DOCSLIB.ORG

Superficial Bcc Granuloma Annulare Ring Finger Eczema Eczema

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Superficial Bcc Granuloma Annulare Ring Finger Eczema Eczema Dermatology Pearls 2019 Charles E. Crutchfield III, MD Clinical Professor of Dermatology University of Minnesota Medical School Thank You I am sorry n Family n Patients/Funny Clinical Stories Camp Discovery Case of the Month [email protected] Goal: Take Home 3 Pearls to Use in your Practice Starting Next Week! Informal and Relaxed Fun Success Stories with Practice Management Pearls Patient Management Pearls Proper Framing Like a pilot flying from NY to LA Don’t Let Perfection be the Enemy of Very Good The treatment could make a scar that will make it look worse! For better patient compliance and overall success, don’t forget to congratulate your patiens on a job well done! Need a Diagnosis and Plan Eclipse with the Family Tinea Capitis Pearls Tinea Capitis Tinea Capitis 8 Week Therapy Under 20kg ¼ tablet 20-40 kg ½ tablet 40+ kg full tablet Warn about potential kerion For the entire family for 2 months 5 day quarantine Acne Treatment Pearls Proper Framing Pile of Medicines for Acne Acne Scarring Saline Injections TheraClear I don’t need a radio Atopic Eczema Pearls Atopic Eczema Atopic Eczema is Asthma of the Skin Acknowledge Atopic Eczema is a Family Condition Dupilumab Il-4, Il-13 Corticosteroids Phototherapy Calcineurin inhibitors PDE4 Inhibitors PDE4 inhibitors are promising new agents in the treatment of inflammatory skin diseases including eczema and atopic eczema. The precise mechanism is still being elucidated. PDE4 inhibitors affect cellular cAMP levels which, in turn, reduces the inflammatory response. Their human cutaneous anti- inflammatory effects are not quite as strong as corticosteroids, but they do work. Their effectiveness seems to be about the same strength as the calcineurin inhibitors. I use them to control mild to moderate eczema, and to maintain improvement in moderate to severe cases of eczema after initially calming down with topical or systemic corticosteroids. Because pharmaceutical preparations of PDE4 inhibitors relatively new, there is always a concern about their cost, availability, and insurance coverage. Side effects tend to be few if any. They definitely have a place in the toolbox of eczema treatments. Steroid Pulse Therapy Bleach Bath Pearl Don’t forger bed linens! Don’t forget PJs! Siri, is Santa Real?? Anesthesia Pearls Zimmer Chiller ProNox Has anyone seen my shoes? Rosacea Pearl Rosacea Pearl !!! Mix 1 bottle of Afrin($6) with 1 bottle of CeraVe pm ($12). Shake. Put on in the morning. Works great for rosacea patients and way cheaper than Mirvaso ($500). Can be layered with Metro Cream! Melasma Treatment Pearls Skin of Color MetorDoctors, Spring 2019 Melanocytes and Melanin Platelet Rich Plasma Pearls Platelet Rich Plasma Hair Loss Pearls NutraFol Actinic Damage Pearls Neutrogena Hydroboost Sunscreen 2 week Combination Treatment for AK’s ISDIN Corrective Sunscreen Itching Pearls Vitiligo Pearls Narrow Band UVB Xeljanz Botox Pearls Additional Uses Hyperhidrosis Migraine Headaches TMJ Facial Slimming Mom………… Practice Management Pearls Get Dr. Johnson’s Doorbell Online Reviews Manage Your Online Reputation Dr. Sheridan and Doctors.com Check on your access What did you go to medical school for? Recognize your staff Get an Office Concierge Can You help me get my skin ready for my wedding? Anything Questions or other Challenging Cases? Emergency Appointments Telephone ‘Curb Side’ Consults 651.209.3617 Sleep on it... Case of the Month [email protected] for anything you may need Thank You.
Load more

Recommended publications
  • Interstitial Granuloma Annulare Triggered by Lyme Disease
    Volume 27 Number 5| May 2021 Dermatology Online Journal || Case Presentation 27(5):11 Interstitial granuloma annulare triggered by Lyme disease Jordan Hyde1 MD, Jose A Plaza1,2 MD, Jessica Kaffenberger1 MD Affiliations: 1Division of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA, 2Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA Corresponding Author: Jessica Kaffenberger MD, Division of Dermatology, The Ohio State University Medical Wexner Medical Center, Suite 240, 540 Officenter Place, Columbus, OH 43230, Tel: 614-293-1707, Email: [email protected] been associated with a variety of systemic diseases Abstract including diabetes mellitus, malignancy, thyroid Granuloma annulare is a non-infectious disease, dyslipidemia, and infection [3,4]. granulomatous skin condition with multiple different associations. We present a case of a man in his 60s There are multiple histological variants of GA, with a three-week history of progressive targetoid including interstitial GA. The histopathology of plaques on his arms, legs, and trunk. Skin biopsy classic GA demonstrates a focal degeneration of demonstrated interstitial granuloma annulare. collagen surrounded by an inflammatory infiltrate Additional testing revealed IgM antibodies to Borrelia composed of lymphocytes and histiocytes. In a less burgdorferi on western blot suggesting interstitial common variant, interstitial GA, scattered histiocytes granuloma annulare was precipitated by the recent are seen
    [Show full text]
  • Granulomatous Dermatitis As a Postherpetic Isotopic Response in Immunocompromised Patients: a Report of 5 Cases William H
    Washington University School of Medicine Digital Commons@Becker Open Access Publications 2018 Granulomatous dermatitis as a postherpetic isotopic response in immunocompromised patients: A report of 5 cases William H. McCoy Washington University School of Medicine in St. Louis Elaine Otchere Washington University School of Medicine in St. Louis Amy C. Musiek Washington University School of Medicine in St. Louis Milan J. Anadkat Washington University School of Medicine in St. Louis Follow this and additional works at: https://digitalcommons.wustl.edu/open_access_pubs Recommended Citation McCoy, William H.; Otchere, Elaine; Musiek, Amy C.; and Anadkat, Milan J., ,"Granulomatous dermatitis as a postherpetic isotopic response in immunocompromised patients: A report of 5 cases." JAAD Case Reports.4,8. 752-760. (2018). https://digitalcommons.wustl.edu/open_access_pubs/7169 This Open Access Publication is brought to you for free and open access by Digital Commons@Becker. It has been accepted for inclusion in Open Access Publications by an authorized administrator of Digital Commons@Becker. For more information, please contact [email protected]. CASE SERIES Granulomatous dermatitis as a postherpetic isotopic response in immunocompromised patients: A report of 5 cases William H. McCoy 4th, MD, PhD,a,b,c Elaine Otchere, BS,a Amy C. Musiek, MD,a,b,c and MilanJ.Anadkat,MDa,b,c Saint Louis, Missouri Key words: Chronic lymphocytic leukemia; granuloma annulare; granulomatous dermatitis; immunocom- promised district; immunodeficiency; immunocompromise; immunosuppression; isotopic response; locus minoris resistentiae; postherpetic isotopic response; Wolf’s isotopic response. INTRODUCTION Abbreviations used: Granulomatous dermatitis (GD) describes disor- ders in which mixed inflammatory infiltrates AML: acute myelogenous leukemia CLL: chronic lymphocytic leukemia composed primarily of histiocytes invade the skin.
    [Show full text]
  • Treatment Or Removal of Benign Skin Lesions
    Treatment or Removal of Benign Skin Lesions Date of Origin: 10/26/2016 Last Review Date: 03/24/2021 Effective Date: 04/01/2021 Dates Reviewed: 10/2016, 10/2017, 10/2018, 04/2019, 10/2019, 01/2020, 03/2020, 03/2021 Developed By: Medical Necessity Criteria Committee I. Description Individuals may acquire a multitude of benign skin lesions over the course of a lifetime. Most benign skin lesions are diagnosed on the basis of clinical appearance and history. If the diagnosis of a lesion is uncertain, or if a lesion has exhibited unexpected changes in appearance or symptoms, a diagnostic procedure (eg, biopsy, excision) is indicated to confirm the diagnosis. The treatment of benign skin lesions consists of destruction or removal by any of a wide variety of techniques. The removal of a skin lesion can range from a simple biopsy, scraping or shaving of the lesion, to a radical excision that may heal on its own, be closed with sutures (stitches) or require reconstructive techniques involving skin grafts or flaps. Laser, cautery or liquid nitrogen may also be used to remove benign skin lesions. When it is uncertain as to whether or not a lesion is cancerous, excision and laboratory (microscopic) examination is usually necessary. II. Criteria: CWQI HCS-0184A Note: **If request is for treatment or removal of warts, medical necessity review is not required** A. Moda Health will cover the treatment and removal of 1 or more of the following benign skin lesions: a. Treatment or removal of actinic keratosis (pre-malignant skin lesions due to sun exposure) is considered medically necessary with 1 or more of the following procedures: i.
    [Show full text]
  • A New Case of Granuloma Annulare
    SOCIETY INTELLIGENCE. 307 the first week of life, but that these had cleared off, and that the child had been free until five months ago. The health of the child was and had always been quite good, but recently it had suffered from broken sleep caused by the irritation of the present eruption. The whole of the body and limbs were covered with a very poly- morphous eruption, and on the face there were a few impetiginous scabs. The buttocks showed the typical thumb-nail-sized red papules of Lichen urticatus, and on the thighs and forearms, especially on the extensor surfaces, were the small hard lichenoid papules which are generally seen as the involution-form of this disease. In addition to these lesions, however, were numerous scratch marks whizh, when first seen, showed a tendency to rise into bulls. There were also large blood-stained hulls on the knees and elbows, and the mark of a recent one on the dorsnm of the right foot. There was no factitious urticaria, and the exhibitors had not found any factitious bullous production, though the case had not been watched rmfficiently long for them to be certain on this point. Dr. WHITFIELDsaid that he thought that everyone present would agree with the diagnosis of Lichen urticatus, but the question arose whether there was something else behind it. Epidermolysis bullosa had occurred to him, but although unable to exclude it he thought the history of seven months’ complete freedom from skin-trouble was against it. Dr. COLCOTTFox said that in his opinion the Lichen urticatus was undoubted, and that he would not like to state without watching the case whether this was accompanied by Epidermolysis bullosa or not.
    [Show full text]
  • Lupus Mimickers
    Lupus Mimickers Arup Kumar Kundu, Somak Kumar Das INTRODUCTION Systemic lupus erythematosus is considered as “the great mimic of other conditions”. Conversely there are many diseases which can mimic SLE as a systemic disease or as dermatological, rheumatological, vasculitic, or immunological mimickers. This monograph is restricted to the lupus mimickers only, not the discussion on SLE. DERMATOLOGICAL MIMICKERS OF S.L.E. 1,2 I. Dermatological conditions mimicking acute cutaneous lupus erythematosus (LE) Rosacea: Rosacea is characterized by erythema of the central face that has persisted for months or more. The convex areas of the nose, cheeks, chin, and forehead are the characteristic distribution [Fig. 1]. Triggers of rosacea may include hot or cold temperature, sunlight (hence, photosensitive), wind, hot drinks, spicy foods, exercise, emotions, alcohol, cosmetics, topical irritants, menopausal flushing, medications etc. Erythematotelangiectatic subtype and papulopustular subtype may mimic acute cutaneous LE. The malar erythema of lupus erythematosus [Fig. 2] can be difficult to differentiate from rosacea3. The presence of pustules and papules or blepharitis favors a diagnosis Fig.1: Acne Rosacea of rosacea, while fine scaling, pigment change, follicular plugging and scarring favor a diagnosis of lupus. In occasional photodistribution. patients, histologic examination of involved skin may be Chloasma / Melasma: It is combined epidermal and dermal necessary for distinction. hyperpigmentation of forehead, cheeks, and perioral area. It Seborrheic dermatitis: Seborrheic dermatitis of the face is a common problem, almost exclusively limited to women; may closely mimic both early rosacea and the butterfly extremely prevalent in Latin America, among patients with lesions of systemic lupus erythematosus2. In contrast to mixed Indian/Spanish background.
    [Show full text]
  • Necrobiosis Lipoidica with Superimposed Pyoderma Vegetans
    CASE REPORT Necrobiosis Lipoidica With Superimposed Pyoderma Vegetans Carl J. Barrick, DO; Omobola Onikoyi, DO; Nektarios I. Lountzis, MD; Tanya Ermolovich, DO; Stephen M. Purcell, DO foul odor was noted in the area underlying the lesion. PRACTICE POINTS Initial punch biopsy demonstrated epidermal hyperplasia • Necrobiosis lipoidica (NL), a chronic granulomatous with neutrophil-rich sinus tracts consistent with pyoderma disease characterized by collagen degeneration, vegetans (PV)(Figure 2A). Tissue culture was positive for granulomatous formation, and endothelial-wall thick- Staphylococcus aureus and Streptococcus anginosus. Cultures ening, is most often seen in association with insulin- for both fungi and acid-fast bacilli were negative for growth. dependent diabetes mellitus (DM). The patient was treated with mupirocin ointment 2% • Asymptomatic, well-circumscribed, violaceous pap- and 3 months of cephalexin 250 mg twice daily, which ules and nodules coalesce into plaques on the lower cleared the purulent crust; however, serous drainage, extremities, face, or trunk in NL. ulceration, and erythemacopy persisted. The patient needed an • Treatment mainstay is topical and intralesional extended course of antibiotics, which had not been previ- corticosteroids at active borders of lesions. Other ously administered to clear the purulence. During this treat- treatments used with some success include tumor ment regimen, the patient’s DM remained uncontrolled. necrosis factor α inhibitors, topical tretinoin, topical tacrolimus, and skin grafting. Control and manage- notA second deeper punch biopsy revealed a layered gran- ment of DM can be helpful. ulomatous infiltrate with sclerosis throughout the dermis most consistent with necrobiosis lipoidica (NL)(Figure 2B). Direct immunofluorescence biopsy was negative. Once the Necrobiosis lipoidica (NL) is a granulomatous inflammatory skin PV was clear, betamethasone dipropionate ointment 0.05% disease strongly associated with diabetes mellitus (DM).
    [Show full text]
  • Paradoxical Reactions Under TNF-Α Blocking Agents and Other Biological Agents Given for Chronic Immune- Mediated Diseases: an Analytical and Comprehensive Overview
    Treatments RMD Open: first published as 10.1136/rmdopen-2015-000239 on 15 July 2016. Downloaded from REVIEW Paradoxical reactions under TNF-α blocking agents and other biological agents given for chronic immune- mediated diseases: an analytical and comprehensive overview Éric Toussirot,1,2,3,4 François Aubin5,6 To cite: Toussirot É, Aubin F. ABSTRACT Key messages Paradoxical reactions under Paradoxical adverse events (PAEs) have been reported α TNF- blocking agents and during biological treatment for chronic immune- other biological agents given What is already known about this subject? mediated diseases. PAEs are defined as the occurrence for chronic immune-mediated Different paradoxical adverse events have been diseases: an analytical and during biological agent therapy of a pathological described under biological agents, mainly tumour comprehensive overview. condition that usually responds to this class of drug. necrosis factor α inhibitors. RMD Open 2016;2:e000239. A wide range of PAEs have been reported including doi:10.1136/rmdopen-2015- dermatological, intestinal and ophthalmic conditions, What does this study add? 000239 mainly with antitumour necrosis factor α (TNF-α) A wide range of paradoxical adverse events have agents. True PAEs include psoriasis, Crohn’s disease been reported including dermatological, intestinal ▸ Prepublication history for and hidradenitis suppurativa. Other PAEs may be and ophthalmic conditions, but their relationship this paper is available online. qualified as borderline and include uveitis, scleritis, with the biological agent exposition remains still To view these files please sarcoidosis and other granulomatous diseases debated. visit the journal online (granuloma annulare, interstitial granulomatous (http://dx.doi.org/10.1136/ dermatitis), vasculitis, vitiligo and alopecia areata.
    [Show full text]
  • Orphanet Journal of Rare Diseases Biomed Central
    Orphanet Journal of Rare Diseases BioMed Central Review Open Access Sweet's syndrome – a comprehensive review of an acute febrile neutrophilic dermatosis Philip R Cohen*1,2 Address: 1University of Houston Health Center, Houston, Texas, USA and 2The Department of Dermatology, University of Texas-Houston Medical School, Houston, Texas, USA Email: Philip R Cohen* - [email protected] * Corresponding author Published: 26 July 2007 Received: 5 July 2007 Accepted: 26 July 2007 Orphanet Journal of Rare Diseases 2007, 2:34 doi:10.1186/1750-1172-2-34 This article is available from: http://www.OJRD.com/content/2/1/34 © 2007 Cohen; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Sweet's syndrome (the eponym for acute febrile neutrophilic dermatosis) is characterized by a constellation of clinical symptoms, physical features, and pathologic findings which include fever, neutrophilia, tender erythematous skin lesions (papules, nodules, and plaques), and a diffuse infiltrate consisting predominantly of mature neutrophils that are typically located in the upper dermis. Several hundreds cases of Sweet's syndrome have been published. Sweet's syndrome presents in three clinical settings: classical (or idiopathic), malignancy-associated, and drug-induced. Classical Sweet's syndrome (CSS) usually presents in women between the age of 30 to 50 years, it is often preceded by an upper respiratory tract infection and may be associated with inflammatory bowel disease and pregnancy.
    [Show full text]
  • Clinical Differential Diagnosis of Cutaneous Lupus Erythematosus 149 It Is Less Inflamed, However, and Its Surface Is Velvety and Occasionally Hyperkeratotic
    CHAPTER 11 Clinical Differential Diagnosis 11 of Cutaneous Lupus Erythematosus Florian Weber, Peter Fritsch The cutaneous manifestations of lupus erythematosus (LE) are notoriously diverse and may mimic a broad range of unrelated skin disorders, although many of its skin symptoms are straightforward and pose few diagnostic problems. Clinical differen- tial diagnosis has a place in directing the dermatologist toward the correct diagnosis in the primary screening process. This chapter summarizes the diagnostic consider- ations at this point, before additional diagnostic procedures are carried out. Of course, a definite diagnosis of LE must be based on the whole of the clinical appear- ance, history, and the histopathologic, immunofluorescent, laboratory, and, occasion- ally, phototesting findings (see the respective sections of this book). Obviously, no reference to these investigational procedures are made in this chapter. The main building blocks that make up the cutaneous lesions of LE are the classic triad of erythema, scaling, and atrophy. The relative weight of these elements, how- ever, is subject to variation according to the type of LE (chronic cutaneous, subacute cutaneous, and systemic), the age and location of the lesions, and the presence of additional morphologic features (e. g., hypertrophy, adipose tissue involvement, and mucopolysaccharide accumulation). Erythema, epidermal thickening and scaling, and atrophy and scarring represent a clinical and dynamic continuum along which all lesions of cutaneous LE (CLE) develop; only the chronic discoid type, however, may go all the way, whereas the other types hold in earlier stages. For this reason, there is a considerable morphological overlap between all types of CLE, and many differential diagnostic considerations pertain to more than one or all types of LE, as will be seen below.
    [Show full text]
  • The Oligosaccharidic Component of the Glycoconjugates in Lichen
    Histol Histopathol (l 999) 14: 697-704 Histology and http://www.ehu.es/histol-histopathol Histopathology The oligosaccharidic component of the glycoconjugates in lichen planus, granuloma annulare, seborrheic keratosis and palmoplantar keratoderma: lectin histochemical study G. Gheril, G. Russo2, P. Cappugi2, E. Sgambatil and S. Gheri Brykl 'Department of Human Anatomy and Histology and 21nstitute of Clinical Dermatology, University of Florence, Florence, Italy Summary. It is well known that cell surface glyco- Introduction conjugates play an important role in cell proliferation, adhesion and differentiation. The aim of this The oligosaccharidic component of the glyco- investigation was to define the changes of the glyco- conjugates in lichen planus and seborrheic keratosis has conjugate saccharidic moieties in the epidermis and been the subject of study by various authors (Prime et derma of patients affected by several skin pathologies al., 1985; Toto and Nadimi. 1987; Gao et al., 1992). The such as seborrheic keratosis, lichen planus, granuloma results reported in the literature, however, are not always annulare and palmoplantaris keratoderma. in agreement. Bioptical specimens from skin lesions as well as Other dermatological pathologies such as palmo- from normal skin were fixed in Carnoy's fluid and plantar keratoderma and granuloma annulare, to our routinely processed. The sections were treated with knowledge, have never been studied regarding the HRP-lectins (PNA, DBA, SBA, WGA, ConA, LTA and distribution of the sugar residues, especially those UEAI). Cytochemical controls were performed for present at the cell surface, which play an important role specificity of lectin-sugar reaction. Some sections were in cell recognition and in cell-to-cell adhesion for pre-treated with neuraminidase prior to staining with determination and maintenance of normal epithelium I-IRP lectins.
    [Show full text]
  • Computer Diagnosis of Skin Disease
    COMPUTERS IN FAMILY PRACTICE Computer Diagnosis of Skin Disease Brian Potter, MD, and Salve G. Ronan, MD Michigan City, Indiana, and Chicago, Illinois A transferable computer program for the differential diagnosis of diseases of the skin, CLINDERM, has been produced for use by physicians on standard IBM and compat­ ible personal microcomputers. This program lists the differential diagnosis and defini­ tive diagnosis of any presented disease of the skin, except single tumors. The physi­ cian operator indicates the distribution and detailed description of lesions, which the interactive system integrates with a comprehensive knowledge base. The computer diagnosis in 129 cases was compared with independent interpreta­ tion of the same information by an academic dermatologist. Results were synony­ mous in 66.7% of all diseases and similar in an additional 4.7%. A common differen­ tial diagnosis was obtained in 24%, for a 95.3% rate of synonymous, similar, or common differential diagnoses. Diagnosis was different in 3.9% and description was inadequate for diagnosis in 0.8%. The variation in diagnosis showed that some descriptive terms are prejudicial of certain diagnoses; that diagnostic terms are not all completely standardized; that some diagnoses are variants of another disease; and that drug-induced eruptions simulate many other diseases. A skin disease can usually be diagnosed by specific description. Most lesions that are not diagnostic from inspection are nodular. A computer can be programmed to list diagnoses according to morphologic description J Fam Pract 1990; 30:201-210. functional, transferable computer software system examination may, however, be excessively complex. Ob­ Afor the differential diagnosis of diseases of the skin, jectivity is improved by recording specific features ac­ called CLINDERM,* has been produced for use by phy­ cording to sets of standardized criteria.
    [Show full text]
  • Prevalence and Risk of Appearence of Skin Lesions Considered to Be Cutaneous Markers of Diabetes in a Population Group in Bihor County
    © 2012 ILEX PUBLISHING HOUSE, Bucharest, Roumania http://www.jrdiabet.ro Rom J Diabetes Nutr Metab Dis. 19(3):285-290 doi: 10.2478/v10255-012-0034-0 PREVALENCE AND RISK OF APPEARENCE OF SKIN LESIONS CONSIDERED TO BE CUTANEOUS MARKERS OF DIABETES IN A POPULATION GROUP IN BIHOR COUNTY Denisa Kovacs , Luiza Demian, Aurel Babeş University of Oradea, Romania received: July 03, 2012 accepted: September 02, 2012 available online: September 30, 2012 Abstract Objectives: The aim of the study was to calculate the prevalence rates and risk of appearance of cutaneous lesions in diabetic patients with both type-1 and type-2 diabetes. Material and Method: 384 patients were analysed, of which 47 had type-1 diabetes (T1DM), 140 had type-2 diabetes (T2DM) and 197 were non-diabetic controls. Results: The prevalence of the skin lesions considered markers of diabetes was 57.75% in diabetics, in comparison to 8.12% in non-diabetics (p<0.01). The risk of skin lesion appearance is over 7 times higher in diabetic patients than in non- diabetics. In type-1 diabetes the prevalence of skin lesions was significantly higher than in type-2 diabetes, and the risk of skin lesion appearance is almost 1.5 times higher in type-1 diabetes than type-2 diabetes compared to non-diabetic controls. Conclusions: The diabetic patients are more susceptible than non-diabetics to develop specific skin diseases. Patients with type-1 diabetes are more affected. key words: cutaneous markers, diabetes, prevalence human body, the skin. As a matter of fact, in Introduction 1935 (pre-antibiotic era), Joslin noted that Diabetes is an extremely important 31% of diabetics presented with skin disease pathological state, particularly regarding it’s symptoms in relation with diabetes [2].
    [Show full text]