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W ith a hand grasping the base o f the heart treatment anemia cheap 1 mg tolterodine visa, cut the pericardium and m ajor ves­ sels symptoms urinary tract infection purchase tolterodine 4 mg visa, the pulm onary artery medicine show order tolterodine 4mg online, and aorta as they extend through the pericardium. One im portant w eight to be m entioned here is that normal cat, raccoon, w ood­ chuck, and even fox hearts do not weigh m ore than 17 grams. M ake the incision, start­ ing at the pulm onary trunk, into the right ven­ tricle, close to the inter­ ventricular septum. Continue the incision, following the interventricular septum, into the right atrium. C heck the right atrioventricular valve, the orifices o f the cra­ nial vena cava, the caudal vena cava, the fossa ovalis, and the coronary sinus. Check the left atrioventricular Incise through the parietal valve and openings to the pul­ cusp o f the left atrioventricu­ m onary veins. To open the aorta, insert the knife under the septal cusp o f the left atrioventricular valve. Check the sem ilunar valves o f coronary the aorta, orifices, and right and Semilunar left coronary arteries, orifice o f valves of aorta the brachiocephalic trunk. Right hip Right and left stifle Right shoulder A tlanto-occipital Right and left hock in young anim als Fibrin and debris m ay only be in the hock joints o f septicem ic ani­ mals. Tiny bits o f fibrin m ay also be seen norm ally in the hock joints o f new born calves, causing some interpretation problem. Tibiol eres* To expose the stifle joints, reflect the skin, bend the joint, and cut the patellar ligam ent 1/3 o f the w ay up from the tibial tuberosity. Prop the head up (hoist, knee, or assis­ tant) to skin the left (down) side o f the head. Insert the knife into the joint and transect the spinal cord and liga­ m ents o f the joint dorsally and ventrally. To rem ove an eye: Grasp, w ith m inim um trac­ tion, the skin w hich has been left around the eye. Rem ove the eye, leaving the optic nerve longer on the left eye for easy identification. Pull the soft tissue back and forth under the knife blade w hile holding the back o f the knife gently against the eye­ ball proper. Some ocular pathologists prefer B ouin’s or Z enker’s, but due to their m ercury content and biohazard ac­ tivity, form alin is satisfactory if the eyes are fixed early. To the right is a diagram show ing the loca­ tion o f the brain in a dorsal view o f the skull. Look into the foram en m agnum to note the normal absence o f the cerebellar vermis. One cut is transverse through the frontal bone, caudal to the zygom atic process o f frontal bone. The cranial part o f the head is tow ards you, your thum b in the eye sock­ et, your fingers around the m andible. W ith the head in upright position, tap it lightly on the table to loosen the brain. Cut the olfactory peduncles, internal carotid arteries, and cranial nerves as the brain is rem oved. Note: It is norm al to find a single white firm V2 I cm white ta­ pered conical m ass hanging from the skull cap m idline attached to meninges. In m any anim als, two red­ dish soft m asses m ay be found hanging in a sim ilar position or slightly forward, and careful m anipulation will show them to be the normal roughly triangular choroid plexi from the lateral ven­ tricles. W P 11086, 20423 41 A transverse saw cut through the skull at the level o f the m iddle o f the eye sockets will cut through the ethm oid tur­ binates to check for progressive ethm oid hem atom a in the horse and parasites in m any species. A transverse saw cut through the snout at the level o f the com m isures o f the lips is needed to check for atrophic rhi­ nitis in pigs. To rem ove the pituitary gland: Pick up the dura from the basilar part o f the occipital bone betw een the sawn condyles. To m ake a bone m arrow im pression sm ear or ob­ tain a section o f marrow, crack open alm ost any large bone o f young or small anim als using the rib cutters to obliquely crack the bone. Prior to checking the distal joints on the limb, skin the limb to include rem oval o f the coronary band. To check the joints on the hind limb distal to stifle: H o c k For reasons o f leverage, start distally at the coffin joint, then pastern, fetlock, and tibiotarsal articulation o f the hock. To open the coffin joint and ex­ Location of of hoof am ine the navicular bursa, cut proxim al to the wall o f the hoof, first dorsally, then on the m edial and lateral sides, deep to the carti­ lage o f the hoof.

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Crepitant Relating to symptoms nausea order tolterodine 1mg with amex or characterized by a crackling medications used to treat bipolar cheap tolterodine on line, Decompensation of the bladder bubbling sound or vibration treatment with cold medical term purchase tolterodine 4 mg on-line, similar to the A condition in which the bladder is not able to sound produced by rubbing hair between the adjust to an increased resistance to urine flow. An unusually late development of secondary Crohn’s disease sexual characteristics and capability for sexual A chronic autoimmune disease that can affect reproduction. Crural fold Depo-Provera A space between the thigh and the lower A trademark for medroxyprogesterone acetate; abdomen. The area of skin supplied with nerve fibers “Cushing’s syndrome” body habitus from a single spinal nerve root. Diagnostics Cyst the science and practice of making a diagnosis A fluid-filled sac. A condition in which an orifice or tubular structure is stretched beyond normal dimen Cystocele sions. Direct inhibition Emesis Straightforward, uninterrupted restraint or Vomiting; upset stomach. An inflammation of an abnormal pouch in the Endometriosis intestinal wall, which is usually found in the A disorder that is characterized by pain during large intestine. A process by which tissues are viewed using Draining sinus tract an endoscope, which consists of a camera A channel or passageway through which pus is mounted on a flexible tube. Ectopic testicle A condition in which a testicle descends to the Epididymitis wrong area. Edema Epididymo-orchitis A condition that is characterized by excess An inflammation and swelling of the epdi swelling in connective tissue. Ejaculation Contractions of the ejaculatory duct in the Eroded prostate gland that cause semen to be ejected Denuded of skin. Etiologic management Fertilization capacity An approach in which diagnosis is based on An ability to fertilize. Filariasis Etiologic organisms An infection by the filaria parasite, a worm Microorganisms that cause a disease. Eunuch-like Like a boy or man whose sexual characteris Fissure tics have not been influenced by male A tear. Visual inspection of interior structures of the Excised body using a nonrigid fiberoptic instrument. Exertional weakness A lack of energy caused by iron-deficiency Folliculitis anemia. Exteriorization Foreskin To transpose an internal organ to the external the prepuce or skin that covers the head of surface of the body. Frank peritonitis Obvious signs of an inflammation of the Facial adiposity peritoneum. A disease in which some families have a Furuncle higher chance than others of developing An infection of a hair follicle. Galactorrhea Female factor A persistent discharge of milk or a white fluid A substance promoting or functioning in a from the breast. Gangrene Femoral pulses A particular type of necrosis that is caused Pulses of the femoral artery located in the by an obstruction or a decrease in the blood upper third of the inner thigh. A diagnostic reagent that is used for a simple laboratory test that identifies bacteria; this is Gastrointestinal problems usually the first test performed in microbiology Illnesses related to the stomach, intestines, and because it is simple, inexpensive, and relative adjacent anatomical structures. Genital ducts Granulomatous orchitis Genital structures, such as the epididymis and A granulated inflammation of the testicle. Germ cell tumors Hansen’s disease A type of cancer that arises from the transfor An infectious disease that is characterized by mation of primordial cells (cells showing the disfiguring skin lesions, peripheral nerve dam earliest structure of an embryo). Hemachromatosis Glans penis An iron-metabolism disorder that is character the foreskin of the penis. Glycosuria Hematemesis the presence of abnormal amounts of sugar in Vomiting of gross blood or bloody material, urine. Gonadal dysgenesis A birth defect that is caused by the absence of Hematogenous spread an X chromosome in some or all cells of a A method by which an infection travels female, which inhibits sexual development and through the bloodstream. Hematoma A mass of usually clotted blood that forms in a Gonococci tissue, organ, or body cavity and is caused by a A specific type of microorganism. A viral infection transmitted through contact with infected blood or other body fluids. Hypergonadotropic hypogonadism Hepatitis B can be transmitted during anal, An excess of gonadotropin secretion by the oral, or vaginal sex. Hepatitis C Hypermobile A viral infection transmitted through contact Moves beyond the normal range with little with infected blood or other body fluids.

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T h is c a n th e n g iv e y o u p a in medications of the same type are known as order tolterodine 4 mg online, b u t s tre tc h in g e x e rc is e s w ill h e lp medicine guide discount tolterodine uk. Y o u n e e d to symptoms 7dp5dt 2 mg tolterodine mastercard h o ld e a c h s tre tc h fo r a t le a s t 3 0 s e c o n d s fo r it to h e lp. P e n g u in w a lk H a m s trin g S tre tc h W a lk o n y o u r h e e ls lik e a p e n g u in. S it d o w n a s s h o w n k e e p in g y o u r k n e e s s tra ig h t a n d re a c h fo r y o u r to e s. B a lle t w a lk H a m s trin g S tre tc h W a lk o n y o u r tip to e s lik e a d a n c e r. P o s tu r e S tr e tc h in g E x e r c is e s (c o n tin u e d ) M a in ta in in g a g o o d p o s tu re is c ru c ia l to k e e p in g y o u r n e c k a n d b a c k h e a lth y s o d o n ’t fo rg e t a b o u t p o s tu re O G o o d P o s tu re G lu the a l S tre tc h S it o r s ta n d w ith y o u r b a c k ta ll, s h o u ld e rs b a c k a n d S it o n th e flo o r w ith y o u r le g s b e n t. G a m e s H ip S tre tc h K n e e l d o w n a s s h o w n k e e p in g y o u r b o tto m tu c k e d If it is d iffic u lt to d o s p e c ific e x e rc is e s, th e n th e re a re s o m e fu n g a m e s th a t u n d e r. L e a n fo rw a rd s o n to th e fro n t le g a n d y o u w ill c a n m a k e e x e rc is in g m o re e n jo y a b le, b u t s till w o rk o n s tre n g th, fle x ib ility a n d fe e l a s tre tc h in y o u r g ro in. F ro g S tre tc h A n im a l w a lk S it d o w n a s s h o w n k e e p in g y o u r b a c k s tra ig h t a n d W a lk o n a ll fo u rs lik e y o u r fa v o u rite fe e t to g e th e r. S ta b ility E x e r c is e s A r m E x e r c is e s A s w e ll a s m a k in g y o u r le g s a n d s to m a c h m u s c le s s tro n g e r a n d m o re fle x ib le, it is im p o rta n t to k e e p y o u r a rm s h e a lth y b y d o in g e x e rc is e s to o. S ta b ility e x e rc is e fo c u s o n y o u r c o re s to m a c h m u s c le s to p ro v id e s u p p o rt to y o u r b a c k a n d g iv e y o u a s tro n g b a s e in w h ic h th e re s t o f y o u r b o d y c a n w o rk w e ll. S im p ly b y h a v in g a g o o d p o s tu re w ill h e lp y o u r c o re s to m a c h m u s c le s b e c o m e s tro n g e r. W a ll P re s s U p S ta n d w ith y o u r h a n d s a t s h o u ld e r h e ig h t o n a w a ll. W o b b le B o a rd D ra w y o u r s h o u ld e r b la d e s b a c k (a s a b o v e) a n d th e n le a n in to th e w a ll, b e n d in g y o u r e lb o w s d o w n. R e tu rn S ta n d o n a w o b b le b o a rd (o r a c u s h io n if y o u d o n ’t to th e s ta rt. W h e n a b le c lo s e y o u r e y e s o r p la y g a m e s lik e th ro w a n d c a tc h w h ile s ta n d in g o n it. A e ro p la n e L ie w ith y o u r s to m a c h w ith y o u r a rm s o u t to th e s id e s, a s s h o w n. D ra w y o u r s h o u ld e r b la d e s to g e th e r a n d lift G y m B a ll y o u r s h o u ld e rs a n d a rm s o ff th e flo o r s lig h tly. W h e n a b le try liftin g o n e fo o t o ff th e flo o r a n d /o r p la y th ro w a n d c a tc h. B a ll o n a W a ll S ta n d w ith a g o o d p o s tu re a n d y o u r h a n d re s tin g o n a W h e e l B a rro w o n G y m B a ll b a ll o n a w a ll. S lo w ly ro ll it in c irc le s a n d m a k e th e m b ig g e r a n d b ig g e r, w h ile k e e p in g a g o o d p o s tu re. W a lk y o u r h a n d s fo rw a rd s s o y o u r le g s a re o n th e b a ll th e n g o b a c k to th e s ta rt. Numerous disorders and traits mapped to and customize drugs and other medical treatments to Simpson-Golabi-Behmel syndrome, type 1 Pettigrew syndrome Obesity/hyperinsulinism Graves disease, susceptibility to Debrisoquine sensitivity Cardioencephalomyopathy, fatal infantile Split hand/foot malformation, type 2 Gustavson mental retardation syndrome Pseudohypoparathyroidism, type Ia Epilepsy, nocturnal frontal lobe and benign neonatal, type 1 Polycystic kidney disease Adenylosuccinase deficiency Hypoparathyroidism Immunodeficiency, with hyper-IgM Legend McCune-Albright polyostotic fibrous dysplasia Epiphyseal dysplasia, multiple Leukodystrophy, metachromatic Autism, succinylpurinemic particular chromosomes are displayed on this poster. Borjeson-Forssman-Lehmann syndrome Cone dystrophy, progressive Testicular germ cell tumor Prostate cancer susceptibility Hemophilia B Fragile X mental retardation the centromere, or constricted portion, of each chromosome. Warfarin sensitivity Epidermolysis bullosa, macular type Osseous dysplasia (male lethal), digital Diabetes insipidus, nephrogenic Adrenoleukodystrophy Cancer/testis antigen Adrenomyeloneuropathy Dyskeratosis Chromosomal regions that vary in staining intensity and sometimes are Colorblindness, blue monochromatic Hemophilia A called heterochromatin (meaning “different color”). Department of Energy Office of Science • Medicine and the New Genetics: How genetic Orthostatic intolerance, then, is an umbrella term for several conditions in which symptoms are made worse by upright posture and improve with recumbency. Neurally mediated hypotension refers to a drop in blood pressure that occurs after being upright. It occurs if too little blood circulates back to the heart when people are upright, a situation that can trigger an abnormal reflex interaction between the heart and the brain that results in a lowering of blood pressure.

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Approximately 30% of undescended testes are non palpable and may be located within the abdominal cavity symptoms 0f brain tumor order tolterodine 2mg overnight delivery. Early treatment is therefore recommended (after the age of six months surgery should be performed within the subsequent year with age 18 months the latest) to medicine bow wyoming tolterodine 4 mg amex conserve spermatogenesis and hormone production medicine in motion tolterodine 1mg mastercard, as well as to decrease the risk for tumours [146]. Early surgical treatment may have a positive effect on subsequent fertility [149]. In men with bilateral cryptorchidism, oligozoospermia can be found in 31% and azoospermia in 42%. Orchidopexy performed before the age of puberty has been reported to decrease the risk of testicular cancer [151]. In adulthood, palpable undescended testis should not be removed because it still produces testosterone. Furthermore, as indicated above, correction of bilateral cryptorchidism, even in adulthood, can lead to sperm production in previously azoospermic men [153]. Vascular damage is the most severe complication of orchidopexy and can cause testicular atrophy in 1-2% of cases. In men with non-palpable testes, the postoperative atrophy rate was 12% in those cases with long vascular pedicles that enabled scrotal positioning. Postoperative atrophy in staged orchidopexy has been reported in up to 40% of patients [154]. Cryptorchidism is often associated with testicular dysgenesis and is a risk factor for infertility and 2b germ cell tumours. Paternity in men with unilateral cryptorchidism is almost equal to that in men without cryptorchidism. Concerning natural conception the role of antioxidants needs further investigations [162]. A No recommendation can be made for treatment with gonadotropins, anti-oestrogens and antioxidants B even for a subset of patients. The method nearest to being generally available clinically is hormonal male contraception, which is based on the suppression of gonadotropins and testosterone substitution to maintain male sexual function and bone mineralisation, and to prevent muscle wasting [165]. However, a combination of testosterone with progestin results in complete suppression of spermatogenesis in all races, and provides contraceptive efficacy equivalent to female hormonal methods [167]. The least invasive approach is no-scalpel vasectomy which is also associated with a low rate of complications [170, 171]. The most effective occlusion technique is cauterisation of the lumen of the vas deferens and fascial interposition [172-174]. Most techniques can be carried out safely under local anaesthesia in an outpatient clinic. An increased rate of prostate cancer in men who underwent vasectomy has not been detected [168, 175]. Acute local complications associated with vasectomy include haematoma, wound infection, and epididymitis in up to 5% of cases [168]. However, patients should be informed preoperatively that, although rare, long-term recanalisation might occur [178]. A “special clearance” given by the urologist with non-motile spermatozoa < 100,000/mL is still under discussion [179]. In a study of 1,469 men who had undergone microsurgical vasectomy reversal, patency and pregnancy rates were 97% and 76%, respectively, for an interval up to 3 years after vasectomy; 88% and 53% for 3-8 years, 79% and 44% for 9-14 years, and 71% and 30% for > 15 years [183]. If secondary epididymal obstruction occurs, tubulovasostomy is needed to reverse the vasectomy (see Chapter 3. All available data indicate that vasectomy is not associated with any serious, long-term side-effects. A Cauterisation and fascial interposition are the most effective techniques for the prevention of early A recanalisation. Inform patients seeking vasectomy about the surgical method, risk of failure, potential irreversibility, A* the need for post-procedure contraception until clearance, and the risk of complications. A concentration of >103 cfu/mL urinary tract pathogens in the ejaculate is indicative of significant bacteriospermia. The sampling time can influence the positive rate of microorganisms in semen and the frequency of isolation of different strains [189].

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Soft tissue necrosis lower limb Local wound care; medical Operative debridement or Life-threatening Death intervention indicated medical treatment buy tolterodine 4mg line. Soft tissue necrosis upper Local wound care; medical Operative debridement or Life-threatening Death limb intervention indicated symptoms bowel obstruction buy tolterodine american express. Dysarthria Mild slurred speech Moderate impairment of Severe impairment of articulation or slurred speech articulation or slurred speech Definition: A disorder characterized by slow and slurred speech resulting from an inability to symptoms for pneumonia quality 2mg tolterodine coordinate the muscles used in speech. Dysgeusia Altered taste but no change in Altered taste with change in diet diet. Ischemia cerebrovascular Asymptomatic; clinical or Moderate symptoms diagnostic observations only; intervention not indicated Definition: A disorder characterized by a decrease or absence of blood supply to the brain caused by obstruction (thrombosis or embolism) of an artery resulting in neurological damage. Myelitis Asymptomatic; mild signs Moderate weakness or Severe weakness or sensory Life-threatening Death. Symptoms include weakness, paresthesia, sensory loss, marked discomfort and incontinence. Seizure Brief partial seizure; no loss of Brief generalized seizure Multiple seizures despite Life-threatening; prolonged Death consciousness medical intervention repetitive seizures Definition: A disorder characterized by a sudden, involuntary skeletal muscular contractions of cerebral or brain stem origin. Stroke Asymptomatic or mild Moderate neurologic deficit Severe neurologic deficit Life-threatening Death neurologic deficit; consequences; urgent radiographic findings only intervention indicated Definition: A disorder characterized by a sudden loss of sensory function due to an intracranial vascular event. Transient ischemic attacks Mild neurologic deficit with or Moderate neurologic deficit without imaging confirmation with or without imaging confirmation Definition: A disorder characterized by a brief attack (less than 24 hours) of cerebral dysfunction of vascular origin, with no persistent neurological deficit. Fetal growth retardation <10% percentile of weight for <5% percentile of weight for <1% percentile of weight for gestational age gestational age gestational age Definition: A disorder characterized by inhibition of fetal growth resulting in the inability of the fetus to achieve its potential weight. Typically, viability is achievable between the twentieth and thirty-seventh week of gestation. Delayed orgasm Delay in achieving orgasm not Delay in achieving orgasm adversely affecting adversely affecting relationship relationship Definition: A disorder characterized by sexual dysfunction characterized by a delay in climax. Dyspareunia Mild discomfort or pain Moderate discomfort or pain Severe discomfort or pain associated with vaginal associated with vaginal associated with vaginal penetration; discomfort penetration; discomfort or pain penetration; discomfort or pain relieved with use of vaginal partially relieved with use of unrelieved by vaginal lubricants or estrogen vaginal lubricants or estrogen lubricants or estrogen Definition: A disorder characterized by painful or difficult coitus. Fallopian tube stenosis Asymptomatic clinical or Symptomatic and intervention Severe symptoms; elective Life-threatening Death diagnostic observations only; not indicated operative intervention consequences; urgent intervention not indicated indicated operative intervention indicated. Premature menopause Present Definition: A disorder characterized by ovarian failure before the age of 40. Prostatic hemorrhage Minimal bleeding identified on Moderate bleeding; medical Severe bleeding; transfusion Life-threatening Death imaging study; intervention intervention indicated indicated; radiologic or consequences; urgent not indicated endoscopic intervention operative intervention indicated indicated Definition: A disorder characterized by bleeding from the prostate gland. Prostatic obstruction Diagnostic observations only; Mild symptoms; elective Severe symptoms; elective intervention not indicated intervention indicated operative intervention indicated Definition: A disorder characterized by compression of the urethra secondary to enlargement of the prostate gland. Testicular hemorrhage Minimal bleeding identified on Moderate bleeding; medical Severe bleeding; transfusion Life-threatening Death imaging study; intervention intervention indicated indicated; radiologic or consequences; urgent not indicated endoscopic intervention operative intervention indicated indicated Definition: A disorder characterized by bleeding from the testis. Vaginal fistula Asymptomatic clinical or Symptomatic and intervention Severe symptoms; elective Life-threatening Death diagnostic observations only; not indicated operative intervention consequences; urgent intervention not indicated indicated intervention indicated Definition: A disorder characterized by an abnormal communication between the vagina and another organ or anatomic site. Respiratory, thoracic and mediastinal disorders Respiratory, thoracic and mediastinal disorders Grade Adverse Event 1 2 3 4 5 Adult respiratory distress Present with radiologic Life-threatening respiratory or Death syndrome findings; intubation not hemodynamic compromise; indicated intubation or urgent intervention indicated Definition: A disorder characterized by progressive and life-threatening pulmonary distress in the absence of an underlying pulmonary condition, usually following major trauma or surgery. Laryngeal edema Asymptomatic; clinical or Symptomatic; medical Stridor; respiratory distress; Life-threatening airway Death diagnostic observations only; intervention indicated. Pulmonary fibrosis Mild hypoxemia; radiologic Moderate hypoxemia; Severe hypoxemia; evidence Life-threatening Death pulmonary fibrosis <25% of evidence of pulmonary of right-sided heart failure; consequences. Voice alteration Mild or intermittent change Moderate or persistent Severe voice changes from normal voice change from normal voice; still including predominantly understandable whispered speech; may require frequent repetition or face-to-face contact for understandability; may require assistive technology Definition: A disorder characterized by a change in the sound and/or speed of the voice. Skin and subcutaneous tissue disorders Skin and subcutaneous tissue disorders Grade Adverse Event 1 2 3 4 5 Alopecia Hair loss of <50% of normal Hair loss of >=50% normal for for that individual that is not that individual that is readily obvious from a distance but apparent to others; a wig or only on close inspection; a hair piece is necessary if the different hair style may be patient desires to completely required to cover the hair loss camouflage the hair loss; but it does not require a wig or associated with psychosocial hair piece to camouflage impact Definition: A disorder characterized by a decrease in density of hair compared to normal for a given individual at a given age and body location. This syndrome is observed in patients who demonstrate a state of generalized leaky capillaries following shock syndromes, low-flow states, ischemia-reperfusion injuries, toxemias, medications, or poisoning. Hematoma Mild symptoms; intervention Minimally invasive evacuation Transfusion, radiologic, Life-threatening Death not indicated or aspiration indicated endoscopic, or elective consequences; urgent operative intervention intervention indicated indicated Definition: A disorder characterized by a localized collection of blood, usually clotted, in an organ, space, or tissue, due to a break in the wall of a blood vessel. Hypotension Asymptomatic, intervention Non-urgent medical Medical intervention or Life-threatening and urgent Death not indicated intervention indicated hospitalization indicated intervention indicated Definition: A disorder characterized by a blood pressure that is below the normal expected for an individual in a given environment. Phlebitis Present Definition: A disorder characterized by inflammation of the wall of a vein. Females of reproductive potential: Exclude pregnancy before the start of treatment, monthly during treatment, and 1 month after stopping treatment.

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