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Atri S, Hammami M, Sebai A, Zaiem A, Laabidi S, Kacem M. Incidental pneumoperitoneum due to pneumatosis intestinalis: A rare case of benign pneumoperitoneum. Int J Surg Case Rep 2024; 116:109363. [PMID: 38340627 PMCID: PMC10943630 DOI: 10.1016/j.ijscr.2024.109363] [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: 12/12/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION AND SIGNIFICANCE Pneumatosis intestinalis (PI), the presence of gas within the intestinal wall, is a rare but significant gastrointestinal condition. It may be associated with underlying gastrointestinal disorders or detected incidentally, posing diagnostic challenges. This article emphasizes the importance of recognizing and managing this condition conservatively when appropriate. CASE PRESENTATION A previously healthy 40-year-old Caucasian female patient presented with left lumbar fossa pain, initially suggestive of renal colic. Physical examination revealed stable vital signs and a soft abdomen. Laboratory tests showed no signs of inflammation or renal abnormalities. Abdominal CT scan ruled out urinary lithiasis but identified pericolonic pneumoperitoneum on the left side. Due to the absence of peritonitis signs, surgical intervention was deferred. Over 72 h of close monitoring, the patient remained stable without clinical deterioration. Subsequent CT scans confirmed pneumatosis intestinalis. The patient remained asymptomatic and underwent a confirming colonoscopy. CLINICAL DISCUSSION Pneumatosis intestinalis can manifest with varying severity and is often linked to underlying gastrointestinal conditions. It can mimic life-threatening conditions like bowel perforation, necessitating careful differentiation. Non-surgical pneumoperitoneum, exemplified in this case, may result from benign causes like PI, warranting meticulous evaluation to prevent unnecessary surgery. CONCLUSION This case highlights the need to recognize and manage asymptomatic PI. A multidisciplinary approach and CT imaging play pivotal roles in ensuring optimal patient outcomes. Vigilance among healthcare professionals is essential to consider PI in asymptomatic patients, mitigating the risk of undue surgical interventions, and facilitating timely diagnosis and intervention when necessary.
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Affiliation(s)
- Souhaib Atri
- Department of General Surgery, Hopital la Rabta, Tunis, Tunisia
| | - Mahdi Hammami
- Department of General Surgery, Hopital la Rabta, Tunis, Tunisia.
| | - Amine Sebai
- Department of General Surgery, Hopital la Rabta, Tunis, Tunisia
| | - Aida Zaiem
- Department of General Surgery, Hopital la Rabta, Tunis, Tunisia
| | - Sarra Laabidi
- Department of Gastroenterology, Hopital la Rabta, Tunis, Tunisia
| | - Montassar Kacem
- Department of General Surgery, Hopital la Rabta, Tunis, Tunisia
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Raabe GG, Schelde-Olesen B, Bjørsum-Meyer T. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac072. [PMID: 35308259 PMCID: PMC8929749 DOI: 10.1093/jscr/rjac072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/19/2022] [Accepted: 02/24/2022] [Indexed: 11/14/2022] Open
Abstract
A 46-year-old male referred to the Emergency Department with pain in the left flank. The patient suffered from Crohn’s disease. He had not experienced any fever, and a urine strip showed signs of blood. A ureteric calculus was suspected and a computed tomography scan was performed, which surprisingly showed free intraperitoneal air (FIA) located along the ascending colon. The patient had no signs indicative of peritonitis and the spontaneous pneumoperitoneum was suspected. Pneumoperitoneum is often associated with severe intraabdominal pathology, such as perforation of the gastrointestinal tract, requiring acute surgical intervention. In ~10% of all cases of FIA, the cause is related to conditions not requiring prompt surgical intervention. Doctors need to recognize the rare condition of spontaneous pneumoperitoneum and correlate these findings to patient complaints to be able to choose the correct conservative strategy and to avoid unnecessary surgical procedures and risks for the patient.
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Affiliation(s)
| | - Benedicte Schelde-Olesen
- Department of Surgery, Odense University Hospital and Svendborg Hospital, Odense and Svendborg, Denmark
| | - Thomas Bjørsum-Meyer
- Department of Surgery, Odense University Hospital and Svendborg Hospital, Odense and Svendborg, Denmark
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Scoglio D, Pozzobon M, Battistioli M, Bonotto G, Caronia V, Gualandi O, Callegari P. Asymptomatic pneumoperitoneum or pneumatosis cystoides intestinalis? Easy to make a mistake. J Surg Case Rep 2021; 2021:rjab138. [PMID: 33927871 PMCID: PMC8068465 DOI: 10.1093/jscr/rjab138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/17/2021] [Indexed: 11/12/2022] Open
Abstract
Pneumoperitoneum refers to the presence of intraperitoneal free gas outside the viscera. A perforation of a hollow viscus is the main cause and usually indicates a surgical emergency. However, some case of pneumoperitoneum can be completely asymptomatic and secondary to benign conditions that do not require any surgical intervention. In this situation a misleading diagnosis of pneumoperitoneum may occur. The authors are going to present a case of a 79-year-old man with an asymptomatic pneumoperitoneum incidentally detected by CT-scan and subsequently revealed to be pneumatosis cystoides intestinalis (PCI) at diagnostic laparoscopy. PCI is a rare condition characterized by the presence of gas-filled cyst in the submucosa/subserosa of the bowel wall that can easily mimic pneumoperitoneum on radiological imaging. A thorough examination of radiological findings is crucial in preventing unnecessary surgical procedures that may expose patients to potential associated morbidities.
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Affiliation(s)
- Daniele Scoglio
- Department of General Surgery, AULSS 2 Marca Trevigiana, ospedale civile di Oderzo (TV), Italy
| | - Maurizia Pozzobon
- Department of General Surgery, AULSS 2 Marca Trevigiana, ospedale civile di Oderzo (TV), Italy
| | - Mauro Battistioli
- Department of General Surgery, AULSS 2 Marca Trevigiana, ospedale civile di Oderzo (TV), Italy
| | - Gianni Bonotto
- Department of General Surgery, AULSS 2 Marca Trevigiana, ospedale civile di Oderzo (TV), Italy
| | - Vincenzo Caronia
- Department of General Surgery, AULSS 2 Marca Trevigiana, ospedale civile di Oderzo (TV), Italy
| | - Orlando Gualandi
- Department of General Surgery, AULSS 2 Marca Trevigiana, ospedale civile di Oderzo (TV), Italy
| | - Paolo Callegari
- Department of General Surgery, AULSS 2 Marca Trevigiana, ospedale civile di Oderzo (TV), Italy
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Matsubara Y, Nanri A, Watanabe K, Shono K, Shono T. A case of pneumatosis cystoides intestinalis complicated by intussusception. Pediatr Int 2020; 62:987-988. [PMID: 32671921 DOI: 10.1111/ped.14219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/13/2020] [Accepted: 02/25/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Yoshie Matsubara
- Department of Pediatrics, NHO Kokura Medical Center, Kitakyushu, Japan.,Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ayumi Nanri
- Department of Pediatrics, NHO Kokura Medical Center, Kitakyushu, Japan
| | - Kyoko Watanabe
- Department of Pediatrics, NHO Kokura Medical Center, Kitakyushu, Japan
| | - Kumiko Shono
- Department of Pediatric Surgery, NHO Kokura Medical Center, Kitakyushu, Japan
| | - Takeshi Shono
- Department of Pediatric Surgery, NHO Kokura Medical Center, Kitakyushu, Japan
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Pneumatosis cystoides intestinalis induced by the alpha-glucosidase inhibitor complicated from sigmoid volvulus in a diabetic patient. Int J Colorectal Dis 2020; 35:943-946. [PMID: 32095873 DOI: 10.1007/s00384-020-03549-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION We present the case of a diabetic patient on treatment with acarbose who had presented a sigmoid volvulus with localized cystic pneumatosis of the sigmoid colon. CASE REPORT A 72-year-old patient with a medical history of atrial fibrillation, DNID in treatment since 10 years by acarbose. The patient was admitted to the emergency for abdominal pain and occlusive syndrome since 48 h without fever or nausea or vomiting. A CT scan was performed that showed a dolichocolon with a sigmoid volvulus. The colonic wall was thickening as well as submucosal and subserosal gas, without extra digestive air or collections. A rectosigmoidoscopy was achieving that showed a sigmoid volvulus with multiple small projections like a submucosa gas bubbles. A laparoscopic non-oncologic sigmoidectomy with primary termino terminal colorectal anastomosis was performed. During the surgical procedure, an aspect of PCI of the sigmoid colon was found. The sigmoid colon was long like a dolichocolon, dilated, and partially twisted. DISCUSSION PCI is a rare condition characterized by the presence of multiple pneumokystes at different layers of the colonic wall. In emergency setting, the presence of colonic pneumatosis precludes the differential diagnosis between the PCI and mesenteric ischemia or ischemic colitis. It can be the cause of unnecessary explorative laparotomy. CONCLUSION PCI is rare disease, in emergency setting, we had to consider in differential diagnosis with colonic vascular disorders.
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Ribolla M, Conti L, Baldini E, Palmieri G, Grassi C, Banchini F, Dacco' MD, Capelli P. Asymptomatic pneumoperitoneum in pneumatosis coli: A misleading operative indication. Int J Surg Case Rep 2020; 69:92-95. [PMID: 32305029 PMCID: PMC7163289 DOI: 10.1016/j.ijscr.2020.03.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/14/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Pneumatosis cystoides intestinalis (PCI) is a rare clinical pathology characterized by sub-mucosal and/or sub-serous cysts of free gas, forming cystic lesions usually ranging from 0.5 to 2.0 cm in size within the gastrointestinal tract. About 3% of patients with PCI develop complications such as pneumoperitoneum, intestinal volvulus, obstruction, or hemorrhage, these cases need immediate surgical intervention. Cyst rupture can produce peritoneal irritation and pneumoperitoneum. PRESENTATION OF CASE A 65-years-old woman was admitted to the Emergency Department for epileptiform convulsions. Her medical hystory included epilepsy, diabetes, lichenoid dermatitis, hypothyroidism, severe cognitive impairment. Abdominal CT scan revealed a dilated large intestine with parietal pneumatosis from the appendix to the transverse colon associated to extensive pneumoperitoneum. The patient underwent emergency laparotomy which revealed the presence of gas within the wall of right and transverse colon and distension of great omentum. No resection was needed as normal blood supply to the bowel present. DISCUSSION Pneumatosis coli can be both asymptomatic or life-threatening condition associated to bowel infarction; this situation can mimic a bowel perforation causing pneumoperitoneum - that sometimes is a non-surgical pneumoperitoneum - and it could be a misleading indication to surgical exploration especially in the case of uncertain origin of a septic shock. CONCLUSIONS We report a case of pneuomoperitoneum due to PCI. Surgical intervention was required for patient's conditions and unclear origin of the sepsis.
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Affiliation(s)
- Marta Ribolla
- Department of Medicine and Surgery, AOU Parma, Via Gramsci 14, Parma, Italy
| | - Luigi Conti
- Department of Surgery, AUSL Piacenza, Via Taverna 49, 29121 Piacenza, Italy.
| | - Edoardo Baldini
- Department of Surgery, AUSL Piacenza, Via Taverna 49, 29121 Piacenza, Italy
| | - Gerardo Palmieri
- Department of Medicine and Surgery, AOU Parma, Via Gramsci 14, Parma, Italy
| | - Carmine Grassi
- Department of Surgery, AUSL Piacenza, Via Taverna 49, 29121 Piacenza, Italy
| | - Filippo Banchini
- Department of Surgery, AUSL Piacenza, Via Taverna 49, 29121 Piacenza, Italy
| | | | - Patrizio Capelli
- Department of Surgery, AUSL Piacenza, Via Taverna 49, 29121 Piacenza, Italy
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Chen YY, Ko TY, Huang YF. Pneumatosis intestinalis causing pneumoperitoneum. Dig Liver Dis 2020; 52:351. [PMID: 31992526 DOI: 10.1016/j.dld.2019.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/12/2019] [Accepted: 12/13/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Yang-Yuan Chen
- Division of Gastroenterology, Endoscopy Center, Changhua Christian Hospital and Yuan Lin Branch, Changhua, Taiwan.
| | - Tung-Yi Ko
- Division of Gastroenterology, Endoscopy Center, Changhua Christian Hospital and Yuan Lin Branch, Changhua, Taiwan
| | - Yung-Fang Huang
- Division of Gastroenterology, Endoscopy Center, Changhua Christian Hospital and Yuan Lin Branch, Changhua, Taiwan
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Brighi M, Vaccari S, Lauro A, D'Andrea V, Pagano N, Marino IR, Cervellera M, Tonini V. "Cystamatic" Review: Is Surgery Mandatory for Pneumatosis Cystoides Intestinalis? Dig Dis Sci 2019; 64:2769-2775. [PMID: 31410751 DOI: 10.1007/s10620-019-05767-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by the presence of intramural gas cysts within the small and large intestines. We describe a case of a 70-year-old man admitted to the Emergency Surgery Department for PCI who was treated conservatively. AREAS COVERED We reviewed 60 cases of PCI described in the international literature over the last 5 years. From our analysis, it appears that the etiology of the gas production within the submucosa or the subserosa of the gastrointestinal tract is still unknown. The rupture of the cysts can lead to pneumoperitoneum that can simulate a surgical emergency. EXPERT COMMENTARY For patients with PCI, a conservative approach is the treatment of choice, with surgery mandatory only for complicated disease.
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Affiliation(s)
- M Brighi
- Departments of Emergency Surgery and Gastroenterology, St. Orsola University Hospital, Bologna, Italy
| | - S Vaccari
- Departments of Emergency Surgery and Gastroenterology, St. Orsola University Hospital, Bologna, Italy
| | - A Lauro
- Departments of Emergency Surgery and Gastroenterology, St. Orsola University Hospital, Bologna, Italy.
| | - V D'Andrea
- Department of Surgical Sciences, La Sapienza University, Umberto I Hospital, Rome, Italy
| | - N Pagano
- Departments of Emergency Surgery and Gastroenterology, St. Orsola University Hospital, Bologna, Italy
| | - I R Marino
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - M Cervellera
- Departments of Emergency Surgery and Gastroenterology, St. Orsola University Hospital, Bologna, Italy
| | - V Tonini
- Departments of Emergency Surgery and Gastroenterology, St. Orsola University Hospital, Bologna, Italy
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Abstract
INTRODUCTION Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by the presence of intramural gas cysts within the small and large intestines. We describe a case of a 70-year-old man admitted to the Emergency Surgery Department for PCI who was treated conservatively. AREAS COVERED We reviewed 60 cases of PCI described in the international literature over the last 5 years. From our analysis, it appears that the etiology of the gas production within the submucosa or the subserosa of the gastrointestinal tract is still unknown. The rupture of the cysts can lead to pneumoperitoneum that can simulate a surgical emergency. EXPERT COMMENTARY For patients with PCI, a conservative approach is the treatment of choice, with surgery mandatory only for complicated disease.
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10
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Abstract
The objective of this report is to document a case of pneumatosis coli in an immunosuppressed dog successfully treated with supportive care that included hyperbaric oxygen. A 9 yr old, neutered male Maltese was presented for hematochezia of ∼36 h duration. The dog had a history of immune-mediated thrombocytopenia that was well managed with prednisone and azathioprine. Initial evaluation was unremarkable except for increased rectal temperature and hematochezia on digital rectal examination. Abdominal radiographs revealed diffuse gas within the colonic wall consistent with pneumatosis coli. Scant-free air was also appreciated in the peritoneal and retroperitoneal cavities. The dog was managed for 4 days in hospital with broad spectrum antibiotic, anthelminthic, and gastroprotectant therapy. He received one session of hyperbaric oxygen therapy while in hospital. Repeat abdominal radiographs after 72 hr of medical management showed improvement of the pneumatosis coli. After 4 days of hospitalization, he was discharged with resolution of clinical signs. Pneumatosis coli is rarely diagnosed in dogs but should be considered in cases with clinical signs of colorectal disease.
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Affiliation(s)
- Amanda Fisk
- From the Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Ashley Allen-Durrance
- From the Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
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11
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Bansal R, Shankar U, Walfish A. Emphysematous Gut. Am J Med Sci 2019; 357:e9. [PMID: 30638598 DOI: 10.1016/j.amjms.2018.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 11/23/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Raghav Bansal
- Division of Gastroenterology and Hepatology, Elmhurst Hospital Center, Elmhurst, New York.
| | - Uday Shankar
- Division of Gastroenterology and Hepatology, Elmhurst Hospital Center, Elmhurst, New York
| | - Aaron Walfish
- Division of Gastroenterology and Hepatology, Elmhurst Hospital Center, Elmhurst, New York
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Rachapalli V, Chaluvashetty SB. Pneumatosis Cystoides Intestinalis. J Clin Diagn Res 2017; 11:TJ01-TJ02. [PMID: 28764267 DOI: 10.7860/jcdr/2017/26197.10087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/25/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Vamsidhar Rachapalli
- Consultant Interventional Radiologist, Department of Radiology, BGS Global Hospital, Bengaluru, Karnataka, India
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Calabrese E, Ceponis PJ, Derrick BJ, Moon RE. Successful treatment of pneumatosis intestinalis with associated pneumoperitoneum and ileus with hyperbaric oxygen therapy. BMJ Case Rep 2017; 2017:bcr-2017-219209. [PMID: 28559286 DOI: 10.1136/bcr-2017-219209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Pneumatosis intestinalis (PI), or the presence of air in the bowel wall, is a rare disorder that is associated with a variety of underlying diseases, including connective tissue disorders. PI presents on a spectrum from asymptomatic to bowel obstruction and acute abdomen. In general, treatment of PI consists of treating the underlying disease. Both normobaric and hyperbaric oxygen have been used to treat PI directly. Here we report a symptomatic scleroderma-related case of PI that responded clinically to hyperbaric oxygen therapy. This report adds to a growing body of literature supporting a role for hyperbaric oxygen therapy in symptomatic PI.
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Affiliation(s)
- Evan Calabrese
- Center for In Vivo Microscopy, Duke University, Durham, North Carolina, USA
| | - Peter Jm Ceponis
- Center for Hyperbaric Medicine, Duke University, Durham, North Carolina, USA
| | - Bruce J Derrick
- Center for Hyperbaric Medicine, Duke University, Durham, North Carolina, USA
| | - Richard E Moon
- Center for Hyperbaric Medicine, Duke University, Durham, North Carolina, USA.,Department of Anesthesia, Duke University Medical Center, Durham, North Carolina, USA
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Pneumomediastinum and pneumoperitoneum secondary to cystic intestinal pneumatosis after percutaneous endoscopic gastrostomy placement. Cir Esp 2017; 95:476-477. [PMID: 28081874 DOI: 10.1016/j.ciresp.2016.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/19/2016] [Accepted: 11/21/2016] [Indexed: 11/21/2022]
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