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which magazine pioneered the photo essay Na 136 viagra kills candidate trinidad meq/l (136 mmol/l). K 3. 6 meq/l (3. 6 mmol/l). Cl 98 meq/l (98 mmol/l). Co2 24 meq/l (24 mmol/l). Bun 15 mg/dl (5. 4 mmol/l). Scr 0. 9 mg/dl (80 μmol/l). Glu 172 mg/dl (9.

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thesis writing literary analysis 3 owing to this delay in onset of effectiveness, pharmacologic therapy with a somatostatin analog often is indicated as bridge therapy. 3 men and women who desire to have children should be warned that pituitary irradiation therapy may impair fertility because of subsequent gonadotropin deficiency. 3 »» outcome evaluation •• lifelong biochemical assessment is critical for determining therapeutic outcomes. Although some patients may experience a rapid decline in gh concentrations after surgery, stabilization of igf-i concentrations usually occurs 3 months after surgery but rarely may be delayed for up to 12 months. Fully assess pituitary function 2 to 3 months after surgery. 3 monitor gh and igf-i concentrations every 3 to 6 months postoperatively to assess treatment response. 3 obtain igf-i concentrations annually in all postsurgical patients to monitor for potential pituitary tumor recurrence. 3 •• assess mri 3 to 4 months after surgery and 3 to 6 months after starting medical therapy. 20 because up to 10% of pituitary tumors may recur within 15 years after surgery,21 continual postoperative monitoring is recommended. 718  section 7  |  endocrinologic disorders •• for patients treated with somatostatin analogs, assess baseline fasting blood glucose, thyroid function tests, and heart rate. Thereafter, periodically monitor patients for adverse reactions such as gi disturbances, glucose intolerance, signs and symptoms of thyroid abnormalities, bradycardia, and arrhythmias in patients receiving longterm somatostatin analogs. Reevaluate igf-i and gh concentrations at 3-month intervals to determine therapeutic response and inquire about symptoms of gallbladder disease (eg, intermittent pain in the upper right abdomen) during follow-up appointments. 3 if normalization of gh and igf-i concentrations are not fully achieved after 1 year, perform mri 6 months later and annually thereafter to monitor tumor mass. 3 •• for patients treated with a gh receptor antagonist, gh concentrations are not measured because pegvisomant is a modified gh molecule that is detected in commercial gh assays, resulting in falsely elevated gh concentrations. Therefore, monitor igf-i concentrations to assess response to pegvisomant therapy. After appropriate dose titration, monitor igf-i concentrations every 6 months. 3 concern for tumor growth requires careful monitoring of tumor size. Therefore, perform mri every 6 months during the first year of therapy and annually thereafter. 3 because of the potential for hepatotoxicity with pegvisomant therapy, it is mandatory to monitor liver enzymes prior to initiation of therapy, monthly during the first 6 months, quarterly for the next 6 months, and then biannually thereafter. 3 more frequent monitoring of liver enzymes is warranted in patients with elevated liver enzymes at baseline. 3 •• for patients receiving dopamine agonists, the maximal suppression of gh and igf-i concentrations may take up to 3 months to achieve. After stable control of biochemical markers is achieved with dopamine agonists or somatostatin analogs, monitor gh and igf-i concentrations annually. 3 •• with conventional multidose radiation therapy, the most rapid decline in gh serum concentrations occurs within the first 2 years. Monitor gh concentrations at the second year and annually thereafter. 3,21 patients who receive single-dose radiation therapy should be evaluated at 6-month intervals because response is observed earlier.

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college election essay 30. Ferrari md. Migraine. Lancet. 1998;351:1043–1051. 31. Axert [package insert]. Titusville, nj. Janssen pharmaceuticals. 2013. 32. Relpax [package insert]. New york, ny. Pfizer. 2013. 33. Frova [package insert]. Malern, pa. Endo pharmaceuticals. 2013. 34. Amerge [package insert].

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