CONTACTS 

SUBJECTS
CT Test 080425 Report Received Condition Stable Right Axilla Not Wor

1103 -
1103 -    ..
1104 - Summary/Objective
1105 -
110501 - Follow up ref SDS 48 9W9I, ref SDS 44 0000.
110502 -
110503 -
110504 -
110505 -
110506 -
110507 -
110509 -  ..
1106 -
1107 -
1108 - Progress
1109 -
110901 - CT Test on 080425 Report Received from Kaiser
110902 -
110903 - Follow up ref SDS 44 6V5I, ref SDS 40 FP5H.
110904 -
110905 - Millie received ref DRT 1 0001 a letter from the primary care
110906 - physician at Kaiser transmitting the CT test on 080425. ref SDS 48
110907 - 9W9I FP5H   Her prior test was on 080212, ref SDS 40 FP5H; and the
110908 - report was received from Kaiser on 080215. ref SDS 44 6V5I
110909 -
110910 -    1.  Subject:  CT Report
110911 -        Received: 4/28/08 5:15 PM
110915 -         ..
110916 -        No change.  Please see below. ref DRT 1 0001
110917 -
110922 -  ..
110923 - The primary care physician at Kaiser responds to a copy of the letter
110924 - Millie submitted to UCSF on 080425; a copy was also sent to the
110925 - doctor's assistant, Arlette, requesting support for timely submission
110926 - of the test report. ref SDS 48 L86Y
110927 -
110928 -            [...below Millie submits letter thanking the doctor for
110929 -            timely submission of the CT test. ref SDS 0 659K
110931 -  ..
110932 - Early receipt of the report today demonstrates effective coordination
110933 - between UCSF and Kaiser.
110934 -
110936 -         ..
110937 -        Test History No Evidence Distant Metastasis
110938 -        Distant Metastasis No Evidence 5 Years Imaging Tests
110939 -
110940 -        Follow up ref SDS 44 GM3N, ref SDS 35 4C6N.
110941 -
110942 -        Type    Date           Received          Source
110943 -         CT     080425 reported on 080428........... ref SDS 0 DA6Q
110944 -         CT     080212 reported on 080215........... ref SDS 44 DA6Q
110945 -         CT     071210 reported on 071213........... ref SDS 35 UG4L
110946 -         CT     070930 reported on 071018........... ref SDS 32 VK8L
110947 -         CT     070723 reported on 070802........... ref SDS 29 IM6M
110948 -         CT     070520 reported on 070524........... ref SDS 28 DA6Q
110949 -         CT     070326 reported on 070329........... ref SDS 27 DA6Q
110950 -         CT     070131 reported on 070202........... ref SDS 26 1Y8G
110951 -         PET/CT 061227 reported on 070102........... ref SDS 24 1Y8G
110952 -         CT     060930 reported on 061012........... ref SDS 22 284J
110953 -         MRI    060708 reported on 060711........... ref SDS 20 PT4K
110954 -         Xray   060623 reported on 060711........... ref SDS 20 WJ6G
110955 -         CT     060505 reported on 060523........... ref SDS 19 E355
110956 -         PET    060414 reported on 060428........... ref SDS 18 WJ6G
110957 -         PET    060120 reported on 060126........... ref SDS 17 WJ6G
110958 -         PET/CT 051005 reported on 051007........... ref SDS 16 WJ6G
110959 -         CT     050530 reported on 050610........... ref SDS 15 G75L
110960 -         CT     050325 reported on 050422........... ref SDS 14 G75L
110961 -         CT     041217 reported on 041230........... ref SDS 13 G75L
110962 -         CT     041103 reported on 041104........... ref SDS 12 WV7H
110963 -         CT     040921 reported on 041005........... ref SDS 10 NL4N
110964 -         CT     040710 reported on 040811........... ref SDS 9 H85S
110965 -         CT     040410 reported on 040416........... ref SDS 7 LK5L
110966 -         CT     040307 reported on 040318........... ref SDS 6 LK5L
110967 -         CT     031031 reported on 031205........... ref SDS 5 IG9K
110968 -         CT     030626 reported on 030710........... ref SDS 4 AL6N
110969 -         CT     030428 reported on 030508........... ref SDS 3 LK5L
110970 -         PET    021218 reported on 030109........... ref SDS 2 LK5L
110971 -         PET    020529 reported on 020603........... ref SDS 1 0001
110973 -         ..
110974 -    1.  Patient
110982 -         ..
110983 -    2.  CT OF THE CHEST, ABDOMEN AND PELVIS
110988 -         ..
110989 -        Date:  080425 1403
110991 -         ..
110992 -        Performed in:  WCM
110994 -         ..
110995 -        Radiology Information Exam Date Exam Time
110996 -        4/25/2008 2:03 PM
110998 -         ..
110999 -        Transcription Type ID Date Author
111000 -        Procedure Note ******** 04/25/200814:03:49WCRX0101 4/25/2008
111001 -
111005 -
111006 -
111007 -
1111 -

SUBJECTS
CT Test 080425 Report Errors Omissions Comparisons Patient History T
CT Test 080425 Report Received Condition Stable Right Axilla Not Wor

4204 -
420501 -  ..
420502 - Errors Omissions Comparisons Patient History Trend Analysis
420503 - Patient History Comparison PE Cor Pulmonale Esophigitis Enlarged Heart
420504 -
420505 - Follow up ref SDS 44 IX4F.
420506 -
420507 - CT test 080428 report continues...
420509 -         ..
420510 -    3.  HISTORY
420511 -
420512 -        Metastatic breast cancer.
420514 -         ..
420515 -        The patient is status post left mastectomy. ref DRT 1 PPUP
420517 -  ..
420518 - The "history" section provides less context than the report for the
420519 - prior test on 080212, as shown on 080215. ref SDS 44 IX4F
420521 -  ..
420522 - The report today repeats errors and omissions listed in the report for
420523 - the prior test, also, listed on 080215. ref SDS 44 IX4L
420525 -  ..
420526 - Failure to track patient history denies the analyst an agenda to
420527 - investigate changes on issues identified as critical to patient
420528 - health.
420530 -  ..
420531 - CT test 080428 report continues...
420532 -
420533 -    4.  TECHNIQUE:
420534 -
420535 -        Technique:  Serial axial images were obtained from the thoracic
420536 -        inlet to the level of the pubic symphysis following the
420537 -        administration of oral as well as 100 ml of Omnipaque 300.
420538 -        ref DRT 1 PPUU
420540 -  ..
420541 - This explanation provides more context, and aligns with the report for
420542 - the prior test reviewed on 080215. ref SDS 44 EO5N
420544 -  ..
420545 - CT test 080428 report continues...
420546 -
420547 -    5.  COMPARISON:
420548 -
420549 -        Chest, abdomen and pelvis CT from 2/12/08, ref DRT 1 0151
420551 -  ..
420552 - Test on 080212 was received from Kaiser and reviewed on 080215.
420553 - ref SDS 44 RV49
420555 -  ..
420556 - The report today provides several specific comparisions on the right
420557 - axilla, per below, and correcting failure to perform these
420558 - comparisions in the prior test, reported on 080215. ref SDS 44 EO7F
420559 - Failure to list patient history, causes comparisons in this report to
420560 - omit critical issues, per above, ref SDS 0 9W8J, which repeats
420561 - omissions in the prior test report on 080215. ref SDS 44 EO7F
420563 -  ..
420564 - Errors and omissions performing test comparisons reported in case
420565 - study on 061012. ref SDS 22 A55J
420567 -  ..
420568 - Case study on medical mistakes reported on 040416. ref SDS 7 GN7J
420569 -
420570 -
420571 -
4206 -

SUBJECTS
Right Axillary Lymph Nodes 3 Stable CT Test 080425 Findings Lymphade

5503 -
550401 -  ..
550402 - Findings Stable No Progression Lymphadenophathy
550403 - Right Axillary 3 Lymph Node Stable No Evidence Progression Disease
550404 - Stable Lymphadenophathy No Progression of Cancer CT Test 080425
550405 - Distant Metastasis No Evidence Disease NED Stable No Progression
550406 -
550407 - Follow up ref SDS 44 EO8F, ref SDS 35 SR5P.
550409 -  ..
550410 - CT test 080428 report continues...
550411 -
550412 -    6.  FINDINGS
550413 -
550414 -        a.  Right axillary lymph nodes are seen, measuring
550415 -            approximately 1.9 cm x 1.1 cm and 1.3 cm x 1.2 cm.  Given
550416 -            differences in slice selection, these are likely similar in
550417 -            size compared to the prior study.  More inferiorly in the
550418 -            right axilla, another, approximately 1.0 cm lymph node
550419 -            (image 19) is without significant change. ref DRT 1 ES9M
550421 -  ..
550422 - The prior report showed nodes...
550423 -
550424 -            ...measuring 12.7 x 11.3 cm versus 11.6 x 11.3 cm on the
550425 -            prior study. ref SDS 44 EO8F
550426 -
550427 -            ...approximately 1.9 x 0.9 cm.  This was present on the
550428 -            prior exam and is unchanged.  In the inferior right axilla
550429 -            (image 16) there is a 1 cm lymph node which appears larger
550430 -            than on the prior exam. ref SDS 44 J85H
550432 -  ..
550433 - There is no identification for comparing one thing with another, but
550434 - assume Kaiser tracking 3 nodes right Axilla, changes are as
550435 - follows...
550436 -
550437 -                Current Test                  Prior Test
550438 -                   080425                        080212
550439 -
550440 -             1.  1.90 x 1.10 cm .............. 1.90 x 0.90
550441 -             2.  1.30 x 1.20 cm .............. 1.27 x 1.13
550442 -             3.  1.00 x 1.00 cm .............. 1.00 x 1.00
550444 -  ..
550445 - This analysis supports the doctor's conclusion that the condition
550446 - appears stable, i.e., without significant change, and differences are
550447 - attributible to test method, which suggests there could have been
550448 - actual decline. ref SDS 0 OO6M
550450 -  ..
550451 - The report uses consistent units of measure, i.e., all "cm,"
550452 - correcting the prior report on 080215. ref SDS 44 GU8K
550454 -  ..
550455 - Problems with image test reporting were previously reviewed on 040416,
550456 - and reflect continuing quality issues. ref SDS 7 PTSX
550457 -
550458 -
550459 -
5505 -

SUBJECTS
Left Axillary Stable CT Test 080425 Findings Lymphadenopathy No Evid

6603 -
660401 -  ..
660402 - Left Axilla Stable No Evidence Disease NED Unchanged Prior Test
660403 -
660404 -
660405 - CT test 080428 report continues...
660406 -
660407 -        b.  The left axilla appears similar to the prior study.
660408 -            ref DRT 1 EN5I
660410 -  ..
660411 - No findings were reported in left axilla on prior test. ref SDS 44
660412 - RV70
660413 -
660414 -
660415 -
6605 -

SUBJECTS
Default Null Subject Account for Blank Record

6703 -
670401 -  ..
670402 - Pretracheal Paratracheal Evidently Same Region
670403 - Paratracheal Adenopathy Unchanged Prior Study 3 Nodes Identified
670404 -
670405 - Follow up ref SDS 44 RV70.
670407 -  ..
670408 - CT test 080428 report continues...
670409 -
670410 -        c.  Small right paratracheal and prevascular lymph nodes are
670411 -            similar in appearance. ref DRT 1 EN5J
670412 -
670413 -               [On 080723 report for CT test on 080718 makes not
670414 -               findings on paratracheal or pretracheal matters.
670415 -               ref SDS 54 RV70
670417 -                ..
670418 -               [On 081112 CT test on 081107 reports few, shotty,
670419 -               nonenlarged pretracheal and prevascular lymph nodes are
670420 -               seen.  On image #20, there is suggestion of a 1.2 cm AP
670421 -               window node which appears enlarged compared with the
670422 -               prior examination.  Some of this appearance, however,
670423 -               may be volume averaging with the overlying pulmonary
670424 -               artery.  A 1-cm pretracheal lymph node is also
670425 -               identified. ref SDS 55 RV70
670427 -             ..
670428 -        d.  No new, enlarged hilar lymph nodes are seen. ref DRT 1 XN5N
670430 -  ..
670431 - These findings align with prior test on 080212, reviewed on 080215.
670432 - ref SDS 44 RV70
670433 -
670434 -               [On 080723 report for CT test on 080718 describes Less
670435 -               than 1 cm low density lesions in the right lobe of the
670436 -               thyroid gland, unchanged from the 4/25/2008 exam,
670437 -               ref SDS 54 NB3L; there is no evident description of
670438 -               "thyroid" in the CT test report for 080425.
670439 -
670440 -
670442 -  ..
670443 - Lungs Increased Opacity Right lower Lobe
670444 - Pulmonary Embolism Findings CT Test 080425 Similar 080212
670445 -
670446 - Follow up ref SDS 44 RV78, ref SDS 35 SR5I.
670448 -  ..
670449 - CT test 080428 report continues...
670450 -
670451 -        e.  Ill-defined areas of reticular opacity are again noted in
670452 -            the left lung apex and lateral, posterior aspect of the
670453 -            right middle lobe.  Patchy areas of increased opacity also
670454 -            noted in the right lower lobe.  Pleural, approximately 4 mm
670455 -            (image 37) and 5 mm (image 46) pulmonary densities in the
670456 -            right middle lobe are without significant change.
670457 -            Approximately 3 mm nodular density in the lateral aspect of
670458 -            the right middle lobe (image 36) also is similar to the
670459 -            prior study. No new pulmonary nodules are seen. ref DRT 1
670460 -            ZS6G
670462 -  ..
670463 - Practice of citing test scan image number is a big help for
670464 - navigating Knowledge Space.
670466 -  ..
670467 - This report for the test on 080425 seems similar to the report for the
670468 - test on 080212 reviewed a few days later on 080215. ref SDS 44 RV78
670469 -
670470 -               [On 080507 Millie reports spike in heart beat (pulse)
670471 -               while laying down in bed; case study shows occassional
670472 -               spike in pulse reported by heart monitor during
670473 -               exercise, evaluated previously as defective equipment.
670474 -               ref SDS 53 CK4K
670476 -  ..
670477 - Pulmonary embolism was found in a CT test on 060930, reviewed on
670478 - 061012.  Findings in the current test seems similar to language in the
670479 - prior report....
670480 -
670481 -                Exam was technically adequate to determine presence of
670482 -                a pulmonary embolism.  There are filling defects within
670483 -                the subsegemental branches of the right lower lobe
670484 -                pulmonary arteries. ref SDS 22 294Q
670486 -  ..
670487 - What are implications of "increased opacity also noted in the right
670488 - lower lobe" in relation to prior findings on 080212 of "new increased
670489 - densities..." and "infiltrate within the lung"?  Is there any
670490 - correlation with ongoing treatment for pulmonary embolism, and/or
670491 - medical problems?
670493 -  ..
670494 - Stable nodules in the lungs were cited by the primary care physician
670495 - at Kaiser in a letter on 070117 to explain the medical chart reporting
670496 - "lung cancer." ref SDS 25 TS8G  The report today for the test on
670497 - 080425 does not mention lung cancer, consistent with previous tests,
670498 - reported on 080215. ref SDS 44 SE6M  Neither does the test today
670499 - mention "interstial/fibrotic" change reported for the test on 071210,
670500 - shown in the record on 071213. ref SDS 35 SR59  Nodular densities are
670501 - all located on the left side in the test on 071210, ref SDS 35 SR59,
670502 - increased densities reported for the test on 080212 were all found on
670503 - the right side, and there is no mention of anything on the left side.
670504 - ref SDS 44 RV78
670505 -
670506 -        1.  Does "reticular opacity" in the left lung apex reported
670507 -            today, ref SDS 0 RV78, correlate to findings of nodules on
670508 -            the left side in the test on 071210, reported on 071213?
670509 -            ref SDS 35 SR59
670511 -             ..
670512 -        2.  Since "reticular opacity" noted "again" today in the left
670513 -            lung apex indicate error, since the report received on
670514 -            080215 for the test on 080212 does not mention this issue?
670515 -            ref SDS 44 RV78
670517 -             ..
670518 -        3.  Findings of nodules on the right side of the lung (lobes),
670519 -            ref SDS 0 RV78, seems similar to findings in the test on
670520 -            080212, reported on 080215. ref SDS 44 RV78
670522 -             ..
670523 -        4.  Does failure to mention "interstial/fibrotic" change in the
670524 -            report today for the test on 080425, combined with failure
670525 -            to mention this issue in the report received on 080215 for
670526 -            the test on 080212 indicate findings in the test on 071210
670527 -            as reported on 071213, ref SDS 35 SR59, have been resolved?
670529 -  ..
670530 - Should the patient change conduct to reduce risks?
670532 -  ..
670533 - On 080226 letter to Kaiser with copy to UCSF requests comment from
670534 - medical team, including notice to coagulation control case management.
670535 - ref SDS 47 S14Y
670537 -  ..
670538 - CT test 080428 report continues...
670539 -
670540 -        5.  Approximately 2.0 cm hypodensity in the hepatic dome is
670541 -            without significant change compared to the prior study.
670542 -            ref DRT 1 4O3G
670544 -  ..
670545 - This aligns with the report for the test on 080212 reviewed on 080215.
670546 - ref SDS 44 RV91
670548 -  ..
670549 - CT test 080428 report continues...
670550 -
670551 -        6.  The gallbladder, pancreas, adrenal glands are within normal
670552 -            limits and without significant change. ref DRT 1 6W3K
670554 -  ..
670555 - This aligns with the report for the test on 080212 reviewed on 080215.
670556 - ref SDS 44 A27K
670558 -  ..
670559 - CT test 080428 report continues...
670560 -
670561 -        7.  Subcentimeter hypodensities are seen within both kidneys
670562 -            which are too small to accurately characterize but appear
670563 -            similar to the prior study. ref DRT 1 XW3O
670565 -  ..
670566 - This aligns with the report for the test on 080212 reviewed on 080215.
670567 - ref SDS 44 347O
670569 -  ..
670570 - CT test 080428 report continues...
670572 -  ..
670573 - Splenic Artery Aneurysms Calcified Lymph Nodes Prior Infection
670574 -
670575 - Follow up ref SDS 44 N96N.
670576 -
670577 -        8.  Calcifications in the region of the splenic hilum which may
670578 -            represent splenic artery aneurysms are similar in
670579 -            appearance as are the likely calcified splenic granulomas.
670580 -            ref DRT 1 334I
670582 -  ..
670583 - This seems to align with the report for the test on 080212 reviewed on
670584 - 080215. ref SDS 44 N96N
670586 -  ..
670587 - CT test 080428 report continues...
670588 -
670589 -            Calcification noted within a normal caliber abdominal
670590 -            aorta.  No evidence of bowel obstruction is seen and
670591 -            appearance is similar to the prior study. ref DRT 1 T74N
670593 -  ..
670594 - This seems to align with the report for the test on 080212 that
670595 - reported the bowel and colon appear unremarkable, reviewed on 080215.
670596 - ref SDS 44 RV51
670598 -  ..
670599 - CT test 080428 report continues...
670600 -
670601 -            The visualized osseous structures also are without
670602 -            significant change. ref DRT 1 C95I
670604 -  ..
670605 - This seems to align with the report for the test on 080212 reviewed on
670606 - 080215. ref SDS 44 768N
670608 -  ..
670609 - CT test 080428 report continues...
670610 -
670611 -    7.  IMPRESSION
670612 -
670613 -        Given differences in technique, likely no significant change in
670614 -        right axillary lymph nodes compared to prior study from
670615 -        2/12/08. ref SDS 0 EO8F  Remainder of examination appears
670616 -        similar to prior study as described above. ref DRT 1 ET3V
670617 -
670618 -
670619 -
670620 -
6707 -

SUBJECTS
CT Test Contrast Medium Injections Needle  Pnetrations Increase 400%

8503 -
8504 - 2310
850501 -  ..
850502 - CT Test Contrast Medium Injections Significant Problems Need Port
850503 -
850504 - Follow up ref SDS 48 L86Y.
850505 -
850506 - Millie submitted ref DIT 1 0001 to the primary care physician at
850507 - Kaiser, using Kaiser's dedicated email system, and responding to his
850508 - letter earlier today submitting the CT test, per above.  Millie's
850509 - letter today follows up the letter on 080425 reporting to the medical
850510 - team that the date of the CT test was moved up from 080426.
850511 - ref SDS 48 L86Y
850513 -  ..
850514 - Millie's letter today says to the doctor at Kaiser...
850515 -
850516 -    1.  Thanks for timely submission [today] of the report on the CT
850517 -        test last Friday. ref SDS 0 6V5I  Looks good. ref SDS 0 EO8F,
850518 -        ref DIT 1 0001
850520 -  ..
850521 - Millie expresses appreciation for Kaiser following up the letter last
850522 - Friday on 080425 requesting submission of the CT test report today or
850523 - tomorrow, ref SDS 48 L86Y, in time to prepare for meeting with the
850524 - medical team at UCSF on Thursday, 080501.
850525 -
850527 -  ..
850528 - Blood Counts Too Low for Treatment Need Solution
850529 -
850530 - Follow up ref SDS 48 KX7J.
850531 -
850532 - Millie's letter to Kaiser continues...
850533 -
850534 -    2.  Difficulty holding blood counts has resulted in my getting only
850535 -        3 of 6 treatments with Carboplatin.  Hopefully, Thursday I'll
850536 -        get another with both cetuximab and Carboplatin.  I feel these
850537 -        have been effective, but we need better consistency.  I'm
850538 -        meeting with Doctor Rugo on Thursday to discuss the blood count
850539 -        problem. Any thoughts I should mention??
850541 -  ..
850542 - Blood counts for NEUTS 1.05 on 080424 increased only slightly from .95
850543 - the week before on 080417, despite skipping treatment for an entire
850544 - week.
850546 -  ..
850547 - Current solutions include...
850548 -
850549 -            1.  Nuepogen to increase blood counts week to week.
850550 -
850551 -            2.  Reduce dose Carboplatin to increase blood counts week
850552 -                to week.
850554 -                 ..
850555 -            3.  Reduce treatments of Carboplatin to 1 or 2 treatments
850556 -                every 4 weeks instead prescribed 3 treatements.
850558 -  ..
850559 - Option 3 has been very effective reducing IBC rash and preventing
850560 - distant metastatis that spreads cancer, while also preventing the
850561 - build up of debilitating side effects that sap strength and vitality.
850562 - Option 3 seems most effective saving time for additonal treatment, and
850563 - reducing the cost of medicine, while maintaining quality of life, as
850564 - reported in the letter to the medical team on 080425. ref SDS 48 L93W
850565 -
850567 -  ..
850568 - CT Test Problem Needle 4 Penetrations Required Inject Contrast Medium
850569 -
850570 - Follow up ref SDS 48 9W9I.
850571 -
850572 - Letter to Kaiser continues...
850573 -
850574 -    3.  CT tests have become increasingly difficult due to limited real
850575 -        estate on my right arm.  The technicians have been great, but
850576 -        it took 4 tries over 2 hours on Friday (ouch!!), as reported in
850577 -        the record [on 080425]. ref SDS 48 FP6F
850579 -         ..
850580 -    4.  I've heard there is a port that supports CT test injections.
850581 -        Can you please check with Doctor Riley-Paull to see if she can
850582 -        swap this out.  If not, can nurses in the Infusion Clinic make
850583 -        the contrast medium injection using the current port??
850584 -
850585 -            [On 080429 Kaiser checking on switching to a "Huber" needle
850586 -            to avoid problems making injections of contrast medium for
850587 -            CT tests. ref SDS 49 1H6Y
850589 -             ..
850590 -            [On 080430 letter to UCSF requests report on experience
850591 -            using this method to relived problems from excessive needle
850592 -            penetrations for injecting contrast medium to perform CT
850593 -            tests. ref SDS 50 W65Q
850595 -             ..
850596 -            [On 080501 Brigid explained that CT test injections of
850597 -            contrast medium causes higher pressures on the port
850598 -            catheter, and so UCSF began installing only Power Ports
850599 -            designed for higher pressures, ref SDS 51 TQ6F; in some
850600 -            cases UCSF approves using port catheter for injecting CT
850601 -            test contrast medium, and in order to avoid injury, pain,
850602 -            and suffering. ref SDS 51 JJ9N
850604 -             ..
850605 -            [On 080502 primary care physician sent a letter to surgeon
850606 -            at Kaiser investigating follow up surgery to upgrade
850607 -            Millie's port catheter implanted on 040419 to a "Power
850608 -            Port" for injecting CT test contrast medium in order to
850609 -            avoid further injury, pain, and suffering, ref SDS 52 VG5J;
850610 -            there is also consideration of using the existing port
850611 -            catheter by slowing the rate of injecting contrast medium
850612 -            for CT tests (point 2), if that is possible, which reduces
850613 -            risk of damaging the port from high pressure that occurs
850614 -            from CT test injections. ref SDS 52 847I
850615 -
850616 -
850617 -
850618 -
850619 -
8507 -