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23 Jan 2010
Yes, you can take antacids with Plavix. It's probably best to separate the doses by 2 hours at least. (You shouldn't however take proton pump inhibitors such as omeprazole with Plavix as they reduce the effectiveness of Plavix).
My friend takes Plavix and has terrible stomach discomfort. He was on omeprozole and has been switched to a prescription prilosec. It does not help. What advise do you have?
I am currently on pantoprazole 40mg which seems to help
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- Side Effects of Plavix (detailed)
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I am very positive person and want to meet someone that also has positive energy . Someone open minded with a free spirit. A sense of humor is an absolute. Most importantly someone that is in to me as much as I am into her. Someone that is not afraid to be noticed. Someone who is not afraid of the world or it's shadow. We are only in this existence for a fraction of a second we must make the most of that second. Most importantly someone that embraces romance. A woman that can appreciate a good opera or play. A night where we rent a car service we get dress and do the night. Or maybe we get room in Big Bear and cuddle by a warm fire and hold each other. What about a night of just listening to soft music and good wine watching a black and white. A woman that could appreciate a nice foot massage or someone that will actually listen to their problems. I am searching for a woman with heart. A woman that likes hikes, camping, yoga and other physical activities would be cool too. I am fit and I would like to meet someone that is concerned about their health as well. I am a great cook and I love to cook for my significant other. You name it I can make it. I am very adventurous and I like to explore and try new things all the time. I love Sunday morning drives to new places and it would be fun to do that with someone once and awhile. I am an artist and I have almost given in to that side of me despite being really good at math and science. I am sure that people always give the positive side of there personality and their best traits. Well here are a few of my short comings. I am messy, a risk taker, can be a bit immature. I am a horrible speller and what some would call a late bloomer. I think those are my worse traits if you're still reading bravo. I want to meet someone that loves to have fun and likes to laugh. I am not a crowding person, but can be affectionate. I can be very supportive and a good listener. I hope after reading this you will consider sending an email my way. I hope everyone can find what they are looking for. Good luck to you all.
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Love this Maria!
thank you Shelly. :)
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I like it too missy. I send my regards pretty lady!
thank you my sweet Ms Debra… how's the winter treating you???
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This is wonderful love the clarity of this and the light.
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Let's begin with the first step. We (as fans) are powerless over the team. No matter how hard I cheer, how much I swear, or whatever I throw, the game is out of my control. In order for their to be a change, we have to accept this fact.
The 3-13 season an abomination. Well, after the 6-10 season of 2010 it is more a downward spiral. All this after coming a couple of plays (or thugs) from being in the 2009-10 Super Bowl. Left staring at the mess that was once among the most feared in the NFL. No more Brett Favre. Half the Williams wall gone. Offensive linemen, wide receivers, linebackers gone. Some remain. But not the same team that should have beat the Saints that fateful game two seasons ago.
I suppose inventory should be taken. it is an important step. What do we have?
The first thing that comes to mind is RB Adrian Peterson. Drafted in 2007, he has been almost saint-like, were it not for a fumbling spell a few years ago, and the recent injury, he might already be canonized. He ran for 296 yards in a single game his rookie year. He has amassed nearly 7,000 yards in five seasons. And 80 rushing touchdowns. All that despite starting only 66 of the 80 games. Playing in 73. If he continues at this pace he will pass Chuck Foreman in the minds of the fans as the greatest VIkings RB ever. For some, he already has.
Percy Harvin is the other offensive skill player that most trust. Taken 22nd in the 2009 draft, Harvin has been electrifying on game days. He won Rookie of the Year honors. He has played in 45 of the 48 potential season games, catching 218 passes for over 2,600 yards. And he has been magnificent in kick returns. And he can run the ball. Only migraine headaches stand in the way of future All-Pro seasons.
Question marks loom over much of the remaining offense. WIll Christian Ponder's game reach a higher level? Will Jerome Simpson contribute at wide receiver? Can Kyle Rudolph replace and exceed the efforts of the departed Shiancoe? And maybe the biggest question, will the offensive line get better? Was the drafting of LT Matt Kalil a sign that the OL can return to its' dominance via the run, and provide enough protection to let Ponder loose?
Yes, lots of questions on offense. Defenisvely, there are maybe even bigger questions.
It appears the defensive line is in order, and with veterans Jared Allen and Kevin Williams returning, one of the better in the league. Names like Brian Robison, Letroy Guion, Christian Ballard, and Fred Evans demonstrate solid depth. Not quite the 1970s Purple People Eaters, but on a 3-13 team maybe a bright spot.
It is the other seven that concern fans. And rightly so. Looking at linebackers, Chad Greenway has been more than good at SLB. Erin Henderson made improvements at WLB last year. This year's MLB is Jasper Brinkley, who has shown flashes, but is not quite the star power as the departed E.J. Henderson. It is as no-name a set of linebackers as I can recall in all my years of fanship.
Worse yet, it the present secondary. The names kepe changing at cornerback, and safety, yet the results have been the same for years now. Antoine Winfield, the run-tackling extrodanairre, is back at one CB spot. Chris Cook occupies the other. The safety spots appear unsettled, with my money on Harrison Smith, the rookie from Notre Dame, eventually inheriting the free safety spot. Mistral Raymond may win the strong safety job. Others defensive backs in the mix include: Chris Carr, Marcus Sherels, JarMarca Sanford, Eric Frampton, Josh Robinson, Brandon Burton, Robert Blanton, Zack Bowman and more.. In early training camp, anyone who has ever played DB is getting looked at somewhere.
So how does a team recover from a three win season when the parts haven't necessarily been replaced?
This season marks the 5th time Minnesota has had to start the season following one with three losses or less. Three of those seasons occurred in early Vikes history. Our opening season (1961) we were 3-11. The next we were 2-11-1. The team improved to 5-8-1 in year three, became a winning team in year four. But when Bud Grant joined in year seven we were coming off a 4-9-1 season. His first year, 1967, we went 3-8-3. We then completely turned our program around. We went to the playoffs the following for years.
How did that change happen? A new coach (Grant) used to winning changed mentality. We traded our star (Tarkenton) and received numerous early picks which we parlayed with our own choices into a playoff team. In 1967 we drafted RB Clinton Jones, WR Gene Washington, DT Alan Page, DB Bobby Bryant, and WR Bob Grim. The next year we added LT Ron Yary, DB Charlie West, and RB Oscar Reed. We would add OG Ed White in 1969. The dynasty had begun.
Later, in 1984, the team fell to 3-13 under Les Steckel.. The next year Minnesota rebounded to 7-9 with Grant returning. Then in 1986 we finsihed 9-7 under new coach Jerry Burns where the Vikings traded for Anthony Carter and Gary Zimmerman. What followed was a three year playoff run. The draft of 1985 had produced this year's Hall of Fame Viking representative: Chris Doleman.
The class of 2012 includes three or four players who could have the same type of impact. And a fancy new kicker to boot. Our past suggest that the GM and front office people will play an important part in our recovery, whether it is the typical 2-3 year wait to return to the playoffs, or if that can be sped up, or worse, slowed down.
So our recovery begins with hope. Minnesota has 25 playoff visits in its' 51 years. We have 17 division championships. Four conference championships. Since thise early years we have been a steady successsful program. Will administration do their part in helping us to return to our roots?
Because it is time for them to step up.
(brief silent moment for Al Davis)
Turning around a troubled football team involves a commitment. While Minnesota has demonstrated talent in most games this year, poor second half performances have turned a 4-1 season into a 1-4 season. With both Detroit and Green Bay at 5-0, this week's game vs. the Bears is crucial in that Chicago stands in the way of movement toward any hope of a North division title and/or a playoff bid. And the Bears are the defending North champion no less.
This Sunday Night's game at New Soldier Field will be the 101st meeting between the two clubs, with the Vikings holding a 52-46-2 edge, though the Bears are 26-21-2 at home, having won the last three straight. 2007 was the last time Minnesota won in Chicago.
Adrian Peterson ran for 224 yards in 2007 as a rookie, and will probably be asked to duplicate that performance, or come close. Minnesota defeated the Cardinals last week thanks to Peterson's 29 carries for 122 yards and three touchdowns. Chicago surrendered over 180 yards vs. the Lions last week, including an long TD run by Jahvid Best. These two facts propel OC Bill Musgrave to consider a large dose of Adrian Peterson.
The commitment to the run will allow Donovan McNabb better opportunities to pass, and he needs them. The Bears' defense is shot, with DE Julius Peppers probably out and two starting safeties benched. Chris Conte and Major Wright replace a ineffective duo that includes dangerous Brandon Merriweather. Still, they are the Bears and will present difficulties for McNabb should he be in passing situations.
Minnesota won the first game of their franchise vs. the Bears in 1961. From 1969 to 1983 the Vikings won 22 of 29 games. But shortly after the Bears have won the 1986 Super Bowl. Chicago recently returned to the Super Bowl only to lose to the Colts' and defensive coach Leslie Frazier in 2007.
The ties obviously do not end there with Frazier, as he was the starting cornerback on the 1985 Chicago team that won the Super Bowl. It was in that game that Frazier's career ended and he ultimately started his coaching career.
So in this the 101st meeting there will be much history to recall. The most recent history has been mostly in favor of Chicago, with 2007 being the last year Minnesota swept the Bears. But despite the poor start, Minnesota looks ready to sweep the Bears this year and here is why....
The 2011 Bears are struggling at offensive line, with Jay Cutler being battered all season. They have given up the third most sacks in the league (18). Minnesota has the 2nd most sacks as a team, with league leading Jared Allen at 8.5, and fellow DE Brian Robison 9th with 4.5 sacks. In their last game Chicago had nine false starts. Sure, that was in a very loud Ford Field, but nine is a big number at an airport.
The strength of the Bears offense has been the play of Matt Forte. He is an elusive back, good running and receiving the ball. But stopping the run has been Minnesota's bread and butter for years on defense, and even with Antoine Winfield doubtful to play, will keep Forte in check. That leaves Cutler forced to throw with a line that has let him down often against a defensive front that has had recent success.
So, as bad as 2011 has been to the Vikings, it appears this Sunday Night all Minnesota needs to do to win is hand the ball to number twenty-eight and block. If they do, we can say..
"We just won, baby".
All the teachers are doing it. Or should. We use rubrics to measure performance and create standards for use in evaluation. Once established, everyone should know what is expected of them, and what is needed for grading purpose.
4 - exceeded standards of position
3 - met standards in all areas
2 - met standard partially; stood out in areas
1 - partial standard met at best
Only a few Vikings will be evaluated in Week One.
Antoine Winfield. A Four.
Winfield had a hand in ten tackles, many of them bringing down Mike "Marion Butts" Tolbert. Antoine sacrificed himself throughout the game. He also forced a fumble; and had an interception. Minnesota could not have asked for much more from Winfield.
Adrian Peterson. Three.
Peterson, coming off of the 100 million dollar signing, ran for 98 yards on only 16 carries. While he was bottled up early by Chargers' linebacker Taeo Spikes, he created holes later in the game. If Minnesota would have had the ball for more than the 22:43 they did, Adrian would have better numbers. But he looked real good at times.
Brian Robison and Jared Allen, DEs. Three.
The Vikings' ends created pressure at times. They were also asked to drop into coverage as Minnesota relied heavily on the blitz to create pressure, which they did in the first half, but not the second. Allen had an important interception; but combined with Robison to have only a single sack. Allen finished with six tackles, Robison three. They were decent.
E.J. Henderson, Erin Henderson, and Chad Greenway, LBs. Two.
The linebackers made tackles. E.J. Henderson had nine with a sack, Greenway eight. But the trio was asked to blitz frequently and only got to Rivers a few times in the game. In addition, the LBs are often responsible for running backs out of the backfield. Mike Tolbert and Ryan Matthews were held to 80 rushing yards on 24 carries. But they combined for 131 yards on 12 receptions. The backers might be a victim of the defensive scheme, but the grade stands.
Letroy Guion, Donovan McNabb, Bill Musgrave, and Bernard Berrian. One.
Each made costly mistakes.
Guion's two offside calls late in the game sealed the loss, though the lack of passing game made that future probably moot. Still, how does a defensive tackle jump twice while staring at the football? My 7th graders will jump less.
McNabb threw for a total of 39 yards. His early mistake throwing low to Percy Harvin resulted in his first ever Vikings' pass being intercepted and cost Minnesota 7 points. McNabb made a couple of nice runs, and was the victim of a drop or two, but overall, Brett Favre was better last year.
The Vikings' offense was pathetic in the second half. Bill Musgrave, brought in from Atlanta, did little to change that. The insertion of Joe Webb cost the Vikings one of the few series they had the ball in the second half. Percy Harvin was looked at too often early, but not enough late. Minnesota did amass 159 rushing yards, but even Tarvaris Jackson threw for more yards in week one. Realizing Harvin returned the opening kick for a TD, the Vikings managed only 10 points on offense.
Berrian was supposed to be the go-to-guy in 2011. He was thrown to twice, and once he dropped a relatively easy pass. Sure, Phil Loadholt did not do enough to protect McNabb on the play, and Berrian had his man easily beaten; but the short ball still was catchable. Go-to-guys make that catch.
A very frustrating loss to start the season, considering it was 17-7 Vikings at half time. But there were signs that things might be better. I liked the improved play of the secondary, and the special teams coverage was decent. Minnesota won the turnover battle 2:1.
The Chargers ended up with 407 yards, but the receivers were shutout for the first third of the game. Despite the strong beginning, San Diego finished with 31 first downs. Tolbert was unstoppable in the red zone. And unfortunately, Minnesota had 9 penalties for 78 yards. Many hurt.
Minnesota had better do some homework before the next test.
Most won't watch. The first preseason game is like a movie trailer. it will give you a quick glimpse of the future, but only enough to entice. Was that Adrian Peterson in there? Will Donovan McNabb throw a touchdown? Who will replace the recent departed Bryant McKinnie? We will not learn tonight.
Tonight is a chance for players to hit someone other than their teammate. A chance to look good for coaches. A first look at new offenses and defenses for many. A chance to turn it up a notch, as it were. And the starters will be on a short string. But we should get a chance to see some rookies. My underdog rookie claim is Emmanuel Arceneaux. I want him to be the next Sidney Rice.
Oh, I will be watching. I have taken all I can of "Jersey Housewives", people who hoard, and crews that look for ghosts in the dark. Tonight is about reclaiming the television. Tonight is a glimpse of sixteen Sundays. As a Vikings fan I have been accustomed to winning, and despite a 6-10 2010 season, I want to win now. Again.
I will hope to see rookies Christian Ponder, Kyle Rudolph, Christian Ballard justify their selection. I do not need much, just a play that says "Wow, he could be...". That's all.
I want to see McNabb protected. Brett Favre looked an awful lot like Archie Manning last year, which in turn made the turnovers, which led to the awful point differential, and hence a poor record. Guys like John Sullivan, Anthony Herrera, and Ryan Cook have to improve. We need to see recent picks Chris DeGeare and Phil Loadholt start to pan out. And most important, someone needs to emerge as a solid left tackle. Right now that looks like former-Colt Charlie Johnson.
I need to see a pass rush. Brian Robison steps in for departed Ray Edwards. There seems to be depth at the defensive line, and it has religiously been our bread and butter for good defense. If the line returns to elite form, the high ranking will follow, and so will the wins. Pat Williams is gone. Kevin will need a substitute. Will Ballard be good enough in his rookie year to play? How good are Fred Evans and Letroy Guion going to be?
I hope to see the team play inspired. In the words of Tupac, "Keep Your Head Up". Too much negativity last year. It is hard not to be down when the Packers and Bears are playing in the NFC Championship and the Lions win out to finish ahead of you. The talent is there. Much of it was in the 2009 NFC Championship. A rise to the top may not be as hard to accomplish as most think. I want the 2011 Vikings to play with more heart than in 2010.
No, I am ready for the 2011 season to begin. The final countdown begins....
Right after "Marley and Me".
Dear fellow Vikings' fans,
It's hot outside. Too hot. I live out in the rural area, where my wife and I assumed a house with a GE heat pump that looks older than me. And we are on off-peak, which means whenever you really need the AC, you cannot have it. Still, recent events cause me too make a stand in saving money. I will not give in. I suffer through this in order to fight injustice, or the rising cost of energy.
Many of you have watched the recent free agent events and made up your minds that more must be done to save the 2011 season. We have to get another quality wide receiver. We have to add an offensive lineman. We have to strengthen our defensive line. Who will play cornerback?
But I am more confident in this year's Vikings already.
First, one of the greatest injustices done to my purple was the giveaway/takeaway ratio. Last year Minnesota ranked dead last in the NFC with a -11. Vikings' passers threw 26 interceptions and ball handlers provided 11 fumbles to the opposition. That type of injustice must end. Brett Favre had a career percentage intercepted (pct. int.) of 3.3, yet last year he was 5.3. Favre would end with a passer rating of 69.9, well below his career average of 86.0
So we have added Donovan McNabb to tutor Christian Ponder and probably lead the 2011 Vikings. McNabb has a career pct. int. of 2.2%. Last year, his worst, he was 3.2% for the Redskins. As bad as McNabb's season was last year, he still had a passer rating significantly higher than Number Four (77.1). McNabb is less likely to be intercepted than Brett Favre.
I am cognizant of the need to improve in other areas. One reason I have so much hope is the work of Coach Dunbar with the Vikings' defensive line. I have been in Dunbar's audience at football clinic;. his presence commands respect. Since he joined the Vikings in 2006 good things have happened. Dunbar, a teammate in college of Henry Thomas and coach in college of Kevin Williams, immediately impacted the Vikings, Minnesota was first against the run in 2006, 07, and 08, becoming only the 2nd team in NFL history to accomplish the feat. Ever since his arrival Minnesota has been known for shutting down the run. In 2010, a down year, the Vikings finished 9th, up from 2nd in 2009.
Moreover, the Vikings have managed a decent pass rush while applying run pressure. In 2009, Minnesota led the NFL in sacks. Jared Allen has had three 14+ sack seasons, one of only a few to ever accomplish the feat. In 2010 Minnesota fell to 15th, though it is difficult for losing teams to acquire sacks. In a land known for great defensive lineman (Page, Eller, Randle, Marshall, Doleman, Millard, Thomas, and so on..), Dunbar has continued to provide. Kevin Williams and Jared Allen are considered among the best in the game.
So fellow fans, there are a few key steps a team must take to enter the playoffs. We must reduce our turnovers. We must provide ample blocking. We must increase our takeaways. And we must apply pressure with the front line.
Donovan McNabb and Christian Ponder will do their best to control the ball. Dunbar and his crew will continue to impress with the front four. Gone are Ray Edwards and Pat Williams. Kevin Williams will have to sit out four games for a delayed suspension. It will be time for newer players to step up. Brian Robison, a 6th year veteran, will be asked to start at DE. Recently signed Fred Evans, Letroy Guion, and rookie Christian Ballard will man the middle until at least one Williams comes back. DE Everson Griffin, the 4th round pick of 2009, and NT Remi Ayodele, a Saints castaway, will also provide efforts.
Given the last five year history, I have no doubt the d-line will provide. The rest is up to the offense. If they can control the ball and score a bit, it could be a much quicker recovery than the pundits would expect. Percy Harvin and Adrian Peterson can help ease the transition to an explosive offense that holds onto the ball.
And despite the summer heat index, I remain cool in thought. Justice can be served by Minnesota in 2011 if they learn to hold onto the ball. And with the Packers hordes gloating (as they should) since the last Super Bowl; it can come none too soon. Maybe by saving money (enduring the heat), I can afford to attend a game or two.
Yours in hope for 2011,
Louis Villaume
From an off-peak home.
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"Modern Day "Pilgram's Progress""
The gentleman reading the book used great inflection
Pilgram's Progress
Tony - I could relate to some of his struggles
Jake - I would like to learn about his life and how he came to know Jesus and Grandmother
This is a really good book - the first part of chapter 5 dealing with community is a great way to see our relationship with God the Father, God the Son and God the Holy Spirit. Chapter 13 addes some great in-site as well.
"Loved it!"
The narrator was wonderful! Loved the flow of the story! Just the right amount of mystery!
Thank you! Getting ready to listen to book 2
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55th out of 75 books — 26 voters
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Start by marking "Prefaces to Shakespeare: Hamlet" as Want to Read:
Prefaces to Shakespeare: Hamlet
First published in the 1930s, these works, published here in economical paperback editions . . . are still considered definitive.
- Stages
- Stages
Hamlet is for the student of Shakespeare, whether in the theatre class or the literature class. It is for actors of Shakespeare, and for the directors. It is a practical guide and an insightful critique. It is also immensely readable.
Paperback, 352 pages
Published April 17th 1995 by Heinemann Drama
(first published April 17th 1993)
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Hamlet: The Play's the Thing!
Nothing But the Title
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Harley Granville-Barker was an English actor, director, producer, critic and playwright.More about Harley Granville-Barker...
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text:
I've been working on a script that would limit the containment of a draggable div to a circle (instead of a rectangular parent div). I found this thread: How to constrain movement within the area of a circle which seemed to solve some of my questions. I've got the proper functions in place and when I call those functions inside the drag function it will return the proper x & y position of the div. I know this because I can check the console log during the drag function and check the position of the div. However, my problem is that I can't seem to set the actual position during the drag event. The console reports the proper position values, but the div never actually gets constrained to the circular boundary. For example, if I drag the div to the center of the circle and then move it up vertically past the circle boundary... the div doesn't stop at the circle, however the console clamps the position to [0,50]//50 is the the center of the circle in both the X & Y axis. I read on some other threads that I might have to use a helper object, but I didn't seem to get anywhere with this method. I'm posting a simplified example in hopes that someone can help. Thank you.
this.light = document.createElement("div");
var circle_cenx = 50.0;
var circle_ceny = 50.0;
var circle_radius = 50.0;
drag: function( event, ui ){
var position = $(that.light).position();
var result = limit(position.left+10, position.top+10, circle_cenx, circle_ceny);
$(that.light).css({'top': result.y, 'left': result.x});
position = $(that.light).position();
function limit(x, y, cenx, ceny) {
var dist = distance([x, y], [cenx, ceny]);
if (dist <= circle_radius) {
return {x: x, y: y};
else {
x = x - circle_cenx;
y = y - circle_ceny;
var radians = Math.atan2(y, x);
return {
x: Math.cos(radians) * circle_cenx + circle_radius,
y: Math.sin(radians) * circle_ceny + circle_radius
function distance(dot1, dot2) {
var x1 = dot1[0],
y1 = dot1[1],
x2 = dot2[0],
y2 = dot2[1];
return Math.sqrt(Math.pow(x1 - x2, 2) + Math.pow(y1 - y2, 2));


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Food and service are great. Good view right off the ocean. Traditional Portuguese sides with extremely well cooked fish. Mixed fish platter and tuna steak is a must.
We landed in this restaurant a bit by accident. The food was good but we ended up paying 30€ for the "fish of the day" which we found a bit expensive compared to the prices elsewhere. It's also here that we've tried the local specialty: swordfish with banana and passion fruit. It's definitely something to try although it has a...
Great location - just sit and watch the waves roll in and the odd plane coming or going. Staff are great - very helpful and cheerful. Food is quite adequate considering the prices are low.
Came here with a trip from our hotel to a madeiran food festival.
Service ok not sure our waitress understood what we wanted on most occasions.
Had to return my steak as I asked for it to be well done and it was medium.
Nice location overlooking the sea. The other food was great.
Worth a visit.
We arrived in Madeira very tired and hungry, drove to Machico and found the Mare Alta. The staff were helpful and friendly, the house red was good quality and the scabbard fish lunches were excellent. Two pieces of fish each cooked perfectly with bananas and passion fruit, salad and spuds. Service was efficient but not rushed and the food was...
As one good restaurant wasn't working we had to find fast some place in Machico to eat. Went to this place with nice views. But from this time I will remember forever that a place with views is never with good food. We tried fish soup. It was too greasy. Shrimps cooked in lots of doubtful quality oil. Salad with...
After our flight home was cancelled due to high winds, we found ourselves in Machico on a Monday night. Wandering away from the hotel we escaped from our 150+ co passengers and on a near deserted seafront found this modern restaurant. Service was attentive and the rice with seafood superb. They also list a number of half bottles on a...
While the location of the restaurant and the ocean view were promising, we were deeply disappointed with the food provided. We have been eating scabbard fish (espada) from the beginning of our stay in Madeira which always was delicious, but the one provided here was unfortunately the worst. In particular, it was ruined by deep fry in untasty fat. Also...
Excellent medley of grilled fish served with steamed potatoes and a slice of baked sweet potato, and with a mixed salad. House white wine good. Service a little slow.
We have been to this restaurant a few times because it's in a great location, it looks modern and trendy but needs to up it's act somewhat. At lunchtime it seems that the large groups of locals that sit inside get all the attention and us tourists who like to sit in the sun get ignored. We had to wait...
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Launcher Update
Get the Desktop App for Battle.net Now
- All your games in 1 place
- Log in once
- Automatic game updates
I transferred here about two months ago to my brother's guild. However he and his friends for the most part are back in college and are hardly on anymore.
This for the most part is my main, a PVE Disc/Holy healer.
I got back into wow a few months back, and am looking to get further FL exp, and into a solid guild before 4.3 hits. ( I'm marked 4/7 but I know the strats for Domo/alyz)
I'm available for the most part mon-thurs 7pm onwards.
Feel free to either to respond here or send me a message in game.
This Alt is also up for grabs, just turned 85 two days ago.
Would also like some raids on her once she is Ilvl appropiate, as I do know the fights..It just seems hard to find pug friendly raids on this server
85 Orc Death Knight
Go Alliance Marie. Do it. Go ahead. I dare you.
Edited by Bôôgeyman on 9/16/2011 4:46 PM PDT
you gonna camp my !@# if I do?
its on like donkey Kong.
Threats of violence. We take these seriously and will alert the proper authorities.
Posts containing personal information about other players. This includes physical addresses, e-mail addresses, phone numbers, and inappropriate photos and/or videos.
Harassing or discriminatory language. This will not be tolerated.


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Young William Wyeth sets out from St. Louis as part of a fur-trapping brigade in 1826, hoping to prove to his family back East that his wandering, capricious nature can be put to good use. Wrestling with his insecurities spurs him forward into the relatively uncharted land west of the settled United States, filled with wild game, angry natives and endless potential.
In V.E. Schwab's A Darker Shade of Magic, three versions of London exist side by side in parallel universes. There's Grey London, where magic is basically extinguished; Red London, where it's abundant; and White London, where it's somewhere in between (and where the control of it as a resource is jealously and viciously contested). There was also a fourth—Black London—whose inhabitants were devoured by magic and which should no longer exist. Schwab's male protagonist, Kell, is one of the few with the power to travel between those Londons, and as such, serves as a diplomatic courier of sorts between the monarchies of each.
Reif Larsen waits 200 pages before betraying his literary lineage by using the phrase "gravity's rainbow." For in his sprawling, pyrotechnic second novel, I Am Radar, one is never far from Pynchon's masterpiece, that once-groundbreaking combination of adolescent hilarity and theoretical physics. The authors share a soaring erudition and ambition—evidenced by the length and ostentation of their books. But where Pynchon's main theme might be a paranoiac fear of annihilation and conspiracy, Larsen's seems to be an affirmation of the pathetic randomness of life. It's telling that his previous book, The Selected Works of T.S. Spivet, was made into a film by the director of Amélie, and his new release resembles the joyful, madcap creations of Wes Anderson.
Crime fiction groupies can usually form a pretty quick mental picture of the cop, PI or little old lady detective in any new mystery novel, and that take remains, embedded in the reader's imagination, for the duration of the story.
It's a glad thing when a reader encounters a character so compelling that you want to punch him in the nose. Such abhorrence—it's not really hatred—can be as pleasurable in its own way as love. Such is the aggravation caused by Jonas Karlsson's weird, insufferably arrogant, not quite neuro-normal protagonist in the crisp, novella-length book The Room.
When 22-year-old Alice becomes pregnant out of wedlock in the early 1930s, both she and her family fear disgrace. Her mother sends her from London to the Gloucestershire countryside to await the baby's birth at a place called Fiercombe Manor, after which she will give the baby to an orphanage. Her mother's old friend, Mrs. Jelphs, is the housekeeper at the empty manor, and she promises to keep watch over Alice, who has concocted a cover story of a recently deceased husband.
The great Richard Price (Clockers, Lush Life) dons a new literary persona as Harry Brandt for this crackling thriller. Haunted NYPD Detective Billy Graves' very name suggests not only his bleak working hours but also a death that landed him on the, well, graveyard shift.
There's something irresistible about a boarding school novel: the picturesque grounds; the tight-knit community of teachers and students and staff; the routine of seminars, lacrosse games and chapel; the inevitable romances that bud in such an insular world. In The Half Brother, her second novel after 2010's sensual The Swimming Pool, Holly LeCraw has created an appealing setting in the Abbott School, a campus at the top of a ridge in north Massachusetts where azaleas and cherry blossoms surround the stone and clapboard buildings, and the grass almost shimmers with mist.
In Welcome to Braggsville, four Berkeley college friends decide to protest a Civil War re-enactment by staging a "performative intervention.
Amanda Filipacchi's fourth novel is a matchless satire that manages to make a point or two along with the fun. It follows a memorable cast of characters, led by Barb, a costume designer and world-class beauty with the kindest of hearts. Convinced of the sheer uselessness and even destructiveness of beauty after a spurned lover kills himself over her, Barb hides her looks under a fat suit.


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Steph Curry: Reviewing The Under Armour Curry One
Steph Curry and Klay Thompson were selected as All-Stars to represent the Golden State Warriors and Steph's week in New York was flat out phenomenal. On top of winning the 3 Point Contest, Steph and Under Armour threw an event to launch their global brand campaign, The Book of Will. Curry's popularity and electrifying style of play has given him worldwide popularity and it's only the beginning. Steph put Un ...Read more ›


text:
Intereting. It could be. What type of floods though? My box can be idling (not asleep/stand by) with no manual network activities.
The kind of flooding I am talking about usually happens below the TCPIP layer at the ethernet layer, and it would not be visible to iptables in your PC because it occurs inside the NIC and is simply not visible at all inside the PC. Typically with such a failure the NIC just sends a constant stream of garbage bits out the interface and overwhelms whatever it is connected to. Sometimes just disconnecting the interface (as would happen if the router rebooted) will cause the defective interface to reset, and everything works again (until the next failure). I am not saying this is what happened in your case, but it might explain why the problem seems to have disappeared after you upgraded your OS.
Interesting. So it's like DDoS my router on my internal tiny network (two desktops [static IP addresses] + two wifis [DHCP] + one cable modem for Internet).
That is why I "stack" my modems/routers/switches with plenty of breathing room.


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V Rohde
Universitätsmedizin Göttingen, Göttingen, Lower Saxony, Germany
Are you V Rohde?
Claim your profile
Total impact
Available from: Donna J Arndt-Jovin
Specific visualization of glioma cells in living low-grade tumor tissue.
S R Kantelhardt
W. Caarls
A. H. B. de Vries
G. M. Hagen
T M Jovin
W J Schulz-Schaeffer
, V Rohde,
A Giese
D J Arndt-Jovin
Available from: Christiane Wegner
Paraganglioma of the filum terminale: review and report of the first case analyzed by CGH.
A Gutenberg
C Wegner
S M Pilgram-Pastor
B Gunawan
, V Rohde,
A Giese
[Show abstract]
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As a rare tumor paraganglioma of the filum terminale is of diagnostic challenge. A thorough review of all published cases most often reveals a benign course if complete surgically resection is achieved. We report on the first molecular cytogenetic analyses performed on filum termiale paragangliomas. A 52-year-old man suffered from low back pain for many years that gradually worsened and was aggravated by sitting and bending. The pain radiated dorsally into both legs. Magnetic resonance imaging (MRI) with and without Gd-DTPA revealed a 12 mm sized, intradural oval mass at the level of L3 with slightly increased T2-signal and a rim of low signal on T2-weighted sequences. The tumor enhanced remarkably after Gd-DTPA. Intervention: The patient underwent a left sided hemilaminectomy of L3. Durotomy revealed a well-delineated, firm and highly vascularized reddish tumor. The proximal terminal filum entered the tumor at the proximal pole and exited its distal pole. Coagulation and dissection of the terminal filum allowed in toto removal of the tumor. DNA was isolated from the formalin-fixed and paraffin-embedded specimen. The tumor was analyzed by comparative genomic hybridization, providing a normal DNA profile without any chromosomal copy number changes. The origin of paragangliomas of the CNS and especially of the filum terminale is still unclear. If no complete surgical resection can be achieved, molecular cytogenetic analysis is of additional value to prognostification of paragangliomas of the filum terminale.
Clinical neuropathology 01/2010; 29(4):227-32. DOI:10.5414/NPP29227
· 1.31 Impact Factor
Implementation of a Critical Incident Reporting System in a Neurosurgical Department
P Kantelhardt
M Müller
A Giese
, V Rohde,
S R Kantelhardt
[Show abstract]
[Hide abstract]
Critical incident monitoring is an important tool for quality improvement and the maintenance of high safety standards. It was developed for aviation safety and is now widely accepted as a useful tool to reduce medical care-related morbidity and mortality. Despite this widespread acceptance, the literature has no reports on any neurosurgical applications of critical incident monitoring. We describe the introduction of a mono-institutional critical incident reporting system in a neurosurgical department. Furthermore, we have developed a formula to assess possible counterstrategies. All staff members of a neurosurgical department were advised to report critical incidents. The anonymous reporting form contained a box for the description of the incident, several multiple-choice questions on specific risk factors, place and reason for occurrence of the incident, severity of the consequences and suggested counterstrategies. The incident data was entered into an online documentation system (ADKA DokuPik) and evaluated by an external specialist. For data analysis we applied a modified assessment scheme initially designed for flight safety. Data collection was started in September 2008. The average number of reported incidents was 18 per month (currently 216 in total). Most incidents occurred on the neurosurgical ward (64%). Human error was involved in 86% of the reported incidents. The largest group of incidents consisted of medication-related problems. Accordingly, counterstrategies were developed, resulting in a decrease in the relative number of reported medication-related incidents from 42% (March 09) to 30% (September 09). Implementation of the critical incident reporting system presented no technical problems. The reporting rate was high compared to that reported in the current literature. The formulation, evaluation and introduction of specific counterstrategies to guard against selected groups of incidents may improve patient safety in neurosurgical departments.
Central European neurosurgery 12/2009; 72(1):15-21. DOI:10.1055/s-0029-1243199
· 0.87 Impact Factor
Available from: Isabella Lupi
A radiologic score to distinguish autoimmune hypophysitis from nonsecreting pituitary adenoma preoperatively.
A Gutenberg
J Larsen
I Lupi
, V Rohde,
P Caturegli
[Show abstract]
[Hide abstract]
Autoimmune hypophysitis (AH) mimics the more common nonsecreting pituitary adenomas and can be diagnosed with certainty only histologically. Approximately 40% of patients with AH are still misdiagnosed as having pituitary macroadenoma and undergo unnecessary surgery. MR imaging is currently the best noninvasive diagnostic tool to differentiate AH from nonsecreting adenomas, though no single radiologic sign is diagnostically accurate. The purpose of this study was to develop a scoring system that summarizes numerous MR imaging signs to increase the probability of diagnosing AH before surgery. This was a case-control study of 402 patients, which compared the presurgical pituitary MR imaging features of patients with nonsecreting pituitary adenoma and controls with AH. MR images were compared on the basis of 16 morphologic features besides sex, age, and relation to pregnancy. Only 2 of the 19 proposed features tested lacked prognostic value. When the other 17 predictors were analyzed jointly in a multiple logistic regression model, 8 (relation to pregnancy, pituitary mass volume and symmetry, signal intensity and signal intensity homogeneity after gadolinium administration, posterior pituitary bright spot presence, stalk size, and mucosal swelling) remained significant predictors of a correct classification. The diagnostic score had a global performance of 0.9917 and correctly classified 97% of the patients, with a sensitivity of 92%, a specificity of 99%, a positive predictive value of 97%, and a negative predictive value of 97% for the diagnosis of AH. This new radiologic score could be integrated into the management of patients with AH, who derive greater benefit from medical as opposed to surgical treatment.
American Journal of Neuroradiology 08/2009; 30(9):1766-72. DOI:10.3174/ajnr.A1714
· 3.17 Impact Factor
Frontal Sinus Osteoma Complicated by Extended Intracranial Mucocele and Cerebral Abscess: Neurosurgical Strategy of a Rare Clinical Entity
A Gutenberg
J Larsen
, V Rohde
[Show abstract]
[Hide abstract]
The combination of paranasal sinus osteoma, mucocele and brain abscess is rare. Only one other case has been reported so far, where the cerebral abscess was diagnosed intraoperatively. We report here on a second patient with combined frontal sinus osteoma, intracerebral mucocele as well as cerebral abscess. However, in our case, the diagnosis of cerebral abscess was reached prior to surgery, which allowed for a tailored treatment strategy with abscess puncture under neuronavigational guidance and, after 3 weeks of antibiotic therapy with documented abscess shrinkage, osteoma and mucocele resection as well as reconstruction of the eroded dura.
Central European neurosurgery 06/2009; 70(2):95-7. DOI:10.1055/s-0028-1082060
· 0.87 Impact Factor
Coil Migration after Endovascular Coil Occlusion of Internal Carotid Artery Pseudoaneurysms within the Sphenoid Sinus
T Struffert
J H Buhk
M Buchfelder
, V Rohde,
A Doerfler
M Knauth
[Show abstract]
[Hide abstract]
We report two cases of coil migration after endovascular treatment of pseudoaneurysm of the internal carotid artery within the sphenoid sinus with coils and noncovered stents. Two patients underwent sphenoid sinus exposure for pituitary adenoma and chronic infection, respectively. As a complication pseudoaneurysms of the internal carotid artery within the sphenoid sinus developed. One patient was treated with stent and coils, the second with coils alone. Both patients experienced coil migration after 9 and 26 months, respectively, with the necessity for further treatment. Imaging was performed using flat detector computed tomography (FD-CT). Literature review revealed two additional cases of coil migration and four patients with the same treatment in stable condition. Pseudoaneurysms of the internal carotid artery are a special entity and the environment of the aneurysm within the sphenoid sinus may change over a long time. Coil embolization may lead to the late onset complication of coil migration with the possible risk of acute epistaxis. As a consequence, these patients need a careful and prolonged follow up. FD-CT is an appropriate technique to visualize the implanted coils and if present the migration of coil material.
min - Minimally Invasive Neurosurgery 05/2009; 52(2):89-92. DOI:10.1055/s-0029-1215579
· 0.62 Impact Factor
205. Robotized image-guided transcranial magnetic stimulation, a novel technique for functional brain-mapping
S. R. Kantelhardt
T. Fadini
M. Finke
K. Kallenberg
V. Bockermann
L. Matthaeus
J. Siemerkus
W. Paulus
A. Schweikard
, V. Rohde,
A. Giese
Clinical Neurophysiology 01/2009; 120(1). DOI:10.1016/j.clinph.2008.07.203
· 2.98 Impact Factor
O.103 Protocol for the randomized controlled SVASONA trial (ISRCTN51046698): Shunt valves plus shunt assistant versus shunt valves alone for controlling overdrainage in idiopathic normal-pressure hydrocephalus in adults
J. Lemcke
U. Meier
C. Müller
M. Fritsch
M. Kiefer
R. Eymann
U. Kehler
N. Langer
, V. Rohde,
H. C. Ludwig
F. Weber
V. Remenez
Clinical Neurology and Neurosurgery 09/2008; 110. DOI:10.1016/S0303-8467(08)70108-2
· 1.25 Impact Factor
O.105 Survival rate and reliability of the ProGAV adjustable CSF shunt: Results of the German prospective multicenter observational study
M. J. Mirzayan
C. Sprung
H.-G. Schlosser
U. Meier
J. Lemcke
M. Messing-Jünger
H.-A. Trost
F. Weber
C. Schul
, V. Rohde,
H.-C. Ludwig
J. Höpfner
Clinical Neurology and Neurosurgery 09/2008; 110. DOI:10.1016/S0303-8467(08)70110-0
· 1.25 Impact Factor
A less invasive surgical concept for the resection of spinal meningiomas.
A Boström
U Bürgel
P Reinacher
T Krings
, V Rohde,
J M Gilsbach
F J Hans
[Show abstract]
[Hide abstract]
The surgical strategy for spinal meningiomas usually consists of laminectomy, initial tumour debulking, identification of the interface between tumour and spinal cord, resection of the dura including the matrix of the tumour, and duroplasty. The objective of this study was to investigate whether a less invasive surgical strategy consisting of hemilaminectomy or laminectomy, tumour removal and coagulation of the tumour matrix allows comparable surgical and clinical results to be obtained, especially without an increase of the recurrence rate as reported in the literature. Between 1990 and 2005, 61 patients (11 men, 50 women) underwent surgery for spinal meningioma. All patients were treated microsurgically by a posterior approach. In 56 of the 61 patients, the above outlined - less invasive - surgical technique with tumour removal and coagulation of the tumour matrix was performed. In 5 patients, dura resection and duroplasty was additionally performed. Electrophysiological monitoring was routinely used since 1996. Recurrence was defined as new onset or worsening of symptoms and radiological confirmation of tumour growth. The pre-and post-operative clinical status was measured by the Frankel grading system. Pre-operatively, 40 patients were in Frankel grade D, 13 patients in grade C, 6 patients in grade E and 1 patient each in grade A and B. Following surgery no patient presented a permanent worsening of clinical symptoms. All patients who initially presented with a Frankel grades A-C (n = 15) recovered to a better grade at the time of follow-up. Patients who presented with Frankel grade D remained in stable condition (n = 27) or recovered to a better neurological status (n = 13). Two patients experienced a temporary worsening of their symptoms, but subsequently improved to a better state than pre-operatively. Two (3.3%) complications (pseudomeningocele, wound infection) requiring surgery, were encountered. The pseudomeningocele developed in a patient who underwent durotomy. During the follow-up period of 2 months to 10 years (mean 31.3 months), 3 patients (5%) required surgery for symptomatic recurrence: 1 patient had 2 recurrences that occurred 4 and 7 years after first tumour removal and matrix coagulation, 1 recurrence occurred 1 year after tumour removal that was accompanied by matrix coagulation in a patient with a diffuse anterocranial tumour extension and 1 occurred 3 years after tumour removal and durotomy. Two patients showed a small recurrence on MRI during follow-up after 2 and 5 years, respectively, without any symptoms requiring surgery. The high rate of favourable clinical results combined with the low rate of recurrences supports our less invasive surgical concept, which does not aim for resection of the dural matrix of the spinal meningioma.
Acta Neurochirurgica 07/2008; 150(6):551-6; discussion 556. DOI:10.1007/s00701-008-1514-0
· 1.79 Impact Factor
Treatment strategies and outcome in patients with non-tuberculous spinal epidural abscess - A review of 46 cases
A Boström
M Oertel
Y Ryang
, V Rohde,
U Bürgel
T Krings
M Korinth
[Show abstract]
[Hide abstract]
Spinal epidural abscess (SEA) is a rare disease and its early detection and appropriate treatment is essential to prevent high morbidity and mortality. There are only few single-institution series who report their experiences with the microsurgical management of SEA and treatment strategies are discussed controversially. Within the last 15 years the authors have treated 46 patients with SEA. This comparatively high number of cases encouraged us to review our experiences with SEA focussing on the clinical presentation, microsurgical management and outcome. Clinical charts of 46 cases with a spinal epidural abscess treated between 1990 and 2004 were reviewed. There were 30 men and 16 women, the age ranged between 32 and 86 years (mean: 57 years). The clinical mean follow-up was 8.5 months (range: 2-84). The clinical presentation and severity of neurological deficits were measured by the Frankel grading system on admission and on follow-up visit. The abscess was located in the cervical spine in 8, the thoracic spine in 17 and the lumbar spine in 21 patients. On admission 8 patients were in Frankel grade A, 7 in B, 15 in C, 8 in D and 8 in E. During follow-up 1 patient was in Frankel grade A, 1 in B, 5 in C, 13 in D and 24 in E. 37 patients underwent primary microsurgery with abscess drainage or removal of chronic granulomatous tissue. The clinical symptoms in 4 patients worsened shortly after the operation due to a compression fracture of the vertebral body (n=2) or progress of the abscess (n=2) making re-operation necessary. 9 patients with severe critical illness or without neurological deficits had primarily a CT-guided puncture for assessment of the causative organism. 3 of them needed additional surgical therapy within the hospital stay because of a new neurological deficit. All patients were immobilised and treated with antibiotics for at least 6 weeks. The mortality was 6.5%. As for complications we noted septicaemia (n=5), meningitis (n=1) and a transient malresorptive hydrocephalus (n=1). Early diagnosis, microsurgical therapy with appropriate antibiotic therapy and careful observation of patients are the keys to successful management of SEA. The goal of surgical treatment is to isolate the causative organism and to perform a decompression at the site of maximal cord compression in cases of neurological deterioration or severe pain. Instrumentation with primary fixation does not seem to be imperative. In cases of post-operative worsening, a fracture of additionally infected bony elements has to be considered and a stabilisation should be discussed on an individual basis.
min - Minimally Invasive Neurosurgery 03/2008; 51(1):36-42. DOI:10.1055/s-2007-1004547
· 1.14 Impact Factor
Robotized image-guided transcranial magnetic stimulation, a novel technique for functional brain-mapping
SR Kantelhardt
T Fadini
M Finke
K Kallenberg
V Bockermann
L Matthaeus
J Siemerkus
W Paulus
A Schweikard
, V Rohde,
A Giese
Klinische Neurophysiologie 03/2008; 39(01). DOI:10.1055/s-2008-1072999
· 0.33 Impact Factor
Management of delayed edema formation after fibrinolytic therapy for intracerebral hematomas: preliminary experimental data.
V Rohde,
N Uzma
R Thiex
U Samadani
[Show abstract]
[Hide abstract]
Fibrinolytic therapy for spontaneous intracerebral hemorrhage using recombinant tissue plasminogen activator (rtPA) is considered a viable alternative to microsurgical hematoma removal. However, experimental data suggest that rtPA is neurotoxic and evokes a late perihematomal edema. We present preliminary data focusing on the avoidance of late edema formation after lysis of an intracerebral hematoma in a porcine model. Twenty pigs underwent placement of a frontal intracerebral hematoma with a minimum volume of 1 mL. Half of the pigs were subjected to rtPA clot lysis and MK-801 injection for blockage of the NMDA receptor-mediated rtPA-enhanced excitotoxic pathway. The remaining 10 pigs received desmoteplase (DSPA) for clot lysis, which is known to be a less neurotoxic fibrinolytic agent than rtPA. MRI on the day of surgery and on postoperative days 4 and 10 was used to assess hematoma and edema volumes. Late edema formation could be prevented in both the MK-801/rtPA and DSPA pigs. The benefits of fibrinolytic therapy for intracerebral hematomas appear to be counterbalanced by late edema formation. MK-801 infusion as an adjunct to rtPA lysis, or the use of DSPA instead of rtPA, prevents late edema and therefore has the potential to further improve results after clot lysis.
Acta neurochirurgica. Supplement 02/2008; 105:101-4. DOI:10.1007/978-3-211-09469-3_21
· 1.79 Impact Factor
Endoscopic cystoventriculostomy and ventriculocysternostomy using a recently developed 2.0 micron near infrared laser in patients with hydrocephalus
HC Ludwig
T Knobloch
K Rostasy
H Teichmann
, V Rohde
Neuropediatrics 12/2007; 37(06). DOI:10.1055/s-2006-973983
· 1.10 Impact Factor
Available from: Yu-Mi Ryang
Transmuscular trocar technique - Minimal access spine surgery for far lateral lumbar disc Herniations
Y M Ryang
M F Oertel
L Mayfrank
J M Gilsbach
, V Rohde
[Show abstract]
[Hide abstract]
Minimal access spine surgery (MASS) is gaining increasing importance in microsurgery of the lumbar spine. From a current prospective series we present data on MASS for far lateral lumbar disc herniations (LLDH) via a transmuscular trocar technique (T(2)). The surgical procedure and operative results are demonstrated in detail. In contrast to conventional percutaneous endoscopic techniques, T(2) allows one to operate in the typical microsurgical fashion combined with the advantages of a minimal endoscopic approach with three-dimensional visualization of the surgical target using the operating microscope. Microsurgery was performed through a 1.6-cm skin incision with an 11.5-mm diameter trocar that is obliquely inserted into the paraspinal muscles pointing at the lateral isthmus of the upper vertebral body. Fifteen patients were evaluated after a median follow-up period of 24 months. Overall outcome according to the modified MacNab criteria, effect of surgery on radicular pain and sensory or motor deficits, duration of surgery, complication rate, and duration of hospital stay were evaluated. Good to excellent clinical outcomes were achieved in 14/15 patients. Radicular pain and motor deficits improved in all patients postoperatively, while sensory deficits recovered in 13/15 patients. The cosmetic results were excellent in all patients. No aggravation of symptoms after surgery was observed in any of the patients. The T(2) technique represents an auspicious alternative to standard open microsurgery for LLDH, which allows achievement of excellent clinical and cosmetic results, preservation of segmental spine stability, and avoidance of excessive soft tissue trauma.
min - Minimally Invasive Neurosurgery 11/2007; 50(5):304-7. DOI:10.1055/s-2007-990292
· 1.14 Impact Factor
First experiences with a 2.0-microm near infrared laser system for neuroendoscopy.
H C Ludwig
T Kruschat
T Knobloch
H-O Teichmann
K Rostasy
, V Rohde
[Show abstract]
[Hide abstract]
Nd:YAG, argon and diode lasers have been used in neurosurgical procedures including neuroendoscopy. However, many neurosurgeons are reluctant to use these lasers because of their inappropriate wavelength and uncontrollable tissue interaction, which has the potential to cause serious complications. Recently, a 2.0-microm near infrared laser with adequate wavelength and minimal tissue penetration became available. This laser was developed for endoscopic neurosurgical procedures. It is the aim of the study to report the initial experiences with this laser in neuroendoscopic procedures. We have performed 43 laser-assisted neuroendoscopic procedures [multicompartmental congenital, posthaemorrhagic or postinfectious hydrocephalus (n = 17), tumour biopsies (n = 6), rescue of fixed and allocated ventricular catheters (n = 2), endoscopic third ventriculostomy (ETV, n = 17) and aqueductoplasty (n = 1)] in 41 patients aged between 3 months and 80 years. The laser beam was delivered through a 365-microm bare silica fibre introduced through the working channel of a rigid endoscope. It was used for the opening of cysts, perforating the third ventricular floor, and for coagulation prior to and after biopsy. The therapeutic goals [creating unhindered cerebrospinal fluid (CSF) flow between cysts, ventricles and cisterns, sufficient tissue samples for histopathological diagnosis and catheter rescue] were achieved in 40 patients by the first and in 2 patients by a second neuroendoscopic operation. In one child, a CSF shunt was later required despite patency of the created stoma proven by magnetic resonance imaging (MRI). In another patient ETV was abandoned due to a tiny third ventricle. There was neither mortality nor transient or permanent morbidity. The authors conclude that the use of the 2.0-microm near infrared laser enables safe and effective procedures in neuroendoscopy.
Neurosurgical Review 08/2007; 30(3):195-201; discussion 201. DOI:10.1007/s10143-007-0078-4
· 1.86 Impact Factor
Management of hydrocephalus in children with plasminogen deficiency
M R Weinzierl
H Collmann
M C Korinth
J M Gilsbach
, V Rohde
[Show abstract]
[Hide abstract]
Congenital plasminogen deficiency is an infrequent disorder, which usually becomes symptomatic as ligneous conjunctivitis. However, pseudomembranous lesions in the mucosa of the pharynx, tracheobronchial tree, and the peritoneum may likewise occur. An accompanying hydrocephalus is extremely rare; only 16 cases have been reported to date. The reports indicate that hydrocephalus, even if treated by ventriculoperitoneal (VP) cerebrospinal fluid (CSF) shunting, worsens the prognosis substantially. Thus, VP CSF shunting does not seem to be the optimal therapy for hydrocephalic children with plasminogen deficiency. We add two cases to the literature, and, on the base of our experience, we propose a management strategy for the hydrocephalus. We report the case history of two children with plasminogen deficiency and associated hydrocephalus. Both children initially were treated with VP shunts and had a very similar clinical course with multiple shunt malfunctions due to nonabsorption by the peritoneum. In the first child, the attempt to treat the hydrocephalus with a ventriculoatrial (VA) shunt failed due to catheter thrombosis. Finally, a ventriculocholecystic shunt was placed in both children, which worked well. In patients with plasminogem deficiency and associated hydrocephalus, special care must be taken in the management of hydrocephalus. The absorptive capacity of the peritoneum is reduced by pseudomembrane formation, which results in VP shunt malfunction. The plasminogen deficiency results in early thrombus formation if atrial catheters are used. Therefore, the authors believe that ventriculocholecystic shunting should be considered early on in the course of the disease.
European Journal of Pediatric Surgery 05/2007; 17(2):124-8. DOI:10.1055/s-2007-964874
· 0.98 Impact Factor
Combined motor and somatosensory evoked potentials for intraoperative monitoring: intra- and postoperative data in a series of 69 operations.
M R Weinzierl
P Reinacher
J M Gilsbach
, V Rohde
[Show abstract]
[Hide abstract]
The primary objective of neurophysiologic monitoring during surgery is to avoid permanent neurological injury resulting from surgical manipulation. To prevent motor deficits, either somatosensory (SSEP) or transcranial motor evoked potentials (MEP) are applied. This prospective study was conducted to evaluate if the combined use of SSEP and MEP might be beneficial. Combined SSEP/MEP monitoring was attempted in 100 consecutive procedures, including intracranial and spinal operations. Repetitive transcranial electric motor cortex stimulation was used to elicit MEP from muscles of the upper and lower limb. Stimulation of the tibial and median nerves was performed to record SSEP. Critical SSEP/MEP changes were defined as decreases in amplitude of more than 50% or increases in latency of more than 10% of baseline values. The operation was paused or the surgical strategy was modified in every case of SSEP/MEP changes. Combined SSEP/MEP monitoring was possible in 69 out of 100 operations. In 49 of the 69 operations (71%), SSEP/ MEP were stable, and the patients remained neurologically intact. Critical SSEP/ MEP changes were seen in six operations. Critical MEP changes with stable SSEP occurred in 12 operations. Overall, critical MEP changes were recorded in 18 operations (26%). In 12 of the 18 operations, MEP recovered to some extent after modification of the surgical strategy, and the patients either showed no (n = 10) or only a transient motor deficit (n = 2). In the remaining six operations, MEP did not recover and the patients either had a transient (n = 3) or a permanent (n = 3) motor deficit. Critical SSEP changes with stable MEP were observed in two operations; both patients did not show a new motor deficit. Our data again confirm that MEP monitoring is superior to SSEP monitoring in detecting impending impairment of the functional integrity of cerebral and spinal cord motor pathways during surgery. Detection of MEP changes and adjustment of the surgical strategy might allow to prevent irreversible pyramidal tract damage. Stable SSEP/MEP recordings reassure the surgeon that motor function is still intact and surgery can be continued safely. The combined SSEP/ MEP monitoring becomes advantageous, if one modality is not recordable.
Neurosurgical Review 05/2007; 30(2):109-16; discussion 116. DOI:10.1007/s10143-006-0061-5
· 1.86 Impact Factor
Rare intramedullary hemorrhage of a brainstem hemangioblastoma
Y-M Ryang
M F Oertel
A Thron
J Gilsbach
, V Rohde
[Show abstract]
[Hide abstract]
Hemorrhages caused by hemangioblastomas are very rare and mostly located in the subarachnoid space. Intraparenchymal bleedings due to hemangioblastomas are even less frequent, and these hemorrhages are almost exclusively located in the supratentorial brain, cerebellum and spinal cord. We report the first case of a brainstem hemorrhage due to a hemangioblastoma of the medulla oblongata. A 47-year-old woman presented with acute onset of headache, anarthria, inability to swallow, left-sided hemiparesis and hemidysesthesia with varying states of vigilance, finally developing acute respiratory failure. Cranial computed tomography (CT) scanning and magnetic resonance imaging (MRI) revealed a small hemangioblastoma of the posterior medulla oblongata causing intraparenchymal hemorrhage and acute occlusive hydrocephalus due to intraventricular hematoma extension. After implantation of an external ventricular catheter to treat acute hydrocephalus, the hemangioblastoma as well as its associated hemorrhage could be removed in toto via a microsurgical posterior median suboccipital approach with minimal foramen magnum enlargement. During the follow-up period of six months postoperatively the patient showed good recovery with only slight residual neurological deficits. The most common causes of brainstem hemorrhages are arterial hypertension and cavernous hemangiomas. However, hemangioblastomas should not be ignored as a possible differential diagnosis for intraparenchymal brainstem hemorrhage. While the prognosis in hypertensive brainstem bleedings is mostly disastrous and surgery rarely indicated, an operative therapy should be considered in cases of hemorrhages caused by underlying tumors. Especially in the treatment of hemangioblastoma, the surgical management strategy is crucial for a successful result. Therefore, the authors recommend including the search for hemangioblastomas into the diagnostic workup in patients with brainstem hemorrhages.
Zentralblatt für Neurochirurgie 03/2007; 68(1):29-33. DOI:10.1055/s-2007-968167
· 0.63 Impact Factor
Optical coherence tomography for experimental neuroendoscopy
H J Böhringer
E Lankenau
, V Rohde,
G Hüttmann
A Giese
[Show abstract]
[Hide abstract]
Optical coherence tomography (OCT) is a non-invasive and non-contact imaging technology that has been applied to several biomedical applications. We have recently demonstrated that OCT allows discrimination of tumor adjacent brain, diffuse and solid tumor tissue and that this technology may be used to detect residual tumor within the resection cavity during resection of intrinsic brain tumors. Here we show that an OCT integrated endoscope can image the endoventricular anatomy and other endoscopically accessible structures in a human brain specimen. A Sirius 713 optical coherence tomography device was mounted to a modified rigid endoscope. A formalin-fixed human brain specimen was used to simulate endoscopic visualization of brain anatomy and two specimens of fixed malignant tumors with endoventricular growth patterns. Simultaneous OCT imaging and endoscopic video imaging of the visible spectrum was possible using a graded index rod endoscope. OCT imaging of a human brain specimen in water allowed an in-depth view into structures like the walls of the ventricular system, the choroid plexus or the thalamostriatal vein. OCT further allowed imaging of structures beyond tissue barriers or opaque media. In this fixed specimen OCT allowed discrimination of vascular structures down to a diameter of 50 mum. In vessels larger that 100 mum the lumen could be discriminated and within larger blood vessels a layered structure of the vascular wall as well as endovascular plaques could be visualized. This in vitro pilot study has demonstrated that OCT integrated into neuroendoscopes may add information that cannot be obtained by the video imaging alone. This technology may provide an extra margin of safety by providing cross-sectional images of tissue barriers within optically opaque conditions.
min - Minimally Invasive Neurosurgery 11/2006; 49(5):269-75. DOI:10.1055/s-2006-954574
· 1.14 Impact Factor
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Uwe Spetzger
Klinikum Karlsruhe
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Volker A Coenen
Universitätsklinikum Freiburg
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Peter Reinacher
Universitätsklinikum Freiburg
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Mehdi Abili
Mashhad University of Medical Sciences
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Wilhelm Küker
University of Oxford
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Universitätsmedizin Göttingen
Göttingen, Lower Saxony, Germany
Georg-August-Universität Göttingen
Faculty of Medicine
Göttingen, Lower Saxony, Germany
University Hospital RWTH Aachen
Department of Neurology
Aachen, North Rhine-Westphalia, Germany
Klinikum Duisburg
Duisburg-Hamborn, North Rhine-Westphalia, Germany
RWTH Aachen University
Department of Neurosurgery
Aachen, North Rhine-Westphalia, Germany
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