text:
A catheter for use in an electrophysiological procedure to ablate a site includes a metallic tip having a first work function and energized by a source of RF energy. The RF energy return path is through a relatively large plate of a metallic material having a second work function and disposed at a location removed from the ablation site. The difference in work functions of the tip and the plate, operating in the presence of an electrolyte represented by intermediate tissue, produces an exchange of electrical charges through chemical reaction to create a galvanic cell. By loading the galvanic cell with a shunt resistor, it becomes a current source providing a current signal having a peak value representative of occurrence of tissue damage. This representation is used to regulate the RF energy applied to the ablation site.
1. Apparatus for ablating tissue at an ablation site in the heart of a human being while avoiding the possibility of tip coagulation, tissue sticking or tissue perforation, said apparatus comprising in combination:
(a) a source of RF energy for irradiating the tissue at the ablation site to cause a temperature rise of the tissue at the ablation site;
(b) a catheter having a tip for contactingly engaging the ablation site and for irradiating the tissue with RF energy to heat the tissue at the ablation site, said tip comprising a first electrode of material having a first work function;
(c) transmission means for conveying RF energy from said source to said tip;
(d) a second electrode displaced from said first electrode and of material having a second work function different from the first work function for electrically contacting an area of tissue of the human being;
(e) a galvanic cell formed by said first electrode, said second electrode and the tissue of the human being serving as an electrically interconnecting electrolyte for generating an electrical current having a peak value corresponding with the occurrence of ablation of the tissue at the ablation site; and
(f) a control circuit responsive to said electrical current generated by said galvanic cell for regulating the operation of said source of RF energy to control RF radiation of the ablation site before and after the electrical current has reached a peak value.
2. A catheter assembly for irradiating tissue at an ablation site of a living being to raise the temperature of the ablation site, to sense the occurrence of ablation, and to terminate heating of the ablation site, said catheter assembly comprising in combination:
(a) a catheter having a tip locatable at the ablation site, said tip being formed of a material having a first work function;
(b) an electrode displaced from said tip and adapted to be in electrical contact with the tissue of the living being, said electrode being formed of a material having a second work function different from the first work function;
(c) a galvanic cell formed by said tip, said electrode, and the tissue of the living being serving as an electrolyte intermediate said tip and said electrode for generating a current corresponding to the temperature of the tissue at the ablation site and having a characteristic representative of the occurrence of ablation of the tissue at the ablation site;
(d) an RF generator interconnected with said tip and said electrode for applying RF energy through said tip to the tissue at the ablation site to heat the tissue at the ablation site; and
(e) a control circuit for regulating said RF generator as a function of the characteristic of the current.
3. Apparatus for ablating tissue at an ablation site, said apparatus comprising in combination:
(a) an RF generator for applying RF energy to the ablation site to heat the ablation site tissue;
(b) a probe adapted to be in contact with the ablation site tissue for irradiating the ablation site tissue with RF energy;
(c) a transmission line for conveying RF energy from said RF generator to said probe;
(d) a galvanic cell for sensing ablation at the ablation site tissue and for producing a signal reflective of the ablation sensed, said galvanic cell including: said probe, an electrode displaced from said probe and displaced from the ablation site, and an electrolyte in electrical contact with said probe and said electrode; and
(e) a control circuit responsive to said signal produced by said galvanic cell for controlling the RF energy applied to said probe.
4. A method for ablating tissue at an ablation site in the heart of a human being, said method comprising the steps of:
(a) generating RF energy from a source of RF energy;
(b) conveying RF energy from the source to a tip in contact with the ablation site;
(c) irradiating the tissue at the ablation site with RF energy from the tip to heat the tissue at the ablation site, the tip comprising a first electrode of material having a first work function;
(d) electrically contacting an area of tissue of the human being with a second electrode displaced from the first electrode and of material having a second work function different from the first work function;
(e) generating an electrical current reflective of the occurrence of ablation of the tissue at the ablation site by a galvanic cell formed by the first electrode, the second electrode and the tissue of the human being serving as an electrically interconnecting electrolyte; and
(f) regulating the operation of the source of RF energy with a control circuit responsive to the electrical current generated by said generating step to control RF irradiation of the ablation site.
5. A method for ablating tissue at an ablation site, said method comprising the steps of:
(a) generating RF energy with an RF generator;
(b) conveying RF energy from the RF generator through a transmission line to a probe;
(c) irradiating the ablation site with RF energy through the probe proximate the ablation site;
(d) producing a signal reflective of the occurrence of ablation at the ablation site tissue with a galvanic cell, the galvanic cell comprising the probe, an electrode displaced from the probe and an electrolyte in electrical contact with the probe and the electrode; and
(e) regulating the output of the RF generator with a control circuit responsive to the signal produced by said producing step.
6. Apparatus for detecting the occurrence of ablation of tissue at an ablation site, said apparatus comprising in combination:
(a) a catheter having a tip for contacting the ablation site to irradiate the ablation site with RF energy to heat the tissue;
(b) a source of RF energy for transmitting RF energy to said tip;
(c) a galvanic cell using the tissue as an electrolyte for generating an electrical signal representative of the occurrence of ablation at the ablation site; and
(d) a control circuit responsive to the electrical signal for controlling the RF energy transmitted to said tip.
7. The apparatus as set forth in claim 6 wherein the electrical signal generated by said galvanic cell depicts a peak value upon occurrence of ablation.
The present application includes subject matter disclosed in and claims priority to a provisional application entitled "APPARATUS AND METHOD FOR INDICATING THERMAL ABLATION", assigned Ser. No. 60/016,647, filed May 15, 1996 and the present application is a continuation-in-part application of a patent application entitled "APPARATUS AND METHOD FOR THERMAL ABLATION", assigned Ser. No. 08/488,887, filed Jun. 9, 1995, now U.S. Pat. No. 5,697,925.
1. Field of the Invention
The present invention relates to catheters and, more particularly, temperature controlled catheter probes for ablating tissue.
2. Background of the Invention
The heart is a four chamber muscular organ (myocardium) that pumps blood through various conduits to and from all parts of the body. In order that the blood be moved in the cardiovascular system in an orderly manner, it is necessary that the heart muscles contract and relax in an orderly sequence and that the valves of the system open and close at proper times during the cycle. Specialized conduction pathways convey electrical impulses swiftly to the entire cardiac muscle. In response to the impulses, the muscle contracts first at the top of the heart and follows thereafter to the bottom of the heart. As contraction begins, oxygen depleted venous blood is squeezed out of the right atrium (one of two small upper chambers) and into the larger right ventricle below. The right ventricle ejects the blood into the pulmonary circulation, which resupplies oxygen and delivers the blood to the left side of the heart. In parallel with the events on the right side, the heart muscle pumps newly oxygenated blood from the left atrium into the left ventricle and from there out to the aorta which distributes the blood to every part of the body. The signals giving rise to these machinations emanates from a cluster of conduction tissue cells collectively known as the sinoatrial (SA) node. The sinoatrial node, located at the top of the atrium, establishes the tempo of the heartbeat. Hence, it is often referred to as the cardiac pacemaker. It sets the tempo simply because it issues impulses more frequently than do other cardiac regions. Although the sinoatrial node can respond to signals from outside the heart, it usually becomes active spontaneously. From the sinoatrial node impulses race to the atrioventricular (AV) node above the ventricles and speeds along the septum to the bottom of the heart and up along its sides. The impulses also migrate from conduction fibers across the overlying muscle from the endocardium to the epicardium to trigger contractions that force blood through the heart and into the arterial circulation. The spread of electricity through a healthy heart gives rise to the familiar electrocardiogram. Defective or diseased cells are electrically abnormal. That is, they may conduct impulses unusually slowly or fire when they would typically be silent. These diseased cells or areas might perturb smooth signalling by forming a reentrant circuit in the muscle. Such a circuit is a pathway of electrical conduction through which impulses can cycle repeatedly without dying out. The resulting impulses can provoke sustained ventricular tachycardia: excessively rapid pumping by the ventricles. Tachycardia dysrhythmia may impose substantial risk to a patient because a diseased heart cannot usually tolerate rapid rates for extensive periods. Such rapid rates may cause hypotension and heart failure. Where there is an underlying cardiac disease, tachycardia can degenerate into a more serious ventricular dysrhythmia, such as fibrillation. By eliminating a reentrant circuit or signal pathway contributing to tachycardia, the source of errant electrical impulses will be eliminated. Ablation of the site attendant such a pathway will eliminate the source of errant impulses and the resulting arrhythmia. Mapping techniques for locating each of such sites that may be present are well known and are presently used.
Interruption of the errant electrical impulses is generally achieved by ablating the appropriate site. Such ablation has been performed by lasers. The most common technique used at an ablation site involves the use of a probe energized by radio frequency radiation (RF). Measurement and control of the applied RF energy is through a thermistor (or it could be a thermocouple) located proximate the RF element at the tip of a catheter probe. While such a thermistor may be sufficiently accurate to reflect the temperature of the thermistor, it is inherently inaccurate in determining the temperature of the tissue at the ablation site. This results from several causes. First, there is a temperature loss across the interface between the ablation site (usually variable due to position of electrode) and the surface of the RF tip. Second, the flow of blood about the non-tissue contact portion of the conductive RF tip draws off heat from the ablation site which causes the thermistor to be cooler than the tissue under ablation. However, temperatures above 100� C. causes coagulum formation on the RF tip, a rapid rise in electrical impedance of the RF tip, and excessive damage to the endocardium. Third, there is a lag in thermal conduction between the RF tip and the thermistor, which lag is a function of materials, distance, and temperature differential. Each of these variables may change constantly during an ablation procedure.
To ensure that the ablation site tissue is subjected to heat sufficient to raise its temperature to perform irreversible tissue damage, the power transmitted to the RF tip must be increased significantly greater than that desired for the ablation in view of the variable losses. Due to the errors of the catheter/thermistor temperature sensing systems, there is a propensity to overheat the ablation site tissue needlessly. This creates three potentially injurious conditions. First, the RF tip may become coagulated. Second, tissue at the ablation site may "stick to" the RF tip and result in tearing of the tissue upon removal of the probe. This condition is particularly dangerous when the ablation site is on a thin wall of tissue. Third, inadequate tissue temperature control can result in unnecessary injury to the heart including immediate or subsequent perforation.
When radio frequency current is conducted through tissue, as might occur during a procedure of ablating a tissue site on the interior wall (endocardium) of the heart with a radio frequency energized catheter, heating occurs preliminarily at the myocardial tissue interface with the tip of the catheter. Given a fixed power level and geometry of the catheter probe, the temperature gradient from the probe interface and a distance, r, into the tissue is proportional to 1/r4. Heating is caused by the resistive (OHMIC) property of the myocardial tissue and it is directly proportional to the current density. As may be expected, the highest temperature occurs at the ablation site which is at the interface of the RF tip and the tissue.
When the temperature of the tissue at the ablation site approaches 100� C., a deposit is formed on the RF tip that will restrict the electrical conducting surface of the RF tip. The input impedance to the RF tip will increase. Were the power level maintained constant, the interface current density would increase and eventually carbonization would occur. At these relatively extreme temperatures, the RF tip will often stick to the surface of the tissue and may tear the tissue when the RF tip is removed from the ablation site.
To effect ablation, or render the tissue nonviable, the tissue temperature must exceed 50� C. If the parameters of the RF tip of a catheter are held constant, the size and depth of the lesion caused by the ablation is directly proportional to the temperature and time at the interface (assuming a time constant sufficient for thermal equilibrium). In order to produce lesions of greatest depth without overheating the tissues at the interface, critical temperature measurement techniques of the RF tip are required.
The current technology for measuring the temperature of an RF tip embodies a miniature thermistor(s) located in the RF tip of the probe. The present state of the art provides inadequate compensation for the thermal resistance that exists between the thermistor and the outer surface of the RF tip, which may be in variable contact with the tissue and affected by blood cooling or between the outer surface of the RF tip and the surface of the adjacent tissue. Because of these uncertainties contributing to a determination of the specific temperature of the tissue at the interface, apparatus for accurately determining when ablation actually occurs would be of great advantage in performing an electrophysiological procedure to ablate a specific site(s) of the myocardial tissue.
A catheter probe having a metal tip energized by an RF generator radiates RF energy as a function of the RF energy applied. When the tip is placed adjacent tissue at an ablation site, the irradiating RF energy heats the tissue due to the ohmically resistive property of the tissue. The catheter tip placed adjacent the ablation site on tissue in combination with an electrically conducting dissimilar metal plate in contact with tissue at a location remote from the ablation site and an electrolyte defined by the intervening tissue create a galvanic cell when the tip and plate have different work functions because of migration of electrical charges therebetween. By loading the galvanic cell, the DC output current is a linear function of the temperature of the ablation site heated by the RF energy. The DC output current of the galvanic cell is used to regulate the output of the RF generator applied to the catheter tip to control the current density at the ablation site. When ablation at the ablation site occurs, the value of the DC output signal drops dramatically irrespective of further applied RF energy and provides a signal to terminate application of further RF energy to avoid possible coagulation of the RF tip, sticking of the tissue to the RF tip and perforation of the tissue.
It is therefore a primary object of the present invention to provide a signal for indicating occurrence of tissue damage at an ablation site in response to RF energy radiated from a catheter tip during an ablation procedure.
Another object of the present invention is to provide an output signal representative of the occurrence of tissue damage at an ablation site for subsequently regulating the RF radiation power level of a probe performing the ablation procedure to obtain tissue damage to a desired depth.
Yet another object of the present invention is to generate a signal representative of actual tissue damage at an ablation site in order to cease further heating of the ablation site by regulating the radiation of RF energy from an ablating RF tip.
Still another object of the present invention is to provide apparatus for determining the occurrence of tissue damage of a cardiac impulse pathway and thereafter cease further heating of the ablation site.
A further object of the present invention is to provide a self-regulating catheter mounted RF radiating element controlled by an output signal reflective of actual tissue damage at an ablation site on the endocardium of a heart suffering tachycardia dysrhythmia and destroy a pathway of errant electrical impulses at least partly contributing to the tachycardia dysrhythmia.
A still further object of the present invention is to provide a method for controlling heating and sensing the occurrence of actual tissue damage at an ablation site and thereafter terminating further heating of the ablation site when the desired depth of tissue damage has been achieved.
These and other objects of the present invention will become apparent to those skilled in the art as the description thereof proceeds.
The present invention may be described with greater specificity and clarity with reference to the following drawings, in which:
FIG. 1 illustrates a simplified representation of the present invention;
FIG. 2 illustrates the current density at an ablation site during an ablation procedure;
FIG. 3 illustrates a representation of a catheter probe embodying a thermistor useful in the present invention;
FIG. 4 illustrates representatives curves for calibrating the temperature of an ablation site through use of a probe embodying a thermistor;
FIG. 5 is a block diagram of circuitry representatively shown in FIG. 1;
FIG. 6 illustrates a catheter probe for sequentially mapping the endocardium, identifying a site to be ablated and ablating the site without relocating the probe;
FIGS. 7A and 7B are graphs illustrating the respective output signals of the power level applied by a catheter tip, the temperature sensed by a catheter mounted thermistor and the galvanic current at an ablation site during an ablation procedure; and
FIG. 8 illustrates the use of a computer to perform certain of the functions manually performed with the circuitry shown in FIG. 5 and to provide displays of information.
Two electrodes of different metals having different work functions in the presence of an electrolyte (such as blood) a saline solution or living tissue, will produce an exchange of electrical charges and an electromotive force (emf) is generated. This emf generator is known as a galvanic cell. A technical discussion of the history of galvanic cells is set forth in Chapter 1.3, entitled "Basic Electrochemistry" (pages 12-31) in a textbook entitled Modern Electrochemistry, authored by John O'M. Bockris, published by Plenum Press., New York, dated 1970. Detailed technical discussions of galvanic cells can be found in: Chapter 4, entitled "Reversible Electrode Potentials" (pages 73-100) of a textbook entitled Electrochemistry Principles and Applications, authored by Edmund C. Potter, published by Cleaver-Hume Press, Ltd., dated 1956; Chapter 4 entitled "Electrodes and Electrochemical Cells" (pages 59-89) of a textbook entitled Introduction to Electrochemistry, authored by D. Bryan Hibbert, published by MacMillan Press Ltd., dated 1993; and Chapter 12 entitled "Reversible Cells" (pages 282-311) of a textbook entitled Electrochemistry of Solutions, authored by S. Glasstone, published by Methuen & Co. Ltd., London, dated 1937 (Second Edition). These technical discussions are incorporated herein by reference.
The magnitude of the potential of a galvanic cell is a function of the electrolyte concentrates and the metals' work functions. The open circuit voltage of the galvanic cell is essentially constant despite temperature changes at the interface between the electrodes and the electrolyte. However, by loading the galvanic cell with a fixed value shunt resistance it simulates a current generator which has an output signal directly proportional to the temperature of the metal and electrolyte interface. The output signal of the current generator can be calibrated as a function of the temperature at the interface. A simple method for calibration is that of referencing the output of the current generator with the output of a thermistor embedded in the electrode at steady state power and temperature conditions at an initial or first temperature and at a second temperature. This will provide two data points for the power/temperature curve of the current generator. Since the output of the current generator is linear, the curve can be extended to include all temperatures of interest.
The present invention is directed to apparatus for ablating an errant cardiac conduction pathway responsible for or contributing to arrhythmia of the heart. The ablation process is performed by heating the ablation site tissue to a temperature typically exceeding 50� C., sufficient to cause ablation of the cells contributing to the errant impulse pathway. The ablation is effected by irradiating the ablation site tissue with radio frequency (RF) energy. For this purpose, a catheter probe tip is positioned adjacent the ablation site, which site has been previously determined by mapping procedures well known to physicians and those skilled in the art. Upon positioning of the probe tip at the ablation site, a source of RF energy is actuated to transmit RF energy through a conductor to the tip of the probe. The RF energy radiates from the tip into the ablation site tissue. The current density at the ablation site is a function of the power of the RF energy irradiating the ablation site and the surface area defining the interface between the tip and the ablation site tissue. Control of the tissue temperature at the interface is of significant importance to control the area and depth of ablation in order to perform the degree of ablation necessary, to prevent coagulation on the tip, to prevent the tip from sticking to the tissue, to prevent avoidable injury to adjacent tissue, to prevent perforation of the tissue, and to avoid unnecessary heating of the blood flowing in and about the tip.
Catheter probes having a thermistor embedded at the tip have been used to perform an ablation procedure and the amount of RF energy applied has been regulated as a function of the temperature sensed by the thermistor. Such temperature sensing is inherently inaccurate in determining the temperature at the ablation site due to the numerous variables present. First, there exists a temperature loss through the interface between the ablation site and the surface area of the tip in contact with tissue. Second, there exists a thermal resistance within the tip which causes temperature lag between the surface area of the tip in contact with the ablation site and the thermistor. Third, the orientation of the tip with respect to the ablation site will vary with a consequent variation of heating of the ablation site. Finally, the blood flowing about the tip area not in tissue contact will draw off heat as a function of both flow rate and orientation of the tip with respect thereto. By experiment, it has been learned that the differences between the tissue temperature at the ablation site and the temperature registered by a thermistor may range from 10� C. to 35� C. Such temperature excursion may result in unnecessary injury without a physician being aware of the injury caused at the time of the ablation procedure. Where ablation is being performed upon a thin wall myocardium, a puncture or a perforation at a later time can and does occur with potentially disastrous results.
The present invention is shown in simplified format in FIG. 1. An RF generator 10 serves as a source of RF energy. The output of the RF generator is controlled by an input signal identified as J1. The RF energy, as controlled by J1, is transmitted through a conductor 12 to a catheter probe 14. This probe is depicted as being lodged within a blood filled chamber 16 of a heart. The chamber may be the right or left atrium or the right or left ventricle. Probe 14 is lodged adjacent, for instance, tissue 18 at an ablation site 20 representing a reentrant circuit to be ablated. As represented, blood continually flows through chamber 16 about and around probe 14.
Probe 14 includes a tip 30 electrically connected to conductor 12 to irradiate ablation site 20 with RF energy. Typically, the frequency may be in the range of about 350 kHz to about 1200 kHz. Such irradiation of the ablation site will result in heating of the ablation site as a function of the current density at the ablation site. The current density is determined by the energy level of the irradiating RF energy and the surface area of the ablation site. More specifically, the heat generated is proportional to the current density squared. This may be expressed as: T(r)=kPd=kI2 R=(J0 2 /r4) R, where T=temperature, r=distance from the interface, J0 =current density at the interface, Pd=power dissipated, I=current at the interface, and R=resistance at the interface. The return path to RF generator 10 is represented by conductor 32. Conductor 32 is electrically connected to a relatively large sized plate 34 placed adjacent the patient's skin, preferably a large surface area of the patient's back. To ensure good electrical contact, an electrically conducting salve may be disposed intermediate plate 34 and patient's back 36. The fluid and tissues of the patient intermediate tip 30 and plate 34, represented by numeral 38, constitutes, in combination, an electrolyte and therefore an electrically conductive path between the tip and the plate. The DC current flow is represented by is and the DC voltage is represented by vs.
As more particularly illustrated in FIG. 2, ablation site 20 has a relatively high concentration of current paths, representatively depicted by diverging lines identified with numerals 42, 44, 46, 48, 50, and 52. These current paths are in close proximity with one another at the ablation site. The resulting high current density will produce heating of the ablation site as a function of the current density. The depth of the ablated tissue is representatively illustrated by line 54. The current density proximate back 36 of the patient adjacent plate 34 is relatively low. With such low current density, essentially no heating of the skin adjacent plate 34 will occur. It is to be appreciated that FIG. 2 is not drawn to scale and is intended to be solely representative of relative current densities resulting from irradiation of an ablation site by tip 30.
Ablation with tissue temperature control permits the physician to optimize the ablation process by allowing the ablation to occur at maximum temperature that is below a temperature conducive to formation of coagulation on the tip. Since such temperature is a function of the RF energy irradiating the ablation site tissue, control of the amount of RF energy transmitted via conductor 12 to the tip is necessary. A presently available type of catheter probe 60 is illustrated in FIG. 3. This probe includes a tip 62 for radiating RF energy received through conductor 64 from a source of RF energy. A thermistor 66 is embedded in tip 62 or in sufficient proximity with the tip to be responsive to the temperature of the tip. A pair of conductors 68 and 70 interconnect thermistor 66 with a signal detection circuit to provide an output signal representative of the temperature sensed. Furthermore, probe 60 may include mapping electrodes 72, 74 and 76. These electrodes may be used in conjunction with manipulation of probe 60 within the heart to detect and identify errant impulse pathways causing cardiac arrhythmia. Conductors 78, 80 and 82 connect electrodes 72, 74 and 76, respectively, to circuitry associated with the mapping functions, as is well known.
As stated above, thermistor 66 is incapable of providing an accurate representation of the temperature at the ablation site. In summary, the causes contributing to inaccurate temperature representation are heat loss through the interface between tip 30 and ablation site 20 (see FIG. 2), thermal lag between the area of tissue in contact with the tip and the sensing element of the thermistor, and heat loss resulting from flow of blood about the tip area not in contact with the tissue.
By experimentation, it has been learned that the combination of tip 30, plate 34 and body 38 perform in the manner of a galvanic cell provided that the tip and the plate are metallic and of different work functions since body 38 acts as an electrolyte; the body is permeated by fluids having electrical properties similar to a saline solution. Experiments indicate that a preferable material for tip 30 is platinum and a preferable material for plate 34 is copper. The open circuit voltage (vs) of this galvanic cell is essentially independent of the temperature of ablation site 20. However, if the galvanic cell is heavily loaded with a shunt resistor, the galvanic cell serves as a current source and the magnitude of the current (is) is linear as a function of the tissue temperature at the ablation site through the 37� C. to 100� C. temperature range of interest. The temperature of the tissue adjacent plate 34 is the body temperature since the current density is insufficient to generate heat of any consequence. Thus, the galvanic cell created by the apparatus illustrated in FIG. 2 provides an output signal representative of the tissue temperature at ablation site 20 and irrespective of the temperature of tip 30.
One method for calibrating the galvanic cell will be described, but other methods may be used which do not require the presence of a thermistor at the tip. A thermistor is embedded in the tip of a catheter probe, such as probe 60. For reasons set forth above, the output of the thermistor is inherently inaccurate with respect to the actual tissue temperature at the ablation site; moreover, the temperature sensed by the thermistor as a function of the power applied is generally nonlinear. However, within a temperature range from a quiescent standby state to a small temperature increase at the ablation site (small increase in power applied), the output signal of the thermistor is essentially linear. By matching the output curve of the thermistor with the generally linear response curve of the galvanic cell, two coincident reference points can be determined. Referring to FIG. 4, there is illustrated a thermistor response curve and a galvanic cell response curve manipulated to be coincident from a point 0 to a point 1. By correlating the temperature indication of the thermistor at these two points, with the current output (is) of the galvanic cell, the temperature response can be linearly extrapolated to obtain a temperature reading correlated with the current output of the galvanic cell. That is, for any given current output of the galvanic cell, the tissue temperature of the ablation site can be determined. Thus, if probe 14 illustrated in FIGS. 1 and 2 is of the type shown in FIG. 3, calibration of the probe at the ablation site can be readily determined. Other methods for calibrating the current output with temperature can also be employed, as set forth above.
Referring to FIG. 5, there is illustrated a block diagram of the major components necessary to control the power applied to a catheter probe for ablating an errant impulse pathway at an ablation site. FIG. 5 shows a temperature input circuit 90 for setting a reference voltage equivalent to the tissue temperature sought for an ablation site at which an ablation procedure is to be performed. The resulting output signal is transmitted through conductor 92 to a servo amplifier 94. The servo amplifier provides an output signal on conductor 96 to control the output power of RF generator 98. A switch 100 controls operation of the RF generator. The RF energy output is impressed upon conductor 102. A blocking capacitor 104 is representative of a high pass filter and blocks any DC component of the signal on conductor 102. Conductor 106 interconnects the blocking capacitor with tip 30 of probe 14 and transmits RF energy to the tip. Tip 30 irradiates ablation site 20 of an endocardium, wall, membrane, or other living tissue to be irradiated with RF energy. Tip 30 is of a substance, such as platinum or other metal, having a first work function. Plate 34 displaced from tip 30, is of a substance, such as copper or other metal, having a second work function which is different from the first work function. Plate 34 is in electrical contact with a mass of tissue 38 intermediate tip 30 and the plate. This tissue, being essentially a liquid and having electrical characteristics of a saline solution, serves in the manner of an electrolyte interconnecting tip 30 and plate 34. The resulting galvanic cell formed, as discussed above, provides a DC output voltage vs across conductors 106 and 108. Shunt impedance R1 heavily loads the galvanic cell formed to convert the galvanic cell to a current source (is) to provide an output signal reflective of the tissue temperature at ablation site 20. The output signal from the galvanic cell is transmitted through conductor 110 to a lowpass filter 112. The output of the lowpass filter is conveyed via conductor 114 to an operational amplifier 120 of a calibration circuit 116. Additionally, a signal measurement and processing circuit 118, connected to conductor 102 through conductor 103 to provide sampling of the output load voltage (V0). It is also connected to conductor 107 through conductor 105 to provide an input signal of the load output) current (I0) sensed, processes the input signals to provide an indication of the impedance, power, and voltage and current levels. A readout 123, connected through conductor 119 to signal measurement and processing circuit 118, provides each of a plurality of indications of impedance, power, voltage level, current level, etc.
Variable resistors R3 and R4, in combination with operational amplifier 120, are representative of adjustments to be made to correlate the output current (is) of the galvanic cell with the tissue temperature of ablation site 20. Calibration circuit 116 can perform the above-described correlation of the thermistor indicated temperature with the current output signal of the galvanic cell to obtain a tissue temperature indication of the ablation site as a function of the current (is) generated by the galvanic cell. A readout 122, connected via conductors 124,126 with the calibration circuit, may be employed to provide an indication of the tissue temperature of the ablation site. An output signal from the calibration circuit is also conveyed via conductors 124 and 128 to servo amplifier 94. This output signal is reflective of the tissue temperature at the ablation site. Thereby, the servo amplifier receives an input signal reflective of the tissue temperature at the ablation site. Circuitry of servo amplifier 94 will determine whether to raise or lower the tissue temperature of the ablation site or to maintain it at its preset temperature. A command signal to increase, to decrease, or to maintain the power output of the RF generator is transmitted from servo amplifier 94 through conductor 96 to the RF generator.
Referring to FIG. 6, there is illustrated a variant of probe 14 useable with the present invention. The combination of first mapping a site of interest and then ablating the site is a lengthy procedure. Were it possible to ablate a site identified during a mapping procedure without relocating the probe or without replacing the mapping probe with an ablating probe, significant time would be saved. FIG. 6 illustrates a catheter probe 130, which may be sufficiently flexible to position all or some of its length in contacting relationship with the surface of the myocardial tissue to be mapped. A tip 132, which may be similar to tip 30 of probe 14, is disposed at the distal end. A plurality of mapping electrodes, such as rings 134, 136, 138, 140 and 142 are disposed proximally along the probe from tip 132. These rings serve a function of mapping the tissue of interest to identify and locate a site to be ablated to destroy the circuit responsible for errant impulses. For these rings to work in the manner of tip 30, as described with reference to FIGS. 1-5, the rings are preferably metallic and have a work function different from that of plate (or electrode) 34. One of a plurality of conductors 144, 146, 148, 150, 152 and 154 interconnect the respective tip and rings with the output of a switching circuit(s) 160. A data acquisition circuit 162 is selectively interconnected through switching circuit 160 to each of rings 132-142 and possibly tip 132. The data acquisition circuit collects data sensed by the rings and/or tips to map the tissue surface traversed by the probe. Upon detection of a site to be ablated to destroy an impulse pathway (circuit), switch circuit 160 switches to interconnect the respective ring (or tip) with RF generator 164. Upon such interconnection, the respective ring (or tip) will irradiate the identified site with RF energy and the ablation function, as described above along with the tissue temperature control function, will be performed.
From this description, it is evident that upon detection of a site located by performing a mapping function, ablation of the site can be performed immediately without further movement or manipulation of the catheter probe. Furthermore, the ablation function can be performed with the circuitry illustrated in FIG. 5 to heat and maintain the tissue at a predetermined temperature until ablation is completed.
Empirically, it has been determined that the circuit and apparatus for ablating tissue, as illustrated in FIG. 5, provides to a physician a very accurate indication of the tissue temperature at the ablation site. With such accuracy, ablation procedures are capable of being performed on thin wall tissue without fear of coagulation of the tip, adhesion of tissue to the tip or puncture, which fears exist with presently used ablation performing apparatus. Furthermore, accurate representation of the temperature at the ablation site is no longer critically dependent upon the orientation of the probe at the ablation site nor upon the extent of the depression of the tissue in response to the pressure exerted by the probe tip. Because of these very difficult to control variables, complete ablation of the errant impulse pathway was not always achieved if the physician were overly cautious. Tip coagulation, sticking tissue and sometimes excessive injury to and puncture of the tissue occurred if the physician were more aggressive. These results were primarily due to the inaccuracy of the information conveyed to the physician during the procedure and not so much due to poor technique.
As will become evident from the above description, tip 30 (and tip 132) does not need a thermistor or a thermocouple to set or determine the temperature of the ablation site. Therefore, the probe can be smaller and more versatile than existing probes. Moreover, the probe can be manufactured at a substantially reduced cost because it is more simple than existing devices. Rings (or other electrodes) located on the catheter can be used for mapping sites of errant impulses and any of the rings (or other electrodes) can be used to irradiate the tissue at such site after identification of the site and without repositioning of the catheter.
As a result of in vivo testing on canines in conjunction with more accurate and expanded signal displays, a further important capability of the present invention has been uncovered. Referring to FIG. 7A, there is illustrated a graph of three signals present during an ablation procedure. The ordinate of the graph depicts time in seconds and the abscissa depicts voltage. Curve 170 depicts the RF power level applied to catheter tip 30 and the voltage scale is proportional to the power level. The power applied is shown as steps 172, 174 and 176. The power is maintained essentially constant at each of these power levels. The power is turned on at time T1 and turned off at time T2. Curve 180 depicts the output of the thermistor within tip 30 (such as thermistor 66 within tip 60 shown in FIG. 3) and the voltage scale is proportional to the temperature sensed by the thermistor. Prior to time T1, section 182 of curve 180 is essentially quiescent and representative of an essentially constant temperature. Upon application of power, the temperature recorded by the thermistor increases, as depicted by section 184, which increase is essentially correlated with the time of power level 172. Upon further increase of the power level (174) section 186 depicts a higher temperature. Similarly, upon application of power level 176, section 188 depicts a yet higher temperature level. After termination of the power applied at time T2 the temperature of the thermistor drops, as depicted by section 189.
The current (I0) generated by the galvanic cell is represented by curve 190 and the voltage scale is proportional to the current. Prior to time T1, the current is essentially constant, as depicted by segment 192. At time T1 and upon application of RF power, the current increases, as depicted by segment 194, until a quiescent state is established after an initial duration of applied power corresponding with power level 172. Upon an increase of applied power level 174, the current increases sharply in segment 196. During the latter time period of power level 174, the rate of increase of current during segment 196 decreases. Upon application of additional power, represented by power level 176, the rate of increase of current level depicted by segment 198 remains essentially constant to a peak identified by numeral 200. It is to be noted that this peak occurs after power corresponding with power level 176 has been applied for a short duration. Thereafter, the current steadily decreases (decays). It may be noted that the peak of the curve representing the temperature of the thermistor, and depicted by point 188A, occurred significantly later than the peaking of curve 190 at point 200.
The cause for peaking of the current produced by the galvanic cell during application of a constant power level was not immediately understood nor evident from the data. Upon further inspection of an in vivo ablation site in the heart of a canine, it was learned that peaking occurred simultaneously with tissue damage (discoloration) at the interface between the catheter tip and the tissue. It is believed that the tissue damage resulted in a change in ion and cation distribution, or change in charge distribution, at the ablation site. That is, the resulting environment of damaged tissue having a reduced charge distribution significantly affected the current generated by the galvanic cell and provided a clear and unambiguous signal.
From these results, one can then draw the following conclusions. First, and as set forth above, the output current of the galvanic cell is correlatable as a function of the temperature of an ablation site irradiated with RF energy. Second, the current output of the galvanic cell formed by the subject undergoing an ablation procedure provides an unambiguous and readily apparent indication (signal) of when the tissue sought to be ablated at an ablation site has in fact been ablated. Third, upon detection of peak 200 during an ablation procedure, further application of RF power may be terminated. Since ablation generally requires a temperature in the range of about 50 to 55 degrees Centigrade, conditions giving rise to tip coagulation, sticking tissue and perforation of the tissue will not occur. The resulting safety feature of the ablation procedure and the elimination of serious possibility for consequential injury will be achieved to a degree never before available.
Referring to FIG. 7B, there is representatively shown a curve 210 depicting applied RF power levels, curve 212 depicting the temperature of a thermistor disposed in a catheter tip performing an ablation procedure, and curve 214 depicting the current output of a galvanic cell which would be present during an ablation procedure. Curve 214 depicts a peak 216 occurring during application of power corresponding with power level 218. At this power level, segment 220 of curve 212 has an initial rise followed by a reduced rate of rise of temperature. Despite the constantly applied power level, curve 214 decreases subsequent to peak 216. Upon application of a higher power level, represented by numeral 220, the decrease of curve 214 is halted and after a small rise maintains an essentially quiescent state. However, segment 224 of curve 212 increases abruptly with a following reduced rate of increase. Upon termination of power at T2 curves 214 and 212 decrease.
The curves depicted in FIG. 7B clearly show that peak 216 occurring in curve 214 is unaffected by subsequent applications of increased power and despite such increased power provides an unambiguous indication of ablation of the tissue at an ablation site.
It is presently believed that the degree of decay of the current signal (curve 180 or 214) is a function of the tissue damage. Moreover, it is believed that the depth of ablation can be controlled as a function of power level and time subsequent to occurrence of ablation (peak 200 or 216).
Referring to FIG. 8, there is illustrated an improved version of the apparatus shown in FIG. 5. The improved version includes a computer 250 which includes a visually perceivable display screen 251 for depicting data, two-dimensional images, etc. For example, readout 123 (depicted in FIG. 5) may be one of the group of images that would be displayed by computer 250. The computer may include a plurality of ports, represented by block 252, through which data, whether digital or analog, may be inputted and outputted. Load/impedance measurement circuit 118 is connected to a port 254 of block 252 via conductor 256. The computer 250 includes the capability for manually or otherwise inputting data that would affect the parameters, operation, or results achieved during an ablation procedure. A port 258 will provide, through conductor 260, an on/off switching function for RF generator 98. A reference voltage representative of a temperature can be applied to servo amplifier 94 through conductor 262 via port 264. The readout function formerly performed by readout 122 (see FIG. 5) can be provided by computer 250 by interconnecting conductor 266 via port 268. Furthermore, the curves displayed in FIGS. 7A and 7B may be readily displayed by computer 250 through use of its display screen 251.
With the use of a computer and associated software, it is now possible for a surgeon to determine on a real time basis the exact moment ablation occurs at an ablation site by denoting the presence of peak 200 (FIG. 7A) or peak 216 (FIG. 7B). Thereafter, further application of RF power is unnecessary and all of the potential hazards of overheating at the ablation site are avoided. However, as the depth of ablation in the tissue is or may be a function of the power level per time of applied RF power, radiation of RF energy may be continued until the level of ablation desired by the surgeon is achieved.
As discussed above, a catheter tip having multiple elements, as depicted in FIG. 6, can be used to simultaneously or sequentially ablate each of a plurality of sites. The use of a computer 250 permits real time monitoring of each ablation site. With such monitoring, control of RF power applied to each ablation site is readily available to a physician.
While the invention has been described with reference to several particular embodiments thereof, those skilled in the art will be able to make the various modifications to the described embodiments of the invention without departing from the true spirit and scope of the invention. It is intended that all combinations of elements and steps which perform substantially the same function in substantially the same way to achieve the same result are within the scope of the invention.
Patent Citations
Non-Patent Citations
Referenced by
Legal Events
Original Image


text:
Corruption Charges
Quiet Weekend For Blagojevich Ahead Of Sentencing
It's a quiet weekend for convicted ex-governor Rod Blagojevich and his family, just days before his sentencing hearing.
Feds Want 15-20 Year Sentence For Blago; Defense Seeks Much Less
Federal prosecutors intend to ask a federal judge to sentence former Illinois Gov. Rod Blagojevich to a 15- to 20-year prison term. But defense attorneys are seeking a much lighter sentence, arguing Blagojevich never profited from the crimes on which he was convicted and caused no public harm.
Blagojevich Wants To Play New Tapes At Sentencing
Former Gov. Rod Blagojevich is asking to play wiretap recordings that were previously placed under seal when he's sentenced next month.
Blagojevich Sentencing Set For December
Former Gov. Rod Blagojevich's sentencing hearing has been scheduled for next month.
Defense Tries To Distance Cellini From Blagojevich
An attorney for an Illinois powerbroker on trial in the last case directly linked to a federal investigation of Rod Blagojevich sought in his opening statement Thursday to distance his client from the disgraced former governor.
Blagojevich Home Listed For Sale For $1.07M
For the first time since revealing that they are trying to sell their home, former Gov. Rod Blagojevich and his wife, Patti, have publicly listed their Ravenswood home for sale at $1.07 million.
Rezko Sentencing Delayed Again
Sentencing has been delayed again for convicted political fixer Antoin "Tony" Rezko, a former fundraiser for ousted Illinois Gov. Rod Blagojevich.
Feds: Rod Blagojevich Could Get 30 Years To Life In Prison
Prosecutors are apparently looking to throw the book at convicted former Gov. Rod Blagojevich – they are estimating that he could get 30 years to life in prison.
Blagojevich Defense Appears To Be Working Toward Appeal
Rod Blagojevich's defense team appears to have taken its first steps toward filing an appeal of his conviction on 17 corruption counts last month.
Blagojevich Convicted On 17 Counts
It took two tries, but federal prosecutors got the victory they were looking for when a federal jury convicted former Gov. Rod Blagojevich of several corruption charges on Monday.
Verdict Reached On 18 Counts In Blagojevich Trial
A verdict has been reached on all but two counts in the re-trial of deposed Gov. Rod Blagojevich.
Blagojevich Jury Ends Another Week Of Deliberations
The ninth day of deliberations is underway for jurors deciding the fate of deposed Gov. Rod Blagojevich.
Day 8 Of Deliberations Over For Blago Jury, Still No Verdict
The jury in Rod Blagojevich's corruption retrial wrapped up its 8th day of deliberations on Wednesday without reaching a verdict.
Blagojevich Jury Finishes Day 7 Without Verdict
The federal jury deciding former Gov. Rod Blagojevich's fate finished its seventh day of deliberations on Tuesday without reaching a verdict.
Blagojevich Jurors Deliberate Another Day With No Verdict
The jury in Rod Blagojevich's corruption retrial wrapped up another day of deliberations on Monday without reaching a verdict.
Blagojevich Jury Asks For Clarification Of Key Instruction
Jurors in Rod Blagojevich's retrial have gone home for the weekend after asking the judge to clarify an instruction regarding 10 of the 20 counts against the former governor.
Blago Jury Wraps Another Day Of Deliberations; No Verdict Yet
Another day of jury deliberations has wrapped up without a verdict in Rod Blagojevich's corruption retrial.
First Note From Blagojevich Jury, But Still No Verdict
Jurors in the corruption retrial of former Gov. Rod Blagojevich wrapped up their third day of deliberations on Tuesday without reaching a verdict, but they did send their first note to the judge.
Blagojevich Jury Wraps Second Day Of Deliberations
Jurors in the Rod Blagojevich corruption retrial have wrapped up their second day of deliberations, meeting without a word on their progress on Monday.
Blagojevich Says He's Never Considered A Plea Deal
Rod Blagojevich says he's never considered a plea deal with federal prosecutors even though the impeached Illinois governor could face the possibility of spending decades behind bars.

subset: commoncrawl


text:
Real Software Engineering
The other day I watched a great presentation about Software Engineering from Glenn Vanderburg, of InfoEther. The term software engineering is often met with criticism. Is developing software really an engineering discipline? Isn't engineering more about calculus? And what about all those software projects that fail? If building software is an engineering discipline, many people are surely doing it wrong. Vanderburg also addresses the waterfall process, where it came from, how it rose in popularity and why it so frequently produced late, misguided or failed software. He describes how modeling relates to engineering and software, and why and when it should be used.
Vanderburg sheds light on the the engineering process. He discusses how software is very different from some traditional disciplines, but very similar to others. He also talks about methods that are being used in the software development industry today that provide customers with working software that functions as it should, is delivered within budget, and does not require endless documentation. The question he asks is "why do we use the term 'software engineering' as a definition for a practice that doesn't work." This video is a must see if you ever see yourself working with software development (whether from the development or the management side).
If anyone doubts the validity of what he says in his speech, it is worth noting that InfoEther (the company in which he is a partner) was recently purchased by Living Social for a large (undisclosed) sum. http://infoether.com/livingsocial


text: Found this interesting article today on the sell of the Pontiac Silverdome in Detroit. "The winning bidder, one of four and whose identity has not yet been released, plans to use the facility for a men's Major League Soccer team and women's professional soccer teams, Fred Leeb, Pontiac's emergency financial manager, told the Free Press in an exclusive interview." http://www.freep.com/article/200911...-submits-winning-bid-of-583000-for-Silverdome


text:
The coming launch of the iPhone 5 will be a big event – maybe the most important in Apple's history, according to FBR Capital analyst Craig Berger.
Berger, who covers the chip sector, estimates that the iPhone 5 over its life cycle could sell as many as 250 million units and generate profits of more than $50 a share. It will be, he writes in a research note, "one of the largest single product opportunities in Apple's history."
He notes that investors seem to be fretting over the impact of carrier policies intended to discourage upgrades will have on sales. But he thinks that factor will be more than offset by the fact that upgrades tend to driven more by product than by eligibility status, and by the potential launch of the new phone with China Mobile early in 2013.
"Together, we expect the two positive catalysts will help drive one of the largest and balanced product cycles in Apple's history," he writes.
Berger thinks the list of winners from a successful iPhone 5 launch will include the chip makers Qualcomm and Fairchild Semiconductor. He estimates that Qualcomm could sees its content in the phone grow to $15 to $18 per phone, up from $8 of parts in the iPhone 4S. He adds that Fairchild Semi could enjoy grow its share of the bill of materials in the handset as well as in the charger for the new phone.
Chip makers expected to play a role in the new phone similar to that in the iPhone 4S incude Broadcom, Avago, Skyworks, Triquint, Cirrus, TI and ON Semiconductor, he contends. He also sees potential lift all three carriers that sell the iPhone in the U.S. – AT&T, Verizon and Sprint.
Apple today is down $2.59, or 0.4%, to $629.10.


text:
Join the 'Dexacorten' group to help and get support from people like you.
Dexacorten Support Group
Latest News
Steroids No Better for Sciatica Pain Than Placebo, Study Finds
TUESDAY, May 19, 2015 – Doctors often prescribe steroid pills to ease the discomfort of sciatica – back and leg pain usually caused by a herniated disk in the lower back. But a new study finds ...
Further Information
Related Condition Support Groups
Inflammatory Conditions, Adrenal Insufficiency, Cerebral Edema, Ankylosing Spondylitis, Addison's Disease, Loeffler's Syndrome, Multiple Myeloma, Croup, Asthma, view more... Rheumatoid Arthritis, Seborrheic Dermatitis, Adrenocortical Insufficiency, Bronchopulmonary Dysplasia, Cushing's Syndrome, Dermatitis Herpetiformis, Bursitis, Adrenogenital Syndrome, Synovitis, Idiopathic (Immune) Thrombocytopenic Purpura, Neurosarcoidosis, Lymphoma, Systemic Lupus Erythematosus, Gouty Arthritis, Eczema, Contact Dermatitis, Atopic Dermatitis, Ulcerative Colitis, Nausea / Vomiting - Chemotherapy Induced, Uveitis (Posterior), Pulmonary Tuberculosis, Meningitis - Listeriosis, Pemphigus, Mountain Sickness / Altitude Sickness, Multiple Sclerosis, Chorioretinitis, Hypercalcemia of Malignancy, Hay Fever, Allergic Rhinitis, Sarcoidosis, Thrombocytopenia, Shock, Tuberculous Meningitis, Psoriatic Arthritis, Toxic Epidermal Necrolysis, Iritis, Evan's Syndrome, Hemolytic Anemia, Erythroblastopenia, Epicondylitis - Tennis Elbow, Aspiration Pneumonia, Asthma - Acute, Inflammatory Bowel Disease, Iridocyclitis, Meningitis - Meningococcal, Meningitis - Pneumococcal, Meningitis - Haemophilus influenzae, Leukemia, Juvenile Rheumatoid Arthritis, Keratitis, Mycosis Fungoides


text:
Below is the poem entitled Fancy That which was written by poet
Wood. Please feel free to comment on this poem. However, please remember, PoetrySoup is a place of encouragement and growth.
Read Poems by
Chad Wood
I'm sipping on a couch-boat in
Van Gogh-painted water.
Bill Evans is dueting his blue-kind
keys with my jolly time ticker.
When my eyes are shut, I think two-dimensional.
I think onomatopoeic.
Fancy that.
Afterall, my generation combines words like
"emotion" and "icon". My generation puts
society on a screen...
Ah, but I suppose the
next will convert the universe into binary,
and leave me behind
with my coffee, and jazz.


text:
Vancouver Classics Commercial Shelving 60 in. x 24 in. x 72 in.
Item #184525
This commercial 5-shelf unit from Vancouver Classics Inc. easily organizes any space or room. Assemble the heavy-duty, chrome finish, NSF® certified shelving easily without tools, and the interlocking shelves allow for multiple configurations. This shelving system is perfect for homes, offices, garages, warehouses, kitchens, restaurants, file room, and any other places you need to organize.
- 5 heavy-duty centre-truss 152.4 cm x 61 cm (60 in. x 24 in.) adjustable shelves
- NSF® certified
- Clear coated chrome finish
- Heavy-duty steel construction
- 4 - 7.6 cm (3-in.) commercial wheels
- 4 leveling feet
- Capacity:
- 272.2 kg (600 lb.) per shelf on leveling feet, evenly distributed
- 45.4 kg (100 lb.) per shelf on wheels, evenly distributed
- 1,360.7 kg (3,000 lb) entire shelving system on leveling feet, evenly distributed
- 226.8 kg (500 lb.) entire shelving system on wheels, evenly distributed
- Units can be linked together to build a larger storage system
- Dimensions (L x W x H): 152.4 cm x 61 cm x 182.8 cm (60 in. x 24 in. x 72 in.)
- Weight: 49.8 kg (109.8 lb.)
- 1 year
Adjustable Shelves: Yes
Brand: Vancouver Classics
Free Standing: Yes
Height: 182.88 cm (72 in.)
Length: 152.4 cm (60 in.)
Material: Metal
Weight: 49.8 kg (109.8 lb.)
Width: 60.96 cm (24 in.)
Costco.ca products can be returned to any of our more than 600 Costco warehouses worldwide.
Membership: We will refund your membership fee in full at any time if you are dissatisfied.
Merchandise: We guarantee your satisfaction on every product we sell and will refund your purchase price, with the following exceptions:
1. Electronics: Costco will accept returns within 90 days from the date of purchase for televisions, projectors, computers, cameras, camcorders, touch-screen tablets, MP3 players and cellular phones and other products identified by Costco from time to time.
2. Diamonds: When returning items containing a 1.00 ct diamond or larger, Costco will require additional time to verify the diamond, in which case a refund will be approved upon positive verification. This process may require two to five business days.
If you request an item be picked up for return, the item must be packaged and available for pick up in the same manner as it was delivered.
If your order was delivered "curb side", it will need to be available for curb side pick up.
If the item arrived to you in a box, it will need to be in a box at the time of pick up.
Costco may in the future restrict its return policy regarding other products. Restriction will be shown at the point of purchase.


text:
Sex Ed: First Time - I Didn t Bleed. Is It Normal?
Louisa makes her lips real pretty for a Mr. Dick
Sex Ed: Girlfriend Doesn t Want To Lose Virginity
Sex Ed: I Want To Finish In Her Mouth
Q&A: Anger Over Circumcision
pornlygirl18...just do as she says.
pornlygirl18 gives a handjob tutorial, part 3
pornlygirl18 gives a handjob tutorial, part 2
sex study
pornlygirl18 talks dirty...
Sex Ed: Can Ejaculation Cause Blindness?
Sex Ed: My Best Friends Girlfriend...
Sex Ed: Best Age For 1st Committed Relationship
Sex Ed: What Went Wrong On The First Date?
Sex Ed: Is My Girl Pregnant? How Can I Tell?
Sex Ed: She Thinks I m Gay! How Do I Ask Her Out?
Josie is jerking off boyfriend without him there
Sex Ed: Popping A Girl s Cherry: Will It Bleed?
Jessica has a big mouth to jerk you off with
Sexy talk on the webcam with Denise
Sex Ed: Help! Boyfriend Won t Use A Condom
Sex Ed: Do Women Care If A Guy Has A Large Penis?
Sex Ed: Can I Get STDs If We re Both Virgins?
Sex Ed: Web Cam Romance And Sex On The 1st Date
Sex Ed: How To Gain Confidence To Ask A Girl Out
EX-GF Filipina bacolod
Sex Ed: She Wants To Do Me With A Strap On?!?


text:
Download our camper application today! Application and fee are due by September 5, 2014.
The cost of camp is $120 and checks can be made payable to 'Camp Koinonia.'
Mail your application and the 2014 fee of $120.00 (US) to:
The Camp Koinonia
1914 Andy Holt Ave.
Knoxville, TN 37996
NOTE: faxed and/or emailed applications will NOT be accepted
Our 5th annual weekend camp for individuals with Down Syndrome will be held September 26-28, 2014 at Camp Wesley Woods in Townsend, TN.
Come join us as we have a fun-filled weekend full of outdoor learning and adventure. Campers will play games, make crafts, shoot archery and more during this fall. The theme and packing list will be posted shortly! If you have any questions please call 865-974-4363 or email firstname.lastname@example.com.
Please click here to download our Student Application for Camp Oginali 2014. Fill out our student information application to volunteer to be a counselor, activity staff, head counselor, or activity leader at Camp Oginali! The cost for volunteers is $20 and the application with payment are due by September 6 to HPER 361. You must turn in a hard copy to the office! Emailed applications will not be accepted. Applications turned in without the fee will not be accepted. Checks made out to Camp Koinonia or exact cash are the payment methods.


text:
Posted at: 11/02/2012 5:12 PM
Updated at: 11/02/2012 8:02 PM
By: Stuart Dyson, KOB Eyewitness News 4
Bernalillo County election officials confirm that dozens of voters living outside the Albuquerque city limits have voted on ballots that were supposed to be for city voters only.
Things went wrong at the Tierra West trailer park just off Route 66 on Nine Mile Hill. It's in the county, not the city, but the address shows up as a city address in the voter database, so voters from Tierra West were issued ballots that included two propositions for city voters only.
One is the question of raising the city minimum wage to $8.50 an hour. The other is a $50 million bond issue for a new Paseo del Norte/I-25 interchange.
The county's chief election official said there is a way to solve this problem.
"It's one very specific ballot style that correlates to that particular area," said County Clerk Maggie Toulouse Oliver. "We can separate those ballots out and when the city canvasses the election they can subtract those votes from the total numbers."
The votes on other issues and candidates would still be counted.
There are about 300 voters living at Tierra West, and polls show the two city ballot issues are likely to pass by a much larger margin than 300 votes.


text:
Two-ply fine cotton and single-needle construction. Extra durable and wrinkle-free. Button-through sleeve placket, back pleat. Machine wash.
Additional Sizes:
Color : Select Swatch Below
$10.00 additional
We have hand selected products to match the product above.
(based on 6 reviews)
Ratings Distribution
5 Stars
4 Stars
3 Stars
2 Stars
1 Stars
of respondents would recommend this to a friend.
Best Uses
Reviewed by 6 customers
Sort by
Displaying reviews 1-6
Back to top
Great everyday shirt for a casual work.
By Randy
from Laguna Niguel, CA
Comments about Jos. A. Bank Traveler Buttondown Long-Sleeve Sportshirt:
Fits great for my 6"3", 210 lb frame. Feels nice, too. And the easy care (little or no ironing) is the plus I want from a shirt.
Bottom Line Yes, I would recommend this to a friend
Was this review helpful? Yes / No
- You may also flag this review
Great Fitting Shirt
By Southern Gentleman
from Atlanta GA
Great Shirt. Comes out of the dryer, ready to wear! Well tailored and fits like a glove.
Well made shirt. Lots of compliments.
By John the Sharp Dresser
from Janesville, WI
To use this shirt, begin by removing from the plastic bag unbuttoning the shirt, and removing any pins, clips, cardboard and paper. Put arms, hands first, into the sleeves. (If you're not sure which arm goes in which sleeve, use trial and error or ask a friend.) Once your arms are in both sleeves, button the shirt in front. If the shirt opens to the back and you are unable to reach the buttons, remove the shirt, and try putting your arms in the opposite sleeves.Then, wearing pants, belts, shoes and socks, walk around and receive praise.
Very nice shirt
By Sue
from VA
Great shirt. Wears well and no wrinkles.
Service and delivery comments:
Delivery couldn't have been better. It arrived within a day!
High quality
By Stan
from Danbury, CT
I would rather right a review after using it for several months.
Traveler Button down
By none
from ct
Excellent. Well made,great fit. My son loves it.
Do you have questions about this product?
Get answers from real customers and in-house experts.
Know the answer? Answer this question
1 answer
Do you have a question about this product?
On all online orders$50 or more◊
For Assistance Contact us Toll Free Anytime at 1-800-285-2265
California Transparency In Supply Chains Disclosure
1-800-285-2265 ©Jos. A. Bank Clothiers, Inc.


text:
Storm Team 8 Meteorologist Terry Swails is back with his favorite fair attraction, the giant tree. This time the tree branches out into broadcasting, helping Terry with a little mic trouble. Terry's probably glad the tree didn't "leaf" him alone!
The giant walking and talking tree crept up on Terry for the first time on opening day at the fair. Check out that video – click here.


text:
I want to add some custom fields to the customer accounts in shopify using the API and then access them on the account page, how can I do that? I see how to create accounts at http://wiki.shopify.com/Customer_%28API%29#Create_a_new_customer_account but can I add an arbitrary field to the request body somewhere? Thank you
Take the 2-minute tour ×
Stack Overflow is a question and answer site for professional and enthusiast programmers. It's 100% free.
AHA! I found where the custom metafields are described - http://www.shopify.com/technology/3032322-new-feature-metafields. On that page is where the syntax for retrieving them in a liquid template is described, and the specifics for creating them from the API are at api.shopify.com/customer.html#create under the example labeled "Create a new customer with a metafield".


text:
Thank you. If a matching email exists we will send you an email in a few minutes with instructions on how to reset your password.
Don't forget to check your spam folder if you cannot find the email. For further assistance please contact us at firstname.lastname@example.com .Okay
Delicate, honey-infused linden and warm, inviting fig form the base notes of this delicious, entrancing fragrance. Set of two glass candles with silver lids.
Known for transforming a home into an oasis for the senses, Archipelago sets a tone of harmony, tranquility, and escape from the pace of the everyday. Lovely to look at, these natural soy candles add a dimension of scented pleasure to a room. They promise gentle, sophisticated, sensory journeys redolent of luscious fruited blends, sunny citrus orchards, and tropical climates.


text:
The Port Arthur Historic Site Management Authority is offering a rare opportunity to find out more about the use of lime in heritage buildings and in particular the preparation and application of lime wash and distemper.
This activity will be of interest to heritage practitioners, tradespeople and owners of heritage propterties who wish to know more about these once common techniques.
The workshop will include presentations by Dr Donald Ellsmore and practical demonstrations with a chance to try your hand at lime washing.
Thursday April 14 9.30am—4.00pm (arrive at Visitor Centre reception by 9.15am)
Meet at the Port Arthur Visitor Centre, from where it is a short walk to the venue, the Visiting Magistrate's House, Port Arthur Historic Site. Parking is available at the Visitor Centre carpark.
There is a fee of $20 towards the cost of lunch and refreshments.
RSVP 11 April to email@example.com or call Harriet on 6251 2334.
The workshop is being presented as part of the Port Arthur Historic Site Management Authority's celebrations of National Heritage Week. To find out more about the celebrations, visit www.portarthur.org.au/nationalheritageweek.
Limewash being applied at a previous Port Arthur workshop
Pots of limewash paint
© 2010-2011 This page was produced by the Port Arthur Historic Site Management Authority.
Use of this website is subject to our disclaimer and copyright notice. This is our Customer Service Charter.
This page www.portarthur.org.au/index.aspx?base=5708 was last updated Monday, 15 March 2010.


text:
A new study released recently by the Potsdam Institute for Climate Impact Research and the University of Innsbruck includes some impactful visualizations of what sea level rise could mean to various … [Read more...]
Using Google Earth to predict sea level rise
Google publishes Crisis Response map for Boulder, Colorado
Similar to maps that Google has released in the past for places like Alberta and Moore, they've just published a Crisis Response map to assist with the flooding in Boulder, Colorado. You can view … [Read more...]
Google publishes Crisis Response map for the Alberta Flooding
As they do after many major weather-related events around the world (such as Moore, Oklahoma last month), Google has just published a Crisis Response map for Alberta to help citizens deal with the … [Read more...]
Fresh imagery from the flooding in Thailand
Last week, we showed you Google's Crisis Response page for the flooding in Thailand. NASA's Earth Observatory has now released some new imagery from the area and it's quite striking. You can view the … [Read more...]
Responding to the Thailand Floods
As Google often does during disasters (such as the Gulf Oil Spill and the Japan Earthquake, Google has set up a Crisis Response page to help provide information for those trying to assist with the … [Read more...]
New false color image of the Morganza flooding
The NASA Earth Observatory has just posted a very powerful false-color image of the flooding that resulted from opening the Morganza spillway last week. The reason for the false-color in this imagery … [Read more...]
Imagery from the Louisiana flooding
A couple of days ago we showed you the location of the Morganza Spillway and the expected flood area, and now some fresh satellite imagery is coming in to show what's actually been happening. The … [Read more...]
Imagery of the flooding in Pakistan
UPDATE, 13-August: Google has now put out a blog entry with a lot more info from their Crisis Response team about the flooding -- read it here. A few days ago we told you that Google was seeking … [Read more...]


text:
Check out the wedding music video parody that we shot and put together for a very special wedding day. Stefani and Jeremy are one of our cousins and reached out to us about a fun video project they wanted to make for their wedding day, and the Gangnam Style song and dance just seemed to be a perfect fit for them. This video was shot in San Francisco and various locations throughout the Bay Area. We hope you like it! Thanks for watching. =)
For all questions, bookings/inquiries, email email@example.com
Congratulations to Stephani Nguyen and Jeremy Ueno!
Connect with us:
Disclaimer: We do not own this song, it belongs to its rightful owners. No copyright infringement intended.
Music copyright goes to Psy - Gangnam Style
Loading more stuff…
Hmm…it looks like things are taking a while to load. Try again?


text:
Friday, March 14, 2014
The North Charleston Fire Department will soon begin responding to fires within Summervilles jurisdiction after Town Council authorized a new agreement Wednesday.
At the March Town Council meeting, Council unanimously approved the mayor to execute an interlocal agreement for automatic aid and response between the Town of Summerville and the City of North Charleston.
According to Summerville Fire Department Chief Richard Waring, the agreement will allow the two municipalities to share fire response resources.
He said whenever a call comes into the 911 Dispatch Center, the dispatchers will automatically send whichever fire department is closer to the scene.
Chief Waring said he has been working toward this collaboration with Chief Gregory Bulanow, North Charleston Fire Department, for the past six months. SFD has been adopting procedures similar to NCFD so when the departments work together they will work seamlessly, he said.
The City of North Charleston also has to approve the agreement before its put into action. According to Linda King at the North Charleston Clerk of Councils office, the North Charleston Public Safety Committee will hear the request on March 20 and the item to be on the councils agenda for approval March 27.
The Journal Scene is pleased to offer readers the enhanced ability to comment on stories. We expect our readers to engage in lively, yet civil discourse. We do not edit user submitted statements and we cannot promise that readers will not occasionally find offensive or inaccurate comments posted in the comments area. Responsibility for the statements posted lies with the person submitting the comment, not The Journal Scene.
If you find a comment that is objectionable, please click "report abuse" and we will review it for possible removal. Please be reminded, however, that in accordance with our Terms of Use and federal law, we are under no obligation to remove any third party comments posted on our website. Read our full terms and conditions.
© 2015 The Journal Scene an Evening Post Industries company. All Rights Reserved.
Registration on or use of this site constitutes acceptance of our Terms of Service, Privacy Policy and Parental Consent Form.


text:
Recent items
Global Outlook for Ice & Snow
The "Global Outlook for Ice & Snow" is a special and unique UNEP report launched to mark World Environment Day on 5 June 2007. Snow and ice, with their large areas but relatively small volumes, ...
Published to 'Complete collection' 04 Jun 2007
The UNEP Shelf Programme
The UNEP Shelf Programme is a partnership of international organizations with expertise in marine geoscience and maritime law, established to assist developing States and small island developing S ...
Published to 'Websites' 09 Nov 2005
Globalis is an interactive world atlas where you decide what is to be displayed on the map. Globalis aims to create an understanding for similarities and differences in human societies, as well as ...
Published to 'Websites' 16 Nov 2003
In Dead Water
Merging of Climate Change With Pollution, Over-Harvest, and Infestations in the World's Fishing Grounds A rapid response report that mapsthe multiple and combined impacts of pollution; alien i ...
Published to 'Complete collection' 15 Apr 2008
The Last Stand of the Orangutan
State of Emergency: Illegal Logging, Fire and Palm Oil in Indonesia's National Parks The survival of orangutans and other rain forest wildlife in Indonesia is seriously endangered by illegal lo ...
Published to 'Complete collection' 17 Oct 2007
Balkan Vital Graphics
Environmental protection is one of the areas where the Balkan countries still face a big challenge to catch up with their western neighbours. After the 1990s conflicts and the breakup of Yugosla ...
Published to 'Balkan Vital Graphics' 29 Apr 2007
Our Precious Coasts
Marine pollution, climate change and the resilience of coastal ecosystems. The ability of coral reefs to survive in a globally-warming world may crucially depend on the levels of pollution to w ...
Published to 'Our Precious Coasts' 29 Apr 2006
Vital Caspian Graphics - Challenges Beyond Caviar
We often associate the Caspian Sea with caviar that is legally or illegally finding its way to our tables, but overlook the footprints left by a number of industries installed on shores of the C ...
Published to 'Vital Caspian Graphics' 29 Jul 2007
Vital Ozone Graphics
"Vital Ozone Graphics – resource kit for journalists" is a joint publication of UNEP DTIE OzonAction and GRID-Arendal. It features 30+ new graphics explaining physical, technical, economic and p ...
Published to 'Vital Ozone Graphics' 29 May 2007
Environment & Poverty Times No. 5
The paper features a collection of short articles, maps, graphics and other illustrations that focuses on the complex links between environment and poverty reduction. It describes how natural re ...
Published to 'Environment & Poverty Times No. 5' 05 Jun 2008
Climate Change
Environment and Security
Impact of Information
Indigenous Peoples
On the move
State of Environment
Sustainable Tourism
UNEP Shelf Programme
Disclaimer, copyright and usage conditions
Copyright © 2014 GRID-Arendal (T)


text:
In a region steeped in our nation's history, Thomas Nelson Community College is proud to make its own history. The new Historic Triangle Campus with 120,000 square-foot building is on nearly 74 acres of land at the Warhill site. The new Historic Triangle campus is located at 4601 Opportunity Way in Williamsburg. The College's new building was designed by Moseley Architects of Virginia.
Strategically located next to Williamsburg-James City County's (W-JCC) newest high school at Warhill, the College will work in collaboration with the W-JCC school system to develop programs and other opportunities that will facilitate the transition of high school students to college.
The new campus serves the workforce development needs of the business community and helps individual citizens achieve their educational goals. The Historic Triangle campuses had an enrollment of more than 2,000 students.
Thomas Nelson Community College has developed a new Health Professions division at the Historic Triangle Campus to bolster its ongoing efforts to enhance the College's Science, Technology, Engineering, Math and Health (STEM-H) programs. The new division will encompass all Dental Hygiene, Nursing, Emergency Medical Services, and Phlebotomy programs.
For more information about the new campus or programs to be offered there, please contact Historic Triangle campus administration at 757-253-4300.
Other information and documents about the new Historic Triangle Campus:


text:
Now entering its 38th season, the Festival is still producing energetic new interpretations of plays, with the artistry and humanity of the Shakespearean canon as our inspiration and guide. The Festival performs to audiences of over 10,000 every summer and operates under an Actors' Equity U/RTA Tier II contract.
We will announce our 2015 season in October 2014. If you are interested in being considered for the 2015 season, please submit a video audition (one Shakespeare monologue in verse, not to exceed 3 minutes) to email@example.com prior to Friday, October 24, 2014. If a callback audition is requested, you will be notified by November 1, 2014. Thanks for your interest in the Illinois Shakespeare Festival.
Thanks for your interest in the Festival!
The Illinois Shakespeare Festival operates as a repertory company. Actors are contracted to play multiple roles in two or more of the season productions. Opportunities to understudy may also be available.
For the 2015 season, the Festival will hire a company of 14 to 15 talented and versatile actors. The Festival seeks out actors who are passionate about working on Shakespearean texts and enthusiastic about sharing their knowledge, energy, and talents with other artists and with our audience members. Creating a positive and supportive environment that fosters artistic excellence is of primary importance at the Festival.
Festival actors are contracted to play roles in three shows. Non-Equity and intern actors may be offered specific roles or a position with roles to be cast upon arrival in May. All Equity and non-Equity positions are paid. The Festival offers housing for all employees.
Contract dates are mid-May through mid-August.
Illinois State University is an EOE/AA employer. Minority/Female/Disability/Veteran.


text:
If you are not completely satisfied with your purchase, you may return it to us within 30 days of receipt for an exchange or refund. The item must be in "new" condition for a full return/exchange value. Items in "used" condition will be subject to a 25% restocking fee. You are responsible for the shipping cost of sending the item(s) back to us. We recommend using a shipping method that is track-able - FedEx One Rate is our preferred shipper (both affordable and reliable). Upon receipt, we will begin processing your exchange/return immediately. We regret that we are unable to refund for shipping charges regardless of circumstances once the order has been shipped.
EXCHANGES: Exchanges are simple. If your requested item is in stock, we will ship out your exchange within 2 business days. Otherwise, we will call or email to let you know the expected wait time. If there is a discrepancy in price between the exchanged items and the original order amount (including discounts & taxes) of less than $3, we will not issue a refund or require you to pay for the difference. If you wish to expedite the process, please call our warehouse before you return the item and verify that we have your desired item in stock. We will pay the shipping back to you on the first exchange (you are responsible for return shipping to us). You will be responsible for the shipping charges of any additional exchanges. Restrictions apply. This policy is subject to change.
RETURNS: Returns are simple, too. Refunds are issued in the same manner that you originally paid. Please allow us 2-3 business days to process your refund. We regret that we are unable to issue a refund for shipping charges regardless of circumstance once the order has shipped. Please note that refunds over 30 days are issued as in-store credit, re-stocking fees* may apply.
SHIPMENT ERRORS & DAMAGED PRODUCTS: In the unlikely event that you received the wrong item or the item(s) you received was damaged in any way, please contact our customer service department within 7 days to let us know about the issue so we can make it right.
Our return/exchange form is completely automated! Simply visit our Return & Exchange Center page and fill out the web form. You will need your order number and the email address associated with your order (if you are unable to locate your invoice, please call us at 1.866.456.7411 for assistance), and what item(s) (size, color, fabric) you wish to receive in exchange for you returned item(s). If you are returning for a refund, you can indicate that in the "notes" section of the form. Once that is complete, print out the form and include in your package along with the item(s) and ship to:
Returns Department 27 S. Chelan Ave Wenatchee, WA 98801
If you are unable to print the exchange request, you may also use your invoice. You MUST include your order number in your return to ensure your request is completed in a timely manner. Again, we recommend you choose a shipping method that is traceable. Please allow our Exchanges & Returns Department 2-3 business days to process your request once your package arrives at our facility.
Sales on all discontinued and closeout merchandise are final and non-refundable. The only exception are clearance corsets, which can be returned for in-store credit only equal to the amount of the purchase price minus a $10 restocking fee. Hosiery and other items of an intimate nature (panties and shapewear with a panty) cannot be returned or exchanged for sanitary reasons.
If you received a special discount based on a minimum order amount and return part of your order, bringing your order total below the minimum amount for the discount your refund/credit will be reduced to reflect the value of the discount..
Please ship your return to:
Returns Department
27 S. Chelan Ave
Wenatchee, WA 98801
United States
Refunds are issued in the same manner as payment was received. Please allow 2-3 business days to process the refund. Refunds via credit card may take an additional 2-3 business days for your credit card company to process the credit. We regret that we are unable to issue a refund for shipping charges regardless of circumstances once the order has been shipped.
In the event a item is returned back for either a refund or exchange that is damaged to the point it can not be resold you will be asked to pay a 25% damage charge in order to complete the return or exchange of that item.
We are so confident that you will love the quality and design of our Authentic Corsets, that we back each corset up with our 100% Satisfaction Guarantee! If you purchase this corset and aren't completely impressed with its quality, send it back to us in the same condition as we sent it to you and we'll refund your entire purchase price*. That's our 100% money back guarantee - no questions asked! *If the corset is returned to us outside of the 30-day No-Hassle Guarantee, you will be issued store credit for the purchase price less any applicable discounts. Purchase price does not include shipping charges. This offer does not apply to discontinued, clearance, fashion, special order, or special offer corsets.
FREE DOMESTIC SHIPPING: Orchard Corset now offers FREE DOMESTIC SHIPPING on US orders. We have a variety of shipping options available through FedEx and USPS. Shipping rates are calculated based on weight during checkout.
FedEx - Orders after 5PM EST will be shipped next business day. If you place an order Friday after 5PM EST, it will not be shipped until the following buisness day.
SAME DAY SHIPPING: We do not ship on weekends or major holidays. We do not guarantee that your items will ship the same day. however, we strive to ship same day on all orders placed before 5PM EST.
SHIPPING POLICIES: Most orders will ship from our Washington Warehouse discreetly, in plain packaging. Please note that we cannot guarantee delivery dates. We provide estimates based on information from our carriers. FedEx guarantees delivery date after the item is ship. Due to circumstances out of our control, we cannot guarantee transit times for international orders. Please be advised that many countries will charge a tax or duty on products coming in from the U.S. Check with your local customs department for information. International orders can only be tracked until they leave the US unless you pay for express or insured shipping methods.
APARTMENT DWELLERS: We recommend Signature Required Delivery for all residents of apartments. Due to security and delivery issues with the USPS and apartment units and complexes that are outside of our control, we have added the option for signature required delivery options to all domestic shipping methods. If you as an apartment dweller elect to ship without Signature Required Delivery, we are unable to re-ship your package in the event your package was not received as addressed.
We ship via FedEx and USPS. When you calculate your shipping rate during checkout, you will select the method and carrier you prefer.
Our shipping rates are calculated based on weight. During checkout there is an option to calculate and choose our method of shipping and carrier you prefer. See our Shipping page for more details.
We recommend Signature Required Delivery for all residents of apartments. Due to security and delivery issues with the USPS and apartment units and complexes that are outside of our control, we have added signature required delivery options to all domestic shipping methods. If you as an apartment dweller elect to ship without Signature Required Delivery, we are unable to re-ship your package in the event your package was not received as addressed.
All international packages will leave our warehouse in the same time frame as domestic orders via USPS. Due to the nature of international shipping, we are unable to guarantee transit times for locations outside of the U.S. Once it has left our warehouse, we cannot be held responsible for delays in shipping. We apologize for any inconvenience this may cause.Please be advised that many countries will charge a tax or duty on products coming in from the U.S. As a legitimate law-abiding business, we are not able to mark the package as "gift" or mark the value as less than you actually paid. Check with your local customs department for information. Shipments will be discreetly packaged and will be accompanied by the appropriate customs forms. Please be advised that orders shipped via USPS are not trackable once they leave the United States.
At Orchard Corset, we accept VISA, MASTERCARD, or AMERICAN EXPRESS and Paypal.
We recommend that our international customers use PayPal because their payment processing system is able to verify international addresses more easily. However, all payment methods are acceptable. If you receive an error code while using your credit card, try entering the city name in the state field as well as the city field. Please contact our customer service for additional assistance.
Promotional discount codes MUST be entered during checkout. Coupon codes cannot be combined with other discount codes and may have restrictions on sale and discount items. If you are having trouble using a code you believe to be valid, please contact our customer service for assistance prior to completing your order.
Gift Certificates are codes used during checkout. The code MUST be entered during checkout. and can be combined with other discount codes, as it is considered payment. The same applies to in store credits, which are done by generating a Gift Certificate code for you to enter at checkout. If you are having trouble using a code you believe to be valid, please contact our customer service for assistance prior to completing your order.
We have taken every measure available to ensure that your information and your own computer are 100% safe on our site. We have an SSL Certificate (secure socket layer). We use industry standard encryption technologies when receiving customer data. You will see the "lock" symbol when you begin the checkout process and it will remain visible until your order has been completed.In addition, we never store your credit card/billing information in our system.
If you have an account simply sign in and click "View Order Status". If you don't have an account and would like to check your order status please contact customer care.
Usually this is due a mismatch in the billing information with your bank. Make sure that the billing address you have entered matches what is on your credit card statement. If that doesn't work, and you have verified with your bank that everything is OK with your card, then contact customer service for assistance.
The system in which we process payments sometimes has a bit of a hang up with international orders. The error code they are giving us indicates a billing address mismatch. This is usually resolved by entering the city name in the state field as well as the city field. You can also choose to check out with PayPal which has a much easier time processing international cards. If the problem persists please contact customer service for assistance.
When your order ships, our system automatically generates an email to you with your tracking number. This is not the case with exchanges we ship out, but we strive to manually send an email to you with your new tracking number. If you have not received an email, please check your spam and be sure to add @orchardcorset.com to your safe sender list. If you still can't locate your email, then contact customer service for assistance.
Orchard Corset is not responsible for the package once it leaves our warehouse. Contact the courier you selected to ship your package with and file a claim. If you have any concerns about your package being delivered safely, we recommend selecting either signature required or an insured shipping method.
Yes, all orders are shipped in plain packages provided by our courier. The return address will state "OC Shipping".
At Orchard Corset we respect our customers and understand that you may have concerns about privacy, so we have instituted privacy policies intended to ensure that your personal information is handled safely and responsibly. Not only do we use all industry standard safety precautions, we also never store your credit card/ billing information in our system. Because of this, you will have to enter your credit card information each time you make a purchase on our website. We also respect your privacy and would never sell, rent, lease or give away ANY personal or private information to third parties.We have taken every measure available to ensure that your information and your own computer are 100% safe on our site. We have an SSL Certificate (secure socket layer). We use industry standard encryption technologies when receiving customer data. You will see the "lock" symbol when you begin the checkout process and it will remain visible until your order has been completed.
Periodically, we will send a newsletter or special promotional mailing where we provide articles, information, and opinions. The articles and websites contained within are not affiliated with Orchard Corset or our parent company, JLK & Associates, in any way. The articles are not intended for commercial use, but are provided in order to share potentially relevant information about the health and well-being of our customers. This newsletter contains links to other Websites. We are not responsible for the content, accuracy or opinions expressed in such Websites, and such Websites are not investigated, monitored or checked for accuracy or completeness by Orchard Corset. If you click on one of the links contained within our newsletters / mailings, you will be re-direceted to a third party site. If you decide to leave our Site and access these third-party sites, you do so at your own risk.
We accept VISA, MASTERCARD, or AMERCIAN EXPRESS at our triple SSL secure website. Or, if you prefer, you can call us toll free at 1-866-456-7411 or 509-888-5554. International Orders: we suggest you use PayPal for international orders because their payment processing system is able to verify international addresses more easily. This will help to avoid any delays in shipping.
If you choose to complete your order using PayPal, you will be redirected to a PayPal-hosted site. At the PayPal site, please CONTINUE through ALL of the screens until you are returned to this store to complete the order. Failure to do so could result in your payment being processed but no invoice or record of the order.