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35 Parks near Coupeville, Washington
Camano, Washington 3.77 miles SE
Oak Harbor, Washington 7.36 miles NW
Nordland, Washington 10.13 miles SW
Ault Field, Washington 10.14 miles NW
Warm Beach, Washington 11.06 miles SE
Coupeville, Washington (map) | (360) 678-4519
Sites: 35 | Latest Rate: $1.00 | 11 Reviews
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Dec 2015 - $1.00
The campground area is basically a big, flat spit with a paved main road and gravel sites. None of the pull-through sites have hookups, but the views are outstanding. Generators are allowed during certain hours. The hook-up sites are in a long oblong and are all back-in. There is reasonable space between sites, but there is nothing but grass and gravel between sites, so no privacy. The restroom was spotless. Showers are $.50 (two quarters) for 3 minutes and the lights are on a sensor, so you may be surprised by the lights going out after you start your shower. When the check-in hut is staffed, or the host is available, tokens can be purchased for the showers.
The ferries do not blow their horns to announce arrival and departure, so are fairly quiet, sounding similar to a train when coming and going. There is no noise associated with loading and unloading and it is actually nice to see the boats coming and going.
The beach is outstanding, and the bluff above the campground has an amazing array of WWII structures put in place to protect the coast. You can spend a day wandering among these structures and imagining what life must have been like for the many soldiers stationed here.
We spent New Year's Eve here and it was blissfully quiet. - rfarkle
Oct 2015 - $13.00
This is a very popular state park that is hard to get into without reservations in the summer. In the shoulder season and during the winter there are no reservations and it's first come, first served. On nice weekends, it can be hard to get into even during the off-season. We came in on a Thursday afternoon and all the hook-up sites (water and electric only) were already taken, as were the best view sites. Still, we were able to get a site with a nice view of the water and the ferry landing. In my opinion the non-hook-up sites are the best because they have the best views and are the most spacious. Washington State parks now have a tiered fee system at their parks (at least some of them anyway). This means that sites are various prices depending on whether they are deemed to be Premium, View or Economy sites. The best thing about this park is the easy access to the ferry which goes over to the charming Victorian town of Port Townsend. It's an easy walk to the ferry from the campground and the walk-on fares are very reasonable. There is no dump station at Fort Casey, but there are dump stations at Fort Ebey and Deception Pass State Parks and they are free if you've been camping at Fort Casey. - BruceandKathyWA
Aug 2015 - $30.00
This Park has clean flush toilets/washroom,clean coin/token showers. Sites are very well maintained. The campground host is very good at welcoming you and answering any questions you may have. As well she decorates the park with gardening. Pots and beds of flowers all over the place to make it a home away from home. Deer and small rabbits are abundant and not afraid of people. The ferry is right there but you forget about while looking at the ocean view. Sea lions,porpoises,seals and whales...when the salmon are running. - SSW69
Coupeville, Washington (map) | (360) 678-4636
Sites: 50 | Latest Rate: $29.00 | 7 Reviews
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May 2015 - $29.00
Previous reviewers pretty well said it all, it hasn't changed. Some sites have water & electric, ours didn't, not a problem for a 3 night stay as we have a genny and genny hours are fair at 8:00AM-10:00PM. I Feel price (includes res. and out of state use fee) pushing the limit for a dry site. I would have rated higher if the price was better and a dump station was onsite. - Procarver
Sep 2012 - $34.00
This is a beautiful heavily wooded state park. There are beautiful ocean & sunset views along the bluff trail that starts at the campground. While the views are beautiful very little of beach is accessible due to the high bluffs. Some but not all sites are suitable for big rigs due to a lot of very large trees. The bathrooms and showers were clean. The office was seldom open but staff were seen frequently checking and maintaining the campground. If you have to self check in be sure to check the board at the check in station for available campsites. The showers take tokens that can be purchased from a vending machine at the check in station. All the campsites had a picnic table and fire ring and the campground host kept the sites clean. We enjoyed our time at this park and would stay again. - pawatt
Aug 2012 - $35.00
This was a great camping location. It is a State Park with electric and water hookups. My rating reflects the fact that there is not a dump station. The sites are layed out well, not too close together, with good privacy. There are plenty of trees that provide lots of shade. We really enjoyed staying there. I also knocked down the rating for the showers -- you had to use tokens to (rather than quarters), and the tokens were only available down the hill at the Ranger information station (not a huge deal, but a bit of a pain). Our kids loved exploring the park, the beach, and the rest of the island. - bigkillerbeeman
Oak Harbor, Washington (map) | (360) 279-4500
Sites: 82 | Latest Rate: $25.00 | 23 Reviews
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Sep 2015 - $25.00
Gravel parking lot. Park will be closed Sep 8 for several years for waste water treatment plant construction. Good water pressure, good electricity, lousy WiFi, had to buy extension for sewer hose, hookups in middle of spot. Not much shade.... think big parking lot but close to bay which also means sea gulls. Noisy. Spots wide enough to park tow vehicle next to trailer. - Jim Lee
Jun 2015 - $25.00
This is an excellent park to stay at. On this web site it says it has closed, however the city council voted to keep the park open till July 6th. At that time it will be close for three years to update the sewer facility and the r.v. park. We were able to receive satellite t.v., verizon cell service etc. There is an amazing amount of things to do there. I would recommend Island Cafe if you are going out to eat..Very good. - Mandalayjo
Oct 2014 - $25.00
There aren't many RV parks on Whidbey Island, only state parks that wouldn't work for our 40 ft bus and jeep we travel with, so we felt fortunate to find this one. It's right on the water in Oak Harbor. The park is roomy and clean. Back-in sites only but wide enough to park our jeep next to us. Each site has a picnic table. There are no laundry facilities. We were able to drive all around the island while we stayed here so the park was in a good location for us. Many grocery and service type stores very close by. We would stay here again. - KellyLynnHoff
Port Townsend, Washington (map) | (360) 385-2828
Sites: 48 | Latest Rate: $45.00 | 53 Reviews
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Jul 2016 - $45.00
We have a 45' motor home and must be level in order to extend our slides. Our size and leveling limitations eliminates many choices of locations. If you have a spot right next to the water then the value would be more in line with the price. The only thing this place offers is proximity to Port Townsend and exceptional views. - Don A
Feb 2016 - $45.00
Returned again this year, early season discount, and beach site. Watching ships go by. Staff very nice, restrooms clean. Yes it is an open parking lot, and some sites are better. We had 307, and you can't get much closer to the beach. They charge for wi fi now, and for the costs. It was a disappointment. You bridge your phone, and area has 4G LTE. Town is a short walk to explore. We'll stay again. - NXTSTOP
Oct 2015 - $35.00
Fabulous views of the water and boat traffic. Very clean. Close to cafes, restaurants and town. It is not a huge RV Park and felt a bit close to the rig on the other side of us, but everyone respectful of their own spaces. The cable tv worked great but with such a great town to see, who needs to watch tv. - mwamsley
Port Townsend, Washington (map) | (360) 344-4400
Sites: 85 | Latest Rate: $36.00 | 41 Reviews
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Jul 2016 - $36.00
Ft. Worden is no longer a State Park and managed by a private company. While the gentleman on the phone was incredibly courteous and helpful, I was definitely misled when making a reservation for my 36 foot fifth wheel. The only place a larger RV should park for a campsite is down on the lower beach area. This kind camp host stressed how much they have been attempting to make this fact known to the company that took over the state park. When we arrived in the upper campsite area with our rig, the tree branches were so low that they got stuck on our solar panels! It took us three hours to rectify the situation. We had made a reservation 5 months in advance. Fortunately, the park made it good for us and found us a site for the entire length of our ten-day duration down in the beachfront area. The history alone is enough reason to visit this incredible site. The grounds are beautifully maintained and the hiking trails are diverse and widespread throughout the 450 acre park. Just miles away from downtown Port Townsend, it is a beautiful and serene location full of opportunities for campers of all ages. Campsites down on the waterfront were level, spacious and provided excellent full hook ups with an incredible view of carrier ships, cruise ships, and an occasional Coast Guard protected submarine. Ft. Worden has on site, a terrific little restaurant set up in the old jail house. Named, "Taps", it is a not to miss. We camped here with two dogs and we would return again, but only to the beach area! - RVLife4us
Jun 2016 - $41.00
After much confusion and a visit to the campground host we were told to go back to a central building to register and get a site number. The registration process is poor (no clear signage) for first time visitors. The site we received was great. It was an long, paved, outside, curved pull-through site, quite private, with E/W/S conveniently located. There are a few on-air tv channels. However, the sewer connection is most bizarre as it is a 4", cast iron elbow parallel with the higher ground around it. Most difficult to connect a tradition sewer hose without making a mess. We camped in a travel trailer and would stay here again. - Living Skies
Apr 2016 - $35.00
The campground is open and located on Puget Sound but there is no view of the water. The sites are open, spacious and mostly level. There is beach access for walking and you are very close to Port Townsend. There is easy access to the ferry to Coupville (Whidbey Island) but you should get a reservation before hand on the Washington Ferry website. - Gindy
200 Battery Way Port Townsend, WA 98368 Port Townsend, Washington 98368 (map) | (360) 344-4431
Sites: 30 | Latest Rate: $30.00 | 4 Reviews
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Jun 2014 - $30.00
Very convenient, although sites were closer than we'd prefer. Nice fire pit. Good paved road, convenient restroom. Not well supervised, as one day, these very weird couple appeared out of no where and were very hyper. They quickly cooked their dinner and were scanning all around them, thank goodness they left after that. Otherwise park was ok. Not the beach front, but in the older, upper area. Adequate for a couple nights. Might return, if nothing better found. - Maltaman
Aug 2011 - $45.00
When I checked on reservation website, it showed the park as full. Knowing the lack of accuracy of their system, we came here anyway. Found there to be several sites available, but due to some strange rule, we could only stay one night without a reservation. We found it to be a decent state park campground with the common lack of amenities, 30 amp, no Wi-Fi, no TV, and no sewer for $45/night. Most sites were back, in some pull throughs. The sites were pretty large and even though it was advertised as beachfront, it was 200 yards, plus to the beach. A few sites were shaded but most were not. The large hill west of the park provides shade in the late afternoon. There is a small store on the property but for goods/services you have to drive into Port Townsend [approx 2-3 miles]. Campground hosts were helpful and nice. After the 1 night stay, we moved to a city campground that was directly on the beach and more convenient. If coming here, it is hard to find and after finding the park, it continues to be difficult to find the campground due to ineffective signage. - yachtjockey
Jun 2011 - $40.00
There is good news and bad news about this park. The bad news: You need to have a good GPS and a personal guide to find out where to go and what to do once you get here. Fort Worden is a decommissioned Army post turned into a state park. Don't expect a grand entrance when you get there. It's just a small gate and sign to welcome you. Once inside, we were lost right away. At the first intersection there is a military type sign with arrows pointing right and left with many designations, none of them having anything to do with camping. We just took a guess and started driving around in our big rig trying to figure out where to go. After a while a park ranger pulled along side of us and asked if we were lost. "What do you think?", I said. He said that we would have to go to the park admin office to register first. "Great, where's that?", I asked. He said to follow him and he took us around to the registration office. So, I park our rig and walk back a block or so to the building (through a drizzle) only to discover that the first requirement is that you need to know the license plate numbers of your vehicles. Oh, boy. How many of you know yours? Good thing I brought my cell phone with me to call my wife and ask her to go out into the drizzle and read them off to me. Of course, none of this is explained anywhere, not even in the email that was sent to us confirming our reservation. I finally got registered and paid up -- not cheap. With taxes, extra vehicle and all, it came to $40 per night. They told me that they were going to be full up and that we got the last site available. They were disingenuous about this. Either that or they are inept. We practically had the whole upper campground to ourselves for the two nights that we stayed. Plus, they put us into a site that was very narrow to back into and the pine trees had overgrown the spot and they had to come out and trim some limbs so that we could get our slide-outs out. When we called the office to see if we could move to the site next door, which was more open and easier to access, they said that every site was booked up through the 4th of July. By the time we left on July 1st, there were at least 5 sites wide open all around us. More bad news -- no Wi-Fi, no sewer hookups and, if you want to use their showers it costs 50 cents for 3 minutes of hot water. Not what you'd expect for $40 per night. Well, the good news. The upper campground is not crowded; you have plenty of space. And, the surroundings are woodsy. There is lots of grass and open areas to let kids play and to run your dog. The park is convenient to a lot of things on the Olympic Peninsula and Port Townsend is a quaint harbor town. We would probably not stay here again. - kingfisher
10541 Flagler Road Nordland, Washington 98358 (map) | (360) 385-1259
Sites: 101 | Latest Rate: $41.00 | 6 Reviews
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Aug 2014 - $41.00
Price reflects out-of-state. We stayed in the lower (open beach) campground. Good hookups, clean but institutional (cement) pay showers. Good walking/hiking/biking. Would stay again. - User3773
Jul 2014 - $36.00
We dry camped in the upper loop. Price reflects premium site. Hook ups Are on the bottom loop, but we prefer the tree of upper loop. Bottom Loop is great, on the beach some sites, but to us a little exposed to weather. The old fort has lots of history, good hiking, and mountain biking trails. We happened to camping gear during might us tides, some clarification get, and crabbing was excellent. We would stay again. - NXTSTOP
Mar 2013 - $6.00
We spent three nights here and really enjoyed our stay. The park appears to have undergone significant improvements since the last time we checked it out. We opted for a back-in site with full hook-ups in an open area with views across the salt water to Port Townsend. The old fortifications and gun emplacements make for fascinating exploring. There are also lots of good biking and hiking trails in the park and it's just a relatively short drive into Port Townsend. We would definitely stay here again. The rate quoted is with our Washington state senior discount off-season pass - a great deal! - BruceandKathyWA
Port Townsend, Washington (map) | (360) 385-1013
Sites: 80 | Latest Rate: $25.00 | 2 Reviews
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Jul 2016 - $25.00
A very basic, but reasonably priced campground located near North Beach and Port Townsend. The campground is a large open grassy field with well marked campsites. Some sites are full hookup, some are water and electric only and some are no hookup. Power is mostly 20 amp with a few 30 amp sites. Bathrooms and showers were worn but clean. They do not take reservations, it is self pay, and there is a host on site. There is no cable and no wifi. Since it is a fairgrounds there are lots of places to walk and to run a dog. I would stay here again. - JoyceM
Jun 2012 - $17.00
We stopped here for one night only and found it to be adequate. All sites on grass. We had water and 20-amp electrical for $17. FHU are available for $20. Close to ferry dock and downtown. - rdoghse
Nordland, Washington (map) | (360) 385-2165
Sites: 40 | Latest Rate: $23.00 | 1 Reviews
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Feb 2009 - $23.00
I wanted to stay at the state park, but found this little gem right before the state park. Turns out this place was cheaper! (The rate is the amount including sales tax.) I had to hunt down the manager, but once I found him, he was friendly and I got checked in easily! Cash or check only, no credit cards. The current manager loves to tell stories, just name something and he has a story! This place is "just the basics" and I'm not kidding! No cable, no laundry, no showers, but there was one porta-potty. On the other hand, it has great landscaping, with lots of trees. The RV slots have adequate spacing between them, except for the "pull-through" spots. The "pull-through" spots are in the center away from the trees (in case you have satellite) and are arranged in the "front and back twosie" kind of thing. Although there were lots of RVs there, at the time I was there, only one RV was in each "twosie" so it wasn't bad. It was very quiet! Although there were some "perms" there, they weren't real obvious. I wouldn't recommend bringing families here, nothing for children to do. However, if you just want a quiet getaway with no responsibility and not having to go anywhere, this was perfect. And may I say again, cheaper than the state park! - DXSMac
Stanwood, Washington (map) | (360) 652-7992
Sites: 31 | Latest Rate: $28.00 | 2 Reviews
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Aug 2010 - $28.00
Small park on Puget Sound Waterfront site. No waterfront campsites. One restroom for the park. Water at spigots in 3-4 locations around park. Electric connections are located such that at back-in sites electric is on the left, while pull through sites electric is on the right. This is the reverse of all campgrounds we have ever been to. If you select this park, bring very long extra extension cords. Excellent park for tents. Some Yurts are available. Park ranger service is inattentive due to budget cuts. Camp host was not visibly present. - jake blake
Mar 2010 - $25.00
Very nice county park. The rangers patrol regularly and make sure everything is as it should be. The sites are very spacious and there are a lot of trees to provide shade. The water is a short but rigorous hike downhill where there is a very nice park for walking the dog or sitting by the shore. The beach is rocky. Overall we enjoyed this campground very much. - gary855


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By Carey Kinsolving "I won't call names or hit people," says Heather, 8. That's a start. Being the light of the world doesn't call for knocking everyone else's lights out. Jesus had something different in mind when he told his disciples: "You are the salt of the earth" and "You are the light of the …
Tag Archive: God
Permanent link to this article: http://www.easttexasreview.com/how-can-christians-be-the-salt-of-the-earth-and-the-light-of-the-world/
Nov 09 2014
Why Has God The Father Given His Son Power Over Everything?
By Carey Kinsolving "Jesus deserves all the power," says Kianna, 9. "He died on the cross to save us from our sins. This is cool for me to believe in him. He created everything, so he should have power over everything. I think he totally deserves it!" In the Apostle John's vision of heaven, he …
Permanent link to this article: http://www.easttexasreview.com/why-has-god-the-father-given-his-son-power-over-everything/
Oct 26 2014
How Do You Know If You're Going To Heaven?
By Carey Kinsolving My grandma thinks I'm going to heaven," says Kole, 6. Why is it that most grandchildren can't get enough of their grandparents? Most grandparents are smart enough to just love on their grandkids. They leave the hard stuff like correction and discipline for the parents. Kids instinctively sense when someone loves them. …
Permanent link to this article: http://www.easttexasreview.com/how-do-you-know-if-youre-going-to-heaven/
Oct 19 2014
What Difference Can a Teacher Make?
A teacher can make a difference by giving less homework, 10 extra minutes for recess, extra field trips and five popcorn parties a day," says Sara, 10. If kids could vote for and serve as school board members, Sara would win easily. "Teachers help us learn skills for later on in life," says Rachel, 11. …
Permanent link to this article: http://www.easttexasreview.com/what-difference-can-a-teacher-make/
Oct 12 2014
Why Is Jesus Forgiving?
Everyone says forgiveness is a lovely idea until they have something to forgive," wrote author C.S. Lewis. Think of a time when someone deliberately hurt you. Then, multiply your pain 10,000 times. You might be able to relate to how God feels when faced with a world of people who have sinned against him. Ultimately, …
Permanent link to this article: http://www.easttexasreview.com/why-is-jesus-forgiving/
Sep 28 2014
What Is the Meaning of the First Commandment?
It means to only have one God, which is God. When we find something, we don't go gaga over it. We still pray to God and not to the new thing," says Ashley, 11. For a fuller understanding of "gaga," let's go to Cory, 11: "When the commandment says to have no other gods 'before …
Permanent link to this article: http://www.easttexasreview.com/what-is-the-meaning-of-the-first-commandment/
Sep 14 2014
What Will You Do When You See God? (Part 2)
"When I see God, he'll make a rainbow for me," says Ally, 5. "He's gonna show me how to make one. He's gonna sit down in the grass and eat an apple with me." Ally's answer is more than cute. It could be insightful as well. Who knows the entire capabilities of a resurrected body …
Permanent link to this article: http://www.easttexasreview.com/what-will-you-do-when-you-see-god-part-2/
Sep 07 2014
What Will You Do When You See God? (Part 1)
"When I see God, I will give him a big hug," says Whitney. "Then I will go say 'hi' to all the people in Bible times. Then I will ask him everything I ask my parents that they can't answer." Whitney, I'm sure your parents will rejoice with you. "I will fall down on my …
Permanent link to this article: http://www.easttexasreview.com/what-will-you-do-when-you-see-god-part-1/


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6082333261 16 Section 66 Jalan Peteri Bintawa Industrial Estate, 93720 Freight Forwarding Cargo & Freight ServicesFreight Forwarding
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text:
The 2010 season ended with heartbreak for the Philadelphia Eagles. The Eagles were driving in Packers territory late in the fourth quarter, down by less than a touchdown. It looked like the Eagles were going to pull off another late playoff comeback under Andy Reid until Michael Vick overthrew Riley Cooper in the end zone. The pass was intercepted by Packers cornerback Tramon Williams and the season was over for the Philadelphia Eagles.
Since then, the Eagles have been very aggressive in the offseason, upgrading all of their weaknesses from 2010. Danny Watkins was drafted in the first round to take over at right guard and both Nnamdi Asomugha and Dominique Rodgers-Cromartie were brought in to improve a secondary that was helpless outside of Asante Samuel last season.
The Eagles have also added two of the best assistant coaches in the game, offensive line coach Howard Mudd and defensive line coach Jim Washburn.
The Eagles appear to be ready for a Super Bowl run in 2011. Will they have a season like 2004, where they won 13 of the first 14 games before resting their starters the final two games, or will they have a third straight season without a playoff win?


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Butternut Squash and Chickpea Tangine
Total Time
1hr 5mins
Prep 25 mins
Cook 40 mins
This one is from Allthingsnice
Ingredients Nutrition
- 1 can chickpeas, drained and washed
- 10 cherry tomatoes
- 1 medium butternut squash, peeled & cut into 2 inch chunks
- 1 onion, finely chopped
- 4 garlic cloves, finely chopped
- 2 tablespoons parsley, finely chopped (more to garnish)
- 1⁄4 cup olive oil
- 1⁄2 teaspoon ground cumin
- 1⁄2 teaspoon ground turmeric
- 1⁄2 teaspoon cayenne pepper
- 1 teaspoon paprika
- 2 teaspoons tomato paste
- 1⁄2 teaspoon sugar
- 1 1⁄2 teaspoons sea salt
- 1 pinch fresh ground black pepper
- 2 cups water
- Finely chop the coriander and parsley. Set Aside. Peel the squash and cut into 4 x 4 cm pieces.
- Finely chop the onion and garlic. Heat the oil in the pot and add the onion. Cook over a low heat until soft.
- Add the garlic and cook for about 20 seconds, then add the cumin, tumeric and cayenne pepper. Cook for 30 seconds, stirring continuously.
- Add the paprika, tomato paste, sugar and half the coriander, parsley, salt and pepper. Stir.
- Add the tomatoes and the drained chickpeas. Stir and then add the pumpkin and the water, stir and then cover with the lid. Once simmering, turn the heat down to low and cook covered for 35 minutes.
- Serve with Couscous.
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Reviewed for ZWT9- I cooked this dish using my new tagine- turned out lovely- moist and flavourful. A great Moroccan flavoured vege dish that was enjoyed .
Flavorful and filling!! Easy to make and lots left over for the next day!


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How do Foxwood Farm and Pinchfield Farm compare in Animal Farm?
2 Answers | Add Yours
The similarity between the two is that they both are adjacent to Animal Farm and seek to benefit from Manor Farm and Mr. Jones' downfall. However, typically, the two owners of the farms fought with each other and disagreed.
Foxwood Farm is not well kept, it is neglected, overgrown, and described as old fashioned. Its owner, Pilkington, enjoyed spending his time pursuing fishing and hunting. Pinchfield's owner was much different. He is described as "tough and shrewd". He also drives hard bargains and finds himself fighting others in law suits frequently. In short, Pilkington is described as more laid back and a little lazy, and Mr. Frederick, Pinchfield's owner, is constantly fighting with people.
Foxwood Farm and Pinchfield Farm are the two farms that are nearest to what is orignially called Manor Farm and is later called Animal Farm (and is then Manor Farm again at the end).
Foxwood Farm is described as being bigger than Pinchfield Farm. However, Foxwood is not run as well as the other farm. Pilkington, its owner, is more interested in hunting and fishing. So his farm is a bit overgrown. Pinchfield is smaller, but it is run quite efficiently.
Pinchfield represents Germany under Hitler while Foxwood is supposed to represent England.
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From the Departments of Pathology and Otolaryngology, the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (Dr North); the Department of Dermatology, The Cleveland Clinic, Cleveland, Ohio (Dr Kahn); the Hospital Nacional de Pediatria, Buenos Aires, Argentina (Dr Cordisco); the Cutaneous Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston (Drs Dadras and Detmar); and the Departments of Pediatrics and Dermatology, University of California–San Francisco Medical Center (Dr Frieden). The authors have no relevant financial interest in this article.
Severe thrombocytopenic coagulopathy may complicate platelet-trapping vascular tumors such as kaposiform hemangioendothelioma and tufted angioma. Low-grade, chronic consumptive coagulopathy may occur with extensive venous and lymphatic malformations. We have also observed patients with rare multifocal, congenital skin and gastrointestinal (GI) tract vascular anomalies of distinctive and remarkably similar appearance, all associated with coagulopathy. We studied the clinical and histopathologic features of 3 patients demonstrating this previously uninvestigated phenomenon.
All 3 patients presented with hundreds of congenital red-brown skin plaques as large as a few centimeters, with similar lesions throughout the GI tract and severe GI tract bleeding. One patient had synovial involvement. All had significant thrombocytopenia, with prothrombin and partial thromboplastin times and fibrinogen levels near the reference range. Corticosteroids and/or interferon alfa treatment resulted in equivocal or no improvement. Skin lesions from all 3 patients were histologically distinctive and similar, including dilated, thin-walled vessels in the dermis and subcutis lined by hobnailed, proliferative endothelial cells (10%-15% immunoreactive for Ki-67), most displaying intraluminal papillary projections. Immunoreaction for the lymphatic marker LYVE-1 was uniformly present.
We propose the term multifocal lymphangioendotheliomatosis with thrombocytopenia to distinguish this newly recognized clinicopathological entity. These congenital lesions, like tufted angioma and kaposiform hemangioendothelioma, show lymphatic differentiation, strengthening the association between abnormal lymphatic endothelium and coagulopathy.
Multifocal vascular tumors and malformations are relatively unusual among vascular anomalies, but are characteristic of several well-defined disorders. These include so-called neonatal hemangiomatosis (benign and disseminated),1 blue rubber bleb nevus syndrome,2 glomuvenous malformations,3,4 Maffucci syndrome,5 hereditary hemorrhagic telangiectasia,6- 8 familial cutaneocerebral capillary malformations,9,10 and familial multiple mucocutaneous venous malformations.11,12 We herein describe 3 patients with an entirely different disorder, characterized by multiple congenital and progressive cutaneous and gastrointestinal (GI) tract vascular lesions with occasional involvement of other anatomic sites, coagulopathy, and distinctive histopathologic features resembling those of solitary acquired lesions recently classified as benign lymphangioendothelioma13 and previously as acquired progressive lymphangioma.14 We propose the term multifocal lymphangioendotheliomatosis with thrombocytopenia to describe this unique and potentially life-threatening condition.
Three patients with an unusual and remarkably similar clinical presentation characterized by multiple discrete cutaneous and GI tract vascular anomalies associated with coagulopathy were identified independently at 3 different institutions. Medical records were reviewed, and hematoxylin-eosin–stained tissue sections were reviewed and compared by one of us (P.E.N.). Biopsy specimens included skin samples of the lower back and right hip synovium (patient 1, aged 5-6 years), a punch biopsy specimen from a left buttock lesion (patient 2, aged 6 years), and a resection specimen from the cheek (patient 3, aged 13 years 9 months). Histochemical, immunohistochemical, and immunofluorescent studies, including evaluation for expression of the lymphatic marker LYVE-1,15 were performed.
For immunofluorescent microscopy, paraffin-embedded sections (6-µm thickness) were deparaffinized, rehydrated, and treated with 0.01% protease XXIV (Sigma-Aldrich Corp, St Louis, Mo) in phosphate-buffered saline solution for 20 minutes at 37°C. Sections were double-stained using a rabbit polyclonal antibody against human LYVE-1 (1:600) (a generous gift from D. Jackson, PhD, John Radcliffe Hospital, Oxford, England16), and a mouse monoclonal anti–human CD31 antibody (1:40; DAKO Corporation, Carpinteria, Calif), followed by incubation with respective secondary antibodies labeled with Texas Red (Jackson ImmunoResearch Laboratories, Inc, West Grove, Pa) (1:50) or fluorescein isothiocyanate (1:50) as described.17 Cell nuclei were counterstained with Hoechst bisbenzimide (Sigma-Aldrich Corp) at 20 mg/mL. For immunohistochemistry, paraffin-embedded sections were deparaffinized, rehydrated, and subjected to antigen retrieval using a steamer method.18 Sections for CD31 immunoreaction were pretreated with pronase (S2013; DAKO Corporation) for 6 minutes before antigen retrieval. Sections were protein blocked18 before incubation with primary antibodies under optimal conditions (Table 1). Bound antibody was detected using an LSAB+ (DAKO Corporation) peroxidase kit and DAB+ (DAKO Corporation) chromagen.18 Negative controls were processed in parallel without primary antibody.
A boy, the product of an uncomplicated 35-week pregnancy, was born with hundreds of cutaneous vascular lesions. There was no family history of similar lesions. Results of a skin biopsy reportedly showed dilated capillaries, without evidence of a vascular tumor. His platelet count at birth was 33 × 103/µL, but increased with oral prednisone therapy. Two weeks postnatally, he was readmitted with GI tract bleeding, and endoscopy revealed diffusely distributed mucosal vascular lesions in the stomach and sigmoid colon. Continued GI tract bleeding and thrombocytopenia necessitated approximately 250 transfusions. His thrombocytopenia fluctuated from 10 × 103/µL to reference levels, but was most commonly 30 × 103/µL to 50 × 103/µL. He did not respond to therapy consisting of systemic corticosteroids or interferon alfa-2a. At 3 months of age, he underwent gastrostomy and suture ligation of multiple gastric hemangiomas, followed by partial colectomy at 1 year of age to remove profusely bleeding vascular lesions, resulting in resolution of intestinal bleeding. He did well until 5 years of age, when he was referred to the University of California–San Francisco for severe right hip pain, a limp, a leg length difference of 2 cm, flexion contracture of the right hip, and persistent skin lesions.
Examination revealed a healthy-appearing boy with hundreds of skin lesions varying in diameter from a few millimeters to several centimeters (Figure 1). The lesions were red-brown to burgundy in color, round to oval in shape, some with a slightly scaly surface (Figure 1C). Although most were superficial, several were indurated, suggesting deeper dermal or subcutaneous involvement.
Patient 1, seen at 5 years of age. Hundreds of red-brown to burgundy skin lesions that varied in diameter from a few millimeters to several centimeters were present on the trunk (A), lower extremities (B), and upper extremities (C), most present since birth. Some lesions had a slightly scaly surface (C).
An incisional biopsy specimen from a truncal lesion demonstrated an abnormal complement of small, ectatic, thin-walled vessels scattered throughout the reticular dermis and subcutis. These vessels, largely devoid of intraluminal erythrocytes, were lined by a monolayer of slightly hobnailed endothelial cells that focally formed intraluminal papillary projections (Figure 2). Most lesional vessels had 1 or more simple, fingerlike projections, and some displayed moderately complex papillary tufts appearing to float freely in the luminal plane of section. Thrombi were not evident. Papillary stromal cores and cells lining the papillae showed strongly positive periodic acid–Schiff reaction, consistent with basement membrane material. These areas were immunonegative for κ/λ light chains (not shown), ruling out accumulation of immunoglobulins. Cells lining the component vessels and papillae were endothelial in nature, as evidenced by CD31 immunoreactivity. A small number of cells closely apposed to endothelial cells lining the vessels and papillary fronds were immunopositive for α-smooth muscle actin (SMA); these were immunonegative for the well-differentiated smooth muscle marker h-caldesmon. Although no mitotic figures were evident, approximately 15% of the lesional vascular cells were positive for the cell proliferation marker Ki-67. Lesional endothelial cells strongly expressed the lymphatic marker LYVE-1 and the panendothelial marker CD31 (Figure 3A). Findings were negative for the infantile hemangioma–associated marker GLUT1.
Specimen from an incisional biopsy of a truncal skin lesion performed on patient 1 at 5 years of age demonstrated an abnormal complement of small, ectatic, thin-walled vessels scattered throughout the reticular dermis and subcutis, lined by slightly hobnailed endothelial cells that focally formed intraluminal papillary projections. Most lesional vessels had 1 or more simple, fingerlike projections (A), and many displayed moderately complex papillary tufts (B). Thrombi were not evident, and lumina contained few, if any, erythrocytes (hematoxylin-eosin, original magnification ×400).
Double immunostaining for the lymphomatic marker LYVE-1/CD31 in patients 1 (A), 2 (B), and 3 (C). Lesional endothelial cells lining the angular, dilated vessels with intraluminal projections strongly expressed the lymphatic hyaluronan receptor LYVE-1 (red) as well as the panendothelial marker CD31 (green). Blood capillaries expressing only CD31 (green) are also evident. Lesional vessels and intraluminal papillary tufts (arrow) focally appear yellow in color owing to mixing of red and green color, reflective of LYVE-1/CD31 coexpression. Cell nuclei are counterstained blue with Hoechst bisbenzimide (Sigma-Aldrich Corp, St Louis, Mo) (original magnification ×200).
A biopsy specimen from the right hip synovium at 6 years of age revealed a relatively sparse proliferation of small vessels, lined by a single layer of endothelial cells rimmed by a few loosely arranged stromal cells. The perivascular stroma was notably myxoid with scattered hemosiderin deposits, a few extravasated red blood cells, and a scant chronic inflammatory infiltrate. During the next 2 years, skin lesions continued to increase in number and size, particularly on the torso. Bone scan findings demonstrated increased uptake in the right hip and left calcaneus, but were otherwise negative. The patient continues to be seen for chronic orthopedic problems, with mild, intermittent coagulopathy.
A white girl presented to The Cleveland Clinic dermatology service, Cleveland, Ohio, at 6 years of age (Figure 4) with a history of hundreds of congenital brown-red papules and nodules, ranging in size from 0.5 to 6 cm, on her trunk and extremities. Episodic severe GI tract bleeding requiring transfusion had begun in the neonatal period and continued into childhood. Family history was negative for similar disorders. Endoscopy demonstrated multifocal mucosal vascular lesions in the stomach and intestines. She was treated with corticosteroids for continuing episodes of GI tract bleeding, with equivocal response. Her platelet count ranged from 33 × 103/µL to 75 × 103/µL. Her medical history was further remarkable for vesicoureteral reflux and recurrent urinary tract infections. "Moth-eaten" bone lesions throughout the skeleton were attributed to long-term corticoseroid therapy. Over time, new subcutaneous skin lesions developed, prompting dermatology referral at 6 years of age.
Hundreds of brown-red papules and nodules, ranging in size from 0.5 to 6 cm, are seen on the extremities (A) and trunk (B) of patient 2, a white girl. The lesions were present since birth.
Results of a punch biopsy of a skin lesion on the back revealed isolated groupings of small, delicate vessels containing intraluminal papillary projections, clustered primarily at the dermal-subcutaneous junction, but also present in the midreticular dermis. As in patient 1, the endothelial cells lining these vessels were immunopositive for LYVE-1 as well as CD31 (Figure 3B); approximately 10% showed nuclear Ki-67 immunoreactivity.
A boy who was the full-term product of an uncomplicated pregnancy displayed hundreds of small cutaneous vascular papules and plaques similar to those of patients 1 and 2 at birth. Family history was negative for similar disorders. At 1 month of age, he was admitted to the Hopital Nacional de Pediatria in Buenos Aires, Argentina, with acute GI tract bleeding. In addition to many small cutaneous lesions, a large segmental lesion involving the maxillary division of the left cranial nerve V dermatome was noted. Endoscopic evaluation revealed lesions of similar appearance in the gastric antrum and the small and large intestines. He required multiple blood transfusions as an infant and received systemic corticosteroids. At 1 year of age he had recurrent intestinal bleeding, increased number of skin lesions, decreased platelet level (18 × 103/µL) with a fibrinogen level in the reference range, and prothromin and partial thromboplastin times that varied from the reference range to mildly elevated. His intestinal bleeding stabilized, and he had no further episodes of bleeding after 3 years of age.
By 11 years of age, he had additional cutaneous lesions (Figure 5) and was significantly disfigured by a large congenital facial lesion. A portion of the large nasal/cheek lesion was removed at the age of 13 years 9 months, revealing an extensive dermal network of dilated, angulated vascular spaces with the appearance of lymphatics, dissecting the dermal collagen and creating stromal and adnexal islands surrounded by thin-walled vascular spaces containing endothelium-lined papillary projections (Figure 6A and B). Cells lining these vessels and papillae were strongly immunopositive for the panendothelial marker CD31 (Figure 6C) and were associated with a variable complement of SMA-positive/h-caldesmon–negative pericytes (Figure 6D). As in the lesions from patients 1 and 2, lesional endothelial cells coexpressed LYVE-1 and CD31, consistent with lymphatic differentiation (Figure 3C).
Patient 3 at 11 years of age. Hundreds of small cutaneous vascular lesions on the extremities and abdomen (A) and back (B), as well as a large facial lesion (not shown) were present at birth. Congenital lesions did not regress, and new lesions appeared throughout childhood.
Hemotoxylin-eosin–stained sections of tissue resected from the large cheek lesion in patient 3, shown at low- (A) and middle-power (B) magnfication, demonstrate an arborizing network of delicate, angular vessels within the dermis, filled with papillary, endothelium-lined intraluminal projections. Cells lining the vessels and their papillae were immunopositive for the panendothelial cell marker CD31 (C) and were associated with a smaller number of pericytes that were immunopositive for α-smooth muscle actin (SMA) (D) and immunonegative for h-caldesmon (not shown) (original magnifications: A, ×100; B, ×200; and C and D, ×400.)
We herein report the clinical and histopathologic features of 3 patients with remarkably similar patterns of congenital and progressive disease, characterized by multifocal cutaneous and GI tract vascular lesions resulting in severe GI tract bleeding beginning in early infancy. Synovial involvement is additionally present in one of these patients. All 3 have chronic, albeit fluctuating thrombocytopenia, and their vascular lesions display distinctive histological features consistent with lymphatic endothelial origin and low-grade proliferative activity. The lesional vessels in these patients are immunoreactive for LYVE-1, a lymphatic endothelial cell-specific marker in normal tissues, including skin,15,16,19 and in tumor-associated lymphatic vessels.17,20,21 On the basis of this striking and previously unrecognized constellation of clinical and pathological features, including positive findings for LYVE-1 and lymphatic morphologic features, we suggest the name multifocal lymphangioendotheliomatosis with thrombocytopenia for this rare disorder.
One previously reported case had clinical features similar to those described herein. In 1987, Odell et al22 described a patient with infantile hemorrhagic angiodysplasia. This neonate presented with multiple congenital skin lesions, severe thrombocytopenia, and GI tract hemorrhage that did not respond to corticosteroid therapy. She died at 7 months of age as a result of GI tract hemorrhage and sepsis. Autopsy showed no other areas of visceral involvement. Published photographs show cutaneous lesions virtually identical to those seen in our patients. The pathological characteristics of this case, with limited photomicrographic documentation, were described as "congeries of dilated capillaries, arterioles, and postcapillary venules," but in all other aspects this patient is similar to ours.
A number of other multifocal vascular skin disorders presenting at birth, in infancy, or in childhood have been described (Table 2).1- 8 The skin lesions in our 3 patients, however, are unique in their clinical and histological appearance, and far more numerous than would be typical in any of these conditions except for diffuse infantile hemangiomatosis. The morphologic characteristics of cutaneous lesions in multifocal lymphangioendotheliomatosis with thrombocytopenia are quite distinctive, characterized by flat or indurated papules and plaques with a red-brown to burgundy color. Many have central pallor, and in some cases central scarlike areas. Slowly progressive onset of new lesions was observed in all cases, without clinical evidence of regression. Multifocal infantile hemangiomas, by contrast, are typically bright red and dome-shaped or nodular in clinical appearance. They typically present in the first few weeks of life and disappear or involute signficantly by 5 years of age. Blue rubber bleb nevus syndrome is characterized by multiple venous malformations involving the skin and GI tract, blue in color, and usually very compressible, with clinical appearances including classic nipplelike lesions, small punctate papules, and larger disfiguring lesions. These lesions may slowly increase in number over time (as in our patients), but remain far fewer in total number. Multifocal venous malformations with glomus cells (eg, glomuvenous malformations and glomangiomas) are clinically similar to but distinguishable from venous malformations, typically involving a large cutaneous area as multiple, soft, red-to-blue nodules that may be widely distributed or confluent, or as pink to deep blue, cobblestonelike plaques that typically thicken with time.25 Maffucci syndrome is usually not congenitally evident, but develops during childhood as multiple bulging, firm, blue-to-purple vascular lesions that are most prominent on the distal extremities. These lie deeper in the dermis and subcutis than the lesions in our patients; patients with Maffucci syndrome differ further in showing lytic bone lesions, whereas GI tract involvement is absent. Hereditary hemorrhagic telangiectasia only rarely presents in early infancy; mucocutaneous lesions typically present first on the tongue and oral mucosa, and later involve the face and extremities during adulthood, most often as small red-to-purple papules with radiating peripheral telangiectasias.
The histological features of the lesions we have observed are also quite different from those described for other conditions characterized by multiple vascular lesions presenting at birth, with or without GI tract involvement. Multiple infantile hemangiomas are vascular tumors composed of microvessels that strongly express a number of unusual antigens, including GLUT1 and Lewis Y antigen, that are also expressed by placental chorionic villus capillaries.18,26 Histological examination of blue rubber bleb nevus syndrome reveals lesions composed of gaping, thin-walled veins (venous malformations), often containing thrombi at various stages of organization. Glomangiomas resemble the venous malformations of blue rubber bleb nevus syndrome in consisting of large, dilated, thin-walled veins in the dermis and subcutaneous tissue, but differ from the latter in their added component of 1 or more layers of uniform, cuboidal glomus cells around the lesional veins. Both of these histological appearances are unlike the delicate vessels with papillary endothelial projections and evidence of lymphatic differentiation that we describe. Patients with Maffucci syndrome have venous malformations and so-called spindle-cell hemangiomas (spindle-cell hemangioendotheliomas), the latter also probably a form of vascular malformation that has been altered by the effects of vascular collapse and thrombosis with a histological appearance different from the lymphatic lesions we have described. The lesions of hereditary hemorrhagic telangiectasia consist of dilated venules and arterioles, not vessels of lymphatic differentiation, with fully developed lesions demonstrating features of arteriovenous malformation.7
The distinctive histological appearance of the lesions in our patients, with dilated LYVE-1–positive vessels that contain characteristic endothelium-lined intraluminal projections, are similar to those of the recently described lesion known as benign lymphangioendothelioma, but this is typically solitary.13,27 This latter entity, originally termed acquired progressive lymphangioma,14,28 is an uncommon, benign lesion that typically appears as a singular lesion in adult patients; to our knowledge, there are only 9 reported cases with childhood onset, including 1 patient with a single congenital lesion.13 All reported cases have involved skin or, less commonly, oral mucosa. Three patients have had multiple lesions,13,27,28 but none had widespread numerous skin lesions or the GI tract involvement and thrombocytopenia that we observed in our 3 patients. Another histologically related lesion is papillary intralymphatic angioendothelioma (PILA).29 Tumors of this type are solitary lesions of uncertain biological potential that resemble and are probably equivalent to 6 childhood tumors described by Dabska30 in 1969 as malignant endovascular papillary angioendothelioma. Two of the cases originally reported by Dabska metastasized, causing death after a long interval; but others to date have behaved in a benign fashion.29 Like benign lymphangioendothelioma and the lesions we describe herein, PILA tumors show papillary intravascular proliferation and histological or immunophenotypic evidence of lymphatic vessels.29 The lesions we describe, however, lack the well-developed and matchsticklike, columnar intraluminal proliferation of endothelial cells seen in PILA. Thus, while sharing evidence of lymphatic differentation, PILA and multifocal lymphangioendotheliomatosis with coagulopathy differ significantly not only in clinical behavior, association with coagulopathy, gross appearance, and growth pattern, but also in histological architecture.
The nature of the coagulopathy in our patients deserves comment. Two major types of coagulopathy are seen in association with vascular anomalies. Large segmental vascular malformations, and occasionally multifocal vascular malformations, can be complicated by a chronic disseminated intravascular coagulopathy thought to be due to chronic intralesional clotting leading to the consumption of clotting factors, elevated D-dimer levels and prothrombin and partial thromboplastin times, and modest decreases in platelet and fibrinogen levels.31 A second type of coagulopathy is the Kasabach-Merritt phenomenon (KMP), seen in association with certain types of vascular tumors, usually solitary but very rarely multifocal.32 It is primarily characterized by platelet trapping with a more marked decrease in platelet and fibrinogen levels, and some elevation of D-dimer levels, with prothrombin and partial thromboplastin times that are mildly elevated or within the reference range. It is now recognized that KMP occurs almost exclusively as a complication of 2 rare types of vascular tumors that demonstrate a significant degree of histological overlap, kaposiform hemangioendothelioma and tufted angioma32,33; very rare cases have also been reported with hemangiopericytoma, including one multifocal case.34 Kasabach-Merritt phenomenon often presents within the first year of life, and although the tumors causing it may persist, the coagulopathy itself nearly always resolves (with treatment) during infancy, rather than continuing into childhood, as was the case in our patients. The coagulopathy in our patients did not resolve with time, but became chronic and fluctuating. In other respects, however, it more closely resembles KMP than the coagulopathy found in association with vascular malformations.
Interestingly, abnormal lymphatic vessels appear to be an intrinsic feature of kaposiform hemangioendothelioma and tufted angioma.32,33,35,36 Furthermore, recent studies have demonstrated diffuse immunoreactivity for the vascular endothelial growth factor receptor 3, a tyrosine kinase expressed on norma lymphatic endothelial cells37 in kaposiform hemangioendotheliomas, supporting the concept that these tumors display a lymphatic differentiation.38 True Kaposi sarcoma, which also shows evidence of lymphatic derivation,39,40 is in some cases associated with coagulopathy.41,42 Our patients have multifocal tumors with positive findings for LYVE-1. These cases together with those causing KMP suggest that vascular tumors arising within lymphatics may be particularly predisposed to platelet trapping. These observations add credence to the growing association between abnormal vessels that are immunopositive for LYVE-1 and coagulopathy, and support the need for further investigation into possible mechanisms of this phenomenon. LYVE-1, a hyaluronan receptor structurally related to CD44, has conclusively been shown to be specific for lymphatic endothelial cells in normal tissues, including the skin,15,16,19 and in tumor-associated lymphatic vessels.17,20,21 In our own experience (P.E.N., S.S.D., and M.D., unpublished data, December 2003), this specificity is well preserved in lymphatic and blood vascular malformations.
The International Society for the Study of Vascular Anomalies has sanctioned an updated classification that divides vascular anomalies into 2 basic groups, vascular tumors and vascular malformations, based on biological behavior and clinical and histological characteristics. We find the entity we describe herein to be not easily classified by this approach. Although many of the lesions are present at birth (typical of malformations), some continue to expand slowly, new ones appear, and at least some show significant endothelial mitotic activity as evidenced by positive findings for Ki-67 (more characteristic with a tumor). The overall histological architecture, however, is that of a malformation, with lesional hypercellularity largely limited to intraluminal proliferations.
Since our initial description of these patients,23,24 4 additional patients of similar clinical presentation and histological features were described in abstract form by Prasad et al,43 using the term congenital cutaneovisceral angiomatosis with thrombocytopenia. Results of LYVE-1 staining were not available for those cases. Two of the patients in this additional series had lung involvement as well as skin and GI tract involvement. It seems likely that these patients are equivalent to those we have described. We prefer the term multifocal lymphangioendotheliomatosis with thrombocytopenia in light of (1) the synovial involvement, in addition to cutaneovisceral involvement, among our cases, (2) the consistent presence of proliferative vessels with positive findings for LYVE-1 within lesions, (3) the histological similarity of individual lesions in this disorder to the well-described benign lymphangioendothelioma most commonly seen as an acquired solitary lesion in adults, and (4) the universal presence of thrombocytopenia. Although most cases of this distinct entity appear to be evident at birth, lesions are progressive and increase in number with time. Thus we cannot exclude the possibility some otherwise identical cases may present later in life.
Since the acceptance of this manuscript, an additional 15-year-old patient with multiple cutaneous and gastrointestinal "hemangiomas" of clinical appearance and behavior remarkably similar to those we have described, also complicated by chronic thrombocytopenia and gastrointestinal bleeding, has been reported by Mukhtar and Letts.44 Although lesional histological characteristics were not documented for this patient, the authors choosing instead to use the generic term "hemangioma," we believe this patient probably also exemplifies multifocal lymphangioendotheliomatosis with thrombocytopenia. It is of interest that this latter patient had bony as well as cutaneovisceral involvement, supporting the concept of a truly multifocal phenomenon.
Corresponding author: Paula E. North, MD, PhD, Department of Pediatric Pathology, Arkansas Children's Hospital, 800 Marshall St, Little Rock, AR 72202.
Accepted for publication September 18, 2003.
This study was supported by the Department of Pathology, University of Arkansas for Medical Sciences, and the Arkansas Children's Hospital Research Foundation, Little Rock.
This study was presented in part in abstract form at the 14th International Workshop on Vascular Anomalies; June 27, 2002; Nijmegan, the Netherlands; and at the Society for Pediatric Pathology Annual Meeting; March 22, 2003; Washington, DC.
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on February 25, 2014 - 12:01 AM
No good Catholic can be pro-choice
In a News article on State Sen. Timothy Kennedy's political career and acceptance of abortion, he said he made the right "choice." In the world today, there is a culture of death in the acceptance of abortion. It is very challenging and difficult to be a Catholic in the political arena. There are laws that are in opposition to Catholic doctrine and values. The church has a commitment to life from conception to death.
Kennedy made his decision based on his "soul searching, thinking and prayer." I believe his sincerity, but there is no degree of rationalization that can make abortion acceptable. Being a Catholic and defending abortion are not aligned. He will remain an acceptable candidate because of his stance. However, he will have to live with his "choice."
Ilona Klein


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Latest News
His Highness the Aga Khan receives the Adrienne Clarkson Prize for Global Citizenship
21 September 2016
At a ceremony in Toronto, the Right Honourable Adrienne Clarkson presented His Highness the Aga Khan with the inaugural Adrienne Clarkson Prize for Global Citizenship.
See also:
Video: Message from Prime Minister Trudeau
Speech: His Highness the Aga Khan
Speech: Adrienne Clarkson
5 million
Each year, in collaboration with its partners, the AKDN provides 5 million people with quality health care, including through outpatient visits and community health programmes.
2 million
Over 2 million students benefit from AKDN education programmes annually. Programmes range from early childhood development to primary and secondary schools, from vocational studies to university degrees.
AKDN employs 80,000 people in over 30 countries around the world. AKDN also relies on thousands of volunteers to help implement and maintain its projects, notably at health and education facilities.


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I am Microsoft certified technology Expert having more than 6 years of development experience in Microsoft technology. From last 4 years I have been working on SharePoint development and customization. I have worked on projects using SharePoint 2013, SharePoint 2010, MOSS 2007, Asp.Net, C#, JavaScript, Jquery, HTML, CSS, XML, XSL etc. I have experience in Sharepoint configuration, Sharepoint web part development, third-party integration. Sharepoint site, list, workflow setup. I am quick learner, handworker, good communicator, an


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Results 201 - 226 of 226 matches
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Kengo Kuma is the latest high-profile name to create a tea service for Georg Jensen, basing his design on traditional Japanese sets (+ slideshow). More »
Tag: Georg Jensen
Patricia Urquiola designs "warm and masculine" collection for Georg Jensen
Spanish designer Patricia Urquiola's first collaboration with Danish metalware brand Georg Jensen includes upside-down jugs and a set of tilted vases (+ slideshow). More »
Zaha Hadid designs range of silver jewellery for Georg Jensen
Architect Zaha Hadid has designed a collection of silver jewellery for Danish design house Georg Jensen, including a twisted cuff and a ring that fits over two fingers (+ slideshow). More »
Running Georg Jensen is "like being the most beautiful girl at the party" says CEO David Chu
Danish metalware brand Georg Jensen has shaken off its "dusty" reputation and now has high-profile designers queuing up to collaborate on products, according to creative director and CEO David Chu (+ slideshow). More »
Marc Newson designs £82,000 silver tea set with mammoth-ivory handles for Georg Jensen
Industrial designer Marc Newson has created a limited-edition silver tea service for Danish metalware brand Georg Jensen, which features handles made from mammoth tusks. More »
Andreas Engesvik's hand-drawn grids inform textile patterns for Georg Jensen Damask
Norwegian designer Andreas Engesvik has created a range of textiles for Danish brand Georg Jensen Damask, with subtle patterns based on hand-drawn lines. More »
Aldo Bakker designs sculptural stainless steel
tableware for Georg Jensen
Milan 2014: Dutch designer Aldo Bakker has created sculptural stainless steel tableware products for Danish metalware brand Georg Jensen. More »
Tea with Georg by Scholten & Baijings
for Georg Jensen
Milan 2013: this silver serving set for tea and cake was designed by Dutch studio Scholten & Baijings for Danish silverware and jewellery company Georg Jensen and launched at Spazio Rossana Orlandi last week. More »
Georg Jensen sold to Investcorp
for $140 million
News: Bahrain-based investment bank Investcorp has agreed to pay $140m to buy luxury design brand Georg Jensen, the Danish luxury brand famous for its silverware and jewellery, from Danish private equity group Axcel. More »
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Robert W. Fogel, 86, a University of Chicago economist whose study of the economics of slavery sparked a furious debate in academia and later helped win him a Nobel Prize, died Tuesday.
The university announced Mr. Fogel's death; his family said he died after a brief illness.
Mr. Fogel wrote 22 books, the last published in April, and, according to the school, was an active faculty member in the Department of Economics and the Booth School of Business who was working on three more books at the time of his death.


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- A Portion of Proceeds Benefit Baltimore Ravens Athletics -
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A Progressive's Silver Linings Playbook: Repeal Stepped-Up Basis
Edward J. McCaffery
USC Gould School of Law
February 25, 2013
Tax Notes, p. 969, February 2013
USC CLEO Research Paper No. C13-3
USC Law Legal Studies Paper No. 13-3
In this brief commentary, I argue that, now that we have no meaningful estate tax for the vast masses of even wealthy individuals and families, it is time to call for an end to stepped-up basis on death and to start doing something, somehow, to shut down the typical tax planning of the wealthy.
Number of Pages in PDF File: 5
Date posted: March 6, 2013
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Upcoming Events
National Suicide Prevention Week is September 5-11, 2016. #NSPW16 For More Information, click here. For More Information on Local Events:
Sudden & Traumatic Loss Training: What Every Caregiver and First Responder Needs to Know - September 8, 2016, 8:00 AM - 4:30 PM, Rapid City Regional Hospital Main Hospital. $35 Registration Fee. CEUs Provided. RSVP to Stephanie at: firstname.lastname@example.com or 605-348-6692 for more information.
World Suicide Prevention Day is September 10, 2016. For More Information on a Theme taking Hold Worldwide, Take 5 to Save Lives, click here.
Locally in Rapid City, the Saturday of National Suicide Prevention Week is Suicide Survivors Day - September 10, 2016, 10:00 AM - 2:00 PM, 1st Congregational UCC Church, 1200 Clark Street, Rapid City, SD. RSVP to Laura at email@example.com or 721-7720.
Upcoming Suicide Prevention Trainings Include Veteran's Mental Health First Aid and ASIST - Applied Suicide Intervention Skills Training - Dates TBD in Rapid City, SD. For more information and to RSVP to be notified of dates and locations when determined email Stephanie at: firstname.lastname@example.com or 605-348-6692.
We are volunteers - survivors ourselves of a loss to suicide as well as community caregivers - who have come together to offer support, guidance, comfort, and assistance to those who have lost a loved one to suicide. Our services are free. To be contacted by an advocacy team member from Rapid City, click here.
As with many organizations, the need for volunteers is great. Our organization is currently in need of volunteers to help with the programs and services that we provide. If you would like to volunteer to help our organization, please contact us or click here to send us a message. Someone will contact you to discuss your time and availability to volunteer.


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have to thank walrath. since he turned me on to GFY i have made a bundle.
try SMD
you probably make some money doing that
I will admit, his call on GFY was a good one. Way to go Walrath.
That's interesting since it's in the middle of its 52 week range. To bad you don't pay attention to my real buys.
It's Donny you should be thanking, hehehe.
You're real good at making yourself laugh. Too bad nobody else thinks you're funny.


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A Ludington dental office wants to help the uninsured get needed dental care during its first annual Dentistry from the Heart event.
Lakewinds Dental Centre in Ludington is offering the free dental care Saturday, May 3 for patients 18-years and older. Each patient will have a choice of a filling, extraction or cleaning.
All patients will be helped on a first-come first-serve basis so people are encouraged to come early. Long lines are expected so make sure to dress for the weather and bring a chair, water and snacks.
Lakewinds Dental Centre is located at 409 W. Ludington Avenue Suite 101, Ludington.


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NFL Commissioner Roger Goodell would "absolutely" want his own child to play football.
After President Obama recently said he'd "have to think long and hard" about allowing a son to take part in the sport, Goodell was asked the same question hours before Sunday's Super Bowl during an interview on CBS's Face the Nation.
Like the president, Goodell has two daughters. The commissioner deflected the question about allowing a son to play football by noting the high incidence of concussions in girls' soccer.
In an interview with the New Republic, Obama had said he loved football but worried about the long-term effects on players of the game's hard hits. Thousands of former players have sued the NFL, alleging that not enough was done to inform them about the dangers of concussions and not enough is being done today to take care of them.


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Welcome, Italian Greyhound Fanciers!
Jun 29, 2013 · 1:00 PMIGGY PLAY DATE IN SPOKANE!Hi everyone! Glad to see so many friends attending our play date! I'll be making a bunch of cookies for our get together and we'll be blocking off access to our deck,... Learn more
Sep 25, 2010 · 1:00 PMIGGY Ambassadors-Inland EmpireJust a get together - talk, share stories, let the IG's get a Conga line going. BYOC!! (Bring Your Own Chair)
Jul 19, 2008 · 3:00 PMJumpin' July IG JamboreeCome one, come all to the first IG play date of 2008! Food: Please bring a favorite snack food and drink. Parking: There's no parking on the south side of the street... Learn more
Sep 8, 2007 · 3:00 PMSilly September MeetupThe date and venue for this play date are set! This will be Purely Playdate--no food required. Just be sure to bring your own chair. We'll be at June's house from 3:... Learn more
Jul 14, 2007 · 6:00 PMJazzy July IG MeetupThis is a potluck dinner. Please bring a salad and your chair. Our hosts will provide beverages and watermelon. Driving Directions from I-90: 01. Take the PLEASANT... Learn more
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Oasis of Peace LopatnicaLopatnica 47
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Father: William Norton b: ABT 1626
Mother: Lucy Downing b: 1625
Marriage 1 Mary Goodhue b: 1663 in Hingham, Plymouth, Massachusetts, USA
RootsWeb.com, Inc. is NOT responsible for the content of the GEDCOMs uploaded through the WorldConnect Program. If you have a problem with a particular entry, please contact the submitter of said entry. You have full control over your GEDCOM. You can change or remove it at any time.


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Aleena Moore is haunted by Jared Holt. It's been six years since she's seen her brother's best friend, the self-destructive bad boy she secretly loved in high school. As the years pass, she knows it's time to move on. Time to decide between a practical nursing degree and her true dream as an artist. Time to get over Jared and give another guy a chance…Just when she opens her heart to her friend, Gabe, Aly returns home to find Jared sleeping on her couch. The teenage boy she loved has grown into a man she can't resist. Covered in tattoos and lost in rage, he's begging to be saved from his demons - the memories of the day he destroyed his family. As the two reconnect, their passion is hot enough to torch Aly's judgment. But can she risk her future for a man who lives on the edge of destruction?
©2014 A.L. Jackson (P)2014 Tantor
"Beautifully written story"
I like Aly's relationship with Jared when they were growing up. How she always loves him, even when she was young.
The concept of this story is not something new but it was beautifully written. This story is about second chance. I could feel Jared's guilt and heartache. I was so sad for his lost but also how he blamed himself. I could feel the chemistry and love between Jared and Aly. I thought the relationship they had growing up was very special. Made me wish that I have someone like Jared growing up; someone who always be there for me and stood up for me.
I look forward to the next book. I hope that Jared learns to let go of the past and guilt.
"B- overall rating..."
My Review:
Overall.... 3.25
Performance... 4.0
Story.... 3.0
I'm a girl who loves angst in my stories, but something about this one was just too over-the-top emotionally for me. I spent a lot of the story rolling my eyes at the characters...and I'll be honest, I'm not sure that would have been the case if I hadn't been listening to it in audio. I don't think it would have bothered me near as much if I had just been reading the book...although I don't think that would have solved my issue completely. This was my first audiobook in the New Adult genre and I just think that's not ideal for me.
I do like the way this book was done with two narrators though. The book alternates the first person pov chapters between Jared and Aleena and there was both a male and female narrators for those chapters. I liked that and truly enjoyed both narrators. They stayed on character and had great distinctive voices for all the various characters in the story.
Then there was the romance. Like I said, it was a bit over the top for me, but that's the way that the NA genre is written it seems. The story did work for me with the characters backgrounds and it definitely had credible conflict. I enjoyed the way the author wrote the flashbacks and intertwined them throughout.
This definitely wasn't my favorite book ever, but the book is written in the normal way for the new adult genre. I think if you generally enjoy that genre, you will like this one too. My heart did break for Jared and his self-loathing at something that was simply a mistake. I had issues with how other's dealt with him when it all happened, because hands down, they were wrong and did him wrong as a result and really ruined a kid's life. He didn't deserve that.
I also really enjoyed the moments with Ally drawing. I liked that she saw Jared behind all the rough and sometimes harsh demeanor.
Not my favorite book, but it wasn't bad. Lesson learned...listening to an audiobook in the NA genre is not for me.
"Interesting Storyline!"
The back and forth tug a war wondering how they would get together
Second chances for people who made mistakes
"Heartbreaking And Beautiful"
Yes. The story is beautiful.
A. L. Jackson's writing style. Characters are well developed and realistic. The story sucks you in right from the beginning.
This is my first audiobook, so it seemed awkward to have a voice for the characters that wasn't what I would have imagined that they sounded like in my head. The narrators sounded older than what I would have imagined for the characters in their early twenties. The male narrator also made me laugh every time he did the softer "female" voice. It was hard to take seriously when you started laughing at emotional points. However, as my first audiobook, I don't have any other frame of reference.
Very emotional throughout the book, at times too much so. Their first big argument, as well as the night they first slept together were moving. Jared could be a bit too dramatic in his self-hate for me at times also.
Beautiful story! A. L. Jackson has a way of writing stories that are beautiful and heartbreaking at the same time. Brace yourself for an emotional read.
That being said, I absolutely love a forbidden love story! Jared has returned to town 6 years after a tragic accident tears his family and his world apart. Allie, his best friend's little sister has loved him since she was a child. She's not a child any longer...and I'm sure you can see where this is leading.
She wants to heal him. He doesn't think that he's worthy of love or happiness, blaming himself for the death of his mother. Jared carries a LOT of guilt around. Seriously, this guy needs a good therapist. At times, his self-punishing, "I don't deserve to be happy," attitude was a bit too much and got on my nerves. Come on Eeyore! Quit being such a downer!
All in all, I liked this story a lot. I'm starting book 2 now. Hopefully, Jared will pep up a little. ;)
"Really Slow Going"
The build up took entirely too long and by the time you got to the issue bam the book is over really. 10 hrs of this and this is how it ends GAHHH. I guess my expectaions were too high and I wanted more. Not for sure as of right now how I really feel about reading book 2 when it comes out.
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Super Nintendo Games
Equinox: Solstice 2 Questions for Super NintendoHome / Super Nintendo /
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Boxshot & Details
- Developer: Sony Music Entertainment
- Publisher: Epic Sony Record
- Genre: Adventure Third-Person
- Release: Not Set
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Preheat oven to 350 degrees. Grease and flour a tube pan (angel food pan).
Make streusel: In small bowl, combine brown sugar, ½ cup of the chips, 1/3 cup of the flour and ¼ cup of the butter. Cut the butter through the mixture to combine. Set aside.
Beat remaining 1 ½ cups flour, the granulated sugar, baking powder, remaining ¼ cup butter, milk and egg with electric mixer on low speed until moistened. Then beat at medium speed 1 minute, scraping bowl as needed.
Put about two-thirds of the batter in the pan, top with most of the raspberries (save some for the middle and top of the cake, and perhaps some for your serving platter). Carefully spread remaining batter on top of raspberries and sprinkle streusel over batter.
Bake in preheated oven 55 to 65 minutes or just until a toothpick comes out clean and top is golden brown. Cool cake in pan upright about 15 minutes, until cool to touch. Remove from pan, flipping carefully and guiding coffee cake to plate, using hands.
Prepare glaze: In small saucepan over medium heat, melt together remaining ½ cup baking chips, corn syrup and water to desired consistency, stirring constantly.
Drizzle glaze over top of warm coffeecake and let some run down sides. Decorate top and middle of cake with remaining raspberries.
Read and share your thoughts on this story.
For your convenience, the same email address and password can now be used to:


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Top Definition
A painful muscle pull that occurs in the upper quadrant of the rib cage just under a golfer's stroking arm.
I just pulled off a miraculous drive but it caused a severe case of golfsides!
de Frank Barron 30 Iunie 2009
Trending Now
Can you define these popular missing words?


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By The Hill Staff - 05/17/12 10:37 PM EDT
• President Obama nominated Thomas Hart Armbruster to be ambassador to the Republic of the Marshall Islands. Armbruster is a diplomat-in-residence at City College in New York. He is a Senior Foreign Service career member with the class of counselor and previously served as the consul general in Russia. He has also served as deputy chief of mission at the U.S. Embassy in Dushanbe, Tajikistan.
• The president has nominated David Bruce Wharton for ambassador to the Republic of Zimbabwe. Wharton is the deputy assistant secretary for public diplomacy within the Bureau of African Affairs at the State Department. The career member of the Senior Foreign Service holds the class of minister-counselor and previously worked for the Bureau of African Affairs as director of the Office of Public Diplomacy and Public Affairs. Before that, he served as deputy coordinator within the State Department's Bureau of International Information Programs.
• The president intends to appoint Caitlin Durkovich to be the Homeland Security Department's assistant secretary for infrastructure protection. Durkovich works for the department as the national protection and programs directorate. Before that, she worked for Abrams Learning & Information Systems Inc. as the emergency management programs director, and for Booz Allen Hamilton as an associate.
• The president chose to appoint Ellen Peel to be the United States commissioner within the International Commission of Atlantic Tunas. Peel works for the Billfish Foundation as president. Before that, she worked for the Center for Marine Conservation as acting regional director. She currently is a member of several fisheries groups, including the National Marine Fisheries Service's Advisory Panel for Highly Migratory Species and the Advisory Committee to the International Commission for the Conservation of Atlantic Tunas.


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Template:Hermit Saints Triptych
From Wikimedia Commons, the free media repository
The Hermit Saints Triptych
This documentation is transcluded from Template:Hermit Saints Triptych/doc.
Multilingual tag for use in the "Title=" field of {{Artwork}}.
{{Hermit Saints Triptych}}
The template takes no parameters.
Additional information
The template is intended to be used in the following namespaces: all namespaces
The template is intended to be used by the following user groups: all users


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The New York-based owner of the Engine 46 firehouse in South Philadelphia said Wednesday that he would consider sparing the 19th-century landmark from demolition if a tenant can be found, according to City Councilman Mark Squilla.
The offer came from Bruce Schanzer of Cedar Realty Trust during a meeting with Squilla and James E. Moylan, president of the Pennsport Civic Association. Along with city preservationists, the men have been working since June to save the gabled redbrick structure next to I-95 on Reed Street.
"I'm cautiously optimistic," Squilla said after the meeting. "We have something to work on now."
While Schanzer made the offer without providing any time frame, Squilla noted that Cedar has no current plans for the site, which includes a large cinderblock building facing Columbus Boulevard. Schanzer's company builds and manages shopping centers and was hoping that a cleared site would be more attractive to potential tenants, Squilla recounted.