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1.
Rev Mal Respir ; 38(6): 664-668, 2021 Jun.
Article in French | MEDLINE | ID: mdl-34024647

ABSTRACT

INTRODUCTION: When a patient treated by immune checkpoint inhibitors for metastatic melanoma presents with pulmonary symptoms, several diagnoses are possible. We report a case of acute granulomatous lung disease secondary to repeated kayexalate inhalations, and probably stimulated by immunotherapy. CASE REPORT: A patient treated with pembrolizumab and then ipilimumab presented with fever and acute shortness of breath. His pulmonary symptoms got progressively worse, leading to an acute respiratory distress syndrome. Chest CT displayed a pattern of non-specific organized pneumonia. Pulmonary infection, tumor progression, specific immune-related lung toxicity and immunotherapy-induced sarcoidosis were discussed. Histopathological examination of a lung biopsy showed a foreign body granulomatous macrophage reaction associated with crystalline, basophilic, purple and laminated elements, evoking kayexalate particles. These elements helped rewrite the diagnosis and confirmed a kayexalate-induced granulomatous lung disease secondary to repeated aspiration. The patient's respiratory condition got better following discontinuation of kayexalate together with systemic corticosteroids. Symptoms relapsed with resumption of the immunotherapy but were controlled with the addition of a new course of prolonged systemic corticosteroid therapy. We can hypothesize that immunotherapy played a role in the recurrence of the granulomatous lung reaction, or that there was an association between an aspiration pneumonia and an immunotherapy-induced lung toxicity. CONCLUSION: Facing respiratory symptoms during immunotherapy, the treatment may be the cause, but lung biopsy should be performed rapidly to arrive to a certain diagnosis.


Subject(s)
Lung Diseases , Melanoma , Humans , Immunotherapy/adverse effects , Lung Diseases/chemically induced , Lung Diseases/diagnosis , Melanoma/drug therapy , Neoplasm Recurrence, Local , Polystyrenes
2.
Prog Urol ; 31(5): 282-292, 2021 Apr.
Article in French | MEDLINE | ID: mdl-33593695

ABSTRACT

AIM: The objective of this study is to present the history of cancers of the external genital organs of male in Hérault using data from the Hérault tumor register (RTH) over a period of 30 years. PATIENTS AND METHODS: Using the RTH database, we studied the development of testicular germ cell tumors (TGCT) and penile cancer (PC) over 30 years, from 1987 to 2016. We analyzed the incidence and mortality data for these tumors. We compared these results to French, European and global data. RESULTS: In 30 years of registration we have recorded 725 cases of TGCT and 175 cases of PC. The age standardized incidence rate (ASR) of TGCT has doubled between 1987 and 2016 (4.2 per 100,000 in 1987 and 9.3 per 100,000 in 2016). It was multiplied by 2.63 in the population of patients aged 30 to 44. There is a decrease of the mortality rate with a ASR of 0.8 deaths per 100,000 in 1987, and 0.4/100 000 in 2016. The PC incidence ASR was stable between 1987 and 2016 (0.4-0.9/100,000). Mortality is stable with a ASR between 0.1 and 0.3 deaths per 100,000 between 1987 and 2016. CONCLUSION: The incidence of TGCT has increased sharply in the Hérault over the past 30 years, while a decrease in mortality has been observed. The proportion of seminomas is increasing; it has gone from 53 % to 60 % in 30 years in the Hérault. The incidence and mortality of PC shows a stability in the Hérault over the past 30 years.


Subject(s)
Neoplasms, Germ Cell and Embryonal/epidemiology , Penile Neoplasms/epidemiology , Testicular Neoplasms/epidemiology , Adult , France/epidemiology , Humans , Incidence , Male , Registries , Time Factors
3.
Prog Urol ; 31(3): 175-182, 2021 Mar.
Article in French | MEDLINE | ID: mdl-33160850

ABSTRACT

OBJECTIVE: The objective of the study was to determine the specificities of renal cell carcinoma (RCC) in the department of Herault using the Herault Tumor Registry over 30 years. METHODS: Data of this study were obtained from the Herault cancer database. We analysed the evolution of RCC from 1987 to 2016, including the incidence, mortality, cancer pathology and staging at the moment of diagnosis. We compared our results with national and international data. RESULTS: We identified 3769 newly diagnosed RCC: 2628 in men (69,7%) and 1141 in women (30,3%). In 2016, RCC was the 8th most frequent cancer, both genders combined, the 7th most frequent cancer in men and the 11th in women. New cases of RCC increased by 4.2 in men and 3.3 in women over the study period. The number of localised forms increased by 9% over 20 years. In 2016, the probability of having a RCC before the age of 75 was of 2.11% for a man and of 0.62% for a woman. CONCLUSION: Over 30 years, the incidence rate of RCC increased in the department of Herault; however, mortality decreased over the same period. This analytical data should be improved by the development of the Registry of Herault Specialised in Onco-Urology (RHESOU). LEVEL OF EVIDENCE: 3.


Subject(s)
Carcinoma, Renal Cell/epidemiology , Carcinoma, Renal Cell/pathology , Kidney Neoplasms/epidemiology , Kidney Neoplasms/pathology , Female , France/epidemiology , Humans , Incidence , Male , Neoplasm Staging , Registries , Time Factors
4.
Prog Urol ; 30(16): 1038-1044, 2020 Dec.
Article in French | MEDLINE | ID: mdl-33012630

ABSTRACT

PURPOSE: In 2016, the Herault tumor registry collected 1961cancers in urology (21.4 % from all Herault cancers this year). RHESOU was created to complete RTH' data with specific parameters in onco-urology. The aim of this study is to describe RHESOU and to give some examples with our first results. MATERIAL AND METHODS: In November 2018, RHESOU (Registry HErault Specialised in Onco-Urology) was founded with the same registry recommendations. It collects specific oncologic parameters and also complete RTH's data. For each urological cancer, a specific survey with different choices was performed to collect a maximum of data which could be present in patients' file. These surveys were used for urological cancers cases that live in Herault in 2017. RESULTS: In 2017, we collected 970 prostate cancers, 581 bladder cancers, 212 kidney cancers, 51 upper excretory tract cancers, 28 testicle cancers and 9 penil cancers. Our urological data collection gives many possibilities to create many requests for detailed analysis in urological cancers. In this article, we reported data from kidney, bladder and prostate cancers. CONCLUSIONS: RHESOU is a new tool opened to the different urologic corporations (urologists, pathologists, oncologists, radiotherapists, radiologists) that permits an overview in urological cancers in Herault. Finally, one important aim is that this tool will be adapted when new treatments or new important parameters appear in the years ahead. LEVEL OF EVIDENCE: 3.


Subject(s)
Medical Oncology , Registries , Urologic Neoplasms , Female , France , Humans , Kidney Neoplasms/diagnosis , Kidney Neoplasms/therapy , Male , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/therapy , Urinary Bladder Neoplasms/diagnosis , Urinary Bladder Neoplasms/therapy , Urologic Neoplasms/diagnosis , Urologic Neoplasms/therapy
5.
Eur J Neurol ; 25(1): 105-110, 2018 01.
Article in English | MEDLINE | ID: mdl-28906581

ABSTRACT

BACKGROUND AND PURPOSE: Whether to withhold mechanical thrombectomy when the diffusion-weighted imaging (DWI) lesion exceeds a given volume is undetermined. Our aim was to identify markers that will help to select patients with large DWI lesions [DWI-Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) ≤ 5] that may benefit from thrombectomy. METHODS: From May 2010 to November 2016, 82 acute ischaemic stroke patients with DWI-ASPECTS ≤5 (43 men, 64.6 ± 14.4 years, National Institutes of Health Stroke Scale 18.4 ± 5.4) treated with state-of-the-art mechanical thrombectomy were studied. Thrombectomy alone was performed in 28 (34%) and bridging therapy in 54 (66%) patients. Recanalization was defined as a thrombolysis in cerebral infarction score 2B-3 and significant hemorrhagic transformation as parenchymal haematoma type 2 (European Cooperative Acute Stroke Study 3 classification). Pretreatment variables were compared between patients with a good (modified Rankin Scale 0-2) and a poor (modified Rankin Scale 3-6) neurological outcome at 3 months. RESULTS: Overall, 28 patients (34%) achieved good neurological outcome at 3 months. Recanalizers were significantly more likely to achieve good outcome (61% vs. 7.3%, P < 0.0001), had lower mortality (24% vs. 49%, P = 0.03) and similar rates of parenchymal haematoma type 2 (9.8% vs. 7.3%, P = 1) compared to non-recanalizers. Regression modelling identified DWI-ASPECTS >2 [odds ratio (OR) 6.93; 95% confidence interval (CI) 1.05-45.76, P = 0.04), glycaemia ≤6.8 mmol/l (OR 4.05; 95% CI 1.09-15.0, P = 0.03) and thrombolysis (OR 3.67; 95% CI 1.04-12.9, P = 0.04) as independent predictors of good neurological outcome. CONCLUSIONS: In patients with DWI-ASPECTS ≤5, two-thirds of patients experienced good neurological outcome when recanalized by state-of-the-art thrombectomy, whilst only one in 14 non-recanalizers achieved similar outcomes. Pretreatment markers of good neurological outcomes were DWI-ASPECTS >2, intravenous thrombolysis and glycaemia ≤6.8 mmol/l.


Subject(s)
Stroke/diagnostic imaging , Stroke/surgery , Thrombectomy/methods , Adult , Aged , Aged, 80 and over , Biomarkers , Brain Ischemia/diagnostic imaging , Brain Ischemia/surgery , Cerebral Infarction/diagnostic imaging , Cerebral Infarction/etiology , Diffusion Magnetic Resonance Imaging , Female , Humans , Image Processing, Computer-Assisted , Intracranial Hemorrhages/etiology , Male , Middle Aged , Predictive Value of Tests , Tomography, X-Ray Computed , Treatment Outcome
6.
Eur J Neurol ; 22(6): 967-72, 2015 Jun.
Article in English | MEDLINE | ID: mdl-25786977

ABSTRACT

BACKGROUND AND PURPOSE: The susceptibility vessel sign (SVS) on T2*-weighted magnetic resonance imaging has been reported in several studies as a negative predictor of early recanalization after intravenous thrombolysis. The meaning of SVS regarding the results of mechanical thrombectomy with stent retrievers was investigated. METHODS: Susceptibility vessel sign presence and length were studied in 153 acute ischaemic stroke patients (82 men; mean ± SD age 59 ± 17 years, baseline National Institutes of Health Stroke Scale score 17.2 ± 6.5) from three stroke centres, treated with either mechanical thrombectomy alone (n = 84) or bridging therapy (n = 69). Variables were compared between recanalizers, defined as thrombolysis in cerebral infarction (TICI) scores ≥2b, and non-recanalizers (TICI<2b). RESULTS: The SVS was present in 113 (73.8%) patients. There was no association between the presence of SVS and recanalization, obtained in 86 (56.2%) patients, in the whole population [odds ratio (OR) 1.24, 95% confidence interval (CI) 0.53-2.92, P = 0.84) and in treatment subgroups (bridging: OR = 0.91, 95% CI 0.29-2.87, P = 1.0; thrombectomy alone: OR = 1.85, 95% CI 0.48-7.16, P = 0.54). However, in SVS+ patients, recanalization decreased with SVS length (OR 0.94 for each additional mm, 95% CI 0.89-0.99; P = 0.02). CONCLUSIONS: The success of recanalization in acute stroke patients treated with stent retrievers was related to thrombus length but not to the presence of SVS.


Subject(s)
Brain Ischemia/therapy , Magnetic Resonance Imaging , Mechanical Thrombolysis/methods , Outcome Assessment, Health Care , Stroke/therapy , Thrombosis/pathology , Adult , Aged , Brain Ischemia/pathology , Cohort Studies , Female , Humans , Male , Mechanical Thrombolysis/instrumentation , Middle Aged , Stents , Stroke/pathology , United States
7.
AJNR Am J Neuroradiol ; 34(2): 360-5, 2013 Feb.
Article in English | MEDLINE | ID: mdl-22821923

ABSTRACT

BACKGROUND AND PURPOSE: The best approach between general anesthesia and conscious sedation to perform mechanical thrombectomy remains unknown. The goal of our study was to evaluate the feasibility, safety, and efficacy of mechanical thrombectomy under conscious sedation in patients with acute ischemic stroke, using the Solitaire FR device, in a prospective, single-center, single-arm study. MATERIALS AND METHODS: The study included consecutive patients with acute ischemic stroke due to a large artery occlusion within 6 hours of symptom onset for the anterior circulation, and within 24 hours for the posterior circulation. After intravenous thrombolysis (when no contraindications), thrombectomy was performed with the Solitaire device in patients under conscious sedation. Primary efficacy and safety end points were good functional outcome (mRS ≤2) at 3 months and mortality at 3 months. Secondary end points were recanalization (TICI ≥2) and failure rate. RESULTS: From May 2010 to July 2011, 36 patients were treated. Median baseline NIHSS score was 17.5. The occlusion site was MCA in 21 patients (58.4%), ICA-MCA tandem occlusion in 9 patients (25.0%), terminal ICA in 2 patients (5.5%), and basilar artery in 4 patients (11.1%). Twenty-three patients (63.9%) received intravenous thrombolysis. Superselective catheterization of the occluded vessel was not feasible in 5/36 cases (13.9%). Successful revascularization was achieved in 28/36 patients (77.8%). After 3 months, 22 patients (61.1%) showed good functional outcome (mRS ≤2) and the median NIHSS score was 8.5. Overall mortality rate at 3 months was 22.2% (8/36). CONCLUSIONS: In acute ischemic stroke, mechanical thrombectomy while under conscious sedation is feasible in a large percentage of cases (86.1%) and is associated with a short procedure delay and a high percentage of good functional outcomes at 3 months (61.1%).


Subject(s)
Conscious Sedation , Stents , Stroke/surgery , Thrombectomy/instrumentation , Thrombectomy/methods , Acute Disease , Adolescent , Adult , Aged , Aged, 80 and over , Anesthesia, General , Feasibility Studies , Female , Humans , Male , Middle Aged , Pilot Projects , Prospective Studies , Stents/adverse effects , Stroke/drug therapy , Stroke/mortality , Thrombectomy/adverse effects , Thrombectomy/mortality , Thrombolytic Therapy , Treatment Outcome , Young Adult
10.
Rev Neurol (Paris) ; 167(6-7): 533-6, 2011.
Article in French | MEDLINE | ID: mdl-21420702

ABSTRACT

INTRODUCTION: Behçet's disease is a multi-system vascular-inflammatory disease with possible involvement of the central nervous system. Lesions of the corpus callosum on MRI have been rarely reported in this disease. CASE REPORT: A 47-year-old woman was admitted for a sudden right hemiplegia and confusion revealing a Behcet's disease. MRI showed a pedonculo-thalamic lesion and a white matter hypersignals, which was suggestive of the disease. Besides, involvement of the corpus callosum was observed. CONCLUSION: This case demonstrates that Behcet's disease should be considered among diseases with corpus callosum involvement.


Subject(s)
Behcet Syndrome/pathology , Corpus Callosum/pathology , Adrenal Cortex Hormones/therapeutic use , Azathioprine/therapeutic use , Behcet Syndrome/complications , Colchicine/therapeutic use , Confusion/etiology , Female , Hemiplegia/etiology , Humans , Immunosuppressive Agents/therapeutic use , Magnetic Resonance Imaging , Middle Aged , Tegmentum Mesencephali/pathology , Thalamus/pathology , Treatment Failure
11.
Mult Scler ; 13(2): 220-3, 2007 Mar.
Article in English | MEDLINE | ID: mdl-17439888

ABSTRACT

We used a global positioning satellite technology odometer to determine the maximum objective walking distance capacity (MOWD) of patients with multiple sclerosis (MS). The MOWD correlated with Expanded Disability Status Scale (EDSS) score (r(2) =0.41; P <0.0001), the MSWS-12 scale (r(2) =0.46; P <0.0001), time to walk 10 m (r(2) =0.51; P <0.02) and walking speed (r(2) =0.75; P <0.001). Limitation of walking capacities was measurable up to 4550 m, strikingly above the 500-m limit of the EDSS. This objective odometer is a promising tool for evaluation and follow-up of patients with MS.


Subject(s)
Disability Evaluation , Multiple Sclerosis, Chronic Progressive/physiopathology , Multiple Sclerosis, Relapsing-Remitting/physiopathology , Severity of Illness Index , Telemetry/instrumentation , Walking , Adult , Female , Follow-Up Studies , Geographic Information Systems , Humans , Male , Middle Aged , Reproducibility of Results , Satellite Communications , Telemetry/standards
12.
Arch Mal Coeur Vaiss ; 100(12): 1025-9, 2007 Dec.
Article in French | MEDLINE | ID: mdl-18223517

ABSTRACT

We report the cases of two patients admitted to the Emergency Department with a clinical picture of right heart failure. An emergency echocardiograph suggested an intra-cardiac tumor which turned out to be a primary intra-cardiac lymphoma in one case, and a diffuse lymphoma principally localised in the heart in the other. Echocardiographic, CT and MRI investigations clarified the sites, as well as anatomical relations and extensions. Histology confirmed the diagnosis, and allowed classification of the lymphoma in order to decide on treatment. A PET scan performed in one patient illustrated the response to treatment. The respective significance of each of these investigations is discussed, in addition to the management. While transthoracic echocardiography remains the key element in the acute management, MRI and PET scans are being used more and more often for determining the character of these lesions, as well as for assisting with therapeutic decisions and for follow-up.


Subject(s)
Heart Failure/etiology , Heart Neoplasms/pathology , Lymphoma/pathology , Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Diagnostic Imaging , Emergency Service, Hospital , Heart Neoplasms/drug therapy , Humans , Lymphoma/drug therapy , Male , Middle Aged
15.
Thorax ; 59(6): 488-93, 2004 Jun.
Article in English | MEDLINE | ID: mdl-15170031

ABSTRACT

BACKGROUND: International guidelines stress the importance of accurately discriminating between asthma and chronic obstructive pulmonary disease (COPD). Although characteristic pathological features have been described for both conditions, their discriminatory power has never been systematically assessed. METHODS: Endobronchial biopsy (EBB) specimens from patients with a clear clinical diagnosis of asthma and COPD (50 per group) were examined by three pathologists in a double blind manner. They were asked to propose a pathological diagnosis of either asthma or COPD and to analyse qualitatively the most frequent abnormalities reported in the literature. RESULTS: The sensitivity and specificity of EBB ranged from 36% to 48% and from 56% to 79%, respectively. Eosinophils strongly biased the pathological diagnoses in favour of asthma, whereas their estimated prevalence was similar (11-37% in asthma and 13-41% in COPD). Metaplasia (11-39% in COPD, 1-18% in asthma) and epithelial inflammation (28-61% in COPD, 11-38% in asthma) tended to be specific to COPD, whereas epithelial desquamation (80-98% in asthma, 61-88% in COPD) and basement membrane thickening (71-94% in asthma, 53-88% in COPD) tended to be associated with asthma. There was acceptable intra- and inter-observer agreement only for metaplasia and epithelial eosinophils. CONCLUSIONS: Specific histopathological features of asthma and COPD probably exist, but current routine analysis procedures to assess EBB specimens are not sufficiently discriminatory. This might be rectified by improving pathological definitions.


Subject(s)
Asthma/pathology , Bronchi/pathology , Pulmonary Disease, Chronic Obstructive/pathology , Adult , Biopsy/methods , Diagnosis, Differential , Double-Blind Method , Female , Humans , Male , Middle Aged , Pilot Projects
16.
J Radiol ; 85(12 Pt 2): 2063-7, 2004 Dec.
Article in French | MEDLINE | ID: mdl-15692420

ABSTRACT

Breast carcinomas with false negative mammogram correspond to carcinomas diagnosed with means other than mammogram when the mammogram, at the time of diagnosis, showed no significant abnormality. The rate of false mammogram is difficult to ascertain because few studies have been published on this subject. The absence of mammographic abnormality is related to histopathological characteristics of the tumor and mammographic features of the patient's breast tissue. The small size of the tumor, the lack of microcalcifications often due to tumor necrosis and the absence of any significant associated desmoplastic reaction are the main histopathological factors encountered, particularly for dense breasts.


Subject(s)
Breast Neoplasms/diagnostic imaging , Breast Neoplasms/pathology , Mammography , False Negative Reactions , Female , Humans
18.
Arch Pediatr ; 6(2): 173-7, 1999 Feb.
Article in French | MEDLINE | ID: mdl-10079886

ABSTRACT

BACKGROUND: Sinus histiocytosis with massive cervical lymphadenopathy (Rosai-Dorfman disease) is a non-neoplastic lymphoproliferative disorder. Extranodal involvement, especially of the nervous system, is unusual. We report a case revealed by neurological symptoms. CASE REPORT: A 10-year-old girl presented with paraparesis due to a dural extramedullary mass on magnetic resonance imaging. Massive cervical lymphadenopathy appeared secondarily. Radiological investigations showed mediastinal, paranasal sinus and lower eyelid involvement. The diagnosis of Rosai-Dorfman disease was established histologically and by immunohistochemical studies of nodal lesions by the demonstration of characteristic sinus histiocytosis with sheets of S-100 protein and CD-68 positive large histiocytes displaying lymphocyte phagocytosis. A dramatic response occurred with complete resolution of all clinical findings after treatment with corticosteroids and etoposide, although neurological lesions were unchanged on magnetic resonance imaging. CONCLUSION: Despite its rarity, this case underlines the unknown pathogenesis of this disease (immune dysfunction?) and the difficulties of treatment (choice of chemotherapeutic agents, duration).


Subject(s)
Histiocytosis, Sinus/diagnosis , Paraplegia/etiology , Adrenal Cortex Hormones/therapeutic use , Child , Dura Mater , Etoposide/therapeutic use , Female , Histiocytosis, Sinus/complications , Histiocytosis, Sinus/drug therapy , Humans , Magnetic Resonance Imaging , Nucleic Acid Synthesis Inhibitors/therapeutic use , Paraplegia/diagnosis , Spinal Cord Diseases/diagnosis , Spinal Cord Diseases/etiology
19.
Ann Pathol ; 19(6): 487-91, 1999 Dec.
Article in French | MEDLINE | ID: mdl-10617805

ABSTRACT

Amyloidosis of the genito-urinary tract is uncommon. We report 8 cases, often misdiagnosed as a neoplastic process (6/8). Amyloidosis was localized in the bladder (3 cases), in the ureter (1 case) and in the prostate and/or seminal vesicles (4 cases). The amyloid protein was characterized in 7 cases by immunohistochemistry. Among the bladder and ureter amyloidosis, 2 cases were classified as AL lambda amyloidosis and one case as AA amyloidosis in a patient with long history of chronic arthritis. In the fourth case, the deposits could not be identified. Nevertheless an AL amyloidosis might be suggested. Two cases of prostate and/or seminal vesicles amyloidosis were stained with an anti-B2M antibody, in hemodialyzed patients. The 2 others, positive with the anti-Transthyretina antibody, were classified as senile amyloidosis. This small series illustrated the heterogeneous pathogenic types of amyloidosis in the urogenital tract and emphasized the interest of immunohistochemistry to identify the chemical composition of these deposits.


Subject(s)
Amyloidosis/pathology , Genital Diseases, Male/pathology , Ureteral Diseases/pathology , Urinary Bladder Diseases/pathology , Adult , Aged , Amyloid/analysis , Arthritis/complications , Female , Humans , Male , Middle Aged , Prealbumin/analysis , Prostatic Diseases/pathology , Seminal Vesicles/pathology
20.
J Radiol ; 79(6): 563-5, 1998 Jun.
Article in French | MEDLINE | ID: mdl-9757285

ABSTRACT

Calcified brain metastases are rare. They are unique or multiple. The primary site is lung, breast, gastro-intestinal tract, uterine cervix, bone or may be unidentified. It corresponds pathologically to an adenocarcinoma, a sarcoma or to a squamous cell carcinoma. We report a case of multiple calcified brain metastases discovered before primary tumour (bronchial adenocarcinoma), raising the problem of differential diagnosis resolved by stereotaxic brain biopsy.


Subject(s)
Adenocarcinoma/secondary , Brain Neoplasms/secondary , Bronchial Neoplasms , Calcinosis , Adenocarcinoma/diagnosis , Adenocarcinoma/pathology , Biopsy , Brain/pathology , Brain Neoplasms/diagnosis , Brain Neoplasms/pathology , Bronchi/pathology , Bronchial Neoplasms/pathology , Female , Humans , Magnetic Resonance Imaging , Middle Aged , Tomography, X-Ray Computed
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