U.S. patent application number 12/843560 was filed with the patent office on 2011-01-06 for labrum retracting burr.
Invention is credited to Kenneth M. Adams, James P. Bradley, Philip S. O'Quinn, Reinhold Schmieding.
Application Number | 20110004215 12/843560 |
Document ID | / |
Family ID | 44772705 |
Filed Date | 2011-01-06 |
United States Patent
Application |
20110004215 |
Kind Code |
A1 |
Bradley; James P. ; et
al. |
January 6, 2011 |
LABRUM RETRACTING BURR
Abstract
A rotary abrader allowing for improved visibility during surgery
and improved aspiration of waste material. This is accomplished by
providing a hood or sheath formed of a clear material and available
in various shapes and sizes. The clear hood or sheath is also
provided with a flattened, angled portion at a tip of the hood, to
assist with retraction of the labral tissue while burring the
glenoid rim. Slots are provided on the cannulated tube to provide
aspiration of waste material and used to attach the hood to the
cannulated tube.
Inventors: |
Bradley; James P.;
(Pittsburgh, PA) ; Schmieding; Reinhold; (Naples,
FL) ; Adams; Kenneth M.; (Naples, FL) ;
O'Quinn; Philip S.; (Naples, FL) |
Correspondence
Address: |
DICKSTEIN SHAPIRO LLP
1825 EYE STREET NW
Washington
DC
20006-5403
US
|
Family ID: |
44772705 |
Appl. No.: |
12/843560 |
Filed: |
July 26, 2010 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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11518909 |
Sep 12, 2006 |
|
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12843560 |
|
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60715615 |
Sep 12, 2005 |
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Current U.S.
Class: |
606/84 |
Current CPC
Class: |
A61B 17/320758 20130101;
A61B 2017/00473 20130101; A61B 17/0218 20130101; A61B 17/3496
20130101; A61B 17/1633 20130101; A61B 17/1684 20130101; A61B
2217/005 20130101; A61B 17/1615 20130101; A61B 2017/00902 20130101;
A61B 2017/22079 20130101; A61B 2017/00907 20130101; A61B 17/32002
20130101; A61B 17/1778 20161101; A61B 2017/320004 20130101; A61B
17/1659 20130101; A61B 2090/08021 20160201; A61B 2017/1602
20130101; Y10T 29/49826 20150115 |
Class at
Publication: |
606/84 |
International
Class: |
A61B 17/16 20060101
A61B017/16 |
Claims
1. An apparatus for abrading tissue, comprising: an inner assembly
rotatably positioned within an outer assembly, wherein an inner
tube of the inner assembly is removable from an outer tube of the
outer assembly; a hub formed at a proximal end of each of the inner
assembly and the outer assembly; an abrading element located at a
distal end of an inner tube of the inner assembly; and a hood
located at a distal end of an outer tube of the outer assembly,
wherein the hood is formed of a clear material and is provided with
a distal tip that forms an angle with a central axis of the
abrading element.
2. The apparatus of claim 1, wherein the angle is of about 30
degrees.
3. The apparatus of claim 1, wherein the distal tip has a first
width and the hood has a second width, the first width being
greater than the second width.
4. The apparatus of claim 1, wherein the hood comprises
polycarbonate.
5. The apparatus of claim 1, wherein the hood may be different
sizes to accommodate the abrading element.
6. The apparatus of claim 1, wherein the hood comprises a proximal
portion that extends about parallel to the central axis of the
abrading element and surrounds at least a portion of the abrading
element.
7. The apparatus of claim 1, further comprising at least one
aspiration port located near the distal end of the inner tube and
extending axially from a lumen of the inner tube to an outer
surface of the inner tube.
8. The apparatus of claim 7, wherein debris may be aspirated
through the at least one aspiration port into the lumen of the
inner tube via suction.
9. A method of glenoid repair, comprising the steps of: providing
an abrading instrument in the vicinity of a glenoid labrum attached
to a glenoid, the abrading instrument comprising a rotary cutter at
a distal end of the abrading instrument and a clear hood attached
to the abrading instrument, the clear hood comprising a
substantially cylindrical portion surrounding part of the rotary
cutter, and a flattened, angled portion located at a most distal
end of the clear hood; retracting the glenoid labrum with the
flattened, angled portion of the clear hood; and simultaneously,
altering a shape of the glenoid with the rotary cutter.
10. The method of claim 9, wherein the flattened, angled portion
forms an angle of about 30 degrees with a central axis of the
rotary cutter.
11. The method of claim 9, wherein the flattened, angled portion is
provided with side regions extending laterally from a central axis
of the clear hood, to increase the contact area with the glenoid
labrum.
12. The method of claim 9, wherein the glenoid repair is a SLAP
repair.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation-in-part of U.S.
application Ser. No. 11/518,909, filed Sep. 12, 2006, which in turn
claims the benefit of U.S. Provisional Application No. 60/715,615,
filed Sep. 12, 2005, the disclosures of which are incorporated by
reference in their entirety herein.
FIELD OF THE INVENTION
[0002] The present invention relates to rotary abraders used in
surgery and, more particularly, to an abrader which gives the
surgeon an improved view of the surgical site during arthroscopic
procedures.
BACKGROUND OF THE INVENTION
[0003] Least invasive surgical techniques have gained significant
popularity because of their ability to accomplish outcomes with
reduced patient pain and accelerated return of the patient to
normal activities. Arthroscopic surgery, in which the
intra-articular space is filled with fluid, allows orthopedists to
efficiently perform procedures using special purpose instruments
designed specifically for arthroscopists. Among these special
purpose tools are various manual graspers and biters,
electrosurgical devices, and powered shaver blades and rotary
abraders. Shaver blades having hollow bores are typically removably
coupled to a shaver handpiece and are used for cutting, resecting,
boring, and abrading both soft and hard tissue at the surgical
site. An arthroscopic abrader (also known as a burr) generally
includes a rotatable inner tube having an abrading head at its
distal end and fixed outer tube for rotatably receiving the inner
tube. Abraders are used for abrading or shaping both soft and hard
tissue as bone, cartilage, ligaments, etc. by use of the rotating
abrading head. As the tissue is being abraded, debris and fluid are
generally drawn or sucked through the rotatable inner shaft which
supports the burr.
[0004] Requirements for a rotary abrader for arthroscopy include a
compact size so as to fit through small cannulae, a means for
removal of debris, and a configuration which allows the surgeon to
access, while retaining good visibility, structures within a joint.
One requirement for good visibility is the effective removal of
debris as it is generated. Another is that the instrument be
configured so that the view of the active portion of the abrader in
contact with the tissue and the view of the tissue being abraded
are not obscured by the instrument.
[0005] Rotary abraders for arthroscopy generally have a shield,
also called a "hood," on one side of the distal end of the outer
tube to prevent inadvertent damage to tissue in close proximity to
the tissue being abraded. The distal end of this hood is angled
with respect to the tube axis so as to expose only one side of the
burr head. During use, the burr head (the abrading element at the
distal end of the rotating inner member) is subjected to
significant lateral forces. Although rotary abraders typically have
a bearing near the distal end of the instrument to support the
inner member, lateral deflection of the burr head occurs to some
degree. Contact between the burr head and the hood is undesirable
since the burr will abrade metal from the hood and deposit metallic
debris in the joint. Accordingly, it is necessary to leave adequate
clearance between the hood and the burr head. Further, hoods are
usually opaque, which hinder visibility of the surgical site during
surgery.
[0006] Removal of debris from the field is accomplished by
aspirating the material from the joint via a lumen in the inner,
rotating member which is connected through a means in the handpiece
to an external vacuum source. The aspiration of material through
the inner member is desirable as this allows easy transfer of the
materials from the proximal end of the instrument to the aspiration
passage of the handpiece. The manner in which material and fluid
enter the lumen at the distal end of the instrument has a large
effect on the volume of flow through the instrument and on the
frequency with which the instrument clogs. Insufficient flow causes
decreased visibility because of residual debris suspended in the
intra-articular fluid. Clogging requires that the instrument be
removed from the joint and "de-clogged." The degree of difficulty
of clog removal is determined by the instrument design. Even if
clog removal is easily accomplished, removing, de-clogging and
reinserting the instrument is a nuisance and causes increased
procedure times. Aspiration effectiveness, and therefore instrument
design, have a large effect on burr efficiency.
[0007] There is a need for an improved rotary abrader that provides
a clear hood to improve visibility during surgery.
[0008] It is accordingly an object of this invention to produce a
rotary abrader with a hood or sheath or guard that is available in
various shapes to improve the procedure of abrading tissue.
[0009] Further, there is a need for an abrading instrument having
rigidity, and an aspiration means which effectively removes debris
without clogging and which can be readily cleared of clogs without
disassembly, and which enhances surgeon visibility in procedures
where visibility is crucial, such as SLAP repair.
SUMMARY OF THE INVENTION
[0010] The present invention is a rotary abrader having a clear
sheath or hood over the abrading element or burr. Slots provided on
the cannulated shaft supporting the burr provide aspiration and are
used to attach the hood to the cannulated shaft.
[0011] Several hoods in various shapes are provided to cover the
burr at the distal end of the abrader. The hoods are formed of a
clear material, such as polycarbonate. The clear material of the
hoods provide visibility of the burr during the procedures.
[0012] The present invention also provides a burr with a hood
having a special configuration designed for labrum retracting
applications. The hood is preferably formed of a clear material to
allow increased visibility of the burr during the labrum retracting
and the cutting procedures.
[0013] Other features and advantages of the present invention will
become apparent from the following detailed description of the
invention, which is provided with reference to the accompanying
drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
[0014] FIG. 1 is a plan view of the outer tube of a rotary abrader
in accordance with an embodiment of the invention.
[0015] FIG. 2 is a side elevational view of an outer tube of the
rotary abrader of FIG. 1.
[0016] FIG. 3 is a side elevational view of the hood of an outer
tube assembly of the rotary abrader of FIG. 1.
[0017] FIG. 4 is a plan view of the hood of an outer tube assembly
of the rotary abrader of FIG. 1.
[0018] FIG. 5 is a perspective view of the hood of the outer tube
assembly of the rotary abrader of FIG. 1.
[0019] FIG. 6 is a plan view of the outer tube of the rotary
abrader of FIG. 1.
[0020] FIG. 7 is a plan view of the outer tube of the rotary
abrader of FIG. 1.
[0021] FIG. 8 is a plan view of the outer tube of the rotary
abrader of FIG. 1.
[0022] FIG. 9 is an expanded axial view of the objects at location
A-A of FIG. 6.
[0023] FIG. 10 is a plan view of the inner tube assembly of the
rotary abrader.
[0024] FIG. 11 is an expanded plan view of the distal end of the
inner tube assembly of the rotary abrader.
[0025] FIG. 12 is a perspective view of the distal end of the inner
tube assembly of the rotary abrader.
[0026] FIG. 13 is an expanded plan view of the distal end of the
inner tube assembly of a rotary abrader in accordance with another
embodiment of the invention.
[0027] FIG. 14 is an expanded plan view of the distal end of the
inner tube assembly of a rotary abrader in accordance with another
embodiment of the invention.
[0028] FIG. 15 is a perspective view of the distal end of the inner
tube assembly of a rotary abrader in accordance with another
embodiment of the invention.
[0029] FIG. 16 is a plan view of the inner tube of a rotary
abrader.
[0030] FIG. 17 is a plan view of the assembled rotary abrader.
[0031] FIG. 18 is a side elevational view of an assembled rotary
abrader.
[0032] FIG. 19 is a plan view of an outer tube assembly of a rotary
abrader in accordance with another embodiment of the invention.
[0033] FIG. 20 is a side elevational view of an outer tube assembly
of the rotary abrader of FIG. 19.
[0034] FIG. 21 is a plan view of an inner tube assembly of a rotary
abrader.
[0035] FIG. 22 is a plan view of an outer tube assembly of the
rotary abrader of FIG. 19.
[0036] FIG. 23 is a plan view of a hood of the rotary abrader of
FIG. 19.
[0037] FIG. 24 is a side elevational view of the hood of a rotary
abrader of FIG. 19.
[0038] FIG. 25 is a perspective view of a hood of the rotary
abrader of FIG. 19.
[0039] FIG. 26 is a side view of a distal end of a rotary abrader
with a hood according to another embodiment of the present
invention.
[0040] FIG. 27 is another side view of the distal end of the rotary
abrader of FIG. 26, rotated about 90 degrees.
[0041] FIG. 28 is a lateral view of a human shoulder with the
glenoid and labrum undergoing an exemplary method of glenoid repair
with the rotary abrader and hood of the present invention.
DETAILED DESCRIPTION OF THE INVENTION
[0042] In the following detailed description, reference is made to
various specific embodiments in which the invention may be
practiced. These embodiments are described with sufficient detail
to enable those skilled in the art to practice the invention, and
it is to be understood that other embodiments may be employed, and
that structural and logical changes may be made without departing
from the spirit or scope of the present invention.
[0043] Referring now to the drawings, where like elements are
designated by like reference numerals, FIGS. 1 through 5 illustrate
the outer tubular portion 50 of a rotary abrader formed in
accordance with the first embodiment of the invention. Outer tube
52 has a proximal end 54 and a distal end 56. Tube 52 has a lumen
53 of diameter 60 and an outer diameter 62. Distal end 56 has a
first portion 64 with an inner diameter 66 formed therein, and a
second portion 68 of length 70 with a diameter 72 formed therein.
Diameter 72 decreases slightly and varies at slope 45 at distal end
56. Diameter 72 is slightly larger than diameter 60. Diameter 66 is
slightly larger than diameter 72. Beveled surfaces 75 and 77
together with outer surfaces 55 define a hood (or guard) 79.
[0044] The hood 79 may be formed of any material, but in an
exemplary embodiment, at least a portion of hood 79 is made of a
clear polymer plastic material, such as polycarbonate. The
polycarbonate hood 79 enhances visualization of the operational
site. The hood 79 also is provided to enhance aspiration and to
protect tissue surrounding the operational site.
[0045] The outer tube 52, as illustrated in FIGS. 6 through 9, is
preferably about 5.15 inches long and has a diameter of about 0.171
inches. Further, elongated slots 73 and 74 extend from the lumen 53
to the tube outer surface 55 (FIG. 3). Two elongated slots 73 are
used to attach hood 79 to the outer tube 52. As shown in FIG. 9,
slots 73 have inward bevels for insert molding, created by laser
cutting, to allow the plastic from hood 79 to fill the space 75.
Also, the slots 73, having a dovetail configuration, prevent the
hood 79 from becoming dislodged. A core pin is inserted into the
lumen of the outer tube 52 to prevent plastic from obstructing the
pathway for inner tube 102 (FIG. 10). Slot 74 provides aspiration
of debris and waste without clogging. A raised diamond knurl 49 at
the proximal end 54 of the outer tube 52 is a point of attachment
for the outer tube 52 with the inner tube 102 (FIG. 10).
[0046] Referring now to FIGS. 10 through 12, inner tube assembly
102 of a rotary abrader constructed in accordance with the
principles of the invention has an elongated tubular portion 104
with a proximal end 106 and a distal end 108. Distal end 108 has
affixed thereto portion 110 having a diameter 114, and a distal
portion 116 forming an abrading element (or burr head) of diameter
117. In addition, a Teflon (FEP) shrink tubing covers the elongated
tubular portion of inner tube assembly 102 to prevent wear and keep
the inner and outer tubes more concentric. Near distal end 108 of
tubular portion 104 aspiration port 111a extends from lumen 112 to
outer surface 113. Aspiration port 111b extends from the distal
portion 116 to a distance immediately before 111a. The suction
pathways 111a and 111b enhance aspiration of waste and debris. An
example of a surgical abrader that provides a suction port proximal
to the bearing to enhance aspiration is disclosed in U.S. Pat. No.
7,077,845, which is incorporated herein by reference in its
entirety. In another preferred embodiment, as illustrated in FIGS.
13 through 15, the burr head and portion 112 extends about 1 inch
without aspiration ports at the distal portion 116. The aspiration
ports may be disposed on the inner tube a distance away from the
burr head. In addition, as best seen in FIG. 16, the inner tube 102
has an elongated tubular portion 104 that extends about 5.4 inches.
A raised diamond knurl 48 at the proximal end 106 of the inner tube
102 is a point of attachment for the inner tube 102 with the outer
tube 52 (FIG. 1).
[0047] Referring now to FIGS. 17 and 18, an assembled rotary
abrader 200 is shown. To assemble, an inner tube assembly 100 is
inserted into the outer tube 52 of outer assembly 50. Inner hub 122
is inserted into the outer hub 120, which is held secure by a
retaining ring 118. The inner hub 122 of inner tube assembly 100,
includes a spring 125, spring retainer 126, and thrust washer 127.
Also, the clear tip hood 79 covers the burr blade.
[0048] In another embodiment, the clear tip hood is removably
interchangeable with other hoods, which are provided in various
shapes. U.S. patent application Ser. No. 11/365,939, which is
incorporated herein by reference in its entirety, provides another
embodiment of an endoscopic rotary abrader with an abrader and an
outer assembly portion having flush ends and a removable hood.
[0049] In another preferred embodiment, as illustrated in FIGS. 19
through 25, a rotary abrader has an outer assembly 310 and inner
assembly 320. A hood 311 is insert molded onto the outer tube 315.
The hood 311 covers the burr blade 312. This abrader is known as a
SLAP burr. In this embodiment, the inner tube 314 is removable from
the outer tube 315. The outer assembly 310 has a proximal end 316
with a hub 317 affixed to the proximal end 316 of outer tube 315.
The inner assembly 320 has a proximal end 318 with a hub 319
affixed to the proximal end 318 of inner tube 314. As discussed
above, to assemble the rotary abrader, the inner tube assembly 320
is inserted into the outer tube 315 of outer assembly 310. Inner
hub 319 is inserted into the outer hub 317, which is held secure by
a retaining ring 321. The inner hub 319 of inner tube assembly 320,
includes a spring 325, spring retainer 326, and thrust washer
327.
[0050] As best seen in FIGS. 23 through 25, the hood 311 has a
different shape than the embodiment discussed above. This shape
provides better protection for the surrounding tissue as the burr
blade abrades the tissue. The hood is preferably made of a
polycarbonate or other clear material to enhance visibility of the
surgical site. Although the hood is shaped differently than the
embodiments described above, the abrader still maintains the
required minimum clearance between the burr head and the hood and
does not obstruct the surgeon's view. In a preferred embodiment,
the hood is enlarged as compared to the diameter of the outer tube.
In this embodiment, the diameter of the abrading element can be
increased and still maintain the minimum clearance required between
the element and the hood.
[0051] FIGS. 26-28 illustrate another embodiment of a hood (guard)
179 of the present invention which may be employed in lieu of the
hoods 79, 311 (and with the rotary cutters of the above-described
embodiments, for example, with the burr 116 of rotary abrader
200).
[0052] Hood 179 is also formed of a clear material but is provided
with a specific design and configuration which allows the
instrument to be employed both for tissue retracting (for example,
labrum retracting in a labral repair) and cutting of tissue (for
example, burring of the glenoid rim during the labral repair). As
detailed below, the hood is provided with a distal portion having a
flatter and wider profile than the rest of the hood, and forming an
angle with the central axis of the burr. Preferably, the hood 179
is employed for simultaneously retracting the labrum and cutting of
the glenoid rim during a labral repair procedure.
[0053] Hood 179 may be removably attached to the outer tube 52 of
outer assembly 50 of the rotary abrader 200, or may be removably
interchangeable with other hoods, which are provided in various
shapes and dimensions, as detailed in U.S. Patent Application
Publication No. 2006/0217751, the disclosure of which is
incorporated herein by reference in its entirety.
[0054] Hood 179 is provided with a substantially cylindrical,
proximal body portion 150 adjacent a middle portion 160 which in
turn continues with an angled, flattened distal portion 170
provided at the tip of the hood. Angled, flattened distal portion
170 extends above a most distal end 116b of rotary element 116
(burr 116) by a distance "H" of about 3-20 mm, more preferably of
about 10 mm (as shown in FIG. 26).
[0055] Distal portion 170 is provided with top and bottom surfaces
171, 173 that may taper in width distally and terminate at an end
175, as shown in FIG. 26. End 175 is preferably a blunt end to
avoid cutting or piercing of tissue during tissue retracting. Top
and bottom surfaces 171, 173 may be slightly curved or may be
flattened. Distal portion 170 is also provided with side areas
170a, 170b that flare out a distance "d" from the outer diameter
"D" (FIGS. 26 and 27) of proximal body portion 150, as shown in
FIG. 27, to increase the contact area with the tissue to be
retracted (i.e., with the labrum to be retracted). Distance "d" may
be about 0.5-5 mm, more preferably about 2 mm.
[0056] While cylindrical body portion 150 and middle portion 160
extend about parallel to longitudinal axis 52a of the outer tube 52
and also to longitudinal axis 116a of the burr 116, the distal
portion 170 forms an angle .alpha.(of about 10-60 degrees, more
preferably of about 30 degrees) with the longitudinal axis 52a of
the outer tube 52 and the longitudinal axis 116a of the burr 116,
as best shown in FIG. 26. In this manner, hood 179 acts as a
retractor that moves the tissue (labrum) away from the burr head
116, to keep it safe during the cutting procedure of the glenoid
rim (i.e., during the glenoid burring part of the labral repair
procedure).
[0057] Hood 179 may be formed of any material, but in an exemplary
embodiment, at least a portion of hood 179 (for example, distal
portion 170) is made of a clear polymer plastic material, such as
polycarbonate. The polycarbonate hood 179 enhances visualization of
the operational site. The hood 179 also is provided to enhance
aspiration and to protect tissue surrounding the operational site,
by retracting tissue.
[0058] Slots may be also provided on the cannulated tube to provide
aspiration of waste material and used to attach the hood 179 to the
cannulated tube (as detailed in the above-described embodiments).
The slots may be provided in different shapes (for example, a
dovetail configuration) to prevent the hood 179 from becoming
dislodged.
[0059] The hood 179 of the present invention may be employed in a
method of treatment of tissue, such as retraction of soft tissue
from bone during shaping of the bone. In an exemplary embodiment
only, the method of tissue treatment of the present invention
comprises the steps of: (i) providing clear hood 179 attached to a
cutting instrument in the proximity of a first tissue adjacent a
second tissue (for example, soft tissue attached to bone); and (ii)
retracting the first tissue with the clear hood 179 while
simultaneously cutting or shaping the second tissue (for example,
the bone) with the cutting instrument.
[0060] The hood 179 of the present invention may be also employed
in a labral repair procedure such as an arthroscopic repair of a
SLAP lesion by: (i) providing clear hood 179 attached to a rotary
cutter in the proximity of the glenoid labrum; (ii) retracting the
glenoid labrum with the clear hood; and (iii) cutting or shaping
the glenoid rim with the rotary cutter. Preferably, steps (ii) and
(iii) are conducted simultaneously.
[0061] FIG. 28 illustrates the interior of a right human shoulder
in a lateral perspective with glenoid 20 and glenoidal labrum 25
undergoing an exemplary method of glenoid repair (such as an
arthroscopic repair of type II SLAP (superior labrum
anterior-posterior) lesion or glenoid resurfacing) with the hood
179 and burr 116 of a rotary abrader such as rotary abrader 200 of
the present invention.
[0062] Appropriate radiological studies may be conducted to
determine if the humeral head and/or glenoid 20 have advanced
patterns of wear that may require procedures alternative or
additional to the one of the present invention. The method of
glenoid repair of the present invention may be performed in the
lateral decubitus or beach chair position. The arthroscope is
initially inserted into the glenohumeral joint through a posterior
portal.
[0063] Once the complete visualization of the glenoid is
established, the rotary abrader 200 (with the hood 179) is
introduced through cannula 10 or through an anterior portal, as
shown in FIG. 28. While the distal end 170 of the hood 179 retracts
glenoid labrum 25, burr 116 shapes the glenoid surface (to remove
remaining articular cartilage, or to remove the damaged cartilage
and bone). While the glenoid adjacent to the labrum is cut/shaped,
the hood 179 preserves the labral tissue that remains intact, as it
could be utilized to assist in additional procedures (such as
fixation of an allograft to the glenoid).
[0064] Although the present invention has been described in
relation to particular embodiments thereof, many other variations
and modifications and other uses will become apparent to those
skilled in the art. Therefore, the present invention is to be
limited not by the specific disclosure herein, but only by the
appended claims.
* * * * *