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Shimizu Y, Che Y, Murohara T. Therapeutic Lymphangiogenesis Is a Promising Strategy for Secondary Lymphedema. Int J Mol Sci 2023; 24:7774. [PMID: 37175479 PMCID: PMC10178056 DOI: 10.3390/ijms24097774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/15/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
Secondary lymphedema is caused by lymphatic insufficiency (lymphatic drainage failure) following lymph node dissection during the surgical treatment or radiation therapy of breast or pelvic cancer. The clinical problems associated with lymphedema are reduced quality of life in terms of appearance and function, as well as the development of skin ulcers, recurrent pain, and infection. Currently, countermeasures against lymphedema are mainly physical therapy such as lymphatic massage, elastic stockings, and skin care, and there is no effective and fundamental treatment with a highly recommended grade. Therefore, there is a need for the development of a fundamental novel treatment for intractable lymphedema. Therapeutic lymphangiogenesis, which has been attracting attention in recent years, is a treatment concept that reconstructs the fragmented lymphatic network to recover lymphatic vessel function and is revolutionary to be a fundamental cure. This review focuses on the translational research of therapeutic lymphangiogenesis for lymphedema and outlines the current status and prospects in the development of therapeutic applications.
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Affiliation(s)
- Yuuki Shimizu
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
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Lajmi Y, Loeuillet L, Petrilli G, Egloff C, Nectoux J, Molac C, Roux N, Pannier E, Achaiaa A, Arkoub ZA, Chuon S, Coussement A, Dupont JM, Malan V, Spaggiari E, Razavi F, Amiel J, Bessières B, Grotto S, Attié-Bitach T. Two novel variations p.(Ser1275Thr) and p.(Ser1275Arg) in FLT4 causing prenatal hereditary lymphedema type 1. Birth Defects Res 2023; 115:563-571. [PMID: 36538874 DOI: 10.1002/bdr2.2141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hereditary lymphedema 1 is a rare congenital condition, characterized by the development of chronic swelling in body parts. It is highly variable in expression and age of onset with different presentations: from feet edema to hydrops fetalis. This affection is genetically heterogeneous with autosomal dominant inheritance and incomplete penetrance due to a mutation in the FLT4 gene in most cases. CASES In our study, we report on two fetuses harboring congenital lymphedema with FLT4 variation and review the prenatal confirmed ones of the literatures. Our cases were selected within fetuses explored by exome sequencing in a diagnosis setting. Prenatal ultrasonography showed hydrops fetalis in one case and an increased nuchal translucency with hydrothorax in the other. Comparative genomic hybridization array on amniocentesis was normal in both cases. Exome sequencing identified a variation p.(Ser1275Thr) and p.(Ser1275Arg) in fetus 1 and fetus 2 in the FLT4 gene, respectively. A de novo mutation at the same codon was reported in prenatal literature suggesting possible genotype phenotype correlation. CONCLUSION Cystic hygroma/hydrops fetalis are possible manifestations of several disorders. This study illustrates how the integration of exome sequencing in prenatal clinical practice can facilitate the diagnosis and genetic counseling of heterogeneous developmental affections.
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Affiliation(s)
- Yosra Lajmi
- Department of Genomic Medicine of System and Organs Diseases, Cochin Hospital, APHP Center, University Paris Cité, Paris, France
| | - Laurence Loeuillet
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
| | - Giulia Petrilli
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
| | - Charles Egloff
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
| | - Juliette Nectoux
- Department of Genomic Medicine of System and Organs Diseases, Cochin Hospital, APHP Center, University Paris Cité, Paris, France
| | - Clémence Molac
- Clinical Genetics, Maternity Port-Royal, APHP Center, University Paris Cité, Paris, France
| | - Nathalie Roux
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
| | - Emmanuelle Pannier
- Gynecology-Obstetrics Department, Port-Royal Hospital, APHP Center, University Paris Cité, Paris, France
| | - Amale Achaiaa
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
| | - Zaina Ait Arkoub
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
| | - Sophie Chuon
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
| | - Aurélie Coussement
- Department of Genomic Medicine of System and Organs Diseases, Cochin Hospital, APHP Center, University Paris Cité, Paris, France
| | - Jean Michel Dupont
- Department of Genomic Medicine of System and Organs Diseases, Cochin Hospital, APHP Center, University Paris Cité, Paris, France
| | - Valérie Malan
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
| | - Emmanuel Spaggiari
- Gynecology-Obstetrics Department, Necker Hospital for Children Diseases, APHP Center, University Paris Cité, Paris, France
| | - Ferechte Razavi
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
| | - Jeanne Amiel
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
| | - Bettina Bessières
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
| | - Sarah Grotto
- Clinical Genetics, Maternity Port-Royal, APHP Center, University Paris Cité, Paris, France
| | - Tania Attié-Bitach
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
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Congenital lymphedema complicated by pain and psychological distress: case report. Am J Ther 2014; 21:e50-2. [PMID: 23615316 DOI: 10.1097/mjt.0b013e3182383c8b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patients with congenital lymphedema who experience pain report more functional interference and psychiatric disturbances than those without pain. These patients also have body image disturbance. We hereby report a case illustrating how pain relief can help in rehabilitative aspect and improve the quality of life and also help to overcome psychiatric manifestation. Pain related to lymphedema is often a neglected aspect of this overlooked problem.
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Connell FC, Ostergaard P, Carver C, Brice G, Williams N, Mansour S, Mortimer PS, Jeffery S. Analysis of the coding regions of VEGFR3 and VEGFC in Milroy disease and other primary lymphoedemas. Hum Genet 2008; 124:625-31. [DOI: 10.1007/s00439-008-0586-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Accepted: 11/05/2008] [Indexed: 10/21/2022]
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Congenital lymphedema-lymphangiectasia associated with scrotal angiokeratoma (Fordyce Type) and hearing impairment. J Clin Gastroenterol 2008; 42:715-9. [PMID: 18496391 DOI: 10.1097/mcg.0b013e31802fba55] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Congenital lymphangiectasia-lymphedema is a rare disorder that presents with edema of the lower half of the body, the face, hands, and scrotum, or with protein-losing enteropathy owing to structural anomalies in the endothelium of the lymphatic system. We describe a biopsy-proven case of severe lymphangiectasia-lymphedema in a 16-year-old boy who was born to consanguineous parents and who, in addition, had mild (20 to 40 dB), early onset, sensorineural deafness and skin abnormalities, consisting of angiokeratomas of the face, hands, and feet, and also a large, localized angiokeratoma of the scrotum and the penis (Fordyce type). Both of the proband's parents had profound (>80 dB), congenital, mixed conductive/sensorineural, nonsyndromic deafness to low-mid frequencies. To the best of our knowledge, this constellation of lymphatic, skin, hearing, and systemic abnormalities seen in the proband has not been previously reported.
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Abstract
Lymphedema of the lower extremities is a diagnostic challenge. Exclusion of secondary causes of limb swelling and secondary lymphedema is the initial step. Primary lymphedema is classified into idiopathic and familial (hereditary) subgroups. Hereditary lymphedema can be nonsyndromic or associated with congenital anomalies or with abnormal physical findings. A 13-year-old girl presented with unilateral lower extremity lymphedema. Her medical and family history was unremarkable. The physical examination was negative for dysmorphic features and congenital anomalies. Lymphoscintigraphy showed no evidence of lymph flow in the left lower extremity, which persisted at the delayed 2-hour image. A comprehensive clinical and family history that includes a thorough physical examination are the mainstays of the medical assessment of lymphedema in children. Isotopic lymphoscintigraphy is generally considered the gold standard for confirmation of the diagnosis. This article discusses the differential diagnosis, reviews the literature, and suggests a simplified and an updated flowchart for the classification of unilateral limb lymphedema in children.
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Affiliation(s)
- Marwan Shinawi
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030, USA.
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Abstract
PURPOSE To provide advanced practice nurses with a greater understanding of the pathophysiology, clinical manifestations, diagnosis, and management of lymphedema. DATA SOURCES Comprehensive literature review of the relevant clinical journals, systematic reviews, and medical textbooks. CONCLUSIONS Lymphedema is a poorly known and understood condition. If not properly diagnosed and promptly treated, lymphedema can cause significant morbidity and mortality. Diagnosis is based on suggestive history and characteristic findings on physical exam that ideally would be confirmed by lymphoscintigraphy. The primary goal in lymphedema treatment is the removal of excess plasma proteins from the interstitial tissues. The goals of management are to decrease the extremity size, maintain the decreased size, prevent complications, and improve function and overall sense of psychological well-being. IMPLICATIONS FOR PRACTICE The ability to properly diagnose lymphedema is crucial to prevent the significant morbidity and mortality that is associated with this condition. It is imperative that patients with lymphedema are referred to specially trained healthcare professionals to ensure optimal treatment.
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Affiliation(s)
- Dayna E Gary
- School of Nursing, University of Maryland at Baltimore, Baltimore, Maryland, USA.
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Ghalamkarpour A, Morlot S, Raas-Rothschild A, Utkus A, Mulliken JB, Boon LM, Vikkula M. Hereditary lymphedema type I associated with VEGFR3 mutation: the first de novo case and atypical presentations. Clin Genet 2006; 70:330-5. [PMID: 16965327 DOI: 10.1111/j.1399-0004.2006.00687.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Mutations in the vascular endothelial growth factor receptor 3 gene, VEGFR3/FLT4, have been identified in a subset of families with hereditary lymphedema type I or Milroy disease (MIM 153100). Individuals carrying a VEGFR3 mutation exhibit congenital edema of the lower limbs, usually bilaterally and below the knees, sometimes associated with cellulitis, prominent veins, papillomatosis, upturned toenails, and hydrocele. In this study, we report the first de novo VEGFR3 mutation in a patient with sporadic congenital lymphedema. We also describe three other families with a VEGFR3 mutation. In each family, one individual had an atypical clinical presentation of hereditary lymphedema type I, whereas the others had the classical VEGFR3 mutation-caused phenotype. The atypical presentations included pre-natal pleural effusion, spontaneous resorption of lymphedema and elephantiasis. Three of the four identified mutations were novel. These data show that de novo VEGFR3 mutations may be present in patients without family history of congenital lymphedema. This has implications for follow-up care, as such individuals have nearly a 50% risk for occurrence of lymphedema in their children. Our findings also indicate that although most patients with a VEGFR3 mutation have the well-defined phenotype for hereditary lymphedema type I, there are exceptions that should be considered in genetic counseling. Because VEGFR3 mutation can cause generalized lymphatic dysfunction and can thus result in hydrops fetalis, VEGFR3 screening should be added to the investigation of cases of hydrops fetalis of an unknown etiology.
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Affiliation(s)
- A Ghalamkarpour
- Laboratory of Human Molecular Genetics, Christian de Duve Institute of Cellular Pathology, Université Catholique de Louvain, Brussels, Belgium
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Spiegel R, Ghalamkarpour A, Daniel-Spiegel E, Vikkula M, A Shalev S. Wide clinical spectrum in a family with hereditary lymphedema type I due to a novel missense mutation in VEGFR3. J Hum Genet 2006; 51:846-850. [PMID: 16924388 DOI: 10.1007/s10038-006-0031-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2006] [Accepted: 06/12/2006] [Indexed: 11/29/2022]
Abstract
Hereditary lymphedema type I (HL-I), also known as Milroy disease, is an autosomal dominant disorder characterized by typical phenotype of infantile onset lower-limb lymphedema accompanied by variable expression of recurrent episodes of cellulites, toenail changes, and papillomatosis. Mutations in the vascular endothelial growth factor receptor 3 (VEGFR3), also known as FLT4 gene, which encodes a lymphatic endothelial-specific tyrosine kinase receptor, have been identified as a genetic cause of HL-I. We report a large Muslim Arab family residing in northern Israel with 14 individuals presenting clinical features of HL-I. Genetic analysis revealed novel missense mutation E1106K in the tyrosine kinase domain II of VEGFR3 that cosegregates with the disorder in the family. Most affected individuals presented with bilateral congenital lower-limb lymphedema. Wide intrafamilial phenotypic variability included two asymptomatic individuals, a case of prenatal hydrothorax evolving to hydrops fetalis, and a late-onset complication, yet unreported, of chronic degenerative joint disease of the knees. This report broadens the known "classic" phenotype of HL-I.
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Affiliation(s)
- Ronen Spiegel
- Genetic Institute, Ha'Emek Medical Center, Afula, 18101, Israel.
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Arash Ghalamkarpour
- Laboratory of Human Molecular Genetics, Christian de Duve Institute and University of Louvain Medical School, Brussels, Belgium
| | - Etty Daniel-Spiegel
- Department of Obstetrics and Gynecology, Ha'Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Miikka Vikkula
- Laboratory of Human Molecular Genetics, Christian de Duve Institute and University of Louvain Medical School, Brussels, Belgium
| | - Stavit A Shalev
- Genetic Institute, Ha'Emek Medical Center, Afula, 18101, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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10
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14-jähriges Mädchen mit schmerzhafter chronischer Fußschwellung. Monatsschr Kinderheilkd 2006. [DOI: 10.1007/s00112-006-1340-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Brice G, Child AH, Evans A, Bell R, Mansour S, Burnand K, Sarfarazi M, Jeffery S, Mortimer P. Milroy disease and the VEGFR-3 mutation phenotype. J Med Genet 2006; 42:98-102. [PMID: 15689446 PMCID: PMC1735984 DOI: 10.1136/jmg.2004.024802] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Primary congenital lymphoedema (Milroy disease) is a rare autosomal dominant condition for which a major causative gene defect has recently been determined. Mutations in the vascular endothelial growth factor receptor 3 (VEGFR-3) gene have now been described in 13 families world-wide. This is a review of the condition based on the clinical findings in 71 subjects from 10 families. All 71 individuals have a mutation in VEGFR-3. Ninety per cent of the 71 individuals carrying a VEGFR-3 mutation showed signs of oedema, which was confined in all cases to the lower limbs. In all but two cases onset of swelling was from birth. Other symptoms and signs included cellulitis (20%), large calibre leg veins (23%), papillomatosis (10%), and upslanting toenails (10%). In males, hydrocoele was the next most common finding after oedema (37%). Thorough clinical examination of these patients indicates that there are few clinical signs in addition to lower limb oedema. Rigorous phenotyping of patients produces a high yield of VEGFR-3 mutations.
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Affiliation(s)
- G Brice
- SW Thames Regional Genetics Unit, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK.
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O'Connor MI, Kransdorf MJ, Menke DM. Soft-tissue malignant fibrous histiocytoma (high-grade undifferentiated pleomorphic sarcoma) arising in a desmoid tumor in a patient with Milroy's disease. Skeletal Radiol 2006; 35:240-3. [PMID: 16437208 DOI: 10.1007/s00256-005-0007-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2005] [Revised: 05/12/2005] [Accepted: 05/12/2005] [Indexed: 02/02/2023]
Affiliation(s)
- Mary I O'Connor
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA.
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13
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Winkler H, Kransdorf MJ, Menke DM. The spacemaster changed the DOI!!! Biotechnol Lett 2006. [DOI: 10.1617/s11527-006-3000-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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ArticleTiltle Language is English. Biotechnol Lett 2006. [DOI: 10.1007/s10529-006-0376-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Travolta J, Kransdorf MJ, Menke DM. Retesting erratum and CCC tool information transfer. Biotechnol Lett 2006. [DOI: 10.1007/s10529-006-0371-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Resistance is futile. Biotechnol Lett 2006. [DOI: 10.1007/s10529-006-0368-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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17
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A really different title to make it even more realistic. Biotechnol Lett 2006. [DOI: 10.1007/s10529-006-0351-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Soft-tissue malignant fibrous histiocytoma (high-grade undifferentiated pleomorphic sarcoma) arising in a desmoid tumor in a patient with Milroys disease. Biotechnol Lett 2006. [DOI: 10.1007/s10529-006-0340-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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19
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Blei F. Peripheral Vascular Anomalies and Vascular Tumors. Vasc Med 2006. [DOI: 10.1016/b978-0-7216-0284-4.50072-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Piller NB. Literature watch. Tissue engineering of perfused microvessels. Lymphat Res Biol 2004; 1:337-41. [PMID: 15624564 DOI: 10.1089/153968503322758166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Neil B Piller
- Lymphoedema Clinic, Department of Surgery, School of Medicine, Flinders University and Flinders Medical Centre, Adelaide, South Australia
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