text:
HowtoTreat PULL-OUT SECTION www.australiandoctor.com.au COMPLETE HOW TO TREAT QUIZZES ONLINE (www.australiandoctor.com.au/cpd) to earn CPD or PDP points. inside What are LFTs? Diagnostic patterns of LFT changes LFTs and investigation of liver disease Five common LFT challenges The authors PROFESSOR GEOFF FARRELL, professor of hepatic medicine, Australian National University Medical School, and gastroenterology and hepatology unit, The Canberra Hospital, Garran, ACT. Abnormal liver ASSOCIATE PROFESSOR function tests NARCI TEOH, associate professor of medicine, Australian National University Medical School, and gastroenterology and hepatology unit, The Canberra Hospital, Garran, ACT. Background CONTEMPORARY practitioners encounters with non-specific and next, interspersed with some general are well versed in how to manage non-spectacular changes in LFTs, comments on the significance of symptomatic patients with diagnos- often performed for health screen- abnormal LFTs for people taking tic patterns of liver biochemical ing or miscellaneous reasons and in medications, the overweight, those tests, such as those that suggest hep- people who are overtly well. living with hepatitis B or C virus atitis, biliary obstruction or medical This article discusses some typi- infections, and those who may have cholestasis, or hepatic malignancy. cal scenarios for reflection on what cirrhosis. More challenging are the everyday doctors need to think about and do cont'd next page HOW TO TREAT Abnormal liver function tests Five common LFT challenges BEFORE reading on, GPs all normal). He has gained Case 4 recent change in medication. are invited to consider the 10kg in weight since his VW, a 32-year-old IT con- As his new GP, now that following cases in light of second marriage 18 months sultant who emigrated from he has moved to a rural their current knowledge. ago. What further investi- Burma in 1998, has known area, you find he is mildly gations might be useful, since student days that, like anaemic (Hb 11.5g/L) with Case 1 and how would you treat several other family mem- iron deficiency, and a platelet 9 AF is a 24-year-old son of a him? bers, he is hepatitis B posi- count of 120 × 10 /L family friend who recently tive. He has always assumed (normal range 150-400 × 9 returned from Mexico. He Case 3 he is healthy because only 10 /L). ALT was 30 U/L, complains of profound NO, a 55-year-old executive "two of three" tests are pos- AST 50 U/L, bilirubin malaise for 10 days, with assistant to a government itive (HBsAg positive, anti- normal, albumin 32g/L, intermittent vomiting and minister, was diagnosed with HBc positive, HBeAg nega- normal alkaline phos- dark urine. He completed a chronic hepatis C virus (HCV) tive). You confirm this phatase; alfa-fetoprotein 3 four-week course of doxycy- infection in 1992. When serological picture, and anti- kU/mL (normal range <12). cline two weeks ago, taken reviewed from time to time, HCV is not detectable. LFTs Abdominal CT is normal for recurrence of acne. LFTs have been normal and appear satisfactory, with apart from possible early He had combined hepati- she became lost to follow-up. ALT 38 U/L. Is this normal? portal hypertension. tis A and B vaccination On presenting for a much- How would you test You send him to a city before travel, and has anti- delayed Pap smear, NO's GP whether he is indeed a gastroenterologist, who per- bodies to both hepatitis A persuades her to have repeat 'healthy carrier'? forms gastroscopy and (total, not IgM) and hepatitis Case 2 LFT testing, and also orders colonoscopy. Finding no B (anti-HBs alone). His BL, a 45-year-old success- an AST test. The results show Case 5 abnormality other than gas- bilirubin level is 25mmol/L ful car dealer, presents with bilirubin 25mmol/L, ALT 60 DT, a 56-year-old retired tric erosions, which he (normal range <20), AST a letter from an insurance U/L, AST 80 U/L, GGT 250 submariner, has had three attributes to aspirin use, the 5800 U/L (normal range company indicating he has U/L, albumin 34g/L (normal drinks a day for the past five gastroenterologist sends DT <40), ALT 4600 U/L (normal been refused an income- range 35-53). What could be years but drank more heav- back to you, indicating he <40), with albumin, total protection policy because of going on here? How would ily during his time in the would be happy to see him protein and alkaline phos- abnormal LFTs (ALT 70 you approach the situation Navy. He has type 2 diabetes again "if hepatic synthetic phatase normal. What are the U/L; GGT 90 U/L [normal with NO, who is far from (HbA1C 6.8%), easy-to-con- function deteriorates". How possible diagnoses, and does range <50]; bilirubin, albu- enchanted with the 'medical trol hypercholesterolaemia should you manage this he need urgent referral? min, alkaline phosphatase model'? and hypertension, without a patient? What are LFTs? 'LIVER function tests' is a time- Table 1: Causes of elevated liver enzymes Table 2: Different reasons for elevated serum bilirubin honoured term for tests performed Pattern Possible causes concentration in clinical chemistry laboratories when one is considering or wants to Hepatocellular pattern A. Not liver disease (other LFTs normal) exclude liver or biliary disease. • ALT more than five times the • Acute viral hepatitis Haemolytic anaemia (eg, spherocytosis) However, LFTs is a misnomer, as upper limit of normal (ULN) (A,B,C,E in travellers) • GGT raised • Drug-induced liver injury Gilbert's syndrome few of the individual tests are spe- • Alkaline phosphatase less • Chronic hepatitis B or C Cardiac failure cific for the liver, and most do not truly reflect liver function than twice the ULN • Alcoholic hepatitis (remember to order Severe bacterial infection and critically ill patients (pneumonia, Gram- (though several do indicate disease) an AST test — see text) negative septicaemia, 'ICU jaundice') (table 1). • Non-alcoholic fatty liver disease (NAFLD) B. Hepatobiliary disease For example, serum bilirubin and non-alcoholic steatohepatitis (NASH) Hepatitis — acute or chronic, any cause (ALT typically elevated > fivefold, level may be elevated for diverse • Autoimmune hepatitis except with alcoholic liver disease) reasons (table 2). Importantly, even Rarer causes Cholestasis — biliary obstruction or medical causes (alkaline phosphatase minor increases in serum bilirubin CMV or EBV hepatitis; Wilson's disease and GGT substantially elevated, ALT less so) accurately reflect impaired liver (children, young adults); alfa-1-antitrypsin deficiency Cirrhosis — the only condition in which level of bilirubin reflects liver function in the presence of cirrhosis, function (minor changes may be important) and bilirubin is a key prognostic NB: Haemochromatosis alone rarely factor in chronic cholestasis with causes abnormal LFTs — consider alcohol cirrhosis, such as primary biliary and NAFLD (diabetes) in C282Y Table 3: Common causes of low serum albumin cirrhosis. Likewise, serum albumin homozygotes with abnormal biochemistry • Impaired synthesis due to poor nutrition (lack of amino acid building blocks) concentration may be low for a Cholestatic pattern • Enhanced breakdown (cachexia of malignancy, HIV, etc) variety of reasons (table 3). • Alkaline phosphatase more Biliary obstruction: • Haemodilution (second trimester of pregnancy, venous blood taken from than twice the ULN • Choledocholithiasis drip arm) Utility of AST (as well as ALT) Most auto-analysers perform ALT • GGT raised more than five • Pancreatic cancer • Protein loss (nephrotic syndrome, protein-losing enteropathy) assays when 'LFTs' are ordered, times the ULN • Cholangiocarcinoma • Cirrhosis — even 'borderline low' values may be significant and this is the most sensitive and • ALT less than five times Medical: specific test for hepatocyte injury. the ULN • Drug-induced liver injury In both cases, the usual ALT:AST hepatic drug reactions also feature However, it can be very useful to • Primary biliary cirrhosis ratio of >2 is lost; instead, it falls to disproportionate increases in AST order AST as well when one sus- • Primary sclerosing cholangitis 0.8. An ALT:AST ratio of ≤0.8 has as well as ALT levels, as does pects alcoholic liver disease or cir- • Neoplastic infiltration of liver relatively poor sensitivity but high Wilson's disease in children and rhosis (any cause). • Sarcoidosis specificity for cirrhosis. Some young adults. Diagnostic patterns of LFT changes Hepatitis However, up to 10% of hospital inpatients (figure 1A). mune conditions, autoanti- line phosphatase is elevated MAJOR elevations of ALT cases may be due to drugs. Major elevations of ALT, bodies, high serum IgG). more than twofold in associ- (more than fivefold) indicate These include those prescribed often with jaundice and When suspected, phone con- ation with major elevation of hepatitis, which in the com- by doctors (or alternative reduced serum albumin level, sultation with a specialist is rec- GGT. munity is usually viral: medicine practitioners) within are also found with autoim- ommended, as treatment with Practitioners should • Hepatitis A, B or C. the previous 6-12 weeks in the mune hepatitis. Note that the prednisone and azathioprine remember that cholestasis is • Hepatitis E after travel to case of adverse drug reactions, older term 'chronic active hep- needs to be instituted promptly not only due to biliary endemic regions (Mexico, but occasionally inadvertent atitis' is no longer used by in severe cases while awaiting obstruction (so-called south-east and south Asia, or deliberate paracetamol poi- hepatologists because 25% of formal review by the hepatolo- 'obstructive jaundice'), but is western China). soning, or the use of recre- cases present acutely. The gist as soon as possible. often attributable to non-sur- • In young people, occasion- ational agents, such as ecstasy. diagnosis and treatment of this gical conditions, especially ally Epstein–Barr virus, with Hepatotoxicity due to drug condition rest on recognising Cholestasis drug reactions (figure 1B). It other features of infectious overdose and adverse drug the autoimmune pathogenesis The other classic pattern of may also: mononucleosis, or cytomega- reactions are more frequent (association with family or LFT abnormalities is • Occur in pregnancy lovirus. causes of abnormal LFTs in personal history of autoim- cholestasis, when serum alka- cont'd page 32 30 | Australian Doctor | 9 April 2010 www.australiandoctor.com.au HOW TO TREAT Abnormal liver function tests from page 30 Figure 1: Drug reactions are a relatively common and important cause of abnormal LFTs in general Table 4: What does a raised serum GGT level mean? (cholestasis of pregnancy). practice, or in hospital settings. Patterns of LFT changes may resemble viral hepatitis. More than any other liver biochemical test, GGT needs to be • Complicate viral hepatitis. A: A case of enalapril hepatitis — liver cell injury with lobular and portal-tract inflammation are • Reflect other autoimmune considered in context of the clinical problem and the results of evident, the latter including neutrophils and eosinophils; ALT peaked at 800 U/L;) or cholestasis liver diseases, such as pri- B: Terbinafine hepatitis — there is no portal tract oedema or inflammation to suggest biliary other LFTs mary biliary cirrhosis, scle- obstruction. Instead bile plugs are evident (orange pigment collectors) and there is feathery • GGT level increases with any pattern of hepatobiliary disease rosing cholangitis and atyp- degeneration of liver cells containing bile pigment. The patient presented with elevation of serum (hepatitis, cholestasis, infiltration, cirrhosis) ical cases of autoimmune alkaline phosphatase, thought to be due to biliary obstruction. hepatitis. • For increases in serum alkaline phosphatase level, Jaundice and bilirubinuria concomitant elevation of GGT level indicates alkaline phosphatase is of liver origin, not bone origin as in disorders (reflecting conjugated hyper- A such as Paget's disease or metastases bilirubinaemia) is often pres- ent with cholestasis, but not • Changes in GGT level are one of the few biochemical markers always, depending on the of excessive alcohol intake: useful when monitoring patients severity of impaired bile flow attempting alcohol abstinence or extent of biliary obstruc- • Isolated elevated GGT level may occur in NAFLD, but usually tion. with ALT abnormalities, fluctuating with weight changes, and One feature of the cholesta- other results (lipids, blood glucose) tic pattern of LFTs that often confuses doctors is the con- • Isolated elevated GGT level may be explained by drug therapy, comitant elevation of ALT; particularly anticonvulsants this often occurs with • In a well person with normal hepatic/abdominal imaging, cholestasis because bile-acid isolated elevation of GGT level is sometimes never explained accumulation in the liver is (and should then be ignored) hepatotoxic. The resultant 'mixed picture' is not particu- larly helpful diagnostically, acids may cleave GGT from phatase, increases are a rela- except that it is rather the plasma membrane by tively sensitive marker for common with hepatic drug their detergent effects). hepatic malignancy, or dis- reactions. Thus, serum GGT levels orders such as sarcoidosis. In a patient with biliary increase no matter what the But in the 21st century, a rise pain or acute pancreatitis, pathophysiological type of in GGT level typically, but ALT elevation is more indica- hepatobiliary disease, not always in association tive of gallstone disease than B whether it be hepatitis or with minor ALT elevation, concomitant liver disease. cholestasis (most causes, is most often indicative of However, the latter is possible although not in pregnancy). fatty liver disease, as dis- when there is cholestasis with In addition, unsafe levels of cussed later. coincident non-alcoholic fatty alcohol intake and a wide In summary, more than any liver disease (NAFLD) — range of drugs increase GGT other liver biochemical test, especially with type 2 diabetes levels by acting as enzyme- GGT needs to be considered or alcoholic liver disease. inducing agents that stimulate in the context of the clinical The more severe and acute its synthesis and release from problem and the results of the biliary obstruction, the the liver. other LFTs (table 4). higher the ALT level. Values Changes in GGT are one of We have been known to exceeding 500 IU/L are occa- the few biochemical markers recommend to occasional sionally seen the day after of alcohol dependence. 'worried well' individuals to complete biliary obstruction, Improvement during absti- discontinue measuring their and such patients must be nence, or exacerbation with repeatedly abnormal GGT referred urgently for ultra- recidivism, is useful when when it is an isolated abnor- sonography and gastroentero- monitoring patients in general mality. However, such logical intervention to relieve practice. In dealing with this people must: the obstruction. common problem, blood test • Be asymptomatic. results such as GGT can • Not be alcohol dependent. The distractions of GGT sometimes serves as a focus • Have a healthy lifestyle elevation for discussion about progress (exercise, food portions, Among currently used LFTs, ple, the value of raised GGT of hepatocytes, and so is read- and unfinished business. diet). the one that causes doctors the in supporting a diagnosis of ily shed into blood when: Another attribute in • Have normal waist cir- most confusion is the GGT. In cholestasis was mentioned • Hepatocellular injury favour of GGT testing is its cumference. some ways it is the least useful above. occurs. sensitivity as an indicator of • Have repeatedly normal single test, but it is invaluable GGT is located on the sur- • Synthesis is stimulated. hepatic infiltration. Along appearances on hepatic in niche contexts. For exam- face (outer plasma membrane) • Bile-acid levels rise (bile with serum alkaline phos- ultrasound (or CT). Other assessments Physical signs • In ill patients, serum creatinine and chronic hepatitis C or NAFLD, even tion early enough to consider transfer Cardinal physical signs of cirrhosis serum sodium. borderline thrombocytopenia is a to a liver transplantation unit (which include: fairly accurate indicator of stage 3 should be consulted when such a • Hard liver edge. Platelet count (bridging) fibrosis or cirrhosis (stage 4 patient is under observation). • Spider naevi. As a matter of course, patients sus- fibrosis). • Splenomegaly and other signs of pected or known to have chronic liver The traditional explanation for this Serum creatinine and sodium portal hypertension. disease will be ordered an FBC as and the sometimes accompanying These indices are very valuable in • Ascites. well as LFTs. Anaemia is an impor- leucopenia is 'hypersplenism second- considering the prognosis for patients • Muscle wasting. tant complication of portal hyperten- ary to portal hypertension'. Decreased with decompensated cirrhosis. For • Subclinical hepatic encephalopathy sion, most often from iron deficiency platelet survival is likely to play a role, example, creatinine is now part of (neuro-psychiatric and neuro-phys- caused by chronic blood loss due to but more important is reduced blood the Method for assessment of End- iological deficits but with a normal portal hypertensive gastropathy, but levels of thrombopoietin, a protein stage Liver Disease (MELD) score mental and neurological status on occasionally from more substantial that regulates platelet synthesis and used to determine the priority for global clinical examination). bleeding from the same lesions, a release and whose synthesis is organ allocation in Australia/New peptic ulcer or oesophago-gastric decreased in the cirrhotic liver. The Zealand, and all international liver Other 'liver tests' varices. Leucocytosis may indicate readily available platelet count has transplantation programs. This spe- After clinical examination, hepatol- bacterial infection, alcoholic hepatitis become the hepatologist's 'surrogate cialised aspect will not be discussed ogists wondering whether a patient or hepatocellular carcinoma. liver function test'. further here. may have cirrhosis pay as much However, gastroenterologists and attention to tests that are not part hepatologists are most concerned PT and INR Serum bile acids of routine LFTs (plus AST) as they with checking for thrombocytopenia. Impaired synthesis of clotting facIn Specialists sometimes use two other do to serum bilirubin and albumin Circulating levels of platelets fall as acute hepatitis, paracetamol hepato- tests as supportive evidence when concentrations. Key additional fibrotic liver disease progresses, toxicity and other instances of clini- assessing particular patterns of liver 'liver' tests include: almost linearly in relation to fibrotic cally significant liver injury, daily test abnormalities. • Platelet count. severity. In a patient with what might monitoring of PT or INR is essential The first is measurement of serum • Prothrombin time (PT) or INR. otherwise seem like 'run of the mill' to detect hepatic functional deteriora- bile acid levels. This test is rarely 32 | Australian Doctor | 9 April 2010 www.australiandoctor.com.au Figure 2: Hepatocellular carcinoma complicates cirrhosis. It is usually incurable when >5cm in diameter and when presenting with symptoms. Screening by Use of LFTs for monitoring drug safety six-month ultrasound and alpha fetoprotein is an important aspect of preventive medicine for the patient with cirrhosis, along with varices and bone A large number of drugs has been associ- Table 5: Medications for which health. ated with drug-induced liver injury. regular LFT monitoring is However, there are only a few instances recommended in which monitoring with LFTs is rec- ommended (other than in package inserts Isoniazid for these agents). Methotrexate For most agents, evidence supporting efficacy of LFT screening to prevent the Synthetic retinoids onset of severe hepatotoxicity is com- Ketoconazole pletely lacking. Symptoms are more Terbinafine (see figure 1B) important than LFT changes for early detection of adverse drug reactions. Certain anticancer drugs Thus, patients should be advised to Prolonged therapy with minocycline report even non-specific symptoms such as malaise, nausea, dyspepsia, facial dis- comfort and fever. Table 6: The undeserved For truly problematic agents — isoni- reputation of statins as azid remains at the top of the list, with a hepatotoxins risk of serious liver injury of about 1%, depending on age — LFTs should be On the evidence of hundreds of measured to ensure practitioners discuss thousands of cases: openly with patients the risk of liver • Fewer than 5% of people taking statins injury and the need to report onset of develop LFT changes performed these days, and needs to 10-50 kU/mL (normal range <12). new symptoms. Only in this way will the be sent to reference laboratories. Higher values are more suggestive continuing instances of acute liver failure • These are nearly always minor and Its value is to confirm cholestasis of primary liver cancer. Hepatic referred for liver transplantation be resolve spontaneously, even during in contexts where other evidence is imaging (CT) should therefore avoided. drug continuation ambiguous. With the advent of always be performed before con- Agents in which LFT monitoring is • Severe drug-induced liver injury from more sophisticated ways to image cluding that a raised AFP is due to recommended are listed in table 5. It is statins is exceedingly rare the liver, biliary tract and pancreas, uncomplicated cirrhosis. sometimes neglected with methotrexate this is rarely required, but fasting use, and although the importance of • Patients with abnormal LFTs are no serum bile acid levels may be useful Imaging methotrexate as a cause of cirrhosis is more likely to develop significant liver for monitoring early onset of When LFTs are abnormal, other much reduced with use of contemporary injury while on statins, and so … cholestasis of pregnancy in a tests are used to diagnose the cause safe doses (up to 25mg/week as a single • LFT monitoring is not warranted woman at high risk (because of a and severity of liver disease. GPs dose), LFT measurement on a quarterly previous episode). can perform hepatitis serology, and basis is advisable to monitor patients at • Most patients taking statins have judicious hepatic imaging (ultra- higher risk. metabolic syndrome, and are therefore Serum alphafetoprotein sonography if they suspect biliary Note that the list in table 5 does not at high risk of NAFLD, itself a very The second test is serum alpha-feto- obstruction or fatty change, CT include the statins. These incredibly common cause of ALT abnormality protein (AFP), an oncofetal protein scan if they suspect malignancy). important agents (to prevent cardiac whose serum levels rise during preg- Patients with cholestasis or severe events, and possibly reduce risk of nancy, with hepatocellular carci- hepatitis should usually be referred dementia) have garnered a reputation as noma (HCC) (figure 2) and rare for urgent specific diagnosis and hepatotoxins that is totally undeserved. sarcomas. However, in a patient treatment. The timing and pre- The evidence against statins being an suspected of having chronic liver referral workup depend on individ- important cause of liver disease is sum- disease, a minor rise in AFP is often ual clinical and social contexts (see marised in table 6. They must be pre- found with cirrhosis, minor being case study discussions below). scribed when they are indicated. Five common LFT challenges revisited Hepatitis — usually but Figure 3: Just as for every patient with metabolic and evident — sore throat, liver failure; likewise, any exclude alcohol as a cause not always cardiovascular problems, those with abnormal LFTs should headache, monocytosis. abnormality of PT/INR. with a reliable history, sup- straightforward have proper anthropometric assessment by their doctor, Tetracyclines are a rela- Failure of other symptoms ported by absence of 'bio- Case 1 revisited including measurement of waist circumference as well as BMI. tively common cause of and ALT to settle over 1-2 markers' such as a dispro- AF has some form of acute As in the older Australian male below, central obesity (>94cm in drug-induced liver injury in weeks should prompt the GP portionately high GGT level hepatitis. Possible diagnoses men, >80cm in women) is nearly always present in those with today's society. The absolute to refer for specialist investi- or macrocytosis on the include viral hepatitis, drug- non-alcoholic fatty liver disease, even without obesity. risk is low (<1 per 100,000 gation and treatment. blood film. induced liver injury, autoim- exposed), but these agents He may also have mune hepatitis and Wilson's are often prescribed in Fatty liver disease — so acquired HCV or HBV from disease (because he is only repeated or prolonged common and so treatable earlier behaviours (IV drug 24 years old). courses. This seemed the Case 2 revisited use, sexual exposure), about Hepatitis A and B are most likely diagnosis in AF's With his recent change in life which the GP should judi- unlikely if recommended case, as he recovered rapidly circumstances, increasingly ciously enquire before order- immunisation schedules and was anti-HEV negative. sedentary occupation and ing hepatitis B and C serol- were completed, but hepati- However, it was also age, BL is now over-nour- ogy. Assuming this history is tis C still needs to be important to exclude ished. Careful doctors will negative, it is important to excluded. If risk factors for autoimmune hepatitis, which perform BMI and waist cir- go straight to the 'nitty HCV are present (injecting can present acutely. Antinu- cumference measurements gritty' and look for evidence drug use or recent sexual clear (ANA), smooth muscle, on a large proportion of of the metabolic abnormali- exposure [with someone and liver/kidney microsomal their patients (many of ties so strongly associated who could have had acute antibodies were all negative whom are overweight but with NAFLD/NASH, and hepatitis C]), perform PCR in this case. ANA may be not huge) (figure 3). look for steatosis by hepatic for HCV RNA even with a positive with tetracycline BL is now motivated by imaging. Ultrasound is negative anti-HCV. hepatitis. his rejection by the insurance appropriate for this, as it is The travel history is Should AF be referred company and his personal reasonably sensitive for more important here, and negative urgently? It is often helpful need to provide security for severe forms of NAFLD tests for hepatitis A, B and C to discuss such a case by his new family. So this is a (figure 4). should prompt ordering of a phone with a specialist col- great time to intervene for The metabolic abnormali- hepatitis E test. Mexico is a league. If the PT is normal someone with over-nutrition. ties associated with fatty high-risk country for this and the patient is reasonably Most likely his minor LFT liver include: waterborne virus, which comfortable, hospital admis- abnormalities are due to • Serum lipids (low HDL, causes severe acute hepatitis. sion is not required. NAFLD. The more severe high LDL, hypertriglyceri- Hepatitis E antibody tests Repeated vomiting or any form of this condition is daemia). need to be sent to a refer- hepatitis in young adults; suggestion of clouding of pathologically similar to • Fasting hyperglycaemia. ence laboratory. other clinical and laboratory consciousness are reasons for alcoholic hepatitis and is • Abnormal glucose toler- Cytomegalovirus and features of infectious urgent referral, as they may termed NASH. ance test (this should be Epstein–Barr virus can cause mononucleosis are usually indicate impending acute However, first we need to cont'd next page www.australiandoctor.com.au 9 April 2010 | Australian Doctor | 33 HOW TO TREAT Abnormal liver function tests from previous page performed if fasting blood Figure 4: Use of hepatic ultrasonography to detect fatty liver disease. This illustration shows not only increased echogenicity anteriorly (towards top of figure) as appreciated by the 'snow storm' appearance, but also deep attenuation of the ultrasound signal posteriorly Summary glucose level is ≥5.6mmol/L). (because so much signal is reflected, none remains to penetrate that far) and blurring of hepatic vessels. Hypertension may also be IN summary, non-specific present. abnormalities of LFTs are The metabolic syndrome common in asymptomatic per se requires lifestyle inter- patients. They most often vention, with or without a indicate NAFLD in over- fatty liver. In BL's case, a Liver/kidney contrast Blurring of vessels weight patients. NAFLD family history of diabetes increases standardised mor- and its complications in his tality by 80%. Treatment of maternal grandmother and such patients should there- two aunts might be com- fore include full work-up pelling reasons to reduce and management for dia- food portions, adopt a 'heart betes, dyslipidaemia and healthy' or diabetic diet, and metabolic syndrome. engage in 20-30 minutes of Patients with HCV or aerobic exercise on a daily HBV infections and those basis (using a pedometer with a history of heavy alco- might help with motivation hol intake and abnormal and objective measurement). liver tests need careful inves- If serum cholesterol is ele- tigation and specialist refer- vated and there is a strong ral to establish whether cir- family history of CVD there Deep attenuation rhosis is likely. The GP is a strong indication to pre- should continue to play a scribe a statin. Presence of role with such patients, not minor LFT abnormalities is only with supportive and far from a contraindication • Hepatic imaging (ultra- will be >10,000 IU/mL and better informed and moti- includes reminders to per- general medical care but in (table 6) — it is almost an sound or CT). referral is strongly recom- vated specialist colleagues form the tests regularly every assisting in preventing nutri- indication! Nonetheless, Irrespective of whether a mended. would take a broader per- six months (our tip is to tional, bone and gastroin- LFTs are useful 'biomarkers' reliable alcohol history is If HBV DNA is <100 spective of preventive issues 'anchor' the program to the testinal and liver complica- to monitor BL's progress with obtained, referral to a spe- IU/mL, the borderline ALT is in GI and liver disease. patient's birthday month). tions. his metabolic challenges. cialist or liver clinic is not due to hepatitis B. People However, GPs do have an Being male, coupled with Modest weight reduction strongly advisable here with chronic HBV infection important role to play in previous and possibly ongo- with normalisation of waist because NO is no longer on are not immune from caring for patients with cir- ing excessive alcohol intake circumference (<95 cm) a smooth course; whatever NAFLD, so measure the rhosis such as DT, who are (>20g/day) and diabetes (the Online resource should greatly improve his has changed, she is now very waistline and proceed to at risk of serious complica- latter two risk factors aggra- • Gastroenterological LFTs, while resuming an likely to have, or be develop- investigate as for case 3. 'In- tions. Some of these are vate ongoing liver injury and Society of Australia: digestivehealthfoundation. exercise program may also ing, cirrhosis. Further, the between' cases of HBV DNA highly preventable and their inflammation) increase DT's gesa.org.au contribute to blood pressure challenges of discontinuing (100-10,000 IU/mL) might impending onset can readily risk for HCC. His glycaemic and glycaemic control. alcohol and considering hep- appropriately be referred to a be detected by simple screen- control and weight likewise atitis C antiviral therapy hepatologist. ing tests (see below). need to be fastidiously man- Hepatitis C — what has before it is too late need to People with chronic hepa- In addition, DT should be aged. changed? be tackled. titis B should also be advised strongly encouraged and regu- Early detection of suspi- Case 3 revisited to alert their healthcare pro- larly reminded to reduce his cious lesions or AFP changes We need to know how long The 'healthy hepatitis B fessionals to their infection, alcohol intake to a maximum should lead to referral to a NO has had chronic HCV carrier' no longer exists especially if they are about of two standard drinks a day, multidisciplinary liver cancer infection, most likely since — B aware! to undergo immunosuppres- with several alcohol-free days team for management. Most she was a teenager experi- Case 4 revisited sive therapies (eg, chemother- during the week, or to abstain Australian cities have devel- menting with drugs (ie, >35 Despite normal physical apy for solid or haematolog- from alcohol altogether if these oped such units now, and years). The presence of examination and normal ical malignancies, anti-TNF levels of restraint cannot be patients with small (asymp- normal LFTs during the last ALT levels, people with agents or high-dose pred- achieved consistently. tomatic) HCCs may be decade would generally indi- chronic HBV infection (often nisone). Under such circum- In all patients with cirrho- offered curative treatment by cate less active hepatitis and called 'carriers') should not stances, the risk of HBV sis, pay attention to optimal resection or, ideally, by liver lower risk of developing be presumed to be, or told, reactivation is very high and nutrition and avoid excessive transplantation. fibrotic liver disease leading that they are 'healthy'. Like can lead to death from ful- salt (which may precipitate Finally, remember the bone to cirrhosis and its complica- other HBsAg-positive indi- minant hepatic failure. ascites) and aspirin and health of your patients with tions of liver failure and viduals, VW should still see All patients who are NSAIDs because of their gas- chronic liver disease. Patients hepatocellular carcinoma. his doctor or specialist annu- HBsAg positive should there- trointestinal bleeding and such as DT (male and So the most immediate ally for review. fore be referred to a hepatol- renal side effects — both female) are at risk of osteo- concerns would be the He still has a risk of devel- ogist or specialist experienced important issues in cirrhosis. porosis and fractures, espe- modest (but highly informa- oping fibrosis, cirrhosis in the management of Screening for oesophageal cially if they: tive) rise in bilirubin level and/or liver cancer. This is chronic hepatitis B before and gastric varices should • Smoke. and the borderline low serum even more likely if the HBV starting profound immuno- still be undertaken, despite • Are aged over 60. albumin level (normal range was acquired vertically and suppressive therapy, so that the recent normal gas- • Are obese or underweight 35-53g/L); her value of 36g/L if he has persistently high antiviral prophylaxis can be troscopy. The findings of (BMI <25). would be unusual in a levels of HBV replication, instituted (lamivudine or mild splenomegaly on DT's • Are using corticosteroids. healthy person. determined by serum HBV entecavir). During and after CT scan result is suggestive • Have had a previous frac- The real clue, though, is DNA level (one test is reim- chemotherapy, close monitor- of early portal hypertension. ture. the reverse ratio of AST:ALT bursable, but discuss the reli- ing of liver tests (at least His next surveillance gas- Annual bone densitometry (see earlier), and possibly the ability of pathology monthly) and HBV DNA (at troscopy should be scheduled (DEXA, MBS #12315: rather high value of GGT. providers with the specialists least three monthly) should for two years hence. The fre- chronic liver disease) and 25- These changes can occur in your area, as there can be be undertaken under the quency of screening gas- hydroxy-vitamin D level are with hepatitis C alone, in major differences in tests guidance of a specialist. troscopy and institution of useful investigations. If vita- which case cirrhosis is likely, used). prophylactic banding of min D levels are <60nmol/L, but they are also features of Referral to a hepatologist Yellow submarine — varices depends on the size treat with a vitamin D sup- alcoholic liver disease. Given for ongoing follow-up/man- preventing your cirrhotic and number of varices, and plement, 3000-5000 IU/day. her attitude to healthcare, agement is highly recom- patient from sinking signs of recent haemorrhage Advise optimal calcium this aspect will need to be mended in this situation, as further with detected on each occasion of intake, regular weight-bear- addressed with considerable antiviral therapy may be complications surveillance. ing exercise and consider bis- skill and sensitivity, particu- indicated; agents such as Case 5 revisited Regular screening for HCC phosphonate therapy (eg, larly on this first visit. tenofovir and entecavir are This patient's thrombocy- is strongly advised for risedronate 35mg once a Investigations to be per- highly effective, with mini- topenia and low albumin patients with cirrhosis (figure week) if: formed during this 'holding mal adverse effects or level are fairly accurate indi- 2). The schedule is six- • The DEXA T score is operation' should include: drug–drug interactions. cators of advanced fibrosis monthly ultrasound and AFP, <–3.0. • FBC, with particular atten- In VW's case, LFTs show or cirrhosis. Not surprisingly, and screening is ineffective • The T score is < –1.5 and tion to platelets and macro- ALT 38 U/L (NR <40), you (and we) are concerned unless a supervised program the patient has been using cytosis. which hepatologists do not that DT's gastroenterologist is undertaken, that is, one in corticosteroids for longer • PT/INR. regard as normal for a lean has taken a narrow view of which the patient and their than three months. • AFP. individual. If it is due to the patient's normal endo- doctor are committed to take • The patient has had a previ- • HCV RNA (PCR). chronic hepatitis B with or scopic procedures and poten- appropriate action based on ous minimal trauma frac- • HCV genotyping. without cirrhosis, HBV DNA tial health issues; hopefully test results, and ideally which ture. cont'd page 36 34 | Australian Doctor | 9 April 2010 www.australiandoctor.com.au HOW TO TREAT Abnormal liver function tests GP's contribution and she was placed on Busco- tion of new stones within the circumference) has been pan and a low-fat diet. Initial biliary system sometimes reversed. Follow-up imaging is investigations were organised. occurs. Sclerosing cholangitis indicated here to make sure Ultrasound showed absent should also be considered. that biliary dilation has gallbladder, mild fatty infiltra- resolved, and there is no tion of the liver and mild Are there any other tests we hepatic infiltration other than prominence of the intrahepatic should have done at the time? with steatosis. ducts. Blood tests revealed all It was reasonable to use Her gut symptoms also DR SANDRA VAN DER LFTS elevated: ALP 115, GGT clinical judgement and appear unresolved, and it may WATER 303, AST 270, LD 428 and observe, but if the clinical pic- be advisable to order an Gordon, NSW ALT 169. Serology showed ture had not settled rapidly, abdominal CT — which immunity to hepatitis A and the next test would be mag- would help find diverticular Case study B and was negative for hepati- netic resonance cholang- disease, etc., while providing ESTELLE, 34, and mother of tis C. abdominopelvic CT scan biliary colic. The test results iopancreatography. Lipase reassurance about hepatobil- four children, usually comes On review three days later detected no abnormality. Her (AST higher than ALT) are should also be tested. One iary/pancreatic disease — and to the practice for routine Pap she was asymptomatic, with abdominal pains settled with also atypical for viral or drug would also consider referral to consider referral for smears and repeat prescrip- the abdomen not tender. mebeverine and a low-caffeine hepatitis, but would be consis- a gastroenterologist for possi- colonoscopy. tions of her oral contraceptive Progress LFTs one week later diet. tent with choledocholithiasis, ble endoscopic retrograde pill (Yaz). were normal apart from an as would the intrahepatic duct cholangiopancreatography. What role, if any, does her In October 2009 she pre- isolated raised GGT (176). Questions for the author dilatation. Rapid resolution of contraceptive pill (Yaz), play sented with severe right-sided Three months later she re-pre- At the initial presentation, ALT elevation, as in this case, Are the persistent elevations of in this scenario? upper-quadrant abdominal sented with spasmodic right- Estelle had some form of acute also occurs with passage of GGT and ALT three months This combination contains pain radiating subcostally. sided pains and tender right hepatitis, which settled very gallstones. Naturally, one later indicative of fatty liver oestradiol, which may increase Although it reminded her of colon. She had lost 12kg on quickly in three days. What would want to be very confi- disease? She has lost 12kg in her risk of gallstone forma- previous biliary colic, she had the low-fat diet and was using are the possible causes (given dent about the alcohol history. weight, bringing her BMI near tion, but she appears to have had a cholecystectomy in Nexium prn for epigastric dis- she claims to be a social Biliary colic more than five to the normal range. Does been taking this agent for 2004. comfort. drinker only)? years after cholecystectomy is weight loss result in reversal some years and, unless there is She is a social drinker and LFTS were repeated and Presentation with severe highly unlikely to be due to of fatty liver and return of a hepatic space-occupying moderately overweight, with showed GGT 128, ALT 47 right-sided upper quadrant retained stones, but in such a LFTs to normal? lesion (which was not seen on a BMI of 30. She was very and normal serum amylase pain radiating subcostally is gallstone-prone person (note Yes. She is still overweight, ultrasonography), there is no tender in the right upper quad- level. She was Helicobacter not suggestive of either hepati- her cholecystectomy age 28 and the critical consideration is likely implication of Yaz in rant, urinalysis was negative pylori negative and an tis or fatty liver disease, but of and obesity [BMI 30]), forma- whether central obesity (waist this clinical picture. INSTRUCTIONS How to Treat Quiz Complete this quiz online and fill in the GP evaluation form to earn 2 CPD or PDP points. We no longer accept quizzes by post or fax. The mark required to obtain points is 80%. Please note that some questions have more than one correct answer. Abnormal liver function tests ONLINE ONLY — 9 April 2010 www.australiandoctor.com.au/cpd/ for immediate feedback 1. Which TWO statements are correct? d) In severe cases of autoimmune hepatitis, indicative of fatty liver disease retinoids, ketoconazole, terbinafine, and a) All 'liver function' tests performed in a urgent treatment with prednisone and c) The platelet count and prothrombin time (PT) long-term use of tetracyclines routine biochemical screen accurately and azathioprine is needed or INR are valuable additional tests in specifically reflect liver function assessing liver disease 9. Which THREE statements are correct? b) Elevated serum bilirubin level is specific for 4. Which TWO statements are correct? d) The anaemia that can occur with liver a) Antinuclear, smooth muscle, and liver/kidney hepatitis or cholestasis a) In cholestasis, serum alkaline phosphatase disease is due to vitamin B12 deficiency microsomal antibodies are associated with c) Serum bilirubin level accurately reflects level is elevated more than twofold, with high autoimmune hepatitis impaired liver function in the presence of levels of GGT 7. Which TWO statements are correct? b) Minor and isolated LFT abnormalities such as cirrhosis b) In cholestasis the biliary obstruction is always a) Platelet levels increase in parallel with the ALT 70 U/L and GGT 90 U/L are consistent d) Non-hepatic causes of low albumin include due to a surgical cause severity of fibrotic liver disease with non-alcoholic fatty liver disease (NAFLD) poor nutrition, enhanced catabolism, loss by c) Medical causes of cholestasis include drugs, b) Thromobocytopenia is in part due to reduced c) NAFLD is associated with elevated serum proteinuria or protein-losing enteropathy hepatitis, automimmune liver diseases and blood levels of thrombopoietin, a hepatic lipid levels, hyperglycaemia, and liver malignancy protein whose synthesis is decreased in hypertension 2. Which THREE statements are correct? d) Jaundice and bilirubinuria is invariably cirrhosis d) Statins are contraindicated in people with a) Serum AST is the most sensitive and present with cholestasis c) Impaired synthesis of clotting factors 2, 7, 9 NAFLD and hypercholesterolaemia because specific test for hepatocyte injury and 10, leading to PT prolongation, always of their hepatic side effects b) The usual ALT:AST ratio of >2 may fall to 5. Which THREE statements are correct? responds to vitamin K administration ≤0.8 in alcoholic liver disease or cirrhosis a) ALT level may be elevated in cholestasis d) Serum alpha-fetoprotein (AFP) is an oncofetal 10. Which THREE statements are correct? c) Some hepatic drug reactions also feature because bile-acid accumulation in the liver is protein whose serum levels rise during a) People with chronic hepatitis B virus (HBV) disproportionate increases in AST as well as hepatotoxic pregnancy and with cirrhosis or infection may have progressive liver disease ALT b) Increased serum levels of GGT occur when hepatocellular carcinoma despite a normal physical examination and d) ALT levels >5 times normal indicate hepatitis there is hepatocellular injury, when synthesis normal ALT level is stimulated, or when bile acid levels rise 8. Which TWO statements are correct? b) In those with chronic hepatitis B, persistently 3. Which THREE statements are correct? c) An increase in serum GGT levels is specific a) Liver CT is the most appropriate imaging high levels of HBV replication (serum HBV a) In the community, the most common causes for the cholestasis of pregnancy investigation when biliary obstruction or fatty DNA level >10,000 IU/mL) warrant referral to of acute hepatitis are hepatitis viruses (A, B, d) Alcohol excess and a wide range of drugs change is suspected a hepatologist for antiviral therapy C), and drugs increase GGT levels by acting as enzyme- b) LFT changes are more important than c) Immunosuppressive therapies (eg, b) Drug-induced hepatitis can be caused by inducing agents that stimulate its synthesis symptoms for early detection of adverse drug chemotherapy, anti-TNF agents or high-dose antibiotics, NSAIDs, antidiabetic agents, and release from the liver reactions prednisone) in those with chronic hepatitis B antihypertensives, paracetamol poisoning, c) Non-specific symptoms such as malaise, may reactivate the hepatitis and lead to death herbal and over-the-counter medicines, and 6. Which THREE statements are correct? nausea, dyspepsia, facial discomfort and from fulminant hepatic failure recreational drugs a) GGT is a sensitive marker of hepatic fever are important early indicators of drug- d) Regular screening for hepatocellular c) Autoimmune hepatitis does not present with infiltration such as that of hepatic malignancy related hepatic reactions carcinoma is not recommended for people the typical elevation in ALT characteristic of b) A rise in GGT level, typically but not always in d) Drugs for which LFT monitoring is with cirrhosis, as there is no curative other types of hepatitis association with minor ALT-level elevation, is recommended include isoniazid, synthetic treatment available CPD QUIZ UPDATE The RACGP now requires that a brief GP evaluation form be completed with every quiz to obtain category 2 CPD or PDP points for the 2008-10 triennium. You can complete this online along with the quiz at www.australiandoctor.com.au. Because this is a requirement, we are no longer able to accept the quiz by post HOW TO TREAT Editor: Dr Giovanna Zingarelli or fax. However, we have included the quiz questions here for those who like to prepare the answers before completing the quiz online. Co-ordinator: Julian McAllan Quiz: Dr Giovanna Zingarelli NEXT WEEK The prevalence of atopy in our population is about 20%, and atopic dermatitis (also known as atopic eczema) appears to be on the increase, not just in Australia but worldwide. The next How to Treat focuses on management of this condition. The author is Dr Gayle Fischer, paediatric dermatologist, The Royal North Shore Hospital, St Leonards, and senior lecturer in dermatology, University of Sydney, NSW. 36 | Australian Doctor | 9 April 2010 www.australiandoctor.com.au
Pages to are hidden for
"Abnormal liver function tests Australian tor"Please download to view full document


text:
Third Cup together: Shintaro Okada makes a pass to teammate Tomo Obata during the preliminary rounds of the 23rd Marianas Cup Beach Volleyball Festival pro-am tournament yesterday at Gov. Joseph Flores Memorial Beach Park. The tournament concludes today. Grant Wieman/Pacific Sunday email@example.com
Moving in for the kill: The preliminary rounds of the 23rd Marianas Cup Beach Volleyball Festival pro-am tournament included 34 teams and professional players from Japan, China and the US. mainland. The tournament concludes today at Gov. Joseph Flores Memorial Beach Park. Grant Wieman/Pacific Sunday email@example.com
The opening rounds of the 23rd Marianas Cup Beach Volleyball Festival pro-am tournament yesterday paved the way for today's final at Gov. Joseph Flores memorial Beach Park.
Guam's Kendra Byrd and Japanese pro Erika Habaguchi played together for the first time yesterday and finished pool play undefeated. Other undefeated women's teams were Nozumi Yanagi and Anna Miyakawa, and Whitney Blandford and Aubrey Waters.
Undefeated men's teams included Chris Shepherd and Borjah Gonzalez, Tyler Willsey and Tsuchiya Takashi, Jeff Carlucci and Brandon Chance, and Jimmy Boonprakong and Aaron Parker.
Byrd and Habaguchi were paired up through a random raffle drawing that is one of the tournament's highlights. It was the second time Byrd has won the raffle and she said playing with a pro is no different than anyone else.
"I'm worried about making her work too hard," Byrd said. "There are some people that just get on the court with you and you're already able to gel with them. ... I'm quieter on the court. We stay calm the whole time and that makes it easier."
Byrd and Habaguchi finished the day 4-0.
Developed chemistry
Local men's star Shintaro Okada was joined by long-time Marianas Cup player Tomo Obata.
"This is our third Marianas Cup together," Okada said. "He comes here a few times a year and we play together then. ... We just work really well together."
Okada and Obata beat Guam players BJ Balajadia and Derrick Wahl in their second match of the day.
The tournament included 34 teams total, director Jon Cramer said, 19 men's and 15 women's, and more than a dozen professional players. Local players, ages 17-51, from Guam, Saipan and the U.S. mainland filled the brackets.
"The tournament's awesome," Okada said. "It's hot but the courts turned out really nice. Good job to Jon Cramer and his crew for putting all the hours in."
There is one permanent court at the beach park and three more courts were constructed for the Cup.
Between matches the players helped organize the tournament, filling in as referees for matches in opposite pools.
"I kind of like it," Byrd said. "Being able to see what they're doing, it's a good way to spy without actually letting them know you're spying."
The tournament concludes today with elimination playoffs. Championship matches should begin around 3 p.m.

subset: commoncrawl


text:
Biscoe, North Carolina
|Biscoe, North Carolina
|Motto: "A Dream Worth Dreaming"
Location of Biscoe, North Carolina
|Coordinates: 35°21′38″N 79°46′49″W / 35.36056°N 79.78028°WCoordinates: 35°21′38″N 79°46′49″W / 35.36056°N 79.78028°W
|United States
|North Carolina
|• Total
|2.0 sq mi (5.1 km2)
|• Land
|2.0 sq mi (5.1 km2)
|• Water
|0.0 sq mi (0.0 km2)
|614 ft (187 m)
|Population (2010)
|• Total
|• Density
|855.8/sq mi (330.4/km2)
|Time zone
|Eastern (EST) (UTC-5)
|• Summer (DST)
|ZIP code
|Area code(s)
|FIPS code
|GNIS feature ID
Biscoe is a town in Montgomery County, North Carolina, United States. The population was 1,700 at the 2010 census. The town is named after Henry Biscoe, an important customer of the local lumber business.
|This section does not cite any references or sources. (July 2010)
The area was formerly called "Filo." The current name was adopted in 1895.
Biscoe's past was dependent on the railroad industry, and it was once an important repair center for railroad equipment. The Aberdeen and West End Railroad (owned by the Page family of Aberdeen, North Carolina, completed a branch to Star, North Carolina from Filo, NC (current Biscoe) in 1895. The A & W. E. R.R. was merged into the Aberdeen and Asheboro Railroad in 1897.
Biscoe was incorporated in 1901.
Former U.S. Congressman Larry Kissell is a resident of Biscoe.
Biscoe is located at 35°21′38″N 79°46′49″W / 35.36056°N 79.78028°W (35.360450, -79.780278).[3]
According to the United States Census Bureau, the town has a total area of 2.0 square miles (5.2 km2), all of it land.
U.S. 220, I-73/74 and N.C. 24/27 all pass through Biscoe.
As of the census[1] of 2000, there were 1,700 people, 535 households, and 393 families residing in the town. The population density was 855.8 people per square mile (329.8/km²). There were 572 housing units at an average density of 287.9 per square mile (111.0/km²). The racial makeup of the town was 58.35% White, 24.47% African American, 0.35% Native American, 0.59% Asian, 15.47% from other races, and 0.76% from two or more races. Hispanic or Latino of any race were 23.24% of the population.
There were 535 households out of which 38.7% had children under the age of 18 living with them, 52.9% were married couples living together, 14.6% had a female householder with no husband present, and 26.4% were non-families. 21.7% of all households were made up of individuals and 9.7% had someone living alone who was 65 years of age or older. The average household size was 2.97 and the average family size was 3.42.
In the town the population was spread out with 28.6% under the age of 18, 11.2% from 18 to 24, 25.6% from 25 to 44, 19.5% from 45 to 64, and 15.1% who were 65 years of age or older. The median age was 34 years. For every 100 females there were 92.7 males. For every 100 females age 18 and over, there were 87.3 males.
The median income for a household in the town was $35,667, and the median income for a family was $37,500. Males had a median income of $23,214 versus $21,089 for females. The per capita income for the town was $15,302. About 8.5% of families and 11.8% of the population were below the poverty line, including 16.4% of those under age 18 and 6.7% of those age 65 or over.
- ^ a b "American FactFinder". United States Census Bureau. Retrieved 2008-01-31.
- ^ "US Board on Geographic Names". United States Geological Survey. 2007-10-25. Retrieved 2008-01-31.
- ^ "US Gazetteer files: 2010, 2000, and 1990". United States Census Bureau. 2011-02-12. Retrieved 2011-04-23.
External links[edit]


text:
- Manhole Explosions Close Bloomfield AvenuePosted 2 weeks ago
- Snow Closes Schools, Postpones Musical, PlayoffsPosted 3 weeks ago
- Snow Day 2: Verona Public Schools ClosedPosted 2 months ago
- Superintendent Warns About DriverPosted 2 months ago
- Parking, Trash Changes During Snow StormPosted 2 months ago
- Early School Dismissal Called For MondayPosted 2 months ago
- Vandalism At HBWPosted 2 months ago
- MyVeronaNJ.com's Top Stories For 2014Posted 3 months ago
- Top Stories For December 2014Posted 3 months ago
- Person Of The Year 2014: Maureen TracyPosted 3 months ago
Minette's Angels, Cancer Foundation, To Hold Fundraiser
The foundation was created in 2004 to honor a Verona resident who died in 2003 after a 10-year battle with breast cancer. Minette Grosso McKenna was a nurse and the foundation offers scholarships to Verona students entering the medical field, especially those who will be nursing majors. It also provides assistance to those in treatment for cancer and supports research and breast health awareness.
The tea will be held at the Rock Spring Country Club in West Orange. The cost is $50 per person and champagne, tea, tea sandwiches and pastries will be served.
Reservations are needed by April 18. You can RSVP to Karen Moran at 973-980-7925 or Karen Lavery at 973-851-9096, and make your check payable to the Minette's Angels Foundation.
To learn more about the Minette's Angels Foundation, see its Web site.
Before you comment, read our Comments Policy
Leave a Reply
Get News Updates By Email
Letter: Don't Just Vote Friendship, Research Candidates
Dear Editor: Do you have a neighbor or friend...
- Posted 20 hours ago
Dominick N. Scarola, 69
Mr. Dominick N. Scarola, 69, died on March 25,...
- Posted 23 hours ago
A Book About Shoes–And Life
Since people have been able to speak, they have...
- Posted 24 hours ago
Where In Verona Is It? Week 52
This is it folks: The last week of MyVeronaNJ.com's...
- Posted 4 years ago
Where In Verona Is It? Week 22
Naughty? Nice? We're not going to be judgmental. We're...
- Posted 4 years ago
PSEG: Here's Verona Outage Map
With the millions of homes without power around New...
- Posted 2 years ago
Eileen (Meehan) OReilly says:
Virginia Citrano says:
Al Arroyo says:


text:
The music narrative film Indietro has its online premiere.
Music narrative film Indietro premieres online
All in the Valley: migration, wilderness and lawlessness in Victorian Cornwall: special Exeter screening and Q&A
Take the themes of a dark Western and transplant them into a bleak, wild Cornish setting of the mid-19th century and you've got yourself the award-winning All in the Valley, which is having a special screening followed by a Q&A at the Exeter Phoenix.= Continue reading
Help the sci-fi buddy movie Until The Day Breaks take off
Until The Day Breaks, a Bristol-based sci-fi buddy movie, is in need of your kick-starter support, and it's worth a look.
Down To The Woods trailer from Surf Hams Film Collective and the Aveton Gifford Film Festival
The Down To the Woods trailer has been released in advance of the Aveton Gifford film festival – Surf Hams.
Extras needed for music video to be shot in Totnes
A Totnes-based shoot for the music video Belfast-based band is in need for a crowd-load of extras, but you best be quick.
Sex, Leins & Videotape #196. Tom Leins reviews The Skeleton Twins, Third Person and Assassin
Sundance-approved comedy-drama The Skeleton Twins (Sony) examines the toxic relationship between estranged twins Maggie (Kristen Wiig, Bridesmaids) and Milo (Bill Hader, Cloudy with a Chance of Meatballs) who reunite after a decade.
After seeing his suicide attempt thwarted, Milo, a depressed, gay, would-be actor finds himself whisked away from Los Angeles to his small New York home town by sister Maggie. However, she has demons – not to mention suicidal thoughts – of her own, and the reunion doesn't run smoothly. As the twins try to reconnect, they realise that the key to fixing their own lives lies in repairing their own strained relationship. Unfortunately, that is easier said than done, and old grievances soon rise to the surface.
Wiig and Hader enjoy a strong rapport, presumably honed during their years working alongside one another on Saturday Night Live, and their evident bond allows them to explore some pretty dark material. Both leads deliver powerful central performances, and despite their comedy backgrounds the pair display impressive dramatic chops. Indeed, perennial comedy sidekick Hader offers an incredibly raw, leftfield performance – one that is likely to make you see him in a new light. The Skeleton Twins is well-observed and highly accomplished – darkly enjoyable stuff.
Limp ensemble drama Third Person (Sony) weaves together the stories of three very different couples, in three different cities. The respective tales play out in Paris, where a Pulitzer Prize-winning author (Liam Neeson), who recently left his wife (Kim Basinger), is having a tempestuous affair with an ambitious young journalist (Olivia Wilde); in Rome, where a shady American businessman (Adrien Brody) meets a mysterious woman with ties to people traffickers (Moran Atias); and in New York, where a lawyer (Maria Bello) is helping a young mother (Mila Kunis) in a custody battle with her famous ex-husband (James Franco).
Paul Haggis (Crash, In The Valley of Elah) used to be a filmmaker with a point to prove, but nowadays he comes across as an aimless bore. The Next Three Days was a sporadically entertaining but ultimately long-winded remake of a superior French film, and Third Person sees him scrape the barrel even harder with its meandering ensemble set-up. The cast is excellent – as good as you could wish to see in any movie – but they are largely wasted in dull, thankless roles. None of the three storylines have enough narrative clout to propel the film, and it quickly degenerates into self-indulgent stodginess. Underwhelming.
Assassin (Signature) stars Danny Dyer (Football Factory) as a sought-after killer-for-hire who breaks the rules of his profession when he falls for a beautiful young woman. But when his paymasters, the most notorious gangland brothers in London (Martin & Gary Kemp, The Krays) hire him to kill his girlfriend's father, his world implodes and he opts to turn his back on his profession and wage war on his dangerous former acquaintances.
Danny Dyer's crowd-pleasing EastEnders gig may have saved him from B-movie purgatory, but unfortunately Assassin sees him backslide into murky territory. Dyer has arguably delivered some of the best acting of his career in EastEnders recently, and it goes to show what a decent performer he is with a solid script (and indeed a coherent narrative) to work with. Assassin offers him neither, and fails to replicate the violent thrills of 2013's vicious Vendetta. Dyer fans are likely to lap it up, but Assassin is cheap and cheerless.
Also out now:
In the nerve-jangling Hostages – The Complete Season One (Arrow Films) brilliant female surgeon Dr. Yael Danon (Ayelet Zurer, Angels & Demons), discovers her family have been kidnapped the night before she is due to perform surgery on the Israeli Prime Minister. The hostage-takers have one demand: "Kill the PM on the operating table or your loved ones die." Forget the lacklustre US remake starring Toni Collette – the original is far superior. Riddled with moral ambiguities and narrative complexities, this is a cracking ten-part thriller.
The Imitation Game (StudioCanal) charts the life and times of Cambridge mathematics graduate Alan Turing (Benedict Cumberbatch, Sherlock), who is recruited by the newly created British intelligence agency MI6 in 1939 to help crack Nazi codes, including the infamous Enigma. Cumberbatch excels as Turing, even if the film's brush-it-under-the-carpet approach to his homosexuality starts to grate. The Imitation Game is watchable throughout, but ultimately too cynical and calculated to enjoy wholeheartedly. Pure Oscar-bait!
Community-focused film competition 'Love Living in' offers £1,000 top prize
Property specialist Leaders has launched a new competition, Love Living in, which shines a spotlight on what it is that makes the place people call home special.
Can you offer work experience to international filmmaking students?
Work experience in film and television for IBDP and A-level students is being sought.
The Plymouth Film Festival returns for 2015 for a full weekend of film fun
Plymouth Film Festival 2015 has extended from a one-day event to a full weekend of film fun to take place at the Plymouth Arts Centre.
More opportunities for local filmmakers as Exeter Phoenix develops digital exhibition space
Along with the new cinema at the Exeter Phoenix, expect a new and expanded film programme that will take place in a new digital exhibition space.
Take Your Time at the Children's International Film Festival 2015
Orson Cornick's film Take Your Time has been selected for screening the Children's International Film Festival 2015 in Dubai.
National and international trailers for Torbay film The Runner
"The Runner – lights, camera, action and coffee – has to be one of the most enjoyable films I've made as director so far. And as a team collaboration, the creative journey has been the most fulfilling," filmmaker John Tomkins told D&CFilm.
Great talent from Cornwall among nominees announced for Celtic Media Festival 2015
Organisers of the Celtic Media Festival have revealed the nominees for the prestigious Torc Awards for Excellence. The winners are set to be revealed at the Festival in Inverness, over April 22-24.
Submit your films for the Surf Hams Film Collective FilmFest 2015
The Surf Hams Film Collective – where film making and digital democracy meet – are celebrating their FilmFest 2015 with a call for films.
The very best surf films from across the globe at Approaching Lines International Festival of Surf in Newquay
Approaching Lines International Festival of Surf presented by Reef hits Newquay. Bringing to the South West three nights of the very best surf films from across the globe, says the blurb.


text:
Visit create.airbnb.com »
Thanks for taking the time to report this user.
Your participation helps keep Airbnb a safe and trusted
community, and it doesn't go unnoticed!
I am from Italy and I currently live in Brooklyn. I have a friend coming from Italy and I am renting the appartment for her. I work in Manhattan, 55 years old....what can I tell you more
Paolo has completed online and offline ID verification.
Learn more »
Had an extremely positive experience hosting Paolo! He arrived on time, was polite and friendly, and the ideal guest. He left the house very clean and respected my property. I would absolutely recommend him!
Paolo was extremely pleasant. Very cordial and with a lot of class. He was very rompt communicating and I recommend him always


text:
Cover Stories
XFINITY On Demand
Catch Up on the 'Fast & Furious' Series
Own all six movies for $6.00 each or rent the first five for $0.99 each before 'Furious 7' opens 4/3.
What to Watch
Watch Movie Trailers, Get Showtimes & More
Preview new and upcoming movies, and get local showtimes and tickets through Fandango.
Which Oscar Winner Is Playing Peekaboo?
A legendary Hollywood star used a bizarre tactic to keep himself 'hidden' from the paparazzi.
Miley's Dad Defends Patrick Schwarzenegger
Billy Ray Cyrus defends his daughter's beau after he was spotted with other women.
Cissy Houston: 'There's Not a Great Deal of Hope'
The Houston family matriarch is breaking her silence about Bobbi Kristina's prognosis.
The Buzz
- Mendes' $6 Dress
- Swift Has a New Beau?
- The End of 'Downton'
- Kutcher's New Mission
- Khloé K. Goes Blonde
- Dion's Sad Revelation
- Duggar Baby 'Late'?
Celebrity Pictures
- Stars and Their Twins
- Animated Voices Trivia
- Teen Idols Then & Now
- '60s Heartthrobs Now
- Odd Celebrity Hobbies
- HBO Axes Fan Fave Show
- Movies with Same Plots
E! Online Daily Dish
Fear The Walking Dead Teaser Trailer Is Here! It's Flu Season...
Mon Mar 30, 2015
The Walking Dead's spinoff, Fear The Walking Dead, is making Los Angeles creeeeepyyyy (ext... Details
Movie Blog
Get the news and reviews from all the latest movies - in theaters and On Demand. It's Showtime!
Movie Trailers
What's in theaters now? What's coming soon? Check out previews of Hollywood's most anticipated movies. Watch Trailers Now
Watch Movies Online
Thousands of your favorite films are just a click away. You can even see some before they hit theaters. Over 3000 Movies
What's in Theaters?
Your guide to the hottest, most-buzzed about movies in theaters this week. Watch clips, check out photos and buy tickets on Fandango.
Like Us on Facebook
Visit our official Facebook page to get the latest updates on your favorite shows, movies and more. Like Us Now
Follow Us on Twitter
Follow XFINITY on Twitter to get the latest updates on your favorite shows, movies and more. Follow Us Now
Movie News
DreamWorks' 'Home' bests 'Get Hard' at box office with $54M
Sun Mar 29, 2015
NEW YORK (AP) — Business was brisk at the weekend box-office, where the DreamWorks animate... Details


text:
- Advertisement -
Yuji Agematsu
Features:Age: All Ages Price:
Found object artist Yuji Agematsu brings an array of his work from the last five years to YU. The New York Times calls him "ephemeral and mindblowing." The opening reception is April 26 from 4–6 pm. If you are interested in the aesthetic of his audio recordings, check out his special event at the Friendly House Gymnasium on April 27 at 7pm.
Phone: (503) 236-7996
Website: yaleunion.org
Event Categories: Art
Event Organizer: Yale Union
Every Sunday, Friday, Saturday at 12pm, from April 23, 2014 until June 29, 2014
April 26, 2014 from 12pm to 5pmShow more...
800 SE 10th Avenue
Portland, Or
Portland, Or
Phone: 503-236-7996
Website: yucontemporary.org
- The Northwest's 8 Best Wildflower Hikes
- Behold Sunriver Resort's $50 Million Facelift
- Portland's Best Breakfast Spots
- Wildfang Launches the Coolest Ad Campaign of the Year
- Jacobsen Salt Buys Out Bee Local
- Portland's Best Breakfasts
- Top Things to Do This Weekend: Mar 26–29
- Portland's 10 Best Restaurants of 2014
- Advertisement -


text:
Posts tagged "project runway"
Liveblogging The "Project Runway" Premiere
They're baaaack. Thank. GOD. "Project Runway" returns tonight, in their new home on Lifetime. Will the show still be fabulous? Sometimes tells us YES. Come on back for our liveblog of the premiere episode tonight at 10 p.m. EST!
Jessica Wakeman
August 20, 2009
Quote Of The Day: Nina Garcia Thinks Trends Are "Ugh"
"I know some [trends] are available at very inexpensive prices, but you fill your closet with all this stuff that, in three months, you won't want anymore. You'll end up spending more money than you save. If you invest in something a little more expensive with longevity, you'll use it more. How many girls do…
Wendy Atterberry
August 20, 2009
Quick Pic: The Emperor's New Clothes
The new season of "Project Runway" premieres tomorrow night on Lifetime. So, as a stunt, they sent all the models with the Naked Cowboy around Times Square riding atop a double decker bus. While we thought leaving Bravo was backwards, now we're wondering why did they get a dude who runs around nearly…
August 19, 2009
Remote Control: What You'll Want To Watch The Week Of August 17th 2009
It's a biggggggg week for reality television, what with the super-sized season premieres of both "Project Runway" and "Top Chef." So what else do you not want to miss this week? Read on.
Kate Torgovnick/Kate-Book.com
August 17, 2009
Reality Show Contestants: The Sweatshop Workers Of The Acting World?
Ever since the first season of "The Real World" (damn that was a long time ago), I've watched reality television evolve—or devolve?—from a bunch of earnest 20-somethings struggling to make it in New York City to a bunch of fame-seeking whores pulling hair, getting wasted, and performing soft porn on camera. (Ever seen "Tila Tequila'…
Ami Angelowicz
August 4, 2009
Will You Watch Bravo's "Launch My Line"?
Anyone excited for Bravo's new series, "Launch My Line"? It may not be "Project Runway," but there is something verrrrry familiar about it. Popwatch reports: "This time, 20 people who are already successful in different lines of work -- music mogul! CEO! -- need only exhibit a 'passion for fashion' in order to compete…
Erin Flaherty
July 28, 2009
Face Off: The "Project Runway All-Star Challenge"
You asked, and now the "Project Runway" gods have blessed you with an all-stars challenge featuring contestants from previous seasons vying for a $100,000 prize. Executive producer Jane Cha says the two-hour, one-off episode will be a bridge to the show's new home on Lifetime -- the first episode of "Project Runway"…
Annika Harris
July 23, 2009
Korto Momolu's Jewelry Line Has Arrived!
Korto Momolu didn't win season five of "Project Runway," but her handmade jewelry definitely stole the show. And now you don't even have to be a top model to wear her designs, because she's bringing the jewelry to the masses on her website. "I tried to do a follow-up on the few piece…
Annika Harris
July 13, 2009
Tim Gunn Dishes On The New "Project Runway" Designers
We were extremely bummed to learn "Project Runway" was "moving to Lifetime from Bravo. Our depression grew when we realized Bravo's "The Fashion Show" is no "Runway" substitute -- Kelly Rowland and Isaac Mizrahi have nothing on Heidi Klum and Tim Gunn! Well, season six of "Runway" is set…
Annika Harris
July 9, 2009
Christian Siriano For Payless 2.0
So, is it fierce enough for you? Christian Siriano of "Project Runway" fame is continuing his collaboration with Payless Shoes. If you remember, the budget shoe company sponsored Siriano's spike studded footwear for his fashion show during New York Fashion Week back in February. His runway shoes have inspired his Fall 2009 collection for…
Zandile Blay
June 29, 2009
When Did Bravo Go From Fantastic To Trash-tastic?
Oh Bravo, why did you do this to me? I lost my faith in TV after the second season of "Survivor," but found hope again in the wonder that was "Queer Eye For The Straight Guy." Upon viewing the first promotional commercial I remember thinking: Could it be? Is it true? Is there really going…
Ali Jawin
June 24, 2009
Since "The Fashion Show" Sucks, Play The "Project Runway Game" Instead
I can't possibly force myself to sit through another episode of "The Fashion Show." I cannot take another hour of Kelly Rowland contorting her face into bizarre sneers. If I hear Isaac Mizrahi say "bye bye, darling," one more time, I will snap. Because I value my sanity, or whatever is left of it since…
Ali Jawin
June 11, 2009
Kelly Rowland Is No Heidi Klum
We are all going through major "Project Runway" withdrawal now that the show has been moved to Lifetime. Every episode of the thrown-together Bravo knock-off "The Fashion Show" is equivalent to a so-so episode of "Runway," but the real nostalgia comes from the longing for "Runway"'s host Heidi Klum. Here are the top four reaso…
Ali Jawin
May 29, 2009
Tim Gunn To The Rescue In New Fashion Comic Book!
Gather 'round, people, gather 'round...we have an announcement to make: Tim Gunn, the infamous voice of reason and fashion adviser on "Project Runway," will become a superhero of sorts in the new comic book series, "Models Inc." Headed by the industry giant, Marvel Entertainment, the miniseries tells the tale of a Fashion Week murder. Whe…
Leonora Epstein
May 22, 2009
Couple Holds Wacky Willy Wonka-Style Wedding
Fans of Candy Land rejoice! This weekend the featured wedding in the New York Times might be one of the quirkiest we've seen yet. Held in Dylan's Candy Bar, Michelle Rosen and David Zornitsky had a candy-themed ceremony as a nod to how the couple met—over a package of Gummi Bears. To show how sweet…
Robyn Moreno
April 27, 2009
"Project Runway" Is Finally Coming To Lifetime, But Do You Still Care About Klum & Co.?
After nearly a year of wondering when and on what channel we'd next see our beloved "Project Runway," the companies involved have reached a settlement, and the show will make Lifetime its new home beginning with the sixth season this summer. During the first five seasons of PR, we basically lived for the…
Catherine Strawn
April 2, 2009
Kenley Got Into A Cat Fight
We always knew Kenley from "Project Runway" was a little cuckoo, and now we have proof! TMZ is reporting that she was arrested yesterday morning after allegedly attacking her ex-fiance -- and throwing a cat at him (among other things). Right now she's behind bars and charged with six crimes, including 2nd degree assault, 3rd…
Catherine Strawn
March 18, 2009
Christian Siriano For Payless Looks Dangerously 'Meh'
And I do mean dangerous! Those spikes could mess a bitch up! The "Project Runway" winner just showed at Fashion Week, but chances are, his upcoming line for Payless is the only Siriano-approved hot tranny fierceness the average woman can afford. Expected to be priced at an affordable $25-$45 per pair when they come…
Amelia McDonell-Parry
February 23, 2009
Jay McCarroll's Eleven Minutes
Jay McCarroll, the fashion designer who won the first season of "Project Runway," is the focus of a new documentary that arrives just in time for New York Fashion Week: "Eleven Minutes." Why 11 minutes? That's how long his first fashion show will last. The cameras follow McCarroll behind the scene…
Susannah Breslin
February 18, 2009
Bravo's "Project Runway" Replacement
Since the "Project Runway" fiasco hasn't been sorted out yet, Bravo has a new fashion competition to replace their signature show, which may or may not be heading over to Lifetime. It's called "The Fashion Show," and it "will follow professional designers as they strive to make their mark in the…
Catherine Strawn
February 5, 2009
Simply Irresistible
All »
Teresa Giudice & Family Sit For Prison Portrait
Making memories!
Amelia McDonell-Parry
April 1, 2015
Choupette Lagerfeld Makes Way More Money Than You
She's a millionaire, what have YOU done with your life today?
Claire Hannum
April 1, 2015
Our Beloved Joni Mitchell Is "Awake And In Good…
Claire Hannum
April 1, 2015
Adrienne Bailon Sings Publicly For The First Time In…
The talented Adrienne Bailon, who you may know as a former Cheetah Girl, a singer from 3LW, or the most rational person to ever appear on "Keeping Up With The Kardashians," ended her nearly six-year break from the musical spotlight to honor late Tejano singer Selena Quintanilla-Perez. Selena died 20 years ago today when she was shot…
Claire Hannum
April 1, 2015
You'll Love
The Problem With Refinery 29's Profile Of A Church Of Scientology Member
10 Reasons Why Spring Is The Best Time To Hook Up (In GIFs)
True Story: I Transitioned From Female To Male


text:
By Catholic Online (NEWS CONSORTIUM)
12/19/2013 (1 year ago)
Catholic Online (www.catholic.org)
Longtime TV comedian Bob Newhart has bowed out of appearing at the Legatus Summit due to the organizations fidelity to Catholic Church teaching on marriage as existing solely between one man and one woman and opposition to homosexual acts. Homosexual activists alerted Newhart to the Legatus position defending marriage as existing only between one man and one woman.
By Catholic Online (NEWS CONSORTIUM)
Catholic Online (www.catholic.org)
12/19/2013 (1 year ago)
Published in Celebrity
Keywords: Bob Newhart, Legatus, Gay agenda, true marriage, family, anti-catholic pressure, GLAAD
LOS ANGELES, CA (Catholic Online) - Legatus, a faithful Catholic organization of Chief Executives, was founded by former Domino's Pizza CEO, Thomas Monaghan. Membership is only available to top level executives who are faithful Catholics.
The official publication of the group, Legatus magazine, in their November 1, 2012, listed five "non-negotiables" for voters. Supporting the redefinition of marriage to include homosexual or lesbian couples was one of the five listed items. The article asked Catholics to inform their voting by the truth as clearly taught by the natural moral Law on the nature of marriage, the dignity of all human life and other key Social Doctrines of the catholic Church and to vot" for those who promote policies in keeping with moral law."
A lifelong Catholic, actor Bob Newhart has a history of working with homosexual people and story lines which include homosexual and lesbian matters. One example is that "The Bob Newhart Show" featured an episode in 1976 with an openly gay character.Newhart also was in the film "In & Out," in which he played a principal dealing with the coming out (openly declaring himself to be homosexual) of one of his teachers, played by Kevin Kline. Most recently, Newhart won an Emmy Award for his guest appearances on "Big Bang Theory," opposite of openly gay actor, Jim Parsons.
The Catholic Church respects all men and women, including those who have same sex attraction or even self identify as homosexual or lesbian. However, the Catholic Church also makes clear that homosexual activity is morally disordered and that all sexual activity outside of marriage is immoral. Newhart certainly knows the teaching of his own church. He was pressured by homosexual activists to withdraw from the speaking engagement.
Two petitions from homosexual activist groups which seek to compel the State and Federal Government to require all Americans to recognize a moral and legal equivalency between homosexual and lesbian relationships and marriage or face the police power of the State, asked Newhart to reconsider his speaking engagement with Legatus. One, created by Faithful America, received 17,000 signatures calling on Newhart to cancel his Legatus commitment.
"Newhart is merely siding with the majority of fair-minded Americans who do not support the anti-LGBT agenda of organizations like Legatus," said Rich Ferraro, Vice President of Communications at GLAAD. "These groups constantly struggle to find high-profile people of faith to speak at their events, but at a time when more and more people of faith are accepting of LGBT people, they will continue to be left to choose between increasingly fringe figures."
Of course, GLAAD is one of the largest promoters of the Homosexual equivalency agenda and openly opposes the Catholic Church in its unchangeable teaching on the immorality of homosexual practice.
Legatus is a Catholic organization which embraces the teaching of the Magisterium of the Catholic Church. It is clear in its own self identification on its website: " In the love of our Lord Jesus Christ, His Church and His Vicar on earth, Legatus is an international organization of practicing Catholic laymen and laywomen, comprised of CEOs, Presidents, Managing Partners and Business Owners, with their spouses, from the business community and professional enterprises. They state that their mission is "to study, live and spread the Catholic faith in our business, professional and personal lives."
The position of the Catholic Church on the nature of marriage as only possible between one man and one women, intended for life and formative of family, is crystal clear. The Congregation for the Doctrine of the Faith of the Catholic Church explained in 2003.
"The Church's teaching on marriage and on the complementarity of the sexes reiterates a truth that is evident to right reason and recognized as such by all the major cultures of the world. Marriage is not just any relationship between human beings. It was established by the Creator with its own nature, essential properties and purpose."
"No ideology can erase from the human spirit the certainty that marriage exists solely between a man and a woman, who by mutual personal gift, proper and exclusive to themselves, tend toward the communion of their persons. In this way, they mutually perfect each other, in order to cooperate with God in the procreation and upbringing of new human lives."
This latest pressure asserted against Bob Newhart is a part of a growing pressure being placed on people to accept the position asserted by a small activist segment of the homosexual community or face the consequences. That approach is a growing threat to authentic freedom.
St. Benedict
St. George
St. Francis of Assisi
St. Barbara
St. Anthony
St. Isidore the Farmer
St. Matthew
St. Christopher
St. Clare
St. Joseph
St. Brigid of Ireland
St. Gerard
St. John the Baptist
St. Florian
St. Joseph of Cupertino
St. Jude
By Greg Goodsell
Actor Gregory Walcott had a long and successful motion picture career. He was inexorably linked in what is popularly considered the worst film ever made, "Plan 9 from Outer Space," directed Edward D. Wood Jr.'s confused opus about space aliens attempts to bring ... continue reading
By Catholic Online (NEWS CONSORTIUM)
That's A LOT of toilet paper... manic comedian Howie Mandel, who suffers from Obsessive Compulsive Disorder, was away in New York City, leaving his California mansion - vulnerable. Roman Atwood of "Deal or No Deal," pulled off an elaborate prank. With the ... continue reading
By Catholic Online (NEWS CONSORTIUM)
By Catholic Online (NEWS CONSORTIUM)
Actor Robert Downey Jr. plays superhero Tony Stark, of the wildly successful "Iron Man" movie series. A little bit of his onscreen superhero must have rubbed off on Downey in real life. He recently gifted a seven-year-old boy, who was born with a partially ... continue reading
By Catholic Online (NEWS CONSORTIUM)
A hero in real life as well as the movies, actor Harrison Ford is expected to recover after crash landing a World War II plane to safety on a California golf course. LOS ANGELES, CA (Catholic Online) - Landing the plane on a fairway at a municipal course in the Los ... continue reading
By Hannah Raissa Marfil (NEWS CONSORTIUM)
American superstar, Taylor Swift, surprised a four-year-old, terminally ill girl with a call via FaceTime earlier this month. Swift's chat with Jalene Salinas, that lasted about 20 minutes, gave Jalene a renewed strength to continue battling her terminal brain tumors. ... continue reading
By Troy Dredge, Catholic Online
Even if you weren't a "Trekker," one who obsessively follows the TV series "Star Trek" and all its permutations over the years, there was no escaping the character of Mr. Spock. A member of the Vulcan race, Leonard Nimoy played the gaunt-faced, pointy eared and ... continue reading
By Catholic Online (NEWS CONSORTIUM)
The role of a voiceover artist is typically an anonymous one. Such was not the case for radio disc jockey and talk show host Gary Owens. Suave and debonair, one hand covering his ear, Owens' rich baritone speaking voice made him a natural for repeating inane ... continue reading
By Catholic Online (NEWS CONSORTIUM)
His name raises ire among all so-called serious practitioners of "serious literature." Talk show host Dick Cavett once declared Rod McKuen as "the world's most understood poet." From his most famous poem, "Listen to the Warm:" "You have to make the good times ... continue reading
By Troy Dredge, Catholic Online
American illustrator Edward Gorey, who died in 2000 at the age of 75, left behind an endearing legacy of "not quite right" storybooks enjoyed by children and adults. His stories were set in a gloomy netherworld that called to mind Victorian England, Edwardian ... continue reading


text:
Video Teaser inspired by the Shannon's Maze
note from the release
When you listen to this EP you cannot keep yourself stable. Your heart pulsates like a bat out of the hell, your blood boils for the rhythm, your soul lingers on one side to the other of the room where your body tries to check the discharge of adrenaline as it emerges.
It reminds me of a film or a video set in the years 90' where a human being, without the effect of drugs, succeeded in penetrating the depths of their own intimacy.
This EP, constructed of 3 tracks, is the antidote to the pain of the day. It's the apotheosis of the night time, it's for the people that don't ask anything else other than to live a true trip riding the boundaries of their own conscience.
These 3 tracks give you this type of emotion or maybe it's just me. Are you able to feel it? Where there is a will, there is a way.
Words by Lorenzo Salmi
A1 Alhek - Numbing (Original Mix)
A2 Alhek - Inertia (Original Mix)
B1 Alhek - Inertia (Ness Remix)
Artwork by Julien Vassiades: julien.roboboogie.us/
Mastered at Soluxion Lab: soluxionlab.wordpress.com/
Loading more stuff…
Hmm…it looks like things are taking a while to load. Try again?


text:
Star Tracks
The singer takes time out from touring for a bash in N.Y.C. Plus: Brad & Angelina, Sofia Vergara, Ashton Kutcher, Emma Watson and more
Credit: Todd Williamson/Invision/AP
Published: Wednesday Jun 05, 2013 | 07:00 PM EDT
More from PEOPLE
Latest News!
- See All the Winners from the Kids' Choice Awards!
- The Style Top 5: Amal Clooney Brings Her Glam Street Style to NYC, Iggy Azalea Gets Candid About Her Body and More
- Lions vs. Crocodile: This Time, It's Personal (VIDEO)
- Inside Story: How Brittany Maynard Became a 'Death with Dignity' Advocate
- Angelina Jolie Makes Her First Post-Surgery Appearance


text:
maintaining beyond your property line
I am new to these forums, so I wasn't sure which topic to post under.
I have recently purchased my deceased grandparents house from my family.
At the back edge of my yard, the ground starts to slope downhill for about 15 feet then becomes a tree line of woods about 30 feet deep until the person in the next neighborhood over's yard starts.
My grandparents lived here since 1950 and I moved in in 2010. For the sixty years my grandparents have lived here, they have always maintained the grass and plants to the back woodsline. I never once thought that my property didn't extend to the woodsline until recently when my mother told me that the property line is actually 15 feet before the woods lines right before the yard starts sloping downhill.
The person who my mother said that owns that section of land has never been up in that section next to my yard, for it is impossible to get to through the thick patch of woods. He or She also has never maintained that section (cutting the grass, trimming bushes, etc)
My concern is that I was planning on building a firepit in that area with a small patio. If I decide to not build it and stop maintaining that area, it will definately get overgrown and be an eye sore.
Is there any type of law that states if you maintain adjacent property to yours that the actual owner does not after so many years that it becomes yours? I have always heard something about this but could never find anything in writing.
Thank you for your replies,
"Is there any type of law that states if you maintain adjacent property to yours that the actual owner does not after so many years that it becomes yours?"
It is called 'adverse possession,' and the actual terms vary from state to state.
Paying taxes on the land is required in some states.
It is also a great way to make enemies.
Prodon the pun, but adverse possession is a real slippery slope. You really need to have your property surveyed to find out where the actual property lines are. If in fact the "extra" property you maintain is not actualy part of your surveyed property, you are free to continue to maintain the area but not to put any semi-permanent structure on the property.
I'd suggest getting to know this neighbor a little bit. He/she may be perfectly happy to sell you this property for a very reasonable price if it is as truly inaccessible to them as you say. You'd become responsible for for the taxes at that point, but would certainly make your plans for the firepit viable.
"He/she may be perfectly happy to sell you this property for a very reasonable price"
You need to have a legal lot line adjustment to make it legit. That may be cost prohibitive.
It may be better to just put together a use agreement between you and the neighbor. The agreement may be as simple as maintaining the status quo, for a set period of time, or as long as both parties hold title to the land.
I don't think adverse posession is an ethical way to exercise one's property rights.
In Texas, various persons have tried to take possession of foreclosed empty houses by trying to use adverse possession. Guess what, the sherriff has not only reemoved these people but thrown their furniture out on the street and arrested them.
As I said befor, you need to have your property surveyed. I suspect you have no idea where your property lines are.
I have a similar situation- soon after we moved in we saw a bit of activity back towards the rear of our property about 500 feet from the house. The husband hiked back to check it out and we met a "backyard neighbor" who had been mowing a little patch of clearing and using it for a picnic table.
They knew the spot was ours but had been using it since the 50's- come to find out they were in-laws of the couple that originally built my house!
They actually know quite a lot about my home as they were here when it was built and helped on a few of the projects- they have been very interesting to talk to. We made no formal agreement, just a handshake "we all know who it belongs to" and carried on.
Soon after that we did have a survey done and walked the boundary with the guy who did it. We marked various trees and landmarks with outdoor spray paint and repaint every year to keep the property line visible and easy to find for everyone.
I also filed a copy of my survey at my county courthouse, which from what I understand is not necessary but good to have done in case any issues come up in the future.
Generally the laws of adverse possession require that you use the land contrary to the owners wishes for a prolonged period of time. By example, in Ohio, you must occupy the land in direct defiance of the landowners expressed wishes for a period of not less than 21 years.


text:
Latest International Space Station Stories
Two Expedition 40 spacewalkers, clad in Russian Orlan spacesuits, wrapped up a 5-hour, 11-minute excursion outside the International Space Station at 3:13 p.m. EDT Monday.
Newly discovered changes to the human immune system that occur during spaceflight could force NASA to address potential health concerns in future six-month to one-year-long manned missions to nearby asteroids or Mars.
FLORHAM PARK, N.J., Aug. 18, 2014 /PRNewswire/ -- Boomerang Systems, Inc., (OTCQB: BMER) the innovative U.S.
The Sally Ride Earth Knowledge Acquired by Middle School Students (Sally Ride EarthKAM) program provides a unique educational opportunity for thousands of students multiple times a year.
NASA has compiled over a million pictures of Earth captured from the International Space Station, and now researchers are looking for your help in cataloging the nearly one-third of those images that were taken at night.
WASHINGTON, Aug. 13, 2014 /PRNewswire-USNewswire/ -- Two Russian cosmonauts aboard the International Space Station will venture outside the orbiting outpost Monday, Aug.
Who doesn't love an upgrade? Newer, better and oh so shiny is great, but what's really fantastic is when a change unlocks new possibilities. That's the case with NASA's fix-it investigation on the International Space Station, the Robotic Refueling Mission (RRM).
eXcellence in IS Solutions Inc.
VANCOUVER, Aug. 12, 2014 /CNW/ - UrtheCast Corp.
WASHINGTON, Aug.
Latest International Space Station Reference Libraries
Space exploration is the exploration and discovery of outer space by use of space technology and is conducted by both robotic spacecraft and humans. Astronomy, which is the viewing of objects in space from Earth, is thought to predate recorded history, but it was the inspiration to modern space exploration. Humans explore space for many reasons including the survival of humankind if Earth cannot sustain life, uniting nations, and scientific research. Physical space exploration began in...
Douglas Wheelock is an American astronaut. He was born Douglas Harry "Wheels" Wheelock on May 5, 1960 in Binghamton, New York. The Apollo 11 moon landing in July 1969 is said to have inspired him to pursue astronautics. He graduated from Windsor Central High School in Windsor, New York in 1978 and immediately went on to attend the United States Military Academy at West Point. After four years as a cadet, he graduated with a Bachelor of Science degree in Applied Science and Engineering. After...
Michael Fincke is a United States Air Force officer and a NASA astronaut who holds the record for the most time spent in space. He was born Edward Michael Fincke on March 14, 1967 in Pittsburgh, Pennsylvania; however, he grew up in its suburb, Emsworth. Fincke graduated from Sewickley Academy in Sewickley, Pennsylvania in 1985, and subsequently attended the Massachusetts Institute of Technology on an Air Force ROTC scholarship. He graduated in 1989 as a double major and earned both a Bachelor...
Atlantis launched from Kennedy Space Center on November 12 at 7:30 AM EST and landed at Kennedy on November 20, 1995 at 12:01 PM EST. The shuttle orbited 129 times at an altitude of 213 nautical miles at an inclination of 51.6 degrees and travelled 3.4 million miles. The mission lasted 8 days, 4 hours, 30 minutes, and 44 seconds. STS-74 marked the second docking of a U.S. Space Shuttle to the Russian Space Station Mir, continuing Phase I activities leading to construction of International...
Timothy Creamer is a NASA astronaut as well as a Colonel in the United States Army. He was born Timothy "TJ" Creamer on November 15, 1959 in Fort Huachuca, Arizona, but he was raised in Maryland. He graduated from Bishop McNamara High School in Forestville, Maryland in 1978, and then went on to earn his Bachelor of Science degree in chemistry from Loyola College in 1982. He was commissioned as a Second Lieutenant in the U.S. Army through the ROTC program. In August 1983, after attending the...
- Large; stout; burly.


text:
Aberdeen's over 50's Tea Dances
The over 50's tea dances are great social events for anyone over 50. Enjoy some refreshments while listening and dancing to some amazing bands.
Supported by the Common Good Fund.
2015 dates
The Tea Dance dates will be published in April 2015.
More Information
For more information please contact Alice Brooks on 01224 523913.
Back to the Aberdeen's Activities for the over 50's home page.