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By: R. Stejnar, M.A.S., M.D.

Co-Director, University of Arizona College of Medicine – Tucson

Second treatment quietus tinnitus buy 100 mg epitol fast delivery, quite apart from problems of proving factual causation medications you can take while pregnant order cheap epitol on line, recognizing claims of the indirectly injured would force courts to medicine rocks state park buy generic epitol 100mg on-line adopt complicated rules apportioning damages among plaintiffs removed at different levels of injury from the violative acts, to obviate the risk of multiple recoveries. And, finally, the need to grapple with these problems is simply unjustified by the general interest in deterring injurious conduct, since directly injured victims can generally be counted on to vindicate the law as private attorneys general, without any of the problems attendant upon suits by plaintiffs injured more remotely. This conduct, the plaintiff alleged, allowed the defendant to offer lower prices and attract more customers, which in turn caused the plaintiff to lose customers and profit. Indeed, ?[i]t was the State that was being defrauded and the State that lost tax revenue as a result. The City alleged that the New Mexico retailer failed to comply with a federal law requiring out-of state vendors to submit customer information to the states into which it ships cigarettes. To ensure fair distribution of tax liens during the auctions, the county enacted a ?Single, Simultaneous Bidder Rule,? requiring each ?tax [lien] buying entity? to bid in its own name and not to use agents or employees to submit simultaneous bids on its behalf. The plaintiffs alleged that this deceptive practice resulted in the defendants receiving a disproportionately higher share of tax liens at the county auction. The plaintiffs further alleged that as a result of this deceptive practice, they were deprived of their ability to obtain their fair share of tax liens at the county auction. But a unanimous Supreme Court rejected this argument, noting that proximate cause is ?a flexible concept that does not lend itself to a black-letter rule that will dictate the result in every case. Applying its direct relation requirement, the Supreme Court held that the plaintiffs? ?alleged injury?the loss of valuable liens?is the direct result of [the defendants?] fraud. It was a foreseeable and natural consequence of [the defendants?] scheme to obtain more liens for themselves that other bidders would obtain fewer liens. Rather, the plaintiffs were the immediate victims of the defendants? fraud and were best situated to sue the defendants. We leave it to the district court on remand to assess Plaintiffs? damages, if the litigation proceeds to that phase. Second, we consider the risk of multiple recoveries by plaintiffs at different levels of injury from the defendants? acts. Here, like in Bridge, and unlike in Anza and Hemi Group, there is no concern of ?duplicative recoveries by plaintiffs removed at different levels of injury from the violation. It is each individual plaintiff who paid out money for Actos prescriptions who now seeks recovery of those payments. Further, Plaintiffs? putative class expressly excludes individuals who are pursuing personal injury claims, so there 7 We note that Defendants? argument that had Plaintiffs not taken Actos, they would have paid for an alternative drug to treat their type 2 diabetes, has not fallen on deaf ears. But at this stage in the proceedings, we take Plaintiffs? allegations that they would not have bought or paid for Actos as true. Plaintiffs do not allege that they would have paid for an alternative diabetes drug had they known Actos carries an increased risk of causing bladder cancer. Further, if what Defendants argue proves true, Plaintiffs may still be entitled to damages if the alternative drugs they would have paid for cost less than Actos. Plaintiffs have alleged there are at least three less expensive alternatives to Actos, and discovery may prove Plaintiffs were likely to have bought these alternatives. Finally, under the third Holmes factor, we consider whether holding Defendants liable in this case justifies the general interest of deterring injurious conduct or whether there are more directly injured victims we can count on to hold Defendants liable. For instance, prescribing physicians who prescribed Actos for their patients may have watched their patients develop bladder cancer. But as far as we can tell from Plaintiffs? complaint, prescribing physicians did not suffer an economic injury. Thus, holding Defendants liable for Plaintiffs? alleged injuries advances the interest in deterring injurious conduct, without including others who did not suffer direct out-of-pocket losses. The plaintiffs alleged that the defendants conspired to persuade the public that scientific studies linking smoking to health risks were not accurate and that the connection between smoking and disease was merely an ?open controversy. The plaintiffs alleged that this wrongful conduct ?resulted in more smoking, less quitting, and smoking of more hazardous cigarettes? among their plan participants, which then resulted in more disease among their plan participants who smoked. In turn, the plaintiffs alleged, they suffered higher expenditures to cover their plan participants? medical bills. We explained that ?all of [the] plaintiffs? claims rely on alleged injury to smokers?without any injury to smokers, [the] plaintiffs would not have incurred the additional expenses in paying for the medical expenses of those smokers.

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It could help to medicine 0031 order epitol 100mg otc acknowledge that your relationship is changing and that you both need time to treatment 2 stroke buy 100 mg epitol adjust medicine lodge kansas buy line epitol. Try to focus on activities that don?t involve penetrative sex such as hugging, skin-to-skin contact or massage. If you need support talking to each other, consider counselling call Cancer Council 13 11 20 or ask your doctor or nurse how to fnd a counsellor in your area. Resuming sexual activity after treatment 35 Communicating with a new partner You may be worried about starting a sexual relationship with a new person in the future. It isn?t easy to decide when to tell a potential sexual partner about any changes to your body (such as you?ve had a breast removed, had a breast reconstruction, need assistance having an erection or have a stoma). Likewise, you may feel concerned about explaining any issues with fertility, especially if you had cancer when you were young. Take your time and let a new partner know how cancer has changed your body when you feel ready. It may be easier if you practise what you want to say (see page 34) with someone and think about answers to questions they may ask. You might want to show the other person how your body has changed before any sexual activity so that you can both get used to how that makes you feel. Talk to your partner about how you are feeling and how things may have changed for you. Choosing your times carefully and being prepared can help you cope better with pain, fatigue, body image problems and other issues. Starting a new If you are starting a new relationship, it may relationship take some time before you feel ready to discuss how cancer has changed your body or the way you have sex. Resuming sexual activity after treatment 37 Overcoming specifc challenges Many of the problems discussed in this chapter are common among anyone with a cancer diagnosis, but some changes afect only females or only males, and others are caused by particular treatments. Fatigue It is common to feel tired and have no energy during and afer cancer treatment. Your tiredness may continue for several weeks or months afer treatment has fnished, but this will vary from person to person. Fatigue can lead to a temporary loss of interest in sex and intimacy or you may need to take a less active role. You may fnd that you have difculty sleeping, lose interest in activities you used to enjoy, don?t feel like eating, or lack energy. If you suspect that you, or someone you care for, may be depressed, you can fnd a depression checklist and helpful information at beyondblue. Plan your doctor know if sex is activities for each day such as important to you, as some exercise, spending time with antidepressants can affect other people, or reading. Overcoming specific challenges 39 Anxiety Feeling anxious and scared is a normal reaction to a cancer diagnosis and its treatment. You might also be worried about having sex afer treatment, concerned that it will hurt. You may feel less anxious if you fnd out more about your illness and ask your treatment team what to expect. Tink about how you have managed stressful situations in the past and discuss these strategies with your partner or a trusted family member or friend. This can show you how that some medicines may to change unhelpful patterns of lower your libido. It will show you trust 13 11 20 for copies of Cancer them and help create intimacy. This may be for emotional reasons, such as worrying or self-consciousness, or from a physical cause, such as fatigue, nerve damage, or painful intercourse. People who have had a body part such as a breast or prostate removed, may need to explore touch and stimulation to other parts of the body to feel ready for sex. Call 13 11 20 to more comfortable ones that for copies of meditation and increase stimulation.

The National Poisons Information Service (0844 892 0111) will provide specialist advice on management of opioid toxicity 24hrs a day treatment abbreviation order generic epitol line. Parenteral morphine and strong opioid alternatives to georges marvellous medicine 100 mg epitol free shipping morphine see also dose conversion chart on following page symptoms rheumatoid arthritis buy 100mg epitol free shipping. Morphine: Has replaced diamorphine as first line injectable strong opioid of choice where 24hrly doses are less than 360mg/24hrs. Greater doses than this cause problems with volume of the corresponding breakthrough dose. The maximum subcutaneous bolus dose tolerated is 2mls and this should be administered slowly to reduce pain at injection site. Injectable morphine is available in 1ml and 2 ml ampoules of the following strengths: 10mg/ml, 15mg/ml, 20mg/ml and 30mg/ml. Where doses are escalating and morphine doses reach hundreds of milligrams, seek specialist advice. There is debate about the relative potency of morphine and oxycodone, and of oxycodone given by different routes. Indicated for stable pain in patients unable to take oral medication and in renal failure. Time taken to achieve stable dose when applied (and to lose subcutaneous reservoir when removed) causes difficulties with titration. Transmucosal Fentanyl Citrate: formulated for administration by buccal (lozenge and tablet), sublingual (tablet) and intranasal (spray) routes. Used in preference to morphine in renal failure because no accumulation of neurotoxic metabolites. Formulations include transdermal patches (one form changed twice weekly, the other once weekly). Intestinal obstruction: disease presentation or recurrence, adhesions, recent surgery. Titrate laxative to effect to achieve regular stool frequency and optimal consistency. Lactulose as it can cause flatulence, abdominal bloating, and can worsen abdominal cramps. Movicol/Laxido) the volumes of which can be difficult for some patients to tolerate. Once constipation is alleviated, start regular oral laxatives to prevent recurrence. Co-danthramer is also available Dantron is eliminated both in as a ?Strong? preparation, urine (causing an orange which is approximately double discolouration) and faeces and can the strength. This increase in volume especially those with poor will encourage peristalsis and oral intake. Gastric stasis: pyloric tumour/nodes, ascites, hepatomegaly, opioids, anticholinergic drugs, autonomic neuropathy. Metoclopramide or Domperidone Nausea relieved by vomiting (often large volume & undigested). Chemotherapy, radiotherapy (useful to distinguish between Acute: Follow oncology guidelines for ?acute? and ?delayed? phase). Ondansetron, corticosteroids & Aprepitant Delayed: Levomepromazine ?Organ damage?: harm to thoracic, abdominal or pelvic viscera Cyclizine caused by malignancy or treatment. Bowel obstruction (may be high, low or multiple levels) First: Cyclizine or Haloperidol where surgery is not appropriate. Then: Cyclizine and Haloperidol in combination High: regurgitation, forceful vomiting, undigested food Then: Levomepromazine Low: colicky pain, large volume vomits, possibly faeculent. Indicated for moderate and highly emetogenic chemotherapy to prevent delayed chemotherapy induced nausea/vomiting. For vagally-mediated nausea/vomiting caused by any distension/compression/disturbance of viscera in thorax, abdomen or pelvis and for brain metastases. Some specialists believe that the anticholinergic effects of cyclizine block the action of metoclopramide and recommend that these two drugs are not combined. If subcutaneous use causes skin irritation, increase dilution of infusion with water only or add dexamethasone 1mg to driver.

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Insulin regulates glucose consumption and lactate production through reactive oxygen species and pyruvate kinase M2 medications side effects order epitol online. Role of miR-182 in response to medicine 44-527 buy epitol with mastercard oxidative stress in the cell fate of human fallopian tube epithelial cells medications safe during pregnancy purchase epitol 100 mg overnight delivery. MiR-422a regulates cellular metabolism and malignancy by targeting pyruvate dehydrogenase kinase 2 in gastric cancer. Accumulation of hydrogen peroxide is an early and crucial step for paclitaxel?induced cancer cell death both in vitro and in vivo. Metabolomic alterations in human cancer cells by vitamin C-induced oxidative stress. Plant polyphenol induced cell death in human cancer cells involves mobilization of intracellular copper ions and reactive oxygen species generation: A mechanism for cancer chemopreventive action. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specifc companies or of certain manufacturers? products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. The responsibility for the interpretation and use of the material lies with the reader. As a pathologist, he did much to assemble the new morphologic terms and the latest classifcations for lymphomas, leukemias and brain tumors. Afer his retirement from the International Agency for Research on Cancer, initially as Chief of the Unit of Epidemiology and later as its Deputy Director, Calum Muir became the Director of Cancer Registration for Scotland. Refractory anemia and other tries, for coding the site (topography) and the myelodysplastic syndromes are now considered to histology (morphology) of the neoplasm, usually be malignant; their behavior codes have therefore obtained from a pathology report. By agreement been changed from /1 (uncertain whether benign with the College of American Pathologists, the or malignant) to /3. However, the morphology section has authors worked with the International Agency for been revised. Appendix 0 in this manual is a summary of but it was fnally decided to review the entire book. We are grateful to registries around the world for their comments on the content of this edition. When the United previously assigned codes, this has not always been Nations was formed afer the Second World War possible. The Sixth Revision of the sible because of the limitations of available code International Statistical Classifcation of Diseases, numbers. Except for lymphatic ple, incidence and survival rates difer according and hematopoietic neoplasms, choriocarcinoma, to the histologic type of the tumor. Physicians expressed a desire edited by Constance Percy, Valerie Van Holten, for a cancer supplement that would also include and Calum Muir. It and emphasized the need for the coding of mor is a dual classifcation and coding system for both phology or histology of tumors. The or uncertain whether malignant or benign) by morphology code for neoplasms has been revised, assigning it to a specifc range of codes identify especially for lymphomas and leukemias. The topogra phy code describes the site of origin of the neoplasms and uses the same 3-character and 4-character cat 3. Tese topography terms have four-character type of the tumor and its biologic activity, in other codes that run from C00. It includes instructions for use and rules for implementation in tumor (cancer) registries and pathology laboratories. Diferences in morphology codes between second and third editions this section consists of a list of terms now considered malignant, a list of all new morphology code numbers and a list of all terms and synonyms 3. In several In order to avoid repetitions caused by diferences instances the terms for neoplasms from more than in spelling, the American spelling of words has one classifcation scheme have been included, for been used, for example ?leukemia? and ?tumor? example malignant lymphomas (959 through rather than ?leukaemia? and ?tumour. However, when the diferences in neoplasms; the listing of terms from diferent clas spelling, such as ?esophagus? and ?oesophagus?, sifcations does not represent endorsement of any result in an appreciable separation of the two forms particular one. The Code Term ffh digit, afer the slash or stroke (/), is a behavior code, which indicates whether a tumor is malig C07.

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C hest Ina ba H medications that cause constipation buy epitol 100 mg free shipping, Ya ng Pa n eta l Pulm o na rydysunctio ninsurvivo rso f childho o dhem a to medications and pregnancy cheap epitol 100mg online lo gicm a ligna nciesa f tera llo geneichem a to medications that cause high blood pressure order line epitol po ieticstem celltra nspla nta tio n. C a ncer M a da na tHa rjuo ja L M, Va ljento S, Vettenra nta K eta l Pulm o na ry unctio n o llo wing a llo geneicstem celltra nspla nta tio ninchildho o d: a retro spective co ho rtstudyo pa tientsPedia tr Tra nspla nt Na ka so ne H O nizuka M SuzukiN, eta l Pre tra nspla ntrisk a cto rs o rcrypto genico rga nizing pneum o nia / bro nchio litiso blitera nso rga nizing pneum o nia a f terhem a to po ieticcelltra nspla nta tio n. A via tSpa ce Enviro nM ed Yo shiha ra S, Ya nik C o o ke K R eta l ro nchio litiso blitera nssyndro m e O S) bro nchio litiso blitera nso rga nizing pneum o nia O O P) a ndo therla te o nsetno ninf ectio uspulm o na ryco m plica tio ns o llo wing a llo geneichem a to po ietic stem celltra nspla nta tio n. Im m uno lo gica bno rm a litiesm a ypersist o rup to yea rspo sttra nspla nt C o nsiderpa tienta ndca ncer/ trea tm ent a cto rspre m o rbid/ co m o rbidhea lth co nditio nsa ndhea lth beha vio rsa sa ppro pria te, tha tm a yincrea se risk. C a ncer R o binM Po rcherR e C a stro A ra ujo R eta l R isk a cto rs o rla the inf ectio nsa f tera llo geneichem a to po ieticstem celltra nspla nta tio n ro m a m a tchedrela teddo no r io l lo o dM a rro w Tra nspla nt Sto rek o o ley T, W itherspo o nR P, eta l Inf ectio usm o rbidityinlo ng term survivo rso f a llo geneicm a rro w tra nspla nta tio nisa sso cia tedwith lo w C T cellco unts m Hem a to l To m blynM C hiller T, Einsele H eta l uidelines o rpreventing inf ectio usco m plica tio nsa m o ng hem a to po ieticcelltra nspla nta tio nrecipientsa glo ba lperspective. The ncilla ry Thera pya ndSuppo rtive C a re W o rking ro up R epo rt io l lo o dM a rro w Tra nspla nt C o sta ntiniS, iC a pua E, o siS, eta l: the m a na gem ento f severe va gina lo bstructio n ro m genita lchro nicgra f tversusho stdisea se: dia gno sissurgica ltechnique a nd o llo w up. InternM ed Hirsch P, L eclercM R ybo ja dM eta l em a le genita lchro nicgra f tversusho stdisea se: im po rta nce o f ea rlydia gno sisto a vo idsevere co m plica tio ns. The ia gno sisa ndSta ging W o rking ro up repo rt io l B lo o dM a rro w Tra nspla nt e1 M etzgerM L, M ea cha m L R Pa tterso n eta l em a le repro ductive hea lth a f terchildho o d, a do lescenta ndyo ung a dultca ncersguidelines o rthe a ssessm enta ndm a na gem ento em a le repro ductive co m plica tio ns C linO nco l 3 Sm ith K nutsso nE, jo rk Y, ro m a n A K eta l enita lchro nicgra f tversusho stdisea se in em a lesa cro sssectio na lstudy. Im pa ired qua lity o f lie R E Psycho lo gica lm a la djustm ent P rosthetic eval u ation P O T T O R A T O O R F U R T H R T T T R V T O Every 6 m o nthsuntilskeleta lly m a ture, then Physica lthera py co nsulta tio n a sneeded percha nging physica lsta tus yea rly such a sweightga in o rga ittra ining with a new pro sthesis, a nd f o rno n pha rm a co lo gica lpa in m a na gem ent O ccupa tio na lthera py co nsulta tio n a sneeded to a ssistwith a ctivitieso f da ily living. Psycho lo gica lso cia lwo rk co nsulta tio n to a ssistwith em o tio na ldif culties rela ted to bo dy im a ge, m a rria ge, pregna ncy, pa renting, em plo ym ent, insura nce, depressio n o rsexua lhea lth. C a ncer 2 O tta via ni R o bertR S, Huh W W, eta l So cio o ccupa tio na la ndphysica lo utco m esm o re tha n yea rsa f terthe dia gno siso o steo sa rco m a inchildrena nda do lescentslim bsa lva ge versusa m puta tio n. Thro m bHa em o st Po lenE, W eintra ubM Sto f erC eta l Po stthro m bo ticsyndro m e a f tercentra lveno usca theterrem o va linchildho o dca ncersurvivo rs pro spective co ho rtstudy. Pedia tr lo o dC a ncer R evelVilk S, M ena hem M Sto f erC eta l Po stthro m bo ticsyndro m e a f tercentra lveno usca theterrem o va linchildho o dca ncersurvivo rsisa sso cia tedwith a histo ryo o bstructio n. Uro l discussio n R a ney r HeynR Ha ys M eta l Sequela e o f trea tm entin pa tients o llo wed o r to yea rsa f terdia gno siso sa rco m a o the bla ddera ndpro sta te. Yea rly P O T T O R A T O O R F U R T H R T T T R V T O R epro ductive endo crino lo gy co nsulta tio n f o rpa tientswishing to pursue pregna ncy via gesta tio na lsurro ga te. C a ncer L a terza R M SievertK de R idder eta l la dder unctio na f terra dica lhysterecto m y o rcervica lca ncer Neuro uro lUro dyn M etzgerM L, M ea cha m L R Pa tterso n eta l em a le repro ductive hea lth a f terchildho o d, a do lescenta ndyo ung a dultca ncersguidelines o rthe a ssessm enta ndm a na gem ento em a le repro ductive co m plica tio ns C linO nco l 3 Skjeldesta d E, Ha gen L o ng term co nsequenceso f gyneco lo gica lca ncertrea tm ento nurina ryinco ntinence: a po pula tio n ba sedcro sssectio na lstudy. A nnSurg discussio n M a denci L, isherS, illerL R eta l Intestina lo bstructio ninsurvivo rso f childho o dca ncer: a repo rt ro m the C hildho o dC a ncerSurvivo rStudy. C linO nco l Pa ulino A C, W en C ro wnC K eta l L a the ef ectsinchildrentrea tedwith ra dia tio nthera py o r W ilm s tum o r Int R a dia tO nco l io lPhys R itcheyM L, Sha m bergerR C Ha a se eta l Surgica lco m plica tio nsa f terprim a rynephrecto m y o r W ilm s tum o r: repo rt ro m the Na tio na lW ilm sTum o rStudy ro up. C hro nicpa in Yea rly L im b length discrepa ncy P O T T O R A T O O R F U R T H R T T T R V T O Increa sed energy expenditure R E Physica lthera py co nsulta tio n a sneeded percha ngesin f unctio na lsta tus such F ibro sis R adiog raph of affected l im b a spo stlengthening, revisio ns, lie cha ngessuch a spregna ncy), a nd f o rno n Pro stheticm a lunctio n Yea rly pha rm a co lo gica lpa in m a na gem ent (lo o sening, no n unio n, Psycho lo gica lco nsulta tio n a sneeded to a ssistwith em o tio na ldif cultiesrela ted E val u ation byorthopedic su rg eon (ideal l y f ra cture) requiring revisio n, to bo dy im a ge, m a rria ge, pregna ncy, pa renting, em plo ym ent, insura nce, byan orthopedic oncol og ist repla cem ento ra m puta tio n depressio n o rsexua lhea lth. Uro l C o zzi C ecca ntiS, redia niS, eta l R ena l unctio na da pta tio nup to the f f th deca de a f tertrea tm ento f childrenwith unila tera lrena ltum o r: a cro sssectio na la ndlo ngitudina lstudy. Pedia trics Hubertus unther eckerK eta l evelo pm ento f hypertensio nisless requenta f terbila tera lnephro nspa ring surgery o rbila tera lW ilm stum o rina lo ng term survey. Uro l J o hnso n C hristensenC irusso S, eta l need o rreeva lua tio no f spo rtspa rticipa tio nreco m m enda tio ns o rchildrenwith a so lita rykidney. Uro l discussio n M itus, Tef tM ellers X: L o ng term o llo w up o rena l unctio nso f childrenwho underwentnephrecto m y o rm a ligna ntdisea se. Pedia tr lo o dC a ncer F inklestein Z, No rko o lP, reen M eta l ia sto lichypertensio nin W ilm s tum o rsurvivo rsa la the ef ecto f trea tm ent repo rt ro m the Na tio na lW ilm sTum o rStudy ro up. A m C linO nco l G rinsellM M Sho wa lterS, o rdo nK eta l Single kidneya ndspo rtspa rticipa tio n: perceptio nversusrea lity. M edPedia trO nco l Sha rp S, R o ss H K a yR ttitudeso f pedia tricuro lo gistsrega rding spo rtspa rticipa tio nbychildrenwith a so lita rykidney. L ea rning def citsin m a th a nd educa tio na lo rvo ca tio na lpro gress R ef erra lto co m m unity services o rvo ca tio na lreha bilita tio n o r o rservices o r rea ding (pa rticula rly rea ding develo pm enta lly disa bled. Neuro co gnitive def citsva rywith extento f surgery, po sto pera tive co m plica tio nsa ndlo ca tio n. Neuro surgery discussio n C a tsm a n errevo etsC E, A a rsen K : the spectrum o f neuro beha vio ura ldef citsinthe po sterio r o ssa syndro m e inchildrena f tercerebella rtum o ursurgery. C a ncer L o A C Ho wa rd A Nicho l eta l L o ng term o utco m esa ndco m plica tio nsinpa tientswith cra nio pha ryngio m a : the ritish C o lum bia C a ncer A gencyexperience. Neuro surg 2 So nderka erS, Schm iegelo w M C a rstensenH eta l L o ng term neuro lo gica lo utco m e o f childho o dbra intum o rstrea tedbysurgeryo nly. M C C a ncer Ya no S, K udo M Hide T, eta l Q ua lityo f lie a ndclinica l ea tureso f lo ng term survivo rssurgica llytrea ted o rpedia triccra nio pha ryngio m a.

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