 
                                    The Pancreas: An Integrated Textbook of Basic Science, Medicine, and Surgery
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Editura: Wiley
Limba: Engleza
Nr. pagini: 1216
Coperta: Hardback
Dimensiuni: 22.6 x 5.1 x 28.2 cm
An aparitie: 2018
DESCRIPTION:
This brand new updated edition of the most comprehensive reference book on pancreatic disease details the very latest knowledge on genetics and molecular biological background in terms of anatomy, physiology, pathology, and pathophysiology for all known disorders. Included for the first time, are two brand new sections on the key areas of Autoimmune Pancreatitis and Benign Cystic Neoplasms. In addition, this edition is filled with over 500 high-quality illustrations, line drawings, and radiographs that provide a step-by-step approach to all endoscopic techniques and surgical procedures. Each of these images can be downloaded via an online image bank for use in scientific presentations.
Every existing chapter in The Pancreas: An Integrated Textbook of Basic Science, Medicine and Surgery, 3rd Edition has been thoroughly revised and updated to include the many changes in clinical practice since publication of the current edition. The book includes new guidelines for non-surgical and surgical treatment; new molecular biologic pathways to support clinical decision making in targeted treatment of pancreatic cancer; new minimally invasive surgical approaches for pancreatic diseases; and the latest knowledge of neuroendocrine tumors and periampullary tumors.
· The most encyclopedic book on the pancreas—providing outstanding and clear guidance for the practicing clinician
· Covers every known pancreatic disorder in detail including its anatomy, physiology, pathology, pathophysiology, diagnosis, and management
· Completely updated with brand new chapters
· Over 500 downloadable illustrations
· An editor and author team of high international repute who present global best-practice
The Pancreas: An Integrated Textbook of Basic Science, Medicine and Surgery, 3rd Edition is an important book for gastroenterologists and gastrointestinal surgeons worldwide.
TABLE OF CONTENTS:
 
 
Contributors xiii
Preface xxix
Abbreviations xxx
About the Companion Website xlii
Section 1 Anatomy of the Pancreas 1
1 Development of the Pancreas and Related Structures 3
 Brian Lewis and Junhao Mao
2 Anatomy, Histology, and Fine Structure of the Pancreas 10
 Daniel S. Longnecker, Fred Gorelick, and Elizabeth D. Thompson
3 Congenital and Inherited Anomalies of the Pancreas 24
 Martin Zenker and Markus M. Lerch
Section 2 Physiology and Pathophysiology of Pancreatic Functions 41
 
 4 Physiology of Acinar Cell Secretion 43
 Ole H. Petersen
5 Physiology of Duct Cell Secretion 56
 Mei Zeng, Laura Vachel, and Shmuel Muallem
6 Pathophysiology of Experimental Pancreatitis 63
 Vikas Dudeja, Rajinder Dawra, and Ashok K. Saluja
7 Physiology and Pathophysiology of Function of Sphincter of Oddi 75
 Savio George Barreto and James Toouli
8 Neurohormonal and Hormonal Control of Pancreatic Secretion 84
 Chung Owyang
9 Regulation of Pancreatic Protein Synthesis and Growth 95
 Maria Dolors Sans and John A. Williams
10 Fibrogenesis in the Pancreas: The Role of Stellate Cells 106
 Minoti V. Apte, Romano C. Pirola, and Jeremy S. Wilson
11 Fibrogenesis of the Pancreas: The Role of Macrophages 117
 Aida Habtezion
12 Insulo–Acinar Relationship 123
 Keiko Shiratori and Kyoko Shimizu
Section 3 Acute Pancreatitis 133
13 Epidemiology and Etiology of Alcohol‐Induced Pancreatitis 135
 Jeremy S. Wilson, Romano C. Pirola, and Minoti V. Apte
14 Epidemiology and Etiology of Acute Biliary Pancreatitis 146
 Michael G.T. Raraty, Andrea Sheel, and John P. Neoptolemos
15 Genetic Factors in Acute Pancreatitis 158
 Zachary Zator and Georgios I. Papachristou
16 The Role of the Intestine and Mesenteric Lymph in the Development of Systemic Inflammation and MODS in Severe Acute Pancreatitis 166
 Alistair B.J. Escott, Anthony R.J. Phillips, and John A. Windsor
17 The Role of Neurogenic Inflammation in Pancreatitis 173
 Jami L. Saloman, Kathryn M. Albers, and Brian M. Davis
18 Molecular, Biochemical, and Metabolic Abnormalities in Acute Pancreatitis 178
 Julia Mayerle, Frank Ulrich Weiss, Walter Halangk, and Markus M. Lerch
19 Histopathology of Acute Pancreatitis 193
 Günter Klöppel
20 Clinical Classification Systems of Acute Pancreatitis 199
 John A. Windsor and Max S. Petrov
21 Clinical Assessment and Biochemical Markers to Objectify Severity and Prognosis 204
 Bettina M. Rau and Guido Alsfasser
22 Acute Pancreatitis Associated With Congenital Anomalies 213
 Christopher R. Schlieve, Andrew L. Warshaw, and Tracy C. Grikscheit
23 Acute Pancreatitis in Children 219
 Mark E. Lowe and Véronique D. Morinville
24 Acute Pancreatitis Associated With Metabolic Disorders, Infectious Diseases, or Drugs 230
 Ali A. Aghdassi and Markus M. Lerch
25 Radiologic Diagnosis and Staging of Severe Acute Pancreatitis 238
 Yoshihisa Tsuji
Clinical Course and Medical Treatment of Acute Pancreatitis 251
26 Conservative Therapy of Acute Pancreatitis: Volume Substitution and Enteral and Parenteral Nutrition 251
 Timothy B. Gardner
27 ICU Treatment of Severe Acute Pancreatitis 258
 Scott R. Gunn and David C. Whitcomb
28 Use of Antibiotics in Severe Acute Pancreatitis: Indications and Limitations 265
 Rainer Isenmann and Mathias Wittau
Interventional and Surgical Management of Acute Pancreatitis 271
29 Indications for Interventional and Surgical Treatment of Necrotizing Pancreatitis 271
 Thomas E. Clancy
30 Management of Infected Pancreatic Necroses: An Endoscopic Approach 277
 Eduardo Rodrigues‐Pinto and Todd H. Baron
31 Minimally Invasive Debridement and Lavage of Necrotizing Pancreatitis 283
 Rebecca Saunders, Michael G.T. Raraty, Chris Halloran, and John P. Neoptolemos
32 Open Surgical Debridement in Necrotizing Pancreatitis 289
 Lutz Schneider and Markus W. Büchler
33 Endoscopic Treatment of Biliary Acute Pancreatitis 296
 Ichiro Yasuda, Shinpei Doi, and Masatoshi Mabuchi
34 Strategies for the Treatment of Pancreatic Pseudocysts and Walled‐Off Necrosis After Acute Pancreatitis: Interventional Endoscopic Approaches 301
 Georg Beyer, Julia Mayerle, and Markus M. Lerch
35 Strategies for the Treatment of Pancreatic Pseudocysts and Walled‐Off Necrosis After Acute Pancreatitis: Surgical Treatment 305
 Naohiro Sata, Masaru Koizumi, and Alan K. Lefor
36 Management of Fluid Collection in Acute Pancreatitis 311
 Felix Lämmerhirt, Frank Ulrich Weiss, and Markus M. Lerch
37 Management of Pancreatic Fistula in Acute Pancreatitis 316
 Jörg Kaiser, Thilo Hackert, and Markus W. Büchler
Long-Term Outcome After Treatment of Acute Pancreatitis 323
38 Long‐Term Outcome After Acute Pancreatitis 323
 Christin Tjaden and Thilo Hackert
Section 4 Chronic Pancreatitis 331
39 Molecular Understanding of Chronic Pancreatitis 333
 John F. Eisses and Sohail Z. Husain
40 Epidemiology and Pathophysiology of Alcoholic Chronic Pancreatitis 342
 Atsushi Masamune and Tooru Shimosegawa
41 Pain Mechanisms in Chronic Pancreatitis 349
 Pierluigi di Sebastiano, Tommaso Grottola, and Francesco F. di Mola
42 Natural History of Recurrent Acute and Chronic Pancreatitis 355
 Rohit Das and Dhiraj Yadav
43 Chronic Pancreatitis with Inflammatory Mass of the Pancreatic Head 365
 Ulrich F. Wellner and Tobias Keck
44 Early Chronic Pancreatitis 371
 Tetsuhide Ito, Masayuki Hijioka, and Tooru Shimosegawa
45 Hereditary Chronic Pancreatitis: Molecular Pattern, Clinical Consequences, and Management Principles 374
 Celeste Shelton and David C. Whitcomb
46 Epidemiology and Pathophysiology of Tropical Chronic Pancreatitis 384
 Shailesh V. Shrikhande and Savio George Barreto
47 Cystic Fibrosis (CFTR)‐Associated Pancreatic Disease 391
 Chee Y. Ooi and Aliye Uc
48 Clinical and Laboratory Diagnosis of Chronic Pancreatitis 397
 Julia Mayerle, Peter Simon, and Markus M. Lerch
49 Evidence of Contrast‐Enhanced CT and MRI/MRCP 406
 J. Enrique Domínguez‐Muñoz, Roberto García‐Figueiras, and Julio Iglesias‐García
50 Chronic Pancreatitis: Risk Factors in Cancer 417
 Albert B. Lowenfels and Patrick Maisonneuve
Conservative Treatment of Chronic Pancreatitis 421
 
 51 Pain Management in Chronic Pancreatitis 421
 Kai Bachmann, Stephanie Plagemann, Yogesh Kumar Vashist, and Jakob R. Izbicki
52 Medical Treatment of Chronic Pancreatitis: Pancreatic Digestive Enzymes: Lipases, Proteases 426
 Mark E. Lowe
53 Nutritional Support of Chronic Pancreatitis 429
 Sinead N. Duggan and Stephen J. O’Keefe
54 Medical Therapy for Chronic Pancreatitis: Antioxidants 435
 Chris E. Forsmark
Strategies for Endoscopic and Surgical Treatment of Chronic Pancreatitis 439
55 Evidence of Endoscopic and Interventional Treatment of Chronic Pancreatitis and Pseudocysts 439
 Jörg Schirra, Markus M. Lerch, and Julia Mayerle
56 Indications and Goals of Surgical Treatment 449
 Ryan T. Groeschl and Michael B. Farnell
57 Pancreatic Duct Drainage Procedure 453
 Dirk Bausch and Tobias Keck
58 Duodenum‐Preserving Pancreatic Head Resection 458
 Hans G. Beger, Bertram Poch, Yang Yinmo, and Waldemar UhlContents vii
59 Major Pancreatic Resection 467
 May C. Tee and Michael B. Farnell
60 Laparoscopic Surgery 479
 Vernissia Tam, Melissa E. Hogg, and Amer Zureikat
Management of Diabetes and Long-Term Outcome of Chronic Pancreatitis 488
61 Chronic Pancreatitis: Long‐Term Outcome After Medical and Surgical Treatment 488
 Volker Aßfalg, Norbert Hüser, and Helmut Friess
62 Management of Pancreatic Diabetes Secondary to Chronic Pancreatitis 495
 Keiko Shiratori
Section 5 Autoimmune Pancreatitis 503
63 Epidemiology of Autoimmune Pancreatitis 505
 Terumi Kamisawa and Tooru Shimosegawa
64 Pathogenesis of Autoimmune Pancreatitis 510
 Yoh Zen
65 Histology of Autoimmune Pancreatitis 516
 Rajib Gupta and Vikram Deshpande
66 Clinical Manifestation of Type 1 Autoimmune Pancreatitis 520
 Tooru Shimosegawa, Morihisa Hirota, and Atsushi Kanno
67 Clinical Manifestations of Type 2 Autoimmune Pancreatitis 534
 Emma L. Culver and George Webster
68 Laboratory Diagnosis of Autoimmune Pancreatitis 539
 J.‐Matthias Löhr, Pia Maier, and Stephan L. Haas
69 What is the Evidence Measuring Immune Markers 544
 Shigeyuki Kawa
70 Imaging Diagnosis of Autoimmune Pancreatitis 550
 Kazuichi Okazaki, Tsukasa Ikeura, Kazushige Uchida, and Makoto Takaoka
71 Medical Management of Autoimmune Pancreatitis 555
 Shounak Majumder and Suresh T. Chari
Long-Term Outcome of Management of Autoimmune Pancreatitis 560
72 Long‐Term Outcome After Treatment of Autoimmune Pancreatitis 560
 Luca Frulloni and Nicolò de Pretis
Section 6 Neoplastic Tumors of the Exocrine Tissue: Benign Cystic Neoplasms of the Pancreas 565
73 Epidemiology of Cystic Neoplasms of the Pancreas 567
 Saurabh Mukewar and Suresh T. Chari
74 Histologic Classification and Staging of Cystic Neoplasms 573
 Noriyoshi Fukushima and Giuseppe Zamboni
75 Molecular Mechanisms of Cystic Neoplasia 580
 Nickolas Papadopoulos and Ralph H. Hruban
76 Clinical Presentation of Cystic Neoplasms 589
 Susumu Hijioka, Kazuo Hara, Nobumasa Mizuno, Nozomi Okuno, and Kenji Yamao
77 Evaluation of Cystic Lesions Using EUS, MRI, and CT 593
 Anne Marie Lennon and Hiroyuki Maguchi
78 Cytologic Evaluation of Cystic Neoplasms 603
 Martha Bishop Pitman
79 Natural History of Cystic Neoplasms: IPMN, MCN, SCN, and SPN 611
 Anna‐Katharina Stadler, Thilo Hackert, Stefan Fritz, and Markus W. Büchler
80 Surveillance or Surgical Treatment in Asymptomatic Cystic Neoplasms 618
 Klaus Sahora and Carlos Fernández‐ del Castillo
Local and Standard Surgical Treatment of Cystic Neoplasms 622
81 Duodenum‐Preserving Partial or Total Pancreatic Head Resection 622
 Hans G. Beger and Bertram Poch
82 Pancreatic Middle Segment Resection 627
 Calogero Iacono
83 The Indications For and Limitations of Tumor Enucleation 632
 Rosalie A. Carr, C. Max Schmidt, and Henry A. Pitt
84 Standard Surgical Management of IPMN, MCN, SPN, and SCN Lesions: Open Approach 641
 Miral Sadaria Grandhi, Barish H. Edil, and Richard D. Schulick
85 Surgical Treatment of Cystic Neoplasms: Laparoscopic Approach 649
 Richard A. Burkhart, Christopher L. Wolfgang, Markus W. Büchler, and Thilo Hackert
86 Management of Recurrence of Cystic Neoplasms 655
 Zhi Ven Fong, Christopher L. Wolfgang, and Keith D. Lillemoe
Long-Term Outcome of Management of Cystic Neoplasms 660
87 Long‐Term Outcome After Observation and Surgical Treatment: What is the Evidence? 660
 Giovanni Marchegiani, Giuseppe Malleo, and Claudio Bassi
Section 7 Neoplastic Tumors of Exocrine Tissue: Pancreatic Cancer 665
88 Epidemiology of Pancreatic Cancer 667
 Evelina Mocci and Alison P. Klein
89 Smoking, a Risk for Pancreatic Cancer: Experimental and Clinical Data 673
 Uwe A. Wittel, Bradley R. Hall, and Surinder K. Batra
90 Molecular Understanding of Development of Ductal Pancreatic Cancer 679
 Laura D. Wood and Ralph H. Hruban
91 Familial Pancreatic Cancer 688
 Alison P. Klein
92 Pathology of Exocrine Pancreatic Tumors 693
 Meredith E. Pittman and Ralph H. Hruban
93 Pancreatic Cancer: Precancerous Lesions 705
 Michaël Noë, Lodewijk A.A. Brosens, and Johan Offerhaus
94 Clinical History and Risk Factors of Pancreatic Cancer 717
 Norbert Hüser, Volker Aßfalg, and Helmut Friess
95 Pancreatic Cancer Within the Uncinate Process: Radiologic and Clinical Characteristics 724
 Sebastian Holländer and Dieter Birk
96 The Role of EUS in the Diagnosis and Differential Diagnosis of Neoplastic Lesions 728
 Susumu Hijioka, Kazuo Hara, Nobumasa Mizuno, Nozomi Okuno, and Kenji Yamao
97 Radiologic Diagnosis of Pancreatic Cancer: CT, MRI 733
 Siva P. Raman and Elliot K. Fishman
98 Screening of Patients with Hereditary Pancreatic Cancer 745
 Michael Goggins
99 The Role of PET in Diagnosis of Pancreatic Cancer and Cancer Recurrence 755
 Norbert Hüser, Volker Aßfalg, Isabel Rauscher, and Helmut Friess
100 Tumor Markers in Pancreatic Malignancies 762
 Shin Hamada, Atsushi Masamune, and Tooru Shimosegawa
101 The Role of Laparoscopy and Peritoneal Cytology in the Management of Pancreatic Cancer 766
 Kyoichi Takaori and Shinji Uemoto
102 Clinical Assessment and Staging of Advanced Pancreatic Cancer 770
 Jennifer LaFemina, Ann K. Friedrich, and Giles F. Whalen
Surgical Treatment of Pancreatic Cancer 776
103 Pancreatic Cancer: Indications for Resection 776
 Akimasa Nakao
104 Pancreaticoduodenectomy for Pancreatic Cancer, Short‐ and Long‐Term Outcomes After Kausch–Whipple and Pylorus‐Preserving Resection 783
 Jin He and John L. Cameron
105 Left Pancreatectomy for Body and Tail Cancer 790
 Georgios Gemenetzis and Christopher L. Wolfgang
106 Total Pancreatectomy: Indications and Limitations 797
 Seiko Hirono and Hiroki Yamaue
107 Laparoscopic and Robotic Resection for Pancreatic Cancer 804
 Deepa Magge, Herbert J. Zeh, and Melissa E. Hogg
108 Extended Radical Surgery for Pancreatic Cancer 814
 Thilo Hackert, Alexis Ulrich, and Markus W. Büchler
109 Palliative Pancreatoduodenectomy: Benefits and Limitations 823
 Christoph W. Michalski, Max Heckler, Mert Erkan, and Markus W. Büchler
110 Bypass Surgery for Advanced Pancreatic Cancer 828
 Jürgen Weitz, Thomas Pausch, Christoph W. Michalski, and Thilo Hackert
Nonsurgical Palliation of Pancreatic Cancer 835
111 Endoscopic and Interventional Palliation of Pancreatic Cancer 835
 Takao Itoi
Medical Treatment of Pancreatic Cancer 842
112 Neoadjuvant Treatment of Pancreatic Cancer: Downstaging Results 842
 Robert A. Wolff and Gauri Varadhachary
113 Adjuvant Chemotherapy in Pancreatic Cancer 847
 Robert P. Jones, Paula Ghaneh, and John P. Neoptolemos
114 Immunotherapy for Pancreatic Cancer 856
 Adrian G. Murphy, Elizabeth M. Jaffee, and Lei Zheng
115 Targeted Therapies for Pancreatic Cancer 865
 Vincent Bernard and Anirban Maitra
116 Palliative Chemotherapy for Advanced Pancreatic Cancer: Survival Benefit and Side Effects of Treatment 872
 Olusola O. Faluyi, Madhuchanda Chatterjee, and Daniel H. Palmer
117 Management of Pain in Pancreatic Cancer 879
 Michael Erdek, Indy Wilkinson, and Zackary E. Boomsaad
118 Role of Radio and Proton Beam Therapy for Pancreatic Cancer 886
 Amol K. Narang, Lauren M. Rosati, Michael D. Chuong, and Joseph M. Herman
119 Management of Cancer Recurrence 895
 Oliver Strobel and Markus W. Büchler
Long-Term Outcome After Treatment of Pancreatic Cancer 906
120 Survival and Late Morbidity After Resection of Pancreatic Cancer 906
 Avinoam Nevler, Charles J. Yeo, and Jordan M. Winter
Section 8 Neoplastic Tumors of the Endocrine Pancreas: Neuroendocrine Tumors of the Pancreas 919
121 Epidemiology and Classification of Neuroendocrine Tumors of the Pancreas 921
 J.J. Mukherjee, Kok‐Onn Lee, and Gregory Kaltsas
122 Pathology of Neuroendocrine Neoplasms 930
 Atsuko Kasajima and Hironobu Sasano
123 Molecular Genetics of Neuroendocrine Tumors 937
 Nickolas Papadopoulos and Ralph H. Hruban
124 Clinical Manifestation of Endocrine Tumors of the Pancreas 947
 Ken Kawabe and Tetsuhide Ito
125 Evidence of Hormonal, Laboratory, Biochemical, and Instrumental Diagnostics of Neuroendocrine Tumors of the Pancreas 953
 Kok‐Onn Lee, Gregory Kaltsas, and J.J. Mukherjee
126 Pancreatic Neuroendocrine Tumors in Multiple Neoplasia Syndromes 961
 Anja Rinke and Thomas Matthias Gress
127 Nonfunctioning Pancreatic Neuroendocrine Tumors: Diagnosis and Management Principles 967
 Takao Ohtsuka, Hideyo Kimura, and Masafumi Nakamura
128 Medical and Nucleotide Treatment of Neuroendocrine Tumors of the Pancreas 972
 Gregory Kaltsas, J.J. Mukherjee, and Kok‐Onn Lee
129 Interventional Radiology in the Treatment of Pancreatic Neuroendocrine Tumors 979
 Takao Ohtsuka, Hideyo Kimura, and Masafumi Nakamura
Surgical Management of Endocrine Tumors of the Pancreas 982
130 Surgical Treatment of Endocrine Tumors: Enucleation 982
 Henning Dralle, Phuong Nguyen Thanh, and Andreas Machens
131 Local Treatment of Endocrine Tumors: Duodenum‐Preserving Partial or Total Pancreatic Head Resection and Pancreatic Middle‐Segment Resection 989
 Hans G. Beger and Wataru Kimura
132 Surgical Treatment of Endocrine Tumors: Major Oncologic Resection 994
 Henning Dralle, Phuong Nguyen Thanh, and Andreas Machens
133 Management of Insulinoma 1002
 Keijiro Ueda, Linkaku Lee, and Tetsuhide Ito
134 Evidence of Medical and Surgical Treatment of Gastrinoma 1009
 Ryuichiro Doi
135 Rare Neuroendocrine Tumors of the Pancreas: Management and Evidence of Surgical Treatment 1013
 Ryuichiro Doi
136 Treatment of Neuroendocrine Tumors of the Pancreas and Biliary Tract 1019
 Andrea Frilling, Ashley K. Clift, and Vito Cincinnati
Long-Term Outcome After Treatment of Neuroendocrine Tumors of the Pancreas 1029
137 Long‐Term Outcome After Treatment of Endocrine Tumors 1029
 Andreas Machens and Henning Dralle
Section 9 Periampullary Cancers and Tumors Other Than Pancreatic Cancer 1035
138 Periampullary Cancer: Clinical Presentation and Diagnostic Strategies 1037
 Amanda B. Cooper and Keith D. Lillemoe
139 Histology and Genetics of Cancer of the Papilla, Distal Common Bile Duct, and Duodenum 1047
 Yue Xue, Michelle D. Reid, and N. Volkan Adsay
140 Adenoma and Adenocarcinoma of the Ampulla of Vater: Diagnosis and Management 1058
 Omer Basar and William R. Brugge
141 Endoscopic Treatment of Adenomas of the Ampulla of Vater: Techniques, Results, Benefits, and Limitations 1068
 Natsuyo Yamamoto, Hiroyuki Isayama, and Kazuhiko Koike
142 Surgical Treatment of Adenoma and Cancer of Papilla of Vater 1074
 Hans G. Beger, Bertram Poch, and Bettina M. Rau
143 Surgical Treatment of Duodenal Cancer 1081
 Fuyuhiko Motoi and Michiaki Unno
144 Surgical Treatment of Distal Cholangiocarcinoma 1083
 Yukihiro Yokoyama, Tomoki Ebata, and Masato Nagino
145 Adjuvant and Palliative Chemotherapy of Periampullary Cancers 1089
 Eyas Mohamed, Paula Ghaneh, and John P. Neoptolemos
Long-Term Survival After Tumor Resection 1097
146 Long‐Term Survival After Resection of Periampullary Cancer 1097
 Masayuki Ohtsuka and Masaru Miyazaki
Section 10 Transplantation of the Pancreas 1107
147 Transplantation of Pancreatic Islets 1109
 Bernhard J. Hering and Melena D. Bellin
148 Transplantation of the Pancreas 1121
 Hans W. Sollinger and Dixon B. Kaufman
Index 1129
| An aparitie | 2018 | 
| Autor | Hans G. Bege, Andrew L. Warshaw | 
| Dimensiuni | 22.6 x 5.1 x 28.2 cm | 
| Editura | Wiley | 
| Format | Hardback | 
| ISBN | 9781119188391 | 
| Limba | Engleza | 
| Nr pag | 1216 | 
 
						 
                                 
                                 
                                         
	     
	     
	     
	     
	     
	     
	     
	     
	     
	    
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