text:
|Publication number
|Publication type
|Application number
|Publication date
|Sep 1, 1998
|Filing date
|Apr 26, 1995
|Priority date
|Apr 26, 1995
|Fee status
|Also published as
|Publication number
|Gail Stevens, Todd A. Thompson, Steven A. Daniel, Robert D. Warner
|Original Assignee
|Gynecare, Inc.
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (53), Non-Patent Citations (8), Referenced by (154), Classifications (19), Legal Events (5)
|External Links: USPTO, USPTO Assignment, Espacenet
This invention relates to a system for ablation of the endometrium of a uterus of a patient, and more particularly to an intrauterine ablation system of the type having a heated distensible bladder secured to a tubular member connected to a controller for monitoring the pressure and regulating the temperature of an inflation medium.
The following terms as used herein have the meaning given below:
"Menorrhagia" means a condition causing excessive uterine bleeding in women.
"Cauterization" means the application of heat to tissue in an amount sufficient to destroy the tissue.
"Necrosis" means the death of cells in tissue.
"Endometrium" is that portion of the inner lining of the uterus to which an embryo normally attaches and excludes the portions of the uterine inner lining forming the cervix, to which the embryo usually does not attach.
Apparatus and methods for cauterization of the endometrium of a uterus, useful in sterilization procedures and cancer treatments, are well known. Thermal and cryogenic treatments have been utilized in such cauterization techniques and typically involve either the direct or indirect application of heat or cold to the tissue to be treated.
For example, a laser hysteroscope has been used to cauterize the endothelial layer of the uterus. Such a laser based procedure suffers from several disadvantages. Foremost, the use of a laser requires the application of an intense amount of thermal energy to a relatively small area of tissue, even though such a large amount of heat may not be necessary to effectively cauterize the tissue. Further, such a treatment requires the physician to continually reposition the laser used in the treatment within the uterus in order to treat the entire endometrium. Such internal manipulation of a laser hystero-scope within the uterus of a patient is both difficult, requiring a significant level of skill to perform, and potentially dangerous. Accidental puncture of the uterine or tissue wall may result from manipulation of the laser scope within the uterus or body cavity, and tissue layers beneath the endo-metrium may be burned if a laser's beam is left focused on one area of tissue for too long a period of time.
Methods and devices have been disclosed for necrosing tissue cells that utilize an extendable bladder which is inserted in the uterus and filled with a circulating fluid or gas at cryogenic temperatures. Such a bladder is maintained in substantially continuous contact with the inner surface of the uterine lining by using liquid nitrogen or freon to pressurize the bladder to a level which ensures adequate contact with the uterus. Such a method and apparatus suffers from the disadvantage of employing cryogenic fluids which could prove toxic to a patient in the event of bladder rupture. Another disadvantage is that the required extremely low temperatures pose a threat to tissue layers adjacent to the uterine endometrium.
A method is also known for effecting necrosis of the endometrium by inserting a distensible bladder into the uterus. The distensible bladder is inflated to a predetermined pressure with a fluid so that the distendable bladder is in contact with substantially all of the tissue lining for which necrosis is desired. The fluid is heated by means of a heating element positioned internal to said distendable bladder. The temperature and pressure of the fluid is controlled by means connected to the distendable bladder. The bladder is maintained inflated with the fluid at a temperature for a period of time sufficient to effect necrosis of the endometrium. Heretofore, such systems have been configured with inefficient heating elements and difficult to use catheters.
Consequently, there is a need for an intrauterine ablation system having a heating element disposed within a distensible bladder that is efficient, while providing reliable control of temperature and pressure, yet being economically and ergonomically configured.
Briefly and in general terms, the present invention provides an apparatus, system and method for endomthelrial ablation. The apparatus provides for heating of an inflation medium within a distensible bladder positioned within a uterus of a patient. The apparatus introduces the inflation medium under pressure into the distensible bladder so as to assure substantially uniform contact of the bladder with the endometrium. The system provides for regulating the temperature and pressure of the inflation medium while the distensible bladder is within the uterus for a desired period of time. The invention further provides a safe and efficacious method for ablating the endometrium of the uterus. The present invention thus provides a relatively inexpensive and easy method to treat menorrhagia in women.
The apparatus of the present invention comprises an elongate tubular member having a first lumen in fluid communication with a handle secured to the proximal end of the tubular member. The apparatus further includes a distensible bladder, for example, a latex rubber balloon, secured to the distal end of the tubular member, for example, a trilumen insertion catheter. A heating element is secured to the distal end of said elongate tubular member and disposed within said distensible bladder.
The heating element includes a tubular core member secured to the distal end of the elongate tubular member. A resistive wire is wound bifilar about the core member and a tubular heat conductive shell is disposed over the core member and the resistive wire. The shell is formed with a wall having a plurality of longitudinal slots for permitting the inflation medium to contact the resistive wire. A first thermocouple is secured to an outside surface of the wall of the tubular shell and a second thermocouple is secured to an inside surface of the wall of the tubular shell.
The handle body is secured to the proximal end of the elongate tubular member and is configured to be wye-shaped. The proximal end of the handle is configured with a fluid fill port connected to and in fluid communication with an inflation lumen of the tubular member. A valve is placed between and in fluid communication with the inflation lumen and the fill port. A syringe may be provided to connect with the fill port to inflate said distensible bladder with inflation medium to a desired pressure.
The wye of the handle further includes a pressure port in fluid communication with the inflation lumen. The one segment of the wye houses an electric socket connected to at least two wires carried within a second lumen of the tubular member and connected to the heating element. Similarly, the electric junction is connected to the four thermocouple leads carried by a third lumen of the tubular member.
The system for performing endothelrial ablation additionally comprises a controller configured to connect to the electrical socket for providing and regulating electric current to the heating element. The controller also includes a pressure sensor in fluid communication with the inflation lumen of the tubular member to provide a pressure signal to a pressure display for visualizing the pressure in the distensible bladder. Further, the controller includes a temperature converter for generating a temperature signal from the thermo-couples and a temperature display for visualizing the temperature within the distensible bladder. The pressure and temperature displays are located on a front panel of a box or unit which contains the controller components.
The controller further comprises a timer for generating an elapsed time signal which is connected to a display also on the front panel of the controller. A heating element controller is electrically connected to the heating element and configured to generate electric current to the resistive wire. Lastly, the controller includes a microprocessor configured to accept the pressure signal, the temperature signal and the elapsed time signal. The microprocessor is further configured to regulate the electric current generated by the heater controller as a function of the temperature, pressure and elapsed time.
The method of the present invention for performing endometrial ablation comprises providing a system in accordance with the present invention and inserting the distensible bladder and a portion of the tubular member into a uterus of a patient. A source of inflation medium is connected to the fluid fill port of the handle and the valve in the handle is opened. The distensible bladder is inflated with the inflation medium to a desired pressure and the valve is closed.
The inflation medium within the distensible bladder is heated by providing electric current to the resistive wire of the heating element. The method provides for heating the inflation medium within the distensible bladder to a desired temperature as indicated by the thermocouples and maintaining the temperature and pressure within the distensible bladder for a desired time interval. Afterwards, the distensible bladder is deflated and the distensible bladder and tubular member removed from the uterus of the patient.
These and other features and advantages of the present invention will become apparent from the following more detailed description, when taken in conjunction with the accompanying drawings which illustrate, by way of example, the principles of the invention.
FIG. 1 depicts a distensible bladder utilized in the method of the present invention which has been inserted into and inflated within uterus of a patient.
FIG. 2 depicts placement of the distensible bladder within the uterus.
FIG. 3 is a perspective of an apparatus constructed in accordance with the invention that illustrates the balloon catheter connections.
FIG. 4 depicts the front panel of the system control unit.
FIG. 5 depicts the rear panel of the system control unit.
FIG. 6 is the vented heating element shell utilized in the method of the present invention.
FIG. 7 is a cutaway view showing the catheter handle.
FIG. 8 is a side view of the handle and its connections to the control unit.
FIG. 9 is partial cross-sectional view showing the heating element of the embodiment shown in FIG. 7.
FIG. 10 is a cross-sectional view of the trilumen insertion tube showing the heating element wire leads and the thermocouple pairs.
FIG. 11 is a cross-sectional view of the umbilical cable.
FIG. 12 is a flow chart of the process control loop showing the monitoring of temperature, pressure and time by the control unit.
FIG. 1 shows an inflated distensible bladder or balloon 5 attached to a trilumen insertion tubing 3 located within a human uterus 6. Inflation of the distensible bladder 5 with a fluid 25 assures uniform contact of the bladder with the endometrial tissue layer 27 of a uterus 6.
The trilumen insertion tubing 3 and the attached distensible bladder 5 must be sufficiently small, when the distensible bladder is deflated, so that it can be conveniently and safely inserted into the uterus 6 through a partially dilated cervix. The trilumen insertion tubing with the deflated bladder is aligned with the cervical canal after the cervix is exposed with a speculum and grasped with a tenaculum. After the distensible bladder 5 has been inserted, the distensible bladder 5 should be inflated to a pressure sufficient to ensure firm contact with the endometrial tissue layer on the interior uterine surface. The bladder pressure should be maintained at or about 45 to 200 mmHg, and preferably about 120 to 160 mmHg, to minimize risk of rupture of the distensible bladder 5 and possible internal injury to the patient.
The distensible bladder 5 must be capable of withstanding high temperatures without rupturing, and preferably is formed of a material that has good heat transfer characteristic to provide efficient heating action. A distensible bladder of a heat curing rubber, such as latex rubber has been found satisfactory. Inflation medium or fluid 25 preferably should be a sterile non-toxic fluid. A five percent dextrose in water solution has been found satisfactory.
As illustrated in FIG. 2, the uninflated distensible bladder 5 attached to trilumen insertion tubing 3 is inserted into the vagina 21, past the cervical os 22, through the cervical canal 23, for placement in the uterine cavity 20. Placement may be aided by virtue of scale gradations 4 present directly on the insertion tubing 3 to indicate the depth of insertion of the bladder 5. The trilumen insertion tubing 3 is made of semi-flexible material, for example acrylonitrile-butadiene-styrene (ABS), to permit easier insertion into the uterus, while providing support needed to manipulate the distensible bladder 5. The trilumen insertion tubing 3 is connected to a control unit 30 as shown in FIG. 3.
FIG. 3 depicts the arrangement of control unit 30 and balloon catheter 1, comprising the distensible bladder 5, insertion tubing 3, catheter handle 10 and the interconnection of those elements. A fluid path comprises that portion of the invention through which the fluid 25 travels, including a fluid source such as a syringe 14, connected to the proximal end of catheter handle 10 via a fluid fill port 16, catheter handle 10, insertion tubing 3, and distensible bladder 5. Hypodermic barrel 14 is connected to the catheter handle 10 through fluid fill port 16 and may be secured in place by a luer lock or other suitable devices. A fluid fill valve 18 is also provided on the catheter handle 10. Manipulation of the fluid fill valve 18 enables the operator of the system to control the amount of fluid 25 in the fluid system, inflation and deflation of the distensible bladder by adding or removing fluid, respectively, and pressure of the fluid 25 in the system. Fluid fill valve 18 also provides protection for the patient by allowing fast and safe reduction of excessive pressures in the system that might build up through some malfunction.
Manipulation of the syringe 14, by depressing a plunger 60 and fluid fill valve 18 at the same time, causes inflation medium 25 to be introduced through the catheter handle 10 into the insertion tubing 3. The inflation medium 25 emerges from insertion tubing 3 and into distensible bladder 5, forcing distensible bladder 5 to expand into contact with the endometrial tissue layer 27 of the uterus 6. The fluid 25 is also directed along the flexible tubing 3 to the control unit 30 allowing measurement of the fluid pressure within the bladder as described below.
Each of the parts of the fluid path is in fluid communication providing constant fluid pressure within the entire fluid system and allowing measurement of pressure of the end attached to the control unit 30. Control unit 30 is connected to catheter handle 10 at its proximal end by means of an umbilical cord or cable 23.
The catheter handle 11, shown in FIGS. 7 and 8 comprises a fluid fill valve 18, connection sacket 19 and connection part 83, and fluid fill port 16. Sacket 19 is designed to accept the power/temperature umbilical cable 70. As shown in FIG. 8, connection plugs 86 may be provided to secure the umbilical cable attachment to the catheter handle. Connection port 83 is designed to accept the pressure line 87.
When the syringe 14 is attached to fluid fill port 16 of the catheter handle 10, fluid can be introduced into the catheter by depressing the fluid fill valve 18 and the plunger 60 at the same time. The pressure display monitor located on the control unit 30 reads the pressure and if the pressure in the distendable bladder is below 70 or above 180 mmHg a warning signal and/or alarm alerts the user that the pressure is either too low or too high. A range of between 120 and 160 mmHg, preferably 150 mmHg is considered to provide the acceptable range of operation.
To remove excess fluid pressure from the distendable bladder 5 when the pressure is too high or when desiring complete removal of the catheter, the plunger 60 of the syringe 14 is drawn back while the fluid fill valve 18 is depressed to create and maintain a negative back pressure. This action will draw the distendable bladder 5 tighter against the catheter.
Referring now to FIG. 7, fluid fill valve controls the fluid pressure supplied to the distendable bladder by being internally connected to the internal pressure line 85 which is connected to the pressure line connector port 83. The body of the handle has a first extremity 86 and a second extremity 89 forming a wye. The fluid fill port 16 is disposed within the first extremity 86. The electrical connectors of the heating element 44 are disposed within the second extremity 89. A pressure port 83 for line 85 is also disposed between the first and second extremity 86 and 89. When fluid fill valve 18 and plunger 60 are depressed, the fluid will be supplied to the distendable bladder 5. Similarly, when the fluid fill valve 18 is depressed and the plunger 60 is drawn back, the resulting negative back pressure which forces the fluid away from the distendable bladder 5 and back into the insertion tube 3 to relieves the pressure.
The control unit 30 is designed to regulate or control heat and operating times as well as monitor and display pressure valves. FIG. 4 shows the front panel 500 of control unit 30. The control unit 30 includes a power switch 529, start button 540 and start button light 550. The temperature of fluid 25 in the distensible bladder 5 is shown at catheter heater temperature display 570. Similarly, the pressure of the bladder is shown at display 560. These indicators allow the practitioner to readily reach the preset pressure range by varying the amount of fluid in the fluid path via manipulation of the syringe 14.
Fluid pressure within the bladder is monitored by displays located on the front of the control unit panel 500. The pressure connector 591 is designed for receiving the pressure line and is directly connected to the pressure transducer (not shown) internal to the control unit. The pressure transducer measures the internal pressure of the fluid path including the pressure of the fluid inside the distendable bladder. The pressure transducer generates a signal indicative of the internal pressure of the fluid path including the pressure inside the distensible bladder.
A connection port 592 is also provided for attaching the umbilical cable to the control unit which can be used both for providing cable and monitoring the temperature within the distendable bladder.
The control unit 30 is a software controlled system with necessary hardware safety backups. The software controls the fluid temperature and pressure, while monitoring the elapsed time of the procedure. The elapsed time is shown in minutes and seconds at display 580. The software includes steps like priming and filling the catheter and starting and stopping the heating therapy cycle. The temperature and pressure, however, are measured and read by both the hardware and the software.
FIG. 12 is a flow chart showing the monitoring of pressure, temperature and elapsed time by the control unit 30. Process control loop of FIG. 12 monitors the acceptable range of measurements for pressure, temperature and elapsed time. When the measurements for temperature, pressure and time exceed or fall below a certain point, the device automatically shuts off. However, before shut off range is reached, the device will alert the user that either pressure, temperature or time variable has entered a dangerously unacceptable range. The user can be alerted by either lighting the hazard light 510 on the control unit panel, by activating an alarm signal, or by both.
Step 121 shows that the present device shuts off automatically when the pressure either exceeds 200 mmHg or falls below 45 mmHg. Warning range 120 can be preset signifying that the pressure measurements are approaching a critical level. In one embodiment, for example, the user was alerted every time the pressure either exceeded 180 mmHg for 2 seconds, or fell below 70 mmHg for any time period.
Step 122 provides automatic shut off for time elapsed for preheat time. The preheat time, or the time it takes for the fluid temperature to reach the level where the therapy session is to be started is set here to a maximum of four minutes. If the temperature has not reached the therapy temperature, a warning signal is given and the device is shut off. Similarly, the elapsed time for the therapy session here is set to eight minutes, not including the preheat time, after which the device will automatically shut off as shown in step 123.
As shown in FIG. 12, the temperature is monitored and displayed by the software. It is desirable for the temperature to reach 85 to 90 degrees Celsius during therapy session, preferably 87 degrees Celsius. When the fluid 25 is first introduced, it has a temperature equal to room temperature. The heat from the body cavity can elevate this temperature to slightly above the room temperature at the onset of the procedure.
Step 124 shows the preheat stage, where the fluid temperature is raised from that of the room temperature to a temperature between 50 and 60 degrees Celsius, preferably 55 degrees Celsius. At 55 degrees Celsius, the therapy stage commences. The preheat stage 124 usually takes between thirty to ninety seconds but it can not exceed four minutes, since the device will automatically shut off operation after four minutes of preheat time if the temperature has not been elevated to 50 to 60 degrees Celsius.
During the therapy stage 125, the temperature is monitored regularly and the heating element 44 is controlled to either slow down the heating process or speed it up. In general both the speeding process during the initial preheat stage and the speeding up and slowing down process of the heating element 44 during the therapeutic stage is controlled by shutting on and off the heating element switch internal to control unit 30.
The software sets up special delays by which the amount of time that the heating element is on and off is controlled. For example, initially during the preheat stage, the heater may be on for 1 milli-second and off for 128 or 256 micro-seconds. But as the preheat stage is terminated and the therapy stage commences, the shut off time may be increased. Basically as shown in FIG. 12, during both the preheat and the therapy stage, the temperature gradient is monitored. If the temperature is increasing and approaching the upper temperature limit the ratio between the on time and off time, or the duty cycle time, is cut in half. Similarly, when the temperature is decreasing and reaching the lower limit, the on to off ratio is increased by a factor of two. This process is repeated until a change in achieved and the temperature either begins to rise or fall as desired. When the temperature enters the desirable range of 85 to 90 degrees Celsius, the duty cycle time is slowed down to maintain the desired range.
When the temperature exceeds 95 degrees or falls below 75 degrees Celsius at any time after the therapy session is started, the device will automatically terminate its operation. However, the user is first alerted before the heating element is shut off completely. In one embodiment, the user was alerted whenever the temperature exceeded 95 degrees or fell below 83 degrees Celsius for a period of 2 seconds or more. In this same embodiment, the heating element's operation would be automatically terminated whenever the temperature exceeded 90 degrees Celsius for 15 seconds (without having to exceed 95 degree limit).
The control unit hardware also includes error correction mechanism with error correction code embedded in the software. A communication port (not shown) or an output port for communication with I/O devices such as a PC printer can also be included when such need exists. The communication port includes a parity checker and interrupt handling mechanism.
In this manner, the control unit 30 monitors and displays instantaneous pressure and allows the device to operate between preset limits of 45 and 200 mmHg. If the pressure readings fall outside these limits, the hazard light 510 turns on.
Similarly, the unit also regulates the temperature inside the distensible bladder 5 by changing a series of electrical current pulses to the heating element 44. When the measured temperature exceeds a preset limit of about 95 degrees Celsius, the hazard light 510 turns on and the electrical current to the heating element is terminated and the user is instructed to abort the procedure.
FIG. 5 depicts the back end or rear of the control unit panel 595. Several fuses 596 are provided as well as a connection port 598 for the providing power to the unit. A voltage indicator 597 is also provided which can be adjusted so that the device is operable either at 110 or 220 V.
Referring now to FIG. 6, at the distal end and affixed to the insertion tube 3, the distensible bladder 5 houses a heating element 44 and two thermocouples 66 and 68. The heating element 44 and one of the thermocouples 66 are surrounded by a heating element shell 45 which has circulation user 46, as shown in FIG. 6, to allow fluid inside the latex balloon to come in contact with the heating element and to protect the balloon from heater coils 47. The second thermocouple 68 is placed outside the heating element shield 45.
The heating element 44 can be viewed with reference to FIGS. 6 and 9. FIG. 6 is an external view of heating element 44, which comprises heating element shell 45 and circulation vents 46. FIG. 9 is a side view, more detailed depiction of the heating element 44, wherein resistive wire leads 49 provide power from system control unit 30 to heating element coil 47 causing heating element coil 47 to heat the fluid 25 which comes into contact with the heating element coil 47 as the fluid 25 flows through the circulation vents 46. The heating element coil 47 is a bifilar wound wire twisted around a core 49, the core being made preferably of ceramic material. The end of the looped wire is then affixed securely to the core 49 at each terminating end 13, and 21. Temperature of the fluid 25 is measured by thermocouple 48 and is displayed at temperature display 32. Heating element coil shell 45 prevents distensible bladder 5 from contacting the heating element coil 47 directly.
The distal end of the core and the heating shell are secured to a plastic tip 52 and the proximal end is secured to a second plastic housing 54 that contains the wires that carry the electrical current into the heating element. A structural support metal conduit 56 is partially embedded in this second plastic housing to ensure structural integrity. The second plastic body 54 is secured to the trilumen insertion tubing 3.
FIG. 10 provides a cross-sectional view of the trilumen insertion tube 3. The trilumen insertion tube 3 has special internal pattern with a circular portion 60 in the middle and two pie shaped portions 61 and 62 encompassing the perimeter of the middle circular portion 60. The circular portion 60 is designed as a fluid channel or path into the distensible bladder 5. The two pie shaped portions 61 and 62 house the thermocouples 66 and 68 and the heater wires 67, respectively.
FIG. 11 depicts a cross-sectional view of the umbilical cable 70. The umbilical cable 70 is used to connect the control unit 30 to the balloon catheter 1, as shown in FIG. 3. The umbilical cable 70 conducts electrical power to the heating element 44, electrical temperature measurement signals from the thermocouples 75 and 76, and shields against Electro Magnetic Interference (EMI) and Radio Frequency Interference (RFI). The umbilical cable 70 interfaces with the control unit 30 and the balloon catheter 1 via a combination of dedicated electrical connectors like plugs and receptacles. The umbilical cable 70 is packed specifically to reduce the outside diameter of the cable.
FIG. 11 shows that the umbilical cable comprises a sheath 74 in which three sets of electrically conducted wires 77, 78 and 79 ultimately connected to the heating element 44 are twisted and packed within the sheath into a low profile twist.
An inner shield 72 is placed in the center of the cable 70. The inner shield 72 houses the two thermocouple pairs 75 and 76. The three sets of electrically conductive wires 77, 78 and 79 are placed at equidistant places around the perimeter of the inner thermocouple shield. These three sets of electrically conducted wires 77, 78 and 79 are ultimately twisted together to provide one set of heater wires which connect to the heating element 44.
The overall methodology used for this treatment of menorrhagia comprises of: powering on the controller; starting-up the initialization process; inserting and filling the catheter and pressurizing it to pressure set point; starting the heating therapy by activating the heating element; continuing the heat and pressure therapy for a preset time of about eight minutes; and monitoring the temperature and pressure during this time so that it does not go beyond a set point of about ninety degrees Celsius. At set time intervals, the current temperature is read to either increase until it reaches the set point, or to maintain the temperature after it reaches the set point.
The invention will now be illustrated by the following example.
The cauterization procedure is preceded by screening against cancer of the affected region within established norms. A PAP smear and endometrial biopsy/ curettage must exclude cancer or precancerous lesions of the uterus and cervix. If a fibroid uterus is present, an ultrasound should exclude ovarian masses. The uterine cavity must be 10 cm or less in length to be suitable for the small distensible bladder size.
It would be preferable if the patient is in a post menstrual condition. Alternatively, the patient may be treated with Danazol or the equivalent. Danazol therapy causes reduction in bleeding to a rate of 800 ml daily as well as a thin endometrium. The treatment should be continued from the 5th day of the previous menstrual period until two weeks after the procedure. However, treating the patient with Danazol or requiring the patient to be in a post menstrual condition is not required. The patient will undergo the procedure in the ambulatory surgery unit or outpatient facility where Valium and/or Demerol can be given intravenously if there is pain during the heating phase of the procedure.
The applicator is inserted after a bimanual examination and speculum of the cervix. Dilation to 6 mm, may be required which may necessitate a local 1% lidocaine block of the cervix. Once in place, the applicator stem protrudes from the vagina and consists of an electrical connecting plug, pressure line, syringe fill port, and rigid tubing. Placement of the applicator may be facilitated by distance markings on the rigid tubing indicating depth of insertion.
Upon placement of the applicator, it will be connected to a control unit via attachment of the electrical connector and flexible tubing attached to the handle to their receptacles on the control unit.
Subsequent to insertion of the applicator, the control unit will be powered on. The temperature of the fluid in the bladder will be preset to 87 degrees Celsius by the control unit and can be measured via the thermocouple located within the bladder. Fluid pressure constraints are preset and upon inflation of the distensible bladder by introduction of fluid to the fluid system by depressing the plunger on the hypodermic barrel, can be easily measured by looking at the pressure display located on the control unit.
The practitioner then proceeds to inflate the distensible bladder by the plunger on the hypodermic barrel which may serve as the fluid source. The practitioner injects the fluid into the fluid system until the control unit display indicates that the fluid pressure is within the preset constraints. The volume required to fill the distensible bladder is about 30 cc in most cases in order to reach the pressure wherein the bladder is substantially in contact with all of the endometrium.
The practitioner then turns on the heating element in order to heat the fluid to a preset level. The heating element in the bladder is connected via the plug to bring the fluid in the bladder to a temperature of about 87 degrees Celsius. Once that temperature level is reached, the system timer is activated to time the procedure and provide automatic turn off of the heating element at the end of a pre-set period.
Upon completion of the procedure, the pressure valve and plunger are depressed to allow the fluid to be withdrawn from the fluid system causing the distensible bladder to deflate. Upon deflation of the distensible bladder, the applicator may be safely withdrawn from the patient.
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|U.S. Classification
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|International Classification
|Cooperative Classification
|European Classification
|Jul 10, 1995
Owner name: GYNECARE, INC., CALIFORNIA
Free format text: ASSIGNMENT EFFECTIVE AS OF APRIL 26, 1995;ASSIGNORS:STEVENS, GAIL;THOMPSON, TODD A.;DANIEL, STEVEN A.;AND OTHERS;REEL/FRAME:007527/0187
Effective date: 19950630
|Mar 20, 2000
Owner name: ETHICON, INC., NEW JERSEY
Free format text: MERGER;ASSIGNOR:ETHICON, INC.;REEL/FRAME:010685/0961
Effective date: 19991210
|Feb 13, 2002
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text:
Jennifer Aniston - Pregnant!
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text:
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Hotel Prince
Near Nayuma Cable office, Tibet road, Palijor Stadium Road, Gangtok 737101, India
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Hotel Prince is located in the heart of Gangtok. It is at 7 kilometer away from Hanuman Tok. The location of this hotel is planned to commute easily to the must see destinations around. This budget property includes Room service, Luggage storage, free parking.
Near Nayuma Cable office, Tibet road Palijor Stadium Road, Gangtok 737101, India


text:
Yatra Itinerary:-
Day One: Chennai
Day Two: Tirupati
Day three: Mahabalipuram
Day Four: Mahabalipuram
Day Five: Chennai Departure
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O Accommodation at Chennai, Tirupati and Mahabalipuram
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text:
Universal Fit
Brainwavz S0 In-Ear Headphones
"Recently I was contacted my Brainwavz to sample one of their brand new products. This review however will be a little different from others and quite a bit shorter as we're only doing some basic design impressions and mostly what counts, the sound to give you guys out there a grasp on S0's signature. To my understanding Brainwavz S0 is a budget orientated in ear headphone that's..." --H20Fidelity
"TDK IE800 VS. BA200 IE800 $40-90 (Discontinued by manufacturer) BA200 $55-120 (Discontinued by manufacturer) (on Head-fi, Ebay, and Amazon) Some have even found these at Ross and TJ Maxx for $10-20. Packaging: Pretty much the same packaging for both IEM's. If both packages were side-by-side, you'd probably have to read the labels pretty carefully to..." --aiaosu
Brainwavz S3
"At the time of the review, the Brainwavs S3 was was on sale at Amazon.com for $79.50 USD. Here is a link to their listing of the product: http://www.amazon.com/gp/product/B0162C1P9O?keywords=brainwavz%20s3&qid=1445842977&ref_=sr_1_1&sr=8-1 Introduction It seems like every few months Brainwavz has an exciting new product coming to the market. While many will feel that..." --Hisoundfi
Brainwavz B2 Dual Balanced Armature Earphones
"Summary of my experience with these: Build: Feels cheap and plasticky. In fact the box appears better made than the earphones. :) Treble: Very detailed, forward and sharp. No real sibilance BUT is very fatiguing after even after short listening sessions Mids: Again very detailed but there appears to be some forward and some recessed elements depending on the track you are listening to. The..." --Krisman
Brainwavz XFIT XF-200 In-Ear Sport Monitors
"For larger images (1200 x 800 - please click any photo)INTRODUCTION Brainwavz is a company that has a good name at the lower end of the price market when it comes to portable audio, and they've specialised particularly in the $20 - $100 end of the market, offering many choices which should give options to suit most people's budget and individual preference. I've previously had both good and bad..." --Brooko
Brainwavz Omega In Ear Monitors
" Many thanks to Brainwavz for the review sample of Brainwavz Omega! Brainwavz Omega is budget IEM from Brainwavz, similarly priced to Brainwavz Jive. Unfortunately I don't have Brainwavz Jive to be compared with, but I will compare it with other IEMs in the similar price category. Product..." --earfonia
Brainwavz R3 Dual Dynamic Driver Earphones
"Quick Summary: While these earphones have a really "unique" design to them, once you get over this, you will be rewarded with a beautifully balanced sound. I would put them on a similar tier as the very popular, and head-fi favorites Hifiman re400 and the Vsonic GR07. This is very high praise, let's find out below! I want to thank Brainwavz for their patience and for sending a pair of..." --Tom22
Brainwavz M3
"Preamble: Before I start with my actual review, I'd like to thank Pandora from GPGSHK and Brainwavz for providing me with a sample of the Brainwavz M3 in exchange for my honest in-depth review. Brainwavz is a Chinese company that is known for making inexpensive headphones with a good price-performance ratio. The M3 that has nothing to do with the same-named German car (J) except for the name..." --HiFiChris
Brainwavz R1
"I'll start of by saying these are a pair of really respectable headphones and these are my subjective opinion on them. At their price point, I think you'll be hard pressed to find anything better without going higher in pricing They perform well for their price. All in all, a good pair of headphones just for casual everyday listening of music. Audiophiles will not be impressed however...." --cjs001
"When i bough these i had no id'ea how they would sound. I read some reviews but it is a iem that was flying under the radar and kind of hide in the shadow of the BA200 which is TDK's flagship ( was, i think it´s discontinued ) All plastic build, feels solid but not expensive. They do have a great fit and can be used both with deep or shallow insertion and a various amount of..." --Arvan


text:
John McConnell (Quebec politician)
From Wikipedia, the free encyclopedia
John McConnell (May 20, 1799 – 1856 or later) was a political figure in Canada East. He represented Stanstead in the Legislative Assembly of the Province of Canada from 1844 to 1851.
He was born in Hatley, Lower Canada, the son of Thomas McConnell, a native of New Hampshire, and Roxana Hovey. McConnell was a member of a citizen's committee formed to promote the construction of a railway from Montreal to Boston via Sherbrooke. He served in the militia, reaching the rank of lieutenant-colonel. In 1820, he married Alice Wadley. McConnell later became involved in the movement favouring annexation with the United States. He did not run for reelection to the assembly in 1851 and was defeated when he ran for reelection in 1854.
- "Biography". Dictionnaire des parlementaires du Québec de 1792 à nos jours (in French). National Assembly of Quebec.


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Follow us on facebook and hyvesDo you want to be kept up to speed of all the developments around the...
|BMX Amsterdam
Welcome to the site of BMX Amsterdam!
This BMX track was built in April 2010 and consists of 5 different lines. Because of this, it's attractive for beginners and advanced bikers, young and old. In exchange for a low admission fee, everyone can use the terrain during fixed opening times.
Asides from coming on your own, it is also possible to participate in clinics.
You can rent materials with us and we'll make sure you'll get an introduction in the basics of BMX in a fun way.
The clinics are suited for children from eight years of age but of course also for adults.


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The independence of BBC Media Action, a charity based at the BBC's broadcasting house in London, has been called into question after it received £4.5m from the European Union last year. The funds will be partly used to support a project to train hundreds of journalists in countries that share potentially volatile borders with the EU. MPs have expressed concern that this funding may influence the BBC's impartiality when reporting on EU matters.
The BBC case serves to highlight the importance of a charity's independence. In order for a body to be regarded as a charity, it must be independent. As many charities increasingly find themselves co-operating with the state in the supply of services, there is a concern within the sector that this may pose a growing threat to independence. But where does the line between acceptable support and coercive influence actually lie and is it always clear?
Questions are certainly likely to be asked of any organisation set up to carry out charitable purposes that are entirely dependent upon a governmental authority for funding and receives funding on terms that enable the governmental authority to decide what services are to be provided and who is to benefit…
If you are registered and logged in to the site, click on the link below to read the rest of the Mills & Reeve briefing. If not, please register or sign in with your details below.


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She gives me such delight
With a special glow
Like a light
She plays her music all night
As I drift off to dream land
I think of her and weep
I want my fairy by my side
To love and hold
I want to share my feelings
Let her know I miss her so
My fairy your so fair
A beautiful fairy of my own
Your voice low as you
Whisper I love you
Give me a big hug
And a smile so bright
I am in a fairy land
Of my own
When I have memories
Of you and I
Your touch is light
Like a feather
As I see your shadow
On the wall
© Copyright 2017 angel plant. All rights reserved.
Status: Finished
Genre: Poetry
Truly exquisite.
Book / Horror
Book / Poetry
Book / Action and Adventure
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Invaluable cannot guarantee the accuracy of translations through Google Translate and disclaims any responsibility for inaccurate translations.
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Lot 247: Ruth Starr Rose lithograph
Fine Art at Auction
by Rachel Davis Fine Arts
22 October 2016
Cleveland, OH, USALive Auction
Ruth Starr Rose (1887-1965) Please Register/Login to access your Invaluable Alerts
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Description: Ruth Starr Rose (American 1887-1965)- ''Golden Slippers''- lithograph in colors, 1947, signed and titled in pencil in original presentation folder, Eighth presentation print for the American Color Print Society, very good condition. 10 x 12 1/2''
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2nd Revised edition
By (author) Peter Fritzsche
Format: Paperback
Normal Price: $17.11
Your Price: $15.40 AUD, inc. GST
Shipping: $7.95 per order
You Save: $1.71! (10% off normal price)
Plus...earn $0.77 in Boomerang Bucks
Availability: Available, ships in 8-11 days
Hamsters by Peter Fritzsche
Book DescriptionThe hamster is a favorite caged pet for children. Here's advice for both children and adults on housing, feeding, general care, and toys and devices to help keep a hamster active and healthy.
Buy Hamsters book by Peter Fritzsche from Australia's Online Bookstore, Boomerang Books.
Book DetailsISBN: 9780764139277
(200mm x 165mm x 4mm)
Pages: 96
Imprint: Barron's Educational Series Inc.,U.S.
Publisher: Barron's Educational Series Inc.,U.S.
Publish Date: 5-Aug-2008
Country of Publication: United States
Books By Author Peter Fritzsche
Iron Wind, Hardback (October 2016)
From a prize-winning historian, a vivid account of German-occupied Europe during World War II that reveals civilians' struggle to understand
Between Two Homelands, Paperback (June 2014)
In 1920, at the age of thirteen, Irmgard Gebensleben first traveled from Germany to The Netherlands on a "war-children transport." She would later marry a Dutch man and live and raise her family there while keeping close to her German family and friends through the frequent exchange of letters.
Turbulent World of Franz Goll, Hardback (March 2011)
Fritzsche traces twentieth-century history through the remarkable diaries of an ordinary Berliner. Franz Goll wrote of hungry winters during WWI, the Berlin bombing, rapes by Russian soldiers, shockwaves cast by Darwin, Freud, and Einstein, the flexing of U.S. superpower, and the strange lifestyles that marked Germany's transition to modernity.
Stranded in the Present, Paperback (April 2010)» View all books by Peter Fritzsche
Explores how Europeans and Americans saw themselves in the drama of history, how they took possession of a past thought to be slipping away, and how they generated countless stories about the sorrowful, eventful paths they chose to follow. This book takes a look at the modern age: our possessions, our heritage, and our newly considered selves.
» Have you read this book? We'd like to know what you think about it - write a review about Hamsters book by Peter Fritzsche and you'll earn 50c in Boomerang Bucks loyalty dollars (you must be a member - it's free to sign up!)
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Thank You!
Your message has been sent to R.A.D. {Rescue Animals in Distress}.
You'll receive a copy, too, at to help you keep track of which pets you've inquired about, and which shelters and rescues you've emailed.
NOTE: Some shelters have physical locations you can visit; some of these shelters may only have pets for a limited time, so please do not wait for a reply—just go visit the shelter! Other organizations are rescue groups run by busy volunteers who may take a while to reply. You can find information about the shelter or rescue group caring for this pet, and their adoption procedures, on the pet's details page on Adopt-a-Pet.com.


text: How Have The Weights Of NFL Positions Changed Over Time?Reuben Fischer-Baum3/17/14 6:31pmFiled to: nflweightsinfographicsRegressing241EditPromoteShare to KinjaToggle Conversation toolsGo to permalink Craig Booth—who previously made those NFL height/weight charts—just released a great series of graphics showing how the median weights of various positions have changed since 1950, based on data from Pro Football Reference. Booth isn't the first to visualize this sort of trend, but the inclusion of the 25th/75th and 10th/90th percentiles helps paint a clear picture of not just the change in weights, but also the relative variance within each of these positions. Plus, I like his colors. Below is the complete set of charts. You can also check them out over on Craig's site, where he adds some interesting notes and lists some of the major outliers. *Recently, Pro Football Reference has started classifying long-snappers as centers. Advertisement Advertisement [craigmbooth.com, via Reddit]Reply24 repliesLeave a reply


text: My new (carpet?) anemone has been moving around for the past few days and has finally settled. But I just saw that half of it was deflated and it looks like it spat out it's guts. There's white stingy stuff around the deflated area. Aside from that, the top half looks like it did when I first bought it. Is normal? or should I start trying to remove it from tank? Just finshed testing. nitrate 20 nitrite 0 ammonia 0.50 (has gone up from 0 in the past 3-4 days, 2 of my clowns died within those days, and I had promptly removed them the moment I noticed. One died within an hour of being seen alive, although she was stuck under a rock for i-don't-know-how-long before I saved her....) phosphate 0.50 PH 8.4


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Research Articles from Managed Care
If you would like to submit an article for publication in Managed Care, see our Call for papers.
Higher cost sharing decreases adherence to oral diabetes drugs and worsens glucose levels
Nine instruments were reviewed based on the extent that they measured the four attributes of primary care. Only one fully met the recommended criteria.
Sharp Health Plan wanted to increase mammography screening for its at-risk female population. Thirty percent of at-risk members were non-adherent. Members' reasons for avoiding screening were examined.
Capital Health Plan achieved a 79% improvement in pain scores and a 54% improvement in function scores for its members
A system in which individual insurance policies may be purchased for separate medical products and services is based on a medical options market and takes its cue from the financial sector


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Random Blog Posts
8 Jul, 2011
Portent Interactive: Origins
By Portent Team
Ever wonder how Portent came to be? Want to know the secret to our success is? How does Portent feel about hookers? What do Cybermen think about Portent? You're in luck, because we created an infographic that will answer these questions and more. Click image for full size.
7 Jul, 2011
11 reasons smart people start internet marketing agencies
By Ian Lurie
A few people described yesterday's post as 'soul killing', 'depressing' and 'horrifyingly accurate'. Today, I'm taking not-incompatible view that all smart people in the internet marketing biz should start their own agencies. Note that I'm not a "follow your bliss" hand waving business philosopher. I think in terms of building a lasting business that can… Read More
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7 Jul, 2011
Creative Art Direction at Portent
By Portent Team
Around 4PM on a Friday afternoon, Tracy called a meeting in his office to discuss the Portent rebrand. I had been given the privilege of creating art for the category pages of our new site, but no one had mentioned what the art should be, except for Elizabeth who wanted PPC to be represented by… Read More
6 Jul, 2011
11 reasons no sane person starts an internet marketing agency
By Ian Lurie
This is the first of a 2-part series that documents 2 voices in my head. One voice perpetually says "You are an idiot for running an agency." The other says "This rocks. It's the greatest job in the world." So fear not: I'm not having a mid-life nervous breakdown. Or, if I am, it's not… Read More
5 Jul, 2011
I lose my fracking mind or: A new Python script
By Ian Lurie
Total. Mind. Meltdown. I'd do a brilliant insightful post today, I'm sure, except that today's events, professional and media-related, combined with my concussing myself with a bicycle rack yesterday, have left me a gibbering idiot. Or brought out the gibbering idiocy that normally lies just beneath the surface. Or something. So instead, here's a little… Read More
1 Jul, 2011
Google+ thoughts – I eat crow
By Ian Lurie
I must eat crow now. Not tasty, breaded and fried, but vaguely icky, with feathers still stuck to it. I dissed Google+ the moment it came out, in part because it failed—it vomited everywhere when I tried to sign up. But now that I've used it for a while, I have to say that it's… Read More
28 Jun, 2011
Google+ outlook, in a nutshell
By Ian Lurie
I just tried to sign up for the Google+ notification list. This is what I got: In case you didn't know, Google+ is Google's latest attempt to break into social media. Judging by the result, I think it'll easily eclipse… Google Buzz.
24 Jun, 2011
The path to marketing nirvana: The peeve, and the rush
By Ian Lurie
What makes Steve Jobs so damned compelling? What about Seth Godin? Howard Stern? Richard Feynman? (choke) Rush Limbaugh? They've found Marketing Nirvana: The place where their beliefs and their product match up. I'm not saying this as a pile of wishy-washy marketing-psychobabble crap. Marketing nirvana is on your to-do list. It's on mine too. If… Read More
23 Jun, 2011
AppSumo deal – all my e-books for $25
By Ian Lurie
AppSumo has taken a real liking to Portent's e-books. Today, they're offering all of our e-books: Conversation Marketing The SEO CopyWriting e-book The Fat-Free Guide to Google Analytics PPC for Small Business (a two-book series) For a total of $25. You can get it here: AppSumo Online Marketing eBook Bundle Posting later today: 10 things… Read More
22 Jun, 2011
To all journalists: I am not a cockroach
By Ian Lurie
Tomorrow I'm going to be speaking to the ONA/SPJ meetup about SEO and social media. ONA is The Online News Association). SPJ is the Society for Professional Journalists. My typical relationship with journalists and their editors goes like this: Ian is a cockroach, only less evolved. Ian isn't a bad guy, but he's going to… Read More
14 Jun, 2011
My deep, dark secret (w/ some free training for you)
By Ian Lurie
I have a secret to confess. I actually run an agency. NO, WAIT. Don't go away! This involves free, no-strings-attached learning stuff. And a cool web site! Bear with me. I know you probably know I have a job. But whenever I meet folks at a conference, they seem to assume that money just sort… Read More
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Friday silliness: The Ultimate Marketer Tease
By Ian Lurie
I've watched The Ultimate Dog Tease 1000 times now. I love it. But I feel so bad for the dog. So, when we decided to spoof it, we tried to think of a creature no one cares about. And we realized – it's us!!!. I went to law school. The only thing less liked than… Read More
9 Jun, 2011
10 Social Media Tips for Politicians
By Ian Lurie
Republicans, Democrats, some of you are pretty stupid when it comes to social media. Exhibit A: Your last name is Weiner—W-E-I-N-E-R— and you send lewd photos via Twitter? Seriously?! Exhibit B: You reply to a Craigslist ad via e-mail, attaching a picture of your six-pack? (that's ex-Congressman Christopher Lee, folks, lest we forget) So, 10… Read More
9 Jun, 2011
AppSumo special on my SEO Copywriting e-book
By Ian Lurie
All good things come to an end, it seems. This deal has expired. You can buy the book for only $2 more, on my site. Or wait and see what the Sumo brings next. I've always been a bit scared of the AppSumo. His tough talk. His topknot. That smug smile. But it turns out… Read More
8 Jun, 2011
A big month at Portent
By Ian Lurie
I'm not much good at bragging about my company, but it's only June 8th, and it's been a big month for us. So, the highlights: New clients Full Circle hired Portent as their internet marketing agency as they expand beyond their Northwest base. We'll be helping with overall strategy and tactics spanning the entire inbound… Read More


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- Description
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Directions: Prepare as a tea - Pour 8 oz of boiling water (212° F) over 1-2 tsp. of herb. Cover and steep 3-4 minutes, strain, and serve.
5 stars
by klizma on November 3, 2015
Product: Organic Red Rose Petals
great product
by vique simba on July 16, 2015
Product: Organic Red Rose Petals
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Redan GA Real Estate & Homes for Sale
0 Properties Found
The median home value in Redan, GA is $101,800.
This is
lower than
the county median home value of $111,200.
The national median home value is $177,414.
The average price of homes sold in Redan, GA is $101,800.
Approximately 54.25% of Redan homes are owned,
compared to 30.8% rented, while
14.95% are vacant.
Redan real estate listings include condos, townhomes, and single family homes for sale.
Commercial properties are also available.
If you see a property you're interested in, contact a Redan real estate agent to arrange a tour today!
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UPDATE: Deutsche Bank Reiterates Hold Rating, Raises PT on Cree
In a report published Wednesday, Deutsche Bank reiterated its Hold rating on Cree (NASDAQ: CREE), and raised its price target from $33.00 to $36.00.
Deutsche Bank noted, "We acknowledge that we underestimated the positive margin impact from higher utilization rates/new products and overestimated the negative margin impact from distributor promotions. That said, even assuming gross margins remain at current elevated levels, we see limited upside to ~$1.50 FY14 eps considering the potential guide for elevated levels of opex in the near term. Risk-reward looks balanced especially as shares are now trading at ~18x FY14 P/E (ex-cash), at the high end of historical valuation range."
Cree closed on Tuesday at $33.47.
Latest Ratings for CREE
|Feb 2017
|JMP Securities
|Market Outperform
|Market Perform
|Dec 2016
|JMP Securities
|Initiates Coverage On
|Market Outperform
|Oct 2016
|Stephens & Co.
View More Analyst Ratings for CREE
View the Latest Analyst Ratings
Posted-In: Deutsche BankAnalyst Color Price Target Analyst Ratings
© 2017 Benzinga.com. Benzinga does not provide investment advice. All rights reserved.


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Over the last several years, the UK has become a major hub for electronic music, playing host to some of the most exciting and genre-defying young artists of our generation. While the minds of many might instantly be drawn to London – whose scene can oftentimes be factitious and divided – there's another city where young musicians have banded together to create one of the most influential electronic music outposts in the world: Bristol. In their first official entry into video, Resident Advisor takes a journey into the city to explore the unique cross-pollination of dubstep, house, techno and other genres.


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2-bedroom-apartment close to Düsseldorf
Størrelse57 m²
- Familie / Barne vennlig
- Kjøkken
- Låsbare rom
- Internett/WiFi
- Vaskemaskin / tørketrommel
- Parkering tilgjengelig
Oversikt over eiendommen
|Erlenstraße, 42697 Solingen, Düsseldorf, Tyskland
|Eiendoms ID
The apartment has got 2 separate bedrooms for 2 people each, a bathroom and a spacious kitchen with dining area and all necessary equipment. TV, DVD, video sets and radio are installed, WIFI is free of charge,
The apartment is in a quiet street, shops and restaurants are within walking distance (200 - 500 m). Free parking in front of the house or in the yard, good access to motorways.
Towels and linen are included.
HusreglerNo smoking
No pets
|Ukentlig rate for en gjest
|Månedlig rate for 1 gjest
|Pris for >1 gjester
|112 NOK pr. gjest/natt ekstra
|Innsjekking etter
|Etter avtale
|Check-in før
|Etter avtale
|Utsjekking før
|Etter avtale
Vurdering av denne eiendommen
Ingrid was a perfect hostess. She helped us in everything. The apartment was near he S-Banh which is perfect to visit Dusseldorf or Köln in a few minutes by train. There is all you can need at the apartment and its very clean and comfortable. We sure repeat at Ingrid's if we come back.
We've stayed for a rather long time at Ingrid's appartment and she made a lot to do out life more interesting and easy. In the beginning, she showed us the surroundings. Then she advised us about the places that are worth seeing and visiting. And in the evenings, we enjoyed of her large collection of movies and music.
We've never met such attentive proprietor before.
We were 3 women came into Dusseldorf to take part in the exhibition and to go sihgtseeings. We were lucky to choose Ingrid's place! Ingrid is a very very helpful person, she cought us up by car from the station, she showed us everything around, and every detail in the flat. The gave us pieces of useful advice every day by sending emails and leaving printed information near the door (about trains, schedule etc...). The flat is really neat, clean, light and comfortable. It has everythibg for living inc towels, homeshoes, soap, tea, dishes..Its well situated. it took us 5 mnutes to get to the nearest station (Fogelpark) and then 20 minutes to the central station of Dusseldorf. so it was really quick and comfortable. The only one thing is Internet. You should bring you laptop for putting Ingrid's 3G flash for internet, there is no wifi there. but nevertheless it was great and we felt really at home!!! Thank you Ingrid and hope to see you again!!! Julia Elena Galina
I stayed in this apartment during EuroShop trade show with three colleagues. All the four of us really enjoyed our stay.
Ingrid is the most friendly and caring host we have ever met. She provided tons of useful information and insider's tips on transport, shops and restaurants.
The apartment is nicely furnished and spacious.
There's everything you might need – lots of clean towels, all the kitchen utensils, brochures about the area etc etc. It's pleasant to know that the host really cares that the guests have everything for a comfortable stay.
Everything is very very clean.
The beds are really comfy.
The area is nice – supermarket and quite a lot of restaurants in a walking distance.
Tried hard to think of any disadvantages, but there are none! Highly recommended!
Ingrid, thanks from all of us! and see you in a couple of years when the next EuroShop will be held.
The apartment was very nice. Thank you very much for Ingrid (the owner) for being a very good host. I was participating at the Medica in Dusseldorf. The apartment is relatively close to the train station and easy to transit to the fair at Messe Arena. The room is highly recommended for the people who love the clean and quiet at night. It is a nice room to stay after all.
I was participating to K2013 exhibition with my collage. The flat is big enough and suitable for two business people and that it is easy to go to the trade fair in Dusseldorf. Very nice place. Train station was near and it was short trip to Dusseldorf. No need for rental car. Ingrid is also very nice and help-full person.
It is a perfect flat, with an excellent location just a few minutes walk from the train station.
Ingrid the host is an incredible person, very friendly and welcoming, she helps in everything that you need.
Everything is perfect, the apartment has everything you need to spend several days, clean, spacious and organized.
I spend a great week here! :)
Strongly recommended for everybody
Sehr schöne Wohnung mit genug Platz für 4 Personen. Anbindung sind sehr Gut und die Vermieterin sehr nett.
Ideale Wohnung für einen Ausflug ins schöne Rheinland. Ruhige Wohnlage in Solingen, meistens Parkplatz direkt vor der Türe, perfekte Verkehrsanbindung nach Köln und Düsseldorf. Die Wohnung ist sehr gut ausgestattet und lässt fast keine Wünsche offen.
zuerst noch einmal ein großes dankeschön an die warmherzige und sympatische ingrid. die wohnung zeigte sich für unseren -leider verregneten- wochenendaufenthalt mehr als ausreichend. sie ist mit liebe zum detail überdurchschnittlich mit nützlichen und schönen dingen eingerichtet, sauber und mit einem riesigen stapel frisch gewaschener handtücher ausgestattet. uns fehlte es an nichts. mit der nahe gelegenen s-bahn ist man in kurzer zeit in den metropolen des rheinlands. für kinder hat ingrid ein großes herz und so war sogar eine liste mit unternehmungsmöglichkeiten mit kindern mit vielen tipps ausgearbeitet. wir können wohnung und vermieterin nur wärmstens weiterempfehlen.
- Kvalitetssikret innkvartering
- Hver vert er verifisert via telefon
- Sikker betaling med SSL-kryptering


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leave your review
American Apparel PhiladelphiaStore's name : Walnut Street
Address & Contacts
Phone number
(215) 568-1373
(215) 568-1373
American Apparel
1611 Walnut St.
19103 Philadelphia
American Apparel
1611 Walnut St.
19103 Philadelphia
Opening Times
|11:00am - 9:00pm
|11:00am - 9:00pm
|11:00am - 9:00pm
|10:00am - 9:00pm
|10:00am - 9:00pm
|10:00am - 9:00pm
|11:00am - 7:00pm
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American Apparel Philadelphia is usually open Sunday.
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- Clothing
- American Apparel in Philadelphia Sansom Commons 3661 Walnut St.
- American Apparel in Cherry Hill 2000 Rt. 38 Unit 1146
- American Apparel in King Of Prussia The Plaza at King of Prussia 160 N. Gulph Rd.
- American Apparel in Philadelphia (2.46 km)
- Ashley Stewart in Philadelphia (5.35 km)
- Ashley Stewart in Philadelphia (5.86 km)
GPS position
- Latitude : 39.950047
- Longitude : -75.167995
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Hotfrog Philippines provides information regarding Havaianas in Cagayan de Oro Misamis Oriental. Havaianas is located at Corrales Avenue Corner Ramon Chaves Street, Cagayan de Oro Misamis Oriental and provides Personal Care services. Contact them on (085) 815 5264 or by visiting them on their website http://ph-en.havaianas.com.
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Nightly Average
Surya Lodge
Dehu Phata, Alandi, none, ALANDI, MAHARASHTRA, India, Pin-412105, Alandi 412105, India
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Surya Lodge Hotel Reviews
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Surya Lodge Hotel Details
Check-in: 1200
Check-out: 1200
Conveniently located just a kilometer away from the absolutely beautiful Indrayani River is Surya Lodge at Alandi in Pune. This hotel provides its guests with moderately furnished rooms ensuring a pleasant accommodation. It provides its guests with free and secure parking, a travel counter to help tour the city and medical services in case of an emergency.
Dehu Phata, Alandi, none, ALANDI, MAHARASHTRA, India, Pin-412105 Alandi 412105, India


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Game Description
Say goodbye to your dead-end corporate job and open your own travel agency. Everyone has to work for a living, but why not make your living by putting together unforgettable vacation packages for your customers? Although you will start off in modest accommodations, your hard work will pay off and allow you to upgrade your office, hire more employees, and perhaps even move to a fancy new office!
Most Recent Reviews To submit a rating or review, download this game
this game is so great who dosen't agree say no if you agree say yes See more See less
this game was boring the only thing i like is that the woman goes fast See more See less
I played this back when it was a trial and I'm reminded why I never got this one. The load time is annoying, the game is too slow and the graphics are less than stellar. It was refreshing to play but not high on my list of favorite TM games. For something similar I recommend Miss Management, it's a far better game. See more See less
This was boring, monotonous and a total disappointment. What's so great about giving travel plans to customers? You are not going to some exotic local yourself, I didn't see any upgrades of anything for yourself as in other TM games. I played this for around ten minutes and it nearly put me to sleep. See more See less
It's really fun at first but it gets boring at times See more See less
It's a very boring game! All you do it click on the person to see what he or she wants. Then all you do is click on your worker to find the papers! That is so boring! I do not recommend this game. See more See less


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Coleman 150-Quart Cooler, Blue
Availability: Only 2 Left In-stock.
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- Holds 223 cans
- Convenient hinged lid with four built-in cup holders
- Rustproof, leak-resistant drain for no-tilt emptying and cleaning
- Two-way handles make it easy and comfortable to carry
- Made with Thermozone insulation that contains no toxic CFCs, HFCs, or HCFCs
- Exterior Dimensions: 44.5 by 19.5 by 18.5 inches (L x W x H)
About Coleman
More than 100 years ago, a young man with an entrepreneurial spirit and a better idea began manufacturing lanterns in Wichita, Kansas. His name was W.C. Coleman, and the company he founded would change life in America. A man plagued with such poor vision he sometimes had to ask classmates to read aloud to him, Coleman saw a brilliant light in 1900 in a drugstore window that stopped him in his tracks. He inquired about the light inside and discovered he was able to read even the small print on a medicine bottle by the illumination. The lamps had mantles, not wicks, and were fueled by gasoline under pressure instead of coal oil. Soon afterward, Coleman started a lighting service that offered a no light, no pay clause--a big step forward for merchants who were burned by inferior products that rarely worked--and drew substantial interest from businesses that wanted to keep their lights on after dark. In the ensuing years, Coleman expanded its product line well beyond lanterns. The company s current catalog is thick with products that make spending time outdoors a pleasure. There are coolers that keep food and drinks cold for days on end, comfortable airbeds that won t deflate during the night, a complete line of LED lights that last for years, powerful portable grills that cook with an authentic open-grill flame, and much, much more. Coleman has truly fashioned much of our outdoor camping experience, and expects to do so for generations to come.
Features : Holds 223 cans *Four cup holders in lid *2 way handles for easier lifting and carrying *Made with Thermozone insulation that contains no toxic CFCs, HFCs, or HCFCs *Made in the U.S.A.
Color : Blue
Size : One Size
Product dimensions : 19.02x42.01x19.02 inches
Product weight : 22.5 pounds
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