Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Volume 69 , Issue 7
Showing 1-17 articles out of 17 articles from the selected issue
Clinical Investigation
  • Study Design and Event Rates for Myocardial Infarction and Coronary Death by Age Category in Japanese Workers
    Kazuhiko Hirobe, Tomohiro Terai, Shigenori Fujioka, Koichi Goto, Seita ...
    2005 Volume 69 Issue 7 Pages 767-773
    Published: 2005
    Released: June 25, 2005
    JOURNALS FREE ACCESS
    Background Although there have been regional studies, there has not been a detailed nationwide investigation of the morbidity from acute myocardial infarction (MI) in Japanese workers. Methods and Results Registration of MI and sudden death was done by full-time occupational physicians in Japan. Among 133,099 workers (109,550 men, 23,549 women) from 41 workplaces (April 1994 to March 1997) and 257,440 workers (207,310 men, 50,130 women) from 76 workplaces (April 1997 to March 2000), 297 fatal and nonfatal cardiac events were registered. The definitions of MI and coronary death followed the criteria of the WHO MONICA Project. The event rate in men rose sharply around the age of 45years. Using definition 1 (fatal definite + fatal possible + fatal unclassifiable + nonfatal definite), the age-standardized annual event rate and case fatality rate for men aged 35-64 years was 40.2 per 100,000 persons and 22.2%, respectively. These figures were significantly lower compared with those from Western reports and were also lower than previously reported for Japanese communities. Conclusion The Morbidity of Myocardial Infarction Multicenter Study in Japan revealed a surprisingly low incidence of coronary events, which may be attributable to prevention and early treatment of coronary risk factors among company workers in Japan. (Circ J 2005; 69: 767 - 773)
    Download PDF (185K)
  • Takeshi Yamamoto, Masahiro Yasutake, Hiromichi Takagi, Koichi Akutsu, ...
    2005 Volume 69 Issue 7 Pages 774-779
    Published: 2005
    Released: June 25, 2005
    JOURNALS FREE ACCESS
    Background The clinical implications of applying the new criteria of acute myocardial infarction (AMI) with cardiac troponins in terms of their diagnostic and prognostic impact in patients with suspected acute coronary syndromes (ACS) have not been well evaluated. Methods and Results The study group comprised 973 consecutive patients who were diagnosed as having ACS with or without ST elevation (STE). They were divided into 3 groups: unstable angina (UA) group (n=195) representing patients with no significant elevations of creatine kinase (CK) and troponin T (TnT); TnT-myocardial infarction (MI) group (n=170) with TnT elevation and no CK elevation (additionally detected AMI by the new criteria); CK-MI group (n=608) with significant elevation of CK (AMI by the old criteria). In the TnT-MI group, 140 (76%) patients had non-STE ACS. In-hospital mortality rates for STE ACS were 0%, 2.5% and 9.7% in the UA, TnT-MI and CK-MI groups, respectively. The corresponding values for non-STE ACS were 1.8%, 4.6%, and 16.5%, respectively (p<0.0001), suggesting a pivotal role of TnT. In multiple logistic regression analysis, significant CK elevation was selected as an independent predictor of in-hospital death in concurrence with age ≥75 years, prior MI, shock and low left ventricular ejection fraction in non-STE ACS. Conclusions The new criteria result in a substantial increase in the diagnosis of AMI from non-STE ACS in particular. They assist greatly in detailed risk stratification of ACS patients, notably in cooperation with the old CK criteria. (Circ J 2005; 69: 774 - 779)
    Download PDF (203K)
  • Noriyuki Takeyasu, Shigeyuki Watanabe, Yuichi Noguchi, Kimito Ishikawa ...
    2005 Volume 69 Issue 7 Pages 780-785
    Published: 2005
    Released: June 25, 2005
    JOURNALS FREE ACCESS
    Background Cilostazol and ticlopidine are commonly prescribed for prevention of thrombosis after coronary stenting, but few studies have compared them. Methods and Results In the present study 642 patients who underwent stenting were randomized to treatment either with cilostazol + aspirin (C group, 321 patients) or ticlopidine + aspirin (T group, 321 patients). Quantitative coronary angiography (QCA) was performed immediately after stenting and at the 6-month follow-up. Treatment was continued until follow-up angiography. Baseline patient characteristics did not differ significantly. With the exception of a higher rate of stenting in a venous graft in the C group, there were no differences in angiographic characteristics or stent type. Baseline QCA analysis of the reference diameter, minimal lumen diameter (MLD) showed no significant differences. Follow-up QCA analysis of the MLD showed no significant differences. There were also no differences in restenosis or target lesion revascularization rates, or in the incidence of adverse reactions. However, the rate of subacute thrombosis (SAT) was significantly higher in the C group than in the T group (2% vs 0.3%, p=0.02). Conclusion In the present study there was a similar restenosis rate with cilostazol or ticlopidine, but the rate of SAT was significantly higher with cilostazol. There was no significant difference in adverse reactions. (Circ J 2005; 69: 780 - 785)
    Download PDF (136K)
  • Eue-Keun Choi, Hyo-Soo Kim, Kyung-Woo Park, Hyung-Kwan Kim, Joung-Won ...
    2005 Volume 69 Issue 7 Pages 786-792
    Published: 2005
    Released: June 25, 2005
    JOURNALS FREE ACCESS
    Background There is a paucity of information regarding the impact of the coronary collaterals on prognosis in type 2 diabetic (T2DM) patients. We developed a novel index, which considers not only the degree of collateral circulation but also the stimulus of collateral development, and investigated its prognostic value in T2DM patients with coronary artery disease (CAD). Methods and Results One hundred and ninety four consecutive T2DM patients were analyzed and followed for an average of 30 months. We measured the diameter stenosis (DS; %), corrected TIMI frame count (CTFC) and Rentrop score at 3 major epicardial coronary arteries. The collateral development (CD) score was calculated by: (Σ Rentrop score +1)/Σ [DS (%) × CTFC] ×1,000. During the follow-up, acute cardiovascular events occurred in 49 patients. By multivariate analysis, the CD score was an independent predictor of adverse events not only in the total population (p<0.001), but in all 3 subgroups (p=0.020 for coronary artery bypass grafting, p=0.030 for percutaneous transluminal coronary angioplasty (PTCA) and p=0.003 for the medical group). Furthermore, patients in the tertile with the highest CD score showed improved survival by Kaplan-Meier analysis in the total population, the PTCA and the medical group. Conclusions The CD score, a novel index of collateral development, may be a useful predictor of clinical outcome in T2DM patients with CAD. (Circ J 2005; 69: 786 - 792)
    Download PDF (173K)
  • Yukihiko Momiyama, Reiko Ohmori, Makoto Nagano, Ryuichi Kato, Hiroaki ...
    2005 Volume 69 Issue 7 Pages 793-797
    Published: 2005
    Released: June 25, 2005
    JOURNALS FREE ACCESS
    Background Interleukin (IL)-12 is thought to play an important role in the development of atherosclerosis and recently, polymorphism of the 3'-untranslated region of the IL-12 p40 gene (A1188C) was reported to be associated with diabetes and multiple sclerosis. However, the association between this genetic polymorphism and coronary artery disease (CAD) has not been studied. Methods and Results The frequency of this polymorphism was investigated in 555 patients undergoing coronary angiography: 395 had CAD, of whom 161 also had a myocardial infarction (MI). With regard to the IL-12 p40 polymorphism, 125 had the A/A, 268 had the A/C, and 162 had the C/C genotype. The prevalence of CAD did not differ among the groups (71%, 73%, and 69%, respectively; p= NS). The prevalence of MI was also similar among the groups (28%, 27%, and 33%, respectively; p= NS). Moreover, the number of >50% stenotic vessels, >50% stenotic segments, and ≤50% stenotic segments did not differ among the 3 groups. Conclusions Polymorphism of IL-12 p40 gene was not found to be associated with the presence or severity of CAD, suggesting that it does not play an important role in the development of this disease. (Circ J 2005; 69: 793 - 797)
    Download PDF (68K)
  • The EARLY Trial
    Jeffrey J Fine, Christie B Hopkins, Patrick AX Hall
    2005 Volume 69 Issue 7 Pages 798-801
    Published: 2005
    Released: June 25, 2005
    JOURNALS FREE ACCESS
    Background Cardiovascular disease remains the primary cause of diabetes-associated morbidity and mortality. Previous studies have failed to provide accurate, inexpensive, screening techniques to detect cardiovascular disease in diabetics. Ankle brachial indices (ABI) testing may be an effective screening technique for diabetics. Methods and Results The aim of this 100-subject clinical study was to determine cardiovascular disease prevalence, via perfusion stress testing, in diabetic patients having abnormal ABI (<0.90) and without known heart disease who were referred to the South Carolina Heart Center, Columbia, SC for nuclear perfusion stress testing. Study data were analyzed using frequency and descriptive statistics and 2-sample T-testing. Mean subject age was 62±11 years, ABI 0.76±13, and ejection fraction 60±12%. Perfusion stress testing detected 49 abnormal electrocardiograms, 36 subjects with coronary ischemia, 20 with diminished left ventricular function, and 26 subjects having significant thinning of the myocardium. There were 71 subjects who tested positive for at least one form of cardiovascular disease. The sole predictive variable reaching significance for the presence of cardiovascular disease was an ABI score <0.90 (p≤0.0001). Conclusion Cardiovascular disease may be predicted among diabetic patients via ABI scores and confirmed by nuclear perfusion testing. (Circ J 2005; 69: 798 - 801)
    Download PDF (59K)
  • Shigeyuki Watanabe, Chikako Ishii, Noriyuki Takeyasu, Ryuichi Ajisaka, ...
    2005 Volume 69 Issue 7 Pages 802-814
    Published: 2005
    Released: June 25, 2005
    JOURNALS FREE ACCESS
    Background In patients with chronic heart failure, an inadequate increase in muscle blood flow resulting from impaired vasodilation plays a key role in their exercise intolerance. However, no non-invasive methods to assess muscle vasodilation during dynamic exercise were available. We investigated whether the changes in tissue hemoglobin and myoglobin content (total-Hb + Mb) determined by non-invasive measurement using near-infrared spectroscopy (NIRS) reflect vessel conductance of working muscle during exercise. Methods and Results Sixteen patients (10 patients with normal cardiac systolic function, 6 with cardiac dysfunction) performed incremental bicycle exercise testing. Total-Hb + Mb from the right vastus lateralis muscle was monitored using NIRS. Leg blood flow (LBF) in the right femoral vein was measured using a thermodilution technique every 30-60 s. Leg vessel conductance was calculated as LBF/mean arterial pressure at each time of the measurement. In all cases except 1, the levels of total-Hb + Mb showed significant correlation with the leg vessel conductance (r=0.792 to 0.980). Intra-subject reproducibility of the NIRS measurement was also confirmed in 6 patients. Conclusions Total-Hb + Mb from NIRS reflected muscle vasodilation during sub-maximal dynamic exercise in patients with and without cardiac dysfunction, indicating that NIRS provides a valuable method to assess the working muscle vasodilation. (Circ J 2005; 69: 802 - 814)
    Download PDF (2806K)
  • Hirofumi Tomiyama, Yutaka Koji, Minoru Yambe, Kazuki Shiina, Kohki Mot ...
    2005 Volume 69 Issue 7 Pages 815-822
    Published: 2005
    Released: June 25, 2005
    JOURNALS FREE ACCESS
    Background Although a very simple method of measuring brachial - ankle pulse wave velocity (baPWV) has become available in a clinical setting, whether baPWV can predict future cardiovascular events remains uncertain. We examined whether baPWV is a predictor of cardiovascular events in patients with acute coronary syndrome (ACS). Methods and Results baPWV measurement was performed in 215 consecutive patients with ACS. During the follow-up period (26±10 months), 46 patients experienced post-hospitalization cardiovascular events (18 patients experienced a major event (eg, stroke, re-admission for heart failure or cardiac death), and 28 patients experienced coronary re-intervention). A receiver operating characteristic curve demonstrated that the best cut-off point of a baPWV for predicting a post-hospitalization cardiovascular event was 17.00 m/s and that for predicting a major cardiovascular event was 18.00 m/s. After the adjustment for the conventional risk factors influencing the prognosis, a multivariate Cox proportional hazards model demonstrated that both cut-off points of baPWV had a significant hazard ratio for a post-hospitalization event: 5.47 (2.69-11.09) and for a major cardiovascular event: 9.22 (2.78-30.56). Conclusions baPWV is a simple predictor of the prognosis of patients with ACS that is independent of conventional risk factors for ACS. (Circ J 2005; 69: 815 - 822)
    Download PDF (222K)
  • Toshimi Koitabashi, Takayuki Inomata, Shinichi Niwano, Mototsugu Nishi ...
    2005 Volume 69 Issue 7 Pages 823-830
    Published: 2005
    Released: June 25, 2005
    JOURNALS FREE ACCESS
    Background The prognostic significance of atrial fibrillation (AF) in chronic heart failure (CHF) remains poorly understood. Methods and Results Death and rehospitalizaion for CHF exacerbation for 427 consecutive patients hospitalized from 1996 to 2002 were retrospectively analyzed in relation to cardiac rhythm: sinus rhythm (SR; n=239) or AF (n=188). The AF group was classified according to an Intervention (n=57) or Non-Intervention (n=131) group for defibrillating AF. During the follow-up of 34±23 months, there was no significant difference of mortality or morbidity between the SR and AF groups, or between the Intervention and Non-Intervention groups, respectively. However, the Non-Intervention group consisted of 28 patients with paroxysmal AF (PAF), which spontaneously converted to SR during hospitalization, and 103 with chronic AF (CAF). The rehospitalization for CHF exacerbation was significantly higher in PAF than that in CAF and SR (p=0.00005 and 0.002, respectively). Multivariate Cox analysis demonstrated that, PAF, but not CAF, was a predictor of readmission (relative risk 2.30, p=0.004, 95% confidence interval 1.30 to 4.05). Conclusions The present data implied that PAF coincident with cardiac decompensation could be a new predictor of prognosis for CHF. The management strategies of AF in CHF should be discussed according to the phenotype of AF. (Circ J 2005; 69: 823 - 830)
    Download PDF (209K)
  • Katsumi Matsumoto, Toshiyuki Ishikawa, Shinichi Sumita, Kohei Matsushi ...
    2005 Volume 69 Issue 7 Pages 831-836
    Published: 2005
    Released: June 25, 2005
    JOURNALS FREE ACCESS
    Background Biatrial (BiA) pacing prevents atrial fibrillation. By an unknown mechanism. The purpose of this study was to use Doppler echocardiography to evaluate the hemodynamic effects during BiA pacing. Methods and Results The subjects were 7 patients with bradycardia - tachycardia syndrome with an implanted pacemaker. Atrial pacing sites were the right atrial appendage (RAA) and coronary sinus. P wave duration during BiA pacing (123 ±16 ms) was significantly shorter than during either RAA pacing (167±19 ms, p<0.05) or sinus rhythm (148±12 ms, p<0.05). Doppler echocardiography revealed a greater cardiac output during BiA pacing than during RAA pacing (4.1±1.1 vs 3.5±0.7 L/min, p=0.042). The Doppler waveform of transmitral flow indicated that the left ventricular contraction interrupted the atrial filling wave during RAA pacing. The interval between the end of the atrial filling wave of transmitral flow and the mitral valvular closing sound was significantly increased by BiA pacing compared with RAA pacing (56±65 vs 40±57 ms, p=0.047). Conclusion Cardiac hemodynamics were improved by BiA pacing and reduction of left atrial load may be one of the mechanisms. (Circ J 2005; 69: 831 - 836)
    Download PDF (1208K)
  • Conventional Mapping Method Without an Electroanatomical Mapping System
    Motohiro Nakao, Akihiko Nogami, Aiko Sugiyasu, Shoichi Kubota, Hideki ...
    2005 Volume 69 Issue 7 Pages 837-843
    Published: 2005
    Released: June 25, 2005
    JOURNALS FREE ACCESS
    Background A variety of supraventricular tachyarrhythmias may occur in patients after undergoing a surgical atriotomy. The purpose of this study was to characterize them and determine the role of conventional mapping. Methods and Results In 45 patients after a surgical atriotomy, 68 atrial tachyarrhythmias were observed. A conventional mapping system with a 20-pole electrode catheter used in the electrophysiological study detected 39 atrial tachycardias (ATs). Type 1 atrial flutter (AFL) was observed in 23 and reverse type 1 AFL in 4. AT was classified into 3 subgroups, namely, incisional macroreentrant AT (n=31), incisional focal AT (n=1) and non-incisional AT (n=7). In the patients with incisional macroreentrant AT after the standard right atriotomy, the 20-pole electrode catheter placed on the incision could easily record the entire sequence of the atrial activation. Successful catheter ablation was achieved in all patients with incisional reentrant AT. The ablation site of incisional reentrant AT was the isthmus between the incision and the superior vena cava cannulation scar in 4, between the incision and the inferior vena cava cannulation scar in 22, and the area at the septal incision in 3. The remaining 2 incisional ATs were left atrial AT and right atrial transincisional AT. Conclusions The conventional mapping system is still very useful for making an electrophysiological diagnosis in patients after a standard right atriotomy. (Circ J 2005; 69: 837 - 843)
    Download PDF (1209K)
  • Analysis of Excised Valve Findings at Reoperation
    Motomi Shiono, Akira Sezai, Mitsumasa Hata, Mitsuru Iida, Nanao Negish ...
    2005 Volume 69 Issue 7 Pages 844-849
    Published: 2005
    Released: June 25, 2005
    JOURNALS FREE ACCESS
    Background Between June 1968 and March 1977, Starr-Edwards cloth-covered ball valves were used for valve replacement on a routine basis. Methods and Results Among the 66 operative survivors who underwent an isolated aortic or mitral valve replacement, 20 patients required reoperation 22 times because of valve dysfunction, thromboembolic complication, paravalvular leakage, hemolytic anemia, and/or prosthetic valve endocarditis. Reoperation was performed at a mean of 15.9±9.8 years after initial replacement. Excised valves were examined and reoperation after initial operation was reviewed. Operative mortality was 10.0%. Freedom from reoperation for aortic valve replacement and mitral valve replacement was 56.2% at 34 years and 61.0% at 37 years after initial operation, respectively. Cloth wear or pannus formation were observed in all excised prostheses. Orifice cloth was more markedly worn in mitral valves than in aortic valves, particularly in mitral valves of more than 20 years old. Pannus overgrowth contributed to valve regurgitation in the older valves. Conclusions Early diagnosis of valve dysfunction and reoperatation are recommended as soon as symptoms appear. (Circ J 2005; 69: 844 - 849)
    Download PDF (359K)
Experimental Investigation
  • Bone Marrow Cell-Seeded Biodegradable Polymeric Scaffold Enhances Angiogenesis and Improves Function of the Infarcted Heart
    Shinya Fukuhara, Shinji Tomita, Takeshi Nakatani, Toshiya Fujisato, Yo ...
    2005 Volume 69 Issue 7 Pages 850-857
    Published: 2005
    Released: June 25, 2005
    JOURNALS FREE ACCESS
    Background The present study examined whether a bioengineered polyglycolic acid cloth (PGAC) impregnated with bone marrow cells (BMC) improved the function and angiogenesis of the infarcted heart. Methods and Results The coronary artery was ligated in Lewis rats and the infarcted area was covered with a PGAC in group 1 (n=8), with a PGAC containing basic-fibroblast growth factor (b-FGF) in group 2 (n=11) and a PGAC containing b-FGF and freshly isolated BMC in group 3 (n=10). In addition, BMC derived from transgenic mice expressing green fluorescent protein (GFP)-BMC were seeded into a PGAC, which was sutured over the infarcted area of C57BL/6 mice (n=5). In the rat study, developed and systolic pressures, dp/dt max and dp/dt min) were the highest in group 3, as were the capillary density in the PGAC and infarcted area. In the mouse study, there were few GFP-BMC in the PGAC, but none in the infarcted area. Conclusions A PGAC with BMC improved cardiac function by inducing angiogenesis without migration of BMC. Freshly isolated BMC work as angiogenic inducers and a PGAC is useful as a "drug delivery system". (Circ J 2005; 69: 850 - 857)
    Download PDF (953K)
Case Report
  • A Case Report
    Ayumi Goda, Takeshi Yamashita, Takeshi Kato, Akira Koike, Kouichi Saga ...
    2005 Volume 69 Issue 7 Pages 858-860
    Published: 2005
    Released: June 25, 2005
    JOURNALS FREE ACCESS
    A 65-year-old man with Brugada-type electrocardiogram (ECG) was admitted to our hospital for chest pain, palpitation and faintness. In the cardiac electrophysiological study, no ventricular tachyarrthymia was induced either at baseline or after pilsicainide (50 mg) infusion. Intravenous administration of pilsicainide exaggerated ST-segment elevation in V1-4 and converted it to the coved type in V1, accompanied by severe chest pain. Coronary angiography revealed the vasospasm of the right coronary artery was induced by pilsicainide, not by ergonovine. This is the first case report of coronary vasospasm induced by a pure sodium channel blocker in a patient with Brugada-type ECG. (Circ J 2005; 69: 858 - 860)
    Download PDF (846K)
  • Motomi Shiono, Mitsumasa Hata, Akira Sezai, Mitsuru Iida, Nanao Negish ...
    2005 Volume 69 Issue 7 Pages 861-864
    Published: 2005
    Released: June 25, 2005
    JOURNALS FREE ACCESS
    A 38-year-old woman who had undergone an original Bentall operation in December 1995 for annuloaortic ectasia associated with ulcerative colitis required reoperation for ascending aortic aneurysm, coronary ostial aneurysm, and patent Cabrol trick. The initial Bentall operation included aortic root replacement using a valved conduit and reconstruction of the coronary arteries. Both coronary ostia were directly anastomosed to the composite valved graft, which was wrapped with the dilated aortic wall, and a Cabrol trick was added at the same time. She underwent reoperation for a 60 mm ascending aortic aneurysm which had been used for wrapping at the initial operation. The findings at reoperation were a patent Cabrol trick, leakage from the distal anastomosis, aneurysm of both coronary ostia, and paravalvular leakage. The repairs included graft replacement, leaving the valvular prosthesis, reconstruction of both coronary arteries by the Piehler method and Carrel patch technique, repair of the paravalvular leakage, and closure of the Cabrol trick. Her postoperative course was uneventful, and the serum concentration of C-reactive protein remained within normal limits. Strict follow-up care is required to avoid further anastomotic dehiscence. (Circ J 2005; 69: 861 - 864)
    Download PDF (493K)
  • Importance of Mapping in the Pulmonary Artery in Left Bundle Branch Block-Shaped Ventricular Arrhythmias
    Hiroshi Tada, Kenji Kurosaki, Sachiko Ito, Shigeto Naito, Minoru Yamad ...
    2005 Volume 69 Issue 7 Pages 865-869
    Published: 2005
    Released: June 25, 2005
    JOURNALS FREE ACCESS
    A patient underwent radiofrequency (RF) catheter ablation of symptomatic idiopathic ventricular contractions (PVCs). RF energy applications at 2 sites in the right ventricular outflow tract (RVOT), where both the earliest ventricular activation and near-perfect pace mapping were obtained, did not abolish the PVC but resulted in changes in the QRS morphology of the PVC. Complete elimination of the PVC was achieved with RF energy application at a site within the pulmonary artery 13 mm above the pulmonary valve, which was greater than 20 mm away from the failed ablation sites within the RVOT. (Circ J 2005; 69: 865 - 869)
    Download PDF (1390K)
  • Syusuke Yagi, Etsuko Tsuda, Wataru Shimizu, Takashi Kurita, Osamu Segu ...
    2005 Volume 69 Issue 7 Pages 870-874
    Published: 2005
    Released: June 25, 2005
    JOURNALS FREE ACCESS
    There is an adult patient population in Japan with undiagnosed coronary artery lesions caused by Kawasaki disease (KD) occurring before 1967, the time at which KD was first described. Two adult patients presented with a low left ventricular (LV) ejection fraction and ventricular tachycardia (VT) caused by presumed KD. A 43-year-old man with rapid VT had a history of an acute febrile illness with desquamation of the fingertips at the age of 10 months. Coronary angiography (CAG) showed segmental stenosis of the right coronary artery (RCA) and occlusion of the left anterior descending artery with a giant aneurysm. The other patient was a 48-year-old man with a history of ischemic cardiomyopathy diagnosed after a previous myocardial infarction when he was 32 years old. He had segmental stenosis of the RCA on CAG. Non-sustained VT with transient unconsciousness was observed during 24-h Holter electrocardiography. Rapid VT with syncope was induced in both patients in the electrophysiologic studies and an implantable defibrillator was required to prevent sudden death. Physicians must be aware that VT can occur in older patients with LV dysfunction many years after KD. (Circ J 2005; 69: 870 - 874)
    Download PDF (656K)
feedback
Top