imported>Brinkery |
imported>Brinkery |
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| |+ | | |+ |
| !Patienteneigene<br /> | | !Patienteneigene<br /> |
| !Alter (Zunahme/Dezenium); Diabetes, Immuninkompetenz (z.B. Karzinompatienten), reduzierter Allgemeinzustanz, <span style="letter-spacing:-.1pt">Übe</span><span style="letter-spacing:-.05pt">r</span><span style="letter-spacing:-.1pt">ge</span><span style="letter-spacing:-.05pt">wicht,</span> <span style="letter-spacing:-.1pt">M</span><span style="letter-spacing:-.05pt">an</span><span style="letter-spacing:-.1pt">ge</span><span style="letter-spacing:-.05pt">lernährung,</span> <span style="letter-spacing:-.15pt">ASA</span><span style="letter-spacing:-.1pt">-</span><span style="letter-spacing:-.15pt">Sco</span><span style="letter-spacing:-.1pt">r</span><span style="letter-spacing:-.15pt">e</span> > 2, <span style="letter-spacing:-.2pt">MSSA/MR</span><span style="letter-spacing:-.25pt">S</span><span style="letter-spacing:-.2pt">A</span><span style="letter-spacing:-.1pt">-</span><span style="letter-spacing:-.25pt">T</span><span style="letter-spacing:-.15pt">r</span><span style="letter-spacing:-.2pt">äge</span><span style="letter-spacing:-.15pt">r,</span> <span style="letter-spacing:-.1pt">F</span><span style="letter-spacing:-.05pt">ieber</span> 1 <span style="letter-spacing:-.1pt">Woc</span><span style="letter-spacing:-.05pt">he</span> <span style="letter-spacing:-.15pt">pr</span><span style="letter-spacing:-.2pt">ä-</span><span style="letter-spacing:-.5pt">O</span><span style="letter-spacing:-.45pt">P</span><span style="letter-spacing:-.3pt">,</span> <span style="letter-spacing:-.05pt">weibliche</span><span style="letter-spacing:-.1pt">s</span> <span style="letter-spacing:-.1pt">Gesc</span><span style="letter-spacing:-.05pt">hle</span><span style="letter-spacing:-.1pt">c</span><span style="letter-spacing:-.05pt">ht bei</span> <span style="letter-spacing:-.15pt">E</span><span style="letter-spacing:-.1pt">in</span><span style="letter-spacing:-.15pt">g</span><span style="letter-spacing:-.1pt">riff</span><span style="letter-spacing:-.15pt">e</span><span style="letter-spacing:-.1pt">n</span> am <span style="letter-spacing:-.1pt">K</span><span style="letter-spacing:-.05pt">olon</span> <span style="letter-spacing:-.05pt">und</span> <span style="letter-spacing:-.05pt">in</span> <span style="letter-spacing:-.05pt">der</span> <span style="letter-spacing:-.15pt">K</span><span style="letter-spacing:-.1pt">ardiochirurgie,</span> <span style="letter-spacing:-.05pt">männliche</span><span style="letter-spacing:-.1pt">s</span> <span style="letter-spacing:-.1pt">Gesc</span><span style="letter-spacing:-.05pt">hle</span><span style="letter-spacing:-.1pt">c</span><span style="letter-spacing:-.05pt">ht</span> <span style="letter-spacing:-.05pt">n</span><span style="letter-spacing:-.1pt">ac</span><span style="letter-spacing:-.05pt">h</span> <span style="letter-spacing:-.25pt">T</span><span style="letter-spacing:-.15pt">raum</span><span style="letter-spacing:-.2pt">a</span><span style="letter-spacing:-.15pt">,</span> <span style="letter-spacing:-.1pt">Gefäßc</span><span style="letter-spacing:-.05pt">hirurgie</span> <span style="letter-spacing:-.05pt">und Kni</span><span style="letter-spacing:-.1pt">e</span><span style="letter-spacing:
| | |Alter (Zunahme/Dezenium); Diabetes, Immuninkompetenz (z.B. Karzinompatienten), reduzierter Allgemeinzustanz, Übergewicht, Mangelernährung, ASA-Score > 2, MSSA/MRSA-Träger, Fieber 1 Woche prä-OP, weibliches Geschlecht bei Eingriffen am Kolon und in der Kardiochirurgie, männliches Geschlecht nach Trauma, Gefäßchirurgie und Kniegelenkersatz, Dialysepatienten, Hepatitis, Stoma, Drogenabusus, Infektionen anderer Lokalisationen, AVK, periphere Ödeme, Lymphangitis, Neuropathie, Rauchen, Linksherzversagen nach koronarem Bypass, bakterielle Translokation bei Laparotomie, Rheumatoide Arthritis bei Kniegelenksersatz, Zirrhose; Risikofaktoren in der Dermatochirurgie nach Lokalisation: Bein unterhalb Knie, Leiste, Keilexzision Lippe oder Ohr, Verletzung der Schleimhautbarriere, Lappenplastik der Nase, Wundverschlüsse bei 2-zeitigem Vorgehen, entzündliche Hauterkrankungen <br /> |
| -.15pt">ge</span><span style="letter-spacing:-.1pt">lenk</span><span style="letter-spacing:-.15pt">e</span><span style="letter-spacing:-.1pt">r</span><span style="letter-spacing:-.15pt">s</span><span style="letter-spacing:-.1pt">atz,</span> <span style="letter-spacing:-.1pt">Dialys</span><span style="letter-spacing:-.05pt">epatient</span><span style="letter-spacing:-.1pt">e</span><span style="letter-spacing:-.05pt">n,</span> <span style="letter-spacing:-.1pt">Hep</span><span style="letter-spacing:-.05pt">atitis,</span> <span style="letter-spacing:-.15pt">S</span><span style="letter-spacing:-.1pt">tom</span><span style="letter-spacing:-.15pt">a</span><span style="letter-spacing:-.1pt">,</span> <span style="letter-spacing:-.1pt">Dr</span><span style="letter-spacing:-.05pt">o</span><span style="letter-spacing:-.1pt">ge</span><span style="letter-spacing:-.05pt">nabusus,</span> <span style="letter-spacing:-.05pt">Inf</span><span style="letter-spacing:-.1pt">e</span><span style="letter-spacing:-.05pt">ktionen</span> <span style="letter-spacing:-.05pt">ander</span><span style="letter-spacing:-.1pt">e</span><span style="letter-spacing:-.05pt">r</span> <span style="letter-spacing:-.15pt">L</span><span style="letter-spacing:-.1pt">okalisationen, AVK</span><span style="letter-spacing:
| |
| -.05pt">,</span> <span style="letter-spacing:-.05pt">peripher</span><span style="letter-spacing:-.1pt">e</span> <span style="letter-spacing:-.1pt">Öde</span><span style="letter-spacing:-.05pt">me,</span> <span style="letter-spacing:-.15pt">Ly</span><span style="letter-spacing:-.1pt">mphangitis,</span> <span style="letter-spacing:-.1pt">Neu</span><span style="letter-spacing:-.05pt">ropathie,</span> <span style="letter-spacing:-.1pt">Rauc</span><span style="letter-spacing:-.05pt">hen,</span> <span style="letter-spacing:-.15pt">L</span><span style="letter-spacing:-.1pt">ink</span><span style="letter-spacing:-.15pt">s</span><span style="letter-spacing:-.1pt">he</span><span style="letter-spacing:-.15pt">rzve</span><span style="letter-spacing:-.1pt">r</span><span style="letter-spacing:-.15pt">sage</span><span style="letter-spacing:-.1pt">n</span> <span style="letter-spacing:-.05pt">n</span><span style="letter-spacing:-.1pt">ac</span><span style="letter-spacing:-.05pt">h</span> <span style="letter-spacing:-.1pt">koronar</span><span style="letter-spacing:-.15pt">e</span><span style="letter-spacing:-.1pt">m</span> <span style="letter-spacing:-.15pt">By</span><span style="letter-spacing:-.1pt">p</span><span style="letter-spacing:-.15pt">ass, b</span><span style="letter-spacing:-.05pt">akt</span><span style="letter-spacing:-.1pt">e</span><span style="letter-spacing:-.05pt">rielle</span> <span style="letter-spacing:-.15pt">T</span><span style="letter-spacing:-.1pt">ranslokation</span> bei <span style="letter-spacing:-.15pt">L</span><span style="letter-spacing:-.1pt">aparotomie,</span> <span style="letter-spacing:-.1pt">Rheu</span><span style="letter-spacing:-.05pt">matoide</span> <span style="letter-spacing:-.1pt">Ar</span><span style="letter-spacing:-.05pt">thrit</span><span style="letter-spacing:-.1pt">is</span> bei <span style="letter-spacing:-.1pt">K</span><span style="letter-spacing:-.05pt">nie</span><span style="letter-spacing:-.1pt">ge</span><span style="letter-spacing:-.05pt">lenk</span><span style="letter-spacing:-.1pt">se</span><span style="letter-spacing:-.05pt">r</span><span style="letter-spacing:-.1pt">s</span><span style="letter-spacing:-.05pt">atz,</span> <span style="letter-spacing:-.1pt">Z</span><span style="letter-spacing:-.05pt">irr</span><span style="letter-spacing:-.1pt">hos</span><span style="letter-spacing:-.05pt">e; Risikofaktoren in der Dermatochirurgie nach Lokalisation: Bein unterhalb Knie, Leiste, Keilexzision Lippe oder <span style="mso-spacerun:yes"> </span>Ohr,</span> <span style="letter-spacing:-.1pt">Ve</span><span style="letter-spacing:-.05pt">rletzun</span><span style="letter-spacing:-.1pt">g</span> <span style="letter-spacing:-.05pt">der</span> <span style="letter-spacing:-.1pt">Sc</span><span style="letter-spacing:-.05pt">hleimhautbarrier</span><span style="letter-spacing:
| |
| -.1pt">e</span><span style="letter-spacing:-.05pt">,</span> <span style="letter-spacing:-.1pt">L</span><span style="letter-spacing:-.05pt">appenpl</span><span style="letter-spacing:-.1pt">a</span><span style="letter-spacing:-.05pt">stik</span> <span style="letter-spacing:-.05pt">der</span> <span style="letter-spacing:-.1pt">Nase</span><span style="letter-spacing:-.05pt">,</span> <span style="letter-spacing:-.1pt">W</span><span style="letter-spacing:-.05pt">undv</span><span style="letter-spacing:-.1pt">e</span><span style="letter-spacing:-.05pt">r</span><span style="letter-spacing:-.1pt">sc</span><span style="letter-spacing:-.05pt">hlüss</span><span style="letter-spacing:-.1pt">e</span> bei <span style="letter-spacing:-.1pt">2-</span><span style="letter-spacing:-.15pt">z</span><span style="letter-spacing:-.1pt">eiti</span><span style="letter-spacing:-.15pt">ge</span><span style="letter-spacing:-.1pt">m Vor</span><span style="letter-spacing:-.15pt">ge</span><span style="letter-spacing:-.1pt">hen,</span> <span style="letter-spacing:-.1pt">e</span><span style="letter-spacing:-.05pt">ntzündliche</span> <span style="letter-spacing:-.15pt">H</span><span style="letter-spacing:-.1pt">aut</span><span style="letter-spacing:-.15pt">e</span><span style="letter-spacing:-.1pt">rkrankun</span><span style="letter-spacing:-.15pt">ge</span><span style="letter-spacing:-.1pt">n</span><br />
| |
| |- | | |- |
| | colspan="2" |Chirurgische Faktoren<br />
| | ! colspan="2" |Chirurgische Faktoren<br /> |
| |- | | |- |
| |präoperative<br />
| | !präoperative<br /> |
| |Notfalloperation, längerer präoperativer Krankenhausaufenthalt, falsche Wahl des Antibiotikums <span style="letter-spacing:-.05pt">und</span> <span style="letter-spacing:-.1pt">f</span><span style="letter-spacing:-.15pt">alsc</span><span style="letter-spacing:-.1pt">her</span> <span style="letter-spacing:-.1pt">Z</span><span style="letter-spacing:-.05pt">eitpunkt</span> <span style="letter-spacing:-.05pt">der</span> <span style="letter-spacing:-.1pt">G</span><span style="letter-spacing:-.05pt">abe,</span> <span style="letter-spacing:-.15pt">V</span><span style="letter-spacing:-.1pt">orbe</span><span style="letter-spacing:-.15pt">st</span><span style="letter-spacing:-.1pt">rahlung,</span> <span style="letter-spacing:-.1pt">Hoc</span><span style="letter-spacing:-.05pt">hrisikooperation,</span> <span style="letter-spacing:-.15pt">Re</span><span style="letter-spacing:-.1pt">zidi</span><span style="letter-spacing:-.15pt">v</span><span style="letter-spacing:-.1pt">ein</span><span style="letter-spacing:-.15pt">g</span><span style="letter-spacing:-.1pt">riff</span><span style="letter-spacing:-.15pt">e</span><span style="letter-spacing:-.1pt">,</span> <span style="letter-spacing:-.1pt">S</span><span style="letter-spacing:-.05pt">teine</span> <span style="letter-spacing:-.05pt">im</span> <span style="letter-spacing:-.1pt">G</span><span style="letter-spacing:-.05pt">allen</span><span style="letter-spacing:-.1pt">g</span><span style="letter-spacing:-.05pt">an</span><span style="letter-spacing:-.1pt">g</span> <span style="letter-spacing:-.05pt">oder</span> <span style="letter-spacing:.5pt"> </span><span style="letter-spacing:-.15pt">G</span><span style="letter-spacing:-.1pt">allen</span><span style="letter-spacing:-.15pt">g</span><span style="letter-spacing:-.1pt">an</span><span style="letter-spacing:-.15pt">gsve</span><span style="letter-spacing:-.1pt">rsc</span><span style="letter-spacing:-.05pt">hluß,</span> <span style="letter-spacing:-.1pt">Er</span><span style="letter-spacing:-.05pt">höht</span><span style="letter-spacing:-.1pt">es</span> <span style="letter-spacing:-.45pt">CR</span><span style="letter-spacing:-.4pt">P</span><span style="letter-spacing:-.3pt">,</span> <span style="letter-spacing:-.15pt">F</span><span style="letter-spacing:-.1pt">r</span><span style="letter-spacing:-.15pt">e</span><span style="letter-spacing:-.1pt">mdkörperimplantationen,</span> <span style="letter-spacing:-.1pt">Rasu</span><span style="letter-spacing:-.05pt">r</span> <span style="letter-spacing:-.05pt">nicht</span> <span style="letter-spacing:-.05pt">unmitt</span><span style="letter-spacing:-.1pt">e</span><span style="letter-spacing:-.05pt">lbar</span> <span style="letter-spacing:-.05pt">vor</span> <span style="letter-spacing:-.5pt">O</span><span style="letter-spacing:-.45pt">P</span><span style="letter-spacing:-.3pt">,</span> <span style="letter-spacing:-.1pt">pr</span><span style="letter-spacing:-.15pt">äope</span><span style="letter-spacing:-.1pt">rati</span><span style="letter-spacing:-.15pt">ve</span><span style="letter-spacing:-.1pt">r</span> <span style="letter-spacing:-.1pt">Ur</span><span style="letter-spacing:-.05pt">inkathe</span><span style="letter-spacing:-.2pt">t</span><span style="letter-spacing:-.25pt">e</span><span style="letter-spacing:-.2pt">r,</span> <span style="letter-spacing:-.15pt">v</span><span style="letter-spacing:-.1pt">or</span><span style="letter-spacing:-.15pt">ausgeg</span><span style="letter-spacing:-.1pt">an</span><span style="letter-spacing:-.15pt">ge</span><span style="letter-spacing:-.1pt">ne</span> <span style="letter-spacing:-.1pt">(neur</span><span style="letter-spacing:-.15pt">oc</span><span style="letter-spacing:-.1pt">hirur</span><span style="letter-spacing:-.15pt">gisc</span><span style="letter-spacing:-.1pt">he)</span> <span style="letter-spacing:-.15pt">E</span><span style="letter-spacing:-.1pt">in</span><span style="letter-spacing:-.15pt">g</span><span style="letter-spacing:-.1pt">riff</span><span style="letter-spacing:-.15pt">e</span><br /> | | |Notfalloperation, längerer präoperativer Krankenhausaufenthalt, falsche Wahl des Antibiotikums und falscher Zeitpunkt der Gabe, Vorbestrahlung, Hochrisikooperation, Rezidiveingriffe, Steine im Gallengang oder Gallengangsverschluß, Erhöhtes CRP, Fremdkörperimplantationen, Rasur nicht unmittelbar vor OP, präoperativer Urinkatheter, vorausgegangene (neurochirurgische) Eingriffe <br /> |
| |- | | |- |
| |intraoperativ<br />
| | !intraoperativ<br /> |
| |Erfahrung des Chirurgen, OP-Dauer >2h, <span style="letter-spacing:-.05pt">infiziert</span><span style="letter-spacing:-.1pt">e</span><span style="letter-spacing:-.05pt">r</span> <span style="letter-spacing:-.1pt">OP-Be</span><span style="letter-spacing:-.05pt">r</span><span style="letter-spacing:-.1pt">eic</span><span style="letter-spacing:-.05pt">h,</span> <span style="letter-spacing:-.1pt">kontaminiert</span><span style="letter-spacing:-.15pt">e</span><span style="letter-spacing:-.1pt">r</span> <span style="letter-spacing:-.1pt">OP-Be</span><span style="letter-spacing:-.05pt">r</span><span style="letter-spacing:-.1pt">eic</span><span style="letter-spacing:-.05pt">h,</span> <span style="letter-spacing:-.05pt">Bluttransfusion,</span> <span style="letter-spacing:-.1pt">Albuminzufuhr,</span> <span style="letter-spacing:-.05pt">lan</span><span style="letter-spacing:-.1pt">ge</span> <span style="letter-spacing:-.15pt">Anäst</span><span style="letter-spacing:-.1pt">hesied</span><span style="letter-spacing:-.15pt">aue</span><span style="letter-spacing:-.1pt">r,</span> <span style="letter-spacing:-.1pt">Hypothermie</span><span style="letter-spacing:-.05pt">,</span> <span style="letter-spacing:-.1pt">S</span><span style="letter-spacing:-.05pt">auerstoffabfall,</span> <span style="letter-spacing:-.1pt">Un</span><span style="letter-spacing:-.05pt">t</span><span style="letter-spacing:-.1pt">e</span><span style="letter-spacing:-.05pt">rkühlung,</span> <span style="letter-spacing:-.15pt">W</span><span style="letter-spacing:-.1pt">undstapler,</span> <span style="letter-spacing:-.1pt">un</span><span style="letter-spacing:-.15pt">v</span><span style="letter-spacing:-.1pt">orher</span><span style="letter-spacing:-.15pt">se</span><span style="letter-spacing:-.1pt">hbar</span><span style="letter-spacing:-.15pt">e</span> <span style="letter-spacing:-.1pt">K</span><span style="letter-spacing:-.05pt">omplikationen,</span> <span style="letter-spacing:-.15pt">OP-Tec</span><span style="letter-spacing:-.1pt">hnik,</span> <span style="letter-spacing:-.15pt">Ve</span><span style="letter-spacing:-.1pt">rfahr</span><span style="letter-spacing:-.15pt">e</span><span style="letter-spacing:-.1pt">nsw</span><span style="letter-spacing:-.15pt">echse</span><span style="letter-spacing:-.1pt">l</span> <span style="letter-spacing:-.15pt">L</span><span style="letter-spacing:-.1pt">apar</span><span style="letter-spacing:-.15pt">os</span><span style="letter-spacing:-.1pt">kopie/</span><span style="letter-spacing:-.15pt">L</span><span style="letter-spacing:-.1pt">aparotomie,</span> <span style="letter-spacing:-.15pt">E</span><span style="letter-spacing:-.1pt">nt</span><span style="letter-spacing:-.15pt">e</span><span style="letter-spacing:-.1pt">rokokk</span><span style="letter-spacing:-.15pt">e</span><span style="letter-spacing:-.1pt">n,</span> <span style="letter-spacing:-.15pt">E</span><span style="letter-spacing:-.1pt">nt</span><span style="letter-spacing:-.15pt">e</span><span style="letter-spacing:-.1pt">ro</span><span style="letter-spacing:-.05pt">bakt</span><span style="letter-spacing:-.1pt">e</span><span style="letter-spacing:-.05pt">rien,</span> <span style="letter-spacing:-.15pt">Bac</span><span style="letter-spacing:-.1pt">t</span><span style="letter-spacing:-.15pt">e</span><span style="letter-spacing:-.1pt">roide</span><span style="letter-spacing:-.15pt">s</span> <span style="letter-spacing:-.1pt">fr</span><span style="letter-spacing:-.15pt">a</span><span style="letter-spacing:-.1pt">gilis</span> <span style="letter-spacing:-.05pt">in</span> <span style="letter-spacing:-.05pt">der</span> <span style="letter-spacing:-.1pt">W</span><span style="letter-spacing:-.05pt">unde</span><br /> | | |intraoperativ Erfahrung des Chirurgen, OP-Dauer >2h, infizierter OP-Bereich, kontaminierter OP-Bereich, Bluttransfusion, Albuminzufuhr, lange Anästhesiedauer, Hypothermie, Sauerstoffabfall, Unterkühlung, Wundstapler, unvorhersehbare Komplikationen, OP-Technik, Verfahrenswechsel Laparoskopie/Laparotomie, Enterokokken, Enterobakterien, Bacteroides fragilis in der Wunde <br /> |
| |- | | |- |
| |postoperativ<br />
| | !postoperativ<br /> |
| |Drainagedauer länger als 3 <span style="letter-spacing:-.3pt">T</span><span style="letter-spacing:-.25pt">age</span><span style="letter-spacing:-.2pt">,</span> <span style="letter-spacing:-.2pt">r</span><span style="letter-spacing:-.25pt">e</span><span style="letter-spacing:-.2pt">spirat</span><span style="letter-spacing:-.25pt">o</span><span style="letter-spacing:-.2pt">r</span><span style="letter-spacing:-.25pt">isc</span><span style="letter-spacing:-.2pt">he</span> <span style="letter-spacing:-.15pt">Sepsis,</span> <span style="letter-spacing:-.2pt">in</span><span style="letter-spacing:-.25pt">vasive</span> <span style="letter-spacing:-.3pt">T</span><span style="letter-spacing:-.25pt">ec</span><span style="letter-spacing:-.2pt">hnik</span><span style="letter-spacing:-.25pt">e</span><span style="letter-spacing:-.2pt">n</span> <span style="letter-spacing:-.25pt">(Ur</span><span style="letter-spacing:-.2pt">inkathet</span><span style="letter-spacing:-.25pt">e</span><span style="letter-spacing:-.2pt">r,</span> <span style="letter-spacing:-.25pt">Tho</span><span style="letter-spacing:-.2pt">r</span><span style="letter-spacing:-.25pt">a</span><span style="letter-spacing:-.2pt">xdrain</span><span style="letter-spacing:-.25pt">age</span><span style="letter-spacing:-.2pt">, Nasenso</span><span style="letter-spacing:-.15pt">nde,</span> <span style="letter-spacing:-.15pt">ZVK),</span> <span style="letter-spacing: | | |Drainagedauer länger als 3 Tage, respiratorische Sepsis, invasive Techniken (Urinkatheter, Thoraxdrainage, Nasensonde, ZVK), Dialyse, frühe Re-Operation wegen Blutung, Liquorleck der Zerebrospinalflüssigkeit, externer Shunt <br /> |
| -.2pt">Dialyse</span><span style="letter-spacing:-.15pt">,</span> <span style="letter-spacing:-.15pt">frühe</span> <span style="letter-spacing:-.2pt">R</span><span style="letter-spacing:-.15pt">e-Operation</span> <span style="letter-spacing:
| |
| -.15pt">w</span><span style="letter-spacing:-.2pt">ege</span><span style="letter-spacing:-.15pt">n</span> <span style="letter-spacing:-.15pt">Blutung,</span> <span style="letter-spacing:-.2pt">L</span><span style="letter-spacing:-.15pt">iquorle</span><span style="letter-spacing:-.2pt">c</span><span style="letter-spacing:-.15pt">k</span> <span style="letter-spacing:-.1pt">der</span> <span style="letter-spacing:-.25pt">Z</span><span style="letter-spacing:-.2pt">e</span><span style="letter-spacing:-.15pt">r</span><span style="letter-spacing:-.2pt">e</span><span style="letter-spacing:-.15pt">brospinalflüssi</span><span style="letter-spacing:-.2pt">g</span><span style="letter-spacing:-.15pt">keit,</span> <span style="letter-spacing:-.2pt">e</span><span style="letter-spacing:-.15pt">xterner</span> <span style="letter-spacing:
| |
| -.25pt">S</span><span style="letter-spacing:-.15pt">hunt</span><br />
| |
| |} | | |} |
| <br /> | | <br /> |
