#46
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Êðàéíå âàæíàÿ íîâîñòü íàñ÷åò áàíäàæà ïðèøëà èç Àìåðèêè
Êðàéíå âàæíàÿ íîâîñòü íàñ÷åò áàíäàæà ïðèøëà èç Àìåðèêè. Êàê èçâåñòíî, â ÑØÀ åñòü ãëàâíûé àäìèíèñòðàòèâíûé îðãàí, êîòîðûé äàåò ðàçðåøåíèå âñåì ìåäèöèíñêèì ìåòîäèêàì, ëåêàðñòâàì è àïïàðàòóðå. Ýòîò àäìèíèñòðàòèâíûé îðãàí íàçûâàåòñÿ FDA (Food and Drug Administration). Åãî àâòîðèòåò âî âñåì ìèðå òàê âûñîê, ÷òî èìåííî ðåøåíèÿ FDA ôàêòè÷åñêè óñòàíàâëèâàþò ìåäèöèíñêèå ñòàíäàðòû âî âñåì ìèðå.
Òàê âîò, â êîíöå 2010 ãîäà (6 äåêàáðÿ) ñîñòîÿëîñü çàñåäàíèå ñîâåòà FDA, ïîñâÿùåííîå áàíäàæèðîâàíèþ æåëóäêà. À êîíêðåòíî, îáñóæäàëñÿ âîïðîñ î ñíèæåíèè Èíäåêñà Ìàññû Òåëà, ïðè êîòîðîì óæå ìîæíî äåëàòü áàíäàæèðîâàíèå æåëóäêà, ñ 40 (÷òî áûëî ôîðìàëüíûì òðåáîâàíèåì ðàíüøå), äî 30. Ñîâåò FDA ïîääåðæàë òàêîå ñíèæåíèå 8 ãîëîñàìè ïðîòèâ 2. Ýòî îçíà÷àåò, ÷òî ñêîðî ýòîò ïîäõîä áóäåò ôîðìàëüíî çàêðåïëåí â ÑØÀ, à çíà÷èò, è âî âñåì ìèðå. Ýòî çíà÷èò, ÷òî ïàöèåíòû, êîòîðûì ðàíüøå îòêàçûâàëè â îïåðàöèè ïî ôîðìàëüíûì ñîîáðàæåíèÿì, ñìîãóò ðåàëèçîâàòü ñâîþ ìå÷òó, íå äîæèäàÿñü, ïîêà èõ âåñ ïîäíèìåòñÿ äî óðîâíÿ ÈÌÒ 40 è âûøå. |
#47
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×óäåñíî - íàïîìèíþ, ÷òî 28 -ãî ÿíâàðÿ â ÝÍÖ çàñåäàíèå ñîãëàñèòåëüíîé ãðóïïû ïî ìîðáèäíîìó îæèðåíèþ, íà îäíî èç çàñåäàíèé êîòîðîé Âû áûëè ïðèãëàøåíû . Êóðèðóåò âîïðîñ êìí ÍÂ Ìàçóðèíà
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Ã.À. Ìåëüíè÷åíêî |
#48
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Íó ïî÷åìó æå òàêàÿ ðåàêöèÿ?
Ñåãîäíÿ ê íàì ïðèõîäèëà ïàöèåíòêà, êîòîðàÿ îïåðèðîâàíà 2 ãîäà íàçàä (åé áûëî ñäåëàíî æåëóäî÷íîå øóíòèðîâàíèå). Ïðèøëà çàïèñàòüñÿ íà ïëàñòèêó æèâîòà.
Ïàöèåíòêà ïîõóäåëà íà 50 êã, ÀÄ îïóñòèëîñü ñî 180 äî 110/70, ãëþêîçà êðîâè 4.8 (ðàíåå áûëà 15 íà ôîíå 50 ÅÄ èíñóëèíà â ñóòêè). ×óâñòâóåò ñåáÿ îòëè÷íî, "ëåòàåò, êàê íà êðûëüÿõ". Íèêàêóþ äèåòó âîîáùå íå ñîáëþäàåò, åñò ÷òî õî÷åò. Óäèâëÿåò åå ðàññêàç î ðåàêöèè ýíäîêðèíîëîãîâ íà äàííóþ ñèòóàöèþ: ñ åå ñëîâ, "îíè êðóòÿò ïàëüöåì ó âèñêà, è ãîâîðÿò çà÷åì òû ñäåëàëà îïåðàöèþ" Íàñ ýòî î÷åíü ñèëüíî ðàññòðàèâàåò. Êàê æå òàê, âåäü ïîëó÷åí îòëè÷íûé ðåçóëüòàò. |
#49
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Ìåíÿ åùå áîëüøå ðàññòàèâàåò Âàøå îòñóòñòâèå íà çàñåäàíèè ïî êîíñåíñóñó, ÷åì òî îáñòîÿòåëüñòâî , ÷òî ñíèæåíèå ìàññû òåëà ÿâëÿåòñÿ çàãàäêîé êàê ïðè÷èíà ðåìèññèè äèàáåòà . Èçìåíåíèå ïàññàæà ïèùè , îãðàíè÷åíèå å¸ ïîñòóïëåíèÿ , âêëþ÷åíèå èíêðåòèíîâ - âîò çàìå÷àòåëüíûå ñîñòàâëÿþùèå ïîáåäû , ïðîñòî ìåäèöèíà -íå îõîòíè÷üè ðàññêàçû è åñëè Âû õîòèòå íàéòè ðàâíîâåñèå ìåæäó ýòîé èäåé è èäååé - "ÈÌÒ áîëüøå 40 êã/ì2 = çîâè ïñèõèàòðà" , (à ïîñëå áàðèàòðè÷åñêèõ îïåðàöèé èõ ïðèõîäèòñÿ çâàòü óæå ñóäåáíûì ìåäèêàì ïîðîé ), òî íå îãàíè÷èâàéòåñü äåäêèìè âñåëêñàìè â âèðòóàëüíîé ðåàëüíîñòè - ßøêîâ è Åãèåâ ó÷àñòâóþò â êîíñåíñóñå , ïî÷åìó òîëüêî ýíäîêðèíîëîãè äîëæíû áèòüñÿ íà ïðèäàíèå ñèòóàöèè ìèíèìàëüíî ïðèñòîéíîé ôîðìû ,íå îãðàíè÷èâàÿñü table talk?
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Ã.À. Ìåëüíè÷åíêî |
#50
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Öèòàòà:
Ñïàñèáî Âàì çà èíòåðåñ, ïðîÿâëåííûé ê òàêîìó íîâîìó è ïîêà íåäîñòàòî÷íî èçó÷åííîìó ôåíîìåíó êàê õèðóðãè÷åñêîå ëå÷åíèå ñàõàðíîãî äèàáåòà. Ñðàçó õî÷ó Âàñ çàâåðèòü, ÷òî ìû (õèðóðãè) íå íàõîäèìñÿ â îïïîçèöèè ê ìåòîäàì êîíñåðâàòèâíîé òåðàïèè. Ýòî áûëî áû ñëèøêîì ñàìîíàäåÿííî è ïðîñòî íåíàó÷íî, åñëè ó÷åñòü ñêóäíîñòü ñâåäåíèé êàñàþùèõñÿ ìåõàíèçìîâ âëèÿíèÿ øóíòèðóþùèõ îïåðàöèé íà óãëåâîäíûé îáìåí. Ìû, òàêæå, íå ÿâëÿåìñÿ ñòîðîííèêàìè îãóëüíîãî ïðèìåíåíèÿ ìåòîäîâ õèðóðãèè äëÿ ëå÷åíèÿ äèàáåòà. Âñå, ÷òî ìû ìîæåì ñåáå ïîçâîëèòü, íà ñåãîäíÿøíèé äåíü, ýòî êàê ðàç table-talk â âèðòóàëüíîé ðåàëüíîñòè. Ñîáñòâåííî Ôîðóì - íàèëó÷øåå ìåñòî äëÿ ïîäîáíûõ æèòåéñêèõ äèñêóññèé. Äóìàþ, ïîýòîìó ïðîôåññîð Ôåäåíêî Â.Â. ðàçìåùàåò çäåñü ññûëêè íà î÷åíü èíòåðåñíûå ðåçóëüòàòû ëå÷åíèÿ íàøèõ ïàöèåíòîâ, êîòîðûì óäàëîñü èçáàâèòüñÿ îò äèàáåòà áëàãîäàðÿ îïåðàöèè æåëóäî÷íîãî øóíòèðîâàíèÿ. ×òî êàñàåòñÿ íàøåãî îòñóòñòâèÿ íà ñîâåùàíèè â Èíñòèòóòå Ýíäîêðèíîëîãèè, êóäà ìû áûëè ïðèãëàøåíû – ñîæàëååì. Íàõîäèëèñü âíå Ðîññèè. Îäíàêî, âñå íàøè ïîæåëàíèÿ, êàñàþùèåñÿ ïðèçíàíèÿ õèðóðãèè â êà÷åñòâå ÎÄÍÎÃÎ èç ìåòîäîâ êîððåêöèè äèàáåòà âòîðîãî òèïà, èçëîæèë Ïðåçèäåíò Ðîññèéñêîãî Îáùåñòâà Áàðèàòðè÷åñêèõ Õèðóðãîâ - ßøêîâ Þðèé Èâàíîâè÷. Ìû áûëè íà ïðåäûäóùåì çàñåäàíèè, è ó íàñ íå ñëîæèëîñü âïå÷àòëåíèå, ÷òî ñóùåñòâóåò íåîáõîäèìîñòü «áèòüñÿ» çà «èäåþ». Ìû ñîâåðøåííî ìèðíûå ëþäè. PS: Ìû äåéñòâèòåëüíî íå çíàåì ïðè÷èíó ñòîëü áëåñòÿùèõ ðåçóëüòàòîâ õèðóðãè÷åñêîãî ëå÷åíèÿ äèàáåòà âòîðîãî òèïà. Áóäåì Âàì ÷ðåçâû÷àéíî ïðèçíàòåëüíû, åñëè Âàì êàê ó÷åíîìó, óäàñòñÿ ïðîëèòü ñâåò íà ýòó çàãàäêó. Òîãäà ìû íå áóäåì ðóêîâîäñòâîâàòüñÿ «äåäêèìè âñåëêñàìè», à áóäåì ññûëàòüñÿ íà Âàøè îáúÿñíåíèÿ. Ñ îãðîìíûì óâàæåíèåì äîêòîð Åâäîøåíêî |
#51
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Ìíå íå ñòîëüêî îáúÿñíåíèÿ ôåíîìåíà íóæíû , ñêîëüêî ñîñòàâëåíèå ïðèåìëåìûõ è àêêóðàòíûõ àëãîðèòìîâ âåäåíèÿ ïàöèåíòîâ è ÑËÎÂ ÎÁ ÎÏÏÎÇÈÖÈÈ õèðóðãîâ ÿ ÍÅ ÏÐÎÈÇÍÎÑÈËÀ .
Ìíå ( è íå ìíå îäíîé ) ñòîèëî íåâåðîÿòíîãî òðóäà ñîáðàòü õèðóðãîâ , ýíäîêðèíîëîãîâ ,äèàáåòîëîãîâ è ïñèõèàòðîâ õîòÿ áû äëÿ ïðîèçíåñåíèÿ ïåðâûõ ñëîâ - ìåòîä åñòü , åñòü ïîêàçàíèÿ è ïðîòèâîïîêàçàíèÿ , åñòü îáó÷åííûå ðàáîòàòü ýòèì ìåòîäîì ëþäè . ß íå ïðîòèâ ôîðóìà ÐÌÑ êàê ìåñòà îáñóæäåíèÿ , íî è ìíå , è Âàì è áîëüíûì ñåé÷àñ êóäà âàæíåå ôîðóì ñúåçäà è ñòðàíèöû ñïåöèàëèçèðîâàííûõ æóðíàëîâ . À ðàññêàç î ïîéìàííîé îäíàæäû âî-î-îò òàêîé ùóêå - ýòî óæå ïðîøëîå ó÷èòåëåé íàøèõ ó÷èòåëåé. Ìû çíàåì î íåãàòèâíîé ðîëè èçáûòêà ìàññû òåëà - ìû íå çíàåì î ìåõàíèçìàõ çàñòàâëÿþùèõ ëþäåé íàáèðàòü íåìûñëèìûå òîííû æèðà . Ìû çíàåì î ðîëè öåíòðàëüíûõ ôàêòîðîâ - è ñóèöèäû ïîñëå áàðèàòðè÷åñêîé õèðóðãèè íèêòî íå îòìåíèë Ãîëîâà çàñòàâëÿåò íåðåäêî íàáèðàòü ìàññó òåëà - è îòðåçàííûé èëè ïåðåðåçàííûé êèøå÷íèê âðÿä ëè ýêâèâàëåíòåí òðàíñïëàíòàöèè ìîçãà . À âîîáùå îñíîâàÿ ïðîáëåìà - ÿâíî êîììåð÷åñêèé õàðàêòåð ó÷àñòèÿ â ðàáîòå áàðèàòðè÷åñêèõ õèðóðãîâ ( ðàç äåëåãèðîâàëè Ï ßøêîâà íà íàø êðóãëûé ñòîë , îí è ðàññêàæåò )
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Ã.À. Ìåëüíè÷åíêî |
#52
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Öèòàòà:
Íà íàø âçãëÿä, ãîâîðèòü î âëèÿíèè êîììåð÷åñêîé ñîñòàâëÿþùåé íà âûáîð ìåòîäà ëå÷åíèÿ íå ñîâñåì êîððåêòíî â äàííîì ñëó÷àå, ïîñêîëüêó ïîêà íå ñóùåñòâóåò áþäæåòíîé àëüòåðíàòèâû, è íàøè ïàöèåíòû ïðîñòî âûíóæäåíû èçûñêèâàòü ñðåäñòâà ñàìîñòîÿòåëüíî. Ýòî, áåçóñëîâíî, íå ïðàâèëüíî. Íàäåþñü, Âû íå õîòèòå îáâèíèòü íàñ â èñïîëüçîâàíèè ìåòîäîâ õèðóðãè÷åñêîãî ëå÷åíèÿ îæèðåíèÿ è äèàáåòà áåç âìåíÿåìûõ ïîêàçàíèé ñ öåëüþ ëè÷íîé íàæèâû? Ìû «äåëåãèðîâàëè» íå ïðîñòî äîêòîðà ßøêîâà, à äîêòîðà ßøêîâà, êîòîðûé èçáðàí Ïðåçèäåíòîì Åâðîïåéñêîãî Îáùåñòâà Áàðèàòðè÷åñêèõ Õèðóðãîâ ñ 2012 ãîäà! Ìû âî âñåì ñ íèì ñîãëàñíû. Ñîãëàñíû ìû, òàêæå, è ñ Âàìè îòíîñèòåëüíî âàæíîñòè "ñòðàíèö ñïåöèàëèçèðîâàííûõ æóðíàëîâ". Ìîæåò áûòü, Âàì óäàòüñÿ ïîâëèÿòü íà ðåäàêöèþ âàøåãî æóðíàëà "Îæèðåíèå è Ìåòàáîëèçì", êîòîðàÿ çàïðîñèëà ó äîêòîðà ßøêîâà 900 000 ðóáëåé çà ïóáëèêàöèþ õèðóðãè÷åñêèõ ñòàòåé? Äîðîãîâàòî çà æåëàíèå ïîäåëèòüñÿ îïûòîì. |
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#53
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Î÷åíü æàëü, ÷òî ó ìåíÿ íåò ïðàâ ìîäåðàòîðà íà ýòîì ôîðóìå, ÿ áû âîîáùå âñþ ýòó âåòêó ïîëíîñòüþ óäàëèë, ïîñêîëüêó âñå ýòî ïðèîáðåëî íå ñîâñåì àäåêâàòíûé êîíòåêñò.
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#54
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Äà ÷òî Âû ãîâîðèòå , íåóæåëè ! Âåê áû ïðîæèëà , òàê è íå çíàÿ , êòî òàêîé ä-ð ßøêîâ . Íó ñïàñèáî , ñêàçàëè . À êàêîâî åìó áûëî îáùàòüñÿ ïðàêòè÷åñêè îäíîìó íà ýòîì êðóãëîì ñòîëå îòíþäü íå ñ áëàãîïðèÿòíî íàñòðîåííûìè ýíäîêðèíîëîãàìè ( è íå òîëüêî èìè , íå ãîâîðèë? )
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Ã.À. Ìåëüíè÷åíêî |
#55
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Öèòàòà:
×òî êàñàåòñÿ 1 òèïà - ýòî Âû ñàìè ñåáå ïåòëþ íà øåþ ìûëèòå èëè íàðî÷íî ?
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Ã.À. Ìåëüíè÷åíêî |
#56
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Öèòàòà:
Óâû , íå ìîãó ïîëíîñòüþ è âîñòîðæåííî îòâåòèòü íà ïðèçûâ ðàáîòàòü âìåñòå íà êîììåð÷åñêîé îñíîâå . ß óæ êàê-òî ïîáàâàþñü - ñåãîäíÿ ïðèçîâåòå ðàáîòàüòü , çàâòðà ðàññêàæåòå , ÷òî âàì ðàññêàçàëè ... Ñòðàííîå äåëî - ÿ êàê-òî áû îðóäîâàëà äàííûìè î áîëüíûõ , ñûëêàìè íà ëèòåðàòóðó- à ó Âàñ íîâûé ïðèåì â ðàìêàõ äîêàçàòåëüíîé ìåäèöèíû - ðàññêàçûâàòü î ñóììàõ , çàïëà÷åííûõ ðàçíûì äîêòîðàì , â ò÷ è ýíäîêðèíîëîãàì . Áðàâî , ýòî íîâî .. Êîìèçì ýòîé ñèòóàöèè â òîì , ÷òî ìû çàòðàòèëè êó÷ó íåðâîâ è ñèë , ñîáèðàÿ âðà÷åé , îòðàáàòûâàÿ ôîðìóëèðîâêè è óðîâíè ñîãëàñîâàííîñòè è äîêàçàòåëüíîñòè , à âçàìåí ìíå Âû ñåé÷àñ ïëþíóëè â ìîðäó è îáåùàëè ðàññêàçàòü ïðî àãðîìàäíûå ïëà÷åííûå ýíäîêðèíîëîãàì äåíüãè , çà÷åì -òî ïðèïëåëè 1 òèï äèàáåòà ( ïîíÿòíî , ÷òî äëÿ Âàñ êàæäûé íà èíñóëèíå -óæå 1 òèï ) , äà åùå ãíåâàåòåñü íà Îæèðåíèå è ìåòàáîëèçì . Óâû , áåç ðåêëàìû æóðíàë íåëüçÿ èçäàòü - ïîýòîìó ðåäàêöèÿ è ïðåäàëàãàåò ñðàâíèòåëüíî ïðèëè÷íûé âàðèàíò- â ñòàòüÿõ ïðî õèðóðãè÷åñêèå ìåòîäû ëå÷íåèÿ èäåò ðåêëàìà èíñòðóìåíòàðèÿ è áàíäàæåé
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Ã.À. Ìåëüíè÷åíêî |
#57
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Morbidity and mortality before and after bariatric surgery for morbid obesity compared with the general population.
Plecka Östlund M, Marsk R, Rasmussen F, Lagergren J, Näslund E. Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]. Abstract BACKGROUND: Bariatric surgery reduces morbidity and mortality in obese subjects, but it is unclear how rates compare with those in the population. The aim was to assess the risk of admission to hospital for obesity-related co-morbidities and overall mortality after bariatric surgery in relation to the general population. METHODS: A nationwide, population-based cohort study was conducted of all patients who underwent bariatric surgery in Sweden between 1980 and 2006. Each patient was compared with ten age- and sex-matched controls randomly selected from the Total Population Register. Hospital admission for co-morbidities was identified through the Patient Register. Cox proportional regression was used to calculate hazard ratios (HRs). RESULTS: A total of 13 273 patients underwent bariatric surgery between 1980 and 2006. After surgery, the overall adjusted HR remained increased for myocardial infarction (HR 1·56, 95 per cent confidence interval 1·35 to 1·81), angina pectoris (HR 2·05, 1·84 to 2·31), stroke (HR 2·13, 1·88 to 2·42), hypertension (HR 2·80, 2·61 to 3·01), diabetes (HR 2·44, 2·23 to 2·67) and death (HR 1·24, 1·15 to 1·34) in these patients compared with the general population. The 4161 patients who underwent gastric bypass surgery no longer had a higher risk of diabetes (HR 1·23, 0·88 to 1·72) or myocardial infarction (HR 0·78, 0·42 to 1·45), whereas morbidity remained increased after restrictive surgery in 7855 patients. The adjusted mortality remained higher after both gastric bypass and restrictive surgery. CONCLUSION: Gastric bypass, but not restrictive surgery, in patients with morbid obesity seems to reduce the risk of diabetes and myocardial infarction to population levels, but the risk of death remains increased. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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Ã.À. Ìåëüíè÷åíêî |
#58
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Risk of suicide after long-term follow-up from bariatric surgery.
Tindle HA, Omalu B, Courcoulas A, Marcus M, Hammers J, Kuller LH. University of Pittsburgh, Pittsburgh, PA, USA. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Abstract PURPOSE: Bariatric surgery is recognized as the treatment of choice for class III obesity (body mass index ≥40) and has been increasingly recommended for obese patients. Prior research has suggested an excess of deaths due to suicide following bariatric surgery, but few large long-term follow-up studies exist. We examined postbariatric surgery suicides by time since operation, sex, age, and suicide death rates as compared with US suicide rates. METHODS: Medical data following bariatric operations performed on Pennsylvania residents between January 1, 1995 and December 31, 2004 were obtained from the Pennsylvania Health Care Cost and Containment Council. Matching mortality data from suicides between September 1, 1996 and December 28, 2006 were obtained from the Division of Vital Records, Pennsylvania State Department of Health. RESULTS: There were 31 suicides (16,683 operations), for an overall rate of 6.6/10,000; 13.7 per 10,000 among men and 5.2 per 10,000 among women. About 30% of suicides occurred within the first 2 years following surgery, with almost 70% occurring within 3 years. For every age category except the youngest, suicide rates were higher among men than women. Age- and sex-matched suicide rates in the US population (ages 35-64 years) were 2.4/10,000 (men) and 0.7/10,000 (women). CONCLUSIONS: Compared with age and sex-matched suicide rates in the US, there was a substantial excess of suicides among all patients who had bariatric surgery in Pennsylvania during a 10-year period. These data document a need to develop more comprehensive longer-term surveillance and follow-up methods in order to evaluate factors associated with postbariatric surgery suicide.
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Ã.À. Ìåëüíè÷åíêî |
#59
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Âîîáùå çäîõíóòü ìîæíî.. Ïîäãîòîâëåíû ñîãëàñèòåëüíûåè äîêóìåíòû è ðàçîñëàíû ßøêîâó è Åãèåâó ( òåì , êòî áûë ) , ïîäãîòîâëåí òåêñò èíôîðìèðîâàííîãî ñîãëàñèÿ è ðàçúÿñíåèÿ ñóòè ïðîöåññà äëÿ áîëüíûõ ( ñîäðàíî âî ìíîãîì ñ Åâðîïåéñêèõ ðàçúÿñíåíèé ) , îáñæäåíà êîìàíäà , êîòîðàÿ äîëæíà ó÷àñòâîâàòü â âåäåíèè ïàöèíåòà, íà÷àòà ðàçðàáîòêà ïîëîæåíèÿ î ÑÏÅÖÈÀËÜÍÎÑÒÈ áàðèàòðè÷åñêàÿ õèðóðãèÿ ..
È âîò , íàêîíåö, ïîìîùü ïðèøëà - ðàäóéòåñü , ìû ïðèøëè ðàññêàçòü Âàì î áàðèàòðè÷åñêîé õèóðóãøèè , âíåìëèòå ...- "à ó íàñ èç òåõ , çà êåì ñëåäèëè , íèêòî íå óìåð , à äâàâàéòå ìû ïðî äåíüãè , ÷òî ýíäîêðèíîëîãè áåðóò ðàññêàæåì , è âààùå , âû òàì âûêðó÷èâàéòåñü êàê õîòèòå , æóðíàëû Âàøè ïå÷àòàÿ - à ãóñàðû äåíåã íå áåðóò... Íî äðóæèòü êîììåð÷åñêè õîòèì"" . Ìîæåò áûòü , åñëè ÷òî-òî è âïðàâäó ñîáèðàåìñÿ âíåäðèòü , áåç ãóñàðñîêãî ïîëåòà , à êàê áîëüøèå è ðàçóìíûå , ñîòðóäíè÷àÿ è ïðîâåðÿÿ è ñåáÿ , è êîëëåã?
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Ã.À. Ìåëüíè÷åíêî |
#60
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