Surgical operation presentation. Presentation on the topic "Surgical operation

Regional State Autonomous Educational Institution secondary vocational education "Dobryanskiy Humanitarian and Technological College them. P.I. Suzev "

Nursing assistance in surgery

Teacher: Pishchuleva T.V.

• A patient - person (individual) who needs and receives nursing care
• Nursing - part of health care, a specific professional activity, science and art aimed at solving existing and potential health problems in a changing environment.
• Environment Wednesday- a set of natural, social, psychological and spiritual factors and indicators that are affected by human activity.

Health Is a state of physical, spiritual, mental and social well-being, and not just the absence of disease or inferiority

(WHO 1947)

• Patient care - sanitary hypurgia (Greek. hypourgiai - to help, provide a service) - medical activities for the implementation of clinical hygiene in a hospital, aimed at alleviating the patient's condition and contributing to his recovery.
• Patient care is of particular importance in surgery as an extremely important element in surgical aggression, which mitigates its adverse consequences and greatly influences the outcome of treatment.

• "Surgery" literally means handicraft, skill (chier - hand; ergon - action)
• by surgery is meant one of the main branches of clinical medicine, which studies various diseases and injuries, for the treatment of which methods of influence on tissues are used, accompanied by a violation of the integrity of body tissues to detect and eliminate a pathological focus.

• Surgical care is a medical activity aimed at helping the patient to meet his basic life needs (food, drink, movement, emptying of the intestines, bladder, etc.) and during pathological conditions (vomiting, coughing, breathing disorders, bleeding, etc.) .).

1.optimization of the patient's living conditions, contributing to the course of the disease

2.speed up the patient's recovery and reduce the number of complications

3. fulfillment of doctor's prescriptions

• General surgical care is the organization of sanitary - hygienic and medical-protective regimes in the department.
• The sanitary and hygienic regime includes:

Organization of cleaning of premises;

Ensuring the hygiene of the patient;

Prevention of nosocomial infection (the term comes from the Latin nosocomium - hospital and from the Greek. nosokomeo- to look after the sick) (nosocomial infections)

Creation of a favorable environment for the patient;

Provision of drugs, their correct dosage and use as prescribed by a doctor;

Organization of high-quality nutrition of the patient in accordance with the nature of the pathological process;

Correct manipulation and preparation of the patient for examinations and surgical interventions.

• The causative agents of surgical infection are pyogenic microbes - aerobes (Staphylococcus, Streptococcus, S treptococcus pneumoniae) and anaerobes(stick of gas gangrene - Clostridium perfringens , tetanus bacillus - Cltridosium tetani) .
• These pathogens cause a specific or nonspecific infection, acute or chronic along the course.

• A necessary condition for the penetration of the pathogen into the body is the presence entrance gate.
• Entrance gates can be of different sizes, from a large wound to a bite or injection site.

• Ways of penetration of infection into the wound - the pathogen can get into the operating wound exogenously, i.e. from the environment, or endogenous- from an inflammatory focus in the body itself (boil, purulent tonsil, carious tooth).

• Exogenous path:

Air - through the air;

Drip - through the liquid that has entered the wound;

Contact - through objects in contact with the wound;

Implantation - through objects that must remain in the wound for the required time.

• Endogenous pathway:
• - hematogenous - with blood flow;
• - lymphogenous - with lymph flow.

Local reaction:

Hyperemia (redness);

Edema (swelling);

Local temperature rise;

Functional impairment.

• Signs general reaction:

Weakness, malaise;

Headache;

Nausea, vomiting;

Increased body temperature, chills;

Changes in the blood test.

• To fight germs in the wound Lister proposed a number of activities and named them antiseptic.
• Bergman chose a different path fight against infection: preventing it from entering the body, and suggested other measures, called asepsis.
• Antiseptic is to fight an infection that has already entered the wound, therefore it is a therapeutic method, and asepsis- preventive.

• Asepsis is a set of measures to ensure that microbes do not enter the human body, including the surgical wound.

Organizational activities (special regime zones);

Physical factors (ventilation, cleaning, UFO);

Chemicals (disinfectants, antiseptics, etc.).

Operating room;

Resuscitation;

Treatment room;

Dressing room.

Limited personnel admission;

Compliance with the dress code;

Compliance with aseptic standards (cleaning of premises).

• Asepsis provided disinfection and sterilization.
• Disinfection- this is the destruction of only vegetative forms of pathogenic and conditionally pathogenic microbes
• Sterilization- this is the complete destruction of microbes and their spores in the sterilized material
• All items that come into contact with the wound must be sterile!

• Sterilization is carried out physical methods(steam, air, in the environment of heated balls) and chemical(chemicals, gases).

PHYSICAL METHOD OF STERILIZATION Air sterilization (dry hot air)

Mode

sterilization

T, o C

Control

Time

Name

sterilization quality

objects

Type of packaging material

• Vitamin C
• succinic acid
• Thiourea
• Thermoindicator tape IS-180

Metal and glass products

• Sucrose
• Thermoindicator tape IS-160

craft package

Silicone rubber products

Optimal mode

wet-strength sack paper, Term storage 3 days

Two-layer packaging made of medical crepe paper

Sparing mode

Term storage 20 days

without packaging

Term storage immediately up to 6 hours under aseptic conditions

Steam sterilization method (autoclaving )

Mode

T, o C

sterilization

P, atm

Time, min

Control

Name of objects

quality

Type of packaging material

sterilization

• Urea
• Thermoindicator tape IS-132

• Benzoic acid
• Thermoindicator tape IS - 120

• Dressing and suture material;
• Surgical underwear;
• Metal and glass products

Products made of rubber, latex, polymeric materials

Sterilization box w / filter

Double packing of coarse calico

Non-impregnated sack paper

Wet-strength sack paper

Crepe paper for medical purposes (single-layer packaging)

Term storage 3 days

Sterilization box with filter

Crepe paper for medical purposes (two-layer packaging)

Term storage 20 days

The modes are given for specific sterilizers.

Prevention of airborne infection

Wet cleaning of premises;

Airing (reduces the number of microbes in the air by 30%);

Wearing of overalls and removable footwear by staff;

UFO premises.

Types of cleaning the operating room (Order of the Ministry of Health of 07/31/1978 No. 720)

- preliminary performed before starting work and consists in wiping horizontal surfaces and turning on a germicidal lamp to disinfect the air;

- current, it is carried out during the operation - a fallen ball, a napkin are raised from the floor, blood is wiped off;

- intermediate- between operations, all used material is removed and the floor is wiped;

- final, at the end of the day, the floor and equipment are washed, airing is carried out;

- general- Walls, windows, equipment, floor are washed once a week.

• Wet cleaning is carried out with a disinfectant - this is a complex consisting of 6% hydrogen peroxide and 0.5% detergent or 1% solution of activated chloramine (with the addition of 10% ammonia).
• After cleaning, the germicidal lamp turns on for 2 hours.

• Zone of absolute sterility - this is the operating room, preoperative and sterilization room of the operating unit.
• High security zone - This is a room for putting on overalls, storing anesthesia equipment and processing instruments.
• Restricted zone - This is a room for storing drugs, instruments, operating clothes, rooms for the staff of the operating unit.
• General mode zone - these are the offices of the head of the department of the senior nurse.

Droplet infection prevention

Wearing masks in the operating room and dressing room.

It is forbidden to conduct unnecessary conversations during the operation and dressings;

It is forbidden to be in the operating room and dressing room for people with acute respiratory infections and with pustular diseases.

Prevention of contact infection

Surgical hand antisepsis;

Sterilization of gloves;

Sterilization of dressings and surgical linen;

Sterilization of surgical instruments;

Surgical field processing.

• machining to wash away germs from the skin's surface and open up pores;
• chemical treatment to destroy the microbes remaining on the skin and in the depths of the pores;
• the use of a chemical substance capable of tanning the leather, i.e. closing the pores.

• It is forbidden to take part in the operation if your hands have cuts, pustules, long nails or nails covered with varnish.
• Spasokukotsky-Kochergin method - wash their hands under running water and soap for 1 minute;
• wash their hands with a sterile gauze napkin for 3 minutes in 2 enamel basins with 0.5% ammonia: in the first basin to the elbow, in the second - only hands and wrists;

• wipe the hands, then the forearms with sterile napkins;
• treat hands for 5 minutes with 96% ethyl alcohol, nail beds with 5% alcohol tincture of iodine.
• Alfeld - wash hands with 2 sterile brushes for 5 minutes. under a stream of warm, running water with soap, dry with sterile napkins, treat hands with 96% ethyl alcohol and 10% iodine solution, nail beds and skin folds.

First-time hand treatment (solution С-4, 720 order)

• Preparation of a solution of pervomur for treating the surgeon's hands: 171 ml of H 2 O 2 33% and 81 ml of 85% formic acid are poured into a glass flask, shake and refrigerate for 90 minutes (1.5 h).
• The resulting mixture is diluted with distilled water. up to 10 liters .
• The resulting solution during the day can be used to treat hands and the operating field.

Processing stages:

Wash hands with soap in running water for 1 minute (without brushes), dry with a towel;

Wash hands in a solution of the first one for 1 minute (30 seconds to the elbow and 30 seconds only the hands and the lower third of the forearms);

Dry with a sterile napkin, first the hands, then the forearms to the elbow of the glove

Hand treatment with chlorhexidine bigluconate (gibitan)

• The working solution of chlorhexidine bigluconate is prepared by diluting the original 20% solution of chlorhexidine bigluconate with 70% ethyl alcohol in a ratio of 1:40.

Processing stages:

Wash hands with running water and soap, dry with sterile wipes;

Treat hands with a few gauze balls, moistened with 0.5% alcoholic solution of chlorhexidine bigluconate not less 3 minutes first to the elbow, then the wrist and hand;

Dry with a sterile napkin;

Wear sterile rubber gloves.

• Processing is carried out in cans for 5-7 minutes, after which the hands are dried with a sterile napkin.
• The disadvantage of this method is the processing time.
• The synthetic film coating of the surgeon's hands with cerigel is carefully applied to the skin of the hands for 2-3 minutes to form a film.
• Brun's method, which consists in treating hands with 96% ethyl alcohol for 10 minutes.

• Stepping- hands are processed in a certain sequence - from the fingertips to the elbow, and cleaner skin during processing should not touch a less clean area.
• Punctuality(wash according to the scheme)
• Symmetry

Sterilization of surgical drapes and dressings

• Sterilization of surgical linen and dressings is carried out by autoclaving. Sterilization mode - 2 atm., 132 ° С, 20 min.

Terms of preservation of sterility:

Bix without filter: unopened - 3 days; opened - 6 hours;

Bix with filter: unopened - 20 days; opened - 6 hours

Stages of processing surgical instruments (OST 42-21-2-85 and Order of the Ministry of Health of 12.07.1989, No. 408)

1st stage - disinfection

• physically - boiling in distilled water for 30 minutes or in a 2% soda solution for 15 minutes;
• chemical antiseptics -3% chloramine 60 min, 6% peroxide 60 min or with 0.5% detergent 60 min

2nd stage - pre-sterilization cleaning

3rd stage - sterilization

• Dry heat method
• Autoclaving

• Chemical method

Hydrogen peroxide 6% for 180 min. (3 hours) at 50 ° C; 18 ° C - 360 min. (6 o'clock)

Deoxon1 1%, 18% for 45 minutes at a temperature of 20 ° C;

Sidex 2% 4-10 hours

Rinse in 2 containers with sterile water for 5 minutes each;

Wrap in a sterile sheet and store in a sterile box.

Can be used within 3 days.

• on the eve of the operation, the patient takes a bath or shower for the purpose of hygienic preparation of the skin;
• immediately before the operation, the skin of both planned and emergency patients is treated with an antiseptic, dried, dry shaving is carried out, then alcohol is treated.

Widely and consistently (from the center to the periphery) the entire operation area is processed twice, and not just the place of the future incision;

Then the place is processed, limited by sterile sheets;

The area is necessarily processed at the end of the operation before suturing, and after suturing.

• The source of such an infection can be sutures, drains, catheters, endoprostheses, transplanted organs and multiple metal structures used in traumatology and orthopedics.
• All implants must be sterile, otherwise they will become a source of purulent-septic processes.

• Threads of artificial or natural origin are used as suture material.
• For example: silk, nylon, lavsan, cotton thread, polyester, horsehair, etc.
• Factory methods of sterilization of suture material are the best - radiation sterilization with gamma rays or gas mixtures. These methods are used for both natural yarns and artificial yarns.

• Capron and fine silk are sterilized in formic acid for 10 minutes, then rinse 3 times in distilled water, store in 96% alcohol. The alcohol is changed every 10 days.
• According to Sitkovsky - catgut skeins are dipped into ether for 24 hours, then rubbed and dipped in a 2% solution of potassium iodide
• According to Kocher - 12 hours degrease the suture material in ether, then it is transferred for 12 hours in 70% alcohol, then transferred to a solution of mercury dichloride 1: 1000 and boiled in this solution for 10 minutes. Store in 96% alcohol before use.

Prevention of endogenous infection

The patient is admitted to the hospital, already having the necessary minimum of examinations (fluorography, blood and urine tests, ECG, the conclusion of a dentist, gynecologist, etc.);

If the source of infection is found, then the planned operation is postponed until it is eliminated;

If the patient has had acute respiratory infections, then the operation is postponed for at least 2 weeks. from the moment of recovery.

• Active is the subcutaneous injection of staphylococcal toxoid: from a dose of 0.1 ml / day, it is increased by 0.2 ml, bringing it to 1 ml, and then, in the reverse order, it is reduced to 0.1 ml / day;
• Passive - hyperimmune antistaphylococcal serum is injected before the operation.

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Mastering the technology of anesthesia Mastering the technology of anesthesia In 1846 the American chemist Jackson and the dentist W. Morton used ether vapor inhalation during tooth extraction. Surgeon Warren in 1846 removed a neck tumor under ether anesthesia. In 1847, the English obstetrician J. Simpson used chloroform for anesthesia and achieved switching off of consciousness and loss of sensitivity. Antiseptics - a method of fighting infection The English surgeon J. Lister (1827-1912) came to the conclusion that wound infection occurs through the air. Therefore, carbolic acid was sprayed into the operating room to fight microbes. Before the operation, the surgeon's hands and the surgical field were also irrigated with carbolic acid, and at the end of the operation, the wound was covered with gauze soaked in carbolic acid. Pirogov N.I. (1810-1881) believed that pus may contain "sticky infection" and used antiseptic agents. In 1885, the Russian surgeon M.S.Subbotin sterilized the dressing to perform surgical interventions, which laid the foundation for the aseptic method. Bleeding F. von Esmarch (1823-1908) proposed a hemostatic tourniquet, which was applied to the limb both during an accidental wound and during amputation. In 1901 Karl Landsteiner discovered blood groups. In 1907, Y. Jansky developed a method of blood transfusion.

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Classification of operations

By the urgency of implementation Urgent Urgent Planned By the volume of intervention Radical Palaeative

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By frequency of execution Single-stage Multi-stage By methods of execution Simultaneous Typical Atypical

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By technique of execution Traditional Non-traditional: endoscopic, microsurgical, endovascular

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Preparing the surgeon for surgery

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Dressing the gown for the surgeon

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Putting on gloves

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Position of the patient on the operating table

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Covering the operating field

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Surgical field treatment

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Surgical stages

Surgical access Surgical approach Wound suturing

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STANDARD CONDITIONS OF OPERATIONS

1. Careful handling of tissues - it is impossible to make rough compression of tissues with instruments, cause overstretching and tears of tissues by manual separation. 2. Careful separation of the constituent anatomical structures, layer-by-layer stitching of organs and tissues. 3. Thorough stopping of bleeding to prevent the development of anemia, secondary bleeding, purulent-inflammatory diseases in the postoperative period. 4. Prevention of wound infection is achieved by observing the rules of asepsis and antisepsis.

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PATHOPHYSIOLOGICAL CHANGES IN THE BODY IN THE POSTOPERATIVE PERIOD

Catabolic phase: lasts 3-7 days; high consumption of energy and plastic materials (proteins, fats and carbohydrates); is a consequence of the activation of the sympatho-adrenal system, hypothalamus and pituitary gland. Reverse phase: lasts 4-6 days; the breakdown of proteins, fats and carbohydrates stops and their active synthesis begins; there is a balance between kata and anabolic processes. Anabolic phase: lasts 2-5 weeks, on average a month; enhanced synthesis of proteins, fats and carbohydrates; activation of the parasympathetic nervous system.

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KEY POINTS OF INTENSIVE POSTOPERATIVE THERAPY

1. Combating pain with narcotic (promedol, omnopon) and non-narcotic (droperedol, fentanyl, diclofenac) analgesics. 2. Prevention and treatment of respiratory failure, the appointment of bronchodilators (eufellin, papaverine); oxygen therapy; breathing exercises; percussion chest massage. 3. Normalization of cardiovascular activity, the appointment of cardiac glycosides (strofontin, korglucon, digoxin); metabolites (Riboxin); potassium preparations (potassium chloride); rheolytics (rheopolyglucin, courantil, agapurin); coronary artery disease (nitroglycerin, nitrong, sustak).

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4. Prevention of exo- and endogenous infection, the appointment of synthetic penicillins (ampicillin, oxycillin); cephalosporins (kefzol, cloforan, cefazolin, cefotaxime); amminoglycosides (gentamicin, sisomycin, dobromycin, methylmecin); fluoroquinolones (pefloxacin, ciprofloxacin). 5. Reduction of catabolic processes, the appointment of vitamins, anabolic steroids (retabolil). 6. Prevention of thromboembolic complications, the appointment of anticoagulants (heparin, fraxiparin, clexane). 7. Infusion therapy to cover functional and pathophysiological fluid losses; hemodynamic blood substitutes (polyglucin, rheopolyglucin, gelatinol, refortan); detoxification blood substitutes (gemodez, polydez); protein blood substitutes (amino acids, albumin, protein); salt and glucose solutions.

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Homeostasis monitoring

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Blood Gas Monitoring

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Complications of the postoperative period from the side of the abdominal cavity

Gastrointestinal suture failure Acute adhesive intestinal obstruction Bleeding into the lumen of the abdominal cavity Bleeding into the lumen of the gastrointestinal tract Abscesses of the abdominal cavity

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Localization of abdominal abscesses

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COMPLICATIONS OF THE POSTOPERATIVE RESPIRATORY SYSTEM

violations of bronchial conduction; atelectasis; hypostatic pneumonia; pleurisy.

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POSTOPERATIVE COMPLICATIONS FROM THE CARDIOVASCULAR SYSTEM

acute cardiovascular failure; acute coronary insufficiency; coronary insufficiency; violation of the rhythm of the heart.

The material was prepared by the teacher of biology of the MOU "Secondary School No. 198" Yapparova Tatyana Vladimirovna

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Stages of surgical treatment: preparation of the patient for surgery, pain relief (anesthesia), surgery. Stages of the operation: surgical access (incision of the skin or mucous membrane), surgical treatment of the organ, restoration of the integrity of tissues damaged during the operation.

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Classification of transactions by nature and purpose:

Diagnostic operations allow the surgeon to make a more accurate diagnosis and are, in some cases, the only diagnostically reliable method. Radical operations completely eliminate the pathological process. Palliative operations relieve the general condition of the patient for a short time. Classification of operations by nature and purpose: Emergency operations require immediate execution (stopping bleeding, tracheotomy, peritonitis, etc.). Urgent operations can be postponed while the diagnosis is being clarified and the patient is being prepared for surgery. Planned operations are performed after a detailed examination of the patient and the necessary preparation for the operation.

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Features of modern surgery

becomes reconstructive surgery, that is, aimed at restoring or replacing the affected organ: a vessel prosthesis, an artificial heart valve, reinforcement with a synthetic mesh of the hernial orifice, etc. becomes minimally invasive, that is, aimed at minimizing the area of ​​intervention in the body - mini-approaches, laparoscopic technique, X-ray endovascular surgery. Surgery is associated with such areas as neurosurgery, cardiac surgery, endocrine surgery, traumatology, orthopedics, plastic surgery, transplantology, ophthalmosurgery, maxillofacial surgery, urology, andrology, gynecology, etc.

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Historical background

Renaissance Ambroise Paré (1517-1590) - A French surgeon replaced the technique of amputation and ligation of large vessels. Paracelsus (1493-1541) - A Swiss doctor developed a technique for using astringents to improve the general condition of the wounded. Harvey (1578-1657) - discovered the laws of blood circulation, defined the role of the heart as a pump. In 1667, the French scientist Jean Denis made the first blood transfusion to a person. XIX century - the century of major discoveries in surgery Topographic anatomy and operative surgery developed. Pirogov N.I. performed a high section of the bladder in 2 minutes, and the amputation of the lower leg in 8 minutes. The surgeon of Napoleon I's army, Larrey, performed 200 amputations in one day.

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Mastering the technology of pain relief In 1846 the American chemist Jackson and the dentist W. Morton used ether vapor inhalation during tooth extraction. Surgeon Warren in 1846 removed a neck tumor under ether anesthesia. In 1847, the English obstetrician J. Simpson used chloroform for anesthesia and achieved switching off of consciousness and loss of sensitivity. Antiseptics - a method of fighting infection The English surgeon J. Lister (1827-1912) came to the conclusion that wound infection occurs through the air. Therefore, carbolic acid was sprayed into the operating room to fight microbes. Before the operation, the surgeon's hands and the surgical field were also irrigated with carbolic acid, and at the end of the operation, the wound was covered with gauze soaked in carbolic acid. Pirogov N.I. (1810-1881) believed that pus may contain "sticky infection" and used antiseptic agents. In 1885, the Russian surgeon M.S.Subbotin sterilized the dressing to perform surgical interventions, which laid the foundation for the aseptic method. Bleeding F. von Esmarch (1823-1908) proposed a hemostatic tourniquet, which was applied to the limb both during an accidental wound and during amputation. In 1901 Karl Landsteiner discovered blood groups. In 1907, Y. Jansky developed a method of blood transfusion.

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Russian surgery

Surgery in Russia began to develop in 1654, when a decree was issued on the opening of bone-setting schools. In 1704, a pharmaceutical business appeared and in the same year the construction of a plant for surgical instruments was completed. Until the 18th century, there were practically no surgeons in Russia, and there were no hospitals either. The 1st hospital in Moscow was opened in 1707. In 1716 and 1719. two hospitals are being commissioned in St. Petersburg.

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