Pub Date : 2023-01-01DOI: 10.4236/ijohns.2023.123013
Abdallah Witti Adou, Awaleh Ahmed Awaleh, Goumaneh Omar, Kamil A. Kamil
{"title":"First Cases of Amygdaloid Cyst in Adults in Djibouti: Case Report of Two Patients","authors":"Abdallah Witti Adou, Awaleh Ahmed Awaleh, Goumaneh Omar, Kamil A. Kamil","doi":"10.4236/ijohns.2023.123013","DOIUrl":"https://doi.org/10.4236/ijohns.2023.123013","url":null,"abstract":"","PeriodicalId":70887,"journal":{"name":"耳鼻喉(英文)","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73888781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4236/ijohns.2023.125031
A. Mbaye, N. Thiam, A. Faye, Mouminatou Seye, H. Ahmed, C. Ndiaye
Dermoid cyst of the oral floor is rare benign tumour, who having three histological aspects: dermoid, teratoid and epidermoid. This one is characterized by the presence of a squamous stratified epithelium with cutaneous remnants. It may occur in any part of the body, however their frequency in the ENT sphere is relatively scarce. Seven per cent (7%) only of epidermoid cysts occur in the cervico-facial area, 1.6% of which locate at the floor level. When they are located submandibular, they can pose diagnostic difficulties and look like a tumour of the submaxillary gland. We report two cases of epidermoid cyst of the floor. Both patients suffered from swelling of the submandibular gland. Magnetic Resonance Imaging was not requested due to lack of resources. However, surgery allowed in both cases the excision of a cyst next to a normal submandibular gland. Patients did well post operatively.
{"title":"Two Cases of Epidermoid Cyst of the Buccal Floor Simulating: A Tumour of the Submandibular Gland","authors":"A. Mbaye, N. Thiam, A. Faye, Mouminatou Seye, H. Ahmed, C. Ndiaye","doi":"10.4236/ijohns.2023.125031","DOIUrl":"https://doi.org/10.4236/ijohns.2023.125031","url":null,"abstract":"Dermoid cyst of the oral floor is rare benign tumour, who having three histological aspects: dermoid, teratoid and epidermoid. This one is characterized by the presence of a squamous stratified epithelium with cutaneous remnants. It may occur in any part of the body, however their frequency in the ENT sphere is relatively scarce. Seven per cent (7%) only of epidermoid cysts occur in the cervico-facial area, 1.6% of which locate at the floor level. When they are located submandibular, they can pose diagnostic difficulties and look like a tumour of the submaxillary gland. We report two cases of epidermoid cyst of the floor. Both patients suffered from swelling of the submandibular gland. Magnetic Resonance Imaging was not requested due to lack of resources. However, surgery allowed in both cases the excision of a cyst next to a normal submandibular gland. Patients did well post operatively.","PeriodicalId":70887,"journal":{"name":"耳鼻喉(英文)","volume":"105 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73115625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4236/ijohns.2023.125037
Louise Mouangue-Mbonjo, Djibril Samaké, Emmanuel Nchinda Choffor, Esthelle Geneviève Ngom, Florent Dimitri Badang, Ahmadou Njifou Njimah, Louis Richard Ndjock, Olive Nicole Pouka
Background: A diverse range of pathologies affect the sinonasal cavities, because of the nonspecific nature of the symptoms, most patients with sinonasal masses are diagnosed late when the disease is at an advanced stage. The diagnostic challenge of identifying the nature of sinonasal masses before treatment would guide therapeutic strategies. Our objective was to evaluate the accuracy of computed tomography in the preoperative diagnosis of sinus masses at the Central Hospital of Yaoundé. Method: A retrospective chart review was conducted; CT scan reports and pathology reports of patients operated for sinonasal masses between January 2012 and November 2022 were compared. Results: Forty-five patients met the inclusion criteria for the study. The average age was 39.98 ± 18.34 years, with extremes of 15 and 87 years. The sex ratio H/F is 0.76 with a female predominance. The median time to consultation was 14 [12 - 18] months, with extremes of 11 and 36 months. The most frequently encountered histological type was benign tumors with sinonasal polyposis (PNS) in the lead, i.e. 34.1% of cases. The types adenocarcinoma, adenoid cystic carcinoma and non-Hodgkin’s lymphoma were represented equally in 6.8% of cases. Management was dominated by Caldwell-Luc surgery, i.e. 59.1% of cases. The frequency of disease recurrence after surgical treatment was 18.2%. As for the mortality rate, it was 11.4%. The concordance rate of the character of malignancy on imaging compared to histology was 90.9%. This level of concordance was statistically significant according to the Gamma test (p < 0.001). The diagnostic performances of imaging in malignant tumors are: Sensitivity 88.9%, Specificity 92.3%, Positive Predictive Value 88.9%, Negative Predictive Value 92.3%. This study shows that computed tomography allows the diagnosis of benign and malignant lesions of sinonasal masses but there are false positive, particularly in the case of the histological type Inverted Papilloma. Conclusion: Preoperative CT scans correlate with histology and have a prognostic role in surgically treated sinonasal masses.
{"title":"Correlation between Computed Tomography and Histopathology Findings of Sinonasal Tumors","authors":"Louise Mouangue-Mbonjo, Djibril Samaké, Emmanuel Nchinda Choffor, Esthelle Geneviève Ngom, Florent Dimitri Badang, Ahmadou Njifou Njimah, Louis Richard Ndjock, Olive Nicole Pouka","doi":"10.4236/ijohns.2023.125037","DOIUrl":"https://doi.org/10.4236/ijohns.2023.125037","url":null,"abstract":"Background: A diverse range of pathologies affect the sinonasal cavities, because of the nonspecific nature of the symptoms, most patients with sinonasal masses are diagnosed late when the disease is at an advanced stage. The diagnostic challenge of identifying the nature of sinonasal masses before treatment would guide therapeutic strategies. Our objective was to evaluate the accuracy of computed tomography in the preoperative diagnosis of sinus masses at the Central Hospital of Yaoundé. Method: A retrospective chart review was conducted; CT scan reports and pathology reports of patients operated for sinonasal masses between January 2012 and November 2022 were compared. Results: Forty-five patients met the inclusion criteria for the study. The average age was 39.98 ± 18.34 years, with extremes of 15 and 87 years. The sex ratio H/F is 0.76 with a female predominance. The median time to consultation was 14 [12 - 18] months, with extremes of 11 and 36 months. The most frequently encountered histological type was benign tumors with sinonasal polyposis (PNS) in the lead, i.e. 34.1% of cases. The types adenocarcinoma, adenoid cystic carcinoma and non-Hodgkin’s lymphoma were represented equally in 6.8% of cases. Management was dominated by Caldwell-Luc surgery, i.e. 59.1% of cases. The frequency of disease recurrence after surgical treatment was 18.2%. As for the mortality rate, it was 11.4%. The concordance rate of the character of malignancy on imaging compared to histology was 90.9%. This level of concordance was statistically significant according to the Gamma test (p < 0.001). The diagnostic performances of imaging in malignant tumors are: Sensitivity 88.9%, Specificity 92.3%, Positive Predictive Value 88.9%, Negative Predictive Value 92.3%. This study shows that computed tomography allows the diagnosis of benign and malignant lesions of sinonasal masses but there are false positive, particularly in the case of the histological type Inverted Papilloma. Conclusion: Preoperative CT scans correlate with histology and have a prognostic role in surgically treated sinonasal masses.","PeriodicalId":70887,"journal":{"name":"耳鼻喉(英文)","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135600460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4236/ijohns.2023.125034
Lauren G. Himes, Nelson H. May, Michele M. Gandolfi
In this case report, we discuss a patient who presented with Tullio’s phenomenon, who also experienced bone-conduction induced seizures on two occasions. Tullio’s phenomenon refers to sound induced vestibular symptoms, including disequilibrium oscillopsia, and vertical nystagmus. We were ultimately able to rule out some of the more common pathologies associated with Tullio’s phenomenon for this patient based on imaging findings. However, given the specific nature of her chronic symptoms, as well as her seizure like activity in clinic, we performed a literature search to investigate other less common pathologies associated with Tullio’s phenomenon. Given her past medical history of mixed psychogenic non-epileptic seizures (PNES), there is likely a somatic component to her presentation. However, given the specific and unexpected nature of these events, we propose that her symptoms may also be related to a unique inner ear pathology. Specifically, we feel that she may have exhibited symptoms of vestibular atelectasis, a relatively new otologic diagnosis characterizing the pathologic collapse of the ampulla and utricle, such that the membranous labyrinth contacts the stapes. In this way, loud sounds or changes in pressure may induce vestibular symptoms. Dizzy patients can be a difficult demographic to diagnose and manage, especially when their presentation is complicated by other functional neurologic disorders. Ultimately, we believe that this case report offers helpful insights into a new disease process associated with Tullio’s phenomenon.
{"title":"Audiogram Bone-Conduction Testing Induced Seizure in Patient with Traumatic Brain Injury","authors":"Lauren G. Himes, Nelson H. May, Michele M. Gandolfi","doi":"10.4236/ijohns.2023.125034","DOIUrl":"https://doi.org/10.4236/ijohns.2023.125034","url":null,"abstract":"In this case report, we discuss a patient who presented with Tullio’s phenomenon, who also experienced bone-conduction induced seizures on two occasions. Tullio’s phenomenon refers to sound induced vestibular symptoms, including disequilibrium oscillopsia, and vertical nystagmus. We were ultimately able to rule out some of the more common pathologies associated with Tullio’s phenomenon for this patient based on imaging findings. However, given the specific nature of her chronic symptoms, as well as her seizure like activity in clinic, we performed a literature search to investigate other less common pathologies associated with Tullio’s phenomenon. Given her past medical history of mixed psychogenic non-epileptic seizures (PNES), there is likely a somatic component to her presentation. However, given the specific and unexpected nature of these events, we propose that her symptoms may also be related to a unique inner ear pathology. Specifically, we feel that she may have exhibited symptoms of vestibular atelectasis, a relatively new otologic diagnosis characterizing the pathologic collapse of the ampulla and utricle, such that the membranous labyrinth contacts the stapes. In this way, loud sounds or changes in pressure may induce vestibular symptoms. Dizzy patients can be a difficult demographic to diagnose and manage, especially when their presentation is complicated by other functional neurologic disorders. Ultimately, we believe that this case report offers helpful insights into a new disease process associated with Tullio’s phenomenon.","PeriodicalId":70887,"journal":{"name":"耳鼻喉(英文)","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135401046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thyroidectomy is a complete or partial surgical removal of the thyroid gland. The aim was to review the particularities of thyroid surgery in children, to review our operative indications and our working method as well as the results by comparing them with the data in the literature. This was a retrospective study covering a sixteen-year period from January 2003 to December 2018. We collated 29 patient records from 3 to 15 years of age. The epidemiological aspect, the indication and the operative gesture, the anatomopathological result were studied. Data were processed using Epi Info version 3.5.4 and Microsoft Excel 2010. Our study shows that thyroid surgery in children accounted for 2% of all thyroidectomies performed (1350 cases). Females were most affected, with a sex ratio of 0.16. The mean age was 12 years, with extremes of 3 and 15 years. Three indication groups: Graves’ disease 62%, heteromulti nodular goiter (HMNG) 28%, thyroid nodule 10%. Thyroid surgery was total in 65.5% of cases; subtotal thyroidectomy in 20.7%. Partial thyroidectomy was performed in 13.7% of cases. We dissected 54 recurrent nerves, and the parathyroids were controlled. Drainage was systematic. We noted one complication (3.4%). It involved immediate postoperative dyspnea requiring a life-saving tracheotomy, and decanulation was performed 48 hours after surgery.
甲状腺切除术是一种完全或部分切除甲状腺的手术。目的是回顾儿童甲状腺手术的特殊性，回顾我们的手术指征和我们的工作方法以及结果，并将其与文献资料进行比较。这是一项回顾性研究，涵盖了从2003年1月到2018年12月的16年时间。我们整理了29例3至15岁的患者记录。对流行病学方面、适应证及手术姿势、解剖病理结果进行了探讨。数据处理采用Epi Info 3.5.4版本和Microsoft Excel 2010。我们的研究表明，儿童甲状腺手术占所有甲状腺切除术的2%(1350例)。女性受影响最大，性别比为0.16。平均年龄为12岁，极值为3岁和15岁。三个适应证组:Graves病62%，异多结节性甲状腺肿(HMNG) 28%，甲状腺结节10%。甲状腺手术占65.5%;甲状腺次全切除术占20.7%。13.7%的病例行甲状腺部分切除术。我们解剖了54条复发神经，控制了甲状旁腺。排水系统。我们注意到一例并发症(3.4%)。术后立即出现呼吸困难，需要进行挽救生命的气管切开术，并在术后48小时进行脱管术。
{"title":"Assessment of Thyroidectomies in Children at the ENT Department of the Thi&#232;s Regional Hospital, about 29 Cases over 16 Years (2003-2018)","authors":"Mamadou Mouctar Ramata Diallo, Ibrahima Diallo, Mamadou Aliou Diallo, Aminata Mbaye, Alsény Camara, Ndiassé Ndiaye, Oumou Amadou Diallo, Abdoulaye Sow, Sory Sacko, Sayon Kourouma, Alpha Oumar Diallo, Mamadou Sakoba Barry, Abdoulaye Keita","doi":"10.4236/ijohns.2023.126039","DOIUrl":"https://doi.org/10.4236/ijohns.2023.126039","url":null,"abstract":"Thyroidectomy is a complete or partial surgical removal of the thyroid gland. The aim was to review the particularities of thyroid surgery in children, to review our operative indications and our working method as well as the results by comparing them with the data in the literature. This was a retrospective study covering a sixteen-year period from January 2003 to December 2018. We collated 29 patient records from 3 to 15 years of age. The epidemiological aspect, the indication and the operative gesture, the anatomopathological result were studied. Data were processed using Epi Info version 3.5.4 and Microsoft Excel 2010. Our study shows that thyroid surgery in children accounted for 2% of all thyroidectomies performed (1350 cases). Females were most affected, with a sex ratio of 0.16. The mean age was 12 years, with extremes of 3 and 15 years. Three indication groups: Graves’ disease 62%, heteromulti nodular goiter (HMNG) 28%, thyroid nodule 10%. Thyroid surgery was total in 65.5% of cases; subtotal thyroidectomy in 20.7%. Partial thyroidectomy was performed in 13.7% of cases. We dissected 54 recurrent nerves, and the parathyroids were controlled. Drainage was systematic. We noted one complication (3.4%). It involved immediate postoperative dyspnea requiring a life-saving tracheotomy, and decanulation was performed 48 hours after surgery.","PeriodicalId":70887,"journal":{"name":"耳鼻喉(英文)","volume":"128 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136304778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4236/ijohns.2023.123021
S. Shanmugam, S. Susikar, Suyash Singodiya
Schwannoma or neurilemmoma is a neurogenic tumor. Around 25% - 45% cases of schwannomas occur in the head and neck, of which less than 4% oc-curs in the nasal cavity and the paranasal sinuses. Isolated schwannomas of the maxillary sinus appear to be extremely rare. We present one such rare case of Right Maxillary Sinus schwannoma in a 48-year-old lady with swelling in the right cheek for 3 years. Infrastructure maxillectomy of the right side was done using Weber-Fergusson approach with Dieffenbach’s modification. The patient made a good postoperative recovery. We report this case keeping in mind the rarity in occurrence of isolated maxillary schwannomas.
{"title":"Maxillary Sinus Schwannoma—A Rare Tumor with Rarer Site of Occurrence","authors":"S. Shanmugam, S. Susikar, Suyash Singodiya","doi":"10.4236/ijohns.2023.123021","DOIUrl":"https://doi.org/10.4236/ijohns.2023.123021","url":null,"abstract":"Schwannoma or neurilemmoma is a neurogenic tumor. Around 25% - 45% cases of schwannomas occur in the head and neck, of which less than 4% oc-curs in the nasal cavity and the paranasal sinuses. Isolated schwannomas of the maxillary sinus appear to be extremely rare. We present one such rare case of Right Maxillary Sinus schwannoma in a 48-year-old lady with swelling in the right cheek for 3 years. Infrastructure maxillectomy of the right side was done using Weber-Fergusson approach with Dieffenbach’s modification. The patient made a good postoperative recovery. We report this case keeping in mind the rarity in occurrence of isolated maxillary schwannomas.","PeriodicalId":70887,"journal":{"name":"耳鼻喉(英文)","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78758432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4236/ijohns.2023.125033
A. Mbaye, Ndiassé Ndiaye, N. Thiam, O. Sano, Rachid Vitamine, Mouhamed Salem Ould Abderrahmane, Maïmouna Diagne, M. Ndiaye
{"title":"Darier-Ferrand Dermofibrosarcoma: A Case Report of a Cervical Localization","authors":"A. Mbaye, Ndiassé Ndiaye, N. Thiam, O. Sano, Rachid Vitamine, Mouhamed Salem Ould Abderrahmane, Maïmouna Diagne, M. Ndiaye","doi":"10.4236/ijohns.2023.125033","DOIUrl":"https://doi.org/10.4236/ijohns.2023.125033","url":null,"abstract":"","PeriodicalId":70887,"journal":{"name":"耳鼻喉(英文)","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90819922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: The congenital malformations of the ear are rare and often isolated, may be unilateral or bilateral, and can be associated with another syndromic malformation. Such malformations so not necessarily impact aesthetics and social relations. Case Presentation: The authors report the case of Samuel M, male born at 38 WA, who is the first child of healthy parents from the same socio-cultural area. His birth weight was 2800 g and he did not have any risk factors for deafness or concept of obstetrical trauma. He presented with congenital malformation manifesting as bilateral ear aplasia with unilateral facial paralysis. Computed tomography revealed abnormalities of the inner ear; functional explorations, such as PEA and OEA, showed findings in favor of bilateral cophosis. ASSR (Auditory Steady-State Responses) was not performed. The announcement of the serious diagnosis of deafness requires multidisciplinary care in order to plan a therapeutic program to limit the impact on the development of language, schooling, and consequently, the socio-professional future of children. Conclusion: This clinical case underlines the fact that interest of the clinical interview before possible multiple surgery does not always guarantee the satisfaction of the desire for repair in this type of patient.
{"title":"Major Ear Aplasia and Cochleovestibular Dysplasia: Rare Congenital Malformation about a Case","authors":"Mouangue-Mbonjo Louise, Epée Ngoué Jeannette, Mantho Fopa Pauline, Njifou Njimah Amadou","doi":"10.4236/ijohns.2023.126043","DOIUrl":"https://doi.org/10.4236/ijohns.2023.126043","url":null,"abstract":"Introduction: The congenital malformations of the ear are rare and often isolated, may be unilateral or bilateral, and can be associated with another syndromic malformation. Such malformations so not necessarily impact aesthetics and social relations. Case Presentation: The authors report the case of Samuel M, male born at 38 WA, who is the first child of healthy parents from the same socio-cultural area. His birth weight was 2800 g and he did not have any risk factors for deafness or concept of obstetrical trauma. He presented with congenital malformation manifesting as bilateral ear aplasia with unilateral facial paralysis. Computed tomography revealed abnormalities of the inner ear; functional explorations, such as PEA and OEA, showed findings in favor of bilateral cophosis. ASSR (Auditory Steady-State Responses) was not performed. The announcement of the serious diagnosis of deafness requires multidisciplinary care in order to plan a therapeutic program to limit the impact on the development of language, schooling, and consequently, the socio-professional future of children. Conclusion: This clinical case underlines the fact that interest of the clinical interview before possible multiple surgery does not always guarantee the satisfaction of the desire for repair in this type of patient.","PeriodicalId":70887,"journal":{"name":"耳鼻喉(英文)","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135444969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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