text:
Devices and methods are described herein for implanting a connector to provide an anastomotic connection at a graft/host vessel junction.
1. A system for loading an anastomosis connector assembly onto a graft vessel, the connector assembly comprising an inner frame and an outer frame, the outer frame having an original state and an expanded state, the system comprising:
an outer frame cartridge configured for releasably holding the outer frame in the expanded state for placement over the graft vessel; and
an inner frame cartridge configured for releasably holding the inner frame and for operatively engaging the inner frame within the graft vessel when the outer frame is in the expanded state.
2. The system of
3. The system of
4. The system of
5. The system of
6. The system of
7. The system of
8. The system of
9. A method for loading an anastomosis connector assembly onto a graft vessel, the connector assembly comprising an inner frame and an outer frame, the outer frame having an original state and an expanded state, the method comprising:
providing the outer frame releasably engaged to an outer frame cartridge wherein the outer frame is provided in the expanded state;
positioning at least a portion of the outer frame about the outside of the graft vessel;
providing the inner frame releasably engaged to an inner frame cartridge;
appositioning the inner frame cartridge with the outer frame cartridge wherein at least a portion of the inner frame is positioned within the graft vessel; and
releasing the outer frame from the expanded state to the original state.
10. The method of
11. The method of
12. The method of
13. The method of
14. The method of
15. The method of
16. The method of
17. An instrument for deploying an anastomosis connector assembly at an anastomosis site, the connector assembly comprising interconnected deflectable inner and outer frames, the instrument comprising:
an outer frame deflector; and
an inner frame deflector;
wherein the deflectors are configured to hold the interconnected anastomotic connector assembly, the outer frame deflector is configured to engage and selectively deflect a portion of the outer frame, and the inner frame deflector is configured to engage and selectively deflect a portion of the inner frame; and
wherein actuation of the deflectors advances the deflectors towards each other to deflect the frames and subsequently release the frames wherein the interconnected connector is deployed as the anastomosis site.
18. The instrument of
19. The instrument of
20. The instrument of
21. The instrument of
22. The instrument of
23. The instrument of
an elongated shaft having a longitudinal axis;
a handle mechanism at a proximal end of the elongated shaft; and
an end effector at a distal end of the elongated shaft and comprising the deflectors, wherein the deflectors are movable by the handle mechanism.
24. The instrument of
25. The instrument of
26. The instrument of
27. A system for implanting an anastomosis connector assembly at anastomotic site to interconnect a graft vessel with a host vessel, the connector assembly comprising interconnectable frames comprising an inner frame and an outer frame, the outer frame having an original state and an expanded state, the system comprising:
a loading apparatus comprising an outer frame cartridge configured for releasably holding the outer frame in the expanded state for placement over the graft vessel, and an inner frame cartridge configured for releasably holding the inner frame and for operatively engaging the inner frame within the graft vessel when the outer frame is in the expanded state; and
a deployment apparatus comprising an elongated shaft and an end effector at a distal end of the elongated shaft, the end effector comprising first and second rotatable deflectors to configured to engage with and remove the interconnected connector assembly from the loading apparatus.
28. The system of
29. The system of
30. The system of
31. A method for implanting an anastomosis connector assembly at anastomotic site to interconnect a graft vessel with a host vessel, the connector assembly comprising interconnectable frames comprising a deflectable inner frame and a deflectable outer frame, the outer frame having an original state and an expanded state, the method comprising:
expanding the outer frame into the expanded state;
positioning at least a portion of the outer frame about the outside of the graft vessel;
appositioning the inner frame with the outer frame wherein at least a portion of the inner frame is positioned within the graft vessel;
releasing the outer frame from the expanded state to the original state wherein the outer frame is interconnected to the inner frame;
deflecting the inner and outer frames;
inserting at least a portion of the deflected inner and outer frames into the host vessel; and
releasing the deflected inner and outer frames wherein the graft vessel is in fluid communication with the host vessel.
32. The method of
33. The method of
This application is a continuation-in-part of U.S. patent Ser. No. 10/810,315 filed Mar. 25, 2004 which is a continuation-in-part of U.S. patent Ser. No. 10/187,655, filed Jul. 1, 2002, which claims the benefit of priority to U.S. Provisional Patent Application Ser. No. 60/387,824, filed Jun. 10, 2002, and is also a continuation-in-part of U.S. patent application Ser. No. 09/991,469, filed Nov. 21, 2001, which is a continuation-in-part of U.S. patent application Ser. No. 09/899,346, filed Jul. 5, 2001, now U.S. Pat. No. 6,626,920, all the disclosures of which are incorporated herein by reference in their entirety.
This relates to producing end-to-side anastomoses, particularly in communication with coronary arteries, the aorta, the subclavian, iliacs, femoral arteries, popliteal arteries, radial arteries, mammary arteries, mesenteric arteries, renal arteries, carotid arteries, cerebral arteries, or other tubular structures. Accordingly, angled anastomosis connectors and associated devices are disclosed.
This invention provides devices and methods to position and secure bypass grafts at host vessel locations without having to stop or re-route blood flow for extended periods of time, which is a condition of conventional sutured anastomoses. In addition, this invention reproducibly creates angled anastomoses between bypass grafts and host vessels thereby optimizing flow dynamics through the anastomoses and mitigating risks associated with suturing, clipping or stapling the bypass graft to a host vessel, namely reduction of anastomotic opening or excessive bleeding from the puncture holes. These risks may be mitigated, in part, by features adapted to avoid bleeding at graft attachment sites and preventing the host vessel from collapsing around the incision point.
In performing cardiac bypass surgery, anastomosis sites are typically provided at a site along a patient's aorta, and another site along a coronary artery beyond a partial or complete occlusion. Alternatively, sequential �jumper� grafts may extend from a main bypass graft to individual coronary artery host vessels thereby requiring a single aortic anastomosis to accommodate multiple coronary anastomoses. As such, in-flow anastomoses are required along the main �feeder� graft and out-flow anastomoses are required to the host vessel coronary arteries. This eliminates the need for side-side anastomoses between a single graft and multiple coronary arteries when producing sequential anastomoses from a single aortic anastomosis. Producing an effective anastomosis along a coronary artery is particularly challenging. The outer diameter of a coronary artery where a distal anastomosis may be needed can range from between about 1 mm to about 4 mm in size. By way of comparison, the outer diameter of the aorta where a proximal anastomosis may be located ranges between about 20 mm and about 50 mm in size.
The relatively small size of the site for a distal anastomosis translates to greater difficulty in a number of ways. Basic surgical challenges are encountered in dealing with the smaller vasculature. Further, an interface issue is introduced. Often, particularly for connection with the smaller coronary arteries, a graft conduit will have a larger diameter than the host vessel. This may be due to the need for a larger diameter conduit to carry adequate blood flow or the result of using a saphenous vein which must be oriented so its valving allows blood to readily flow in the desired direction from the proximal anastomosis to the distal anastomosis, thereby orienting the larger end of the graft toward the distal site. For whatever reason, the mis-match in size in joining the graft to the coronary artery must be addressed. The angled anastomotic junction created by the connector embodiments of the invention accommodate this mis-match in ratio between the host vessel and graft inner diameters. In fact the angled design enables the connector embodiments to address any ratio between graft and host vessel inner diameters.
The present invention is adapted to handle these issues as well as others as may be apparent to those with skill in the art. The angled-type connectors described herein may be employed with precision and speed, resulting in treatment efficacy not heretofore possible.
The ability to convert coronary artery bypass grafting procedures and peripheral bypass grafting procedures to less invasive approaches involving small incisions and remote creation of anastomoses are particularly difficult with conventional suturing techniques and are amenable to the embodiments and approaches for the angled connectors and associated components.
The invention includes various improvements in end-side anastomosis systems. Particularly, connectors for producing distal anatomoses are described. They each include a fitting comprising a heel section with a trailing segment that is deflectable about a hinge region to allow for placement and securing the device. Curvilinear side and forward-facing portions are preferred. Most preferably, these portions are configured to conform to the shape of a host vessel and direct the opening (incision) through the host vessel to assume the shape defined by the fitting. Such a fitting may alone serve as a connector between a host vessel and a graft provided that it includes features capable of compressing the host vessel and graft in place or otherwise maintaining close apposition between the graft and host vessel. Alternatively, the connector may comprise a fitting in combination with a collar adapted to secure a graft to the fitting and compress the graft and host vessel.
Various features for improving the deployability of a connector, hemostasis at the connector to host vessel interface, and blood flow through the anastomoses may be provided by the invention. Further, various tools for use in preparing for and creating an end-side anastomosis may comprise part of the invention. Finally, various instruments and accessories decreasing the access required to deploy the connector to enable minimally invasive surgical approaches may comprise part of the invention.
While connectors and deployment devices according to the present invention are preferably used in peripheral and coronary artery bypass grafting procedures, at a distal (out-flow) or proximal (in-flow) location, it is to be understood that the systems described herein may be used for purposes other than creating artery-to-artery or vein-to-artery anastomoses. The systems may also be used to produce anastomoses between bypass grafts and host vessels to treat other occlusions, vascular abnormalities such as stenoses, thromboses, aneurysms, fistulas and other indications requiring a bypass graft. The system of the present invention is also useful in bypassing stented vessels that have restenosed, and saphenous vein bypass grafts that have thrombosed or stenosed. Further, the invention may have other applications, such as producing arterial to venous shunts or fistulas for hemodialysis, bypassing lesions and scar tissue located in the fallopian tubes causing infertility, attaching the ureter to the kidneys during transplants, and treating gastrointestinal defects (e.g., occlusions, ulcers, obstructions, etc.).
The present invention variously includes the devices as well as the methodology disclosed. Furthermore, it is contemplated that sub-combinations of features, especially of the connector features disclosed, comprise aspects of the invention.
Each of the following figures diagrammatically illustrates aspects of the present invention. The illustrations provide examples of the invention described herein. Like elements in the various figures often are represented by identical numbering. For the sake of clarity, some such numbering may be omitted.
The variations of the invention discussed herein are applicable to robotic surgery, endoscopic, and other less invasive (i.e., minimally invasive) surgery. As noted above, the present invention includes variations of anastomosis connectors having features adapted to perform angled anastomoses. Anastomotic connectors, tools and associated methodology for producing in-flow (proximal) and out-flow (distal) anastomoses are described variously in U.S. and foreign patent and applications entitled, �Percutaneous Bypass Graft and Securing System�, U.S. Pat. No. 5,989,276; �Percutaneous Bypass Graft and Securing System�, U.S. Pat. No. 6,293,955; �Percutaneous Bypass Graft Securing System�, PCT Publication No. WO 98/19625; �Sutureless Anastomosis Systems�, U.S. patent application Ser. No. 09/329,503; �Sutureless Anastomosis Systems�, PCT Publication No. WO 99/65409; �Thermal Securing Anastomosis Systems� U.S. Pat. No. 6,361,559; �Thermal Securing Anastomosis Systems�, PCT Publication No. WO 99/63910; �Aortic Aneurysm Treatment Sytems�, U.S. patent application Ser. No. 09/329,658; �Aortic Aneurysm Treatment Systems�, PCT Publication No. WO 00/15144; �Additional Sutureless Anastomosis Embodiments�, U.S. patent application Ser. No. 09/654,216; �Anastomosis Systems�, U.S. patent application Ser. No. 09/730,366; �End-Side Anastomosis Systems�, PCT Publication No. WO 01/416653; �Advanced Anastomosis Systems�, U.S. patent application Ser. No. 09/770,560; �Distal Anastomosis System�, U.S. patent application Ser. No. 09/899,346; �Distal Anastomosis System�, U.S. patent application Ser. No. 09/991,469; �Improved Distal Anastomosis System�, U.S. Provisional Application Ser. No. 60/333,276; and �Sutureless Anastomosis System Deployment Concepts�, U.S. patent application Ser. No. 09/927,978 and applications and patents claiming benefit hereto, all commonly owned by Converge Medical, Inc. and each of which is incorporated herein by reference in its entirety.
Connector Embodiments & Associated Components
The connector in
Referring to
As shown in
A lateral portion may be provided integrally with a form providing at least part of leading segment (16) and trailing segment (18). As described above, this continuous coverage ensures complete tissue capture between the fitting (10) inside the host vessel and the collar (not shown) outside the host vessel. Complete coverage ensures hemostasis at the vessel to graft interface.
As shown in
The connectors of
As shown in
The angled connector geometry provides a further enhancement in that a single version accommodates a wide range of graft diameters. By angling the graft relative to the host vessel, the cut end of the graft, which defines the graft toe (48) and the angle the graft extends from the connector may be modified to produce a cross-section that matches the specific connector size.
As shown in
As shown in
Features that are preferable for fitting (10), in addition to the basic leading and trailing segment configuration, are found in connection with a hinge section (28), shown in
To displace trailing segment (18) sufficiently, the rotation about torsional sections accounts for a substantial amount of the displacement required of trailing segment (18). The additional displacement arises from bending of the trailing segment (18) relative to the junction between the trailing segment and the torsional sections.
Such dual action provides for certain advantages; namely, upon forward deflection of trailing segment (18), i.e., deflection of trailing segment (18) towards leading segment (16), the lateral portions connected to torsional sections are caused to be drawn or flexed inward. This action facilitates introduction of connector (4) into host vessel (8) by clearing portions that could otherwise interfere with entry. In addition, the design of the embodiment in
The embodiment in
Turning now to the features of collar (12),
The expansion spring members (35) in the embodiment in
This expansion spring embodiment also enables lengthening the distance from the tab or latch (24) of the collar and the location on the expansion spring to which the trailing segment of the fitting abuts. As the inner frame is advanced relative to the outer frame, the trailing segment contacts the expansion spring and further force causes the lateral (outer) links of the expansion spring to deflect causing the inner frame tab or latch to move past the latch of the outer frame. This facilitates securing the collar to the fitting around the graft by locating the tab (24) of the collar beyond the tab (22) of the fitting without having to engage and dramatically pull tab (24) past the tab (22). Upon releasing the external force deflecting the collar, the expanding spring members recoil towards the undulating pattern urging the collar towards its resting, smaller diameter configuration thereby engaging the tab (24) of the collar to the tab (22) of the fitting and compressing the collar against the base (14) of the fitting.
Preferably, the distal band (39) of the collar (12) extends completely around the anastomosis from the heel to the toe to overlap or interface with corresponding lateral features (20) of a complimentary fitting (10) to form a complete seal at an anastomosis site. Likewise, the shape of the bore of the collar as shown in
Another feature of the collar (12) embodiment shown in
Ears (37), shown in
The collar embodiments in
Whether prepared in connection with a collar or not, connector (4) is preferably installed at an anastomosis site as shown in
When connecting a graft to a small diameter host vessel, the graft toe (48) preferably resides along the exterior surface of the host vessel so it doesn't substantially reduce the cross-sectional area of the host vessel. When a connector is provided with a collar (12), the visible result will resemble that in
The function of the connector (as an in-flow anastomotic junction or out-flow anastomotic junction) also impacts the location of the graft toe (48) (e.g. inside the host vessel, and/or outside the host vessel). Other aspects of the anastomotic junction also impact the location of the graft toe. For example, when securing a graft to a host vessel having a large wall thickness (e.g. aorta), the graft toe (48) is preferably located along the interior surface of the host vessel so the thick cut end of the aorta is not exposed to blood flow. As such, flow disruptions are avoided by ensuring a smooth transition from the graft to the host vessel. When everting the tissue to minimize the metal exposed to blood, the graft toe is preferably located along the interior surface of the host vessel therefore the cut end of the graft and host vessel are isolated from blood flow. As shown in
Angled Anastomosis Procedure and Accessory Devices
Now that many of the device features of the invention have been described, the process associated therewith is set forth in the order in which it is preferred that a surgeon or surgical team take action to perform a coronary bypass procedure, peripheral bypass procedure, or other procedure associated with creating anastomoses between tubular body structures during surgical, minimally invasive, endoscopic, robotic, catheter-based, or a combination of these approaches. Variation of this procedure is, of course, contemplated. Furthermore, it is to be understood that the devices described herein may be used outside of this context.
This being said, after opening a patient and taking a measurement between intended target sites for in-flow (proximal) and out-flow (distal) anastomoses, a graft member (6) of sufficient length is obtained. Typically this will be a saphenous vein. Alternately, another harvested vessel (such as the left internal mammary artery, right internal mammary artery, radial artery, or other autologous vessel), a synthetic graft (e.g. ePTFE, urethane, etc.), non-vascular autologous tissue (e.g. pericardium, submucosa, etc.), a genetically engineered tubular structure, or a donor tissue may be used as a graft.
Especially in the case where an organic member is used, the vessel will be sized to determine the appropriate connector size. This is preferably done with reference to the inner diameter of the graft by inserting pins of increasing size (e.g. by 0.25 mm increments) until the graft no longer easily fits over a given pin. The size of the largest pin over which graft easily fits over sets the inner diameter of the graft. Alternatively, a �go/no-go� gauge may be used where a single connector covers a wide range of graft inner diameters. The �go/no-go� gauge would have a minimum inner diameter and a maximum inner diameter at which the inner diameter of the graft should reside to be used with the specific connector configuration.
Next, a connector for producing an anastomosis at a desired angle, and having an appropriate size is chosen. The size of fitting (10) and optional collar (12) covers a range of graft inner diameters and is preferably chosen by matching the first incremental size over the inner diameter of the graft to a chart of connector sizes that accommodate the measured graft diameter. It is contemplated that connector component sizes may be sized to fit grafts of a diameter from about 2 mm to about 6 mm progressively, at 0.5 mm to 2.0 mm increments. The acute angle of the connector embodiments enables a specific connector size to accommodate a wide range of graft sizes because the graft is oriented at an angle relative to the connector bore and this relationship may alter based on the size matching between the graft and the connector. For example, a 3 mm diameter connector has been demonstrated to accommodate graft inner diameters between 3 mm and 5 mm without constricting the lumen of the graft or otherwise adversely affecting the transition from the graft to the host vessel with respect to flow barriers or disruptions.
Once appropriately sized connector components are chosen, a graft is skeletonized 10 mm away from the end to be used in connection with the anastomosis. This may be accomplished by holding the adventitia tissue away from the graft with forceps and removing selected portions with Potts or Dissecting scissors.
At this stage, graft (6) is passed through the collar (12), which has already been expanded to facilitate advancing the graft. The collar (12) may be housed or prepackaged on an outer frame (collar) loading cartridge (102) (see
As shown in
Another embodiment of an outer frame cartridge (105) is illustrated in
In order to facilitate the insertion of the graft (6) into outer frame (12) and then the insertion of the inner frame (10) into graft, both of which require care and accuracy, a loading tool (112), as shown in
In order to receive graft (6) through its bore, outer frame (12) is expanded. This is accomplished by means of lever (118) on the outer frame cartridge (102) of
The outer frame (12) and graft (6) are now ready to receive the fitting or inner frame (10). An inner frame cartridge (100) is used to advance the outer frame (10) into the cut end of the graft such that the trailing segment (18) of the fitting is oriented into engagement with the expansion spring (35) of the collar or outer frame (12).
Holding handle (108) of the inner frame cartridge, a fitting or inner frame (10), which has been operatively engaged with the distal end of shaft (126), is guided such that the base (14) of the fitting passes into the cut end of the graft (6) and under the expansion spring (35) of the collar or outer frame (12) and such that the trailing segment (18) of the fitting resides outside the graft and expansion spring. Once the trailing segment (18) is appropriately positioned, the inner frame cartridge (100) is snapped into engagement with the loading tool (112) as described above. Then the inner frame cartridge (100) is advanced using a shaft dial (120 or 218) thereby advancing the fitting relative to the collar. An indicator gauge (122) (provided on the loading tool embodiment of
It is preferred that connector (4) be set and prepared for deployment within a deployment device, as shown in
The deployment tool in
The deployment tool also incorporates a toe deflector (164) and a heel deflector (162) pivotally connected to end effector (168). During the deployment procedure, the toe deflector is used to engage the elliptical loop (31) of the collar to deflect and release the distal band (39) of the collar. The heel deflector is used to engage and deflect the trailing section (18) of the fitting during deployment.
Once deployed, the heel deflector (162) and toe deflector (164) are released enabling the trailing section (18) of the fitting and the distal band (39) of the collar, respectively, to return towards their resting configuration causing the tissue (host vessel and graft) residing between the fitting and the collar to be compressed, like a gasket, and ensure hemostasis at the anastomosis. It should be noted that the toe deflector (164) and the heel deflector (162) may be actuated simultaneously; the toe deflector may be offset from heel deflection to enable full deployment of the trailing section of the fitting prior to full release of the distal band of the collar; or may be operated independently.
With the trailing segment and the distal band deflected into the deployment configuration, connector (4) is positioned into the host vessel. This is preferably performed by inserting the leading section (16) through the arteriotomy (or venotomy if the host vessel is a vein), and then advancing the lateral features (20) of fitting (10) as may be provided. Deflected trailing segment (18) is then advanced through the heel end of the arteriotomy and into host vessel (8); then the trailing segment (18) is released by actuating the deployment tool towards its resting configuration, as shown in
In instances when a collar (12) is used in connector (4), it is also released to compress toe portion (48) of graft (6) against host vessel (8). Release of collar (12) may also result in compressing graft (6) against portions of host vessel (8) opposed by lateral fitting portions (20), especially when the lateral portions are integrated with the trailing segment.
The deployment tool embodiment shown in
The embodiment in
A compression spring (154) provides resistance to advancing the rod (152) relative to shell (150) and handle block (142) and ensures the resting position of the deployment tool is in the deflected state. The compression spring (154) is stiff enough such that with the trailing segment (18) of the fitting and the distal band (39) of the collar deflected, the deployment tool may be handed to the operator without having to manually hold the handle apart or worrying that the handle may accidentally become actuated and release the connector before it is appropriately positioned. Alternatively, a locking mechanism may be incorporated in the deployment tool to ensure the handle does not accidentally actuate.
The stabilizer (166) is bonded to the shell (150) and provides a support for the connector and defines the pivots for the toe deflector (164) and the heel deflector (162). The stabilizer also determines the angle at which the connector sits relative to the rod and shell of the deployment tool. For reverse insertion the stabilizer (166) is configured to orient the toe of the connector at an acute angle (<90 degrees) to the shell of the deployment tool. For perpendicular insertion, the stabilizer is configured to orient the toe of the connector at approximately 90 degrees to the shell. For acute insertion, the stabilizer is configured to orient the heel of the connector at an acute angle (<90 degrees) to the shell.
The toe deflector (164) and the heel deflector (162) are rotatably attached to the stabilizer (166) with pins (156). Intermediate linkages (158 and 160) connect the proximal ends of the heel deflector (162) and the toe deflector (164) to the rod (152) with a second compression spring (154) to orient the deflectors in the appropriate resting, �deflected� orientation when released. The intermediate linkages (158 and 160) and the associated compression spring (154) enable the offset deflection of the toe deflector (164) from the heel deflector (162). As the heel deflector is actuated by squeezing the handles (146) the toe deflector (164) remains in the deflected, non-released position until the trailing segment (18) is fully released and the compression spring (154) is fully actuated such that movement of the rod engages the toe deflector linkage (160) which initiates the actuation of the toe deflector (164) and releases the distal band (39) of the collar. This two-staged release provides one additional benefit in that a tactile signal indicates the complete release of the trailing segment (18) and initiation of the release of the distal collar band (39). The toe deflector (164) provides another benefit in that it separates the ears (37) of the connector from engagement with the pins (170) once fully actuated to fully release the connector from the deployment tool and indicating completion of the angled anastomosis.
Actuation of the deployment tool to open or egress deflectors (162, 164) so that a subject connector may be grasped for deployment into a vessel involves the following actions with reference to
An additional mechanism, such as adjustment knob (210) as illustrated in
The deployment end effector of
The loading and deployment tools described above may be provided as a cooperative system. For example, the loading tool of
Once in place, the completed anastomosis is inspected for leakage. This may be done before and/or after an anastomosis at the other end of the graft (if required) is complete. At a minimum, an inspection of the angled anastomosis should be made when blood is flowing through graft (6). If leakage is detected, and it cannot be remedied by adjustment of the graft or collar, the anastomosis site may be packed until bleeding terminates, bioglue (e.g., as available through Cryolife in Kennesaw, Ga.) may be applied to the anastomosis, and/or a stitch of suture material may be applied. In extremely rare instances where these steps do not prove adequate, it may be necessary to reposition or remove the connector (4).
Jaw arm (302) of tool (300) may also be provided with a guide (314) as illustrated in
The above-described tools greatly facilitate forming an anastomotic connection between vessels, particularly in less invasive approaches where the surgical spaces are relatively small. Consequently, the surgeon is often working from a position or angle in which visualization of the anastomotic site is less than optimal. This can be particularly problematic when the coronary vessel being bypassed is one which is located more laterally and/or posteriorly on the heart, e.g., circumflex, obtuse marginals, posterior descending artery, and/or which is relatively deep within the myocardium. In particular, accurate placement of the heel or trailing segment of the inner frame of the connector within the arteriotomy may be extremely difficult. The visualization tools illustrated in
For less invasive approaches, bridging or endoscopic vein harvesting tools may be utilized to access the host vessel, expose the host vessel and stabilize the host vessel as the arteriotomy is created and the connector is deployed into the host vessel. Such devices include the SaphLITE� manufactured by Genzyme Surgical, Inc. for saphenous vein harvesting. This, and other such bridging devices, may be used to access peripheral host vessels through a small incision, and enable a less invasive approach to inserting angled connectors into the popliteal artery, femoral artery, iliac artery, etc. due to the features of the connector and accessory devices. The connector may also be used in conjunction with anastomosis isolation devices such as the enclose� Anastomosis Assist Device manufactured by Novare Surgical, Inc. Such isolation devices clamp a region of the aorta and provide a membrane to prevent bleeding while the anastomosis is created. As such, the angled connector embodiments in this invention may readily be inserted through an incision created prior to or after deploying such isolation device and used to create the anastomosis.
Fabricating Connector Components
Now, returning to the elements of connector (4), optional inventive features and a manner of manufacture is described. A preferred manner of producing connector components according to the present invention is by machining tubing to include features that may be stressed and set into shape to produce connector elements like those depicted in
The machining may be accomplished by electron discharge machining (EDM), mechanically cutting, laser cutting or drilling, water-jet cutting or chemically etching. It is to be noted that portions of the connectors may be fabricated as a separate components and bonded by spot welding, laser welding or other suitable manufacturing process to form complete structures. Typically, after whatever cutting or forming procedure is employed, the material is set in a desired final shape. Where a metal is used, one or more flexure steps followed by heating will accomplish this. If the connector elements are made of alternate material such as a plastic or a composite, other forming procedures as would be apparent to one with skill in the art may be used.
Preferably, connector elements are made from a metal (e.g., titanium) or metal alloy (e.g., stainless steel or nickel titanium). Other materials such as thermoplastic (e.g., PTFE), thermoset plastic (e.g., polyethylene terephthalate, or polyester), silicone or combination of the aforementioned materials into a composite structure may alternatively be used. Also, connectors fabricated from nickel titanium may be clad with expanded PTFE, polyester, PET, or other material that may have a woven or porous surface. The fittings may be coated with materials such as paralyne or other hydrophilic substrates that are biologically inert and reduce the surface friction. To further reduce the surface tension, metallic or metallic alloy fittings may be bead blasted, chemically etched, and/or electropolished. Evidence suggests that electropolishing reduces platelet adhesion because of the smooth surface. Alternatively, the fittings may be coated with heparin, thromboresistance substances (e.g., glycoprotein IIb/IIIa inhibitors), antiproliferative substances (e.g., rapamycin), or other coatings designed to prevent thrombosis, hyperplasia, or platelet congregation around the attachment point between the bypass graft and the host vessel. Alternatively, a material such as platinum, gold, tantalum, tin, tin-indium, zirconium, zirconium alloy, zirconium oxide, zirconium nitrate, phosphatidyl-choline, or other material, may be deposited onto the fitting surface using electroplating, sputtering vacuum evaporation, ion assisted beam deposition, vapor deposition, silver doping, boronation techniques, a salt bath, or other coating process.
A still further improvement of the fittings is to include beta or gamma radiation sources on the end-side fittings. A beta or gamma source isotope having an average half-life of approximately 15 days such as Phosphorous 32 or Palladium 103 may be placed on the base and/or petals of the end-side fitting using an ion-implantation process, chemical adhesion process, or other suitable method. Further details as to optional treatments of connectors according to the present invention are described in 10.00. Of course, connector fitting (10) and any associated collar (12) may be made differently. To avoid electrolytic corrosion, however, dissimilar metals should not be used.
Preferably, NiTi (Nitinol) tubing or flat stock is used to produce connector components. Irrespective of material format, a preferred alloy includes a 54.5-57% Ni content, and a remainder Ti by weight (less minor amounts of C, O, Al, Co, Cu, Fe, Mn, No, Nb, Si and W) is used. Such alloy has an Af for at about −10 to −15� C. Consequently, for typical handling and in use, the material will exhibit superelastic properties as is most desired.
Still, it is contemplated that connectors according to the present invention may utilize thermoelastic or shape memory characteristics instead, wherein the material of either or both fitting (10) and connector (12) change from a martensitic state to an austenitic state upon introduction to an anastomosis site and exposure to a sufficiently warm environment. Taking advantage of the martensitic state of such an alloy will ease deflecting rear segment (18) and distal band (39) and maintaining their positions until placement.
Utilizing either thermoelastic or superelastic properties makes for a connector that can have certain members stressed to a high degree and return without permanent deformation from a desired position. However, it is contemplated that either or both fitting (10) and collar (12) may be made of more typical materials such as stainless steel or plastic. For fitting (10), this is feasible in view of the manner in which rear segment (18) is displaced for insertion into a host vessel. Hinge section (28) permits designs in which the stress applied by torsion is lower that applied in simply deflecting a rear petal or segment as shown and described in U.S. and foreign patents and applications entitled, �Improved Anastomosis Systems�, U.S. patent application Ser. No. 09/730,366; �End-Side Anastomosis Systems�, PCT Publication No. WO 01/41653; �Advanced Anastomosis Systems (II)� U.S. patent application Ser. No. 09/770,560.
This being said, the tube stock used to prepare distal connector fitting preferably has an outer diameter between 0.080 and 0.240 in (2 to 6 mm) and a wall thickness between 0.004 and 0.010 in (0.1 to 0.25 mm). Slightly larger diameter stock (or end product) will be used for each matching collar. The stock thickness for NiTi material used to form collars will typically have a wall thickness between about 0.004 in and about 0.010 in. Especially, for fitting (10) where it is possible to use thin stock in view of strength requirements, this will be preferred in order to minimally obstruct blood flow past the fitting. Larger connector components will typically be made of thick stock to account for increased stiffness required of such configurations relative to smaller ones.
The invention has been described and specific examples or variations of the invention have been portrayed. The use of those specific examples is not intended to limit the invention in any way. In all, it is to be understood that each of the features described in connection with the various connector components and projections for forming the same may be mixed and matched to form any number of desirable combinations. Further, it is contemplated that additional details as to the use or other aspects of the system described herein may be drawn from Abstract, Field of the Invention, Background of the Invention, Summary of the Invention, Brief Description of the Drawings, the Drawings themselves and Detailed Description and other background that is intended to form part of the present invention, including any of the patent applications cited above, each of which being incorporated by reference herein in its entirety for any purpose. Also, to the extent that there are variations of the invention which are within the spirit of the disclosure and are equivalent to features found in the claims, it is the intent that the claims cover those variations as well. All equivalents are considered to be within the scope of the claimed invention, even those which may not have been set forth herein merely for the sake of relative brevity. Finally, it is contemplated that any single feature or any combination of optional features of the inventive variations described herein may be specifically excluded from the invention claimed and be so-described as a negative limitation.
Referenced by
Legal Events
Original Image


text:
Cada vez mais lindo!!!!!!!Só os topstops!!
Im not gay and even i can tell that this guy is really good looking compared to robert patinson. The girls here keep writing that they prefer robert because this guy looks like he is on steroids,i just don see it,maybe is because you are comparing the two,and scince pattinson has the body of mr burns from the simpsons,u see taylor enourmos,when he is only defined and has good muscle tone,u dont need steroids for that at all,its called working out and eating right
Taylor is not hot!!!He's a child not a man.
im team edward... but i still luv jacob :)
this guy is NOT good looking. his tan and abs are abnormal. And his eyes are too small, nose is flat. call me names but I dOnt care. What I said is the truth.
woooooooooooooooooooooooooooo he is gourgeous mahn i luv u more than eny wun ur so hottttttttt
HOT!!! I love him!
People are bizarre. : P The vampire dude gets his airbrushed on and your type swoons...this kid works his ass off and is a black belt and his are too "artificial". ...sigh. >.<
i will fuck the shit out ov him LUV U TAYLOR
sophia fuck up, like you'll ever get a man that looks this good!
fuck you, taylor lautner is amazing, he is so fucking sexy!
* Sex Bomb, Sex Bomb, He's a Sex Bomb! * =D
Now THAT is PERFECTION. Not fake like Rob's (=
oh myyy hes sexay
ummm..that pic was yummy!!!!
Now this i like. TAYLOR LAUTNER IS A FREAKING SEX GOD
he is so hot but then robert is hotter
I like werewolf better than vampire. Vampire suck blood and their eyes scary. Werewolf hunts, Vampire is a host of an innocents souls.
he is just sexy top to bottom.
looks like a pig human hybrid....
He should have been the vampire... Check out his upper fangs!!!!
he is so hot
He looks fake in this photo :/ Fake? Works out and has good genetics, not sure how that is fake?
...have to give it to the kid, that body he worked his a$$ off for. A black belt vs. a pasty guy who never works out or combs his hair, hmmm tough call. Much better than the dude who had to have abs airbrushed on. : P
He looks fake in this photo :/ WTF? y r u so f*cking rude? He's so much more real than rob. rob has spray on abs
Just 2 let everyone no, Tay Tay is the sexiest out of all of the twilight ppl. Most ppl like him because of his bod, but I think he's awesome because he is so nice 2 everbody and he makes smart choices even though hes a celeb
oh really?:))) hahah:))) i love taylor ,he is sooo sweet and sexy in the same time,i don`t like rob,he is ..:-?? i don`t know how to say....old school:)) i like taylor:X and really rob muscules were drawn?
now thats my type ==]
[quote=Doyle Lively]i dnt lyk... same 'ere!
He looks fake in this photo :/
he's f*cking hot! am melting badly.. HHA (;
He is the epitome of sexy...wish I was 18 again.....Oh well!
ikright but this is not his best picture
OMG i kant beelieve pple re actually sayin dat!!! Taylorz abz re AWESOMMM nd I LOVE HMMM..
[quote=Meisha Ellis]He's Absalutly Amazing And Not Just For His Body He's Funny And A Great Actor I'd Give Him My Number Any Day But Thats If He'd Take It Haha x ur right like taylor would take ur # pluss all that buff is 100% FAKE PURE BEEF PATTIES
[quote=Doyle Lively]i dnt lyk... i dont like him all that. but i'm not gonna lie hes 98.5% HOTTTT great role in twilight though
he's hot...............nd i definitely lyk wt i c
i love taylor. go team jacob
he's just sooo nasty-looking
i really cant stand this kid... annoying in twilight and in real life ughh f*ckk you bitch your anoying in real life dont say sh*t if you dont know how to say sh*t got tht
bitchhhhh im sorry but taylors to fake probably ur fake from top to bottom bitcch u just jealous that u aint never gonna get tht so f u
Well well...
lol you're insane if you prefer Rob over Taylor =/ I like them both but did you know that Rob's "muscles" were actually drawn? lol if you look at Pattinson's stomach in the other pic, the sunlight shows very much that his abs are real, they just shaded stuff to make them look more defined. I'm pretty sure they do that kind of stuff for all the (half) naked twilight stars.
he is handsome but i dont know.. smh
hesss SOOO SEXY idc what anyone says haha :) AGREED!
you are SEXY HOT taylor lautner
* Thats not too much muscle, Kellan has the same amount of muscle mass!!* Yes,but how old is Kellan?
gosh *.* my personal 1# ahhh i love him to death!!!
OMG i know right? :D you are both dumb , that's just the caracter he had to play in the movie and he is sweet in real life!!!
[quote=Lizzie Bennett]Weird voice. Short. Bulky. Boring. Butterface. F*CK YOU GIRL!!!!!
chaka!!! imbiyerna!!!
Weird voice. Short. Bulky. Boring. Butterface.
Yummy abs, amazing face, really funny, awsome actor... absolutely perfect! xx :)
I like
dats just sexy
he is hot and his body is very nice...
He is so fine!! :) Team Jacob allll the way!! :D
and this may sound really weird, but i liked him better with long hair! not that it made him look good or something. its just that he looked so much friendlier and when he cut his hair he's such a jerk in new moon! xx OMG i know right? :D
he is so hot...but in this picture u cant see all of his sexiiness
i think Jacob is hot and a brilliant actor! i respect him as a person,not only as an actor. Btw, love his bod!!!
I'd let him do any-ANYthing to me!(; if he ever wanted to slap my face with his muscly dick, then I'm all for it!♥
i love him he is so beautiful i am team jackob i hate eduard he is like a dad person
he's the beeeest!!
and this may sound really weird, but i liked him better with long hair! not that it made him look good or something. its just that he looked so much friendlier and when he cut his hair he's such a jerk in new moon! xx
and this may sound really weird, but i liked him better with long hair! not that it made him look good or something. its just that he looked so much friendlier and when he cut his hair he's such a jerk in new moon! xx
ooh my gawd ... im sorry, but i have to disagree with some of you. i don't think he's hot or sexy etc at all. (as you can hear im 100% Team Edward haha) sorry but ... Taylor Lautner is a nono to me.
i really do like taylor... but its sad that everybody just likes him for his mucles. even though this is a hell of a sexy picture i liked him wayyy before twilight! scince sharkboy and lava girl LOL!!
I LOVE YOU TAYLOR!!!! ur abs are sooooomuch more sexy... too bad that ur like.....3yrs older than me....so sad!!! i wish i was famous so i could meet you, but i think your with Selena Gomez......good luck!!
鈥 ======== http://www.newgoin.com/ ======== http://www.newgoin.com/ We need your support and trust!!! Dear friends, please temporarily stop your footsteps To our website Walk around A look at Maybe you'll find happiness in your sight shopping heaven and earth You'll find our price is more suitable for you. Welcome to our website http://www.newgoin.com/ Thanks to the support! http://www.newgoin.com/ >>>------I love you! ---->鈥
Dear customers, thank you for your support of our company. Here, there's good news to tell you: The company recently launched a number of new fashion items! ! Fashionable and welcome everyone to come buy. If necessary, please plut: www.newgoin.com We need your support and trust! 鈺扳€斺敇 銆 鈹呪槄`_銆 鈹傦技锛匡伎鈺?暛鈺?暛鈺?伎锛匡紡鈹 銆€銆€ 鈹 鈹傘€€銆€銆€銆€銆€銆€銆€銆€銆€銆€銆€銆€ 鈹傘€€銆€銆€銆€銆€銆€銆€銆€銆€銆€銆€鈹傘€€ 鈹 銆€鈼忋€€銆€銆€銆€銆€銆€銆€鈼忋€€鈹傘€€ 鈹傗墶銆€銆€銆€銆€é"忋€€銆€銆€銆€鈮♀攤 鈹傘€€銆€銆€銆€銆€銆€銆€銆€銆€銆€銆€鈹傘€€ 鈺扳€斺€斺敩锛?棨鈻解棩锛?敩鈥斺€斺暞 銆€銆€銆€é"溿€€銆€é"å¿‹â'¬â'¬éŠ†â'¬é" 銆â'¬éŠ†â'¬éŠ†â'¬é"溾暛锛å¶ç´žé"›å¶æšœé" 鈹屸敩鈹?敩鈹愩€€ 鈺炩暓鈺р暓鈺р晲鈺愨暓鈺р暓鈺р暓鈺р暓鈺р暋1
love lautner! he worked so hard for that abs! he deserves a compliment anyway. its not fake.. he is athletic!
His abs is not really awesome like Robert Pattinson but its okay I still like Taylor. .. xD
lol you're insane if you prefer Rob over Taylor =/I like them both but did you know that Rob's "muscles" were actually drawn? lol um shame they werent drawn , he showed them in a interveiw to prove it. AND taylors nose neck and muscles are waaay to big for me :)
so hott
i really cant stand this kid... annoying in twilight and in real life ughh
totally agree
el es mucho mas bello que ROBERT PATTINSON !! TE AMO TYLOR
very very very very nice !!! kiss kiss
omg, he is so hot
Rob , body was drawn , sorry but its the pure truth , even Rob said it. Taylor bod is perfected by all the hard work he does. All you people only like rob because he portrays a vampire ( who are crazy to think they are real) its a freaking film good film , but just a film. If Rob did not portray a vampire , he wouldn't even be loved at all. Taylor was always hot and cute , even when he was in "Shark boy and Lava Girl" or Cheaper by the dozen. Taylor has a great Bod!
hes sooo fit :P love him x
That is jusst pure SEXY!!! Yummmmmmmmmmmmmmmm. :P :P And that aint too much muscle at all. :| ii LOVE Taylor Launter ♥♥♥♥♥♥♥
he is so cute..I LOVE HIM!!! such a hottie..
he doesnt have to much muscle he has one amazing body.xx
Yuppy... There's not alot of guys like that!!... My sister in-law and I think he's hotter then Rob!
You have a beautiful boy and you're hot
cute bute hes chest is too big
sexiness is 2 much f*ck!!!!!!!!!!!!!
loking hot dont say
now THAT...... is SEXXXXXXXXY!!!
Just perfect ! ily
Oh, hell, yeah...
nienawidze go!!!!!!!!!!!!!!!!!f*ck YOU JAKOB!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! TY SMIERDZĄCY KUNDLU!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
he had to get the muscles to keep his role as jacob and gained 3o pds worth of um
hesss SOOO SEXY idc what anyone says haha :) i know hes way more than sexy hes the hottest guy iv ever seen!
he is soooo not sexy.. wääääääääähhhh.. girls nowadays have really no taste..
bitchhhhhim sorry but taylors to fake bitch taylor isn't fake rob doesn't like doing excersise taylor does excersise i haven't seen taylor do anythibg active btw i don't hate rob either
Aside from having to be buff for the movie, he's got a blackbelt in karate. Those muscles are real.Abercrombie models have bigger muscles and they're just models. Jeeze. look to tell you the truth you have a mind of a ten year old.
I prefer Rob. this guy's nose looks like a smashed patato. :p by the way, he has a huge ego. And nobody likes that kind of guys. :l
He has a much better bod thn taylor...hands dwn!
he is absolutly super i love him
how could annybody NOT like this most smokin guyy i have EVER seen
ahhhhhh OMG sooo sooo soo dang sexyyy .!!
f*ck me..... lol
girl - that is exactly what comes to mind when you look at him doesn't it ... :)
Taylor is the stuff dreams are made of ...
Ok, Sophia Smith,First of all , He HAD to gain that muscle casue he is dedicated,He does NOT have a BUTT-CHIN and he does NOT have "Vampire" teeth you idot,and thier whiter than yours i bet. This man is beyond beautiful. And if you cant see that then your one of the most unluckiest people on this planet. I Feel Sorry For You.But also i dont.
yammy :D hell yea i love him
OMGGGG i´ll kill for him
* Thats not too much muscle, Kellan has the same amount of muscle mass!!* thank you someone has eyes!!!!!!!!!!!!!!!!!!!!!!!
""lol you're insane if you prefer Rob over Taylor =/"" i totally agree wiv u !!!! rob is NOT hot !!! love u taylor xx
I like this man it's beautiful............
dam nice body i could stare at it all day and it wint get old man he sexy this body is better than edward love u taylor
Oh! I cant understand all the people who like Robert Pattinson! he looks really ugly and (blä vad ful!) he is so ugly, and besides, he looks quite ugly. It looks like he's been taking drugs. Seriously. sh*t he is so...
[quote=Sophia Smith]agree 100%, way too much muscle and with his butt china nd his vampire (ik he acts in twilight, but still) looking teeth, this guy is anything but hot! yes he is hot
I love Tay Tay! but this pic is fake!
goooooooooood ;d
[quote=Doyle Lively]i dnt lyk... Are you insane???
this guy is absolutly PERFECT!!! there´s no man like him in this world!!! you're insane if you prefer Rob over Taylor
Ui nossa Taylor(Jacob) é um gato Meu Deus !!!! eu quero,eu quero !!!!
Ui nossa Taylor(Jacob) é um gato Meu Deus !!!! eu quero,eu quero !!!!
SEXY as hell
hmmm dats wot am taking BOUT !!!
he's been had a good body eva since he was a lil kid and he look really good he was born good lookin lol.............so i doubt its stariods....he just knos how 2 work out
6 pack attack
lol you're insane if you prefer Rob over Taylor =/I like them both but did you know that Rob's "muscles" were actually drawn? lol bitchhhhh im sorry but taylors to fake
ok, I don't hate Rob but I hate that ppl say that Rob's hotter than Tay! Well in my opinion Taylor has a hot bod! Too much muscels u say? Check on what happens to ppl that take steroids or just watch an episode of wwe... He looks awesome! His muscles look great and he has a greta personality. He got more fans from his abs and he didn't want 2 show them off as much as the director... He's so bashful when ppl talk about his bod but that makes him so awesome! He thinks ppl like him for his abs...some do though but I liked him way back when he was sharkboy! Love him for working so hard and being so comitted to his job! ;) And ofcourse for not drinking a lot or smoking (like Rpb) or having to paint those abs! Love tay! Forever!
rob is totaly CUTE but taylor is HOT!!
Taylor Lautner is the best looking topless celebrity, hands down!!
this is nice. verry verry nice :D
So hott babbbyyy
he is sooooooooo sexy he makes me smile x
i love uuuuuuuuu
And I disagree with firstname.lastname@example.com he dosen't look like he's 10 sweetheart that was dumb
Jacobs hotter than hot so hate on it!!!!!!!!!!!!!!!
f*ck me NOW!
He looks like a 10 year old kid with way to many muscles. But cute he is. * He doesn't look 10....you sound 10 for writing that comment!*
hes attractive kinda but i think rob looks way better
He looks like a 10 year old kid with way to many muscles. But cute he is.
Aside from having to be buff for the movie, he's got a blackbelt in karate. Those muscles are real. Abercrombie models have bigger muscles and they're just models. Jeeze.
He's Absalutly Amazing And Not Just For His Body He's Funny And A Great Actor I'd Give Him My Number Any Day But Thats If He'd Take It Haha x
lol you're insane if you prefer Rob over Taylor =/ I like them both but did you know that Rob's "muscles" were actually drawn? lol
* Thats not too much muscle, Kellan has the same amount of muscle mass!!*
hesss SOOO SEXY idc what anyone says haha :)
the thing is...he HAD to be this buff for the movie. he is a werewolf you know...and wolves have to look massively steriody muscley. but i prefer rob over him. but he has to look like that to potray his character the correct way.
yammy :D
agree 100%, way too much muscle and with his butt china nd his vampire (ik he acts in twilight, but still) looking teeth, this guy is anything but hot!
He's very handsome, but I think all that muscles too artificial.
i dnt lyk...

subset: commoncrawl


text:
Deb's Reviews > Stay Close
Stay Close
by Harlan Coben
by Harlan Coben
Deb's review
Mar 08, 12
Read in March, 2012 — I own a copy
Started and finished this page turner in a day! Well written book full of suspense till the very end. The author does a great job at developing the three main characters at the beginning of the book. A book that I suggest to my reader friends.
Sign into Goodreads to see if any of your friends have read Stay Close.sign in »
No comments have been added yet.


text:
This is an excellent three star hotel very near the train station and ferry terminal to Amalfi. The service was quite good and the breakfast was very good. Double room was a good size. Good value for the price charged.
- Reservation Options:
- TripAdvisor is proud to partner with Booking.com, Travelocity, Priceline, Expedia, Hotels.com, Odigeo and Tingo so you can book your Plaza Hotel reservations with confidence. We help millions of travelers each month to find the perfect hotel for both vacation and business trips, always with the best discounts and special offers.
- Also Known As:
- Plaza Hotel Salerno


text:
About us
Brani & Desi is the new brand name of Gemelli Design
Sofia, Bulgaria, Tel. (+359)888251995; (+359)887505381;
VEGETARIAN RESTAURANT, bar & natural health food store
restaurant and bar
garden of colors
freedom to think and to dream
The task of the project is to design a Fruits and Vegetables LOUNGE/SHOP, which is a multiple functions shop with the name we gave "The garden of the colors".
We use four fundamental colors – white, orange, red and green. The White is mixed by all colors in perfect balance and harmony.
The inspiration for the project is the Nature and her unlimited number of colors. The Keywords to define the word Nature are BIRTH, LIVE, SPIRIT, SENSE, FREEDOM, UNLIMITED, COLOURS, BLENDING, HARMONY, BEAUTY, FRESH, MOOD.
Featured news
Brani & Desi - Awarded
Brani & Desi Highly commended Award, "Transform the Future" 3, 2009
3th Dalsouple ® design contest: This year's judges were Jim McClelland, Editor of Sustain Magazine, Tim Gaukroger, MD of Dalsouple and Jim Hamilton, Janice Kirkpatrick and Ross Hunter, directors of Graven Images design agency.
Read more
This year's 'Transform' opened the field to a host of new ideas. For the first time, entries were welcomed from professional designers as well as students, and a second category for product design was introduced alongside interiors.Highly commended:Interiors Branimira & Desislava Ivanova, Italy (professional), The Garden of the Colours.
Featured news
freedom of the body and spirit
To integrate the Nature in the interior we use sustainable natural colorful rubber materials. The trees and their crown inspired us for the design of the space.
This is the color of Purity and awakened Spirit. The orange color is the true color of the sun. The aspects of this color are Sociable, Enthusiastic, Joyous etc. The red color is the most emotionally intense color.The Green color is currently the most popular decorating color, green symbolizes nature. It is the easiest color on the eye and can improve vision.
Featured news
Featured news
Featured news
Sofia, Bulgaria, Tel. (+359)888251995, (+359)887505381,
© 2014 All rights reserved to Brani & Desi


text:
MultiMonitorTool is a small tool that allows you to do some actions related to working with multiple monitors. With MultiMonitorTool, you can disable/enable monitors, set the primary monitor, save and load the configuration of all monitors, and move windows from one monitor to another. You can do these actions from the user interface or from command-line, without displaying user interface. MultiMonitorTool also provides a preview window, which allows you to watch a preview of every monitor on your system.
- Added new columns: Monitor ID, Monitor Key, Monitor String, Monitor Name, Monitor Serial Number. (The values of 'Monitor Name' and 'Monitor Serial Number' columns are taken from the EDID data of the monitor)
- Fixed bug: The Left-Top column displayed the coodinates as top-left instead of left-top
Reviewing 1.72 (Nov 9, 2014)
great software, this makes working with several Monitors easier


text:
Actually finding his wallet twice is not so out of the ordinary. How many times have they killed Osama Bin Laden? How many times have we killed the toilet commode's (al Quaeda's) # 2 leader? At least three times by my counting.
Yes, what most people think is reality is actually no more real than The Truman Show.
Ignore everything you get through television. Do not believe anything someone from the federal government tells you.
- Login to post comments


text:
Thom Bartley
User Stats
Profile Images
User Bio
Thom Bartley is a photographer based in the West Midlands. He specialises primaraily in field based portraiture. His work has been featured numerous times in print and he shoots regularly for private clients, businesses, fashion designers and events.
Please send all enquiries to firstname.lastname@example.com


text:
{Ko-Nig} To pull a Koenig, a person that misses an unmissable shot in any sport.
Brendan had a wide open net, but pulled a Koenig.
by Spencer Ryan October 30, 2006
10 Words Trending Now
Alphabetical List
Type your email address below to get our free Urban Word of the Day every morning!
Emails are sent from firstname.lastname@example.com. We'll never spam you.×


text:
Finger Lakes Health
For Nurses
For Physicians
Online Services
Apply for a Job
E-mail a Patient
FLH Medical, P.C. Urgent Care and Physician Practices
For FLH Employees
Geneva General Hospital Virtual Tour
Learn about our Financial Aid Program
Listen to a Podcast
Make A Donation
Patient Portal
Print a Healthy Recipe
Read Recent News
Register for Finger Lakes Health E-News
Register for an Event or Class
Research Health Information
Request an Appointment
Share Your Story
Tell Us About Your Care
View Multi-Media Library
Visit a Patient
2011 News Releases
2010 News Releases
2009 News Releases
Finger Lakes News
Geneva General Hospital's Radiology and Women's Health Services Excel at Annual DOH Survey
Geneva, NY—Geneva General Hospital's Radiology and Women's Health Services recently underwent their semi-annual New York State Department of Health Survey and were both found to be free of any deficiencies by the New York State Department of Health. This survey is conducted under strict guidelines, established by the State of New York, in areas such as patient and staff safety, processes and procedures, quality control and performance improvement.
"The staff in these two areas should take pride in this accomplishment. This type of clinical excellence is a tribute to their dedication to the patients of Finger Lakes Health" said Jeff Fultz, director of diagnostics.
Geneva General Hospital's Women's Health Services and Radiology departments see over 26,000 patients a year for testing including mammography, ultrasound, stereotactic breast biopsies, bone density scanning and diagnostic imaging (X-Ray).
Taylor-Brown Auxiliary Sponsoring Jewelry Sale
Nov 26, 2014
SSMH Donates Building to YCRR
Nov 25, 2014
Fall/Winter 2014 Thrive, Health and Wellness Magazine Now Available On-Line
Nov 20, 2014
Geneva General Hospital Auxiliary Sponsoring Book Fair
Nov 20, 2014
Geneva General Hospital Receives Top Performer Accolades for Pneumonia and Surgical Care
Nov 19, 2014
Taylor-Brown Auxiliary Sponsoring Book Sale
Nov 17, 2014
Geneva General Hospital Auxiliary Remembrance Project Begins
Oct 31, 2014
Geneva General's New Vision Medical Careers Program Welcomes Class of 2015
Oct 30, 2014
Soldiers & Sailors Awarded Accreditation for CT Unit
Oct 22, 2014
Geneva General Surgical Associates Colorectal Surgeon Dr. Craig J. Collins receives Specialty Board Certification
Oct 17, 2014
Finger Lakes Health
196 North Street, Geneva, NY 14456
Telephone Directory
Your Privacy
Maps & Directions
Site Search


text:
Details: Get $150 Off Aquadra Systems 75 Gallon Modular Rainwater Catchment Tank
100% Success • 1 Comment
1 year ago by Anonymous
Details: Get 5% off on all Aluminum Refueling Transfer Tanks and Aluminum Diesel Auxiliary Tanks. Expires 7/4/11.
17% Success • Add a Comment
Details: Get 15% off. Expires 5/2/11.
11% Success • Add a Comment
3 coupon codes & deals for tank-depot.com. The Tank Depot is an online store that offers a wide rang e of products that include water tanks, plastic storage tanks, poly water tanks, septic cisterns, septic tanks, underground water tanks, portable containment tanks, pick up truck and water hauling tanks, rainwater tanks, pump out and septic holding tanks, RV water and so much more.
Show More
Never miss a deal.
Be the first to know.
Plus get our best deals in our email newsletter. Privacy Policy
Show more popular stores
RetailMeNot Coupons AppSave on-the-go with deals from your favorite stores
Deal AlertsGet our best offers & never miss a deal
Be SocialConnect with us on Facebook, Twitter, and Google Plus
The Real Deal BlogA daily dose of fresh news, trending topics and best buys
Submit a CouponShare the love! Submit a coupon you've found
©2010 - 2014 RetailMeNot Inc. All rights reserved. Site Map | Terms of Use | Privacy Policy
RetailMeNot is a registered trademark of RetailMeNot, Inc. Merchant trademarks are the property of the respective merchant and their presence does not necessarily mean that RetailMeNot, Inc has an affiliation with the merchant.


text:
verve talk
theology is for preaching
Tuesday, October 14, 2014
I Do The Very Thing I Hate
I Do The Very Thing I Hate (Audio) Romans 7:15-25 July 6, 2014 Calvary - St. George...
Wednesday, October 1, 2014
"...Or Are You Envious Because I Am Generous"
Matthew 21:23-32 September 28, 2014 Calvary - St. George Church, Manhattan Audio link here...
Friday, May 2, 2014
The Stranger Right in Front of You
Luke 24:13-35 St. Thomas Memorial Church Easter 3 May 4, 2014 Have any of you ever s...
Monday, April 14, 2014
Losing Heart
Holy Wednesday Have any of you ever had a mentor whom you long looked up to suddenly grow ...
Sunday, March 23, 2014
The Gospel is for Christians Too
Romans 5:1-11 St. Thomas Memorial Church Lent III March 23, 2014 The Gospel is for Ch...
Sunday, November 24, 2013
'You Got the Power to Let Power Go?'
' You Got the Power to Let Power Go? ' Luke 23:33-43 Church of the Nativity Christ th...
Friday, November 22, 2013
I Believe in the Resurrection
I Believe in the Resurrection Luke 21:5-19 (20-28) St. Thomas' Memorial Church November 1...
View web version


text:
In Mixed Catch, NF Senior Editor Linc Bedrosian spotlights a wide range of commercial fishing-related news items from coast to coast.
Friday, 26 August 2011
It's become quite a week for acts of God on the East Coast.
First came Tuesday's 5.9-magnitude earthquake that struck Virginia and was felt in many East Coast states.
Earthquakes of magnitude aren't a common occurrence on the Atlantic side of the country.
"It was unbelievable," says longtime NF contributor Larry Chowning, who writes for the Southside Sentinel in Urbanna, Va. "It only took about 15 seconds, but it seemed like it took forever."
While the earthquake shook buildings — and shook up residents a little — the good news is that it didn't affect Virginia's fishing industry. But there's no rest for the wicked; fishermen have turned their attention to the next crisis — Hurricane Irene.
In preparation for the storm, Virginia watermen will likely pull up crab pots to mitigate gear loss from Irene, Chowning says. Likewise, any crab pots that would usually be stored on docks will be moved to a more secure storage facility. There's also concern for the state's seafood processing plants that are situated right on Chesapeake Bay and its tributaries.
On Wednesday, Irene slammed the Bahamas, carrying 120 mph winds. The powerful storm, since downgraded to Category 2, is heading for North Carolina, where vacationers have been evacuated from coastal counties.
Fishermen from the Carolinas north to Maine are busy preparing to weather the storm, which forecasters say will track north along the East Coast. They're working to keep boats and fishing gear safe from damage as best they can.
Like the rest of the East Coast fishermen, Virginia watermen will be keeping a close eye on Irene.
"I assure you they're watching the weather," Chowning says. "But the crabs will know before we do."
National Fisherman Live: 11/06/14
In this episode:
NOAA report touts 2013 landings, value increases
Panama fines GM salmon company Aquabounty
Gulf council passes Reef Fish Amendment 40
Maine elver quota cut by 2,000 pounds
Offshore mussel farm would be East Coast's first


text:
Personal lines rates continued to rise during October, rising an average 3%, according to a survey released last week by Dallas-based electronic insurance exchange MarketScout.Rates for homeowners coverage on houses valued at less than $1 million increased 4%, while rates for more expensive houses ...MORE
The Independent Insurance Agents & Brokers of America's political action committee, InsurPac, distributed more than $1.8 million in the 2014 campaign cycle, which resulted in a 93% congressional victory rate, the Alexandria, Virginia-based producer group announced shortly after Tuesday's midterm ...MORE
Independent insurance agents and brokers posted a 56% success rate in producer hiring in the past five years, although the hiring performance of the top and bottom firms varied widely, found a new study from Atlanta-based Reagan Consulting. Reagan Consulting's Producer Recruiting & Development ...MORE
Aon P.L.C. President and CEO Gregory Case has been named one of the 100 best-performing CEOs in the world by the Harvard Business Review.Mr. Case, who ranked 69th on the list, has been at Aon's helm since 2005. According to the publication, "the knock on most business leaders is that they ...MORE
Even as the rates for commercial property/casualty lines had decelerated, rates for personal lines continued their upswing in September, according to a recently released analysis by Dallas-based electronic insurance exchange MarketScout.MarketScout found that homeowners insurance rates for houses ...MORE
Arthur J. Gallagher & Co. has acquired New York-based Hagedorn & Co.Terms of the transaction were not disclosed.Founded in 1869, Hagedorn is a retail insurance broker providing property/casualty, risk management, group benefits and personal lines insurance products and services for commercial and ...MORE
Arthur J. Gallagher & Co. has acquired Everett James, Inc. located in Ridgefield, Connecticut, Itasca, Illinois-based Gallagher announced this week. Terms of the transaction were not disclosed.Everett James offers employee benefits consulting and brokerage services primarily for large and middle- ...MORE
A slowly of rate increases seen in the commercial lines insurance sector is beginning to show up in personal lines as well.A report issued Friday by Dallas-based electronic insurance exchange MarketScout found that U.S. personal lines insurance rates rose an average of only 2% in August. For homes ...MORE
National Financial Partners Corp. has expanded its business in New England with a pair of brokerage acquisitions.NFP closed the acquisition of Poulos Insurance Inc.,which has 19 offices in Massachusetts, New Hampshire and Vermont on Aug. 4. Four days later, NFP closed the acquisition of Boston- ...MORE
USI Insurance Services is in the midst of celebrating its 20th anniversary with "20 for 20: USI Gives Back," which the Valhalla, New York-based brokerage describes as "a nationwide event where each of the more than 140 USI offices across the United States invests their time, ...MORE


text:
- Publisher: Focus Home Interactive
- Release Date: Apr 21, 2011
User Score
Generally favorable reviews- based on 22 Ratings
User score distribution:
Positive: 16 out of 22
Mixed: 4 out of 22
Negative: 2 out of 22
Review this game
- User score
- Most active
- By date
- Most helpful
- Most Clicked
Jul 19, 2012Great Characters, voice acting, humour, graphics, story. A fun game that's worth the price, and worth the time. Recommended for point-n-click enthusiasts.
Jul 19, 2012Fantastic Game, I bought mine during the summer sale. I loved everything about it. I agree completely with that other guy, it was very funny and worth the price (Summer Sale at least). An all round great game.
Mar 11, 2014The Next Big Thing is a lovable adventure game from the makers of the Runaway series. The graphics are beautiful and the characters are funny, entertaining and absolutely lovable! The Next Big Thing is an unique and unforgettable adventure experience that I will always hold dear.
May 30, 2013I like this game. I find myself liking very few games. Most of them I believe to be mediocre. Maybe I am just a bastard but I like this game. This game has charm coming out the wazoo! Quirky fun AND memorable characters. So many games. So forgettable. This one is not. I suggest you pick it up. It was the first point n click adventure puzzle game I have played. Honestly. Yeah. I know. Terrible. Apparently it's a genre I may have a thing for and it's thanks to this game. BUY IT!… Expand
Sep 6, 2011The fifth title Pendulo revives an adventure that did not have the desired success, using as pillars surreal dialogues, an absolutely fantastic storyline, and fun from start to finish. Through a series of colorful characters, though very short, Hollywood Monsters 2 shows his best on a technical level, through perfect cinematics and animations.
Jul 19, 2011Hollywood Monsters 2 is a good game: its sense of humor and great graphic design make it something that every graphic adventure fan wouldn't miss. Some puzzles may be frustrating, but it's definitely worth a try.
Jul 3, 2011Of course, any niggles relating to the quality of puzzles is alleviated somewhat by the quality of animation. [Issue#110, p.117]


text:
Four men were held at gunpoint inside a Turlock apartment Thursday night during a home invasion robbery.
Police are looking for the two men who beat and robbed a 39-year-old man and kept him locked in the trunk of his car for hours early Saturday.
The Turlock Police Department has arrested one man in connection to a downtown jewelry store burglary, but the actual thief remains at large.
Two traffic stops in two hours led to the seizure of two guns and two arrests by the Turlock Police Department Saturday night.
An observant and determined witness helped the Turlock Police Department capture a suspected thief.
The Stanislaus County Sheriff's Department has identified two men as persons of interest in the case of a stabbing that occurred in Salida on Sunday.
An earlier sexual battery not guilty plea was reduced to a "no contest" stipulation for simple battery against a female employee by former Turlock Journal and Manteca Bulletin publisher Paul Mahony, 54, in the Manteca Branch of the San Joaquin County Superior Court Friday morning.
A Turlock man has been arrested on child pornography charges following an investigation by the Sacramento Internet Crimes Against Children Task Force.
The Turlock woman who was accused of leaving her newborn baby in a Dumpster has accepted a plea deal that will send her to prison for eight years.
An attempt to steal pet medication from a department store turned into a robbery that included a chase across the freeway and came to an end with a blitz tackle in a book store.
A woman using a phony identification card was arrested Thursday afternoon at a bank for fraud and cocaine possession.
A woman taking part in a funeral procession was arrested for driving under the influence Thursday morning, the Turlock Police Department reported.
The newly opened Primo's Market on South First Street in Turlock was the victim of armed robbery on Friday night.
California State University Police Sgt. Matt Dillon, and Turlock Police Officer Queray McMihelk chat with Trina Walley of the Turlock Downtown Property Owner's Association.
The morning of May 28, 1992, was just like any regular day for Aline Gosselin. The 9-year-old girl dressed for school, ate her cereal, gathered up her homework and headed out the front door, unaware that she would never step foot in that house again and that the good-bye she and her mother exchanged that morning would be their last words spoken to one another.
The Turlock Police Department is seeking the public's help in identifying the man who robbed a Turlock bank Thursday afternoon.
The arraignment for a Turlock man accused of sexually assaulting an employee at his Oakdale pizza restaurant was postponed because the Stanislaus County District Attorney's Office has not filed any criminal charges against him.
A Turlock man is facing charges of assault with a deadly weapon after using his car to hit a woman he was arguing with, the Turlock Police Department reported.
A drive-by shooting was reported late Friday evening.
The Turlock Police Department is investigating a robbery at a Turlock fast food restaurant that happened early Sunday.
A 36-year-old Turlock woman had her car impounded in Ceres over the weekend after she was seen driving recklessly down Hatch Road with three minors aboard.
The Turlock Police Department is asking for the public's help in finding a missing 10-year-old boy.
Two Mexican restaurants in Turlock were broken into early Wednesday and law enforcement is looking at the possibility the same suspects were responsible for both break-ins.
The unlicensed driver who struck a woman pushing a stroller with three children across a Turlock street has been arrested on felony hit and run charges.
Two men, one armed with a handgun and the other toting a sledgehammer, robbed a Turlock jewelry store Wednesday, escaping with an undisclosed amount of jewels.
Three children and their babysitter were hit by a car while crossing W. Main Street at the West Avenue crosswalk just before 6 p.m. tonight.
Page 1 of 1


text:
Holocaust Memorial Day : Pope in the Cologne Synagogue
Version 8 and above required to view videos
Uploaded by Catholic Online on Feb 3, 2009
And in the 20th century, in the darkest period of German and European history, an insane racist ideology, born of neo-paganism, gave rise to the attempt, planned and systematically carried out by the regime, to exterminate European Jewry. The result has passed into history as the Shoah. The victims of this unspeakable and previously unimaginable crime amounted to 11,000 named individuals in Cologne alone; the real figure was surely much higher. The holiness of God was no longer recognized, and consequently, contempt was shown for the sacredness of human life.
0 Comments
Leave a Comment
Suggested Videos
St. Benedict Parish Feast 8,241 views View Video
Is Benedict the First Eco-Pope? 6,478 views View Video
Pope: Stop Fighting In The Middle East 9,352 views View Video
Pope John Paul�s Right Hand Man 9,307 views View Video
VATICAN.COM 4,145 views View Video
Want to share your informative and entertaining video with an international audience? Sign In
Most Popular
WARNING GRAPHIC PHOTOS (RAW) - ISIS begins killing Christians in Mosul, CHILDREN BEHEADED Read More
Feast of Christ the King and Advent: What Does it Mean? Read More
WARNING GRAPHIC, RAW PHOTOS -- ISIS on Christians: 'There is nothing to give them but the sword' Read More
Here are 10 Very Interesting Facts About the Catholic Church You Probably Didn't Know! Read More
Lebanese singer gives Arab world a scare - by wearing a dress that's barely there! Read More


text:
The Catoosa County, Ga., sheriff's son is back in jail after he did not appear in court as scheduled on charges he received last year in Tennessee.
Jeremy Phillip Summers was arrested in October 2010 when he drunkenly dialed 911 and said a shooter was on the loose in downtown Chattanooga, records show.
But when officers from all over Hamilton County responded to the call, several with drawn rifles, they realized the 28-year-old had made a prank call and Summers was arrested.
Summers was charged with making false reports, 911 violation, criminal impersonation and public intoxication, court records show. He failed to appear in court on the charges.
Summers, who has been arrested at least five times in Tennessee, was taken back to the Hamilton County Jail on Friday, Chattanooga Police Department spokeswoman Sgt. Jerri Weary said.
Summers has been charged with multiple DUIs and in 2006 with burglary of an auto and vandalism charges, records show. He also pled guilty that same year to malicious mischief and the burglary charges were dismissed.
Joy Lukachick Smith is the city government reporter for the Chattanooga Times Free Press. Since 2009, she's covered crime and court systems in North Georgia and rural Tennessee, landed an exclusive in-prison interview with a former cop convicted of killing his wife, exposed impropriety in an FBI-led, child-sex online sting and exposed corruption in government agencies. Earlier this year, Smith won the Malcolm Law Memorial Award for Investigative Reporting. She also won first place in ...
Oh, that little Jeremy, he's such a prankster! Not to mention a self absorbed, spoiled, overgrown baby with a drinking problem who poses a danger to the public at large. Just how much political pull does a sheriff from a North Georgia county have in Tennessee? Apparently it is quite a lot. We will see what happens this time.
Everything I've seen seems to reflect Sheriff Summers has done no more than any father would or should do.He was picked up for failure to appear not given a citation for FTA.He has to be a good sheriff to stay in office and just gets a lot of bad publicity because of his son.I've seen plenty of kids who do the opposite of what they are taught growing up.My kids aren't perfect but praise the Lord they turned out great once they grew up.Lay off the sheriff's back and let hin continue to do a good job! You and your son are in my prayers!
This "kid" needs to go to rehab for at least 30-60 days. He is spoiled because he thinks dad will get him out of every kind of trouble he gets himself into...
Grow up, Jeremy! Mom and Dad, let him face his own troubles and mis-deeds....All you can do is raise 'em right and then they're own their own...they make their OWN mistakes from then on!


text:
L'Occitane • 20% Shea Butter Hand Cream • Lotions/ Creams
(843 reviews)
|Average Rating.
|Would buy this product again.
*TOP REVIEWER* cathykl on 11/25/2013 11:56:00 AM more reviews by cathykl
Age: 30-35 Skin: Combination, Olive, Warm Hair: Brunette, Straight, Medium Eyes: Brown
This hand cream is amazing. Working in a hospital - I have to wash my hands a hundred times a day. I also have eczema so I need something to keep my hands soft without irritation.
I've used dozens of different types of hand cream but this one really stands out. It's thick and heavy and you just need a tiny bit. It spreads easily like butter, slightly greasy at first but sinks in pretty fast. I need to be able to slap on those annoying hospital gloves if necessary right after so I can't have a slick coating with hand cream - this is just perfect. Also, I've noticed this is the only cream that seems to "last" through washing. Meaning that if I wash my hands an hour after applying cream I don't need to re-apply. I've started using this on dry patches on my legs or arms because it worked so well on my hands.
The only cons? The fragrance. I'm not a big fan of the smell, it's not awful, smells slightly of lavender to me, and thankfully it's not strong but again, for work, the hospital bans any fragranced products so luckily this doesn't garner any complaints. The other issue is the tube - I'm on a new just opened tube now, but my last older tube cracked at the top and would leak some cream, plus the label fell off and left a sticky gunk on the tube that never went away. So it's not the most purse-friendly item, but then again I do buy this in the larger tube size and maybe the small one would be just fine. Overall -those are just minor complaints, this hand cream is the best I've tried so far.
1 out of 1 people found this review helpful. Was this review helpful to you? Yes No
vickyplum on 11/25/2013 11:01:00 AM more reviews by vickyplum
Age: 44-55 Skin: Very Oily, Fair Hair: Brunette Eyes: Blue
Best hand cream bar none - and I've used them all. Last thing at night before I go to bed and that's me done for the day. Smell gorgeous, sinks right in and makes your hands as soft as a baby's ...
1 out of 1 people found this review helpful. Was this review helpful to you? Yes No
*TOP REVIEWER* GrRoxxy on 11/10/2013 12:18:00 PM more reviews by GrRoxxy
Age: 18 & Under Skin: Combination, Fair-Medium, Warm Hair: Blond, Wavy, Medium Eyes: Grey
I had small tube of this 4 years ago. Next time I bought it I chose the perfumed version (less she butter, more liquid, not good). Now I got the original back.
The tube is practical, I like the simplicity of it and it remains me of the painting tubes (love these).
The consistency is on thicker side, its not oily though.
It sinks in fast, it doesn't leave sticky film but silky smooth one.
The scent is pleasant.
I recommend, I haven't found better one.
1 out of 1 people found this review helpful. Was this review helpful to you? Yes No
glitterandsparkles42 on 11/10/2013 11:42:00 AM more reviews by glitterandsparkles42
Age: 18 & Under Skin: Combination, Fair, Cool Hair: Brunette, Straight, Coarse Eyes: Hazel
Best hand cream I've ever used. It's kind of expensive but it lasts for such a long time because it's so moisturizing you won't need a lot. Great for dry skin.
1 out of 1 people found this review helpful. Was this review helpful to you? Yes No
*TOP REVIEWER* JadaIgwe on 11/2/2013 2:56:00 PM more reviews by JadaIgwe
Age: 30-35 Skin: Dry, Deep Dark Hair: Black Eyes: Brown
This is a really moisturizing hand cream
The only con is that the smell is the scent is too strong. It is very rich and warming it up in your hands helps it absorb better. It comes in a large metal tube so it will last forever. It's a good hand cream for really dry hands
Was this review helpful to you? Yes No
YXXC on 10/30/2013 5:22:00 AM more reviews by YXXC
Age: 36-43 Skin: Combination, Fair Hair: Blond Eyes: Other
Yeah, it's nice, but it's not hardcore enough. If you want a good, deeply conditioning hand cream, it's Neutrogena all the way. That's the hand cream that eradicates dry, scaly hands. Shea butter does smell nice but this isn't moisturising enough for me. For more honest reviews, 'like' Face Up To It on Facebook, Twitter @YoCalliss, yocalliss.wordpress.com. Thanks :)
Was this review helpful to you? Yes No
*TOP REVIEWER* JennyWalsh1 on 10/28/2013 10:39:00 PM more reviews by JennyWalsh1
Age: 36-43 Skin: Other, Tan Hair: Brunette Eyes: Blue
I got this as a gift and I LOVE this. I'm not quite sure what the scent is, but it's totally pleasant. The lotion it's self is very smooth, easily absorbed, and moisturizing. I would definitely repurchase, even with the steep price.
1 out of 1 people found this review helpful. Was this review helpful to you? Yes No
icestars on 10/14/2013 11:23:00 PM more reviews by icestars
Age: 19-24 Skin: Oily, Medium Hair: Black Eyes: Brown
Great product. I got a free sample of it at the mall and I have to say; I not that impressed. Moisturization? Great. It is amazing and really moisturizers my hand really well. However, my hand cream from bath and works has 2 fl. oz. and does just the same job for five bucks. Plus, it smells so much better than that sickly sweet baby powder scent. I don't know if its just me, but I hate the scent of the hand creme. Overall, I think it's a great product but I will not be purchasing.
Was this review helpful to you? Yes No
mellouise on 8/5/2013 9:26:00 AM more reviews by mellouise
Age: 30-35 Skin: Acne-prone, Fair Hair: Blond Eyes: Blue
I have really dry hands, and this stuff is great. It moisturises deeply, and the effects last. This leads to my hands looking younger and more healthy. It smells lovely, and sinks in quickly, leaving no greasy feeling - it's ok to touch papers etc. straight away without leaving a mark. I've repurchased twice now.
The pricing is currently £21 for 150ml, £8 for 30ml.
My only gripe is the packaging - yeah it looks great and retro, I love that it's not plastic, but it's heavy and sharp and the cap is awkward to remove/replace.
2 out of 2 people found this review helpful. Was this review helpful to you? Yes No
lawgirl07 on 8/5/2013 9:14:00 AM more reviews by lawgirl07
Age: 19-24 Skin: Sensitive, Medium Brown Hair: Black Eyes: Brown
Love love love!!
My boyfriend's mum gave me a tube of this a while back and it is amazing!
It's actually gotten me into L'Occitane and hand creams in general.
It's super rich and creamy and feels absolutely amazing. The scent is subtle but really nice and to top it off, it leaves my hands feeling a lot smoother.
The packaging is kind of old-school but in a good way and it's small enough to just keep in your handbag.
The only minor downside is that it does leave your hands a bit greasy straight after use. Having said that, it's a hand cream so that comes with the deal. And at any rate, the greasiness isn't sticky and it gets absorbed pretty quickly anyway.
Top Rated Lotions/ Creams
- 32 reviews
Badger Cuticle Care63 reviews
Flexitol Heel Balm81 reviews
Eucerin Aquaphor Healing Ointment1204 reviews


text:
A sweater that causes disease and loss of all friends. Wearing it might provoke one to boil themselves in a bath of acid.
by JA NUJ December 14, 2003
10 Words Trending Now
Alphabetical List
Type your email address below to get our free Urban Word of the Day every morning!
Emails are sent from firstname.lastname@example.com. We'll never spam you.×


text:
MVC Widget Error
7 Tips to Prepare for Your Appointment
The key to a successful appointment is communication. To get the most out of your visit, prepare ahead of time so you can lead the conversation with your doctor. These 7 tips will get you ready
Appointments & Offices
Check insurance plans, locations and make an appointment
Is Dr. Sickel accepting new patients?
- Yes.
Office Locations
- Affiliated Sante Group
- 1400 Spring St Ste 100
- Silver Spring, MD 20910
- (301) 589-2303 (Office)


text:
Police: Naked Burglar Breaks Into Homes While His Own House Burns Nearby [UPDATE]
Police say an 18-year-old is accused of breaking into two homes while naked at about the same time his own house was on fire. Police now say drugs were involved.
Police say an 18-year-old is accused of breaking into two homes while naked at about the same time his own house was on fire. Police now say drugs were involved.
Watch the first 15 seconds of this Taste of Country Music Festival highlights video to learn what this party in the mountains is all about. Watch the rest because it just looks like so much fun!
If you were considering signing up to receive a free turkey from Manna in Bangor, you need to do it in the next couple of days. Registration closes Friday. And if you want to donate, now's the perfect time!
Upstate New York is getting pounded by snow, with up to 70 inches expected in some areas by this evening. While we feel bad for what these folks are going through, the pictures from the State Police may make us feel better about today's cold temperatures.
When you walk in the doors of the Anah Shrine Center on Main Street in Bangor, be prepared to be put in the Christmas Spirit! Beginning this Friday at 12 noon, the 3rd Annual Feztival of Trees will open to the public, with nearly 70 fully decorated and gifted trees for you to browse through, and choose which one you'd most like to adorn your home this holiday season!
It turns out that Dierks Bentley doesn't really mind if you throw up on his stage.
Naturally, most people think of Nashville as country music's mecca, but Las Vegas is quickly becoming a second home for the genre. The most recent act to take residency is Rascal Flatts, who are booked for a short run at the Joint, which is located inside the Hard Rock Hotel and Casino.
As winter approaches a dispatcher from the Presque Isle Police Department reminds all Maine residents to be sure your address numbers are highly visible during the winter months.
We reported earlier today about a crash on Route 17 in Augusta near Rebecca's Restaurant that shut down traffic in both directions for a while. The names of the people involved in the crash have been released by authorities.
Trisha Yearwood says her song 'PrizeFighter' has become a business anthem for her, as well as a personal one. With women in country music struggling to find radio space, and with the changes in the music business since she released her last album seven years ago, the 50-year-old knows better than to pin her expectations on sales or chart numbers.


text:
Tried 'em all
All very speed like with a bit too much edge. At high dosages some hallucinations but not worth the discomfort and tension. Ecstasy is waaaaaaaaay better, not on the same playing field. Not even the same hemisphere.
Mollies are actually MDMA 70-80% of the time, press tabs it drops to about 25 % and usually lots of other adulterants.
MDMA is magic. Changed my life, I can see how it may become habit forming. Lots of sites with info on the web to test your supplies.
I test
By putting half a dose in a spoon. real = 0 to peaking in 5.5 seconds, NOTHING else does that.
I can hear the gasping already, bring the outrage, I've used a needle and I'm sure this will tarnish our reputations when all the MSM sees elektable and starts pouring thru our posts. Maybe they won't let us be mainstream !!! Oh no!!! :@)
btw i have thus far successfully managed to control my mad face eatIng urge by munching some pie while feeling the "LOVE"
Share this:
I have sworn upon the altar of God eternal hostility to every form of tyranny over the mind of man.
- Login to post comments


text:
Today at Flavorpill, we learned that OK Go will be releasing a music video featuring 1,000 handmade instruments. We watched Kristen Bell have a breakdown over a sloth. We guesstimated the fashion trends that might pop up on the new season of Mad Men. We found out that Amazon Publishing's books will not be carried at Barnes & Noble. We were mesmerized by this blue ice cave in Iceland. We were introduced to a girl who can say any word or phrase backward immediately. We loved this definitive guide to classic cocktails that breaks down 68 drinks into their constituent parts. We watched a washing machine self-destruct. We met some vikings. We felt itchy looking at this bark-style dress. We wondered if a teen art gallery was a good idea. And finally, we saw the return of the scrunchie — but we're not sure if even a geeky 3D printed Hilbert curve-style one can make us like it.
Recent Features
- 1d
'True Detective' Season 2 Will Probably Not Be Based on Mashed Potatoes: Links You Need to See
Staff Picks: Flavorwire's Favorite Cultural Things This Week
- 1d
- 1d
How to Be the Funniest Woman Writer on Twitter, With Megan Amram, Author of 'Science... For HER!'
- 1d
No, Richard Cohen, Appealing to "Real Men" Isn't the Way to End Campus Rape Culture
I Watched Every 'Beverly Hills, 90210' Thanksgiving Episode, and All I Got Was This Unexpected Appreciation for Steve Sanders
The Spontaneous Overflow of Powerful Feelings: Poetry as a Political Response
Popular PostsView All Posts
- 1d
'Before I Disappear': The Best Thanksgiving Weekend Movie No One's Talking About
- 3d
8 Great, Overlooked Shows From the 2013-2014 TV Season to Catch Up On Over Thanksgiving
- 3d
100 Years Later, What Have We Learned From James Joyce's 'Dubliners'?
- 4d
- 4d
- View All Posts


text:
It is very easy to use and worked as soon as I installed it and turned it on (that was a surprise!). Then I tried various different settings on my site - skyscraper, horizontal, slide, background designs - they are all quick and easy to configure, fun to try out, and they look professional too.
The user manual also explains everything step by step if needed.
I definitely recommend this plugin and am so glad I found it today!
Cheers, Louise
Hi Louise,
Thank you for your very nice words! Good luck with your new blog.


text:
Pigskin Pigsplosion NFL Week 12 Preview: Chiefs Try to Avoid Trap, Cardinals Continue to Get No Respect at Seattle
Can the Chiefs avoid the letdown? We debate it.
Can the Chiefs avoid the letdown? We debate it.
We all picked the Bears. Just to warn you.
Plus old division rivalries like Cincinnati vs. Jacksonville remind you why they got split up.
Last Week Ryan: 6-9 Stephen: 6-9 Jason: 9-6 (…)
The Jets get our week started in primetime. Yippy.
Plus, thoughts on "former teammates" hating on Cutler and the top Red Zone game of the week, Titans versus Jags.


text:
Arizona > Santa Rosa Yellow Pages > Shopping > Grocery Stores Santa Rosa
We did not find any businesses listed for Grocery Stores in Santa Rosa, AZ (city)
Would you like to ...
Would you like to ...
- Search for Grocery Stores in Tucson, AZ Metro (city)?
- Choose Another City?
- Choose a Different Category?
- Search for Shopping instead?
updating results
Fresh Vitamins
(877) 743-2253
Your Source For Natural Products.
New Life Health Centers - Speedway
(520) 428-5748
4841 E Speedway Blvd
Tucson, AZ 85712
Tucson, AZ 85712
New Life Knows Nutrition.
You are currently searching