61. Portal Systemic Encephalopathy Portal systemic encephalopathy,, Print this article, see bilirubinencephalopathy FS The Encyclopaedia of Medical Imaging Volume VI1, http://www.amershamhealth.com/medcyclopaedia/Volume VI 1/PORTAL SYSTEMIC ENCEPHA

Medcyclopaedia About Medcyclopaedia Amersham Health Search for: Type a word or a phrase. All forms of the word are searchable. Advanced search Browse entry words starting with: A B C D ... Other characters Try our Medcyclopaedia Premium Edition with added tools and functionality tailored to make your working day easier. The following tools are presently available: Expanded search *For Medical Professionals only, registration required Portal systemic encephalopathy, see bilirubin encephalopathy FS The Encyclopaedia of Medical Imaging Volume VI:1 Welcome to Medcyclopaedia. This site is open to a public audience, still we want to know a little more about our visitors. Please tick off the boxes that match your profile. Do you live in Europe? Yes No Are you a medical professional? Yes No This frame will disappear when submitted Legal Contact us Making Waves

62. NIMULID TABLET Livoluk solution is a brand of Lactulose, a synthetic disaccharide, which ishighly useful in the management of portal systemic encephalopathy and also http://www.panacea-biotec.com/products/livoluk.htm

For the use of a Registered Medical Practitioner or a Hospital or a Laboratory only LIVOLUK Description Pharmacology Pharmacokinetics Indications ... Dosage and Administration Description: Livoluk solution is a brand of Lactulose, a synthetic disaccharide, which is highly useful in the management of portal systemic encephalopathy and also constipation. LIVOLUK is colourless to amber, syrupy liquid. Each 15ml contains: Lactulose 10g (As Lactulose Concentration USP) Pharmacology: TOP Pharmacokinetics: Lactulose is poorly absorbed. When given orally, only small amounts reach the blood. Urinary excretion is less than or equal to 3% and is essen­tially complete within 24 hours. Lactulose exerts its effect only in the colon. Transit time through the colon may be slow, therefore, 24-48 hours may be required to produce a normal bowel movement. Indications: Livoluk is indicated in the treatment of constipation, chronic constipation, after haemorrhoidectomy, in elderly after barium meal examination, in bed ridden or institutionalized patients and others, in prevention and treatment of portal systemic encephalopathy including the stages of hepatic pre-coma and coma. Livoluk reduces blood ammonia levels by 25% to 50%. This generally parallels improved mental state and EEG patterns. Contraindications: Livoluk is contraindicated in patients who require a low galactose diet.

63. Hepatitis Central, DIAGNOSIS OF HEPATIC ENCEPHALOPATHY Comparison of lactulose and neomycin in the treatment of chronic portalsystemicencephalopathy. A double blind controlled trial. http://hepatitis-central.com/hcv/liver/encephalopathy/role.html

Hepatology, May 1999, p. 1605-1607, Vol. 29, No. 5 HEPATOLOGY Elsewhere DIAGNOSIS OF HEPATIC ENCEPHALOPATHY: WILL IN VIVO PROTON MRS PLAY A ROLE? Haseler LJ, Sibbitt WL Jr, Mojtahedzadeh HN, Reddy S, Agarwal VP, McCarthy DM. Proton MR spectroscopic measurement of neurometabolites in hepatic encephalopathy during oral lactulose therapy. AJNR Am J Neuroradiol 1998;19:1681-1686. [ Medline ] Reprinted with permission. ABSTRACT BACKGROUND AND PURPOSE: MR imaging and MR spectroscopy are increasingly being used to determine response to pharmacologic therapy. Hepatic encephalopathy (HE) is characterized by abnormal cerebral metabolites, yet the response to lactulose and other anti-HE measures is still primarily determined by using arbitrary categorical clinical rating scales, rather than MR spectroscopy. The purpose of this study was to determine whether MR spectroscopy could demonstrate relevant neurometabolic changes associated with lactulose therapy and thereby provide further support for the use of MR spectroscopy in clinical trials.

64. Member Sign In systemic and hemodynamic disturbance, electrolyte abnormalities, renal impairment,and encephalopathy is lower Transjugular Intrahepatic Portal Systemic Shunt. http://www.medscape.com/viewarticle/442364_4

If you are having trouble logging in: In order to use Medscape, your browser must be set to accept "cookies." To find out how to adjust your browser settings, please click here Log In Username Password Forgot your password? Not a Member? Register Now for free access to: MEDLINE (Optimized for Physicians) 200+ Free CME Courses 25 Medical Specialty Sites 100+ Medical Journals Conference Coverage Daily Medical News About Medscape Help WebMD Health

65. Untitled Document Indication Constipation. Acute and chronic portal systemic encephalopathy.Lactugal. Acute and chronic portal systemic encephalopathy. Lactulose. http://www.toplocalwebsites.net/hospitalweb/Pharmaceutical database/DrugsL.htm

PHARMACEUTICAL DATABASE L Drugs are listed alphabetically by manufacturer 's product name. (Note: Some of these drugs may not be available in the United Kingdom.) The following information is not intended as a medical advice. While every attempt is made to be accurate, we do not assume responsibility for any mistakes, omissions or the use of the pharmaceutical products listed in this database. Contact: admin@hospitalweb.co.uk RETURN TO HOSPITAL WEB DIRECTORY OF PHARMACEUTICAL COMPANIES A ... X Y Z (Click on letter to go the drugs starting with that letter.) ALLERGIES. CARDIOVASCULAR. CENTRAL NERVOUS SYSTEM. CONTRACEPTION. ... SKIN. Labosept. (UK) Manufacturer: L.A.B. Treatment Class: Ear, Nose, Throat. Oropharyngeal. Indication: Mouth and throat infections. Lacabiotal. (UK) Manufacturer: Sevier. Treatment Class: Ear, Nose, Throat. Oropharyngeal. Indication: Infections of the upper respiratory tract. Lacre-lube. (UK) Manufacturer: Allergan. Treatment Class: Eye. Ocular lubricants. Indication: Eye lubricant, corneal protection.

66. Untitled Document Indication Constipation. Portal systemic encephalopathy. Electrolade. IndicationConstipation. Acute and chronic portal systemic encephalopathy. Lactugal. http://www.toplocalwebsites.net/hospitalweb/Pharmaceutical database/GASTROINTEST

PHARMACEUTICAL DATABASE GASTROINTESTINAL (Note: Some of these drugs may not be available in the United Kingdom.) The following information is not intended as a medical advice. While every attempt is made to be accurate, we do not assume responsibility for any mistakes, omissions or the use of the pharmaceutical products listed in this database. Contact: admin@hospitalweb.co.uk RETURN TO HOSPITAL WEB DIRECTORY OF PHARMACEUTICAL COMPANIES A ... X Y Z (Click on letter to go the drugs starting with that letter.) ALLERGIES. CARDIOVASCULAR. CENTRAL NERVOUS SYSTEM. CONTRACEPTION. ... SKIN. Aciphex (US). Manufacturer: Eisai Inc. Treatment class: Gastrointestinal. Indication: Gastroesophageal reflux disease (GERD), and duodenal and gastric ulcers (proposed). Actigall (US). Manufacturer: Summit Pharmaceuticals. Treatment class: Gastrointestinal. Indication: radiolucent, noncalcified gallstones. Aggrastat (US). Manufacturer: Merck Treatment class: Cardiovascular Indication: Unstable angina and non-Q-wave myocardial infarction Aggrenox (US).

67. IM Abstract 39-5 Case 10 Portal Systemic encephalopathy Presenting with Dressing and Constructional ApraxiaTakeshi Kanda, Shigeru Nogawa, Kazuhiro Muramatsu, Atsuo Koto and Yasuo http://www.naika.or.jp/im/im39/ab39_5/c390510.html

Portal Systemic Encephalopathy Presenting with Dressing and Constructional Apraxia Takeshi Kanda, Shigeru Nogawa, Kazuhiro Muramatsu, Atsuo Koto and Yasuo Fukuuchi From the Department of Neurology, Keio University, Tokyo Received for publication June 29, 1999; Accepted for publication November 1, 1999 We report a case with portal systemic encephalopathy who presented with dressing and constructional apraxia and subtle weakness of the left hand. We initially suspected a cerebrovascular attack in the right cerebral hemisphere, but brain T -weighted magnetic resonance (MR) imaging revealed high intensity in the basal ganglia and hyperammonemia was detected. We performed abdominal MR angiography, which visualized an intrahepatic portal systemic shunt. Cerebral blood flow, measured by xenon-enhanced computed tomography, was decreased in the bilateral, but more dominantly right-sided, parietal watershed regions. We speculate that these boundary territories might be susceptible to damage by toxic metabolites of hepatic encephalopathy. (Internal Medicine 39: 419-423, 2000)

68. DUPHALAC Syrup In portal systemic encephalopathy administration of large doses of Duphalacresults in a significant reduction in the pH of the colonic contents. http://home.intekom.com/pharm/schering/duphalac.html

INDICATIONS CONTRA-INDICATIONS DOSAGE SIDE-EFFECTS PREGNANCY OVERDOSE IDENTIFICATION PATIENT INFORMATION DUPHALAC syrup SCHEDULING STATUS: Unscheduled PROPRIETARY NAME (and dosage form): DUPHALAC syrup COMPOSITION 5 mL Duphalac contains lactulose (4-0-b-D-galactopyranosyl-D-fructofuranose) 3,3 g. PHARMACOLOGICAL CLASSIFICATION A. 11.5 Laxatives. PHARMACOLOGICAL ACTION Duphalac is a synthetic disaccharide of fructose and galactose, which is not split into its monosaccharide constituents in the small intestine due to the lack of a specific enzyme. It reaches the colon unchanged where it is broken down by the saccharolytic flora into organic acids, such as lactic acid and acetic acid, acids formed in the colon under physiological conditions. Due to this local osmotic effect in the colon, water is retained, the faecal mass softened and normal colonic peristalsis restored. The mode of action differs from that of conventional laxatives. In portal systemic encephalopathy administration of large doses of Duphalac results in a significant reduction in the pH of the colonic contents. Lowering the pH promotes conversion of non-ionised ammonia into ionised form. The latter form being non-absorbable leads to reduction of absorption of ammonia from the intestine into the portal circulation and may even promote the excretion of ammonia from the circulation into the faeces. In addition, the enhanced growth of saccharolytic bacteria results in a decreased formation of ammonia.

69. LAXETTE SOLUTION In portal systemic encephalopathy administration of large doses of LAXETTEresults in a significant reduction in the pH of the colonic contents. http://home.intekom.com/pharm/medpro/laxette.html

INDICATIONS CONTRA-INDICATIONS DOSAGE SIDE-EFFECTS PREGNANCY OVERDOSE IDENTIFICATION PATIENT INFORMATION LAXETTE SOLUTION SCHEDULING STATUS: Not scheduled PROPRIETARY NAME (and dosage form): LAXETTE SOLUTION COMPOSITION: Each 5 mL LAXETTE contains 3,3 g lactulose PHARMACOLOGICAL CLASSIFICATION: A 11.5 Laxatives. PHARMACOLOGICAL ACTION: LAXETTE is a synthetic disaccharide of fructose and galactose, which is not split into its monosaccharide constituents in the small intestine due to the lack of a specific enzyme. It reaches the colon unchanged where it is broken down by the saccharolytic flora into organic acids, such as lactic acid and acetic acid - acids formed in the colon under physiological conditions. Due to this local osmotic effect in the colon, water is retained, the faecal mass softened and normal colonic peristalsis restored. In portal systemic encephalopathy administration of large doses of LAXETTE results in a significant reduction in the pH of the colonic contents. Lowering the pH promotes conversion of non-ionised ammonia into ionised form. The latter form being non-absorbable leads to reduction of absorption of ammonia from the intestine into the portal circulation and may even promote the excretion of ammonia from the circulation into the faeces. LAXETTE cannot be hydrolysed in the intestine, thus very little absorption occurs. Small amounts of non-hydrolysed lactulose may be absorbed, but these are readily excreted via the kidneys.

70. Variceal Bleeding IS THE PORTAL SYSTEMIC SHUNT STILL PERFORMED? One was the frequencyof encephalopathy (dysfunction of the brain) as a complication. http://www.liverkids.org.au/fvariceal_bleeding.htm

This site is hosted by Netfirms Web Hosting WHAT ARE VARICES? Normally, blood from the intestines and spleen is brought to the liver through the portal vein. In people with severe liver damage (cirrhosis) however, the normal flow of blood through the liver is blocked. This can lead to swelling of the liver and potentially the spleen. Blood from the intestines is then rerouted around the liver through small vessels primarily in the stomach and oesophagus. Some of these blood vessels become quite large and swollen (varices). These varices may rupture due to high blood pressure (portal hypertension) and thin vessel walls, causing bleeding in the upper stomach or oesophagus. WHAT IS A PORTAL SYSTEMIC SHUNT? In cases where severe bleeding occurs, surgical shunt procedures may be used to improve the flow of blood through the varices, and to stop bleeding and relieve pressure in these swollen blood vessels. Introduced in 1945, the portal shunt (portal systemic shunt) was the first definitive form of therapy used for patients who had bled from varices. The procedure involves the surgical joining of two veins, the portal vein and the inferior vena cava, to relieve pressure in the portal vein that carries blood into the liver. WHO QUALIFIES FOR THIS PROCEDURE?

71. Data Sheet Hepatic encephalopathy (Portal systemic encephalopathy, hepatic coma) is a neuropsychiatricsyndrome which can complicate all forms of hepatic disease. http://www.medsafe.govt.nz/profs/Datasheet/a/Alphalactulosesyrup.htm

Data Sheet ALPHA-LACTULOSE Lactulose 3.34g/5mL Presentation Uses Actions Lactulose is a synthetic disaccharide used in the treatment of constipation and in hepatic encephalopathy. Studies in patients with a history of chronic constipation have shown that lactulose therapy causes a significant increase in the number of bowel movements per day and the number of days on which bowel movements occur. Lactulose reaches the colon virtually unchanged. There it is metabolised by colonic bacteria to lactic acid and other shortchain carboxylic acids. The end result is a change in the osmotic pressure and acidification of the colonic contents resulting in an increase in stool water content with resultant distention and softening of the stool which in turn promotes increased peristalsis and bowel evacuation. It may take 48 hours before an effect is obtained. The therapeutic action of lactulose in ameliorating the symptoms of hepatic encephalopathy is considered to be a result of the following: Reduction of faecal pH leading to a reduced ammonia absorption via nonionic diffusion and/or diffusion of ammonia from the blood into the gut. The trapped ammonia is then excreted in the stools. Suppression of urase producing organisms Induction of an osmotic type of diarrhoea which diminishes faecal statis with reduction of nitrogenous substances for ammonia production. Decreased absorption of ammonia from the gut also results from shortening intestinal transit time.

72. Danilaxgen Eur.) doses are given for Portal Systemic encephalopathy, the pH in the colonis reduced significantly by the acetic and lactic acid production. http://www.tcmlondon.com/danilaxgen.htm

TCM HEALTHCARE (LONDON) LTD TECHNOLOGY PLAZA KING’S ROAD QUARRY BAY HONG KONG TEL: +852 28 FAX: + 852 2579 0233 E-MAIL: tcm@tcmlondon.co m Danilax Mixture (Lactulose Solution BP / Ph. Eur.) General Information Presentation: Danilax Mixture (Lactulose Solution BP / Ph. Eur.) is a clear,almost colourless to brownish – yellow syrup. Each 5ml contains 3.35gm of Lactulose with less than 400mg Galactose and 200mg Lactose. User: Danilax Mixture (Lactulose Solution BP / Ph. Eur ) is a semi-synthetic disaccharide. It passes essentially unchanged into the colon where it is broken down by normal colonic bacteria mainly into acetic and lactic acids. These acids exert a local osmotic effect in the colon resulting in increased faecal bulk and stimulation of peristalsis. A soft stool is formed and the normal bowel action is encouraged without irritation or direct interference with the gut mucosa. Danilax Mixture (Lactulose Solution BP / Ph. Eur ) prevents the formation of hard stools. Unlike the traditional laxative preparations which act either on the innervation or musculature of the intestine or by bulk stimulus

73. Hepatic Portal System associated with cirrhosis. Patients usually present with splenomegaly,ascites, GI bleeding and/or portal systemic encephalopathy. http://www.rnceus.com/ld/portsys.htm

The hepatic portal system begins in the capillaries of the digestive organs and ends in the portal vein. Consequently, portal blood contains substances absorbed by the stomach and intestines. Portal blood is passed through the hepatic lobules where nutrients and toxins are absorbed, excreted or converted. Restriction of outflow through the hepatic portal system can lead to portal hypertension. Portal hypertension is most often associated with cirrhosis. Patients usually present with splenomegaly, ascites, GI bleeding and/or portal systemic encephalopathy. The consequences of portal hypertension are due to portal systemic anastomosis formed by the body as an attempt to bypass the obstructed liver circulation. These collateral vessels form along the falciform ligament, diaphragm, spleen, stomach and peritoneum. The collaterals find their way to the renal vein where blood drained from the digestive organs is let into the systemic circulation.

74. Liver Disorders removed by the liver. Liver encephalopathy is also called portalsystemicencephalopathy, hepatic encephalopathy, or hepatic coma. http://www.childrensmemorial.org/depts/gastroenterology/liver/default.asp

Home Medical Departments Digestive Disorders Liver Disorders Common Characteristics of Liver Disease What are some common liver disease symptoms? When diagnosing liver disease, the physician looks at the patient's symptoms and conducts a physical examination. In addition, the physician may request a liver biopsy, liver enzyme tests, an ultrasound, or a CT scan (computed tomography scan). Some common liver disease symptoms include the following, each of which are described briefly below: jaundice, cholestasis,liver enlargement, portal hypertension, ascites,liver encephalopathy and liver failure. What is jaundice? Jaundice is a yellow discoloration of the skin and whites of the eyes due to an abnormally high level of bilirubin (bile pigment) in the bloodstream, which is then excreted through the kidneys. High levels of bilirubin may be attributed to inflammation or other abnormalities of the liver cells, or blockage of the bile ducts. Sometimes jaundice is caused by the breakdown of a large number of red blood cells, which can occur in newborns. Jaundice is usually the first sign, and sometimes the only sign, of liver disease.

75. Clinical Manifestations And Diagnosis Of Hepatic Encephalopathy As an example, a portal systemic encephalopathy index includes a quantitativeassessment of asterixis, EEG findings, performance on connection tests, and http://www.uptodate.com/patient_info/topicpages/topics/Cirrhosi/11409.asp

Following is the full text, Medline abstracts and images of a topic review from UpToDate Some of the regular features found in UpToDate , such as drug information, links to related topics, and a simple but powerful search engine, are not incorporated here. USE OF PROFESSIONAL JUDGMENT Clinical manifestations and diagnosis of hepatic encephalopathy CLINICAL MANIFESTATIONS LABORATORY TESTS Ammonia Venous ... MAGNETIC RESONANCE SPECTROSCOPY Peter Ferenci, MD UpToDate performs a continuous review of over 290 journals and other resources. Updates are added as important new information is published. The literature review for UpToDate version 11.1 is current through December 2002; this topic was last changed on September 30, 2002. Hepatic encephalopathy describes the spectrum of potentially reversible neuropsychiatric abnormalities seen in patients with liver dysfunction after exclusion of unrelated neurologic and/or metabolic abnormalities. The term implies that altered brain function is due to metabolic abnormalities, which occur as consequence of liver failure. The full reversibility of symptoms after improvement of liver function is considered to be direct proof of this causal relation. A generally accepted nomenclature could provide a solution to this debate and provide a standard for clinical studies. To achieve this goal, the World Organization of Gastroenterology (OMGE) commissioned a Working Party to reach a consensus in this area. A group of experts proposed a consensus statement at the 11th World Congress of Gastroenterology in Vienna in 1998 (

76. Loyola Univ. Health Sys. - Liver Disorders - Common Characteristics Of Liver Dis removed by the liver. Hepatic encephalopathy is also called portalsystemicencephalopathy or hepatic coma. Symptoms may include http://www.luhs.org/health/topics/liver/common.htm

You are here: Home Health Information Health Topics Liver Disorders Common Characteristics of Liver Disease What are some common liver disease symptoms? When diagnosing liver disease, the physician looks at the patient’s symptoms and conducts a physical examination. In addition, the physician may request a liver biopsy, liver function tests, an ultrasound, or a CT scan (computerized tomography scan). Some common liver disease symptoms include the following, each of which are described briefly below: jaundice itching liver enlargement portal hypertension - bleeding from the esophagus and stomach ascites hepatic encephalopathy

77. Jaypharm Korea Monohydrate ). 5. Therapeutic Indications. (1) Constipation (2) Acuteand chronic Portal systemic encephalopathy. 6. Mode of action. Lactitol http://www.jaypharm.com/en_product_sub01.html

ctri-Lactitol powder Lactitol is new Prebiotics developed by Purac, Netherlands. Lactitol is a soluble disaccharide derivative which is metabolized by the intestinal microflora producing organic acids, thus reducing the pH of the colon. Consequently, it is normalizing the physiological rhythm of the colon and effectively treats constipation. 1. Trade name ctri-Lactitol powder 2. Qualitative and Quantitative composition: Lactitol monohydrate 10g / sachet. There are no other ingredients 3. Pharmaceutical Form White, crystalline powder 4. Chemical formula ( 4-¥â D-Galactopyranosyl-D-Sorbitol Monohydrate ) 5. Therapeutic Indications (1) Constipation (2) Acute and chronic Portal systemic encephalopathy 6. Mode of action Lactitol is a disaccharide derivative consisting of galactose and sorbitol which is only minimally absorbed and is not hydrolysed by the disaccharidases of the gastrointestinal tract and thus reaches the colon unchanged. In the colon it is broken down to short chain organic acids, mainly acetic

78. Canine Portal Caval Liver Shunt Disease In conclusion the portal systemic shunt appears to be growing in frequency but allresult in central nervous system disorders called hepatic encephalopathy. http://www.shihtzu.org/health/astchlth/astcshnt/

Canine Portal Caval Shunt from "Health Research" by Vicki Cooper reprinted from the ASTC Bulletin , Nov- Dec 94. Those who engage in the dog breeding game of genetic wheel of fortune are challenged to arm themselves with information that is complex as well as mysterious. When the idiosyncrasies of breeding dogs confront me, I attack with the fervor possessed only by Jurassic Park's flesh eating dinosaurs. In this way, I attempt to convert road blocks into stepping stones. I believe that knowledge is empowering, and I am accountable to share my knowledge with my peers. This dinosaur recently dined on a strict diet of books and articles regarding canine portal systemic shunt. Therefore, contained in this study with be a brief description of normal liver function, followed by a explanation of liver shunt disease, included will be a discussion of the cause, symptoms and treatments concerning dogs with portal systemic shunts (PSS). It has been suggested that type of shunt may influence the age of onset and severity of clinical signs. "It could be speculated that prior to onset of clinical signs, the majority of portal blood passed through the liver rather than the shunt. With time there may have been an increase in intrahepatic resistance which causes a higher proportion of blood to shunt to the systemic circulation resulting in [late life] clinical signs..." (Laflamme, 1988 136). VanGundy (1988) substantiates this theory by reporting the sufficient blood flow though the portal system may maintain a degree of hepatic function for the first years of life. Perhaps a secondary mild insult [to the liver] resulted in loss of function.

79. EZILAX Chronic constipation, Hepatic encephalopathy (portal systemic encephalopathy). 5ml.10ml. 510ml. 5ml. Hepatic encephalopathy (portal systemic encephalopathy) http://www.tpmc.com.sa/ezilax.htm

EZILAX® (Lactulose) Composition: Each 15 ml of syrup contains : Lactulose 10 g added as Lactulose Concentrate USP. Properties: Lactulose is broken down by the intestinal flora into organic acid of low molecular weight. These organic acids occur normally in the colon where they promote bowel movement and ensure the formation of a soft stool.Lactulose is not absorbed significantly and has no calorific value. Ezilax initiates return to normal physiology of the colon. It may therefore take up to 48 hours before normal defaecation occurs. Ezilax can be safely taken during pregnancy and by diabetics. Ezilax does not cause habituation. Indications: Ezilax is used in the treatment of : Chronic constipation, Hepatic encephalopathy (portal systemic encephalopathy). Dosage and administration: Chronic constipation: The total daily dose is taken preferably during breakfast. The dosage for constipation can be varied according to the individual response, but the following serves as a guide. Starting Dose for 3 days Per Day Maintenance Dose Per day Adults: Severe cases Moderate Cases Mild Cases Children: 6-14years Infants Hepatic encephalopathy (portal systemic encephalopathy) : Initial dose : 30 – 50 ml (20-33 g) three times daily.

80. Hepatic Encephalopathy Hepatic encephalopathy. DESCRIPTION Altered mental and neuromotor functioning associatedwith acute or chronic liver disease and/or portal systemic shunting of http://www.5mcc.com/Assets/SUMMARY/0411.html

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