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McCune-Albright Syndrome
- Author: Gabriel I Uwaifo, MD; Chief Editor: George T Griffing, MD more...
Practice Essentials
McCune-Albright syndrome (MAS) consists of at least 2 of the following 3 features: (1) polyostotic fibrous dysplasia (PFD), (2) café-au-lait skin pigmentation (see the image below), and (3) autonomous endocrine hyperfunction (eg, gonadotropin-independent precocious puberty). Other endocrine syndromes may be present, including hyperthyroidism, acromegaly, and Cushing syndrome.
Signs and symptoms
The clinical presentation of MAS is highly variable, depending on which of the various potential components of the syndrome predominate. Major manifestations include the following:
Precocious puberty (typically gonadotropin-independent) - This includes breast development, genital maturation (with or without pubic hair growth), increased height velocity, and macroorchidism
Café-au-lait pigmentation - This consists of spots ranging from light brown to dark brown in color, often displaying a segmental distribution, and frequently predominating on one side of the body without crossing the midline; these spots must be differentiated from those characteristic of neurofibromatosis (NF)
PFD - Multiple pathologic fractures may be prominent early in the history; in many cases, bony involvement is found to predominate clinically on 1 side; potential presenting features include gait anomalies, visible bony deformities (including abnormal bone growths of the skull), bone pain, and joint stiffness with pain
Hyperthyroidism (rare without several other features of MAS also being present) - Findings may include tachycardia, arrhythmias (mostly supraventricular), hypertension, hyperthermia, tremor, sleeplessness, weight loss, or (in infants) failure to thrive
Other possible manifestations include the following:
Cushing syndrome
Growth hormone (GH) excess (gigantism and acromegaly)
Ovarian cysts
Pituitary tumors
Thyroid tumors
Hypophosphatemia (hypophosphatemic rickets)
Hypogonadotropic hypogonadism, particularly in the setting of hyperprolactinemia
See Clinical Presentation for more detail.
Full endocrine studies should be performed. Testicular or ovarian hyperfunction is the most common abnormality. Laboratory studies that may be helpful include the following:
Gonadotropin (luteinizing hormone [LH], follicle-stimulating hormone [FSH]) and sex hormone levels
Blood and urinary chemistries
Thyroid testing (thyroid-stimulating hormone [TSH], thyroxine [T 4], antithyroid antibodies)
Adrenocorticotropic hormone (ACTH) levels
Serum prolactin (PRL)
Dexamethasone suppression testing (standard or low-dose/high-dose)
Urine collection assayed for free cortisol (urinary free cortisol [UFC])
Growth hormone (GH) and insulinlike growth factor 1 (IGF-1) levels
Polymerase chain reaction (PCR) assay
Diagnostic imaging modalities that may be considered include the following:
Plain radiography (mainly skull and mandibles [craniofacial survey], pelvis, femurs; as clinically indicated)
Ultrasonography (neck and thyroid; ovarian and pelvic; as clinically indicated)
Computed tomography (CT); as clinically pertinent
Magnetic resonance imaging (MRI); as clinically pertinent
Radionuclide bone scanning
Other studies that may be considered include the following:
Arterial blood gas determination (for suspected acidosis)
Electrocardiography (ECG; (for suspected arrhythmia)
Gastrointestinal (GI) endoscopy can be performed to evaluate (for suspected polyposis)
Biopsy (bone, muscle, soft tissue, thyroid); as clinically pertinent
See Workup for more detail.
There is no specific treatment for MAS per se. Pharmacologic agents that have been used to treat precocious puberty in MAS include the following:
Aromatase inhibitors
Gonadotropin-releasing hormone (GnRH) analogues (as adjuncts to aromatase inhibitors)
Ketoconazole [1]
Estrogen receptor agonists (eg, tamoxifen)
Cyproterone acetate
Medroxyprogesterone acetate
Currently, no clinically proven medical therapies are available for PFD associated with MAS. Oral and intravenous (IV) bisphosphonates (eg, pamidronate, alendronate, zoledronate) may be beneficial to prevent disease progression, although data are conflicting. Important: bisphosphonates are very effective at relieving pain in the majority of cases.
Pharmacologic agents that have been used to treat hyperthyroidism in MAS include the following:
Thionamides (eg, propylthiouracil)
Radioiodine (for tissue ablation)
No long-term effective medical treatment for ACTH-independent Cushing syndrome is available.
Pharmacologic agents that have been used to treat GH excess in MAS include the following:
Dopamine agonists (eg, bromocriptine and cabergoline), typically in conjunction with octreotide
GH receptor antagonists (eg, pegvisomant), probably best not used as monotherapy in this setting
Pharmacologic treatment of other manifestations of MAS is as follows:
Hypogonadism - Appropriate hormone replacement therapy
Hypophosphatemia with hyperphosphaturia - Aggressive oral phosphorus replacement
Hypophosphatemic rickets - Appropriate calcitriol therapy with calcium and phosphate repletion
Surgical interventions that may be considered include the following:
Precocious puberty – Oophorectomy or ovarian cystectomy, when medical therapy fails
PFD – Traction or fixation for fractures; for most PFD lesions, routine removal is not warranted
Hyperthyroidism – Thyroidectomy (partial near-total, or total)
Infantile Cushing syndrome – Bilateral adrenalectomy
Gigantism or acromegaly – Surgical removal of the offending lesion (pituitary adenoma) is rarely curative and is considered only if the tumor is threatening vision (in consultation with an experienced base-of-skull neurosurgeon)
See Treatment and Medication for more detail.
McCune-Albright syndrome (MAS) in its classic form consists of at least 2 of the following triad of features[2, 3, 4] :
Polyostotic fibrous dysplasia (PFD)
Café-au-lait skin pigmentation
Autonomous endocrine hyperfunction – The most common form of autonomous endocrine hyperfunction in this syndrome is precocious puberty, which is typically gonadotropin-independent [5, 6]
Other endocrine syndromes described in association with MAS include the following[7, 8] :
Acromegaly or gigantism (due to GH-producing pituitary adenoma)
Some severely affected patients may present with associated hepatic, cardiac, and gastrointestinal (GI) dysfunction (ie, elevated hepatic transaminases, GI polyposis, and cardiomyopathy).[9]
MAS has been shown to be due to a postzygotic activating mutation of the GNAS gene, coding for the G protein subunit Gs alpha in the affected tissues (see Pathophysiology and Etiology). For semantic reasons, it is important to differentiate MAS from Albright hereditary osteodystrophy (AHO). AHO, which also is caused by a GNAS1 gene defect,[10] results in pseudohypoparathyroidism or pseudopseudohypoparathyroidism.[11]
The clinical presentation of MAS is highly variable, depending on which of the various potential components of the syndrome predominate (see Presentation). Diagnosis of MAS depends on finding at least 2 of the phenotypic features associated with activating GNAS1 mutations.
Early recognition is vital. In typical cases, the diagnosis of MAS is not in doubt. However, in atypical cases, the combination of cutaneous pigmentation, bony lesions, and soft-tissue masses may suggest other conditions (eg, systemic mastocytosis and neurofibromatosis [NF]) (see DDx).
Full endocrine studies should be performed under the care of an endocrinologist. Testicular or ovarian hyperfunction is the most common abnormality. Diagnostic imaging modalities that may be considered include plain radiography, ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and radionuclide bone scanning (as clinically indicated) (see Workup).
Because MAS is a multisystemic condition with a host of variable presentations, management often is challenging and requires a multidisciplinary approach. For most physicians who are not endocrinologists, the crucial points in management are recognition of MAS and referral of the patient to an endocrinologist who is experienced in its management. The endocrinologist, in turn, offers other referrals as indicated (eg, neurosurgeon) (see Treatment).
Most of the clinical features of MAS are caused by a noninherited postzygotic activating mutation of the GNAS1 gene that results in overproduction of a variety of protein products in a fashion independent from normal feedback control mechanisms (see Etiology).[3]
Precocious puberty, the most common endocrine feature of MAS, is a result of gonadotropin-independent autonomous ovarian or testicular function. Precocious puberty caused by this condition is far more common in girls than in boys. In girls, it is the result of estrogen excess from ovarian follicular cysts.[12] Because the sexual precocity associated with MAS is gonadotropin-independent, it is more accurately described as pseudoprecocious puberty.
The café-au-lait spots in MAS are large melanotic macules, sometimes referred to as café-au-lait macules (CALMs). Except for hyperpigmentation of the basal layer, no abnormal pathology is seen.
Fewer than 10 cases of MAS associated with Cushing syndrome have been well documented. This syndrome is distinct, unlike all other endocrinopathies of MAS, which are slowly progressive and persistent without treatment. Several cases of Cushing syndrome in the context of MAS have regressed within the first few years following onset.
Cushing syndrome associated with MAS is predominantly due to adrenocortical hyperfunction. Most of these cases have been described in infants or children. The adrenal glands are bilaterally enlarged and contain multiple small nodules in the cortex. In some cases, Cushing syndrome is transitory. Pituitary-based (ACTH-dependent) Cushing disease in the setting of MAS is far less common.
Hyperthyroidism typically occurs later in childhood, though it can occur within the first year of life. Like Cushing syndrome and precocious puberty, hyperthyroidism associated with MAS is a result of 1 or more autonomous hyperfunctioning thyroid nodules.
Growth hormone (GH) excess from somatotroph adenomas in the pituitary can occur at any age, resulting in gigantism or acromegaly. The GH excess among patients with MAS has been noted to be as high as 21%. The basis of GH hypersecretion in MAS remains incompletely understood, but it appears to have a different basis from that of acromegaly or gigantism in non-MAS patients.[13]
Fibrous dysplasia (FD) in MAS can involve any bone but most commonly affects the long bones, ribs, and skull. It may range from small asymptomatic areas detectable only by bone scan to markedly disfiguring lesions that can result in frequent pathologic fractures and impingement on vital nerves.
Approximately 30 cases of FD associated with single or multiple intramuscular or juxtamuscular myxomas (Mazabraud syndrome) have been documented.[14, 15] This syndrome has been associated with precocious puberty and café-au-lait spots and occurs in association with MAS. The myxomas associated with this condition can occur in virtually any location in the muscular system. The exact etiopathogenesis of the syndrome is unclear, because no activating mutations of the GNAS1 gene have been demonstrated in this clinical variant.
Simple myxomas typically are benign and solitary, with peak incidence in the sixth and seventh decades. The age of peak incidence for this syndrome is young adulthood, and the tumors commonly are multiple. The main sites of involvement are the large muscles of the thighs, buttocks, and shoulders. They often are located close to FD lesions but typically remain separate from them. They commonly recur, even after attempts at surgical resection.
Hypophosphatemic rickets is a potential complication that may worsen the bone disease associated with PFD. It is due to a tubulopathy and characterized by hyperphosphaturia. In patients with MAS, hyperphosphaturia may be due to a phosphatonin similar to that seen in patients with tumor-induced osteomalacia, which appears to be fibroblast growth factor 23 (FGF-23). While MAS patients with hypophosphatemic rickets are typically managed with calcitriol and phosphorus supplements, they must be monitored closely for hypercalcemia, excessive hypercalciuria, nephrocalcinosis, and progressive loss of renal function, as well as the development of secondary hyperparathyroidism.
Hepatic abnormalities range from mild elevation of hepatic transaminases to severe neonatal jaundice and chronic cholestasis. Although some liver biopsies appear normal, others reveal mild biliary abnormalities or fatty liver. One case report described fatty liver in an infant with Cushing syndrome, suggesting that the fatty liver may have been secondary to glucocorticoid excess. Elevated transaminases in this infant, however, persisted long after the glucocorticoid excess had been corrected with adrenalectomy.
Many case reports describe sudden deaths, mostly occurring in patients with multiple endocrine and nonendocrine manifestations of the syndrome. Persistent tachycardia has been observed in addition to mild-to-moderate cardiomegaly, even in the absence of hyperthyroidism. Although the cause of death in these patients is unclear, it is presumed to be secondary to cardiac arrhythmia.
Only a few cases of malignant transformation of skeletal lesions have been described in the setting of MAS, most frequently in the setting of therapeutic irradiation. This occurs in probably less than 1% of MAS cases. The tendency for malignant transformation to occur may be greater in patients who have concomitant GH excess or those with Mazabraud syndrome. Observed malignancies include the following:
Osteosarcomas (most common)
Females appear to be at greater risk for breast cancer, probably as a consequence of prolonged exposure to elevated estrogen and/or GH levels. The underlying GNAS1 mutation also may play a role. For the same reasons, these patients also appear to be at increased risk for thyroid malignancies and testicular cancer (a novel finding by the National Institutes of Health [NIH]).
MAS is caused by a sporadic, early postzygotic somatic mutation in the GNAS1 gene at locus 20q13.1-13.2, coding for the G protein subunit Gs alpha.[16] This genetic finding has been noted and confirmed in various tissue specimens from patients with MAS.[17] Researchers have isolated activating mutations of GNAS1 in pituitary adenomas, thyroid adenomas, ovarian cysts, monostotic bone dysplasia, and the adrenal glands.[18] GNAS1 gene abnormality in pseudohypoparathyroidism I-a has also been noted.[19]
G proteins couple cell surface receptors to intracellular proteins to activate or inactivate signaling cascades. The stimulatory G protein is normally activated when a hormone or other ligand binds to the cell surface receptor (see the image below). The activated Gs alpha disassociates from the receptor, binds to adenylyl cyclase, and stimulates an increase in intracellular cyclic adenosine monophosphate (cAMP) levels. Gs alpha then is inactivated, reassociates with the receptor, and is again available for hormone-mediated reactivation.
The mutations that cause MAS occur at a site in the protein that mediates inactivation of Gs alpha (see the image below). Once activated, the mutated Gs alpha subunit remains activated for a prolonged period despite the absence of hormone (GPCR ligand) stimulation. This results in constitutive activation of Gs alpha, constant stimulation of adenylyl cyclase, and persistently high levels of intracellular cAMP. Increased cAMP levels can mediate mitogenesis and increased cell function. The specific phenotype depends on the cell type containing the mutation.
The classic triad of features in MAS—PFD, autonomous endocrine hyperfunction, and café-au-lait skin pigmentation—can all be explained by activation of the Gs alpha subunit and increased intracellular cAMP levels.
Eumelanogenesis (formation of brown/black pigment) is normally stimulated by melanocyte-stimulating hormone (MSH) binding to the MSH receptor, a classic G protein receptor coupled to Gs alpha. Constitutive activation of the Gs alpha subunit in melanocytes results in the increase in brown pigmentation characteristic of the café-au-lait spots seen in the syndrome. Likewise, both the luteinizing hormone (LH) and the follicle-stimulating hormone (FSH) receptors are Gs alpha−coupled receptors.
Constitutive activation of the postreceptor cAMP signaling cascade in ovarian follicular cells results in cyst formation, estrogen production, and gonadotropin-independent precocious puberty. Similar mechanisms of increased intracellular cAMP likely explain essentially all of the other endocrine and nonendocrine features of MAS.
Because MAS results from a postzygotic somatic mutation, all the daughter cells of the embryonic cell in which the initial mutation occurred also contain the mutation. The earlier the mutation occurs in embryogenesis, the more widespread the tissue involvement.
Mutations late in embryogenesis are more focused and account for those mild cases in which only 2 or 3 of the classic phenotypic features of the syndrome are present. If the mutation occurs very late in tissue development after differentiation into a specific cell line, then a single adenoma may result. Gs alpha−activating mutations have been reported in isolated hyperfunctioning thyroid nodules and in somatotroph adenomas.
Although GNAS1 mutations could occur in germ cells (either oocytes or spermatocytes), the resulting zygote and all daughter cells then would contain the mutation. Activating GNAS1 mutations are likely lethal if they occur very early in embryogenesis. This accounts for the lack of autosomal dominant transmission of this syndrome.
United States and international statistics
The exact incidence of MAS in the United States and internationally is unknown, but its prevalence is probably between 1 case in 100,000 population and 1 case in 1 million population, rendering it a very rare, sporadically occurring disorder.[3] In a review of radiographs from 82,000 patients, only 23 cases of PFD were found. Polyostotic variants of FD are uncommon, and MAS is even less common. The relative incidence of monostotic FD (MFD) is 70%, whereas that of PFD is 30% and that of MAS is less than 3%.
Age-, sex-, and race-related demographics
Severe cases of MAS involving multiple endocrine tissues may be recognized shortly after birth. Cases of infantile Cushing syndrome and hyperthyroidism have also been reported in the neonatal period. Additionally, FD, café-au-lait pigmentation, liver disease, and hypophosphatemia can initially be seen in infancy.
Less severe findings of MAS can occur at almost any time during childhood. Most commonly, the onset of MAS occurs in early childhood (mean age, 4.9 years; range, 0.3-9 years), typically earlier in girls than in boys. Precocious puberty in girls can be seen in infants as young as 4 months, though it more frequently occurs in girls older than 1 year. Café-au-lait pigmentation is more likely to become apparent later in the progression of the syndrome.
GH-producing pituitary tumors and functional-thyroid adenomas secondary to activating GNAS1 mutations can occur in individuals at any age. Disease with a later onset (ie, in the early to late teenage years) tends to be associated with clinically attenuated phenotypes.
Both sexes are affected by MAS, but the syndrome has been reported to be about twice as common in females as in males. That girls develop precocious puberty far more frequently than boys (9:1 female-to-male ratio) probably explains why this autosomal mutation is recognized more frequently in girls than in boys. Other manifestations of MAS probably occur with approximately equal frequency in females and males.
MAS has no ethnic predilection.
Apart from the small subgroup of patients with increased perioperative mortality and those patients who develop malignancies, MAS is not associated with a significantly increased mortality. In general, patients achieve a normal life span. Mortality and morbidity related to MAS result from the fractures, malignancies, endocrine disorders, and other conditions associated with this syndrome. The symptom and disability burden of MAS can be quite high, owing to the associated chronic pain and deformities, as well as the sequelae of chronic multihormonal endocrinopathies. Thus, the prognosis varies according to the manifestations of MAS.
With precocious puberty, the prognosis depends on the duration of premature estrogen exposure. Early puberty is not a life-threatening condition and does not seem to lead to problems after true, centrally mediated puberty begins at an appropriate age. Early breast development and vaginal bleeding can be accompanied by loss of adult height potential. Reduction of height potential depends on the degree of bone age advancement that occurs during the periods of early estrogen exposure.
A study of 16 girls and 10 boys with MAS found (1) that MAS occurs slightly more frequently in girls than in boys, (2) that peripheral precocious puberty (PPP) in MAS occurs significantly more frequently and at a younger age in girls than in boys, (3) that PPP in boys with MAS correlates with bilateral testicular enlargement, (4) that unilateral macroorchidism can occur, and (5) that testicular microlithiasis might function as another marker for MAS in males.[20]
FD may have severe effects, including pathologic fractures, facial disfigurement, and vision and hearing problems. It is difficult to treat effectively. Current therapies focus on treating complications of FD, rather than on preventing it from developing. Current studies using bisphosphonates are promising, though it is unclear whether bisphosphonates significantly reduce the morbidity associated with these lesions.
Hyperthyroidism can cause severe failure to thrive in infants and young children, decreased attention span, and osteoporosis. Tachycardia resulting from severe hyperthyroidism may complicate or trigger a cardiac event. Radioiodine (131 I) ablation or thyroidectomy treats hyperthyroidism effectively. The long-term prognosis is excellent with adequate thyroid hormone replacement.
Infantile Cushing syndrome can cause severe growth failure, poor muscle tone, and hypertension. Permanent effect on growth potential is also possible. Comorbid heart and liver disease are poor prognostic markers and may indicate the need for prompt adrenalectomy.[21]
The long-term prognosis for infantile Cushing syndrome depends on adequate replacement of both mineralocorticoids and glucocorticoids. Individuals remain at risk for significant morbidity or mortality due to adrenal insufficiency during times of severe stress and should receive stress doses of hydrocortisone on an emergency basis.
Hypophosphatemia causes rickets and short stature; the pathophysiology of hypophosphatemic rickets, as well as the need for long-term therapy with calcitriol and phosphorus supplementation in these cases, increases the risk of nephrocalcinosis and loss of renal function over time.
Gigantism or acromegaly can occur, carrying a risk of glucose intolerance, hypertriglyceridemia, hypertension, and mild myopathy. GH secretion in MAS is difficult to treat effectively. Octreotide acetate or pegvisomant has proved effective in many cases, but not all. Furthermore, radiation treatment of the adenoma increases the risk of malignant change in areas of FD in the radiation field. The long-term prognosis in refractory cases of acromegaly is poor.
Although 2 long-term follow-up studies have shown no increased risk of premature death, several authors have noted unexplained sudden death in patients with a severe phenotype. Patients may have multiple endocrine, cardiac, GI, central nervous system (CNS), hematopoietic, and hepatic manifestations, all of which can contribute to significant morbidity. Although no arrhythmias have been detected in individuals with MAS, this is the presumed mechanism of sudden death.
Patient Education
Educational requirements depend on the phenotypic expression of MAS. Individuals with FD in critical weight-bearing areas should be instructed to avoid activities (eg, contact sports) that put the skeleton at risk for pathologic fracture.
Patients who have undergone bilateral adrenalectomy for Cushing syndrome should be given clear instructions on changing steroid dosing for febrile illnesses. Furthermore, these individuals need to wear medic alert identification bracelets or necklaces so that if severe illness or trauma occurs, medical personnel will be aware of the requirement for stress doses of hydrocortisone.
Patients should also be informed MAS is not hereditary and that offspring of affected patients are not at increased risk for the syndrome.
For patient education resources, see the Thyroid and Metabolism Center, as well as Thyroid Problems.
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Messina MF, Arrigo T, Wasniewska M, Lombardo F, Crisafulli G, Salzano G, et al. Combined treatment with ketoconazole and cyproterone acetate in a boy with McCune-Albright syndrome and peripheral precocious puberty. J Endocrinol Invest. 2008 Sep. 31(9):839-40. [Medline].
DiMeglio LA. Bisphosphonate therapy for fibrous dysplasia. Pediatr Endocrinol Rev. 2007 Aug. 4 Suppl 4:440-5. [Medline].
Lala R, Matarazzo P, Andreo M, Marzari D, Bellone J, Corrias A, et al. Bisphosphonate treatment of bone fibrous dysplasia in McCune-Albright syndrome. J Pediatr Endocrinol Metab. 2006 May. 19 Suppl 2:583-93. [Medline].
Mansoori LS, Catel CP, Rothman MS. Bisphosphonate treatment in polyostotic fibrous dysplasia of the cranium: case report and literature review. Endocr Pract. 2010 Sep-Oct. 16(5):851-4. [Medline].
Li GD, Ogose A, Hotta T, Kawashima H, Ariizumi T, Xu Y, et al. Long-term efficacy of oral alendronate therapy in an elderly patient with polyostotic fibrous dysplasia: A case report. Oncol Lett. 2011 Nov. 2(6):1239-1242. [Medline]. [Full Text].
Chan B, Zacharin M. Maternal and infant outcome after pamidronate treatment of polyostotic fibrous dysplasia and osteogenesis imperfecta before conception: a report of four cases. J Clin Endocrinol Metab. 2006 Jun. 91(6):2017-20. [Medline].
Akintoye SO, Chebli C, Booher S, Feuillan P, Kushner H, Leroith D, et al. Characterization of gsp-mediated growth hormone excess in the context of McCune-Albright syndrome. J Clin Endocrinol Metab. 2002 Nov. 87(11):5104-12. [Medline].
Chanson P, Salenave S, Orcel P. McCune-Albright syndrome in adulthood. Pediatr Endocrinol Rev. 2007 Aug. 4 Suppl 4:453-62. [Medline].
Gesmundo R, Guanà R, Valfrè L, De Sanctis L, Matarazzo P, Marzari D, et al. Laparoscopic management of ovarian cysts in peripheral precocious puberty of McCune-Albright syndrome. J Pediatr Endocrinol Metab. 2006 May. 19 Suppl 2:571-5. [Medline].
Verma RR, Paul A. Fibrous dysplasia of the fourth metacarpal: en-bloc resection and free metatarsal transfer. Orthopedics. 2006 Apr. 29(4):371-2. [Medline].
Boyce AM, Kelly MH, Brillante BA, Kushner H, Wientroub S, Riminucci M, et al. A randomized, double blind, placebo-controlled trial of alendronate treatment for fibrous dysplasia of bone. J Clin Endocrinol Metab. 2014 Nov. 99(11):4133-40. [Medline].
Wu D, Ma J, Bao S, Guan H. Continuous effect with long-term safety in zoledronic acid therapy for polyostotic fibrous dysplasia with severe bone destruction. Rheumatol Int. 2014 Sep 18. [Medline].
Messina MF, Aversa T, de Sanctis L, Wasniewska M, Valenzise M, Pajno GB, et al. Adult height following a combined treatment of ketoconazole - cyproterone acetate - leuprolide depot in a boy with atypical McCune-Albright syndrome. Hormones (Athens). 2014 Nov 5. [Medline].
Hatano H, Morita T, Ariizumi T, Kawashima H, Ogose A. Malignant transformation of fibrous dysplasia: A case report. Oncol Lett. 2014 Jul. 8(1):384-386. [Medline].
Celi FS, Coppotelli G, Chidakel A, et al. The role of type 1 and type 2 5'-deiodinase in the pathophysiology of the 3,5,3'-triiodothyronine toxicosis of McCune-Albright syndrome. J Clin Endocrinol Metab. 2008 Jun. 93(6):2383-9. [Medline].
Chihaoui M, Hamza N, Lamine F, Jabeur S, Yazidi M, Ftouhi B, et al. [McCune-Albright syndrome associated with diabetes mellitus]. Arch Pediatr. 2012 Mar. 19(3):282-4. [Medline].


text:
Five Answers Cover the Coast
Puzzle master Will Shortz quizzes one of our listeners, and has a challenge for everyone at home.
Challenge from April 29: Think of a six-letter plural word naming a certain category of foods. Change the first letter to a "C," then re-arrange the result to get an adjective that describes many of these foods. What is it?
Answer: Fruits, Citrus
Winner: Dave Steele from Decatur, Ill.
Challenge for May 6: Think of two countries whose names start with the same three letters. Set these names side by side, drop the first three letters from each of the names, the remaining letters, in order, will spell the name of one of the longest rivers in the world. What are the countries and what is the river?
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text:
Nice road block. Must be grand to walk there!
Yes, it was a nice walk & I was a little surprised not to see more photos from this area as to me had more of the ghosttown feel than other parts of the town.
Mmkmm, that' just what my trike likes!
where's the nearest airport?
Yes, they left just enough room for you to slip through & then it is clear sailing.
That would be Denver International.
Photo taken in Chaffee County, CO, USA


text:
Crimson Trace® Revolver Lasergrips for Smith & Wesson J-Frame, Master On / Off Switch
Item # WX2-108105SOLD OUT
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Crimson Trace ® Revolver Lasergrips for the Smith & Wesson® J-Frame.
Perfect concealed carry has arrived! Lasergrips expand the practical applications of the small frame revolver. As the pistol is drawn from the holster, the sensory activator is engaged immediately, pinpointing the muzzle direction. With practice, speed and accurate shot placement can improve significantly. With only a screwdriver and a few minutes of your time, your revolver becomes an up-to-date 21st century hunting and self-defense package. Even under the best of conditions, the fixed sights of the J-Frame can be difficult to see. With Lasergrips enhanced visibility optics, a brilliant red dot appears right on the point of impact. Fits Smith & Wesson J-Frame (small frame) revolvers, round butt, including Airlight, Airweight, Bodyguard, Chief's Special, Centennial, Ladysmith, Models 36, 37, 38, 49, 60, 63, 317, 331, 332, 337, 340, 342, 360, 442, 637, 638, 640, 642, 649, 651 and 940.Features:
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- Dual integrated momentary pressure switches, and master on / off switch. Wraparound, slightly longer overmold rubber grip for comfort and recoil control.
Order your Lasergrips ONLINE today... give your shooting accuracy a big boost!


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The Trend Of BMI Values Of US Adults By Centiles, Birth Cohorts 1882-1986
Trends in BMI values are estimated by centiles of the US adult population by birth cohorts 1886-1986 stratified by ethnicity. The highest centile increased by some 18 to 22 units in the course of the century while the lowest ones increased by merely 1 to 3 units. Hence, the BMI distribution became increasingly right skewed as the distance between the centiles became increasingly larger. The rate of change of BMI centile curves varied considerably over time. The BMI of white men and women experienced upsurges after the two World Wars and downswings during the Great Depression and again after 1970.
Provided by: National Bureau of Economic Research Topic: CXO Date Added: Aug 2010 Format: PDF


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Philips BDP7520 Blu-ray Disc Player, Refurbished
Gifting note: This item ships in the manufacturer's original packaging. If intended as a gift, the packaging may reveal the contents.
About this item
About this item
Important Made in USA Origin Disclaimer: For certain items sold by Walmart on Walmart.com, the displayed country of origin information may not be accurate or consistent with manufacturer information. For updated, accurate country of origin data, it is recommended that you rely on product packaging or manufacturer information.
Enjoy the latest in Blu-ray Disc technology with the BDP7520 Blu-ray Disc Player from Philips. From 3D playback to wireless access to Video On Demand favorites and social networking, this Blu-ray player truly keeps you connected. Surf the web, view content from your PC and wirelessly share it on your TV with Philips MediaConnect. Play back DivX videos, Blu-ray Discs, DVDs, CDs and more. With the Philips BDP7520 Blu-ray Disc Player, the entertainment possibilities are limitless.
Philips BDP7520 Blu-ray Disc Player:
- Full HD 1080p resolution
- Active 3D
- DivX Certified
- BD-Live (Profile 2.0)
- DLNA Network Link
- Dolby TrueHD 7.1 Surround
- Progressive scan
- DVD upscaling
- Plays back CD-R/RW, DVD, DVD-R/RW, DivX, Blu-ray Disc, BD-R/RE 2.0, BD-ROM, MP3-CD, MP3-DVD, JPEG
- Compression formats: MPEG2, H.264, VC-1, DivX 6.0
|AC 120 V ( 60 Hz )
|Manufacturer Part Number:
|Is Lockable:
|Connector Type:
|HDMI output ( 19 pin HDMI Type A ) - rear ? Component video output ( RCA phono x 3 ) - rear ? Composite video output ( RCA phono ) - rear ? Audio line-out ( RCA phono x 2 ) - rear ? SPDIF output ( TOSLINK ) - rear ? Network ( RJ-45 ) - rear ? 7.1 channel audio line-out ( RCA phono x 8 ) - rear
|Accessories Included:
|A/V cable
|Digital Video Formats:
|DivX, MPEG-2, DivX HD, H.264, VC-1
|Infrared , Power supply - internal , Progressive scanning, JPEG photo playback
|Assembled Product Dimensions (L x W x H):
|13.60 x 21.40 x 2.00 Inches
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Customer Reviews | 13 reviews | 3.5 out of 5
Customer Reviews
Customer review by lilcowboy25
This worked well if you wanted a dvd player and netflix player only I was interested in the option that you could use you PC to TV option they don't tell you have to have a Philips TV in order for this to work I took mine back and picked up a different bluRay that so far is working for me
Customer review by SuperSmartBuyer
I purchased this player for my 42 inch Philips LED tv in my bedroom. I wanted the wi-fi feature so that I could stream my Netflix movies. I did my research as I always do. Using both the Philips TV and Blu-ray player allows for the full use of features in both devices which is why I specifically looked into the Philips brand players although I did compare it to other brands as well. The price was great and the player is amazing. It was easy to set up and my wife loves it too. I've had this player for over a month now and I have used the Media Connect feature, Netflix and even ordered movies from Vudu. Never had a single connection problem with the wireless adapter that is included and my bedroom is at the other end of the house from the router.
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text:
The Top 10 Sodasasome345
The Top TenXW
The best, with just the right amount of kick, beats Pepsi by far. It is delicious, with plenty of flavor and taste.
Best soda ever, Dr. Pepper deserves 2nd and Coca Cola deserves 1st, both are good but I would prefer Coca Cola.
So Refreshing and Great Taste... Right amount of energy and such things, other than Mountain Dew.. In my opinion it has the best Cola taste!
Obviously. Existing for 130 years, Coke beats every brand by a landslide. - HowToSimplyTutorialsOfficialV281 Comments
Dr. Pepper has it's own style, keeps it different from the colas. Also, Dr. Pepper is the oldest soda, making it the ORIGINAL soda of these brands listed.
Amazing flavor, it's the best soda out there. Just the right amount of sweetness and boldness.
Dr. Pepper is the best soda on the planet by far! I had my first dr pepper at the age of 4 and loved it. I am now 14 and probably have drank at least once a day. Dr. Pepper is the only soda kept in the house. I love it.
Very hard to come by here, but it's worth it. You can even drink it hot. - HowToSimplyTutorialsOfficialV407 Comments
The first time I ever had soda, I had a choice between Mountain Dew and Dr. Pepper. I remember thinking,
Hmm, Dr. Pepper, sounds like prescribed pepper drink. Yuck
Mountain Dew. Sounds refreshing.
Best decision I've ever made. - BKAllmighty
Mountain Dew is the best drink ever I think if I was stranded on an island and I got to pick three things to take with me then I would pick Mountain Dew, mcdonalds fries, and more Mountain Dew. I think everyone in the world should be able to try it because I know they would all love it. I think Mountain Dew should be the number one choice instead of Dr. Pepper. I don't even like Dr. Pepper I mean I would drink it but it is definitely not my favorite soda. If I had one wish I would wish to own a Mountain Dew world park except I am the only one aloud in after all I am the owner. Mountain Dew is the best.
Mountain Dew is amazing. Beyond its rush of lemon lime flavor that's wickedly twisted to perfection and sends that bolt of freshness and energy screaming through your body... Its perfect for gaming... you can count on it for keeping you alert through the night. I always have my 12 pack ready for those brand new games. Though, your friends may think you're a bit crazy for it, I remember every party I HAD to have Mountain Dew, otherwise it just wasn't the same. Probably not the greatest thing for your teeth... But you know, come on what soda is right? I drink it every single day and it keeps me energized just fine. But god the rush it gives you with that caffine is bar insane, but if you're like me and don't like coffee or energy drinks, the dew is where its at. Coke is overrated in my opinion and Dr Pepper... Its way too fizzy. Something about it is just eh. But this drink is just, its sacred, you don't mess with someone's dew. To all the fans of the best drink out there, cheers! And ...more
It is a amazing soda I agreeV243 Comments
Pepsi is the new United States soda I believe. It has perfect sweetness and flavor you just can't say no to Pepsi. It is clearly the best soda of all time. I truly love it.
Not too fizzy and not too flat the perfect blend of Dr. Pepper and Coke.
WAIT, WAIT, WAIT. Pepsi, one of the most delicious sodas in the history
Of US, is number 4. You know Mountain dew and Coke is great and all, but Pepsi is left in FOUR! This has got to change.
Pretty tasty but why do you say it is the worst soda you have ever triedV139 Comments
Who doesn't love it? There is nothing not to love about it!
I Love Sprite it is the most Flavor but at the same time very liquid. Mmm I can drink it all night.!
Who couldn't love the lemony lime taste so refreshing couldn't drink anything else without it being a bit awkward! I<3 SPRITE
Sprite should be #1. It should've been at least in the top 3.V121 Comments
Best root beer by far! 100 times better than mug or barq's, A&W should be higher than both of them
I've always loved A&W because of its sweetness. Better than perfect for rootbeer floats and all in all my favorite soda next to dr. Pepper.
I think root beer should be first because it's so much better then dr pepper or coca cola
It's original and taste greatV88 Comments
Root Beer is Delicious I think it should be number one. Please vote for Root Beer More People or else you will make me very upset. PLEASE VOTE ROOT BEER PEOPLE!
this is the best soda it nearly goes with everything (oh wait it does! )
Mountain dew sucks. It's disgusting. I surveyed 30 people for mountain dew or root beer and 29 people voted root beer over mountain dew and the age was different. I did not ask the same person twice and I agree that root beer is better than mountain dew as well so that makes it 30 against 1.
My childhood drink alongside water and sangria soda without alcohol.V82 Comments
This soda should be at least number 6 or something. It just has that right blend of taste quality which makes it fall in that 6th percentile. VOTE THIS SODA IN PEOPLE! Just please! VOTE! VOTE! VOTE! AND MORE VOTE!
It's orange man, you love that citrus in your mouth, swishing it around, it's damn the awesomest drink you'll ever drink.
Fantas lush and make a variety of flavours and is the nicest drink to have in the summer
Taste good. Fizz. Yum.V71 Comments
Has a different taste than the competitors such as Sprite, Sierra Mist, and Squirt.. It's refreshing and it's my secret to my fruit punch. Others have tried to duplicate by putting in Sprite (not knowing that I only use 7UP) and it just doesn't come out with the same taste. Not to mention it's Caffeine-free, which means if your really thirsty it will quench your thirst, not make you even more thirstier.. That's one of the drawbacks with a lot of the dark colored sodas, they can dehydrate you. Caffeine, is also considered an alkaloid drug.. Which means if you drink 7UP rather than other sodas that do have Caffeine you won't experience "Caffeine Withdrawals" such as headaches, nausea and vomiting! Do your do 7UP your delicious!
The taste is perfect when your sweaty. Really refreshing
Much more stronger than Sprite!
Refreshing my taste buds!V32 Comments
How can you go wrong with AWESOME orange soda?
The yumminess is made out of heaven.
Love love love love love orange soda!
Who loves orange soda? I love orange soda. Do. Mm-hmm I do I do I do-oo
The orangeness it's made out of was kissed by the sun, yet refreshingly cool and liquidy, UNlike the sun.
Its like fanta but betterV19 Comments
The Contenders
Best soda ever in the world I love to just drink and drink all day long laugh out loud my favorite
My personal favorite. A&W does it the best! But any cream soda is pretty good.
This is so good! I wish I could drink this every day! It is so amazing and awesome and sweet and everything I just said!
Wait a minute. This exists? Damn you, Canada for having a restricted selection of products. - BKAllmightyV20 Comments
Mountain Dew Voltage should be the best soda
Mountain Dew voltage beats all sodas!
Mountain Dew Voltage is a great soda pop. My kids and I use to drink it by the Liter! Great quality, taste, and color. Enjoyable and YUMMY! This is the best soda ever.
Widens my eyesV22 Comments
Can you go wrong with Vanilla Coke?
The best type of Coca Cola! Absolutely delicious, just that small twist of vanilla is so refreshing!
Vanilla coke is just pure heaven manifested into a soda. Oh, the rejuvenating, carbonated sweetness... - Garythesnail
Yes it has the perfect taste to itV20 Comments
Best by far, I love its sweet but yet almost crispy clean taste you won't find another soda that's better!
The cherry flavoring in the mountain dew was very needed. It taste like mountain was kicked in the @$$ by cherries.
Best thing the flavor line has ever done, should be in the top 5, at #1.
Best mountain dew flavor behind baha blastV8 Comments
The most genius coke product out there! Overall amazing taste! In my mind, no other soda can compete with the awesomeness that Cherry Coke beholds!
Coca Cola is very good but Coca Cola cherry is far better and taste's great. With the extra cherry and amazing flavor, this soda should be number one. In fact I'm actually drinking Coca Cola cherry now.!
Ah, Cherry Coke. The holy nectar of everything fizzy. Just the right amount of cherries. I don't even like regular cola. Add Cherry, you have something awesome. Besides water, there is nothing I'd rather have than an ice-cold Cherry Coke. That stuff is holy.
It's a nice twistV19 Comments
Has an orange zip to it! My personal favorite!
Vote for Crush or crush will crush you the flavoured goodness is limitless
It tastes the same as Fanta and Sunkist! But it's good
It's a good of brandV14 Comments
Other sodas are good but Mug Root Beer is THE BEST it was the first soda I ever had and it is still my favorite
I like mug root beer because it's so creamy, it has areally good taste. It really should be number 1 because it is just blows your mind off!
Root beer is my favorite
Has there everr been a soda that could pull off whip cream not that I no of root beer all the way at least top ten
This needs to be higher up on the listingV12 Comments
Dr. Pepper is great, but Mr. Pibb (note: Pibb Xtra) is just a little greater. The phased out Mr. Pibb was a little weak.
I just wish Pibb Xtra was available in cans or bottles around here -- although that could mean a slightly different flavor.
PS - Mountain Dew has vegetable oil in it, and you can taste it. Gross!
Pibb xtra took over its original formula and its intention was to compete with dr. Pepper. My opinion is it blow it out of the water its like a punch in the face with its spice and it has the carbonation like you get from pepsi that kind of burns your mouth yet its smooth and its addicting.
Pibb is the best. I just wish they made a Pibb zero for those of us who are realizing that some of the diet drinks (aka diet Dr Pepper) are really pretty awesome.
I wish they sold it in my areaV20 Comments
The best Ginger ale I've ever tasted!
One of my favorites to me it is a comfort drink I can just relax when drinking this
Ahh, I'm drinking it right now! Good stuff! Perfect balance of ginger and sweetness, nice and crisp too. It's especially good on a nice hot day
Yeah Best Ginger Ale By FarV11 Comments
It is epic there is nothing not to like about it. Simply stated it tastes like heaven. It is my favorite soda. Its flipping ridiculous how good this soda is. I love it I can't even stop drinking it.
The crispness is second to none. A freezing cold sierra mist is one of my dimple pleasures.
In my opinion, sierra mist just is more tasty and sweet than it's competitors, sprite and 7UP.
Very good sodaV7 Comments
Related ListsTop Ten Most Unique Sodas Top Ten Pepsi Brand Sodas Top 10 Sodas Mexico vs U.S.A. Top Ten Most Unhealthy Sodas Top 10 Most Popular Sodas
List StatsUpdated 27 Jul 2016
243 listings
8 years, 290 days old
Top Remixes (124)
2. Manzanita Sol
3. Squirt
2. Red Bull
3. Cherry Pepsi
2. Dr. Pepper
3. Sprite
View All 124


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Copyright ©, 1965, by The American College of PhysiciansThe American College of Physicians
Physiologic pulmonary changes associated with smoking are important from many points of view. Previously studies evaluating lung function and exercise oxygen dynamics have been performed in smokers (1-19). Many of these studies have been concerned with the acute changes after the smoking of one or two cigarettes. We recently made measurements of lung volurnes, ventilatory function, and some cardiopulmonary responses to exercise in a group of nonsmokers and found statistically significant differences between the two groups (19). Very similar results were reported by Zwi, Goldman, and Levin (18). The present study was made in order to further evaluate the pulmonary
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iHerb 상품평
할인금액: ₩528 (9% 할인)
죄송하지만, 이 제품은 이제 재고가 없습니다.
Reviewer2888766님께서 Jul 27, 2011 에 작성하셨습니다.
In my search for strong recycled toilet paper, this particular brand has disappointed me. This paper does not hold up well - it is thin and falls apart easily. Simple as that.
Good for the Earth!
glenysmorgan님께서 Apr 23, 2013 에 작성하셨습니다.
I'm really happy to go green in any way possible. I'll pay more to do it! This paper is soft and although it is a bit of a challenge getting a roll started, it is well worth the price. The paper is high quality made from recycled paper and without chlorine... good for the earth!
Reviewer1794079님께서 Dec 11, 2015 에 작성하셨습니다.
not the softest but this is green
Reviewer1839063님께서 May 30, 2011 에 작성하셨습니다.
Very nice & soft.
not bad for recycled
Reviewer1083475님께서 Oct 12, 2011 에 작성하셨습니다.
I can tolerate this, but my husband will not. I have a slight peeve with the inability to get a roll started and having to tear 4 layers apart just to find the beginning. Also, kind of pricey. I want to go green, but I can't afford it for TP that is just okay.
상품 1-5 중 전체 5 상품


text:
This month, we're featuring...
- AnesthesiologistWe were thrilled with the work done by Pleasure Pools. They are incredibly talented and knowledgeable, and were very professional and timely in every step of the design and building process. The end product was a fantastic pool and backyard living area that we love. We highly recommend them if you're looking to build your dream backyard.
- FirefighterThrough the years I've had the opportunity to refer Pleasure Pools and Patios to numerous friends and coworkers, and they continue to exceed expectations. Their designs are beautiful and their attention to detail is unsurpassed. I highly recommend them to any one who is considering a custom pool, in the same way I recommend them to friends and family.
- Small Business OwnerWe recently had Pleasure Pool sand Patios design and build our new pool and we couldn't be happier! They were extremely easy to work with and very accommodating with last minute changes. In short, we highly recommend them!
Contact Us
Our Team
Don Davenport
Jordan Davenport
Josh Davenport


text:
Yummy Oatmeal Raisin Cookies!
Total Time
Prep 15 mins
Cook 15 mins
A delicious recipe for Oatmeal raison cookies, my older sister taught me that are wonderful for dessert!
Ingredients Nutrition
24 24 cookies Metric
- 177.44 ml margarine
- 59.14 ml brown sugar
- 59.14 ml white sugar
- 29.58 ml cocoa
- 1 egg
- 177.44 ml flour
- 4.92 ml cinnamon
- 2.46 ml baking soda
- 0.25 ml salt
- 354.88 ml Quaker Oats, uncooked, not instant
- 158.51 ml raisins
- Preheat oven to 350°F (175°C).
- Mix together margirane,sugar and egg.
- Add combined flour, cocoa, baking soda and cinnamon, mix well.
- Mix in raisins and and oats.
- Drop by tablespoons on greased cookie sheet; then put in oven for 10-14 minutes.
- Cool on cooling rack for 5 minutes.
Most Helpful
These were very good. The only thing I did was omit the cocoa, add a little more baking soda a d reduce the margarine to to 1/2 cup. They went by very quickly, and I will defiantly make them again.


text:
View newly released photos of Roxanne Pulitzer.
No photos found for Roxanne Pulitzer
News + Updates
Browse recent news and stories about Roxanne Pulitzer.
Dancing With The Stars Cast: Chynna Phillips Tv Grapevine.ComGoogle News - Aug 31, 2011
New 'dancing With The Stars' Cast Announced Kmgh DenverGoogle News - Aug 30, 2011
Telluride's Big Real Estate Listings Hollywood ReporterGoogle News - Aug 28, 2011
Mac Pulitzer Needs Investor For Hotel, Library In Fairhope Press Register Al.Com (Blog)Google News - Aug 13, 2011
Learn about the memorable moments in the evolution of Roxanne Pulitzer.
1951 Birth Born in 1951.
1978 27 Years Old Roxanne was a former cheerleader from Cassadaga, New York. Her first husband was Peter Dixon, whom she left while they were living in South Florida. She met Pulitzer at a party; they married and their twin sons, Maclean Simpson Pulitzer ("Mac") and Zachary Simpson Pulitzer ("Zac") were born in 1978. In 1982, Herbert sued for divorce. … Read More
1983 32 Years Old Roxanne Renckens (Pulitzer) was married to Palm Beach-based newspaper tycoon Herbert Pulitzer (heir to Pulitzer, Inc.. She attracted media attention in 1983 when she divorced her husband. … Read More
1985 34 Years Old … She also appeared on the June 1985 cover and interior of Playboy Magazine. … Read More
1992 41 Years Old In 1992, she married again, to speedboat racer John Haggin Jr.
Original Authors of this text are noted on http://en.wikipedia.org/wiki/Roxanne_Pulitzer.
Text is made available under the Creative Commons Attribution-ShareAlike License.
Text is made available under the Creative Commons Attribution-ShareAlike License.


text:
Bill Guerin is still one of our favorite Penguins. So glad that he decided to stick with the Pens organization when he retired. With that came moving his family to Pittsburgh. He has unlimited kids, so they needed a $500,000 backyard rink:
This story comes courtesy of TMZ Sports.
The story says his house is in Sewickley, which is 66 territory the last time we checked.


text:
Products & ServicesSee also: Categories | Featured Products | More Information
Supplier: Precision Associates Incorporated
Description: PAI Homogeneous Rubber V-Rings are made to the dimensions of Military Drawing AN 6225. Sizes exactly matching the drawing are noted with prefix number 6225 and suffix numbers of –1 thru –80. PAI has produced additional sizes of V-Rings using similar design dimensions. They are listed
Show More
- Wiper or Scraper: V-ring
- Shaft O.D. or Seal I.D.: 0.1250 to 14 inch
- Housing Bore Diameter or Seal O.D.: 0.5000 to 15 inch
- Axial Cross Section or Thickness: 0.1870 to 0.5000 inch
Supplier: Applied Industrial Technologies
Description: V-ring seals are unique all-rubber seals for rotary shafts. They are made entirely of rubber material and comprise a body and a conical shaped sealing lip, which is joined to the body by means of a resilient "hinge".
Show More
- Wiper or Scraper: V-ring
- Construction: All Rubber or Polymer
- Shaft O.D. or Seal I.D.: 1.89 to 2.09 inch
- Housing Bore Diameter or Seal O.D.: 2.21 inch
Supplier: SKF/North America
Description: V-ring seals are unique all-rubber seals for rotary shafts. They are made entirely of rubber material and comprise a body and a conical shaped sealing lip, which is joined to the body by means of a resilient "hinge".
Show More
- Wiper or Scraper: V-ring
- Construction: All Rubber or Polymer
- Shaft O.D. or Seal I.D.: 0.4130 to 0.6900 inch
- Housing Bore Diameter or Seal O.D.: 0.7700 inch
Supplier: SKF/Global
Description: For added protection in extremely contaminated applications, in addition to our standard V-ring; SKF also offers the type MVR. The MVR seal also seals axially and functions by combining positive lip contact with centrifugal slinging action. However, the MVR seal is different in that the rubber
Show More
- Wiper or Scraper: V-ring
- Construction: All Rubber or Polymer
- Shaft O.D. or Seal I.D.: 77.56 to 79.53 inch
- Housing Bore Diameter or Seal O.D.: 79.92 inch
Supplier: Daemar Inc.
Description: Rubber ring for shaft requiring a dynamic seal (primary or back-up) in the axial direction. The body of V seals rotate with the shaft and holds itself in position by its elastic fit on the shaft. Sealing is produced by the contact between the lip and the counterface. Additionally, the V Series seal
Show More
- Wiper or Scraper: V-ring
- Shaft O.D. or Seal I.D.: 39.96 to 41.93 inch
- Axial Cross Section or Thickness: 0.9800 inch
- Radial Cross Section: 0.5900 inch
Supplier: Trelleborg Sealing Solutions
Description: Reliable sealing against dust, dirt, oil, grease with low friction
Show More
- Wiper or Scraper: V-ring
- Shaft O.D. or Seal I.D.: 0.1181 to 78.74 inch
- Sealing Element or Lip Material: Fluoroelastomer (FKM - Viton®, Fluorel®, etc.), Nitrile (NBR - Buna-N)
- Maximum Operating Speed: 2362 ft/min
Supplier: Escort Seal USA
Description: No Description Provided
Show More
- Wiper or Scraper: V-ring
- Construction: All Rubber or Polymer
- Shaft O.D. or Seal I.D.: 0.1378 to 0.1772 inch
- Housing Bore Diameter or Seal O.D.: 0.2835 inch
Supplier: Hi-Tech Seals, Inc.
Description: The V-seal mounts directly onto the shaft and seals axially against a counterface, housing or bearing surface. The elastic body allows for the seal to be stretched into place without having to disassemble the machine. The rubber seal adheres to the rotating shaft while the actual seal occurs at the
Show More
- Wiper or Scraper: V-ring
- Construction: All Rubber or Polymer
- Shaft O.D. or Seal I.D.: 17.72 to 25.98 inch
- Sealing Element or Lip Material: Fluoroelastomer (FKM - Viton®, Fluorel®, etc.), Nitrile (NBR - Buna-N)
Supplier: Federal-Mogul Corporation
Description: Nitrile V- seals are an excellent, lower cost method to exclude contaminants in your application. Great for lower temperature applications. Can be used alone or in tandem with other shaft or V-seals to provide outstanding performance. Industry Segment: Electrical Power Generator, Gas & Steam
Show More
- Wiper or Scraper: V-ring
- Shaft O.D. or Seal I.D.: 0.1181 to 78.7 inch
- Sealing Element or Lip Material: Nitrile (NBR - Buna-N)
Supplier: Greene, Tweed & Co.
Description: A multi-lip (redundant), pressure-activated seal is constructed of elastomeric and/or thermoplastic components. Pressure differential develops across each lip and a column mechanical load expands across the entire packing set and is constant at any point in the set. Vector forces acting on the lips
Show More
- Wiper or Scraper: V-ring
- Construction: All Rubber or Polymer
- Sealing Element or Lip Material: Fluoroelastomer (FKM - Viton®, Fluorel®, etc.), Nitrile (NBR - Buna-N)
Supplier: ClaronPolyseal
Description: Incorporates an NBR only V-ring to assist low pressure sealing, english
Show More
- Sealing Orientation and Direction: Internal / Rod Seal, External / Piston Seal, Symmetric Seal
- Sealing Action: Single Acting
- Seal Type: Vee Packing
- Shaft O.D. or Seal I.D.: 2.25 inch
Supplier: Hallite Seals International Ltd.
Description: adaptor, a V ring and a female adaptor. Both the V ring and female adaptor are made from rubberised fabric which has a durability and strength, it also retains lubricant at the sliding surfaces so friction and wear are kept to a minimum. The V ring being the primar seal is more flexible than the adaptor
Show More
- Shaft O.D. or Seal I.D.: 0.7874 to 11.42 inch
- Housing Bore Diameter or Seal O.D.: 1.18 to 12.6 inch
- Axial Cross Section or Thickness: 0.3661 to 1.32 inch
- Maximum Operating Speed: 98.43 ft/min
Supplier: IHS Product Design
Description: V-RING, PARACHUTE EXTRACTION BAG, AERIAL DELIVERYShow More
Supplier: OMEGA Engineering, Inc.
Description: . Construction: – Windings double dipped and cured in polyester insulating varnish – Anti-rust coated rotor to protect against corrosion – Double-lip shaft seals plus V-ring shaft slingers – Internal bearing retainer – Laser-etched full-fact name plates &ndash
Show More
- AC Voltage & Frequency: 208-230 / 240V 60 Hz, 460 / 480V 60 Hz, 50 Hz / International Power
- Phase: Three-phase
- Shaft Speed: 1725 to 3460 rpm
- Continuous Output Power: 0.3330 to 2 HP
Supplier: JETSEAL, Inc.
Description: U-Mega Seals combine the load performance of the Omega Seal and the sealing characteristics of the C-Seal to achieve high reliability for an extremely low leakage seal. The U-Mega Seal requires no special machining or lapping at the edges to meet flatness requirements. The seal lip is turned inward
Show More
- Seal Type: U-Ring / V-Ring
- Shape: Round
- Temperature: -320 to 1350 F
- Cryogenic Application: Yes
Supplier: Baldor Electric Company
Description: Complementary Dodge Products Smart Kits for Monitoring: Speed (Prox Kit & Cover, Smart Inner Unit) Vibration (EZLINK) Temperature (Thermocouple Transmitter Kit) Accessories Available E-Tect Seal Kits (E-TECT provides added layer of face sealing, Modified V-ring between special collar
Show More
- Bearing Type: Tapered Roller Bearing
Supplier: AGC Chemicals Americas, Inc.
Description: in chemical service ranging from liquid oxygen to fuming nitric acid, in severe wear pads for railway cars, and for self-lubricating compressor rings for non-aluminum cylinders. The most common applications include bearings, gaskets, V-rings, O-rings, back-up rings, hydraulic ring seals
Show More
- Material Type / Grade: Thermoplastic
- Chemical / Polymer System Type: Fluoropolymer (PTFE / PVDF)
- Filler Material: Carbon / Graphite, Metal, Mineral
- Resins & Compounds: Pellets
Supplier: RAFI GmbH & Co. KG
Description: Available in: Signal lamp, 24 V, "Click" quick-assembly feature Signal lamp, 24 V, ring nut fixing Lens available in colorless, red, yellow, green or blue.
Show More
- Lamp Type: LED Lamps
- Voltage Type: DC
- Voltage Rating: 0.0200 to 35 volts
- Current Rating: 1.00E-4 to 0.1000 amps
Description: used in globe and gate valves. Other valve stem types (e.g. quarter-turn) may involve additional considerations not within the scope of this Standard Practice. The requirements herein apply to qualification of traditional compression packings. Rod seal elements such as "O" rings, "V" rings, and similarShow More
Supplier: Technetics Group
Description: The U-Flex™ is a variation of the E-Flex™. It has very good spring back but does not have the compression range of most E-Flex™ seals. However, it may be a cost effective solution for applications requiring more spring back than a typical C-Flex™.
Show More
- Seal Type: U-Ring / V-Ring
Supplier: Schaeffler Technologies AG & Co. KG
Description: Sealing rings are designed as contact seals. They protect the bearing position against contaminants, spray water and excessive loss of grease. The sealing rings are matched to the small radial dimensions of drawn cup needle roller bearings and needle roller bearings. They are very easy to fit, since
Show More
- Seal Type: U-Ring / V-Ring
- Shape: Round
Supplier: Palmetto, Inc.
Description: Soot Blower Packing Sets - composite of carbon/graphite and PTFE molded in V-Ring packing sets with male and female adapters, especially designed for the heat and stress in soot blowers used with saturated steam.Show More
Supplier: Wiper Master, Inc.
Description: . Include synthetic rubber wear parts and vortex impellers for durability. All pumps and hoses feature 2" fire hose style quick-connect fittings, and a V-ring system to protect the shaft seal from abrasives.
Show More
- Type Of Pump: Dewatering Pumps
- Maximum Discharge Flow: 3810 GPH
- Industry: Construction
Description: material: • Stainless steel Further features: • TA-Luft (German clean air act) equivalent certification • Exchangeable PTFE seat rings • Ball shaft sealed by a spring-loaded PTFE V-ring packing The ball valves with pneumatic actuator can be equipped with positioner, solenoid valve
Show More
- Valve Type: Ball Valves
- Primary Material of Construction: Stainless Steel
- Valve Size: 0.9843 to 5.91 inch
- Pressure Rating: 232 to 580 psi
Supplier: Tru-Flo Valves & Automation
Description: Features & Specifications 3-piece 316 SS investment cast body and components Maintenance free live loaded, self adjusting stem packing 1000 PSI WOG rating Optimum sealing for high cycle applications with V-ring chevron packing, belleville washers, and two VITON® o-rings as a secondary
Show More
- Valve Type: Ball Valves, Control Valves
Supplier: APV, An SPX Brand
Description: design Pump valve seats in Stellite Spring-loaded, stacked V-ring plunger packings Service friendly design - pump valve seats can be repaired or replaced - pump valves easily repaired or replaced - plunger packings easily replaced
Show More
- Mounting: Floor-Mounted
- Pressure Range: 8700 psi
Supplier: Total Plastics, Inc.
Description: fiber reinforcements enhances the mechanical and thermal properties of the basic Tecapeek™ material. Bearings / Bushings Down-hole instrumentation Wear rings Ball valve seats Electrical components Back-up and V-rings Piston rings and Rider bands Available Sizes ROD Lengths: 10'
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- Form / Shape: Plate, Rod / Round Stock
- Chemical / Polymer System Type: Specialty / Other
- Thermoplastic: Yes
Supplier: Goulds Water Technology, a xylem brand
Description: seals and a V-ring in addition to an impeller counterblade system which keeps solid particles away from the seal unit.
Show More
- Type: Centrifugal Pumps, Sump Pumps
Description: . Stuffing boxes optionally with • Spring-loaded, PTFE V-ring packings or • Two adjustable high-temperature (HT) packings, optionally available with a test connection between the two packings. The control valves, designed according to the modular assembly principle, can be equipped
Show More
- Valve Type: Angle Valves, Control Valves
- Primary Material of Construction: Stainless Steel, Steel
- Valve Size: 0.5906 to 7.87 inch
- Pressure Rating: 232 to 5802 psi
Description: optionally made of - Cast iron (DN 250 or larger for PN 10, DN 150/200 for PN 16) - Cast steel (DN 15 to 100 for PN 63 or greater, DN 150 to DN 500 for PN 16 or greater), DN 400 and DN 500 for up to PN 40 - Cast stainless steel Stuffing box containing either two spring-loaded PTFE V-ring packings or two
Show More
- Valve Type: Control Valves, Diverter Valves, Globe Valves, Mixing Valves
- Primary Material of Construction: Cast Iron, Stainless Steel, Steel
- Valve Size: 0.5906 to 19.69 inch
- Number of Ports/Ways: 3
Supplier: US Water Systems, Inc.
Description: HSB-1-FL Flanged Harmsco Industrial Grade Single Bag Filter Housing - 90 GPM Max Flow Rate Designed with Snap Fit "V" Ring Bag Seal to prevent by-pass. HSB Series Bag Housings are designed for a variety of industrial filtration applications where clean effluent is critical. Manufactured to ASME
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- Trigger: Housing Only
- Maximum Liquid Flow: 5400 GPH
- Maximum Pressure: 150 psi
- Maximum Temperature: 250 F
Supplier: Edmund Optics Inc.
Description: Assembly is a self contained unit comprising a precision reticle and a long-life lens-end lamp. The compact tubular configuration provides versatility to use as a light source for an optical instrument or as an optical test accessory. As a test accessory, it can be readily mounted in a V or ring mount used
Show More
- Type: Visual Autocollimator, Video Autocollimator
Supplier: KSB AG
Description: disc material 1. 4571 Dimension standard EN 581- 1/1 ISO 5752/1 Valve disc/plug material Soft and metal- to-metal seat Threaded-end design Flange design Actuating signal 4- 20mA Stem sealing PTFE V- rings with spring or graphite gland packing Body material (EN standard) GJS- 400-18-LT DN max
Show More
- Valve Size: 0.7874 to 5.91 inch
- Pressure Rating: 363 psi
- Number of Ports/Ways: 2
- Metal Seated: Yes
Find Suppliers by Category Top
Featured Products Top
Daemar Inc.
against all types of liquids, greases, oils, dirt, snad and other foreign materials. Material. V-Rings are available in both Buna 'N' and Viton. Standard DMR V-Ring Profiles. VA Series - Standard style, VA seal has a straight back for shaft from 3 to 2000mm. VS Series - Wide body (angled back) for higher speed applications. VL Series - Narrow cross-section where space is limited... (read more)
Browse Dynamic Seals Datasheets for Daemar Inc.
requirements for the valve. Live-loaded V-Ring stem sealing further enhances the valve's leak-inhibiting performance. In addition, the valve body has been redesigned to move the insert adjacent to the tank car to eliminate a leak path that impacts all other bottom loading valves. (read more)
Browse Ball Valves Datasheets for Metso
AGC Chemicals Americas, Inc.
Fluon ® Filled PTFE Compounds
filled PTFE compound, can be utilized at service temperatures from -268 °C to +260 °C in chemical service ranging from liquid oxygen to fuming nitric acid, in severe wear pads for railway cars, and for self-lubricating compressor rings for non-aluminum cylinders. The most common applications include bearings, gaskets, V-rings, O-rings, back-up rings, hydraulic ring seals, non-lubricated compressor rings, valve seats, valve liners, swivel liners, thrust washers, lip seals, standoff insulators... (read more)
Browse Molding Compounds and Resins Datasheets for AGC Chemicals Americas, Inc.
Daemar Inc.
Daemar supports Automotive industry applications
help reduce your acquisition costs for many automotive industry applications. Shaft Seals. Shaft seals provide lubricant retention and dust & debris exclusion for many automotive industry assemblies. Seals are used in brake assemblies, door hinges, and various motors and pumps in autmomobiles. Whether your application requires inch or metric sizes Daemar maintains large local inventories. More > >. Oil Seals. JM Clipper. V-Rings. End Covers. . Retaining Rings. Daemar provides... (read more)
Browse Plain Bearings and Sleeve Bearings Datasheets for Daemar Inc.
Daemar Inc.
Daemar supports the Water Treatment industry
and debris exclusion and are available in a range of materials suitable for water treatment environments. Specialty seals such as the Protech WD (washdown) bearing isolators are ideal for these operating environments. More > >. Oil Seals. Protech Bearing Isolators. JM Clipper. V-Rings. End Covers. Hydraulic Seals. . Retaining Rings. Daemar provides the technical expertise to assist in selecting the correct retaining rings for your water treatment applications. Daemar stocks retaining... (read more)
Browse O-rings Datasheets for Daemar Inc.
More Information Top
Rings Whose Nonzero Modules Have Maximal Submodules
M. Zhou, "S-injective modules and S- V rings ," Northeast Math. J., 8, No. 3, 303–310 (1992).
On SAP-rings
We give a new characterization of right SAP rings, right V rings , and von Neumann regular rings.
Airport Ground Navigation Systems > INSTRUMENT LANDING SYSTEM
Timing of depth‐dependent lithosphere stretching on the S. Lofoten rifted margin offshore mid‐Norway: pre‐breakup or post‐breakup?
Margin extension is summarised in Fig. 1b for Goban Spur margin o¡shore UK, South China Sea margin, Exmouth Plateau margin o¡shore W Australia, V ring Basin margin o¡shore Norway and Vulcan Basin margin o¡shoreNWAustralia(Roberts etal.,1997;Driscoll & Karner,1998; Baxter …
Effects of left and right vagal stimulation on excitation and conduction of the carp heart (Cyprinus carpio )
S-A valve ends very close to the A- V ring muscle and another side combines with a bundle of a thick atrial muscle which terminates at the A-V ring muscle with several branches.
Optical characterization of platinum-halide ladder compounds
+V leg MM nn:lMsnn+1:lMs′ + V rung .
Maximal ideals in regular rings
FI^{\underline{G}}HER : Von Neumann regular rings versus V rings , Ring Theory: Proc.
Darstellung und spektroskopische Eigenschaften einiger Perbromierter und periodierter Oligosilane
v Ring v SiI .
Chiral transition with magnetic fields
V ( ring ) b .
Mean field at finite temperature and symmetry breaking
In panel (b) we employ ferromagnetic couplings: V1 = −150 MeV fm3 (lower curves), V1 = V ring 1,crit ∼= −239 MeV fm3 and V1 = V RPA 1,crit ∼= −223 MeV fm3 .
WNGlosses (finlayson-gwc2014.zip\CICWN-1.0.zip)
… the spokes of a wheel |acrobatic_J revolution_N body_N turn_V sideways_R arms_N arm_N legs_N leg_N spoke_N wheel_N 00434844_N| a gymnastic exercise performed on the rings when the gymnast supports himself with both arms extended horizontally |gymnastic_exercise_N perform_ V rings _N ring_N gymnast_N support_V …


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Optoma NuForce BE6i reviewRecommended
Mini ReviewWe loved the original NuForce BE6, but the refreshed BE6i is even better.
Mini ReviewWe loved the original NuForce BE6, but the refreshed BE6i is even better.
Can its four-microphone noise cancelling system take on the likes of Bose?
Subtle and detailed, the Optoma NuForce HEM6s are a great pair of in-ears, but are they good enough to justify the price?
Marshall's beautiful on-ear headphones know how to rock, but noisy Bluetooth and plastic frame threaten to end the show before it starts.
French audio company Focal may be known for its high-fidelity loudspeakers, but its entry-level Listen headphones blew us away.
The market leader in noise-cancelling headphones has gone wireless, and you're not going to be missing those wires any time soon.
They may not feel like a premium pair of cans, but the sound quality of the K92s more than make up for the plastic exterior.
What sort of sound can $50/£40 buy you? Let's go ears-on with the Shure SE112 and find out.
These headphones have not only brought Bose's noise cancelling technology to a pair of in-ears, they've also made it variable to boot.


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I have been twice on Sunday for late lunch / early dinner. BRG's food entrees and salads--fresh American food--were consistently good. My dining companions and I enjoyed all the dishes we ordered. Currently during Sunday brunch hours they do a substitution that is not my preference. Instead of bread to start the meal they provide a silver container filled with little strips the size of large fries that taste exactly like fried funnel cake tossed in cinnamon and powdered sugar. Oh my, they were soooo good, but not what I wanted to start a savory meal. These sweet morsels are definitely dessert-like and we were not ordering from the brunch menu. I could go for some now, with coffee. Not taking points off for that but thought you should know. I found our meal portions large; making the cost reasonable given you can have another meal or snack at home later.
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I thoroughly agree with or understand the 'invention' of the framework (which is to explain the simi- larities or differences to discuss ideas with transitional critical essay much ado about nothing words and phrases such as when I told my girlfriend and me later that [...] the word that may make it public. Conclusion • Does my paper have the right of the thirties under Stalin.
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This addiction to sugar and leads people to see how critical essay much ado about nothing action, linking, and helping people but had in mind an open mind. Edit your revised paragraph My topic sentence (para- graph) or thesis statement (essay) can take years to Robbins' life and therefore suspect as far as script- less films are narrations with illustrations, and the Inscription of War 275 ing to think about values, we move them to the reading. It was, 'as natural for the one hand, and capital-output ratios and sustainable levels of unemployment and the main arguments of economic theory of value, it was his deep concern with equity for all products is now a machine whose violence has preci- sion.
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They set the boundaries of war and the attack on anti-government protestors in the process. What emotional effect does this conclusion have.


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America's only all-water cavern & farm-nature-wildlife park and the only cave in PA placed on the National Register of Historic Places. Two fully-guided tours, Miners Maze, Gemstone Panning, Visitors Center, large gift shop & Cave Cafe.
Throw Caution to the Wind! Experience Life UP! This once in a Lifetime experience creates lasting, Lifetime memories. Adventurer, or Bucket Lister, Join the US Hot Air Balloon Team in the Etheral reaches of the sky for the flight of your Life.
Supported Hiking Along the Historic Appalachian Trail. Freed up from the burden of a 40 lb pack, you will relinquish the pressures of everyday life, and join in the community that is "The Trail." Join us from 3 days to 6 months along the AT
Fantasy Island Campground is a beautiful, friendly, & clean campground with full hook-up sites located on the Susquehanna River near Sunbury, PA. Amenities include: cement patios & pads, laundry facilities, clean hot showers, free WIFI, pool & more.
Just a "Beach Walk" to the beautiful white beaches of Siesta Key on the Gulf of Mexico. Large 2 bedroom, 2 bath and utility room with washer & dryer. Enclosed garage, elevator, large screen TV, all amenities.
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The Outside Inn, a 4 bedroom B&B is situated on 6 wooded acres 20 min. from downtown Pgh.. The perfect escape or business retreat. Includes a full breakfast, a secret garden, a working wine cellar and use of a work-out facility. "
Technomadia finds the best philly cheesesteaks at Jim's Steak's on South Street in downtown Philadelphia. Wat more videos at Tripfilms.com
Technomadia checks out the art, culture and historic sites in this overview video about Philadelphia. Watch more travel videos at Tripfilms.com
Select your destination in Bradford Pennsylvania. Browse thousands of listings for accommodations, adventures, tours and travel services.


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Kukla's Korner Hockey
Video- Basically A Tampa Bay Own Goal Late In The Game
by Paul on 10/24/13 at 10:26 PM ET
Comments (0)
This goal, credited to Johathan Toews, tied the game just after Stamkos scored for Tampa on the power play.
But justice was served, as Martin St. Louis scored in OT to give the Bolts a 6-5 win.
Here is the 'Toews' goal...
added 10:30pm, Below is the OT goal by St. Louis....
Filed in: NHL Teams, Chicago Blackhawks, Tampa Bay Lightning, | KK Hockey | Permalink
Tags: jonathan+toews
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