Complications of needle electromyography: Hematoma risk and correlation with anticoagulation and antiplatelet therapy
Identifieur interne : 000A69 ( Istex/Corpus ); précédent : 000A68; suivant : 000A70Complications of needle electromyography: Hematoma risk and correlation with anticoagulation and antiplatelet therapy
Auteurs : Stacy L. Lynch ; Andrea J. Boon ; Jay Smith ; C. Michel Harper Jr. ; Elisa M. TanakaSource :
- Muscle & Nerve [ 0148-639X ] ; 2008-10.
Abstract
Electromyography (EMG) is considered a relatively safe procedure based primarily on clinical experience. Literature review reveals few reported complications from bleeding or hematoma formation. No evidence‐based guidelines exist for EMG procedures in patients who are taking anticoagulant or antiplatelet medications. The purpose of this study was to determine if patients taking anticoagulant or antiplatelet agents exhibit an increased risk of hematoma formation after routine needle EMG of the tibialis anterior muscle when compared to controls. Study subjects underwent routine needle EMG of the tibialis anterior muscle followed by ultrasound examination to evaluate for the presence of hematoma formation. A mean of 30.8 min elapsed between needle insertion and ultrasound evaluation. A total of 101 patients who were taking warfarin were studied. They had International Normalized Ratio (INR) values at or above 1.5, and two were found to have small, subclinical hematomas. Of 57 patients taking clopidogrel and/or aspirin, 1 was found to have a small, subclinical hematoma. In the control group (51 patients taking neither class of medication), no hematomas were found on ultrasound. This study suggests that hematoma formation from a standard needle EMG is rare. In addition, hematoma formation in our study group of patients on anticoagulant or antiplatelet medications was also uncommon, and no patients with documented hematomas experienced symptoms. These findings should be considered when determining the feasibility of electrodiagnostic evaluation of patients who are taking anticoagulant or antiplatelet medications. Muscle Nerve, 2008
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DOI: 10.1002/mus.21111
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Boon</name><affiliation><mods:affiliation>Department of Physical Medicine and Rehabilitation, Mayo Clinic, Ei‐2119E, 200 1st Street SW, Rochester, Minnesota 55905, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Physical Medicine and Rehabilitation, Mayo Clinic, Ei‐2119E, 200 1st Street SW, Rochester, Minnesota 55905, USA</mods:affiliation></affiliation></author><author><name sortKey="Smith, Jay" sort="Smith, Jay" uniqKey="Smith J" first="Jay" last="Smith">Jay Smith</name><affiliation><mods:affiliation>Department of Physical Medicine and Rehabilitation, Mayo Clinic, Ei‐2119E, 200 1st Street SW, Rochester, Minnesota 55905, USA</mods:affiliation></affiliation></author><author><name sortKey="Harper Jr, C Michel" sort="Harper Jr, C Michel" uniqKey="Harper Jr C" first="C. Michel" last="Harper Jr.">C. 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Tanaka</name><affiliation><mods:affiliation>Department of Anesthesiology, Hennepin County Medical Center, Minneapolis, Minnesota, USA</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">Muscle & Nerve</title><title level="j" type="alt">MUSCLE AND NERVE</title><idno type="ISSN">0148-639X</idno><idno type="eISSN">1097-4598</idno><imprint><biblScope unit="vol">38</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="1225">1225</biblScope><biblScope unit="page" to="1230">1230</biblScope><biblScope unit="page-count">6</biblScope><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><date type="published" when="2008-10">2008-10</date></imprint><idno type="ISSN">0148-639X</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0148-639X</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Electromyography (EMG) is considered a relatively safe procedure based primarily on clinical experience. 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In the control group (51 patients taking neither class of medication), no hematomas were found on ultrasound. This study suggests that hematoma formation from a standard needle EMG is rare. In addition, hematoma formation in our study group of patients on anticoagulant or antiplatelet medications was also uncommon, and no patients with documented hematomas experienced symptoms. These findings should be considered when determining the feasibility of electrodiagnostic evaluation of patients who are taking anticoagulant or antiplatelet medications. 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Lynch MD</name><affiliations><json:string>Department of Physical Medicine and Rehabilitation, Mayo Clinic, Ei‐2119E, 200 1st Street SW, Rochester, Minnesota 55905, USA</json:string></affiliations></json:item><json:item><name>Andrea J. Boon MD</name><affiliations><json:string>Department of Physical Medicine and Rehabilitation, Mayo Clinic, Ei‐2119E, 200 1st Street SW, Rochester, Minnesota 55905, USA</json:string><json:string>Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA</json:string><json:string>Department of Physical Medicine and Rehabilitation, Mayo Clinic, Ei‐2119E, 200 1st Street SW, Rochester, Minnesota 55905, USA</json:string></affiliations></json:item><json:item><name>Jay Smith MD</name><affiliations><json:string>Department of Physical Medicine and Rehabilitation, Mayo Clinic, Ei‐2119E, 200 1st Street SW, Rochester, Minnesota 55905, USA</json:string></affiliations></json:item><json:item><name>C. Michel Harper Jr. MD</name><affiliations><json:string>Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA</json:string></affiliations></json:item><json:item><name>Elisa M. Tanaka DO</name><affiliations><json:string>Department of Anesthesiology, Hennepin County Medical Center, Minneapolis, Minnesota, USA</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>electromyography</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>hematoma</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>warfarin</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>clopidogrel</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>aspirin</value></json:item></subject><articleId><json:string>MUS21111</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>article</json:string></originalGenre><abstract>Electromyography (EMG) is considered a relatively safe procedure based primarily on clinical experience. Literature review reveals few reported complications from bleeding or hematoma formation. No evidence‐based guidelines exist for EMG procedures in patients who are taking anticoagulant or antiplatelet medications. The purpose of this study was to determine if patients taking anticoagulant or antiplatelet agents exhibit an increased risk of hematoma formation after routine needle EMG of the tibialis anterior muscle when compared to controls. Study subjects underwent routine needle EMG of the tibialis anterior muscle followed by ultrasound examination to evaluate for the presence of hematoma formation. A mean of 30.8 min elapsed between needle insertion and ultrasound evaluation. A total of 101 patients who were taking warfarin were studied. They had International Normalized Ratio (INR) values at or above 1.5, and two were found to have small, subclinical hematomas. Of 57 patients taking clopidogrel and/or aspirin, 1 was found to have a small, subclinical hematoma. In the control group (51 patients taking neither class of medication), no hematomas were found on ultrasound. This study suggests that hematoma formation from a standard needle EMG is rare. In addition, hematoma formation in our study group of patients on anticoagulant or antiplatelet medications was also uncommon, and no patients with documented hematomas experienced symptoms. These findings should be considered when determining the feasibility of electrodiagnostic evaluation of patients who are taking anticoagulant or antiplatelet medications. 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Michel</forename><surname>Harper</surname><roleName type="degree">MD</roleName></persName><affiliation>Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA<address><country key="US"></country></address></affiliation></author><author xml:id="author-0004"><persName><forename type="first">Elisa M.</forename><surname>Tanaka</surname><roleName type="degree">DO</roleName></persName><affiliation>Department of Anesthesiology, Hennepin County Medical Center, Minneapolis, Minnesota, USA<address><country key="US"></country></address></affiliation></author><idno type="istex">1705BB80F625E1851166CC72B33CFD6F641496FA</idno><idno type="DOI">10.1002/mus.21111</idno><idno type="unit">MUS21111</idno><idno type="toTypesetVersion">file:MUS.MUS21111.pdf</idno></analytic><monogr><title level="j" type="main">Muscle & Nerve</title><title level="j" type="alt">MUSCLE AND NERVE</title><idno type="pISSN">0148-639X</idno><idno type="eISSN">1097-4598</idno><idno type="book-DOI">10.1002/(ISSN)1097-4598</idno><idno type="book-part-DOI">10.1002/mus.v38:4</idno><idno type="product">MUS</idno><imprint><biblScope unit="vol">38</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="1225">1225</biblScope><biblScope unit="page" to="1230">1230</biblScope><biblScope unit="page-count">6</biblScope><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><date type="published" when="2008-10"></date></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><abstract xml:lang="en" style="main"><head>Abstract</head><p>Electromyography (EMG) is considered a relatively safe procedure based primarily on clinical experience. Literature review reveals few reported complications from bleeding or hematoma formation. No evidence‐based guidelines exist for EMG procedures in patients who are taking anticoagulant or antiplatelet medications. The purpose of this study was to determine if patients taking anticoagulant or antiplatelet agents exhibit an increased risk of hematoma formation after routine needle EMG of the tibialis anterior muscle when compared to controls. Study subjects underwent routine needle EMG of the tibialis anterior muscle followed by ultrasound examination to evaluate for the presence of hematoma formation. A mean of 30.8 min elapsed between needle insertion and ultrasound evaluation. A total of 101 patients who were taking warfarin were studied. They had International Normalized Ratio (INR) values at or above 1.5, and two were found to have small, subclinical hematomas. Of 57 patients taking clopidogrel and/or aspirin, 1 was found to have a small, subclinical hematoma. In the control group (51 patients taking neither class of medication), no hematomas were found on ultrasound. This study suggests that hematoma formation from a standard needle EMG is rare. In addition, hematoma formation in our study group of patients on anticoagulant or antiplatelet medications was also uncommon, and no patients with documented hematomas experienced symptoms. These findings should be considered when determining the feasibility of electrodiagnostic evaluation of patients who are taking anticoagulant or antiplatelet medications. Muscle Nerve, 2008</p></abstract><textClass><keywords xml:lang="en"><term xml:id="kwd1">electromyography</term><term xml:id="kwd2">hematoma</term><term xml:id="kwd3">warfarin</term><term xml:id="kwd4">clopidogrel</term><term xml:id="kwd5">aspirin</term></keywords><classCode scheme="articleCategory">Research Article</classCode><classCode scheme="tocHeading1">Research Articles</classCode></textClass><langUsage><language ident="EN"></language></langUsage></profileDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/1705BB80F625E1851166CC72B33CFD6F641496FA/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Wiley Subscription Services, Inc., A Wiley Company</publisherName><publisherLoc>Hoboken</publisherLoc></publisherInfo><doi registered="yes">10.1002/(ISSN)1097-4598</doi><issn type="print">0148-639X</issn><issn type="electronic">1097-4598</issn><idGroup><id type="product" value="MUS"></id></idGroup><titleGroup><title type="main" xml:lang="en" sort="MUSCLE AND NERVE">Muscle & Nerve</title><title type="subtitle">Official Journal of the American Association of Electrodiagnostic Medicine</title><title type="short">Muscle Nerve</title></titleGroup></publicationMeta><publicationMeta level="part" position="40"><doi origin="wiley" registered="yes">10.1002/mus.v38:4</doi><numberingGroup><numbering type="journalVolume" number="38">38</numbering><numbering type="journalIssue">4</numbering></numberingGroup><coverDate startDate="2008-10">October 2008</coverDate></publicationMeta><publicationMeta level="unit" type="article" position="20" status="forIssue"><doi origin="wiley" registered="yes">10.1002/mus.21111</doi><idGroup><id type="unit" value="MUS21111"></id></idGroup><countGroup><count type="pageTotal" number="6"></count></countGroup><titleGroup><title type="articleCategory">Research Article</title><title type="tocHeading1">Research Articles</title></titleGroup><copyright ownership="publisher">Copyright © 2008 Wiley Periodicals, Inc.</copyright><eventGroup><event type="manuscriptAccepted" date="2008-06-23"></event><event type="publishedOnlineEarlyUnpaginated" date="2008-09-10"></event><event type="firstOnline" date="2008-09-10"></event><event type="publishedOnlineFinalForm" date="2008-09-24"></event><event type="xmlConverted" agent="Converter:JWSART34_TO_WML3G version:2.3.2 mode:FullText source:FullText result:FullText" date="2010-03-15"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-02-03"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-10-31"></event></eventGroup><numberingGroup><numbering type="pageFirst">1225</numbering><numbering type="pageLast">1230</numbering></numberingGroup><correspondenceTo>Department of Physical Medicine and Rehabilitation, Mayo Clinic, Ei‐2119E, 200 1st Street SW, Rochester, Minnesota 55905, USA</correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:MUS.MUS21111.pdf"></link></linkGroup></publicationMeta><contentMeta><countGroup><count type="figureTotal" number="4"></count><count type="tableTotal" number="3"></count><count type="referenceTotal" number="15"></count><count type="wordTotal" number="3860"></count></countGroup><titleGroup><title type="main" xml:lang="en">Complications of needle electromyography: Hematoma risk and correlation with anticoagulation and antiplatelet therapy</title><title type="short" xml:lang="en">Hematoma Risk after Needle EMG</title></titleGroup><creators><creator xml:id="au1" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Stacy L.</givenNames><familyName>Lynch</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au2" creatorRole="author" affiliationRef="#af1 #af2" corresponding="yes"><personName><givenNames>Andrea J.</givenNames><familyName>Boon</familyName><degrees>MD</degrees></personName><contactDetails><email>boon.andrea@mayo.edu</email></contactDetails></creator><creator xml:id="au3" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Jay</givenNames><familyName>Smith</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au4" creatorRole="author" affiliationRef="#af2"><personName><givenNames>C. Michel</givenNames><familyName>Harper</familyName><nameSuffix>Jr.</nameSuffix><degrees>MD</degrees></personName></creator><creator xml:id="au5" creatorRole="author" affiliationRef="#af3"><personName><givenNames>Elisa M.</givenNames><familyName>Tanaka</familyName><degrees>DO</degrees></personName></creator></creators><affiliationGroup><affiliation xml:id="af1" countryCode="US" type="organization"><unparsedAffiliation>Department of Physical Medicine and Rehabilitation, Mayo Clinic, Ei‐2119E, 200 1st Street SW, Rochester, Minnesota 55905, USA</unparsedAffiliation></affiliation><affiliation xml:id="af2" countryCode="US" type="organization"><unparsedAffiliation>Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA</unparsedAffiliation></affiliation><affiliation xml:id="af3" countryCode="US" type="organization"><unparsedAffiliation>Department of Anesthesiology, Hennepin County Medical Center, Minneapolis, Minnesota, USA</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en" type="author"><keyword xml:id="kwd1">electromyography</keyword><keyword xml:id="kwd2">hematoma</keyword><keyword xml:id="kwd3">warfarin</keyword><keyword xml:id="kwd4">clopidogrel</keyword><keyword xml:id="kwd5">aspirin</keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><title type="main">Abstract</title><p>Electromyography (EMG) is considered a relatively safe procedure based primarily on clinical experience. Literature review reveals few reported complications from bleeding or hematoma formation. No evidence‐based guidelines exist for EMG procedures in patients who are taking anticoagulant or antiplatelet medications. The purpose of this study was to determine if patients taking anticoagulant or antiplatelet agents exhibit an increased risk of hematoma formation after routine needle EMG of the tibialis anterior muscle when compared to controls. Study subjects underwent routine needle EMG of the tibialis anterior muscle followed by ultrasound examination to evaluate for the presence of hematoma formation. A mean of 30.8 min elapsed between needle insertion and ultrasound evaluation. A total of 101 patients who were taking warfarin were studied. They had International Normalized Ratio (INR) values at or above 1.5, and two were found to have small, subclinical hematomas. Of 57 patients taking clopidogrel and/or aspirin, 1 was found to have a small, subclinical hematoma. In the control group (51 patients taking neither class of medication), no hematomas were found on ultrasound. This study suggests that hematoma formation from a standard needle EMG is rare. In addition, hematoma formation in our study group of patients on anticoagulant or antiplatelet medications was also uncommon, and no patients with documented hematomas experienced symptoms. These findings should be considered when determining the feasibility of electrodiagnostic evaluation of patients who are taking anticoagulant or antiplatelet medications. Muscle Nerve, 2008</p></abstract></abstractGroup></contentMeta></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Complications of needle electromyography: Hematoma risk and correlation with anticoagulation and antiplatelet therapy</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Hematoma Risk after Needle EMG</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Complications of needle electromyography: Hematoma risk and correlation with anticoagulation and antiplatelet therapy</title></titleInfo><name type="personal"><namePart type="given">Stacy L.</namePart><namePart type="family">Lynch</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Physical Medicine and Rehabilitation, Mayo Clinic, Ei‐2119E, 200 1st Street SW, Rochester, Minnesota 55905, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Andrea J.</namePart><namePart type="family">Boon</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Physical Medicine and Rehabilitation, Mayo Clinic, Ei‐2119E, 200 1st Street SW, Rochester, Minnesota 55905, USA</affiliation><affiliation>Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA</affiliation><affiliation>Department of Physical Medicine and Rehabilitation, Mayo Clinic, Ei‐2119E, 200 1st Street SW, Rochester, Minnesota 55905, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jay</namePart><namePart type="family">Smith</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Physical Medicine and Rehabilitation, Mayo Clinic, Ei‐2119E, 200 1st Street SW, Rochester, Minnesota 55905, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">C. Michel</namePart><namePart type="family">Harper Jr.</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Elisa M.</namePart><namePart type="family">Tanaka</namePart><namePart type="termsOfAddress">DO</namePart><affiliation>Department of Anesthesiology, Hennepin County Medical Center, Minneapolis, Minnesota, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><place><placeTerm type="text">Hoboken</placeTerm></place><dateIssued encoding="w3cdtf">2008-10</dateIssued><dateValid encoding="w3cdtf">2008-06-23</dateValid><copyrightDate encoding="w3cdtf">2008</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">4</extent><extent unit="tables">3</extent><extent unit="references">15</extent><extent unit="words">3860</extent></physicalDescription><abstract lang="en">Electromyography (EMG) is considered a relatively safe procedure based primarily on clinical experience. Literature review reveals few reported complications from bleeding or hematoma formation. No evidence‐based guidelines exist for EMG procedures in patients who are taking anticoagulant or antiplatelet medications. The purpose of this study was to determine if patients taking anticoagulant or antiplatelet agents exhibit an increased risk of hematoma formation after routine needle EMG of the tibialis anterior muscle when compared to controls. Study subjects underwent routine needle EMG of the tibialis anterior muscle followed by ultrasound examination to evaluate for the presence of hematoma formation. A mean of 30.8 min elapsed between needle insertion and ultrasound evaluation. A total of 101 patients who were taking warfarin were studied. They had International Normalized Ratio (INR) values at or above 1.5, and two were found to have small, subclinical hematomas. Of 57 patients taking clopidogrel and/or aspirin, 1 was found to have a small, subclinical hematoma. In the control group (51 patients taking neither class of medication), no hematomas were found on ultrasound. This study suggests that hematoma formation from a standard needle EMG is rare. In addition, hematoma formation in our study group of patients on anticoagulant or antiplatelet medications was also uncommon, and no patients with documented hematomas experienced symptoms. These findings should be considered when determining the feasibility of electrodiagnostic evaluation of patients who are taking anticoagulant or antiplatelet medications. Muscle Nerve, 2008</abstract><subject lang="en"><genre>keywords</genre><topic>electromyography</topic><topic>hematoma</topic><topic>warfarin</topic><topic>clopidogrel</topic><topic>aspirin</topic></subject><relatedItem type="host"><titleInfo><title>Muscle & Nerve</title><subTitle>Official Journal of the American Association of Electrodiagnostic Medicine</subTitle></titleInfo><titleInfo type="abbreviated"><title>Muscle Nerve</title></titleInfo><genre type="journal">journal</genre><subject><genre>article-category</genre><topic>Research Article</topic></subject><identifier type="ISSN">0148-639X</identifier><identifier type="eISSN">1097-4598</identifier><identifier type="DOI">10.1002/(ISSN)1097-4598</identifier><identifier type="PublisherID">MUS</identifier><part><date>2008</date><detail type="volume"><caption>vol.</caption><number>38</number></detail><detail type="issue"><caption>no.</caption><number>4</number></detail><extent unit="pages"><start>1225</start><end>1230</end><total>6</total></extent></part></relatedItem><identifier type="istex">1705BB80F625E1851166CC72B33CFD6F641496FA</identifier><identifier type="DOI">10.1002/mus.21111</identifier><identifier type="ArticleID">MUS21111</identifier><accessCondition type="use and reproduction" contentType="copyright">Copyright © 2008 Wiley Periodicals, Inc.</accessCondition><recordInfo><recordContentSource>WILEY</recordContentSource><recordOrigin>Wiley Subscription Services, Inc., A Wiley Company</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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