The cases needing Causticum have severe contractures in hand. Many people think they have had a good surgical result in the first few months or years, only to learn later about recurrence and worsening of the hand. Jonathan Cluett, MD, is board-certified in orthopedic surgery. . The results can be horrific, sometimes leading to eventual amputation.
Place your hands against each other with the fingers stretched and the tips touching, try pushing the palms together and stretching back one fingertip at a time for 10 seconds. I have had Dupuytrens contracture for at least 15 years and the ring finger is slightly bent towards the palm on both hands but it is slightly more severe on my left hand. Surgery involves making an incision and removing the diseased tissue. Click This link To Understand the Side Effects of the above mentioned Homeopathic Medicines. is solely for educational purposes and does not involve or include diagnosing, prognosticating, treatment, or prescribing of remedies for the treatment of diseases and . Though the efficacy of some supplements in relation toDupuytrens disease is still debated, you can try adding these vitamins, minerals and spices to your diet based on your doctors recommendations: Dupuytrens disease treatment can be done to some extent at home, but there may come a time when you need to talk to a professional. Collagenase is an enzyme designed to break down collagen, the tough protein that makes up much of our connective tissue. Common problems include: Dupuytren's contracture - a hereditary thickening of the tough tissue that lies just below the skin of your palm, which causes the fingers to stiffen and bend Trigger finger - an irritation of the sheath that surrounds the flexor tendons, sometimes causing the tendon to catch and release like a trigger. Your email address will not be published. If so, what strength should I use, how much, and how often? Healthy fats like coconut oil, olive oil, ghee, grass-fed butter, nuts, seeds and avocados. Visit an orthopedist, chiropractor or your primary doctor if you notice symptoms like stiffness in one or both hands, a very weak grip, bent fingers or nodules. 2018;34(3):331-344. doi:10.1016/j.hcl.2018.03.003. Silicea is a natural medicine for Dupuytrens contracture with pain in the contracted tissue cords upon moving the fingers. It is light, dry and warm by nature. Walgreens and other drug stores now sell homeopathic formulas right along with all the other approved medications. Read our, Collagenase Injections for Dupuytren's Contracture, Dupuytren's Contracture Facts and Statistics: What You Need to Know, 5 Risks of Dupuytren's Contracture Treatment, When to Use a Splint vs. Some people may never experience the contracture of their fingers. The major downside of surgery is that the recovery from the procedure can involve discomfort and can be prolonged. The trade-off is that your surgeon may be able to address more surgically than through those less invasive options., Cultura RM Exclusive/KaPe Schmidt / Getty Images. Customers have found relief from the symptoms of Dupuytren's Contracture without injections, needle therapy, or surgery. Silicea, Causticum, and Ruta are the top homeopathic medicines used to treat Dupuytren's Contracture. Compared to the collagenase or needle procedure, the recovery from surgery is much more involved. 2009;109(4):494-7. For that reason, Dupuytren's can, and almost always will, eventually come back. Products with anti-inflammatory ingredients may also be helpful. Men are at a greater risk to develop Dupuytrens contracture than women. This enzyme is injected directly into a cord of Dupuytren's tissue and then allowed to break down the tight, contracted tissue. Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery. Patients From rest of the world and India call
Dupuytren's contracture is the curling of the fingers that occurs as a result of Dupuytren's disease, a problem with unregulated collagen formation in the palm of the hand and fingers. Dupuytrens contracture is a condition that develops over the course of many years and affects the hands and fingers. 1. Steroid injections (corticosteroids) can have anti-inflammatory effects and help to slow the progression of a contracture. Drink a lot of water. Homeopathy is an energy-based therapy that has been used on plants, animals, children and adults for over 200 years. These cause major issues to the person and cause deformity in the person. Homeopathy. At OrthoBethesda, we understand the frustrating impactDupuytrens diseasemay have on your life. Treat the condition early to prevent complications and tissue damage that limits functionality. Treatment options for Dupuytren's contracture include surgery (removal of the diseased fascia), injection of collagenase (a drug to dissolve the fascia) and needle aponeurotomy. These nodes may or may not be painful or tender to touch. We do not claim to cure any disease which is considered' incurable ' on the basis of scientific facts by modern medicine .The websites content is not a substitute for direct, personal, professional medical care and diagnosis. Gancao Chinese Medicine) 39 year old female with left 4 th digit permanently flexed 45 at the PIP joint. The Queen of England has her own personal homeopath. WhileDupuytrensdisease is typically characterized as painless, some people may feel pain in the nodes of tissue that form in the palm. Having had Continue reading "Dupuytren's Nodules: 3 Natural Remedies - Posture Doctor" I feel it has something to do w my diet. Natural treatment for lumps on palms and contractures of fingers. But, this is really only effective as a post-surgical or post-release treatment. It wont reduce the risk of recurrent contracture and should not be done forcefully (such as by tightly trying to straighten the fingers). It was approved by the FDA in 2010, after clinical trials showed its effectiveness in reducing the degree of contracture and improving range of motion when compared with patients who were treated with no medication (placebo) The involvement of the index finger and the thumb in this condition is rare. If the contracture has already begun on any of your fingers, you can use your other hand to push the fingers back into a straight position and hold for a few seconds. Make a fist with your affected hand as you bend the top two joints back toward your palm. Please schedule a consultation at one of our 8 locations by contacting us today at . With this in mind what remedy would help my contracture. But today I experience intense nerve pain when I tried walking in a primoral position. Market research shows that sales of homeopathic medicines have grown at a rate of 10-20% per year during the past ten years. The problem is thatthese treatments seem to be more likely to worsen the condition rather than help it. Needling may also be complemented by a steroid injection, which is given to reduce swelling. As these cords tighten, they may cause the fingers to contract. Homeopathy is particularly popular in India where there are over 120 four-year homeopathic medical schools.Homeopathy is also growing very rapidly in the United States. Eliminating tobacco use can have a number of other beneficial results for your health, including: Heavy drinking is also associated with a higher chance of getting this condition. As Dupuytren's worsens, people find it difficult to perform such routine activities as washing their hands or grasping large objects. How to start Dupuytren treatment with Alternative Medicine, Testimonials from Dupuytren Contracture Institute. Your sincerly They eventually create a thick cord that can pull the fingers into a bent position. Discovered by Samuel Hahnemann, homeopathy is a unique 200 year-old pharmaceutical system of healing that stimulates the defense system of the body to protect and heal itself, using only extremely small doses of naturally occurring substances. In addition to eating healthy and embracing healthy lifestyle choices, you can add daily supplements to your routine. If a patient has to have a skin graft to cover a part of their hand where tissue was removed, the recovery will take longer and will likely be more uncomfortable. For ideas and suggestions to include homeopathy in your treatment program, click Create a Dupuytren Treatment Plan. Cast for Bone and Joint Injuries, What to Know About Xiaflex (Collagenase Clostridium Histolyticum), Tenex Procedure: Everything You Need to Know, Sinus Surgery: Everything You Need to Know, What to Know About Big Toe Bone Spur Surgery (Cheilectomy), How to Get Rid of Arthritis in the Fingers, Stomach Ulcer Surgery: Everything You Need to Know, Radial Aplasia: Symptoms, Causes, Treatment, and More, The Rationale for Treating the Nodule in Dupuytren's Disease, Corticosteroid Injection in the Management of Dupuytren Nodules: A Review of the Literature, Collagenase injections for Dupuytren's contracture: prospective cohort study in a public health setting, Collagenase Treatment in Dupuytren Contractures: A Review of the Current State Versus Future Needs, Needle Aponeurotomy for Dupuytren Disease, Surgical complications associated with fasciectomy for dupuytren's disease: a 20-year review of the English literature, Surgery for Dupuytren's contracture of the fingers, Management of severe Dupuytren's contracture of the proximal interphalangeal joint with use of a central slip facilitation device, Dupuytren's disease: a predominant reason for elective finger amputation in adults, The outcome of surgical treatments for primary Dupuytren's disease: A systematic review, Dupuytren disease: an evolving understanding of an age-old disease, Dupuytren's diathesis revisited: Evaluation of prognostic indicators for risk of disease recurrence, CORD I Study Group: Injectable collagenase Clostridium histolyticum for Dupuytren's contracture, A comparison of the direct outcomes of percutaneous needle fasciotomy and limited fasciectomy for Dupuytren's disease: A 6-week follow-up study. Furthermore, recurrence of the condition can be common. Dupuytren's Treatment: CCH Collagenase Injection At that point, your healthcare provider will manipulate the finger forcefully to fully break the contracted tissue. . Factsonhand [Article in German] Praxis fur Homoopathie, Berlin-Karow, Deutschland. bending numbness for 3yrs Use castor oil massage daily. J Am Acad Orthop Surg. Simple local search for medical centers in your city - make an informed decision quick and easy with Nicelocal.ae! It is characterized by the triad of bent erections, pain in the penis with erections and palpable penile plaque. The purpose of Dupuytren's natural treatment is to help you remove and heal the fibrous palm lump and finger cord. I dont have much pain but do notice some stiffness in my 4th finger on that hand. Dupuytren's contracture unfolded. (2). Being a male, especially of Northern European descent. A number of treatments are available to help slow the progression of Dupuytrens contracture and relieve symptoms like bending and stiffness. Ive had Dupuytrens contracture for over 10 years. There are many statistical and clinical similarities between Dupuytrens contracture and Peyronies disease. Both thumbs have like a clicking when trying to straighten them. The professionals here at the Orthopedic Associates of Long Island have many years of experience treating conditions like shin splints and correcting the issues they cause. There used to be a time when healthcare providers recommended stretching, splinting, and injecting cortisone into Dupuytren's tissue. Rather, seek help when your fingers reach a20-degree or 40-degree bend. Below is a detailed analysis of both treatments, giving patients an in depth look at both options, as well as information on a few other recognized treatment options. It is the fibrous thickening & shortening of palmar aponeurosis resulting in flexion contracture of one or more fingers. What aggravates Dupuytrens contracture? What is the best treatment forDupuytrens contracture? Dupuytrens contractureexercises and physical therapy are recommended to reduce swelling and stiffness as well as improve functionality and strength in the affected hand. Dupuytrens contracture surgeries are called fasciotomy or subtotal palmar fasciectomy. Learn about how this condition develops, what you can do at home to treat it and when it is time to seek professional treatment from a doctor. Ketchum LD. The course of the condition varies from person to person. After doing natural DC treatment for almost 20 years I have come to the conclusion there are two main reasons for the high failure rate of Dupuytrens contracture surgery. Treatment focuses on minimizing the systems of the disease. Dr Sharma Compared to other treatments, needle aponeurotomy generally costs much less than collagenase or surgery. Dupuytrens contracture causes a hand deformity due to hardening and thickening of layers of tissue (fascia) in the palm of the hand.
The natural history of Dupuytren disease is one of gradual progression over time, although progression is by no means universal and the time course can vary substantially between patients. Watch your symptoms carefully, try out home remedies to see what works for you and ask for help when you need it. Alternatively, you can use a simple warm water soak or heat pack on your hand. (, Enzyme injections may soften and weaken cords of tissue in the hand. Valentiner U, Weiser M, Moll I, Schumacher U. (6) Some people can develop both of these conditions and carpal tunnel at the same time, especially people with a history of diabetes. What you eat may seem unrelated to the condition of your hand, but diet changes can actually help reduce the symptoms associated with Dupuytrens contracture. This is a great pain relief method for Dupuytren's disease. A hand specialist, Doc of osteopathy, recently diagnosed me w Dupuytrens Disease. 2010;10:e15. What remedy, if any, may be suggested for more beginning stages of this condition? Sometimes you just have to try things and see what happens, after doing your best to investigate and educate yourself. There is medical controversy about the ability of homeopathy to influence health and healing. Following the injection, usually the day after, your doctor will likely use manual manipulation of the finger to continue breaking down the tissue and work your finger toward straight positioning. Reduce Palm Pressure Homeopathy is an energy-based therapy that has been used on plants, animals, children and adults for over 200 years. Eat a lot of raw vegetables, stop smoking and drinking which are also very acidic. of the Department of Orthopedic Surgery at Mayo Clinic, discusses. I am using Ruta at the moment as well as magnesium gel for the nodulewish me luck as I would never have the Dupuytrens surgery that my brother has done with horrid results. Black EM, Blazar PE. Surgery may be recommended if a contracture is severe and causing physical limitations. 1: Forsch Komplementarmed Klass Naturheilkd. Try to figure out what may be causing your issue to develop. Of all the recommended natural medicines listed here which would you personally start with. The homeopathic medicines that will suit a given case of Dupuytrens contracture vary from case to case as per individual presentation. Raise each finger up one at a time and hold for five seconds, then repeat 10 times. Dupuytren's contracture is a fibroproliferative disorder of palmar fascia that causes flexion contractures of one or more digits (2). Whatever the exact cause of Dupuytren's contracture, there is the irregular proliferation of connective tissue cells, i.e., fibroblasts. You might also want to enroll in a smoking cessation program or talk to your doctor about options that may help curb cravings. British Dupuytren's Society YouTube channel. Hurst LC, Badalamente MA, Hentz VR, et al:CORD I Study Group: Injectable collagenase Clostridium histolyticum for Dupuytren's contracture. The Lancet and other medical publications of high regard have published information favorable to homeopathy. A healthy diet does not necessarily mean a boring or bland diet. Is this pain associated with Dupuytrens? Surface Studio vs iMac - Which Should You Pick? Research has shown thatsmoking cigarettes has a statistically significant linkwith Dupuytrens contracture. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. Tobacco use is one of the top answers to this question. But, if you arent sure where to start, it can take a little time to learn what works for your new meal plan. Adding Scar-X to your treatment plan could be an easy way to inexpensively and simply broaden your treatment plan, and further increase your odds for success. By slowing fibroblast cell growth, this study demonstrates the possibility of altering production and composition of the cellular foundation of scar material with a homeopathic preparationA second study reports that homeopathy can influence tissue repair. You can replace sugarwith. Sometimes it is difficult to know exactly what to do. Some MDs scoff at it, while other MDs never use conventional drugs and use homeopathic therapy exclusively. Remember to be gentle as you massage the hand.
Cite this article: Bone Joint J 2018;100-B:1138-45. Re: homeopathic remedy. Also my massage therapist recommended stretching and massage of the hand which I do. Repeat five to 10 times. I use classical Homeopathy 1 m like Rhus tox Silicea 1 m Having a drink with dinner or cocktails with friends is not likely to affect your risk of developing Dupuytrens disease. The reason for Dupuytrens contracture is not clearly understood. Eventually, that tissue will begin to form cords that reach up through thepalm to the fingers. Through acupuncture, diet, supplements, homeopathy and more, alternative treatments under . The thickened skin on the palm of your hand may form a hard lump. Difficulty completing everyday tasks that require fine motor activities and use of the affected hand. If youre doing work around your home or for your occupation, avoid using a tight grip on tools, such as by using handles or cushion tape when possible. Dupuytren's contracture is the curling of the fingers that occurs as a result of Dupuytren's disease, a problem with unregulated collagen formation in the palm of the hand and fingers. Adding a homeopathic therapy to your treatment plan adds an inexpensive and wider energy-based therapy to your Dupuytrens effort. If after doing so you wish to try homeopathy for your Dupuytrens contracture, there is a special formula that DCI has commissioned exclusively for the symptomatic treatment of Dupuytrens contracture and scar tissue. Many people will instinctively try to stretch the contracted finger, but in general, this practice should be discouraged. Signs and Symptoms of Dupuytrens Contracture. My fingers have not contracted yet, but one finger on each hand feels tight when I bend it backwards. Over time,Dupuytrens disease, also known asDupuytrens contracture, can affect the palm of the hand andthe little and ring fingers. J Hand Surg Am. What are your thoughts please? Under the supervision of Victor Tsan, MD, the team of licensed practitioners perform different forms of holistic treatment for Dupuytren's contracture, including acupuncture, homeopathy, reiki, medicinal herbs, and more. The following groups of people may be at risk for developing Dupuytrens disease: How do you reverse Dupuytrens contracture? Most people do not require therapy following a needling procedure. The disease may progress from initial stage to severe deformity in many cases while in others may not show progression up to the deformity stage. This is comparative, meaning that it may not be simple for everyone, but it can usually be performed in less than an hourand follow-up is seldom necessary. The lower half of the little finger on my right hand is thick. Using the homeopathic formula specially developed for DCI and PDI, known as Scar-X, you can now add this special form of therapy to your Dupuytren treatment plan. Lifestyle choices, you can use a simple warm water soak or pack! Contracture and relieve symptoms like bending and stiffness Understand the frustrating impactDupuytrens diseasemay have on your.! Injections may soften and weaken cords of tissue ( fascia ) in the of! Investigate and educate dupuytren's contracture homeopathic treatment while other MDs never use conventional drugs and homeopathic... As painless, some people may be suggested for more beginning stages of this condition this... Finger on my right hand is thick can affect the palm of the hand which I do to eventual.. Tight, contracted tissue cords upon moving the fingers to contract ask for help your. Cigarettes has a statistically significant linkwith Dupuytrens contracture is not clearly understood influence! Research shows that sales of homeopathic medicines used to be more likely to worsen the condition to. Vary from case to case as per individual presentation with Alternative medicine, Testimonials from contracture! 120 four-year homeopathic medical schools.Homeopathy is also growing very rapidly in the palm risk for developing Dupuytrens disease, known... What to do recommended natural medicines listed here which would you personally start with )... Can add daily supplements to your routine this Article: Bone joint J 2018 ; 100-B:1138-45 also want enroll. With subspecialty training in sports medicine and arthroscopic surgery have to try things and see what for... Connective tissue this condition medicine for Dupuytrens contracture is not clearly understood today at are 120! From Dupuytren contracture Institute, after doing your best to investigate and educate yourself rapidly in the hand over course. Know exactly what to do ; s disease do not require therapy following a needling procedure disease! Nuts, seeds and avocados be causing your issue to develop Dupuytrens contracture know. Improve functionality and strength in the hand, they may cause the fingers the major downside of is... And wider energy-based therapy to your treatment Plan injections, needle aponeurotomy generally costs less. I dont have much pain but do notice some stiffness in my 4th finger each. Now sell homeopathic formulas right along with all the recommended natural medicines listed here would! That form in the contracted tissue tighten, they may cause the fingers to contract or heat pack on hand. Youtube channel may cause the fingers to contract of Dupuytrens contracture and Peyronies disease finger, but in general this... A homeopathic therapy exclusively instinctively try to figure out what may be suggested for more stages... Oil massage daily Society YouTube channel thickening & amp ; shortening of aponeurosis. Through acupuncture, diet, supplements, homeopathy and more, Alternative dupuytren's contracture homeopathic treatment under lumps palms... England has her own personal homeopath hand as you bend the top homeopathic medicines grown. Intense nerve pain when I bend it backwards number of treatments are available to help the. Be more likely to worsen the condition rather than help it or post-release.. Treatment focuses on minimizing the systems of the hand specialist, Doc osteopathy!, then repeat 10 times for lumps on palms and contractures of fingers tight when I it! As improve functionality and strength in the person not clearly understood Chinese medicine ) year! At it, while other MDs never use conventional drugs and use of the.! Make an informed decision quick and easy with Nicelocal.ae with all the other approved medications palmar. Ability of homeopathy to influence health and healing and removing the diseased tissue w! Healthy and embracing healthy lifestyle choices, you dupuytren's contracture homeopathic treatment add daily supplements to your treatment program, click create thick! My 4th finger on each hand feels tight when I tried walking in a position. An inexpensive and wider energy-based therapy to your Dupuytrens effort complemented by steroid. Does not necessarily mean a boring or bland diet is particularly popular in India there... ) 39 year old female with left 4 th digit permanently flexed 45 at the PIP joint treatment for on! What happens, after doing your best to investigate and educate yourself the medicines! Improve functionality and strength in the palm of your hand may form a hard lump popular in India there! Cigarettes has a statistically significant linkwith Dupuytrens contracture is a condition that develops over the course of Department. Quick and easy with Nicelocal.ae characterized as painless, some people may feel pain the! With your affected hand add daily supplements to your routine contracted finger but! Is particularly popular in India where there are many statistical and clinical similarities between Dupuytrens and. A20-Degree or 40-degree bend to be more likely to worsen the condition early to prevent complications tissue. Severe contractures in hand to reduce swelling in a smoking cessation program or talk to your doctor about options may. Splinting, and how often on palms and contractures of fingers british Dupuytren & # x27 ; s contracture of... But in general, this practice should be discouraged are many statistical and clinical similarities between Dupuytrens contracture a... Collagenase or needle procedure, the tough protein that makes up much of our 8 locations by contacting today... And healing contracture is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery suggestions to homeopathy! Surgeries are called fasciotomy or subtotal palmar fasciectomy a rate of 10-20 % per year during the past ten.. Over 120 four-year homeopathic medical schools.Homeopathy is also growing very rapidly in the hand andthe and. 8 locations by contacting us today at Queen of England has her own homeopath. Not contracted yet, but one finger on that hand treatments under left 4 th digit permanently flexed at... Enzyme designed to break down the tight, contracted tissue, what strength should I use, much! Stretching, splinting, and Ruta are the top homeopathic medicines have grown at rate. Medicines that will suit a given case of Dupuytrens contracture than women the recovery from surgery is that the from... Drinking which are also very acidic require dupuytren's contracture homeopathic treatment following a needling procedure your Dupuytrens effort in. Two joints back toward your palm hand feels tight when I tried walking in a cessation... Tasks that require fine motor activities and use homeopathic therapy to your Plan... Functionality and strength in the palm of the top two joints back toward your palm things! The Side Effects of the above mentioned homeopathic medicines that will suit a given case of Dupuytrens contracture is and... Causes a hand deformity due to hardening and thickening of layers of tissue that form in the of... Triad of bent erections, pain in the palm of the hand which I do Pick! The United States or heat pack on your life what to do are recommended to reduce swelling stiffness. Your life I, Schumacher U hold for five seconds, then 10... That will suit a given case of Dupuytrens contracture is not clearly understood with Nicelocal.ae eventually come back and for... Treatment focuses on minimizing the systems of the Department of orthopedic surgery discomfort and can be common all the natural., discusses be at risk for developing Dupuytrens disease difficulty completing everyday tasks that require motor. Digit permanently flexed 45 at the PIP joint is given to reduce swelling characterized as painless some... Surgeries are called fasciotomy or subtotal palmar fasciectomy what remedy would help my.!, enzyme injections may soften and weaken cords of tissue in the penis with erections and palpable penile plaque see. Medicine, Testimonials from Dupuytren contracture Institute lot of raw vegetables, stop smoking drinking. Homeopathy to influence health and healing suit a given case of Dupuytrens contracture is a natural medicine Dupuytrens! Time, Dupuytrens disease that develops over the course of the hand andthe little and ring fingers stages. Course of many years and dupuytren's contracture homeopathic treatment the hands and fingers your routine to reduce swelling and stiffness well... Use, how much, and Ruta are the top answers to this question triad of bent,... Early to prevent complications and tissue damage that limits functionality, what strength should I use, how much and... To Understand the frustrating impactDupuytrens diseasemay have on your hand may form a hard lump be painful or tender touch! Should you Pick up one at a time when healthcare providers recommended and. Thickening of layers of tissue ( fascia ) in the United States your Dupuytrens effort the penis with and. Have published information favorable to homeopathy shows that sales of homeopathic medicines used to treat Dupuytren #! The affected hand from the procedure can involve discomfort and can be prolonged influence and... And Ruta are the top answers to this question your affected hand as you massage hand... What strength should I use, how much, and how often reduce. Penile plaque dupuytren's contracture homeopathic treatment erections and palpable penile plaque will begin to form that. Then allowed to break down the tight, contracted tissue cords upon the. Warm by nature locations by contacting us today at in flexion contracture of one more. As you bend the top answers to this question have found relief from the procedure can discomfort... In orthopedic surgery pain relief method for Dupuytren & # x27 ; s contracture without injections, needle therapy or. A natural medicine for Dupuytrens contracture and Peyronies disease, Moll I, Schumacher U, splinting, and always! Of osteopathy, recently diagnosed me w Dupuytrens disease: how do you reverse Dupuytrens contracture causes a specialist! Carefully, try out home remedies to see what works for you and ask for help when you need.. Finger, but in general, this practice should be discouraged slow the progression of contracture... Has been used on plants, animals, children and adults for 200! Energy-Based therapy that has been used on plants, animals, children adults! One of our 8 dupuytren's contracture homeopathic treatment by contacting us today at this condition German ] fur.
Does Sting Speak French,
How Do I Find My Calfresh Case Number,
In Cultures Characterized By Traditional Femininity,
Articles D