Welch Company
San Francisco, CA


S U M M A R Y


DIARY: April 27, 2010 08:30 AM Tuesday; Rod Welch

Millie meeting Doctor Johnson 3rd cycle Abraxane 10th relapse cancer.

1...Summary/Objective
2...Kaiser's Medical Chart Knowledge Management System


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CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 87 0000. ref SDS 75 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Background
0409 -
040901 - On 100203, Millie resumed treatment after a 3-week pause ordered by
040902 - Doctor Johnson, on 100112 0830, ref SDS 60 G68H, while Millie was
040903 - treated to recover from a very severe case of shingles infection,
040904 - reported earlier on 100104 1115. ref SDS 55 0P9S
040906 -  ..
040907 - On 100217 0730 Millie got the 3rd treatment of the 3rd cycle with
040908 - Navelbine for Millie to recover from the 9th relaspe of cancer.
040910 -  ..
040911 - On 100218 1000 Millie got Neupogen treatment at Kaiser to maintain
040912 - blood counts essential for getting Navelbine chemotherapy treatment
040913 - for cancer. ref SDS 71 ER95
040915 -  ..
040916 - On 100218 1000 Millie had emergency meeting with Doctor Johnson,
040917 - primary care physician at Kaiser, after getting Neupogen treatment;
040918 - the doctor diagnosed relapse of shingles, and prescribed a 4th cycle
040919 - of treatment, but only with Acyclovir (Zovirax) 800 MG tablets,
040920 - ref SDS 71 0Y6O; the doctor also diagnosed Millie's 10 relapse of
040921 - cancer, and ordered switching treatment from Navelbine to Abraxane,
040922 - beginning on 100303. ref SDS 71 023N   The doctor further ordered a CT
040923 - test to evaluate rising pain. ref SDS 71 ES40
040925 -  ..
040926 - On 100218 1230 Millie had emergency CT test. ref SDS 71 PQ6R
040928 -  ..
040929 - On 100301 0005 letter to medical team reports improvement from CT test
040930 - on 100218, and increased energy may indicate Navelbine can continue
040931 - another cycle. ref SDS 74 ER95
040933 -  ..
040934 - On 100302 0830 meeting at Kaiser, ref SDS 75 ER95; Doctor Johnson
040935 - prescribed Abraxane for Millie starting treatment tomorrow for
040936 - recovering from 10th relapse of cancer. ref SDS 75 FB67  Blood counts
040937 - dropped significantly, ref SDS 75 IC4N; since Abraxane side effects
040938 - reduce blood counts this increases chances of shingles recurrence; the
040939 - doctor advised that treatment for cancer will be paused again, if
040940 - shingles recurs. ref SDS 75 FC68  Only way for Millie to get treatment
040941 - for shinges concurrent with cancer is to switch from Abraxane to a
040942 - "targeted" treatment for cancer that does not injure bone marrow
040943 - producing blood. ref SDS 75 IC85
040945 -  ..
040946 - On 100330 0830 meeting with Doctor Johnson, primary care physician, to
040947 - evaluate staring 2nd cycle Abraxane chemotherapy treatment to recover
040948 - from 10th relapse of cancer. ref SDS 87 ER95
040950 -  ..
040951 - On 100427 0830 meeting at Kaiser Doctor Johnson initially noted how
040952 - well Millie looks, reflecting ECOG performance score 0, showing Millie
040953 - is healthy and strong like anyone else, with the proper treatment,
040954 - ref SDS 0 OJ6I; The doctor advises again that Millie's patient history
040955 - of multiple relapses requires strategy of treatment "targeted" to the
040956 - genetic profile of her cancer in order to extend survival with a life
040957 - worth living that avoids pain and suffering caused by chemotherapy,
040958 - like Abraxane. ref SDS 0 SJ6N
040959 -
040960 -
040961 -
040962 -
040964 -  ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - Doctor Johnson was very pleased this morning, saying to Millie - "You
041302 - look so good, nobody can believe you have severe cancer."
041304 -  ..
041305 - Millie related Laura's letter on 080611, sharing the hope they will
041306 - both one day feel as good as they look. ref SDS 11 IZ4H
041307 -
041308 -        [On 100501 1037 Millie confirms the doctor's finding from
041309 -        examination today that she looks extremely well; Millie relates
041310 -        that she does not feel well due to intolerable side effects of
041311 -        Abraxane chemotherapy, which only subside for a day or so each
041312 -        week before the next treatment, which is when the doctor
041313 -        performs examinations, thus presenting a false positive on
041314 -        tolerating chemotherapy. ref SDS 90 U49Q
041316 -         ..
041317 -        [On 100731 1343 Doctor Johnson called with condolences on
041318 -        Millie's death 2 days earlier on 100729, and commended Millie
041319 -        for always looking well despite suffering fatal decline from
041320 -        cancer, and other debilitating infections from shingles and
041321 -        phlebitis. ref SDS 97 5E5H
041323 -  ..
041324 - Millie reported new IBC rash on her right side.  She is worried cancer
041325 - may be cascading out of control.  On 030606 Doctor Johnson warned that
041326 - patients need treatment in time to be effective before cancer reaches
041327 - critical mass and can no longer be controlled. ref SDS 2 P97J
041329 -  ..
041330 - Doctor Johnson examined Millie's IBC sites and noted cancer seems
041331 - contained on Millie's left side, but is clearly progressing on the
041332 - right side after the 2nd cycle of Abraxane chemotherapy, and following
041333 - the start of Abraxane on 100302. ref SDS 75 FB67  He feels expanding
041334 - IBC rash on the right breast aligns with rising trend for Millie's
041335 - cancer marker CA 15-3 listed on 090323, ref SDS 30 J13O, shows
041336 - Abraxane is not effective for Millie.  The doctor explained that
041337 - failure of Abraxane aligns with Kaiser's Chief Pharmacist, Zan,
041338 - warning the medical team that Abraxane would not help Millie recover
041339 - from cancer, and could cause fatal infection, reported on 100219 1453.
041340 - ref SDS 72 ER95, and cited in Millie's letter to the team a few weeks
041341 - later on 100301 0005. ref SDS 74 OO5X
041343 -             ..
041344 -            [On 100501 1037 Millie reports to medical team that cancer
041345 -            has worsened since the meeting on 100427, ref SDS 90 U46W,
041346 -            and requests immediate treatment with PARP. ref SDS 90 U44Y
041348 -  ..
041349 - The doctor said he has finally had time to make the review Millie
041350 - requested in letters the past months for the medical team to compare
041351 - trade-offs that identify the best treatment for Millie to recover from
041352 - UCSF medical mistakes that caused her cancer to relapse, requested
041353 - most recently in Millie's letter on 100329 2322. ref SDS 86 WA9U
041355 -             ..
041356 -            [On 100622 1511 case study shows Millie submitted 32
041357 -            letters requesting the medical team order treatment
041358 -            prescribed by UCSF for Millie to recover from UCSF medical
041359 -            mistakes. ref SDS 96 LQ7G
041361 -  ..
041362 - Doctor Johnson advised that Millie's patient profile suffering a 10th
041363 - relapse has mutated her cancer into a very aggresssive disease that
041364 - resists chemotherapy.  He said Millie needs treatment for her cancer
041365 - as a "chronic disease" with new agents "targeted" to the genetic
041366 - profile of her cancer, and so do not kill healthy cells.  This will
041367 - extend Millie's survival with quality of life that avoids pain and
041368 - suffering caused by chemotherapy.
041369 -
041370 -            [On 100501 1037 Millie reports to medical team that despite
041371 -            looking good the day of examination, that she is bed-ridden
041372 -            with drugs to control pain 4 - 6 days a week. ref SDS 90
041373 -            PQWR
041375 -  ..
041376 - Previously on 070105, Doctor Johnson explained benefits of agents
041377 - "targeted" to cancer cells, when he changed Millie's treatment plan
041378 - from chemotherapy at Kaiser, to cetuximab provided by Doctor Rugo on
041379 - referral at UCSF. ref SDS 9 PK68
041381 -  ..
041382 - On 080829, Doctor Johnson notified Millie that Kaiser has no more
041383 - treatments suitable to her patient profile, because Kaiser only has
041384 - chemotherapy agents, and Millie needs "targeted" treatment.  He asked
041385 - Millie to notify Doctor Rugo for UCSF to submit a list of follow on
041386 - "targeted" agents, so that the medical team (Kaiser and UCSF) is
041387 - prepared to switch treatments in time to be effective for Millie to
041388 - recover from her next relapse. ref SDS 14 PX5V
041390 -  ..
041391 - Case study on 090213, shows the medical team planning to treat
041392 - Millie's cancer as a chronic disease with therapy targeted to her
041393 - cancer, as ordered by Doctor Johnson at Kaiser. ref SDS 29 PT3N
041395 -  ..
041396 - Last month on 100302, Doctor Johnson's reported that the only way to
041397 - treat Millie's cancer concurrent with shingles infection is with
041398 - therapy targeted to cancer, because targeted therapy does not harm
041399 - blood counts, so her immunity is not compromised. ref SDS 75 IC85
041400 - However, her current treatment with Abraxane chemotherapy which Kaiser
041401 - started on 100303, weakens her immune system risking fatal infection,
041402 - including shingles relapse.
041404 -  ..
041405 - Doctor Johnson explained during the meeting today, that "targeted"
041406 - therapy for Millie can be implemented with PARP to increase recovery
041407 - from cancer and avoid harmful side effects of chemotherapy.  On
041408 - 100112, Doctor Johnson presented advantages of PARP reported in a
041409 - professional journal for oncology, Cure, as targeting Millie's triple
041410 - negative status. ref SDS 60 N586  On 090616, Doctor Rugo reported that
041411 - Kaiser and UCSF agreed in a letter that Millie's next treatment would
041412 - be with PARP. ref SDS 41 KD6L
041414 -  ..
041415 - The doctor cited Doctor Rugo at UCSF for progress treating patients
041416 - with agents "targeted" to the genetic profile of cancer, rather than
041417 - conventional chemotherapy.  Doctor Johnson said he doesn't know why
041418 - Doctor Rugo has not notified him for Millie to start treatment with
041419 - PARP, planned by UCSF in Tara's call for Doctor Rugo reported on
041420 - 090716 2106. ref SDS 42 EE5W  He feels Millie has somehow "slipped
041421 - through the cracks" the past few months, despite Millie's many letters
041422 - asking for treatment with PARP.  He explained a hectic schedule
041423 - starting a new department at Kaiser has reduced time for coordinating
041424 - Millie's care.  His calendar has now cleared, so there is time to
041425 - contact Doctor Rugo about switching Millie from Abraxane chemotherapy
041426 - at Kaiser, to getting treatment with PARP at UCSF, required for Millie
041427 - to recover from UCSF medical mistakes.
041428 -
041429 -        [On 100501 2017 Doctor Rugo reports plans to collaborate
041430 -        with Doctor Johnson at Kaiser on work plan for Millie to
041431 -        recover from 11th relapse of cancer caused by UCSF medical
041432 -        mistakes. ref SDS 91 456L
041434 -         ..
041435 -        [On 100504 1609 Sara, Practice Manager for UCSF Oncology Breast
041436 -        Care Clinic, called and notified Millie that Doctor Rugo will
041437 -        soon communicate with Doctor Johnson to coordinate with Kaiser
041438 -        on planning Millie's next treatment to recover from the 11th
041439 -        relapse of cancer. ref SDS 94 NT5N
041441 -  ..
041442 - Previously, the doctor reported having cleared a hectic schedule so
041443 - there was time to implement Millie's treatment plan, reported on
041444 - 090909 1344. ref SDS 44 3P4G  Months later, the doctor cited further
041445 - delays prevented starting Millie with PARP, reported on 091112 0930.
041446 - ref SDS 46 QN5G
041448 -  ..
041449 - Doctor Johnson wants to keep the current schedule for Millie to get 2
041450 - more treatments with Abraxane.  He will schedule treatment at UCSF to
041451 - start after Millie returns from vacation at the end of May.
041453 -  ..
041454 - Millie said she is very grateful that Kaiser and UCSF are now ready to
041455 - implement treatment with PARP planned on 090616. ref SDS 41 KD6L  Pain
041456 - and suffering has been overwhelming the past months getting
041457 - chemotherapy while waiting to start treatment with PARP, icluding
041458 - shingles infection which was nearly fatal in January.
041459 -
041460 -        [On 100501 1037 Millie letter to medical team confirms
041461 -        understanding of new strategy to treat Millie's cancer with
041462 -        targeted therapy. ref SDS 90 F25O
041464 -         ..
041465 -        [On 100501 2017 Doctor Rugo reports plans to collaborate
041466 -        with Doctor Johnson at Kaiser on work plan for Millie to
041467 -        recover from 11th relapse of cancer caused by UCSF medical
041468 -        mistakes. ref SDS 91 456L
041470 -         ..
041471 -        [On 100502 2143 Kaiser confirms that some patients respond well
041472 -        to new "targeted" therapies. ref SDS 92 YX8L
041474 -         ..
041475 -        [On 100502 2143 Kaiser reports that all of the strategies for
041476 -        "targeted" therapies have been executed for Millie, which
041477 -        conflicts with the record in this case, showing Millie has not
041478 -        been treated with PARP, nor other agents pending for Millie.
041479 -        ref SDS 92 MZ4N
041481 -         ..
041482 -        [On 100504 1609 Sara, Practice Manager for UCSF Oncology Breast
041483 -        Care Clinic, called and notified Millie that Doctor Rugo will
041484 -        soon communicate with Doctor Johnson to coordinate with Kaiser
041485 -        on planning Millie's next treatment to recover from the 11th
041486 -        relapse of cancer. ref SDS 94 NT5N
041487 -
041488 -
041489 -
0415 -

SUBJECTS
Default Null Subject Account for Blank Record

0503 -
050401 -  ..
050402 - Kaiser's Medical Chart Knowledge Management System
050403 -
050404 - Follow up ref SDS 87 R45K, ref SDS 75 R45K.
050405 -
050406 -    1.  Subject:  Visit 04/27/10
050407 -        Patient presents with: RECHECK
050408 -        Received: 4/27/10 9:23 AM
050409 -        To: Mildred A Buck
050410 -        From: ROBERT ALLSTON JOHNSON MD
050412 -         ..
050413 -    2.  History of Present Illness:
050414 -
050416 -        74 Y female with a history of IBC of left breast who was
050417 -        initially diagnosed 03/04/02. S/P AC x's 4 from 04/23/02
050418 -        through 07/01/02 followed by Taxotere ending 12/04/02.  She had
050419 -        recurrent disease noted initially in the cervical LN's
050420 -        03/03/04.  On E2100 Study with Taxol/Avastin, but she had a PE
050421 -        noted on CT 11/03/2004.  Then, because of progression of
050422 -        disease, the patient was started on Taxotere and Xeloda
050423 -        4/15/05.  She had a total of 8 cycles ending 9/16/05.  She had
050424 -        a palliative left mastectomy performed 10/21/05.  Then her left
050425 -        chest lesions began expanding again.  The patient started
050426 -        Taxotere and Xeloda again 07/21/06 for 7 cycles.  She was
050427 -        started on a Clinical Trial 02/01/07 at UCSF and was randomized
050428 -        to the Erbitux only (no Carbo) Arm.  She had weekly Carboplatin
050429 -        added 03/13/08 because of progression of disease.  Her disease
050430 -        progressed again and she began a Phase I/II Study of Sunitinib
050431 -        (SU11248) at UCSF 11/14/08.  Lengthy discussion about current
050432 -        status and response to therapy. Because of cytopenias, MTX to
050433 -        be D/C'd and Sutent and CTX held and then dose reduced.  The
050434 -        patient started hyperthermia/XRT at UCSF 02/19/09 and completed
050435 -        it 03/17/09.  She has started the MPA Clinical Trial at UCSF
050436 -        06/16/09 but this has been D/C'd.  She started Gemzar 07/28/09
050437 -        and received Cycle #4 11/05/09.  Because of evidence of
050438 -        progression she was switched to Navelbine 11/18/09.  However,
050439 -        she then developed erythema and nodularity on her right breast.
050440 -        Because of this and a rising CA 15-3 she was switched to
050441 -        Abraxane 03/03/10.  She states that lymphedema continues to
050442 -        increased in the right arm.  Pain persists across right
050443 -        forehead, head, and down neck to across upper back. She is
050444 -        tolerating chemotherapy.  She is here for FU.
050446 -         ..
050447 -    3.  Current medications:
050448 -        HYDROCODONE/ACETAMINOPH 5-5
050449 -        WARFARIN 4 MG TABLETS
050450 -        LUMIGAN 0.03% EYE DROPS (2.
050451 -        TIMOLOL MALEATE 0.5% EYE DR
050452 -        OXYCODONE W/APAP 5-325 MG T
050453 -        AEROCHAMBER Z-STAT/PLUS W/O
050454 -        QVAR 80 MCG ORAL INHALER
050455 -        ALBUTEROL HFA 90MCG ORAL IN
050456 -        GUAIFEN/CODEIN 100-10MG/5ML
050457 -        LORAZEPAM 1 MG TABLETS
050459 -         ..
050460 -    4.  Review of systems:
050461 -        Constitutional: Appetite and energy level are improving. Plans
050462 -        on taking trip to the Mediterranean in May; 12 day cruise
050463 -        Eyes: Seen by Ophthalmology 01/11/10
050464 -        ENT: No nose bleeds.
050465 -        Cardiovascular: No SOB, palpitations or chest pain
050466 -        Respiratory: No hemoptysis or cough. No DOE noted.
050467 -        GI: No nausea, vomiting or diarrhea
050468 -        GU: No hematuria or dysuria
050469 -        Musculoskeletal: Left neck spasm and right shoulder pain stable with Robaxin
050470 -        Skin: Pruritis of chest wall resolved
050471 -        Neurological: Persisting mild postherpetic neuropathy
050472 -        Psychiatric: No evidence of anxiety or depression today
050474 -         ..
050475 -    5.  Physical Exam:
050476 -        ECOG Performance Score 0
050477 -        BP 178/88 | Temp (Src) 97.9 F (36.6 C) (Oral) | Wt 136 lb 12.8 oz (62.052
050478 -        kg) | SpO2 97%
050479 -        Head: shingles right side of forehead largely gone
050480 -        Eyes: normal conjunctiva
050481 -        Mouth: normal mucosa
050482 -        Lymph: no nodes palpable in neck or axillae
050483 -        Breasts: evidence of erythema to other breast. Less edema
050484 -        in both arms
050485 -        Lungs: clear to percussion and auscultation
050486 -        Heart: regular without murmur or gallop
050487 -        Abd: soft with normal bowel sounds. No masses or organomegaly
050488 -        Ext: Edema increasing in both arms now
050489 -        Bones: no tenderness
050490 -        Neuro: awake, alert, and oriented. Moves all extremities
050491 -        well. Normal gait.
050493 -         ..
050494 -    6.  Lab:
050495 -        Creatinine 0.57 mg/dL
050496 -        ALT (SGPT) 11 U/L
050498 -         ..
050499 -    7.  Anticoag Ther? WARFARIN
050500 -        PT, Patient H 18.5 Sec
050501 -        PT INR 1.8 Ratio
050503 -         ..
050504 -    8.  WBC 4.8 K/uL
050505 -        RBC 3.77 M/uL
050506 -        Hemoglobin 11.6 g/dL
050507 -        Hematocrit 35.5 %
050508 -        MCV 94 fL
050509 -        RDW H 15.2 %
050510 -        Plt 294 K/uL
050512 -         ..
050513 -    9.  CA 15-3
050514 -        -----------
050515 -        367 H
050516 -        384 H
050517 -        369 H
050518 -        426 H
050519 -        328 H
050520 -        275 H
050522 -         ..
050523 -   10.  Imaging:
050524 -
050525 -        02/18/10 CT THORAX W CONTRAST - 1. Mild interval improvement of
050526 -        the patchy ground glass opacities bilaterally.  There are still
050527 -        a few patchy densities noted predominantly in the bilateral
050528 -        lung bases.  New area of subsegmental atelectasis vs
050529 -        post-inflammatory scarring right upper lobe.  Resolution of
050530 -        small left pleural effusion.
050532 -         ..
050533 -        01/19/10 MRI BRAIN WO/W CONTRAST(STD) - No significant
050534 -        abnormalities.
050536 -         ..
050537 -        09/19/09 CT THORAX W CONTRAST - No pulmonary emboli on a
050538 -        technically good study.  The lungs show multiple areas of
050539 -        groundglass opacity and multiple small areas of more confluent
050540 -        density.  Tiny left pleural effusion.  S/P left mastectomy.  A
050541 -        few additional minor findings, as described above.  Since July
050542 -        20, 2009 CT scan of the chest, there has been resolution of
050543 -        many of the pulmonary opacities but there are now many new
050544 -        ones, especially in the left lower lobe and in the right upper
050545 -        lobe.  The left pleural effusion is much smaller.  Otherwise,
050546 -        no change.
050548 -         ..
050549 -        09/19/09 CHEST, SINGLE
050551 -         ..
050552 -        07/31/09 RIBS, UNILATERAL, 2 VIEWS - Right ribs appear intact
050554 -         ..
050555 -        07/20/09 CT THORAX W CONTRAST - 1. Negative for pulmonary
050556 -        embolus. 2.  New small left pleural effusion.  No pleural
050557 -        enhancement or evidence of loculation. 3.  Otherwise stable
050558 -        chest CT compared with recent examination from one month
050559 -        earlier.
050561 -         ..
050562 -        06/12/09 CT THORAX, ABDOMEN, PELVIS W CONTRAST
050564 -         ..
050565 -        06/12/09 CT NECK W CONTRAST
050567 -         ..
050568 -        03/17/09 DXA BONE DENSITY, AXIAL - 1. Bone mineral density
050569 -        calculated for the LUMBAR SPINE is statistically consistent
050570 -        with osteopenia. 2.  Bone mineral density calculated for the
050571 -        TOTAL HIP is statistically consistent with osteopenia.
050573 -         ..
050574 -        01/22/09 SHOULDER, COMPLETE 2+ VIEWS - Orthopedic follow up.
050575 -        See Orthopedic note for details.  S/P reduction of anterior
050576 -        shoulder dislocation.
050578 -         ..
050579 -        01/22/09 SHOULDER, ONE VIEW - Dislocation, right shoulder.
050580 -        Fracture right humeral head
050582 -         ..
050583 -        01/22/09 CT CERV SPINE W/O CONTRAST - Degenerative changes of
050584 -        the cervical spine without evidence of acute C spine fracture
050585 -        or loss in alignment.
050587 -         ..
050588 -        01/22/09 CT HEAD W/O CONTRAST - 1. No evidence of acute infarct
050589 -        or hemorrhage. 2.  Sinus disease.  Mild nasal septal deviation
050590 -        to the right.
050592 -         ..
050593 -   11.  Assessment:
050594 -
050595 -        1. Persisting mild postherpetic neuropathy. Pruritic now.
050596 -        2. Metastatic breast cancer (IBC) lung, lymph node and
050597 -           chest wall
050598 -        3. Cancer pain controlled better on MS
050599 -        4. Lymphedema slightly worse on right; has compression garment
050600 -        5. Anticoagulation monitoring
050602 -         ..
050603 -   12.  Plan:
050604 -
050605 -        1. Continue Abraxane 100 mg/m2 or 150 mg/m2 iv qw x 3 weeks
050606 -           every 4 weeks
050607 -        2. Continue serial CA 15-3's
050608 -        3. Plan for May 15th cruise
050609 -        4. Refill Percocet and Morphine
050610 -        5. Blood draws from port only because of bilateral lymphedema
050611 -        6. RTC one month
050613 -                ..
050614 -               [On 100529 0930 blood draw went smoothly correcting past
050615 -               problems, because nurse relied on instructions in
050616 -               medical chart on 100427, directing use of Millie's Power
050617 -               Port for blood draws, ref SDS 0 X74Q, and restating
050618 -               directions in the doctor's letter to the Kaiser Walnut
050619 -               Creek Infusion Clinic on 091112, ref SDS 46 UN8F, and so
050620 -               in Millie's case overrules the new policy change a few
050621 -               months ago that prevented nurses from drawing blood
050622 -               using Millie's port, thereby forcing Millie to get blood
050623 -               drawn from her arms infected with cancer, causing her
050624 -               cancer to spread, e.g., on 100104, ref SDS 56 4Q30, and
050625 -               which conflicted with the doctor's order to avoid blood
050626 -               draws and blood pressure procedures on Millie's arms
050627 -               infected with cancer. ref SDS 95 SK8M
050628 -
050632 -
050633 -
050634 -
050635 -
050636 -
050637 -
050638 -
050639 -
0507 -