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Verma R, Sharma P. Lateral medullary syndrome due to brain stem tuberculoma. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2011; 59:382-384. [PMID: 21751596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Brainstem tuberculomas are quite unusual, accounting for less than 5 % of all intracranial tuberculoma. Intracranial tuberculoma is rare form of central nervous system tuberculosis. Lateral medullary syndrome is a combination of clinical features commonly attributed to infarction in territory of posterior inferior cerebellar artery or vertebral artery. We report a case suffering from lateral medullary syndrome resulting from brainstem tuberculoma which has not been reported so far in the literature. This patient was started on antituberculous chemotherapy and repeat magnetic resonance imaging of the cranium revealed regression of the lesion.
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Morera M, Sala N, Domènech S, Llibre JM. [Encephalitis with multiple space occupying lesions in a patient with human immunodeficiency virus type 1 infection]. Enferm Infecc Microbiol Clin 2011; 29:227-9. [PMID: 21324560 DOI: 10.1016/j.eimc.2010.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 07/13/2010] [Accepted: 08/31/2010] [Indexed: 11/30/2022]
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Bathla G, Khandelwal G, Maller VG, Gupta A. Manifestations of cerebral tuberculosis. Singapore Med J 2011; 52:124-131. [PMID: 21373739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Intracranial tuberculosis continues to be a serious problem in both the developing and developed world, with significant morbidity and mortality. It has protean manifestations and at times, poses significant diagnostic challenges to both the radiologist and the treating physician. This pictorial essay aims to acquaint the radiologist with the varied imaging spectrum of intracranial tuberculosis, both the common and uncommon appearances.
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Anuradha HK, Garg RK, Sinha MK, Agarwal A, Verma R, Singh MK, Shukla R. Intracranial tuberculomas in patients with tuberculous meningitis: predictors and prognostic significance. Int J Tuberc Lung Dis 2011; 15:234-239. [PMID: 21219687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
SETTING Intracranial tuberculomas are commonly observed neuroimaging abnormalities in tuberculous meningitis (TBM). OBJECTIVE to evaluate the predictors and prognostic significance of tuberculomas in patients with TBM. DESIGN In a retrospective follow-up study, contrast-enhanced magnetic resonance imaging was performed at study inclusion and after 9 months of follow-up. Univariate analysis and multivariate analysis were used to identify predictive factors for tuberculoma. Prognosis (death and severe disability) was assessed using the modified Rankin scale. RESULTS At inclusion, 43 of 110 patients had cerebral tuberculomas. Seven patients developed paradoxical tuberculomas. Predictors of tuberculomas were raised cerebrospinal fluid (CSF) protein (>3 g/l) and meningeal enhancement. Multivariate analysis did not show any significant predictors. During follow-up, the only significant predictor of paradoxical development of tuberculomas was raised CSF protein (>3 g/l). After 9 months of follow-up, 32 patients had died or had severe disability. Survival analysis revealed that patients with tuberculomas and those without tuberculomas had a similar prognosis. CONCLUSION Tuberculomas occurred in approximately 39% of the patients with TBM. Significant predictors were meningeal enhancement and raised CSF protein. TBM patients with or without tuberculomas had a similar prognosis.
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Abstract
Intracranial tuberculoma and neurocysticercosis (NCC) are the most frequent granulomatous infections in the central nervous system. Here we report a 41-year-old man with disseminated intracranial tuberculoma mimicking NCC. The patient complained of relapsing vertigo and vomiting consistent with Bruns syndrome. Serum antibodies against cysticercosis were positive. Magnetic resonance imaging (MRI) of the brain showed multiple disseminated ring-enhanced lesions. An initial diagnosis of NCC was made based on clinical signs and MRI. However, during antiparasitic treatment, the patient exhibited fever, meningitis signs, and positive cerebrospinal fluid findings for tuberculosis. The diagnosis was therefore corrected as tuberculoma. After three months of antituberculous treatment, the patient recovered clinically and on MRI. Our results highlight the importance of differential diagnosis of these two diseases in the early stage.
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Aggarwal A, Godbole T, Mittal H, Dua R. CNS neoplasm: a missed diagnosis. Indian J Pediatr 2011; 78:116-7. [PMID: 20936379 DOI: 10.1007/s12098-010-0259-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 09/29/2010] [Indexed: 11/28/2022]
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Kanikomo D, Diallo O, Maiga Y, Diop AA, Diallo M, Ba C, Sakho Y. [Tuberculoma of the posterior fossa: 3 cases in the departement of neurosurgery, university hospital of Gabriel Toure]. LE MALI MEDICAL 2011; 26:69-72. [PMID: 22766251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The cerebral tuberculoma is an expansive process of slow evolution of the tuberculous bacillus. Bacteriological diagnosis is rarely made. It is usually radiological or histological. The treatment is medical and surgical. We conducted a retrospective study from March 2007 to February 2010 which focused on three cases of cerebral tuberculoma. Two of our patients were male, 75% against 25% female: The age of our three patients was respectively 47, 23, and 4 years. The history of extrapulmonary tuberculosis was found in one case. The heaviness of the head was the pattern in a patient operated on for Pott's disease. The diagnosis was suspected by neuroradiology in 3 patients and histological confirmation was made in 2 cases. The polychimiotherapy of 12 months was established and the improvement has been obtained from the third month of treatment.
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Sundar US, Ramteke VV, Vaidya MS, Asole DC, Moulick ND. Suprasellar tuberculoma presenting as panhypopituitarism. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2010; 58:706-709. [PMID: 21510470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Suprasellar tuberculomas are exceptionally rare. We present the case of a middle aged male who presented with generalised apathy and meningism of two weeks duration. Neuroimaging was suggestive of tuberculomas in suprasellar cistern, while endocrinological investigation showed panhypopituitarism manifesting as pituitary hypothyroidism, hypocortisolism, and hyperprolactinemia. Cerebrospinal fluid examination showed lymphocytic reaction with raised proteins. A diagnosis of suprasellar tuberculoma with panhypopituitarism was made. The patient was started on antituberculous treatment and hormone replacement which led to remarkable improvement in condition of patient and resolution of tuberculous granuloma in follow up imaging.
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Sinha MK, Garg RK, Anuradha HK, Agarwal A, Parihar A, Mandhani PA. Paradoxical vision loss associated with optochiasmatic tuberculoma in tuberculous meningitis: A report of 8 patients. J Infect 2010; 60:458-66. [PMID: 20346972 DOI: 10.1016/j.jinf.2010.03.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 03/16/2010] [Accepted: 03/19/2010] [Indexed: 11/28/2022]
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Narang M, Gomber S, Upreti L, Dua S. Multiple intracranial tubercular abscesses in a child. Kathmandu Univ Med J (KUMJ) 2010; 8:244-246. [PMID: 21209545 DOI: 10.3126/kumj.v8i2.3568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
2 Year old girl presented with fever and cough for 4 months. Neurological examination revealed right sided hemiplegia. Contrast enhanced computed tomography of brain showed multiple hypodense ring enhancing lesions. Pus on aspiration of intracranial abscess showed positive polymerase chain reaction for Mycobacterium tuberculosis. A possibility of tuberculosis though not commonly recognised may be considered in any child presenting with prolonged fever and multiple intracranial abscesses.
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Napon C, Diallo O, Kabore J. [Athetosis in relation with intracranial tuberculomas in a patient from Burkina Faso]. MEDECINE TROPICALE : REVUE DU CORPS DE SANTE COLONIAL 2009; 69:513-515. [PMID: 20025188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Athetosis is generally characterized by involuntary movements due to damage of the extrapyramidal tract secondary to neonatal cerebral anoxia or nuclear icterus. The purpose of this report is to describe the case of a 41-year-old man who was admitted to the neurology department of the Ouagadougou teaching hospital in Burkina Faso for right hemiathetosis in relation with intracranial tuberculomas ongoing for two years. Diagnosis was based on clinical findings, i.e., lymph node tuberculosis and positive HIV1 serology; on CT scans showing multiple low density nodular lesions of variable size with annular contrast at the level of the right cerebellum and calcification at the left parietal level and in projection of the left capsulolenticular area; and on favorable response to tuberculosis treatment.
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Thwaites G, Fisher M, Hemingway C, Scott G, Solomon T, Innes J. British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children. J Infect 2009; 59:167-87. [PMID: 19643501 DOI: 10.1016/j.jinf.2009.06.011] [Citation(s) in RCA: 313] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 06/26/2009] [Accepted: 06/26/2009] [Indexed: 12/14/2022]
Abstract
SUMMARY AND KEY RECOMMENDATIONS: The aim of these guidelines is to describe a practical but evidence-based approach to the diagnosis and treatment of central nervous system tuberculosis in children and adults. We have presented guidance on tuberculous meningitis (TBM), intra-cerebral tuberculoma without meningitis, and tuberculosis affecting the spinal cord. Our key recommendations are as follows: 1. TBM is a medical emergency. Treatment delay is strongly associated with death and empirical anti-tuberculosis therapy should be started promptly in all patients in whom the diagnosis of TBM is suspected. Do not wait for microbiological or molecular diagnostic confirmation. 2. The diagnosis of TBM is best made with lumbar puncture and examination of the cerebrospinal fluid (CSF). Suspect TBM if there is a CSF leucocytosis (predominantly lymphocytes), the CSF protein is raised, and the CSF:plasma glucose is <50%. The diagnostic yield of CSF microscopy and culture for Mycobacterium tuberculosis increases with the volume of CSF submitted; repeat the lumbar puncture if the diagnosis remains uncertain. 3. Imaging is essential for the diagnosis of cerebral tuberculoma and tuberculosis involving the spinal cord, although the radiological appearances do not confirm the diagnosis. A tissue diagnosis (by histopathology and mycobacterial culture) should be attempted whenever possible, either by biopsy of the lesion itself, or through diagnostic sampling from extra-neural sites of disease e.g. lung, gastric fluid, lymph nodes, liver, bone marrow. 4. Treatment for all forms of CNS tuberculosis should consist of 4 drugs (isoniazid, rifampicin, pyrazinamide, ethambutol) for 2 months followed by 2 drugs (isoniazid, rifampicin) for at least 10 months. Adjunctive corticosteroids (either dexamethasone or prednisolone) should be given to all patients with TBM, regardless of disease severity. 5. Children with CNS tuberculosis should ideally be managed by a paediatrician with familiarity and expertise in paediatric tuberculosis or otherwise with input from a paediatric infectious diseases unit. The Children's HIV Association of UK and Ireland (CHIVA) provide further guidance on the management of HIV-infected children (www.chiva.org.uk). 6. All patients with suspected or proven tuberculosis should be offered testing for HIV infection. The principles of CNS tuberculosis diagnosis and treatment are the same for HIV infected and uninfected individuals, although HIV infection broadens the differential diagnosis and anti-retroviral treatment complicates management. Tuberculosis in HIV infected patients should be managed either within specialist units by physicians with expertise in both HIV and tuberculosis, or in a combined approach between HIV and tuberculosis experts. The co-administration of anti-retroviral and anti-tuberculosis drugs should follow guidance issued by the British HIV association (www.bhiva.org).
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Gubkina MF, Gorelyshchev SK, Petrakova II, Elufimova VF. [A case of rare localizations of tuberculosis in a child]. TUBERKULEZ I BOLEZNI LEGKIKH 2009:47-49. [PMID: 19886014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Guillén-Quesada A, García-Armengol R, Pérez-Muñoz N, Gargallo E, García-García JJ, Costa-Clara JM. [Intracranial tuberculoma: a case report and review of the literature]. Rev Neurol 2008; 47:631-634. [PMID: 19085878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Cerebral tuberculoma constitutes an important neurotuberculosis clinical form with high morbimortality and important diagnoses difficulty. CASE REPORT Only giant cerebral tuberculoma case in 3 years-old man who present dizziness and surgically treated by diagnostic suspicion of cerebral tumor. CONCLUSION Cerebral tuberculomas can often be confused with cerebral tumors when they are not included in differential diagnosis.
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Mioulet D, Sagui E, Bregigeon M, Rey F, Fuentes S, Brosset C. [Cerebral tuberculoma, paradox of management]. MEDECINE TROPICALE : REVUE DU CORPS DE SANTE COLONIAL 2008; 68:551-552. [PMID: 19068996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Ho BL, Hsu CY. Miliary intracranial tuberculomas presenting as rapidly reversible encephalopathy. ACTA NEUROLOGICA TAIWANICA 2008; 17:149-150. [PMID: 18686656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Mackert BM, Conradi J, Loddenkemper C, van Landeghem FKH, Loddenkemper R, Ignatius R, Schneider T. [Neurotuberculosis: a continuing clinical challenge]. DER NERVENARZT 2008; 79:153-66. [PMID: 17673961 DOI: 10.1007/s00115-007-2322-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In Germany neurotuberculosis is quite rare. Familiarity with the disease is nonetheless important because of many differential diagnoses and therapeutic implications. The diagnosis of neurotuberculosis is made by considering of clinical presentation, CSF, and cerebral imaging. Early diagnosis, prompt initiation of effective antitubercular therapy, and clinical staging are necessary for establishing a long-term treatment prognosis. The results of neurotuberculosis therapy are often unsatisfactory despite the availability of effective drugs. Lasting damage or death can be averted in fewer than half of the patients. Studies now confirm that early adjuvant corticoid therapy reduces lethality and morbidity. Resistant new strains of the pathogen, Mycobacterium tuberculosis, complicate therapy. Recent discoveries especially in diagnosis and therapy are explained using case evidence.
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Thrupp S, Furneaux C, Kennedy M, McGrath N. A rare cause of post-partum headache: cerebral tuberculomas. THE NEW ZEALAND MEDICAL JOURNAL 2008; 121:60-65. [PMID: 18480887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Navarrete A C, Rosas K M, Sáez M D, Tenhamm F E, Nogales-Gaete J. [Cerebelous syndrome by infratentorial brain tuberculornas and mutisystemic tuberculosis in AIDS patient]. Rev Chilena Infectol 2008; 25:122-126. [PMID: 18483645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
We present a clinical case of a patient who consulted for a cerebelous syndrome and diplopia associated to 10 kg weight loss in six months and multiple adenopathies. Cerebral imagenology study evidenced the presence of granulamatous masses at the cerebellum and midbrain level, there were no cerebrospinal fluid abnormalities. Systemic tuberculosis (TB) diagnosis was done based in finding of acid-fast bacilli positive staining in urine and lymph node biopsy. HIV infection was documented by ELISA serology. CD4 cell count was 590 cell/mm3, classifying the case a AIDS Cl stage. TB was treated according to national guidelines leading to good clinical and imagenology evolution. The clinical case scenario of infratentorial tuberculomas without meningitis as a first manifestation of TB and AIDS is unusual, generating our interest in reporting this case.
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Zorn-Olexa C, Laugel V, Martin ADS, Donato L, Fischbach M. Multiple intracranial tuberculomas associated with partial status epilepticus and refractory infantile spasms. J Child Neurol 2008; 23:459-62. [PMID: 18401037 DOI: 10.1177/0883073807309252] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report the case of a 10 month-old girl presenting with multiple intracranial tuberculomas associated with partial status epilepticus and cerebrovascular accident in the left sylvian territory. She later developed paradoxical enlargement of the tuberculomas during antituberculous treatment and severe neurological sequelae with refractory infantile spasms. The development of infantile spasms in this context is particularly remarkable, and this case is illustrative of the complex interrelationship between intracranial lesions, partial status epilepticus, and infantile spasms. It also highlights the difficult diagnosis of cerebral tuberculomas in infants and further supports the need for continued vigilance in industrialized countries.
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Subramanian A, Shankar Joshi B, Roy AD, Roy R, Gupta V, Dang RS. NMR spectroscopic identification of cholesterol esters, plasmalogen and phenolic glycolipids as fingerprint markers of human intracranial tuberculomas. NMR IN BIOMEDICINE 2008; 21:272-88. [PMID: 17614100 DOI: 10.1002/nbm.1191] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Detailed (1)H and (13)C NMR spectroscopy of lipid extracts from 12 human intracranial tuberculomas and two control brain tissue samples was performed to assess the role of lipids in the disease process. One-dimensional and two-dimensional NMR techniques were used to resolve the mixture of lipid components and make resonance assignments. The lipid components that could be identified in tuberculoma lipid extracts and not in control samples were: cholesterol ester, plasmalogen and phenolic glycolipids. It is proposed that the combined occurrence of these lipid components can be used as 'fingerprint markers' for the differentiation of intracranial tuberculoma from healthy brain tissue. Furthermore, phenolic glycolipids present in intracranial tuberculomas may have diagnostic significance in differentiating them from other disease conditions of the central nervous system such as malignant tumors.
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Sonmez G, Ozturk E, Mutlu H, Sildiroglu O, Haholu A, Kutlu A, Basekim C, Kizilkaya E. An unusual intraventricular lesion: tuberculoma. J Neuroradiol 2008; 35:63-4. [PMID: 17714784 DOI: 10.1016/j.neurad.2007.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
An unusual case of tubercular granulomatous hypophysitis is reported. A sellar mass diagnosed as pituitary adenoma in MRI, showed non-caseating granulomas, glandular destruction and fibrosis in histology. Stain for acid-fast bacilli (AFB) were negative and the case was misdiagnosed as Idiopathic Granulomatous hypophysitis. The patient came back 2 weeks after trans-sphenoidal endoscopic resection with meningitis. CSF showed mixed pleocytosis. PCR for Mycobacterium tuberculosis was positive. The case is reported to highlight the need to maintain a high degree of suspicion for tuberculosis in any form of granulomatous hypophysitis, with or without caseous necrosis, in regions endemic for tuberculosis to prevent subsequent complications.
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