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best job essay However, dopamine agonists administered to patients with acromegaly exert the opposite effect and suppress gh release from the tumor. The first dopamine agonist used for acromegaly, bromocriptine, achieved normal igf-i concentrations in fewer than 10% of patients. 6 the large doses of bromocriptine required to achieve the desired response are often associated with dose-limiting toxicity such as gi discomfort and orthostatic hypotension. Cabergoline, a selective long-acting dopamine agonist with improved tolerability, can effectively reduce gh and igf-i concentrations in approximately 40% of patients. 3 acromegalic patients with coexisting hyperprolactinemia achieve a more favorable response to cabergoline. 3 although orally administered dopamine agonists are the least expensive medical therapy for managing acromegaly, the major disadvantage is their relative lack of efficacy compared with existing therapeutic options. Cabergoline may be considered for patients with modest elevation of gh and igf-i concentrations less than two times the upper limit of normal. It may also be used as adjunctive therapy in patients unresponsive to monotherapy with somatostatin analogs or pegvisomant. 7 although cardiac valvular abnormalities have been observed in patients using higher doses of cabergoline for parkinson disease, similar findings have not been reported in patients with acromegaly. 3,19 nonetheless, echocardiographic monitoring for potential cardiac abnormalities is warranted for patients who require prolonged, high-dose cabergoline therapy. Radiation therapy  radiation therapy is an important adjunctive therapy in patients with residual gh excess after surgery or pharmacologic therapy. Treatment involves the use of radiation to destroy rapidly growing tumor cells, and often results in a reduction in tumor size. A major complication of radiation therapy is hypopituitarism, requiring lifelong hormone replacement. 3 there is also the potential for optic nerve damage if the pituitary tumor is near the optic tracts. Radiation therapy may take 10 to 20 years before its full effects become evident. 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.

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http://projects.csail.mit.edu/courseware/?term=short-narrative-essay-example short narrative essay example Segmental necrosis o muscle bers are seen in most causes o myoapthy. In ammation and vasculitis polymyositis lymphocytic in ltration o endomysium. Abnormal muscle bers are scattered throughout the ascicle (not grouped to one portion, as in dermatomyositis). No signs o vasculopathy or immune complex deposition. Dermatomyositis perimysial in ammatory in ltrate with vascular c5b-9 deposition in the perimysial blood vessels. Peri asicular atrophy and brosis. Abnormal muscle bers grouped to one portion o the ascicle. Inclusion body myositis characterized by in ammation. Vacuolar inclusions other myopathies, such as scleroderma, mixed connective tissue disorder, sjogren syndrome, and acioscapulohumeral dystrophy, may be associated with lesser degree o in ammation. Vasculitis in ammatory vascular destruction can occur in systemic disease. Granulomatous myopathy may be seen in systemic sarcoidosis. Changes in muscle protein and histochemical stains presence or absence o structural proteins detected by special enzyme staining can be help ul in the diagnosis o various orms o muscular dystrophy. A normalities of mitochondria mitochondrial myopathies classic hallmark o mitochondrial diseases is subsarcolemmal and inter myo brillar accumulation o mitochondria, which can be visualized by light microscopy using gomori trichrome stain.

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