<!-- server: ecapp0503p.utd.

com -->

<html> <head> <title>uptodate inc.</title> <meta http-equiv="content-type" content="text/html; charset=utf-8"></meta> <meta name="description" content="uptodate, electronic clinical resource tool for physicians and patients that provides information on adult primary care and internal medicine, allergy and immunology, cardiovascular medicine, emergency medicine, endocrinology and diabetes, family medicine, gastroenterology and hepatology, hematology, infectious diseases, nephrology and hypertension, neurology, obstetrics, gynecology, and women's health, oncology, pediatrics, pulmonary, critical care, sleep medicine, rheumatology, and more."/> <meta name="keywords" content="uptodate, up to date, adult primary care, internal medicine, allergy, immunology, cardiovascular medicine, emergency medicine, endocrinology, diabetes, family medicine, gastroenterology, hepatology, hematology, infectious diseases, nephrology, hypertension, neurology, obstetrics, gynecology, women's health, oncology, pediatrics, pulmonary, critical care, sleep medicine, rheumatology, asthma, arthritis, rheumatism, blood and lymphatic disease, bones joints and muscles, brain and nervous system, cancer, children's health, digestive disease, endocrine system and hormones, general health, heart disease, hiv and aids, infections and immunizations, kidney disease, liver disease, lung disease, men's health, mental health, pregnancy"/> <meta name="copyright" content="2008 uptodate"/> <link rel="stylesheet" type="text/css" href="/styles.css;jsessionid=0688d3f20facad88da449d3b1785bd4d.0503"/> <link rel="stylesheet" media="print" type="text/css" href="/print_styles.css;jsessionid=0688d3f20facad88da449d3b1785bd4d.0503"/> <style> /* ie hack */ * html body { padding: 94px 0px 0px 0px; } </style> </head> <body>

<style> /* ie hack */ * html #contentfullpage { height: 100%; }

</style> <div id="contentfullpage" style="top:94px; left:0px; right:0px; bottom:0px;"> <table border="0" cellspacing="0" cellpadding="0" height="100%" width="100%"> <tr> <td valign="top">

<noscript> <img src="/images/spacer.gif;jsessionid=0688d3f20facad88da449d3b1785bd4d.0503" height="10" width="1"> <table border="0" cellspacing="0" cellpadding="3" bordercolor="#000000" bgcolor="#000000" width="100%" align="center" style="margin: 5px;"> <tr> <td> <table width="100%" border="0" cellspacing="0" cellpadding="5" bgcolor="#ff0000"> <tr> <td> <strong><font color="#000000">it seems to us that you have your javascript turned off on your browser. javascript is required in order for our site to behave correctly. please enable your javascript to continue use our site.</font></strong> </td> </tr> </table> </td> </tr> </table> <img src="/images/spacer.gif;jsessionid=0688d3f20facad88da449d3b1785bd4d.0503" height="10" width="1"> </noscript>

<meta name="decorator" content="default" /> <table border="0" cellspacing="0" cellpadding="0" width="720" align="center"> <tr><td><img src="/images/spacer.gif;jsessionid=0688d3f20facad88da449d3b1785bd4d.0503" height="10" width="1"></td></tr> <tr> <td><h1>the page you requested is available only to <i>uptodate</i> subscribers.</h1></td> </tr> <tr><td><img src="/images/spacer.gif;jsessionid=0688d3f20facad88da449d3b1785bd4d.0503" height="30" width="1"></td></tr> <tr> <td> <b>if you are a subscriber...</b>

<br/><br/> <input type="button" value=" log in

"

onclick="window.location='/online/login.do;jsessionid=0688d3f20facad88da449d3b1785 bd4d.0503';"/> <br/><br/>or, if you are not a subscriber<br/><br/> <input type="button" value=" subscribe now " onclick="window.location='/home/store/index.do;jsessionid=0688d3f20facad88da449d3b 1785bd4d.0503';"/>

</tr> </table>

</td> </td> </tr> <tr> <td height="1">

<div id="footer" style="width:100%; float: left;"> <span style="margin-left: 17px; margin-top: 5px; display: block;"> &copy; 2008 uptodate, inc. all rights reserved. <span class="pipespace">|</span> <a href="/online/license.html;jsessionid=0688d3f20facad88da449d3b1785bd4d.0503" class="footerlink">subscription and license agreement</a>

<span class="pipespace">|</span>support tag: [ecapp0503p.utd.com75.126.202.84-0688d3f20f-]<br /> </span> </div> </tr> </table> </div> </td>

<div class="tertiarytxt" id="feedback"> <table cellspacing="0" border="0">

<td><img src="/images/white_circle.gif;jsessionid=0688d3f20facad88da449d3b1785bd4d.0503" height="15" width="19" class="va-middle" alt=""></td> <td valign="center"><a href="/online/login.do;jsessionid=0688d3f20facad88da449d3b1785bd4d.0503" class="logintxt">log in</a></td> </tr> </table> </div>

<tr>

<script language="javascript" type="text/javascript" src="/functions.js;jsessionid=0688d3f20facad88da449d3b1785bd4d.0503"></script> <script language="javascript" type="text/javascript"> function openemailform(dest, source) { var newwin = window.open( "/home/feedback/letter.do;jsessionid=0688d3f20facad88da449d3b1785 bd4d.0503?destination=" + dest + "&referer=" + escape(window.location.href) + ((source)?"&source=" + source: ""), "contact_us", "toolbar=no,menubar=no,resizable=no,height=440,width=450" ); newwin.focus(); } </script> <div id="help"> <table cellspacing="0" border="0"> <tr> <td><img src="/images/white_circle.gif;jsessionid=0688d3f20facad88da449d3b1785bd4d.0503" height="15" width="19"></td>

<td valign="center"><a href="#" onclick="openemailform('editorial'); return false;" styleclass="demotxt">feedback</a></td>

</tr> </table> </div> <style type="text/css" media="screen"> #header { position: absolute; height: 94px; top: 0;

} </style> <style type="text/css" media="print"> #header { display:none; } </style> <div id="header">

left: 0; width: 100%;"

<script language="javascript" type="text/javascript" src="/feedback.js;jsessionid=0688d3f20facad88da449d3b1785bd4d.0503"></script> <div id="topleftlogo"><a href="/home/index.html;jsessionid=0688d3f20facad88da449d3b1785bd4d.0503"><img src="/images/logo.gif;jsessionid=0688d3f20facad88da449d3b1785bd4d.0503" height="51" width="138" border="0" alt="uptodate"></a> </div> <div id="dvversiontxt">online 16.1</div> <div class="tertiarytxt" id="tertiary"> <a href="/home/index.html;jsessionid=0688d3f20facad88da449d3b1785bd4d.0503" class="tertiarytxt">home</a> <span class="pipespace">|</span> <a href="/online/about/contact_us.html;jsessionid=0688d3f20facad88da449d3b1785bd4d.05 03" class="tertiarytxt">contact us</a> <span class="pipespace">|</span> <a href="/online/about/index.html;jsessionid=0688d3f20facad88da449d3b1785bd4d.0503" class="tertiarytxt">about uptodate</a> <span class="pipespace">|</span> <a href="/online/help/index.html;jsessionid=0688d3f20facad88da449d3b1785bd4d.0503" class="tertiarytxt">help</a> </div> <div id="topnavmenucontainer"> <ul id="navlist"> <li> <img src="/images/menu_up.gif;jsessionid=0688d3f20facad88da449d3b1785bd4d.0503" height="23" width="14"> </li> <li> <img src="/images/menu_dots.gif;jsessionid=0688d3f20facad88da449d3b1785bd4d.0503" height="23" width="1"> </li>

<li><a href="/online/content/search.do;jsessionid=0688d3f20facad88da449d3b1785bd4d.0503"> new search</a></li> <li><img src="/images/menu_dots.gif;jsessionid=0688d3f20facad88da449d3b1785bd4d.0503" height="23" width="1"></li>

<li><a href="/online/content/toc.do;jsessionid=0688d3f20facad88da449d3b1785bd4d.0503?tock ey=table_of_contents/patient_information">patient info</a></li>

<li><img src="/images/menu_dots.gif;jsessionid=0688d3f20facad88da449d3b1785bd4d.0503" height="23" width="1"></li>

<li><a href="/online/content/toc.do;jsessionid=0688d3f20facad88da449d3b1785bd4d.0503?tock ey=table_of_contents/what's_new">what's new</a></li>

<li><img src="/images/menu_dots.gif;jsessionid=0688d3f20facad88da449d3b1785bd4d.0503" height="23" width="1"></li> <li style="background-image: url(/images/spacer.gif;jsessionid=0688d3f20facad88da449d3b1785bd4d.0503);"><img src="/images/right_shim.gif;jsessionid=0688d3f20facad88da449d3b1785bd4d.0503" height="23" width="16"></li> </ul> </div>

<style type="text/css" media="screen"> #greybar { top: 89px; height: 5px; position: absolute; bottom: 0; left: 0; width: 100%;" }

</style> <style type="text/css" media="print"> #greybar { display:none; } </style> <div id="greybar">

<!--

simple greybar -->

<table width="100%" border="0" cellpadding="0" cellspacing="0" bgcolor="#ffffff"> <tr><td background="/images/fade_top_bg_patient_home.gif;jsessionid=0688d3f20facad88da449d 3b1785bd4d.0503"><img src="/images/spacer.gif;jsessionid=0688d3f20facad88da449d3b1785bd4d.0503" height="10" width="14" alt=""></td></tr> </table>

</div> </div> <style type="text/css" media="screen"> #topsearchbar { left: 180px; top: 18px; width: 602px; position:absolute; } </style> <style type="text/css" media="print"> #topsearchbar { display:none; } </style> <style type="text/css" media="screen"> #topsearchbar { left: 35%; top: 18px; width: 390px; position: absolute; } </style> <style type="text/css" media="print"> #topsearchbar { display:none; }

</style> <div id="_pleasewaitmask" style="visibility:hidden; border:0; z-index:6000; position:absolute; top:0px; left:0px; width=100%; height=100%; visibility:hidden; background-color:#ffffff; filter:alpha(opacity=55); opacity:0.55; -mozopacity:0.55;"></div> <!-- this is the please wait screen --> <div id="_pleasewait" style="z-index:7000; background-color:#f5f5f5; position:absolute; visibility:hidden; top:0px; left:0px; width:300px; height:100px; border:1px solid #000000; vertical-align: middle; filter:alpha(opacity=95); opacity:0.95; -moz-opacity:0.95;"> <table border="0" cellspacing="0" cellpadding="0" align="center" height="100"> <tr> <td valign="middle"><img src="/images/progress.gif;jsessionid=0688d3f20facad88da449d3b1785bd4d.0503" align="absmiddle" border="0" id="_pleasewaitprogress"></td> <td>&nbsp;</td> <td valign="middle"> <font face="arial" size="3" color="#336633"> <strong>please wait</strong> </font> </td> </tr> </table> </div> </body> </html>