outcomes. Negative training outcomes included failure to complete the residency, failure to pass the anatomic pathology component of the American Board of Pathology examination, and/or failure to obtain or hold a position immediately following training. FINDINGS: Thirty-three trainees recorded diagnoses for 54 326 surgical pathology cases, with outcome data available for 15 residents. Mean case-based performance was significantly higher for those with positive outcomes, and outcome status could be predicted as early as postgraduate year-1 (P  =  .0001). Performance on the first postgraduate year-1 rotation was significantly associated with the outcome (P  =  .02). Although trainees with unsuccessful outcomes improved their performance more rapidly, they started below residents with successful outcomes and did not make up the difference during training. There was no significant difference in Step 1 or 2 United States Medical Licensing Examination (USMLE) scores when compared with performance or final outcomes (P  =  .43 and P  =  .68, respectively) and the resident in-service examination (RISE) had limited predictive ability. DISCUSSION: Differences between successful- and unsuccessful-outcome residents were most evident in early residency, ideal for designing interventions or counseling residents to consider another specialty. CONCLUSION: Our longitudinal case-based system successfully identified trainees at risk for failure to acquire critical competencies for surgical pathology early in the program.

20.
Brain Pathol ; 17(4): 354-62, 2007 Oct.
Article in English | MEDLINE | ID: mdl-17610522

ABSTRACT

Rare cases of West Nile virus (WNV)-associated inflammation outside the central nervous system (CNS) have been reported. We evaluated the systemic distribution of WNV in postmortem tissues during encephalitis in six patients using immunohistochemistry. WNV antigens were detected in neurons of CNS (all 6 cases), kidney (4 cases), lungs (2 cases), pancreas (2 cases), thyroid (2 cases), intestine (2 cases), stomach (1 case), esophagus (1 case), bile duct (1 case), skin (1 case), prostate (1 case) and testis (1 case). In systemic organs epithelial cells were infected. In none of the six cases were viral antigens identified in hepatocytes, heart, adrenal gland, nerves, skeletal muscles, bone, vessels and fat. All cases in which viral antigens were identified in systemic organs in addition to CNS were severely immunocompromised transplant recipients. With the exception of testis and brain, most foci of infection were not associated with inflammation. While the absence of inflammation may in part be due to patient immunosuppression or to possible transient nature of any host response, compartmentalization of viral antigen to the luminal region of epithelial cells may sequester WNV from immune recognition. Comparison of our findings with previous reports suggests that patients with WNV encephalitis can have widespread systemic infection.


Subject(s)
Antigens, Viral/immunology , Viscera/virology , West Nile Fever/complications , West Nile virus/immunology , Adult , Aged , Aged, 80 and over , Autopsy , Brain/immunology , Brain/pathology , Brain/virology , Disease Progression , Epithelial Cells/immunology , Epithelial Cells/pathology , Epithelial Cells/virology , Fatal Outcome , Female , Humans , Immunocompromised Host/immunology , Immunohistochemistry , Male , Middle Aged , Viremia/pathology , Viremia/physiopathology , Viremia/virology , Viscera/immunology , Viscera/pathology , West Nile Fever/immunology , West Nile Fever/pathology
SELECTION OF CITATIONS
SEARCH DETAIL
...