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Medical ultrasonography

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  1. [1]
    الصورة الرمزية جوهرة المحيط
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    عضو شرف

     وسام الشكر

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    تاريخ التسجيل: Sep 2006
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    Medical ultrasonography

    From sound to image
    The creation of an image from sound is done in three steps - producing a sound wave, receiving echoes, and interpreting those echoes.
    Producing a sound wave
    A sound wave is typically produced by a piezoelectric transducer encased in a probe. Strong, short electrical pulses from the ultrasound machine make the transducer ring at the desired frequency. The frequencies can be anywhere between 2 and 15 MHz. The sound is focused either by the shape of the transducer, a lens in front of the transducer, or a complex set of control pulses from the ultrasound scanner machine. This focussing produces an arc-shaped sound wave from the face of the transducer. The wave travels into the body and comes into focus at a desired depth.
    Older technology transducers focus their beam with physical lenses. Newer technology transducers use phased array techniques to enable the sonographic machine to change the direction and depth of focus. Almost all piezoelectric transducers are made of ceramic.
    Materials on the face of the transducer enable the sound to be transmitted efficiently into the body (usually seeming to be a rubbery coating, a form of impedance matching). In addition, a water-based gel is placed between the patient's skin and the probe.
    The sound wave is partially reflected from the layers between different tissues. In detail, sound is reflected anywhere there are density changes in the body: e.g. blood cells in blood plasma, small structures in organs, etc. Some of the reflections return to the transducer.
    Receiving the echoes
    The return of the sound wave to the transducer results in the same process that it took to send the sound wave, except in reverse. The return sound wave vibrates the transducer, the transducer turns the vibrations into electrical pulses that travel to the ultrasonic scanner where they are processed and transformed into a digital image.

    Forming the image
    The sonographic scanner must determine three things from each received echo: 1.) The direction of the echo. 2.) How strong the echo was. 3.) How long it took the echo to be received from when the sound was transmitted. Once the ultrasonic scanner determines these three things, it can locate which pixel in the image to light up and to what intensity.
    Transforming the received signal into a digital image may be explained by using a blank spreadsheet as an analogy. We imagine our transducer is a long, flat transducer at the top of the sheet. We will send pulses down the 'columns' of our spreadsheet (A, B,C, etc.). We listen at each column for any return echos. When we hear an echo, we note how long it took for the echo to return. The longer the wait, the deeper the row (1,2,3,etc.). The strength of the echo determines the brightness setting for that cell (white for a strong echo, black for a weak echo, and varying shades of grey for everything in between.) When all the echos are recorded on the sheet, we have a greyscale image.
    Sound in the body
    Ultrasonography (sonography) uses a probe containing one or more acoustic transducers to send pulses of sound into a material. Whenever a sound wave encounters a material with a different density (acoustical impedance), part of the sound wave is reflected back to the probe and is detected as an echo. The time it takes for the echo to travel back to the probe is measured and used to calculate the depth of the tissue interface causing the echo. The greater the difference between acoustic impedances, the larger the echo is. If the pulse hits gases or solids, the density difference is so great that most of the acoustic energy is reflected and it becomes impossible to see deeper.
    The frequencies used for medical imaging are generally in the range of 1 to 13 MHz. Higher frequencies have a correspondingly smaller wavelength, and can be used to make sonograms with smaller details. However, the attenuation of the sound wave is increased at higher frequencies, so in order to have better penetration of deeper tissues, a lower frequency (3-5 MHz) is used.
    Seeing deep into the body with sonography is very difficult. Some acoustic energy is lost every time an echo is formed, but most of it is lost from acoustic absorption. A common model of this loss is 0.3 dB /cm of depth / MHz. (MHz of the imaging frequency in use.)
    The speed of sound is different in different materials, and is dependent on the acoustical impedance of the material. However, the sonographic instrument assumes that the acoustic velocity is constant at 1540 m/s. An effect of this assumption is that in a real body with non-uniform tissues, the beam become somewhat de-focused and image resolution is reduced.
    To generate a 2D-image, the ultrasonic beam is swept. A transducer may be swept mechanically by rotating or swinging. Or a 1D phased array transducer may be use to sweep the beam electronically. The received data is processed and used to construct the image. The image is then a 2D representation of the slice into the body.
    3D images can be generated by acquiring a series of adjacent 2D images. Commonly a specialised probe that mechanically scans a conventional 2D-image transducer is used. However, since the mechanical scanning is slow, it is difficult to make 3D images of moving tissues. Recently, 2D phased array transducers that can sweep the beam in 3D have been developed. These can image faster and can even be used to make live 3D images of a beating heart.
    Most sonographic machines can also produce color images. The colors are usually used to represent movement and is used to study blood flow and muscle motion. As a usage example, this representation makes it easy to detect leaky heart valves because the leak shows up as a flash of unique color. Colors may alternatively be used to represent the amplitudes of the received echoes.



    How is the procedure performed?

    For most ultrasound exams, the patient is positioned lying face-up on an examination table that can be tilted or moved.
    A clear gel is applied to the area of the body being studied to help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin. The sonographer (ultrasound technologist) or radiologist then presses the transducer firmly against the skin and sweeps it back and forth over the area of interest.
    Doppler sonography is performed using the same transducer.
    When the examination is complete, the patient may be asked to dress and wait while the ultrasound images are reviewed. However, the sonographer or radiologist is often able to review the ultrasound images in real-time as they are acquired and the patient can be released immediately.
    In some ultrasound studies, the transducer is attached to a probe and inserted into a natural opening in the body. These exams include:
     Transesophageal echocardiogram. The transducer is inserted into the esophagus to obtain images of the heart.
     Transrectal ultrasound. The transducer is inserted into a man's rectum to view the prostate.
     Transvaginal ultrasound. The transducer is inserted into a woman's vagina to view the uterus and ovaries.
    Most ultrasound examinations are completed within 30 minutes to an hour.


    What will I experience during and after the procedure?

    Most ultrasound examinations are painless, fast and easy.
    After you are positioned on the examination table, the radiologist or sonographer will spread some warm gel on your skin and then press the transducer firmly against your body, moving it back and forth over the area of interest until the desired images are captured. There may be varying degrees of discomfort from pressure as the transducer is pressed against the area being examined.
    If scanning is performed over an area of tenderness, you may feel pressure or minor pain from the procedure.
    Ultrasound exams in which the transducer is attached to probe and inserted into an opening of the body may produce minimal discomfort.
    If a Doppler ultrasound study is performed, you may actually hear pulse-like sounds that change in pitch as the blood flow is monitored and measured.
    Once the imaging is complete, the gel will be wiped off your skin.
    After an ultrasound exam, you should be able to resume your normal activities.



    Who interprets the results and how do I get them?

    A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician, who will share the results with you. In some cases the radiologist may discuss preliminary results with you at the conclusion of your examination.
    What are the benefits vs. risks?
    Benefits
     Ultrasound scanning is noninvasive (no needles or injections) and is usually painless.
     Ultrasound is widely available, easy-to-use and less expensive than other imaging methods.
     Ultrasound imaging uses no ionizing radiation.
     Ultrasound scanning gives a clear picture of soft tissues that do not show up well on x-ray images.
     Ultrasound causes no health problems and may be repeated as often as is necessary if medically indicated.
     Ultrasound is the preferred imaging modality for the diagnosis and monitoring of pregnant women and their unborn infants.
     Ultrasound provides real-time imaging, making it a good tool for guiding minimally invasive procedures such as needle biopsies and needle aspiration of fluid in joints or elsewhere.


    Risks
     For standard diagnostic ultrasound there are no known harmful effects on humans.
    What are the limitations of General Ultrasound Imaging?
    Ultrasound waves are reflected by air or gas; therefore ultrasound is not an ideal imaging technique for the bowel. Barium exams and CT scanning are the methods of choice for bowel-related problems.
    Ultrasound waves do not pass through air; therefore an evaluation of the stomach, small intestine and large intestine may be limited. Intestinal gas may also prevent visualization of deeper structures such as the pancreas and aorta. Patients who are obese are more difficult to image because tissue attenuates (weakens) the sound waves as they pass deeper into the body.
    Ultrasound has difficulty penetrating bone and therefore can only see the outer surface of bony structures and not what lies within. For visualizing internal structure of bones or certain joints, other imaging modalities such as MRI are typically used.

  2. [2]
    جوهرة المحيط
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    عضو شرف
    الصورة الرمزية جوهرة المحيط


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    Medical ultrasonography
    Medical ultrasonography (sonography) is an ultrasound-based diagnostic imaging technique used to visualize muscles and internal organs, their size, structures and possible pathologies or lesions. Obstetric sonography is commonly used during pregnancy and is widely recognized by the public. There are a plethora of diagnostic and therapeutic applications practiced in medicine.
    In physics the term "ultrasound" applies to all acoustic energy with a frequency above human hearing (20,000 hertz or 20 kilohertz). Typical diagnostic sonography scanners operate in the frequency range of 2 to 15 megahertz, hundreds of times greater than this limit. The choice of frequency is a trade-off between spatial resolution of the image and imaging depth: lower frequencies produce less resolution but image deeper into the body.

    A fetus in the womb, viewed in a sonogram

    "3D ultrasound" of a developing fetus at 29 weeks


    Diagnostic applications
    Sonography (ultrasonography) is widely utilized in medicine. It is possible to perform diagnosis or therapeutic procedures with the guidance of sonography (for instance biopsies or drainage of fluid collections). Sonographers are medical professionals who perform scans for diagnostic purposes; they work with specialized doctors called sonologists who provide reports of the images obtained. Sonographers typically use a hand-held probe (called a transducer) that is placed directly on and moved over the patient. A water-based gel is used to couple the ultrasound between the transducer and patient.
    Sonography is effective for imaging soft tissues of the body. Superficial structures such as muscles, tendons, testes, breast and the neonatal brain are imaged at a higher frequency (7-15 MHz), which provides better axial and lateral resolution. Deeper structures such as liver and kidney are imaged at a lower frequency 1-6 MHz with lower axial and lateral resolution but greater penetration.
    Therapeutic applications
    Therapeutic applications use ultrasound to bring heat or agitation into the body. Therefore much higher energies are used than in diagnostic ultrasound. In many cases the range of frequencies used are also very different.
    • Ultrasound may be used to clean teeth in dental hygiene.
    • Ultrasound sources may be used to generate regional heating in biological tissue, e.g. in occupational therapy, physical therapy and cancer treatment.
    • Focused ultrasound may be used to generate highly localized heating to treat cysts and tumors (benign or malignant), This is known as Focused Ultrasound Surgery (FUS) or High Intensity Focused Ultrasound (HIFU). These procedures generally use lower frequencies than medical diagnostic ultrasound (from 250 kHz to 2000 kHz), but significantly higher energies. HIFU treatment is often guided by MRI.
    • Focused ultrasound may be used to break up kidney stones by lithotripsy.
    • Ultrasound may be used for cataract treatment by phacoemulsification.
    • Additional physiological effects of low-intensity ultrasound have recently been discovered, e.g. its ability to stimulate bone-growth and its potential to disrupt the blood-brain barrier for drug delivery. kaley
    From sound to image
    The creation of an image from sound is done in three steps - producing a sound wave, receiving echoes, and interpreting those echoes.
    Producing a sound wave

    Medical Sonographic Scanner
    A sound wave is typically produced by a piezoelectric transducer encased in a probe. Strong, short electrical pulses from the ultrasound machine make the transducer ring at the desired frequency. The frequencies can be anywhere between 2 and 15 MHz. The sound is focused either by the shape of the transducer, a lens in front of the transducer, or a complex set of control pulses from the ultrasound scanner machine. This focussing produces an arc-shaped sound wave from the face of the transducer. The wave travels into the body and comes into focus at a desired depth.
    Older technology transducers focus their beam with physical lenses. Newer technology transducers use phased array techniques to enable the sonographic machine to change the direction and depth of focus. Almost all piezoelectric transducers are made of ceramic.
    Materials on the face of the transducer enable the sound to be transmitted efficiently into the body (usually seeming to be a rubbery coating, a form of impedance matching). In addition, a water-based gel is placed between the patient's skin and the probe.
    The sound wave is partially reflected from the layers between different tissues. In detail, sound is reflected anywhere there are density changes in the body: e.g. blood cells in blood plasma, small structures in organs, etc. Some of the reflections return to the transducer.
    Receiving the echoes
    The return of the sound wave to the transducer results in the same process that it took to send the sound wave, except in reverse. The return sound wave vibrates the transducer, the transducer turns the vibrations into electrical pulses that travel to the ultrasonic scanner where they are processed and transformed into a digital image.
    Forming the image
    The sonographic scanner must determine three things from each received echo: 1.) The direction of the echo. 2.) How strong the echo was. 3.) How long it took the echo to be received from when the sound was transmitted. Once the ultrasonic scanner determines these three things, it can locate which pixel in the image to light up and to what intensity.
    Transforming the received signal into a digital image may be explained by using a blank spreadsheet as an analogy. We imagine our transducer is a long, flat transducer at the top of the sheet. We will send pulses down the 'columns' of our spreadsheet (A, B,C, etc.). We listen at each column for any return echos. When we hear an echo, we note how long it took for the echo to return. The longer the wait, the deeper the row (1,2,3,etc.). The strength of the echo determines the brightness setting for that cell (white for a strong echo, black for a weak echo, and varying shades of grey for everything in between.) When all the echos are recorded on the sheet, we have a greyscale image.
    Sound in the body

    Linear Array Transducer
    Ultrasonography (sonography) uses a probe containing one or more acoustic transducers to send pulses of sound into a material. Whenever a sound wave encounters a material with a different density (acoustical impedance), part of the sound wave is reflected back to the probe and is detected as an echo. The time it takes for the echo to travel back to the probe is measured and used to calculate the depth of the tissue interface causing the echo. The greater the difference between acoustic impedances, the larger the echo is. If the pulse hits gases or solids, the density difference is so great that most of the acoustic energy is reflected and it becomes impossible to see deeper.
    The frequencies used for medical imaging are generally in the range of 1 to 13 MHz. Higher frequencies have a correspondingly smaller wavelength, and can be used to make sonograms with smaller details. However, the attenuation of the sound wave is increased at higher frequencies, so in order to have better penetration of deeper tissues, a lower frequency (3-5 MHz) is used.
    Seeing deep into the body with sonography is very difficult. Some acoustic energy is lost every time an echo is formed, but most of it is lost from acoustic absorption. A common model of this loss is 0.3 dB /cm of depth / MHz. (MHz of the imaging frequency in use.)
    The speed of sound is different in different materials, and is dependent on the acoustical impedance of the material. However, the sonographic instrument assumes that the acoustic velocity is constant at 1540 m/s. An effect of this assumption is that in a real body with non-uniform tissues, the beam become somewhat de-focused and image resolution is reduced.
    To generate a 2D-image, the ultrasonic beam is swept. A transducer may be swept mechanically by rotating or swinging. Or a 1D phased array transducer may be use to sweep the beam electronically. The received data is processed and used to construct the image. The image is then a 2D representation of the slice into the body.
    3D images can be generated by acquiring a series of adjacent 2D images. Commonly a specialised probe that mechanically scans a conventional 2D-image transducer is used. However, since the mechanical scanning is slow, it is difficult to make 3D images of moving tissues. Recently, 2D phased array transducers that can sweep the beam in 3D have been developed. These can image faster and can even be used to make live 3D images of a beating heart.
    Most sonographic machines can also produce color images. The colors are usually used to represent movement and is used to study blood flow and muscle motion. As a usage example, this representation makes it easy to detect leaky heart valves because the leak shows up as a flash of unique color. Colors may alternatively be used to represent the amplitudes of the received echoes.
    Doppler sonography
    Sonography can be enhanced with Doppler measurements, which employ the Doppler effect to assess whether structures (usually blood) are moving towards or away from the probe, and its relative velocity. By calculating the frequency shift of a particular sample volume, for example a jet of blood flow over a heart valve, its speed and direction can be determined and visualised. This is particularly useful in cardiovascular studies (sonography of the vasculature system and heart) and essential in many areas such as determining reverse blood flow in the liver vasculature in portal hypertension. The Doppler information is displayed graphically using spectral Doppler, or as an image using color Doppler (directional Doppler) or power Doppler (non directional Doppler). This Doppler shift falls in the audible range and is often presented audibly using stereo speakers: this produces a very distinctive, although synthetic, pulsing sound.
    Strictly speaking, most modern sonographic machines do not use the Doppler effect to measure velocity, as they rely on pulsed wave Doppler (PW). Pulsed wave machines transmit pulses of ultrasound, and then switch to receive mode. As such, the reflected pulse that they receive is not subject to a frequency shift, as the insonation is not continuous. However, by making several measurements, the phase change in subsequent measurements can be used to obtain the frequency shift (since frequency is the rate of change of phase). To obtain the phase shift between the received and transmitted signals, one of two algorithms is typically used: the Kasai algorithm or cross-correlation. Older machines, that use continuous wave (CW) Doppler, exhibit the Doppler effect as described above. To do this, they must have separate transmission and reception transducers. The major drawback of CW machines, is that no distance information can be obtained (this is the major advantage of PW systems - the time between the transmitted and received pulses can be converted into a distance with knowledge of the speed of sound).
    In the sonographic community (although not in the signal processing community), the terminology "Doppler" ultrasound, has been accepted to apply to both PW and CW Doppler systems despite the different mechanisms by which the velocity is measured.
    Microbubbles
    The use of microbubble contrast media in medical sonography to improve ultrasound signal backscatter is known as contrast-enhanced ultrasound. This technique is currently used in echocardiography, and may have future applications in molecular imaging and drug delivery.
    Strengths of sonography
    • It images muscle and soft tissue very well and is particularly useful for delineating the interfaces between solid and fluid-filled spaces.
    • It renders "live" images, where the operator can dynamically select the most useful section for diagnosing and documenting changes, often enabling rapid diagnoses.
    • It shows the structure of organs.
    • It has no known long-term side effects and rarely causes any discomfort to the patient.
    • Equipment is widely available and comparatively flexible.
    • Small, easily carried scanners are available; examinations can be performed at the bedside.
    • Relatively inexpensive compared to other modes of investigation (e.g. computed X-ray tomography, DEXA or magnetic resonance imaging).
    Weaknesses of ultrasonic imaging
    • Large body habitus, obese patients limit image quality as the overlying adipose tissue (fat) scatters the sound and greater depth the sound waves need to travel attenuate or weaken the signal on transmission and reflection back to the transducer. A fetus close to the surface will be imaged at a higher resolution than those at greater distance to the skin surface.
    • Sonographic devices have trouble penetrating bone. For example, sonography of the brain is very limited.
    • Sonography can detect fluid surrounding the lung (pleural effusion) but the high impedance mismatch between the solid tissues and the air filled lungs limits image.
    • Sonography performs very poorly when there is a gas between the transducer and the organ of interest, due to the extreme differences in acoustical impedance. For example, overlying gas in the gastrointestinal tract often makes ultrasound scanning of the pancreas difficult, and lung imaging is not possible (apart from demarcating pleural effusions).
    • Even in the absence of bone or air, the depth penetration of ultrasound is limited, making it difficult to image structures deep in the body, especially in obese patients.
    • The method is operator-dependent. A high level of skill and experience is needed to acquire good-quality images and make accurate diagnoses. For information on education and certification in sonography see ARDMS.
    • There is no scout image as there is with CT and MR. Once an image is acquired there is no exact way to tell which part of the body was imaged.
    Dangers of ultrasonic imaging
    The safety of ultrasound has been studied extensively. All medical procedures have beneficial consequences with risk for detrimental consequences. However, the important question is: what is the balance between the two?
    Ultrasound does have bio-effects. Usually these are in some proportion to the amount of energy put into in the tissue, and high-intensity ultrasound can have the following effects:
    • Cavitation: Very high negative acoustic pressures can cause temporary microscopic vacuum pockets. When these collapse, they produce very high local temperatures that can cause damage to the immediate region.
    • Heat generation: Local tissue absorbs the ultrasound energy and increases their temperatures. Long-duration elevated temperatures above 41 C can damage tissue.
    • Bubble formation: dissolved gases come out of the solution due to local heat increases
    Heat and cavitation are the two primary known detrimental bio-effects and for this reason, the use of ultrasound is regulated by government agencies.
    Ultrasonography is generally considered a "safe" imaging modality. However slight detrimental effects have been occasionally observed.

    MEDICAL DIAGNOSTIC APPLICATIONS
    Ultrasonic technology emerged as a medical diagnostic technology in the late 1960's and the
    field of obstetrics has been one of the first applications [3]. The most widely used techniques
    2
    today are pulsed echo (2.0 to 7.0 MHz) and Doppler imaging (2 to 4 MHz). Currently used
    equipment offers real-time imaging, where the moving fetus is viewed on a color monitor. Pulse
    echo techniques are employed with the transducer coupled either in contact, immersion or using
    a liquid delay line. To obtain instant images, a transducer array is used and the reflected signals
    are monitored. The sensitivity and resolution have been improved to a level that allows viewing
    of even the movements of the fetal heart, and to conduct accurate measurements on the monitor.
    Such measurements form the cornerstone of the assessment of fetal gestational age, size and
    health. Progressively, ultrasonics has become an indispensable tool for many medical diagnostic
    applications. It has a vital role in the assessment of pregnant woman, in patients with heart
    disease, stroke and disorders of the vascular system, and in imaging of other vital organs such as
    the liver, kidneys, as well as the abdomen and soft tissues. An example of the capability of
    pulse-echo imaging can be viewed in Figure 1. This capability allows the examination of
    atherosclerosis and other disease processes.
    Figure 1: A pulse echo
    imaging of the Aortic valve
    in real time, allowing
    visualization of the heart
    valve in motion. [Ref-.
    http://www.webcom.com/ld
    vonch/cardult.html].
    The Doppler shift principle has been used for a long time in fetal heart rate detectors. Recent
    developments, such as the use of real-time color flow mapping which clearly depicts the flow of
    blood in the vessels, and allows measurement determinations makes the method a very effective
    diagnostic tool. The use of real-time color flow mapping clearly depicts the flow of blood in the
    vessels. Color Doppler is particularly indispensable in the diagnosis and assessment of heart
    valve disorders, congenital heart abnormalities and the visualization of reduced blood flow in
    diseased vessels. The development of real-time imaging with the selectable combination of color
    hues onto shades of gray has added a powerful imaging capability for viewing subtle tissue
    details. This enhancement provides a better interpretation of the ultrasonic images. The use of
    3-D imaging is being developed for volumetric measurements as well as to enhance image
    interpretation and presentation.

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  5. [5]
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    شكراً شكراً شكراً شكراً شكراً شكراً شكراً شكراً شكراً شكراً شكراً شكراً شكراً
    شكراً شكراً شكراً شكراً شكراً شكراً شكراً شكراً شكراً شكراً شكراً شكراً
    شكراً شكراً شكراً شكراً شكراً شكراً شكراً شكراً شكراً شكراً شكراً
    شكراً شكراً شكراً شكراً شكراً شكراً شكراً شكراً شكراً شكراً
    شكراً شكراً شكراً شكراً شكراً شكراً شكراً شكراً شكراً
    شكراً شكراً شكراً شكراً شكراً شكراً شكراً شكراً
    شكراً شكراً شكراً شكراً شكراً شكراً شكراً
    شكراً شكراً شكراً شكراً شكراً شكراً
    شكراً شكراً شكراً شكراً شكراً
    شكراً شكراً شكراً شكراً
    شكراً شكراً شكراً
    شكراً شكراً
    شكر


    رائع جدا و مشكور على هذا المجهود الرائع
    و جزاك الله كل خير

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    لا يستحق الحياة ... من يعجز عن صنع المعجزة التي يحقق بها ذاته

  10. [10]
    ليدي لين
    ليدي لين غير متواجد حالياً
    عضو فعال جداً


    تاريخ التسجيل: Jan 2008
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