Management And Prognosis

Most of the time the diagnosis is suspected in an infant with heart defect or cholestasis.

The diagnosis relies on:

• Clinical examination: facies, icterus, xanthomas, cardiac murmur, and liver enlargement.

• Chest radiographs: butterfly-vertebrae.

• Ophthalmologic examination: embryotoxon and other anterior chamber anomalies, retinitis.

Further evaluation includes:

Renal ultrasound examination and function tests. Ear examination and audiogram.

There is no specific treatment, and except for the presence of complex congenital heart diseases the presence or severity of a clinical feature carries no predictive value.

Complex cardiac disease may require surgery; pulmonary stenosis is usually well tolerated and does not progress. When liver involvement is present, careful nutritional management is mandatory especially if liver transplantation is indicated. Supplementary lipid-soluble vitamins must be given regularly either orally or by intramuscular injections. Relief of pruritus is a major problem; ursodeoxycholic acid may be used but rifampi-cin and opioid-antagonists are more effective. The prognosis of liver disease is worse in children who present with neonatal cholestatic jaundice. However, severe liver complications are possible even after late onset of liver disease, demanding follow-up throughout life. Liver transplantation is eventually necessary in roughly 30% of patients.[3,8,9]

Spontaneous intracranial bleeding is a widely recognized complication, and AGS patients are at special risk for bleeding, either spontaneous or during surgery or other medical procedures. This should be taken into account before deciding on an invasive procedure.[10]

JAG1. Furthermore, the number and the severity of the features vary among patients carrying the same mutations _ ^ even within the same family. A significant frequency of mosaicism for JAG1 mutations has been reported.[13]

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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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