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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Preoperative preparation of a patient with grade II leg Lymphedema for his third hip replacement surgery</title><author><name sortKey="Guerreiro Godoy, Maria De Fatima" sort="Guerreiro Godoy, Maria De Fatima" uniqKey="Guerreiro Godoy M" first="Maria De Fátima" last="Guerreiro Godoy">Maria De Fátima Guerreiro Godoy</name><affiliation><nlm:aff id="aff0005">Medicine School of Sao Jose do Rio Preto (FAMERP) and Clinic Godoy, Sao Jose do Rio Preto, Brazil</nlm:aff></affiliation><affiliation><nlm:aff id="aff0015">Godoy Clinic, São Jose do Rio Preto, Brazil</nlm:aff></affiliation></author><author><name sortKey="Pereira De Godoy, Livia Maria" sort="Pereira De Godoy, Livia Maria" uniqKey="Pereira De Godoy L" first="Livia Maria" last="Pereira De Godoy">Livia Maria Pereira De Godoy</name><affiliation><nlm:aff id="aff0010">Medicine School of Lusiadas-Santos-Brazil and Godoy Clinic, São Jose do Rio Preto, Brazil</nlm:aff></affiliation><affiliation><nlm:aff id="aff0015">Godoy Clinic, São Jose do Rio Preto, Brazil</nlm:aff></affiliation></author><author><name sortKey="Lopes Pinto, Renata" sort="Lopes Pinto, Renata" uniqKey="Lopes Pinto R" first="Renata" last="Lopes Pinto">Renata Lopes Pinto</name><affiliation><nlm:aff id="aff0015">Godoy Clinic, São Jose do Rio Preto, Brazil</nlm:aff></affiliation></author><author><name sortKey="Pereira De Godoy, Jose Maria" sort="Pereira De Godoy, Jose Maria" uniqKey="Pereira De Godoy J" first="Jose Maria" last="Pereira De Godoy">Jose Maria Pereira De Godoy</name><affiliation><nlm:aff id="aff0005">Medicine School of Sao Jose do Rio Preto (FAMERP) and Clinic Godoy, Sao Jose do Rio Preto, Brazil</nlm:aff></affiliation><affiliation><nlm:aff id="aff0015">Godoy Clinic, São Jose do Rio Preto, Brazil</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27866037</idno><idno type="pmc">5121162</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5121162</idno><idno type="RBID">PMC:5121162</idno><idno type="doi">10.1016/j.ijscr.2016.09.033</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">002277</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002277</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Preoperative preparation of a patient with grade II leg Lymphedema for his third hip replacement surgery</title><author><name sortKey="Guerreiro Godoy, Maria De Fatima" sort="Guerreiro Godoy, Maria De Fatima" uniqKey="Guerreiro Godoy M" first="Maria De Fátima" last="Guerreiro Godoy">Maria De Fátima Guerreiro Godoy</name><affiliation><nlm:aff id="aff0005">Medicine School of Sao Jose do Rio Preto (FAMERP) and Clinic Godoy, Sao Jose do Rio Preto, Brazil</nlm:aff></affiliation><affiliation><nlm:aff id="aff0015">Godoy Clinic, São Jose do Rio Preto, Brazil</nlm:aff></affiliation></author><author><name sortKey="Pereira De Godoy, Livia Maria" sort="Pereira De Godoy, Livia Maria" uniqKey="Pereira De Godoy L" first="Livia Maria" last="Pereira De Godoy">Livia Maria Pereira De Godoy</name><affiliation><nlm:aff id="aff0010">Medicine School of Lusiadas-Santos-Brazil and Godoy Clinic, São Jose do Rio Preto, Brazil</nlm:aff></affiliation><affiliation><nlm:aff id="aff0015">Godoy Clinic, São Jose do Rio Preto, Brazil</nlm:aff></affiliation></author><author><name sortKey="Lopes Pinto, Renata" sort="Lopes Pinto, Renata" uniqKey="Lopes Pinto R" first="Renata" last="Lopes Pinto">Renata Lopes Pinto</name><affiliation><nlm:aff id="aff0015">Godoy Clinic, São Jose do Rio Preto, Brazil</nlm:aff></affiliation></author><author><name sortKey="Pereira De Godoy, Jose Maria" sort="Pereira De Godoy, Jose Maria" uniqKey="Pereira De Godoy J" first="Jose Maria" last="Pereira De Godoy">Jose Maria Pereira De Godoy</name><affiliation><nlm:aff id="aff0005">Medicine School of Sao Jose do Rio Preto (FAMERP) and Clinic Godoy, Sao Jose do Rio Preto, Brazil</nlm:aff></affiliation><affiliation><nlm:aff id="aff0015">Godoy Clinic, São Jose do Rio Preto, Brazil</nlm:aff></affiliation></author></analytic><series><title level="j">International Journal of Surgery Case Reports</title><idno type="eISSN">2210-2612</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Highlights</title><p><list list-type="simple"><list-item id="lsti0005"><label>•</label><p>Lymphedema resulting from dynamic or mechanical changes of the lymphatic system.</p></list-item><list-item id="lsti0010"><label>•</label><p>Trauma surgery is possible to develop lymphedema.</p></list-item><list-item id="lsti0015"><label>•</label><p>Intensive treatment reduce the volume of leg edema prior to a surgery to replace a hip prosthesis in a patient with grade II leg lymphedema.</p></list-item></list></p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Godoy, J M" uniqKey="Godoy J">J.M. Godoy</name></author><author><name sortKey="Godoy, M F" uniqKey="Godoy M">M.F. Godoy</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="De Godoy, Jose Maria Pereira" uniqKey="De Godoy J">Jose Maria Pereira de Godoy</name></author><author><name sortKey="Andrade, Mauro" uniqKey="Andrade M">Mauro Andrade</name></author><author><name sortKey="Azevedo, Walter Ferreira" uniqKey="Azevedo W">Walter Ferreira Azevedo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lee, B" uniqKey="Lee B">B. Lee</name></author><author><name sortKey="Andrade, M" uniqKey="Andrade M">M. Andrade</name></author><author><name sortKey="Bergan, J" uniqKey="Bergan J">J. Bergan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="De Godoy, J M" uniqKey="De Godoy J">J.M. de Godoy</name></author><author><name sortKey="Godoy, M" uniqKey="Godoy M">M. Godoy</name></author><author><name sortKey="De, F" uniqKey="De F">F. de</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Int J Surg Case Rep</journal-id><journal-id journal-id-type="iso-abbrev">Int J Surg Case Rep</journal-id><journal-title-group><journal-title>International Journal of Surgery Case Reports</journal-title></journal-title-group><issn pub-type="epub">2210-2612</issn><publisher><publisher-name>Elsevier</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27866037</article-id><article-id pub-id-type="pmc">5121162</article-id><article-id pub-id-type="publisher-id">S2210-2612(16)30375-3</article-id><article-id pub-id-type="doi">10.1016/j.ijscr.2016.09.033</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Preoperative preparation of a patient with grade II leg Lymphedema for his third hip replacement surgery</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Guerreiro Godoy</surname><given-names>Maria de Fátima</given-names></name><degrees>PhD, OT</degrees><role>Prof</role><email>mfggodoy@gmail.com</email><xref rid="aff0005" ref-type="aff">a</xref><xref rid="aff0015" ref-type="aff">c</xref><xref rid="cor0005" ref-type="corresp">⁎</xref></contrib><contrib contrib-type="author"><name><surname>Pereira de Godoy</surname><given-names>Livia Maria</given-names></name><degrees>Undergraduate student</degrees><role>Research Group</role><email>godoylmp@gmail.com</email><xref rid="aff0010" ref-type="aff">b</xref><xref rid="aff0015" ref-type="aff">c</xref><xref rid="fn0005" ref-type="fn">1</xref></contrib><contrib contrib-type="author"><name><surname>Lopes Pinto</surname><given-names>Renata</given-names></name><degrees>PhT, Physiotherapist Master’s student</degrees><role>Researcher</role><email>renata_l_p@yahoo.com.br</email><xref rid="aff0015" ref-type="aff">c</xref><xref rid="fn0005" ref-type="fn">1</xref></contrib><contrib contrib-type="author"><name><surname>Pereira de Godoy</surname><given-names>Jose Maria</given-names></name><degrees>MD, PhD</degrees><role>Professor</role><email>godoyjmp@gmail.com</email><xref rid="aff0005" ref-type="aff">a</xref><xref rid="aff0015" ref-type="aff">c</xref><xref rid="fn0005" ref-type="fn">1</xref></contrib></contrib-group><aff id="aff0005"><label>a</label>Medicine School of Sao Jose do Rio Preto (FAMERP) and Clinic Godoy, Sao Jose do Rio Preto, Brazil</aff><aff id="aff0010"><label>b</label>Medicine School of Lusiadas-Santos-Brazil and Godoy Clinic, São Jose do Rio Preto, Brazil</aff><aff id="aff0015"><label>c</label>Godoy Clinic, São Jose do Rio Preto, Brazil</aff><author-notes><corresp id="cor0005"><label>⁎</label>Corresponding author at: Avenida Constituição, 1306-Sao Jose do Rio Preto-CEP 15025120-Brazil <email>mfggodoy@gmail.com</email></corresp><fn id="fn0005"><label>1</label><p id="npar0005">Adress for contact: Avenida Constituição, 1306-São Jose do Rio Preto, SP-Brazil CEP: 15025-120.</p></fn></author-notes><pub-date pub-type="pmc-release"><day>28</day><month>9</month><year>2016</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="collection"><year>2016</year></pub-date><pub-date pub-type="epub"><day>28</day><month>9</month><year>2016</year></pub-date><volume>29</volume><fpage>193</fpage><lpage>195</lpage><history><date date-type="received"><day>6</day><month>8</month><year>2016</year></date><date date-type="rev-recd"><day>21</day><month>9</month><year>2016</year></date><date date-type="accepted"><day>21</day><month>9</month><year>2016</year></date></history><permissions><copyright-statement>© 2016 The Author(s)</copyright-statement><copyright-year>2016</copyright-year><license license-type="CC BY-NC-ND" xlink:href="http://creativecommons.org/licenses/by-nc-nd/4.0/"><license-p>This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).</license-p></license></permissions><abstract abstract-type="author-highlights" id="abs0005"><title>Highlights</title><p><list list-type="simple"><list-item id="lsti0005"><label>•</label><p>Lymphedema resulting from dynamic or mechanical changes of the lymphatic system.</p></list-item><list-item id="lsti0010"><label>•</label><p>Trauma surgery is possible to develop lymphedema.</p></list-item><list-item id="lsti0015"><label>•</label><p>Intensive treatment reduce the volume of leg edema prior to a surgery to replace a hip prosthesis in a patient with grade II leg lymphedema.</p></list-item></list></p></abstract><abstract id="abs0010"><sec><title>Introduction</title><p>The treatment of lymphedema remains a challenge to modern medicine, due to the characteristics of the disease.</p></sec><sec><title>Case Presentation</title><p>Report on the case of a 75-year-old patient with lower limb lymphedema for treatment prior to surgery. At age 45, he made the first hip replacement surgery in the left leg. One year later he performed the same surgery on the right leg. At that time his legs had slight ankle edema mainly of the left leg and the entire left leg was affected by lymphedema. At 68 years old the patient returned to the surgeon, who indicated a third surgery to replace the left hip prosthesis. The patient was evaluated by bioimpedance, which measured the volumes of right and left legs at 5.52 and 7.24 l, respectively. Five days of intensive treatment were proposed using Mechanical Lymphatic Therapy (RAGodoy<sup>®</sup>), Manual Lymphatic Therapy and compression therapy with a grosgrain stocking for 24 h per day. On the fifth day, there was significant improvement in the volume (right leg 4.45 l and left leg 5.57 l).</p></sec><sec><title>Discussion</title><p>In this case report intensive treatment was used to reduce the volume of leg edema prior to a surgery to replace a hip prosthesis in a patient with grade II leg lymphedema. Small positive and negative changes, which are common in the evolution of this type of case but the end result was a total reduction of the edema.</p></sec><sec><title>Conclusion</title><p>The patient underwent surgery to replace the prosthesis after total reduction of edema.</p></sec></abstract><kwd-group id="kwd0005"><title>Keywords</title><kwd>Lymphedema</kwd><kwd>Joint prosthesis</kwd><kwd>Treatment</kwd></kwd-group></article-meta></front><body><sec id="sec0005"><label>1</label><title>Introduction</title><p>The treatment of lymphedema remains a challenge to modern medicine, due to the characteristics of the disease. Lymphedema predominantly affects poor populations, usually there is no cure and there are few therapeutic options in the public and private healthcare sectors. This situation is exacerbated in less developed countries where the lack of government resources and specialized health professionals has led to the marginalization of the disease <xref rid="bib0005" ref-type="bibr">[1]</xref>.</p><p>Lymphedema is an accumulation of water, salts, electrolytes, high molecular weight proteins and other elements in the interstitial space resulting from dynamic or mechanical changes of the lymphatic system that lead to a progressive increase in the volume of an extremity or body region with decreased functional and immunological capacity, weight gain and morphological changes <xref rid="bib0010" ref-type="bibr">[2]</xref>.</p><p>A combination of therapies is recommended in the treatment of lymphedema, with the three most important being myolymphokinetic exercises, lymphatic drainage and compression therapy <xref rid="bib0005" ref-type="bibr">[1]</xref>, <xref rid="bib0015" ref-type="bibr">[3]</xref>. Myolymphokinetic exercises cause muscle movements that stimulate the veno-lymphatic return and under certain conditions help to reduce the volume of lymphedema, particularly when the movements are assisted <xref rid="bib0020" ref-type="bibr">[4]</xref>.</p><p>The aim of this study was to evaluate the use of intensive treatment using Mechanical Lymphatic Therapy associated to grosgrain compression therapy to reduce leg volume of a patient with grade II leg lymphedema before his third hip surgery to replace an artificial hip.</p></sec><sec id="sec0010"><title>Case report</title><p>The case of a 75-year-old patient with leg lymphedema is reported. The patient was referred to the Clinica Godoy in Sao Jose do Rio Preto to treat lymphedema in June 2012. That patient was born with hip luxation and always walked with a limp. At age 45, he went to an orthopedic doctor complaining of pain in the left hip. An examination of the joint was performed, and osteoarthritis of the hip was diagnosed; hip replacement surgery was indicated. One year later he performed the same surgery on the right leg.</p><p>At that time he noticed that his legs had slight ankle edema, mainly of the left leg. In 2011 the entire left leg was affected by lymphedema. After two years he visited a vascular specialist complaining of pain and swelling. An ultrasound was performed which diagnosed only edema. The patient was advised to use an elastic knee-length stocking.</p><p>In 2005, he began to experience moderate pain of around 5 on a scale of 0–10 in the left knee and hip. After consulting the orthopedic doctor, osteoarthritis of the left knee joint was diagnosed.</p><p>In 2011, the entire left leg was affected by edema and the joint pain had increased in intensity, albeit intermittently, at around 8 on a scale of 0–10. The patient returned to the orthopedist, who recommended a third surgery to replace the left hip prosthesis however the patient was referred to a specialist to treat the edema before the surgery.</p><p>At the clinica Godoy the patient was diagnosed with lymphedema of both legs. On evaluating by bioimpedance (body composition analyzer InBody S10 – BioSpace, Seoul, Korea), the volumes of the right and left legs were 5.52 and 7.24 l, respectively.</p><p>The patient was submitted to intensive treatment for five consecutive days. Treatment consisted of Mechanical Lymphatic Therapy (RAGodoy<sup>®</sup>) for 8 h/day, Manual Lymphatic Therapy (one hour daily) and a low-stretch compression stocking (grosgrain) worn continuously for 24 h/day with adjustments being made daily. There was significant improvement by the fifth day with the volume of the right leg dropping to 4.45 l and of the left leg to 5.57 l. The patient was discharged and advised to continue wearing the grosgrain stocking and walking to maintain the results. In this period, he was followed up on an outpatient basis, and during the subsequent three months he had a continuous improvement reducing the volume of the right leg to 4.14 l and of the left leg to 4.16 l (<xref rid="tbl0005" ref-type="table">Table 1</xref>). Soon after the edema was normalized bilaterally, he was submitted to surgery.</p><p>This study was approved by the Research Ethics Committee of FAMERP (# 200264-11/12/12) and the participant gave his informed consent.</p></sec><sec id="sec0015"><label>2</label><title>Discussion</title><p>In this case report intensive treatment was used to reduce the volume of leg edema prior to a surgery to replace a hip prosthesis in a patient with grade II leg lymphedema. Five days of intensive treatment significantly reduced the size of both legs. After this, the reduction in leg volume continued until the surgery was scheduled. The maintenance of the results and further reductions were supervised on a continuous outpatient basis; fortnightly or monthly monitoring is essential. Small positive and negative changes, which are common in the evolution of this type of case, were observed but the end result was a total reduction of the edema. In the literature, there are no reports of this type of approach being used in the preoperative period to prepare a patient for surgery.</p><p>Intensive treatment in this case was based on the association of Mechanical Lymphatic Therapy (RAGodoy<sup>®</sup>) for about 8 h daily, Manual Lymphatic Therapy for one hour and grosgrain compression stockings worn continuously (24 h/day). The RAGodoy<sup>®</sup> mechanical drainage device reproduces the physiological movements of the muscles of the calf and foot. The calf muscles function as a venous and lymphatic ‘pseudo-heart’, as external forces help the contraction mechanism of the lymphatic vessels and stimulate contractions of lymphangions. Muscle activity is critical in natural lymph drainage.</p><p>This approach not only significantly reduced the edema, but also controlled muscular trophism and joint mobility because of the dorsiflexion motion provided by the mechanical lymphatic drainage device.</p><p>Mechanical lymph drainage is critical to rapidly reduce limb volume, but compression is necessary to maintain the results. The use of inelastic compression is indicated to treat lymphedema because of the working pressures caused by muscle activity that favor drainage. It is important to educate patients about the need to use well-adjusted compression mechanisms during exercising and daily activities. The mechanism used must be correctly adjusted to avoid any discomfort, pain or pinching of the skin.</p><p>Mechanical Lymphatic Therapy (RAGodoy<sup>®</sup>) associated with low-stretch compression mechanisms, such as grosgrain stockings, has a synergistic effect in reducing the volume of lymphedematous limbs. The association of active programmed exercises with low-stretch stockings may have a synergistic effect in reducing limb volume. It is possible to reduce the limb volume to normal or near to normal and maintain the reductions by keeping the compression stocking well-adjusted.</p><p>Lymphedema treatment prior to the occurrence of an orthopedic surgery no is related in the literature.</p><p>The treatment of lymphedema before orthopedic surgery can reduce the fibrosis and facilitating surgery.</p><p>Therefore this study presents a new therapeutic option for these patients and a way to reduce complications.</p></sec><sec id="sec0020"><title>Competing interests</title><p>The authors declare that they have no competing interests (political, personal, religious, ideological, academic, intellectual, commercial or any other) in relation to this manuscript.</p></sec><sec id="sec0025"><title>Ethical approval</title><p>The study was approved by the Ethical Committee of FAMERP (# 200264-11/12/12) and the participant gave his informed consent.</p></sec><sec id="sec0030"><title>Consent</title><p>The participant gave his informed consent and signed.</p></sec><sec id="sec0035"><title>Financial support</title><p>All authors declared don’t have financial support for this research.</p></sec><sec id="sec0040"><title><bold>Authors</bold>’ contributions</title><p>All authors participated and contributed to all phases of the study.</p></sec><sec id="sec0045"><title>Guarantor</title><p>Prof. Maria de Fátima Guerreiro Godoy.</p></sec></body><back><ref-list id="bibl0005"><title>References</title><ref id="bib0005"><label>1</label><element-citation publication-type="journal" id="sbref0005"><person-group person-group-type="author"><name><surname>Godoy</surname><given-names>J.M.</given-names></name><name><surname>Godoy</surname><given-names>M.F.</given-names></name></person-group><article-title>Godoy & Godoy technique in the treatment of lymphedema for under-privileged populations</article-title><source>Int. J. Med. Sci.</source><volume>7</volume><issue>2</issue><year>2010</year><fpage>68</fpage><lpage>71</lpage><pub-id pub-id-type="pmid">20428336</pub-id></element-citation></ref><ref id="bib0010"><label>2</label><element-citation publication-type="journal" id="sbref0010"><person-group person-group-type="author"><name><surname>de Godoy</surname><given-names>Jose Maria Pereira</given-names></name><name><surname>Andrade</surname><given-names>Mauro</given-names></name><name><surname>Azevedo</surname><given-names>Walter Ferreira</given-names><suffix>Jr.</suffix></name></person-group><article-title>IV Latin American consensus on the treatment of lymphedema</article-title><source>J. Phlebol. Lymphol.</source><volume>4</volume><issue>November</issue><year>2011</year><fpage>13</fpage><lpage>16</lpage></element-citation></ref><ref id="bib0015"><label>3</label><element-citation publication-type="journal" id="sbref0015"><person-group person-group-type="author"><name><surname>Lee</surname><given-names>B.</given-names></name><name><surname>Andrade</surname><given-names>M.</given-names></name><name><surname>Bergan</surname><given-names>J.</given-names></name></person-group><article-title>International Union of Phlebology. Diagnosis and treatment of primary lymphedema. Consensus document of the International Union of Phlebology (IUP)-2009</article-title><source>Int. Angiol.</source><volume>29</volume><issue>October (5)</issue><year>2010</year><fpage>454</fpage><lpage>470</lpage><pub-id pub-id-type="pmid">20924350</pub-id></element-citation></ref><ref id="bib0020"><label>4</label><element-citation publication-type="journal" id="sbref0020"><person-group person-group-type="author"><name><surname>de Godoy</surname><given-names>J.M.</given-names></name><name><surname>Godoy</surname><given-names>M.</given-names></name><name><surname>de</surname><given-names>F.</given-names></name></person-group><article-title>Development and evaluation of a new apparatus for lymph drainage: preliminary results</article-title><source>Lymphology</source><volume>37</volume><issue>June (2)</issue><year>2004</year><fpage>62</fpage><lpage>64</lpage><pub-id pub-id-type="pmid">15328758</pub-id></element-citation></ref></ref-list></back><floats-group><table-wrap id="tbl0005" position="float"><label>Table 1</label><caption><p>Volume measured by bioimpedance before starting daily sessions and during the follow up.</p></caption><alt-text id="at0255">Table 1</alt-text><table frame="hsides" rules="groups"><thead><tr><th align="left">Date</th><th align="left">Left leg</th><th align="left">Right leg</th></tr></thead><tbody><tr><td align="left">25/06/12</td><td align="left">5.52</td><td align="left">7.24</td></tr><tr><td align="left">26/06/12</td><td align="left">4.93</td><td align="left">6.34</td></tr><tr><td align="left">27/06/12</td><td align="left">4.45</td><td align="left">5.57</td></tr><tr><td align="left">02/07/12</td><td align="left">4.35</td><td align="left">4.71</td></tr><tr><td align="left">06/07/12</td><td align="left">3.85</td><td align="left">4.59</td></tr><tr><td align="left">12/07/12</td><td align="left">3.95</td><td align="left">3.94</td></tr><tr><td align="left">27/07/12</td><td align="left">4.04</td><td align="left">4.08</td></tr><tr><td align="left">17/08/12</td><td align="left">4.07</td><td align="left">3.86</td></tr><tr><td align="left">17/09/12</td><td align="left">4.14</td><td align="left">4.16</td></tr></tbody></table></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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