text:
|Publication number
|Publication type
|Application number
|Publication date
|Feb 14, 2002
|Filing date
|Jun 4, 2001
|Priority date
|Jul 10, 1998
|Publication number
|Ulrich Dietz, Harold Darius, Olaf Eick, Victor Duysens
|Original Assignee
|Medtronic, Inc.
|Export Citation
|BiBTeX, EndNote, RefMan
|Referenced by (27), Classifications (15), Legal Events (1)
|External Links: USPTO, USPTO Assignment, Espacenet
[0001] This patent application claims priority and other benefits from U.S. Provisional Patent Application Ser. No. 60/210,733 entitled "Temperature-Controlled High Frequency Ablation for Creation of Transmyocardial Channels" to Dietz et al. filed Jun. 12, 2001, and incorporates the entirety of same by reference herein. This patent application is also a continuation-in-part of U.S. patent application Ser. No. 09/453,096 entitled "Medical Device and Method for Transmyocardial Revascularization" to Dietz et al. filed Dec. 2, 1999, which is a divisional of U.S. patent application Ser. No. 09/113,382, now abandoned, entitled "Medical Device and Method for Transmyocardial Revascularization" to Dietz et al. filed Jul. 10, 1998, and incorporates the respective entireties of same by reference herein.
[0002] This invention is generally directed to the field of surgery, and more particularly to surgery procedures to improve the flow of blood to the heart muscle.
[0003] The number and variety of medical methods available to repair the effects of cardiovascular disease has increased rapidly over the last several years. More particularly, alternatives to open heart surgery and cardiovascular by-pass surgery have been extensively investigated, resulting in non-surgical procedures such as percutaneous transluminal coronary angioplasty, laser angioplasty, and atherectomy. These procedures are primarily directed toward the reduction of stenosis within the vasculature of a patient by either expanding the lumen through the use of a balloon, or ablating or otherwise removing the material making up the stenosis.
[0004] While such procedures have shown considerable promise, many patients still require bypass surgery due to such conditions as the presence of extremely diffuse stenotic lesions, the presence of total occlusions and the presence of stenotic lesions in extremely tortuous vessels. Also, some patients are too sick to successfully undergo bypass surgery, and because the above treatments require surgical backup in the case of complications, they are untreatable. Some patients requiring repeat bypass surgeries are also untreatable, such as those whose coronary arteries of insufficient internal diameter to serve as target vessels for bypass implantation; heart transplantation is regarded as the only therapeutic measure currently available for such patients.
[0005] One alternative to the foregoing procedures is known as Trans-Myocardial Revascularization (TMR). In TMR, channels are formed in the ventricle wall. Theoretically, such channels can provide blood flow directly from the left ventricular chamber to ischemic heart muscle. A history and description of this method is presented by Dr. M. Mirhoseini and M. Cayton in "Lasers in Cardiothoracic Surgery" in Lasers in General Surgery (Williams & Wilkins; 1989) pp. 216-223. To date, the most common clinical experimental approach to forming such channels employs a laser. See, for example, U.S. Pat. No. 5,755,714 to Murphy-Chutorian and U.S. Pat. No. 5,380,316 to Aita et al. Such channel forming attempts with laser technology, however, have largely been unsuccessful. In particular, most channels formed by laser means become occluded owing to the body's inflammatory response. As a result, the channels quickly become unavailable to deliver the blood to surrounding tissue.
[0006] Besides laser-based TMR, others have proposed mechanical means, the application of heat energy, or both to form channels in cardiac tissue. See, for example, European Patent Application EP 0 829 239 A1 to Mueller. To date, however, such attempts have been unsuccessful. In an abstract from the 70th Scientific Sessions of the American Heart Association (published in Circulation '96, No. 8, Suppl. I, pages 1-217), McKenna et al report the use of RF energy to form channels in cardiac tissue. The reported results are similar to those obtained using laser-based TMR, namely, that channels become occluded. McKenna et al did not report the use of temperature control for the delivered RF.
[0007] Still other TMR and TMR-like measures have been attempted to treat coronary heart disease (CHD) as alternatives to traditional bypass grafting and interventional coronary artery procedures. For example, some investigators have implanted various kinds of tubes into the myocardium having openings to the left ventricle. Transmyocardial puncturing was first described by White and Hishey as a method to restore blood supply in emergency situations. Sen et al. studied the possibility of transventricular needle puncture in acute ischemic myocardium. Walter et al. continued these studies by creating channels with cannulas of a diameter of 1.4 to 4.0 mm. Despite good initial success rates, long term patency has not been documented in any of these studies, however. More recently, transmyocardial holes created by laser ablation are described by Mirhoseini et al. In concordance with Mirhoseini and Horvath et al., where long term patency of channels is demonstrated. Sequential histologic examination of laser generated channels shows that an inflammatory process leads to fibrosis and consequent occlusion of channels, however.
[0008] Although laser transmyocardial revascularization (PMR) performed in patients having end stage CHD reduces symptoms in most patients, no improvement in myocardial function or long term patency of the channels has been documented. One of the major disadvantages of PMR procedures is that open heart surgery is required, which is accompanied by a mortality rate of up to 20%.
[0009] Patents and printed publications describing various aspects of the foregoing problems and the state of the art are listed below.
[0010] 1. Beck, C. S.: The development of a new blood supply to the heart by operation. Ann Surg 1933; 102:801
[0011] 2. Vineberg A. M., Walker J: Development of an anastomosis between the coronary vessels and a transplanted mammary artery. Can Med Assoc J 1964; 55: 117.
[0012] 3. White M, Hershey J E: Multiple transmyocardial puncture revascularization in refractory ventricular fibrillation due to myocardial ischemia. Ann Thorac Surg 1968; 6: 557.
[0013] 4. Sen P K, Udwadia T E, Kinare S G: Transmyocardial acupuncture. J Thorac Cardiovasc Surg 1965; 50:181.
[0014] 5. Walter P, Hundeshagen H, Borst H G: Treatment of acute myocardial infarction by transmural blood supply from the ventricular cavity. Eur Surg Res 1971; 3: 130.
[0015] 6. Mirhoseini M: Revascularization of the heart with laser. J Microvasc Surg 1981; 2: 253.
[0016] 7. Mirhoseini M, Shelgikar S, Cayton M M: New concepts in revascularization of the myocardium. Ann Thorac Surg 1988, 45: 415-12.
[0017] 8. Horvath K A, Smith W J, Laurence R G, et al: Recovery and viability of an acute myocardial infarct after transmyocardial laser revascularization. J Am Coll Cardiol 1995; 25: 258-63.
[0018] 9. Wittkampf F H, Wever E F, Derksen R, et al: LocaLisa: new technique for real-time 3-dimensional localization of regular intracardiac electrodes. Circulation 1999; 99: 1312-1317.
[0019] Broadly, it is the object of the present invention to provide an improved method for performing TMR. It is a yet further object of the present invention to provide a method for performing TMR which results in channel formation which permits chronically increased blood circulation in the region of cardiac tissue adjacent to the channels.
[0020] All patents and printed publications listed hereinabove are hereby incorporated by reference herein, each in its respective entirety. As those of ordinary skill in the art will appreciate readily upon reviewing the drawings set forth herein and upon reading the Summary of the Invention, Detailed Description of the Preferred Embodiments and claims set forth below, at least some of the devices and methods disclosed in the patents and publications listed hereinabove may be modified advantageously in accordance with the teachings of the present invention.
[0021] Various embodiments of the present invention have certain objects. That is, various embodiments of the present invention provide solutions to problems existing in the prior art, including, but not limited to, the problems listed above and problems such as: (a) intramyocardial channels created by laser energy tending to occlude over time; (b) necrotic zones forming around laser created channels having unpredictable extents and occurring at unpredictable frequencies; (c) channels in cardiac tissue formed by laser means are transmural, with the consequence that epicardial holes may result in pericardial bleeding; (d) not measuring the temperature of cardiac tissue adjacent the channels during PMR, with the consequence that cardiac tissue heating is controlled inadequately and channels of unpredictable morphology, necrotic zone extent and shape result; (e) cardiac tissue temperatures exceeding 100� C., resulting in tissue burning and charring, and subsequent inflammatory response; (f) local variations in cardiac tissue anatomy leading to structures such as adjoining blood vessels causing excessive convective heat loss or requiring highly variable energy levels; and (g) barotrauma being associated with laser-created channels.
[0022] Various embodiments of the present invention have certain advantages, including, without limitation, one or more of: (a) increasing the number of channels formed in cardiac tissue remaining open and unoccluded; (b) eliminating the occurrence of barotrauma since barotrauma is not associated with the delivery of radio-frequency energy to cardiac tissue; (c) stabilizing channels formed in cardiac tissue so that perfusion of cardiac tissue can continue for a significant period of time after the channels have been formed; (d) permitting a high degree of temperature control when forming channels in cardiac tissue; (e) avoiding the burning or charring of cardiac tissue during channel formation; (f) avoiding the formation of necrotic zones of excessive extent adjacent to the channels; and (g) minimizing the occurrence of epicardial holes.
[0023] Various embodiments of the present invention have certain features, including one or more of the following: (a) the formation of well defined and predictable necrotic zones adjacent to cardiac tissue channel; (b) a temperature sensor disposed near, on or in a cardiac tissue piercing and energy delivery means; (c) an extendable and retractable piercing means configured to pierce the myocardium to a preset depth; (d) temperature sensor means in combination with radio-frequency energy delivery means in a feedback control system resulting in the energy being delivered to cardiac tissue being automatically adapted to local anatomical variations in cardiac tissue.
[0024] The present invention relates to a transluminal medical system for revascularization of portions of a human heart through the formation of intramyocardial channels in cardiac tissue using piercing and radio-frequency energy delivery means. The channel forming system of the present invention may be configured in two basic embodiments: (a) a first embodiment where a transluminal steering and delivery system comprises a guide catheter or sheath which functions largely apart from and independent of other components in channel forming system (with the notable exception of a means for extending and retracting a piercing means from a distal end of the guide catheter or sheath), and (b) a second embodiment where a transluminal steering and delivery system is integrated into and combined with other components of the channel forming system, such as a piercing means, means for delivering radio-frequency energy to the piercing means, and temperature sensing means.
[0025] In one embodiment of the system of the present invention, there are provided a catheter delivered needle for piercing heart tissue, a radio-frequency energy source coupled to the needle, and means for controlling the radio-frequency energy source so that a predetermined temperature is obtained and not exceeded in the cardiac tissue adjacent the needle. The controller may also be configured to limit the amount time during which radio-frequency energy is delivered to the cardiac tissue. The needle may be cylindrical and have a piercing length of between about 3 mm and about 9 mm, and a piercing diameter of between about 0.5 mm and about 1.5 mm.
[0026] In a further embodiment of the system of the present invention, an ultrasonic sensor senses the distance from the distal end of the piercing means to an outer surface of the heart. Additionally, the piercing means may be configured to deliver a pharmacological agent to the cardiac tissue, such as physiologic mediators (e.g., growth factors, RNA, DNA or cDNA) or drugs for enhancing blood flow.
[0027] The present invention will become better understood by reference to the following Detailed Description of the Preferred Embodiments of the present invention when considered in connection with the accompanying Figures, in which like numbers designate like parts throughout, and where:
[0028]FIG. 1 is a view of a first embodiment of the present invention configured to access the endocardial surface of the left ventricle.
[0029]FIG. 2 depicts the distal tip 10 of catheter 1 of FIG. 1.
[0030]FIG. 3 depicts a second embodiment of the present invention.
[0031]FIG. 4 shows an end view of the embodiment shown in FIG. 3.
[0032]FIG. 5 shows a third embodiment of the present invention.
[0033]FIG. 6 depicts one method of the present invention.
[0034]FIG. 7 depicts a further embodiment of the present invention.
[0035]FIG. 8 depicts another embodiment of the present invention.
[0036]FIG. 9 depicts yet a further embodiment of the present invention.
[0037]FIG. 1 shows a first embodiment of the present invention disposed within a human body, and is configured to access the endocardium of the left ventricle. Catheter 1 is introduced into the left ventricle via aorta 3 using well known femoral percutaneous access methods. Although such an access method is preferred in some embodiments of the present invention, other access methods may also be employed, such as a direct surgical cut down which exposes an exterior or interior portion of the heart requiring revacularization. Catheter 1 comprises catheter body 5 and distal tip 10. Catheter body 5 typically comprises a biocompatible polymeric sheath, and has one or more conductors or guide lumens disposed therewithin. The particular design of catheter body 5 depends on the design of the distal tip 10, as well as the particular handling characteristics an individual physician prefers. For example, the catheter body may be made to be more or less stiff along its entire length or along various portions of its length, as is well known in the art. Moreover, the catheter body may include one or more guide lumens, or one or more guide catheters, or both. Still further, the catheter body may feature rapid exchange capabilities to permit a guide wire to be introduced first into a patient's body, followed by the guide catheter being advanced to a site within the patient's body over the wire.
[0038] The proximal end of the catheter body couples to a radio-frequency (RF) energy generator 11 that delivers "Radio Frequency Energy (RF Energy)". In the illustrated embodiment, the system operates in a monopolar mode. In this mode the system requires skin patch electrode 12 that serves as an indifferent second electrode, as is well known in the art. In an alternative embodiment the system could also be operated in a bipolar mode in which catheter 1 includes two electrodes.
[0039]FIG. 2 depicts the distal tip 10 of catheter 1. As seen, distal tip 10 essentially comprises piercing means or needle 20 disposed distally from the distal end of the catheter body 5. Needle 20 is preferably cylindrically shaped and has a sharpened tip. Needle 20 may have a piercing length PL of between about 3 mm and about 9 mm, with 7 mm being a preferred PL. A maximum piercing diameter PD of between about 0.5 mm and about 1.5 mm for needle 20 is preferred, with 0.7 mm being most preferred. Needle 20 may cooperate with the catheter body, and in particular with the catheter diameter "CD" of the catheter body, such that the piercing length of the needle cannot exceed the total needle length. If the distal end of the catheter body is appropriately configured, shaped and sized it will not follow the needle through the heart when certain ranges of force are applied. In one preferred embodiment of the present invention, the catheter body is at least 3 French in diameter. Of course, the particular dimensions of the catheter body depend on the patient's condition and a physician's preference. Thus, piercing means and catheter having greater or lesser lengths or diameters may also be used. Moreover, while the needle is shown as made of metal, the needle and/or various portions of the needle need not be formed of metal. For example, the end cap may be formed of glass or polymer. The needle may also be provided without any end cap.
[0040] Needle 20 includes within or near it a temperature sensing device, here illustrated as a thermowire 21. Thermowire 21 permits the temperature of the tissue in the region of the needle to be reliably measured. Thermowire 21 is coupled to RF energy generator 11. Needle 20 is also coupled to RF energy generator 11. Also illustrated is guide lumen 22 disposed within an interior portion of catheter body 5. Guide lumen 22 may be provided to permit a stylet or other control devices to be inserted within catheter body 5 and thereby permit more precise control of needle 20. The particular design of catheter body 5 may be selected from among many known designs.
[0041]FIG. 3 depicts another embodiment of the present invention. Multiple piercing needles 35-1 and 35-2 are disposed distally from the distal end of catheter body 5. Each of needles is preferably cylindrically shaped and has a thermosensor disposed therein or nearby.
[0042]FIG. 4 shows an end view of the embodiment shown in FIG. 3 Several needles 35-1, 35-2, 35-3 and 35-4 are disposed distally from catheter body 5. In this embodiment, multiple channels may be created during a single piercing procedure. While four needles are illustrated, more or less needles may also be employed.
[0043]FIG. 5 shows a further embodiment of the present invention. The distal end of catheter body 5 features a piercing needle 20. Catheter body 5 and piercing needle 20 have a design similar to those shown above in FIG. 2, but further comprise ultrasonic sensor 36 disposed at or near at the distal end of catheter body 5. Ultrasonic sensor 36 is coupled to ultrasonic sensing driver or device 37 through conductor(s) 38. Ultrasonic sensor 36 and driver 37 may be configured in any suitable manner, including those disclosed in Patents WO 9517131, WO 9526677, EP 740565, EP 739183, WO 9519201, WO 9515784, EP 474957 to Ferek-Petric. Sensor 36 and driver 37 permit the distance between catheter distal end 36 and the surface of the cardiac tissue to be measured. Such surfaces include both inner as well as outer myocardial surfaces when the catheter is used in an endocardial manner. Such sensors therefore permit needle 20 to be introduced into the myocardium, but without piercing therethrough into the pericardial space. As is well known in the art, perforation of the myocardium permits bleeding of the heart to occur from inside out. Such bleeding is known as pericardial effusion and may lead to serious complications. Ultrasonic sensing driver 37 may further include a controller to permit the distance of the sensed heart surface to be correlated with the length of piercing needle 20 such that the distance from the sharpened tip of the piercing needle to the finer outer surface of the local region of the myocardium may be calculated and displayed to the physician.
[0044]FIG. 6 depicts one method of the present invention. At step 61 a catheter having one or more piercing needles as described above is inserted into the body. At step 62 the piercing needle or needles is inserted into the heart tissue. At step 63 RF energy is delivered through the needle into the heart tissue surrounding the needle so that a lumen or channel is formed in the heart tissue. This step may further include the step of modulating the RF energy delivered in accordance with the temperature sensed at or near needle 20 so that the temperature of cardiac tissue surrounding needle 20 does not exceed a predetermined temperature. This step may also include delivering the modulated RF energy for a predetermined period of time between approximately 5-25 seconds with 15 seconds preferred. Of course, the particular period of time over which energy is delivered depends on the patient's physiology, the doctor's preferences, the piercing needle's size and geometry, the temperature set points employed and other factors. In a preferred embodiment, the temperature set point ranges between about 60� C. and about 80� C., with 70� C. being preferred. The temperature set point is important because the highest temperature reached in the cardiac tissue surrounding the needle determines the amount and degree of necrosis that will form. The inventors believe that the temperature ranges set forth herein minimize the ultimate zone of necrosis. In step 64 RF energy is turned off and in step 65 the needle is withdrawn. At step 66 the procedure may be repeated at another location. Finally, the catheter is withdrawn at step 67.
[0045] Step 64 may further include delivering a pharmacological agent through the needle while it is still inserted in the heart tissue. A catheter suitable for such delivery is shown in FIG. 7. Such pharmacological agents may include vasodilators, anticoagulants, platelet inhibitors, growth factors stimulating angiogenesis or myocyte growth or their respective RNA, cDNA or DNA sequences.
[0046] It is also to be understood that step 62 may include providing a catheter, sensing the distance from the catheter's distal end to one or more surfaces of the heart, and calculating and displaying the distance between the sharpened distal tip of the needle to the sensed surface of the heart. In such a manner a physician may reliably control the depth to which needle 20 pierces cardiac tissue. The system of the present invention may also include a device for providing a "stop forward movement signal" to the physician to prevent transmural myocardial piercing.
[0047]FIG. 7 depicts a further embodiment of the present invention substantially the same as that shown in FIG. 2, but where agent infusion holes 99 in fluid communication with an agent source. As discussed above in FIG. 6, the system and of the present invention may deliver one or more pharmacological agents through needle 20 while inserted in cardiac tissue. Such pharmacological agents may include vasodilators, anticoagulants, platelet inhibitors, growth factors stimulating angiogenesis or myocyte growth or their respective RNA, cDNA or DNA sequences.
[0048]FIG. 8 depicts a further embodiment of the present invention substantially the same as that shown in FIG. 4, but where needles 98-1 through 98-4 are square in cross-section.
[0049]FIG. 9 depicts a further embodiment of the present invention substantially the same as that shown in FIG. 5, but where needle 97 is curved along its length and in a single plane. Of course other types of curves may be used, including multi-planar curves, helixes, and so on.
[0050] Transmyocardial channels were created using a radiofrequency (RF) probe. The catheter consisted of a 4 F application catheter having a cylindrical ablation electrode (� 0.8 and 1 mm, 5 mm long) and a sharpened conus. A thermocouple was incorporated in the center of the ablation electrode. We evaluated the impact of temperature- and power controlled applications on the resulting channel dimensions and shape, and the size of surrounding necrosis. In 12 anesthetized rabbits the RF probe (� 0.8 mm )was introduced from the epicardial surface via a thoracotomy for 4-7 applications along the left ventricular (LV) wall. Transmyocardial channels were created by either temperature controlled (in 5 rabbits) or power controlled (in 7 rabbits) applications for 3-10 seconds. The RF probe was then removed. The experiments were terminated after 4 h. The dimensions of transmyocardial channels and zones of necrosis were measured using an automatic morphometric system and cross sections stained with HE and Fuchsin, respectively. By this, the mean diameter of transmyocardial channels and necrosis was calculated. The shape of the transmyocardial channels was analyzed using HE stained cross sectional slices. Persistent transmyocardial channels could be identified in 22/25 of the temperature controlled applications and in 28/35 of the power controlled applications. Temperature- and power controlled applications yield in transmyocardial channels with diameters ranging from 113 to 743 μm. The channels had a more round shape created with temperature control as compared to power control with a comparable maximum temperature. The diameters of the channels created with power controlled energy delivery correlated poorly with the duration (r=0.1), the energy-time product (r=0.08), and the max. temperature (r=0.1). Diameters of transmyocardial channels created with temperature controlled energy delivery were weakly correlated with duration (r=0.4) and the ablation temperature (r=0.35), but highly correlated with the temperature-time product (r=0.8). The diameter of the necrosis was correlated with the max. temperature in both groups, r=0.9 for temperature control and r=0.58 for power control, respectively, but not correlated with the temperature-time product in the temperature controlled group (r=0.3).
[0051] The creation of persistent channels was discovered to depend on the temperature time product of the RF energy administered. Thus, a temperature-controlled energy delivery is necessary for the reproducible generation of transmyocardial channels that remain detectable for at least 4 hours.
[0052] A catheter system comprising an 8 F guiding catheter in which a 6 F guiding catheter was used together with a 4 F application catheter. A cylindrical ablation electrode 1 mm in diameter and 5 mm in length with a sharpened conus was employed. A thermocouple was incorporated into the center of the ablation electrode to permit temperature-controlled energy delivery. At the end of the series of these experiments a 7 F catheter with an extractable needle and bi-directional steerability was employed. In 9 anesthetized pigs (2535 kg) the system was introduced by a transfemoral approach. The ablation electrode was inserted into the myocardium for its entire length followed by temperature controlled HF energy delivery with a target temperature of 75� C. for 5 s. Fifteen piercings without energy application were performed in one pig. The LETR principle was used in 5 animals to assess the contact and introduction of the needle electrode into the myocardium. The LETR-principle is based on the hypothesis that the temperature rise resulting from the application of low levels of radiofrequency energy (0.1W) varies according to the amount or degree of electrode-tissue contact. A firm electrode-tissue contact causes a relatively high temperature increase, whereas a poor contact causes a low temperature increase.
[0053] A LocaLisa system was used in two animals to determine the spatial position of the needle electrode and to mark the location of the channels. The LocaLisa system features an orthogonal lead configuration where three independent alternating currents of 1 mA each are delivered through the patient's chest, with frequencies of 30.27 kHz, 30.70 kHz, and 31.15 kHz being employed for the transversal, axial, and saggital directions, respectively. The LocaLisa system has two input amplifiers for measuring the resulting sensed signals on two mapping catheter electrodes relative to a stable skin or catheter reference electrode. The amplitudes of the three frequency components were optically transmitted to a Macintosh computer. A custom-designed software application provided moving-average filtering, calibration, and real-time display of the position of the distal portion of the mapping catheter. During energy delivery temperature, RF power and impedance were continuously recorded with a computer.
[0054] Six pigs were harvested one hour after the procedure (acute pigs) and three after 3 weeks (chronic pigs). Histological examination was done in serial sections of 5 μm thickness stained with H&E and fuchsin in the acute pigs, and with Elastica v. Gieson in the chronic pigs. The ferret diameter of the channels, the necrotic zone and the fibrotic zone were calculated. The shapes of the channels and the degrees of obstruction were assessed.
[0055] It was determined that a total of 107 channels were stabilized using radio-frequency energy delivery and an additional 15 channels were stabilized without energy delivery. In the 107 cases, the average temperature achieved was Tavg=70.4�2.7� C. (61-76� C.) requiring an average RF power Pavg=3.9�4.2W (1-30W). The impedance between the RF probe and the indifferent electrode averaged Imp=171�32 Ω (104-242 Ω). Hemodynamic parameters remained stable in all but one animal which died because of ventricular fibrillation. Three pigs had minor pericardial effusions. The endocardial ostium could be identified in 88 of the 107 cases. Histomorphometry of the channels and the necrotic zone was done in 46 out of 67 cases for acute pigs, and of the ferrit diameter in 33 out of 39 cases for chronic pigs. 65% of the acute pigs had channels having oval shapes. 85% of the acute pigs had patent channels. The mean degree of obstruction was 50%, where obstructive material consisted of thrombus. In the acute pigs the ferret diameter of the channels was 850�456 μm and that of the necrotic zone 3100�700 μm. In the chronic pigs 2 patent channels were found as well as 31 channel remnants containing a partially recanalized thrombus surrounded by a dense mesh of capillaries. The ferret diameter of the fibrotic zone was 2800�850 μm.
[0056] PMR was shown to be feasible using radio-frequency TMR. Reproducible intramyocardial channels were created that persisted and stayed open for at least 1 hour in a high percentage of cases. After 3 weeks, intense neovascularization of the fibrotic zone was observed.
[0057] Although specific embodiments of the invention are described here in some detail, it is to be understood that those specific embodiments are presented for the purpose of illustration, and are not to be taken as somehow limiting the scope of the invention defined in the appended claims to those specific embodiments. It is also to be understood that various alterations, substitutions, and modifications may be made to the particular embodiments of the present invention described herein without departing from the spirit and scope of the appended claims.
[0058] In the claims, means plus function clauses are intended to cover the structures and devices described herein as performing the recited function and their equivalents. Means plus function clauses in the claims are not intended to be limited to structural equivalents only, but are also intended to include structures and devices which function equivalently in the environment of the claimed combination.
[0059] All printed publications, patents and patent applications referenced hereinabove are hereby incorporated by referenced herein, each in its respective entirety.
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|U.S. Classification
|International Classification
|Cooperative Classification
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|Oct 17, 2001
Owner name: MEDTRONIC, INC., MINNESOTA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:DIETZ, ULRICH;DARIUS, HAROLD;EICK, OLAF;AND OTHERS;REEL/FRAME:012261/0606;SIGNING DATES FROM 20010813 TO 20010824

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The 2015 ECK Worldwide Seminar talk by Sri Harold Klemp will be available on the Internet. Online sign-up begins on or around October 16 (check at www.ECKseminars.org for the broadcast sign-up announcement).
Broadcast dates:
Audio: October 24, 11:30 p.m., central time, through November 1, 11:30 p.m., central time.
Video: November 6, 5:00 p.m., central time, through November 15, 11:30 p.m., central time.


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Welcome to the Queen of the Holy Rosary Website. Our parish and people are so blessed! I invite you to be a part of the spirit of Queen. A spirit whose foundation rests upon faith in Jesus Christ.
Our doors are open wide to any who seeks to worship and serve our Lord! Our community is diverse, with members young and old; life long Catholics, returning Catholics and newly baptized. We embrace all who wish to be one with us in faith.
Mission Statement
Led by the Spirit of God . . . We are a Catholic faith community dedicated to becoming a dynamic center of worship and Christian involvement. Our enthusiasm and love will fill each member and permeate the larger communities that surround us. We strive to recognize and celebrate our diversity. We challenge ourselves to lead lives that will reflect our beliefs.
To Register in the Parish
To register in the Parish, stop at the Information Station after Mass or at the Parish Office during the week. Registering for on-line giving does not automatically register you in the Parish.
Office Hours
NEW eGiving
Ministry Schedules
Mass Times
8:15 a.m. (1st Saturday of the month only)
4:00 p.m. (Fulfills Sunday Obligation)
7:00 a.m., 9:00 a.m., 11:00 a.m.
Weekday Mass Monday - Friday: 8:15 a.m.
Parish Choirs
The Parish Choir will begin rehearsals September 8th at 7:30 p.m. in the church. Anyone interested in joining us is welcome! The children's choir will begin rehearsals September 9th at 5:15 p.m. in the John Paul II School Music Room.
- Father Craig Maxim, Pastor
- Paul Coquillette, Parish Administration
- Ruth Mailand, Bookkeeper
- Cathy Mahr, Parish Office
- Margi Kettner, Parish Office
- Denise Godinez, Religious Education Director / Sacramental Preparation / School of Religion (SOR K-8)/VIRTUS Coordinator/ Crusaders YOUth Group (grades 8-12)
- Sheryl Lickteig, Senior Adult Ministry / Hospital Ministry/RCIA
- Michael Kim, Music Director


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(published in the Toronto Globe and Mail, Friday, Octber 4, 2002)
This year the Queen is celebrating the 50th anniversary of her reign and is visiting many parts of Canada. Twenty-six years ago she visited Montreal for the 1976 Olympics and I have a special memory of the Sunday my wife Rosslyn and I spent with the Queen, Prince Philip and Prince Andrew, when they went to church and then toured the Olympic Stadium and other Olympic sites.
As a Provincial minister in the Bourassa government at the time, I was invited to accompany the Queen for a day, during her official visit. Also present was Bud Drury, a Federal minister in Trudeau's cabinet. I have recorded the events as follows.
We arrive at the Royal Yacht "Britannia" at Bickerdike basin, in the port of Montreal, where hundreds of people are straining against the wire fence. We are met by the Vice-Admiral in charge of the Queen's household and by the personal staff, who are all relaxed and charming. We have coffee in the main lounge and Prince Philip enters, but goes immediately into a small room, where he apparently intends to practice reading the lesson, which he will read at church that morning.
The Queen's Personal Private Secretary, who seems to be the real person in charge, and who has seen the jostling, surging crowd outside, asks me if the canvas roof to the large white Cadillac convertible that the Queen is to ride in, should be put up or down. Not knowing the mood of the crowd, I advise that we should not risk leaving the Queen in the open and that the car should be covered. The Queen enters, we are all presented, she asks for "Philip", he appears and we all head down the gangway. The crowd lets out an enormous cheer and we proceed off in cars with the Cadillac in the lead, unfortunately with the roof in place.
At Ste Catherine and University Streets there is an even larger, cheering crowd and we enter the Anglican Cathedral for the service. Philip reads the lesson without a hitch and after the service the Queen meets the Roman Catholic Archbishop of Montreal and leaders of all other denominations, as well as some Anglican friends of mine, who are variously amused or annoyed at my presence in the Royal cortege. At this point, the Principal Private Secretary asks again, if I thought they should put down the convertible roof and I suggest they should. We leave the Church to joyous cheering from the crowd which has swelled even more, while RCMP, Surete du Quebec, and Montreal police are everywhere holding back the crowd and presumably standing on guard. There are even plainclothesmen, talking importantly into the large walkie-talkies of the era.
The Queen enters the open Cadillac and we are just about to ride off, when a tall, bearded man in flowing robes, sandals and long blond hair has somehow breached security and leans over towards the Queen and hands her flowers and a scroll-like object. The Cadillac takes off like a shot while its roof is snapped down and we all follow in haste. The bearded figure is bundled off, by all four branches of the gendarmerie, who contend vigorously over his inert body. It later turns out that he is a French Canadian monarchist, who has picked wild flowers for the Queen and has written a long poem of affection and fealty for the occasion.
As we travel through Montreal to the Olympic village, there are more consultations with the Private Secretary, the roof is put down for the rest of the day and we are met by waving, welcoming bystanders on the streets as we proceed along.
At the Olympic Village we have lunch with the athletes in their cafeteria and we all carry our own plates, except for the Queen. Prince Andrew, who is a slim teenager and dreadfully handsome (a young Barrymore), plays outrageously to the girl athletes present, all of whom seem to be completely infatuated. I find him a little vain and inane, but am clearly in a minority. The Queen, on the other hand, is witty, informed, interested in everyone and speaks fluent French.
We then visit the wrestling and swimming pavilions, followed by tea in a private cordoned-off area in the interior of the Olympic Stadium. At tea, the Queen takes a tiny tin box from her purse and puts two small sacrene pills into her cup, just as everyone used to do in those days. She is sitting with Prince Philip and Drury on her left and Andrew, Rosslyn and myself opposite. At her right elbow on a table is a telephone, which for no reason whatsoever, starts to ring loudly and without stop. The Queen unperturbed, carries on with the conversation, despite the incessant ringing. Finally, Prince Andrew says, "Why don't you pick it up and say, 'Hello'". The Queen says nothing, but looks at him with the most withering of laser-beam stares and Andrew is at last subdued and remains so, for the rest of the day. Later on the Queen is to say that Andrew is the handsome one and Charles the nice one. (She was very protective of Andrew, nevertheless, and wanted him at the Olympics, insisting that he get virtual head of state treatment at the various official banquets.)
We next enter the Olympic Stadium, where a soccer match is in progress. As we take our places high up in the VIP box, there is applause, which gains in magnitude. The Czechoslovakian referee, down on the field, sees who has arrived and immediately whistles the play to a stop. He meticulously forms the teams into two straight lines and then steps forward and salutes with a flourish worthy of a Royal Hussar of the old Austrian Empire. Play resumes and we realize that there are already breaches in the façade of East Bloc Communism.
Eventually, the caravan of cars heads back to the Royal Yacht, where we say good-bye.
Needless to say, I had become an admirer of the Queen, her dignity, sangfroid and charm and was soon after seen, picking wild flowers and composing long poems of homage.
William Tetley
Professor, McGill Law Faculty,
Minister of Financial Institutions in the Bourassa Cabinet of 1970 to 1976


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Winning Abstracts from the 2012 Medical Student Abstract Competition: Xylobezoar (Paper Bezoar) in the Sigmoid Colon Masquerading as Diverticulitis
Author: Sophia Nguyen, BA - University of Colorado School of Medicine, Class of 2012
Introduction: Bezoars are accumulations of indigestible material such as vegetable matter, hair or medications in the gastrointestinal tract. These concretions are most frequently found in the stomach and can cause serious medical problems such as bowel obstruction, impaction and perforation.
Case Presentation: A 41-year-old female with a history of bipolar disorder and iron deficiency anemia presented to the emergency department with 2 days of severe stabbing left lower quadrant (LLQ) abdominal pain radiating to the left groin. The pain was unchanged with food intake or position. She had not had a bowel movement (BM) in 3 days. Her medical history revealed occasional pica, a previous ectopic pregnancy and regular menstruation without menorrhagia. She smoked tobacco and was on parole for previous cocaine use. On physical exam, her vital signs were normal and she had LLQ abdominal tenderness but no peritoneal signs. An initial work-up revealed a WBC 14K/uL, hematocrit 31%, MCV 78fl, ferritin 69g/L and iron saturation 3%. Urinalysis, urine hCG and comprehensive metabolic panel were normal. A CT KUB showed a strictured segment of the sigmoid colon with mild pericolonic inflammatory fat stranding around the descending colon seemingly most consistent with colitis. Intravenous metronidazole and ampicillin-sulbactam were initiated for treatment of diverticulitis.
Due to continued constipation and concern for a stricture and mechanical obstruction, a flexible sigmoidoscopy was scheduled. Upon re-interviewing the patient, she admitted to recent consumption of paper in the amount of 2 novels. Subsequent sigmoidoscopy revealed a large bezoar composed of typing paper with visible printed words in the sigmoid colon causing complete obstruction. Neither snare nor roth net were able to remove the bezoar. This area was flushed with 1.5 L of tap water which allowed stool to pass and revealed underlying mucosal ulceration and large diverticula. With daily enemas and a liquid diet, the patient was able to pass the bezoar and resumed normal BMs.
Discussion: Given the inherent ability of bezoars to mimic various gastrointestinal maladies, clinicians should have a high index of suspicion when evaluating a patient with abdominal pain, a history of pica and underlying psychiatric illness. Most commonly, bezoars are diagnosed by endoscopy and are composed of hair. Only few cases of paper bezoars causing colonic ischemia have been reported and these have been diagnosed by laparotomy. Thus, this is a rare case of a colonic xylobezoar diagnosed and treated via flexible sigmoidoscopy. Furthermore, this patient likely had iron deficiency anemia caused by her mucosal ulceration and diverticula, thereby escalating her paper craving. Early recognition could help shorten hospitalization time, allow for diagnostic and therapeutic endoscopy as opposed to surgery and decrease complications associated with bezoars.
Back to May 2012 Issue of IMpact
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text:
I have a YUI datatable and I am putting the following data in the table:
{key:"name", label:"name", editor: nameChoiceEditor},
{key:"group", label:"group", editor: groupChoiceEditor},
{key:"colony", label:"colony", width: 210, editor: colonyChoiceEditor},
Here the
name column's width is set to the maximum length of characters entered for that name, and the same with
colony's column width is set to 210 irrespective of the length of the data.
My problem is when the
name column, having multiple words like "odaiah chitukuri", is showing in two lines like so:
But when it is one word like "odaiahchitukuri" it is showing in a single line, meaning the column is adjusting to fit the word.
I should have the different words in sigle line. How to do that?


text:
Susan Dewey, Ph.D., is an applied feminist anthropologist with over a decade of research and consulting experience on sex work, violence against women, and feminized labor. Since receiving her Ph.D. in 2004, Dr. Dewey has published widely in these areas, including seven books, several dozen articles and book chapters, substantial technical reports for UN Women and the U.S. Census Bureau, and has presented her research findings at almost 40 conferences and universities around the world. Her work has received critical acclaim in high impact journals such as Contemporary Sociology, Anthropological Quarterly, and American Ethnologist, and has featured in national media outlets such as The Chronicle of Higher Education.
Dr. Dewey's scholarly investigations into sex work commenced with her Fulbright Hays-funded dissertation research in India, where she explored young women's use of intimate labors as a social mobility strategy, and which resulted in her first book, Making Miss India Miss World: Constructing Gender, Power, and the Nation in Postliberalization India (Syracuse University Press, 2008). Her second book, Hollow Bodies: Institutional Responses to Sex Trafficking in Armenia, Bosnia, and India (Kumarian Press, 2008), was based upon her postdoctoral work in Armenia (and later Bosnia-Herzegovina), where she explored how anti-trafficking initiatives impacted individuals involved in a complex amalgamation of international organizations, non-governmental organizations, and activist groups. Her third book, Neon Wasteland: On Love, Motherhood, and Sex Work in a Rust Belt Town (University of California Press, 2011), explores how sex workers in upstate New York negotiate their lives as parents, family members, and employees while working in a profession widely regarded as incompatible with motherhood and fidelity.
Engaging in sex work research over the course of nearly a decade prompted the publication of her most recent book, co-authored with anthropologist Dr. Tiantian Zheng, Ethical Research with Sex Workers: Anthropological Approaches (Springer, 2013). Her current sex work-related research focuses upon harm reduction and help-seeking strategies amongst street-based sex workers in Denver, Colorado.


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Dremel Abrasives
Abrasive accessories include sanding discs, sanding sheets, grinding cups and hook & loop sheets. They grind, smooth, cut, polish and clean. These accessories are typically disposable pads, sheet belts or discs designed to be used with power tools like sanders, grinders or routers. Before purchasing abrasive accessories, check that they are compatible with your particular tool.
We also carry sanding backing pads and other sanding accessories.
5 Item(s)
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text:
Food Curated | Northern Spy Food Co.
By Liza de Guia | May. 5, 2014 | 4:05
The chef Hadley Schmitt shows how to make the Egg Begley Jr., a kale and egg sandwich initially created for the GoogaMooga Festival in Prospect Park, Brooklyn.
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Found 2 jobsbetween $40,000 and $49,999 matching your criteria
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Microsoft OneNote or EverNote for Taking Notes and Web Clippings
Microsoft OneNote vs EverNote - which is a better softare for storing web clips, taking handwritten notes, organizing life and getting things done the David Allen way.
Microsoft OneNote vs EverNote - which is a better softare for storing web clips, taking handwritten notes, organizing life and getting things done the David Allen way.
I recently ordered the Adobe CS3 Master Collection through a friend and he just told me that I will have to pay additional 9% customs duty for importing software in India.
The new version of Adobe Captivate 3 will be available for download in August 2007. Sorry, no mac version again but Adobe Captivate 3 is available for Windows XP/ 2000 / Vista and supports Powerpoint Office 2007 slide animations.
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text:
Welcome to APUG Charlotte
Printable View
Welcome to APUG Charlotte
I'm also in high school, Charlotte. Nice to see that our age range is represented here!
Welcome, Welcome!!! Hope you find the world of film as interesting as I do. There is a lot of help and information here, so don't be a stranger.
Thanks to all who have and will greet me. Well, Mars got a little boring so now I'm in a small town in Massachusetts (for now). And once again, I'm looking forward to what I will learn from this community. :)
Well, Mass is a tad closer than Mars. My offer still stands. If you would like an enlarger that handlae 35mmand 6x6(120) negatives. find a eway to afford shipping and it's yours.
Rick, that would be awesome. I will message you, thanks!
Charlotte - hello and welcome to APUG from Springfield, Mass!! :D
Welcome Home Charlotte !
Hello Charlotte and welcome to APUG.


text:
Crowne Plaza Kitchener-Waterloo
No prices found through our partners. Please contact the business directly or check some of our recommended alternatives.
How has this hotel rated in the past?
- Shuttle bus service
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- Swimming pool
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Travel Blogs from Kitchener
One More Sleep!
... evening on Sunday, but we don't actually leave Bangkok until Monday night, so I've got a buffer there. And then coming home, I don't really care what happens; it's just going home so it's not like I will miss anything! Fingers crossed I won't need to rely on any of these back-up plans, but I have learned that you can never be too prepared! I will try to keep this blog updated as often as I can. Happy ...
First Football game
... The Mustangs were great to watch. Their tackles were fantastic, their plays were precise and effective and their players didn't get carried off due to injury every 5 mins like our guys did.
The game went for 4 hours. It was raining.... yet the stadium was packed and there were even fireworks for every time our team ran across the purple line (that happened once).
The rules are taking time to learn. It seems like a violent ...
Let the Countdown Begin!
First of all, fundraising finally came to a close on Friday. Thank you SOOOOO much to everyone who supported me in preparation for this trip. With all of your donations, I not only reached my $2500 goal but far exceeded it!! The final count was up to around $2900 so you are all amazing. We are super excited to be able to buy awesome water safety equipment, arts and crafts for the kids, and sports equipment.
With only 15 days left until takeoff - yep, FIFTEEN, time flies - I am ...
KITCHENER - DAY 1 "Shade Tippin'"
... to the park where all kinds of different ethnic food tents had been put up. Every type of food you could imagine! Turkish,
Indian, Vietnamese, Turkish, Chinese, Turkish, Greek and Turkish. Even Turkish!
After getting a fake-vegetarian vietnamese meal (with tiny pieces of ham in the rice – It's a
trap!) I got my camera out a got awesome magic hour shots of the guys, which
Packing List for 4 Months Away
... toothpaste and toys, generously donated by the people at our dentist's office, Christmas gifts, and some extra shoes and clothes for us.
On top of this, we are taking two small light bags with a puppet theatre and a parachute. Whew!
-------Connie's Packing List-----
Main Pack: L.L. Bean Bigelow Medium Daypack 31 litres (3 lb 10 oz)
Daypack: L.L. Bean Stowaway Daypack (1 lb)


text: The location of this hotel is great as it is in the center of the city. The hotel is hip and chic. The rooms are comfortable but small (keep in mind you are paying top dollar to stay here). The staff (other than the porter and the bartender) were not helpful and somewhat dismissive toward us. This hotel caters mainly... More


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The Journal Sentinel's team of Packers beat writers provide the latest news, notes and analysis
Aaron Rodgers on 'Jimmy Kimmel Live'
Green Bay Packers' quarterback Aaron Rodgers was on "Jimmy Kimmel Live" on Thursday night. You can watch the entire episode here.
Absent that, here are some highlights of Rodgers' appearance, courtesy of Sports Business Daily:
Kimmel: "Our next guest is the reigning Super Bowl MVP, and if the NFL doesn't get its act together, he could be for a very long time."
Kimmel's first question to Rodgers was, "You think there's going to be an NFL season because I can't bet on Connect Four forever."
Rodgers: "I think so."
Kimmel: "What about the NBA? Are you hearing anything about that?"
Rodgers: "They're actually losing money, as opposed to what our owners are saying, we're making money. NBA might be losing money."
Kimmel: "So you're on the owner's side on the NBA deal?"
Rodgers: "No." Kimmel asked, "I didn't think you would be. Is it possible that the players are slowing down negotiations just so they don't have to go to minicamp?"
Rodgers: "Well, nobody likes training camp. I know the Packers, we're enjoying this. We've just been celebrating for the last six months."
Kimmel noted the Packers have not been invited to the White House since winning the Super Bowl and Rodgers said of President Obama, who is from Chicago, "I don't think he's a big fan (of the Packers)."
Kimmel replied, "Because he's a Bears fan?" Rodgers: "Wisconsin is a Democrat state. I don't know what the problem is."
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2/19/2013 (2 years ago)
Catholic Online (www.catholic.org)
Ignorance of Scriptures is ignorance of Christ, wrote St. Jerome in his Commentary on Isaiah. And if what the Jewish poet Hayim Nahman Bialik said is true for Judaism is also true for Scripture (which we have no reason to doubt)--that knowing Judaism in translation is like kissing one's mother through a veil--then we encounter at least some impediment, though it be as thin as a veil, in being ignorant of the Greek and Hebrew of the Scriptures.
Catholic Online (www.catholic.org)
2/19/2013 (2 years ago)
Published in Living Faith
Keywords: Latin, Hebrew, Greek, sacred languages, Andrew M. Greenwell
CORPUS CHRISTI, TX (Catholic Online) - In Book IX of St. Isidore of Seville's Etymologies--perhaps the world's first encyclopedia--St. Isidore (ca. 560-636 A.D.) states that three sacred languages (tres linguae sacrae) excel all others throughout the world: Hebrew, Greek, and Latin.
Tres sunt autem linguae sacrae: Hebraea, Graeca, Latina,
quae toto orbe maxime excellunt.
His enim tribus linguis super crucem Domini
a Pilato fuit causa eius scripta.
The justification for St. Isidore's claim was built upon Pilate's command--surely guided by divine Providence in St. Isidore's view--that the titulus crucis, the placard on the True Cross that identified Jesus' supposed crime, was to be written in Greek, Latin, and Hebrew: "Jesus of Nazareth, the King of the Jews." (John 19:19; cf. Luke 23:38; Matt. 27:37, 15:26)
In his poem "Apotheosis," the 4th century Christian poet Prudentius wrote about Pontius Pilate's stumbling into the truth that Jesus was, in fact, King of the Jews, and not only of the Jews, but of the entire Cosmos, the Pantokrator, as follows:
Pilatus iubet ignorans "I, scriba, tripictis
digere versiculis quae sit subfixa potestas,
fronte crucis titulus sit triplex, triplice lingua
agnoscat Iudaea legens et Graecia norit
et venerata Deum percenseat aurea Roma."
In ignorance, Pilate commands, "Go, scribe, and thrice
Inscribe the lines under which power hangs affixed,
Afront the cross, let the title be thrice, in three tongues
That by reading, Judaea may recognize, the Greeks know,
And golden and venerated Rome regard God."
To be sure, other religious traditions have their own sacred languages. For example, the Muslims have the classical Arabic of the Qur'an. The Hindus have their Sanskrit. The Copts have their Coptic, and the Eastern Orthodox Churches their Slavonic.
But for the Roman Catholic, and really for all Christians of the West, the three sacred languages have been, are still, and forever must be, Hebrew, Greek, and Latin.
St. Jerome, who translated the New Testament from Greek to Latin and the Old Testament from Hebrew into Latin and gave the Church the Vulgate, obviously had intimate knowledge of all three sacred tongues.
Yet St. Jerome's contemporary St. Augustine, while he had knowledge of Latin beyond criticism, admits in his Confessions that as a youth he disliked Greek, though retained some facility with it, and that his knowledge of Hebrew was such that he would not even recognize Genesis 1:1 if Moses himself read it to him in Hebrew. Conf. I.13-14, XI.3 Also, we mustn't forget that St. Thomas Aquinas had virtually no knowledge of either Greek or Hebrew, and yet he is the common doctor of the Church, and his knowledge of the faith and his sanctity are both unimpeachable.
Goethe said that he who does not know foreign languages knows nothing of his own. But this is not entirely true. The critic Ben Johnson famously said of William Shakespeare that he had "small Latin and less Greek." Hebrew goes unmentioned by Johnson, but we may be sure that Shakespeare's knowledge of Hebrew was less even than his Greek. Shakespeare, we might hardly point out, got along quite famously without such knowledge, and knew his English quite well pace Goethe's observations.
So it is not necessary for salvation, or even necessary for literary ability, to know Latin, Greek, or Hebrew. Nor is it necessary to travel to Rome or Jerusalem to be a saint. Nevertheless, there is much value in having at least some familiarity with these three languages, or at least some of their words, just as there has always been value to going on pilgrimage to holy sites. Exploring Hebrew, Greek, and Latin is analogous to going on an intellectual or conceptual pilgrimage.
Perhaps we can learn something about ourselves, or about Church, or about our Faith, or even about God by learning a little about Hebrew, Latin, and Greek.
The Old Testament, of course, is by and large written in Hebrew, although the 2nd century B.C. Greek translation of it known as the Septuagint--itself a Greek word worth exploring--is of venerable pedigree. The New Testament comes to us in Greek, though it is full of Semitisms that one unfamiliar with Hebrew or Aramaic would be deaf to. Obviously, knowledge of some Hebrew and Greek helps facilitate or develop intimacy with Scriptures.
Ignorance of Scriptures is ignorance of Christ, wrote St. Jerome in his Commentary on Isaiah. And if what the Jewish poet Hayim Nahman Bialik said is true for Judaism is also true for Scripture (which we have no reason to doubt)--that knowing Judaism in translation is like kissing one's mother through a veil--then we encounter at least some impediment, though it be as thin as a veil, in being ignorant of the Greek and Hebrew of the Scriptures.
Though Latin is not a "scriptural" language in the strictest sense, the Latin Vulgate--the translation of the Bible by St. Jerome from Hebrew and Greek--is given great pride of place in the Roman Catholic Church, being regarded (by the Council of Trent) as "authentic," and of "probative force in questions of faith and morals."
Moreover, Latin is the liturgical language of the Roman rite, the common language of the Church, the inspiration and substance of Gregorian chant, and--along with, though to a lesser extent, Greek--is absolutely central in understanding Roman Catholic doctrine and theology.
How do we know the importance of sentire cum ecclesia (to think with the Church) if we don't know what sentire cum ecclesia means?
In this series entitled Tres Linguae Sacrae, we will explore certain Hebrew, Greek, and Latin words or phrases that are scripturally, liturgically, or theologically important to Catholics.
We will explore virtually untranslatable but frequently-used Hebrew words with a wide variety of subtle meanings--such as the Hebrew word nephesh, commonly translated as "soul"--and words--such as the Hebrew word for "covenant" or "testament," berith--whose whose conceptual depth is such that understanding it is the compass or key needed to understand the Scriptures as Scott Hahn has put it.
There are, of course, Hebrew words that we still use in the Latin liturgy--Amen, Alleluia, Hosanna--or Greek words that remain as vestiges of a liturgy once prayed in Greek--Kyrie and eleison--which warrant exploration.
We will gaze at words that are virtually made up or cobbled together to describe things wholly new--such as the Greek kecharitomene in Luke 1:28--used of Mary and translated as "full of grace," or, controversially, "highly favored," or the mysterious epiousios--supersubstantial--which is found in the Lord's Prayer in Matthew 6:11 and Luke 11:3, and curiously translated rather mundanely: "Give us this day our daily (epiousion) bread."
We can expect to go over some Latin or Greek terms that are absolutely essential to understanding Catholic doctrine. One thinks of the term transubstantiatio--which we transliterate into English as transubstantiation--or the word trinitas, given to us by the African Church Father Tertullian (which was invented by him) and is central to our faith: Trinity.
What about the Greek word hypostasis equivalent to the Latin word persona, essential for understanding both ourselves as persons, and the Trinity as three persons in one God? Or what about those curious words which mean the same thing--circumincessio or perichoresis, in Latin and Greek respectively--which dare to speak about the mystery of mysteries: the relations of the persons within the Blessed Trinity. How can man even utter words about such things so far above his ken and his experience?
Some of these words have extensive and intensive histories and involve subtle concepts that can make the difference between the heretic and the orthodox. What a difference one letter makes--in this case the Greek letter iota or "i"--in a Creed! What odium theologicum (theological "hatred") it engendered!
Yet how utterly important this iota was--with greater weight than any jot and tittle of the Hebrew Scripture--since it spelled the difference between Jesus being God, or being less than God, a difference of infinite proportion. You go one way (without the iota) and you are Christian. You go the other way (embrace the iota) and you deny Christ. The Holy Spirit shunned the iota, though the Spirit worked hard to find the Church's champion and the Paraclete's mouthpiece: St. Athanasius.
Only the most crass and religiously obtuse--like the historian Edward Gibbon--would deride "the furious contests which the difference of a single diphthong excited," as if it mattered not whether Jesus was in fact God or merely God's superlative creature.
The Nicene Creed we take for granted today and wherein we aver each Sunday that Jesus is "consubstantial with the Father," the same substance as the Father, translates the Greek homoousios to Patri. Against St. Athanasius--the champion of the Nicene Creed--the heresiarch Arius insisted that the truth was not that Jesus was homoousios to Patri (of one substance with the Father), but homoiousios to Patri (of a similar, i.e., created, lesser substance as the Father).
But this is to get a little ahead of the story. Before we begin this series, we might invoke as patrons St. Jerome (the patron saint for translators) and St. Gotteschalk (the patron saint of linguists).
With our patrons in hand, let us go on a pilgrimage of words!
Andrew M. Greenwell is an attorney licensed to practice law in Texas, practicing in Corpus Christi, Texas. He is married with three children. He maintains a blog entirely devoted to the natural law called Lex Christianorum. You can contact Andrew at email@example.com.
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Fried Green Tomatoes
Total Time
Prep 10 mins
Cook 15 mins
A truly southern dish.
Make and share this Fried Green Tomatoes recipe from Food.com.
Ingredients Nutrition
- 4 large green tomatoes
- 1⁄2 cup all-purpose flour or 1⁄2 cup cornmeal
- 1⁄4 teaspoon pepper
- 1 teaspoon salt
- bacon drippings or salad oil
- Cut tomatoes into 1/4" slices.
- Combine flour, salt and pepper; dredge tomato slices with this mixture.
- Place in heavy skillet containing hot bacon drippings.
- Fry slowly until brown, turning once.


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We last visited in 2005 and despite the hotel having expanded somewhat, it didn't diminish the wonderful customer care and tranquility at this island paradise. An ideal infinity pool is only one of the additions that we found as improvements.
Luxor is in desperate need of tourists at the moment and we expeienced little hassle in the town and felt safe at all times. I hope for the peoples' sake that Egypt's politicians can reach a peaceful compromise.
- Official Description (provided by the hotel):
- Nestled upon the private "Kings Island" in the Nile that covers 660,000 sqm, the resort truly is an oasis of peace and tranquility. The idyllic, landscaped hotel grounds are expansive and home to the two main buildings, bungalows and three enticing swimming pool areas. The historic sights of Luxor, located only 4 kilometres from the hotel, can be easily reached by complimentary shuttle buses. The island is connected to the mainland only by a bridge and is virtually free of charge. This makes the resort an ideal location for families with children. The resort has been renovated in 2010 and extended by 320 rooms and suites in 10 elegant bungalows, new restaurants, a pool of 2,800 sqm in size and a SPA with fitness centre (from early-sommer 2011). ... more less
- Reservation Options:
- TripAdvisor is proud to partner with Expedia, Booking.com, TripOnline SA, Travelocity, HotelTravel.com, Odigeo, Hotels.com, Agoda, Priceline and Low Cost Holidays so you can book your Maritim Jolie Ville Kings Island Luxor reservations with confidence. We help millions of travelers each month to find the perfect hotel for both vacation and business trips, always with the best discounts and special offers.
- Also Known As:
- Maritim Jolie Ville Kings Island Luxor Hotel Luxor
- Jolie Ville Luxor
- Movenpick Luxor


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EORI - Economic Operator Register and Information.doc
EORI-Economic Operator Register and Information. DGAIEC – Direcção Geral das Alfândegas e dos Impostos Especiais Sobre o Consumo Type of form Registation ...
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C220A - Sea Kargo Ltd.doc
Application for Economic Operator Registration and Identification (EORI) Who should use this form? UK applicants who are not registered for VAT in the UK, or ... Down
C220A - Sea Kargo Ltd
Application for Economic Operator Registration and Identification (EORI) Who should use this form? UK applicants who are not registered for VAT in the UK, orwww.seakargo.com/images/companies/1/c220a_seakargo_ltd.doc
1 - Митници :: Начало
EORI number whenever this number is available to the person lodging the summary declaration. Mandatory: If the customs office of departure is not in the EU but the ...www.customs.bg/document/3509
As Members are aware, the EU Advance Cargo Declaration ...
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C220 - Application for Economic Operator Registration …
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Country Garden Inn and Spa
No prices found through our partners. Please contact the business directly or check some of our recommended alternatives.
How has this inn rated in the past?
- Suites
- Continental Breakfast
- Free High-Speed Internet
- Swimming pool
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Half day classes!
... subway back to Boston. I decide do take a trolley tour of The Freedom Trail as it takes in the most significant historical sites of the Revolutionary War. It was actually pretty good, I saw all of the key sites and learnt a lot about Paul Revere's ride and the key battles in and around the city and Charlestown. After wards I walked back to some I particularly liked and spent some time around the Boston Common, Beacon Hill area. Caught the subway back to Cambridge about ...
... amp; German spoken on the tourist trail - especially when you're trying to listen to a commentary or announcement. It's apparently mandatory to speak very loudly in these languages and if two or more people can speak at once, all the better. The Freedom Trail is a walking tour that takes you to all the historic sites you have just seen from the trolley bus tour. You can either be escorted by a costumed guide or purchase a $3 map and do it at your own pace. We chose ...
Boston and Harvard
... fitness running park as was filled with joggers - one made me jump out of my skin when he ran up behind me! Here you had a good view off Cambridge across Charles River. Back into Boston passing some very picturesque shopping streets to the Public Garden and Boston Common. Both were very pretty and a lovely spot to enjoy the sunshine. We then joined the Seaport loop, the pier was very pretty and looked across the harbour to boston airport where you could watch ...
Lovely Boston
... for the Americans. The monument is very impressive and commands an excellent elevated position with views over the City. Tramping back we realised that we hadn't stopped for lunch so at 3.30 we popped into a nice Italian restaurant on a back street called Salem St. We were seated next to a couple of sisters who hailed from Boston and had a very nice chat with them as we ate. I had an excellent pizza whilst Chris had a fusili pasta ...
BOSTON:- A great Historic and interesting City.
... early start enabled us to catch the high speed ferry and some 1 hour 30 mins later we arrived at the beautiful and historic resort. The crossing was billed as "calm" but as I have the sea legs that are capable of being knocked of balance by looking at a pond in a strong wind, green gills appeared without warning and I went "on deck" for some air pleased to note land was in sight...... Cape Cod architecture is unique and is typified by small wooden buildings ...


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Hi ladies!
I have started to feel very nautious! It started yesterday. Previous to this I had not been nautious at all...is this normal? and if so is there anything you guys have experienced that has made it a little better? like tums,pepto,crackers anything? lol. I have my first ultrasound tomorrow so I guess I could ask them about it too, but I thought you ladies may even know better than the dr's since you're going through it too....thanks in advance.


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Nell Powers Wright, 87, died Dec. 26. She was a Campbell County school
for 29 years where she taught all elementary school grades at College Hill from 1954 until 1963 and West LaFollette from 1963 until 1981.ÊDuring this time she taught over 1,000 students whom she loved dearly, keeping and cherishing every gift they ever gave her for Christmas or any other occasion.
Nell was born in Jacksboro on March 20, 1925 to Larry Carson Powers and Mary Agnes Clotfelter Powers, also a Campbell County teacher.ÊShe was very close to her dad, Larry, a civil engineer who taught her how to use all kinds of tools of his trade.ÊShe followed him around to his construction sites any time she had an opportunity to help.ÊLarry worked all over the country on all types of civil engineering projects such as the Smyrna airport and the Newfound Gap road from Gatlinburg to Cherokee, N.C.ÊNell's paternal grandfather, William Barton Powers, was a medical doctor in Jacksboro and one of the founders of the Eagle Bluff Hotel in Jacksboro, which was a famous mineral springs destination during the early 1900s.ÊHer paternal grandmother, Florence Woodson's father was one of the first settlers and earliest landowners of the Powell Valley.
Nell loved her roller skates and bicycle and often rode her bicycle to classes at Central High School in Jacksboro. During high school she rode her bicycle from Jacksboro to LaFollette to visit a certain young man, Dudley Victor Wright, who worked at Riggs Drug store on the corner. After graduating high school, she travelled to New York City by train with her clothes in a trunk. She lived in the Martha Washington Hotel for women and worked as a model with the John Robert Powers agency.ÊShe later returned to Tennessee to attend East Tennessee State University.
When Dudley returned from World War II, Nell and Dudley were married in 1945.ÊDudley became a well-respected community leader in LaFollette.ÊHe was a manager with Home Beneficial Life Insurance Company, deacon at First Baptist Church, and president of the Campbell County Shrine Club.
Nell worked as a bookkeeper for the LaFollette Utilities before receiving her first teaching position in 1954.ÊIn 1958 she received a B.S. degree from Lincoln Memorial University.ÊShe was a charter member of the Knoxville Chapter of Daughters of the Nile, an international fraternal organization that serves as a social and charitable organization and works to raise money for the Shiners Hospital for children.ÊBoth Dudley and Nell enjoyed the Shrine organizations and loved to dance at the Shiners Balls in Knoxville. Wright was also a member of the East Tennessee Education Association, National Education Association, and the First Baptist Church of LaFollette.
After her retirement from teaching in 1981 she spent much of her time with her grandchildren Jason and Suzanne, in the summers taking them to Cumberland Falls State Park, Berea, Ky., Silver Dollar City in Pigeon Forge, and to all the miniature golf games available. Her grandchildren took the place of her school children in her retirement.
She lived in Jacksboro and LaFollette for 78 years before moving to Knoxville in 2002 to be near her daughter.ÊFor the past three and a half years, she was a resident of the Brakebill Nursing Home in Knoxville.
Nell was preceded in death by her husband, parents, and her sister June Powers Bivens.
She is survived by her daughter Sharon Wright Cottrell and husband Brad; two grandchildren, Jason Cottrell and wife, Angela, and Suzanne Cottrell Christensen and husband, Jeff; four great-grandchildren Katie, Kenzie, Jake, and Olivia Cottrell all of Knoxville; two nephews, David and Eric Bivens of Mechanicsville, Va. and brother William Barton Powers of Limestone.
The family will receive friends from noon until 2 p.m. on Jan. 6 at Cross-Smith Funeral Home in LaFollette with funeral services following at 2 p.m. in the Cross-Smith Funeral Home chapel with Dr. Duane Mills officiating.
Interment will be at Jacksboro Cemetery following the service.
Cross-Smith Funeral Home was in charge of arrangements.
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Cross Smith Funeral Home
300 East Central Avenue
La Follette
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Published in LaFollette Press on Jan. 3, 2012
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Book your room at Sleep Inn Denver Tech Center
Get an overview of this hotelHotel in Greenwood Village with free breakfast and indoor pool
Situated in the business district, this hotel is 1.5 mi (2.5 km) from Fiddler's Green Amphitheater and 2.8 mi (4.5 km) from Park Meadows Mall. Sky Ridge Medical Center and Kennedy Soccer Complex are also within 9 mi (15 km).
Hotel Features
Along with an indoor pool, this smoke-free hotel has a fitness center and coffee/tea in the lobby. Free buffet breakfast, free WiFi in public areas, and free self parking are also provided. Other amenities include a business center, dry cleaning, and a 24-hour front desk.
Room Amenities
All 115 rooms provide conveniences like refrigerators and microwaves, plus free WiFi and LED TVs with cable channels. Guests will also find coffee makers, free weekday newspapers, and free local calls.Information missing or incorrect? Tell us!
Hotel Amenities
Hotel Amenities
Sleep Inn Denver Tech Center features an indoor pool and a fitness center. A computer station is located on site and high-speed wireless Internet access is complimentary. A business center is on site. Guests can enjoy a complimentary breakfast. This Greenwood Village hotel also offers coffee/tea in the lobby, complimentary newspapers in the lobby, and dry cleaning/laundry services. Onsite self parking is complimentary.
Sleep Inn Denver Tech Center is a smoke-free property.
- 24-hour front desk
- Business center
- Coffee/tea in lobby
- Free newspapers in lobby
- Computer station
- Dry cleaning/laundry service
- Elevator/lift
- Fitness facilities
- Free breakfast
- Free self parking
- Free WiFi
- Indoor pool
- Number of floors - 3
- Safe-deposit box at front desk
- Smoke-free property
- Television in lobby
- Total number of rooms - 115
Family Friendly Amenities
- Free Wi-Fi
- Indoor pool
- Microwave
- Refrigerator
Available in all rooms: Free WiFi
Available in some public areas: Free WiFi
Free self parking
Room Amenities
- Air conditioning
- Cable TV service
- Climate control
- Coffee/tea maker
- Free toiletries
- Free weekday newspaper
- Daily housekeeping
- Desk
- Free local calls
- Free WiFi
- Hair dryer
- In-room safe (laptop compatible)
- Iron/ironing board
- Microwave
- Phone
- Premium TV channels
- Private bathroom
- Refrigerator
Where to Eat
Guests are offered a complimentary buffet breakfast.
Nearby Things to Do
Recreational amenities at the hotel include an indoor pool and a fitness center.
The recreational activities listed below are available either on site or nearby; fees may apply.
- Golfing nearby
- Hiking/biking trails nearby
To make requests for specific accessibility needs, complete the "Special or Accessibility Requests" section of "Trip Preferences" when you book your hotel.
- Accessible bathroom
- Accessible path of travel
- Braille or raised signage
- Accessible parking
- In-room accessibility
- Roll-in shower
Hotel Policies
Minimum check-in age is 18
Check-in time ends at 3 AM
Check-in time starts at 3 PM
Check-out time is noon
Payment types
Children and extra beds
- Children are welcome.
Pets allowed, Pets not allowed
You need to know
Extra-person charges may apply and vary depending on hotel policy.
Government-issued photo identification and a credit card or cash deposit are required at check-in for incidental charges.
Special requests are subject to availability upon check-in and may incur additional charges. Special requests cannot be guaranteed.
- The name on the credit card used at check-in to pay for incidentals must be the primary name on the guestroom reservation.
No rollaway/extra beds available
No cribs (infant beds) available
Optional extras
- Pet fee: USD 15 per pet, per night