Wilson disease should be considered in patients with uncertain signs of hepatic, neurological, or psychiatric disease. Ocular slit-lamp examination as well as measurement of serum ceruloplasmin, urinary copper excretion before and after D-penicillamine challenge, and liver biopsy with determination of the hepatic copper content are required. It has to be pointed out that Wilson disease is a diagnostic challenge because of the variety of clinical presentations and laboratory findings. Genetic analysis is rendered difficult by a high number of different mutations in distinct regions of the ATP7B gene and the high prevalence of compound heterozygotes. Genetic testing is indicated in patients in which the clinical presentation and the laboratory tests do not allow a definite diagnosis. A negative genetic test result does not rule out Wilson disease. Family screening of firstgrade relatives should be done to detect asymptomatic cases. Early therapy with chelators or zinc is lifesaving and has to be continued lifelong. Special attention has to be directed to therapy compliance and occurring side effects. Liver transplantation is necessary in decompen-sated liver disease, but its utility in neurological disease is controversial.

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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