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van Braak H, Gorter RR, van Wijk MP, de Jong JR. Laparoscopic Roux-en-Y feeding jejunostomy as a long-term solution for severe feeding problems in children. Eur J Pediatr 2023; 182:601-607. [PMID: 36396861 PMCID: PMC9899162 DOI: 10.1007/s00431-022-04705-3] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/19/2022] [Accepted: 11/07/2022] [Indexed: 11/19/2022]
Abstract
UNLABELLED Enteral feeding is a common problem in children with gastric emptying disorders. Traditional feeding methods in these patients often show a high rate of complications and maintenance issues. Laparoscopic Roux-en-Y feeding jejunostomy (LRFJ) has been described in a few patients as a minimal invasive option for enteral access in these children. The aim of this study is to evaluate the outcomes of the LRFJ procedure in our tertiary referral center. We conducted a retrospective case-series including all patients, aged 0-18 years old, that underwent a LFRJ procedure between August 2011 and December 2020 for the indication of oral feeding intolerance due to delayed gastric emptying. Outcomes evaluated were complications (short and long term) and parenteral satisfaction. In total, 12 children were identified that underwent LRFJ for the indication of oral feeding intolerance due to delayed gastric emptying. A total of 16 complications were noted in 8/12 patients (67%). Severity classified by Clavien-Dindo were grade I (n = 13), grade II (n = 1), and grade IIIB (n = 2). In 11/12 patients, parents were satisfied with the results. CONCLUSIONS Although minor complications after LRFJ are common in our patients, this technique is a safe solution in patients with gastric emptying disorders leading to a definitive method of enteral feeding and high parenteral satisfaction. WHAT IS KNOWN • Traditional tube feeding in children (duodenal, PEG-J-tubes) with severe delayed gastric emptying can be challenging with a high rate of complications and maintenance issues. • Open loop jejunostomy and Roux-en-Y jejunostomy are alternative, permanent methods of feeding but either invasive or are accompanied by severe complications. Little is known in the literature about laparoscopic Roux-en-Y feeding jejunostomy. WHAT IS NEW • Laparoscopic Roux-en-Y feeding jejunostomy is a permanent, safe and minimal invasive alternative option for enteral feeding in children with severe delayed gastric emptying..
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Affiliation(s)
- H van Braak
- Department of Pediatric Surgery, Amsterdam University Medical Center, Noord-Holland, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - R R Gorter
- Department of Pediatric Surgery, Amsterdam University Medical Center, Noord-Holland, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - M P van Wijk
- Department of Pediatric Gastroenterology, Amsterdam University Medical Center, Noord-Holland, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - J R de Jong
- Department of Pediatric Surgery, Amsterdam University Medical Center, Noord-Holland, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Roorda D, van der Steeg AFW, van Dijk M, Derikx JPM, Gorter RR, Rotteveel J, van Goudoever JB, van Heurn LWE, Oosterlaan J, Haverman L. Distress and post-traumatic stress in parents of patients with congenital gastrointestinal malformations: a cross-sectional cohort study. Orphanet J Rare Dis 2022; 17:353. [PMID: 36089585 PMCID: PMC9465926 DOI: 10.1186/s13023-022-02502-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Congenital gastrointestinal malformation (CGIM) require neonatal surgical treatment and may lead to disease-specific sequelae, which have a potential psychological impact on parents. The aim of this study is to assess distress and symptoms of post-traumatic stress disorder (PTSD) in parents of patients with CGIM. In this cross-sectional study, seventy-nine parents (47 mothers and 32 fathers) of 53 patients with CGIM completed the Distress Thermometer for Parents (DT-P) and the Self Rating Scale for Posttraumatic Stress Disorders (SRS-PTSD) as part of the multidisciplinary follow-up of their children (aged 5–35 months). Group differences were tested between parents and representative Dutch reference groups with regard to rates of (clinical) distress and PTSD, and severity of overall distress and PTSD, for mothers and fathers separately. Mixed model regression models were used to study factors associated with the risk of (clinical) distress, PTSD and with severity of symptoms of PTSD (intrusion, avoidance and hyperarousal).
Results
Prevalence of clinical distress was comparable to reference groups for mothers (46%) and fathers (34%). There was no difference in severity of overall distress between both mothers as well as fathers and reference groups. Prevalence of PTSD was significantly higher in mothers (23%) compared to the reference group (5.3%) (OR = 5.51, p < 0.001), not in fathers (6.3% vs 2.2.%). Symptoms of intrusion were commonly reported by all the parents (75%). Longer total length of child’s hospital stay was associated with more severe symptoms of intrusion, avoidance and hyperarousal. Child’s length of follow-up was negatively associated with severity of intrusion.
Conclusions
Having a child with CGIM has a huge impact on parents, demonstrated by a higher prevalence of PTSD in mothers, but not fathers, compared to parents in the general population. Monitoring of symptoms of PTSD of parents in follow-up is necessary.
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Knaapen M, Van der Lee JH, Gaillard EL, Cense HA, In 't Hof KH, Kneepkens CMF, Wijnen MH, Heij HA, Bakx R, van Heurn LWE, Gorter RR. Non-operative treatment of children with simple appendicitis: long-term follow-up (5 years) in a prospective cohort study. Br J Surg 2021; 108:e99-e100. [PMID: 33793731 PMCID: PMC10364911 DOI: 10.1093/bjs/znaa052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/23/2020] [Indexed: 11/14/2022]
Abstract
Long-term results after non-operative treatment for children with simple appendicitis seem promising, possibly avoiding appendicectomy in 70 per cent of children after a median follow-up of 5 years. The need for delayed appendicectomy more than 2 years after the initial treatment is rare (0–5 per cent) and no complications occurred past 1 year, including children who underwent delayed appendicectomy.
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Affiliation(s)
- M Knaapen
- Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - J H Van der Lee
- Paediatric Clinical Research Office, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, the Netherlands
| | - E L Gaillard
- Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - H A Cense
- Department of Surgery, Red Cross Hospital, Beverwijk, the Netherlands
| | - K H In 't Hof
- Department of Surgery, Flevoziekenhuis, Almere, the Netherlands
| | - C M F Kneepkens
- Department of Paediatric Gastroenterology, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - M H Wijnen
- Department of Paediatric Surgery, Princess Maxima Centre, Utrecht, the Netherlands
| | - H A Heij
- Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - R Bakx
- Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - L W E van Heurn
- Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - R R Gorter
- Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Olthof DC, Reemst S, Sleeboom C, Kuijper CF, van Schuppen J, Derikx JPM, Gorter RR. Diagnostic accuracy of abdominal ultrasound to detect pathology that needs surgical exploration in children with umbilical discharge. J Pediatr Surg 2021; 56:1436-1440. [PMID: 32951887 DOI: 10.1016/j.jpedsurg.2020.07.036] [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: 06/19/2020] [Revised: 07/08/2020] [Accepted: 07/16/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Umbilical discharge is common in children and mostly attributed to infection or granuloma. However, an underlying congenital abnormality warranting surgery might also be present. Ultrasound is the imaging modality of choice to diagnose the presence of a congenital abnormality. The aim of this study is to investigate diagnostic accuracy of the ultrasound to detect pathology requiring surgical excision. METHODS All patients ≤18 years with umbilical discharge from January 2008 to September 2019 were retrospectively included. Diagnostic accuracy, i.e., sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR-), were calculated. RESULTS Eighty-one patients were included and 56 were operated. The ultrasound was false positive in 10 patients and false negative in 13 patients. The sensitivity of ultrasound was 71.1% (95% CI 55.7-83.6), specificity 72.2% (54.8-85.8), PPV 76.2% (64.7-84.8), NPV 66.7% (54.8-76.8), LR+ 2.6 (1.5-4.5) and LR- 0.40 (0.2-0.7). CONCLUSIONS This study shows that the diagnostic accuracy of ultrasound for detecting underlying congenital abnormalities warranting surgery for umbilical discharge in the pediatric population is low, even with experienced pediatric radiologists. Therefore, the role of the ultrasound in the diagnostic workup and value in clinical decision making is limited. TYPE OF STUDY Study of diagnostic test. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Sophie Reemst
- Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - C F Kuijper
- Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - J P M Derikx
- Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
| | - R R Gorter
- Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
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Bom WJ, Knaapen M, Gorter RR, van Rossem CC. [Revised guideline for acute appendicitis. Amendments to diagnostics and treatment]. Ned Tijdschr Geneeskd 2020; 164:D4470. [PMID: 32406636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Recently, the revised guideline 'Guideline for diagnostics and treatment of acute appendicitis' was published by the Dutch Surgical Society. A patient with limited clinical symptoms and low suspicion of appendicitis can be assessed again at a later time, during which ultrasound diagnostics can be repeated. Following an inconclusive ultrasound scan in children who possibly have appendicitis, it is no longer recommended to perform diagnostic laparoscopy; rather, MRI diagnostics are indicated. In young adults with possible appendicitis, in whom a diagnosis cannot be established using ultrasound, the advice is to use MRI diagnostics instead of CT imaging; this particularly applies to women of child-bearing age. For patients with appendicitis an appendectomy remains the recommended treatment, although one can consider treating adults with suspected simple appendicitis with antibiotics alone. It is important that this decision is made in consultation with the patient. Laparoscopic appendectomy reduces the number of wound infections and admission length, and is therefore usually preferred over open method appendectomy. If a patient with appendicitis is 24-28 weeks pregnant,consultation with a specialist centre is indicated regarding the obstetric management and possibly referral.
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Affiliation(s)
- W J Bom
- Tergooi Ziekenhuis, afd. Chirurgie, Hilversum/Blaricum
- Contact: W. J. Bom
| | - M Knaapen
- Amsterdam UMC, afd. Kinderchirurgie, Amsterdam
| | - R R Gorter
- Amsterdam UMC, afd. Kinderchirurgie, Amsterdam
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Bom WJ, Knaapen M, Gorter RR, van Rossem CC. [Acute appendicitis: treatment in accordance with new guideline]. Ned Tijdschr Geneeskd 2020; 164:D4690. [PMID: 32406639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In this clinical lesson we present two patient cases. A 66-year-old female patient with a clinical, biochemical and radiological suspicion of complex appendicitis. The patient undergoes an appendectomy and post-operative recovery is beset with complications. The other case involves a 24-year-old male patient with suspected simple appendicitis. He is successfully treated with antibiotics and without surgery. By using these patients as examples, we discuss the revised clinical guideline for diagnosing and treating acute appendicitis. Besides that, we also discuss the differentiation between simple and complex appendicitis and how this can influence the treatment plan.
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Affiliation(s)
- W J Bom
- Tergooi Ziekenhuis, afd. Chirurgie, Hilversum/Blaricum
- Contact: W. J. Bom
| | - M Knaapen
- Amsterdam UMC, afd. Kinderchirurgie, Amsterdam
| | - R R Gorter
- Amsterdam UMC, afd. Kinderchirurgie, Amsterdam
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Reiber BMM, Gorter RR, Tenhagen M, Cense HA, Demirkiran A. [Mesenteric venous thrombosis during pregnancy; a rare cause of acute ischaemia of the small intestine]. Ned Tijdschr Geneeskd 2016; 160:A9898. [PMID: 27353154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Acute ischaemia of the small intestine is caused by mesenteric venous thrombosis in 5-15% of patients. The non-specific symptoms frequently lead to a diagnostic delay. CASE DESCRIPTION A 30-year-old pregnant woman presented at the accident and emergency department with progressive abdominal pain, nausea and vomiting. During admission the patient developed signs of peritonitis. Diagnostic laparoscopy revealed a picture of mesenteric venous thrombosis, and we resected 170 cm ischemic small intestine. No underlying cause was identified, apart from the pregnancy. The patient was treated with low-molecular-weight heparin and later gave birth to a healthy child. CONCLUSION If a patient presents with (unexplained) progressive abdominal symptoms and disproportional abdominal pain without peritonitis, the possibility of intestinal ischaemia should be considered during differential diagnosis.
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Affiliation(s)
- B M M Reiber
- Rode Kruis Ziekenhuis, afd. Heelkunde, Beverwijk
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van den Boom AL, Gorter RR, van Haard PMM, Doornebosch PG, Heij HA, Dawson I. The impact of disease severity, age and surgical approach on the outcome of acute appendicitis in children. Pediatr Surg Int 2015; 31:339-45. [PMID: 25687156 DOI: 10.1007/s00383-015-3677-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE Although a national guideline has been implemented, the optimal approach for appendectomy in children remains subject of debate in the Netherlands. Opponents of laparoscopy raise their concerns regarding its use in complex appendicitis as it is reported to be associated with an increased incidence of intra-abdominal abscesses. The aim of this study was to evaluate the outcome of surgical approaches in both simple and complex appendicitis in paediatric patients. METHODS A 10-year retrospective cohort study was performed (2001-2010) in paediatric patients treated for suspected acute appendicitis. Patients were divided into either simple or complex appendicitis and into different age groups. Primary outcome parameters were complication rate (intra-abdominal abscess (IAA), superficial surgical site infection (SSI) and readmission) and hospital stay. RESULTS In total, 878 patients have been treated (median age 12, range 0-17 years). Two-thirds of the patients younger than 6 years had complex appendicitis, compared to one quarter in the group aged 13-18. In the complex appendicitis group, LA was associated with more IAA and early readmissions. In the simple appendicitis group, the complication rate was comparable between the two approaches. Significantly more IAAs were seen after LA in the youngest age group. CONCLUSION This study demonstrates the unfavourable outcome of LA in the youngest age group and in patients with complex appendicitis. Therefore, we advise to treat these patients with an open approach.
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Affiliation(s)
- A L van den Boom
- Surgery, IJsselland ziekenhuis, Pr Constantijnweg 2, 2906 ZC, Capelle aan den ijssel, The Netherlands,
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Gorter RR, van der Lee JH, Go PMNYH, Wijnen MHWA, Meijer RW, Cense HA, Kneepkens CMF, Heij HA. Appendicitis in children: an ongoing debate. Pediatr Surg Int 2013; 29:759-60. [PMID: 23456287 DOI: 10.1007/s00383-013-3288-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2013] [Indexed: 11/29/2022]
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Abstract
INTRODUCTION Various surgical methods are used to treat meconium ileus (MI), including resection with enterostomy (RES), primary anastomosis (RPA), and purse-string enterotomy with intra-operative lavage (PSI). The aim of this study is to discuss the surgical treatment of MI, based on our experience. PATIENTS AND METHODS Of the 41 MI patients treated at our institution between 1984 and 2007, 18 had simple MI and 23 had complex MI. These groups were analyzed according to treatment modality, concentrating on length of hospital stay, complications [peritonitis, septicemia, adhesive small bowel obstruction (ASBO), and malabsorption/diarrhea], need for additional surgical procedures, mortality. RESULTS Of the 18 patients with simple MI, 7 (39%) were successfully treated with diluted Gastrografin® enema. The remaining 11 patients were treated surgically: two underwent RPA, of whom one died; five had RES, of whom one developed ASBO; four underwent PSI, of whom two developed peritonitis. In the complex MI group, 14 patients underwent RPA, with peritonitis occurring in three (one died); nine underwent RES, of whom two developed ASBO. CONCLUSION In patients with simple MI, conservative treatment with diluted Gastrografin® enema is an effective initial treatment in our hands. In case of failure, RES is advisable. Patients with complex MI are candidates for RES. RPA and PSI seem to have higher complication rates.
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Affiliation(s)
- A. Karimi
- Pediatric Surgical Center of Amsterdam, Emma Children’s Hospital AMC and VU University Medical Center, P. O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - R. R. Gorter
- Pediatric Surgical Center of Amsterdam, Emma Children’s Hospital AMC and VU University Medical Center, P. O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Chr. Sleeboom
- Pediatric Surgical Center of Amsterdam, Emma Children’s Hospital AMC and VU University Medical Center, P. O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - C. M. F. Kneepkens
- Department of Pediatric Gastroenterology, VU University Medical Center, Amsterdam, The Netherlands
| | - H. A. Heij
- Pediatric Surgical Center of Amsterdam, Emma Children’s Hospital AMC and VU University Medical Center, P. O. Box 22660, 1100 DD Amsterdam, The Netherlands
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Abstract
Trichobezoars (hair ball) are usually located in the stomach, but may extend through the pylorus into the duodenum and small bowel (Rapunzel syndrome). They are almost always associated with trichotillomania and trichophagia or other psychiatric disorders. In the literature several treatment options are proposed, including removal by conventional laparotomy, laparoscopy and endoscopy. We present our experience with four patients and provide a review of the recent literature. According to our experience and in line with the published results, conventional laparotomy is still the treatment of choice. In addition, psychiatric consultation is necessary to prevent relapses.
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Affiliation(s)
- R. R. Gorter
- Pediatric Surgical Center of Amsterdam, Emma Children’s Hospital AMC and VU University Medical Center, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - C. M. F. Kneepkens
- Department of Pediatric Gastroenterology, VU University Medical Center, Amsterdam, The Netherlands
| | - E. C. J. L. Mattens
- Pediatric Surgical Center of Amsterdam, Emma Children’s Hospital AMC and VU University Medical Center, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - D. C. Aronson
- Pediatric Surgical Center of Amsterdam, Emma Children’s Hospital AMC and VU University Medical Center, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
- Present Address: Department (Division) of Pediatric Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - H. A. Heij
- Pediatric Surgical Center of Amsterdam, Emma Children’s Hospital AMC and VU University Medical Center, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
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