Elbow Arthroscopy

5.9 Conclusions Taking in consideration the high rate of success and low rate of complications in literature and in our personal experience we consider, in respect of literature indications, elbow arthroscopy as first choice treatment ...

Elbow Arthroscopy

This book, which derives from an initiative of the Education Committee of The International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS), addresses all aspects of elbow arthroscopy. Anatomy is thoroughly introduced, referencing safe portals and describing techniques to minimize risk of complications. Subsequent chapters focus on the use of arthroscopy in a range of conditions, including osteochondritis dissecans, stiff elbow, epicondylitis, elbow instability, and elbow fractures. Guidance is provided on diagnosis and indications for arthroscopy, and arthroscopic technique is clearly detailed. A key chapter describes complications and how to avoid them. The authors are experts and pioneers in the field from North America, Australia, and Europe who have in common the ability to teach complex procedures in a simple way. This book will be an invaluable aid for the developing surgeon and an excellent reference for the experienced surgeon.​

Wrist and Elbow Arthroscopy

J Bone Joint Surg Am. 1932;14:349–50. 3. Andrews JR, Carson WG. Arthroscopy of the elbow. Arthroscopy. 1985;1:97–107. 4. Holt SM, Savoie III FH, Field LD, et al. Arthroscopic management of elbow trauma. Hand Clin. 2004;20:485–95. 5.

Wrist and Elbow Arthroscopy

This fully revised and updated follow-up to Dr. William B. Geissler’s Wrist Arthroscopy has expanded its scope to include arthroscopy techniques of the elbow in addition to the wrist. This practical guide covers fundamental topics, such as arthroscopic anatomy, set-up and the proper evaluation of wrist and elbow pain, along with advanced discussions of electrothermal shrinkage, arthroscopy of the thumb and small joints of the hand, and specific diagnoses for an array of common injuries. Current minimally invasive procedures are described in detail, including management of carpal instability, arthroscopic proximal row carpectomy, arthroscopic knotless TFCC repair, arthroscopic SLIC screw for scapholunate instability, arthroscopic fixation of intra-articular fractures of the hand, arthroscopic partial wrist fusions, and innovative techniques in dry arthroscopy. Arthroscopic management of the elbow includes treatment for arthritis, contractures and instability. Selected chapters contain companion video as well, demonstrating surgical set-up and arthroscopic techniques. Written by a truly international cast and edited by an expert in arthroscopic hand and upper extremity surgery, Wrist and Elbow Arthroscopy is a practical guide to technique for orthopedic surgeons, hand surgeons, and sports medicine practitioners alike.

Wrist and Elbow Arthroscopy with Selected Open Procedures

Conclusion While still evolving, arthroscopy has already established a role in elbow trauma management. It should only be considered a useful adjunct, however, if it facilitates the exposure or makes the reduction and fixation easier, ...

Wrist and Elbow Arthroscopy with Selected Open Procedures

Now in its revised and significantly expanded third edition, this comprehensive, authoritative text reinforces its standing as the gold standard on arthroscopic techniques for the wrist and elbow, now including selected open surgical techniques as well. Fundamental topics, such as anatomy, operative set-up, assessment, and lasers and electrothermal devices open the book. Generously illustrated with intraoperative photographs and full-color figures, chapters covering arthroscopic techniques are full-length and in detail. Topics include the management of TFCC tears, joint instability, arthritis, fractures and nonunions, dorsal and volar ganglions, and many more conditions and injuries of the wrist and elbow. While chapters on open techniques could present an extensive history and background of the subject as compared to the arthroscopic chapters, they will be focused approaches discussing why the author thinks it is the best open technique, including tips, tricks, pearls and how to perform the operation. Open management of ulnar impaction, scapholunate instability, total wrist arthroplasty, and elbow contractures are discussed, among others. Selected chapters include video supplements for additional, real-world demonstrations of techniques. Bringing together a truly international cross-section of experts and thought leaders in orthopedics and hand surgery, Wrist and Elbow Arthroscopy with Selected Open Procedures, Third Edition remains the premier resource for all clinicians working in this field.

Operative Arthroscopy

SUMMARY Arthroscopy of the elbow is a technically demanding surgical procedure, and careful attention to detail is essential to performing a safe and reproducible arthroscopic examination. It is important that the skin be properly ...

Operative Arthroscopy

Extensively revised and updated for its Third Edition, Operative Arthroscopy remains the most comprehensive and authoritative reference in this rapidly advancing specialty. World-renowned experts describe the latest instrumentation and techniques and detail proven minimally invasive procedures for the knee, shoulder, elbow, wrist, hip, foot, ankle, and spine. New topics in this edition include meniscus repair with implantable devices, arthroscopic knot tying, and arthroscopy in athletes. Hundreds of full-color arthroscopic views, surgical exposures, and line drawings guide surgeons in technique and clinical decision-making. This edition includes a free DVD of surgical procedures, with over 200 minutes of video to demonstrate key points and techniques.

Advanced Arthroscopy

Arthroscopy of the elbow joint: a cadaver study. J Bone Joint Surg 1932,14A:349—350. . Watanabe M. Arthroscopy of small joints. J Jpn Orthop Assoc 1971;45:908. . Johnson LL. Diagnostic and surgical arthroscopy. St. Louis: CV Mosby, ...

Advanced Arthroscopy

Focusing on the most current, cutting-edge, innovative, and advanced arthroscopic techniques for wrist and hand, elbow, shoulder, hip, knee, ankle, foot, and spine, this book presents orthopaedic surgeons with the detailed procedures needed to stay competitive in the age of managed care. With contributions from specialist leaders in orthopaedic and arthroscopic surgery, the text is supplemented by full-color arthroscopic views and custom illustrations, detailing complex procedures for rotator cuff tear, TFCC repair, meniscus repair, ACL reconstruction, intraarticular fractures and many others. Special sections on laser applications in arthroscopy and office arthroscopy make this volume a must for every practicing orthopaedic surgeon.

Operative Techniques Shoulder and Elbow Surgery E Book

Complications of elbow arthroscopy. J Bone Joint Surg [Am]. 2001;83:25–34. This retrospective series documented complications in elbow arthroscopy among 473 patients treated for a variety of conditions. (Level III evidence).

Operative Techniques  Shoulder and Elbow Surgery E Book

Part of the practical, highly illustrated Operative Techniques series, this fully revised title by Drs. Donald H. Lee and Robert J. Neviaser brings you up to speed with must-know surgical techniques in today’s technically demanding shoulder and elbow surgery. Step-by-step, evidence-based guidance walks you through both common and unique cases you’re likely to see in your practice, while tips, pearls, and pitfalls help you optimize outcomes. Includes new and comprehensive coverage of nerve transfers for shoulder and elbow restoration after upper trunk brachial plexus injuries, thoracic outlet syndrome, suprascapular nerve neuropathy, closed treatment of shoulder dislocations, and more.

Operative Elbow Surgery E Book

With the advances in techniques and tools for elbow arthroscopy, treatment of the stiff elbow by arthroscopic methods has become increasingly popular. Arthroscopy offers improved joint visualization, reduced pain, smaller scars, ...

Operative Elbow Surgery E Book

This is an authoritative and comprehensive resource for orthopaedic surgeons and trainees dealing with traumatic and non-traumatic disorders of the elbow. It covers all aspects of elbow surgery from anatomy, biomechanics, investigation and diagnosis, to the latest surgical approaches and implant devices. With full colour illustration s throughout this reference work provides practical instructions to the optimal surgical techniques (both traditional open and minimally invasive) for the full range of common and uncommon elbow disorders. An international team of contributors, carefully selected for their particular expertise discuss their preferred approaches and provide practical guidance on bone and soft tissue reconstruction. Comprehensive review of treatment options. Coverage takes you through basic science and biomechanics right up to the clinical application of the latest surgical techniques and devices. Outstanding full colour illustrations incorporated throughout. Provides an accurate visual guide to the surgical approaches and techniques under discussion World class team of expert contributing authors from Europe, Asia, Australia and North America. Therapeutic options and preferred methods of treatment are drawn from all over the world. Accompanying video clips of common procedures. Allows the user to see actual exams and procedures as performed by experts

Arthroscopy and Endoscopy of the Hand Wrist and Elbow

Acknowledgment I would like to thank Dr Shawn O'Driscoll of Mayo Clinic, Rochester, Minnesota USA for his teaching. The principle and surgical technique of elbow arthroscopy I described in this chapter are straightly learned from him.

Arthroscopy and Endoscopy of the Hand  Wrist and Elbow

This book provides detailed advancement on arthroscopy and endoscopy of hand, wrist and elbow. It covers basic knowledge of procedures and dedicated introduction of surgical techniques for disease management. Endoscopic procedures with their advantage in surgical exposure and post-operative rehabilitation have been extensively performed in upper limb diseases. Cases presentation with well-illustrated arthroscopic and endoscopic photos for common clinical conditions was provided. The format is a step-by-step procedure for easy reference, particularly for surgeons in their training.

AANA Advanced Arthroscopy The Wrist and Elbow E Book

William B. Stetson Elbow arthroscopy is a technically demanding procedure, and extensive hands-on training and supervised experience are needed to acquire proficiency. When performed with appropriate judgment and technique, ...

AANA Advanced Arthroscopy  The Wrist and Elbow E Book

AANA Advanced Arthroscopy: The Wrist and Elbow, by Felix H. Savoie, III, MD and Larry D. Field, MD, helps you make the most effective use of advanced and emerging, state-of-the-art arthroscopic techniques for managing a wide range of wrist and elbow problems. Premier arthroscopic surgeons discuss disease-specific options, managing and avoiding complications, and rehabilitation protocols...in print and online. 15 videos demonstrate arthroscopic RH resection for post-traumatic arthritis, arthroscopic management of ulnotriquetral abutment, arthroscopy and the management of MC and phalangeal fractures, two-portal CTR: the Chow technique, elbow PLICA arthroscopic débridement, and more. Access the fully searchable text, along with a video library of procedures and links to PubMed online at expertconsult.com. Stay current through coverage of hot topics like Osteocapsular Arthroplasty of the Elbow; Elbow Fractures; Arthroscopic Excision of Dorsal Ganglion; Midcarpal Instability: Arthroscopic Techniques; Acute Scaphoid Fractures in Nonunions; Carpal, Metacarpal, and Phalangeal Fractures; and Endoscopic Carpal Tunnel Release: Chow Technique. Hone your skills thanks to 15 videos of techniques—on Arthroscopic RH Resection for Post-Traumatic Arthritis, Arthroscopic Management of Ulnotriquetral Abutment, Arthroscopy and the Management of MC and Phalangeal Fractures, Two-Portal CTR: The Chow Technique, Elbow PLICA Arthroscopic Débridement, and more—performed by experts. See arthroscopic surgical details in full color and understand nuances through interpretative drawings of technical details. Optimize surgical results and outcomes with an emphasis on advanced and emerging arthroscopic techniques, surgical tips, and pearls.

Essential Techniques in Elbow Surgery

Haapaniemi T, Berggren M, Adolfsson L. Complete transaction of the median and radial nerves during arthroscopic release of posttraumatic elbow contracture. Arthroscopy. 1999;15:784–7. 2. Jones GS, Savoie III FH.

Essential Techniques in Elbow Surgery

This book provides surgical tips, pearls and pitfalls of the ten most common surgical procedures performed by elbow surgeons in daily clinical practice. It is written by some of the most recognized elbow surgeons in the world and follows a homogeneous format so the reader can easily grasp the key points. A very high quality of pictures depicting the surgical steps, together with representative drawings is one of the main strengths of this book. After reading this concise guide, the reader will feel confident in performing basic surgical procedures around the elbow, knowing where the risks are and improving the technique to achieve an optimal results for patients.

Essentials In Elbow Surgery

Functional outcomes of arthroscopic capsular release of the elbow. Arthroscopy. 2006;8:842–9. 7. Shahane SA, Stanley D. A posterior approach to the elbow joint. J Bone Joint Surg Br. 1999;81(6):1020–2. 8.

Essentials In Elbow Surgery

The idea of this book is very simple. Nowadays, there are many good, very comprehensive, “thick” books available on Elbow Surgery. Although they are useful to obtain discrete information about specific topics, they are too large to be a user friendly for a general orthopedic surgeon facing common elbow problems. The increasing interest among young surgeons on elbow problems is remarkable. It has been our experience throughout the years, teaching our residents and visitors, that there is a real demand for a less extensive book, easy to read, and with practical information about the most commonly encountered problems of the elbow. This text would be enough to understand the common elbow practice for a general orthopedic surgeon and a guide to learn basic elbow surgery during training. There is nothing like this available today. It will be strongly oriented to practice, and all the authors, well known internationally for their expertise on elbow surgery, will be homogeneous in their message.

The Elbow and Its Disorders

The patient is seen in the office 1 week after surgery, and his or her progress is monitored so that full range of motion is attained. OUTCOMES AND FUTURE DIRECTIONS Probably one of the most successful operations in elbow arthroscopy is ...

The Elbow and Its Disorders

A must-have resource for any orthopaedic library, the latest edition of this technique-focused guide to the elbow has been revised and updated to give you even more coverage of trauma, arthroscopy, soft tissue injury, and joint replacement. the new full-color illustrations visually enhance an already great resource for both the novice becoming familiar with elbow anatomy and biomechanics and the seasoned surgeon treating difficult elbow problems.

Arthroscopy and Endoscopy of the Elbow Wrist and Hand

Pederzini LA, Nicoletta F, Tosi M, Prandini M, Tripoli E, Cossio A. Elbow arthroscopy in stiff elbow. Knee Surg Sports Traumatol Arthrosc. 2014;22(2):467–73. 13. Swaroop A, Avasthi S, Yadav M, Kumar S, Bharti A, Sengar G. Assessment of ...

Arthroscopy and Endoscopy of the Elbow  Wrist and Hand

This book explores the numerous recent advances in arthroscopic and endoscopic surgery of the smaller joints of the upper extremity – elbow, wrist, and hand. Providing readers with all necessary information, i.e. relevant surgical anatomy and a clear description of technical steps, it uniquely and comprehensively presents arthroscopic and endoscopic techniques of small joints in one publication. The procedures are subdivided according to the pathology (instability, fractures, etc.) or grouped by the region within the anatomical area and include the relevant anatomy, extensive cadaveric dissections, devices and instrumentation, surgical procedures, pearls and pitfalls. High-quality colour illustrations further simplify and complement the description of surgical techniques. Written by pioneers of these techniques, the book is designed to be an up-to-date reference resource for both new and advanced orthopaedic surgeons wanting to become familiar with these techniques.

Surgical Techniques for Trauma and Sports Related Injuries of the Elbow

Complications of elbow arthroscopy. J Bone Joint Surg Am. 2001;83-A(1):25–34. 2. Leong N, Cohen J, Lord E, Wang J, McAllister D, Petrigliano F. Demographic trends and complication rates in arthroscopic elbow surgery. Arthroscopy.

Surgical Techniques for Trauma and Sports Related Injuries of the Elbow

In this book, leading international surgeons with expertise in the field provide cutting-edge information on the surgical techniques to treat sports and trauma injuries of the elbow. Indications for the different techniques are clearly explained, and practical aspects that allow safe and reproducible clinical outcomes are described. For the common procedures, a number of surgical technique options are presented, ensuring that the reader gains a broader perspective on this evolving surgical field. Throughout, valuable tips and tricks are highlighted that will assist both the experienced and the training surgeon in achieving maximum efficiency in their surgical practice. The book includes hundreds of illustrations, line diagrams, and clinical and cadaveric photographs to assist the reader in appreciating the principles of the clinical anatomy and the surgical techniques. Videos aid in understanding the finer points of the procedures. Surgical Techniques for Sports and Trauma Related Injuries of the Elbow is published in collaboration with ISAKOS. It will provide readers with a new comprehension of the topic and will be of value to students, physiotherapists, sports physicians, and orthopaedic surgeons.

Operative Techniques in Hand Wrist and Elbow Surgery

Biomechanics of the elbow. In: Morrey BF, ed. The Elbow and Its Disorders. Philadelphia: WB Saunders, 2000: 43–74. 3. Ball CM, Meunier M, Galatz LM, et al. Arthroscopic treatment of posttraumatic elbow contracture. J Should Elbow Surg ...

Operative Techniques in Hand  Wrist  and Elbow Surgery

Derived from Sam W. Wiesel’s four-volume Operative Techniques in Orthopaedic Surgery, this single-volume resource contains the user-friendly, step-by-step information you need to confidently perform the full range of operative techniques from the hand to the elbow. In one convenient place, you’ll find the entire Hand, Wrist, and Elbow section, as well as relevant chapters from the Shoulder and Elbow, Pediatrics, Sports Medicine, and Oncology sections of Operative Techniques in Orthopaedic Surgery. Superb full-color illustrations and step-by-step explanations help you master surgical techniques, select the best procedure, avoid complications, and anticipate outcomes. Written by global experts from leading institutions, Operative Techniques in Hand, Wrist, and Elbow Surgery, 2nd Edition, provides authoritative, easy-to-follow guidance to both the novice trainee or experienced surgeon.

Surgical Techniques of the Shoulder Elbow and Knee in Sports Medicine E Book

Elbow arthroscopy. J Am Acad Orthop Surg. 2008;16:574–585. 2. Wada T, Yamauchi M, Oki G, Sonoda T, Yamakage M, Yamashita T. Efficacy of axillary nerve block in elbow arthroscopic surgery: a randomized trial. J Shoulder Elbow Surg.

Surgical Techniques of the Shoulder  Elbow  and Knee in Sports Medicine  E Book

Ensure optimal outcomes from each shoulder, elbow, and knee sports medicine surgery with the consistent, step-by-step approach offered in this comprehensive reference. Surgical Techniques of the Shoulder, Elbow, and Knee in Sports Medicine, 3rd Edition, covers both open and arthroscopic surgeries, providing the expert guidance you need on everything from patient positioning, anatomy, relevant biomechanics and the latest orthopaedic surgery techniques, through pearls and pitfalls and post-operative care. Contributing authors are renowned sports medicine surgeons who equip you with a global perspective on the most recent orthopaedic advances. Covers the latest open and arthroscopic techniques for both common and not-so-common sports medicine pathologies. Offers a comprehensive approach to each pathology including rehabilitation protocols and return-to-play criteria. Contains more than 15 new chapters: First-time Shoulder Dislocation, Ulnar Collateral Ligament Reconstruction (various techniques), Managing Bone Loss on the Humeral Head, Cartilage Allografts for the Treatment of Cartilage Lesions of the Knee, and many more. Provides up-to-date information on timely topics such as complex decision making for the patellofemoral joint, biologics and injection therapy for the management of osteoarthritis, and primary ACL repair techniques. Highlights step-by-step text with numerous high-quality illustrations, surgical photographs, and MRIs and radiographs. Includes access to an online surgical video collection covering Arthroscopic Rotator Cuff Repair: Double Row Techniques; Arthroscopic Repair of Multidirectional Instability of the Shoulder; Ulnar Collateral Ligament Repair and Reconstruction: DANE Technique; Double Bundle Anterior Cruciate Ligament Reconstruction; and Management of Proximal Tibiofibular Instability.

Campbell s Operative Orthopaedics Sports Injuries of the Shoulder and Elbow E Book

Gallay SH, Richards RR, O'Driscoll SW: Intraarticular capacity and compliance of stiff and normal elbows, Arthroscopy 9:9, 1993. Greis PE, Halbrecht J, Plancher KD: Arthroscopy removal of loose bodies of the elbow, Orthop Clin North Am ...

Campbell s Operative Orthopaedics  Sports Injuries of the Shoulder and Elbow E Book

Now available for the first time - a convenient eBook on sports injuries of the shoulder and elbow from Campbell's Operative Orthopaedics, edited by Drs. S. Terry Canale and James H. Beaty! Load it onto your mobile device or laptop for quick access to world-renowned guidance on shoulder and elbow sports injuries from the experts at the Campbell Clinic. Consult this title on your favorite e-reader with intuitive search tools and adjustable font sizes. Elsevier eBooks provide instant portable access to your entire library, no matter what device you're using or where you're located. Achieve optimal outcomes in managing sports injuries of the shoulder and elbow with practical, high-yield chapters on MRI in Orthopaedics • Shoulder and Elbow Injuries • Recurrent Dislocations • Traumatic Disorders • General Principles • and Shoulder and Elbow Arthroscopy. Vividly visualize how to proceed with 3 surgical videos, plus a wealth of completely new step-by-step illustrations and photos especially commissioned for this edition. Depend on the authority of Campbell's Operative Orthopaedics - the most trusted and widely used resource in orthopaedic surgery, authored by Drs. S. Terry Canale, James H. Beaty, and 5 other authorities from the world-renowned Campbell Clinic. Access other high-interest areas of Campbell's with these other mini eBooks: Reconstructive Procedures of the Knee: 978-0-323-10135-6 Adult Spine Surgery: 978-0-323-10137-0 Hand Surgery: 978-0-323-10138-7

Surgical Techniques in Sports Medicine

Other complications in elbow arthroscopy are iatrogenic articular cartilage injury, infection, persistent drainage of portals, synovial fistula formation, and problems associated with the tourniquet. Complications such as arthrofibrosis ...

Surgical Techniques in Sports Medicine

Featuring more than 950 photographs and drawings—including 500 in full color—this text offers step-by-step instructions on techniques for performing common and complex sports medicine procedures in the upper and lower extremities. Noted experts who have developed or perfected these techniques guide the reader in stepwise detail through each procedure. Where appropriate, the book covers both open and arthroscopic techniques for each injury or problem. Coverage includes the most current and cutting-edge techniques as well as traditional tried and true procedures in operative sports medicine.

Recent Advances in Arthroscopic Surgery

Neurovascular anatomy and elbow arthroscopy: Inherent risks. Arthroscopy. 1987;2(3):191-197 Marshall PD, Fairclough JA, Johnson SR, Evans EJ. Avoiding nerve damage during elbow arthroscopy. Journal of Bone and Joint Surgery.

Recent Advances in Arthroscopic Surgery

This book is aimed at providing an overview of arthroscopic joint surgery involving major joints in the body. It discusses all aspects of arthroscopy including complex surgical procedures, feasibility of performing surgery as an OPD procedure, and complications associated with these surgeries. The chapters are organised in regional basis and presented in an easy-to-understand format. This book will benefit all sports medicine physicians, orthopaedic surgeons and trainees, physiotherapists, and all clinicians involved in treating joint diseases. The combination of the authors' shared experiences with facts and presentation of figures and photographs will help the reader in understanding the complex principles involved. This can be used as a text for an individual or a "must have" reference book for any medical library.

Minimally Invasive Surgery in Orthopedics

Prior to using elbow arthroscopy, a surgeon should be comfortable with similar open procedures, and, as technical skills are learned, procedures of appropriate complexity should be undertaken. It is suggested that when beginning elbow ...

Minimally Invasive Surgery in Orthopedics

Minimally invasive surgery has evolved as an alternative to the traditional approaches in orthopedic surgery and has gathered a great deal of attention. Many surgeons are now p- forming all types of procedures through smaller surgical felds. Along with changes in the surgical technique, there have been rapid advances in computer navigation and robotics as tools to enhance the surgeon’s vision in the limited operative felds. With these new techniques and technologies, we must ensure that these procedures are performed safely and effectively with predictable clinical outcomes. This book has been expanded from our previous publi- tions to include spine and foot and ankle surgery, along with updated sections on knee arth- plasty, hip arthroplasty, and upper extremity surgery. The clinical information and surgical techniques, along with tips and pearls, provided by experts in the feld allows the reader to grasp a comprehensive understanding of the nuances of MIS. It is our intention that this text will be a valuable reference for all orthopedic surgeons. New York, NY Giles R. Scuderi, MD Piscataway, NJ Alfred J. Tria, MD v BookID 127440_ChapID FM_Proof# 1 - 14/09/2009 Contents Section I The Upper Extremities 1 What Is Minimally Invasive Surgery and How Do You Learn It? . . . . . . . . . . . . . . . . . . . . . 3 Aaron G. Rosenberg 2 Overview of Shoulder Approaches: Choosing Between Mini-incision and Arthroscopic Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Raymond A. Klug, Bradford O. Parsons, and Evan L. Flatow 3 Mini-incision Bankart Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Edward W. Lee, Kenneth Accousti, and Evan L. Flatow 4 Mini-open Rotator Cuff Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .