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BAGIAN ILMU BEDAH CASE PRESENTATION

FAKULTAS KEDOKTERAN NOVEMBER 2013

UNIVERSITAS HASANUDDIN

STENOSIS ANI

OLEH :

NUR NAJWA SARONI

C11109777

PEMBIMBING :

d! "USFITARIA ALVINA

SUPERVISOR :

P#$ d! FARID NUR MANTU% S&!B% S&!BA

DIPRESENTASIKAN DALAM RANGKA

TUGAS KEPANITERAAN KLINIK BAGIAN ILMU BEDAH

FAKULTAS KEDOKTERAN

UNIVERSITAS HASANUDDIN

2013

1



LEMBAR PENGESAHAN

"'() *+,'(d','()'( d-*'.'/ -(- +(',''( *'/.' :

N'' : N N'4.' S'#(-

NIM : C 11109777

F'5,'6 : K+d#,+'(

U(-+6-,'6 : U(-+6-,'6 H'6'(dd-(

Jd5 C'6+ : Stenosis Ani

T+5'/ +(+5+6'-'( ,)'6 d'5' '()' +&'(-,+''( 5-(- &'d' B')-'( I5

B+d'/ F'5,'6 K+d#,+'( U(-+6-,'6 H'6'(dd-(!

M''66'% N#+*+ 2013

2

P+*-*-()%

d! "6$-,'-' A5-('

M+()+,'/-%

S&+-6# B')-'( I5 B+d'/

S*d--6- B+d'/ A('

P#$ d! F'-d N M'(,% S&!B% S&!BA



LAPORAN KASUS

I. IDENTITAS PASIEN

N'' : B S

U : 23 /'-

J+(-6 K+5'-( : L'-85'-

N#! RM : 32;1

A5'', : D6( B+#&&' K'*! L.

R'()'( : NICU K'' 2B

T'())'5 MRS : 12 < 10 < 2013

II. ANAMNESIS : A55#'('(+6-6 =I* &+(d+-,'>

• K+5/'( U,'' : P+, +*+6'

• A('(+6-6 T+&-&-( :

D-'5'- 6+4' 6-' 7 /'- 6+,+5'/ +5'/-'(! M(,'/ 'd'% $++(6- 1 '5-%

,-d' +(+&#,% -6- ?'-'( *+.'(' (-()! R-.'', 6+-() (,'/

6+4' 6-' 7 /'-! A(' '5'6 +(+,+! B'() '- *+6' 6+d--,86+d--,%

#(6-6,+(6- +(?+! A(' ,-d' &+('/ +('()-6 6'', *'() '- *+6'! T-d'

&+('/ $+6+6 *+?'& d''/! R-.'', '(' 6+)+' *'() '- *+6'

+#(- 6+,+5'/ 5'/-% *+.'(' /-4' +/-,''(! K+(?-() ,-d' &+('/

+5' d'- 5*'() &'(,',! F+6+6 ,-d' &+('/ *+?'& '- +(?-()! '('

,-d' &+('/ +.+5 6'', *'() '- +?-5! B'() '- +?-5 5'(?'% .'('

(-()! T-d' 'd' )','58)','5 d- d'+'/ +'5'(! R-.'', #&+'6-

6+*+5(' ,-d' 'd'! R-.'', &+())(''( 5'6',-$ ,-d' 'd'! P++4''(

''/ &+,'(- d'( -* ,-d' *++4'!

R-.'', +5'/-'( : B'- 5'/- ?& *5'( = 29 -()) >% 5'/- 6&#(,'(

d-,#5#() d(% 5'()6() +('()-6% *+', *'d'( 5'/- 3% )!

R-.'', +/'-5'( : I* ,-d' &+('/ ,+4',/% ,-d' &+('/ d+'% ,-d'

,++(' 'd-'6- ',' ,+'&- 'd-'6-% ,-d' &+('/ +()#(66- 4'

6+5'' +/'-5'(! )-@- -* *'- d'( /'(' -( -,'-( '()

d-+6+&'( d#,+ 6+5'' +/'-5'(! U6-' 6'', /'-5 2 ,'/(! G;P;A0

3



III. PEMERIKSAAN FISIK :

Status present : S'-, 6+d'() < G-@- ?& < C#&#6 +(,-6

Tana !ita" :

N'd- : 120< +(-,

P+('&'6'( : <+(-,

S/ : 3%90 C

Kepa"a :

K#(4(),-' : A(+-6 =8>% -(4+6-# =8>

S5+' : I,+6 =8>

B-*- : T-d' 'd' 6-'(#6-6

G6- : P+d''/'( =8>

Le#er :

K+5+(4' )+,'/ *+(-() : T-d' ,+d'&', &+*+6''(

DVS : R82 ?H20

M'66' ,# : T-d' 'd'

N+- ,+'( : T-d' 'd'

A$o%en :

I(6&+6- : D-6,+(d+d =>% -, )+' ('&'6%

d' ?#(,# =8>% d' 6,+-$() =8>

A65,'6- : P+-6,'5,- => +6'( +(-()',

;



P'5&'6- : M'66' ,# =8>% (+- ,+'( =8>

P+6- : H-&+,-&'(-

R+?,'5 ,#?/+ :6$-(),+ +(?+-% '('5-6 '('5 6+&-, =4'-

+5-()-() d'&', d-'6'(>% '&5' ,-d' #5'&6%

#6' 5-?-(! M'66' ,# ,-d' 'd'! ! H'(d6?/#+( :

d''/ =8> 5+(d- =8> $+6+6 =>

T#ora&s :

I(6&+6- : S-+,-6 -- d'( '('(

P'5&'6- : N+- ,+'( =8>% '66' ,# =8>

P+6- : S#(# '('( --

A65,'6- : B(- &+('&'6'( : *#(#+6-5+

B(- ,'*'/'( : R#(/- 8<8% W/++@-() 8<8

I'. DIAGNOSIS

S,+(#6-6 '(- d+'4', -()'(

'. PENATALAKSANAAN A(AL

8 IVFD d+,#6+ 10 ?? < 4'

8 N,-6- +(,+'5 : 66 30 ??

8 A&-?-55-( 30 ) < )BB< 4'

8 G+(,'-?-( ; ) < )BB< 2; 4'

8 B6-('6- d+()'( d-5',# H+)' = *+/'6-5 6'&'- (#!13>

'I. HASIL PEMERIKSAAN

•

Pe%eri&saan La$oratoriu%:



• pe%eri&saan USG a$o%en )*+),+*,)-

I(,+&+,'6-

8 T'&' d-5','6- d'( +?/# d'' '() *'(' &'d' )'6,+ d'( 5##&8

5##& 66!

8 H+&' : +?/# &'+(- (#'5% ,-d' ,'&' d-5','6- '65+% *-5+

d?, -(,' d'( 5+6- &',#5#)- 5'-(('

8 GB : d'5' *','6 (#'5

8 P'(+'6 : 65-, d- -d+(,-$-'6-

8 L-+( : '( d'( +?/# &'+(- (#'5

8 K+d' )-(4'5 : '(% *+(, d'( +?/# &'+(- (#'5

8 VU : -(+ -(-'5

K+6'( : +,+#-66

enis pe%eri&saan )/+),+*,)-

DARAH RUTIN

WBC 10!103<U5

RBC 3!0110<L

HGB 11!1 )<dL

PLT ;00103

HCT 31!0

KIMIA DARAH

GDS 7 )<d5

SGOT 21 <5

SGPT <5

U+ )<d5

K+',-(-( 0!3 )<d5

A5*-( 3!0 )<d5

E5+,#5-,

N' 139 #5<L

K !02 #5<L

C5 111 #5<L



• Pe%eri&saan 0oto po"os a$o%en )*+),+*,)-

I(,+&+,'6-

8 d'' 66 ,+d-6,-*6- 6'&'- + d-6,'5

8 ,'&' d-5','6- 5##&85##& 66% ,-d' ,'&' )'*''( /+-() *#(+

8 +d' &6#'6 5-(+ ,-d' ,+-6'5-6'6-% +d' &+&+-,#(+'5 $', 5-(+ -(,'

8 ,5'() ,5'() '() ,+-6'5-6'6- -(,'

+6'( : +,+#-66

Pe%eri&saan 1o"on in Loop 2)3+),+*,)-4I(,+&+,'6-

8 Ud'' 66 ,+d-6,-*6- 6'&'- + d-6,'5 $+?'5 '66 &#6-,-$

8 T'&' d-5','6- 5##&85##& 66 d'( ,-d' ,'&' )'*''( /+-()

*#(+ 6+,' '- $5-d 5++5!

8 K+d' &6#'6 5-(+ ,-d' ,+-6'5-6'6-

8 K+d' &+&+-,#(+'5 $', 5-(+ -(,'

8 K+6'( : ,-d' ,'&' ,'(d'8,'(d' 6,+(#6-6 '(-

7



M+,+#-66

• Foto BNO 5 OMD 2*-+),+*,)-4

Foto BNO

I(,+&+,'6-

8 Ud'' 66 ,+d-6,-*6- 6'&'- + d-6,'5 d+()'( $+?'5 '66 &#6-,-$

8 T'&' d-5','6- 5##&85##& 66 d'( ,-d' ,'&' )'*''( /+-()

*#(+ 6+,' '- $5-d 5++5

8 K+d' &6#'6 5-(+ ,-d' ,+-6'5-6'6-

8 K+d' &+&+-,#(+'5 $', 5-(+ -(,'

Foto %aa6uoeno6rap#7

I(,+&+,'6-

8 K#(,'6 6+('.' -#d- d-'6'( +5'5- )'6,-? ,*+ '()

,+&'6'() +5'5- #'5 6+*'(' ;05 ,'(&' ,'/'('( +()-6- )'6,+%

d#d+(% 4+4(

8 T-d' ,'&' $-55-() d+$+?, '&( 'dd-,-#('5 6/'d#.

Foto po"os a$o%en *8 9a%

I(,+&+,'6-

8 T-d' ,'&' 6-6' #(,'6



K+6'( : ,-d' ,'&' ,'(d'8,'(d' 6,+(#6-6

G'*''( +,+#-66

9



'II. RESUME

S+#'() '(' 5'-85'-% 6-' 23 /'-% '6 '/ 6'-, d+()'(

+5/'( &+, d-6,+(d+d '() d-'5'- 6+4' 6-' 7 /'- 6+,+5'/ +5'/-'(!

M(,'/ 'd'% $++(6- 1 '5-% ,-d' &#+,-5% -6- ?'-'( *+.'(' (-()!

R-.'', 6+-() (,'/ 'd'% 6+4' 6-' 7 /'-! B'() '- *+6' 6+d--,8

6+d--,% #(6-6,+(6- +(?+! A(' ,-d' &+('/ +('()-6 6'', *'() '-

*+6'! T-d' &+('/ $+6+6 *+?'& d''/! R-.'', '(' 6+)+' *'() '-

*+6' +#(- 6+,+5'/ 5'/-% *+.'(' /-4' +/-,''(! K+(?-() ,-d'

&+('/ +5' d'- 5*'() &'(,',! F+6+6 ,-d' &+('/ *+?'& '-

+(?-()! '(' ,-d' &+('/ +.+5 6'', *'() '- +?-5! B'() '- +?-5

5'(?'% .'(' (-()! T-d' 'd' )','58)','5 d- d'+'/ +'5'(! R-.'',

#&+'6- 6+*+5(' ,-d' 'd'! R-.'', &+())(''( 5'6',-$ ,-d' 'd'!

P++4''( ''/ &+,'(- d'( -* ,-d' *++4'!

R-.'', +5'/-'( : B'- 5'/- ?& *5'( = 29 -())> 5'/- 6&#(,'(

d-,#5#() d(% *'- 5'()6() +('()-6! B+', *'d'( 5'/- 3% )!

R-.'', +/'-5'( : I* ,-d' &+('/ ,+4',/% ,-d' &+('/ d+'% ,-d'

,++(' 'd-'6- ',' ,+'&- 'd-'6-% ,-d' &+('/ +()#(66- 4'

6+5'' +/'-5'(! )-@- -* *'- d'( /'(' -( -,'-( '()

d-+6+&'( d#,+ 6+5'' +/'-5'(! U6-' 6'', /'-5 2 ,'/(! G;P;A0

D'- &++-6''( $-6-6 d-d'&','( )'*''( : 6'-, 6+d'() < )-@-

?& < ?#&#6 +(,-6! T'(d' -,'5% ('d-: 120<+(-,% &+('&'6'(:

<+(-,% 6/: 3%9 0C!! P'd' +)-# '*d#+( -(6&+6- +*()% -,

)+' ('&'6% d' ?#(,# =8>% d' 6,+-$() =8>! A65,'6- d-d'&','( &+-6,'5,- => +6'( +(-()',% &'5&'6- '66' ,# =8>% (+- ,+'( =8>!

L-+( ,-d' ,+'*'! P+6- /-&+,-&'(-! P'd' &++-6''( ,/#'6 d'5'

*','6 (#'5! P'd' &++-6''( +?,'5 ,#?/+ d-d'&','( 6$-(),+

+(?+-% '('5-6 '('5 6+&-, ,+,'&- 4'- +5-()-() d'/ d-'6'(%

'&5' ,-d' #5'&6% #6' 5-?-(! H'(d6?/#+(: d''/=8> 5+(d-=8> $+6+6=>

D'- /'6-5 &++-6''( 5'*#',#- *+&' &++-6''( d''/ ,-(

d'( &++-6''( --' d''/ +((4'( d'5' *','6 (#'5! P'd'

10



&++-6''( 'd-#5#)- '-, $#,# &#5#6 '*d#+( d'( USG '*d#+(

d-d'&','( )'*''( +,+#-66!

'III. DISKUSI

STENOSIS ANI

A! D+$-(-6-

S,+(#6-6 '(- +&''( 6', +'d''( d-'(' 5+( '(6

+(+&-,! S,+(#6-6 '(- &'d' *'- 'd'5'/ +5'-('( #()+(-,'5 ','

*'.''(! S,+(#6-6 '(- 'd'5'/ ,-d' 5+()'&(' &++*'()'( +*-#(-

&'d' d-6,'5 '(6 d-'(' ,+4'd- &+*+(,'( +*'( '('5 '() ,-d'

6+&('! S,+(#6-6 '(- #()+(-,'5 +&''( 6', '5$#'6- '(#+,'5!

S+d'()'( 6,+(#6-6 '(- &'d' d+.'6' 6+-() ,+4'd- '-*', #&5-'6- d'-

#&+'6- &'d' d'+'/ '(#+,'5!

M'5$#'6- '(#+,'5 +&''( 6', 6&+, d'- '(#'5- #()+(-,'5

'() ,+d-- d'- '(6 -&+$#',' d'( 5#'' &+6-6,+(! A(6 -&+$#','

+&''( +5'-('( #()+(-,'5 ,'(&' '(6 ',' d+()'( '(6 ,-d' 6+&('%

6+d'()'( 5#'' &+6-6,+( d-'-*','( '+(' &+-6'/'( '(,'' ,',6

-('-6% ,',6 )+(-,'5-' d'( ,',6 d-)+6,-6 ,-d' ,+4'd-! M'5$#'6-

'(#+,'5 +&''( +6''( *+6&+, 5'6 &'d' &++*'()'( *')-'(

,+*'.'/ d'- 6'5'( -(,+6,-('5 d'( #)+(-,'5! K+,-' '5$#'6- ,+4'd-% #,#,

d'( 6''$ '() *+/*()'( d+()'( '(6 4)' 6+-() +()'5'-

'5$#'6- d'5' d+'4', '() 6''! D+$+ #5#)- 'd'5'/ '(#'5- '()

&'5-() 6+-() *+'-,'( d+()'( '5$#'6- '(#+,'5% d--,- d+$+ &'d'

+,+*'% +6,--,'6 d'( 6-6,+ 'd-#'65'!

P+('()'('( d-5''( &'d' *'- d+()'( '5$#'6- '(#+,'5

6+,+5'/ 2; 4'% '+(' ,+'('( -(,'5-('5 ''( +(-()', 6+/-())'

d'&', +(d##() +#(- +5' + &+-(+ &'d' +5'-('( 5+,'

+(d'/% ',' +5' +5'- +,/' &'d' +5'-('( 5+,' ,-())- d'( +*+-

.', *')- d'' (, ++(/- 66 /-())' +(?'&'- 4() d-6,'5

66! N'(% *-5' d-*-''( 5+*-/ d'- 2; 4'% *'- *++6-# +()'5'-

&+$#'6- '+(' d-6,+(6- '() *+5+*-/'(!

11



B! E&-d+-#5#)-

M'5$#'6- '(#+,'5 ,+4'd- 6+,-'& 1 d'- !000 +5'/-'(!

M'5$#'6- -(- 5+*-/ 6+-() ,+4'd- &'d' &-' d'( &-' d' '5- 5+*-/ *'('

+()'5'- '5$#'6- '(#+,'5 5+,' ,-())- ',' -(,++d-+,! E&',

&5/ 6'&'- ,4/ &5/ &+6+( d'- &+(d+-,' +()'5'- 6', ',' 5+*-/

d+$+ ,'*'/'( d'- 6-6,+ #)'( 5'-(('! K+5'-('( '() &'5-() 6+-()

,+4'd- &'d' &-' 'd'5'/ '(6 -&+$#',' d+()' $-6,5' +,#+,'% d--,-

$-6,5' +,#&+-(+ +d-'( $-6,5' +,#+6-' ',' *5'dd+ (+?!

P'd' .'(-,'% '() ,+6+-() 'd'5'/ d+$+ +,#+6,-*5+% +d-'( $-6,5'

,'(+6&+-(+'5! "'() +,-)' '() ,+6+-() 'd'5'/ &+6-6,+( 5#''! L+6-

-(- 'd'5'/ '5$#'6- '() *+6&+, 5'6 d-'(' +,% ')-('% d'(

,',6 -('-6 *+,+ d'( *+6', +*+(, 6', 6'5'(! P'd'

&++-6''( $-6-% d'&', d-5-/', 6', 5*'() 6'4' &'d' &+-(+!

C! E*-#5#)-

S+?'' +*-#5#)-6% 6'5'( &+(?+(''( *+'6'5 d'- F#+),%

M-d), d'( H-(d),! F#+), ''( +*+(, $'-()% 6-6,+ &+('&'6'(

*')-'( *'.'/% +6#$')6% 5'*() 6+*')-'( d#d+(% /',- d'( 6-6,+

*-5-+ 6+,' &'(+'6! M-d), +*+(, 66 /'56% 6+*')-'( d#d+(%

6+% '&&+(d-% #5#( '6?+(d+( 6'&'- &+,+()'/'( #5#( ,'(6+6!

H-(d), +5'6 d'- -d), /-())' + +*'( 5#''% +*'( -(-

,+66( d'- +(d#d+ 5#''% d'( +,#d+ d'- &#,#d+ < '('5&-,!

H-(d), +*+(, 6+&+,-)' d-6,'5 d'( #5#( ,'(+6 % #5#(d+6+(d+(% 6-)#-d% +,% *')-'( ','6 '('5-6 '(-! E(d#d+ /-(d), -(-

4)' +*+(, 5'&-6'( d'5' '(d() +-/ d'( +,'! B')-'( '/-

/-(d), *+'' + d'5' 5#''% 6', #())' '() d-5'&-6- +(d#d+

'() *+/*()'( 5'()6() d+()'( +,#d+ &+''(! D'+'/

&+,+'( '(,'' +(d#d+ d'( +,#d+ +*+(, +*'(' 5#''!

P'd' &++*'()'( 6+5'(4,('% ,-*5 6', -)- +5-(,'()% '-,

6+&, #+,'5% &'d' 6d, '(,'' '55'(,#-6 d'( 66 *+5''()! S+', -(-

12



,*/ + ''/ 'd'5% '+(' -, +*')- 5#'' +(4'd- *')-'(

'(,+-#% '-, 6-(6 #)+(-,'5-6 &--,-$% d'( *')-'( &#6,+-#% '-,

'('5-6 '(#+,'5-6! K+,-' 4'(-( *+ -())% 6+&, #+,'5

+(?'&'- +*'( 5#''% d'( d- d'+'/ -(- ,+*+(,5'/ #&6

&+-(+'5-6! M+*'( 5#'' +d-'( ,+*')- +(4'd- +*'(' '('5-6 d-

*+5''()% d'( +*'( #)+(-,'5-6 d-d+&'(! M+*'(' '('5-6 d-+5-5-()-

#5+/ ,#(4#5'(8,#(4#5'( +6+(-% d'( &'d' -()) +8 6+5'&, -(-

,+5+,' d- d'6' ?+()'( +,#d+% '() d-+('5 6+*')'- ?+5'/ '(6 ','

&#,#d+! P'd' -()) +89 +*'( '('5-6 #*+% d'( ,+*'5'/

4'5'( '(,'' +, d+()'( d(-' 5'! B')-'( ','6 '('5-6 '('5-6 *+'6'5

d'- +(d#d+ d'( d-&+d''/- #5+/ &+*5/ d''/ /-(d),% '-, ',+-

+6+(,+-' -($+-#! S+d'()'( 6+&+,-)' *')-'( *'.'/ '('5-6 '('5-6

*+'6'5 d'- +,#d+ d'( d-&+d''/- #5+/ ''! R+,'5+6% '() +&''(

?'*'() d'- ',+- &d+(d' -(,+('! T+&', &+6'*()'( '(,'' *')-'(

+(d#d+ d'( +,#d+ d-*+(, #5+/ 5-(+' &+,-(','% '() ,+d'&', ,+&',

d- *'.'/ #5(' '('5-6! P'd' )'-6 -(-% +&-,+5 *+*'/ d'- +&-,+5 ,#'

+(4'd- +&-,+5 *+5'&-6 )+&+()!

U66 ,+*+(, 5'- -()) ++&', d-6+*, 6+*')'- &--,-$ ),!

K+)')'5'( &++*'()'( '() 5+()'& d'- 6+&, #+,'5-6

+()/'6-5'( '(#'5- 5+,' ,-())- ',' 6&' 5+',#! S+d'()'( '(#'5-

5+,' +(d'/ ',' -($' 5+',# *+'6'5 d'- d+$+ &++*'()'(

&#,#d+ d'( 5-&','( )+(-,'5! P'd' '(#'5- 5+,' ,-())-% #,#, 5+',# '(-

&++*'()'((' ,-d' (#'5! S+d'()'( #,#, 6$-(),+ +6,+(6 d'(

-(,+(6 d'&', ,-d' 'd' ',' d-+(,+!

T'/'&8,'/'& &+,*/'( ,+4'd- &'d' $#'6- '(',#- (#'5d'- *')-'( *'.'/ '-, '(6% +, d'( 6'5'( #)+(-,'5! P'd' -())

+8; &+,*/'( ,+d'&', 5#'' d'( 6,, '() d-6+*, +*'(

5#''! K5#'' 'd'5'/ 6,, (#'5 &'d' *() d'( 'd' &'d' '(6-'

(, .', '() 6-()', &'d' ,'/'& &+,*/'(! S+*+5 '(6-'

5'/-% 5#'' 'd'5'/ 6,, d-'(' #5#(% 6'5'( -(% d'( )+(-,'5

*+'' +d-'( +5' d'- ,*/ +5'5- 6', 5*'()! M'(6-'

+5'5- 6', ,'/'& &+,*/'( d-'(' 5#'' +&''( 6,, '()

13



(#'5% +d-'( ,*/ 5*'() '() ,+&-6'/ (, +, d'( ,',6

-( d'( &'d' .'(-,' 4)' ,+*+(, ')-('! P++*'()'( (#'5 -(-

4)' ,+4'd- &'d' &++*'()'( 6,, '() d-6+*, +*'( 5#''!

J-' +*'( -(- ,-d' *++*'() (#'5% 5#'' ()-( '6-/

,+d'&', 6+,+5'/ +5'/-'( &'d' .'(-,' ',' &'d' &-' ''( *++*'()

*+(, d'- '(6 -&+$#','!

D! A(',#- D'( F-6-#5#)- R+, D'( A(6

K'('5-6 '(- 6)-?'5 ,+5+,' '(,'' ?-(?-( '(#+,'5 d'( '('5 +)+%

-'8-' 6+&'(4'() 3 ?% 6+d'()'( '('5-6 '(- '(',#-6 ,+5+,' '(,''

5-(+' d+(,',+ d'( '('5 +)+% 6+-,' 181! ?! K'('5-6 '(- ,+d-- d'-

6$-(),+ '(- -(,-(6- d'( +6,-(6-% #6' '(- d'( '65' 6*#6'!

S$-(),+ '(- +6,-(6- +&''( *')-'( d'- #,#, 5+',# '(- '()

+*+(, d-'$')' &+5-6! S$-(),+ '(- -(,-(6- +-5-- #,#, '()

(-% '() *+$()6- +()', $5',6% &+()+5''( ?'-'( d'( $+6+6! O,#,

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