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Vitamin D receptors are abundant in the adrenal cortex ], suggesting a potential direct regulatory function for vitamin D in the biosynthesis of adrenal steroids. The Gardner-Wells tongs must be placed over the patient's scalp, and if time permits, an space of the scalp over the tong insertion level ought to be shaved and prepped with an antiseptic answer and infiltrated with local anesthetic. The internal elastic lamina was disrupted or fully destroyed and aneurysmal dilatation was often seen (Fig erectile dysfunction caffeine discount apcalis sx 20 mg with visa.