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The most common adverse reactions with colesevelam are constipation medicine woman dr quinn order 35 mg actonel amex, dyspepsia medicine cards buy actonel 35 mg online, and nausea. Like cholestyramine, colesevelam can increase serum triglyceride levels and is contraindicated in patients with triglyceride levels greater than 500 mg/dL. The large tablets can cause dysphagia or esophageal obstruction; thus this drug should be used with caution in patients with swallowing disorders. An oral suspension, dissolved in 4 to 8 ounces of water, is available for patients who have difficulty swallowing the tablets. Other drugs should be administered at least 1 hour before or 4 to 6 hours after a dose of colestipol to prevent interference with absorption. Because the drug can increase serum triglycerides, it should not be administered to patients with hypertriglyceridemia. Nursing Responsibilities: Key nursing implications for patients receiving cholestyramine are included in the Nursing Practice Application for Patients Receiving Pharmacotherapy for Hyperlipidemia on pages 512­513. The first fibric acid agent, clofibrate (Atromid-S), was widely prescribed until a 1978 study determined that it did not reduce mortality from cardiovascular disease. In fact, clofibrate was found to increase overall mortality, compared to a control group. Although this drug is no longer marketed in the United States, three other fibric acid agents, fenofibrate (TriCor), fenofibric acid (Trilipix), and gemfibrozil (Lopid), are sometimes used for patients with high triglyceride levels. Combining a fibric acid agent with a statin results in greater decreases in triglyceride levels than either drug used alone. The most common adverse effects of the fibrates are abdominal pain, nausea, and vomiting. This increase in gallbladder disease has not been seen with other fibric acid agents, but drugs in this class are generally not used in patients with preexisting gallbladder or biliary disease. Its ability to lower lipid levels, however, is unrelated to its role as a vitamin because much higher doses are needed to produce its antihyperlipidemic effects. As with other lipid-lowering drugs, maximum therapeutic effects may take a month or longer to achieve. Taking one aspirin tablet 30 minutes prior to niacin administration can reduce uncomfortable flushing in many patients. More serious adverse effects such as hepatotoxicity and gout are possible but uncommon. Patients with elevated liver enzymes or a history of liver disease should use an alternate drug to lower lipids. In patients predisposed to gout, niacin may increase uric acid levels and precipitate acute gout. Niacin is not usually prescribed for patients with diabetes mellitus because the drug can raise fasting glucose levels. When beginning therapy, patients with diabetes should monitor their blood glucose levels more frequently until the effect of niacin is determined. Because of the high incidence of adverse effects, niacin is most often used in lower doses in combination with a statin or bile acid sequestrant; the beneficial effects of these drugs are additive. Because supplemental niacin is available without a prescription, patients should be instructed not to attempt selfmedication with this drug. If niacin is to be used to lower cholesterol, it should be done under medical supervision. It is considered a second-line therapy that is used when statins are ineffective or not well tolerated. By inhibiting the uptake of free fatty acids by the liver, hepatic production of triglycerides is decreased. Nervous system effects include headache, dizziness, peripheral neuropathy, and diminished libido. Contraindications/Precautions: Gemfibrozil may worsen or cause biliary disease; thus it is contraindicated in patients with preexisting gallbladder disease or serious liver impairment. Because it is excreted by the kidneys, the drug should be used cautiously in patients with renal impairment. Drug Interactions: Although antihyperlipidemic agents from different drug classes are sometimes combined to produce an enhanced effect, the use of gemfibrozil with statins increases the risk of myositis and rhabdomyolysis. In most cases the risk of rhabdomyolysis, which may be fatal, outweighs the potential benefits of combined statin and gemfibrozil therapy. Serum glucose levels must be carefully monitored because the dosage of the antidiabetic drug may require adjustment. One advantage of the fenofibrate formulations over gemfibrozil is that they may be taken once daily rather than twice a day. Several fenofibrate formulations, which vary in strength, bioavailability, and whether the drug should be administered with a meal, are available. The most recent formulation, Trilipix, was approved in 2008 for concurrent therapy with statins. Liver tests should be performed periodically to monitor for elevated serum transaminases. Myopathy and rhabdomyolysis have been reported and the risks for these adverse effects are increased when fibrates are coadministered with a statin. In the early 2000s, a class of drugs was discovered that inhibits the absorption of cholesterol.

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The nurse should assist patients to evaluate their current dietary intake treatment bee sting actonel 35 mg low price, especially when cultural diets are followed symptoms checklist actonel 35 mg buy without a prescription, to be sure that adequate amounts of fat-soluble vitamins and proteins are taken, along with lowered fat intake. Because the fibric acid agents may affect antidiabetic medications, the nurse can also help the patient with diabetes and family members to select culturally desirable foods that will aid in the stabilization of blood glucose as well. These values change periodically as additional research becomes available on the association between heart disease and lipid levels. Establishing treatment guidelines for dyslipidemia has been difficult because the condition itself has no symptoms and the progression to cardiovascular disease may take decades. The guidelines are based on accumulated evidence that reducing borderline high cholesterol levels can result in fewer heart at- tacks and decreased mortality. These guidelines will likely lead to more widespread use of antihyperlipidemics, which are already the most widely prescribed drug class in the United States. Blood lipid profiles are used to classify the different patterns of hyperlipidemias observed in clinical practice. The specific type of dyslipidemia exhibited by patients is considered when planning therapy. For example, Type I requires dietary restrictions and does not respond well to pharmacotherapy. Whereas the remaining types respond to the statins, the hypertriglyceridemias may respond better to therapy with fibric acid agents (fibrates). Many patients with borderline high-risk laboratory values can control their dyslipidemia entirely through nonpharmacologic means. Because many patients who take lipid-lowering drugs have underlying cardiovascular disease, these lifestyle changes are particularly important. Following are the most important lipid-reduction lifestyle interventions: Monitor blood lipid levels regularly, as recommended by the health care provider. Increase soluble fiber in the diet, as found in oat bran, apples, beans, grapefruit, and broccoli. The single most important lifestyle factor contributing to dyslipidemia is a high amount of saturated fat in the diet. Nutritionists recommend that the intake of dietary fat be limited to less than 30% of the total caloric intake. Cholesterol intake should be reduced as much as possible and not exceed 200 mg/day. It is interesting to note that restriction of dietary cholesterol alone will not result in a significant reduction in blood cholesterol levels. In fact, cutting back on cholesterol consumption may actually increase the amount of circulating cholesterol. The liver reacts to a low cholesterol diet by making more cholesterol and by inhibiting its excretion whenever saturated fats are present. Saturated fats are the building blocks that the liver uses for making cholesterol. Patients must therefore reduce saturated fat in their diet to less than 7% of total calories, in addition to reducing cholesterol consumption, in order to control the amount made by the liver and to ultimately lower blood cholesterol levels. Plant sterols, also called phytosterols or stanols, are lipids used by plants to construct their cell membranes. When ingested, the plant sterols compete with cholesterol for absorption in the digestive tract. Rich, natural sources of plant sterols include wheat, corn, rye, oats, and rice, as well as nuts and olive oil. In recent years, plant sterols have been added to commercial products such as margarines, salad dressings, certain cereals, and some fruit juices. To be of benefit in reducing high serum cholesterol, nutritionists recommend a daily intake of plant sterols of 2 to 3 grams. Cholesterol levels can be reduced by 10% to 15% after just a couple of months of sufficient plant sterol intake. In the late 1970s substances were isolated from various species of fungi that were found to inhibit cholesterol production in human cells in the laboratory. This class of drugs, known as the statins, has revolutionized the treatment of lipid disorders. Dyslipidemias are also a concern for some pediatric patients, and multiple research studies have demonstrated that the early stages of atherosclerosis begin in childhood. With the increasing childhood obesity epidemic, there is concern that dyslipidemias, cardiovascular disease, and metabolic syndrome will occur at younger and younger ages. Risk factors include overweight or obese children, family history of dyslipidemias or premature cardiovascular disease, hypertension, smoking or passive smoke exposure, and known lipid disorders. Subsequent research studies have demonstrated the safety of statins in the pediatric population but no long-term studies have been done, and the drugs are recommended for short-term use. It was also noted that for girls past the age of first menarche, teaching about pregnancy prevention and the risks of taking statins while breast-feeding should be included in patient education. The drop in lipid levels is not permanent, however, so patients must continue these drugs for the remainder of their lives or until their hyperlipidemia can be controlled through dietary or lifestyle changes. This type of therapy is called secondary prevention, because the patient is already at risk for increased mortality. The data is less clear regarding primary prevention: administering statins to patients with no history of cardiovascular disease. For these patients the risk of adverse drug effects and cost of the medication must be carefully weighed against potential benefits. Some, but not all, studies show benefits for primary prevention and this will likely remain a topic of continuing research. Currently, seven statins are available for treating various types of dyslipidemias, and these are listed in Table 32.

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Patient and Family Education: Do not drink alcohol because this may cause stomach irritation administering medications 6th edition effective 35 mg actonel. Drugs Similar to Celecoxib (Celebrex) Celecoxib (Celebrex) is the sole medication in this class medications made from plants generic actonel 35 mg on-line. Assessment throughout administration: Potential Nursing Diagnoses Acute or Chronic Pain Hyperthermia Deficient Fluid Volume Deficient Knowledge (Drug Therapy) Risk for Injury, related to adverse drug effects Assess for desired therapeutic effects. The provider should be notified if fever remains present after 3 days or if increasing signs of infection are present. Immediately report undiminished fever, changes in level of consciousness, febrile seizures, tachycardia, blood pressure over 140/90 or per parameters as ordered, to the health care provider. Acetaminophen can be hepatotoxic in large doses or if taken when hepatic dysfunction is present. Men who consume more than two alcoholic beverages per day or women who consume more than one alcoholic beverage per day should consult their health care provider before taking acetaminophen. Enteric-coated tablets should be swallowed whole without chewing, crushing, or breaking. Immediately report unusual changes in visual acuity, blurred or diminished vision, reports of spots in vision, or changes in color sense to the provider. Immediately report any eye pain, diminished or blurred vision, or changes in color sense. Do not use aspirin or salicylates in children under age 19 unless ordered by the provider or within 2­3 weeks after the varicella vaccination has been administered to these children. Patient understanding of drug therapy: Use opportunities during administration of medications and during assessments to discuss the rationale for drug therapy, desired therapeutic outcomes, most commonly observed adverse effects, parameters for when to call the health care provider, and any necessary monitoring or precautions. Household measuring devices such as teaspoons differ significantly in size and amount and should not be used for pediatric or liquid doses. While she is preparing to leave the hospital she mentions to the nurse that the new medication written on the prescription sounded a lot like the medication she routinely takes for depression (Celexa). The reduction of fever occurs by its direct action on the heat-regulating center of the hypothalamus to produce peripheral vasodilation, sweating, and dissipation of heat. It is often combined with opioid analgesics; adding acetaminophen provides additive pain relief and allows for lower doses of the narcotic (see Chapter 29). Acetaminophen has no effect on platelet aggregation and does not exhibit cardiotoxicity. The risk for adverse effects is dose related and increases with the longterm use of this drug. Acute acetaminophen poisoning is very serious, and symptoms include anorexia, nausea, vomiting, dizziness, lethargy, diaphoresis, chills, epigastric or abdominal pain, and diarrhea. Excessive acetaminophen use is the number one cause of acute hepatic failure in the United States. Chronic ingestion of acetaminophen results in neutropenia, pancytopenia, leukopenia, thrombocytopenic purpura, hepatotoxicity in alcoholics, and renal damage. Contraindications/Precautions: Patients who are allergic to acetaminophen should not be administered this medication. Acetaminophen should be administered cautiously to patients with rheumatoid or osteoarthritis, malnutrition, bone marrow depression, and immunosuppression. Chronic administration of acetaminophen should be avoided in patients with renal impairment because this drug can worsen kidney function. Acetaminophen (Tylenol) Classification: Therapeutic: Nonopioid analgesic, antipyretic Pharmacologic: Para-aminophenol derivative Therapeutic Effects and Uses: Approved in 1950, acetaminophen relieves mild to moderate pain but has no effect on inflammation. Acetaminophen is approved to treat pain associated with osteoarthritis of the hip or knee, dysmenorrhea, dental procedures, headache, and myalgia. Acetaminophen is available for the oral (suspension, tablets, chewable tablets, extended release tablets, and oral granules) or rectal routes. Drug Interactions: Acetaminophen should not be administered with alcohol or to patients who consume alcohol with regularity because this greatly increases the risk of hepatotoxicity. Due to additive hepatotoxic effects, acetaminophen should not be administered with barbiturates, carbamazepine, diphenylhydantoin, isoniazid, rifampin, and sulfinpyrazone. Acetaminophen will decrease lamotrigine levels, if the drugs are administered concurrently. Long-term use of acetaminophen and warfarin will result in increased hypoprothrombinemic effects. Zidovudine administered with acetaminophen may increase the risk of bone marrow suppression. For maximum effectiveness, the antidote should be administered within 8 hours of acetaminophen ingestion. Nursing Responsibilities: Key nursing implications for patients receiving acetaminophen are included in the Nursing Practice Application for Patients Receiving Pharmacotherapy for Inflammation and Fever on pages 732­733. Lifespan and Diversity Considerations: Monitor hepatic function laboratory values in the older adult more frequently because normal age-related physiological changes increase the risk of adverse effects. Patient and Family Education: Do not drink alcohol because the combination of alcohol and acetaminophen can cause serious and even fatal liver damage. Drugs Similar to Acetaminophen (Tylenol) Acetaminophen is the only medication in this class. She has taken ibuprofen for fevers and menstrual cramps in the past, but Joycee cannot find any in the house as she gets ready to head off to school. Her parents have already left for work, and they trust her to check with you, the nurse who lives next door, before taking any medication. She is an honors student, works hard to get good grades, and hates to miss school. Celecoxib (Celebrex) An 80-year-old woman, who is scheduled for a total knee replacement next month, currently takes ibuprofen (Motrin, Advil) 600 mg three times per day. A client who is taking warfarin (Coumadin) A client takes aspirin (acetylsalicylic acid) daily for pain in the right knee.

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Explain the effects of cardiac output medicine 3d printing 35 mg actonel with visa, peripheral resistance xanthine medications order actonel australia, and blood volume on hemodynamics. Discuss how the vasomotor center, baroreceptors, chemoreceptors, and hormones regulate blood pressure. Cardiac Structure and Function Cardiac Muscle Coronary Arteries Cardiac Conduction System Cardiac Output Hemodynamics and Blood Pressure Hemodynamic Factors Affecting Blood Pressure Neural Regulation of Blood Pressure Hormonal Influences on Blood Pressure It is likely that the nurse will administer more cardiovascular drugs than any other class of medications. First, health care providers have discovered the huge benefits of keeping blood pressure and blood lipid values within normal limits and how to prevent heart attacks and strokes. Second, the heart and vessels simply weaken over time and, as the average life span of the population increases, more pharmacotherapy will be needed to treat the cardiovascular diseases of older adults. These two goals of cardiovascular pharmacotherapeutics, prevention and treatment, are used routinely for nearly all people at some stage during their life span. A comprehensive knowledge of cardiovascular anatomy and physiology is essential to understanding cardiovascular pharmacology, which encompasses the next 11 chapters of this book. The purpose of this chapter is to offer a brief review of the components of the structure and function of the cardiovascular system that are important to pharmacotherapy. For more comprehensive treatments of these topics, the student should refer to an anatomy and physiology textbook. These three components work as an integrated whole to transport various substances throughout the body, providing the necessary life substances essential to all cells. Disruption of this flow for even brief periods can have serious, if not mortal, consequences. The functions of the cardiovascular system are diverse and include the following: Transport of nutrients and wastes Pumping of blood Regulation of blood pressure Regulation of acid­base balance Regulation of fluid balance Regulation of body temperature Protection against invasion by microbes It must be clearly understood that the cardiovascular system can only function with the cooperation of other body systems. For example, the role of the autonomic nervous system in controlling heart rate and blood vessel diameter is presented in Chapter 16. The kidneys are intimately involved in assisting the cardiovascular system with fluid and acid­base balance, as discussed in Chapter 36. The respiratory system must bring oxygen to the blood and remove carbon dioxide from it. The solid, automaticity, 489 formed elements of the blood are the erythrocytes, leukocytes, baroreceptors, 494 and platelets. Carrying the ironectopic foci, 491 containing protein hemoglobin, erythropoietin, 485 the erythrocytes are responsible extrinsic pathway, 488 for transporting oxygen to the fibrin, 488 tissues and carbon dioxide from the tissues to the lungs. Without fibrinogen, 488 a nucleus, a single erythrocyte hemopoiesis, 486 can carry as many as one billion hemostasis, 487 molecules of oxygen. Erythroinotropic agents, 492 cyte homeostasis is controlled by intrinsic pathway, 488 erythropoietin, a hormone secreted by the kidney in response myocardium, 489 to low oxygen levels in the blood. Insufficient prothrombin, 488 numbers of erythrocytes or reflex tachycardia, 494 structural defects such as sickle shapes lead to anemia, which is a renin-angiotensincommon indication for pharmaaldosterone system cotherapy (see Chapter 42). Unlike erythrocytes, thrombopoietin, 486 which are all identical, there are several types of leukocytes, each vasomotor center, 494 serving a different function. For venous return, 492 example, neutrophils are the most common leukocyte and they respond to bacterial infections through phagocytosis of the microbes. The second most common leukocyte, the lymphocyte, is the key cell in the immune response that responds by secreting antibodies (B lymphocytes) or secreting cytokines (T lymphocytes) that rid the body of the microbe. Too many leukocytes, called leukocytosis, is a sign of infection, inflammation, or perhaps leukemia. The final formed elements of the blood are thrombocytes or platelets, which are actually fragments of larger cells called megakaryocytes. Platelets stick to the walls of damaged blood vessels to begin the process of blood coagulation, which prevents excessive bleeding from sites of injury. Abnormally low numbers of platelets, or thrombocytopenia, can result in serious delays in blood clotting. Platelet homeostasis is controlled by the hormone thrombopoietin, which promotes the formation of additional platelets. The role of platelets and thrombopoietin in blood coagulation is a major topic in Chapter 41, which discusses the pharmacotherapy of blood coagulation. The production and maturation of blood cells, called hemopoiesis, or hematopoiesis, occurs in red bone mar- row. It is here that primitive stem cells of the blood, which have the capacity to develop into any blood cell type, become committed to becoming an erythrocyte, leukocyte, or platelet. This process occurs continuously throughout the life span and is subject to various homeostatic controls as well as chemical and physical agents. For example, ionizing radiation and a large number of drugs have the potential to adversely affect bone marrow and cause myelosuppression. Myelosuppression is a very serious adverse effect that reduces the number of erythrocytes, leukocytes, and thrombocytes, leaving patients susceptible to anemia, infection, and bleeding. Many agents used to treat cancer and those given to reduce the possibility of transplant rejection can produce profound myelosuppression as a dose-limiting adverse effect. The primary proteins in plasma are albumins (54%), globulins (38%), and fibrinogen (7%). Albumin is the primary regulator of blood osmotic pressure (also called oncotic pressure), which determines the movement of fluids among the vascular, interstitial, and cellular compartments or spaces. Globulins, also known as immunoglobulins or antibodies, are important in protecting the body from foreign agents such as bacteria or viruses.

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Mepivacaine is sometimes combined with levonordefrin symptoms zinc poisoning buy actonel on line, a vasoconstrictor that prolongs the duration of action of the local anesthetic shakira medicine 35 mg actonel with visa. Prilocaine (Citanest): Approved in 1965, prilocaine is used primarily for dental anesthesia via infiltration or nerve block. Ropivacaine (Naropin): Ropivacaine is a newer local anesthetic agent approved in 1996 that is used in epidural anesthesia and postoperative pain management. It has an onset of action of 1 to 30 minutes and a duration of anesthetic action of 2 to 6 hours. It is important that disinfecting agents with heavy metal content not be used to disinfect the skin prior to the insertion of the epidural catheter because these have been associated with swelling and edema. Also, the container of ropivacaine should not be cleaned with a heavy metal disinfecting agent. Unlike most local anesthetics, the presence of epinephrine does not affect the systemic absorption of ropivacaine. Drugs Similar to Lidocaine (Anestacon, Dilocaine, Xylocaine, Others) Other local anesthetic amides include articaine, bupivacaine, dibucaine, mepivacaine, prilocaine, and ropivacaine. The amides levobupivacaine (Chirocaine) and etidocaine (Duranest) have been removed from the U. Articaine (Septocaine, Zorcaine): Approved in 2000, articaine is approved for administration by infiltration or by nerve block for dental procedures. Articaine appears to diffuse through soft tissue and bone better than other local anesthetics. It is combined with epinephrine, which provides vasoconstriction and prolongs the duration of action. Bupivacaine (Marcaine, Sensorcaine): Approved in 1972, bupivacaine is an amide local anesthetic that is used for infiltration anesthesia, peripheral sympathetic nerve, and epidural block. Its 3- to 9-hour duration of action is one of the longest of any local anesthetic. Dibucaine (Nupercainal): Approved in 1947, dibucaine is administered to relieve pain and itching related to hemorrhoids and other anorectal disorders. It is also administered to relieve discomfort from insect bites, sunburn, minor burns, cuts, and scratches. It is a long-acting amide anesthetic that inhibits the initiation and conduction of nerve impulses by Adjuncts to Anesthesia 30. In addition, anesthetics dampen vital reflexes, which can lead to aspiration pneumonia. Adjunctive medications are those used to enhance anesthesia or to make the procedure safer and less unpleasant for patients. Oral benzodiazepines may be given for several days prior to a major procedure to lessen anxiety. Just prior to surgery, midazolam (Versed) may be administered parenterally to sedate the patient and to cause perioperative amnesia (see Section 30. If the patient reports allergy to "caine" drugs, note the specific drug and reactions the patient experienced. Report a blood pressure less than 90/60 mmHg, pulse above 100 beats/min, or per the parameters as ordered by health care provider. Expect blanching in the localized area if the local anesthetic contained epinephrine. Report any increasing drowsiness, dizziness, lightheadedness, confusion, or agitation immediately. Implementation Interventions and (Rationales) Ensuring therapeutic effects: Patient-Centered Care Teach the patient that the area may be numb for several hours after the procedure is completed. Assess the localized area for numbness and blanching if the local anesthetic included epinephrine. An ability to perceive pressure-type sensations may remain during anesthesia and may be alarming to the patient. Epinephrine in the anesthetic solution will constrict localized blood vessels and result in blanching of the area. Have the patient alert the health care provider if more than slight pressure sensation or any pain is noticed during anesthesia. Report blood pressure below 90/60 mmHg or per the parameters as ordered by the health care provider, tachycardia, bradycardia, changes in level of consciousness, dyspnea, or decrease in respiratory rate, immediately. Bradycardia, hypotension, decreased level of consciousness, decreased respiratory rate, and dyspnea may signal the anesthesia has entered the systemic circulation and is acting as a general anesthetic. Aspiration of food or liquids is possible until swallowing sensation and gag reflex return. Histamine (H2) receptor antagonists such as ranitidine (Zantac) or famotidine (Pepcid) can reduce the possibility of aspiration pneumonia by decreasing gastric fluid volume and reducing acidity. Anticholinergic drugs such as atropine may be administered prior to surgery to reduce salivary and airway secretions. Pain management: Pain reduction is an important component of preanesthesia and postanesthesia care. Opioids are used when the pain is expected to be severe, but these agents can cause significant respiratory depression. Clonidine (Catapres, Duraclon) is a centrally acting alpha2-adrenergic agonist that has been used to reduce severe pain associated with surgery. When administered epidurally Duraclon allows the dosages of the anesthetic and opioids to be reduced.

References

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• Auge, B.K., Munver, R., Kourambas, J., Newman, G.E., Preminger, G.M. Endoscopic management of symptomatic caliceal diverticula: a retrospective comparison of percutaneous nephrolithotripsy and ureteroscopy. J Endourol 2002;16:557-563.
• Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol. 2007;50:e1-e157.
• Ben-Meir A, Sonpal I, Patterson L, et al. Cigarette smoking, but not NSAIDs or alcohol use or comorbidities, is associated with anastomotic ulcers in Roux-en-Y gastric bypass (RYGB) patiets. Surg Obes Relat Dis. 2005;1:263.
• Stolle C, Glenn G, Zbar B, et al. Improved detection of germline mutations in the von Hippel-Lindau disease tumor suppressor gene. Hum Mutat 1998; 12(6):417-423.