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Young Osprey's First Flying Lesson
A windy day is perfect for testing out those wings without having to leave the nest. Beautiful birds.
By: Sarcasmonaut | Comments: 27 | Views: 1762 | Votes: 18 | Shared: 0
Location: Boulder, Colorado, United States | Leaked: 8 hours ago in Other Entertainment
First-Person Flying Experience Takes Viewers to Cloud Nine
After spending his school days staring at planes, Jerry decided to learn how to fly. In this video, he takes flight above Kalakhang Maynila in the Philippines and took his experience one step further.
By: Viral Video | Comments: 7 | Views: 1062 | Votes: 0 | Shared: 0
Leaked: 8 hours ago in Other Entertainment
Pilatus PC-12 Takeoff and Fly-By
A great looking Pilatus PC-12 C-FWBK is seen taking off from CZNL in Nelson, British Columbia. Enjoy a nice close-up taxi and take off view followed by a fly-by over the airport! I hope you all enjoy
By: TheHDAviation | Comments: 4 | Views: 788 | Votes: 0 | Shared: 0
Location: Nelson, British Columbia, Canada | Leaked: 6 days ago in Vehicles
Red Arrows Fly With Airbus at Farnborough Air Show
At the 2016 Farnborough Air Show, attendees were treated to something truly rare and special. The famous Red Arrows crew participated in a fly-by with an Airbus A350 XWB. The sight of the massive pass
By: Viral Video | Comments: 5 | Views: 606 | Votes: 0 | Shared: 0
Leaked: 6 days ago in Other Entertainment
Fly 'Red Wings' - Moscow Plane Crash
Moscow, December 2012
By: spud4x | Comments: 16 | Views: 2572 | Votes: 3 | Shared: 0
Location: Russia | Leaked: 4 days ago in Vehicles
Cyclist meets her maker in spectacular fashion
Crouching tiger hidden cyclist style. Happened in Thailand near Mae Hia. source
By: skinner | Comments: 42 | Views: 5495 | Votes: 7 | Shared: 0
Location: Mae Hia, Chiang Mai, Thailand | Leaked: 3 days ago in WTF, Vehicles
Speedflying in Eastern France
In the French town of Chamonix, these paragliders demonstrated their insane speedflying skills as they performed barrel rolls, skimmed along the water, and even flew against a cable car that was goin
By: DailyPicksandFlicks | Comments: 7 | Views: 1367 | Votes: 4 | Shared: 0
Leaked: 4 days ago in Other Entertainment
Solar-powered plane takes off on final leg of epic challenge
An aircraft – powered by solar energy – has left Egypt on the last leg of the first ever fuel-free flight around the world. Solar Impulse 2 climbed out of Cairo on Sunday in darkness, bound fo
By: Euronews | Comments: 21 | Views: 1184 | Votes: 2 | Shared: 0
Leaked: 1 day ago in Other News
Exclusive: The First Indian Air Force Women Who Went Into Combat
It's a story that has been forgotten in the fanfare of India's first women fighter pilots being commissioned into the Indian Air Force earlier this year. India's first women combat aviators
By: RTTN Channel | Comments: 20 | Views: 759 | Votes: 1 | Shared: 0
Leaked: 2 days ago in Other News
The Wall Street Journal: Russia Bombed Base in Syria Used by U.S.
An outpost near the Jordanian border that is used by U.S. and British special forces was hit by the airstrikes last month When Russian aircraft bombed a remote garrison in southeastern Syria last m
By: Namenlos | Comments: 34 | Views: 2545 | Votes: 7 | Shared: 9
Location: Syria | Leaked: 3 days ago in Syria
30 astonishing questions Turkey coup attempt leaves us with
1. There is no precedence in history of a coup which was done by blocking bridges. Rather than closing the Bosporus Bridge, the coup-plotters could have used the same military force to preven
By: UraniumConversionPlantNr4 | Comments: 22 | Views: 1493 | Votes: 1 | Shared: 0
Leaked: 3 days ago in Other Middle East
Skynet is about to go live! - US Marines Test Awesome New Futuristic Military Combat Robots In Action
US marines from 3rd Battalion, 5th Marine Regiment test the awesome futuristic new MAARS, MUUT, PD-100, Instant Eye & PGI Phantom military combat robots developed by the Marine Corps Warfight
By: Aker04 | Comments: 163 | Views: 11425 | Votes: 9 | Shared: 18
Leaked: 4 days ago in Weapons
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MP3 Developments MP3Producer
MP3Producer is an app that rips CDs to create MP3 files.
- Rip CDs to MP3, OGG, WMA or wave files quite well
- Free alternatives available
Bottom Line
If MP3Producer were being given away, we'd probably give it a marginal nod, but with free programs such as BonkEnc, Windows Media Player, and others around we just can't see forking over $40 for any ripping program, let alone one with a cumbersome interface.
Price$ 39.91 (AUD)
Best Deals (Selling at 1 store)
- 2GB MP3 Player - Red 75.99
MP3Producer is an app that rips CDs to create MP3 files.
With the myriad of programs out there for ripping CDs and creating MP3s, you have to work hard to stand out from the crowd. We wish we could say that MP3Producer does, but at best it's a faceless man-in-the-middle product.
Not that MP3Producer doesn't rip CDs to MP3, OGG, WMA or wave, or transcode between those formats as stated.
It does all of that quite well, as a matter of fact. However, there are free programs that work just as well and MP3Producer forcing you to switch between CD to OGG, CD to WMA, WAV to OGG, etc. modes to deal with various file types becomes tiresome in a hurry.
Most programs let you add files en masse without regard to file type. If they don't support them, they just don't load them.
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text:
Vascular Lesion Embolization Imaging
- Author: Orhan Konez, MD; Chief Editor: Kyung J Cho, MD, FACR, FSIR more...
Embolization is defined as the "therapeutic introduction of various substances into the circulation to occlude vessels, either to arrest or prevent hemorrhaging; to devitalize a structure, tumor, or organ by occluding its blood supply; or to reduce blood flow to an arteriovenous malformation."[1]
Embolization, or embolotherapy, is performed by radiologists who have completed advanced postresidency training (fellowship) in interventional radiology (see the images below).[2, 3, 4, 5, 6, 7]
Embolization may have 3 therapeutic goals:
- An adjunctive goal (eg, preoperative, adjunct to chemotherapy or radiation therapy)
- A curative goal (eg, definitive treatment such as that performed in cases of aneurysms, arteriovenous fistulae [AVFs], arteriovenous malformations [AVMs], and traumatic bleeding)
- A palliative goal (eg, relieving symptoms, such as those of a large AVM, which cannot be cured by using embolotherapy alone)
Medical conditions treated by using embolotherapy can be grouped as follows:
- Vascular anomalies (eg, AVM, AVF, venous malformation [VM], lymphatic malformation [LM], and hemangioma)
- Hemorrhage (eg, pseudoaneurysms and GI tract, pelvic, posttraumatic, epistaxis, and hemoptysis bleeding)
- Other conditions (eg, tumors, varicoceles, and organ ablation)
Embolization Materials And Substances
Materials used in embolization include coils, ethanol, sodium tetradecyl sulfate, cyanoacrylate, polyvinyl alcohol (PVA), microspheres, and gelatin sponge (Gelfoam), among others.[8, 9, 10, 11, 12]
Coils can be grouped into microcoils and macrocoils. Macrocoils, also called Gianturco coils, were first introduced in 1975. Coils have the advantage of being precisely positioned under fluoroscopic control. Occlusion occurs as a result of coil-induced thrombosis rather than mechanical occlusion of the lumen by the coil. To increase the thrombogenic effect, Dacron wool tails are attached to coils. The coils are available in many sizes and may be delivered through commonly used angiographic catheters (4-5F).[13]
Microcoils (platinum coils) can be delivered through microcatheters (2.2-3.5F). They can be particularly useful when superselective coil embolization is required. Microcoils are highly thrombogenic, radiopaque, and biocompatible. Again, the thrombogenic effect primarily results from the addition of silk or synthetic fibers, not from the coil.[14, 15]
Collateralization is a potential disadvantage of coil embolization, and it can result in the persistence of flow into the vascular territory of the vessel that was embolized with the coil. Additionally, when proximal occlusion occurs with coil embolization, repeat intervention via the same artery becomes difficult, if not impossible. Mechanically and electronically detachable coils are currently available.
Ethanol (absolute alcohol) is the most commonly used liquid agent. Embolization with absolute alcohol has a direct toxic effect on the endothelium that activates the coagulation system and causes the microaggregation of red blood cells.
In the treatment of vascular malformations, ethanol has demonstrated its curative potential compared with the palliative effect seen with other embolic agents. Occlusion of the lumen occurs within minutes or days. Ethanol can be damaging if it reaches the capillary bed of any given tissue (eg, skin), and it usually causes significant soft-tissue swelling, which may subsequently cause compartment syndrome (nerve compression).
When absolute alcohol is mixed with a contrast medium and when small catheters are used, superselective vascular embolization can be safely performed under fluoroscopic guidance. Ethiodized oil (Ethiodol), an oily contrast medium, is used most commonly.
If large amounts of absolute alcohol enter the systemic circulation, toxic effects can occur. These include central nervous system (CNS) depression, hemolysis, and cardiac arrest. Slow, careful injections by using balloon occlusion arterial catheters for delivery and by applying manual compression on the draining veins (or tourniquet control) or balloon occlusion of the draining system may decrease alcohol washout from the lesion and reduce acute systemic toxicity. Ethanol 1 mg/kg is the maximum amount that can be injected during a single session.
Sodium tetradecyl sulfate
Sodium tetradecyl sulfate (Sotradecol) is another sclerosant. This contains 2% benzyl alcohol and is commonly used for VMs and varices. Use of this agent is less painful for the patient, and it is considered to be less toxic then absolute alcohol. Therefore, some lesions can be treated without general anesthesia.
Sodium tetradecyl sulfate can be used as a sclerosant in various concentrations (1-3%); however, manufacture of this agent has been discontinued in the United States. This author has begun using ethanolamine oleate (Ethamolin; Questcor Pharmaceuticals, Hayward, Calif) instead of sodium tetradecyl, with the same indications.
Cyanoacrylate, or N- -butyl-2-cyanoacrylate (NBCA) is a rapidly hardening liquid adhesive often referred to as glue. The substance hardens (polymerizes) immediately on contact with blood or other ionic fluid. Polymerization results in an exothermic reaction that destroys the vessel wall.[2]
Penetration of the capillary bed causes severe tissue injury. Because of the rapid polymerization, coaxial catheterization, precise positioning of the delivery catheter, and considerable skill are required for NBCA embolization. When a suitable location is reached by using a microcatheter, the catheter is flushed with 5% dextrose to clear it of any blood or contrast medium.
Under real-time fluoroscopic control, a mixture of NBCA and oily contrast medium is delivered. As soon as a cast of the vascular tree is seen fluoroscopically, the delivery microcatheter is quickly removed so that the catheter tip does not adhere to the vessel. Again, the catheter is flushed quickly with 50% dextrose so that it can be reused during the same procedure.
A foreign-body inflammatory reaction is the primary disadvantage of the use of this embolic material.
Polyvinyl alcohol
PVA is obtained by the reticulation of PVA (Ivalon) with formaldehyde. PVA is available as particles with a large range of sizes. For sizes as large as 710 μ m, a microcatheter can be used as a delivery catheter.
Successful PVA-particle embolization depends on the formation of a thrombus in which a large proportion of the embolized vessel is filled with thrombus rather than PVA particles. Histologically, this agent causes intraluminal thrombosis associated with an inflammatory reaction, with subsequent organization of the thrombus. PVA is considered a permanent embolic agent because of the low frequency of recanalization of the embolized vessels. PVA is not absorbable, and it likely produces permanent occlusion.
PVA is usually administered in a mixture of contrast medium and isotonic sodium chloride solution under fluoroscopic guidance. Aggregation of PVA particles can be minimized by using dilute contrast medium in a matched-density suspension; for example, Omnipaque and sodium chloride solution can be used in a ratio of 1:0.4 for contour particle suspension. PVA particles have a tendency to aggregate within the vessel once administered, potentially leading to an occlusion that is more proximal than intended. Diluted mixtures advance more distally, whereas concentrated mixtures cause more proximal occlusions.
Tris-acryl gelatin microspheres
Microspheres (Embosphere; Biosphere Medical, Rockland, Mass) are biocompatible, hydrophilic, nonresorbable, and precisely calibrated particles produced from an acrylic polymer and impregnated with porcine gelatin. Microspheres are available in sizes of 40-1200 µm, and they are supplied in apyrogenic sterile sodium chloride solution.
To provide the desired clinical outcome, appropriately sized microspheres and delivery catheters must be chosen to best match the size of the target vessel. For example, when AVMs are being embolized, choose a particle size that occludes the nidus without passing into the systemic circulation. These particles typically do not aggregate, and this is a distinct advantage of microspheres compared with PVA particles.
Microspheres can tolerate temporary compression of 20-30% to facilitate their passage through the delivery catheter. When a coaxial technique is used, a 2.5-3.0F microcatheter allows the passage of microspheres as large as 700 µm for embolization.
Because microspheres are not radiopaque, contrast enhancement must be used to monitor embolization under fluoroscopic guidance. Microspheres are considered permanent embolic particles.
Gelfoam is a sterile gelatin sponge intended for application to bleeding surfaces for hemostasis or for use as a temporary intravascular embolic material. It is a water-insoluble, off-white, nonelastic, porous, and pliable material. Gelfoam may be cut without fraying, and it can absorb and hold many times its weight in blood and other fluids.
Gelfoam is usually absorbed completely (depending on the amount used, degree of saturation with blood, and site at which it is used), with little tissue reaction. When used as an embolic material, the vessel recanalizes within a few weeks. Gelfoam is supplied in a sterile envelope enclosed in an outer peelable envelope. It is available in sizes from 12 mm to 6 cm.
Other materials
Other less commonly or previously used materials include balloons, microfibrillar collagen (Avitene), autologous materials, ethylene vinyl alcohol, alginates, phosphoryl choline, sodium morrhuate, hot contrast material, and 50% dextrose.
Vascular Anomalies
Vascular anomalies are grouped into 2 categories: hemangiomas and vascular malformations. Vascular malformations are categorized further as high-flow lesions (AVM, AVF), low-flow lesions (capillary malformation, VM, LM), or combined vascular malformations. Embolotherapy with a variety of embolic materials is commonly used in the treatment of vascular anomalies.
Hemangiomas are benign tumors that require no treatment in most patients. In rare patients, embolization may be necessary (particularly in patients in whom therapy is needed urgently) because of spontaneous hemorrhage or functional abnormality caused by the extreme size of the lesion or the particular anatomic location or because of significant congestive heart failure. In addition, embolotherapy is considered useful prior to surgical resection in select patients and in patients in whom a hemangioendothelioma causes Kasabach-Merritt phenomenon (platelet trapping). Embolotherapy of a hemangioma or hemangioendothelioma can be performed with the use of particles.[16]
The goal of embolotherapy is to block a large percentage of the tumor vessels, thereby preventing further trapping and destruction of the platelets and hastening involution of the lesion. Some tumors may require several sessions of embolotherapy because of revascularization of the tumor. Infantile hepatic hemangioendotheliomas, a variant of infantile hemangioma, usually are multiple and frequently are complicated by congestive heart failure. In the clinical setting, the goal of embolotherapy is to reduce hepatic arterial flow, which sufficiently relieves high-output cardiac failure. A variety of embolic materials have been used. Coils are an infrequently used embolic agent for hemangioma. In some patients, embolization of other nearby arteries (eg, intercostals) may also be necessary.
Arterial portography should be performed to exclude the possibility of feeders from the portal system. A rare entity called noninvoluting hemangioma, which is found in the adult population, may also respond to transluminal embolization (usually with particles such as PVA or microspheres). This procedure is performed mostly to improve the cosmetic appearance.
Arteriovenous malformation
AVMs are typically characterized by a nidus of abnormal vessels in which shunting of arterial blood to veins occurs. These vascular anomalies are usually present during childhood but often demonstrate a sudden increase in size in response to trauma, hormones, or other stimuli. Although a clinical grading system has been used among surgeons, no grading system has been developed for imaging. Most AVMs can be managed by transcatheter embolization and/or sclerotherapy.[17] Some focal AVMs can be treated by surgical excision. Proximal embolization or ligation of the feeding arteries usually worsens matters because of subsequent recruitment of collaterals, and transluminal embolization of the nidus cannot be performed afterward. The collaterals that develop are more problematic in terms of transcatheter treatment; however, embolization of the feeding arteries may be indicated prior to surgical excision.[18, 19, 20, 21]
Whenever possible during primary embolotherapy, the nidus should be embolized. In the author's practice, absolute alcohol is most commonly used, and it is the most effective agent in the treatment of AVMs. If the nidus cannot be reached through the feeding arteries, direct percutaneous cannulation of the nidus can be attempted. In selected patients with AVMs, another therapeutic approach is embolic occlusion of the venous outflow.
Cervicofacial AVMs
For dental arcade AVMs, spontaneous or catastrophic hemorrhage during tooth extraction is a common presentation. Embolization of the AVM in this region requires superselective catheterization of the involved branches of the external carotid artery and other regional arterial branches (eg, thyrocervical trunk) using microcatheters and the coaxial technique.[3, 22]
Embolotherapy can be performed with NBCA, alcohol, particles, and/or microcoils, depending on the nature and extent of the malformation. Gelfoam can also be used for preoperative embolization. Patients with dental AVMs associated with acute bleeding and loose teeth should undergo embolization immediately prior to tooth extraction. Possible complications of embolotherapy of cervicofacial AVMs include stroke, nerve paralysis, skin necrosis, infection, blindness, and pulmonary embolism.
Extremity AVMs
In the extremities, AVMs can be diffuse and may involve the entire extremity (Parkes-Weber syndrome). Extremity AVMs typically present with extremity-length discrepancy, high cardiac output, pain, and ulceration. Extremity lesions can be treated with multiple embolizations and/or surgical resections or amputation of the extremity. Incidentally, some small extremity AVMs can be identified in the elderly population and usually are of uncertain etiology and clinical significance (see the images below).
A detailed preembolization angiographic examination is important for mapping the feeders and draining veins. During the injection of contrast material, the injection rate and duration should be adjusted so that arteriovenous connections can be identified accurately. A high injection rate in a short period is appropriate for AVMs.
Selective catheterization with microcatheters is required to reach the nidus of the AVM (see the images below).
Significant complications of embolotherapy possibly include skin necrosis (blisters), nontarget embolization (which also includes pulmonary emboli), and systemic sclerosant toxicity if a liquid agent (eg, alcohol) is used.
Pulmonary AVMs
Pulmonary AVMs also are called pulmonary AVFs. They have a high association with Osler-Weber-Rendu syndrome (also called hereditary hemorrhagic telangiectasia syndrome). Symptoms may include dyspnea, cyanosis, and clubbing. Paradoxic embolization may cause stroke or brain abscess. This anomaly can be classified as simple or complex on the basis of the number of feeding and draining veins. In simple lesions, a single artery and vein are involved; in complex lesions, 2 or more supplying arteries and 1 or more draining veins are involved.
Most pulmonary AVMs (80%) are simple. Although a surgical approach (thoracotomy and resection) is the traditional mode of therapy, transcatheter embolization is currently a preferred alternative. Transcatheter embolization offers significantly reduced morbidity and mortality rates, particularly in hereditary hemorrhagic telangiectasia syndrome.
Possible complications of embolotherapy include nontarget embolization in the systemic circulation (through the AVM shunt) or in other noninvolved pulmonary arteries. Therefore, properly sizing the coil to the feeding (afferent) artery is essential. A preliminary detailed angiography is essential for mapping the feeders and draining veins, paying particular attention to the size of the feeders. Basically, a successful embolization is accomplished by nesting 1 or more coils in the feeding artery, which occludes flow through the AVM shunt.
Generally, feeding arteries larger than 3 mm should be embolized. Feeders smaller than 3 mm have low risk of paradoxic embolization and should be left out unless they are simple and straightforward technically. A coil that is 2- to 3-mm larger than the feeding artery is usually selected. If the feeding artery is large in caliber (>12 mm), a balloon occlusion of the proximal artery via a second groin puncture can be used for a more controlled coil deployment. Postembolization syndrome can occur and is characterized by pleuritic chest pain, pleural fluid, atelectasis, fever, and leukocytosis.
Arteriovenous fistula
AVFs are relatively large arteriovenous connections and may be congenital or secondary to trauma, surgery, or underlying vascular abnormality (eg, neurofibromatosis).[23] AVFs may be seen in any part of the body. A patient may present with cardiac failure, localized growth disturbances, neurologic deficits, and ischemic changes. Unlike AVMs, AVFs can be cured with embolotherapy. The embolotherapy technique used depends on the size, location, and hemodynamics of individual lesions. The goal of embolotherapy is to occlude the fistula and the immediate draining vein.
Embolization can be achieved by using coils, balloons, or tissue adhesives. Gelfoam or particles are not appropriate for use in AVF embolization. Detachable coils or balloons are ideal because these embolic materials can be positioned optimally before they are detached. Balloons also have the advantage of conforming to the size and shape of the abnormal vessels. Microcoils have several advantages over macrocoils. They are nonferromagnetic, they are delivered via microcatheters, and they cause no significant artifacts on subsequent MRI studies.
Microcoils can be dislodged; however, this complication can be minimized by performing flow-control techniques (eg, balloon occlusion, tourniquet, or blood pressure cuff control). The other disadvantage of coil embolization is that the clot that forms around the coil may dissolve, resulting in recanalization. Appropriate nesting of several coils (packing) can minimize recanalization. Also, thrombosis can be augmented by soaking the coils in thrombin before deployment or by injecting sclerosants around the coils. If adequate coil packing cannot be accomplished, tissue adhesive can be effectively used in combination with coils. Covered stents have great potential for replacing coil embolization of the involved vessel in the treatment of AVFs.
Venous malformation
VMs are the most common type of vascular malformations and can vary significantly in size and clinical presentation. These lesions (usually distinguished by a bluish discoloration with swelling and pain) may also be associated with systemic syndromes such as blue rubber-bleb nevus syndrome or Maffucci syndrome. Sinus pericranii (communication between intracranial and extracranial venous drainage) is also commonly associated with craniofacial VMs. These lesions can be treated with embolotherapy (sclerotherapy) and/or surgical excision. The type of treatment used depends on the morphology, size, and location of the malformation.
A preliminary venogram is usually obtained to evaluate the deep venous system and to determine if any communication exists between the VM and the extremity veins. In particular, a venogram is performed on extremity VMs (see the image below).
The lesion is localized by using ultrasonography, and the largest-appearing cystic portion of the lesion is selected. Then, the lesion is accessed by using real-time ultrasonographic guidance and a small Angiocath needle (typically, 20-22 gauge). The lesion is studied with contrast agent injections under fluoroscopy as well as digital subtraction angiography (see the image below).
Subsequently, sclerotherapy is performed by using ethanol (absolute alcohol) or sodium tetradecyl mixed with a contrast medium (Ethiodol or iodinated contrast) under real-time fluoroscopic control.[24]
Several types of hemorrhage can be treated with embolization. Examples include hemoptysis; epistaxis; and GI tract, postpartum pelvic, posttraumatic, and iatrogenic hemorrhage (eg, postbiopsy or nephrostomy tube insertion).
GI hemorrhage
Major causes of upper GI tract hemorrhage are ulcer disease, gastritis, Mallory-Weiss tears, and varices. The most common causes of a lower GI tract hemorrhage are angiodysplasia, diverticulosis, and bleeding after endoscopic biopsy. If the bleeding source is identified on arterial angiogram (see the images below), the patient is treated by using either intra-arterial vasopressin infusion (Pitressin) or embolization of the bleeding mesenteric artery.
Embolization is usually the first line of treatment in patients with upper GI tract bleeding and is used as the second line of treatment in patients with lower GI tract bleeding (usually used if vasopressin treatment fails).
Embolization in the arcades proximal to the bleeding vasa recta is recommended to minimize the risk of bowel necrosis. The most commonly used embolic agents are coils (macrocoils or microcoils) and Gelfoam pieces (torpedoes). Coil embolization is particularly helpful if the bleeding is caused by focal vascular abnormalities such as a false aneurysm. Some interventional radiologists have also used PVA, although the use of PVA or other particles should be avoided because of the risk of bowel infarction. After embolization, control angiography is performed to determine if bleeding (contrast material extravasation) continues via any collaterals. The primary advantage of embolotherapy is the immediate cessation of bleeding without prolonged catheterization (unlike vasopressin infusion therapy).
Pelvic hemorrhage
Intractable pelvic hemorrhage, either posttraumatic or postpartum, should be approached in a similar interventional fashion. A surgical approach to control active bleeding in acute trauma setting is usually not favored. Detailed angiographic examination with superselective injections in the branches of the internal iliac artery is mandatory. Embolization can be performed by using an autologous blood clot, Gelfoam torpedoes, PVA particles, cyanoacrylate (glue), coils, or detachable balloons. At the capillary level, embolization with small particles or Gelfoam powder is contraindicated (because of the elimination of collateral flow, which results in massive tissue necrosis).[25, 26]
A specific anatomic relationship between the fracture site and the affected vessel often allows embolization of the branch (frequently the obturator artery) even when no obvious bleeding site is detected. In patients with intractable puerperal hemorrhage in whom no bleeding site is noted on angiograms, limited embolization of the branches of the anterior division of the internal iliac artery (particularly of the uterine artery) usually is performed with temporary agents (either autologous blood clot or Gelfoam). In particular, liquid or particle embolization of the inferior gluteal branch of the anterior division should be avoided to minimize the possibility of sciatic nerve injury. (This branch supplies muscles of the thigh and buttocks and the sciatic nerve.) In addition, embolization of the posterior division of the internal iliac artery should be avoided because of the risk of gluteal necrosis.
Hemoptysis is considered massive when at least 300 mL of blood is lost in less than 24 hours, and it may be life threatening. Common causes of massive hemoptysis are cystic fibrosis, bronchiectasis, tuberculosis, and aspergillosis. Malignancy is rarely a cause. Surgical intervention is usually not feasible because of severe pulmonary disease; therefore, embolization of the bleeding bronchial arteries can be life saving.[27]
Bronchial arteries are variable. They usually arise from the descending thoracic aorta between thoracic vertebrae T4 and T7. The right bronchial artery arises from the intercostobronchial trunk in most patients (>90%). The left bronchial artery usually arises directly from the aorta and is multiple in most patients. Occasionally, the right and left bronchial arteries arise from a common trunk.
Although some bronchial branches may supply the spinal cord, the most important of these branches is the artery of Adamkiewicz. This artery usually arises from an intercostal or lumbar artery on the left. Other spinal branches from the right intercostobronchial artery, thyrocervical, or costocervical arteries may be identified. A preliminary thoracic aortogram may be performed, which usually shows abnormal bronchial arteries. An aortogram helps in outlining the bronchial anatomy.
Because of potential source of collaterals, a subclavian arteriogram also is obtained, particularly if the upper lung field is involved. Then, the bronchial arteries are catheterized and studied with selective injections. The most common appearance of the abnormal bronchial artery (the bleeding source) is increased caliber of the bronchial artery with some hypervascularity over the lung field (see the image below).
Contrast agent extravasation, shunting from bronchial to pulmonary arteries, or aneurysmal changes in the involved bronchial artery rarely are identified.
Embolotherapy is usually performed with particles (PVA or embospheres) and Gelfoam pledgets. When the decision is made to use particles, appropriately sized particles should be used. Sizes are usually 500-710 µm for PVA and 500-800 µm for embospheres. Use of coils is inappropriate, and absolute alcohol or cyanoacrylate is no longer used for bronchial artery embolization because of the risk of tissue necrosis (bronchial and/or esophageal).
Embolization is performed as selectively as possible (when necessary, by using a microcatheter and coaxial technique) to minimize tissue necrosis and nontarget embolization (eg, spinal artery). Special care should be taken to prevent reflux by injecting the embolic material slowly under continuous fluoroscopic control. Gelfoam pledgets/torpedoes usually are used to occlude the abnormal artery more proximally after particle embolization.
Intractable epistaxis is a nosebleed that does not respond to conservative treatment (nasal spraying of vasoconstrictors, nasal packing, blood transfusion). Etiologies include uncontrolled hypertension with or without superficial mucosal abnormality (eg, Osler-Weber-Rendu syndrome).
Epistaxis can be treated by either surgical means (eg, cautery, vascular ligation) or endovascular embolotherapy. Internal carotid arteriograms are obtained to exclude aneurysms. Then, the external carotid artery is catheterized, and control angiography is performed initially to map the vascular anatomy and to check for the presence of a collateral supply to the intracranial circulation.[28]
During catheterization of the external carotid artery and its branches, vasospasm is a common problem. Nitroglycerin can be used to treat this. The target branch is usually the pterygopalatine division of the internal maxillary artery, which is distal to the origin of the meningeal and temporal arteries. By using a microcatheter, the pterygopalatine division is catheterized and embolized with particles (most commonly PVA). If bleeding is not caused by a neoplastic entity, embolotherapy can be performed in the 250- to 500-µm range. If a neoplastic entity is the cause, the capillary bed needs to be embolized. This embolization can be accomplished by using smaller particles (150-250 µm).
Although the procedure is considered safe if performed by an experienced physician, possible complications can occur. These include ischemia, pain, cranial nerve damage, blindness, and stroke.
Posttraumatic hemorrhage
Posttraumatic hemorrhage can be due to either a blunt or penetrating injury to a vessel, typically arteries in the extremities with penetrating injuries or associated fractures or arteries to the organs (eg, renal arteries, after blunt trauma). Some patients may present after an orthopedic procedure, such as total hip replacement. Pelvic fracture-related uncontrollable pelvic bleeding is a common indication for embolotherapy. An angiographic study is mandatory, not only to aid selecting in the appropriate subsequent embolization procedure but also in planning for possible future surgical interventions.[29]
Coil embolization is appropriate in extremity branch arteries responsible for the bleeding because it offers a fast and permanent occlusion of the vessel. The bleeding vessel should be embolized proximal and distal to the site of arterial injury. Avoid embolization of arteries that endangers limb viability. Hemorrhage or AVF formation after organ biopsy (particularly renal biopsy), or iatrogenic traumatic hemorrhage, is a common complication (ie, iatrogenic traumatic hemorrhage) that can be treated with embolization.
Pseudoaneurysms occur secondary to trauma or infection and consist of the leakage of blood into the confined perivascular space at the site of a vessel wall disruption. A good alternative to surgical repair is transluminal and/or percutaneous embolotherapy. Embolotherapy is the treatment of choice, especially when pseudoaneurysms are not accessible or when the patient is not a surgical candidate because of sepsis or other medical conditions.[30]
Embolic materials used for pseudoaneurysms include coils, detachable balloons, thrombin, Gelfoam, and NBCA. In large-neck pseudoaneurysms, a stent placement combined with coil embolization has been described. If the involved vessel cannot be catheterized or if a pseudoaneurysm is close to the skin surface (typically a pseudoaneurysm in the groin after cardiac catheterization), the pseudoaneurysm can be directly punctured with a fine needle (eg, 22 gauge), and thrombin can be injected. When the involved artery is embolized with coils, the artery also should be embolized distal to the origin of the pseudoaneurysm so that collaterals do not fill the aneurysm.
Other Conditions Treated With Embolization
Malignant tumors
Indications for embolotherapy in neoplastic conditions include preoperative embolization and palliative embolization, which alleviates symptoms, reduces further dissemination, and increases the response to other treatment modalities (eg, radiation therapy). Embolotherapy can be used for many types of malignant tumors.[4] Renal malignancy is the most common type of tumor treated with embolotherapy. In particular, tumors extending into the hilum or other adjacent structures for which surgical removal is difficult are treated by using embolotherapy. In these patients, prior embolization of the tumor shrinks the mass and minimizes blood loss during surgical removal.
Unresectable tumors can be made operable by means of embolotherapy. If the entity is in its end stage (disseminated metastatic deposits), the technique can be used for palliation to control pain and hematuria. Other reported malignancies in which embolotherapy has been used include pelvic malignancies and bone tumors. Hemorrhage resulting from malignancy or radiotherapy (eg, due to radiation cystitis) can be controlled by using embolotherapy.
Uterine fibroids
Uterine leiomyomata or fibroids commonly are found in women in their 30s and 40s. Symptomatic fibroids can be treated by means of medical (medication), surgical, or interventional measures. Medical treatment consists of the use of several medications (eg, nonsteroidal anti-inflammatory drugs [NSAIDs], birth control pills, gonadotropin-releasing hormone analogues [Lupron], and antiprogesterones [RU-486]). Surgical treatment of fibroids includes hysterectomy or myomectomy, both of which require general anesthesia and hospitalization. A myomectomy is a local treatment and has a high recurrence rate.
Transcatheter embolotherapy is a well-recognized therapeutic alternative to surgery with a high patient satisfaction rate and positive therapeutic results. Particles (either PVA or microspheres) are the embolic agents most often used in patients with uterine fibroids. Particle sizes of 355-500 µm and 500-710 µm are used most commonly. Embolization is usually performed with an initial angiographic examination of the internal iliac arteries, followed by catheterization of the uterine arteries and the delivery of particles under fluoroscopic guidance (see the images below).
After the procedure, some pain, fever, and nausea are common (postembolization syndrome), but these are usually tolerable and easily managed. Complications from this procedure are rare. However, infection is a risk after this procedure. The 2 most significant complications are amenorrhea and fibroid slough retention. Embolotherapy may hasten or initiate menopause in a perimenopausal patient whose ovaries depended on the contribution of uterine arterial flow.
Chemoembolization is commonly performed in hepatic malignancies. The technique is used in patients with unresectable liver tumors, particularly hepatocellular carcinoma and metastatic liver disease. To proceed with chemoinfusion/chemoembolization, the patent portal vein with hepatopetal flow is typically required. The bilirubin level should be less than 3 mg/dL to perform chemoinfusion/chemoembolization safely.[31]
Vigorous intravenous hydration is required before the procedure for at least 24 hours. Initially, a superior mesenteric arteriogram is usually obtained to demonstrate whether a hepatic artery (originating from the superior mesenteric artery) has been replaced and to demonstrate patency of the portal vein. Then, the celiac truncus and, subsequently, the common hepatic artery are catheterized and studied to exclude the replaced hepatic arteries and to outline the vascular anatomy (see the image below).
The involved lobar hepatic artery or, more commonly, the first- or second-order branches of this artery is subsequently catheterized by using a microcatheter (eg, Turbo Tracker; Boston Scientific, Quincy, Mass), and the chemoinfusion material is injected under fluoroscopic guidance. The tip of the catheter must be placed distal to the cystic and gastroduodenal arteries. The most commonly used chemoinfusion mixture consists of 10 mL of iopamidol (Isovue), 20 mL of Ethiodol, and 60 mg of doxorubicin (see the image below).
The chemoinfusion is usually followed by embolization with a slurry of gelatin sponge powder (Gelfoam).
Lidocaine is intra-arterially administered to reduce pain after the chemoinfusion/chemoembolization treatment. The delivery catheter must be positioned beyond the cystic and gastroduodenal arteries before the chemoinfusion/chemoembolization treatment is begun. For additional information, see Chemoembolization, Hepatic.
Varicocele is a common cause of male infertility and is characterized by abnormally dilated veins in the pampiniform plexus. Primary varicoceles are due to a retrograde venous flow in the spermatic vein (due to incompetent valves), whereas secondary varicoceles are due to abdominal masses (venous outflow obstruction). Most varicoceles are located on the left side, because the left spermatic vein drains into the left renal vein, whereas the right spermatic vein drains directly into the inferior vena cava (IVC) (stress differences in anatomy). Right varicoceles (particularly unilateral) should be explored with additional imaging to exclude an abdominal mass or, less likely, situs abnormalities.[32]
Patients with varicoceles may present with a dull ache in the scrotum or groin, which is worsened by physical activity or long periods of standing, or varicoceles may be found during an infertility workup. Aside from these populations, adolescent patients without symptoms can be treated to eliminate the risk of developing testicular atrophy. After a varicocele is corrected, an improvement in fertility is expected when embolotherapy is performed for the appropriate indications.
Although both surgical correction and embolization are effective in the treatment of varicoceles, percutaneous embolization of the vein is more appropriate primarily because of its lower morbidity rate. Access can be obtained via either the internal jugular or femoral vein. With the catheter positioned well into the renal vein, a renal venogram is obtained to outline the venous structures.
Catheterization of the left spermatic vein can be problematic because of venous spasms or anatomic variants (5-19%), such as small vein size or intact valves. Catheterization of the right spermatic vein can be problematic primarily because of its acute angle to the IVC and because of variations in its origin (usually immediately anterior and inferior to the right renal vein orifice). With the catheter in the upper spermatic vein, an injection is made while the patient performs a Valsalva maneuver. The vein should be opacified all the way down to the inguinal ring to ensure that collaterals do not reconstitute a varicocele distally. If direction of flow is not antegrade and if contrast material fills the veins below the inguinal ring, the varicocele can be confirmed angiographically (see the image below).
Preliminary angiographic confirmation of the condition is important before embolotherapy. False-positive results can occur if the catheter is wedged or if contrast material is injected too forcefully. During embolotherapy, the catheter is advanced further to the level of the inguinal ring, and the spermatic vein is embolized by various liquids and materials (or a combination). These materials include coils (Gianturco or microcoils), detachable balloons, and sclerosant agents such as alcohol, sodium tetradecyl, boiling contrast, or glue (see the image below).
Particles such as PVA or embospheres are not used because they may cause testicular infarction or may cause nontarget embolization in the lungs. Some prefer a coil embolization distally (just above the inguinal ring) followed by the injection of 2 mL of sodium tetradecyl mixed with 0.5 mL of contrast agent and finally with coiling the spermatic vein more superiorly (usually within 2 cm of its origin). Communication between the spermatic vein and other veins neither constitutes a contraindication to embolotherapy nor appears to affect the results.
Organ ablation
Splenic embolization can be used as a preoperative therapy or as an alternative to the surgical removal of the spleen. Indications include posttraumatic bleeding, variceal bleeding secondary to portal hypertension or splenic vein thrombosis, hypersplenism, thalassemia major, thrombocytopenia, idiopathic thrombocytopenic purpura, Gaucher disease, and Hodgkin disease. Embolotherapy is performed with superselective catheterization/embolization of the splenic artery by using embolic particles while the tip of the catheter is beyond the caudal pancreatic artery. Careful fluoroscopic control of the splenic area is required to limit the total infarction to approximately 60% of the spleen.
Renal embolization is an alternative to surgical removal of the kidney, and indications include end-stage renal disease or renovascular hypertension requiring unilateral or bilateral nephrectomy and renal transplant with native kidneys in situ. The procedure requires selective catheterization of the renal artery with further advancement of the catheter so that the catheter is wedged or with the use of a balloon occlusion catheter to minimize the possibility of embolic material spillage into the aorta. The preferred embolic agents are particles (eg, PVA) and/or liquid agents such as ethanol or NBCA. Postinfarction syndrome is relatively common and characterized by pain, which can be managed with narcotics. This pain usually subsides within 48-72 hours.
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Starke RM, Komotar RJ, Otten ML, Hahn DK, Fischer LE, Hwang BY, et al. Adjuvant embolization with N-butyl cyanoacrylate in the treatment of cerebral arteriovenous malformations: outcomes, complications, and predictors of neurologic deficits. Stroke. 2009 Aug. 40(8):2783-90. [Medline]. [Full Text].
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Home > News > Honda: Nanotech needs more government support
May 25th, 2004
Honda: Nanotech needs more government support
U.S. Rep. Mike Honda plans to introduce a bill next year in Congress to further research into nanotechnology to help spur economic growth in Silicon Valley. Mr. Honda, a Democrat from San Jose, told people at a breakfast meeting Tuesday morning that he is drafting legislation to fund turning basic research into nanotechnology into actual commercial products.
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James Cameron Glad Oscars Not Penalizing Kathryn Bigelow
James Cameron is glad Oscar bosses didn't penalize Kathryn Bigelow's Academy Award-winning movie "The Hurt Locker" after one of the producers was caught campaigning for votes - calling the incident a "dumb mistake". Nicolas Chartier was left red-faced after he emailed colleagues urging them to vote for the gritty war movie in the Best Picture category before the ballot closed on March 2.
He was banned from attending Sunday night's, March 7 star-studded ceremony, but the embarrassing incident failed to curb "The Hurt Locker" 's Oscar success - the movie landed six honors including Best Picture and Best Director for Bigelow.
And Cameron is adamant Bigelow should not be blamed for the controversy. He tells Access Hollywood, "I really couldn't care less about that. It doesn't reflect at all on Kathryn's integrity because the producer made a dumb mistake."
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- Rihanna Swarmed by Her Fans in 'Goodnight Gotham' Music Video
- Tony Parker Welcomes Second Child With Wife Axelle Francine
- Candice Swanepoel Bares Baby Bump While Posing Completely Naked in This Photo


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Gardner Talks Florida; FAU Camps
Jacksonville (Fla.) Atlantic Coast High School wide receiver/defensive back David Gardner holds five scholarship offers coming out of last month's spring practice period. The 6-foot-2 and 174-pound rising senior is hoping summer camps produce a couple more opportunities. Earlier this week Gardner attended camp at Florida and early next week he will camp at Florida Atlantic. "I went to Florida on Monday. I talked to Coach Roper (Florida offensive coordinator Kurt Roper) and had a great conversation. I really did turn a lot of head. Coach T-Rob (Florida secondary coach Travaris Robinson) had me play a little defensive back and Coach Muschamp (Florida head coach Will Muschamp) and Coach Roper had me playing receiver. I am very close to getting an offer I think. I have been keeping in touch with Coach Roper lately. I was blessed with the opportunity to learn some things to take back to my high school," said Gardner of camping with the Gators. Cincinnati, Eastern Michigan, UAB, Maryland and Florida International have already offered Gardner who is also hearing from Iowa State and Minnesota. "FAU is coming on very, very hard. I will be down there Monday. Hopefully with my performance I will be able to get an offer. They said they are just waiting for me to get on-campus and they will make their decision then. They said I'm very high on their board and I am one of the guys they want," Gardner said of his plans for next week. Gardner also plans on attending camp in Jacksonville at FIU's satellite camp. He will also camp at Maryland during the last weekend in June. The talented two-way player spoke very highly of his relationship with Maryland wide receiver coach Keenan McCardell. Please check back with Scout.com for future updates on David Gardner.
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Home of the finest food for 80 years.
Inspired by food, drinks & great service, our teams aim is to compliment any function with a creative yet dedicated approach, whether you are looking for:
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01926 409579 or contact us by email
When you're choosing the food for the most important day of your life, you want to make sure you choose the best. It doesn't get much better than catering by Aubrey Allen.
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Equipped to deliver your event with innovation and style in marquees, fixed sites and outdoor locations.
Our team of award-winning chefs, led by head chef Russell Blackwell, are renowned for using the finest ingredients in delicious, innovative and stylish ways.
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Private events for private clients, one of the broadest services that we offer. Serving the UK's finest.
Private events for private clients can be anything that you want them to be. Working personally with our senior event management team will ensure that you are able to create something that your VIP guests will talk about for years.
Current private clients use our services on boats, in castles, at home and on the road. This service is for the discerning client who needs a little more than usual.
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We are experienced catering & event managers and have enjoyed supporting both small and large scale events held in stately homes, offices as well as outdoors in marquees.
If you are looking for a gala dinner for two thousand or a bespoke party in the grounds of your offices, we are very happy to support with coordinating all elements of this with you.
Pulling together all of your suppliers to create one team to ensure cohesion between decoration, ambiance, catering and services.
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Warwick Castle
We are proud to be the nominated catering partner at Warwick Castle, this is an amazing venue to hold weddings, corporate fun days and many other events.
Ragley Estate
At the heart of the Ragley Estate stands Ragley Hall, one of Warwickshire's most stunning and welcoming stately homes and the perfect venue for your romantic wedding. Ragley Hall dates back to 1680 and is set within 400 acres of picturesque parkland and gardens.
Ashton Lodge Country House
An exclusive use wedding venue in the heart of Warwickshire. Built in the Edwardian era and set in grounds of 3 acres, this wonderful country house provides a unique place to celebrate your special day.
Alveston Pastures Farm
Alveston Pastures Farm is a peaceful setting three miles south of Stratford-upon-Avon in the heart of the Warwickshire countryside. During your event, guests are free to wander in the surrounding countryside around the cottages and enjoy the wonderful photo opportunities of our formal gardens and the maze.
Bordesley Park
Bordesley Park Wedding Venue is an exclusive use venue set in a private family estate in the heart of the Worcestershire countryside. It enjoys panoramic views of the most spectacular landscape Britain has to offer.
Upton House
Celebrating a special event or hosting a party for up to 70 people? Having a National Trust Property all to yourself can be a dream you can now fulfil. Aubrey Allen are now working with Upton House & Gardens to provide wonderful food in a beautiful place at a reasonable cost.
Victorian SuABC
Looking for a unique location to hold your meeting or social event? Look no further than the picturesque Victorian SuABC on the banks of the River Avon opposite The Royal Shakespeare Theatre! Perfect for small meetings, training sessions, product launches and social events, our clubhouse can happily host up to 60 guests.
Kenilworth Castle
With its Elizabethan gatehouse, pretty parterre garden and recreated Elizabethan Garden all exclusively yours, Kenilworth Castle will turn your special day into a truly unique and unforgettable occasion.
Sherbourne Park
Sherbourne Park is an impressive Grade II listed Georgian house set on an estate between Warwick and Stratford upon Avon.
Parochial Hall
Situated in Kenilworth, the Parochial Hall's rooms provide an exceptional setting for parties, wedding receptions, baptism celebrations, anniversary parties, concerts, lectures, activity classes and much more. Hire includes use of the kitchenette and garden.
Springhill House
Springhill House is a delightful lakeside country house located in the Vale of Evesham, the heart of the English Midlands. The house and gardens provide an ideal business and recreational location for weddings, conferences and parties.
From a luxury wedding banquet to an informal buffet, we can create a menu that's perfect for your event.
Call our Events Team now to discuss your plans and see how we can help.
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"I would just like to take this opportunity to thank you and your staff for your support on the Jaguar Immersion Event. The food, service and quick responses to time changes were second to none. We know we asked a lot of you due to the nature of the event and you definitely delivered. We have already received some great feedback regarding the catering so thank you once again!"
Lauren Wray, Launch Events, Jaguar Land Rover
UBT Event – "We look forward to working with you again in the near future"
"Many thanks for the exceptional service from Catering by Aubrey Allen at our recent seminars. We had a lot of excellent feedback regarding the food, and also regarding the attitude of your team and the good organisation of the event. We look forward to working with you again in the near future."
Naomi & Mark Borrows Wedding – "The canapés were wonderful and didn't last long with our guests!"
"Thank you very much for the delicious food we enjoyed on our wedding day and absolutely fantastic service and attention to detail. The canapés were wonderful and didn't last long with our guests ! We were very impressed with how attentive the team were, in particular Andrew who really looked after us. We are real foodies and the wedding breakfast certainly hit the mark. We've received so many compliments about the catering since, we wouldn't hesitate to recommend you and will be Popping into the shop soon to by Warwickshire Whizzer Sausages."
Elkstones 70th Birthday Party – "Everything went like clockwork"
"On the night itself everything was absolutely perfect. Luke the chef was amazing and Andrew, at front of house, kept the evening on an even keel. Everything went like clockwork and the food was spectacular. I can wholeheartedly recommend Catering by Aubrey Allen."
Marcin and Elaine Wedding – "All of your staff were so attentive and helpful, we couldn't have asked for more."
"On behalf of Elaine and myself, I would like to thank you very much for helping to make our wedding reception on Saturday 22 August such a great success. The food was absolutely delicious, both the dinner and the amazing hog roast, and the service was fantastic too. All of your staff were so attentive and helpful, we couldn't have asked for more. We really appreciate all of your hard work, and would like to say a very special thank you to Grainne who was absolutely lovely and ensured that everything was to precision. Please pass on our thanks and appreciation to all of your staff and chefs who contributed to making our wedding celebration very special."
Tracey Foster-Bateman Assoc.CIPD
DCA Design International – "A good time was had by all and made all the better by the fantastic customer service"
"I just wanted to say a huge thank you for supporting the DCA Christmas party again. A good time was had by all and made all the better by the fantastic customer service of you and the team."
Tom Evershed
Warwickshire College – "Highly appreciated and entirely appropriate for our special event."


text:
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Date: date unknown
Description: View down dirt path through a wooded area. Beyond the trees are houses and buildings.
Date: 1962-12-01 ca.
Description: A furrow of a newly plowed field, with a small tree-lined ridge visible in the background.
Date: 1925
Description: View along shoreline of a mill on a river. There is a man loading bags onto a cart at the front. There is a wooded hill on the right.
Date: 1963-10-20 ca.
Description: A small herd of Holstein cows graze in a field. Beyond the cows are cornfields, and in the background are trees on a small ridge line.
Date: 1962-12-01
Description: A valley and farm in the vicinity of Highway F to the west.
Description: View from a bridge looking down a river.
Date: 1909
Description: View of the side of a mill. The mill has a large awning over a loading dock. A man with a beard and a hat stands near the side of the mill.
Date: 1911 ca.
Description: Students pose sitting sideways at their desks in the classroom for a group portrait. The teacher is standing in the back near a door.
Description: Black Earth hearse drawn by horses. Chris Schanel, the Black Earth undertaker, is driving.
Description: View across street of a group of men standing on the sidewalk in front of the bank. A streetlamp hangs from a utility line.
Date: 1955 ca.
Description: Aerial view of downtown, including river.
Description: View of the front of the high school. The grounds feature a hand-pump water well and a flag post.
Description: Two men stand on the sidewalk in front of a boardinghouse [?]. A man and a dog sit on the porch of the Valley House.
Date: 1913
Description: Photographic postcard view of the aftermath of a train wreck. Survivors and onlookers are gathered on and around the railroad tracks.
Date: 1873 ca.
Description: Siri Rustebakke, center, sits in front of a house with her daughters and daughter-in-law and four spinning wheels. Original negative c109. Compare with D31...
Date: 1960-05-22
Description: Two dead foxes hang from a barbed wire fence in a field.
Description: Black Earth hearse drawn by horses. Chris Schanel, the Black Earth undertaker, is driving. In the background on the right a small pig is running near a fen...
Description: View down an unpaved road with shops on either side. A horse and carriage is coming down the street, and another horse and carriage is parked in front of a...
Description: Exterior from street of the State Bank. The building features a large plate glass window, double front doors, and a retracted awning.
Date: 1956-06-24
Description: Group photograph of the Fauerbach baseball team in Black Earth.
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text:
Motorsport Facility Installs Grey-Water Geothermal System
Prairie Hills Motorsport Club, located in Lake Village, Indiana and scheduled to open in the spring of 2009, is using a grey water geothermal system from Encore Energy for heating and cooling. Upon completion, the entire complex will be spread over 872 acres of Northwest Indiana prairie. It's the longest track in the Western Hemisphere, according to a press release.
Encore Energy says that benefits of the grey water system will be realized immediately through reduced cost and time of installation because the system does not require drilling deep bore well fields or trenching
Further incentives include savings on energy bills of up to 70 percent versus traditional air source A/C units, according to Encore.
"Everything about Prairie Hills Motorsport Club is state-of-the-art," said Michael Krupka, CEO of Prairie Hill Motorsport Club. "That includes the track, the facility, and the Encore Energy Systems geothermal technology that will provide comfort in heating and cooling for our staff, members, and guests."
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Rejection stinks. Literally reeks of awful times and no good very bad days. I won't say that I've gone so far as to dress in my exes clothes and do a heightened version of the chop, but I won't say that I haven't, either. There are just some times when crying over Coco is the only thing that makes sense (the woman, not the drink, but I wouldn't say no to both together). The important thing to remember is it's just hair; it grows back. Oh, and also, he's not worth it and another guy will come along and all that jazz. But for serious. Don't chop your hair off. If any of this makes the slightest bit of sense to you, watch Miss U Like Crazy. If it doesn't make sense, watch and all shall be revealed.
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5.0 stars 7 reviews
Avvo Rating: 10.0
Licensed since 2001
I am Certified by the Supreme Court of New Jersey as a Criminal Trial Attorney, and have been involved with the field of criminal law throughout my entire career. There are very few lawyers with this certification - less than .0033% of the lawyers...
Practice areas & skills: Criminal Defense, DUI & DWI, Speeding & Traffic Ticket, Expungement
5.0 stars 5 reviews
Licensed since 1986
I have practiced in the area of Family Law since I graduated from law school in 1986. My first position was as law clerk to Harvey Sorkow, JSC, who was the presiding judge in the family part, in Bergen County at that time. Most of that year was ...
Practice areas & skills: Family, Divorce & Separation, Litigation
5.0 stars 2 reviews
Licensed since 1978
Review: "I was forced to file for bankruptcy, post divorce, as my ex spent like a drunken sailor during the four year separation. I got stuck with 34% of the debt., which I was not able to pay. I was a stay at home mom during the ...
Practice areas & skills: Divorce & Separation, Alimony, Child Support, Child Custody, Marriage & Prenuptials
5.0 stars 11 reviews
Licensed since 1961
Phil Chapman concentrates in counseling New Jersey business owners of small to medium sized companies, including a business that is family owned.
Why is Phil Chapman such an effective business lawyer?
Because so much of effective counseling invo...
Practice areas & skills: Business
5.0 stars 137 reviews
Licensed since 1991
Review: "I actually used Mr. Marootian because of the excellent reviews he received on this website and I couldn't be happier with the outcome of my case. Mr. Marootian kept me informed on all aspects of my case and was very ...
Practice areas & skills: DUI & DWI, Speeding & Traffic Ticket
5.0 stars 8 reviews
Licensed since 1992
Ken Weitzman is the managing partner and founding member of WEITZMAN LAW OFFICES, LLC, which specializes in intellectual property ("IP") law. Mr. Weitzman, who is a registered patent attorney, has the highest Martindale-Hubbell peer review rating ...
Practice areas & skills: Patent Application, Trademark Application, Patent Infringement, Trademark Infringement, Intellectual Property
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On May 10, 2007, Robert A. Bianchi, Esq., was nominated by the Governor of the State of New Jersey to serve as the Morris County Prosecutor. Mr. Bianchi was unanimously confirmed by the New Jersey Senate Judiciary Committee. He was thereafter una...
Practice areas & skills: Criminal Defense, Domestic Violence


text:
RATINGS: 1134 WEIGHTED AVG: 3.46/5 SEASONAL: Winter EST. CALORIES: 207 ABV: 6.9%
Each year, when people are starting to unpack their winter clothes and replenish their firewood, our tiny brewery in the coastal redwoods of Northern California makes seasonal preparations of a different kind. As the cold arrives, we release a unique beverage created to add warmth to even the coldest and darkest of winter's days. Winter Solstice Seasonal Ale begins with a very high original gravity to create a hearty and spicy brew with a deep amber hue and a smooth finish. Anderson Valley Brewing Company wishes you the very best for the holiday season and the New Year.
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systems jobs near Bakersfield, CA
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Staff Pharmacist
PillPack Pharmacy - Bakersfield, CA
Enter prescriptions into pharmacy filling system with high degree of accuracy and efficiency. PillPack is now hiring a Staff Pharmacist for our NEW Bakersfield,...
Diesel Technician/Mechanic
Myers Diesel Repair Inc - Bakersfield, CA
Perform inspection, maintenance and repairs on heavy duty vehicles, such as trucks, trailers, forklifts, pickups, etc. Responsible for diesel engines,...
Information Systems Technician
U.S. Navy - United States
Operating and maintaining global satellite telecommunications systems. Applying diagnostic, corrective and recovery techniques to information systems....
Program Director
College Community Services - Bakersfield, CA
The Act provided funding to develop a loan forgiveness program in order to retain qualified professionals working within the Public Mental Health System (PMHS)....
Acct Rep Owner
Johnson Controls - Bakersfield, CA
And seating components and systems for automobiles. Develops relationship with Systems and Solutions sales organization to exceed customers' expectations....
Licensed Agents: FUN Career - Retirement Planning For Teachers!
MyLifeWerks Insurance Services, LLC - Bakersfield, CA
We have the system, if you have the work ethic and personality. We have a working system in place that provides an agent with a tested game plan which leads to...
Occupational Therapist
Guardian Angel Home Health - Bakersfield, CA
Guardian Angel offers state of the art equipment, electronic charting system in HCHB (HomeCare Homebase,) competitive fulltime salaries, flexible scheduling,...
Network Specialist (CA- Edwards)
CDI Corporation - Bakersfield, CA
Responsible for maintaining LAN - WAN barrier systems to prevent unauthorized access to MTF systems. Expertise in Windows networks, Cisco Systems and HP...
Full Time Occupational Therapist Rosewood Senior Living Community
Consonus Healthcare Services - Bakersfield, CA
Streamlined therapy procedures & systems, as well as state of the art therapy equipment and computer systems for email, time keeping, resident notes & billing...
Senior Manager, Cybersecurity-Embedded Systems
Hyundai USA - California
Senior Cybersecurity-Embedded Systems Manager. ~ Distinguish system security threats and vulnerabilities. , you will support defining US Market cybersecurity...


text:
The 9th annual Indianapolis Bar Association Diversity Job Fair has a strong history of success. Nearly 600 students from 82 schools across the nation have interviewed over the last eight years, and 20 percent have accepted job offers.
Over the course of 24 hours, there will be:
The Boston Lawyers Group (BLG) is a consortium of over 40 of the largest law firms, government agencies, and corporations in Boston. Its mission is to promote the hiring, retention, and professional development of attorneys of color in its member organizations. A primary goal of the BLG is to increase the number of law students of color that member organizations hire for their Boston office.…Find out more »
The National LGBT Bar Association's annual Lavender Law® Career Fair is designed to achieve a sense of community and inclusion for LGBT candidates within the legal profession's recruiting efforts.
This program is designed to provide students with a safe, confidential space where they can ask questions about job search skills, being out on your resume, in interviews and in the workplace, and…Find out more »
The Minnesota Minority Recruitment Conference (MMRC) is an annual event that connects the legal employers in the Minneapolis/St. Paul metropolitan area with top rising 2L and 3L candidates from around the country. Each year's conference and job fair includes around 25 employers and approximately 100 law students. Employers participating in the…
The Delaware Minority Job Fair Committee of the Delaware State Bar Association is pleased to acknowledge the 25th Anniversary of the Job Fair. The committee enthusiastically invites students at your law school to apply for an invitation to participate in the 2016 Delaware Minority Job Fair for Second- and Third-Year Law Students, which will be held on Saturday, August 6, 2016 at Widener…Find out more »
The primary purpose of the Heartland Diversity Legal Job Fair (HDLJF) is to increase the participation of under-represented groups in the practice of law in Kansas City. The founders and organizers of the HDLJF strongly believe that the inclusion of diversity in its many facets, including, without limitation, race, color, religion, gender, gender identity, sexual orientation, national origin,…Find out more »
The 33rd Annual Cook County Bar Association Minority Job Fair will be held at the Embassy Suites, 511 North Columbus Drive, Chicago, Illinois 60611. Please explore the site for more detail.
The objective of the CCBA Minority Job Fair remains unchanged to recruit the brightest and most talented minority law students of color and match them with employers (law firms, corporations, government…
Check Back for UpdatesFind out more »
Perkins Coie will host the 30th Annual Northwest Minority Job Fair at its Seattle Office. Promoting diversity is a core value at the firm, and it embraces diversity as part of its commitment to excellence and community. Embracing diversity allows those at Perkins Coie to draw from varied perspectives and communities in order to deliver excellence to our clients and to attract the very best…Find out more »
A Conversation on Religion, Politics, and Pluralism with Senator John Danforth and Professor John Inazu at Central Presbyterian in Clayton, Missouri. Details to follow.Find out more »


text:
Bullet to the Head misses its target
It is always nice to watch old school action movies. They are movies that do not rely too much on CGI (Computer Generated Images) and the action scenes and stunts are real. This is why I like Arnold Schwarzenegger's latest film, The Last Stand. The movie is entertaining despite its ridiculous plot and stock characters. Plus, I think Schwarzenegger made a good comeback movie despite
his age. However, it was a box office flop. Now we have Sylvester Stallone's new movie, Bullet to the Head, which is Stallone's first solo movie in nearly five years. So, can
Stallone still sell this movie on just his name alone?
Bullet to the Head stars Sylvester Stallone as Jimmy Bobo, a New Orleans hit man who is hired to eliminate corrupt ex-cop Hank Greely. Bobo and his partner Louis Blanchard (Jon Seda) accomplish this task and wait at a local bar to receive their payment from their employers. However, Bobo realizes their employers have set them up when an assassin kills Bobo's partner. Bobo then partners up with detective Taylor Kwan (Sung Kang). Now the two decide to work together, and their investigation leads to a wider conspiracy involving an African gangster, corrupt politicians and dirty cops. This film tries to pay homage to
the mismatched buddy cop action films like Lethal Weapon, Running Scared and Tango and Cash, but it fails to do so. Stallone is one of the kings of 1980s action movie,
but in this flick, he seems to be on autopilot. Director Walter Hill, who jump started the buddy cop film genre with 1982's 48 Hrs., does nothing new here. Given the director's long and interesting career, I had expected something better than
this stale film. The movie treats itself so seriously that it has no time to develop any type of buddy relationship. Kang and Stallone have no chemistry at all, and that really hurts the film. Ultimately, Bullet to the Head does not add anything to the action genre. The movie is based off the critically acclaimed French graphic novel, Du Plomb Dans Tete, but
something obviously gets lost in translation as this is just a generic action movie. There are so many recycled elements in this film from better action movies. This movie has nostalgia on its side, but besides that aspect, this is a cliché action film that can easily be labeled as direct-to-DVD material.
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Kit includes:
♦ 1) Nikon D3300 Digital SLR Camera & 18-55mm G VR DX II AF-S Zoom Lens (Grey)
♦ 2) Nikon 55-300mm f/4.5-5.6G VR DX AF-S ED Zoom-Nikkor Lens
♦ 3) Nikon DSLR Camera/Tablet Messenger Shoulder Bag
♦ 4) Transcend 32GB SecureDigital (SDHC) 300x UHS-1 Class 10 Memory Card
♦ 5) Spare EN-EL14/a Battery for Nikon
♦ 6) Battery Charger for Nikon EN-EL14/a
♦ 7) Xit 12" Flexible DSLR Camera Tripod (Red/Black)
♦ 8) 3 Color Universal Soft Screen Pop-Up Flash Diffusers
♦ 9) Vivitar 52mm UV Glass Filter
♦ 10) Vivitar 58mm UV Glass Filter
♦ 11) PD HDMI to Mini-HDMI (C) Gold Audio/Video Cable (6')
♦ 12) PD ML-L3 Wireless Shutter Release Remote Control for Nikon Cameras
♦ 13) PD 6-Piece Camera & Lens Cleaning Kit
♦ 14) PD 8 SD / 2 MicroSD Memory Card Case
♦ 15) PD Universal LCD Screen Protectors
The Nikon D3300 Digital SLR makes it fun and easy to preserve special moments in lifelike beauty. It features stunning 24.2-megapixel photos and 1080p Full HD videos with tack-sharp details, vibrant colors and softly blurred backgrounds. Like sharing pictures? Your photos can appear instantly on your compatible smartphone or tablet for easy sharing with the optional WU-1a Wireless Adapter. Whether you're creating high-resolution panoramas, adding artistic special effects or recording HD video with sound, the D3300 will bring you endless joy, excitement and memories. This camera outfit includes the versatile AF-S DX NIKKOR 18-55mm f/3.5-5.6G VR II lens with Vibration Reduction technology which provides 4 stops of blur-free handheld shooting.
The Nikon AF-S 55-300mm ED VR Zoom Lens is a 5.5x zoom lens with Vibration Reduction, which reduces the effects of camera shake allowing hand-held shooting at up to 4 shutter speeds slower.


text:
2013-04-09 20:24:00
Julia Gray
Allergy season seems to have hit us a bit early this year, thanks to a mild winter.
Experts say - that you may be doomed to sneeze.
Dr. Adam Williams, an allergist at Bend Memorial Clinic says you might thank your parents if you suffer from allergies.
"that has to do with our genetic predisposition. So people who are going to develop allergies are destined to do so by the genes they inherit from their parents. And only some people have those genes, about 40% of the people have those genes."
Williams says allergies happen when antibodies in the nose and throat react to pollen and dust - and springtime is the worst - because all of the trees and flowers are shooting bursts of pollen into the air, and any slight breeze can send you running for the tissues.
In Central Oregon - juniper is the biggest problem, but there are some very effective products on the market that can help you cope.
"I just want to make sure that people understand that there's lots of good options out there for their primary care doctor or primary provider or allergist if the need arises. And to not suffer needlessly. There'a a lot of options that can help with allergy symptom control."
King Solomon Lane closed between Ferguson Road and King David. (7/25)
Jones Road, full road closure between Bennington Lane and NE Butler Market Road. May 18 – August 18, local access only.
Oregon State University off-site improvements for intersection reconstruction, July 11 – August 3, 7 a.m. – 4:30 p.m., at intersection of Chandler Avenue and Yates Drive.
Orion Drive closed in two locations for sewer work; at the intersection with Avery Lane and between Desert Woods Drive and King Hezekiah Way. From July 11 to Sept. 6. Detours marked.
Valhalla Sewer Relocation Project, Mt. Washington Drive at Shevlin Park Road intersection and North to Regency Street. Nighttime closures with detours marked during roundabout construction. Daytime closures for construction towards Regency Street. 7 p.m. – 7 a.m., July 11 – November.
R.A.B. Construction:
Murphy Road and Parrell Road closed with detours. (9/30)
Powell Butte Highway at Neff and Alfalfa Market Roads (8/31)
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Iran,Iraq ink deal on gas export
22 July 2013 [09:50] -
Iran and Iraq signed a high profile agreement on Sunday according to which Iran will supply natural gas to Al-Baghdad, Al-Mansouriyah and Sadr power plants in Iraq, Tehran Times reported.
The deal was signed by Iranian Oil Minister Rostam Qasemi and his Iraqi counterpart Abdul Kareem Luaibi in Baghdad.
According to the deal, Iran would pump 25 million cubic meters of natural gas per day to the Iraqi power plants.
Based on the agreement, Iran would earn $3.7 billion a year from natural gas exports to Iraq.
Deputy Iranian Oil Minister Javad Owji said on Sunday that officials from the Iranian Oil Ministry had been negotiating for two years with officials from the Iraqi Energy Ministry for exporting gas to the neighboring country. He said negotiations took place in Tehran, Mashhad and Baghdad.
The operation for the construction of the pipeline for transferring the gas has started both in Iraq and Iraq, Owji said, adding that it is predicted the construction of the 227-kilometer-long pipeline in Iran would be completed by September.
He put the cost of the 48-inch pipeline at 342 million dollars.
Before visiting Baghdad for signing the gas deal, Owji said that Iran is seeking to establish a "new troika" for exporting gas to Europe.
Owji also said that Iran's annual incomes from gas exports will reach 8 billion dollars in 2014.
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