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Subaru Outback 2.5i Limited
Get excited about the 2013 Subaru Outback. Smooth gearshifts are achieved thanks to the 2.5 liter 4 cylinder engine, and for added security, dynamic Stability Control supplements the drivetrain. All of the premium features expected of a Subaru are offered, including: a rear window wiper, 1-touch window functionality, a power seat, telescoping steering wheel, power door mirrors, a roof rack, and cruise control. Features such as automatic climate control and leather upholstery prove that economical transportation does not need to be sparsely equipped. Premium sound drives 9 speakers, providing you and your passengers a sensational audio experience. Subaru ensures the safety and security of its passengers with equipment such as: dual front impact airbags with occupant sensing airbag, head curtain airbags, traction control, brake assist, anti-whiplash front head restraints, ignition disabling, and 4 wheel disc brakes with ABS. Sophisticated all wheel drive technology maintains a firm grip on the road. It also arrives with a Carfax history report, indicating just one previous owner. We know that you have high expectations, and we enjoy the challenge of meeting and exceeding them! Please don't hesitate to give us a call.


text:
Unisex terrycloth bathrobe in 100% cotton
£ 70.00
incl. VAT
All item details
STARS bathrobe – the stunning star print in a positive-negative look make this terrycloth bathrobe a cosy head-turning.
- Soft, pure cotton terrycloth
- Stunning star print in a positive-negative look
- Hood
- Patch pocket at hip height
Material and care
- Outer fabric: 100% Cotton
Your complete outfit
Create your individual outfit

subset: commoncrawl


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|Agustin Martin
|Re: Ispell and unibyte characters
|Wed, 28 Mar 2012 21:18:21 +0200
|Mutt/1.5.21 (2010-09-15)
On Mon, Mar 26, 2012 at 04:08:06PM -0400, Eli Zaretskii wrote: > > Date: Mon, 26 Mar 2012 19:39:12 +0200 > > From: Agustin Martin <address@hidden> > > > > Hi Eli, > > Thanks for responding, I was beginning to think that no one is > interested. In general, I find that ispell.el is in sore need of > modernization; at least that's my conclusion so far from playing with > hunspell (with which I want to replace my aging collection of Ispell > and its dictionaries that I use for many years). > > > At least for aspell ispell.el already uses utf8 as default communication > > encoding and [:alpha:] as CASECHARS (and ^[:alpha:] as NOT-CASECHARS). > > OTHERCHARS is guessed from aspell .dat file for given dictionary. > > The question is, why isn't this done for any modern speller. The only > one I know of that cannot handle UTF-8 is Ispell. I think the only real remaining reason is for XEmacs compatibility. AFAIK XEmacs does not support [:alpha:]. I thought about filtering ispell-dictionary-base-alist when used from FSF Emacs, so it uses [:alpha:] and still keeps compatibility. I am currently a bit busy, but at some time I may try this for Debian and see what happens. For XEMACS in Debian GNU/* even changing to [:alpha:] should have a reduced impact, strings provided by dictionary maintainers take precedence, but better if I can easily do the above anyway, so [:alpha:] is used if available. Once release happens, I'd like to commit some other changes to decrease XEmacs incompatibilities in ispell.el and flyspell.el, so my changes for Debian GNU/* become smaller. > OTHERCHARS are not very important anyway, at least for languages I'm > interested in. > > > Since currently it is not possible to ask hunspell for installed > > dictionaries (hunspell -D does not return control to the console) > > no one tried something similar for hunspell. > > In what version do you have problems with -D? Hunspell 1.3.2. Does not return control until I press ^C. This may be useful if someone wants to know about installed hunspell dictionaries and prepare something to play with that info, in a way similar to what is currently done for aspell in ispell.el. > In any case, hunspell supports multiple dictionaries in the same > session. One can invoke it with, e.g., "-d en_US,de_DE,ru_RU,he_IL" > and have it spell-check mixed text that uses all these languages in > the same buffer (at least in theory; I didn't yet try that in my > experiments). Clearly, this can only be done with UTF-8 or some such > as the encoding. Right. > So I think we should deprecate usage of the unibyte characters in the > ispell.el defaults, and simply use [:alpha:] for all languages. As a > bonus, we can then get rid of the ridiculously long and hard to > maintain customization of each new dictionary you add to your > repertory. Just one entry will serve almost any language, or at least > supply an excellent default. > > > > The only reason for this limitation I could find is in > > > ispell-process-line, which assumes that the byte offsets returned by > > > the speller can be used to compute character position of the > > > misspelled word in the buffer. Are there any other places in > > > ispell.el that assume unibyte characters? > > > > Not sure if using utf8 and [:alpha:] has caused some problem for aspell, > > I do not remember reports about this. > > Since I wrote that, I found that the problem was due to a bug in > hunspell (which I fixed in my copy): it reported byte offsets of the > misspelled words, rather than character offsets. After fixing that > bug, there's no issue here anymore and nothing to fix in ispell.el. > There's a bug report with a patch about that in the hunspell bug > tracker, so there's reason to believe this bug will be fixed in a > future release. You mean http://sourceforge.net/tracker/?func=detail&aid=3178449&group_id=143754&atid=756395 I filed that bug one year ago and received no reply from hunspell maintainers. This year I received a followup with a proposed change, but there is still no reply to it. There is other problem that mostly hits re-using ispell default entries under hunspell http://sourceforge.net/tracker/?func=detail&aid=2617130&group_id=143754&atid=756395 [~ prefixed strings are treated as words in pipe mode] that now stands for three years. I have waited in the hope this is fixed, but I think I will soon commit to Emacs the same change I use for Debian, making sure extended-character-mode is nil for hunspell. I do not think extended-character-mode pseudo-charsets will ever be implemented in hunspell. -- Agustin
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Baby Girl Dies After Parents Plea For Stolen Phone
An 11-month old Melbourne girl has died just days after her parents' desperate search for their missing mobile phone, which contains hundreds of family photos including those of their dying daughter.
The father of baby Amiyah Windross, Jay, posted a heartbreaking Facebook tribute sharing their "utter sadness" at losing their child.
"Amiyah's last hours were spent peacefully and calmly, cuddling in Mummy's and Daddy's arms," he said.
"Amiyah battled hard and fought an undiagnosed neurological issue from the day she was born.
"Her strength, her courage, and her unrelenting fight was on display from her first breath, all the way till her last."
The news of Amiyah's death comes just five days after the parents posted a series of emotional pleas on Facebook for help finding a missing mobile phone.
"Someone has picked up Dee's phone from a toilet next door to Target in Chadstone around 5:30 pm," the post reads.
"It is a Samsung Galaxy S8 with a purple cover.
"Our 11 month daughter is currently deteriorating in ICU and is in her last days with us and this phone holds all our memories of her.
"We understand that you have either found a new phone to use, or you can sell it to make money, but please understand that this means more than money to us. This is worth life to us."
Amiyah had been in and out of intensive care since she was born, and the phone contains most of the images the couple have of their daughter.


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Yeast infection discharge is easy to identify since they are either thick white or light yellow and look like cottage cheese. The colored discharge also causes an itchy burning feel on vagina. Here, we will mainly discuss how yeast infection vaginal discharge looks like, causes, remedies, and treatment. Yeast exists naturally in the vagina. A yeast infection only occurs when there is an overgrowth of an organism known as the Candida albicans.
Vaginal discharge is a very important fluid in the vagina since it cleanses the vagina and keeps it healthy. It washes away bad bacteria and any form of dirt in the vagina. It is always odorless and switches color between white and clear depending on the stage of a menstrual cycle a woman is in. It only gets foul odor and odd colors when infected by a fungi or bacteria
How does yeast infection discharge look like?
Below are some characteristics of yeast infection discharge and how to identify them. This can help you identity early signs of vaginal discharge and get treatment in good time.
Milky white discharge
Milky white vaginal discharge that is odourless is a normal vaginal discharge. It is common after right after menstruation. It is usually stretchy when you approach ovulation phase. Do not worry about milky white discharge unless it produces a foul smell. In that case you need to visit your doctor for a diagnosis and treatment.
Thick white discharge with odour
Thick white discharge with an odour is a sign and symptom of yeast infection. It is very irritating and uncomfortable to have a bad smell coming out from down there. It can interfere with a woman's sex life because they will shy away from it in order to avoid the embarrassment.
The worst mistake you can do is to apply a fragrance down there in order to counter this smell. The chemicals found on sprays will interfere with the pH level of your vagina and cause more harm than good.
White vaginal discharge that look like cottage cheese
Vaginal discharge can be white before menstruation occurs. But it is important to observe your discharge for any signs of abnormalities. Yeast infection discharge appears as a white vaginal discharge that look like cottage cheese which may not be smelly .According to NHS, "If your discharge is thick and white like cottage cheese, not smelly and occurs with itchiness and soreness around your vagina, you may have thrush." Ensure you seek treatment if you notice such a vaginal discharge on your panty liner.
Yellow discharge yeast infection
Most yeast infection discharge is white and thick but the discharge can also be light yellow if you have yeast infection. It can be yellow and look like cottage-cheese. Just ensure you visit a doctor when the vaginal discharge looks abnormal.
Yeast infection mucus /egg white discharge
Towards ovulation the amount of mucus in vaginal discharge increases and makes the discharge look watery or egg white. If you get yeast infection around this time then you have watery and cloudy discharge. You should visit a doctor when your discharge changes colour from egg white to cloudy or milky during ovulation.
Yeast infection on vulva/rash/red/symptoms
Yeast infection discharge is not smelly in most cases. It is important to know other symptoms that come with yeast infection apart from the type of discharge. Seek treatment if you experience the following symptoms along an abnormal discharge;
- Itchy and burning sensation in the vagina
- Red bumps or red rash on the outer skin of the vagina
- Inconsistent menstrual cycle
- Pain during sexual intercourse
- Pain while urinating or menstruating
- Spotting
Yeast infection brown sticky
Yeast infection discharge is usually thick white and look like cottage cheese. However, if you get a yeast infection right after your period the discharge is brown and sticky instead of white and sticky. The brown ness can be caused by a tinge of blood that mixes with the vaginal discharge.
Sometimes some little drops of blood remain in the cervix and come out after you thought your periods are gone. You will also experiences other symptoms like foul smell, itchy feeling in the vagina and burning sensation while urinating or having sex.
Causes and meaning of white vaginal discharge
Vaginal discharge is either egg white or white in colour depending on the stage of your menstrual cycle. Egg white discharge occurs a day before ovulation. After ovulation the discharge turns into either milky white or thick white discharge.
Milky white vaginal discharge is normal discharge and it is produced naturally by the vagina as a lubricant. It should be odorless and not itchy .It also helps sperm swim into the ovary in case a woman engages in unprotected sex.
Thick white vaginal discharge is also normal if it has got no odor, however, if it stinks or look like cottage-cheese then it is a yeast infection discharge.
Thick white vaginal discharge can have the several meaning and causes as follows;
- A sign of pregnancy. Pregnancy hormones cause the production of thick white discharge which blocks off pathogens from getting into the cervix hence protects the uterus. It keeps the vagina healthy as well.
- When a woman is sexually aroused, the cervix produces thick white vaginal discharge that acts as a lubricant during sexual intercourse. It should not have an odor unless it is a yeast infection discharge.
- The semen of a male is also thick and white. In case a man ejaculated during sexual intercourse, the excess semen will flow out of the vagina immediately after sex. You got no reason to worry about it. Just take a shower and wash it off.
Causes and meaning of yellow vaginal discharge
Yellow vaginal discharge is an abnormal type of discharge because a normal discharge should be clear or white and sticky with mucus. Yellow vaginal discharge is caused by vaginal infections like bacterial vaginosis or sexually transmitted infection like trichomoniasis.
Common causes of vaginal discharge
Vaginal discharge is produced from glands found in the uterus and the cervix. It is usually produced in small amount and its main purpose is to cleanse the vagina and keep it healthy.
The colour, consistency and amount of vaginal discharge are influenced by other factors like hormonal imbalance during pregnancy or infections. Yeast infection discharge usually comes out in more volumes as compared to the normal discharge.
Pregnant women get even much more discharge to a point that they have to wear pant liners to avoid soaking their panties. Vaginal discharge is also produced during sexually intercourse in order to aid in sexual activities.
According to Mayo Clinic, "Vaginal discharge is a combination of fluid and cells continuously shed through your vagina. Normal vaginal discharge helps keep vaginal tissues healthy, provide lubrication and protect against infection and irritation. The amount, color and consistency of normal vaginal discharge varies — from whitish and sticky to clear and watery — depending on the stage of your reproductive (menstrual) cycle."
Yeast infection without discharge
Abnormal Vaginal discharge is one of the symptoms of yeast infection but it does not occur in all cases. Some women experience yeast infection in the vagina without having yeast infection discharge. It is important to check out for other symptoms discussed above.
Home remedies for yeast infection
Women are very prone to vaginal yeast infection. It occurs often in a woman's lifetime. Since it is a common problem there are several home remedies that have tested and prevent to help cure this kind of infection. These remedies are not only for the discharge but also deals with other symptoms of yeast infection like red rash and bumps on the vagina.
1. Natural Yogurt
Natural plain yoghurt is very health and women should drink yoghurt regularly in order to increase the number of good bacteria in their system. Plain yoghurt contains good bacteria known as Lactobacillus acidophilus that maintain the acidic pH level of the vagina. Do not use yoghurt if you are allergic to dairy.
- Natural yoghurt
- Honey
- Cotton ball
- Tampon
- Clean water
- Clean piece of cloth
How to get rid of white discharge using yogurt
- Soak a cotton ball in natural yoghurt
- Apply the yoghurt directly to your vagina using the soaked cotton ball by squeezing it so that the yoghurt spreads in the vagina
- Let the yoghurt stay in the vagina for an hour
- Wash it off using clean water
- You can also deep a tampon in the plain yoghurt and then insert in in your vagina and leave it in there for 2 hours
- The yoghurt should also be applied on the red rash caused by yeast infection
- Wash off the yoghurt after an hour
- Pat the region around the vagina dry with a clean piece of cloth
- Repeat any of the options thrice a day
- Introduce yoghurt into your system by drinking it as well
- Mix a cup of natural yoghurt with 3 table spoons of honey to sweeten and drink it every day.
2. Apple Cider Vinegar
Apple cider vinegar is acidic hence it balances the natural pH balance of the vagina hence making the vagina conducive for the growth of good bacteria that prevent infection. Apple cider vinegar also helps in getting rid of any foul smell that may be emanating from the vagina due yeast infection.
What you need
- Apple cider vinegar
- Clean water
- Cotton ball
What to do
- Mix apple cider vinegar and water in the ration of 1:10 and fill your bathtub with it
- Soak your body in this water
- If you don't have a bathtub then use water to rinse your vagina then wash it off after 20 minutes
- Use mixture to wash your vagina twice a day for 3 days to get rid of the smelly yeast infection discharge.
- Alternatively, mix one tablespoon of apple cider vinegar with drinking water and consume it once a day.
- If you have red rashes then apply diluted apple cider vinegar on the bumps
3. Garlic
Garlic that is used at home to cook food is medicinal. It contains an antiseptic and antifungal agent called allicin which is capable of fighting yeast infection in the vagina.
- Garlic cloves
- A Pestle & a mortar
- A Knife
- Clean water
- A clean piece of cloth
- Peel off the back cover of garlic cloves
- Dice them into cubes using a knife
- Place them in the mortar
- Pound with a pestle to form a paste
- Add olive oil to the paste
- Apply the paste on the yeast infection rash
- Let it settle for 20 minutes then wash it off and dry your vagina.
- Before you go to bed
- Take another clove of garlic and peel off the back cover
- Cut the garlic into half and put the garlic in your vagina
- Let it stay there overnight
- Do this for 3 nights
4. Cranberry Juice
Cranberry juice is an antifungal agent. It fights Candida albicans that causes yeast infection in the vagina. Cranberry juice will generally boost your immune system.
What to do
- 1 liters of water
- 4 cups fresh cranberries
- 1-1/2 cups sugar
- 1/2 cup lemon juice
- 1/2 cup orange juice
- Sieve
Instruction on use
- Add 4 cups of cranberries to a liter of water
- Boil the cranberries in the water
- Cover and simmer for 20 minutes until the cranberries pop
- Sieve the juice using a fine strainer
- Let it cool or chill it in the refrigerator
- Drink the unsweetened cranberry juice daily for a week
5. Boric Acid
Boric acid is not a natural home remedy. It is a chemical substance used as a cleaning agent, pest control or as a remedy for infections. It has got antibacterial and antifungal properties are able to treat yeast infection rash and soothe the bumps. However, it is not recommended for pregnant women.
- Medicinal grade Boric acid
- Distilled water
- A clean piece of cloth
- A cotton ball
What to do
- Mix a pinch of boric acid in 1 glass of distilled water
- Soak a cotton ball with the boric acid solution
- Apply the solution on the red rash caused by yeast infection
- Let it settle on the skin and dry up
- Rinse off the acid using plenty of clean water
- Pat dry the skin using a clean piece of cloth. Dampness encourages the overgrowth of yeast
- Repeat this process once a day for 2 weeks
6. Tea Tree Oil
Tea tree oil is an antifungal agent that is capable of fighting fungus that cause yeast infection discharge. Mix tea tree oil with water or other essential oils like olive oil to dilute its harshness on your skin. Pregnant women should not use tea tree oil because it is harmful to their baby.
- Tea tree oil
- Olive Oil
- A Cotton Ball
- Tampon
- Clean water
- A clean piece of cloth
What to do
- Ensure that your vagina and the skin surrounding it is clean and dry
- Dilute tea tree oil with water in the ration of 1:1
- Dip a tampon in the diluted tea tree oil
- Insert the tampon in your vagina
- Let it stay in their for 2 hours
- Remove and dispose the tampon
- For the rashes
- Pour a little amount of tea tree oil in a cup and mix it with olive oil to reduce its harshness on your skin.
- Soak a cotton ball with the mixture of tea tree oil and olive oil.
- Gently apply the oil mixture using the cotton ball on the bumps caused by yeast infection
- Let the oil mixture settle overnight
- Wash it off in the morning
7. Oregano Oil
Oregano oil is an antifungal agent that is capable of fighting free radicals in your body that cause infections hence boosting your immune system. It is also advisable to dilute Oregon oil with olive oil or coconut oil before applying it on your skin because it can be harsh on the delicate skin that covers the vagina.
- Oregano Oil
- Olive Oil
- A Cotton Ball
- Clean water
- A clean piece of cloth
- Ensure that your vagina is clean and dry
- Pour a little amount of oregano oil in a cup and mix it with coconut oil to reduce its harshness on your skin.
- Soak a cotton ball with the mixture of oregano oil and coconut oil
- Gently apply the oil mixture using the cotton ball on the red rash caused by yeast infection.
- Let the oil mixture settle overnight
- Wash it off in the morning and pat dry your skin using a clean piece of cloth. Remember that yeast infection thrives in damp environment.
- Repeat this process every night before you go to sleep.
9. Calendula Flowers
Calendula is a natural herb that is both an antifungal and anti-inflammatory agent. It fights vaginal yeast infection and reduces the inflammation caused by yeast infection bumps .However, Calendula flowers remedy is not recommended for pregnant women.
- Calendula flowers
- A Pestle & a mortar
- A knife
- A clean piece of cloth
What to do
- Wash the calendula flowers
- Cut them into big chunks with a knife
- Place them in the mortar
- Pound with a pestle to form a paste
- Ensure that the affected is clean and dry
- Smear the paste on the rash caused by yeast infection
- Let it settle for 20 minutes and dry
- Rinse it off with warm water
- Dry your skin with a clean piece of cloth to avoid dampness
- Repeat this procedure 3 times a day until you notice a significant change
10. Olive Oil
Olive oil is has got anti-oxidant and anti-inflammatory properties, therefore it is ideal in fighting yeast infections. It will destroy the excess yeast causing the infection. Olive oil is also a moisturizer and it will soothe the red rash that is caused by yeast infection.
- Olive oil
- A Cotton Ball
- A clean piece of cloth
- Clean water
What to do
- Wash your vagina with plenty of water
- Dry your skin
- Soak a cotton ball with olive oil
- Apply olive oil directly on the bumps or rash caused by yeast infection. Let the oil stay on your skin over night
- Wash it off when you wake up in the morning.
- Repeat this process every night until you see a significant change
11. Coconut Oil
Coconut oil is an essential oil that acts as an effective antifungal agent that is capable of fighting Candida albicans which is the fungi that is responsible for yeast infection discharge. Coconut oil is a natural moisturizer and it will soothe your skin.
- Coconut oil
- A Cotton Ball
- A clean towel
What to do
- Take a shower before you go to bed
- Wash your vagina with plenty of water
- Dry your skin with a clean towel
- Soak a cotton ball with coconut oil
- Apply coconut oil on area affected by the yeast infection rash using the cotton ball
- Let it stay overnight on your skin.
- Repeat this process every night until you see a change
[button color="red" size="medium" link="http://www.alldischarge.org/vaginal-discharge/early-pregnancy-discharge-look-like-feel-like-causes-meaning/" icon="EARLY PREGNANCY DISCHARGE" target="true"]EARLY PREGNANCY DISCHARGE[/button]
Yeast Infection Discharge Teatment
Yeast infection discharge is a symptom of yeast infection. Antifungal treatments will get rid of the infection and all its symptoms. Antifungal medicine is available in the form of creams, ointments, and tablets that can be taken orally or inserted in the vagina. Your doctor will advise you on what to use.
If you have had yeast infection in the past or your infection is mild then you can just purchase these medicines over the counter and follow instructions given by the pharmacist. Some of these medicines are Miconazole, Clotrimazole ,Tioconazole and Butoconazole. If the symptoms persist seek medical advice.
- http://www.medicinenet.com/yeast_infection_in_women_and_men/article.htm
- https://msu.edu/user/eisthen/yeast/symptoms.html
- https://draxe.com/vaginal-yeast-infection/
- https://mygynecologist.net/brown-stringy-discharge-6-possible-causes/6/
- http://www.webmd.com/women/guide/vaginal-discharge-whats-abnormal#1
- http://www.nhs.uk/Conditions/vaginal-discharge/Pages/Introduction.aspx
- https://familydoctor.org/condition/vaginal-discharge/
- http://www.top10homeremedies.com/home-remedies/home-remedies-for-yeast-infection.html
- https://www.checkpregnancy.com/thick-white-discharge-3-types-what-they-mean/
- http://candidaspecialists.com/vaginal-yeast-infection-discharge/?data1=symptoms
- http://www.mayoclinic.org/symptoms/vaginal-discharge/basics/definition/sym-20050825


text:
Thursday 23 Feb.
Mini Minx upped the ante in our running Battle of the Potty.
While getting the minxes ready for bed, either me or The Boss (usually him) takes off her nappy and lets her play with Maxi and Midi's old pink potty whilst brushing 3 sets of toddler teeth, washing hands, faces, botties, etc.
Tonight she insistently asserted, "Poo! Poo!"
No chance, my little love, you've filled 3 big stinky reeking nappies today. So I took my eyes off her for a few mins to sort out brushing her sisters' teeth.
"Yeah, clever girl."
"Uh-huh, Mummy with you in a minute."
"Yep, good girl."
"Mama! Poo!!" So I looked round from carefully scrubbing around Maxi's latest loose tooth.
"Holy crap!" I exclaimed (yes, that was a pun, and yes, I am a potty-mouth myself), as Mini leapt into the air, startled. "You've done a poo! In the potty! Wow!" so me and Mini's sisters erupted in some mental, loud, over-exuberant applause. Oh right, I noted to myself, and you've also pooed on the floor. And have now stepped in it and are dragging it all round the bathroom and over the entire pile of clothes – yaaaargh! Then she proceeded to proudly stick her finger into her vulva and pee on the floor, spraying it everywhere. Maxi and Midi giggled, I whipped her onto the potty, reassuring her she was the cleverest girl in the world, whilst inwardly wailing at the mess. She kept saying, "Wee-wee! Wee-wee!" so I shouldn't have been surprised when she then peed in the potty as an encore.
Guess who's a smug toddler? 23 months old today. It's my move, now. I am afraid. Very afraid.


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In the event that you are likewise keen on making the most from Black Friday bargains then you ought to comprehend the intricate details of this energizing project since it will be essential for you have finish understanding towards these arrangements. There are many Black Friday Questions among the general population and they are occupied with knowing it in profound. It is a standout amongst the most critical and gainful shopping occasion and you will presumably get a kick out of the chance to exploit from it. Its beginning falls upon the arrival of Friday after the Thanksgiving. In this year 2017, it can be on the November 26. Individuals love to get the most recent and most worthwhile arrangements on that day and they would love to make them shop. They jump at the chance to invest their energy in that day since they will have an opportunity to make the most Black Friday Deals.
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You can take the assistance of Internet for making the most from Black Friday Deal on the grounds that these arrangements will be accessible for you on the Internet effortlessly and you will discover them advantageously without confronting any frenzy or inconvenience. You can have energizing offers and blessings while going to these internet shopping stores and this thing will be more appropriate for you than some other way.
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Presently, there won't be any Black Friday Questions in your psyche and you would have seen terrifically critical focuses obviously. You can make the most from this Black Friday Deal, on the off chance that you will participate in this occasion. You will discover this event brimming with hues and advantages, many individuals will love to have some partake in it by shopping increasingly. You can get numerous different favorable circumstances from that day and it is not so distant from you. This arrangement will give you an opportunity to choose most fitting blessing and item for you.


text:
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Information on Mechanical engineering department
Since the indepenendence day Azerbaijan republic has chosen economical development portfolio which requires establishment of specific companies in government and private sector. No need to argue qualified engineers as well as other professionals are required to work in those establishments, which requires preparation of engineering professionals in means of education. Worldwide economical relationships, conclusion of international treaties, as well as development and invention of technologies, establishment of new companies and advance of private sector and etc. encourages engineers to take their knowledge and expertise to a next level. For the same reason Department of Mechanical Engineering has been established within Baku Engineering University.
Initially students were admitted only to Mechanical Engineering qualification (code: 050630) which were taught only in english until 2017/2018 education year, since then department offers Mechanical Engineering in both english and azerbaijan languages, Machine engineering (code: 050612) and Process automation engineering (code: 050628). In the same year, department started to offer master degree programs in Mechanical engineering (code: 060630), Theory of Machines and Mechanisms (code: 050628) and Phd program in Mechanics of deformable solids (code: 2002.01).
Aim of the department
Department aims to prepare engineers with extensive knowledge of their qualifications, striving for further development. That is why, besides engineering courses selective language courses are offered to enable the students to extend their research database. We aim to preapre engineers with proper engineering ethics to aid Azerbaijan republic with its economical and social development plan. To do so, department bases the syllabus on the program confirmed by Education Ministry of Azerbaijan Republic. It should be noted that syllabuses have been prepared in accordance with educational program of world leading universities. The lectures are taught in english and azerbaijan languages.
Department's scope of activities
Department offers education and research on "Mechanical engineering", "Machine engineering" and "Process automation engineering" courses.
Department's academic staff
Head of department
PhD.in Technical Sciences Mirzayev Huseyn Ibrahim oghlu
Phd.in Technology Shirzadov Farhad Mahammad oglu
PhD.in Technical Sciences Nadirov Ugurlu Mahammed oglu
Hasanli Ayshen Tahir gizi
Huseynov Orkhan Sabir oglu
Hasanov Seymur Sadraddin oglu
Department's international relations
Department's professor-lecutrer staff conduct research with scientists of the universities in USA, Germany, England, Russia and Turkey.
Role of Department in students' internship and career
Department organizes technical trips and internships to the companies to provide them with practical knowledge as well as theoritical. It should be also noted that, good amount of students end up being emplyed by the same companies providing internship.
Department's facilities
There are 12 well equipped laboratories functioning within Mechanical engineering department. These are:
Departments student oriented academic and social activities
Students are working on the projects in the department's laboratories under the supervision of academic staff. Students can join certain research group or propose new research theme to work on. Projects of our students are exhibited in different events.
In addition, students are enlisted in 'Mechanical engineering' club as well as other student associations and are participating in a variety of activities organized within university.


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Jim Wyatt, SENIOR WRITER/EDITOR
INDIANAPOLIS – Titans coach Mike Vrabel is a big fan of receiver Corey Davis, who doubled his production in his second NFL season.
Davis led the team in receptions (65) and receiving yards (891) in 2018.
"I think that Corey did make a big jump," Vrabel said. "It is hard to come from college, where there is just one coverage … and they are bigger than the corner and they just throw it up. (In the NFL) the route tree gets a lot bigger, and their route craft has to improve, and I think he did that.
"And he is the best blocking receiver that we have on our football team. He embraces it, and he does a great job. I don't want to overlook the fact that our No.1 receiver is our best blocker, and I appreciate that."
But here at the NFL Combine, the Titans will see a talented group of receivers, including several who are expected to go in the first round of the NFL Draft.
Titans general manager Jon Robinson said the team has also discussed adding a veteran receiver to the mix when free agency begins as well. Alongside Davis, the Titans currently have a roster filled with young receivers, including Taywan Taylor, Tajae Sharpe, Darius Jennings and Cameron Batson.
Davis, the fifth overall pick in the 2017 draft, credits veteran Harry Douglas for providing leadership in his first year in the NFL. A year ago, Rishard Matthews began the year as the veteran of the group, but he left during the season.
"We've certainly talked about that, as well as other position groups," Robinson said. "You have to have a mixture of veteran guys and youth at really every position group.
"I'd say that position group is one of our younger position groups, so we'll kind of go through free agency and see how the market goes, and if there is a veteran out there we feel like can help us, we're certainly not averse to adding one of those guys."


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A woman named Blaise posted on Facebook how terribly upsetting it is for her when a server uses the colloquialism "you guys" when referring to her since, you know, she is not a guy. That's right, everyone, Blaise has a vagina and it is an angry one. She wants servers to call her "ma'am," which I would be more than happy to do if she was sitting in my section because I always get a kick out of calling a woman "ma'am" when I know she is younger than me. It's basically a chance for me to call her an old lady right to her face.
Maybe Blaise has a point that some servers are a bit too relaxed and informal, but no server who uses that phrase is trying to insult anyone. Blaise clearly has a stick lodged up her ass because rather than just ask the server to not assume she has a penis, she corrects those waiters. And "not gently either," she claims. She is probably as rough on those waiters as she is on her maxi-pad. She wants to make sure that servers know they are not her buddy nor her equal and servers need to be put in their place. Put in their place? Where exactly is their place? Stationed in the back corner of the restaurant with their head bowed down waiting until you call upon them? Maybe their "place" is on their hands and knees groveling for your pennies. Or maybe you think their place is in the restroom so they can wipe your ass for you when you're finished expelling your lunch from Taco Bell.
Blaise, grow up. No server wants to intentionally piss off their table because all that will do is affect the tip and why would they do that? If a server walks by your table and says, "can I get anything else for you guys right now?" all he wants to know is if you need more butter, Ranch dressing or Diet Coke. (He's just being nice by asking because we all know you do. You do want more butter, Ranch dressing and Diet Coke.)
The relationship between a server and a customer should be one of mutual respect. We are all equals in this world and just because you cobbled together enough money for an all-you-can-eat shrimp special at the Red Lobster does not entitle you to look down on a person who is doing a service for you. You freely admit that your attitude makes you sounds snooty, but I beg to differ. It makes you sound like a miserable person that no server would ever want to serve. You are the kind of person that makes so many people in the service industry question whether or not they even like people anymore. If you are as rude to servers as you imply that you are, the bad service you may receive is probably result of your very own attitude. Remember the golden rule? Treat others as you would want to be treated. If you want your servers to treat you with respect, maybe you should treat them that way too.


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After two Creed films and six Rocky instalments – some unforgettable, some regrettable – Sylvester Stallone is saying goodbye to the US$1.4 billion franchise.
For now, at least.
In a touching speech shared on his Instagram page, the 72-year-old took a moment to reflect on his career as he hangs up the gloves as one of cinema's most iconic characters.
Watch the video in the player above
Side note: Stallone is 72 years old? Time flies.
It's hard to say whether Stallone's retirement from the franchise will endure the inevitable giant cheque offered by a nameless executive for a starring role in a reboot, but something tells me he's genuinely happy to be seeing the end of it.
Video not available in your region? Watch in on Instagram.


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How to Tag People In Facebook Page
Let's take a glimpse at some of the most important ways you can tag others on Facebook. Note that your friends' privacy settings could influence a few of these.
How To Tag People In Facebook Page
1. Tagging in Status Updates
Whenever you post a status update, you can tag your friends by inputting an @ icon followed by their name. As you kind, a small home window shows up and also updates immediately to show the most effective suit for the message you have actually entered. Click someone's name and also it will show up highlighted in blue on your post. This means you've efficiently tagged them.
You could actually tag individuals besides friends by doing this, consisting of friends of friends, organisations, and extra. And this helps Tagging others in comments, also. Just understand that Tagging someone will make your post noticeable to their friends.
2. The "Who Are You With?" Feature
Facebook permits you to add numerous components to your posts, consisting of surveys, ask for referrals, and moods. Click the Tag Friends alternative, and also you'll see a brand-new With box below your post. Enter several names here as well as your post will include them at the end of your post.
While the above approach allows you tag any individual in a post, this allows you tell your target market that you were with particular people. Hence, it only allows you to tag your friends.
3. Picture Tagging
Tagging friends in images allows others easily determine them. It additionally adds those images to the Photos of You area for anybody in the picture. Open up any type of Facebook picture and if there's a face inside, Facebook will certainly include a show a box when you computer mouse over it. Click in the text area listed below as well as enter the individual's name to tag them.
If package does not show up, click Tag Photo at the end of the display and drag a box over the individual's face. Then enter their name to tag them.


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|WARCRC Update for 2-19-2009
|Thread Tools
|Display Modes
Senior Member
Join Date: Jan 2007
Location: WA.
Posts: 2,993
Update for 2-19-2009
updates for 2-19-2009
1-We will be going back to a Full on old school drivers meeting with penalty demo
2- If you compete you will at sometime be required to score or judge and know how to do it correctly. Ask at anytime if you have questions.
3- The club fees are 20.00 per year to have your points tracked and recorded, and should be paid by the 3rd comp of the new season, You can pay your club dues with PayPal or at most comps. You can also donate to the club anytime of the year you want using PayPal.
4- All the club funds allow us to pay for trophies, hats, hoodys, raffle prizes etc.
5- If someone you know is not ready to judge or score because they are new, please stay at your post till the next qualified person comes up.
6-All drivers should be prepared to judge and / or score keep for any class they run. You may be asked by the event marshal to help out at any time, regardless of where in line you fall, in order to make sure everybody helps carry the load. If you are unsure of your abilities or how to do so correctly, we'll team you up with somebody who can help train you.
Also -
7-In order to ensure the integrity of our scoring process: Following every run, it will be the driver?s responsibility to make sure their score is recorded to the master course score sheet before retrieving their individual sheet back from the scorekeeper. Late recording of scores will not be allowed. The scorekeeper will maintain control of a driver's individual sheet during any off-course repair periods.
8- Please try to use, http://www.wheretoracerc.com/to sign up and try to do it at least 3 days prior to the comp, sooner is always better than later, that gives us time to plan and have all the needed supplies.
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A look at the Mossberg 590 Shockwave Shotgun and its effectiveness as a home defense firearm. This compact 12-gauge is defined as a Non-NFA Firearm and requires no tax stamp for purchase.
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From Guns.com, a look at the suppressor-ready Henry Frontier Lever-Action Rifle with Threaded Barrel. This lever-action rifle is available in 22 S/L/LR and 22 Magnum. The model tested is equipped with an AAC suppressor. Lever Frontier 24" Threaded Suppressor Barrel .22 S/L/LR: Model Number: H001TSPR Action Type: Lever Action Rifle Caliber: .22 S/L/LR Capacity: 10 LR/16 …


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In discovery, the team of researchers has identified the "fingerprints" of about multiple metals which are present in one of the least dense exoplanets. The group of researchers comprised from the University of Cambridge and the Institute de Astrofisica de Canarias (IAC) in Spain, and they have taken the help of the Gran Telescope Canarias (GTC) to observe WASP-127b.
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Jonathan Adkins – Master Personal Trainer
At HTSW- since 2018
Jonathan Adkins has been a fitness coach/personal trainer for 6 years. He has a passion for fitness which started 12 years ago when he began working out with a home weight set in his basement. Proof that everyone is a beginner at some point.
He played 4 years of football at Glenbard West, and 2 years at North Central College where he received his BA in Exercise Science.
He believes in a holistic approach to fitness; training for strength, conditioning, improving mobility and flexibility as well as following a balanced diet. Fitness and proper nutrition can provide everyone with vitality and longevity in recreational activities they love.
Jon specializes in strength development, fat loss training, and athletic development.
- BA in Exercise Science, North Central College
- CPR/AED Certified


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Taking place over 3 pivotal moments in the history of the American Video Store, our intimate story of clerks and customers examines the rise and fall of a cultural phenomenon that defined a generation.
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A friend of mine is making gingerbread men this week. Her house is going to smell heavenly! Gingerbread is the true smell of Christmas – in my opinion. It got me thinking that I too should try to fit making gingerbread into my schedule.
I came across this super cute itsy bitsy gingerbread house that you put on your mug. Check out Not Martha for full details and instructions on how to make these tiny creations.


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GUTU – Foul play is suspected in the death of Sukufile Foto (14) of Hwiru location, Mpandawana whose dead body was found in her room after arriving from a night club at around 3am on Monday.
Neighbours who declined to be named said that they heard a scream from Foto's room and no one took the matter seriously and when they opened her door after day break they found her dead.
"I don't know what happened. I stay in Chatikobo and I was summoned by Police to come to Mpandawana to attend Sukufile who is my brother's daughter. Both Sufukile's father and mother are late hence the Police called me. Sufukile was renting a room at Mpandawana and was staying alone", said Albert Foto.
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Some sources said Sufukile was eight months pregnant.
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Related Pages
Primary 6
We are enjoying being back at school with lots of challenges in our new P6!
We have started our new topic called 'Are ye dancin'?'. It is an intergenerational project and we will be working with our senior partners at Kincarrathie House. We are looking forward to meeting them next week! Some of us are a little nervous but excited to hear their stories. We have been getting help from Helen and Caroline from Oaknote and Agent Rendell from Alzheimer Scotland to prepare for our visit. We have been using dictaphones and working on interview techniques and open questions.
In maths we are learning about place value, for example, putting numbers in the correct columns, writing numbers in words and digits and ordering numbers and decimals. We have been reading a lot of our class novel 'The Garbage King' and writing about it too in Literacy Circles. In PE we have been doing volleyball and Benchball.
This term has been full of fun! We have been doing multiplication, addition and subtraction sums in problem solving. In PE we have been doing child-friendly bleep tests individually and in groups to improve our fitness. We have been looking at Growth Mindset and working on our emotion masks and 'Learning Pits'. In art we made profile picture art of our faces which tell you what we like and about our hobbies.
In Are Ye Dancin'? we have started writing and rehearsing our radio plays and next week Hamish (the sound guy) is coming into school to record them. We have been working with a variety of people on the project including a clinical psychologist called Liesbeth from the University of Edinburgh who came to talk to us about our questionnaires.
So far since the October holidays we have been continuing to work on our topic Are Ye Dancin'? We have been learning how to do some ballroom dancing such the foxtrot and the jive. Peter and Felicity from Edinburgh came in to teach us the moves. In our groups we are designing our own dance halls and we are applying all our skills like literacy, maths, art & design and teamwork skills.
In maths we are learning about area and perimeter and measuring. In literacy we have looking at newspapers and learning how to write headlines and orientations. In PE we have started to do some gymnastics and we are learning how to do headstands and handstands!
This week we had a visit to Kincarrathie House where we demonstrated our foxtrot, jive and the chocolatee! We really enjoyed ourselves and even one of our senior partners had a dance with Peter, the professional dancer. We got to listen to our radio plays and they are available online to listen to. With Mrs Brown, we were learning how to create function machines and made our own robotic function machines.
Click here to listen to our radio plays for Are Ye Dancin'? :-)
This week we have been learning about acute, obtuse and reflex angles in maths and using a protractor properly. Sadly, we visited Kincarrathie House for the last time and we had a tea party with cake and juice. We also performed our plays for our senior partners and let them listen to our radio plays. We have been practising out literacy skills in our daily Literacy half Hour. In art we have been making paper snowflakes to decorate the hall.
This week P6 performed their P6 special assembly Are Ye Dancin'? for our parents and also the school. It was loads of fun and we had a good time! We are going to display all our learning at Perth Concert in a special installation for the public to visit. On Monday we watched the P1 - P4 Nativity and began our 'GIve Racism the Red Card' competition entry. In PE we have practising our ceilidh dancing.
In P6 we have started our new topic We Are Scientists! This is a science topic and we are looking forward to doing experiments and finding out the answers to all our questions. We planned our questions and they are on our Learning Wall. We want to find out about magnets, explosions, electricity and much more! We hope Mrs Daniels will let us do the mentos and coke experiment! In Literacy Circles we have started reading Goodnight Mister Tom and it's really good. In maths we are learning about 3D shapes like an icosahedron, torus and hyperboloid. We have some P6 trips to go on soon too.
In P6 we are starting to learn about air resistance and by making parachutes, we are learning how to keep an egg safe when dropping it from a great height. In PE we have started to learn about being personal trainers by creating a list of exercises for our partners to work through! In Maths we have been learning about tally marks, frequency tables, grouped frequency tables and questionnaires. Recently, we visited Perth Museum to learn about what life was like in WW2 because we are reading a novel called Goodnight Mister Tom which is set in WW2. With our new teacher, Miss Ferguson, we have been learning about advertisements and hopefully, in the future, we will get to design our own one!
Recently we have been doing lots of science experiments with Miss Ferguson. We have been investigating evaporation, chromatography and dissolving and really enjoyed doing the Bear Grylls challenge and Harry Potter potion challenge! We are reading Goodnight Mister Tom and we designed and built Anderson Shelters in our teams which people used to have in their back gardens to protect them from bombing in WW2. We also got to design our own adverts to advertise our products using all the techniques that we have learnt about.
For our third topic we have started learning about World War II. We have been writing questions that we would like answered throughout the duration of our learning.
Yesterday we took part in Take Your Child to Work Day and many of us went with our parents or adults we know to discover what their typical working day is like.
Earlier this week we participated in Racing to School's event at Perth Racecourse where we got to watch horseracing, learn about different jobs in the horse industry and complete maths activities.
Recently we have enjoyed starting cricket and we will be competing in a cricket festival!


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What is parathyroid adenoma
A parathyroid adenoma is a noncancerous (benign) tumor of the parathyroid glands. The parathyroid glands are located in the neck, near or attached to the back side of the thyroid gland. The parathyroid glands in the neck help control calcium use and removal by the body. The parathyroid glands do this by producing parathyroid hormone (PTH). Parathyroid hormone (PTH) helps control calcium, phosphorus, and vitamin D levels in the blood and is important for healthy bones.
A single parathyroid adenoma is responsible for 80% to 85% of hyperparathyroidism, with double adenomas the culprit in 4% to 5%, and parathyroid hyperplasia in 10% to 12% 1). Parathyroid adenomas are most common in patients 50 to 70 years old; however, they can occur at any age. Women are affected 3-times as often as men 2).
Many patients with a parathyroid adenoma are asymptomatic, with hypercalcemia incidentally discovered on routine lab work. Symptomatic parathyroid disease will most commonly manifest as symptoms of hypercalcemia such as bone pain, abdominal pain, fatigue, polyuria, nephrolithiasis, constipation, mental changes and depression. More extreme elevations in calcium can cause complications such as cardiac arrhythmias, coma, and death. A patient is unlikely to have outward physical signs of a parathyroid adenoma.
Parathyroid adenoma diagnosis is often made by the presence of hypercalcemia in blood, followed by an imaging test of the neck.
Most parathyroid adenomas do not have an identified cause. Sometimes a genetic problem is the cause. This is more common if the diagnosis is made when you are young.
Conditions that stimulate the parathyroid glands to get bigger can also cause an adenoma. These include:
- Genetic disorders
- Taking the drug lithium
- Chronic kidney disease
Women over age 60 have the highest risk for developing this condition. Radiation to the head or neck also increases risk.
Parathyroid adenoma causes
The cause of a parathyroid adenoma remains unknown for most patients 3). The most common genetic mutation associated with sporadic parathyroid adenomas is the cyclin D1/PRAD1 gene. Alteration in the normal function of this gene affects parathyroid hormone (PTH) secretion. Approximately 20% to 40% of sporadic parathyroid adenomas have overexpression of cyclin D1. Regarding environmental factors, some data suggest that a history radiation therapy predisposes a patient to parathyroid disease later in life. Long-term calcium deficiency may also result in parathyroid disease due to chronic stimulation of parathyroid hormone (PTH) 4).
A parathyroid adenoma is primarily composed of chief cells, but it can also include oxyphil cells, oncocytes, transitional oncocytes, or a mixture of these cell types. There may also be a rim of normal parathyroid tissue surrounding the adenoma. Microadenomas tend to be unencapsulated; however, larger tumors may have a thin fibrous capsule present with cystic degeneration seen within the tumor. Characteristics such as thick fibrous capsule, adherence to surrounding tissues, vascular and capsular invasion, tumor necrosis, and increased mitotic activity should not be seen in benign adenoma and are more suggestive of carcinoma.
Parathyroid adenoma symptoms
Many people with parathyroid adenoma have no symptoms. Parathyroid adenoma is often discovered when blood tests are done for another medical reason.
Parathyroid adenomas are the most common cause of hyperparathyroidism (overactive parathyroid glands), which leads to an increased blood calcium level. Symptoms may include any of the following:
- Confusion
- Constipation
- Lack of energy (lethargy)
- Muscle pain
- Nausea or decreased appetite
- Urinating more often at night
- Weak bones or fractures
The pathologic gland itself is rarely palpable, and an obvious neck mass is more suggestive of thyroid pathology or parathyroid carcinoma.
Parathyroid adenoma complications
An untreated parathyroid adenoma could cause complications related to hypercalcemia. A rare clinical phenomenon is a parathyroid crisis, which is characterized by extremely high calcium levels, usually more than 15 mg/dL. Symptoms include changes in mental status leading to nervous system failure and coma.
Osteoporosis and the increased risk for bone fractures is the most common concern.
Other complications are less common, but may include:
- Nephrocalcinosis (calcium deposits in the kidneys that can reduce kidney function)
- Osteitis fibrosa cystica (softened, weak areas in the bones)
Complications from surgery include:
- Damage to a nerve that controls your voice
- Damage to the parathyroid glands, which causes hypoparathyroidism (lack of enough parathyroid hormone) and low calcium level
Complications can also arise with resection of the parathyroid adenoma. Injury to the recurrent laryngeal nerve is a serious complication of endocrine surgery and has consequences of hoarseness (unilateral damage) or airway occlusion (bilateral damage). Direct trauma to the nerve due to clipping, grasping, or stretching can cause damage. Indirect deleterious effects on the nerve include skeletonization, thermal injury, or compression. The damage may be transient in cases of compression or stretching, and may resolve in 4 to 6 weeks. However, if improvement in function is not seen after 6 to 12 months, the damage should be presumed to be permanent. If the damage is recognized intra-operatively, immediate primary repair or grafting should be performed.
Parathyroid adenoma diagnosis
Blood tests may be done to check levels of:
- Parathyroid hormone (PTH)
- Calcium
- Phosphorus
- Vitamin D
A 24-hour urine test may be done to check for increased calcium in the urine.
Other tests include:
- Bone density exam
- Kidney ultrasound or CT scan (may show kidney stones)
- Kidney x-rays (may show kidney stones)
- Neck ultrasound
- Sestamibi neck scan (to check for swelling of the parathyroid glands)
Hypercalcemia seen on routine lab work performed for other purposes is the most common initial sign of hyperparathyroidism. In most patients, this hypercalcemia is mild and may even be intermittent, and is usually less than 1.0 mg/dL above normal upper limits. Unexplained hypercalcemia on a repeated set of lab work warrants further investigation. PTH level should be subsequently measured, and it may be elevated or even within normal limits, although inappropriately so given the patient's hypercalcemia. Twenty-four-hour urinary calcium may also be measured, but it is not essential for diagnosis 5).
The next step in evaluation is radiographic imaging. Imaging is essential because it not only guides operative planning but distinguishes a single adenoma from a multi-gland hyperplastic disease.
Normal parathyroids are generally too small to be seen on ultrasound; therefore, visualization of this gland should raise suspicion for a pathologic process. If an adenoma identifiable on ultrasound, it should appear as homogeneously hypoechoic extrathyroidal oval mass with a fat plane separating it from normal thyroid tissue. A feeding artery may also be visualized entering the superior or inferior pole of the adenoma. Ultrasound alone has a sensitivity of only 60% to 80% because it is operator dependent. It may be used as an adjunct nuclear imaging.
The gold standard of parathyroid localization is single-radioisotope scintigraphy with technetium-99m (99mTc) combined with single photon emission computed tomography (SPECT) imaging. SPECT is a 3-dimensional sestamibi scan which improves the visualization of parathyroid glands. The combination of these methods has a 91% to 98% sensitivity for identifying parathyroid adenomas.
An alternative is dual-radioisotope imaging, in which both 99mTc pertechnetate and thallium-201 (201Tl) are given. Thallium is taken up by both the thyroid and parathyroid, while pertechnetate only has avidity for the thyroid. Subtraction imaging is then used to visualize the glands. Drawbacks to this method include the necessity of a subtraction program, long imaging times, and limited views.
Four-dimensional CT and MRI have also been used in parathyroid imaging. However, they are only 75% and 40% to 85% sensitive respectively. For that reason, nuclear imaging for preoperative localization. Four-dimensional CT and MRI may have a more beneficial role in localizing ectopic glands after failed parathyroidectomy. In a study of 45 patients who had undergone previous neck exploration, 4-dimensional CT had 88% sensitivity for abnormal parathyroid glands compared with sestamibi SPECT or neck ultrasound (54% and 21%, respectively).
Figure 1. Parathyroid adenoma ultrasound
Figure 2. Parathyroid adenoma SPECT scan
Footnote: Static and SPECT images were acquired at 15 min and 3 hours. Delayed CT- SPECT was performed. Initial images show mild focal uptake in the region of the thyroid left upper and right lower poles. No other abnormal extra-thyroid uptake is detected in the rest of the neck or mediastinum. Delayed images show locally retained uptake corresponding to a soft tissue nodule posterior to the left upper pole and another little nodule posterior to the right lower pole. Mild uptake in sub centimeter left supraclavicular lymph nodes is non-specific. Mild uptake in the left anterior mediastinum is probably within physiological limits.
Parathyroid adenoma treatment
Surgery is the most common treatment, and it often cures the parathyroid adenoma. But, some people choose to only have regular checkups with their health care provider if the hyperparathyroidism (overactive parathyroid glands) is mild.
To help improve hyperparathyroidism (overactive parathyroid glands), your doctor may ask you to stop taking calcium and vitamin D supplements. Women who have gone through menopause may want to discuss treatment with estrogen.
Parathyroid adenoma surgery
Traditionally, bilateral 4-gland exploration was the procedure of choice for hyperparathyroidism. However, because a single parathyroid adenoma causes 85% of the disease, minimally invasive parathyroidectomy is emerging as the gold standard for a parathyroid adenoma 6).
After parathyroidectomy, the calcium levels will drop for the next 2-4 days but few patients will develop symptoms. However, if symptoms appear, treatment with calcium gluconate may be required. if the hypocalcemic state persists, one will need to supplement with oral calcium.
Due to the short half-life of PTH, the Miami criteria dictates that the PTH level should decrease by at least 50% within 10 minutes of parathyroid adenoma removal. If this value is not met, further exploration is warranted. Missing parathyroid glands can be found in the retropharyngeal or retro- esophageal planes, posterior mediastinum, thymus, mediastinum, inside the thyroid capsule or gland, or in the carotid sheath 7).
Persistent hyperparathyroidism after parathyroid surgery is most likely due to a missed parathyroid adenoma. The thymus has been reported as the most common ectopic site for parathyroid adenomas, followed by the thyroid gland, undescended glands, carotid sheath and the retroesophageal space.
Parathyroid adenoma prognosis
When treated, parathyroid adenoma outlook is generally good.
References [ + ]
|1, 3.
|Wolfe SA, Sharma S. Parathyroid Adenoma. [Updated 2019 Mar 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507870
|Edafe O, Collins EE, Ubhi CS, Balasubramanian SP. Current predictive models do not accurately differentiate between single and multi gland disease in primary hyperparathyroidism: a retrospective cohort study of two endocrine surgery units. Ann R Coll Surg Engl. 2018 Feb;100(2):140-145
|Sahli ZT, Karipineni F, Zeiger MA. A garden of parathyroid adenomas. BMJ Case Rep. 2017 Aug 03;2017
|Raruenrom Y, Theerakulpisut D, Wongsurawat N, Somboonporn C. Diagnostic accuracy of planar, SPECT, and SPECT/CT parathyroid scintigraphy protocols in patients with hyperparathyroidism. Nucl Med Rev Cent East Eur. 2018;21(1):20-25.
|Komarowska H, Bromińska B, Luftmann B, Ruchała M. Primary hyperparathyroidism in pregnancy – a review of literature. Ginekol. Pol. 2017;88(5):270-275
|Mourad M, Buemi A, Darius T, Maiter D. Surgical options for primary hyperparathyroidism. Ann. Endocrinol. (Paris). 2015 Oct;76(5):638-42.