1
|
Mihara Y, Kado H, Matsumoto K, Kurose R, Tsujinaka E, Nakai K, Yamauchi A, Hatta T. Peritoneal Dialysis-associated Peritonitis Due to Streptococcus oralis Three Weeks after Peritoneal Dialysis Initiation. Intern Med 2024; 63:707-710. [PMID: 37438136 PMCID: PMC10982001 DOI: 10.2169/internalmedicine.2035-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/04/2023] [Indexed: 07/14/2023] Open
Abstract
A 60-year-old man with end-stage renal disease due to nephrosclerosis had a peritoneal dialysis catheter (PD) embedded with stepwise initiation of peritoneal dialysis using Moncrief and Popovich's technique three months ago. PD was initiated three weeks after creating an exit site. He presented with abdominal pain and fever a day before admission and was diagnosed with PD-associated peritonitis caused by Streptococcus oralis. Medical consultation after admission revealed a history of wisdom tooth extraction following PD catheter placement, resulting in delayed wound healing. Transient bacteremia can occur after tooth extraction, leading to PD-associated peritonitis. Contemplating the oral milieu in patients undergoing PD is pertinent.
Collapse
Affiliation(s)
- Yu Mihara
- Department of Nephrology, Omihachiman Community Medical Center, Japan
| | - Hiroshi Kado
- Department of Nephrology, Omihachiman Community Medical Center, Japan
| | - Kenji Matsumoto
- Department of Nephrology, Omihachiman Community Medical Center, Japan
| | - Ryo Kurose
- Department of Nephrology, Omihachiman Community Medical Center, Japan
| | - Erika Tsujinaka
- Department of Nephrology, Omihachiman Community Medical Center, Japan
| | - Kunihiro Nakai
- Department of Nephrology, Omihachiman Community Medical Center, Japan
| | - Asuka Yamauchi
- Department of Nephrology, Omihachiman Community Medical Center, Japan
| | - Tsuguru Hatta
- Department of Nephrology, Omihachiman Community Medical Center, Japan
| |
Collapse
|
2
|
Ito Y, Ryuzaki M, Sugiyama H, Tomo T, Yamashita AC, Ishikawa Y, Ueda A, Kanazawa Y, Kanno Y, Itami N, Ito M, Kawanishi H, Nakayama M, Tsuruya K, Yokoi H, Fukasawa M, Terawaki H, Nishiyama K, Hataya H, Miura K, Hamada R, Nakakura H, Hattori M, Yuasa H, Nakamoto H. Peritoneal Dialysis Guidelines 2019 Part 1 (Position paper of the Japanese Society for Dialysis Therapy). RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00348-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AbstractApproximately 10 years have passed since the Peritoneal Dialysis Guidelines were formulated in 2009. Much evidence has been reported during the succeeding years, which were not taken into consideration in the previous guidelines, e.g., the next peritoneal dialysis PD trial of encapsulating peritoneal sclerosis (EPS) in Japan, the significance of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), the effects of icodextrin solution, new developments in peritoneal pathology, and a new international recommendation on a proposal for exit-site management. It is essential to incorporate these new developments into the new clinical practice guidelines. Meanwhile, the process of creating such guidelines has changed dramatically worldwide and differs from the process of creating what were “clinical practice guides.” For this revision, we not only conducted systematic reviews using global standard methods but also decided to adopt a two-part structure to create a reference tool, which could be used widely by the society’s members attending a variety of patients. Through a working group consensus, it was decided that Part 1 would present conventional descriptions and Part 2 would pose clinical questions (CQs) in a systematic review format. Thus, Part 1 vastly covers PD that would satisfy the requirements of the members of the Japanese Society for Dialysis Therapy (JSDT). This article is the duplicated publication from the Japanese version of the guidelines and has been reproduced with permission from the JSDT.
Collapse
|
3
|
Terada K, Sumi Y, Aratani S, Hirama A, Sakai Y. Peritoneal Catheter Removal for Peritoneal Dialysis-Related Peritonitis Caused by Gram-Negative, Rod-Like Pseudomonas aeruginosa Infection During Antibiotic Therapy for Enterococcus faecalis. J NIPPON MED SCH 2020; 87:304-308. [PMID: 32475900 DOI: 10.1272/jnms.jnms.2020_87-511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Peritonitis is a common complication of peritoneal dialysis (PD) and can result in PD catheter removal, permanent hemodialysis, and, potentially, death. Prediction and prevention of PD-related peritonitis are thus extremely important. In 2016, the International Society for Peritoneal Dialysis published guidelines for patients with peritonitis undergoing PD. The guidelines cover most cases of PD-related peritonitis caused by bacteria and include clear indications for catheter removal. However, difficulties often arise when deciding the timing of catheter removal. When multiple enteric organisms are identified in a culture of dialysis effluent, peritonitis may be caused by intra-abdominal pathology, which is associated with substantial mortality. In such cases, catheter removal is considered. In this report, we describe a case in which, during antibiotic therapy for PD-related peritonitis due to Enterococcus faecalis alone, the patient developed a relapse of peritonitis caused by a newly detected Gram-negative, rod-like Pseudomonas aeruginosa. He required catheter removal because of the possibility of peritonitis recurrence. Although additional study is required, early catheter removal may be effective when a new organism is detected during antibiotic therapy for PD-related peritonitis caused by an organism not meeting the definition of refractory peritonitis.
Collapse
Affiliation(s)
- Kohsuke Terada
- Department of Nephrology, Graduate School of Medicine, Nippon Medical School
| | - Yuichiro Sumi
- Department of Nephrology, Graduate School of Medicine, Nippon Medical School
| | - Sae Aratani
- Department of Nephrology, Graduate School of Medicine, Nippon Medical School
| | - Akio Hirama
- Department of Nephrology, Graduate School of Medicine, Nippon Medical School
| | - Yukinao Sakai
- Department of Nephrology, Graduate School of Medicine, Nippon Medical School
| |
Collapse
|
4
|
Aratani S, Nakagawa Y, Sumi Y, Sakai Y. Bacillus subtilis-associated abdominal catastrophe in a Japanese patient with peritoneal dialysis-related peritonitis. COGENT MEDICINE 2020. [DOI: 10.1080/2331205x.2020.1747343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Sae Aratani
- Department of Nephrology, Graduate School of Medicine, Nippon Medical School Tokyo Japan
| | - Yuta Nakagawa
- Department of Nephrology, Graduate School of Medicine, Nippon Medical School Tokyo Japan
| | - Yuichiro Sumi
- Department of Nephrology, Graduate School of Medicine, Nippon Medical School Tokyo Japan
| | - Yukinao Sakai
- Department of Nephrology, Graduate School of Medicine, Nippon Medical School Tokyo Japan
| |
Collapse
|
5
|
Wu YL, Lin YS, Hsueh TYR, Lo WC, Peng KC, Kao MJ. Green dialysate and gallbladder perforation in a peritoneal dialysis patients: a case report and literature review. BMC Nephrol 2018; 19:165. [PMID: 29973169 PMCID: PMC6033235 DOI: 10.1186/s12882-018-0974-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gallbladder perforation is a rare but lethal condition and its diagnosis is usually difficult and delayed. Frequently, gallbladder rupture is associated with cholecystitis, but spontaneous perforation was ever described. However, spontaneous rupture of gallbladder has never been reported in patients underwent peritoneal dialysis. CASE PRESENTATION We report a 62-year-old man who presented with abdominal pain for 2 days to clinic. Peritoneal dialysis-related peritonitis was diagnosed initially. It was followed by spontaneous gallbladder perforation with greenish dialysate. The patient was managed successfully by antibiotic treatment and primary closure of gallbladder perforation with external drainage. He recovered from this critical condition and stayed on dialysis. CONCLUSIONS Early diagnosis and timely surgical intervention yields a good prognosis in PD patients with gallbladder perforation. Surgical intervention and antibiotic treatment are the mainstay of treatment. Both of them should take place promptly.
Collapse
Affiliation(s)
- Yueh-Lin Wu
- Department of Nephrology, Taipei City Hospital, Zhongxiao Branch, No. 87, Tongde Road, Nangang District, Taipei, 115 Taiwan
| | - Yi-Sheng Lin
- Department of Nephrology, Taipei City Hospital, Zhongxiao Branch, No. 87, Tongde Road, Nangang District, Taipei, 115 Taiwan
| | | | - Wen-Ching Lo
- Division of Gastroenterology, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan
| | - Kuo-Chou Peng
- Division of Medical Imaging, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan
| | - Mu-Jung Kao
- Division of Rehabilitation, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan
| |
Collapse
|
6
|
Hayata M, Yamashita J, Tokunaga K, Ejima M, Sagishima K, Nakagawa S, Hashimoto D, Baba H, Maruyama K, Kohrogi Y, Mizumoto T, Mukoyama M, Kamohara H. Refractory peritonitis by spontaneous perforation of the common bile duct in a patient receiving peritoneal dialysis. RENAL REPLACEMENT THERAPY 2017. [DOI: 10.1186/s41100-017-0132-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
|
7
|
Li PKT, Szeto CC, Piraino B, de Arteaga J, Fan S, Figueiredo AE, Fish DN, Goffin E, Kim YL, Salzer W, Struijk DG, Teitelbaum I, Johnson DW. ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment. Perit Dial Int 2016; 36:481-508. [PMID: 27282851 PMCID: PMC5033625 DOI: 10.3747/pdi.2016.00078] [Citation(s) in RCA: 610] [Impact Index Per Article: 76.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 05/04/2016] [Indexed: 12/19/2022] Open
Affiliation(s)
- Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Cheuk Chun Szeto
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Beth Piraino
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Javier de Arteaga
- Department of Nephrology, Hospital Privado and Catholic University, Cordoba, Argentina
| | - Stanley Fan
- Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, UK
| | - Ana E Figueiredo
- Nursing School-FAENFI, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Douglas N Fish
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | - Eric Goffin
- Department of Nephrology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Belgium
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Clinical Research Center for End Stage Renal Disease, Daegu, Korea
| | - William Salzer
- University of Missouri-Columbia School of Medicine, Department of Internal Medicine, Section of Infectious Disease, MI, USA
| | - Dirk G Struijk
- Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - David W Johnson
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| |
Collapse
|
8
|
Bieber SD, Anderson AE, Mehrotra R. Diagnostic testing for peritonitis in patients undergoing peritoneal dialysis. Semin Dial 2014; 27:602-6. [PMID: 25039456 DOI: 10.1111/sdi.12270] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Scott D Bieber
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington
| | | | | |
Collapse
|
9
|
Windpessl M, Prischl FC. Surgical peritonitis in peritoneal dialysis patients: an absence of (radiological) evidence is not evidence of its absence. Intern Med 2014; 53:645. [PMID: 24633043 DOI: 10.2169/internalmedicine.53.1251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Martin Windpessl
- The 4th Department of Medicine, Division of Nephrology, Klinikum Wels-Grieskirchen, Austria
| | | |
Collapse
|
10
|
|
11
|
Li PKT, Szeto CC, Piraino B, Bernardini J, Figueiredo AE, Gupta A, Johnson DW, Kuijper EJ, Lye WC, Salzer W, Schaefer F, Struijk DG. Peritoneal dialysis-related infections recommendations: 2010 update. Perit Dial Int 2012; 30:393-423. [PMID: 20628102 DOI: 10.3747/pdi.2010.00049] [Citation(s) in RCA: 585] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Nikitidou O, Liakopoulos V, Kiparissi T, Divani M, Leivaditis K, Dombros N. Peritoneal dialysis-related infections recommendations: 2010 update. What is new? Int Urol Nephrol 2011; 44:593-600. [PMID: 21744125 DOI: 10.1007/s11255-011-9995-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 05/06/2011] [Indexed: 11/25/2022]
Abstract
The International Society of Peritoneal Dialysis (ISPD) 2010 guidelines on PD-related infections reflect the bulk of knowledge acquired over the last 5 years. It includes new information about causative agents of peritonitis, isolation techniques, or therapeutic regimens. Monitoring of infection rates by reporting of peritonitis and exit site infections, isolated microorganism, and presumed etiology is recommended. Furthermore, special focus is given on careful evaluation of each episode of peritonitis in order to determine the route of infection and to reassess patient's training. In this article, we record the changes in the last ISPD (2010) guidelines compared to the previous ones published in March 2005.
Collapse
Affiliation(s)
- Olga Nikitidou
- Peritoneal Dialysis Unit, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 1 St. Kyriakidi street, 54636 Thessaloniki, Greece
| | | | | | | | | | | |
Collapse
|
13
|
Pajek J, Guček A, Škoberne A, Pintar T. Severe Peritonitis in Patients Treated With Peritoneal Dialysis: A Case Series Study. Ther Apher Dial 2011; 15:250-6. [DOI: 10.1111/j.1744-9987.2011.00946.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
14
|
|
15
|
Abstract
In this short review we highlight the diagnostic challenge presented by surgical peritonitis in peritoneal dialysis patients, giving attention to etiology, clinical presentation, diagnosis, and management. Despite improvements in medical imaging and a reduction in overall rates of peritonitis in peritoneal dialysis, the mortality of surgical peritonitis has not changed in recent years and remains a challenge for the clinical team.
Collapse
Affiliation(s)
- Badri M. Shrestha
- Sheffield Kidney Institute, Sheffield Teaching Hospitals Foundation NHS Trust, Sheffield, United Kingdom
| | - Peter Brown
- Sheffield Kidney Institute, Sheffield Teaching Hospitals Foundation NHS Trust, Sheffield, United Kingdom
| | - Martin Wilkie
- Sheffield Kidney Institute, Sheffield Teaching Hospitals Foundation NHS Trust, Sheffield, United Kingdom
| |
Collapse
|
16
|
Zurowska A, Feneberg R, Warady BA, Zimmering M, Monteverde M, Testa S, Calyskan S, Drozdz D, Salusky I, Kemper MJ, Ekim M, Verrina E, Misselwitz J, Schaefer F. Gram-negative peritonitis in children undergoing long-term peritoneal dialysis. Am J Kidney Dis 2008; 51:455-62. [PMID: 18295061 DOI: 10.1053/j.ajkd.2007.11.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Accepted: 11/28/2007] [Indexed: 11/11/2022]
Abstract
BACKGROUND The proportion of gram-negative causative organisms in peritoneal dialysis-associated peritonitis is increasing. Little published information for this complication exists in children. The objective of this study is to evaluate the clinical presentation, early and late response to treatment, and identification of factors influencing the outcome of gram-negative peritonitis (GNP) in children. STUDY DESIGN Case series. SETTING AND PARTICIPANTS 104 children (aged 7.9 +/- 5.9 years) with 121 GNP episodes reported to the International Pediatric Peritonitis Registry from October 2001 through December 2004. PREDICTORS Patient, clinical, bacteriological, and treatment features. OUTCOMES Initial response to empirical treatment was assessed after approximately 72 hours of therapy. Final outcome was judged according to the occurrence of death, technique failure, relapse, need for catheter exchange, and a composite end point defining full functional recovery. RESULTS 44% of episodes of GNP occurred in children younger than 5 years. Causative organisms included Pseudomonas species, 21%; Klebsiella species, 18%; Escherichia coli, 17%; and Acinetobacter species, 12%. Thirty-two percent of organisms classified as gram-negative were not identified further. Clinical manifestations were severe and uniform for all causative gram-negative agents. A substantial proportion (20%) of organisms were resistant to ceftazidime, with resulting suboptimal response to empirical therapy. By day 3 of initial empiric treatment, 85% of children with GNP had improved clinically (39%, complete resolution; 46%, improvement in symptoms), 10% showed poor response, and 5% had worsening of symptoms. Multivariate analysis identified severe abdominal pain, use of a single-cuff catheter, and intermittent (versus continuous) intraperitoneal ceftazidime administration as independent predictors of worse initial response to treatment. Full functional recovery was achieved in 86% of episodes. Nineteen patients (16%) required catheter removal, 11 (9%) experienced a relapse, 7 (6%) discontinued peritoneal dialysis therapy permanently, and 3 died. Lack of clinical improvement after 72 hours of therapy (odds ratio, 5.39; P < 0.01) and the presence of an exit-site infection (odds ratio, 7.69; P = 0.01) independently increased the risk of an incomplete functional recovery. LIMITATIONS The study was not designed to assess absolute incidence figures or risk factors for the development of GNP in children. CONCLUSIONS GNP is a significant complication of long-term peritoneal dialysis therapy in children, and a substantial proportion of affected children are at risk of permanent sequelae. Because results of empiric treatment with ceftazidime are suboptimal in the setting of this infection, alternative antimicrobial agents should be reconsidered.
Collapse
Affiliation(s)
- Aleksandra Zurowska
- Department of Paediatric and Adolescent Nephrology and Hypertension, Medical University of Gdansk, Poland
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Jacob P, Mueller MH, Hahn J, Wolk I, Mayer P, Nagele U, Hennenlotter J, Stenzl A, Konigsrainer A, Glatzle J. Alterations of neuropeptides in the human gut during peritonitis. Langenbecks Arch Surg 2007; 392:267-71. [PMID: 17377803 DOI: 10.1007/s00423-007-0168-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Accepted: 02/02/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS Gastrointestinal motility is reduced during sepsis but the pathomechanism involved is poorly understood. We investigated the expression of substance P (SP) and vasoactive intestinal peptide (VIP) in the myenteric plexus during peritonitis in human small bowel. MATERIALS AND METHODS Tissue samples of the small bowel were gathered from healthy patients and from patients with peritonitis. Immunohistochemistry for myeloperoxidase (MPO), SP, and VIP was performed in whole mount sections. To determine the level of inflammation, MPO-positive cells were counted in the circular muscle layer. SP and VIP immunoreactivity was analyzed in myenteric plexus neurons. The area of positive immunoreactivity for either neuropeptide within the plexus was analyzed and set in relation to the total area of the plexus and consecutively expressed as percentage. RESULTS During peritonitis, MPO-positive cells significantly increased by approximately fourfold as compared to healthy tissue. The immunoreactivity for SP was significantly reduced by approximately 80% in myenteric plexus neurons during peritonitis. In contrast, the immunoreactivity for VIP significantly increased by nearly twofold during peritonitis. CONCLUSIONS During peritonitis, the inflammatory reaction within the gut is increased. The neuropeptide expression in myenteric plexus neurons was observed as shifting towards increased expression of VIP, known to inhibit intestinal motility, and towards decreased expression of the prokinetic neuropeptide SP.
Collapse
Affiliation(s)
- P Jacob
- Department of General and Transplantation Surgery, University Hospital of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Faber MD. Predicting outcomes of peritoneal-dialysis-associated peritonitis based on dialysate white blood cell count. NATURE CLINICAL PRACTICE. NEPHROLOGY 2007; 3:14-5. [PMID: 17183256 DOI: 10.1038/ncpneph0360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Accepted: 09/26/2006] [Indexed: 05/13/2023]
Affiliation(s)
- Mark D Faber
- Division of Nephrology, Henry Ford Hospital, Detroit, MI 48202, USA.
| |
Collapse
|