Heart Lung Machine

Also called: Lung Heart Machine, Extracorporeal Circulation Machine, Oxygenator Bypass Machine, Heart Lung Bypass Machine, Pump Oxygenator

- Summary
- About heart-lung machines
- Potential risks
- Questions for your doctor

Reviewed By:
Abdou Elhendy, MD, PhD, FACC, FAHA
David Slotnick, M.D.
Neil R. Bercow, M.D., FACS

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Summary

During an open-heart surgery (such as valve or bypass surgery), the heart-lung machine is used to take over the functions of the heart and lungs. Also known as a cardiopulmonary bypass machine, it allows the surgeon to carefully stop the heart while the vital organs continue to receive blood and oxygen. When patients are on the heart-lung machine, very delicate work can be performed by surgeons without interference from bleeding or the heart’s pumping motion.

When first used successfully A heart lung machine takes over the heart's functions during open–heart surgery.in humans in 1955, the machine was a revolutionary piece of equipment. Today, the heart-lung machine is used in about 1 million cardiac surgeries every year, including surgeries to the coronary arteries, heart valves and other structures of the heart. The heart-lung machine has a very low complication rate, approaching 1 percent for certain surgeries.

Newer medical technology is being developed that may someday replace the heart-lung machine in some circumstances. These technologies include systems that allow surgeons to operate on a beating heart, without use of the heart-lung machine. Known as off-pump surgery, this is used when surgeons are operating on the coronary arteries.

Cardiopulmonary bypass

Cardiopulmonary bypass (CPB) is a technique that temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and the oxygen content of the body. The CPB pump itself is often referred to as a Heart-Lung Machine or the Pump. Cardiopulmonary bypass pumps are operated by allied health professionals known as perfusionists in association with surgeons who connect the pump to the patient's body. CPB is a form of extracorporeal circulation.
Contents
[hide]

* 1 Uses of cardiopulmonary bypass
o 1.1 Surgical procedures in which cardiopulmonary bypass is used
* 2 History
* 3 Components of cardiopulmonary bypass
o 3.1 Tubing
o 3.2 Pumps
+ 3.2.1 Roller pump
+ 3.2.2 Centrifugal pump
o 3.3 Oxygenator
o 3.4 Cannulae
o 3.5 Cardioplegia
* 4 Operation
* 5 Complications
* 6 References
* 7 External links

[edit] Uses of cardiopulmonary bypass

Cardiopulmonary bypass is commonly used in heart surgery because of the difficulty of operating on the beating heart. Operations requiring the opening of the chambers of the heart require the use of CPB to support the circulation during that period.

CPB can be used for the induction of total body hypothermia, a state in which the body can be maintained for up to 45 minutes without perfusion (blood flow). If blood flow is stopped at normal body temperature, permanent brain damage normally occurs in three to four minutes — death may follow shortly afterward.

Extracorporeal membrane oxygenation (ECMO) is a simplified form of CPB sometimes used as life-support for newborns with serious birth defects, or to oxygenate and maintain recipients for organ transplantation until new organs can be found.

CPB mechanically circulates and oxygenates blood for the body while bypassing the heart and lungs. It uses a heart-lung machine to maintain perfusion to other body organs and tissues while the surgeon works in a bloodless surgical field. The surgeon places a cannula in right atrium, vena cava, or femoral vein to withdraw blood from the body. The cannula is connected to tubing filled with isotonic crystalloid solution. Venous blood that is removed from the body by the cannula is filtered, oxygenated, cooled or warmed, and then returned to the body. The cannula used to return oxygenated blood is usually inserted in the ascending aorta, but it may be inserted in the femoral artery. The patient is administered heparin to prevent clotting, and protamine sulfate is given after to reverse effects of heparin. During the procedure, hypothermia is maintained; body temperature is usually kept at 28ºC to 32ºC (82.4-89.6ºF). The blood is cooled during CPB and returned to the body. The cooled blood slows the body’s basal metabolic rate, decreasing its demand for oxygen. Cooled blood usually has a higher viscosity, but the crystalloid solution used to prime the bypass tubing dilutes the blood.

[edit] Surgical procedures in which cardiopulmonary bypass is used

* Coronary artery bypass surgery
* Cardiac valve repair and/or replacement (aortic valve, mitral valve, tricuspid valve, pulmonic valve)
* Repair of large septal defects (atrial septal defect, ventricular septal defect, atrioventricular septal defect)
* Repair and/or palliation of congenital heart defects (Tetralogy of Fallot, transposition of the great vessels)
* Transplantation (heart transplantation, lung transplantation, heart-lung transplantation)
* Repair of some large aneurysms (aortic aneurysms, cerebral aneurysms)
* Pulmonary thromboendarterectomy
* Pulmonary thrombectomy

[edit] History

Dr. Clarence Dennis led the team that conducted the first known operation involving open cardiotomy with temporary mechanical takeover of both heart and lung functions on April 5, 1951 at the University of Minnesota Hospital. The patient did not survive due to an unexpected complex congenital heart defect. This followed four years of laboratory experimentation with dogs.[1]

The first successful open heart procedure on a human utilizing the heart lung machine was performed by John Gibbon on May 6, 1953 in Philadelphia. He repaired an atrial septal defect in an 18-year-old woman.[2]

[edit] Components of cardiopulmonary bypass

Cardiopulmonary bypass consists of two main functional units, the pump and the oxygenator which remove oxygen-deprived blood from a patient's body and replace it with oxygen-rich blood through a series of hoses.

[edit] Tubing

The components of the CPB circuit are interconnected by a series of tubes made of silicone rubber or PVC.

[edit] Pumps

[edit] Roller pump

The pump console usually comprises several rotating motor-driven pumps that peristaltically "massage" tubing . This action gently propels the blood through the tubing. This is commonly referred to as a roller pump, or peristaltic pump.

[edit] Centrifugal pump

Many CPB circuits now employ a centrifugal pump for the maintenance and control of blood flow during CPB. By altering the speed of revolution (RPM) of the pump head, blood flow is produced by centrifugal force. This type of pumping action is considered to be superior to the action of the roller pump by many because it is thought to produce less blood damage (Hemolysis, etc.).

[edit] Oxygenator

The oxygenator is designed to transfer oxygen to infused blood and remove carbon dioxide from the venous blood. Cardiac surgery was made possible by CPB using bubble oxygenators, but membrane oxygenators have supplanted bubble oxygenators since the 1980s.

The oxygenator was first conceptualised in the 17th century by Robert Hooke and developed into practical extracorporeal oxygenators by French and German experimental physiologists in the 19th century. Bubble oxygenators have no intervening barrier between blood and oxygen, these are called 'direct contact' oxygenators. Membrane oxygenators introduce a gas-permeable membrane between blood and oxygen that decreases the blood trauma of direct-contact oxygenators. Much work since the 1960s focused on overcoming the gas exchange handicap of the membrane barrier, leading to the development of high-performance microporous hollow-fibre oxygenators that eventually replaced direct-contact oxygenators in cardiac theatres.[3]

Another type of oxygenator gaining favour recently is the heparin-coated blood oxygenator which is believed to produce less systemic inflammation and decrease the propensity for blood to clot in the CPB circuit.

[edit] Cannulae

Multiple cannulae are sewn into the patient's body in a variety of locations, depending on the type of surgery. A venous cannula removes oxygen deprived blood from a patient's body. An arterial cannula is sewn into a patient's body and is used to infuse oxygen-rich blood. A cardioplegia cannula is sewn into the heart to deliver a cardioplegia solution to cause the heart to stop beating.
Venous Arterial Cardioplegia
Right atrium Proximal aorta, distal to the cross-clamp Proximal aorta, proximal to the cross-clamp
Vena cavae Femoral artery Coronary sinus (retrograde delivery)
Femoral vein Axillary artery Coronary ostia
Distal aorta Bypass grafts (during CABG)
Apex of the heart

[edit] Cardioplegia
Main article: Cardioplegia

A CPB circuit consists of a systemic circuit for oxygenating blood and reinfusing blood into a patient's body (bypassing the heart); and a separate circuit for infusing a solution into the heart itself to produce cardioplegia (i.e. to stop the heart from beating), and to provide myocardial protection (i.e. to prevent death of heart tissue).

[edit] Operation

A CPB circuit must be primed with fluid and all air expunged before connection to the patient. The circuit is primed with a crystalloid solution and sometimes blood products are also added. The patient must be fully anticoagulated with an anticoagulant such as heparin to prevent massive clotting of blood in the circuit.

[edit] Complications

CPB is not benign and there are a number of associated problems:

* Postperfusion syndrome (also known as Pumphead)
* Hemolysis
* Capillary Leak Syndrome
* Clotting of blood in the circuit - can block the circuit (particularly the oxygenator) or send a clot into the patient.
* Air embolism
* Leakage - a patient can rapidly exsanguinate (lose blood perfusion of tissues) if a line becomes disconnected.

As a consequence, CBP is preferentially only used during the up to several hours a cardiac surgery may take. The longest time anyone has survived on CPB is 16 days.[4]

[edit] References

1. ^ Dennis C, Spreng DS, Jr., Nelson GE, et al. Development of a pump-oxygenator to replace the heart and lungs; an apparatus applicable to human patients, and application to one case. Ann Surg 1951; 134:709-721
2. ^ Cohn, Lawrence. Fifty Years of Open-Heart Surgery. Circulation. 2003;107:2168
3. ^ Lim M (2006). "The history of extracorporeal oxygenators". Anaesthesia 61 (10): 984–95. doi:10.1111/j.1365-2044.2006.04781.x. PMID 16978315.
4. ^ 16 days without a heart The Straits Times. April 3, 2008. By Ong Hwee Hwee, Taiwan Correspondent.

[edit] External links
Sister project Wikimedia Commons has media related to: Category:Cardiopulmonary bypass

* International Consortium For Evidence-Based Perfusion
* Extracorporeal Circulation: Perfusion Systems. In: Cohn LH, Edmunds LH Jr, eds. Cardiac Surgery in the Adult
* Multimedia Manual of Cardiothoracic Surgery. Cardiopulmonary bypass collection.
* Perfusion Line
* The Virtual Textbook Of Extracorporeal Technology
* Video of early USSR heart-lung machine experiments

[hide]
v • d • e
Health Science – Medicine - Surgery - Cardiac surgery procedures (ICD-9-CM V3 35-37)
Coronary heart disease
Angioplasty - Coronary artery bypass - MIDCAB - Off-pump coronary artery bypass - TECAB
Heart valves
Aortic valve repair - Aortic valve replacement - Mitral valve repair - Mitral valve replacement - Ross procedure
Great vessels
Bentall procedure - Pulmonary thromboendarterectomy - Valve-sparing aortic root replacement
Myocardium
Cardiomyoplasty - Dor procedure - Heart transplantation - Septal myectomy - Ventricular reduction - Alcohol septal ablation
Pericardium
Pericardiocentesis - Pericardiectomy
Congenital heart disease
Atrial septostomy - Blalock-Taussig shunt - Fontan procedure - Norwood procedure - Rastelli procedure - Kawashima procedure - Mustard procedure
Conduction system
Maze procedure (Cox maze and minimaze) - Pacemaker insertion

Heart Disease

Cardiovascular disease (CVD), including heart disease and stroke, remains the leading cause of death in the United States despite improvements in prevention, detection, and treatment. CVD is no longer thought of as a disease that primarily affects men as they age. It is a killer of people in the prime of life, with more than half of all deaths occurring among women.

Cardiovascular diseases remain the leading cause of disability among working adults. Stroke alone accounts for the disability of more than a million Americans. The economic impact on the health system grows larger as the population ages. In 2001, the estimated cost of health care expenditures and lost productivity attributable to cardiovascular diseases was $298 billion.
Cardiovascular Disease in New York State

Cardiovascular diseases are the leading causes of death in New York State, killing more than 70,000 residents each year. For every person who dies from a heart attack or angina, 18 people live with these conditions. For every person who dies from a stroke, seven people cope with the consequences of a non-fatal event. Many of these survivors are disabled and cannot lead productive lives. They also are at high risk for additional events. These numbers are increasing as the epidemic of heart disease and stroke continues.
Learn More About Cardiovascular Disease

* Cardiovascular Health in New York State
* Coronary Heart Disease, About
* Coronary Heart Disease in New York State
* Diet and Cardiovascular Disease
* Physical Inactivity and Cardiovascular Disease
* Stroke

New York Programs to Improve Cardiovascular Health

* Healthy Heart Program
* Community Healthy Heart Contractors (2003-2007)
* Healthy Heart Program School and Worksite Contractors (2005-2010)
* Binghamton (NY) Low-Fat Milk Campaign Summary
* Guidelines for Healthy Meetings
* Heart Check - Assessing Worksite Support for a Heart Healthy Lifestyle (PDF, 217MB, 21pg.)

Statistics and Data

* Cardiovascular Disease Data and Statistics

Occupational Cancer

Based on well-documented associations between occupational exposures and cancer, it is estimated that approximately 20,000 cancer deaths and 40,000 new cases of cancer each year in the U.S. are attributable to occupation.

Millions of U.S. workers are exposed to substances that have tested as carcinogens in animal studies. However, less than 2% of chemicals in commerce have been tested for carcinogenicity.

Cancer is a group of different diseases that have the same feature, the uncontrolled growth and spread of abnormal cells. Each different type of cancer may have its own set of causes. Many factors play a role in the development of cancer. The importance of these factors is different for different types of cancer. A person's risk of developing a particular cancer is influenced by a combination of factors that interact in ways that are not fully understood. Some of the factors include:

* Personal characteristics such as age, sex, and race
* Family history of cancer
* Diet and personal habits such as cigarette smoking and alcohol consumption
* The presence of certain medical conditions
* Exposure to cancer-causing agents in the environment
* Exposure to cancer-causing agents in the workplace

In many cases, these factors may act together or in sequence to cause cancer.
Cancer Clusters

Scenario
[Image: Worker pulling a hydraulic cleaner from an open vinyl chloride reactor at Avon Lake, OH in 1974, prior to the exposure controls mandated by the OSHA standard. Vinyl chloride is known to cause angiosarcoma of the liver.] Worker pulling a hydraulic cleaner from an open vinyl chloride reactor at Avon Lake, OH in 1974, prior to the exposure controls mandated by the OSHA standard. Vinyl chloride is known to cause angiosarcoma of the liver.

Three members of the staff of an elementary school were diagnosed with cancer in 1997 and 1998; one person each with brain, liver, and ovarian cancer. Since 1998, four cases of breast cancer also were diagnosed. Increased concern among employees regarding the potential association between the workplace and the cancers prompted a request for an investigation.

The information below addresses cancer clusters in general and shows how this type of information would be used to respond to this scenario.

Cancers often appear to occur in clusters, which scientists define as an unusual concentration of cancer cases in a defined area or time. A cluster also occurs when the cancers are found among workers of a different age or sex group than is usual. The cases of cancer may have a common cause or may be the coincidental occurrence of unrelated causes. Although the occurrence of a disease may be random, the distribution of that disease may not be uniform, and clusters of disease may arise by chance alone. When cancer in a workplace is described, it is important to determine the primary site of the cancer.
What do we look for when evaluating a cancer cluster?

1.

Because cancer is a common disease, cancer can be found among people at any workplace. In the United States, one in two men and one in three women will develop cancer over the course of their lifetime. These figures show the unfortunate reality that cancer occurs more often than many people realize. Disease or tumor rates are very variable in small populations and rarely match the overall rate for a larger area, such as the state, so that for any given time period some populations have rates above the overall rate and others have rates below the overall rate. So, even when there is an excess, this may be completely consistent with the expected random variability.
[Image: Worker handling amosite asbestos, which is known to cause lung cancer and mesothelioma, at a pipe insulation manufacturing plant in Tyler, TX, in the early 1970s.] Worker handling amosite asbestos, which is known to cause lung cancer and mesothelioma, at a pipe insulation manufacturing plant in Tyler, TX, in the early 1970s.

In the scenario above, 95 staff members had worked at the school since it opened in 1992. Breast cancer is the most common type of cancer in women, affecting an estimated one of every eight women. Because the school's workforce was primarily composed of women, it was not unusual to see several cases of breast cancer. Although these breast cancers were diagnosed within a relatively short time frame, this made sense given the age of the staff and the age distribution for breast cancer.
2.

Cancer clusters thought to be related to a workplace exposure usually consist of the same types of cancer. When several cases of the same type of cancer occur and that type is not common in the general population, it is more likely that an occupational exposure is involved. When the cluster consists of multiple types of cancer, without one type predominating, an occupational cause of the cluster is less likely.

In our example, four types of cancer were diagnosed among the elementary school staff.
3.

When a known or suspected cancer-causing agent is present and the types of cancer occurring have been linked with these exposures in other settings, we are more likely to make the connection between cancer and a workplace exposure. We also look to see whether cancer is occurring among employees in particular jobs or areas of the workplace. This can help to identify exposures.

School environments do not typically contain significant hazardous exposures. Asbestos can be a concern in older buildings, but while it is known to cause lung cancer and mesothelioma, it is not known to cause the types of cancer reported among this group of employees.
4.

The time between first exposure to a cancer-causing agent and clinical recognition of the disease is called the latency period. Latency periods vary by cancer type, but usually are 15 to 20 years, or longer. Because of this, past exposures are more relevant than current exposures as potential causes of cancers occurring in workers today. Often, these exposures are hard to document.

The average time from first employment in the school to the diagnosis of cancer among staff members in the elementary school in our example was 5.7 years.

Conclusions for the scenario above
[Image: Workers on top of a coke oven. Work on top of coke ovens is known to cause lung and skin cancer, and thought to cause kidney cancer.] Workers on top of a coke oven. Work on top of coke ovens is known to cause lung and skin cancer, and thought to cause kidney cancer.

The distribution of types of cancer did not appear unusual given the age and gender of the employees. No known biologically significant exposures were identified. The building only became occupied in 1992, therefore, given what we know about latency periods, none of the cancer cases met the latency criterion. Given this information, it was concluded that the cancers reported among these workers were unlikely to be the result of employment at the elementary school.

This scenario illustrates the key questions that are answered in response to cancer cluster inquiries. Historical experience at NIOSH has shown that most reports of cancer clusters indicate the coincidental occurrence of cancer in workforce members. In most situations, particularly in non-industrial work environments, it is not possible to link the cancers to exposures at work.

Methamphetamine

* Fact Sheet: Methamphetamine and HIV: Basic Facts for Service Providers (March 2006) (PDF, 20 KB, 4pg.) - New!
o To order multiple copies, please visit the Clinical Guidelines & Quality of Care website to order online, or download the Provider Materials Order Form.
* A Key to Methamphetamine-Related Literature (January 2007) (PDF, 9MB, 448 pgs) - Updated!
o This document is a comprehensive, thematic index of methamphetamine-related journal articles. It contains links from cited articles to the abstracts in PubMed.
o Because of the large size of A Key to Methamphetamine-Related Literature, you are encouraged to download it, store it on your computer and view it directly through the Adobe Reader rather than through a browser extension or add-on.
* Letter Regarding Methamphetamine Injection-Related Risks (October, 2005)
* Resource Sheet: Methamphetamine Injection
* Letter Regarding Use of Methamphetamine in New York State (December, 2004)
* Available Resources Surrounding Methamphetamine

HIV/AIDS

HIV

Human Immunodeficiency Virus (HIV) is a virus. You may hear that someone is "HIV infected", "has HIV infection", or "has HIV disease." These are all terms that mean the person has HIV in his or her body and can pass the virus to other people.

HIV attacks the body's immune system. The immune system protects the body from infections and disease, but has no clear way to protect it from HIV. Over time, most people infected with HIV become less able to fight off the germs that we are all exposed to every day. Many of these germs do not usually make a healthy person sick, but they can cause life-threatening infections and cancers in a person whose immune system has been weakened by HIV.

People infected with HIV may have no symptoms for 10 or more years. They may not know they are infected. An HIV test is the only way to find out if you have HIV. See HIV Counseling and Testing for information and resources on HIV testing in New York State.

HIV spreads when infected blood, semen, vaginal fluids, or breast milk gets into the bloodstream of another person through:

* direct entry into a blood vessel;
* mucous linings, such as the vagina, rectum, penis, mouth, eyes, or nose, or
* a break in the skin.

HIV is not spread through saliva (spit).

HIV is spread through:

* Vaginal, anal, or oral sex without using a condom.
* Sharing needles, syringes, or works to inject drugs, vitamins, hormones, steroids, or medicines.
* Women with HIV infection can pass HIV to their babies during pregnancy, delivery, and breastfeeding.
* People who are exposed to blood and/or body fluids at work, like health care workers, may be exposed to HIV through needle-sticks or other on-the-job exposures.

It may also be possible to pass HIV through sharing needles for piercing or tattooing.

A person infected with HIV can pass the virus to others during these activities. This is true even if the person:

* has no symptoms of HIV
* has not been diagnosed with AIDS
* is taking HIV medications
* has an "undetectable" viral load

HIV is not spread by casual contact like sneezing, coughing, eating or drinking from common utensils, shaking hands, hugging, or use of restrooms and drinking fountains.
AIDS

Acquired Immune Deficiency Syndrome (AIDS) is a late stage of HIV disease. There are medications that have helped people living with HIV or AIDS live longer, healthier lives. Some people have lived for more than 20 years and have taken medicines for more than 10 years. But, there is no cure.

Note: This site contains HIV prevention messages that may not be appropriate for all audiences. Since HIV infection is spread primarily through sexual practices or by sharing needles, prevention messages on this site may address these topics.

People Prepared for Emerging Health Threats

CDC will contribute to national, state, and local efforts to prepare for and prevent public health disasters before they occur.

People in all communities will be protected from infectious, occupational, environmental, and terrorist threats.

When a disaster has occurred, CDC will be prepared to respond and support national, state, and local partners in responding in order to improve public health outcomes.

After response to a disaster has ended, CDC will assist national, state, and local partners in the recovery and restoration of public health functions.

Learn more at CDC's Emergency Preparedness and Response Web site.
Objectives

66. Integrate and enhance the existing surveillance systems at the local, state, national, and international levels to detect, monitor, report, and evaluate public health threats.
67. Support and strengthen human and technological epidemiologic resources to prevent, investigate, mitigate, and control current, emerging, and new public health threats and to conduct research and development that lead to interventions for such threats.
68. Enhance and sustain nationwide and international laboratory capacity to gather, ship, screen, and test samples for public health threats and to conduct research and development that lead to interventions for such threats.
69. Assure an integrated, sustainable, nationwide response and recovery capacity to limit morbidity and mortality from public health threats.
70. Expand and strengthen integrated, sustained, national foundational and surge capacities capable of reaching all individuals with effective assistance to address public health threats.

West Nile Virus

What is West Nile virus?

WNV is a mosquito-borne infection that can cause serious illness, and in some cases, death. Although a person's chances of getting sick are small, there are some simple steps you can take to reduce your risk of being bitten by mosquitoes.
What are the symptoms of WNV?

Most people who are infected with WNV will not have any type of illness. It is estimated that 20 percent of the people who become infected will develop West Nile fever: mild symptoms, including fever, headache and body aches, occasionally with a skin rash and swollen lymph glands. In many individuals, these symptoms are so mild that they go unnoticed or undetected.

The symptoms of severe infection (West Nile encephalitis or meningitis) can include headache, high fever, neck stiffness, muscle weakness, stupor, disorientation, tremors, convulsions, paralysis and coma. It is estimated that one in 150 persons infected with the WNV will develop the more severe form of the disease. Usually, symptoms occur from three to14 days after exposure. There is no specific treatment for viral infections, other than to treat the symptoms and provide supportive care.
Who is at risk for getting WNV?

All residents of areas where virus activity has been identified are at risk of getting WNV; persons over 50 years of age are at the highest risk for severe disease.
How is WNV transmitted?

WNV is primarily transmitted through the bite of an infected mosquito. Over 30 species of mosquitoes have been infected nationwide. WNV has been transmitted by blood transfusion or organ transplantation in a small number of cases. As a result, U.S. blood collection agencies are screening blood donations for the presence of the virus.

These transfusion- and transplant-related cases make up a small percentage of those infected with WNV. Although persons needing blood transfusions or organ transplants should be aware of the risk of WNV infection, the benefits of receiving needed transfusions or transplants outweigh the potential risk for infection.

Transplacental transmission (pregnant woman to unborn child) and transmission through breast-feeding have also been documented. The number of these cases is small. Pregnant women should consult their health care provider for more information.
Do all mosquitoes transmit disease?

No. Most mosquitoes do not transmit disease. While there are about 70 different species of mosquitoes in New York state, only certain species have been associated with WNV.
Where do mosquitoes live and breed?

Mosquitoes lay their eggs in moist areas, such as standing water. The eggs become larvae that remain in the water until the adults mature and fly off. Weeds, tall grass and shrubbery provide an outdoor home for adult mosquitoes. They can also enter houses through unscreened windows and doors or broken screens. Many mosquitoes will breed in containers that hold water, such as flowerpots or discarded tires.
When are mosquitoes most active?

Some mosquitoes are active between dusk and dawn, when the air is calm. However, others will feed at any time of day. Mosquitoes prefer a warm, moist environment. They are active from early summer until late fall in New York state. In southern states that have a warm year-round climate, mosquitoes that transmit WNV are active year-round. New Yorkers should take measures to protect themselves from mosquito bites when traveling to these states.
Which birds can carry WNV?

In New York state, most WNV-positive birds have been American crows. The state Health Department is using dead crow sightings to track WNV, so it is important to report any dead crows to your local health department or to the toll-free dead bird hotline, 1-866-537-BIRD (2473). Not all dead crows need to be tested for WNV. If the bird is not going to be collected, you may dispose of it. Wear thick gloves, double bag the bird and place it in the trash. Barehanded contact with dead animals should always be avoided.
Can my pet be infected?

Pets occasionally get WNV from mosquito bites, but very seldom get sick. Horses are more susceptible to serious illness from WNV than are dogs and cats. Natural infection of a pet by contacting or eating an infected dead bird has not been documented.
How can I protect myself and my family?

To reduce the mosquito population around your home and property, reduce or eliminate all standing water:

* Dispose of tin cans, plastic containers, ceramic pots or similar water-holding containers.
* Dispose of used tires. Used tires are a significant mosquito breeding site. Call your local landfill or Department of Public Works to find out how to dispose of them properly.
* Drill holes in the bottoms of recycling containers that are kept outdoors.
* Make sure roof gutters drain properly and clean clogged gutters in the spring and fall.
* Remove leaf debris from yards and gardens.
* Turn over wading pools and wheelbarrows when not in use.
* Change the water in birdbaths twice weekly.
* Clean vegetation and debris from edges of ponds.
* Clean and chlorinate swimming pools, outdoor saunas and hot tubs.
* Drain water from pool covers.
* Use landscaping to eliminate standing water that collects on your property.

Should we stay indoors?

It is not necessary to limit outdoor activities. However, you can and should try to reduce your risk of being bitten by mosquitoes. In addition to reducing standing water in your yard, make sure all windows and doors have screens and that all screens are in good repair. If WNV is found in your area:

* Wear shoes and socks, long pants and a long-sleeved shirt when outdoors for long periods of time, or when mosquitoes are most active.
* Consider using mosquito repellent, according to directions, when it is necessary to be outdoors when mosquitoes are biting.

What is being done in my community to control mosquitoes?

The New York State Department of Health, along with other state agencies, local health departments, colleges and environmental groups, has prepared a plan to address issues related to WNV in the state and has devised a preventive strategy to minimize the impact. Local communities are implementing various control measures based on geographic location and level of risk. For more information regarding activities in your specific area, contact your local health department or visit the department's Web site at http://www.health.state.ny.us or write: New York State Department of Health, Fight the Bite, Box 2000, Albany, NY 12220. For environmental health information, call 1-800-458-1158.

Dengue Fever (breakbone fever, dengue hemorrhagic fever)

What is dengue fever?

Dengue fever is a mosquito-borne disease caused by a virus. The disease is mainly tropical in origin but occasionally residents or visitors from other countries may arrive in this country with dengue fever. Although cases originating in the United States are virtually unknown, epidemic levels have recently been reported in parts of the Caribbean and Central America.
Who gets dengue fever?

Dengue fever may occur in people of all ages who are exposed to infected mosquitoes. The disease occurs mainly in tropical Asia and the Caribbean, usually during the rainy seasons in areas with high numbers of infected mosquitoes.
How is dengue fever spread?

Dengue fever is spread by the bite of infected Aedes mosquitoes.
What are the symptoms of dengue fever?

Dengue fever is characterized by the rapid development of a fever that may last from five to seven days with intense headache, joint and muscle pain and a rash. The rash develops on the feet or legs three to four days after the beginning of the fever. The hemorrhagic form of dengue fever is more severe and associated with loss of appetite, vomiting, high fever, headache and abdominal pain. Shock and circulatory failure may occur. Untreated hemorrhagic dengue results in death in up to 50 percent of cases.
How soon do symptoms appear?

Dengue fever may occur from three to 14 days after exposure to an infected mosquito, commonly within four to seven days.
Does past infection with dengue virus make a person immune?

Infection with one of the four strains of dengue virus usually produces immunity to that strain but does not provide protection against the other strains.
What is the treatment for dengue fever?

There is no specific treatment available. Intravenous fluids and oxygen therapy are often used for patients who experience shock during their illness.
What can be done to prevent the spread of dengue fever?

Since cases of dengue appearing in New York are imported, control measures are limited to advising travelers to affected areas to minimize exposure to infected mosquitoes. Use of mosquito netting and repellents may be helpful in minimizing exposure.

Cholera

What is cholera?

Cholera is a bacterial disease that affects the intestinal tract. It is caused by a germ called Vibrio cholerae. Although only a few cases are recognized in the United States each year, epidemic levels of cholera have recently been reported in parts of Central and South America.
Who gets cholera?

While cholera is a rare disease in the U.S., those who may be at risk include people traveling to foreign countries where outbreaks are occurring and people who consume raw or undercooked seafood from warm coastal waters subject to sewage contamination. In both instances, the risk is small.
How is the germ spread?

The cholera germ is passed in the stools. It is spread by eating or drinking food or water contaminated by the fecal waste of an infected person. This occurs more often in underdeveloped countries lacking adequate water supplies and proper sewage disposal.
What are the symptoms of cholera?

People exposed to cholera may experience mild to severe diarrhea, vomiting and dehydration. Fever is usually absent.
How soon do symptoms appear?

The symptoms may appear from a few hours to five days after exposure.
What is the treatment for cholera?

Because of the rapid dehydration that may result from severe diarrhea, replacement of fluids by mouth or by the intravenous route is critical. Antibiotics, such as tetracycline, are also used to shorten the duration of diarrhea and shedding of the germs in the feces.
Is there a vaccine for cholera?

A vaccine is available and is sometimes recommended for travelers to certain foreign countries where cholera is occurring. However, the vaccine offers only partial protection (50 percent) for a short duration (two to six months). Some physicians feel that foreign travelers almost never contract cholera and that use of the current vaccine cannot be justified.
How can cholera be prevented?

The single most important preventive measure is to avoid consuming uncooked foods or water in foreign countries where cholera occurs unless they are known to be safe or have been properly treated.

Hepatitis A

Hepatitis A, caused by infection with the hepatitis A virus (HAV), has an incubation period of approximately 28 days (range: 15–50 days). HAV replicates in the liver and is shed in high concentrations in feces from 2 weeks before to 1 week after the onset of clinical illness. HAV infection produces a self-limited disease that does not result in chronic infection or chronic liver disease. Read More

Hepatitis A, caused by infection with the hepatitis A virus (HAV), has an incubation period of approximately 28 days (range: 15–50 days). HAV replicates in the liver and is shed in high concentrations in feces from 2 weeks before to 1 week after the onset of clinical illness. HAV infection produces a self-limited disease that does not result in chronic infection or chronic liver disease.

However, 10%–15% of patients might experience a relapse of symptoms during the 6 months after acute illness. Acute liver failure from hepatitis A is rare (overall case-fatality rate: 0.5%). The risk for symptomatic infection is directly related to age, with >80% of adults having symptoms compatible with acute viral hepatitis and the majority of children having either asymptomatic or unrecognized infection. Antibody produced in response to HAV infection persists for life and confers protection against reinfection.

HAV infection is primarily transmitted by the fecal-oral route, by either person-to-person contact or consumption of contaminated food or water. Although viremia occurs early in infection and can persist for several weeks after onset of symptoms, bloodborne transmission of HAV is uncommon. HAV occasionally might be detected in saliva in experimentally infected animals, but transmission by saliva has not been demonstrated.

In the United States, nearly half of all reported hepatitis A cases have no specific risk factor identified. Among adults with identified risk factors, the majority of cases are among men who have sex with other men, persons who use illegal drugs, and international travelers.

Because transmission of HAV during sexual activity probably occurs because of fecal-oral contact, measures typically used to prevent the transmission of other STDs (e.g., use of condoms) do not prevent HAV transmission. In addition, efforts to promote good personal hygiene have not been successful in interrupting outbreaks of hepatitis A. Vaccination is the most effective means of preventing HAV transmission among persons at risk for infection. Hepatitis A vaccination is recommended for all children at age 1 year, for persons who are at increased risk for infection, for persons who are at increased risk for complications from hepatitis A, and for any person wishing to obtain immunity. Hide

Asthma Information

Asthma is a chronic disease of the lungs. In New York State (NYS), more than 1.1 million adults have asthma 1. Asthma occurs at any age but is more common in children than adults. Nationally, nearly one in 13 school-age children have asthma, and that rate is rising more rapidly in preschool-aged children and those living in urban inner cities than in any other group. Although there is no cure for asthma, asthma attacks can be prevented and controlled with proper care. New York is actively working with health care providers, community coalitions, schools, families and many others to fight asthma so people with asthma can live a full and active life.

This web site is designed to provide accurate, current and useful information for people with asthma and for the people who care for them. New resources will be added often. Please check back frequently.
Asthma News and Events

* New York State Asthma Surveillance Summary Report - October 2007 (PDF, 2.3MB, 170pg.) (Posted 2/26/2008)
* New York State Asthma Surveillance Summary Report - October 2005 (PDF, 4.1MB, 88pg.)
* Clinical Guideline for the Diagnosis, Evaluation, and Management of Adults and Children with Asthma - 2009 (PDF, 245KB, 16pg.)
* National Heart, Lung, and Blood Institute: Guidelines for the Diagnosis and Management of Asthma (EPR-3) - 2007
* MMWR Recommendations and Reports, Key Clinical Activities for Quality Asthma Care: Recommendations of the National Asthma Education and Prevention Program - March 28, 2003 / Vol. 52 / No. RR-6 (PDF, 247KB, 12pg.)
* Working Group Report on Managing Asthma During Pregnancy: Recommendations for Pharmacologic Treatment - Update 2004 (NIH)

About Asthma

* Asthma Overview
* Asthma and the School Environment in New York State
* Information on Asthma in New York State (Data tables, trends, charts and maps)
* New York's Action Against Asthma
* What is Work-Related Asthma
* Asthma on the Athletic Field
* Asthma Action Plan and Informational Materials
* Frequently Asked Questions

Asthma Related

* Asthma and Influenza (Flu)
* Regional Coalitions
* Related Links
* Asthma Triggers

Vegepa - Try our NEW Chewables - Available now!

Vegepa is a patented formulation containing a unique ratio of ultra-pure EPA from marine fish oil and GLA from organic virgin evening primrose oil, providing a highly concentrated source of omega-3 and omega-6 long-chain fatty acids. As such, Vegepa combines the benefits that both these natural substances bring to the body.

Without compromising on ingredients or concentration, Vegepa Chewables provide the benefits of highly concentrated omega-3 and omega-6 fatty acids in a tasty, orange flavoured, chewable capsule. Combining ultra-pure EPA from marine fish oil with GLA from organic virgin evening primrose oil (containing immune-supporting triterpenes), this unique formulation provides cells with the nutrients required for efficient chemical signalling, integral to healthy brain function. We use only natural flavourings, to retain purity and keep our products free from artificial additives, colourings and preservatives. Vegepa Chewables are completely sugar-free, as well as being free from artificial sweeteners.
* Rich in botanical triterpenes
* Gluten-free
* Molecularly distilled
* GMO-free
* Derived from marine fish
* Dairy-free
* Yeast-free


Fatty acids play an important part in the functioning of every living cell in the body. Specifically they may help the body in several ways including: improving the circulatory system, aiding concentration, maintaining a balanced mood and keeping joints in good condition.

The EPA in Vegepa is derived from fish oil - the highest yielding source of long-chain omega-3 fats. This fatty acid forms a vital part of the diet as it enables the body to produce many substances that are necessary for health and well-being. EPA also plays a vital role in the structure, development and functioning of the brain. It can benefit sufferers of an array of mental and physical illnesses as well as lowering the risk of many potential health problems.

The EPO in Vegepa is derived from the cold-pressing of evening primrose seeds. When EPO is unprocessed and unrefined it is a rich source of botanical triterpenes - hormone-like substances which play an important role in immune function. EPO is renowned for oiling the joints and nourishing the skin, hair and nails. A rich source of the omega-6 GLA, the importance of EPO in relation to the structure of cell membrances and, consequently, effective cell signalling, cannot be over-emphasised.

The manufacturing process for Vegepa is of the highest standard. Using a molecular distillation process the EPA is extracted from fish oil - and hence ultra-purified - removing all unwanted substances and impurities including DHA (docosahexaenoic acid). Whilst this omega-3 fatty acid is vital for health, EPA is converted naturally by the body into DHA so it is unnecessary to take DHA in supplement form. Furthermore, some studies have demonstrated that DHA in supplement form inhibits the beneficial effects of EPA. The highly purified oil is left "ultra-pure" and in a form that is most bioavailable to the body. To find out more about this please click here.

It is recommended that Vegepa should be taken on a daily basis. To find out more please click here.

Each Vegepa capsule contains:

280 mg ultra-pure EPA (omega-3) from marine fish oil

100 mg organic virgin evening primrose oil (containing omega-6)

1 mg vitamin E (anti-oxidant)

The outer capsule shell contains fish gelatine.

Price: £11.70 for 60 x 500 mg capsules.


Each Vegepa Chewables capsule contains:

224 mg ultra-pure EPA (omega-3) from marine fish oil

80 mg organic virgin evening primrose oil (containing omega-6)

1 mg vitamin E (anti-oxidant)

Price: £10.70 for 60 x 400 mg capsules.

New study finds continued abstinence is key to increased survival from alcohol-related liver disease

However, the downside is that up a quarter of people with alcohol-related cirrhosis die before they get the chance to stop drinking. Alcohol-related cirrhosis develops silently but usually presents with an episode of internal bleeding or jaundice - which is often fatal.

The study, led by Dr Nick Sheron, senior lecturer at the University of Southampton and consultant hepatologist at Southampton General Hospital, found that abstinence from alcohol is the key factor in long-term prognosis, even with relatively severe alcohol-related cirrhosis of the liver.

The study appears in this month's Addiction journal. The aim was to determine the effect of pathological severity of cirrhosis on survival in patients with alcohol-related cirrhosis.

Liver biopsies from 100 patients were scored for the Laennec score of severity of cirrhosis between 1 January 1995 and 31 December 2000, and medical notes were reviewed to determine various clinical factors including drinking status.

Using up-to-date mortality data from the National Health Service Strategic Tracing Service, Dr Sheron found that drinking status was the most important factor determining long-term survival in alcohol-related cirrhosis of the liver.

He found that the degree of cirrhosis on biopsy had less impact on survival. Abstinence from alcohol at one month after diagnosis of cirrhosis was the more important factor determining survival with a seven year survival of 72 per cent for the abstinent patients against 44 per cent for the patients continuing to drink.

Dr Sheron, who has just been appointed as one of two internal advisors to the new Commons Health Select Committee on Alcohol, comments: "These findings illustrate the critical significance of stopping alcohol intake, in alcohol-related cirrhosis but unfortunately the services needed to help these patients stay alcohol free simply do not exist in many parts of the UK.

Antibiotics Dangerous for Diarrhoea in Children Caused by E.Coli

Researchers have warned doctors that Antibiotics when given to children with diarrhea caused by Escherichia coli bacteria, may put the children at increased risk of developing a serious condition known as "Hemolytic-Uremic Syndrome". The report appears on the website of The New England Journal of Medicine (www.nejm.org). Hemolytic-uremic syndrome, which occurs most commonly in children after a gastrointestinal infection, begins with vomiting and bloody diarrhea and can ultimately result in kidney failure. Based on this new study, physicians should avoid giving antibiotics to children with E. coli infections, principal author of the study Dr. Philip I. stated.

Fitness Log

Benefits of our Fitness Log

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More Benefits of our Fitness Log

Features of our Fitness Log

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Tracking
Log the food you eat, cardio and strength exercise, daily metrics such as blood pressure and heart rate, body measurements, and general notes.
* Fitness Log Weight Goal Planner

Personalization
Create custom foods, meals, exercises, workouts, lists such as the shoes you wore on your run. Also, layout your home dashboard page to display only the charts and fields that you desire.
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Calendar
View your log entries at-a-glance with the calendar. From this view you can create or edit log entries, move/copy/delete log entries, view a detailed summary of the day's data, and easily navigate to other dates.
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Reporting
What good is logging all of this data if you can't make heads or tails out of it. Our Fitness Log provides many reporting options with a variety of options that allow you to pull just the information you need and display it in a manner that fits your specific needs.
* Fitness Log Calories In/Out Chart

Frequent Updates
Our Fitness Log is always growing with new features added continuously. We listen to customer feedback and implement new features based on that information.
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More Features of our Fitness Log

Our Fitness Log is free for 7-days and then only $29.95 for an annual subscription. That's less than a dime a day for a tool guaranteed to help you maintain a healthy lifestyle!

The free trial provides all features of our Fitness Log and no credit card is requied to sign up. The annual subscription fee is not recurring, you will be billed once and asked if you would like to subscribe again once your subscription has expired. There is no risk - so sign up now!



Motivation
Putting your goals in writing, sharing with your friends, and seeing progress all help motivate you to keep going.
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Accountability
Logging your diet and exercise while visually seeing the difference between the amount of calories you are consuming vs. the amount you are expending makes it clear where you need to focus your efforts.
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Planning
Our weight loss planner allows you to experiment with different levels of calorie consumption, exercise, and your target date to create a healthy plan for sustained weight loss.
* Fitness Log Weight Goal Chart

Consistency
The ability to see at-a-glance the days you've completed exercise helps make you more consistent, which is the key to a healthy lifestyle.
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Availability
Our Fitness Log is accessible anywhere there is a computer and an internet connection. Log your diet and exercise from home, the gym, on vaction, at work, or wherever you may be.
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Analysis
A computer-based fitnes log outperforms pen and paper in many ways. Easily identify trends with powerful reporting features to determin which aspects of your training or weight-loss program need attention.

Fitness: Things to Consider When Buying Home Fitness Equipments

There are a hundred lots of home fitness equipment nowadays that are sold in the market. Do not make the mistake in buying something and then regretting why you bought it after a day or two. Home fitness equipments vary and you should always have one good reason to buy it. Don't believe on everything commercials tell you about the equipment. Some equipment may seem easy to use on television but n fact will not really work for you. Try to ask yourself first of these questions before you grab your wallet and buy that equipment.
Do you need it? The equipment should suit your interests and needs. The activities that you will do with that equipment should be challenging and something to enjoy on. Buying equipment is never a guarantee that you will use it especially if it is something new that makes it harder to use. Make sure that you already know the equipment and that it is something that you already tried in a fitness club. Start from buying small equipments that are aligned to your interests.

Can you afford it? Don't be fooled with the thought that you will be forced to use something because you spent too much money for it. Expensive equipments are never an assurance that you will use them or that they are effective for you. Always consider how much are you willing to pay for certain equipment. Also ask yourself iif it is worth it. Always check on the quality before you buy equipment. The price may be too low but consider that the quality can also be low. Or it may be expensive but then the quality is not that good. You can try choosing on cheaper alternatives but not sacrificing the quality of the equipment.

You may also want to check out for some used equipments. Most of the time, this is where you find a better deal. You can even find equipments that do not seem to have been used at a very low rate. Or you can find the equipment 3 months old but the price is almost half the original.

Do you have enough space for it? This is often what buyers forget to consider. Try to consider first where to place a treadmill before buying it. Before you buy something, make sure you know where you will place it. Your place may not accommodate the equipment. Plan ahead and make sure that the equipment can be placed in your home without causing any hassle.

Is it safe for you? If you have existing conditions, be sure to check with your doctor to make sure that the equipment will be safe for you. Some equipment may be painful to use and might cause harm to your body. So make sure to try it first be fore you buy it.

It also suggested that you first consider if a gym near you already has that equipment. You can save money by just registering to that gym and use that equipment compared the price you will spend if you will buy that product.

Buying fitness equipments should be bought with consideration. Do not buy by impulse. Always ask the opinion of a professional gym instructor before you buy something.Submit your articles and get a PR4 backlink to your website! Submit Articles! We provide free articles and information. Check us out at Free Articles!

Making Fitness Less Work

There is no doubt that fitness is something that is required of people because it helps to strengthen the body and to keep it healthy. There is also no doubt that fitness can be work as it should push the body farther to gain success. Yet, you can have both hard work and enjoyment! For example, consider the right equipment for your fitness workout. Perhaps having a home gym would inspire you. Equipment like fitness bands and even a Bowflex could be used. You can even tailor your fitness regimen around activities that you enjoy such as hiking, swimming and running. Anyone can benefit from having physical activity in their lives in some form or another.

It is also important to consider what areas you need to work out. For some, a workout will include both cardio activities and muscle toning. Each time that this happens, the body can become more and more fit. A cardio workout can be something that inspires you. You may even want to target specific areas that are important tot you. For example a back workout can help to strengthen that area of the body. A popular need is that of an abdominal workout.

Of course, fitness also includes the importance of targeting the areas of your body that are hurt or otherwise weakened. For example, through fitness you can work on treating lower back strain and help treating muscle spasms. The goal of any workout is to improve your health and wellness. When you do activities that you like, target areas of your body that are important to you and have the tools necessary to make it happen, anyone can benefit from a total fitness area.
Fitness Product Type

Quality Fitness Equipment Products


Full List of Fitness Equipment Care Guides
Fitness Brands
Nautilus
Life Fitness
Keiser
Weider
SCIFIT
ProForm
Powertec
Kettler
Star Trac Treadmills
Schwinn
Cybex
HealthRider
Gold's Gym Equipment
Bowflex
Precor
Landice Treadmills
NordicTrack
Fitness Articles
Sport Injuries
Understanding Knee Sprains
Treating Plantar Fascitis
Treating Lower Back Strain
Treating Bruised Ribs
Treating Whiplash
Treating Ligament Sprains
Treating Bursitis
The Truth about Dieting
The Benefits Of Push-ups
Weight Loss Tips
Understanding Bone Fractures
Treating Muscle Spasms
Workout Routines
Exercise Ball Workout
Cardio Workout
Leg and Butt Workout
Abdominal Workout
Chest Workout
Upper Body Workout
Back Workout

Cardio Equipment
Spinning Bikes
Free-Standing Cardio Equipment
Kick Boards
Swim Goggles
Boxing Gloves
Trampolines
Swim Fins
Heavy Bags
Slide Boards
Skipping Ropes
Hydraulic Fitness Equipment
Rowing Machines
Stair Steppers
Recumbent Bikes
Steppers
Stationary Bikes
Elliptical Machines
Treadmills
Fitness Balls
Stability Balls
Medicine Balls
Wobble Boards
Aerobic Equipment
Yoga Mats
Step Platforms
Exercise Mats
Fitness Accessories
Heart Rate Monitors
Scales
Fitness Apparel
Pedometers
Water Bottles
Gym Bags
Reading Racks
Fitness Journals
Stop Watches

How to Use Ironman Home Gym Warehouse Discount Coupons

Using discount coupons listed here is very easy. You will have to click on the link above, the link will be opened in a new window and you will be reached to ironman home gym warehouse product page, now you will have to select products you need and add them into your cart. After you have finished your shopping you will be taken to the checkout page or payment page, now at the time of checkout find a box in the page to enter the discount coupon, enter the discount coupon you may find in the link at our site on which you've clicked and went to ironman home gym warehouse site. After engering discount coupon, click redeem this coupon and you will see some discount based on to your shopping amount.

Some stores offer discount by percentage and some offer fix discount amounts. for stores which offer discount by percentage you will get discount on your shopping amout, as much you will shop as much you will get discount. For stores which offer fixed discounts either you will have to shop a minimum shopping amount to be eligible for this discount or you will get some fix discount on any amount you shop.

Some links do not require any discount coupon, for those links you only need to click the link, go to the shopping site, select your products and you will find some discounts in the prices of products without any discount coupons.

Some stores also offer free shipping or gift certificates when you shop online.

You may email these ironman home gym warehouse promotional links and ironman home gym warehouse store page to your friends and / or family members.

Buy Fitness Equipments - Proform, Bigfitness, Ironman, ITrain Discount Coupons

Fitness Equipments Site offers discount coupons and coupon codes for our site's visitors to get discounts in their online shopping in purchasing fitness equipments online. We offer discount coupons of many online fitness equipment stores like Big Fitness, Cyber Checkout, HyperStrike, ICON Health & Fitness, Ironman Home Gym Warehouse, iTRAIN, ProForm & Workout Warehouse, Uniform City.

Blackheads

Blackheads are essentially comedones that appear as tiny blackish dots on the surface of the skin. Blackheads are classified as acne (acne vulgaris) and are very common in people of all ages, often occurring on the facial area in cases of teen acne and adult acne.

Blackheads differ from other types of pimples (whiteheads for example) in that they are usually very tiny, and can stay the same size instead of resulting in inflammation. Blackheads can appear anywhere on the skin where there are pores or follicles, but are mostly found on the face and arms. If untreated, it is possible for blackheads to progress into cystic acne or acne scars. In order to prevent the formation of blackheads, you need to address acne from the outside and inside by addressing bacterial buildup, and strengthening the pore from the inside.

We recommend ZenMed as an effective professional acne system to address and prevent blackheads. The ZenMed Derma Cleanse system was voted the number one acne treatment in 2008 according to users and professionals.

Visit the Offical ZenMed Derma Cleanse Website

How Do Blackheads Form?

Blackheads form much the same way that other pimples form. When the sebaceous glands, under the skin, overproduce the natural oil sebum, it fills the sebaceous duct (and pore) and secretes on to the skin. In some cases, when mixed with debris or skin cells, the sebum can clog a pore. When this results in inflammation, a pimple results. However, when the pore does not become inflamed, the result is a blackhead. The oils, usually transparent in color, start to oxidize in the pore and eventually turn a brownish-black color. The presence of the oil in the pore can also cause the pore to grow in size. The end result is what looks like a small black dot (really an open pore clogged with oils) and hence the name ‘blackhead’.

Blackhead Removal

Treating blackheads can be somewhat different than other types of pimples in that blackheads will not always disappear with regular acne cleansing. This is because the oils are clogged in a pore and the area is not inflamed (for regular pimples, when the inflammation is controlled, the clogged pore is cleared in the process). In most cases blackheads will disappear after regular acne treatment; if they don’t, here are some other options:

Facial Mask

Facial masks can be used as a form of facial acne treatment. Many blackhead facial masks are sold over the counter, and usually only require one to two applications. Facial masks usually start with a warm solution used to open the pores of the affected area. The facial mask is then applied and left on for a prolonged period of time. When the facial mask is removed, it literally pulls the excess oils from the open pores, thus removing the blackheads and clearing the skin. Follow-up lotions that tighten the pores or help the skin (vitamin A) are sometimes applied as a finishing technique.

Facial scrub

Facial scrubs are also common for treating blackheads both when addressing teen acne and adult acne. Facial scrubs usually contain granules of one form or another that are also used for exfoliating skin masks. The scrubbing helps rid the skin of dead skin cells as well as working its way into clogged pores, loosening them and ridding them of the materials clogged inside. Facial scrubs can irritate the skin in some cases and should not be used for blackheads when other acne is affecting the area. Facial scrubs can be purchased retail or made via various acne home remedies.

Blackhead Extractor

Another way to tackle the blackhead removal involves the use of a professional blackhead remover. These removers typically contain a sharp lancet for piercing whiteheads and a clean object for using pressure on blackheads. In some removers, a ringed device is used to press on blackheads; in other removers a group of fine loops provides the needed pressure on unsightly blackheads. Leaving blackheads untreated can lead to cystic acne.

Pressure Device

There are numerous ‘pressure’ devices that can be purchased explicitly for clearing blackheads and blackhead removal. Usually equipped with a ring-link end, these devices are pressed against the skin surrounding a blackhead. When pressure is applied, it literally squeezes out the clogged pore. In some cases, a warm solution is applied beforehand to loosen and expand the pores.
Blackheads, although they look different than traditional ‘pimples’, are indeed acne and should be addressed. Once blackheads are completely removed, a daily cleansing routine will usually keep your skin clear.

Best Acne Products Reviewed

Our users have completed reviewing the top 30 commercial acne treatments. After testing and rating each treatment, our users and professionals voted ZenMed Derma Cleanse, Clearpores and Acnezine as the top acne treatments of 2008. The reviews were based on safety, effectiveness and value.

After rating the top 10 acne products, then filtering that list down to the best 3 acne treatments of those, our users voted ZenMed Derma Cleanse as the #1 acne treatment for 2008 based on Former Acne Sufferers and Professionals.

Visit the Official ZenMed Derma Cleanse Website

ZenMed Derma Cleanse - Rated the #1 Acne Treatment of 2008

ZenMed Derma Cleanse is an all natural, holistic and effective acne treatment. The treatment is formulated from 100% pure natural botanicals, is non-comedogenic, and is effective on acne of any severity - both mild breakouts and blemishes, as well as severe acne. It is safe for everyone - children, teenagers and adults. ZenMed Derma Cleanse is a holistic acne treatment - meaning it also addresses acne internally by regulating impurities and hormones, which aggravate the skin and help to cause acne. ZenMed has no side effects, does not require a prescription for purchase, and causes no sensitive skin in sunlight. It does not use benzoyl peroxide, which can dry the skin. The product has a 60 Day Money Back Guarantee. ZenMed Derma Cleanse was voted number one acne treatment of 2008 by our users, with a 96/100 overall rating.

Benefits of ZenMed Derma Cleanse:

# Non Comedogenic
# All Natural
# Safe for Everyone
# Effective on all Types of Acne
# Addresses Acne Internally and Externally
# Money Back Guarantee (60 Day)

Click the link below to learn more at the ZenMed Derma Cleanse website

Visit the official ZenMed Derma Cleanse Website

ClearPores - Rated the #2 Acne Treatment of 2008

ClearPores was voted the #2 best acne treatment of 2008. It was voted as very effective, and does use natural herbs and skin care essentials to reduce inflammation and reduce any redness and irritation. It is also effective in cleaning out the pore and eliminating acne. Our users gave ClearPores a 92 / 100 rating, and we highly recommend this product as well to our users.

Click the link below to learn more at the Clearpores website

Visit the official ClearPores Website

AcneZine - Rated the #3 Acne Treatment of 2008

AcneZine is all natural, mild on the skin, and very effective in removing sebum, declogging the pore, and destroying bacteria which forms at the onset of an acne breakout. It contains just enough benzoyl peroxide to completely eliminate bactetira, but remain gentle on the skin. We believe AcneZine offers good value to the consumer and give this treatment a 90 / 100 rating.

Click the link below to learn more at the AcneZine website

Nidek KM-450 Keratometer (EQ0052)

The KM-450 is a one position instrument for objectively measuring corneal curvature. The added feature for internal readings for the presbyopic practitioner for those who prefer to work in subdued lighting where external readings are difficult.
Features and Benefits
Internal readings in millimetres and dioptres.
Measures both meridians without changing optical system.
Dual eye level sighting system. Facilitates horizontal alignment.
Positive fixation. Permits rapid measurement of central corneal area.
Wide angle eyepiece with engraved focusing scale.
Brass and steel moving parts assure durability.
Technical Specifications
Dimensions:450 (W) x 545 (D) x 467 (H) mm
Weight:: 17.0 kg
Range: 36D to 52D in 0.125mm steps
Range: 6.5 to 9.4mm in 0.025mm steps

NIDEK - KM-500 Hand-held Keratometer

NIDEK introduces a unique hand-held, automatoc keratometer with incredibly quick readings. All operations are controlled by just five switches.

This innovation offers high convenience with

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a wide observation window
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clear target ring with speed variation for quick alignment
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easy-to-read LCD for both R/L data
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infra-red full data transmission to printer
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60 minutes continuous measurement
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single 90 minute recharge
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accurate data
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special sagittal-K readings

Hand-held or attached to a slit lamp for versatility and economy.

Keratometry

Involves measurement of the corneal front surface, giving a numerical measurement of the three dimensional corneal surface, at present with the Nidek Auto keratometer and the Javal Schiotz keratometer.

This service is available for patients at the main eye clinic based at St. James's University Hospital.

Nidek Marco KM 500 Wireless Keratometer Portable NR BIN

Buy It Now price: US $2,500.00
Best Offer US $1,500.00


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Reconditioned Nidek AR-1100 / Auto Refractor

Detailed Product Description

- used, but perfectly refurbished by ex-nidek & topcon engineer.
- wonderful working condition.
- cover repainted or replaced.
- warranty:6 months after sale.

Features
- compact and light weight
- built-in TV monitor.
- 180 readings in 0.5 sec. Measuring time.
- changeable vertex distance
- error display for both mis-alignment and over range.
- starburst and unaided visual acuity charts.
- unaided visual acuity measurement.
- PD measurement
- I. O. L. Implanted eye measurement.
- automatic switch off.
- selected value print-out.
- patient number print-out.

If you want to check refurbishing condition or for further information, please contact us!

Lenses for Astigmatism

Give up your glasses without sacrificing sharp, clear vision. Think you can't wear soft contact lenses because you have astigmatism? That's the way it used to be, but not any more. Designed especially for correcting astigmatism, toric soft contact lenses can give you the same vision clarity you enjoyed while wearing glasses. Topics include:

* How Astigmatism Affects Vision
* Clear Vision Without Glasses
* A Range of Choices

How Astigmatism Affects Your Vision

Astigmatism is a common vision problem. The good news is that it can be corrected with toric soft contacts instead of glasses.
Clear Vision Without Glasses

Can you really give up your glasses and see just as well? With toric soft contact lenses you can - even though you have astigmatism.

* Advanced technology and unique prism design corrects your astigmatism.
* As affordable as a good pair of glasses.

top
A Range of Choices

CIBA VISION supplies toric contact lenses in nearly 3,000 different prescriptions. If you need an even stronger prescription, however, ask your eye care professional about CIBA VISION's specially made toric lenses, available for those individuals with more specific correction needs.
AIR OPTIX® for Astigmatism

Feature a new breakthrough design which ensures comfortable lens wear throughout the day. They are recommended for daily wear and monthly replacement.
Focus® DAILIES® TORIC All Day Comfort

The world's first daily disposable lens for astigmatism, Focus® DAILIES® TORIC All Day Comfort combines excellent visual acuity with the comfort, convenience and hygiene of wearing a fresh, new pair of lenses everyday.
Focus® Toric

A leading soft contact lens for astigmatism available in a wide range of prescriptions to fit a variety of vision correction needs. Focus Toric is designed as a monthly replacement lens.
DuraSoft® 3 OptiFit® ColorBlends® Toric

Just because you have astigmatism doesn't mean you can't have fun. Now you can enjoy our unique DuraSoft 3 OptiFit ColorBlends Toric, for quarterly replacement, which combines three colours on the lens to create the most natural eye colour change ever. Available in many beautiful shades - blue, green, brown, gray, honey, turquoise and amethyst.
DuraSoft® 3 OptiFit® Toric

Available in a handling tint or your choice of 15 different colours to change even the darkest eyes.
Cibasoft Progressive Toric

A lens designed for the correction of both astigmatism and presbyopia.

Soflens38 Contact Lenses Item Code : c100

BAUSCH & LOMB® SofLens® 38 (polymacon) Visibility Tinted Contact Lenses has a high-performance, ultra thin design with a time-tested lens material that provides crisp, clear vision, comfort, and deposit resistance in the lens. The Soflens 38 contact lens is a soft hydrophilic and spherical lens. Users of contact lenses should follow the advice given by the eye care specialist in order to ensure a smooth wearing of the contact lenses.

Availability

Delivery Within 4-5 Working Days

What You Are Paying:

£22.50 Per Box - 6 Months
£21.00 Per Box - 12 Months

6 Months- 6 Pairs (£45)
12 Months- 12 pairs (£84)

Oasys Contact Lenses Item Code : c103

The Johnson & Johnson Oasys lenses, that are flexible continuous wear, offer the highest level of oxygen in the Johnson & Johnson range. They have known to reduce contact lens dryness. Not only that, they have the highest UV ray blocking feature. It is greater than 99 percent UVB and 95 percent UVA1. You may use the Johnson & Johnson Oasys flexible, continuous wear contact lenses for overnight or extended wear. It can be used as a weekly disposable lens, after your optician has authorized it.

Availability

5-6 working days

3 Months- 6 Pairs (£39)
6 Months- 12 Pairs (£69)
12 Months- 24 Pairs (£129)

All Pro Ecg Machine INstrument Co.,Ltd

All Pro Ecg Machine Co.,Ltd is a growing manufacturer and supplier of Ecg Machine products, our products have been sold worldwide to hospitals, healthcare institutions, clinical and science laboratories, general industry and public customers in more than 110 countries.

With a very professional team, we design, develop and manufacture medical devices and health products, as well as provide specialized products and services. Depending on integrity and dependability in our products, we take requirements of our clients as our obligation and have become indispensable supports of many customers.

Thanks for visiting our website, your comments and inquiries are welcome. “All Pro improves Your Work” is our final goal, and we hope to cooperate with you in the near future.

PHACOEMULSIFICATION

What is Phacoemulsification?
Phacoemulsification has gained in popularity in recent years, and is now the preferred form of cataract removal. Although this procedure has been available to us for a long time, recent advances and refinements in machine and microsurgical instruments have made it safer and more effective than previously.

The technique of phacoemulsification utilizes a small incision. The tip of the instrument is introduced into the eye through this small incision. Localized high frequency waves are generated through this tip to break the cataract into very minute fragments and pieces, which are then sucked out through the same tip in a controlled manner. A thin 'capsule' or shell is left behind after cleaning up of the entire opaque cataract.

The incision size for phacoemulsification is approximately 3.0 millimeters in width. If a lens implant that can be folded is used following removal of the cataract, this incision may not have to be enlarged. If a lens is used which cannot be folded, the incision must be enlarged to 5.0 or 5.5 mm
Are the stitches required after Phacoemulsification?
The incision (wound) required for phacoemulsification is small (3 mm) and the wound construction is such that it is self-sealing. Therefore a surgery in which a foldable lens has been implanted through the small 3 mm wound, generally does not require any stitch, as it is watertight. The surgeries in which the wound has been enlarged (5 or 5.5 mm) to put a lens that can not be folded, is likely to require one stitch, because the wound is larger.

In addition, some surgeons simply prefer the safety of having the incision sutured, even if the incision is already watertight. The best procedure for a patient is usually the one with which his or her ophthalmologist feels the most comfortable, since these variations of cataract surgery are all quite effective.

What are the advantages of Phacoemulsification over routine extracapsular surgery?
In a conventional surgery the incision required is larger (10-12 mm) and requires stitches for closing. This larger incision takes 6-8 weeks to heal. Moreover, the stitches can cause distortion of the normal curvature of the cornea (the clear part of eye) and thus lead to astigmatism and blurred vision because of this.
Essentially all the advantages of phacoemulsification are because of small incision, which is self-sealing. The wound is more stable and the chances of wound complications are minimized. The patients can resume their normal activity faster as compared to conventional extracapsular surgery. The wound healing is faster and more predictable, and therefore glasses can be prescribed much earlier as compared to the conventional surgery. The patient requires less follow up visits for checkups. As the incision is small and in many cases stitches are not required, the cornea does not get distorted and therefore the chances of significant astigmatism is minimized. At Visitech, the surgeons routinely perform Phacoemulsification with foldable intra ocular lens implantation.