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Dubbelboer, I. R., Lilienberg, E., Karalli, A., Axelsson, R., Brismar, T. B., Ebeling Barbier, C., . . . Lennernäs, H. (2018). Reply to "Comment on 'In Vivo Drug Delivery Performance of Lipiodol-Based Emulsion or Drug-Eluting Beads in Patients with Hepatocellular Carcinoma'". Molecular Pharmaceutics, 15(1), 336-340
Åpne denne publikasjonen i ny fane eller vindu >>Reply to "Comment on 'In Vivo Drug Delivery Performance of Lipiodol-Based Emulsion or Drug-Eluting Beads in Patients with Hepatocellular Carcinoma'"
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2018 (engelsk)Inngår i: Molecular Pharmaceutics, ISSN 1543-8384, E-ISSN 1543-8392, Vol. 15, nr 1, s. 336-340Artikkel i tidsskrift (Fagfellevurdert) Published
sted, utgiver, år, opplag, sider
American Chemical Society (ACS), 2018
Emneord
Lipiodol, doxorubicin, drug-eluting beads, hepatocelluar carcinoma, image-guided transarterial tumor therapy, interventional radiology, liver cancer, local therapy, transarterial chemoembolization (TACE)
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-335507 (URN)10.1021/acs.molpharmaceut.7b00840 (DOI)000419419800033 ()29185767 (PubMedID)
Tilgjengelig fra: 2017-12-06 Laget: 2017-12-06 Sist oppdatert: 2018-05-04bibliografisk kontrollert
Rosenqvist, K., Sheikhi, R., Nyman, R., Rorsman, F., Sangfelt, P. & Ebeling Barbier, C. (2018). Transjugular intrahepatic portosystemic shunt treatment of variceal bleeding in an unselected patient population.. Scandinavian Journal of Gastroenterology, 53(1), 70-75
Åpne denne publikasjonen i ny fane eller vindu >>Transjugular intrahepatic portosystemic shunt treatment of variceal bleeding in an unselected patient population.
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2018 (engelsk)Inngår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 53, nr 1, s. 70-75Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

OBJECTIVE: To evaluate transjugular intrahepatic portosystemic shunt (TIPS) in variceal bleeding in a clinical setting.

MATERIALS AND METHODS: Retrospective review of 131 patients (116 with liver cirrhosis) treated with TIPS with covered stent grafts in a single centre from 2002 to 2016.

RESULTS: Survival at 1 and 2 years was 70% and 57% in patents with, and 100% at 2 years in patients without liver cirrhosis, respectively. A high Child-Pugh score and severe hepatic encephalopathy (HE) within 12 months post-TIPS were related to increased mortality. Re-bleeding occurred in 8% within 12 months and was related to TIPS dysfunction and a post-TIPS portosystemic gradient (PSG) of ≥5 mmHg. The main cause of TIPS dysfunction was that the stent did not fully reach the inferior vena cava. There was no correlation between the PSG and the occurrence of HE.

CONCLUSIONS: TIPS was safe and prevented re-bleeding in patients with variceal bleeding, with or without liver cirrhosis, regardless of Child-Pugh class and of how soon after bleeding onset, the TIPS procedure was performed. A post-TIPS PSG of ≥5 mmHg was associated with an increased risk for re-bleeding and there was no correlation between the post-TIPS PSG and the occurrence of HE.

Emneord
TIPS, TIPS dysfunction, Variceal bleeding, hepatic encephalopathy, liver cirrhosis, portal hypertension, portosystemic gradient, re-bleeding, transjugular intrahepatic portosystemic shunt
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-331785 (URN)10.1080/00365521.2017.1386795 (DOI)000418116300010 ()28990812 (PubMedID)
Tilgjengelig fra: 2017-10-18 Laget: 2017-10-18 Sist oppdatert: 2018-05-15bibliografisk kontrollert
Rosenqvist, K., Ebeling Barbier, C., Rorsman, F., Sangfelt, P. & Nyman, R. (2018). Treatment of acute portomesenteric venous thrombosis with thrombectomy through a transjugular intrahepatic portosystemic shunt: a single-center experience.. Acta Radiologica, 59(8), 953-958
Åpne denne publikasjonen i ny fane eller vindu >>Treatment of acute portomesenteric venous thrombosis with thrombectomy through a transjugular intrahepatic portosystemic shunt: a single-center experience.
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2018 (engelsk)Inngår i: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 59, nr 8, s. 953-958Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background: Acute portomesenteric venous thrombosis (PMVT) is a potentially life-threatening condition and urgent treatment is required.

Purpose: To retrospectively evaluate the efficacy and safety of treating acute PMVT by the creation of a transjugular intrahepatic portosystemic shunt (TIPS) followed by thrombectomy.

Material and Methods: Six patients (all men, age range = 39-51 years) presenting with acute PMVT were treated with transjugular thrombectomy (TT) through a TIPS created in the same session. The intervention included iterated venography through the TIPS one to three times within the first week after diagnosis and repeated thrombectomy if needed (n = 5).

Results: Recanalization was successful with persistent blood flow through the main superior mesenteric vein, portal vein, and TIPS in all six patients. Five patients were treated primarily with thrombectomy through a TIPS with clinical improvement. The final patient was initially treated with surgical thrombectomy and bowel resection. TIPS and TT was performed two days after surgery due to re-thrombosis but the patient deteriorated and died of multi-organ failure. Procedure-related complications were transient hematuria (n = 3) and transient encephalopathy (n = 2). In-hospital time was <14 days in four of the five patients with primary TIPS and TT. No sign of re-thrombosis was noted during follow-up (mean = 18 months, range = 8-28 months).

Conclusion: Thrombectomy through a TIPS is feasible and can be effective in recanalization and symptom-relief in acute PMVT.

Emneord
Portal vein, mesenteric vein, thrombectomy, thrombosis, transjugular, transjugular intrahepatic portosystemic shunt (TIPS)
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-335506 (URN)10.1177/0284185117742683 (DOI)000436017600009 ()29202584 (PubMedID)
Tilgjengelig fra: 2017-12-06 Laget: 2017-12-06 Sist oppdatert: 2018-08-29bibliografisk kontrollert
Lilienberg, E., Dubbelboer, I. R., Karalli, A., Axelsson, R., Brismar, T. B., Ebeling Barbier, C., . . . Lennernäs, H. (2017). In vivo Drug Delivery Performance of Lipiodol-based Emulsion or Drug-eluting Beads in Patients with Hepatocellular Carcinoma. Molecular Pharmaceutics, 14(2), 448-458
Åpne denne publikasjonen i ny fane eller vindu >>In vivo Drug Delivery Performance of Lipiodol-based Emulsion or Drug-eluting Beads in Patients with Hepatocellular Carcinoma
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2017 (engelsk)Inngår i: Molecular Pharmaceutics, ISSN 1543-8384, E-ISSN 1543-8392, Vol. 14, nr 2, s. 448-458Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Doxorubicin (DOX) delivered in a lipiodol-based emulsion (LIPDOX) or in drug-eluting beads (DEBDOX) is used as palliative treatment in patients with intermediate-stage hepatocellular carcinoma (HCC). The primary objective of this study was to evaluate the in vivo delivery performance of DOX from LIPDOX or DEBDOX in HCC patients using the local and systemic pharmacokinetics of DOX and its main metabolite doxorubicinol (DOXol). Urinary excretion of DOX and DOXol, and their short-term safety and anti-tumor effects were also evaluated. In this open, prospective, non-randomized multi-center study, LIPDOX (n=13) or DEBDOX (n=12) were injected into the feeding arteries of the tumor. Local (vena cava/hepatic vein orifice) and systemic (peripheral vein) plasma concentrations of DOX and DOXol were determined in samples obtained up to 6 h and 7 days after treatment. Tumor response was assessed using computed tomography or magnetic resonance imaging. The Cmax and AUC0-24 h for DOX were 5.6-fold and 2.4-fold higher in LIPDOX vs DEBDOX recipients, respectively (p <0.001). After 6 h, the respective mean proportions of the dose remaining in the liver or drug-delivery system (DDS) were 49% for LIPDOX and 88% for DEBDOX. LIPDOX releases DOX faster than DEBDOX in HCC patients and provides more extensive local and systemic exposure (AUC) to DOX and DOXol initially (0-7 days). DEBDOX formulation has a release and distribution of DOX that is more restricted and rate controlled than LIPDOX.

Emneord
doxorubicin, doxorubicinol, drug eluting beads, local delivery, local therapy, hepatocellular carcinoma, liver cancer, lipiodol, transarterial chemoembolization, transarterial infusion chemotherapy
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-311314 (URN)10.1021/acs.molpharmaceut.6b00886 (DOI)000393630100012 ()27997198 (PubMedID)
Forskningsfinansiär
Swedish Research Council, S21-2011-373
Tilgjengelig fra: 2016-12-22 Laget: 2016-12-22 Sist oppdatert: 2018-01-13bibliografisk kontrollert
Rosenqvist, K., Eriksson, L.-G., Rorsman, F., Sangfelt, P. & Nyman, R. (2016). Endovascular treatment of acute and chronic portal vein thrombosis in patients with cirrhotic and non-cirrhotic liver. Acta Radiologica, 57(5), 572-579
Åpne denne publikasjonen i ny fane eller vindu >>Endovascular treatment of acute and chronic portal vein thrombosis in patients with cirrhotic and non-cirrhotic liver
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2016 (engelsk)Inngår i: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 57, nr 5, s. 572-579Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

BACKGROUND: Treatment of patients with portal vein thrombosis (PVT) differs due to different etiology and wide range of symptoms but certain patients seems to benefit from endovascular intervention.

PURPOSE: To assess the safety and efficiency of endovascular treatment of acute and chronic PVT in patients with cirrhotic and non-cirrhotic liver.

MATERIAL AND METHODS: Twenty-one patients with PVT treated with an endovascular procedure in 2002-2013 were studied retrospectively. Data on etiology, onset and extension of thrombus, presenting symptoms, methods of intervention, portal pressure gradients, complications, recurrence of symptoms, re-interventions, clinical status at latest follow-up, and survival were collected.

RESULTS: Four non-cirrhotic patients with acute extensive PVT and bowel ischemia were treated with local thrombolysis, in three combined with placement of a transjugular intrahepatic portosystemic shunt (TIPS) placement. Three recovered and have survived more than 6 years. In six non-cirrhotic patients with chronic PVT and acute or threatening variceal bleeding recanalization and TIPS were successful in three and failed in three. Eleven cirrhotic patients with PVT and variceal bleeding or refractory ascites were successfully treated with recanalization and TIPS. Re-intervention was performed in five of these patients and five patients died, three within 12 months of intervention. Four cirrhotic patients had episodes of shunt-related encephalopathy and three had variceal re-bleeding.

CONCLUSION: TIPS was found to be effective in reducing portal hypertension in patients with PVT. In patients with extensive PVT and bowel ischemia treatment with TIPS combined with thrombolysis should be considered.

Emneord
Portal vein; thrombosis; liver cirrhosis; endovascular procedure; retrospective study
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-261206 (URN)10.1177/0284185115595060 (DOI)000374327600010 ()26253926 (PubMedID)
Tilgjengelig fra: 2015-08-31 Laget: 2015-08-31 Sist oppdatert: 2017-12-04bibliografisk kontrollert
Rosenqvist, K., Sheikhi, R., Eriksson, L.-G., Rajani, R., Rorsman, F., Sangfelt, P. & Nyman, R. (2016). Endovascular treatment of symptomatic Budd-Chiari syndrome - in favour of early transjugular intrahepatic portosystemic shunt.. European Journal of Gastroenterology and Hepathology, 28(6), 656-660
Åpne denne publikasjonen i ny fane eller vindu >>Endovascular treatment of symptomatic Budd-Chiari syndrome - in favour of early transjugular intrahepatic portosystemic shunt.
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2016 (engelsk)Inngår i: European Journal of Gastroenterology and Hepathology, ISSN 0954-691X, E-ISSN 1473-5687, Vol. 28, nr 6, s. 656-660Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

INTRODUCTION: Treatment of Budd-Chiari syndrome (BCS) has shifted from mainly medical treatment, with surgical shunt and orthotopic liver transplantation (OLT) as rescue, to medical treatment combined with an early endovascular intervention in the past two decades.

PURPOSE: To assess the safety and efficiency of endovascular treatment of symptomatic patients with BCS and to compare mortality with symptomatic BCS patients in the same region treated with only sporadic endovascular techniques.

METHODS: This was a retrospective review of clinical data, treatment and survival in 14 patients diagnosed with BCS and treated with endovascular methods from 2003 to 2015. A national epidemiology study of BCS from 1986 to 2003 was used for comparison.

RESULTS: Thirteen of the 14 patients eventually had transjugular intrahepatic portosystemic shunt (TIPS), four after previous liver vein angioplasty. TIPS were performed with polytetrafluoroethylene-covered stents and technical success was 100%. Calculated preinterventional prognostic indices indicated a high risk of TIPS dysfunction, OLT and death. However, only one patient died and one had an OLT, and the 1- and 2-year primary TIPS-patency was 85 and 67%, respectively. Episodes of de-novo hepatic encephalopathy occurred in three patients. Overall 1- and 5-year transplantation-free survival was 100 and 93% compared with 47 and 28%, respectively, in 1986 to 2003.

CONCLUSION: TIPS seems to be a safe and effective treatment for symptomatic BCS and there is an obvious improvement in transplantation-free survival compared with conservatory medical treatment. It should, therefore, be considered early, as first-line intervention, in patients with insufficient response to medical treatment.

HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-285913 (URN)10.1097/MEG.0000000000000621 (DOI)000375147100008 ()26958788 (PubMedID)
Tilgjengelig fra: 2016-04-20 Laget: 2016-04-20 Sist oppdatert: 2017-11-30bibliografisk kontrollert
Ebeling Barbier, C., Garske-Román, U., Sandström, M., Nyman, R. & Granberg, D. (2016). Selective internal radiation therapy in patients with progressive neuroendocrine liver metastases. European Journal of Nuclear Medicine and Molecular Imaging, 43(8), 1425-1431
Åpne denne publikasjonen i ny fane eller vindu >>Selective internal radiation therapy in patients with progressive neuroendocrine liver metastases
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2016 (engelsk)Inngår i: European Journal of Nuclear Medicine and Molecular Imaging, ISSN 1619-7070, E-ISSN 1619-7089, Vol. 43, nr 8, s. 1425-1431Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

PURPOSE: To evaluate the safety and efficacy of selective internal radiation therapy (SIRT) in patients with unresectable liver metastases from neuroendocrine tumours (NETLMs).

METHODS: This retrospective study included 40 patients with progressive NETLMs (22 women, 18 men, mean age 61.6 years) who underwent SIRT with (90)Y-labelled resin microspheres. Tumour response was evaluated according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST) on CT or MR images. Medical records were reviewed.

RESULTS: In the 40 patients, 54 evaluable SIRT procedures were performed, 33 to the right liver lobe (mean activity 1.31 GBq), 13 to the left lobe (mean activity 0.85 GBq), and 8 to both lobes (mean activity 1.61 GBq). Late follow-up imaging (mean 20 months) was performed after 44 of the treatments. Objective tumour response and disease control rates were 54 % (29 of 54 treatments) and 94 % (51 treatments), respectively, at the early follow-up examination (mean 3 months) and 34 % (15 treatments) and 57 % (25 treatments), respectively at the late follow-up examination. Mean overall survival from the first SIRT was 34,8 months and survival rates at 1, 2, 3 and 5 years were 76 %, 59 %, 52 % and 35 % respectively. Adverse effects were generally mild and easily manageable, except in one patient who died from radiation-induced liver failure. Of the 45 patients, 18 (45 %) had received peptide receptor radionuclide therapy (PRRT) prior to SIRT.

CONCLUSION: SIRT with (90)Y-labelled resin microspheres is a safe and effective treatment for patients with progressive NETLM, and also for those who have received prior PRRT.

Emneord
Selective internal radiation therapy; Neuroendocrine liver metastases; Transarterial; Yttrium
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-268834 (URN)10.1007/s00259-015-3264-6 (DOI)000378005000006 ()26631239 (PubMedID)
Tilgjengelig fra: 2015-12-10 Laget: 2015-12-10 Sist oppdatert: 2017-12-01bibliografisk kontrollert
van Laar, T., Nyholm, D. & Nyman, R. (2016). Transcutaneous port for levodopa/carbidopa intestinal gel administration in Parkinson's disease. Acta Neurologica Scandinavica, 133(3), 208-215
Åpne denne publikasjonen i ny fane eller vindu >>Transcutaneous port for levodopa/carbidopa intestinal gel administration in Parkinson's disease
2016 (engelsk)Inngår i: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 133, nr 3, s. 208-215Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

OBJECTIVE: To evaluate the safety and tolerability of the T-Port(®) for intestinal infusion of levodopa/carbidopa gel in patients with advanced Parkinson's disease (PD).

METHODS: This prospective study was carried out in 24 patients with PD (15 males, mean age 61.8 years, mean duration PD 18.7 years). All adverse device effects were evaluated at 2 weeks, 3 months and 6 months and until explantation or death.

RESULTS: Post-operative complications were similar to endoscopic gastrojejunostomy placement (four peritoneal irritation, one pocket pain). Eight patients with prior experience with the endoscopic gastrojejunostomy preferred the T-Port. The total device experience was 83.6 years, and the average survival time was 3.6 (range 1.1-5.2) years. Six T-Ports were still in use, and two patients had died due to non-device-related reasons. Sixteen T-Ports had been explanted due to 15 stoma reactions (14 inflammations and one infection) and one tilting of the T-Port. The T-Ports were replaced with endoscopic gastrojejunostomy system as replacements with T-Ports were not part of the study. Only two device malfunctions occurred (one catheter breakage at 3 year post-implant and one T-Port leakage of levodopa/carbidopa gel). No tube kinking, dislocation or blockage occurred. The number of adverse device effects proved to be significantly lower as compared to the endoscopic gastrojejunostomy literature data.

CONCLUSIONS: The T-Port is safe and well tolerated, and the low number of tube problems is a potential advantage compared with the endoscopic gastrojejunostomy system. Proper cleaning and local treatment of the stoma site around the T-Port are essential to prolong its longevity.

Emneord
clinical trial; levodopa/carbidopa infusion; Parkinson's disease; percutaneous endoscopic gastrojejunostomy; transcutaneous port
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-261204 (URN)10.1111/ane.12464 (DOI)000371628100006 ()26213103 (PubMedID)
Forskningsfinansiär
Swedish Research CouncilVINNOVA
Tilgjengelig fra: 2015-08-31 Laget: 2015-08-31 Sist oppdatert: 2018-06-05bibliografisk kontrollert
Ebeling Barbier, C., Lundin, E., Melki, V., James, S. K. & Nyman, R. (2015). Percutaneous Closure in Transfemoral Aortic Valve Implantation: A Single-Centre Experience. Cardiovascular and Interventional Radiology, 38(6), 1438-1443
Åpne denne publikasjonen i ny fane eller vindu >>Percutaneous Closure in Transfemoral Aortic Valve Implantation: A Single-Centre Experience
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2015 (engelsk)Inngår i: Cardiovascular and Interventional Radiology, ISSN 0174-1551, E-ISSN 1432-086X, Vol. 38, nr 6, s. 1438-1443Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

PURPOSE: To report the experience of a percutaneous closure device used for transfemoral transcatheter aortic valve implantation (TAVI) in an unselected patient and operator population.

MATERIALS AND METHODS: Eighty-two consecutive patients (32 women, 50 men) who underwent transfemoral TAVI between September 2009 and February 2014 at our hospital were retrospectively reviewed for percutaneous closure device (PCD) failure, vascular complications, and bleeding. The diameter and calcification of the common femoral artery (CFA) and the thickness of the subcutaneous fat layer in the groin were assessed on computed tomography images.

RESULTS: The incidences of PCD failure and minor and major vascular complications were 19.5 % (n = 16/82), 19.5 % (n = 16/82), and 7 % (n = 6/82) respectively. 8.5 % (n = 7/82) had a minor perioperative bleeding, 6 % (n = 5/82) had a major bleeding, and none had any life-threatening bleeding. When PCD failed, haemostasis was obtained with fascia suturing, covered stent placement, or with surgical cutdown. Thirty-day mortality and 1-year all-cause mortality were 8.5 % (n = 7/82) and 19.5 % (n = 16/82), respectively. In a multiple regression analysis, the CFA diameter and the presence of severe calcification were independently related to PCD failure (correlation coefficient = -0.24, p = 0.027 and correlation coefficient = 0.23, p = 0.036, respectively).

CONCLUSION: PCD failure was related to a small CFA diameter and to a severely calcified CFA. Failure could largely be managed with minimally invasive techniques such as covered stents or fascia suturing.

HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-254046 (URN)10.1007/s00270-015-1117-0 (DOI)000365219100005 ()25968476 (PubMedID)
Tilgjengelig fra: 2015-06-04 Laget: 2015-06-04 Sist oppdatert: 2017-12-04bibliografisk kontrollert
Ebeling-Barbier, C., Garske-Roman, U., Antonodimitrakis, P., Sandström, M., Nyman, R. & Granberg, D. (2015). Radioembolization with 90Y-Labelled Resin Microspheres in Patients with Liver Metastases from Neuroendocrine Tumors. Paper presented at 12th Annual ENETS Conference for the Diagnosis and Treatment of Neuroendocrine Tumor Disease, MAR 11-13, 2015, Barcelona, SPAIN. Neuroendocrinology, 102(1-2), 136-137
Åpne denne publikasjonen i ny fane eller vindu >>Radioembolization with 90Y-Labelled Resin Microspheres in Patients with Liver Metastases from Neuroendocrine Tumors
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2015 (engelsk)Inngår i: Neuroendocrinology, ISSN 0028-3835, E-ISSN 1423-0194, Vol. 102, nr 1-2, s. 136-137Artikkel i tidsskrift, Meeting abstract (Annet vitenskapelig) Published
Emneord
radioembolization, neuroendocrine, liver metastases
HSV kategori
Identifikatorer
urn:nbn:se:uu:diva-266080 (URN)10.1159/000431385 (DOI)000361683500156 ()
Konferanse
12th Annual ENETS Conference for the Diagnosis and Treatment of Neuroendocrine Tumor Disease, MAR 11-13, 2015, Barcelona, SPAIN
Tilgjengelig fra: 2015-11-05 Laget: 2015-11-05 Sist oppdatert: 2017-12-01bibliografisk kontrollert
Organisasjoner