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Welcome to PlumbWorks
Our Story
We live by the army values of Loyalty, Duty, Respect, Selfless Service, Honor, Integrity and Personal Courage. And that's how we're doing plumbing at PlumbWorks.
Integrity means we always give a free, no obligation estimate and use flat rate pricing, plus we have a price match guarantee.
Respect means you will never get ambushed by a sales pitch. We will always have a licensed plumber doing your work, who is not on commission.
Personal Courage is what we have in facing even the toughest plumbing challenges – so throw em at us! Drain, Sewer, Repipe you name it.
We've hired the best licensed plumbers that carry those same core values, because we know that's the kind of plumber you want to have in your home. Our licensed plumbers tackle all job including:
- Drain Cleaning
- Water Line Repair / Replacement
- Sewer Line Repair / Replacement
- Whole House Re-pipes
- Hydro-jetting
- Water Heaters and Water Heater service
- Sump/Sewage pumps
- Sink and Faucet repair or replacement
- Toilets repaired and replaced
- Sewer Video Inspection services
- Residential, Commercial and Restaurant Specialists
- Removal of Orangeburg pipe
- And 24 HOUR EMERGENCY REPAIR SERVICE
(Sorry, we're not providing septic or well plumbing or new construction plumbing at this time.)
Experts in Getting you Plumbing Rebates from your Local Providers
Like Us on Facebook and take $20 off any plumbing service.
Just tell your PlumbWorks plumber at time of service. Cannot be combined with other discounts. Click the Facebook link to the left…yes look left! Then click like on the FB page and get this discount. Check our page for weekly do it yourself plumbing tips. They are EZ and save $.
Do you have concerns about Orangeburg Pipe?
Orangeburg pipe is very common around Puget Sound, and highly concentrated in Tacoma area homes. This pipe is deteriorating and we can offer expert re-piping services to remove your orangeburg pipe and replace it. Learn more and prevent a disaster in your home.
Our Fair Price Commitment
We're the Seattle plumbing alternative for homeowners who are tired of flushing their wallet down the drain and just want quality plumbing services at no nonesense prices. Whether you want Seattle plumbing, Tacoma re-piping, Lynnwood tub replacement or Bellevue drain cleaning - all around Puget Sound, we've got your expert plumbing services covered.
PlumbWorks plumbing is a division of Washington Energy Services. Washington Energy is locally owned and operated for over 55 years and BBB A+ rated. Our people understand the Northwest market and its customers. We have always had licensed, bonded and insured plumbers, now we have more of them and they are ready to help you with any plumbing problem. All of our PlumbWorks plumbers have plumbing licenses.
Are you ready for a plumber Seattle? For repiping, drain cleaning, general plumbing and 24 hour emergency repairs, give us a call at 800-590-4969
Lic # PLUMBWE888LO


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text:
- Budget
Time Out rating:
Venue details
Asmara 386 Coldharbour Lane
- Venue phone:
020 7737 4144
- Opening hours:
Dinner served 5.30pm-midnight daily
- Transport:
Tube: Brixton tube/rail
- Price:
Main courses £7.20-£9.80. Set meal £30 (2 people) vegetarian, £32 (2 people) meat
- 386 Coldharbour Lane
- 51.461803,-0.113060
- 386 Coldharbour Lane
Reviews & ratings
This is a really cool authentic place to eat, I'd recommend the meat platter for 2, to share, which comes served on sourdough pancakes, (various stewed meats and veg), and more sourdough if you run out, and extra chillis if you need them. Afterwards there is a cute plate of popcorn and delicious coffee served. The local beers taste good, the house wine is also very tasty. It is one of my fave restaurants in Brixton. Regarding the comment below, the bread is sourdough, so that is how it is supposed to taste, it is by far not the worst place ever....maybe you should go to Mcdonalds or KFC next time, Jen.
Marie-D Wed Feb 6Rated as: 4/5 -
Very good food!
Rohan Thu Dec 27 2012Rated as: 5/5 -
This restaurant is a joke ordered a chicken dish for 9 pounds and got a moues portion consisting of the smallest leg sauce one egg and hard rice. The bread is sour and tastes awful. Please don't go it's the worst place ever!
Jen Sun Nov 25 2012 -
Lovely relaxed place to eat with friends - ideally very hungry ones. The vegetarian options are good. Make sure you allow enough time after your meal for coffee and popcorn - the roasting etc takes a while but is a lovely experience. A really special and authentic place to eat.
Beck Fri Nov 16 2012Rated as: 4/5 -
Busy for a Wednesday night. We got the last table. Service was slow because of the crowd that was in, but when the food came it was delicious and the service was great - friendly, polite and human. We had the massob (?) - the set meal for two, meat option, with an extra portion of shiro (chickpea puree). Couldn't finish it there was so much!
Alem Shiro Thu Nov 1 2012 -
The food was really tasty and not like anything I had ever tried before. I would go back and spend another evening there. It was open late, so we did not leave until after 11pm when we had to rush off to the Ritzy cinema. The staff were polite and the atmosphere was relaxed.
BON Sat Feb 4 2012Rated as: 4/5 -
Unfriendly and dishonest service (was given a meal portion for two people while we requested a meal for three people...and we have been charged for three people...) .. highly poor client service ... not recommended at all.
firstname.lastname@example.com Mon Oct 31 2011


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1962 Volkswagen Beetle Convertible finished in sunny Yukon Yellow. Upgraded with a 1500cc engine from a 1974 Beetle. (The original 1200cc motor is included).... More
GR Auto Gallery is pleased to present this 1968 Volkswagen Beetle for purchase. With simplicity & efficiency that was combined with a high build... More
1962 VW Beetle Classic, Full Sunroof, 100% Nut & Bolt Restoration. For those of you who (like me) love the looks of the early Beetles,... More
Beautifully restored example of the classic 66 Beetle. Rare 50HP, 1285 CC engine that some have said is the most desirable of all Beetle's... More
1968 Volkswagen Squareback for sale in Chicago Illinois. This 1968 Volkswagen Squareback for sale in our Chicago Showroom. This stellar 68\ Volkswagen is powered... More
This 1966 Volkswagen Beetle is for sale in our Louisville KY Showroom. Before that rock band ever even thought about coming to America this... More
1967 Volkswagen Karmann Ghia. 4 cylinder engine, 4 speed transmission, AM radio and more. Looks and runs great. Don't forget to view the video... More
1966 VOLKSWAGEN BEETLE COUPE FINISHED IN CLASSIC PEARL WHITE WITH BEAUTIFUL RED INTERIOR! ONE YEAR ONLY 50-HORSEPOWER 1,300CC ENGINE! #'S MATCHING ENGINE! 4-SPEED MANUAL TRANSMISSION! BEAUTIFULLY RESTORED! ORIGINAL JACK! A CLASSIC... More
1967 Volkswagen Dune Buggy, Original Meyers--Manx body on a 1967 Volkswagen chassis. All new except for transmission. Complete frame up restoration. Paint is1996 Dodge Viper blue. Rare side pods.... More
More than anything old Beetles are about fun. There are a lot of cars that just take themselves too seriously but this 1963 VW... More
Beetle guys if you're going to modify your early VW this is how you do it right. This 1966 Beetle looks right sits right... More
1963 VW BEETLE 2D HARDTOP CUSTOM - Dupont metallic turquoise pearl with clearcoat - custom black cloth bucket seats - sensational custom sound system... More
1969 Volkswagen Beetle Convertible, She is just back from Autoplex of Lewisville, TX with a beautiful new paint job in the original Diamond Blue... More
Despite its wonderful lowered stance and slightly oversized rubber this ultra-clean 1967 Volkswagen Beetle is the product of an exacting restoration that returned it... More
Since the minute the first one rolled off the ship in the US the Volkswagen Beetle has been a favorite of customizers. Perhaps it's... More


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Latest Video Posts: Nicole Richie
10 Celebrities Who Ruled Social Media in 2013!
Best Dressed and Sexy Trends at the American Music Awards!
We Spy Body-Part Prints: Would You Wear Lips and Eyes?
The Best Halloween Celebrity Cross-Dressers
Celebrities Turn to Pop Culture For Their Halloween Costumes
How Does She Do It? Jessica Alba Perfects Menswear
Nicole Richie Makes THIS Look Sexy?
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Nicole Richie Shows Skin and Leads the Best-Dressed CFDA Pack
Video: Highlights Direct From the CFDA Awards Carpet! Plus, Who Wore What
The Best Bangs to Flatter Your Face Shape
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Whether or not you're a fan of importing games, nothing can really beat playing something in your native language. It's sometimes hard to know just what is going to make it to the West and what isn't, though. In our inaugural edition of the Guide's Localization Radar, we'll take a look at the likely candidates to get picked up. READ MORE
The holiday season is a good time to look back, so Jeff, Chris, Andrew, Graham, Lucas and Henry talk about the year's biggest events and how they've changed the way we play games.
Check out the show here, check us out on iTunes or use the RSS feed in your favorite podcast aggregator. Let us know what you think! Email podcast[at]snackbar-games.com.
Hosts: Jeff deSolla, Chris Ingersoll, Andrew Passafiume, Graham Russell, Henry Skey, Lucas White.
Music: Podcast theme by Tom Casper.
The theme of Falcom and XSEED's latest, Ys: Memories of Celceta, is exploration. Series hero Adol Christin has always been portrayed as an adventurer, but this time around, the focus turns away from combat and puzzles and puts most of its eggs in a basket of discovery. It is an interesting take on the Ys formula, but due to some technical issues and a few underwhelming design choices, the Vita debut of the series isn't as exciting as it should be. READ MORE
It's an exciting time to be a video game enthusiast. Feelings of welcomed anxiety accompany insatiable fascination with the coming of new consoles. You want to read everything you can, while jumping up and down like a four-year-old discovering trampolines. Along with these feelings comes a tsunami of analysis, debate, competition, reviews and industry predictions. The "old" consoles and games will receive price drops, the new consoles will fuel the fire of internet flame wars and, here at Snackbar, we'll talk and talk and talk about the Xbox One and PS4 until our throats are sore. New, new, new.
All major changes have consequences. Nothing exists in a bubble; new consoles are great for some, but what does it mean for the sector of the gaming industry that won't immediately benefit? Will brick-and-mortar stores slowly fade away, as Blockbuster did? Will we see the death of the mid-range developer? READ MORE
The team behind Adventure Time: Explore the Dungeon Because I DON'T KNOW! certainly had all the pieces in place to make a compelling title. WayForward has a long history of making good-to-great experiences using licensed properties, and the show (especially creator Pendleton Ward) certainly enjoys and reveres the medium. The first collaboration was a riff on Zelda II, an inspired choice that was nostalgic without being overdone. This second title's inspirations are less clear. READ MORE
Grobda is a mash-up. It can be described as a hectic Berzerk clone, an evolved version of Atari's Combat or a Xevious spin-off. There are hints and touches and small influences, yet by mixing them so seamlessly it manages to become its own game, free to be judged on its own merits. READ MORE
The Legend of Zelda: A Link Between Worlds is essentially a direct sequel to A Link to the Past, set in the same world and with many callbacks to one of the finest games ever made. Many of the mechanics, such as the constant switching between Hyrule and another world — in this case the kingdom of Lorule (a bit of wordplay also made by The Wonderful 101, oddly) — make a return in some form or another, but Link Between Worlds adds some modern twists to the classic Zelda gameplay. READ MORE
2012′s Dust: An Elysian Tail was a downloadable gem, and a labor of love for its creator, Dean Dodrill. We talked to him about his experiences making the game, thoughts on game design and what he's working on now.
Snackbar Games: Everyone starts off somewhere. Which games influenced you the most when you first started playing? You have mentioned that Ys Book I & II for the TurboGrafx-CD in particular is your favorite game of all time. What drew you to it?
Dean Dodrill: I've been gaming for a long time, ever since we got our first standalone Pong machine. My earliest gaming experiences were on the TI-99 4a computer, but it wasn't until the NES came along when a video game ignited my sense of wonder. I still remember watching a friend play Super Mario Bros. for the first time, and being blown away by the fact that you could climb into the clouds. READ MORE
When faced with following up Super Mario Galaxy as the flagship home 3D platformer, developer EAD Tokyo made a product out of cobbling together disparate smaller ideas. There's the new (Cat Mario), the recent (local multiplayer), the classic (the overworld) and the callback (character abilities). This, meshed with the 3D Land aesthetic, sounds like it would be promising but uneven, a pile of good things that just can't come together in a logical way.
But no, Super Mario 3D World is great both in parts and as a whole. READ MORE
Media Molecule, a developer known for putting its most creative tools into the hands of the players, is a factory of imaginative design. The LittleBigPlanet games have done well to demonstrate its talents, but are more a showcase for its fans and not of its own abilities as a studio. Tearaway is the first game from them that infuses their design philosophies and creative ambitions into a title that feels like a passion project. Most importantly of all, it's probably the best demonstrations of the Vita as a system. READ MORE


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Boulder County Parks and Open Space is proud to present, Carve! Selected Works from the Hygiene Champion Cottonwood," on exhibit at the Longmont Museum from November 23, 2013 through January 20, 2014. The public is invited to attend the exhibit
Read more: Area Artists Honor Gentle GiantAnother week gone by, and Lyons is making it! Everyone is proud of the way the Town is recovering.
Let's give credit to Victoria, Town Manager, Mayor Julie, Board members Sandy Banta (ongoing engineer who meets with the officials everyday at 4 p.m.), Dawn Weller (liaison to the Sustainable Futures Commissio), Kirk Udovich (liaison for PCDC, who are
Read more: About Town - Nov. 21, 2013AARP Foundation Tax-Aide, the nation's largest free, volunteer-run tax preparation and assistance service, is seeking volunteers across the state to help Colorado taxpayers who are seeking assistance preparing and filing their 2013 tax returns.
Volunteers do not need to be an AARP member or retiree to participate. Tax-Aide is particularly in need of volunteers who are bilingual in English/Spanish to support the increasing number of Spanish-speaking taxpayers seeking assistance.
Stories on Stage presents "Making Merry" Saturday, December 14 at 2:00 p.m. at The Dairy Center for the Arts in Boulder and Sunday, December 15 at 1:30 p.m. and 6:30 p.m. in Denver at the Seawell Ballroom at the Denver Performing Arts Complex. Single tickets are $28.Tickets for December 14 in Boulder are available by calling the Dairy Center at
Read more: Stories on Stage presents "Making Merry"Magic 8-Ball
I shake my magic 8 Ball
what do I see?
The whole world round
Out in front of me
Visual, artistic realms
Cohabitating with real life
Experiences persist amongst the turbulence
Making performance life art
Form and function flowing, imitating
Real vs. Imagined?
Observation relation
Magic 8-Ball
Tell me the tale
Tell me the TRUTH
By: Martin Soosloff
The regional premiere of Conor McPherson's Tony Award-winning play "The Seafarer" is coming to The Dairy Center in Boulder this December.
The play, one of the most frequently produced plays at regional theaters around the country, is about four Irish drinking buddies gathering on Christmas Eve, and one of them has to play poker with the devil for his soul.
NOVEMBER 11, IS VETERANS DAY. Yes, a day to honor our veterans of all wars, who fought for us through the years since 1776, because we did not like the English rule. Since then we have had many wars, and they are still happening, luckily not in America. But our service men and women are sent to fight overseas, all for the cause to keep Americans save. We truly owe each and every one of them our deep gratitude. "The Land of the Brave, and the Home of the Free" God bless and keep you all!
Our thanks to the Lyons High School and other bands of the St. Vrain District who participated in the Veterans Day Parade in Longmont on Monday.
Read more: About Town -Nov. 14, 2013


text:
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I am happy to announce the release of node-perfectapi version 1.0. This release improves stability, and improves scalability. For a brief intro to perfectapi, just follow the link.
I'll talk about scalability a little bit because it is an important new feature. As you probably know, Node.js applications run by default in a single process. It is easy to use code to workaround this limitation (at least within a single machine), but it is up to the programmer to know how best to do that in a way that makes their code scale appropriately.
What I did for this release is simplify that decision a little bit for the developer, by automatically scaling the perfectapi code across multiple CPUs. This means that HTTP requests and responses are handled by separate processes than the developer's code. Any errors in that code will be isolated, and any delays in that code will not affect the developers code.
For the developers, their own code can still make use of additional workers for CPU intensive tasks. There is an example in the source code that demonstrates how to do this, as well as some benchmarks that show expected gains when using additional workers.


text:
I taught it might be interesting and a bit of a laugh if we tried predicting the final line up using what we know so far and see who gets the most matches with the final list. Once again assuming 12 mechs divided equally between the weight classes and taking into account the tonnages of the known mechs here are my guesses.
We need 2 lights, 1 medium, 1 heavy and 2 asaults.
Commando 25T (personally hate it but can't stand bug mechs either and need a lighter mech)
Raven 35T (OK this one is what I want to see but have a feeling it'll be the Wolfhound)
Whitworth 40T (just for lighter Med)
Warhammer 70T (well it is in the trailer)
Awsome 80T
Battlemaster 85T (keeping a weight gap to maintain Atlas impact)
Well they are my guesses although just writting them I wanted to make changes already, Locust, Spider, Lynx, Wolverine, Stalker and Cyclops were all on my shortlist.
Edited by Fiachdubh, 30 January 2012 - 01:16 PM.


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What do Harper's PR people do?
All this week, the Star has been running a series called Secret Capital. The purpose of this series was to give Star readers a multi-faceted, close-up view of the way in which an unprecedented degree of control is being exerted over communication in Ottawa these days. My contribution to this series ran yesterday.
The final two installments, by my colleagues Tonda MacCharles and Allan Woods, appear in today's paper. Tonda tells how the control fixation comes right from the top, from the Prime Minister himself.
Allan has given us a closer glimpse into the communications shop of the Harper PMO when it's on the road.
The Woods' piece raises a question that all of us who have travelled with the PM have asked -- why bring along so many media handlers when you have a practice of not dealing with the media? Why is the Canadian taxpayer footing bills running to the tens of thousands to ferry these folks around the world, when, from Woods' reports, they seem to be little more than political tourists, rushing into elevators, for instance, to have their photos taken with President Bush?
I was on the first two foreign trips with Harper in early 2006, and like the rest of the pack, I simply was at a loss to understand what the communications folks were doing all the time we were in Afghanistan and Cancun. We rarely saw them and when we did, they had nothing to say. They seemed to function more as junior security officers. (In Afghanistan, I'm not sure additional security was needed, since Harper appeared to be well protected by the formidable, and scary, JTF2 guys.)
Subsequent foreign trips have just sealed and reinforced the pattern of virtual absence by the PMO communications team. Now reporters know to go to foreign governments for information about what Harper has been saying and doing on the road.
At any rate, it's worth reading the whole series if you have the time. It may help answer the question, often asked by supporters of the Harper government, about why we don't tell the government's side of the story often enough in our reportage. Here's the simple answer -- we can't tell the story if we don't know it.
Harper, it's said, is a long-term planner; his genius lies in his ability to identify the goal at the end of the road, and let the skirmishes and tactics sort themselves out along the way. So we've seen the skirmishes and tactics. The bigger question is: to what end?


text:
Dr. Abu-Judeh was a Cardiovascular Interventional Radiology fellow at New York Presbyterian Hospital, Cornell Medical Center, New York, NY. He is currently an Assistant Professor at the University of Dentistry of New JerseyNew Jersey Medical School. Dr. Khilnani and Dr. Min are Professors and Dr. Kandarpa is the Chief of the Cardiovascular Interventional Radiology Section at New York Presbyterian Hospital, Cornell Medical Center, New York, NY.
Recently, uterine artery embolization (UAE) has received much attention in both the scientific literature and the lay press as a minimally invasive procedure for treating symptomatic fibroid disease. Increasing numbers of women report satisfaction with the effectiveness and efficiency of the procedure over the conventional options. The purpose of this article is to review the literature regarding UAE and its development, techniques, indications, results, and complications. The results to date indicate that UAE is a highly successful, uterine-sparing alternative to hysterectomy for women with symptomatic fibroid disease.
A MEDLINE literature search using the words "uterine fibroid embolization" (UFE) or "uterine artery embolization" (UAE) revealed 196 articles as of May 1, 2002. Those articles include review articles, case series, case reports of adverse effects, and technical notes; addressing anatomical vascular considerations, fertility and pregnancy issues, animal experiments, embolic material choices, quality of life, and cost effectiveness.
Many women with fibroids choose to seek treatment only for symptomatic relief, with the main motivation often being quality-of-life issues. Conservative measures and traditional treatments may not be an option for many women. Surgical interventions are an undesirable option for some women since many consider the uterus an important aspect of their femininity. 1 The absence of an effective complication-free treatment for fibroid disease has led to a plethora of treatment modalities. Uterine artery embolization is a relatively new procedure that produces impressive results in the treatment of symptomatic uterine fibroids. It carries a very low rate of complications and preserves the uterus.
Transarterial embolization for active pelvic bleeding has been considered the therapy of choice for decades. Trauma surgeons have long used pelvic embolization to control acute traumatic pelvic hemorrhage. The first reported case of pelvic embolization for the treatment of obstetrical hemorrhage was in 1979. 2 Since then, embolization has gained more recognition and has been used to treat a wide variety of obstetric and gynecologic diseases associated with bleeding, including postpartum hemorrhage and ectopic pregnancy. 3 Uterine artery embolization has also been used successfully as presurgical gynecologic prophylaxis to decrease the amount of blood loss. In 1994, Ravina et al 4 were the first to describe pelvic embolization or UAE as an adjunct to surgery in the treatment of fibroids. A year later, he described the procedure as the primary treatment of uterine fibroids. 5,6
Since 1994, there has been an exponential rise in the number of UAEs performed annually. Worldwide, approximately 15,000 women, including more than 10,000 in the United States, have been treated with UAE for symptomatic uterine fibroid disease. Numerous published reports involving a total of more than 2000 patients have demonstrated the effectiveness and safety of this procedure. Symptomatic uterine leiomyoma are a significant source of morbidity to many women and place a substantial burden on our healthcare system. Uterine artery embolization has emerged as a minimally invasive procedure for treatment of symptomatic uterine fibroids and has gained acceptance as a primary treatment for symptomatic fibroids.
Uterine fibroids are the most common benign tumors in women with an estimated incidence of 20% to 40% in women over 35 years of age. Fibroid tumors affect women of all ages and races; however, there is a higher incidence among African-American women. 7,8
Leiomyoma is a benign smooth-muscle tumor that most commonly affects the body of the uterus but may also be found in the cervix, broad ligament, and, rarely, the ovary. The precise etiology of leiomyomas is unknown, although it is clear that the effects of hormones are pivotal as they typically occur during the reproductive period when hormonal influences are at their maximum. Studies have shown that leiomyomas have abnormal gene expression that maintains high levels of sensitivity to estrogen during the estrogen-dominated proliferative phase of the menstrual cycle. 9 Fibroids may vary in size from a few millimeters to 20 cm in size and may become symptomatic depending on their location and size.
Menorrhagia is the most common presenting symptom of fibroids. 10 The bleeding can be severe enough to cause microcytic anemia that iron supplementation alone is not enough to correct. Submucosal fibroids cause most bleeding in women with fibroids. Because of their location on the endometrium, submucosal fibroids place pressure on the uterine lining that builds with each menstrual cycle. This, in turn, can cause abnormal bleeding. 11 Another common fibroid-related symptom is pelvic pain or pressure and may even, depending on their location (ie, subserosal), affect the gastrointestinal or genitourinary systems. Pelvic pressure from the increasing size of a fibroid, regardless of location, can also produce menorrhagia. Fibroids may transmit transmural pressure on the bladder, causing urinary frequency. If large enough, fibroids may obstruct urinary flow through pressure on the ureters. Similarly, a fibroid may put pressure upon the bowel, causing constipation, painful bowel movements, and hemorrhoids. Fibroids may even cause neuropathic pain often involving the lower back and legs. Frequent complaints from patients include increased abdominal girth and distention, producing a disturbing cosmetic effect. During pregnancy, fibroids can cause recurrent miscarriage and premature birth. 10,11
Medical treatment for uterine fibroids may include the use of nonsteroidal anti-inflammatory agents, oral contraceptive pills, or progesterone analogs. Gonadotropin-releasing hormone agonist (GnRH) is reserved for more severe cases and is mainly limited to presurgical management to decrease blood loss during subsequent myomectomy or hysterectomy. 10 This treatment may result in improvement of symptoms and reduction in fibroid size of an average of 40% in the first 3 months of therapy. 12 GnRH is associated with postmenopausal symptomatology and cannot be used for periods longer than 6 to 9 months. 12 The fibroids often regrow to their original size within a few months of discontinuing the treatment. 10,12
Operative management of uterine fibroids includes laparoscopic, hysteroscopic, vaginal, or abdominal hysterectomies. These procedures may be associated with significant surgical morbidity (adhesions, infection, blood loss, thromboembolic events) and infertility. 10 Fibroid disease is the single most common condition (30%), and gynecologists in the United States perform more than 150,000 hysterectomies each year to relieve symptoms of uterine fibroids. 13 The rate of hysterectomy, however, has shown to vary with geographic region, the woman's age, level of education, and insurance coverage. 13 The main advantage of hysterectomy is that the risk of further fibroids is nonexistent. It is, however, a major surgical procedure with an extended recovery period of up to 6 weeks and with significant postoperative morbidity and mortality. Any hysterectomy means the end of childbearing, and in addition to the direct surgical risks, there may be long-term physical, emotional, and psychological effects, potentially including depression and loss of sexual pleasure. 14,15 If a salpingo-oophorectmy is performed along with the hysterectomy prior to menopause, it triggers premature onset of menopause with loss of ovarian-derived estrogen and androgens and may increase the risk of early bone loss and the onset of menopausal symptoms. 16
Surgical alternatives to hysterectomy have evolved, resulting in a 20% decline in the prevalence of the procedure in the last quarter century. Each year 35,000 myomectomies (transvaginal or laparoscopic) are performed to relieve the symptoms of uterine fibroids. Laparoscopic myomectomies are limited to a maximum fibroid size of 10 cm, or not more than four leiomyomas. 17 There is an average of 81% resolution of menorrhagia with myomectomies. 17 However, this procedure has its associated increased risk of hemorrhage, adhesions, lengthy operating time, postoperative morbidity (including pain), and longer hospital stays than with hysterectomy. 16 In addition to these shortcomings, 20% to 25% of women who undergo a myomectomy will ultimately require an additional procedure to further treat the fibroid. 16
Two recent cost studies from a single institution found that UAE compares favorably with hysterectomy 18 and myomectomy. 19 The estimated hospital cost for UAE was $3080. The cost for hysterectomy ranged from $3100 to $4900, depending on the type of procedure performed, and the cost for abdominal myomectomy was $5597. Although not included in these studies, there is an indirect cost of the lost work days during recovery, which is significantly lower in patients receiving UAE than in those undergoing hysterectomies or myomectomies.
Patient selection and preprocedure evaluation are extremely important: the correct diagnosis of symptomatic fibroid disease must be reached and other causes of uterine bleeding must be excluded. The patient should be interviewed, and a consultation with a gynecologist is advocated. In our institution, the patient is given reading materials to further familiarize her with all aspects of the treatment. Currently, premenopausal women who have uterine fibroids and symptoms that correlate reasonably well with the size and location of the fibroids are candidates for UAE. A complete medical history should be obtained. A physical examination, including a pelvic examination, should be performed within 6 months of the procedure. A normal PAP smear within 12 months is also required. The possibility of pregnancy should be excluded. If the patient has history of pelvic infection, cultures for gonorrhea and chlamydia should be obtained. In our institution, we obtain follicle-stimulating hormone (FSH) levels prior to UAE. Endometrial biopsy may be obtained for patients with abnormal bleeding, particularly if they are older than age 40. 20 If the patient is taking GnRH, the medication should be discontinued 8 to 12 weeks prior to procedure.
Contraindications to UAE include pregnancy, acute or chronic pelvic infection, arteriovenous malformation, renal insufficiency, active vasculitis, or pelvic irradiation. Although severe allergy to contrast is a contraindication to perform UAE, there is a case report in the literature describing technical success using CO 2 . 21
The possibility of a leiomyosarcoma should always be considered part of the differential diagnosis of uterine fibroids. It is extremely difficult, however, to prospectively differentiate a growing fibroid from a leiomyosarcoma with the currently employed imaging modalities, including magnetic resonance imaging (MRI). Theoretically, a positron-emission tomography (PET) scan might be of value.
This lack of adequate imaging options has led many physicians to perform deep fibroid biopsies, although this procedure has a low reliability rate (specificity and sensitivity), even in cases with known leiomyosarcoma. The incidence of leiomyosarcoma is rare and routine biopsies are not advocated, particularly given the low positive yield. 20
Postprocedure follow-up imaging is necessary; both ultrasound and MRI are effective. The physician should be suspicious of cancerous lesions if the fibroids do not decrease in size after embolization or, particularly, if the fibroids continue to enlarge.
Women with extremely large fibroids (>20 cm) may not experience significant benefit from UAE due to bulk-related symptoms. McLucas et al 22 identified, with a strong statistical significance ( P = 0.05), that leiomyomata with a diameter >8.5 cm is a predictor of failure. Although Spies et al 23 could not duplicate the statistical strength of McLucas's report, their conclusion was that smaller size leiomyoma and submucosal location were indicators for a positive outcome. There are no strong data to suggest that large fibroids are at increased risk for post-UAE infection. 20
The initial reports of UAE suggested a link between UAE failure and the presence of adenomyosis. 24,25 These early studies, which were conducted retrospectively to find an explanation for UAE failures, discovered islands of adenomyosis on the pathological examination. In a more recent retrospective series of 15 patients, the authors concluded that UAE can be beneficial in patients with menorrhagia and adenomyosis. 26 We also recently reported our experience in patients with uterine fibroids and co-existing adenomyosis. 27 Although the number of patients was small (10 patients), there was a suggestion that women with focal adenomyosis may be more responsive to UAE than those with diffuse adenomyosis.
Many interventional radiologists say they would consider offering UAE to patients with adenomyosis, since the only other successful alternative is hysterectomy, and would perform the procedure after counseling the patient and explaining the potential for failure (G. Siskin, informal oral communication, 2002 SCVIR meeting).
Menorrhagia in postmenopausal women can be severe enough that some women may seek relief. In our experience, postmenopausal women who refuse surgery and who are still suffering from fibroids can experience relief following UAE. Careful gynecologic clearance must be performed to exclude malignancy. This procedure can be very challenging technically, particularly in patients not receiving hormone replacement therapy. 28 The uterine artery is typically small and can be very difficult to access.
Prior to UAE, imaging should be performed to confirm the presence of fibroids, to exclude other causes of bleeding, and to serve as a baseline for future follow-up. Both ultrasound and MRI are capable of diagnosing fibroids, showing their location, and obtaining volumes to determine both fibroid and uterine size. Although ultrasound is significantly less costly than MRI, there is a trend toward obtaining an MRI rather than an ultrasound. An MRI is less operator-dependent and is reproducible. It has been shown to be more specific and sensitive than ultrasound for imaging of fibroids. 20 It is better at defining pedunculated fibroids and concomitant diseases, such as adenomyosis, which may affect management. Patients with subserosal pedunculated fibroids have a theoretical risk of devascularization of the attachment leading to torsion or even detachment of the fibroid; in these cases, a necrotic mass will be left in the peritoneal cavity. 29 Patients may benefit from laparoscopic myomectomy with or without premyomectomy UAE to decrease intraoperative bleeding. Patients with submucosal fibroids may benefit from hysteroscopic myomectomy since there is a risk of degenerating fibroid falling into the uterine cavity, a phenomenon noted even with nonpedunculated fibroids.
There is a recent trend to perform perfusion MRI with gadolinium. In one study, it was found that there is a difference in perfusion between the myometrium and leiomyoma following bilateral UAE. 30 At 1 month, there was recovery of myometrial perfusion but perfusion to the leiomyoma remained depressed. The reduction of leiomyoma perfusion correlated with the improvement in clinical score at 1 month. Leiomyomas high in signal intensity on the initial T2-weighted images showed greater volume reduction than those with low signal intensity. The authors concluded that dynamic MRI may be used to predict clinical response, while signal intensity on T2-weighted images predicts volume reduction. Three-dimensional color Doppler sonography can depict fibroid vascularity and, in some cases, can reveal collateral flow not depicted by uterine artery (UA) arteriography 31 ; however, post-UAE sonographic peak systolic velocity did not show predictive value. 32
Infection control and pain management
On the day of the UAE, informed consent is obtained from the patient. Preprocedure prophylactic antibiotic administration is advocated. Most interventional radiologists use cefazoline (Ancef, SmithKline Bechum, Pittsburg, PA), others may use antibiotic with more gram-negative coverage such as ceftriaxone (Rocephin, Roche, Nutley, NJ). A Foley catheter is inserted to eliminate impairment of visualization of pelvic vasculature due to a distended bladder.
A protocol for pain management should be developed in consultation with the anesthesia service. Different pain management schemes have been developed, mostly dependent on each institution's protocol. This protocol should include preprocedure, intra-procedure, and immediate postprocedure management, as well as in-hospital and outpatient pain management.
Most centers administer a combination of nonsteroidal anti-inflammatory drugs and narcotics prior to initiation of the procedure. Most UAE procedures are performed under conscious sedation, achieved with an intravenous (IV) combination of narcotics and benzodiazepines, typically fentanyl, morphine sulphate, and midazolam. Subcutaneous 1% lidocaine solution is the local anesthetic of choice. Unlike tumor embolization in other organs, lidocaine injection into the UA has led to spasm and constriction of the UA, resulting in incomplete embolization and no significant pain relief. 33
There are several published strategies for pain management following UAE. Oral, IV, or epidural pain medications have been employed. Patient-controlled analgesia is frequently employed post-UAE and the set-up must be in place as soon as the procedure is over because frequently the pain may start immediately after UAE or even near the end of the procedure.
Giving medications with different mechanisms of action, such as nonsteroidal anti-inflammatory drugs and opioids, has proven to provide adequate pain control in both the inpatient and outpatient settings. 20 In most centers, patients will stay overnight for pain control; however, some centers have had success performing the procedure in an outpatient setting. 34 Almost all patients will experience postembolization syndrome, consisting of a variable constellation of pelvic pain, cramping, nausea, vomiting, fever, and lethargy. The pain may be most severe immediately after the UAE. Although pain may indicate devascularization of the fibroid or fibroid ischemia, pain has not been found to be a reliable indicator of procedure success. 35 Lack of postprocedure pain, however, correlates well with procedure failure. It is important to have a team approach and an agreed-upon protocol among all services and individuals who may encounter the patient during or after this procedure.
It should be kept in mind that UAE is a vascular procedure and that careful attention to technique is essential for successful results. For the most part, most interventionalists are well versed in the different catheters and wires required to access the uterine arteries and are fairly skilled at doing so. However, there are certain issues that have been discussed in the literature that deserve attention.
Most interventional radiologists use the single-access, right common femoral artery approach using a 5F sheath. 36 There are some who advocated using the double-access approach, right and left common femoral arteries, citing the lower radiation risk as well as shortened procedure time. 20 This approach has not been used widely; however, due to the need for two interventional radiologists and the doubling of the risk of access-siterelated complications. Moreover, there is a minor additional cost of a selective catheter, and a significant increase in cost if there is a need for two microcatheters. 18
Most interventional radiologists will place the tip of a 5F or 4F catheter at the aortic bifurcation and perform a pelvic arteriogram to illustrate the origin of the internal iliac arteries, confirm the presence of dilated uterine arteries, and demonstrate the presence and location of a dominant UA. This step may be substituted with a pelvic magnetic resonance arteriogram (MRA). 37
Once in the internal iliac artery, most interventionalists use an oblique posterior projection and perform a road map to assist in selecting the UA. Typically, a contralateral oblique (20š to 30š) is sufficient. Occasionally, a steep oblique (40š to 50š) is needed, and infrequently, an ipsilateral oblique is required, particularly in the case of upper origin of the UA from the main trunk of the internal iliac artery. 38
For complete and successful embolization of the UA, the interventional radiologist should be aware of the anatomical variations of the artery. It is typically the first branch of the anterior division of the internal iliac artery, and it may arise from the medial or the lateral aspect of the anterior division. Other variations of the origin of the UA relate to its take-off in relation to the division of the internal iliac artery. Typically, there is a shared origin with the cystic or vaginal arteries. The UA has a tight curve in its proximal segment, followed by a descending, transverse, and then ascending segment. 20,38 The cervicovaginal branches, which some believe play a role in post-UAE sexual dysfunction, 39 typically originate from the transverse segment of the UA. If possible, the tip of the catheter should be placed distal to those branches. Arcuate (main intramural), radial, and peripheral uterine arteries are further subdivisions of the UA that supply the body of the uterus. In a hypervascular uterus "parasitized vascularity" from ovarian or other pelvic vessels may occur. 40,41
In initial reports, UA catheterization was performed with a 4F or 5F catheter; however, given that the UA is fairly tortuous artery, introducing a 4Fr or 5Fr catheter may lead to straightening the vessel, introduce artificial kinking, and reduce the flow around the catheter. Multiple authors have described spasms and constrictions preventing complete embolization with the use of such catheters. There is a strong current trend toward use of a 3F microcatheter to cannulate the UA. In a hand poll conducted at the 2002 Annual Meeting of the Society of Cardiovascular & Interventional Radiology (SCVIR), close to 40% of interventional radiologists said that they routinely used 3F microcatheters in every case, as do we in our practice. Furthermore, nearly 100% of those polled said they had used microcatheters at least in some cases.
It should also be remembered that patients who are on GnRH therapy might experience spasm and constriction of the UA, leading to difficult and sometimes incomplete embolization. 42
There are important collaterals between the right and left UA, between the ovarian artery and the UA, and between the round ligament artery and the UA. In most cases, the fibroid receives its blood supply from the UA alone. In some cases, the ovarian artery may provide vascular supply to the fibroid. If reflux into the ovarian artery is noted during embolization, most authors recommend continuing the embolization as long as the embolic material is not allowed to go beyond a short segment into the ovarian artery so that it immediately washes back into the uterus. 20
The presence of ovarian collaterals to the fibroids is a recognized risk for UAE failure. 43-45 It has been suggested that routine pre-embolization search (aortography and selected ovarian arteriography) for ovarian supply of fibroids is not warranted because of the assumed rarity of such collateral supplies and the radiation dose to the patient. 43 Given the impact of the discovery of ovarian collaterals on patient management, there is a current trend--including in our practice--to perform aortography at the conclusion of the embolization, with the tip of the catheter at the level of the renal arteries in search for ovarian collaterals. 44,45 If dilated ovarian arteries are discovered, the option of distal particulate embolization or proximal embolization with a temporary agent should be considered. 44 If no intervention was made, the mere recognition of a major ovarian collateral may expedite the surgical treatment or bring the patient back for a second procedure with the intent to embolize the ovarian artery. Although not reported in the literature, an abdominal/pelvic MRA may be useful in discovering dilated ovarian arteries.
Embolic material
The choice of embolic material should be based on the size of the vessels. The blood supply of uterine leiomyoma is provided by the uterine arteries and is characterized by two vascular networks of different sizes. The peripheral blood supply comes from dilated and tortuous arteries, and the central blood supply is composed of few fine arterioles derived from the peripheral network. 40 According to research by Pelage et al, 38 the target vessels for UAE are the prefibroid vascular plexuses, which are typically 500 to 600 µm in diameter.
There are currently three embolic materials on the market that are used in UAE 46 : gelatin sponge pledgets (Gelfoam, Pharmacia & Upjohn Co., Kalamazoo, MI), polyvinyl alcohol particles (PVA) (Contour, Interventional Therapeutic, Fermont, CA), and tri-acryl gelatin microspheres (Embospheres, BioSphere Medical, Rockland, MA). Although each agent has advantages and disadvantages, there is no consensus at this time as to which embolic material is best. Thus, the choice of embolic material is an individual choice for the interventional radiologist.
Gelfoam is significantly less expensive than any other embolic material. In the past, it was used as the embolic material of choice for obstetrical hemorrhage since it preserved fertility in such cases. 47 It may be used in UAE for fibroid disease as a sole embolic material 48 or it can be used to supplement the embolization or to "cap" a vessel that has been embolized with a different agent. 20
The majority of UAE procedures reported in the literature have been performed with PVA as the embolic agent. The recommended size is 300 to 500 µm or 500 to 700 µm. 49 There are disadvantages, however, to using PVA. It tends to occlude catheters, particularly the 3F size. It also tends to aggregate in and lodge in proximal vessels that are larger than those vessels believed ideal for UAE.
Calibrated microspheres have been introduced into the market recently. 50 They are appealing because, unlike PVA, they are less likely to occlude a microcatheter and they are deformable. Their homogenous flow-dependent distribution makes them well suited for occluding the target vessels thought to be ideal for embolization. Recommended sizes are 500 to 700 µm or 700 to 900 µm depending on the use of microcatheters. 50 In a late-breaking abstract at the 2002 Annual SCVIR meeting, the authors compared the new generation of Embospheres, EmboGold, with the bland Embospheres and found a surprisingly high rate (44% or 4 of 9 patients) of endometritis with the EmboGold. 51 We have used EmboGold in more than 20 patients, and our endometritis rate for both bland Embospheres and EmboGold is 0%.
Although Gelfoam is considered a temporary agent because it is reabsorbed relatively rapidly, it stimulates the most inflammatory response of the embolic agents used.
In women who undergo UAE with PVA alone, there appears to be restoration of flow in the main UA within 16 months after UAE. 20 Sterling et al 20 found that by using both PVA and Gelfoam together, the vessels remain occluded 3 to 12 months postprocedure. They do not, however, advocate the use of this method for patients desiring fertility.
Recent presentations at the SCVIR meeting described extravascular location of Embospheres on pathologic examination of hepatic tumors resected postembolization. 52 The size of embo-spheres used in hepatic tumor embol-ization is significantly smaller (40 to 120 µm) than those used in UAE, and it remains to be seen if larger particles behave in the same manner as the smaller particles.
The end point
The initial goal of UAE using PVA was to maintain embolization until there was complete stasis in the UA. This approach is being abandoned by most interventional radiologists who now look for other signs to end the embolization. This has become more important since Embospheres do not accomplish the complete stasis seen with PVA. Most interventional radiologists now look for signs such as the "pruned-tree" appearance of the ascending segment of the UA (Figure 1), or the appearance of new collaterals or filling of previously undemonstrated ovarian artery. Other signs include staining of the lower uterine segment and reflux of contrast around the catheter in the UA. 20 More recently fluoroscopic visualization of 5 pulsations of contrast in the UA before it dissipates has been used as another sign to end the embolization (J. Spies, informal oral communication, SCVIR 2002 Annual Meeting).
There are currently more than 20 large (>50) case series published worldwide. Table 1 summarizes the results of 11 of them. 24,28,33,53-60 The reported technical success rate of bilateral UAE is between 95% and 100%, and may approach 100% in cases in which the risk of dissecting the UA would be significantly reduced with the use of a 3F microcatheter. Symptomatic relief of menorrhagia is between 85% and 96%, and relief from bulk symptoms is between 69% and 92%. There is a 30% to 50% decrease in uterus size and 40% to 100% decrease in fibroid size. Most patients (90% to 100%) had a 1-night hospital stay.
Pathologically, fibroids undergo hyaline degeneration following UAE. Grossly, they are soft in consistency and pale on pathologic sectioning. The hyalinized areas are translucent and may be either small and localized or extensive. Microscopically, typical hyaline changes are characterized by marked cellularity and loss of the usual myomatous architecture. 61 After UAE, the majority of leiomyomata will decrease in volume and show changes on MRI, characterized by an increased signal intensity on T1-weighted images and a homogenous decreased signal intensity on T2-weighted images (Figure 2). 62 Fibroids may have a hypoechoic appearance on sonography, which correlates well with the hyaline degeneration seen in fibroids following UAE. 63 Unlike the typical dense, coarse, and central calcification of spontaneously degenerating fibroids, fibroids degenerating post-UAE have peripheral calcification that correlates with the peripheral aggregation of PVA particles in peripheral fibroid arteries. 63
UAE failure
There is an average failure rate for UAE of approximately 10%. 20 Suspected causes include incomplete or unilateral embolization, extremely large fibroids, presence of uterine leiomyosarcoma, coexisting adenomyosis, and presence of collateral blood supply, such as ovarian artery and round ligament artery (a branch of the inferior epigastric artery).
In some cases, incomplete embol-ization is due to spasm or constriction of the UA. This can be due to the use of 4F or 5F catheters and has also been associated with theuse of GnRh. Many interventional radiologists now use 3Fr microcatheters routinely to select and embolize the UA. In a recent study, 8 of 12 patients who underwent unilateral UAE had unsuccessful outcomes due to technical failure. 64 One failure was in a patient with a previously ligated internal iliac artery and another was in a patient who had unilateral UAE for technical reasons and did not undergo a second UAE. The authors concluded that patients who undergo unilateral UAE for technical reasons (inability to access the UA, eg, spasm) should be offered a second UAE to embolize the failed site shortly (within 3 to 4 weeks) after the initial procedure. Patients with congenitally absent UA may respond with similar success to those who undergo bilateral embolization.
Leiomyomas are a well-known cause of infertility, and there are serious risks in pregnancy in a leiomatous uterus. The effect of UAE on fertility is not clear for several reasons. To date, most treated patients are in their 40s and 50s and do not desire future pregnancies. However, numerous pregnancies have been reported after UAE. 65,66 These positive reports are difficult to interpret since the exact number of women attempting to get pregnant is not available. In a series of 12 patients with obstetric hemorrhage who underwent Gelfoam embolization, 11 resumed normal menses and all 3 patients who desired pregnancy achieved full-term, healthy newborns. 47 Currently, most interventional radiologists, for ethical reasons, counsel women desiring future pregnancy to consider other options. McLucas et al 67 reported a 33% term pregnancy rate in women younger than 40 years old, a rate comparable to that of women who underwent myomectomy. The authors conclude that pregnancy is a viable option for women undergoing UAE and that their preliminary data suggest that fertility is enhanced in women undergoing UAE.
A UAE experiment was performed in sheep with no fibroids and was found to be associated with a decrease in the number of pregnancies. 68 We wonder if it would not be the case in uteri with fibroids, but unfortunately there are no animal models with fibroids. Additional studies are needed to further evaluate the effect of UAE on fertility in leiomyomatous uteri.
The effect of UAE on menses is also difficult to assess for the same reasons. Most series report a rate of 2% to 5% cessation of menses. 65,66 In a recent series of 66 women, the reported ovarian failure rate was 14% 69 ; however, when the authors stratified their data, it was noted that no women under 45 years of age developed ovarian failure. Moreover, surgical options do not appear to be protective from early hormonal menopause even in women undergoing ovarian-conserving hysterectomies. 70 In one study, there was no statistically significant change ( P = 0.16) in ovarian function measured by basal FSH after UAE for the overall group. 71 However, for patients aged 45 or older, there was approximately a 15% chance of an increase in basal FSH into the perimenopausal range. 71
Impaired sexual function after hysterectomy is well documented in the literature. 14 There are also substantial, well-described emotional and psychological problems that may occur in a woman after hysterectomy. 15 A woman may feel "desexed," or may consider herself "half a woman." There is a single case report in the literature describing sexual dysfunction after UAE. 39 The authors propose that occlusion of the cervicovaginal branches may have caused cervical ischemia and, in turn, loss of orgasm; however, the patient eventually recovered sexual function. Recent abstracts reported that UAE was found not to cause sexual dysfunction and may even improve sexual function in patients presenting with bulk symptoms. 72,73
Arteriographic complications (such as hematoma, bleeding, and puncture-site arterial thrombosis) and complications related to the use of closure devices 20 have been reported. Most complications are minor, rarely requiring aggressive thrombolytic therapy. One case, however, did require a femoral-femoral bypass. 49 There are also reports of uterine infections, most minor, but a few required hysterectomies, and one case resulted in fatal septicemia. 20 There are reports of uterine ischemia and perforation. There have been cases of deep vein thrombosis and two reported cases of pulmonary embolism, one resulting in death. 20 There are a total of four known cases of death following UAE, the other two deaths being from sepsis. 20
Radiation exposure during UAE is of particular concern and deserves special attention. In a 20-patient series published by Nikolic et al, 74 the mean estimated ovarian dose was 22.34 cGy. This dose is equivalent to one to three barium enema examinations, and is unlikely to result in acute or long-term radiation injury or genetic risk to the patient. However, the dose range reported in the same series was 4 to 65 cGY. 74 It is important to note this variation in radiation dose, which was attributed to inconsistent fluoroscopic times. With more experience, the same group of physicians was able to decrease the radiation exposure by approximately 50% using pulsed fluoroscopy, avoiding magnification and oblique fluoroscopy, and by simultaneous bilateral embolization and arteriography. 75
Uterine artery embolization is a very promising and minimally invasive procedure with extremely favorable results. SCVIR (which recently changed its name to the Society of Interventional Radiology) has a comprehensive research strategy to validate UAE as a primary treatment for symptomatic uterine fibroids and has created the UFE registry. The interventional community as a whole is committed to research and information gathering so that patients may benefit from a state-of-the-art procedure that provides better care with fewer adverse effects.


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Gerber® Gator Axe Combo
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Features a forged steel head and unbreakable handle. Includes a 2-3/4" Gator fixed blade knife that magnetically locks into the handle of the axe.
Rated 4.7 out of 5 by 9
Rated 4 out of 5 by Fishin4bass723 Small but hardy
It's small but works good only thing i wish is it had a longer handle, guess that will be my next purchase.
May 24, 2013
Rated 5 out of 5 by abber good purchase
Gerber /gator axe combo is really nice.small but fits me well the knife fitting in axe is sweet. Gerber makes goodstuff.
January 30, 2013
Rated 5 out of 5 by SkeeterZX200 Good Little Axe
Good little ax for cutting limbs and saplings the edge isn't very sharp at all out of the package but with a good stone it is easy to sharpen
November 5, 2012
Rated 4 out of 5 by hikerboy great buy
great compact axe for hiking , camping, hunting or whatever. all around very handy the knife came out of package super sharp, only reason it didnt get five stars was the handle of the axe was a bit small in diameter for someone with bigger hands but with the gator grip you dont lose controle of it, the axe itself could use a bit of sharpening right away also, other than that great purchase
February 2, 2012
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Axe:Overall Length: 8.75"
Blade Length: 2.70"
Weight: 23.60 oz.
Head: Forged Steel
Handle: Gator-Grip
Overall Length: 7.01"
Blade Length: 2.88"
Weight: 2.00 oz.
Overall Length: 8.75"Blade Length: 2.70"
Weight: 23.60 oz.
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Shelby GT350 Tribute, for sale in Raleigh, North Carolina, for $39,900.
This 1965 Mustang started life as a true 289 Fastback GT car. However, now it is a Shelby GT350 "Tribute"car with the help of a complete mechanical and cosmetic restoration. The body was stripped completely down to metal and redone to a beautiful show quality finish. The entire interior was also done to an extremely high standard. We know the entire history of this car from new and it is a one family owned car out of Arkansas with absolutely no rust. New alloy 5-spoke vintage wheels and modern tires make this one a joy to drive. This car came from the factory with all the right options including 289ci engine with 4-bbl, front power disc brakes, limited slip, and 4-speed manual. The highly desirable options, along with being a rust free example, is why we decided to purchase and restore the car. We could go on and on about every aspect of the car and the restoration, but come to our showoom and see the car and we guarantee you will be very impressed. And, by the way, the dual exhaust system on this car sounds awesomeCar Shipping... Direct to your door!
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A spate of IPO activity has raised hopes that the moribund Hong Kong market is coming back to life. But most lawyers aren't counting on it.
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A Comeback for Hong Kong Capital Markets?
The Asian Lawyer
November 26, 2012
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Petit Palace Madrid Aeropuerto Reviews
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Note: This recipe is especially for kids with lactose intolerance. Kids with lactose intolerance often need to limit or avoid dairy products.
This is a quick and easy way to add a vegetable serving into your daily meal plan.
Prep time: 25 minutes
1 zucchini, sliced 1 yellow squash, sliced 1/2 red bell pepper, chopped 2 tomatoes, chopped 1/4 c. fat-free Italian dressing 2 c. brown rice, cooked 1/4 c. soy parmesan cheese non-stick cooking spray
Serves: 4
Serving size: 1 cup vegetables and 1/2 cup rice
Nutritional analysis (per serving):
165 calories 7 g protein 2 g fat 0 g sat fat 31 g carbohydrate 4 g fiber 0 mg cholesterol 278 mg sodium 117 mg calcium 1.4 mg iron
Note: Nutritional analysis may vary depending on ingredient brands used.
You can also serve over this dish over pasta. If you would like more of a cheesy flavor, add soy mozzarella to the vegetables.
Reviewed by: Allison Brinkley, RD, LD/N CNSD Date reviewed: December 2003
Note: All information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.
© 1995-2009 The Nemours Foundation/KidsHealth. All rights reserved.
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Mark Fadool, clinical director of mental health services at Odessa Brown Children's Clinic, provides early warning signs of mental health issues in kids and teens and urges us all to notice the signs and act early.
In this 30-second video, learn why children should ride in the back seat in a rear-facing car seat until they are age 2, or until they reach the upper weight or height limit for their seat.
En este video de 30 segundos aprenda por qué los niños deben ir en el asiento trasero mirando hacia atrás hasta los 2 años o hasta que lleguen al límite de estatura o de peso para su asiento.


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This problem is near the cave on the Eliminator. It starts on a big jug and goes up over the overhang to a two finger pocket. Then go up left to a slope and try to top out. Hope you don't get beached. Ben can't do it.
Crash pad.
Ben can do it
I'm not gonna be an ass about this but this problem is [definitely] not v2+ it is more like a v0- but it is an ok problem.
It's pretty height dependent - that first move is big and it's a blind slap. I've seen very strong shorter climbers flail - I'm tall and think V0- is rather generous.
For everyone that believes that this is V0-, are you sure you are thinking of the right problem. I believe this line goes left from the starting holds to slopers, then a mantle up over the top utilizing a side pull. If you go right from the starting hold, and use anything on the right side of the arete, then V0 would be accurate, but if you stay left of the arete, V2+ is a more accurate grade.
Yes, that's the problem I'm talking about. V0- for me, but like I said, it's very height dependent.
It is like v9 it is so hard it took me three years and I only did it once on top rope with 9 spotters and a trifold crash pad it is hard hard hard. If you think it is v2 you must be as good as Tom Cruise and he is really good like in MI2 that was killer.
I did this today, and [I don't] believe its v2+. I would rate this a v1 to v1+. Top out is pumpy, rest is easy if you find the right holds.
Ummm...does it count if I sent it without using the sloper to the left of the arete??
I threw it down in the 2nd day I was in Ft. Collins. It was tough but it was a super fun climb. Ripped up my fore-arms, but it's worth it.
This is a good problem to work on for a while, but once you hit it the problem is more like a V1 and that seems to take some of the fun out.
If you use the right holds without the right side of the problem (near the top), it's more of a V2+, but if you use the hold near the top it does drop it down. I would say a smaller person with not a big reach won't be able to do it the best.
Not sure if it's a problem on here or not, but I will post this regardless. For a fun variation (which I have yet to do), start on the bomber jug and, instead of throwing the heel and moving onto the "flake", throw from the jug to the finger pocket on the sloper with your left. It's an awkward, short "dyno," but I know people have done this variation before. If you think the standard "Beached Whale" is too easy, give this variation a try!
Everytime I'm out in CO, I go to this problem and really bust my arms on this one. But it's worth losing the skin on your forearms to get the problem done. Hike to it and Do it.
Did the eliminate of this the other day (the flake you go to from the starting bloc is off for feet and hands). It definitely makes going back to Beached Whale worthwhile again. If you've gotten tired of sending the standard, aren't working Mammen Traverse, and it's a hot day, get into the shade and try the eliminate, I promise you'll like it! Anyone know if this has a name or what it reportedly goes at?
If you've sent the eliminate but still can't bring yourself to leave the shady bliss of this boulder try this. Begin by traversing the east face ("East Face" traverse on this site) from the NE prow (near end of east face traverse) to the left, using whatever you want. When you reach the ledge approximately 6 ft right of beached whale, drop down low. From here make an awkward move left to gain the starting hold of beached whale around the corner. Top out via standard beached or try it with the eliminate. Moderately harder and definitely more interesting.
Another good variation is to start on the jug, move to the flake but then either cross to a pinch or gaston with your left then move to the slopers and top out. If you gaston with your left, I would just use it as an intermediate then bump to the top, not that hard. But crossing to the pinch is real interesting and significantly harder. Will post picture marked "fun variation".


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Call me blind, but I didn't see it coming.
Everybody was running, I didn't hear nothing except gun blasts.
It happened so fast.
I didn't really know this kid, though I sat by him in class.Everyone who knew Marcus Cummings couldn't say it was a surprise when the tortured, broken teen brought his dad's gun to school and blasted through the halls. Sure it was a tragedy, but no one could say that they didn't see it coming. There were over 20 deaths, and many more injured, all from a boy who was tired of being beaten and tortured. The last gunshot echoed the longest through the halls. Marcus claimed his own life, right there in front of the Chemistry lab.
The nation heard of the pain, the loss, the fear... but they couldn't really understand it. They couldn't fathom the feeling of watching your best friend, your sweetheart, your teacher being shot by a teen who had been pushed too far by too many. They would never feel the fear of being hidden away in a classroom, praying the boy, who wouldn't hurt a fly just a few days ago, would pass by and ignore the room. Not even a parent could realize the overwhelming regret of a life lost for a life saved.
First day back at school since the shooting. It's lunch, and the whole school is silent. No one dares speak a word, and there is a thick heaviness that hangs like dense smog in a large city. You have agreed to meet after school with a few other students to talk about something that no one is really sure about. But, it gets you out of counselling, and it sounds promising. You decide you've got nothing left to lose.Leonard straightened out his sleeves then cracked his knuckles nervously. He was put together, as usual. He was wearing a black suit, a white dress shirt, a blue tie, and nice, black dress shoes. He looked different though. He seemed hard, like there was a shell around him now. The Leonard you would have met just a week ago was a happy, handsome young man who would work his hardest at everything. But on Friday, when the shooting happened, something changed in Leonard, and it was instant. He leaned against a tree and crossed his arms, then turned his face to the sky, taking in the last of the suns rays.
Aspen looked up at the tall man leaning against the tree. Her hair had been combed recently, thanks to the local church, but it was starting to get tangles. Her big, blue eyes blinked slowly, and she opened her mouth to speak, but no words came, as though her words were afraid to break the fragile silence. She looked over to the horizon, able to see a storm moving in from the east, and she sat in the dry, brown grass. She folded her hands in her lap, then looked at the boy.
"Where is everyone?" she asked, the silence suddenly gone. Leonard opened his eyes and looked at the dirty girl who was here. She was the first one here, besides Leonard.
"They're coming, or they chickened out and went to counselling," he explained, his rich, deep voice making little noise in the quiet of the empty park. Leonard then scratched his chin gently and tapped his pocket, feeling the cash in his pocket. It was a hefty sum, and he sighed lightly, covering his eyes with his hand. Lola softly grabbed Leonard's hand and licked her lips. She didn't know what was happening.
Aspen nodded thoughtfully, then looked around at the empty park for signs of life.


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I've been a fan of rock band since the beginning. Since standing in line for Rock band part 1 I've played rock Band pretty much every day since then. I've bought RB 2 and most of the DLC to thirst my rock hunger. I play the Drums must of the time at the expert level and I'm always looking for a good drum challenge. I was in a real band for a short time in college when they needed a back up drummer so I have a little bit a recording experience. I think my real passion for the game will make me a excellent volunteer. Thanks for the opportunity.
My Gamertag is Chevelleman1970


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There are varieties of gadgets available in today's UK market. It's really a tough task to select the winner among all of them. Every gizmo is designed in a way to do a specific task. Such amazing latest gadgets and gizmos are exclusively loaded with style and advanced technology. As the technology is getting advanced day by day, a new widget is coming out in market everyday. These small devices can be categorized in to birthday gifts, puzzles, games, travel, home, electronics and eco gadgets. Continue reading
Mobile phone insurance is something most iPhone owners consider at one point or another. As friend's tales of water damaged and stolen phones become more common however, iPhone insurance becomes a larger consideration.
Read more


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Oak Bay Reviews
• A WorldWeb.com Travel Guide to Reviews in Oak Bay, NB, Atlantic Canada.
Reviews Directory
Welcome to WorldWeb.com reviews! Please use the links below to find reader-submitted reviews, tips and ratings about travel services and local businesses in Oak Bay. If you would like to share an experience you've had with a Oak Bay hotel, restaurant or other business, we encourage you to write a review of your own.- Hotel Reviews (1)


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Experienced newbee - recomendations for kernel, diskless config and other Q's?
Many of your questions may have already been answered in earlier discussions or in the FAQ. The search results page will indicate current discussions as well as past list serves, articles, and papers.
ds10025 at hermes.cam.ac.uk ds10025 at hermes.cam.ac.ukFri Jun 1 11:00:09 PDT 2001
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I've installed Readhat 6.2 and in the process of setting up the first node. It is possible to down load a copy of Scyld Beowulf? Regards Dan --On 01 June 2001, 11:40 -0400 "Sean Dilda" <agrajag at scyld.com> wrote: > On Fri, 01 Jun 2001, d.bussenschutt at mailbox.gu.edu.au wrote: > >> A few questions from an experienced sys-admin that is a "beowulf >> newbee"... >> >> If I use Redhat, what version had best support for Beowulf? The older >> version have been around the longest, so we know they "work", but does >> 2.2.19 (redhat 7.0) or the 2.4.x (redhat 7.1) kernel give better >> out-of-the-box support? (I'll still have to compile the kernel, but that's >> no big deal) > > Red Hat Linux really doesn't include Beowulf support. Red Hat once put > out a CD called 'Extreme Linux' that was Red Hat Linux 5.0 plus some > Beowulf stuff. > > However, we currently ship a product called Scyld Beowulf. It is based > off of Red Hat Linux with additions that make it great for setting up a > Beowulf cluster. It will allow th ehead node to install out of the box. > Setting up a slave node for our cluster can be as easy as just sticking > a floppy disk in (and it will just use a ramdisk), or if you want to > actually setup swap and some harddrive space (like /tmp), can take as > long as 5 minutes. Our latest release is based off of Red Hat Linux 6.2 > with a 2.2.17 kernel. However, newer releases are always in the works.
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Books, Manual, Training
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Topic: Books, Manual, Training (Read 3640 times)
Making baby steps
Posts: 3
Re: Books, Manual, Training
Reply #15 on:
September 19, 2012, 03:56:04 pm »
On a serious note, are we against charging for a professional setup of linuxMCE and end user support. By charging I'm thinking of only hardware and labor of hardware installation, the os and os setup would have to be free, correct?
Posts: 526
Re: Books, Manual, Training
Reply #16 on:
September 19, 2012, 08:40:01 pm »
Pluto Public License, via wayback...
See my User page on the LinuxMCE Wiki for a description of my system configuration (click the little globe under my profile pic).
LinuxMCE God
Posts: 2420
Re: Books, Manual, Training
Reply #17 on:
September 19, 2012, 09:27:15 pm »
Quote from: dowster on September 19, 2012, 03:56:04 pm
On a serious note, are we against charging for a professional setup of linuxMCE and end user support. By charging I'm thinking of only hardware and labor of hardware installation, the os and os setup would have to be free, correct?
there is no problem with charging somebody for a professional setup. But it should be a professional setup and not just a default install where the customer is referred to the forum/irc to search for help to get his installation working :-)
rock your home -
home automation
LinuxMCE God
Posts: 5400
DOES work for LinuxMCE.
Re: Books, Manual, Training
Reply #18 on:
September 19, 2012, 09:58:59 pm »
Most of us who have been around, have experienced this, _first hand_.
Posts: 429
Re: Books, Manual, Training
Reply #19 on:
November 09, 2012, 02:32:10 pm »
My name is James and I'm...
not an alcoholic. But I do have a confession to make-
I too have dreamed of earning money via linuxMCE.
I've been afraid to bring it up before because although I don't know the history, I've often come across posts on the forum where people have been sent packing when there was any sort of commercial flavour to their interest in this project. I bring it up now partly because the issue has come up again and partly because I've almost given up on that dream...
Deep breath... so can I ask the following of you guys-
Firstly, please don't alienate me and chase me out of town with pitchforks for raising this discussion. I love linuxMCE and would love to be part of the project, ultimately contributing once I have built up the skills to do so. I've tried a bit but I'm still very green. Regardless of whether or not you guys dash my dream of quitting my dayjob for this, I want to stick with the project for personal use and, as I said above, keep my software skills sharp by contributing.
And then, be gently honest with me about the issues surrounding earning an income related to linuxMCE. I'll tell you my thinking, and you can, gently, explain where I'm off track.
Here goes.
Reasoning- quite simple, of course. I want to do something (for a living that is) that I love. Which is greedy at this point because I have a pretty decent job in software development and I almost love it. But it's in a big corporate with all the red-tape and process and egos and bad decisions and poor management and closed-source, proprietary software and so difficult to actually do anything that really adds value. And a wee bit less flexible in terms of time and location than I would, in my greediness, like.
So for a long time I've been thinking I need to "do my own thing". And then I was introduced to linuxMCE. And it blew my socks off. Not from the dollar-potential, but just because it really ticked all the boxes for me. Open-source, freely avaiable, linux-based and basically intrinsically better than anything else out there. So I got stuck in and blundered around as a newbie does, figuring out how I can set up my own system. Then, shortly after getting my first MD up and running, I got the idea that maybe this was it... maybe if I could get the skills in this I could somehow earn a living helping people set up their own systems. And if I could do that, wouldn't that just be my dream job?
My idea was that I would not sell the software or the hardware... I would sell my time. My time would be sold as advice/ desgin/ consulting/ support/ assistance or actual setup. Yes, I imagined selling turnkey type solutions but explicitly with the lids off both in terms of hardware and software- eg. I can either design the system for you and charge you for my time (you can buy the hardware and install it) or I can design it, charge for my time and charge for my time sourcing the hardware and setting it up. And I would always be absolutely open and upfront about the whole thing - point the to the project, explain that it was free and open and they could do it themselves if they wanted or, at any time, chuck my services and take over.
Now, to my mind, that didn't violate any of the licenses.... and maybe it would have worked, maybe it wouldn't. Certainly I'm nowhere near having the skills or knowhow to do it....
But then with more reading on the forums, I came across the posts where anyone with a commercial interest was sent packing. Of course, in all the cases I agreed with the lambasting because it was some joker coming on as a complete newbie and essentially wanting the community to help him for free while he earned cash. And that wasn't even vaguely where my dream was... but some of the comments made me think it went quite a bit beyond that... to the point where any type of income earned related to linuxMCE was going to get you ostracised from the community. That's how it appears at least.
And if that's the case, I'm quite prepared to accept that and forget about my dream and carry on as a normal (for now) and hopefully one day super user that can give back more than I got out.
However, if it's not the case, and some of you guys are prepared to clarify to me what the position of the community is in this regard, without forever hating me ignoring me on IRC and forums just for raising this, then I'd really welcome your feedback. This thread happens to include most of the guys that I respect in the community already so it seemed the ideal place to post this question.
Thoughts? Flames? Severe beatings?
Incidentally, believe it or not, I hoped that if by some chance I was successful with my venture, I would really be able to give back in a big way. You see, currently I have a std day job that more or less supports the family, full time at home and very little time I can give to linuxMCE. Which was one of the reasons I hoped to make it my vocation. Because then I could devote all my working time to the project.... and hopefully not just mine, but a team of developers. See, I already manage a team of software developers... that's what I do. And I thought of bailing, starting my own company, and then pulling the best of them in to work on linuxMCE- Firstly to become experts in it, and secondly to start contributing. Obviously we'd be contributing in specific areas where we felt there was a market but being open source, everything we developed would go straight back to the project for everyone to use. Because we wouldn't be selling the software or the hardware, we'd be selling our expertise... so success for linuxMCE would mean success and a market for us.
Don't laugh.
I welcome your thoughts guys. Be gentle.... it's not everyday someone tells you their dream!
LinuxMCE God
Posts: 2420
Re: Books, Manual, Training
Reply #20 on:
November 09, 2012, 08:15:47 pm »
Just be aware that parts of the code are licensed under the Pluto Public License, and the current copyright holders have an exclusive deal with a big vendor. So chances to get a bunch of licenses from them are basically NIL, nada, null, VOID. If you want to sell licenses maybe talk to Dianemo. They did get their licenses before Pluto sold the copyright. I don't know how many they have left, but this is probably the only currently possible approach to get some.
rock your home -
home automation
Posts: 429
Re: Books, Manual, Training
Reply #21 on:
November 12, 2012, 07:53:44 am »
Thanks, Hari.
Any idea who this is? =>
Quote from: hari on November 09, 2012, 08:15:47 pm
current copyright holders
And this vendor =>
Quote from: hari on November 09, 2012, 08:15:47 pm
exclusive deal with a big vendor.
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Ray Kurzweil's latest graphs show that technology's breakneck advances will only accelerate -- recession or not. He unveils his new project, Singularity University, to study oncoming tech and guide it to benefit humanity.
Ray Kurzweil is an engineer who has radically advanced the fields of speech, text, and audio technology. He's also one of our finest thinkers, revered for his dizzying -- yet convincing -- writing on the advance of technology, the limits of biology, and the future of the human species. Full bio »
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Upgrade from Agilent VEE Pro 8.0 to Agilent VEE Pro 9.3
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Things We Forget - A
by Post-it Guy
Things We Forget posters: for over three years now the Postit Guy, an anonymous artist, has been drawing an inspirational message on a sticky note and leaving it to its fate in a public places in Singapore and elsewhere. The TWF notes are catalogued at http://thingsweforget.blogspot.com. And now the best notes are available as posters.
Sheet size: 70 Things We Forget notes in A1 (59.4 X 84 cm)
Print Quality: Offset Lithographic Printing on 100 gsm wood-free paper. Poster printed by A&D Printhub Singapore.
Delivery & Shipping (Worldwide)
Your poster will be packed in a Hard Tube and delivered by Singapore Post. On confirmation and dispatch of your order, you will be provided with a tracking number. You can expect your poster in maximum 30 workings days after confirmation of your payment.


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What? You think Nong Film looks fake? Awww, she's so cute. The over the top make up is very normal in pageants. They have to look lively to the audience and judges. If they put on natural make up they'll look pale. Here is a photo of Nong Film in a more natural look. She's so cute.
More of Nong Filmy! ^_^


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Posted April 16, 2012
DubConqueror: As a question to add to this opinion of mine: would you care to name sites that do make well-argumented and detailed reviews?
The German print-magazine PC Games does that. Not all of their reviews land on their website, however. You best take a look for yourself: http://www.pcgames.de/Artikel-Archiv/Tests/