text:
|Publication number
|Publication type
|Application number
|Publication date
|Dec 12, 2000
|Filing date
|Nov 10, 1998
|Priority date
|Oct 19, 1994
|Fee status
|Also published as
|Publication number
|Bradly A. Jendersee, Robert D. Lashinski
|Original Assignee
|Medtronic Ave, Inc.
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (14), Referenced by (81), Classifications (9), Legal Events (5)
|External Links: USPTO, USPTO Assignment, Espacenet
This application is a division of U.S. patent application Ser. No. 08/478,192, filed Jun. 7, 1995, now U.S. Pat. No. 5,836,965, which is a continuation-in-part of U.S. patent application Ser. No. 08/326,023, filed on Oct. 19, 1994, abandoned.
This invention relates to medical implant devices. More specifically, the invention relates to a stent encapsulated by an expandable balloon for delivery and deployment in narrowing coronary or peripheral vessels in humans.
Cardiovascular disease, including atherosclerosis, is the leading cause of death in the U.S. The medical community has developed a number of methods and devices for treating coronary heart disease, some of which are specifically designed to treat the complications resulting from atherosclerosis and other forms of coronary arterial narrowing.
An important development for treating atherosclerosis and other forms of coronary narrowing is percutaneous transluminal coronary angioplasty, hereinafter referred to as "angioplasty" or "PTCA". The objective in angioplasty is to enlarge the lumen of the affected coronary artery by radial hydraulic expansion. The procedure is accomplished by inflating a balloon within the narrowed lumen of the coronary artery. Radial expansion of the coronary artery occurs in several different dimensions, and is related to the nature of the plaque. Soft, fatty plaque deposits are flattened by the balloon, while hardened deposits are cracked and split to enlarge the lumen. The wall of the artery itself is also stretched when the balloon is inflated.
Angioplasty is typically performed as follows: A thin walled hollow guiding catheter is introduced into the body via a relatively large vessel, such as the femoral artery in the groin area or the brachial artery in the arm. Once access to the femoral artery is achieved, a short hollow sheath, or guiding catheter, is inserted to maintain a passageway during the procedure. The flexible guiding catheter must negotiate an approximately 180 degree turn through the aortic arch to descend into the aortic cusp where entry may be gained to either the left or the right coronary artery, as desired.
After the guiding catheter is advanced to the area to be treated by angioplasty, a flexible guidewire is inserted into the guiding catheter through an expandable balloon (described infra) and advanced to the area to be treated. The guidewire is advanced across the lesion, or "wires" the lesion, in preparation for the advancement of a balloon catheter having an expandable balloon portion composed of polyethylene, polyvinyl chloride, polyolefin, or other suitable substance, across the guide wire. Currently, most balloons utilize two folded wings wrapped around the hollow catheter tube. The balloon catheter is placed into position by sliding it along the guide wire. The use of the relatively rigid guide wire is necessary for steerability to advance the catheter through the narrowed lumen of the artery and to direct the balloon, which is typically quite flexible, across the lesion. Radiopaque markers in the balloon segment of the catheter facilitate positioning across the lesion. The balloon catheter is then inflated with contrast material to permit fluoroscopic viewing during treatment. The balloon is alternately inflated and deflated until the lumen of the artery is satisfactorily enlarged.
Unfortunately, while the affected artery generally can be enlarged, in some instances the vessel restenoses chronically, or closes down acutely, negating the positive effect of the angioplasty procedure. In the past, such restenosis has frequently necessitated repeat PTCA or open heart surgery. While such restenosis does not occur in the majority of cases, it occurs frequently enough that such complications comprise a significant percentage of the overall failures of the PTCA procedure, for example, twenty-five to thirty-five percent of such failures.
To lessen the risk of restenosis, various devices have been proposed for mechanically keeping the affected vessel open after completion of the angioplasty procedure. Such mechanical endoprosthetic devices, which are generally referred to as stents, are typically inserted into the vessel, positioned across the lesion, and then expanded to keep the passageway clear. Effectively, the stent overcomes the natural tendency of the vessel walls of some patients to close back down, thereby maintaining a more normal flow of blood through that vessel than would be possible if the stent were not in place.
Various types of stents have been proposed, including self-expandable and expandable stents, although to date none has proven completely satisfactory. Expandable stents generally are conveyed to the area to be treated on balloon catheters or other expandable devices. For insertion, the stent is positioned in a compressed configuration along the delivery device, such as a balloon catheter defining a balloon with two folded and wrapped wings, to make the stent diameter as small as possible. After the stent is positioned across the lesion, it is expanded by the delivery device, causing the length of the stent to contract and the diameter to expand. Depending on the materials used in construction of the stent, the stent maintains the new shape either through mechanical force or otherwise.
One such expandable stent for delivery on a balloon catheter is the Palmaz stent (U.S. Pat. No. 4,733,665) which may be thought of as a stainless steel cylinder having a number of slits in its circumference, resulting in a mesh when expanded. The stainless steel cylinder is compressed onto the outside of a non-expanded balloon catheter which includes stent retainer rings at each end of the stent to help to maintain the stent on the balloon. Also, it is advisable to place a sheath over the compressed stent and balloon assembly to retain the stent on the balloon and to create an even outer surface on the assembly for negotiation through the narrowed vessels. Boneau U.S. Pat. No. 5,292,331 provides a unitary wire-like stent structure configured to form a plurality of upper and lower axial peaks, and is delivered and expanded in a similar manner.
Significant difficulties have been encountered with deployment of known prior art stents, including difficulty in maintaining the stent on the balloon and in achieving symmetrical expansion of the stent when deployed. Currently, some stent delivery systems retain the stent on the delivery catheter by means of either (a) plastically deforming the stent so that it is crimped onto the balloon, or (b) having the stent exhibit a small enough internal diameter to act as an interference fit with the outside diameter of the balloon catheter. The disadvantage with these methods is that the limited amount of securement between the stent and the balloon is not always adequate to insure that the stent will properly stay in place while advancing the stent to and through the target lesion. Additionally, the outer surface of the delivery device is uneven because the stent generally extends outwardly beyond the balloon and may contact a narrowed vessel wall and be displaced while the catheter negotiates a narrowed vessel. Most known expandable stent delivery systems utilize a removable sheath system on the outside of the stent, with or without retainer rings, that is removed once the stent is at the delivery site. This method protects the stent and provides a smooth surface for easier passage through vessels, but the method increases the crossing profile of the delivery device thereby decreasing the device's ability to track through narrowed and tortuous vasculature. This and other complications have resulted in a low level of acceptance for such stents within the medical community, and to date stents have not been accepted as a practical method for treating chronic restenosis.
A long felt need exists for a delivery and deployment method for stents which ensures positional stability of the stent during delivery without the need for an external sheath, thereby substantially decreasing the cross sectional profile of the balloon delivery device, and ensures symmetrical expansion of the stent at deployment.
The stent delivery and deployment method of this invention provides a frozen-in balloon in intimate contact with, and/or surrounding, a stent to assure stent attachment to the balloon, i.e. excapsulation. This method is especially valuable at the proximal and distal ends of the stent for delivery purposes because a smoother transition occurs between the distal and proximal surfaces of the balloon catheter and the distal and proximal ends of the stent, and it also is effective along substantially the entire length of the stent. The frozen-in balloon form is achieved by encapsulating the stent so that the balloon may expand part way around the stent and adhere thereto. The preferred method of encapsulating the stent and balloon includes the steps of compressing the stent on the outside or the balloon, placing a sheath over the compressed stent to prevent expansion, and exposing the sheathed stent and balloon to an elevated temperature while pressurizing the balloon. The elevated temperature and pressurization causes the balloon to expand from below the stent to fill at least some of the spaces between the stent and the sheath. Following expansion and exposure to an elevated temperature, the balloon and stent are cooled while maintaining pressure in the balloon, so that the balloon profile will be "frozen around" (formed and somewhat adhered to) the stent. Alternatively, heat without pressurization of the balloon may be sufficient for encapsulation when the compressive forces of the sheath against the stent, which is pressed against the heated balloon, enables encapsulation of the stent.
If desired, the encapsulated stent may include conventional retainers at the proximal and/or distal end of the balloon. Such retainers may be located on top of the balloon or within the balloon. Additionally, the balloon itself may be used to form one or more stent retainers during encapsulation. In this aspect of the invention, a space is defined between the balloon and the sheath, proximal and/or distal to the stent, so that the balloon expands to occupy the space and form one or more retainers during the encapsulation process. Retainers assist in delivery by providing a smooth transition between the encapsulated stent and the catheter surface.
The preferred balloon for the method described above defines multiple (three or more) folded and wrapped "wings" or radial extensions on a balloon delivery device to assure radially symmetrical stent expansion during deployment. The preferred balloon utilizes four wings for a Boneau stent having four axial turns at each end, and the balloon length and number of wings may be tailored to the particular stent or stents to be deployed. By utilizing more than two wings, more symmetrical stent deployment and vessel coverage can be achieved. Symmetrical stent deployment results in symmetrical expansion and support of the target lesion thereby suggesting use of multiple folds for standard PTCA balloon catheters with or without stents.
The method of this invention may be used with most self-expanding and expandable prior art stents, such as tubular slotted stents, and including connected stents, articulated stents, and multiple connected or non-connected stents. It is preferred to use a stent apparatus such as the Boneau stent which is formed preferably from a single piece of wire defining axial bends or turns between straight segments. The stent apparatus can then be encapsulated on a balloon catheter using the inventive method, delivered to the affected vessel and expanded in place, all as described herein. Some of the intended uses include PTCA type stenting, PTA type stenting, graft support, graft delivery, INR use, GI tract use, drug delivery, and biliary stenting.
A general object of the present invention is to provide a stent delivery and deployment method that overcomes the drawbacks and limitations of the prior art.
A specific object of the present invention is to provide a stent delivery and deployment method that eliminates the need for a deployment sheath and results in a low profile device with a more regular outer surface that may be delivered through tortuous, narrowed vessel.
Another specific object of the present invention is to provide a stent delivery and deployment method which encapsulates the balloon and stent thereby securing the stent to the balloon and decreasing the profile of the stent and balloon.
Yet another specific object of the present invention is to provide a stent delivery and deployment method which includes a balloon with three or more wrapped and folded wings to ensure symmetrical deployment of the stent and expansion of the lesion to be treated.
One more specific object of the present invention is to provide an encapsulated stent and balloon have a retainer at the distal and/or proximal ends of the stent for maintaining the stent on the balloon and for forming a smooth outer surface on the encapsulated stent device.
Still another specific object of the invention is to provide a method for encapsulating the majority of expandable and self-expanding stents for treating vessels in humans.
These and other objects, advantages and features of the present invention will become more apparent upon considering the following detailed description of preferred embodiments, presented in conjunction with the accompanying drawings.
FIG. 1 is a longitudinal cross sectional view of two encapsulated stents and a balloon embodying the principles of the present invention and shown on a balloon catheter device.
FIG. 2 is a longitudinal cross sectional view of the stents of FIG. 1 compressed upon a balloon of a balloon catheter and shown prior to the encapsulation process.
FIG. 3 is a longitudinal cross sectional view of the stents and balloon during the encapsulation process and shown positioned within interior and exterior sheaths.
FIG. 4 is a cross sectional view taken along lines 4--4 of FIG. 2 and showing four folded and wrapped wings of the balloon beneath one of the stents.
FIG. 5 is a cross sectional view showing the partially inflated form of the balloon around the stent.
FIG. 6 is a cross sectional view taken along lines 6--6 of FIG. 1 and showing the frozen-in form of the balloon around the stent.
FIG. 7 is a longitudinal cross sectional view of two encapsulated stents and a balloon showing retainers on the outside of the balloon.
FIG. 8 is a longitudinal cross sectional view of encapsulated stents and a balloon showing retainers on the inside of the balloon and attached to the balloon catheter.
FIG. 1 shows an encapsulated stent assembly 20 embodying the principles of the present invention. Two stent segments 10 are shown, and it will be recognized by those skilled in the art that one or more stent segments 10 may be used depending upon the size and configuration of the narrowed vessel to be treated. Additionally, when more than one stent segment 10 is used, the segments may be connected together by articulated or rigid joints, or multiple single stent segments may be deployed on the balloon catheter 30.
The balloon catheter 30 preferably is of a low profile design defining a tapered distal tip 32, and an inner lumen 34 for insertion of a conventional guide wire (not shown). Any conventional or modified balloon catheter device may be used, such as a PTCA balloon catheter, and it is preferred that the expandable balloon portion 36 be configured on the catheter 30 so that the collapsed balloon defines three or more folded wings 38 which are wrapped around the outside of the catheter tube 40 as best shown in FIG. 4. In the embodiment in FIG. 4, the balloon 36 defines four folds 38 wrapped around the catheter tube 40 in a clockwise direction.
The preferred balloon 36 is formed from a material such as polyethylene, polyethylene terephthalate (PET), or from nylon or the like. The length and diameter of the balloon may be selected to accommodate the particular configuration of the stent to be encapsulated. The balloon may be carried on any catheter, although PTCA low profile catheters and over the wire catheters are preferred. The wings of the balloon are formed by pulling the balloon catheter through a forming tool having a generally cylindrical cross section and defining a terminal opening configured to produce the desired number of wings in the balloon. For instance, configuration of the terminal opening may include three or four slits radiating outwardly from the end of the forming tool, depending upon the number of folds to be produced. As the balloon catheter is pulled through the forming tool, the balloon is pushed through the configured terminal opening and exits having, for instance, three separate flutes. The balloon catheter bearing the fluted balloon portion then is pulled into a sheath, preferably a two part sheath made of Teflon or other suitable materials, so that the flutes fold and wrap around the catheter in a clockwise direction to form a generally spiral configuration around the catheter. The sheath-balloon catheter assembly is subjected to heat, preferably by placing the assembly in a heat set oven, to form a crease in substantially the length of each of the folded flutes. The sheath also may be of unitary construction. Following heat setting, the balloon 36 retains the creases formed in the wings and defines a generally symmetrical, cylindrical cross section, as best seen in FIG. 4.
Referring now to FIGS. 1-5, the Boneau stent is shown for illustration purposes only, and Boneau U.S. Pat. No. 5,292,331 is hereby incorporated by reference. Each of the stent segments 10 is preferably a short, single wire stent 10 having an expandable, generally cylindrical body portion defining an inside surface and an outside surface. In the stent segments 10 shown, the single piece of wire is bent to form a plurality of upper and lower axial turns 2. The plurality of upper turns 2 are connected to the plurality of lower turns 2 by substantially straight sections 4. The axial turns 2 can be seen to permit the stent segment 10 to be compressed or expanded over a wide range while still maintaining a significant mechanical force, such as required to prevent a vessel from restenosis or recoiling.
The stent segments 10 are preferably constructed of implantable materials having good mechanical strength, such as implantable quality stainless steel wire. The outside of the stent segments may be selectively plated with platinum, or other implantable radiopaque substances, to provide improved visibility during fluoroscopy. The cross-sectional shape of the finished stent segment 10 may be circular, ellipsoidal, rectangular, hexagonal, square, or other polygon, although at present it is believed that circular or ellipsoidal may be preferable.
The minimum length of each stent segment 10, or the distance between the upper turns and lower turns 2, is determined in large measure by the size of the vessel into which the stent 20 will be implanted. Additionally, each stent segment 10 may define N number of turns, N being preferable between 2 and 10. In the stent segments 10 shown in the drawings, the segments define four upper and four lower axial turns 2. The stent segments 10 may be connected together by articulated or rigid joints, or they may be deployed in a multiple spaced apart, non-connected configuration. The implanted encapsulated stent assembly 20 will preferably be of sufficient length as to maintain its axial orientation with the vessel without shifting under the hydraulics of blood flow (or other fluid flow in different types of vessels), while also being long enough to extend across at least a significant portion of the affected area. At the same time, the encapsulated stent 20 should be short enough as to not introduce unnecessarily large amounts of material as might cause undue thrombosis.
Following selection of the configuration and size of a stent segment 10, or multiple connected or non-connected stent segments, the segment or segments 10 are compressed upon the outside of the balloon 36 of the balloon catheter 30 as best shown in FIGS. 2 and 4. An interior sheath 42 is placed over each end of the balloon catheter 30, and an exterior sheath 44 is placed over the interior sheath 42 to cover the stent segments 10 and overlap with the interior sheath 42. The sheaths 42, 44 are preferably non-expandable, and of a size to accept insertion of the stent segments 10 mounted on the balloon. Sheaths 42, 44 are shown for example only, and it will be recognized by those skilled in the art that the balloon catheter and stents compressed thereon also may be placed within a mold to prevent expansion of the stent and configured to allow expansion of the balloon as desired.
Next, the balloon catheter 30 preferably is pressurized by introducing air, or an inert gas such as nitrogen, through the lumen 34 into the interior of the balloon to partially expand the balloon 36 within the sheaths 42, 44. The assembly then is exposed to an elevated temperature while maintaining pressurization of the balloon. The pressure may be, for example, approximately 70 psi, and the elevated temperature may be achieved by placing the sheathed assembly into an oven at approximately 150 degrees Fahrenheit to accomplish the heating step.
FIGS. 4-6 demonstrate, respectively, the configuration of the balloon 36 prior to pressurization, the configuration during inflation, and the frozen-in form configuration around and adhering to a stent segment 10. The balloon 36, and the wings 38, expand partially outwardly to occupy spaces around the axial turns 2 and between the straight sections 4 so that the balloon 36 and the stent segments 10 are in intimate contact. Those skilled in the art will recognize that expansion of the balloon also depends upon the form of the particular stent selected for encapsulation. Pressure between the stent and the balloon during heating and balloon pressurization causes an adherence upon cooling. Adherence is required for encapsulation which includes both intimate contact between the stent and the balloon as well as contact where the balloon surrounds at least a portion of the stent.
Alternatively, pressurization of the balloon during the heating step is not required where the sheaths 42, 44 fit tightly around the stent-balloon assembly. Pressure radiating inwardly from the sheaths 42, 44 to press against the stents 10 causes the stents 10 to press against the heated balloon to achieve encapsulation.
Following heating, the balloon-stent assembly is removed from the heat and allowed to cool within the sheath. In those cases where the balloon has been pressurized during heating, the internal pressure is maintained. Cooling sets the shape of the balloon 36 which adheres to the stent 10 following cooling, thereby allowing removal of the sheaths 42, 44 for delivery of the assembly 20 within a vessel. Because of the adherence between the stent segment 10 and the balloon 36 of the encapsulated stent assembly 20 and the more regular surface area created by encapsulating stent assembly segments, the encapsulated stent assembly 20 may be delivered without an external sheath.
As best shown in FIG. 3, and in FIG. 1, the encapsulated stent assembly 20 may include a distal retainer 50 and/or a proximal retainer 52. The retainers 50, 52 further secure the stent segment 10 to the balloon 36 and create a smooth transition between the balloon/stent area of the delivery device and the distal and proximal surfaces of the delivery device of the encapsulated stent assembly 20. The retainers 50, 52 may be formed by the balloon itself during the encapsulation process, with the configuration of the formed retainers 50, 52 determined by the dimensions of the spaces between the inner sheath 42 and the stent segments 10. Formed retainers 50, 52 may be tapered or non-tapered. Alternatively, conventional retainers 54 may be attached over the balloon 36 prior to encapsulation, as shown in FIG. 7, or the retainers 54 may be placed within the balloon 36, as shown in FIG. 8. One or two retainers 54 may be used, and conventional retainers may be made from any implantable material, such as implantable stainless steel or polymers. Depending upon the configuration of the encapsulated stent assembly 20, retainers generally range in length from 0-20 mm.
The encapsulated stent assembly 20 is delivered to the desired site with or without a guiding catheter and using a conventional guidewire for steerability to negotiate the area to be treated. Conventional radiopaque markers and fluoroscopy may be used with the device for positioning the encapsulated stent assembly and for viewing the expansion procedure. Once the encapsulated stent assembly is in place across the lesion, the balloon may be inflated in a conventional manner. In the embodiment shown in FIGS. 4-6, the four wings 38 expand evenly to form four, symmetrical expanded flutes which symmetrically expand the inner diameter of the encapsulated stent outwardly by increasing the angle at the axial bends. During typical balloon expansion pressures of approximately 6 atmospheres or 90 psi, occurring within the human body and at body temperature, the heat set creases dissipate. The folded and wrapped wing configuration of the balloon ensures that the balloon will provide radially uniform inflation so that the stent will expand substantially equally along each of the peaks. Uniform expansion of the lumen of the vessel occurs with uniform, symmetrical expansion of the encapsulated stent and balloon. The amount of inflation, and commensurate amount of expansion of the stent, may be varied as dictated by the lesion itself, making the stent assembly of the present invention particularly flexible in the treatment of chronic restenosis and abrupt reclosure.
Because of the inflation of the balloon and expansion of the arterial wall of the vessel the arterial wall bulges radially. At the same time, the plaque deposited within the intima of the vessel is displaced and thinned, and the stent is embedded in the plaque or other fibrotic material adhering to the intima of the vessel.
Following inflation of the balloon and expansion of the encapsulated stent within the vessel, the balloon is deflated so that it pulls away from the stent for removal. The deflated balloon generally forms from 11/2 to 23/4 wings, including a generally U-shaped deflated form, and the deflated wings do not retain the creases created by the heat setting balloon formation process discussed above. The deflated balloon easily folds around the balloon catheter for removal.
The exterior wall of the vessel attempts to return to its original shape through elastic recoil. The stent, however, remains in its expanded form within the vessel, and prevents further recoil and restenosis of the vessel. The stent maintains an open passageway through the vessel. Because of the low mass of the preferred support device of the present invention, thrombosis is less likely to occur. Ideally, the displacement of the plaque deposits and the implantation of the stent will result in a relatively smooth inside diameter of the vessel.
While the primary application for the stent is presently believed to be treatment of cardiovascular disease such as atherosclerosis or other forms of coronary narrowing, the stent of the present invention may also be used for treatment of vessels in the kidney, leg, carotid, or elsewhere in the body. In such other vessels, the size of the stent may need to be adjusted to compensate for the differing sizes of the vessel to be treated.
While this invention has been described in connection with preferred embodiments thereof, it is obvious that modifications and changes therein may be made by those skilled in the art to which it pertains without departing from the spirit and scope of the invention. For instance, the encapsulation method and deployment is not limited to any particular expandable stent device. Accordingly, the aspects discussed herein are for illustration only and should not limit the scope of the invention herein which is defined by the claims.
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|Feb 13, 2003
|Medtronic Ave, Inc.
|Balloon stent assembly system and method
|Jan 14, 2002
|Jul 17, 2003
|Rangarajan Sundar
|Stent delivery system, device, and method for coating
|Jan 22, 2002
|Jul 24, 2003
|Todd Campbell
|Stent assembly with therapeutic agent exterior banding
|Feb 27, 2003
|Aug 28, 2003
|Meadox Medicals, Inc.
|Catheter with stent and method for the production of a catheter with stent
|Mar 29, 2002
|Oct 2, 2003
|Todd Campbell
|Coated stent with protective assembly and method of using same
|May 3, 2002
|Nov 6, 2003
|James Shortt
|Method and apparatus for mounting a stent onto a stent delivery system
|May 3, 2002
|Nov 6, 2003
|O'shaughnessy Donagh
|Stent balloon assembly and methods of making same
|Feb 15, 2002
|Jul 15, 2004
|Johnson Eric G.
|Method of balloon catheter stent delivery system with ridges
|Apr 21, 2003
|Oct 21, 2004
|Medtronic Ave.
|Method and system for stent retention using an adhesive
|Apr 13, 2004
|Oct 21, 2004
|Ronan Rogers
|Method and system for stent retention using an adhesive
|May 11, 2004
|Nov 17, 2005
|Cervantes Marvin J
|Protective packaging assembly for medical devices and method of using same
|May 20, 2005
|Nov 24, 2005
|Medtronic Vascular, Inc.
|Folded balloon for catheter
|Feb 10, 2005
|Aug 10, 2006
|Advanced Cardiovascular Systems, Inc.
|Stent delivery balloon catheter having improved stent retention
|Aug 1, 2006
|Dec 21, 2006
|Medtronic Vascular, Inc.
|Stent Delivery System and Device
|Oct 2, 2006
|Apr 12, 2007
|Meadox Medicals, Inc.
|Catheter with stent and method for the production of a catheter with stent
|Dec 6, 2006
|May 3, 2007
|Boston Scientific Scimed, Inc.
|Multiple-wing balloon catheter and membrane to reduce damage to coated expandable medical implants
|Apr 5, 2007
|Oct 9, 2008
|Boston Scientific Scimed, Inc.
|Catheter Having Internal Mechanisms to Encourage Balloon Re-folding
|Jun 21, 2007
|Dec 25, 2008
|David Slattery
|Device delivery system with balloon-relative sheath positioning
|Dec 19, 2007
|Jun 25, 2009
|Vipul Dave
|Method of Retaining a Polymeric Stent on an Expansion Member
|Jul 24, 2009
|Nov 12, 2009
|Eric Gerard Johnson
|Balloon catheter stent delivery system with ridges
|May 21, 2008
|Nov 26, 2009
|Boston Scientific Scimed, Inc.
|Systems and methods for heating and cooling during stent crimping
|Sep 10, 2008
|Mar 11, 2010
|Boston Scientific Scimed, Inc.
|Pre-crimp balloon inflation
|Mar 1, 2011
|Jun 23, 2011
|Boston Scientific Scimed, Inc.
|Catheter Having Internal Mechanisms to Encourage Balloon Re-folding
|Mar 16, 2010
|Sep 22, 2011
|Abbott Laboratories
|Easy marker placement balloon mold
|Nov 15, 2002
|Jan 3, 2007
|Boston Scientific Limited
|Multiple-wing balloon catheter to reduce damage to coated expandable medical implants
|Jul 25, 2002
|Feb 20, 2003
|Medtronic Ave, Inc.
|Balloon stent retaining assembly and method
|Nov 15, 2002
|Jul 24, 2003
|Boston Scientific Limited
|Multiple-wing balloon catheter to reduce damage to coated expandable medical implants
|U.S. Classification
|606/198, 604/96.01, 606/194
|International Classification
|Cooperative Classification
|European Classification
|Apr 10, 2002
Owner name: MEDTRONIC AVE, INC., CALIFORNIA
Free format text: MERGER;ASSIGNOR:ARTERIAL VASCULAR ENGINEERING, INC.;REEL/FRAME:012802/0198
Effective date: 19990128
|May 28, 2004
|Fee payment
Year of fee payment: 4
|Jul 25, 2005
Owner name: MEDTRONIC VASCULAR, INC., CALIFORNIA
Free format text: CHANGE OF NAME;ASSIGNOR:MEDTRONIC AVE, INC.;REEL/FRAME:016301/0439
Effective date: 20030908
|May 15, 2008
|Fee payment
Year of fee payment: 8
|Jun 12, 2012
|Fee payment
Year of fee payment: 12


text:
When Anna and Russell first start protesting against going on the cruise, one of their arguments is that they'll have to arrange for someone to pick up their mail and newspapers. Later on, when they change their minds and decide to go, Anna says, "We won't even tell them we're leaving. We'll just send a postcard." If they don't tell anyone they're leaving, how will Cliff know he's supposed to pick up their mail and newspapers?
I am a little confused about Anna & Russell's history: in this episode, as Cliff is presenting the portrait, he tells a long winded story about how Anna and Russell first met when he was a performer in an Army band at a dance Anna attended. But in Independence Day, Anna tells a story about how Russell tried to tattoo Anna's name on his chest when they were Theo's age, leading us to believe the couple were childhood sweethearts, like Cliff & Clair. Furthermore, when Cliff is telling the story about Russell in the bandstand, he says his father was a trumpet player, but in all the episodes where Russell performs music, he's called Russell "Slide" Huxtable because he plays the TROMBONE. We even see him play the trombone in "Play It Again, Russell." How well does Cliff REALLY know his parents?
(The family unveils the painting of Russell and Anna to them. They are very moved by it.)
Russell: (speechless) Son...
Cliff: I hope you don't mind the way I express myself.
Russell: No, I don't. (hugs Cliff)
Russell: I've been to Europe and I didn't care for it.
Cliff: Yeah, but it was 1943 and you were running alongside of a tank.
Cliff: You know, the 22 years I've been married to you have been the happiest one-day-at-a-time of my life.
(Cliff and Clair are snuggling in bed. Cliff moves over closer to Clair.)
Clair: Cliff, your feet are freezing!
Cliff: That's why I brought them over there.
Clair: Well, why don't you move your feet over to your side of the bed until they warm up.
(Cliff pulls his feet away.)
Cliff: Now they're cold and lonely.
Russell: Veal!!!
Voted #1 episode by Nick @ Nite viewers.
Earle Hyman and Clarice Taylor were both nominated for Emmys for Outstanding Guest Performer in a Comedy.
Instead of the usual extended scene montage, this episode's
ending credits roll to the family's performance.
This episode was named one of TV Guide's Best Television Episodes ever.
The family lip-synchs to Ray Charles' "The Night Time Is the Right Time."

subset: commoncrawl


text:
Araabmuzik Talks Musical Manipulation, Improvisation, and Bouncing Back With "Dream World"
Back in late February, hip-hop/EDM producer AraabMuzik aka Abraham Orellana fell victim to an attempted robbery in Harlem. And while the altercation left him with gunshot wounds to the head, it did not prohibit the gifted producer from jumping back into the studio to finalize his highly-anticipated new album, Dream World.
And the release is exactly that -- a wide arrangement of 16 tracks that transitions smoothly through EDM, Hip Hop, R & B and back again. With a distinct mixtape feel, Orellana obviously has an ear for methodical track transitions, flipping the switch at a moment's notice from the Indian chants on "War Cry" to the sultry vocal stylings of Vchanny in "Dream". As such, we wanted to speak with Orellana ahead of the Dream World's release about everything from the infancy stages of his career to his newfound range and growth.
You started out when you were around 16 in Providence, Rhode Island, which isn't exactly a hub for hip-hop. How did you find your passion in both hip hop and EDM and eventually gain your footing in the music industry?
I've always had a passion for music -- that wasn't really something I [worked on] or decided on. So I just wanted to expand my talents and start producing my own music. Me coming from a musical family, and playing instruments, I wanted to just create my own beats and music. When that started I was able to learn and create lanes for myself as a music producer. That's when I started exploring different types of genres of music. That's basically how it started.
Since then you've been able to produce tracks and work with a lot of huge names. How has it been to work with artists like Kendrick, Cam'ron and Alicia Keys?
I started off working with Cam'ron and then Diplo in my early stages. Then I started branching off with different artists such as A$AP and Alicia. My sound has changed a lot to [the point] where I'm able to work with these types of A-list artists. It's important as a musician to be able to be versatile, definitely.
You mentioned before that you played keyboard and drums, so as a person who plays traditional instruments, what do you say to those who perceive mixing and sampling as a 'lesser' form of art.
I mean, manipulating songs and samples and chopping them up and making it your own is definitely a skill. Not anyone can make something out of nothing or take something and make it completely their own. My generation [was definitely all about] chopping up samples and making crazy little songs and beats. But the new age now is definitely not like that at all. I'm not really hearing that in anything nowadays. People from the South and the West Coast aren't too heavy on samples. The East Coast is definitely where you hear that most. Right now I'm trying to bring it back to those [sample-heavy] times. On the album, I have just a little bit of everything, [every] type of music and style. I wanted to give the people just a little bit of everything.
Read the full story at Paper
By Peyton Dix


text:
Homemade ice cream is a special and comforting treat. Just because you need to watch your sugar does not mean that you cannot enjoy a bowl of ice cream now and then. Some advance planning ensures that you enjoy your bowl as much as anyone else.
Choose a Recipe
There are specialty sugar-free ice cream recipes available on the Internet. Many of them incorporate pudding mix and evaporated milk, along with artificial sweeteners of one form or another. You could go this route, or you might consider using an old favorite recipe and adapting it to be lower and sugar. This might be a more natural option, especially if your old standby does not include highly processed ingredients.
Pick Your Sweetener
Since you will not be using processed white sugar to sweeten your ice cream, pick a different sweetener. Stevia is a natural alternative sweetener from a South American plant that is a hundred times sweeter than sugar. A little bit goes a long way with Stevia. Some more naturally minded people also like to use Xylitol or erythritol. If you are not concerned about keeping things natural, Splenda is easy to measure and use like sugar.
Making and Storing Your Ice Cream
Follow your recipe to make your homemade ice cream. If you are using a sugar-free recipe, this will not be hard, but if you have chosen to adapt an old recipe it will take some tweaking. If you are using Splenda, simply follow the directions for substitution on the bag. If you are using Stevia or other sweeteners, add a tiny amount to your ice cream batter at a time and taste as you go along until you reach a level of sweetness that pleases your palette. Once the batter is perfected, freeze it in your ice cream maker and store in an air-tight container in the freezer until ready to serve.


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Astoria Cabinet
Written by Katie on January 20, 2009. Permalink
The maple frame with black doors makes for a nice blocky/modern look, and thankfully, the price is under the $1 G mark.
shown in maple with lacquered doors (w/ adjustable interior shelf)
additional wood and lacquer options available
60″L x 18″D x 24″H (legs 6.5″H)
$950.00, Buy it here.
Purchase Information:Price: $950.00
Availability: Buy Astoria Cabinet here


text:
The Hi Hat & Sound and Fury Present
Pop Wig Records Rock Gig #1 ft. Angel Dust
Big Bite, Odd Man Out, Bugg, firewalker
Sun · June 11, 2017
7:00 pmThe Hi Hat
$12.00 - $15.00
Sold Out
This event is all ageshttps://hihat.ticketfly.com/event/1462798/
Angel Dust
"What I appreciate most about Angel Du$t, and A.D. in particular, is the authenticity of their approach. They shun genre norms, but not in a pretentious way, they just don't care what you think they're supposed to be. There's a wildness to it, like they don't have anyone telling them what may or may not work, and somehow it all works. On A.D., they manage to pull together influences from all corners of the punk universe and, against all odds, bring it together in a cohesive and memorable way. A.D. is at the same time incredibly familiar and the wildest record you'll hear this year."
Venue Information:
The Hi Hat
5043 York Blvd
Los Angeles, CA, 90042
The Hi Hat
5043 York Blvd
Los Angeles, CA, 90042


text:
We all know that Bitcoin is presently the best-known cryptocurrency in the industry. There are a few currencies that also tried to do the same, however they didn't get the same results, but the arrival of YOcoin appears to be a bit different.
The only problem right this moment is whether this new type of currency can actually possess the competitive edge to achieve success where so many bitcoin alternatives have not.
Let us have a close look at this new entrant and the feasible benefits that it might offer to all the folks out there who are trying to find a bitcoin alternative. Listed here are a few of the important details that you should know.
If there's one thing that YOcoin is proud of, it is the fact that it's simpler to mine. Additionally, there are some reports claiming that you could mine these coins at home so long as you have a very good quality graphics card. As you may all know, you need a graphics card because it includes graphical processing units (GPUs) that are very great at the SHA hashing mathematics required to solve the transaction blocks.
If you are considering this new cryptocurrency, you won't need to use a high-end graphics card for mining. You can accomplish this easily via a decent graphics card.
Wallets are now available for Windows, Mac OS X and Linux so you can start hunting this altcoin right this moment. All of the coins that you'll mine will also be documented in a blockchain.
The Chief Operating Officer of YoCoin, Dave Wilson, declared that they have been working really hard on this project for a long time so they are looking forward to bring this currency to the next level and beyond. This can be quite intriguing since they're laying out their future plans for this currency. Network marketing firms get lots of benefits from this cryptocurrency, but the team is trying to grow their reach and bring this to casinos and other vendors. The success of this plan will depend solely on how they are going to implement it. You could state that it would be quite hard for people to accept this new type of currency, but once it's implemented, there will surely be a lot of advantages to the users.
You have to understand the new innovations that YoCoin wants to do in the foreseeable future like the issuance of physical YOC coins and mobile wallet for Android users. Actually, these coins can be used as gift to your friends and family or you can also collect them if you want. These coins will likely be viewed as a collectible rather than currency, but you have the option to use it both ways. This will surely be intriguing because plenty of people are waiting for these improvements. We can possibly anticipate more from this new form of Internet cash. This cryptocurrency will competitor bitcoin or surpass it.
This might be much simpler to mine than bitcoin so it is expected that a younger crowd and millenials will probably be involved with this. If you want to try this out, you have to begin your research about this without any further delay.
Go here to find out more about YOcoin


text:
Add a focal point to any room with the Alderton black and silver framed mirror. Features a transitional angular 3 in. x 1 in. frame elegantly finished in distressed black with a silver pewter lip. The perfect compliment and size for vanity / bath applications.
- Elegant beveled mirror
- Durable polystyrene frame
- Distressed black and silver finish
- Can hang horizontally and vertically


text:
The warming trend continues into spring. It's been in the eighties all week and the waters temperatures are following. There are more baitfish moving in around the bay and I've been spotting some sharks which are very common during the summer months in the bay, it almost seems more like summer conditions now. Twice this week I spotted larger tarpon rolling in the shallows in the early morning and these were large fish. I didn't dare make a cast to them with my lighter gear but it's time to think about bringing a heavier setup for maybe an opportunity to hook up with one.
Early one morning during the week I visited one of the backcountry areas to do a little fly fishing looking for snook for a few hours. I knew better and during the busier tourist season here it's one place I usually avoid because of it's easy access off of Hwy 41, it can attract a lot of traffic. The location is the East River part of Fachahatchee Strand. Most of the area kayak tour company's apparently are doing their eco tours here and all I can say when three different kayak tour groups showed up with their groups the birds and wildlife vacated the area and I did shortly after. I won't be going back there till summer.
If your interested in seeing the Real Everglades with no interruptions feel free to contact me.
A nice 30" + Snook
Paul with a real nice trout, just moving to the area from Utah I took Paul out to show him some of the ways I kayak fish the area.
22" Trout from today. I can't believe how many larger trout are being caught lately out and around the bay.
Sunrise Redfish
The very early starters getting out on Chokoloskee bay will have the opportunity to see groups of Roseate Spoonbills roosting on a couple of the Mangrove islands through the summer
The happy Egret's


text:
House Appropriations Committee
CommitteeHide Overview icon-hide
Committee Proceedings
- Committee Meetings/Hearings Schedule (House Committee Repository)
Live and Archived Video of Hearings and Meetings
(January 2012-present)
Website: http://appropriations.house.gov/
Information on subcommittees, membership, leadership, news, and more.
More on This Committee
Committee Activity
Committees may hold hearings on policy issues and on specific bill proposals, consider and further develop bill proposals through a markup process, and report legislation and recommended changes to the full chamber.
1-1 of 1
- BILL1. H.R.6079 — 112th Congress (2011-2012) Repeal of Obamacare Act Sponsor: Rep. Cantor, Eric [R-VA-7] (Introduced 07/09/2012) Cosponsors: (162) Committees: House - Energy and Commerce, Ways and Means, Education and the Workforce, Natural Resources, Judiciary, House Administration, Rules, Appropriations, Budget Latest Action: Senate - 07/16/2012 Read the second time. Placed on Senate Legislative Calendar under General Orders. Calendar No. 451. (All Actions) Tracker:
This bill has the status Passed House
Here are the steps for Status of Legislation:
- Introduced
- Passed House


text:
Ratings based on 1 Verified Reviews
1.0 Room cleanliness
1.0 Service & staff
1.0 Room comfort
1.0 Hotel condition
Expedia Verified Reviews
by A verified traveler from LA, CA
WARNING!!! NOT A HOTELPosted Aug 18, 2011
This place shouldn't even come up under hotels! If you look them up under other sites, you read nothing but fake reviews obviously written by the owner himself. It talks about the friendly staff, great foods provided, free fast internet, daily cleaning service, blah blah. This "apartment" isn't located in 1 place like it sounds. It's located all over the city as individual condos. It did NOT have any tv's, A/C didn't work upstairs, ROACHES everywhere, no desk, no garden, and the "included internet and parking in the price" is a lie. The public area he speaks about is at restaurants or internet cafes which is not free and parking is anywhere you can find on the streets. When I called to tell him about all of this his response was.." Madam if you wanted all of this then you should've paid more and booked a real hotel. I can't control what people write on the reviews. I don't know why they wrote those things. Internet is available out in public areas, I didn't say in the apartment. There's bugs because you are near the port. There's bugs everywhere, it's not my fault. I can move you far away to another apartment, but it won't be near the city if you don't want bugs..but I can't guarantee there won't be any though. Yes the maids come twice a week like you read, before you come and the 4th day when you leave. That's twice a week right there." In all my travels, I doubt people would write reviews raving about amenities and service that clearly aren't available! RUN FAST!!!!!!


text:
- Search CSN:
- Members: Login to search all areas
- Not a member? Click here to search public areas
May 23, 2012 - 2:16 pm
Hi Everyone,
Thanks for listening.
May 23, 2012 - 2:26 pm
Yes there is hope. Do you use dilators? Start small and increase the size gradually, or ask your love to help you with this, and it is more natural. Unless of course you get the dilators that are like the real thing. As far as reversal there are many on the correctol board that have had reversals and it just takes time. My dad had a reversal and it took time for the body to adjust. I wish you the best and keep us posted. Lori
May 23, 2012 - 2:31 pm
Thank you, my doctor did mention dilators, I guess I will tell him I want to try them.Delores
May 23, 2012 - 2:51 pm
You can order a set on Amazon for $54.95.
May 23, 2012 - 3:10 pm
can order a set on Amazon? I am confused I guess I don't know what diolators are, maybe I should research them, I thought it was a prescription. Thank you, I will check it out.
May 23, 2012 - 6:25 pm
Hi, and welcome to our family. I can see why it is a happy/scarey time for you. I finished my treatment about 13 months ago and also have a colostomy bag. Many people being treated never need one, and some become permanent...I still have mine. My GYN/ONC and GE doc are all just a bit unsure if I have enough sphincter control to make a reversal logical. They say one never knows for sure, but that I have excess radiation damage. I belong to a ostomy site C3Life where many people with ostomies have had very successful reversals, but admit it often takes a couple months to get your body back into working order...so be patient. I was recently diagnosed with Breast Cancer now so have kind of tabled the whole thing for a while. As far as vaginal issues from radiation, they are very real for most of us. My GYN works with Cervical Cancer patients and said it is common to pack the vagina with moist gauze during treatment to prevent stenosis, he didn't know exactly why it is not common practice for Anal Cancer. At my recent check-up he could barely get a swab to test for Cervical Cancer!!! Dialators seem to be the sensible way back, but I have also heard of women insirting the smallest size tampons for an hour or two at a time then working up to larger ones and increased time...just never leave in for too long without changing. This may be an option for those not comfortable with a dialator. My doc also said that most of my pelvic organs have fused together from the pelvic radiation making future surgeries a bit more complicated, another thing I was thrilled to hear. Its funny, I am a big soccer fan...I feel like a goalie who keeps making these great saves (recovering), but no matter how great I play my team (body) can't score a goal to win the game!!! Best of luck to you, keep posting to let us know how things are going. As always, all in my prayers.
May 23, 2012 - 7:04 pm
God bless you for all that u have been thru and will go thru. With everything going on with yourself your ability to support others is truly admirable. I know that it is hard to deal with these setbacks and endless tests and treatments. I think you are playing a good game and you will win. But I think you know that it is how you play the game that really matters. Thank you for your genorisity of spirit here.
May 24, 2012 - 12:43 am
Thankyou for your support...we are all on this journey together, and the truth is more will join us!! I always feel like the more we can be there for each other the the less we focus just on our own issues. Through our communication of ideas with each other we also may stumble onto some truely helpful advice that would otherwise be missed. I often tend to compare things like I did the soccer game (I forget what thats called)....but you're right, its how you play the game, and I plan to play my best! Its one heck of a sport though isn't it????
May 24, 2012 - 12:45 am
Thankyou for your support...we are all on this journey together, and the truth is more will join us!! I always feel like the more we can be there for each other the the less we focus just on our own issues. Through our communication of ideas with each other we also may stumble onto some truely helpful advice that would otherwise be missed. I often tend to compare things like I did the soccer game (I forget what thats called)....but you're right, its how you play the game, and I plan to play my best! Its one heck of a sport though isn't it????
May 23, 2012 - 10:21 pm
I highly recommend you seek out a pelvic physical therapist....yes, there is such a thing. Hopefully your gyno can recommend one that has helped radiation patients in the past. When I finished treatment, a Q-tip was a pretty lofty goal! However, with the ingenuity of my PT and working outside the norm, I am back to fairly normal. I will have to continue with dilators for the rest of my life, small sacrifice. I ordered my dilators from vaginismus.com. Be patient and it can happen. Please feel free to contact me if you need more intimate information on how it all works.
May 24, 2012 - 1:34 pm
Thank you for your information. I don't have a gyn, only my Oncology Radioligist, Oncology Chemo, Oncology Surgeon, and my General doctor. My Surgeon was the doctor that told me about diolators. I guess I will talke to him more about them. Thanks again.
May 24, 2012 - 7:27 pm
Thanks for the info - I never heard of a pelvic physical therapist. I'm seeing PT but I don't think she (or the hospital in general) deal with radiation-affected pelvis's in general. I've often thought to ask but I'm a bit shy about it. She does great, my PT, but I would surely like to see someone who has experience in pelvis's that have been affected by radiation. No one seems to address the problem of radiation damage, only the facts as they see them today. You're sore? You hurt? We'll work you and massage the area we think might be affecting you - no real knowledge about radiation-induced damage. I have a very real feeling that there's something rather easy to fix that is being overlooked.
How does one go about that? Just ask? I know it seems like a simpleton question, but I really think it's important and am not sure how to phrase the request. Truth is I haven't tried a truly sexual relationship since treatment. My husband and I are happy are things are, which I am so very grateful for. We may be different from others, but we don't see sex (intercourse) as the end-all to everything (no, he's not weird, he's VERY much a man - the most masculine and wonderful man I have ever met in my life). I'm much happier with a hug and a loving husband, and my husband is the same way. Guess we are just lucky that we agree on the same thing.
I've had pap smears and the gyn didn't mention any trouble so I guess things are ok in that area.
Goodness, we're all so different - no one person can tell another what is normal and what is not. Ha! I guess that's what makes the world go round.
Eihtak - thank you - I agree that the more we focus on others the less our own problems seem. You've been through so much - you are truly an inspiration to me and I'm sure many others. Thanks for being here. I so much wish you all the best life has to offer.
May 24, 2012 - 9:00 pm
You should check with your gyno for a referral, or your PT for a Pelvic PT specialist. They are different. Once you find one, you'll need to find out if she has any experience with radiation patients as it is different than their typical patient. However, if you are able to have a regular pap smear, you are probably fine. I would recommend that when you do try that you use lubricant as your horomones are shot and you are probably pretty dry. I get the thing about sex not being the end all, but you need to maintain good vaginal depth and with for future exams so you may want to start using dilators on a regular basis if you choose not to have sex on a regular basis. I had some "fusing" because of radiation and it could still occur as it is normal as we age anyway. Maybe you might want to order a set of dilators and see how you do and perhaps you won't need to even seek out a pelvic PT.
Please feel free to call or contact me if I can help or clear or give further explanation. I know this is a very personal subject, believe me I get it!
May 24, 2012 - 9:54 pm
Thanks so very much Joanne - I so much appreciate your response,
I don't want to use dilators, plain and simple fact - intercourse is not important to me (my hormones have been shot for about 10 years, since I went into menopause) - actually intercourse is not important to me at all - the whole subject gave me more problems than I want to deal with now. I'm glad to be done with it. And thankfully my husband feels the same. Not to say that we didn't have a great sex life before - just that it's not at all important anymore. I guess if vaginal dryness is normal anyway, why bother if we're both happy with things as they are... I know not many people will agree with me, but if there's one of you out there who's feeling like you're weird for not wanting intercourse, and my post can help you feel like you're not alone, then it's worth it for me to post.
Thanks for the info on the recommendations for a pelvic PT - thing is, I like my PT a lot and am a little embarrassed to ask her for a recommendation for someone else, more proficient in pelvic damage due to radiation - I know, I've got to get past that and just ask her.
Thank you for getting it - it IS a very personal subject (and I can't believe I'm posting such personal details) but it helps to know that there are folks out there that don't think I'm some kind of weird knucklehead.... :)
One more thing that I want to say - and it may have nothing to do with anything - my hormones stopped working when I had a very bad viral upper respiratory infection about 10 year ago. It may have had nothing to do with my anal cancer diagnosis, but since then nothing has been right. I know it's speculation, but I really think that infection, or whatever it was, had something to do with not only my lack of sexual response, but with the cancer itself - like something went wrong with my immune system way back then and may have allowed the cancer/virus to assert itself. Sorry if this sounds stupid, but I always have associated that virus with something really bad.
Edit: One more comment :) There are lots of folks/women who don't have a man to encourage intercourse - what do they do? Those who are 'with someone' are not the only people in the world. I don't say this to be obnoxious or difficult, just that not everyone is 'with' someone...ya know? Dilators, yes, that's an option I guess....but there are so MANY stories and individual circumstances in this world.
May 25, 2012 - 10:23 pm
It is sooo awesome you are being brave and asking the questions. NEVER in a million years did I think I would be discussing such things as this! Yeah for all of us. Frankly, who cares about your sex life anyways?! Meaning, whatever it is, is your normal and that is perfectly wonderful. (hope that didn't sound mean, wasn't meant to) Just don't want you feeling weird. If you choose to remain not partaking in intercourse, you still MUST keep yourself open for medical reasons. I have a man, but if we are inactive for a period of time I will have to continue the use of dilators as things can shrink and possible fuse. So please don't not consider using dilators to maintain a healthy vaginal situation. I am using premarin as part of the healing process, but that won't be for much longer. It just helps the tissue become more supple. The premarin is an estrogen therapy, however it shouldn't be a risk for anal cancer survivors as anal cancer is not a hormone related cancer. Hope all this helps and doesn't confuse anyone.
May 24, 2012 - 9:55 pm
Hi, Rose
My hubby and I are the same way... we are in our 60's and since each of us have gone through cancer, we have rarely been intimate.
In February, I started seeing the oncology team at the VA hospital, where both my hubby and I go. The team is made up of the oncologist, the rad oncologist, and the general surgeon.
Yesterday, I met with one of the rad onc doctors. He was great and showed me what my CAT scan looked like. Because I have been having difficulty with my legs, hips, and balance, I'm not sure whether I have muscle or nerve damage, and/or whether the damage is permanent. My onc says he has seen it both ways: it either completely goes away, or it never gets better, and it takes time.
I got some good advice from my rad onc yesterday... He is very nimble and he showed me many exercises and movements to gain the strength in my legs and pelvic area (the site of the radiation). He suggested yoga. He showed me the moves and even helped put my legs into the proper position, which I couldn't do on my own. One thing is to lie on my back and draw my knees up to my chest and hold for as long as possible. It actually felt good, once I got into that position. He also said that, since I have the neuropathy problem, that I have to move as though I am a recovering stroke patient. He is very experienced in the radiation of the pelvis. He said to keep moving, keep training and stretching the leg and hip muscles, or they will totally stiffen up. If you are like me, I can't sit for more than 5 minutes without my hip muscles stiffening. I have to stop after about 10 minutes of driving and get out to really stretch my legs, or else I stiffen up like a 90-year old.
He said that the radiation causes the shrinking vaginal and anal openings, and also muscle damage in the pelvis moving down down to the legs and feet. The chemo causes the "nerve" damage in the hips, legs and feet.
He suggested my going to the YMCA or to the American Cancer Society, the Hope Club, for yoga classes, which are free. I think that may help you. I never heard of a pelvic PT either. So, I am very glad for the info.
As far as the dilators go, my gyn, who also is well versed in oncology, said to use the dilator which is approx 1 inch in diam... to lube it good, and only insert it to the point of where it starts to feel uncomfortable. She said to leave it there for 30 sec to a min and then take it out. Do this on a daily basis.. after enough times, you will be able to insert the dilator farther. She said not to go over 4 or 5 inches deep. She also said to goop up well and to have intercourse as much as desired. The intercourse keeps the vagina/cervix from closing... very important, necessary for gyno exams.
Hope this helps.
God bless.
May 24, 2012 - 10:19 pm
Thank you so much Captain - it's so nice to hear I'm not the only one concerning (you know what(!!!) - sex(!!!!).
It's so good to hear that this pain may go away. Course it might stay, but I'd rather believe it'll go away :)
I've heard so much about yoga and have yet to try it but I know it's somewhere there in my future. I'm not exactly like you because I can sit for hours without pain - it's walking more than about 250 feet that makes me cramp up like a lobster. The drawing the legs up - yes, that feels REALLY good. I'm surprised to hear that the chemo causes these problems - I've always been told that it's the radiation.
Who knows - sometime maybe I'll get back on the 'track', but I thank you SO MUCH for interjecing a little bit of "I'm not totally weird, I may be normal after all" into my brain. Thanks SO much.
May 25, 2012 - 1:40 am
You made me smile! You are totally normal in the brain and everywhere else too. Between all my issues and my husband also recovering from a bone marrow transplant sex is not part of our lives right now. I don't expect it will be again either, and I'm so very ok with that. Even before either of us were sick, I felt it not necessary. Believe me, I've had some wonderful, exciting, fullfilling, sexual experiences in my life, both with my husband the past 30yrs and in the years before him with someone else (or two). But at some point I guess I just felt....done???? Truth be known, not having much sex, when healthy, I had more energy and felt less stressed, weird and the opposite of what you'd think, but worked for me. I think its just another way we are all different. It is although, important to prevent or treat vaginal stenosis (shrinkage and fusing) so for those of us who have had pelvic radiation and who are not sexually active should probably take some steps in keeping that area in good working order.(lol) Since you have not had a problem with a pap test, you are just fine! Also, try the yoga just for fun...I started a gentle/light yoga class after Christmas and it was great. I had to stop for a while, but hope to start again soon.
May 26, 2012 - 5:08 pm
hey, we all have various problems. after tx, some of us can have sex, some can not. that is not the most important part of life. it is very hard to do and painful for some of us which makes it no fun .. you have a wonderful hubby. also, what is very good about this site is that we can say anything and are accepted. the docs need to know what happens to us after tx so that they can do better for the next person. at MDA , they ask about the sex part. You do need to keep the vagina open for health reasons. i think that it might get closed as the years go on if you do not use dilators. this closure could cause problems later on. so think about trying the dilators. sephie
May 25, 2012 - 12:12 pm
You need to go to a gyn Thats what i did .he started me on PREMARIN VAGINAL CREAM .And it works wonders .It took about 2 mon and we could have sex it works I use it about 3 times a week The Dr said i will have to use this forever but thats ok with me .Good luck with ever thing.Shirley


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Andrew Ceresney, Director of the SEC's Division of Enforcement, spoke on May 13, 2015, at the University of Texas School of Law about the division's Cooperation Program that recently celebrated its five-year anniversary. His remarks focused primarily on the successes of the program, the various cooperation agreements and tools utilized by the program, and the benefits of cooperation for both cooperators and the division. "Cooperation is critical to building cases," Director Ceresney stated, "[...] all too often, we at the SEC are left without such a narrator in our cases, facing nothing but hostile witnesses who have no incentive to tell the truth and no desire to assist us."
Mr. Ceresney explained that cooperation is achieved through a number of different tools, including, but not limited to, formal cooperation agreements. The use of formal cooperation agreements are, however, in Mr. Ceresney's view, "[...] at the heart of [the division's] cooperation program." He indicated that more than 80 formal cooperation agreements have been signed over the past five years, and that these agreements have been particularly successful in insider trading cases. The division also uses deferred prosecution agreements (DPAs) and non-prosecution agreements (NPAs), but they are a "relatively limited" part of the division's practice. The division has announced its use of only five DPAs and five NPAs since the start of the program.
The division also utilizes defendants' admissions of fact and wrongdoing. Mr. Ceresney noted that admissions are especially beneficial in order to "lock in a witness's version of events before trial to ensure predictable testimony" or when a cooperation agreement is not feasible for any number of reasons. For example, if the division feels that a defendant is not credible or would not provide especially helpful testimony, they may obtain admissions.
Reverse proffers are also used by the division. Reverse proffers involve sharing with a defendant and his counsel key documents and other information that may be used against him. This tool has helped the division obtain settlements and also persuade defendants to cooperate.
Mr. Ceresney also noted that the SEC's history over the last five years demonstrates that the benefits of cooperation are real in terms of charging decisions, monetary relief and bars.
Prosecutorial discretion may work to certain cooperators' benefit by either resulting in dropped charges or charges for less serious violations. The SEC does not announce whether charges are dropped for certain cooperators, but Mr. Ceresney stated that "based on an analysis of our cooperation agreements, [...] a significant percentage involved instances where the Division declined to recommend charges." A significant reduction in monetary penalties is also a benefit to cooperators. While reductions do not extend to disgorgement, relief for cooperators may come in the form of a flexible calculation of such disgorgement, or a reduction or elimination of a penalty. Finally, cooperators may receive a benefit in the form of remedial relief from certain industry suspensions or bars.
Mr. Ceresney ended his remarks with a strong recommendation: "When faced with the prospect of a potential enforcement action, I hope that individuals will consider seriously cooperation, which carries with it significant benefits and which can be a viable way to avoid a terrible result."
Speech by Andrew Ceresney, Director of SEC Division of Enforcement


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GraphicRiver Seamless Pattern in Pink Colors 4467205
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Bochy not optimistic Torres can return Tuesday
Andres Torres took a few quickened steps in his recovery from an Achilles strain and hopes to come off the disabled list when he's eligible next Tuesday. Manager Bruce Bochy isn't so optimistic.
"He's made progress, just not as fast as we would like," Bochy said Friday. "He still has to check off a couple of boxes."
Torres spent the Giants' off-day Thursday testing his injured left leg under the supervision of trainers at AT&T Park. He did some light running and some side-to-side agility drills — but at nowhere near full speed.
"They didn't want me to go to fast," Torres said Friday. "We're going to do this progressively."
The Giants leadoff hitter went on the 15-day D.L. last Friday, a trip he had hoped to avoid completely. Torres will undergo another MRI exam this week "just to make sure everything is fine."
Bochy wants to see Torres' ability to run the bases. His game is speed (26 stolen bases last year), so the Giants want him back only when he's ready to motor again.
Torres insists that he can make a dramatic improvement by Tuesday. "I hope so," he said. "Let's see what happens."
The Braves' Tim Hudson (listed at 6-foot-1, 175 pounds) faces the Giants' Tim Lincecum (5-11, 165). Together, they weigh only slightly more than the 2010 Pablo Sandoval.
On the mound, though, both are towering figures. Hudson ranks fourth among active starters with 167 wins; Lincecum is one of only three pitchers since World War II to lead the N.L. in strikeouts over three consecutive seasons.
"It's a great matchup, I'll say that," Bochy said. "There are similar guys because there's been lots of talk about their stature."


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A gorgeous 925 sterling silver and genuine turquoise gemstone pin. This marvelous pin is made up of a stunning 925 fineness sterling silver metal that looks like branches or stems of a bush in this pin. This gorgeous sterling silver metal surrounds a lovely piece of genuine turquoise in the very center. This piece of genuine turquoise is held in place by the silver metal and looks very unique and beautiful. The back of this item has a lovely pin and strong clasp closure that holds very well. This item is also signed on the back "925 AUJ" inside of a rectangular cartouche. The pin measures 1 1/2" long by 1 3/8" wide and is in excellent condition. The sterling silver has recently been cleaned and looks as good as new. A tremendous piece of 925 sterling silver with a turquoise gemstone.
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|20 Aug 2011
Microphone is not being recognized
My Sony VAIO CA is not recognizing that I have a built-in microphone next to the WebCam. When I right click on the speaker icon in the lower-right corner and click "Recording devices" it shows I have none, even though I do. What can be done? There is no specific driver for it on the Sony site. How come my computer can't recognize the built-in microphone?
|My System Specs
|20 Aug 2011
Win 7 Ultimate x64
Did you install the webcam driver/software? I'm guessing that the necessary driver/software for the mic is part of that.
P.S. The full model number of the laptop would help, Vaio CA is the series of laptop, not the model number.
|My System Specs
|20 Aug 2011
The model is VPCCA290X. The only "driver" offered on the site is the WebCam Companion 4 software. I just updated it and when I open it and click "Audio", under "Audio devices" is a blank space
|My System Specs
|20 Aug 2011
Ooh, nevermind, I fixed it! I right-clicked on the speaker icon, clicked "Recording devices", right-clicked on the empty space and clicked "Show disabled devices" and then I enabled it. I'm not sure how it became disabled, but it's working now
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hard drive NOT recognized in computer but IS recognized in disk mgmnt.
I just rebuilt an old system using Windows 7 Home Premium after using WinXP pro for many years. The primary hard drive is WDC 150 Mg and Win7 is installed and updated to current with SP1. I dropped a second WDC hard drive in, formatted and was going to use it for a 2nd backup unit. Both of these...
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Gaming Headset, Microphone not Recognized
I just bought the Turtle Beach Z2 gaming headset and I've gone through numerous different processes of trying to get the microphone to actually work and can't seem to get it. The sound out of the headphones work fine but my computer isn't recognizing the sounds from the headset. I have IDT audio on...
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Built-in Webcam Microphone and Microphone Line-in Not Working
I have a Dell Vostro 1500, running 32-bit Windows 7. It came with Vista, but I upgraded to Windows 7 a couple months ago, which I think is causing the issues I'm experiencing. According to whoever I'm speaking with, the sound for the microphone built in to my webcam fades in and out and gets...
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microphone not recognized
I run windows 7 . The sound card is on the mother board. Chipset G 965 express. The sound plays on speakers but the microphone does not work. It is not even recognized. The problem may be driver. Current driver Driver Name: HdAudio.sys Driver Version: 6.01.7600.16385 (English)...
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I have a built in microphone but it doesnt seem too work i have checked it is default device and done everything I can but now I am stuck.
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Very low microphone
Im on windows 7 rtm and the mic is REALLY low. In microphone ive already set 20db boost and its at 100. Im using a creative xfi fatality pro. Also ive tried with razer piranha and steelsound 3h headsets and both are really really low. Ideas? Cheers
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Powered by Record Information ServicesHome > Chicago Homes > Latest Sales Search > Articles
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What's My Home Value?
Tax assessors, home appraisers and real estate brokers all have valued our home differently. We were appraised for $350,000 last year, which was $110,000 lower than the assessed value for the same period. We're wondering how a "true market" value can be determined fairly when the players use different rules. Is there a designated agency or government official to contact regarding this discrepancy?
Here's a quick rundown of the estimates you can receive for your property value:
• Appraisers provide an independent estimate of fair market value. For residential property, that value is largely determined by the comps (or comparable properties) used in the appraisal. If you get two appraisals, you will likely get two different sets of comps and therefore differing valuations. Appraisers receive a fixed fee for their service, regardless of the value they determine.
• Real estate brokers look at recent past sales, typically from local MLS systems. They offer a "broker price opinion" or "Comparative Market Analysis" (CMA). These are not appraisals, but rather an effort to establish the sale or purchase price for a given property as the representative of a buyer or seller. Again, differing comps will produce differing values.
• Assessments are efforts by local governments to determine the fair market value of a property. That valuation, multiplied by the tax rate, produces your property tax bill.
While appraisals and CMAs rely on the latest market sales, that may not match up with assessments. In some jurisdictions, assessments are only updated every three years. Thus, it is possible to get an assessment that lags behind the market – whether the market is going up or down.
The result is that assessments, CMAs and appraisals are all likely to vary. There is no governmental agency to sort out which is better or worse. You're going to get different results depending on who you ask and when. It's not a system failure, it's just the result of different approaches to a complex question.
If you see big discrepancies in prices, point them out to the person who is estimating your property value – that is, if they're not in your favor.
Peter G. Miller is the author of The Common-Sense Mortgage and a veteran real estate columnist. Have a question? Please write to firstname.lastname@example.com Foreclosure Article Archives
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Hi! On this page, we're sharing our convention experiences with you. After going to a convention, we'll write about it. We will make an overview of the convention and write about all the aspects. We will also compare some of the conventions & organisations. let us know what you think is important on a convention via email@example.com!
We went to Weekend of Hell again! Yeah! As some of you might now, Weekend of Hell was the first convention we ever attended. Because of that, it will always be special to us! Oh yes it will. It feels like it was yesterday... I remember we walked into the Turbinenhalle not knowing what to expect and a little bit shy, but by the end of the day we had thrown away all our shame. We really had a blast. Usually, Weekend of Hell takes place in November. This year however, the organization decided to also organize a spring edition!Hell yeah! All I can say is: the more, the merrier.
Of course were very happy and we knew instantly we wanted to go. What I love most about Weekend of Hell is that you can get close to the actors and really have a chat. You can make pictures while they're signing. And there's a specific crowd at the con: horror fans. And I love that! Everyone seems to be in relax mode at Weekend of Hell and we need that to keep the balance, because when at a convention our adrenaline levels peak. It's a great atmosphere and everyone is there for one thing: to have a lot of fun! So... Let's talk about this edition of Weekend of Hell!
Liv, Sigmund, Tristan and and I went to the FACTS Convention again! We were very excited, because FACTS had an amazing guest list. Besides that: We always love attending FACTS. It's definitely one of my favorite comic cons. There's always so much to do and to see. I couldn't agree more. I was looking forward to FACTS since a they announced Nathan Fillion as a guest and that feeling grew even more when Ben McKenzie and Morena Baccarin to the list. And of curse they already announced Hodor (Kristian Nairn), you gotta love Hodor! So sit back and relax, because in this article we will tell you everything about our general experiences at FACTS - The Spring Edition 2017...
We visited FACTS on Saturday April 1st (and that is not a joke). We left from the Netherlands at around 7.30 and arrived at Flanders Expo around 10. Liv and I had a press accreditation, so we went in via the press entrance. That went easy and fast. We entered in the merchandise hall and it became busy quite fast. It was a nice kind of busy however. Many people were there already, but the atmosphere was great. People were happy to be at FACTS and were having a great time. And so were we! Tristan and Sigmund came in through the normal entrance and I guess that went pretty smoothly too, because we met up with them not long after. We talked a little and then our ways parted; Tristan and Sigmund started their quest in the merchandise section, while we decided to take a look around in the Guest Hall.
Most of you know already: We went to Dutch X-Mas Con! I can tell you already we had a lot fun and will write a lot of articles! Today we show you some amazing cosplayers we saw at the convention. I always love to see cosplay at Comic Cons. You can just see all the work that's been put in the costumes. Here are a few great cosplays from Dutch X-Mas Con! Enjoy and let us know in the comments: Which one is your favorite? And what will be your next cosplay? If you're one of the cosplayers on the picture and have a link to your website/ facebook page, let us know! We'll put the link in this article so people know how to find you. If you want us to send the photo to you via e-mail, just send a message to firstname.lastname@example.com!
Liv and I went to Arccon 2016 (June 25 th & 26th). It was organised by KLZ Events. Arccon is fan convention with guests from the series The Flash and Arrow. February 27th, I was home alone. Just browsing the internet. When I saw this promotion for Arccon. The prices for the passes were lower: We must have seen it at exactly the same time. Liv and I started talking via Whatsapp immediately. Well, within a few minutes we bought the tickets. Yes that was a very spur of the moment decision. In my opinion it was now or never, so we decided to just do it! At that moment, there were 3 guests announced. (Colton, Rick and Manu). Later on also Katie and Shantel were announced. We were very happy with this awesome line-up and already bought some photo ops and autographs. Later on, we received the bad news that Colton had cancelled, followed by Katie and Manu. Well that wasn't fun! All week I walked around with a grumpy face, grumpy cat would be jealous of. But, KLZ also had good news. They found replacements quickly: Matt Ryan, Violett Beane and Michael Rowe! I was especially happy with the announcement of Matt Ryan. I loved him in his role as Constantine (he really does a brilliant job on portraying this one).But I was thrilled about all three replacements.
This was our first KLZ convention!
We went to Dutch Comic Con!! We had a weekend tickets, so 2 days of fun. Here's what we thought:
October 2015, we went to FACTS for the first time! FACTS is a Belgian Comic Con. I was very impressed by the way it was set up. So this year, we decided to go again. And this time we had a whole weekend! Yay! This was the first time, there was a spring edition. We arrived a bit after 10. Parking was a bit confusing: Many parking places, we didn't know immediately where to go. Luckily there were parking attendants that showed us where to go. Walking from the parking lot to FACTS took about 10 minutes. There was quite a line to get in. We had been expecting this. FACTS already announced many checks and you weren't allowed to take in bags bigger than an A4. But: The queue went very smoothly. We stood in line a while, but it went well. The line moved constantly: No standing still. So for me, the queue wasn't a problem. On Sunday things went even more smoothly. You have to imagine there was a big hall were everybody came in, then there was bag and ticket control. After that, you walked into another hall with some things to do and eat. This was the real entrance hall. On Sunday they let people go through security checks before 10, so everyone was waiting in the second hall for the doors to open. You could take a seat and have some coffee. Or get your picture taken. At 10 o' clock sharp the big doors opened and everyone was inside in a few minutes. Great organization! What I like the most about FACTS is the variety. There's so much to do! A lot of merchandise, props, actors, cosplayers and games. I can't get bored at FACTS!
Sundaymorning, lyrical faces & star bucks coffee. That's the start of our Walker Stalker adventure. We were excited since we bought the tickets in july, so at this moment we were unstoppable! We were buzzing from excitement and after a very small (but very effective) cup of espresso, my adrenaline levels were sky high. We made a 'plan'. We knew what we really wanted to do and see and the rest would be just extra! And after all the tweets and facebookposts we read about the day before, we knew it would be a jungle in there. So we needed that plan.
(We wrote this article together: Carola and Liv. The regular font is Carola speaking and the italic text is Liv. Enjoy!)