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Tuesday, June 22, 2010

Smoking .. Why is it so difficult to quit ?

Extracted from the website of American Council on Science & health

[By David Krogh, author of the new book Smoking The Artificial Passion published by W.H. Freeman and Company, is a science writer and editor at the University of California]


Almost everyone has watched someone try to quit smoking. They charge into the effort with optimism because of some new-found belief that hypnotism, nicotine gum or acupuncture will do the trick this time. They quit for a week or two, maybe even a few months, but then suddenly they're...smoking again. And, it's not just one cigarette here and there, their all-consuming habit has returned It's as if the whole effort to stop never took place.

Why does this happen? How can someone not choose whether to continue this strange ritual of inhalation and exhalation ? The mystery behind the inability to quit relates to the nature of the drug. Nicotine has almost no effect on a smoker that an onlooker can perceive. We believe we know why heroin is attractive: it makes people euphoric. In a slightly different way, the same thing is true of alcohol or cocaine. It would make sense that the more a drug does for us, the more alluring it would be. But if this is true, how can we explain nicotine, which hardly seems to have any noticeable effect and yet, to judge by its number of users, is easily the world's most addictive substance ?

Why Do People Smoke ?

To understand these contradictions we must drop our preconceived notions about what constitutes an attractive mental or physical state for most people.

Most of us believe, that drugs will be attractive in direct proportion to how euphoric they make us feel; but this is not the case. Jack Henningfield of the National Institute on Drug Abuse points out that if we gave heroin to 50 randomly selected people, most would get sick and would never want any again. We actually have a massive test-case that proves this every day: Thousands of hospital patients receive painkilling dependence-producing drugs in large quantities, yet almost none become serious drug abusers as a result.

It's clear that what makes a drug attractive is not only that people get high with it; but rather that people find it useful — perhaps for getting high, but also for other, less exotic reasons.

The important reason with nicotine is that the drug helps the user maintain his or her daily routine, especially at work. We have some telling information about smoking in the workplace. In the early 1970s, British researchers T.W. Meade and N.J. Wald asked some 3,600 workers to detail when they actually smoked cigarettes from the time they awoke until they went to bed. The results showed that these people smoked most of their cigarettes and had their two highest hourly rates of smoking while on the job.

So, what do people want from a drug ? To judge by this evidence, they want to be able to function. It is work, after all, that calls upon us to perform in a way that will keep a paycheck coming in. The work environment is likely to present us with situations that make us feel uncomfortable, abnormal. We may feel hammering tension from having too much to do or drowsiness and boredom from having too little to do.

The findings scientists have uncovered in the past 30 years regarding the effects of nicotine, depict a drug that is almost perfectly suited to returning people to a state which might be called psychological neutrality, no matter whether they have been removed from this state by stress or boredom.

Electroencephalograph studies show that nicotine generally arouses human beings. Give a subject a dose of nicotine and his brainwave activity will increase in frequency, a sign of increased arousal. However, we also have some evidence that nicotine sedates or depresses smokers, depending on the dosage and environment. (In general, larger doses of nicotine tend to sedate while smaller doses tend to arouse)

Consider that smokers may be able to move themselves up or down at will on a stimulation/sedation continuum by simply taking in a given amount of nicotine in a given situation. The ability to do this — and do it almost instantaneously — would obviously be a very attractive proposition for almost anyone. Is there little wonder that nicotine has found such favor in the workplace ?

Any drug that can function in such different ways might be expected to have varied effects when people actually perform tasks under its influence. This is just what we find with nicotine. There is evidence that people's physical reactions can actually speed up with nicotine. For example, non-smokers given nicotine can tap on a keyboard about five percent faster under its influence. Concentration during a long, boring task may also improve with nicotine. In one study, smokers and nonsmokers were asked to note pauses in the sweep hand of a clock. The smokers could maintain their vigilance remarkably well over an 80-minute test, while the nonsmokers' concentration steadily waned. We also have reason to believe that nicotine may moderate aggressive or anxious mood states. It may, in fact, have effects much like those of the milder tranquilizers.

These various research results cannot be regarded as conclusive. The idea that smoking provides absolute benefits in mental and emotional functioning has a number of critics. But, smoking research continues. Nevertheless, these findings do present a consistent picture of why nicotine is seemingly so attractive. Nicotine is the all-time addictive drug of choice because so many people use it in so many different ways.

More information can be found in

Nicotine has Deadly Addictive Power

Regardless of the smoker's perceived benefits from tobacco, one would assume that an overwhelming consideration must be the likelihood of an early grave after a life of gnawing addiction. However, the addictive qualities of nicotine often overpower a smoker's fear of premature death.

Thanks in large part to work done at the National Institute on Drug Abuse in the 1980s, it is now clear that all the elements of addiction found with "serious" drugs like heroin and cocaine are also found with nicotine. Smokers trying to quit are likely to become as psychologically distressed as the average psychiatric outpatient. In animal experiments, squirrel monkeys will press levers as many as 250 times to get a single intravenous dose of nicotine. Human smokers under the same conditions will dose themselves at orderly, predictable rates depending on how much nicotine they are getting — the very hallmark of an activity controlled by a substance.

People tend to think of nicotine addiction as a kind of lap-dog version of addiction — the real thing existing only with truly addictive substances, such as heroin or cocaine. The smokers everyone knows don't live in squalid crash-pads, rob people, or worse. How similar can heroin addiction and nicotine addiction be ?

Such reasoning ignores the fact that nicotine is legal and thus easily available at a low cost. Were this not the case, nicotine addicts might demonstrate all the depraved trappings of drug culture that we now see with harder drugs. Consider, for example, the account of a Mr. N.A. Photiades, who wrote to the Times of London in 1957, looking back on his experience in World War II :

I had the misfortune to be a prisoner for nearly four years during the war and found that the one thing that men were unable to give up was cigarette smoking. There was, in fact, a very active market in bartering the handful of rice we received daily for the two cigarettes our hosts so kindly gave us. I have actually seen men die of starvation because they had sold their food for cigarettes.

Such stories have been repeated at various intervals in history when tobacco has been unavailable or available only at the most prohibitive cost. The message from these accounts is: Whatever the cost of nicotine, people will pay it.

Given the probable benefits of nicotine and its addictive power, it's understandable why quitting is so difficult. Smoking works itself into every facet of waking life, essentially as an unhealthy means of relating to one's environment. It is a drug of physical dependence, as surely as cocaine or heroin.

Nicotine Addiction can be beaten

On the face of it, this would seem to present a forbidding set of circumstances for anyone who wants to quit. But while it is true that most individual attempts to quit smoking will end in failure, it is also true that 42 million Americans have quit smoking. Clearly it is possible, though quitting may take several attempts and some clever strategy.

This is important to keep in mind when trying to quit. It is a rare smoker who can stop for good on his or her first attempt. Smokers should not feel that there is something wrong with them — that they are more hooked or less resolute than others — if they don't succeed on the first go around. One must regard an unsuccessful attempt to quit as an exercise in getting to know one's habit. (i.e. When did temptations to smoke arise and when were they absent ?)

Nicotine gum or the new nicotine skin patch (both available by prescription) are useful tools in the quitting arsenal. Initial clinical trials on the nicotine patch look very promising. Nicotine gum, which has been around for years, lessens the early withdrawal symptoms smokers are likely to feel. Nicotine substitutes allow the quitter to conquer the habitual behavioral aspects of smoking before dealing with the physical symptoms of withdrawal.

Another piece of advice : People trying to quit should stay away from people who smoke. Nearly three quarters of all quitters who relapse do so in the presence of people who are smoking — usually after having asked one of these people for a cigarette.

Finally, smokers who want to quit should attempt to develop a repertoire of coping strategies as the research literature phrases it. Saul Shiffman, perhaps the nation's leading expert on smoking relapse, has found that people who develop such strategies are far less likely to relapse in a given "crisis" than those who don't. Such strategies can be divided into the "cognitive" and "behavioral". They involve "thinking" or "doing" something specific to overcome those moments when the ex-smoker really craves a cigarette. Thinking: about the effort you've invested so far; about how much your kids will benefit; about your uncle who died from emphysema. Doing: Getting up and leaving a bar; going out for a walk; sitting down to play with a video game.

Even the person who mixes and matches these and other strategies is not likely to find quitting easy. Smoking is a tenacious habit precisely because it is so intimately tied to the everyday acts in our lives. Nevertheless, with determination and a smart strategy, it is possible to quit smoking.

Tuesday, June 15, 2010

What is Angioplasty and Stenting ?

[Extracted from]

An angioplasty is a procedure where a balloon is passed into your artery on the end of a tube (catheter) and is inflated (blown up) to treat a narrowed or blocked artery. The initiator of this technique was Charles Dotter, a radiologist in Oregon who started this work in 1964. The angioplasty technique means that surgery may be avoided in many cases. There are two techniques for performing angioplasty - transluminal and subintimal. In the transluminal technique the balloon is placed in the centre of the artery (in the lumen) where blood would normally flow.

Angioplasty of left common iliac artery

In subintimal angioplasty (Bolia, 1989) the balloon is intentionally placed within the layers of the arterial wall. As far as the patient is concerned, angioplasty is very similar to an angiogram except that a slightly bigger catheter is used and therefore the risks of bleeding are slightly greater. For this reason, in most cases, you will be asked to stay overnight. You will usually be asked to start taking aspirin before you are admitted as this makes the blood less sticky. A common dose is 75 mg per day. If you have a stomach ulcer or are allergic to aspirin, please tell your doctor.The angiogram opposite shows the artery on the left before angioplasty and on the right following angioplasty.

During the angioplasty

Angioplasty takes a little longer than simple angiography and you may feel the doctor changing, and pushing, catheters in and out of your groin artery. Although this is occasionally a little uncomfortable, it is not usually too painful. Once in position the artery will be stretched by inlating the balloon. This is a special balloon (Gruentzig balloon) that will only inflate to a fixed diameter which will vary depending on the size of the artery being treated. The reason for this is that the fixed diameter prevents overinflation of the balloon and reduces the risk of rupturing the artery. If there appears to be a good angiographic result no further procedures may be necessary. Sometimes, if the appearance of the treated artery is not ideal the situation can be improved or salvaged by inserting a special device called a stent to keep the artery open. This is just a small metal tube that expands in your artery to keep the area open and allow more blood to flow through. Stents appear to be especially useful in larger arteries above the level of the hip joint.

They can be used in arteries in the thigh but results are mixed and it should not be a routine procedure at this level of the leg. An editorial in the British Journal of Surgery recently concluded that "doctors have not the slightest clue whether primary stenting for arterial occlusive disease below the inguinal ligament (groin area) is of any real use" (Reekers 2008).

After the angioplasty

Unless there is a contraindication most patients should be taking aspirin. In some cases Heparin injections (anticoagulation) will be given for 24 hours to prevent the blood clotting at the site of the angioplasty. Rarely you may require warfarin tablets to thin the blood for a few months. You will normally be allowed home the following day. If you are given heparin or warfarin this may delay your departure by a few days. There is a growing trend to use clopidogrel to improve angioplasty success in leg arteries as it does seem to be important in patients undergoing coronary angioplasty in the heart. There is no evidence that clopidogrel is helpful following lower limb angioplasty.

You will be seen again in the clinic by your surgeon to assess the success of the angioplasty and to decide upon any further treatments. Unfortunately, in about 10% of cases, angioplasty is not successful and other treatments will need to be considered. In addition, even where successful angioplasty has been performed, there is a risk that the area in the artery will narrow down again. After one year, about 20-40% of arteries will have re-narrowed. In some cases, it may be possible to repeat the angioplasty at that time although in others this may not be possible. Very rarely, if angioplasty does not work, the circulation may actually worsen. If this is a particular risk in your case, your surgeon and /or radiologist will discuss the risks with you.

What are the possible side effects/complications ?

Bleeding – a small amount of bleeding sometimes occurs when the catheter is removed. Before the procedure is finished, the radiologist will ensure, by pressing on the artery, that all bleeding has completely stopped. Occasionally this bleeding can cause a small lump around the groin and commonly causes some bruising in the skin for a few days after the procedure. This is normal and will clear up on its own. Serious bleeding is very uncommon.

False aneurysm - rarely a pulsating lump develops in the groin at the site where the catheter was inserted into the artery. This is because bleeding took place after the catheter was removed. The clot produced forms a small sac with liquid blood in the centre. This blood pulses because it is connected to the artery through the hole made by the catheter. The sac with blood in the centre is called a false aneurysm. These days this problem can usually be treated by a simple injection into the sac to make the liquid blood in the centre form a clot and block the small hole in the artery. Thrombin is the naturally occurring blood clotting agent which is injected. It is usually very effective.

Pain/Discomfort – local anaesthetic is injected into the skin just before the catheter is placed into the artery. This should take away any severe pain, but it is likely you may feel some gentle pushing and pulling during the procedure. The blood vessels themselves do not feel the guiding wire or catheter. Injecting the dye sometimes causes a sensation of warmth, but this usually lasts only a few seconds.

Reactions to the dye – Reactions to modern dyes apart from the sensation of warmth are very uncommon. Various reactions and allergies can still occur and the staff are fuly trained and equipped to deal with any reaction which may occur. Reactions may include skin rashes, vomiting, asthma, low blood pressure and disturbances of heart beat and kidney damage. Kidney damage is a real risk but only inpatients with kidney function already impaired. If your kidney function is normal no special precautions are required. If your kidney function is abnormal then patients are routinely given intravenous fluids for some hours before the procedure. This not only dilutes the dye as it passes through the kidneys but also acclelerates the passage of dye throught the kidney lessening the risk of damage. Other treatments have been tried to reduce kidney injury but there is no evidence they are effective.

Damage to blood vessels – this can occur during angioplasty especially if the artery is already badly diseased. The catheter may make a hole in the blood vessel or strip the lining from the blood vessel. Usually these problems can be dealt with by the radiologist at the time of the procedure. If it is not possible to deal with the problem in radiology then an operation may be required.

Nerve effects– sometimes the local anaesthetic can numb main nerves in the front of the thigh, causing numbness going down the leg and weakness. This will wear off after an hour or so.

Equipment failure – it is theoretically possible for the catheter or its guiding wire to break and leave a fragment inside the body. Procedures are available to deal with this eventuality in the radiology department but occasionally surgery may be required. Failure of technique – occasionally it is not possible to perform the angioplasty. This may be because the artery is too diseased. Sometimes inserting a metal stent to hold the artery open can be helpful, especially for larger arteries in the pelvis.

Blood clots – blood clots can form at the angioplasty site within the artery. These can usually be dealt with by using enzymes that dissolve the lot, but can sometimes be a problem which can cause the circulation to deteriorate.

Kidney damage - Damage can occur to cells in the kidney during an angiogram. This can lead to a deterioration in kidney function if your kidneys are already diseased. The cause of the damage is the special radio-opaque dye that is injected into the arteries so that they can be seen with X-rays. Although other dyes are available (gadolinium) they are probably no safer than conventional dyes. If the doctors know your kidneys may be at risk during an angiogram, they can reduce the risks of damage by giving extra fluids in an intravenous drip before during and after your angiogram.

Can I do anything to help myself ?

You cannot do anything to relieve the actual narrowing in your arteries. However, you can improve your general health by taking regular exercise, stopping smoking and reducing the fat in your diet. Your blood pressure should also be measured and kept under control. These actions will help slow down the hardening of the arteries which caused the problem in the first place, and may avoid the need for further treatment in the future.

How effective is angioplasty ?

The effectiveness of angioplasty depends on exactly which type of angioplasty is performed. In general if the artery is only narrowed, and has not totally blocked, then angioplasty is more likely to be successful and any improvement is likely to last longer. If the length of artery to be treated is short (less than 5cms), then angioplasty is likely to be more successful than if a much longer length of artery is diseased and requires treatment. Angioplasty is more likely to be successful in a large artery (iliac arteries in pelvis) versus a small artery (tibial arteries in calf). Other factors that may be important are the amount of plaque and degree of calcification present. Disease at the origin or start of a blood vessel when it branches may jeopardise success. Apart from technical issues related to the angioplasty, factors such as diabetes and thrombophilia are important in ongoing benefits from angioplasty.

A 1 cm long narrowing in a large iliac artery (in the pelvis) supplying the leg, treated by angioplasty is likely to produce a very good result. In contrast a 10cms blockage in a tibial artery in the calf may be very tricky to treat by angioplasty. Overall angioplasty is technically successful in 90-100% of patients, but the late results can be less impressive. For short arterial occlusions in the thigh the angioplasty site can remain open in 60-80% of patients, but the effect on symptoms is frequently poorly investigated. In less suitable arterial disease the benefits of angioplasty may be considerably less. In a study reporting the results of subintimal angioplasty for severe arterial disease in the legs only 25% (25 in 100) of the arteries were still open at 12 months and results were poorer when segments of artery greater than 10cms long were treated (Smith BM et al, 2005). The patency rates (whether the artery is open or not) of angioplasty are important, but what matters to the patient is whether their quality of life is improved. For instance a patent artery after angioplasty may improve walking distance by 100 metres, but the patient may feel almost as much disability as they did before their angioplasty. If the angioplasty does not improve quality of life and decrease the disability suffered by the patient it is worthless, even if the artery is open and the patient can walk a little further on a treadmill. There is some evidence that angioplasty makes minimal difference to quality of life particularly over the longer term (Spronk et al 2008).

A recent study (BASIL, 2005) has compared angioplasty with bypass surgery in patients with severe limb ischaemia (see bypass surgery). In patients who are suitable for both angioplasty and bypass surgery, an angioplasty first strategy had broadly similar outcomes to surgery, although a more recent analysis indicates surgery is a more durable policy in patients with a life expectancy of more than 2 years. Unfortunately, the majority of patients presenting with severe disease (approximately 80%) are not suitable for both strategies and are more likely to require surgery. In general vascular specialists will attempt angioplasty first in place of surgery if there is a reasonable chance of a good outcome. If this fails bypass surgery is still likely to be an option. In the USA, since 1996, there has been a 40% increase in the use of angioplasty in the leg arteries and a 30% decline in open bypass surgery (Nowygrod, 2006).

Other techniques

Cutting balloon angioplasty (using blades on the external balloon surface to score the inside of the artery), laser assisted angioplasty (cutting through and vapourising plaque with a laser), cryoplasty (using freezing) and mechanical devices to remove plaque have all been tried and found wanting in terms of patency rates and superiority over simple balloon angioplasty.

What is an Angiogram ?

[Extracted from]

The picture below is an angiogram of the blood vessels around the hip joint.

An angiogram is a special form of x-ray that permits the diagnosis of blockages (occlusions) or narrowings (stenosis) in the arteries of the body. During the test, a tube (catheter) is inserted into an artery at the groin. A special radio-opaque dye (contrast medium) is injected down the tube and x-ray pictures are taken as the solution passes along the blood vessels. The whole procedure usually lasts approximately one hour. The arteries take blood from the heart to supply oxygen to muscles and organs and the angiogram will tell your doctor if the supply of blood is abnormal. The procedure is performed by a specialist interventional radiologist or a vascular surgeon.

An  angiogram

Preparation for the angiogram

You will normally be admitted to the ward for a few hours beforehand to check out your general health and to prepare you for the angiogram. On the day of the test you may eat and drink as normal although this may vary between hospitals. If you take regular medications you should take your usual morning doses. The only exception to this might be if you are taking warfarin, in which case you should follow instructions provided for you. Frequently warfarin is stopped before an angiogram, but not always. If you have diabetes and inject insulin you should have your normal food and insulin dose, unless instructed not to. On arrival, you will be seen briefly by the doctor, the test will be explained to you and you will be asked to sign a consent form. This is to ensure you understand the test and its implications. Please tell the doctor if you have had any allergies or bad reactions to drugs or other tests. It would also be helpful to mention to the doctor if you have asthma, hayfever, diabetes, or any heart or kidney problems. Kidney problems can be particularly important. This is because the dye used to outline the arteries can damage the kidneys if special precautions are not taken. If you have any worries or queries at this stage don't be afraid to ask. The staff will want you to be as relaxed as possible for the test and will not mind answering your queries. You will be asked to put on a hospital gown. The test will take place in the x-ray department, a nurse will escort you and stay with you during the test. A small drip will be placed into a vein in the arm or hand during the procedure. This may be used to give intravenous fluids. It may be necessary to trim some of the hair from the groin area before the test to help skin cleaning.

During the angiogram

The radiologist (x-ray doctor) will inject a local anaesthetic into the skin at the groin "freezing" the area. After this injection the procedure should be fairly painless. The long fine tube (catheter) is then inserted into the artery at the groin (common femoral artery), and using x-rays to help, the radiologist manipulates the catheter into the correct position. You will not feel the catheter being moved around your body. X-ray pictures are taken whilst the dye is injected down the catheter into the blood vessels. To be able to take pictures along a length of arteries, the radiologist will move the bed so that different portions of the arteries can be examined. Sometimes angiograms are also performed by placing a catheter in the arteries of the arm (brachial or axillary angiogram).

Some injections may cause hot flushing for a few seconds, and an occasional feeling of wanting to pass urine. When the test is completed the catheter is removed and pressure will be applied to the groin for approximately ten minutes to minimise any bruising. Sometimes small devices can be deployed into the puncture site to seal the hole more quickly eg angioseal, perclose

After the angiogram

You will be taken back to the ward to rest for a few hours. It is important that you lie quietly so that the groin does not bleed again. The nursing staff will check the groin, and foot pulses at regular intervals. If no pulses are present the colour and temperature of the foot is important. Providing all is well, you will be allowed home, but you need someone with transport to take you home, or to accompany you in a taxi. Some patients do require overnight stay. It is important that you rest completely until the next day to ensure that the puncture site in the groin heals up. If after you get home you notice any swelling or bleeding at the puncture site, you should press on this and call your GP's surgery for advice.

When do I know the angiogram result ?

The radiologist and vascular surgeon will look at the x-ray pictures and discuss their findings. They will decide the best form of treatment for you and then write to you, or see you again in the outpatient clinic. The treatment can then be discussed and as always it is the patient who decides whether to proceed with treatment or not. For most patients today angioplasty (see below) will be performed at the same time as angiography and so there will be no need to return for a further procedure.

Haemorrhoid Surgery by Rubber Band Ligation

Rubber band ligation is a common surgical approach for hemorrhoid treatment in today society. This has been adopted as an alternative treatment method, besides the normal surgery. Initially, when the rubber band is applied onto the base of each haemorrhoid, patient will often experience excruiting pain (sometimes, it may hurt for a whole day).

To apply the rubber band ligation technique, a patient has to lie on his, or her side with their knees drawn up to their chest. The physician will use a proctoscope that is inserted into the rectum, to allow room in the anal cavity for the medical tools. A pair of forceps is then used to pull the hemorrhoid through the neck of the ligator (see diagrams) and soon, after it reaches the deeper end, the doctor will release a small rubber band that is attached at the tip of his ligator. This band will act in cutting off the blood supply to the infected vein, which will eventually cause it to dry out and fall off. Recovery period will be between 4 - 5 days.

The use of rubber bands in such treatment has gone way back in history during the time of Hippocrates, where they wrote about tying hemorrhoids off with strings in the olden days.

Normally, after the procedure is over, patients will be sent home and provided with painkiller to ease any discomfort (usually, Ibuprofen). It is important to avoid painkiller such as Aspirin, as there are known ingredients which will cause the muscles and its surrounding tissues to swell, and contract.

Most medical procedures have a number of potential side effects and rubber band ligation is no exception too. There is always a possibility of the elastic band slipping off, or breaking along with pain; bleeding; anal fissure; and infection at the location of their hemorrhoid. Nevertheless, the best advantage to this method will resolve the pain and problem faster, when compared to the other surgical methods. However, this does not guaranteed that it will prevent the growth of future hemorrhoids, although there are cases where some patients enjoyed permanent disappearance of their haemorrhoid.


The Haemoband Multi-Ligator

This is a new device that facilitates the easy Rubber Band Ligation of haemorrhoids. Being disposable and low in cost, it offers a very attractive alternative to current haemorrhoid devices by providing an easy-to-use; ergonomically designed product; and pre-loaded with four rubber bands. This unit has been designed to optimise, simplify and substantially cost-reduce the ligation process. With its innovation (dual function hand grip), operation is simple. Just position the multi-ligator as required and gently squeeze the trigger to induce suction. Continue to pull the trigger to its final position to apply the band. Then, release the trigger to reduce suction and free the haemorrhoid. The multi-ligator is automatically reloaded with the next band ready for immediate use. [Product features : Slim 120mm insertion probe/Low cost/Solo operation/Multi-application/Rapid/Reduces procedure time to under 3 minutes/Accurate/4 pre loaded Latex Free Bands/Reduced patient discomfort/Single use/fully disposable unit and clinically efficient].

Saturday, June 12, 2010

Garage Del Parco in Milan, Italy

Website Review for Garage Del Parco

This is an interesting site which is very simple and easy to browse. It will be very useful for any potential car buyer to find their dream car. At this moment, the choice of vehicles is rather limited and I believe it will be a matter of time, before it will be loaded with plenty of vehicles for sale.

At a first glance, the layout of the site is very user-friendly and the speed of loadingis rather fast. Personally, I felt the whole range of vehicles should be grouped up in different categories. Preferably, based on pricing basis. In this manner, potential buyers can go straight to the category that is within their budget, instead of wasting their time in scrolling and browsing through every single item. It will be inconvenient for end users and they might lose their interest, when the number of vehicles for sale is increased tremendously, in the future.

Judging from the background of this family business, it sounds very established as it was founded since year 1978 and the children are managing it today. All personnel employed in the business seems very experienced in this field and are committed to deliver their best customer service and satisfaction. Importantly, they also owned a fully-equipped and extremely tidy workshop. This is where all vehicles acquired are fully inspected, maintained, washed (internally and externally), polished and even disinfected before they are released for sale. Their workshop is also supported by a team of experienced mechanics, to attend to all enquiries.

When I browse through all the vehicles shown for sale in their home page, their condition appeared almost new and were in almost showroom condition. Anyone who visited this site will surely
be attracted to purchase, if the price is within their budget. To achieve this, it is the company's policy to acquire only good condition vehicles from the sellers.

Interestingly, this company also offers many benefits to potential buyers. For the interested buyer, they even permit them to test drive their preferred choice of vehicle for a day, before deciding whether to purchase and if they are short of cash, end financing is also available (with conditions applied). How could anyone resist such personalised service ? Their main mission is to provide good customers satisfaction and repeated customers too. For those who wishes to trade-in their existing vehicles, such arrangement can also be discussed.

All their vehicles sold are carrying at least a year warranty and for those vehicles that are less than 08 years old, their warranty period will even increased to 02 years. This is a superb committment to capture loyal customers.

Overall, their site carries a fast loading time. The layout has been simple and quite eye catching. However, the host should try to change the overall font to ‘Arial’ as the existing one is quite boring and unpleasant, especially when someone has to spend a longer time browsing it. Since there are a lot of empty spaces, I would suggest the host to upload a few nice scenic photographs of Milan and make their website design more interesting.

If given a chance, I would change the bright maroon color of their background to something more lighter, so that it can match with the color tone of the vehicles posted for sale. The existing bright color is quite irritating to the eyes when a potential buyer is browsing their home page. Incidentally, the character font should be in smaller letter (normally, capital letter is avoided) and the picture of each vehicle should be slightly larger too. The later request is to attract the attention of the buyer when it is easily noted.

It is quite interesting to note that the host is very committed in his business. Every detail is easily available with just one click at the links, located at the left hand side of their page. Also, I was particularly impressed with the testimonials posted by previous buyers.

In conclusion, I think the host has accomplished a great task in promoting themselves and with their commitment to deliver their services, I wish them every success !

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