The SOTO-USA Update is published by SOTO-USA solely for the purpose of education. All rights reserved by SOTO-USA to accept, reject or modify any submission for publication. The opinions stated in the electronically printed material herein are those of the authors and do not necessarily represent the opinions of SOTO-USA or other individuals associated with SOTO-USA. SOTO-USA does not guarantee or make any representation that the printed material contained herein is valid, reliable or accurate. SOTO-USA does not assume any responsibility for injury arising from any use or misuse of the printed material herein. The printed material contained herein is assumed to be from reliable sources and there is no implication that the printed material herein present the only, or the best methodologies or procedures for the care or treatment of conditions discussed. It is incumbent upon the reader to verify the accuracy of any diagnosis and treatment information contained herein, and to make modifications as new information and/or research arises.