Manual Refractory Road in Cambodia

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On average, the most expensive place to eat and drink was Siem Reap.

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That covered food, bottled water, and a couple beers for the both of us. Subtract the beer and the cost was usually halved. Public bus transportation is reasonably inexpensive. We used tuk-tuks a handful of times for short rides between hotels and bus stations. We rented a motorbike at four of five destinations.

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We twice rented a private car and driver for transportation between Battambang and Siem Reap. Jen was never comfortable with haggling over a couple bucks or a few pennies. She felt it was wrong to do when the difference in price meant nothing to us, but meant a great deal to the people from whom we were buying things. I, on the other hand, like to haggle.

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The locals expect to do some haggling, at least with other Khmers, so I also see it as participation in local custom. I haggled when we purchased items at markets, shops, or roadside stands. I haggled over hotel room prices, particularly when we were staying several nights. I haggled over motorbike rental rates.

He also developed atrial fibrillation with a ventricular rate of bpm. Due to his refractory congestive heart failure status, a biventricular pacemaker was recommended. However, a current generation biventricular device was not available at that time. Procedure The patient was prepped and draped in a sterile manner in the cardiac catheterization laboratory.

Prior to the procedure, echocardiography was repeated, confirming his severe left ventricular dysfunction. Using curved and straight stylets, a Medtronic lead Medtronic, Inc. Jude Medical, St. Paul, Minnesota was placed in the right atrium using the same method.

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In the LAO 30 view, the catheter was manipulated into the coronary sinus ostium, first by advancing it into the right ventricle, then retracting it while applying counterclockwise torque as the sheath was slowly withdrawn from the right ventricle Figure 1. An injection was made to confirm the location, but due to the sharp angle of the sheath, the vein developed spasm distal to the sheath, and we could not visualize the branches.

An image was taken as a road map and the guidewire was removed. The only left ventricular lead available was the first-generation Biotronik Corox LV-H 75 lead Biotronik, Berlin, Germany , a stylet-driven unipolar lead. It was placed into the sheath and advanced into the coronary sinus to the approximate location of the lateral branch.


There was difficulty torquing the lead blindly into the branch vessel. We readvanced the BMW wire into the branch to guide us. The Corox lead was then torqued, and followed the guidewire alongside it into the lateral coronary sinus branch vessel Figure 2. Unipolar pacing and sensing numbers were excellent, and there was no diaphragmatic stimulation.

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The multi-purpose sheath was not a peel-away sheath and no cutting tools were available. Make an offer on the job lot.

Can provide receipts and info on where to get extra materials when needed, can even give you the contact for the construction crew who worked on the job good workers with a supervisor that speaks very good English. Catch is it needs to be picked up from central Phnom Penh by Tuesday evening or it will go into storage and wait a few months before I can be bothered dealing with it again. Make an offer!

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Is the bunch still up for sell? Thanks a lot in advance. Best, Marius.