Hereditary Lymphedema of the Leg – A Case Report
Identifieur interne : 002359 ( Pmc/Corpus ); précédent : 002358; suivant : 002360Hereditary Lymphedema of the Leg – A Case Report
Auteurs : Birgit Heinig ; Torello Lotti ; Georgi Tchernev ; Uwe WollinaSource :
- Open Access Macedonian Journal of Medical Sciences [ 1857-9655 ] ; 2017.
Abstract
Primary of hereditary lymphedema is a rare but progressive disease. It is yet not curable. We present a 48-year-old male patient with hereditary lymphedema of his left leg, that was realised by minor trauma (able twist) when he was seven years old. He had never been treated for lymphedema but experienced multiple erysipelas during his life. After diagnostic procedures to exclude other causes of leg swelling, the diagnosis of hereditary lymphedema of the leg, stage III was confirmed. We initialized complex decongestive therapy. During two weeks of intensive treatment, the circumference of the left leg could be reduced by 10 cm. This case illustrates the “natural course” hereditary lymphedema. But it raises the hope that even after decades of ignorance, the patients benefits from complex decongestive treatment. Therapeutic nihilism is unnecessary and poses lymphedema patients to risks of infection and secondary malignancies like Stewart-Trewes syndrome.
Url:
DOI: 10.3889/oamjms.2017.082
PubMed: 28785330
PubMed Central: 5535655
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Hereditary Lymphedema of the Leg – A Case Report</title><author><name sortKey="Heinig, Birgit" sort="Heinig, Birgit" uniqKey="Heinig B" first="Birgit" last="Heinig">Birgit Heinig</name><affiliation><nlm:aff id="aff1"><italic>Center of Physical and Rehabilitative Medicine, Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany</italic></nlm:aff></affiliation></author><author><name sortKey="Lotti, Torello" sort="Lotti, Torello" uniqKey="Lotti T" first="Torello" last="Lotti">Torello Lotti</name><affiliation><nlm:aff id="aff2"><italic>Department of Dermatology, University of Rome “G. Marconi”, Rome, Italy; Department of Biotechnology, Delft University of Technology, 2628 BC, Delft, The Netherlands</italic></nlm:aff></affiliation></author><author><name sortKey="Tchernev, Georgi" sort="Tchernev, Georgi" uniqKey="Tchernev G" first="Georgi" last="Tchernev">Georgi Tchernev</name><affiliation><nlm:aff id="aff3"><italic>Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior, and Onkoderma Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria</italic></nlm:aff></affiliation></author><author><name sortKey="Wollina, Uwe" sort="Wollina, Uwe" uniqKey="Wollina U" first="Uwe" last="Wollina">Uwe Wollina</name><affiliation><nlm:aff id="aff4"><italic>Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany</italic></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28785330</idno><idno type="pmc">5535655</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5535655</idno><idno type="RBID">PMC:5535655</idno><idno type="doi">10.3889/oamjms.2017.082</idno><date when="2017">2017</date><idno type="wicri:Area/Pmc/Corpus">002359</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002359</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Hereditary Lymphedema of the Leg – A Case Report</title><author><name sortKey="Heinig, Birgit" sort="Heinig, Birgit" uniqKey="Heinig B" first="Birgit" last="Heinig">Birgit Heinig</name><affiliation><nlm:aff id="aff1"><italic>Center of Physical and Rehabilitative Medicine, Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany</italic></nlm:aff></affiliation></author><author><name sortKey="Lotti, Torello" sort="Lotti, Torello" uniqKey="Lotti T" first="Torello" last="Lotti">Torello Lotti</name><affiliation><nlm:aff id="aff2"><italic>Department of Dermatology, University of Rome “G. Marconi”, Rome, Italy; Department of Biotechnology, Delft University of Technology, 2628 BC, Delft, The Netherlands</italic></nlm:aff></affiliation></author><author><name sortKey="Tchernev, Georgi" sort="Tchernev, Georgi" uniqKey="Tchernev G" first="Georgi" last="Tchernev">Georgi Tchernev</name><affiliation><nlm:aff id="aff3"><italic>Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior, and Onkoderma Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria</italic></nlm:aff></affiliation></author><author><name sortKey="Wollina, Uwe" sort="Wollina, Uwe" uniqKey="Wollina U" first="Uwe" last="Wollina">Uwe Wollina</name><affiliation><nlm:aff id="aff4"><italic>Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany</italic></nlm:aff></affiliation></author></analytic><series><title level="j">Open Access Macedonian Journal of Medical Sciences</title><idno type="eISSN">1857-9655</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Primary of hereditary lymphedema is a rare but progressive disease. It is yet not curable. We present a 48-year-old male patient with hereditary lymphedema of his left leg, that was realised by minor trauma (able twist) when he was seven years old. He had never been treated for lymphedema but experienced multiple erysipelas during his life. After diagnostic procedures to exclude other causes of leg swelling, the diagnosis of hereditary lymphedema of the leg, stage III was confirmed. We initialized complex decongestive therapy. During two weeks of intensive treatment, the circumference of the left leg could be reduced by 10 cm. This case illustrates the “natural course” hereditary lymphedema. But it raises the hope that even after decades of ignorance, the patients benefits from complex decongestive treatment. Therapeutic nihilism is unnecessary and poses lymphedema patients to risks of infection and secondary malignancies like Stewart-Trewes syndrome.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Schook, Cc" uniqKey="Schook C">CC Schook</name></author><author><name sortKey="Mulliken, Jb" uniqKey="Mulliken J">JB Mulliken</name></author><author><name sortKey="Fishman, Sj" uniqKey="Fishman S">SJ Fishman</name></author><author><name sortKey="Grant, Fd" uniqKey="Grant F">FD Grant</name></author><author><name sortKey="Zurakowski, D" uniqKey="Zurakowski D">D Zurakowski</name></author><author><name sortKey="Greene, Ak" uniqKey="Greene A">AK Greene</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Soran, A" uniqKey="Soran A">A Soran</name></author><author><name sortKey="Ozmen, T" uniqKey="Ozmen T">T Ozmen</name></author><author><name sortKey="Mcguire, Kp" uniqKey="Mcguire K">KP McGuire</name></author><author><name sortKey="Diego, Ej" uniqKey="Diego E">EJ Diego</name></author><author><name sortKey="Mcauliffe, Pf" uniqKey="Mcauliffe P">PF McAuliffe</name></author><author><name sortKey="Bonaventura, M" uniqKey="Bonaventura M">M Bonaventura</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lindqvist, E" uniqKey="Lindqvist E">E Lindqvist</name></author><author><name sortKey="Wedin, M" uniqKey="Wedin M">M Wedin</name></author><author><name sortKey="Fredrikson, M" uniqKey="Fredrikson M">M Fredrikson</name></author><author><name sortKey="Kj Lhede, P" uniqKey="Kj Lhede P">P Kjølhede</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ruocco, E" uniqKey="Ruocco E">E Ruocco</name></author><author><name sortKey="Puca, Rv" uniqKey="Puca R">RV Puca</name></author><author><name sortKey="Brunetti, G" uniqKey="Brunetti G">G Brunetti</name></author><author><name sortKey="Schwartz, Ra" uniqKey="Schwartz R">RA Schwartz</name></author><author><name sortKey="Ruocco, V" uniqKey="Ruocco V">V Ruocco</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Brouillard, P" uniqKey="Brouillard P">P Brouillard</name></author><author><name sortKey="Boon, L" uniqKey="Boon L">L Boon</name></author><author><name sortKey="Vikkula, M" uniqKey="Vikkula M">M Vikkula</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cohen, Md" uniqKey="Cohen M">MD Cohen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Heinig, B" uniqKey="Heinig B">B Heinig</name></author><author><name sortKey="Wollina, U" uniqKey="Wollina U">U Wollina</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Carl, Hm" uniqKey="Carl H">HM Carl</name></author><author><name sortKey="Walia, G" uniqKey="Walia G">G Walia</name></author><author><name sortKey="Bello, R" uniqKey="Bello R">R Bello</name></author><author><name sortKey="Clarke Pearson, E" uniqKey="Clarke Pearson E">E Clarke-Pearson</name></author><author><name sortKey="Hassanein, Ah" uniqKey="Hassanein A">AH Hassanein</name></author><author><name sortKey="Cho, B" uniqKey="Cho B">B Cho</name></author><author><name sortKey="Pedreira, R" uniqKey="Pedreira R">R Pedreira</name></author><author><name sortKey="Sacks, Jm" uniqKey="Sacks J">JM Sacks</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wollina, U" uniqKey="Wollina U">U Wollina</name></author><author><name sortKey="Heinig, B" uniqKey="Heinig B">B Heinig</name></author><author><name sortKey="Schonlebe, J" uniqKey="Schonlebe J">J Schönlebe</name></author><author><name sortKey="Nowak, A" uniqKey="Nowak A">A Nowak</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">Open Access Maced J Med Sci</journal-id><journal-id journal-id-type="iso-abbrev">Open Access Maced J Med Sci</journal-id><journal-title-group><journal-title>Open Access Macedonian Journal of Medical Sciences</journal-title></journal-title-group><issn pub-type="epub">1857-9655</issn><publisher><publisher-name>ID Design 2012/DOOEL Skopje</publisher-name><publisher-loc>Republic of Macedonia</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28785330</article-id><article-id pub-id-type="pmc">5535655</article-id><article-id pub-id-type="publisher-id">OAMJMS-5-451</article-id><article-id pub-id-type="doi">10.3889/oamjms.2017.082</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Hereditary Lymphedema of the Leg – A Case Report</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Heinig</surname><given-names>Birgit</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Lotti</surname><given-names>Torello</given-names></name><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Tchernev</surname><given-names>Georgi</given-names></name><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Wollina</surname><given-names>Uwe</given-names></name><xref ref-type="aff" rid="aff4">4</xref><xref ref-type="corresp" rid="cor1">*</xref></contrib></contrib-group><aff id="aff1"><label>1</label><italic>Center of Physical and Rehabilitative Medicine, Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany</italic></aff><aff id="aff2"><label>2</label><italic>Department of Dermatology, University of Rome “G. Marconi”, Rome, Italy; Department of Biotechnology, Delft University of Technology, 2628 BC, Delft, The Netherlands</italic></aff><aff id="aff3"><label>3</label><italic>Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior, and Onkoderma Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria</italic></aff><aff id="aff4"><label>4</label><italic>Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany</italic></aff><author-notes><corresp id="cor1"><label>*</label><bold>Correspondence:</bold> Uwe Wollina. Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany. E-mail: <email xlink:href="uwollina@googlemail.com">uwollina@googlemail.com</email></corresp></author-notes><pub-date pub-type="collection"><day>25</day><month>7</month><year>2017</year></pub-date><pub-date pub-type="epub"><day>19</day><month>7</month><year>2017</year></pub-date><volume>5</volume><issue>4</issue><fpage>451</fpage><lpage>453</lpage><history><date date-type="received"><day>25</day><month>5</month><year>2017</year></date><date date-type="rev-recd"><day>21</day><month>4</month><year>2017</year></date><date date-type="accepted"><day>26</day><month>4</month><year>2017</year></date></history><permissions><copyright-statement>Copyright: © 2017 Birgit Heinig, Torello Lotti, Georgi Tchernev, Uwe Wollina.</copyright-statement><copyright-year>2017</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/CC BY-NC/4.0"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).</license-p></license></permissions><abstract><p>Primary of hereditary lymphedema is a rare but progressive disease. It is yet not curable. We present a 48-year-old male patient with hereditary lymphedema of his left leg, that was realised by minor trauma (able twist) when he was seven years old. He had never been treated for lymphedema but experienced multiple erysipelas during his life. After diagnostic procedures to exclude other causes of leg swelling, the diagnosis of hereditary lymphedema of the leg, stage III was confirmed. We initialized complex decongestive therapy. During two weeks of intensive treatment, the circumference of the left leg could be reduced by 10 cm. This case illustrates the “natural course” hereditary lymphedema. But it raises the hope that even after decades of ignorance, the patients benefits from complex decongestive treatment. Therapeutic nihilism is unnecessary and poses lymphedema patients to risks of infection and secondary malignancies like Stewart-Trewes syndrome.</p></abstract><kwd-group><kwd>Primary lymphedema</kwd><kwd>Secondary lymphedema</kwd><kwd>Complex decongestive therapy</kwd><kwd>Immunocompromised district</kwd><kwd>Erysipelas</kwd><kwd>Fibrosis</kwd><kwd>Elephantiasis nostra</kwd></kwd-group></article-meta></front><body><sec sec-type="intro" id="sec1-1"><title>Introduction</title><p>Primary or congenital lymphedema is a rare disorder. It occurs 1 in 100 000 persons affecting in < 90 % of cases the lower limbs [<xref rid="ref1" ref-type="bibr">1</xref>]. Primary lymphedema may be present at birth or sometimes develop year’s later - also called lymphedema tardum. Secondary lymphedema is seen more often after an injury to lymphatic vessels and lymph nodes – a common problem in certain cancer treatment protocols like in breast or endometrial cancer [<xref rid="ref2" ref-type="bibr">2</xref>, <xref rid="ref3" ref-type="bibr">3</xref>].</p><p>Primary lymphedema is a progressive, not-curable disease. Subcutaneous enlargement of fibro-adipous tissue leads to progressive limb swelling, loss of functionality, mobility and quality of life. Lymphedematous skin is an immunocompromised district predisposing to infection and tumours [<xref rid="ref4" ref-type="bibr">4</xref>].</p></sec><sec id="sec1-2"><title>Case report</title><p>A 48-year-old male patient presented with a swelling of his left leg. He had a medical history of multiple erysipelas of the same leg and an ankle twist when he was 7-year-old. Despite antibiosis, he had never had diagnostics or treatments before.</p><p>On examination, we observed men without any signs of cardiopulmonary decompensation. He had neither inguinal lymphadenopathy nor a total involvement of the oedema. There were no sensorimotoric deficiencies.</p><p>There was a collum-like pasty oedema of his left leg, pressable on the upper leg but impressable on the lower leg. The distal lower leg was further characterised by fibrosis, pachydermia, and hyperkeratosis left leg. There was a dewlap-like disfiguration of soft tissue in the ankle region (<xref ref-type="fig" rid="F1">Fig. 1a</xref>). Foot and toes were edematous with a positive Stemmer sign. The interdigital skin was macerated.</p><fig id="F1" position="float"><label>Figure 1</label><caption><p>Hereditary lymphedema of the left leg. (a) Before treatment, (b) After two weeks intensive complex decongestive treatment</p></caption><graphic xlink:href="OAMJMS-5-451-g001"></graphic></fig><p>Routine laboratory was unremarkable.</p><p>Imaging: Color Duplex sonography demonstrated normal venous and arterial blood flow without any signs of recent or previous thrombosis.</p><p>X-ray of feet disclosed degenerative changes of the proximal joint of digitus I on both feet and edematous soft tissue changes (<xref ref-type="fig" rid="F2">Fig. 2a</xref>, <xref ref-type="fig" rid="F2">Fig. 2b</xref>). Abdominal ultrasound remained unremarkable.</p><fig id="F2" position="float"><label>Figure 2</label><caption><p>X-ray of feet: (a) left side with edematous changes of soft tissue, (b) right side. Arthrosis of Dig. I proximal joints on both sides</p></caption><graphic xlink:href="OAMJMS-5-451-g002"></graphic></fig><p>We diagnosed hereditary lymphedema of the left leg, stage III.</p><p>Treatment and course: We started with manual decongestive therapy (manual lymph drainage for the left leg combined with padded short stretch bandages and manual mobilisation of the left ankle. Topical interdigital treatment consisted of nystatin zinc-oil. During 15 days of inpatient complex decongestive therapy, there was a reduction of leg circumferences of 10 cm (<xref ref-type="fig" rid="F1">Fig. 1b</xref>). Outpatient treatment was continued. Bandaging was replaced by flat knitted socks for the upper leg (compression class II) and flat knitted socks for lower leg and foot (compression class III).</p></sec><sec sec-type="discussion" id="sec1-3"><title>Discussion</title><p>The patient suffered from an ankle twist at the age of seven. After that a persistent swelling oft he left leg developed. The trauma caused an overload for his lymphatic vessels. Usually, no lymphedema develops, but in the case of a predisposition with congenital malformation of lymphatic vessels, any trauma may realise the genetic disposition. His course was characterised by ignorance of lymphedema and absence of any treatment. This predisposed him to an increased risk of streptococcal soft tissue infections (erysipelas). The possible enters forte for germs is the intertriginous dermatitis of the interdigital space.</p><p>In primary (congenital) lymphedema germline mutations of at least 20 different genes have been identified which are enoding for protein interacting with vascular endothelial growth factor (VEGF) receptor-3 or with other tyrosin kinases. These mutations act on RAS/MAPK or PI3/AKT signal transduction [<xref rid="ref5" ref-type="bibr">5</xref>].</p><p>There is yeat no cure for hereditary lymphedema. Complex decongestive therapy is considered the major approach. However, sufficient muscular-joint interactions are important for decongestion as well [<xref rid="ref6" ref-type="bibr">6</xref>].</p><p>Our case report demonstrates that (a) therapeutic nihilism is contra productive and (b) even in longstanding lymphedema complex decongestive therapy is an effective treatment [<xref rid="ref7" ref-type="bibr">7</xref>]. Surgical treatments include liposuction, lymphodemous anastomosis, vascularized lymph node transfer, and combined/multiple approaches. These methods are limited to a minority of patients [<xref rid="ref8" ref-type="bibr">8</xref>].</p><p>Debulking soft tissue resection can become necessary in case of major fibrosis according to elephantiasis nostras with formation of immature lacune-like lymphatic vessels and massive fibrosis [<xref rid="ref9" ref-type="bibr">9</xref>]</p></sec></body><back><fn-group><fn fn-type="supported-by"><p><bold>Funding:</bold> This research did not receive any financial support.</p></fn><fn fn-type="other"><p><bold>Competing Interests:</bold> The authors have declared that no competing interests exist.</p></fn></fn-group><ref-list><title>References</title><ref id="ref1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Schook</surname><given-names>CC</given-names></name><name><surname>Mulliken</surname><given-names>JB</given-names></name><name><surname>Fishman</surname><given-names>SJ</given-names></name><name><surname>Grant</surname><given-names>FD</given-names></name><name><surname>Zurakowski</surname><given-names>D</given-names></name><name><surname>Greene</surname><given-names>AK</given-names></name></person-group><article-title>Primary lymphedema:clinical features and management in 138 pediatric patients</article-title><source>Plast Reconstr Surg</source><year>2011</year><volume>127</volume><fpage>2419</fpage><lpage>2431</lpage><comment>https://doi.org/10.1097/PRS.0b013e318213a218 PMid:21617474</comment><pub-id pub-id-type="pmid">21617474</pub-id></element-citation></ref><ref id="ref2"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Soran</surname><given-names>A</given-names></name><name><surname>Ozmen</surname><given-names>T</given-names></name><name><surname>McGuire</surname><given-names>KP</given-names></name><name><surname>Diego</surname><given-names>EJ</given-names></name><name><surname>McAuliffe</surname><given-names>PF</given-names></name><name><surname>Bonaventura</surname><given-names>M</given-names></name><etal></etal></person-group><article-title>The importance of detection of subclinical lymphedema for the prevention of breast cancer-related clinical lymphedema after axillary lymph node dissection;a prospective observational study</article-title><source>Lymphat Res Biol</source><year>2014</year><volume>12</volume><fpage>289</fpage><lpage>294</lpage><comment>https://doi.org/10.1089/lrb.2014.0035 PMid:25495384</comment><pub-id pub-id-type="pmid">25495384</pub-id></element-citation></ref><ref id="ref3"><label>3</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Lindqvist</surname><given-names>E</given-names></name><name><surname>Wedin</surname><given-names>M</given-names></name><name><surname>Fredrikson</surname><given-names>M</given-names></name><name><surname>Kjølhede</surname><given-names>P</given-names></name></person-group><article-title>Lymphedema after treatment for endometrial cancer - A review of prevalence and risk factors</article-title><source>Eur J Obstet Gynecol Reprod Biol</source><year>2017</year><volume>211</volume><fpage>112</fpage><lpage>121</lpage><comment>https://doi.org/10.1016/j.ejogrb.2017.02.021 PMid:28242470</comment><pub-id pub-id-type="pmid">28242470</pub-id></element-citation></ref><ref id="ref4"><label>4</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ruocco</surname><given-names>E</given-names></name><name><surname>Puca</surname><given-names>RV</given-names></name><name><surname>Brunetti</surname><given-names>G</given-names></name><name><surname>Schwartz</surname><given-names>RA</given-names></name><name><surname>Ruocco</surname><given-names>V</given-names></name></person-group><article-title>Lymphedematous areas:privileged sites for tumors, infections, and immune disorders</article-title><source>Int J Dermatol</source><year>2007</year><volume>46</volume><fpage>662</fpage><comment>https://doi.org/10.1111/j.1365-4632.2007.03244.x PMid:17550576</comment><pub-id pub-id-type="pmid">17550576</pub-id></element-citation></ref><ref id="ref5"><label>5</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Brouillard</surname><given-names>P</given-names></name><name><surname>Boon</surname><given-names>L</given-names></name><name><surname>Vikkula</surname><given-names>M</given-names></name></person-group><article-title>Genetics of lymphatic anomalies</article-title><source>J Clin Invest</source><year>2014</year><volume>124</volume><fpage>898</fpage><lpage>904</lpage><comment>https://doi.org/10.1172/JCI71614 PMid:24590274 PMCid:PMC3938256</comment><pub-id pub-id-type="pmid">24590274</pub-id></element-citation></ref><ref id="ref6"><label>6</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Cohen</surname><given-names>MD</given-names></name></person-group><article-title>Complete decongestive physical therapy in a patient with secondary lymphedema due to orthopedic trauma and surgery of the lower extremity</article-title><source>Phys Ther</source><year>2011</year><volume>91</volume><fpage>1618</fpage><lpage>1626</lpage><comment>https://doi.org/10.2522/ptj.20100101 PMid:2186↣</comment><pub-id pub-id-type="pmid">21868611</pub-id></element-citation></ref><ref id="ref7"><label>7</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Heinig</surname><given-names>B</given-names></name><name><surname>Wollina</surname><given-names>U</given-names></name></person-group><article-title>Complex decongestive therapy</article-title><source>Hautarzt</source><year>2015</year><volume>66</volume><fpage>810</fpage><lpage>818</lpage><comment>https://doi.org/10.1007/s00105-015-3674-1 PMid:26315101</comment><pub-id pub-id-type="pmid">26315101</pub-id></element-citation></ref><ref id="ref8"><label>8</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Carl</surname><given-names>HM</given-names></name><name><surname>Walia</surname><given-names>G</given-names></name><name><surname>Bello</surname><given-names>R</given-names></name><name><surname>Clarke-Pearson</surname><given-names>E</given-names></name><name><surname>Hassanein</surname><given-names>AH</given-names></name><name><surname>Cho</surname><given-names>B</given-names></name><name><surname>Pedreira</surname><given-names>R</given-names></name><name><surname>Sacks</surname><given-names>JM</given-names></name></person-group><article-title>Systematic review of the surgical treatment of extremity lymphedema</article-title><source>J Reconstr Microsurg</source><year>2017</year><comment>doi:10.1055/s-0037-1599100. https://doi.org/10.1055/s-0037-1599100</comment></element-citation></ref><ref id="ref9"><label>9</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wollina</surname><given-names>U</given-names></name><name><surname>Heinig</surname><given-names>B</given-names></name><name><surname>Schönlebe</surname><given-names>J</given-names></name><name><surname>Nowak</surname><given-names>A</given-names></name></person-group><article-title>Debulking surgery for elephantiasis nostras with large ectatic podoplanin-negative lymphatic vessels in patients with lipo-lymphedema</article-title><source>Eplasty</source><year>2014</year><volume>14</volume><fpage>e11</fpage><comment>PMid:24741382 PMCid:PMC3944717</comment><pub-id pub-id-type="pmid">24741382</pub-id></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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