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|Número de publicación
|Tipo de publicación
|Número de solicitud
|Fecha de publicación
|11 Ene 2007
|Fecha de presentación
|21 Jun 2006
|Fecha de prioridad
|27 Mar 2003
|También publicado como
|Número de publicación
|William Malecki, Dan Francis, Kenneth Horne, Mark Deem, Hanson Gifford, Jose Alejandro
|Cesionario original
|Cierra, Inc.
|Exportar cita
|BiBTeX, EndNote, RefMan
|Citada por (25), Clasificaciones (31), Eventos legales (4)
|Enlaces externos: USPTO, Cesión de USPTO, Espacenet
This application is a continuation of U.S. patent application Ser. No. 11/249,566 (Attorney Docket No. 022128-000202US), filed Oct. 12, 2005, which is a continuation of U.S. patent application Ser. No. 10/958,533 (Attorney Docket No. 022128-000201US), filed Oct. 4, 2004, which was a divisional of U.S. patent application Ser. No. 10/679,245 (Attorney Docket No. 022128-000200US), filed Oct. 4, 2003, which claimed priority to U.S. Provisional Patent Application Nos.: 60/458,854 (Attorney Docket No. 022128-000100US (formerly 020979-002100US)), filed Mar. 27, 2003; 60/478,035 (Attorney Docket No. 022128-00011US (formerly 020979-00211US)), filed Jun. 11, 2003; and 60/490,082 (Attorney Docket No. 022128-000120US (formerly 020979-002120US)), filed Jul. 24, 2003, the full disclosures of which are incorporated herein by reference. This application is related to U.S. patent application Ser. No. 10/665,974 (Attorney Docket No. 022128-000300US (formerly 020979-002600US)), filed Sep. 18, 2003, the full disclosure of which is incorporated herein by reference.
The invention generally relates to medical devices and methods. More specifically, the invention relates to energy based devices and methods for treatment of patent foramen ovale.
Fetal blood circulation is much different than adult circulation. Because fetal blood is oxygenated by the placenta, rather than the fetal lungs, blood is generally shunted away from the lungs to the peripheral tissues through a number of vessels and foramens that remain patent (i.e., open) during fetal life and typically close shortly after birth. For example, fetal blood passes directly from the right atrium through the foramen ovale into the left atrium, and a portion of blood circulating through the pulmonary artery trunk passes through the ductus arteriosus to the aorta. This fetal circulation is shown in attached
At birth, as a newborn begins breathing, blood pressure in the left atrium rises above the pressure in the right atrium. In most newborns, a flap of tissue closes the foramen ovale and heals together. In approximately 20,000 babies born each year in the US, the flap of tissue is missing, and the hole remains open as an atrial septal defect (ASD). In a much more significant percentage of the population (estimates range from 5% to 20% of the entire population), the flap is present but does not heal together. This condition is known as a patent foramen ovale (PFO). Whenever the pressure in the right atrium rises above that in the left atrium, blood pressure can push this patent channel open, allowing blood to flow from the right atrium to the left atrium.
Patent foramen ovale has long been considered a relatively benign condition, since it typically has little effect on the body's circulation. More recently, however, it has been found that a significant number of strokes may be caused at least in part by PFO. In some cases, stroke may occur because a PFO allows blood containing small thrombi to flow directly from the venous circulation to the arterial circulation and into the brain, rather than flowing to the lungs where the thrombi can become trapped and gradually dissolved. In other cases, thrombi might form in the patent channel of the PFO itself and become dislodged when the pressures cause blood to flow from the right atrium to the left atrium. It has been estimated that patients with PFOs who have already had cryptogenic strokes have a 4% risk per year of having another stroke.
Further research is currently being conducted into the link between PFO and stroke. At the present time, if someone with a PFO has two or more strokes, the healthcare system in the U.S. may reimburse a surgical or other interventional procedure to definitively close the PFO. It is likely, however, that a more prophylactic approach would be warranted to close PFOs to prevent the prospective occurrence of a stroke. The cost and potential side-effects and complications of such a procedure must be low, however, since the event rate due to PFOs is relatively low. In younger patients, for example, PFOs sometimes close by themselves over time without any adverse health effects.
Another highly prevalent and debilitating condition—chronic migraine headache—has also been linked with PFO. Although the exact link has not yet been explained, PFO closure has been shown to eliminate or significantly reduce migraine headaches in many patients. Again, prophylactic PFO closure to treat chronic migraine headaches might be warranted if a relatively non-invasive procedure were available.
Currently available interventional therapies for PFO are generally fairly invasive and/or have potential drawbacks. One strategy is simply to close a PFO during open heart surgery for another purpose, such as heart valve surgery. This can typically be achieved via a simple procedure such as placing a stitch or two across the PFO with vascular suture. Performing open heart surgery purely to close an asymptomatic PFO or even a very small ASD, however, would be very hard to justify.
A number of interventional devices for closing PFOs percutaneously have also been proposed and developed. Most of these devices are the same as or similar to ASD closure devices. They are typically "clamshell" or "double umbrella" shaped devices which deploy an area of biocompatible metal mesh or fabric (ePTFE or Dacron, for example) on each side of the atrial septum, held together with a central axial element, to cover the PFO. This umbrella then heals into the atrial septum, with the healing response forming a uniform layer of tissue or "pannus" over the device. Such devices have been developed, for example, by companies such as Nitinol Medical Technologies, Inc. (Boston, Mass.) and AGA Medical, Inc. (White Bear Lake, Minn.). U.S. Pat. No. 6,401,720 describes a method and apparatus for thoracoscopic intracardiac procedures which may be used for treatment of PFO.
Although available devices may work well in some cases, they also face a number of challenges. Relatively frequent causes of complications include, for example, improper deployment, device embolization into the circulation and device breakage. In some instances, a deployed device does not heal into the septal wall completely, leaving an exposed tissue which may itself be a nidus for thrombus formation. Furthermore, currently available devices are generally complex and expensive to manufacture, making their use for prophylactic treatment of PFO impractical. Additionally, currently available devices typically close a PFO by placing material on either side of the tunnel of the PFO, compressing and opening the tunnel acutely, until blood clots on the devices and causes flow to stop.
Research into methods and compositions for tissue welding has been underway for many years. Of particular interest are technologies developed by McNally et. al., (as shown in U.S. Pat. No. 6,391,049) and Fusion Medical (as shown in U.S. Pat. Nos. 5,156,613, 5,669,934, 5,824,015 and 5,931,165). These technologies all disclose energy delivery to tissue solders and patches to join tissue and form anastamoses between arteries, bowel, nerves, etc. Also of interest are a number of patents by inventor Sinofsky, relating to laser suturing of biological materials (e.g., U.S. Pat. Nos. 5,725,522, 5,569,239, 5,540,677 and 5,071,417). None of these disclosures, however, show methods or apparatus suitable for positioning the tissues of the PFO for welding or for delivering the energy to a PFO to be welded.
Causing thermal trauma to a patent ovale has been described in two patent applications by Stambaugh et al. (PCT Publication Nos. WO 99/18870 and WO 99/18871). The devices and methods described, however, cause trauma to PFO tissues to hopefully eventually cause scar tissue formation which will close the PFO. Using such devices and methods, the PFO actually remains patent immediately after the procedure and only closes sometime later. Therefore, a physician may not know whether the treatment has worked until long after the treatment procedure has been performed. Frequently, scar tissue may fail to form or may form incompletely, resulting in a still patent PFO.
Therefore, it would be advantageous to have improved methods and apparatus for treating a PFO. Ideally, such methods and apparatus would help seal the PFO during, immediately after or soon after performing a treatment procedure. Also ideally, such devices and methods would leave no foreign material (or very little material) in a patient's heart. Furthermore, such methods and apparatus would preferably be relatively simple to manufacture and use, thus rendering prophylactic treatment of PFO, such as for stroke prevention, a viable option. At least some of these objectives will be met by the present invention.
The present invention generally provides devices and methods for treating patent foramen ovale (PFO). More specifically, the devices and methods involve advancing a catheter device to a position in the heart for treating the patent foramen ovale and applying energy to (or removing energy from) tissues adjacent a PFO to substantially close the PFO acutely. By "substantially," it is meant that a stable tissue bridge will be formed across the PFO, which will withstand physiologic pressures. A substantially closed PFO, however, may still have one or more small gaps or openings, which will in at least some cases close over time via the healing process. By "acutely," it is meant that the PFO is substantially closed when the closure procedure is completed. Thus, acute closure distinguishes devices and methods of the present invention from prior protocols, which rely on delayed PFO closure via tissue healing and scarring. "Acutely," for purposes of this application, does not mean temporarily, since devices and methods of the present invention will typically provide for permanent (or at least long-term) PFO closure.
The phrase "tissues adjacent a PFO," or simply "PFO tissues," for the purposes of this application, means any tissues in, around or in the vicinity of a PFO which may be used or manipulated to help close the PFO. For example, tissues adjacent a PFO include septum primum tissue, septum secundum tissue, atrial septal tissue lateral to the septum primum or septum secundum, tissue within the tunnel of the PFO, tissue on the right atrial surface or the left atrial surface of the atrial septum and the like. By "application or removal" of energy, it is meant that energy may be transferred either to or from PFO tissues. In various embodiments, any of a number of energy transfer devices and forms of energy may be used to provide such energy transfer. Types of energy used may include, for example, radiofrequency energy, cryogenic energy, laser energy, ultrasound energy, resistive heat energy, microwave energy and the like.
Application of energy to (or removal of energy from) tissues to substantially close the PFO acutely may sometimes be referred to as "tissue welding." Preferably, tissue welding methods of the present invention will be performed without using tissue soldering material or other foreign material. In some embodiments, however, it may be advantageous to use one or more solder materials. Various solders and other tissue soldering matrices are described more fully in U.S. patent application Ser. No. 10/665,974 (Attorney Docket No. 022128-000300US), which was previously incorporated by reference. Examples of tissue solders or adhesives which may be used include, but are not limited to, autologous blood, albumin, collagen, fibrin, cyanoacrylates, mussel byssus adhesives, polymer hot melt adhesives and the like.
In some embodiments of the present invention, devices and methods further provide for bringing tissues adjacent a PFO together (or "apposing" tissues). In various embodiments, tissues may be apposed before, during and/or after application or removal of energy to the tissues. Generally, energy application or removal will act to denature collagen in the PFO tissues. If the tissues are apposed before and/or during denaturation and/or while the collagen in the tissues is allowed to renature, the collagen in once-separated tissues binds together to bring the tissues together. Therefore, although not required, some embodiments of the invention include one or more devices for bringing (and possibly holding) tissues together before, during and/or after energy application or removal. Such devices include, for example, PFO tissue covering members, which may also be suction or vacuum application members, expandable members within the PFO tunnel, distal tip members for contacting a left atrial surface of PFO tissue and the like. By providing for substantial, acute closure of a PFO, devices and methods of the invention may be advantageous for preventing stroke, treating migraine headaches and/or preventing or treating other medical conditions caused or exacerbated by PFO.
In one aspect of the present invention, a method of treating a PFO in a heart involves advancing a catheter device to a position in the heart for treating the PFO and applying energy to the tissues with the catheter device to substantially close the PFO acutely. In some embodiments, as just mentioned, the method further includes bringing the tissues at least partially together, preferably using the catheter device but in some embodiments using a separate device. For example, in some embodiments the tissues are brought together before applying the energy. Optionally, the tissues may then be held together while applying the energy. In some embodiments, the tissues are held together after the energy has been applied as well. The method may also involve cooling the tissues after the energy has been applied.
Bringing the tissues at least partially together may be accomplished by any of a number of suitable devices and methods. In one embodiments, for example, the tissues are contacted with a tissue covering member adjacent a distal end of the catheter device. The tissue covering member may cause blood pressure in a left atrium of the heart to bring the tissues at least partially together. In some embodiments, the tissue covering member may be further used to apply vacuum force to the tissues.
Although the catheter device may be positioned in a number of different locations for treating a PFO, in some embodiments advancing the catheter involves positioning a distal end of the catheter in a right atrium of the heart. Advancing the catheter may also include advancement over a guide catheter or guidewire extending into the PFO. Optionally, the guide catheter or guidewire may extend through the PFO into a left atrium of the heart.
In some embodiments, the method further includes retracting a sheath portion of the guide catheter to expose an expanding member within the PFO, the exposed expanding member bringing the tissues adjacent the PFO at least partially together. Such an expanding member may provide lateral force to the tissues adjacent the PFO, for example, and in some embodiments will do so without extending into the left atrium. As is explained further below, such expanding members may comprise "fishmouth," two-pronged members in one embodiment, and may be constructed of shape memory materials, spring-loaded materials or the like. By spreading PFO tissues laterally between two prongs (for example), the tissues come together in the area between the prongs. Optionally, the method may also include contacting a left atrial surface of at least one of a septum primum and a septum secundum with a distal portion of the expanding member and retracting the expanding member to bring the tissues adjacent the PFO together. For example, the distal portion may contact the septum primum and pull it toward the right side of the heart, into contact with the septum secundum. At some point after the expanding member has been used to appose the tissues adjacent the PFO, it may be advantageous to retract the expanding member to a position within the guide catheter. For example, the expanding member may be retracted in some embodiments before removing the guide catheter through the main catheter device.
As mentioned, in some embodiments the catheter device may be advanced over a guidewire rather than a guide catheter. The guidewire typically extends through the PFO and may include an expanding portion along its length for expanding within the PFO. Optionally, the guidewire may extend into the left atrium, and the method may optionally include contacting a left atrial surface of at least one of a septum primum and a septum secundum with a distal portion of the guidewire and retracting the guidewire to bring the tissues adjacent the PFO together.
Any suitable type of energy may be applied to the PFO tissues to provide acute PFO closure. In some embodiments, for example, monopolar or bipolar radiofrequency energy is applied, while in alternative embodiments cryogenic, resistive heat, ultrasound, microwave, or laser energy, heat energy in the form of heated fluid such as saline, or the like may be applied. Energy may be applied by energizing a single conductive member of the catheter device or multiple conductive members, in various embodiments. Generally, any suitable devices for energy delivery are contemplated.
Some embodiments of the method may further involve monitoring an amount of energy applied to the tissues. For example, monitoring the energy may involve monitoring a temperature of the tissues, an impedance of the tissues and/or the like. Such a method may further involve determining when a sufficient amount of energy has been applied to the tissues to acutely close the PFO. Optionally, the method may also include discontinuing the application of energy when the sufficient amount of energy has been applied.
Any of the above methods may also involve directly visualizing the PFO and the adjacent tissues using at least one visualization device coupled with the catheter device. Such a visualization device may include a fiber optic device, an ultrasound device or any other suitable visualization device.
In another aspect of the invention, a method of treating a PFO in a heart involves advancing a catheter device to a position in the heart for treating the patent foramen ovale and removing energy from tissues adjacent the patent foramen ovale with the catheter device to substantially close the patent foramen ovale acutely. Removing energy from the tissues may be achieved using any suitable device(s), such as by contacting the tissues with one or more cryogenic energy members. Any of the additional or alternative method steps described above may be applied to this aspect of the invention.
In another aspect of the invention, apparatus for treating a PFO in a heart includes a catheter device having a proximal end and a distal end and at least one energy transmission member adjacent the distal end for applying energy to, or removing energy from, tissues adjacent a PFO to acutely close the PFO. Some embodiments further include at least one tissue apposition member adjacent the distal end for at least partially bringing the tissues together. In some embodiments, the tissue apposition member comprises a tissue covering member. The tissue covering member may have any suitable configuration and be constructed from any suitable material(s). In some embodiments, for example, the tissue covering member has a suction cup or cone shape.
In some embodiments, the tissue covering member fully covers the opening of the PFO to allow blood pressure in a left atrium of the heart to bring the tissues together. Additionally, the tissue covering member may comprise a suction member for applying vacuum force to the tissues to bring the tissues together. Optionally, the tissue covering member may be expandable from a first delivery dimension to a second treatment dimension. In some embodiments, the catheter further comprises a flexible isolation portion disposed between the tissue covering member and the catheter device to prevent unwanted movement of the tissue covering member during use. In some embodiments, the at least one energy transmission member is coupled with the tissue covering member.
Some embodiments of the apparatus further include a guide member for advancing through the PFO, with the catheter device being slidably disposed over the guide member. The guide member may include, for example a guide catheter and at least one expandable member disposed within the guide catheter, wherein the guide catheter is retractable to expose the expandable member to allow it to expand within the PFO. The expandable member, in turn, may have any suitable configuration, but in some embodiments it includes at least two members that expand apart to provide lateral force to the tissues adjacent the PFO, such as a "fishmouth" or two-prong expandable member. When exposed, the expanding member may also provide dilatory force to the tissues adjacent the PFO. To provide expandability, the expandable member may be made of shape memory material, may be spring loaded, and/or the like.
In alternative embodiments, the guide member may comprise a guidewire having an expandable portion along its length. For example, the expandable portion may be a divided portion, the divided portion comprising expandable shape memory material. Optionally, the guide member may include at least one tip for contacting a left atrial surface of the tissues adjacent the PFO. Such a tip may be conformable to the left atrial surface. The guide member may be retractable to engage the at least one tip with the left atrial surface.
In any of the above embodiments, one or more guide members, or component parts of a guide member, may act as one or more energy transmission members. In some embodiments, for example, an expanding member may act as a monopolar or bipolar radiofrequency electrode.
The at least one energy transmission member of the catheter device may comprise any suitable energy transmission device or combination of devices. For example, the transmission member may transmit radiofrequency energy, cryogenic energy, resistive heat energy, ultrasound energy, microwave energy, laser energy or any other form of energy for treating PFO tissues. In preferred embodiments, the energy transmission member comprises a monopolar or two bipolar radiofrequency transmission members. Such a transmission member, for example, may be curved to approximate the curvature of the PFO. In other embodiments, straight transmission members, mesh or braided transmission members, multiple pin-point transmission members or the like may be used.
In some embodiments, the energy transmission member(s) are coupled with the tissue apposition member. Thus, tissues may be brought into apposition and energy may be applied using the tissue apposition member. In some embodiments, energy transmission member is movable along at least part of a circumference of the at least one tissue apposition member. In alternative embodiments, the energy transmission member comprises a guide member for advancing through the PFO, with the catheter device being slidably disposed over the guide member. Again, the guide member typically includes at least one expandable portion for expanding within the PFO to at least partially bring together the tissues adjacent the PFO, and in some embodiments the expandable member acts as the energy transmission member(s). In still other embodiments, energy transmission members may be coupled with both the tissue apposition member and the guide member/expandable member.
Apparatus of the invention may further include at least one sensor coupled with the catheter device for sensing an amount of energy delivered to the tissues by the at least one energy transmission member. Sensors, for example, may be infrared sensors, thermistors, thermocouples or the like, though any sensors may be used. Optionally, a microprocessor may be coupled with the at least one sensor for processing sensed data to determine when the amount of delivered energy has reached a desired amount of energy.
These and other embodiments are described in further detail in the following description related to the appended drawing figures.
Devices and methods of the present invention generally provide for patent foramen, ovale (PFO) treatment through application or removal of energy. Methods involve advancing a catheter device to a position in the heart for treating the PFO and applying energy to (or removing energy from) tissues adjacent a PFO to substantially close the PFO acutely. Terms such as "substantially," "acutely," and "tissues adjacent the PFO" are defined above in the Brief Summary of the Invention. Devices of the invention generally include a catheter device having a proximal end and a distal end and at least one energy transmission member adjacent the distal end for applying energy to or removing energy from tissues adjacent the PFO.
As mentioned above in the background section,
With reference to
Although the embodiment in
Referring now to
In general, catheter device 210 comprises an elongate, flexible catheter which may be advanced through the vasculature of a patient to a position in the heart for treating a PFO. Thus, catheter device 210 may have any suitable length, diameter, cross-sectional profile and the like, and may be constructed of any suitable material. Tissue apposition member 212 (or multiple tissue apposition members in some embodiments) is disposed at or near the distal end of catheter device 210. Although many different types of devices may be used to bring tissues of the PFO together, in one embodiment (shown in
In this and other embodiments, tissue apposition member 212 may also include one or more vacuum members for applying vacuum to the PFO tissues. In one embodiment, for example, suction lumen 236 (
Tissue apposition member 212, especially when configured as a PFO-covering member, may be collapsible/expandable to facilitate advancement and delivery of catheter device 210. For example, tissue apposition member 212 may comprise a collapsible polymeric cover disposed over an expandable/collapsible frame. In other embodiments, tissue apposition member 212 may be constructed of a shape memory material, such as nitinol or another shape memory metal, spring stainless steel or the like, to allow catheter device 210 to be delivered through vasculature and then allow tissue apposition member 212 to expand to contact and appose the PFO tissues. In some embodiments, catheter device 210 and tissue apposition member 212 may be delivered to a location for PFO treatment through an introducer sheath. To further enhance the use of apparatus 200, an angle between catheter device 210 and tissue apposition member 212 may be selected to approximate a convenient angle for delivery and/or deployment. In one embodiment, for example, the angle between catheter device 210 and tissue apposition member 212 may approximate the angle between the inferior vena cava and the interatrial septum. Any other configuration, combination of angles and the like is contemplated, however. In some embodiments, for example, direct steering of the angle of tissue apposition member 212 relative to catheter device 210 may be employed to enhance delivery of catheter device 210 to a treatment site.
To further facilitate use of apparatus 200, catheter device 210 may include one or more radiopaque markers 226 for facilitating visualization of the device 210. Catheter device 210 may also include a "flexible isolation portion" 228, which in some embodiments comprises a rigid but shapeable portion disposed toward the distal end of catheter device 210, between tissue apposition member 212 and the generally flexible proximal portion of catheter device 210. Flexible isolation portion 228 may help to isolate tissue apposition member 212 from some or all movement experienced by the more flexible, proximal portion of catheter device 210, thus allowing a PFO treatment procedure to be performed without significant movement of tissue apposition member 212. In other embodiments, flexible isolation portion 228 may be more flexible than the more proximal portion of catheter device 210, thus enhancing maneuverability, shapability or the like of the position of tissue apposition member 212 relative to the more proximal portion.
Energy transmission members 214 may comprise any of a number of devices and may transmit any suitable type of energy for closing a PFO. Some types of energy which may be used, for example, include radiofrequency, cryogenic, resistive heat, ultrasound, microwave and laser energy. Radiofrequency energy transmission members 214 may be either monopolar or bipolar, with monopolar catheter devices also including a grounding member. Energy transmission members 214 may have any suitable configuration. For example, they may have a curved shape to approximate a radius of curvature of the PFO, as shown in
As mentioned earlier, the phrase "tissue welding" herein is used to mean application of energy to (or removal of energy from) PFO tissues to substantially and acutely close the PFO. Energy transmission members 214 generally provide for transfer of energy to or from PFO tissues to denature collagen in the tissues, and when the collagen is allowed to renature, with the tissues apposed, the once separated tissues bind together to form a stable tissue bridge. This stable tissue bridge substantially and acutely closes the PFO, preferably permanently. PFO tissues may, in some embodiments, be brought and held together by one or more tissue apposition members 212. Energy transmission members 214 provide sufficient energy transfer, for a sufficient time, to weld the tissues. The time span of energy transmission may be, for example, from about 0.5 seconds to about 15 minutes, and more preferably from about 30 seconds to about 5 minutes. Energy transmission, in some embodiments, may be from about 0.5 Watts to about 100 Watts, and more preferably from about 2 Watts to about 20 Watts. Any other suitable energy and timing combination may also be used. In one experimental example, a PFO in a section of pig heart tissue used ex-vivo in a flowing saline test fixture was closed by applying suction to appose the PFO tissues and applying RF energy at approximately 25 watts for 7 minutes. RF energy application was then discontinued, but suction was continued for an additional 1 minute to keep tissues in apposition while the tissue cooled, to allow collagen in the tissues to reorganize and bind together to form a stable tissue bridge. Many other energy amounts, energy application times, tissue apposition times and the like are contemplated, however.
Although any type of energy may be transmitted by energy transmission members 214, some embodiments will make use of monopolar or bipolar radiofrequency (RF) energy. Devices may use monopolar radiofrequency energy, for example, wherein energy is applied simultaneously to all conductive elements, completing the circuit through an external ground pad affixed to the skin of the patient. Alternatively, bipolar energy may be applied to all conductive elements simultaneously, and the circuit completed through a ground element incorporated elsewhere on apparatus 200. Further embodiments may include applying bipolar energy between two or more energy transmission members 214, which are electrically isolated from one another within catheter device 210.
Control systems coupled with energy transmission members 214 or tissue apposition member 212, or otherwise disposed within apparatus 200, may sense an amount of energy delivered to PFO tissues and, optionally, may automatically stop energy delivery upon detecting a change in condition of energy delivery, for instance an increase in electrical resistance or impedance in PFO tissues or in apparatus 200, an increased energy draw from the treatment apparatus, and/or the like. In some embodiments, energy delivery may be automatically stopped when an amount of delivered energy reaches a desired level, such as an amount of energy sufficient to substantially close the PFO. The amount of delivered energy may be monitored by any suitable method, such as monitoring temperature or impedance in PFO tissues or the like. In some embodiments, one or more sensors coupled with tissue apposition member 212, energy transmission members 214, or any other part of apparatus 200 may be used for monitoring such indicia. Examples of sensor devices include but are not limited to infrared sensing devices, thermistors and thermocouples. A control system may also include a microprocessor coupled with the sensors to determine when a desired amount of energy has been delivered and/or to automatically stop energy transmission. In alternative embodiments, a microprocessor may be included in apparatus 200 which can sense, monitor and control energy delivery, thus not requiring separate sensors.
With continued reference to
Guide catheter 220 may contain one or more expandable members 222 or other similar devices for expanding within the PFO to help bring the PFO tissues together, anchor catheter device to the PFO tissues, or both. As shown in
Expandable member 222 may have any suitable configuration and may be constructed from any suitable materials. For example, expandable member 222 may be spring loaded, made of shape memory material, such as nitinol or spring stainless steel or the like. Alternatively, expandable member 222 may be expanded mechanically by one or more expansion members coupled with expandable member 222 and controlled via an actuator at the proximal end of guide catheter 220. During delivery of guide catheter 220, expandable member 222 reside within guide catheter 220. Guide catheter 220 may then be withdrawn to deploy expandable member 222 either within the PFO or within the left atrium to be drawn back into the PFO. In some embodiments, expandable member 222 has one or more pre-shaped or shapeable distal tips 223. Tips 223 may be used, for example, to help locate and cross the PFO. Tips 223 may also be used to contact a left atrial surface of the septum primum or other PFO tissue, so that when the expandable member 222 is pulled proximally tips 223 help bring the PFO tissues together and/or anchor apparatus 200.
In some embodiments, one or more expandable members 222 may include or be coupled with one or more energy transmission members. For example, expandable member 222 may include one or more radiofrequency transmission members for monopolar or bipolar RF transmission. A fish mouth expandable member 222, for example, may include a bipolar RF transmission member on each prong of the fish mouth. In some embodiments, energy transmission members may be included in or coupled with both expandable member 222 and tissue apposition member 212. In any such embodiments, some portions of the energy transmission member(s) may be insulated, to prevent unwanted energy transmission to tissues. For example, in some embodiments a distal tip extending to contact a left atrial surface of PFO tissues may be insulated to prevent energy transmission from the tip.
Referring now to
Apparatus 300 of
Referring now to
In use, catheter device 410 is typically advanced over guidewire 420 to a treatment location. Split portion 422 and optionally distal tip 423 are then used to help appose the tissues adjacent the PFO. Before, during or after retraction of guidewire 420, energy transmission portion 432 is retracted into tissue apposition member 412. PFO tissue is then brought together using tissue apposition member 412, and energy is transmitted to the tissues using energy transmission portion 432. In some embodiments, tissue apposition member 412 provides for application of vacuum energy to the tissues to suction the tissues at least partially into tissue apposition member 412, thus enhancing contact of the tissues with energy transmission portion 432. Energy transmission portion 432 may comprise, for example an electrode mesh material, while tissue apposition member 412 may comprise an elastic coated mesh or other material. Again, any features described above in reference to other embodiments may be applied to the embodiment shown in
With reference now to
Referring now to
That being said, in one embodiment, a PFO treatment method includes advancing a guide catheter 720 through the PFO, between tissues T adjacent the PFO, the guide catheter 720 containing an expandable member (
Once guide catheter 720 is in place and expandable member 722 is deployed, catheter device 710 may be advanced over guide catheter 720 to a position for treatment of the PFO (
Apparatus and methods according to the present invention may rely on energy, in various forms, to seal the PFO, either with or without an associated implant device. As an alternative to implant-based devices, systems according to the present invention can function to weld the PFO closed with no implant left behind. As illustrated in
Referring to
As illustrated in
In other embodiments, PFO closure systems according to the present invention may utilize one or more clips to close the PFO. Such systems can be divided into designs that involve both a right and left atrial component, and those that are right-sided only. While they are generally not energized, it may be desirable to add energy to any of these designs to facilitate adhesion and sealing.
Referring now to
Referring now to
Referring now to
In another embodiment, a patch might also be used on the right atrial side to provide an additional means to seal the PFO. If it is desirable to prevent the wire around the patch area from receiving RF energy, it is possible to electrically insulate the portion of the wire that is not desired to burn into the tissue (not shown). In another embodiment, the "zig zag" portion 852 of the coil 850 located in the flattened passageway between the primum and secundum might have sharp features (such as needles or barbs) which cause the adjacent surfaces of the primum and secundum to bleed and heal together. RF energy might be used in any of the embodiments of the spiral spring coil described above to burn some or all of the device into the tissue and promote rapid healing and prevent embolization.
As mentioned above, the foregoing method may be altered in any number of ways without departing from the scope of the invention. In some embodiments, for example, tissues adjacent the PFO are brought at least partially together and energy is applied to the tissues to acutely close the PFO with fewer steps and/or fewer device components than just described. For example, application of suction to appose tissues is not required in all embodiments. Furthermore, a variety of different types of energy may be applied to the tissues from a variety of differently configured energy transmission devices. In some embodiments, one or more of the steps described above may be repeated one or more times, such as by repeating a tissue welding step. The above description, therefore, is provided for exemplary purposes only.
Although the foregoing description is complete and accurate, it has described only exemplary embodiments of the invention. Various changes, additions, deletions and the like may be made to one or more embodiments of the invention without departing from the scope of the invention. Additionally, different elements of the invention could be combined to achieve any of the effects described above. Thus, the description above is provided for exemplary purposes only and should not be interpreted to limit the scope of the invention as set forth in the following claims.
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|Clasificación de EE.UU.
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|6 May 2008
Owner name: TERUMO KABUSHIKI KAISHA,JAPAN
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:CIERRA, INC.;REEL/FRAME:020930/0649
Effective date: 20080505
|1 Abr 2015
|Fee payment
Year of fee payment: 4
|12 May 2015
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Year of fee payment: 4
|12 May 2015
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text: Front Angled view Back Easy-to-adjust manual controls Focus switch HDMI (mini) and USB interface Top controls Top view View larger Fujifilm X100S 16.3-megapixel digital camera with fixed 23mm lens Item #: 072X100S 2 Reviews This item is no longer available. Original Price: $1,299.99 Shop all Point-and-shoot Cameras Need help? 1.888.955.6000 Email Chat Ask an expert advisor No pressure, no commission — just lots of good advice from our highly trained staff. Overview Reviews Details Accessories Articles & Videos by David Brown Cool updates to an instant classic Fujifilm earned the adoration of camera enthusiasts with the retro styling and uncompromised image quality of its X100. Now, they have updated this well-received design with an improved sensor and more processing firepower, for a compact camera capable of true SLR-grade photography. The X100S builds on the success of the X100, letting you capture even more detail and more action with less noise thanks to improved response times and enhanced resolution. Fast auto focus and even better image quality Fujifilm's improved X-Trans CMOS II sensor is an SLR-size APS-C chip designed for lightning-fast auto focus as well sparkling image resolution. Hybrid AF automatically switches between standard contrast auto focus and faster phase detection AF, for speedy focus times even while shooting fast action. And given this sensor's sophisticated design, there's no need for an optical low-pass filter — that means the sensor captures unfiltered light directly from the lens, for ultra-high resolution beyond what you'd expect from its 16.3-megapixel specification. Like the sensor, the improved EXR Processor II features a newly developed noise-reduction process, which separates and minimizes noise, allowing spectacular low-light performance. Plus, the enhanced processor means faster response times — from quicker start-up speeds to continous shooting up to 6 frames per second at full resolution. The X100S gives you total creative control during shooting. The lens remains the same, but manual focus has a new twist A camera is only as good as its lens and, like the previous X100, the X100S has a great one. The fixed 23mm f/2 Fujinon lens lets you capture stunning natural color and bright detail, whether you're shooting casual snapshots or artistic compositions destined to hang on your wall. The manual focus ring — made from machine-milled metal, like the other controls — works in tandem with the electronic viewfinder for a unique new feature. Fujifilm's newly developed Digital Split Image feature divides the frame into two images. Proper focus brings them into alignment, ensuring pinpoint sharpness while you maintain manual control. Hybrid electronic and optical viewfinder The X100S carries forward its predecessor's innovative hybrid electronic and optical viewfinder, selectable via the front switch. The EVF features newly enhanced resolution and an LCD readout of real-time shooting data, also available through the OVF, for info like shutter speed and f-stop. The built-in eye sensor switches the viewfinder on when you peer through its rather large opening. There's also a 2.8" LCD screen, ideal for reviewing photos and HD video. A beautiful design made more user-friendly With ergonomically designed manual dials, you'll maintain total creative control without having to give up shooting flexibility or readiness. An aperture lens ring and top-panel shutter speed and exposure compensation dials are designed for easy access while holding the camera up to your eye. The leather-grained finish on the magnesium-alloy body makes the X100S easy to grip, for the feel of an old-school rangefinder with all the benefits of 21st-century imaging power. Highlights:16.3-megapixel effective recordingAPS-C size X-Trans CMOS II image sensor (23.6 X 15.6 mm) for rich tonal gradation and true-to-life colorfixed 23mm Fujinon Aspherical f/2 lens (35mm equivalent focal length: 35mm)minimum focus distance: 2.6 ft. (normal), 3.9 inches (macro mode)high-def movie mode with stereo sound (up to 1080p/60fps)hybrid optical/electronic viewfinder (2,360,000 dot resolution for EVF) with eye sensor and dioptric adjustment2.8" LCD screen (460,000 dot resolution)advanced Fujifilm EXR II image processor for improved natural color and low noisemanual focus ring with dual split images displayed on LCD and EVF for sharpening focusHybrid AF automatically switches between phase detection and contrast AF for auto focus speeds as fast as 0.08 secondsbuilt-in neutral density filter (3 stops) for greater exposure flexibilitydurable, lightweight magnesium alloy top and base with synthetic leather finishthreaded shutter button compatible with mechanical shutter release cablesbuilt-in flashhot shoe for optional Fujifilm flasheswarranty: 1 yearOur 60-day money-back guaranteeExposure Modes and Controls:continuous shooting mode: 6 frames per second (up to 31 JPEG frames)shutter speed range: 30-1/4,000 seconds, bulb (up to 60 minutes)sensitivity or ISO (film speed equivalent) range: 200-6400 (extended output sensitivity equivalent ISO 100, 12,800, and 25,600)program auto, shutter-priority, aperture-priority, and manual exposure modesauto exposure, film simulation, dynamic rage and ISO sensitivity bracketing (up to 3 frames for each)File Formats and Storage:image storage modes: JPEG, RAW, and RAW+JPEGtop JPEG/RAW resolution (pixels): 4,896 x 3,264 (3:2); 4,896 x 2,760 (16:9)H.264 MOV movie files up to 1920 x 1080 resolution at up to 60 frames per second with stereo soundrecords photos and video onto optional SD, SDHC, or SDXC memory cardsConnections and Dimensions:high-speed USB interfacemini HDMI output (cable not included)5-3/8"W x 3"H x 2-1/4"Dweight (including battery and memory card): 15.7 oz.Supplied Accessories:rechargeable lithium ion battery and chargerlens capshoulder strapUSB cablesoftware CD-ROM Today's point-and-shoot cameras make great pictures easier than ever From baby's first steps, to that dream vacation in the islands, these cameras make it easy to capture life's greatest hits. Today's cameras have helpful automatic features, like face detection and scene recognition that make shooting more foolproof than ever. And they all have plenty of megapixels for detailed photos that stay sharp, even when you enlarge and print them. Fujifilm X100S Reviews Average Customer Review: 2 reviews Review this product Submit a review and then enter to win a $350 rewards card Filter by rating: 5 Star: (0) 4 Star: (0) 3 Star: (0) 2 Star: (0) 1 Star: (0) Review this product: Thanks for taking the time to share your experiences about this product. Please be sure to focus your comments on the product itself. Read our Review Guidelines for more information. Review title * Email Your email won't be visible. Please use the email address that is associated with your order. Display name (e.g., JohnD) Your review will be signed using the display name and location * Your location (e.g., Charlottesville, VA) * Your rating Click on a star to rate the overall product on a scale of 1-5 1500 characters left * Your review Attach a YouTube Review Crutchfield Video Review Guidelines Only submit videos that you made or are authorized to use. Do not submit videos that contain music, video or visuals that are copyrighted and belong to someone else. Please see our Review Guidelines for more information. Enter the URL of your YouTube™ video review or product demonstration. e.g., "http://www.youtube.com/v/o79TWHh598U" 500 characters left Pros 500 characters left Cons * Agree to Terms By checking this box you agree your review becomes the property of Crutchfield, that you are over 18 years of age, that you own or have owned this product, and that you are located within the United States or its territories. Please see our Review Guidelines for more information. We reserve the right (but are not obligated to) review all submissions and edit or remove any review in any manner which we deem necessary. Your review should be posted within seven days. Fuji x100s Written By LarryG, Pittsburgh, Pa on Sunday, June 16, 2013 Crutchfield Customer Review (What's this?) Near to a Leica M2 in a digital camera. Sturdy feel and quick to operate, like a rangefinder camera. Image quality close to a "35mm" sensor in a Canon Mk5II. Variable color/contrast/tone "film" selection provides satisfying creative flexibility. Attentive Crutchfield sales and customer support a bonus. Pros: See above. Multiple function/feature controls and well thought out operating methods acceptable for even picky professional use. Cons: Fixed lens is soft at F2:( While somewhat intuitive, effective camera operation requires reading the manual. Battery life a fraction of digital SLR and high-end POS cameras. Shutter a "hair" slower than film camera:) 4 out of 4 people found this helpful Was this review helpful? Yes No Amazing Camera Written By Bauman, Whitestone NY on Saturday, April 06, 2013 Crutchfield Customer Review (What's this?) Great camera, worth the wait. Has all the x100 has and more. Worth the price of camera. Crutchfield had great price I live in NY. You know what I mean by that. Pros: all features Cons: none 5 out of 10 people found this helpful Was this review helpful? Yes No Hands-on research Features and specs chart | What's in the box? | In-depth notes What's in the box? Download owner's manual X100S digital camera (silver/black) Lens cap (installed) NP-95 Lithium-Ion rechargeable battery (3.6V 1800mAh 6.2Wh) BC-65N Battery charger (4.2V/650mA) 6.75' AC cord 2' USB cable (with Type A USB on one end and a proprietary connection on the other end) Neck strap 2 Metal strap clips Clip attaching tool 2 Protective covers Finepix CD (software and owner's manual on CD-ROM) Owner's Manual (Eng) Owner's Manual (Span) Product Registration Company contact sheet (Stop--Need Help or Have Questions?) Fujifilm Digital Camera Worldwide Network Important Safety Instructions (for battery charger) 2 Corrections sheets Features and Specs General LCD Screen Size 2.8" Adjustable-angle LCD No Wi-Fi No Touchscreen No Waterproof No GPS-enabled No Lens 35mm Equivalent 35mm Optical Zoom 1x Digital Zoom --- Filter Diameter N/A Manual Focusing Yes Manual Exposure Yes Built-in Flash Yes HDMI Output Mini Memory Internal Memory 24 MB Memory Media SD/SDHC/SDXC Image Effective Megapixel Count 16.3 Total Megapixels --- Image Stabilization None Highest Resolution 4896 x 3264 HD Video Recording 1920 x 1080 Dimensions Width (inches) 5-3/8 Height (inches) 3 Depth (inches) 2-1/4 Weight With Battery (ounces) 15.7 Warranty Parts Warranty 1 Year Labor Warranty 1 Year Product Research Features Inputs and Outputs Notes Supplied Software Features Retro Design: The Fujifilm X100S digital camera, like its predecessor X100, is designed to look like a classic 35mm film camera with many of the features of a high-quality DSLR. It has a synthetic leather-wrapped body with a die-cast magnesium top and base, and precision milled metal rings and dials. The fixed focus lens is protected by an aluminum lens cap. Upgrades: The X100S features the new APS-C X-Trans CMOS II sensor and improved EXR Processor II. With an improved Fujinon 23mm F2 fixed lens, the X100S delivers fast autofocus speeds of up to 0.08 seconds, 25% increased image resolution, and 30% reduced noise over the first generation X100. 23mm Lens: The X100S is equipped with an F2 23mm fixed focal length Fujinon lens. This is equivalent of a 35mm lens in 35mm photography. The all-glass lens configuration (6 groups/8 elements) includes a double-sided aspheric lens, Super EBC (electron beam coating) to reduce ghosting, and a 9-blade aperture diaphragm for pleasingly defocused background effects. The built-in ND filter, equivalent to 3 f-stops, reduces the amount of light to 1/8 for those situations where you want to shoot at a slow shutter speed or keep a wide aperture. The lens has a focus range of 2.6' to infinity in normal mode and as close as 3.9" (10 cm) in Macro mode. Note: The camera does not allow for interchangeable lenses. LCD Monitor: The X100S has a 2.8" color LCD monitor featuring approximately 460,000 dots and approximately 100% horizontal and vertical coverage in the shooting mode. When shooting, you can choose from a standard display, a custom display, or a detailed display. Hybrid Viewfinder: The camera is equipped with a Hybrid Viewfinder, which is switchable between an optical viewfinder and electronic viewfinder. As you bring the camera up to your face, an eye sensor in the viewfinder will switch automatically to viewfinder mode. A built-in diopter allows you to adjust the viewfinder to your eyesight, either with or without glasses. Details of each type of viewfinder include the following: Optical Viewfinder (OVF): The Reverse Galilean Optical Viewfinder offers a wide field of view (approx 26°) for maximum clarity with no shutter time lag. It has a integrated 2,360,000 dot LCD panel to display shooting information. It has approximately 90% frame coverage and 0.5x magnification. Electronic Viewfinder (EVF): The 0.48" High-Definition Electronic Viewfinder provides 100% coverage and detailed shooting information with its 2,360,000 dots of resolution. You can preview focus, depth of field, exposure, and white balance before you shoot, and view the photo instantly after shooting. Recording Media: Still images and movies can be recorded onto optional SD, SDHC, or SDXC memory cards. The X100S also has an internal memory of approximately 24 MB to allow you to store a few test images in case your memory card is full. Still Image Quality: The X100S records still images in JPEG format in 3:2, 16:9, and 1:1 aspect ratios in three sizes and two compression ratios (Fine and Normal). In addition, RAW images can be recorded from the raw, uncompressed image data from the camera's image sensor. RAW format images must be processed on a computer using the supplied RAW File Converter application software. You can also shoot a RAW + JPEG image at the same time, with separate RAW and JPEG files recorded and stored. JPEG 3:2 Image Sizes JPEG 16:9 Image Sizes JPEG 1:1 Image Sizes L: 4896 x 3264 M: 3456 x 2304 S: 2496 x 1664 L: 4896 x 2760 M: 3456 x 1944 S: 2496 x 1408 L: 3264 x 3264 M: 2304 x 2304 S: 1664 x 1664 HD Movies: The X100S can record Full HD movies 1920 x 1080 in MOV format (H.264 standard with LPCM stereo sound) at 60 fps and 30 fps. Individual movies files cannot exceed 10 minutes in length, regardless of the capacity of the memory card. Motion Panorama: The camera is capable of taking panoramic images by panning the camera through one of two angle settings. As you pan the camera, multiple frames are recorded and automatically stitched together in the camera to create the panoramic image. The Motion Panorama options are: Motion Panorama 120°: Horizontal: 6440 x 1440 Vertical: 2160 x 6440 Motion Panorama 180°: Horizontal: 9600 x 1440 Vertical: 2160 x 9600 Shooting Modes: The Fujifilm X100S lets you set the shutter speed and aperture automatically or manually. The shutter speed and aperture settings combine for four shooting modes: Shooting Mode Shutter Speed1 Aperture2 Program AE Automatic Automatic Shutter Priority Manual Automatic Aperture Priority Automatic Manual Manual Manual Manual 1Shutter Speed Options: Auto, 1/4000, 1/2000, 1/1000, 1/500, 1/250, 1/125, 1/60, 1/30, 1/15, 1/8, 1/4, Time (selectable 1/2 to 30 seconds), Bulb 2Aperture Options: Auto, f/2, f/2.8, f/4, f/5.6, f/8, f/11, f/16 ISO Sensitivity: You can manually set the camera's sensitivity from ISO 200 to ISO 6400 in 1/3 EV increments. Extended settings are equivalent to ISO 100 (Low), ISO 12800 (High) or ISO 25600 (High). The Auto settings will adjust the sensitivity settings according to the shooting conditions with maximum ISO of 400, 800, 1600, 3200, or 6400. The higher the sensitivity setting, the better the camera is at reducing blur in poor lighting conditions, however, high settings can result in more noise in the recorded images. White Balance: White balance is used to preserve natural colors under different types of lighting. You can select Auto, Direct Sunlight, Shade, "Daylight" fluorescent lamps, "Warm White" fluorescent lamps, "Cool White" fluorescent lamps, Incandescent light and Underwater (requires waterproof case). In addition, you can measure for a white balance value or display and select from a list of color temperatures. Film Simulation: The X100S can simulate the effects of different kinds of film, including black-and-white. You can select one of the following options: Provia/Standard: standard color reproduction Velvia/Vivid: a high-contrast palette of saturated colors, suited for nature photos Astia/Soft: a soft-toned palette of less-saturated colors PRO Neg Hi: offers additional contrast. Recommended for outdoor portraits. PRO Neg Std: a soft-toned palette for enhanced skin tones. Recommended for studio portraits. Monochrome: standard black-and-white Monochrome + Y Filter: black-and-white pictures with slightly increased contrast; tones down the brightness of the sky Monochrome + R Filter: black-and-white picture with increased contrast; also tones down the brightness of the sky Monochrome + G Filter: softens skin tones in black-and-white photos Sepia: takes pictures in sepia tone Color Space: Depending upon how you intend to use the image, you can choose the output color space at the general sRGB setting or the broader color rendition of Adobe RGB. Exposure Compensation: Using the dedicated Exposure Compensation dial on the top of the camera, you can alter the exposure from the value suggested by the camera, making pictures brighter or darker. You can adjust the exposure a total of 13 steps from -2.0 to +2.0 EV in 1/3 EV steps. Exposure compensation is available in all shooting modes except Manual. Continuous Shooting: You can capture motion in a series of pictures using the Continuous Shooting mode. You can choose from frame rates of approximately 6 frames per second or 3 fps. Maximum number of frames is 31 and 44 respectively. Self-timer: The camera gives you the choice of a 10-second or 2-second self timer. The 10 second self timer is recommended for self portraits, while the 2-second self timer is used to reduce blur caused by the camera moving when the shutter button is pressed. Auto Focus: In most cases, the X100S uses contrast-detection TTL (through the lens) Auto Focusing. You can choose between two AF Modes: Single or Continuous. You can also focus manually using the focus ring on the lens. Flash Modes: The X100S has a built-in flash with an effective range of 1.6' to 29.5'. Red-eye removal minimizes the "red-eye" effect, and is available for each flash mode. You can choose from the following flash modes: Auto: flash fires automatically as required by the shooting conditions Forced Flash: flash will fire whenever a picture is taken Slow Synchro: auto flash combined with slow shutter speeds (tripod recommended) Suppressed Flash (Off): flash does not fire, even when the subject is poorly lit. Commander: the built-in flash can be used to control optional remote flash units. External Flash: for when an optional third-party flash unit is used. Optional External Flash: The X100S has a hot shoe for adding optional external flash units, such as EF-20, EF-42, or EF-X20. Light Metering: The X100S uses 256-segment, TTL (through-the-lens) metering, where the camera automatically assesses the scene and selects the optimum exposure. You can select from three metering options: Multi, Spot, or Average. Viewing Images: Images can be played back one-at-a-time or in a variety of multi-frame views. Multi-frame options include a side-by-side two-frame display (with smaller thumbnails of the previous and next frames, 9-image grid (3 x 3) and a 100-image grid (10 x 10) of micro-thumbnails. In the 9- and 100-image grid views, the highlighted image is slightly enlarged. Image Search: The Image Search function lets you search pictures by the following criteria: Date: Search for photos by date Face: Search for photos that include faces Favorites: Search for photos by rating Type: You can easily search your pictures according to the type of photos: still photos, pictures taken in burst mode, or movie footage. Upload Mark: Search for pictures selected for upload to a specified destination. Playback Zoom/Cropping: You can enlarge a still image in the monitor according to the image quality (size). After you have zoomed in and scrolled the picture to the desired composition, you can create a cropped image of a picture. Copies will have an aspect ratio of 3:2, and will be saved as a separate file. Resize: To create a small copy of a picture, you can select "Resize" from the menu. The new images vary in size with the original image. Slide Show: You can view pictures in an automated slide show. You can select normal playback, normal playback that zooms in on faces, or multiple pictures at once. Printing Pictures: Using DPOF (Digital Print Order Form), you can designate which images to print, and whether to print them with or without date. Pictures can be printed as followed: Printer or Photo Lab: plug the camera into a Pictbridge-compatible printer, insert the memory card into a compatible printer, or take the memory card to a digital photo lab Transferring to Computer: transfer the images to a computer before printing them Power Requirements: The X100S is powered by the supplied NP-95 Lithium-Ion rechargeable battery. A fully-charged NP-95 is good for approximately 330 shots. The supplied BN-65N battery charger will charge an NP-95 battery in about 210 minutes. Auto Power Off Function: When the camera is operated on battery power, the Auto Power Off function will automatically turn off the camera to reduce the drain on the batteries if no operations are performed for 2 minutes or 5 minutes, as set in the menu. Regardless of the option selected, the camera will not automatically turn off when connected to a printer or computer, or when a slide show is in progress. Inputs and Outputs Notes Digital In/Out: The X100S features a single proprietary jack for connecting the supplied USB cable. This output allows you to download your photos to your computer via USB, or connect the camera to a compatible PictBridge printer. The same connection is used for the optional MIC-ST1 stereo microphone. HDMI: The camera has a mini-HDMI (Type C) output for connecting the camera to your HDTV. An optional mini-HDMI to HDMI cable is required. Supplied Software System Requirements: The X100S is equipped with MyFinePix Studio Ver.4.2 for Windows, Raw File Converter versions for Windows and Macintosh, and the Owner's Manual in .pdf format. In order to use this software, your computer must be using one of the following operating systems: MyFinePix Studio Ver.4.2/Raw File Converter for Windows: Windows 8, Windows 7 (Service Pack 1), Windows Vista (SP2), Windows XP (SP3) Raw File Converter for Macintosh: Mac OS X 10.6 - 10.8 Our Product Research Team At Crutchfield, you'll get detailed, accurate information that's hard to find elsewhere. That's because we have our own in-house Product Research team. They verify what's in the box, check the owner's manual, and record dimensions, features and specs. We stay on top of new products and technologies to help people make informed choices. Sorry, the Fujifilm X100S is no longer available. Looking for a similar item? Shop all Point-and-shoot Cameras Or, you can still... 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Rosh Hashanah Recipes
|White Bean and Heirloom Tomato Ragu
This stylish side is satisfying and deliciously different. The creamy beans are a perfect soaker-upper for the rich braising liquid. The beans are a perfect side for vegetarians and can be a base for a vegetable dish. Just add kale and you have a new dish!
1 pound cannellini beans, soaked overnight in water
Discard the soaking water and place the beans in a large saucepan. Cover the beans with about 5 cups of water and bring to a boil. Cook until the beans are tender, about 45 minutes. Drain the beans.
Recipe: kosher, parve, side dish


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30 Amp Generator Adapter Cord
Catalog Item # 56837
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Weight: 1.5 lbs.
Manufacturer: Conntek Integrated Solutions Inc
Mfg Part #: 14825
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Vertus Charter School
Authorizer: Board of Regents
|Enrollment in 2014-2015:
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|Rochester City
|Year of Operation in 2014-2015
- Institution data such as school's address, principal, phone number
- Vertus Charter School website
*Note to Charter School Administrators: If any of the information on this page needs to be updated, please email firstname.lastname@example.com. If any of the information on the cross-linked institutional data page needs to be updated, please update the SEDREF system (the Department's centralized directory for all schools) by emailing email@example.com (and copy email@example.com) with the updated information and include your BEDS code.
Last Updated: September 24, 2014


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Anybody could pick Jim Harbaugh based on Stanford. It was brutally physical relentless basic football, but incorporating plenty of smart and clever schemes on offense. I never doubted him after he beat USC as 41 point underdog.
I remember many posters on Canes sites touting Harbaugh to replace Larry Coker after the 2006 season. Now that required special insight, since Harbaugh was at the obscure University of San Diego football program.
Horrible is a douche did you see his temper tantrum when he lost the challenge? Since he is a media darling, he will be passionate, if it had been a player, it would be heavy fines and suspension.
I do agree with op, Ross had good instincts about horrible. I trust Mr Ross's instincts now.
Just the fact that Ross and Ireland identified one of the right coaches should lend credibility.
if u agree that he was right on about Harbaugh can u also agree that he was an idiot that had no clue how to pursue this coach since he did not have an opening but of course people will continue to defend this


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Rather then abandoning old reads to the landfill, colorstory designs recycles magazines into delightfully tactile art objects. This beautiful Space Needle shadowbox features a detailed, hand-cut design of the Space Needle and the Seattle skyline, accented by a background of green magazine clippings. This whimsical layered piece can be hung on the wall or it can sit upright on a table.
Black frame is ¾" thick and 1 ¾" deep. Ready to hang.
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Churches of Chiloé
Churches of Chiloé
The Churches of Chiloé represent a unique example in Latin America of an outstanding form of ecclesiastical wooden architecture. They represent a tradition initiated by the Jesuit Peripatetic Mission in the 17th and 18th centuries, continued and enriched by the Franciscans during the 19th century and still prevailing today. These churches embody the intangible richness of the Chiloé Archipelago, and bear witness to a successful fusion of indigenous and European culture, the full integration of its architecture in the landscape and environment, as well as to the spiritual values of the communities.
Églises de Chiloé
Les églises de Chiloé constituent un exemple unique en Amérique Latine d'architecture religieuse en bois. Elles représentent une tradition initiée aux XVIIe et XVIIIe siècle par des prêcheurs jésuites itinérants, tradition poursuivie et enrichie par les Franciscains au XIXe siècle et qui prévaut encore de nos jours. Ces églises illustrent l'extraordinaire richesse de l'archipel de Chiloé et témoignent de la fusion réussie de la culture et des techniques indigènes et européennes, de la parfaite intégration de son architecture dans le paysage et l'environnement, ainsi que des valeurs spirituelles des communautés.
كنائس تشيلوي
تشكّل كنائس تشيلوي مثالاً فريداً عن الهندسة الدينية الخشبية في أميركا اللاتينية. وهي تعكس تقليداً خاصاً أطلقه المبشرون اليسوعيون الجوّالون في القرنين السابع عشر والثامن عشر، ثم تابعه وعزّزه الرهبان الفرنسيسكانيون في القرن التاسع عشر وهو لا يزال رائجاً حتى يومنا هذا. تجسّد هذه الكنائس الوفرة التي يتمتع بها أرخبيل تشيلوي كما تشهد على الإنصهار الناجح بين الثقافة والتقنيات الأصلية والأوروبية وعلى الإندماج المذهل لهندسة هذا الأرخبيل في المنظر الطبيعي والبيئة المحيطة به، الى جانب القيم الروحية للمجتمعات المحلية.
source: UNESCO/ERI
奇洛埃教堂是拉丁美洲特有的基督教木式建筑的杰出代表,所代表的建筑传统始于17和18世纪的耶稣会布道团(Jesuit Peripatetic Mission),在19世纪得到圣芳济会(Franciscans)的发扬,并流传至今。这些教堂象征了智利群岛文化上的繁荣,也见证了当地文化与欧洲文化的成功融合,建筑与自然环境,以及当地社会精神价值的有机统一。
source: UNESCO/ERI
Церкви на островах Чилоэ
Церкви Чилоэ являются уникальным для Латинской Америки примером развития форм церковной деревянной архитектуры. Они представляют традицию, начатую в XVII-XVIII вв. иезуитской странствующей миссией, продолженную и развитую в XIX в. францисканцами, и превалирующую до сих пор. Эти церкви представляют собой также часть нематериального наследия островов Чилоэ и служат примером успешного слияния местной и европейской культур, органичного включения архитектуры в окружающий ландшафт и признания духовных ценностей местных общин.
source: UNESCO/ERI
Iglesias de Chiloé
Construidas enteramente de madera, las iglesias de Chiloé constituyen un ejemplo único de la arquitectura religiosa en Latinoamérica. Son representativas de una tradición arquitectónica iniciada por los predicadores itinerantes jesuitas en los siglos XVII y XVIII. Tras haber sido continuada y enriquecida por los franciscanos en el siglo XIX, esa tradición perdura todavía en nuestros días. Además de ilustrar la riqueza cultural del archipiélago de Chiloé, estas iglesias atestiguan la lograda fusión de la cultura y las técnicas indígenas con las europeas, la perfecta armonización de su arquitectura con el paisaje y al entorno físico, y la perdurable continuidad de los valores espirituales las comunidades isleñas.
source: UNESCO/ERI
source: NFUAJ
Kerken van Chiloé
De Kerken van Chiloé zijn een uniek voorbeeld van bijzondere houten architectuur in Latijns-Amerika. Zij vertegenwoordigen een traditie die geïnitieerd werd door de Jezuïtische ambulante missie in de 17e en 18e eeuw, voortgezet en verrijkt werd door de Franciscanen in de 19e eeuw en vandaag de dag nog steeds levend is. De kerken getuigen van een succesvolle combinatie van inheemse en Europese cultuur, de volledige integratie van architectuur in de omgeving en de geestelijke waarden van de gemeenschappen. Tegen het einde van de 19e eeuw waren er meer dan 100 kerken gebouwd, waarvan er tegenwoordig nog 60 over zijn.
Source: unesco.nl
Outstanding Universal Value
Brief Synthesis
In the Chiloé archipelago off the coast of Chile are about 70 churches built within the framework of a "Circular Mission" introduced by the Jesuits in the 17th century and continued by the Franciscans in the 18th and 19th centuries. The most exceptional illustrations of this unique form of wooden ecclesiastical architecture (the so-called Chilota School of architecture) are the churches of Achao, Quinchao, Castro, Rilán, Nercón, Aldachildo, Ichuac, Detif, Vilupulli, Chonchi, Tenaún, Colo, San Juan, Dalcahue, Chellín and Caguach. These sixteen churches are outstanding examples of the successful fusion of European and indigenous cultural traditions. The abilities of the people of Chiloé as builders achieved its highest expression in these wooden churches, where farmers, fishermen and sailors exhibited great expertise in the handling of the most abundant material in this environment, wood. Along with the churches, the mestizo culture resulting from Jesuit missionary activities has survived to the present day.
This isolated archipelago was colonized by the Spanish in the mid 16th century. The Jesuits, who arrived in 1608, used a circulating missionsystem in their evangelization of the area: religious groups made annual tours around the archipelago, staying for a few days at locations where churches were erected jointly with the communities of believers. The rest of the year a specially trained layperson attended the spiritual needs of the inhabitants. The construction techniques and architecture of the churches of Chiloé are specific to this locale: European experience was adapted and reformulated, giving rise to a vernacular tradition, supported by a great quantity and variety of testimonies which are still in use. Along with the culture of the archipelago, these churches are the result of a rich and extensive cross-cultural dialogue and interaction.
Along with their basic architectural design (tower façade, basilican layout and vaulted ceiling), these sixteen churches are significant for their building material, their construction systems and the expertise demonstrated by the Chilote carpenters, as well as for their interior decoration, particularly the traditional colours and the religious images. The churches are distinguished by an indigenous tradition of building in wood strongly influenced by boat-building techniques, as shown by the forms and jointing of the tower and roof structures. The orientation and location of the churches is deliberate: constructed according to the demands of the sea, they were arranged on hills to be seen by navigators and to prevent flooding. Their associated esplanades remain important components: they embody communication with the sea; they are the scenes of religious festivals; and even those that have been transformed into formal plazas still evoke the arrival of the missionaries during their circulating mission. Devotional and communitarian practices, religious festivals and supportive group activities such as minga (unpaid community work) are key components of the intangible values of the relationship between the communities and the churches. Also of importance is the subsoil of the churches, which one day may reveal information about the relationship between the locations of the churches and pre-Hispanic indigenous ritual sites.
Criterion (ii): The Churches of Chiloé are outstanding examples of the successful fusion of European and indigenous cultural traditions to produce a unique form of wooden architecture.
Criterion (iii): The mestizo culture resulting from Jesuit missionary activities in the 17th and 18th centuries has survived intact in the Chiloé archipelago, and achieves its highest expression in the outstanding wooden churches.
All the elements necessary to express the Outstanding Universal Value of the 26.2-ha serial property are located within its boundaries. The boundaries are nevertheless very constricted, and most of the components lack a coherent buffer zone.
The collapse of the church of Chonchi's tower as the result of a storm in March 2002 highlighted the fact that the state of conservation and the vulnerability of the churches were worse than previously assessed, particularly at the time of nomination. These churches require constant conservation efforts; the nature of the building material and the environmental characteristics make continual maintenance an imperative. The communities have always assured their conservation, but current phenomena associated with modernization and globalizations have increased the vulnerability of the churches.
The Churches of Chiloé present a high degree of authenticity in terms of their forms and designs, materials and substances, and locations and settings. Their architectural forms, materials and building systems constitute the zenith of a typological evolution, and have been preserved without substantive changes. Their function as places of worship has also been preserved. Interventions have retained all the richness of the typologies of connections, joints and fittings; period technology has been recovered and applied; and exceptional combinations of connections of a deeply local and singular character have been discovered. The traditions, techniques and management systems have been maintained, as have the essential conditions of the sites. Recent restorations have influenced a substantive reflection on the role of the intangible heritage.
Protection and management requirements
The sixteen churches of Chiloé are part of the Catholic Church's Diocese of Ancud. They are administered by the Bishop of Ancud and by parish priests who have the support of the Friends of the Churches of Chiloé Foundation, a private entity presided over by the Bishop himself and created specifically for the conservation and enhancement of the churches. The Foundation was created by the Diocese to address the communities' needs related to conservation, to bring professionals into the conservation process and to secure contributions by the State for their protection and restoration. The sixteen churches of Chiloé were declared a National Monument of Chile by means of various Decrees under Law No. 17.288 (1970). The supervision and protection of these assets is carried out by the Government of Chile through the National Monuments Council. The problem of the lack of coherent buffer zones for the property's components is being addressed through the protection and regulation of the surrounding areas.
The clearest challenges for sustaining the Outstanding Universal Value of the property over time are the recovery and promotion of a local "culture of maintenance" for the buildings; the effective religious and community use of the churches by the population; and the active participation of local people in the conservation effort. The unified and selfless participation of the community in the conservation and preservation of the wisdom, expertise and ancestral knowledge of the carpenters, as well as participation in preventive maintenance and critical restoration, are essential in this regard.
The sustainability of the conservation effort is a significant challenge: the churches are located at the centres of their communities' development, and a formula must be found to ensure their conservation in the context of any such development. The Government of Chile, with the support of the Inter-American Development Bank, has implemented a large-scale program since 2003 that has managed to reverse serious damage, particularly in the tower façades. Formulas must be found to ensure that, for example, tourism may result in tangible benefits for the communities and churches while at the same time avoiding the high risks of commercialization or trivialization.
A shortage of fine hardwoods and the protection of the species that provide them represent current challenges. The use of alternative woods that have the exceptional properties of larch and cypress is therefore being explored. Investigating, recording and transmitting the building techniques to new generations are essential, as well as research on the properties of different woods and on the treatments that mitigate the effects of weathering and attacks by xylophages. Finally, it is necessary to make advances in risk preparedness and in the environmental protection of these churches.
The churches of Chiloé present a delicate balance of social, environmental, physical and spiritual factors. It is the spiritual value inherent in these sixteen churches that gives rise to the complexity of their conservation. This is not a matter of simply repairing buildings; the challenge here is much greater, and in that challenge the very significance of heritage endeavour is in question.
Long Description
The Churches of Chiloé are outstanding examples of the successful fusion of European and indigenous cultural traditions to produce a unique form of wooden architecture. The mestizo culture resulting from Jesuit missionary activities in the 17th and 18th centuries has survived intact in the Chiloé archipelago, and achieves its highest expression in the outstanding wooden churches.
In the 16th century the inhabitants of the Chiloé archipelago, which extends from the Chacao Canal to the Corcovado Gulf, followed a sedentary way of life, based on a mixed farming and fishing economy. Spanish navigators had discovered the archipelago by the mid-16th century, but colonization did not begin until 1567, when Martín Ruiz de Gamboa founded the towns of Santiago de Castro and Chacao on the Isla Grande de Chiloé.
Following an exploratory visit in 1608, the Society of Jesus began sending its members to initiate the process of evangelization that was to shape the cultural features of the Archipelago. At first these missions were not permanently inhabited, but over time the Jesuits began building chapels and lodgings for their members, constructed by the local community using local materials and techniques. They appointed laymen, chosen from the leading families, to serve as fiscales, to care for the church and its cemetery and to minister to the basic spiritual needs of the community. This was in the Jesuit tradition, which encouraged active development of their social and religious life by indigenous communities. By the end of the 19th century over 100 churches had been built; between 50 and 60 survive to the present day, and 14 of these constitute the World Heritage site: Achao (Quinchao); Quinchao; Castro; Rilán (Castro); Nercón (Castro); Aldachildo (Puqueldón); Ichuac (Puqueldón); Detif (Puqueldón); Vilipulli (Chonchi); Chonchi; Tenaún (Quemchi); Colo (Quemchi); San Juan (Dalcahue); and Dalcahue.
The traditional Chiloé churches are located near the shore, facing an esplanade, which in some cases has been developed into a true plaza (Achao, Dalcahue), but elsewhere is no more than an open space defined by a fence or trees (Quinchao). Its size is determined by the importance of the religious festivals that take place there. The churches consist of a large volume with a pitched roof. The most typical feature of these buildings is the tower facade, on the side facing the esplanade, made up of an entrance portico, the gable wall or pediment, and the tower itself. This became the focus of urban development in these communities.
The portico is a characteristic feature of the earlier churches, but is lacking in those built in the 20th century. The tower is the dominating vertical feature, both as a religious element supporting the cross and also as a beacon for sailors. Most are of two or three storeys, with hexagonal or octagonal drums to reduce wind resistance. Only at Tenaún are there smaller flanking towers. The horizontal volume of the church varies, but depth is favoured over width. They conform with a basilican ground plan with three aisles, only the central one extending to the back wall. The aisles are separated by solid wooden columns on stone pads; these support a huge beam that forms the ridge. In most cases the main nave is barrel-vaulted, the flanking aisles having flat ceilings. Achao with its segmented ceiling and Rilán with fan vaulting are rare exceptions. The latter is clearly influenced by Gothic architecture, and elements of other major architectural styles can be recognized - Classicism at Chonchi, Renaissance at Nercón and Baroque at Achao. Everywhere there is abundant evidence of the Chilota mastery of working wood. The characteristic form and materials of the churches show virtually no variation over four centuries.
The ornamentation of the churches is profuse and varied. All the churches are adapted skilfully to their physical environment. They are built on hillsides, so as to avoid flooding during heavy rains, and are raised off the ground. The north sides are protected against storms, which generally come from this direction. They are fully enclosed structures, as protection against wind and rain, which can be heavy in this region.Source: UNESCO/CLT/WHC
Historical Description
In the 16th century the inhabitants of the Chiloé archipelago followed a sedentary way of life, based on a mixed farming and fishing economy. Spanish navigators had discovered the Archipelago by the mid-16th century, but colonization did not begin until 1567, when Martín Ruiz de Gamboa founded the towns of Santiago de Castro and Chacao on the Isla Grande de Chiloé.
The Spaniards were impressed by the mild, receptive character of the local people. The universal encomienda system was applied, whereby the indigenous people paid tributes to the Spanish crown by working for the settlers in return for food and religious instruction. There were occasional native revolts, of which the most serious occurred in 1712, occasioned by the harsh treatment of the natives by the encomenderos of the time, who accused the Jesuits of having inspired the revolt, which was brutally repressed.
Missionaries had arrived with the first settlers, from the orders of St Francis and Our Lady of Mercy. Following an exploratory visit in 1608, the Society of Jesus began sending its members to initiate the process of evangelization that was to shape the cultural features of the Archipelago and to result in the building of the churches that figure in the present nomination.
The Jesuit strategy was encapsulated in the Peripatetic Mission. Annual tours were made by groups of Jesuits setting out from their College in Castro during the temperate months. They spent a few days at each of their missions according to a planned schedule; the missions had been founded close to the shore so as to permit these tours to be made by boat. While there they would attend to the spiritual and material needs of the communities. At first these missions were not permanently inhabited, but over time the Jesuits began building chapels and lodgings for their members, constructed by the local community using local materials and techniques. They appointed laymen, chosen from the leading families, to serve as fiscales, to care for the church and its cemetery and to minister to the basic spiritual needs of the community. This was in the Jesuit tradition, which encouraged active development of their own social and religious life by indigenous communities. By the end of the 19th century over a hundred churches had been built; between fifty and sixty survive to the present day.
Pirate raids were a feature of the 17th century, and the Spaniards living in the towns began to desert them in favour of greater security in the countryside. By so doing they took over the lands of the indigenous people, increasing racial and cultural assimilation between the two groups. The majority Chilota group in the Archipelago is the result of this process of interbreeding (mestizaje). Christianity was embraced by the natives whilst the Spaniards adopted the local language, Veliche (now extinct), for communication. The Spaniards also adopted the way of life of the local people, engaging in fishing and agriculture and using their technologies.
When the Jesuits were expelled in 1767 their work was continued by the Franciscans, who appreciated the value of the Jesuits' work and actively continued it. They used the Peripatetic Mission as the basis for the creation of nine centres, each with its own area of work. This was to become the present parish system, created in 1840.
Despite the efforts of the Spanish colonial power, the towns became no more than administrative centres, and by the time colonial rule came to an end there were no more than five towns (villas) in Chiloé. The strategic importance of the Archipelago was recognized, however, and it was dependent on the Captaincy General of Lima rather than that of Chile. The military garrison was stationed in the fortress of San Carlos de Ancud, founded in 1768.
The Chilota population was deeply loyal to the Spanish Crown. When the struggle for Chilean independence began in 1810, Chiloé became the headquarters of the Spanish operation to recover Chile and Peru. Although this failed, Chiloé remained a Spanish enclave after Chile finally won its independence in 1818; it remained the last toehold of Spanish rule in South America until it was incorporated into the new Republic eight years later.
Chiloé enjoyed a period of prosperity in the 19th century. Its ports were visited by ships travelling south and its timber was a major export. This came to an end at the end of the century, as a result of the opening of the Panamá Canal and the over-exploitation of the islands' cypress and larch trees. During the first half of the 20th century the economy also suffered from serious problems in agriculture and stockbreeding. As a result there was substantial Chilota emigration southwards, to Patagonia and the Magallanes Straits area. At the present time the economy of the Archipelago is developing on the basis of the controlled industrial exploitation of the natural resources (timber and fish) and traditional agriculture and fishing.Source: Advisory Body Evaluation
News (1)
- World Heritage Committee Inscribes 61 New Sites on World Heritage List Wednesday, November 29, 2000


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- Independent
- The Enterprise
- The Recorder
A Lusby man received a 10-year suspended jail sentence Friday in Calvert County Circuit Court after a passenger in a vehicle he was driving was killed in a single-vehicle accident in September 2012.
Eric A. Harvey, 20, was indicted Jan. 22 on charges of two counts each of negligent homicide driving under the influence and driving under the influence of alcohol, and one count each of negligent manslaughter — automobile, negligent homicide driving while impaired, criminally negligent manslaughter and driving while impaired by alcohol.
He pleaded guilty in May to one count of negligent manslaughter — automobile, and, as part of a plea agreement with the Calvert County State's Attorney's Office, the remaining charges were dropped.
Harvey was given a 10-year suspended jail sentence Friday and placed on five years of supervised probation.
At 8:29 p.m. Sept. 12, 2012, members of the Calvert County Sheriff's Office Crash Reconstruction Team responded to the 600 block of Gunsmoke Trail in Lusby for a reported car accident, according to a September press release from the sheriff's office.
Officers found a 2003 green Jeep Liberty in a wooded area next to a home on Gunsmoke Trail. The driver, Harvey, who was 19 at the time, was taken to Prince George's Hospital Center for treatment of a broken femur.
Passenger Justin E. Wilder, 19, of Lusby was taken to Calvert Memorial Hospital where, due to injuries he received in the accident, he was pronounced dead by hospital staff, the press release stated.
Officials said the Jeep was traveling south on Gunsmoke Trail near Sitting Bull Trail and, as the Jeep began to turn, the driver lost control and left the roadway, according to the press release. The Jeep drove through the front yard of a nearby residence, became airborne, crossed the driveway of the residence and continued into the wooded area behind the home. The passenger side of the Jeep hit a large tree before stopping, deputies said.
Harvey gave a recording to deputies while at the hospital, charging documents state, where he allegedly admitted to drinking several alcoholic beverages prior to the crash. Deputies said there was evidence of alcohol at the scene of the accident inside the vehicle and an odor of alcoholic beverages coming from inside the vehicle. Witnesses on the scene also provided statements that Harvey appeared to be intoxicated and the smell of alcohol was coming from his person, charging documents state.


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Tale Of The Tape: Washington Redskins At Minnesota Vikings
Washington Redskins
Minnesota Vikings
Special Teams
Stephen Curry already has a splash brother feeding him the ball on the NBA hardcourt, but with his brother signing with the neighboring Kings, we could see the real brothers facing off a lot more frequently in the very near future.
Last offseason the San Francisco Giants offered up big money to keep Pablo Sandoval in town, only to watch the fan favorite sign to play with the Red Sox. At the time, there was no obvious replacement for "The Panda." But now that Matt Duffy has outplayed Casey McGehee, it's time see what they're getting for their money.
Let's look at how the numbers of the two best players in the series so far.


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Step back to the earliest years of Stevie Y mania with this amazing pre-captaincy poster! Published exclusively for SportsPosterWarehouse.com, it delves deep in the archives for a shot of Yzerman in action during his earliest days in the NHL - as early as 1983, but no later than 1985 - looking great as the earnest teenager who brought the pride back to Hockeytown. You won't believe how young he looks! The perfect addition to your Yzerman collection - and if you could ever get it autographed, WOW.
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