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Grandfield Public Schools Mission Statement
Our Motto "Learners today—Leaders tomorrow"
Visit us on these social media sites
"Attention Parents: Grandfield High School will be selling a limited amount of Blue and Gold product to help raise money for our AG program. We will be selling sausage for $7.00, Bacon packages for $16.00, and Chicken fritters for $20.00. All product is first come, first serve until all the product is sold off. To purchase any Blue and Gold Products, please see Mr. Fox or Darcy Gray in the High School office. Thank you for your support."
P.O. Box 639 ∙ 811 West 3rd ∙ Grandfield, OK 73546
Superintendent Office (580)479-5237 ∙ High School Office (580)479-3140
March 8, 2016
Dear Parents and Guardians,
As you may know, Grandfield High School has a closed campus lunch policy for our 7th-12th grade students. The policy was adopted in a measure to keep all of our students safe and under our supervision during the lunch time break.
Unfortunately, the past couple of months have highlighted some loopholes in our policy. In an effort to close those loopholes, the Grandfield Board of Education has adopted the following policy, to be enforced effective immediately:
Grades 7th through 12th will not be allowed to leave campus during lunch. If students leave at lunch they must be picked up and checked out and checked back in by their parents or guardians each day. In order to be checked out, their parent/guardian must physically sign them out in the high school office, at the time of lunch. No phone call authorization will be permitted. Students who are not checked out properly will be considered truant. Students will need to stay in the cafeteria or commons area during lunch period. Students are not allowed to take food or drinks out of the cafeteria.
Please contact the high school office if you have any questions regarding this matter.
Matthew Fox
Grandfield High School Principal


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In the News
Baker backs bid to add charter schools in Mass.
Governor Charlie Baker said Wednesday that he would support a ballot question to raise the state cap on charter schools, if advocates are successful in placing the initiative before voters in 2016.Read More
State poised to add 668 charter school seats in Boston
The state Education Department is poised to add hundreds of charter school seats in Boston, potentially loosening the logjam in a city where thousands of children remain on waiting lists.Read More
Your View: Pioneer Institute — Cap on charter schools needs to be lifted
Breathtaking results from yet another study, and the announcement that three prominent Boston lawyers plan to mount a constitutional challenge to Massachusetts' charter public school cap, have reignited the seemingly endless debate about charter schools' place in the commonwealth's education markRead More
Massachusetts Takes On a Failing School District
The Massachusetts public schools consistently rank at or near the top in the nation for performance on the rigorous, federally backed math and reading exams known as the National Assessment of Educational Progress.Read More
Boston valedictorian didn't let pregnancy slow her down
Loiselle Gonzalez Baez was determined not to let history repeat itself.Read More
Charter schools take a commendable step
CHARTER SCHOOLS in Massachusetts hRead More
Charter schools to pool resources
Charter schools across Massachusetts, which critics accuse of dodging a public duty to teach students with disabilities or language barriers, are stepping up their efforts to educate those students through a new statewide collaborative that will enable the institutions to share staff, training, and programs.Read More
Study on race, gender misses key variable: charter schools
BOSTON HAS been a national leader in building bridges between traditional Boston Public Schools and charter public schools in the city. The three-year-old Boston Compact has brought us together to share best practices and find mutual savings on transportation costs and facilities. Mayor Walsh is the cofounder of a charter school, and the incoming superintendent, Tommy Chang, is a former charter school leader.Read More
Prep Charter plans to build new $24.5M school
Boston Preparatory Charter Public School has filed formal plans with the city to build a pRead More
Report: Area charter schools can be model for hiring teachers
LOWELL -- The innovative approaches to hiring and handling teachers that schools like Lowell Collegiate Public Charter School anRead More

subset: commoncrawl


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Dirt Bike Brakes
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See all reviews for this product Galfer Superlight Tsunami Oversized Front Brake Rotor Kit MotoVet - Mokena Ill Much better than stock "They are progressive and will not just throw you over bars. There was a break in period. After broken in brakes have a great feel. Also a little drag noise you won't hear when riding but after installing it is like alignment off but after 10 minutes wheel will be quiet and should have no drag. I know how to align wheel and thought something wrong but was just something not really mentioned in install papers included. Total time install approx 20-25 minutes."
See all reviews for this product
Say goodbye to spongy brakes.
Are your dirt bike brakes not cutting it any more? Are they getting tired, making noise, or just not working at all? MotoSport is here to help with a huge selection of replacement dirt bike brake components and upgrades. Starting off, our dirt bike brake pads section has all the pad options you need, from the stock braking of the Renthal Brake Pads all the way up to the race-spec EBC "X" Series Carbon brake pads, made for the most hardcore enduro riders that demand pads with little to no fade. If you're looking to replace or upgrade your dirt bike brake rotors, MotoSport carries a great selection of rotors to choose from. If you're jsut replacing your old, worn out rotor, take a look at the selection of Galfer brake Rotors and Driven brake rotors. Would you like to upgrade to a bigger front disc? Check out the kits from EBC and Brembo Brakes! By increasing the size of your rotors, you're also increasing the swept area that the pad passes over, dramatically increasing brake feel, while dissipating heat better, leading to far less brake fade in more demanding riding conditions.
Get rid of those flexy rubber brake lines!
Your bike's stock brake lines, in most cases, are made of a high-density rubber that has an inherent amount of flex even when they're new, but they rapidly degrade over time. Did you know that most manufacturers recommend replacing all your dirt bike brake lines every five years? Not many people do, but if they knew what a huge difference new lines made, they would pay more attention. At MotoSport, we carry brake lines made out of braided stainless steel, which won't expand under braking like the OEM lines will, plus they last many years longer than stock rubber lines. Find your bike in the ride selector tool, then check out our brake line kits from Galfer and Ride Engineering!


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Need a fresh 'n' fruity idea for a starter or small lunch? This strawberry and creamy goat's cheese salad ticks all the boxes. The candied walnuts are the cherry on top of a fabulous dish. So easy, yet so effective. Thanks to Paige and Gregorio from Dinner In The Field for opening our eyes to these flavour combinations. www.dinnerinthefield.com/
Pasta alla Norma is so simple but so full of flavour. Chefs Paige & Gregorio from Dinner In The Field cooked it up for our Big Night In using an abundance of fresh ingredients straight from the market. It's a showstopper main course and the kind of food you want to serve to a loved one to show how much you care. www.dinnerinthefield.com/
Italian Chef Gregorio from Dinner In The Field shared his recipe for an authentic and frankly 100% perfect tiramisu. You won't encounter one that's better! Light, airy and beautifully rich with the cocoa and espresso infusion. If you're cooking Italian food you simply cannot go on until this recipe is there to finish your meal. www.dinnerinthefield.com/
At first this seems weird, but the more you think about it the more sense it makes! Why not dip your 'lost' bread into a yummy herb cheesy custard instead of a sweet one? Trust us, you need to try this.
If you're wanting to find out a little more about the stars of our recent, epic Big Night In, you're in the right place. We Grilled Paige and Gregorio, the Chef Team and wonderful couple behind Dinner In The Field, a foodie experience like no other… First up, how did you guys meet? Paige: I ... show more
Fruity crostini are little bits of bread with fruit on top of them. There's minimal cooking involved in the recipe so have fun and enjoy these easy little treats!
We're taking a risk with this one, because it doesn't get much more traditional than this dish from Malaysia. We hope we got it right!
Surf and turf!!! Yeah we get excited about surf and turf. All the best things on one plate and you are never ever going to have kebabs without an awesome dressing ever again after this.
Pavlovas can get a bit boring if you've made a few! Plain meringue with cream and fruit just doesn't cut it any more! We asked for your suggestions and together found the perfect chocolate and coffee pavlova that tastes great and is totally different!
As you all know I am a deeply positive person with a cotton candy centred disposition but (and this may surprise you) I can get annoyed and sometimes, dare I say it, miffed. And you will have noticed that this content is sitting on a food based platform. There's our context. So let's get straight ... show more
We've got 3 great picnic recipes for you from our recent adventure in the countryside! Check out our eBook, 'Food With Friends: The Picnic Hamper' for more great picnic recipes...


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Chocolate Color Me Papers
Happy Days Papers
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1 Million Twitter followers
This project was successfully completed by aounrizvi for $30 USD in 15 days.Get free quotes for a project like this
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It must be 1 Million Twitter followers
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+25% when I get 250K followers on Twitter
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Florida's First Choice for Autism Support
FAU Center for Autism and Related Disabilities (CARD) provides expert consulting, training and support, at no charge, for people with autism and related disabilities, their families, employers, the professionals and community and governmental agencies serving them.
Our Mission
CARD provides support and assistance with the goal of optimizing the potential of people with autism and related disabilities.
Call State CARD: 1.800.9.AUTISM
Call FAU CARD: 561.297.2023
Email Us:
Oct 7
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Want to to help transform the lives of the entire community? FAU CARD is a 501 (c)(3) nonprofit organization that has helped over 3,700 individuals, family members, friends and professionals with autism and related disabilities.


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Structural Pest Control Section
Structural Pest Control License, Certification and Recertification Examination Schedule
* License examinations given only at sites identified with an asterisk (*).
*April 5, 2016 9:30 AM License & Certification Exams
Gov. James G. Martin Building-N.C. State Fairgrounds
1025 Blue Ridge Road
Raleigh, N.C. Capacity 50
April 28, 2016 -1:00 PM Certification Exam Only (In association with NC State Pesticide School)
JC Ralston Arboretum
4415 Beryl Road-Brickhaven Building
Raleigh, NC Capacity 50
919-515-3113 (directions) 919-733-6100 (registration)
January February March April May June
July August September October November December
Return to schedule.


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King Richard finally lays his hand on title as Hughes rounds off season to remember
Racing correspondent Marcus Townend reflects on a memorable 2012 Flat season which ended on Saturday.
Away from Frankel, the biggest story as Frankie Dettori's 18-year association with Sheik Mohammed's Godolphin ended.
With only domestic one Group One success – Colour Vision in the Ascot Gold Cup – and 51 winners, Dettori endured his worst campaign since his plane crash season in 2000.Talk of a fourth championship tilt in 2013 may be bravado and Frankie will find picking up quality rides easier than finding the 120-plus wins he needs to be a contender.
While Godolphin thrusting Mickael Barzalona, still not the finished article, into the No 1 hot seat is a calculated risk.
Going it alone: Frankie Dettori will ride on a freelance basis next season
Richard Hughes 172 wins – 834 rides - £2,121,904
Amy Ryan 40 wins- 370 rides - £323,763
John Gosden 118 wins – 630 runners - £3,741,132
Godolphin 145 wins – 795 runners - £3,157,361
Graham Lee. The 36-year-old Grand National winner's switch to Flat racing has yielded an amazing 87 wins, including the Stewards' Cup on Hawkeyethenoo, from 757 rides supplied by an incredible 141 different trainers. At this rate, Lee is capable of matching his achievement of over 1,000 winners over jumps.
Frankel's 11-length demolition of Excelebration and co in the Queen Anne Stakes at Royal Ascot. His Juddmonte International Stakes win was more emotional with trainer Sir Henry Cecil at his side and more significant stepping up to 10 furlongs but it was the spectacular show on the sport's biggest stage that got the wider world hooked on the wonder colt.
Camelot's St Leger defeat. The champagne was on ice but the script went awry. Did jockey Joseph O'Brien get it wrong, the colt's stamina run out or was Camelot hyped beyond his worth? He is still a 2,000 Guineas and Derby winner but, after another defeat in the Arc, the star of a modest colts' Classic crop has a reputation to rebuild next year.
Richard Hughes gave everyone a month's start after a ban picked up in India but still won his first title at the age of 39 with 172 winners, including his own Magnificent Seven at Windsor on October 15. A gem of a ride to land the Nassau Stakes on The Fugue at Glorious Goodwood lives in the memory. Amid occasion pockets of indifference, Hughes' passion the title demonstrated once again its true value to the vast majority of riders.
Happy days: Richard Hughes is crowned Champion Jockey by Paul Hanagan
A tie. The unflappable Joe Fanning, whose 175 winners when all-weather successes are taken into account give him the biggest aggregate of any jockey and Danny Tudhope. Down and almost out with six winners in 2010 but up to 76, largely via his potent partnership with trainer David O'Meara, which including two Group Twos on Penitent.
His aura plus the impeccably focused handling of Frankel during a physically demanding year ensured Sir Henry Cecil dominated the 2012 Flat season, although a first championship for John Gosden rewarded consistent high-quality results from a squad of horses headed by Nathaniel.
Homecoming Queen's nine-length 1,000 Guineas romp at 25-1 for Aidan O'Brien and Ryan Moore. Two defeats later she was retired as a broodmare. It now looks a fluke, possibly prompted by the long delay at the start. But as a Classic-winning half-sister to 2007 Arc winner Dylan Thomas, her Coolmore Stud owners won't care.
Shock: Homecoming Queen was a surprise winner of the 1,000 Guineas
Apprentice champion Amy Ryan has not received the same publicity as Hayley Turner but, unlike her fellow jockey who shared the 2005 apprentice championship with Saleem Golam, Amy became the first female jockey to win the title outright with her 40 wins.
Jim Bolger's Godolphin-owned Dewhurst winner Dawn Approach plus their own Fillies Mile winner Certify head the betting for the 2013 2,000 and 1,000 Guineas but watch out for Just The Judge, the Charlie Hills-trained Rockfel Stakes winner and 1,000 hope. Telescope has legitimate Derby hope for Sir Michael Stoute.
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Marc Broussard's Soul Revue
His thirties might be a threat that's still five years off, but Marc Broussard's voice sounds twice its age when in blue-eyed-soul character.
Broussard's third LP, S.O.S.: Save Our Soul, hit stores last month. It's a leap of faith in image (goodbye, peach fuzz; hello, Brokeback Mountain) and in sound (Seventies soul juice on tap instead of bayou swamp water). But it's one of mind as well, for the singer/songwriter is now "thankfully free" of Island Records' major-label chains and off to add a little youth to the Vanguard Records corps.
The son of Boogie Kings guitarist and Louisiana Hall of Famer Ted Broussard, Marc grew up on a diet of northern soul crooners such as Donny Hathaway and Stevie Wonder before moving on to Prince and Brian McKnight. No absent father was Ted, who often dragged his preschool-age son onstage to sing "Johnny B. Goode," and, much later, contributed session work to Marc's first solo album, the rather aptly titled Momentary Setback.
In his far-better-received second LP, Carencro, Broussard tabled the bayou-sloshing "Home," which Kelly Clarkson often covered during her Addicted summer tour. At that time, Broussard was all about becoming the next Prince, but with S.O.S. he has settled into a breezy, feel-good trip. "I want to take what was beautiful and right about old-school soul and make it alive again," he says. "Soul music grew out of the church, out of gospel, but somewhere along the way it lost its heart. I want to give that heart -- the good vibes, the happiness, the love -- back to the music and back to the people, whether it's a new generation who've never heard what genuine soul sounds like or listeners who grew up on it."
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Most Cited Annals of Vascular Surgery Articles
The most cited articles published since 2011, extracted from Scopus.
Current usage and future directions for the bovine pericardial patchXin Li | Yuanyuan Guo | Kenneth R. Ziegler | Lynn S. Model | Sammy D D Eghbalieh | Robert A. Brenes | Susun T. Kim | Chang Shu | Alan Dardik
Volume 25, Issue 4, May 2011, Pages 561-568
Bovine pericardium (BP) is widely used in surgery and is commonly used as a patch after arteriotomy in cardiovascular surgery. BP patches have several advantages compared with prosthetic patches, including superior biocompatability, easy handling, less suture line bleeding, and possibly reduced rates of infection. These advantages of BP have led to its common use during carotid endarterectomy (CEA). However, long-term clinical results reported after CEA have suggested several issues that may be related to the patch, including restenosis, pseudoaneurysm formation, infection, fibrosis, calcification, and thrombosis. These complications may diminish the long-term efficacy of CEA and suggest potential areas for improvement of surgical patches. Understanding the mechanisms by which BP heals after patch angioplasty may lead to next generation tissue-engineered patches. © Annals of Vascular Surgery Inc.
Is open repair still the gold standard in visceral artery aneurysm management?Enrico Maria Marone | Daniele Mascia | Andrea Kahlberg | Chiara Brioschi | Yamume Tshomba | Roberto Chiesa
Volume 25, Issue 7, October 2011, Pages 936-946
Background: Visceral artery aneurysms and pseudoaneurysms represent a rare disease with high mortality. The aim of this study was to report a single center experience of open repair (OR) and endovascular treatment (ET) of 94 patients, and to analyze short- and midterm results. Methods: Between 1988 and 2010, 94 patients, 43 men and 51 women, mean age of 57.6 years (range, 23-87 years), were referred to our Institute with a diagnosis of visceral artery aneurysm or pseudoaneurysm. Arteries involved were splenic artery in 44 cases, hepatic artery in 17, renal artery in 18, superior mesenteric artery in six, celiac trunk in three, gastroduodenal in two, and pancreaticoduodenal in four. An abdominal aortic aneurysm coexisted in three (3%) cases, whereas in six (6%) cases, there were multiple visceral aneurysms. ET was indicated based on the anatomical location of the aneurysm or for patients at high risk for surgery. Results: A total of 74 patients underwent OR, whereas ET was performed in 20 patients. Technical success was achieved in all cases treated by open surgery. Splenectomy was performed in 11 cases, and in six, splenic autotransplantation was performed. At 6 months of follow-up, a Tc99m-labeled red cell scintigraphy showed that autotransplants were viable in four patients (67%). No cases of pancreatitis or splenic infarction were observed. Among renal artery aneurysms, nephrectomy was necessary in one case of renal infarction for massive thrombosis of the ex-vivo reconstructed renal artery. Four surgical conversions were recorded (one thrombosis of the hepatic artery, one massive hemorrhage after embolization of superior mesenteric artery aneurysm, and two cases of sac enlargement after 24 and 48 months). An endoleak was present in a patient treated for a splenic artery aneurysm, but it resolved spontaneously after 6 months. No complications were observed in patients undergoing surgical conversion after ET. Perioperative mortality in the surgical group was 1.3% (1/74). There was no perioperative mortality in the endovascular group. No statistically significant difference was found between groups in terms of perioperative mortality (p = 1.00). Perioperative morbidity was 9.4% (7/74) in the surgical group, and 10% (2/20) in the endovascular group (p = 1.00). Follow-up was available for 16 patients in the endovascular group (80%) and 63 in the surgical group (85%), with a mean duration of 42 months (1-192 months). In the whole cohort, actuarial survival at 10 years was 68%. The Kaplan-Meier estimates of survival at 1 and 5 years were 100% and 85%, respectively, for OR, and 100% and 40%, respectively, for ET, with no significant difference between the two groups Conclusion: ET is safe and feasible in selected patients, but incomplete exclusion may be observed, requiring late surgical conversion in a significant number of patients. Long-term results (high survival, low complication rate) confirm the durability of the surgical approach that in our experience remains the gold standard with satisfactory results, especially for aneurysms involving the visceral hilum. © 2011 Annals of Vascular Surgery Inc.
Genes and abdominal aortic aneurysmIrene Hinterseher | Gerard Tromp | Helena Kuivaniemi
Volume 25, Issue 3, April 2011, Pages 388-412
Abdominal aortic aneurysm (AAA) is a multifactorial disease with a strong genetic component. Since the first candidate gene studies were published 20 years ago, approximately 100 genetic association studies using single nucleotide polymorphisms (SNPs) in biologically relevant genes have been reported on AAA. These studies investigated SNPs in genes of the extracellular matrix, the cardiovascular system, the immune system, and signaling pathways. Very few studies were large enough to draw firm conclusions and very few results could be replicated in another sample set. The more recent unbiased approaches are family-based DNA linkage studies and genome-wide genetic association studies, which have the potential of identifying the genetic basis for AAA, only when appropriately powered and well-characterized large AAA cohorts are used. SNPs associated with AAA have already been identified in these large multicenter studies. One significant association was of a variant in a gene called contactin-3, which is located on chromosome 3p12.3. However, two follow-up studies could not replicate this association. Two other SNPs, which are located on chromosome 9p21 and 9q33, were replicated in other samples. The two genes with the strongest supporting evidence of contribution to the genetic risk for AAA are the CDKN2BAS gene, also known as ANRIL, which encodes an antisense ribonucleic acid that regulates expression of the cyclin-dependent kinase inhibitors CDKN2A and CDKN2B, and DAB2IP, which encodes an inhibitor of cell growth and survival. Functional studies are now needed to establish the mechanisms by which these genes contribute toward AAA pathogenesis. © Annals of Vascular Surgery Inc.
Thoracic endovascular repair (TEVAR) in the management of aortic arch pathologyErin H. Murphy | Gregory A. Stanley | Mihaiela Ilves | Martyn Knowles | J. Michael Dimaio | Michael E. Jessen | Frank R. Arko
Volume 26, Issue 1, January 2012, Pages 55-66
Background: Conventional repair of aortic arch pathology is associated with significant mortality and stroke rates of 6-20% and 12%, respectively. Because endografting has excellent results for descending thoracic aortic disease, extension of thoracic endovascular repair (TEVAR) to the arch is a consideration. Methods: Records of patients with aortic arch pathology treated with TEVAR were reviewed. Branch vessels were (1) covered without revascularization, (2) surgically bypassed, (3) stented, or (4) fenestrated. Technical success was defined both by accurate endograft deployment with disease exclusion and by target vessel revascularization. Patient postoperative outcomes, complications, and follow-up are reported. Results: Between March 2006 and January 2010, 58 patients with arch pathology were treated with TEVAR. Indications included aneurysm (n = 19, 32.8%), dissection (type A: n = 3, 5.2%; type B: n = 18, 31.0%), transection (n = 8, 13.8%), pseudoaneurysm (n = 6, 10.3%), or other (n = 4, 6.9%). Pathology was zone 0 (n = 1, 1.7%), zone 1 (n = 10, 17.2%), zone 2 (n = 45, 77.6%), or zone 3 (n = 2, 3.4%). Interventions were emergent in 44.8% and elective in 55.2%. The left subclavian (LSA) was covered in all and revascularized (n = 23, 39.7%) via bypass (n = 13, 22.4%), stenting (n = 4, 6.9%), or fenestration (n = 6, 10.3%). The carotid was revascularized (n = 11, 19.0%) with bypass (n = 7, 12.1%) or stenting (n = 4, 6.9%). One patient (1.7%) underwent innominate revascularization with a homemade branched endograft. Technical success was 100% for endograft deployment and 97.1% for revascularization. Thirty-day mortality was 3.4% (2 of 58). ICU and hospital stays were 5.8 ± 6.8 (range: 0-34; median 4) and 10.9 ± 8.0 (range: 1-40; median: 9) days, respectively. Morbidities included renal failure (n = 3, 5.2%), respiratory (n = 2, 3.4%), myocardial infarction (n = 1, 1.7%), stroke (n = 6, 10.3%), and spinal cord ischemia (SCI) (n = 2, 3.4%). SCI (p < 0.001), but not stroke (p = 0.33), was associated with LSA sacrifice. Stroke was associated with underlying pathology and graft selection (p = 0.01). During follow-up of 10.6 ± 9.1 (range: 0-43) months, 17 patients (29.3%) required 20 reinterventions for endoleak (n = 8, 13.8%), disease extension (n = 5, 8.6%), steal (n = 4, 6.9%), or other reasons (n = 3, 5.2%). Dissection patients had a higher rate of reintervention (p = 0.01). All patients with steal had LSA sacrifice and were left-hand dominant. Conclusions: TEVAR can effectively treat aortic arch pathology in high-risk patients with low morbidity and mortality. TEVAR and branch vessel revascularization techniques may be extended to the more proximal arch without increased complications compared with patients with subclavian only involvement. Stroke remains the most significant drawback of arch interventions. Indications for intervention, graft selection, and revascularization choices may all affect outcome. LSA sacrifice is associated with increased SCI and may predispose left-handed patients to symptomatic weakness. © Annals of Vascular Surgery Inc.
Visceral artery aneurysms, an experience on 32 cases in a single center: Treatment from surgery to multilayer stentEmanuele Ferrero | Michelangelo Ferri | Andrea Viazzo | Alessandro Robaldo | Paolo Carbonatto | Alberto Pecchio | Andrea Chiecchio | Franco Nessi
Volume 25, Issue 7, October 2011, Pages 923-935
Between 2000 and 2010, 32 patients (17 males; mean age: 64.7 [range: 18-85] years) with visceral artery aneurysms (VAAs) were treated in our center. The site of aneurysmal disease was: splenic artery (18), hepatic artery (5), superior mesenteric artery (3), pancreaticoduodenal artery (3), celiac axis (2), and gastroduodenal (1). Six patients (18.75%) presented with an aneurysm rupture. Nine cases received an endovascular treatment. Primary technical success was achieved in six patients. Failures included one case of immediate stent occlusion, one stent migration, and one failed attempt of embolization. In 24 cases, the surgical treatment was performed successfully. The total survival rate was 90.6% (in urgency: 75%; in election: 95.8%). A follow-up period of 34.7 months (range: 2-117 months) showed good results. Because of the potential risk of rupture, VAAs should be treated. A new endovascular technology based on a multilayer stent could provide us with a new alternative to VAA treatment, guaranteeing both aneurysmatic sac thrombosis and the correct perfusion of the organs. However, this new technology is not suitable for all aneurysms and requires a specific training and learning curve. In subjects with a low surgical risk, surgery guarantees a definitive and long-lasting repair with a good organ perfusion. © 2011 Annals of Vascular Surgery Inc.
Interleukin-6: A potential target for post-thrombotic syndromeBrandon M. Wojcik | Shirley K. Wrobleski | Angela E. Hawley | Thomas W. Wakefield | Daniel D. Myers | Jose A. Diaz
Volume 25, Issue 2, February 2011, Pages 229-239
Background: Deep vein thrombosis (DVT) and its associated sequelae, post-thrombotic syndrome (PTS), are significant health care problems in the United States. It is estimated that a maximum of 60% of patients diagnosed with DVT develop PTS, which is characterized by extensive perivenous and mural fibrosis. Interleukin-6 (IL-6) has been linked to fibrosis, and high circulating plasma levels have been found to increase the risk of developing DVT. The aim of this study was to elucidate the role of IL-6 in the progression of vein wall fibrosis by using a mouse model of DVT. Methods and Results: C57BL/6 mice (n = 136) were treated with either anti-IL-6 monoclonal antibody or control rat-immunoglobulin G. Thrombus was induced by using an inferior vena cava ligation model. The inferior vena cava and thrombus were harvested at days 2, 6, or 14 for thrombus weight, gene expression of IL-6 and/or C-C motif chemokine ligand 2 (CCL2), inflammatory cell recruitment, and morphometric analysis of vein wall fibrosis. Mice treated with anti-IL-6 had smaller thrombus weights at day 2, decreased vein wall gene expression and protein concentration of CCL2 at day 2, and impaired vein wall influx of monocytes from days 2 to 6, as compared with controls. Intimal thickness was reduced by 44% (p < 0.05) and vein wall collagen deposition was decreased by 30% at day 14 in the anti-IL-6 group (p < 0.05). Conclusions: Neutralizing IL-6 throughout venous thrombogenesis decreased the production of CCL2, reduced monocyte recruitment, and decreased vein wall intimal thickness and fibrosis. These results suggest that IL-6 may serve as a therapeutic target to prevent the fibrotic complications seen in PTS. © Annals of Vascular Surgery Inc.
A genetic study of chronic venous insufficiencyRaffaele Serra | Gianluca Buffone | Andrea De Franciscis | Diego Mastrangelo | Vincenzo Molinari | Rossella Montemurro | Stefano De Franciscis
Volume 26, Issue 5, July 2012, Pages 636-642
Background: Chronic venous insufficiency (CVI) is an important cause of morbidity in Western countries. The aim of this study is to demonstrate the heredity of CVI, focusing on molecular and genetic aspects of the disease. Methods: The study depended on the recruitment of informative families, accurate determination of the phenotype of each family member, and blood sample for DNA extraction for genetic analysis. Each family member was invited to attend a vascular consultation. A genealogical tree for each recruited family was composed. Then, a peripheral blood sample for DNA extraction from each member of the recruited families was obtained for genetic evaluation. Results: By the evaluation of genealogical trees, it was evident that CVI segregates, in all families studied, in an autosomal dominant mode with incomplete penetrance. In nine families studied, varicose veins were linked to the candidate marker D16S520 on chromosome 16q24, which may account for the linkage to FOXC2. Conclusion: In our study, in families with affected patients with the D16S520 marker, there was evidence of saphenofemoral junction reflux. The fact that there is linkage to a candidate marker for the FOXC2 gene suggests there is a functional variant within, or in the vicinity of, which predisposes to varicose veins. Further studies are necessary to identify genes and mechanism so as to achieve better understanding of the genetic basis of CVI. © Annals of Vascular Surgery Inc.
The ankle-brachial index and the diabetic foot: A troublesome marriageDimitri Aerden | Dany Massaad | Karl Von Kemp | Franciscus Van Tussenbroek | Erik Debing | Bart Keymeulen | Pierre Van Den Brande
Volume 25, Issue 6, August 2011, Pages 770-777
Background: The ankle-brachial index (ABI) is a simple, noninvasive, widely used test that detects peripheral arterial disease (PAD). In patients with diabetes, the ABI is notoriously unreliable and this is usually attributed to medial calcinosis, which stiffens the arteries and renders them poorly compressible. However, the distribution of atherosclerotic lesions in those with diabetes is different as well: lesions predominantly reside in below-the-knee (BTK) arteries. To what extent this contributes to the unreliability of the ABI is unknown. The aims of this study were (1) to confirm the notion that the ABI poorly predicts PAD in the diabetic foot, (2) to determine whether arterial calcifications can be blamed, and (3) to establish the role of the distribution of atherosclerotic lesions. Methods: We studied 187 lower extremities with a diabetic foot that had an intra-arterial angiography and an ABI. The extent of atherosclerosis on angiography was rated by scoring all arterial segments from the aorta to the foot conforming to the Joint Vascular Societies reporting standard. Arterial calcification was assessed using a 4-level severity scale based on the number and length of calcified arterial segments as seen on plain X-ray. The ABI was calculated using four arterial pressures (two brachial, dorsal pedal, and tibial posterior arteries). To prove that the standard ABI is ill-designed to detect atherosclerosis located in BTK arteries, we postulated that an ABI that incorporated more information about these arteries would correlate better with angiographic atherosclerotic disease. To this end, we compared the standard ABI (which only uses the highest distal pressure available and neglects the pressure in other BTK arteries) with two alternatively calculated ABIs: one using the lowest pressure as numerator, and one with the average of both pressures while assuming a pressure of 0 for arteries that were not found by Doppler. Results: The ABI could be determined in 123 cases (65.7%), mean ABI was 0.92. Analysis of the angiographies showed that atherosclerotic lesions had a high predilection for BTK arteries. The correlation between ABI and angiographic PAD was weak (Pearson correlation coefficient r = -0.487). Arterial calcification was absent in 36.9%, and considered to be light (5.4%), moderate (17.1%), or heavy (40.6%). Patients with moderate or heavy calcifications were grouped together and considered to have calcified arteries. These individuals had a lower ABI (p < 0.013), more advanced atherosclerotic disease (p < 0.001), and a higher interbrachial pressure differential (p < 0.017). Of all the ABIs tested, the one that used both distal pressures correlated best (r = -0.554) with atherosclerotic disease. Irrespective of how the ABI was calculated, patients without calcifications consistently had a better correlation with atherosclerotic disease than those with calcified arteries. Conclusion: The ABI underestimated angiographic atherosclerotic disease in this population of patients that we thought had PAD causing tissue loss. Calcifications were frequently present and indeed can be partly blamed for the unreliability of the ABI, but the distribution of atherosclerotic disease can be held responsible as well: the ABI is hampered by design because it is meant to detect a drop in pressure caused by the additive effect of serially located lesions in the arterial tree. In the diabetic foot, where lesions tend to be situated in BTK arteries (which lie parallel to each other), the pressure measured in one distal artery is less representative of atherosclerotic disease in the lower extremity. © Annals of Vascular Surgery Inc.
The nutcracker syndromeSridhar Venkatachalam | Kelly Bumpus | Samir R. Kapadia | Bruce Gray | Sean Lyden | Mehdi H. Shishehbor
Volume 25, Issue 8, November 2011, Pages 1154-1164
Left renal vein (LRV) compression, commonly referred to as the nutcracker syndrome or renal vein entrapment syndrome, is a rare and often overlooked condition. Anatomically, the LRV traverses the space between the superior mesenteric artery and the aorta in close proximity to the origin of the artery. In affected individuals, the LRV is subjected to compression between these two structures, resulting in renal venous hypertension. A review of published data on this condition reveals either case reports or small case series. The classic symptoms of nutcracker syndrome include left flank pain with gross or microscopic hematuria. Patients are often children or young adults, with a slight predisposition for women who may also present with pelvic congestion symptoms such as pelvic pain and dyspareunia. Most patients have disease symptoms for many years and nondiagnostic investigations before proper diagnosis can be made. Appropriate diagnostic work-up and treatment may help alleviate patient morbidity from this chronic condition. Although surgical repair has been the standard of care, more recently endovascular intervention has become the first line of therapy. This tabular review compiles published cases in the adult population during the period between 1980 and 2009. © 2011 Annals of Vascular Surgery Inc.
Incidence and characteristics of venous thromboembolic disease during pregnancy and the postnatal period: A contemporary seriesDavid J. O'Connor | Larry A. Scher | Nicholas J. Gargiulo | Jinsuk Jang | William D. Suggs | Evan C. Lipsitz
Volume 25, Issue 1, January 2011, Pages 9-14
Background: To evaluate the incidence and characteristics of venous thromboembolic events (VTE) associated with pregnancy in a contemporary patient series. Methods: We performed a retrospective review of 33,311 deliveries between June 2003 and June 2008. Patients with objective documentation of a VTE during pregnancy or the 3-month postnatal period were identified from hospital discharge International Classification of Disease Codes edition 9 codes. Diagnosis of deep venous thrombosis (DVT) was largely made by a Duplex ultrasound, whereas pulmonary embolism (PE) was diagnosed by a computerized tomographic angiography (CTA). Results: Of 33,311 deliveries during the study period, 74 patients (0.22%) had a VTE. There were 40 incidents of DVT (0.12%) and 37 of PE (0.11%). DVT involved the iliac veins (6), the femoral or popliteal veins (16), the infrapopliteal veins (17), and the axillary vein (1). Most (57.5%) of the DVTs involved the left lower extremity. Thirty-eight (51.6%) of the VTEs occurred in the postnatal period, and of those 33 (87%) occurred within 1 week of delivery. Most of the postnatal VTEs (68%) were seen in patients who underwent a cesarean section. Among patients with VTE during pregnancy, there were 28% in the first trimester, 25% in the second, and 47% in the third. Events were distributed among maternal age groups as follows: 26% aged 13-24, 50% aged 25-34, and 24% aged 35-54. Of the 35 patients tested for a hypercoagulable disorder, 12 were found to have a positive test result. Five (6.8%) of these 74 patients had a prior history of VTE, with two having a hypercoagulable disorder. In addition, 45 of the 74 patients were on oral contraceptive therapy or received hormonal stimulation therapy before pregnancy. Patients with a VTE during pregnancy were treated with low molecular weight or unfractionated heparin. Most postnatal patients were treated with subcutaneous low molecular weight heparin and coumadin. Six inferior vena cava filters were placed in patients with bleeding complications as a result of anticoagulation. There were no deaths during the study period. Conclusions: Comparing our results with historic controls (DVT: 0.04-0.14% and PE: 0.003-0.04%), the incidence of DVT in pregnancy has not changed significantly. We note, however, that the incidence of pulmonary embolus in our series is higher than previously reported. CTA has been used for the diagnosis of PE since the past decade. The increase in the rate of PE in the current series may be because of the higher sensitivity of CTA when compared with previous diagnostic modalities. © Annals of Vascular Surgery Inc.
Comparison of early and midterm results of open and endovascular treatment of popliteal artery aneurysmsRaffaele Pulli | Walter Dorigo | Aaron Fargion | Giovanni Pratesi | Alessandro Alessi Innocenti | Domenico Angiletta | Carlo Pratesi
Volume 26, Issue 6, August 2012, Pages 809-818
Background: Aim of this study was to retrospectively compare perioperative (<30 days) and 2-year results of open and endovascular management of popliteal artery aneurysms (PAAs) in a single-center experience. Methods: From January 2005 to December 2010, 64 PAAs in 59 consecutive patients were operated on at our institution; in 43 cases, open repair was performed (group 1), whereas the remaining 21 cases had an endovascular procedure (group 2). Data from all the interventions were prospectively collected in a dedicated database, which included main preoperative, intraoperative, and postoperative parameters. Early results in terms of mortality, graft thrombosis, and amputation rates were analyzed and compared by χ2 text or Fisher exact text. The surveillance program consisted of clinical and ultrasonographic examinations at 1, 6, and 12 months and yearly thereafter. Follow-up results (survival, primary and secondary patency, limb salvage) were analyzed by Kaplan-Meier curves, and differences in the two groups were assessed by log-rank test. Results: There were no differences between the two groups in terms of sex, age, risk factors for atherosclerosis, and comorbidities; PAAs were symptomatic in 48% of cases in group 1 and in 29% in group 2 (P = 0.1). Fifteen patients with mild-to-moderate acute ischemia due to PAA thrombosis underwent preoperative intra-arterial thrombolysis, 13 in group 1 and 2 in group 2. In open surgery group, nine cases were treated with aneurysmectomy and prosthetic graft interposition, and in seven cases, the aneurysm was opened and a prosthetic graft was placed inside the aneurysm. In 27 cases, ligation of the aneurysm with bypass grafting (21 prosthetic grafts and 6 autologous veins) was carried out. In group 2, 20 patients had endoprosthesis placement, whereas in the remaining patient, a multilayer nitinol stent was used. There was one perioperative death in a patient of group 2 who underwent concomitant endovascular aneurysm repair and PAA endografting. Cumulative 30-day death and amputation rate was 4.5% in group 1 and 4.7% in group 2 (P = 0.9). Follow-up was available in 61 interventions (96%) with a mean follow-up period of 22.5 months (range: 1-60). Estimated primary patency rates at 24 months were 78.1% in group 1 and 59.4% in group 2 (P = 0.1). Freedom from reintervention rates at 24 months were 79% in group 1 and 61.5% in group 2 (P = 0.2); estimated 24-month secondary patency rates were 81.6% in group 1 and 78.4% in group 2 (P = 0.9), and freedom from amputation rates were 92.7% and 95%, respectively (P = 0.7). Conclusions: Endovascular treatment of PAAs provided, in our initial experience, satisfactory perioperative and 1-year results, not significantly different from those obtained with prosthetic open repair in patients with similar clinical and anatomical status. There is, however, a trend toward poorer primary patency rates among patients endovascularly treated, who also seem to require more frequently a reintervention. © 2012 Annals of Vascular Surgery Inc.
Laser saphenous ablations in more than 1,000 limbs with long-term duplex examination follow-upGiorgio Spreafico | Lowell Kabnick | Todd L. Berland | Neal S. Cayne | Tom S. Maldonado | Glenn S. Jacobowitz | Caron R. Rockman | Pat J. Lamparello | Ugo Baccaglini | Nung Rudarakanchana | Mark A. Adelman
Volume 25, Issue 1, January 2011, Pages 71-78
Background: The goal of this study was to evaluate the duplex results of endovenous laser ablation in the treatment of incompetent great saphenous veins (GSV) and small saphenous veins (SSV) with at least 1-year follow-up. Methods: A retrospective registry was entered by 11 centers from Europe and America, organized by the International Endovenous Laser Working Group. Data concerning 1,020 limbs in patients with incompetence of the GSV and/or SSV, treated with the Endovenous Laser Ablation (EVLA) procedure, were collected. EVLA failures were defined on duplex imaging as reflux confined to the saphenofemoral or saphenopopliteal junction, reflux confined to the main saphenous trunk, or reflux of both junction and main trunk (totally patent saphenous vein) were analyzed at one or more years postoperatively. Results: The mean age of patients was 54 ± 5 years (range: 18-91 years). The average body mass index was 25. There was a paucity of severe complications: One case of third-degree skin burn, six patients with postsurgical deep vein thrombosis (0.6%), and 27 cases of sensory nerve damage (2.7%). At 1-year, the rate of complete occlusion of the saphenous trunk was 93.1%. There were 79 cases of treatment failures as evidenced by duplex: 22 isolated junction failures (2.2%), 44 isolated trunk failures (4.4%), and 13 totally patent veins (1.3%). Two-year duplex results were reported for 329 limbs with the identification of 19 new cases of failure. No new cases of failure were reported at 3-year follow-up of 130 limbs. Cumulative failure rates estimated by Kaplan-Meier analysis were 7.7% at 1-year and 13.1% at 2- and 3-year follow-up. Conclusions: On the basis of a duplex scan performed at least 1-year post-treatment, this multicenter registry confirms the safety and efficacy of the EVLA procedure in the treatment of GSV and SSV reflux. Considering the continued failure rate documented in the present study, an annual follow-up by duplex is recommended to 2 years after EVLA. © Annals of Vascular Surgery Inc.
Endovenous laser ablation: A review of mechanisms of actionMarc E. Vuylsteke | Serge R. Mordon
Volume 26, Issue 3, April 2012, Pages 424-433
Background: The aim of this article is to summarize and review the proposed theories on the laser action during endovenous ablation. Methods: Laser mechanics and laser-tissue interaction are summarized from articles found in literature. Several theories, like the "steam bubble theory," the "direct contact theory," the "heat pipe," and "direct light energy absorption" are discussed. Results: The laser light emitted intraluminally can be absorbed, scattered, or reflected. Reflection is negligible in the near-infrared spectrum. By combining absorption and scattering, the optical extinction of different wavelengths related to different biological tissues can be determined. The direct contact of the fiber tip and the vein wall may be a way of destroying the vein wall, but results in ulcerations and perforations of the vein wall. Avoiding this contact, and allowing direct light absorption into the vein wall, results in a more homogenous vein wall destruction. If the energy is mainly absorbed by the intraluminal blood, the laser fiber will act as a heat pipe. Histological studies show that a more circumferential vein wall destruction can be obtained when the vein is emptied of its intraluminal blood. The use of tumescent liquid reinforces spasm of the vein and protects the perivenous tissue. Conclusion: Several factors play an important role in the mechanism of endovenous laser ablation. Direct energy absorption by the vein wall is the most efficient mechanism. It is important to empty the vein of its intraluminal blood and to inject tumescent liquid around the vein. © 2011 Annals of Vascular Surgery Inc.
Updated systematic review and meta-analysis of randomized clinical trials comparing carotid artery stenting and carotid endarterectomy in the treatment of carotid stenosisZhen Jie Liu | Wei Guo Fu | Zhen Ying Guo | Lai Gen Shen | Zhen Yu Shi | Jia Hui Li
Volume 26, Issue 4, May 2012, Pages 576-590
Background: To compare carotid artery stenting (CAS) versus carotid endarterectomy (CEA) in the treatment of carotid stenosis, including two recently published, large, prospective, randomized trials of these therapies. Methods: We searched electronic databases for prospective, randomized, controlled trials involving carotid stenosis patients who underwent CAS or CEA, focusing on studies published in 1995 to 2010. Primary outcomes were death, stroke, and myocardial infarction. Results: Thirteen trials containing 7,501 patients were analyzed, and odds ratios (ORs) were calculated for CAS versus CEA. The risk of stroke or death within 30 days was higher after CAS than CEA (OR = 1.57; 95% confidence interval [CI] = 1.11-2.22), especially in previously symptomatic patients (OR = 1.89; 95% CI = 1.48-2.41). However, the risk of stroke or death within 1 year was comparable (OR = 1.12; 95% CI = 0.55-2.30). In a subgroup analysis, the risk of death and disabling stroke at 30 days did not differ significantly between CEA and CAS (death: OR = 1.43; 95% CI = 0.85-2.40; disabling stroke: OR = 1.28; 95% CI = 0.89-1.83), whereas the rate of nondisabling stroke within 30 days was much higher in the CAS group (OR = 1.87; 95% CI = 1.40-2.50). The risks of myocardial infarction within 30 days and 1 year were significantly less for CAS. Conclusion: CAS is inferior to CEA with regard to the incidence of stroke or death for periprocedural outcomes, especially in symptomatic patients. However, CAS was associated with a lower incidence of myocardial infarction. These procedures may be considered complementary rather than competing modes of therapy, each of which can be optimized with careful patient selection. © Annals of Vascular Surgery Inc.
Skin grafting followed by low-molecular-weight heparin long-term therapy in chronic venous leg ulcersRaffaele Serra | Gianluca Buffone | Andrea De Franciscis | Diego Mastrangelo | Tiziana Vitagliano | Manfredi Greco | Stefano De Franciscis
Volume 26, Issue 2, February 2012, Pages 190-197
Background: Venous leg ulcers are responsible for more than half of lower extremity ulcerations, with an overall prevalence ranging from 0.06 to 2% in the general population. Methods: A total number of 120 patients with chronic venous leg ulcers (CEAP C6), secondary to primary chronic venous insufficiency, were recruited (81 F, 39 M, age range: 50-79, mean age: 64.6). All patients enrolled in this study had wounds that had failed to heal for more than 2 months and were refractory to conventional medical and physical therapy. Sixty patients (group A) underwent skin grafting followed by low-molecular-weight heparin long-term therapy. Sixty patients (group B) underwent skin grafting as sole procedure. The follow-up was of 5 years. Results: At hospital discharge, all patients had healed ulcers. In group A, at 5 years, about 90% of the ulcers remained healed. In group B, at 5 years, about 56% of the ulcers remained healed. Conclusions: In our experience, long-term treatment with low-molecular-weight heparin seems to have improved early and late results of patients, who underwent reconstructive surgery for chronic venous ulcer; 90% of the ulcers remained healed at 5 years of follow-up. Probably, extracellular matrix-modulating treatments, such as heparin administration, may complete the management strategy for difficult-to-heal or chronic wounds. © 2011 Annals of Vascular Surgery Inc.
Simplified frailty index to predict adverse outcomes and mortality in vascular surgery patientsJoseph Karam | Athanasios Tsiouris | Alexander Shepard | Vic Velanovich | Ilan Rubinfeld
Volume 27, Issue 7, May 2013, Pages 904-908
Background Frailty has been established as an important predictor of health-care outcomes.We hypothesized that the use of a modified frailty index would be a predictor of mortality and adverse occurrences in vascular surgery patients. Methods: Under the data use agreement of the American College of Surgeons, and with institutional review board (IRB) approval, the National Surgical Quality Improvement Program (NSQIP) Participant Utilization File was accessed for the years 2005-2008 for inpatient vascular surgery patients. Using the Canadian Study of Health and Aging Frailty Index (FI), 11 variables were matched to the NSQIP database. An increase in FI implies increased frailty. The out comes-assessed were mortality, wound infection, and any occurrence. We then compared the effect of FI, age, functional status, relative value units (RVU), American Society of Anesthesiology (ASA) score, and wound status on mortality. Statistical analysis was done using chi-square analysis and stepwise logistic regression. Results: A total of 67,308 patients were identified in the database, 3913 wound occurrences, 6691 infections, 12,847 occurrences of all kinds, and 2800 deaths. As the FI increased, postoperative wound infection, all occurrences, and mortality increased (P < 0.001). Stepwise logistic regression using the FI with the NSQIP variables of age, work RVU, ASA class, wound classification, emergency status, and functional status showed FI to have the highest odds ratio OR) for mortality (OR = 2.058, P < 0.001).Conclusions: A simplified FI can be obtained by easily identifiable patient characteristics, allowing for accurate prediction of postoperative morbidity and mortality in the vascular surgery population. © 2013 Elsevier Inc. All rights reserved.
Altered metalloproteinase-9 expression as least common denominator between varicocele, inguinal hernia, and chronic venous disordersRaffaele Serra | Gianluca Buffone | Giuseppe Costanzo | Rossella Montemurro | Edoardo Scarcello | Domenico Marco Stillitano | Rocco Damiano | Stefano De Franciscis
Volume 28, Issue 3, January 2014, Pages 705-709
Background: Varicocele, inguinal hernia, and clinical manifestations related to chronic venous disorders are often associated, and collagen metabolism together with metalloproteinases (MMPs) alterations may be implicated. The aim of this study was to analyze the relationship between these factors. Methods: We evaluated tissue and plasma samples from patients with varicocele, inguinal hernia, and great saphenous vein reflux, who underwent surgical treatment for their conditions. We then analyzed and correlated these findings with MMP levels. Results: Significantly higher levels of MMP-1, -2, -12, and -13 were found in patients with inguinal hernia. MMP-9 levels were higher in patients with at least two of the conditions indicated. Conclusion: MMP-9 seems to be the common thread in various clinical conditions and is related to a more general and progressive disorder of collagen metabolism. © 2014 Elsevier Inc. All rights reserved.
The use of oxybutynin for treating axillary hyperhidrosisNelson Wolosker | José Ribas Milanez De Campos | Paulo Kauffman | Samantha Neves | Marco Antonio Munia | Fábio Bisceglijatene | Pedro Puech-Leão
Volume 25, Issue 8, November 2011, Pages 1057-1062
Background: To evaluate the effectiveness and patient satisfaction with the use of oxybutynin for treating axillary hyperhidrosis in a large series of patients. Methods: One hundred two patients with axillary hyperhidrosis were treated with oxybutynin. During the first week, patients received 2.5 mg of oxybutynin once a day in the evening. From the 8th to the 42nd day, they received 2.5 mg twice a day, and from the 43rd day to the end of the 12th week, they received 5 mg twice a day. All of the patients underwent two evaluations: before and after (12 weeks) the oxybutynin treatment, using a clinical questionnaire; and a clinical protocol for quality of life (QOL). Results: More than 80% of the patients experienced an improvement in axillary hyperhidrosis; 36.3% of them presented a great improvement, and half of the patients showed improvements at all hyperhidrosis sites. Most of the patients showed improvements in the QOL (67.5%). The patients with very poor QOL before the treatment presented greater satisfaction levels after treatment. The side effects were minor, dry mouth being the most frequent (73.5%). Conclusions: Oxybutynin is a good alternative to sympathectomy. It presents good results and improves QOL without the side effects of sympathectomy. © 2011 Annals of Vascular Surgery Inc.
Surgical management of hemodialysis-related central venous occlusive disease: A treatment algorithmJavier E. Anaya-Ayala | Patricia H. Bellows | Nyla Ismail | Zulfiqar F. Cheema | Joseph J. Naoum | Jean Bismuth | Alan B. Lumsden | Michael J. Reardon | Mark G. Davies | Eric K. Peden
Volume 25, Issue 1, January 2011, Pages 108-119
Background: Creation and preservation of dialysis access in patients with central venous occlusive disease (CVOD) is a complex problem. The surgical approach and decision-making process remains poorly defined. We evaluated our experience in the surgical management of hemodialysis-related CVOD. Surgical technique, demographics, complications, reinterventions, access function rates, and factors influencing morbidity and mortality were examined. Methods: From January 2006 to May 2010, we performed a total of 1,703 dialysis access-related procedures, 1,021 arteriovenous fistulas (AVFs), 335 arteriovenous grafts (AVGs), and 314 access revisions including endovascular salvage procedures. Seventeen patients (10 women [58%] with a mean age of 44 ± 27 years) with CVOD who were not suitable for peritoneal dialysis or kidney transplant underwent 20 complex vascular access procedures. The indications were need for access creation in 14 cases (70%) and preservation in the remaining 6 (30%). Polytetrafluoroethylene (PTFE) was used for all surgical bypass grafts (BPG). All patients had previously undergone multiple access surgeries and had failed percutaneous interventions for CVOD. Results: The surgical planning centered on finding venous outflow for an arteriovenous (AV) access; central venous reconstructions were necessary in 10 (50%) cases (seven [35%] in the thoracic central venous system and three [15%] in infradiaphragmatic vessels) and extracavitary venous BPG in two (10%) cases. Non-venous access options included axillary arterial-arterial chest wall BPG in five (25%) cases and brachial artery to right atrium BPG in three (15%). Technical success was achieved in all cases (100%). Mean follow-up was 14.1 months, both BPG and AV access patency rates were 66% at 6 months and overall average AV access function time was 9.2 months. Of these, 85% of patients were discharged home and following 19 (95%) cases they returned or improved their baseline functional status. One death occurred from multiorgan failure during the 30-day postoperative period. Four additional patients died within 3 years of the procedure secondary to nonsurgical-related comorbidities. Conclusion: The need for complex vascular accesses will continue as the number of patients with end-stage renal disease increases. CVOD is an access surgical challenge and with this article we propose a decision-making algorithm. © Annals of Vascular Surgery Inc.
The significance of endoleaks in thoracic endovascular aneurysm repairJean Marc Alsac | Ilya Khantalin | Pierre Julia | Paul Achouh | Patrick Farahmand | Clément Capdevila | Khaled O. Isselmou | Jean Noël Fabiani
Volume 25, Issue 3, April 2011, Pages 345-351
Background: Endoleak is one of the rare complications that occur after thoracic endovascular aneurysm repair (TEVAR). The aim of this study was to assess the incidence of endoleaks and the predictive factors for their occurrence, as well as their effect on secondary interventions after TEVAR. Methods: Medical and radiological data of all TEVAR procedures performed between 2004 and 2008 were entered prospectively into our database and reviewed retrospectively. Primary endpoints included were the incidence and the type of endoleak, aneurysmal sac expansion, and secondary interventions. Results: In all, 67 patients (18 women and 49 men; mean age, 67 ± 14 years) were treated consecutively for descending thoracic aortic aneurysms (mean diameter: 69 ± 18 mm) by TEVAR during the observed period, using 83 stent-grafts (11 Cook TX2, 31 Gore TAG, and 41 Medtronic Valiant), with a median follow-up of 27 months (range: 2-64). In 13 of 67 patients, 14 (19.4%) endoleaks were diagnosed, of which 71% (10 of 14) were type I, 29% (4 of 14) were type II, and none were type III. Ten endoleaks (71%) were diagnosed on the first postoperative computed tomographic angiography at 1 month, and the other four (29%) developed later on. Predictive factors for endoleaks on univariate analysis included age (p = 0.04), length of the proximal neck immediately after the left subclavian artery (p = 0.04), the fusiform morphology of the descending thoracic aortic aneurysms (p = 0.04), and the type of stent-graft used (p = 0.02). Eight of the 10 type I endoleaks (80%) were successfully treated by endovascular means, using proximal cuffs (n = 5) or distal extensions (n = 3). None of type II endoleaks were treated by secondary intervention. The six endoleaks treated conservatively were all associated with a significant mean increase of their aneurysmal sac (+3.2 ± 2.6 mm) during follow-up. No secondary conversion to open surgery was performed to treat an endoleak. Conclusions: On the basis of the study, it seems as if endoleaks are detected in one of the five patients treated with TEVAR during follow-up period, particularly if they are old with a proximal and fusiform aneurysm. Short- and mid-term follow-up suggest that most type I endoleaks can successfully be treated by endovascular techniques and that type II endoleaks treated conservatively require a close radiological monitoring. © Annals of Vascular Surgery Inc.
Emerging national trends in the management and outcomes of lower extremity peripheral arterial diseaseMichael S. Hong | Adam W. Beck | Peter R. Nelson
Volume 25, Issue 1, January 2011, Pages 44-54
Background: In this study, we sought to analyze emerging national trends in the treatment of lower extremity peripheral arterial disease and associated outcomes. Methods: The Nationwide Inpatient Sample was queried between 2001 and 2007. Patients diagnosed with lower extremity atherosclerosis were selected by using the International Classification of Diseases, 9th Revision codes 440.20-440.24, resulting in an average of 307,000 annual hospitalizations. Within this group, we determined the annual number of lower extremity bypasses, endovascular interventions, and major and/or minor amputations (below-the- and/or above-the-knee amputation versus toe and/or foot amputation). Chi-square analysis was performed on discharge-weighted data to compare two periods (2001-2003 and 2004-2007) to determine changes in management and differences in outcome. Multivariate logistic regression was used to identify predictors of amputation. Results: Comparing the two periods, it was found that the average annual number of endovascular interventions increased by 78% (37,692 vs. 67,248, p < 0.001), and open lower extremity bypasses decreased by 20% (68,326 vs. 54,348, p < 0.001). Annually, the total number of interventions increased by 15% (106,018 vs. 121,596, p < 0.001), whereas the number of total amputations (59,693 vs. 50,254, p < 0.001), major amputations (39,543 vs. 31,043, p < 0.001), and minor amputations (20,150 vs. 19,211, p < 0.001) performed all significantly decreased. Diabetes was the leading predictor of amputation, especially those involving the toe and forefoot. After adjusting for age and comorbidities, African Americans were found to have a 2.4 times odds of amputation as compared with Caucasians, whereas those with Medicare or Medicaid had a 1.5 times odds as compared with those having private insurance or Health Maintenance Organization. Conclusions: Between the periods examined, we observed that the treatment of lower extremity peripheral arterial disease has evolved with increased use of lesser invasive endovascular techniques and fewer open lower extremity bypasses. These trends are associated with fewer major lower extremity amputations. Significant socioeconomic disparities persist in amputation rates, with racial minorities and those with Medicare or Medicaid having higher odds of amputation. © Annals of Vascular Surgery Inc.
Buerger's diseasePhong T. Dargon | Gregory J. Landry
Volume 26, Issue 6, August 2012, Pages 871-880
Buerger's disease (thromboangiitis obliterans) is a nonatherosclerotic segmental inflammatory disease of small- and medium-sized arteries of the distal extremities of predominantly young male tobacco users. Early symptoms may include episodic pain and coldness in fingers, and late findings may present as intermittent claudication, skin ulcers, or gangrene requiring eventual amputation. Tobacco cessation is the cornerstone of treatment. Other modalities of reducing pain or avoiding amputation have not been as successful. This review summarizes in tabular form the types of treatment that have been used, including therapeutic angiogenesis. © 2012 Annals of Vascular Surgery Inc.
Risk factors associated with the diagnosis of abdominal aortic aneurysm in patients screened at a regional veterans affairs health care systemKevin C. Chun | Kai Y. Teng | Leann A. Chavez | Elyse N. Van Spyk | Kiana M. Samadzadeh | John G. Carson | Eugene S. Lee
Volume 28, Issue 1, January 2014, Pages 87-92
Background An active abdominal aortic aneurysm (AAA) screening program at a regional Veterans Affairs (VA) health system identifies patients at risk for AAA. The purpose of this study is to evaluate unique risk factors associated with the AAA diagnosis upon AAA screening examination to identify the most at risk patients for AAA. Methods Data were extracted from a regional VA health care system to identify patients who underwent AAA screening within a 3-year period. An aortic diameter ≥3.0 cm was defined as an AAA. Patient risk factors included age, body mass index, total cholesterol, estimated glomerular filtration rate (eGFR), statin use, and active smoking status; the presence of hypertension, diabetes, coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), or peripheral vascular disease (PVD) was also evaluated. Risk factors were compared in a multivariate analysis between patients with AAA and patients with a normal aorta. Results A total of 6,142 patients (mean ± SD age: 72.7 ± 5.3 years) were screened for AAA between January 2007 and December 2009. A total of 469 patients (7.6%) with AAA were identified. The following risk factors were significantly associated with a diagnosis of AAA: age >75 years (39.6% vs. 28.9%; P < 0.001), prevalence of CAD (43.1% vs. 28.5%; P < 0.001), COPD (26% vs. 11.4%; P < 0.001), PVD (37.3% vs. 7.7%; P < 0.001), eGFR <60 mL/min (36.7% vs. 24.3%; P < 0.001), and current smoking (23.2% vs. 15.3%; P < 0.001). The risk factors significantly associated with normal aortic size were the presence of diabetes (18.6% vs. 27.4%; P < 0.001) and total cholesterol ≥200 mg/dL (10.4% vs. 15%; P = 0.04). Conclusions The diagnosis of AAA in a large screening study is typically identified in patients who are at high risk for cardiovascular disease. The presence of diabetes is a major cardiovascular risk factor that is more associated with normal aorta when compared to patients with the AAA diagnosis. Total cholesterol ≥200 mg/dL was associated with decreased AAA risk, and renal insufficiency was associated with increased AAA risk. © 2014 by Elsevier Inc. All rights reserved.
Chronic venous ulcer: Minimally invasive treatment of superficial axial and perforator vein reflux speeds healing and reduces recurrencePeter B. Alden | Erin M. Lips | Kate P. Zimmerman | Ross F. Garberich | Adnan Z. Rizvi | Alexander S. Tretinyak | Jason Q. Alexander | Kathryn M. Dorr | Mark Hutchinson | Sarah L. Isakson
Volume 27, Issue 1, January 2013, Pages 75-83
Background: Chronic venous ulcer (CVU) is common and is responsible for significant health care expenditures worldwide. Compression is the mainstay of treatment, but long-term compliance with this therapy is often inconsistent, particularly in the elderly and infirm. Surgical ablation of axial and perforator reflux has been used as an adjunct to compression to reduce recurrence rates and assist healing. These surgical techniques are being replaced by minimally invasive procedures, such as thermal ablation and foam sclerotherapy, in the treatment of uncomplicated venous disease. The role for these techniques in the treatment of CVU is just beginning to be defined. Methods: Eighty-six patients with CVU with 95 active ulcers (Clinical, Etiology, Anatomy, Physiology-CEAP clinical class 6) presenting to a multispecialty wound clinic were retrospectively reviewed and analyzed by leg. All patients underwent duplex scanning for venous insufficiency. Ulcer dimensions at each visit were recorded and used to calculate healing rates. Presence or absence of ulcer recurrence at 1-year follow-up was recorded. Ulcers treated with compression alone ("compression group") were compared with those treated with compression and minimally invasive interventions, such as thermal ablation of superficial axial reflux and ultrasound-guided foam sclerotherapy (UGFS) of incompetent perforating veins and varicosities ("intervention group"). Results: The average age in the intervention and compression groups was 67 and 71 years, respectively (P = not significant [NS]). Body mass index was 32.4 ± 9.5 and 33.6 ± 11.8 kg/m2, in the compression and intervention groups, respectively (P = not significant [NS]). Ulcers were recurrent in 42% of the intervention group and 26% of the compression group (P = NS). In the intervention group, 33% had radiofrequency ablation of axial reflux, 31% had UGFS of perforators, and 29% had both treatments. The only complication of intervention was a single case of cellulitis requiring hospitalization. Compared with the compression group, the ulcers in the intervention group healed faster (9.7% vs. 4.2% per week; P = 0.001) and showed fewer recurrences at 1-year follow-up (27.1% vs. 48.9 %; P < 0.015). Multivariate analysis showed use of intervention was the strongest determinant of healing with a coefficient of variation of 7.432, SE 2.406, P = 0.003. Analysis of just the intervention group before and after intervention using matched pairs showed acceleration of healing after intervention from ranging from a median of 1.2% (interquartile range [IQR], 14.3) to 9.7% (IQR, 11.3) per week (P ≤ 0.001). Conclusions: Minimally invasive ablation of superficial axial and perforator vein reflux in patients with active CVU is safe and leads to faster healing and decreased ulcer recurrence when combined with compression alone in the treatment of CVU. © Annals of Vascular Surgery Inc.
The ongoing battle between infrapopliteal angioplasty and bypass surgery for critical limb ischemiaKatja B C Schamp | Robbert Meerwaldt | Michel M P J Reijnen | Robert H. Geelkerken | Clark J. Zeebregts
Volume 26, Issue 8, November 2012, Pages 1145-1153
Background: Critical limb ischemia (CLI) represents the extreme of the peripheral arterial occlusive disease spectrum and is associated with high mortality. Limb salvage often requires infrapopliteal revascularization by either angioplasty or bypass surgery. The past decade has witnessed a paradigm shift in CLI management toward endovascular treatment. This narrative review describes the clinical outcome, treatment strategy, and limitations of both modalities. Method: A literature search was performed of the PubMed and Cochrane databases. All articles, published until September 2011, describing treatment by infrapopliteal arterial revascularization were included. Results: Angioplasty and bypass surgery are both related to a limb salvage rate of approximately 80% at 3-year follow-up. Patency rates appear to be higher after surgery. A reliable comparison of the two modalities, however, is complicated by various confounders, including patient selection, lesion characteristics, and complication rates. Additionally, most studies did not describe the standard use of best medical treatment or outcome for relief of ischemic pain, wound healing, or functional improvement. Conclusion: Infrapopliteal angioplasty and bypass surgery both provide an acceptable limb salvage rate, but patency appears to be better after bypass surgery. Both modalities are likely to be complementary. Additional randomized trials are indicated to provide a treatment algorithm for patients with CLI and infrapopliteal arterial occlusive disease. © Annals of Vascular Surgery Inc.


text:
Atrium Medical Center (Atrium) is committed to meeting the needs of the under-served. The hospital participates in multiple programs that help to improve the quality of life for those in need. Atrium's involvement in partnering with Primary Health Solutions helps to meet the medical needs of the uninsured. Atrium Medical Center Auxiliary members support many vital programs and services at the hospital, and Project SEARCH provides employment training and opportunities to people with significant disabilities. Atrium Medical Center's dedication to serving those in need is reflected in these programs as well as in day-to-day activities at the hospital.
Atrium is proud to provide support to those without insurance or the financial resources to pay for quality medical care. In 2006, the former Mid-Miami Healthcare Foundation - now known as Atrium Medical Center Foundation - contributed $150,000 to help Primary Health Solutions serve the medical needs of the uninsured and vulnerable.
With medical offices in Fairfield, Hamilton, Middletown and Oxford, Primary Health Solutions is a non-profit organization providing primary, dental, vision, behavioral and other health care services regardless of patients' income or insurance status. Many of these patients live below the poverty level. Atrium's commitment to meeting the needs of the under-served helps to provide quality primary health care to everyone who needs it.
Atrium's Auxiliary is a group of generous-spirited hospital volunteers who freely give their time and abilities to help others who are injured or ill. Auxiliary members support the hospital and its programs through special fundraising efforts and active services. There are multiple ongoing services funded by the Auxiliary, such as supplying books for children who come into the emergency department, knitting hats for babies and chemo patients, and providing health career scholarships for high school seniors and college students. In honor of the generosity of the Auxiliary members, the mezzanine-level family waiting area at Atrium Medical Center is named the Atrium Auxiliary Family Lobby. All Atrium Medical Center volunteers are invited to be Auxiliary members.
Atrium firmly believes in providing each person with the necessary tools to succeed. The hospital's Project SEARCH program provides employment and education opportunities for individuals with significant disabilities. The program provides workforce development that benefits the individual, community, and workplace. The hospital's SEARCH Project is administered on-site through Butler Technology and Career Development Schools. Participants are trained in a variety of jobs throughout the hospital, working in each area for 12 weeks at a time for the duration of the school year. This program is an excellent way for the area's under-served residents to receive the training and experience necessary to lead a fulfilling life.
Content Updated: July 12, 2016
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Enermax "Liberty" EL620AWT 620-watt Power Supply
What You Get
After you remove the plastic wrapping and open the box, you'll be greeted with the power supply, a power cord, a manual, mounting screws, a promotional lanyard with the Enermax logo, and a nylon pouch bulging with ... well, we'll get to that in a bit.
The Liberty 620 has a design that we've seen before on Enermax units. It uses a single 120mm fan on the bottom with a simple mesh design exterior panel to get rid of unwanted heat. On this panel you have only a plug for the power cable and an On/Off rocker switch. It lacks the voltage switch between 115v and 230v since this model automatically handles the chore of figuring out which type current you are using. Just a little feature that can keep you from trashing the unit from the beginning by not paying attention to this little switch.
As far as power is concerned, the Liberty model being tested offers up a dual 12v rail like we've seen before. Each of the rails can handle a maximum of 22A of power draw, but both combined max out at 36A. This is still a good deal of power. Many I've seen have a difficult time offering up even 30A of power along the 12v rail. To round out the abilities of this PSU, the 5v rail can handle a draw of 32A and the 3.3v rail can handle 28A.
Like past Enermax power supplies we've seen in the past, the 620 watt rating is what the unit is rated at on a constant basis. This opens up a huge number of windows for your system, regardless if you want dual PCI-E graphics, a water cooler that runs off the PSU, or even a massive number of fans with lighting. The Liberty 620 has what it takes to handle the load you throw at it. In the event you peak out at a higher level somehow, this particular model has a peak load of 680 watts.
A quick look at the business end of the power supply shows a nice modular design. This is a nice feature that is beginning to show prominence since it allows you to keep cable clutter to a minimum. You only attach the cables that are needed for your particular system and leave the others stored away. It sure does make it easier when it comes to wrapping up the extra cabling so you can keep it out of the way of your airflow.
You'll also be able to see that the primary power coupler coming from the back of the unit is protected by a plastic guard that keeps the wiring from rubbing the metal of the housing, possibly causing a short of the system. It is also wrapped to aid in clutter.
As far as the ports, you have more than you do cables, so you have room to grow with your system. It also has the ability to handle two PCI-E devices, but I guess we can cover that when we take a look at the cabling harnesses. Hmmm ... looks like I may have given away what was in that nylon pouch, huh?
Yes, you guessed right, that bulging nylon pouch is for conveniently carrying the modular cabling used for the power supply. Lets get them out of the packaging, though, so we can see what we have to work with.
There certainly are a bunch of these things. To total up the possibilities, we have ten 4-pin Molex, ten SATA, one FDD, and two PCI-E. This is a huge boost when compared to most other power supplies on the market! And remember, if you don't need that many power connections, just leave the extra cabling harnesses in the pouch and store it away. That way it will be handy when you upgrade next.
For those concerned with the main power coupler, fear not. The type connection used on this Liberty model can handle either a 20-pin or 24-pin motherboard with ease. The shot above shows the extra 4 pins that can be removed on the left. This will help this power supply grow with your system.
As a side note, the 4-pin auxiliary power connection is actually a 4+4 design that handles newer technologies hitting the market. The Liberty power supply is compatible with ATX, BTX, CEB and EEB system boards, so you're set for either home or server use.
Finally, I'd like to bring your attention to the Molex connectors used on this PSU. While it may seem simple, that curved plastic tab makes removing the connector from a device an easy task. I can think of a lot of times when I'm trying to remove a Molex and the thing is very difficult to get out. I never want to put too much pressure on it because I can just see myself pulling out the power port from the device I'm working with. This little tab allows you to just squeeze down on the top of the Molex and loosen the connector from the device, making it easier and safer to remove the power. Very nice addition here.
PRICING: You can find products similar to this one for sale below.
United States: Find other tech and computer products like this over at Amazon's website.
United Kingdom: Find other tech and computer products like this over at Amazon UK's website.
Canada: Find other tech and computer products like this over at Amazon Canada's website.
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text:
Linkbuilding for swedish wine onlinestore
This project received 25 bids from talented freelancers with an average bid price of €119 EUR.Get free quotes for a project like this
Skills Required
Project Budget€30 - €250 EUR
Total Bids25
Project Description
We´ve just started our new online store for wine in sweden. The store is onpage search engine optimized. Now we need to generate the first links to the plattform.
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text:
Hindi to multi language subtitle
This project received 16 bids from talented freelancers with an average bid price of ₹6817 INR.Get free quotes for a project like this
Skills Required
Project BudgetN/A
Total Bids16
Project Description
Dear All, We have around 50 movies for subtitling but we need it in multi-language... 1. Hindi-english 2- Hindi-Arabic 3- Hindi-Spanish 4- Hindi-French 5- Hindi-Jerman Please quote on reasonable price...
Looking to make some money?
- Set your budget and the timeframe
- Outline your proposal
- Get paid for your work
Hire Freelancers who also bid on this project
Looking for work?
Work on projects like this and make money from home!Sign Up Now
- Forbes
- The New York Times
- Time
- Wall Street Journal
- Times Online


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Related Publications
- Related by Author
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Related Links
The Jew Within: Self, Family, and Community in America
Jewish Family & Life (JFL Media), May 2001
Topic: Jewish Identification, Publications, Judaic Studies, Survey, Jewish Studies, Scholarship, Academic Research
Name of Publication: Sh'ma: A Journal of Jewish Ideas
Editor: Berrin, Susan
Volume/Issue: Vol.31/no.582
Page Number(s): 16-17
Genre: Book Review
Coverage: United States
Language: English
Copyright Holder: Publisher
Copyright Information: Download for personal use, freely distribute link
Bibliographic Information:
Prell, Riv-Ellen. The Jew Within: Self, Family, and Community in America. Sh'ma: A Journal of Jewish Ideas. Jewish Family & Life (JFL Media). May 2001: 16-17. http://www.bjpa.org/Publications/details.cfm?PublicationID=8655
» View Publication
(PDF, 264 Kb)


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2000 Chevrolet Monte Carlo SS 2dr Coupe
I'm 19 now bought this car after my '89 cutless rusted out. I saw this car at the dealership (in mid 2011) it caught my eye right away so I took for a test drive, liked it, bought it, took it home that same day. I've had it for almost a year right now and I have to say it's a very reliable car to have except the tranny is slipping at 188,000 miles, my driver side seat heater went out, had to replace the front right bearing, and the control arm. When I bought it it still had the original fuel pump so i had to replace that as well. It has great pick up for how heavy and big the car is which is pretty surprising, while getting good gas mileage about 22 city and 28 hwy.
Leather interior, very sporty look and feel, great handling and performance, great space and leg room in the rear, big trunk space for my sports equipment and golf clubs, or for groceries
I first bought the car and was excited because not too many of them were around. It had a few problems at first covered under my warranty, fuel filter leaked, needed a rear strut. It shifted great at first and now at around 125000 its really rough. Things started to go wrong after the 120000 mile mark. Little things at first, coolant temperature sensor, some of the plastic paneling in the car. Windshield wipers The main problem is the tranny which is very common around 120000 k. Besides that the car is powerful for being a large sedan. 0-60 in about 8 seconds. You can by-pass the governor as well...as soon as you reach the governor quickly put it in neutral and back in to gear, there ya go!
Comfortable, quick, Not bad on gas.
Get rid of the cheap interior, build them to last, make them in a 5-speed, place everything in and around the engine in a better spot, cant even change power steering fluid without getting angry! Had to remove head pipe to change temperature sensor.
As a car salesman, I sold these for years, and just purchased one for myself. The 2000-2007 Monte Carlo was a standout in the GM lineup, and used models are a bargain in SS trim (avoid base models). The car, unfortunately, was misunderstood -- witness the reviews here. It was really one of the last "personal luxury" cruisers -- stylish, extremely economical with the 3.8, roomy, and as powerful as it needed to be. A better performer than most 4-cyl cars, cheaper to operate than many, cheap to repair. If maintained, expect 200K-plus miles. Only drawback is the endemic GM midsize steering shaft problem, which can be solved cheaply ($5 or so) with DIY lubing. A wonderful car, a classic.
2-door styling. SS model offers full luxury and sport handling, long wheelbase gives smooth ride. 200 hp in 2000-2005 SS models is plenty; GM's 3.8 motor is one of the great all-time engines for power and fuel economy (30- plus mpg on highway -- no fooling!) Used models with less than 100K are cheap!
A little late for this, since the car was dropped after 07 model year. Would have been nice if GM solved the steering-shaft problem once and for all, but regular maintenance takes care of it. Advice to prospective purchasers -- this problem is no big deal; every car has quirks and this has very few.
I've owned a lot of cars over the 35+ years I have been driving, and consider myself a "car guy". I've owned mostly Japanese-Honda, Subaru, etc. Approaching a mid life crisis, I was looking for a car to accompany me on that journey. I'm a big guy, and wanted some comfort, and I usually carry a lot of stuff, even some lumber once in a while. I saw the first 2 MonteCarlo SS's on my local dealer lot, and loved the retro look. One of my favorite cars was the 1973 Monte, and this captured that essence nicely but updated. This car was impressively well made (Canada), was very comfortable and very reliable after a 6 month rough period at first. This was a winner for GM, sorry to see that it is gone
Exterior styling, interior build quality and versatile layout. Surprising all weather handling with snow tire and traction control.
Transmission could be troublesome on occasion skipping a shift. Otherwise trouble free after some software upgrades. Home run on this one for GM-they got me back to American brands.
I bought this car in 2003 with 60,000km. I am now up to 280,000km and the car runs as smooth as the day I bought it. Haven't had to touch anything under the hood. Just the usual wheel bearings and tye rod replacements that you would normally have to with this kind of mileage. I have car pooled with people recently who drive imports and I just find they can't compare to the smoothness/comfort of a GM.
Comfort and reliability. Powerfull V6. Great gas mileage if you keep it under 115km/h
Bring it back!!!!!
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The Victorian Premier has defended unscheduled rail closures of the Ballarat to Melbourne line set to take place later this year.
Topics: transport, states-and-territories, ballarat-3350, horsham-3400
A senior Department of Primary Industry (DPI) official says he is concerned about the level of despair among Mallee farmers about their financial situation.
Topics: agribusiness, states-and-territories, mildura-3500
Posted| Updated
Emergency crews expect to work well into the afternoon cleaning up damage from fierce wind and rain storms that lashed central Victoria overnight.
Topics: storm-event, storm-disaster, bendigo-3550
Federal and state governments are being urged to reach an agreement on overdue national rail legislation in the wake of yesterday's accident at Regency Park in Adelaide's north.
Topics: transport, rail, states-and-territories, sa
Posted| Updated
Nearly 200 Alcoa workers from across Western Australia have gone on strike after an employee was sacked for giving a female colleague a present the company says was a sex toy.
Topics: mining-industry, bunbury-6230, perth-6000
Northern Territory police have seized cannabis plants in three operations in Darwin's rural area.
Topics: police, drugs-and-substance-abuse, nt
Police have praised members of the public who apprehended two men after a supermarket manager was bashed in the Perth suburb of Carine.
Topics: crime, perth-6000
A teenage girl charged with murdering her baby has appeared in the Ballarat Magistrates Court in central Victoria.
Topics: crime, ballarat-3350
Queensland's State Development Minister says the proceeds from the sale of Telstra should go into tax reform to encourage more people to move to rural areas.
Topics: tax, regional, federal-government, states-and-territories, longreach-4730, bundaberg-4670, cairns-4870, mackay-4740, mount-isa-4825, rockhampton-4700, toowoomba-4350, townsville-4810
The Northern Territory branch of the Australian Medical Association (AMA) says it is more concerned about the treatment of staff at Alice Springs Hospital than building defects.
Topics: states-and-territories, doctors-and-medical-professionals, healthcare-facilities, alice-springs-0870
Alice Springs Town Council says its $6 million civic centre redevelopment is progressing to schedule.
Topics: local-government, alice-springs-0870
Posted| Updated
Weather forecasts are notoriously fickle, but bees, caterpillars and bears are proving as divided as meteorologists on how the long northern hemisphere winter will last.
Topics: business-economics-and-finance, offbeat, zoology, weather, united-states, finland, japan
Lifestyle mogul Martha Stewart will star in a prime-time spin-off of NBC's hit reality show The Apprentice sometime after her release from prison next month, the network says.
Topics: television, united-states
Israeli Prime Minister Ariel Sharon will meet his most senior Cabinet ministers tonight to consider offering goodwill gestures to Palestinians ahead of a summit in Egypt next week.
Topics: world-politics, unrest-conflict-and-war, israel, egypt, palestinian-territory-occupied
Posted| Updated
The Prime Minister says Australian troops providing humanitarian aid in the tsunami-devastated Indonesian province of Aceh will come home "fairly soon".
Topics: federal-government, tidal-wave, australia, aceh
A Norwegian student has told police he suspects drugs were planted in his bag during a trip to Bali two years ago.
Topics: crime, courts-and-trials, southport-4215
Broken Hill Mayor Ron Page will conduct a review on the performance of city councillors during the past 12 months.
Topics: local-government, broken-hill-2880
A National party delegation will tour far west NSW next week to meet the community.
Topics: nationals, regional, broken-hill-2880
Unseasonable weather will continue in south-east South Australia for the next few days.
Topics: storm-disaster, mount-gambier-5290
Port Augusta police say there is a need for better planning of youth activities, after a major brawl in the city, but say a police shortage is not the issue.
Topics: police, youth, local-government, port-augusta-5700
It is claimed nursing staff at the Barmera Hospital were shocked at an announcement that there was no intention to reduce or change the mix of staffing in the hospital's aged care facility.
Topics: aged-care, unions, healthcare-facilities, barmera-5345
Posted| Updated
New South Wales all-rounder Dominic Thornely has been ruled out of the Blues' side for Saturday's one-day match against Tasmania in Hobart.
New South Wales all-rounder Dominic Thornely has been ruled out of the Blues' side for Saturday's one-day match against Tasmania in Hobart.
A US Senator has demanded that the CIA director release thousands of pages of documents detailing the agency's ties with former Nazis who aided in Cold War espionage against the Soviet Union, officials said.
Topics: world-politics, world-war-2, united-states, germany
The Meatworkers Union has called on the Blue Ribbon company in northern Tasmania to abide by a court ruling and re-employ 17 workers.
Topics: industrial-relations, work, unions, launceston-7250