41. Picture Of Cholesteatoma And Mastoidectomy   * Otolaryngology Houston Surgical pictures of a mastoidectomy and the removal of a cholesteatoma from themastoid antrum. http://www.ghorayeb.com/Cholesteatoma.html

Otolaryngology Houston Bechara Y. Ghorayeb, MD 8830 Long Point, Suite 806 Houston, Texas 77055 Tel. 713 464 2614 Professional Information Office Information What is Otolaryngology? Post-Op Information ... Home This page was last updated: March 13, 2005 Pictures of Cholesteatoma Pictures Ear Pictures Tympanic Membrane Perforation Mastoidectomy ... Home Picture of Mastoidectomy showing a large cholesteatoma in the mastoid antrum. Picture of the cholesteatoma after its removal.

42. Mastoid Surgery - Mastoidectomy For Cholesteatoma Mastoid surgery mastoidectomy for cholesteatoma. http://www.entusa.com/mastoid_surgery.htm

Mastoidectomy ( Mastoid Surgery ): Search PubMed for Cholesteatoma for Mastoidectomy Click on colored text for word definitions !! Before the advent of antibiotics, mastoid surgery used to be one of the most frequent surgeries performed. Acute mastoiditis was common and the treatment is a mastoidectomy . Today, mastoid surgery is performed less often. The most common indication is to remove a cholesteatoma or a skin cyst in the ear. A cholesteatoma most commonly starts to form from a retraction pocket in the eardrum. The sequence of events begins with eustachian tube dysfunction which leads to negative pressure in the middle ear . The eardrum is sucked into the middle ear and slowly forms a pocket. The pocket enlarges and retracts deep into the ear. Skin debris gets caught, it becomes infected and slowly expands. A cholesteatoma is formed, it erodes bone and can cause hearing loss, dizziness, facial paralysis and can even erode into the brain. The picture on the right shows a large attic cholesteatoma tympanosclerosis and an ear tube in the eardrum.

43. Cholesteatoma Medical Information cholesteatoma Information from Drugs.com. cholesteatoma is a type of cystlocated in the middle ear. Causes. cholesteatoma can be a congenital (present http://www.drugs.com/enc/cholesteatoma.html

Home New Drugs Latest News Drug Interactions ... Forum Drugs.com - prescription drug and medicine information available on over 24,000 approved- medications and pharmaceuticals, including side effects and drug interactions. Log-in Register Advertisement Buy a Link Now Special Offers From our sponsors Categories Diabetes Gastro Center Weight Loss AIDS/HIV ... Sexual Health Advertisement Advanced Search Or click the first letter of a drug name: A B C D ... Z Cholesteatoma Injury Disease Nutrition Poison ... Tympanic membrane Cholesteatoma Definition Cholesteatoma is a type of cyst located in the middle ear. Causes Cholesteatoma can be a congenital (present at birth) defect, but it more commonly occurs as a complication of chronic ear infection . Long-term inflammation and malfunction of the eustachian tube leads to chronic negative pressure in the middle ear. This pulls a portion of the eardrum (tympanic membrane) inward, creating a sac or cyst that fills with old skin cells and other debris. The cyst becomes chronically infected. The cyst typically continues to fill with debris over time and may erode the mastoid bone and the bones of the middle ear. Symptoms drainage from the ear , usually chronic hearing loss in one ear pain or numbness in the ear or around the ear dizziness Exams and Tests Inspection of the ear may show a pocket or perforation (opening) in the eardrum, often with drainage. The deposit of old skin cells may be visible with an otoscope.

44. Dr. Koop - Cholesteatoma cholesteatoma is a type of located in the middle ear. http://www.drkoop.com/ency/93/001050.html

Home Health Reference Cholesteatoma Jul 29, 2005 Search: Dr.Koop MEDLINE Diseases Symptoms Procedures Natural Medicine ... Drug Library Inside DrKoop News Archive Animations Health Videos Health Tools ... Newsletters Cholesteatoma Injury Disease Nutrition Poison ... Prevention Cholesteatoma Definition: Cholesteatoma is a type of cyst located in the middle ear. Causes, incidence, and risk factors: Cholesteatoma can be a congenital (present at birth) defect, but it more commonly occurs as a complication of chronic ear infection . Long-term inflammation and malfunction of the eustachian tube leads to chronic negative pressure in the middle ear. This pulls a portion of the eardrum (tympanic membrane) inward, creating a sac or cyst that fills with old skin cells and other debris. The cyst becomes chronically infected. The cyst typically continues to fill with debris over time and may erode the mastoid bone and the bones of the middle ear. New Features Fewer Migraines Skin Cancer Atkins/Low Carb Diets Learn More About Migraines * All Health Centers * Acne Addictions AIDS/HIV Alcohol Abuse Allergies Alternative Medicine Alzheimer's Arthritis Asthma Attention Deficit Disorder (ADHD) Backache Bipolar Affective Disorder Birth Control Blood Blood Pressure Bone/Joint/Tendon Bowel Brain Breast cancer Cancer Cerebral Palsy Cholesterol Cramps Crohn's Disease Cysts Dental/Oral Depression Diabetes Diet, Fitness, Looks

45. National Deaf Children S Society - Cholesteatoma An NDCS factsheet on cholesteatoma. Information aimed at parents. http://www.ndcs.org.uk/information/childhood_deafness/cholesteatoma/

YOU ARE HERE: Home Information Childhood deafness Cholesteatoma Cholesteatoma Childhood deafness Understanding deafness Hearing aids Cochlear implants ... Meningitis Cholesteatoma Enlarged vestibular aqueducts Waardenburg's syndrome Why does my child have hearing loss? Communication ... Useful organisations Cholesteatoma An NDCS factsheet on cholesteatoma. Aimed at parents. To download the factsheet, click on the link below. Cholesteatoma (2005) (106 kb) To download and read this NDCS publication you will need Adobe Reader, which can be downloaded very simply and at no charge from the Adobe website Join in the discussion at Parent Place Would you like to discuss issues and share experiences with other parents? Why not visit Parent Place, the NDCS online forum for parents, to join in the discussions on a whole range of topics. Visit Parent Place Would you like to comment on this NDCS publication? Has this NDCS publication been useful to you or could we improve it somehow? We are constantly updating existing publications and adding new ones to our list and would love to hear from you if you think there is anything we could do better. Please use the 'Post comment' function on the right of the page to send us your comments. Thanks!

46. Cholesteatoma cholesteatoma what it is, how it forms, the damage that it may do, and how itis treated. http://www.doctorhoffman.com/xcholes.htm

The Medical Consumer's Advocate This letter originally appeared in Dr. Hoffman's column on allHealth.com. Cholesteatoma The writer reports that her young son has had two operations for cholesteatoma; she states that the doctor "botched" the operation, and he is now completely deaf in the operated ear. She is seeking more information on cholesteatoma. Cholesteatoma is best defined as "skin growing in a place where skin normally does not grow." The middle ear (the cavity behind the ear drum) is the usual location for cholesteatoma, but I have heard of cholesteatomas arising within the facial sinuses and other parts of the body (usually as a result of previous penetrating trauma, such as a stab wound, which presumably forced a collection of skin cells into the sinus or body cavity.) Middle ear cholesteatoma can arise in a number of ways. For example, some people have a condition called Eustachian tube dysfunction , in which the Eustachian tubes fail to appropriately ventilate the middle ear space. If the middle ear is poorly ventilated, the air pressure behind the ear drum can become lower than the "outside" air pressure, and if this pressure difference is large and persistent, a portion of the ear drum can be "sucked inward," forming a

47. Cholesteatoma cholesteatoma and Mastoidectomy. What is a cholesteatoma? A cholesteatoma is asac of skin that arises off the eardrum and erodes into the middle ear and http://www.uphs.upenn.edu/balance/patient education brochures/cholesteatoma.htm

Cholesteatoma and Mastoidectomy What is a cholesteatoma? A cholesteatoma is a sac of skin that arises off the eardrum and erodes into the middle ear and mastoid bone. It is a benign growth or tumor that causes damage because as it grows, it erodes structures that fall in its path. What structures can a cholesteatoma effect? As the cholesteatoma grows into the middle ear it can erode the bones of hearing causing a significant hearing loss. As it grows farther it can cause a facial paralysis as it erodes into the facial nerve that supplies the muscles of the face. It may also grow into the inner ear causing spinning vertigo and inner ear or sensorineural hearing loss. If it is allowed to continue to grow it can erode into the brain cavity causing infections such as meningitis or abscess. In addition, cholesteatoma may become infected which will cause the ear to drain. Infections in the cholesteatoma cause them to grow more rapidly, thus increasing the damage that a cholesteatoma may cause. What is the treatment of cholesteatoma?

48. Otorhinolaryngologic Diseases cholesteatoma, Middle Ear Croup - Deafness - Ear Diseases - Epistaxis - Hearing cholesteatoma A Serious Ear Condition - Sinus Care Center (US) http://www.mic.ki.se/Diseases/C09.html

search search staff sitemap ABOUT KAROLINSKA INSTITUTET ... print this page Diseases and Disorders Links pertaining to Otorhinolaryngologic Diseases Alert! Patients and laypersons looking for guidance among the target sources of this collection of links are strongly advised to review the information retrieved with their professional health care provider. Start Page Contents: Cholesteatoma, Middle Ear Croup Deafness Ear Diseases ... Voice Disorders Otorhinolaryngologic Diseases Head and Neck Exam [C Goldberg] - School of Medicine, UCSD (US) Otolaryngology (and Facial Plastic Surgery) - eMedicine Otolaryngology Resources on the Internet [A Moore] Grand Rounds Archives , and some documents in Pediatric Otolaryngology Pediatric Otolaryngology [TM Davidson] - UCSD (US) Ear, Nose, and Throat Information Center [P. Casano] - Sinus Care Center Dr Quinn's Textbook from U of Texas Med Branch (US) Practical ENT for Primary Care - Univ of Toronto (CA) ENT UK , including some Patient Information - British Assoc Otorhinolaryngolists (UK) Antimicrobial Therapy in Otolaryngology/Head and Neck Surgery [DNF Fairbanks] - AAO (US) Otoweb at Univ of Wisconsin-Madison (US) - (US) Otolaryngology Houston [BY Ghorayeb] - (US) Anatomy of the Neck - Baylor Coll. (US)

49. 8th International Conference On Cholesteatoma & Ear Surgery 8th International Conference on cholesteatoma Ear Surgery. http://www.chole2008.org/

Dear Friends and Colleagues, I am very pleased to announce that the 8th International Conference on Cholesteatoma and Ear Surgery will be held during June 2008 in Turkey. The time for next get-together for us professionals is addressed to Antalya - Belek. The scientific program will be focused on epidemiology, pathology, pathogenesis, imaging, clinical features and management of cholesteatoma in a wide spectrum of subtopics. As it is used to be, the topics will be discussed in a highly scientific level by the distinguished authors and researchers from all over the world. The conference will also feature activities such as temporal bone dissection courses, live surgeries transmitted by Satellite links and the instructional courses sponsored by the European Academy of Otology and Neurotology. Special sessions will be provided for the very well known dedicated societies such as Politzer Society, European Academy of Otology and Neurotology and Mediterranean Society of Otology and Audiology. Chairman 8th International Conference on Cholesteatoma and Ear Surgery var sc_project=569223; var sc_partition=4; var sc_security="651fae2d";

50. Defeating Deafness : Cholesteatoma : Cholesteatoma A cholesteatoma is an abnormal skin growth behind the eardrum, normally the The first stage of treatment of cholesteatoma will involve tackling the http://www.defeatingdeafness.org/cholesteatoma page1976.html

@import url(styles/ddnew.css); ask a question glossary site map links ... It's good to talk For all your questions about deafness and hearing loss, call our Freephone information line: Did you know? In the UK there are around 2 million people who would benefit from using hearing aids, but they are only used by 1.4 million. Help defeat deafness There are many different ways you can help us in our work. Keep up to date Subscribe to our free email newsletter for the latest developments from the world of hearing research. Donate Frequently asked questions Are there any treatments for tinnitus? What is glue ear? ... What causes age-related hearing loss? Print this page Email this page to a friend Text-only version Cholesteatoma A cholesteatoma is an abnormal skin growth behind the eardrum, normally the result of severe or repeated cases of 'glue ear' (otitis media) or other middle ear infections. The growth can increase in size, forming a skin cyst or pouch and damaging the delicate bones of the middle ear, affecting hearing and balance. Cholesteatomas are slow growing, non-malignant growths but, left untreated, they can result in serious damage to the middle and inner ear. The enzymes which are contained in cholesteatomas are activated through contact with water. If the ear is infected, these enzymes will react with the fluid to erode the bone to the inner ear, potentially causing hearing loss and, if facial nerves are also affected, paralysis. In rare and extreme cases, untreated cholesteatomas can erode the intercranial cavity, causing more serious infections such as meningitis.

51. Defeating Deafness : Latest Research Developments : Cholesteatoma Research cholesteatoma research. Defeating Deafness is funding a number of research cholesteatoma. Defeating Deafness is the UK s medical charity for deaf and http://www.defeatingdeafness.org/cholesteatoma research page1744.html

@import url(styles/ddnew.css); ask a question glossary site map links ... It's good to talk For all your questions about deafness and hearing loss, call our Freephone information line: Did you know? 70 to 80% per cent of people who visit nightclubs will experience temporary tinnitus, potentially causing longer-term hearing problems. Help defeat deafness There are many different ways you can help us in our work. Keep up to date Subscribe to our free email newsletter for the latest news from Defeating Deafness and the world of hearing research. Donate Frequently asked questions Are there any treatments for tinnitus? What is glue ear? ... What causes age-related hearing loss? Print this page Email this page to a friend Text-only version Cholesteatoma research Defeating Deafness is funding a number of research teams studying cholesteatoma, including: A team of researchers at the University of Nottingham, is evaluating the role of special enzymes, called MMPs, to see how they affect the ear. Researchers in Glasgow are studying the early stages of the cholesteatoma, gaining vital knowledge about how the disease progresses. THIS SECTION Latest developments in hearing loss research Hair cell research Genetic research Tinnitus research ... Cochlear implant research SEE ALSO DEAFNESS : THE FACTS Cholesteatoma Defeating Deafness is the UK's medical charity for deaf and hard of hearing people.

52. Cholesteatoma A cholesteatoma is a greasylooking mass or accumulation of debris that is seenin a retraction pocket or perforation. It often presents as chronic otorrhea http://www.aap.org/otitismedia/www/vc/ear/rvw/rvw20.cfm

Pneumatic Otoscopy Review Course Cholesteatoma 1.Tools 2.Landmarks 3.Views 4.Light Reflex ... AOM Case Studies Cholesteatoma A cholesteatoma is a greasy-looking mass or accumulation of debris that is seen in a retraction pocket or perforation. It often presents as chronic otorrhea unresponsive to antibiotic therapy. The diagram below shows how a retraction pocket can enlarge and accumulate debris to form an acquired cholesteatoma. Cholesteatomas also may be congenital. Cholesteatoma 20 of 21

53. Cholesteatoma cholesteatoma is a skin growth that occurs in the middle ear behind the eardrum.It may be acquired due to repeated infection, which causes ingrowth of the http://www.entcolumbia.org/cholest.htm

Cholesteatoma What is a cholesteatoma? A cholesteatoma is a skin growth that occurs in an abnormal location, usually in the middle ear behind the eardrum. It is most commonly due to repeated infection, which causes an ingrowth of the skin of the eardrum. It may also be congenital (present at birth). Cholesteatomas often take the form of a cyst or pouch that sheds layers of old skin that builds up inside the ear. Over time, the cholesteatoma can increase in size and destroy the surrounding delicate hearing bones of the middle ear (ossicles). Chronic infection and hearing loss are common side effects of the disease process. Meningitis, dizziness, and facial muscle paralysis are rare but can result from continued cholesteatoma growth. How does cholesteatoma occur? A cholesteatoma usually occurs because of poor eustachian tube function as well as infection in the middle ear. The eustachian tube conveys air from the back of the nose into the middle ear to equalize ear pressure ("clear the ears"). When the eustachian tubes work poorly (perhaps due to allergy, a cold or sinusitis), the air in the middle ear is absorbed by the body, and a partial vacuum forms in the ear. The vacuum pressure sucks in a pouch or sac by stretching the eardrum, especially areas weakened by previous infections. This sac often becomes a cholesteatoma. A rare congenital form of cholesteatoma (one present at birth) can occur in the middle ear and elsewhere, such as in the nearby skull bones. However, the type of cholesteatoma associated with ear infections is most common.

54. Treatment And Removal Of Cholesteatomas A cholesteatoma is a skin growth that occurs in the middle ear behind the eardrum . Surgical removal of cholesteatoma, and sometimes mastoidectomy, http://www.entcolumbia.org/cholrem.htm

Treatment and Removal of Cholesteatomas Cholesteatoma is a serious but treatable ear condition which can only be diagnosed by medical examination. Persisting earache, ear drainage, ear pressure, hearing loss, dizziness, or facial muscle weakness signals the need for evaluation by an otolaryngologist-head and neck surgeon. Initial treatment may consist of a careful cleaning of the ear, antibiotics, and ear drops. Therapy aims to stop drainage in the ear by controlling the infection. The extent or growth characteristics of a cholesteatoma must also be evaluated. Large or complicated cholesteatomas usually require surgical treatment to protect the patient from serious complications. Hearing and balance tests, x-rays of the mastoid (the skull bone next to the ear), and CAT scans (3-D x-rays) of the mastoid may be necessary. These tests are performed to determine the hearing level remaining in the ear and the extent of destruction the cholesteatoma has caused. Cholesteatoma Surgery Surgery is performed under general anesthesia in most cases. The primary purpose of the surgery is to remove the cholesteatoma and infection and achieve an infection-free, dry ear. Hearing preservation or restoration is the second goal of surgery. In cases of severe ear destruction, reconstruction may not be possible. Facial nerve repair or procedures to control dizziness are rarely required. Reconstruction of the middle ear is not always possible in one operation; and therefore, a second operation may be performed six to twelve months later. The second operation will attempt to restore hearing and, at the same time, inspect the middle ear space and mastoid for residual cholesteatoma.

55. ► Cholesteatoma A medical encycopedia article on the topic cholesteatoma. http://www.umm.edu/ency/article/001050.htm

var MenuLinkedBy='AllWebMenus [2]', awmBN='530'; awmAltUrl=''; Disease Nutrition Surgery Symptoms Injury ... Encyclopedia (English) Toggle English Spanish Cholesteatoma Overview Symptoms Treatment Prevention Definition: A type of cyst located in the middle ear. Causes, incidence, and risk factors: Cholesteatoma can be a congenital defect, but it more commonly occurs as a complication of chronic ear infection . Long-term inflammation and malfunction of the eustachian tube leads to chronic negative pressure in the middle ear. This pulls a portion of the eardrum (tympanic membrane) inward, creating a sac or cyst that fills with old skin cells and other debris. The cyst becomes chronically infected. The cyst typically continues to fill with debris over time and may erode the mastoid bone and the bones of the middle ear. Tympanic membrane Review Date: 9/5/2002 Reviewed By: Jason Newman, M.D., Department of Otolaryngology, Kaiser Permanente Medical Group, Washington, DC. Review provided by VeriMed Healthcare Network.

56. THE MERCK MANUAL OF GERIATRICS, Ch. 129, Ear Disorders cholesteatoma. An enlarging sac of squamous epithelium containing A cholesteatomamay erode through the tegmen, allowing an epidural abscess to form. http://www.merck.com/mrkshared/mmg/sec15/ch129/ch129h.jsp

57. Cholesteatoma The Texas Pediatric Otolaryngology Center is a specialized, childcentered practicefor the care of patients from infancy to 18 years of age. http://www.texaspedioto.com/cholesteatoma.html

Dr. Edmonds Dr. Duncan Dr. Jones Dr. Albright ... Directions Ears and Hearing Ear Infections Additional Insights Cholesteatoma Cochlear Implants ... Swimmer's Ear Cholesteatoma A perforation of the ear drum will generally heal without surgery. In some cases, however, instead of normally healing, the skin of the ear drum can grow through the hole into the middle ear. If infection is present, the skin will continue to grow into the middle ear and will become a tumor of the ear termed a cholesteatoma. Cholesteatomas are NOT a form of cancer. They are benign tumors. As they grow, they can look like an onion peel of white skin formed into a ball. Cholesteatomas can also be present without a hole in the ear drum, and without a history of ear infection. These types of cholesteatoms are called congenital cholesteatomas. They are often overlooked until they grow to a relatively large size. Cholesteatoma can destroy the bones of hearing as they grow, especially when the ear is infected. Consequently, symptoms of cholesteatoma include hearing loss and recurring discharge from the ear. Pus or unpleasant smelling fluids coming from the ear are common. A surgical microscope is necessary to make a proper inspection and cleansing of the condition, especially when there is infection. Cholesteatomas actively erode bone because they contain enzymes which are activated by moisture. In time, cholesteatomas will eventually erode the bone leading into the inner ear. This can cause nerve loss and deafness as well as severe imbalance and dizziness. The thin plate of bone that separates the roof of the ear from the brain can also be eroded by cholesteatomas.

58. Cholesteatoma xray2000 Nick\ s Website 3000+ xray images and Info. http://www.e-radiography.net/radpath/c/cholesteatoma.htm

Cholesteatoma Definition A tumor-like mass of keratinizing squamous epithelium and cholesterol in the middle ear, usually resulting from chronic otitis media, with squamous metaplasia or extension of squamous epithelium inward to line an expanding cystic cavity that may involve the mastoid and erode surrounding bone. Radiographic Appearance Traditionaly a series of films to include: Slit PA through the orbits, slit 30o fronto occipital amd "stenvers" obliques were utilised to demonstrate a widening of the internal auditory meatus, Computed tomography is the study of choice for imaging of the temporal bone in cholesteatoma. However, MR can be a complimentary modality when intracranial extension and bony defects are observed or suspected. Additionally, MR is indicated for cases of facial nerve involvement and unexplained sensorineural hearing loss. Cholesteatomas have variable signal intensities in contrast enhanced MR. Generally, signals are isointense on T1 weighed imaging and become moderately hyperintense on lengthening of the TR. Debris usually is present. Cholesteatomas typically do not enhance with gadolinium, except rarely at the edges of the lesion. MR is useful to delineate intracranial complications including abscesses, lateral sinus thrombosis, and meningitis. These lesions may occur in the middle ear, mastoid cavity, or the petrous apex.

59. Map & Graph: Countries By Mortality: Cholesteatoma Of Middle Ear cholesteatoma of middle ear. The mortality statistics consist of deaths registeredin national vital registration systems, as submitted to the World Health http://www.nationmaster.com/graph-B/mor_cho_of_mid_ear

Supporter Benefits Signup Login Sources ... Pies Factoid #23 The United States consumes more energy than India, the Middle East, South America, Africa, South East Asia and Oceania combined - which means more than 3.1 billion people Interesting Facts Make your own graph: Hold down Control and click on several. Compare All Top 5 Top 10 Top 20 Top 50 Top 100 Bottom 100 Bottom 20 Bottom 10 Bottom 5 All (desc) in category: Select Category Agriculture Crime Currency Democracy Disasters Economy Education Energy Environment Food Geography Government Health Identification Immigration Industry Internet Labor Language Lifestyle Media Military Mortality People Religion Sports Taxation Transportation with statistic: view: Correlations Printable graph / table Pie chart Scatterplot with ... * Asterisk means graphable. What's new? Our next offering Latest newsletter Student area Lesson plans Top Countries The most requested countries (descending order): United States Canada India China ... Mortality : Cholesteatoma of middle ear View this stat: Per capita Show map full screen Country Description Definition: Total for all ages and sexes. Database compiled January 2004. Total of figures for:

60. Cholesteatoma cholesteatoma is a type of cyst located in the middle ear. What are the causesof cholesteatoma? The most common cause of cholesteatoma is having frequent http://www.doctoronline.nhs.uk/masterwebsite1Asp/targetpages/specialts/ent/chole

Cholesteatoma [To print this page click here] What is cholesteatoma? Cholesteatoma is a type of cyst located in the middle ear. What are the causes of cholesteatoma? The most common cause of cholesteatoma is having frequent ear infections. A cyst can develop and become chronically infected. The cyst typically continues to grow and may erode the mastoid bone, bones of the middle ear and even the brain if left untreated. Occasionally cholesteatoma is congenital. What are the symptoms? You may experience: bad smelling fluid draining from the ear; hearing loss in one ear; pain or numbness in the ear or around the ear; dizziness. How is it diagnosed? The doctor may be able to see the cholesteatoma when they look in your ear with an otoscope or do a CT scan which shows the bones and cavities around and in the ear. How is cholesteatoma treated? The only known treatment is surgical removal. Surgery may involve the creation of a space which used to be the middle ear and mastoid bone. This may need cl... You are currently viewing our reduced public web site. For our full site, please visit nww.doctoronline.nhs.uk on the NHS Net.

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