DOCSLIB.ORG

Overactive Bladder in Midlife Women

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Overactive Bladder in Midlife Women PATIENT The ® Female Patient and What You Should Know About HANDOUT Overactive Bladder in Midlife Women veractive bladder is a common and ounces per day. It is possible, however, that too little fluid embarrassing problem that affects many can cause very concentrated urine that can irritate your bladder. So be sure not to over restrict fluids. Owomen before, during, and beyond Avoid bladder irritants. Certain foods and beverages menopause. The most common symptoms are that are high in caffeine or acid (such as coffee, cola soft frequent, sudden urges to urinate, with occasional drinks, grapefruit juice, and tomatoes) can contribute to OAB by irritating the lining of the bladder. leakage. Several treatments are available. Develop pelvic floor strength. Muscle training, such as doing Kegel exercises to strengthen your pelvic muscles, What is overactive bladder? involves learning how to isolate and contract the levator Overactive bladder (OAB) is a condition in which nerves ani muscle, a broad, thin muscle on the side of your pel- send signals to the bladder at the wrong time, causing vis. Massage and stretching may also improve OAB the muscles in the bladder wall to squeeze without warn- symptoms. ing. The most common symptoms are frequent, sudden Retrain your bladder. Once a woman has learned how urges to urinate. Occasionally, women experience urine to isolate and contract her pelvic floor muscles, she can leakage. Having to go to the bathroom up to seven times contract these muscles at the first sensation of the urge a day is normal for many women, but women with OAB to urinate. This technique can suppress the feeling of may find that they need to urinate even more frequently. having to go to the bathroom. Women who do not have OAB is a common and potentially embarrassing problem OAB but feel they need to urinate frequently can also use that affects many women before, during, and beyond this process to suppress the urge and thus extend the menopause. intervals between trips to the toilet. OAB affects 16.6% of the general female population in Acupuncture. At least one study suggests that acu- the United States. It becomes more common as women puncture may improve OAB symptoms. age. The involuntary loss of urine can be unpleasant, dis- tressing, and may significantly affect a woman’s quality If these lifestyle options aren’t effective, of life. Women with OAB often attempt to cope with what other treatments can I try? symptoms on their own instead of seeking help because • Your doctor may prescribe a medicine to block the they don’t have good access to health care, feel embar- nerve signals that cause frequent urination and rassed, or are unaware that treatment is available for this urgency. Anticholinergic medications can help relax condition. Don’t be embarrassed! There are many treat- bladder muscles and prevent bladder spasms. ment options, and your doctor can help you. • Some of the medicines you may already be taking might be affecting the nerves and muscles of the uri- How will I know if I have OAB? nary tract and contribute to bladder control problems. Symptoms of OAB include: Ask your doctor if an alternative medicine is available • Urinary frequency is the bothersome need to urinate and see if it solves your urinary problem. eight or more times a day, or two or more times at night. • There are also several surgical techniques available to • Urinary urgency is the sudden, strong need to urinate treat OAB, including detrusor injection of Clostridium immediately. botulinum toxin type A (better known as Botox), nerve • Urge incontinence is defined as the leaking or gush- stimulation, and other methods. When other therapies ing of urine that follows a sudden, strong urge. fail, one of these may be an option. • Nocturia is when a woman wakes up at night to urinate. Where can I learn more? Are there nondrug and nonsurgical National Institutes of Health overview of urge inconti- strategies for managing OAB? nence/overactive bladder at www.ncbi.nlm.nih.gov Yes, your doctor may recommend some of the following /pubmedhealth/PMH0002250. lifestyle options: Basics of overactive bladder from the Mayo Clinic Restrict fluids. Women who normally drink large at www.mayoclinic.com/health/overactive-bladder amounts of liquids should limit their intake to about 64 /DS00827. 3/12 The Female Patient and The North American Menopause Society grant permission to reproduce this handout for the purposes of patient education. A downloadable version of this patient handout is also available at: www.femalepatient.com and www.menopause.org. .
Load more

Recommended publications
  • Urinary Incontinence Embarrassing but Treatable 2015 Rev
    This information provides a general overview on this topic and may not apply to Health Notes everyone. To find out if this information applies to you and to get more information on From Your Family Doctor this subject, talk to your family doctor. Urinary incontinence Embarrassing but treatable 2015 rev. What is urinary incontinence? Are there different types Urinary incontinence means that you can’t always of incontinence? control when you urinate, or pee. The amount of leakage Yes. There are five types of urinary incontinence. can be small—when you sneeze, cough, or laugh—or large, due to very strong urges to urinate that are hard to Stress incontinence is when urine leaks because of control. This can be embarrassing, but it can be treated. sudden pressure on your lower stomach muscles, such as when you cough, sneeze, laugh, rise from a Millions of adults in North America have urinary chair, lift something, or exercise. Stress incontinence incontinence. It’s most common in women over 50 years usually occurs when the pelvic muscles are weakened, of age, but it can also affect younger people, especially sometimes by childbirth, or by prostate or other pelvic women who have just given birth. surgery. Stress incontinence is common in women. Be sure to talk to your doctor if you have this problem. Urge incontinence is when the need to urinate comes on If you hide your incontinence, you risk getting rashes, too fast—before you can get to a toilet. Your body may only sores, and skin and urinary tract (bladder) infections.
    [Show full text]
  • Review of Systems
    code: GF004 REVIEW OF SYSTEMS First Name Middle Name / MI Last Name Check the box if you are currently experiencing any of the following : General Skin Respiratory Arthritis/Rheumatism Abnormal Pigmentation Any Lung Troubles Back Pain (recurrent) Boils Asthma or Wheezing Bone Fracture Brittle Nails Bronchitis Cancer Dry Skin Chronic or Frequent Cough Diabetes Eczema Difficulty Breathing Foot Pain Frequent infections Pleurisy or Pneumonia Gout Hair/Nail changes Spitting up Blood Headaches/Migraines Hives Trouble Breathing Joint Injury Itching URI (Cold) Now Memory Loss Jaundice None Muscle Weakness Psoriasis Numbness/Tingling Rash Obesity Skin Disease Osteoporosis None Rheumatic Fever Weight Gain/Loss None Cardiovascular Gastrointestinal Eyes - Ears - Nose - Throat/Mouth Awakening in the night smothering Abdominal Pain Blurring Chest Pain or Angina Appetite Changes Double Vision Congestive Heart Failure Black Stools Eye Disease or Injury Cyanosis (blue skin) Bleeding with Bowel Movements Eye Pain/Discharge Difficulty walking two blocks Blood in Vomit Glasses Edema/Swelling of Hands, Feet or Ankles Chrohn’s Disease/Colitis Glaucoma Heart Attacks Constipation Itchy Eyes Heart Murmur Cramping or pain in the Abdomen Vision changes Heart Trouble Difficulty Swallowing Ear Disease High Blood Pressure Diverticulosis Ear Infections Irregular Heartbeat Frequent Diarrhea Ears ringing Pain in legs Gallbladder Disease Hearing problems Palpitations Gas/Bloating Impaired Hearing Poor Circulation Heartburn or Indigestion Chronic Sinus Trouble Shortness
    [Show full text]
  • Overactive Bladder
    Overactive Bladder Introduction Symptoms You Might Notice “Overactive bladder” (OAB) or “unstable bladder” • A strong urge to urinate with little warning. refers to the feeling of needing to urinate much more • More frequent urination. often than is average. Since a medical name for the • Possible dribbling or loss of a large amount of urine. bladder muscle is the “detrusor,” you may also hear this • Difficulty postponing urination. This becomes a major condition called names like “detrusor overactivity” or issue for people with OAB, and can limit activities and “detrusor instability.” travel. OAB is a complex problem, but generally, the • Usually, no physical pain is associated with this bladder may contract/squeeze prematurely and hard problem, but it can be very emotionally and socially enough to make urine leak out before you can make it to disturbing. the bathroom. This type of urine loss is called “urge • Need to get up more than once at night to urinate. incontinence.” • Some people may experience an uncomfortable OAB can occur at any age. Some people are born sensation of urgency. with conditions that affect nerve and muscle signals, resulting in frequent urination, accidents, and bed Possible Causes Your Health Care Provider wetting in children. Other people may not develop OAB May Look For until they are older. The body and its muscles change • Usually no outward physical signs of OAB. with aging, making OAB quite common in older adults. • In older men, this type of bladder problem may be Additionally, certain disease processes or treatments associated with prostate enlargement. may change the bladder to be more sensitive, leading to • In older women, OAB may be related to skin, blood OAB symptoms.
    [Show full text]
  • Urinary System
    Urinary system Urinary system terms Nephr/o, Kidney Nephritis, renal artery ren/o Hydronephrosis (abnormal condition involving back Hydro/o Water up of urine into the kidney Cystitis, cystectomy (inflammation of, removal of Cyst/o Bladder bladder) Pyel/o Renal collecting ducts Pyelogram (X-ray of the collecting ducts) Polyuria, anuria (frequent urination, no urine Ur/o, -uria Urine formation) Olig/o Scanty, less than normal Oliguria (reduced urine formation) To surgically reattach, fix in Nephropexy (surgically attach kidney in normal -pexy normal position anatomical position) Urinary system diseases Nephrosis – a noninflammatory disease of kidneys. Nephrolith – a kidney stone. Urethritis – inflammation of the urethra, the final pathway for urine in both sexes, and the common pathway for urine and semen in the male. Nocturia – frequently getting up and urinating during the night. Enuresis – involuntary release of urine, most often in reference to “bedwetting.” Urinary system procedures Nephrologist – I am hoping by now, you would know this is a physician specializing in kidney diseases. Urologist – a physician specializing in the genitourinary tract, which includes kidneys, urinary bladder and urethra of both men and women and the prostate and testes in men. Cystoscopy – looking into the urinary bladder with a fiberoptic instrument. Intravenous pyelogram – special X-rays showing the drainage pattern of the kidneys. A dye opaque to X-rays is injected into a vein. After a waiting period for the blood and dye to pass through the kidneys, X-rays can be taken of the collecting system of the kidney, ureter and bladder. Retrograde pyelogram – personally, I prefer the former procedure! In this procedure a dye opaque to X-rays is flushed backwards up the urethra and bladder and up the ureters to the kidneys.
    [Show full text]
  • Frequently Asked Questions About Overactive Bladder
    ABOUT OAB Frequently Asked Questions about Overactive Bladder What is Overactive Bladder (OAB)? If you live with OAB, you may also: Overactive Bladder (OAB) isn’t a disease. It’s the u Leak urine (incontinence): Sometimes people name of a group of urinary symptoms. The most with OAB also have “urgency incontinence.” common symptom of OAB is a sudden urge to This means that urine leaks when you feel urinate that you can’t control. Some people will the sudden urge to go. This isn’t the same as leak urine when they feel this urge. Having to “stress urinary incontinence” or “SUI.” People urinate many times during the day and night is with SUI leak urine while sneezing, laughing or another symptom of OAB. doing other physical activities. (You can learn more about SUI at UrologyHealth.org/SUI.) How common is OAB? u Urinate frequently: You may also need to go OAB is common. It affects millions of Americans. to the bathroom many times during the day. As many as 30 percent of men and 40 percent The number of times someone urinates varies of women in the United States live with OAB from person to person. But many experts symptoms. agree that going to the bathroom more than eight times in 24 hours is “frequent urination.” Who is at risk for OAB? u Wake up at night to urinate: Waking from As you grow older, you’re at higher risk for sleep to go to the bathroom more than once a OAB. But no matter what your age, there are night is another symptom of OAB.
    [Show full text]
  • Gotta Gotta Go Right Now: a Comprehensive Assessment of Frequent Urination and Nocturnal Enuresis
    Gotta Go Right Now: A Comprehensive Assessment of Frequent Urination and Nocturnal Enuresis Kelly Haack, M.A., and William J. Warzak, Ph.D. Department of Psychology, Munroe-Meyer Institute at the University of Nebraska Medical Center INTRODUCTION METHOD RESULTS Participant Bartter’s Syndrome Baseline 2 Months Following BRT ¾ Bartter’s Syndrome is caused by a defect in the kidney’s ¾ The participant was a 14-year-old male with Bartter’s Syndrome. Fluid Intake and Output Fluid Intake and Output ability to reabsorb potassium. ¾ He presented with frequent daytime and nighttime voiding. 1000 1000 ¾ As a result, the kidneys remove too much potassium from ¾ Medical History: 900 900 the body. 4 years old: Renal Ultrasound showed normal kidneys and 800 800 ¾ Excessive loss of potassium leads to muscle cramping and hypokalemia (low potassium level) was ruled out. Intake weakness, constipation, increased frequency of urination, 700 700 Intake and growth failure. 11 years old: Ditropan XL 10 mg daily and Imipramine 35 mg 600 600 daily were prescribed to treat symptoms of overactive bladder, Nocturnal Enuresis 500 500 ML such as frequent urination. ML ¾ Nocturnal Enuresis is involuntary passing of urine while 12 years old: Neurological exam was normal and neurogenic 400 400 asleep. bladder was ruled out. 300 300 Output Bartter’s Syndrome Output • Continued taking Ditropan and Imipramine. 200 200 and • Prescribed DDAVP 0.6 mg each evening to increase urine 100 100 concentration and decrease urine production. Nocturnal Enuresis 0 0 ¾ Adolescents with Bartter’s Syndrome often have a problem • Started use of a urine alarm; however, it was a short trial and 3:00 6:00 7:45 9:45 1:00 2:30 4:00 5:00 6:20 8:00 9:30 1:00 2:45 5:00 7:00 9:00 2:00 4:00 5:00 7:00 9:00 1:45 4:00 7:00 4:00 7:05 9:45 2:00 4:00 5:45 7:00 9:30 2:30 5:00 7:45 2:30 4:30 7:00 9:30 1:45 5:00 12:00 11:00 11:00 10:45 12:00 10:00 12:00 concentrating urine and excrete an excessive volume of he slept through it and continued to wet 5 out of 7 nights.
    [Show full text]
  • Urinary Tract Infections
    Urinary Tract Infections www.kidney.org Did you know that... n Urinary tract infections (UTIs) are responsible for nearly 10 million doctor visits each year. n One in five women will have at least one UTI in her lifetime. Nearly 20 percent of women who have a UTI will have another, and 30 percent of those will have yet another. Of this last group, 80 percent will have recurrences. n About 80 to 90 percent of UTIs are caused by a single type of bacteria. 2 NATIONAL KIDNEY FOUNDATION n UTIs can be treated effectively with medications called antibiotics. n People who get repeated UTIs may need additional tests to check for other health problems. n UTIs also may be called cystitis or a bladder infection. This brochure answers the questions most often asked about UTIs. If you have more questions, speak to your doctor. What is a urinary tract infection? A urinary tract infection is what happens when bacteria (germs) get into the urinary tract (the bladder) and multiply. The result is redness, swelling and pain in the urinary tract (see diagram). WWW.KIDNEY.ORG 3 Most UTIs stay in the bladder, the pouch-shaped organ where urine is stored before it passes out of the body. If a UTI is not treated promptly, the bacteria can travel up to the kidneys and cause a more serious type of infection, called pyelonephritis (pronounced pie-low-nef-right- iss). Pyelonephritis is an actual infection of the kidney, where urine is produced. This may result in fever and back pain. What causes a UTI? About 80 to 90 percent of UTIs are caused by a type of bacteria, called E.
    [Show full text]
  • FDA CVM Comprehensive ADE Report Listing for Afoxolaner
    CVM ADE Comprehensive Clinical Detail Report Listing Cumulative Date Range : 04-Sep-2013 -thru- 31-Jul-2018 Included 1932a cases = : True Included Medicated Feed cases = : False DRUG: AFOXOLANER Species: Cat Route of Administration: oral Sign: VOMITING, Number of times reported: 4 Sign: HYPERACTIVITY, Number of times reported: 3 Sign: ITCHING, Number of times reported: 3 Sign: LETHARGY, Number of times reported: 3 Sign: PRURITUS, Number of times reported: 3 Sign: ACCIDENTAL EXPOSURE, Number of times reported: 2 Sign: ANOREXIA, Number of times reported: 2 Sign: LABOURED BREATHING, Number of times reported: 2 Sign: NOT EATING, Number of times reported: 2 Sign: PANTING, Number of times reported: 2 Sign: SEIZURE NOS, Number of times reported: 2 Sign: ABNORMAL TEST RESULT, Number of times reported: 1 Sign: AGITATION, Number of times reported: 1 Sign: ALOPECIA, Number of times reported: 1 Sign: ANAEMIA NOS, Number of times reported: 1 Sign: ATAXIA, Number of times reported: 1 Sign: CERVICAL VENTROFLEXION, Number of times reported: 1 Sign: CONSTIPATION, Number of times reported: 1 Sign: DECREASED CHOLESTEROL (TOTAL), Number of times reported: 1 Sign: ELEVATED ALT, Number of times reported: 1 Sign: ELEVATED AST, Number of times reported: 1 Sign: ELEVATED BUN, Number of times reported: 1 Sign: ELEVATED CREATINE-KINASE (CK), Number of times reported: 1 Sign: ELEVATED CREATININE, Number of times reported: 1 Sign: ELEVATED TOTAL BILIRUBIN, Number of times reported: 1 Sign: EXCESSIVE LICKING AND/OR GROOMING, Number of times reported: 1 Sign: FEVER,
    [Show full text]
  • TYPE 1 DIABETES Symptoms
    TYPE 1 DIABETES Title: Endocrinology Source: Mayo Clinic Link: http://www.mayoclinic.com/health/type-1-diabetes/DS00329 Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin, a hormone needed to allow sugar (glucose) to enter cells to produce energy. Type 2 diabetes, which is far more common, occurs when the body becomes resistant to the effects of insulin or doesn't make enough insulin. Various factors may contribute to type 1 diabetes, including genetics and exposure to certain viruses. Although type 1 diabetes typically appears during adolescence, it can develop at any age. Despite active research, type 1 diabetes has no cure, although it can be managed. With proper treatment, people who have type 1 diabetes can expect to live longer, healthier lives than in the past. Symptoms By Mayo Clinic staff Type 1 diabetes signs and symptoms can come on quickly and may include: • Increased thirst and frequent urination. As excess sugar builds up in your bloodstream, fluid is pulled from your tissues. This may leave you thirsty. As a result, you may drink — and urinate — more than usual. • Extreme hunger. Without enough insulin to move sugar into your cells, your muscles and organs become depleted of energy. This triggers intense hunger that may persist even after you eat. Without insulin, the sugar in your food never reaches your energy-starved tissues. • Weight loss. Despite eating more than usual to relieve hunger, you may lose weight — sometimes rapidly. Without the energy sugar supplies, your muscle tissues and fat stores may simply shrink.
    [Show full text]
  • Urinary System Diseases and Disorders
    URINARY SYSTEM DISEASES AND DISORDERS BERRYHILL & CASHION HS1 2017-2018 - CYSTITIS INFLAMMATION OF THE BLADDER CAUSE=PATHOGENS ENTERING THE URINARY MEATUS CYSTITIS • MORE COMMON IN FEMALES DUE TO SHORT URETHRA • SYMPTOMS=FREQUENT URINATION, HEMATURIA, LOWER BACK PAIN, BLADDER SPASM, FEVER • TREATMENT=ANTIBIOTICS, INCREASE FLUID INTAKE GLOMERULONEPHRITIS • AKA NEPHRITIS • INFLAMMATION OF THE GLOMERULUS • CAN BE ACUTE OR CHRONIC ACUTE GLOMERULONEPHRITIS • USUALLY FOLLOWS A STREPTOCOCCAL INFECTION LIKE STREP THROAT, SCARLET FEVER, RHEUMATIC FEVER • SYMPTOMS=CHILLS, FEVER, FATIGUE, EDEMA, OLIGURIA, HEMATURIA, ALBUMINURIA ACUTE GLOMERULONEPHRITIS • TREATMENT=REST, SALT RESTRICTION, MAINTAIN FLUID & ELECTROLYTE BALANCE, ANTIPYRETICS, DIURETICS, ANTIBIOTICS • WITH TREATMENT, KIDNEY FUNCTION IS USUALLY RESTORED, & PROGNOSIS IS GOOD CHRONIC GLOMERULONEPHRITIS • REPEATED CASES OF ACUTE NEPHRITIS CAN CAUSE CHRONIC NEPHRITIS • PROGRESSIVE, CAUSES SCARRING & SCLEROSING OF GLOMERULI • EARLY SYMPTOMS=HEMATURIA, ALBUMINURIA, HTN • WITH DISEASE PROGRESSION MORE GLOMERULI ARE DESTROYED CHRONIC GLOMERULONEPHRITIS • LATER SYMPTOMS=EDEMA, FATIGUE, ANEMIA, HTN, ANOREXIA, WEIGHT LOSS, CHF, PYURIA, RENAL FAILURE, DEATH • TREATMENT=LOW NA DIET, ANTIHYPERTENSIVE MEDS, MAINTAIN FLUIDS & ELECTROLYTES, HEMODIALYSIS, KIDNEY TRANSPLANT WHEN BOTH KIDNEYS ARE SEVERELY DAMAGED PYELONEPHRITIS • INFLAMMATION OF THE KIDNEY & RENAL PELVIS • CAUSE=PYOGENIC (PUS-FORMING) BACTERIA • SYMPTOMS=CHILLS, FEVER, BACK PAIN, FATIGUE, DYSURIA, HEMATURIA, PYURIA • TREATMENT=ANTIBIOTICS,
    [Show full text]
  • EMA Medical Terms Simplifier
    EMA medical terms simplifier Plain-language description of medical terms related to medicines use polyuria petechiae tophi trismus idiopathic immunoglobulins acute antagonist An agency of the European Union 19 March 2021 EMA/158473/2021 EMA Medical Terms Simplifier Plain-language description of medical terms related to medicines use This compilation gives plain-language descriptions of medical terms commonly used in information about medicines. Communication specialists at EMA use these descriptions for materials prepared for the public. In our documents, we often adjust the description wordings to fit the context so that the writing flows smoothly without distorting the meaning. Since the main purpose of these descriptions is to serve our own writing needs, some also include alternative or optional wording to use as needed; we use ‘<>’ for this purpose. Our list concentrates on side effects and similar terms in summaries of product characteristics and public assessments of medicines but omits terms that are used only rarely. It does not include descriptions of most disease states or those that relate to specialties such as regulation, statistics and complementary medicine or, indeed, broader fields of medicine such as anatomy, microbiology, pathology and physiology. This resource is continually reviewed and updated internally, and we will publish updates periodically. If you have comments or suggestions, you may contact us by filling in this form. EMA Medical Terms Simplifier EMA/158473/2021 Page 1/76 A│B│C│D│E│F│G│H│I│J│K│L│M│N│O│P│Q│R│S│T│U│V│W│X│Y│Z
    [Show full text]
  • Overactive Bladder During Childhood: When and How It Should Be Treated
    Incont Pelvic Floor Dysfunct 2010; 4(1):13-17 Review Overactive Bladder during Childhood: When and How It Should Be Treated Yi-Sheng Chen, M.D.1, Stephen Shei-Dei Yang, M.D.2, Shang-Jen Chang, M.D.2 Department of Urology1, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan; Division of Urology2, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan and School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan fkqolar`qflk ê~íÉ=çÑ=ÉåìêÉëáë=ÇÉÅêÉ~ëÉÇ=ïáíÜ=~ÖÉI=áí=åÉîÉê=êÉ~ÅÜÉÇ=MBK=qÜÉ=êÉëìäíë çÑ=íÜÉ=ëíìÇó=Äó=h~êàáï~ê~=Éí=~ä=~äëç=ëÜçïÉÇ=íÜÉ=ë~ãÉ=íêÉåÇ=xVzK=få=íÜÉ m~íáÉåíë=ïáíÜ=çîÉê~ÅíáîÉ=Ää~ÇÇÉê=El^_F=ïÉêÉ=~ëëìãÉÇ=íç=Ü~îÉ é~íáÉåíë=ïáíÜ=Ç~óíáãÉ=ìêáå~êó=áåÅçåíáåÉåÅÉI=ìêÖÉåÅó=~äçåÉ=ï~ë=íÜÉ=ãçëí ÇÉíêìëçê=çîÉê~ÅíáîáíóI=ìêÖÉ=ëóåÇêçãÉI=ÜóéÉê~ÅíáîÉ=Ää~ÇÇÉêI=éÉêëáëíÉåí Åçããçå=ÅÜ~ê~ÅíÉêáëíáÅ=áå=ÄçíÜ=ëÉñÉëK áåÑ~åíáäÉ=Ää~ÇÇÉêI=~åÇ=ÇÉíêìëçê=ÜóéÉêíçåá~K=`ÜáäÇêÉå=ïáíÜ=l^_=ã~ó éêÉëÉåí=ïáíÜ=ëóãéíçãë=çÑ=Ç~óíáãÉ=ÑêÉèìÉåí=ìêáå~íáçåI=ìêÖÉåÅóI=áåÅçåJ m^qelmevpflildv íáåÉåÅÉ=~åÇ=åáÖÜííáãÉ=ÉåìêÉëáëK=qÜÉ=ÇÉÑáåáíáçå=çÑ=éÉÇá~íêáÅ=l^_=Äó=íÜÉ fåíÉêå~íáçå~ä=`ÜáäÇêÉåDë=`çåíáåÉåÅÉ=pçÅáÉíó=Ef``pF=áë=áå=~ÅÅçêÇ~åÅÉ=íç qÜÉ=é~íÜçéÜóëáçäçÖó=çÑ=l^_=áë=åçí=ïÉää=ìåÇÉêëíççÇK=qê~Çáíáçå~ääóI íÜÉ=ÅçåëÉåëìë=çÑ=íÜÉ=fåíÉêå~íáçå~ä=`çåíáåÉåÅÉ=pçÅáÉíó=Ef`pF=xNzK=qÜÉ l^_=áë=íÜçìÖÜí=íç=ÄÉ=íÜÉ=êÉëìäí=çÑ=ã~íìê~íáçå=ÇÉä~óK=oÉÅÉåíäóI=êÉëÉ~êÅÜJ ÅçêÉ=ëóãéíçã=çÑ=l^_=áå=ÅÜáäÇêÉå=áë=ìêÖÉåÅó=xNzK=fí=ã~ó=çÅÅìê=ïáíÜ Éêë=Ü~îÉ=ëÜçïå=íÜ~í=l^_=ã~ó=Ü~îÉ=~å=~ëëçÅá~íáçå=ïáíÜ=ëÉñì~ä=ÇóëJ ëóãéíçãë=çÑ=ìêÖÉ=áåÅçåíáåÉåÅÉI=ÑêÉèìÉåí=ìêáå~íáçå=~åÇ=åçÅíìêå~ä ÑìåÅíáçå=xNMJNOzK=^äëçI=íÜÉ=êÉëÉ~êÅÜÉêë=~äëç=ëìÖÖÉëíÉÇ=íÜ~í=l^_=ã~ó
    [Show full text]