Dear Sir Acute pancreatitis is reported to be an unusual manifestation of systemic lupus erythema... more Dear Sir Acute pancreatitis is reported to be an unusual manifestation of systemic lupus erythematosus (SLE), especially as an initial sign of the disease. Moreover, it has never been reported as an initial manifestation of subacute cutaneous lupus erythematosus (SCLE).1,2 We report two cases of acute pancreatitis, as the initial presentation of SLE in one patient and SCLE in the other one. Patient 1 is a 24-year-old womanwith a 2-week history of fatigue, malaise, arthralgia of knee, fever, generalized abdominal pain and recent onset of alimentary vomiting. There was no history of alcohol, drugs or any other medications. Physical examination revealed a diffuse erythema with purpuric elements on the dorsum of her hands and forearms and erythematous, scaly, maculo-papular lesions on the trunk (Figure 1); generalized abdominal tenderness with no guarding or hepato-splenomegaly was detected. Laboratory tests showed: WBC 1600/mm3 (normal 4000–10,000), RBC 3,400,000/mm3 (normal 3,800,000–5,100,000), HGB 9.7 g/dL (normal 12.0–16.0), PLT 84,000/mm3 (normal 130,000– 400,000); AST 70 U/L (normal 5–32), ALT 45 U/L (normal 6–31), γGT 66 U/L (normal 5–36), LDH 921 U/L (normal 220–480), amylase 456 U/L (normal 28–100) and lipase 443 U/L (normal 13–60). Triglycerides and calcium serum level were normal. Serology for HIV, CMV, EBVwas negative; ANA positive at titre of 1:5120, positive dsDNA antibody at titre of 1:40, anti-histone antibody 3.8 (normal range 0.0–1.1 index). ESR was 65 mm/h (normal 1–18), complement 3 (C3) 41.1 mg/dL (normal 83.0–177.0), complement 4 (C4) 9.3 mg/dL (normal 15.0–45.0), anticardiolipin, anti-SSA/Ro and lupus anticoagulant antibodies were negative. A biopsy and direct immunofluorescence (DIF) of a trunk lesion were suggestive for lupus. Abdominal Computed Tomographic (CT) and ultrasonic scan showed a swollen pancreas, but no gallbladder stones (grade B according to Balthazar scale). A diagnosis of acute pancreatitis and SLE was made according to the clinical signs and laboratory results and the patient started therapy with methylprednisolone at initial dose of 1 mg/kg daily i.v. and somatostatin 3.5 μg/kg/h i.v. After 7 days, in consideration of the clinical improvement, azathioprine 1.5 mg/kg daily was associated and somatostatin stopped. After 6 weeks, no cutaneous lesions were detectable and the pancreatic enzymes returned normal. After a further period of 6 weeks, the treatment was progressively reduced to methylprednisolone 0.1 mg/kg/day and azathioprine 0.3 mg/kg/day. Patient 2 is a 39-year-old woman with a 4-week history of a few papules of the face and erythematous, oedematous papules, some of themwith ring forms, of the upper trunk and arms (Figure 2). She had a 5week history of persistent abdominal pain, loss of appetite associated, in the last week, with nausea and intermitting vomiting. The patient had no history of alcohol or drug use. Laboratory tests were normal except: AST 70 U/L, ALT 62 U/L, γGT 61 U/L, amylase 388 U/L, lipase 419 U/L, LDH 879 U/L, ESR 18 mm/h, ANA titre of 1:160, anti-SSA/Ro antibody 1.5 index (normal 0.0–1.1). Abdominal CT and ultrasound scan showed fullness of the pancreatic head and absence of stones (grade A according to Balthazar scale). A biopsy of a trunk lesion and DIF were evocative of lupus. A diagnosis of SCLE with acute pancreatitis was made and the patient was started on treatment with somatostatin 3.5 μg/kg/h i.v. and methylprednisolone 1 mg/kg daily i.v. with Lupus (2008) 17, 695–697
Un accident occlusif aigu pendant la grossesse est une complication rare mais potentiellement gra... more Un accident occlusif aigu pendant la grossesse est une complication rare mais potentiellement grave qui peut poser des difficultes diagnostiques et mettre en jeu le pronostic maternel et fœtal. Nous rapportons le cas d´une patiente âgee de 22 ans, sans antecedents, admise pour des contractions uterines au terme de 37 semaines d´amenorrhees. L´examen a l´admission etait sans anomalies. La patiente a presente 7 heures apres l´admission des vomissements repetitifs avec polypnee et fievre. Une cesarienne a ete decidee en urgence devant l´apparition d´une bradycardie fœtale a l´enregistrement du rythme cardiaque fœtal ERCF. Le diagnostic de volvulus du colon droit sur un mesentere commun complet a ete pose en per-operatoire apres l´extraction fœtale. Le colon droit etait distendu et necrose avec trois tours de spire. La decision etait de realiser une colectomie droite avec anastomose ileo-colique termino laterale. L´evolution de la patiente en post operatoire etait favorable. A travers c...
UNLABELLED We report a prospective study of 42 cases of primary uncomplicated umbilical and epiga... more UNLABELLED We report a prospective study of 42 cases of primary uncomplicated umbilical and epigastric hernia operated by laparoscopy with a 1 year mean follow-up. The purpose of our study is to investigate the contribution of laparoscopy in the treatment of in terms of results in the short and medium term. Early surgical morbidity was 14.3%. There was no mortality. At 6 months of the intervention, 28.5% of patients have kept umbilical pain. At 1 year of intervention, 2 patients have kept umbilical chronic pain. No case of recurrence was noted. In conclusion, the laparoscopic approach should be reserved for cases of large hernias and for recurrent and incisional hernias. KEY WORDS Epigastric hernia, Laparoscopy, Mesh, Umbilical hernia.
OBJECTIVE Hydatid cysts of the spigelian lobe, that is, segment I of the liver, are rare. We anal... more OBJECTIVE Hydatid cysts of the spigelian lobe, that is, segment I of the liver, are rare. We analyzed their clinical and therapeutic particularities. METHODS We conducted a retrospective search for the hydatid cysts of the liver treated surgically in our department from January 1, 1994, through December 31, 2005. Cases were identified and confirmed with the following investigatory techniques: routine abdominal ultrasonography, abdominal computed tomography recommended by the ultrasound operator when a cyst was discovered in segment I, routine intraoperative cholangiography, and three separate serological techniques: electrosyneresis, hemaglutination and ELISA (enzyme-linked-immunosorbent assay)(the latter two being quantitative). The cystic cavity was treated with hypertonic serum. Several surgeons performed different combinations of the following techniques: deroofing, sometimes with omentoplasty, simple drainage, and subtotal pericystectomy. RESULTS We treated 44 hydatid cysts of ...
BACKGROUND The histopathological examination of cholecystectomy specimens has not been standardiz... more BACKGROUND The histopathological examination of cholecystectomy specimens has not been standardized with a debate concerning the routine and the selective approach. The aim of this study was to assess the information obtained from routine histopathological examination of cholecystectomy specimens. METHODS All histopathological reports of cholecystectomy specimens between January 2003 and December 2016 were analyzed, including a clinical diagnosis of benign gallstone disease or cholecystitis. RESULTS A total of 20,584 reports were examined. The mean age of patients was 54.2 years. Patients aged more than 60 years represent 37.6% of the study population. Of all patients, 15,973 (77.6%) were females. Incidental gallbladder cancers (GBC) were present in 155 cholecystectomies specimens (0.8%). 67.1% of GBC are at T2 and T3 stage. Granulomatous cholecystitis was diagnosed in only 19 cases (0.1%). GBC were more prevalent in older patients (P < 10-6) and cholesterolosis was more prevalent in young patients (P < 10-6). There was no gender predilection for GBC (P = 0.739). CONCLUSIONS The rate of incidental gallbladder carcinoma in our study is low, yet, we found a higher proportion of T2 and T3 carcinomas stage. Granulomatous cholecystitis may need further investigations and treatments. When a selective approch of histopathological examination of cholecystectomy specimens is used, it is important to take into account that clinical parameters are significantly associated with gallbladder cancer.
BACKGROUND The colostomy may be terminal or lateral, temporary or permanent. It may have psycholo... more BACKGROUND The colostomy may be terminal or lateral, temporary or permanent. It may have psychological, medical or surgical complications. AIM reporting the incidence of surgical complications of colostomies, their therapeutic management and trying to identify risk factors for their occurrence. METHODS A retrospective study for a period of 5 years in general surgery department, Habib Bourguiba hospital, Sfax, including all patients operated with confection of a colostomy. Were then studied patients reoperated for stoma complication. RESULTS Among the 268 patients who have had a colostomy, 19 patients (7%) developed surgical stoma complications. They had a mean age of 59 years, a sex ratio of 5.3 and a 1-ASA score in 42% of cases. It was a prolapse in 9 cases (reconfection of the colostomy: 6 cases, restoration of digestive continuity: 3 cases), a necrosis in 5 cases (reconfection of the colostomy), a plicature in 2 cases (reconfection of the colostomy) a peristomal abscess in 2 case...
We report a prospective study of 42 cases of primary uncomplicated umbilical and epigastric herni... more We report a prospective study of 42 cases of primary uncomplicated umbilical and epigastric hernia operated by laparoscopy with a 1 year mean follow-up. The purpose of our study is to investigate the contribution of laparoscopy in the treatment of in terms of results in the short and medium term. Early surgical morbidity was 14.3%. There was no mortality. At 6 months of the intervention, 28.5% of patients have kept umbilical pain. At 1 year of intervention, 2 patients have kept umbilical chronic pain. No case of recurrence was noted. In conclusion, the laparoscopic approach should be reserved for cases of large hernias and for recurrent and incisional hernias. Epigastric hernia, Laparoscopy, Mesh, Umbilical hernia.
The colostomy may be terminal or lateral, temporary or permanent. It may have psychological, medi... more The colostomy may be terminal or lateral, temporary or permanent. It may have psychological, medical or surgical complications. reporting the incidence of surgical complications of colostomies, their therapeutic management and trying to identify risk factors for their occurrence. A retrospective study for a period of 5 years in general surgery department, Habib Bourguiba hospital, Sfax, including all patients operated with confection of a colostomy. Were then studied patients reoperated for stoma complication. Among the 268 patients who have had a colostomy, 19 patients (7%) developed surgical stoma complications. They had a mean age of 59 years, a sex ratio of 5.3 and a 1-ASA score in 42% of cases. It was a prolapse in 9 cases (reconfection of the colostomy: 6 cases, restoration of digestive continuity: 3 cases), a necrosis in 5 cases (reconfection of the colostomy), a plicature in 2 cases (reconfection of the colostomy) a peristomal abscess in 2 cases (reconfection of the colostom...
Hydatid cysts of the spigelian lobe, that is, segment I of the liver, are rare. We analyzed their... more Hydatid cysts of the spigelian lobe, that is, segment I of the liver, are rare. We analyzed their clinical and therapeutic particularities. We conducted a retrospective search for the hydatid cysts of the liver treated surgically in our department from January 1, 1994, through December 31, 2005. Cases were identified and confirmed with the following investigatory techniques: routine abdominal ultrasonography, abdominal computed tomography recommended by the ultrasound operator when a cyst was discovered in segment I, routine intraoperative cholangiography, and three separate serological techniques: electrosyneresis, hemaglutination and ELISA (enzyme-linked-immunosorbent assay)(the latter two being quantitative). The cystic cavity was treated with hypertonic serum. Several surgeons performed different combinations of the following techniques: deroofing, sometimes with omentoplasty, simple drainage, and subtotal pericystectomy. We treated 44 hydatid cysts of segment I surgically in 10...
European Journal of Gastroenterology & Hepatology, 2011
Abdominal pain observed in Henoch-Schönlein purpura (HSP) is usually attributed to edema and hemo... more Abdominal pain observed in Henoch-Schönlein purpura (HSP) is usually attributed to edema and hemorrhage in the small bowel wall, secondary to a small-vessel vasculitis. Pancreatitis secondary to HSP is extremely rare. Here we report a 53-year-old man presented with acute pancreatitis that developed into characteristic rashes seen during HSP at the second day of the clinical onset, together with arthritis and glomerulonephritis. HSP is a rare and benign cause of acute pancreatitis. This complication can occur as an initial manifestation of HSP. Elevated serum amylase level can be considered as the early diagnostic tool for HSP pancreatitis. The patients with HSP who have abdominal pain as their chief complaint should be evaluated for pancreatitis, by routine serum amylase and abdominal computed tomography scan, to plan the specific treatment and avoid unnecessary surgery.
Dear Sir Acute pancreatitis is reported to be an unusual manifestation of systemic lupus erythema... more Dear Sir Acute pancreatitis is reported to be an unusual manifestation of systemic lupus erythematosus (SLE), especially as an initial sign of the disease. Moreover, it has never been reported as an initial manifestation of subacute cutaneous lupus erythematosus (SCLE).1,2 We report two cases of acute pancreatitis, as the initial presentation of SLE in one patient and SCLE in the other one. Patient 1 is a 24-year-old womanwith a 2-week history of fatigue, malaise, arthralgia of knee, fever, generalized abdominal pain and recent onset of alimentary vomiting. There was no history of alcohol, drugs or any other medications. Physical examination revealed a diffuse erythema with purpuric elements on the dorsum of her hands and forearms and erythematous, scaly, maculo-papular lesions on the trunk (Figure 1); generalized abdominal tenderness with no guarding or hepato-splenomegaly was detected. Laboratory tests showed: WBC 1600/mm3 (normal 4000–10,000), RBC 3,400,000/mm3 (normal 3,800,000–5,100,000), HGB 9.7 g/dL (normal 12.0–16.0), PLT 84,000/mm3 (normal 130,000– 400,000); AST 70 U/L (normal 5–32), ALT 45 U/L (normal 6–31), γGT 66 U/L (normal 5–36), LDH 921 U/L (normal 220–480), amylase 456 U/L (normal 28–100) and lipase 443 U/L (normal 13–60). Triglycerides and calcium serum level were normal. Serology for HIV, CMV, EBVwas negative; ANA positive at titre of 1:5120, positive dsDNA antibody at titre of 1:40, anti-histone antibody 3.8 (normal range 0.0–1.1 index). ESR was 65 mm/h (normal 1–18), complement 3 (C3) 41.1 mg/dL (normal 83.0–177.0), complement 4 (C4) 9.3 mg/dL (normal 15.0–45.0), anticardiolipin, anti-SSA/Ro and lupus anticoagulant antibodies were negative. A biopsy and direct immunofluorescence (DIF) of a trunk lesion were suggestive for lupus. Abdominal Computed Tomographic (CT) and ultrasonic scan showed a swollen pancreas, but no gallbladder stones (grade B according to Balthazar scale). A diagnosis of acute pancreatitis and SLE was made according to the clinical signs and laboratory results and the patient started therapy with methylprednisolone at initial dose of 1 mg/kg daily i.v. and somatostatin 3.5 μg/kg/h i.v. After 7 days, in consideration of the clinical improvement, azathioprine 1.5 mg/kg daily was associated and somatostatin stopped. After 6 weeks, no cutaneous lesions were detectable and the pancreatic enzymes returned normal. After a further period of 6 weeks, the treatment was progressively reduced to methylprednisolone 0.1 mg/kg/day and azathioprine 0.3 mg/kg/day. Patient 2 is a 39-year-old woman with a 4-week history of a few papules of the face and erythematous, oedematous papules, some of themwith ring forms, of the upper trunk and arms (Figure 2). She had a 5week history of persistent abdominal pain, loss of appetite associated, in the last week, with nausea and intermitting vomiting. The patient had no history of alcohol or drug use. Laboratory tests were normal except: AST 70 U/L, ALT 62 U/L, γGT 61 U/L, amylase 388 U/L, lipase 419 U/L, LDH 879 U/L, ESR 18 mm/h, ANA titre of 1:160, anti-SSA/Ro antibody 1.5 index (normal 0.0–1.1). Abdominal CT and ultrasound scan showed fullness of the pancreatic head and absence of stones (grade A according to Balthazar scale). A biopsy of a trunk lesion and DIF were evocative of lupus. A diagnosis of SCLE with acute pancreatitis was made and the patient was started on treatment with somatostatin 3.5 μg/kg/h i.v. and methylprednisolone 1 mg/kg daily i.v. with Lupus (2008) 17, 695–697
Un accident occlusif aigu pendant la grossesse est une complication rare mais potentiellement gra... more Un accident occlusif aigu pendant la grossesse est une complication rare mais potentiellement grave qui peut poser des difficultes diagnostiques et mettre en jeu le pronostic maternel et fœtal. Nous rapportons le cas d´une patiente âgee de 22 ans, sans antecedents, admise pour des contractions uterines au terme de 37 semaines d´amenorrhees. L´examen a l´admission etait sans anomalies. La patiente a presente 7 heures apres l´admission des vomissements repetitifs avec polypnee et fievre. Une cesarienne a ete decidee en urgence devant l´apparition d´une bradycardie fœtale a l´enregistrement du rythme cardiaque fœtal ERCF. Le diagnostic de volvulus du colon droit sur un mesentere commun complet a ete pose en per-operatoire apres l´extraction fœtale. Le colon droit etait distendu et necrose avec trois tours de spire. La decision etait de realiser une colectomie droite avec anastomose ileo-colique termino laterale. L´evolution de la patiente en post operatoire etait favorable. A travers c...
UNLABELLED We report a prospective study of 42 cases of primary uncomplicated umbilical and epiga... more UNLABELLED We report a prospective study of 42 cases of primary uncomplicated umbilical and epigastric hernia operated by laparoscopy with a 1 year mean follow-up. The purpose of our study is to investigate the contribution of laparoscopy in the treatment of in terms of results in the short and medium term. Early surgical morbidity was 14.3%. There was no mortality. At 6 months of the intervention, 28.5% of patients have kept umbilical pain. At 1 year of intervention, 2 patients have kept umbilical chronic pain. No case of recurrence was noted. In conclusion, the laparoscopic approach should be reserved for cases of large hernias and for recurrent and incisional hernias. KEY WORDS Epigastric hernia, Laparoscopy, Mesh, Umbilical hernia.
OBJECTIVE Hydatid cysts of the spigelian lobe, that is, segment I of the liver, are rare. We anal... more OBJECTIVE Hydatid cysts of the spigelian lobe, that is, segment I of the liver, are rare. We analyzed their clinical and therapeutic particularities. METHODS We conducted a retrospective search for the hydatid cysts of the liver treated surgically in our department from January 1, 1994, through December 31, 2005. Cases were identified and confirmed with the following investigatory techniques: routine abdominal ultrasonography, abdominal computed tomography recommended by the ultrasound operator when a cyst was discovered in segment I, routine intraoperative cholangiography, and three separate serological techniques: electrosyneresis, hemaglutination and ELISA (enzyme-linked-immunosorbent assay)(the latter two being quantitative). The cystic cavity was treated with hypertonic serum. Several surgeons performed different combinations of the following techniques: deroofing, sometimes with omentoplasty, simple drainage, and subtotal pericystectomy. RESULTS We treated 44 hydatid cysts of ...
BACKGROUND The histopathological examination of cholecystectomy specimens has not been standardiz... more BACKGROUND The histopathological examination of cholecystectomy specimens has not been standardized with a debate concerning the routine and the selective approach. The aim of this study was to assess the information obtained from routine histopathological examination of cholecystectomy specimens. METHODS All histopathological reports of cholecystectomy specimens between January 2003 and December 2016 were analyzed, including a clinical diagnosis of benign gallstone disease or cholecystitis. RESULTS A total of 20,584 reports were examined. The mean age of patients was 54.2 years. Patients aged more than 60 years represent 37.6% of the study population. Of all patients, 15,973 (77.6%) were females. Incidental gallbladder cancers (GBC) were present in 155 cholecystectomies specimens (0.8%). 67.1% of GBC are at T2 and T3 stage. Granulomatous cholecystitis was diagnosed in only 19 cases (0.1%). GBC were more prevalent in older patients (P < 10-6) and cholesterolosis was more prevalent in young patients (P < 10-6). There was no gender predilection for GBC (P = 0.739). CONCLUSIONS The rate of incidental gallbladder carcinoma in our study is low, yet, we found a higher proportion of T2 and T3 carcinomas stage. Granulomatous cholecystitis may need further investigations and treatments. When a selective approch of histopathological examination of cholecystectomy specimens is used, it is important to take into account that clinical parameters are significantly associated with gallbladder cancer.
BACKGROUND The colostomy may be terminal or lateral, temporary or permanent. It may have psycholo... more BACKGROUND The colostomy may be terminal or lateral, temporary or permanent. It may have psychological, medical or surgical complications. AIM reporting the incidence of surgical complications of colostomies, their therapeutic management and trying to identify risk factors for their occurrence. METHODS A retrospective study for a period of 5 years in general surgery department, Habib Bourguiba hospital, Sfax, including all patients operated with confection of a colostomy. Were then studied patients reoperated for stoma complication. RESULTS Among the 268 patients who have had a colostomy, 19 patients (7%) developed surgical stoma complications. They had a mean age of 59 years, a sex ratio of 5.3 and a 1-ASA score in 42% of cases. It was a prolapse in 9 cases (reconfection of the colostomy: 6 cases, restoration of digestive continuity: 3 cases), a necrosis in 5 cases (reconfection of the colostomy), a plicature in 2 cases (reconfection of the colostomy) a peristomal abscess in 2 case...
We report a prospective study of 42 cases of primary uncomplicated umbilical and epigastric herni... more We report a prospective study of 42 cases of primary uncomplicated umbilical and epigastric hernia operated by laparoscopy with a 1 year mean follow-up. The purpose of our study is to investigate the contribution of laparoscopy in the treatment of in terms of results in the short and medium term. Early surgical morbidity was 14.3%. There was no mortality. At 6 months of the intervention, 28.5% of patients have kept umbilical pain. At 1 year of intervention, 2 patients have kept umbilical chronic pain. No case of recurrence was noted. In conclusion, the laparoscopic approach should be reserved for cases of large hernias and for recurrent and incisional hernias. Epigastric hernia, Laparoscopy, Mesh, Umbilical hernia.
The colostomy may be terminal or lateral, temporary or permanent. It may have psychological, medi... more The colostomy may be terminal or lateral, temporary or permanent. It may have psychological, medical or surgical complications. reporting the incidence of surgical complications of colostomies, their therapeutic management and trying to identify risk factors for their occurrence. A retrospective study for a period of 5 years in general surgery department, Habib Bourguiba hospital, Sfax, including all patients operated with confection of a colostomy. Were then studied patients reoperated for stoma complication. Among the 268 patients who have had a colostomy, 19 patients (7%) developed surgical stoma complications. They had a mean age of 59 years, a sex ratio of 5.3 and a 1-ASA score in 42% of cases. It was a prolapse in 9 cases (reconfection of the colostomy: 6 cases, restoration of digestive continuity: 3 cases), a necrosis in 5 cases (reconfection of the colostomy), a plicature in 2 cases (reconfection of the colostomy) a peristomal abscess in 2 cases (reconfection of the colostom...
Hydatid cysts of the spigelian lobe, that is, segment I of the liver, are rare. We analyzed their... more Hydatid cysts of the spigelian lobe, that is, segment I of the liver, are rare. We analyzed their clinical and therapeutic particularities. We conducted a retrospective search for the hydatid cysts of the liver treated surgically in our department from January 1, 1994, through December 31, 2005. Cases were identified and confirmed with the following investigatory techniques: routine abdominal ultrasonography, abdominal computed tomography recommended by the ultrasound operator when a cyst was discovered in segment I, routine intraoperative cholangiography, and three separate serological techniques: electrosyneresis, hemaglutination and ELISA (enzyme-linked-immunosorbent assay)(the latter two being quantitative). The cystic cavity was treated with hypertonic serum. Several surgeons performed different combinations of the following techniques: deroofing, sometimes with omentoplasty, simple drainage, and subtotal pericystectomy. We treated 44 hydatid cysts of segment I surgically in 10...
European Journal of Gastroenterology & Hepatology, 2011
Abdominal pain observed in Henoch-Schönlein purpura (HSP) is usually attributed to edema and hemo... more Abdominal pain observed in Henoch-Schönlein purpura (HSP) is usually attributed to edema and hemorrhage in the small bowel wall, secondary to a small-vessel vasculitis. Pancreatitis secondary to HSP is extremely rare. Here we report a 53-year-old man presented with acute pancreatitis that developed into characteristic rashes seen during HSP at the second day of the clinical onset, together with arthritis and glomerulonephritis. HSP is a rare and benign cause of acute pancreatitis. This complication can occur as an initial manifestation of HSP. Elevated serum amylase level can be considered as the early diagnostic tool for HSP pancreatitis. The patients with HSP who have abdominal pain as their chief complaint should be evaluated for pancreatitis, by routine serum amylase and abdominal computed tomography scan, to plan the specific treatment and avoid unnecessary surgery.
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