text:
|Publication number
|Publication type
|Application number
|Publication date
|Apr 6, 2006
|Filing date
|Nov 18, 2005
|Priority date
|Sep 16, 1994
|Also published as
|Publication number
|Seth Foerster, Fred Burbank, Mark Ritchart, Elias Zerbouni
|Original Assignee
|Foerster Seth A, Burbank Fred H, Ritchart Mark A, Zerbouni Elias A
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (4), Referenced by (22), Classifications (15), Legal Events (2)
|External Links: USPTO, USPTO Assignment, Espacenet
This is a continuation of U.S. application Ser. No. 10/966,551, filed Oct. 15, 2004, which is a continuation of U.S. application Ser. No. 09/954,646, filed Sep. 18, 2001, which is a continuation of U.S. application Ser. No. 09/776,125, filed Feb. 2, 2001, which is a continuation of U.S. application Ser. No. 08/858,389, filed May 19, 1997, now issued as U.S. Pat. No. 6,228,055, which is a continuation of U.S. application Ser. No. 08/308,097, filed Sep. 16, 1994, now abandoned. All of the above patents and applications are expressly incorporated herein by reference in their entirety.
This invention relates to methods and devices for marking and defining particular locations in human tissue, and more particularly relates to methods and devices for permanently defining the location and margins of lesions detected in a human breast.
It is desirable and often necessary to perform procedures for detecting, sampling, and testing lesions and other abnormalities in the tissue of humans and other animals, particularly in the diagnosis and treatment of patients with cancerous tumors, pre-malignant conditions and other diseases or disorders. Typically, in the case of cancer, when a physician establishes by means of known procedures (i.e., palpation, x-ray, MRI, or ultrasound imaging) that suspicious circumstances exist, a biopsy is performed to determine whether the cells are cancerous. Biopsy may be an open or percutaneous technique. Open biopsy removes the entire mass (excisional biopsy) or a part of the mass (incisional biopsy). Percutaneous biopsy on the other hand is usually done with a needle-like instrument and may be either a fine needle aspiration (FNA) or a core biopsy. In FNA biopsy, very small needles are used to obtain individual cells or clusters of cells for cytologic examination. The cells may be prepared such as in a Papanicolaou (Pap) smear. In core biopsy, as the term suggests, a core or fragment of tissue is obtained for histologic examination which may be done via a frozen section or paraffin section. The chief difference between FNA and core biopsy is the size of the tissue sample taken. A real time or near real time imaging system having stereoscopic capabilities, such as the stereotactic guidance system described in U.S. Pat. No. 5,240,011, is employed to guide the extraction instrument to the lesion. Advantageous methods and devices for performing core biopsies are described in the assignee's co-pending patent application Ser. No. 08/217,246, filed on Mar. 24, 1994, and herein incorporated by reference.
Depending upon the procedure being performed, it is sometimes desirable to completely remove suspicious lesions for evaluation, while in other instances it may be desirable to remove only a sample from the lesion. In the former case, a major problem is the ability to define the margins of the lesions at all times during the extraction process. Visibility of the lesion by the imaging system may be hampered because of the distortion created by the extraction process itself as well as associated bleeding in the surrounding tissues. Although the lesion is removed and all fluids are continuously aspirated from the extraction site, it is likely that the process will "cloud" the lesion, thus impairing exact recognition of its margins. This makes it difficult to ensure that the entire lesion will be removed.
Often, the lesion is merely a calcification derived from dead abnormal tissue, which may be cancerous or pre-cancerous, and it is desirable to remove only a sample of the lesion, rather than the entire lesion, to evaluate it. This is because such a lesion actually serves to mark or define the location of adjacent abnormal tissue, so the physician does not wish to remove the entire lesion and thereby lose a critical means for later re-locating the affected tissue. One of the benefits to the patient from core biopsy is that the mass of the tissue taken is small. However, oftentimes, either inadvertently or because the lesion is too small, the entire lesion is removed for evaluation, even though it is desired to remove only a portion. Then, if subsequent analysis indicates the tissue to be malignant (malignant tissue requires removal, days or weeks later, of tissue around the immediate site of the original biopsy), it is difficult for the physician to determine the precise location of the lesion, in order to perform necessary additional procedures on adjacent potentially cancerous tissue. Additionally, even if the lesion is found to be benign, there will be no evidence of its location during future examinations, to mark the location of the previously removed calcification so that the affected tissue may be carefully monitored for future reoccurrences.
Thus, it would be of considerable benefit to be able to permanently mark the location or margins of such a lesion prior to or immediately after removing or sampling same. Marking prior to removal would help to ensure that the entire lesion is excised, if desired. Alternatively, if the lesion were inadvertently removed in its entirety, marking the biopsy site immediately after the procedure would enable re-establishment of its location for future identification.
A number of procedures and devices for marking and locating particular tissue locations are known in the prior art. For example, location wire guides, such as that described in U.S. Pat. No. 5,221,269 to Miller et al., are well known for locating lesions, particularly in the breast. The device described by Miller comprises a tubular introducer needle and an attached wire guide, which has at its distal end a helical coil configuration for locking into position about the targeted lesion. The needle is introduced into the breast and guided to the lesion site by an imaging-system of a known type, for example, x-ray, ultrasound, or magnetic resonance imaging (MRI), at which time the helical coil at the distal end is deployed about the lesion. Then, the needle may be removed from the wire guide, which remains in a locked position distally about the lesion for guiding a surgeon down the wire to the lesion site during subsequent surgery. While such a location system is effective, it is obviously intended and designed to be only temporary, and is removed once the surgery or other procedure has been completed.
Other devices are known for marking external regions of a patient's skin. For example, U.S. Pat. No. 5,192,270 to Carswell, Jr. discloses a syringe which dispenses a colorant to give a visual indication on the surface of the skin of the point at which an injection has or will be given. Similarly, U.S. Pat. No. 5,147,307 to Gluck discloses a device which has patterning elements for impressing a temporary mark in a patient's skin, for guiding the location of an injection or the like. It is also known to tape or otherwise adhere a small metallic marker, e.g. a 3 millimeter diameter lead sphere, on the skin of a human breast in order to delineate the location of skin calcifications (see Homer et al., The Geographic Cluster of Microcalcifications of the Breast, Surgery, Gynecology, & Obstetrics, December 1985). Obviously, however, none of these approaches are useful for marking and delineating internal tissue abnormalities, such as lesions or tumors.
Still another approach for marking potential lesions and tumors of the breast is described in U.S. Pat. No. 4,080,959. In the described procedure, the skin of the portion of the body to be evaluated, such as the breasts, is coated with a heat sensitive color-responsive chemical, after which that portion of the body is heated with penetrating radiation such as diathermy. Then, the coated body portion is scanned for color changes which would indicate hot spots beneath the skin surface. These so-called hot spots may represent a tumor or lesion, which does not dissipate heat as rapidly because of its relatively poor blood circulation (about 1/20 of the blood flow through normal body tissue). This method, of course, functions as a temporary diagnostic tool, rather than a permanent means for delineating the location of a tumor or lesion.
A method of identifying and treating abnormal neoplastic tissue or pathogens within the body is described in U.S. Pat. No. 4,649,151 to Dougherty et al. In this method, a tumor-selective photosensitizing drug is introduced into a patient's body, where it is cleared from normal tissue faster than it is cleared from abnormal tissue. After the drug has cleared normal tissue but before it has cleared abnormal neoplastic tissue, the abnormal neoplastic tissue may be located by the luminescence of the drug within the abnormal tissue. The fluorescence may be observed with low intensity light, some of which is within the drugs absorbance spectrum, or higher intensity light, a portion of which is not in the drugs absorbance spectrum. Once detected, the tissue may be destroyed by further application of higher intensity light having a frequency within the absorbance spectrum of the drug. Of course, this method also is only a temporary means for marking the abnormal tissue, since eventually the drug will clear from even the abnormal tissue. Additionally, once the abnormal tissue has been destroyed during treatment, the marker is destroyed as well.
It is also known to employ biocompatible dyes or stains to mark breast lesions. First, a syringe containing the colorant is guided to a detected lesion, using an imaging system. Later, during the extraction procedure, the surgeon harvests a tissue sample from the stained tissue. However, while such staining techniques can be effective, it is difficult to precisely localize the stain. Also, the stains are difficult to detect fluoroscopically and may not always be permanent.
Additionally, it is known to implant markers directly into a patient's body using invasive surgical techniques. For example, during a coronary artery bypass graft (CABG), which of course constitutes open heart surgery, it is common practice to surgically apply one or more metallic rings to the aorta at the site of the graft. This enables a practitioner to later return to the site of the graft by identifying the rings, for evaluative purposes. It is also common practice to mark a surgical site with staples, vascular clips, and the like, for the purpose of future evaluation of the site.
A technique has been described for the study of pharyngeal swallowing in dogs, which involves permanently implanting steel marker beads in the submucosa of the pharynx (S. S. Kramer et al., A Permanent Radiopaque Marker Technique for the Study of Pharyngeal Swallowing in Dogs, Dysphagia, Vol. 1, pp. 163-167, 1987). The article posits that the radiographic study of these marker beads during swallowing, on many occasions over a substantial period of time, provides a better understanding of the pharyngeal phase of degluitition in humans. In the described technique, the beads were deposited using a metal needle cannula having an internal diameter slightly smaller than the beads to be implanted. When suction was applied to the cannula, the bead sat firmly on the tip. Once the ball-tipped cannula was inserted through tissue, the suction was broken, thereby releasing the bead, and the cannula withdrawn.
Of course, this technique was not adapted or intended to mark specific tissue sites, but rather to mark an entire region or structure of the body in order to evaluate anatomical movements (i.e., swallowing motions). It also was not intended for use in humans.
Accordingly, what is needed is a method and device for non-surgically implanting potentially permanent markers at the situs of a lesion or other abnormal tissue, for the purpose of defining the margins of a lesion before it is removed and/or to establish its location after it has been removed. The markers should be easy to deploy and easily detected using state of the art imaging techniques.
This invention solves the problems noted above by providing an implantable device which is particularly adapted to mark the location of a biopsy or surgery for the purpose of identification. The device is remotely delivered, preferably percutaneously. Visualization of the marker is readily accomplished using various state of the art imaging systems. Using the invention, it is possible to permanently mark the location or margins of a lesion or other tissue site, prior to removing or sampling same. The markers function to provide evidence of the location of the lesion after the procedure is completed, for reference during future examinations or procedures.
More particularly, a device is provided for marking tissue within a human body to identify a selected location for a diagnostic or therapeutic procedure. The device comprises a marker element and an apparatus for remotely delivering the marker element from outside the human body to the selected tissue location. Since, with remote delivery (e.g. percutaneously) direct visual access is not possible, an aided visualization device is used, such as an imaging system, an endoscope, or the like. Deployment of the marker element is such that it becomes implanted in the tissue.
The delivery apparatus preferably includes a member, which may comprise a tube, such as a needle, cannula, or trocar, of any known type for delivering medications, surgical equipment, or other items to the interior of a patient's body. The member may also be the body of an optical instrument such as an endoscope, laparoscope, or arthroscope. In the preferred embodiment, a biopsy needle or gun, such as is often used to extract tissue for examination in a biopsy procedure, is used in conjunction with the marking device, comprising a portion of the delivery apparatus, in order to provide a means for entering the patient's body and positioning the marker element at the selected tissue location. However, in other embodiments, the marking device is self contained, having a means itself for obtaining entry to the body, and being guided by a commercially available guidance system, such as a stereotactic guidance system.
The aforementioned member or tube, which typically comprises a cannula or needle having a lumen, has a distal end portion or region and a proximal end portion or region, and is adapted to extend through the body. The distal region is adapted to retain and deploy the marker element and the proximal region is linked to the distal region, so that predetermined marker deployment functions may be communicated from the proximal region to the distal region. In some embodiments, these deployment functions are communicated by means of the marker elements themselves traveling through the lumen for deployment from the distal region. In other embodiments, an actuator extends axially through the lumen to communicate deployment functions to the marker element held on or by the distal region. The apparatus is preferably guided to the selected tissue location, i.e., the site of the detected lesion or other abnormality, using a stereotactic guidance system or similar imaging system.
Several alternative embodiments of the marking device are disclosed. In one embodiment, the distal region of the tube includes a forming die, which is adapted to form each marker element into a predetermined shape, preferably a helix, as the marker element is deployed from the lumen. In a number of alternative embodiments, a mechanism, such as a mandrel, is used to push the marker elements through the tube. The marker elements may comprise a pre-formed spring having a predetermined shape, which is compressed into a linear position within the tube lumen. Upon deployment from the lumen, the spring is adapted to expand and assume its predetermined shape to such an extent that the energy of its expansion is sufficient to implant the marker element into the tissue at the selected tissue location. In some embodiments, implantation is accomplished because the marker elements have a plurality of attachment elements, each having a tip end (sometimes sharpened) which expands outwardly with sufficient energy to embed and anchor itself into the tissue at the selected tissue location. In other embodiments, the marker element has blunt, rather than sharpened edges, but is adapted to expand sufficiently upon exiting from the tube that its edges press radially against the selected tissue, thereby wedging and implanting the marker element.
In yet another embodiment of the invention, the tube lumen is adapted to receive a deployment actuator connector, or center wire, which extends axially through the lumen. The connector includes a distal portion which extends distally of the tube and a proximal portion which extends proximally of the tube. The proximal portion is attached to a deployment actuator, such as a pull ring, while the distal portion is attached to the marker element. On the connector, proximal to the distal portion, is a predetermined failure point which is adapted to be the weak point on the connector by failing first under tension. In operation, once the tube distal region has been positioned at the selected tissue location, the deployment actuator is actuated in a proximal direction to pull the marker element against the distal region of the tube. The tube distal region thus functions as a forming die to cause the marker element to bend until it abuts the tube distal region at its junction with the distal portion of the connector, such that the marker element is reconfigured to a desired shape. The proximal portion of the connector is adapted to be severed from the distal portion at the predetermined failure point upon the application of continued tension on the deployment actuator after abutment of the marker element against the tube distal region, thereby releasing and implanting the marker element.
Another important feature of the invention is the ability to utilize marker elements having a plurality of shapes. In some embodiments, these shapes may be created merely by utilizing different sized material stock or different cross sections. This shape diversity permits the adoption of a system wherein each shape denotes a different selected tissue location or event.
In a preferred embodiment of the invention, the device is adapted to be employed in combination with a medical instrument which transports the device to the selected tissue location responsive to positional control by a guidance system. The medical instrument preferably draws a vacuum to isolate and retain tissue at the selected location in a tissue receiving port. The marking device is adapted to deploy the marker element into the retained tissue.
In another aspect of the invention, a marker element is provided for marking tissue within a human body to identify a selected location for a diagnostic or therapeutic procedure. The marker element, which is preferably comprised of a biocompatible, implantable, and substantially radiopaque material, is adapted to be deployed to the selected tissue location percutaneously by a delivery instrument, so as to become implanted in the tissue.
A number of different marker element configurations and materials may be employed. Materials may include stainless steel, titanium, and the like, as well as non-metallic materials, such as polymers, salts, and ceramics, for example. In some embodiments, the marker element may actually be formed into a desired shape by a forming die in the delivery instrument, while in other embodiments, it may comprise a spring which radially expands upon exit from the delivery instrument to embed itself in the tissue.
In yet another aspect of the invention, a method for permanently marking tissue in a human body to identify a selected location for a diagnostic or therapeutic procedure is disclosed, which comprises actuating a delivery instrument, having a tube with a distal region, to a position wherein the tube extends through the human body and the distal region is at the selected location. A marker element is then deployed from the tube distal region to the selected tissue location so that it becomes anchored in the tissue.
These and other aspects and advantages of the present invention are set forth in the following detailed description and claims, particularly when considered in conjunction with the accompanying drawings in which like parts bear like reference numerals.
Now with more particular reference to the drawings,
To place the marker element 12 at a desired location, a biopsy needle or gun is preferably used, though other known delivery means could be used as well. For example, the stand-mounted biopsy instrument described in U.S. patent application Ser. No. 08/217,246, previously incorporated by reference into this application, is a preferred instrument for introducing the marker element into the body of a patient. One embodiment of such an instrument 26 is partially illustrated in
Operation of the biopsy instrument to facilitate the placement of a tissue marker is illustrated sequentially in
As shown in
As shown in
Now again referring to
In operation, the tube 54 of the marking instrument is inserted into the patient's body in the direction of the arrow 58, as shown in
With reference to
Now referring to
Finally, with reference to
In the preferred embodiment, the marker element 12 is fabricated of stainless steel. However, many other biocompatible, radiopaque, implantable materials may be used for the marker element 12 as well, including, for example, titanium, tantalum, or nickel-titanium alloys. Additionally, while a 3-pronged umbrella end is shown and described, any number of prongs may be used, if desired.
While it is preferred that the marker element 12 be deployed using the biopsy instrument described and shown in
Now with reference to
A primary difference between the
Referring now to
There are two primary differences between the embodiments of
Still with reference to
Again in this embodiment, the spring 12 b may be fabricated of any known biocompatible, implantable, radiopaque material, though stainless steel is preferred. Additionally, the forces required to deploy the attachment members on the spring may be customize by varying the spring filar, dimensions, material, and/or the number of coils in the torsional part of the spring.
In actuality, the
Again, the
In practice, a radiologist or other operator of the equipment can use a marker shaped like marker 12 b, as shown in
In this embodiment, each marker element 12 e is deployed distally through the open distal region 90 e of the tube 54 e by a mandrel 98 e, much as in the previous embodiments shown in
An advantage of this embodiment is that, because of the tight compression of the springs 12 e within the tube 54 e, a larger number of markers can be inserted therein simultaneously, thereby permitting the deployment of more markers without having to pause and disengage to re-load.
Another advantage the
It should be noted that the springs need not be limited to the configuration illustrated, but could include any spring of any configuration which expands to secure its position. While stainless steel is presently preferred, any other biocompatible, implantable, and radiopaque material could be used alternatively. Also as in the previous embodiments, marker elements may be similarly deployed radially through a side port in tube 54 e (not shown), or any other angle, to accommodate delivery through an existing instrument (i.e., cannula, needle, endoscope, laparoscope, or the like).
Still another alternative embodiment of the marking instrument 10 is shown in
This embodiment is versatile in that it is capable of continuously deploying any number of marker elements without the necessity of re-loading, since all that is required is a continuous feed of wire segments into the proximal region of the tube 54 f. Furthermore, differently sized and shaped helixes may be delivered in the same procedure by utilizing marker wires of different diameters and/or preformed curves, which approximate different helical shapes as they pass through the die portion. Thus, loading a plurality of different sized wires into the needle yields a plurality of different shaped markers.
Of course, as with the previous embodiments, although stainless steel is presently preferred, many different types of biocompatible, implantable, and radiopaque materials could be utilized within the scope of the invention. Also as in the previous embodiments, marker elements may be similarly deployed at different angles to accommodate delivery through an existing instrument (i.e., cannula, needle, endoscope, laparoscope, or the like).
Unlike previous embodiments,
Though a number of different embodiments of the conceptual invention have been described and shown, it is considered to be within the scope of the invention for the marking elements and delivery instruments to take on many other forms. For example, embolization coils like that illustrated in
Marker elements of many other materials and configurations may be used as well. For example, one such multi-appendaged jack-shaped marker 12 h is illustrated in
Referring now to
While this invention has been described with respect to various specific examples and embodiments, it is to be understood that the invention is not limited thereto and that it can be variously practiced within the scope of the following claims.
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|Amplatz; Curtis
|Method of forming medical devices; intravascular occlusion devices
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|Bard Peripheral Vascular, Inc.
|Tissue localizing and marking device and method of using same
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|Oct 26, 2010
|Bard Peripheral Vascular, Inc.
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|Sep 27, 2011
|Ion Beam Applications S.A.
|Elongated markers for soft tissue volume identification
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|Mar 6, 2012
|Bard Peripheral Vascular, Inc.
|Apparatus and method for implanting a preloaded localization wire
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|Nov 6, 2012
|Devicor Medical Products, Inc.
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|Mar 1, 2011
|Jan 29, 2013
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|Jun 11, 2013
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|Jan 7, 2014
|Senorx, Inc.
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|Jan 14, 2014
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|Mar 11, 2014
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|Feb 24, 2015
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|May 26, 2015
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|May 26, 2015
|C. R. Bard, Inc.
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|Jan 25, 2013
|Jun 2, 2015
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|Oct 29, 2002
|Apr 15, 2004
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|Nov 17, 2003
|Jun 17, 2004
|Inrad, Inc.
|Tissue localizing and marking device and method of using same
|Sep 30, 2005
|Feb 16, 2006
|Sirimanne D L
|Biopsy cavity marking device
|Jul 25, 2005
|Aug 27, 2009
|Calypso Medical Technologies, Inc.
|Anchoring wirless markers within a human body
|Aug 25, 2011
|Leimbach Jessica P
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|U.S. Classification
|606/185, 600/562
|International Classification
|Cooperative Classification
|European Classification
|Jul 9, 2010
Owner name: DEVICOR MEDICAL PRODUCTS, INC., WISCONSIN
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:ETHICON ENDO-SURGERY, INC.;REEL/FRAME:024656/0606
Effective date: 20100709
|Jul 13, 2010
Owner name: GENERAL ELECTRIC CAPITAL CORPORATION, AS AGENT, MA
Free format text: SECURITY AGREEMENT;ASSIGNOR:DEVICOR MEDICAL PRODUCTS, INC.;REEL/FRAME:024672/0088
Effective date: 20100709


text:
Behind the Scenes
Just for Fun: Amanda "Thomas Keller" Hesser
It was a busy day in the test kitchen when all of a sudden Amanda turned her computer screen, showed us all the New York Times homepage, and asked, "Is that Thomas Keller in my kitchen?" The article in question is about California chefs crusading against the state's upcoming ban on the sale of foie gras, headed up by a photo of the French Laundry's Thomas Keller standing and looking serious in a kitchen that looks remarkably like Amanda's. Well, we had only one option. Readers, we present you Amanda "Thomas Keller" Hesser.Read More »

subset: commoncrawl


text:
|News » Archives
ETSU Soccer Shut Out by Davidson
Sunday, September 30, 2001Davidson, N.C. -- The East Tennessee State soccer team lost its fifth straight game in a 4-0 shutout by the Davidson Wildcats at Smith Field Sunday afternoon. With the conference loss, the Buccaneers drop to 1-7-1 and 0-4 in conference play. The Wildcats improve to 4-6 overall and 3-1 in the Southern Conference. The Wildcats took control of the game early and dominated throughout the remainder of the contest. Sophomore forward Leigh Anne Hoskins initiated the Wildcat scoring frenzy with a shot from sophomore midfielder Denielle Erikson at the 20:53 mark of the first half. The goal, her fifth of the season, places her on top of the Wildcat scoring list. Junior midfielder Lauren Dennis and sophomore midfielder Alia Antonucci-Alter contributed their first goals of the season in the win. At the 45:47 mark, Dennis headed the ball past East Tennessee goalkeeper Heather Sanden off passes from Hoskins and junior midfielder Tara Maloney. With the goal, the Wildcats took a 2-0 lead into the break. Antonucci-Alter eliminated any chance of a Buccaneer come back in the final period, scoring twice, first at the 65:47 mark and then again at 83:02. She delivered the shot into the back of the net off passes from Erikson and Maloney on the first goal and then made a direct kick from 10 yards out on the second play. The shutout was Davidson keeper Sarah Hobart's second of the season. She collected seven saves during the game while Sanden made nine. Davidson outshot the Buccaneers 31 to nine in the game. The Buccaneers next travel to Nashville, Tenn. to play a non-conference game against the Belmont Bruins at 2 p.m. on Oct. 4, 2001.


text:
Talk:Main Page
Please update the wiki to 1.5.5. Thanks.
--Pcj 01:35, 11 Dec 2005 (MST)
Hah, beat you with 1.5.6!
--220.127.116.11 10:22, 20 January 2006 (PST)
Please update the wiki to 1.6.7. Thanks.
--Pcj 12:39, 26 March 2006 (PST)
Upgrading (older!)
Please update the wiki to 1.5.3. Thanks.
--Pcj 01:35, 11 Dec 2005 (MST)
Bleargh. Tried to, but it wasn't pretty. Realised I needed to have command-line access to run php scripts that couldn't be run via the web. So then I upgraded anyway and all got messed up, and then I reverted to a backup.
Might try again at some point, but not right now :P
--Justas 06:59, 11 Dec 2005 (MST)
...All you have to do is replace the files with the updated ones. Well...read the UPGRADE file that comes with the download first.
--Pcj 10:39, 11 Dec 2005 (MST)
It's currently running on 1.4.7. Lots of database changes with 1.5. I read the UPGRADE file, the official MediaWiki "1.4.7 to 1.5.2" upgrade tutorial and then some, but it was still rather messy. I'll probably try to do the db upgrade on my local machine, back it up and restore on BnS, or see if James has any details on accessing the command line.
--Justas 11:27, 11 Dec 2005 (MST)
Hah! I just ran the install script and remade the LocalSettings.php like it said...don't know why that doesn't work for you.
--Pcj 15:28, 11 Dec 2005 (MST)
Phew! Done!
Now I just gotta start fixing all those PHP scripts that were based on the old database schema. Gah.
--Justas 09:35, 20 December 2005 (MST)
Uh, nope, it's still 1.5.3...be sure to change the Wanted Pages include, too.
--Pcj 20:15, 23 December 2005 (MST)
*kicks pcj in the nutsch*
Btw, is 1.5.3 -> 1.5.4 just a file-based upgrade or are there any database changes needed as well?
--Justas 03:16, 24 December 2005 (MST)
It was just file-based for me.
--Pcj 08:49, 24 December 2005 (MST)


text:
Practice Philosophy
Dr Harrell has been practicing Plastic Surgery for over 24 years. As in most endeavors, experience is a powerful teacher and Dr Harrell has gained a vast amount of experience, particularly in the realm of Aesthetic(Cosmetic) Surgery.
It is our desire to offer our patients a world class experience as it relates to their surgical experience and results.
From the initial contact during the consultation process through to the preoperative, surgical and postoperative stages, Dr Harrell and his staff will do everything possible to ensure the most positive experience and the highest level of satisfaction.
This involves thoroughly understanding your concerns and planning the best surgical or medical approach for you - with you as a partner with the doctor - to achieve the best results possible.
Surgery is performed only in licensed or accredited surgical facilities with fully trained anesthesia providers to ensure the highest level of safety.
We invite you to visit our website or contact our office for further information and allow us to provide you with excellent care.
Doctor Harrell's practice is now almost exclusively dedicated to Aesthetic(Cosmetic) Surgery. Doctor Harrell performs a significant number of Breast Augmentation, Liposuction and Rhinoplasty procedures. His training and Board Certification in both Plastic Surgery and Otolaryngology gives him special expertise in facial surgery, such as Rhinoplasty, Facelift amd Eyelid surgery. Dr Harrell has special expertise in ethnic rhinoplasty for Hispanics, African-Americans and Asians due to his extensive experience in this area. He also is one of the few surgeons in South Florida with in-depth experience using the Trans-Umbilical approach to Breast Augmentation when desired by patients seeking this approach.
Additionally there is a Medical Spa incorporated into the doctor's office. A wide variety of facials are offered by the onsite Aesthetician, as well as light peels, waxing and laser hair removal. Dr Harrell also performs deeper peels for those patients desiring even more correction of their skin concerns. Dr Harrell has over 15 years experience with the Obagi Skin Care Line. The SkinCeutical skin care line is offered as well.
In addition, Doctor Harrell offers Wellness Evaluations and the popular HCG diet. A number of products are available in the form of supplements. Dr Harrell has partnered with the Life Extension Foundation to offer the highest grade of supplements available commercially to patients wishing to feel as good as they look.
The Consultation Process is absolutely critical to helping ensure a high level of satisfaction with the surgery and indeed, the entire pre and post operative experience.
Dr Harrell will take the time to hear your concerns, perform a thorough Medical History and perform a pertinent Examination. He has a relaxed 'bedside manner' which aids in diffusing any normal anxiety a patient may be experiencing.
Dr Harrell feels it is essential to understand the your concerns thoroughly and to be able to communicate the findings and the proposed treatments clearly, in language you can understand. An educated patient is an empowered patient and a partner, along with the surgeon, in obtaining the best results possible.
All questions will be answered completely during the consultation and representative photographs of patients who have had a similar procedure will be presented as well.
After the consultation with Dr Harrell one of Doctor Harrell's patient consultants will discuss the procedure further and work with the you to answer any remaining questions.
The goal of everyone you see during the consultation is listen to your concerns and educate you to the best of their ability.
Doctor Harrell utilizes only accredited or licensed surgical facilities when performing surgical procedures. Procedures which are more minor in nature may be performed under local anesthesia in the office setting. Our surgical facilities utilize only board certified Anesthesiologists, CRNA's and Anesthesia Assistants. Patients always have a choice in deciding which anesthesia care giver they wish to use. Safety is of utmost concern and Doctor Harrell feels that the facilities he currently uses meet the highest standards for safety and superior patient care. For patients wishing to do so, tours of the facilities may be arranged prior to the procedure.
Location & Office Hours
2133 North Commerce Parkway
Weston, FL 33326
View Map
Our standard office hours are Monday through Friday from 9:00 a.m. to 5:00p.m.
Evening and Saturday appointments are available by special request.
Our office may be contacted by telephone and website twenty four hours a day.
Payment Options
American Express, Visa, MasterCard, Patient Financing, Cash, Personal Checks, CareCredit


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|My most successful backpacking trip was from Tuolumne Meadows to Glen Aulin with my two sons, my nephew, my oldest son's friend, and two of my best...[more]
|I visited Yosemite National Park on 5th September 1965! The scenic beauty and waterfalls were fantastic and I remember laying myself down...[more]
|Carlon Falls was a great find because it was a hot Saturday. We needed a place to swim near our camp (5 miles outside the west gate)...[more]
|I visited these falls April 2005 and loved them. It's almost as good as Yosemite Falls but you have to be in the right place...[more]
|Yep, Pywiack is an elusive falls, tucked in fold in a canyon and viewable from narrow angles. I once did a one day trek from Tenaya Lake...[more]


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Football is popular, both for players and spectators. The following article will give you tips to help you understand the sport. Apply what you learn to playing or watching the game. It'll really help increase your love of the sport.
Practice kicking a football. Kicking may be a secondary talent in football, but it remains important. Too many people that play football do not spend enough time bettering their kicking game. This may cause a player to have trouble getting the football through the goalposts.
Develop your workout regimen and stick with it. You don't want to be changing your workout routine once you start it. The best way to benefit from working out is to find a great routine and do it several times a week. Don't let yourself quit and begin a new one every time.
Take some time to practice kicking the ball. Kicking is not the primary skill for football, but it remains essential. Too many players don't spend enough time practicing their kicking skills. They won't be able to make a field goal if this is the case.
Agility is an important thing to have if you're a football player. Jumping rope, jumping over cones and running through tires are wonderful exercises to better agility. You need both fast reflexes and fast thinking to perform well. The exercises mentioned above all require these abilities, and that is why they can help you to grow as a player. The more you do these training exercise, the more your agility will increase.
If you learn that a new trick is working exceptionally well on the field, don't overuse it. You opponent will learn your next move rendering the play ineffective if you use it often.
Always be a teammate who is supportive. Teamwork is crucial to a successful football team. You will ride the ups and downs of the season together. Remember that you should never say "I", rather, think in the sense of "we". Remembering this, working in harmony with your team is a must for promoting confidence within the people around you. Group confidence will inevitably result in more wins.
Develop your workout regimen and stick with it. You want to avoid starting an exercise routine and changing it right away. Exercise will only be beneficial if you perform a quality routine several times a week. Resist the temptation to keep trying new approaches over and over.
Everyone who is involved in the sport of football can agree that they love the game. The advice in this article should help you appreciate the game a bit more. Use them to turn your skills into the best on the field.


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Simply Giant: Tom Coughlin Leads Franchise To 4th Lombardi Trophy
No more hot seat for Tom Coughlin. No more second-guessing. The 65-year-old made NFL history on Sunday.
Patriots' Wes Welker Not So Sure-Handed When It Matters Most
Blame me, Welker said. Blame me for letting a ball I always catch fall to the ground.
What A Catch! Manningham's Fourth-Quarter Grab One For The Ages
Sure, Victor Cruz had on his dancin' shoes Sunday. But it was fellow wide receiver Mario Manningham who saved the Giants with his feet.
Officials Warn Of Tightened Security At Super Bowl
Homeland Security Secretary Janet Napolitano joined NFL and other officials in warning that security for Sunday's game at Lucas Oil Stadium would be significantly heightened.
Video: 'Littlest Giant Fan' Knows His Stuff!
As Big Blue fever sweeps the Tri-State area, we noticed a video on YouTube of one little guy who just might be the littlest Giants fan.
The Bowlies: A Hall of Fame for Super Bowl Commercials
By Elijah Bates Hello there, my friends, and welcome to The Bowlies! If you're not familiar with the concept (which you couldn't be, given that it only existed in my head until a couple of […]
Giants-Patriots Super Bowl XLVI Song "Throw So Good"
Tim Capezzone and Ian Cunningham have another parody song. This time the duo remade the 1997 hit "Feel So Good" by Mase.
So You Want To Go To Indy?
So you want to go to Indy, but you're not sure of the best/cheapest way to get into the biggest game of the year, right? SeatGeek and CBS Local have teamed up to give you […]
Super Bowl XLVI: The Rematch
Eli Manning and Tom Brady's rivalry presented in graphic form. We're giving you a comprehensive, head-to-head look at Eli Manning's Giants and Tom Brady's Patriots in preparation of Super Bowl XLVI. Get details on their […]
Giants Vs. Patriots Is Old School Vs. Cutting Edge
Tom Coughlin and Bill Belichick present one of the most fascinating coaching duels for a Super Bowl, as the two approach the game in entirely different ways.


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News from the Heights If you need more information, call Le Moyne's Office of Communications at 315-445-4555 or contact via email Joe Della Posta or Molly McCarthy. Read past issues of the magazine Le Moyne College to Host Lecture on Yeats
SYRACUSE, N.Y. (For Immediate Release) … Le Moyne College will host a lecture by Rob Doggett, assistant professor of English at the State University of New York at Geneseo, on Thursday, February 22, at 4:30 p.m. in Grewen Auditorium. His talk is titled "Nationhood and William Butler Yeats' 'The Tower.'"

 Doggett's analysis of Yeats, "Deep-Rooted Things: Empire and Nation in the Poetry and Drama of William Butler Yeats," was drawn from an ACIS award-winning dissertation and published by the University of Notre Dame Press in 2006. Doggett has also been an invited speaker at the prestigious Yeats School in Sligo, Ireland. He holds a bachelor's degree from Gettysburg College and a master's and doctorate from University of Maryland.

 The lecture is free and open to the public. It is part of the Irish Lecture Series at
 Le Moyne, which was created with the support of the Strategic Initiative Fund to celebrate the College's creation of an Irish literature minor. For more information, contact Professor Kate Costello-Sullivan at 445-4215 or email@example.com
posted on: 2/2/2007


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