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Published in: European Radiology 7/2004

01-07-2004 | Vascular-interventional

Diagnosis and management of deep vein thrombosis of the upper extremity: a review

Authors: Henk J. Baarslag, Maria M. W. Koopman, Jim A. Reekers, Edwin J. R. van Beek

Published in: European Radiology | Issue 7/2004

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Abstract

Deep vein thrombosis of the upper extremity is an increasing clinical problem due to the use of long-term indwelling catheters for chemotherapy or long-term feeding. The clinical diagnosis is difficult to make, and various imaging modalities have been used for this purpose. The use of (interventional) radiological procedures has been advancing in recent years. This review describes the clinical background, the imaging modalities that may be employed, treatment options and outcome of patients with upper extremity thrombosis.
Literature
1.
go back to reference Leebeek FW, Kappers-Klunne MC, Gomez-Garcia EB (2000) Deep venous thrombosis of the arm: etiology, diagnosis and treatment. Neth J Med 144:361–364 Leebeek FW, Kappers-Klunne MC, Gomez-Garcia EB (2000) Deep venous thrombosis of the arm: etiology, diagnosis and treatment. Neth J Med 144:361–364
2.
go back to reference Rutherford RB, Hurlbert SN (1996) Primary subclavian-axillary vein thrombosis: consensus and commentary. Cardiovasc Surg 4:420–423PubMed Rutherford RB, Hurlbert SN (1996) Primary subclavian-axillary vein thrombosis: consensus and commentary. Cardiovasc Surg 4:420–423PubMed
3.
go back to reference Hung SSJ (1989) Deep vein thrombosis of the arm associated with malignancy. Cancer 64:531–535PubMed Hung SSJ (1989) Deep vein thrombosis of the arm associated with malignancy. Cancer 64:531–535PubMed
4.
go back to reference Kooy JBD, van der Zant F, van Beek EJR, Beaumont-Koopman MMW, Reekers JA (1997) Pulmonary embolism complicating deep vein thrombosis of the upper extremity more commonly related to central venous catheters. Neth J Med 50:238–242PubMed Kooy JBD, van der Zant F, van Beek EJR, Beaumont-Koopman MMW, Reekers JA (1997) Pulmonary embolism complicating deep vein thrombosis of the upper extremity more commonly related to central venous catheters. Neth J Med 50:238–242PubMed
5.
go back to reference Lindblad B, Tengborn L, Bergqvist D (1988) Deep vein thrombosis of the axillary-subclavian veins: epidemiological data, effects of different types of treatment and late sequelae. Eur J Vasc Surg 2:161–165PubMed Lindblad B, Tengborn L, Bergqvist D (1988) Deep vein thrombosis of the axillary-subclavian veins: epidemiological data, effects of different types of treatment and late sequelae. Eur J Vasc Surg 2:161–165PubMed
6.
go back to reference Luciani A, Clement O, Halimi P et al (2001) Catheter-related upper extremity deep venous thrombosis in cancer patients: a prospective study based on Doppler US. Radiology 220:655–660PubMed Luciani A, Clement O, Halimi P et al (2001) Catheter-related upper extremity deep venous thrombosis in cancer patients: a prospective study based on Doppler US. Radiology 220:655–660PubMed
7.
go back to reference Baarslag HJ, van Beek EJR, Koopman MMW, Reekers JA (2002) Prospective study of color duplex ultrasonography compared with contrast venography in patients suspected of having deep venous thrombosis of the upper extremities. Ann Int Med 136:865–872PubMed Baarslag HJ, van Beek EJR, Koopman MMW, Reekers JA (2002) Prospective study of color duplex ultrasonography compared with contrast venography in patients suspected of having deep venous thrombosis of the upper extremities. Ann Int Med 136:865–872PubMed
8.
go back to reference Tilney NL, Griffiths HJG, Edwards EA (1970) Natural history of major venous thrombosis of the upper extremity. Arch Surg 101:792–796PubMed Tilney NL, Griffiths HJG, Edwards EA (1970) Natural history of major venous thrombosis of the upper extremity. Arch Surg 101:792–796PubMed
9.
go back to reference Prescott SM, Tikoff G (1979) Deep venous thrombosis of the upper extremity: a reappraisal. Circulation 59:350–355PubMed Prescott SM, Tikoff G (1979) Deep venous thrombosis of the upper extremity: a reappraisal. Circulation 59:350–355PubMed
10.
go back to reference Donayre CE, White GH, Mehringer SM, Wilson SE (1986) Pathogenesis determines late morbidity of axillosubclavian vein thrombosis. Am J Surg 152:179–184PubMed Donayre CE, White GH, Mehringer SM, Wilson SE (1986) Pathogenesis determines late morbidity of axillosubclavian vein thrombosis. Am J Surg 152:179–184PubMed
11.
go back to reference Kerr TM, Lutter KS, Moeller DM et al (1990) Upper extremity venous thrombosis diagnosed by duplex scanning. Am J Surg 160:202–206PubMed Kerr TM, Lutter KS, Moeller DM et al (1990) Upper extremity venous thrombosis diagnosed by duplex scanning. Am J Surg 160:202–206PubMed
12.
go back to reference Monreal M, Lafoz E, Ruiz J, Valls R, Alastrue A (1991) Upper-extremity deep venous thrombosis and pulmonary embolism. A prospective study. Chest 9:280–283 Monreal M, Lafoz E, Ruiz J, Valls R, Alastrue A (1991) Upper-extremity deep venous thrombosis and pulmonary embolism. A prospective study. Chest 9:280–283
13.
go back to reference Burihan E, Poli de Figueiredo LF, Francisco J, Miranda F (1993) Upper extremity deep venous thrombosis. Analysis of 52 cases. Cardiovasc Surg 1:19–22PubMed Burihan E, Poli de Figueiredo LF, Francisco J, Miranda F (1993) Upper extremity deep venous thrombosis. Analysis of 52 cases. Cardiovasc Surg 1:19–22PubMed
14.
go back to reference Prandoni P, Polistena P, Bernadi E et al (1997) Upper-extremity deep vein thrombosis. Risk factors, diagnosis, and complications. Arch Int Med 157:57–62CrossRef Prandoni P, Polistena P, Bernadi E et al (1997) Upper-extremity deep vein thrombosis. Risk factors, diagnosis, and complications. Arch Int Med 157:57–62CrossRef
15.
go back to reference Martinelli I, Cattaneo M, Panzeri D et al (1997) Risk factors for deep venous thrombosis of the upper extremities. Ann Intern Med 126:707–711PubMed Martinelli I, Cattaneo M, Panzeri D et al (1997) Risk factors for deep venous thrombosis of the upper extremities. Ann Intern Med 126:707–711PubMed
16.
go back to reference Ruggeri M, Castaman G, Tosetto A et al (1997) Low prevalence of thrombophilic coagulation defects in patients with deep vein thrombosis of the upper limbs. Blood Coagul Fibrinolysis 8:191–194PubMed Ruggeri M, Castaman G, Tosetto A et al (1997) Low prevalence of thrombophilic coagulation defects in patients with deep vein thrombosis of the upper limbs. Blood Coagul Fibrinolysis 8:191–194PubMed
17.
go back to reference Heron E, Lozinguez O, Alhenc-Gelas M et al (2000) Hypercoagulable states in primary upper-extremity deep venous thrombosis. Arch Int Med 160:382–386CrossRef Heron E, Lozinguez O, Alhenc-Gelas M et al (2000) Hypercoagulable states in primary upper-extremity deep venous thrombosis. Arch Int Med 160:382–386CrossRef
18.
go back to reference Leebeek FW, Stadhouders NA, van Stein D et al (2001) Hypercoagulability states in upper-extremity deep venous thrombosis. Am J Hematol 67:15–19CrossRefPubMed Leebeek FW, Stadhouders NA, van Stein D et al (2001) Hypercoagulability states in upper-extremity deep venous thrombosis. Am J Hematol 67:15–19CrossRefPubMed
19.
go back to reference Kuriakose P, Colon-Otero G, Paz-Fumagalli R (2002) Risk of deep venous thrombosis associated with chest versus arm central venous subcutaneous port catheters: a 5-year single-institution retrospective study. J Vasc Interv Radiol 13:179–184PubMed Kuriakose P, Colon-Otero G, Paz-Fumagalli R (2002) Risk of deep venous thrombosis associated with chest versus arm central venous subcutaneous port catheters: a 5-year single-institution retrospective study. J Vasc Interv Radiol 13:179–184PubMed
20.
go back to reference Horne MK III, Mayo DJ, Alexander HR et al (1994) Upper extremity impedance plethysmography in patients with venous access devices. Thromb Haemost 72:540–542PubMed Horne MK III, Mayo DJ, Alexander HR et al (1994) Upper extremity impedance plethysmography in patients with venous access devices. Thromb Haemost 72:540–542PubMed
21.
go back to reference Petrakis IE, Sciacca V, Katsamouris AN (2001) Upper extremities deep venous thrombosis: comparison of light reflection rheography and colour duplex ultrasonography for diagnosis and follow-up. Panminerva Med 43:69–75PubMed Petrakis IE, Sciacca V, Katsamouris AN (2001) Upper extremities deep venous thrombosis: comparison of light reflection rheography and colour duplex ultrasonography for diagnosis and follow-up. Panminerva Med 43:69–75PubMed
22.
go back to reference Kohler A, Hoffmann R, Platz A, Bino M (1998) Diagnostic value of duplex ultrasound and liquid crystal contact thermography in preclinical detection of deep vein thrombosis after proximal femur fractures. Arch Orthop Trauma Surg 117:39–42CrossRefPubMed Kohler A, Hoffmann R, Platz A, Bino M (1998) Diagnostic value of duplex ultrasound and liquid crystal contact thermography in preclinical detection of deep vein thrombosis after proximal femur fractures. Arch Orthop Trauma Surg 117:39–42CrossRefPubMed
23.
go back to reference Perrier A, Desmarais S, Miron MJ et al (1999) Non-invasive diagnosis of venous thromboembolism in outpatients. Lancet 353:190–195PubMed Perrier A, Desmarais S, Miron MJ et al (1999) Non-invasive diagnosis of venous thromboembolism in outpatients. Lancet 353:190–195PubMed
24.
go back to reference de Moerloose P, Desmarais S, Bounameaux H et al (1996) Contribution of a new, rapid, individual and quantitative automated D-dimer ELISA to exclude pulmonary embolism. Thromb Haemost 75:11–13PubMed de Moerloose P, Desmarais S, Bounameaux H et al (1996) Contribution of a new, rapid, individual and quantitative automated D-dimer ELISA to exclude pulmonary embolism. Thromb Haemost 75:11–13PubMed
25.
go back to reference Lensing AWA, Prandoni P, Büller HR et al (1990) Lower extremity venography with iohexol: results and complications. Radiology 177:503–505PubMed Lensing AWA, Prandoni P, Büller HR et al (1990) Lower extremity venography with iohexol: results and complications. Radiology 177:503–505PubMed
26.
go back to reference McLachlan MS, Thomson JG, Taylor DW et al (1979) Observer variation in the interpretation of lower limb venograms. Am J Radiol 132:227–229 McLachlan MS, Thomson JG, Taylor DW et al (1979) Observer variation in the interpretation of lower limb venograms. Am J Radiol 132:227–229
27.
go back to reference Baarslag HJ, van Beek EJR, Tijssen JGP et al (2003) Deep vein thrombosis of the upper extremity: intra- and interobserver study of digital subtraction venography. Eur Radiol 13:251–255PubMed Baarslag HJ, van Beek EJR, Tijssen JGP et al (2003) Deep vein thrombosis of the upper extremity: intra- and interobserver study of digital subtraction venography. Eur Radiol 13:251–255PubMed
28.
go back to reference Falk RL, Smith DF (1987) Thrombosis of upper extremity thoracic inlet veins: diagnosis with duplex Doppler sonography. Am J Roentgenol 149:677–682 Falk RL, Smith DF (1987) Thrombosis of upper extremity thoracic inlet veins: diagnosis with duplex Doppler sonography. Am J Roentgenol 149:677–682
29.
go back to reference Gaitini D, Kaftori JK, Pery M, Engel A (1988) High-resolution real-time ultrasonography. Diagnosis and follow-up of jugular and subclavian vein thrombosis. J Ultrasound Med 7:621–627PubMed Gaitini D, Kaftori JK, Pery M, Engel A (1988) High-resolution real-time ultrasonography. Diagnosis and follow-up of jugular and subclavian vein thrombosis. J Ultrasound Med 7:621–627PubMed
30.
go back to reference Knudson GJ, Wiedmeyer DA, Erickson SJ et al (1990) Color Doppler sonographic imaging in the assessment of upper-extremity deep venous thrombosis. Am J Roentgenol 154:399–403 Knudson GJ, Wiedmeyer DA, Erickson SJ et al (1990) Color Doppler sonographic imaging in the assessment of upper-extremity deep venous thrombosis. Am J Roentgenol 154:399–403
31.
go back to reference Köksoy C, Kuzu A, Kutlay J et al (1995) The diagnostic value of colour Doppler ultrasound in central venous catheter related thrombosis. Clin Radiol 50:687–689PubMed Köksoy C, Kuzu A, Kutlay J et al (1995) The diagnostic value of colour Doppler ultrasound in central venous catheter related thrombosis. Clin Radiol 50:687–689PubMed
32.
go back to reference Kröger K, Schelo C, Gocke C, Rudofsky G (1998) Colour Doppler sonographic diagnosis of upper limb venous thromboses. Clin Sci 94:657–661PubMed Kröger K, Schelo C, Gocke C, Rudofsky G (1998) Colour Doppler sonographic diagnosis of upper limb venous thromboses. Clin Sci 94:657–661PubMed
33.
go back to reference Cronan JJ, Dorfman GS, Scola FH et al (1987) Deep venous thrombosis: US assessment using vein compression. Radiology 162:191–194PubMed Cronan JJ, Dorfman GS, Scola FH et al (1987) Deep venous thrombosis: US assessment using vein compression. Radiology 162:191–194PubMed
34.
go back to reference Baxter GM, Kincaid W, Jeffrey RF et al (1991) Comparison of colour Doppler ultrasound with venography in the diagnosis of axillary and subclavian vein thrombosis. Br J Radiol 64:777–781PubMed Baxter GM, Kincaid W, Jeffrey RF et al (1991) Comparison of colour Doppler ultrasound with venography in the diagnosis of axillary and subclavian vein thrombosis. Br J Radiol 64:777–781PubMed
35.
go back to reference Zontsich T, Turetschek K, Baldt M (1998) CT-Phlebography. A new method for the diagnosis of venous thrombosis of the upper and lower extremities. Radiologe 38:586–590PubMed Zontsich T, Turetschek K, Baldt M (1998) CT-Phlebography. A new method for the diagnosis of venous thrombosis of the upper and lower extremities. Radiologe 38:586–590PubMed
36.
go back to reference Haage P, Krings T, Schmitz-Rode T (2002) Nontraumatic vascular emergencies: imaging and intervention in acute venous obstruction. Eur Radiol 12:2627–2643PubMed Haage P, Krings T, Schmitz-Rode T (2002) Nontraumatic vascular emergencies: imaging and intervention in acute venous obstruction. Eur Radiol 12:2627–2643PubMed
37.
go back to reference Kim H, Chung JW, Park JH et al (2003) Role of CT venography in the diagnosis and treatment of benign thoracic central venous obstruction. Korean J Radiol 4:146–152PubMed Kim H, Chung JW, Park JH et al (2003) Role of CT venography in the diagnosis and treatment of benign thoracic central venous obstruction. Korean J Radiol 4:146–152PubMed
38.
go back to reference Oudkerk M, Van Beek EJR, Wielopolski P et al (2002) Comparison of contrast-enhanced MRA and DSA for the diagnosis of pulmonary embolism: results of a prospective study in 141 consecutive patients with an abnormal perfusion lung scan. Lancet 359:1643–1647CrossRefPubMed Oudkerk M, Van Beek EJR, Wielopolski P et al (2002) Comparison of contrast-enhanced MRA and DSA for the diagnosis of pulmonary embolism: results of a prospective study in 141 consecutive patients with an abnormal perfusion lung scan. Lancet 359:1643–1647CrossRefPubMed
39.
go back to reference Laissy J, Fernandez P, Karila-Cohen P et al (2003) Upper limb vein anatomy before hemodialysis fistula creation: cross-sectional anatomy using MR venography. Eur Radiol 13:256–261PubMed Laissy J, Fernandez P, Karila-Cohen P et al (2003) Upper limb vein anatomy before hemodialysis fistula creation: cross-sectional anatomy using MR venography. Eur Radiol 13:256–261PubMed
40.
go back to reference Shinde TS, Lee VS, Rofsky NM et al (1999) Three-dimensional gadolinium-enhanced MR venographic evaluation of patency of central veins in the thorax: initial experience. Radiology 213:550–560 Shinde TS, Lee VS, Rofsky NM et al (1999) Three-dimensional gadolinium-enhanced MR venographic evaluation of patency of central veins in the thorax: initial experience. Radiology 213:550–560
41.
go back to reference Ruehm SG, Zimny K, Debatin JF (2001) Direct contrast-enhanced 3D MR venography. Eur Radiol 11:102–112PubMed Ruehm SG, Zimny K, Debatin JF (2001) Direct contrast-enhanced 3D MR venography. Eur Radiol 11:102–112PubMed
42.
go back to reference Fraser DG, Moody AR, Morgan PS et al (2002) Diagnosis of lower-limb deep venous thrombosis: a prospective blinded study of magnetic resonance direct thrombus imaging. Ann Int Med 15:89–98 Fraser DG, Moody AR, Morgan PS et al (2002) Diagnosis of lower-limb deep venous thrombosis: a prospective blinded study of magnetic resonance direct thrombus imaging. Ann Int Med 15:89–98
43.
go back to reference AbuRahma AF, Short YS, White JF, Boland JP (1996) Treatment alternatives for axillary-subclavian vein thrombosis: long-term follow-up. Cardiovasc Surg 4:783–787CrossRefPubMed AbuRahma AF, Short YS, White JF, Boland JP (1996) Treatment alternatives for axillary-subclavian vein thrombosis: long-term follow-up. Cardiovasc Surg 4:783–787CrossRefPubMed
44.
go back to reference Seigel EL, Jew AC, Delcore R et al (1993) Thrombolytic therapy for catheter-related thrombosis. Am J Surg 166:716–719PubMed Seigel EL, Jew AC, Delcore R et al (1993) Thrombolytic therapy for catheter-related thrombosis. Am J Surg 166:716–719PubMed
45.
go back to reference Fraschini G, Jadeja J, Lawson M et al (1987) Local infusion of urokinase for the lysis of thrombosis associated with permanent central venous catheters in cancer patients. J Clin Oncol 5:672–678PubMed Fraschini G, Jadeja J, Lawson M et al (1987) Local infusion of urokinase for the lysis of thrombosis associated with permanent central venous catheters in cancer patients. J Clin Oncol 5:672–678PubMed
46.
go back to reference Beygui RE, Olcott C IV, Dalman RL (1997) Subclavian vein thrombosis: outcome analysis based on etiology and modality of treatment. Ann Vasc Surg 11:247–255CrossRefPubMed Beygui RE, Olcott C IV, Dalman RL (1997) Subclavian vein thrombosis: outcome analysis based on etiology and modality of treatment. Ann Vasc Surg 11:247–255CrossRefPubMed
47.
go back to reference Kunkel JM, Machleder HI (1989) Spontaneous subclavain vein thrombosis: a successful combined approach of local thrombolytic therapy followed by first rib resection. Surgery 106:114 Kunkel JM, Machleder HI (1989) Spontaneous subclavain vein thrombosis: a successful combined approach of local thrombolytic therapy followed by first rib resection. Surgery 106:114
48.
go back to reference Rauwerda JA, Bakker FC, van den Broek TA, Dwars BJ (1988) Spontaneous subclavian vein thrombosis: a successful combined approach of local thrombolytic therapy followed by first-rib resection. Surgery 103:477–480PubMed Rauwerda JA, Bakker FC, van den Broek TA, Dwars BJ (1988) Spontaneous subclavian vein thrombosis: a successful combined approach of local thrombolytic therapy followed by first-rib resection. Surgery 103:477–480PubMed
49.
go back to reference Machleder HI (1993) Evaluation of a new treatment strategy for Paget–Schroetter syndrome: spontaneous thrombosis of the axillary-subclavian vein. J Vasc Surg 17:305–315; discussion 316–317CrossRefPubMed Machleder HI (1993) Evaluation of a new treatment strategy for Paget–Schroetter syndrome: spontaneous thrombosis of the axillary-subclavian vein. J Vasc Surg 17:305–315; discussion 316–317CrossRefPubMed
50.
go back to reference Reekers JA, Mewissen MW, Baarslag HJ (1999) Interventional techniques for venous thrombosis. Pulmonary embolism. Blackwell Science, Berlin, pp 398–409 Reekers JA, Mewissen MW, Baarslag HJ (1999) Interventional techniques for venous thrombosis. Pulmonary embolism. Blackwell Science, Berlin, pp 398–409
51.
go back to reference Francis CW (2001) Ultrasound-enhanced thrombolysis. Echocardography 18:239–246CrossRef Francis CW (2001) Ultrasound-enhanced thrombolysis. Echocardography 18:239–246CrossRef
52.
go back to reference Mumme, Heinen W, Geier B, Maatz W, Barbera L, Walterbusch G (2002) Regional hyperthermic fibrinolytic perfusion after unsuccessful venous thrombectomy of extensive deep venous thrombosis. J Vasc Surg 36:1219–1224CrossRefPubMed Mumme, Heinen W, Geier B, Maatz W, Barbera L, Walterbusch G (2002) Regional hyperthermic fibrinolytic perfusion after unsuccessful venous thrombectomy of extensive deep venous thrombosis. J Vasc Surg 36:1219–1224CrossRefPubMed
53.
go back to reference Sharafuddin MJ, Sun S, Hoballah JJ (2002) Endovascular management of venous thrombotic diseases of the upper torso and extremities. J Vasc Interv Radiol 13:975–990PubMed Sharafuddin MJ, Sun S, Hoballah JJ (2002) Endovascular management of venous thrombotic diseases of the upper torso and extremities. J Vasc Interv Radiol 13:975–990PubMed
54.
go back to reference Urschel HC Jr, Patel AN (2003) Paget–Schroetter syndrome therapy: failure of intravenous stents. Ann Thorac Surg 75:1693–1696; discussion 1696CrossRefPubMed Urschel HC Jr, Patel AN (2003) Paget–Schroetter syndrome therapy: failure of intravenous stents. Ann Thorac Surg 75:1693–1696; discussion 1696CrossRefPubMed
55.
go back to reference Lee MC, Grassi CJ, Belkin M et al (1998) Early operative intervention for primary subclavian vein thrombosis: an effective treatment approach. J Vasc Surg 27:1101–1107PubMed Lee MC, Grassi CJ, Belkin M et al (1998) Early operative intervention for primary subclavian vein thrombosis: an effective treatment approach. J Vasc Surg 27:1101–1107PubMed
56.
go back to reference Malina JE (1995) Need for emergency treatment in subclavian vein effort thrombosis. J Am Coll Surg 181:414–420PubMed Malina JE (1995) Need for emergency treatment in subclavian vein effort thrombosis. J Am Coll Surg 181:414–420PubMed
57.
go back to reference Héron E, Lozinguez O, Emmerich J et al (1999) Long term sequelae of spontaneous axillary-subclavian venous thrombosis. Ann Intern Med 131:510–513PubMed Héron E, Lozinguez O, Emmerich J et al (1999) Long term sequelae of spontaneous axillary-subclavian venous thrombosis. Ann Intern Med 131:510–513PubMed
58.
go back to reference AbuRahma AF, Robinson PA (2000) Effort subclavian vein thrombosis: evolution of management. J Endovasc Ther 7:302–308PubMed AbuRahma AF, Robinson PA (2000) Effort subclavian vein thrombosis: evolution of management. J Endovasc Ther 7:302–308PubMed
59.
go back to reference Bern MM, Lokich JJ, Wallach SR et al (1990) Very low doses of warfarin can prevent thrombosis in central venous catheters. A randomized prospective trial. Ann Int Med 112:423–428PubMed Bern MM, Lokich JJ, Wallach SR et al (1990) Very low doses of warfarin can prevent thrombosis in central venous catheters. A randomized prospective trial. Ann Int Med 112:423–428PubMed
Metadata
Title
Diagnosis and management of deep vein thrombosis of the upper extremity: a review
Authors
Henk J. Baarslag
Maria M. W. Koopman
Jim A. Reekers
Edwin J. R. van Beek
Publication date
01-07-2004
Publisher
Springer-Verlag
Published in
European Radiology / Issue 7/2004
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-004-2252-1

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