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ABSTRACT: Persistent mullerian duct syndrome describes a group of patients with a 46 XY karyotype and normal male external genitalia, but internal mullerian structures. A 7-month-old boy presented with a left inguinal hernia, a left undescended testis and a right impalpable testis. Inguinal herniorrhaphy was performed and laparoscopy was done for search of a right impalpable testis and internal genitalia simultaneously. Laparoscopic examination revealed the structure like a mullerian duct remnant along the left spermatic duct in rectovesical fossa and right intra-abdominal testis. The structure like a mullerian duct remnant was not removed to preserve the left spermatic duct. Left orchiopexy and right laparoscopic staged Fowler- Stephens orchiopexy were performed. Chromosomal analysis was 46 XY karyotype and we diagnosed this case as persistent mullerian duct syndrome.
Hinyokika kiyo. Acta urologica Japonica 09/2012; 58(9):507-9.
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ABSTRACT: A 50-year-old woman visited our department for further examination of incidental bladder tumor detected by ultrasound at her health check. Cystoscopy demonstrated a submucosal tumor in the anterior wall of the urinary bladder. Magnetic resonance imaging revealed that the tumor had high intensity in T2- weighted images. The slightly-elevated serum level of dopamine and uptake image in the meta iodobenzyl granidine-scintigraphy test suggested that she might have ectopic pheochromocytoma in the urinary bladder. Partial cystectomy with extirpation of the tumor was performed. The histological diagnosis was schwannoma, which is rarely found in the urinary bladder.
Hinyokika kiyo. Acta urologica Japonica 09/2010; 56(9):513-6.
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ABSTRACT: We assessed the variations in stage, prostate specific antigen at diagnosis, Gleason score, risk classification and primary therapy in Japanese prostate cancer patients, and compared with those of the US patients.
Between 2004 and 2006, the distribution of primary therapy and clinical characteristics of 2303 newly diagnosed patients at Nara Medical University and its 23 affiliated hospitals were assessed to compare with those of the Cancer of the Prostate Strategic Urological Research Endeavor data and to clarify the differences in data between the USA and Japan.
The proportions of clinical T stage of 3-4, prostate specific antigen at diagnosis >20 ng/ml, Gleason score of 8-10 and high-risk group were greater in our study than those of the Cancer of the Prostate Strategic Urological Research Endeavor data (T3-4, 26.2 vs. 3.5-11.8%; prostate-specific antigen, 34.1 vs. 8.1-27.0%; Gleason score, 29.3 vs. 9.7-12.1%). Regarding the primary treatments, 51% of patients received primary androgen deprivation therapy, 30% underwent radical prostatectomy, 14% received radiation therapy and 2% had watchful waiting in our study, while the corresponding figures in the Cancer of the Prostate Strategic Urological Research Endeavor data were: radical prostatectomy, 44%; radiation therapy, 23%; primary androgen deprivation therapy 20% and watchful waiting 10%.
The Japanese prostate cancer patients still have higher prostate-specific antigen at diagnosis, higher Gleason score and higher clinical stage than the US patients. The trends of primary therapy for prostate cancer were different from those in the USA. The higher rate of primary androgen deprivation therapy is characteristic for the Japanese patients.
Japanese Journal of Clinical Oncology 03/2010; 40(6):588-92. · 1.78 Impact Factor
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ABSTRACT: We conducted two studies to examine the hypothesis that lower urinary tract obstruction induces excessive production of prostaglandin E2 (PGE2) in the bladder in young boys, with consequent overactive bladder (OAB) symptoms. The subjects were boys aged less than 15 years old who were scheduled to undergo surgery in our department from October 2006 to March 2008. In study 1 (n=25), the patients were divided into two groups based on the presence or absence of lower urinary tract obstruction. In study 2 (n=38), the patients were classified by age. The PGE2 level in the bladder was determined by washing with saline before the operation and urinary symptoms were evaluated using the Pediatric Lower Urinary Tract Scoring System. In study 1, the PGE2 level in the bladder of patients with lower urinary tract obstruction was higher than in those without obstruction (49.1+/-37.4 vs. 21.5+/-10.1 pg/mL, P=0.0475). In study 2, the PGE2 level in the bladder was negatively correlated with age (r=-0.379, P=0.0207). A higher level of PGE2 is found in boys with bladder outlet obstruction due to urethral stricture and in younger boys, and this elevated level of PGE2 may induce OAB symptoms.
Biomedical Research 12/2009; 30(6):343-7. · 1.15 Impact Factor
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ABSTRACT: Although hypospadias repair for preserving the urethral plate is popular among pediatric urologists, applying this procedure to severe hypospadias is controversial. We report the outcome of applying additional modifications to the modified tubularized transverse preputial island flap (TPIF) procedure reported previously [Patel RP, Shukla AR, Austin JC and Canning DA. Modified tubularized transverse preputial island flap repair for severe proximal hypospadias. BJU Int 2005;95:901-4] for repairing severe hypospadias.
We retrospectively evaluated our series of 22 patients (mean age 17.5 months) who underwent the modified TPIF with an additional simple modification of meatoplasty with V-incision suture. Patients were followed for a mean period of 18 months.
After releasing the chordee, the hypospadiac orifice was retracted to become penile in five patients (22.7%), penoscrotal in six (27.3%), scrotal in nine (40.9%), and perineal in two (9.1%). The median length of the neourethra was 46 mm. One-stage repair was successful in 19 patients (86.4%) without any complications.
Our modified TPIF procedure yielded favorable outcomes functionally and cosmetically with a low postoperative morbidity rate. Such a procedure can be considered useful for repairing severe hypospadias when the urethral plate cannot be preserved.
Journal of pediatric urology 01/2009; 4(6):438-41. · 1.38 Impact Factor
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ABSTRACT: Increased nocturnal urinary volume is closely associated with nocturia. We investigated the relationship between nocturnal polyuria and the variation of body fluid distribution during the daytime using bioelectric impedance analysis.
A total of 34 men older than 60 years were enrolled in this study. A frequency volume chart was recorded. Nocturnal polyuria was defined as a nocturnal urine volume per 24-hour production of greater than 0.35 (the nocturnal polyuria index). Bioelectric impedance analysis was performed 4 times daily at 8 and 11 a.m., and 5 and 9 p.m. using an InBody S20 body composition analyzer (BioSpace, Seoul, Korea).
A significant difference was found in mean +/- SEM 24-hour urine production per fat-free mass between the groups with and without nocturnal polyuria (17.8 +/- 1.4 vs 7.7 +/- 0.9 ml/kg). The increase in fluid in the legs compared with the volume at 8 a.m. was significantly larger at 5 p.m., while there was no difference in the arms or trunk. Nocturnal urine volume significantly correlated with the difference in fluid volume in the legs (r = 0.527, p = 0.0019) and extracellular fluid volume (r = 0.3844, p = 0.0248) between the volumes at 8 a.m. and 9 p.m.
Overproduction of urine per fat-free mass leads to nocturnal polyuria. Extracellular fluid accumulates as edema in the legs during the day in patients with nocturnal polyuria. The volume of accumulated extracellular fluid correlates with nocturnal urine volume. We suggest that leg edema is the source of nocturnal urine volume and decreasing edema may cure nocturnal polyuria.
The Journal of urology 12/2008; 181(1):219-24; discussion 224. · 4.02 Impact Factor
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ABSTRACT: To evaluate the prognosis of our series of patients with renal cell carcinoma (RCC) and tumor thrombus involving inferior vena cava (IVC) treated with nephrectomy and thrombectomy.
In 46 patients with unilateral RCC extending into IVC who underwent nephrectomy and thrombectomy (T3b in 38 patients, T3c in 6, T4 in 2, N+ in 15, M1 in 21), overall and cancer-specific survival rates were estimated, and the univariable and multivariable analysis were carried out to determine the prognostic factors among age, gender, performance status, fever, inflammatory laboratory parameters, nodal and distant metastasis, tumor thrombus level, pathological parameters and postoperative interferon-alpha administration.
The median age was 66.5 (range 35-79) years. The median follow-up was 18.0 (mean 36.7 +/- 38.7) months. The overall and cancer-specific 5-year survival rates were 32.9% and 40.0%, respectively. The univariate analysis revealed that fever (hazard ratio: HR 4.03), C-reactive protein (HR 4.89), grade of tumor cell (HR 3.83), and lymph node metastasis (HR 5.99) were independent prognostic factors of cause-specific survival in all patients. The multivariate analysis demonstrated that lymph node metastasis (HR 4.13) was the only independent prognostic factor of cause-specific survival. The extension level or postoperative interferon-alpha administration did not influence the prognosis of patients with tumor thrombus involving IVC.
Aggressive surgery should be considered first in RCC patients with any levels of tumor thrombus. However, patients with both IVC involvement and nodal metastasis showed significantly poor prognosis, and development of novel intensive multidisciplinary therapies will be needed.
International Journal of Urology 06/2008; 15(5):394-8. · 1.75 Impact Factor
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ABSTRACT: The pathogenesis of anemia in patients with chronic renal failure has been greatly attributed to erythropoietin (EPO) deficiency. Recently, however, there has been some thought that uremic inhibitors might suppress the activity of EPO and reduce the maturation of erythropoiesis. Polyamines are well known to be involved in the regulation of cellular proliferation and differentiation. Furthermore, the polyamine levels in the serum or erythrocytes are elevated in chronic hemodialysis patients, and can be lowered immediately by hemodialysis. In the present study, we first measured the polyamines levels (putrescine, spermidine, spermine) by high performance liquid chromatography (HPLC) in 20 chronic hemodialysis patients, and investigated the effects of polyamines on erythropoiesis by in vitro bioassay using fetal mouse liver cells. The direct effects of polyamines in erythroid colony formation in the medium with and without EPO were evaluated. Each polyamine level in chronic hemodialysis patients was higher than in the healthy subjects, and a significant negative correlation was found between polyamines and erythropoiesis. Polyamines inhibited the activity of EPO, but they did not have any direct effect on colony formation of the fetal mouse liver cells. These results suggest that polyamines have inhibitory effects on the proliferation or maturation of erythroid precursor cells and are intimately involved in the pathogenesis of renal anemia in chronic hemodialysis patients.
Therapeutic apheresis and dialysis: official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy 07/2006; 10(3):267-72. · 1.39 Impact Factor
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ABSTRACT: A 61-year-old man presented with an asymptomatic intrapelvic retrovesical tumor, measuring 8.5 cm in maximum diameter, which was revealed by preoperative diagnostic imaging for transverse colon cancer. When he was referred to our department one year after hemi-colectomy, this tumor showed no change in size, but there was some suspicion of concomitant malignancy because of large tumor size and contrast enhancement in a region adherent to the right seminal vesicle. En-bloc resection of the tumor along with the right seminal vesicle was performed retroperitoneally. The tumor was diagnosed histopathologically as retroperitoneal ganglioneuroma. Herein, we report this rare case of intrapelvic retroperitoneal ganglioneuroma, and present a brief review of the relevant literature including the present case.
Nippon Hinyōkika Gakkai zasshi. The japanese journal of urology 12/2004; 95(7):809-12.
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ABSTRACT: To investigate retrospectively whether postoperative renal function in patients with renal cell carcinoma can be preoperatively predicted by a combination of the preoperative serum creatinine (sCr) and the renal parenchymal volume (RPV) estimated by three-dimensional image reconstruction of the preoperative diagnostic imaging.
Of 155 patients who had undergone radical nephrectomy, 76 were eligible for inclusion in our study (group 1). Group 2 was comprised of 26 of 37 patients who had undergone partial nephrectomy. The postoperative RPV in both groups was estimated from the preoperative computed tomography scans or magnetic resonance imaging and were compared with the actual RPV estimated from the postoperative imaging using a three-dimensional image reconstruction program. The postoperative creatinine clearance (Ccr) was predicted from the preoperative Ccr calculated from the sCr level and by the ratio of the postoperative/preoperative RPV. The correlations between the predicted postoperative Ccr and the actual, measured postoperative Ccr were analyzed statistically.
In both groups, a statistically significant correlation was found between the postoperative RPV, estimated from the preoperative images and postoperative images. The predicted postoperative Ccr correlated significantly with the actual, measured postoperative Ccr in group 1 (r = 0.86, P <0.0001) and group 2 (r = 0.98, P <0.0001). The postoperatively increased sCr achieved stable levels within 2 to 4 weeks after nephrectomy and showed no statistically significant subsequent changes during 3 years of follow-up.
The present results demonstrated that prediction of the postoperative Ccr, using the preoperative sCr and the postoperative RPV estimated from the preoperative routine diagnostic imaging, is a simple and reliable method for the evaluation of early and medium-term postoperative renal function.
Urology 11/2004; 64(5):904-8. · 2.43 Impact Factor
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ABSTRACT: Post-transplantation renal artery stenosis is recognized at relatively early periods after renal transplantation. We report herein our experience of utilizing transluminal expanded metal stents (Palmaz stent and Wall stent) for post-transplantation renal artery stenosis, and monitoring with intravascular ultrasound (IVUS) imaging. The recipients were a 51-year-old woman (case 1) and a 57-year-old man (case 2), and the grafts were procured from cadaveric donors. Renal function had deteriorated suddenly at 5 months after renal transplantation in case 1 and at 86 months in case 2. The cause of the graft dysfunction was renal arterial stenosis. Color doppler ultrasound imaging and angiography diagnosed post-transplantation renal artery stenosis. The renal artery stenosis was serious, being greater than 90% in both patients. Percutaneous transluminal angioplasty (PTA) was performed, but its effectiveness was not sufficient; therefore, an indwelling endoluminal metallic Palmaz stent and an indwelling Wall stent were placed at the sites of stenosis while monitoring was done with IVUS. No complications were recognized at all. The length and degree of stenosis location became clear by using IVUS, and suitable stents could be selected for the renal artery stenosis. The clinical effect was excellent; the renal function improved to the pre-hospitalization value. We conclude that the Palmaz stent and the Wall stent were useful as a noninvasive strategy for treating post-transplantation renal artery stenosis. This procedure could be performed safely and surely using IVUS.
Clinical and Experimental Nephrology 07/2004; 8(2):155-9. · 1.37 Impact Factor
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ABSTRACT: It has been suggested that advanced glycation endproducts (AGEs) accumulate in arteriosclerotic lesions, playing and important role in the development and progression of arteriosclerosis. A chemical quantification method using high-performance liquid chromatography (HPLC) has been established to determine pentosidine levels in these products. Some studies reported that the abdominal aorta calcification index (ACI), obtained by computed tomography (CT), was useful for noninvasively diagnosing arteriosclerosis and determining its severity. In the present study, we measured the ACI and plasma pentosidine in patients receiving maintenance hemodialysis, and investigated the association between arteriosclerosis and pentosidine.
In 73 patients receiving maintenance hemodialysis (43 men; 30 women), we determined the ACI, and investigated the association of the ACI with plasma total pentosidine, total cholesterol, triglyceride, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, serum creatinine, and parathyroid hormone (PTH), as well as the product of serum calcium and serum phosphorus, duration of dialysis, and age.
The ACI did not correlate with total cholesterol, triglyceride, HDL cholesterol, LDL cholesterol, serum creatinine, PTH, or the product of serum calcium and serum phosphorus. Age, duration of dialysis, and plasma total pentosidine correlated with the ACI: (y = -33.12 + 0.913x; r = 0.407; P < 0.01), (y = 13.94 + 0.403x; r = 0.488; P < 0.01), and (y = 14.13 + 0.630x; r = 0.365; P < 0.01), respectively.
It is suggested that pentosidine may be associated with arteriosclerotic development in hemodialysis patients. It has been suggested that advanced glycation endproducts (AGEs) accumulate in arteriosclerotic lesions, playing an important role in the development and progression of arteriosclerosis. A chemical quantification method using high-performance liquid chromatography (HPLC) has been established to determine pentosidine levels in these products. Some studies reported that the abdominal aorta calcification index (ACI), obtained by computed tomography (CT), was useful for noninvasively diagnosing arteriosclerosis and determining its severity. In the present study, we measured the ACI and plasma pentosidine in patients receiving maintenance hemodialysis, and investigated the association between arteriosclerosis and pentosidine.
Clinical and Experimental Nephrology 03/2004; 8(1):48-53. · 1.37 Impact Factor
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ABSTRACT: Aggressive angiomyxoma is a rare benign mesenchymal myxoid tumor that arises from the pelvic soft tissues and perineum in relatively young females. This tumor has the ability to infiltrate locally and has a high risk of local recurrence after extirpation, but no potential to metastasize. We report here a rare case of aggressive angiomyxoma that developed in the scrotum of a 47-year-old male. Immunostaining of the resected specimen revealed that the tumor cell nuclei stained strongly and diffusely for androgen receptors (80% of the tumor cells), and moderately and partly for progesterone receptors (20% of the tumor cells). However, staining was negative for estrogen receptors. It is highly suggested that the growth of aggressive angiomyxoma in males may depend on androgen manipulation, contrary to its frequent and close association with estrogen receptor expression, which has been reported in females.
International Journal of Urology 01/2004; 10(12):672-5. · 1.75 Impact Factor
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ABSTRACT: Abstract Aggressive angiomyxoma is a rare benign mesenchymal myxoid tumor that arises from the pelvic soft tissues and perineum in relatively young females. This tumor has the ability to infiltrate locally and has a high risk of local recurrence after extirpation, but no potential to metastasize. We report here a rare case of aggressive angiomyxoma that developed in the scrotum of a 47-year-old male. Immunostaining of the resected specimen revealed that the tumor cell nuclei stained strongly and diffusely for androgen receptors (80% of the tumor cells), and moderately and partly for progesterone receptors (20% of the tumor cells). However, staining was negative for estrogen receptors. It is highly suggested that the growth of aggressive angiomyxoma in males may depend on androgen manipulation, contrary to its frequent and close association with estrogen receptor expression, which has been reported in females.
International Journal of Urology 11/2003; 10(12):672 - 675. · 1.75 Impact Factor
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Mitsuhiro Tambo,
Hideaki Kondo,
Takanori Kitauchi,
Akihide Hirayama,
Masaki Cho,
Kiyohide Fujimoto, Katsunori Yoshida,
Seiichiro Ozono,
Yoshihiko Hirao,
Eiji Yamada,
Kunio Ichijima
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ABSTRACT: Here we report a rare case of inflammatory myofibroblastic tumor of the retroperitoneal space. A 46-year-old woman had had microscopic hematuria for 5 years. Ultrasonographic examination for screening revealed two solid tumors adjacent to the right kidney. These tumors were suspected to be malignant fibrous histiocytoma or liposarcoma by computed tomography and magnetic resonance imaging. She underwent resection of these retroperitoneal tumors and additional right nephrectomy because these tumors were adhered to the kidney and liposarcoma was highly suspected on frozen sections. Histopathologic examination finally revealed that the tumors were inflammatory myofibroblastic tumor arising within Gerota's fasia. She has been followed up for 9 months without any evidence of local recurrence.
Hinyokika kiyo. Acta urologica Japonica 06/2003; 49(5):273-6.
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ABSTRACT: We report a rare case of chromophobe cell renal carcinoma found in a 52-year-old female who had received hemodialysis therapy for 13 years. She was diagnosed as having a left renal tumor 7.5 cm in diameter with acquired cystic disease of the kidney (ACDK) by ultrasonographic examination during periodical systemic screening. As abdominal computed tomography scanning and enhanced color Doppler ultrasonography suspected that the hypervascular tumor was renal cell carcinoma, she underwent translumbar nephrectomy in July 2000. The histopathological diagnosis was chromophobe cell carcinoma with pT2 and grade 2 malignancy. Chromophobe cell carcinoma is uncommon among renal tumors with ACDK found in long-term hemodialysis patients.
International Journal of Urology 03/2003; 10(2):99-102. · 1.75 Impact Factor
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ABSTRACT: A 30-year-old male was referred to our department during the examination and treatment for hypertension, because he had not achieved complete erection since the age of 26 years. After detailed examination, he was diagnosed to be suffering from nodal polyarteritis. Since erectile dysfunction persisted, the patient was hospitalized to investigate the cause of erectile dysfunction. Measurement of the penile brachial index (PBI) and cavernous infusion of papaverine hydrochloride strongly suggested the presence of arterial erectile dysfunction. Internal-pudendal angiography revealed multiple microaneurysms in the bilateral internal pudendal arteries, suggesting that nodal polyarteritis caused arterial erectile dysfunction.
Hinyokika kiyo. Acta urologica Japonica 12/2002; 48(11):663-6.
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Yoshihiko Hirao,
Kiyohide Fujimoto,
Masahito Yoshii,
Nobumichi Tanaka,
Yoshiki Hayashi,
Hitoshi Momose,
Shoji Samma,
Eijiro Okajima,
Hirotsugu Uemura, Katsunori Yoshida,
Seiichiro Ozono
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ABSTRACT: To determine the methodological usefulness of non-ischemic complete enucleation for small renal cell carcinomas (RCC) using a microwave tissue coagulator (MTC).
Fifty-nine patients (61 kidneys) underwent non-ischemic complete tumor enucleation by MTC. Of the 59 patients, 46 had an elective indication and 15 kidneys of 13 patients had an imperative indication. RCC was exposed with minimal peri-renal detachment. The demarcation line, 7-10 mm from the tumor, was coagulated at 8-10 mm intervals with a microwave antenna needle for 30-40 s at 50-60 W. The renal tumor was excised along the coagulated zone with normal surrounding tissue. The enucleation bed was covered with fibrin glue or fat tissue without approximation.
The operations were successfully completed in all intended cases. The mean operation time was 160 +/- 43 (median: 160) min and the mean blood loss was 313 +/- 370 (median: 158) ml. No major bleeding or urine leakage from the enucleation bed was observed in 62.2 and 88.5% of cases, respectively. The minor bleeding and urine leakage were controlled easily with absorbable sutures. None of the cases presented with postoperative bleeding or urine leakage from the enucleation bed. Severe impairment of the renal function was not observed in any case evaluated by means of serum creatinine, creatinine clearance and radioisotope examination. The 5-year overall survival rate was 87% without recurrence up to 23.1 +/- 19.5 months of the mean follow-up.
Non-ischemic complete tumor enucleation using MTC constitutes a simple, reliable and less invasive alternative to ordinary nephron-sparing surgeries for small RCC.
Japanese Journal of Clinical Oncology 04/2002; 32(3):95-102. · 1.78 Impact Factor
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ABSTRACT: We studied how transition zone index (TZ index) influenced the therapeutic efficacy of benign prostatic hyperplasia (BPH). In addition, we retrospectively investigated the availability of TZ index in selection of the more effective therapeutic method for BPH.
One hundred twenty-five patients with symptomatic BPH whose prostate volume (PV) was more than 15 ml by transrectal ultrasonography were investigated. Sixty-nine men underwent transurethral resection of the prostate (TURP) whereas 56 were treated with alpha 1-blocker. Tamsulosin hydrochloride. These patients were evaluated based on TZ index as well as ordinary parameters of BPH; international prostatic symptom score, QOL score, peak flow rate and PV.
The patients with TZ index > or = 0.5 showed good therapeutic results in the TURP group. On the other hand, the patients with TZ index < 0.5 showed favorable response in alpha 1-blocker group. Multivariate analysis revealed that TZ index affected the therapeutic efficacy more strongly than the other parameters.
TZ index had strong influence on therapeutic efficacy of TURP or alpha 1-blocker and seemed to be a useful tool for the selection of BPH therapy.
Nippon Hinyōkika Gakkai zasshi. The japanese journal of urology 02/2002; 93(1):20-7.
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ABSTRACT: The exposure of blood to hemodialysis membranes results in numerous phenomena and/or complications in hemodialyzed patients, which have an influence on the quality of life (QOL) of those patients. A vitamin E-modified regenerated cellulose membrane (E-membrane) was developed to act as a scavenger for reactive oxygen species causing complications in hemodialysis patients. Neopterin (NEOP) is a metabolite derived from guanosine triphosphate with the production and release of NEOP being induced in monocytes and macrophages by cytokines such as interferon-gamma (IFN-gamma). Serum neopterin levels are shown to be a reactive marker of bioincompatibility of dialysis membranes in hemodialysis patients. The following report evaluates the usefulness of serum NEOP as a marker for the biocompatibility of the E-membrane hemodialyzer in a clinical study. In the clinical study, where extracorporeal ultrafiltration strategies with E-membranes were employed, the serum levels of NEOP were lower than those in patients using cellulose triacetate membranes (C-membranes). In the long-term evaluation of the biocompatibility of E- and C-membranes, the increase of serum neopterin levels in the C-membrane was higher than those in the E-membrane. In conclusion, the evaluation of serum neopterin levels during hemodialysis shows that the E-membrane has a good biocompatibility in hemodialyzed patients.
Artificial Organs 02/2002; 26(1):54-7. · 2.00 Impact Factor
