unn?rilf,u?mnr:

vdaaddoqTa?l: ?fl11fi2{u Ylu.o.AvaliYttItagfl glulau:il:lTTuu

Aa v dd2::nu:srllnHuvdo{?l?fliln1il?::n

Review Article

n r esffu ou rfi sunffulu {q.r o rq

Delrium in Older Adults

lt v ed?::NUIgTl:RUI2TfrT:

ild o qfiufi z ?Iquntnil-frsmnil zmz

Anchaleeporn Wisitwong, RN., PhD

Boromaraiachonani College of Nursing

Sawanpracharak

Nakhon sawan

Sawanpracharak Medical Journal

Vol.s No.2 May-August 2oog

o

UYIUlu d v dt , 4e - I a v

nrerau du rf, aunan rfl u n { I ar nr:fi dr 6'19 uasn u il a a'Lu {dr u qt ar fl (Geriatricr q v Aa , & o, t. d a c n

Syndrome) Ioturql'{rJLu{6.:arqfiriudru u1.lFr5.:Ltlua1n1:triutl4H{a'Ifl1:Lns??la{n1:tou1l?EJ

firfinr:il:yffiu fiunu uav{ornr:quaoEi'r.,rtfitJrsailDY.:urirt:n a#?u'[fr{q',:arqnfru6udan'n,'iAte 'et'd v v o Ja {r4 e

ua.:nr:t6ud':gogdtrJatfrriatrfiru16 urifithjfrnrtrulnrtrut{'t-[onttttt.:ttaLLacLildUnudltfinfla{n1:Lauu?El Qsat..-.-..qir\ev t v o o v d r & Y--u---larflldiunr:nuarirtr nr Lltnr:toull'lEllutt:{il1n?u n{n?4fl1{

- i.--'- -" '-'qi- o

,

zrfllnu a1fl 79 fl t udau riaururl:.,:nsrurades6a.:rJaamvkiasnran fra.:'[daril

aaufl aart ur*r,[riru. do.: n f, o.:r,ru ria ru q nm m nln {r]r er fil:nir ru 6a I: n nrT ru riulafi m qtc . A & - uv- u A - -a u

racl:nilootqorrTuriai.,: lfiiunr:ilrrioroiaruqnuilln (TUR-P) iuYl 21 rlqFl4muu 2551 iln.]q

Eirm-or 1 {u {r.Jrulilurrrfodu ryo,analr'uor qornutda: 6.:arElfltnf,ad'lfrnT.:naaortfiaorriravavvva\9

;;asd,t U 6t?Ufl aaT, ( Foley's catheter) tt arUr a6.: 64.: Lfr r.tr ry

ntt a U= a Li

' s e+ fl trl:tiluru1afiru6o.l ilrnQnfra.:'lfid'ufl]J1fl tll s {u Inu s{lgtLmg a1 " q

rfiauriau fiornt:ilrnfra.: uriunr:fnr*rfiI:{flEr1u'ra tfrfusrtrliutj:smru a1n1:rta1tvd,vdtU$YYaa@tdl

rrriti.gfiarnr:r}prfrolrtlu 6l fi1u 1 ni.,:fllfriunmlilaaeri1tilu Acute cholecystitis with common

bite duct stone lfrir.tnr:r,iT d'Br Cholecystectomy {ud ZA fi.,:mlnru 2551 ?tfuraqjl:',tnurlra

{rJr a u a un #utrj afi n i n n n-r r a #a',: nr: t ir rin n a-t n tt ru t6 u ilr n il :c n a u riu d.: rrr p, fi a u dv,e a o6re e, a ---4-.y a e,t

fldOUtT{durrrrand',.,6UUa-.,:1il6urna 6.,:nr-Lltrau.l nu1 naannu ?unaunl:rl1nn 4u?q

r1rd'nrir-lrafialn11d'1ldu zunonzuad{ d.:arud1rnf,affLfrnT .:maaorudaorrir uavalEtd?uflaamv---'''-qi q q t'-''--v- ' 't',:1fifilnrnf,ofio1flu'da'':nar',:6u(Foley's cathete0 uflruila,.l1Fln Ltat T-tube vttllu1na{nfl "v y\ v

usidtnar.,:?u rdil? Hacd'lu tLavuoufi au naa o

€,v€d?:: Fl il :s{1 5 fl 1*r?f, d1 : e < aad Ioornail, ?diln?{u 142

R1?vfufiurfiaurrdur{lu#.,:arnT :rirza.:nr:r6udrEruavrfin{ulul:.:r,rarura finmruv v dv - <j! ,a t d r o o y A 'o r : A ddrJ?\ufinilrJaa?rfimlily'l{uTs6l.0n [tu n1L?1:vus[?alYtaH[uL:{}lEllulaLy'liltu fl6utd'unr1ild1rJ1:ntunr:rirfionr:il u1{:1Hfin1:iuiuarnmilsirrdailnoEJadoukinn-urmfiaurdu

ru

rir'lfrrilunr:srian:auniarurn{urdashfiillaaanalnl:',]rr{u1u1n frtflnT :rfiraaluan1uu3maq

a.:du unca'n:1fl'rror1flrfiu{rt''tr uascirr{lurJo{ririT uraqiruru{uuau'[ul:.:nenuraduru(3){nmc#uaurfruul,{a-uv{u1fr4.: SaEJas 14-so unrr{luflqrrnrtnfifindrir6'r-uum1ru1fiiunr5?fioq-a

Saaas 6G-70 6.:rir1frte.ftfriunr:fla.:rYuuacnl:q-nn1:aua ufifi:ra.:ru'irnrrrriaT rur:nfla.:riu1fr

taanv go-40 nmrdYudurduuvrd'uyruruTnlu{rlau:ru;inqn {rJruarq:n::ar {drerriasnr:ilvi &-- ' ur ui

rracrideufildiunr:rirminlorurqillrridrsairn-nnrsandvliln urncr.lrFinfir'lo(o){{a

n ? ril?nJ rgro.rnr: s ffu au tfi a uuffunrecfuaurduuild'ulun1u1a'.,]nqudlfiilou "l 6a Acute confusion LLas

Detirium dturla'irrfra '[uadnfirirfflfiaBrru{rleafiiut{inurlumrieudru-orinqn'jr tcuA dt j io v et,

psychosis fitrtlunr:fiaar:fi fi n 1 nn{draF)

nrrr#uaurfiauna'u (Detirium) u{lunq'ruorn1:?o{Fr?1ruffinrr-rfirrJf,uurLila{ {.rhErq{{

ac?1FrdsJ1B nmruoi.r'[o rirtfrnr:Sfiormtanr:fu5fiorrlnfi Insnrrufiailnfiocrfluaa"[urir.:ura'rqr{aJA a, &s a 6 v d { ! A

6{U Gl A1atilU{2lil.]fiTOtuU2ULLAeilA1fl1:L8Jn.,]?16le Ov d aa u tar d- -J a

61il1 A 3Jq n t?UA til:n',l lfi n?1 ilfi iJ1 U LtAs [{tn fufl n1T?uaau(", 3J a nu6us6t{u nad ^ , a v 9A uO v Y t A y

t 1 fi nrr l fi orrj n fi za.::vd'u nm ru5fi n pi'ilu nr:iuirio fi .,: ur n fiailfl 1 uuo n m ndeJlB{{- u ,,j s ) uv, Aa

mlu rmlil d fi ,: n :sfr u 6 ul fi ir fl n r r :J a'.,:'Lo un v n r r ru au'[o n n n',:

z; finr:rrJdsurila.,r?o.rnr:iuf; tfiud nmruarrur:n'lunr:qi1aaa.] finmrufinrlnfirdsr

rirnr:fufrrar anrud unna mtanerrufinilnfirdurn-unr:"Lfinrur n?1sJfiailnfira.:nr:fufr.lv uvo ATr[rJ LnLnna1flfl1?vdila{rdail (Dementia)

3) nrrrufinr.lnfidrfindun-.:ndrar{luaqjde.:rraratu .1 arorflud'rlru.:n6arilu{uuasuddtOr

ilnilo1n1:tuu 9 141U 6l Luu1.1t?.:tXn',t

+; fif,ar.raafuauuornil:c{6n1:n:?oi1{n1u mtaruanr:nr?an1.:frs{rjfr ffi nr:dilun?1ilfinr.tnfiudl.:ornl:nnr.,:nrfl o'innr:1fiiudr:fir* nr:lfiu1r5omrfiEfimuo* .,:irrufu

tvdfrl[?19ll[0uu00u[flu{

d1 tfi n z a { R r a vn'u au rd a u r r niu r fi n o r n fl o {a ir ru m n r a a d r.,: ( M u ltif acti o ri al )

fiaruryfigruiirf,lutrlfirdsrriunmrukiaru4nza{:slru61:dail:rarn (Neurotransmitters)aifr.:nruqrurfi urnitnr:frFfl(Cognitive Function) v{q6nr:sJ(Behavior) rasolTilai (Mood)v 6 A A d v u €t au v I q u v o

tOtilAA?\: nA lJn?lNdtJTlUflT?tJY1{U{AUTs14?'1.:il44fl{nU1 (Predisposing Factors) uar

fld o ou"ud 2fl.n.-d.B. zssz

rlo{sri.:'lfrrfinprecipitating Factors) oririuffJrudfinrrurrl:1cu1.,]il1n0ionr:tfinnrrsfuaud v t e , J YAa 4 d '----

rf,cruyrnn L?iu r1q.:atqnqilfralElq.,ril1n ryfiilnrrrailo{Ldailuasiln1?s:?ilfia1sau1{A aq - ,oea d t d -r {e -..--:'-..-..-.--F ^

ctall v

rfiofirloo'srir'Lrlrfiorrfiu..:odr.:udEr rriu ldsruauuautv{El.:Ft:{tnu?nil[sn'ldtnnnl?v6{udud u\e yt v\ & , --.A dc{ e '51 .Y4-- | LYu v

rf,aurryd'uld rrfr.irfidrElfrlilril:rvu1',rrilaililaafltr{ [fitnnfia1safl1.,] tf,u LFI:uu1:s{u{v4 t - -u-Q - - - ' lfiarn{ru psychoactive fifiIanrarfinrnmc#uautdsuila-ulfitriurdeJrniu

ffiffillffiil?,:*,-*]lH;::HH;:ffi;:;ffi ri:n r:r,:n 1 rn',,1:1'd z(')

Frtl{d t rlqo-Ut'ndr (Predisposing Factors) ta.: nl:tfi nnrrvAt auufr fl ufl d'u

il:vmyt flon-ufrndr

a-nufustl:s?tn:

R1?sn1:iuf; I rlqrur

ooAfl1?rn1:n1ilU111

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nr:iu tl:cYl1 u?11.: il1 n

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tllFlt1El

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oA9lOill\:V{1

rprdaulurkitdAAYiln0n:TeJuafldrcAYil11:s?nflnntJ

9rtn1:il4\:tfiUUflflTAd

nr:ldEuunnda.:

114U1

nnlnturnr:

lfifl1 Psychoactive malutfiFt

inurfirsarfialfltfiorAaild:1t

o

a

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a

a

a

a

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l, v dd?:Tnil:eu1:nut?{d1: U < AAd Ioarnail: ?fl?t!?{u 144

Jqvvm1:1{fi t rJoo'a"fr'ndr (Predisposing Factors) ?a{nrLfinn1?B#u6lurdcruvrau (rio)

il:sunnq9voilaafl{nu1

I:niruunvnl?cr6ud?u o r6uilru?uu:t-4Fo iJlTn:?ilfia1uagl\:o l:nrriuuartnr{oito fiil:v'56l:nuaooL6anuacdila{o frI n:cuurl:sarvro fi amrufi nilnfinr.-:rrumrlufi n

ddv. iln1:u1nlQu nrsnnilnr r6udru:rffinorfrrfl finrf,a Htv

J q a ' jooea v d u

Fl1:1.,1n 2 Uaafl t:.:(Precipitating Factors) ?1711 Lfi tflnfl1?scturlutaflUilau

il:cmY'r rJod'flri.i

EJ'I

I:n:cuuil:rarYr

nr:r6udaa

lfiiuSeoative Hypnotics

lfiiuNarcotics

lfiiunnticnolinergic Drugsvya:flu1Fr?uu1fia1utuFr

Adfl1:6tOUU1 fi:A LLAAnAfloA

Stroke

16aoraantuarua.:Aveav

ttl 0fi 3J 613J O',1 A n LdUfi :O dil A'-: A n tduq

anoLdo

9VR1?s trn: nfl au01 n fl 1 ::n u1

r6urJr s rfi uunfu uari n q n

fllnoanarauI

R1?ffiOndv a 3 ,

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t11'tvq/0t

a

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Dekim in otder Adutrs fld o ouiud 21.A.-d.a. 2552

m1:1.0fi z rlo{urdtlPrecipitating Factors) dri',tfrtnrnrrs#uAutflaunn-u 1rio1

rJ:vmn rJo{ari.:

n1:zu1nFr

d.,:urnf,oru

v?1FtU',r

smvrLnzulnl::uttT.lci

UUAO:snuaauiluFl'lq

n?1ilfinilnfrm{trln{ufin (Electrolyte, Glucose, pH.)

16iu nr: air n"'ornr.-: o a fl otl 6 n eiYvv I u 90[n:un1:tJ1nail? [a

VvOtOsAn1:rfl 1:nu1 Lu?1U? UU1U n? nq n

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tn:u n1:Tl1?1 Fl6l n1:mA1 UA U1{

nmruthod(

n?1ilrn:fl4il1{01Tilil{rvu

UAULilfiAUfiA1U?U

dil1nily,r91urauyi.:oaunrilo raua[ucifiqird'rdafirrdn.:d1tfln?o.:nrrrduaut6flul'{a-uq

ri.,:mr:r.:d gr)

Audan1:1,lfl 3 d',ltrata{R1?sdudutauuilau

q

u uiloqu

ritejo "l watch Death"

o

01n1:u1

| = lnfection

W - Withdrawal

A = Acute metabolic

T = Toxins, drugs

C = CNS Pathology

!4./tv-vnr:fi rr t?on1.,:tAutldd't?s ilana'n tau 61il4.:ah t6{u

ua a no a a d fl 1u aufi ah nd I Benzodiazepine urdflfr atuqu

nmilfi ailnfisa.,: Etectrolyte ttnril uf,aalqata.:n:or

rh.: riuma lmmel

arn{ru opiates, salicylates, fl1fr1un1:d'nraudtu"ld

a rd u:a fl rri' (NSA| Ds), a 16 u:a fl d', n{ u arri:'[0, Di goxin,

Lidocaine, Dilantin, Anticholinergics, ulfnulil'l',l6 nAluaa4-

raaaorrdoordruat tuatan {n fllTotnlaan n.tlaotdfl

d?::ri'ilrst'iin drrtar: uaa--tIoarnail: 'ldYrf?{H 146

rt1:'r.,rfi g dlrfinta{Rmsfuaurduuv{#u (Fia)q

u uiloqa

rileio "l watch Death"a1n1:u1

H = Hypoxia

D = Deficiencies

E = Endocrine

A = Acute vascular

T = Trauma

H = Hea\4y metals

d . 4 uO 9 q s a 3

f,n uan m:a fi?Laailrfia? n?1ilou[a?1&r9l'r

n1r?1Fr Thiamine 1At; inrfiu StZrdYogrLYr:oEn Hyperparathyroidism fl1?uu.rn'rnLuLnafl{{

a 3-fi:a n1r'JaunFt Adrenal insufficiencydvaf,auan n?lNFtuLaCInd{?nqnmila1 n1771'htfl ila.,:{(Hypertensive Encephalopathy)

a)aevn 1 TU 1 n tA ! n FITUy n 1 Ty{ A n n n fi n n 3J f,I1 ?cfi n \: fl 1 T rJ 1 Fl ft

fiura.onrn'r il:am urunfi rdaru

AC AlIUtIRtlUO

fl u r Bai:ci m u 1? a \:fl 'r ? s fu au 16 fl u n du f.:hi uri'fi'or riJ u n m ru fi or rl n 6 nr,,:6 m'[od rfi or

a1nfiila{ 6ililAfluil1a1nuru1?r?o{f,1:dail:varm n1:dnLdurravRl?rrniunL{oi,r(o)

1) unul?t?lo.t Cholinergic Deficiency t?iu nr:'lfrar Anticholinergic ?ir'1frrfinfl1?vv d uo u < , i {o ei Jarludutouuti{aulunuLtasdFl? LLacv'ru?1 Serum Anticholinergic Activity tvlu?ruturyil?umil

vdvfl1?sdudutauuy{au

;3d,d'2) n1:LlnlIJ?U?IA{ Dopamines (Dopaminergic Excess) L[Asil,.lAFl0fl1:fi4{

Acetylcholine nr:lfiurn{ru oopaminergic ttiu Levodopa uae Brupropion rflurJoo-a'fi'nrjrrir

lfrrfinnmsa*uautduulid'uLtns Dopamine Antagonists ttiu Antipsychotic Agent 6{1sJ1tf:r

inurnmv#uaurdaun#ulfi3) uyru'r?1?a.ld1:dail:carildu tdu Norepinephrine, Serotonin, r-aminobutylic

acid, Glutamate L[nr Melanin a'rafiumuln'lunr:tfinnmc#uaurdflul'{a'uttria".:firnangruA v 9 A v u (eEuUuxou q'.lo1atRna1n!0dtJ1'{udnu Cholinergic unr Dopaminergic Pathways

4) UYlUlmI a{ Cytokines :?uYi.: lnterleukin - 1, lnterleukin - 2, lnterleukin - 6,

tumor necrotic factor a (TNF-a) Ltas lnterferon o1a?i1'lrl'rfiornrrca'uaur6fluna-ulora

trllriiru Permeability ?Ja\: Blood-brain Barrier uasfinr:rilduurrrla.:ta.:d1:dail:sd1?l

5) nm smrSil n r{ai{ rfl u n'r : r6u rh EIfi ':a fl 1:uT n r6ud n:s{u:rr-ruil:ram fi ruyn m fi n

ttnc Hypothalamic-pituitary-adrenocortical axis trJrfiru:coiu Cytokine Ltas Chronic

Hypercortisolism nr:fi Chronic Hypercortisolism fizuarf,aoia Hyppocampal Serotonin

(5- hydroxyl tryptamine (s-TH)) s-HT,o receptor [a;a1adflfrtfionmv#uautdaunfru

147nr'rsdrlruiurfl d1]1u{q'!s rq

Delrim in old€r Adulrs fld O ou-ld 2 yl.a.-d.a. 2552

AAo1R1:udo{Yl1{nnun

{rJrunmrfiaurderuilaTufint:unor.:aan?a.r?\qAn::ildfin?1ilfinrlnfinT .:6rrlufia1El

a-nuruylorernl:Lrdn{aanfla.:v{qfin::ruovfidnuruvta?\1rLLFIflrir.:orn{rJrelfifiarn1:nr.:tndu 1

dnr*ruavlqfin::iJfiLrdo.,toan d1il'nnmi.:aanl{lu 3 il:slRil (Subtypes of Delirium) ro' ar ritdd o r' v - tn1:finr.rloravTrltltfirud a1n1:1. Hyperactive: Hnqnn::Llrl?u?'lEl duf,u anuruso'

14?1n:srr?{ :yrrn:c{.r rt'nriauhild qorr5eufiu.:ri.r In:o.jra lTotriTira{6u 'urnnrlilonnu

rmtoaan riru:ry vr5a5a.:lfr d.:hid'rurt'urfniuarnunr:ni rr{af,u taurfiulilruTkivrqndt rlulultJq

a4,da-ijtre,6AYq'4?1 Y6raruar.tmSoailn:rufrnmaon Lndou[u?rtauLaau'].,rr?Ftt:? rtulrtunn La{1El SJrJu:''lEi tlas

q

d A q , - J o d A e\ , 3- f.v- ---.e^^^^^^^t^^.a^^^^-- \4vt

finrrrufinilrurjunnfir'lnrfi.:mfi.: {r-har.J:runnflfiruurhiunr:tfinorn1:il:td'rYtmaauld'draat' x dv v'v- ttiutl:vunnu:n fnururornr:2. Hypoactive : rJ1l ? u1l TYtfllluQYil n fl ufuyFl?\: fl u?1 tj re ' J a t d , 4i , 9/ 4 - affuan.:oanlduri rfra.:fril uqurilu daunrdfltal$Ftuau n1:LaaauL?12t1fi:aann{ :?t fl{

V tvv u v v A v a Y Y t 149 vtt 5l ! A

nr:1&t'5sh:yfn:yi.:pir frta.: rryorfioufi5al,{n{1 aa.l&to{4ilr.:L5Qnmrura llil?u[unAtlu" '""*d "' ";""' "-^:'-- --;'; .;'

---

^:-;' j^ d,

q { q

ilflflnasLnfl Lunl??uaoufiTaLn?ufl1t?uaflflYlilnv{alnLuunrrvfrrutrtSr (Depression) mtot

ol \etfl1?sA1 6J LA{,tu

B. Mixed subtype: fia-nr*ruvrnqfin::rudrrAn.-:aonhin.:d Aa"u1rJrur:vvtjr.: HyperactiveA d, i te A

uav Hypoactive {.:ttluil:clRYlTlv{u Lnennilqa

T{?r'rularnvrur6za.:frrhud1il1Tn#.rLnnLfiun?1rurrlduuLtila.,:tro',:{.rlrulfi#',:rrri:cttt-o ''-- qi q

ur:nd.,:r{luarnr:drriaufiarnr:forrau r?iu vru'ir(rirun:c#un:vd1u nrs?un:v?1El LLaE

frr-hura.:oruan'irnmru6n#uau trifrarur6 nto'ju1 "Mixed ,p" "tflua"l:1df," ar:ruaitr-Jdauurla.:-i.')gAUtdvyadudd

Sfintrriauua.:ttasrfrfl.: nr:iuifrorilnh uauuaunal{auil']n u:l [uq,ld.:arqYlelnl?s6{tla{trlotJqq-{q

rg.rfi#.:rnn1fi'irulf,auurJar1ilornr6ru tdu 'iumarurn{u rJaamsn:vil3rrn:sil:oei rac

triaarurfiu r{lufru

a1n1:d1Fi6U 6l m1.:nAfin lfiud ntwunnia{flo{:voriunrrruf;6nrir rrasrSo',:afir1ryryr

uavnr:fui uan.:aandra{.:mrrnr:uaufiorilnF drrtfianmrun:.:sir fi4.:6ilttaluntanrudq {u

nr:iu{finrlnfi uilad.,rrhfin rfiuntr?laaurara'rn1rilnauil:cdril niu rriuararlrrndar{luga'-o

d v ud v ,A dr a - X 'Iqa d le auriumrmutdouusi'rrlfruaurilurJFt 6.:ilarurilouYhl lirr?? LafluL6lu.,:nuun$aclrlFl0u 6]11n

--J;;;;;#;;;"d;a'tirir-x, irrr,*rnrn't.*r.,aru*.'i.t',8r" tilufiu ,rno',ndq

de,Aavavdggliat:rururilauuLtun{ Ltu ?nfln{?a f,iltFl:1 mTanl?:1?

J I v t a , ai ai f X ' 'I ''lfion::runr:rnfraulmrmr.:druir.,:nrufinrlnfi Inelrnfioulm?rJ1nflu iuma ogihjfr',:

m:an1:LnaauLfi?aoa{ {il Lilrnnau[nr mSatfinr{6trJu'1.,]?i?.:'iurruur.l?irlf,.:ltttuu t '6, r vo !l {qt-!4----.-'^.-4-.

narru6orauduLrutilu:suu rtdndaanrJl[nuflooanillauLon?1il1[.lLFl LtJiln?1ilFlatuo{

rfioornr:fidu{rhudrutn6Ii#n'i{ritfi raianfiruriuflutr-l uriu {rJrarair1frf,.:'ir1il{orriruo

{.:mrrnr:uouLmcnl:fiurriduurrrla.,: #nuaum#urirlnarliu nar's6uhjsaruuou

6? r: d'il:sfl r in dr':tar : ^^J ao0,rall: ?aT[?{u 148

uJfiau9 nul

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D eli rium"/"20 S e I f D i re ct e d/"2O 20 07 %2OE. p dt

g. qtu10 ufi.:a'jr.o, lr:finti il1a1fi::tJ, 6lR1Tt aTSra'aru, EBun: d'u63nT runu.o o u o f 9u ay v u o

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151n'l?stirnurio!il6'u1!{$o 1q

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