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Hajhouji F, Benyaich Z, Laghmari M, Ghannane H, Ait Benali S. Spontaneous spinal epidural hematoma in a toddler presenting with torticollis: case report and literature review. Childs Nerv Syst 2023; 39:1935-1939. [PMID: 36738321 DOI: 10.1007/s00381-023-05870-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/28/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Spontaneous spinal epidural hematoma (SSEH) is a rare entity, especially in toddlers and infants. The nonspecificity of its presenting symptoms in children may be a source of delayed diagnosis. CASE DESCRIPTION We report the case of a 20-month-old young boy without medical history who presented with irreducible torticollis, worsened a few days later by severe tetraplegia and respiratory distress. Spinal magnetic resonance imaging (MRI) showed a posterior epidural hematoma, extending from C3 to T1 and compressing the spinal cord. An urgent decompressive surgery via an extensive laminectomy and evacuation of the clot was performed. The patient demonstrated a partial neurological recovery on follow-up. CONCLUSION SSEH is a rare and serious condition that may compromise the functional and vital prognosis of the patient, hence the importance of prompt diagnosis and urgent treatment.
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Affiliation(s)
- Farouk Hajhouji
- Department of Neurosurgery, CHU Mohammed VI of Marrakech, Marrakech, Morocco
- Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Zakariae Benyaich
- Department of Neurosurgery, CHU Souss Massa, Agadir, Morocco.
- Faculty of Medicine and Pharmacy of Agadir, Ibn Zohr University, Agadir, Morocco.
| | - Mehdi Laghmari
- Department of Neurosurgery, CHU Mohammed VI of Marrakech, Marrakech, Morocco
- Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Houssine Ghannane
- Department of Neurosurgery, CHU Mohammed VI of Marrakech, Marrakech, Morocco
- Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Said Ait Benali
- Department of Neurosurgery, CHU Mohammed VI of Marrakech, Marrakech, Morocco
- Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
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Bouaré F, Noureldine MHA, Hajhouji F, Ghannane H, Jallo GI, Ait Benali S. Complex craniosynostosis in the context of Carpenter's syndrome. Childs Nerv Syst 2022; 38:831-835. [PMID: 34244844 DOI: 10.1007/s00381-021-05288-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
Carpenter's syndrome or acrocephalopolysyndactyly type II is a rare genetic autosomal recessive disease, with an incidence estimated at 1 per 1 million births. Common findings of a brachydactyly, polysyndactyly, and a trefoil-like skull with extreme brachycephaly due to fusion of the bilateral coronal, sagittal and lambdoid sutures. We report a 12-month-old male who was referred to our care for evaluation of a craniofacial deformity-a trefoil-like skull, flattened and receding forehead, bulging of temporal bones, hypertelorism, exorbitism, and polysyndactyly in the upper and lower limbs and psychomotor delay. Head computed tomography (CT) with 3D reconstruction revealed craniosynostosis with fusion of the coronal, metopic, and sagittal sutures. Correction of the craniofacial deformity was performed with satisfactory aesthesis of the craniofacial bones at 2 years of follow-up. Early correction of craniofacial deformity in Carpenter's syndrome is usually safe within 6 to 12 months. Venous drainage abnormalities and ectatic emissary veins can lead to significant bleeding and may be detected on MR angiography. Significant skull weakening may lead to bony fragmentation while creating cranial flaps and is best evaluated with 3D CT imaging. Taking these pitfalls into consideration decreases the chances of aborting the surgery and may lead to better overall outcomes.
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Affiliation(s)
- Fah Bouaré
- Department of Neurosurgery, Arrazi Hospital VI University HospitalCadi Ayyad Université, Ibn Sina Avenue, Mohammed, BP2360, PrincipalMarrakesh, Morocco
| | - Mohammad Hassan A Noureldine
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
| | - Farouk Hajhouji
- Department of Neurosurgery, Arrazi Hospital VI University HospitalCadi Ayyad Université, Ibn Sina Avenue, Mohammed, BP2360, PrincipalMarrakesh, Morocco
| | - Houssine Ghannane
- Department of Neurosurgery, Arrazi Hospital VI University HospitalCadi Ayyad Université, Ibn Sina Avenue, Mohammed, BP2360, PrincipalMarrakesh, Morocco
| | - George I Jallo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, USA
| | - Said Ait Benali
- Department of Neurosurgery, Arrazi Hospital VI University HospitalCadi Ayyad Université, Ibn Sina Avenue, Mohammed, BP2360, PrincipalMarrakesh, Morocco
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Chibbaro S, Gubian A, Zaed I, Hajhouji F, Pop R, Todeschi J, Bernard G, Di Emidio P, Mallereau CH, Proust F, Ganau M. Cervical myelopathy caused by ventrally located atlanto-axial synovial cysts: An open quest for the safest and most effective surgical management. Case series and systematic review of the literature. Neurochirurgie 2020; 66:447-454. [PMID: 33068595 DOI: 10.1016/j.neuchi.2020.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/31/2020] [Accepted: 09/08/2020] [Indexed: 11/15/2022]
Abstract
OF BACKGROUND DATA Despite a good understanding of the natural history of spinal synovial cysts (SCs), a widespread agreement regarding their optimal management is still lacking. This is particularly true for SCs occurring at the C1-C2 level, which are rare, but oftentimes lead to a rapidly evolving cervical myelopathy. METHODS We report a series of 4 patients (M:F ratio=1:1; mean age 63.5 years) presenting with progressive cervical myelopathy secondary to ventrally located C1-C2 SCs. All patients underwent a postero-lateral facet-sparing intradural approach with total excision of the SCs. Functional status was assessed pre- and postoperatively with Nurick scale and the modified Japanese Orthopaedic association grading. Furthermore we conducted a systematic review, following PRISMA guidelines of pertinent literature to contextualize the options for surgical management of such lesions. RESULTS Complete excision of the SCs was confirmed radiologically and on histological analysis. All measures of functional status improved post-operatively, and no cyst recurrence or need for instrumented fusion were noted during follow up (range from 22 to 88 months). CONCLUSION Our experience suggests that the facet-sparing intradural approach provides excellent clinical outcomes without causing any C1-C2 instability. This is in keeping with the take home message emerging from our literature review, which confirms that treatment should aim at radical resection of SCs while minimizing the risk of postoperative instability.
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Affiliation(s)
- S Chibbaro
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France; Department of Neurosurgery, Lariboisiere University Hospital, Paris, France
| | - A Gubian
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - I Zaed
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France.
| | - F Hajhouji
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - R Pop
- Interventional Neuroradiology Unit, Strasbourg University Hospital, Strasbourg, France
| | - J Todeschi
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - G Bernard
- Department of Neurosurgery, Lariboisiere University Hospital, Paris, France
| | - P Di Emidio
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - C-H Mallereau
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - F Proust
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - M Ganau
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
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Bouaré F, Laghmari M, Etouche FN, Arjdal B, Saidi I, Hajhouji F, Ghannane H, Amro L, Tassi N, Benali SA. Unusual association of COVID-19, pulmonary tuberculosis and human immunodeficiency virus, having progressed favorably under treatment with chloroquine and rifampin. Pan Afr Med J 2020; 35:110. [PMID: 33282065 PMCID: PMC7687509 DOI: 10.11604/pamj.supp.2020.35.2.24952] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 07/12/2020] [Indexed: 01/13/2023] Open
Abstract
Infection with the new coronavirus has been declared an international health emergency. Its curative treatment is unknown and is the subject of several clinical trials. In addition, the concomitant association of COVID-19 with tuberculosis and the human immunodeficiency virus, hitherto never described, is potentially fatal. We report the illustrative case of a 32-year-old patient who presented this trifecta of infections and who did well under treatment with chloroquine and anti-mycobacterial drugs. This patient arrived at the ER with respiratory discomfort that had been evolving over a month with symptoms of flu and deterioration of her general condition. A chest CT scan revealed an aspect of lung miliary tuberculosis with isolation of Koch’s bacilli in the sputum. A polymerization chain reaction (PCR) was positive for COVID-19 on a nasopharyngeal swab. HIV serology was positive. The course was marked by a spectacular clinical improvement and two negative COVID-19 PCR controls at the end of treatment (at days 9 and 10). Anti-tubercular drugs (especially, rifampin) are powerful enzyme inducers that can reduce the effectiveness of chloroquine in our patient. This therapeutic success may be linked to the effect of anti-tubercular drugs against SARS ncov-2, especially rifampin, inhibiting the formation of messenger RNAs of SARS ncov-2 or to the synergistic effect of chloroquine and rifampin. Researchers should explore the effect of these drugs on SARS ncov-2.
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Affiliation(s)
- Fah Bouaré
- Coronavirus Infection Unit, Department of Neurosurgery of The Arrazi Hospital, King Mohammed VI University Teaching Hospital, BP2360 Principal, Ibn Sina Avenue, Marrakesh
| | - Mehdi Laghmari
- Coronavirus Infection Unit, Department of Neurosurgery of The Arrazi Hospital, King Mohammed VI University Teaching Hospital, BP2360 Principal, Ibn Sina Avenue, Marrakesh
| | - Felicité Nyafame Etouche
- Coronavirus Infection Unit, Department of Infectious Diseases of the Arrazi Hospital, King Mohammed VI University Teaching Hospital, BP2360 Principal, Ibn Sina Avenue, Marrakesh
| | - Badr Arjdal
- Coronavirus Infection Unit, Department of Neurosurgery of The Arrazi Hospital, King Mohammed VI University Teaching Hospital, BP2360 Principal, Ibn Sina Avenue, Marrakesh
| | - Imane Saidi
- Coronavirus Infection Unit, Department of Respiratory Medicine of the Arrazi Hospital, King Mohammed VI University Teaching Hospital, BP2360 Principal, Ibn Sina Avenue, Marrakesh
| | - Farouk Hajhouji
- Coronavirus Infection Unit, Department of Neurosurgery of The Arrazi Hospital, King Mohammed VI University Teaching Hospital, BP2360 Principal, Ibn Sina Avenue, Marrakesh
| | - Houssine Ghannane
- Coronavirus Infection Unit, Department of Neurosurgery of The Arrazi Hospital, King Mohammed VI University Teaching Hospital, BP2360 Principal, Ibn Sina Avenue, Marrakesh
| | - Lamyae Amro
- Coronavirus Infection Unit, Department of Respiratory Medicine of the Arrazi Hospital, King Mohammed VI University Teaching Hospital, BP2360 Principal, Ibn Sina Avenue, Marrakesh
| | - Noura Tassi
- Coronavirus Infection Unit, Department of Infectious Diseases of the Arrazi Hospital, King Mohammed VI University Teaching Hospital, BP2360 Principal, Ibn Sina Avenue, Marrakesh
| | - Said Ait Benali
- Coronavirus Infection Unit, Department of Neurosurgery of The Arrazi Hospital, King Mohammed VI University Teaching Hospital, BP2360 Principal, Ibn Sina Avenue, Marrakesh
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Benyaich Z, Hajhouji F, Laghmari M, Ghannane H, Aniba K, Lmejjati M, Ait Benali S. Awake Craniotomy with Functional Mapping for Glioma Resection in a Limited-Resource-Setting: Preliminary Experience from a Lower-Middle Income Country. World Neurosurg 2020; 139:200-207. [PMID: 32311556 DOI: 10.1016/j.wneu.2020.04.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Awake craniotomy with brain mapping aims to maximize resection of gliomas located within eloquent regions while minimizing the risk of postoperative deficits. This technique is common practice in the developed world but has yet to be implemented in most low- and middle-income countries (LMICs). We assessed the feasibility, safety, and efficiency of functional-based glioma resection using minimal facilities in a limited-resource institution. METHODS This is a retrospective review of patients harboring gliomas within eloquent regions who underwent awake craniotomy and tumor resection guided by cortico-subcortical mapping at a tertiary hospital of an LMIC. Patient characteristics, surgical results, and functional outcomes were studied. RESULTS Twenty consecutive patients with a mean age of 37 years were enrolled in the study. Seizure, present in 70% of patients, was the major presenting symptom. Eighteen patients had diffuse low-grade gliomas and 2 patients had high-grade gliomas. Intraoperative events were dominated by seizures, occurring in 5 patients (25%). The average extent of tumor removal was 89.5% and the rate of total and subtotal removal was 85%. New postoperative deficits were observed in 5 patients (25%), and permanent deficits were found in 1 patient (5%). The main hurdles encountered were the difficulties in investigating patients and human resource availability. CONCLUSIONS Awake craniotomy with brain mapping for functional-based resection of gliomas can be safely achieved in a limited-resource institution with good functional and oncologic results.
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Affiliation(s)
- Zakariae Benyaich
- Department of Neurosurgery, Mohamed the VIth University Hospital Center of Marrakech, Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco.
| | - Farouk Hajhouji
- Department of Neurosurgery, Mohamed the VIth University Hospital Center of Marrakech, Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Mehdi Laghmari
- Department of Neurosurgery, Mohamed the VIth University Hospital Center of Marrakech, Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Houssine Ghannane
- Department of Neurosurgery, Mohamed the VIth University Hospital Center of Marrakech, Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Khalid Aniba
- Department of Neurosurgery, Mohamed the VIth University Hospital Center of Marrakech, Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Mohamed Lmejjati
- Department of Neurosurgery, Mohamed the VIth University Hospital Center of Marrakech, Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Said Ait Benali
- Department of Neurosurgery, Mohamed the VIth University Hospital Center of Marrakech, Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
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Hajhouji F, Ganau M, Helene C, Romano A, Gubian A, Proust F, Chibbaro S. Rare encounters: Primary pineal malignant melanoma with lepto-meningeal spread. Case report and literature review on management challenges and outcomes. J Clin Neurosci 2019; 65:161-165. [DOI: 10.1016/j.jocn.2019.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 03/22/2019] [Indexed: 12/24/2022]
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Hajhouji F, Lmejjati M, Aniba K, Laghmari M, Ghannane H, Benali SA. Foramen magnum meningioma's management: the experience of the department of neurosurgery in Marrakesh. Pan Afr Med J 2017; 26:42. [PMID: 28451020 PMCID: PMC5398218 DOI: 10.11604/pamj.2017.26.42.10838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 01/22/2017] [Indexed: 11/11/2022] Open
Abstract
Our study is a retrospective analysis of the clinical data, surgical outcomes, histological finding and prognosis of foramen magnum meningiomas through a serie of 8 cases operated at the department of neurosurgery at Mohammed VI medical university hospital, Marrakesh. From January 2002 to December 2015. There were 3 male and 5 female patients (mean age, 46.75 years). Cervico-occipital pain (100%) and motor deficit (100%) were the most common presenting symptoms. MRI was the most appropriate diagnostic tool in visualizing tumors of this region. All operations were performed by the posterior approach and gross total resection was achieved in 7 cases. Surgical mortality was 20%. 3 other patients had complications like CSF leak (25%), meningitis (12,5%) and transient worsening of neurological deficit (12.5%) but made neurological recovery later. Foramen magnum meningiomas have long been regarded as difficult lesions both in terms of diagnosis and management. However, with the availability of MR imaging, newer surgical techniques and skull base exposures, the excision of these lesions is becoming easier and safer.
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Affiliation(s)
- Farouk Hajhouji
- Department of Neurosurgery, Mohammed the sixth University Hospital, Marrakesh, Morocco
| | - Mohammed Lmejjati
- Department of Neurosurgery, Mohammed the sixth University Hospital, Marrakesh, Morocco
| | - Khalid Aniba
- Department of Neurosurgery, Mohammed the sixth University Hospital, Marrakesh, Morocco
| | - Mehdi Laghmari
- Department of Neurosurgery, Mohammed the sixth University Hospital, Marrakesh, Morocco
| | - Houssine Ghannane
- Department of Neurosurgery, Mohammed the sixth University Hospital, Marrakesh, Morocco
| | - Said Ait Benali
- Department of Neurosurgery, Mohammed the sixth University Hospital, Marrakesh, Morocco
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Hajhouji F, Aniba K, Laghmari M, Lmejjati M, Ghannane H, Benali SA. Epilepsy: unusual presentation of cerebral hydatid disease in Children. Pan Afr Med J 2017; 25:58. [PMID: 28250882 PMCID: PMC5321155 DOI: 10.11604/pamj.2016.25.58.10706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 09/26/2016] [Indexed: 12/05/2022] Open
Abstract
Cerebral hydatid disease is very rare, representing only 2% of all cerebral space occupying lesions even in the countries where the disease is endemic. Intracranial hydatid cysts are more common in children and occur more frequently in the supratentorial space. The aim of this paper is to describe the characteristic features of computed tomography (CT) and magnetic resonance imaging (MRI), and to determine the clinical presentation and surgical outcome of cerebral hydatid disease. A 7-year-old girl was admitted to the emergency department because of an epileptic attack. On radiological examination a round, cystic lesion appeared in the parietal lobe and caused shift of the midline structures. The cyst was successfully removed using the dowling technique. The postoperative period was uneventful and seizures were not seen during follow up. Hydatid cyst of the brain presents clinically as intracranial space occupying lesion and is more common in children, it is well demonstrated by CT and MR examinations, and Surgery is the treatment option with affordable morbidity and low mortality.
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Affiliation(s)
- Farouk Hajhouji
- Department of Neurosurgery, Mohammed the sixth University Hospital, Marrakesh, Morocco
| | - Khalid Aniba
- Department of Neurosurgery, Mohammed the sixth University Hospital, Marrakesh, Morocco
| | - Mehdi Laghmari
- Department of Neurosurgery, Mohammed the sixth University Hospital, Marrakesh, Morocco
| | - Mohammed Lmejjati
- Department of Neurosurgery, Mohammed the sixth University Hospital, Marrakesh, Morocco
| | - Houssine Ghannane
- Department of Neurosurgery, Mohammed the sixth University Hospital, Marrakesh, Morocco
| | - Said Ait Benali
- Department of Neurosurgery, Mohammed the sixth University Hospital, Marrakesh, Morocco
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Hajhouji F, Chibbaro S, Proust F. Mélanome malin primitif de la pinéale : à propos d’un cas et revue de la littérature. Neurochirurgie 2017. [DOI: 10.1016/j.neuchi.2016.11.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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