Balanche Ajar Va Shalyachikitsa

~ ~~ ~
~ ~~ ~
m mm m
m mm m
i ii i
i ii i
m mm m
m mm m

M MM M
M MM M
o oo o
o oo o
A AA A
A AA A
m mm m
m mm m
O OO O
O OO O
m mm m
m mm m
a aa a
a aa a

d dd d
d dd d

e ee e
e ee e

` `` `
` `` `
{ {{ {
{ {{ {
M MM M
M MM M
{ {{ {
{ {{ {
H HH H
H HH H
$ $$ $
$ $$ $

g gg g
g gg g
m mm m
m mm m

S SS S
S SS S
S SS S
> >> >
> >> >
> >> >
m mm m
m mm m
m mm m

. .. .
. .. .
. .. .

_ __ _
_ __ _
_ __ _
r rr r
r rr r
r rr r
Z ZZ Z
Z ZZ Z
Z ZZ Z
m mm m
m mm m
m mm m
j jj j
j jj j
j jj j
r rr r
r rr r
r rr r

Z ZZ Z
Z ZZ Z
Z ZZ Z
b bb b
b bb b
b bb b
~ ~~ ~
~ ~~ ~
~ ~~ ~
b bb b
b bb b
b bb b
o oo o
o oo o
o oo o
- -- -
- -- -
- -- -
^ ^^ ^
^ ^^ ^
^ ^^ ^
m mm m
m mm m
m mm m
o oo o
o oo o
o oo o
g gg g
g gg g
g gg g
b bb b
b bb b
b bb b
o oo o
o oo o
o oo o

n w VH$mg mR>r Vmd Z m n w VH$mg mR>r Vmd Z m n w VH$mg mR>r Vmd Z m n w VH$mg mR>r Vmd Z m
~ mb e ` {M{H$g m h m A ma mo` g od oVrb Vg m
Xwb {j b ob mM ^ mJ ! H$Xm{MV b h mZ _ wb h r Hw$Qy>~ m` m
A WmO Z mV {h g m CMb V Z mh rV, h o ` m_ mJ Mo EH$ H$ma U
A g y e H$Vo. n a VwA mO H$mb EHy$U M n m{P Q>r h h o W ` m
O _ m` mV _ wb m` m A ma mo` me r {Z J S>rV g _ ` mH$S>o
~ ma H$mBZ o b j XoU ma o Xj n mb H$ A mh oV. ` m` m
~ moYZ mg mR>r ` mn w VH$mMo ` moO Z . ` mI oa rO ~ mb H$m` m
A ma mo` a j U mV _ h d mMm d mQ>m CMb U m` m n ` oH$mb m
h U O oM \ ${_ b r {\ ${O {e ` g , A ma mo` g o{d H$m d
~ mb a moJ Vk mZ mh r Cn ` w $ R>a ob A e r n wp VH$m.
H$e Z / _ Wi m H$e Z / _ Wi m H$e Z / _ Wi m H$e Z / _ Wi m
- ~ ` mM H$O o{Z Q>b A Z m_ {b O A mn a oe Z H$ $Z ~ ` m
Ho$ ` mO mD$ e H$VmV.
- J o ` m 3 0 Vo 3 5 d f mV A mn a oe Z P mb o ` m Z d O mV
A ^ H$mMm _ ` yXa 6 0 Q> ` md $Z 1 0 Q> ` mn ` V I mb r
A mb ob mA mh o.
- n oS>r` mQ>rH$ g O Z Z d O mV A ^ H$mn mg yZ g mYma U n U o 1 5
d f mn ` V` m _ wb md a g O uH$b mb og ` m {Z a mH$a U mg mR>r
e {H$` mH$a VmV.

A n n [a M` A n n [a M` A n n [a M` A n n [a M`
O _ O _ O _ O _ : :: : 2 A m Q>mo~ a 1 9 7 5 ( A h _ Xn ya , {O h m- b mVya )

e mb o` {e j U e mb o` {e j U e mb o` {e j U e mb o` {e j U : :: : ` e d V {d mb ` ,
A h _ Xn ya .

S>m. _ rZ mj r Z b ~ b o- ^ mog b o
_ h m{ _ h m{ _ h m{ _ h m{d mb ` rZ {e j U d mb ` rZ {e j U d mb ` rZ {e j U d mb ` rZ {e j U : : : :
_ h m_ mJ mYr _ h m{d mb ` , A h _ Xn ya .
Xh md r ( 1 9 9 0 ) d ~ ma md rV ( 1 9 9 2 ) a m` mV a m` mV a m` mV a m` mV
g d W_ g d W_ g d W_ g d W_
d H$s` {e j U d H$s` {e j U d H$s` {e j U d H$s` {e j U : :: :
E_ . ~ r. ~ r. Eg . d E_ . Eg . O Z a b g O a r, g oR>
O r. Eg . _ o{S>H$b H$mb oO d Ho$. B. E_ . h mp n Q>b
_ w~ B ` oWyZ {d e of m{d ` mZ on yU
g O a rVrb S>m. J rVm a md _ o_ moa rA b mBP ` m
_ mZ H$a r

d mS>r` m h mp n Q>b _ w~ B ` oWyZ E_ . g r. EM.
n oS>r` mQ>rH$ g O a r {d f ` mMo{d e of {e j U
{S>b mo_ Q>A m\ $ Z e Z b ~ moS>h r {X r ~ moS>mMr n Xd r
g n mXZ
` md g m{` H$ H$ma H$sX : ` md g m{` H$ H$ma H$sX : ` md g m{` H$ H$ma H$sX : ` md g m{` H$ H$ma H$sX :
~ r. O o. _ oS>rH$b H$mb oO d g g yZ U mb ` , n wU o` oWo
J ob r 6 d f } A {Y ` m ` mVr h U yZ H$m` a V
~ mb e ` [M[H$g m{d f ` H$ A Z oH$ n [a f Xm_ ` o
g h ^ mJ d VwVrH$a U
{Z ` VH$m{b H$m_ YyZ g mV` mZ o A ma mo` {d f ` H$
b oI Z
d H$s` O Z g _ ` oA Z oH$ b oI H$m{e V
h o W MoH$ A n , b S> S>moZ oe Z H$n d e {H$` m
{e ~ ra m_ ` oe ` {d e ma X h U yZ g h ^ mJ
A mVmn ` V 2 0 0 0 h Z A {YH$ ~ mb $U md a ` e d r
e {H$` m

_ Z moJ V _ Z moJ V _ Z moJ V _ Z moJ V
I a Va g d mX h mHw$R> ` mh r Z m` mMmn m` mM. A m_ ` m
S>m Q>a r n oe mV Va g d mXmM _ h d \ $ma H$f mZ o O mU d V.
EI mXm` w{Z h {g Q>rV J mo S>_ oS>b {_ i d b ob mS>m Q>a h r n oe Q>e r
g wg d mX g mY` mV A n ` e r R>a b m Va A m` w ` mV J Vr H$
e H$V Z mh r. ` mCb Q>EI mXm{d f ` mMr g mYma U O mU A g b ob m
n U C m_ g ^ mf U H$me ` A g b ob m ` mMm g h H$ma r n oe Q>Z m
A mn b og o H$a ` mV ` e d r h moVmo; h m d H$e m mVrb A Z w^ d
I yn ~ mob H$mA mh o.
Ho$. B. E_ . b m E_ . ~ r. ~ r. Eg . Mo {e j U KoV
A g VmZ mM g ^ mf U H$me ` mMr h r O mU A mb r. ` mM H$mi mV
{g N>mVr{d H$ma Vk S>m. A e moH$ _ h me ya , A p Wa moJ Vk
S>m. n r. ~ r. ^ mog b o; Vg oM O J _ m` Vm{_ i mb ob o{d ` mV B.
EZ . Q>r. g O Z S>m. {_ b t X H$sVZ o ` m` mg ma ` m{XJ O mMm
` m` mn oe Q>e r A g b ob mg wg d mX O d i y Z n mh VmA mb m. ` mM
_ Xy, {_ V^ mf r ~ mob U I a M I yn {e H$d yZ J ob .
g oH$S> E_ . ~ r. ~ r. Eg . b m ~ mBO oa ~ mBd mS>r` m
h mp n Q>b _ ` o n oS>r` mQ>rH$ {d f ` m` m _ {h ` m^ a m` m
n mo Q>t J Xa ` mZ , Xwg ` m _ O ` md a A g b o ` m d mS>Z . 2 1
_ ` o S>moH$md ` mMr g Yr {_ i mb r. VoWo ~ mb U mMm
e {H$` ob m {_ i U ma m g H$ma m_ H$ {Vg mX d ` mZ Va Mr

[a H$ h a r n mh Z A mn U h r ~ mb e ` {M{H$g mVk h m` M ` m
{d Mma mZ _ Z mV R>mU _ mS>b r.
g wXd mZ Ho$. B. E_ . d Hy$n a _ YyZ E_ . Eg . O Z a b
g O a rMo {e j U n yU Ho$ ` mZ Va E_ . g r. EM. ` m
g wn a n oe m{b Q>r A ` mg H$_ mMr d oe n a rj m m{d ` mZ oC mrU
P m ` mZ o ~ mb e ` {d e ma X ~ Z ` mMm _ mJ _ moH$i m P mb m.
VrZ d f m` m ` m {e j U H$mi mV ~ mB O oa ~ mB d mS>r` m
h mp n Q>b _ ` o A Z oH$ Vk ~ mb e ` {d e ma XmMo _ mJ Xe Z
b m^ b o. {e d m` d oi mod oi r h moU m` m p b Z rH$b _ rQ>t J g ,
d H$s` n [a f Xm ` m_ YyZ KoVb o ` m g h ^ mJ m_ wi o _ w~ BVrb
BVa H$mb oO m_ Yrb d Xoe ^ a mVrb H$mh r {d e of k m` m
_ mJ Xe Z mMmb m^ {_ i mb md {d f ` mMok mZ J ^ h mo` mV
_ XV P mb r.
n a Vy ` m k mZ mMr I a r H$g moQ>r b mJ b r Vr E_ . g r.
EM. MmA ` mg H$_ n wU H$ $Z n w` mV g g yZ h mp n Q>b _ ` o
~ mb e ` {M{H$g me m {d ^ mJ mV A {Y ` m ` mVr h U yZ
H$m` a V A g VmZ mM. A mVmn ` V {_ i {d b ob o k mZ ,
g ^ mf U H$me ` n wa on ya d mn $Z , EH$Q> mZ o n oe Q> d
Z mVod mBH$mMm {d d mg g n mXZ H$a U o, Cn b Y VwQ>n w` m
g mYZ g m_ J rV CV_ [a P Q>g XoU o h r H$g a V H$a V
A g VmZ mM, g mo` m_ a mR>r ^ mf oV n mb H$mZ md g m_ m` O Z mZ m

g _ O ob A e m e XmV ~ mb e ` {M{H$g me m m~ b _ m{h Vr
{b h md r ` mH$ n Z oZ oCMb Ya b r.
d oi {_ i ob V| h mEHo$H$m H$a U mMo mW{_ H$ b oI Z
Ho$b o. _ m ` mZ Va {b I mU g d n e u d g wb ^ h moBb ` mg mR>r
` mV A md ` H$ Vo ~ Xb H$a U o h o I a M I yn _ moR> A m h mZ
h moV. n a Vwg wXd mZ o` mb mh r ` mo` {Xe m{_ i V J ob r d A mO
~ mb e ` {M{H$g me m md a M h o b oI Z A mn ` mg _ moa
R>od VmZ mA {Ve ` A mZ X h moV A mh o.
_ a mR>rVrb {b I mU mMm _ mP m h m n {h b mM ` Z
A g ` mZ o d H$mh r e Xm` m g k m _ a mR>r ^ mf oV XoU e `
Z g ` mZ oH$mh r [R>H$mU r h ob oI Z ~ moO S>d mQ>` mMr e ` Vm
A mh o. g yk d mMH$ ` mMr V_ m Z ~ mi J Vm A mn b m A {^ m`
` $ H$a Vrb h r A n oj m!

A n U n { H$m A n U n { H$m A n U n { H$m A n U n { H$m

` m A g ` n mb H$mZ r A mn ` m Vmh ` mZ m
{d d mg mZ oA m_ ` mh mVr g mon d b ` mZ m
d
` m Vmh w ` mZ m, ` mZ r A mh r ` m` md a H$a V
A g b o ` mCn Mma mZ m( H$s ` moJ mZ m) C m_ {Vg mX XoD$Z
A mh mb m~ mb e ` {d e ma X h r n Xd r ~ h mb Ho$b r

F $U {Z X}e F $U {Z X}e F $U {Z X}e F $U {Z X}e
_ r _ mP o mW{_ H$ d $n mMo b oI Z H$a rV A g VmZ mM,
~ mb e ` {M{H$g me m md a rb H$mh r _ m{h Vr "A ma mo` k mZ oa r
{Xd mi r 2 0 0 7 ' ` m A H$mV {g P mb r. ` m~ b A H$mMo
g n mXH$ d {g ~ mb a moJ Vk S>m. h o_ V O moe r d S>m. A MZ m
O moe r ` mMo A m` {VH$ A m^ ma . I a oVa ` m` m o_ i
A mJ h m_ wi oM _ r _ mP og d {b I mU d oi oV n yU H$ $ e H$b od
A mO Vo n w VH$ $n mZ o H$m{e V h moV A mh o. ` mV S>m. h o_ V
O moe t Mo_ mZ {g H$ n mR>~ i A {Ve ` _ h d mMoA mh o.
` mV g O Z S>m. a d t ~ mn Q> g a mZ r A mn ` m
A {V ` V {XZ M` }VyZ d oi mV d oi H$mTy>Z n w VH$mg mR>r
Vmd Z m{b h rb r. ` m~ b ` mMo_ Z n yd H$ A m^ ma .
S>m. g O ` A moH$, {g ~ mb e ` {M{H$g mVk , C m_
b oI H$/ g ^ mf U n Qy>d Ho$. B. E_ . _ w~ BMoS>rZ ` mZ r d oi mV
d oi H$mTy>Z _ mP o mW{_ H$ d $n mMo b oI Z Z O a oI mb yZ
KmVb od VoA {YH$ g mo` m^ mf oV _ mS>` m~ m~ V H$mh r _ m{b H$
g yMZ m Ho$ ` m ` m~ b _ r ` mMr g Xd F $U r a mh rZ .
` mM _ mU o n w` mVrb n o{S>` m{Q>H$ g O Z S>m. J moqd X XmVma
` mZ rh r {b I mU d mMyZ ` mV H$mh r ~ Xb H$a ` m~ m~ V
g wM{d b o. ` mZ r Ho$b o ` m_ mJ Xe Z m~ b ` mMoA m^ ma . g g yZ
U mb ` mMoA {Y R>mVmS>m. A O ` MXZ d mb o, e ` {M{H$g m
{d ^ mJ _ wI S>m. g O rd R>mHy$a ; Vg oM _ mP o` o R>g h H$ma r S>m.

Xg {_ V qg J ` mZ r _ m` m` mg d Cn H$_ mZ mg Xmo{XV n mqR>~ m
{Xb m, ` m~ b ` mMoA m^ ma .
` m b oI md a rb H$mh r g wk d mMH$m` m {V{H$` m_ wi o
n wT>rb g d b oI Z n w VH$ $n mZ o {g H$a ` mMm Cg mh
d mT>b m. Xa ` mZ S>m. d mg Vr d g wZ rb n m` J wS>o` mZ rh r g d
b oI Z d mMyZ \ ${_ b r {\ ${O {e ` g g mR>r Vo A md ` H$
A g ` mMr d mh r {Xb r, ` m~ b ` mMo A m^ ma . l r{d m
H$me Z Mo Ho$o$. l r. Cn | Hw$b H$U u ` mZ r _ m` mg ma ` m
Z d mo{XV b o{I Ho$b m A md ` H$ Vog d _ mJ Xe Z H$ $Z _ mmo
b oI Z n w VH$ $n mZ o H$m{e V Ho$b o.
` m g d ` mn mV _ r _ m` m Ka ` m O ~ m~ Xm` mVyZ
A j a e : d oi Mmoa b m. ` md oi r _ m` mHw$Qw>~ r` mZ r {d Z mVH$ma
_ b m _ mob mMr _ XV Ho$b r. ` m{e d m` mW{_ H$ e w b oI Z mV
X Vr g wM{d ` mV Ka ` mg d mMmM h mV^ ma b mJ b m.
Hw$Qw>~ r` mn H$s b {b V Xm^ moi H$a , VZ wO m {e n ya H$a , S>m.
{M m Xm^ moi H$a , S>m. d mg wXod n a i rH$a ` mZ rh r g w d mVrMo
{b I mU d mMyZ ` mV H$mh r ~ Xb g wM{d b o, H$mh r _ h d m` m
g yMZ m Ho$ ` m. _ mP o n Vr ~ mb a moJ Vk S>m. e m_ ^ mog b o
` mZ rh r d oi mod oi r H$mh r A Z w $n g yMZ mHo$ ` m. ` m~ b ` m
g d m` mF $U mV a mh U oM _ r n g V H$a oZ .

A me A me A me A me r rr rd mX d mX d mX d mX

S>m. a d t ~ mn Q S>m. a d t ~ mn Q S>m. a d t ~ mn Q S>m. a d t ~ mn Q
> >> >

A mYw{Z H$ d H$m_ ` o J o ` m 5 0 d f m_ ` o H$mVrH$ma H$
J Vr P mb r A mh o. ` mMoM n wT>Mo n mD$b h U yZ {d {d Y
n oe {b Q>rO A m ` m. g mYma U 1 9 6 0 ` m C ma mYmV
~ mb e ` {M{H$g o_ ` o n a Xoe mV {e Hy$Z ^ ma Vr`
e ` {M{H$g H$ ^ ma VmV ` oD$ b mJ b o. _ w~ B` m e oR>
O r. Eg . _ oS>rH$b H$mb oO A m{U Ho$. B. E_ . U mb ` m_ ` o
~ mb e ` {M{H$g m {d ^ mJ 1 9 6 9 - 7 0 ` m g w_ ma mg
A p Vd mV A mb m.
b h mZ _ wb m_ ` oO _ VA g b ob r ` J od BVa A mO ma
` m` me {H$` m_ ` od A Z o Wo{e A me m m_ ` og w m~ a rM
J Vr h moV J ob r. e {H$` m mA {YH$ ` e d r d g wb ^ h mod y
b mJ ` m. ` mH$a Vm{d e of A ` mg H$_ V` ma H$a ` mV A mb m
d Vk V` ma h mod yb mJ b o.

g d g m_ m` mZ mb h mZ _ wb m` mA mO ma m~ b d ` mg mR>r
A md ` H$ e {H$` m~ b _ m{h Vr Z g Vo. n a Vw b h mZ
_ wb m_ ` o d a rV {Z XmZ d d a rV Cn Mma A m{U e {H$` m
P m ` mVa e ma ra rH$ ` J od BVa A mO ma ~ a oh moD$ e H$VmV h o
b j mV R>od b on m{h O o.
S>m. _ rZ mj r Z b ~ b o mh e ma {d m{WZ r. ` mXh md r d
~ ma md r` m n a rj oV a m` mV W_ A m ` m h mo` m. ` mZ r
A {Ve ` _ oh Z VrZ oA m{U {O XXrZ o~ mb e ` {M{H$g me m mMr
CM n Xd r {_ i {d b r A mh od _ moR> m U mb ` mV H$m_ Ho$b o
A mh o. ` mZ r m A mO ma mg ~ YrMr _ m{h Vr d ` md a rb
e {H$` mMr _ m{h Vr g mo` m e XmV ` m` m b oI Z mVyZ
_ mS>b r A mh o. A g o Cn H$_ A md ` H$ A mh oV. H$ma U
O Z g m_ m` mZ mh r _ m{h Vr H$ $Z KoU oA md ` H$ A mh o. ` mZ r
O a m n w VH$mMm b m^ KoVb m Va d a rV {Z XmZ h mo` mg
_ XV h moBb . _ mP r A e r Yma U m A mh o H$s d H$s`
` md g m{` H$mZ r A e m H$ma Mr n w VHo$ {b h Z g _ mO m_ ` o
A {YH$ O mJ H$Vm{Z _ mU H$a ` mMr J a O A mh o. _ mP r I m r
A mh oH$s g wO mU d mMH$ mn w VH$mMmb m^ KoVrb .
S>m. _ rZ mj r Z b ~ b o- ^ mog b o mZ m_ m` me w^ oN>m.

A {^ m` A {^ m` A {^ m` A {^ m`
"~ mi mMoA mO ma d e ` {M{H$g m' h oS>m. _ rZ mj r ^ mog b o
` mZ r A ` mg n yU {b {h b ob o ~ mb a moJ md a rb e ` {M{H$g m Mo
n w VH$. {d e of h U O oh on w VH$ g wJ _ d g w~ moY _ a mR>r ^ mf oV
A mh o.
` m n w VH$mV b o{I Ho$Z o Z d O mV ~ mb H$m` m g _ ` m d
` md a rb {Z a mH$a U - A mO Cn b Y A g b o ` m {d {d Y
e {H$` m_ YyZ H$e m~ ` mh moD$ e H$VmV, ` mMr _ m{h Vr {Xb r
A mh o. ` m_ wi oh on w VH$ g d d J mVrb n mb H$mZ mCn ` w V d
d mMZ r` A mh o.
H$ma U A mn b r d VMr _ wb o O a r "e a ra A m I b w
Y_ g mYZ _ ' ` mC Vr _ mU oA ma mo` n yU A g b r Va r, A mn U
A mn ` mg ^ mod Vmb r e oO ma r/ n mO ma r, d Z mVod mBH$mV Z d O mV
A ^ Ho$ d ` m` m {d {d Y B{` me r {Z J S>rV A e m J ^ ra
d n m` m g _ ` m n mh V A g Vmo. ~ mb H$mMo ` wa mob m{O H$b
mb og , {H$S>Z r` m {d H$Vr EoHy$Z ` mHw$i h moV A g Vmo.
A e md oi r O a A mYrM A g on w VH$ d mMZ mV A mb oA g ob Va
` m ~ mb H$m` m n mb H$mZ m A mn U m n w VH$m` m A mYma o
e {H$` mH$ $Z Ko` m~ b _ mJ Xe Z H$ $ e H$Vmo.
n yd u` m H$mi r Ka m_ ` o O g m "A mO r~ mBMm ~ Q>d m'
A g m` MmVg oM h o n w VH$, ` mZ m _ a mR>r ^ mf mA d J V A mh o
` m` mKa r A g U oA md ` H$ A mh o. ~ mb H$m` mO Z Z |{` me r

g ~ YrV {d H$ma md a Va d oi rM e {H$` m H$a U o {H$Vr
A md ` H$ A mh o h o S>m Q>a b o{I Ho$Z o g d A J mZ o CH$b yZ
XmI d b oA mh o.
BJ O r e XmMr d H$s` n [a ^ mf m A g b ob o J ^
{d k mZ md a rb h o_ a mR>r n w VH$ _ m` mg ma ` m H$b me mI o` m
_ {h b mZ mh r A J Xr g wJ _ n U og _ O Vo. ~ mb a moJ md a rb k mZ mV
Cn ` w V A e r ^ a Q>mH$Vo. qH$~ h Z mh og n yU n w VH$M _ mS>U r d
{d d oMZ m` m >rZ o Z o_ Ho$ d Z oQ>Ho$ P mb o A mh o. H$moR>oh r
{d f ` mMmn m h mi d mn g ma mZ mh r. A mO H$mb ` m"n m{P Q>r h
h o W' ` m O _ m` mV g _ mO mb m A ma mo` g n Z VoH$S>o Z oU ma m
h mXrn V^ M A mh o.
Vo h m _ m` m _ Vo Ka mKa mV J moHw$i Z mX` mg mR>r
""~ mi mMo A mO ma d e ` {M{H$g m' ' h o n w VH$ h U O o
H$ U $n M A mh o!
- -- - m. S>m. b b rV m. S>m. b b rV m. S>m. b b rV m. S>m. b b rV Mm X mXm^ mob H$a Mm X mXm^ mob H$a Mm X mXm^ mob H$a Mm X mXm^ mob H$a
S>m. _ rZ mj r e m_ ^ mog b o( ~ mb e ` {M{H$g mVk ) ` mZ r
_ a mR>rV {b h rb o ` m ""~ mi mMo A mO ma d e ` {M{H$g m' ' ` m
n w VH$mMm "d ` { $H$- ` md g m` rH$' d H$s` g od m H$a U m` m
d mb mC m_ Cn ` moJ h moBb . b h mZ h U O oM O _ O mV Vo1 5
d f mn ` V` m ~ mi mMo e {H$` m b mJ U ma o A mO ma d ` mMo
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{Xb r A mh o. ~ mi m` m A mO ma mMo b d H$a {Z XmZ P m ` mZ o,
` md a d oi rM Cn Mma H$a U o e ` h moBb . ^ {d ` mV A e r
~ mb Ho$ {Z a moJ r d g wT> h moVrb . O _ O mV ` J mMo b d H$a
{Z XmZ d {Z a mH$a U P m ` m_ wi o~ mb _ ` wMo _ mU ~ ` mn H$s
H$_ r h moBb . _ a mR>rV J m_ H$ d {M n mZ o _ m{h Vr
{X ` m_ wi o d H$s` g od m H$a U ma o S>m Q>a d g m_ m` U /
` mMo Z mVod mBH$ ` m Xmoh m|Z m ~ mb e ` {M{H$g me m ` m
{d f ` mMr _ m{h Vr g _ O Vo. S>m. _ rZ mj r e m_ ^ mog b o ` m` m
` Z mMoH$a md oVod T>oH$mVwH$ H$_ rM A mh o. g _ mO CZ Vrg mR>r
` m` mH$Sy>Z A g oM Z d Z d rZ Cn H$_ n ma n S>md oV A e r
n a _ oa Ma U r Z _ {d Z Vr H$a Vmo. ` m` m ` Z mb m A mh r
XmoKo S>m. g m. d mg Vr n m` J wS>o d S>m. g w {Z b n m` J wS>o ` m` m
e w^ oN>m.
S>m. g w{Z b n m` J wS>o S>m. g w{Z b n m` J wS>o S>m. g w{Z b n m` J wS>o S>m. g w{Z b n m` J wS>o
A ` j O Z a b p Q>e Z g A g mo{g Ee Z , n wU o.

n w VH$ H$me Z g _ ma ^ : n w VH$ H$me Z g _ ma ^ : n w VH$ H$me Z g _ ma ^ : n w VH$ H$me Z g _ ma ^ :
S>m. g w{Z b n m` J wS>o, S>m. e a X A J a I oS>H$a , n X_ ^ wf U
S>m. Ho$. EM. g MoVr, S>m. _ rZ mj r Z b ~ b o- ^ mog b o, S>m. _ m` m
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A Z wH$_ {U H$m A Z wH$_ {U H$m A Z wH$_ {U H$m A Z wH$_ {U H$m
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A moi I ~ mb e ` {M{H$g me m mMr . . .
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H$mh r g m_ m` e {H$` mMm b oI mO moJ m
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7 ) H$mh r Z oh _ r A mT>i U m` mn a Vy{H$a H$moi d $n m` m
g _ ` m
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A mYw{Z H$ ` wJ mVrb ~ mb e ` {M{H$g me m
1 ) b mo H$mo{n H$ g O a r
2 ) S>oHo$A a g O a r
3 ) Q>o_ g ob Woa n r

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A moi I ~ mb e ` {M{H$g me m mMr . . . A moi I ~ mb e ` {M{H$g me m mMr . . . A moi I ~ mb e ` {M{H$g me m mMr . . . A moi I ~ mb e ` {M{H$g me m mMr . . .
A tiny baby sweet and new can make the biggest
dreams come true ! I a M Ka mV g wT> ~ mi O _ mb m` oU o
` mn oj mXwg a m_ moR>mHw$R>b mA mZ X A g ye H$Vmo.
A mO H$mb Va \ $ V {Z a moJ r d g wT> ~ mb H$ A g md o
A e r A n oj m ~ mi J U ma r A Z oH$ O moS>n r A mh oV. h o d Z n wU
H$a ` mV ( ~ mi mMr d mT> d A ma mo` ` d p WV A mh o h o
XmI {d ` mV) J ^ me ` m` m g wVrn wd g moZ moJ m\ $sMm d ` mV
H$mh r Xmof A g ` mg ~ mi mMo A mn a oe Z H$ $Z Vmo Xya >
H$a U m` mn oS>r` mQ>rH$ g O Z Mm _ mob mMmd mQ>mA mh o.
~ mb e ` {M{H$g me m mMm CX` : ~ mb e ` {M{H$g me m mMm CX` : ~ mb e ` {M{H$g me m mMm CX` : ~ mb e ` {M{H$g me m mMm CX` :
d H$s` e m m` m J Vr~ a mo~ a d d mT>` mk mZ m~ a mo~ a
` oH$mb mA mn mn ` mj o mVrb BW^ wV _ mh rVr A g U oJ a O oM
d mQy> b mJ b . {e d m` Cn Mma m~ XXb d mT>` m A n oj m_ wi o
d H$s` j o mV {d {d Y {d e of mon Mma d A {V{d e of mon Mma
A p Vd mV A mb o. ` mVrb M EH$ h U O o
~ mb e ` {M{H$g me m qH$d mn o{S>` mQ>rH$ g O a r h mo` . 1 9 6 5
g mb m_ ` o ^ ma VmV n o{S>` mQ>rH$ g {O H$b A g mo{g Ee Z Mr
Wmn Z m P mb r O r B{S>` Z A g mo{g Ee Z A m\ $ n o{S>` mQ>rH$
g O g A WmV A m` . E. n r. Eg . ` m Z md mZ oA p Vd mV A mh o.

` mA mYrg wXm b h mZ _ wb md a e {H$` m H$a U ma o g O g
h moVo.

n l r S>m. A ma . Ho$. J mYr S>m. E_ . Eg . a m_ H$ U Z
CXmh a U mW- A mWa {S>g m, _ oO a Ba mU r, n l r S>m.
A ma . Ho$. J mYr, S>m. E_ . Eg . a m_ H$ U Z B` mXr. n a Vw
A mn U _ wb m` m ` J m` m {Z _ yb Z mH$S>o n yU b j md o A g o
` mVrb H$mh r {Z >md VmZ md mQ> ` mZ o( ` mV S>m. J mYr d S>m.
a m_ H$ U Z h o A J WmZ r h moVo) , ` mZ r BVa g h H$m` m` m
_ XVrZ o ~ a mM g Kf H$ Z ~ mb e ` {M{H$g me m ` m
{d f ` mb me ` {M{H$g me m mMr EH$ A {V{d e of mon Mma e mI m
h U yZ _ m` Vm{_ i d yZ {Xb r.
` mZ Va b h mZ _ wb m` m A ma mo` me r g ~ {YV {d {d Y
A mO ma m~ b , ` md a H$a m ` m b mJ U m` m {d {d Y
e [H$` m~ b , _ wb m_ Yrb O _ O mV {d H$Vt ` m
{Z _ yb Z m~ b ~ a rM H$mVr P mb r d {Xd g |{Xd g ` mV ^ a M
n S>V A mh o.

n o{S>` mQ>rH$ g O Z ~ XXb WmoS>og o n o{S>` mQ>rH$ g O Z ~ XXb WmoS>og o n o{S>` mQ>rH$ g O Z ~ XXb WmoS>og o n o{S>` mQ>rH$ g O Z ~ XXb WmoS>og o. . . . . . . . . . . .
n o{S>` mQ>rH$ g O Z A WmV b h mZ _ wb mMm g O Z h m EH$
g wn a n oe m{b Q>A g Vmo. E_ . Eg . O Z a b g O a r Z Va ` mZ o/
{VZ ob h mZ _ wb mMo {d H$ma d ` md a rb e [H$` mg ~ YmV 3
d f mMm I mg A ` mg H$_ n yU H$ $Z M.Ch. Pediatric
Surgery h r n Xd r g n mXZ Ho$b ob r A g Vo.
n o{S>` mQ>rH$ g O a rMr ` mVr : n o{S>` mQ>rH$ g O a rMr ` mVr : n o{S>` mQ>rH$ g O a rMr ` mVr : n o{S>` mQ>rH$ g O a rMr ` mVr :
A mVm n o{S>` mQ>rH$ g O Z H$a rV A g b o ` m H$m_ mMm WmoS>m
A mT>md mKoD$` mV.
1 ) 1 ) 1 ) 1 ) ` J / a MZ m_ H$ Xmof A g b o ` m~ mi mMoA mn a oe Z H$ $Z
` m ` J m_ wi o A mb ob o A n J d Xya H$a U o h o n o{S>` mQ>rH$
g O Z Mo _ w ` H$m_ A mh o. ` m{e d m` b h mZ _ wb m` m
A ma mo` me r {Z J S>rV ~ ` mMe m J mo Q>r_ ` o n o{S>` mQ>rH$ g O Z
_ h d mMr ^ w_ rH$mn ma n mS>VmV.
J ^ me ` mVrb ~ mi mV ` J A g ` mMr e H$m A g ` mg
g wVrVk / g moZ mob m{O Q> ^ md r n mb H$mZ m n o{S>` mQ>rH$
g O Z H$S>o a o\ $a H$a VmV. ` md oi r ~ mi mV Z H$s A Z m_ b r
A mh oH$m h o O mU yZ KoU o, A g ` mg {VMo d $n Vrd A Wd m
g m` H$e m H$ma MoA mh oh oVn mg U od ` mA Z wf J mZ o^ md r
n mb H$mMog _ wn Xoe Z H$a U oh r A mO H$mb n o{S>` mQ>rH$ g O Z Mr

_ moR>r O ~ m~ Xma r A g Vo. A mO ma ( ` J m) ~ XXb g mYma U
_ mh rVr, ` md a rb e {H$` oMr _ mh rVr, ` mVrb \ $m` Xo /
YmoHo$, g mYma U I M, g wVr H$Yr d Hw$R> ` m H$ma oH$a m` Mr
` md ` mg ma ` mA Z oH$ ~ m~ VrV n o{S>` mQ>rH$ g O Z _ mJ Xe Z
H$a VmV.
A g o O moI _ rMo ~ mi Vn U g d g mo` r A g b o ` m {R>H$mU r
Ho$ ` mZ o~ mi m` mO _ mZ Va Mr Ymd n i Q>mi yZ d a rV ` mo`
Cn Mma H$a U o e ` h moVo. ` mb mM Q>mg Q>mg Q>mg Q>mg \ \\ \ $a BZ ` wQ>oa mo $a BZ ` wQ>oa mo $a BZ ` wQ>oa mo $a BZ ` wQ>oa mo A g o
g ~ moYb oO mVo.
CXmh a U mW - H$O o{Z Q>b S>m` \ $_ {Q>H$ h {Z ` m_ ` o
( ~ mi m` m d mg n Q>b mg N>oX A g Vmo d A mVS>r N>mVrV
J o ` mZ o) ~ mi mb m O _ mZ Va d mg Ko` mg I yn A S>Wi m
` oVmo. ` mA mO ma mMo{Z XmZ b d H$a Z P m ` mg ~ mi O J ` mMr
e ` Vm Yyg a h moVo. H$YrH$Yr ~ mi mb m H${ _ d mg moN>d mg
XoD$Z ` md a A mn a oe Z H$a md ob mJ Vo. ` m_ wi oM ` md oi r ~ mi
g d A ` md V g mo` r A g b o ` m {R>H$mU r A g U o h U O o O U y
~ mi mb mO rd Z XmZ M {_ i m ` mg ma I oA mh o!
2 ) 2 ) 2 ) 2 ) O | h m~ mi mV ` J A mh oA e r e H$mA g Vo` md oi og
O _ mZ Va b J oM ~ mi mMr Vn mg U r H$ $Z ` m ` J m` m
{Z a mH$a U mg mR>r A mn a oe Z H$a ` mMr J a O A mh o H$m` Vo
R>a d Vm` oVo. ` m_ wi oEa d r O _ mZ Va {Z XmZ h moBn ` V d m` m

O mU ma md oi d mMVmod ~ mi m` m{O d mb mYmoH$mh mo` mA mYrM
Cn Mma g w $ h moVmV.
Q>>{HA mo- Bg mo\ o${O A b {\ $ ` wb mg ma ` mH${S>e Z _ ` o
( A Z Z {b H$m n yU ~ Z b ob r Z g Vo d Vr d mg Z {b Ho$b m
O moS>b ob r A g Vo) Va h o I wn M Cn ` w V R>a Vo. ` mV EH$Xm
~ mi mb mXyY n mO ` md a VoN>mVrV O mD$Z ` w_ mo{Z ` mh moVmod
~ mi mMr V` oV I mb md Vo. A mn a oe Z ` m` e p d Vo>d a h r ` mMm
{d n a rV n [a U m_ h moVmo. ~ mi n o{S>` mQ>rH$ g O Z ` m
XoI a oI rI mb r A g ` mg A mn a oe Z g mR>r g J ` mV MmJ b r
p WVr ( d A mn a oe Z Mr d oi g wXm) R>a d Vm` oVo.
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( Q>oS>) n wT>` m A mn a oe Z ` m A mYr ~ mi mMr Hw$R>b r
n wd V` ma r P mb r n m{h O o ` m J mo Q>rH$S>o ~ ma H$mBZ o b j md o
b mJ Vo.
CXmh a U mW CXmh a U mW CXmh a U mW CXmh a U mW- h M wJ {S>g rO d A Z moa o Q>b _ mb \ $m _ }e Z
( g S>mg mMr O mJ m Z g b o ` m) _ wb m_ ` o A mVS>` m` m
A V^ mJ mMr d N>Vm I wn _ h d mMr A mh o. ` md a M n wT>rb
A mn a oe Z Mo~ a oMg o` e A d b ~ yZ A g Vo.

4 ) 4 ) 4 ) 4 ) A mn a oe Z Z Va ~ mi m` mV` oVrMm ` d p WV A mb oI
R>od yZ ` mg mR>r A mn a oe Z Ho$b ob oA mh o Vo ` e d r P mb oA mh o
qH$d m Z mh r, ` mZ Va ~ mi mMr d mT> ` d p WV A mh o Z m,
A mn a oe Z _ ` o H$mh r J wVmJ wV A g ` mg Vo e moYyZ ` md a
Cn Mma H$a U oh rh r O ~ m~ Xma r n o{S>` mQ>rH$ g O Z n ma n mS>VmV.

5 ) 5 ) 5 ) 5 ) A mn a oe Z Mr J a O Z g ` mg ` m ~ mi md a A md ` H$
d {H$` Cn Mma H$ $Z ` m` m V` oVrMm A mb oI R>od b m
O mVmo.
A mZ wf {J H$ BVa O ~ m~ Xm` m: A mZ wf {J H$ BVa O ~ m~ Xm` m: A mZ wf {J H$ BVa O ~ m~ Xm` m: A mZ wf {J H$ BVa O ~ m~ Xm` m:
Z d O mV A ^ H$m` m d H$O o{Z Q>b A Z m_ b rO ` m
e {H$` m~ a mo~ a M g mYma U n U o1 5 d f }d ` mn ` V` m _ wb m V
( O _ V: Z m_ b A g b o ` m ) H$mh r g {O H$b mb o_
A g ` mg ` mMo {Z a mH$a U H$a U o d A mn a oe Z Z Va ` mMr
~ mb a moJ Vk m` m _ XVrZ o XoI ^ mb H$a U o h rh r n o{S>` mQ>rH$
g O Z Mr _ moR>rM O ~ m~ Xma r A mh o.
CXmh a U mW CXmh a U mW CXmh a U mW CXmh a U mW- -- - A n |{S>g m` Q>rg g mR>r e {H$` m, BQw>g g oe Z
( A mVS>r EH$_ oH$mV Kwg ` mZ o {Z _ mU h moU ma m A S>Wi m)
[a S> e Z , _ mZ oVrb J mR>rg mR>r / d oJ d oJ ` m Q>` w_ g g mR>r
e {H$` m, A n KmVmV O I _ r P mb o ` m _ wb md a ` mo` Vo
Cn Mma d e {H$` m, g H$_ g rO Z ( g wVm) B` mXr.
` m d ` mg ma ` m A Z oH$ O ~ m~ Xm` m n o{S>` mQ>rH$
g O Z b m n ma n mS>m ` m b mJ VmV d ` mg mR>r ` mZ o E_ . Eg .
O Z a b g O a rZ Va b h mZ ~ mi m` m e {H$` mg X^ mV n wU
Ho$b ob m I mg A ` mg H$_ H$m_ r ` oVmo. A e m A Z oH${d Y
O ~ m~ Xm` m n o{S>` mQ>rH$ g O Z n ma n mS>V A g ` mZ o ~ mi mMo

A mn a oe Z h o ` m` m _ mJ Xe Z mI mb rM H$a U o H|$ h mh r
g moB H$a d ~ mi m` m{h VmMoR>a Vo!
Cn Mma mVrb H$mVr : Cn Mma mVrb H$mVr : Cn Mma mVrb H$mVr : Cn Mma mVrb H$mVr :
J ^ me ` m_ ` o/ O _ mZ Va b J oMM P mb ob o a moJ {Z XmZ ,
d oi od a P mb ob o d {H$` Cn Mma d ` mo` Vr e {H$` m,
{VO {d H$m_ wi o P mb ob o B\ o$ e Z H$Q>mob , a V d {d {d Y
a VKQ>H$mMr Cn b YVVm d ^ wb r` m V mV P mb ob r
A m M` H$ma H$ J Vr, A n w` m d O Z m` m / {Xd g m` m
~ mi m` m g J mon Z mV P mb ob r H$mVr, Q>moQ>b n a oQ>a b
` wQ>re Z ( ` mV a Vd m{h ` mVyZ n mof U _ w ` o{Xb r O mVmV)
` m_ wi o A mn a oe Z Z Va / A mn a oe Z Xa ` mZ ` m _ wb mMr {d e of
H$mi O r KoVm ` oD$ b mJ b r A mh o d ` m_ wi oM _ ` w_ wI r
n S>U m` m _ wb mMo d {d e of V: Z d O mV A ^ H$mMo _ mU
n w H$i M H$_ r P mb oA mh o. J o ` m3 0 Vo3 5 d f mV A mn a oe Z A mn a oe Z A mn a oe Z A mn a oe Z
P mb o ` m/ b mJ U m` m P mb o ` m/ b mJ U m` m P mb o ` m/ b mJ U m` m P mb o ` m/ b mJ U m` m Z d O mV A ^ H$mMm _ ` yXa 6 0 6 0 6 0 6 0
Q> H$` md $Z Q> H$` md $Z Q> H$` md $Z Q> H$` md $Z 1 0 Q> ` mn ` V 1 0 Q> ` mn ` V 1 0 Q> ` mn ` V 1 0 Q> ` mn ` V I mb r A mb mA mh o.

CX>` mMo~ mb e ` {M{H$g me m : CX>` mMo~ mb e ` {M{H$g me m : CX>` mMo~ mb e ` {M{H$g me m : CX>` mMo~ mb e ` {M{H$g me m :
~ mb e ` {M{H$g me m m_ ` o A mVm \ $sQ>b g O a r,
BQ>m` wQ>oa mBZ BQ>a h oe Z b g O a r, Q>o_ g ob ( _ yi n oe r)

Woa n r h o H$ma h r CX>` mb m ` oV A mh oV. ` mV ~ mi A mB` m
n moQ>mV d mT>V A g VmZ mM ` m` md a e {H$` m Ho$b r O mVo.
_ m ` mj o mV A O yZ ~ a rM J Vr h m` Mr A mh o, O oU oH$ $Z h o
V k mZ g d g m_ m` m` mA md m ` mV ` oBb .

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e ee e
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n mQ>rb n Vrn Z r h o e h a mVrb {g XY
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A g b ob mYmoH$mQ>i b mh moVm. n a VwA mn ` mb mh r J moo >b d H$a
b j mV Z A m ` mZ o ~ mi mMo d f U H$mT>md o b mJ b o h r ~ moMU r
n mQ>rb Xmn ` mb mb mJ yZ a m{h b r Vr H$m` _ MrM !
Xwg a m EH$ {H$ g mh r A g mM n mb H$mZ m g w H$a U ma m
A mh o.
A Wd h m [Vg a rV {e H$U ma m A mBd {S>b mMm EHw$b Vm
EH _ wb J m. e mi oVrb h e ma {d mWu. _ m Vmo ~ g yZ b Kd r
H$a Vmo ` md Z ` mMo d J {_ ` mb m {MS>d m` b m b mJ ` mZ o
Vmo H$mh rg m A ~ mob d EH$b H$m|S>m P mb m h moVm. A ` mg mVh r
b j b mJ oZ m. e mi oVyZ VH$ma r ` oD$ b mJ ` m. A mVm _ m
A mBd S>rb mMoS>moi oI mS>H$Z CKS>b o. _ moR>oP m ` md a A mn a oe Z
H$ h U yZ Xwb {j b o ` m h m` n mo n oS>r` mg _ wi o A Wd ` m
A m` w ` mV H$mob mh b _ mO b mh moVm.

I a M b h mZ _ wb m` mO Z Z |{` me r g ~ {YV A mO ma h o
~ ` mM A e r KmVH$ d m O rd KoU o Z g b o Va r ` mH$S>o Ho$b ob o
Xwb j h oA j ` d XrKH$mb rZ n [a U m_ H$a U ma oA g ye H$Vo.
H$mh r g m_ m` g _ ` mMr CH$b H$a ` mMm ` Z ` m
b oI m ma oHo$b mA mh o.
1 ) 1 ) 1 ) 1 ) \ \\ \ $m` _ mo{g g $m` _ mo{g g $m` _ mo{g g $m` _ mo{g g
B{` m` m Q>moH$me r A g b o ` m Mm_ S>rMo _ wI ~ ma rH$
A g ` mZ oVr _ mJ oH$a VmZ ` oU oh U O o\ $m` _ mo{g g . ~ a oMXm
n mb H$ _ wb m` m {e Z _ wS>md a rb H$mVS>r ( Foreskin) _ mJ o
O mV Z mh r h U yZ A m_ ` mH$S>o ` oVmV. ` mV b j mV
Ko` mg ma I r ~ m~ h U O o ~ - ` mMe m _ wb m_ ` o\ $m` _ mo {g g
h o d ` mn a d o A g Vo A m{U I a oVa Z mO yH$ d g d oXZ mj _
{e Z _ wS>mMo ~ m KQ>H$mn mg yZ a j U H$a U o h o ` m Mm_ S>r` m
P S>n oMo H$m_ A g Vo. ` m_ wi o \ $ {e Z m` m Q>moH$md a rb
d Mm {d b J P mb ob r Z mh r h U yZ ( Xwg a m H$mh r mg
Z g ` mg ) n mb H$mZ r V h m` Mr J a O Z mh r. g mYma U V:
_ wb Mma Von mM d f mMoh moBn ` V h r d MmA mn moA mn _ mJ oh moD$
b mJ Vo. Ca b o ` m A J Xr WmoS> m _ wb m_ ` o ~ mH$s b j U
A g VmV d ` m` mV A mn a oe Z Z o\ $moa H$sZ g moS>d yZ X` md r
b mJ Vo. _ m A mn a oe Z H$a m` ` m A mYr _ wb mb m
h m` n mo n oS>r` mg ( _ y _ mJ I mb ` m ~ mO yb m CKS>U o) h r

A Z m_ b r Z mh r Z m ` mMr n yU I m r H$a md r. e H$m
A g ` mg Vk mMo_ mJ Xe Z ` md o.

Mm_ S>r` mP S>n oZ oP mH$b ob o {e Z _ wS
e {H$` mH$o h mJ a O oMr A mh e {H$` mH$o h mJ a O oMr A mh e {H$` mH$o h mJ a O oMr A mh e {H$` mH$o h mJ a O oMr A mh o:
Hw$WyZ e yH$a U o, \ w$J m` oU o
Wm~ yZ Wm~ yZ / W|~ W|~ b Kd r h moU o
b Kd rMr Yma ~ ma rH$ h moU o
d ma d ma b Kd rMoB\ o$ e Z h moU o
O Z Z |{` m` m n wT>` m Mm_ S>rVrb O Vwg g J
( ~ b Z mon m Wm` Q>rg ) B` m{X b j U oA mT>i ` mg

B b m_ d ` y Y_ mZ wg ma Va g wVm H$a U o h m EH$
Y_ {d YrM A mh o.
A mn a oe Z n yd u H$a md ` m` mMmM` m: A mn a oe Z n yd u H$a md ` m` mMmM` m: A mn a oe Z n yd u H$a md ` m` mMmM` m: A mn a oe Z n yd u H$a md ` m` mMmM` m:
a J moR>` m` m {H$` oV H$mh r Xmof Z mh r ` mMr
Vn mg U rX>d ma o I m r Ho$ ` md a h o A mn a oe Z Ho$b o O mVo,
O oU oH$ Z A mn a oe Z Xa ` mZ H$YrH$Yr A mT>i U ma m O m VrMm
a $ md Q>mi Vm` oVmo.
e {H$` oMo d n e {H$` oMo d n e {H$` oMo d n e {H$` oMo d n d dd d ` mZ Va ` mZ Va ` mZ Va ` mZ Va Mr H$mi O r Mr H$mi O r Mr H$mi O r Mr H$mi O r : :: :
A mn a oe Z ( g wVm g wVm g wVm g wVm) H$ $Z O m VrMr H$mVS>r H$mT>b r O mVo.
A mn a oe Z Z Va _ wb mb m{Xd g mVyZ 2 - 3 d oi mH$mo_ Q>n m` m` m
Q>~ _ ` o ~ g d ` mg I n ` m J i yZ n S>VmV. ` mZ Va \ $ $
_ D$ H$n S> mZ o d Mm H$moa S>r H$a md r. {d a Ki U ma o Q>mHo$
KmV ` mZ oVoH$mT>m` Mr J a O Z g Vo.
H$mh r g m_ m` e H$m: H$mh r g m_ m` e H$m: H$mh r g m_ m` e H$m: H$mh r g m_ m` e H$m:
1 ) Mm_ S>r n a V ` oBb H$m?
B{` m` m Q>moH$me r A g b ob r Mm_ S>r EH$Xm g wVm H$ $Z
H$mT> ` md a n a V d mT>V Z mh r. n a Vyn wU Mm_ S>r H$mT>md ` mMr
Z g ` mg \ $ $ b Kd rMo[N {Xg ` mBVn V H$mVS>r H$mT>b r
O mVo.

2 ) _ moR>on U r H$mh r mg h moBb H$m?
{e Z _ wS>mMr d Mm A ` V g d oXZ mj _ A g yZ
g m_ m` n U oVr b mb g a a J mMr A g Vo. g wVmHo$ ` md a _ m
Vr H$mi g a h moVo. n a VwBVa H$mh rh r mg h moV Z mh r.
2 ) 2 ) 2 ) 2 ) n a m n a m n a m n a m\ \\ \ $m` _ mog rg $m` _ mog rg $m` _ mog rg $m` _ mog rg
e y` m O mJ od a ` m H$mVS>rVb o^ moH$ b h mZ A g VmZ m
H$YrH$Yr \ $moa H$sZ O moa mV _ mJ oI oMb r O mVod ` mZ Va Vr
n wT>oA mU Vm` oV Z mh r, d mEH$Xm_ mJ oHo$b ob r Mm_ S>r n a V n wT>o
A mU ` mMo g moB H$a {a ` m {d g a ` mg ; {e Z _ wS>mMm
a V d mh ( A e w ) ~ X h moD$Z ` mb m g yO ` oVo. h o
{Xg m` b mh r I yn A m|J i d mU od mQ>Vo. I yn Ce ra P m ` mg e w
a $ d mh h r ~ X h moD$Z J J a rZ h mo` mMr e ` VmA g Vo.

g yO A m ` mZ o A m|J i d mU o {Xg U ma o {e Z

B_ O g r Q>rQ>_ |Q> : B_ O g r Q>rQ>_ |Q> : B_ O g r Q>rQ>_ |Q> : B_ O g r Q>rQ>_ |Q> :
` mV b d H$a mV b d H$a Wm{Z H$ ^ yb XoD$Z , h mVmZ o
{e Z _ wS>md a Xm~ XoV \ $moa p H$Z n wT>o KoVb r O mVo. Vo e `
Z g ` mg \ $moa p H$Z b m EH$ C^ m N>oX KoD$Z ( Dorsal
Meatotomy) Vr n wT>oA mU md r b mJ Vo.
A {V_ Cn Mma : A {V_ Cn Mma : A {V_ Cn Mma : A {V_ Cn Mma :
A e m Ho$g og _ ` o g yO n wU n U o A mog a ` md a h U O o
g mYma U : 2 - 3 A mR>>d S>` mZ Va g wVmHo$b mO mVmo.
3 ) 3 ) 3 ) 3 ) ~ b Z mon m Wm` Q>rg ~ b Z mon m Wm` Q>rg ~ b Z mon m Wm` Q>rg ~ b Z mon m Wm` Q>rg
O Z Z |{` m` m n wT>` m Mm_ S>r_ ` o O Vw g g J h moVmo.
\ $moa H$sZ d {e Z _ wS> ` m Xmoh m|Mmh r Xmh h moD$Z , Vo
EH$_ oH$mZ m{MH$Q>VmV. Mm_ S>rMo_ wI A mHw$MZ n md Vod b Kd r
H$a VmZ m mg h moVmo.

O Vwg g J m_ wi oA mb ob r g yO

e {H$` oMo d n / d oi : e {H$` oMo d n / d oi : e {H$` oMo d n / d oi : e {H$` oMo d n / d oi :
g yO d Xmh H$_ r P m ` md a h U O og mYma U V: 2 Vo3
A mR>d S> mZ Va g wVmH$a md mb mJ Vmo.
mg h moD$ Z ` o` mg mR>r. . . . . mg h moD$ Z ` o` mg mR>r. . . . . mg h moD$ Z ` o` mg mR>r. . . . . mg h moD$ Z ` o` mg mR>r. . . . .
h m mg h moD$ Z Xo` mg mR>r O Z Z |{` m` m d N>VoMr
H$mi O r KoU o A {Z d m` A mh o. {d e of V: A mKmoi r` m d oi r
O Z Z |{` m` mn wT>Mr Mm_ S>r ( {O VH$s _ mJ oO mBb {VVH$s )
_ mJ oH$ Z [e Z _ wS>md a rb n mT>a Q>Wa g m\ $ H$a md md Vmo^ mJ
H$moa S>mH$ Z Mm_ S>r n wd d V H$a md r.
4 ) 4 ) 4 ) 4 ) Bd m` Z b h {Z ` m Bd m` Z b h {Z ` m Bd m` Z b h {Z ` m Bd m` Z b h {Z ` m ( O mKoVrb A VJ i ( O mKoVrb A VJ i ( O mKoVrb A VJ i ( O mKoVrb A VJ i )
J ^ m` m d mT>r` m e od Q>` m Q>` m>V ( ~ mi m` m
n moQ>mVyZ ) d f U O mKoV ` m_ mJ mX>d ma o d a ` mA md a U mg {h V
A S>H$ome mV CVa VmV. Vr I mb r ` o` mMm_ mJ ~ X P mb mZ mh r
Va ` mVyZ A mVS>` mMmEI mXm^ mJ I mb r ` oVmo. ` mV _ moR` m
_ mU g mg ma I mM O mKoV \ $wJ d Q>m {Xg Vmo. A S>H$moe mVh r g yO
O mU d Vo. A mVS> mMm^ mJ d a I mb r h moV A g ` mZ o h {Z ` mMm
A mH$ma H$_ rO m V h moVmo. a S ` md a A mH$ma d mT>Vmo.
A mVS>` mZ mA moT> ~ g ` mZ o n moQ>mV XwI Vo. CO ` m CO ` m CO ` m CO ` m ~ mO yb m
h {Z ` m h mo` mMo _ mU Sm ` m > ~ mO yn oj m O m V O m V O m V O m V ( g mYma U V:
6 0 % BVHo) A g Vo. Va Xmoh r ~ mO wb mh {Z ` mh mo` mMo _ mU
1 0 % BVHo A g Vo.

A n w` m{Xd g m` m~ mi mVrb CO ` m~ mO yMmBd m` Z b h {Z ` m

mg H$moU mb mh moD e H$Vmo? mg H$moU mb mh moD e H$Vmo? mg H$moU mb mh moD e H$Vmo? mg H$moU mb mh moD e H$Vmo?
{d e of V: A n w` m{Xd g m` m_ wb m_ ` oh mA mO ma O m V
_ mU mV A mT>i Vmo. Vg oM H$mh r H$ma U mZ o n moQ>mVrb Xm~
d mT> ` mZ oh r h m A mO ma g ^ d Vmo. h U O o d a Mod a
g XuI moH$b mh moU ma r _ wb o, Hw$n mo{f V _ wb o, h r. n r. e Q>Mon oe Q ,
_ H$` wb a {S> Q>m\ $sMon oe Q>B` m{X.
~ h wVoH$d oi m e ma r[a H$ Vn mg U rX>d ma oM {Z XmZ H$a Vm
` oVo. d a rb b j U oA g ` mg {Z XmZ A {Ve ` g mon A mh o.
e {H$` oMo d n / d e {H$` oMo d n / d e {H$` oMo d n / d e {H$` oMo d n / d oi oioi oi : :: :
H$ma U h {Z ` md h m` S>mog rb ` mVrb \ $a H$ A moi I b m
J ob m n mh rO o. h {Z ` m A g ` mg b d H$a A mn a oe Z H$a ` mMr

J a O A g Vo. n a Vy h m` S>mog rb _ ` o ~ mi mb m A mn U
XoI a oI rI mb r R>od ye H$Vmo. {e d m` h oA mn a oe Z Vm{ H$ Q>` m
_ moR>` m _ mU g m_ Yrb h {Z ` m` m A mn a oe Z n oj m WmoS>o d oJ i o
A g yZ Von w H$i M H$me ` mZ oH$a md ob mJ Vo. ` mV h {Z ` mQ>m_ r h {Z ` mQ>m_ r h {Z ` mQ>m_ r h {Z ` mQ>m_ r
Ho$b r O mVoh U O oM A mVSr I mb r ` o` mMm_ mJ Q>mH$mKoD$Z
~ X Ho$b mO m>Vmo.
d oi oV A mn a oe Z Z P m ` mg . . . . . d oi oV A mn a oe Z Z P m ` mg . . . . . d oi oV A mn a oe Z Z P m ` mg . . . . . d oi oV A mn a oe Z Z P m ` mg . . . . .
b d H$a A mn a oe Z Z Ho$ ` mg h {Z ` mg H$_ ` oA mVS>r
A S>Hy$Z / A mVS>` mZ mn ri ~ g yZ VoI a m~ h mo` mMr e ` Vm
A g Vod ~ mi J ^ ra h mo` mMo _ mU d mT>Vo.
A d a mo{YV h {Z ` mMr b j U o A d a mo{YV h {Z ` mMr b j U o A d a mo{YV h {Z ` mMr b j U o A d a mo{YV h {Z ` mMr b j U o: :: :
h {Z ` mMmA mH$ma H$_ r Z h moU , n moQ>\ wJ U o, {n d ` m
Cb Q> m, e mMmg Z h moU oB` m{X
A d a mo{YV h {Z ` m A g ` mg ~ mi mb m d oXZ me m_ H
A mn YoXoD$Z A mVS>r n moQ>mV n a Vd ` mMm ` Z Ho$b mO mVmo.
Vr _ ` oJ o ` mg ( 4 8 Vmg mZ Va ) WmoS>r g yO A mog a ` md a
A mn a oe Z H$ $Z {S>\ o$ Q> ~ X H$a Vm ` oVmo. A ` Wm VmH$mi
_ oO a g O a r H$a md r b mJ Vo. ` md oi r ~ mi mb mA g U ma mYmoH$mh r
d mT>Vmo.

_ wb t _ Yb mh {Z ` m: _ wb t _ Yb mh {Z ` m: _ wb t _ Yb mh {Z ` m: _ wb t _ Yb mh {Z ` m:
_ wb t _ ` o h {Z ` m h mo` mMo _ mU _ wb m` m Vwb Z oV
n w H$i M H$_ r A g Vo. _ m ` mVrb 1 - 2 % _ wb t _ ` oqb J
A {Z p MVVm A g ` mMr e ` Vm A g ` mZ o A mn a oe Z n yd u
n moQ>mMr g moZ moJ m\ $s, ~ ma ~ mS>r h r Vn mg U r d H$Yr H$Yr
H$a rA moQ>mBn ( J wU g w ) ` mMmM` mh r H$a m ` m b mJ VmV.
5 ) 5 ) 5 ) 5 ) h m` S>>mog rb ( A S>H$moe O b d { ) h m` S>>mog rb ( A S>H$moe O b d { ) h m` S>>mog rb ( A S>H$moe O b d { ) h m` S>>mog rb ( A S>H$moe O b d { )
` mV h {Z ` m _ mU oM mog og g h O m` Z b rg h r
n moQ>mb m O moS>U ma r Z m{b H$m ~ X P mb ob r Z g Vo. n a Vy ` m
Z {b Ho$Mr $Xr H$_ r A g Vo. {Xd g m` m g w $d mVrb m
A S>H$moe mMm A mH$ma N>moQ>m A g Vmo, n a Vw {Xd g mA I oa rg
n moQ>mVrb n mU r O _ mP m ` mZ oVmon w H$i M d mT>Vmo.
Xwg ` m WmoS> m A g mYma U H$ma mV mog og g
h O m` Z b rg h r Z {b H$m _ Y ` m^ mJ mV ~ X P mb ob r A g Vo;
\ $ V {~ O mS>m` m^ mod Vr A g b o ` mn mVi Xwn Xa r A md a U mV
n mU r g mR>Vod A S>H$moe mV g yO O mU d Vo.

h m` S>>mog rb _ wi od mT>b ob mCO d mA S>H$moe

e {H$` oMo d n : e {H$` oMo d n : e {H$` oMo d n : e {H$` oMo d n :
h m` S>>mog rb g mR>r b mJ U ma o A mn a oe Z h o h {Z ` m
A mn a oe Z g ma I oM A mh o. ` m_ ` o O mKod a N>oX KoD$Z
CXa n moH$i rb mO moS>U ma r Z {b H$m~ X Ho$b r O mVo. _ m ` mV
h {Z ` mQ>m_ rI oa rO h m` S>mog rb g H$_ Yrb n mU r H$mTm>d ob mJ Vo.
` m_ wi o \ $ V h m` S>mog rb _ ` o g wBKmb yZ n mU r
H$mT>U o, ` mV BO o e Z XoU o, ~ mh o Z H$mh r A mf Yo b md U o
( ` mZ o Z mO yH$ d MoMm Xmh h moBb ) ` m J mo Q>r Q>mi ` m
n m{h O oV. Vg oM Vk mZ m Z XmI d ` mg A mn a oe Z MwH$s` m
n X>YVrZ o h mo` mMr e ` Vmd mT>Vod g mYmA mO ma ~ i md Vmo.
e {H$` mH| h mH$a md r? e {H$` mH| h mH$a md r? e {H$` mH| h mH$a md r? e {H$` mH| h mH$a md r?
~ - ` mMe m Ho$g og _ ` o h r CXa n moH$i rb m O moS>U ma r
Z {b H$m {Z g J V: ~ X h moV O mVo. _ wb 1 d f mMo
P m ` md a XoI rb g yO Ve rM a m[h ` mg e {H$` mHo$b r O mVo.
_ moR> m_ mU g mVrb h m` S>mog rb : _ moR> m_ mU g mVrb h m` S>mog rb : _ moR> m_ mU g mVrb h m` S>mog rb : _ moR> m_ mU g mVrb h m` S>mog rb :
h o` oWoh oVwV: Z _ yX H$ob ob oA mh o. ` mV \ $ $ ~ rO mS>m` m
^ mod Vr n mU r g mR>Vo d A S>H$moe md a N>oX KoD$Z ( b h mZ
_ wb m _ mU o O mKod a N>oX Z KoVm ) h m` S>>mog rb [a n oA a Ho$b o
O mVo. b h mZ _ wb m_ ` o A e m Vh oZ o e {H$` m h moU o n yU V:
MwH$sMoA mh o.

6 ) 6 ) 6 ) 6 ) A Z {S>g oS>oS>Q>o Q>rO A Z {S>g oS>oS>Q>o Q>rO A Z {S>g oS>oS>Q>o Q>rO A Z {S>g oS>oS>Q>o Q>rO : : : : ( I mb r Z CVa b ob od f U ) ( I mb r Z CVa b ob od f U ) ( I mb r Z CVa b ob od f U ) ( I mb r Z CVa b ob od f U )
d f U mMo Vmn _ mZ e a ra m` m Vmn _ mZ ` m 2 - 3 A e
g o[ g ` g I mb r R>od U o h o A S>H$moe mMo H$m_ A mh o. ` m_ wi o
~ rO mMVmn _ mZ {Z ` { V a mh yZ ~ rO {Z {_ Vr MmJ b r h moVo.
mg H$moU mb mh moVmo? mg H$moU mb mh moVmo? mg H$moU mb mh moVmo? mg H$moU mb mh moVmo?
h {Z ` m _ mU oM A n w` m {Xd g m` m _ wb m_ ` o O m V
_ mU mV A mT>i U ma mh mA mO ma A mh o.
d f U mMr J ^ me ` mVrb d mT d f U mMr J ^ me ` mVrb d mT d f U mMr J ^ me ` mVrb d mT d f U mMr J ^ me ` mVrb d mT>:
g w $d mVrb m d f U mMr d mT> ( J ^ me ` mV) ~ mi m` m
n moQ>mV h moV A g Vo. g mYma U V: J ^ ma n U m` m 7 ` m
_ {h ` mn mg yZ H$mof O mKoV ` m _ mJ mVy Z I mb r CVa m` b m
b mJ VmV d g mYma U n U o 9 ` m _ {h ` mn ` V Vo d a ` m
A md a U mg [h V A S>H$moe mV n yU n U o CVa b ob oA g VmV. ~ a oMXm
A n w` m {Xd g m` m _ wb m_ ` oo O _ mZ Va 3 _ {h ` mn ` V
A SH$mof n yU n U oI mb r CVa VmV.
A mZ wf [J H$ BVa mg : A mZ wf [J H$ BVa mg : A mZ wf [J H$ BVa mg : A mZ wf [J H$ BVa mg :
9 0 % Ho$g og _ ` o h {Z ` mh r A g Vmo d ` m_ wi o
A d a mo{YV h {Z ` mMm n mb o_ BWoh r ` od y e H$Vmo. ` md oi r
~ rO H$mof m` m a V d mh md a n [a U m_ h moD$Z Vo {Z H$m_ r

h mo` mMr e ` VmA g Vo. ` m_ wi o A d a mo{YV h {Z ` m A g ob
Va b d H$a mV b d H$a A mn a oe Z Ho$b oO mVo. Vg oM g mYma U V:
1 ` m d f mn mg yZ I mb r Z A mU b o ` md f U m_ ` on moQ>mVrb
C U Vo_ wi o h moU ma o Xw n [a U m_ O mU d VmV. d f U mg BO m d
Z Va ` mMmh mg g ^ d Vmo.
XrKH$mb rZ n a rU m_ XrKH$mb rZ n a rU m_ XrKH$mb rZ n a rU m_ XrKH$mb rZ n a rU m_ : :: :
b d H$a A mn a oe Z Z Ho$ ` mg d f U CXa d mO mKoVM
a mh VmV. ~ rO {Z {_ Vr Wm~ Vod n wZ n mXZ m` mH$m` j _ Vod a
A {Z > n [a U m_ h moVmo. Xmoh r ~ mO yb m h m Xmof A g U m` m
_ wb m_ ` o _ moR>on U r d ` d mMo n _ mU n w H$i M O m V
_ mU mV A mT>i yZ A mb o A mh o. {e d m` d f U mmm H H$a moJ
h mo` mMrh r e ` Vmd mT>Vo.
{Z XmZ : {Z XmZ : {Z XmZ : {Z XmZ :
~ h wVoH$d oi me ma r[a H$ Vn mg U rX>d ma oM {Z XmZ H$a Vm` oVo.
_ m ` m _ wb m_ ` o A g U m` m Xwg ` m A Z m_ b rO
O mU ` mg mR>r ( h U O o_ w qn S>mMoXmof , _ w _ mJ mVrb BVa Xmof
/ A S>Wi o B` m{X) n moQ>mMm g moZ moJ m\ $s Ho$b m O mVmo . O a r
g moZ moJ m\ $s d f U mMr p W{V XmI d yZ , A mn a oe Z g mR>rMm
d oe _ mJ R>a {d ` mg _ XV H$a V A g b oVa r h r I m rb m` H$
{Z XmZ n Vr Z mh r.

d H$s` e m mVrb J Vr_ wi o ( g y _ Cn H$a U o, g o\ $
A Z Woe r` m ) d ~ rO H$mof mV d ` mn a d o h moU m` m ~ Xb mMm
g I mob A ` mg P m ` m_ wi o A mO H$mb _ wb 6 _ {h ` mMo
h moBn ` VM d mQ>~ {KVb r O mVod ` mZ Va b d H$a mV b d H$a
e {H$` mH$ Z ~ rO H$mof I mb r A mU b mO mVmo.
h r e {H$` m T> n X>YVrZ o ( Bd m` Z b H$Z mb
CKSyZ ) A m{U b mo H$mon rH$ ` m XmoZ H$ma o Ho$b r O mVo.
~ rO H$mof I yn d a A g ob Va 2 Q>` m_ ` oh r g O a r H$a md r
b mJ Vo.
[a Q> Q>mBb Q>o Q>rO [a Q> Q>mBb Q>o Q>rO [a Q> Q>mBb Q>o Q>rO [a Q> Q>mBb Q>o Q>rO :
` mV d f U I mb r CVa b ob o A g VmV, n a Vw Vo
A S>H$moe mV Z a mh Vm d a I mb r h moVmV. ~ h wVoH d oi m ` mg mR>r
Hw$R> ` mh r e {H$` oMr J a O n S>V Z mh r.
7 ) 7 ) 7 ) 7 ) ~ rO mSmMmn ri ~ rO mSmMmn ri ~ rO mSmMmn ri ~ rO mSmMmn ri
h m I a Va J ^ ra H$ma M h Q>b m n m{h O o. ` m_ ` o
d f U m` m~ mh oa rb A md a U mMm^ mJ d V: ^ mod Vr {\ $a ` m_ wi o
d f U m` m a Vd mh r` mZ m n ri ~ g Vmo d a V d mh n yU n U o
~ X h mo` mMrh r e ` Vm A g Vo. h m {d H$ma EH$X_ b h mZ
_ wb mV ( Z d O mV ~ mb H$m_ ` o) d n mJ S>md WoV A mT>i Vmo.

mg H$Yr g ^ d Vmo? mg H$Yr g ^ d Vmo? mg H$Yr g ^ d Vmo? mg H$Yr g ^ d Vmo?
- d f U m` m ~ m A md a U mVrb d r` Z {b H m d
a Vd mh r` mMr
b m~ r O m V A g ` mg
- A n KmVmZ o ~ rO mS>mg BO mP m ` mg
b j U o: b j U o: b j U o: b j U o:
` m ~ mO yb m n ri A mh o{VH$S>Mr J moQ>r d a I oMb r O mVo,
_ wb m` mO mKoV g yO ` oVo, Vrd d oXZ mP m ` mZ o _ wb A MmZ H$
a S>m` b mb mJ V, n moQ>mVXo{I b XwI V.
~ a oMXm ~ rO mSmMmn ri A m{U A S>H$moe mMr ( + d f U mMr)
g yO d Xmh ` mVrb \ $a H$ A moi I U o A d KS> A g Vo. I a Va
~ rO mSmMm n ri A mh o H$s Z mh r h o Hw$R>b rh r Vn mg U r 1 0 0 %
I m rn yd H$ g mJ y e H$V Z mh r. ` m_ wi o b d H$a mV b d H$a
A mn a oe Z Q>o~ b d a a V d mh n mh U oh rM 1 0 0 % I m rb m` H$
{Z XmZ n X>YVr h Q>b r n mh rO o.

VmH$mi e {H$` oMr J a O . . . . . . VmH$mi e {H$` oMr J a O . . . . . . VmH$mi e {H$` oMr J a O . . . . . . VmH$mi e {H$` oMr J a O . . . . . .
g mYma U V: Xh md f mZ Va h m mg P m ` mg A Q>r n _
A Q>r~ S>rO >V` ma h moD$Z d Yd h r ` o` mMr e ` VmA g Vo.
` m_ wi oM ~ rO H$mof mMm n ri h r I a r n oS>r` mQ>rH$ g O uH$b
B_ O g r h Q>b r n mh rO o. ` mV U O a 6 Vo8 Vmg m` m
A mV S>m Q>a mH$S>o A mb m d ` m` md a VmH$mi e {H$` m
Ho$b r J ob r Va A mn U d f U H$mi oh mo` mn mg yZ d mMd ye H$Vmo.
n U h m H$mb md Yr {O VH$m O m V {VVH$ d f U d mMd ` mMo
` Z Ywg a h moVmV.

H$mi n Sb >ob d f U
A mn a oe Z Q>o~ b d a d f U mMm a $ d mh Vn mg yZ a $ d mh Vn mg yZ a $ d mh Vn mg yZ a $ d mh Vn mg yZ Vo
A S>H$mof mV {d {e Q>>> n VrZ on a V ~ g {d b oO mVmV O oU oH$ Z
n wh mA g m mg h moU ma Z mh r. d f U H$mi oP mb ob oA g ` mg
_ m VoH$mTyZ Q>mH$` m{e d m` Xwg a mn ` m` Ca V Z mh r.

8 ) 8 ) 8 ) 8 ) h m` n mo n oS>r` mg h m` n mo n oS>r` mg h m` n mo n oS>r` mg h m` n mo n oS>r` mg : : : :
` m_ ` o _ y Z {b H$m qb J m` m Q>moH$me r Z CKS>Vm
` m` m I mb ` m ~ mO yb m CKS>Vo A m{U ` mn wT>rb ^ mJ mV
_ y _ mJ mMm{d H$mg P mb ob mZ g Vmo. g mYma U V: 1 0 0 n H$s 3 33 3 - -- -
4 44 4 _ wb m_ ` oh mXmof A mT>i Vmo.

I mb ` m~ mO yb mCKS>U ma r _ y Z {b H$m

H$ma U o: H$ma U o: H$ma U o: H$ma U o:
J a moXa n U mV _ wb mV n w f g oa H mMo _ mU H$_ r
A g ` m_ wi o d m r g oa H$mMo n _ mU d mT> ` mZ o ( CXm.
A mB_ Yrb Q> y_ a , g VVr{Z ` _ Z m` mJ mo ` mMmCn ` moJ ) h m
A mO ma g ^ d ` mMr e ` VmA g Vo.

- b Kd r {Va n r / n m` md a n S>U o( n g a >U o)
- b Kd rMr Yma ~ ma rH$ A g U o
- {d d mh mn MmV ` m ` mYr_ wi oqb J mV d mH$S>on U m` oD$Z
` moZ rn d oe A d KS> h mo` mMr d d r` I : b Z
J ^ me ` _ wI mn mg wZ Xwa P m ` mZ o` m ma od ` d mMr e ` Vm
A g Vo.
e {H$` mHo$ h mJ a O oMr A mh o? e {H$` mHo$ h mJ a O oMr A mh o? e {H$` mHo$ h mJ a O oMr A mh o? e {H$` mHo$ h mJ a O oMr A mh o?
` mA mO ma mg mR>r g y _ Xmof / CU rd ( Minor Defects )
g moS>> ` mg A mn a oe Z H$ Z H$a o e Z H$a md o b mJ Vo. _ m
_ w _ mJ {O mH$m I mb r CKS>Vmo {VVH$r A mO ma mMr Vrd Vm
O m V d {VVHo$ A mn a oe Z {H$MH$Q> ~ Z Vo. H$mh rd oi m 2 - 3
Q>` m_ ` oh r A mn a oe Z H$a md ob mJ Vo.
A mZ wf [J H$ BVa mg : A mZ wf [J H$ BVa mg : A mZ wf [J H$ BVa mg : A mZ wf [J H$ BVa mg :
O o h m h m` n mo n oS>r` mg I oa rO d f U h r I mb r CVa b ob o
Z g VmV, ` md oi r _ wb m_ ` oqb J A {Z p MVVm( A J ` ) A mh o
H$m` ` mg mR>r Vn mg U r H$a md r b mJ Vo. ` mg mR>r H$a m ` m
b mJ U m` m A mn a oe Z _ ` o h m` n mo n o{S>` mg H$a o e Z I oa rO
O Z Z |{` mMr EHw$U M R>od U g wYma ` mg mR>r ~ a rM n wZ a MZ m
H$a md r b mJ Vo( Masculanising Genitoplasty)

e {H$` oMr d oi : e {H$` oMr d oi : e {H$` oMr d oi : e {H$` oMr d oi :
~ ` mMXm` m_ wb m V n w f g oa HmMo _ mU H$_ r A g yZ
EM. g r. O r. d m Q>o Q>mo Q>oa mZ Mo BO o e Z {X ` mg ` m` mV
qb J d X>Yr h moVod ` mZ Va e {H$` m Ho$ ` mg Vr ` e d r
h mo` mMr e ` Vmd mT>Vo. h oA mn a oe Z EH$ VoXrS>d f m` mn wT>o
Ho$b oO mVo. n a Vy _ wb 4 Vo5 d f mMoh mo` mA mYr A mn a oe Z ` m
g J ` m Q>oO og n yU P m ` mg _ moR>on U r _ wb m_ ` o
d V: ~ X>Xb / d V: ` mO Z Z o{` m~ X>Xb ` yZ J S {Z _ mU
h mo` mMoA mn U Q>mi ye H$Vmo. >
9 ) 9 ) 9 ) 9 ) b o~ r` b g m` {Z Ho$ b o~ r` b g m` {Z Ho$ b o~ r` b g m` {Z Ho$ b o~ r` b g m` {Z Ho$
_ wb t _ Yrb O Z Z |{` me r {Z J S>rV g _ ` mn H$s
g d m{YH$ A mT>i U ma r g _ ` mh mo` . ` mo{Z _ mJ mn wT>oEH$ n mVi
n S>XmV` ma P m ` mZ o` mo{Z _ mJ n yU n U oP mH$b mO mVmo. Xmoh r
b o{~ ` m _ m` Z moa m( b Kw^ J mo >) EH$_ oH$me r O wi >b ob oA g VmV.
~ a oMXm ~ mi mb m \ $ma mg Z g Vmo. _ m n mb H$M O m V
h d mb {Xb P mb ob o A g VmV. I a Va ` mo{Z _ mJ A mh o qH$d m
Z mh r ( A ~ g |Q> h O m` Z m ) A e r e H$m A m ` mZ o ~ mi mb m
S>m Q>a mH$S>oA mU b oO mVo.

EH$_ oH$mZ m{MH$Q>b ob o b o{~ ` m _ m` Z moa m
- -- - b Kd rb m O i O i h moU o,
- I mO ` oU o,
- W|~ W|~ b Kd r h moU o,
- b Kd rMoB\ o$H$e Z h moU oB` m{X.
O Z Z |{` m` m d NVoMr H$mi O r Z KoV ` mg h m
mg d ma d ma h moD$ e H$Vmo.
Cn Mma : Cn Mma : Cn Mma : Cn Mma :
b Kd rMmO Vyg g J A g ` mg W_ ` mg mR>r Cn Mma
Ho$b oO mVmV. ` mZ Va h mn mVi n S>XmA mn a oe Z Z o g moS>d Vm
` oVmo. A mn a oe Z Z Va h m^ mJ d N>d H$moa S>mR>od U o_ h d mMo
A mh o. ` mZ Va B Q>moO Z / Q>ra mBS>` w $ _ b _ b md ` mZ o
b o{~ ` m _ m` Z moa m n a V O wi yZ ` oV Z mh rV. _ m ` mg mR>r

XrK H$mb md Yrg mR>r Cn Mma H$a U o J a O oMo A g Vo.
n mb H$mZ rh r h o ^ mJ n a V O wi yZ ` oU ma Z mh rV ( {d b J
a mh Vrb ) ` mg mR>r Xj VmKoVb r n m{h O o.

N>mVre r g ~ YrV mb og N>mVre r g ~ YrV mb og N>mVre r g ~ YrV mb og N>mVre r g ~ YrV mb og
_ {Wb rMr H${\ $` VM {Z a mi r ! {V` m ~ mi mb m H
O oZ oQ>b S>m` \ $_ Q>rH$ h {Z ` mA g ` mMo{Z XmZ J ^ md WoVM
P mb h moV. {Vb mA m{U {Z {I b b mg w $d mVrb mVon Md m` b m
O S> J ob I a . n a Vy b J oMM Vo g md a b o. g wk n U mZ o ` mZ r
~ mi m` m ( O _ mZ Va h moU m` m) A mn a oe Z g mR>r _ mZ {g H$ d
A m{WH$ V` ma r g w $ Ho$b r. _ XVrg mR>r A md ` H$ _ Z w ` ~ i h r
C^ Ho$b . {S>{b h a rh r g d g mo` r A g b o ` m A ` mYw{Z H$
h m n rQ>b _ ` o P mb r. Xwg ` m {Xd e r ~ mi mMo Vk mH$Sy>Z
A mn a oe Z P mb o. ~ mi mZ oh r A mn a oe Z b m d EHy$U M Q>rQ>_ |Q>b m
CV_ {Vg mX {Xb m. WmoS>` m{Xd g mVM _ {Wb r g wI $n n U o
~ mi mg h Ka r J ob r. ~ mi mb m d oi od a ` mo` Vr Q>rQ>_ |Q>
{_ i m ` mZ o` mMmO rd d mMb mh moVm.
{V` m~ a mo~ a M A S>_ rQ> P mb ob r A {XVr _ m BVH$s
^ m` d mZ Z h Vr. {V` m ~ mi md a Q>H$sA mo - Bg m\ o${O A b
{\ $ ` yb mg mR>r e {H$` mP mb r I a r, n U ~ mi mb mA p n a oe Z
` w_ mo{Z ` m P m ` mZ o d X` Xmof A g ` mZ o S>m Q>a ` mb m
d mMd ye H$b oZ mh rV.
N>mVre r g ~ YrV {d {d Y g _ ` mMr CH$b n wT>rb
b oI m ma oHo$b r A mh o.

1 ) 1 ) 1 ) 1 ) Q>H$sA mo Q>H$sA mo Q>H$sA mo Q>H$sA mo- -- - Bg m Bg m Bg m Bg m\ \\ \ o${O A b { o${O A b { o${O A b { o${O A b {\ \\ \ $ ` yb m $ ` yb m $ ` yb m $ ` yb m
d mg Z {b H$m d A Z {b H$m EH$_ oH$mZ m O moS>b o ` m
A g ` mZ o A Z {b Ho$Vrb md d mg Z {b Ho$V \ w$\ \ wg mV
O mD$Z ~ mi mb m` y_ mo{Z ` mh moVmo( Aspiration Pneumonia) .
h m A mO ma J ^ m` m d mT>r` m 1 9 Vo 3 3 ` m {Xd g mV
O S>U KS>U rV Xmof {Z _ mU P m ` m_ wi oh moVmo. 8 5 % Ho$g og _ ` o
A Z {b Ho$Mm I mb Mm, O R>a mH$S>rb ^ mJ ( b moA a n mD$M)
d mg Z {b Ho$e r O moS>b ob mA g Vmod d a Mm^ mJ ( A n a n mD$M)
A YmVa r A g Vmo.
A mZ wf [J H$ BVa Xmof : A mZ wf [J H$ BVa Xmof : A mZ wf [J H$ BVa Xmof : A mZ wf [J H$ BVa Xmof :
h m A mO ma A g b o ` m ~ mi m_ ` o X` m` m {d H$ma mMo
_ mU O m V A g Vo. {e d m` ` md oi r n J V h moU m` mXwg ` m
A d ` d n U mb rMoh r A mO ma ` m _ wb m_ ` o A mT>i VmV.
CXmh a U mW CXmh a U mW CXmh a U mW CXmh a U mW- -- - g S>mg mMr O mJ m Z g U o, _ w qn S>, _ U Ho$ d
h mVmn m` m` m h mS>mVrb Xmof B` m{X.
1 ) VmoS>md mQ>o^ a n ya b mi / \ o$g ` oU o
2 ) XwY {n VmZ m~ mi H$mi o{Z i on S>U o
3 ) b h mZ ~ mi mV ` y_ mo{Z ` mh moU o

J a moXa n U mV J ^ O b mMo _ mU O m V A g ` mg
~ mi m` m O _ mZ Va ~ mb a moJ Vk _ moR>r Q>` y~ ( H$WoQ>a )
V>moSmd mQ>o Q>mHy$Z Vr n moQ>mV ` d p WV O mVo` H$s Z mh r h o
~ KVmV. O mV Z g ` mg Vr Q>` y~ Ve rM R>od yZ ~ mi mMo
E g >a oO KoVb oO mVmV. Va rh r e H$mA g ob Va {d {e Q> md U
( S>m` ) Q>mHy$Z {Z XmZ mMr I m r Ho$b r O mVo.

~ X A g b o ` m A n a n mD$MMmE g >- a oH$WoQ>a g {h V
VmH$m{b H$ Cn Mma : VmH$m{b H$ Cn Mma : VmH$m{b H$ Cn Mma : VmH$m{b H$ Cn Mma :
1 ) Vm|S>md mQ>o ` oU ma o md N>mVrV O mU ma Z mh rV ` mMr
H$mi O r
KoU o.
- {Z ` {_ V g e Z

- ~ mi mMr ` mo` p WVr : ~ mi mb mCn S>o H$ Z
P mon d U o
2 ) d m\ $ma m, N>mVrMo{d {e Q> ` m` m_ H$ma d {VO {d HmZ r
` y_ mo{Z ` mMr Q>rQ>_ |Q>H$a U o.
A {V_ Cn Mma : A {V_ Cn Mma : A {V_ Cn Mma : A {V_ Cn Mma :
A {V_ Q>rQ>_ |Q> _ m A mn a oe Z h rM A mh o. ` mV ~ mi WmoS>o
p Wa Wmd a P m ` md a A mn a oe Z g mR>r KoVb oO mVo. g O a r h r
g y m_ oO a ` m H$ma mV _ moS>Vo. ~ ` mMd oi m N>mVr CKS> ` md a
A mVrb n [a [ WVr n mh yZ M {Z U ` KoVm` oVmo. d mg Z {b Ho$e r
A g b ob mO moS>d oJ i m H$ $Z A Z {b Ho$MoXmoh r ^ mJ ( A n a
/ b moA a n mD$Mog ) , O d i A mU b o O mVmV d VU md a {h V
n XVrZ oEH$_ oH$mZ mmmoS>b oO mVmV.
A mn a oe Z Z Va h r {VO {d Ho$, d m\ $ma m d {\ $O rA moWoa n r
{VVH$sM _ h d mMr A mh oV. A mn a oe Z ` md oi r Q>m ` md a VmU
` oV A g ` mg d mn mD$Mog ` ma $ d mh mMr I m r Z g ` mg
H$YrH$Yr O d i ` m {Q> ` wM A md a U h r KmVb O mV. h d m,
a V, md B` m{X A mV g mRy>Z a mh y> Z ` oV d \ w$\ w$g mM
g a U Z rQ> h md h U yZ S>oZ ooO Q>` w~ R>od b r O mVo.
~ mi mMr N>mVr I a m~ A g ` mg d m A Z {b Ho$` m
n mD$Mog ` m a $ d mh mMr I m r Z g ` mg ~ mi mb m

h |{Q>b oQ>a d a ( H { _ d mg moN>d mg m` m _ {e Z d a ) R>o d m` Mr
J a O ^ mg Vo.
A mn a oe Z Z Va Mr H$mi O r : A mn a oe Z Z Va Mr H$mi O r : A mn a oe Z Z Va Mr H$mi O r : A mn a oe Z Z Va Mr H$mi O r :
EH$XmA Z {b Ho$d a MoQ>mHo$ ` d p WV A mh oV ` mMr I m r
P m ` md a M ~ mi mb m Vm|S>mZ >o XwY n mO Vm ` oVo. ` mg mR>r
A mn a oe Z Z Va 5 Vo 1 0 {Xd g mMm H$mb md Yr O mVmo.
g w d mVrb mZ mH$mVrb Z i rVwZ XyY {Xb oO mVo( Q>o Q>\ $sS>g ) .
XrKH$mb rZ g _ ` m: XrKH$mb rZ g _ ` m: XrKH$mb rZ g _ ` m: XrKH$mb rZ g _ ` m:
1 ) Q>H$sA mo - Bg m\ o${O A b {\ $ ` yb m A g b o ` m _ wb m_ ` o
d mg Z {b H$mh r H$_ O moa A g Vo d Vr Z a mo ( Collapse)
h mo` mMr e ` VmA g Vo.
2 ) ~ ` mMe m _ wb m_ ` o I moH$ ` md a ^ w H$` mg ma I m A md mO
` oVmo( Barking Cough ) . n U H$mb mVa mZ oVmoA mn moA mn H$_ r
h moV O mVmo.
3 ) A mb {n mmMm mg - 3 0 Vo6 0 % _ wb m_ ` oO R>a mMm^ mJ
d a A moT>b mJ o ` m_ wi od ~ Z md QrVrb Xmof m_ wi oA mb {n VmMm
mg h moVmo.
4 ) Q>mHo$ _ ma b o ` mO mJ r A Z Z {b H$mA e V: ~ ma rH$ P m ` mZ o
~ mi mb mS>m` b oQ>oe Z Mrh r J a O ^ mg Vo

` e mMo _ mU . . . . ` e mMo _ mU . . . . ` e mMo _ mU . . . . ` e mMo _ mU . . . .
P Q>n Q> {Z XmZ , g n yU Cn Mma n XVrM {Z ` moO Z d
A mn a oe Z Z Va Mr ` mo` H$mi O r ` m_ wi oh r e {H$` m` e d r
h mo` mMo _ mU 6 0 V 6 0 V 6 0 V 6 0 Vo8 0 % o8 0 % o8 0 % o8 0 % BVn V d mT>b oA mh o.
A Z m_ b rMmXy{_ i H$ma : A Z m_ b rMmXy{_ i H$ma : A Z m_ b rMmXy{_ i H$ma : A Z m_ b rMmXy{_ i H$ma :
Xmoh r n mD$Mog _ Yrb A Va I yn O m V A g ` mg
n {h ` m A mn a oe Z ` md oi r \ $ $ Q>mo_ mO Ho$ ` m O mVmV.
~ mi mb m J Q>m Q>m_ r ma o \ $rS> Ho$b O mV d H$mb mVa mZ o
A Z {b Ho$Mo ^ mJ EH$_ oH$mZ m O moS>b o O mVmV. h r e {H$` m
\ $ma {H$MH$Q> A g yZ ` mMm g g og a oQ>h r H$_ r A mh o. n a Vw
g wXd mZ oh m H$ma ${MVM A mT>i Vmo.
2 ) 2 ) 2 ) 2 ) HO oZ oQ>b S>m` HO oZ oQ>b S>m` HO oZ oQ>b S>m` HO oZ oQ>b S>m` \ \\ \ $_ Q>rH$ h {Z ` m $_ Q>rH$ h {Z ` m $_ Q>rH$ h {Z ` m $_ Q>rH$ h {Z ` m
Z d O mV ~ mb H$m_ ` o d mg n Q>b ( S>m` \ $_ ) h m
d g Z mMo H$m_ H$a U ma m _ w ` Z m` y A g Vmo. Vg oVa g d
d ` moJ Q>m_ ` on moQ>d N>mVrVrb A d ` d d oJ i oR>od ` mMoH$m_
h m n S>Xm H$a Vmo. {e d m` I moH$U o, Cb Q>r H$a U o,
_ b _ w {d g O Z , ~ mi mMmO _ A m{X {H$` m_ ` on moQ>mVrb /
N>mVrVrb oe a H$_ rO m V H$a ` mMoH$m_ h mn S>XmH$a Vmo.
H$YrH$Yr h m n S>Xm n yU Z ~ Z ` mg ( ` m` m
S>md rH$S>rb _ mJ ` m ^ mJ mV N>oX A g Vmo) ` mVyZ O R>a ,

b h mZ / _ moR>r A mVS>r, ` H$V , b rh m, _ w qn S> h o A d ` d
N>mVrV A moT>b oO mVmV.
` m _ wb m_ ` o \ w$ \ w$g h r n yU j _ VoMr ~ Z b oob r Z g VmV
( Pulmonary Hypoplasia) . ` m_ wi od d a A moT>b ob r A mVS>r
\ w$J ` m_ wi o N>mVrVrb X~ md d mT>Vmo d _ wb m` m d mg md a
Xw n {a U m_ h moVmo.
1 ) Ymn b mJ U o
2 ) d mg moN>d mg O b X J VrZ oh moU o
3 ) {Z b mJ md Wm
4 ) XyY Z {n U o/ n MZ o

N>mVrV A moT>b r J ob ob r A mVS>r
B_ O g r Q>rQ>_ |Q>: B_ O g r Q>rQ>_ |Q>: B_ O g r Q>rQ>_ |Q>: B_ O g r Q>rQ>_ |Q>:
` m_ ` o ~ mi m` m O R>a mV Z i r Q>mHy$Z O R>a mMo d
A mVS> mMo A mH$ma _ mZ H$_ r H$a ` mMm ` Z Ho$b mO mVmo.

~ mi mb mA mn a e oZ ` mA mYrh r d g Z ` md a R>od ` mMr J a O
n S>ye H Vo.
e {H$` oMo e {H$` oMo e {H$` oMo e {H$` oMo d n d n d n d n : :: :
~ mi mMr V` oV WmoS>r p Wa P m ` md a N>mVrV
A S>H$b ob oA d ` d h i yh i yn moQ>mV n a Vd b oO mVmV d n S>mb m
A g b ob mN>oX {e d b mO mVmo. A mn a oe Z n moQ>md a / N>mVrd a N>oX
( Incision) KoD$Z H$a Vm ` oVo. A mn a oe Z Z Va h r \ w$\ w$g m` m
n [a n d Vod a [a H$ h a r A d b ~ yZ A g Vo.
_ moR> m _ moR> m _ moR> m _ moR> m _ wb m_ Yrb _ wb m_ Yrb _ wb m_ Yrb _ wb m_ Yrb b j U o: b j U o: b j U o: b j U o:
WmoS> m_ moR> m_ wb m_ ` o
1 ) d ma d ma g XuI moH$b mh moU o
2 ) d O Z Z d mT>U o
` m_ wi o _ wb mb mS>m Q>a mH$S>oA mU b O mV. A mn a oe Z
d a rb _ mU oM Ho$b oO mVo.

3 ) 3 ) 3 ) 3 ) E n mB_ m( N>mVrVrb n y) E n mB_ m( N>mVrVrb n y) E n mB_ m( N>mVrVrb n y) E n mB_ m( N>mVrVrb n y)
{O d mU y~ mYo` m ` y_ mo{Z ` md a ` mo` Cn Mma Z
P m ` mg , ~ a oMXm \ w$\ w$g md a U m_ ` o md O _ m h moVmo.
H$mb mVa mZ o, O Vyg g J A mQ>mo ` mV Z A m ` mg ` mMm n y
~ Z Vmo. ` mI oa rO \ w$ \ w$g m` m d a Mo A md a U O mS> d H$R>rU
~ Z Vod d mg moN>d mg mV A S>Wi m` oVmo.

N>mVrV O _ mP mb ob mn y
1 >>) Ymn b mJ U o,
2 ) d mg H$ Q>Vm
3 ) Vmn ` oU o,
4 ) I moH$b mh moU o
5 ) N>mVrV XwI U o B` m{X mg Mmb ya mh VmV.

H$YrH$Yr h o N>mVr` mQ>r~ r N>mVr` mQ>r~ r N>mVr` mQ>r~ r N>mVr` mQ>r~ rMob j U A g ye H$Vo.
VmVS>rMo Cn Mma : VmVS>rMo Cn Mma : VmVS>rMo Cn Mma : VmVS>rMo Cn Mma :
g w d mVr` m Q>oO og _ ` o_ ` o\ $ V N>moQ>r Z i r Kmb yZ
N>mVrVb mn y H$mT>Vm` oVmo. ` mM~ a mo~ a ` mo` Vr {VO {d H$o,
` mo` _ m oV {X ` mg d _ wb m` m A mh ma mMr ` d { WV
H$mi O r KoV ` mg A mO ma A mQ>mo ` mV ` oVmo.
e {H$` oMr e {H$` oMr e {H$` oMr e {H$` oMr J a O / d n : J a O / d n : J a O / d n : J a O / d n :
_ m H$mh rd oi m _ wb mb m Ce ra m h m n rQ>b _ ` o A mU b o
O mVod ` md oi ob m A mO ma ~ a mM ~ i md b ob mA g Vmo. ` m_ w i o
_ moR>r e {H$` m H$ $Z N>mVrVb m n y d O mS> P mb ob r \ w$\
wg mMr A md a U ( Pleura) H$mT>md r b mJ VmV. ` mZ Va
\ w$\ w$g mMoH$m` n yd d V h m` b m~ a mM H$mb md Yr b mJ Vmo.
` mXa ` mZ d m\ $ma m, n mp Q>H$ A Z KQ>H$ d d g Z mMo
` m` m_ ` mMmXoI rb _ wb mMr H$Vr g wYma ` mV _ h d mMm
d mQ>mA g Vmo.

n MZ g Woe r {Z J S>rV Xmof n MZ g Woe r {Z J S>rV Xmof n MZ g Woe r {Z J S>rV Xmof n MZ g Woe r {Z J S>rV Xmof
{Z VmM Mma {Xd g mM ~ mi g ma ` m Cb Q>` m H$a V
h moV. XyYXoI rb n MV Z h V. ~ mi mb m _ mb ~ md ob A Q>o{O ` m
A g ` mM S>m Q>a mM {Z XmZ h moVd ` mg mR>r e {H$` mh mM
~ mi O J ` mMmEH$_ od Cn m` h moVm.
_ m Ed T>` mb h mZ ~ mi mMr e {H$` mh U O oI yn M
O moI r_ ( O d i O d i ~ mi J _ md U ) A g g _ rH$a U S>mo ` mV
A g ` mZ o {V` m Ka Mr _ mU g e {H$` og mR>r V` ma h moV
Z h Vr. I a Va A mn a oe Z _ YyZ [a H$ h a h moU ma r BVa ~ mi h r
XmI d yZ P mb r h moVr. A moi I r` m A mU I r EH$m g O Z e rh r
` mZ r g b m_ g b V Ho$b r h moVr. n a Vy H$mh r Ho$ ` m ` mMo
e H$m{Z a g Z h moV Z h Vo.
` m h moU m` m {d b ~ m_ wi o ~ mi mb m A g b ob m YmoH$m
I a moI a M d mT>V h moVm. e od Q>r {Z Vm d {Z I rb b m WmoS>
{Z j yZ M g m{J Vb H$s EH$XmMmH$m` Vmo{Z U ` ` mZ mh rVa
~ mi mb mKa r KoD$Z O m. XmoKoh r _ J Ka ` m` m _ Z m{d $ M
A mn a oe Z g mR>r V` ma P mb o.
g wXd mZ o A mn a oe Z ` e d rn U o n ma n S>b o. H$mh rh r
J wVmJ wV Z h moVmg h m ` m{Xd e r ~ mi mb mQ>o Q>- \ $sS>g g w $
H$a Vm A mb o. A mn U ` mo` Vmo {Z U ` KoD$Z ~ mi mMm O rd
d mMd b mh U yZ XmoKA mZ XmV h moVr. Ka ` mZ mh r ` mMr MyH$
C_ J b r h moVr.

O R>a m` m I mb ` m ( A Ymo) ^ mJ mVb m A S>Wi m d O R>a m` m I mb ` m ( A Ymo) ^ mJ mVb m A S>Wi m d O R>a m` m I mb ` m ( A Ymo) ^ mJ mVb m A S>Wi m d O R>a m` m I mb ` m ( A Ymo) ^ mJ mVb m A S>Wi m d
b h mZ A b h mZ A b h mZ A b h mZ A mVS>` mVrb b mH$ mVS>` mVrb b mH$ mVS>` mVrb b mH$ mVS>` mVrb b mH$ ` m Z d O mV ~ mi mMo A mn a oe Z
H$a m ` m b mJ U m` mVe m g m_ m` g _ ` m. . . . n a Vy ~ ` mMd oi m ~ ` mMd oi m ~ ` mMd oi m ~ ` mMd oi m
J a g _ O yVr_ wi o ~ mi d oi od a Q>rQ>_ oQ> {_ i ` mn mg yZ d {MV J a g _ O yVr_ wi o ~ mi d oi od a Q>rQ>_ oQ> {_ i ` mn mg yZ d {MV J a g _ O yVr_ wi o ~ mi d oi od a Q>rQ>_ oQ> {_ i ` mn mg yZ d {MV J a g _ O yVr_ wi o ~ mi d oi od a Q>rQ>_ oQ> {_ i ` mn mg yZ d {MV
a mh Vo a mh Vo a mh Vo a mh Vo d ` m_ wi o A mn a oe Z Xa ` mZ ( ^ yb r_ wi o) d
A mn a oe Z Z Va e a ra {H$` me m mVrb ~ Xb m_ wi o ~ mi e a ra {H$` me m mVrb ~ Xb m_ wi o ~ mi e a ra {H$` me m mVrb ~ Xb m_ wi o ~ mi e a ra {H$` me m mVrb ~ Xb m_ wi o ~ mi
XJ md ` mMr e ` Vm XJ md ` mMr e ` Vm XJ md ` mMr e ` Vm XJ md ` mMr e ` Vm A {YH$M d mT>Vo. A {YH$M d mT>Vo. A {YH$M d mT>Vo. A {YH$M d mT>Vo. ` m Xw Q>MH$mVyZ
g moS>d U yH$ h mo` mg mR>r ` m mb og Mr A J moXa M _ mh rVr H$ $Z
KoD$` m.

1 ) 1 ) 1 ) 1 ) B B B B\ \\ \ $Q>mBb h m` n a Q>m{ $Q>mBb h m` n a Q>m{ $Q>mBb h m` n a Q>m{ $Q>mBb h m` n a Q>m{\ \\ \ $H$ n m` b moa rH$ Q>oZ m{g g $H$ n m` b moa rH$ Q>oZ m{g g $H$ n m` b moa rH$ Q>oZ m{g g $H$ n m` b moa rH$ Q>oZ m{g g
( (( ( A m` . EM. n r. Eg A m` . EM. n r. Eg A m` . EM. n r. Eg A m` . EM. n r. Eg . ) . ) . ) . )
O R>a m` m I mb ` m ^ mJ mV A g b o ` m J mob mH$ma
Z m` yZ m g yO A m ` mZ o O R>a mVyZ XyY d md I mb r
CVa ` mV A S>Wi m` oVmo. h mA mO ma n {h ` m_ wb m_ ` o ( _ ob
g o g ) O m V _ mU mV A mT>i Vmo. g mYma U n U oO _ mZ Va 3 Vo
6 A mR>d S> mXa ` mZ _ wb mV I mb rb b j U oA mT>i VmV.
b j U o b j U o b j U o b j U o/ {Mh o / {Mh o / {Mh o / {Mh o: :: :
1 ) XyY n mO ` md a H$mh r d oi mZ o X` mg ma I r Cb Q>r
h moVo. Cb Q>r O moa mZ og _ moa \ o$H$b r O mVo. ` mZ Va
_ m ~ mi mb mI yn ^ wH$ b mJ Vo.

2 ) ~ mi mb m XyY n mO ` md a n mo Q>mV J mo i m {\ $a VmZ m
O mU d Vmo.
3 ) d ma d ma Cb Q>r P m ` m_ wi o~ mi m` me a ra mVrb n mU r
d j ma
Xmoh moMmh mg h moVmo. a VmVrb A mb mMo _ mU h r H$_ r
h moVo.
` m_ wi o I a Va h r g {O H$b n oj m _ o S>rH$b B_ O g r g {O H$b n oj m _ o S>rH$b B_ O g r g {O H$b n oj m _ o S>rH$b B_ O g r g {O H$b n oj m _ o S>rH$b B_ O g r
h Q>b r O mVo, H$ma U A mn a oe Z H$a ` mA mYr h mXmo f Xy a
H$a md mb mJ Vmo.
~ mi mb m d a rb _ mU o b j U o A g Vrb d J mR> h mVmb m
b mJ V A g ob Va A m` . EM. n r. Eg . h o{Z XmZ g _ O md o. n a Vy
Vg oZ g ` mg n moQ>m` mg moZ moJ m\ $sZ o {Z XmZ Ho$b oO mVo.

O R>a m` mI mb ` m^ mJ mVrb J mR> aoI m{M

Cn Mma Cn Mma Cn Mma Cn Mma : :: :
n mU r d j ma ` mMo _ mU n wd d V P m ` md a M A mn a oe Z
Ho$b o O mVo, O oU oH$ $Z ~ mi mb m A mn a oe Z Xa ` mZ d m
A mn a oe Z Z Va h moD$ e H$U ma og ^ m ` YmoHo$ Q>mi Vm` o VmV.
e {H$` oMo d n e {H$` oMo d n e {H$` oMo d n e {H$` oMo d n : :: :
` mV ( a _ Q>oS>g n m` b moa mo_ m` mQ>m_ r) O mS> P mb o ` m
J mob mH$ma Z m` yd a EH$ C^ m N>oX KoVb mO mVmo. ` m_ wi oVoWo
O R>a mMmA V^ mJ CKS>Vmod XyY I mb r CVa ` mV A g b ob m
A S>Wi m Xya h moVmo. ` e mMo _ mU O d i O d i 1 0 0 % A mh o.
A mn a oe Z Z Va 1 2 - 2 4 Vmg mV ~ mi mb m \ $sS>g Mmb y
H$a Vm` oVmV. W_ Z i rZ o _ mU ~ X>Y n XVrZ oQ>o Q>\ $sS>g
{Xb oO mVmV d ~ mi mb m ` d p WV n MZ h moV A g ` mg Vo
d mT>d yZ d mQ>r M_ MmZ o {H$d m VZ n mZ XoVm ` oVo.
A mn a oe Z Z Va h r O R>a mMm A mH$ma d A mVa A md a U mMr g yO
CVa on ` V ~ mi mb m WmoS>` m\ $ma _ mU mV Cb Q` m h moD$
e H$VmV.
2 ) 2 ) 2 ) 2 ) S>oA moS>oZ b A Q>o{O ` m S>oA moS>oZ b A Q>o{O ` m S>oA moS>oZ b A Q>o{O ` m S>oA moS>oZ b A Q>o{O ` m
` mV S>oA moS>oZ _ h U O o b h mZ A mVS> mMm g w d mVrMm
^ mJ n yU n U o ~ Z b ob m Z g Vmo. BQ>m` yQ>oa mBZ h g yb a

A p g S>|Q>h o ` m_ mJ MoEH$ H$ma U A g ye H$Vo. ~ a o MXm S>mD$g
qg S>mo_ A g b o ` m _ wb m_ ` o ( 3 0 %) h r A Z m _ b r A mT>i Vo.
g J mo {d d mh Ho$b o ` mXmn ` m` m_ wb m _ ` oVa ` mA mO ma mMo
_ mU I yn M O m V A mT>i yZ A mb oA mh o. ( {O d V) O _ b o ` m
2 5 0 0 _ wb mn H$s EH$m_ ` oh mXmof A mT>i Vmo. h mA mO ma
A g b o ` m~ mi m_ ` o X` m` m {d H$ma m Mo _ mU O m V A g Vo.
{e d m` ` md oi r n J V h moU m` m Xwg ` m A d ` d n U mb rMoh r
A mO ma O d i O d i 5 0 % _ wb m_ ` oA mT>i VmV. CXmh a U mW:
h X>` Xmof , A Z Z {b H$mn yU Z ~ Z U o, g S>mg mMr O mJ mZ g U o
B` mXr.

S>oA moS>oZ b A Q>o{O ` m: n moQ>mMmE g - a o A mH$Vr{M

b j U o b j U o b j U o b j U o: :: :
1 ) J a moXa n U mV A mB` mn moQ>mV ( J ^ me ` mV ) J ^ O b
O m V _ mU mV A g Vmo.
2 ) O _ mZ Va ~ mi mb m
- {n d i r Cb Q>r h moU o.
- XyY Z n MU o
h o mg h moD$ e H$VmV.
3 ) ~ ` mM _ wb m_ ` oA mVS> mMr g b Z Vm Z g ` m_ wi o
H$md ri h r
h moVmo.
{Z XmZ {Z XmZ {Z XmZ {Z XmZ : :: :
n moQ>m` mE g - a od a ` mMo{Z XmZ H$a Vm` oVo.
e {H$` oMo d n e {H$` oMo d n e {H$` oMo d n e {H$` oMo d n : :: :
A mn a oe Z H$ Z A mVS> mMm d a Mm d I mb Mm ^ mJ
EH$_ oH$me r O moS>b oO mVmV ( ` mVrb mn Xya H$ob r O mVo) .
A mVS> md a rb O I _ ^ a m` b m g mYma U V: 5 Vo 7 {Xd g
b mJ VmV. ` mZ Va h i yh i y~ mi mb m Q>o Q>\ $sS>g Mmb yH$a Vm
` oVmV.

3 ) 3 ) 3 ) 3 ) _ mb a moQ>oe Z _ mb a moQ>oe Z _ mb a moQ>oe Z _ mb a moQ>oe Z ( + ( + ( + ( + h m yb g h m yb g h m yb g h m yb g ) ) ) )
A mO ma m~ X>Xb Mr g mYma U _ m{h Vr : A mO ma m~ X>Xb Mr g mYma U _ m{h Vr : A mO ma m~ X>Xb Mr g mYma U _ m{h Vr : A mO ma m~ X>Xb Mr g mYma U _ m{h Vr :
J ^ m` md mT>r` m6 Vo1 0 ` mA mR>d S>` mV A mVS> mMr
d mT> ~ mi m` mn moQ>m` m~ mh oa Z mi o_ ` oh moV A g Vo. Xh m ` m
A mRd S> mZ Va ` md oi ob mn moQ>mMo Z m` yn yU n U oV` ma P mb ob o
A g VmV d CXa n moH$i rMr j _ Vm d mT>b ob r A g Vo, ` md oi r
A mVS>r h i yh i y n moQ>mV n a VVmV d EH$m {d {e Q>> {e V~ XY
n XVrZ o n moQ>m` m A mVrb A md a U m Xma o WmZ mn h moVmV.
` m {H$` oV Hw$R>oh r A S>Wi mA m ` mg , ` md ` o ~ mi mb m mg
h moVmo. A mVS` m` m ` m MwH$s` m R>od U rb m _ mb a moQ>oe Z _ mb a moQ>oe Z _ mb a moQ>oe Z _ mb a moQ>oe Z A g o
g ~ moYb oO mVo.
h m Xmof A g b o ` m _ wb mV A mVS> mZ m n ri n ri n ri n ri ~ g ` mMr ~ g ` mMr ~ g ` mMr ~ g ` mMr
e ` Vm e ` Vm e ` Vm e ` Vm ( Volvulus) g m_ m` _ wb mn oj m n w H$i M O m V
A g Vo. ` m_ wi oh r I a r n oS>r` mQ>>rH$ g {O H$b B_ O g r A mh o.

_ mb a moQ>oe Z E g - a o

\ \\ \ $ V $ V $ V $ V _ mb a moQ>oe Z A g ` mg _ mb a moQ>oe Z A g ` mg _ mb a moQ>oe Z A g ` mg _ mb a moQ>oe Z A g ` mg
XyY Z n MZ o,
Cb Q` m( {n d i r) .
h m yb g P m ` mg h m yb g P m ` mg h m yb g P m ` mg h m yb g P m ` mg A mVS>` mb m n ri ~ g ` mg d a rb
b j U mI oa rO
n moQ>\ w$J U o,
g S>mg md mQ>o a V md h o mg h moVmV d ~ mi mMr
V` oV J ^ ra ( g ra r` g ) h moVo.
{Z XmZ : {Z XmZ : {Z XmZ : {Z XmZ : 1 ) 1 ) 1 ) 1 ) ~ mi mV A mT>i U ma r b j U o
2 ) 2 ) 2 ) 2 ) n moQ>mMm n moQ>mMm n moQ>mMm n moQ>mMmE g E g E g E g - -- - a o a o a o a o - -- - 9 0 Vo9 5 % Ho$g og _ ` o` m
XmoZ
J mo Q>rd $Z {Z XmZ H$a Vm` oVo.

3 ) 3 ) 3 ) 3 ) n moQ>mMmg moZ moJ m n moQ>mMmg moZ moJ m n moQ>mMmg moZ moJ m n moQ>mMmg moZ moJ m\ \\ \ $s $s $s $s - -- - g moZ moJ m\ $sZ o h m ` yb g A mh oH$s
Z mh r h o MmJ ` m H$ma o H$i y e H$Vo. ` mVh r S>mn b a S>mn b a S>mn b a S>mn b a
g moZ moJ m g moZ moJ m g moZ moJ m g moZ moJ m\ \\ \ $s $s $s $s A g ` mg {Z XmZ mMr e m d Vr d mT>Vo.

4 ) 4 ) 4 ) 4 ) ~ oa r` _ E g ~ oa r` _ E g ~ oa r` _ E g ~ oa r` _ E g - -- - a o: a o: a o: a o:
WmoS>` m_ moR>` m_ wb m_ ` o_ mb a moQ>oe Z Mr b j U o
A g Vrb d H$Vr p Wa A g ob Va ~ ` mMd oi m ~ oa r` _
\ $mb mo- Wy h o n oe b E g - a oO Ho$b oO mVmV.
e {H$` oMo d $n : e {H$` oMo d $n : e {H$` oMo d $n : e {H$` oMo d $n :
` mV A mVS>` mZ m A g b ob m n ri g moS>d b m O mVmo. O o
Bands / n Q>Q>o A mh oV, Vo _ moH$i o Ho$b o O mVmV d Z mH$mVrb
Z i rd mQ>o {Xb ob o g b mBZ b h mZ A mVS>` m` m g w $d mVr` m
^ mJ mVyZ ( S>oA moS>oZ _ d O o` wZ _ ) ` d p WV I mb r CVa V`
` mMr I m r P m ` md a M n moQ>md a MmN>oX n a V {e d b mO mVmo.
~ ` mMd oi m Xwg ` m EI mX>` m e {H$` o` m d oi r h m
mb o_ A mH$p _ H$n U oA mT>i yZ A m ` mg , ` md oi ob mXoI rb
_ w ` e {H$` o` m O moS>rb m _ mb a moQ>oe Z H$a o e Z h r
e {H$` mH$a md r b mJ Vo. ` mV A mVS>r EH$m{d {e Q>n XYVrZ o
CXa n moH$i rV ~ g d b r O mVmV. A mn a oe Z Z Va A mVS>` mVrb
md ` d p WV I mb r CVa Vm` V ` mMr I m r P m ` md a M
~ mi mb m\ $sS>g g w $ Ho$b oO mVmV.
4 ) 4 ) 4 ) 4 ) _ mb ~ md ob A Q>oO r` mO _ mb ~ md ob A Q>oO r` mO _ mb ~ md ob A Q>oO r` mO _ mb ~ md ob A Q>oO r` mO
g m_ m` V: _ mZ d r ( N>moQ> m) A mVS> mMr b m~ r 5 Vo
6 _ rQ>a BVH$s A g Vo. Z d O mV ~ mb H$mV Vr 2 5 0 g o_ r

BVH$s A g Vo, Va r_ ` wA a ~ mb H$mV 1 1 5 g o_ r BVH$s H$_ r
A g Vo. n a Vy mA Z m_ {b _ ` oA mVS> mMmH$mh r ^ mJ J ^ m VM
{d a Ki ` mZ oA mVS> mMr \ $mQ>m\ yQ P mb ob r A g Vo. {e d m`
N>moQ> m A mVS> mMr b m~ r g mYma U g a mg a rn oj m I wn M H$_ r
A g Vo. ` m_ wi o A mMm ( XyYmMm XyYmMm XyYmMm XyYmMm) d m n moQ>mV V` ma h moU m` m
A V md mMm n d mh I {S>V h moD$Z Z d O mV ~ mb H$mV
I mb rb n _ mU o mg g ^ d VmV. A mB_ ` o A g b ob m
C a $Xm~ d m BQ>m` yQ>oa mBZ h g y b a A p g S>|Q>_ w i o
A Q>oO r` O CX>^ d VmV.

_ mb ~ md ob A Q>oO r` mE g - a o
n moQ>\ w$J U o
Cb Q> mh moU o

{e d m` ~ mi mZ o EH$Xm H$mi r e r ( _ oH$mo{Z ` _ )
Ho$ ` md a qH$d m ` mZ Va Z d O mV ~ mi mb m
g m_ m` n U o h moVo Ve r e r Z h moVm H$a S>` m a J m` m
N>moQ> m e |~ S>mg ma ` m J w{Q>H$m J wXXd ma md mQ>o~ mh oa
` oVmV.
1 ) ` m_ ` o{Z XmZ h on moQ>m` m E g - a o d a Ho$b oO mD$ e H$Vo.
2 ) ~ a oMXm o g r_ ` oh r J ^ O b mMo _ mU O m V A g ye H$Vo.
Cn Mma mMo d n : Cn Mma mMo d n : Cn Mma mMo d n : Cn Mma mMo d n :
h mXmof Xya H$a ` mg mR>r A mn a oe Z {e d m` n ` m` Z mh r.
` mV A Z m_ {b ` m H$ma mZ wg ma A mVS> mMmZ o_ H$m{H$Vr ^ mJ
H$mTy>Z Q>mH$m` Mm h o{Z p MV Ho$b o O mVo, d ` mZ Va Cd [a V
^ mJ H$S>m ` d p WV H$ Z VmU {d a h rV n XVrZ oEH$_ oH$mZ m
O moS>b oO mVmV. A Z m_ b r` mn wT>MmA mVS> mMm^ mJ d mn a b m
J ob m Z g ` mZ o A mH$ma mZ o I yn b h mZ A g Vmo d ` m_ wi o h o
A mVS>o EH$_ oH$mZ m O moS>` mMr e {H$` m A {Ve `
H$me ` n yd H$ H$a md r b mJ Vo.

_ Q>rn b A Q>oO r` mO - A mVS> mMr P mb ob r \ $mQ>m\ yQ
A mn a oe Z Z Va A mVS>` mMr h mb Mmb g w P m ` md a
W_ Z mH$mVrb Z i rVyZ d ` mZ Va Vm|S>mZ o \ $sSg {Xb o
O mVmV. EHy$U M Cn Mma mV A mn a oe Z I oa rO a $mVrb j ma mMo
_ mU ` d p WV a mh rb ` mMr H$mi O r KoU o; A md ` H$VoZ wg ma
` mo` _ mU mV a $ d a $KQ>H$ n wa d U o, {VO {d Ho$ ` m
J mo Q>rh r {VV ` mM_ h d m` mA mh oV.
5 ) 5 ) 5 ) 5 ) BQ>` wg g oe Z BQ>` wg g oe Z BQ>` wg g oe Z BQ>` wg g oe Z
g mYma U n U o 6 _ h rZ oVo2 d f m` m_ wb mV A mT>i U ma m
h mA mO ma A mh o. {d e of V: ~ mi mb m n ya H$ A mh ma
( Supplementary Feeds) Mmb yHo$ ` md a d mg XuI moH$ ` m
Z Va h m mg h mD$ e H$Vmo. A mVS>r EH$_ oH$mV Kwg ` mZ o
A mVS>` mZ mg yO ` oVod I mb rb _ mU ob j U o{Xg VmV.
~ a oMXmb h mZ A mVS>` mMme od Q>Mm^ mJ ( A m` {b E_ ) h m
` mn wT>rb _ moR>` mA mVS>` mV ( Colon) Kwg b oob mA g Vmo. h m

mg h r _ wb rn oj m_ wb m_ ` o( _ ob g o g ) O m V _ mU mV
A mT>i Vmo.
- n moQ>\ w$J U o
- Cb Q>` m( {h a d r / {n d i r ) h moU o
- g S>mg md mQ>oa V md
- ~ mi mMo n m` Xw_ Sy>Z a S>U o
1 ) e ma r[a H$ Vn mg U r
2 ) E g - a o
3 ) g moZ moJ m\ $s

d a rb _ mU ob j U oA g Vrb Va ~ mi mb mA S>_ rQ>H$ $Z
W_ mon Mma W_ mon Mma W_ mon Mma W_ mon Mma Ho$b o O mVmV. g wBVyZ g b mBZ / {VO {d Ho$
{Xb r O mVmV. ~ mi m` m J wn Mo a Vh r V` ma R>od b o O mVo.
` mZ Va ~ mi mMo ~ oa r` _ E{Z _ mXoD$Z E g - a o Ho$b oO mVmV.
h r Vn mg U r H$a ` m_ mJ o a moJ {Z XmZ d Cn Mma h r Xmoh r
C{XX Q>oA g VmV. ~ oa r` _ Xma o[a S> e Z ~ oa r` _ Xma o[a S> e Z ~ oa r` _ Xma o[a S> e Z ~ oa r` _ Xma o[a S> e Z P m ` mg A mn a oe Z Mr

J a O ^ mg V Z mh r. n a VyVoZ g moS>d b oJ o ` mg / ~ mi mb m2 4 ~ mi mb m2 4 ~ mi mb m2 4 ~ mi mb m2 4
Vmg mn oj m Vmg mn oj m Vmg mn oj m Vmg mn oj mCe ra mS>m Q>a mH$S>oA mU b oJ o ` mg A mn a oe Z {e d m` A mn a oe Z {e d m` A mn a oe Z {e d m` A mn a oe Z {e d m`
Xwg a mBb mO Z mh r. Xwg a mBb mO Z mh r. Xwg a mBb mO Z mh r. Xwg a mBb mO Z mh r.

BQ>` wg g oe Z : EH$_ oH$mV Kwg b ob r A mVS>r - a oI m{M d
A mn a oe Z Xa ` mZ Mm\ $moQ>mo
A mn a oe Z n yd u ~ mi m` m a VmVrb n mU r j ma ` mMo
_ mU g b mBZ Xma o Z m_ b P m ` md a M n w T>rb _ w `
e {H$` mHo$b r O mVo. O oU oH$ $Z A mn a oe Z Xa ` mZ Mm^ yb o_ wi o
CX^ d y e H$U ma mYmoH$mH$mh r _ mU mV Q>mi Vm` o Vmo.
e {H$` oMo d $n : e {H$` oMo d $n : e {H$` oMo d $n : e {H$` oMo d $n :
A mn a oe Z Z o EH$_ oH$mV Kwg b ob oA mVS>o g mo S>d b o O mVmV.
A mVS>` mMma V d mh ` d p WV A mh o` mMr I m r Z g ` mg ,
A mVS>` mZ m J a _ n m` mMm Xh m{_ {Z Q>o e o H$ Xo D$Z , 1 0 0 %
A mp g O Z XoD$Z n a V a V d mh mMr MmMn U r Ho$b r O mVo.
Va rXoI rb a V d mh A n ya mA g ` mg / A mVS>n y d un mg yZ

H$mi A g b ob ( J J rZ g ) A g ` mg Vmo^ mJ H$mTy>Z Q>mHy$Z
Ca b o ` m A mVS>` m` mH$S>mEH$_ oH$mZ mO moS> ` mO mVmV.
A mn a oe Z Z Va h r ` mo` _ mU mV g b mBZ , a V,
A ` w{_ Z Q>mg ` wO Z B` m{XMr J a O n S>Vo. A mVS>` md a
Q>mHo$ _ ma b ob oA g ` mg , O m V {Xd g ~ mi mb m n ya H$ Cn Mma
X>` md o b mJ VmV. Q>mHo$ ` d p WV A mh oV ` mMr I m r
P m ` md a M VmoS>mZ o d n XmW Mmb y H$a Vm ` oVmV. ~ mi mb m
Ce ra m h mp n Q>b _ ` o A mU b ob o A g ` mg d {d e of V:
A mVS>` mMm J J a rZ A g ` mg a Vm` mO Vyg g J m_ wi o~ mi
{g a r` g h mo` mMr e ` Vmd mT>Vo.
6 ) 6 ) 6 ) 6 ) A n |{S>g m` Q>rg A n |{S>g m` Q>rg A n |{S>g m` Q>rg A n |{S>g m` Q>rg
A m n wN> A WmV A n o{S> g b m A mb ob r g yO d Xmh h U O o
A n |{S>g m` {Q>g .

O Vwg g J m_ wi oV~ \ w$J b ob oA n |{S> g

1 ) ^ yH$ Z b mJ U o,
2 ) n moQ>mV CO d rH$S>oI mb ` m~ mO yg XwI U o,
3 ) Vmn ,
4 ) Cb Q` m B` m{X.
~ a oMXm e ma r[a H$ Vn mg U r Xma oM {Z XmZ h moD$ e H$Vo. _ m
{Z XmZ mMr I m r Z g ` mg n wT>rb n _ mU o Vn mg ` m Ho$ ` m
O mVmV.
1 . g r. ~ r. g r. g r. ~ r. g r. g r. ~ r. g r. g r. ~ r. g r. - -- - a VmVrb d oVn oe rMo _ mU B\ o$ e Z _ wi o
d mT>b ob oA mT>i Vo.
2 . b Kd rMmVn mg b Kd rMmVn mg b Kd rMmVn mg b Kd rMmVn mg - ` m Xma o_ y Z {b Ho$V ( _ y _ mJ mV Hw$R>o)
B\ o$ e Z Z mh r Z m ` mMr I m r H$a Vm ` oVo. A g ` mg
H$YrH$Yr ` m_ wi od a rb b j U oO mU d ye H$VmV.
3 . g moZ moJ m g moZ moJ m g moZ moJ m g moZ moJ m\ \\ \ $s $s $s $s - ` m Xma o A n |{S> g b m g yO A g ` mMo, ` mV
n yA g ` mMod mn moQ>mVM A n |{S> g \ w$Q> ` mMo{Z XmZ h moD$
e H$Vo.

A n |{S>g m` {Q>g Mm mg A mh o ` mMoVn mg ` m Xma o {Z XmZ
P m ` mg d A O yZ ` m{R>H$mU r J mR> ~ Z b ob r Z g ` mg

VmH$mi e {H$` m H$ Z A n |{S> g H$mTyZ Q>mH$b o O mVo.
` mb mM A n |{S>g o Q>m_ r A n |{S>g o Q>m_ r A n |{S>g o Q>m_ r A n |{S>g o Q>m_ r A g og ~ moYb oO mVo.
4 . 4 . 4 . 4 . ~ oa r` _ E{Z _ m ~ oa r` _ E{Z _ m ~ oa r` _ E{Z _ m ~ oa r` _ E{Z _ m - H$YrH$Yr d a rb g d b j U o
A n |{S>g m` Q>rg I oa rO BVa A mO ma mVh r A g ye H$VmV. ` md oi r
{Z XmZ H$a ` mg mR>r d a rb MmM` m` m ~ a mo~ a rZ o ~ oa r` _
E{Z _ m Vn mg U rh r H$a md r b mJ Vo. ` mV XrKH$mi ( 2 4
Vmg mn oj m O m V ) ~ oa r` _ A S>Hy Z a mh r ` mg
A n |{S>g m` Q>rg Mo{Z XmZ Ho$b oO mVo.
d a rb b j U o A g ` mg e {H$` m h r _ wb m` m
Symptom Free Period _ ` o Ho$b r O mVo. ` mb mM Interval
Appendicectomy A g og ~ moYb oO mVo. d a rb e {H$` mh r
T>d b mo H$m{n H$ ` mXmoZ H$ma oH$a Vm` oVo.
H$mh r g m_ m` e H$m. . . . . H$mh r g m_ m` e H$m. . . . . H$mh r g m_ m` e H$m. . . . . H$mh r g m_ m` e H$m. . . . .
_ wb mMoA n |{S> g MoA mn a oe Z P mb ob oA mh o, Va rh r _ YyZ -
_ YyZ n moQ>mV XwI Vo.
e {H$` o` mA mYr A m n wN>Xmh h oM n moQ>XyI rMoH$ma U
A mh o ` mMr n wU I m r P m ` md a M A mn a oe Z H$a U o ` mo`
R>a Vo. H$mh rd oi ob m _ m _ y _ mJ mVrb B\ o$ e Z , n moQ>mVrb
J mR>r ( {b \ $ Z moS > >> >g Z m A g b ob r g yO ) h oh r n moQ>XyI rMo
H$ma U A g ye H$Vo. {Z XmZ mMr I m r

Z g ` mg A mYw{Z H$ V k mZ mMrh r _ XV KoVm ` oVo.
CXmh a U mW CXmh a U mW CXmh a U mW CXmh a U mW- -- - g rQ>r H$Z , b mo H$mon r B` m{X.
7 ) 7 ) 7 ) 7 ) n a n a n a n a \ \\ \ $moa o{Q> h n oa rQ>moZ m` Q>rg $moa o{Q> h n oa rQ>moZ m` Q>rg $moa o{Q> h n oa rQ>moZ m` Q>rg $moa o{Q> h n oa rQ>moZ m` Q>rg
` mV ~ h VoH$d oi mZ d O mV ~ mb H$mMoO R>a , N>moQoA mVSo d m
H$YrH$Yr _ moR>oA mVSo [Hd m$A n |{S> g _ ` oN>oX h moVmo.
~ a oMXmh oA Z mH$b Z r` A g Vo. n a VyH$YrH$Yr O _ V:
A J Xr A ` d W _ wb , ` m` mV a VXm~ H$_ r P m ` mZ o
n MZ g Wo` m ` m ^ mJ mMm a Vn wa d R>m Wm~ Vmo, O _ V:
d H$s` _ XV ( [a g {g Q>oe Z ) b mJ b ob r _ wb o /
d g Z ` md a M _ wb ` mV d mT>b o ` m oe a _ wi oO R>a mb mN>oX
h moVmo d m h e wJ O {S>g rP A g b ob r _ wb o ` m` mV
~ H$ oe a _ wi o _ moR>o A mVS>o d m A n |{S> g b m ^ moH$ n S>Vo. N>oX
h moD$Z ` mMo {Z XmZ h mo` mV ~ a mM H$mb md Yr J ob ob m
A g ` mg n moQ>mV h d md md O _ m h moVmV. ` mVM ~ mi mb m
XyY n mO b oJ o ` mg Voh r ` mN>oXmVyZ ~ mh oa n Sy>Z n moQ>mV n g a Vo
d H$mb mVa mZ o ~ mi mV O Vyg g J mMr b j U o{Xg yb mJ VmV.

n moQ>mV O _ mP mb ob r h d m: E g - a o
1 ) n moQ>\ w$J U o,
2 ) d mg Ko` mg mg h moU o,
3 ) d mg moN>d mg O moa mV h moU o,
4 ) Z mS>r H$_ r h moU o,
5 ) ~ mi mMr V` oV A MmZ H$ I mb md U o,
6 ) A n o{j V {V{H$` m/ {Vg mX Z XoU o

Cn Mma Cn Mma Cn Mma Cn Mma mMo d n : Mo d n : Mo d n : Mo d n :
h r b j U oA g ` mg {Z XmZ mMr e ` Vmb j mV KoD$Z
H$moU ` mh r Vn mg U r{e d m` ~ mi md a VmH$mi Cn Mma h moU o
J a O oMoA g Vo. ` mV n moQ>md a EH$ N>moQ>mN>oX KoD$Z h d m/ md
~ mh oa n S>md m` mg mR>r N>moQ>r S>oZ oO Q>` y~ R>od b r O mVo. _ m h o
\ $ V Vmn wa VoCn Mma P mb o. ` mI oa rO ~ mi mb mn ya H$ Cn Mma >

- {VO {d Ho$, ` mo` _ m oV g b mBZ , a V d a VKQ>H$
B` mXr XoD$Z ~ mi mMr V` oV WmoS>r g wYma ` md a _ w `
e {H$` m ( b moQ>m_ r) H$ $Z n moQ>mVrb g X> p WVrMm
A mT>md m KoVb m O mVmo. N>oX {H$Vr _ moR>m A mh oV, ` m` m H$S>m
H$e mA mh oV, ` m^ mJ mMma V d mh , n moQ>mV O _ m P mb ob r
KmU , ~ mi mMr EHy$U p WVr ( d O Z , _ ` w[a Q>r) , O Vyg g J
A mh oqH$d mH$g o, d g Z ` mMr Cn b YVmd {Z XmZ ` m
g J ` m J mo Q>t Mm {d Mma H$ $Z A mn a oe Z Mo Z o_ Ho$ d $n
R>a d b o O mVo.
N>oX N>moQ>md a V d mh R>rH$ A g ` mg ( {d e of V: O R>a
d N>moQ>` mA mVS>` mMmN>oX) H$S>m ` d p WV H$ $Z Vmo{e d b m
O mVmo. _ m _ moR>` m A mVS>` mMm N>oX A g ` mg h e wJ O
{S>g rP Mr e ` Vm O m V A g ` mZ o N>oX P mb ob o A mVS>o
n moQ>m~ mh oa H$mT>b oO mVo( Q>mo_ mO Ho$ ` mO mVmV) . n moQ>mVrb
KmU g b mBZ Z o ` d p WV g m\ $ H$ $Z d md ~ mh oa
` o` mg mR>r Z i r R>oD$Z n moQ>md a rb Kmd n a V ~ X Ho$b m
O mVmo.
A mn a oe Z Z Va h r n ya H$ Cn Mma Mmb yR>od b oO mVmV d
EH$Xm O R>a mMr / A mVS>` mMr p WVr ` d p WV A mh o` mMr
I m r P m ` md a M ~ mi mb m \ $sS>g Mmb yHo$b o O mVmV. Q>mo_ m

A g ` mg g mYma U : 6 Vo8 A mR>d S>` mZ Va a o Q>b ~ m` mg r
H$ $Z h e wJ O {S>g rP A mh o{H$d mH$g o` mMr MmMU r Ho$b r
O mVo. A g ` mg S>oO S> g O a rO H$a m ` m b mJ VmV ( ` m
h e wJ O {S>g rP ` me rf H$mI mb r {d Vma mZ oZ _ yX Ho$b o ` m
A mh oV) . h e wJ O {S>g rP Z g ` mg Q>mo_ mO ~ X Ho$ ` m
O mVmV . EHy$U B_ O g r d g n m}Q>r h Q>rQ>_ |Q>` m O moa md a
~ ` mM Ho$g og ` e d rn U oh mVmi Vm ` oVmV.
8 ) 8 ) 8 ) 8 ) Z oH$moQ>m` qP J EQ>a moH$mob m` Q>rg Z oH$moQ>m` qP J EQ>a moH$mob m` Q>rg Z oH$moQ>m` qP J EQ>a moH$mob m` Q>rg Z oH$moQ>m` qP J EQ>a moH$mob m` Q>rg ( (( ( EZ . B. g r. ) EZ . B. g r. ) EZ . B. g r. ) EZ . B. g r. )
h m _ w ` d o A ` d W d H$_ r d O Z m` m /
{Xd g m` m Z d O mV ~ mb H$m_ ` oA mT>i U ma m A mO ma A mh o.
H$mh r H$ma U mZ o qH$d m \ $ V r_ ` wA a Ho$A a g mR>r
EZ . A m` . g r. ` y. V A g U ma r _ wb , XrKH$mi Cn me r ( Nil
Per Orally) A g U ma r _ wb ` mMo~ i r R>a VmV. ` mV b h mZ
Vg oM _ moR>` m A mVS>` mb m g yO ` oU o XrKH$mi A mVS>` mMr
h mb Mmb Z h moU o, n moQ>mMm Mm_ S>rMm ^ mJ h r b mb h moU o
` oWn mg yZ ; n a \ $moa oQ>r h n oa rQ>moZ m` Q>rg qH$d m A MmZ H$ ~ mi
XJ md U o` mHw$R> ` mh r A d WoV H$Q> h moD$ e H$Vmo. ` m_ wi o
A mO ma mMr b j U h r ` m- ` m Q>oO n _ mU o ~ Xb VmV.
g mo` rg mR>r ` mA mO ma mb mA mn U EZ . B. g r. A g oM g ~ moYy.

EZ . B. g r. - A n w` m{Xd g mMo~ mb H$
b j U o: b j U o: b j U o: b j U o: g m_ m` V: b j U on wT>rb _ mU oA g ye H$VmV.
1 ) ~ mi mb m XyY Z n MU ( Z wH$VM XyY n mO m` b m Mmb y
Ho$b o ` m_ wb mV) ,
2 ) n moQ>mMmKoa d mT>U ,
3 ) n moQ>\ w$J U ,
4 ) g S>mg md mQ>o a V md ( Vmo ~ ` mMd oi m \ $ V g w _
_ mU mVM A g Vmo) ,
5 ) A MmZ H$ d mg KoU Wm~ U ( Apnea) ,
6 ) A MmZ H$ ~ mi mMr V` oV I mb md U ,
7 ) n moQ>m` m{d {e Q>^ mJ mV J moi mg e J mR>O mU d U ,
8 ) n moQ>m` mn wT>` m^ mJ mb mg yO ` oU o, Vmob mb h moU ;
9 ) n moQ>V~ \ w$J U B` m{X.

1 ) p b Z rH$b g n re Z p b Z rH$b g n re Z p b Z rH$b g n re Z p b Z rH$b g n re Z
d a rb H$ma ` m _ wb m_ ` oEZ . B. g r. Mr e ` Vm
b j mV KoD$Z H$mh r b j U {Xg ` mg VmH$mi ` m
{Z XmZ mMm{d Mma H$a U / h moU h r a moJ {Z XmZ mMr n {h b r Q>on
h Q>b r n mh rO o.
2 ) n moQ>mMmE g n moQ>mMmE g n moQ>mMmE g n moQ>mMmE g - -- - a o a o a o a o( Portable)
A mVS>` m` m {d {e Q> ^ mJ mb m g yO A mh o, Vo
{d Vma b ob A mh o, n moQ>mV n mU r O _ m P mb ob oA mh oqH$d mH$g o;
A mVS>` mb m N>oX Va P mb m Z mh r` Z m h o E g - a o d a H$i y
e H$Vo. _ wb A ` d W A g ` mZ o ~ mi mb mE g - a o g mR>r Z
h mb d VmEZ . A m` . g r. ` y. VM E g - a oHo$b mO mVmo( Portable
X-Ray). A mVS>` mb m N>oX Z g ` mg 6 Vo 8 Vmg mZ r n a V
E g - a oH$ $Z ~ KrVb mO mVmo.
A mVS>` mMm EI mXm {d {e Q> ^ mJ E g - a oV
n wd u _ mU oM d ` mM O mJ r {Xg ` mg A mVS>` mMr d m^ m{d H$
h mb Mmb h moV Z mh r` od EZ . B. g r. h o{Z XmZ A g ye Ho$b h o
J h rV Ya b oO mVo.

3 ) g r. ~ r. g r. g r. ~ r. g r. g r. ~ r. g r. g r. ~ r. g r. - -- - a VmVrb d oVn oe t Mo _ mU n w H$i M
d mT>b ob o{H$d mKQ>b ob oA g Vo.
4 ) b S>J g og ` mVn mg U rV A mT>i U ma oA {g S>mo{g g A {g S>mo{g g A {g S>mo{g g A {g S>mo{g g
5 ) g S>mg mMmVn mg g S>mg mMmVn mg g S>mg mMmVn mg g S>mg mMmVn mg - g w _ a V md mMr Z m|Xh r {VVH$rM
_ h d mMr A mh o.
A ) A ) A ) A ) g n m}Q>r h Q>rQ>_ |Q> g n m}Q>r h Q>rQ>_ |Q> g n m}Q>r h Q>rQ>_ |Q> g n m}Q>r h Q>rQ>_ |Q>
~ mi mb mCn me r ( Nil Per Orally ) R>od U
~ mi mb m ` mo` _ mU mV {e a oVyZ g b mBZ , a V,
a VKQ>H$ B` m{X XoU o
[VO {d Ho$
Z mH$mV Z i r R>od yZ md n moQ>mV O _ m h moU ma Z mh rV
` mMr H$mi O r KoU o
d mg moN>d mg mg mR>r A md ` H$ Vr _ XV H$a U
{Z ` _ rV e ma r[a H$ Vn mg U r - H$mi O rn yd H$ n a Vn a V
~ mi m` m g X>` p WVrMm A mT>md m KoU o; d ` m _ mU o
Cn Mma mV A md ` H$ Vo ~ Xb H$a U o. Vmn _ mZ ,
d g Z mMmd oJ , Z mS>rMr J Vr, n moQ>mMmKoa ` mg d Z m|Xr

n mh U . H$Yr H$Yr H$_ r P mb ob b S> oe a {Z ` rV
R>od ` mg mR>rh r {d {e Q>A mf Ymon Mma H$a md ob mJ VmV.

~ ) A mn a oe Z Mr J a O ~ ) A mn a oe Z Mr J a O ~ ) A mn a oe Z Mr J a O ~ ) A mn a oe Z Mr J a O
A mVS>` mb m N>oX A g ` mg h m ^ mJ Q>mo_ m h U yZ
~ mh oa A mU b mO mVmo
n moQ>mMr d Mm b mb A g ` mg {H$d m J mR> b mJ V
A g ` mg
~ mi mMr V` oV WmoS>` md oi mV I mb md ` mg

EH$Xa rVM h mA mO ma P mb o ` m~ mi mMo n moZ mg rg h o
\ $ma MmJ b o Z mh r A m{U A mO H$mb Va A {Ve ` { _ ` wA a
_ wb mZ md mMd ` mV d X>` H$e m mb m` oVoA g b ob o` e b j mV
KoVm` mA mO ma mMr d mT>b ob r ` mVr b j mV ` oBb .
I a Va A mn ` m _ wb mZ m ( EZ . B. g r. ) ( EZ . B. g r. ) ( EZ . B. g r. ) ( EZ . B. g r. ) h m A mO ma A mO ma A mO ma A mO ma
h moD$M X>` m` Mm Z mh r h moD$M X>` m` Mm Z mh r h moD$M X>` m` Mm Z mh r h moD$M X>` m` Mm Z mh r ` mMr WmoS>` m\ $ma _ mU mV H$mi O r H$mi O r H$mi O r H$mi O r
g d M ~ mb a moJ Vk mZ m/ g ~ [YVmZ mKoVm` oBb .

_ moR> m _ moR> m _ moR> m _ moR> mA mVS> m` mg _ ` m A mVS> m` mg _ ` m A mVS> m` mg _ ` m A mVS> m` mg _ ` m
g moZ mb r, 1 5 d f u` H$` H$m. Z d d rV {e H$U ma r.
h g a r, g wXa , g w d $n . e mi oVrb b {J H$Vm {e j U m` m
b mg Z Va _ m {V` m^ md {d d mV ~ a rM Cb Wmn mb W P mb r.
A mn ` mO Z Z o{` mMr a MZ mBVa mn oj md oJ i r A mh od ` m` m
H$a o e Z g mR>r A mn a oe g Mr J a O A mh o h o EoH$ ` md a Va
{V` mn m` mI mb Mr O _ rZ M g a H$b r. {Vb ma o Q>mo h O m` Z b
{\ $ ` wb mMm mb o_ h moVm. H$a o e Z g mR>r Q>oS> g O a rMr d
H$mh r H$mb md YrH$a rVm_ b {d g O Z mg mR>r n moQ>md a H${ _ _ wI
~ Z d ` mMr J a O h moVr.
A mB{d Z md mT>b o ` mg moZ mb rMmh m mb o_ b j mV Z
A m ` mZ o_ moR>rM g _ ` mCX^ d b r h moVr. _ moR>` mA mVS>` me r
g ~ YrV A Z moa o Q>b _ mb \ $m_ }e Z , ~ XYH$mo R>Vm d h e wJ
{S>g rP Mr _ mh rVr n wT>rb b oI m Xma oH$ $Z KoD$` m.
1 ) 1 ) 1 ) 1 ) _ wb m_ Yrb ~ XYH$mo R>Vm _ wb m_ Yrb ~ XYH$mo R>Vm _ wb m_ Yrb ~ XYH$mo R>Vm _ wb m_ Yrb ~ XYH$mo R>Vm( (( ( H$m Q>rn oe Z H$m Q>rn oe Z H$m Q>rn oe Z H$m Q>rn oe Z ) )) )
~ XYH$mo R>Vm A WmV H$m Q>rn oe Z h U O o Hw$R>b m
A mO ma Z mh r Va h o EH$ b j U A mh o. n a VyEH$Xm mg Mmb y
P m ` mg ` m` m Xw Q>MH$mV _ wb d ` mMo g d Hw$Qy>~ r`
A S>H$VmV. h o XrKH$mi Mmb y a m{h ` mg ` mb m d H$s`
n [a ^ mf oV h {~ ` wA b H$m Q>rn oe Z ( Habitual Constipation)
h U yZ g ~ moYb oO mVo.

h m h m h m h m mg h moU m` m_ wb mVrb mg h moU m` m_ wb mVrb mg h moU m` m_ wb mVrb mg h moU m` m_ wb mVrb b j U o: b j U o: b j U o: b j U o:
1 ) 3 - 3 {Xd g mn ` V e mMmb mZ h moU o,
2 ) e mMmb mH$S>H$ h moU o,
3 ) O moa b md U o, g S>mg H$a VmZ m_ wb mb m mg h moU o
4 ) n moQ>\ w$J U o
5 ) O od U ` d p WV Z H$a U o,
6 ) n yd u g S>mg mMo {Z ` U A mb o ` m _ wb m_ ` o H$n S>o
I a m~ h moU oB` m{X b j U oA mT>i VmV.

- XrKH$mi V` n mZ
- A mh ma mV d n XmWmMon m~ `
- A mh ma mVrb Mmo ` mMr ( a of oXma n XmWmMr) H$_ Va Vm
- _ mZ {g H$ A mKmV
~ ` mMd oi m _ wb m_ ` o Z oh _ rMm / g d ` rMm _ b md a moY
A g ` md a e mMm` m Z mO yH$ O mJ r Mra n SyZ O I _ h moVo
( {\ $e a ) . h m mg Mmb y P m ` md a _ wb e mMmb m O m` Mo
h oVyn a n a n wT>oT>H$b VmV d H$m Q>rn oe Z A mU I r d mT>Vo.

Cn Mma mMo d n : Cn Mma mMo d n : Cn Mma mMo d n : Cn Mma mMo d n :
H$m Q>rn oe Z {O VHo$ O wZ mQ> ( Chronic) , {VVH$m
Cn Mma mb m {Vg mX {_ i m` b md oi b mJ Vmo; d {VVH$mO m V
H$mi h r Q>rQ>_ |Q>Mmb yR>od md r b mJ Vo. Chronic Constipation
` mXw Q>MH$mVyZ _ wb mMr g wQ>H$mH$a md ` mMr A g ` mg \ $ V
A mf YmZ r H$m Q>rn oe Z Mr Q>rQ>_ |Q> H$ $Z Mmb V Z mh r, Va
g d n mV ` md a EH$mMd oi r Q>rQ>_ |Q> Ho$b r J ob r n mh rO o d Vr
g d g _ md oe H$ g d g _ md oe H$ g d g _ md oe H$ g d g _ md oe H$ A g b r n mh rO o. ` mV n wT>rb KQ>H$mMr H$mi O r
KoVb r O mVo.
1 ) ~ mi mMr Vn mg U r H$ $Z g S>mg m` mO mJ r H$mh r e ma r[a H$
Xmof Z mh r Z m` mMr I m r Ho$b r O mVo.
CXmh a U mW - g S>mg mMr O mJ m n wT>o / N>moQ>r A g U o;
A g ` mg Vmog moS>d b mO mVmo.
2 ) {\ $e a g mR>r Wm{Z H$ Cn Mma
CXmh a U mW - O I _ b d H$a ^ a ` mg mR>r H$mo_ Q>
n m` m` m Q>~ _ ` o {Xd g mVyZ 2 - 3 d oi m ~ g d U o
O oU oH$ $Z ` mO mJ r e oH$ {_ i ob ; Q>ra mBS>, A Q>r~ m` moQ>rH$
d b moH$b A Z m WoQ>rH$ H$s_ B` m{X.
3 ) ` mM~ a mo~ a g S>mg g m\ $ / _ D$ h mo` mg mR>r Vm|S>mZ o
A mf Yo Mmb yHo$b r O mVmV.

4 ) Q>rQ>_ |Q>Mmg d m{YH$ _ h d mMm g d m{YH$ _ h d mMm g d m{YH$ _ h d mMm g d m{YH$ _ h d mMmn U ~ ` mMd oi mXwb {j b ob m
^ mJ h U O o Hw$Q>w>~ r` mMo g _ wn Xoe Z d A mh ma {d h ma mV
Ho$b ob o~ Xb .
_ mMo n XmW- {~ H$sQ>o, ~ oS>, n o Q>rO ; O H$ \ yS>- d o\ $g ,
e rVn o` od J a o ` mMo _ mU A ` n A g md o.

\ $i o, H$` m H$moqe ~ ra r, _ moS> A mb ob r H$S>Ym` o,
H$moS>` mg {h V VU Ym` o, n mb o^ m` m, h mVg S>rMmVmXyi ,
a of oXma n XmW` mMmg _ md oe H$a md m.
I a Va h rM _ w ` Q>rQ>_ |Q>h U md r b mJ ob ; H$ma U EH$Xm
` m~ m~ rMr H$mi O r KoVb r H$s _ J n wT>oA m` w ` ^ a _ wb mb m
H$m Q>rn oe Z ` mVS>m ` mVyZ A mn U d mMd ye H$Vmo.
2 ) 2 ) 2 ) 2 ) A Z moa o Q>b _ mb A Z moa o Q>b _ mb A Z moa o Q>b _ mb A Z moa o Q>b _ mb \ \\ \ $m_ }e Z $m_ }e Z $m_ }e Z $m_ }e Z
` m _ wb m_ ` oa o Q>_ d A Z b H$Z mb ( e mmmMr O mJ m)
g m_ m` n U o ~ Z b ob o Z g Vo d _ moR>o A mVS>o N>moQ>` m
{\ $ ` wb m` m ( Z {b H$m) g h m` mZ o _ y _ mJ me r /
` moJ r_ mJ me r O moS>b ob o A g Vo. A Z moa o Q>b _ mb \ $m_ }e Z
A g b o ` m_ wb m_ ` o X` m` m {d H$ma mMo _ mU O m V A g Vo.
{e d m` ` md oi r n J V h moU m` mXwg ` mA d ` d n U mb rMoh r
A mO ma ` m _ wb m_ ` o A mT>i VmV. CXmh a U mW CXmh a U mW CXmh a U mW CXmh a U mW- -- - _ U Ho$,
_ y qn S> d h mVmn m` m` m h mS>mVrb Xmof B` m{X. . . . 1 0 %
_ wb m_ ` oQ>H$sA mo- Bg m\ o${O A b {\ $ ` yb mh r A g Vmo. h m

Xmof ^ ma VmV I yn O m V _ mU mV A mT>i Vmo. Vg oM X{j U
^ ma VmV H$mh r O _ mVrV g J mo {d d mh m_ wi oVa ` mMo _ mU
I yn O m V A mh o.

_ wb m_ Yrb Xmof
b j U o/ BVa mg : b j U o/ BVa mg : b j U o/ BVa mg : b j U o/ BVa mg :
1 ) g S>mg n moQ>mV Vw~ yZ a mh V A g ` mZ o ~ mi mMon moQ>
\ w$J U o, Cb Q` mh moU o( {n d i r ) h o mg h mooVmV.
2 ) ` m p WVr_ ` o ~ mi mb m ` mo` Cn Mma Z
{_ i m ` mg n moQ>mVM A mVS>` mb m ^ moH$ n Sy>Z ~ mi J ^ ra
h mo` mMr e ` Vmg ^ d Vo.
3 ) {e d m` {n V d mg Z {b Ho$V J o ` m_ wi o
` y_ mo{Z ` mh mo` mMr e ` VmA g Vo.
4 ) d ma d ma Cb Q> m_ wi o ~ mi mV e a ra e w H$Vm` oVo.

` mg mR>r b J oMM ( EH$Xm ~ mi 2 4 Vmg mMo
P m ` md a ) ~ mi mMo H$mh r n oe b E g - a oO > H$ $Z
A Z m_ b r Z o_ H$r {H$Vr _ mU mV A mh o/ Z o_ H$s b o h b Hw$R>o
A mh o h o R>a d b o O mVo d ` mZ wg ma e {H$` m Ho$b r O mVo
I a Va ~ mi mb mO _ mZ Va n h r ` m2 4 Vmg m` m O _ mZ Va n h r ` m2 4 Vmg m` m O _ mZ Va n h r ` m2 4 Vmg m` m O _ mZ Va n h r ` m2 4 Vmg m` mA mV H$mi r H$mi r H$mi r H$mi r
e r h moU e r h moU e r h moU e r h moU d ` mMr Z m|X R>od b r O mU I wn _ h d mM A mh o, n a Vy
` mH$S>oXwb j Ho$ ` mZ o~ mi mb mC{e a m Xd mI m` mV A mU b
O mV; ` md oi r O Vyg g J m_ wi o Cn Mma b m {VVH$m MmJ b m
{Vg mX {_ i V Z mh r d ~ mi XJ md ` mMr e ` Vmd mT>Vo.

A Z m_ b rMo{Z XmZ H$a ` mg mR>r ~ mi mb mCn S>oH$$Z Ho$b ob mE g - a o

- b mo Q>mBn A Z m_ b r A g ` mg EH$Xme {H$` m
H$ $Z n yU Xw Vr ( H$a o e Z ) h moD$ e H$Vo.
- n a Vy BQ>a _ oS>rEQ>/ h m` Q>mBn g mR>r Q>` mQ>` mZ o
e {H$` mH$a md >r b mJ Vo.
Q>oS> Q>oS> Q>oS> Q>oS> g O a r : g O a r : g O a r : g O a r :
` mV g d W_ S>md rH$S>on moQm` mI mb ` m^ mJ mV
H$mob m Q>m_ r H$ $Z ( _ b {d g O Z mg mR>r H { _ _ mJ d _ wI )
A mVS>` m_ ` o A g b ob m A S>Wi m Xya H$ob m O mVmo. EH$Xm
~ mi mb m A g b ob m YmoH$m Q>i b m, d O Z d mT>m` b m b mJ b oH$s
_ J ( g mYma U V: ~ mi 3 _ {h ` mMo P m ` md a ) _ w `
e {H$` m H$ Z g S>mg mMr O mJ m Z g {J H$[a ` m / Z m_ b
O mJ r ~ Z d b r O mVo. ` mZ Va g mYma U V: 6 Vo 8
A mR>d S> mZ Va H$mob m Q>m_ r ~ X Ho$b r O mVo.
A mn a oe Z Z Va Z ` mZ o ~ Z d b o ` mJ wX> ma mMo_ wI
~ ma rH$ h moD$ Z ` o h U yZ S>m` b oQ>oe Z H$a ` mMmg m {Xb m
O mVmo.

H$mob m Q>m_ r : n moQmd a rb _ b {d g O Z mg mR>rmmH{ _ _ mJ
_ wb t _ Yrb Xmof : _ wb t _ Yrb Xmof : _ wb t _ Yrb Xmof : _ wb t _ Yrb Xmof :
_ wb r_ Yrb Xmof WmoS>m d oJ ` m H$ma Mm A g Vmo.
n w H$i d oi m e mmmMr O mJ mg m_ m` n U o~ Z b ob r A g Vo, n a Vy
Z oh _ r` m O mJ r Z CKS>Vm, ` mn oj m n wTo CKS>Vo. ` mV
{\ $ ` y>b m_ moR>mA g yZ ` mXd ma o g S>mg ~ mh oa n S>V A g ` mZ o
Z d O mV ~ mi mb m ( O _ V: ) H$mh r mg Z g Vmo. A e m
_ wb r_ ` o b Kd r d e mmmMr O mJ m EH${ Vn U o CKS>V
A g ` mZ o g S>mg H$a VmZ m ` mVZ m h moVmV. ` mI oa rO
d ma d ma b Kd rMo B\ o$ e Z h moVo.
~ mi mb mH$mh r mg h m` ` mA mYr A mn a oe Z Ho$ ` mg Vo
EH$m Q>oO _ ` oM H$a Vm` oVo. ` mZ Va _ m Q>` mQ>` mZ oM
e {H$` m H$a md r b mJ Vo. ` m A mO ma mV g S>mg md a {Z ` U
` o` mMon _ mU 7 5 - 8 0 % BVHo$ A g Vo.

{\ $ ` wb mXd ma on wTo CKS>U ma r e mmmMr O mJ m
h m A mO ma A g b ob r _ wb Perinatal Period _ ` o oo o
XJ md ` mMr H$ma U o XJ md ` mMr H$ma U o XJ md ` mMr H$ma U o XJ md ` mMr H$ma U oh U O oC{e a md H$s` _ XV {_ i U o C{e a md H$s` _ XV {_ i U o C{e a md H$s` _ XV {_ i U o C{e a md H$s` _ XV {_ i U o d m
` m` mV A g b ob oA mZ wf [J H$ BVa Xmof .
3 ) 3 ) 3 ) 3 ) h e wJ {S>g rP h e wJ {S>g rP h e wJ {S>g rP h e wJ {S>g rP ( (( ( _ oJ mH$mob Z _ oJ mH$mob Z _ oJ mH$mob Z _ oJ mH$mob Z ) )) )
` mV _ moR> mA mVS> mMr h mb Mmb KS>d yZ A mU U m` m
Z g mMr d mT>n wU n U o P mb ob r Z g Vo. ` mVrb n a m{g n WoQ>rH$
J J b rA mZ g o g A p Vd mV Z g VmV. A mVS>` m` m
_ O mn wa d R>` mV {~ KmS>P m ` mZ o~ mYrV ^ mJ O mS> d A $X
h moVmo. g m_ m` V: O >| h m _ moR>` m A mVS> mMm H$mh r ^ mJ
A mHw$MZ n md Vmo, V|o h m n wT>` m ^ mJ mMo g a U h moD$Z
A mVS> mVrb _ b n wT>o T>H$b b o O mVo. n a Vw h e wJ
{S>g rP _ ` o h oh moV Z mh r. ` m_ wi o A mVS> mMm d a Mm^ mJ
( Z m_ b A mVS> ) A d m^ m{d H$[a ` m g a U n md Vmo.
^ ma VmV ` m a moJ mMo _ mU I yn O m V A mh o. Ho$d i ` m

a moJ mMo{Z XmZ ~ ` mMd oi mS>m Q>a mZ m_ mh rV Z g ` m_ wi oqH$d m _ mh rV Z g ` m_ wi oqH$d m _ mh rV Z g ` m_ wi oqH$d m _ mh rV Z g ` m_ wi oqH$d m
Vr e ` Vmb j mV Z KoV ` m_ wi o~ a rM _ wb XJ md VmV. Vr e ` Vmb j mV Z KoV ` m_ wi o~ a rM _ wb XJ md VmV. Vr e ` Vmb j mV Z KoV ` m_ wi o~ a rM _ wb XJ md VmV. Vr e ` Vmb j mV Z KoV ` m_ wi o~ a rM _ wb XJ md VmV.

{d Vma b ob oZ m_ b A mVS>o d O mS P mb ob m~ mYrV ^ mJ

b j U o : b j U o : b j U o : b j U o :
1 ) {S>b oS> 1 ) {S>b oS> 1 ) {S>b oS> 1 ) {S>b oS>n g oO A m n g oO A m n g oO A m n g oO A m\ \\ \ $ _ oH$mo{Z ` _ : $ _ oH$mo{Z ` _ : $ _ oH$mo{Z ` _ : $ _ oH$mo{Z ` _ :
g mYma U V: 9 0 - 9 5 % _ wb mZ m O _ mZ Va n [h ` m 2 4
Vmg mV H$mi r e r h moVo. n a Vy4 8 Vmg mZ Va XoI rb Vr P mb r
Z mh r Va _ oJ mH$mob Z ` m{Z XmZ Mr e ` Vmb j mV ` md r.
A WmV A n w` m{Xd g mMr d O _ md oi r O Vyg g J P mb ob r _ wb
` mb mA n d mX A g ye H$VmV.
2 ) Vrd d $n mMm_ b md a moY : 2 ) Vrd d $n mMm_ b md a moY : 2 ) Vrd d $n mMm_ b md a moY : 2 ) Vrd d $n mMm_ b md a moY :
~ a rM _ wb XmoZ - XmoZ , VrZ - VrZ {Xd g g S>mg H a V
Z mh rV. ~ a oMXmE{Z _ mqH$d mg n mo{P Q>a r Q>mH$ ` md a M g S>mg
h moVmo. ` m_ wi o n moQ> {Xd g |{Xd g \ w$J V O mVo. _ wb Hw$n mo{f V

h moV. h mVn m` ~ ma rH$ d mQ>VmV. h o A g oM XrKH$mi Mmb y
a m[h ` mg _ wb mMr d mT>XoI rb I wQ>Vo. ` m_ wi od oi rM Cn Mma
h mooU oA ` V {Z H$S>rMo~ Z Vo.
3 33 3 ) EQ>a moH$mob m` {Q>g ) EQ>a moH$mob m` {Q>g ) EQ>a moH$mob m` {Q>g ) EQ>a moH$mob m` {Q>g >: :: :
g S>mg ~ a mM d oi A mVS> mV Vw~ yZ a mh r ` m_ w i o
O Vy~ mYm h moVo. A mVS>` m` m A mVa A md a U mb m g yO ` oD$Z
A mVS> mVrb {d f ma r ` a $m ma oe mof b r O mVmV d _ wb mb m
O VyXmof h moVo. e mMmb mn mVi h moVo, KmU d mg ` oVmo. ~ mi mb m
Vmn ` oVmo. ~ a oMXm n moQ>\ w$J b ob oA g Vo. ` m` m` mA mO ma mMr
g d g m_ m` O Z _ mU g mZ m d A J Xr H$mh r S>m Q>a m_ ` og w m
_ m{h Vr Z g Vo. ` m_ wi o{Z XmZ h mo` mg d ` mo` Cn m` ` mo O Z m
( A mn a oe Z B` m{X) h mo` mg d oi b mJ Vmo. {e d m` BVH$m
H$mb md Yr J o ` m_ wi o _ moR> m A mVS> mb m ^ a n ya g yO ` oVo d
` m_ wi o A mn a oe Z h o _ Q>r Q>oS>M H$a md ob mJ Vo.

n moQ>\ w$J rZ o V ~ mb H$

1 ) 1 ) 1 ) 1 ) n moQ>mMm E g n moQ>mMm E g n moQ>mMm E g n moQ>mMm E g - -- - a o: a o: a o: a o:
` mE g - a o_ ` oA mVS> mZ mg yO A mh oqH$d mZ mh r h o
H$i y e H$V. Vg oM A mVS> mb m N>oX P mb mA g ` mg ` mMh r
{Z XmZ h moD$ e H$Vd n moQ>mV n mU r O _ mP m ` mMm A XmO
` oD$ e H$Vmo.
2 ) ~ oa r` _ EZ r_ m: 2 ) ~ oa r` _ EZ r_ m: 2 ) ~ oa r` _ EZ r_ m: 2 ) ~ oa r` _ EZ r_ m:
h o` m a moJ mMo {Z XmZ H$a ` mg mR>r Ho$b oO mU ma o n oe b
E g - a oO A mh oV. ` m_ ` o J wXXd ma md mQ>o N>moQ>r Z i r Kmb yZ
S>m` ( ~ oa r` _ ) Q>mH$b m O mVmo d A mVS> m_ Yrb ~ oa r` _ Mm
d mh _ m{Z Q>a d a n m{h b m O mVmo. m mog rO a Xa ` mZ
_ m{Z Q>a d a ~ {KVb o ` m KQ>Z mMr Z m|X Ho$b r O mVo. {e d m`
A mVS>o Z $s {H$Vr {d Vma b ob o( A mVS>` mMmA mH$ma {H$Vr
d mT>b ob m A mh o) A mh o h o H$i ` mMm A mn a oe Z ` m d oi ob m
Z $sM \ $m` Xmh moVmo.
3 ) a o Q>b ~ m` mg r : 3 ) a o Q>b ~ m` mg r : 3 ) a o Q>b ~ m` mg r : 3 ) a o Q>b ~ m` mg r :
h r WmoS>r B h o{P h Q>o Q> A g b r Va r a moJ {Z XmZ mMr
I m rb m` H$ n X>YVr h U Vm ` oBb . ` m_ wi o h e wJ {S>g rP
A mh oqH$d mZ mh r ` mMo1 0 0 % {Z XmZ h moD$ e H$Vo.

g O a r{d f ` r . . . g O a r{d f ` r . . . g O a r{d f ` r . . . g O a r{d f ` r . . .
EH$Xm{Z XmZ P m ` md a n oe Q>Mod ` , _ moR> mA mVS> mMm
g mBP ( S>m` b oQ>oe Z {H$Vr A mh o ) , {H$Vr d oi m
EQ>a moH$mob m` Q>rg P mb ob A mh o ` md Z Hw$R> ` m H$ma M
A mn a oe Z H$a m` Mh oR>a d b O mV.
` mM g ~ YmV b n a mo H$mon r / Q>on b a Mr Cn b YVmh oh r
_ h d mMo KQ>H$ A mh oV. A mVS> mb m I yn g yO A g ` mg
~ h VoH$Xm Q>oS> g O a rM H$a md r b mJ Vo. n {h ` m Q>oO _ ` o
H$mob m Q>m_ r Ho$b r O mVoo. ` mZ Va A mVS> mMr g yO H$_ r
P m ` md a g mYma U V: 3 Vo 6 _ {h ` mZ r _ w ` e {H$` m
( (( ( S>o S>o S>o S>o\ \\ \ $sZ oQ>r h n yb Wy A mn a oe Z ) $sZ oQ>r h n yb Wy A mn a oe Z ) $sZ oQ>r h n yb Wy A mn a oe Z ) $sZ oQ>r h n yb Wy A mn a oe Z ) Ho$b r O mVo. ` mV _ moR>` m
A mVS>` mMm a o Q>_ I oa rO BVa A H$m` j _ ^ mJ H$mT>b m
O mVmo. ` mZ Va 6 Vo8 A mR>d S>` mZ r H$mob m Q>mo_ r ~ X Ho$b r
O mVo.
A mn a oe Z Z Va _ wi Mm {H$Vr ^ mJ {e H$ A mh o,
H$mob m Q>mo_ r Ho$b r A mh o d mZ mh r ` md a A mn a oe Z Mo` e mn ` e
A d b ~ yZ A g Vo. A mn a oe Z Z Va h r H$mh rd oi m H$m Q>rn oe Z /
EQ>a moH$mob m` Q>rg Mr e ` Vm A g Vo. n a Vy ~ ` mMd oi m Vo
N>moQ>` me {H$` oX>d ma oXya h moD$ e H$Vo.

A ma A ma A ma A ma mo` {e j U mMr J a O : mo` {e j U mMr J a O : mo` {e j U mMr J a O : mo` {e j U mMr J a O :
{Z XmZ b d H$a P m ` mg [g J b Q>oO _ ` oh r A mn a oe Z
h moD$ e H$Vo d ` m_ wi o h m n rQ>b m` P oe Z Mm I M, ` mg mR>r
md m b mJ U ma m d oi d _ mZ {g H$ mg , Vg oM n ` oH$
g O a rg mR>r md m b mJ U ma m O Z a b A Z Wo{e ` m ( ^ yb ) h o
g J i A mn U Q>mi ye H$Vmo. ` mg mR>r b h mZ _ wb md a Cn Mma >
H$a U m` m, A ma mo` g ood oe r g ~ {YV ` oH$mb m A mO ma m~ b
n wa oe r _ m{h Vr {_ i U _ h d mMA mh o.

{H$S>Z r` m{d H$Vr {H$S>Z r` m{d H$Vr {H$S>Z r` m{d H$Vr {H$S>Z r` m{d H$Vr
g m` b r {d k mZ e mI oMr n Xd rYa . I a Va S>~ b
J ` wEQ >! Z m_ b {S>b r h a r h moD$Z n y mVr P mb ob r. XmoZ
_ {h ` m` m _ mh oa n U mZ Va g m` b r g mg a r A mb r I a r, n a Vy
` mZ Va _ m ~ mi mMo d O Z H$mh r Ho$ ` m d mT>oZ m. g d O U
~ mi mb m XyY H$_ r n S>V` h U yZ g m` b rb m Xmof XoV h moVo.
{~ Mma r A J Xr a S>d ob r P mb r h moVr. I moXyZ I moXyZ
{d Mma ` md a ~ mi mb mA YyZ _ YyZ Vmn ` oVmod b Kd rVyZ KmU
` oVo h r _ m{h Vr n wT>o A mb r. ~ mi mb m b J oMM A S>{_ Q> H$ $Z
` m` mA md ` H$ ` mVn mg ` mHo$ ` m. n r. ` y. h h O ` m
{Z XmZ mZ Va b J oMM Xy{~ U r X ma oe {H$` mh r P mb r. VXZ Va
_ m ~ mi mMo d O Z ` d p WV d mTy> b mJ b o. g m` b r` m
g mg a ` m_ S>i rMr Z ma mO r Va Hw$R> ` mHw$R>on i mb r.
g d mZ m n wT>rb Vn mg ` m{d f ` r d n wT>o ` md ` m` m
I ~ a Xma r{d f ` r ` mo` ` m g yMZ m XoD$Z ~ mi mb m{S> MmO
Ho$b .
n r. ` y. h h d ` mg ma I mM {H$S>Z re r {Z J S>rV
A g b ob m n r. ` y. O o. A m~ Q> e Z A WmV _ w me ` mMr g yO
` m{d f ` rMr _ mh rVr ` mb oI mV KoD$` m.

1 ) 1 ) 1 ) 1 ) n r. ` y. h h O n r. ` y. h h O n r. ` y. h h O n r. ` y. h h O
_ wb m` m ( _ ob g o g ) _ y _ mJ mV, b Kd r` m
{n e d r` mI mb r EH n mVi n S>XmA g Vmo, ` m_ wi ob Kd r` m
d mh mV A S>Wi m ` oVmo. qH$~ h Z m h m A mO ma \ $ $ _ wb m_ ` o
A mT>i Vmo.
J ^ me ` mV ~ mi mMr _ y qn S>oV` ma h moVmZ mM h mn S>Xm
~ Z b ob mA g ` mZ o_ y [n S>mMr d mT> g wa d mVrn mg yZ M g Xmof
h moVo. {e d m` XrKH$mi X~ md A m ` mZ o ( Persistent Back
Pressure Changes ) {H$S>Z rO d ` mVrb g w $d mVrb m
~ Z b o ` m Z o\ $mg ( O o {H$S>Z rMo \ $e Z b ` wZ rQ> A mh o) h o
{Xd g o{Xd g I a m~ h moD$Z e od Q>r _ wb m_ ` o _ y qn S> Xm~ ` _ y qn S> Xm~ ` _ y qn S> Xm~ ` _ y qn S> Xm~ `
h moVo. ` mZ m S>m` m{b g rg d {H$S>Z r ` ma mon U mMr
( Q>mg b mQ>Mrh r) J a O n Sy> e H$Vo. {H$S>Z r Q>mg b mQ> {H$S>Z r Q>mg b mQ> {H$S>Z r Q>mg b mQ> {H$S>Z r Q>mg b mQ>
b mJ U ma m h m _ wb m_ Yrb _ w ` d J _ w ` d J _ w ` d J _ w ` d J A mh o; ` m` moJ o ` m
A mO ma mMr ` mVr d m~ ` b j mV ` oBb .
A ) A ) A ) A ) ` m _ wb m_ ` o n r. ` y. h h O Mo {Z XmZ C{e a m h mo Vo,
` m` mV I mb rb _ mU ob j U o A mT>i VmV.
1 ) Wm~ yZ Wm~ yZ , W|~ W|~ b Kd r h moU o
2 ) b Kd rMr Yma ~ ma rH$ A g U o, Yma O d i n S>U o

3 ) b Kd rVyZ KmU ` oU o, ~ mi mb mVmn ` oU o
4 ) b Kd rMmH$Q>mob Z ` oU o ( 3 - 4 d f mZ Va h r)
5 ) d mg moN>d mg O b X J VrZ o h moU o
6 ) d ma d ma h moU m` mO Vyg g J m_ wi o~ mi mMr d mT> ` d p WV Z
h moU oB` m{X .

~ ) ~ ) ~ ) ~ ) n a Vy A mO H$mb {Z ` {_ Vn U o h moU m` m J ^ me ` m` m
g moZ moJ m\ $s_ wi o ~ a oMXmn r. ` y. h h A g ` mMr e ` Vm~ mi
J ^ me ` mV A g VmZ mM d Vd Vm` oVo. ~ mi mMr Xmoh r _ y qn S>od
_ y Z {b H$mZ mA g b ob r g yO d _ y me ` O mS>A g U oh r ` mMr
H$mh r {Mh o A mh oV. {e d m` ` m _ wb m_ ` o J ^ O b h r n wa oo g o Z
~ Z ` mZ o J ^ m` m N>mVrMr h mb Mmb ` d p WV h moV Z mh r
{S>b r h a rZ Va ~ mi mb m d g Z m_ ` o mg h moVmo d
g w{VH$md WoV A e r ~ mb Ho$ XJ md ` mMr e ` VmA g Vo.
~ mi m` m Xmoh r _ y qn S>mZ m d _ y Z {b H$mZ m g yO
A g U o h o n r. ` y. h h Mo _ wI H$ma U A g y e H$Vo. A e r
e ` Vm A g ` mg d oZ g r` m 2 0 A mR>d S>` m` m A mYrM
{H$S>Z rO Z m g yO A g ` mg ^ md r n mb H$mMog _ wn Xoe Z H$ $Z
` mZ mA ~ me Z Mmh r g b m{Xb mO mVmo.

~ mi m` m O _ mZ Va b d H$a mV b d H$a ` mb m
n oS>r` mQ>rH$ g O Z Z o~ KU oJ a O oMoA mh o.
1 ) e ma r[a H$ Vn mg U r e ma r[a H$ Vn mg U r e ma r[a H$ Vn mg U r e ma r[a H$ Vn mg U r - -- -
O _ mZ Va ~ mi b Kd r H$Yr d H$e r H$a Vo, n mo Q>mV
g yO A mh oH$m` ( O r g yO {H$S>Z rO , _ y Z {b H$md b Kd r` m
{n e d r_ wi o A g y e H$Vo) , d mg mMr b ` H$e r A mh o B` m{X
J mo Q>r ~ [KV ` mO mVmV.
2 ) g moZ moJ m 2 ) g moZ moJ m 2 ) g moZ moJ m 2 ) g moZ moJ m\ \\ \ $s $s $s $s - -- -
~ mi mMr g moZ moJ m\ $s H$ $Z A mYrMo{Z XmZ ~ a mo~ a A mh o
qH$d mH$g oh o ~ [KVb oO mVo. {e d m` ^ {d ` mV h r g X^ MmMU r
h U yZ Cn ` moJ r n S>Vo.
3 ) a Vm` mMmM` m 3 ) a Vm` mMmM` m 3 ) a Vm` mMmM` m 3 ) a Vm` mMmM` m-
~ mi m` m a Vm` m MmM` mh r Ho$ ` m O mVmV. ` mV
b S> H$mD$Q> ( g r. ~ r. g r. ) , b S> ` w[a ` m Z m` Q>moO Z ,
{H$` m{Q>Z rZ , b S>J g og B` m{X J mo Q>r g _ m{d Q>A g VmV.

4 44 4 ) a VXm~ mMo_ mn Z ) a VXm~ mMo_ mn Z ) a VXm~ mMo_ mn Z ) a VXm~ mMo_ mn Z - -- -
n r. ` y. h m h O A g b ob r _ wb H$YrH$Yr CMa VXm~ mMr
~ i r R>a VmV. Vmo H Q>mob h mo` mg mR>r {d {e Q> A mf YmMrh r
_ XV ` md r b mJ Vo.
5 ) b Kd rMon W: H$a U 5 ) b Kd rMon W: H$a U 5 ) b Kd rMon W: H$a U 5 ) b Kd rMon W: H$a U - -- -
b Kd rMm O Vyg g J , moQ>rg Mo _ mU , {d {e > J w d
` mJ mo Q>r Vn mg ` mO mVmV.
6 ) E_ . g r. ` y. 6 ) E_ . g r. ` y. 6 ) E_ . g r. ` y. 6 ) E_ . g r. ` y. -
` mZ Va ~ mi mMr p WVr d m^ m{d H$ A g ` mg d
b Kd rMm O Vyg g J Z g ` mg ; b d H$a mV b d H$a
_ y _ mJ mVrb Z i rd mQ>oA mf Y Q>mHy$Z ~ mi mMo n oe b E g - a oO
Ho$b oO mVmV, ` mg E_ . g r. ` y. A g oh U VmV. ` m_ ` on S>Xm
A mh o qH$d mZ mh r, _ y _ mJ m` m ` m^ mJ mb mg yO A mh oH$m` ,
_ y me ` d _ y Z {b H mMr p WVr H$e r A mh oh oH$i Vo.

{H$S>Z r_ ` oO mU ma m b Kd rMm [a b g

VmH$m{b H$ VmH$m{b H$ VmH$m{b H$ VmH$m{b H$ Cn Mma : Cn Mma : Cn Mma : Cn Mma :
O _ mZ Va 4 8 Vmg mZ Va h r ~ mi mZ ob Kd r Ho$b r Z mh r,
A moQ>rn moQ>mV g yO A mh o qH$d m ~ mi W|~ W|~ b Kd r H$a V ` h o
b j mV A m ` mg ~ mi m` m_ y me ` mV Z i r Kmb yZ h mA SWi m
Vmn ya VmXya Ho$b mO mVmo.
` mZ Va e ` {VV ` mb d H$a ~ mi mMr {g Q>mo H$mon r {g Q>mo H$mon r {g Q>mo H$mon r {g Q>mo H$mon r
H$ $Z h mn S>XmO mi b mO mVmo. h oH$a VmZ m~ mi mb mn yU ^ wb
X>` md r b mJ Vo. n a Vy` m _ wb m_ ` ob Kd rMm Vrd O Vyg g J
A g Vmo d {H$S>Z rMr H$m` j _ Vm I yn H$_ r A g Vo ` m
_ wb m_ ` o Q>mo_ mO ( Highest Diversion ) H$ $Z _ y [n S>mMo

H$m_ n yd d V h mo` mg mR>r g Yr {Xb r O mVo. ` m` moJ o O a
B\ o$ e Z H$Q>mob P mb o Va h i yh i y~ mi mMr d mT> h moD$ b mJ Vo
d ` mZ Va H$mb mVa mZ oh mA S>Wi mXya Ho$b mO mVmo.
A mn a oe Z Z Va Mr H$mi O r A mn a oe Z Z Va Mr H$mi O r A mn a oe Z Z Va Mr H$mi O r A mn a oe Z Z Va Mr H$mi O r : :: :
A mn a oe Z Z Va h r b Kd rMmVm~ m` m` b md oi b mJ Vmod
H$YrH$Yr n yU {Z ` U ` oV Z mh r. ` m_ w b mMr d mT> ` d p WV
h moVoA mh oqH$d mZ mh r, a $Xm~ d mT>b ob mZ mh r Z m, _ y qn S>mMo
H$m_ H$g o A mh o , b Kd rMm O Vyg g J A mh o qH$d m Z mh r h o
~ K` mg mR>r {Z ` {_ V XoI ^ mb A md ` H$ A mh o.
` mV a Vm` m d b Kd r` mMmM` m, g moZ moJ m\ $s,
[a Z b H$Z d H$YrH$Yr Urodynamic Scan ` mMmM` mMm
A V^ md H$a md m b mJ Vmo. ` m_ wi o _ wb A mO ma r n S>` m` m _ wb A mO ma r n S>` m` m _ wb A mO ma r n S>` m` m _ wb A mO ma r n S>` m` m
A mYrM ` m` m g _ ` m e moYU o A mYrM ` m` m g _ ` m e moYU o A mYrM ` m` m g _ ` m e moYU o A mYrM ` m` m g _ ` m e moYU o d ` md a ` mo` Vr
Cn m` ` moO Z mH$a U o Cn m` ` moO Z mH$a U o Cn m` ` moO Z mH$a U o Cn m` ` moO Z mH$a U o_ h d mMoR>a Vo.
b h mZ _ wb md a Cn Mma H$a U m` m S>m Q>a m_ ` o h r
` m~ X>Xb A O yZ O mU {Z _ mU h moU o J a O oMo A mh o. ` m` moJ o,
` mVrb H$mh r _ wb mZ mVa r A mn U XrKH$mb rZ _ y qn S>Xm~ `
h mo` mn mg yZ d mMd ye Hy$.

2 ) n op h ` wa oQ>oa rH$ O e Z A m~ Q> e Z ( n r. ` y. O o. 2 ) n op h ` wa oQ>oa rH$ O e Z A m~ Q> e Z ( n r. ` y. O o. 2 ) n op h ` wa oQ>oa rH$ O e Z A m~ Q> e Z ( n r. ` y. O o. 2 ) n op h ` wa oQ>oa rH$ O e Z A m~ Q> e Z ( n r. ` y. O o.
A m~ Q> e Z ) A m~ Q> e Z ) A m~ Q> e Z ) A m~ Q> e Z )
` m_ ` o _ y qn S> d _ y d mh H$ Z {b H$m O oWo O moS>b ob o
A g VmV. VoWo, a MZ m_ H$/ H$m` m_ H$ A S>Wi m A g Vmo d
` m~ mO yMr b Kd r ` d p WV I mb r CVa V Z mh r. ` m
A mO ma mb m A mn U n r. ` y. O o. A m~ Q> e Z A g oM g ~ moYy.

n r. ` y. O o. A m~ Q> e Z _ wi oCO ` m{H$S>Z rb mA mb ob r g yO

1 ) _ y qn S>mb m g yO ` oVod ` md ` on moQ>mV J mR>b mJ Vo
2 ) n moQ>mV XwI Vo
3 ) b Kd rVyZ a V md h moU o
4 ) b Kd rVyZ KmU ( n y) ` oU o, d ma d ma Vmn ` oU o ` m_ wi oh r ` m
_ wb mZ mS>m Q>a mH$S>oA mU b oO mVo

{Z XmZ {Z XmZ {Z XmZ {Z XmZ : :: :
1 ) g moZ moJ m 1 ) g moZ moJ m 1 ) g moZ moJ m 1 ) g moZ moJ m\ \\ \ $s $s $s $s
A mO H$mb J ^ me ` m` m g moZ moJ m\ $s_ wi o ~ mi n moQ>mV
A g VmZ mM ` m{d H$ma mMo{Z XmZ H$mh r _ mU mV H$mh moBZ mh moVo
d ` m_ wi o~ mi mb m mg h m` ` mA mYrM Cn m` ` moO Z mH$a Vm
` oVo.
2 ) [a Z b H$Z 2 ) [a Z b H$Z 2 ) [a Z b H$Z 2 ) [a Z b H$Z
[a Z b H$Z Xma oZ o_ Ho$ {Z XmZ P m ` md a A mn a oe Z Mr
b J oMM J a O A mh oqH$d mZ mh r h oS>m Q>a R>a d VmV.
A mn a oe Z {e d m` A mn a oe Z {e d m` A mn a oe Z {e d m` A mn a oe Z {e d m` Cn Mma : Cn Mma : Cn Mma : Cn Mma :
\ $mb mo- A n g moZ moJ m\ $s Xma o {H$S>Z r` m g mBP Mm
A mb oI R>od b mO mVmod g yO I yn A g ` mg / d mT> ` mg d m
{H$S>Z rMoH$m_ H$_ r P m ` mg ( A g ` mg ) A mn a oe Z Mmg b m
{Xb mO mVmo.
b h mZ _ wb m_ ` o d {d e of V: ` m {d H$ma m_ ` o
_ y Z {b Ho$Mm A mHma ( ` mg ) I yn M b h mZ A g ` mZ o h o
A mn a oe Z I yn M H$me ` n yd H$ H$a md b mJ V. A mn a oe Z Z o
{H$S>Z r` mH$m_ mV n yT>oh moU ma mg ^ m ` h mg Q>mi Vm` oVmo.

` wa mob m{O H$b mb og ` wa mob m{O H$b mb og ` wa mob m{O H$b mb og ` wa mob m{O H$b mb og
e d a r` m n {h ` m ~ mi mb m _ oqZ J mo_ m` b mog rb Mm
mb o_ h moVm. Vr d {d Z ` n wT>` m ~ mi mg mR>r ` Z H$a V
h moVo. ` md oi r Hw$R>b r I ~ a Xma r ` md r h U O o~ mi mV h o ` J
CX^ d U ma Z mh r ` m~ XXb _ mh rVr ` m` b m XmoK
p b {Z H$_ ` o A mb r h moVr. e d a rb m b J oMM \ $mo{b H$ A {g S>
g b r_ |Q>oe Z Mmb yHo$b d ` mZ Va g mYma U n U o3 _ h r` mZ r
~ mi mg mR>r ` Z H$a m` Mmd J ^ Yma U mP m ` mZ Va XoI rb 2
Vo 3 _ h rZ o g b r_ |Q>oe Z Mmb y R>od m` M h m g m {Xb m.
d f ^ a mZ oXmoK~ mi mb mKoD$Z A ` mZ XmZ o^ oQ>m` b mA mb r. h o
~ mi n yU V: Z m_ b h moV.
I a M ` mo` g _ wn Xoe Z mA ^ md r {H$VrVa r ` J
A g b ob r _ wb O _ mb m` ooVmV d ` mMr Q>rQ>_ |Q> d EH$yU M
O ~ m~ Xma r h r n mb H$mg mR>r _ moR>r S>moHo$XwI rM R>a Vo.
_ oqZ J mo_ m` b mog rb d h m` S>moHo$\ $b g ` m _ mmg Woe r
{Z J S>rV g _ ` mMmD$h mn moh ` mb oI mV Ho$b mA mh o.

1 ) 1 ) 1 ) 1 ) _ oZ t J moo_ m` b mog rb _ oZ t J moo_ m` b mog rb _ oZ t J moo_ m` b mog rb _ oZ t J moo_ m` b mog rb ( (( ( E_ . E_ . g r E_ . E_ . g r E_ . E_ . g r E_ . E_ . g r . ) . ) . ) . )
n mR>r` m H$` mb J V _ mma mye >r g ~ Y>rV J mR>
A g Vo. Vr n mR>r_ mJ o _ mZ on mg yZ H$Q>r^ mJ mn ` V Hw$R>oh r A g y
e H$Vo. n a Vy 5 0 % d oi m _ U ` m` m I mb ` m ^ mJ mV

_ mH$S>h mS>mO d i J mR> A g Vo. A e m n H$ma Mr J mR> A g b o ` m
_ wb mMo _ mU Z wH$` mM O _ b o ` m 1 0 0 0 _ wb mn H$s 1 Vo
4 BVn V A mh o

H$Q>r^ mJ mVrb _ oZ t J mo_ m` b mog rb Mr _ moR>r J mR>
E~ rA mob rO r. . . E~ rA mob rO r. . . E~ rA mob rO r. . . E~ rA mob rO r. . .
A mB` m n moQ>mV J ^ d mT>V A g VmZ m g mYma U V:
\ $b Z mZ Va g mYma U V: 3 0 Vo4 0 {Xd g mV ` ya b Q> y~ ~ X
h moVo. ` m {H$` oV A S>Wi mA m ` mg ( ` ya b Q> y~ n yU n U o
~ X Z P m ` mg ) h o ` J CX^ d V. A mBb mMmb yA g b ob r
H$mh r A mf YoCXmh a U mW- A mH$S>r ( \ $sQ>) g mR>rMr A mf Yod
H$mh r h rQ>{_ g Mr H$_ Va Vm` m_ wi oh o ` J g ^ d V. \ $mb rH$
A g rS>Mr H$_ Va Vm h o ` moJ mA Vr {g P mb ob oEH$ H$ma U
A mh o. ` m_ wi oh o ` J Q>mi ` mg mR>r J ^ Yma U on yd 3 _ {h Z od
` mZ Va g mYma U V: 3 _ {h Z o \ $mb rH$ A g rS> Q>~ b oQ>g

( 4 0 0 g) Ko` mMm g m {Xb m O mVmo. n a Vy J ^ ma n U mMo
{Z ` moO Z Ho$ ` mg M h oe ` A mh o.
Xwg a m n ` m` h U O o g d O Z Z j _ _ wb t Z m
b mA mYrn mg yZ \ $mb rH$ A g rS> Mmb y H$a U o. [e d m` H$mh r
J ^ {Z a moYH$m_ YyZ h r ( g VVr{Z ` _ Z m` m J mo ` m_ YyZ )
\ $mb rH$ A g rS> Xo` mMm Vmd e mg Z m` m{d Mma mYrZ A mh o.
n Wmb mO r : n Wmb mO r : n Wmb mO r : n Wmb mO r :
` mV _ U ` mVrb Xmof m>~ a mo~ a M _ mma my_ YyZ O mU ma o
_ mmVVy d ` md a rb A md a U o h oh r g Xmof A g VmV.
H$Q>r^ mJ m_ ` o J mR> A g ` mg n m` m` m h mb Mmb r {Z ` { V
H$a U m` mZ g m{Z H$m_ r P m ` mZ o` m_ wb m_ ` on m` mMr VmH$X
g m_ m` _ wb mn oj m~ a rM H$_ r A g Vo. n [a U m_ r n m` mV Xmof
{Z _ mU h moVmV. {e d m` _ b _ w md a Vm~ m Z g ` mZ o O rd Z
X` Z r` h moVo.
Vg oM ` m J mR>r~ a mo~ a M _ |Xy_ ` o A a Z m S> {M` ma r A a Z m S> {M` ma r A a Z m S> {M` ma r A a Z m S> {M` ma r h o
_ mb \ $m_ }oe Z A g Vo, ` m_ wi o_ |XyVrb n mU rh r d mT>Vod ` mMm
~ wX>` mH$md a / Q>rd a {d n a rV n [a U m_ h moVmo. h U O oM ` m
A mO ma mV _ Q>r[g Q>r_ B h m d _ |Q > _ Q>r[g Q>r_ B h m d _ |Q > _ Q>r[g Q>r_ B h m d _ |Q > _ Q>r[g Q>r_ B h m d _ |Q >A g Vo. ` m_ wi o
Q>rQ>_ |Q>h r Ve rM g d g _ md oe H$ A g md r b mJ Vo.

` J mMo_ mn Z : ` J mMo_ mn Z : ` J mMo_ mn Z : ` J mMo_ mn Z :
1 ) 1 ) 1 ) 1 ) Z m` ye $sMo_ moO _ mn ( Z m` ye $sMo_ moO _ mn ( Z m` ye $sMo_ moO _ mn ( Z m` ye $sMo_ moO _ mn ( _ g b MmQ>vJ _ g b MmQ>vJ _ g b MmQ>vJ _ g b MmQ>vJ ) )) ) : : : :
` m_ ` o g m` {d wVn d mh mZ o Crn Z n m` mMr VmH$X
Z o_ H$s {H$Vr A mh o d b Kd r / g S>mg mMm H$Q>mob {H$Vr
n _ mU mV A mh o h o MmQ> Ho$b o O mVo. VXZ Va S>m Q>a mZ m
Cn Mma m` m {Z n mr~ b ^ m ` H$a U o g mon o O mVo. n m` m` m
Z m` y~ b mMo Z o_ Ho$ {M g _ moa A g ` mg ` mMo ` Wmo{MV
n wZ d g Z ` mMmCn ` moJ H$ Z KoVm` oVmo.
CXmh a U mW- _ g b n md a 3 Vo4 ( Z m_ b b o h b 5
A g Vo) A g ` mg n m` mMo{Z ` _ rV ` m` m_ H$a ` mg A mn U
n mb H$mZ m d _ wb mZ mh r n d m H$ e H$Vmo; d WmoS> me m
A mYma mZ o ( CXmh a U mW- Hw$~ S> m KoD$Z ) h r _ wb o Mmb y
e H$VmV. n a Vy n md a 0 qH$d m 1 A g ` mg A e m _ wb mg mR>r
p h b MoA a Mmn ` m` {Z d S>md mb mJ Vmo.
H$mh r Z m` yn wO ` mMr / _ g b J wn Mr VmH$X BVa mn oj m
O m V A g ` mg Q>|S>Z Q>m \ $a g O a r H$ Z _ wb mb mO m VrV
O m V J {V_ mZ VmXoVm` oD$ e H$Vo.
2 ) n mR>r` m_ U ` mMoE g 2 ) n mR>r` m_ U ` mMoE g 2 ) n mR>r` m_ U ` mMoE g 2 ) n mR>r` m_ U ` mMoE g - -- - a oO : a oO : a oO : a oO :
` m ma o{H$Vr _ U ` mV Xmof A mh o, \ $ $ J mR>A g b o ` m
O mJ r mb o_ A mh oH$s ` m{e d m` Xwg a rH$S>oh r _ U ` mV Xmof

A mh oh oH$i Vo. {e d m` _ U ` m` m XmoZ ^ mmmV {H$Vr A Va
A mh o h oH$i ` mZ oJ mR> H$mT> ` md a Ca U ma m{S>\ o$ Q> A mn U
~ X H$ {H$d m H$g o; ` mg mR>r H$mh r n oe b g {O H$b
mo{g O a Mr J a O A mh oH$m` h oR>a d Vm` oVo.
3 ) 3 ) 3 ) 3 ) n mR>r` m_ U ` mg mR>r E_ . A ma . A m` . : n mR>r` m_ U ` mg mR>r E_ . A ma . A m` . : n mR>r` m_ U ` mg mR>r E_ . A ma . A m` . : n mR>r` m_ U ` mg mR>r E_ . A ma . A m` . :
E_ . A ma . A m` . Ho$ ` mZ oJ mR>_ mma my_ ` o{H$Vn V
A mV_ ` o A mh o, Z o_ H$m Hw$R>o d {H$Vn V CU rd A mh o, {H$Vr
_ mmVVyI a m~ P mb ob oA mh oV, A O yZ Hw$R>b mA Z wf {J H$ Xmof
A mh o H$m, A mn a oe Z Xa ` mZ Hw$Rb r H$mi O r ` m` b m h d r
` mMmA XmO ~ mYVm ` oVmo. {e d m` ` m~ a mo~ a _ |XyMoh r E_ .
A ma . A m` . Ho$b o A g ` mg S>mo ` mV {H$Vr n mU r A mh o,
A m mmn ` V {H$Vr h mZ r P mb ob r A mh o mMrh r _ m{h Vr {_ i Vo
d Ho$g Mo ( n oe Q>Mo ) n yU a moJ {Z XmZ h mo` mV ` mMm I yn M
\ $m` Xmh moVmo.
4 ) 4 ) 4 ) 4 ) \ \\ \ $S>mo H$mon r $S>mo H$mon r $S>mo H$mon r $S>mo H$mon r ( A mn W _ mo H$mon r) :
n oe QMr X >r g m_ m` A mh oH$m` , Q>rQ>_ | Q>Z Va ` mb m
{H$Vn V {Xg ye Ho$b h o \ $S>mo H$mon rZ oA mn U R>a d ye H$Vmo.
5 ) 5 ) 5 ) 5 ) n moQ>mMog moZ moJ m n moQ>mMog moZ moJ m n moQ>mMog moZ moJ m n moQ>mMog moZ moJ m\ \\ \ $s $s $s $s : :: :
` mVrb ~ ` mM _ wb mV h g m` H$mo` ya oQ>a b [a b g _ wi o
{H$S>Z rb m / _ y d mh H$ Z {b H$mZ m g yO A g Vo. b Kd rMm

O Vyg g J A g Vmo. n oe Q>b mXrKH$mi ` mo` _ m oV {VO {d Ho$
{X ` mZ oA mn U {H$S>Z rMog ^ m ` Z wH$g mZ Wm~ d ye H$Vmo.
e [H$` oMr J a O e [H$` oMr J a O e [H$` oMr J a O e [H$` oMr J a O : :: : I mb rb J mo >t g mR>r A mn a oe Z Ho$b oO mVo.
1 ) n mR>r` m J mR>rg mR>r J mR>rg mR>r J mR>rg mR>r J mR>rg mR>r - J mR>r` m O mJ r {MH$Q>b o ` m
Z g m A mn a oe Z Z o g moS>d ` m O mVmV. ` m` moJ o n wT>o h moU ma o
g ^ m ` Z wH$g mZ Q>mi Vm` oVo.
2 ) S>mo ` mVrb n mU r H$_ r H$a ` mg mR>r n mU r H$_ r H$a ` mg mR>r n mU r H$_ r H$a ` mg mR>r n mU r H$_ r H$a ` mg mR>r - O oU oH$ $Z
_ |Xyd a rb Xm~ H$_ r h moD$Z _ |XyMr d mT> d m^ m{d H$[a ` m
h moBb .
3 ) n m` mMmXmof Xya H$a ` mg mR>r

[V~ YH$ Cn Mma : [V~ YH$ Cn Mma : [V~ YH$ Cn Mma : [V~ YH$ Cn Mma :
n wT>` m ~ mi mVh r h o ` J A g ` mMo _ mU {H$` oH$
n Q>t Z r d mT>Vo. ` m_ wi o Vo Q>mi ` mg mR>r A mBd S>rb mZ r
J ^ ma n U mMo{Z ` moO Z H$a md od \ $mob rH$ A {g S>g b r_ | Q>oe Z
4 0 0 g Z KoVm` m` m1 0 n Q>rZ oO m V h U O o4 0 0 0 g
BVHo$ d {Z ` {_ Vn U o ` md o. {e d m` h o ` J ~ mi d mT>V
A g VmZ m ( oZ g r` m 2 0 A mR>d S>` m` m A mYrM)
H$i ` mg / A e r e ` Vm A g ` mg ; ^ md r n mb H$mMo
g _ wn Xoe Z H$ $Z ` mZ mA ~ me Z Mmh r g b m{Xb mO mVmo.

H$mh r Z md r` n yU Cn Mma n Vr : H$mh r Z md r` n yU Cn Mma n Vr : H$mh r Z md r` n yU Cn Mma n Vr : H$mh r Z md r` n yU Cn Mma n Vr :
A mO H$mb H$mh r g |Q>g _ ` o ~ mi J ^ me ` mV d mT>V
A g VmZ mM { {{ {\ \\ \ $Q>b g O a r $Q>b g O a r $Q>b g O a r $Q>b g O a r H$ Z ` m ` J m` m H$a o e Z g mR>r
` Z Ho$b m O mVmo` . ` mb m {_ i U ma m {Vg mXh r A Z wHy$b
A mh o. n U ^ ma VmV A O yZ Va r h o ` j mV ` m` Mo A mh o.
` mI oa rO _ yi n oe r _ yi n oe r _ yi n oe r _ yi n oe r n ` ma mon U n ` ma mon U n ` ma mon U n ` ma mon U h m n ` m` h r A mVm Cn b Y
h moVmo` .
2 ) 2 ) 2 ) 2 ) h m` S>moHo$ h m` S>moHo$ h m` S>moHo$ h m` S>moHo$\ \\ \ b g b g b g b g
_ |XyO b mMm {Z Ma m h mo` mg mR>r A g b ob r _ |XyVrb
d m^ m{d H$ O mJ m~ X A g ` mZ oS>mo ` mMmKoa d mT>Vmo. ~ mi mb m
S>moH$o CMb U o O _ V Z mh r. n [a U m_ r C^ o a mh U o, Mmb U o ` m
{H$` mh r C{e a mZ o h moVmV. d mT>b o ` m _ |XyO b m_ wi o
H$d Q>rVrb oe a d mT>Vod ` mMm A mO y~ mO y` m _ |Xyd a X~ md
` oVmo. h i yh i y _ |XyMr P rO h moD$ b mJ Vo. {e d m` S>mo ` m` m
Z g md a Xm~ A m ` mZ o Q>rh r A Yy h moVo. BQ>mHo${Z A b n oe a
O g oO g od mT>Vo, Vg o` mMoA {YH$ Xw n [a U m_ O mU d yb mJ VmV.
Vo{d {d Y Ho${Z ` b Z h ` mn m g r_ wi oh moVmV.

A {V[a V d mT>b ob mS>mo ` mMmKoa h m` S>moHo$\ $b g - S>mo ` m` mZ g md a
A mb o b mXm~

1 ) BQ>mHo${Z A b n oe a d mT> ` mg 1 ) BQ>mHo${Z A b n oe a d mT> ` mg 1 ) BQ>mHo${Z A b n oe a d mT> ` mg 1 ) BQ>mHo${Z A b n oe a d mT> ` mg
- XyY, A {J i ` mV ~ mYm` oVo
- d ma d ma Cb Q> m
- d mg mg mg h mooU o
- Z mS>rMr J Vr H$_ r h moU o
2 ) h o oe a A g oM XrKH$mi O m V a mh r ` mg _ oSy>b a r g |Q>a
( d g Z mMo {Z ` U H$a U ma m _ |XyMm ^ mJ ) H$d Q>r` m ~ mh o a
n mR>r` m _ U ` mV d r > h moVmo; d ` m_ wi o A MmZ H$ d mg
~ X h moD$Z _ yb XJ md ye H$Vo.

3 ) _ |XyMr P rO _ |XyMr P rO _ |XyMr P rO _ |XyMr P rO P m ` mg h r _ wb o_ X~ w rMr h moVmV. Vg oM
n m` m` mZ g md a X~ md ` oD$Z n m` mMr VmH$X H$_ r h moVo( O U y
H$mh r b H$d m_ ma b mA mh o) . ` mb mn a mn a og rg A g oh U VmV.
n wT>on wT>on m` mVrb VmH$X n yU n U oH$_ r h moD$Z n a m{b g rg Mmh r
YmoH$m g ^ d Vmo. Vg oM _ b _ y mMo {Z ` U O m` mMmh r YmoH$m
A g Vmo.
4 ) _ moR> m_ wb m_ ` o d ma d ma Cb Q> md S>moHo$Xw I r h moU oh r
b j U oh r h m` S>moHo$\ $b g e r g ~ {YV A g y e H$VmV. {e d m`
S>mo ` m` m h mb Mmb r H$a U m` m Z g md a d > S>mo ` m` m
I mo~ U r` mh mS>md a X~ md A m ` mZ o_ wb S>moi od a H$ $Z ~ Ky
e H$V Z mh r. Vg oM S>moi oI mo~ U r` m~ mh oa A m ` mZ oS>mo ` md a
n mn ` mn yU ~ X h moV Z mh rV. ` m_ wi oS>mo ` m` mH$S>mCKS> m
a mh rb o ` m^ mJ mMr {d e of H$mi O r ` md r b mJ Vo.
1 ) J ^ O b mMo _ mU O m V A g U o.
2 ) ~ mi mMo S>moHo$ _ moR>o ( Z m_ b a |O ` m d a Vr) A g U o d
S>mo ` mMmKoa d oJ mZ od mT>U o.
3 ) 3 ) 3 ) 3 ) Q>mi yZ ^ a U o/ Q>mi y\ w$J U oB` mXr.
1 ) 1 ) 1 ) 1 ) e ma r[a H$ Vn mg U rV A mTi U ma r b j U o b j U o b j U o b j U o

2 ) Q>mg 2 ) Q>mg 2 ) Q>mg 2 ) Q>mg \ \\ \ $mQ>Z ob g moZ moJ m $mQ>Z ob g moZ moJ m $mQ>Z ob g moZ moJ m $mQ>Z ob g moZ moJ m\ \\ \ $s : $s : $s : $s :
Q>mi y CKS>r A g VmZ m ` mVyZ ( Q>mg \ $mQ>Z ob )
g moZ moJ m\ $s H$ $Z h m` S>moHo$\ $b g {H$Vr _ mU mV A mh o, Xmoh r
( S>m ` md CO ` m) ~ mO yb mg ma I mA mh o H$r VoA g _ mZ A mh o,
n m` m_ ` o O Vyg g J A mh o {H$d m H$g o h o g moZ moJ m\ $sZ o H$i y
e H$Vo.
3 ) 3 ) 3 ) 3 ) g rQ>r H$Z : g rQ>r H$Z : g rQ>r H$Z : g rQ>r H$Z :
O o h m Q>mi y ~ X A g Vo {H$d m ` J mMo n yU {Z XmZ h d o
A g Vo, Vo h m S>mo ` mMm g rQ>r H$Z ( H$m` wQ>a mBS>>
Q>mo_ moJ m\ $s ) Ho$b m O mVmo d ` mMo A MyH$ {Z XmZ Ho$b o O mVo.
~ a oMXm _ |XyO b d mh H$ {g Q>r_ _ ` o A S>Wi m A g ` mZ o
n m` mMm{Z Ma mh moV Z mh r d S>mo ` mVrb n mU r d mT>Vo.

h m` S>moHo$\ $b g - S>mo ` mMmg rQ>r H$Z

A mO H$mb g w{VH$md WoV A {YH$ MmJ b r H$mi O r
KoVb r J o ` m_ wi o~ a rMe r A n w` m{Xd g mMr _ wb oh r d mMd ` mV
A mn U ` e d r h moV A mh moV. n a Vw` m` mn H$s H$mh r _ |XyVrb
a $ md mMo ~ i r R>a VmV. { _ ` wA a ~ o~ rO _ ` o _ |XyVrb
a $d mh r` mZ mA mYma XoU m` mCVt Mr d mT> P mb r Z g ` mZ o
WmoSm h mXa m ~ g ` mg _ |XyV a $ md h moVmo. ` m a $J mR>r
e mof ` m O mD$Z , VoWo {Z _ mU P mb ob r n moH$i r _ |XyO b mZ o
^ a b r O mVo. {e d m` b rS>rJ _ wi o_ |XyO b mMm{Z Ma mh mo` m` m
n {H$` oV A S>Wi m` oD$Z h m` S>moHo$\ $b g h moD$ e H$Vo. Voh i yh i y
H$_ r h mo` mMr e ` Vmh r A g Vo.
2 ) O o h m h m` S>moHo$\ b g A a Z m S> {M` ma r _ mb \ $m_ }oe Z
qH$d m Q> w~ a ` wb m{g g _ wi o A g V Vo h m b d H$a mV b d H$a
` mMm {Z Ma m h moU J a O oM A mh o. Z mh rVa ` mMo Xw n [a U m_
O mU d m` b md oi b mJ V Z mh r.
Cn Mma mMo d $n : Cn Mma mMo d $n : Cn Mma mMo d $n : Cn Mma mMo d $n :
1 ) g ` mMr M{b V n Vr h U O o h |Q>r ` wb mo- n oa rQ>mo{Z ` b
e Q> ( h r. n r. e Q>) . ( h r. n r. e Q>) . ( h r. n r. e Q>) . ( h r. n r. e Q>) . ` mV _ |XyO b h o EH$m Z i r ma o ( O r
M_ S>rI mb yZ KmVb ob r A g Vo) n moQ>mV S>oZ Ho$b oO mVo. VoWyZ Vo
e a ra mV e mof b od e a ra m~ mh oa \ $oH$b oO mVo.
2 ) Xwg a r g ` mn M{b V h moV A g b ob r Z d rZ Cn Mma n Vr
h U O o ES>mo H$mon rH$ WS> h |Q>r ` wb m Q>m_ r ( B. Eg . Q>r) ( B. Eg . Q>r) ( B. Eg . Q>r) ( B. Eg . Q>r) .

` mV 8 0 - 8 5 % BVH$o` e mMon _ mU A mT>i yZ A mb oA mh o. ` m
Cn Mma n VrV Xw~ rU rZ o _ |Xy` m WS> h |Q>rH$b ` m ^ mJ m` m
I mb r N>oX KoD$Z _ |XyO b g ~ A a o Z mBS> n og _ ` oS>oZ Hoo$b m
O mVmo. h r XoI rb EH$ H$ma Mr BQ>a b e Q>t J {g Q>r_ M
h U m` b mh d r.
e Q> Ho$ ` mZ Va Mo [a P Q>g h o _ w ` V: e Q> H$a ` m` m
A mYr {H$Vn V h mZ r P mb ob r A mh o, _ |XyO b mMmO Vyg g J A mh o
qH$d mH$g o` md a M O m V _ mU mV A d b ~ yZ A g VmV.
` m _ wb mV e Q>Z Va _ |XyMr d mT> g m_ m` n U o h moVo, Vr
Z m_ b ~ w r_ moMr d g HVXe Z r A ` J A g VmV. n a VyH$mh r
_ wb mV e Q>Z Va h r _ |XyMr P rO A ` mh Vn U o Mmb y a mh Vo d
Cn Mma mZ m h U md m {VVH$m {Vg mX {_ i V Z mh r. e Q>e r
g ~ YrV J wVmJ wVrMrh r A mh oV.
EHy$U M _ oqZ J mo_ m` b mog rb d h m` S>moHo$\ $b g ` m Xmoh r
A mO ma mV ~ mi Cn Mma mZ Va h r ~ mi g Xmof a mh Vo. ` m_ wi oM h o
A mO ma h moD$M Z XoU od P m ` mg b d H$a mV b d H$a Cn Mma
H$ $Z g ^ m ` h mZ r Q>mi U A mn ` mh mVmV A mh o. ` mg mR>rM
A mn ` m A mh ma mVrb \ \\ \ $mob rH$ A {g SMr _ m m ` mo` $mob rH$ A {g SMr _ m m ` mo` $mob rH$ A {g SMr _ m m ` mo` $mob rH$ A {g SMr _ m m ` mo` A mh oZ m
` mMr H$mi O r KoU d J ^ Yma U od oi r d mT>rd n wa d R>m KoU o h r
Vg Xr Vg Xr Vg Xr Vg Xr g d ^ md r _ mVmZ r KoVb r n m{h O o.

H$mh r Z oh _ r A mT>i U m` m n a Vy{H$a H$moi d $n m` m H$mh r Z oh _ r A mT>i U m` m n a Vy{H$a H$moi d $n m` m H$mh r Z oh _ r A mT>i U m` m n a Vy{H$a H$moi d $n m` m H$mh r Z oh _ r A mT>i U m` m n a Vy{H$a H$moi d $n m` m
g _ ` m g _ ` m g _ ` m g _ ` m
Xwg a rV {e H$U ma m{d e mb A S>I i V ~ mob Vmoh o Hyb
h o W MoH$A n ` m d oi r ` m` m {e {j Ho$Z o g m{J Vb o. ` mb m
Q>J - Q>m` A g ` mMo A mT>i b o. h r ~ m~ Xwb {j b r J o ` mZ o
` m` m J Vrb m~ a rM I ri ~ g b r h moVr. A mn a oe Z Z oO r^
g moS>d yZ ` mZ Va n rM Woa n r Q>Mr Q>rQ>_ |Q> Mmb y Ho$b r.
Va rXoI rb g _ d ` rZ _ wb mBVHo$ g ^ mf U H$me ` Vmo mV
H$ $ e H$b mZ mh r.
Voa md f m` mn a mJ b m_ mZ oV 8 - 1 0 {Xd g mn mg yZ J mR>
A mh od Vmn ` oVmo` h U yZ n mb H$ KoD$Z A mb o. Q>r. ~ r. Mr e H$m
A g ` mZ oE\ $. EZ . E. g r. ( g wBZ oVn mg U r) Ho$b r. {Z XmZ n Ho$
P mb o. b J oMM A mf Ymon Mma >Mmb yHo$ ` mZ on wT>MmA Z WQ>i b m.
Q>J - Q>m` , _ mZ oVrb J mR>r, Z m^ re r g ~ YrV g _ ` m
B` mXr {H$a H$moi d $n m` m n a Vy Z oh _ r A mT>i U m` m
mb og ~ XXb A {YH$ _ mh rVr KoD$` mn wT>rb b oI mV.
1 ) 1 ) 1 ) 1 ) _ mZ oVrb J mR>r _ mZ oVrb J mR>r _ mZ oVrb J mR>r _ mZ oVrb J mR>r
~ a oMXm _ mZ oV J mR>r P m ` m_ wi o Km~ $Z O mD$Z
_ wb mZ m S>m Q>a mH$S>o Z ob o O mVo. n U g mYma U n U o 9 0 %
_ wb m_ ` o h o BVa g m` m A mO ma mMo/ O Vy~ mYoMo b j U
A g Vo

o H$mZ mV n yA g U o
o S>mo ` mV H$m|S>m/ O Vy~ mYmA g U o
o g m` Z yg m` Q>rg / Q>mpg g Mm mg
o XmVmM/ {h a S>` mMB\ o$ e Z
o Ke mMmO Vyg g J
o Q>r. ~ r.
o BVa A mO ma

qb \ $mo_ m` m_ mZ oVrb J mR>r

Vn mg H$o h mJ a O oMo Vn mg H$o h mJ a O oMo Vn mg H$o h mJ a O oMo Vn mg H$o h mJ a O oMoA mh oV. . . A mh oV. . . A mh oV. . . A mh oV. . .
1 - 2 J mR>r A g Vrb d ` m d mT>V Z g ` mg / ` m_ wi o
H$mh r mg Z g ` mg n mb H$m` m g _ wn Xoe Z m{e d m` Xwg a
H$mh rh r H$a ` mMr J a O Z g Vo. n a Vy J mR> d mT>V A g ob ;
_ wb mb mVmn , Z oh _ rMmI moH$b m, d O Z H$_ r h moU o, a V md ,
h mS>mZ mg yO B` m{X b j U o A g ` mg J mR>rMmVn mg H$a U o
J a O oMo~ Z Vo.
` mV 1 ) a VmMmVn mg ( g r. ~ r. g r. ) ,
2 ) N>mVrMmE g - a o
3 ) J mR>rV g wBQ>mHy$Z Vn mg ( FNAC) d
4 ) _ mQ>moQ>o Q>( d MoMr MmMU r) ` m_ wb ^ y V J mo Q>r A V^ yV
A g VmV.
5 ) {h Q>mo {h Q>mo {h Q>mo {h Q>mo- -- - n Wmb mO r n Wmb mO r n Wmb mO r n Wmb mO r
d a rb MmM` mZ r {Z XmZ P mb oZ mh r Va J mR>H$mT>yZ
` mMm Vn mg ( {h Q>mo- n Wmb mO r) Ho$b m O mVmo d ` mX>d ma o
n Ho$ {Z XmZ n Ho$ Ho$b oO mD$ e H$Vo.

J mR>r d mT>` mMr BVa H$ma U o: J mR>r d mT>` mMr BVa H$ma U o: J mR>r d mT>` mMr BVa H$ma U o: J mR>r d mT>` mMr BVa H$ma U o:
g m` mg m` O Vy~ mYo_ wi o J mR>r A mh oV H$m ` wHo${_ ` m
( a VmMmH$H$a moJ ) , qb \ $mo_ m ( a g J WrMmH$H$a moJ ) , ES>g Mr
b mJ U B` mXr H$ma U o A mh oV ` mMr Vn mg U r H$a U o J a O oMo
A g Vo.
H$mh r _ wb m_ ` oBVa {R>H$mU rh r h U O oH$mI oV, O mKoV
A e mJ mR>r A g ye H$VmV. ` md oi r H$mh r _ moR>mA mO ma Z mh r
Z m h o O mU yZ KoD$Z ` mZ wg ma Cn Mma mMr {Xe m R>a d md r
b mJ Vo.
2 ) 2 ) 2 ) 2 ) Q>J Q>J Q>J Q>J - -- - Q>m` Q>m` Q>m` Q>m`
{O ^ oI mb rb d Mm b h mZ d VmoH$S>r A g ` mZ o O r^
{MH$Q> ` mg ma I r d mQ>Vo.

{MH$Q>b ob r O r^

1 ) _ wb mb m n Q>~ mob ` mV A S>MU ` oVo
2 ) {d e of V: X` d Vmb ` >d U m` m CMma mV
O r^ / XmV/ Qm>i y
` mMmg n H$ ` oV A g ` mZ o Vo CMma U oA d KS>h moVo.
CXmh a U mW: a , b B` mXr.
3 ) {O ^ oMr d m^ m{d H$ h mb Mmb Z P m ` mZ o
- b mi J i U o{H$d m
- \ $ V ^ md {Z H$ J m|Yi CS>m ` mZ o _ moR>on U r _ w b mZ m
S>m Q>a mH$S>oA mU b oO mVo.
e {H$` mH$o h mJ a O oMr A mh e {H$` mH$o h mJ a O oMr A mh e {H$` mH$o h mJ a O oMr A mh e {H$` mH$o h mJ a O oMr A mh o: :: :
_ wb 3 - 4 d f mMoh moBn ` V O a O r^ A moR>m` mn wT>oA mU Vm
` oV A g ob / Q>mi yb m b mJ V A g ob Va e {H$` m H$a ` mMr
J a O Z mh r.
e {H$` oMo d n e {H$` oMo d n e {H$` oMo d n e {H$` oMo d n d ` m d ` m d ` m d ` mZ Va Mr H$mi O r : Z Va Mr H$mi O r : Z Va Mr H$mi O r : Z Va Mr H$mi O r :
` mV e {H$` oZ o O r^ g moS>d b r O mVo. ` mZ Va H$mh r
{Xd g Vm|S>m` m d N>VoMr H$mi O r KoV ` mg A mO ma n yU n U o

~ a mh moVmo. A mn a oe Z Va n rM Woa {n Q>Mo_ mJ Xe Z Ko` mMr
J a O ^ mg Vo.
3 ) Z m^ rMm( A ~ {b H$b ) h {Z ` m 3 ) Z m^ rMm( A ~ {b H$b ) h {Z ` m 3 ) Z m^ rMm( A ~ {b H$b ) h {Z ` m 3 ) Z m^ rMm( A ~ {b H$b ) h {Z ` m

h mb h mZ _ wb m_ ` og d m{YH$ A mT>i U ma m h {Z ` mA mh o.
` mV Z m^ rMr O mJ m n yU ~ X P mb ob r Z g Vo. ` mVyZ A mVS>r
qH$d m A mo_ oQ>_ ~ mh oa ` oVo d \ w$J m ( J mR>) A m ` mg ma I m
d mQ>Vmo. H$_ r {Xd g m` m ~ mi m_ ` o Bd m` Z b
h {Z ` m _ mU oM A ~ {b H b h {Z ` mMo n _ mU XoI rb O m V
A g Vo. ` m A mO ma m_ ` o A mn a oe Z Mr KmBZ H$a Vm d a Mod a
Vn mg yZ {S>\ o$ QMr g mBP H$_ r h moVo` ` mMr I m r H$a Vm` oVo.
g mYma U V: ~ mi 1 Vo2 d f mMoh moBn ` V g yO A mn moA mn H$_ r
h moVo. _ wb 3 d f mMoh moD$Z - XoI rb Z m^ rVrb {N> ~ X Z
P m ` mg e {H$` mH$ $Z Vo~ X H$a Vm` oVo.

Z m^ rMmh {Z ` m

A m~ Q> Q>oS> h {Z ` mMm mg : A m~ Q> Q>oS> h {Z ` mMm mg : A m~ Q> Q>oS> h {Z ` mMm mg : A m~ Q> Q>oS> h {Z ` mMm mg :
n U H$YrH$Yr 3 d f mI mb rb _ wb o A m~ Q> Q>oS> h {Z ` m
h U yZ A m_ ` mH$S>o ` oVmV. ` mV n moQ>mVrb A d ` d A mVS>r
Z m^ r_ wI mV A S>H$ ` m_ wi o _ wb m` m n moQ>mV XwI Vo;
A mVS>` mZ mg yO ` oU o, Cb Q` mh moU o, h o mg h moVmV.
B_ O g r Q>rQ B_ O g r Q>rQ B_ O g r Q>rQ B_ O g r Q>rQ>_ |Q>: >_ |Q>: >_ |Q>: >_ |Q>:
~ mi mb m d oXZ me m_ H A mf Yo XoD$Z A mVS>r n moQ>mV
n a Vd ` mMm ` Z Ho$b m O mVmo 4 8 Vmg mZ Va WmoS>r g yO
H$_ r P m ` md a A mn a oe Z H$ $Z {N> ~ X H$a Vm ` oVo.
H$YrH$Yr h {Z ` m g H$_ ` o A S>H$b o ` m A mVS>` mMm
a V d mh ~ X n Sy>Z VoH$mi on S>` mMr e ` VmA g Vo. n U h o
_ mU Bd m` Z b h {Z ` m` mVwb Z oV I yn M H$_ r A g Vo.
4 ) 4 ) 4 ) 4 ) A mo_ A mo_ A mo_ A mo_ \ \\ \ $b m` Q>rg $b m` Q>rg $b m` Q>rg $b m` Q>rg
Z m^ r_ ` o O Vyg g J P m ` m_ wi o Z m^ r d g ^ mod Vmb Mm
^ mJ b mb h moVmo, VoWog yO ` oVo. H$YrH$Yr Z m^ rVyZ n yh r ` oD$
b mJ Vmo. ~ a oMXm VoWrb d N>VmZ a mI ` m_ wi oA g oh moVo.
Q>rQ>_ |Q>: Q>rQ>_ |Q>: Q>rQ>_ |Q>: Q>rQ>_ |Q>:
` m_ ` o ~ o~ rMr O mJ m H$moa S>r d d N> R>oD$Z ~ mi mb m
{VO {d Ho$ {Xb r O mVmV. ` m_ wi o ~ a oMXmg yO CVa Vo. n a Vy
H$YrH$Yr A mVS>o d m b Kd rMr {n e d r Z m^ re r O moS>b ob o

A g VmV d ` mVrb md Z m^ r ma o~ mh oa ` oVmo. A e md oi ob m
A mn a oe Z H$ Z M Vo~ a oH$a md ob mJ Vo.
5 ) 5 ) 5 ) 5 ) A ~ {b H$b J ` wb mo_ m A ~ {b H$b J ` wb mo_ m A ~ {b H$b J ` wb mo_ m A ~ {b H$b J ` wb mo_ m
Z m^ rd a b mb g a J mR> ` oVo d ` mVyZ {MH$Q> md ` o V
a mh Vmo. g ^ mod Vmb Mr d Mmb mb h moVo.

J ` wb mo_ m- ~ o~ rd a rb J mR>

` mg mR>r H$mn a g \ o$Q>/ {g h a Z m` Q>oQ>Z oMa H$m{Xb m
O mVmo{H$d mJ ` wb mo_ m` m_ wi me r K>YmJ m~ mY ` mZ o` mMm
a $ d mh Wm~ Vmo. VoA mn moA mn J i yZ n S>Vo.

A mU I r EH$ g mon mCn m` h U O o d N >Ho$b ob mg Yd d m
{_ R>mMm I S>m {MH$Q>n Q>Q>rZ o ~ o~ rd a KQ>Q> >~ g d md m. ` m_ wi o
~ o~ r H$moa S>r h moVo. A g o Z P m ` mg A {S>Z mo_ m h o {Z XmZ
g _ O md o. ` mV Z m^ rMm {h g m d g ^ mod Vmb Mm n moQ>mMm ^ mJ
H$mT>md mb mJ Vmo.
6 ) 6 ) 6 ) 6 ) a o Q>b mob g a o Q>b mob g a o Q>b mob g a o Q>b mob g
g S>mg mMr O mJ m ( a o Q>_ >) J wX ma md mQ>o I mb r g a H$Vo.
_ wb Hw$n mo{f V A g Vo . ~ a oMXm XrKH$mi O wb m~ mZ Va h m
A mO ma CX>>^ d Vmo. _ moR>` mA mVS>` mb mO mJ od a Y $Z R>od U ma o
Z m` y H$_ O moa / {e Wrb P m ` mZ o A J ~ mh oa ` oVo. O moa
b md ` md a qH$d m _ b {d g O Z m` m d oi rM g S>mg mMr O mJ m
I mb r ` oVo.

J wX ma md mQoI mb r A mb ob oa o Q>_ >

mob g H$_ r _ mU mV A g ` mg , VX>Z Va A mn moA mn
A mV O mVo. n a Vy A {YH$ H$mb md Yr J o ` mg Vo h mVmZ o A mV
Kmb md ob mJ Vo. a V md A ^ md mZ oM h moVmo.
Q>rQ>_ |Q : Q>rQ>_ |Q : Q>rQ>_ |Q : Q>rQ>_ |Q :
g w $d mVr` m H$mi mV Q>n t J d _ wb m` m A mh ma mV
A md ` H$ Vo~ Xb Ho$b oO mVmV. Va rXoI rb mob g Vg mM
a mh r ` mg A mn a oe Z Z oXya H$a md mb mJ Vmo.
7 ) 7 ) 7 ) 7 ) a o Q>b n mb rn a o Q>b n mb rn a o Q>b n mb rn a o Q>b n mb rn
EH$ b mb g a J mR>g S>mg m` md mQ>oI mb r ` oVod d a Mod a
a V md h moVmo. g S>mg g m\ $ h moVmod _ wb mb mn moQ>mV XwI V
Z mh r. _ wb m_ Yrb n Sy>a moJ m` m A Z oH$ H$ma U mn H$s h o EH$
H$ma U A mh o. J wX ma md mQ>o Vn mg U r Ho$ ` md a ~ a oMXmJ mR>
h mVmb mb mJ Vo.

J wX ma md mQ>o Vn mg U r Ho$ ` md a ~ mh oa A mb ob r J mR>d a V md

N>moQ>o A mn a oe Z H$ $Z J mR> H$mT>Vm` oVo.
8 ) 8 ) 8 ) 8 ) {h _ {O A mo_ m {h _ {O A mo_ m {h _ {O A mo_ m {h _ {O A mo_ m
h mV, J mb , S>mo ` mMmd a Mm^ mJ , Moh a m, O r^ ` m{R>H$mU r
N>moQ>` m a Vd {h ` mMr A {Z ` {_ V d A _ ` mX d mT> h moD$Z
a Vd m{h ` mMm n wO H$m ~ Z Vmo. ` mb mM {h _ {O A mo_ m A g o
g ~ moYb o O mVo. ~ a oMXm O _ mZ Va 1 0 - 1 5 {Xd g Hw$R>b rh r
J mR>Z g Vo, \ $ V N>moQ>r b mb g a O _ I yU {Xg Vo. ` mZ Va
_ m h i yh i yb mb a J mMr J mR>~ Z Voo. W_ 6 - 7 _ [h Z o d mT>yZ
g mYma U 1 - 2 d f mn ` V ` m I wU m H$_ r h moV O mVmV. H$mh r
d oi ob m1 2 d f mn ` V XoI rb {h _ {O A mo_ mO A mn moA mn H$_ r
h moVmV. n U ` mVrb H$mh r J mR>r ` m{Z ` _ mb m A n d mX
A g VmV.

O r^ d I mb ` mA moR>mMm {h _ {O A mo_ m

1 ) I mO ` oU o,
2 ) a V md h moU o( d {MVMh m mg h moVmo) ,
3 ) J mR>S>mo ` m` mO d i A g ` mg X Q>rd a h r ` mMmn [a U m_
h moVmo.
4 ) ^ S>H$ b mb a J mM>r, I S>~ S>rV ^ ` X I yU ( d U )
O mU d Vo.

{Z XmZ : {Z XmZ : {Z XmZ : {Z XmZ : d a rb {R>H$mU r I wU mA mT>i VmV .
- ~ a oMXm_ wb mb mBVa H$mh rh r mg Z g Vmo.

- h mVmZ oXm~ {X ` mg a V {Z KyZ J o ` mZ o ` mI wU m
a J h rZ
h moVmV d Xm~ H$mT> ` mg n yd d V b mb h moVmV.
Cn Mma Cn Mma Cn Mma Cn Mma mMo d n : Mo d n : Mo d n : Mo d n :
~ ` mMd oi m n mb H$m` m g _ wn Xoe Z m{e d m` H$mh rh r
H$a ` mMr J a O Z g Vo. _ m J mR> d mT>V A g ` mg , A d KS>
O mJ r A g ` mg d m {d Xwn n U m ` oBb BVH$s _ moR>r A g ` mg
BO o e Z Q>rQ>_ |Q>Z o ` mMr d mT> a moI Vm ` oVo. H$mh r d oi ob m

CXmh a U mW CXmh a U mW CXmh a U mW CXmh a U mW- -- - h mV, S>moHo$ ` oWrb J mR>r J wVmJ wV h mo` mMr
e ` VmO m V A g ` mZ o A mn a oe Z Z o H$mT> ` mO mVmV .
9 ) 9 ) 9 ) 9 ) {g Q>rH$ h m` J mo_ m {g Q>rH$ h m` J mo_ m {g Q>rH$ h m` J mo_ m {g Q>rH$ h m` J mo_ m
` mV n m_ w ` mZ o_ mZ , Moh o` mMmI mb Mm^ mJ , H$mI ` oWo
J mR>A mT>i Vo. Vr _ D$, {b ~ {b ~ rV b mJ Vo.

h m` J mo_ mMr _ mZ od a rb J mR>
1 ) ~ a oMXm~ mi mb mH$mh r mg Z g Vmo.
2 ) J mR>I yn _ moR>r A g ` mg _ m O _ VmM ~ mi mb m d mg
` m` b m
mg h moVmo.
3 ) O Vyg g J P m ` mg d a Mr Mm_ S>r b mb h moVo, Vmn ` o Vmo.

Cn Mma H$a U oH$o h mJ a O oMoA mh o? Cn Mma H$a U oH$o h mJ a O oMoA mh o? Cn Mma H$a U oH$o h mJ a O oMoA mh o? Cn Mma H$a U oH$o h mJ a O oMoA mh o?
5 0 % Ho$g og _ ` o6 _ {h ` mn ` V J mR>n y U V: H$_ r h moVo.
` mZ Va _ m Vr A mn a oe Z Z o H$mT>md r b mJ Vo. H$mh r d oi m
_ mZ oV A g b ob r J mR>N>mVrV Kwg ` mZ oh r d g Z mb mA S>Wi m
` oVmo. ` md oi r b mJ U ma r g O a r _ m ~ a rM {H$MH$Q>A g Vo.
1 0 ) 1 0 ) 1 0 ) 1 0 ) _ mZ A mI S>U o _ mZ A mI S>U o _ mZ A mI S>U o _ mZ A mI S>U o ( (( ( Q>Z m}_ Q>mBS Q> w_ a Q>Z m}_ Q>mBS Q> w_ a Q>Z m}_ Q>mBS Q> w_ a Q>Z m}_ Q>mBS Q> w_ a >) >) >) >)
A {V[a $ X~ md A m ` mZ o Q>Z m}p b S>mo_ Q>mBS> ` m
_ mZ o` m_ w ` Z m` y_ ` oa $ md h moD$Z g mYma U J moQ>r` m
A mH$ma mMr g yO ( J mR>) ` oVo. h o g m_ m` mV: , ~ mi 1 - 2
A mR>d S` mMo P m ` md a A mT>i Vo. ~ mi mMm Moh a m {d
{Xe ob m d i b ob m a mh Vmo. J mR> A g b o ` m ~ mO yb m ~ mi Moh a m
d i d V Z mh r. n m` mi y( ~ rM S>r{b h a r) _ wb d {S>{b h a r` m
d oi r {M_ Q> mMmd mn a P mb o ` m_ wb m_ ` oh mQ>` w_ a h mo` mMo
_ mU O m V A g Vo. ~ mi mb m Xwg a mH$mh rh r mg Z g Vmo.

Q>m{Q>H$mo{b g _ wi o{d $X {Xe oo b md i b ob mMoh a m

Cn Mma Cn Mma Cn Mma Cn Mma :
1 ) J mR>rd a Mmoi ` mMo/ _ g mO H$a ` mMoQ>mi md o
( ` mZ oA mU I rZ M h mZ r h moVo)
2 ) 2 ) 2 ) 2 ) { {{ {\ \\ \ $O rA moWoa n r : $O rA moWoa n r : $O rA moWoa n r : $O rA moWoa n r : ~ mi g yO A mb o ` mg mBS>b m_ mZ d i d V
Z mh r. {Xd g mVyZ 3 0 - 4 0 d oi m A mn U ` m {Xe oob m _ mZ
d i d m` Mm( {O VH$s O mBb {VVH$s ) n ` Z H$a md m. ~ mi J mR>
A g b o ` m{Xe oZ o_ mZ d i d ` mg C mw V h moBb A g m ` Z
H$a md m. ( ` m ~ mO yb m I oi ` mMm A md mO H$a U o / ~ mi mb m
h mH$ma U o) B` m{X.

d oi oV Bb mO Z P m ` mg . . . . . d oi oV Bb mO Z P m ` mg . . . . . d oi oV Bb mO Z P m ` mg . . . . . d oi oV Bb mO Z P m ` mg . . . . .
` m J mR>rg mR>r d oi rM ` mo` Cn m` ` moO Z m Ho$b r Z mh r Va
` mMoXw n [a U m_ O mU d VmV. J mR>A mb o ` m Z m` yMm ^ mJ
VVyZ r ^ Z {Z KVmo. Z m` yMr b m~ r H$_ r h moVo. _ mZ
Z oh _ rH$[a Vm ( Permanently) Xwg ` m ~ mO wb m ( J mR>r` m
{d $X {Xe oob m) d i b ob r a mh Vo. ` mb mM Q>m{Q>H$mo{b g Q>m{Q>H$mo{b g Q>m{Q>H$mo{b g Q>m{Q>H$mo{b g A g o
h U VmV. ` m_ wi o Moh ` m` m ` m ~ mO y` m BVa Z m` y` m
d mT>rd a h r n [a U m_ h moVmo. Moh ` mMr EHy$U R>od U M ~ Xb Vo.
` md oi r _ m _ moR` me {H ` oZ oH$a o e Z H$a md ob mJ Vo.

1 1 ) 1 1 ) 1 1 ) 1 1 ) J i d m( H$a Q>) J i d m( H$a Q>) J i d m( H$a Q>) J i d m( H$a Q>)
S>mo ` mMmd a Mm^ mJ , _ mZ , H$mI , O mK, T>wJ U B` m{X
{R>H$mU r J i d m h moVmV. EHy$U M A d N>Vm d Wm{Z H$
O Vyg g J J i d mh mo` mg H$ma U r^ yV R>a Vmo. d Mo` mI mb r n y
O _ m h moD$Z J i d o h moVmV. _ ma b mJ U o, Ke mMm O Vyg g J ,
S>mo ` mVrb H$m|S>m, XmVmMo / {h a S` mMo B\ o$ e Z h r H$ma U o
A g ye H$VmV.

S>m ` mI mX>` md a rb H$a Q>
1 ) d Mod a d ` mI mb r g yO ` oU o
2 ) h mVmb m J mR>b mJ U o
3 ) J mR>rMm^ mJ J a _ d b mb h moU oo
4 ) Vmn ` oU o.
5 ) n e P m ` mg A {Ve ` d oXZ mh moVmV.

Cn Mma Cn Mma Cn Mma Cn Mma :
g w $d mVrb m n {VO {d H$o XoD$Z ~ a oMXm J i d m H$_ r
h moVmV. _ m EH$Xm ` m {n H ` mg d m H$_ r Z P m ` mg
A mn a oe Z Z o Mra XoD$Z ( S>>oZ H$ $Z ) ` mVrb n y H$mT>b m
O mVmo. ` mZ Va XoI rb A ~ g og H$p h Q>r b d H$a ~ X h moD$ Z ` o
h U yZ {Z ` {_ Vn U o S>oqg J g H$a m ` m b mJ VmV. EH$Xm A mV
g mMb ob o a V d n y` mMm ` d p WV {Z Ma mP m ` md a Vmn
b J oM H$_ r h moVmo.

^ ^^ ^
^ ^^ ^
m mm m
m mm m
J JJ J
J JJ J
3 33 3
3 33 3

A AA A
A AA A
m mm m
m mm m
Y YY Y
Y YY Y
w ww w
w ww w
{ {{ {
{ {{ {
Z ZZ Z
Z ZZ Z
H HH H
H HH H
$ $$ $
$ $$ $
` `` `
` `` `
w ww w
w ww w
J JJ J
J JJ J
m mm m
m mm m
V VV V
V VV V
r rr r
r rr r
b bb b
b bb b

~ ~~ ~
~ ~~ ~
m mm m
m mm m
b bb b
b bb b
e ee e
e ee e

` `` `
` `` `
{ {{ {
{ {{ {
M MM M
M MM M
{ {{ {
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H HH H
H HH H
$ $$ $
$ $$ $

g gg g
g gg g
m mm m
m mm m
e ee e
e ee e
m mm m
m mm m

S>oHo$A a g O a r S>oHo$A a g O a r S>oHo$A a g O a r S>oHo$A a g O a r
EHy$U M h mp n Q>b m` P oe Z Mm Hw$Qw>~ m` m A WmO Z md a d
Z mVog ~ Ymd a h moU ma mn [a U m_ b j mV KoD$Z S>oHo$A a g O a r h r
g H$ n Z mCX` mb mA mb r A mh o.
` mV U mb m( ~ mb U ) e {H$` o` mA mYr {d {d Y
Vn mg ` m d a moJ {Z XmZ mg mR>r XmI b Z H$a Vm {Z XmZ
~ m U md WoV ( A mo. n r. S>r. ~ og rg d a ) Ho$b oO mVo. ` mZ Va
~ mi mb m g O a r` m {Xd e r g H$mi r A S>{_ Q> H$ Z
A mn a oe Z Z Va Mma Vog h mVmg mVM Ka r g moS>b oO mVo. A WmVM
` m n H$ma mMm A d b ~ H$mh r {H$a H$moi e {H$` m~ m~ VrVM
H$a Vm` oVmo.
~ mb e ` {M{H$g me m mV g ` mh {Z ` m/ h m` S>mo g rb
g O a r, g wVm, A ~ g og S>oZ oO g ma ` m e {H$` m d H$mh rd oi m
h m` n mo n oS>r` mg g O a rg mR>r S>oHo$A a n VrMmA d b ~ Ho$b m
O mVmo. ` m n Vr` m d mn a m_ wi o XrKH$mi
h m n rQ>b m` P oe Z g mR>r h moU ma mI Md d oi oMmA n ` ` Q>mi yZ
` mo` Vo[a P Q>g XoVm` oVmV.
_ m ` mg mR>r
- A mo. n r. S>r. ~ og rg d a a moJ {Z XmZ mg mR>r A md ` H$ g d
Vn mg ` mMr g mo`
- A md ` H$VoZ wg ma ~ mb a moJ Vk mH$Sy>Z Vn mg U r

- Vk ^ wb Vk mH$Sy>Z ~ mi mMr Vn mg U r ` m{e d m`
- A mn a oe Z Xa ` mZ A Z n o{j Vn U oH$mh r J wVmJ wV P m ` mg
^ a Vr H$a ` mg mR>r A md ` H$ ` mg mo` rg w{d Ym
- d ` mg mR>r b mJ U ma r n yd n a d mZ J r ` m g d ~ m~ t Mr
n yVVmh moU o A md ` H$ A mh o.
Ve r Vr P m ` mg A {YH$m{YH$ e {H$` m S>o Ho$A a
g O a r h U yZ H$a Vm` oVrb d ` mMoA n o{j V b m^ ~ mb $U
d n mb H$ XmoKmZ mh r {_ i Vrb . A mn a oe Z n yd u ~ mi mMr g ~ YrV
e [H$` mJ h mb m ^ oQ> KS>d yZ A mU ` mg A mn a oe Z ` m d oi r
h moU ma r A d WVm H$_ r H$a Vm ` oD$ e H$Vo. ` mg mR>r ` m
{WA Q>a g _ yh mMr a MZ mh r MmB S> \ o$S>b r A g ` mg
A ` wV_ .
~ mi mMr EH$Xa rV V` oV ( b mJ mm` mA mn a oe Z I oa rO )
A mn a oe Z A mYr g wT> A g U o d ` mb m Xwg ` m Hw$R> ` m
Q>rQ>_ |Q>Mr J a O Z g U o` m~ m~ rh r ~ mi mg mR>r S>oHo$A a g O a rMm
d mn a H$a Vm` oBb H$mh oR>a d VmZ m_ h d m` mR>a VmV.

The Future is Bright for Day Care Surgery !

b mo H$mo{n H$ g O a r b mo H$mo{n H$ g O a r b mo H$mo{n H$ g O a r b mo H$mo{n H$ g O a r
n moQ>m` m A V^ mJ mV S>moH$md yZ n mh ` m` m _ mZ d m` m
{O k mg oVyZ b mo H$mo{n H$ g O a rMmCJ _ P mb m. ` mb mM H$s -
h mob g O a r ( Key hole surgery ) A g oh r g ~ moYb oO mVo.
` m_ ` o Z m^ r` m d a Vr n moQ>md a N>moQ>mg m N>oX KoD$Z
Xw{~ U u` m g h m` mZ o Vn mg U r Ho$b r O mVo. J a O A g ` mg
e {H$` o` m d $n mZ wg ma A mU I r XmoZ VoVrZ b h mZ N>oX
KoD$Z e {H$` m n ma n mS>b r O mVo. A mon Z g O a r _ mU oM
A mn a oe Z A mYr ~ mi mMr g J i r n wd V` ma r P m ` md a n wU
^ yb oI mb r ` m H$ma Mr e {H$` mHo$b r O mVo.

b mo H$mon >r - n moQ>md a rb N>oX
~ mb e ` {M{H$g me m mV g ` m O R>a m` m
J mR>rg mR>r ( A m` . EM. n r. Eg . ) n m` b moa mo_ m` mQ>m_ r, n moQ>mVrb
N>moQ> m J mR>r H$mT>` mg mR>r CXmh a U mW qb \ $Z moS> ~ m` mg r,
{_ P |Q>oa rH$ {g Q> E g rO Z , A mo h oa r` Z {g Q> > E g rO Z ,

{H$S>Z r` m H$mh r e {H$` m ` mg mR>r b mo H$mo{n H$ g O a rMm
d mn a Ho$b mO mVmo` .
_ m ` mMm m_ w ` mZ o Cn ` moJ h moVmo Vo A Z {S>g |S>oS> A Z {S>g |S>oS> A Z {S>g |S>oS> A Z {S>g |S>oS>
Q>o Q>rO Q>o Q>rO Q>o Q>rO Q>o Q>rO ` mH$S>re Z _ ` o. d f U mMon moQ>mVrb WmZ A moi I yZ ,
VoVoWyZ g moS>d yZ - a Vd m{h ` md d r` d m{h Z rg H$Q>I mb r
A mU yZ A S>H$mof mV ~ g d ` mg mR>r ( A m{H$A mon o g r) d h {Z ` m
g O a rg mR>r.
E n mB_ m h U O oM N>mVrV O _ m P mb ob m n y
H$mT>` mg mR>rh r b mo H$mon Mm d mn a H$ob mO mVmo. ` m H$ma ` m
g O a rb mp h S>rA moA {g Q>oS>Wmoa H$mo H$mo{n H$ g O a r ( VATS )
A g og ~ moYb oO mVo.
b mo H$mo{n H$ g O a r_ ` o N>oX b h mZ A g ` m_ wi o
O I _ b d H$a ^ a Vo. b d H$a {S> MmO P m ` mZ o
h m n rQ>b m` P oe Z Mm I Mh r H$_ r h moVmo. {e d m` H$_ rV H$_ r
d oXZ mh mh r EH$ d mT>rd b m^ $U mb m{_ i Vmo.
A WmV ` mg mR>r b mJ U ma r I mg Cn H$a U o, S>m Q>a mMo
{d e of e ` H$me ` ( b mo H$mon rVrb {e j U ) , Vk ^ yb Vk
d J a O n S> ` mg $U m` mV` oVrb mO moI r_ h moD$ Z XoVm
A mon Z g O a r n ma n mS>` mMr {g X>YVm d A md ` H$ Vr
n yd n a d mZ J r ` m J mo Q>rMr {Z VmV J a O A g Vo.
{Xd g o{Xd g ~ ` mMe m {H$MH$Q> e {H$` mXoI rb ` m H$ma o
H$a ` mMo A {YH$m{YH$ H$me ` H$me ` H$me ` H$me ` d J Vr J Vr J Vr J Vr n oS>r` mQ>rH$ g O Z
A m_ g mV H$a V A mh oV. ` m_ wi o^ {d ` mV ~ h Vme e {H$` m
b mo H$mon r Xma oh moD$ b mJ Vrb ` mV e H$mM Z mh r.

Q>o_ g ob Woa n r Q>o_ g ob Woa n r Q>o_ g ob Woa n r Q>o_ g ob Woa n r
Q>o_ g ob Woa n r A WmV _ wi n oe r ` ma mon U h m
e X ` moJ WmoS> mA {YH$ _ mU mV A mn U g d mZ rM EoH$b ob m
A g ob . ~ moZ _ a mo Q>mg b mQ > h m _ yi n oe r ` ma mon U mMm
H$ma 1 9 8 5 g mb mn mg yZ M{b V A g b m Va r Q>o_ g ob
Woa n r ` m H$ma mMr _ mh rVr g d g m_ m` mZ mh moVo` Vr J o ` m
5 - 6 d f mV.
_ yi n oe r h U O oe a ra mVrb BVa Hw$R> ` mh r n oe r V` ma
H$a ` mMr / d V: Mo d $n ~ Xb ` mMr j _ Vm A g b o ` m
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A mh o. A mn ` mH$S>o g ` m {X b rVrb Eg g Wo_ ` o A e m
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_ wi n oe r h U yZ Cn ` moJ h moD$ e H$Vmo A g m Xmd m
H$mo h mn ya mVrb {g X>Y ra moJ Vk S>m. g Vre n H$s ` mZ r
n w` mVrb EH$m g e moYH$ {_ m` m g ` moJ mZ o Ho$b m` . ` mMo
` m~ m~ VrVrb g e moYZ h r ` mZ r n {g Ho$b oA mh o. EH$Xa rV
e a ra mVrb Hw$R> ` mh r n oe t Mr P mb ob r P rO ^ $Z H$mT>` mg
d ` mMr O mJ mKo` mg ` m Q>o_ g o g g O h moVm` oV.
^ {d ` mV $U m` m EHy$U M Q>rQ>_ |Q>_ ` o ` m Mm
{Z p MVM g h ^ mJ A g ob h od oJ i og mJ m` b mZ H$mo!

A mO ma mMr g {j V g yMr A mO ma mMr g {j V g yMr A mO ma mMr g {j V g yMr A mO ma mMr g {j V g yMr
e {H$` m b mJ U m` m A mO ma mMr g yMr ` oWog {j V $n mV
{Xb ob r A mh o. A {YH$ _ m{h Vr H$g mVrb n R> H$_ mH$md a
Cn b Y A mh o.
1 ) 1 ) 1 ) 1 ) A Z {S>g oS>oS>Q>o Q>rO A Z {S>g oS>oS>Q>o Q>rO A Z {S>g oS>oS>Q>o Q>rO A Z {S>g oS>oS>Q>o Q>rO : :: : ( (( ( 7 7 7 7 7 7 7 7 - -- - 8 0 8 0 8 0 8 0 ) ) ) )
I mb r Z CVa b ob od f U
2 ) 2 ) 2 ) 2 ) A n |{S> A n |{S> A n |{S> A n |{S>g m` Q>rg g m` Q>rg g m` Q>rg g m` Q>rg : :: : ( 4 7 ( 4 7 ( 4 7 ( 4 7 - -- - 4 9 ) 4 9 ) 4 9 ) 4 9 )
A m n wN>A WmV A n o{S> g b mA mb ob r g yO d Xmh h U O o
A n |{S>g m` {Q>g .
3 ) 3 ) 3 ) 3 ) A Z moa o Q>b _ mb A Z moa o Q>b _ mb A Z moa o Q>b _ mb A Z moa o Q>b _ mb \ \\ \ $m_ }e Z $m_ }e Z $m_ }e Z $m_ }e Z : :: : ( ( ( ( 9 1 9 1 9 1 9 1 - -- - 9 6 9 6 9 6 9 6 ) ) ) )
_ wb m_ ` oe mmmMr O mJ m( Z m_ b a o Q>_ d A Z b H$Z mb )
~ Z b ob r Z g Vod _ moR>oA mVS>oN>moQ>` m{\ $ >` yb m` m( Z {b H$m)
g h m` mZ o_ y _ mJ me r / ` moJ r_ mJ me r O moS>b ob oA g Vo.
4 ) 4 ) 4 ) 4 ) Bd m` Z b h {Z ` m Bd m` Z b h {Z ` m Bd m` Z b h {Z ` m Bd m` Z b h {Z ` m ( O mKoVrb A VJ i ( O mKoVrb A VJ i ( O mKoVrb A VJ i ( O mKoVrb A VJ i ) : :: : ( (( ( 3 8 3 8 3 8 3 8 - -- - 4 1 4 1 4 1 4 1 ) ) ) )
A mVS>` mMm ^ mJ I mb r A m ` mZ o O mKoV d mA S>H$ome mV
{Xg U ma m\ $wJ d Q>m.

5 ) 5 ) 5 ) 5 ) En mB_ m En mB_ m En mB_ m En mB_ m( N>mVrVrb n y) ( N>mVrVrb n y) ( N>mVrVrb n y) ( N>mVrVrb n y) : :: : ( ( ( ( 6 1 6 1 6 1 6 1 - -- - 6 2 6 2 6 2 6 2 ) ) ) )
\ w$ \ w$g m` md a ` mA md a U m_ ` o md d n yO _ m h moD$Z
VoO mS>/ H$R>rU ~ Z Vod d mg moN> d mg mV A S>Wi m` oVmo.
6 ) 6 ) 6 ) 6 ) B B B B\ \\ \ $Q>mBb h m` n a Q>m{ $Q>mBb h m` n a Q>m{ $Q>mBb h m` n a Q>m{ $Q>mBb h m` n a Q>m{\ \\ \ $H$ n m` b moa rH$ Q>oZ m{g g $H$ n m` b moa rH$ Q>oZ m{g g $H$ n m` b moa rH$ Q>oZ m{g g $H$ n m` b moa rH$ Q>oZ m{g g : :: : ( (( ( 6 4 6 4 6 4 6 4 - -- -
6 6 6 6 6 6 6 6 ) ) ) )
O R>a m` m A Ymo ^ mJ mV A g b o ` m Z m` yZ m ( g ` yb a
_ g g >) g yO ` oVo d O R>a mVyZ A Z KQ>H$ I mb r CVa ` mV
A S>Wi m` oVmo.
7 ) 7 ) 7 ) 7 ) BQ>` wg g oe Z BQ>` wg g oe Z BQ>` wg g oe Z BQ>` wg g oe Z : :: : ( ( ( ( 7 77 7 4 44 4 - -- - 7 77 7 7 ) 7 ) 7 ) 7 )
A mVS>r EH$_ oH$mV Kwg ` mZ o A mVS>` mZ m g yO ` oVo.
~ a oMXm b h mZ A mVS>` mMm e od Q>Mm ^ mJ ( A m` {b E_ ) h m
` mn wT>rb _ moR>` mA mVS>` mV ( Col on ) Kwg b oob mA g Vmo. n moQ>
\ w$J U o, Cb Q>` m, g S>mg md mQ>o a V md B` m{X b j U o
{Xg VmV.
8 ) 8 ) 8 ) 8 ) HO oZ oQ>b S>m` HO oZ oQ>b S>m` HO oZ oQ>b S>m` HO oZ oQ>b S>m` \ \\ \ $_ Q>rH$ h {Z ` m $_ Q>rH$ h {Z ` m $_ Q>rH$ h {Z ` m $_ Q>rH$ h {Z ` m: :: : ( (( ( 5 8 5 8 5 8 5 8 - -- - 6 0 6 0 6 0 6 0 ) ) ) )
d mg n Q>b n yU ~ Z b ob o Z g Vo ( ` m` m S>md rH$S>rb
_ mJ ` m ^ mJ mV N>oX A g Vmo) . ` mVyZ O R>a , b h mZ / _ moR>r
A mVS>r, ` H$V, b rh m, _ w qn S>B` m{X A d ` d N>mVrV A moT>b o
O mVmV. \ w$ \ y$g mMrh r n yU d mT>P mb ob r Z g Vo.

9 ) 9 ) 9 ) 9 ) H$m Q>rn oe Z H$m Q>rn oe Z H$m Q>rn oe Z H$m Q>rn oe Z ( _ wb m_ Yrb ~ XYH$mo R>Vm) : ( _ wb m_ Yrb ~ XYH$mo R>Vm) : ( _ wb m_ Yrb ~ XYH$mo R>Vm) : ( _ wb m_ Yrb ~ XYH$mo R>Vm) : ( ( ( ( 8 8 8 8 8 8 8 8 - -- - 9 1 9 1 9 1 9 1 ) ) ) )
e mMmb mH$S>H$ h moU o, 3 - 3 {Xd g mn ` V e mMmb mZ h moU od m
e r H$a VmZ mO moa b md U oh U O oH$m Q>rn oe Z .
1 0 ) 1 0 ) 1 0 ) 1 0 ) Q>H$sA mo Q>H$sA mo Q>H$sA mo Q>H$sA mo- -- - Bg m Bg m Bg m Bg m\ \\ \ o${O A b { o${O A b { o${O A b { o${O A b {\ \\ \ $ ` yb m $ ` yb m $ ` yb m $ ` yb m: :: : ( ( ( ( 5 4 5 4 5 4 5 4 - -- - 5 55 5 8 88 8 ) ) ) )
` mV d mg Z {b H$md A Z {b H$mEH$_ oH$mZ mO moS>b o ` m
A g VmV. A KQ>H$ d Vm|S>mVrb md d mg Z {b Ho$V J o ` mZ o
~ mi mb m` w_ mo{Z ` mh moVmo.
1 1 ) 1 1 ) 1 1 ) 1 1 ) S>oA moS>oZ b A Q>o{O ` m S>oA moS>oZ b A Q>o{O ` m S>oA moS>oZ b A Q>o{O ` m S>oA moS>oZ b A Q>o{O ` m: :: : ( (( ( 6 6 6 6 6 6 6 6 - -- - 6 8 6 8 6 8 6 8 ) ) ) )
S>oA moS>oZ _ h mb h mZ A mVS> mMmg w d mVrMm^ mJ n yU n U o
~ Z b ob mZ g Vmo. A _ mJ n yU ~ X A g ` mZ oXyY n mO ` md a
Cb Q>` mh moVmV.
1 2 ) 1 2 ) 1 2 ) 1 2 ) Z oH$moQ>m` qP J EQ>a moH$mob m` Q>rg Z oH$moQ>m` qP J EQ>a moH$mob m` Q>rg Z oH$moQ>m` qP J EQ>a moH$mob m` Q>rg Z oH$moQ>m` qP J EQ>a moH$mob m` Q>rg ( EZ . B. g r. ) ( EZ . B. g r. ) ( EZ . B. g r. ) ( EZ . B. g r. ) : :: : ( ( ( ( 8 3 8 3 8 3 8 3 - -- -
8 7 8 7 8 7 8 7 ) ) ) )
h m _ w ` d oA ` d W d H$_ r d O Z m` m/ {Xd g m` m
Z d O mV ~ mb H$m_ ` o A mT>i U ma m A mO ma A mh o. ` mV
A mVS>` mb m ( b h mZ Vg oM _ moR> A mVSo) g yO ` oU o, XrKH$mi
A mVS>` mMr h mb Mmb Z h moU o, g S>mg md mQ>o g w _ a V md ,
n moQ>mMm g _ moa Mm ^ mJ h r ( B h m h h moD$Z ) b mb h moU o d m
A mVS>` mb mN>oX h moU o, J J a rZ h moU oB` m{X b j U oA mT>i VmV.

1 3 ) 1 3 ) 1 3 ) 1 3 ) n a m n a m n a m n a m\ \\ \ $m` _ mog rg $m` _ mog rg $m` _ mog rg $m` _ mog rg : :: : ( ( ( ( 3 6 3 6 3 6 3 6 - -- - 3 7 3 7 3 7 3 7 ) ) ) )
e y` m O mJ od a ` m H$mVS>rVb o ^ moH$ b h mZ A g VmZ m
EH$Xm_ mJ oHo$b ob r Mm_ S>r n a V n wT>oA mU ` mMo {d g a ` mg ;
{e Z _ wS>mMma V d mh ( A e w ) ~ X h moD$Z ` mb mA mb ob r
g yO .
1 4 ) 1 4 ) 1 4 ) 1 4 ) n a n a n a n a \ \\ \ $moa o{Q> h n oa rQ>moZ m` Q>rg $moa o{Q> h n oa rQ>moZ m` Q>rg $moa o{Q> h n oa rQ>moZ m` Q>rg $moa o{Q> h n oa rQ>moZ m` Q>rg : :: : ( (( ( 8 0 8 0 8 0 8 0 - -- - 8 3 8 3 8 3 8 3 ) ) ) )
~ h VoH$d oi m Z d O mV ~ mb H$mMoO R>a , N>moQ>` mA mVS` mMm
H$mh r ^ mJ d h e wJ {S>g rP _ ` o oo o _ moR>o A mVS>o, A m n yN>
A WmV A n |{S> g ` m_ ` o N>oX h moVmo. n moQ>mV J g og O _ m
P m ` mZ on moQ>V~ \ w$J Vod d mg moN> d mg mV A S>Wi m` oVmo.
1 5 ) 1 5 ) 1 5 ) 1 5 ) n r. ` y. O o. A m~ Q> e Z n r. ` y. O o. A m~ Q> e Z n r. ` y. O o. A m~ Q> e Z n r. ` y. O o. A m~ Q> e Z : :: : ( ( ( ( 1 0 9 1 0 9 1 0 9 1 0 9 - -- - 1 1 0 1 1 0 1 1 0 1 1 0 ) ) ) )
_ y Z {b H$m {H$S>Z rb m O oWo O moS>b ob r A g Vo VoWo
H$m` m_ H$ A S>Wi m A g Vmo d ` m~ mO yMr b Kd r ` d p WV
I mb r CVa V Z mh r. ` mH$ma U mZ ob Kd r` m d mh mV A S>Wi m
` oVmo d {H$S>Z rb mg yO ` oVo.
1 6 ) 1 6 ) 1 6 ) 1 6 ) n r. ` y. h h O n r. ` y. h h O n r. ` y. h h O n r. ` y. h h O : :: : ( ( ( ( 1 0 3 1 0 3 1 0 3 1 0 3 - -- - 1 0 8 1 0 8 1 0 8 1 0 8 ) ) ) )
_ wb m` m ( _ ob g o g ) _ w _ mJ mV b Kd r` m {n e d r` m
I mb r EH$ n S>XmA g Vmod b Kd r H$a VmZ mb Kd rMm d mh
a moI b mO mVmo.

1 7 ) 1 7 ) 1 7 ) 1 7 ) \ \\ \ $m` _ mo{g g $m` _ mo{g g $m` _ mo{g g $m` _ mo{g g : :: : ( ( ( ( 3 3 3 3 3 3 3 3 - -- - 3 6 3 6 3 6 3 6 ) ) ) )
B{` m` m Q>moH$me r A g b o ` m Mm_ S>rMo _ wI ~ ma rH$
A g ` mH$ma U mZ o Vr _ mJ oH$a VmZ ` oU oh U O o\ $m` _ mo{g g .
1 8 ) 1 8 ) 1 8 ) 1 8 ) ~ b Z mon m Wm` Q>rg ~ b Z mon m Wm` Q>rg ~ b Z mon m Wm` Q>rg ~ b Z mon m Wm` Q>rg : ( (( ( 3 7 3 7 3 7 3 7 - -- - 3 33 3 8 88 8 ) ) ) )
O Z Z |{` m` m n wT>` m Mm_ S>r_ ` o ( \ $moa H$sZ d
{e Z _ wS>) O Vyg g J P m ` mZ oA mb ob r g yO d h moU ma mXmh .
1 9 ) 1 9 ) 1 9 ) 1 9 ) ~ rO mSmMmn ri : ~ rO mSmMmn ri : ~ rO mSmMmn ri : ~ rO mSmMmn ri : ( (( ( 4 5 4 5 4 5 4 5 - -- - 4 7 4 7 4 7 4 7 ) ) ) )
d f U m` m ~ mh oa rb A md a U mMm ^ mJ d V: ^ mod Vr
{\ $a ` m_ wi o d f U m` m a Vd mh r` mZ m n ri ~ g Vmo d
a V d mh n yU n U o~ X h mo` mMrh r e ` VmA g Vo.
2 0 ) 2 0 ) 2 0 ) 2 0 ) _ mb a moQ>oe Z _ mb a moQ>oe Z _ mb a moQ>oe Z _ mb a moQ>oe Z : :: : ( (( ( 6 9 6 9 6 9 6 9 - -- - 7 1 7 1 7 1 7 1 ) ) ) )
J ^ md WoV O g mO g mn moQ>m` m Z m` yMm{d H$mg h moVmod
CXa n moH$i rMr d mT>h moVoVg on moQ>m~ mh oa J ob ob r A mVS>r h i yh i y
n moQ>mV n a VVmV d EH$m{d {e Q>>{e V~ XY n XVrZ on moQ>m` m
A mVrb A md a U m ma o WmZ mn h moVmV. ` m {H$` oV Hw$R>oh r
A S>Wi mA m ` mg , ` md ` o ~ mi mb m mg h moVmo. A mVS` m` m
` m MwH$s` mR>od U rb m_ mb a moQ>oe Z A g og ~ moYb oO mVo.

2 1 ) 2 1 ) 2 1 ) 2 1 ) _ oZ t J moo_ m` b mog rb _ oZ t J moo_ m` b mog rb _ oZ t J moo_ m` b mog rb _ oZ t J moo_ m` b mog rb : :: : ( (( ( 1 1 1 1 1 1 1 1 1 1 1 1 - -- - 1 1 7 1 1 7 1 1 7 1 1 7 ) ) ) )
` mV n mR>r` m H$` mb J V ( _ mZ on mg yZ H$Q>r^ mJ mn ` V)
_ mma mye >r g ~ Y>rV J mR>A g Vo. ( ` ya b Q> y~ n yU n U o~ X
Z P m ` mg h r {d H$Vr g ^ d Vo. )
2 2 ) 2 2 ) 2 2 ) 2 2 ) _ mb ~ md ob A Q>oO r` mO : _ mb ~ md ob A Q>oO r` mO : _ mb ~ md ob A Q>oO r` mO : _ mb ~ md ob A Q>oO r` mO : ( ( ( ( 7 1 7 1 7 1 7 1 - -- - 7 77 7 4 ) 4 ) 4 ) 4 )
A mVS> mMmH$mh r ^ mJ J ^ mVM {d a Ki ` mZ oA mVS> mMr
\ $mQ>m\ yQ P mb ob r A g Vo. ` m_ wi oA mMm( XwYmMm) d mn moQ>mV
V` ma h moU m` m A V md mMm n d mh I {S>V h moVmo d Z d O mV
~ mb H$mV Cb Q>` m, n moQ>\ w$J U oB` mXr b j U o{Xg yZ ` oVmV.
2 3 ) 2 3 ) 2 3 ) 2 3 ) [a Q> Q>mBb Q>o Q>rO [a Q> Q>mBb Q>o Q>rO [a Q> Q>mBb Q>o Q>rO [a Q> Q>mBb Q>o Q>rO : ( (( ( 4 44 4 3 33 3 ) ) ) )
d f U I mb r CVa b ob oA g VmV, n a Vw VoA S>H$moe mV Z
a mh Vmd a I mb r h moVmV.
2 4 ) 2 4 ) 2 4 ) 2 4 ) b o~ r` b g m` {Z Ho$ b o~ r` b g m` {Z Ho$ b o~ r` b g m` {Z Ho$ b o~ r` b g m` {Z Ho$ : :: : ( (( ( 5 0 5 0 5 0 5 0 - -- - 5 55 5 2 22 2 ) ) ) )
Xmoh r b o{~ ` m _ m` Z moa m ( b Kw^ J mo >) EH$_ oH$me r
O wi >b ob o/ EH$_ oH$mZ m{MH$Q>b ob oA g ` mZ o ` mo{Z _ mJ m` m
d a EH$ n mVi n S>XmV` ma h moD$Z ` mo{Z _ wI n yU n U o P mH$b o
O mVo.

2 5 ) 2 5 ) 2 5 ) 2 5 ) h m` S>>mog rb h m` S>>mog rb h m` S>>mog rb h m` S>>mog rb ( A S>H$moe d { ) : ( A S>H$moe d { ) : ( A S>H$moe d { ) : ( A S>H$moe d { ) : ( ( ( ( 4 1 4 1 4 1 4 1 - -- - 4 2 4 2 4 2 4 2 ) ) ) )
n moQ>mVrb n mU r O _ mP m ` mZ o/ {~ O mS>m` m^ mod Vmb ` m
Xwn Xa r A md a U mV n mU r g mR> ` mZ o A S>H$moe mb mA mb ob r g yO .
2 6 ) 2 6 ) 2 6 ) 2 6 ) h m` n mo n oS>r` mg h m` n mo n oS>r` mg h m` n mo n oS>r` mg h m` n mo n oS>r` mg : :: : ( (( ( 4 8 4 8 4 8 4 8 - -- - 5 0 5 0 5 0 5 0 ) ) ) )
_ w Z {b H$m qb J m` m Q>moH$me r Z CKS>Vm ` m` m
I mb ` m~ mO yb mCKS>VoA m{U ` mn wT>rb ^ mJ mV _ w _ mJ mMm
{d H$mg P mb ob mZ g Vmo.
2 7 ) 2 7 ) 2 7 ) 2 7 ) h m yb g h m yb g h m yb g h m yb g : :: : ( ( ( ( 7 77 7 0 ) 0 ) 0 ) 0 )
N>moQ>` mA mVS>` mb mn ri ~ g yZ ` mMma V d mh I {S>V
h moVmo. g J r A mVS>` mMo J J a rZ h moVo.
2 8 ) 2 8 ) 2 8 ) 2 8 ) h e wJ {S>g rP h e wJ {S>g rP h e wJ {S>g rP h e wJ {S>g rP : :: : ( (( ( 9 6 9 6 9 6 9 6 - -- - 1 0 1 1 0 1 1 0 1 1 0 1 ) ) ) )
_ moR> m A mVS> mMr h mb Mmb KS>d yZ A mU U m` m Z g mMr
( n a m{g n WoQ>rH$ J J b rA mZ g o g ) n wU d mT> P mb o b r Z g Vo
d m ` m A p Vd mV Z g VmV. ` m_ w i o _ moR> mA mVS>` mMr
d m^ m{d H$ h mb Mmb h moV Z mh r d H$m Q>rn oe Z h moV.
2 9 ) 2 9 ) 2 9 ) 2 9 ) h m` S>moHo$ h m` S>moHo$ h m` S>moHo$ h m` S>moHo$\ \\ \ b g b g b g b g : :: : ( (( ( 1 1 7 1 1 7 1 1 7 1 1 7 - -- - 1 2 2 1 2 2 1 2 2 1 2 2 ) ) ) )
` mV _ oXy` m Vwb Z oV _ |XyO b mMo _ mU d mT> ` mZ o
S>mo ` mMo A mH$ma _ mZ d mT>Vo. S>mo ` mMm Koa h r _ mU m~ mh oa
d mT>Vmo.

g X^ g y{M g X^ g y{M g X^ g y{M g X^ g y{M

1 ) d H$mMr ` e moJ mWm a mO h g H$me Z
S>m. MH$mV d mJ i o
2 ) _ wb oA e r d mT>d m a mO h g H$me Z
b oI H$ : A ma . Ho$. A mZ X
A Z wd mX : S>m. {d d mg a mU o
3 ) d mS> Z ~ a n mM, Ho$BE_ a moh Z n H$me Z
S>m. a d r ~ mn Q>` mMoA Z w^ d H$WZ
( e XmH$Z : g wZ r{V O Z )
4 ) Pediatric Surgical Diagnosis Jaypee Brothers
Dr. Sanjay Oak, Dr. Nitin Chaubal
5 ) Pediatric Surgery James ONeil, Jr(et al.) 5
th

Ed
n
Mosby
6 ) Z d r ~ mi J wQ>r n mb H$mg mR>r g mHo$V H$me Z
S>m. O mo Z mn S>i H$a

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