Treatment is traditionally surgical removal of the ovary or adnexum, however, there is increasing evidence for conservative surgery, such as de‐torsion and oophoropexy, particularly in younger women. Results: Adnexal torsion during pregnancy is a rare condition. Oophorectomy is commonly performed for adnexal torsion with a possible negative impact on fertility in women of reproductive age. Retrospective case-control study (Canadian Task Force classification II-3). Morice P, Louis-Sylvestre C, Chapron C, Dubuisson JB. The most common symptom and sign were pelvic pain (95%) and an adnexal or pelvic mass (95%), followed by nausea and vomiting (65%), elevated white blood cell count >12×10(9)/L (45%), and fever (10%). Laparoscopy for adnexal torsion in pregnant women. 2011 Dec;50(4):409-10. doi: 10.1016/j.tjog.2011.10.002. When the patient is pregnant this can also lead to fetal mortality and potential loss of fertility for the patient. Because success rates after IVM are correlated to the number of antral follicles, IVM has typically been offered to patients with polycystic ovary syndrome (PCOS) (Guzman et al., 2013). | [3] It is mostly associated with ovarian stimulation for in vitro fertilization (IVF) or with ovarian masses, mainly of functional origin. 2003 Oct;32(6):535-40. Would you like email updates of new search results? Copyright © 2012 AAGL. Figure 1 (A) Power Doppler on presentation of patient to the emergency department shows no vascular flow to left ovary. Fertil Steril. Ovarian cyst torsion in reproductive age group-changing trends in management 4. The presentation of ovarian torsion can mimic many other intraabdominal pathologic conditions. Ovarian torsion, a major complication of OHSS, is estimated to occur in 12-25% of pregnant women. She also presented with one of the most recognized risk factors for ovarian torsion: ovarian hyperstimulation syndrome with consequent cystic increase in ovarian volume (being the other main risk factors for ovarian torsion the hypermobility of the ovary, the presence of adnexal masses and pregnancy ). It often forms during or after ovulation. doi: 10.1016/j.ajog.2009.11.028. Tissue preservation was achieved more frequently in pregnant than in nonpregnant patients (95% vs 77%; p < .001), and the duration of surgery was 15 minutes shorter in the pregnant women (p < .001). Although rare, ovarian torsion is a serious but treatable risk of in vitro fertilization (IVF). 2009 Dec. 92(6):1983-7. Comparison of ovarian torsion between pregnant and non-pregnant women at reproductive ages: sonographic and pathological findings. Measurements and main results: Recurrence of ovarian torsion occurs more frequently in pregnant patients, and in particular in enlarged multicystic ovaries. It is possible to perform volume reduction before OPU and also possible to become pregnant by embryo transfer afterward. Smorgick N, Pansky M, Feingold M, Herman A, Halperin R, Maymon R. The clinical characteristics and sonographic findings of maternal ovarian torsion in pregnancy. This twisting can cut off blood flow to the ovary and fallopian tube. Both hemorrhagic and ischemic necrosis were present. It is possible to perform volume reduction before OPU and also possible to become pregnant by embryo transfer afterward. The clinical symptoms could be confused with other acute abdominal conditions. The diagnosis of OT during pregnancy is often missed due to nonspecific clinical features and uncommon objective findings. 2. An ovarian rupture is a medical emergency. Online ahead of print. Ovarian torsion can sometimes be difficult to diagnose in pregnancy. Hasiakos D, Papakonstantinou K, Kontoravdis A, Gogas L, Aravantinos L, Vitoratos N. J Obstet Gynaecol Res. Management of a Ruptured Ovarian Cyst. Here, we report two cases of ovarian torsion after IVF and discuss the optimal management of this … Case Reports Case 1. Open torsion, right salpingectomy and cystectomy were performed. Bider D, Mashiach S, Dulitzky M, Kokia E, Lipitz S, Ben-Rafael Z. Surg Gynecol Obstet. BMC Pregnancy Childbirth. Study objective: Ovarian Torsion in Pregnancy (4 Posts) Add message | Report. abdominal pain, emergency laparotomy was performed, which revealed ruptured ectopic pregnancy and ovarian torsion with active bleeding and a 7×6 cm cyst in the same side with two rounds of torsion. trimester after ovarian hyper stimulation.2 Increased frequency during pregnancy is due to greater laxity of the tissues adjoining the ovaries and tubes as well as to enlargement of the ovary in early pregnancy secondary to corpus luteum cyst. Here, we report our experience managing ovarian torsion in early pregnancy after IVF treatment. The mean (SD) gestational age in the pregnant group was 11.5 (7.7) weeks. COVID-19 is an emerging, rapidly evolving situation. | | Treatment options limited to surgery, either by laparoscopy approach or laparotomy. An ovarian cyst is a fluid-filled sac in or on the surface of an ovary. 2010 Jun;202(6):536.e1-6. A 23-year-old woman, gravida 1, para 0, pregnant in the 6 th week of gestation after IVF-ET treatment, was admitted to our hospital due to acute lower abdominal pain. Successful pregnancy complicated by early and late adnexal torsion after in vitro fertilization. Bouguizane S, Bibi H, Farhat Y, Dhifallah S, Darraji F, Hidar S, Lassoued L, Chaieb A, Khairi H. J Gynecol Obstet Biol Reprod (Paris). Ovarian rupture and torsion . A gestational age eight-week pregnant woman who received in vitro fertilization (IVF) came to the clinic and was suspected of adnexal torsion. Twenty pregnant women were identified with surgically proven OT, 10 in the first trimester, eight in the second, and two in the third. Adnexal torsion frequently occur in the first trimester after ovarian stimulation for IVF (2–5). 2015 Mar;94(3):236-44. doi: 10.1111/aogs.12542. Lo LM, Chang SD, Horng SG, Yang TY, Lee CL, Liang CC. The majority of ovarian torsion cases affect women of reproductive age, but girls can have the condition as well. Aziz D, Davis V, Allen L, Langer JC. Mashiach S, Bider D, Moran O, et al. Both ovarian torsion and ovarian ectopic pregnancy are rare entities and can be easily missed unless one has a high degree of suspicion. Surgeons always try to save the ovary after torsion, when possible, because a woman’s ability to have children decreases after an ovary and/or fallopian tube is removed. Because pregnant women are usually … The left side is thought to barely have space because of the sigmoid colon. Ovarian torsion associated with infertility treatment often occurs mainly with ovarian hyperstimulation syndrome (OHSS) after OPU, but if it seems to be caused by ovarian swelling just before OPU. A gestational age eight-week pregnant woman who received in vitro fertilization (IVF) came to the clinic and was suspected of adnexal torsion. Pansky M, Feingold M, Maymon R, Ben Ami I, Halperin R, Smorgick N. J Minim Invasive Gynecol. The ovary and fallopian tube are typically involved. Would you like email updates of new search results? 2020 Aug 24;20(1):483. doi: 10.1186/s12884-020-03173-7. Women who were pregnant after IVM were younger (28.6 ± 3.4 years vs 29.3 ± 3.6 years, P = 0.005) and had ... such as ovarian hyperstimulation syndrome or ovarian torsion. They can occur during the childbearing years or after menopause.Most ovarian cysts are benign (not cancer) and go away on their own without treatment. The larger the cyst, the more likely that ovarian torsion will occur. Sixty-four pregnant women and 198 nonpregnant women with episodes of adnexal torsion. doi: 10.1097/MD.0000000000020627. Other symptoms may include nausea. When the torsion occurs in the right ovary, the symptoms may be confused with the appendix. Copyright © 2011. A total of 98 cases were confirmed as ovarian torsion, including 72 cases in group 1 and 26 cases in group 2. Halimeh R, Tomassian S, El Hage M, Metri N, Bersaoui M, Daou R, Anastasiadis E. Case Rep Obstet Gynecol. Quant Imaging Med Surg. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Although the etiology of the disease is not fully understood, predisposing factors include increased ovarian size, free mobility, and long pedicle. De‐torsion is a more conservative surgical approach that should be considered in … Ovarian torsion is an acute abdomen requiring prompt intervention. Torsion occurs due to two main reasons 2: 1. hypermobility of the ovary: <50% 2. adnexal mass: ~50-80% 2.1. most lesions are dermoid cysts or paraovarian cysts 2.2. large cystic ovaries undergoing ovarian hyperstimulation are at particular risk 2.3. masses between 5-10 cm are at most risk 13 J Pediatr Surg 2004; 39:750. In patients undergoing ovulation induction with gonadotropins, the incidence of ovarian torsion is as high as 6%, and 16% for those who have ovarian hyperstimulation syndrome. We report a very rare case of bilateral ovarian torsion complicating SOHSS in a singleton pregnancy, which was successfully managed by laparoscopic detorsion. Ovarian torsion, a major complication of OHSS, is estimated to occur in 12-25% of pregnant women. NLM Pregnancy after treatment for infertility is a risk factor for adnexal torsion. None of these patients had significant complications during or after surgery. Pregnancy after treatment for infertility is a risk factor for adnexal torsion. Ovarian torsion is a condition that occurs when an ovary twists around the ligaments that hold it in place. It can cause internal bleeding. Ovarian torsion occurs more on right side, presumably because the sigmoid colon limits the mobility of the left ovary. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Clipboard, Search History, and several other advanced features are temporarily unavailable. While classically the pain is sudden in onset, this is not always the case. Clinical characteristics, treatment and outcomes of adnexal torsion in pregnant women: a retrospective study. Ovarian torsion involves torsion of the ovarian tissue on its pedicle leading to reduced venous return, stromal edema, internal hemorrhage, and necrosis. This study was conducted to review the clinical manifestations, and to compare the outcome between laparoscopy and laparotomy in women undergoing surgery for ovarian torsion (OT) during pregnancy. USA.gov. This study assessed the clinical characteristics, treatment and outcomes of adnexal torsion in pregnant women. Keywords: ovarian cyst torsion, pregnancy, corpus luteum cyst. Epub 2006 Dec 4. USA.gov. Ovarian torsion is usually treated with laparoscopic surgery. Clinical characteristics, treatment and outcomes of adnexal torsion in pregnant women: a retrospective study. The clinical presentation is often nonspecific with few distinctive physical findings, commonly resulting in delay in diagnosis and surgical management. He X, Zhao X, Wang X, Liang G, Qi H, Zhu C, Huang Z, Zhang J. Arch Gynecol Obstet. abdominal pain, emergency laparotomy was performed, which revealed ruptured ectopic pregnancy and ovarian torsion with active bleeding and a 7×6 cm cyst in the same side with two rounds of torsion. Comparison of adnexal torsion between pregnant and nonpregnant women. Harkins G. Ovarian torsion treated with untwisting: second look 36 hours after untwisting. Conclusion: Contact us to talk with a fertility expert and determine an effective plan of action if you are experiencing symptoms of this complication. However, with in vitro fertilization (IVF) treatments, ovarian hyperstimulation may increase the size of the ovaries and result in the occurrence of adnexal torsion. Since it has been described as a severe complication after controlled ovarian hyper-stimulation for in vitro fertilization (IVF), it is more common in IVF pregnancies. andlaparoscopichypothesis.Therightovarywascompletely necrotic. | I'm currently about 5 and a bit weeks pregnant. A retrospective study was conducted at a tertiary center between January 2008 and January 2018. The diagnosis depends mainly on the clinical manifestation, D-dimer level and imaging tests such as compression ultrasonography and computed tomography pulmonary angiogram. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. 2008 Aug;34(4 Pt 2):683-7. doi: 10.1111/j.1447-0756.2008.00907.x. The symptoms are nonspecific, and can be confused with other acute abdominal conditions such as appendicitis, ureteral or renal colic, cholecystitis and bowel obstruction. J Minim Invasive Gynecol 2007; 14:270. | Rarely, a cyst may be malignant (cancer) (see FAQ096 Ovarian Cancer). Adnexal torsion of hyperstimulated ovaries in pregnancies after gonadotropin therapy. Djavadian D, Braendle W, Jaenicke F. Laparoscopic oophoropexy for the treatment of recurrent torsion of the adnexa in pregnancy: case report and review. It is possible to perform volume reduction before OPU and also possible to become pregnant by embryo transfer afterward. 1. Open torsion, right salpingectomy and cystectomy were performed. 2020 Jul 13;9(7):2209. doi: 10.3390/jcm9072209. | 2007 Mar;87(3):697.e9-12. They may want to monitor the cyst throughout your pregnancy. The incidence of ovarian torsion after IVF treatment is rare, ranging from 0.08 to 0.13% [9]. 2009 Sep-Oct;16(5):551-3. doi: 10.1016/j.jmig.2009.05.003. Ovarian torsion during pregnancy is a rare condition, more common in the third trimester, and exceptional during the first trimester(1). She had no complications or recurrence of ovarian torsion during this pregnancy. VTE after ovarian torsion-detorsion in pregnancy is an infrequent event and is more likely to occur in the first and second trimester. Recurrence of ovarian torsion occurs more frequently in pregnant patients, and in particular in enlarged multicystic ovaries. The increased use of assisted reproductive technologies has led to an increase in the risk of adnexal torsion, particularly in pregnant women or women with ovarian hyperstimulation syndrome (OHSS). It can be intermittent or sustained and results in venous, arterial and lymphatic stasis. Approximately 20% of the cases occur during pregnancy 1. To compare the clinical manifestation, management, and outcome of adnexal torsion in pregnant and nonpregnant women. The most frequent types of ovarian masses in pregnancy are corpus luteum cysts, endometriomas, benign cystadenomas, and mature cystic teratomas called dermoids. Interventions: Laparoscopy versus open surgery for adnexal masses in pregnancy: a meta-analytic review. The incidence of ectopic pregnancies after an in- vitro fertilization (IVF) procedure is 3 to 5 times higher than that of the general population and is reported to be in the range of 1 - 5 %. Ye P, Zhao N, Shu J, Shen H, Wang Y, Chen L, Yan X. Arch Gynecol Obstet. We report a very rare case of bilateral ovarian torsion complicating SOHSS in a singleton pregnancy, which was successfully managed by laparoscopic detorsion. Ovarian torsion has a bimodal age distribution occurring mainly in young women (15-30 years) and post-menopausal women. Role of surgery . At 30 weeks gestation, the patient delivered healthy infants by cesarean section because of severe preeclampsia. Ovarian torsion. Clipboard, Search History, and several other advanced features are temporarily unavailable. Tertiary care university hospital. eCollection 2019. 2020 Feb 17;20(1):19. doi: 10.1186/s12880-020-00422-1. Ovarian torsion is a disorder with a very high patient morbidity. 1991 Nov;173(5):363-6. Heterotopic pregnancy with adnexal torsion is … Pregnancy is a risk factor for torsion (odds ratio: 18:1) but remains an uncommon event (0.167%). This condition is usually associated with reduced venous return from the ovary as a result of stromal edema, internal hemorrhage, hyperstimulation, or a mass. During this minimally invasive procedure, a small incision is made at the abdomen. NIH The difficulty for the clinician lies in differentiating between ovarian torsion and other etiologies such as ectopic pregnancy, appendicitis, ovarian cysts, pelvic inflammatory disease (PID), urinary tract infection (UTI), nephrolithiasis, and endometriosis. Diagnosis of ovarian torsion in pregnancy can be made with clinical presentations in conjunction with ultrasound with color Doppler. Sonographic demonstration of multicystic ovaries was more common in pregnant women with recurrent torsion than in women with a single episode of torsion (86% vs 31%; p = .009). Conservative management of ovarian torsion in pre-pubertal girl 3. As the woman is likely to present with nonspecific symptoms of lower abdominal pain, nausea, and vomiting, ovarian torsion can often be misdiagnosed as appendicitis or preterm labour. 2021 Jan 11. doi: 10.1007/s00404-020-05864-0. A quick and confident diagnosis is … Ethical issues. (B) Color-flow Doppler after aspiration of ovarian cysts and body … Ovarian torsion is also a medical emergency where a large cyst causes an ovary to twist or move from its original position. Maternal ovarian torsion in pregnancy is a rare complication. 2008 Dec;34(6):1020-5. doi: 10.1111/j.1447-0756.2008.00806.x. After adjustment for such covariates as age, pregnancy was found to be associated with a lower rate of AT (adjusted odds ratio 0.314, 95% confidence interval [CI] 0.237–0.416, P value <0.01) and ovarian hyperstimulation syndrome was associated with a higher rate of AT (adjusted odds ratio 20.091, 95% CI 3.607–111.908, P value <0.01). Feng JL, Zheng J, Lei T, Xu YJ, Pang H, Xie HN. The pregnancy was fine, butplacenta previa was diagnosed, so the patient under … Epub 2017 Sep 7. Introduction Ovarian torsion refers to the complete or partial rotation of the ovary on its ligamentous supports, which often leads to an impedance of its blood supply [1].Adnexal torsion during pregnancy is very rare and the incidence is reported to be in the range of 0,01-0,05 per hundred [2].It occurs in all three trimesters, but is most common in the first trimester. [Adnexal torsion: a report of 135 cases]. This site needs JavaScript to work properly. While some ruptured ovarian cysts can cause little to no symptoms, others are more severe. Ovarian torsion in IVF twin pregnancy. HHS • There is a high rate of cyst recurrence after the procedure (33–40%) • Offered only to simple benign cysts • If it’s a malignant cyst then it may increase the stage of cancer, but it is uncertain if this worsens the prognosis. Introduction Ovarian torsion refers to the complete or partial rotation of the ovary on its ligamentous supports, which often leads to an impedance of its blood supply [1].Adnexal torsion during pregnancy is very rare and the incidence is reported to be in the range of 0,01-0,05 per hundred [2].It occurs in all three trimesters, but is most common in the first trimester. If a disease such as ovarian tumor is found during the work-up, attempts to become pregnant can be delayed until the disease has been treated. If this happens, surgery is necessary to restore blood flow. A retrospective study was conducted at a tertiary center between January 2008 and January 2018. The patient was discharged 48 hours after the operation with a good general condition Laparoscopy versus laparotomy for surgical intervention of ovarian torsion. Accordingly, adnexectomy was performed more often in group 1 (P=0.002). Harkins G. Ovarian torsion treated with untwisting: second look 36 hours after untwisting. Delayed diagnosis and treatment can cause ovarian necrosis and fetal loss. Ovarian torsion usually occurs on just one side and can cause sudden, intense pain and vomiting. Laparoscopic Adnexal Detorsion in a 20-Week Pregnant Patient: A Case Report and Literature Review. Using the International Classification of Disease, Ninth Revision, and Clinical Modification, we reviewed the clinical records of patients with OT during pregnancy between 1997 and 2008 at a university hospital. It is a gynecological emergency and requires urgent surgical intervention to prevent ovarian necrosis. Eighty-two pregnant women with surgically … Patients: J Gynecol Obstet Biol Reprod (Paris). 2019 Nov 11;2019:1093626. doi: 10.1155/2019/1093626. This study assessed the clinical characteristics, treatment and outcomes of adnexal torsion in pregnant women. The laparoscope transmits images onto a screen, which guides the surgeon in addressing the torsion. VTE after ovarian torsion-detorsion in pregnancy is an infrequent event and is more likely to occur in the first and second trimester. Clinical, surgical and pathologic findings of adnexal torsion in pregnant and nonpregnant women. Case Report . J Clin Med. Thirty six episodes of adnexal torsion in the pregnant group (56%) developed after treatment for infertility, compared with only 14 such episodes (7%) in the nonpregnant group (p < .001). NIH Ovarian torsion seldom occurs during pregnancy. The diagnosis depends mainly on the clinical manifestation, D-dimer level and imaging tests such as compression ultrasonography and computed tomography pulmonary angiogram. AbstractObjectiveMaternal ovarian torsion in pregnancy is a rare complication. Maternal adnexal torsion in pregnancy, with a reported incidence of 1–10 per 10,000 spontaneous pregnancies, is very uncommon. Design: ruthieruthuk Mon 14-May-18 19:36:30. The incidence of the disease increases after ovarian stimulation for the treatment of fertility. However, the outcomes of pregnancy varied: 12 (60%) term deliveries, three (15%) preterm deliveries at over 31 gestational weeks, one missed abortion and four elective abortions in the first trimester. Conclusion: Pregnancy after treatment for infertility is a risk factor for adnexal torsion. A repeated episode of torsion occurred more frequently in the pregnant group (14% vs 4%; p = .03). None of these patients had significant complications during or after surgery. An ovarian cysts is a sac or pouch filled with fluid or other tissue that forms in or on an ovary.Ovarian cysts are very common. Hyttel TE, Bak GS, Larsen SB, Løkkegaard EC. pregnancies, occurring more frequently in the first trimester after ovarian hyper stimulation. Heterotopic pregnancy is also a rare entity and cause pain abdomen but without the classical symptom of bleeding per vaginum. Adnexal torsion during pregnancy is a gynecological emergency. Distinctive pattern of left-right asymmetry of ovarian benign teratomas in Chinese population: a 12-year-long cross-sectional study. In the first trimester, women may have corpus luteum cysts that cause the ovary to … Published by Elsevier B.V. NLM Ovarian torsion (OT) is when an ovary twists on its attachment to other structures, such that blood flow is decreased. 2020 Jan;10(1):137-147. doi: 10.21037/qims.2019.11.06. Ovarian Torsion Blood flow to the ovary is reduced or cut off when the weight of a cyst causes the ovary to turn over on itself one or more times (called ovarian torsion). A laparoscope (an instrument with a small lighted camera at the end) is inserted. Laparoscopic Detorsion of Twisted Ovary in a Nulliparous Woman with a Recurrent, Bilateral Mature Cystic Teratoma 5. Please enable it to take advantage of the complete set of features! Maternal adnexal torsion in pregnancy is associated with significant risk of recurrence. Ssi-Yan-Kai G, Rivain AL, Trichot C, Morcelet MC, Prevot S, Deffieux X, De Laveaucoupet J. Emerg Radiol. Taiwan J Obstet Gynecol. BMC Pregnancy Childbirth. The treatment of ovarian tumors before attempting pregnancy decreases the risk of a corpus luteum cyst or OHSS. I. However, the outcomes of pregnancy varied: 12 (60%) term deliveries, three (15%) preterm deliveries at over 31 gestational weeks, one missed abortion and four elective abortions in the first trimester. With ovarian torsion, the blood supply to the ovary can be blocked and permanently hurt the ovary. The increased use of assisted reproductive technologies has led to an increase in the risk of adnexal torsion, particularly in pregnant women or women with ovarian hyperstimulation syndrome (OHSS). In our patient, right sided ovarian torsion was suspected as appendicitis. Overall, most women recover well from ovarian torsion and the chances of it reoccurring are slim. Setting: J Obstet Gynaecol Res. Sorry if this comes up twice, I posted but nothing appeared so don't think it uploaded properly. Surgery to treat proved adnexal torsion. Maternal adnexal torsion in pregnancy, with a reported incidence of 1–10 per 10,000 spontaneous pregnancies, is very uncommon. This can cut off blood supply to the ovary. Fertility and Sterility 1496.e10. Ovarian torsion in children: is oophorectomy necessary? Pregnant patients are reported to have a 1% increased risk of ovarian tor-sion compared to nonpregnant patients. It is a rare condition in the pregnancy and it is tipically detected in the right side. Pregnancy after treatment for infertility is a risk factor for adnexal torsion. Characteristics and surgical invervention of ovarian torsion in pregnant compared with nonpregnant women. Adnexal torsion during pregnancy: report of four cases and review of the literature. Hasson J, Tsafrir Z, Azem F, Bar-On S, Almog B, Mashiach R, Seidman D, Lessing JB, Grisaru D. Am J Obstet Gynecol. In conjunction with ultrasound with color Doppler difficult and occasionally remains a dilemma!, Ahn JW, Kim JS, Choi JY, Lee SH more. Not always the case presumably because the sigmoid colon limits the mobility of the complete of! 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Vitro fertilization ( IVF ) came to the ovary and fallopian tube protocol as described in reports... Tomography pulmonary angiogram cases occur during pregnancy is often missed due to nonspecific clinical features and uncommon objective findings a! 7 ):2209. doi: 10.1016/j.jmig.2009.05.003 K, Kontoravdis a, Gogas L, Vitoratos N. J Minim Invasive.... Cyst is a gynecological emergency TE, Bak GS, Larsen SB, Løkkegaard EC can!, Xu YJ, Pang H, Wang Y, Sarig-Meth T Maymon.
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