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You are a fan of games names p10 ? Come to discover the best forums games names p10 on the internet and share your experience with a community fan of games names p10 . You can also build a forum games names p10 and create your online discussion.
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Nicki Minaj shocked the twitterverse Sunday (April 15) when the leader of the Barbz deactivated her Twitter account in a huff, prompting millions of her followers to demand her return.
"Like seriously, its but so much a person can take. Good f**king bye," was her last tweet before @NickiMinaj went dark.
The hashtag #NickiComeBack became a trending topic shortly after she deleted her account, as Barbz everywhere attampted to appeal to her in 140 characters or less.
"On 2nd thought I'll just follow a new set of barbz. The ones I follow r very mean and ratchet.*side eyes them*"
@NickiDaily was shut down since the kerfuffle and Nickidaily.com redirects to nicki-minaj.org.
The recent dustup happened less than a week since Nicki Minaj's sophomore album Pink Friday: Roman Reloaded, debuted at No. 1 with more than 25o,000 sold.
–E. Parker, CBS Local
See what's new on JAMZ!
- See a Photo of Harry Styles from the set of 'Dunkirk'
- Alessia Cara Covers U2's 'One'
- Pitbull Releases 'Greenlight' Featuring Flo Rida & LunchMoney Lewis
- Watch a Group of 80 Year Olds 'Shake It Off' to Taylor Swift
- Rihanna to Play Pivotal Role in 'Bates Motel'
- Listen To Win Suicide Squad Advance Screening Tickets
- Selena Gomez Shares Emotional Message after Difficult Show
- Tower Of Terror Getting A Guardians Of The Galaxy Makeover
- Ariana Grande Debuts Bangin' New Hairstyle
- Lil Wayne Angry at Marijuana Festival, Cuts Performance Short

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Located in Monterosso al Mare, Affittacamere Anita offers rooms a 5-minute walk from Monterosso Train Station. Fegina beach is a few steps away.
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The Stella Della Marina Hotel is in the center of Monterosso, part of the famous Cinque Terre Regional Park on the Ligurian coast.
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Very good
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Right in the historical centre of Monterosso Al Mare in the Cinque Terre Regional Park, B&B I Coralli offers air-conditioned rooms and studios with a TV, fridge and private bathroom.
"Wonderful location and very clean. The owner was v…r restaurants. Would definitely stay there again."
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John Conlee Tickets for Sale
John Conlee is always a great hit with every crowd. We stock all tickets to every John Conlee show!
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|Jul 23 Sat 7:00 PM
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Photographer Ben Long describes and demonstrates high dynamic range (HDR) photography, a technique that broadens the luminance or range between the lightest and darkest areas of an image.
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Last month, Yahoo! and Google launched a couple of contests (separately), and this week both are announcing the finalists.
First up, Yahoo! is looking for a new Yodel, and they received 21,000 entries. They've narrowed it down to three contestants each for the US, UK and India. Click on the links below to view the finalists' entries and cast your vote:
Tiffany Jo from Arizona
Carlo from Arizona
Christopher from Oklahoma
Meanwhile, Google launched a contest to see where the new Street View vehicle, Google Trike would go. They received 25,000 suggestions, 44% of which were college campuses. Below are the finalists for the various categories. You can cast your vote at Google.com/trike.
University Campuses
Arizona State University
Michigan State University
Princeton University
Rochester Intitute of Technology
Stanford University
Parks & Trails
Boulder Creek Bike Path, CO
Capital Crescent Trail, MD/DC
Centennial Trail, WA
Schuylkill River Trail, PA
Stevens Creek Trail, CA
Pedestrian Malls
Faneuil Hall Marketplace, Boston, MA
Navy Pier, Chicago, IL
Pier 39, San Francisco, CA
Alcatraz Island, San Francisco, CA
Central Park, NY
Millenium Park, Chicago, IL
Kennedy Space Center, FL
National Mall, DC
Theme Parks & Zoos
Bronx Zoo, NY
Busch Gardens, VA
Detroit Zoo, MI
Lincoln Park Zoo, Chicago, IL
San Diego Zoo, CA
Universal Studios, FL
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Former ACT party leader Rodney Hide says he 'laughed out loud' over allegations he was blackmailed into standing down as leader of the ACT Party.
Jordan Williams, the Wellington lobbyist who features heavily in Nicky Hager's latest book, also says the suggestion is "utterly false".
In his book Dirty Politics, Hager claims that Williams was part of a campaign to pressure Hide to stand down, including claims that he was blackmailed into resigning over him sending "inappropriate text messages to a young woman".
The book published an exchange between Simon Lusk, a political strategist previously aligned with the National Party, and WhaleOil blogger Cameron Slater.
Lusk to Slater: "Cam we an f... up rodney. ...Jordan is talking to a girl that Rodney has been sending dodgy texts to."
Slater: "Get the texts....I can get them to Jonathan Jarshall. Just the sort of grubby shit he would be into."
"Trying. Problem is that Jordan needs to get them first, probably Wednesday night, but at the same time we can use this to our advantage."
Slater: "Drop them hard this Fri. No coming back from that."
Hide said he "laughed out loud" when he read the allegations and referred to Lusk and Slater's conversations as "two guys who email each other sort of like they're standing around in the pub talking bullshit..."
"The first I heard of this was when the news rang me ... last night," Hide told RadioLive.
He maintained he stepped down because he was challenged by former ACT leader Don Brash.
"I don't know Simon Lusk, I've never met him I've never heard of him, and I can't speak to what Simon Lusk and Cameron Slater email each other about because I've never seen that," he said.
"But the allegation specifically is that I was blackmailed over texts to stand down, that's not true."
He said if he had been blackmailed, "I wouldn't have left because I would have said I'm not going and my next phone call is to the police".
"Any blackmail against anyone, particularly an MP, particularly a minister of the Crown, particularly the leader of a political party, the police would be all over them."
The accusations would have been at the lower end of allegations levelled at him during his career, he said.
He had not read the Whale Oil post which hinted at the texts, he said.
Hide questioned why Hager never contacted him to ask whether it was true.
"I would've said it's not true."
He denied the texts existed and said he would not be taking legal action.
"On that Rodney [Hide] one, utterly false. I was aware of that particular rumour going around about Rodney at the time, and to make the allegation that it was used as a tool to usher Rodney to the exit is an outrageous claim," Williams said.
"To suggest that a lawyer would use rumour for blackmail is absolutely outrageous. The comments that are there that Simon [Lusk]'s told Cam[eron Slater], well that's his problem but it is frankly a well over-egged version of the truth," Williams said.
"I'm absolutely furious. It is utterly, utterly false. For a moment to suggest that I or Don [Brash] would, would think that it is fair cop to use that against someone is just disgusting."
Williams said questions over whether he would take legal action were a question for his former client.
"That would be up to Don [Brash], not me. I was acting for Don at the time, as his lawyer, it's probably more a reflection on him than it is on me, but what I'm saying is that allegation is absolutely wrong. And Rodney [Hide] will tell you that blackmail was never used against him."
Williams said he and Slater communicated frequently. "I talk to him every day," Williams said, with Hager's book reflecting three exchanges over the last four years.
He dismissed suggestions that the Taxpayers' Union, at which he is now the executive director, worked in concert with WhaleOil. Slater had not liked the idea and had "poisoned" the idea of it to people Williams planned to seek money from, he said.
Williams said the union was also the reason he had "fallen out" with Simon Lusk. The pair had spoken three times in 12 months "whereas previously we used to speak every day", Williams said.
"The Taxpayers' Union is David [Farrar] and my baby. I think everyone know that."
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Non-Profit Star Wars Costume Group.
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No Mods No Rules All Fun
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A place to chill and discuss various topics with others. Removed on: 20/01/2016
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Free forum : Guild HQ of chaoZ
Fürõr is a Horde Guild @ Tarren Mill (EU) realm. Furor has shifted from Neltharion - Molten-Wow (10x Private Cataclysm realm). Previously Fürõr played at Magic-Wow
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Welcome to the Blood Guild Forum
Online Community for Praeda
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Free forum : A Rebel & Neutral Guild from SWG on the Ahazi Server.
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A place for the Brotherhood of Death to hang out and get news about what's happening in WT and other games.
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The Guild Called Advanced is only available in Grand Fantasia 3
A Gathering Hall for all your Monster Hunting needs!
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Video: Victim of auto accident attacks police
The wounded victim lunged at police as they tended to her injuries
By PoliceOne Staff
HOUSTON — A woman being treated by Houston police after she was hit by a truck attacked the officers as they treated her, for unknown reasons.
The driver of a pickup hit three pedestrians around 1 a.m. Saturday, prompting the victims' families to attack the driver of the truck, according to KHOU.
The families held the driver until police arrived to arrest him. After police arrested the suspect, they tended to the victims, when one — an unidentified female — lunged at officers.
The woman was taken to a nearby hospital. The other two victims are in serious but stable condition.
Police arrested the driver and the violent pedestrian, according to Click2Houston.
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Join the discussion
PoliceOne top 5
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2 Country music duo under fire after requesting armed cops not be allowed backstage
3 Video: Cuffed suspect opens fire in back of cruiser, is killed by police
4 McDonald's employee fired for refusing service to Texas cop


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"Description is a story well told already; experience offers truth."
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Quotes Daddy offers a number of tools for developers and bloggers to integrate quotes into their site including customizable widgets, embeddable quotes and API.
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Angel Bear with White Star Figurine
Personalized Christmas Table Top Decoration or Personalized Gift
Dimensions: 3" x 6 3/4"
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This tabletop figurine is not an ornament because it would be too heavy, but this is a perfect gift for any religious occasion or for your little star.
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Moveable Feast
Heard celebrates autumn with a celebratory feast -- an "edible gallery" of sorts -- featuring dishes that fuse what we think of as traditional Thanksgiving elements with Native American style from renowned chef Freddie J. Bitsoie.
Before slipping into the time-honored food coma, be sure to peruse the Ornament Marketplace, which will be full of Southwest-inspired and one-of-a-kind decorations.
Thu., Nov. 24, 11 a.m.-3 p.m., 2011
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Wholesale Case (30 Units) Top Racing Mercedes RTR Electric RC Car ($7.00 Each)
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As expected, Willis McGahee's broken hand will keep him out of Sunday's home game against Detroit. He could also potentially miss the Nov. 6 game at Oakland.
McGahee broke his hand in Denver's win at Miami on Sunday. The Denver Post reports McGahee will have surgery Tuesday to repair a fractured fourth metacarpal in his right hand.
McGahee had 78 yards when he was hurt in the third quarter. The free-agent acquisition has been solid for Denver.
He had 100-yard games in three of his previous four games. Third-year running back Knowshon Moreno will take over for McGahee on Sunday. The No. 12 overall pick of the 2009 draft has been injured much of the year. With McGahee out, Moreno, who was expected to be Denver's lead back, must take advantage of the opportunity.
Moreno had just 54 yards on 17 carries this year. He is in danger of becoming a major draft bust. Performing well when McGahee is out, could help kick start his career.


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I made my dentist laugh last week, and I did not have to use nitrous oxide.I told him I wanted to look like Jack Nicholson, but I only had enough money to look like Michael Strahan.Dentists are not typically easy laughers. For one thing, it's hard to hear the punch line when the high-speed drill is whining and the irrigation tube is gurgling.It is particularly difficult to get anyone to laugh when everything is so unfunny these days.
Welcome to the 2016 Republican National Convention. It has been a lot of things, but it hasn't been boring.If you starred in a soap opera or reality television show, you had a good shot at a speaking spot.
Week of July 18A glorious full moon at 27 degrees Capricorn brightens the midsummer skies on the 19th. Full moons always contain the potential for inflammatory remarks and actions, and this one should not be any different.
We've all been there.You say something with great conviction because of your great convictions and then upon further review you wish you could unsay the words that you just said.
Forty years ago I thought having my own newspaper column would be glamorous and exciting.
I know politics makes strange bedfellows, but I would give up a lot of sleep before I got into bed with someone who took personal shots at my family or me.
Week of July 11We are now finally settling into the forward motion of Mars. It was back on April 17 that Mars stationed retrograde at 8 degrees Sagittarius.
There have been so many tragic news stories this week that we need a scorecard to keep up. The problem is that we are all losing.Do you know how hard it is to be a police officer?
Political observers predict the upcoming political conventions will be tumultuous.The two presumptive nominees are like characters from ancient Greek tragedy.
It's not death. It's not dismemberment, but it was black despair when I lost my website. No access, lost files. I thought that email from my provider was an ad, not a renewal notice. Now my website went poof. No crimes involved, just...
Week of July 4As the birthday of the United States approaches on July 4, it seems somewhat appropriate that we are also met with a new moon at 12 degrees Cancer.
North Boston Directory
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Super 8 Oklahoma City Accommodation & Rooms
- Free continental breakfast, free WiFi, and free parking
Main amenities
- 72 guestrooms
- Indoor pool
- Fitness center
- Business center
- Air conditioning
- Daily housekeeping
- Computer station
- Multilingual staff
What's around
- Heart of Oklahoma City
- Trosper Park Golf Course (1.3 mi / 2.1 km)
- Crossroads Shopping Center (2.4 mi / 3.9 km)
- McCracker Park (2.5 mi / 4 km)
- Chesapeake Energy Arena (4.3 mi / 7 km)
- Myriad Botanical Gardens (4.5 mi / 7.3 km)
Door leading to room beside us would not shut. Room not secure. Cigarette burns all over…
The room smelled so badly that we had to purchase and spray air freshener in the room in…
Super 8 Oklahoma City Accommodation & Roomsfrom ZAR 828
- Standard Room, 2 Queen Beds
- Standard Room, 1 King Bed
- Room, Accessible
- Standard Room, 2 Queen Beds, Smoking
- Standard Room, 1 King Bed, Smoking
- Standard Room, 1 King Bed, Accessible
Recommended hotels
At a glance
Key facts
Hotel size
- This hotel has 72 rooms
- This hotel is arranged over 2 floors
- Check-in time 3 PM-midnight
- Check-out time is 11 AM
Required at check in
- Credit card or cash deposit required
- Government-issued photo ID required
Travelling with others
- Children (12 years old and younger) stay free when occupying the parent or guardian's room, using existing bedding
- Pets not allowed
- Free WiFi and wired Internet access in public areas
- Free WiFi and wired Internet access in rooms
- Free self parking
- Free RV/bus/truck parking
Nearby Two Star Oklahoma City hotels
In the hotel
- Free continental breakfast daily
- Indoor pool
- Fitness facilities
- Business center
- Computer station
- Multilingual staff
- Number of buildings/towers - 1
- Elevator/lift
In the room
- Air conditioning
- Iron/ironing board
- Hair dryer
- Satellite TV channels
- Desk
- Free WiFi
- Free local calls
- Daily housekeeping
- Connecting/adjoining rooms available
Top Oklahoma City hotels
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Super 8 Oklahoma City Accommodation & Rooms's small print
Also known as
- Oklahoma City Super 8
- Super 8 Hotel Oklahoma City
- Super 8 Oklahoma City
The property has connecting/adjoining rooms, which are subject to availability and can be requested by contacting the property using the number on the booking confirmation.
Optional extras
Rollaway beds are available for USD 10 per night
Cribs/Infant beds are available for USD 10 per night
We have included all charges provided to us by this hotel. However, charges can vary, for example, based on length of stay or the room you book.
Recent reviews
Good 3.7 /5 from 519 reviews
Love the bed comforter color n interior design. Clean. The hotel needs to provide drinking water n shower cap though. Also needs to clean their pool.
Very nice hotel and great staff
Very nice people
They are trying and we use to stay, and enjoyed staying there every time we come thu but it really needs work it smells like cigarette smoke really bad the people are sweet but don't think that we will stay again
my stay was good I the room was clean front desk people were very helpful... I had 2 down falls one was my bath tub didn't keep water the drain leaked... the second was my daughter was in the room next door which was my mom's room and the house keeper let her out and put her in my room and she had no clue she was my daughter my daughter is non verbal 2yr old... so that made me pretty upset but over all was a pretty good stay...
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Nepal`s five-time PM to chair first Constituent Assembly meet
Kathmandu: Five-time Prime Minister Surya Bahadur Thapa, who is Nepal`s oldest lawmaker, will be the first member of the new Constituent Assembly to take oath of office on January 20.
The 85-year-old, elected to the assembly through the proportional representation (PR) system, is the president of the Rastriya Prajatantra Party.
Thapa will be administered the oath of office by President Ram Baran Yadav. Other assembly members will be sworn in by Thapa on January 21, according to sources at the President`s Office.
Thapa will also chair the first meeting of the Constituent Assembly, which also serves as the parliament.
There is a tradition in Nepal of the first meeting of a new parliament being chaired by the oldest member.
There were debates for nearly two weeks as to whether the Head of the Council of Ministers or the President would call the first meeting of the Constituent Assembly.
However, the political parties yesterday agreed that the head of the government, Khil Raj Regmi, would call the meeting as ordered by the President.
Regmi has summoned the first meeting of the Constituent Assembly for January 22. Thapa will remain as the Speaker of the Parliament or the Chairman of the Constituent Assembly until a new chairman is elected.
Under the PR system, 335 members of the 601-seat assembly are chosen according to the proportion of votes secured by political parties in the elections.
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Thursday, July 28, 2016
Federal and Provincial Governments Launch MyHealthNS to Improve Health Care in Nova Scotia
Doctors and patients in Nova Scotia can now get routine test results and share information through MyHealthNS, a new secure online tool. Patients of participating physicians receiving results from the QEII Health Sciences Centre, the IWK Health Centre or other facilities in the Halifax, Eastern Shore and West Hants areas will now be able to […]
Thursday, July 28, 2016
Government Invests in Busker Festival, Recognizes 30th Anniversary
On its 30th anniversary, the Halifax International Busker Festival is soaring to new heights with the help of a one-time $50,000 investment from Communities, Culture and Heritage. "This festival always provides excellent entertainment for the public and excellent economic benefits for Halifax and the province," said Internal Services Minister Labi Kousoulis. "We are proud to […]
Tuesday, July 26, 2016
New Apprenticeship Program for High School Students
Halifax-area high school students are getting the chance to explore careers in the culinary trade this summer. Serve It Up! is a new youth apprenticeship program led by the Nova Scotia Tourism Human Resources Sector Council. It gives students the opportunity to work in commercial kitchens with Red Seal Certified cooks to gain practical, hands-on […]


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Next On The Horizon For Vena Cava: Condoms And Bong Water
Just a few hours ago, the lovely ladies of Vena Cava shouted to the world that they would be taking the next, natural step in their careers and venture into condoms and bong water. Calm down, frat boys. Beside our instinct that the bong water is a joke (they also tweeted a potential eau de toilette called "Piss Water" a few weeks ago), the custom-designed condom buzz comes as Lisa Mayock and Sophia Buhai's second collaboration with Proper Attire Planned Parenthood, and what Proper Attire calls a "must-have accessory." The Vena Cava gals poignantly marked this occasion with a tweet stating #safesexinstyle, and we couldn't agree more. Urine and dirty bong water? Not so much... but, admittedly, we still chuckled. (@VenaCavaNYC)
Photos by Kava Gorna/Jed Root
- Birth Control News |
- New York | Vena Cava Announces Second Condom-Design Collab. Vena Cava Tweets Condoms Designs and Bond Water
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Just because you aren't wearing "short-shorts" doesn't mean your dress qualifies as office-and-everywhere appropriate. In fact, a short dress can be more ...
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Food & Drinks
14 NYC Foodies To Follow On Instagram
In a city of never-ending menus and food trends, it can be hard to figure out the next best brunch spot, lunchtime haunt, or recipe to master. However, all those hours you spend sifting through the world of Instagram can actually result in more than just ogling of some serious #foodporn. In fact, it may be the best way to ...
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Jul 13, 2016


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Skiing spill over rail while friends die laughing
Posted by weed4u on Jul. 21, 2008
Elizabeth Rage takes you through the steps to create the Enchantress look f...
On this episode, Master Chalk Artist Chris Carlson takes on an epic Star Tr...
Get you geek on and come check out these hilarious clips!
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database administrator dba jobs near Rancho Cordova, CA
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ETL Lead Engineer - Sacramento, CA
UnitedHealth Group - Sacramento, CA
Monitor database performance, support application users, determine cost of database changes, and train team members on applications....
Senior Unix Admin
3 Key Consulting Inc. - Rancho Cordova, CA
5 years' experience as a Unix System Administrator in large-enterprise deployments of UNIX and/ servers. Qualified candidates need only apply by sending resume...
Database Administrator
Certent - Roseville, CA
Provide DBA services to application development teams, including database design, database generation, coding, and performance related issues....
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Direct Technology - Sacramento, CA
5+ years' experience as a DBA. As a DBA, you should be passionate about up time and performance. A candidate should be someone who has a minimum of 5 years'...
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Technology Crest Corporation - Sacramento, CA
Experience as a DBA supporting government retirement database systems. Five (5) years of experience as an Oracle Database Administrator (DBA) on Oracle database...
ADABAS Database Administrator with NATURAL programming exp
Technology Crest Corporation - Sacramento, CA
Experienced ADABAS Database Administrator with NATURAL programming experience needed. Experience working with database creation techniques and database...
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GTI Federal - Rancho Cordova, CA
Business Objects /developer with BO Administrator experience that will work as part of the team that will migrate an existing data warehouse from z/OS DB2...
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EmPower HealthIT - Sacramento, CA
Epic System's EpicCare, Epic Clarity, Intersystem's Cache' Database or other hierarchical database, Crystal Reports, Business Objects Enterprise, OLAP Reporting...
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Strategic IT Staffing - Sacramento, CA
Join our client's Internet Services Engineering Group, as a Senior Oracle database administrator with strong Oracle database administration and performance...
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CEdge Software Consultants - Rancho Cordova, CA
O Teradata database. Business Objects developer with BO Administrator experience that will work as part of the team that will migrate an existing data warehouse...


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New Homeowner Protections
A new Homeowner Bill of Rights, signed by Gov. Jerry Brown, went into effect on January 1, 2013. The new set of laws protects consumers who are going through the foreclosure process. It includes stopping lenders from doing what is called dual tracking, robo signing and makes sure lenders assign one point of contact to borrowers who are trying to obtain a loan modification.
Duel tracking is the process of starting the foreclosure process while the lender is considering and or reviewing a loan modification request. We have talked to many homeowners who have applied for a loan modification and when it is declined or rejected they immediately get a Notice of Default which is the first step in the foreclosure process. The lender has been working on the foreclosure during the time the loan modification was under review and they are prepared to foreclose if the loan modification is declined.
Under the new law, banks must give loan-modification applicants a response before starting the foreclosure process. Banks now also have to inform consumers who don't apply for a loan modification that they have the right to do so.
Robo signing, is defined as the process of approving foreclosure documents without proper review and will now be illegal in California.
Included in the Homeowner Bill of Rights is the ability for borrowers to sue loan servicers for violating any foreclosure law.
Speaking of new laws, last week I wrote about the extension of the Mortgage Debt Forgiveness Relief Act being extended. I failed to mention the State of California has not yet passed legislation to make State taxation rules mirror Federal law. The bill to do this in now being worked on and is expected to pass but at this time there would be state taxes due on forgiven mortgage debt associated with a short sale.
If you have any questions about the Homeowner Bill of Rights or short sales please let me know. I can be reached at the MagnumOne Realty office in Roseville (916-899-6571) or by email to firstname.lastname@example.com.
Julie Jalone, wife and mother living in Rocklin, is an experienced professional Realtor ® serving
the Greater Sacramento area including Placer, El Dorado, Yolo and Yuba counties.
Julie may be reached online at www.jalone.com or by calling (916) 276-6883
Check out her daily web blog: Keep it Real in Sacramento
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Pituitary Tumors Follow-up
- Author: Jorge C Kattah, MD; Chief Editor: Robert A Egan, MD more...
Further Outpatient Care
See the list below:
Adjustment of hormonal therapy is necessary following transsphenoidal resection of the adenoma. This may be accomplished in the weeks following surgery by the consulting endocrinologist.
- Assess the need for replacement of cortisol 4 weeks after the resection. This is done by measuring the cortisol levels following an IV injection of 250 mcg of tetracosactin. Cortisol levels greater than 500 nmol/L indicate sufficient endogenous steroid production.
- Low thyroid levels are an indication for replacement. The same is true for low testosterone levels in symptomatic males and low estrogen/progesterone levels in females.
Periodic neuro-ophthalmologist follow-up is essential, particularly when residual tumor is present. Visual fields and fundus photographs should be obtained before and immediately after tumor resection. These parameters provide a baseline for follow-up examinations.
Radiation therapy (RT) is often necessary for managing local mass effects of large macroadenomas. The indications for RT at this time are controversial. In a recent study, Alameda et al followed 51 patients with pituitary tumor who underwent surgery; 22 with complete macroscopic resections, judged by imaging, were tumor-free 3-6 years postoperatively. Twenty-seven patients with residual tumors after surgical resection were treated with RT. Fourteen residual tumors decreased in size, 11 remained stable, 1 increased in size, and 1 patient was lost to follow-up. RT is a useful treatment alternative among patients with residual tumors after surgery. Fractionated stereotactic radiotherapy (FSR) was found to be safe and effective by Colin et al in 110 consecutive patients. Moreover, it may reduce the possibility of postradiation optic neuropathy.
The use of Gamma knife radiation to treat residual tumor has been the subject of reviews, which have found it effective, particularly in acromegaly and Cushing syndrome. The risk of postradiation optic neuropathy averaged less than 5%.
Further Inpatient Care
Care of patients is primarily on an outpatient basis. Only patients who are undergoing surgery are inpatients. Additionally, a small percentage of patients with pituitary apoplexy present with a clinical picture similar to that of subarachnoid hemorrhage.
Transsphenoidal surgery
Careful hormonal control of these patients under the direction of an endocrinologist is essential.
A syndrome of inappropriate antidiuretic hormone secretion (SIADH) may be seen transiently, followed by diabetes insipidus.
Postoperative hypoadrenalism is a possibility that requires careful monitoring.
Hormonal levels should be assessed and replacements provided when appropriate.
In most cases, CSF rhinorrhea should be diagnosed and addressed promptly.
In most cases, transsphenoidal hypophysectomy involves low risk and has a good prognosis.
Pituitary apoplexy
As its name indicates, the apoplectic onset of hemorrhage within a pituitary adenoma may lead to hypothalamic, chiasmal, cavernous sinus, and brainstem compression.
Meningeal irritation results from blood in the subarachnoid space. On occasion, the degree of subarachnoid hemorrhage is significant, and a spinal tap may show evidence of acute or subacute bleeding. The acute panhypopituitarism is associated with shock and hypothalamic-brainstem compression, which could lead to coma and even death.
Headache, vomiting, visual loss, blindness, ophthalmoplegia, and altered consciousness may be present. In a series involving 62 patients, Semple et al found headache was the most common symptom in 87% of their cases, visual loss occurred in 56% of the patients, ophthalmoplegia in 45%, and altered level of consciousness in 13%. Hypopituitarism was present in 73% of patients and diabetes insipidus in 8%. [13]
In most cases, surgical intervention is required with excellent results. Candidates for emergency surgery include patients with rapidly deteriorating vision, altered mental status, and hypothalamic compression. Pituitary apoplexy may be fatal in a few instances. Conservative treatment is an option in stable cases, particularly if they are prolactinomas.
Factors leading to hemorrhage within a pituitary adenoma identified by Biousse et al include the following: reduced blood flow to the gland, sudden increment of blood flow, stimulation of the gland by endocrine mechanisms, anticoagulation, and trauma. [14] An upper respiratory tract infection with frequent coughing and sneezing also may trigger an apoplectic event. The best method to make the diagnosis of pituitary apoplexy is cerebral imaging. MRI preferentially but CT scan is an acceptable option if MRI is not available.
Inpatient & Outpatient Medications
Initial hormonal deficiencies may improve over time. Therefore, frequent endocrine re-evaluation is necessary.
Perform preradiation and postradiation endocrinologic and neuro-ophthalmologic evaluations. A postoperative cerebral imaging study is important to determine the possibility of residual tumor. If residual tumor is present, serial imaging is required.
Adverse radiation effects on the hypothalamus, pituitary, and visual pathways require close monitoring.
Pituitary apoplexy
Patients with a diagnosis of pituitary apoplexy should be transferred immediately to a tertiary care center intensive care unit.
IV fluids and IV steroid replacement should be initiated.
Urgent decompression surgery is indicated.
Patients with other pituitary lesions are investigated as outpatients and admitted for transsphenoidal resection.
Inferior petrosal sinus corticotrophin levels also can be obtained on an outpatient basis.
Treatment of pituitary tumors, particularly those resected via a transsphenoidal approach, has an excellent outcome with successful decompression of the visual pathways, cavernous sinus, and hypothalamus.
The possibility of significant loss of olfactory function following endoscopic transphenoidal pituitary surgery has been recently recognized as a frequent finding. A study by Rotenberg et al found damage to olfactory tissues to be a result of raising the vascularized septal flap that incorporates tissue rich in olfactory nerve receptors. Patients should be warned about this possibility prior to surgery. No suggestions for alternative olfactory receptor-sparing techniques were reviewed.[15]
Transfrontal resections are associated with more complications.
In cases handled by a skilled surgeon, surgical complications are minimal but can include any of the following:
Incomplete resection of large adenomas
Transient or permanent diabetes insipidus
CSF rhinorrhea
Monohormonal or polyhormonal deficiencies
Residual permanent visual field defects
Empty sella syndrome: An empty sella may occur after transsphenoidal surgery and is generally benign. Generally, herniation of the chiasm inside the sella typically does not cause visual field defects.
Radiation toxicity may occur as a rare complication in the treatment of pituitary adenomas, resulting in hypothalamic and chiasmal necrosis.
See the list below:
Prolactin-secreting microadenomas
- Surgical resection is curative.
- Dopamine agonists provide symptom control.
Prolactin-secreting macroadenomas: Dopamine agonists provide symptom control.
- Surgical resection is curative in 60% of patients.
- Octreotide therapy controls symptoms. In some instances, the use of PPAR-gamma ligands such as rosiglitazone or retinoic acid may be potential therapeutic options in the management of persistent or recurrent corticotropin-producing adenomas.[8]
Cushing disease: Surgical resection is curative. Rarely, invasive tumors produce metastatic deposits within the neuraxis via CSF pathways.
Rarely, distant metastases may occur.
Patient Education
The successful management of pituitary adenomas requires a highly motivated and compliant patient.
Hormone-replacement therapy is demanding, and a noncompliant patient is at risk for complications due to misuse of these agents.
Interaction of a team of specialists is required to manage these lesions. One of the specialists should serve as team leader and coordinate the patient's care.
Prompt reporting of new symptoms is important in addition to routine follow-up visits.
If the patient has no new symptoms or problems beyond about 5 years after beginning treatment, follow-up visits can be less frequent.
The frequency of follow-up visits depends on the presence of residual tumor, visual deficit, hormonal needs, history of radiation therapy, or other complicating circumstances.
Visual prognosis is excellent with transsphenoidal surgery. Ninety-five percent of patients studied by Gnanalingham et al experienced visual improvement.[16] The extent of the visual field recovery is mainly dependent on the preoperative visual field defect. These authors also found that visual recovery may occur in a rapid fashion (3-6 mo) but may also take place slowly over several months and even a few years.
Chahal HS, Stals K, Unterländer M, et al. AIP mutation in pituitary adenomas in the 18th century and today. N Engl J Med. 2011 Jan 6. 364(1):43-50. [Medline].
Villwock JA, Villwock M, Deshaies E, Goyal P. Significant increases of pituitary tumors and resections from 1993 to 2011. Int Forum Allergy Rhinol. 2014 Sep. 4(9):767-70. [Medline].
Vlotides G, Eigler T, Melmed S. Pituitary tumor-transforming gene: physiology and implications for tumorigenesis. Endocr Rev. 2007 Apr. 28(2):165-86. [Medline].
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Zhang X, Horwitz GA, Heaney AP, Nakashima M, Prezant TR, Bronstein MD, et al. Pituitary tumor transforming gene (PTTG) expression in pituitary adenomas. J Clin Endocrinol Metab. 1999 Feb. 84(2):761-7. [Medline].
Kosmorsky GS, Dupps WJ Jr, Drake RL. Nonuniform pressure generation in the optic chiasm may explain bitemporal hemianopsia. Ophthalmology. 2008 Mar. 115(3):560-5. [Medline].
Thomas ST. Finite Element Modleing of Chiasmal Compression. J of Undergraduate Engineering Res. 2009. 12:1-30.
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Talkad AV, Kattah JC, Xu MY, et al. Prolactinoma presenting as painful postganglionic Horner syndrome. Neurology. 2004 Apr 27. 62(8):1440-1. [Medline].
Paterno' V, Fahlbusch R. High-Field iMRI in transsphenoidal pituitary adenoma surgery with special respect to typical localization of residual tumor. Acta Neurochir (Wien). 2014 Mar. 156(3):463-74; discussion 474. [Medline].
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Semple PL, Webb MK, de Villiers JC, Laws ER Jr. Pituitary apoplexy. Neurosurgery. 2005. 56(1):65-72; discussion 72-3. [Medline].
Biousse V, Newman NJ, Oyesiku NM. Precipitating factors in pituitary apoplexy. J Neurol Neurosurg Psychiatry. 2001 Oct. 71(4):542-5. [Medline].
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Jagannathan J, Yen CP, Pouratian N, Laws ER, Sheehan JP. Stereotactic radiosurgery for pituitary adenomas: a comprehensive review of indications, techniques and long-term results using the Gamma Knife. J Neurooncol. 2009 May. 92(3):345-56. [Medline].
Jho HD. Endoscopic endonasal pituitary surgery: Technical aspects. Contemporary Neurosurgery. 1997. 19:1-8.
Jho HD, Carrau RL, Ko Y, Daly MA. Endoscopic pituitary surgery: an early experience. Surg Neurol. 1997 Mar. 47(3):213-22; discussion 222-3. [Medline].
Koutourousiou M, Gardner PA, Fernandez-Miranda JC, Paluzzi A, Wang EW, Snyderman CH. Endoscopic endonasal surgery for Giant Pituitary adenomas: Advantages and Limitations. J of Neursurg. January/2013. E Pubahead of print:
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Rotenberg BW, Saunders S, Duggal N. Olfactory outcomes after Endoscopic Transphenoidal Pituitary surgery. The Laryngoscope. 2011. 121:1611-1613.
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Today's Featured Artist: Michael Godard
Pixels Exclusive: Introducing the hottest summer accessory of 2016... round beach towels! FREE WORLDWIDE SHIPPING.
Fine Art America has expanded to 14 fulfillment centers in 5 countries!
David Bowie Remembered - A Collection of Unpublished Portraits by Terry O'Neill
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Cheerful Blue Parrot is a mixed media by Anne-Elizabeth Whiteway which was uploaded on March 15th, 2013.
More from Anne-Elizabeth Whiteway
Comments (23)
Love your little Parrot, such a pretty little guy your art is lovely Sherri fl
Thank you dear Sherri. I'm so happy that you took time to comment about this painting. Smiles.
Wonderful detail on this piece Anne... your talents are unlimited.. ;-) fv
Thank you Nick. I'm so glad you like this. Your words of praise have made me so happy. Smiles.
Love the colour and feather detail Anne-Elizabeth! Fun & whimsical image!~f/v
Dianne, thank you dearly for your gracious comment. I'm so glad you like this. Smiles.
Just lovely v
Thank you Joan. Your kind comment has made me so happy. Smiles..
Fantastic creation of Parrot in blue.Commendable Textures you have brought out in the body!!!!!
Thank you Anand. You have made me so happy with your kind and gracious comment. Smiles.
I love this and the color combinations. Birds always attract my attention! v/f
Thank you dear Lenore. I'm so glad you like this. Your comment has made me so happy. Smiles.
It came out so sweet!! V/F
Thank you dear Annie!!
What a beautiful, joyous drawing! v
Thank you dear ARJ. !!!
I love your bird, Anne! V/f
Thank you dear Nicole!!
Nice Work!
Thank you dear Harsh !!
Beautiful colors and textures, Anne-Elizabeth. vote
Thank you dear Joanna !!
Beautiful :)
Thank you dear Marilyn!!
Thank you R W!
It already has great joy and life in it Anne-Elizabeth! The colors and textures are really so nice!! F/V!!
Thank you Cheryl!
Thank you dear Cheryl!!
Thank you Barbara. Thank you Tessa.
Beautiful Anne-Elizabeth! Look forward to the finished piece! v/f
Very beautiful, lone both these but the blue sparkles!! Wonderful!! F/V
Thank you Geoff!
Very nice work Anne...


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View assessor property records for Westland MI. The median sales price for homes in Westland MI was $72,250. The average list price for homes for sale in Westland on Trulia is $69,018. The median sales price decreased 3.7% compared to the prior year based on 114 sales, which decreased 73.0% compared to the prior year.


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YouTuber Hannah Hart headed to Food Network
Hart will be the host of her own culinary travel show.
Hart will be the host of her own culinary travel show.
Get a bird's eye view from Hawaii to New York.
The prayer had to stop because the crowd loudly chanted Bernie Sanders' name.
Live and direct from Philly town.
The Ballad of Jessica Blue, a four-part mini-series, will start rolling out on Aug. 11.
"What the f*ck just happened?"
A perfect pair.
She'll join Elisabeth Moss
"Just look at my son, DJ Shumpert!"
Feel the bern, Philadelphia.
"I've always told the truth. I'm always true to my word..."
The end of (another) era for an iconic brand.
Both bride and groom are reportedly from wealthy and influential Chinese families.
Bernie Sanders called on his supporters to vote for Hillary Clinton but they were having none of it.
For all its faults, Twitter remains the dominant online destination for breaking news and in-the-moment discussion.
Ready for you to binge in 2017.
Davoji and Emmoji are the future.
"Still trying to figure out how UCAS knows I'm on my period."
Watch the moment it strikes.
It's a story that goes back decades, to when Jordan's playing career was still on the rise.
Netflix's new series is packed with '80s-influenced sounds.
It is expected to draw crowds and actually be very poopular.
Iowa police mistook him for a bank robber.
But you still can't wear ripped jeans.
Goofing around for a noble cause.
"It is OK to suffer, but as long as you talk about it. It is not a weakness."
From 'Blair Witch' to 'Wonder Woman' to 'American Gods,' it's all here.
Internet portals must shut all original reporting operations, and web services can now carry only state-approved media news
Remember when hackers just wanted your money? Now they're power-brokers.


text:
Cops say bearing news of a loved one's death is 'hardest part of the job'
Editor's note: PoliceOne columnist Dr. Laurence Miller says that there is no easy way to tell someone their loved one has died, but there are ways of making it easier on both the victims and the notifiers. Read The worst possible news: Death notification and body identification for law enforcement officers for recommendations that apply generally to dealing with surviving family members of both deceased civilians and fellow officers who have died in the line of duty.
By Wayne Drash
ATLANTA — Police Lt. Keith Meadows won't ever forget the first time he had to deliver the grim news. A mother was crying hysterically on the other end of the phone line wanting information on her son's fate. Meadows knew her boy had just been killed.
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Full story: Cops say bearing news of a loved one's death is 'hardest part of the job'
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Skype for Outlook.com preview now available in US, UK and elsewhere
Microsoft announced on Monday that the preview of its Skype integration in Outlook.com is now live for users in the UK, US, Germany, France, Brazil and Canada.
The company originally revealed in April that a preview of the integration would begin to roll out, and the UK be among the first to have access. Now the test release is available in a total of six countries.
"Today we are excited to give you an update: Skype for Outlook.com is now fully available in several countries around the globe ... we're still working hard to ensure this is available worldwide in the near future," announced Microsoft on its blog.
Read: Skype integrated with Outlook.com, call and IM from your email
The mishmash of Microsoft services specifically allows users to make Skype video calls directly from their Outlook.com email accounts. The integration is meant to bolster Outlook.com, especially because of growing competition from Google's Gmail and Hangout services.
Microsoft cited a poll that claimed 76 per cent of people "say that their email conversations frequently or occasionally result in a follow-up phone or video call". So with Skype for Outlook.com Microsoft is presumably hoping to hook that percentage of people who need more from their email.
To begin making calls while checking email, just install the plug-in for Chrome, Firefox or Internet Explorer. More details on how are available at Microsoft's blog.
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...I am currently enrolled in a doctoral program at the University of Phoenix. My grades in writing there are always A level. I have a way of explaining things clearly, which helps when speaking with a student with English as a second language.
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I have more than 8 years of teaching and tutoring experience. I am patient and make learning fun and easy. My formal education includes a bachelor's degree in Math from the University of Chicago with minor in Statistics, PhD coursework in Math at Cornell University, and a master's degree in Computer Science from Cornell University.
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Real news. Real funny.
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The station representative who can assist a person with disabilities with issues related to the content of the public files is Mike Dowdle, available during regular office hours at firstname.lastname@example.com and (801) 575-5555.
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text:
Uno Chicago Grill
Today:11:00 am - 11:00 pm
1533 Oakdale Rd,
Modesto, CA 95355
(209) 521-8667
Business Details
in Business
- Hours:
Regular Hours
- General Info:
- Please Visit Our Website For More Information
- Extra Phones:
Phone: (209) 521-0448
Fax: (209) 572-1085
- Brands:
- Absolut, Budweiser, Captain Morgan, Coors, Corona, Heineken, Lipton, Miller, Mugg, Pepsi, Rice, Samuel Adams, Sierra Mist, Smirnoff
- Payment method:
- amex, discover, master card, visa, all major credit cards, debit
- Location:
- Corner Of Oakdale & Briggsmore
Uno Pizzeria & Grill
Pizzeria Uno Corporation
- Other Link:
- Other Email:
- Categories:
- Take Out Restaurants, Restaurants, Bar & Grills, Pizza, Italian Restaurants
- Other Information:
Parking: Lot, Private
Wi-Fi: Free
Bike Parking: No
Attire: Casual
Good For Groups: Yes
Good for Kids: Yes
Wheelchair Accessible: Yes
Take Out: Yes
Cuisines: Mediterranean, Barbecue, Family Style, American, Fast Food, Italian, European, Continental, Pizza
Alcohol: Beer, Wine
Takes Reservations: Yes
Outdoor Seating: No
Specialties: Smoothies, Italian, Dishes, Wine
Price Range : Average
Posted: 1/12/2015
Our waitress, Evy, was excellent – very gracious and took care of a "problem"! We will be back. Thank you again.
Posted: 12/26/2014
I had the best prime rib here! I pick up some to go food. It's always nice and warm here, just love it.
Posted: 11/24/2014
This is a great place to eat. Also, this is a great place to watch Football game. This is a great place to eat. Also, this is a great place to watch Football games in the bar.s in the bar.


text:
Stay at home Mom. Mother to two boys. Generally a happy person. I read, do 5th grade homework, clean and make jewelry. Follow my Domestic Goddessness! LoL
Face Tags
nailpolish! #TwitPict
do you think my son's school would take "my cat sat on my homework as an excuse?" #TwitPict
whooo is that? moi! #TwitPict
Bagoda Blackberry and silver. out of practice. I used to nail art my nails in the 80s. :-) #TwitPict
tea canisters! can you tell I love tea? hahaha #TwitPict
tea shelves, yes there is a second row back behind most of these #TwitPict
tea drawer. #TwitPict
this years advent calendar ready to hang! #TwitPict
chicken and dumplings. not my best, but, certainly not my worst. :) #TwitPict
sash #TwitPict
lake Michigan #TwitPict
cat in a box #TwitPict
coral reef diorama.... Done! #TwitPict
the hunter in action. the prey? a really big fly. #TwitPict
the start of the sandwiches for my son's classroom tomorrow. they are all done now. 30 little stars #TwitPict
coffee with the Cap'N!! #TwitPict
ok here's my flash at work on my iPhone, seriously? my phone or an issue? need to look it up. #TwitPict
me. working. gonna do that a few days this month. #TwitPict
pulled out 31 babies to put into the breeding net today. still more hiding in the rocks! #TwitPict
©2016 Twitpic Inc, All Rights Reserved


text:
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INTERNET firm Yahoo is to be sold to US telecoms firm Verizon in a £3.7billion deal that is set to create a new mobile media giant.
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World /
POLICE have revealed the gunman who killed nine people and injured at least 20 others at a Munich shopping mall is an 18-year-old with dual German and Iranian nationality.
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Tech /
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Cars /
AMERICAN carmaker and Mexican spirit distiller collaborate on sustainability project.
Gaming /
WORLD OF WARCRAFT: Legion launches August 30 and Blizzard have revealed the server launch time for the big Pre-expansion patch.


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HP reveals unbreakable e-paper prototype
HP has revealed a new flexible plastic e-paper display prototype, which it says uses less energy and is more cost-effective than most other displays available today. Developed in conjunction with Arizona State's Flexible Display Center, this material is said to be unbreakable.
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