text:
|Publication number
|Publication type
|Application number
|Publication date
|May 4, 2010
|Filing date
|Mar 10, 2005
|Priority date
|May 21, 2004
|Fee status
|Also published as
|Publication number
|Robert J. Hughes, Timothy G. Dietz, Michael J. Andreyko, William E. Clem, Martin B. Albini
|Original Assignee
|Ethicon Endo-Surgery, Inc.
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (101), Non-Patent Citations (28), Referenced by (69), Classifications (44), Legal Events (5)
|External Links: USPTO, USPTO Assignment, Espacenet
The present application claims the benefit of U.S. provisional patent application entitled "MRI BIOPSY DEVICE" to Hughes et al., Ser. No. 60/573,510, filed on 21 May 2004 and is related to the nonprovisional patent application entitled "LOCALIZATION MECHANISM FOR AN MRI COMPATIBLE BIOPSY DEVICE" to Hibner et al., Ser. No. 10/171,330, filed on 23 Apr. 2002, and published on 23 Oct. 2003 as Pub. No. US 2003/0199785, the disclosure of both are hereby incorporated by reference in their entirety.
The present invention relates, in general, to a method of imaging assisted tissue sampling and, more particularly, to an improved method for positioning a biopsy probe with respect to a magnetic resonance imaging (MRI) breast coil for acquiring subcutaneous biopsies and for removing lesions.
Recently, core biopsy devices have been combined with imaging technology to better target a lesion in breast tissues. One such commercially available product is marketed under the trademark name MAMMOTOME™, by Ethicon Endo-Surgery, Inc. An embodiment of such a device is described in U.S. Pat. No. 5,526,822 issued to Burbank, et al., on Jun. 18, 1996, and is hereby incorporated herein by reference. Its handle receives mechanical and electrical power as well as vacuum assist from a remotely positioned control module that is spaced away from the high magnetic field of a Magnetic Resonance Imaging (MRI) machine.
As seen from that reference, the instrument is a type of image-guided, percutaneous coring, breast biopsy instrument. It is vacuum-assisted, and some of the steps for retrieving the tissue samples have been automated. The physician uses this device to capture "actively" (using the vacuum) the tissue prior to severing it from the body. This allows the sampling of tissues of varying hardness. In addition, a side opening aperture is used, avoiding having to thrust into a lesion, which may tend to push the mass away, cause a track metastasis, or cause a hematoma that, with residual contrast agent circulating therein, may mimic enhancement in a suspicious lesion. The side aperture may be rotated about a longitudinal axis of the probe, thereby allowing multiple tissue samples without having to otherwise reposition the probe. These features allow for substantial sampling of large lesions and complete removal of small ones.
In the aforementioned Pub. No. US 2003/0199785 to Hibner et al., localization fixtures are described that are attachable to a breast coil. These localization fixtures aid in accurately positioning the probe to a location of a suspicious lesion within breast tissue. In particular, the X-Y-Z Cartesian coordinates of a suspicious lesion are referenced to a fiduciary marker in the localization fixture. Humanly visible measurement guides for each axis then allow the probe to be correspondingly positioned after a patient has been withdrawn from a closed bore MRI machine without the need for imaging the probe during insertion. In addition, the localization fixture enables use of a detachable probe of an MRI biopsy device. Thus, during subsequent reimaging of the probe, a handle of the MRI biopsy device may be detached, as may be necessary within the close confines of a closed bore MRI machine. When the handle is attached to the probe, various support structures of the localization fixture are described that support the extended length of the handle.
While a localization fixture used with a detachable MRI biopsy probe has a number of advantages, it would be desirable to incorporate additional features that further assist in accurately positioning the probe, preventing over insertion or inadvertent retraction of the probe, and supporting the MRI biopsy device.
Consequently, a significant need exists for an improved localization fixture for in an MRI guided biopsy procedure that assists in locating a suspicious lesion and for accurately performing a biopsy or complete removal of the suspicious lesion, even in conjunction with the close confines of closed bore MRI machines.
The invention overcomes the above-noted and other deficiencies of the prior art by providing a localization and guidance assembly that interfaces an MRI biopsy device to a breast coil to accurately position and maintain a probe at a desired position in a patient's breast for performing biopsy and related diagnostic and therapeutic procedures, and especially for making a single insertion and taking multiple biopsy samples.
In one aspect of the invention, a guide element is selectively positioned parallel to a desired axis of penetration into a patient. A mount movingly engages the guide element so that a penetrating portion of a biopsy instrument is supported along the axis of penetration during insertion into the patient. A depth limiting member, attached to a selected one of the mount and guide element, is advantageously adjusted prior to full insertion to arrest distal movement of the mount when the penetrating portion reaches a desired depth.
In another aspect of the invention, a localization fixture compressively localizes a patient's breast, while a pedestal is laterally positioned to support the guide element, which is also vertically adjusted on the pedestal into parallel alignment with the desired axis of penetration. Thereby, accurate insertion and greater hands free maintenance of position is achieved for breast biopsy procedures.
In yet another aspect of the invention, a method of guiding a penetrating portion of a biopsy device includes aligning a guide element parallel to and offset from a designated axis of penetration into a patient. Setting a depth limit for penetration prior to penetrating tissue assures that overshooting the intended target is avoided. Then slidingly engaging the penetrating portion of the biopsy device to the guide element effects penetration of the patient along the designated axis of penetration until arrested by the depth limit setting.
The present invention shall be made apparent from the accompanying wings and the description thereof.
The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the invention, and, together with the general description of the invention given above, and the detailed description of the embodiments given below, serve to explain the principles of the present invention.
Turning to the Drawings, wherein like numerals denote like components throughout the several views, in
The MRI biopsy system 10 includes a control module 12 that typically is placed outside of a shielded room containing an MRI machine (not shown) or at least spaced away to mitigate detrimental interaction with its strong magnetic field and/or sensitive radio frequency (RF) signal detection antennas. The control module 12 controls and powers an MRI biopsy device 14 that is compatible for use in close proximity to the MRI machine. An example of an MRI biopsy device 14 is the afore-mentioned MAMMOTOME™ instrument. The MRI biopsy device 14 is accurately positioned by a localization fixture 16 that is attached to a breast coil 18, which in turn supports a patient (not shown). Examples of commercially available breast coils 18 include the BIOPSY BREAST COIL MODEL BBC by MRI DEVICES CORPORATION of Waukesha Wis. A guidance assembly 20, and in particular a sleeve 22, advantageously attaches to the localization fixture 16 to increase imaging and therapeutic flexibility and accuracy in conjunction with selective use of the MRI biopsy device 14 at particular parts of the procedure. The guidance assembly 20 may include one or more obturators 24 with one depicted that seals the sleeve 22 during insertion and during subsequent portions of the procedure in which the MRI biopsy device 14 is not inserted therein. A depth stop 26 is provided for use with the localization fixture 16 to advantageously prevent over-insertion of the sleeve 22, inadvertent retraction of the sleeve 22 and/or to enhance accurate placement of the sleeve 22 to a desired location along the Z-Axis.
For convenience, herein a convention is used for locating a suspicious lesion by Cartesian coordinates within breast tissue referenced to the localization fixture 16 and to thereafter position an instrument (e.g., sleeve 22) to this location without necessarily continuously imaging the region. As will be described in greater detail below, a perforated barrier that is compressed along an outside side of the breast, with respect to a medial plane of the chest of the patient, defines an X-Y plane, with the X-axis being vertical (sagittal) with respect to a standing patient and which corresponds to a left to right axis as viewed by a clinician facing the externally exposed portion of the localization fixture 16. A fiduciary marker (not shown) attached to or positioned relative to the localization fixture 16 proximate to the patient's skin defines the origin of this plane. Perpendicular to this X-Y plane extending toward the medial side of the breast is the Z-axis, which typically corresponds to the orientation and depth of insertion of the MRI biopsy device 14, although it should be appreciated that variations may allow insertion at an angle to this Z-axis. Thus, for clarity, the term Z-axis may be used interchangeably with "axis of penetration", although the latter may or may not be orthogonal to the spatial coordinates used to locate an insertion point on the patient.
Separating the tracking rail that supports a mount/depth stop from a biopsy rail that supports the weight of the biopsy device advantageously reduces interference between the various components, allowing a sequence of operation wherein certain components may be selectively installed and removed without interfering with other components.
In use, the MRI biopsy system 10 is prepared for use by placing a cable management spool 30 upon a cable management attachment saddle 32 that projects from a side of the control module 12. Wound upon the cable management spool 30 is a paired electrical cable 34 and mechanical cable 36 for communicating control signals and cutter rotation/advancement motions respectively. In particular, electrical and mechanical cables 34, 36 each have one end connected to respective electrical and mechanical ports 40, 42 in the control module 12 and another end connected to a holster 44 that receives the MRI biopsy device 14. An MRI docking cup 46, which may hold the holster 44 when not in use, is hooked to the control module 12 by a docking station mounting bracket 48.
An interface lock box 50 mounted to a wall provides a tether 52 to a lockout port 54 on the control module 12. The tether 52 is advantageously uniquely terminated and of short length to preclude inadvertent positioning of the control module 12 too close to the MRI machine. An in-line enclosure 56 may advantageously register the tether 52, electrical cable 34 and mechanical cable 36 to their respective ports 54, 42, 44 on the control module 12. A remote keypad 58 may be distally connected to the electrical cable 34 to enhance clinician control of the MRI biopsy device 14, especially when controls on the MRI biopsy device 14 itself are not readily accessible after insertion into the localization fixture 16.
Vacuum assist is provided by a first vacuum line 60 that connects between the control module 12 and an outlet port 62 of a vacuum canister 64 that catches liquid and solid debris. A tubing kit 66 completes the pneumatic communication between the control module 12 and the MRI biopsy device 14. In particular, a second vacuum line 68 is connected to an inlet port 70 of the vacuum canister 64. The second vacuum line 68 divides into two vacuum lines 72, 74 that are attached to the MRI biopsy device 14. With the MRI biopsy device 14 installed in the holster 44, the control module 12 performs a functional check. Saline is manually injected into biopsy device 14 to serve as a lubricant and to assist in achieving a vacuum seal. The control module 12 actuates a cutter mechanism (not shown) in the MRI biopsy device 14, monitoring full travel.
The portion of the MRI biopsy system 10 used near the MRI machine is also assembled. The generally known breast coil 18 is placed upon a gantry of the MRI machine, along with other body support pads (not shown). The localization fixture 16, which is attached within a recess on either lateral side of the breast coil 18 to access a patient's breast that is pendulously exposed therein, includes a horizontal medial plate 80, a reusable base assembly 82, a lateral assembly 84, and a positioning pedestal 86. The localization fixture 16 is also assembled with a disposable medial fence 90 and a lateral window (or perforated plate) 92.
The base assembly 82 is placed within a selected lateral recess of the breast coil 18. The medial fence 90 attaches to a medial edge of the medial plate 80, aligned vertically approximately along a longitudinal axis of the breast coil 18 under an inner edge of a selected breast aperture 94 that receives a patient's breast. With the patient thus positioned and the outer area of the breast sterilized, the lateral window 92 is downwardly slid into a three-sided frame guide 96 of the lateral assembly 84, which in turn is placed upon the medical plate 80. The base assembly 82 and lateral assembly 84 are moved with respect to one another along the Z-axis to compress the patient's breast between the medial fence 90 and the lateral window 92. A mechanism formed between the lateral assembly 84, base assembly 82, and medial plate 80 maintains this compression.
Contrast agent may be injected into the patient to enhance the imaging. The gantry is advanced into the MRI machine bore to image the localization fixture 16 and breast tissue. The fiduciary marker on the lateral window 92 is located and designated as the origin of the X-Y-Z coordinates. Then a suspicious lesion is located within the image and a point thereon selected to determine its location relative to the origin. It should be appreciated that orienting the X-Y-Z axis of an initial scan may be facilitated by having the lateral window 92 formed of an imagable material, thus presenting an X-Y plane in addition to the origin point of the fiduciary marker. With the target location determined, the gantry is withdrawn from the MRI machine bore.
The positioning pedestal 86 is slidably engaged along the X-axis of the lateral assembly 84 and defines a vertical guide for positioning a single targeting rail ("track") 98 at a selected Y-axis coordinate. The track 98 in turn provides a depth guide along the Z-axis for positioning the depth stop 26 and the holster 44 at a desired Z-axis coordinate. The depth stop 26 is latched onto the track 98. Thereafter, a marking instrument (not shown) may be inserted through the depth stop 26 to mark the insertion point on the breast. Thereafter, the depth stop 26 is moved out of the way. Anesthesia is injected superficially, following by a scoring cut at the marked location and a subsequent injection of anesthesia more deeply into the scored cut. The depth stop 26 is then repositioned on the track 98 to the desired Z-axis coordinate reference.
The obturator 24 is inserted into the sleeve and may be positioned to close any apertures of the sleeve 22 (side and/or distal end) to present a closed surface to the breast tissue. The obturator may also be shaped or formed to enhance the visibility of the aperture location. One or the other of the obturator 24 and sleeve 22 presents a sharp tip (not shown) to penetrate breast tissue. For instance, if using a sleeve 22 having an open end, an obturator may provide a sharp tip.
The obturator 24 is inserted into the sleeve 22 and the combination is guided by the track 98 to a proper orientation until an accurate depth is reached as set by the depth stop 26. Once fully inserted, the depth stop 26 prevents over-insertion. The sleeve 22 advantageously latches to the track 98 and/or the depth stop 26 to prevent inadvertent retraction, such as when the obturator 24 is withdrawn, and pressure is received from the breast tissue or later when a probe 100 of the MRI biopsy device 14 is withdrawn from the sleeve 22.
The gantry is moved into the MRI machine bore and the patient is imaged again to confirm placement of the sleeve 22 with respect to the suspicious lesion. Advantageously, imagable materials of the sleeve 22 and/or obturator 24, perhaps comprising or including marker material, enhance the ability to confirm the location of the sleeve 22 and its sleeve side aperture 102 as positioned for subsequent biopsy samples.
The patient is removed from the MRI machine by retracting the gantry and the holstered MRI biopsy device 14 is brought to the localization fixture 16. A protective cap (not shown) is removed from the probe 100 of the MRI biopsy device 14 and the obturator 24 is removed from the sleeve 22. Mounting of the holster 44 to the track 98 is shown in
Thereafter, the MRI biopsy system 10 may take tissue samples by activating a cutter mechanism in conjunction with vacuum assist, withdrawing the cutter and withdrawing a tissue sample, the latter perhaps also with vacuum assist. The probe 100/sleeve 22 combination are capable of manual, or perhaps automatic, rotation to a desired angle with respect to their longitudinal axis for additional samples or additional samples may be taken at the current orientation by further resorting to vacuum assist. The cutter is then advanced to close the probe side aperture 104 and the holster 44 is withdrawn from the localization fixture 16, thereby removing the probe 100 from the sleeve 22.
Additional steps or combinations of steps may be performed at this point such using the probe 100, a specialized obturator 24 (e.g., stylet), or merely the sleeve 22 to guide various agents to the surgical site of the biopsy. Examples include draining fluids, inserting anesthetic agents, inserting hemostatic agents, insufflating with pneumatic pressure and inserting a marker for subsequently locating the site of the biopsy, or other diagnostic or therapeutic procedures.
The patient is then typically drawn back into the MRI machine bore for reimaging to confirm removal of at least a portion of the suspicious lesion and possibly placement of a marker. During this reimaging, the sleeve 22 is sealed with the obturator or stylet 24. Thereafter, the localization fixture 16 is removed, the patient bandaged and removed from the gantry, and the disposable portions of the MRI biopsy system 10 disposed of as medical waste.
Elemental Version of Guidance Assembly Incorporating Single Targeting Rail for Depth Stop and Biopsy Device.
With particular reference to
The single targeting rail 98 may be longitudinally sized to be proximally extending sufficient that the MRI biopsy device 14 engages the single targeting rail 98 prior to the probe 100 contacting the patient's skin. The single targeting rail 98 is also sized to not extend proximally so far as to preclude use in a closed bore MRI machine (not shown). Such a MRI biopsy system 10 is believed to minimize the procedure turn-around time to less than 45 minutes as described above. Yet with this expeditious turn-around, a radiologist may position the probe 100 accurately to within 2 mm (5 mm maximum) of the lesion center. Further, the radiologist may maximize access to both breasts (left or right) during a procedure (both sides of the table) with minimal repositioning of the patient. Further, a minimal amount of force to penetrate tissue is required, such as less than 4 lbs. Although the depth stop 26 serves to prevent overshooting, features for repositioning the depth stop 26 prior to further insertion of the probe 100 allow clinical flexibility in targeting another location.
Orthogonal Targeting and Biopsy Rails ("Cradle").
A lateral face 210 of the targeting rail 204 includes an upper flange 212 and a lower flange 214 each having an L-shaped cross section for slidingly receiving a sleeve mount 216. Vertical rows of laterally projecting ridges 218 in each flange 212, 214 serve as a locking surface for the sleeve mount 216. Between the flanges 212, 214, a side channel 220 is recessed therein. The sleeve mount 216 guides a sleeve 222 by having its sleeve hub 224 proximally received in a hub receptacle 225 of the sleeve mount 216 and distally positioned and constrained by a depth stop 226.
The depth stop 226 includes a slide member 228 that engages the side channel 220. A depth stop housing 230 attaches thereto, terminating in a reticule 232. A locking lever 234 is vertically pinned within a distally open recess (not shown) defined in the depth stop 226 with a lateral portion 236 spring biased away therefrom such that distally projecting feet 238 pivot against and engage the ridges 218, especially against a proximal movement. Depressing the lateral portion 236 proximally against the distally open recess of the depth stop housing 230 releases the distally projecting feet 238 to allow repositioning the depth stop 226 distally.
An axis of penetration of the biopsy device 10 is aligned with the axes defined by the targeting rail 204 and the biopsy rail 206, which are laterally and vertically orthogonally offset therefrom, respectively. Extending a horizontal plane from the targeting rail 204 and extending a vertical plane from the biopsy rail 206 intersect at a common centerline that is the axis of penetration. Having the biopsy rail 206 vertically aligned and parallel to the axis of penetration advantageously provides support for the weight of the biopsy device 14 with a minimum of torsion loads that may otherwise create deflections of an inserted distal end. Thereby, even for a relatively heavy and elongated device, positioning and maintaining its distal end is achievable within 5 mm, and even 2 mm, of a desired insertion point. Thereby, a "hands free" procedure may be performed, avoiding the inconvenience or the impracticabilitxis of penetration in the illustrative version may be replaced by one vertically displaced above the axis of penetration. In particular, having a cradle that may be engaged to either side of the targeting rail 204 would provide further vertical symmetry to take full advantage of the space afforded by the breast coil 18.
While a "hands free" capability is advantageous for a single insertion/multiple sample biopsy device, it should be appreciated that such penetration guidance with a preset depth stop as described herein has application to even light-weight biopsy devices that employ a core needle biopsy with a single insertion per single sample. In particular, correct placement need not be conditional on continuous imaging. Over penetration during insertion and inadvertent displacement is avoided when hands are free.
A bottom dovetail channel 240 in the targeting rail 204 receives a top dovetail extension 242 on the cradle 202, which is slid therein. It should be appreciated that mounting is shown herein on the right side of the positioning pedestal 86 when viewed proximally, but that the guidance assembly 200 advantageously comprises symmetric parts that allow mounting and use on either side of the positioning pedestal 86 to increase flexibility in positioning the probe 100. Thus, a horizontal base 244 of the cradle 202 forms the biopsy rail 206 as a biopsy guide channel 246 flanked by a first and second pair of monocle receptacles 248, 250 so that a pair of locking hooks 252 on a monocle 254 may be inserted in either pair of monocle receptacles 248, 250, depending on which is closer to the patient. Rather than mounting the cradle 202 to the targeting rail 204 as depicted, the cradle may be directly attached to the positioning pedestal 86 (not shown). The cradle 202 is mechanically robust and can support the gross weight of the MRI biopsy device 14. Since the MRI biopsy device 14 does not share the cradle 202, the cradle 202 may be optimized to support the MRI biopsy device 14 when either shallow or deep lesions need to be accessed.
A guide bushing 256 inserted in a monocle reticule 258 guides a marking instrument and/or a scoring scalpel (not shown) as an initial step in locating and preparing an insertion point. The monocle 254 may be removed thereafter or left in place to guide the sleeve 222 in addition to the reticule 232 of the depth stop 226, the latter which may also hold a guide bushing 260 for guiding the sleeve 222. Removing the guide bushings 256, 260 allows for the reticules 258, 232 of the monocle 254 and depth stop 226 to guide a larger component, such as a fiducial 262 used for locating a suspicious lesion relative to the guidance assembly 200.
The alignment of the sleeve 222 is maintained by first passing through the hub receptacle 225 of the sleeve mount 216, which receives the sleeve hub 224. In the illustrative version, the sleeve 222 has an open ended shaft 266 for receiving an obturator 268 that includes a piercing tip (e.g., flat blade) 270 at a distal end of solid obturator shaft 272. A beveled recess 276 into the solid obturator shaft 272 is aligned with a sleeve side aperture 278 of the sleeve 222, and thus ultimately of the probe 100 (
The sleeve hub 224 has its proximal cylindrical edge 280 attached to a guidance thumbwheel 282 that proximally extends from the hub receptacle 225 of the sleeve mount 216 for rotating the sleeve 222 to position its sleeve side aperture 278 with reference to a visual mark, depicted as a locking slot 284, on the thumbwheel 282 corresponding thereto. The thumbwheel 282 includes a central through hole 286 sealed by a wiper seal 288 and a duckbill seal 290 trapped between the thumbwheel 282 and the proximal cylindrical edge 280 of the sleeve hub 224. Thus insertion of the obturator 268, which includes a locking tab 292 that enters the locking slot 284, closes the central through hole 286 and forms a dynamic seal against the wiper seal 288.
After removing the obturator 268, a stylet 298 may be inserted into the sleeve 222 so that a proximally presented hose nib 300 of the stylet 298 may be used to insufflate the surgical site or used for other purposes such as draining bodily fluids or inserting therapeutic or diagnostic agents through a stylet shaft 302 of the stylet 298 to a stylet side aperture 304 that is aligned with the side aperture 278 of the sleeve 222. The stylet 298 also includes a locking tab 306.
The sleeve mount 216 includes a downwardly spring-biased rocker latch 308 that snaps onto a ramped catch 310 on the depth stop 226, preventing inadvertent retraction of the sleeve 222. The sleeve mount 216 may be disengaged by downward pressure on a proximal actuating arm 312 of the rocker latch 308. An upwardly spring-based rocker latch 314 attached to the bottom of the sleeve mount 216 similarly engages the depth stop 226. Thus, after the depth stop 226 is set on the targeting rail 204 to a desired depth of insertion, the sleeve mount 216 may be distally advanced without overshooting and subsequently be held in place when removing implements therefrom such as the obturator 268, stylet 298, and MRI biopsy device 14.
Second Rail Elemental Integration of Z-Stop Feature into Sleeve Mount.
Second Rail Sleeve Mount with Elemental Knuckle Mediated Rough Adjust.
Second Rail Sleeve Mount with Rough Adjust and Release Buttons.
With particular reference to
In use, the rough adjust button 608 is depressed to allow positioning the sleeve block 610 when detached from the primary targeting rail 204 (
Telescoping Depth Guidance Assembly.
In use, in
Pawl Locking Telescoping Depth Guidance Assembly.
Laterally Guided Biopsy Cassette.
The above-described versions of the MRI biopsy system 10 advantageously enable remotely setting of a depth stop prior to engaging a biopsy device 14 with a localization fixture 16 to penetrate tissue. It would be desirable that the various components be assembled in a fashion that reduces separate sterile packaging, reduces the likelihood of damage due to contact with the sharp penetrating tip of a sleeve or obturator, and simplifies assembly and use. To that end, a dispensing housing partially enshrouds a penetrating member (e.g., detachable probe, close ended sleeve, open ended sleeve with penetrating obturator) while allowing access to a depth stop for presetting a desired depth of penetration. A dispensing actuator (e.g., plunger) is thereafter employed to effect engagement and penetration with the simultaneous removal of the dispensing housing from the penetrating member.
With particular reference to
In use, in
Cassette Deployed Second Rail Sleeve Mount with Rough Adjust and Release Buttons.
While the present invention has been illustrated by description of several embodiments and while the illustrative embodiments have been described in considerable detail, it is not the intention of the applicant to restrict or in any way limit the scope of the appended claims to such detail. Additional advantages and modifications may readily appear to those skilled in the art. For example, other imaging modalities may benefit from aspects of the present invention. As another example, a fiduciary marker separate from the lateral plate may be positioned to a specific point on the exterior of the patient's breast as part of a guidance assembly.
As an example, while the illustrative versions incorporate positioning and penetration guidance along Cartesian X-Y-Z coordinates, it should be appreciated that applications consistent with the present invention may utilize other adjustment schemes such as spherical, cylindrical or other coordinate systems. It should be noted that various versions described above allowed for rotation of the depth guidance member such that the axis of penetration was not solely in the Z-axis, orthogonal to the X-Y axis defined by the localization fixture. This capability to adjust the angle of penetration may be desirable in certain instances to penetrate into the patient to minimize tissue damage (e.g., minimize the length of the penetrated tissue), to obscure any scarring of the skin, to avoid certain tissues such as the chest wall, etc
As another example, other types of biopsy devices may advantageously be guided during penetration. In U.S. patent application Ser. No. 11/025,556 filed on 29 Dec. 2004, entitled "CORE SAMPLING BIOPSY DEVIDE WITH SHORT COUPLED MRI-COMPATIBLE DRIVER" to John A. Hibner, et al., the disclosure of which is hereby incorporated by reference in its entirety, both a long-stroke and a short-stroke core biopsy are described.
As another example, while many desirable features enable and enhance use in MRI suite, applications consistent with the present invention may be employed with other imaging modalities (e.g., ultrasonic, CT, etc.).
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|U.S. Classification
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|International Classification
|Cooperative Classification
|European Classification
|May 2, 2005
Owner name: ETHICON ENDO-SURGERY, INC., OHIO
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text:
I'm starting to worry. I may not stop until every wall in my house is covered in plates.
Last weekend we scored two blue and white plates for $6 at the Trash and Treasure sale. Score!
One of them just happened to be the perfect design to make our long anticipated plate clock.
I'm not going to lie, it was hard. Mostly because I measured wrong and got the wrong size drillbit. And full disclosure, the hard part of this project was done 100% by my wonderful husband, while I sat there and plugged my ears. Drill+china=screeeeeeech.
To make your clock, first you need to find your center. Our plate was a lace work design with an obvious center, yay! Otherwise, measure across the middle in several places and make sure you've got the exact center. This is really really important. You may end up with a plate that's almost completely drilled through before you see the light coming through and realize that's nowhere NEAR the center. This may have happened with our skyline plate. Maybe.
Once you've found your center point, set your plate on a towel with a piece of wood or thick cardboard underneath. You'll need a masonry bit that's slightly larger than the diameter of your clock motion set (this can be picked up at any hobby store). This was my problem.
Because the 1/4″ masonry bit we used was slightly smaller than the clock motion parts, we used a combination of the masonry bit, a larger regular bit, and a knife to scrape out the ceramic. Yeah, I told you he was awesome.
Using the regular bit led to a few chips. We didn't mind since the plate is obviously old and used anyway. A masonry bit of the proper size probably wouldn't have chipped the plate (note: the masonry bit did cause some chipping on the back of the plate when it went through. I would suggest drilling from the front).
Plus, you can't really notice it unless you're really looking.
Once you get a big enough hole, put in the clock motion and fasten it down. Then add your hands and set the time.
Not bad for $7, right? Especially considering that you can get a similar version on Etsy for upwards of $40. Or at least, you could. One of the plates she uses is $6 at Pier 1 folks. this is a perfect DIY project if you've got an electric drill.
I would say the key is to go slowly. This is not a five minute project, but it was totally worth the time it took. A totally custom clock for my kitchen makes me so happy. Especially the blue lacework next to the yellow geometric.

subset: commoncrawl


text:
Fifty years before the series begins, scientists learn that a group of comets will enter ...WATCH
When humanity is threatened by an alien menace, when all other options have been exhausted, ...WATCH
From UFOs to psychic powers and government conspiracies, history is riddled with unexplained events. Get ...WATCH
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Superman Red Son: Motion Comics bring the pages of Mark Millar's Eisner-Award-nominated comic book series ...WATCH
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Blast off for excitement with television's first science fiction hit! The trendsetter for such shows ...WATCH
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The Clangers are strange, long-nosed, pink, woolly creatures that live inside a small blue planet, ...WATCH
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Two hundred years in the future, in a fully colonized solar system, police detective Josephus ...WATCH
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After a particle accelerator causes a freak storm, CSI Investigator Barry Allen is struck by ...WATCH
The Greatest Adventure: Stories from the Bible is a direct-to-video series produced by Hanna-Barbera that ...WATCH
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The Head is the story of Jim, a trade-school student in New York City who ...WATCH
Don't Panic! This is the story of Arthur Dent, an average Englishman who life is ...WATCH
David Banner is a research scientist trying to find a way to tap into the ...WATCH
The Incredible Hulk is an animated television series based on the Marvel Comics character of ...WATCH
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The Invaders, alien beings from a dying planet. Their destination: the Earth Their purpose: to ...WATCH
Darien Fawkes is a thief and conman with a scientist brother, Kevin. Kevin develops a ...WATCH


text:
City of Anacortes Finance Department
Department Mission: The Finance Department mission is to be responsive, helpful, and efficient in serving the citizens of Anacortes, elected officials, and their other city departments. The Finance Department is committed to the highest quality financial management, in compliance with applicable federal, state, and local laws.
Finance Department Functions: The Finance Administration oversees all department activities and coordinates the preparation and publication of the City's Annual Report, Budget and Capital Facilities Plan. They provide financial planning and analysis support to other City departments, the Mayor and the City Council. They manage the Treasurer's office as prescribed by state law and oversee all debt administration, banking services, and City investments. The administrators are also responsible for coordinating internal and external audits.
The Finance Staff manages the accounting activities for the City. They are responsible for accounts payable, payroll, purchasing services and financial reporting. The staff is also responsible for cash receipts, accounts receivable, business and dog licensing. The Utility section is responsible for the billing and collection functions associated with water, sewer, storm drain, solid waste, and utility taxes.
The Finance Department is open Monday through Friday, 8:00 PM to 5:00 PM. We are closed on City holidays.
City of Anacortes Finance Department
Steve Hoglund, Finance Director
City Hall Municipal Building
904 6th Street
Corner of 6th Street & Q Avenue, behind the US Post Office
Mailing Address: PO Box 547 Anacortes WA 98221
City Hall Main Telephone: (360) 293-1900
Fax: (360) 293-1928


text:
Sam Grant Wiki at Wikia
Miss Pippin Reed is Sam Grant's wife, she puts up with Sam Grant endlessly and never seems to get angry. She is Professor Reed's daughter and has adopted three children of her own, Sparks, Sam Doople and Criminal Face. Her only friend outside of the gang is Mrs M. According to Professor Reed, she was named after a war general called 'Miss Pippin Reed' However after it is revealed that the Professor never even went to war, he admits that Miss Pippin Reed was named after the dog from 'Come Outside'. Nothing is known of Miss Pippin Reed's mother.


text:
SOUTH KOREA: Kia shows LPG hybrid, hydrogen SUV
Kia Motors has unveiled liquefied petroleum gas-electric hybrid version of the Forte and its eco-friendly sub-brand Eco Dynamics.
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text: Blue Lamb Furnishings of Newburyport, MA has been redesigning and refinishing vintage furniture since 2012. Phil and Lauren Santoro established Blue Lamb after realizing a shared passion for reviving mid-century relics. Our pieces can be purchased at our showroom at The Barn at Todd Farm in Rowley, MA, or at Salt & Grove in Newburyport, MA. Contact us at (781) 799-3148 or via email at firstname.lastname@example.com.


text:
Paulina Rubio
Personality Number 8
Paulina Rubio is a Mexican Singer, Actress, Television Music Competition Judge, Hostess, Model, Businesswoman and is considered the Queen of Latin Pop Music.
She was born on Thursday June 17th 1971, in Mexico Distrito Federal, Mexico.
Paulina Rubio appears strong and powerful. She has an impressive personality and can influence and even intimidate through sheer force. She has natural authority. Paulina's competence and enthusiasm attract people with resources.
Rubio radiates confidence. People defer to her because they sense her sureness and effectiveness. Paulina Rubio also exudes a kind of controlled benevolence. People sense that she is generous, once she is convinced of the worthiness of the cause.
It is important for Paulina to dress well. Rubio radiates a kind of raw power and able-ness, which needs to be refined and enhanced by her clothing. Paulina Rubio may even dress a bit flashy, but that will not harm her. Quality is among Paulina's highest priorities, and should reflect in her clothing.
Although most eights have a strong constitution, they can be prone to indigestion, ulcers, and heart disease due to their reckless eating and drinking habits and their propensity to be workaholics.
Her Achilles heel is Paulina's capacity for an egocentric attitude. The negative side of her personality can cause Rubio to be ruthless, greedy, and intensely lonely.
Conversely, Paulina Rubio can be spontaneous and excited. She is essentially warm and jovial. In her heart of hearts, Paulina wants everyone to be as excited and as happy as her. Those who are around Rubio often sense this, and her coworkers and employees usually like her.
You and Paulina
About Paulina's Personality number
Rubio's Personality number often serves as a censoring device, both in terms of what Paulina sends out, as well as what she allows to approach.
It discriminates in the kinds of people and information Paulina Rubio lets enter her heart and mind.
Read more about our numerological interpretation of Paulina Rubio's personality


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This is a disambiguation page; that is, one that points to other pages that might otherwise have the same name. If you followed a link here, you might want to go back and fix that link to point to the appropriate specific page.
Fall or The Fall can refer to:
- The Fall in Demon: The Fallen
- The Fall in Demon: The Descent
- Autumn


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President Abdulla Yameen Abdul Gayoom has conveyed greetings to the people of the Maldives on the occasion of Eid Milad-un-Nabi (PBUH). He also sent greetings of this auspicious day, to the leaders of Islamic countries, Islamic organisations and the entire Muslim Ummah.
In his message the President said that the Holy Prophet was the example for all Muslims to follow. He urged the people to emulate the life and teachings of Prophet Muhammad, and to strengthen unity and harmony among us.


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Carriage Works Apartments
50 South Highland Avenue York Pennsylvania 17404
Are you the property manager?
Carriage Works Apartments is an income restricted rental community located in the Borough of West York, Pennsylvania, minutes from Route 30 and I-83. This newly converted historic structure features one, two and three bedroom apartments. Carriage Works offers residents spacious open floor plans, oversized pella windows, ceramic tile bathrooms, ample closet space, hardwood floors & carpeting, central air and much more. To help save on energy expenses, each apartment has been equipped with ENERGY STAR certified windows, lighting and appliances as well as a state-of-the-art geothermal heating, ventilating and air conditioning system. The community offers on-site management, lounges and game rooms, and off-street parking.
Other Apartments Nearby
East York
|1 Bed
|$923 - $940
|2 Beds
|$1044 - $1062
|3 Beds
|$1268 - $1288


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This recently renovated deluxe resort hotel features an array of fabulous amenities, with 10 floors offering a total of 1,338 suites. Facilities within the air-conditioned hotel include a foyer with a 24-hour reception desk, a safe, a currency exchange desk, a cloakroom and a lift as well as a newspaper stand, a caf�, a delicatessen, a lounge, bars and restaurants. There is a games room as well as meeting facilities and fees apply for use of the room and laundry services. Those arriving by car are able to make use of the hotel car park. Younger guests may let off steam in the playground.There is a complimentary shuttle bus service to Walt Disney World. Minimum check-in age is 21.The spacious, well-appointed suites come with many excellent amenities including an en suite bathroom with a hairdryer, a direct dial telephone, satellite/ cable TV, a radio, an Internet connection, a safe, a double or king-sized bed, a small fridge, a microwave, a coffee machine and ironing equipment. Individually controlled heating and air conditioning also come as standard. The suites have space for up to 6 persons, with a maximum of 4 adults.
From Orlando Airport|Take 417 South (Central Florida Greenway) to exit #6. Follow to World Center Drive (do NOT turn right onto International Drive). After the light, we are located on the right side. Tolls will total $2.00


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We help you find a Ambleside tuba tutor. Tuba tuition are a great way to begin an entertaining new hobby, pick up a new talent and gain confidence in tuba. Try our service to search for Ambleside tuba tutors and select which matches your requirements so you can enjoy your tuba lessons in Ambleside immediately!
This is the only place to contact Ambleside tuba teachers in the UK, helping you find Ambleside tuba tuition close to you and Ambleside teachers to help with any instrument like piano, violin or guitar. We can help you find Ambleside tuba lessons or a one-to-one Ambleside tuba teacher to prepare for tuba exams and develop your tuba skills! We order Ambleside tuba teachers in your area by their hourly charges and proximity to you.
If you are a tuba teacher wishing to offer your tuba tuition services in Ambleside or throughout the UK, please register with First Tutors: Music or find out more about us here. Becoming a Ambleside tuba tutor is a wonderful way to re-affirm your own knowledge by providing tuba tuition while helping someone else, all in your local Ambleside area!


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Dr. Akua Afriyie-Gray MD Patient Reviews
- Obstetrics and Gynecology Maywood, IL
Overall Rating
16 Patient Reviews
- Friendly Staff
- Promptness
- Appropriate Followup
- Spends Time With Patients
- Bedside Manner
- Easy Appointments
- Fair and Accurate Diagnosis
- Wait Time 18.8 minutes
Showing 1 - 12 reviews
5.0 of 5
January 27th, 2016
She literally saved my life! Skilled and nice too!
2.0 of 5
October 16th, 2015
I saw Dr. Akua Afriyie-Gray one evening at her Oakbrook Office. She is not my regular doctor, but I made an appointment with her because of my work schedule. My appointment was at 6:20pm. I waited alone and unattended until 7:20PM. Once she tended to me, she appeared to be polite and somewhat apologetic about the 1 hour delay. She pulled up my medical records before examining me and gave me quite the shock. She stated I had a high-risk pregnancy and needed to plan a date for my emergency c-section because I have placenta previa. I am 37 weeks pregnant. I explained that this information was never brought to my attention by my regular doctor. Dr. Gray stated that she could not examine me because of the placenta previa...meaning the placenta was blocking the baby from being delivered vaginally. After this news, she rushed me out of her office. I drove home an emotional wreck because I felt very confused and alone. The next morning, Dr. Gray phoned me and said it was an oversight on her end and that the baby was fine for the time being. No where in my medical records did it say I had placenta previa. I spoke with my regular doctor and she stated that mistakes happen. I feel that this was a huge oversight on her part and it should be acknowledged. Often times, doctors forget that we are human and we need some sort of guidance and comfort. I felt this was very irresponsible on her part. The emotional rollercoaster I was placed on could have very well sent me into early labor. I just pray no one else has to endure this kind of experience.
5.0 of 5
April 10th, 2015
The BEST
Absolutely, hands down, one of the best providers! Caring, compassionate, dedicated, intelligent, competent, consummate professional!
5.0 of 5
September 18th, 2014
Wish she had delivered my second!
She is amazing! She was my doctor for my first daughter almost 10 years ago. We just had our second and currently reside in Texas, I wish I still lived in Illinois. The doctors here were rude, inconsiderate, discourteous, cold and calculating. If I had a choice of a doctor it would definitely be Dr. Gray every time! I truly miss her, I miss how enjoyable she made the experience. She was by far the best doctor I have ever had, I still remember her to this day. That should count for something. Thank you for being an amazing doctor, keep doing what you're doing. Don't get jaded by the system, like my current doctor is!
5.0 of 5
May 11th, 2013
Best Of Tge Best
The best Dr. I've met. Were thinking about having another baby & want you for our O.B & you have moved on us. :(
5.0 of 5
February 7th, 2009
Excellent Doctor
Dr. Afriyie-Gray has delivered my children and I would refer her to anyone. She was laid back yet professional. She made me feel comfortable enough to ...
5.0 of 5
February 7th, 2009
The Best!
I love this doctor. She has delivered my children. She very caring and helpful.
3.0 of 5
June 3rd, 2016
5.0 of 5
April 26th, 2016
5.0 of 5
July 30th, 2015
5.0 of 5
July 28th, 2015
1.0 of 5
January 5th, 2015
Health Guides
Nearby Doctors
Dr. Akua Afriyie-Gray, MD is similar to these 3 Doctors near Maywood, IL.
Maywood, IL
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Birmingham is the largest and most populous British city outside London and is famous for its network of canals, many of which radiate from Sherborne Wharf and are now lined with trendy cafes and bars, but what is there to do in the city for kids? Drayton Manor: This is a theme park that is built for all ages. With a 15 acre zoo with animals ranging from Tigers to Snakes, Owls to Monkey's and even some dinosaurs if you… Continue Reading "My Top 5 places to visit in Birmingham with Kids"
Tag: Cadbury World
A Christmas Party at Cadbury World
Last year we went on holiday to Newcastle Under Lyme and spent a week exploring various locations up North. One of the destinations I wanted to go to was Cadbury World but sadly we ran out of time so when Carnival Cruises announced that we would be having a Christmas party and that it was at Cadbury World we were very excited! The drive up to Birmingham took around three hours and was uneventful. We were hopeful for a glorious… Continue Reading "A Christmas Party at Cadbury World"


text: South AfricaLion mauls US tourist to death in South Africa park Woman killed after lion jumps into her vehicle through an open window at a wildlife park near Johannesburg. 02 Jun 2015 06:49 GMT | South Africa, Africa, Wildlife The victim died as paramedics tried to save her, while her male companion was injured in the incident [File: AFP]An American tourist has been mauled to death in South Africa after a lion jumped into her vehicle through an open window at a park on the outskirts of Johannesburg, police and officials said. "She was driving with a male person at the park, they were attacked by the lion, she was killed at the park and the man has been taken to hospital," police spokesman Lungelo Dlamini said on Monday. Dlamini said he did not have a name for the 22-year-old woman or what part of the United States she was from. Her travelling companion was South African. The woman died while paramedics tried to save her, Lion Park assistant director of operations Scott Simpson said. "The gentleman sustained some injuries to his arm, he was fighting the lion off inside the car. Our staff rushed over immediately and chased the lion away from the car," Simpson told local radio. Last month, a lion killed a man at a zoo in the South African city of East London after he jumped into the animal's enclosure.Source: Reuters


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All Agriculture Content
Illini Farm Toy Show set to begin Friday in Urbana
URBANA — An annual farm toy show sponsored by young farmers in the area will be held next week.
$5.7 million grant to UI to find ozone-resistant corn
CHAMPAIGN — On an ozone action day, when air quality levels are unhealthy, especially for people with conditions like asthma, even plants feel the stress.
UI prof: Ethanol boom over; biodiesel ramping up
CHAMPAIGN — A University of Illinois professor says the ethanol boom is over, but farmers may soon enjoy the benefits of a boom in biodiesel.
Scott Irwin, a professor of agricultural and consumer economics, said the U.S. will likely need to boost production of biodiesel sharply in order to meet Environmental Protection Agency mandates.
Gates Foundation gives UI $25 million for photosynthesis research
URBANA — In what has been described as a "game-changing" grant, the Bill & Melinda Gates Foundation has awarded the University of Illinois a five-year, $25 million grant to fund photosynthesis-focused research that could address global food security challenges in the future.
Andersons completes purchase of grain, agronomy assets
CHAMPAIGN— The Andersons Inc. announced on Monday it has completed the purchase of most of the grain and agronomy assets of Green Plains Grain Co.
The Andersons, based in Maumee, Ohio, already has grain terminals in Ohio, Illinois, Indiana, Michigan and Nebraska. Locally, it has grain handling and storage facilities in Champaign and Mansfield.
Corn, soybean prices falling
DEWEY — Corn and soybean prices, which hit record highs in August, have been dropping since then and may fall further, a commodity research analyst said.
"There is still risk downside in prices," Brian Basting of Bloomington-based Advance Trading told about 50 farmers Tuesday at an agricultural seminar sponsored by the Dewey Bank.
U.S. soybean harvest expected to beat forecast
URBANA — Soybean prices have declined the last two months, and prices could go either way in coming months, University of Illinois agricultural economist Darrel Good said.
Soybean prices reached a peak on Sept. 4, when November futures traded for $17.89 a bushel, Good said in a UI press release. The price has since declined to the $15-a-bushel range.
Ford County leases farmland for highest rent ever
PAXTON — Farmland owned by Ford County will be leased for the next two years for the highest amount ever.
At a public auction this week, cash-rent leases for three county-owned farms were awarded for a total of $122,860 per year — an increase of $34,740 from the winning bids from two years ago.
Corn prices have dairy cows getting taste of Bud
URBANA — The cows here are eating the stuff that's used in beer-making. But don't expect your child to be growing a taste for Budweiser.
Byproducts from Anheuser-Busch in St. Louis just come a lot cheaper than corn at its high post-drought prices. The University of Illinois is also working with cotton byproducts in its dairy farms south of Urbana.
Business roundup: Manager chosen for Stone Creek course
URBANA — Northbrook-based KemperSports has been chosen by The Atkins Group to manage Stone Creek Golf Club in Urbana.
KemperSports operates golf facilities as well as athletic clubs, lodging venues and major sporting events.


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Games like this and this in particular have always been distinctive features neskolno - gemypley simple, simple design, smooth animation and a lot of difficulties that await you, with so much that nerves can take even the most hardened gamer! By itself is full of people who love these games because they throw a real challenge your abilities and your endurance!
This time our hero - a ball that travels in the next futuristic fantasy world, in fact just rolls along the track with a bunch of obstacles, all that is required of you - lightning reaction, because the most important thing - not to crash, because the speed is just huge! In fact, this game can be called Rahner, because it has no logical beginning and any end, your results - the distance by which you could drove off, the main thing is it unlike most Rahner - a hell of a challenge.
But in the game just two significant problems - Donath and jambs with little control, in this case enormously. Donat will allow you to remain on the control points, and therefore only with him you can put a real record without him - maloverotyano, especially when you consider the fact that the obstacles are different every time, remember not work. But even with the ability to save the ball sometimes does not respond to your actions, so no matter what reaction you did not have - have the ability to cut and start all over again ... at such moments is especially great opportunity to enter into a rage and smash your smartphone ... so be careful I warned!
Pros and features of the game HEX: 99
Disadvantages game HEX: 99
Bottom line: definitely a decent game for those who love the terrible difficulties for the rest, I can not recommend it, but it did not become popular until the developers did not deign to solve the problem of the responsiveness of the ball.
The best impossible 3D twitch game just got even better!
-still mercilessly difficult and insanely addictive!
Celebrate the Holidays with a fresh, addictive challenge.
*Turn off sfx and music
*share your scores and compete with friends on game center*
*Please remember to review HEX:99 again as each update refreshes the ratings*
Any Issues? Comments? Feature Requests? - send an email to firstname.lastname@example.com
|date of download
|The size
|no viruses
|inspection date
| View report
(Proverechno using the service virtustotal.com)
| full network access
Allows the app to create network sockets and use custom network protocols. The browser and other applications provide means to send data to the internet, so this permission is not required to send data to the internet.
| view network connections
Allows the app to view information about network connections such as which networks exist and are connected.
| view Wi-Fi connections
Allows the app to view information about Wi-Fi networking, such as whether Wi-Fi is enabled and name of connected Wi-Fi devices.
| modify or delete the contents of your USB storage
Allows the app to write to the USB storage.
Attention! All files represented on this site either were found freely distributed on the internet or by their authors' permission. If any of materials on this site violates your rights, report us
Rating:(5) 4.45★ 89%
Rate the game:Plot


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Quote:hopefully by then I should be all healed from the full contact matches in July.what say the rest of you?
Quote: Already talked with her and she will be at the event, maybe her husband will stare you down again. LOL
Artifacts from the Ryukyu Kingdom missing since WWII.
Visit www.ShisaLion.Org
to view pictures
Stun Guns
Self Defense Products-stun guns, pepper spray, tasers
and more
Complete surveillance systems for covert operations
or secure installation security
Asylum Images
Book presents photo tour of the Trans-Allegany Lunatic Asylum. A must if you're going to take a ghost tour!


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On the Elation, again....: Carnival Elation Cruise Review by cruisefan33
Overall Member Rating
On the Elation, again....
Destination: Western Caribbean
Embarkation: New Orleans
We had early dining in the Inspiration dining room. Our wait staff was very attentive and entertaining. The food was very good. Something new on this ship is the seaday brunch. I was really impressed with the food. The breads were really good and the brunch variety was also very nice. The steak and eggs, huevos rancheroes, and chocolate chip pancakes were my family's favorites. I also enjoyed the Chinese food on the Lido deck several times. I preferred the beef skillet More with black bean sauce. It was delicious without being spicy.
This was our 9th visit to Cozumel. We just took a taxi to Paradise Beach and lounged there all day. This is not an all inclusive beach break, but I needed a little break from all of the overeating I had been doing on the cruise. The kids enjoy going there and it is a fairly inexpensive way to spend the day in Cozumel. It's beach was ranked number 8 among the most beautiful Mexican beaches.
In Progreso, we booked an all inclusive beach break through AutoProgreso once we got on land. We spent the day lounging and eating. It was very nice and we had an amazing time, just soaking up rays.
Our room steward was Karma; he was amazing. I wish I could take him home with me. He kept our room spotless and was very friendly and helpful to us. On the first day, I asked for a bucket of ice, and from then on, he brought me a bucket of ice twice per day for the sodas I had brought on board.
Debarkation was a breeze. Since I had purchased Faster to Fun, we were sent to a specific lounge to wait to debark. We were then brought downstairs by a Carnival worker and we were literally the first ones off the boat.
We had such a nice time! We have had a terrible winter, so 5 days of sun and pampering was just what my family needed. I love this boat. I love that it is smaller than most, so there aren't as many people. I love the way Carnival treats families. I love having my meals prepared for me and my room cleaned for me. For the money, there is no better vacation than a cruise. Our next cruise will be in July on the Dream, and I will let you know how that turns out. Thanks for taking the time to read this review! Less
Published 04/07/14
Cabin review: E190
Nice room. Close to back elevator, so easy ride to Tiffany's dining room. Also, this room is right below Inspiration dining room, so it is an easy climb to dinner. We never heard noise from the above dining room.
Read Cruise Critic's Carnival Elation Review >>
Carnival; never again
Very fun and comfortable
First and last Carnival cruise
Family Cruise
50th BIRTHDAY CELEBRATION
Family Cruise
First cruise - The crowds both...
Carnival; never again
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Spend Your Life With Me MP3
Provided to YouTube by Sony Music Entertainment Spend Your Life With Me · Dave Mason / 戴夫梅森 Let It Flow ℗ 1977 Sony Music Entertainment, Inc.
Eric Benét (featuring Tamia) - Spend My Life With You MP3
from the album "A Day In The Life" (1999)
Catalina's - Spend Your Life With Me MP3
We Promote Carolina Beach/Shag Music ! All Music 0n SomeBeachMusic.com Is For Entertainment Only ! ...
Come Spend Your Life With Me by Dale Adriatico MP3
Album: Hello World Artist: Dale Adriatico Dale Adriatico is a Philippine singer fame in the 1970s . During the 1970s and 1980s, he sang on different sides of the ...
Come Spend Your Life With Me.wmv MP3
Come Spend Your Life With Me... by Dale Adriatico... created by... PHILmarloy... louielvis2000.
COME SPEND YOUR LIFE WITH ME (1977) - Dale Adriatico MP3
Singer-composer Dale Adriatico sings a George Canseco classic. I ripped this from the LP "Hello World".
I Just Wanna Spend My Life With You MP3
I Just Wanna Spend My Life With You Like a dream you can't explain Love can chase the bidding of your heart Like the sunshine in the rain Love can make your ...
Imagine Dragons - I Bet My Life MP3
Get Smoke + Mirrors on iTunes now: http://smarturl.it/IDSmokeMirrors Get Smoke + Mirrors Deluxe version with 4 exclusive songs only at Target: ...
I Bet My Life
Imagine DragonsI know I took the path that you would never want for me I know I let you down, didn't I? So many sleepless nights where you were waiting up on me Well, I'm just a slave unto the night Now remember when I told you t[...]
Locked Away Lyrics - R City ft. Adam Levine (Lyric Video) HD MP3
Locked Away Lyrics by R. City ft. Adam Levine is my favorite song at the moment! Get this song on iTunes here: http://smarturl.it/LockedAwayi Lyrics: If I got ...
Trade Martin - Spend Your Life With Me MP3
Trade Martin, one of the best song writers ever, here is a quick glimps of the talent Trade has displayed! Do a research on him, you will be amazed, I sure was!
spend your life with me MP3
Trade Martin-Spend Your Life With Me MP3
Trade Martin.
Sam, spend your 5:53 of your life for me please. MP3
Thak you for changing me.
Adam Kontras - "Spend Your Life with Me" MP3
Entry Soon.
Spend Your Life With Me - Trade Martin MP3
There is nothing we would love more than to spend the rest of our lives together sharing our love each and every day.
Tasha, Will you spend your life with Me MP3
Lyrics: Over these past few years you have been so much to me We've been friends together and laughed together and been awkward together and I don't want ...
Dave Mason - Spend My Life With You - What Do We Got Here - Janet Gaynor Pics MP3
O que leva as pessoas a comporem canções tão belas como estas do Mestre Dave Mason? O que leva as pessoas a fazerem de sua Arte a manifestação de ...
Do You Love Me Enough to Spend the Rest of Your Life With Me MP3
http://shirahchante.com/faithful-friend/ Listen to "Faithful Friend" podcast, https://www.buzzsprout.com/12801/234775-faithful-friend or listen on iTunes, ...
You Spend Your Life Loving Me MP3
Provided to YouTube by Believe SAS You Spend Your Life Loving Me · Mike Rose Soul and Sax ℗ Orbitone Records Released on: 2013-12-19 Composer: F. L ...
Will you spend the rest of your life with me? ♥ MP3
The Time You Have (In JellyBeans) MP3
How much time we have in jellybeans. Share on FB :: http://on.fb.me/1aIJcmq (U can add a note) Tweet This :: http://bit.ly/11ZGj9V (U can change the tweet) ...
Dead Or Alive - You Spin Me Round (Like a Record) MP3
Dead Or Alive's official music video for 'You Spin Me Round (Like A Record)'. Click to listen to Dead Or Alive on Spotify: http://smarturl.it/DoASpot?
You Spin Me Round (Like A Record)
Dead Or AliveIf I, I get to know your name Well, if I could trace your private number, baby All I know is that to me You look like you're lots of fun Open up your lovin' arms I want some, want some I set my sights on you (And no one else will do) An[...]
Sam Hunt - Take Your Time MP3
'Take Your Time' available on Sam's debut album, Montevallo available everywhere now, click here. http://geni.us/3RzI Follow Sam Hunt: ...
Take Your Time
Sam HuntI don't know if you were looking at me or not You probably smile like that all the time And I don't mean to bother you but I couldn't just walk by And not say hi And I know your name Cause everybody in here knows your name And you're not looking for anything right now So I do[...]
Trade Martin - Spend Your Life With Me MP3
Coed 590, 1964.
Whitney Houston - My Love Is Your Love MP3
Whitney Houston's official music video for 'My Love Is Your Love'. Click to listen to Whitney Houston on Spotify: http://smarturl.it/WhitneyHSpotify?
My Love Is Your Love
Whitney HoustonIf tomorrow is Judgement Day And I'm standin' on the front line And the Lord asks me what I did with my life I will say I spent it with you If I wake up in World War 3 I see destruction and poverty And I feel like [...]
How would you really enjoy spending your life... if money were no object? MP3
What makes you itch? Students come to me and say, "Well, we're getting out of college and we haven't the faintest idea of what we want to do." So I always ask ...
I just wanna spend my life with u......... MP3
Like a dream you can' t explain love can chase a beating of your heart Like the sunshining in the rain love can make your whole world fall apart All i wanted now ...
Hadouken! - Spend Your Life MP3
Listen Ive got a bit of fiscal trouble I dont wanna sob but I need a few bob In the last year Ive seen my debt double And I cant pay it back coz I aint got a job It must ...
iPhone Tips To Change Your Life MP3
You spend your whole life staring at your phone, might as well know how to use it. Share on Facebook: http://on.fb.me/1d8quoQ (You can change the text) Share ...


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Aerosoles Party Plush Platform Wedge Sandals
Ships from USA , delivers within 14-21 DaysAdd to wishlist
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No questions asked return or exchange*: items may be returned or exchanged for a full refund in the original form of payment or a Vogily Credit within 14 days after shipping. Your satisfaction is our biggest prize, so we do everything to ensure that you are happy with your purchase. All products are 100% authentic, procured from brands directly and are backed by our purchase protection with 10 times money back guarantee. *Please refer to the detailed return policy on the site for exceptions
Ships from USA , delivers within 14-21 Days


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I made cupcakes tonight and some SMBC. I have some left over and want to know how to preserve it. I'm leaving for vacation on Thursday, so I won't be using it any time soon. Can anyone tell me if I can freeze this, without it breaking down when it's thawed? thank you.
3 replies
I've frozen mine with no adverse effects.
I make large batches a freeze all the time. Just allow it to come to room temperature before rebeating. If it does break, just let it warm up a bit and then beat again, it will come back to life!
Great to know! Thank you!


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I worked for a water company some years ago, and I got to meet quite a wide variety of people. I am bisexual, 28, and can appreciate beauty in all forms. Most of the people I got called out to were, as you would say normal, but a few had extremely interesting tastes including one with a fully functional dungeon hidden away in one of their bedrooms!
But I digress. The particular place I would like to tell you about was in Croydon in late 1999. The boiler had broken, and it was up to me to see that the homeowner didn't freeze in the winter months.
I arrived at the house and was greeted at the door by a nice attractive brunette by the name of Mrs Green. She was about 5'10'', late 20's with short dark brown hair and a slim figure. It was early afternoon, but she looked as though she was going clubbing by the state of her attire. Knee high boots, a short black skirt and legs sheathed in black stockings covered her lower half and a tight dark grey top accentuated her fine cleavage nicely. She bent down to pick up the milk from the doorstep, and I caught a glimpse down her top. She was braless and my cock stirred from it's slumber.
Inviting me in, she introduced herself as Mrs Green, although I already knew this from the job sheet, and I quickly set about looking for any faults with the boiler.
It was not an easy task as one of the more difficult to reach pipes had cracked. I was there for a good hour before finally finishing, and I was looking forward to an afternoon off cracking one out over the image of her cleavage.
We settled the invoice and I prepared to leave. Mrs Green leant forward on the breakfast table, her cleavage more prominent than before.
"We can't really afford this bill, and my husband is still at work. Can I pay it off some way else?" she asked.
It took all of my will power to take my eyes from her chest and I answered.
"Sure. What would you like to...."
I was cut off as she threw herself at me. Sticking her tongue into my mouth, and grabbing my crotch, I became fully aware of how she would pay for it.
With my hands creeping up her skirt (she wore suspenders as well!) we kissed passionately for a few minutes before she led me upstairs.
Wasting no time, we quickly undressed and I climbed on top of her on the bed. Her breasts were nice and pert and I saw that she trimmed her hair beautifully (I fully shave my pubes by the way). I was pleased that she left her stockings and boots on, as the cold leather against my back really turns me on.
She wrapped her stockinged and booted legs around my waist and pulled me into her. Although she wasn't fully wet yet, I slipped in very easily which was a bit of a surprise. Little did I know that in a few minutes, I would find out exactly why she was so loose.
I started to pump my hard dick inand out of her, but the looseness of her cunt didn't really have that much of an effect on me. Sure I was turned on, super tuned on in fact, but as I found it a strain to really get my juices flowing. She, other hand, seemed to be loving every minute of it. I whispered in her ear.
"Have you ever taken it in your ass?"
She looked straight at me and sharply replied.
"Never. Not by my husband, and certainly not by you."
I apologised at once and went back to grinding away at her. She was still writhing beneath me when I heard footsteps.
I froze, so did Mrs Green.
"Shit, my husband", she whispered.
I jumped off the bed and looked for my clothes, but it was too late. The door swung open, and a massive black man stood there. He was well over 6 feet tall, heavily built and a bald head. He looked really mean.
"Wha the fuck do you think you're doing cunt?".
I didn't answer. His wife was laying naked on the bed, I was stood next to her - also naked. There was nothing I could say.
"You piece of shit. I'm going to fuck you up." he screamed and took a few steps towards me. For some reason, he then stopped.
"No. I'm not going to fuck you up just yet. Get back on her".
Mrs Green tried to protest, but her husband cut her off.
"Bitch shut up!", he yelled "I'm gonna have me a white boy now".
My cock was still hard, and I could only imagine what he meant by that last statement which only made me harder. I got myself back inside her and started fucking her again.
I was half aware of the black guy taking off his clothes as I pounded his wife, but I became fully award of him as I felt his hands on my buttocks.
"She don't like giving it in the ass. Now I'm going to have your's fucker".
I felt his weight press against my back and the head of his cock resting between my ass crack.
"You better bite down on something" he said, "this ain't going to be pretty".
And with that he pushed his prick into my ass. I bit down on the pillow next to Mrs Green's head. The pain was unbearable. My ass felt like it had been ripped wide open, but the black man kept pushing.
I had completely frozen by this point, but the pressure of my pubic bone against his wife's clit made her violently orgasm. Her screams joined mine and I could feel her pussy lips contracting against my hard shaft.
I now knew why her cunt was so loose. Her husband was massive. I couldn't tell how long or wide it was, but it filled my ass completely. I was going to be so sore tomorrow.
The pain had subsided a bit and he started to pump his long black cock in and out of my ass. He would sink in me to the balls, and then pull out almost completely. My poor ass felt like it was being turned inside out, but I was starting to get used to the pain and was shortly starting to really like it.
I began to pump his wife's cunt again, and the continued pressure on her clit built her up to another orgasm. She climaxed for a second time, digging her nails deep into my back. This sudden pain, along with the pleasure my ass was receiving, sent me over the edge. I froze and emptied my balls deep within her. I laid still, completely exhausted, and waited for her husband to cum.
I didn't have to wait long. He drilled me faster and faster until I felt his hot sticky cum erupt into my ass. He shuddered as he filled me up.
We remained like that for a few seconds before he stood up.
"Go and make us some coffee" he ordered his wife. "Me and lover boy here ain't finished yet".
She giddily left the room as I turned over on the bed. "Now you're going to suck" he ordered me.
For the rest of the afternoon, I had to please him (and sometimes her) in any way he saw fit. I got two mouthfuls of cum plus another bollock load in my ass before I was allowed to leave, but I loved every minute of it.
She forgot about the bill as well.