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  • 1
    Electronic Resource
    Electronic Resource
    Metabolic and hormonal effects of muscular exercise in juvenile type diabetics (1977)
    Springer
    Diabetologia 13 (1977), S. 355-365 
    Details
    ISSN: 1432-0428
    Keywords: Juvenile type diabetes ; muscular exercise ; blood glucose ; ketosis ; free fatty acids ; amino acids ; insulin ; glucagon ; growth hormone ; cortisol
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Metabolic and hormonal effects of muscular exercise were studied in juvenile-type diabetics in relation to the prevailing degree of metabolic control and compared with those in healthy control subjects. Two groups of diabetic patients, one in moderate metabolic control and one in ketosis due to insulin withdrawal, were subjected to a 3 hour bicycle ergometer test of comparable, mild work intensity. In both groups of diabetics the exercise-induced rise in blood lactate was similar, but was significantly higher than in control subjects. Blood alanine levels showed a transient, significant rise in both diabetic groups, but not in controls. Blood concentrations of branch-chained amino acids remained unchanged. In the moderately controlled diabetics, exercise induced a marked fall of blood glucose and increases in blood levels of free fatty acids (FFA), ketone bodies and glucagon, which were comparable to the exercise effects in normal controls. In ketotic diabetics, however, exercise led to an additional rise in blood glucose concentration and to increases in ketone body, glucagon and cortisol levels. Significant correlations were found between the exercise effect on blood glucose and initial blood levels of glucose, FFA, ketone bodies and branch chained amino acids: pre-exercise values of above 325 mg/dl glucose, 1173 μmol/l FFA, 2.13 mmol/l ketone bodies and 0.74 mmol/l branch chained amino acids led to increased blood glucose levels on exercise, whereas below these limits glucose fell during the exercise test. These findings seem to be, at least in part, explained by the hypothesis of a permissive effect of insulin during stimulation of muscle glucose uptake by exercise. The increased circulating levels of glucagon and cortisol during exercise in ketotic diabetics might represent additional hyperglycaemic and, probably more important, lipolytic and ketogenic stimuli. The results suggest that in moderately controlled, non-ketotic diabetics blood glucose falls during exercise; in ketotic, relatively insulin deficient patients, muscular activity has adverse metabolic and hormonal effects: a further increase in blood glucose, plasma glucagon and cortisol and a rapid aggravation of ketosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01223279
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  • 2
    Electronic Resource
    Electronic Resource
    Wachstumshormon, Gonadotropine und Cortisol im Plasma von Männern unter kombinierter Anwendung des Insulinhypoglykämie/LH-RH-Stimulationstestes (1974)
    Springer
    Journal of molecular medicine 52 (1974), S. 194-196 
    Details
    ISSN: 1432-1440
    Keywords: HGH ; LH ; FSH ; cortisol ; combined insulin-induced hypoglycaemia/LH-RH test ; STH ; LH ; FSH ; Cortisol ; kombinierter Insulinhypoglykämie/LH-RH-Test
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Es wird über die kombinierte Durchführung des Insulinhypoglykämie/LH-RH-Tests mit Bestimmung des STH, LH, FSH und Cortisol im Plasma von männlichen Normalpersonen berichtet. Die simultane Anwendung beider Stimulationstests bietet die Möglichkeit, gleichzeitig die somatotrope, gonadotrope und indirekt die adrenocorticotrope Partialfunktion des HVL zu beurteilen.
    Notes: Summary The combined application of the insulinhypoglycaemia and LH-RH test, including determinations of HGH, LH, FSH and cortisol in plasma of normal males is described. The combination of both stimulation tests allows to investigate simultaneously the somatotrophic, gonadotrophic and, indirectly, the adrenocorticotrophic partial functions of the anterior pituitary gland.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01614397
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  • 3
    Electronic Resource
    Electronic Resource
    Virilismus bei Nebennierenmarktumor mit ektopischem ACTH-Syndrom (1975)
    Springer
    Journal of molecular medicine 53 (1975), S. 321-327 
    Details
    ISSN: 1432-1440
    Keywords: Adrenal medullary tumor ; ectopic ACTH syndrome ; Nebennierenmarktumor ; ektopisches ACTH-Syndrom
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Es wird von einem 14jährigen Mädchen berichtet, bei dem mit 6 Jahren die Diagnose eines Adrenogenitalsyndroms gestellt wurde. Ursache des Virilismus/Hirsutismus war ein Nebennierenmarktumor mit ektopischem ACTH-Syndrom. Das radioimmunologisch im Tumor nachgewiesene ektopische ACTH führte nicht zu einer maximalen Nebennierenrindenstimulation, so daß die Mehrproduktion an ACTH durch den hypothalamischen-hypophysären-adrenalen Regelkreis während des Tages kompensiert werden konnte. Die erhöhten Konzentrationen an Dehydroepiandrosteron, Östron und Testosteron im Plasma und von 17-Ketosteroiden und freiem Cortisol im Urin waren adrenaler Herkunft. Nach Entfernung des Tumors trat spontan die Menarche ein, und die erhöhten Plasmakonzentrationen normalisierten sich. Ein Adrenogenitalsyndrom konnte ausgeschlossen werden.
    Notes: Summary The case of a 14-year-old girl with hirsutism and virilism due to the secretion of ectopic ACTH by an adrenal medullary tumor is described. At the age of 5 years changes in appearance had begun with masculinization. The effect of ACTH-like material, measured by radioimmunoassay in plasma and in tumor tissue, was compensated partially by the hypothalamo-pituitary-adrenal feedback mechanism. Increased concentrations of dehydroepiandrosterone, estrone and testosterone in plasma and of 17-ketosteroids and free cortisol in urine orginated in the adrenals. After operation of the tumor menarche began spontaneously, hirsutism disappeared and testosterone plasma concentrations returned to normal. An adrenogenital syndrome was excluded.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01469059
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  • 4
    Electronic Resource
    Electronic Resource
    Untersuchungen zur Glukagon-, STH- und Cortisolsekretion bei insulininduzierter Hypoglykämie bei insulinabhängigen Diabetikern (JDD) ohne autonome Neuropathie (1980)
    Springer
    Journal of molecular medicine 58 (1980), S. 1197-1205 
    Details
    ISSN: 1432-1440
    Keywords: Insulin-dependent diabetes ; Insulin-induced hypoglycemia ; Autonomic diabetic neuropathy ; Glucagon ; Growth hormone ; Cortisol ; Insulinabhängiger Diabetes mellitus ; insulininduzierte Hypoglykämie ; autonome diabetische Neuropathie ; Glukagon- ; STH- ; Cortisolsekretion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Insulininduzierte Hypoglykämien bei Diabetes mellitus sind Ausdruck unzureichender Gegenregulation, an der verschiedene kontrainsulinäre Hormone beteiligt sind. Ziel der vorgelegten Studie war es zu untersuchen, ob zwischen insulinabhängigen Diabetikern und Stoffwechselgesunden Unterschiede im Sekretionsverhalten von Glukagon, Cortisol und STH während einer insulininduzierten Hypoglykämie bestehen, und welche Bedeutung insbesondere Glukagon bei der Regulation insulininduzierter Hypoglykämien zukommt. Insulininduzierte Hypoglykämien werden nur bei Stoffwechselgesunden und nicht aber bei insulinabhängigen Diabetikern durch endogenes Glukagon gegenregulatorisch beeinflußt. Während einer insulininduzierten Hypoglykämie bei insulinabhängigen Diabetikern ist die fehlende Glukagonsekretion während einer insulininduzierten Hypoglykämie nicht an das Vorliegen einer autonomen diabetischen Neuropathie gebunden, sondern scheint davon unabhängig zu sein. Bei insulinabhängigen Diabetikern wird ein gegenregulatorischer Glukoseanstieg erst nach Zufuhr relativ hoher Dosen exogenen Glukagons erreicht. Die STH-Sekretion verhält sich während einer insulininduzierten Hypoglykämie bei Stoffwechselgesunden und insulinabhängigen Diabetikern ähnlich und hat offenbar für eine schnelle Hypoglykämiegegenregulation, wenn überhaupt, nur eine untergeordnete Bedeutung. Sie könnte vielmehr Ausdruck einer dienzephal ausgelösten Streßsituation sein. Die Cortisolsekretion verhält sich wie die STH-Sekretion in beiden Kollektiven gleich. Der glukoneogenetische Effekt von Cortisol reicht nicht aus, um eine schnelle Hypoglykämiekompensation zu erzielen. Dies schließt langfristige Effekte nicht aus.
    Notes: Summary Insulin-induced hypoglycemias are a sign of non-sufficient counterregulation, in which different contra-insulinary hormones participate. The aim of the study was to investigate, whether there exists a difference between IDD and non-diabetics regarding secretion of glucagon, cortisol, and growth hormone during an insulin-induced hypoglycemia and further on pointing out, expecially, the importance of glucagon. Insulin-induced hypoglycemias are counterregulated in non-diabetics, not in IDD. The missing glucagon secretion during insulin-induced hypoglycemia in IDD seems to be independent from an autonomic neuropathy. Only after high doses of exogenous glucagon can one see a counterregulating increase of glucose. The STH secretion is similar in non-diabetics and IDD during an insulin-induced hypoglycemia and has evidently only a secondary effect in hypoglycemic counterregulation. The STH secretion may be the expression of a diencephal-triggered stress situation. The cortisol secretion is the same in both groups. The gluconeogenetic effect of cortisol is not sufficient to accomplish a fast compensation of hypoglycemia. This does not exclude long-term effects. When inhibiting the secretion of insulin and different contra-insulinary hormones with somatostatin, one is able to demonstrate that glucagon alone is a sufficiently counterregulatory hormone in insulin-induced hypoglycemias.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01478876
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  • 5
    Electronic Resource
    Electronic Resource
    Durchführung und Interpretation des Metopironkurztests (1972)
    Springer
    Journal of molecular medicine 50 (1972), S. 1049-1055 
    Details
    ISSN: 1432-1440
    Keywords: Metyrapone test ; total corticoids/blood ; 11-deoxycorticoids/blood ; 11-oxycorticoids/blood ; competitive protein binding ; interpretation ; side effects ; normal subjects ; obesity ; liver disease ; hypothyroidism ; thyrcotoxicosis ; acromegaly ; hypopituitarism ; adrenal insufficiency ; Metopirontest ; Gesamtcorticoide/Blut ; 11-Deoxycorticoide/Blut ; 11-Oxycorticoide/Blut ; kompetitive Proteinbindungsmethode ; Interpretation ; Nebeneffekte ; Normalpersonen ; Adipositas ; Hypo- und Hyperthyreose ; Akromegalie ; adrenale und hypophysäre Insuffizienz
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung In einem Metopironkurztest werden 4 g Metopiron (M) innerhalb von 2 1/2 Std oral appliziert. 11-Deoxy-, 11-Oxy- und Gesamtcorticoide in den Plasmaproben (vor Testbeginn sowie 2, 4 und 8 Std nach initialer Metopirongabe) werden mit Tetrachlorkohlenstoff bzw. Dichlormethan extrahiert und mit Hilfe einer kompetitiven Proteinbindungsmethode bestimmt. Zwischen der 11-Oxycorticoidausgangskonzentration (8.00 Uhr;t=0; vor M-Einnahme) und der 11-Deoxycorticoid-maximalkonzentration (16.00 Uhr;t=8 Std) besteht eine signifikante Korrelation (r=0,84), so daß sich mit der Regressionsgeraden ein M-Test eindeutig beurteilen läßt. Als normales Testergebnis werden Werte innerhalb des 1s-Streubereiches betrachtet, während Werte, die unterhalb des 1s- und innerhalb des 2s-Streubereiches liegen, als grenzwertig und solche, die sich unterhalb des 2s-Streubereiches befinden, als pathologisch angesehen werden. Mit Hilfe dieses Auswertungsverfahrens wurden die M-Tests von Patienten nach langjähriger Corticoidtherapie und von solchen mit Myokardinfarkt, Adipositas, Lebercirrhose, Hypothyreose, Hyperthyreose, Akromegalie sowie adrenaler und hypophysärer Insuffizienz beurteilt.
    Notes: Summary In a shortened Metyrapone-test 4 g of Metyrapone (M) are orally administered during 2 1/2 hrs. The concentrations of 11-deoxy-, 11-oxy- and total corticosteroids in plasma samples, taken before and 2, 4 and 8 hrs after starting the application of M, are estimated by means of a competitive protein binding radioassay. Evaluating 25 M-tests of endocrinologically healthy subjects a significant correlation was found (r=0,84) between the initial concentrations of 11-oxycorticosteroids (800 a.m.;t=0) and the maximal concentrations of 11-deoxycorticosteroids (400 p.m.;t=8 hrs). In interpreting the M-tests we consider normal all results near the regression line, as borderline those below the 1s-region and as pathological all those which are below the 2s-level of the regression line. Thus “normal”, “still normal” and “pathological” tests can be well defined. The results of M-tests evaluated from plasma samples of patients suffering from various diseases such as myocardial infarction, obesity, liver cirrhosis, hypothyroidism, thyreotoxicosis, acromegaly, hypopituitarism and adrenal insufficiency are presented and interpreted by this method.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01486766
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  • 6
    Electronic Resource
    Electronic Resource
    Kein Einfluß von Digitalis auf Sexual-und Nebennierenrindenhormone bei gesunden Probanden und bei Patienten mit Herzinsuffizienz (1984)
    Springer
    Journal of molecular medicine 62 (1984), S. 65-73 
    Details
    ISSN: 1432-1440
    Keywords: Digitalis ; testosterone ; estradiol ; cortisol ; cardiac index
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Digoxin was studied to see whether it impairs adrenal function and feminizes male subjects by changing plasma sexual hormones; both have been reported on previously. In eight healthy male subjects neither estrone (38.7±7.7 vs 35.4±3.2 pg/ml) nor estradiol (35.8±6.4 vs 32.2±3.9 pg/ml) nor testosterone (6.32±0.74 vs 6.45±0.73 ng/ml) were found to be altered by digoxin administration (plasma levels 1.55±0.27 ng/ml) lasting 35 days. The same was true of free testosterone (147±24 vs 142±19 pg/ml) and free estradiol (657±77 vs 615±78 fg/ml). Even maximal stimulation of the adrenal and gonadal glands by adrenocorticotropic hormone (ACTH) and human chorionic gonadotropin (hCG) did not exhibit any digoxin-induced alterations in the synthesizing capacity of steroid hormones, as shown by plasma cortisol (increase from 128±18 to 389±18 ng/ml) and testosterone (from 5.96±0.90 to 10.33±1.19 ng/ml). Furthermore, seven subjects on digoxin were observed over a period of 150–210 days; they did not show any increase of estrogens. This was also found in three subjects when estrogen levels were elevated initially due to extreme obesity. Also, 35 patients who took β-methyldigoxin (n=8), β-acetyldigoxin (n=20) and digitoxin (n=7) from 1 to 9 (x:1.9) years demonstrated normal plasma concentrations of gonadal and adrenal steroids, irrespective of duration of application or the digitalis compound. However, our studies showed that sexual hormones are correlated to cardiac performance: with decreasing cardiac index, testosterone (r: 0.86;P〈0.01) and estradiol (r: 0.68;P〈0.05) decreased significantly. We conclude that digoxin does not exert any influence on plasma sexual steroids. Since no competition between digoxin and estradiol receptors was found, it may even be the digitalis compound of choice when feminization is expected due to other complications. Furthermore, on digoxin the adrenal gland is capable of synthesizing cortisol sufficiently.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01769665
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  • 7
    Electronic Resource
    Electronic Resource
    Endokrinologische Funktionsdiagnostik der hypothalamo-hypophysären Insuffizienz (1979)
    Springer
    Journal of molecular medicine 57 (1979), S. 487-497 
    Details
    ISSN: 1432-1440
    Keywords: Pituitary insufficiency ; Combined insulin hypoglycaemia/LH-RH/TRH-Test ; Sheehan syndrome ; Chromophobic adenoma ; Craniopharyngioma ; Acromegaly ; Prolactin-producing tumors ; Hypothalamo-pituitary dwarfism ; Hypophysenvorderlappeninsuffizienz ; kombinierter Insulinhypoglykämie/LH-RH/TRH-Test ; Sheehan-Syndrom ; Chromophobes Adenom ; Craniopharyngiom ; Akromegalie ; Prolaktinom ; Diencephalo-hypophysärer Zwergwuchs
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die funktionsdynamische Diagnostik des Zwischenhirn-Hypophysensystems erfolgte bei Patienten mit Sheehan-Syndrom, chromophobem Adenom, Craniopharyngiom, Prolaktin-produzierenden Hypophysentumoren, Akromegalie, hypothalamo-hypophysärem Minderwuchs und konstitutionell bedingter Entwicklungsverzögerung. Dabei wurde ein kombinierter Insulinhypoglykämie/LH-RH/TRH-Test angewandt, um die Häufigkeit und das Ausmaß der Hypophysenvorderlappeninsuffizienz zu beurteilen. Bei den genannten Erkrankungen fand sich nahezu regelmäßig — die Akromegalie ausgenommen — eine somatotrope Insuffizienz. Relativ häufig lag auch eine Beeinträchtigung der gonadotropen Funktion vor, wobei im allgemeinen ein pathologischer LH-RH-Test mit einem mehr oder weniger ausgeprägten Androgenmangel korreliert. Eine adrenocorticotrope Insuffizienz bestand bei den meisten Patienten mit Sheehan-Syndrom, chromophobem Adenom und Craniopharyngiom, während sie bei der Akromegalie und beim hypothalamo-hypophysären Minderwuchs seltener nachzuweisen war, woraus sich die jeweilige Notwendigkeit einer Substitution mit Corticoiden ergibt. Der TRH-Test spiegelt das Bestehen einer sekundären Hypothyreose nur unvollkommen wider und kann bei organischen Prozessen im Zwischenhirn-Hypophysenvorderlappenbereich durchaus normal ausfallen, so daß für die Frage einer Schilddrüsenhormonsubstitution die T3- und T4-Bestimmung im Blut entscheidend ist. Sowohl mit dem LH-RH- als auch mit dem TRH-Test ist eine eindeutige Trennung der hypothalamischen von der hypophysären Ursache der Insuffizienz nicht möglich.
    Notes: Summary A functional diagnosis of the diencephalo-hypophyseal system was carried out in patients with Sheehan syndrome, chromophobic adenoma, craniopharyngioma, prolactin-producing pituitary tumours, acromegaly, hypothalamo-pituitary dwarfism and constitutional retardation. A combined insulin hypoglycaemia/LH-RH/TSH test was performed to define frequency and extent of anterior pituitary insufficiency. With these illnesses, almost generally, a somatotropic insufficiency (except in acromegaly) was found. An impairment of gonadotropic function was often present, in general a pathologic LH-RH test correlating with a more or less developed androgen deficiency. An adrenocorticotropic insufficiency was found in most patients with sheehan syndrome, chromophobic adenoma and craniopharyngioma while in acromegaly and hypothalamo-pituitary dwarfism it was present less frequently, necessitating a substitution with corticoids. The TRH test reflects only incompletely a secondary hypothyroidism, and can be normal with organic processes of the diencephalo-hypophyseal region, making a T3 and T4 estimation in the blood decisive for a thyroid hormone substitution. A clear-cut separation of the hypothalamic from the pituitary cause of the insufficiency is neither possible with the LH-RH nor with the TRH test.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01487819
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  • 8
    Electronic Resource
    Electronic Resource
    Stumme Nebennierentumoren bei Patienten mit Adrenogenital Syndrom (1987)
    Springer
    Journal of molecular medicine 65 (1987), S. 627-633 
    Details
    ISSN: 1432-1440
    Keywords: Silent adrenal tumors ; Adrenogenital syndrome ; Computer tomography ; Hyperplasia ; Plasma hormone concentrations ; Late onset form ; Simple virilizing form
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Adrenal tumors accidently detected by CT scan are increasingly seen in patients without clinical signs of adrenal diseases. We studied whether enhanced adrenal stimulation is of importance in the development of adrenal tumors. For this purpose 22 patients with adrenogenital syndrome (AGS) were studied by CT scan. One of these patients suffered from C-11β-hydroxylase-, one from C-3β-hydroxy steroid dehydrogenase-, and 20 from C-21-hydroxylase deficiency. The average adrenal size of these patients was 506±79 mm2 as compared to 132±8 mm2 in the controls (P〈0.001). Only two patients with the late onset form revealed adrenal glands of normal size. There was a significant correlation between adrenal size and patients' age (P〈0.01). Females with the simple virilizing form revealed adrenal glands larger than those of the late onset form (640±169 vs 308±56 mm2). Eighteen patients with AGS exhibited one (n=11) or several (n=7) adrenal tumors, the size of which was 5–9 mm in diameter in 9, 10–20 mm in 7, and more than 50 mm in 2 patients. There was a significant correlation between adrenal hyperplasia and tumor diameter (P〈0.001). No correlation was found between tumor size and plasma concentrations of testosterone or 17-hydroxyprogesterone, patients' age at the time of diagnosis, or clinical signs of androgenization. Again, tumors were larger in females suffering from the simple virilizing form of AGS than in those with the late onset form (14.8±5.5 vs 7.7±0.8 mm). Our investigations show that adrenal tumors are found almost regularly (82%) in patients suffering from AGS. Incidence and size of these tumors appear to correlate to the degree as well as the duration of adrenal stimulation. As these tumors are benign, it is suggested that in case of accidental detection of silent adrenal tumors, an adrenogenital syndrome should be excluded by endocrinological tests.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01875496
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  • 9
    Electronic Resource
    Electronic Resource
    Cushing's syndrome due to ACTH-production of an ovarian carcinoid (1989)
    Springer
    Journal of molecular medicine 67 (1989), S. 640-644 
    Details
    ISSN: 1432-1440
    Keywords: Ectopic ACTH syndrome ; Ovarian carcinoid ; Immunosuppression
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The case of a 56-year old woman with severe Cushing's syndrome due to ovarian ACTH-production is described. Both clinical picture and biochemical pattern were consistent with the ectopic ACTH syndrome. ACTH was found by specific immunohistochemical staining in a carcinoid tumor of the patient's right ovary. In contrast, pituitary cells exhibited immunoreactive ACTH to only a minimum extent.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01718148
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  • 10
    Electronic Resource
    Electronic Resource
    Adrenogenitales Syndrom — heute eine radiologische Diagnose? (1990)
    Springer
    Journal of molecular medicine 68 (1990), S. 328-331 
    Details
    ISSN: 1432-1440
    Keywords: Silent adrenal tumors (incidentaloma) ; Computertomography ; Congenital adrenal hyperplasia ; Laboratory findings ; clinical symptomes
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The following case report shows the course of disease of a 37 year old man, who showed the classical symptomes of an untreated congenital adrenal hyperplasia. But only when an adrenal tumor accidentally was detected, the endocrinological tests and the diagnosis of the congenital adrenal hyperplasia were made. By this diagnosis the planned adrenalectomy could be avoided now.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01649025
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