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6 Chocolate sponge cakes topped with fondant with sugar paste decorations
Sugar, Water, Pasteurised Free Range Egg, Rapeseed Oil, Fortified Wheat Flour (Wheat Flour, Calcium Carbonate, Niacin, Thiamin), Glucose Syrup, Cocoa Mass, Humectant: Vegetable Glycerine, Waxy Maize Starch, Cocoa Butter, Cocoa Powder, Chocolate (Sugar, Cocoa Mass, Fat Reduced Cocoa Powder), Fat Reduced Cocoa Powder, Emulsifiers: Propane 1 2 Diol Esters of Fatty Acids, Mono- and Diglycerides of Fatty Acids, Sodium Stearoyl-2-Lactylate, Soya Lecithin, Whey Powder (Milk), Raising Agents: Diphosphates, Sodium Carbonates, Preservative: Potassium Sorbate, Wheat Gluten, Salt, Palm Oil, Glazing Agents: Arabic Gum, Carnauba Wax, Beeswax, Shellac, Colours: Riboflavin, Carmines, Copper Complexes of Chlorophyll and Chlorophyllins, Carotenes, Beetroot Red, Anthocyanins, Titanium Dioxide, Iron Oxides, Curcumin, Paprika, Whole Milk Powder, Stabilisers: Tragacanth, Xanthan Gum, Spirulina, Flavouring, Dried Free Range Egg Albumen
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|[Ligne directrice - Note] Note du photographe|
|No Matter where you go inn Arizona, You find a different look, climate, and people. The state is a gold mine for the photographer. A must visit|
|Vous devez vous authentifier pour démarrer une discussion.|
Yes a wonderful jigsaw of life....
A lot of great pictures in it !!
This is the mystery of life, to be present in the most inhospitable places.
- [2018-04-01 10:53]
I like it.....good work!!!

domain: geography


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Chapter 40 The clinical evaluation of orbital lesions is treacherous due to the overlap of signs and symptoms of disease caused by orbital inflammatory processes with those of orbital mass lesions. For this reason, the differential diagnosis of orbital inflammation presented in this chapter almost always includes neoplastic and vascular diseases along with infection and systemically associated processes. We presuppose that lesions caused by trauma have been ruled out by the medical history. Attention to several questions during patient evaluation can facilitate the diagnosis and management of inflammatory lesions of the orbit. The onset, duration, localization, and progression of symptoms are of utmost importance. Inflammatory lesions of the orbit are much more common than neoplastic lesions, either benign or malignant. Lesions of chronic duration (months to years) with limited effect on orbital structure and function are more likely to be benign (whether neoplasia or low grade inflammation), as opposed to lesions of short duration (days to weeks), which are most likely to be malignant neoplasia or high grade, acute inflammation.1,2 Hyperacute presentation (hours) suggests either hemorrhage into a preexisting lesion, or fulminant inflammation or infection. Pain is nonspecific and is a frequent complaint in patients with either malignancy or inflammation. However, numbness often indicates neoplastic neural invasion. Working through the differential diagnoses, the history, physical findings, imaging characteristics, results of prudent laboratory investigation, and histopathologic evaluations guides the clinician to the correct diagnosis and treatment for orbital inflammation. The most reasonable format for categorization has been presented separately by Jakobiec and colleagues2 and Rootman et al.1 This chapter utilizes their approach with some modification as is outlined in Table 40–1. Orbital diseases in this category have been lumped in the past into a relatively poorly descriptive grouping labeled “orbital pseudotumor.” More recent schemes suggest dividing diagnostic elements into those with more nonspecific inflammatory processes, or into those with more specific inflammatory patterns, based on a known etiology of the inflammation (infection), or on a specific inflammatory configuration (e.g., granulomatous). In this discussion, those nonspecific idiopathic inflammations of the orbit that primarily affect the anterior orbital structures, the posterior structures, and those with diffuse orbital processes are considered together. Those predominately affecting the extraocular muscles and lacrimal gland are considered subsequently. Since the early 19th century, the term orbital pseudo-tumor has been used to describe a set of orbital lesions composed of benign nonspecific idiopathic inflammatory infiltrates, characterized by accumulation of heterogeneous cellular constituents, and with varying degrees of fibrosis. Several authors have since recommended abandonment of this term in favor of a more practical nomenclature designated as nonspecific idiopathic orbital inflammation (NSIOI).3,4 Several subtypes have been described based on lesion location (anterior orbital inflammation, posterior orbital inflammation, diffuse orbital inflammation, myositis, dacryoadenitis), the degree of inflammation (focal, diffuse), or the amount of fibrosis (sclerosing). The clinical presentation in any of these may be acute (hours to days), subacute (days to weeks), or chronic (weeks to months). This discussion focuses on the more common presentation of multifocal (anterior or posterior orbital) and diffuse orbital inflammation, and not those related to infection or to specific local or systemic processes.
ORBITAL INFLAMMATION AND INFECTION
NONSPECIFIC INFLAMMATIONS OF THE ORBIT
NONSPECIFIC IDIOPATHIC ORBITAL INFLAMMATION
The clinical evaluation of orbital lesions is treacherous due to the overlap of signs and symptoms of disease caused by orbital inflammatory processes with those of orbital mass lesions. For this reason, the differential diagnosis of orbital inflammation presented in this chapter almost always includes neoplastic and vascular diseases along with infection and systemically associated processes. We presuppose that lesions caused by trauma have been ruled out by the medical history.
Attention to several questions during patient evaluation can facilitate the diagnosis and management of inflammatory lesions of the orbit. The onset, duration, localization, and progression of symptoms are of utmost importance. Inflammatory lesions of the orbit are much more common than neoplastic lesions, either benign or malignant. Lesions of chronic duration (months to years) with limited effect on orbital structure and function are more likely to be benign (whether neoplasia or low grade inflammation), as opposed to lesions of short duration (days to weeks), which are most likely to be malignant neoplasia or high grade, acute inflammation.1,2 Hyperacute presentation (hours) suggests either hemorrhage into a preexisting lesion, or fulminant inflammation or infection. Pain is nonspecific and is a frequent complaint in patients with either malignancy or inflammation. However, numbness often indicates neoplastic neural invasion. Working through the differential diagnoses, the history, physical findings, imaging characteristics, results of prudent laboratory investigation, and histopathologic evaluations guides the clinician to the correct diagnosis and treatment for orbital inflammation. The most reasonable format for categorization has been presented separately by Jakobiec and colleagues2 and Rootman et al.1 This chapter utilizes their approach with some modification as is outlined in Table 40–1.
Orbital diseases in this category have been lumped in the past into a relatively poorly descriptive grouping labeled “orbital pseudotumor.” More recent schemes suggest dividing diagnostic elements into those with more nonspecific inflammatory processes, or into those with more specific inflammatory patterns, based on a known etiology of the inflammation (infection), or on a specific inflammatory configuration (e.g., granulomatous). In this discussion, those nonspecific idiopathic inflammations of the orbit that primarily affect the anterior orbital structures, the posterior structures, and those with diffuse orbital processes are considered together. Those predominately affecting the extraocular muscles and lacrimal gland are considered subsequently.
Since the early 19th century, the term orbital pseudo-tumor has been used to describe a set of orbital lesions composed of benign nonspecific idiopathic inflammatory infiltrates, characterized by accumulation of heterogeneous cellular constituents, and with varying degrees of fibrosis. Several authors have since recommended abandonment of this term in favor of a more practical nomenclature designated as nonspecific idiopathic orbital inflammation (NSIOI).3,4 Several subtypes have been described based on lesion location (anterior orbital inflammation, posterior orbital inflammation, diffuse orbital inflammation, myositis, dacryoadenitis), the degree of inflammation (focal, diffuse), or the amount of fibrosis (sclerosing). The clinical presentation in any of these may be acute (hours to days), subacute (days to weeks), or chronic (weeks to months). This discussion focuses on the more common presentation of multifocal (anterior or posterior orbital) and diffuse orbital inflammation, and not those related to infection or to specific local or systemic processes.
Nonspecific idiopathic orbital inflammation (NSIOI: “orbital pseudotumor”)
Specific orbital inflammation
Inflammation secondary to infection
Giant cell (temporal) arteritis
Adult orbital xanthogranuloma
Ruptured dermoid, mucocele
Lymphoproliferative (neoplastic) inflammation/infiltration
Langerhans’ cell histiocytosis
URGENCY OF EVALUATION
The urgency of evaluation is dependent on the symptom complex. Those patients with severe pain or decreased vision need to be seen promptly. Those with a more indolent course or mild diplopia should be seen as soon as is practicable. If the patient is also diabetic or otherwise immunocompromised, examination should proceed emergently to rule out fungal infection (particularly mucormycosis).
Nonspecific idiopathic orbital inflammation (NSIOI) usually presents between the ages of 30 and 50, but can occur in children and the elderly.1 Although children can present with bilateral disease, adults usually have unilateral involvement. There is no gender or ethnic predilection.
Pain is a hallmark of NSIOI. In the acute form, the onset is sudden, but depending on the degree of inflammation present, it can also be subacute, with onset over days. Pain is localized to the periorbital region on the side of involvement, and may be exacerbated by ocular movement. If a posterior inflammatory picture is present, pain may be more modest. If associated with scleritis, pain may be referred to the temple.
Lid Swelling and Erythema
Lid involvement varies with degree of inflammation, but is not as dramatic as that seen in orbital cellulitis. Swelling can include the periorbital regions, frequently demarcated by the orbital septum at the orbital rim (Fig. 40–1). Swelling should not be indurated or warm. Lid swelling is less prominent in posterior NSIOI.
Double vision is sometimes described, but is less prominent than that seen with primary inflammation of extraocular muscles (myositis). The diplopia may be caused by muscle restriction, especially in the more fibrotic forms, or due to congestion. Forced ductions and cross-cover analysis sometimes indicates decompensation of a preexisting phoria. Posterior NSIOI usually presents as an orbital apex syndrome often with multiple muscle involvement.
Vision loss is uncommon in anterior forms of NSIOI except as secondary to ocular inflammation. In posterior forms, vision decline can occur due to compression or involvement of the optic nerve. Vision loss can also be caused by secondary uveitis or scleritis with retinal involvement. Uveitis is a more common finding in anterior NSIOI.
Patients frequently complain of loss of energy, but do not have systemic signs of infection (afebrile).
Although proptosis is considered the hallmark of orbital mass effect, the degree of proptosis in NSIOI can be quite variable depending on the degree of inflammation and fibrosis. There is usually resistance to ocular retropulsion, often with pain. Proptosis is less prominent with posteriorly located inflammation (apical).
Conjunctival Injection and Chemosis
This is generalized across the conjunctiva, and the injection is not severe unless significant ocular involvement is present.
With both posterior and anterior forms of NSIOI, some degree of uveal inflammation may be seen. This can include iridocyclitis, pars planitis, posterior uveitis, and posterior scleritis.5 Retinal striae from choroidal involvement or posterior ocular mass effect may be present, and can lead to a hyperopic shift. Secondary exudative retinal detachment has been described.5
Inflammation of the optic nerve head or the surrounding nerve fiber layer has been described uncommonly, both in association with choroiditis, and separately. This can lead to visual acuity and field loss.6
An increase in intraocular pressure can be seen in anterior NSIOI, with either direct inflammation of trabecular meshwork structures, or secondary to blockage of aqueous outflow passage.7 Cyclitis (inflammation of the ciliary body) without significant cellular release into the aqueous can result in a lowering of intraocular pressure.
The following features should raise the question of alternative diagnoses:
Bilateral orbital involvement. This is more common in children, but in adults raises the question of thyroid ophthalmopathy, cavernous sinus thrombosis, or systemic vasculitis such as polyarteritis nodosa, Wegener’s granulomatosis, or Erdheim-Chester disease. Lymphoproliferative neoplasia is often bilateral.2
Significant ophthalmoparesis. Suggests alternatives as described previously in this chapter. Aqueous cell and flare and pertinent ocular signs can indicate orbital ischemic syndrome.
Fever, warmth, significant orbital/lid swelling. Orbital cellulitis must be ruled out.
Paranasal sinus disease. Although orbital inflammation may follow nonspecifically from a sinus inflammation, sinus and hence orbital infection must be entertained, as well as vasculitic processes such as Wegener’s granulomatosis.8
Presence of diabetes mellitus or immunocompromise. Mucormycosis needs to be ruled out emergently.
Orbital cellulitis, uveitis without orbital involvement, posterior scleritis without orbital involvement, systemic inflammatory syndromes (collagen vascular disease), Wegener’s granulomatosis, arteriovenous fistula. In children, orbital cellulitis, rhabdomyosarcoma, leukemic infiltrate, metastatic neuroblastoma should be considered.
Hemorrhage into preexisting orbital mass, Tolosa-Hunt syndrome, lymphoma, fungal infections including mucormycosis, paranasal sinus tumor spread, Wegener’s granulomatosis
Because of the possibility of intracranial extension or involvement,9 neuroimaging of both the brain and orbits is absolutely required. This should be performed in both axial and coronal planes (digital reconstruction if not available), and both with and without contrast medium. Computed tomography (CT) is generally ordered initially due to the improved visualization of bone and paranasal sinuses.2 Subsequent magnetic resonance imaging (MRI) is often also ordered for better visualization of the brain, cavernous sinus, and some soft tissue components of the orbit. MRI should also be ordered with additional fat suppression techniques.
CT with contrast (Fig. 40–2) typically reveals a diffuse orbital infiltrate that, in anterior forms, is ragged on the edges and conforms to the curvature of the globe.10 Scleral involvement appears as thickening and enhancement. Remodeling of bone is not uncommon, sometimes including hyperostosis.11 Bone erosion is more common in neoplasia.2 In posterior NSIOI (Fig. 40–3), CT often depicts enhancement and enlargement of the optic nerve sheath as well as the perineural fat or posterior portions of the extraocular muscles.12
Ultrasound in both A and B mode can help in the diagnosis of scleritis and differentiation of orbital mass structures. Posterior scleritis with effusion at Tenon’s capsule can create the “T-sign.”13
Depending on the clinical presentation, especially if atypical, some laboratory tests may be helpful. These include complete blood count (CBC) with differential, treponemal tests [microhemagglutination of Treponema pallidum (MHA-TP)], erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), fasting serum glucose (rule out diabetes and potential mucormycosis), anti-neutrophil cytoplasmic antibodies (ANCA), and angiotensin-converting enzyme (ACE). Based on the initial workup, more directed laboratory studies may be warranted, as might radiographic analysis of other body regions.
Biopsy, either by direct visualization or by needle, should be considered if the presentation is atypical or if response to treatment is incomplete. Any past history of neoplasia heightens the need for histopathology. If mucormycosis is suspected, biopsy is of paramount importance.
Biopsy results depend on the site selected and the stage of disease. In early disease, edema and a heterogeneous mild inflammatory infiltrate are typically seen, composed of lymphocytes, plasma cells, eosinophils, and sometimes polymorphonuclear cells.2Eosinophils are more prominent in children and can even be elevated in the blood.14 With disease progression, both the inflammatory component and the fibrotic component increase, with cells becoming separated by strands of collagen radiating from the orbital septa and vessels, into the fat. Lymphoid follicles, usually multicentric, are seen in the more chronic forms of NSIOI. Perivascular lymphocytic cuffing is common and does not represent vasculitis. With chronicity, more fibrosis occurs with gradual replacement of orbital structures including fat and muscle.
Corticosteroids remain the mainstay of acute therapy, and can produce dramatic results in a matter of hours to days. Some authors utilize steroid failure as an indicator for alternative diagnostic workup. A typical regimen includes prednisone 80 to 100 mg by mouth daily for 2 to 3 weeks, with slow taper over the ensuing 3 weeks to prevent recurrence.2 Rootman1advocated taper over 2 to 3 months. Addition of gastric protective agents is important (i.e., ranitidine, 150 mg p.o. b.i.d.; or famotidine, 40 mg p.o qhs; or others) and should be maintained throughout steroid therapy. Steroids are less successful in subacute or chronic cases where fibrosis is already a component.
Radiotherapy (1500 to 2000 cGy) is sometimes administered in refractory cases, with appropriate shielding of the globe.2 If no or poor response to radiation therapy occurs, biopsy or rebiopsy should be considered.
Additional topical steroid medication is sometimes used in fulminant cases of anterior NSIOI with uveitis, depending on severity of the inflammation. Prednisolone acetate 1% applied every 1 to 6 hours with or without a cycloplegic agent may provide local therapy and relief from ciliary spasm. Newer drugs, including topical cyclosporine, may be indicated in chronic cases.
Glaucoma attendant with NSIOI, whether due to ocular inflammation, or ocular compression, should be treated accordingly.
FOLLOW-UP AND REFERRAL
Depending on the reliability of the patient, initial follow-up evaluation should be performed in 3 to 7 days to check for treatment response. Worsening of symptoms after 48 hours of treatment should be reported to the physician, and other causes, especially infectious, entertained. Intraocular pressure monitoring to observe for steroid effects is important.
Recurrence is uncommon, but may indicate need for longer treatment, or alternative antiinflammatory or immunosuppressive drugs. If there is not a dramatic response to initial therapy, referral to an orbital disease specialist can be helpful.
IDIOPATHIC SCLEROSING INFLAMMATIONS OF THE ORBIT
Although some authors have included idiopathic sclerosing inflammation of the orbit (ISIO) as a subset of idiopathic orbital inflammation, such classification is probably inappropriate.2 Rootman et al3 have argued that ISIO represents a unique clinicopathologic entity that is related to other systemic multifocal fibrosclerosing processes such as retroperitoneal fibrosis, mediastinal fibrosis, sclerosing cholangitis, Reidel’s fibrous thyroiditis, and pachymeningitis. ISIO is manifest as a chronic, primarily fibrotic process, with mild inflammation, which is immunologically mediated. It is relatively uncommon, occurring in only 5% of patients with orbital inflammations of nonthyroid designation.1 Most disease begins in the lacrimal region, with 20% beginning in apical orbital locations. Diffuse orbital and myositic subtypes have been encountered. As disease progresses, sclerosis becomes more diffuse, and may spread intracranially, or into the pterygoid fossa.
URGENCY OF EVALUATION
The clinical onset of disease is subacute or chronic. However, because early treatment has been said to decrease further sclerosis, evaluation should proceed in a relatively short time period. If the patient is diabetic or otherwise immunocompromised, evaluation should proceed urgently in order to rule out mucormycosis.
Idiopathic sclerosing inflammation of the orbit occurs in the same population as other idiopathic inflammatory orbital processes; namely, young adults to those of elderly age. There is no predilection for gender or ethnicity.
Patients may complain of a low-grade, dull pain localized around the orbit or orbits, which fluctuates little over time.
Double vision is more common in later stages of the disease after significant fibrosis has restricted extraocular muscle movements. In some patients, despite severe ocular restriction, no diplopia is noted, possibly due to unilateral or alternating visual suppression.
Loss of acuity and visual field are not uncommon and suggest compression or stretching of the optic nerve and need for aggressive treatment.
Proptosis is variable and dependent on the degree of sclerosis. In some patients, the degree of proptosis may be considerable. Associated resistance to ocular retropulsion is present.
Lid droop may be seen with involvement of the superior orbit/levator palpebrae region. Mass effect on the lid can also cause ptosis.
When anterior fibrosis adjacent to the lids occurs, lids may swell, but are usually without significant erythema, and there is never induration or signs of orbital cellulitis.
Episcleral vessels may be injected on the affected side, but chemosis is less prominent than in nonsclerosing inflammatory variants. Significant conjunctival injection suggests possible carotid-cavernous fistulas.
Restriction of Ocular Movement
Depending on the degree and location of involvement, restriction of extraocular muscles occurs. In severe cases this can present as a “frozen globe.”
The following features should raise the question of alternative diagnoses
Significant lid retraction. This is more common with thyroid eye disease.
History of previous cancer. Orbital metastasis, including bilaterally, is not uncommon for lung, breast, bowel, prostate, and some other types of cancer.
History of diabetes or other form of immunocompromise. Emergent evaluation for possible mucormycosis should ensue.
History of previous systemic vascular disease such as Wegener’s granulomatosis.
Fever. Suggests possible infection.
The differential diagnosis includes thyroid ophthalmopathy, sarcoidosis, Wegener’s granulomatosis, orbital infections including fungal and mycobacterial, Erdheim-Chester disease (especially if bilateral), meningioma, fulminant sinus disease with spread, sinus neoplasia with spread, lymphoma.
Because of the possibility of intracranial extension or meningeal involvement, neuroimaging of both the brain and orbits is absolutely required. This should be performed in both axial and coronal planes (digital reconstruction if not available), and both with and without contrast medium. CT should be ordered initially due to the improved visualization of bone and paranasal sinuses.2 Subsequent MRI is often ordered to better visualize the brain, cavernous sinus, and some soft tissue components of the orbit. MRI should be ordered with additional fat-suppression techniques.
Imaging of the orbit frequently reveals homogeneously enhanced areas of opacification with ragged margins. There may be opacification of extraocular muscles or the lacrimal gland. Posterior infiltration may show stretch of the optic nerve. In severe disease, there may be total wall-to-wall opacification of all orbital structures except the globe.
When the diagnosis is not clear, additional tests might include CBC with differential, ANCA, ANA, thyroid-stimulating hormone (TSH), MHA-TP, serum protein electrophoresis (SPEP), purified protein derivative (PPD) with controls, chest x-ray, ACE, and other directed tests based on results of the workup.
Because of the extent of the differential diagnosis, and the overlap of clinical and physical characteristics, biopsy of orbital structures is common in this entity. Representative sample should be obtained and a portion of the biopsy sent in saline (i.e., no fixative) for flow cytometric and/or molecular analysis. Pathology usually shows a paucicellular chronic inflammatory infiltrate with significant desmoplastic stroma that infiltrates and obliterates orbital fat and muscles. Inflammatory cells include lymphocytes, plasmacytes, histiocytes, and occasional lymphoid follicles. Eosinophils are not usually seen.
In the past, as in other NSIOI, sclerosing inflammation has been treated primarily with steroids, with radiation therapy and chemotherapy comprising second-line approaches. However, discouraging results are often obtained, with up to 30% of patients progressing despite treatment of any sort. Because of this, Rootman and colleagues3 have advocated an aggressive approach aimed at early diagnosis and treatment with multiple immunosuppressive agents. Systemic prednisone has been combined with drugs directed against B cells (methotrexate, cyclophosphamide, azathioprine, depending on the age of the patient) and/or against T-cells (cyclosporine). Management with these agents is best accomplished along with a rheumatologist and an oncologist or chemotherapist. Disease arrest without further progression has been reported using this combined approach.1 Resolution of fibrosis already present prior to therapy, however, has not been reported. Occasionally surgical debulking or orbital exenteration has been utilized to stem aggressive disease and intracranial extension.4
FOLLOW-UP AND REFERRAL
Because of the aggressive and relentless nature of idiopathic sclerosing inflammation of the orbit, and because of the need for multidisciplinary management of treatment paradigms, most patients should be referred to an orbital specialist who will coordinate the approach.
NONSPECIFIC ORBITAL INFLAMMATORY MYOSITIS
Orbital myositis is one of the most common NSIOIs, and involves idiopathic inflammation primarily of the extraocular muscles. It is differentiated from the more anterior, posterior, or diffuse subsets of NSIOI discussed previously. Fifty percent of patients with orbital myositis possess underlying immunologic abnormalities.1 Other systemic associations include prior upper respiratory tract infections,15 antecedent flu-like illness, sinusitis, allergic rhinitis, asthma,16 and influenza vaccination.17
URGENCY OF EVALUATION
Urgency of evaluation is linked to the severity of the presenting symptoms and their developmental course. If pain or diplopia is extreme, a more rapid evaluation is necessary. If symptom presentation is subacute, the patient should be seen soon, but not necessarily urgently. If there is any associated visual acuity or field loss (indicating additional anterior, posterior, or diffuse orbital involvement), the patient should be seen urgently. The patient with diabetes or who is otherwise immunocompromised should be seen emergently to rule out mucormycosis.
Myositis can occur anytime from adolescence to elderly age, with no gender or ethnic predilection.
Fifty percent of patients present with double vision of acute or subacute onset. There are cases with chronic development of symptoms (weeks to months).
Most patients present with periorbital and retrobulbar pain of sudden onset (over hours to days) that is worsened by extraocular movement. Subacute and chronic forms have also been reported.
Visual changes are a rare, but concerning manifestation of myositis and indicate possible posterior orbital muscle inflammation or posterior apex involvement. Patients with vision loss should be evaluated and treated quickly.
Extraocular Muscle Restriction
The movement of the affected extraocular muscle is usually reduced in the appropriate field of action, and forced ductions are often positive. Muscle restriction may result in retraction of the globe on attempted gaze opposite the side of the involved muscle.18 Any extraocular muscle, vertical or horizontal, can be affected in equal proportion.1 Recurrent disease is more likely to involve multiple muscles and is often bilateral.
Proptosis is frequently present, but often not pronounced unless multiple muscles are involved. There is usually resistance to retropulsion of the globe, sometimes with associated pain.
Conjunctival Chemosis and Injection
Injection of episcleral and conjunctival vessels with associated chemosis may be seen overlying the insertion of the involved muscle or muscles. Significant chemosis or injection, however, should be a red flag for possible infection.
The following features should raise the question of alternative diagnoses:
Significant lid retraction. This is more likely a feature of thyroid ophthalmopathy.
Significant ophthalmoparesis. This may be related to orbital ischemic syndrome, carotid cavernous fistula, or fulminant infection.
Significant chemosis or conjunctival injection. As in number 2.
Significant ptosis without lid swelling. This may relate to myasthenia gravis or more widespread anterior NSIOI.
History of previous cancer. Metastatic disease to extraocular muscles has been reported.
Visual loss. Although myositis with involvement of the posterior portion of the muscles can cause optic nerve compression and vision loss, multiple other causes may be involved including posterior NSIOI, infection, or neoplasia. Occasionally lymphoproliferative processes can mimic posterior myositis.
Young age at onset. Consideration for acute presentation of rhabdomyosarcoma is of paramount importance.
Fever. Suggests infectious causes.
Differential diagnosis includes thyroid ophthalmopathy; carotid-cavernous fistula; myasthenia gravis; Tolosa-Hunt syndrome; lymphoma; orbital metastasis; primary extraocular muscle tumors; amyloidosis; sarcoidosis; systemic lupus erythematosus; Wegener’s granulomatosis; orbital infection including fungus, spirochetes, and parasites; and other nonspecific orbital inflammation syndromes.
To rule out other orbital processes, some of which may involve other central nervous system (CNS) regions, neuroimaging of both the brain and orbits is absolutely required. This should be performed in both axial and coronal planes (coronal digital reconstruction if not available directly), and both with and without contrast medium. CT is generally ordered initially due to the additional visualization of bone and somewhat improved images of the paranasal sinuses.2 Subsequent MRI is often also ordered for better visualization of the brain, cavernous sinus, and some soft tissue components of the orbit. MRI should be ordered with additional fat-suppression techniques.
CT images usually demonstrate the characteristic diffuse enlargement of the entirety of the affected extraocular muscle, including the tendon (as opposed to thyroid ophthalmopathy, which typically spares the tendon). Orbital tissue adjacent to the muscle may be locally infiltrated showing a ragged enhancement on contrast CT adjacent to the muscle substance.
In atypical cases, or where the diagnosis is in doubt, ancillary lab tests might include CBC with differentiation, ESR, CRP, TSH, ANA, ANCA, ACE, acetylcholine receptor antibodies (binding, blocking, and modulating forms), SPEP, MHA-TP, and Lyme Western blot.19
If there is no response to treatment or if the diagnosis is in doubt, a biopsy of extraocular muscle and associated orbital tissue should be considered. Needle biopsy is not usually adequate in this circumstance. Attempts should be made to obtain an affected portion of muscle. The pathologic characteristics of myositis are similar to those of other forms of nonspecific idiopathic orbital inflammation, namely, a polymorphous infiltrate of mixed lymphocytic, plasmocytic, eosinophilic, and less commonly polymorphonuclear cells. Histopathologic differentiation from thyroid ophthalmopathy can be difficult, but eosinophilia is not usually present in the latter.2 With chronicity, variable amounts of fibrosis can be present with replacement of muscle fibers.
As in other forms of NSIOI, corticosteroids remain primary in treatment of myositis. Single muscle involvement may require less hefty doses of steroids (prednisone, 40–60 mg p.o. per day tapered on a symptomatic basis). Alternatively, treatment with nonsteroidal antiinflammatory drugs (NSAIDs) has been advocated, or even observation if disease is on the wane.1 Disease in such patients usually improves rapidly with treatment, and is monophasic. If disease is bilateral or if multiple muscles are involved, higher doses of prednisone are indicated (prednisone 80–100 mg p.o. per day for 2 to 3 weeks). Recurrence and refractivity are more common in subacute and chronic presentations, requiring longer treatment periods with slower taper protocols over 4 to 6 weeks.1 Pulse intravenous steroids have been advocated in extreme cases including apical orbital disease with visual loss (IV methylprednisolone 250–1000 mg over 1 to 2 hours every month or every 2 months, changing to orals with taper based on symptomatic response). Appropriate gastric protection should be provided to patients on steroids via an H-2 blocker (ranitidine, cimetidine) or proton pump inhibitor (omeprazole, rabeprazole, lansoprazole).
Radiotherapy has been advocated by some in recalcitrant cases. Considerable rates of recurrence have occurred in these patients, however,20 prompting suggestions that higher radiation dosage might be required.21
FOLLOW-UP AND REFERRAL
Patients should be seen in follow-up within 3 to 7 days after onset of therapy, to evaluate response. Any worsening of symptoms during this period should be reported to the physician immediately, and infectious causes should be evaluated, including mucormycosis in diabetic or immunocompromised patients. Intraocular pressure should be monitored, as some patients develop steroid-induced glaucoma. Subsequent follow-up should be based on response to therapy. If there is no response to therapy, referral to an orbital specialist should be considered.
NONSPECIFIC INFLAMMATORY DACRYOADENITIS
In dacryoadenitis, the primary location of nonspecific idiopathic orbital inflammation is in the lacrimal gland. Because there is normally a small resident population of lymphocytes found at lacrimal ductules, rapid development of lacrimal inflammation in part arising from this locus is not surprising. Dacryoadenitis is the second most common presentation of NSIOI, following only myositis in frequency.1 Evolution of symptoms can be acute, subacute, or chronic. Fifty percent of patients presenting with an enlarged lacrimal gland do not have true nonspecific inflammatory disease but are likely to have an associated systemic disorder, especially if the course is chronic. Close attention to historical, physical, radiologic, and pathologic characteristics helps discern the true nature of the lesion.
URGENCY OF EVALUATION
Urgency of evaluation is linked to the severity of the presenting symptoms. If lacrimal gland swelling is particularly painful, or if there is induration or fever, more rapid evaluation should follow to rule out infection. Although chronic presentation is not urgent, evaluation and workup should proceed directly in order to rule out tumor.
Dacryoadenitis can occur at any age from young adulthood to an elderly age. There is no predilection for disease by gender or race.
In acute dacryoadenitis, there is sudden onset of pain and tenderness over the superotemporal region of the orbit overlying the lacrimal gland. If inflammation has additionally involved the lateral rectus, there may be pain on extraocular movement.
Diplopia is not usually a presenting symptom unless concomitant involvement of the lateral rectus is present.
Lid Swelling and Erythema
The temporal portion of the upper lid on the affected side is frequently swollen and red. The region can sometimes feel warm, but is without induration or other signs of orbital cellulitis. A typical S-shape deformity of the lid is produced, sometimes resulting in ptosis.
Enlarged Lacrimal Gland
The palpebral lobe of the lacrimal gland is frequently enlarged enough to be easily seen in the temporal conjunctival fornix, and may be tender to palpation.
Lateral regions of the bulbar conjunctiva adjacent to the lacrimal gland may be injected and chemotic. This will be more prominent if the lateral rectus is also involved. Chemosis and injection of the conjunctiva distant from the temporal region suggests more widespread involvement, an infection, or arteriovenous fistulae.
Proptosis is usually minimal. There may be slight downward and inward displacement of the globe.
Extraocular Muscle Restriction
The lateral rectus is not usually restricted, but may show slight decrease in range of function if additionally involved. Significant muscle restriction indicates a myositic component.
The following features should raise the question of alternative diagnoses:
Bilateral presentation. This may suggest a lymphoproliferative process or associated systemic disease such as Sjögren’s syndrome, Crohn’s disease, or sarcoid.
Significant conjunctival chemosis and injection. Attention should be directed to possible orbital cellulitis or carotid-cavernous fistulas.
Significant proptosis. Lacrimal gland inflammation usually molds to the globe in the orbit without much mass effect. Prominent proptosis or displacement of the globe suggests neoplasia, mucocele, or other noninflammatory processes.
History of previous cancer. Metastatic disease to the lacrimal gland is possible.
Bone erosion on CT. This is more indicative of neoplasia.
Fever. This suggests orbital cellulitis.
Visual loss. This suggests more fulminant inflammation, or addition ocular or posterior orbit processes.
Severe pain and/or numbness. This raises the question of perineural invasion by a malignant process.
Differential diagnosis includes specific inflammatory processes such as sarcoidosis; infections including bacterial, mycobacterial, spirochetal, or viral infection; lymphoma; Sjögren’s syndrome; Wegener’s granulomatosis; ruptured dermoid cyst; or lacrimal gland involvement in systemic autoimmune disease such as Crohn’s disease.22 Historical, physical, and radiographic, and biopsy findings can usually help differentiate these diseases from typical inflammatory dacryoadenitis.
Radiologic evaluation of the orbit is absolutely necessary in the evaluation of lacrimal gland lesions. CT scan with and without contrast should be ordered in axial and coronal planes, with thin cuts. MRI may add information, especially in atypical cases. CT characteristics of nonspecific inflammatory dacryoadenitis include an oblong enlargement of the lacrimal gland, which molds to the curvature of the globe as it extends posteriorly (Fig. 40–4). Primary epithelial tumors of the lacrimal gland will have a more rounded appearance. The gland may appear in a V shape if the orbital lobe and palpebral lobe are involved.2 The bony orbit is normal, and if erosion is seen, then a neoplasm is likely. Occasionally infiltration of the lateral rectus is seen.
Both A- and B-mode ultrasound investigation can be useful in differentiating lacrimal gland processes.1The lacrimal gland shows enlargement with internal reflectivity. Echolucency is apparent anteriorly near the sclera if the lateral rectus is also involved.
In typical cases, laboratory tests are not usually helpful. In atypical cases, consideration should be given to CBC with differential, ANA, ANCA, ACE, chest x-ray, MHA-TP, SPEP, ESR, CRP, mumps immunoglobulin M (IgM) titer, and other tests as suggested by the workup.
Lacrimal Gland Biopsy
Lacrimal gland biopsy is necessary because of the overlap in symptoms caused by lacrimal gland inflammation, lacrimal gland neoplasia, and gland enlargement secondary to systemic processes. Care should be taken to obtain a representative sample, which may require percutaneous anterolateral orbitotomy. This approach has the added benefit of avoiding the proximal lacrimal ducts. A sample large enough to allow for flow cytometric or molecular analysis of the inflammatory cells will help diagnose lymphoma. In this case, the pathologist should be consulted prior to biopsy and a portion submitted in saline without delay. Needle biopsy is usually not sufficient for diagnosis. Biopsy results typically show the same inflammatory infiltrate as seen in other NSIOI (see previous), with associated fibrosis and loss of lacrimal acini, depending on chronicity (Fig. 40–5).
As with other NSIOIs, corticosteroids are the primary treatment for inflammatory dacryoadenitis. Moderate dosage of prednisone, 40 to 60 mg by mouth every morning should be instituted initially.1 To prevent relapse, taper should take place over 1 to 3 months depending on symptom expression, decreasing by 5 to 10 mg per week. As always, gastric protection with H-2 blockers or proton pump inhibitors is helpful in reducing ulceration (see previous). Although NSAIDs have been advocated by some, the recurrence rate in NSAID treated patients is high compared with steroids.23 In refractory patients, low-dose radiation and surgical debulking have been performed.24,25 These measures are seldom necessary, as response to corticosteroids is typically rapid.
FOLLOW-UP AND REFERRAL
Initial follow-up should occur within 3 to 7 days after treatment initiation, with strict directions to the patient to contact the physician immediately should the symptoms worsen (an indication of possible infection). Intraocular pressure should be checked while the patient is on steroids. Patients who do not respond to treatment may benefit from referral to an orbital specialist.
SPECIFIC INFLAMMATIONS OF THE ORBIT
The specific inflammations of the orbit can be best understood if divided into three categories: (1) inflammations associated with known and identifiable pathogens (infection); (2) inflammations with a specific constellation of findings (either locally or systemically); and (3) inflammations with specific histopathologic patterns.1
ORBITAL INFLAMMATION CAUSED BY INFECTION
Recognition of orbital infection is critical, as some infections can cause rapid and devastating disease with considerable morbidity and mortality. For the immunocompromised host, orbital infections are particularly hazardous. The proximity of the orbit to the brain and the contiguity of orbital structures with intracranial structures provide a readily accessible scaffold for intracranial extension. Evaluation of possible orbital infection, therefore, is urgent.
Infections of the orbit run the gamut of the microbe world including bacterial, viral, fungal, and parasitic. Interestingly, true viral infections of orbital tissues, even in immunocompromised hosts, have not been described outside of viral-induced dacryoadenitis following mumps or upper respiratory infections.2Hence viral infections are not discussed here.

domain: medical


text:
Introduced by Robert Gitt. Jon Mirsalis on Piano. Lillian Gish in Victor Seastrom's none-too-puritanical adaptation of Hawthorne.
Introduced by Robert Gitt. A mandolin wizard, an eccentric violinist, and a quartet of singing cops: early musical shorts (1927-29) are full of surprises.
Introduced by Robert Gitt. This breezy comedy-mystery starring a young Loretta Young hasn't been seen for over 70 years!
Introduced by Robert Gitt. Sidney Poitier made his feature debut as a young doctor in this explosive, controversial portrayal of 1950s America's repressed racial hostilities. With Richard Widmark, Ossie Davis, and Ruby Dee.
Introduced by Robert Gitt. A tough, fast-paced pre-Code look at the class divide, with John Barrymore as a Jewish lawyer who's worked his way up from tenement to skyscraper.
Introduced by Robert Gitt. Stanley Kubrick's early masterwork stars Kirk Douglas in a brilliantly visualized, unsparing critique of military hypocrisy, set during WWI but resonant now.
Introduced by Robert Gitt. Gary Cooper and Helen Hayes in Frank Borzage's moving adaptation of the Hemingway classic. This print restores censored footage and includes both original and alternate endings.
Illustrated Lecture by Robert Gitt. UCLA's chief film preservationist presents an entertaining, informative, and visually stunning history of color in the movies, illustrated with clips from gloriously preserved 35mm prints.
Introduced by Caroline Yeager. Dziga Vertov's experimental documentary on the miners of the Don Basin brilliantly juxtaposes image and sound. Chaplin called it "one of the most superb symphonies I have known. Dziga Vertov is a musician."

domain: library


Parasound Halo A 51 Multichannel Amplifier
Country of Origin: Usa
Ooberpad proudly presents to you the high-performing Parasound Halo A 51 Multichannel Amplifier. The Halo A 51 is a robust THX Ultra2 certified, 5-channel high bias Class A/AB amplifier that packs a punch with an optimal amount of performance that only most really high-end systems achieve, again nailing Parasound's colours to the mast when it comes to that getting the best value for money.
1-year manufacturer's warranty
- Circuitry designed by legendary John Curl
- THX Ultra2 certified
- High bias Class A/AB operation
- Balanced inputs with discrete circuits and XLR connectors
- Direct Coupled - no capacitors or inductors in signal path
- Complementary MOSFET driver stage and JFET input stage
- 40 beta-matched 15 amp, 60 MHz bipolar output transistors
- 2.2 kVA encapsulated toroid power transformer with independent
- secondary windings for each channel
- 164,000 μF power supply filter capacitance
- DC Servo and relay protection circuits
- AC present, channel status, high temperature indicators
- Heavy-duty 24k gold-plated 5-way speaker terminals
- Gold-plated RCA input jacks; ground lift switch
- Auto turn-on by 12v trigger or audio signal
- 4u Chassis, carry handles, rack mounting adapter included
Benefits of Parasound Halo A 51 Multichannel Amplifier:
High Bias Class A/AB operation
The Halo A 51 is ideal for any higher-end multi-channel application and will drive the most demanding of loads within a system - so it is a good choice not just for the top-notch quality custom installation in-wall systems but obviously is equally sure-footed with large floor-standers as well. The root of this adaptability is primarily its 2.2 kVA encapsulated toroid power transformer with independent secondary windings for each channel, plus the A51's high bias class A/AB operation working in tandem with its directly coupled design (there are no capacitors or inductors in the signal path).
The synergy of power and dynamism are quantifiable as the A 51 can output between 250 watts to 400 watts per channel - this is a real-world measurement as this is whilst all channels are being driven (20 Hz - 20 kHz - 60 amperes peak per channel). This high power and high current output performance deliver very flexible dynamic 'headroom', which is why the amplifier can be sublimely subtle when required, and unabatedly severe when raw power is needed.
As anticipated, the build quality and components used in the A 51 are superlative. The seriousness of the amplifier can be seen externally with the casework - as the A 51's 4u chassis is robustly constructed to the most stringent standards and also has rear-mounted carry handles (rack mounting adapter included for custom installation applications) for moving its dynamic footprint to where it’s required.
Where to buy?
Buy Parasound Halo A 51 Multichannel Amplifier online at the best price in Mumbai, Delhi, Bangalore, Chennai and all across India. Enjoy expert, prompt and courteous customer service from the Ooberpad.com team. We will help you choose better and will give you all the support you need to take the right buying decision in India.
Technical Specifications of Parasound Halo A 51 Multichannel Amplifier:
|Brand & Model #||Parasound Halo A 51|
|Continuous power output||
250 watts RMS x 5, 20 Hz - 20 kHz, 8 Ω, all channels driven
400 watts RMS x 5, 20 Hz - 20 kHz, 4 Ω, all channels driven
||60 amperes peak per channel|
||5 Hz - 100 kHz, +0/-3 dB at 1 watt|
|Total Harmonic Distortion
||< 0.2 % at full power|
|IM distortion: balanced 16 V rms||< 0.04 %|
||> 130 V/µsecond|
||> 1.5 dB|
> 78 dB at 1 kHz;
> 63 dB at 20 kHz
|Input Sensitivity||1 V for 28.28 V, THX Reference Lev|
|Input Impedance||47 k Ω unbalanced; 94 k Ω balanced|
|S/N ratio||112 dB, input shorted, IHF A-weighted|
||> 1100 at 20 Hz|
||110V - 120V|
17-1/2" w x 7-5/8" h x 20" d, 7" h without feet
80 lb. / 36.28 kg


text:
JDR Solutions, a provider of support services and infrastructure to the equipment finance industry, added Kimberly Fumega as senior solutions architect and for a role in client support, Jim Litke as senior software solutions architect and Ellen Mueterthies as ASPIRE SME.
“Kimberly, Ellen and Jim have several years of industry/software platform experience that will benefit every current and future JDR customer,” Doug Williams, president of JDR Solutions, said. “We are fortunate to be able to secure these valuable resources to assist JDR’s continuing growth.”
Fumega has been in the equipment finance industry since 1986, when she began her career at Pitney Bowes. Fumega has 25 years of lease accounting software experience. She spent the last 11 years with Xerox Financial Services as a senior software analyst, with her main focus on leasing software enhancements, testing, upgrades and reporting.
Mueterthies’ career in equipment finance also began in 1986 with Ervin Leasing. Mueterthies spent the past eight years with Unifi Equipment Finance as project manager/ASPIRE administrator, a role which included user acceptance and reporting responsibilities.
Litke’s career in equipment finance started in 2005 with Olympus America. Litke has more than 28 years of Unidata programming experience.
From an operations standpoint, disruption evokes an air of anxiety and panic. What we’ve all experienced the last year and a half has made critical infrastructure break down as society and the equipment finance industry has coped with a rapidly... read more
As we continue to navigate the COVID-19 pandemic, many smaller equipment finance companies may not have access to the same level of information upon which larger industry players rely. Our guest editors suggested we ask several Monitor 100 companies to... read more

domain: news


text:
- What's On
- Courses, Classes and Workshops
- News & Blogs
- Your Visit
- About Us
- Venue Hire
Simon Armitage has been described as ‘the best poet of his generation’. His latest collection explores life against a backdrop of economic recession and social division where globalisation has made alienation a common experience. He was born in West Yorkshire and lives near Saddleworth Moor.
His work includes his translation of Sir Gawain and the Green Knight and books exploring the South west’s coast path and the Pennine Way. He joins Alexandra Harris, the author of Weatherland, a history of English weather, to discuss time and place. Chaired by Radio 3 presenter Philip Dodd.
Simon Armitage is the author of many collections of poetry. His new work is The Unaccompanied. He has received many awards for his work and is Professor of Poetry at Oxford University.
Alexandra Harris is Professor of Literature at the University of Liverpool and a New Generation Thinker. She is the author of Weatherland: Writers and Artists under English Skies and Romantic Moderns.
For your information…
- A restricted number of tickets will be available on the day on a first come first served basis.
- Please take your seats 10 minutes prior to the event start time otherwise you may lose your place.

domain: literature


text:
Ludo is a board game that originated in India. It is a two-player or four-player game in which the players move their four pieces around the board, attempting to reach their home base first. The game has been adapted into several versions, each with its variations. Technological advancements have led us to play Ludo on mobile. How? Just download a Ludo apk file. This article highlights APK and the top 4 Ludo real money apk you can download to win cash!
Watch the video below to learn how to download the Ludo APK file:
- Ludo Real Money APK
- Ludo APK: How to Download?
- Top Ludo APK Download
- Why download Ludo APK?
- Ludo Real Money APK: FAQs
Ludo Real Money APK
APK stands for Android Package Kit and is the file format Android uses to distribute and install mobile apps. Like an executable (.exe) file in Windows, an APK is a format Android uses to deliver and install a mobile app to a device.
What is Ludo Apk?
Ludo Apk is a mobile gaming app based on the classic board game of the same name. It allows users to play the game on their phones, with features like 24/7 tournaments, multiplayer games, and quick gameplay. Some apps also allow users to win real ludo money.
Ludo APK: How to Download?
You can play Ludo on mobile by downloading the Zupee apk. By downloading one app, you can play 4 types of Ludo games on the Zupee apk.
The Zupee APK is available for download through the official Zupee website. After downloading the APK file to your device, you will need to install it on your device. After the software has been successfully loaded on your smartphone, you may begin using it to play Ludo.
Ludo Supreme, Ludo Ninja, Ludo Supreme League, and Ludo Turbo are the four unique versions of the classic ludo board game that Zupee offers. Ludo Supreme and Ludo Turbo are both games that use dice; however, Ludo Ninja is a form of Ludo played without dice.
Steps to download Ludo real money apk
Here are 6 steps to download the Zupee apk and play Ludo online:
- Download and install the Zupee apk on your mobile device.
- Open the app and register.
- Select the Zupee Ludo game:
- Ludo Supreme
- Ludo Supreme League
- Ludo Ninja
- Ludo Turbo
- Select a game format – 1 vs. 1, 1 winner, 2 winners, 3 winners, Single-player.
- Play with or without an entry fee.
- Start the game
Top Ludo APK Download
Let us take a look at the top 4 Ludo Apk by Zupee:
Ludo Supreme Gold APK
Ludo Supreme Gold, aka Ludo Supreme, is a classic real-time multiplayer game with a modern twist, available for both iOS and Android platforms. The game has attractive graphics, an easy-to-use interface, and customizable gameplay options for up to four players. It is a novel spin on the traditional board game Ludo and was the first version to allow players to win real money.
How to play Ludo apk games on Ludo Supreme?
Ludo Supreme Gold APK is an Android app that allows users to play the classic game of Ludo on their smartphones. To play Ludo Gold APK Supreme:
- You can play Ludo in various formats: 1 vs. 1, 1 winner, 2 winners, and 3 winners.
- Pick the tournament you want to play: one that requires payment or is free. In the tournament, with an entrance fee, you can win additional cash prizes.
- Rolling the dice is the first step in starting the game. It is not necessary to have a six to begin playing.
- You will gain one point for each box that you shift. You will get an additional 56 points for every token you take home.
- The prize pool is awarded to the player (or players, if there are two or three winners) who has the most points after the allotted time has elapsed. A game with two players lasts eight minutes, whereas a game with four players lasts ten minutes.
Watch this video to learn how to play Ludo Supreme:
Ludo Ninja APK
Ludo Ninja is a dice less Ludo game by Zupee. All players can see the dice’s upcoming values and strategically decide how to move their tokens. Every player has limited moves and needs to earn maximum points to win. Download Ludo Ninja APK now!
How to play Ludo apk games on Ludo Ninja?
Here is how you can play the Ludo ninja apk game:
- Many game modes are available in Ludo Ninja, including 1v1, 1 winner, 2 winners, and 3 winners.
- You have the option of playing paid games or playing them for free. When you play paid games, you can earn as much as ten lakhs.
- The absence of dice in Ludo Ninja lends the game its distinctive quality. You can get an early look at the values you will get next, allowing you to strategize more effectively to take down your opponent.
- You do not require a six to begin playing.
- You get one point for each box you move, and if your tokens reach the “Home” box in the center of the board, you receive 56 points.
- The game restricts the number of moves based on the no. of players.
- After the game, the player accumulating the most points will be awarded the prize pool.
Play Ludo Online and Win Cash on Ludo Ninja. Click “Download App button”!
Ludo Turbo APK
Ludo Turbo condenses all of the enjoyable aspects of the traditional game of Ludo into a tight game that even members of today’s Gen-Z enjoy playing.
How to play Ludo apk games on Ludo Turbo?
This is how you play the speed ludo games on Ludo Turbo:
- You can pick between 1 vs 1, 1, 2, or 3 winners.
- You can participate in either free or paid versions of Ludo Turbo.
- It is unnecessary to have a six to begin playing.
- One point is rewarded for each box that is moved, and 56 points are given for each token that successfully reaches the ‘Home’ square.
- The limit for each player in games with two players is 30 moves, whereas the limit for each player in games with four players is 18.
- The victor of a game of Ludo Turbo is determined to be the person who finishes the game with the highest points total. The prize money is awarded to the winner of the competition.
Click the “Download App” button to play ludo apk games on Ludo Turbo.
Ludo Supreme League APK
Ludo Supreme League is a single-player online Ludo Tournament. You can download the Zupee apk to play Ludo Supreme League.
How to play Ludo apk games on Ludo Supreme League?
Here is how you play the Ludo apk games:
- You will be assigned 4 Yellow color tokens. They are in an open position, so you don’t need to roll a six to activate them.
- There will be 12 tokens on the board – 4 of Green, Red, and Blue.
- You need to cut the tokens on the board to get the points they carry. You can check the points of each token by clicking on them.
- Get 1 point for each box moved by your token.
- Additional 56 points are added if you take your token home.
- Ludo supreme League is a timed game. You will have 15 sec to play your turn.
- You win by ranking high on the leaderboard.
Click the “Download App” button to play ludo apk games on Ludo Supreme League.
Why download Ludo APK?
Here are some reasons why you should download the ludo real money apk by Zupee:
- Zupee offers four versions of Ludo – Ludo Supreme, Ludo Supreme League, Ludo Ninja & Ludo Turbo – all in one place.
- Players don’t have to download them separately.
- Players get enormous cashback and referral bonus options in this ludo cash APK.
- Players have the option of withdrawing ludo money instantly.
- The games of Zupee Ludo are fast-paced, i.e., all games are likely to be over within 10 minutes.
- Players can win huge sums up to Rs. 10 lakhs monthly.
- This ludo real money APK is wholly trusted, safe and secure, with all players verified. The game is free of any bots.
- The game offers multiplayer options with 2 and 4 players in multiple formats, i.e., 1 vs. 1, 1 winner, 2 winners, and 3 winners.
- Zupee upholds fair play for all its players and has 24/7 dedicated customer services.
Ludo Real Money APK: FAQs
A Ludo APK is a mobile application package file that allows users to install and play the game Ludo on their Android devices. It is a digital version of the classic board game, providing an interactive and convenient way to enjoy Ludo on smartphones or tablets.
To download and install a Ludo APK, you need to find a trusted source that provides the APK file. You can search for the desired Ludo APK online and visit reliable app repositories or official game developer websites. Once you have the APK file, you can enable the “Unknown Sources” option in your device settings to allow installation from third-party sources and then simply run the APK file to install the Ludo game.
Yes. You can download the Zupee apk without any fee. Moreover, Zupee ludo games, like Ludo Supreme, Ludo Turbo, and Ludo Ninja, allow you to play Ludo online with and without an entry fee.
Many Ludo real money APKs are free, allowing players to enjoy the game without any cost. However, some versions might offer in-app purchases or display advertisements to generate revenue for the developers. It’s essential to review the app’s description or user reviews to understand its pricing model and potential additional costs.
Zupee offers all four versions of Ludo online games – Ludo Supreme, Ludo Ninja & Ludo Turbo – all in one place.
Yes. You can play ludo online and win real money on Zupee. Toh, khelo ludo and jeeto paisa online.
Ludo Supreme gold apk is the same as the Ludo supreme apk. Ludo Supreme Gold is also known as Ludo Gold APK. All three terms are the same, and the process to download it is similar. Always download the Ludo supreme apk, Ludo Ninja apk, and Ludo turbo apk from the official website.

domain: entertainment


- No Cancellation
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- Children Under 1.2m Not Permitted
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The Salzburger Philharmonie Orchester
It was founded in 1996 by the violinist Elena Denisova and the conductor/pianist Alexei Kornienko, with the aim of raising awareness of lesser-known works and shedding new light on well-known pieces through striking and unusual interpretations.
Its members are drawn from a select circle of soloists, the number of players varying according to the needs of the project in hand. One of the guiding principles of the ensemble is the assertion that “a work must be born anew with every performance”.
Besides of the orchestra's broad repertoire, which includes the classic school (Haydn, Mozart, Beethoven), as well as the modern one (Johann Strauss, Franz Hummel), one of the main emphasizes is the musical-cultural exchange.
Over the years the orchestra has performed all over the world, including the Netherlands, Finland, Italy, Slovenia, and Germany. It has also won Italy's Premio alla Cultura Award.
Conductor: Alexei Kornienko
Alexei Kornienko is an outstanding musician whose work is characterized both by unconditional and joyful attention to the text and also boldness in interpretation. This seeming contradiction, in fact, stands the Austrian conductor Kornienko in very good stead.
His work as a pianist of the Russian school, with his extraordinarily wide Classical and Romantic repertoire, is combined profoundly with his work as a conductor, which he has steadily expanded in recent years.
Concertmeister: Elena Denisova
As an ambassador of tonal sensuality, Elena Denisova ranks as one of the finest and most charismatic violinists of her generation. Known for her great musical maturity, individual style of interpretation and supreme virtuosity, her performances have won critical acclaim from press and public alike.
1. G. Bizet: Carmen Ouverture
2. W.A. Mozart: Eine kleine Nachtmusik'
3. Johann Strauss:：Frühlingstimme Walzer (Sopran-Solo) Op.410
4. Chinese Piece：Jasmine
5. L.v. Beethoven:：Romanze for Solo Violin und Orchestra in F-Dur
6. J. Hellmesberger：Leichte Schritte
7. Chinese Piece：Spring Fesival Overture
8. Eduard Strauss：Blütenkranz Johann Strauss'scher Walzer
9. Mile Waldteufel - The skaters Waltzer Op. 183
10. Johann Strauss：Éljen a Magyar Hungarian Pollka Quickly Op.332
11. Johann Strauss：An den sch?nen blauen Donau Walzer Op.314
12. Good news from Beijing
13. Radetzky Marsch


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Nude with Coral Necklace (Akt mit Korallenkette) 1910 - August Macke
The Open Window - Juan Gris
Fairy Tree (Red Roofed Houses with Tree) 1955 - Fernand Toussaint
Rocky Landscape - August Macke
Evening at Badacsony 1930 - Jeno Gadanyi
States of Mind II: The Farewells - Umberto Boccioni
Japanese Picture 032 - Bertalan Por
House In The Garden - August Macke
Utopian Construction With Boards - Paul Klee
Form in Space 1959 - Fernand Toussaint
American Art related news

domain: artistic


text:
This extended semi-detached, three-bedroom 1970s home is located close to the edge of Pershore and only 0.3 miles from Pershore High School Academy.
Entering from Wyre Road, a paved and tarmac driveway to the front of the property provides ample parking for 6+ cars and a single garage separates the front and rear of this generous plot. The south-facing gardens beyond comprise a paved patio and lawns, surrounded by planted borders.
Ground floor: Entrance hall, large living room/ dining area with central fireplace and sliding glass doors leading to a generous open plan kitchen/ breakfast room overlooking the rear gardens, utility room and cloakroom/ W.C.
First floor: Landing with storage cupboard, bedroom one (double) with built in wardrobe, bedroom two (double), bedroom three and bathroom with white suite comprising; bath, basin and W.C.
33 Hurst Park Cottages benefits from a gas central heating system and double glazing throughout. Current Energy Performance Certificate (EPC) rating = D.
The Georgian market town of Pershore sits on the banks of the River Avon. Located between Worcester and the north Cotswolds and approx. 35 miles from Birmingham.
Surrounded by glorious countryside and beautiful villages, Pershore punches well above its weight as a great place to live, work and socialise. Boasting an enviable range of independent shops (and a few well-known chains), award-winning restaurants, pubs and busy coffee shops; the town also enjoys its own thriving, community run arts centre and theatre presenting a regular schedule of shows, films and exhibitions.
A short distance from the rear of this property are some lovely walks, along the banks of the River Avon to Pershore town centre; passing through Wyre Mill and Avon Meadows Community Wetlands en-route.
Planning enquires concerning the property and surrounding area can be made with Wychavon DC at www.wychavon.gov.uk
Environmental enquires concerning the property and surrounding area can be made with Environment Agency at www.environment-agency.gov.uk and general information can be found at www.google.com/earth
Broadband enquiries at the property concerning its availability and estimated strength and download speeds can be made with bt.com
Misrepresentation Act: These particulars are prepared with care but are not guaranteed and do not constitute, or constitute part of, any offer or contract. Intending purchasers must satisfy themselves of these particulars? accuracy by inspection or otherwise, since neither the vendor nor Johnsons shall be responsible for statements or representations made. The Vendor does not make or give, and neither Johnsons nor any person in their employment, has any authority to make or give any representation or warranty in relation to this property.
We endeavour to make the sales details accurate, if there is any matter(s) that is particularly important to you, please check with us prior to travelling any distance to view the property. Johnsons are unable to comment on the state of repair or condition of the property or confirm that any services equipment or appliances are in satisfactory working order. Reference to tenure is based upon information supplied by the vendor. Fixtures and fittings not included.


“Woe unto you who fails to understand the importance of metadata.”
* The Minnesota Republican party banned their own candidate for Supreme Court from the State Fair. I just feel bad that she’ll never know who won the prize pig competition. [Minneapolis Star-Tribune]
* Lawyers are narcissists and that’s not good for their careers. [Law and More]
* A writer figures out that American University’s Law School is a trap. [Washington City Paper]
* Disturbing video of a judge ordering the illegal assault and arrest of a disabled, indigent litigant. The fact that this is the second “judge assaults a litigant” incident I’ve written about in a week is terrifying. [Sacramento Family Court News]
* Steph Cha’s new tale of old school noir, Beware Beware (affiliate link), is now available. Its setting is “a picture of desolation, of crushed dreams dressed in grimy fourth-hand garments.” And yet, somehow she’s not talking about the last days of Dewey. [LA Times]
* If you’re doing some kind of charity, do us a favor and shut up about it. [What About Clients]
* A Connecticut lawyer was barred from ever representing women again for the rest of his career. Now he may be disbarred for breaking that simple condition. [Connecticut Law Tribune]
Biglaw bonuses this year were insane. In an industry that usually plays “follow the leader” when it comes to associate bonuses, this year felt more like a poker tournament.For a full recap of the 2014 bonus season, fill out this brief form and receive ATL’s Biglaw Bonus Poker infographic.
* A Maryland judge ordered a court officer to deliver an electrical shock to a defendant. What the hell? [Baltimore Post-Examiner]
* Be less of a lawyer. [Medium]
* New York agrees to pay out $10 million to wrongfully convicted man. He may be gone, but former D.A. Charles Hynes is still costing the city money. [New York Times]
* Sentence requiring former Supreme Court justice to write apology letters to every judge in the state on a picture of her in handcuffs struck down as “unorthodox gimmick.” Now she has to write the letters on regular paper because apparently the apology letter part was an “orthodox gimmick.” [Penn Live]
* The public domain is awesome. [Clickhole]
* Lawyer accused of asking office manager if she wanted a “Dirty Sanchez.” Does anybody ever answer yes to that question? [Barstool Sports]
* In this summer’s Biglaw lawsuitpalooza, real estate and conflicts took the lead as headliners. Poor Boies Schiller had double the trouble when it came to ethics complaints. Ouch. [Am Law Daily]
* New Jersey taxpayers owe Gibson Dunn & Crutcher about $6.5 million thanks to Governor Chris Christie’s Bridgegate scandal. Thanks for the pain in our pocketbooks, chief. [Daily Report (reg. req.)]
* “It’s been a minor inconvenience to us, but of course I don’t like somebody hijacking my name and using it to hurt someone else.” Two Florida law firms are investigating why someone sent out 42 anonymous state bar complaints against one firm using the other firm’s mailing address. [Orlando Sentinel]
* Charleston School of Law is starting a new academic year with even more confusion than it was in last year, considering that its InfiLaw buyout is in a state of flux. Maybe that’s a good thing. [Post and Courier]
* Three ex-Lingerie Football League players have filed class action suits against the club, alleging minimum wage law violations. Come on, pay these half-naked athletes a living wage. [National Law Journal]
* It’s not that Justice Kennedy cares more about gay rights than women’s rights, it’s that Justice Kennedy understands gay rights better than women’s rights. That’s a much less charitable but shorter read of this insightful piece by a former Kennedy clerk. [Dorf on Law]
* The judge caught making racist and sexist remarks about Charlize Theron’s adoption has been banned from the bench. He wants to be judged on more than this incident. To quote Dr. Hibbert: “And hillbillies want to be called ‘Sons of the Soil’, but it ain’t gonna happen.” [Associated Press via Yahoo! News]
* Adam Carolla is keeping his fight against patent trolls alive. Ziggy socky ziggy socky hoy hoy hoy! [Mashable]
* Yesterday, the man who shot young Renisha McBride for knocking on his door was convicted of second-degree murder. Sadly, it was just one more in a string of cases where some idiot bought into the rhetoric of shooting first and asking questions later that gun lobbyists have pushed for years. [New York Times]
* Here’s something, a former law firm CIO wrote a novella called I Spy, You Spy, We All Spy (affiliate link) based on the allegedly true events of the “law firm spying on its own lawyers, employees and some of its employees’ family members.” Delightful. [Amazon]
* “Why Young Lawyers Shouldn’t Hate Hate Hate Baby Boomers Holding On to Jobs.” OK, I’ll go back to hating them for being the self-absorbed Me Generation that made Gordon Gekko a role model. [Law and More]
* At oral argument in the marriage equality cases, the lawyers and the Sixth Circuit exhibited… a lot of misconceptions. [Constitutional Accountability Center]
* The battle over the EPA’s Carbon rules isn’t over yet. Gear up for a Supreme Court trip. [Breaking Energy]
* Do you need to know how to pronounce the SCOTUS case of Volkswagenwerk Aktiengesellschaft v. Schlunk? There’s an app for that. [Law Technology News]
Why is the Bar handing out your Social Security Number to anyone who asks?
Besides their good looks and fame, they’re also increasing their focus on data security. In the wake of “Celebgate,” the Sony Pictures hack, and nearly daily data breaches targeting massive corporations to individuals, law firms are finally recognizing the importance of bringing their cybersecurity policies up to speed.
A prominent criminal defense lawyer might face criminal charges; what are the allegations against him?
It sounds like the Connecticut Bar may want to reevaluate its decision.
A “reproduction” is the same as “just making up stuff on a home computer,” right?
Litigators are like unruly kids, which is why this benchslap with a sanction straight out of elementary school is so appropriate.
* Proximate cause and the Incredible Hulk. Whatever, everyone knows Kirby was the real brains behind Palsgraf. [The Legal Geeks]
* Someone is having fun with their RFAs: Admit… that we are going to whip the dog piss out of you. We were specifically chided: “please don’t say ‘only in Arkansas,’” so we won’t. You should feel free to say exactly that though. [Hawg Law Blog]
* Not really surprising, but patent trolling is the worst it has ever been. I’ll sit here and wait for the New York Times to blame millennials. [io9]
* The most important Supreme Court decision you’ve never heard of! Well, except I have heard of it. In fact, there was a year-long college debate topic about it. But it’s still important. [Washington Post]
* What’s the appropriate sentence for having a dog off a leash? Confining the guy to a seven-county area? [LA Weekly]
* Things to do in Denver when you’re a lawyer: allegedly scam a few million off a client. [Denver Post]
* Meet the lawyer who came up with the quirky reading that got the D.C. Circuit to temporarily derail Obamacare. [Wall Street Journal]
* Meanwhile, this title says it all about Halbig: “Well, Conjecture, Tendentious Misreadings, and Cherry Picking Are Kinds of Evidence.” Pour a little out for Lionel Hutz. [Lawyers, Guns & Money]
* Everyday we (the ABA) hustlin’. [Law and More]
A prominent law professor believes Governor Cuomo should resign if these allegations prove true. He probably won’t.


text:
My coil embolization is scheduled for tomorrow (Tuesday) morning. I have a couple of questions. First, they are planning to use general anesthesia, and I have a bad cold/cough, is it safe to do while sick or should it be postponed? Secondly, they said to plan on staying overnight in ICU and going home the next day, did anyone else really get to go home the next day? Lastly, what can I expect to feel like after the coils are in? I never really have headaches, but I am afraid that from I have read headaches are to be expected after the procedure. How long should I expect to have headaches or other side effects and what other side effects should I be aware of? I am getting a little scared, can you tell?
I am still not sure that this is going to solve my problems of dizziness, gait disturbance, fatigue, and "brain fog" because I don't know which problems are from the aneurysm and which are from lupus.
First, I think you need to call your Neurosurgeons office and tell the nurse you are sick with a cold and what do they suggest...it is important for them to make that finally decision...Not sure how long you will be in NICU...I was in NICU after my coiling embolization for 10 days and then 2 days in regular step down room...everyone is different...I asked my neurosurgeons what side effects after coiling and they told me I may have bad headaches for about 6 months...Lastly, it is reasonable to be scared...I hope you can take something in order to relax today...but please call and verify that surgery ok with a cold...gotcha in my thoughts and prayers ~ colleen
Yeah, if you've got a bad cold/cough right now..I can't imagine your Neurosurgoen wanting to proceed at this time.... your immunity is already on the down-side right now, and going in for this procedure I'd think you should be feeling strong. Get well ! Peace, Janet
Dear Miracle...prayers for your decisions...and, results... based on the feedback you get from your doc/nurse...
Colleen and others have said it all so well... Please keep us informed...
Thanks for the advice and prayers. I will let you know how it goes. Thanks again!
You have my prayers for today...I am assuming you went in for the coiling...be well...~ God Bless ~ Colleen
Everything went great. They gave me a breathing treatment before I went in and the anesthesiologist said with the tube down your throat she could give treatments during the surgery. Not sure if she had to or not, but everyone said I did great. Spent the night in ICU, sent to the stoke unit around 4pm today, then discharged around 6:30pm tonight. I have a bit or a sore throat and am a bit stiff and sore, but NO headache...I hope I did not jinx myself by saying that, but I feel better than I thought I would. Much easier than my abdominal hysterectomy when I could not even move without pain for a couple of weeks. So, I am just going to get a lot of sleep and rest for the next couple of days and hope things stay as good as they are now.
This is great news...now rest and heal...Gotcha in my Thoughts ~ Colleen

domain: health


text:
Should Kids Take Vitamin Supplements?
People often ask me, Should my kids take vitamin supplements. Vitamins and minerals are important elements of any healthy diet for children. While the human body cannot produce adequate amounts of many vitamins, obtaining these vitamins from nutritional foods is essential. Children with a balanced diet rarely need vitamin supplements; however, exceptions do exist.
- Consult your Pediatrician before your kids take vitamin supplements: If you are concerned that your child’s nutritional needs cannot be met through diet alone, talk to your pediatrician first. Large quantities of vitamin supplements are not necessarily healthy, and your pediatrician will be able to recommend appropriate supplements. Children with a poor appetite, erratic eating habits or a very restrictive diet may need a multivitamin or other supplement to address missing pieces in their diet.
- Work With KareBoost’s Pediatric Registered Dietitian (Nutritionist): Most nutritional needs can be met through a balanced diet, but if you are struggling to figure out what that means for your family, consider working with our nutritionist. A nutritionist can help you plan meals and devise a plan that is not only nutritious but also delicious.
- Eat a Wide Variety of Fruits and Vegetables: One way to work towards a balanced diet is by including many fruits and vegetables in your child’s diet. For example, Vitamin C is found in citrus fruits, strawberries, spinach and broccoli. Vitamin A, essential to normal growth and tissue repair is found in yellow vegetables and also diary products. Also look for foods with calcium, such as low-fat dairy, Vitamin D, such as eggs, and iron, such as beef, turkey and spinach.
Remember, when in doubt about your child’s nutritional needs, or before your kids take vitamin supplements consult your pediatrician. After following your doctor’s recommendations, consider meeting with our nutritionist or our health coach to design healthy meals that your child will like.
Andrea Berez, MS, RD, CSP
Pediatric Registered Dietitian


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Who does not love sweet paragraphs? Not Me, and this is the reason why I will always find ways of sending a sweet paragraph to my girlfriend, so if you are looking for a sweet paragraph to send to your girlfriend, you will not want to miss this post.
What is a sweet paragraph to say to your girlfriend?
You might be asking the question, what is a sweet paragraph to send to your girlfriend
Sweet paragraphs are just love letters, love messages, short or long love text messages that you send to your girlfriend when she is around you ( OR NOT ). Every young woman out there craves attention from her man. Every woman wants to have an idea of the extent of the love her man has for her. Every woman wants to know how much her lover appreciates and values her love. I therefore agree with you when you say;
I buy her expensive gifts
I take her outs on treats and daycation.
Isn’t that enough show of love already? Yes I totally agree that it is, BUT do you know the impact that words have in a lady’s love life? it is the cheapest and most affordable way of capturing the depth and essence of love and loving to your woman. When you pass across sweet I love you paragraphs to your woman, you are conveying the extent and depth of your feelings in a way no one and nothing can. Not even your expensive gifts or expensive vacations can capture the true feelings of love like the sweet paragraphs.
Before we move on, I’d love you to see other amazing love paragraphs that you can copy, tweak, send or share with your lover, family, friends or even colleagues. There is love in sharing isn’t it?
Back to a sweet paragraph to send to your girlfriend, when you want to speak your feelings out or say what is in your heart, I would advise that whenever your woman is not around you at that time you caught that bug, you should quickly pen it down in a note and send it across to her.
You know what some romantic guys do of late? They pen down their love paragraphs and leave them in locations where they know their woman can quickly discover them and read. ISN’T THAT ROMANTIC?
Examples of sweet paragraphs to send to your girlfriend
Here are a couple of examples of sweet paragraphs to send to your girlfriend that you need to know to be able to share the sweet feelings of love
Appreciate her smiles and chuckles
The truth is, every woman loves her man to appreciate all those physical attributes that she possesses, and a way of getting her swelling in love is by just mentioning how much brings laughter into your life through her smile. I have heard from a of friends how the smile from ladies have given them headaches and made them want for more. The impact of a smile from a beautiful woman is amazing on men. Therefore it will not be a bad idea for you to appreciate that particular attribute from your woman.
Sweet paragraphs like:
Your smile has brightened my life. I can’t just explain the way I feel whenever you open those lips of yours in deep chuckles and laughter. The most special moments in my life are when you smile whenever you are around. You know what? I will make sure that I keep you happy everyday of my life, so that you can continue to smile in happiness, and whenever you are not here, just smile over the phone, or anywhere else, and I will feel it right from here!
Appreciate her weirdness
We all have our dose of weirdness don’t we? Something unique, strange and kind of odd. Not totally a turn off by the way, but something that is weirdly funny about ourselves or others. It may be from the way your woman sweats on her nose, or the funny way she dances, or the weird looks she gives when she is tipsy. Whatever that is, you need to find a way of writing sweet paragraphs to let her know that these are the weird, geeky things that has endeared her to you more. A more exciting and loving way of sending this to her is to first tease her about her weirdness and manners before going ahead to appreciate her. She may be a bit flustered at first, but she will warm up to the fact that you find her weirdness a part of her total package and you completely LOVE it.
See an example:
I know you may feel shy when you read this text, but I just want you to know that I am aware of how you snort when you laugh. It may be an unconscious thing on your part but I know it and I love you that way. Please do not stop doing that because with all of us comes different weirdness and peculiarities, as I have mine as well. I wonder what will have happened to our love if you do not have your bout of strangeness. I love the total package of you my lady.
Appreciate her Sense of humour
Every lady will tell you they love guys who has a huge sense of humour. Nobody wants to be found around a dull and boring kind of guy. So is guys, you can easily ascertain how compatible you are with your lover through her funny side. See, getting someone who can make you laugh is not easy, people even get paid to make people laugh. So when you find a lady with that deep sense of humour, always find ways of letting her know that you value and love her.
See an example
You have made me laugh in crazy ways. You have made me happy in the best ways. You are an answer to my prayers to God; that I find companion that I can share love and laughter with. Your goofy self is what I crave for everyday of my life. Sometimes, I wanted to ask God why he packed fun and mischief into one single body. But I know why he did, he packed all this together to make me happy. You are my second half and an exciting personality to love. You need to know this, I cannot go through life without having you by my side. You are the definition of love, life, fun, happiness and laughter all rolled into one body. You are simply the best gift ever and I value your love. Thank you for everything. I love you!
A sweet paragraph to send to your girlfriend
I love the way you handle things, your work ethic inspires me. Just before we met I never had any plans for my life. But after you came into my life, everything took a new path and there was more focus on direction for me. You made me realize that as a team, there will be more focus and direction in making my dreams into a reality. I am extremely happy today and very much grateful for your assistance and patience with me. Not everyone can deal with a difficult guy like me, yet you stayed because you saw potentials and because our dreams aligned with on another. You are everything I can wish for in a woman, and indeed I know that you are a blessing to me and my unborn generation.
I am sure my children will he happy, proud and excited to have you as a mom, and they will also be thankful for having you by my side to give birth to them. Life has not been fair to a lot of us, but you have made me realize that life is really unfair to everyone and the moment we seize to take responsibilities for what life avails us, the better in reaching our goals and fulfilling our purpose in life. You gave my life a new purpose and help me chart a new direction. You are indeed a queen and I am your king, because queens are meant for kings.
Before we met, I never thought I could ever meet or fall in love with someone like you, and what a ride has it been since then till now. We had our issues, you know? But that only made us better and stronger because a relationship can never progress if two individuals do not own up their acts and deal with issues as they come. I infact appreciate your maturity in dealing with issues and I value how you handle preferences and situations with an holistic view. You are a dream of any man, and I am super proud to have you as my lover.
When the time comes darling, we will both walk down the aisle together, because we both know that is the height of finding love and it is time to consummate our relatonship of so many years. I love you darling.
Now you have a sweet paragraph to send to your girlfriend. What are you still waiting for?


Who We Are.
We Are Australian Family Owned -
Founded in 1995.
PROVIDE MOBILE CAR AIR CONDITIONING SERVICE AND SPARE PARTS
OUR 5 point Mission Statement:
1/ To provide A/C repairs at a family friendly price.
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3/ Provide a fast and reliable repair to your cars A/C system at an affordable price.
4/ Honest assessment and advice for necessary repairs and correct operation of your A/C.
5/ Keep our price affordable for Families.
are renowned for:
1. NO Bull - We ONLY Fix what is broken!
2. NO Up sell!
3. How we quickly identify faulty or leaky AC systems.
4. Affordable prices - Trade direct to the Public.
5. Our experience - 30 Years.
6. Technical knowledge and quality workmanship.
7. Our TEAM is experienced - Licensed - Accredited.
With over 30 years experience You can trust Snowmobile to;
DIAGNOSE the fault in your car air conditioning system.
REPAIR the fault in your car air conditioning system.
RE-GAS your car air conditioning system.


The long-gestating rumors have become a reality: Smallville will soon live on in comic book form.
A press release confirms that former show writer Bryan Q. Miller will pick up where the series left off in May with the April 13 online publishing of a new comic book; new chapters will then be released each week, with the first of these available in print on May 16.
“Six months after Clark Kent donned the cape and took to the skies to save Earth from Apokolips... enter Season 11!” says Miller. “New allies abound! New enemies afoot! And old friends return where they’re least expected!
"[Pere Perez] and colorist Chris Beckett have done a fantastic job of capturing the look of the show and the players, and [artists Gary Frank and Cat Staggs] are knocking it out of the park on covers. I couldn’t be more excited to help give seasoned viewers and new readers an all-access pass to Clark’s first year in the cape.”
Oliver Queen/Green Arrow, Chloe Sullivan-Queen, Lois Lane, Lex Luthor and General Lane will all play roles in the upcoming new editions.


There is a lot of buzz about the Google Nexus 2016 that is going to be out soon. The last Nexus release, Nexus 5X, and Nexus 6P wasn’t a favorite with stock Android lovers since there were some unpopular tweaks that Google made on the devices. Reports suggest that Google is giving their all to make sure that they do not repeat what happened with Nexus 5X and Nexus 6P when they release Google Nexus 2016.
The last two Google Nexus devices were different. While the Nexus 5X was a mid-range Nexus device it didn’t have very powerful hardware, and users had to go for the larger 5.7-inch Nexus 6P to experience the stock Android experience that Nexus is known for.
With reports suggesting that HTC is going to look after the packaging, stock Android aficionados are hopeful that they will not be disappointed. HTC is going to incorporate the same hardware inside each handset. Mobiles N Apps reported that since HTC is going to look into the manufacturing of the Google Nexus 2016, their handsets are going to be similar to the ones seen for Desire.
Google Nexus 2016 will be available in two variants, Nexus Marlin and Nexus Sailfish. According to BGR, the Nexus Marlin is going to have a finish that is going to be similar to the HTC 10, with a metal device. The Nexus Sailfish is going to have a body incorporating both metal and plastic.
Google is consciously working towards using different materials for the phone casing so that they can lower the prices for the devices. The Google Nexus 2016 will use a lot of plastic so that they can be cheaper than the other leading phones in the market.
With Nexus Sailfish using more plastic than metal, it is going to be cheaper than the Nexus Marlin. The price for Google Nexus 2016 is expected to be around $350.
It has been confirmed that the Google Nexus 2016 Marlin is going to have a display of 5.5-inch while the Nexus Sailfish is going to have a 5.2-inch display. Nexus Marlin will have an AMOLED display of 2.560X1,440 pi.
It is going to be powered by the Snapdragon 820 processor and a 4GB RAM. Nexus Marlin is going to have a 32GB disk space, which will be expandable to 128GB.
The Google Nexus 2016 Marlin is going to be equipped with a fingerprint scanner at the back of the device. The phone is going to have a powerful rear camera of 12 MP and a front camera of 8 MP. The battery is going to be a 3,450 mAh.
The specs for Google Nexus 2016 Sailfish is going to have a full HD AMOLED display. The processor for the device hasn’t been revealed yet, but it is likely to be a quad-core 2.0 GHz processor with a 4GB RAM. The phone is going to have a 2,770 mAh battery.
While Google hasn’t officially come out to reveal the specs for the upcoming Nexus phones, there is a lot of leaked information flooding the internet. One of the most trending leaks about Google Nexus 2016 states that the Sailfish variant is going to run on the Qualcomm Snapdragon 820 processor and not the Snapdragon 821, as had been rumored.