WO2000013592A1 - Dispositif destine a la reception et a l'actionnement d'une aiguille de biopsie - Google Patents

Dispositif destine a la reception et a l'actionnement d'une aiguille de biopsie Download PDF

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Publication number
WO2000013592A1
WO2000013592A1 PCT/DE1999/002841 DE9902841W WO0013592A1 WO 2000013592 A1 WO2000013592 A1 WO 2000013592A1 DE 9902841 W DE9902841 W DE 9902841W WO 0013592 A1 WO0013592 A1 WO 0013592A1
Authority
WO
WIPO (PCT)
Prior art keywords
receiving
biopsy needle
handpiece
tube
needle
Prior art date
Application number
PCT/DE1999/002841
Other languages
German (de)
English (en)
Inventor
Jürgen Heinrich
Original Assignee
Gip Medizintechnik Gmbh
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Gip Medizintechnik Gmbh filed Critical Gip Medizintechnik Gmbh
Priority to JP2000568403A priority Critical patent/JP2002524127A/ja
Priority to EP99955675A priority patent/EP1112027A1/fr
Priority to CA002340376A priority patent/CA2340376A1/fr
Publication of WO2000013592A1 publication Critical patent/WO2000013592A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
    • A61B10/02—Instruments for taking cell samples or for biopsy
    • A61B10/0233—Pointed or sharp biopsy instruments
    • A61B10/0266—Pointed or sharp biopsy instruments means for severing sample
    • A61B10/0275—Pointed or sharp biopsy instruments means for severing sample with sample notch, e.g. on the side of inner stylet
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
    • A61B10/02—Instruments for taking cell samples or for biopsy
    • A61B10/04—Endoscopic instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
    • A61B10/02—Instruments for taking cell samples or for biopsy
    • A61B2010/0208—Biopsy devices with actuators, e.g. with triggered spring mechanisms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
    • A61B10/02—Instruments for taking cell samples or for biopsy
    • A61B10/04—Endoscopic instruments
    • A61B2010/045—Needles

Definitions

  • the invention relates to a device for receiving and actuating a biopsy needle that can be inserted into an endoscope.
  • a device of the type referred to above is already known (see e.g. US-A-4 249 541).
  • the biopsy needle can only be actuated manually, which is sometimes not sufficient to penetrate m solid patient tissue.
  • the invention is therefore based on the object of showing a way of achieving in a device of the type mentioned at the outset in a safe manner that m solid tissue can also be penetrated with the biopsy needle.
  • a handpiece which can be attached to the endoscope is provided and which has a hollow needle belonging to the biopsy needle and a cutting device guided in the respective hollow needle at the proximal ends of the m receiving devices permitted that can be tensioned by spring force in such a way that in the tensioned state the hollow needle and the cutting device are retracted a piece in the handpiece, and that of the tensioned receiving devices the receiving device provided for receiving the cutting device before the one intended for receiving the hollow needle Recording device can be triggered.
  • the invention has the advantage that, in a relatively simple manner, the biopsy needle can penetrate m solid tissue within a very short time, m which cannot be penetrated or can only be penetrated with great difficulty by manual actuation of the biopsy needle.
  • the spring force is preferably provided by two separate springs, which are individually associated with the two receiving devices. This has the advantage of a particularly simple construction.
  • the hollow needle and the cutting device are each connected to a separate holding part which is accommodated in its own receiving device. This measure enables a very simple recording of the elements m of the device according to the invention which form the biopsy needle.
  • the above-mentioned holding parts are preferably each formed by a longitudinally symmetrical shaped body which has strong bulges extending in its longitudinal direction and provided at the end with a strong bulge in between, which is set back with respect to the bulges provided at the end; the transition between the bulges runs on the respective one
  • Sliding side of the molded body and the receiving devices are each shaped so that they receive the relevant molded body in a form-fitting manner. This measure has the advantage that those occurring when using the device according to the invention due to the action of the spring force
  • the receiving devices include stop buffers which, together with the relevant receiving devices, can be adjusted while maintaining their mutual distance in the axial direction of the biopsy needle are.
  • the stop buffers are expediently made of an elastic material, especially plastic.
  • a pointer part is expediently connected to one of the stop buffers or to a supporting part carrying the latter, the pointer tip of which ends next to an adjustment scale provided in particular on the handpiece.
  • a tensioning device is expediently provided, which is held in its rest position by spring force. This results in a relatively low design effort for tensioning the receiving devices.
  • the tensioning device in question can advantageously be actuated by a cable arrangement. This has the advantage of a particularly simple clamping device.
  • the holding devices are preferably held in the tensioned state by means of latches on holding parts, of which the holding part which can be brought into contact with the latching device for the cutting device is designed as a trigger in the handpiece, and the latching part of the holding device serving to hold the hollow needle is so noted that it will only be triggered by the first-mentioned recording device if it is shortly in front of or at its buffer. This results in the advantage of a relatively low design effort for the locking connections mentioned.
  • a tube arrangement for receiving the biopsy needle is preferably provided at the distal end of the handpiece, and the handpiece is connected to the relevant tube arrangement on the endoscope. attachable to the scope. This has the advantage of a particularly simple and easy connection of the handpiece to the endoscope.
  • the tube arrangement expediently consists of an outer tube and an inner tube through which the biopsy needle can be passed, and between these two tubes an extendable intermediate tube is provided, through the distal end of which the biopsy needle can be passed.
  • the cutting device of the biopsy needle is preferably designed as a stylet, which has the advantage that the biopsy needle can be cut particularly effectively.
  • the hollow needle of the biopsy needle is expediently formed by a very thin-walled tissue tube made of plastic, and expediently a protective tube surrounding the biopsy needle is also formed by a tissue tube made of plastic.
  • the fabric hose is designed in such a way that its surfaces are fabric-like. This allows a relatively low frictional resistance to be achieved between the individual parts of the biopsy needle, so that it can be used without problems even in the case of a considerable length in the range of over 1.
  • Fig. 1 shows a sectional view of a pipe arrangement which can be used in the device according to the invention
  • Fig. 2 shows a schematic sectional view of the basic structure of a handpiece of the device according to the invention in the relaxed state.
  • FIG. 3 shows a schematic sectional view of the handpiece shown in FIG. 2 in the tensioned state.
  • Fig. 4 shows a biopsy needle with holding parts that can be picked up the handpiece.
  • 5 shows an enlarged view of the distal end of the biopsy needle.
  • 6 shows a front view of a practical holding part
  • FIG. 7 shows a rare sectional view of the holding part shown in FIG. 6.
  • FIG. 8 shows the holding part shown in FIGS. 6 and 7 in a top view together with a holding device.
  • the tube arrangement 1 shows a pipe arrangement 1 which can be used in the device according to the invention in connection with the handpiece to be explained.
  • the tube arrangement 1 consists of an outer tube 2 and an inner tube 3 with a passage opening for a biopsy needle. Both tubes are designed here as metal tubes, for which aluminum is preferably used and through which a biopsy needle can be passed.
  • the inner tube 3 is embedded at its right end with a plate-shaped part 5 in the end part 6 of the outer tube 2, which also has a passage opening for the biopsy needle mentioned.
  • the inner tube 3 has m grooves, through which an intermediate tube 7, which is still provided between the outer tube 2 and the inner tube 3, is guided on this inner tube 3.
  • the intermediate tube 7 is guided with a piston part 8 in the outer tube 2; it has a fastening part 9 at its distal end, which also has a passage opening for the biopsy needle mentioned and with which the tube arrangement 1 can be fastened to an endoscope.
  • the intermediate tube 7 can be led out of the tube arrangement 1, whereby its exact guidance is always guaranteed.
  • a biopsy needle passed through the tube arrangement is also always well and safely guided, even when the intermediate tube 7 is pulled out of the tube arrangement 1.
  • FIG. 2 shows the already mentioned hand piece 10 m in a schematic sectional view.
  • the pipe arrangement shown in FIG. 1 can be attached to the left end face 11 of the handpiece 10, which is indicated by the puncture point between FIGS. 1 and 2.
  • This handpiece is used to attach a hollow needle belonging to a biopsy needle and a cutting device guided in the respective hollow needle, as will be explained with reference to FIGS. 4 and 5, on the proximal
  • End m receiving devices 12 and 13 are connected to one another in such a way that the biopsy needle picked up by the handpiece and the previously mentioned passages are aligned with one another.
  • the receiving devices 12 and 13 sit at a certain distance from one another on an adjusting rod 14 which carries at its right end a threaded part 15 which is received by a threaded opening 16 in the handpiece 10.
  • the adjusting rod 14 in question can be rotated by means of an adjusting wheel 17.
  • two compression springs 18 and 19 are provided, which are individually associated with the mentioned receiving devices 12 and 13 according to FIG. 2 and which each press these receiving devices 12 and 13 to the left against the stop buffers 20 and 21 .
  • These stop buffers 20, 21, which consist of an elastic material, in particular plastic, are fixed in their relative position to one another. They can only be used together with the setting rod 14 and thus with the lines 12 and 13 are moved when the adjusting rod 14 is rotated by the adjusting wheel 17.
  • a pointer part 22 is connected to the stop buffer 20 and ends with its pointer tip in the area of an adjustment scale 23, which is provided in particular on the handpiece 10 itself. To this end, the pointer part 22 projects through a slot 24 provided in the handpiece 10.
  • FIG. 2 also includes a tensioning device 25 which, with latches 26 and 27, can abut stops 28 and 29, which are connected to the receiving devices 12 and 13, respectively.
  • a tension spring 30 pulls the tensioning device 25 to the left in its rest position.
  • the relevant tensioning device according to FIG. 2 can be pulled to the right by means of a cable arrangement 31 and thus allows the receiving devices 12, 13 to bring their tensioned state, as illustrated in FIG. 3.
  • a latching pawl 32 connected to the receiving device 12 bears against the stop buffer 21 for the receiving means 13, and a latching pawl 33 connected to the receiving device 13 bears against a holding part 34 which is likewise designed here as a latching pawl and which is actuated by an actuating button 35, which is printed by a spring 36 m in its upper position, can be locked.
  • the above-mentioned compression springs 18 and 19 are thus considerably compressed, which means that the handpiece or, more precisely, its receiving devices 12, 13 are tensioned. If the actuation button 35 is pressed down, the latching connection between the latching parts 33, 34 is first triggered and the receiving device 13 is quickly moved to the left by the spring force of the spring 19.
  • the receiving device 13 Shortly before its stop buffer 21 or at this stop buffer, the receiving device 13 triggers the detent pawl 32, so that the receiving means 12 is then quickly moved to the left by the spring force of the spring 18. As mentioned above, this becomes powerful and rapid movement is required for a biopsy needle to be inserted into the solid tissue.
  • the biopsy needle 37 in question has an inner part 38 designed as a cutting device, which is received at its proximal end by a holding device or a separate holding part 39, which is held by the holding device 13 of the handpiece 10 is recordable.
  • the biopsy needle 37 also includes a hollow needle 40, which is received by a separate holding part 41. This holding part 41 can be received by the receiving device 12 of the handpiece 10.
  • a protective tube or protective tube 42 which surrounds the biopsy needle, is shown in FIG. 4.
  • F g. 5 shows the distal end of the biopsy needle 37 in an enlarged partial view.
  • the cutting device 38 is designed as a stylet, behind which a location of reduced material thickness is provided.
  • the stylet or the cutting device is surrounded by a thin-walled plastic fabric tube forming the hollow needle 40, which in turn is surrounded by a fabric tube forming the protective tube 42.
  • the fabric hoses are preferably made of a nylon material (registered trademark) with a clear fabric structure.
  • the friction of the individual elements of the biopsy needle is so low that it can be used without problems over a length of over 1 m. It should be noted that the biopsy needle in question can not only be used in conjunction with the previously explained handpiece, but can also be used in general.
  • FIG. 6 shows the above-mentioned holding part 50 m from a front view
  • FIG. 7 shows an associated rare sectional view
  • FIG. 8 shows the holding part 50 m from a top view together with a holding device 54.
  • the holding part 50 in question has one according to FIGS. 6 and 7 Through opening 51 for receiving the cutting device 38 or the hollow needle 40 of the biopsy needle according to FIGS. 4 and 5.
  • the holding part is
  • the protrusions 52, 53 preferably each correspond to a circular cross section, the center of which lies outside the long center of the associated shaped body.
  • the diameter of the respective central bulge 53 can be approximately 2/3 of the diameter of each of the bulges 52 provided at the end.
  • the molded body also has recessed handle sides on its front and rear end sides, as can be clearly seen in FIG. 7.
  • Body parts with a triangular cross-section are provided on the underside of these handles, which in connection with the above-mentioned bulges 52, 53 leads to a very good distribution of force when the holding parts designed in this way and the correspondingly complementary receiving devices are used.

Abstract

Elément (10) à main applicable sur un endoscope et recevant une aiguille de biopsie, qui comporte des dispositifs récepteurs (12, 13) destinés à recevoir une aiguille creuse appartenant à l'aiguille de biopsie et un dispositif de coupe introduit dans l'aiguille creuse. Lesdits dispositifs récepteurs sont mis sous contrainte par un ensemble à ressorts et à encliquetage (18, 19, 32, 21, 33, 34) de manière telle que lorsqu'ils sont sous contrainte, l'aiguille creuse et le dispositif de coupe sont retenus dans l'élément (10) à main. Des deux dispositifs récepteurs (12, 13), c'est d'abord le dispositif récepteur (13) du dispositif de coupe qui est libéré, à la suite de quoi le dispositif récepteur (12) de l'aiguille creuse est lui aussi libéré.
PCT/DE1999/002841 1998-09-08 1999-09-08 Dispositif destine a la reception et a l'actionnement d'une aiguille de biopsie WO2000013592A1 (fr)

Priority Applications (3)

Application Number Priority Date Filing Date Title
JP2000568403A JP2002524127A (ja) 1998-09-08 1999-09-08 生検ニードルを受容しかつ操作するための装置
EP99955675A EP1112027A1 (fr) 1998-09-08 1999-09-08 Dispositif destine a la reception et a l'actionnement d'une aiguille de biopsie
CA002340376A CA2340376A1 (fr) 1998-09-08 1999-09-08 Dispositif destine a la reception et a l'actionnement d'une aiguille de biopsie

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE1998140978 DE19840978A1 (de) 1998-09-08 1998-09-08 Vorrichtung zur Aufnahme und Betätigung einer Biopsienadel
DE19840978.8 1998-09-08

Publications (1)

Publication Number Publication Date
WO2000013592A1 true WO2000013592A1 (fr) 2000-03-16

Family

ID=7880218

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/DE1999/002841 WO2000013592A1 (fr) 1998-09-08 1999-09-08 Dispositif destine a la reception et a l'actionnement d'une aiguille de biopsie

Country Status (5)

Country Link
EP (1) EP1112027A1 (fr)
JP (1) JP2002524127A (fr)
CA (1) CA2340376A1 (fr)
DE (1) DE19840978A1 (fr)
WO (1) WO2000013592A1 (fr)

Cited By (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7670282B2 (en) 2004-06-14 2010-03-02 Pneumrx, Inc. Lung access device
US7766891B2 (en) 2004-07-08 2010-08-03 Pneumrx, Inc. Lung device with sealing features
US7766938B2 (en) 2004-07-08 2010-08-03 Pneumrx, Inc. Pleural effusion treatment device, method and material
US8157837B2 (en) 2006-03-13 2012-04-17 Pneumrx, Inc. Minimally invasive lung volume reduction device and method
US8888800B2 (en) 2006-03-13 2014-11-18 Pneumrx, Inc. Lung volume reduction devices, methods, and systems
US9125639B2 (en) 2004-11-23 2015-09-08 Pneumrx, Inc. Steerable device for accessing a target site and methods
US9173669B2 (en) 2008-09-12 2015-11-03 Pneumrx, Inc. Enhanced efficacy lung volume reduction devices, methods, and systems
US9402633B2 (en) 2006-03-13 2016-08-02 Pneumrx, Inc. Torque alleviating intra-airway lung volume reduction compressive implant structures
US9474533B2 (en) 2006-03-13 2016-10-25 Pneumrx, Inc. Cross-sectional modification during deployment of an elongate lung volume reduction device
WO2022226944A1 (fr) * 2021-04-29 2022-11-03 苏州市立普医疗科技有限公司 Dispositif et procédé d'excitation d'aiguille à ponction entièrement automatique et aiguille à ponction entièrement automatique

Families Citing this family (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
ITFI20020216A1 (it) * 2002-11-07 2004-05-08 Aurelio Gironi Dispositivo per prelievi agobioptici.
DE102005062740B3 (de) * 2005-12-22 2007-07-19 INSTITUT FüR MIKROTECHNIK MAINZ GMBH Biopsienadelset, Schussapparat und Biopsiegerät zur minimal-invasiven Entnahme von Gewebeproben
US8192353B2 (en) * 2007-10-05 2012-06-05 Tyco Healthcare Group Lp Visual obturator
US10390838B1 (en) 2014-08-20 2019-08-27 Pneumrx, Inc. Tuned strength chronic obstructive pulmonary disease treatment
CN106137273A (zh) * 2016-08-06 2016-11-23 上海市同济医院 一种可读数内窥镜活检钳

Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4249541A (en) 1979-04-26 1981-02-10 David S. Pratt Biopsy device
EP0238461A1 (fr) * 1986-02-19 1987-09-23 C.R. Bard, Inc. Dispositif pour prélever des échantillons de tissu
US4763667A (en) * 1986-09-19 1988-08-16 Microvasive, Inc. Tissue-penetrating catheter device
DE3909575C1 (en) * 1989-03-23 1990-08-09 Feinwerkbau Westinger & Altenburger Gmbh & Co Kg, 7238 Oberndorf, De Biopsy device for one-handed operation
WO1992000040A1 (fr) * 1990-06-22 1992-01-09 Bennett Lavon L Dispositif de biopsie ajustable permettant de regler la taille de l'echantillon
DE4419894A1 (de) * 1994-06-07 1995-12-14 Gip Medizin Technik Gmbh Endoskopische Punktionsnadelvorrichtung
US5535755A (en) * 1989-07-22 1996-07-16 Heske; Norbert Tissue sampler
DE29708149U1 (de) * 1997-05-07 1997-09-25 Binmoeller Kenneth F Dr Biopsiegerät

Patent Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4249541A (en) 1979-04-26 1981-02-10 David S. Pratt Biopsy device
EP0238461A1 (fr) * 1986-02-19 1987-09-23 C.R. Bard, Inc. Dispositif pour prélever des échantillons de tissu
US4763667A (en) * 1986-09-19 1988-08-16 Microvasive, Inc. Tissue-penetrating catheter device
DE3909575C1 (en) * 1989-03-23 1990-08-09 Feinwerkbau Westinger & Altenburger Gmbh & Co Kg, 7238 Oberndorf, De Biopsy device for one-handed operation
US5535755A (en) * 1989-07-22 1996-07-16 Heske; Norbert Tissue sampler
WO1992000040A1 (fr) * 1990-06-22 1992-01-09 Bennett Lavon L Dispositif de biopsie ajustable permettant de regler la taille de l'echantillon
DE4419894A1 (de) * 1994-06-07 1995-12-14 Gip Medizin Technik Gmbh Endoskopische Punktionsnadelvorrichtung
DE29708149U1 (de) * 1997-05-07 1997-09-25 Binmoeller Kenneth F Dr Biopsiegerät

Cited By (21)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7775968B2 (en) 2004-06-14 2010-08-17 Pneumrx, Inc. Guided access to lung tissues
US7670282B2 (en) 2004-06-14 2010-03-02 Pneumrx, Inc. Lung access device
US7766891B2 (en) 2004-07-08 2010-08-03 Pneumrx, Inc. Lung device with sealing features
US7766938B2 (en) 2004-07-08 2010-08-03 Pneumrx, Inc. Pleural effusion treatment device, method and material
US9125639B2 (en) 2004-11-23 2015-09-08 Pneumrx, Inc. Steerable device for accessing a target site and methods
US10034999B2 (en) 2004-11-23 2018-07-31 Pneumrx, Inc. Steerable device for accessing a target site and methods
US8888800B2 (en) 2006-03-13 2014-11-18 Pneumrx, Inc. Lung volume reduction devices, methods, and systems
US9474533B2 (en) 2006-03-13 2016-10-25 Pneumrx, Inc. Cross-sectional modification during deployment of an elongate lung volume reduction device
US10226257B2 (en) 2006-03-13 2019-03-12 Pneumrx, Inc. Lung volume reduction devices, methods, and systems
US10188397B2 (en) 2006-03-13 2019-01-29 Pneumrx, Inc. Torque alleviating intra-airway lung volume reduction compressive implant structures
US9402633B2 (en) 2006-03-13 2016-08-02 Pneumrx, Inc. Torque alleviating intra-airway lung volume reduction compressive implant structures
US9402632B2 (en) 2006-03-13 2016-08-02 Pneumrx, Inc. Lung volume reduction devices, methods, and systems
US9402971B2 (en) 2006-03-13 2016-08-02 Pneumrx, Inc. Minimally invasive lung volume reduction devices, methods, and systems
US8932310B2 (en) 2006-03-13 2015-01-13 Pneumrx, Inc. Minimally invasive lung volume reduction devices, methods, and systems
US9782558B2 (en) 2006-03-13 2017-10-10 Pneumrx, Inc. Minimally invasive lung volume reduction devices, methods, and systems
US8157837B2 (en) 2006-03-13 2012-04-17 Pneumrx, Inc. Minimally invasive lung volume reduction device and method
US10058331B2 (en) 2008-09-12 2018-08-28 Pneumrx, Inc. Enhanced efficacy lung volume reduction devices, methods, and systems
US9192403B2 (en) 2008-09-12 2015-11-24 Pneumrx, Inc. Elongated lung volume reduction devices, methods, and systems
US9173669B2 (en) 2008-09-12 2015-11-03 Pneumrx, Inc. Enhanced efficacy lung volume reduction devices, methods, and systems
US10285707B2 (en) 2008-09-12 2019-05-14 Pneumrx, Inc. Enhanced efficacy lung volume reduction devices, methods, and systems
WO2022226944A1 (fr) * 2021-04-29 2022-11-03 苏州市立普医疗科技有限公司 Dispositif et procédé d'excitation d'aiguille à ponction entièrement automatique et aiguille à ponction entièrement automatique

Also Published As

Publication number Publication date
CA2340376A1 (fr) 2000-03-16
EP1112027A1 (fr) 2001-07-04
DE19840978A1 (de) 2000-03-09
JP2002524127A (ja) 2002-08-06

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