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Franzén, Thomas
Alternative names
Publications (10 of 17) Show all publications
Karapiperis, D., Vrakas, S., Ignatova, S., Tribonias, G. & Franzén, T. (2022). Primary malignant melanoma of the esophagus. Clinical Case Reports, 10(4), Article ID e05660.
Open this publication in new window or tab >>Primary malignant melanoma of the esophagus
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2022 (English)In: Clinical Case Reports, E-ISSN 2050-0904, Vol. 10, no 4, article id e05660Article in journal, Editorial material (Other academic) Published
Abstract [en]

We report a case of primary malignant melanoma of the esophagus.

Place, publisher, year, edition, pages
Oxford, United Kingdom: John Wiley & Sons, 2022
Keywords
esophagus; melanoma
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:liu:diva-184689 (URN)10.1002/ccr3.5660 (DOI)000783841700001 ()35474989 (PubMedID)
Available from: 2022-05-03 Created: 2022-05-03 Last updated: 2023-05-04Bibliographically approved
Hägg, M., Tibbling, L. & Franzen, T. (2015). Effect of IQoro(R) training in hiatal hernia patients with misdirected swallowing and esophageal retention symptoms. Acta Oto-Laryngologica, 135(7), 635-639
Open this publication in new window or tab >>Effect of IQoro(R) training in hiatal hernia patients with misdirected swallowing and esophageal retention symptoms
2015 (English)In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 135, no 7, p. 635-639Article, review/survey (Refereed) Published
Abstract [en]

Conclusion: Misdirected swallowing can be triggered by esophageal retention and hiatal incompetence. The results show that oral IQoro(R) screen (IQS) training improves misdirected swallowing, hoarseness, cough, esophageal retention, and globus symptoms in patients with hiatal hernia. Objectives: The present study investigated whether muscle training with an IQS influences symptoms of misdirected swallowing and esophageal retention in patients with hiatal hernia. Methods: A total of 28 adult patients with hiatal hernia suffering from misdirected swallowing and esophageal retention symptoms for more than 1 year before entry to the study were evaluated before and after training with an IQS. The patients had to fill out a questionnaire regarding symptoms of misdirected swallowing, hoarseness, cough, esophageal retention, and suprasternal globus, which were scored from 0-3, and a VAS on the ability to swallow food. The effect of IQS traction on diaphragmatic hiatus (DH) pressure was recorded in 12 patients with hiatal hernia using high resolution manometry (HRM). Results: Upon entry into the study, misdirected swallowing, globus sensation, and esophageal retention symptoms were present in all 28 patients, hoarseness in 79%, and cough in 86%. Significant improvement was found for all symptoms after oral IQS training (p less than 0.001). Traction with an IQS resulted in a 65 mmHg increase in the mean HRM pressure of the DH.

Place, publisher, year, edition, pages
Informa Healthcare, 2015
Keywords
Cough; dysphagia; esophagus; globus; hoarseness; hiatal incompetence; manometry; muscle training; lip force; swallowing capacity test
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-120134 (URN)10.3109/00016489.2015.1016185 (DOI)000356672600001 ()25963055 (PubMedID)
Note

Funding Agencies|Centre for Research and Development, Uppsala University/County Council of Gavleborg, Gavle, Sweden; Council for Regional Research in Uppsala and Orebro region, Sweden

Available from: 2015-07-14 Created: 2015-07-13 Last updated: 2017-12-04
Hagg, M., Tibbling, L. & Franzen, T. (2015). Esophageal dysphagia and reflux symptoms before and after oral IQoro(R) training. World Journal of Gastroenterology, 21(24), 7558-7562
Open this publication in new window or tab >>Esophageal dysphagia and reflux symptoms before and after oral IQoro(R) training
2015 (English)In: World Journal of Gastroenterology, ISSN 1007-9327, E-ISSN 2219-2840, Vol. 21, no 24, p. 7558-7562Article in journal (Refereed) Published
Abstract [en]

AIM: To examine whether muscle training with an oral IQoro(R) screen (IQS) improves esophageal dysphagia and reflux symptoms. METHODS: A total of 43 adult patients (21 women and 22 men) were consecutively referred to a swallowing center for the treatment and investigation of long-lasting nonstenotic esophageal dysphagia. Hiatal hernia was confirmed by radiologic examination in 21 patients before enrollment in the study (group A; median age 52 years, range: 19-85 years). No hiatal hernia was detected by radiologic examination in the remaining 22 patients (group B; median age 57 years, range: 22-85 years). Before and after training with an oral IQS for 6-8 mo, the patients were evaluated using a symptom questionnaire (esophageal dysphagia and acid chest symptoms; score 0-3), visual analogue scale (ability to swallow food: score 0-100), lip force test (greater than= 15 N), velopharyngeal closure test (greater than= 10 s), orofacial motor tests, and an oral sensory test. Another twelve patients (median age 53 years, range: 22-68 years) with hiatal hernia were evaluated using oral IQS traction maneuvers with pressure recordings of the upper esophageal sphincter and hiatus canal as assessed by high-resolution manometry. RESULTS: Esophageal dysphagia was present in all 43 patients at entry, and 98% of patients showed improvement after IQS training [mean score (range): 2.5 (1-3) vs 0.9 (0-2), P less than 0.001]. Symptoms of reflux were reported before training in 86% of the patients who showed improvement at follow-up [1.7 (0-3) vs 0.5 (0-2), P less than 0.001). The visual analogue scale scores were classified as pathologic in all 43 patients, and 100% showed improvement after IQS training [71 (30-100) vs 22 (0-50), P less than 0.001]. No significant difference in symptom frequency was found between groups A and B before or after IQS training. The lip force test [31 N (12-80 N) vs 54 N (27-116), P less than 0.001] and velopharyngeal closure test values [28 s (5-74 s) vs 34 s (13-80 s), P less than 0.001] were significantly higher after IQS training. The oral IQS traction results showed an increase in mean pressure in the diaphragmatic hiatus region from 0 mmHg at rest (range: 0-0 mmHG) to 65 mmHg (range: 20-100 mmHg). CONCLUSION: Oral IQS training can relieve/improve esophageal dysphagia and reflux symptoms in adults, likely due to improved hiatal competence.

Place, publisher, year, edition, pages
Baishideng Publishing Group Co. Limited, 2015
Keywords
Esophageal dysphagia; Manometry; Muscle training; Oral screen; Reflux
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-120225 (URN)10.3748/wjg.v21.i24.7558 (DOI)000356924900024 ()26140003 (PubMedID)
Note

Funding Agencies|Centre for Research and Development, Uppsala University/County Council of Gavleborg, Gavle, Sweden; Council for Regional Research in Uppsala and Orebro, Sweden

Available from: 2015-07-21 Created: 2015-07-20 Last updated: 2017-12-04
Strand, A. H. & Franzen, T. (2014). Influence of Life Style Factors on Barretts Oesophagus. Gastroenterology Research and Practice, 2014(408470)
Open this publication in new window or tab >>Influence of Life Style Factors on Barretts Oesophagus
2014 (English)In: Gastroenterology Research and Practice, ISSN 1687-6121, E-ISSN 1687-630X, Vol. 2014, no 408470Article in journal (Refereed) Published
Abstract [en]

Background. Since the incidence of adenocarcinoma of the oesophagus is rising, the prognosis is poor, and surveillance programs are expensive and mostly cost ineffective, there is a need to increase the knowledge of risk factors in Barretts oesophagus and oesophageal cancer in order to be able to give attention to medical prevention and/or surveillance programs. Aim. To study if there is a correlation between the development of Barretts oesophagus and GOR (gastro oesophageal reflux), family history of GOR, and life style factors, such as alcohol, smoking habits, and mental stress. Methods. Fifty-five consecutively selected patients with Barretts oesophagus (BO) examined at Linkoping University Hospitals Oesophageal Laboratory were matched by sex, age, and duration of reflux symptoms with 55 GOR patients without Barretts oesophagus at the Oesophageal Laboratory. The medical charts in respective groups were examined for comparison of life style factors, mental stress, medication, duration of gastroesophageal acid reflux at 24 hr-pH-metry, and incidence of antireflux surgery and of adenocarcinoma of the oesophagus (ACO). Also, potential gender differences and diagnosis of ACO were studied. Results. Mean percentage reflux time on 24 hr-pH-metry was higher for the Barretts oesophagus group, 18% for women and 17% for men compared to 4% for women and 4% for men in the control group (P less than 0.05). Family history of GOR was more frequent in Barretts oesophagus patients (62%) than in the control group (35%) (P less than 0.05). Male patients with Barretts oesophagus had medical therapy for their GOR symptoms to a higher extent (38%) than male controls (65%) (P less than 0.05). No difference was found in the number of tobacco users or former tobacco users between Barretts oesophagus patients and controls. Barretts oesophagus patients had the same level of alcohol consumption and the same average BMI as the control subjects. Female patients with Barretts oesophagus rated themselves as more mentally stressed (67%) than the female controls (38%) (P less than 0.05). In the five-year medical chart follow-up, five of 55 patients developed adenocarcinoma among the Barretts oesophagus patients, none in the control group. Conclusions. Long reflux time and family clustering of GOR seem to influence the development of Barretts oesophagus. Smoking habits, alcohol consumption and BMI do not seem to have any impact on the development of Barretts oesophagus.

Place, publisher, year, edition, pages
Hindawi Publishing Corporation, 2014
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-108946 (URN)10.1155/2014/408470 (DOI)000337369300001 ()
Available from: 2014-07-15 Created: 2014-07-13 Last updated: 2017-12-05
Franzen, T. & Tibbling, L. (2014). Is the severity of gastroesophageal reflux dependent on hiatus hernia size?. World Journal of Gastroenterology, 20(6), 1582-1584
Open this publication in new window or tab >>Is the severity of gastroesophageal reflux dependent on hiatus hernia size?
2014 (English)In: World Journal of Gastroenterology, ISSN 1007-9327, E-ISSN 2219-2840, Vol. 20, no 6, p. 1582-1584Article in journal (Refereed) Published
Abstract [en]

AIM:

To determine if the severity of gastroesophageal reflux disease is dependent on the size of a hiatus hernia.

METHODS:

Seventy-five patients with either a small (n = 25), medium (n = 25) or large (n = 25) hiatus hernia (assessed by high resolution esophageal manometry) were investigated using 24-h esophageal monitoring and a self-assessed symptom questionnaire. The questionnaire comprised the following items, each graded from 0 to 3 according to severity: heartburn; pharyngeal burning sensation; acid regurgitation; and chest pain.

RESULTS:

The percentage total reflux time was significantly longer in the group with hernia of 5 cm or more compared with the group with a hernia of < 3 cm (P < 0.002), and the group with a hernia of 3 to < 5 cm (P < 0.04). Pharyngeal burning sensation, heartburn and acid regurgitation were more common with large hernias than small hernias, but the frequency of chest pain was similar in all three hernia groups.

CONCLUSION:

Patients with a large hiatus hernia are more prone to have pathological gastroesophageal reflux and to have more acid symptoms than patients with a small hiatus hernia. However, it is unlikely that patients with an absence of acid symptoms will have pathological reflux regardless of hernia size.

Place, publisher, year, edition, pages
Baishideng Publishing Group Co. Limited, 2014
Keywords
Heartburn; Hiatus hernia; Acid reflux
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-105581 (URN)10.3748/wjg.v20.i6.1582 (DOI)000331613300018 ()24587634 (PubMedID)
Available from: 2014-03-28 Created: 2014-03-27 Last updated: 2017-12-05Bibliographically approved
Tibbling, L., Gezelius, P. & Franzen, T. (2011). Factors influencing lower esophageal sphincter relaxation after deglutition. World Journal of Gastroenterology, 17(23), 2844-2847
Open this publication in new window or tab >>Factors influencing lower esophageal sphincter relaxation after deglutition
2011 (English)In: World Journal of Gastroenterology, ISSN 1007-9327, E-ISSN 2219-2840, Vol. 17, no 23, p. 2844-2847Article in journal (Refereed) Published
Abstract [en]

AIM: To study the relationship between upper esophageal sphincter (UES) relaxation, peristaltic pressure and lower esophageal sphincter (LES) relaxation following deglutition in non-dysphagic subjects. METHODS: Ten non-dysphagic adult subjects had a high-resolution manometry probe passed transnasally and positioned to cover the UES, the esophageal body and the LES. Ten water swallows in each subject were analyzed for time lag between UES relaxation and LES relaxation, LES pressure at time of UES relaxation, duration of LES relaxation, the distance between the transition level (TL) and the LES, time in seconds that the peristaltic wave was before (negative value) or after the TL when the LES became relaxed, and the maximal peristaltic pressure in the body of the esophagus. RESULTS:Relaxation of the LES occurred on average 3.5 s after the bolus had passed the UES and in most cases when the peristaltic wave front had reached the TL. The LES remained relaxed until the peristaltic wave faded away above the LES. CONCLUSION: LES relaxation seemed to be caused by the peristaltic wave pushing the bolus from behind against the LES gate.

Place, publisher, year, edition, pages
Baishideng Publishing Group Co. Limited, 2011
Keywords
Deglutition; Lower esophageal sphincter; Peristalsis; Relaxation; Upper esophageal sphincter
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-69849 (URN)10.3748/wjg.v17.i23.2844 (DOI)000292115500008 ()
Note

DOI does not work: 10.3748/wjg.v17.i23.2844

Available from: 2011-08-10 Created: 2011-08-08 Last updated: 2018-03-05
Franzen, T., Anderberg, B., Wirén, M. & Johansson, K.-E. (2005). Long-term outcome is worse after laparoscopic than after conventional Nissen fundoplication. Scandinavian Journal of Gastroenterology, 40(11), 1261-1268
Open this publication in new window or tab >>Long-term outcome is worse after laparoscopic than after conventional Nissen fundoplication
2005 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 40, no 11, p. 1261-1268Article in journal (Refereed) Published
Abstract [en]

Objective. No long-term studies of laparoscopic and open fundoplication were available in 1994. The aim of this study was to compare reflux control and side effects after laparoscopic and open fundoplication. Material and methods. Adult patients with uncomplicated gastro-oesophageal reflux disease were included in this prospective randomized clinical trial between laparoscopic and open 360° fundoplication. Patients with uncomplicated gastro-oesophageal reflux disease were included with the exception of those with weak peristalsis or suspected short oesophagus. Two senior surgeons, well trained in laparoscopic antireflux surgery, performed the 45 laparoscopic operations. Forty-eight patients underwent open surgery performed or supervised by two other senior surgeons, also well trained in gastro-oesophageal surgery. One of the latter recruited all the patients. Manometry and 24-h oesophageal pH monitoring were performed before operation and 6 months postoperatively. Manometry also included a short-term reflux test, an acid clearing test and an acid perfusion test. Symptom evaluation was performed before surgery, 6 moths after and at long-term follow-up (33-79 months postoperatively) by the same surgeon. Long-term follow-up also included endoscopy. Results. Six months after laparoscopy 4 patients had disabling dysphagia. None of the patient had disabling dysphagia after laparotomy. Four patients had mild heartburn 6 months after laparoscopy and 2 patients after laparotomy. Between 6 months' follow-up and long-term follow-up, 6 patients were reoperated on in the laparoscopy group and 2 patients in the laparotomy group. Three patients operated on with laparotomy had died of intercurrent diseases. After laparoscopy, at long-term follow-up, 62% of patients (28/45) were satisfied compared with 91% (41/45) after laparotomy. The difference was significant (p < 0.01). Conclusions. Early postoperative reflux control was similar for laparoscopic and conventional fundoplication. At long-term follow-up significantly more patients were satisfied after laparotomy than after laparoscopy. © 2005 Taylor & Francis.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-30447 (URN)10.1080/00365520510023521 (DOI)16014 (Local ID)16014 (Archive number)16014 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13
Franzén, T. (2003). Success and failure of conventional and laparoscopic fundoplication in gastro-oesophageal reflux disease. (Doctoral dissertation). Linköping: Linköpings universitet
Open this publication in new window or tab >>Success and failure of conventional and laparoscopic fundoplication in gastro-oesophageal reflux disease
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The outcome of antireflux surgery in a single institution during two decades is presented.

101 consecutive patients operated with open partial2 70° fundoplication and crural repair during 1982-1989 were prospectively analysed. All stages ofpreoperative oesophagitis were represented. Reflux competence, symptomatology, and postoperative side-effects were evaluated six months and ten years postoperatively. Recurrence (8%) was more common in patients who had severe oesophagitis before operation. The operative method is effective for long-term reflux control, it does not cause dysphagia, and it has few side-effect. Some months prior to the introduction oflaparoscopic fundoplication our unit had changed from partial to total fundoplication as a standard operation for gastro-oesophageal reflux disease (GORD). It was then convenient to perform the total Nissen fundoplication laparoscopically. All 50 patients operated with laparoscopic technique during a 30-months period 1992-1994 were prospectively compared with 21 patients operated with open technique. Nine patients were converted and then analysed in the open group. We tried to select patients with uncomplicated disease for laparoscopy but 7 patients in this group had severe disease diagnosed at preoperative endoscopy or/and at operation. In the open group 9 patients had severe disease. The patients were investigated six months, two years, and five years postoperatively. Early postoperative manometry was prognostic for recurrence. At long term follow-up the reflux control was similar, 10% of the patients operated with laparoscopy had recurrence and 8% of the patients operated with open technique.

Summer 1994 to spring 1998 we included 93 patients with uncomplicated GORD in a randomised clinical trial between laparoscopic and open 360° floppy Nissen fundoplication with crural repair. 45 patients were operated on laparoscopically and 48 patients underwent laparotomy. Only one patient was converted and then analysed in the laparotomy group. The patients were investigated before operation, half a year after and at long-term follow-up (33-79 months postoperatively). Long-term follow up also included endoscopy. Operation time was significantly longer for laparoscopy compared to laparotomy, 155.6 (±36.5) minutes and 104.3 (±30.7) minutes respectively (p<0.05). Laparoscopy patients had significantly shorter hospital stay, 3.6 (±1.9) days, compared to 5.8 (±1. 7) days for laparotomy patients. Sick leaves were 20.7 (±9.9) days for laparoscopy patients and 28.3 (14.7) for laparotomy patients. The difference was significant (p<0.05). Early postoperative reflux control was similar for laparoscopic and conventional fundoplication. Early side-effects were more frequent after laparoscopy. Significantly less laparoscopy patients were satisfied at long-term follow-up; only 62% of the laparoscopy patients were satisfied compared to 91% of the laparotomy patients.

We have investigated the mechanisms and anatomical failures in twenty-one patients reoperated after laparoscopic total fundoplication. Recurrent heartburn occurs when wrong part of the stomach is used for the fundoplication. Dysphagia after failed laparoscopic total fundoplication is caused by hiatal fibrosis or other mechanical causes rather than a normal and tight fundoplication.

Also the reproducibility of an important diagnostic tool for GORD, the 24-hour pH monitoring, was evaluated. Twenty-two adult patients admitted to The Oesophageal Laboratory for 24-hour pH monitoring were investigated twice, six weeks apart, under identical conditions. The test was strictly standardised with the use of an antimony pH- probe and the patients hospitalised during 24 hours. We found that a normal 24-hour pH test should be assessed with caution because the biological variability of gastro-oesophageal reflux is not negligible from time to time.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2003. p. 55
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 796
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-25644 (URN)10019 (Local ID)91-7373-554-X (ISBN)10019 (Archive number)10019 (OAI)
Public defence
2003-06-06, Berzeliussalen, Hälsouniversitet, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-10-10Bibliographically approved
Tibbling Grahn, L., Blackadder, L., Franzén, T. & Kullman, E. (2002). Gastric bile monitoring: An in vivo and in vitro study of bilitec reliability. Scandinavian Journal of Gastroenterology, 37(11), 1334-1337
Open this publication in new window or tab >>Gastric bile monitoring: An in vivo and in vitro study of bilitec reliability
2002 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 37, no 11, p. 1334-1337Article in journal (Refereed) Published
Abstract [en]

Background: It has been claimed that the combination of bile and hydrochloride acid (HCl) has a noxious effect on intestinal mucosa. The aim was to study the reliability of the Bilitec 2001 method in monitoring the presence of bile in repeated tests and at different pH and water dilutions. Methods: 24-h esophageal pH and gastric Bilitec monitoring were performed twice with an interval of 6 weeks in 23 patients with symptomatic gastroesophageal reflux (GER). In vitro tests of pH and Bilitec recordings were performed with different mixtures of bile, HCl and water. Results: Gastric bile was present in 37% of the recording time, 28% during day time and 47% during nights. No significant difference was found between the two test occasions. The maximum bile concentration in the stomach was significantly lower in patients with severe pathological GER than in those with normal GER. When concentrated bile was diluted with the same volume of HCl, the pH level fell below 4. The maximum absorption limit with Bilitec in concentrated bile was gradually reduced with decreasing pH. The Bilitec technique recorded the presence of bile even at a pH of 1.4, but not if the bile was diluted with water at a ratio of 1:100 or more. Conclusions: Bilitec gastric recordings show the same clinical result when repeated under standardized conditions. The Bilitec technique is not reliable for monitoring the amount and concentration of bile in the stomach. Bile reflux cannot be monitored with the pH recording technique.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24936 (URN)10.1080/003655202761020632 (DOI)9342 (Local ID)9342 (Archive number)9342 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13
Franzén, T., Anderberg, B., Tibbling Grahn, L. & Johansson, K.-E. (2002). Prospective evaluation of laparoscopic and open 360o fundoplication in mild and severe gastro-oesophageal reflux disease. European Journal of Surgery, 168(10), 539-545
Open this publication in new window or tab >>Prospective evaluation of laparoscopic and open 360o fundoplication in mild and severe gastro-oesophageal reflux disease
2002 (English)In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 168, no 10, p. 539-545Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:

To investigate the relationship between five-year control of reflux and early postoperative oesophageal function after total fundoplication done either laparoscopically or through a laparotomy in severe and mild reflux disease.

DESIGN:

Prospective open study.

SETTING:

University hospital, Sweden.

PATIENTS:

In the group with severe disease 9 patients had a laparotomy and 7 laparoscopy. The corresponding figures for the group with mild disease were 21 and 34 respectively.

RESULTS:

The increase in lower oesophageal sphincter pressure 6 months after operation in patients with recurrent disease was significantly less than that for patients with good reflux control (p < 0.01). In patients who had laparotomy, including 30% (9/30) with severe reflux disease, good long-term reflux control was found in 93% (27/29). In patients operated on laparoscopically including 17% (7/41) with severe reflux disease good long-term reflux control was found in 90% (35/39).

CONCLUSION:

The mechanism of recurrence differed between patients with severe disease who had a laparotomy and patients with mild disease operated on laparoscopically. Early postoperative manometry was prognostic for recurrence. Long-term reflux control seems to be similar after laparotomy and laparoscopy. Further randomised studies are needed.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24845 (URN)12666693 (PubMedID)9243 (Local ID)9243 (Archive number)9243 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
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