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Duration: 10 minutes
Make your way to king's Market for a special opportunity to greet LEGOLAND® royalty! Princesses and knights of all ages can meet Princess Lily amidst her extravaganza of princess dresses, crowns, wands, wings, and more – all available for purchase. Don't miss your opportunity to become a Princess or knight for the day!
Please note that showtimes are subject to change or cancellation without prior notice.
LEGOLAND California(760) 918-5346One LEGOLAND DriveCarlsbad, CA 92008
LEGOLAND Hotel(877) LEGOLAND (877-534-6526)5885 The Crossings DriveCarlsbad, CA 92008
Come play your part at LEGOLAND® California Resort, located just 30 minutes north of San Diego and one hour south of Anaheim. With more than 60 rides, shows and attractions it's an interactive, hands-on theme park experience for families with children 2-12. The Resort is also home to SEA LIFE® Aquarium and the world's first LEGOLAND Water Park. And if you've ever dreamed of spending the night at LEGOLAND, LEGOLAND Hotel at the Resort is now open and less than 2 miles from the nearest beach!This LEGO® themed hotel features 250 rooms based on the popular LEGO lines Pirate, Kingdom and Adventure. Add nightly children's entertainment, interactive LEGO features throughout and early access to LEGOLAND Park for Hotel guests, it's the LEGO experience you've always dreamed of! Book your San Diego vacation now at LEGOLANDhotel.com or call (877) LEGOLAND (534-6526).There are five other LEGOLAND Parks in the world – LEGOLAND Billund in Denmark, LEGOLAND Windsor outside of London, LEGOLAND Florida in the U.S., LEGOLAND Deutschland near Günzburg, Bavaria Germany and LEGOLAND Malaysia.Prices, times and schedules subject to change without notice. LEGO, the LEGO logo, the Brick configuration, the Minifigure and LEGOLAND are trademarks of the LEGO Group. ©2014 The LEGO Group. LEGOLAND CALIFORNIA RESORT AND SEA LIFE ARE A PART OF THE MERLIN ENTERTAINMENTS GROUP.Star Wars and all characters, names and related indicia are © & ™ Lucasfilm Ltd. All designs are property of Lucasfilm, Ltd.
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text: See all your footwear options at once with our Satin Nickel Floor-to-Ceiling Shoe Tree. Each of the six adjustable tiers revolve for easy access to the pair you want. There's also a basket that can store socks and accessories. It's an exceptional solution for storing shoes in small spaces, as it takes up very little floor space.


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Search Wyoming Dog Rescues and Shelters Here.
Find Australian Cattle Dog Puppies and Dogs for Adoption Today!
Doggies Blog: Recent Posts
Wyoming: Australian Cattle Dog Breeders
Below is a sample search of our Australian Cattle Dog breeders with puppies for sale. The search tool above returns a list of breeders located listings located nearest to the zip or postal code you enter. From there you can see photos of their pups, find out detailed information on their web page and contact them by email, phonoe or even get driving directions.
(Detailed contact information has been omitted Use Enter your zip or postal code above to access our up to date directory).
This is a FREE search tool! Use the form at the top to get complete listings for breeders in your area!
KS Ranch Heelers
Additional Information: Blue/Red Australian Cattle Dogs (Heelers) from over 10 Generations of loyal, smart, hardworking, healthy dogs bred and raised here on our cattle ranch. Puppies come current on shots/worming, Health Guarantee, and AKC registration (if applicable). Older pups, started and finished dogs available occasionally.
Blue/Red Australian Cattle Dogs (Heelers) from over 10 Generations of loyal, smart, hardworking, healthy dogs bred and raised here on our cattle... ...
JonVers Australian Cattle Dogs
Additional Information: Producing dogs that exemplify the beauty, structural & mental soundness of the ACD. Imported parents,all pups produced are guaranteed free from blindness due to prcd-PRA. Health guarantee.
At JonVers we aim to produce a dog that exemplifies the beauty and structural soundness of the Australian Cattle Dog, a dog anyone would be... ...
RHR Cattle Dogs
Quality Australian Cattle Dogs-aka Queensland Heelers. Family raised with bloodline on site. Beautiful blues--AKC and non. Unregistered pups will... ...
Ozark Autumn Australian Cattle Dogs
Additional Information: PUPPIES DUE MID JANUARYREDS AND BLUES EXPECTEDPRA A by ParentageRaised in home with young childShow Prospects possibleAKC CH sire and AKC CH dam Natural Working lines
Additional Information: Pride through performance! Wonderful companions, competitive showdogs,incredible work ethic. Complete health and genetic testing. Guarantee.
Hardtack cattle dogs possess a quick wit combined with drive and instinct. They are sound in structure and temperament. We utilize complete... ...
Additional Information: Blue Heeler puppies available at this time. Our puppies are the shorter and stocker type and very very intelligent and highly trainable. I have 4 MALES $250 ea. and 1 FEMALE $300 ea. Call anytime
Sapphire Kennel
Additional Information: We have puppies! Long Term Breeder of Quality Blue & Red Heelers. We have bred to maintain the original cattle dog. Ch. bloodlines. AKC, ARF, NSDR, Health Guarantee. Good Dogs For Good People!
We own a small farm in South Arkansas and have been part of the ACD family for many years. We strive to raise the original Cattle Dog with the... ...
G3 Kennels
Additional Information: G3 Kennels is located in Coushatta, Louisiana, about 35 minutes south of Shreveport. Our CKC Australian Cattle Dogs (Heelers)are given much love and attention until they find a new home with you.
G3 Kennels JD and Brenda Giddens 6286 Highway 783 Coushatta, LA 71019 (318) 932-5485 $300 EACH Litter Date: Contact... ...
Ammons Cowdogs
Additional Information: AKC Australian Cattle Dogs (Heelers) - We have top quality blues and reds. Raised on the farm with kids, cats and other critters. Pups come current on vaccinations, dewormings, and health guaranteed.
Ammons Cowdogs is located near the small town of Robeline, Louisiana. You probably won't find Robeline on many maps, but it's near the historic... ...
King's Kennels
Additional Information: we have a total of 6 Working CKC BLUE heelers. Three solid light blue female two natural bob tails. one full masked dark female and male.please check out our facebook page for more information.
its that time for a new waiting list !!! we have planned on breeding josey and tuff of fall of next year wanting a christmas litter. if you... ...
Portwood's Heelers
Additional Information: Australian Cattledog Heeler Pups CKC reg.I am a 30+yr blue heeler breeder. I ONLY BREED BLUES & own all parents, 30 DAY HEALTH GUARANTEE IN WRITING, SHOTS,WORMING U/T/D. 859-873-5185 8a-5p only
My name is Carol & been in the Australian Cattledog business & breeding for 30+ yrs,& have an excellent reputation. Got into heelers when we... ...
T'S Heelers/Kennel
Additional Information: Pups available !! Call to get yours today at 205-359-0052!
Hello, my name is Twilia Smith with T'S heelers/kennel. I love the breed blue heeler. I have owned, breed and raised them for years. My stud... ...
S & S Kountry Girl Kennels
Additional Information: I love this breed. They are loyal, hard working, and necessary for livestock farms. The colors are usually red or blue with tan markings, a partial mask, full mask, or no mask at all.
Hi we are just a couple of country girls that realized the need for working dogs. We love the breed. We were raised with these type dogs. They are... ...
TumbleWeeds Heelers
Additional Information: AKC registered Blue Heelers. Working and showline stock. Bloodlines are Hiredhand and Lindsey's Rocky Top. Beautiful, healthy well socialized puppies at reasonable prices. Puppies available now.
I have two AKC litters available Sire Hiredhand Rowdy Rustler X Lindseys Rocky Top Lola born July 8... ...
Lindsey's Rocky Top Kennel
Additional Information: We really enjoy raising the AUSTRALIAN CATTLE DOGS & think they are the best dogs ever.They are our friends & are so smart, loyal & quick to learn.They love praise & their aim is to please you.
We started Lindsey's Rocky Top Kennel in 1992 after we purchased a red female "POO" AKA LINDSEY'S RUSTIC LADY� in 1990 just for a pet and... ...
Michele W.
Additional Information: Blue Heeler puppies available now $ 400 1st shots and worming males and females. Contact for pictures
Roan Valley Farm
Additional Information: Australian Cattle Dog puppies 4 females and 1 male all blues and beautifully marked. Very loving and social and extremely loyal. First shots and wormed $400.00
Beautiful Blue Heeler puppies available now. 4 females and 1 male, beautfully marked and great temperments. Call Steve for details. $400.00 ...
Bison Ridge ACD'S
Additional Information: Akc registered top champion bloodlines ,health guarantee.UPDATED 10/29/2014
Additional Information: OFFERING TOP QUALITY AKC AUSTRALIAN CATTLE DOG PUPPIES aka Red and Blue Heelers for pet, working and/or show with excellent temperments. Parents have PRA,OFA,BAER testing *Calls are best 570-479-3976
AKC�TOP QUALITY AUSTRALIAN CATTLE DOG PUPS WITH EXCELLENT TEMPERAMENTS AND HEALTH. (BLUE & RED HEELERS WITH FULL/HALF MASK) Pups�will�be�sold... ...
Blue Moon Kennels
Additional Information: We have australlian cattle dogs for sale both red and blue. They are around 8 weeks old. We have 7 puppies for sale $350.00 each. They would make wonderful herding dogs.
Heel Nipper's Australian Cattle Dogs
Additional Information: AKC Australian Cattle dogs from working & show lines. Family raised & well socialized. We welcome working, competition & family homes.
A small kennel located in Massachusetts. Over 20 years experience with the breed. Striving for quality not quantity. Our dogs are sound... ...
Wind-Dancer's Kennel
Additional Information: We have beautiful, strong, well balanced Cattle Dogs. They live, breed, and birth in our home. They are raised in our warm loving home. Parents are Registered Service Dogs. They are socialized daily.
Important: breeders.NET has not screened the listed breeders and accepts no responsibility for their reputation or quality. It is your responsibility to investigate. See How to Find a Dog.


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Hot VideoFirst it was a book that was both adored and made fun of, in roughly equal measures. Before long "50 Shades of Grey" will be in movie theaters, and the first trailer is now available. Steaminess factor: 6.5 out ot 10.
COLDWATER � To the players and fans of the Coldwater and Sturgis high schools, their football rivalry is a sacred bond.
Israeli tank shells hit a compound housing a U.N. school in the Gaza Strip on Thursday, killing at least 15 people and wounding dozens who were seeking shelter from fierce clashes on the streets outside, Palestinian officials said, as Israel pressed...
Refrigerators are so common today we forget that it was once little more than a box with a block of ice in it.
Comic-Con has invaded San Diego and we have you covered! From 75th anniversary of Batman to the premieres of Starz's Outlander and new DC Comics shows The Flash, Gotham and Constantine,...
After 15 years of mostly gentle persuasion, the Foundation for Individual Rights in Education has announced that it is partnering with a major law firm on an aggressive litigation strategy to address First Amendment violations on college...
Jack Bauer was thisclose to getting the last laugh.After turning himself in to the Russians in exchange for Chloe's (
By Don email@example.com � Steve Shaw is competent to stand trial in the death of 7-month-old Carson Emanuel Burm, Branch County District Judge Brent Weigle ruled Tuesday.
[WARNING: The following contains spoilers from�Hemlock Grove's Season 2 finale. Read at your own risk.]We need to talk about�
This week, a group of�Sailor Moon�fans recreated an entire episode of the anime classic, shot for...
- Events Calendar


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- Mrkt_Commentary – Daily after-the-bell commentary from 'Mrkt_Rwnd', nightly 'ETF Rewind Lite' technical readings, and live trading room chat access (included automatically with all other subscription types). NOW AVAILABLE!
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The 803 shaft by Gait is made with a high-strength alloy with a partial decal finish for a good look when you play lacrosse. This stick is also extremely lightweight and is enhanced with Scandium for added durability.
Lamentamos que todavia no hay descripción en español para este producto.


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Hrithik Roshan and Suzanne Khan might have drifted apart but Hrithik Roshan is still in good terms with his ex-wife's family and enjoys Holi with Suzanne Khan's sister Farah Khan Ali, brother Zayed Khan and his two children, Hredhaan and Hrihaan. Farah posted the pictures of the Holi and
The International Indian Film Academy 2011
zayed khan News
Hrithik Roshan might have separated from his wife Suzanne Khan last year but he was not alone on his 40th birthday. He arranged a yacht party on January 10th and he was joined by his two children, Hrehaan and Hridhaan and other family members. Hrithik has recently ann
Bollywood actress Dia Mirza who is dating businessman Sahil Sangha for the last couple of years and contemplating marriage next year goes out on a date with Sahil. The actress looked charming in a short printed dress. Dia Mirza confirmed that she would marry boyfriend Sahil next year.


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Studies have shown that adjuvant therapy for breast cancer may increase the chance of long-term survival by preventing a recurrence. Learn more about it.
Review Date: March 21, 2013
NIH National Cancer Institute
It is normal for someone undergoing cancer treatment to feel distressed about hair loss. Keep in mind that your hair will probably grow back and learn some steps to minimize the problem.
Review Date: December 18, 2012
American Cancer Society
Learn about hormone replacement therapy, surgery and radiation as treatment options for pituitary disorders.
Review Date: February 25, 2013
Hormone Health Network
This book is a guide that you can refer to throughout radiation therapy. It has facts about radiation therapy and side effects, and describes how you can care for yourself during and after treatment.
Review Date: February 20, 2013
This series of radiation therapy side effects sheets offers practical tips to help you during radiation therapy. Learn about self-care, common problems radiation patients face, and questions to ask your doctor.
Review Date: April 25, 2012
Find out how various x-ray, CT, MRI, ultrasound, radiation therapy and other procedures are performed. Learn about patient safety, what you may experience, and how to prepare for exams.
Review Date: November 09, 2012
American College of Radiology


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Rosen Centre Hotel is in convenient walking distance of many of International Drive's favorite attractions. For those destinations a little further out, the I-RIDE Trolley transports Orlando visitors up and down this bustling strip.
Make your Orlando vacation or convention trip unforgettable by staying at the hotel that's In the center of it all- the Rosen Centre Hotel. Our luxurious accommodations and superior service combined with our excellent location will ensure you get the most out of your stay in Orlando.


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NHL Edition Goal Light Score One Today!
Lowest Price Guarantee
If within 30 days of your online purchase at Kotulas.com, you find the identical product nationally advertised for less by one of our competitors, we will refund to you 110% of the difference!
Nationally advertised low prices found online must be printed out completely with proof of competitor's name and the offer's expiration date clearly visible. To receive your refund, please mail a copy of the advertisement with the offer's expiration date visible, together with a copy of your invoice to:
Kotula's Ecommerce Marketing
P.O. Box 1499
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Valid on retail price of item only, not on shipping and/or handling charges. No close-outs, misprints, price quotes, coupons, rebates, auction websites or liquidations. Also not valid on Member Club pricing. Item must be identical make and model#. Competitor product must be available and in-stock at the time of claim. Please allow 6 weeks for processing.
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Light the lamp and celebrate the big goal, or anything else, with the NHL Edition Goal Light. You get the excitement of flashing lights and an NHL-style horn sound with a simple click of the puck-shaped remote control. The unit is programmed to replicate the official goal horn sound from each of the NHL arenas, so its easy to customize your celebration to match the live action. Since each light also has a 3.5mm audio out plug, you can hook it up to external speakers or a home surround sound system and really rock the place. This officially licensed NHL product includes labels for all 30 NHL teams, letting you add your favorite team's logo. Its a great addition to any man cave. Uses 4 AA batteries for light and 2 AAA batteries for the remote (batteries included).
Manufacturer Warranty:
1 year Limited Warranty
Suggested accessories:
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More power to ya with Duracell Coppertop batteries, engineered to deliver the right level of power for your business or household needs. Batteries are guaranteed to remain fresh for up to 7 years. Individually date coded to ensure freshness. Environmentally friendly batteries are mercury free and work in a wide variety of devices. Pack of 8. U.S.A.
Order Over $25 for Free Shipping!
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More power to ya with Duracell Coppertop batteries, engineered to deliver the right level of power for your business or household needs. Batteries are guaranteed to remain fresh for up to 7 years. Individually date coded to ensure freshness. Environmentally friendly batteries are mercury free and work in a wide variety of devices. Pack of 8. U.S.A.
Check out some of our other amazing gear!
Your head will be moving around like a bobblehead as you try to keep up with the incredibly fast action on the Arctic Ice, a 7-ft. air hockey table with a 110V, 110 CFM high-speed fan that lets the puck hover effortlessly for smooth and fast play. Table also sports extra rail height and space to keep the puck in play. You also get a timer with 10, 15 and unlimited timed game options, electronic LED scoring and adjustable volume, plus on/off and game reset switches. The smooth, glossy white playing surface resembles an ice rink. Dual end rail puck return. Legs have levelers for uneven surfaces. Includes 4 pucks and 4 pushers. Overall 84in.L x 48in.W x 32in.H. Some assembly.
Manufacturer Warranty:
1 year Limited Warranty
This officially licensed NHL pub table is ideal for your bar, rec or game room on hockey night or any time. The 28in. dia. table top features 1in. solid wood construction with scratch-resistant, UV-protected acrylic top with the Wild logo proudly displayed, along with chrome-plated banding on the table top. It includes a 42in.H chrome base with footrest and adjustable levelers. The table ships in 2 boxes; some assembly is required. U.S.A.
Some multi-game tables make you go through a big production, flipping over the top to play another game. This table offers you a 3-in-1 gaming opportunity without breaking your back. Simply slide the proper insert onto the top of the table to change the game. It's easy! Choose billiards, slide table hockey and table tennis. You get everything you need: game table with playfield inserts, set of 2 1/4in. billiard balls, two 57in. cues, 2 chalks, 2 table tennis paddles and 2 balls, net and post set, 2 hockey pushers and 2 pucks. Table is 84in.L x 46in.W x 31 1/4in.H. Some assembly.
Manufacturer Warranty:
1 year Limited Warranty
If your goal is to improve the look of your rec room or man cave, give this NHL team logo revolving wall light a spin. The motorized, UL listed light features the logo of the Detroit Red Wings and even comes with a puck-shaped pull chain. The light is a big 20in.L x 10in.W x 10in.H and comes complete with a T5 8 Watt bulb. Rugged ABS construction; all mounting hardware included.
Throw on your jersey, grab some snacks and get ready to cheer. Third period victory! This 1:25 scale Detroit Red Wings Zamboni® will have you mustering all your pride in your favorite NHL team. Engineered in consultation with the staff at Zamboni, this model features the detailing of the authentic, life-size Zamboni ice resurfacer: hockey boards, ice-look display base and intricate die-cast metal detailing. NHL® team graphics are the genuine article. 11.3in. x 6.8in. x 6.5in.


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Mind you I am primarily a DPS kinda guy. If it's a mob you are not targeting that you lose, probably the DPS' fault. Make it your mission to teach people how to use the Target's Target function (default is the F key). Example, I'm on my DK (can peak at 16-18k in random heroics). I set you, the tank, as my focus. The group is pulled and you establish a fighting location, this is when I hit the F Key and get at it. As long as you stick to that target, I can go all out and not pull threat.
Hell I use the F key so much that often (read being uber lazy), after the first target in a group pull dies, I'll simply hit TAB, F, F. The TAB selects something in front of me, the first F should bounce my target to the tank and the second F puts me on the mob the tank is targeting.


text: The Arts In Medicine Open Art Studio is open to Moffitt patients, their families and friends, Moffitt staff and volunteers. Arts In Medicine is part of Patient and Family Services at Moffitt Cancer Center. For more information, please contact Cheryl Belanger, Coordinator of Arts In Medicine at (813)745-1836 or firstname.lastname@example.com


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Second Nature seeks the services of two Implementation Fellows to support colleges and universities in successfully fulfilling their reporting requirements of the American College & University Presidents' Climate Commitment (ACUPCC). The Implementation Fellows will work as part of the ACUPCC Support Team on the Second Nature staff to help current signatory institutions fulfill the reporting requirements of the ACUPCC, with an emphasis on supporting Minority-Serving Institutions (MSIs) and Under-Resourced Institutions (URIs) that are signatories of the ACUPCC. Reporting requirements include the development of greenhouse gas inventories, writing and implementing campus-wide climate action plans, developing sustainability research and curricular initiatives, energy and financing analysis, and engagement of senior leadership and community partnerships. For more information and to apply, visit: http://secondnature.org/about/employment/implementation-fellow.html
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- Signing up for the MassCommute Bicycle Challenge! May 2, 2014
- Eco-Rep Update: Where We Eat, Live, and Play April 23, 2014
- A Message from Tufts' Provost David Harris – Century Ride! April 14, 2014


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Written by Rich Forestano Wednesday, 21 August 2013 00:00
Nassau County selected Nassau Events Center to redevelop Nassau Coliseum and the surrounding property, by offering the county a significantly sweeter deal.
Bruce Ratner, the developer of the Barclays Center in Brooklyn and NEC's chief executive, beat out Hank Ratner (no relation) and the Madison Square Garden Company after the county narrowed its choices to the two entertainment giants last month.
At a news conference in Mineola on Thursday, Aug. 15, Mangano noted revenue differences in the two proposals drove the final decision.
NEC agreed to pay 8 percent of the gross revenue each year to Nassau County and 12.75 percent of parking fees. The group guaranteed payment of $4 million per year, escalating 10 percent every five years during the lease. That would total at least $195 million over the life of the lease. [Both plans are based on a 34-year lease with an optional 15-year extension.] On top of that revenue, NEC offered an additional 8 percent of revenue generated by its entertainment facilities.
MSG would have paid $1.50 per ticket sold, rather than a percentage. It guaranteed $3 million in the first year, escalating 5 percent every five years. MSG payments would total $112 million over the life of the lease. What's more, MSG wanted to retain development rights to the site. NEC's plan allows the county to retain those rights.
Both companies agreed to shoulder the maintenance and utility costs of the property. County officials estimated that utilities costs $2 million alone each year.
Mangano said the selection committee was impressed by NEC's willingness to accept immediate responsibility for the coliseum at its sole expense and pay a measurably higher annual minimum rent with higher escalations.
"With options exercised, the minimum lease payment grows to $334 million," Mangano said of Ratner's proposal.
NEC's lease must be approved by the county legislature and the Nassau Interim Finance Authority. County Executive Edward Mangano said NIFA "sees no issue" with the NEC plan.
Bruce Ratner developed the Barclays Center, where the New York Islanders will move once their Nassau Coliseum lease expires on Aug. 1, 2015. He said he's "grateful to be selected to revitalize" the 77-acre site here. Syosset-based developer Ed Blumenfeld joined forces with NEC in last month after his group's proposal was rejected.
NEC's $229 million plan calls for a 13,000-seat arena, a 2,500-seat indoor theater, an ampitheater, up to 10 restaurants, an ice skating rink and 50,000 square feet of retail space. The developer also plans to have the Islanders host at least six home games at the site.
Mangano said NEC's proposal would create a "downtown-like" atmosphere at the site.
"We are ready to get to work to deliver a world-class coliseum and a thriving sports, entertainment and retail center that Long Island deserves," Ratner said in a statement.
MSG's $250 million plan offered a 14,500 seat stadium, with restaurants, bars and had the support of Donald Monti of Renaissance Downtown, the master developer of the hub. That group hoped to recruit an amateur hockey team to the site and get WNBA's New York Liberty to play select home games.
"While we are disappointed with the county's decision, we are not at all surprised given the history of this project, " MSG said in a statement. "We will be watching closely as this process moves to the county legislature."
Republican Legislator Rich Nicolello said the recent proposals were the most realistic going back to the failed Lighthouse plan of Islanders owner Charles Wang.
"We have to go through the details of the lease but my first impression is very positive," he said. "It's taken way too long for us to get to this point."


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Lymphedema After Surgery in Patients With Endometrial Cancer, Cervical Cancer, or Vulvar Cancer
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This clinical trial studies lymphedema after surgery in patients with endometrial cancer, cervical cancer, or vulvar cancer. Collecting information over time about how often lymphedema occurs in patients undergoing surgery and lymphadenectomy for endometrial cancer, cervical cancer, and vulvar cancer may help doctors learn more about the disease and plan the best treatment.
Stage IA Cervical Cancer
Stage IA Endometrial Carcinoma
Stage IA Vulvar Cancer
Stage IB Cervical Cancer
Stage IB Endometrial Carcinoma
Stage IB Vulvar Cancer
Stage II Endometrial Carcinoma
Stage II Vulvar Cancer
Stage IIA Cervical Cancer
Stage IIIA Vulvar Cancer
Stage IIIB Vulvar Cancer
Stage IIIC Vulvar Cancer
Stage IVB Vulvar Cancer
Procedure: therapeutic lymphadenectomy
Procedure: therapeutic conventional surgery
Procedure: therapeutic laparoscopic surgery
Procedure: study of high risk factors
Other: questionnaire administration
Procedure: psychosocial assessment and care
Procedure: quality-of-life assessment
|Study Type:
|Study Design:
|Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Supportive Care
|Official Title:
|The Lymphedema and Gynecologic Cancer (LEG) Study: Incidence, Risk Factors, and Impact in Newly Diagnosed Patients
- Incidence of lymphedema, assessed through volumetric measurements using serial circumferential measurements performed from 10 cm above the heel to the inguinal crease at 10 cm intervals [ Time Frame: Up to 24 months ] [ Designated as safety issue: No ]A competing risks analysis will be required to estimate the cumulative incidence of lymphedema. Transition probabilities in the Markov Chain will be estimated by simple proportions, ignoring covariates, to address this primary objective. Confidence intervals for the cumulative incidence of lymphedema then will be computed using the Delta Method, utilizing the fact that the transition proportions have and asymptotic multivariate normal distribution.
- Surgical outcome including number of lymph nodes removed, laterality of nodes removed (bilateral vs. unilateral), lymph node status (presence/absence of metastases) [ Time Frame: Baseline ] [ Designated as safety issue: No ]
- Post-surgical outcome including development of infection, type of closed suction drain used, lymphocyst formation, use of radiation, and use of chemotherapy [ Time Frame: Up to 24 months ] [ Designated as safety issue: No ]
- Frequency and severity of adverse events as assessed by the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0 [ Time Frame: Up to 24 months ] [ Designated as safety issue: Yes ]
- Quality of life as assessed by the FACT-G, FACT-Cx, FACT-V, IES, Lymphedema Symptoms Assessment, and Lymphadenopathy Assessment questionnaires [ Time Frame: Up to 24 months ] [ Designated as safety issue: No ]A mixed linear model similar to above one will be fitted to the FACT-G scores with the moderate or severe lymphedema as a time-dependent variable.
- Self-report of lymphedema symptoms as measured by the Lymphedema Scale which assesses 20 symptoms [ Time Frame: Up to 24 months ] [ Designated as safety issue: No ]The lower lymphedema symptoms will be assessed with the GCLQ. A generalized linear mixed model will be used to explore the relationship in changes in limb volume. To reflect the observed covariance pattern of the QOL data, the 'empirical' variance will be used in estimating the precision of parameter estimates. Satterthwaite's DF will be used in significance testing.
|Estimated Enrollment:
|Study Start Date:
|June 2012
|Estimated Primary Completion Date:
|July 2017 (Final data collection date for primary outcome measure)
|Assigned Interventions
Experimental: Supportive care (lymphedema assessment)
Patients with vulvar cancer undergo a radical vulvectomy or hemi-vulvectomy followed immediately by an ipsilateral or bilateral inguinal-femoral lymphadenectomy.
Patients with cervical cancer undergo a radical hysterectomy or trachelectomy and bilateral pelvic lymphadenectomy +/- para-aortic nodal sampling via vaginal, laparoscopic, or open route.
Patients with endometrial cancer undergo a laparoscopic-assisted vaginal hysterectomy, a total laparoscopic hysterectomy, or total abdominal hysterectomy with pelvic lymphadenectomy +/- para-aortic node sampling.
Patients undergo limb measurements at baseline, weeks 4-6, and at 3, 6, 9, 12, 18, and 24 months.
Procedure: therapeutic lymphadenectomy
Undergo lymphadenectomyProcedure: therapeutic conventional surgery
Undergo surgeryProcedure: therapeutic laparoscopic surgery
Undergo surgeryProcedure: study of high risk factors
Undergo lymphedema assessmentOther: questionnaire administration
Ancillary studiesProcedure: psychosocial assessment and care
Ancillary studies
Other Names:Procedure: quality-of-life assessment
Ancillary studies
Other Name: quality of life assessment
Detailed Description:
I. To prospectively estimate the incidence of lower extremity lymphedema in patients undergoing radical surgery with a concurrent lymphadenectomy with a concurrent lymphadenectomy for a gynecologic malignancy.
II. To identify risk factors for the development of lower extremity lymphedema following radical surgery for each of three types of gynecologic malignancy and to develop a corresponding predictive model.
I. To identify the effect that lower extremity lymphedema has on quality of life (QOL) (as measured with Functional Assessment of Cancer Therapy - General [FACT-G] + disease specific subscale), psychological adjustment (as measured with Impact of Events Scale [IES] and Functional Assessment of Chronic Illness Therapy [FACIT] body image items) and physical disability (of lower extremity as measured with Lower Extremity Functional Scale [LEFS]) and physical function(as measured by FACT-Functional Wellbeing [FW] subscale, FACIT disease specific items & patient-reported outcomes measurement information system [PROMIS] items) and to investigate potential protective mechanisms (FACT-Social Wellbeing [SW] subscale and patient characteristics).
II. To explore if patient self-reported symptoms (as measured with the lymphedema [LE] Symptom Measure [Cancer Lymphedema Questionnaire (GCLQ)]) are associated with the development of lymphedema in patients undergoing radical surgery for gynecologic malignancy.
I. To explore the effect of moderate or severe lymphedema (primary endpoint) on QOL outcomes, as measured by the FACT-General (G) questionnaire.
Patients with vulvar cancer undergo a radical vulvectomy or hemi-vulvectomy followed immediately by an ipsilateral or bilateral inguinal-femoral lymphadenectomy.
Patients with cervical cancer undergo a radical hysterectomy or trachelectomy and bilateral pelvic lymphadenectomy +/- para-aortic nodal sampling via vaginal, laparoscopic, or open route.
Patients with endometrial cancer undergo a laparoscopic-assisted vaginal hysterectomy, a total laparoscopic hysterectomy, or total abdominal hysterectomy with pelvic lymphadenectomy +/- para-aortic node sampling.
Patients undergo limb measurements at baseline, weeks 4-6, and at 3, 6, 9, 12, 18, and 24 months.
|Ages Eligible for Study:
|18 Years and older
|Genders Eligible for Study:
|Accepts Healthy Volunteers:
Inclusion Criteria:
Patients will be registered into three distinct groupings, and each group will be analyzed as a separate study:
- Patients who will undergo or have undergone hysterectomy/bilateral salpingo-oophorectomy (BSO) and pelvic lymphadenectomy +/- para-aortic node sampling via open or laparoscopic technique for clinical stage I-II or surgical stage I-III uterine carcinoma, including those receiving postoperative adjuvant therapy; patients enrolling after surgery may have a pathologic stage of I-III OR
- Patients who will undergo or have undergone radical hysterectomy or trachelectomy and pelvic lymphadenectomy +/- para-aortic node sampling via open or laparoscopic technique for clinical stage IA-IIA cervical carcinoma, including those receiving postoperative adjuvant therapy OR
- Patients with vulvar cancer who will undergo or have undergone definitive surgery for primary stage I-IV vulvar cancer who will or have received a radical vulvectomy or radical local excision with concurrent unilateral or bilateral inguinal or inguinal-femoral lymphadenectomy; patients who are going to receive multi-modality therapy (radiation +/-chemotherapy) after undergoing surgery are eligible; patients may undergo sentinel node mapping as long as it is followed by a full lymphadenectomy
- Patients must have signed an approved informed consent and authorization permitting release of personal health information
- Patients must have a serum albumin level of >= 3.0 within 14 days of entry
- Surgery must occur within 5 business days before study entry or within eight weeks after study entry
Exclusion Criteria:
- Patients with any prior clinical history of lower extremity lymphedema
- Patients who have a history of congestive heart failure, chronic renal disease, or chronic liver disease
- Patients with a prior history of chronic lower extremity swelling
- Patients with a Gynecologic Oncology Group (GOG) performance grade of 3 or 4
- Patients with a history of other invasive malignancies if their previous cancer treatment included any of the surgical procedures
- Patients who have had prior lower extremity vascular surgery (arterial or venous)
- Patients who have had prior pelvic, abdominal, inguinal, or lower extremity radiation therapy
- Patients who have had or are going to receive another elective surgery during the same operative event as their pelvic (cervical or uterine cancers) or inguinal (vulvar) lymphadenectomy
- Patients cannot be enrolled on the trial unless there is at least one person at the participating site who has been trained in performing limb measurements
- Patients who do not undergo or have not undergone the lymphadenectomy portion of the procedure
- Patients who enter the study and then undergo sentinel node biopsy without the intention of undergoing complete lymphadenectomy
Please refer to this study by its ClinicalTrials.gov identifier: NCT00956670
Show 161 Study Locations
|Principal Investigator:
|Richard Barakat
|Gynecologic Oncology Group
No publications provided
|Responsible Party:
|Gynecologic Oncology Group
|ClinicalTrials.gov Identifier:
|NCT00956670 History of Changes
|Other Study ID Numbers:
|Study First Received:
|August 8, 2009
|Last Updated:
|March 7, 2014
|Health Authority:
|United States: Institutional Review Board
Additional relevant MeSH terms:
Vulvar Neoplasms
Endometrial Neoplasms
Uterine Cervical Neoplasms
Genital Diseases, Female
Genital Neoplasms, Female
Lymphatic Diseases
Neoplasms by Histologic Type
Neoplasms by Site
Neoplasms, Glandular and Epithelial
Urogenital Neoplasms
Uterine Cervical Diseases
Uterine Diseases
Uterine Neoplasms
Vulvar Diseases
ClinicalTrials.gov processed this record on November 27, 2014


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To ensure guest satisfaction, all of our properties are rated according to the guidelines below. Please ask your reservations agent if you have any questions regarding these ratings.
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Obtaining an Identification Card
You must be a resident of Virginia to obtain an ID card.
An ID card:
- Has no age restriction.
- Is available for an adult or child who does not already hold a learner's permit or driver's license issued from a state within the United States.
- Both adult ID and child ID cards expire at the end of the month in which you were born when you reach an age divisible by five; (e.g. 20, 25, 30 etc.)
Individuals required to register with the Virginia State Police Sex Offender and Crimes Against Children registry (Virginia Code Chapter 9 of Title 9.1) will be issued ID cards valid for five years.
If you are authorized to be in the U.S. temporarily, you will be issued an ID card valid only for the amount of time that you are legally permitted to stay in the U.S. You will not be eligible to receive a limited duration ID card if your authorized stay in the U.S. is less than 30 days from the date of your application. The expiration of the ID card will be the same as the expiration date shown on the document used to prove legal presence. If the document does not show an expiration date, the ID card will be valid for one year.
You may exchange your valid Virginia driver's license for an ID card for a $10.00 fee. If you are age 70 or older and have not previously held an ID card, there is no charge for exchanging your license for an ID card. You will be charged the $10.00 fee if you are 70 or older and have previously held an ID card.
Required Documents
If you are applying for an ID card for the first time and do not hold a valid Virginia driver's license, each time you apply for the ID card, you will be required to show two proofs of identity (only one primary document if you are under age 19), one proof of legal presence and one proof of Virginia residency. You will be required to show these required documents on each return visit until your ID card is issued.
If you were born in 1937 or earlier and you want to apply for an ID card, you will not have to provide proof of legal presence if you now hold or previously held a Virginia driver's license or ID card, provided your license or ID card has not been expired for more than 5 years and DMV can verify that it was issued to you. If you do not still have the license or ID card when you apply for your new ID card, be prepared to provide alternative proof that you held the old license or ID card. DMV will attempt to verify your old license or ID card if you cannot provide any alternative proof. However, if DMV cannot verify its issuance, or you are authorized to be in the U.S. temporarily, you will be required to present one document as proof of legal presence to obtain your new ID card.
You can find out which documents that DMV will accept as proof of identity, legal presence, and Virginia residency can be found either by:
- reviewing Acceptable Documents for Obtaining a Driver's License or ID Card (DMV 141)
- using the interactive Document Guide.
All documents must be originals. Temporary documents and photocopies of documents will not be accepted. All documents will be subject to verification, which may delay the issuance of your identification card. DMV will not accept a document as proof of identity, legal presence or residency when there is reason to believe it has been altered, fraudulently obtained or is fake, forged, counterfeit, or otherwise non-genuine or illegitimate. DMV may require additional documents.
Falsifying information on any driver's license or identification card application is a criminal offense. Altering or assisting a person with improperly or fraudulently obtaining a driver's license, learner's permit, CDL, CDL instruction permit or ID card are also criminal offenses.
Documents accepted by DMV as proof of identity, legal presence and Virginia residency may change without prior notice.
DMV will assign you a customer number which will display on your ID card. If you wish to change your DMV-assigned number in the future, you may be required to present documentation from law enforcement or the courts indicating that you may be a victim of identity theft.
Selective Service Registration
Generally males under age 26 must register with the Selective Service. If you are required by federal law to register with the Selective Service, you must authorize DMV to forward your personal information to the Selective Service unless you have already registered.
If you are under age 18, your parent or guardian must sign your application authorizing the Selective Service to register you when you turn age 18. Law prohibits DMV from issuing any type of driver's license or ID card to an applicant who is required by federal law to register with the Selective Service but who refuses to authorize DMV to send his information to the Selective Service. If you have questions about Selective Service registration, visit the Selective Service website at www.sss.gov or call 847-688-6888 (TTY: 847-688-2567).
Completing the Application
When applying for an ID card or a hearing-impaired ID card, you must complete a Driver's License, Identification Card, and Voter Registration Application (form DL 1P). For a child ID card (under age 15), complete the Identification Card for Minors Application (DL 5). You may complete these forms before or after coming to DMV. Use your full legal name on the application. Abbreviations and nicknames will not be accepted.
For your convenience, you also may apply to register to vote, change your voter registration address, or indicate your desire to become an organ donor when you apply for your ID card.
An ID card costs $10.00. You may pay your fees with cash, money order, check, check card or major credit card.
You will receive your newly designed secure ID card in the mail. DMV has converted to a new secure process for issuing driver's licenses and ID cards and has discontinued issuing them over the counter. The new secure process is similar to the U. S. passport process and reduces the risks of fraud.
If you have renewed your ID card, you can continue to carry your old ID card with your receipt until you receive your new ID card in the mail.
Make sure DMV has your current, correct address on record, as your license will be mailed to the address in DMV's records. Notify DMV right away if you have moved. The U.S. Postal Service will not forward driver's licenses.
DMV may refuse to issue a driver's license or identification card to any applicant who appears for photographing in a disguise or intentionally distorts their face to alter their appearance.
For examples of ID cards, refer to images of driver's licenses and identification cards.