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The perfect chew for dogs with common beef allergies, Only Natural Pet Buffalo Knots Dog Chews combine a unique protein with a satisfying texture.
Specially designed to give your dog an amazing chewing experience, Only Natural Pet Buffalo Knots Dog Chews are made with the highest quality water buffalo, which is high in protein and low in fat. The single ingredient water buffalo is from free range, grass fed animals that are raised without hormones or antibiotics.
Only Natural Pet Buffalo Knots Dog Chews are ideal for dog's with common beef and poultry allergies because of their unique protein source and because they're grain-free and have no preservatives or additives. Plus, the amazing knotted shape at both ends allows for incredible tooth and gum cleaning.
Only Natural Pet Buffalo Knots Dog Chews
Allergy friendly dental health has never been so delicious thanks to Only Natural Pet Buffalo Knots Dog Chews.
Each chew measures approximately 7". Available in a 13.45 oz bag (containing 4 chews) or a 3 pack (containing 12 chews).
Please Note: Buffalo Knots, although irresistible to dogs, can be pungent for many people, so feeding outside or in a separate room is preferred.
Country of Origin: India
Manufacturer: Only Natural Pet
Ingredients - 100% Water Buffalo Intestines
Guaranteed AnalysisCrude Protein (min) 75%Crude Fat (min) 13%Crude Fiber (max) 2%Moisture (max) 8%
Feeding Guidelines
Always supervise your pet while chewing.
The reviews below are presented for informational purposes only and are not intended as an endorsement of any product. The information is not intended to be a substitute for visits to your local veterinarian. Instead, these testimonials offer the reader information and opinions written by pet owners and/or veterinarians concerning animal health and products that they have used.
(based on 12 reviews)
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Great treats
By spitfire
from Carrollton, GA
Comments about Only Natural Pet Buffalo Knots:
My dogs really enjoyed these overall - this was their first time getting these kinds of treats!
Bottom Line Yes, I would recommend this to a friend
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Yummy for the Dogs, Stinky for the Humans
By Kimberly Gauthier
from Marysville, WA
A package has four chews and we have four dogs, which was perfect and what peaked my interest. Although the chews don't last long (less than 10 minutes), they did the job. Our dogs enjoyed them on a rainy day; I needed to occupy them with something while I started laundry and this was perfect.Although the chews aren't messy, our dogs did drool a little so I laid down towels to catch the drool.
knot for strong chewers
By Great Dane
from North Carolina
gave one to each of my great danes. One is an aggressive chewer, and it was gone before I turned back from given my other guy one. The less aggressive chewer made his last about 2 minutes before it was gone.
Bottom Line No, I would not recommend this to a friend
My dog went nuts for these!
By Husky Lover
from Boulder, CO
My dog went absolutely nuts over these! Be warned, they're super stinky, but from experience, that's what my dog considers the best of the best. As soon as I pull out the bag, he's dancing circles around me waiting for his special treat.
(0 of 1 customers found this review helpful)
my dog will not touch them
By buford
from texas
our dogs usually love only natural treats and chews, but these are not going to cut it
Not worth the smell
By Crazy Dog Lady
from Ennis, MT
These are really, really bad smelling. Pungent doesn't begin to describe the smell. You don't want them in your house for sure. They have to be stored outside the smell is so bad. Yes, the dog loves them but whew! Even as much as I love my dog I will be passing on buying these again.
I like the smell and so do my dogs
By KJ in NC
from Western North Carolina
I have to smile at the comments about the smell. I like it and so do my dogs. So many products have a chemical/unnatural odor but these smell very earthy and healthy. I am curious as to what part of the buffalo they come from. Will have to find out.
Bitter Sweet
By Mrs.Mama.
from Cloverport, KY
Our German Shepherd puppy LOVES these things. But beware, they have an awful odor. Definitely an outside or doors/windows open kind of bone.
Happy Pup!
By Corgi Lover
from Phoenixville, Pa
I gave these to my Corgi and he eats them up so fast! They do have an odor to them, but my dog gobbles them quickly that it doesn't last long enough to be a bother.
A Favorite in Our House of Chewers!
By Nicole @ Pretty Opinionated
from Poconos, PA
I received a complimentary package of this product in exchange for an honest review. All opinions are my own. I have three dogs. Two are 13 and one is 8. All three absolutely LOVED these knots. They last a long time, even for my 8-year-old dog who could probably eat an entire buffalo in under 5 minutes. What really surprised me was the fact that, while they lasted a while, they weren't all that difficult for my older girls to chew! We'd definitely get these again!
Images shared by Nicole @ Pretty Opinionated
© 2016 Only Natural Pet LLC - All Rights Reserved


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Gurren Lagann Pumpkin 2012! by kenchinbladeWatch
©2012-2016 kenchinblade
My first crack at a special pumpkin done last month but only got around to uploading it now, tried to do some shaving on the design but it didn't really work, so I just cut through lmao. Your drill is the drill that will pierce the heavens!

subset: commoncrawl


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Never fail sponge
Total Time
Prep 15 mins
Cook 25 mins
This is the easiest sponge i have ever made! I have made it many times and it has turned out perfect everytime! great for kids to make, and you can add whatever you like to it :)
Ingredients Nutrition
- 4 eggs
- 3⁄4 cup caster sugar
- 1⁄2 cup custard powder
- vanilla essence (a splash)
- 1⁄2 cup cornflour
- 1 teaspoon cream of tartar
- 1⁄2 teaspoon bicarbonate of soda
- Beat eggs until creamy.
- add sugar gradually and beat until thick and creamy.
- add vanilla.
- sift all other ingredients together.
- add sifted ingredients gradually to mixture.
- bake in a moderate oven (180 degrees Celcius) for 20-25 minutes.
Most Helpful
I made it for my 1st ever Sponge and dont think i beat it enough cause it didnt turn out at all.Maybe you could give an est. time to beat for?
I baked the cake in a fan forced owen for 15 minutes and it turned too crusty and hard. I could not cut it into two so I had to decorate the cake as it is. I don't know what but something went wrong somewhere!


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Half black learning white lies
Lyric Meaning
- Cole is half black and half white, and as he grows older he sees the small lies that contributed to his wrong view of the world.
"Half black" being his identity. "white lies" a double entendre alluding to the other part of his identity and also having to hide the truth for the greater good
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With striking views of the River Tyne and its landmark bridges, the Hilton Newcastle Gateshead Hotel boasts an excellent location on the Gateshead Quays, walking distance from the city center, Sage Gateshead and Metro Arena.
Unwind in a modern guest room with internet access and a stylish granite bathroom. Upgrade to the Executive floor for access to a private lounge with complimentary refreshments and panoramic windows overlooking beautiful Newcastle and Gateshead.
Swim laps in the 15-metre heated indoor swimming pool or re-energise at the fitness center, equipped with cardio machines and weights. Treat yourself to a manicure, facial, or massage in the Ocean Rooms Spa or relax in the sauna.
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Announcing Cotton Spandex Jersey!
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Equipping Latinos and other underserved communities in the DC and Baltimore Metropolitan Areas with the skills and financial tools to create a better future for their families and communities.
2015 Foundation Support
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LEDC is also grateful for the collaborative support from key partners working in the field of asset building and community-based economic development.
@ 2015 Latino Economic Development Center :: Contact LEDC :: Contact Webmaster :: Site MapLEDC-DC Office| WeWork Wonder Bread Factory 641 S St NW Washington, DC 20001Phone: (202) 588-5102 | Fax: (202) 588-5204LEDC-Maryland Office | 11002 Veirs Mill Road, Suite 503 Wheaton, MD 20902 | Phone: 1-866-977-LEDC


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Phil Everly of rock's Everly Brothers dies at 74, L.A. Times reports
LOS ANGELES -- Phil Everly, who with his brother Don made up the Everly Brothers, one of the biggest rock and country acts of the 1950s and early 1960s, died on Friday at the age of 74, the Los Angeles Times reported.
Everly died in the Los Angeles suburb of Burbank of complications from chronic obstructive pulmonary disease, his wife, Patti, told the Times for a story on the paper's website.
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Considered by some to be Britain's first practicing female architect. Established her Glasgow practice in 1920. Works included the Coatbridge War Memorial, the Glasgow Mercat Cross, and commissions for certain elements of St. Mary's Episcopal Cathedral and Music School in Edinburgh.
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Thick Skull Before and After by MaszeattackWatch
©2012-2016 Maszeattack
wow, this is from way back in November of 2008 o.o his name is Thick Skull, from all the skulls on his neck c: My original inspiration for this creature design is just from sitting on the school bus on one of those cool mornings where the inside of the bus window has a fog on the glass where kids draw smiley faces and create feet marks with the sides of their hands and fingers. I saw this basically in the fog one morning in the bus window and created it from there. I find many creature deigns just from the carpet rubbed a certain way or, like I said, foggy windows, even clouds. Though I feel my inspiration has died down a lot since I created this creature, I like going back and redrawing my old friends Thanks for looking! I left the new drawing outside of the frame to create a coming-to-life effect in a way c:
here's the original: [link]
Artwork and Character Design belongs to me
here's the original: [link]
Artwork and Character Design belongs to me
FFFFFFT srsly dont wanna find that dear n my mountains o-o or meadows.....or anywhere for that matter...anywhere other then HELL! *runs away*
haha yea true but he's not mean, just misunderstood and scary lookin >.<
Interesting, thats really kool.
What an interesting character!
thanks! its almost hard to create unique characters that look really unlike someone else's in a way, more of a challenge though then >
that is something new. i like how you made a mane of skulls. It's very interesting :3


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NPR Newscast
4min 45sec
Amanda Knox listens to questions during her trial in Perugia, Italy, on June 12, 2009.
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May 9, 2013 Does the breathless excitement seen in media coverage of Amanda Knox amount to sexism? Commentator Barbara J. King argues 'yes' and says its part of an age-old pattern in human culture.
This undated photo taken from the Kaufman County, Texas, website shows Kaufman County District Attorney Mike McLelland. McLelland and his wife were found killed in their house on Saturday.
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March 31, 2013 The killings of the Kaufman County district attorney and his wife come two months after an assistant district attorney for the same county was shot dead a block from his office. Police say they will "assume" the killings are linked "until it's proven otherwise."
Messy Mya.
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September 25, 2012 The victim, killed in 2012, was a local celebrity of sorts in New Orleans. But the trial of his accused killer was stopped after a court employee spoke up to say there was a video of the murder. But where is that video? No one knows yet.
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The man wanted in connection with the sex assault in Barley Lane.
Douglas Patient, Reporter, covering Waltham Forest. Call me on 07824 530 127 / / News
Police have released a CCTV image of a man wanted in connection with the sexual assault of a teenager.
The assault of a 15-year-old girl took place on June 15 between 3pm and 3.30pm in the public toilets, in Barley Lane, Goodmayes.
The victim was walking towards Barley Lane from Seven Kings station when a man forced her into the toilets where she was assaulted.
Police would like to speak to a man who they describe as dark-skinned with a black beard, believed to be either 16 or 17 years-old, around 5ft 5ins and of slim build.
At the time of the assault he was wearing a blue adidas hooded top, blue trousers, and trainers, with a nike man bag over his left shoulder.
Anyone with any information should contact DC Simon Chapman on 0208 217 9874 or Crimestoppers anonymously on 0800 555 111.
Promoted Stories
Police release CCTV of teenage sexual assault suspect, after the June incident in Barley Lane, Goodmayes
CCTV is often not worth a carrot when the crooks wear hoodwink.
CCTV is often not worth a carrot when the crooks wear hoodwink.


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Trash Fashion are a four-piece band made up of brothers Tom Marsh and Ben Marsh (lead vocals and lead guitar, respectively) joined by Matt Emerson (as drummer) and Jim Ready (as bassist). Their current UK record label is Propaganda Records and in Japan it is Vinyl Junkie. All members originally hail from Birmingham and are now based in London.
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Southeastern Connecticut Delays/Cancellations
Hartford — A potential face-off between Gov. Dannel P. Malloy and Republican Tom Foley could end up being a repeat of the neck-and-neck race they ran in 2010, according to the results of a Quinnipiac University poll released today that showed each candidate being backed by 42 percent of those surveyed.
Malloy defeated Foley in 2010 by less than half of a percentage point. Among potential Republican candidates, 36 percent said they support Foley, followed by Danbury Mayor Mark Boughton with 11 percent and Shelton Mayor Mark Lauretti with 6 percent. Foley is better known than the other Republicans, so it is understandable that he is in the lead, said Douglas Schwartz, director of the poll.
"The poll is good news for Tom Foley," Schwartz said. "He dominates in the Republican primary for governor. He is also the strongest general election candidate against Governor Malloy."
But at the same time, Schwartz said, things could change between now and Election Day, and Malloy wasn't putting much stock in a March poll.
"Polls come and go, numbers go up and down," Malloy's director of communications, Andrew Doba, said in a press release. "The governor always does what he thinks is best for the state and the right thing to do."
Malloy has a job approval rating of 48 percent; Schwartz said an approval rating below 50 percent is a danger sign for an incumbent.
"I would say Malloy gets a lukewarm job approval rating," he said.
Malloy has some structural advantages, such as the fact that Democrats outnumber Republicans in Connecticut and, as an incumbent, he would get more press coverage and be able to raise campaign funds, Schwartz said.
The poll also shows widespread support for increasing the minimum wage as President Obama arrives in the state today to advocate that the federal minimum wage be increased from $7.25 an hour to $10.10.
Seventy-one percent of Connecticut voters surveyed said they are in favor of raising the minimum wage while 25 percent said they are opposed, according to the poll. Of Democrats, 93 percent are in favor while 53 percent of Republicans are against. Forty-seven percent of voters also said they thought increasing the minimum wage would help the economy.
While Republicans are against an increase, Foley said he supports it.
"The minimum wage is a fairness issue, so I support raising the minimum wage nationally to help people who struggle the most to earn a living," he said in a press release. "But Connecticut's problem isn't the minimum wage. Connecticut's problem is that far too many people, particularly young minorities in our cities, have no job at all. The job of a governor is to support policies and create an environment where high value added jobs, not minimum wage jobs, are available for everyone who wants one."
State voters gave Obama the lowest approval rating since he took office. Obama has a 45 percent approval rating compared to a 71 percent approval rating in 2009, according to the poll.
Whether Obama's presence in Connecticut will help Malloy's re-election chances remains to be seen, Schwartz said.
"Gov. Malloy's camp must think that it helps, but we will have to see, we will see in our future polls whether it really helps," Schwartz said.
But politically speaking, Malloy "is on the right side of the minimum wage issue with the overwhelming majority of Connecticut voters in favor of increasing the minimum wage," he said.
In a statement Tuesday, Malloy said increasing the minimum wage is "good for the economy and it's the right thing to do."
"We simply have to do better, and that starts with a fair, living wage for workers across Connecticut and across this country. Together, let's grow the middle class and open the doors of opportunity for millions of Americans," he said.
As for how "things are going in Connecticut," 37 percent said they were somewhat satisfied, 31 percent said they were somewhat dissatisfied and 28 percent said they were very dissatisfied. Only 4 percent said they were very satisfied.
Malloy scored best in personal qualities — 60 percent of voters said he has strong leadership qualities, 59 percent said he is honest and 50 percent said he cares about their needs. But personal qualities don't necessarily translate into job approval ratings, which are impacted by how people feel about the economy, Schwartz said.
The survey included 1,878 registered voters, with a 2.3 percent margin of error.
42 percent want to increase the minimum wage to $10.10 per hour
8 percent want to increase it to something less than $10.10 per hour
20 percent want to increase it to more than $10.10 per hour
25 percent want no increase
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Runway Clarabel Color-Blocked Dress
Original: $428.00 NOW: $171.20 This item is Final Sale.
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Update your evening collection with this boldly color-blocked A-line dress.
- V-neck. Sleeveless.
- Allover color-block detail.
- Sheer mesh insets at shoulders and back. Flutter detail at bodice.
- A-line skirt. Contrast banded waist.
- Center back zipper with hook-and-eye closure.
- Crepe: Acetate, Rayon. Silk: 100% Silk.
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I found the place very expensive - around usd 120 a day - and the rooms are very small and not so clean. I know that everything on pirenopolis is expensive, but this one is simply not worty. For usd 10 more, you may get much better places to stay.
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I am stuck between two "compromise" brevet bikes, and I would like your impressions. Aside from "best fit". I am looking at getting either:
- a Felt Z70, aluminum frame, carbon fork, mostly 105 components and weighs less; or
- a Surly Cross Check, which is all steel, weighs more, and has a less desireable compenent profile.
I am irrationally phobic about carbon forks, and would prefer steel, but OTOH, I am strongly drawn to the brifters and the 105-ness of the Z70, and I think it is probably a slightly nimbler bike than the CC. Anybody ridden either of these on brevets?


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Wednesday, February 10, 2016
RC2 to Build New Bob Toys
RC2 Corp. has been awarded a license to produce a broad new line of Bob the Builder preschool toys under its Learning Curve brand. The product line, based on HIT Ent.'s recently ... Continue Reading →
Mike Young Journeys to ToddWorld
Mike Young Prods. (MYP) has signed on as producer/distributor of the upcoming series ToddWorld, created by award-winning kids' author-illustrator Todd Parr and writer Gerry Renert, ... Continue Reading →
Levy Named Sr. VP of Marketing at Sony Pictures Digital
Don Levy has been assigned to the post of Sr. VP of marketing and communications at Sony Pictures Digital (SPD). Prior to joining Sony, he worked as a freelance production publicist ... Continue Reading →
ComputerCafé Becomes CaféFX
After 10 years in business, ComputerCafé founding partners Jeff Barnes and David Ebner are renaming their feature EFX studio CaféFX (www.cafefx.com) and are creating a ... Continue Reading →
Fox Kids Europe Names New Commercial Sales Head
Mel Alcock is the new executive director of commercial sales at Fox Kids Europe (www.foxkidseurope.com), where he will be in charge of advertising sales and sponsorship revenue for ... Continue Reading →
Pioneer Becomes Geneon
On Oct. 1, Tokyo-based advertising giant Dentsu will acquire a majority of the outstanding shares of anime distributor Pioneer Ent. (USA) and its sister company Pioneer LDC. Both companies ... Continue Reading →
Toonz Animation India Names Director of European Marketing
Prominent European animation producer/director John Cary has joined Toonz Animation India and its U.S. branch, Toonz USA, as director of European Marketing. With thirty years of media ... Continue Reading →
Nokia N-Gage-es Developers with Contest
Nokia today announced ConnectCoder/N-Gage Mobile Game Deck Game Battle 2003, a competition for game developers across Europe, the U.S. Canada to find the hottest game ideas that take ... Continue Reading →
Sesame Workshop Names New AD of Int'l TV Sales
Mai Nguyen is the new assistant director of international television sales for Sesame Workshop, in charge of program sales in Asia, Latin America, Canada and the Caribbean. She is also ... Continue Reading →


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I know exactly how my ankle/foot should be placed, and can do it no problem in the walk, but once I trot or canter my foot does this. I know I am doing it wrong, I just can't seem to remember until I look at pictures and videos after the fact. Otherwise nice pictures that I now want to trash because of that one thing >.<
Any tricks to help get my foot placed correctly? I am not gripping the horse with my feet, just letting my toe drop. I usually ride English if any advice makes that matter


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Pistachio frangipane tarts and some birkes
Summer is most definitely my favourite time of the year. And finally it's here! Few things are better than wandering about outdoors in the early hours of morning, letting the sun shine down on you and inhaling the refreshing scents of wet grass, blooming flowers and the fresh, salty air blowing in from the sea.
Summer also means an abundance of ripe berries and fruit. Yesterday I spotted some lush, perfectly ripe strawberries that a farmer was selling. When you get them just right; blood red, plump, juicy and wildly fragrant, few things outmatch strawberries. Strawberries pair perfectly with pistachios, so this morning I prepared some pistachio frangipane tarts and dressed them up with some succulent berries after baking. Below is a photo of blind baked pâte sucrée shells and pistachio frangipane in the red bowl. For the pistachio frangipane, I mixed 2 parts pistachio cream (just replace almond meal with pistachio meal in your almond cream recipe) with 1 part Grand Marnier flavoured pastry cream.
The tarts were filled 2/3 the way up with pistachio frangipane and baked at 190C for 15 - 20 mins, until baked through. They were then cut into smaller portions and brought along to the office together with some freshly baked tebirkes. A terrific summer treat :)


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My wife and I stayed here for 5 nights on our first trip to Melbourne. After traveling around Australia for 3 weeks, we liked this place so much, we stayed here last 3 nights of our holiday. This guest house was probably to best value accommodation in Melbourne. Our room, bathroom and whole guest house were very clean and looked... More
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September 30, 2012
OrangebloodsHD: David Ash the Leader
OrangebloodsHD: Texas' QB is a Winner from Orangebloods.com on Vimeo.
David Ash may have been a question mark heading into the season, but the sophomore has continued to progress and pulled up the big come from behind win with 2 1/2 minutes left in Stillwater. The Texas Longhorns couldn't say anything but great things about Ash, including one senior who stated "Even David you can tell he has a different swagger out there."
Hear all of the Longhorns comments after the win in Stillwater in Calm, Cool, and Collected, Texas' QB is a Winner.


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Ferris Eugene Beekley
Position: B-G
Height: 5-8 Weight: 185 lbs.
Born: February 27, 1897 in West Chester, OH
Died: June 15, 1986 in Cincinnati, OH
High School: Lockland
College: Miami (OH) (school history)
Weighted Career AV (100-95-...): 0 (15060th overall since 1950)
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How much of your destiny is truly predetermined? How much of it is self-fulfilling prophecy? (There are technical terms for these things, I think, except I can't remember them. Confirmation bias? Forer effect?)
Somewhat sadly and quite pathetically, I've come to identify myself with an unusual type of literary protagonist: the hero who doesn't get the girl. Off the top of my head, there are only really three stories I can think of where this happens unambiguously.
Though I actually have never read it, the first one is Wuthering Heights, in the character of Heathcliff. My friend was reading Wuthering Heights at the time and told me that I reminded her of this character. (Great.) But I actually probably first ran into this character in Michael Penn's song "No Myth" which is, naturally, a song about a guy who isn't able to hook up with the girl that he loves. But I think it definitely ranks up there on the list of obscure literary references made by a pop song. (Interesting bits of trivia: Michael Penn is the brother of the actor Sean Penn, and married the singer Aimee Mann) While this song came out in 1990, the most striking memory I have attached to this song is driving up 880 in Milpitas in 1998, although I don't particularly remember where I was going.
Another character to which I've been likened is Sydney Carton, the doomed alcoholic barrister who falls hopelessly in love with Lucy Manette, and for whom he eventually sacrifices his life for. I didn't read this book until my junior year in college, during a trans-Pacific plane trip to the Philippines. My sister had just read it for high school at the time. What struck her about the character was the aura of wasted potential that clung to this character.
Lastly, and perhaps less literary, is Severus Snape from the Harry Potter series. The love of his life, Lily Evans, ends up marrying a guy Severus totally hates, James Potter. Lily is eventually murdered by the Dark Lord Voldemort, providing the driving force for Snape's hidden-yet-unwavering opposition to the bad guys, although he is eventually killed as well (for what I feel were rather arbitrary reasons, but I guess an author has got to do what an author has got to do when a deadline is looming.) He kind of combines the increasing bitterness and vengefulness of Heathcliff driven by losing the woman he loves first to marriage to a rival, and then to death, with Sydney Carton's aura of wasted potential, total despair and wanton self-sacrifice, dying what seems to me, a meaningless death, since he does not get to find out that Voldemort was successfully vanquished and that Harry actually lives.
When I first read the dénouement to Snape's subplot, I was astonished. Here was an actual character who could hold the torch for a lost love some 15+ years after the fact, and who ends up dedicating his entire life in memory of her, without hope or ambition of ever finding love again. As far as he was concerned, it seemed to me that he considered his life pretty much over. Finally. A character that I could relate to!
The astonishment soon turned into a mild depression, with the realization that the probability of me dying alone and unloved is pretty high, and ever increasing with time, and while it doesn't seem like a good way to go, I'm in no mood to really do anything about it. It is, to put it bluntly, fucking hopeless.
But then again, there are far worse things in life than to be alone and unloved. For some unknown reason, the depression managed to snap a few days ago. While nothing has changed with regard to my non-existent love life, there seems to be something that has changed in my perspective.
My current attitude seems to range somewhere between "oh well" and "I don't give a fuck." I haven't exstinguished hope entirely, but I'm pretty much gearing myself up for a continued solitary existence for however many more years I may have left. (I am utterly convinced that I am going to die young, for pointless reasons, and in quite possibly a violent manner.) Odds say, given my personal and strong family history of depression, anxiety, and just general insanity, I am most likely to end my life in suicide. Still, you can never rule out the random drunk driver going the wrong way on the freeway. Or early-onset coronary artery disease, the way my diet is. Suicide by hamburger. What a way to go.
Then I read about this metaphor about life, and I have to say, "Yeah. That's it."
Life. You do with it what you can. The faster your realize the things you can't or won't do, the less time you waste living with regret. I guess. Something like that.
Sorry, comments are closed for this article.


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on screen capture recorder to video windows free
open source directshow "screen capture" device allows capture/stream desktop (VLC, etc.) with some helper utilities for such.
User Ratings
User Reviews
This is an example of how to fail at making video capture software. How do you fail so badly that it rotates the video 40-45 degrees, lags, and speeds up audio playing it at the wrong time? I can't find any video capture software that does worse than this. dl.dropbox.com/u/30270697/Archives/test2.mp4 (4.39MB) - I mean, wow. That was just utterly terrible. A total waste of the 48MB download I had to do to get this crap.
This software has mediocre settings description. Essentially turning things into a trial and error test until things are working properly. There are settings that work in reverse of what you'd expect. Regarding performance e.g. CPU and GPU usage efficiency things are even worse. On my weak laptop I could only record windowed OpenGL game at 15 fps and also needed to record at ultrafast preset and then transcode the output video to lower it's size in order to avoid audio-video asyncronization. This ended when I switched to FFSplit. Their screen capture filter it's much faster. No need to post transcode and on same laptop I can guaranteed record at 20 fps. I even think to try 25.
Great product, it works really well. I love it for making free training videos.
What to say - this program is a usable tool. Thanks to the developers.
Great Tool ! Congratulations. Patrick (Belgium)


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Herbed Mashed Potatoes Recipe
5 2
Sandi Pichon of Slidell, Louisiana adds rosemary, garlic and lemon peel to this rich potato side dish, making it special enough for guests.
- 4 large potatoes, peeled and cubed
- 1/3 cup chopped onion
- 1 garlic clove, minced
- 1 tablespoon butter
- 3/4 cup sour cream
- 1 teaspoon dill weed
- 1/4 to 1 teaspoon salt
- 1/2 teaspoon minced fresh rosemary
- 1/2 teaspoon grated lemon peel
- 1/4 teaspoon crushed red pepper flakes, optional
- Paprika, optional
- Place potatoes in a large saucepan and cover with water. Bring to a boil. Reduce heat; cover and cook for 10-15 minutes or until tender. Meanwhile, in a small skillet, saute onion and garlic in butter until tender.
- Drain and mash potatoes; add the onion mixture, sour cream, dill, salt, rosemary, lemon peel and red pepper flakes if desired.
- Spoon into a greased 1-1/2-qt. baking dish. Sprinkle with paprika if desired. Cover and bake at 350° for 25 minutes or until heated through. Yield: 6 servings.
Originally published as Herbed Mashed Potatoes in Quick Cooking September/October 2001, p57
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text:
Mr. and Mrs. Pines
this wiki
Mr. and Mrs. Pines are the unseen parents of Dipper and Mabel Pines. Not much is known about them.
Early life
Mr. and Mrs. Pines have been raising their twin children, Dipper and Mabel, since birth. Mrs. Pines would dress her son in a lamb costume and have him perform the Lamby Lamby Dance since he was at least five. At one point in the twins' childhood, Mr. Pines returned from a Windows '95 conference, likely related to his computer-based occupation and received a promotional bag containing a t-shirt. Lacking the intentions to ever wear it, the shirt was handed down to Mabel, who now uses it as a sleep shirt.[1]
Season 1
Early in the summer, Mr. and Mrs. Pines agreed the twins required some "fresh air," and sent them to stay in Gravity Falls, Oregon to stay at their great uncle's house in the woods.[3]
They are only briefly (and partially) shown in "Tourist Trapped," their arms and torsos shown as they trade their son and daughter's video games and cat for luggage and sunscreen.
Mabel mentions Mrs. Pines in "The Inconveniencing," recalling that she used to dress Dipper up in a lamb costume and have him perform the Lamby Lamby Dance.
In "Double Dipper," Wendy mentions she always assumed Dipper's nickname was derived out of his parents' hatred of him.
Both parents are briefly mentioned in "The Time Traveler's Pig," when Blendin Blandin threatens Dipper and Mabel by saying he will go back in time to prevent their parents from ever meeting. Because they still exist, the twins conclude that he forgot.
Mr. Pines is mentioned throughout "Fight Fighters" by Rumble McSkirmish, who believes that Robbie killed Mr. Pines, however, it is made clear by Dipper that this was a lie and that his father is, in fact, alive and well.
In "The Deep End" Mabel shows Mermando a picture of the family kickboxing.
In "Gideon Rises," Stan tries to reassure Mr. and Mrs. Pines that Dipper and Mabel are doing fine over the phone, claiming that they are staying at a four-star hotel, though they are actually staying at Soos' abuelita's run-down house.
Mrs. Pines is mentioned by Mabel in "Mailbox," as she wishes to send her mother a video of her sticking one hundred gummy worms up her nose.
Season 2
Mr. and Mrs. Pines are mentioned again in "Dungeons, Dungeons, and More Dungeons," when Mabel was writing a letter to them, describing how her summer in Gravity Falls has been so far.
In "Dipper and Mabel vs. the Future," Mr. and Mrs. Pines are mentioned when Ford tells Dipper that, his parents would be thrilled that he could give Dipper such an advanced education.
Season 1
- 101. "Tourist Trapped" (no lines)
- 105. "The Inconveniencing" (mentioned)
- 107. "Double Dipper" (mentioned)
- 109. "The Time Traveler's Pig" (mentioned)
- 110. "Fight Fighters" (mentioned)
- 120. "Gideon Rises" (mentioned)
- 3. "Mailbox" (mentioned)
Season 2
- 212. "A Tale of Two Stans" (mentioned)
- 213. "Dungeons, Dungeons, and More Dungeons" (mentioned)
- 216. "Roadside Attraction" (mentioned)
- 217. "Dipper and Mabel vs. the Future" (mentioned)
- Dipper and Mabel's middle names are their parents' first names[4], like Alex and Ariel Hirsch.
- Since Stan shares the same surname as Dipper and Mabel, it can be inferred that he's Mr. Pines' paternal uncle.
- Mr. Pines' occupation is related to computers.[5]


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Where Elephants Reign Supreme by dainbramage1Watch
©2012-2016 dainbramage1
Definitely 'Other Worldly,..'. Out there,.. Wonderful image!
Coo !l
well done
Very good work.
Mawwahaha, it's wonderful!
Beautiful alienscape
Hide the Peanuts!!!!! Great Job Brent! I am thoroughly Impressed!
Great piece! Amazing variations from these formulas.
Thanks! Yes, I like the variations. I think I've got a little more exploring to do with these.
I just watched a movie called "Water for Elephants" that was so good...
This reminds me of that.
I just watched a movie called "Water for Elephants" that was so good...
This reminds me of that.
Thanks Jim! I remember the previews for that movie but never saw it. I'll have to check it out.
Ohh, so cool, I saw your image over at ff, and was going here to say it reminded me of the very image you are showing here, but to be honest, I never give out parameters, no need to give credit, still glad you got inspired!!! makes me soooooo happy!
Thank you sir! I actually started with the params from my image "I'm a Big Fan" that I uploaded about a year ago. I didn't see the elephants though until you uploaded "Fractal Elephant Valley" and then there they were. This time around I see all the elephants, but don't ask me to count them.
Forgot to say I think it is even better than mine, lovely render Brent!!!
very cool!
awesome 3d factal!
Well done Brent!
very good
Very impressed, great piece!!!
I'm also reminded of mushrooms and octopuses for some reason ;D great job!!


text:
AR Maintenance DEMO
by: Fraunhofer-FKIE | 4
by: Fraunhofer-FKIE | 4
This is a Demo-App to illustrate the AR functionality of the Open Active World framework developed at our institute (http://open-activewrl.sourceforge.net).
If you point the camera of the android device at the marker (http://s7.directupload.net/images/111219/nonwxlg4.png), a 3D model of a Opel motor will appear. This model can be viewed by moving the device around the marker.
Tags: ar maintenance , 3d model motor , best ar viewer , 3d model viewer , 3d model motor free downlaod , 3d model motora , free 3d model motorblok , 3В модель для ar , ar marker mit modell
from 4 reviews
Free - V0.93 - 6M
Sorry ...
This app is no longer available.


text:
Jimmy WildeJimmy Wilde (1923) Theatrical Cartoon
This page has been viewed 6 times this month, and 381 times total.
- Theatrical FilmTheatrical
- Traditional Animation
- Webster Cartoons, Napoleon Films.
- Directed By Tom Webster.
- Produced By Tom Webster.
- Animated By W.D. Ford, Joe Noble.
- Written By Tom Webster.
- Originally Released in 1923 (Estimate).
- Originally Released Theatrically.
- Black & White
- United Kingdom
Cartoon Summary:
We do not have a synopsis for this cartoon; why don't you send us one?
Cartoon Production Information:
Silent film.
Jimmy Wilde was a then-famous boxer.
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Submit Additional Information:
Do you have anything to add to this page? Have we made any mistakes... or do you have any additional information about Jimmy Wilde? If so, we would love to hear from you. Please send us a quick note with your additions or corrections to this page, and we will make the corrections as soon as possible!
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Do you love Jimmy Wilde, or do you think it is the worst cartoon ever? Let us know what you think! Surely you have an opinion... so share what you think. Take a minute and post your own comments about this cartoon here.


text:
© National Portrait Gallery, London
Sir Maurice Bowra; Sylvester Govett Gates; L.P. Hartley
by Lady Ottoline Morrell
vintage snapshot print, 1924
1 7/8 in. x 3 1/8 in. (49 mm x 79 mm) image size
Purchased with help from the Friends of the National Libraries and the Dame Helen Gardner Bequest, 2003
NPG Ax141548


text:
Hi there
Im heading to several cities Cordoba, Granada and Sevilla this summer. Can anyone please advise where the nicest places are to eat and whether there are any halal eateries anywhere if at all? I would like to sample some traditional Spanish food too, i.e. paella, tapas etc and dont mind eating in a non-halal restaurant as long as there are veg and seafood dishes also available. Much thanks.


text:
Error 468: Cannot Resolve Collation Conflict
Recently we installed a new version sql 2005 sp2 on a Windows 2003 server.
At installaion time we choose the Windows Locale for the collation (this was the default- the server was installed with Dutch
The Netherlands).
The first application database we have created is with SQL_Latin1_General_CP1_CI_AS (the supplier of the application supplied the database creation scripts with this collation, we did not change).
When i clik on - security - logins, select a user and click on Securables, i receive error 468:
Cannot resolve collation conflict between "SQL_Latin1_General_CP1_CI_AS" and "Latin1_General_CI_AS"in the UNION operation.
The error only occurs when we click successively on General - Server Roles - User Mapping - Securables
What is wrong?
Additional information
- select serverproperty('Collation')
select name, collation_name, compatibility_level from sys.databases
namecollation_name compatibility_level
ADB_ReportServerLatin1_General_CI_AS_KS_WS 90
ADB_ReportServerTempDBLatin1_General_CI_AS_KS_WS 90
ADB_OrgaSQL_Latin1_General_CP1_CI_AS 90
I have read many thing on the web concerning collation error 468, and that it has to do with the tempdb, but i still do not know......
- Do i have a problem, because the error only occurs in SSMS (as far as we know now)?
- Do all my present and future database should have the collation Latin1_General_CI_AS?
- What if some application required different collation?
All information is welcome.
Best regards,


text:
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text:
Are you P Fuentes?Claim your profile
Publications (151)329.47 Total impact
Article: Accessi chirurgici toracoaddominali[Show abstract] [Hide abstract]
ABSTRACT: Le vie di accesso toracoaddominali sono quelle di elezione per la chirurgia aortica, esofagea e in alcuni settori della chirurgia generale in elezione o in urgenza. Una buona conoscenza anatomica del diaframma e della regione toracoaddominale consente di adattare al meglio il gesto chirurgico alle circostanze. Dalla scelta dello spazio intercostale, dal tipo di dissezione e dalla sezione del diaframma dipendono la semplicità di esposizione e, in parte, il decorso generale dell'intervento. In queste vie di accesso la branca posteriore del nervo frenico viene ampiamente esposta e una buona conoscenza dell'anatomia del diaframma ne consente una buona sezione e riparazione. La via toracoaddominale può essere scelta in due situazioni. Si può trattare di un'indicazione nel settore della chirurgia in elezione, sia come prima scelta per avere una buona esposizione, sia in seconda battuta per ampliare verso il torace un accesso addominale o verso l'addome un accesso toracico. Può inoltre essere scelta come accesso in regime di urgenza dettata da alcune circostanze particolari (patologia toracica traumatica chiusa o aperta, ferita toracoaddominale penetrante) in cui si preveda di dover ampliare una laparotomia verso il torace o, al contrario, un accesso toracico verso l'addome. In queste situazioni il chirurgo deve poter esporre e controllare tutti gli elementi vascolari degli organi sovra- e sotto diaframmatici in un unico campo operatorio. Questi accessi toracoaddominali non sono di esclusivo interesse dei chirurghi toracici o vascolari, ma di tutti i chirurghi che praticano la chirurgia generale in elezione o in urgenza. Nella prima parte di questo capitolo vengono approfondite le conoscenze anatomiche necessarie alla realizzazione di questi accessi. In una seconda parte viene descritta la tecnica chirurgica in dettaglio a seconda delle circostanze riscontate, con dettagli riguardanti la toracotomia posterolaterale con frenotomia, la toracofreno-laparatomia destra o sinistra, la toracolaparotomia o sternolaparotomia. Il testo è illustrato da schemi per una comprensione ottimale.
- [Show abstract] [Hide abstract]
ABSTRACT: La mediastinite necrotizzante discendente acuta è una malattia infettiva gravata da cattiva prognosi quoad vitam in un buon numero di casi (mortalità dal 20% al 40%), causata dalla diffusione verso il mediastino di un processo infettivo a origine orofaringea o cervicale. Una diagnosi precoce e un'ottimale gestione terapeutica sono essenziali per la sopravvivenza dei pazienti. La TC toracocervicale è indispensabile per la diagnosi e la successiva gestione. La terapia si basa sugli antibiotici a largo spettro, la chirurgia e il drenaggio, nonché il trattamento di eventuali insufficienze d'organo. Sono stati proposti diversi approcci chirurgici ma la cervicotomia associata a una toracotomia convenzionale rappresentano la procedura più appropriata. Una gestione meno invasiva può essere raccomandata nel caso in cui la diagnosi venga fatta precocemente e che il drenaggio toracico sia efficace. La sorveglianza clinica, laboratoristica e strumentale può indicare successivamente una toracotomia.
- [Show abstract] [Hide abstract]
ABSTRACT: Acute mediastinitis is a life-threatening complication (20 to 40 % of mortality) secondary to oropharyngeal abscesses, neck infections or oesophageal leak spreading into the mediastium. Early diagnosis and optimal therapeutic approach are crucial for patient survival. CT scanning of the cervical and thoracic area is a useful tool for diagnosis and follow-up. Treatment is based on broad-spectrum antibiotherapy, adequate surgery, mediastinal drainage, and treatment of possible organ failure. There is no surgical standardized attitude. Mini-invasive approach could be satisfactory when prompt diagnosis is established and the thoracic drainage is effective. Repeated postoperative CT scanning and close clinical and laboratory monitoring could make an additional thoracotomy a second-line procedure.
- [Show abstract] [Hide abstract]
ABSTRACT: Acute mediastinitis is a life-threatening complication (20 to 40 % of mortality) secondary to oropharyngeal abscesses, neck infections or oesophageal leak spreading into the mediastium. Early diagnosis and optimal therapeutic approach are crucial for patient survival. CT scanning of the cervical and thoracic area is a useful tool for diagnosis and follow-up. Treatment is based on broad-spectrum antibiotherapy, adequate surgery, mediastinal drainage, and treatment of possible organ failure. There is no surgical standardized attitude. Mini-invasive approach could be satisfactory when prompt diagnosis is established and the thoracic drainage is effective. Repeated postoperative CT scanning and close clinical and laboratory monitoring could make an additional thoracotomy a second-line procedure.
- [Show abstract] [Hide abstract]
ABSTRACT: Necrotizing fasciitis is an uncommon infection caused by microorganism called "fl esh eating bacteria". It remains a life threatening condition associated with high mortality rate. Its location to the chest wall is exceptional. Herein, we report the case of a 39 years old female, without comorbidity, presenting a necrotizing fascitiis of the chest wall complicating an empyema. We described the surgical management with a three-steps procedure: antibiotherapy- debridement, Vacuum Assisted Closure (VAC) and delayed surgical reconstruction .
Article: Is malignant pleural mesothelioma a surgical disease? A review of 83 consecutive extra-pleural pneumonectomies[Show abstract] [Hide abstract]
ABSTRACT: To report on the experience with radical surgery, with emphasis on the long-term outcome, for malignant pleural mesothelioma (MPM) at a single institution. From our prospective database over a 17-year period, we reviewed 83 consecutive patients undergoing radical surgery for MPM in a multimodality programme. The long-term overall survival was analysed using the Kaplan-Meier method. A total of 83 patients (65 males, median age: 60 years) underwent an extra-pleural pneumonectomy (EPP) with a curative intent. Epitheliod MPM was the most frequent (82%) cause. A right-sided disease was present in half of the cases (n=42). The International Mesothelioma Interest Group (IMIG) stage of the disease was 2 in 36%, 3 in 45% and 4 in 9% of the cases. Preoperative chemotherapy consisting of a doublet cisplatin-pemetrexed (mean of three cycles) was offered to 10 patients (12%). Postoperative therapies, either chemotherapy or radiotherapy, were given in 25 patients (30%). The 30-day and 90-day mortality rates were 4.8% and 10.8%, respectively. Postoperative complications occurred in 39.8% and were major in 23 patients (27.7%). Re-operation was necessary in 12 cases (14.5%) for one of the following reasons: broncho-pleural fistula (n=4), bleeding (n=3), diaphragmatic patch rupture (n=3), oesophago-pleural fistula (n=1) and empyaema (n=1). The mean hospital stay was 43 days. The median survival was 14.5 months, while the overall 1-, 2- and 5-year survival rates were 62.4%, 32.2% and 14.3%, respectively. These results concur with the published data of the most experienced centre with regards to the mortality and morbidity after EPP for MPM. In line with the biggest series reported in the past, the observed 5-year survival rate of almost 15% is disappointing.
Article: Extracapsular Lymph Node Involvement Is a Negative Prognostic Factor After Neoadjuvant Chemoradiotherapy in Locally Advanced Esophageal Cancer[Show abstract] [Hide abstract]
ABSTRACT: To assess prognosis depending on whether lymph node involvement (LNI) is intracapsular or with extracapsular breakthrough in patients with a locally advanced esophageal cancer treated with neoadjuvant chemoradiation and surgery. Ninety-four consecutive patients with an esophageal cancer staged IIB (n = 17) and III (n = 77) received neoadjuvant chemoradiation followed by transthoracic esophagectomy with two-field lymphadenectomy. Histology was squamous cell carcinoma (n = 46) and adenocarcinoma (n = 48). Neoadjuvant therapy consisted of association of 5-fluorouracil/cisplatin concomitantly with a 45-Gy radiation therapy. Disease-free survival (DFS) excluding the in-hospital mortality was analyzed according to the nodal status and the invaded/resected lymph node ratio (LNR). Clinical factors affecting survival or predictors of extracapsular invasion were investigated by multivariate analysis. Five-year DFS rates were 46, 36, and 11% in N0 patients (n = 56), intracapsular LNI patients (n = 18), and extracapsular LNI patients (n = 10), respectively (p = 0.002). Intracapsular LNI patients with an LNR <0.1 (n = 12) had a 5-year DFS rate similar to N0 patients (44 versus 46%, p = 0.95). Intracapsular LNI patients with an LNR > or =0.1 (n = 6) had a DFS rate similar to extracapsular LNI patients (18 versus 11%, p = 0.69). Multivariate analysis revealed that the sole independent factor affecting DFS was the extracapsular LNI (HR = 3.9, p = 0.026). The number of invaded LN seemed to be the sole significant predictive factor for the development of ECLNI (HR = 2.39, p = 0.008). After neoadjuvant chemoradiotherapy, there was a significant difference on DFS depending on whether LNI was intracapsular or extracapsular. Extracapsular invasion seems to be an independent negative prognostic factor affecting survival, and its presence is related to the number of invaded LN.
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ABSTRACT: The choice of the colon as an oesophageal substitute results primarily from the unavailability of the stomach. However, given its durability and function, colon interposition keeps elective indications in patients with benign or malignant oesophageal disease who are potential candidates for long survival. The choice of the colonic portion used for oesophageal reconstruction depends on the required length of the graft, and the encountered colonic vascular anatomy, the last being characterised by the near-invariability of the left colonic vessels, in contrast to the vascular pattern of the right side of the colon. Accordingly, the transverse colon with all or part of the ascending colon is the substitute of choice, positioned in the isoperistaltic direction, and supplied either from the left colic vessels for long grafts or middle colic vessels for shorter grafts. Technical key points are: full mobilisation of the entire colon, identification of the main colonic vessels and collaterals, and a prolonged clamping test to ensure the permeability of the chosen nourishing pedicle. Transposition through the posterior mediastinum in the oesophageal bed is the shortest one and thereby offers the best functional results. When the oesophageal bed is not available, the retrosternal route is the preferred alternative option. The food bolus travelling mainly by gravity makes straightness of the conduit of paramount importance. The proximal anastomosis is a single-layer hand-fashioned end-to-end anastomosis to prevent narrowing. When the stomach is available, the distal anastomosis is best performed at the posterior part of the antrum for the reasons of pedicle positioning and reflux prevention, and a gastric drainage procedure is added when the oesophagus and vagus nerves have been removed. In the other cases, a Roux-en-Y jejunal loop is preferable to prevent bile reflux into the colon. Additional procedures include re-establishment of the colonic continuity, a careful closure of the mesentery to avoid a further internal hernia, and routine appendectomy. When applying these technical aids, the chances of achieving a viable and well-functioning colon graft are excellent.
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ABSTRACT: Surgery is the cornerstone of treatment for resectable tumours of the oesophagus. Recent advances of surgical techniques and anaesthesiology have led to a substantial decrease in mortality and morbidity. Respiratory complications affect about 30% of patients after oesophagectomy and 80% of these complications occur within the first five days. Respiratory complications include sputum retention, pneumonia and ARDS. They are the major cause of morbidity and mortality after oesophageal resection and numerous studies have identified the factors associated with these complications. The mechanisms are not very different from those observed after pulmonary resection. Nevertheless, there is an important lack of definition, and evaluation of the incidence is particularly difficult. Furthermore, respiratory complications are related to many factors. Careful medical history, physical examination and pulmonary function testing help to identify the risk factors and provide strategies to reduce the risk of pulmonary complications. Standardized postoperative management and a better understanding of the pathogenesis of pulmonary complications are necessary to reduce hospital mortality. This article discusses preoperative, intraoperative, and postoperative factors affecting respiratory complications and strategies to reduce the incidence of these complications after oesophagectomy.
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ABSTRACT: Some patients with localised oesophageal cancer are treated with definitive chemoradiotherapy (CRT) rather than surgery. A subset of these patients experiences local failure, relapse or treatment-related complication without distant metastases, with no other curative treatment option but salvage oesophagectomy. The aim of this study was to assess the benefit/risk ratio of surgery in such context. Review of a single institution experience with 24 patients: 18 men and 6 women, with a mean age of 59 years (+/-9). Histology was squamous cell carcinoma in 18 cases and adenocarcinoma in 6. Initial stages were cIIA (n=5), cIIB (n=1) and cIII (n=18). CRT consisted of 2-6 sessions of the association 5-fluorouracil/cisplatin concomitantly with a 50-75 Gy radiation therapy. Salvage oesophagectomy was considered for the following reasons: relapse of the disease with conclusive (n=11) or inconclusive biopsies (n=7), intractable stenosis (n=3), and perforation or severe oesophagitis (n=3), at a mean delay of 74 days (14-240 days) following completion of CRT. All patients underwent a transthoracic en-bloc oesophagectomy with 2-field lymphadenectomy. Thirty-day and 90-day mortality rates were 21% and 25%, respectively. Anastomotic leakage (p=0.05), cardiac failure (p=0.05), length of stay (p=0.03) and the number of packed red blood cells (p=0.02) were more frequent in patients who received more than 55 Gy, leading to a doubled in-hospital mortality when compared to that of patients having received lower doses. A R0 resection was achieved in 21 patients (87.5%). A complete pathological response (ypT0N0) was observed in 3 patients (12.5%). Overall and disease-free 5-year survival rates were 35% and 21%, respectively. There was no long-term survivor following R1-R2 resections. Functional results were good in more than 80% of the long-term survivors. Salvage surgery is a highly invasive and morbid operation after a volume dose of radiation exceeding 55 Gy. The indication must be carefully considered, with care taken to avoid incomplete resections. Given that long-term survival with a fair quality of life can be achieved, such high-risk surgery should be considered in selected patients at an experienced centre.
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ABSTRACT: X.-B. D'Journo, P. Michelet, J.-P. Avaro, D. Trousse,R. Giudicelli, P. Fuentes, C. Doddoli, P. Thomas Surgery is the cornerstone of treatment for resectable tumours of the oesophagus. Recent advances of surgical techniques and anaesthesiology have led to a substantial decrease in mortality and morbidity. Respiratory complications affect about 30% of patients after oesophagectomy and 80% of these complications occur within the first five days. Respiratory complications include sputum retention, pneumonia and ARDS. They are the major cause of morbidity and mortality after oesophageal resection and numerous studies have identified the factors associated with these complications. The mechanisms are not very different from those observed after pulmonary resection. Nevertheless, there is an important lack of definition, and evaluation of the incidence is particularly difficult. Furthermore, respiratory complications are related to many factors. Careful medical history, physical examination and pulmonary function testing help to identify the risk factors and provide strategies to reduce the risk of pulmonary complications. Standardized postoperative management and a better understanding of the pathogenesis of pulmonary complications are necessary to reduce hospital mortality. This article discusses preoperative, intraoperative, and postoperative factors affecting respiratory complications and strategies to reduce the incidence of these complications after oesophagectomy.
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ABSTRACT: Objective: To review the long-term results of redo gastro-esophageal reflux disease (GERD) surgery with special emphasis on residual acid-suppressing medications, pH monitoring results, and quality of life. Methods: Retrospective analysis of 52 patients (24 males) who underwent redo GERD surgery between 1986 and 2006 through a transthoracic (n = 14), or a transabdominal (n = 38) approach. Indications were recurrent GERD in 41 patients, and complication of the initial surgery in 11. Quality of life was evaluated by telephone enquiry using a validated French questionnaire (reflux quality score, RQS). Results: Postoperative complications occurred in 18 patients (35%), resulting in one death (2%). Reoperation was required in seven patients. At 1 year, 26 patients (51%) had 24 h pH monitoring, among whom 2 (8%) were proved to have recurrence of GERD. RQS values were calculated in 38 patients with a mean follow-up of 113 months. Fifty percent of this subgroup had a RQS value beyond 26/32, indicating an excellent quality of life. Among these 38 patients, 20 (53%) had acid-suppressing medications whatever their RQS values. Patients who underwent transthoracic GERD surgery had the highest RQS values (p = 0.02), a lower rate of complications (p = 0.06) and a lower rate of reoperation (p = 0.04). Conclusion: Our experience confirms that selection of candidates for redo GERD surgery is a challenging issue. A transthoracic approach seems to produce better results and lower rates of complications.
Article: Airway colonisation and postoperative pulmonary complications after neoadjuvant therapy for oesophageal cancer[Show abstract] [Hide abstract]
ABSTRACT: To evaluate the clinical relevance of preoperative airway colonisation in patients undergoing oesophagectomy for cancer after a neoadjuvant chemoradiotherapy. From 1998 to 2005, 117 patients received neoadjuvant chemoradiotherapy for advanced stage oesophageal cancer. Among them, 45 non-randomised patients underwent a bronchoscopic bronchoalveolar lavage (BAL group) prior to surgery to assess airways colonisation. The remaining patients (n=72) constituted the control group. The two groups were similar with respect to various clinical or pathological characteristics. Thirteen of the 45 BAL patients (28%) had a preoperative bronchial colonisation by either potentially pathogenic micro-organisms (PPMs) (n=7, 16%) or non-potentially pathogenic micro-organisms (n=6, 13%). Cytomegalovirus (CMV) was cultured from BAL in four patients. Pre-emptive therapy was administrated in seven patients: four antiviral and three antibiotic prophylaxes. Postoperatively, 14 patients (19%) developed acute respiratory distress syndrome (ARDS) in the control group and three (7%) in the BAL group (p=0.064). The cause of ARDS was attributed to CMV pneumonia in six control group patients on the basis of the results of open lung biopsies (n=3) or BAL cultures (n=3) versus none of the BAL group patients (p=0.08). Timing for extubation was shorter in the BAL group (mean 13+/-3 h) as compared with the control group (mean 19.5+/-14 h; p=0.039). In-hospital mortality was not significantly lower in BAL group patients when compared to that of control group patients (8% vs 12.5%). Airway colonisation by PPMs after neoadjuvant therapy is suggested as a possible cause of postoperative ARDS after oesophagectomy. Pre-emptive treatment of bacterial and viral (CMV) colonisation seems an effective option to prevent postoperative pneumonia.
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ABSTRACT: T4-disease for non-small cell lung cancer (NSCLC) includes different conditions: mediastinal invasion, neoplastic pleural cytology, and multifocal disease in the same lobe; regarding the last category, no strict criteria allow to differentiate satellite nodules from synchronous multiple primary tumours. Retrospective study of 56 patients who underwent a complete resection from 1985 to 2006 of a NSCLC graded pT4N0 due to multifocal disease. A small nodule (<1cm) closed to the primary tumour, in a same pulmonary segment with an identical histology was considered as a satellite nodule (pT4sn). Multiple tumours, sized more than 1cm, with an identical histology, located in the same lobe but in different segment were considered as synchronous cancers (pT4sc). There were 44 males and 12 females: 35 patients were graded T4sn and 21 patients T4sc. The median age was 62.5 years. The two groups were similar for sex, age, tobacco consumption, ASA score, NYHA, Charlson's index, spirometric parameters, cardiovascular comorbidity and history of previous extra-thoracic malignancies. All had a complete anatomic resection with mediastinal lymphadenectomy. Thirty-day mortality rate was 3.6%. Overall 5-year and 10-year survival rates were 48.2% and 29.9%, respectively. There was a non-significant trend for a worse survival in T4sn group patients when compared to that of T4sc group patients: 42.9% vs 52.3% at 5 years, and 25% vs 34.9% at 10 years (p=0.62). Multifocal T4 stage IIIB disease is a heterogeneous category where overall prognosis is far better than those of other T4 subgroups. Survival rates associated with pT4sn and pT4sc look roughly similar because of the small size of the subgroups usually submitted to comparison in most series. In the present experience, respective survival figures diverge, suggesting different biological behaviours.
Article: Synchronous multiple primary lung cancer: An increasing clinical occurrence requiring multidisciplinary management[Show abstract] [Hide abstract]
ABSTRACT: No guidelines detailing recommendations for the selection and treatment of patients with synchronous multiple primary lung cancer have been published. We report on a single-institution experience with synchronous multiple primary lung cancer, with emphasis on long-term survival. We performed a retrospective study of 125 consecutive patients with synchronous multiple primary lung cancer who underwent operation between 1985 and 2006. Various treatment strategies were applied, including perioperative therapy. Potential prognosticators were submitted to univariate and multivariate analyses. Tumors were bilateral (n = 34) or ipsilateral (n = 91). Optimal surgical treatment (complete anatomic resection with radical lymphadenectomy) was possible in 65.6% of the cases. pN0 disease was present in 32.3% of the patients; 30-day and 90-day mortality rates were 4.5% and 11%, respectively. Two- and 5-year overall survivals were 61.6% and 34%, respectively, with a median survival of 35 months. On univariate analysis, smoking status, high Charlson index, low forced expiratory volume in 1 second, occurrence of postoperative complications, and performance of a pneumonectomy affected the overall survival adversely. Conversely, bilateral disease, location in the same lobe, and pN0 disease were favorable prognosticators. On multivariate analysis, low forced expiratory volume in 1 second, nonoptimal surgical treatment, and performance of a pneumonectomy were independent predictors of poor long-term survival, whereas female sex, younger age, asymptomatic disease, pN0 status, and performance of an adjuvant treatment affected the survival favorably. Provided there is an appropriate selection process, patients with synchronous multiple primary lung cancer are expected to benefit from surgery. Optimal surgery should be performed, but pneumonectomy should be avoided whenever possible. Adjuvant treatment is suggested to provide an added survival advantage.
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ABSTRACT: The aim of the present study was to determine the risk factors and impact on outcome of blood transfusions following pneumonectomy for thoracic malignancies. A retrospective analysis of 432 consecutive patients was carried out, of whom 183 (42.4%) were transfused post-operatively. The associations between blood transfusions and 20 variables were assessed by univariate and multivariate analysis. Survival analysis included log-rank test and Cox regression model. Patient age, neoadjuvant treatment, completion pneumonectomy and extended procedures were independent predictors of transfusion. It was found that 30-day mortality increased significantly from 2.4% (no transfusion) to 10.9 and 21.9% (<or=2 and >2 red blood cell packs, respectively). Blood transfusion was the strongest predictor of 30-day mortality (odds ratio (OR) 10; 95% confidence interval (CI): 3.7-27), respiratory failure (OR 19.2; 95% CI 7.4-49.4) and infectious complications (OR 3; 95% CI 1.5-6.2). In the 367 lung cancer patients, a significantly lower 5-yr survival was observed in univariate analysis of transfused patients (27.8+/-5.4% versus 39.4+/-4.5%). In a Cox regression analysis, blood transfusion was no longer found to be significant. A dose-related correlation is suggested between blood transfusion and early mortality through an increase of infectious and respiratory complications. In contrast, blood transfusion had no independent adverse impact on long-term survival.
Article: Long-Term Observation and Functional State of the Esophagus After Primary Repair of Spontaneous Esophageal Rupture[Show abstract] [Hide abstract]
ABSTRACT: Long-term outcome of patients treated for a spontaneous esophageal rupture (Boerhaave's syndrome) is seldom reported. From 1989 to 2004, 62 esophageal perforations were treated in a single institution. Eighteen patients presented with a spontaneous esophageal rupture. Among them, 15 could be treated with a transthoracic primary repair and constituted the material of the present study. A chart review was performed with special attention to survival, residual symptoms, and anatomic and motility disorders. Three patients died postoperatively (20%). At last follow-up, 10 patients were alive and 2 had died from unrelated causes. At a median delay of 13 months (3 to 74), 7 patients accepted to undergo complementary investigations. None of them had any anatomic abnormality as checked by barium swallow. Six patients complained of mild symptoms from gastroesophageal reflux. Six patients (85%) presented with esophageal motility disorders on manometry and 4 (54%) had nocturne chronic reflux disease on pH monitoring. Two patients underwent endoscopic ultrasonography, of which one presented with a focal absence of one layer of the esophageal wall within the area of the suture. With time, no patient experienced recurrence, but one developed a cancer in the cervical esophagus. These results suggest that esophageal functional disorders are the rule after primary repair of a Boerhaave's syndrome. Whether or not these findings are causal, coincidental, or related to the surgical treatment remains unclear. However, performance of routine postoperative explorations is strongly encouraged for a better understanding of this challenging condition.
Article: Late pulmonary artery stump thrombosis with post embolic pulmonary hypertension after pneumonectomy[Show abstract] [Hide abstract]
ABSTRACT: Ten years after right pneumonectomy for primary lung cancer, a 51 year old man developed a pulmonary artery stump thrombosis which produced microemboli in the remaining lung and, in turn, led to chronic pulmonary hypertension. This case strongly suggests that prolonged postoperative thromboembolic prophylaxis should be considered in patients undergoing right pneumonectomy.
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phenylephrine hemorrhoidal gel - topical, Preparation H (cont.)
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June Doorn
Published in the Dorset Echo on 20 August 12
June Doorn (nee Churchill) Passed away at home in Den Helder, Holland on 13th August 2012 aged 76. Beloved mum to David & Linda, Gary & Jos, much loved Grandma & Great Grandmother, she will be greatly missed!! Funeral to be held in Holland on Monday 20th August.
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Beautiful BalancePosted on 04 / 02 / 2013
I had dinner there last night with my girlfriend and we couldn't have been happier or more satisfied. She had the Cabbage and Artichoke Wrap. It was awesome! Not sure how one "wraps" it because the pita is piled high and overflowing with delicious cabbage, artichoke, salad and rice perfectly spiced. I had the spicy vegetable curry and it was great. We both raved about how perfectly balanced the spices were in our dishes. As our bites moved from the front of our mouths to the back, the different flavors took turns emerging and stating their cases. It was a beautiful thing! But the real star of the meal was an appetizer, Makouda. Potato balls. Doesn't sound that wonderful, does it? What a surprise! There were five good sized balls, fried crispy and not oily in the least. Drizzled delicately with a sauce and sprinkled with fresh parsely. Inside was creamy, spicy mashed potatoes. This is the type of dish you take smaller and smaller bites because you want it to last longer!
Cons: Waiter wore t-shirt and tennis shoes.


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Matthew 21:15New International Version (NIV)
15 But when the chief priests and the teachers of the law saw the wonderful things he did and the children shouting in the temple courts, "Hosanna to the Son of David," they were indignant.
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