text:
Tom Smart, Deseret Morning News
On Wednesday morning, at Prophet Elias Greek Orthodox Church, Father Matthew Gilbert celebrated a service of Divine Liturgy for Saint Demetrios the Great Martyr. The congregation included dozens of children from the St. Sophia parochial school, which is housed in the Prophet Elias Church.
During the homily, Father Gilbert told Demetrios' story in simple words, so the children could understand. He talked of the bravery of this saint who was born in the year 270 A.D. and who was killed because he would not give up his faith in Christ. Father Gilbert urged his listeners to be brave as well.
Be brave in doing what is right, even if others laugh at you, he said. Be brave enough to be a peacemaker. Be brave when you make a mistake. Ask for forgiveness and try again.
"What do you do when you make a mistake on your paper in school?" he asked the children. "You erase. You ask for help." In the same way, we must ask for God's help every day, he said.
The children, even the littlest ones, appeared to be paying attention to his words. They also seemed to know the liturgy of the church. As the service progressed, they knew when to say "Lord, have mercy," and when to say "Grant this, O Lord," and they knew when to say these words in English and when to say them in Greek.
Meanwhile, at the Holy Trinity Greek Orthodox Church in downtown Salt Lake, Father Michael Kouremetis also conducted a service in honor of Saint Demetrios on Wednesday morning. His congregation was older, for the most part. But the liturgy the prayers and the responses and the chants and the Bible readings were the same. In fact, the same words and the same service for Saint Demetrios was said in Orthodox churches all over the world, on Wednesday.
This weekend, Utah's Greek community will celebrate its 100th anniversary. People will dine and dance and take in a history display. They'll honor the first immigrants, the men who came to work on the railroads and in the mines and the women who married them and started families half a world away from their own mothers and fathers.
Above all, they'll celebrate their faith. One hundred years ago this month, on 400 West and 400 South in Salt Lake City, the first Greek Orthodox Church in Utah was consecrated.
Father Kouremetis says it is the church that has kept the Greek heritage and culture alive in this state. The church has kept the language alive and kept families united, generation after generation. "The church is the bonding agent which kept us all together and gave us, always, hope. Even in the darkest times."
And there were some hard times, says Constantine Skedros, who has just finished a church history called "100 Years of Faith and Fervor." The immigrants who came here at the turn of the past century came because their families were desperately poor, Skedros says.
They probably never intended to stay. They thought they'd send some money home, perhaps help pay for a dowry so their sister could marry, or tide the family over in a year when the crops had failed. When they realized they would stay, they knew they would need to make the observances of their faith.
The 1900 Census showed three Greeks in Utah. But by 1904 there were several hundred Greek men working in and around the Salt Lake Valley. Their labor came cheap, but they worked hard and they were saving a dime here, a nickel there to build a church.
In 1905, 200 Greek men met and formed a corporation. They bought land near 400 West on 400 South for $1,600 and got a loan from the Walker Brothers' bank for $7,000. The first Holy Trinity Church was consecrated on Oct. 29, 1905.
Salt Lake City, then, became the site of the 14th Greek Orthodox Parish in the United States, the first parish to be established between St. Louis and San Francisco.
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text:
|Publication number
|Publication type
|Application number
|Publication date
|Mar 17, 2009
|Filing date
|Jul 16, 1999
|Priority date
|May 10, 1993
|Fee status
|Publication number
|Philip E. Eggers, Hira V. Thapliyal
|Original Assignee
|Arthrocare Corporation
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (106), Non-Patent Citations (92), Referenced by (46), Classifications (55), Legal Events (4)
|External Links: USPTO, USPTO Assignment, Espacenet
This application is a divisional and claims the benefit of U.S. application Ser. No. 08/874,173 filed Jun. 13, 1997, now U.S. Pat. No. 6,179,824, the disclosure of which is incorporated by reference.
The present invention is related to commonly assigned U.S. patent applications Ser. No. 08/561,958, filed on Nov. 22, 1995, now U.S. Pat. No. 5,697,882; Ser. No. 08/485,219 filed Jun. 7, 1995, now U.S. Pat. No. 5,697,281; which was a continuation-in-part of PCT International Application, U.S. National Phase Serial No. PCT/US94/05168 filed May 10, 1994; which was a continuation-in-part of U.S. patent application Ser. No. 08/059,681, filed on May 10, 1993, now abandoned; which was a continuation-in-part of U.S. application Ser. No. 07/958,977, filed on Oct. 9, 1992, now U.S. Pat. No. 5,366,443; which is a continuation-in-part of U.S. application Ser. No. 07/817,575, filed on Jan. 7, 1992, now abandoned, the full disclosures of which are incorporated herein by reference.
The present invention relates generally to apparatus and methods for maintaining patency in body passages and more particularly to a catheter system capable of selectively ablating occlusive media within a body lumen. The present invention is particularly useful for the electrosurgical cutting or ablation of invasive tissue growth in and around a stent anchored in the body lumen to help reduce or eliminate restenosis of the body lumen.
When a patient is suffering from atherosclerosis, significant occlusions or blockages are formed on the interior wall of the artery. As a result of these occlusions, the organ or extremity to which blood is to be supplied is compromised and the patient may experience a myocardial infarction or stroke. In less severe cases, it is often sufficient to treat the symptoms with pharmaceuticals and lifestyle modification to lessen the underlying causes of the disease. In more severe cases, a coronary artery blockage can often be treated using endovascular techniques such as balloon angioplasty, atherectomy, laser or hot tip ablation, placement of stents, and the like.
Percutaneous transluminal balloon angioplasty (PTBA) has become a recognized method of reducing the occlusion of blood vessels. The procedure involves routing a catheter having an inflatable balloon at the distal end thereof through the vascular system until the balloon is positioned at the site of the stenotic lesion to be treated. The balloon is then inflated to compress the atherosclerotic plaque into the wall of the blood vessel, thus increasing the size of the opening and enhancing blood flow through the affected artery. However, this successful procedure is overshadowed by the occurrence of restenosis, a re-narrowing of the artery. Studies have shown that 30-40 percent of angioplasty patients experience restenosis within 3-6 months of the angioplasty procedure. When restenosis occurs, patients may be treated with cardiovascular medications, additional angioplasty procedures or bypass surgery.
Restenosis often occurs because the wall of the dilated artery tends to spring back to its original shape following deflation of the dilation balloon. Arterial stenting has been introduced as a solution to the recoil of the vessel wall. Arterial stenting involves the placement of an expandable coil spring or wire-mesh tube within the occluded artery to reopen the lumen of the blood vessel. One example of an arterial stent is disclosed in U.S. Pat. No. 4,739,792 to Julio Palmaz. The Palmaz device comprises an expandable wire-mesh graft or prosthesis which is mounted upon an inflatable balloon catheter. The catheter assembly, including the graft, is delivered to the occluded area and is then inflated to radially force the graft into contact with the occlusion. As the graft expands, the lumen of the blood vessel is opened and blood flow is restored. After complete expansion of the graft, the balloon catheter is deflated and removed, leaving behind the graft to buttress and prevent elastic recoil of the blood vessel wall.
Although this method is successful in preventing recoil of the vessel wall, restenosis will often still occur. Smooth muscle cells which form the vessel wall tend to proliferate and build-up in the newly stented area of the blood vessel. This cellular build-up may eventually become large enough to block the lumen of the blood vessel.
It has recently been determined that localized heating of the blood vessel wall may inhibit the proliferation of smooth muscle cells which are believed to cause restenosis. One example of localized blood vessel heating is disclosed in U.S. Pat. No. 4,799,479 to Spears. The Spears patent discloses an apparatus for angioplasty having an inflatable balloon catheter which is provided with a meshwork of electrical wires to supply heat to a vessel wall. Following balloon angioplasty, the external surface of the balloon is heated to fuse together disrupted tissue elements and to kill smooth muscle cells which are believed to lead to restenosis. Unfortunately, the Spears device does not adequately prevent the spontaneous elastic recoil of the arterial wall. Immediately following angioplasty, the arterial wall begins to spring back to its original shape.
Thus stenting in and of itself is ineffective in preventing restenosis due to the occurrence of cellular proliferation. Likewise, balloon dilation in combination with localized heating does not adequately prevent restenosis since the vessel wall tends to spontaneously return to its original occluded shape.
Other techniques have recently been developed to help reduce incidences of restenosis. For example, procedures for irradiating the angioplasty-site with UV light to reduce the proliferation of smooth muscle cells at the site have been disclosed. In addition, techniques have been disclosed for the controlled application of thermal and/or electrical energy directly to the stent by, for example, including resistive or inductive heating elements that may include radiofrequency electrodes within the stent. The radiofrequency energy is then applied to the stent to disrupt the cellular growth in or around the stent. One major disadvantage of these procedures is that it is difficult to selectively apply the energy to the invasive tissue without causing thermal damage to the body lumen wall. In particular, methods that apply energy, such as RF energy, directly to the stent will often cause thermal damage to the surrounding body lumen in which the stent is anchored.
The present invention comprises apparatus and methods for maintaining patency in body passages subject to occlusion by invasive tissue growth. The apparatus and methods of the present invention may be used to open and maintain patency in virtually any hollow body passage which may be subject to occlusion by invasive cellular growth or invasive solid tumor growth. Suitable hollow body passages include ducts, orifices, lumens, and the like, with exemplary body passages including the coronary arteries. The present invention is particularly useful for reducing or eliminating the effects of restenosis in coronary arteries by selectively removing tissue ingrowth in or around stents anchored therein.
The principles of the present invention are generally applicable to any body lumen which becomes partially or totally occluded. The present invention is particularly useful in a lumen containing a lumenal prosthesis, such as a stent, stent-graft or graft, which may be metallic, non-metallic or a non-metallic coated metallic structure. Restenosis often occurs when arthermateous media or thrombus moves or grows through or around the cylindrical wall of the prosthesis to partially occlude the body passage. Methods of the present invention comprise advancing an electrosurgical catheter within the body passage such that an electrode terminal is positioned near the occlusive media. High frequency voltage is applied to one or more electrode terminal(s) at the distal end of the catheter such that an electrical current flows from the electrode terminals( ), through the region of the occlusive media and to the return electrode to selectively remove the occlusive media without directly applying thermal or electrical energy to the prothesis or the lumenal wall. The electrode terminal is then advanced through the vacancy left by the removed occlusive media to recanalize the vessel. By selectively removing the occlusive media without passing energy directly to the stent, thermal damage to the surrounding lumenal wall is minimized.
A particular advantage of the present invention is the confinement of current flow paths between the return electrode and one or more electrode terminals to the vicinity of tissue ablating region. This confinement of current flow paths minimizes the undesired flow of current through portions or all of the stent, which may otherwise induce non-specific tissue injury beyond the site of recanalization of the occluded lumen. In one configuration, the return electrode is a movable guide wire positioned radially inward from the electrode terminal such that the electrical current flows from the electrode terminal radially inward to the return electrode, thereby inhibiting current flow through the prosthesis. In another embodiment, the return electrode is an annular band positioned proximal of the electrode terminal(s).
In preferred embodiments, the high frequency voltage is applied in the presence of electrically conducting fluid such that a current flow path is generated between the electrode terminal(s) and the return electrode through the electrically conducting fluid. Preferably, the electrically conductive fluid is delivered through an internal lumen in the catheter (or through a separate instrument) to a region around the occlusive media to displace naturally occurring bodily fluids. This region is then fluidly isolated to confine the electrically conducting fluid around the tissue ablation site. In one embodiment, the region is isolated by advancing proximal and distal balloons to either side of the region, and inflating these balloons to effect a seal with the interior wall of the body passage.
Once the target site is isolated from the rest of the vasculature, the supply of electrically conductive fluid is continuously delivered to the region and balanced with the aspiration of fluid from the site of intended recanalization. The electrode terminal(s) are energized by applying a high frequency voltage between electrode terminal(s) and the return electrode, which can be a movable guide wire. A high electric field is created at the surface of the electrode(s) which causes the volumetric removal or ablation or target tissue in close proximity with the electrode terminal(s). As the occlusive media is ablated, gaseous products are generated which are entrained in the electrically conducting fluid and removed through the aspiration lumen in the catheter. The current flux lines are generally confined to the central portion of tissue ablation region because they generally flow inward towards the return electrode and because the occlusive media generally shields the outer region of the body passage (including the stent) from the current flux lines. This minimizes undesirable interaction between the electrical current and the stent. In an exemplary embodiment, the distal portion of the catheter body is reciprocally rotated as the electrode terminal is energized to selectively ablate the occlusive media. The catheter body is then advanced through the vacancy left by the ablated occlusive media to recanalize the vessel.
In a specific aspect of the invention, the high frequency voltage applied between the electrode terminal(s) and the return electrode generates high voltage gradients in the vicinity of the electrode terminals. These high voltage gradients are sufficient to create an electric field at the distal boundary of these electrodes(s) that is sufficiently high to break down the occlusive media through molecular dissociation or disintegration. The high frequency voltage imparts energy to the target site to ablate a thin layer of tissue without causing substantial tissue necrosis beyond the boundary of the occlusive media within the body passage. This ablative process can be precisely controlled to effect the volumetric removal of the occlusive media within a small blood vessel with minimal heating of, or damage to, the surrounding stent and lumenal wall.
A further understanding of the nature and advantages of the invention will become apparent by reference to the remaining portions of the specification and drawings.
The present invention provides systems and methods for selectively applying electrical energy to a target location within or on a body lumen, particularly including atheromatous material which partially or fully occludes a blood vessel or other body lumen. In addition to blood vessels, body lumens that may be treated by the method and apparatus of the present invention include the urinary tract (which for example may be occluded by an enlarged prostrate in males), the fallopian tubes (which may be occluded and cause infertility), and the like. Exemplary solid tissues include abdominal tissues, neurological tissues, benign and malignant solid tumors, myocardial tissue and the like. Thus, the methods and apparatus may be used in a wide variety of procedures, including intravascular, urological, laparoscopic, arthroscopic, thoracoscopic, orthopedic, gynecologic, electrothermal, lithotripsy, spinal disc ablation, and the like. For convenience, the remaining disclosure will be directed specifically to the intravascular treatment of blood vessels but it should be appreciated that the apparatus and methods can be applied to other body lumens and passages as well as solid tissue sites for a variety of purposes.
The stenotic material in blood vessels will be, by way of example but not limited to, atheroma or atheromatous plaque. It may be relatively soft (fresh) or it may be calcified and hardened. The invention applies heat selectively to the stenotic material while limiting unwanted heating of the blood, the surrounding vessel wall and the stent anchored therein. More particularly, the present invention confines the current flow paths between the return electrode and electrode terminals to the vicinity of the tissue ablating region. This confinement of current flow paths minimizes the undesired flow of current through portions or all of the stent, which may otherwise induce non-specific tissue injury beyond the site of recanalization of the occluded lumen.
The present invention may use a single active electrode or an electrode array distributed over a distal contact surface of a catheter. The electrode array usually includes a plurality of independently current-limited and/or power-controlled electrode terminals to apply electrical energy selectively to the target tissue while limiting the unwanted application of electrical energy to the surrounding tissue and environment (e.g., the stent and the lumenal wall). The electrode terminals may be independently current-limited by isolating the terminals from each other and connecting each terminal to a separate power source or current or power limiting element (e.g., inductor) that is isolated from the other electrode terminals. Alternatively, the electrode terminals may be connected to each other at either the proximal or distal ends of the probe to form a single wire that couples to a power source.
The electrosurgical catheter will comprise a flexible body having a proximal end and a distal end which supports one or more electrode terminals. The electrode terminal(s) are preferably supported by an inorganic insulating support positioned near the distal end of the catheter body. The return electrode may be part of the catheter body, part of a separate movable guide wire or on another instrument. In the preferred embodiments, the return electrode comprises a separate movable guide wire positioned within an internal lumen of the catheter body. The proximal end of the catheter will include the appropriate electrical connections for coupling the return electrode and the electrode terminal(s) to a high frequency power supply, such as an electrosurgical generator.
The catheter will also include other internal lumens for providing separate functions, such as delivering fluid and aspirating products of ablation from the target site. Preferably, the catheter will have a fluid delivery lumen for delivering electrically conducting fluid to the target site, and an aspiration lumen coupled to a vacuum source for aspirating non-condensible gases and other products of ablation from the site.
The catheter will also preferably include an isolation system for fluidly isolating the region around the target site. In one embodiment, the isolation system includes proximal and distal balloons that are movable to portions of the body passage proximal and distal to the region of the target site. The distal balloon, by way of example, may be formed on a hollow guide wire that is fluidly coupled to an inflation source, such as a syringe. The proximal balloon, for example, may be coupled to the catheter body proximal to the active and return electrodes.
The invention typically includes guiding apparatus for guiding the catheter along a pathway approximating the central region of the occluded blood vessel. The guiding apparatus is usually an electrically conducting wire that may serve as the return electrode. The electrically conducting wire is extensible from the tip of the catheter and is located within and concentric to the catheter conveniently being in the form of a movable or fixed guidewire, usually being a movable guidewire.
The electrode array may include only one electrode terminal, or it may include at least two isolated electrode terminals, sometimes at least four electrode terminals, sometimes at least six electrode terminals, and often 50 or more electrode terminals, disposed over the distal contact surfaces on the catheter. By bringing the electrode array(s) on the contact surface(s) in close proximity with the target tissue (e.g., occlusive media) and applying high frequency voltage between the array(s) and an additional return electrode in direct or indirect contact with the patient's body, the target tissue is selectively ablated or cut, permitting selective removal of portions of the target tissue while desirably minimizing the application of energy to the surrounding stent and lumenal wall.
In an exemplary embodiment, each individual electrode terminal in the electrode array is electrically insulated from all other electrode terminals in the array and is connected to a power source which is isolated from each of the other electrodes in the array or to circuitry which limits or interrupts current flow to the electrode when low resistivity material (e.g., blood or electrically conductive saline irrigant) causes a lower impedance path between the return electrode and the individual electrode terminal. The isolated power sources for each individual electrode may be separate power supply circuits having internal impedance characteristics which limit power to the associated electrode terminal when a low impedance return path is encountered, may be a single power source which is connected to each of the electrodes through independently actuatable switches or may be provided by independent current or power limiting elements, such as inductors, capacitors, resistors and/or combinations thereof. The current or power limiting elements may be provided in the probe, connectors, cable, controller or along the conductive path from the controller to the distal tip. A more complete description of a system and method for selectively limiting current and power to an array of isolated electrode terminals can be found in commonly assigned, co-pending application Ser. No. 08/561,958, filed Nov. 22, 1995, the complete disclosure of which is incorporated herein by reference for all purposes.
In a preferred aspect, this invention takes advantage of the differences in electrical resistivity between the target occlusive media and the surrounding conductive liquid (e.g., isotonic saline irrigant, blood or the like). By way of example, for any selected level of applied voltage, if the electrical conduction path between the return electrode and one of the individual electrode terminals within the electrode array is blood (having a relatively low electrical impedance), the current control means connected to the individual electrode will limit current flow so that the heating of intervening conductive fluid is minimized. On the other hand, if a portion of or all of the electrical conduction path between the common or return electrode and one of the individual electrode terminals within the electrode array is occlusive media (having a relatively higher electrical impedance), the current control circuitry or switch connected to the individual electrode will allow current flow sufficient for the deposition of electrical energy and associated ablation or electrical breakdown of the target tissue in the immediate vicinity of the electrode surface.
It should be clearly understood that the invention is not limited to electrically isolated electrode terminals, or even to a plurality of electrode terminals. For example, the array of active electrode terminals may be connected to a single lead that extends through the catheter shaft to a power source of high frequency current. Alternatively, the catheter may incorporate a single electrode that extends directly through the catheter shaft or is connected to a single lead that extends to the power source.
In the case of a single electrode, the invention may also use current limiting means to apply electrical energy selectively to the target tissue while limiting the unwanted application of electrical energy to the surrounding tissue.
In this embodiment, the electrode may be connected to current limiting elements or to circuitry which limits or interrupts current flow to the electrode when low resistivity material (e.g., blood or electrically conductive saline irrigant) causes a lower impedance path between the return electrode and the electrode. The current limiting elements or circuitry may be configured to completely interrupt or modulate current flow to the electrode, for example, when a certain percentage of the electrode surface is in contact with low resistivity material. In one embodiment, the current flow will be modulated or completely interrupted when, for example, a large portion of the electrode surface is exposed to electrically conductive fluids and, therefore, not in sufficiently close proximity or contact with the target tissue. In this manner, current can be selectively applied to the target tissue, while minimizing current flow to surrounding fluids and adjacent non-target tissue structures.
In addition to the above described methods, the applicant has discovered another mechanism for ablating tissue while minimizing the depth of necrosis. This mechanism involves applying a high frequency voltage between the active electrode surface and the return electrode to develop high electric field intensities in the vicinity of the target tissue site. In this embodiment, the active electrode(s) include at least one active portion having a surface geometry configured to promote substantially high electric field intensities between the active portion and the target site when a high frequency voltage is applied to the electrodes. These high electric field intensities are sufficient to break down the tissue by processes including molecular dissociation or disintegration. The high frequency voltage imparts energy to the target site to ablate a thin layer of tissue without causing substantial tissue necrosis beyond the boundary of the thin layer of tissue ablated. This ablative process can be precisely controlled to effect the volumetric removal of tissue with minimal heating of or damage to the surrounding stent and tissue structures, such as the lumenal wall.
In an exemplary embodiment, the high electric field intensities at the active portion of the active electrode(s) may be generated by positioning the active electrode and target site within an electrically conducting fluid, such as isotonic saline or the naturally occurring body fluids in a blood vessel, such as blood, and applying a high frequency voltage that is sufficient to vaporize the electrically conducting fluid over at least a portion of the surface of the active electrode in the region between the active portion of the active electrode and the target tissue. Since the vapor layer or vaporized region has a relatively high electrical impedance, it increases the voltage differential between the active electrode tip and the tissue and causes ionization within the vapor layer due to the presence of an ionizable species (e.g., sodium when isotonic saline is the electrically conducting fluid). This ionization, under optimal conditions, induces the discharge of energetic electrons and photons from the vapor layer and to the surface of the target tissue. A more detailed description of this phenomena can be found in application Ser. No. 08/561,958, filed on Nov. 22, 1995, the complete disclosure of which has already been incorporated herein by reference.
Suitable electrode surface geometries for producing sufficiently high electric field intensities to reach the threshold conditions for vapor layer formation may be obtained by producing sharp edges, discontinuities, and/or corners at the active portion of the active electrode(s). Alternatively, the electrode(s) may be specifically designed to increase the edge/surface area ratio of the active portion through the use of shaped wires (e.g., square or hexagonal wires) or tubular electrodes offering high electric field intensities along the inside and outside perimeters of the tubular electrode. Additionally or alternatively, the active electrode surface(s) may be modified through chemical, electrochemical or abrasive methods to create a multiplicity of surface aspirates on the electrode surface. Suitable electrode designs for use with the present invention may be found in co-pending, commonly assigned application Ser. No. 08/687,792, filed Jul. 19, 1996, the complete disclosure of which is incorporated herein by reference.
The voltage applied between the return electrode and the electrode array will be at high or radio frequency, typically between about 5 kHz and 20 MHz, usually being between about 30 kHz and 2.5 MHz, and preferably being between about 50 kHz and 1 MHz. The RMS (root mean square) voltage applied will usually be in the range from about 5 volts to 1000 volts, preferably being in the range from about 50 volts to 800 volts, and more preferably being in the range from about 60 volts to 500 volts. These frequencies and voltages will result in peak-to-peak voltages and current that are sufficient to vaporize the electrically conductive fluid and, in turn, create the conditions within the vaporized region which result in high electric fields and emission of energetic photons and/or electrons to ablate tissue. Typically, the peak-to-peak voltage will be in the range of 40 to 4000 volts and preferably in the range of 100 to 3200 volts and more preferably in the range of 300 to 2400 volts.
As discussed above, the voltage is usually delivered in a waveform having a sufficiently high frequency (e.g., on the order of 5 kHz to 20 MHz) such that the voltage is effectively applied continuously (as compared with e.g., lasers claiming small depths of necrosis, which are generally delivered in brief pulses at a repetition rate of about 10 to 20 Hz). Hence, the duty cycle (i.e., cumulative time in any one-second interval that energy is applied) is on the order of about 50% for the present invention, as compared with lasers which typically have a duty cycle of about 0.001% to 0.0001%.
Usually, the current level will be selectively limited or controlled and the voltage applied will be independently adjustable, frequently in response to the resistance of tissues and/or fluids in the pathway between an individual electrode and the return electrode. Also, the applied voltage level may be in response to a temperature control means which maintains the target tissue temperature within desired limits at the interface between the electrode arrays and the target tissue. The desired tissue temperature along a propagating surface just beyond the region of ablation will usually be in the range from about 40� C. to 100� C., and more usually from about 50� C. to 60� C. The tissue being ablated (and hence removed from the operation site) immediately adjacent the electrode array may reach even higher temperatures. A temperature sensor may be incorporated within the distal end of the electrosurgical device to measure a temperature indicative of the nearby tissue beyond the ablation boundary.
Referring to the drawings in detail, wherein like numerals indicate like elements, a lumen recanalization catheter system 2 is shown constructed according to the principles of the present invention. Catheter system 2 generally comprises an electrosurgical catheter 6 connected to a power supply 80 by an interconnecting cable 86 for providing high frequency voltage to a target tissue and an irrigant reservoir or source 100 for providing electrically conducting fluid to the target site. Catheter 6 generally comprises an elongate, flexible shaft body 12 including a tissue ablating region 8 at the distal end of body 12, and a proximal balloon 40 positioned on body 12 proximal to region 8. In a specific embodiment, a guide wire 28 (which may also serve as a return electrode) includes a distal balloon 18 which may be axially translated relative to region 8 and proximal balloon 40, as discussed in further detail below.
The proximal portion of catheter 6 includes a multi-lumen fitment 114 which provides for interconnections between lumens and electrical leads within catheter 6 and conduits and cables proximal to fitment 114. By way of example, a catheter electrical connector 96 is removably connected to a distal cable connector 94 which, in turn, is removably connectable to generator 80 through connector 92. One or more electrically conducting lead wires (not shown) within catheter 6 extend between one or more active electrodes at tissue ablating region 8 and one or more corresponding electrical terminals (also not shown) in catheter connector 96 via active electrode cable branch 87. In the illustrative embodiment, hollow guide wire 28 functions as the return electrode, and is electrically attached within a contact housing 111 by a sliding electrical contact (not shown). A return electrode cable branch 89 couples the sliding electrical contact to catheter connector 96. Electrical leads within cable 86 allow connection between terminals corresponding to return electrode 28 and one or more active electrodes 32 in distal cable connector 94 and generator 80.
Generator 80 is a high frequency generator operating at a frequency in the range of about 5 kHz to 20 MHZ, more preferably in the range of 30 kHz to 2.5 MHZ. The output voltage of generator 80 can be selectively applied between the return electrode and one or more active electrodes using footpedal 88, which is coupled to generator 80 via a footpedal cable 90 and removable connector 91. Generator has a selector 84 to change the applied voltage level, and may also include a second pedal (not shown) for remotely adjusting the energy level applied to the electrodes. A more complete description of a suitable generator is described in commonly assigned co-pending patent application Ser. No. 08/561,958, filed Nov. 22, 1995, the complete disclosure of which has previously been incorporated herein by reference.
Conductive fluid 30 is provided to tissue ablation region 8 of catheter 6 via a lumen (not shown in
System 2 further includes an aspiration or vacuum system (not shown) to aspirate liquids and gases from the target site, and syringes 106, 108 for inflating distal and proximal balloons 18, 40, respectively. By way of example, as the plunger of syringe 108 is depressed, fluid in the syringe chamber is displaced such that it flows through a conduit 107 and an internal lumen 57 within catheter 6 (not shown in
Referring now to
Referring to
Once the target site is isolated from the rest of the vasculature, the supply of electrically conductive fluid 30 is continuously delivered to region 8 and balanced with the aspiration of fluid from the site of intended recanalization. The active electrode(s) 32 is (are) then energized by applying a high frequency voltage between active electrode(s) 32 and return electrode or guide wire 28. A high electric field is created at the surface of active electrode(s) 32 which causes the volumetric removal or ablation or target tissue in close proximity with active electrode(s) 32. The flow of electrical current between return electrode 28 and active electrode(s) 32 is shown by current flux lines 62 in
Referring to
A first embodiment of tissue ablation region 8 of catheter 6 is shown in
In an exemplary embodiment, the support member 34 will comprise an inorganic insulator, such as ceramic, glass, glass/ceramic or a high resistivity material, such as silicon or the like. An inorganic material is generally preferred for the construction of the support member 34 since organic or silicone based polymers are known to rapidly erode during sustained periods of the application of high voltages between electrodes 50 and the return electrode 28 during tissue ablation. However, for situations in which the total cumulative time of applied power is less than about one minute, organic or silicone based polymers may be used without significant erosion and loss of material of the support member 34 and, therefore, without significant reduction in ablation performance.
As shown in
In use with the present invention, catheter 6 is rotated about 180 degrees clockwise and then about 180 degrees counter clockwise as the electrodes 50 are energized by generator 80 (
Return electrode 28 comprises an electrically conducting material, usually metal, which is selected from the group consisting of stainless steel alloys, platinum or its alloys, titanium or its alloys, molybdenum or its alloys, and nickel or its alloys. The return electrode 28 may be composed of the same metal or alloy which forms the active electrodes 50 to minimize any potential for corrosion or the generation of electrochemical potentials due to the presence of dissimilar metals contained within an electrically conductive fluid 30, such as isotonic saline (discussed in greater detail below).
Referring now to
In use, catheter 6 is rotated about 180 degrees clockwise and then about 180 degrees counter clockwise as the electrodes 32 are energized by generator 80 (
The second embodiment of
A third embodiment of tissue ablation region 8 is illustrated in
A fourth embodiment of tissue ablation region 8 is illustrated in
Referring to
A seventh embodiment of the invention is shown in
|Cited Patent
|Filing date
|Publication date
|Nov 26, 1934
|Aug 11, 1936
|Talley Trice Spencer
|Electric hemostat or cautery
|Aug 16, 1933
|Oct 6, 1936
|Wappler Frederick Charles
|Electrodic instrument
|Mar 10, 1967
|Aug 12, 1969
|Anhalt James E Sr
|Cautery tip
|Jan 2, 1970
|Jan 11, 1972
|Meditech Energy And Environmen
|Chromatic temperature indicator
|Mar 11, 1971
|Nov 6, 1973
|Sherwood Medical Ind Inc
|Pacing catheter with frictional fit lead attachment
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|RF renal denervation catheter with multiple independent electrodes
|Jan 19, 2012
|Dec 29, 2015
|Boston Scientific Scimed, Inc.
|Guide-compatible large-electrode catheter for renal nerve ablation with reduced arterial injury
|Dec 10, 2012
|Feb 23, 2016
|Cardiac Pacemakers, Inc.
|Methods for modulating cell function
|Apr 11, 2011
|Mar 8, 2016
|Vessix Vascular, Inc.
|Power generating and control apparatus for the treatment of tissue
|Mar 4, 2014
|Mar 29, 2016
|Boston Scientific Scimed, Inc.
|Medical devices and methods for treatment of hypertension that utilize impedance compensation
|Nov 14, 2011
|May 3, 2016
|Boston Scientific Scimed, Inc.
|Catheter guidance of external energy for renal denervation
|Mar 12, 2013
|May 3, 2016
|Vessix Vascular, Inc.
|Selective drug delivery in a lumen
|Aug 13, 2009
|May 10, 2016
|Andrea Del Corso
|Occlusion device for vascular surgery
|Jul 30, 2011
|Jun 7, 2016
|Boston Scientific Scimed, Inc.
|Precision electrode movement control for renal nerve ablation
|Oct 10, 2012
|Jun 14, 2016
|Boston Scientific Scimed, Inc.
|Method of making an off-wall spacer cage
|Jan 25, 2005
|May 15, 2008
|Transpharma Medical Ltd.
|Transdermal Delivery System for Polynucleotides
|May 5, 2011
|Bosel Christopher D
|Thermochemical ablation needle
|Aug 13, 2009
|Jul 21, 2011
|Andrea Del Corso
|Occlusion device for vascular surgery
|Dec 6, 2012
|Estech, Inc. (Endoscopic Technologies, Inc.)
|High-voltage pulse ablation systems and methods
|May 22, 2013
|Sep 11, 2013
|Gas-injection thrombosis-removal device and application thereof
|May 22, 2013
|Aug 26, 2015
|U.S. Classification
|International Classification
|Cooperative Classification
|European Classification
|Feb 2, 2006
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Effective date: 20060113
|Sep 17, 2012
|Fee payment
Year of fee payment: 4

subset: commoncrawl


text:
Rep. Alan Silvia is absolutely correct. There's a lot at stake for Massachusetts families this November. We all need to do what we can to encourage more voter participation on the SouthCoast. It starts with making time to vote, but we need to spread the word about what's on the line.
I will be voting no on Question 3. The misguided effort to repeal Gov. Deval Patrick's expanded gaming law will hurt our chance to keep jobs and revenue right here in Massachusetts. Every year Massachusetts residents spend close to $900 million at casinos in other New England states. That's a lot of tax revenue down the drain. We need the expected $400 million in new tax revenues that resort casinos are expected to generate.
Let's stop the madness. Springfield and Plainville have already approved proposals that will bring jobs and revenue.
Vote no on Question 3.
Daniel Garrity
Location, ST | website.com


text:
With both Stanislas Wawrinka and Richard Gasquet losing, the win improves Federer's hopes of making the ATP World Tour Finals in London.
Federer overcame a slow start to win in one hour and 51 minutes but this was the first time in five meetings that he had conceded a set against Istomin.
The second set was relatively comfortable but he had to defend four break points in his first service game of the decider before winning five games on the bounce to move into the next round.
Del Potro overcame Henri Laaksonen in straight sets 6-4 6-4 to move into the next round where he will face Marcos Baghdatis.
The Argentine, who won the tournament last year, dispatched his opponent in one hour and 19 minutes having taken three of his seven break points.
He has already confirmed his place at the 'Final Showdown' in London and is heading there on a good run of form having reached the final at his past two tournaments in Tokyo and Shanghai.
Richard Gasquet's hopes of qualifying for the ATP World Tour Finals suffered a blow when he was surprisingly beaten by Michael Llodra in the first round at the Swiss Indoors in Basel.
Gasquet, who is ninth in the Race to London, would have moved ahead of Stanislas Wawrinka into the eighth and final qualification spot but was ousted in an hour and 10 minutes, losing 6-4 6-2 to fellow Frenchman Llodra.
It is Llodra's first ATP Tour win since Wimbledon in June.
Gasquet has one more chance to reach the season-ending shoot-out in London, which is on home ground at next week's BNP Parisbas Masters in Bercy.
He has been helped by Wawrinka's own failure in Basel, while seventh-ranked Tomas Berdych also crashed out on Tuesday.
Llodra, 33, will face compatriot Paul-Henri Mathieu for a place in the quarter-finals.
ATP Basel results
Round two
3-Roger Federer (Switzerland) beat Denis Istomin (Uzbekistan) 4-6 6-3 6-2
Ivan Dodig (Croatia) beat 6-Kei Nishikori (Japan) 6-1 6-2
Round one
1-Juan Martin Del Potro (Argentina) beat Henri Laaksonen (Switzerland) 6-4 6-4
Vasek Pospisil (Canada) beat Robin Haase (Netherlands) 6-4 6-4
Michael Llodra (France) beat 5-Richard Gasquet (France) 6-4 6-2
8-Grigor Dimitrov (Bulgaria) beat Radek Stepanek (Czech Republic) 6-3 6-3
Paul-Henri Mathieu (France) beat Denis Kudla (U.S.) 6-4 7-5
- Sports & Recreation
- Tennis
- Richard Gasquet
- Michael Llodra
- Federer
- Henri Laaksonen
- Stanislas Wawrinka


text:
News Koichi Ohata Unable to Attend Sakura-Con This Weekend
posted on 2009-04-10 22:05 EDT
Designer of Gunbuster, Macross II, M.D. Geist undergoing emergency surgery
Washington state's Sakura-Con announced on Wednesday evening that Guest of Honor Koichi Ohata will not be able to attend the event this weekend as planned. According to the convention, the prolific mechanical designer and director is undergoing emergency surgery.
Ohata designed the title robot in Aim for the Top! Gunbuster and worked on Mobile Suit Gundam: Char's Counterattack, The Super Dimension Fortress Macross II: Lovers, Again, and Borgman. He also created M.D. Geist and directed Ikkitousen: Dragon Destiny, Burst Angel, Genocyber, Blue Gender: The Warrior, You're Under Arrest: Full Throttle, and various other anime titles.


text:
I stayed three nights at Elena's. Apartment is in good location, just a 5min to the subway Cinecitta station (with takes You in 20min to Termini), 15min to the subway Anagnina station (from there in 30min by bus to the Ciampino airport). The room was cosy and clean, the bed was very comfortable. Additionally there is a big, wonderful balcony where you can rest on fresh air. Elena gives her guests a lot of privacy. You are able to use kitchen as well as some products in the fridge. I definitely recommend this place for stay in Rome.
Problem with this review?


text:
when I open the related post panel to manually add related posts to the article, the search form returns a few article with the specific word I write in search form. Is there a possibility to retrieve more results?
And often there is an article that is not so related to the word I wrote
(ie: I search "ever" and returns one article with the word "clever" in content, but not other articles with "ever" in title).
Thank you.


text:
Very helpful young lady when we checked in and room clean and spacious. BUT, shower luke warm at best, towels small, no milk for tea and coffee in the room.
The worst was yet to come though - We were told that breakfast was from 8.30 until 10 but when we arrived in dining room at 9.40 it was clear that the staff were annoyed that we had arrived 'so late'! We were made to feel very unwelcome by all the staff we encountered. Cooked breakfast was virtually thrown in front of us and noone came to offer us top ups for drinks or any toast, although this was apparently included! In fact they were clearing away around us, including shifting tables about!
A real shame because this could be a really nice place to stay!
- Official Description (provided by the hotel):
- Just two turns from J19 on M62, ideal place to stay over if you visiting Manchester or Greater Manchester destinations. Relax in our cozy lounge. If you fancy a swim or work out we have an arrangement with The Heywood Village Centre which guests can use for free.Free Wifi & Free Car Parking. ... more less
- Reservation Options:
- TripAdvisor is proud to partner with Hotels.com, Travelocity, Priceline, Hotwire, Booking.com and Agoda so you can book your Birch Hotel 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:
- Birch Hotel Manchester
- Birch Hotel Heywood, Greater Manchester, UK


text:
Pickled Beets
Tangy pickled beets are a summertime favorite. Try them as a garnish for a Greek salad or as part of a relish tray at your next summer barbecue.
- 3 1/2 pounds beets, peeled and cut into 1/8- to 1/4-inch-thick slices (about 11 cups)
- 1 tablespoon pickling spice
- 3 cups distilled white vinegar, or cider vinegar
- 3 cups water
- 2 tablespoons plus 2 teaspoons sea salt
- 2 tablespoons sugar
- Step 1
- Place a large bowl of ice water next to the stove. Bring a large pot of water to a boil. Add about a third of the beet slices, cover, return to a boil and cook for 5 minutes. Use a slotted spoon to transfer the beets to the ice water to cool. Repeat with the two remaining batches of beets.
- Step 2
- Drain the cooled beets and divide among 6 pint-size (2-cup) canning jars or similar-size tempered-glass or heatproof-plastic containers with lids. Add 1/2 teaspoon of pickling spice to each jar.
- Step 3
- Combine vinegar, 3 cups water, salt and sugar in a large saucepan. Bring to a boil and stir until the salt and sugar dissolve. Boil for 2 minutes. Remove from the heat.
- Step 4
- Carefully fill jars (or containers) with the brine to within 1/2 inch of the rim, covering the beets completely. (Discard any leftover brine.)
- Step 5
- Place the lids on the jars (or containers). Refrigerate for at least 24 hours before serving. Store in the refrigerator for up to 1 month.
© Meredith Corporation. All rights reserved. Used with permission.
For more recipes go to EatingWell.com


text:
HelpMeVote: Hellenic parliamentary election 2012
Principal Investigator(s) : Andreadis, Ioannis; Chadjipadelis, Theodore;
Citation: Andreadis, Ioannis; Chadjipadelis, Theodore. HelpMeVote: Hellenic parliamentary election 2012. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2014-08-07. http://doi.org/10.3886/E10794V6
Persistent URL: http://doi.org/10.3886/E10794V6
Project Description
HelpMeVote is a Greek Voting Advice Application that was completed about 480000 times in the period from its official beginning (18/04/2012) until the Election Day (06/05/2012). The number of citizens who have participated in the Greek Parliamentary Elections of May 2012 is 6476818. Thus, if we suppose that all HelpMeVote users have used it only once and that all of them have participated in the elections, then we can estimate that HelpMeVote users are circa 7.4% of those who participated in the elections. For updated information please see: http://elnes.gr/node/9
Date Created: 2014-07-01
Scope of Project
Subject Terms: voting behavior, voter preferences, parliamentary elections, issues
Geographic Coverage: Greece
Time Periods : 2012
Additional Publications
Report a Problem
Found a serious problem with the data, such as disclosure risk or copyrighted content? Let us know.
This work is licensed under a Creative Commons Attribution 4.0 International License.
openICPSR data are distributed exactly as they arrived from the data depositor. ICPSR has not checked or processed this material. Users should consult the investigator(s) if further information is desired.


text:
The team from Radio Warwickshire find out what is important in the community and tell you the listener about it. listen to 'We report on what you WANT to know! ' on Audioboo
Meeting the girls talking about the old days..
The team caught up with the Girls to talk about Leamington 50 years ago. listen to 'Meeting the girls talking about the old days..' on Audioboo
We Report on Events in Warwickshrie and Beyond..
Contact the team if you have a story to tell. Listen to Jack Linstead tell the team about his blog and training for the half marathon on March. listen to 'We Report on Events in Warwickshrie and Beyond..' on Audioboo
The Grand Opening of Serious Style
Tonight is the launch of the brand new premises for Serious Style – Hair Boutique, beauty and nails. On Warwick Road Kenilworth. The team open the doors from 7 pm to 9 pm for a glass of bubbly and a chance to meet the team and have a look around the new salon. listen to 'The Grand Opening of Serious …
Award Winning Business Family Business – Bibijis
Business Owners Baljit and Ian from Kenilworth tell the ram from Radio Warwickshire about their awarding winning cooking sauce: Bibijis www.bibijis.com listen to 'Award Winning Business Family Business – Bibijis ' on Audioboo
We Report on Talent – Worcestershire Film Festival
Listen to the interview with the team behind the very first Worcestershire Film Festival – The team from Radio Warwickshire report on the talent in Warwickshire and beyond. listen to 'We Report on Talent – Worcestershire Film Festival' on Audioboo
Interview with George Jesse Turner – International Documentary Maker
The team from Radio Warwickshire were invited along to Coventry University to Meet George Jesse Turner, who has worked on one of the greatest TV documentary series ever, 'Seven Up' started nearly half a century ago on ITV and has followed a diverse group of British children through the thick and thin of life. The critically acclaimed show is pure …
Advertise With – Radio Warwickshire
Fun Days out – Contact the team and send the reporters to your venue to make a bespoke advert for your company. listen Advertise With – Radio Warwickshire' on Audioboo
Singer Song Writer Brian Colburn track – 'Here We Are'
Brian Colburn, independent singer / songwriter latest track – "Here We Are" An acoustic-based rock musician hailing from New Jersey, Brian Colburn has been a mainstay of the NJ music scene for the past decade, and is currently making a name for himself in the singer / songwriter circle. Colburn's music is grounded in soaring melodies and memorable hooks, giving …
folk duo O'Hooley & Tidow –
Folk duo O'Hooley & Tidow: Playing this Friday 25th January at Stratford-Upon-Avon Folk Club, also playing at Warwick Folk Festival in July. Listen to the beautiful track 'The Last Polar Bear' from their current album 'The Fragile'. The team from Radio Warwickshire will be reporting live from the gig – listen again at 7.30pm on the 'A Bit of Liane …


text:
The Equalizer (1985–1989)
Episode List
Season 2
8 Oct. 1986Prelude
When an investigative reporter is abducted. His daughter calls McCall and demands to know where her father is. It seems her father was doing a piece on a country's leader whom Agency helped get into power, whose turned into an oppressor and they want to know who the members of the opposition are. And she claims McCall was the man who helped him get into power. McCall tries to find him but is warned he's going to be stepping on some big toes.
15 Oct. 1986Nocturne
A music critic overhears a voice in an elevator and identifies him as the man who had abducted her, raped and beaten her so badly that she lost her sight.
22 Oct. 1986A Community of Civilized Men
McCall helps a woman who's being harassed by a guy. He warns him off. Later the woman is killed and McCall goes after the guy but it turns it wasn't him. And it also turns out it wasn't her whom the killer was after. McCall thinks it's the woman's daughter and when he goes to see her she doesn't know why so McCall offers to protect her. At the same time Control wants something from him.
29 Oct. 1986Joyride
Some boys decide to take a hearse for a joyride. They find a casket inside filled with drugs. One of the boys decides to sell them, he is later killed. The father of another boy calls McCall for help. McCall learns that the owner of the drugs is a dangerous man and will do whatever he has to to get them back.
5 Nov. 1986Shades of Darkness
A National Guard lieutenant witnesses a murder but the perpetrator escapes and the victim dies in his arms. He is arrested and accused of the crime. His priest, who was with McCall in the army, contacts the Equalizer for help.
12 Nov. 1986Nightscape
A woman is brutally gang-raped on the NY subway and her husband tries to track down those responsible. She contacts McCall to help save her husband.
19 Nov. 1986Counterfire
McCall is arrested for the murder of a blind man who had earlier thrown himself on McCall's car pretending to have been run down.
26 Nov. 1986The Line
A young black man is killed accidentally when a watch group startles him. To protect themselves, they make it appear he was caught in the commission of a crime. And the police believe their claim. But his mother refuses to believe it and calls McCall to prove it. But her other son just wants to get a gun and go after them.
3 Dec. 1986Tip on a Sure Thing
When a race between two horses is being highly touted the press is giving a lot of coverage to the underdog. And everyone seems to be betting on that horse. So a bookie takes all of the action and decides to ensure that the other horse will win. So he kidnaps the son of the underdog horse's jockey. The jockey's wife then calls McCall who advises them to call the police but the man refuses to do that. So McCall turns to an agent who is a gambler to help him find out who kidnapped the boy before the race begins.
10 Dec. 1986The Cup
With McCall at his side, Kostmayer tries to help his brother, a priest, who refuses all assistance after being wounded in a drive-by shooting that kills a parishioner. They soon determine that Father Kostmayer has become privy to a KGB assassination plot revealed through the confession of the murdered man.
17 Dec. 1986Heartstrings
When a woman's newborn baby disappears and the police are unable to help her, she calls McCall. After ruling out the possibility of her child being abducted for ransom or by disgruntled relative. McCall believes that her baby was taken by someone who deals with gray adoptions and when the mother who had earlier agreed to give her baby changed her mind, the person grabbed her child in desperation. McCall tries to find out who this mother is so he can find the broker. And when he finds the person who was going to adopt the baby, McCall learns he has ties to the Agency.
7 Jan. 1987High Performance
A female construction worker while on the job thinks she saw a murder. She then calls McCall to help prove she wasn't seeing things. So he goes to where she saw it to check it out. Problem is that it's the skeletal structure of a building under construction and it's on a high level and he has a fear of heights.
14 Jan. 1987Beyond Control
The death of a KGB mole forces Control to operate without the resources or knowledge of the Company; he asks for McCall's help to locate the stolen files of a secret committee while avoiding one of the KGB's top operatives.
21 Jan. 1987Carnal Persuasion
A woman, whose husband was arrested for a crime she knows he didn't commit, is approached by the judge handling her husband's case and is propositioned by the man. She then calls McCall and tells him what happened. McCall first starts by asking another judge what she knows about the man, and learns that he appeared to come from out of nowhere, which means he is in someone's pocket. McCall then goes to see a friend of her husband who tells him that some criminal needs a man in his position for his smuggling operation but the man is honest and wouldn't be a part of it ...
4 Feb. 1987Memories of Manon: Part 1
Yvette Marcel who is Control's god daughter was grabbed by a couple of men, who then threatens to kill her father who is a Canadian agent unless she can find out who her father's informant known as Chrysalis is. She turns to Control who then asks Robert for help because her mother is someone Robert knew very well.
11 Feb. 1987Memories of Manon: Part 2
After Marcel tells McCall of his connection to Yvette, he goes to make sure she's safe. But Dorgan who is desperate to know who Chrysalis is, grabs her. So McCall has to try and find a way to save her and get Dorgan off Marcel.
18 Feb. 1987Solo
McCall falls for a woman framed in the murder of a police officer.
25 Feb. 1987A Place to Stay
When a young girl from the suburbs runs away from an abusive home environment to live on the streets of New York, the girl's mother hires McCall to find her. He is thrust into the seedy underworld of child pornography in order to save her.
6 May 1987Coal Black Soul
A serial killer of middle-aged women wants McCall to kill him. Meanwhile, McCall begins a romance with a psychiatrist whom he saves from a peeper.
13 May 1987First Light
McCall is out of town appearing in a hearing being conducted by a Senator over an op (operation) Control did a few years ago on him, and McCall's testimony could take Control down. Scott and a friend are trying to help an old man who is being terrorized by someone. After McCall saves Control, he hurries home to help Scott.
20 May 1987Hand and Glove
When the father of a woman with psychological issues is murdered, McCall steps in to help.
27 May 1987Re-Entry
A boy who senses something is wrong with his father calls McCall to help him. McCall learns that he is being pressured to help some people rob his employer. McCall has a plan to help him but the people coercing the father grabs the boy and tells McCall not to interfere. So McCall has to find out how they knew about him and where the boy is.


text:
[ Home | News | Products | Beta | Links | Register ]
v3.5.1, Interactive World Clock with Displays up to 1280x1024
Available as separate Intel and PowerPC Applications. Updated for Recent and Upcoming Time Zone Changes
On this page you may:
Key Benefits of HourWorldTM for the Macintosh
What is it Like? Nothing else. HourWorldTM is unique!
Now incorporating GTS® from Global Time Systems, HourWorldTM offers a trusted worldwide time reference, enhanced with time zone animation that adjusts automatically as daylight saving starts and stops in countries around the world.
HourWorldTM provides a world of time, sun and moon information graphically, attractively, and intuitively. A beautiful blend of graphics and text, HourWorldTM deserves a place in your Power Macintosh.
* What time is it in Alice Springs,
How far away is it, and what direction?
* What is a good time for a conference call with Sydney, Seattle, New York, London, and Manama?
* Is it daylight or nighttime in New York? When is sunrise tomorrow? Sunset?
* Where can I get an almanac printout for my city or location? Kathmandu?
* What will the lighting and shadows be like at 10 AM next October 12, in Santiago, Chile?
* What time will the moon rise in Boston next March 3rd?
* When should I plan my astronomy observation to have a moonless, starry night?
* What direction should I aim my shortwave antenna to pick up Moscow?
* Where along the horizon will the sun and moon rise today? What times?
* What will the moon look like tonight? What is will be the maximum lunar illumination?
* When will it be dark enough to use my telescope?
* Is Auckland on daylight time or standard time on November 14th?
* I have an idea of the lighting I want for a photographic "shoot". When will it occur?
* What will be the solar radiation at local noon today? What is it right now?
VGA HourWorld Display (56k)
DOWNLOADS: The software downloadable below is the full version with full features and documentation. Until a registration key is entered, full operation is limited to 30 days. Registration information is included in the download package. Requires Mac OS X 10.4 (Tiger) or later. Download a version compatible with your Mac.
Download HourWorld v. 3.5.1 for Intel Mac (2006 or later)- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Download HourWorld v. 3.5.1 for PowerPC Mac (2005 or earlier)
[ Home | News | Products | Beta | Links | Register ]


text:
Houseboat, from Edelman
Houseboat is a strategic and creative thinking approach from Edelman designed to enable senior clients to tackle complex and pressing business and communication challenges.
Click here for immediate crisis support
Global Chair, Crisis and Risk Practice: Harlan Loeb
The trust of customers and the public is developed by how companies manage reputational risk and crisis response. This is where our global Crisis & Risk team can help, especially when the stakes are highest.
Our team has built a proven record, validated by very high client satisfaction scores, of protecting the most important, yet fragile, organizational asset: reputation. We represent multidisciplinary backgrounds that include skilled litigators, investigative journalists, business intelligence specialists, veterans of government service and communicators from a variety of business sectors. With team members in more than 60 offices around the world, Edelman is connected 24/7 to provide strategic support and advocacy.
Our team counsels global companies, mid-sized organizations, nonprofits, government entities and high-profile individuals to tackle a range of preparedness, reputational and communications challenges. Our strength lies in an ability to accommodate a breadth of issues and scope while executing flawlessly for our clients.
Over the last 10 years, reputational crisis and risk has escalated dramatically, ushering an era when operating realities require companies to be prepared to move at the new pace of risk.
With the growing confluence and influence of social media, rapidly expanding customer expectations and private regulation driven by cause-oriented nongovernmental organizations, a growing gap exists between reputational risks and organizational capacity to manage them.
We believe the organizational mandate is clear:
Our team has gained international recognition for providing crisis counsel and preparedness support in every industry sector, and our experience extends to:
Expertise & Intellectual Property
Houseboat is a strategic and creative thinking approach from Edelman designed to enable senior clients to tackle complex and pressing business and communication challenges.
The 2014 Edelman Trust Barometer is the firm's 14th annual exploration of trust.
Members of the EMEA leadership team have written a series of essays to share their thoughts on the current state of trust in their market or area of expertise.
We deploy public engagement to help improve public health.
We work with clients from the court of law to the court of public opinion.
Exploring the nuances of consumers in one of the world's most complex and diverse regions.
Edelman and Brandtology's ongoing study to track and analyze online conversations around technology brands.
By taking actions that build trust, companies not only earn a license to operate; they earn a license to lead.
The CFA Institute & Edelman Investor Trust Study highlights the dimensions and actions that shape investors' trust in the investment management industry.
The Edelman Privacy Risk Index (ePRI) helps organizations around the world, better understand security and privacy risk and its impact on corporate reputation.
The Connections Index tool is ideal for any company that wants to understand drivers of engagement and where it should focus employee engagement efforts for maximum impact.
We surveyed 36 companies to explore headcount, reporting lines and areas of improvement.
Our approach centers on listening with new intelligence to help brands meaningfully engage with people online.
Companies must navigate the increasingly complex environment surrounding the collection, use and protection of corporate and personal data.
Edelman Berland's Beltway Barometer surveys 400 of the most politically elite, influential and engaged citizens in the Washington, D.C. area, with 200 respondents per party.
Case Studies
Edelman developed an interactive map and digital advocacy widget for Business Roundtable.
To educate consumers worldwide about cybercrime, Edelman GCRM client Norton partnered "CSI" creator Anthony E. Zuiker on Cybergeddon, a groundbreaking digital crime thriller.
As the global crisis agency of record for the world's largest airline, Edelman serves an integral role in the company's crisis response activities.
Blog Posts
At The Washington Post's 2015 inGENuitY Millennial Entrepreneur Summit held last week in Washington, D.C., Senator Penny Pritzker said, "Taking risks should be valued and nurtured because it allows us to be innovative." Sitting in the audience as both a millennial and budding communications marketer, I couldn't have agreed more.
This week, the NYPD asked people to tweet photos of themselves with officers, tagged with #myNYPD. The responses quickly turned sarcastic and critical.
Here are four key considerations for communicators when dealing with Heartbleed.
Get acquainted with Eugenia, Madrid's "chief morale officer," and learn how she boosts the office's culture and the welfare of her colleagues.
As we confront a crisis of leadership today both in business and government, this half-century anniversary of JFK's death should be a time to reflect and to renew a commitment to seek out common purpose and collective destiny.
As we come to grips with the full impact of Haiyan on the Philippines, keeping the story going will be instrumental to rebuilding and recovery.
"Never waste a crisis," explains Pat Christen, CEO of HopeLab. "Everyone has resilience, and resilience is inherent in innovation."
I had the pleasure of play-acting the role of a hyper Indian journalist arriving at the scene of an explosion at a factory. This is how a typical mock interview went.
At the annual meeting of the Public Relations Institute of New Zealand, I was asked to address global trends and where I felt the PR industry was heading.