text:
|Numķro de publication
|Type de publication
|Numķro de demande
|Date de publication
|29 nov. 2011
|Date de dķp¶t
|31 juil. 2006
|Date de prioritķ
|7 juin 1995
|╔tat de paiement des frais
|Autre rķfķrence de publication
|Numķro de publication
|Julian Nikolchev, Dai Ton, Amy Thurmond
|Cessionnaire d'origine
|Conceptus, Inc.
|Exporter la citation
|BiBTeX, EndNote, RefMan
|Citations de brevets (285), Citations hors brevets (84), Rķfķrencķ par (5), Classifications (20), ╔vķnements juridiques (2)
|Liens externes: USPTO, Cession USPTO, Espacenet
This application is a continuation of U.S. patent application Ser. No. 10/846,047, filed May 14, 2004, which is a continuation of U.S. patent application Ser. No. 09/591,874, filed Jun. 12, 2000, now U.S. Pat. No. 6,871,650, entitled "Contraceptive Transcervical Fallopian Tube Occlusion Devices and Their Delivery", which is a continuation of U.S. patent application Ser. No. 08/474,779, filed Jun. 7, 1995, now U.S. Pat. No. 6,176,240, entitled "Contraceptive Transcervical Fallopian Tube Occlusion Devices and Their Delivery".
The present invention relates generally to contraception, and more particularly to intrafallopian contraceptive devices and nonsurgical methods for their delivery.
Worldwide demand exists for safe, effective methods of both contraception and permanent sterilization. Although a variety of contraception and sterilization methods are available, all of the existing methods have limitations and disadvantages. Thus, the need for additional safe, low cost, reliable methods of contraception and permanent sterilization, both in developed and less developed countries, is widely recognized.
Many presently available contraception methods require significant user involvement, and user non-compliance results in quite high rates of failure. While the theoretical effectiveness of existing contraceptives, including barrier methods and hormonal therapies, is well established, overcoming user noncompliance to improve overall efficacy has proven difficult.
One form of contraception which is less susceptible to user noncompliance is the intrauterine device (IUD). IUDs have been found to have higher rates of reliability, and are effective for a longer period of time, than most other commercially available contraceptives. Unfortunately, IUDs are also associated with serious infectious complications. For this reason, the use of IUDs within the United States has decreased dramatically. Additionally, IUDs are subject to unplanned expulsion, and must be removed due to excessive pain or bleeding in a percentage of cases, further reducing the acceptance of the IUD as a contraceptive method. Interestingly, the efficacy of copper IUDs appears to be higher than that of non-metallic IUDs. The reason for this has not been fully explained.
Commercially available options for permanent sterilization include fallopian tube ligation and vasectomy. These methods are surgical, are difficult to reverse, and are not available to many people in the world. It is common knowledge that fertilization occurs in the fallopian tubes where the sperm and ovum meet. Tubal ligation avoids this by complete occlusion of the fallopian tubes.
It has previously been proposed to reversibly occlude the fallopian tubes, for example, by in vitro formation of an elastomeric plug, or otherwise anchoring a device on either side of the narrowest region of fallopian tube, called the "isthmus." Such fallopian tube occlusion methods appear promising; however, an unacceptably high percentage of the non-surgical devices proposed to date have become dislodged during previous studies. Even where non-surgical intrafallopian devices have remained in place, they have been found to be only moderately effective at preventing conception.
For these reasons, it would be desirable to provide effective, reliable intrafallopian devices for contraception and sterilization. It would be particularly desirable to provide highly effective intrafallopian devices which did not require surgery for placement. It would be especially desirable if such devices and methods allowed easy placement of the device, but were less susceptible to being dislodged than previously proposed non-surgical intrafallopian devices.
The experimental use of a stainless steel intrafallopian device is described in Transcatheter Tubal Sterilization in Rabbits, Penny L. Ross, RT 29 "Investigative Radiology", pp. 570-573 (1994). The experimental use of an electrolytically pure copper wire as a surgical contraceptive intrafallopian device in rats was described in "Antifertility Effect of an Intrafallopian Tubal Copper Device", D.N. Gupta, 14 Indian Journal of Experimental Biology, pp. 316-319 (May 1976).
U.K. Patent Application Pub. No. 2,211,095 describes a uterine screw plug for blocking the fallopian tube. European Patent Application Pub. No. 0,010,812 describes a device for placement in the oviducts having enlargements at either end for anchoring the device. The same device appears to be described in Netherlands Patent No. 7,810,696.
The use of tubal occlusion devices is described in "Hysteroscopic Oviduct Blocking With Formed-in-Place Silicone Rubber Plugs", Robert A. Erb, Ph.D., et al., The Journal of Reproductive Medicine, pp. 65-68 (Aug. 1979). A formed-In-place elastomeric tubal occlusion device is described in U.S. Pat. No. 3,805,767, issued to Erb. U.S. Pat. No. 5,065,751, issued to Wolf, describes a method and apparatus for reversibly occluding a biological tube. U.S. Pat. No. 4,612,924, issued to Cimber, describes an intrauterine contraceptive device which seals the mouths of the fallopian tubes.
German Patent No. 28 03 685, issued to Brundin, describes a device for plugging a body duct with a device which swells when in contact with a body fluid.
Alternative contraceptive devices are disclosed in copending U.S. patent application Ser. No. 08/475,252, the full disclosure of which is herein incorporated by reference.
The present invention provides intrafallopian devices and methods for their placement to prevent conception. The intrafallopian devices of the present invention are transcervically delivered, resiliently anchored structures which are formed at least in part from copper to provide long term contraception, or alternatively permanent sterilization, without the need for surgical procedures or the increased bleeding, pain, and risks of infection associated with intrauterine devices (IUDs).
The use of copper in the intrafallopian device of the present invention improves its efficacy as a contraceptive method. Devices formed from plastically deformable materials, however, are less readily restrained in the fallopian tube. Apparently, the large variation in the actual shape and dimensions of fallopian tubes does not provide reliable anchoring for a pre-formed deformable intrafallopian device. The intrafallopian device of the present invention therefore comprises a resilient structure, usually a metallic coil, which includes a copper alloy, a copper plating, or copper fibers, ideally comprising an alloy including at least 75% copper. The coil material typically includes beryllium, zinc, stainless steel, platinum, a shape memory alloy such as Nitinol™, or the like. Preferably, the coil is composed of an alloy of beryllium and copper. Although the present device will generally result in occlusion, it need not completely occlude the fallopian tube to prevent the meeting of the sperm and ovum. Instead, the presence of the copper on the resilient structure is sufficient to provide effective contraception.
Conveniently, the present invention further comprises non-surgical placement of such intrafallopian devices by transcervical introduction. The resilient structure is restrainable in a straight configuration, e.g., by inserting the device within a catheter, greatly facilitating and reducing the risks of introduction. Thus, the cost and dangers associated with existing surgical contraceptive and sterilization procedures are avoided.
In a first aspect, a contraceptive intrafallopian device according to the present invention comprises a resilient structure having a proximal end and a distal end. The resilient structure comprises copper, and is biased to form at least one bend near the proximal end of the primary coil. Similarly, the resilient structure is also biased to form at least one bend near its distal end. These proximal and distal bends define an isthmus-traversing region therebetween. Preferably, the isthmus-traversing region also includes at least one bend, thereby helping to anchor the coil within the fallopian tube.
Generally, the resilient structure of the present intrafallopian device will be formed as a primary coil. To help restrain the coil within the fallopian tube, fibers are attached to some embodiments of the coil, the fibers optionally comprising a polyester material such as Rayon™, Dacron™, or the like. Alternatively, copper fibers may be used to increase the exposed copper surface area, the copper fibers generally having a diameter on the order of 0.001 inches.
The bends of the present intrafallopian device are generally formed as a secondary shape imposed on a primary coil. The primary coil is most easily formed as a straight cylindrical coil. The secondary shape will be imposed on the primary coil by bending, optionally heat treating the primary coil while bent. The individual bends may take a wide variety of forms, including sinusoidal curves, the individual loops of a continuous secondary coil, or the like. However, the secondary shape generally defines an overall width which is larger than the fallopian tube, so that the tubal wall restrains the resilient structure when it is released.
Preferably, each of the bends of the present intrafallopian device forms a loop in the primary coil when in a relaxed state. Ideally, the loops are separated by straight sections of coil. The alternating of loops with straight sections of coil forms a large diameter "flower coil," which provides a large relaxed overall width, and also features bends at tight radius, both of which promote retention. Conveniently, the primary coil generally has a diameter less than that of the fallopian tube, and can be restrained in a straight configuration for placement within the fallopian tube, typically by inserting the primary coil within a delivery catheter.
In another aspect, a contraceptive intrafallopian device according to the present invention comprises a resilient primary coil having a primary coil diameter. The primary coil comprises copper, and forms a secondary shape when in a relaxed state. The secondary shape defines a plurality of bends and an overall width which is larger than the primary coil diameter. Thus the primary coil can be easily anchored in a fallopian tube which is smaller in diameter than the secondary shape. Preferably, the present device reacts with a force sufficient to prevent axial movement of the device within the fallopian tube when restrained in a lumen having a diameter in the range between 0.5 mm and 3 mm. The actual anchoring force will depend on the shape of the coil and the modulus of elasticity of the material used.
In yet another aspect, a intrafallopian contraceptive delivery system according to the present invention comprises an elongate body in which the resilient primary coil described above is slidably disposed. A shaft is also slidably disposed within the elongate body and is located proximally of the primary coil. The distal end of the shaft includes a coil interface surface, while the elongate body restrains the primary coil in a straight configuration.
Preferably, a bend in the isthmus-traversing region of the present intrafallopian device, together with the proximal and distal anchor bends, restrains the resilient structure within the isthmus of the fallopian tube. The distal anchor is inserted into the ampulla, distal of the isthmus, while the proximal anchor is located in the ostium, proximal of the isthmus. Unintended movement of the device is further avoided by locating the isthmus-traversing region within the isthmus to resiliently impose anchoring forces against the tubal wall.
In a still further aspect, an intrafallopian contraceptive method according to the principles of the present invention comprises restraining a resilient structure in a straight configuration and transcervically inserting the resilient structure into a fallopian tube. The resilient structure is affixed within the isthmus by releasing a bent isthmus-traversing region. The bend of the isthmus-traversing region exerts a force against the wall of the fallopian tube, anchoring the device within the isthmus. Preferably, a distal anchor on the resilient structure is released distally of the isthmus, and a proximal anchor is released proximally of the isthmus, the distal and proximal anchors generally formed from bends in the resilient structure. Optionally, an electric current is applied through the resilient structure to the fallopian tube, thereby effecting permanent sterilization.
The present invention encompasses a contraceptive intrafallopian device which can alternatively be used as both a permanent and a reversible means of contraception. The present contraceptive methods and devices minimize the danger of non-use which has limited the efficacy of prior art contraceptive techniques. Moreover, the location of the present devices within the fallopian tubes provides a reduced risk of the infectious complications, increased bleeding, and pelvic pain associated with intrauterine devices (IUDs). Furthermore, the location and the novel shape of the present intrafallopian device provides significant advantages over IUDs, which have been found to be susceptible to unplanned expulsion and removal due to excessive pain and bleeding. The present invention takes advantage of the increase in effectiveness associated with copper IUDs, providing a resilient structure including copper which may be transcervically positioned without the need for surgery.
Although the present contraceptive method may be included within a group of contraceptive techniques generally referred to as fallopian tube occlusion methods, the present invention does not necessarily rely solely on blocking the fallopian tube to prevent fertilization. Instead, contraception is apparently provided by disrupting of ovum transport, the process of fertilization, and/or cleavage of the ovum. While the effect that copper has on these processes is not fully understood, it does appear that copper intrafallopian devices offer potentially significant increases in effectiveness over intrafallopian devices formed of other materials. Optionally, the present invention further encompasses devices which promote tissue growth within the tube to induce tubal occlusion, further inhibiting conception.
The present invention is anchored within the isthmus of the fallopian tube, overcoming the unintended expulsion of the device and the resulting failure of the contraceptive method. Such intrafallopian device expulsion has been the single greatest factor limiting the efficacy of easily positioned intrafallopian contraceptive techniques.
The present intrafallopian devices are generally elongate resilient structures preformed into secondary shapes. These secondary shapes will bias the resilient structure so as to provide strong forces against the lumen wall of the fallopian tube. Clearly, the secondary shape must have a larger outer diameter than the inner diameter of the fallopian tube.
Conveniently, the present resilient structures are insertable into a catheter, the catheter wall restraining the resilient structure in a straight configuration. As the resilient structure has an outer diameter when in the straight configuration which is less than the inner diameter of the fallopian tube, the catheter containing the present intrafallopian device is easily transcervically introduced. Moreover, the device is readily removed by snaring the resilient structure near the proximal end and pulling proximally on the resilient structure, thereby straightening the resilient structure and allowing it to be withdrawn without injuring the fallopian tube. Alternatively, an electrical current is applied to the device after it is at least partially releasing the fallopian tube, providing permanent sterilization.
Referring now to
The primary coil 12 of intrafallopian device 10 includes a proximal end 14 and a distal end 16. Between these ends, three loops 20 are formed, each having an inner diameter 22. Located between loops 20 are straight sections 24, which increase the overall cross-section of the intrafallopian device to an overall width 26. Preferably, inner diameter 22 is in the range from 2 mm to 10 mm, while overall width 26 is at least 6 mm, ideally being in the range from 8 mm to 40 mm. Distal and proximal ends 14, 16 each include an atraumatic endcap 18 to prevent injury to the fallopian tube.
Preferably, primary coil 12 is formed from a beryllium copper alloy wire. Beryllium copper provides the resilience necessary to avoid expulsion of the device, and also provides the increased effectiveness of a copper contraceptive intrafallopian device. Alternatively, primary coil 12 is formed from a resilient metal, such as stainless steel, platinum, a shape memory alloy, or the like. If such materials are used, primary coil 12 is preferably plated with copper or a copper alloy or otherwise has copper attached.
To further reduce the possibility of expulsion of intrafallopian device 10, fibers are optionally carried on primary coil 12. The fibers may be short individual fibers, or may alternatively be wound into primary coil 12. Preferably, the fibers comprise copper, thereby increasing the total copper surface area. Such copper fibers are preferably bonded to primary coil 12 with solder, brazing, a polymeric adhesive, or the like. Alternatively, polyester fibers such as Dacron™, Rayon™, or the like, are bonded to the surface of primary coil 12 using a polymeric adhesive. The polyester fibers promote increased tissue growth around the coil, thus further reducing the possibility of expulsion of the device from the fallopian tube.
A secondary shape has been superimposed on the primary coil to form intrafallopian device 10, the secondary shape comprising loops 20 separated by straight sections 24. This secondary shape is herein referred to as a "flower coil." The flower coil shape is particularly advantageous in that outer diameter 26 is substantially larger than the primary coil diameter, while the individual loops 20 have relatively small inner diameters 22 which will maintain the largest possible anchoring force against the fallopian tube. Minimizing inner diameter 22 also ensures that anchoring force is applied within the fallopian tube, despite the curvature of the fallopian tube.
Referring now to
In both embodiments of the present intrafallopian device 10, 30, at least one loop adjacent to the proximal end is disposed proximally of the narrowest portion of the fallopian tube, referred to as the isthmus. Similarly, at least one loop of the intrafallopian device is disposed distally of the isthmus. These proximal and distal loops act as anchors, helping to prevent proximal or distal movement of the intrafallopian device. In the embodiment of
Alternative intrafallopian device 30 may be positioned with multiple loops acting as proximal or distal anchors, or may alternatively have all but the proximal and distal anchor loops disposed along the fallopian tube to act as anchors within the lumen of that body. Advantageously, the embodiment of
Referring now to
Intrafallopian delivery catheter 50 receives the present intrafallopian device within the distal end of lumen 56 of elongate body 52. Lumen 56 has an inner diameter which is slightly larger than outer diameter 36 of the primary coil. The present intrafallopian device is therefore straightened to a straight configuration as it is loaded proximally into the distal end of lumen 56. Elongate body 52 is sufficiently strong to restrain the primary coil in the straight configuration, but must remain sufficiently flexible to allow maneuvering within the body lumen. Elongate body 52 is preferably formed from an inelastic, flexible material such as polyurethane, PET, or the like.
Referring now to
Use of the present contraceptive intrafallopian device will be described with reference to
After elongate body 52 extends past isthmus 80, guide wire 78 is removed. An intrafallopian device according to the present invention is inserted in the proximal end of elongate body 52, the intrafallopian device being restrained in a straight configuration by the elongate body. The device is advanced distally using shaft 54, the shaft and elongate body forming delivery catheter 50 (
Once delivery catheter 50 is properly positioned, elongate body 52 may be axially withdrawn. Shaft 54 axially restrains the intrafallopian device at the target location during withdrawal of elongate body 52, as described regarding
The present invention further encompasses permanent sterilization by passing a current through the shaft to the intrafallopian device after elongate body 52 has been partially withdrawn, but before the intrafallopian device is fully released. Fallopian tube tissue in contact with the intrafallopian device is dessechated, and thus attached to the present intrafallopian device. This action also causes permanent tubal damage, leading to the formation of scar tissue which encapsulates the intrafallopian device and causes permanent occlusion of the tubal lumen. Clearly, the resilient member/shaft interface must be conductive to allow the present non-surgical method of permanent sterilization.
In conclusion, the present invention provides a contraceptive intrafallopian device which may be positioned without surgery. While the above is a complete description of the preferred embodiments of the invention, various alternatives, modifications, and equivalents may be used. For example, a wide variety of secondary shapes, including open loops, continuous bends, sinusoidal curves, or the like, may be imposed on the primary coil. Therefore, the above description should not be taken as limiting the scope of the invention, which is defined instead solely by the appended claims.
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|Erb, R.A. et al., "Hysteroscopic Oviduct Blocking with Formed-in-Place Silicone Rubber Plugs," The Journal of Reproductive Medicine, pp. 65-68, Aug. 1979.
|Fischer, Michael E. et al., "Silicone Devices for Tubal Occlusion: Radiographic Description and Evaluation," Radiology (Jun. 1984).
|Free, Michael J. et al., "Technology for Mechanical Fallopian Tube-Blocking Device," Advances in Female Sterilization Techniques (Harper & Row 1976).
|Gordon, A.G., et al., Atlas of Gynecologic Endoscopy, Mosby-Wolfe Press, 2nd Edition, 1995 (Title Page and Table of Contents are enclosed herewith).
|Gupta, D.N. et al., "Antifertility Effect of an Intrafallopian Tubal Copper Device," Indian J. Exp. Biol., vol. 14, pp. 316-319, May 1976.
|Hamou, J. et al., "Hysteroscopic Placement of Nylon Intratubal Devices for Potentially Reversible Sterilization," The Fallopian Tube: Basic Studies and Clinical Contributions (1986).
|Hamou, J. et al., "Hysteroscopic Reversible Tubal Sterilization," ACTA Europaea Fertilitatis, vol. 15, No. 2, 1984.
|Hayashi, Motoyuki, "Ch. 28: Tubal Sterilization by Cornual Coagulation Under Hysteroscopy," Human Sterilization (Ralph Richart et al., eds. 1972).
|Hosseinian, Abdol "31: Hysteroscopically Delivered Tubal Plugs," Reversal of Sterilization (John Sciarra et al., eds. Harper & Row 1978).
|Hosseintan, et al., "Hysteroscopic Implantation of Uterotubal Junction Blocking Devices", Advances in Female Sterilization Techniques, 1976, Sciarra, et al., Eds., Harper & Row, New York, pp. 169-175.
|J.F. Huka & K.F. Omran, "Ch. 27: Cauterization for Tubal Sterilization," Human Sterilization (Ralph Richart et al., eds. 1972).
|Jay Cooper & Richard Houck, "Ch. 33: Study Protocol, Criteria, and Complications of the Silicone Plug Procedure," Female Transcervical Sterilization (Gerald Zatuchni, M.D. et al., eds., Harper & Row 1983).
|Jay M. Cooper, "Hysteroscopic Sterilization," Clinical Obstetrics and Gynecology, vol. 35, No. 2 (Jun. 1992).
|Kerin, J.F., "New Methods for Transcervical Cannulation of the Fallopian Tube," International Journal of Gynecology and Obstetrics, 51 Suppl. 1 (1995) pp. S29-S39.
|Leonard, Fred "Ch. 14: Polymer Implants," Female Sterilization (Ralph Richart et al., eds. 1972).
|Luukkainen, Tapani et al., "15: Five Years' Experience with the Nova-T and T-Cu IUDs," Intrauterine Contraception (Gerald Zatuchni et al., 1984).
|Malinak, Russell, M.D. et al., "Oviduct Occlusion Following Implanation of Proplast," Advances in Female Sterilization Techniques (John Sciarra et al., eds. Harper & Row 1976).
|Manganiello, Paul D. et. al., "A Bipolar Radiofrequency Catheter Fails to Occlude a Feline Uterine Horn: A Model for Fallopian Tube Occlusion," The Journal of the American Association of Gynecologic Laparoscopists, vol. 5, No. 3 (Aug. 1998).
|Medical News, "Hysteroscope simplifies sterilization," J. of Am. Med. Assn., vol. 225, No. 6 (Aug. 6, 1973).
|Neuwirth, Robert S. et al., "Hyesteroscopic Sterilization," Hysteroscopic Sterilization (John Sciarra et al. eds., 1974).
|Ovion, Inc.'s and Conceptus, Inc.'s, Joint Claim Construction and Prehearing Statement Pursuant to Patent Local Rule 4-3, Case No. C-02-3884 (MHP), filed in U.S. District Court Northern District of California, San Francisco Division, executed Aug. 6, 2003, pp. 1-5; Table 1, pp. 1; Table 2, pp. 1-67; Table 3, pp. 1-6; and Joint Claim Construction and Prehearing Statement Pursuant to Patent Local Rule 4-3, with Expert Reports, tabs 1-4 as exhibits.
|Ovion, Inc.'s Complaint for Patent Infringement; and Demand for Jury Trial, Case No. C-02-3884, filed in U.S. District Court Northern District of California, executed Aug. 13, 2002, pp. 1-5.
|Ovion's, Inc.'s Ovion's Reply to Amended Counterclaims of Conceptus; Demand for Jury Trial, Case No. -02-3884, filed in U.S. District Court Northern District of California, executed Oct. 25, 2002; with Proof of Service, pp. 1-12.
|PCT Notification of Transmittal of International Preliminary Examination Report, PCT/US98/20031 dated Jun. 30, 2000, 5 pages.
|PCT Notification of Transmittal of the International Preliminary Examination Report, PCT/US96/07486 dated Sep. 8, 1997.
|PCT Notification of Transmittal of the International Search Report or the Declaration PCT/US96/07483 dated Sep. 5, 1996, 5 pages.
|PCT Notification of Transmittal of the International Search Report or the Declaration PCT/US96/07486 dated Sep. 5, 1996, 4 pages.
|PCT Notification of Transmittal of the International Search Report, PCT/US98/20031 dated Jan. 20, 1999, 5 pages.
|PCT Written Opinion PCT/US96/07483 dated Jul. 20, 1997, 4 pages.
|PCT Written Opinion PCT/US96/07486 dated May 19, 1997, 4 pages.
|PCT Written Opinion, PCT/US98/20031 dated Aug. 31, 1999, 4 pages.
|Quinones et al., "Hysteroscopic Sterilization", Int. J. Gynecol. Obstet., 1976, 14:27-34.
|Quinones, Rodolfo et al., "Tubal Electrocoagulation Under Hysteroscopic Control," Hysteroscopic Sterilization (John Sciarra et al., eds. 1973).
|Reed, T.P. et al., "Tubal Occlusion with Silicone Rubber," The Journal of Reproductive Medicine, pp. 25-28, Jul. 1980.
|Request for Interference with U.S. Patent No. 6,096,052 under 37 CFR¦ 1.607 and Second Preliminary Amendment, filed on Oct. 3, 2001 with US Patent Office.
|Richard Houck & Jay Cooper, "Hysteroscopic Tubal Occlusion With Formed-InPlace Silicone Plugs: A Clinical Review," Obst. & Gyn., vol. 62, No. 5 (Nov. 1983).
|Richart et al., "Evaluation of Polymer Flock and Metal Alloy Intra-Tubal Device in Pigtail Monkeys", Contraception, 1978, 18(5):459-468.
|Risquez, F., et al., "Transcervical Tubal Cannulation, Past, Present, and Future" Fertility and Sterilization, Centro Medico Docente La Trinidad, Caracas, Venezuela, and Mount Sinai Hospital Medical Center and Rush Medical College, Chicago, IL, vol. 60, No. 2, Aug. 1993 pp. 211-226.
|Robert Neuwirth, Richard Levine, and Ralph Richart, "Hysteroscopic tubal sterilization," Am. J. of Obst. and Gyn., vol. 116, No. 1 (May 1, 1973).
|Ross, P.L. et al., "Transcatheter Tubal Sterilization in Rabbits," Investigative Radiology, vol. 29, No. 5, pp. 570-573, 1994.
|Schmitz-Rode, Thomas et. al., "Experimental Nonsurgical Female Sterilization: Transcervical Implantation of Microspindles in Fallopian Tubes," Journal of Vascular and Interventional Radiology, vol. 5, No. 6 (Nov.-Dec. 1994).
|Sciarra, "Heteroscopic Approaches for Tubal Closure", Research Frontiers in Fertility Regulation, 1980, Zatuchni, et al., Eds. Harper & Row, New York, pp. 270-286.
|Sciarra, J.J., et al., eds., Advances in Female Sterilization Techniques, Harper & Row, Publishers, 1976, Title page and Table of Contents are enclosed herewith, pp. 169-181, 186-189.
|Sciarra, John "26: Hysteroscopic Approaches for Tubal Closure," Fertility and Sterility: Official J of the Am. Fertility Soc., vol. 34, No. 5 & 6 (1980).
|Sonmez et al., "Sterilization with fibrin sealant in a rabbit uterine horn model," Am J Obstet Gynecol., vol. 177, issue 3, 1997, pp. 573-578.
|Steptoe, P.C., "Potential Use of Intratubal Stents for Reversible Sterilization," Laaroscopy, pp. 91-99, circa 1976.
|Sugimoto, Osamu, "Hysteroscopic Sterilization by Electrocoagulation," Hysteroscopic Sterilization (John Sciarra et al., eds., 1973.
|Swope, C.H. "Ch. 23: Production of Clinically Useful Interactions of Laser Radiation With Tissue," Human Sterilization (Ralph Richart et al., eds. 1972).
|Theodore Reed & Robert Erb, "Hysteroscopic Tubal Occlusion With Silicone Rubber," Obst. & Gyn., vol. 61, No. 3 (1983).
|Thompson, Horace et al., "Evaluation of Experimental Methods of Occluding the Uterotubal Junction," Female Sterilization: Prognosis for Simplified Outpatient Procedures (Gordon Duncan et al, eds. 1972).
|U.S. District Court California Northern District Civil Docket for Case #:3:02-cv-01968 MHP, pp. 1-10.
|U.S. District Court California Northern District Civil Docket for Case #:3:02-cv-03884, pp. 1-8.
|U.S. District Court California Northern District, Case #09-cv-02280 WHA, Hologic Inc.'s First Amended Invalidity Contentions, Jan. 22, 2010, 31 pages.
|U.S. District Court California Northern District, Case #09-cv-02280 WHA, Hologic Inc.'s Invalidity Contentions, Jan. 4, 2010, 70 pages.
|V. Rimkus & K. Semm, "Hysteroscopic Sterilization-a Routine Method?" Int'l. J. Fertility vol. 22 (1977).
|V. Rimkus & K. Semm, "Hysteroscopic Sterilization—a Routine Method?" Int'l. J. Fertility vol. 22 (1977).
|Vancaillie, et al, "A New Method of Transcervical Female Sterilization: Preliminary Results in Rabbits," Fertility and Sterility vol. 51, No. 2, Feb. 1989, pp. 335-338.
|Wilson, E.W., "Sterilization" BailliĶre's Clinical Obstetrics and Gynecology, vol. 10, No. 1, Apr. 1996, pp. 103-119.
|Wilson, E.W., "The Evolution and Methods for Female Sterilization", International Journal of Gynecology & Obstetrics 51 Suppl. 1 (1995) S2-S13.
|Zipper, J. et al., "Supression of fertility by intrauterine copper and zine in rabbits," Am. J. of Obstetrics and Gynecology (Oct. 15, 1969).
|Brevet citant
|Date de dķp¶t
|Date de publication
|11 nov. 2011
|11 dķc. 2012
|Conceptus, Inc.
|Occlusion devices and methods
|11 nov. 2011
|22 janv. 2013
|Conceptus, Inc.
|Occlusion devices and methods
|7 mai 2012
|24 dķc. 2013
|Conceptus, Inc.
|Occlusion devices and methods
|20 ao¹t 2012
|27 mai 2014
|Bayer Essure Inc.
|Occlusion devices and methods
|19 nov. 2012
|27 mai 2014
|Bayer Essure Inc.
|Occlusion devices and methods
|Classification aux ╔tats-Unis
|128/830, 128/831
|Classification internationale
|Classification coopķrative
|Classification europķenne
|16 janv. 2014
Owner name: BAYER ESSURE INC., CALIFORNIA
Free format text: CHANGE OF NAME;ASSIGNOR:CONCEPTUS, INC.;REEL/FRAME:032075/0466
Effective date: 20131025
|29 mai 2015
|Fee payment
Year of fee payment: 4


text:
Pinterest is the latest social media craze and seems to have the web all aflutter. It is currently the web's second fastest growing site — of any kind, having gone past the ten-million user mark just a month after launching.
This latest social media platform goes far beyond simply just sharing or liking things of interest. It allows users to collaborate on various projects or topics of interest.
From creating a mood board for your home renovations to keeping tabs on the latest trends and things you just can't live without — Pinterest allows you to literally pin various items onto your pinboard to mix and match, keep for later or share and get the opinions of others.
You can also use this as a new way of expressing yourself by creating a board and pinning things to it that you feel are a good reflection of who you are. Think of it as a visual representation of yourself, or various aspects of your life.
Some eyebrows may be a little crossed at this stage — perhaps we should go back to the basics and explain how everything works:
What are "Pins"
A pin is any image that is added to your online pinboard which can be linked from the web or uploaded. You can add captions, notes , doodles or big bold type and lots of exclamation marks if the pin of interest is something you've had your eye on for a while and you're trying to persuade a certain someone to spoil you with it. You can then share it with them, in case they needed a helpful hint.
Ok, so where do I "pin things"?
Your pinboard is where you group related pins. Think mind-map, mood-board or collage. You can have separate pinboards for different categories. So for instance you could have one for the new kitchen you're busy redoing, the bedroom you always wanted, cool tech ideas, articles or gadgets, design, gift ideas, recipes, or even just fun things you like and want to keep tabs on.
Great, so how do my friends and I share or collaborate on our Pinterests?
You can share content by the act of "repinning" — essentially this is when you pin something to your board that has been pinned on someone else's. This is a way to collaborate with your followers as well as uncover new ideas. Yes it's an open platform. People will be stealing with their eyes so watch out. I wouldn't use this as a platform to put together your biggest client's marketing strategy or as a platform for gathering your thoughts for your next great design idea.
In terms of collaboration the possibilities are endless and it's been said that Pinterest's future success lies in its capabilities in this regard. Adding contributors to one of your pinboards will let you work together to plan an event (from a hen's party to a corporate function) or collect research and information for a long-term project.
At this stage the Pinterest, in its infancy, is being used predominantly for personal projects and doesn't seem to have much business-focused marketing yet. It's also interesting that the platform is dominated by women. Surprising? Not really. When did you last see a guy making a scrapbook for his dream wedding, next big bash or child's graduation? Exactly.
However this is a very viable and easily accessible platform and looking at the business success of Facebook, I'm pretty sure we can expect this aspect of the platform to take off pretty soon.
And wait, there's more
Browser Bookmarking and adding price information is another cool aspect of this platform as it allows you to add a bookmark to your Web browser so you can pin images from other sites.
For example, if you're shopping online (say at H&M or Zara #todiefor) you can click the bookmark to create a pin of that image. This will automatically link the photo to the retail website, so someone can find out more info on the specific product if they 'like'. Its always nice to know how much money you're letting yourself in for, no matter how shiny and pretty something may be. Adding price information to the pin will show that item's cost whenever someone hovers their mouse over the picture on your pinboard.
So how do I get started?
Currently Pinterest is only open to invited users. Yeah, it's elite like that. You can request an invite at www.pinterest.com though and they're not too snooty so you can expect an invite to be in your inbox within a day or two.
Gone are the days of scrapbooking and keeping hard copy files of things we like, want or need. Now we can just pin them directly off the site where we most probably found them in the first place and "cloud" them together for when we need them. Or just want to pass time by looking at pretty desirable trinkets.
Forget spinning. Try pinning!
Worth checking out this presentation I put up recently on Slideshare. Pretty exhaustive run down of stats, facts, demographics and insights. Hope you find useful.
I don't see any mention of the requirement in Pinterest's Terms of Service that requires that any content you pin must either be owned by you or you have obtained permission to Pin It from the creator.
No South African App? and what about TOP12WINES and Powertime for BBZ10?
Everything you need to know about Cape Town's water rationing
Videos of little girl robbing women in Cape Town goes viral on Facebook
When will Cape Town run out of water? This tool imagines the scenarios
Sexual assault accused Bryan Singer deletes Twitter, online articles removed
Viral video: Johannesburg Metro police officer attacked in Hillbrow
Facebook evens the playing field by discontinuing 'dark posts'
'Cape of Storms to Come' uncovers the origins of Cape Town's water crisis
DStv launches VOOV's 'world first' live streaming social channel
TWR #130: SA Black Friday deals, Silicon Valley, Battlefront 2, and more
Netflix survey suggests users are unashamed of watching in public
Memeburn focuses on everything digital in the emerging markets sphere. More about us here

subset: commoncrawl


text:
AT&T's HTC Vivid ready for Android Ice Cream Sandwich
ATT says owners of HTC Vivid phones can now update to the Ice Cream Sandwich version (4.0) of Android.
It's the first update of the mobile operating system to be issued by a wireless carrier, ATT says. Google, which developed Android, released 4.0 late last year, but few devices run on the latest version.
Several other ATT devices will be receive an upgrade in the coming months: LG Nitro, Motorola ATRIX 2, Motorola ATRIX 4G, Pantech Burst, Pantech Element, Samsung Captivate Glide, Samsung Galaxy Note, Samsung Galaxy S II, Samsung Galaxy S II Skyrocket and Samsung Galaxy Tab 8.9.
Starting today, customers can download the update via Wi-Fi by visiting www.att.com/vividupdate. If Wi-Fi is not available, you can download it to a PC and install it on the phone.
HTC Vivid customers who have not downloaded by March 23 will receive a text message alerting them of the new software.
Verizon Wireless previously announced its list of phones and tablets that will upgrade to 4.0. The list can be found here.
Other HTC models across all carriers that will upgrade to 4.0 include Sensation 4G, Vivid, Amaze 4G, EVO 3D, EVO Design 4G, Rhyme, Thunderbolt, Droid Incredible 2 and HTC Rezound.
Motorola says the following models will be upgraded throughout the year: Droid Razr, Motorola Razr, Droid 4, Droid Bionic, Atrix 2 and the Photon 4G smartphones and Droid Xyboard 10.1 and 8.2 tablets.


text:
Dr. Michel Giunta,
- Over 20,000 ocular procedures
Educational Background
Dr. Michel Giunta completed his medical degree at the University of Montreal, followed by a specialization in eye surgery also at the University of Montreal. Following his residency in ophthalmology, Dr. Giunta did a mini-fellowship in glaucoma at Montreal's Maisonneuve-Rosemont Hospital, and a fellowship in vitreo-retina disease and surgery through Toronto's Western Hospital and the University of Toronto.
Refractive Experience
Dr. Giunta has more than 15 years of experience in intraocular and refractive surgery and has performed thousands of ocular procedures. He has been a staff surgeon and retina specialist in the department of surgery, division of ophthalmology, at the Centre Hospitalier Universitaire de Sherbrooke (CHUS) since 1994. Dr Giunta is also a professor of clinical training at CHUS, and served as director of ophthalmology.
In addition to his professional duties, Dr Giunta remains active in academia. He has lectured on the topics of intraocular injections and retinal emergencies, and conducted research on macular degeneration and diabetic retinopathy.
Associations and Professional Memberships
- Canadian, American and European Societies of Cataract and Refractive Surgery
- Canadian Ophthalmological Society
- American Academy of Ophthalmology
- Royal College of Physicians and Surgeons
- Canadian Glaucoma Society
- American Board of Ophthalmology
- American and European Societies of Retinal Surgeons


text:
State-Licensed Investigative Agency
A VERY PRIVATE EYE is a state-licensed investigative agency, specializing in litigation support and due diligence inquiries. AVPE has, over the years, built a strong and trusted reputation throughout the local legal and business community.
As a total source firm, AVPE offers progressive solutions to meet clients' needs. All of the company's investigators are also individually licensed by the State of Florida and have been subjected to intensive screening prior to their
employment. The staff brings a diverse representation of experience to AVPE.
The quality to our work product is unmatched by the majority of the competitors in the markets that we serve. The AVPE staff is a proven commodity and is prepared to complete your assignment with professionalism, integrity, and the utmost consideration to your needs.
Office: 407.273.6646
Fax: 866.687.8880
3936 S. Semoran Blvd. #487
Orlando, FL 32822
Service Areas: All of Florida
FL Agency License: A 2900131
Oliver W. "Ollie" Phipps is a University of Central Florida graduate and former U.S. Air Force OSI Special Agent. He has been in the investigation industry for almost 30 years. During his four years with OSI, Ollie served with detachments in Austin, TX, Manila, PI a nd Cocoa Beach, FL. While the OSI was responsible for major investigations into crime and counter-intelligence, Ollie specialized in fraud inquiries. He worked cases with all the federal law enforcement agencies and many state and local ones as well.
As a Florida state-licensed Private Investigator, Ollie supervised and conducted a variety of investigations, specializing in surveillance. He has performed hundreds of disability cases, featuring both videotaped and digital still photographic evidence. Ollie has also completed many domestic surveillances, background and asset checks, discharged accident investigations, directed due diligence evaluations and carried out undercover work in a variety of matters.
Ollie is also a partner of American Security Systems International, Inc., an investigative firm based in Asia. They offer due diligence and intellectual property protection inquiries and enforcement services. Long-term clients include Gucci, Salvatore Ferragamo, Omega, Cartier, and Adidas, among others.
AVPE's investigative staff is prepared to provide competent and thorough investigative support to the legal community.
AVPE adheres to the strictest possible code of ethics in all investigations. Chapter 493 F.S. legislates confidentiality and professionalism in the conduct of licensed inquiries.
Investigators are trained and educated on traditional and current investigative methods and trends. AVPE is prepared to assist you in every step of your case preparation.
AVPE has experience supporting litigation involving commercial disputes, family matters, personal injury, insurance fraud, and general and premises liability investigations.
- Litigation Support Services
- Witness Location and Interviewing
- Recorded and Written Statements
- Scene Investigations
- Asset Searches and Judgment Recovery
- Liability/General Litigation Investigations
- Records Research
Personal relationships are a sensitive area for many clients. Members of the investigative staff are compassionate and sensitive towards the needs of both the client and the case at hand. Professionalism allows AVPE to maintain objectivity and make calm assessments on behalf of all clients.
Why choose A Very Private Eye?
- Because we only have a two hour minimum on field work
- Because we customize our surveillance schedule according to our clients' needs
- The agency's president is a former Federal Agent & has decades of experience as a PI
Before you commit, ensure you know to whom and what you are committing! AVPE will help you make an informed decision through a unique background check service. Discretion is maintained at all times for the protection and privacy of our clients.
Infidelity Investigations
AVPE clients are guaranteed discrete and professional investigations. No matter what the circumstances, clients can be assured of one thing: AVPE will find the truth! Staff members are available to help you find peace of mind, any time, any day.
Parenting Plan (Custody) Investigations
AVPE's proven methods are designed to assist clients in establishing the facts necessary to gain or modify a parenting plan or custody. AVPE will work with your attorney to specifically manage your case in the way that will guarantee maximum effectiveness.
Debtor location and Asset research
AVPE can assist in tracking down debtor individuals and firms. Asset research can reveal tangible assets, such as property and vehicles, and financial holdings, such as bank and portfolio accounts.
Fact-Finding and Due Diligence
The investigative staff is thoroughly experienced in the research and intelligence-gathering methods necessary to help insure you have the basis for sound decision making.
Competitive Intelligence
Does your success hinge upon staying one step ahead of the competition? AVPE has the proper sources and methods necessary to keep you informed of your rivals' activities.
Employee Misconduct Investigations
AVPE is pleased to offer discrete and aggressive internal investigations for business clients. Avoid the pitfalls of privacy concerns. AVPE can provide undercover agents to assist in ferreting out ongoing fraud or embezzlement. AVPE has closely affiliated specialists, such as a forensic accountant, a polygrapher, and a computer forensics expert, that can be called in when necessary. AVPE will handle these matters for you, and leave you free to focus on the business at hand, your business.
Pre-Employment Screening
Shrinkage, loss, and workplace violence can be mitigated and often prevented through proper employee screening. Avoid the pitfalls of the Fair Credit Reporting Act (FCRA). AVPE staff will prepare a screening package tailored to your needs. Packages may include criminal, civil, and credit searches, as well as a detailed verification of references, work history, financial status, and education.
Technical Surveillance Counter Measures (TSCM) Sweeps
Are you being bugged? Insure the privacy of your communications by contracting AVPE to do an electronic sweep of your home, business, car, airplane, or yacht. The founder of AVPE is a former government wiretap expert and can find those bugs for you. A room or telephone can be bugged for as little as $50 from parts purchased at an electronics store.
Need to know what has been written on or what sites have been visited? Need to know who your employee/spouse/child is communicating with on the internet? AVPE has a closely affiliated computer forensic examiner who can recover deleted files, track internet and email usage, and uncover other potential items of interest or liabilities on your computers.
"Oliver and the team at AVPE are a benchmark for discretion & professionalism, and have supreme competency in the field of private investigation. The investigator that was assigned to our [my] case was experienced and attentive to our [my] needs, and we [I] always knew we [I] could pick up the phone and get a hold of them, or Oliver and his management team at all times. When EVERYTHING is on the line things need to be done right the first time, AVPE needs to be your first call."
– Dennis L., President & C.E.O. of Night Auditors
"I wanted to share this note with you and your team regarding your recent operation. You and your team's persistence acquired evidence needed to reveal and defend against secret plans with another man to move my young kids away from their father. Besides several other trips to visit him in remote parts of the nation, the subject returned to Orlando again and you ultimately caught the clear video evidence we needed. These individuals had been engaged in adultery elsewhere every month for over 7 months. Your professional help delivered. Please give my thanks and gratitude to your team in really bringing this home in the last critical hours."
– Father of 4 and 6 year old children


text:
Does it mean "in an improper time (makes his image) as extremly greedy and in a fine day as filshy rich"?
And what does "Spock-like mind" mean?
Here's the problem: the one time in his cautious, careful, risk-averse candidacy that Romney gambled, he lost. Putting Paul Ryan on the ticket has been a disaster. Ryan's budget ideas -- voucherizing Medicare, privatizing Social Security, gutting education and giving tax breaks to the rich -- are toxic. The Romney-Ryan budget plan has cemented Romney's image as Gordon Gekko on a bad day; Thurston Howell III on a good one.
Romney's aides are right when they tell the press a debate is a series of moments, and they are wise to try to craft some moments. But they are fools for telling The New York Times: "(Romney's) strategy includes luring the president into appearing smug or evasive about his responsibility for the economy."
First, let me assure you our president reads The New York Times and has almost certainly deployed his Spock-like mind on avoiding smugness or evasion. Any strategy that relies on your opponent to err is a hope, not a strategy.
Debate advice: Obama, light a cig; Romney, throw deep - CNN.com
Student or Learner


text:
John Petrucci's soloing style incorporates many different elements. One element he seems to always go back to is his love of throwing chromatic lines within his solos.
This kind of a guitar lick can really create a lot of tension when used properly within a solo. It creates a sense of total chaos.
The key to learning this guitar lick and incorporating it into your playing is to understand how it can be understood as a bunch of smaller repeating elements. Most very complicated licks can be understood this way in some shape or form.
If you watch the whole video guitar lesson you should easily be able to create similar chromatic lines yourself.
Download the FREE TAB PDF for this lesson below.
John Petrucci Style Chromatic Scales TAB PDF
Hope you have fun with this one. After you get the patterns down it also makes a great alternate picking exercise. 😀
If these free lessons help you, please donate to keep new ones coming daily. Thanks!! 🙂


text:
The Australian dollar fell against its US counterpart today after the Chinese trade balance demonstrated an unexpected surplus. The currency extended its rally versus the Japanese yen.
China's trade surplus had a negative impact on the Aussie. The surplus was caused not just by rising exports, but also by the bigger-than-expected decline of imports. It was bad for Australia as most of nation's goods are sold to the Asian country.
AUD/USD fell from 1.0264 to 1.0236 as of 15:28 GMT today. AUD/JPY rose from 97.32 to 98.21 and its daily high was at 98.89 — the highest since August 2008.
If you have any questions, comments or opinions regarding the Australian Dollar, feel free to post them using the commentary form below.


text: So I just got this preamp... BRAND NEW! But old. The instructions included seem kind of vague. The online instructions don't seem to match up with some things. {} Included: (2) 500k audio pots (center detent), a B50K pot (center detent), a pan pot, a 25k pot, a TCT unit, a box with green wires, a 30k micro pot, 2 cards with resistors and caps taped on. So basically, I'd like to know... What's the box with the green wires used for? Why does the one pot (B50k) have resistors attached? {} From what I can gather, I believe that the resistor'd pot was supposed to be a B25k, but they ran out, so this got replaced. I also guess that the A25k pot is the volume, after the pre section and before the jack. So another question is, if I wanted to run a passive tone control, can I do it? I have a stacked 25k audio pot, so I thought it may be able to be run post-preamp (oxymoron?), but wasn't sure. Any help would be very much appreciated.


text:
IWC competes against tough competition at ISU
The Iowa Wesleyan College track and field teams competed at the Iowa State University Open on Saturday.
More than 40 teams competed in the meet, including ISU and Drake, as well as 16 other Iowa schools.
The Tigers competed well in the high-caliber meet that included many NCAA All-Americans from each division as well as several elite post-collegians.
Michael Klostermann opened up on his specialty, the hurdles, for the first time this season. Klostermann ran to a 48th place finish in the 60-meter hurdle prelims. He later came back and ran the 400-meter dash, finishing 72nd overall and clocking in at 55.20 seconds.
Duane Lee also had a strong meet for the Tigers. Lee's top run came in the 400-meter dash, in which he closed hard down the stretch to take third in his heat. Lee's time of 52.29 seconds placed him 48th overall in the event. Lee also competed in the 60-meter dash, running 7.26 seconds, good for 39th in the prelim.
Jaimee Crosby ran strong for the IWC women, competing in the 600-yard run and the 400-meter dash. Crosby competed for the Tigers for the first time this season on Saturday, running strong in a tough double for the day. In the 600-yard run, Crosby finished 48th overall (1:47.08). She followed that up by finishing 67th in the 400-meter dash (1:13.83).
"It was a great opportunity to run at a high-caliber meet against top-notch competition," Head Coach Tad Hulst said. "We competed well, and now we have a week off so we can put in some quality work to fine-tune some things."
The Tigers return to action on Saturday, Feb. 2 when they travel to Cornell College in Mt. Vernon. The meet is scheduled to start at 10 a.m.


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Artist description:
People sent me messages asking if he was sad or angry. The Idea here is that he has ripped out his wings, obviously he doesn't like who he is, or something represented by the wings on his back. No, I did not get this idea from Xmen.
Flash Draw Created Mar 18, 2008 470 x 338px Unless noted Copyright 2008 joyproject.
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people like you amaze me cuz I cant draw half as good with the old drawing stuff and wut im saying is u r awesome at drawing
WOW! your art is just amazing!!
kool! 5
Did you do the same one on deviantart?...perfect! 10
the expression is so strong...i feel his agony...10 + fav
it's beautiful. to me it's like he's very unpleased with himself. he's trying to change that in a way. great metaphore.
this speaks so loudly, love the idea! :)
this is extremely good i love your style its a,azing lol :D 10
this sorta makes me sad. good job!
really gooddd