TUGAS KESEHATAN MASYARAKAT RIWAYAT ALAMIAH PENYAKIT JANTUNG KORONER
DOSEN PEMBIMBING : H. ALFIAN YUSUF, YUSUF, SKM., S.Pd., M.Kes
DI SUSUN OLEH NAMA: MUHAMMAD KAMIL NIM: P07131216115 P07131216115
KEMEN!IAN KESEHAAN KESEHAAN !EPUBLIK INDONESIA POLIEKNIK KESEHAAN KEMEN!IAN KESEHAAN BAN"A!MASIN P!OG!AM DIPLOMA I# GI$I AHUN 2016%2017
RIWAYAT ALAMIAH PENYAKIT JANTUNG KORONER
A. Definisi Penyakit Jantun K!"!ne" #PJK$
Pe&'()*+ "(&+&- K/&e/ P"K (d(( s(+ )e(*&(& '(&- d*se4(4)(& e (d(&'( e&'e*+(& d(& e&'4(+(& (/+e/* )/&(/*( '(&- e&-(*/)(& d(/( )e ++ (&+&-. A(4*( e&'e*+(& *&* e&(d* (/(, d((+ e&*4)(& se/(&-(& (&+&-. Se(/+, 2008. P(d( (&+&-, -(&--(& (+( e&'()*+ '(&- se/*&- +e/(d* (d(( e&'()*+ (&+&)/&e/, '(*+ +e/((&-&'( (*/(& d(/( d* e4 (/+e/* )/&e/ '(&- e&'(* )s*-e& d(& &+/*s* &+) e&--e/())(& (&+&-. Se(/+, 2001. Pe&'()*+ "(&+&- K/&e/ P"K *(( e&'()*+ (&+&- '(&- +e/+(( d*se4(4)(& )(/e&( e&'e*+(& (/+e/* )/&(/*( ()*4(+ /ses (+e/s)e/s*s (+( s(se (+( )4*&(s* )ed(&'(. M(*d, 2007. Me&/+ 9D9, e&'()*+ (/+e/* )/&e/ +e/(d* )e+*)( (+ '(&- d*se4+ () e&) d* (/+e/* '(&- e(s) d(/( )e (&+&- d*se4+ (/+e/* )/&e/. P() +e/d*/* d(/* e&d((& )es+e/, '(&- d((+ +e/()(s* d(( (/+e/*. Ke+*)( *&* +e/(d*, (/+e/* d((+ e&'e*+ d(/* ;()+ )e ;()+. P/ses *&* d*se4+ (+e/s)e/s*s.
%. Ri&ayat A'a(ia) Penyakit Jantun K!"!ne"
!*;('(+ ((*( e&'()*+ &(+/( < d*se(se (d(( des)/*s* +e&+(&- e/((&(& ;()+ d(& e/)e4(&-(& e&'()*+ (d( *&d*=*d, d*(* se() +e/(d*&'( ((/(& de&-(& (-e& )(s( *&--( +e/(d*&'( ()*4(+ e&'()*+, see/+* )ese4(& (+( )e(+*(&, +(&( +e/*&+e/s* e s(+ *&+e/=e&s* /e=e&+*< (& +e/(e+*). B*s( M/+*, 2010 F(se /e(+-e&es*s d*(* se+e( s*( 12 +(&. *4&(& e() d(( e4 d(/( d*(*. B*( s((+ /e((, (&() >e&de/&- ((s 4e/(/(-(, s)( ()(& ()(&(& 4e/e(), 4()(& e/)), 4e/(/+* 4e/(d( (d( <(se /e&+(&. "*)( )&d*s* *&* 4e/(&-s&+e/s, 4()(& e&*&-)(+ e4* (/( )e+*)( e(s)* s*( s)ses 30 +(& )e (+(s, ()( <(se s4)*&*s d*(*. "*)( s*( (&+(/( 30 ?80 +(& +e/(d* *e/+e&s* 4e/(/+* <(se )*&*s d*(*. "*)( *e/+e&s* +*d() d((+ d*)e&d(*)(&, ()( (d( s*( 85 +(& )e (+(s, )e&-)*&(& +e/(d* e&'4(+(& e() (d( e4 d(/( >/&e/. e/(d*( e&'()*+ (&+&- )/&e/. S('&, 2010.
!*;('(+ ((*( e&'()*+ (&+&- >/&e/ se>(/( e&-)( '()&*:
*. Ta)a+ P"e,+at!enesis
P(d( +(( *&* +e/(d* /ses e+*-*s, d*(&( <()+/ e&'e4(4 (-e&+ &+) e/+(( )(*&'( 4e/+e de&-(& e(. e+(*, <()+/ e&'e4(4 (-e&+ 4e e&*4)(& e&'()*+, (&'( s(( +e/(d* *&+e/()s* de&-(& e( d(& ee+())(& d(s(/?d(s(/ 4(-* 4e/)e4(&-&'( e&'()*+. H( *&* 4e/(/+* e/()(& <()+/ /es*). F()+/ !es*) &+) e&'()*+ (&+&- )/&e/ (d(( (?( d(( )e*d(& '(&d*4&-)(& e/)e4(&-(& e&'()*+ se>(/( d*&*, 4e4e/(( <()+/ /es*) e&'(* e&-(/ s(&-(+ )(+ d(& '(&- (*&&'(. Be4e/(( <(>+/ /es*) +e/se4+ (&+(/( (*&: Tinkat s!sia' ek!n!(i
•
*&-)(+ ss*( e)&* '(&- +*&--* e&'(* /es*) +e/)e&( e&'()*+ (&+&)/&e/. K(/e&( /(&- de&-(& ss*( e)&* +*&--* e&'( )e>e&de/&-(& &+) +e/(d*&'( e/4((& ( )&ss* ()(& de&-(& )(d(/ )es+e/ +*&--*. Ka-a" k!'este"!' yan ti-ak sei(an
•
Ke+*d()se*4(&-(& (&+(/( )es+e/ HDL d(& LDL d(& LDL '(&- e4* +*&--* ()(& e&-()*4(+)(& e&'()*+ (&+&- )/&e/. •
Tekanan -a"a) tini #)i+e"tensi$
e)(&(& d(/( +*&--* se>(/( +e/s e&e/s ()(& e&*4)(& )e/s()(& d*&d*& e4 (/+e/* )/&e/ se>(/( e/((&?((&. "*)( )e/s()(& *+ d*e/(/( de&-(& e&d((& e()%)es+e/ ()(& e&*4)(& e&'e*+(& e4 d(/( (/+e/* )/&(/*. •
Me"!k!k
Pe/(&(& /)) +e/(d( e&'()*+ (&+&- )/&e/ d((+ +*4 d(( 4e4e/(( >(/(, d*(&+(/(&'( : ( K(/4&&)s*d( 9O '(&- +e/)(&d&- d* d(( (s( /) e4* )(+ e&(/*) (+( e&'e/( )s*-e& d*4(&d*&-)(& se d(/( e/( de&-(& e-4*&&'(, se*&--( e&/&)(& )((s*+(s d(/( e/( +e/se4+ &+) (4(;( )s*-e& )e (/*&-(& +e/(s) (&+&-.
4 Pe/)) e**)* )(d(/ )es+e/ HDL '(&- e4* /e&d(, 4e/(/+* e*&d&- +e/(d( e'()*+ (&+&- )/&e/ e&/&. > Me/)) d((+ e&'e4&'*)(& (&-*&(, '(*+ s()*+ d(d( '(&- e/()(& +(&d( +e/(d( (d(&'( s()*+ (&+&-. (&( (d(&'( -e(( *+, e&de/*+( +*d() ()(& s(d(/ e&'()*+ 4e/4(('( '(&- sed(&- e&'e/(&-&'(. •
Diaetes Me'itus
Pe&-*d( d*(4e+es (( '(&- sd( 4e/)*)(s* )e (/( )/&e/ (&+&-. (
Ke-e)(&
4
!*;('(+ )e+/&(& e&'()*+ (&+&- d(( )e(/-(
>
K/(&- (/(-(
d
S+/ess Ad(&'( d( (+( e4* <()+/ /es*) ()(& 4e/*(+ )(* e&(*))(& /es*) ++( +e/(d(
e&'()*+ (&+&- )/&e/.
/.
Ta)a+ Pat!enesis
a. Ta)a+ Inkuasi
M(s( *&)4(s* P"K +*d() d*+e&+)(& ;()+&'( se>(/( (s+*, *&)4(s* *&* d*e&-(/* e 4(&'() <(>+/ /es*) '(&- e&-)*&)(& +e/(d*&'( )(/d*=(s)e/. F()+/ /es*) *&* e&'e4(4)(& e&)(& )es+e/ (d( e4?e4 d(/( '(&- e&-()*4(+)(& +e/4e&+)&'( <()?<() '(&- e&-()*4(+)(& +e/s4(+&'( e4 d(/(. Pe&)(& )es+e/ (d( e4 d(/( '(&- +e( e&>((* +*+*) e& e&-()*4(+)(& )e+*d()se*4(&-(& )&d*s* +4 d(& e(> +e/4e&+)&'( e&'()*+ )(/d*=(s)e/. P(d( +(( *&* 4e +e/(d* -(&--(& <&-s* /-(& d(& 4e e&&))(& -e((. e/(d* e/4((& (&(+* d(& *s+-'. P(d( e&'()*+ (&+&- )/&e/ +e/(d* (+e/s)e/+*) (d( e4 d(/( )/&e/ '(&- e&-()*4(+)(& e&'e*+(& e4 d(/(. F(se *&* s*+ &+) d*d*(-&s( se>(/( )*&*s )(/e&( 4e e&*4)(& -e(( '(&- (s+*.
. Ta)a+ Penyakit Dini
Me/()(& )&d*s* )e+*)( +e( +e/(d* e/4((& <&-s* /-(& '(&- +e/)e&( d(& e&*4)(& -e((. Pe&'()*+ (&+&- se/*&- )(* e&'e4(4)(& -e(( '(&- e/+(( 4e/( &'e/* (+( ses() d* d(d(. N'e/* ()*4(+ s(+ se/(&-(& (&+&-, 4*(s(&'( +e/(s( (d( 4(-*(& +e&-( d(d(. B*(s(&'( 4e/s*<(+ 4e/(+ d(& d((+ e&'e4(/ )e(/( (&( s((, +e+(* e4* >e&de/&- e&'e4(/ )e(/( d(- d(& e&-(&. N'e/* 4e/(&-s&-, e&de/*+( e/(s( ses() d(& s()*+, +e+(* &'e/*&'( d((+ 4e/s*<(+ /*&-(& d(& (s &+) s(+ se/(&-(& (&+&- +e/+(( (d( /(&-+(. N'e/* (&+&- +e/(d* *)( (&+&- )e)/(&-(& d(/(. )(/e&( )e4(&'()(& e&'()*+ (&+&- +e/+(( e&-e&(* 4**) )*/* (&+&-, ()( (/?(/ ()(& e&-((* 4e&d&-(& d(& ()(& e&-()*4(+)(& /(s( ses(). Pe&de/*+( (&+&- )/&e/ '(&- e&-((* ses() &(<(s e&-((* e&'4(+(& (/+e/* )/&e/ ()(& )e)/(&-(& (*/(& d(/( )e ++ (&+&- '(&- (/+*&'( ++?++ (&+&- +*d() e&d((+ &+/*s* d(& )s*-e& se*&--( +*4( s(+ )e(d((& '(&- d*)e&( se4(-(* *s)e*) *s>e*(. D*&d*&- (/+e/* )/&e/ '(&- e&-(&d&- se/(4+?se/(4+ ++ s, e s(+ se4(4 d((+ 4e/)e/+ s(se de&-(& ()*4(+ e&'e*+&'( e4 d(/( se>(/( +*4(?+*4(, se*&--( e&de/*+( e/(s()(& &'e/* d(d(, 4()(& s((* +e/(d* se/(&-(& (&+&- e&d(d(). M(&*+/*s 4*(s(&'( +*4 )(/e&( (d(&'( )e)/(&-(& s(* )s*-e& )e ++ (&+&- (d( s((+ ()+*=*+(s (+(& d(( )e(d((& *s+*/((+ de&-(& s()*+ '(&- )(s '(*+ ses() &(<(s d* +e&-( d(d( '(&- d((+ e&'e4(/ s((* ee/ d(& /((&-, &d() )*/* (+( )(&(& d(& e&-(& 4()(& s((* +e/(s( +e4s )e &--&-, )(d(&-?)(d(&- -( d*/(s()(& see/+* @s*+ 4e/&(<(s . Se/(&-(& -e(( &'e/* d(d( se()*& (/* se()*& 4e/(&-s&- ((. N'e/* d(d( '(&- se()*& (/* se()*& (( e&>e/*&)(& s4(+(& )/&e/ ()*& e&e4( d(& s4(+(& )/&e/ se()*& e&+ e&((&- *( e4 '(&- 4e/(/+* (s)(& )s*-e& 4(+ ++ (&+&- '(&- d*('(&* ()*& +**s. K&d*s* (*&&'( d*)e&( de&-(& (>+e '>(/d *&<(/>+ AMI '(*+ /s()&'( ++ (&+&- ()*4(+ e&'4(+(& (/+e/* se>(/( ++( '(&- d*se4(4)(& e>(&'( () e() (+e/s>e/s*s (d( (/+e/* )/&e/ se>(/( +*4(?+*4( d(& ()(& e&*4)& -e(( s()*+ d(d( '(&- e4(+, &(<(s e&de) d(& se/*&-)(* e&de/*+( ()(& )e*(&-(& )es(d(/(& ses((+.
0.
Ta)a+ Penyakit Lan1ut
Ke(d((& d*(&( e&'()*+ (&+&- )/&e/ sd( e/&( +e/(d* d(( d*/* sese/(&&+) 4e/(&- (+( e&(d* e4* 4e/(+. P(d( +(( *&* e&de/*+( +e( +*d() d((+ (-* e())(& e)e/((& d(& *)( d(+(&- 4e/4(+, &'( +e( ee/)(& e/(;(+(&. Pe&'()*+ (&+&- )/&e/ +*4 ()*4(+ +*4&(& e() (+( )(/(&- '(&- d*se4+ (+e/(, +e/(d* d* d(( d*&d*&- (/+e/* e(s) d(/( 4e/)s*-e& )e (&+&- d(& e&'e*+ *&--( (*/(& d(/( +e/-(&--. P(d( +(( *&* e4 d(/( e&de/*+( sd( +e/4e&+) @)(/(+ e() ()*4(+ d(/* e() d(/(%)es+e/ '(&- d*4*(/)(& +*&--* &+) ;()+ '(&- (( '(&- d*se4(4)(& +*d() e&-&+/ e() d(/( de&-(& 4(+ d(& d*e+, d*e/)*/()(& (&'( e/ ;()+ se +(& &+) e&(d*)(& *( e4 )/&e/ e&(d* +e/s4(+ ++(. H( ( +e/se4+ '(&- )ed*(& d((+ e&'e4(4)(& +e/(d*&'( >(/d*(> (//es+ '(&- 4*s( e&'e4(4)(& )e(+*(& e&d(d()
-.
Ta)a+ Ak)i" Penyakit
Se4 se/&(, d(( <(se *&* e&de/*+( sd( se4, d*+(&d(* de&-(& +*d() +e/s4(+&'( e4 d(/( e <(). K/&*s, d(( <(se *&* -e(( e&'()*+ +*d() 4e/4( d(( (/+* +*d() 4e/+(4( 4e/(+ (+(& +*d() 4e/+(4( /*&-(&, (d( d(s(/&'( (s* d(( )e(d((& s()*+. Me&*&--(, d(( <(se *&* e&de/*+( sd( +*d() d((+ d*se4)(& se*&--( e&-()*4(+)(& )e(+*(&.
2. Pen0ea)an Penyakit Jantun K!"!ne" *. Pen0ea)an P"i(!"-ia'
Pe&>e-((& P/*/d*( '(*+ e&>e-((& d(/* <()+/?<()+/ '(&- e&-)*&)(& +e/(d*&'( (&+&- )/&e/. See/+*: (. 4. >. d. e. /.
Me&-/(&-* &(*)&'( +e)(&(& d(/( d(& e&-/(&-* )(d(/ e() d(/( d(( +4 Me&-e&d(*)(& 4e/(+ 4(d(& d(& d*e+ Me&-/(&-* s+/ess Me())(& (/(-( d(& /e()s(s* Me&-4( )e4*(s((& ()(&
Pen0ea)an P"i(e"
Pe&>e-((& /*e/ e/()(& ('( (;( e&>e-((& P"K se4e se/(&e&de/*+(. D*())(& de&-(& e&de)(+(& )&*+* 4e/( e&'(& <(>+/?<()+/ /es*) P"K +e/+(( (d( )e) /es*) +*&--*. Pe&>e-((& /*e/ d*+)(& )e(d( e&>e-((& +e/(d( 4e/)e4(&-&'( /ses (+e/s>e/s*s se>(/( d*&*. De&-(& de*)*(&, s(s(/(&&'(
(d(( )e) s*( d(. D(& se+*( /(&- '(&- e/ e/4( >(/( *d &+) e&'e((+)(& d*/*&'( se&d*/* see/+*: C
a. Hea't) P"!(!ti!n #P"!(!si Kese)atan$
P(d( +(( e&>e-((& *&*, d*())(& (d( s((+ (s* se(+. *d() (&'( &+) e&-(&+*s*(s* e&'()*)*+ (+e/s)e/s*s s(( +e+(* -( e&'()*+?e&'()*+ '(&- (*&.K(/e&( ('( *&* 4e/+(& (-(/ )&d*s* )ese(+(& +e+e +e/(-(. P/s* )ese(+(& '(&- d*())(& (d(( e4e/* e&'(& +e&+(&- e&-e+((& )ese(+(& )ss&'( e&'()*+ (&+&)/&e/, (/(-( se>(/( +e/(+/, e&'e*4(&-)(& (s(& -** d(( +4, e())(& ee/*)s((& se>(/( 4e/)((, d(& e-e+((& se>(/( -e&e+*s +e&+(&- /*;('(+ e&'()*+.
C
. S+e0ifi0 P"!te0ti!n #Pe"'in-unan K)usus$
B(-* '(&- 4e/es*) +*&--* +e/(d( e&'()*+ (&+&- d*(/()(& &+) 4*s( e&-*&d(/* (?( '(&- 4*s( e&*&--(()(& )e4*(s((&?)e4*(s((& see/+* e/)), +*d() e&-)&ss* (>, e&(-( )(d(/ )es+e/, +e)(&(& d(/( d(& d*(4e+es d* 4(;( )&+ de&-(& se/*&- 4e/)&s+(s* de&-(& d)+e/.
3.
Pen0ea)an Sekun-e"
Pe&>e-((& se)&de/ d*+)(& &+) e&e(s)(& +*&d()(&?+*&d()(& e&>e-((& '(&- d*())(& se+e( e&'()*+ +e/(d*, *s(&'( se+e( s(+ se/(&-(& (&+&-. ((?+(( &+) ee/4(*)* d*/* e&de/*+( se+e( se/(&-(& (&+&-, d*(* de&-(& e&>(-((& se)&de/ '(*+ (&-(& e/)), d*e+ /e&d( e() e;(&, (+*(& <*s*) se>(/( +e/(+/ d(& >&+/ +e)(&(& d(/( +*&--*. D((+ ( d*())(& s((?s(( &+) e&-(&>/)(& 4e)(& +/4s '(&- e&'e4(4)(& e4 &(d* >/&e/ e/ d*())(& e&-4(+(& sed*&* &-)*& &+) e&d((+)(& )e4e/(s*(& '(&- e4* 4(*). Pe&-4(+(& '(&- >e(+ d(& sede/(&( &+) e&-*(&-)(& &'e/* d(& (&s*e+(s d((+ d*-&()(& 4(+ see/+* /<*&. I&ds+/* ()(&(& e&'(* e/(& e&+*&- &+) e&>e-( e&'()*+ (&+&- de&-(& e&-/(&-* )(&d&-(& e(), -( d(& -(/( d(( /d) e/e)(. Ad(& e(&<((+(& (*& '(*+ e4e/*)(& (4e (d( se( )e(s(& ()(&(& de&-(& (&(*s*s )(&d&-(& /+e*&, )(/4*d/(+, e(), -(/( d(& )(/*&'(. Me&'ed*()(& e4* 4(&'() <(s**+(s (/(-( d(& -/ (/(-( se/+( ( e4* 4(&'() d/&-(& 4(-* /(&-?/(&- de;(s( &+) e(&+)(& )e-*(+(& <*s*) se+e( e/e)( e&*&--()(& 4(&-) se)(. Ad(& +(((& &+) e&de+e)s* e&'()*+ (&+&- (d( +(( (;( d*&(()(& s)/*&*&-.
Se(*& *+ e&>e-((& se)&de/ &+) e&'()*+ (&+&- )/&e/ -( d((+ d*())(& de&-(&:
a. Ea"'y Dian!sis an- P"!(+t t"eat(ent #Dian!sis -an Pen!atan see"a$
Se4e +e/(d*&'( )*)(s*, (+e/s)e/s*s &-)*& +*d() ()(& +e/d*(-&s*s. K*)(s* '(&- +e/(d* (d((, +e/de&-(/&'( bruit s(/( e&* (d( ee/*)s((& de&-(& stetoskop 4*s( e/()(& e+&) d(/* (+e/s)e/s*s. De& '+ &(d* (d( d(e/( '(&- +e/)e&( 4*s( 4e/)/(&-. P(d( +(( *&* e&e)(& e&de/*+( d*())(& de&-(& e())(& s/=e' (d( )e) 4e/es*) d(& e())(& e(/(&. D(( s/=e' '(&- d*())(& d((+ e())(& ee/*)s((& &+) ed*(-&s*s e&de/*+(. Pee/*)s((& '(&- 4*s( d*())(& &+) e&d*(-&s*s (+e/s)e/s*s '(*+ : (. 4. >. d. e. <.
ABI ankle-brachial index, e&-)/(& +e)(&(& d(/( d* e/-e(&-(& )()* d(& e&-(&. Pee/*)s((& Doppler d* d(e/( '(&- +e/)e&(. S)e&*&- ultrasonik Duplex. CT scan d* d(e/( '(&- +e/)e&(. Arteriografi resonansi magnetik d* d(e/( '(&- +e/)e&(. IVUS intraascular ultrasound . Pe&-4(+(& 4*s( d*())(& de&-(& e4e/*)(& 4(+?4(+(& &+) e&/&)(& )(d(/
e() d(& )es+e/ d(( d(/( >&+&'( >es+'/(*&e, )es+*, (s( &*)+*&(+, -e<*4/*, /4), =(s+(+*&. As*/*&, +*>*d*&e d(& >*d-/e (+( (&+*?)(-(& 4*s( d*4e/*)(& &+) e&-/(&-* /es*) +e/4e&+)&'( 4e)(& d(/(.
4.
Pen0ea)an Te"sie"
Pe&>e-((& +e/s*e/, '(*+ e&>e-((& '(&- d*())(& de&-(& e&>e-( +e/(d*&'( )*)(s* '(&- e4* 4e/(+ )e&-)*&(& e&*4)(& e&'()*+ (+( )e(+*(&. Y(*+ d((+ d*())(& de&-(&: a. Disai'ity Li(itati!n #Pe(atasan Disai'itas$
"*)( +e/d((+ -e(( '(&- ()+, s4(+(& ()+ '(&- e&-(&>( )e((& ++ d(& (/*&-(& )*+ &+) 4e/)&+/()s* (+( s(( s(+ /-(& sd( +*d() d((+ 4e/<&-s* se/&(, &-)*& d((+ d*())(& e&-4(+(& se(&+&'(, see/+*: (. Pe4ed((& A&-*(s+* 4(& d*())(& &+) e/(+()(& () d(& e&*&-)(+)(& (*/(& d(/( '(&- e(* e&d((& e(). 4. E&(/+e/e)+* e/()(& s(+ &+) e&-(&-)(+ e&d((&.
>. Pe4ed((& 4'(ss e/()(& /sed/ '(&- s(&-(+ *&=(s*<, d*(&( (/+e/* (+( =e&( '(&- &/( d(/* e&de/*+( d*-&()(& &+) e4(+ e4(+(& -&( e&-*&d(/* (/+e/* '(&- +e/s4(+. d. /4'+*>. "*)( (/+e/* +e/s4(+ e (d(&'( -((& d(/(, 4*(s(&'( d*4e/* 4(+ &+) e(/+)(& -((& )e d(( (/+e/* s((* -((& *+ )e4(* &/(. e. Pe&--&((& A&-*-/('. De&-(& >(/( e(s))(& >(+e+e/ )e>* )e d(( (/+e/* d(& d* >e, d(& )ed*(& s4(+(& +e/se4+ d* +&- de&-(& s*&(/ . Re)ai'itati!n #Re)ai'itasi$
!e(4**+(s* e&-4(+(& '(&- ses*<*) d*+e&+)(& 4e/d(s(/)(& : (. 4. >. d. e.
Us*(, )ese(+(& se>(/( e&'e/ d(& /*;('(+ )ese(+(&. Pe/(s(& d(/* e&'()*+ +e/se4+ D(e/( '(&- e&-((* s4(+(& (&d(?+(&d( d(& -e((?-e(( '(&- d*((* (s*e& !*;('(+ )ese(+((& d(& e&-4(+(&(& sese/(&- +e/)(*+ de&-(& se&s*=*+(s&'( +e/(d(
+e/(*/sed/ e&-4(+(& '(&- e/&( d*((* <. A/( '(&- d* (/()(& &+) e&'()*+ *&* )e de(&&'(. -. Pe&d((+ (+( **(&.
!e(4**+(s* '(&- d*())(& (d(( e&e/((& e/*() se(+ d(( )ese(/*(& see/+* e&-*&d(/* )&ss* (> d(& /)) se/+( (/(-( se>(/( +e/(+/, (s(& -** '(&ses(*, e&-*&d(/* ()(&(&?()(&(& '(&- +*&--* )es+e/, ee/*)s((& se>(/( 4e/)((, d(& s*)+e/(* &+) e&-e&d(*)(&.
