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<H3><FONT face=3Dverdana,arial,helvetica,sans-serif =
color=3D#63ceff>Clinical=20
review</FONT></H3><FONT face=3Dverdana,arial,helvetica,sans-serif=20
size=3D+1><I>Extracts from "BestTreatments"</I></FONT>
<P>
<H2>Treating head lice </H2></NOBR><STRONG>Beth Nash, =
</STRONG><I>physicians=20
editor, BestTreatments</I></STRONG></NOBR>=20
<P><FONT size=3D-1>BMJ Publishing Group, London WC1H 9JR <A=20
href=3D"mailto:bnash@bmjgroup.com">bnash@bmjgroup.com</A> </FONT>
<P>
<P><A name=3DBDY><!-- null --></A><BR clear=3Dright>
<TABLE cellSpacing=3D0 cellPadding=3D0 width=3D"100%" bgColor=3D#ffffff>
  <TBODY>
  <TR>
    <TD vAlign=3Dcenter align=3Dleft width=3D"5%" bgColor=3D#ffffff><IMG =
height=3D21=20
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width=3D10></TD>
    <TH vAlign=3Dcenter align=3Dleft width=3D"95%"><FONT color=3D#63ceff =

      size=3D+2>&nbsp;&nbsp; Introduction =
</FONT></TH></TR></TBODY></TABLE>
<TABLE cellPadding=3D5 align=3Dright border=3D1>
  <TBODY>
  <TR>
    <TH align=3Dleft><FONT size=3D-1><A=20
      href=3D"http://bmj.com/cgi/content/full/326/7401/1256#top"><IMG =
height=3D9=20
      hspace=3D5 src=3D"http://bmj.com/icons/toc/uarrow.gif" width=3D11=20
      border=3D0>Top<BR></A><IMG height=3D9 hspace=3D5=20
      src=3D"http://bmj.com/icons/toc/dot.gif" width=3D11 =
border=3D0><FONT=20
      color=3D#464c53>Introduction</FONT><BR><A=20
      href=3D"http://bmj.com/cgi/content/full/326/7401/1256#SEC1"><IMG =
height=3D9=20
      hspace=3D5 src=3D"http://bmj.com/icons/toc/darrow.gif" width=3D11=20
      border=3D0>Treatment<BR></A><A=20
      href=3D"http://bmj.com/cgi/content/full/326/7401/1256#SEC2"><IMG =
height=3D9=20
      hspace=3D5 src=3D"http://bmj.com/icons/toc/darrow.gif" width=3D11=20
      border=3D0>Misconceptions about head lice:...<BR></A><A=20
      href=3D"http://bmj.com/cgi/content/full/326/7401/1256#BIBL"><IMG =
height=3D9=20
      hspace=3D5 src=3D"http://bmj.com/icons/toc/darrow.gif" width=3D11=20
      =
border=3D0>References<BR></A></FONT></TH></TR></TBODY></TABLE>&nbsp;<BR><=
B>Description</B>=20
Head lice are parasites that usually infest the<SUP> </SUP>scalps of =
school age=20
children, although adults also get them.<SUP> </SUP>Lice attach their =
eggs to=20
hair shafts near the scalp and lay<SUP> </SUP>five to six eggs a day. =
Lice never=20
willingly leave the head;<SUP> </SUP>they stay close to the scalp for =
food,=20
shelter, warmth, and<SUP> </SUP>moisture. They are most often found =
behind the=20
ears and at the<SUP> </SUP>back of the neck. Hatched eggshells (nits) =
may be=20
confused<SUP> </SUP>with dandruff. The mature louse is the size of a =
sesame=20
seed<SUP> </SUP>and has six legs and hook-like claws that grasp the =
strand<SUP>=20
</SUP>of hair tightly, making it difficult to dislodge. It feeds<SUP> =
</SUP>on=20
the host's blood every three to six hours, which can cause<SUP> =
</SUP>scalp=20
itching, though most cases are asymptomatic. The diagnosis<SUP> </SUP>of =
lice=20
infestation can be made definitively only if living<SUP> </SUP>lice are=20
present.<A =
href=3D"http://bmj.com/cgi/content/full/326/7401/1256#FIG1"></A><SUP>=20
</SUP>
<P><A name=3DFIG1><!-- null --></A><BR clear=3Dleft>
<TABLE cellSpacing=3D0 cellPadding=3D4 width=3D"1%" align=3Dleft =
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  <TBODY>
  <TR>
    <TD>
      <TABLE cellSpacing=3D0 cellPadding=3D0 width=3D"1%" =
bgColor=3D#ffffff border=3D0>
        <TBODY>
        <TR>
          <TD bgColor=3D#eeeeee><FONT face=3D"arial, helvetica" =
size=3D-1><IMG=20
            height=3D162=20
            =
src=3D"http://bmj.com/content/vol326/issue7401/images/small/bt02main.f1.g=
if"=20
            width=3D200 border=3D0> </FONT></TD></TR>
        <TR>
          <TD bgColor=3D#eeeeee><FONT face=3D"arial, helvetica" =
size=3D-1>DR JEREMY=20
            BURGESS/SPL
            =
<P></FONT></P></TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE><SUP></=
SUP>
<P><A name=3DSEC1><!-- null --></A><BR clear=3Dright>
<TABLE cellSpacing=3D0 cellPadding=3D0 width=3D"100%" bgColor=3D#ffffff>
  <TBODY>
  <TR>
    <TD vAlign=3Dcenter align=3Dleft width=3D"5%" bgColor=3D#ffffff><IMG =
height=3D21=20
      alt=3D"" hspace=3D5 src=3D"http://bmj.com/icons/toc/rarrow.gif" =
width=3D10></TD>
    <TH vAlign=3Dcenter align=3Dleft width=3D"95%"><FONT color=3D#63ceff =

      size=3D+2>&nbsp;&nbsp; Treatment </FONT></TH></TR></TBODY></TABLE>
<TABLE cellPadding=3D5 align=3Dright border=3D1>
  <TBODY>
  <TR>
    <TH align=3Dleft><FONT size=3D-1><A=20
      href=3D"http://bmj.com/cgi/content/full/326/7401/1256#top"><IMG =
height=3D9=20
      hspace=3D5 src=3D"http://bmj.com/icons/toc/uarrow.gif" width=3D11=20
      border=3D0>Top<BR></A><A=20
      href=3D"http://bmj.com/cgi/content/full/326/7401/1256#BDY"><IMG =
height=3D9=20
      hspace=3D5 src=3D"http://bmj.com/icons/toc/uarrow.gif" width=3D11=20
      border=3D0>Introduction<BR></A><IMG height=3D9 hspace=3D5=20
      src=3D"http://bmj.com/icons/toc/dot.gif" width=3D11 =
border=3D0><FONT=20
      color=3D#464c53>Treatment</FONT><BR><A=20
      href=3D"http://bmj.com/cgi/content/full/326/7401/1256#SEC2"><IMG =
height=3D9=20
      hspace=3D5 src=3D"http://bmj.com/icons/toc/darrow.gif" width=3D11=20
      border=3D0>Misconceptions about head lice:...<BR></A><A=20
      href=3D"http://bmj.com/cgi/content/full/326/7401/1256#BIBL"><IMG =
height=3D9=20
      hspace=3D5 src=3D"http://bmj.com/icons/toc/darrow.gif" width=3D11=20
      =
border=3D0>References<BR></A></FONT></TH></TR></TBODY></TABLE>&nbsp;<BR><=
STRONG>Treatments=20
that are likely to work</STRONG><BR><I>Malathion</I><BR>Malathion works =
as well=20
as other agents used to kill lice. Malathion<SUP> </SUP>must be left on =
for at=20
least eight hours for it to work. It<SUP> </SUP>is applied to dry hair =
until the=20
scalp and hair are wet and<SUP> </SUP>thoroughly coated. If lice are =
found 7-10=20
days after treatment,<SUP> </SUP>treat again with the same or different=20
medication. The alcohol<SUP> </SUP>in malathion lotion and the =
terpenoids may=20
cause stinging. Malathion<SUP> </SUP>is considered safe in pregnancy or=20
breastfeeding.<SUP> </SUP>
<P><I>Lindane</I><BR>Although lindane may work as well as other =
insecticide=20
based<SUP> </SUP>agents, its use is limited by its potential =
neurotoxicity.<SUP>=20
</SUP>It is applied, for only four minutes, to wet the hair and =
skin<SUP>=20
</SUP>or scalp of the affected area and surrounding hairy areas.<SUP>=20
</SUP>Treatment may be repeated after seven days if necessary. =
Lindane<SUP>=20
</SUP>should be avoided in pregnancy and breastfeeding. If it must<SUP> =
</SUP>be=20
used in pregnancy, it should only be used once.<SUP> </SUP>
<P><I>Permethrin</I><BR>Permethrin may work better than lindane, though =
most=20
trials<SUP> </SUP>were done before permethrin was widely used and=20
resistance<SUP> </SUP>to the drug developed. It is used as 1% creme =
rinse left=20
on<SUP> </SUP>for 10 minutes. If the first application fails to kill =
the<SUP>=20
</SUP>eggs (that is, if young hatching lice are found using a =
suitable<SUP>=20
</SUP>detection comb) a second treatment is indicated, usually =
seven<SUP>=20
</SUP>days after the first treatment. Undertreatment in this =
situation<SUP>=20
</SUP>could contribute to the development of resistance to the =
drug.<SUP>=20
</SUP>There is no role for a third application, as this will =
contribute<SUP>=20
</SUP>to resistance and is not likely to be effective. Permethrin<SUP> =
</SUP>has=20
not been studied in pregnancy.<SUP> </SUP>
<P><I>Pyrethrins</I><BR>Pyrethrins are used as a 0.33% shampoo or =
mousse, by=20
applying<SUP> </SUP>enough to thoroughly wet the hair and leaving it on =
for=20
10<SUP> </SUP>minutes. All pyrethrum products that conform to the US =
Food<SUP>=20
</SUP>and Drug Administration criteria for use in humans require<SUP> =
</SUP>a=20
second application after 7-10 days, to ensure treatment of<SUP> =
</SUP>lice=20
emerging from eggs that have not been killed by the first<SUP>=20
</SUP>application. Pyrethrins work as well as permethrin.<SUP> </SUP>
<P><STRONG>Treatments that need further study</STRONG><BR><I>Herbal =
treatments=20
and aromatherapy</I><BR>Herbal treatments (including tea tree oil) and=20
aromatherapy<SUP> </SUP>are sometimes used to treat head lice. No =
studies have=20
evaluated<SUP> </SUP>their efficacy or possible toxicity.<SUP> </SUP>
<P><I>Mechanical removal of lice or viable louse eggs by =
combing</I><BR>There is=20
insufficient evidence to determine the efficacy of<SUP> </SUP>"bug =
busting" (wet=20
combing with conditioner). Many combs have<SUP> </SUP>been developed for =
lice=20
removal, but many that are used are<SUP> </SUP>inappropriate. There is =
little=20
evidence to support the use<SUP> </SUP>of any combing method. In one =
trial,=20
significantly more people<SUP> </SUP>treated with malathion than with =
bug=20
busting had no lice at<SUP> </SUP>seven days (31/40 (78%) <I>v</I> 12/32 =
(38%)).=20
A new study (which<SUP> </SUP>we have not yet added to the =
BestTreatments site)=20
looked at<SUP> </SUP>permethrin creme rinse with and without combing;=20
permethrin<SUP> </SUP>without combing was marginally more =
effective.<SUP><A=20
href=3D"http://bmj.com/cgi/content/full/326/7401/1256#REF1">1</A></SUP><S=
UP>=20
</SUP>
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      alt=3D"" hspace=3D5 src=3D"http://bmj.com/icons/toc/rarrow.gif" =
width=3D10></TD>
    <TH vAlign=3Dcenter align=3Dleft width=3D"95%"><FONT color=3D#63ceff =

      size=3D+2>&nbsp;&nbsp; Misconceptions about head lice: what does =
the=20
      research really show? </FONT></TH></TR></TBODY></TABLE>
<TABLE cellPadding=3D5 align=3Dright border=3D1>
  <TBODY>
  <TR>
    <TH align=3Dleft><FONT size=3D-1><A=20
      href=3D"http://bmj.com/cgi/content/full/326/7401/1256#top"><IMG =
height=3D9=20
      hspace=3D5 src=3D"http://bmj.com/icons/toc/uarrow.gif" width=3D11=20
      border=3D0>Top<BR></A><A=20
      href=3D"http://bmj.com/cgi/content/full/326/7401/1256#BDY"><IMG =
height=3D9=20
      hspace=3D5 src=3D"http://bmj.com/icons/toc/uarrow.gif" width=3D11=20
      border=3D0>Introduction<BR></A><A=20
      href=3D"http://bmj.com/cgi/content/full/326/7401/1256#SEC1"><IMG =
height=3D9=20
      hspace=3D5 src=3D"http://bmj.com/icons/toc/uarrow.gif" width=3D11=20
      border=3D0>Treatment<BR></A><IMG height=3D9 hspace=3D5=20
      src=3D"http://bmj.com/icons/toc/dot.gif" width=3D11 =
border=3D0><FONT=20
      color=3D#464c53>Misconceptions about head lice:...</FONT><BR><A=20
      href=3D"http://bmj.com/cgi/content/full/326/7401/1256#BIBL"><IMG =
height=3D9=20
      hspace=3D5 src=3D"http://bmj.com/icons/toc/darrow.gif" width=3D11=20
      =
border=3D0>References<BR></A></FONT></TH></TR></TBODY></TABLE>&nbsp;<BR>
<UL>
  <LI>There is no evidence to support the cleaning of sheets and =
clothing,<SUP>=20
  </SUP>or the treating of earphones, baseball helmets, and =
furniture<SUP>=20
  </SUP>with insecticide sprays.<SUP> </SUP><BR>
  <LI>Infection is spread between people<SUP> </SUP>only by relatively=20
  prolonged<SUP> </SUP>head to head contact; thus it<SUP> </SUP>is =
typically=20
  spread between people<SUP> </SUP>who know each other well.<SUP> =
</SUP>Lice=20
  seen on chairs, pillows, and<SUP> </SUP>hats are dead, sick, or =
elderly<SUP>=20
  </SUP>or are cast skins of lice=97these<SUP> </SUP>cannot infect a =
person.<SUP>=20
  </SUP><BR>
  <LI>School based "no-nits" policies (banning children with nits<SUP>=20
  </SUP>until all nits are removed) do not make sense=97less than<SUP> =
</SUP>20%=20
  of school children with nits will go on to develop infestation<SUP>=20
  </SUP>within 14 days. About half of children sent home for head =
lice<SUP>=20
  </SUP>don't have them. Many public health experts believe that =
"no-nits"<SUP>=20
  </SUP>policies should be abandoned.<SUP> </SUP><BR>
  <LI>Treatment should not be started<SUP> </SUP>unless live lice are=20
  found.<SUP> </SUP>Nits are not a sign of active infestation<SUP> =
</SUP>with=20
  head lice.<SUP> </SUP><BR>
  <LI>Cutting hair, or tying it back, is not helpful<SUP> </SUP>and may=20
  increase<SUP> </SUP>the incidence of infestation by making it<SUP>=20
  </SUP>easier for lice to<SUP> </SUP>move off of and on to the =
scalp.<SUP>=20
  </SUP><BR>
  <LI>Head<SUP> </SUP>lice are probably more common in girls because =
girls=20
  are<SUP> </SUP>more<SUP> </SUP>likely to have close contacts during =
play=97not=20
  because<SUP> </SUP>they have longer hair.<SUP> </SUP><BR>
  <LI>Head lice are harmless. If detached<SUP> </SUP>from their host =
they=20
  are<SUP> </SUP>vulnerable and effectively dead.<SUP>=20
</SUP><BR></LI></UL><SUP></SUP>
<P>
<P>
<HR align=3Dleft width=3D"30%" SIZE=3D1>
<A name=3D""><!-- null --></A><SUP></SUP><BR clear=3Dright><IMG =
height=3D60=20
src=3D"http://bmj.com/content/vol326/issue7401/images/medium/bestreat.f1.=
gif"=20
width=3D200 border=3D0><I>This is an extract from BestTreatments,<SUP> =
</SUP>which=20
provides a shared online information resource for patients<SUP> =
</SUP>and=20
doctors, based on Clinical Evidence (<A=20
href=3D"http://www.clinicalevidence.com/">http://www.clinicalevidence.com=
/</A>).<SUP>=20
</SUP>More information about head lice, including references for<SUP>=20
</SUP>this</I> BMJ <I>article, is at <A=20
href=3D"https://www.besttreatments.org/headlice">https://www.besttreatmen=
ts.org/headlice</A></I><SUP>=20
</SUP>
<P><A name=3D""><!-- null --></A>This extract from BestTreatments will =
remain=20
available at <A href=3D"http://bmj.com/">bmj.com</A>.<SUP> </SUP>The =
rest of the=20
BestTreatments website (<A=20
href=3D"http://www.besttreatments.org/">http://www.besttreatments.org/</A=
>)<SUP>=20
</SUP>is currently available only to patients who are members of<SUP>=20
</SUP>United Healthcare plans in the United States.<SUP> </SUP>
<P><A name=3DBIBL><!-- null --></A><BR clear=3Dright>
<TABLE cellSpacing=3D0 cellPadding=3D0 width=3D"100%" bgColor=3D#ffffff>
  <TBODY>
  <TR>
    <TD vAlign=3Dcenter align=3Dleft width=3D"5%" bgColor=3D#ffffff><IMG =
height=3D21=20
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width=3D10></TD>
    <TH vAlign=3Dcenter align=3Dleft width=3D"95%"><FONT color=3D#63ceff =

      size=3D+2>&nbsp;&nbsp; References =
</FONT></TH></TR></TBODY></TABLE>
<TABLE cellPadding=3D5 align=3Dright border=3D1>
  <TBODY>
  <TR>
    <TH align=3Dleft><FONT size=3D-1><A=20
      href=3D"http://bmj.com/cgi/content/full/326/7401/1256#top"><IMG =
height=3D9=20
      hspace=3D5 src=3D"http://bmj.com/icons/toc/uarrow.gif" width=3D11=20
      border=3D0>Top<BR></A><A=20
      href=3D"http://bmj.com/cgi/content/full/326/7401/1256#BDY"><IMG =
height=3D9=20
      hspace=3D5 src=3D"http://bmj.com/icons/toc/uarrow.gif" width=3D11=20
      border=3D0>Introduction<BR></A><A=20
      href=3D"http://bmj.com/cgi/content/full/326/7401/1256#SEC1"><IMG =
height=3D9=20
      hspace=3D5 src=3D"http://bmj.com/icons/toc/uarrow.gif" width=3D11=20
      border=3D0>Treatment<BR></A><A=20
      href=3D"http://bmj.com/cgi/content/full/326/7401/1256#SEC2"><IMG =
height=3D9=20
      hspace=3D5 src=3D"http://bmj.com/icons/toc/uarrow.gif" width=3D11=20
      border=3D0>Misconceptions about head lice:...<BR></A><IMG =
height=3D9 hspace=3D5=20
      src=3D"http://bmj.com/icons/toc/dot.gif" width=3D11 =
border=3D0><FONT=20
      =
color=3D#464c53>References</FONT><BR></FONT></TH></TR></TBODY></TABLE>&nb=
sp;<BR>
<OL><A name=3DREF1><!-- null --></A>
  <LI value=3D1><SUP></SUP>Meinking TL, Clineschmidt CM, Chen C, Kolber =
MA,=20
  Tipping RW, Furtek CI, Villar ME, Guzzo CA. An observer-blinded study =
of 1%=20
  permethrin creme rinse with and without adjunctive combing in patients =
with=20
  head lice. <I>J Pediatr</I> 2002 Nov;141: 665-70<!-- HIGHWIRE =
ID=3D"326:7401:1256:1" --><A=20
  =
href=3D"http://bmj.com/cgi/external_ref?access_num=3D10.1067/mpd.2002.129=
031&amp;link_type=3DDOI">[CrossRef]</A><A=20
  =
href=3D"http://bmj.com/cgi/external_ref?access_num=3D000179182300020&amp;=
link_type=3DISI">[ISI]</A><A=20
  =
href=3D"http://bmj.com/cgi/external_ref?access_num=3D12410195&amp;link_ty=
pe=3DMED">[Medline]</A><!-- /HIGHWIRE --><SUP>=20
  </SUP></LI></OL><BR clear=3Dall><A name=3Dresponses><!-- eletters =
--></A>
<H2>Rapid responses:</H2>
<P><FONT face=3Dverdana,arial,helvetica,sans-serif size=3D-1>Read all <A =

href=3D"http://bmj.com/cgi/eletters/326/7401/1256">Rapid =
responses</A></FONT>=20
<DL>
  <DT><STRONG>Treatment of head lice</STRONG>=20
  <DD>Paramoo Sudevan=20
  <DD>bmj.com, 6 Jun 2003 <FONT =
face=3Dverdana,arial,helvetica,sans-serif=20
  size=3D-1><A =
href=3D"http://bmj.com/cgi/eletters/326/7401/1256#33051">[Full=20
  text]</A></FONT>=20
  <DT><STRONG>Electrocuting the b******s</STRONG>=20
  <DD>Ian Pennell=20
  <DD>bmj.com, 6 Jun 2003 <FONT =
face=3Dverdana,arial,helvetica,sans-serif=20
  size=3D-1><A =
href=3D"http://bmj.com/cgi/eletters/326/7401/1256#33052">[Full=20
  text]</A></FONT>=20
  <DT><STRONG>Neem oil kills headlice</STRONG>=20
  <DD>Rachel M Calam=20
  <DD>bmj.com, 6 Jun 2003 <FONT =
face=3Dverdana,arial,helvetica,sans-serif=20
  size=3D-1><A =
href=3D"http://bmj.com/cgi/eletters/326/7401/1256#33055">[Full=20
  text]</A></FONT>=20
  <DT><STRONG>Head Lice: A Disruptive Social Problem</STRONG>=20
  <DD>Martin. G. Buckley=20
  <DD>bmj.com, 6 Jun 2003 <FONT =
face=3Dverdana,arial,helvetica,sans-serif=20
  size=3D-1><A =
href=3D"http://bmj.com/cgi/eletters/326/7401/1256#33060">[Full=20
  text]</A></FONT>=20
  <DT><STRONG>endorse the finetooth comb</STRONG>=20
  <DD>M D Dominic Bell=20
  <DD>bmj.com, 6 Jun 2003 <FONT =
face=3Dverdana,arial,helvetica,sans-serif=20
  size=3D-1><A =
href=3D"http://bmj.com/cgi/eletters/326/7401/1256#33062">[Full=20
  text]</A></FONT>=20
  <DT><STRONG>Treating head lice--view from the battlefield</STRONG>=20
  <DD>Sylva Dolenska=20
  <DD>bmj.com, 7 Jun 2003 <FONT =
face=3Dverdana,arial,helvetica,sans-serif=20
  size=3D-1><A =
href=3D"http://bmj.com/cgi/eletters/326/7401/1256#33097">[Full=20
  text]</A></FONT>=20
  <DT><STRONG>Re: endorse the finetooth comb</STRONG>=20
  <DD>Sylva Dolenska, et al.=20
  <DD>bmj.com, 7 Jun 2003 <FONT =
face=3Dverdana,arial,helvetica,sans-serif=20
  size=3D-1><A =
href=3D"http://bmj.com/cgi/eletters/326/7401/1256#33098">[Full=20
  text]</A></FONT>=20
  <DT><STRONG>Herbs in the Treatment of Headlice</STRONG>=20
  <DD>Cindy L Jones=20
  <DD>bmj.com, 7 Jun 2003 <FONT =
face=3Dverdana,arial,helvetica,sans-serif=20
  size=3D-1><A =
href=3D"http://bmj.com/cgi/eletters/326/7401/1256#33102">[Full=20
  text]</A></FONT>=20
  <DT><STRONG>Natuarl history should dictate management of head =
lice</STRONG>=20
  <DD>Surinder Bakhshi=20
  <DD>bmj.com, 7 Jun 2003 <FONT =
face=3Dverdana,arial,helvetica,sans-serif=20
  size=3D-1><A =
href=3D"http://bmj.com/cgi/eletters/326/7401/1256#33104">[Full=20
  text]</A></FONT> </DD></DL><A name=3Drelated><!-- other related =
--></A>
<H2>Other related articles in BMJ:</H2>
<DL>
  <DT><FONT size=3D-1>EDITOR'S CHOICE</FONT><BR><STRONG>Head lice: =
boring for=20
  doctors, important to patients.</STRONG>=20
  <DD>Richard Smith<BR>BMJ 2003 326: 0. <NOBR><A=20
  href=3D"http://bmj.com/cgi/content/full/326/7401/0-g">[Full text]</A>=20
  &nbsp;</NOBR>=20
  <P></P></DD></DL><BR clear=3Dall><BR clear=3Dall>
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