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Monday, December 26, 2011
Sunday, December 18, 2011
Used Auto Parts - Craigslist Versus Pick and Pull Junkyards
When many vehicle owners need car, truck, van, RV, or jeep parts, they usually turn to their local junkyard. Many of these junk yards have a pick and pull policy. Meaning, you can buy the part for cheap, but you must find that part yourself and remove it from the vehicle in question. Although it sounds like a lot of work, it is a great way to find cheap auto parts. Another way is visiting Craigslist.org. In fact, which is the best approach?
Unfortunately, not all junkyards in the United States sell used car parts. This is unfortunate, as these pick and pull yards have shown us that even the oldest cars and those in the worst shape still have salvageable parts. If you do not have access to one of these auto establishments, it is best to visit Craigslist.org. To get started, select your state and then the nearest city. Browse or search the website to find car, truck, van, RV, or jeep parts.
One of the many benefits to using Craigslist to find cheap car accessories is the search function. You don't have to spend hours sifting through a junkyard to find what you need. Instead, you sit at home on your computer and perform a search. To find the best deals and what you need, search with targeted phrases. Search with the make, model, or part you need. For example, Honda Civic fenders, Mercedes hubcaps, Geo Tracker door, Dodge Ram tailgate, and so forth.
At most pick and pull auto yards, you are charged a set price for each part. This is good if you only need one or two items. However, many buyers want to have an entire junk car on hand for parts in the future. At an established auto yard, this can cost you thousands of dollars or more. On Craigslist.org you are likely to find better prices. You may get a junk car for as little as 0! These cars don't run and the seller doesn't want to bother with needed repairs, so they sell the vehicle as a junk car and sell it for next to nothing. The only downside is you may need to rent or borrow a car trailer to tow it home.
Monday, December 5, 2011
Reviews on Top 3 Commercial Vacuum Sealers
If you are looking for a way to save money and eat right, a commercial vacuum sealer may be the answer. From personal kitchens to corporate restaurants, thousands of people have found the appeal of the vacuum sealer. With important features such as saving foods from spoiling and locking in nutrients and flavor, choosing the right vacuum sealer can be a difficult task. Vacuum sealers can prevent freezer burn in food and can, in some cases, double the freezer life of meats and vegetables!
With all of the different features of vacuum sealers, it is imperative that you determine which features you need and which commercial vacuum sealer is right for you. With such an important task, the right vacuum sealer can make all the difference. Choose from either a chamber vacuum system, which uses a chamber to remove air, enabling you to save even the most delicate foods or a standard vacuum sealer.
Chamber Vacs are generally considered top of the line by industry standards. Relatively inexpensive compared to other commercial vacuum sealing machines, you get a huge bang for your buck. These heavy duty vacuum sealers remove oxygen and other harmful chemicals that may be polluting the outside environment. Most come with a two year warranty and part replacement guarantee. These vacuum sealers are great for anyone who is serious about storing food without sustaining any damage.
If you are looking for a tabletop commercial vacuum sealer, such as the American International Electric (AIE) 18 Volt sealer, you are in luck. With state of the art technology, these sealers boast some of the quietest sealing capabilities. For increased ease of use, an electric foot control peddle is often included as a high quality accessory. The retractable stainless steel nozzle system ensures enhanced vacuum flow and easier, more effective packaging. Many people feel there are no better sealers than a tabletop commercial vacuum sealer.
For the most economical and useful option, try a unit that is designed for large amounts of food such as the ARY SVP-10 VacMaster Commercial Vacuum Sealer. It is a sure bet for all your sealing needs. This commercial vacuum unit is designed to handle large quantities of food at a time, making your job easier. This sealer boasts the ability to seal an entire turkey at one time. With hands free operation, and a seal time of less than forty seconds, the ARY SVP-10 is a great choice.
Whether you are looking for the quickest, quietest or easiest vacuum sealer, one of these top three rated vacuum sealers is for you. Commercial quality vacuum sealers are the way to go for every food preserving need.
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Wednesday, November 30, 2011
RV Shows
Each year, around this time, the RV show season starts. RV shows, like boat shows, are intended to introduce the new model year RV's and to help disseminate RV related information to the consumer. These shows are usually scheduled during the slower time of the year, the winter months, to help jump start the selling season. RV dealers from miles away will bring their wares to these shows. For the buyer, RV shows put everything you need to see and learn about RV's under one roof, making it the ideal forum to conduct research and make informed RV buying decisions.
I mentioned that RV dealers will come from miles around. This includes many local dealers from the area in which you live. If at all possible you want to find a dealer that is within a reasonable distance from where you live. As bad as it sounds, if you buy from an out of state dealer or one far from home, the local RV dealer may not give you the best service after the sale. The most important concern here is that you deal with a reputable RV dealer.
A good place to start your search for a reputable RV dealer is at a local RV show. When you attend an RV show don't be afraid to ask questions about the RV dealership and the products they offer. For starters you need to find a reputable RV dealer with a reputable, professional staff. A reputable dealer wants your business and they want you to return to them for future business. I have been in many RV dealerships that I wouldn't hesitate to do business with and I have been in others that I couldn't leave soon enough. Remember, you're at the show to check out the dealer as well as the product and you should plan to visit the RV dealer's physical location before you buy. If at all possible talk to some other people who have dealt with the dealership in the past. Don't be afraid to ask them to give you a tour of the dealership. Look at the service department. Do they have certified technicians? Do they have the capability and facilities to do routine maintenance and warranty work on the units they sell? Look at the Parts and Accessory department. Do they offer a good selection of parts and accessories? Do they have a good selection of RVs to choose from? How long have they been selling certain manufacturer brands? How long have they been in business?
There are some great deals offered at some RV shows and with all of the excitement, and a good salesperson, it's easy to make a hasty purchase. If they can offer a great deal at the show, chances are they can offer a great deal after the show, unless the offer included a manufacturer discount or rebate for show dates only. Let them know you might be interested in a particular unit or deal, but you want to visit the dealership before you buy.
There is a lot of ground to cover at an RV show and a wealth of information available. Not only will you find a good selection of RV dealers to check out, but there will be every make and model of RV imaginable too. RV shows are a great place to do some comparison shopping. Keep in mind that RV's are available in entry, mid-line, and high-end models. When comparing prices, make sure it is apples to apples. One RV may look like another one, but you need to compare the options, construction, equipment and features they both have to offer. See who offers the best deal but remember if the dealer goes out of business next month, or isn't equipped to work on the RV, your best deal may turn out to be a bad deal.
RV shows aren't just for RV dealers to showcase their products. RV shows are a great source for information, from knowledgeable representatives, on every aspect of the RV industry. You will find information on campgrounds and RV resorts, aftermarket RV products, RV accessories and free RV seminars. Some of these seminars might be helpful to you in making some of your buying decisions. Check with the show office on seminar topics and times.
RV shows are also a good place to talk to RV manufacturer representatives and other industry experts. Many of the RV manufacturers send knowledgeable representatives to assist RV dealers with their products. Don't be afraid to talk with other RVers at the show too. Many of these people have years of RV experience and knowledge of different products.
Buying an RV is a major decision. To make the best buying decision possible you need to do your research and be well informed. I would like to offer you ten tips to making an informed RV buying decision.
1) If you're not absolutely sure an RV is right for you try renting one before you buy.
Rule number one for owning an RV is you have to use it. It can be difficult to determine if an RV is right for you if you have never used one. Plan a weekend or week-long trip and rent an RV to try it out. Renting an RV can be a good indicator to gauge if an RV is in your future. But I caution you, once you get the RV bug it's hard to get rid of.
2) Know which type of RV is right for you and your family before you buy.
RV's come in numerous types, sizes and price ranges. Know which type is right for you and what price fits your budget. Take the time to research your specific needs, and how you plan to use the RV. If you plan to travel cross-country in the RV a motorized RV might make more sense than a towable RV. If you plan to go camping in the backwoods, off the beaten trail, a pop up or truck camper would probably make more sense.
3) New or Used?
This is a major consideration before you purchase an RV. To assist you with making this decision consider how you plan to use the RV and what your budget is. If you only plan to take a couple of weekend trips, or use it for one week out of the year, a used RV might be best for you. And, it won't do you any good to own an RV if there isn't enough money left in the budget to enjoy it.
4) If you buy a towable RV make sure you have a tow vehicle that can safely tow it.
You might find your dream RV only to discover your tow vehicle can't tow it. If you already own the vehicle you plan to tow with determine how much it can safely tow and shop for an RV based on that information. If you plan to buy a tow vehicle select the travel trailer or fifth wheel trailer first, then buy a vehicle that can safely tow it. RV dealerships should have trained personnel to assist you with matching the tow vehicle and trailer.
5) If you plan to purchase a motorized RV drive it before you buy it
Driving a motorhome for the first time can be a little intimidating, but it's important that you test drive it before you buy it. You want a motorhome that you feel comfortable driving because you will spend a lot of time behind the wheel. Check out all of the controls, the view, mirrors and make sure it performs the way you expect it to.
6) Do your research
Buying an RV is a major investment, similar to an automobile or your home. You need to do your research before you buy. There are lots of RV manufacturers and RV brands to choose from. You want an RV dealer and a manufacturer that will stand behind the product after the sale. You can research manufacturers on the internet, request brochures, take factory tours and attend local RV shows to learn more about all of the options you have.
7) Buy from a reputable RV dealership
A reputable RV dealership will have a professional sales, parts and service staff. This is an important consideration during and after the purchase of your RV. It's important that you select the right type of RV, floorplan and brand for you and your family, and that there are qualified technicians to service the unit after the sale. A reputable RV dealership can make your RV ownership experiences much more pleasurable.
8) Protecting your investment
When you purchase your RV consider some other factors that will help protect your investment. I recommend looking into some type of extended service contract that goes beyond the manufacturer warranty period. There are numerous plans available, so shop around for the best deal. Get specialized RV insurance coverage. It's different from your home and auto policy. When you need specialized coverage you'll be glad you have it.
9) Now that you own it, where can you use it?
The Recreation Vehicle Industry Association, RVIA states that there are approximately 8,500 RV parks and campgrounds located near national parks and forests, popular tourist attractions, along interstates and in cities and small towns. With the Internet you have instant access to most of these public and private campgrounds, RV Parks and RV Resorts. Other good resources are travel guides, magazines, campground directories and state tourism boards to help plan your next RV trip.
10) Back to rule number 1
I mentioned earlier if you own an RV you need to use it, otherwise it's just a large lawn ornament. So, pack up the RV, the kids and the pets and head out to explore this wonderful country we live in and build some lasting memories with family and friends.
So what are you waiting for? Find out when the next RV show will be in your area and make it a point to attend it. Oh, and don't forget to wear some comfortable walking shoes!
Find an RV show near you:
http://www.rvia.org/AM/customsource/INCL_Shows.cfm?section=local_shows&all=1
Happy Camping,
Mark J. Polk
Copyright 2008 by Mark J. Polk owner of RV Education 101
Saturday, November 26, 2011
Teeth and Your Child
THE incidence of dental decay in what is presumably the best fed nation in the world today staggers the imagination, writes Dentist Samuel Dreizen in The Journal of School Health. "Less than 5% of the school age population in this country is spared the ravages of this disease." To combat the ravages of dental decay, children need the help of their parents.
If you are a parent, what can you do to help your children in this regard? You can teach them things they should know about dental care. And it might well start with building up an appreciation for their teeth.
Designed for Long Usage
You can help your children to appreciate what a marvel teeth really are. Why, the enamel in teeth is the hardest substance in your body. From very hard substances such as some candy, nuts and crushed ice, to soft breads, cookies and cooked rice, teeth can take a lot of physical abuse. They also work under a wide range of temperatures, depending on what a person eats. At one meal they are likely to have a 180° F. beverage passed over them, and the next minute 20° ice cream. It is enough to make your teeth chatter!
These amazing teeth are able to last a long time for those who take good care of them. The Creator designed them that way, and it is good for children to know this. Much of the reason why people do not keep their teeth in later years of life has to do with their own neglect or that of their parents. You can truly do much to influence the development and maintenance of good, sound teeth in your children.
Tooth Development
To help your children, it is well to know about tooth development. This can be divided into three phases: (1) The period during which the crown of the tooth is formed from tissue cells and calcifies or hardens in the jawbone; (2) the period of eruption, when the tooth first becomes visible and root development is in progress; and (3) the maintenance period, during which time the root formation is completed and the crown of the tooth is fully visible.
Most permanent teeth are from eight to ten years old before they are completely developed. During part of this time they are forming in the jawbone itself. Usually all the primary or baby teeth have begun to form while the child is still in the mother's womb. As early as the second or third month of pregnancy, these primary tooth buds begin developing. Six-year molars, which are permanent teeth, start to form between the seventh intrauterine month and birth. From this time until about age three the crown grows to its adult size and is calcified.
Eruption of the tooth into the mouth usually takes place between the ages of six and seven, but the root of the tooth is not completely formed until the age of nine or ten. So think of it: Ten years in the making! You can see that they were designed to last a long time.
During this development period there is much that can be done to influence these teeth to grow into sound structures.
Nutritional Factors
You can appreciate how much good nutrition plays a part in developing sound teeth if you keep in mind that up to half of the time the permanent teeth are developing, they are beneath the gum tissue in the jawbone. As has been shown by dental research, "the incidence of tooth decay, in particular, has been shown to be related to specific nutritional abnormalities that occur during tooth development."
Teeth provide a permanent record of the past nutritional status of the individual. Yes, while teeth are developing, a lack of proper nutrient building blocks may cause some weakness in the final structure and this may allow the teeth to decay more readily.
Nearly all the primary teeth and some of the permanent teeth begin forming while the child is still in the mother's womb. So, the mother needs good nutrition, perhaps even supplementing her diet with vitamins and minerals to assure this proper growth and development of not only the teeth but various tissues of the body as well.
After the child is born and begins eating for himself, the parental influence can and should be especially well directed. The time for developing sound eating habits is in the earlier years of life.
Included in the diet each day should be a good variety of basic foodstuffs, including foods from the various food groupings: proteins, carbohydrates and fats. Even though the foods that are eaten in various parts of the world will differ greatly, it is a good idea for parents to encourage their children to eat fresh fruits and vegetables. Raw fruits and vegetables provide a variety of benefits that refined and processed foods many times cannot give. Not only do they provide good nutrition but they also encourage exercise of the teeth and gums because of their texture, which requires longer chewing. Be sure the child eats what is good for him and not just the things he likes.
There are other factors that influence the development of good teeth, such as heredity and disease. But over these you have little control, so your efforts need to be directed mainly in the areas where they will do the most good. Of course, there is no universal diet that will keep your child's teeth decay-free throughout his life, but there are certain foods that are much better than others.
After the Teeth Erupt
Up until now we have mainly considered how to help your child to develop sound teeth. As the tooth begins its eruption into the mouth, its environment suddenly changes. Now it can be attacked by food and acid-forming bacteria; these can break through even very hard enamel and eventually cause a cavity. Some teeth can be so severely damaged that they have to be removed.
There are two apparent ways to combat the damaging effect of these acid attacks: Eliminate to a large extent the refined sugars and clean the teeth thoroughly.
Modern diets contain much of refined sugars and rapidly fermentable carbohydrates such as sucrose. These, in combination with certain strains of bacteria, can be very damaging to tooth structure. Dental investigators have come to appreciate that the eating of excessive amounts of such carbohydrates speeds up the progress of tooth decay. On the other hand, if the intake of refined foods is reduced or even eliminated from the diet of children, the decay rate is likewise slowed down or even stopped.
Some children are much more susceptible to cavities than others. The decay rate differs widely from child to child, but the fact remains that much of the decay problem is tied up with the intake of sweets.
An effective program for cutting down on the consumption of sweets begins with the parents. Parents who consume a large quantity of cookies, candies and cakes themselves will have a hard time convincing their offspring not to do the same. Children develop an appetite for sweets at an early age. If such foods are kept around the home all the time and are readily available, then poor eating habits will be the result. This does not mean that sweets have to be eliminated entirely. Proper cleaning after such snacks can also be an effective way to cut down on the cavities.
Proper Cleaning
Usually a child can be taught to brush his teeth as early as two years of age and no later than three. Parental supervision, of course, is important. And it is a good idea for the parents to brush their teeth at the same time and thus set the proper example. This also encourages the child to keep toothbrushing a part of his daily routine.
After the child has had an opportunity to do his share, the parent may want to go over the teeth again to be sure a thorough job has been done. Areas of special concern at that age are the tops or biting surfaces of all the back or molar teeth.
The cheek and tongue sides of those teeth, near the gumline, are frequently areas that decay because they are not brushed properly. Food particles are allowed to build up, causing a white ring around the teeth in this area. Even after the food material is removed, the acid from the food and bacteria may leave a white ring in the enamel as evidence of decay activity. Proper toothbrushing can do much to prevent this from happening.
It takes practice and a lot of effort to do a thorough job in cleaning the teeth with a toothbrush. By the age of three a child usually has twenty primary or baby teeth in the mouth. Each of these teeth has five surfaces that need to be cleaned. That amounts to one hundred tooth surfaces that need attention. In the permanent set of teeth, there are 32 teeth or 160 surfaces to keep clean. Think of that the next time you pick up your toothbrush!
Toothbrushing is probably the most widely practiced method of cleaning the teeth. Brushing in any old way is not good enough. There are several methods advocated by the dental profession. As has been stated in the November 1969 Journal of the American Dental Association, "Effectiveness of oral hygiene procedures is more a matter of technique and effort than of materials used." You can improve on your technique, as well as the amount of effort you put into the cleaning of your teeth, with practice.
Any supplementary methods for cleaning teeth, such as the use of dental floss or tape, toothpicks and interdental stimulator's should be done before brushing, especially if a medicated dentifrice is used. To do the most good, these cleaning agents need to reach the teeth.
Dental floss is probably more effective than any other method for cleaning between the teeth. Because it can be drawn down gently in between the teeth, it can dislodge food particles and debris that a toothbrush would never reach. This is important because most tooth decay and periodontal disease start between the teeth. Flossing should be followed with vigorous rinsing to wash away the loosened particles. If this procedure is followed up with a thorough brushing of the teeth and gums, the mouth will feel refreshingly clean.
There will be times when a person is caught without his toothbrush and toothpaste. When this happens, one can use a clean, rough washcloth to accomplish an emergency cleaning. Mouth rinsing will also help to a certain extent when no other method is available.
Tooth Decay
Decayed areas will show up as small dark-colored areas in the grooves and crevices on the biting surfaces. They also appear as dark-gray areas between the teeth. In these little cracks and fissures, food is sometimes packed and can be difficult to remove. As the bacteria in the mouth begin to act on it, an acid substance is produced. This acid is what does the damage. Of course, it takes several acid attacks eventually to break through the outer enamel surface. Once it makes its way into the inner tooth structure, the dentin, this process proceeds much more rapidly, as the dentin is much softer.
So the time to stop the process is before it starts, by removing food particles, especially the carbohydrates, from the teeth quickly. This means teaching children to brush after snacks as well as after meals.
Brush any suspicious areas very thoroughly. If the area is still dark or discolored after careful brushing, a trip to the dentist is in order. The smaller the cavity when discovered, the simpler the repair will be.
Age three is a good time for your child's first visit to the dentist whether you see cavities or not. Usually by this age all the primary teeth (twenty) are fully erupted into the mouth and need regular care to remain healthy.
Each primary tooth is actually holding space needed for the permanent tooth that is developing in the jawbone underneath it. If the primary tooth is lost due to decay or other factors before the permanent tooth is ready to erupt, then the teeth tend to crowd together. Thus there may not be enough room for the permanent tooth.
Much expensive tooth-straightening work can be avoided by helping your children to keep all primary teeth as long as they were intended to be there. This is also true of the permanent teeth. If one is lost, it is wise to have it replaced. Of course, you can get along without a replacement, but the missing tooth eventually causes other problems, such as teeth shifting out of proper position or alignment, causing food to pack in between.
So, there are many factors in developing and maintaining sound teeth. Some of these factors you can control. Why not teach your children proper care of their teeth from an early age? Later on, they will be most grateful.
Monday, November 21, 2011
Travel Trailers for Sale
Travel Trailers are also known as Caravans. They are the attached vehicles behind the main driving vehicle. They are an excellent space increasing tool and are perfect for sleeping and travelling comfortably. It can take the stress of mobility and all kinds of roads and yet provide excellent living spaces. Long road trips would be very difficult without a travel trailer. You can be at home in a travel trailer; in fact many people today have chosen an alternative lifestyle where the trailer itself is their home. They keep moving about in it throughout the country and parking it at designated trailer parks where others like them camp before hitting the road again to a new destination. They are the modern gypsies but in a very neat and adventurous way.
The people who travel in it whether temporarily for trips or as a permanent home are quite different from the bad image associated with words like "trailer trash". These new breed of free spirits have jobs and sources of income that allow them to work while on the move. They have satellite TV and internet attached to their vehicles and they do not need to be wired in order to be connected.
You can get travel trailers of any size as small as a camping tent or as big as a house. A trailer trip is an adventure everyone should experience once in a while. It saves you on the need to build a tent every time and every place you camp. You can have the things you love from your home set in a trailer and it would look the same throughout the journey, no need to pack and unpack. It not only saves you a lot of money in travel tickets and hotel reservations but it also saves you the unnecessary hassles of holiday rush that spoil everything good about holidays. A travel trailer journey is so much fun that even if you can afford first class airfare and 7 star hotels, you would still love the travel trailer journey more. You get to see so much of the road and the places you visit rather than the quick zip trip in an airplane.
Trailers began with gypsies of Europe or "pikers" as they are called in England. Gypsies kept moving from one place to the other and developed large fabricated attachments to their vehicles and carriages. One of the world's earliest records of travel trailers for sale goes back to 1880.
Travel trailers are a way of bringing your home with you on your travel. It is the closest definition of a home away from home. Travelling in a family or friends' group is a lot of fun and you can move and stop on your own terms. Road trips are a lot of fun and every person should at least go one a very long stretched out road trip at least once. The experience changes you as a person and you become much more developed in your thinking and awareness about your country. You would meet loads of amazing and interesting people on your travel trailer road trip as compared to pesky people you usually meet seated next to you on flights.
Thursday, November 17, 2011
Graco TotBloc Pack 'N Play with Carry Bag, Bugs Quilt
!±8± Graco TotBloc Pack 'N Play with Carry Bag, Bugs Quilt
Brand : Graco | Rate : 
| Price : $101.97
Post Date : Nov 17, 2011 15:18:30 | Usually ships in 24 hours
| Price : $101.97Post Date : Nov 17, 2011 15:18:30 | Usually ships in 24 hours
Whether home or away, this Pack 'N Play Playard helps you give Baby a safe place to play. It has a strong, stable frame and airy mesh walls so Baby's comfortable and 4 interactive bug toys to keep him entertained. The roomy square design gives him plenty of play space to crawl, explore, and figure out what to do with all those developing muscles. It sets up and folds in less than a minute and comes with a handy carry bag, so you can easily bring it with you to your yard, the beach, Grandma's, or anywhere the day might take you.
- Large and roomy 36" x 36" square play space for little one to play
- Sets up and folds in less than a minute for use anywhere and everywhere
- Durable frame weighs less than 25 pounds and airy mesh on all sides provide maximum ventilation
- Convenient carrying bag for no-fuss travel and storage
- Easy to clean
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Monday, November 14, 2011
Cushing's Syndrome: Abnormal Levels of Cortisol
Cushing's syndrome is a disorder caused by elevated levels of cortisol in blood and the normal level of cortisol may rise either by the intake of glucocorticoid drugs or by tumors that result in excessive secretion of cortisol or adrenocorticotrophic hormone (ACTH). Truly speaking Cushing's disease is the result of a tumor in the pituitary gland that causes excessive secretion of ACTH which in turn elevates the level of cortisol. About 70% of the patients suffering from this disease get affected due to the tumors and rest 30% suffer from the disease because of the intake of glucocorticod drugs. The pathology of the disease was first studied in detail by Harvey Cushing in 1932. The syndrome is also known as Itsenko-Cushing syndrome or hypercorticism. This syndrome is not only confined to humans only but has also been identified in domestic dogs, horses and rarely in cats. The syndrome should not be confused with a clinical condition identified as Cushing's triad where the intracranial pressure increases enormously. The disease is known to affect the individuals of the age group 20-50. According to a report about 10-15 million individuals suffer from Cushing's syndrome every year.
Individuals suffering from Cushing's syndrome may develop moon-like faces, facial plethora, supraclavicular fat pads, buffalo hump, truncal obesity and purple striae. They often complain of proximal muscle weakness, easy bruising, weight gain, hirsutism and growth retardation in children. Hypertension, osteopenia, diabetes mellitus and impairment of the immune system are other common symptoms. Excessive intake of exogenous glucocorticoids is also responsible for this syndrome. Exogenous steroids results in suppression of the hypothalamic-pituitary-adrenal axis. An individual with suppressed hypothalamic-pituitary-adrenal axis may not be able to increase steroid production appropriately during a medical illness or stress so requires exogenous doses of steroids to avoid adrenal crisis.
The most frequently observed symptoms of Cushing's syndrome include rapid weight gain particularly of the trunk and face with sparing of the limbs. A very common sign is the development of fat pads around the collar bone, on the back of the neck and a round face also known as moon face. Other symptoms include excessive sweating or hyperhidrosis, dilation of capillaries (telangiectasia), thinning of skin and other mucous membranes, purple or red striae on the trunk, buttocks, arms, legs or breasts, proximal muscle weakness, hirsutism, baldness or brittle hairs. The rare symptoms include hypercalcemia that causes skin necrosis. Excessive secretion of cortisol also affects other endocrine systems and causes insomnia, inhibited aromatase, reduced libido, impotence, amenorrhea and infertility due to elevations in androgens. Patients also suffer from psychological disturbances that may range from euphoria to psychosis. Depression and anxiety are other common symptoms. The most striking and remarkable skin changes include facial acne, susceptibility to superficial dermatophyte and malassezia infections and characteristic purplish striae on abdomen.
Other noticeable symptoms include polyuria, persistent hypertension and insulin resistance that cause hyperglycemia and diabetes mellitus. Insulin resistance is accompanied by skin changes like acanthosis nigricans in axilla and around the neck as well as skin tangs in axilla. If left untreated Cushing's syndrome results in the development of heart disease and chances of death increase. Excessive secretion of ACTH causes hyper-pigmentation. Hyper-pigmentation is the due to the activity of Melanocyte Stimulating Hormone (MSH) which is produced as a byproduct from ACTH synthesis. This hormone is formed from Pro-opiomelanocortin (POMC). Cortisol also participates in the exhibition of activity of the mineralocorticoids in high concentrations and causing hypertension and hyperkalemia. Gastrointestinal disturbances, infections and impaired wound healing are the other symptoms of this syndrome. Osteoporosis is also a symptom associated with Cushing's syndrome. Bone loss also occurs and bones of lower back, hip and shoulders also start paining. Cortisol level can also increase due to intake of estrogen in the contraceptive pills that contain a blend of estrogen and progesterone. Estrogen is responsible for the increase of cortisol-binding globulin that is responsible for the elevated level of cortisol.
When body tissues are exposed to elevated levels of cortisol for prolonged period of time then Cushing's syndrome occurs. Many individuals suffer from this syndrome as they consume exogenous glucocorticoid hormones namely prednisone for asthma, rheumatoid arthritis, lupus and other inflammatory diseases. Rest of the individuals develops this syndrome due to overproduction of cortisol by the body. A chain of events generally occur inside the body that finally results in the formation of cortisol. Hypothalamus is a very important part of brain which is about the size of a sugar cube sends corticotrophin releasing hormone (CRH) to the pituitary gland. This CRH stimulates pituitary gland which in turn releases the adrenocorticotrophic hormone (ACTH) that finally acts on the adrenal glands. Adrenal glands are small glands located just above the kidneys and when they are stimulated by the action of ACTH they release cortisol in the bloodstream. Cortisol has a number of important functions to perform inside the body. It maintains blood pressure and cardiovascular function, reduces immune system's inflammatory response and regulates the metabolism of proteins, carbohydrates and fats.
Cortisol also helps the body to respond to stress. For this reason, women in last 3 months of pregnancy and the highly trained athletes normally have high levels of cortisol. People suffering from depression, alcoholism, malnutrition and panic disorders also have elevated levels of this hormone. When the level of this hormone is adequate in blood then, the hypothalamus and pituitary release less CRH and ACTH. This confirms that cortisol released by the adrenal glands is precisely balanced to meet body's requirements. However, if something wrong happens either with adrenal glands, hypothalamus or pituitary glands then this balance may experience fluctuations. Pituitary adenomas are responsible for most of the cases of Cushing's syndrome. These adenomas are benign, non-cancerous, tumors of pituitary glands that result in excessive secretion of ACTH. Most patients have a single adenoma. This type of Cushing's syndrome is five times more frequent in women as compared to that in men. Some benign or malignant tumors that arise outside the pituitary gland can also produce ACTH and this condition is identified as ectopic ACTH syndrome. Lung tumors are associated with 50% of such cases and men are affected three times more than women. The most common forms of ACTH-producing tumors are oat cell, small cell lung cancer or carcinoid tumors and they account for 25% of lung cancer cases. Other types of tumors that also result in the production of ACTH are pancreatic islet cell tumors, medullary carcinomas of thyroid and thymomas.
Sometimes abnormalities may also take place in the adrenal glands and Cushing's syndrome may occur. This condition generally crops up in the individuals of 40 years of age. Most of these cases involve non-cancerous tumors of adrenal tissues known as adrenal adenomas that are responsible for excessive secretion of cortisol in the bloodstream. Adrenal cancers rarely result in the development of Cushing's syndrome. Cancer cells result in excessive secretion of cortisol and adrenal androgens. Most of the cases of this syndrome are not inherited at all. In very rare cases of Cushing's syndrome individuals have inherited tendency of developing tumors of one or more endocrine glands. In Primary Pigmented Micronodular Adrenal Disease children or young individuals develop small cortisol-producing tumors of the adrenal glands. In Multiple Endocrine Neoplasia Type I (MEN I) hormone secreting tumors of parathyroid glands, pancreas and pituitary occur. Cushing's syndrome in MEN I may occur due to pituitary, ectopic or adrenal tumors.
Pituitary gland is located just beneath the hypothalamus and both these essential structures are finally present in the brain. The paraventricular nucleus (PVN) of hypothalamus is responsible for the production of corticotropin-releasing hormone (CRH) which in turn stimulates the pituitary gland to release adrenocorticotropin (ACTH). ACTH travels via blood and reaches the adrenal glands which get activated and release cortisol. The zona fasciculata of the cortex of the adrenal gland respond to ACTH and finally release cortisol. Elevated levels of cortisol exhibit a negative feedback on the pituitary which finally decreases the secretion of ACTH. Adenoma in the cortex of the adrenal glands is also responsible for the excessive secretion of cortisol which is one of the causes responsible for Cushing's syndrome. Adenoma causes the cortisol level to become very high and the levels of ACTH are also very low. This syndrome only refers to hypercortisolism where the ACTH levels become very high along with elevated levels of cortisol in the blood. The levels of ACTH are very high because a tumor in the pituitary gland makes it unresponsive to the negative feedback against the elevated levels of cortisol. This disease was the first autoimmune disease discovered in humans.
Diagnosis of Cushing's syndrome is based on the patient's medical history, physical examination and laboratory tests. Tumors of the adrenal and pituitary gland can be detected by using X-rays. These tests can help a medical expert to identify if the blood cortisol levels are high and why this is so. The 24-hour urinary level free cortisol level test is the most appropriate diagnostic test. In this test as the name indicates urine of the patient is collected after an interval of 24 hours and then levels of cortisol are checked. If the amount of cortisol is higher than 50-100 micrograms within an interval of 24 hour then the individual is at the risk of suffering from this syndrome. The level of cortisol may vary depending upon the techniques utilized. Once Cushing's syndrome is diagnosed other tests are required to locate the exact regions that are associated with the abnormality that results in excessive cortisol production. These tests are based on the choice of the endocrinologist. Dexamethasone suppression test is another test that can be performed. This test helps to distinguish patients with excessive production of ACTH due to pituitary adenomas from those with ectopic-ACTH producing tumors. Here the patients are given a synthetic glucocorticoid known as dexamethasone orally for every 6 hours for 4 days. For the first two days the dose of this compound are kept low while it is increased to higher ones on the last two days. 24-hour urine samples are also collected before the administration of this compound.
Cortisol and other glucocorticoids signal the pituitary gland for lowering the secretion of ACTH in blood so the normal response after taking dexamethasone is a drop in blood and urine of cortisol levels. Different responses of cortisol to dexamethasone are noticed depending upon the cause of Cushing's syndrome either by pituitary adenoma or ectopic ACTH-producing tumor. The dexamethasone suppression test can give false results for the patients suffering from depression, high estrogen levels, alcohol abuse, stress and acute illness. Drugs namely phenytoin and phenobarbital may also give false results in response to this compound. So the physicians advise the patients to stop the usage of these drugs one week before undergoing dexamethasone suppression test. CRH stimulation test helps to distinguish between patients with pituitary adenomas or those with ectopic ACTH-producing tumor and cortisol-secreting adrenal tumors. Patients are given injections of cortiocotropin releasing hormone which in turn is responsible for the secretion of ACTH from the pituitary glands in blood. Patients with pituitary adenomas generally experience very high levels of ACTH and cortisol in blood. This response is generally rarely seen in the patients with ectopic ACTH syndrome and never in patients with cortisol-secreting adrenal tumors.
Direct visualization of endocrine glands or radiologic imaging helps in the identification of shape and size of pituitary and adrenal glands. These techniques help to detect if any tumor is present. The most common techniques used are computerized tomography scan and magnetic resonance imaging. Computerized tomography actually produces a series of X-ray images that imparts a cross-sectional image of any part of body. Magnetic resonance imaging also generates images of body parts but no ionizing radiation is used. The imaging techniques are generally used for the detection of tumor once Cushing's syndrome is finally diagnosed. These techniques are not used for the diagnosis of Cushing's syndrome. Petrosal sinus sampling is another test that is not always used but can be used for the separation of pituitary from the ectopic causes of Cushing's syndrome. Petrosal sinuses are actually the veins that drain blood to the pituitary glands so blood samples are taken from them by the introduction of catheters by using local anesthesia and mild sedation. X-rays are often used for the detection of the correct position of the catheters. To improve the diagnostic accuracy injections of CRH are often given. The levels of ACTH in the petrosal sinuses are measured and then they are compared with the ACTH levels in a forearm vein. Higher levels of ACTH in the petrosal sinuses than in the forearm vein is indicative of the presence of pituitary adenoma and if the levels are similar then ectopic ACTH-syndrome is present.
Some individuals have elevated cortisol levels but do not show progressive effects of Cushing's syndrome like muscle weakness, fractures and thinning of skin. These individuals may be suffering from pseudo-Cushing's syndrome which was originally described in people who were depressed or alcohol addict. These individuals do not show long term effects shown by individuals with Cushing's syndrome so they do not require direct treatment of the endocrine glands. Generally dexamethasone-CRH test is performed to distinguish patients of pseudo-Cushing's syndrome from those with Cushing's syndrome. This test combines dexamethasone suppression and CRH stimulation tests. Elevated levels of cortisol suggest the presence of this disease. Some individuals may have substantially high levels of cortisol but they do not show effects of this syndrome. The high cortisol levels may be compensating for body's resistance for cortisol effects. This rare syndrome of cortisol resistance is a genetic state that results in hypertension and chronic androgen excess. Sometimes other conditions may be associated with this disease like the polycystic ovarian syndrome that causes menstrual disturbances, weight gain from adolescence, excessive hair growth and sometimes diabetes. Generally weight gain, high blood pressure, abnormal levels of cholesterol and triglycerides are associated with resistance to insulin action and diabetes often described as Metabolic Syndrome X. Patients with this disorder generally do not have elevated levels of cortisol.
The common treatments available for Cushing's syndrome include surgery, radiation, chemotherapy or use of cortisol-inhibiting drugs. A number of therapies are available to treat the ACTH-secreting adenomas of Cushing's syndrome. The most commonly used treatment is the surgical removal of the tumor known as transsphenoidal adenomectomy. In this process the surgeon approaches the pituitary gland either through the nostril or through an opening made below the upper lip. Very fine instruments and special kind of microscope required for this purpose. As this surgery is very complicated so the patients are advised to consult the specialized centers only. The success rate of the surgery is 80% if carried out by an experienced surgeon. If surgery fails or only temporary cure is achieved then it can be repeated in order to obtain good results. After the successful pituitary surgery the elevated levels of ACTH drop two times lower as compared to the normal level. This is a natural but temporary drop in the level of ACTH and the patients are given synthetic form of cortisol. This replacement therapy can be stopped in most of the patients within an interval of one year.
Patients who fail to give promising results to transsphenoidal adenomectomy or candidates who are not suitable candidates for surgery, radiotherapy is a promising treatment. Radiation to the pituitary gland is generally given at an interval of 6 weeks. The chances of success range from 50-80% in both adults and children. A combination of radiotherapy and a drug known as mitotane helps in faster recovery. Mitotane suppresses cortisol production and thereby brings a decline in the plasma and urine hormone levels. Mitotane has shown 30-40% better results in the patients with Cushing's syndrome. To cure the overproduction of cortiol due to ectopic ACTH syndrome, it is always beneficial to remove all the cancerous tissue that produces ACTH. Surgery, chemotherapy, radiotherapy, immunotherapy or a combination of these therapies can help in removal of cancerous tissue. The ACTH-secreting tumors may be very small or widespread at the time of diagnosis so mititane is a promising drug that can be administered for better results. In some cases if the pituitary surgery is not successful then surgical removal of the adrenal glands may replace the drug therapy. Surgery is the only treatment available for the benign and cancerous tumors of adrenal glands. Primary Pigmented Micronodular Adrenal Disease and the familial Carney's complex require surgical removal of adrenal glands.
Iatrogenic Cushing's syndrome is the most common form of Cushing's syndrome which is generally caused by treatment with corticosteroids. The incidence of the pituitary tumors may be relatively high but only a minute fraction of them are active and result in excessive hormone secretion. Adults with this disease may show symptoms like extreme weight gain, excessive hair growth in women, high blood pressure and skin problems. Additional symptoms may include muscle and bone weakness, osteoporosis, diabetes mellitus, hypertension, sleep disturbances, moodiness, irritability and depression followed by amenorrhea in women, decreased fertility in men, baldness and hypercholesterolemia. Most of the cases of Cushing's syndrome are due to the action of exogenous glucocorticoids. About 13 cases per million individuals are diagnosed every year that are due to the endogenous reasons. Of these 70% of cases are due to ACTH-producing tumor, 15% due to ectopic-ACTH and 15% due to primary adrenal tumor.
Mortality and morbidity associated with Cushing's syndrome are primarily due to the effects caused by excessive levels of glucocorticoids. A very large pituitary tumor may cause panhypopituitarism and visual loss. Rare adrenocortical adenomas are also associated with a survival rate of only 5 years. Excess glucocorticoids also cause perforated viscera and increased susceptibility to fungal infections. Other additional problems that crop up due to excessive glucocorticoids include hypertension, obesity, osteoporosis, fractures, impaired immune function, impaired woun healing, glucose intolerance and psychosis. The female-to-male ratio of Cushing's syndrome is 5:1 which may be either due to pituitary or adrenal tumor. Ectopic ACTH production is more frequent in men than women due to increased incidence of lung tumors in them. The peak period of occurrence of Cushing's syndrome due to adrenal or pituitary adenoma is 25-40 years. Ectopic production due to lung cancer may occur in later phase of life. For keeping a regular check on Cushing's syndrome patients should be educated about adrenal crisis. Instruction for the intake f specific drug for treatment should be given.
Saturday, November 5, 2011
Maclaren Techno XT Stroller - Good Or Average?
The MaClaren Corporation has come a long way since it was started back in 1965 by Owen Maclaren. Even though over a million strollers were just recalled a a week ago (due to some tragic accidents with 12 children) they are still considered one of the best lightweight stroller manufacturers in the US and England. Gracco used to totally own the market but over the last ten years they have seen their market share slip in this particular industry. This is because they make all their items out of lightweight aircraft aluminum and durable joints (they used to make aircraft parts so they apply that technology to strollers).
One of their best models they have come up with have been the their "Techno" model. This stroller is not only very lightweight at 15 pounds but is extremely easy to maneuver through any terrain imaginable including sand, snow, and grass due to its huge six inch wheels. Its also because of these two factors that this particular model was voted as the second best stroller for parents to use when they are taking their toddler to the zoo, mall, or theme park.
You can fold this particular stroller up extremely easily. This model was designed by its makers to be folded up in a matter of minutes and can be stored anywhere you can think.
It comes with a visor and nice canopy at the top that you may use to block the sun out of your baby's eyes, block against strong wind, or be a barrier for the rain.
As far as safety and comfort go its has gotten high honors as well. For comfort is has a nicely padded four position reclining seat (much like in a car where your you tilt your seat back to lay down or at 90 degrees to sit up) and for safety it comes with a height adjustable padded 5-point safety harness.
Now here are some of the cons to this stroller. The wheel brakes do lock up sometimes. They locked up on me three times in one day when I was using this particular model. When they do its a huge pain to them un-locked. The canopy lever is also known to be faulty on these models and does not stay in place like it should. This can really be a problem when you want to open it on a nice sunny day and its keeps coming down.
Its also very expensive. Its a really nice stroller but its 0. That is a lot of money for just some added features.
Nevertheless it does come with a lifetime warranty warranty and that's worth something. If anything breaks down or malfunctions on this stroller than you can take it back and get a full refund, replacement parts, or a full replacement baby stroller all together.
Out of a possible 1-10 I think this stroller is an 8.5. A lot of features, really good set up, but for the price tag they could have added more and they really need a better braking system.
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