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TR's April 2014 peripheral staff picks When we introduced our new System Guide format in February, we cut out peripherals in order to focus more closely on internal PC components. Our... Type: Feature article Tags: Multimedia Storage Systems Displays Input devices |
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Intel to renew commitment to desktop PCs with a slew of new CPUs Today, in a press conference at GDC, new Intel desktop CPU head Lisa Graff offered her assessment of the desktop PC market and offered Type: Feature article Tags: CPUs Chipsets Systems |
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Gigabyte's Brix Pro reviewed The first, Intel-built NUC (short for Next Unit of Computing) debuted a little over a year ago, and our own Scott Wasson picked it apart... Type: Feature article Tags: Systems |
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TR's February 2014 System Guide We've reworked our famous TR System Guide with a new, component-centric format, which tells readers not just which components to choose, but also how... Type: Feature article Tags: Systems |
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TR's Christmas 2013 system guide Yes, it's time for a new TR system guide. We have old recommendations to tune up, availability constraints to account for, and price hikes... Type: Feature article Tags: Systems |
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TR's fall 2013 system guide We've updated our four staple builds to account for all of the latest hardware releases, including the arrival of new graphics cards from AMD... Type: Feature article Tags: Systems |
148 |
Inside Intel's Atom C2000-series 'Avoton' processors Today, Intel officially unveiled the Atom C2000-series products based on Avoton, so we have the opportunity to offer a little more detail about this... Type: Feature article Tags: CPUs Servers |
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TR's back-to-school 2013 system guide The back-to-school season is upon us, and we've updated our system guide for the occasion. In addition to refreshing our usual builds, we've... Type: Feature article Tags: Systems |
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Intel aims to reinvent the data center Last week, Intel hosted an event for press and analysts where it provided some updates on the state of its data center business. Then... Type: Feature article Tags: CPUs Systems Networking Servers |
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TR's Summer 2013 system guide Over a few short months, we've seen the arrival of Intel's Haswell processors, AMD's Richland APUs, and Nvidia's GeForce GTX 700 series. In this Type: Feature article Tags: Systems |
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Intel's Thin Mini-ITX platform: nine months later Nine months after our first brush with Thin Mini-ITX, we're taking another look at the platform, this time with a state-of-the-art all-in-one PC that... Type: Feature article Tags: Systems |
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TR's April 2013 System Guide We've updated our famous system guide to account for the latest graphics cards (and their accompanying game bundles) as well as recent introductions in... Type: Feature article Tags: Systems |
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TR's February 2013 System Guide In the latest edition of the TR System Guide, we've tweaked our usual builds to incorporate newer components and price changes, making our recommended... Type: Feature article Tags: Systems |
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Zotac's Zbox ID42 Plus nettop reviewed This $400 home-theater machine crams a Sandy Bridge processor and a desktop GeForce into a surprisingly small package. We've tinkered with it, both in... Type: Feature article Tags: Systems |
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How to build a PC: The Tech Report guide Building a PC from parts might seem daunting, but it's really not that difficult. We've published an in-depth guide that walks through every... Type: Feature article Tags: Systems |
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Review: Intel's Next Unit of Computing Intel has crammed a pretty capable PC into a box that will fit into the palm of your hand and dubbed it the "Next Unit... Type: Feature article Tags: CPUs Motherboards Systems |
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Telecom industry seeks to stay the FCC's net neutrality rules | 3 |
You might say their plans... ... (•_•) ( •_•)>⌐■-■ (⌐■_■) ...took an arrow to the knee. YYYEAAAAHHHHH | +96 |


text:
B = Biographical Sketch D = Diaries M = Memoirs N = Newspaper Accounts OC = Official Correspondence OR = Official Report PC = Private Correspondence
Army of the Potomac
Brig. Gen. P. G. T. Beauregard (M, OC1, OR1, OR2 Pt 1, OR2 Pt 2, OR3,)
Acting Assistant Adjutant General (AAAG)
- Col. T. Jordan (OR)
- Capt. C. H. Smith
Acting Assistant Quartermaster (AAQ)
- Maj. Cabell
- Col. R. B. Lee
Signal Officer
- Col. Williamson
- Chief Surg R. L. Brodie
- Col. S. Jones
Aides-de-camp (ADC)
- Col. Chesnut
- Col. Chisolm
- Col. Hayward
- Col. Manning
- Col. Miles
- Col. Preston
- Col. Rice
- Capt. D. B. Harris
- Capt. W. H. Stevens
- Lt. W. Ferguson
- Lt. H. E. Peyton
Headquarters Escort
- Capt. John F. Lay, Powhatan Troop (OR)
- Capt. K. E. Utterback, Little Fork Rangers
First Brigade
Brig. Gen. Milledge L. Bonham (OR1, OR2)
- Col. Lay, AAG
- Col. Kemper, AAQ
- Lt. Washington, AAQ
- Maj. Kennedy, Chief Commissary
- Maj. Walton, Military Secretary
- Gen. Hagood, ADC
- Gen. McGowan, ADC
- Col. Aldrich, ADC
- Col. Lipscomb, ADC
- Col. Simpson, ADC
- Maj. Butler, ADC
- Maj. Davies, ADC
- Maj. M. B. Lipsocmb, ADC
- Maj. Tompkins, ADC
- Capt. A. Moss, ADC
- Capt. Nyles, ADC
- Capt. Stevens, ADC
- Capt. Venable, ADC
11th NCV (later 21st NCI)
2nd SC
3rd SC
7th SC
8th SC
8th LA (N)
- Col. H. B. Kelly (Not in Johnston's OOB)
- Co. B – Capt. A. Larose (N)
30th VA Cav
Alexandria Light Artillery (4 Guns)
1st Company Richmond Howitzers (4 Guns)
- Capt. J. C. Shields
Second Brigade
Brig. Gen. Richard S. Ewell (OR, PC1, PC2)
- Lt. Col. Charles Humphrey Tyler, AAAG
- Capt. Fitzhugh Lee, AAAG
- Capt. Charles H. Rhodes, AQM
- Lt. George Campbell Brown, ADC (M)
- Cadet John Taliaferro, ADC
- Robert F. Mason, ADC
- Edgar A. Hudnut, Clerk
5th AL (D)
6th AL
- Col. J. J. Seibels
6th LA
- Col. J. G. Seymour
- Co. E – 1st Sgt. John Tobin (PC)
Cavalry Battalion
- Col. J. G. Jenifer
Washington Artillery (4 Guns)
- T. L. Rosser
Third Brigade
Brig. Gen. David R. Jones (OR1, OR2)
- Lt. Latham, AAAG
- Capt. Coward, AAQ
- Capt. Curfell, AAQ
- Capt. Ford, AAQ
- Capt. Taylor, AAQ
- Lt. McLemore, AAQ
17th MS
- Col. W. S. Featherstone (OR)
18th MS
- Col. E. R. Burt (OR)
5th SC
- Col. Micah Jenkins (OR)
Flood's Company, 30th VA Cav
- Capt. J. W. Flood
Washington Artillery (2 Guns)
- Capt. M. B. Miller
Fourth Brigade
Brig. Gen. James Longstreet (OR1, OR2)
- Lt. Armistead, AAAG
- Lt. P. T. Manning, AAQ
- Col. Lubbock, ADC
- Col. Riddick, ADC
- Col. Terry, ADC
- Capt. Chichester, ADC
- Capt. Goree, ADC (PC1, PC2)
- Capt. Sorrel, ADC
- Capt. Thompson, ADC
- Capt. Walton, ADC
5th NCI
- Col. McRae
- Lt. Col. Joseph P. Jones (OR)
1st VA
- Col. Moore
- Maj. F. G. Skinner
11th VA
- Col. S. Garland
17th VA
24th VA
- Col. P. Hairston
Company E, 30th VA Cav
- Capt. E. Whitehead (OR)
Washington Artillery (2 Guns) (N)
- Capt. Garnett
5th Brigade
Col. Philip St. George Cocke (OR)
- Capt. Harris, Chief Engineer
8th VA
18th VA
- Col. R. E. Withers (OR)
19th VA
- Col. P. St. George Cocke
- Lt. Co. J. B. Strange
28th VA
49th VA (Battalion)
Schaeffer's Independent Battalion (N1, N2)
Loudon Artillery (4 Guns)
- Capt. Arthur L. Rogers (OR)
- Lieut. Henry Heaton
Lynchburg Artillery (4 Guns)
- Capt. H. Grey Latham (OR)
Wise Troop (Cavalry Company)
6th Brigade
Col. Jubal A. Early (OR1, OR2)
- Capt. Gardner, AAAG
- Lt. Willis, ADC
7th LA
13th MS
- Col. W. Barksdale
7th VA
- Col. J. L. Kemper
Washington Artillery (5 Guns) (N)
- Lt. C. W. Squires (OR)
- Lt. J. B. Richardson
- Lt. J. B. Whittington
7th Brigade
- Capt. A. L. Evans, AAAG
- Capt. McCausland, ADC
- Capt. Rogers, ADC
1st Special LA Battalion (N1, N2, N3)
- Maj. C. R. Wheat (W) (OR)
- Lt. Allen C. Dickinson, ADC (N)
4th SC
- Col. J. B. E. Sloan (OR)
Alexander's Troop, 30th VA Cav
- Capt. J. D. Alexander (OR)
Terry's Troop, 30th VA Cav
- Capt. W. R. Terry (OR)
1 Section Lathams Artillery (2 Guns)
Reserve Brigade
Brig. Gen. Theophilus H. Holmes (OR)
- Lt. Walker, AAAG
1st AR
- Col. J. F. Fagan
2nd TN
- Col. W. Bate
Purcell Artillery (6 Guns)
- Capt. L. Walker
Albemarle Light Horse
- Capt. Eugene Davis
- Major John Scott
Hampton's SC Legion (6 Companies)
Col. Wade Hampton (W) (OR); Capt. J. Conner (PC1, PC2)
Harrison's Battalion of Cavalry (4 Companies)
Maj. Julian Harrison
Camp Pickens Battery
Capt. I. S. Sterrett
Army of the Shenandoah
Gen. Joseph E. Johnston (M, OR1, OR2)
Acting Adjutant General (AAG)
- Brig. Gen. E. Kirby Smith
- Maj. Thomas Grimke Rhett (OR)
Acting Assistant Adjutant General (AAAG)
- Capt. Thomas L. Preston
Acting Assistant Quartermaster (AAQ)
- Maj. McLean
- Maj. Kearsley
- Maj. William Henry Chase Whiting
- Col. W. N. Pendleton (OR)
- Col. Thomas
Aides-de-camp (ADC)
Col. Cole
Col. Duncan
Maj. Dees
Capt. Fauntleroy
Capt. Mason
Lt. James B. Washington
1st Brigade
Brig. Gen. Thomas J. Jackson (OR, PC)
Col. F. B. Jones, AAAG
Lt. A. S. Pendleton, Ordnance
Capt. Marshall, ADC
Lt. T. G. Lee, ADC
Cadet N. W. Lee, ADC
Cadet Thompson, ADC
2nd VA (M)
- Col. J. W. Allen (OR)
4th VA (M)
- Col. J. F. Preston
- Co. I – Pvt. John H. B. Jones (M)
5th VA
Col. K. Harper
Co. L – Capt. J. H. Waters (OR)
27th VA
- Lt. Col. J. Echols
33rd VA (8 Companies) (M)
Rockbridge VA Artillery (4 Guns)
2nd Brigade
Col. Francis Bartow (K)
Brig. Gen. S. R. Gist, ADC
Col. Shingler, ADC
Maj. Stevens, ADC
7th GA
- Lt. Col. L. J. Gartell
8th GA
Wise Artillery (Alburtis' Battery) (4 Guns)
- Capt. E. G. Alburtis
- Lt. John Pelham (PC)
3rd Brigade
Maj. William H. C. Whiting placed in command after the battle (OR)
Capt. T. L. Preston, AAAG
Brig. Gen. S. R. Gist
Maj. R. A. Howard
Capt. A. Vander Horst (Gist, Howard, & Vander Horst filed this OR for Bee's Brigade, but are not listed on any OOB as part of Bee's staff)
4th AL (M)
- Col. Egbert J. Jones (MW)
- Lt. Col. Evander M. Law (W)
- Maj. Charles L.Scott (W)
- Capt. Thomas J. Goldsby (OR)
- Unknown (PC)
2nd MS
- Col. W. C. Falkner
11th MS (Companies A & F)
- Lt. Col. P. F. Liddell
6th NC (Not Brigaded) (N)
- Col. C. F. Fisher (K)
- Co. E – Lt. J. A. McPherson (PC)
Staunton Artillery (4 Guns)
4th Brigade
Brig. Gen. Edmund Kirby Smith (W); Col. Arnold Elzey (OR)
- Lt. Chentney, AAAG
- Lt. McDonald, AAQ
- Col. Buist, ADC
- Capt. Cunningham, ADC
- Capt. Hill, ADC
- Capt. Tupper, ADC
- Lt. Contee, ADC
1st MD Battalion (M)
- Lt. Col. G. H. Steuart
- Unknown Officer (PC)
3rd TN
- Col. J. C. Vaughn
10th VA
13th VA (Left at Manassas)
- Col. A. P. Hill
Newtown Artillery (4 Guns)
Capt. George. A. Groves
Lt. R. F. Beckham
Not Brigaded
1st VA Cav
Thomas Artillery (Stanard's Battery) (4 Guns)
- Capt. P.B. Stanard

subset: commoncrawl


text:
*** Welcome to Remnants, a 2nd generation Harry Potter play-by-post role-playing game. The goal of Remnants is to allow people of all ages to come together in a safe and friendly setting in order to share two common interests - writing and Harry Potter. So go on and have a look around and make an account if you're interested. *** *** Timeline: August 22 - September 2 August 22nd - Percy Weasley's Birthday September 3rd - Hogwarts Express leaves from King's Cross September 4th - Classes start at Hogwarts <
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Course Details Course Description About The Instructor |
Session, Dates: 1 (08/29/2011 - 12/17/2011) Days: R Time: 07:45 - 10:15 am Location: Moon Campus Room: John Jay 239 Seats Available: 2 Seats Credits: 1 |
Course includes a laboratory/recitation period consisting of hands-on demonstrations of topics reviewed in lecture and experimentation utilizing the analytical techniques and equipment reviewed in this course. Language of anatomy, histology, integumentary system, and skeletal and muscular systems will be studied in detail. Principles of scientific inquiry are integrated throughout the course.
Lewis M. Stein, D.P.M.
Coordinator, Pre-Med / Lecturer of Biology
email@example.com 412-397-6336 phone 412-397-8277 fax John Jay 146 Profile |


text:
"WOW! I learned so much. "Happy Feet", enough said."
Yes, I would recommend this book to anyone interested in the people around them.
I remember reading a book about body language in the eighties. I can't remember the exact title, I was quite a bit younger, (weren't we all?). But.. in that book a lot of the same observation were made.
No, but he did a great job.
*See Headline
I loved this book. It comes with a PDF. Make sure you download it.
"Thank you Kim Harrison for the memories!"
Wow! What can I say? Kim Harrison did an extraordinary job at wrapping up her "Hollows" series. We finally find out the answers to so many questions that have been floating around for almost the entire series.
I really liked that Ivy is such a prevalent part of this book. She has really sacrificed a lot because of her love and friendship for Rachel. So it was nice to see some light come into her sometimes sad existence.
There is plenty of Trent in this book too. Which was GREAT! But one of the best parts of this book is the relationship between Al and his "itchy witch".
What a good book. I'm still wheeling. It's just that incredible. I wish other series I've read would have ended half this good.
"Surprisingly Great."
I kinda stumbled upon this book. It turned out to be really good. The main character is very interesting and well written.
I liked the premise. An older women walks into a bar to drown her sorrows after her husband's death. Two vampires decide to make a bet to see how long it would take her to change, planning to kill her after the act. Instead, she escapes and has to figure out how to be a vampire on her own.
It only gets more interesting. I highly recommend this book.
"My Favorite IAD Book, Hands Down!"
I loved this book! I bought it as a Kindle edition first, and then I counted the days until it was released as an audio book.
This book has every thing that fans of PNR love. Great characters with good chemistry, an engaging story and a lot of good old fashioned humor.
BTW Robert Petkoff is the perfect narrator for this series. He does a great job with all the many, many different accents.
"I'm a fan of Kresley Cole, But not this book"
I've read all of the books in the IAD series. But I'm sorry to say, this is my least favorite of them all. Which is sad , because I was really looking forward to Regin the Radiant's story.
The problem I had was with the main male character, Declan Chase. He is just not a good man. The things he does are really cruel, and he doesn't seem to feel bad for all the pain he has inflected on the immortals he held in his prison. I just couldn't get over that.
"If you loved I, CLAUDIUS. You'll love this book!"
I'm a huge fan of I, Cladius and Claudius the God by Robert Graves. So, when I heard about this book, I was really excited.
It is written in the same manner as Robert Graves' books. But, this time Livia gets her say.
GREAT BOOK! I recommend it to all historical fiction fans.
"Much Better Than Last book"
Don't get me wrong, I liked the last book in Patricia Briggs' Mercy Series. It is just that for some reason or another, Mercy is always a little better when Adam and her are separated for some of the story. With this book you get it all. Mercy at her finest . Solving the most complex situations.
My only complaint, is that I wish Adam and Mercy's sex scenes where a little more detailed. I would like to know what they were thinking. All and all great bool. Well worth the credit.
"It Doesn't Get Better Than This!"
Great Story. Unbeatable Narration. Perfect Mixture of Sexual Tension, Humorous Interaction, and Great Sex between the Main Characters. Everything and Anything a Lover of the Paranormal Genre could hope for and more.
This is such a great Book.
Audible, Please Make all of Kresley Cole's books available. SOON!
"New Spin-Off Series. Not as Good as Shadowdellers."
I'm a fan of Jacquelyn Frank and of Xe Sands. So I'm a little disappointed that I couldn't get into Ms. Frank's latest Nightwalker branch-off series. I couldn't get over the whole one body, two souls concept.
But from reading some of my fellow Audible Book Readers reviews. A lot of you like this series very much. I'll have to wait for the next book (which is already in print) and see if it is more appealing to me. You never know.
I just wish she would write the 4th book in the Shadowdellers series. Now, that is a HOT & interesting series. One of my all time favorites.
"Memories, 1st Book to Freak Me Out! I was only 13."
I have no idea, how at the age of 13, I managed to get my hands on this book. But I did, and I became completely obsessed with it.
I read it so much, that my Mother took it away from me. She said "I acted different and strange" while I was reading it.
She must not have read "Flowers" before me. Because there is NO WAY she would have allowed me anywhere near this book. What with the child abuse, the incestuous affair, the murdered child, not to mention, the poisoning of the three legged pet mouse . I wouldn't let my kids read it either.
So, imagine my surprise to find "Flowers In The Attic" while checking out the New Release page on Audible. All those old, strange feelings came rushing back. So, of course, I bought the book, downloaded it, and began listening right there and then. All the while feeling the familiar naughtiness of my youth. Like sneaking to the candy store without telling anyone (which I did a lot) .
What are my thoughts and reactions to "Flowers" after all the time that has passed? Well first, I can't believe how much I remember from the story. I can still picture the characters exactly how I saw them as my younger self. And second, I'm amazed how well this story, which was written in the late 70's, has held up to the test of time. It's still a sad and very interesting tale of love, loss, and the ultimate betrayal.
Would I recommend it? Yes, it's credit worthy. Alyssa Bresnahan is an experienced and talented narrator. Which as fellow audiobook readers, we know, can make or break even the best written books out there.
FYI : While listening to this book, I acted "different and strange ". But no one noticed. :)
What can I say, this is one of the best series Audible has to offer. Each book is better than the last.
The narration is PERFECT! Luke Daniel's performance, as the main character, Atticus, is right on. I swear, Author, Kevin Hearne and Mr. Daniels must be buddies. How else could Mr. Hearne 's wit, humor, and intensity be conveyed with such perfect pitch and play?
I found myself lost in this book. Which is a very nice place to be. :)
Worth the Credit? YES. I can not wait for the next book.
HUMOUR. ACTION. DRUIDISM, AND SEXY.... EVERYTHING. What else can a girl ask for?!!!


text:
Wednesday, December 13, 2006
Pancreas stuff, #3
"In the matter of Patient X," read the letter from the state board of medical licensing, "we find no evidence of improper dispensing of narcotics. In the future, however," they went on, most helpfully, "we suggest you pay more attention to how your prescription behavior may appear." The fact that the letter was sent to my colleague and not to me made it no less infuriating. You did nothing wrong, they'd told him. But you need to pay more attention to how idiots like ourselves may react to your practice-habits, rather than to the needs of your patients. Brilliant.
It's been said that the main indication -- without which you ought not go ahead -- for surgical treatment of chronic pancreatitis is addiction to narcotics. Pain, in other words: pain unmanageable by any other means is what provides the rationale for operating on people with chronic pancreatitis. When Patient X had been sent to me, that's exactly the situation he was in, along with the typical debilitating malabsorption syndrome. The non-disciplined disciplined doc was a gastroenterologist, the best around, the one I'd go to if I needed one. Circumspect, brilliant, ethical, dedicated, hard-working, in case the idiots on the board hadn't noticed. But I'm getting off point. Bastards. Sorry. Pin-headed pricks. OK; my bad. Where was I?
Patients suffering from chronic pancreatitis are rarely if ever (as opposed to those with the previously-posted acute form) at death's door. Instead of (or as a result of) boiling away in an acute froth, their pancreases have hardened into a wooden wedge, stuck to and behind colon and stomach, functioning poorly, generating constant and sometimes crescendoeing pain. Neither able to produce the needed amount of digestive juices nor to dribble them freely into the gut, the chronically inflamed pancreas also may short its owner on insulin, making him/her diabetic. In pain, having stinky fat-laden diarrhea, diabetic: those people -- as I said in the first post in this series -- can be miserable enough to wish they were dead. Ol' Patient X was: he was at the end of his rope when I saw him. Coincidentally, the letter from the board announcing an inquiry (initiated by a concerned pharmacist) arrived at my friend's office about the time Mr. X arrived in mine.
Let it be said: surgery for chronic pancreatitis is no panacea. Outcomes are unpredictable, as they are with any therapy whose primary goal is reduction of pain. To the extent that surgical treatment is rational (well-selected, it is, in my opinion), it breaks down into two options: drain or remove. And the choice between those two approaches depends mostly on the pancreatic duct. If it's big and dilated, drainage is probably the way to go. If it's obliterated and/or filled up with tons of calcification, you might want to remove most (or all) of the pancreas. Given the previously described tough location, now distorted by scarring, and given the debility of losing all digestive enzymes (they can be taken in pill form, to marginally adequate effect) and of becoming a brittle diabetic, surgeons (this one, anyway) tend to choose door number one, when the opportunity presents itself, and to avoid door number two like the plague. But it's not simple. When there are lots of operations to accomplish the same goal, it follows that the perfect one hasn't been invented. This gives you an idea of the problem with pancreatitis. But I'm a simple guy. There's one operation I especially like.
Here's an example of a normal pancreatic duct: (the big thing on the left [black arrow] is a scope; the red arrow shows the duct.)
And here's a nicely obstructed and surgically approachable one:
I don't want to get all technical here. Let's just say it's fun do to this:
(And here is an example of why operative photographs are pretty much useless, compared to diagrams.)
Patient X loved it, too. Taking huge doses of narcotics for months, you'd think (especially if he were a drug seeker) that he'd soak them up like a parched pig post operatively. He didn't. In less than two weeks, he was off them for good. (Which sorta pudding-proofed the GI doc's argument that he was treating legitimate pain, and halted the inquiry. By the way: it's not the inquiry per se that hacked me off: it was the pissy letter.)
Because they've saved my hide a few times, I really have no business complaining about radiologists. But they expropriated some of my favorite operations; namely, draining pancreatic pseudocysts. Like draining pus, it's deeply satisfying, because it works: see cyst, drain cyst, say goodbye to cyst. Unlike people housing pus, however, most people who have a pancreatic pseudocyst don't feel bad; so you have to convince them they need it treated. It's true. But it's never comfortable to feel like you're talking someone into an operation. It's one reason I haven't gotten totally depressed over losing the operation to the radiopods. Another is that it comes along pretty rarely. Plus, in some locations, surgery is sometimes still the better choice.
A true cyst is a collection of glandular secretions fully surrounded by a wall made up of duct lining cells. A pseudocyst, in the context of pancreatic secretions, is a collection of pancreatic juice left over from acute pancreatitis, formed into a defined sac, but surrounded by, well, just stuff. Scar tissue, whatever. Small ones, recently formed, have a decent chance of going way on their own. Big ones risk getting infected, or spontaneously draining into the rest of the abdominal cavity; which is why draining them is a good idea. Paradoxically, I suppose, the dangerous anatomy I've talked about in this series turns out to be good when it comes to draining pseudocysts: stuck to the back of the stomach, a cyst can be drained by opening into the front of the stomach, confirming the location with a needle out the back, then cutting down on that back wall and into the cyst.
A row of sutures around the edges of the hole prevents leakage, and eventually the cyst just withers away into the stomach, sealing back up like it was never there. The radiologists do that, now, with a needle (followed by a tube) poked through the abdominal wall, the front and back of the stomach, and into the cyst. Works great. Dammit.
61 comments:
- Kat said...
Thank you. It's good to hear a docs perspective on pancreatitis.
Thank you so much for all your information and the acknowledgement that messing with the pancreas is a terrible thing to do. I had one attack of acute pancreatitis that made me pretty sick...retained a stone after my gallbladder was removed, and in the process of having that stone removed. Now I live with Chronic pancreatitis with acute flares (which aren't so cute...) God bless you for writing about it. I appreciate it!
- azian_chinai said...
hi.my sister will undergo Pancreaticojejunostomy.because of complete pancreatic duct obstruction.she is married now and lives in UK.But, she is having a vacation here in the philippines.what are the dangers of the said procedure?and where do u think will be the best country to do the procedure and what hospital?
- jannet said...
Can a person live with only 1/4 of his pancreas? A pseudocyst has been removed 6 wks ago and is still draining 40cc daily. 46 lbs have been lost in less than 4 months.
- Sid Schwab said...
jannet: yes. People can live without their entire pancreas. They will be diabetic and require insulin, and will need to take pancreatic enzyme pills. But it can work. With a third of a pancreas, depending on the underlying conditon of the gland that's left, it's likely they'd need those things too, but less; and easier to manage.
- Kaffinity said...
Hey Doctor Sid - do you know much about a Roux-en-y-loop? My mum had one done last July. Prior to that she had a partial necrostomy (think thats right) She had 2 pseudocysts and a drain for 3 months. I am not sure exactly what the Roux Loop did. She has changed fron Acute (she nearly died) to chronic Pancreatitis. She cant eat much but is not diabetic.
Karen. (Worried daughter) - 11/25/2007 5:33 AM
- Sid Schwab said...
Karen: that's exactly what a picture in this post shows: the one with the blue background, about which I said it's fun to do this. With chronic pancreatitis, no operation is a cure. But given the proper anatomy, this can succeed in lessening pain.
- Kaffinity said...
So is a Roux loop a lateral pancreaticojejunostomy?
My mum is in a lot of pain all the time and she was booked in to have all her pancreas and spleen removed but the surgeon performed the Roux loop instead. I often wonder would she have been better
to get rid of the pancreas?
Its great to talk to a surgeon by the way - thanks.
karen. - 11/25/2007 2:27 PM
- Sid Schwab said...
Yes. You can see how the bowel has been rearranged into the shape of a "Y." The choices are all imperfect, and the results hard to predict. This operation is most likely to work when the ducts are significantly dilated. I have no way to comment on a specific case from afar.
- Kaffinity said...
Oh I understand you cant be specific I just appreciate any kind of response. Its a very serious and depressing condition.
After surgery on his pancreis, my brother got bacillus gram negative
rods. All I know about it is that it is a blood infection. Can you give me an idea of why and how he
would have got this? I can not find any info on it. Thank you so much. - 12/25/2007 10:19 AM
- Sid Schwab said...
That description fits several bugs that live in the gut in everyone. E. coli is an example. (Even though e.coli infections get lots of coverage when they show up in restaurants, we all have them living normally in us.) Getting infection with those bugs is a risk for anyone undergoing any surgery on the intestinal tract; and most operations on the pancreas are included. So it's not real common, but neither is it rare. Depending on the nature of the surgical infection, when they start in the belly it's not hard for it to spread into the bloodstream. When it does happen, the cause may or may not be serious; and it may or may not respond easily to antibiotics. Scary as it sometimes is, an infection like that, more often than not, is relatively easily treated, depending on the specific cause.
Thank you so much. He is at least out of the hosptial, sent home with antibiotics and had his blood tested again today. Many thanks for answering my questions.
I have (3)pancreatic pseudocysts. Had pancreatitis 2/08. My pseudocysts are all larger than 6 cm and my Dr. says as long as I am feeling ok I shouldn't worry about them. What are your feelings?
- Sid Schwab said...
It's one of those gray areas, and decisions going forward need to take in account many individual factors to which I'm not privy. In general, the "conventional wisdom" is that cysts which persist longer than 6 weeks and which are greater than 6 cm ought to be strongly considered for drainage. Are those concepts based on well-studied data? Probably not. Can one predict what would happen if they aren't drained? No. Among the possibilities are: nothing, rupture, infection, bleeding. Of the ways to drain, the options are with the xray guided placement of a tube, or by surgery.
In difficult areas like this, I think additional input is a good idea: from a gastroenterologist and/or a surgeon, one with plenty of experience operating on the pancreas. - 7/30/2008 1:52 PM
Most of the stuff on this blog is from one to three years ago so I'm just wondering if you still answer. I had a whipple surgery to remove two cancerous cysts from my pancreas in Aug. of 2007. Because of no insurance I haven't had any follow ups or meds, trying to avoid the death issue I avoided the whole topic of mortality of whipple surgery survivors but now am experiencing gas, pain, bowel problems and headaches. Can you suggest some web sites or books on recent research on help for whipple surgery survivors???????? Is there still a five year survival rate for us??????????
- Sid Schwab said...
Shellee: survival rates are only marginally useful, in that they apply to large numbers of people but can't tell anything about an individual. In addition, if you really had cancerous "cysts," it could indicate a less dangerous form of pancreatic cancer. If you want to know what the data are, it's important that you know exactly what your pathological diagnosis was.
As to websites; the symptoms you describe -- depending on what you mean by "bowel problems" could indicate pancreatic insufficiency, or another syndrome called "dumping syndrome." You could search those terms and see if what you come up with compares to what's going on with you. The best idea of all, of course, is to see a doctor; but I understand how difficult that can be without insurance. You might contact the hospital in your area to be put in touch with their social service department to see what help might be available. - 11/28/2008 7:48 PM
Have you heard of an large mural thrombus in the aorta causing pancreatitis?
- Sid Schwab said...
Heard of it. Never have seen it. I assume it's pretty rare. Here's an article that refers to it.
Hi, I wrote to you back in November about having some side effects from the Whipple surgery and you replied that I should find out more about my diagnose. I did find a letter from the endoscopic ultrasound and fine-needle aspirate biopsy that was taken. This is what the doctor said, "Aspirate came back positive for mucinous changes within the cyst fluid. This finding puts you at significant risk for progression into a pancreatic malignancy, and the whipple is a very acceptable treatment plan." Does this mean it wasn't cancerous and only had the potential? I did some research on dumping syndrome and it sounds very much like what is going on with me. I still have no insurance, any suggestions on diet that may help relieve the symptoms of this. Is it absolutely necessary to take enzymes and can a enzyme supplement from the health food store do the same thing as a prescribed enzyme? Any symptoms that I should watch for that I should go to the doctor immediately? I really appreciate your advice as it is so difficult to get up to date information online. Thank you.
- Sid Schwab said...
Shelley: I hate to get into specifics for people I don't know. I infer from what you wrote that there was no malignancy found in the needle aspirate. It might also be useful to know of the final diagnosis of the pancreas after it was removed, ie, whether there was anything else found.
If you found articles on dumping, you must have also seen recommendations about diet. Generally they include avoiding high-sugar foods, drinking liquids between meals rather than with meals, etc.
As to enzymes: if there is known pancreatic insufficiency, then pancreatic enzymes are generally useful. Unless the "enzymes" you are talking about from the health food store are specifically pancreatic enzymes --which they likely aren't -- they won't be useful. A hallmark of pancreatic insufficiency is diarrhea, particularly involving undigested fats, and very often weight loss. Once again, you'd be much better off with the care of a doctor who can see you and know you. All I can do is make general comments, and I can't really go beyond what I've said here. - 1/20/2009 7:37 PM
Thank you for your comments. I know you can't give me medical advice that I can absolutely live on, but I do appreciate your comments and it gives me ideas as to do more research on other options. I will eventually go to the doctor but at this time I have to choose my visits wisely as I know I will need those doctor visits more as my side effects become worse. Again, thank you for your help.
- Susan said...
My has pancrease cancer that is one solid tumor and has not spread. He had never had any pain untill 3 weeks ago when he was diagnosed with a large(baseball) size pseudocyst. He is now in pain and unable to eat. The doctors says that draining the cyst would not be useful to him. She said that it could come back.
What do you think? - 3/02/2009 1:21 PM
- Sid Schwab said...
Susan, that's a really hard question to answer without knowing details, such as whether the cancer was removed, whether the cyst is separate from the cancer, what the source of the pain is felt to be. Getting a second opinion in complicated cases is often useful, but it should be from someone able to examine the person and review the records. I try to provide general information and insights, but it's nearly impossible to give a meaningful opinion on specific cases from so far away.
I have a quick question, this does not relate to a personal experience, just curious. If a patient has severe acute pancreatitis of unknown origion, no stones in any ducts blocking flow, but only known hx possible etoh. Person does not report drinking that much, but recently a lot in a short period of time. CT shows edema surrounding pancreatic head, with phlegm? cxr also shows elevation of L hemidiaphragm. Pt wbc goes from 11 to 17, and creatinine shoots up from 0.9, to almost 2. urine output minimal and very dark tea colored. b/p being supported by ivf @ rate >150cc/hr. Initially had Kcl, but when potassium level started to rise, removed from fluids. Platlets start to drop, amylase>700, lipase>60000, all liver enzymes elevated, along with bilirubin. pt is npo, with pain, and abx covered. Pt appears to be third spacing, and is on 3l./nc with tachycardia. Surgical consult ordered. What could the surgeon possibly do in this case, when there is no cyst or abscess noted on the ct one day prior, could they even do anything at this point? If you don't feel comfortable answering I understand. I am just truley interested to know what role the surgeon would play in helping, if no identifiable mass, cyst, present to drain to duodenum? thank you in advance, even if you don't respond.
- Sid Schwab said...
Because people with pancreatitis can get pretty sick and sometimes require surgery of one sort or another, surgeons are often consulted even when it's not clear there's an operation in the future. In the case you describe, it doesn't seem there'd be an immediate role for a surgeon, and there may well never be. But asking one to follow along isn't unusual.
thank you for your response.
Thank you for taking the time to sit down and explain this information in less technical terms-
i am a new grad nurse and i had a patient recently that had a cyst drained following an acute pancreatitis and in the blink of an eye became septic.
i had never heard of these cysts in nursing school- he had a hx of heroine abuse and etoh with constant tremors so aside from the temp spikes and the sharp wbc spike there wasnt much clinical data to determine his impending change in status. he had been tachycardic since admission (the information i got in report) in the 140's. bp was stable and became more and more tachypenic as the shift went on. none of the doctors addressed anything but the tremors which ceased while he slept except for the pulmonolgist who did a thoracentesis and got 400ml out.
since i am still learning and questioning every step i take- be it guided with my preceptor or independent. i am curious if there is anything i totally missed with the picture, a way i could of convinced them of his transfer to icu prior to profuse diaphoresis and a temp of 103 that wasnt being touched by the norco and tylenol any longer. - 4/01/2010 2:22 PM
- Sid Schwab said...
newRN: people with pancreatitis can be sick as hell, and there are so many complicating issues it's hard to say much from so far away. Was he dehydrated, was the cyst infected, was the pleural fluid infected? I have no way of knowing. But I think the most common error initially is not replacing fluids adequately, as well as electrolytes, calcium, etc. I'm a prejudiced surgeon, but in my experience medical people undershoot fluid resuscitation severely; and they make critical decisions -- like draining the cyst -- without surgical input.
It's a difficult decision about when/whether/and by what means to drain a cyst. In my view, it's often an error to do so early in the process, because many resolve on their own, and traversing the area can cause sepsis. Was that a factor? Who knows?
As a newbie, you're in a tough position when you have concerns. Not knowing more about what was going on, it's hard to suggest what to say or do; but you certainly DO have a right to raise concerns. Maybe you could sheepishly ask, for your own edification, when they typically ask surgeons to consult. What are their criteria for deciding when to drain a cyst? That sort of stuff. Obsequious. Because you're just a silly young nurse and they're wise and all-knowing doctors.... Heh.
It gets easier, I think. I can tell you that when certain nurses who'd been around the block a couple of times, and with whom I'd worked a lot, called me to say something was wrong with so-and-so, I paid a LOT of attention. - 4/01/2010 5:27 PM
I really enjoyed your blog, particularly the ones about pancreatitis. I had acute gallstone necrotizing pancreatitis in March, 2009, was in the hospital 6 months, had kidney and lung failure, sepsis, 4 nosocomial infections, 7 operations, etc. My surgeon definitely saved my life, and I am doing well now with just one surgery left (to reverse my ileostomy, as the pancreatic enzymes destroyed half of my colon). This helped me understand what I went through. It was hell, but I survivied, thanks to my surgeons and other doctors.
As a 33 year old who suffered from pregnancy induced acute pancreatitis who now suffers from plain old chronic pancreatitis, it's nice to see a surgeon who knows just how much pain we are in and don't just take the meds for the sake of it !. Now if you could just do something about the alcoholic tag i get everytime i attend my local hospital i'd be EXTREMELY grateful !!.
- Sid Schwab said...
anonymous: that's about as bad as it can get and still be survived. Whew!
Scotsferret: wish I could help. - 8/31/2010 2:34 PM
Yes, it was a bad case of pancreatitis. Every doctor I saw (I had 7 different specialists) said it was a miracle I lived. They were getting ready to tell my family I was most likely going to die when I turned the corner. On top of all that, 3 months ago I found out I had endometrial cancer (which I believe was indirectly caused by the previous illness). Hopefully, it is cured by the surgery I had 2 months ago. I am doing remarkably well, and am not even diabetic. My surgeon is my hero! Thanks for your blogs; you write quite beautifully.
Nyllrap (formally anonymous) - 9/01/2010 12:41 PM
Absolutely superb and informative blog. Cheers mr Sid. I had open necrosectomy 18 month ago in Manchester uk. I was very poorly and really lucky to be where I am down today, lucky that I was eventually treated by a brilliant man and his team, mr o'reily, who knew their business all ends up. He, and all the men and women like he and yourself who study, and understand the pain and anguish, both physical and mental, have my heart felt thanks and admiration. Heavens only knows how many families are still together thanks to your knowledge, skill, and dedication.
Wish I could put into words how in awe I am of you folks.
Paul. Manchester UK. - 9/03/2010 3:37 PM
- Sid Schwab said...
Thanks very much for your words, Paul. You've come through well, I infer.
I'm as good as I've been in a long time, apart from addiction to pain killers, but I'm due to face up to this very soon.
My probs now are more mental than pain. I'm absolutely terrified of being ill again so I eat tramadol to make sure I feel no twinges.
It's refreshing to see words from people who have treated sufferers of this illness and to see that you don't all just assume immediately that every patient is an alcoholic, although I understand this is the main cause of pancreatitis?
I had acute attack in 2008, leading up to this attack I was suffering attacks at least once a week, mainly after creamy foods and deserts. My gallbladder was removed due to stones, I was great for 3 month then attacks started up again. Soon they were daily, after lunch I would gomand sit in my car and double up in agony. 36 year old man crying in works car park in pain every day.
The attacks normally settled 3/4 hour after eating. Last attack did not settle and my wife called ambulance at 2 am. The next 3 month I spent in hospital with my surgeon, who had previously whipped my GB out, just dosing me up on antibiotics trying to let the pancrease settle. It didn't and I was transferred to North Manchester general. They tried to drain via tube in left side of body but this did not aid so attempted to perform keyhole but when I awoke I was told they could not access because no room past spleen and kidney.
2 days after that I underwent open necrosectomy and went to HDU. Whilst there I was on ketamine and was given double my dosage. Night after I felt a pop in left kidney area and began passing lots of blood clots from below. I had my normal cathater replaced with one which forced saline I to bladder to ensure that clots were not allowed to build. Eventually let home with stoma drain passing approx 150cc per day. Self injected to reduce, forget the name of injection, and went on from there.
I'm still scared stiff with every tummy ache or heartburn but need to learn that life is for living and I've been granted the opportunity to do that thanks to skill and dedication of doctors and nurses who tended me, as well as my brilliant wife and kids who put up with my neurotic mood swings and almost hypochondriac personality :-)
I hope that you guys get the opportunity to reflect, during retirement, on all the success stories and families you have helped over your careers. You truly are miracle workers. You may think at times you're just doing your job but that job sometimes gives people like me our lives back when, without intervention, my wife would be a widow, and my children fatherless.
Stay lucky chief.
Paul. - 9/04/2010 3:51 PM
I just had my second confirmed bout of pancreatitis - with a cyst found by CT scan this time... and plenty of stomach pain over the past few years. I'm not a drinker (in fact coworkers tease me about that) but I do have high triglycerides - something my dad unintentionally shared with me.
On this fine autumn Saturday night I'm in my recliner watching tv and the clock for my next dose of pain meds. Wasn't admitted to any hospital... but I'm waiting to hear from a local gastro doc to see what he wants to do.
I had hoped he could just cut me open and "fix" this - but after reading these posts I think I'll ask what non-invasive options I have. Will they want to sample the fluid in this cyst? or maybe just take a closer look at it?
I don't mind losing a bit of weight, but I'm starting to miss having real meals... and the pain can be quite intense if I'm not medicated... but I can't drive when I AM medicated. *sigh*
I'm single, in my late 40's and diabetic. I sure don't want to think this is going to run my life from here on out. - 10/23/2010 6:07 PM
- Sid Schwab said...
Like much else about the pancreas, cysts are tricky. If acute, they may resolve on their own, with no intervention needed. Sampling the fluid might be considered if there's a question of it being infected; otherwise, not too likely.
Depending on location, a persistent cyst can usually be drained with percutaneous techniques (ie, with a needle through the skin), non-surgically. - 10/23/2010 6:40 PM
can a person live a healthy life without pancreas plz do help me
- adi said...
hi frnds, pz help me out im sufferinf from chronic pancreataties with attacks after every 10 days. can a person live a healthy life without pancreas
- Sid Schwab said...
adi: it is indeed possible to live a pretty normal life with no pancreas. The most serious issue is that one would be diabetic and need to take insulin. But diabetics can do pretty much anything they want in life.
It's usually necessary to take pancreatic enzyme pills with meals, also. But for people with severe debilitating chronic pancreatitis, it can be a fair trade. - 11/10/2010 8:06 AM
- Dale said...
Thanks for the information on pancrease removeale .There isnt much info. out there. Ive had pacretitis for 32 years. The galbladder had stones but with all the gas it didnt show up on tests.Over the years I had some very good doctors and nurses. I also had some that should never have taken up that line of work. The pain from pancretitus for me was unreal. Many day you wished you were dead.I ended up taking methadone 30 MG up to 10 times daily. Finally my pacrease shut right down and I had 90 % of it removed. I now only require 10 MG of methadone at night. I could proably not take that but if I dont the pain keeps me up most of the night.The only problem now is I feel tired all the time. I take insulen 5 times A day plus Cotazym ECS. 20 with meals. Dont get me wrong Im not complaning as I feel 200% better since operation. What im asking is there some thing else I can try for the tiredness. Thank you for your info Dale
- Sid Schwab said...
Dale: you didn't say how recently the operation was, but tiredness can last for months after major surgery like that. However, since there are lots of possible reasons for tiredness, there's no way for me to make a suggestion other than to say you should work with your doctor to address it.
- The3rdEYE said...
Hi,streight to the poit sir. I have chronic pancreatitis. What I want to know is once the whipple is performed and they cut the damaged part of the pancreas off, what ever percentage of the pancreas is left in my gut does it keep on self destruction mode or it stops there? are enzymes enough to survive without a pancreas? Also I keep on hearing about these artificial pancreas but they only seem to be focused on diabetics, do you know of any advances that are being made that can help people like us?
- Sid Schwab said...
3rdEye: Doing a Whipple procedure for chronic pancreatitis is pretty rare, in my experience; in fact, if the chosen operation is to remove pancreas (as opposed to a Peustow procedure to drain it), one would usually choose more or less the opposite of a Whipple. In other words, remove the body and tail of the pancreas but leave the head, where all the anatomy is.
For pancreatitis, any operation that aims to remove the pancreas, all or in part, is nearly sure to leave the patient diabetic and in need of taking digestive enzymes. For those with severe chronic pain, it can be a fair trade. If the anatomy is right -- ie if the pancreatic duct is dilated, the initial choice is usually something like the Peustow.
Taking pancreatic enzymes generally can work well. As you said, "artificial pancreas" generally refers to ways of managing insulin requirements. The cells that produce insulin, islet cells, can be harvested and transplanted as well, although that's a process still fairly rarely done.
As you seem well aware, chronic pancreatitis is a very frustrating and difficult disease. I wish you well. - 7/20/2011 8:52 AM
- Sid Schwab said...
P.S: Re-reading my original post, I see I didn't use the term "Peustow procedure." That refers to the operation I said it's fun to do, the lateral pancreaticojejunostomy.
my son had a very large pancreatic pseudocyst needle biopsied yesterday US and gastroscopy. Today he is in much more pain that he has been in (which has been significant) says it feels like muscle pain. Any ideas why? I have suggested he call the doc....
- Sid Schwab said...
I agree with your suggestion. There's no way I can have any useful insight from so far away.
Hi, What is the life expectancy for someone who has a total pancreatectomy for CP ? The figures I've read all seem to relate to TP for PC rather than CP which I guess would reduce it ? What are you thoughts on TP with auto islet transplantation ?
Thanks - 10/08/2013 1:55 PM
- Sid Schwab said...
I'm sorry, I'm well aware of but have no personal experience with total pancreatectomy for CP. I've done subtotal pancreatectomy, and drainage procedures (pancreaticojejunostomy) but not total. I'd have to look up the answers to your questions the same way you would, as to life expectancy, and how it's altered by islet cell transplant.
I hope you can find satisfactory answers. It's a very difficult situation, as you well know. - 10/08/2013 7:40 PM
Two years ago I developed sudden intense abdominal paind, went to the ER and was diagnosed with acute-on-chronic pacreatitis. So I quit drinking, reduced fat consumption, felt fine after a couple months. Dr said I could ease back into a normal diet so I did and felt totally fine for 2 years. This September I went to an amusement park with the kids, ate a fatty sandwich a buttery soft pretzel and went on some rides. That night I fell into sudden pain, vomited and ended up in the ER with another attack. My doctor says he doesn't know what triggered either attack. I think fatty sandwiches have something to do with it. Now he has me on Creon "to rest my pancreas". Does that sound like a reasonable prescription? Also, is it "normal" for a person with CP to have an occasional attack despite attempts to control fat intake (currently aiming for about 50g of fat per day).
- Sid Schwab said...
I've not heard of using pancreatic enzymes to "rest" the pancreas, which is not to say it isn't done or isn't rational. Just that I'm only aware if them being used for people who don't produce enough of them on their own.
It's not rare that people with CP have flareups with no evident cause. I assume your gallbladder, if still present, has been evaluated for stones... - 11/11/2013 12:13 PM
thanks for the quick reply. my gall bladder has been looked at a few times with ultrasound and nothing remarkable has ever been observed. It seems that the more time passes, the more my doctor feels like an idiopathic diagnosis is appropriate.
I've done loads of web searches for information about use of Creon to "rest" the pancreas but I've come up empty handed. I just wonder if the pancreas receives feedback from the digestive system as would be provided by the presence of Creon. If not then it would respond the same to food regardless of the presence/absence of the creon (which happens to be very costly). Do you know if such feedback would be reasonably expected? - 11/11/2013 1:23 PM
- Sid Schwab said...
Doubt it. There are such feedback mechanisms, for hormones, such as thyroid hormone, sex hormones, etc; but I'm unaware of such a feedback loop for pancreatic enzymes. There is, of course, for insulin from the pancreas. But entirely another kettle of fish.
If your doctor knows something I don't, it wouldn't be the first time it's happened. - 11/11/2013 1:30 PM
- Stephen C said...
So how does a pancreas "know" what's entering the gut? I've been told to avoid fat since that's hard on the pancreas (i.e., requires more enzymes to digest). Is there some mechanism through which the constituents of the chyme prompt a specific response from the pancreas or does the pancreas simply get turned off and on whenever the stomach empties regardless of what I've swallowed?
- Sid Schwab said...
Excellent question, Stephen, forcing me back to my med school days to dredge it up. Fact is there are all sorts of feedback mechanisms in all sorts of places in the body; the gut and the pancreas participate actively.
When food hits the gut, and, for that matter, the stomach, there are several hormones, notably CCK, which is the one used to test gallbladder function in a HIDA scan, a long with a few others. They stimulate pancreatic secretion, and gallbladder contraction.
I don't know that it's "harder" on the pancreas to secrete fat-digesting enzymes than the ones for proteins; again, if your doc knows something I don't I'd not find it astounding.
Here are a couple of links, which I'm too lazy to HTML-ify for you:
http://en.wikipedia.org/wiki/Cholecystokinin - 11/13/2013 8:33 AM
from what i've gathered, the notion is that when your food has been digested, the signal goes back to your pancreas to say "turn off". Fats digest more slowly so they prolong the duration of pancreatic activity. if enzymes are supplemented then the digestion process should go a little faster and the pancreas get's "all clear" a little sooner than w/o the enzymes.
One October, out of the blue, i developed severe chest pains. as an active mid 30's guy in good health i was freaked out by what seemed like a heart attack so I went to the ER. After a lot of head scratching, the diagnosis was pericarditis. i was prescribed steroids and took them for a couple of weeks and everything turned out fine. weird. so then two years later to the day i go back in to the ER with pancreatitis. several dr's, lots of blood work, a bunch of images later and i get the idiopathic diagnosis. I was told to go home, eat light and don't drink. so that's what i did with only tiny excursions (one beer here or there). all was good for two years and then wham. October comes around and i'm back in the er with pancreatitis again.
my dr thinks my pancreas just makes stones, they clog the duct, the enzymes back up, i go into acute pancreatitis, the stone passes and i'm back to normal.
my wife thinks i have lymes disease since i spend loads of time in the woods building mt bike trails. i dunno what's going on but this thing about every two years having a nasty "itis" is a drag. do you have any hunches? autoimmune maybe? - 12/12/2013 12:43 PM
- Sid Schwab said...
No hunches. I don't like to get into the diagnosis business online. But I'll say that in my experience, and knowledge such as it is, the sort of stones that cause pancreatitis and pass are those formed in the gallbladder, passing into the bile duct. Calcifications can occur in the pancreas, but as far as I know they stay there.
- Kim Spring said...
gI was born with an annular pancreas that caused a complete obstruction of my duodenum. I had surgery at 5 days old to remove the obstruction. In my early 20's, I begin to have bouts of pancreatitis. I am now 44 and have been diagnosed with chronic pancreatitis. This year alone I have had 5 er visits and 1 hospitalization. I was seen at the Mayo clinic in Rochester, Mn in 2012. They did not have a lot to offer me. Said I was not a good candidate for surgery because of previous surgery. I was just seen last week at the Mayo in Jacksonville and they are saying I need surgery. Either puestow procedure or total pancreatectomy with islet cell transplantation. I meet with the surgeon tomorrow to hear his recommendations. My GI doctor doesn't think the puestow will be an option as he feels there is only a small amount of pancreas left and not enough to be able to attach to anything. I do not feel as though I will be on board with the pancreatectomy and islet cell transplant. Everything I've read says that this is not for me. Removing the pancreas seems like a drastic measure. Even though I have suffered with pain quite a bit, and my life has been altered in many ways, I just think this surgery would be even worse. Any advice or experience with people who have had this done and if they have any regrets?
- Sid Schwab said...
I think the surgeon's opinion about your options will be more useful than that of the non-surgeons. Having had previous surgery can make it more difficult but won't likely exclude the possibility. Similarly, whether you're a candidate for Peustow or not depends on the anatomy of the pancreatic duct.
You're as aware as I am that chronic pancreatitis is a pretty bad hand to have been dealt. I had good results with Peustow, but I never had a patient who'd begun with annular pancreas. Nor have a done a total pancreatectomy for the disease; but I know it's a reasonable option in the right circumstances. I'm old enough that islet cell infusion was in its infancy when I was in active practice. I think it represents a significant advancement.
I'm late in answering your questions, and for that I apologize. I assume they've been dealt with much better than I did; I'd love to know what you learned and what you've decided.


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Wishing everyone a New Year filled with New Hope, New Joy and New Beginnings. God Bless you through out 2014... Have an unforgettable New Year!
Stripes tomorrow WTG ..YB.Shep
Have a nice week and Merry Christmas, a Happy New Year, and a prosperous 2013 to you and your family! Thanks for a another great year! Ron
A BIG CONGRATS on reaching 1M and your first new red car! Awesome, most new GBs will never make it to 1M, but you did! : ) You're one of only 6,663 GBs of more than 8,000,000 GBs to have accumulated at least 1,000,000 points! Keep going another 2 or 3 million! Another 2M and you'll be into that nice big limo! : ) Only 2,227 GBs have made it to 2M, so there is room for you there also! Many GBs ahead of you have already retired! DON'T give up now like so many of those that retired once they got to 1M and 2M! You're doing great, it takes persistence and dedication, but you can do it, so keep going! Keep going like a PRO Orlando GasBuddy! Have a nice week! Thanks buddy! Ron
Thanks for becoming my buddy! Ron
Congratulations on becoming #20 on the "30 Days Points Leaders" list, way to go buddy.
Thanks for posting; please take the time to "Pump Up" articles that you feel are worthwhile. If you don't know how to pump up the vote; please ask.


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What about MSAA?
Phoronix: Morphological Anti-Aliasing With Mesa 8.0
One of the less talked about features of Mesa 8.0 is its ability to handle MLAA, which is short for Morphological Anti-Aliasing. But how does MLAA on the open-source graphics drivers affect the OpenGL performance and is it worth it for boosting the image quality through this anti-aliasing technique? In this article are some benchmarks of MLAA under Mesa 8.0.
What about MSAA?
When it comes to post processing AA, FXAA seems much better than MLAA anyway. But the "real deal" is MSAA. This really needs to be supported. Though with the huge performance issues of the whole open source graphics stack at the moment, it would probably kill even whatever little performance there is. Going from 80FPS to 70FPS on the binary blobs is not an issue, but going from 30FPS to 20FPS on the open drivers is a huge issue.
Note that FXAA, even though introduced by NVidia, is a generic AA method, just like MLAA, and works perfectly fine on AMD hardware too.
Last edited by RealNC; 02-14-2012 at 06:37 AM.
Looking at the screenshots, I'd prefer the mlaa_color option, and given that it has a less severe performance drop, that makes me even more likely to use it. Now we just need to optimize the crap out of both it and the rest of the stack.
Thanks Michael for running the tests. Could you post the full-resolution lossless pics of Nexuiz, for easier comparison?
It's also surprising how little performance impact there was going from 2 to 16. It's up to 8x more work per pixel.
That's the drawback of the color version. The depth one does not blur text.
In my opinion, FXAA blurred too much, while (Jimenez's) MLAA kept texture details much better. But your comparison is flawed, HardOCP compared AMD's MLAA to FXAA, which is a lot slower and worse in quality compared to Jimenez's algorithm.
I doubt there's much to optimize in the implementation itself, I believe the bottlenecks are in the gallium context switch. Possibly also some buffer switching could be done faster.
The way just turning it on really hurts performance, but then turning up the quality has no impact. Obviously something other than the shader computations is limiting the speed.
Didn't Jiminez throw away this algorithm and create some new AA technique recently, or update to a new version? Is there any plan to bring that in, or will Mesa stick with this code for a while?
Indeed, he did. IIRC, it's called SMAA (subpixel morphological AA) and offers significantly better quality at the same performance cost.
Do note that the old-school MSAA is quickly becoming obsolete with these new methods. SMAA offers quality equivalent to 4x MSAA at the cost of 2x MSAA and with greater flexibility to boot. A proper in-game implementation doesn't suffer from blurry fonts, so there's very little reason to use MSAA anymore - its few advantages don't outweight its cost.Originally Posted by RealNC
Jimenez's papers are worth a read.
SMAA isn't a full rewrite/new algo, it builds on the MLAA work. SMAA 1x is only slightly changed from the older MLAA.
The higher quality modes are also slower, only the 1x mode is ~the same speed as MLAA.
No plans from my side, but patches welcome as usualIs there any plan to bring that in, or will Mesa stick with this code for a while?
Michael: Can you please use lossless pictures in these reviews? It's kind of hard to see the differences with all the jpeg artifacts.
A suggestion for future test: do a "stress test" to compare texture mipmapping with/without AF and different levels of AA.
MSAA(and related) is of course preferred over MLAA.


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Other Brands by Elizabeth Arden
- Arden Beauty
- Blue Grass
- Daytona 500
- Eau Fraiche Elizabeth Arden
- Elizabeth Arden
- Fifth Avenue
- Fifth Avenue After Five
- Fifth Avenue Nights
- Fifth Avenue Nyc
- Fifth Avenue Style
- Green Tea
- Green Tea Camellia
- Green Tea Cherry Blossom
- Green Tea Exotic
- Green Tea Honey Drops Variety
- Green Tea Honeysuckle
- Green Tea Intense
- Green Tea Lavender
- Green Tea Lotus
- Green Tea Spiced
- Green Tea Summer
- Green Tea Tropical
- Mediterranean
- Mediterranean Breeze
- Pretty
- Pretty Hot
- Provocative
- Provocative Interlude
- Red Door
- Red Door Revealed
- Red Door Shimmer
- Red Door Velvet
- Sandalwood
- Splendor
- Sunflowers
- Sunflowers Dream Petals
- True Love
- Untold Eau Legere
- Design House: Elizabeth Arden
- Fragrance Notes: raspberry, bergamot, orange blossom, rose, jasmine, amber, sandalwood, musk
- Year Introduced: 2012
No reviews written for this product
Now this is what I call the ultimate romantic fragrance. Everyone I knew wore Red Door for years and quite frankly,it's not really my kind at all. But red door aura has definitely become my favorite and I think every woman should own this beauty in their collection. Please include the lotion or shower gel next time.
Written by Sassy Sista on October 11, 2014
Read Review details ►I've been a fan of everything created by the one & only Elizabeth Arden but most of all,I love her perfumes,because they're timeless and affordable. I tried almost every perfume throughout my lifetime and this one,not surprisingly,bowled me over. Red Door Aura is so lovely and versatile,it fits in virtually anywhere,anytime you want. I hope this will become a classic like the original. Highly recommended.
Written by number1fan on September 08, 2014
Read Review details ►I've heard about this new fragrance Red Door Aura by Elizabeth Arden & I just had to try it for myself. It is absolutely beautiful & it definitely has an air of romance to it. I can see a young bride wearing this on her wedding day/night or even a fun night out. It's everything you'll ever want in a fragrance,sexy,romantic,long-lasting & feminine altogether in one fantastic bottle!! I guarantee you will not regret this purchase at all.
Written by Moonlight lady on May 04, 2014
Read Review details ►I wanted to like the original RD but it was just to powerful and smelled to old for me. I love this new RD and wear it all the time. Its like a modern version of RD. For me it seems to be the bottle I pick up the most. It is spring now and this is an EDT so its not to heavy you can go very heavy with it and its not overpowering. I don't like florals but this has some wood notes to it and a freshness and the dry down is creamy. Perfect for everyday! I only wish it came in a EDP so the scent would last longer!
Written by Drewk84 on April 16, 2014
Read Review details ►Red Door Aura, what an enchanting fragrance!! I know about the original Red Door but never tried it,and I still have a quarter bottle left of my last one,fifth avenue. I got this for Christmas last year and the compliments kept coming my way. It sure feels wonderful being a lady. Elizabeth Arden wins again!!
Written by Itgurl on January 05, 2014
Read Review details ►


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On heels of historic start, Sanchez can deliver sweep
Righty opposes Diamond after striking out 17 batters last time out
Anibal Sanchez was a "nice pitcher," as manager Jim Leyland put it, for the Tigers in the second half last season, posting a 3.74 ERA in 12 starts down the stretch. He was even better in the postseason, suffering two losses in three starts despite an impressive 1.77 ERA.
But Sanchez has been something else entirely so far this season. He showed that Friday, when he struck out a franchise-record 17 batters over eight shutout innings against the Braves. He walked only one, picked up his third win and lowered his ERA to 1.34 after five starts.
Though it would seem difficult to improve on that kind of performance, Sanchez will set out to do so Wednesday afternoon at Comerica Park, where the Tigers will go for their sixth straight win and a series sweep against Scott Diamond and the Twins.
"He's really been impressive with his stuff. I thought, from what I've seen, his stuff is much better than it was the first couple outings for us. He's really got good stuff," Leyland said. "When we first got him, he looked nice, a nice pitcher, good pitcher, but even last year, towards the end, you could see that his stuff was really good.
"But he's stronger, too. He's stronger this year. I could tell he's done some strengthening stuff. If you look at Sanchez, he doesn't look like a very big guy, but if you look at his arms, they're huge. You'd be surprised. He's bigger than you think he is. And he's got really good stuff."
He'll face Diamond, who set a career-high mark in a much less enviable category Friday, when the Rangers roughed him up for 12 hits. Yet Diamond was able to minimize the damage and recorded a quality start, allowing three runs over 6 1/3 innings. Still, the lefty took his second loss in three starts this season.
After giving up two runs on three doubles in the first inning, Diamond settled in and didn't allow another run until the sixth inning, when he served up a solo homer to Adrian Beltre.
"I feel like I battled," Diamond said Friday. "It's kinda frustrating the first inning mounted on me just a little bit, but I was able to battle from there. The defense made some nice plays behind me, and I was able to make pitches and get groundballs when I needed to."
Twins: Mauer snaps skid, may sit Wednesday
• Catcher Joe Mauer went 1-for-4 in Tuesday's 6-1 loss and snapped an 0-for-21 stretch with a third-inning single. Mauer entered the game with just two hits in his last 30 at-bats, a skid that came on the heels of a 10-game hitting streak.
But Mauer, the only Twin to play in all 23 games this season, may sit out Wednesday's series finale at Comerica Park. Minnesota has an off-day Thursday, and manager Ron Gardenhire would like to give Mauer some extra rest, though he said the catcher feels "great."
"[Wednesday's] a day game, and I look at that, because of the off-day, as a chance to maybe get through tonight and see how [Ryan] Doumit is feeling," Gardenhire said Tuesday. "[Doumit] had a flu bug yesterday. We're trying to get him through that. But my goal is to maybe give [Mauer] tomorrow and have the off-day, back-to-back days."
• Gardenhire started Wilkin Ramirez in center field for the first time this season, and Ramirez responded by going 2-for-3 with an RBI double off Justin Verlander and a walk.
Tigers: Coke dealing with sore groin
• Lefty reliever Phil Coke is still bothered by the left groin strain that's sidelined him since last weekend, and the Tigers haven't gained much certainty regarding when he'll be ready to return.
Coke didn't pitch Tuesday night and his availability to do so hinged on a pregame throwing session. Lefty Drew Smyly pitched another scoreless inning Tuesday after recording four big outs Monday night, and lefty Darin Downs could also be called upon to face left-handed hitters.
• With the lefty Diamond on the mound, Matt Tuiasosopo and Brayan Pena should be back in the Tigers' lineup Wednesday.
Worth noting
• Miguel Cabrera went 1-for-4 with a homer Tuesday night, his 997th hit since joining the Tigers before the 2008 season. He's now only three hits shy of becoming the 30th player in franchise history to record 1,000 hits in a Tigers uniform.
• Twins first baseman Justin Morneau has 206 career homers and needs one more to tie Kirby Puckett for fifth on the Twins' all-time list.
Adam Berry is a reporter for MLB.com. Follow him on Twitter at @adamdberry. This story was not subject to the approval of Major League Baseball or its clubs.


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Chris Brown has revealed that he once had sex on a plane.The hip hop star, who has been going to great efforts to improve his reputation by expressing how sorry he is for beating up Rihanna back in 2009, didn't do a great job of showing he's a stand up guy during an appearance on BET 106 on Monday.C Breezy (Brown) stopped by to chat with his rapper mate Bow Wow about the usual yawn-inducing stuff like his new album and music and other slightly surprising topics such as his painting for charity and work as an artist.But the cheeky pair's good behaviour didn't last for long. Brown took over as host and quizzed best pal Bow Wow on the strangest place he's ever had sex, the Mirror reported.Lots of fake shyness and laughter flew from the bodies of the pair in a possible bid to prove they are really good boys deep down but Bow soon revealed he'd slept with a girl on the back seat of a jeep.Brown went one step further and revealed he's joined the mile high club and has had sex on a plane.
I was on a commercial flight in first class. But it was one of them European first classes where you've got the big front so you can put the cover up so nobody won't see nothing," he said.MORE ON CHRIS-RIHANNAChris Brown admits assaulting RihannaChris Brown has admitted that he assaulted Rihana and that he was arrogant and hotheaded. Talking on a radio, the recording artist show told that he knew that no one would ever forget the night he assaulted his girlfriend before the February 2009 Grammys, but as he prepared to release his new album, he was hoping to put at least some of that old drama behind him, the US magazine reported. MORE
I'm definitely in love with RiRi, says Chris BrownChris Brown has confirmed that he is in love with Rihanna and shared details of their relationship in a new interview. Brown, 23, spoke about the controversial pairing during an interview on morning radio show Big Boy's Neighborhood on Friday. When asked by host Big Boy if he is in love, he replied saying, "I'm a lover, man. Definitely in love," News.com.au quoted him as saying. FULL STORYRihanna warns Chris Brown, says will walk away if he hits againR&B star Rihanna has warned boyfriend Chris Brown that she will walk away if he ever hits her again. The 25-year-old Diamonds singer claimed Brown, who physically assaulted her in 2009, now had a fantastic heart, reported Sun Online.
"If he gives me that again, here's what I give him: nothing. I just walk away. He doesn't have that luxury of messing up again," she said. FULL STORYRihanna on why she took Chris backRihanna, who is currently celebrating her 25th birthday in Hawaii with her boyfriend Chris Brown, has defended taking the rapper back in her life insisting that he is a fantastic person at heart.
The 25-year-old singer has come to the rescue of Brown, who was convicted of assaulting her after a pre-Grammy's party in 2009 saying that it is different now between the couple. STORYRihanna gets intimate with Chris Brown on birthday, tweets pics againChris Brown was spotted nuzzling into Rihanna's neck, as pop star shares intimate pictures of her 25th birthday bash on her Instagram account on Wednesday. The We Found Love, who opted to dress in a has revealing white cut-out dress, captioned the picture as: 'Like #diamonds in the sky', the lyrics from her recent hit song, the Daily Mail reported. In another snap, captioned '#birthdaybehavior', Brown is seen with his hands around her lady loves waist, resting his face on her arm as Rihanna pulls a sultry pose. FULL COVERAGERihanna gets attacked by fan, Chris Brown hurtRapper Chris Brown is hurt after hearing Rihanna was injured by a fan. The force of the bottle caused Rihanna, 24, to fall and cut open her knee. Her bodyguard's leg was also injured as he attempted to catch her attacker.
But Brown is now relieved to hear she is okay. MORERihanna `glassed` by fan for reuniting with beau Chris BrownRihanna was left bleeding after a man, apparently angered by her decision to get back together with abusive former boyfriend Chris Brown, threw a bottle at her during a night out at nightclub The Box, it has been reported.According to MediaTakeOut.com, the 24-year-old singer stumbled and fell into a grate, slicing open her leg, the New York Post reported. GLASSED!
Rihanna's dad feels Chris Brown deserves second chanceRihanna's father Ronald Fenty feels that her on and off boyfriend rapper Chris Brown deserves 'a second chance' in love.
The 24-year-old star was violently attacked by the Brown in 2009, but Fenty has given his blessing after it was reported that they got back together. ONCE AGAIN?
Rihanna ignores Chris Brown, celebrates Valentine's Day aloneSinger Rihanna and on-off boyfriend Chris Brown have again sparked rumours of a split, after Rihanna refused to be seated near him at a party here.
Both of them ignored each other during a night out at Popular Demand's one-year anniversary party at the Playhouse night club here Wednesday. SPLIT?Engaged? Rihanna flaunts wedding ring at GrammysThe R&B singer Rihanna was spotted with an engagement ring at the 55th Annual Grammy Awards held on February 10 in Los Angeles. It's been four years since Chris Brown shocked the world when he brutally attacked the pop star, leaving her bruised after a pre-Grammys party, reports Daily Mail. HITCHEDRihanna blows kiss to Chris Brown in court during hearingRihanna blew a kiss to Chris Brown, as he appeared before a judge over allegations that he cheated his way out of community service.
The 24-year-old singer walked into the LA court house on Brown's arm today, sitting behind his legal team, then left in the same car afterwards, the Mirror reported.
The case was adjourned with the judge wanting to see more evidence that Brown had fiddled with the amount of hours service he has completed since being sentenced for battering Rihanna in 2009. FULL STORYRihanna worries over Chris BrownSinger Rihanna was worried about ex-boyfriend Chris Brown after hearing he was involved in a car crash. She is relieved he was not hurt. She was seen comforting Brown at a pre-Grammys party just hours after he banged into a wall on Saturday. "Rihanna is just relieved Chris is okay. She was like 'what the f**k' when she heard he lost control of the wheel. She blew his cell up and panicked even more when he didn't pick up," contactmusic.com quoted a source as saying. WORRIED!If dating Chris Brown mistake, it's my mistake: RihannaIt's official: R&B diva Rihanna says she is back together with Chris Brown, who is still on probation for assaulting her in 2009, saying "It's different now."
"I decided it was more important for me to be happy," Rihanna told Rolling Stone magazine in an interview published on Wednesday on its website.
"I wasn't going to let anybody's opinion get in the way of that. Even if it's a mistake, it's my mistake," she said of her renewed romance with singer Brown, 23, that has prompted consternation from fans and celebrity media because of their history. READChris Brown's ex Karrueche Tran reveals love triangle with RihannaChris Brown's former girlfriend Karrueche Tran has spoken about her split from the singer, saying how it felt to watch him climb back into bed with on-off girlfriend Rihanna.In her first magazine cover shoot, the 24-year-old model poses topless in nude knickers for Rolling Out and opened up about the unfortunate love-triangle she found herself tangled up in."It was very hard. I try my best to just ignore the negativity, which is hard for me because it's a lot to deal with," the Mirror quoted her as saying. LOVE TRIANGLERihanna attends Chris Brown's ex club partyRihanna was recently spotted at her on-again off-again flame Chris Brown's ex-girlfriend Karrueche Tran's club party.
The 24-year-old Diamonds singer attended the party on Thursday, which was thrown by Tran to celebrate her Rolling Out magazine cover, the New York Daily News reported. READ ONChris Brown strips to undies with Rihanna after spending Xmas togetherIn the picture, the American rapper is seen posing topless while Rihanna, who was flaunting her stomach in a black revealing outfit that flashed her midriff teamed with heels, sat on the front of a car, the Mirror reported.
The picture shows Brown sporting the same pair of boxers, which he wore in a snap taken with the 'Umbrella' hitmaker on Christmas day. RACY COUPLERihanna-Chris Brown still together, still going strongRihanna and Chris Brown were spotted arriving together and sitting side-by-side at the LA Lakers vs. NY Knicks game at Staples Center, Los Angeles, on Christmas.
The couple arrived in the arena in the same car, but got out of the vehicle separately,TMZ.comreported.
The pair eventually met up inside the arena and sat down together in their courtside seats. STILL TOGETHERRihanna-Chris Brown's on-off relationship finally over?It seems Rihanna's on-off relationship with Chris Brown is over after she decided to spend Christmas without him. According to earlier reports, the R&B star was supposed take Brown to her native Barbados for celebrations with family.
She was hoping the trip would end any bad feeling between her relatives and the hip-hop star who was charged with assaulting her in 2009. OVER OR NOT?Efforts to get back together? Chris Brown posts pic with RihannaChris Brown posted a picture on Instagram cuddling up with Rihanna before deciding to take it down 15 minutes later, indicating that the couple may still be together despite reports of their split earlier.The pop princess tweeted angrily about being 'single' and sent cryptic tweets about 'goodbye' after the hip-hop star larked about with strippers in Paris. CHRIS-RIHANNARihanna wants time off to have baby with Chris BrownRihanna, who recently got back with her former boyfriend Chris Brown, is reportedly planning to have a baby with him. According to Closer magazine, the 24-year-old singer rocked her record label bosses by asking for time off so she could get pregnant.
"She asked her record company when the best time would be for her to take off, as she wants a baby," the Sun quoted a source as saying. MOREChris Brown posts picture with lingerie-clad RihannaRapper Chris Brown has gone online to post a picture of himself and singer Rihanna, seen wearing white lingerie and a large-sized camouflage coat. Rihanna is seen chilling on a sofa, while Brown is sitting next to her, dressed in a white T-shirt and baseball cap and smoking a roll-up, reports thesun.co.uk. RACY COUPLERihanna to take Chris Brown to meet familyRihanna is reportedly planning to take Chris Brown back to her native Barbados in a bid to win over her friends and family. She is said to have reserved a plush five-star villa on the exclusive Gold Coast area of the tropical island for a "bonding holiday".
The 24-year-old singer hopes Brown, who beat her in a vicious assault in 2009, will be able to convince her close circle that he's a changed man, the Sun reported. BACK FOR GOOD?(With additional inputs)


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Comments On Mar 24, 2015:no issues so far
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Comments On Feb 23, 2015:Replaced my previously worn fork seals with these bad boys and have 4 rides on them already and no leaks! Great seal
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Comments On Feb 13, 2015:Very good seals that can handle almost any abuse you try to put them through!
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Comments On Sep 22, 2014:NOK seals in my package. I'm almost certain the NOK seals are OEM on a lot of bikes. Pro X seals that are OEM quality at half the price!
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Comments On Mar 16, 2014:Installation went smoothly, they don't stick, and they don't leak. Will buy these again.
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Comments On Mar 06, 2014:These seals hold up just as good if not better than OEM going on my second season with these seals and no signs of leaking so far. (knock on wood). Pro-X products continue to never let me down.
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Comments On Jan 16, 2014:Dont leak. Use them on all the forks i do.
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Comments On Sep 22, 2013:Purchased installed and working great! Had some good hard rides on them and working as expected!
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Comments On Sep 05, 2013:Perfect factory replacement and long life.
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Comments On Jan 07, 2013:I was happy to see these were NOK name brand seals when I got them. They lasted me almost a season of recreational riding before I saw one start leaking, even with seal savers on the forks. I do ride in a lot of mud though. I would not hesitate to buy another pair for the price.
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Before I made my purchase I read and re-read all the reviews on this Tommy Hilfiger down-filled jacket and other Michael Kors, Kenneth Cole, etc. variations bc I wanted the best quality, most flattering and cost-effective option. I thought long and hard about writing this review and know that you'll find mine most helpful. Now, I'm only 5'2" and 140lbs, not top heavy and have a lil belly 'n booty. I purchased the medium eventho I fall about 1-2" larger than the Overstock.com size chart notes and the jacket fits me great, so I would say it runs very slightly bigger, but really it is true to size (I think the Overstock.com size chart actually runs a little small). I feel like I can wear light to medium weight sweaters underneath and the zipper is dual ended, which is a huge help bc the coat is long and you don't want to be restricted like a sausage, esp. if you're a little hippy/have a booty. I completely agree with the other review writers in regard to quality- it has really classy argyle print piping and is mostly fabric lined. Also, I went with Tommy Hilfiger as it has 60/40% down/waterfowl filling-- not as great as 100% down, but better than ***** % and price! Give this coat a try, you won't be disappointed, just know your body measurements!
I wore this all winter and couldn't be happier with it. Very warm, and it looks nice as well
The coat was quite warm. Feathers coming out though.
i get tons of compliments.
Stylish, great extra features and pockets, and plenty warm!! Washes well too. Love this coat!
This was a best-selling coat, so I figured people were onto something. You guys: Do you all feel like you're huge? It was just too unflattering, so I returned it. I think it's possible to have a warm coat that's cute, too, and this coat was not it.
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Trauma is a serious injury or shock to the body. It is caused by a physical force, such as violence or an accident. The injury may be complicated by psychiatric, behavioral, and social factors. This can cause the disability to be greater than just physical injuries.
Some causes of trauma include:
- Motor vehicle accidents
- Falls
- Near-drowning
- Gunshots
- Fires and burns
- Stabbing
- Other physical assault
- Fire, flood, earthquake, lightening, or other natural disaster
- Contact sports
- Electrical shock
- Animal attacks
- Explosions
- Plane crashes
Risk Factors
Some factors increase your chances of developing trauma. You are at increased risk if you are aged 1-44 years.
The symptoms associated with trauma vary and depend on the type of injuries you have suffered. Some symptoms may include:
- Breathing problems
- Bleeding
- Loss of feeling and/or muscle strength
In addition, the following psychological effects may occur in response to trauma:
- Anxiety, numbness, dissociation and/or inappropriate calmness
- Anger and frustration
- Acute stress disorder such as distress, memories, avoidance, and numbing in the months after trauma
- Depression
- Post-traumatic symptoms and/or disorder
- Avoidance and public anxiety
A medical team will assess your symptoms and medical history. A physical exam will be done. It may include a chest exam, abdomen and pelvis exam, exam of extremities, and a neurologic exam. A psychological exam and/or suicide assessment may also be done.
Your bodily fluids may be tested. This can be done with blood tests.
Your vital signs may be tested. This can be done with:
- Blood pressure measurement
- Respiratory monitoring
- Electrocardiogram (EKG)
Imaging tests can be used to evaluate the injured area. These may include:
- Chest x-ray
- Abdominal ultrasound
- CT scan
- Spine x-ray
- Angiography
Treatment usually includes the following:
- Resuscitation and/or stabilization to normalize vital signs, control blood loss, and restore organ function
- Further surgeries and/or treatments
- Cognitive-behavioral therapy (CBT) to address ongoing psychological symptoms from the trauma
To help reduce your chance of trauma:
- Always use seat belts.
- Never drive or operate any equipment while under the influence of alcohol or drugs. Certain medications can be dangerous as well.
- Do not use a cell phone while driving.
- Keep poisons, medication, and cleaning supplies locked up. Keep them away from small children.
- Teach children to swim. Teach all family members about water safety.
- Develop a fire safety plan.
- Make sure all alarm and fire equipment is up to date such as smoke alarms, carbon monoxide alarms, and fire extinguishers.
- If you have firearms in the house, make sure they are kept unloaded. Keep them in a locked location.
- Wear helmets while biking.
- Wear the right safety equipment for all sports and recreation activities.
- Wear appropriate protective gear when using power tools.
- Help prevent falls in the home. Install night-lights, grab bars, and hand rails.
- Avoid putting yourself at risk for an accident, violence, or other physical trauma.


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