In the last few years, the understanding of HHT has expanded rapidly and several diagnostic and therapeutic protocols have been proposed. On the other hand, the management of the disease is extremely complex because multiple organs are involved. The management of HHT

patients should aim at controlling local and systemic symptoms and preventing complications. Epistaxis greatly influences the quality of life of HHT patients and it should be treated especially when the episodes begin to be very frequent and severe. Oral tranexamic acid administration and estrogen therapy in women significantly reduce the frequency of the episodes and ameliorate the quality of life of these patients. Septal dermatoplasty should be proposed when severe epistaxis leads to life-threatening anemia.

In the follow-up of affected persons, the lung and the brain are of particular concern because each may contain clinically silent lesions that can result in sudden morbidity and mortality. Echo-bubble is widely recognized as the most accurate technique to screen PAVMs. Cerebral screening by MRI should be performed at least once during the lifetime of patients, preferably in childhood. Presymptomatic intervention by embolotherapy for both PAVMs and CAVMs may positively influence outcome.

The systematic screening of liver involvement has not been generally suggested because the hepatic shunts are frequently asymptomatic, but considering the high frequency of these lesions and the possibility of severe complications, adult patients should undergo abdominal echo-color-Doppler examination before being included in a follow-up program. Lastly, the screening of the GI telangiectases should be performed in the presence of a severe anemia only partially explained by recurrent epistaxis. Endoscopy permits the diagnosis and treatment of telangiectases located in the upper digestive tract and in the colon with laser coagulation, whereas the examination of the small bowel depends on the availability of capsule endoscopy which, however, cannot be considered yet as a screening procedure because of its high cost. In conclusion, at present, HHT management requires a multidisci-plinary approach and the availability of several diagnostic and therapeutic options. Multispecialistic cooperation is needed to develop a specific biological test for HHT diagnosis in addition to new therapeutic approaches for the disease, such as gene replacement.

Getting Started With Dumbbells

Getting Started With Dumbbells

The use of dumbbells gives you a much more comprehensive strengthening effect because the workout engages your stabilizer muscles, in addition to the muscle you may be pin-pointing. Without all of the belts and artificial stabilizers of a machine, you also engage your core muscles, which are your body's natural stabilizers.

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