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Hiroyuki Kozakura, Kensaku Hirata, Masataka Hashiguchi, Takuya Akamine ...
1988 Volume 36 Issue 3 Pages
940-943
Published: April 25, 1988
Released on J-STAGE: February 25, 2010
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Intramedullary Ender nailing was used in 42 fractures of the tibial shaft; 26 fractures were closed, 14 open and 2 delayed and non union.
Union was demonstrated radiographically at 13 weeks in 40 patients (95%). The major complications were nail protrusion at the knee (3 patients), malunion (3 patients), delayed union (2 patients) and osteomyelitis (1 patient).
With proper application and careful aftertreatment, even highly complex tibial fractures can be treated by this method.
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Tetsujiro Kikuchi, Nobuaki Tsunoda
1988 Volume 36 Issue 3 Pages
944-946
Published: April 25, 1988
Released on J-STAGE: February 25, 2010
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It is difficult to find out a fresh compression fracture of the osteoporotic spine in the elderly people, especially having a kyphotic deformity and compression fractures at the multiple levels.
We designed an objective method to diagnose a fresh compression fracture radiographically, in which the height of the vertebral bodies was increased (more than 3mm) in the prone position more than in the supine position in the profile view of the total spinal radiography.
We have observed 17 cases of the above-mentioned criteria since April in 1986 and researched how the vertebral compression fractures in the osteoporotic spine affected on the progression of the spinal deformities.
In the posture with a poor balance like kyphosis, kyphotic deformity tends to progress. On the other hand, kyphotic deformity tends to remain in the lordo-kyphotic posture.
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Tomoaki Yoshikawa, Hiromichi Norimatsu, Satoshi Mori
1988 Volume 36 Issue 3 Pages
947-950
Published: April 25, 1988
Released on J-STAGE: February 25, 2010
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We measured the bone mineral density (BMD) at three regions of the proximal femur (neck, Ward's triangle, trochanteric) by dual photon absorptiometry in 104 healthy men and 107 healthy women, in comparison with the BMD of the same regions in 33 women with femoral neck fractures.
Age-related decrease of BMD value was recognized at three regions in control men and women. Especially the curve for Ward's triangle decreased much faster than other curves and crossed the curve for trochanteric region at the 5th decade in men and 6th decade in women. In women acceleration of the decrease of BMD value at each region was seen after the menopause. Each BMD value of the fracture group was in 95% normal range at each region except several BMD values of transcervical fractures. From the ratio between the femoral neck and Ward's triangle, and the femoral neck and trohanteric region, control group had regular fasion of age-related bone mineral loss, but fracture group showed irregularity.
In conclusions the each value of BMD at proximal femur decreases gradually with aging in both men and women. Women have postmenopausal acceleration of bone loss even in cortical bone. It is clear that osteoporotic change at proximal region of the femur is caused by aging.
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Changes in degree of bone atrophy before and after treatment
A. Kuba, K. Iwasaki, T. Ohno, K. Sagara
1988 Volume 36 Issue 3 Pages
951-957
Published: April 25, 1988
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Tatsuo Kutsuna, Ryuji Kitajima, Yukihiko Tsutsumi
1988 Volume 36 Issue 3 Pages
958-962
Published: April 25, 1988
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This paper reported the results of the treatment of 50 trochanteric fractures of the femur in patients with the average age of 80 years. Of these 50 fractures, 46 cases were operated on and 4 cases were treated non-operatively.
The majority of the patients suffered from internal diseases such as hyper-tension, heart disease, anemia and etc. Ninety-two percent of the patients had mild-poor or poor risk on admission.
The results of treatment were as follows;
(1) All patients obtained bone fusion, and fracture line disappeared in 16 to 20 weeks on the X-ray films.
(2) Local complications observed were progressive osteoporosis in 13 patients (26%), pain in 2, cutt-off of the compression hip screw in one, and mild coxa vara deformity in one.
(3) Six patients became wheelchair bound or bedridden after the episode of the fracture.
(4) There were five death cases (10%) at the time of this investigation. The causes of death were pneumonia, cancer, and cirrhosis of the liver.
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Hiroaki Fujii, Takuo Hayashi, Akinori Hamamura, Hirotaka Iwanaga
1988 Volume 36 Issue 3 Pages
963-965
Published: April 25, 1988
Released on J-STAGE: February 25, 2010
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The follow-up study of 64 patients over the age of 65 years old with intracapsular femoral neck fracture was undertaken. Eighty-one percent (53/64) of the patients were female.
The mean age was 76 years old, and the average duration of follow-up was 3 years and 3 months (ranging from 5 months to 9 years). The patients were classified into four social function groups on admission to the hospital and at discharge, and again at the follow-up. We investigated the placement of the patients after discharge from hospital and social function at three points. Deterioration was found to be considerably influenced by the associated diseases.
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Koji Fukahori, Keisuke Sera, Toyoaki Takeshita, Yoshiomi Umeki, Ryuzo ...
1988 Volume 36 Issue 3 Pages
966-967
Published: April 25, 1988
Released on J-STAGE: February 25, 2010
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With aged society, femoral neck fracture in the aged is increasing year by year. We have operated for the prevention of the general complications. This time, we performed follow-up study of cases that were operated on from 1981 to 1986. At this study 17 cases had been already died within one year after operation because of heart disease.
In the group of alone life and life with family, they recovered to the almost same level as before injury.
In another group of hospitalization and old-aged home, their walking ability decreased after discharge from our hospital.
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Hiro Kameyama, Shigeki Hidaka, Shinsuke Matsumoto
1988 Volume 36 Issue 3 Pages
968-971
Published: April 25, 1988
Released on J-STAGE: February 25, 2010
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From July, 1983 to April, 1987, we operated on 85 cases for femoral neck fracture, and examined that how many patients lived and to what degree they obtained ADL.
Postoperative ADL was not related to age, types of fracture and operation in most patients. It was difficult to maintain the level of ADL at discharge because of complications.
At the time of this study, 22 cases were already dead, and most causes of death were malignancy, pneumonia and heart failure.
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Takashi Nitamizu, Yoshihiro Hasegawa, Hirokazu Tabira, Masashi Sagara, ...
1988 Volume 36 Issue 3 Pages
972-974
Published: April 25, 1988
Released on J-STAGE: February 25, 2010
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Fracture of the proximal femur in aged people is common. 131 fractures were treated at our hospital in the last three years. The age of the patient ranged from 52 years to 98 years with an average of 79.5 years.
Problem area of this condition was discussed. Activity of daily living and level of psychological disorder before injury both related to the results deeply. Thirty-eight patients out of 120 (31%) were unble to walk alone after treatment.
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Hiromichi Norimatsu, Satoshi Mori, Tomoaki Yoshikawa
1988 Volume 36 Issue 3 Pages
975-978
Published: April 25, 1988
Released on J-STAGE: February 25, 2010
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Bone mineral density (BMD) at the lumbar spine and femoral neck was measured by scanner type dual photon absorptiometer (LUNAR DP3) in control population and primary osteoporosis. Histomorphometric study of the iliacal trabeculae was added to evaluate bone dynamics in osteoporosis. Primary osteoporosis was classified to postmenopausal and senile osteoporoses. BMD value of lumbar spine in postmenopausal osteoporosis was lower than age-matched control, and that of senile osteoporosis showed no difference from control value. Many patients of femoral neck fractures were assumed as senile osteoporosis, because their BMD values of the femoral neck were in the range of age-matched control value. Histomorphometric result showed normo- or low-turnover bone in postmenopausal osteoporosis and low turnover bone in senile osteoporosis.
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Sadamichi Ikeda, Katsuro Iwasaki, Tomonori Hayakawa
1988 Volume 36 Issue 3 Pages
979-983
Published: April 25, 1988
Released on J-STAGE: February 25, 2010
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Calcitonin has been considered to be useful in the treatment of back pain due to senile osteoporosis. However, a proper quantity and an effect for increasing the bone volume have not been proved. We have studied these points for 6 months using eel calcitonin derivative, elcitonin, in 10 units twice a week without another supplement. A proper quantity was estimated by the clinical results using Itami's chart. Bone volume was evaluated by microdensitometory of the roentogenograms of the second metacarpal bone. The majority of the spontaneous back pain was relieved by 10 times of injection and the disturbance of activity of daily living due to pain was frequently improved by 30 times of injection. The level of bone volume was maintained or slightly increased up to 8 months but it was somewhat lessened after 60 times of injection.
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Hideaki Kishimoto, Kichizo Yamamoto, Hiroshi Hagino, Koji Kuranobu, Ak ...
1988 Volume 36 Issue 3 Pages
984-986
Published: April 25, 1988
Released on J-STAGE: February 25, 2010
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Thirty-five osteoporotic women, with a mean age of 69 years (range, 58-86 years), were treated by our “long-cycle” ADFR regime according to Frostian concept. Frostian concept is a rational therapeutic approach to manipulating the basic ARF sequence, named ADFR treatment. The effect of ADFR treatment on bone mass in osteoporotic women was examined at orgen level in this study.
Each cycle of our ADFR treatment consists of a) activation by 1α-OH-D
3 (1.5μg/day), b) depression by calcitonin (10 ECU Elcatonin two times a week), c) free or low dose administration of 1α-OH-D
3 (0.25μg/day) and d) repeat of this ADF regime. The bone mineral mass of the distal 1/6 site of the radius was monitored using 125-I single photon absorptiometry, knowing when and how long to give and when to withdraw the drugs.
Not all patients responded alike to the ADFR treatment. An increase of bone mass following atemporary decrease was found in 24 (69%) of 35 patients, but in 11 patients bone mass did not change consistently. The increase of bone mass in responder group was about 9% of the value before treatment.
The significant difference of the bone mineral status before starting therapy in two groups was detected. In responder group, 1/6/1/3 ratio of initial BMC/BW value was low, but high in non-responder group.
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Shinichi Mishima, Katsumi Suzuki, Nario Ihara, Hiroshi Ojima, Kenzo It ...
1988 Volume 36 Issue 3 Pages
987-991
Published: April 25, 1988
Released on J-STAGE: February 25, 2010
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The question of whether pulsing electromagnetic fields (PEMF) can influence the bone metabolism, especially the epiphyseal plate, in growing animals and men, is still unanswered. In this study, PEMF was applied to growing mice treated with a high dose of 1-hydroxye-thylidine-1, 1-bisphosphonate (HEBP, 40mg/kg/day) for 4 weeks. PEMF consisted of 15Hz repetitive pulse burst, that is, 228μs pulse width and 5ms burst width. HEBP inhibited the mineralization of cartilage and bone, namely, there was a widening of the epiphyseal plate which is comprised mainly of proliferating cells and an increase of osteoid on the metaphysis. Histologically, between the HEBP group and the HEBP+PEMF group, no significant changes were observed in the lumbar spine and distal end of the femur.
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An Experimental Study
Naohisa Tayama, Tsukasa Yamaguchi, Keiko Lin, Yoichi Sugioka, Takaaki ...
1988 Volume 36 Issue 3 Pages
992-995
Published: April 25, 1988
Released on J-STAGE: February 25, 2010
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We reported the development of epiphyseal vessels in the femoral head of white rabbits. We prepared specimens for microangiography by modified Spalteholz technique and H. E. or Safranin-O staining for microscopic observation. The characteristic structure of epiphyseal vessels was found to be formed on the 4th week after birth and completed by 2 months after birth. With maturing of epiphyseal vessels, the thickness of the epiphyseal growth plate decreased. Tuft formations are characteristic for the ends of epiphyseal vessels and they have been connected one another for 1.5 months from birth. With maturing of epiphyseal vessels, however, the connections of tuft formation disappeared.
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Yoshiichi Sasaki, Yoichi Sugioka
1988 Volume 36 Issue 3 Pages
996-999
Published: April 25, 1988
Released on J-STAGE: February 25, 2010
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To investigate the influence of the overload to the epiphyseal growth, fifty-two rabbits, ten to fourteen days old, had the left ulnar diaphysis excised and for the radiological and histological studies of the radius were killed at variable time interval from the second to the 35th postoperative day. Following results were obtained. 1. Within 12 days tilt of radial epiphysis towards the palm and curvature of radius towards the ulna were produced. 2. Following 2 weeks, tilt, curvature, size of the epiphysis and length of radius decreased, probably due to the synostosis of ulna. 3. At histological study ulnar side of epiphyseal plate showed short proliferative cell column and the hypertrophic cell grouped into the clusters or augmentation of the height of the base of the columnar layer. Radial side demonstrated few changes or a fissure passing within the enchondral ossification at which epiphyseal side showed augmentation of the columnar layer.
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Yasuo Noguchi, Yoichi Sugioka
1988 Volume 36 Issue 3 Pages
1000-1003
Published: April 25, 1988
Released on J-STAGE: February 25, 2010
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The cytoskeleton and plasmalemmal undercoat of bone-surface cells, especially of osteoclasts, have been studied in detail mainly by fluorescence microscopy and transmission electron microscopy, but its three-dimensional organization and its changes under various hormonal or pathological conditions have not fully been understood. To observe the three-dimensional organization of intracellular structures of the bone-surface cells by high resolution scanning electron microscopy (SEM), we used a new method of tissue-preparation for SEM. Parietal bones of the neonatal mice were removed and the inner-surface cells of those were mechanically raptured. Then, the free surface plasmalemma of the cells was detached by adhering it to the polylysine-coated glass. These bones were fixed, dehydrated, and dried by the critical point drying method. In the cells which had morphological characteristics of osteoblasts, filamentous networks of cytoskeleton were observed. These filaments were about 10nm or less in diameter and, thus, were thought to be actin filaments and intermediate filaments. Three-dimensional organization of filamentous networks was more obvious in stereopair micrographs. Membranous organelles to which the filaments attached were also observed.
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Yasuo Noguchi, Yoichi Sugioka
1988 Volume 36 Issue 3 Pages
1004-1007
Published: April 25, 1988
Released on J-STAGE: February 25, 2010
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Spontaneous osteoarthritis occurs not only in human joints but also in various animal joints. We studied osteoarthritic changes in the ICR mouse knee joint by light microscopy. Three-month-old mice showed no arthritic changes. Femoral condyles of 12-month-old mice showed early osteoarthritic changes such as irregularity of the articular surface (fibrillations) and disappearance of superficial discoid chondrocytes. Four of ten condyles had a loss of the articular cartilage extending to the calcified zone (advanced osteoarthritis) in the central weightbearing area. Every 23-month-old mouse knee showed advanced osteoarthritic changes. Proliferative changes such as chondrocyte clusters and osteophyte formation were not observed. There was a sclerosis of the subchondral bone and necrosis of almost all the calcified cartilage chondrocytes in young adult mice, which were thought to be major pathogenetic factors of the osteoarthritis of the mouse.
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Chikafumi Arita, Takao Hotokebuchi, Ken Arai, Yoichi Sugioka, Kenji Ta ...
1988 Volume 36 Issue 3 Pages
1008-1010
Published: April 25, 1988
Released on J-STAGE: February 25, 2010
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We studied the effects of FK 506 (FK) on collagen arthritis in Sprague-Dawley rats and compared its effects with those of Cyclosporin (CS). A 10-day course of oral administration of FK at a dose of 6.0mg/kg/day, began on the day of type II collagen immunization, suppressed the development of arthritis as well as humoral and DTH skin test responses to type II collagen. When FK administration at a dose of 6.0mg/kg/day was started on day 7 or 14 after immunization, the arthritis index and DTH test were suppressed. FK is a cytostatic immunosuppresive agent, but the mechanism by which FK exerts its effects on the immune system is not clearly understood, but the results of the present study show the difference of immunosuppressive mechanisms between FK and CS.
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As a neuromuscular composite allograft
Takao Hotokebuchi, Ken Arai, Chikafumi Arita, Nobuhiko Samoto, Yoichi ...
1988 Volume 36 Issue 3 Pages
1011-1013
Published: April 25, 1988
Released on J-STAGE: February 25, 2010
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As a neuromuscular composite allograft model, limb allografts with Cyclosporin (CS) treatment using three inbred rat strains, Fischer (F344; RT1), Lewis (LEW; RT1) and Brown Norway (BN; RT1) were performed and the neuromuscular composite was examined clinically, histologically and electromyographically. All of the animals were divided into three experimental groups, minor-mismatched allografts (LEW to F344), major-mismatched allografs (BN to F344) and syngrafts (F344 to F344) as controls. The animals of both allograft groups were treated with CS for 16 days. A mild skin rejection was observed in the major-mismatched allograft group about 50 days after operation, however, the rejection was restricted almost to the skin. Reaction to painful stimuli was observed in all of these three groups about 12 to 16 weeks after operation. Histologic examination of the muscles and nerves in the grafted limbs demonstrated nomal architecture and good regeneration of the axons. Both muscular contraction and evoked potential were observed by electrical stimuli in all three experimental groups. Our results indicate the possibility of clinical neuromuscular composite allografts with the use of CS as well as other organ transplantation.
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Kazuhiro Sakai, Shinya Kawai, Kazuteru Doi, Seiji Sumiura, Hiroyasu Ic ...
1988 Volume 36 Issue 3 Pages
1014-1016
Published: April 25, 1988
Released on J-STAGE: February 25, 2010
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Alumina ceramics have superior biocompatibility, and when placed in bone, mechanical bonding with new bone formation at the interface can be made. However, under dynamic stress, fibrosis with bleeding, hyperemia and necrotic bone interposes between them. This is thought to be the main cause of “clear zone” shown in the radiogram of the hand with alumina ceramic finger implants replacement. These are investigated experimentally in this paper. And conclusively, it is suggested that the shape and size of the stem, the structure of the hinge, and the postoperative fixation period should be improved to have better results.
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Masayoshi Oga, Yasurou Kuga, Tsuyoshi Arizono, Seiya Jinguji, Youichi ...
1988 Volume 36 Issue 3 Pages
1017-1019
Published: April 25, 1988
Released on J-STAGE: February 25, 2010
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When disks of PMMA were exposed to the cells of Staphylococcus E46, a thick adherent biofilm, composed of these bacteria and of their exopolysaccharide products (glycocalyx), developed on the PMMA surface within 24h. After this colonization, established biofilm on PMMA was exposed to PBS containing 2mg of cefotiam per ml, and a significant proportion of the bacterial cells within the biofilm were found to be still viable after 12h or 24h of exposure to this very high concentration of antibiotic. Floating cells taken from the test system were completely killed. These data indicate that growth within thick adherent biofilms confers a measure of cefotiam resistance on cells of Staphylococcus E46.
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Toshihiko Taguchi, Kazuyuki Sakurada, Teturou Murakami, Kouichi Tamaru ...
1988 Volume 36 Issue 3 Pages
1020-1022
Published: April 25, 1988
Released on J-STAGE: February 25, 2010
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The purpose of this paper is to discribe comparison of the human and rabbit spinal nerve root. Rabbits have been selected in several studies on spine as they are easy to obtain and to keep. However, an appreciation of the differences in structure is essential for the correct extrapolation of results in the human situation.
The cervical spines were removed from fresh cadavers and 6 rabbits. The specimens were fixed in 10% formalin. They were evaluated histologically with the use of HE, Azan, PAS and EVG stains.
The main results found in this study were as follows;
(1) The structure of the connective tissue of spinal nerve roots in the human and rabbts were essentially same.
(2) However, there were a few differences between them.
i) Spinal ganglion of rabbits were closer to spinal cord.
ii) In rabbits, arachnoid and root sheath were thiner and arachnoid villi were underdeveloped.
iii) Subarachnoid space of rabbits was narrower.
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Hiroaki Konishi, Takayoshi Torigoshi, Nobuyuki Ito, Kenji Kumagai
1988 Volume 36 Issue 3 Pages
1023-1026
Published: April 25, 1988
Released on J-STAGE: February 25, 2010
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The retrograde axonal transport technique with horseradish peroxidase was performed to determine the distribution of motorneurons innervating the tibialis anterior muscle. The assessment of the sciatic nerve after compression injury was added.
1) The spinal anterior horn cells of 10 rats were stained with DAB after using Horseradish Peroxidase axonal retrograde transportion.
2) The anterior horn cells innervating the tibialis anterior muscles were found to distribute between distal L-3 and proximal L-5 (mainly mid L-4) using above the technique.
3) The sciatic nerve after compression test will have positive M wave in EMG at the repair process if the ipsilateral anterior horn cells have 30% more labelled cells than the controlled site.
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Atsuhiko Wakisaka, Shinya Kawai, Minoru Saika, Yasuo Kainaga, Kouzou N ...
1988 Volume 36 Issue 3 Pages
1027-1030
Published: April 25, 1988
Released on J-STAGE: February 25, 2010
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The pathogenesis of OPLL is not well understood. We have been studying its morphological and radiographical features.
We carried out histological investigations on 8 surgical materials and 1 autopsy case. They all were prepared for study with hematoxyline eosine, stain, and 2 of them with double tetracycline bone labeling were prepared with undecalcified ground section with Villanueva bone stain.
Degenerative change of the ligament, increasing numbers of vessels and appearance of cartilage cells could be seen at upper, lower and vertebral or disc side of all types of OPLL, especially in the continuous type.
Undecalcified section showed that osteoid could be seen much at the edge of OPLL except canal side. On fluoromicroscopic findings, tetracycline bone labels could be seen much at the same side where osteoid existed, but especially at disc lebel.
Bone formation must be accelerated at the edge of OPLL.
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Mutsuro Kuwahata, Kunio Sasaki, Takahide Kozuma, Jone H. Lin, Takuya T ...
1988 Volume 36 Issue 3 Pages
1031-1033
Published: April 25, 1988
Released on J-STAGE: February 25, 2010
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We studied patients with degenerative lumbar scoliosis by comparing the findings of plain radiography and computed tomography. Definition of degenerative scoliosis was curvature with degenerative changes (spondylotic changes) above 5 degrees and no vertebral rotation distal to the apex. 32 cases were seperated into two groups by configulation of facet of plain radiography. Ten cases were in Group 1 with frontally oriented facet and 22 cases in group 2 with sagittal facet. In CT, osteophyte formation, degeneration of facet and angle of facet were studied. Group 1 showed moderate degenerative changes but group 2 showed marked degenerative changes radiographically. We thought scoliosis with sagittal facet developed early displacement of center of motion and rendered unstable spine. Facet configulation was important to preserve the normal rotational motion.
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Kazutoshi Nakaie, Masatoshi Naito
1988 Volume 36 Issue 3 Pages
1034-1036
Published: April 25, 1988
Released on J-STAGE: February 25, 2010
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One hundred and eighty cases who had orthopedic probrems were studied using 5-MHz real-time ultrasound scannars. We conclude that the method is non-invasive and easily applicable and makes it possible to detect morphologic changes in these patients.
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Kensuke Yonemura, Hiroshi Mizuta, Takaaki Sagara, Katsuhiko Sakuma, Yo ...
1988 Volume 36 Issue 3 Pages
1037-1041
Published: April 25, 1988
Released on J-STAGE: February 25, 2010
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Magnetic resonance imaging (MRI) was compared to computed tomography (CT) in 14 patients with soft tissue tumors. Seven patients were with benign tumors and the other 7 with malignant tumors. In benign tumors, MRI was judged superior to CT in 3 of the patients, and equal in four, whereas it was evaluated superior to CT in 6 out of 7 patients with malignant tumors. MRI was superior to CT in delineating the extent of the neoplasm and in contrast with surrounding structures, especially in malignant tumors. In addition, saggital or coronal images obtained by MRI were valuable in determining the longitudinal extent of the tumors. The histological diagnosis was not determined by either MRI or CT. Finally, we concluded that MRI was more useful than CT as an imaging technique.
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Teruaki Ohashi, Toshiaki Asakura, Masashi Sagara, Hiroshi Kanae, Yoiti ...
1988 Volume 36 Issue 3 Pages
1042-1046
Published: April 25, 1988
Released on J-STAGE: February 25, 2010
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Sixteen patients with hip joint disorders were examined by Magnetic Resonance Imaging (MRI). They consisted of 7 cases of pseudarthrosis or intracapsular fracture of the femoral neck, one case of fracture-dislocation, 5 cases of osteoarthritis of the hip joint and three cases of avascular necrosis of the femoral head.
Two of five cases of intracapsular fracture of the femoral neck were post-operative. MRI was very useful for detection of avascular necrosis of the femoral head, and for the selection of operative procedures for intracapsular fracture of the femoral neck.
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A. Kuba, K. Iwasaki, N. Kawai
1988 Volume 36 Issue 3 Pages
1047-1052
Published: April 25, 1988
Released on J-STAGE: February 25, 2010
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Takashi Hiramatsu, Kenji Maeda, Naosuke Tashiro, Junji Oda, Hironori H ...
1988 Volume 36 Issue 3 Pages
1053-1057
Published: April 25, 1988
Released on J-STAGE: February 25, 2010
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A case of osteopoikilosis is presented. A woman aged twenty-three years visited our clinic with pain in abdomen and four limbs.
Physical and laboratory examinations gave no specific abnormal findings. Roentgenograms of the pelvis revealed typical picture of osteopoikilosis, and literature on this rare condition is reviewed.
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