the las vegas center for plastic surgery

2006-01-18T07:30:00.000-05:00

2006-01-17T06:07:00.000-05:00

SHREWSBURY, N.J. -- In what is believed to be the first time a patient from Connecticut undergoes a rare living-donor nerve transplant, a 21-year-old male from New London received donor nerves from his mother to reverse the paralysis of his right arm on Friday, January 7, 2005. The procedure took place at Monmouth Medical Center, and was performed by a team of medical professionals led by Dr. Andrew Elkwood, M.D. of the Plastic Surgery Center in Shrewsbury, NJ.

The nerve transplant is a complex procedure that utilizes advanced technology in order to reverse many life-altering paralyses. This weekend's surgery was performed on 21-year-old Dylan Brigham's arm, which was left paralyzed from a motorcycle accident in August 2003. As part of the procedure, the medical team surgically removed nerves from his mother's legs, and simultaneously transplanted them into Dylan's arm. The procedure also required the doctors to take nerves from Dylan's own legs and transplant them into his arm.

"Nerve transplants have shown incredible promise in helping once-paralyzed patients regain mobility that surpasses their previous expectations for recovery," said Dr. Andrew Elkwood. "We are extremely pleased with the success of previous living-donor nerve transplants, and anticipate further advancements in medical technology that will continue to help reverse life-altering paralyses caused by accidents, strokes and other medical tragedies."

In May 2004, Dr. Andrew Elkwood performed a father-daughter living-donor nerve transplant, which resulted in the patient gaining full mobility of her once paralyzed arm surpassing all prior prognoses for her recovery. Dr. Elkwood used the same procedure in June 2004 to restore functionality of another patient's paralyzed arm, which was left paralyzed from a car accident nine months prior to the surgery. In addition, Dr. Elkwood made use of cadaverous nerves when he performed the first nerve transplant ever to take place on the East Coast in March 2003, on a patient who was shot in the arm and leg. The patient has since regained near-complete functionality of his once paralyzed arm and leg.

About Dr. Elkwood

Dr. Andrew Elkwood, M.D., is a plastic and reconstructive surgeon who performs unique operations involving nerve rebuilding and complex reconstruction. Dr. Elkwood and his team are among the few doctors in the country to perform operations such as brachial plexus reconstruction, facial reanimation, nerve transplantation, and nerve grafting to preserve erectile function after prostate cancer. Dr. Elkwood is certified by the American Board of Surgery and the American Board of Plastic Surgery in General Surgery and Plastic Surgery. He is also a Fellow of the American College of Surgery (FACS) and a Fellow of the American Society of Aesthetic Plastic Surgery. Dr. Elkwood practices at The Plastic Surgery Center, with offices in NJ and Manhattan. For further information, please visit the Plastic Surgery Center's website at www.looknatural.com.

2006-01-17T06:06:00.000-05:00

By middle age, the marks of soft tissue laxity are visible on the face. The corners of the mouth are drooping, the lower eyelids have lengthened, and the malar fat pads are slipping south.

To correct these structural changes and rejuvenate the face, Paul Tessier, M.D., renowned craniofacial surgeon, first described the "midface lift."

However, putting the tissue back where it belonged and holding it there was not an easy matter. Surgeons encountered three problems: difficulty of dissection, difficulty of fixation and unpredictability of results.

Attempts to "improve" on Dr. Tessier's procedure led to a profusion of individualized techniques but only modest gains in ease or predictability. Today, the midface continues to be the most complicated and frustrating operation that many surgeons perform.

Altering midface dynamic

In October 2003, the U.S. Food and Drug Administration (FDA) cleared the Endotine Midface developed by Coapt Systems for subperiosteal midface suspension.

Packaged with disposable insertion tools, the implant is a small, five-tined platform attached to an ultra-thin leash. The tines grip subdermal cheek tissue, spreading tension over a broad area. Once implanted, the L-lactide/glycolide device begins to dissolve as tissues reaffix to the zygoma and maxilla. At five months, only 40 percent of the initial mass remains. At 12 months, the device is completely reabsorbed.

After using the implant in more than 75 patients (about half of them enrolled in clinical trials), we conclude that the Endotine makes fixation easy, fast and adjustable--without the awkward, unpredictable and hazardous placement of sutures. Operating time is markedly reduced by as much as an hour overall. Most importantly, results are predictable and often dramatic, leading to uniformly satisfied patients.

Patient selection

Patient selection is a key factor in good outcomes. The target population is 40- to 60-year-old women and men who have minimal to moderate laxity and good elasticity.

Younger patients get more dramatic results with improvements extending from the eyes to the lower midface and jowl. Benefits to older patients are concentrated in the upper midface. We do not recommend the procedure for patients over the age of 60 because attachment between periosteum and soft tissue is too lax.

Unfamiliarity

Very few patients are familiar with the midface lift.

Some arrive for consultation with a browlift in mind but later opt for a combination of browlift and midface lift. This produces synergistic results that are more dramatic than the midface alone. Other patients seek a "natural" slightly younger look with minimal discomfort and downtime. A third group--generally in their 50s--has already had surgical intervention to the lower face and neck but complains that this did not produce a healthy, rejuvenated appearance.

Overall, the midface is ideal for patients who have been receiving botulinum and dermal filler treatments and are now willing to move on to a procedure that has fewer stigmata and less scarring and potential hairline alterations than a full facelift. We look at the midface as a "transitional" procedure, not as a replacement for the facelift.

Implanting the device

The Endotine maybe inserted through incisions in either the temporal or buccal sulcus areas. The dissection phase of the operation remains largely unchanged, whether using an open or endoscopic approach.

If the Endotine is implanted through the temporal incision, the device is introduced using the insertion tool. If the Endotine is implanted through an oral incision in a retrograde fashion, it helps to first trim the edges of the leash so passage is smoother. The device is then introduced through the mouth, grasped (via temporal incisions) with forceps, and pulled through.

Regardless of point of entry, the device sits over the maxillary antrum, not the zygoma. After the insertion tool is retracted, digital pressure to the exterior of the cheek forces the tines into the periosteum. Tension on the leash completes the engagement process and lifts the periosteum along with attached skin and soft tissue. Surgeons can quickly experiment with vectors and degrees of tautness until the desired aesthetic is achieved. Finally, the leash is sutured to deep temporal fascia, and all incisions are closed.

More dramatic results

Combining the midface with a browlift will produce more elevation and, therefore, more dramatic results. (In fact, overcorrection is now a possibility.) The operation takes about 50 percent longer than a browlift alone.

In the postoperative phase, patients need to be on a soft food diet and warned against heavy lifting or straining. Bruising and edema should resolve within seven to 14 days. The recovery period can be reduced by diligent use of ice compresses for the first 48 hours. Some patients, especially thinner ones, may complain of discomfort upon palpation. However, this has not been a significant issue. Placement of the device is sufficiently distant from the facial nerve branches (frontal, orbital and zygomatic) that nerve damage is unlikely. Depending on the extent of dissection, a rare patient may experience nerve weakness during brow elevation, closure of eyes, or elevation of the corner of the mouth. This is a temporary issue, unrelated to fixation; it should resolve within six weeks.

In the first 75-plus consecutive patients, there have been no complications, no extrusions, no instances when the lift slipped, and no requests for removal of the device.

Benefits of sutureless fixation

The problems with sutures are numerous. It takes time to prepare and place the sutures. They have to be threaded up to the brow like puppet strings. Adjustments to tension or vector are difficult to achieve and time-consuming.

If placed in the wrong position, sutures must be removed and redone. This leads to multiple puncture points, which are vulnerable to infection. Sutures that remain in place may break, entrap nerves, tear through tissue or cause dimpling.

Use of the Endotine Midface eliminates all of these problems. (It is especially helpful in patients who have more tissue mass, such as men.) Achieving symmetry is easy and fast. If necessary, surgeons can go back in and reposition the device or tighten the lift for a period of several weeks after surgery.

In the past, we've experienced redo rates of around 10 percent. The Endotine also eliminates that. There is only one trip to the operating room. Any needed adjustments can be quickly made in the office under a local anesthetic. Finally, because the device is bioabsorbable, there is no need to remove sutures.

The Endotine is the first device specifically designed for subperiosteal midface tissue fixation. It shaves 30 to 60 minutes and a lot of frustration from a standard operation.

Conclusion

The midface lift, when approached through intraoral or temporal incisions and matched to the Endotine, effectively addresses the concerns of middle-aged women and men who want to look rejuvenated in a subtle, natural way with less bruising, swelling and downtime.

Patients who have had a forehead lift in conjunction with the midface suspension appear to be the happiest. Many report favorable comments from friends and family, leading to a high level of satisfaction.

Dr. Berkowitz is a plastic surgeon based in the San Francisco Bay Area. Dr. Beeson has a private practice in Carmel, Ind., where he performs otolaryngology/head, neck and facial plastic surgery. Dr. Moscoe is a plastic surgeon in Austin, Texas.

Disclosure: Drs. Berkowitz, Beeson and Moscoe have served as clinical investigators for Coapt Systems. Dr. Moscoe has no financial interest in the company. As members of the Coapt medical advisory board, Drs. Beeson and Berkowitz have stock option grants.

2006-01-15T19:06:00.000-05:00

Byline: Amy Driscoll

MIAMI _ To trace her remarkable journey, Bilkis Khatun has only to look in the mirror.

The skin grafts and cartilage and fading scars on her face tell the story of a life rebuilt, from "honor crime" victim in Bangladesh to outspoken survivor in a land halfway around the world.

In the last four years, she has been lasered and stitched, transplanted and tucked. Doctors custom-made a prosthetic ear, surgically implanted a brow, re-created a nose with the last nub of cartilage from her destroyed ear.

But plastic surgery works on the outside. Medical records don't chart the changes within. For Bilkis, now 17 and headed back to her country, the strength and bravery she discovered after enduring an act of unspeakable cruelty may be the greatest makeover of all.

"Oh, my god!"

She cups a hand over her mouth, half laughing, half dismayed. She's watching videotaped news footage of herself when she arrived at Miami International Airport in May 2001. This girl is fresh from Dhaka, in an Indian-style tunic and dark sunglasses so enormous they almost swallow her face. She looks petrified.

The newscasters describe her in grave tones: a disfigured Bangladeshi girl who traveled to Florida for reconstructive surgery after thugs threw acid on her face.

The image shifts to a news conference. Her new plastic surgeon discusses her case and so does her foster mother. On television, Bilkis sits small and silent as a voice-over warns of "graphic pictures" to come: close-ups of Bilkis' ravaged face.

She shakes her head at the big screen. "I've changed a lot."

She is not talking about the plastic surgery.

The Bilkis of today doesn't much resemble her black-and-white schoolgirl picture taken before the attack. She looks like a new self, with scars and uneven skin pigment still evident.

"I worked really hard to have this new face," she says. "But the face, it's not that important. I think what's inside, that's important."

She was 13 at the time of the acid attack. In Bangladesh, such assaults are known as "honor crimes," often committed by spurned boyfriends or angry husbands to avenge themselves, using the most available weapon: battery acid. The Acid Survivors Foundation, started in 1999, reports that there were 283 acid-throwing assaults between January and October last year.

In Bilkis' case, the details are murky. Two men, hired by a would-be suitor she says she never met, broke into her home at night to pour acid on her face. One was later caught, though the specifics of his punishment are unclear. Bilkis spent months in a Dhaka hospital before the Florida/Georgia chapter of Healing the Children stepped in.

Oprah Winfrey had aired a show that spring on international violence against women, including acid attacks in Bangladesh. In Weston, Fla., a single mother with two daughters watched from her sickbed and took action. Within minutes, Heidi Marer was on the Internet offering to help.

"I was saving the world," she jokes.

A few miles away in Fort Lauderdale, someone else was prepared to help, too. Dr. Russell Sassani, who would become Bilkis' chief plastic surgeon and perform 14 surgeries on her, had heard about Healing the Children from his partner, Michael Schneider. Schneider was involved in an airline program that provided adult escorts for children traveling solo, some as part of the charity's campaign.

"As horrific a crime as this was, Mike made me realize it would be a greater crime if we did nothing to help," Sassani said.

Less than two months later, Bilkis stepped off a plane in Miami, armed with a month's worth of English lessons.

___

It was a cool night in Khalishpur. She was sound asleep in bed next to her younger cousin, Nurjahan.

Without warning, sleep turned to roaring pain. Hot, then cold on her face. She found herself running outside, hearing cries _ her voice, her cousin's.

Someone called an ambulance. Bilkis saw her father, crying. She had never seen him cry before. Her mother's face, stunned. Neighbors, too, the whole village, crowded around.

She looked for Nurjahan, spotting a small figure, curled up with arms around her knees. Her face was oddly white and puffed out. She was weeping, almost soundlessly.

Bilkis wondered if Nur was going to die.

They sat together, waiting for the ambulance. Bilkis, not crying, kept her eyes on her cousin. She reached up and touched her own face, very gently. It felt hard, more like wood than skin. She dropped her hand.

It would be three months before she would look into a mirror.

___

(EDITORS: BEGIN OPTIONAL TRIM)

"When I found out what happened to Bilkis, I was like, damn, that is messed up," says Jessica Stallard, a friend at the Whiddon-Rogers Education Center in Fort Lauderdale.

The two girls are the same age, 17. They share a computer class and a curiosity about each other's worlds.

"When people see her for the first time, they ask what happened _ I did," Jessica says. "But I don't really look at it anymore, and from what I've seen, neither does anyone else. It's just her."

Bilkis, a junior, has taught Jessica about the Bangladeshi culture and loaned her Bollywood DVDs, Indian musicals filled with unrequited love. Jessica has taught Bilkis a few things, too, like what a hickey is.

"I think she was raised a lot more strict and more respectful in her culture," Jessica says. "I mean, she's never even kissed anyone."

(END OPTIONAL TRIM)

After 3-{ years in South Florida, Bilkis is Americanized, for better and maybe worse. The girl who once jumped into a pool fully clothed because she didn't want anyone to see her scars is long gone. She no longer needs the signs that her foster mother initially posted in her room _ common phrases written in both English and Bangla _ to help them communicate. She's not even that crazy about her own country's food anymore.

She wears low-slung jeans, wedge shoes, a T-shirt that says "custom built," and rides up to show her belly-button ring. She likes dollar stores and reading, everything from the Helen Keller story to "The House on Mango Street."

When she meets people who speak Bangla, she fumbles to respond in her own language.

"It just comes out English," she says.

Healing the Children has made changes in its program based in part on Bilkis' experiences. Children flown in for surgeries now generally stay no longer than six months.

"I think we were a little naive about how long it would take for this kind of massive reconstruction," said Tina Heydorn, executive director of the Florida/Georgia chapter. "Now we send them home between surgeries and bring them back. We do that to preserve the integrity of the family and their culture."

During her stay, Bilkis has seen the generous side of Americans. Her surgeries would easily cost several hundred thousand dollars. She's had her own room in her foster mother's home for three years and in her plastic surgeon's house for the final eight months. She's been to Walt Disney World and Wal-Mart and Virginia to see snow _ all gifts given freely to a Muslim girl living in a post-Sept. 11 United States.

Bilkis has ambitions and plans now. She wants to become a doctor, or perhaps a nurse.

"I don't know how I'll do it, but I'll do it," she says, gazing out a car window at the suburbs of Broward County. "I want to help people the way people have helped me. I'll try when I go back, I'll really try to do it.

The odds are against her, and she knows it. She is returning to a tiny village in a third-world country where her parents don't have a phone or running water and rickshaws are common. Customarily, acid survivors have been ignored or shunned in a society reluctant to acknowledge that the problem exists.

Today, "no one will judge whether she did anything wrong _ which of course she didn't _ but they'll all still know when she walks down the street in her village," explained Nasreen Pervin Huq, a women's activist with the group Nari Pokkho in Dhaka. "In the past, girls like Bilkis lived out their lives in anonymity in their villages. Not seen and not heard."

But one thing Bilkis has learned in the United States is the power of self-determination.

"I don't care what people think or if they look at me," she says with a shrug. "I just don't care. That's not going to stop me."

(EDITORS: BEGIN OPTIONAL TRIM)

___

At the hospital, the doctor asked if anyone had thought to wash the girls' faces. No one had. He shook his head. Skin touched by acid should be flushed with water. It helps keep the acid from reaching the bone. That was the first time Bilkis realized she had been attacked with acid.

From then on, she averted her eyes from every surface that might show her reflection. One day in a hospital bathroom, she caught a glimpse of a disfigured face in the mirror. She didn't recognize it. It was hers.

(END OPTIONAL TRIM)

___

Bilkis is crying.

She didn't cry when she left Bangladesh. She didn't even cry _ much _ when she had to wear bandages covering her whole head for weeks.

But here, among dozens of friends at an Indian restaurant in Dania Beach at her going-away party, she's clutching a napkin to her eyes. She's sad to leave, but joyful at the thought of seeing her family. It is, she says, "a happy kind of cry."

The banquet room is filled with Bilkis supporters. The Chodhry family, from Pakistan, who invited her to their home and took her to the mosque. Doctors and nurses who worked for free. Brandon Cox, the vet who lives around the corner, with her children. Laura Van Epps and her toddler daughter, Caroline, who took Bilkis to dollar stores and the park.

And of course, her three "parents," Sassani, Schneider and Marer. Shepherding a teenager through three years of grueling operations _ and feeding and schooling and housing her _ has taken their combined efforts. Strangers at the beginning of this odyssey, they are good friends now.

In a few days, they'll put Bilkis on a plane, her three suitcases crammed with books and clothes and a laptop. The goodbyes are beginning.

"I'm just so proud to sit and talk with her and hear her English and see her demeanor and her laughter," Marer says. "It was all worth it."

Then her doctor, Sassani: "We hope you shine when you go back, Bilkis."

Schneider tries not to choke up, then does, as he reflects on the ways Bilkis has grown, in empathy and strength and bravery, "because she had to."

Now it is Bilkis' turn. In a red sari for the occasion, hair pulled up and new ear fastened, she strikes a pose and cues the music.

With a flourish, she's off _ swirling, twisting, leaping around the room. She's been practicing this dance for weeks, copying it from a favorite Bollywood movie, and she is giving it everything she has. Hair in her eyes, bare feet alive to the music, it is a dance of complete abandon.

As the final note sounds, she is grinning like she can't stop. And the applause begins.

(EDITORS: STORY CAN END HERE)

___

For years afterward, she dreamed about the attack, reliving the moment destruction rained down on her head.

She doesn't dream about it anymore. In her new dreams, she is not a victim. In her new dreams, she is defending her cousin.

Nur, who also had years of surgeries in Florida, e-mailed Bilkis in July from Bangladesh. Someone had told her she didn't look any different now, which made her angry. It made Bilkis even angrier.

"That was so mean," Bilkis says. "And it's not true!"

In her dream, Bilkis is confronting the person who said these things about Nur, and she is cursing him. In English.

___

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2005-12-24T16:13:00.000-05:00

Fair Disclosure Wire

08-08-2005

OPERATOR: Good morning and welcome to the Integra LifeSciences second quarter 2005 earnings conference call. [OPERATOR INSTRUCTIONS] It is now my pleasure to turn the floor over to your host, Stuart Essig, President and CEO. Sir, you may begin.

STUART ESSIG, PRESIDENT AND CEO, INTEGRA LIFESCIENCES: Good morning, everybody, and thank you for joining us for the Integra LifeSciences investors conference call. I'm Stuart Essig, President and CEO of Integra LifeSciences Holdings Corporation. Joining me today are David Holt, SVP of Finance, and Jack Henneman, Chief Administrative Officer.

During this call we will review our financial results for the second quarter of 2005, which we released yesterday afternoon, and our forward-looking guidance for the third quarter of 2005 and the full years 2005 and 2006. At the conclusion of our prepared remarks, we will take questions from members of the telephonic audience.

Before we begin, Jack Henneman will make some remarks regarding the content of this conference call.

JACK HENNEMAN, SVP FINANCE, INTEGRA LIFESCIENCES: This presentation is open to the general public and can be heard through telephone access or via a live webcast. A replay of the conference call will be accessible starting 1 hour after the conclusion of the live event.

Access to the replay is available through August 22, 2005, but dialing 973-341-3080, access code 6175823, or through the webcast accessible on our home page.

Today's call is a proprietary presentation of Integra LifeSciences Holdings Corporation and is being recorded by Integra. No recorded, reproduction, transcript, transmission or distribution of today's presentation is permitted without Integra's consent.

Because the content of this call is time sensitive, the information provided is accurate only as of the date of this live broadcast, August 8, 2005. Unless otherwise posted or announced by Integra, the information in this call should not be relied upon beyond August 22, 2005, the last day that an archived replay of the call authorized by Integra will be available.

Certain statements made during this call are forward-looking within the meaning of the Private Securities Litigation Reform Act of 1995.

Among others, statements concerning management's expectations of future financial results, new product launches and regulatory approval and market acceptance of these new products, future product development programs and potential business acquisitions are forward looking.

Forward-looking statements involve risks and uncertainties that could cause actual results to differ materially from predicted results. For a discussion of such risks and uncertainties, please refer to the "Factors that may affect our future performance," included in the business section of Integra's annual report on Form 10-K for the year ended December 31st, 2004, and information contained in our subsequent filings with the Securities and Exchange Commission.

These forward-looking statements are made based upon our current expectations and we undertake no duty to update information provided during this call.

Certain non-GAAP financial measures are disclosed in this presentation. A reconciliation of these non-GAAP financial measures to the most comparable GAAP measures is provided in the press release we issued yesterday, which is available on our website in the press release section under investor relations.

STUART ESSIG: Thank you, Jack. We achieved record revenues in the quarter. Total revenues in the second quarter of 2005 increased by $13.3 million to $69.8 million, a 24% increase over the second quarter of 2004. Excluding recently acquired product lines, second quarter revenues increased by $7.4 million or 14% over the prior year period.

We reported net income of $7.7 million or $0.23 per diluted share for the second quarter of 2005. When adjusted for certain acquisition, integration and restructuring-related charges, net income for the second quarter of 2005 was $9.6 million or $0.29 per diluted share.

These acquisition, integration and restructuring-related charges included costs associated with the closing of various facilities and related transitions, employee terminations, product line discontinuations and other related costs, including inventory fair value purchase accounting adjustments. You will recall that in our first quarter earnings release and conference call we anticipated significant acquisition, integration and restructuring costs during the remainder of 2005.

Operating income was $12.1 million for the second quarter.

Acquisition, integration and restructuring-related charges reduced our operating income by $3.1 million.

Our implant revenues in the second quarter increased over the prior year period by 40%. Rapid growth in our nerve repair products, our dermal repair products and acquired sales of Newdeal products for the foot and ankle accounted for most of the increase in implant product revenues.

Sales of our NeuraGen and NeuraWrap products increased approximately 70% over the prior year period. Sales of our dermal repair products increased approximately 45% over the second quarter of 2004.

Newdeal product revenues were $4.1 million and we are receiving strong feedback on the Newdeal system of foot and ankle products.

Newdeal sales in the United States are growing, along with the expansion and training of our reconstructive surgery sales force, which we expect to reach 50 people by the end of the year. We have opened over 150 U.S. Newdeal accounts since we began selling the products in late Q1 of this year.

Sales of the NPH Low Flow Hydrocephalus Valve that we introduced in late 2004 also contributed to the growth in implant products revenues for the quarter.

We had record sales of DuraGen products this quarter. These products continue to grow, although at slower rates than in earlier years. We continue to see competition in duraplasty in line with previous quarters, but the total opportunity is such that we expect duraplasty to remain a very important, growing and profitable business for years to come.

Importantly, we introduced, in February, our third generation duraplasty product, the Suturable DuraGen Dural Regeneration Matrix.

Sales of Suturable DuraGen have been ramping significantly monthly since our launch. We believe this product will enhance our ability to compete against other suturable dural grafts. The product is intended for us by surgeons who want Integra's tissue remodeling technology for procedures that require suturing.

Revenues for our instrument product lines in the second quarter increased over the prior year period by 20%. Increased sales of our JARIT surgical instruments and ultrasonic aspirator product lines provided most of the internal growth in instruments. The Mayfield product line, acquired during the second quarter of 2004, also continues to provide strong results.

Monitoring revenues in the second quarter increased over the prior year period by 2%. Year-over-year growth in monitoring product revenues continues to be affected by slower-than-expected acceptance of our LICOX brain oxygen monitoring system in the United States and slower growth in external drainage systems.

We expect that our NeuroSensor cerebral blood flow monitoring system and the AccuDrain external drainage system will contribute to improvements in the performance of this category in future periods.

The NeuroSensor is currently in evaluation at approximately 20 institutions.

Our private label product revenue in the second quarter increased over the prior year by 26%. Increased revenues of the Absorbable Collagen Sponge that we supply for use in Medtronic's INFUSE bone graft product and revenues of Biopath, a product we sell to Johnson & Johnson, more than offset the removal of the Signature Technologies cranial fixation OEM revenues from our private label products category. You will recall that we discontinued manufacturing cranial fixation products for Medtronic at the end of last year's second quarter.

We received a one-time royalty payment of approximately $500,000 based on additional patent claims associated with the Biopatch product license.

Our gross margin on total revenues in the second quarter of 2005 was 61%. Although we had strong growth in higher gross margin products, we incurred $1.8 million in restructuring and manufacturing transfer costs, fair value purchasing accounting adjustments and certain inventory write-offs associated with a discontinued product line.

These charges reduced our gross margin by 3%.

We anticipate having additional restructuring and manufacturing transfer costs for the remainder of this year. Excluding these charges, we expect to continue to see a positive trend in the gross margin.

Selling, general and administrative expenses increased by $6.6 million to $26.0 million in the second quarter of 2005, with $2.2 million of the increase attributable to acquired operations. Selling, general and administrative expenses this quarter were significantly higher as a proportion of revenues than in the prior year.

Approximately $1 million of these higher expenses were related to costs associated with the closing of various facilities and related transitions, employee terminations and other acquisition, integration and restructuring-related costs. We excluded these costs from our calculation of adjusted earnings because we believe that, given our strategy of seeking acquisitions and the nature of the restructurings underway in our European operations, net income adjusted to exclude costs related to acquisitions, integrations and restructurings is a useful additional basis to measure the performance of our business operations, both in this quarter and in future periods.

During the second quarter we continued the integration of the Newdeal Group's international business with our existing international sales and distribution network and launched the Newdeal products through our reconstructive sales force. The Newdeal foot and ankle implant products are an important part of our strategy to sell the Integra wound repair and dermal and nerve regeneration products to the surgeons who see chronic wounds every day.

Our objective is to provide a full range of products for foot and ankle surgeons so that our reconstructive surgery sales force can be a one-stop-shop for surgeons in that specialty. We believe that Newdeal's first rate foot and ankle orthopedic products and Integra's high-tech wound repair and nerve regeneration technology are, together, the most compelling suite of products, both metallic and ortho-biologic, sold specifically to foot and ankle surgeons.

While other companies have much larger sales forces at their disposal, we're catching up fast. We are rapidly building our reconstructive surgery sales organization. Furthermore, we believe we are unique in building a direct sales organization dedicated to foot and ankle rather than one sharing selling time with other orthopedic specialties. Today we have approximately 40 sales professionals in the U.S. reconstructive surgery group and we are working to increase that number to 50 by the end of the year.

We believe that our track record in neurosurgery proves that we have the management expertise to build the best sales force in a market segment and we plan to do it again in foot and ankle. That being said, we have continued to model this year's growth in our U.S.

Newdeal revenues modestly for the remainder of this year, pending further evidence of the results of our efforts.

This past quarter we announced the restructuring of certain European operations and in June we entered into an agreement with our labor representatives of employees affected by the closing of one of our facilities. The company will continue discussion of further anticipated restructurings of its European operations with local labor representatives. The costs of these activities will depend upon various considerations, including the number of employees to be terminated and their locations, the availability of other jobs with Integra LifeSciences, and the level of severance benefits.

We expect to reinvest the bulk of the savings from these activities in further building our European sales, marketing and distribution organization and in integrating the Newdeal Group's business with our existing sales and distribution network.

The company expects to incur significant cost over the remainder of this year in connection with the employee severance, legal and other items related to restructuring and integration activities, largely in Europe. Based on management's preliminary assessment, Integra LifeSciences estimates that the cost of its restructuring and integration activities, including those discussed above, will not exceed $8 million in the aggregate. Through the 6 months ended June 30th, 2005, we have incurred $3.8 million of these charges. We currently expect the remaining charges to occur over the remainder of 2005 and to impact our 2005 GAAP reported earnings per diluted share guidance by approximately $0.14.

I will now turn the presentation over to David Holt, our SVP of Finance, who will provide more information regarding our interest expense, tax rate and foreign currency exposure.

DAVID HOLT, SVP FINANCE, INTEGRA LIFESCIENCES: Thank you, Stuart. We recorded interest expense of $822,000 and interest income of $907,000 in the second quarter of 2005. Net interest income decreased slightly from the prior year period.

Other expense was $541,000 in the second quarter of 2005 as compared to other income of $135,000 in the prior year period. Other expense this quarter included losses of $522,000 related to foreign exchange transactions. We currently do not have any hedging programs for these positions.

We continue to generate substantial cash flow from our operations. In the second quarter of 2005, we generated cash flows from operations of $16.2 million, a $6.5 million increase over the second quarter of 2004. Our year-to-date cash flow from operations, through June, was $29.5 million.

Accounts receivable improved approximately-- to approximately 69 days of sales outstanding at December 31st, 2004, to approximately-- from 69 days of sales outstanding at December 31st, 2004, to approximately 61 days at June 30th, 2005, as a result of increased collection efforts during 2005. We expect our days outstanding to remain constant with current levels.

International sales were 27% of total sales this quarter, compared to 21% of total sales for the full year of 2004.

Inventory days on hand were approximately 246 days at June 30th, 2005, compared to 244 days at the end of the first quarter. We have increased inventory levels in 2005 in order to minimize the impact on our customers as we complete various manufacturing transfers and restructuring activities.

In May 2005, our board of directors authorized us to repurchase shares on our common stock up to an aggregate of $40 million through December 31, 2006. During the second quarter we repurchased 750,000 shares under this program for approximately $24.7 million. We may continue to purchase up to $15 million in shares either in the open market or in privately negotiated transactions.

At June 30th, 2005, we had cash and investments of approximately $148 million. Our weighted average common shares outstanding used for the calculation of diluted earnings per share in the second quarter of 2005 was approximately 34.7 million shares.

Our income tax expense-- our income expense rate was approximately 34.5% in the second quarter of 2005 versus 36.8% in 2004 and our amortization expense for the quarter was $1.7 million, an increase of $619,000 over the prior year period.

And now let me turn the presentation back over to Stuart.

STUART ESSIG: Thank you, David. Our management team continues to seek out external opportunities for growth and any such opportunities that we consummate could affect our results going forward. It is a top priority of our management team to complete significant and accretive transactions this year and next, however, the forward-looking guidance that we have provided does not reflect the impact of any such future business acquisitions or additional strategic partnerships.

We are updating our expectations for total revenues and earnings per share for 2005 and reiterating our expectations for 2006. Total revenues in 2005 are expected to be between $283 million and $290 million. Total revenues in 2006 are expected to be between $340 million and $350 million. Our guidance for the third quarter of 2005 is for total revenues in the range of $70 million to $74 million.

Excluding charges related to acquisitions, integrations and restructurings, earnings per diluted share in 2005 are expected to be within a range of $1.29 to $1.34 in the full year and $0.33 to $0.36 in the third quarter. On a GAAP-reported basis, we expected earnings per share in 2005 to be within a range of $1.15 to $1.20 in the full year and $0.28 to $0.31 in the third quarter.

Earnings per diluted share in 2006 remain unchanged in a range of $1.65 to $1.75. Our expectation ranges for 2006 earnings per share-- earnings per diluted share, do not reflect the impact of expensing stock options beginning January 1st, 2006, under the accounting standard recently issued by the Financial Accounting Standards Board.

I would like to take a moment to focus on the expectations for each of our product categories for modeling purposes. Based on our total revenue guidance for 2005, we expect implant revenues of $112 to $114 million, instrument revenues of $95 million to $98 million, monitoring revenues of $49 to $51 million and private label revenues of approximately $27 million.

Looking beyond 2005, we expect sales to grow in excess of 25% for the implant product lines and 15% for the remainder of the product lines.

Overall, our long-term organic growth rate expectation for revenues is in the range of 15% to 20% per annum.

The consolidated gross margin percentage, excluding costs related to acquisitions, integrations and restructurings, for the full year is expected to increase to 66% of total revenues in 2006.

Long term, we are targeting SG&A expense at 32% to 34% and R&D at between 5% and 6%.

We are very optimistic about the prospects for our reconstructive surgery strategy. We believe that the combination of the Newdeal products and our soft tissue regeneration technology provides the perfect platform on which to build a rapidly growing extremities business. The first evidence in support of this strategy is the significant increase in sales of Integra tissue regeneration products during the second quarter. We believe that as we add sales representatives and Newdeal accounts, sales of our reconstructive products will accelerate.

Our instrument business also continues to be strong. Not only has the Mayfield business, which is not included in our organic growth numbers, grown significantly since we acquired it, but it has been an excellent means for pushing our neuro reps into accounts that have been closed to them in the past. JARIT continues to take share from its competitors.

This concludes our prepared remarks. I'll be happy to answer all of your questions. Operator, you may turn the call over to our participants.

OPERATOR: [OPERATOR INSTRUCTIONS] Dave Turkaly, WR Hambrecht.

DAVE TURKALY, ANALYST, WR HAMBRECHT: I was wondering, just in terms of the guidance for the restructuring costs of not to exceed $8 million and about $4 million so far, can you just remind us exactly, if you could, what plants these involve, what product lines, if there's any more detail that you can give us on that and why you think now you're about halfway through.

STUART ESSIG: OK, Dave. First of all, we did not discuss it on our last conference call because we were still at a phase in our discussions with the various labor representatives that we couldn't.

I can tell you more now.

We announced a significant restructuring of our Tuttlingen operation, which we call IMA -- it's where we make the Berchtold electrosurgery devices and we are in the process of transitioning that facility into our Andover facility, where we make our electronic processes-- products and processes. There'll be a significant headcount reduction as we shut down the site in Germany.

In addition, we are in discussions with labor representatives of our Biot manufacturing plant, so where we make the NMT shunts and epilepsy and drainage and there's no intention to shut that site, but rather we're in discussions with labor representatives about a reduction in headcount.

There are other restructuring activities going on, as well, in Europe, including a significant restructuring of our sales and marketing organization, of which a number of people, on the one hand have been terminated and on the other hand there's significant hiring going on and actually net/net we'll be up in heads in our sales and marketing organization, in particular leveraging the significant management organization that we acquired in Newdeal to take responsibility for much of the European sales and marketing.

We are, in the United States, shutting our spinal specialties facility in Texas and it's being-- it's in the process of being merged into our California location where we make the variety of Camino products and other products. We're also moving a significant number of activities out of our New Jersey facility, some of which are more appropriately in our California facility and many of which are being moved down to Puerto Rico.

So I was actually thinking about it last night. There is no site that we have right now that isn't at the receiving end of some significant restructuring activity designed to improve efficiency and take out costs.

When this is all done, we expect on the order of 75 heads to be reduced and that does not include, for example, adding heads into sales and marketing. So in terms of manufacturing and G&A we expect on the order of 75, maybe closer to 85, heads will come out of the organization. And we know, in particular, what the numbers look like in France and in Germany, but the way the accounting works is we're only able to accrue a certain proportion of it in the second quarter and we have a pretty good sense for what will be accrued in the third and the fourth quarters.

Our objective is to have all of this put behind us by the end of the year so as we go into the new year we will have accumulated all of the expenses, but some of that just depends on the process we follow and we obviously have to follow the local laws and negotiate in good faith with all of our labor representatives. So net/net we know we've spent -- from an accounting perspective -- about $4 million and we would expect to spend another significant chunk in the third quarter and then a much smaller amount in the fourth quarter.

DAVE TURKALY: Thanks for all the detail. Can you give us an update, too, on the-- kind on the implant side, your direct sales force kind of in that business now, where that stands today?

STUART ESSIG: Yes. Our objective is to finish the year at 50 people for what we're referring to as our reconstructive sales organization.

And keep in mind, reconstructive includes the following products, the Integra dermal regeneration and repair products, so all of the various flavors of the Integra artificial skin products. It includes the nerve products, NeuraGen and NeuraWrap, although our neuro group also sells those products. So you can think of the 2 divisions co-marketing the nerve repair products with the neuro group calling on neurosurgeons who do some of the procedures and the reconstructive group calling on, principally foot and ankle, plastic and, to some extent, other surgeons who would use the nerve products. And then the reconstructive group also sells the Padgett dermatomes and meshers.

So you put all of those products together and then add to that Newdeal, which we just began selling in March, I believe, of this year, and that's a pretty nice portfolio of products and that has really benefited from the increase in headcount. So what we're going to do is add another 10 sales reps between now and the end of the year to get to 50. 50 includes 4 or 5 management people and 3 clinical people and then the rest are reps and that's been a big ramp up and I would say, practically speaking, we've probably added 20 of those people in the last 3 to 4 months, so they still have a learning curve. But you can see the impact on the Integra numbers this quarter and also in the number of Newdeal accounts these guys have opened.

DAVE TURKALY: And your neuro group is how big?

STUART ESSIG: OK. The neuro group is approximately 110 people. We have been selectively adding reps this year, in particular as we've been promoting reps who are particularly successful into management or other facilities-- sorry, other activities, we've been able to split those territories and sometimes add 2 or 3 reps. So we're at about 110 field-faced people this year, with approximately 90 to 100 territories and that's up 20 from the end of last year, plus or minus.

DAVE TURKALY: Great and then just one last one, if I might. The-- the $500K of income you had for Biopatch, is that-- you're not showing-- that's not in "other," that's actually in the private label of $7.8?

STUART ESSIG: Correct.

OPERATOR: Raj Denhoy, Piper Jaffray.

RAJ DENHOY, ANALYST, PIPER JAFFRAY: Just a-- a couple broad questions. You took down guidance a little bit for 2005 here, took the top end of the range off. I'm curious what's driving that. Is there a particular weakness in particular areas you're look at or maybe you could just flesh that out a little bit for us?

STUART ESSIG: No, there's no particular weakness. We went product category by product category and discussed performance. I think the reality is, it's 3 months since we last gave guidance and while we were very pleased with the second quarter results, you just stare at the rest of the year and it just seems less practical to expect we would get that last $3 million of revenue. So we didn't take down the guidance range at the bottom of the range, we just trimmed the top end of the range because we want to have a realistic range at all times.

But actually, if we look at the performance of the business in the last 3 months, we've been very surprised and pleased with the overall performance -- record revenues of DuraGen, Integra continuing to grow at over 40%, NeuraGen over 70%, Newdeal international doing very well and a nice uptake in the United States. And the only one that's really continued to be a struggle is our neuro monitoring business, but on the other hand, a nice introduction of new products this quarter. NeuroSensor now in 20 accounts. AccuDrain, which has both improved features but also an improved price point, is an important part of that division.

And then finally, in the-- we've been talking about the private label business coming back for about a year and a half and it's happening exactly the way we said it would happen, but just a little bit earlier, which is there are a lot of product lines that got restructured, literally, 2 years ago, including the termination of the Signature relationship with Medtronic, and now a lot of the slower growth product lines have kind of trailed off and the faster growth products, like the Absorbable Collagen Sponge for the BMP, like Biopatch are really starting to dominate the numbers.

And so I have been saying for over a year and a half we expect that part of the business to grow at or above 15% and I think we're there now and we'll have an easy comparison next quarter, because it'll be the first quarter that Signature went away.

RAJ DENHOY: Fair enough. A couple of drill-down questions, though. On monitoring, I'm curious why do you think LICOX has yet to get traction? It sounds like-- I think last time I got an update that was at 150-180 centers. Is it still just not-- is the data not there? Or maybe you could give us some thoughts around that.

STUART ESSIG: OK. First of all, we remain absolutely committed to LICOX and the interest and technical development of LICOX has continued to be significant. As you know, it is not standard of care and it's going to be a while until it's standard of care and until it's standard of care, we've concluded that the uptake-- we just have to be cautious on any predictions.

This is one we've been wrong on in the last year and a half. We thought it would grow a lot more quickly, simply because of how innovative the technology was, but the truth is, it is a project and we have to work the project and the project involves training clinical people, training neurosurgeons. It's a significant effort.

The other reason it's not growing as quickly as we'd like has to do with the attention that we're giving it. The truth is, we have so many other opportunities, whether it's DuraGen and Suturable DuraGen, both the defensive battle and the offensive activities, whether it's the NPH valve, which has big opportunities -- those are all taking priority over a much more labor-intensive, time-consuming product line, which is LICOX.

That being said, I came prepared with some statistics. We have close to 200 monitors now in the United States and we sold 14 monitors during the quarter. So it's not like it's slowing down. It's just that it's not going to move our numbers until we're able to have a much more significant impact. And so we're, in some ways, turning our attention to doing a better job of selling the whole product category, from NeuroSensor, LICOX, Camino, drainage and are working on strategies to better position those products together in institutions with more additional focus, perhaps with some more clinical support in the coming year.

And I think we'll have more to say on that as we go into the next year, but in the meantime, it's important but we're not giving it the focus internally that we were giving it a few years ago and so we're trying to make we appropriately signal that to the investment community, as well.

RAJ DENHOY: OK and then just on DuraGen, are you expectations still that what you're seeing in the market place is trialing of these new products and that the business will eventually come back? And maybe you could comment a bit on what the pricing environment is out there, as well, whether you've seen J&J and Medtronic maybe compete a bit more on price?

STUART ESSIG: OK. First of all, we continue to think that most of the impact on our business is trialing. I would say the good news in the last couple quarters is some of the places that tried and switched have switched back to us. There's certainly going to be a level of competitive activity, reasonably indefinitely, with some accounts liking competitors' products.

But that being said, I-- we feel like this is settling in to a more typical competitive situation and the initial interest and thrust and enthusiasm from the competition is starting to wear off. Just like we have been battling hard and expending a lot of energy and focus on preventing the competition from taking share, picture them and the amount of energy and focus they've put into trying to take the share and I think, in a lot of cases, they're getting discouraged.

So I don't want to just describe it as indefinitely just trialing.

What I do want to say is we're not seeing a lot of competitive activity whereby people are taking accounts from us. At some point, certainly, they will take some accounts and will keep them, but we're just as active now in taking accounts away from them and we're just as focused on trying now to really grow the business, whether it's in spine, whether it's in taking autograft share, as we are in defending.

So, I guess, to be clear we will continue to defend the business.

We'll continue to see trialing and competitive activity but it's been close, now, to a year and a half since this process began and, candidly, I think we've won the battle. But that doesn't mean we won't continue to have an aggressive environment.

In terms of pricing, I don't really want to comment on pricing. What I can say is we had record revenues for the quarter, so whatever the impact of pricing was, it didn't impact our ability to have a record DuraGen quarter.

RAJ DENHOY: OK.

STUART ESSIG: So I want to strike the right balance to say this is going to be competitive. We are not positioning this as the leading growth driver like we were a year and a half, two years ago, and I think we've done the right things in terms of putting a lot of other growth drivers beside DuraGen, but, as I said in my script, we continue to see this-- expect this to grow, be a very significant focus for our salespeople, and be very profitable.

RAJ DENHOY: OK. And then just one-- just a housekeeping one. I don't know if you gave the FX impact in the quarter, foreign currency impact?

STUART ESSIG: We didn't, but I've got it written down. What is it, Dave, $300,000?

DAVID HOLT: Yes, $320.

STUART ESSIG: Yes, $300,000 on the top line.

OPERATOR: David Zimbalist, Natexis.

MIKE DUNCAN, ANALYST, NATEXIS BLEICHROEDER: This is actually Mike Duncan (ph) for David.

On gross margins, if you exclude the adjustments and the effect of the royalty payment for the Biopatch, it looks like they were actually slightly down sequentially. Could you discuss what's going on there?

STUART ESSIG: Well, we didn't exclude the adjustment for the royalty, so if you back that out, I don't know the answer. Maybe that makes it slightly down. I mean, overall the gross margin continues to grow on an adjusted basis and we tried to outline, in the footnotes to our press release as well as in this call, the significant number of adjustments and impacts from all of the restructuring activity we're doing. But we are not seeing gross margin come crashing, once you back out all of these adjustments.

And as I said-- I said in the script, we continue to expect 2006 to be at the 66% level and reiterated our guidance in that regard.

MIKE DUNCAN: OK, great. And then for inventory days on hand, it continues to be kind of 245 days. Can you talk about when you expect that rate to decline?

STUART ESSIG: Yes. If I can take, if you don't mind, a little victory lap. I've been promising our investors that we would get our balance sheet more in line with our historical performance and we stated on prior calls that because of the Oracle implementation that we were still living with at the end of the year and because of some of the restructuring activity, both our AR and our inventory would and then did expand.

This quarter our AR was down to 61 days, which is back in line with historical precedent. So we have been traditionally at about 60 days.

What might be missed is that our international business is up at 26% to 27% of revenue. So actually, if you look at our domestic AR, it's improved significantly and so I just want to remind people that we've really crossed the bridge. Our Oracle system is working well. Some of the surprises we had in the first quarter and before are behind us and our days inventory-- sorry, our days AR are in line with where we would expect them to be.

You are correct, the next big project is to get our inventory days down, although that has nothing to do with the Oracle implementation.

It really has to do with all of these transitions that are going on.

For example, in a number of our European operations we needed to get our inventory in place so that we can stop manufacturing and move the line from a particular location to another particular location.

Same thing with the San Antonio facility. Same thing with a variety of the restructuring activities we're doing. And in order-- with the kind of variable gross margins that we have, you really don't want to go on back order. You want to make sure you're shipping everything according to demand.

And so we have built inventories to levels that, by the way, are in line with other players in the industry, but are just ahead of our historical precedent. And so we do expect to get it back down, probably as we go into 2006, but don't look for anything significant this year. There's a lot going on inside of those numbers.

So, for example, we've built up inventory in one location. We'll be starting up inventory in another and we will be drawing down the inventory from the first location. So different things will move around, but don't expect the inventory days to come down significantly until we go into 2006.

All right. So that's the summary.

MIKE DUNCAN: OK, great. And then final question, on the private label, given the guidance that you gave for private label, it looks like you're expecting it to decline in the second half. Is that the right way to think about that?

STUART ESSIG: Well, a couple things are going on, keep in mind.

First, we had just an extraordinarily strong quarter in private label as all of our-- almost every one of our customers really had just a lot of demand. And that was every-- every one of the private label areas, even some of the ones that historically were shrinking. So, yes, we don't expect it to be $7.8 million in the next 2 quarters.

That being said, the organic growth inherent in the next 2 quarters, even at levels lower than the $7.8 million, is well above the last few quarters because Signature is out of those numbers. So when you do the year-to-year comparison in Q3 and Q4, the organic growth is actually going to be still quite high, well above the last few quarters, because we're finally through that Signature comparison.

But no, we don't expect $7.8 million, and, again, $0.5 million of that was, in fact, a one-time payment, although the-- that one-time payment has to do with additional patent protection, which is going to improve our royalties on that product going forward.

OPERATOR: John Calcagnini, CIBC World Markets.

JOHN CALCAGNINI, ANALYST, CIBC WORLD MARKETS: [audio interference] I wanted to ask you, so what is your target for inventory days over, say, a 5-year period? How much of this is just a function of having a lot of SKUs and a corporate decision to not stock out, et cetera, and how much of it is that you've got all these integrations going on and so you're safety stocking? I'm just trying to understand that picture.

STUART ESSIG: [inaudible] on mute or no one will be able to hear the answer. So the question, for those people who couldn't hear, was what's our target for inventory days and is it a short-term function that we have built this inventory or is it a longer-term trend?

And I would say that it's certainly the case that we've built a lot of inventory for all of these restructuring activities and we certainly expect it to come down. On the other hand, we're aggressively entering the orthopedic business with Newdeal and with some of the other products and we're aggressively building our international operations, which would drive the inventory days up.

I'm pretty happy with inventories anywhere between 200 days and 240 days and we've benchmarked ourselves with our peer group and that's pretty good. I would say we expect it to come down in the new year because we do have a big project to finish up these transitions and manage that inventory down to appropriate levels.

So I would say anywhere between 200 and 240 days is a pretty good number for us and certainly we've got a very strong balance sheet and it's not hurting us to have that inventory and we don't want to stock out. So I can't give you that good an answer, because it's reflected on a number of different factors.

JOHN CALCAGNINI: OK, but that range helps, 200 to 240. I wondered if you could also talk about, is there anything that's going to-- any inventory that had to be marked up associated with Newdeal or other transactions that cycle through the cost of goods line that result in the gross margin in the second half of this year being lower than it otherwise would have been? And what is your expectation for the gross margin in the second half?

STUART ESSIG: OK. First, on the question of Newdeal markups, there was markup-- acquisition accounting and that was in the first and the second quarter and it was about $200,000 a quarter. So our gross margin was depressed by $200,000 a quarter in Q1 and Q2 because of acquired inventory from Newdeal. And, by the way, we broke that out in our footnote in the adjustment categories.

In terms of the back end of this year, we're targeting, in line with historical guidance, we're targeting 63% without the adjustments and, obviously, a higher gross margin with the adjustments. So there's really no change in our perspective on gross margin and it should be growing toward the back half of the year so that we are in line with ability to achieve a 66% gross margin in 2006.

JOHN CALCAGNINI: And in '06, is the driver some of these headcount reductions you're doing that gets you to that 66% from 63% or 64% today?

STUART ESSIG: It's so many different things, John. Certainly the headcount matters, but as I've reiterated in prior calls, that won't even impact our numbers for a minimum of approximately 200 to 240 days, because we've got to turn the inventory and if we built those inventories we have to turn them before we put products into inventory at the lower cost of goods sold.

So the biggest impact on our numbers next year and our ability to get to 66% comes from, first, the overall growth in the business and the ability to absorb relatively constant overhead into more units. The second biggest impact is the impact of selling our highest gross margin products, such as DuraGen, NeuraGen and the Integra dermal regeneration template, but also, now, there's a number of other products that have very high gross margins, like Newdeal and KraniOS and NPH. So we have a lot of high gross margin products and that's probably the second biggest factor and then the third, longer term, is, in fact, the cost that we're taking out of the sites that we're shutting.

OPERATOR: Alex Arrow, Lazard Capital.

ALEX ARROW, ANALYST, LAZARD & COMPANY: If I could maybe start with just going back to the private label, I know you said the Signature relationship with Medtronic was a big part of the change. Can you tell us INFUSE and BMP contributed to that-- the very strong June quarter, understanding that you're not looking for that in the second half of the year? But just for this quarter, was it really an INFUSE effect?

STUART ESSIG: First of all, I'm not going to break out the individual product lines in the private label. We haven't in the past and don't intend to, going forward. What I can reiterate, Alex, is it was, essentially, all of the product lines, very strong, or most of the product lines, very strong. And it included, certainly, INFUSE, but also the Biopatch, also our dental products, also a whole host of other products that we generally don't even talk about -- the hemostatic agent, the cryosurgery. We've got a lot of stuff in that, either things that we had in the past or lines that we've acquired, and it just all was very strong, which is why we're not necessarily predicting that level of strength in the third quarter.

ALEX ARROW: OK, so since it's a very diversified base that would probably be all un-correlated with each other, why would you project that the growth would then taper off in the second half? I mean, the fact that it comes from a lot of different sources would make me think that that would be more of a sustainable trend?

STUART ESSIG: Because I just can't draw a line from one point. It may turn out to be stronger. It may turn out to be an anomaly. The mistake I don't want to make is saying we've got a trend in private label that's so much in excess of our guidance and say it's going to continue.

ALEX ARROW: OK. OK. On DuraGen, I understand you're not commenting on the pricing competition and that there is the trialing still continuing. On the issue of bundling, can you say how much bundling versus product features is what's really affecting the accounts?

You're taking some away from them, they're taking some from you. Are they using a lot of bundling? Are you able to use any bundling? And how much is that versus product features?

STUART ESSIG: I-- if I can try to give a qualitative-- or a quantitative answer to a good qualitative question, I think bundling is very unimportant and I think product features is very important.

So I don't think they're taking much business bundling from us and I don't think we're taking much business bundling from them. I think it's the features and benefits of our product and the relationships that our representatives have with the customers.

ALEX ARROW: OK, well-- STUART ESSIG: When I say "relationships," what that really means is service.

ALEX ARROW: OK, well, given that you seem to have the best features on your DuraGen product line, why would they be taking any accounts from you in that case?

STUART ESSIG: I mean, again, with close to 2000 accounts you're going to be some of their reps who either, for a moment in time have better relationships with customer or, on average, have better relationships with customers. Also, it's just the case that beauty's in the eye of the beholder and you're going to have a certain number of accounts that think the competitive product is better, despite our, either efforts or ability to prove that it's not or to prove that ours is better.

So we're the market leader and, therefore, we're the guy to shoot at.

That being said, we're also the guy to show leadership, which includes building the spine business, driving our adhesion indication in Europe, introducing new products like Suturable DuraGen and other products that we have in the pipeline.

So you're always going to have competitive activity and that was what we've been saying from day one. We compete with Medtronic and J&J every day in the drainage business and that is a business that is very competitive and generally we win. And the same thing, I expect, is going to be true in duraplasty.

ALEX ARROW: OK. All right, that's fair. If I could ask 2 questions on Newdeal. The $4.1 million was a little bit lighter than we had been looking for. I think that's-- from your comments it's on the U.S.

side. Can you comment on how the Wright Medical inventory transition--? Is that completely over and, therefore, that will probably help us figure out our Newdeal estimates in the second half of this year?

STUART ESSIG: The $4.1 million was just a little bit lower than our own internal expectation, but close enough that we viewed it as in line. It wasn't particularly more the European or the U.S. business, I just think it was a couple hundred thousand dollars one way or the other.

In terms of the U.S. business, we're actually pretty pleased with our guys' performance, 150 new accounts and keeping in mind that about 20 of these reps that we have haven't been working for us for more than 4 to 6 months. So it's kind of doing what we expected it to and I-- honestly, I'm just so happy that the group is doing this well. And we're hiring 10 more and we're going to keep taking accounts.

At this point, I do not know how much inventory they have. I can't even speculate what they have.

I do know that we continue to run into product-- Wright Medical product in the field and it's our job to convince our customers to acquire that product from us rather than buy it from Wright. I certainly hope they've gotten to the point where they've drawn it down. Their public statements would lead us to believe they're out selling the CHARLOTTE system in competition to us, which I can only assume is true.

But I don't know how much inventory is out there, but we're not-- at this point, I'm not talking about the inventory any more. We're just doing our job and growing the business and I don't really either attribute our success or our failure in the market to the remaining inventory that's out there. You won't hear me talking about it, because I just don't know.

ALEX ARROW: OK, thank you. But would it be reasonable for us to assume that at some point they're simply going to run out and not get any more and then you will have a step function up at that point?

STUART ESSIG: I don't know if they'll ever run out or they'll just throw it away. We're not selling any to them. I mean, at some point, if we were able to take all the accounts and convert them to Newdeal, it's theoretically possible they could have that product indefinitely and since they've written it off, I don't know what they're going to do with it. They certainly are not permitted to sell it outside the United States. They do have the right to keep bleeding it out in the U.S.

And, I mean, it's a sort of a funny thing. If we're real successful with our product line and they're real successful with CHARLOTTE, they could sit on the old Newdeal inventory for a really long time.

ALEX ARROW: OK. OK and then the other question I have on Newdeal, the amount of restructuring that's going on in Europe, which sounds like there's quite a bit of-- probably you've done most of this, I would think, but the negotiations with the labor representatives, the severance laws, which seem to be a lot different in Europe than the U.S. acquisitions you've done in the past, this is probably taking a lot of your time.

Is it fair for us to think that this is taking time away that you would otherwise be evaluating new acquisitions and should we figure that into our projections for the rate of your new acquisitions? In other words, a lot of-- a lot of just hours of the day that you spend negotiating Newdeal reorganization that you could otherwise be evaluating new stuff?

STUART ESSIG: Actually, I can say categorically the answer to that is no. We have built a pretty diverse and capable management team around the world. If I spend a few hours a week on the restructuring in Europe, that's the most I spend. We have a European operations team that is spending-- and G&A team that is spending the bulk of their time on restructuring those manufacturing facilities. But, candidly, our U.S. manufacturing and operations group is not-- they're spending the bulk of their time on reorganizing the U.S.

operations.

In terms of the sales and marketing group over there, we've kept them completely out of it. So a number of people have been taken out of the sales and marketing organization over there, but the sales and marketing leadership in Europe is not involved at all in the restructuring of the plants. So there's no involvement there, either.

And, in fact, the G&A team sitting here in Plainsboro, New Jersey, is as focused as ever on acquisitions and other leading-- sorry, leadership activities in new product development, in growing the business and really the 2 sets of restructurings and the European sales and marketing activity can all happen simultaneously with M&A activity.

The only thing we slowed down was in the first quarter as we were giving ourselves some time to make sure that our Oracle transition was stable, we certainly did slow some things down in the tail end of last year and in the first quarter to make sure that that transition in our Oracle ERP system went well and we didn't have some uncontrollable set of events. As I said, for the most part, that's behind us and we are as committed and enthusiastic about our ability to grow the business today as we ever have been.

And keep in mind, to anticipate one of your questions, there have been many other periods where we've gone 5 or 6 months or 7 or 8 months without doing acquisitions and it's not completely in our control when and which deals get done, but the strategy and the capacity to do those deals haven't changed at all.

ALEX ARROW: OK, great, and if I could have one last question just on the neuro-monitoring business, given that it's the one struggling business, your comments to us about the NeuroSensor and the AccuDrain launches, should we-- would it be reasonable for us to interpret that to mean that you're saying that this is probably the last struggling quarter we're going to see, given the growth of the new launches? Or is that a reach?

STUART ESSIG: I don't want to say that yet. You have our guidance for the year and for going forward on all of the product lines.

I think we should have an easier comparison in the back half of the year on monitoring. It's generally been the case the back half of the year has been stronger on monitoring than the first half of the year.

That's been the case for the last 3 years. And then you're going to ask me why and we still don't have a good answer why, but we would certainly expect the back half of the year to be an improvement over the first half of the year in monitoring.

But the overall trend in terms of the performance of our monitoring business requires some improved strategic activity on our part. And don't read that as we don't want to keep the business. What I mean by that is we're going to try to do things to make that business grow.

We've been waiting too long for LICOX as the reason for that business to grow and I think we have some other ideas for how to drive that business and we'll be starting to roll those out in the back half of the year and into the next year, but they do involve a refocusing of our activities in terms of growing the overall business rather than just continuing to beat on people's door over LICOX as the primary growth driver.

ALEX ARROW: Do you think you've lost any market share in neuro monitors to J&J, out with a new neuro monitor during the last couple quarters?

STUART ESSIG: We have definitely not lost any market share, to our knowledge. The issue is the overall growth of the market and we are the guys who have been growing it and we've put too much effort into growing it through LICOX and not enough effort into growing it in a more comprehensive way. But we do not believe we've lost any market share. In fact, we believe we've taken market share in the United States from J&J.

OPERATOR: William Plovanic, First Albany Capital.

WILLIAM PLOVANIC, ANALYST, FIRST ALBANY CAPITAL: I'm wondering if you could give us a little more color on the infrastructure that you are putting in place in Europe in terms of direct countries, size of that channel, what-have-you?

STUART ESSIG: Yes, sure. This is a real positive set of events. First of all, we've been really delighted by how quickly the Newdeal sales and marketing team have embraced being part of Integra and it's a real testament to the leadership of the individuals involved there.

We have really made a bet on those guys in terms of giving them responsibility for, in particular at the moment, the direct sales and marketing organization. So the President of Newdeal and the individuals in that organization have been put in charge of our European sales and marketing organization, reporting in to Bob Paltridge, who, as you know, is our sales-- is our SVP of Sales for the entire company.

That group there is responsible for the direct markets of France, Germany and England then in the last 6 months we've also gone direct in the Benelux markets, terminating a number of distributors in Belgium and the Netherlands and adding sales reps. Now in each of those countries we've scaled up the headcount and I'll try to rattle off some statistics.

By the end of the year, we should be at 10 direct reps in Germany selling all of our products other than Newdeal, because Newdeal will continue to go through an orthopedic distributor in Germany. But we've-- we're essentially doubling our direct sales force selling the neuro products and skin and NeuraGen and DuraGen adhesion in Germany.

In Benelux we have approximately 6 or 7 sales reps, broken into neuro focused and orthopedic focused. In England we'll be adding another 2 or 3 direct reps focused on all of our product lines -- again, other than the Newdeal, which goes through a distributor. And in France, Newdeal-- that was really their home market and we're adding additional neuro reps there and they've taken responsibility for managing our neuro sales force in France, as well. I would guess we have about 15, plus or minus, 15 to 20 direct people in France calling on accounts there.

So you put that together, it's a decent-sized organization. And then in the rest of the markets, we go through distributors and we've doubled our headcount of people in Europe calling on and managing the distributor network. So previously we really only had 1 or 2 people who managed hundreds of dealers and now with the leadership of the Newdeal group we've added another 2 or 3 dealer managers so I think we've got a total of 5 who are managing the distributors that we use.

And that will force focus on those distributors and encourage them to pick up not just the easy product lines like DuraGen, but some of the more difficult product lines, building opportunities.

So a significant headcount. We're in the process of recruiting a marketing team there. This will be the first time we had a direct European marketing group and, similarly, we're building a clinical organization over there. So I committed at the end of last year to essentially doubling our sales and marketing infrastructure in Europe and certainly with the addition of the Newdeal team we've more than done that already.

WILLIAM PLOVANIC: OK. And then if I look at the SGA, excluding all the one-time charges, it was pretty high, I think almost-- it was 35.9%, right around there. I was just wondering-- is that what this is, is just the buildout of the infrastructure and as we start to see the sales ramp up off all the new reps that have been added we should see this come down to what your guidance is?

STUART ESSIG: Yes. And I felt good about being able to answer Alex's question that it isn't just the guys here around the table managing all these restructurings. The other side of it is there's a fair amount of G&A that we've added in the last year and a half, whether it be to accomplish the restructuring activity, to put in the new and manage the IT system. We've been making a significant investment in growing the business and that includes regulatory, quality, legal, business development, all of those, and then certainly a big chunk of what you're seeing is the buildup in sales and marketing dollars in the recon business in the U.S. and in the European business and, frankly, no let up in neuro.

When we started the year we thought we would stick with roughly 80 reps and the more we looked at the opportunities that we were missing in various places around the country, we're ending the year closer to 90 to 95 territories in neuro. And so, yes, we're spending more than probably we anticipated spending a year and a half ago, but we see really good opportunities there and, yes, the model says that the sales market G&A are scalable and, therefore, will come down as a percentage of sales as the revenues grow.

WILLIAM PLOVANIC: OK. And last question, just on the R&D, that was significantly lower than what we were looking for. I guess the-- we're trying to find out, the PMA that you're doing to do for the anti-adhesion domestically, are there reasons for the delay in that and that's why the R&D is down or what-- can you kind of give us some reasons why that it's so low?

STUART ESSIG: No, it's a good question. First of all, we do expect the R&D to ramp. There's 2 aspects to it. About half of the shortfall is in just things that we didn't have the time or resources to do -- so various development and filing and other activities that just did not get down in the quarter that we would have liked to have gotten done and have nothing to do with the DuraGen adhesion PMA.

The second thing that impacted the number, so about the other half of the shortfall, is that the clinical trial will not start until the new year and we've budgeting assuming that there would be significant P&L impact in the first-- sorry, in the beginning and the first half of this year and going into the back half of the year and the truth is, until we enroll the first patient the costs are just not as high as we thought they would be.

So you'll see that start to ramp as the year rolls along and we start having things like investigator meetings and we start paying the fees for setting IRBs, but the truth is, we are in discussions right now with the FDA about what the clinical trials should look like and there is no delay and there is no lack of enthusiasm but the real spending won't start to hit until the first half of next year. A big part of that is the per patient fees are just the biggest part of the whole trial.

WILLIAM PLOVANIC: Right. In the discussion with the FDA, I mean, you're trying to get your IND, is it-- what's kind of the hangup? Are you-- is it just trying to figure out what the best primary end point's going to be, continuing that adhesion trials have always been difficult?

STUART ESSIG: There's-- Bill, there's no hangup. Our original guidance was we would start the trial in the fourth quarter and so we're saying we're going to start it at the beginning of the first quarter. So it's a few months delayed from what our expectations were, but, candidly, there's no hangup. It's just a question of working through all the aspects.

We hired a CRO. We've hired a group to assist in the imaging. There's no hangup, it's just a big project.

OPERATOR: Robert Goldman, KeyBanc.

ROBERT GOLDMAN, ANALYST, KEYBANC CAPITAL MARKETS: Just a couple remaining things. The expenses due to the expensing of stock options for next year, can you just remind us how much that's going to be?

STUART ESSIG: We haven't given any forward-looking guidance and we won't this quarter. What we can tell you is to refer you to the part of our 10-Q or our 10-K which talks about what the historical expensing has been and in Q2 what you'll find is that it would have reduced our earnings per share by $0.04. I think in the first quarter it was $0.05.

So I really-- I'm not prepared to give forward-looking guidance yet, but if you just used history, it would be $0.04 or $0.05 a quarter.

ROBERT GOLDMAN: OK. So then finally, there's been a question already on why the lowering of guidance for 2005 and I think it is reality that this is your second straight quarter of lowering guidance for 2005. Now that's either because the business is a bit weaker-- weakening or that your discretionary spending is increasing. And I get the sense that it's probably the latter and you cited some increase in the sales force territories beyond prior expectations, but I wanted to give you a chance just to react to that and if, in fact, it is your discretionary if you can give us some of the examples of how the spending is going higher than you might have been expecting 1 and 2 quarters ago?

STUART ESSIG: OK. I guess a couple of things. First of all, some of the guidance changes that we make, as you go through the year, is just a reflection of the history and rolling in the fact that in Q1, in Q2 we had a certain level of performance and we guide for the full year and those have to impact the overall number and so mathematically if you're coming in in the mean of the guidance, then you're-- you need to bring down the top end or you're just going to assume that in the fourth quarter there's some heroic performance.

So, I mean, I hate to state the obvious, but as the year rolls along you've got to look at the number and adjust it accordingly and we really do work hard to give guidance that's accurate and balanced and so I don't want a situation where we somehow leave outstanding the assumption that we're going to catch up in the fourth quarter for what was good but not the top end of the range performance in the first half.

So that's the biggest thing. Now to answer your question about how we've changed our spending during the year, I think you're right. We just have so many opportunities and I really don't want to slow down with some of the really extraordinary opportunities that we have, for example in the-- in the European business and we could control our spending and not ramp up, but then that's an opportunity missed and I don't think it's good for the long term for the company.

So if you ask where have we-- where could we have chosen, early in the year, to watch our spending and, therefore, put us in a position to really come in higher in our earnings per share, it's probably in the sales and marketing because most of what we've done in the G&A and in the infrastructure spending was just important to the long-term future. We probably could have spent loss on the growth of the reconstructive business and the growth of the European, but I think that would have been an opportunity missed and I think you'll look back as we go into the next few years and say those were smart decisions in terms of driving the revenue growth.

And you just look at the performance in the second quarter. 70% improvement in what's not a small business any more, this nerve repair business. 45% improvement in the skin business, which is not a small business anymore.

So I think what you're seeing is the strategy playing out and our decision as a management team that it's smart to reinvest but also to come in in the range of guidance that we gave.

ROBERT GOLDMAN: If I could just followup on the sales -- and it's important as we develop our '06 models. But when you looked at the first quarter results, you lowered for the year. You then looked at the second quarter results and you lowered your guidance for the year. So something on sales must be weakening beyond your expectations. And perhaps you could speak to that?

STUART ESSIG: Honestly, I don't really have anything more to say than I have. The business is performing well, our implant business particularly well. I don't have really anything to state except that we think the guidance is balanced.

OPERATOR: Jayson Bedford, Adams Harkness.

JAYSON BEDFORD, ANALYST, ADAMS HARKNESS: Most of my questions have been asked, but a few followups. First, can you put the number of Newdeal accounts in context in terms of the 150 accounts how many of those were using Newdeal before and then what's the potential number?

Where can that 150 go to?

STUART ESSIG: Well, we don't really know how many accounts Wright Medical had. If I could venture a guess, it was somewhere between 250 and 750, but we don't honestly know. Unfortunately, the way the original deal between Newdeal and Wright was structured, Wright was not obliged to provide us with a customer list.

Certainly many of the accounts that we're calling on have used the product before and really liked the product and so we had to prove to them that we could provide the same kind of quality service and support that Wright always did, which I think we are proving ourselves to those customers. The-- you'd be surprised, though, many of the accounts are new accounts.

And, again, the estimate for the market was well over $100 million of foot and ankle products and Newdeal wasn't even close to that number going through Wright in the United States. So there's a lot of potential out there with other players in the foot and ankle. And I'll reiterate, we're now the only player with a sales force exclusively focused on foot and ankle as opposed to that being one of the products carried, along with hips and knees and spine and all the other products that those distributor-based sales forces have. So I think our focus is going to pay off.

In terms of potential number of accounts, it's really huge, Jayson.

It's every orthopedic foot and ankle surgeon, frankly quite a few orthopods who just do foot and ankle from time to time and then surgical podiatry is a big part of the business, as well. You add it all up, I don't doubt that as we go into last year, we could have well over 500 accounts, certainly the way our sales reps are opening new accounts.

JAYSON BEDFORD: OK. And that $100 million market, is that U.S. or is that a worldwide number?

STUART ESSIG: I believe it's U.S., but I don't have that in my hands.

JAYSON BEDFORD: OK. That's helpful. And then just jumping over to the DuraGen side of the business, it came in a little higher than our expectations. Understandably, growth slowed a little bit from years past. Is that solely due to the impact of competition or is the market growth slowing a little bit?

STUART ESSIG: Boy, that's a hard question to answer, but I do not believe that the market growth has slowed. I think the market's actually increasing and, again, I can only say anecdotally having the other competitors in the market -- I mean, you go back 4 years ago, nobody even cared about duraplasty. And now the number of surgeons focused on getting the dura right, whether they're focused on a watertight seal, whether they're focused on tissue regeneration, whether they're focused on adhesion prevention, it's a real topic and that expands the market.

Also, we're not a spine company, so the focus that we've made has really been on neurosurgeons, but when you get up to 90 or 100 reps, there's just more time for them to call on spinal-- spinal orthopods and drive the product there. And as you go outside the U.S., the adhesion potential that we've got with our current labeling and, frankly, the interest that we're getting in this clinical trial in the United States, I only see the market size increasing. I don't-- we still think more than half of the market's available from autograft.

So I don't think it's market size. I think what you've seen-- the slowing in growth is clearly the impact of the competition over the last year, but if you just think about what we've accomplished, and a record quarter in DuraGen, we're going to win this battle.

JAYSON BEDFORD: OK and just as a follow-on, are you getting traction with DuraGen as an adhesion barrier in Europe? And then secondly, can you maybe talk about within the DuraGen family the product mix?

Obviously, you're trying to push higher price Suturable and DuraGen Plus.

STUART ESSIG: I don't want to talk about the mix except to say that Suturable DuraGen and DuraGen Plus are very successful, are growing and are at a price premium. I don't really want to provide the competition with a road map as to how.

As for adhesion in Europe, there's real interest. I would say it's still too early to claim that a big impact on our growth or on our revenues is coming from adhesion in Europe. Things are slower, for us at least, in terms of European having an impact on our numbers, particularly since our U.S. business is so big.

But there's definitely a lot of interest in adhesion in Europe.

There's definitely support from a number of our distributors and our direct group for marketing there. Again, we're not the strongest company in Europe, so we're not going to see that have the biggest impact on our numbers, although, obviously, with the reorganization of our sales group there I expect we'll do increasingly better.

So I really think on adhesion in Europe it's too early to say. But on our new products there's significant interest and uptake in our new products.

JAYSON BEDFORD: OK. And then finally, just on the dermal line, it grew 45% in the quarter. Is it mostly just the impact of selling into the orthopedic channel or is it the impact of new products? Are you seeing greater use in the burn units?

STUART ESSIG: Well, the good news is it's not burns. It's definitely the smaller sizes, the BMWD, the-- now the IMWD, the single-layer product, and it's not really yet most the orthopedic guys. It's have the 40-plus sales people in the field calling on plastics, reconstruction and foot and ankle. It's early for them to have built those relationships with the foot and ankle guys, so they're not really getting those sales principally from foot and ankle yet.

It's just the sheer quantity of them calling on wound centers, calling on foot and ankle, calling on reconstructive, calling on plastic. As they build those relationships, there's no question that there's a nice synergy between the Newdeal products and the NeuraGen and the skin, but at the moment it's really a numbers game. It's just having those additional reps and they're commissioned to sell product and that's what they're out there doing every day.

JAYSON BEDFORD: OK, sounds good. And then lastly, just housekeeping.

In terms of the share count exiting the quarter and what we should look for going forward on the share count? Is it just a little over 34 million shares?

STUART ESSIG: Yes, we're projecting about 34.5 for the third quarter.

OPERATOR: Glenn Novarro, Banc of America Securities.

GLENN NOVARRO, ANALYST, BANC OF AMERICA SECURITIES: 2 quick questions. One, Stu, on the NPH valve. You made a few comments on it.

Can you give us a little bit more color on how that is ramping up and whether or not this could be a material product for the company like DuraGen or the dermal products are?

And then just quickly on the tax rate for this year and next year, are you still projecting about 34.5%? Thanks.

STUART ESSIG: Yes, in reverse order. On the tax rate, yes, we expect 34.5%.

On NPH, our sales of NPH are up very significantly and continue to be up significantly quarter-over-quarter, month-over-month. It's not yet at the size where it's worth breaking out and saying it had a significant or material impact on the quarter, which is why we didn't, but it's to minimize the potential. And, yes, I believe it has the same potential as a DuraGen or skin for the company.

Keep in mind, we're not the market leader in hydrocephalus, so we're starting in neuro, really having to leverage our relationships in the ICU from the Caminos and the LICOXs, our relationships with DuraGen, but we do not have that market leadership position that Medtronic and J&J do in introducing new hydrocephalus technology. So it certainly is a-- is a significant effort on our part.

That being said, the price point is great. The margin is great and our sales force is highly incented to grow that business and is growing it and will grow it. So the potential is there, but I don't want to highlight it until the revenues are more significantly there.

OPERATOR: Amit Hazan, SunTrust.

AMIT HAZAN, ANALYST, SUNTRUST ROBINSON HUMPHREY CAPITAL MARKETS: Just a couple of followup questions. First, on the guidance, just so I understand -- and I apologize if I missed it -- if we look at the adjusted EPS guidance for 2005, the range has been lowered by $0.04.

Can you specifically kind of give us an idea of where-- what's been taken out of that, what's implied in that lowered EPS range?

STUART ESSIG: Not really, Amit. I mean, it's just a reflection of the revenue range is now-- I think it's the same bottom end of the range, but we've brought the top end of the range down by $3 million, so if you bring the top end of the revenue range down by $3 million you've got no choice but to bring the top end of the earnings down, because, particularly when you've got a gross margin of 63%-64%, that's coming out of somewhere and we're not going to cut spending to try to make it up.

AMIT HAZAN: Am I looking at it correctly? Because it looks like the bottom end was lowered by $0.04, as well?

STUART ESSIG: The bottom end was lowered, both because of the performance in the second quarter, which was in the middle of the range, and then our expectations as we roll out the sales and marketing with these additional revenues-- sorry, with the revenues being what they are, that it's going to-- it's going to hit those numbers.

I can't break it out in particular. We've got a model that we roll out every quarter and those are the numbers that it drives.

AMIT HAZAN: Got it. OK and then with regard to Mayfield, number one, did it contribute at all to organic growth in the quarter? And maybe if we kind of look at it going forward in the next couple of quarters, if you can tell us, just maybe what it's been growing at so we get an idea of how to-- how that's going to contribute to organic growth?

And then thirdly, if you can, I know you gave us a long term range of 15% to 20% now, but if you can give us an idea of what specifically for '05 you're looking for for your organic growth rate?

STUART ESSIG: OK. Mayfield was not included in any of the organic calculations, because the way we do our math is you have to own it for a year for it to count. So it'll start going into organic revenue growth next quarter, sorry third quarter.

When we bought it, it was growing at about 10% a year. We think we're outperforming that 10% in our hands, although, again, as I said it's not shown that way in the calculation of organic growth. I think it should be in line with the guidance that we've given, which is it should be a 15% grower along with the instrument business that we sort of placed it in.

In-- so that's the answer to that question. What was his other question?

DAVID HOLT: Year-over-year-- STUART ESSIG: Oh. Well, the organic growth rate that's implicit in the year-over-year guidance is-- we've given you the revenue guidance for 2005, so you just have to back into the organic growth rate. Use the range that we gave you. I don't have it at my hands here, but we gave you the range for 2005.

AMIT HAZAN: OK. And just a couple of last followup questions. Number one, on the LICOX question, if you can give us an idea of what your backlog might look at at this point and then, number two, with regard to the NeuroSensor product, is that contributing at all to revenues at this point? And when might you see a more meaningful contribution to revenues there?

STUART ESSIG: Well, it didn't-- there were no revenues for NeuroSensor in Q2. In Q3 there are revenues, but they're not going to be material.

We have 20 sites up and running evaluating the NeuroSensor and I would guess we'll finish the quarter with 30 sites up and running evaluating the NeuroSensor. Some of them will buy the product, but it's not going to be a material impact in the quarter.

In terms of LICOX, what we said was we have 195 monitors in the United States. We sold 14 in the second quarter. We have 37 monitors on evaluation in various hospitals. So we don't really calculate a backlog, but certainly with 37 LICOX on evaluation, some fraction of those will convert this quarter.

OPERATOR: Karen Mroz-Bremner, Shaker Investments.

KAREN MROZ-BREMNER, ANALYST, SHAKER INVESTMENTS: Most of my questions have been answered. I'm sorry if I missed this, though. On the gross margin, you had said 63% is what you're targeting for the back half of the year?

STUART ESSIG: That's the adjusted number. You can back out-- some proportion -- and we haven't given guidance as to what that proportion is -- but some proportion of the restructuring activities to get to an adjusted gross margin. Keep in mind, in Q2, the vast majority of the restructuring and integration costs actually hit cost of goods sold.

So the answer is, previously we gave guidance of 64% for the year and the-- if we adjust the 63% for the one-time charges, you'll be in excess of that 64% in the back half of the year.

OPERATOR: Thank you. We have no further questions at this time.

STUART ESSIG: OK. Well, then, thank you all for joining us for our second quarter conference call.

OPERATOR: Thank you. This does conclude today's conference. You may disconnect your lines at this time. Have a wonderful day.

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2005-12-17T10:45:00.000-05:00

KRT Photos

03-17-2005

US NEWS MED-NEWEARS 3 SL

KRT US NEWS STORY SLUGGED: MED-NEWEARS KRT PHOTO VIA ST. LOUIS

POST-DISPATCH (March 22) Nicholas Kossman, shown in this family

photo when he was 2 years old, was born without normal ears so

a plastic surgeon crafted new ones for him. (gsb) 2005 (Diversity)

Document Name|US NEWS MED-NEWEARS 3 SL

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Document Date|Mar/17/2005

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Photographer |HANDOUT

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Format |2200 x 1486 Color JPEG

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Category |A DIV

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Keywords |krthealthmed, krtnational national, krthealth

|health, krtkidhealth kid, krtedonly, krtdiversity

|diversity, woman women, youth, 2005, krt2005,

|plastic surgery, ear, youth, child, deformity,

|corrective surgery

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© 2005 Knight-Ridder/Tribune News Service

2005-12-14T10:27:00.000-05:00

RDATE:02072005

Los Angeles, CA - CITY Cosmetics will be pampering GRAMMY presenters and performers such as Jennifer Lopez, Marc Anthony and Alicia Keys at the Official GRAMMY Lounge during rehearsals February 10th - 12th at the STAPLES Center in Los Angeles. This hot beauty company, which invented the # 1 selling Collagen Lip Plumping Treatment CITY LIPS, is known for its one-of-a-kind technology in collagen treatments and its loyal celebrity following.

Music royalty like Lisa Marie Presley and the first lady of hip hop, Faith Evans, are fans of CITY Cosmetics. Hollywood heavyweights like Desperate Housewives` Teri Hatcher and Nicollette Sheridan, Academy Award nominee Virginia Madsen, as well as Jamie Lynn Discala, and red carpet divas Joan Rivers and Melissa Rivers picked up CITY FACE before the Golden Globes.

CITY Cosmetics is pleased to be inducted into the coveted GRAMMY gift basket. Queen Latifah, the host of the 47th Annual GRAMMY Awards, and 135 celebrity nominees and presenters will each receive the official GRAMMY gift basket, filled with the latest in luxury merchandise worth over $30,000. CITY Cosmetics will include a two month starter supply and a gift certificate good for a one-year supply of each CITY FACE product - valued at more than $2,300. Gift basket recipients include performers U2, Green Day, and Tim McGraw and nominees Norah Jones, Gwen Stefani, Joss Stone and Sheryl Crow. Presenters scheduled to appear include Ellen DeGeneres, John Travolta, Mark McGrath, Gary Sinise, Steven Tyler and supermodel Tyra Banks.

Chad Wright, CEO of CITY Cosmetics commented, "We are thrilled to introduce our newest anti-aging skin treatments to the hottest music stars of today.

The CITY FACE line can assist these celebrities in putting their best face forward at live performances, photo shoots and public appearances."

The CITY FACE Line included in the GRAMMY gift basket includes:

* CITY FACE Thermal Micro-D Treatment - Dissolves dull lifeless skin and impurities leaving skin clear and polished while drastically reducing pore size. ($39 retail)

* CITY FACE Collagen Peptide Skin Remodeler - Creates healthy, soft, radiant skin by tightening and brightening. ($59 retail)

* CITY FACE Collagen Peptide Wrinkle Reverser - Stimulates collagen production to plump up wrinkles and gently relax face muscles to prevent future wrinkles. ($69 retail)

About CITY Treatments and the Science behind Them:

CITY Cosmetics invents one-of-a-kind topical collagen treatments that are safe, pain-free alternatives to plastic surgery and injection treatments.

Their two treatment lines include: CITY Lips (the Good Housekeeping recommended collagen lip plumping treatment), and CITY Face, a next generation, anti-aging treatment that restores collagen, plumps up wrinkles and increases cell renewal for radiant softer skin that looks years younger. CITY Lips uses Oligopeptide and Celadrol Technology to increase lip size safely and painlessly by stimulating lips to produce their own collagen and hyaluronic acid. CITY Lips is the #1 best-selling Lip Plumper at SEPHORA stores in USA, Canada, UK, France and 9 other European Countries. CITY Lips attributes their success to proprietary cutting-edge science with formulas that build and repair collagen, make lips fuller and reduce lip wrinkles.

CONTACT: Michelle McFarlandTel: +1 801 355 7999e-mail: Media1@citycosmetics.comWWW: http://www.citycosmetics.com

((M2 Communications Ltd disclaims all liability for information provided within M2 PressWIRE. Data prepared by named party/parties. Further information on M2 PressWIRE can be obtained at http://www.presswire.net on the world wide web. Inquiries to info@m2.com)).

2005-12-12T07:45:00.000-05:00

Byline: Maura Lerner; Josephine Marcotty; Staff Writers

Suzanne McLain of Minneapolis is amazed that the federal government is even thinking of lifting the ban on silicone breast implants. After all, she believes they made her and thousands of other women chronically ill.

But Dr. Jennifer Harrington, an Edina surgeon, says it's the right time to consider bringing them back because science has shown they were never as dangerous as critics made them out to be.

On Tuesday, a federal panel of experts narrowly rejected a California company request to bring the controversial implants back to the market. The panel said there still isn't data to show how long the implants last or what happens when they break.

The panel will vote today on whether or not to recommend approval for a second California manufacturer.

For 13 years, silicone implants have been in medical purgatory. They were banned by the Food and Drug Administration (FDA), except for limited use, in the face of one of the largest class-action suits in legal history. Now the FDA must decide whether to make them available to the thousands of women who want them for cosmetic reasons or for reconstruction after cancer surgery. It is the second time since 2003 that an FDA expert panel has debated the question. Tuesday's vote followed two days of hearings that reawakened passions on both sides of the debate in Minnesota and throughout the country. For some, the bitterness and fear still linger despite a decade's worth of studies showing that the implants do not cause disease.

"There seems to be a body of evidence supporting that they're not as dangerous as originally thought," said Charles Zimmerman, a Minneapolis lawyer who once handled hundreds of lawsuits against implant manufacturers. Yet, he says, "I think the burden is to prove they're safe."

An array of problems

In Minnesota, hundreds of women filed lawsuits in the 1980s and 1990s claiming that their silicone implants had ruptured and caused chronic health problems. The complaints ranged from depression to cancer to diseases involving the immune system, such as lupus and rheumatoid arthritis.

Eventually, manufacturers - including the 3M Co. in Maplewood - agreed to create a $4.3 billion fund to settle more than 100,000 claims, a settlement that helped bankrupt the largest manufacturer, Dow Corning. But many women have yet to receive payment because of lingering legal disputes.

The furor prompted the FDA to impose a ban on the use of the silicone implants in 1992. Since then, the ban has been eased for research and for women who want them for reconstructive surgery after breast cancer. But the lawsuits and the FDA ban resulted in a stream of scientific studies over the past decade that have found no connection between the implants and disease.

No problems found

"Good studies were done," said Harrington, the Edina surgeon. "And it has not panned out that silicone was the cause of any these problems." She said silicone implants are softer and more natural looking than the saline-filled implants that are more commonly used. She has implanted hundreds of silicone implants in women who needed reconstructive surgery and in those who are part of a research study for a third manufacturer.

"I've never had a problem," she said.

Now two companies, Mentor and Inamed Corp., are making their case that the FDA should lift the ban so they can sell silicone implants to anyone who wants them.

Inamed Corp. acquired the implant business that 3M had once owned. Mentor Corp. was founded in Minneapolis by three Minnesota businessmen but moved to California in 1985. It still operates a manufacturing plant in Minneapolis.

On Tuesday, the FDA's expert panel decided that Inamed had not succeeded in making its case. The members voted 5 to 4 that lingering questions about how long the implants last must be answered before they are widely sold.

Without that information, "How can we get an informed consent from our patients?" asked FDA adviser Dr. Amy Newburger, a New York dermatologist. "It makes me very uneasy. I don't feel secure about the safety."

The FDA isn't bound by its panel's recommendation, and it will make the ultimate decision at a later date.

For some, the new debate has reopened old wounds.

"It surprises me that anyone would do it again," said McLain, 70, who had silicone implants following a double mastectomy at age 50. At the time, "Safety wasn't even discussed. They said this was for life." But the implants leaked, and when she had them removed in 1993, she learned that silicone had spread like "silly putty" throughout her body, she said. She developed several disorders, including Graves' disease, anemia and numbness, all of which she blames on the implants.

Lorri Rowe, 59, of White Bear Lake, who once led the group Women Against Silicone Poisoning (WASP), is equally appalled at the idea of bringing them back. She got silicone implants after a double mastectomy 21 years ago. She blames them for chronic fatigue, pain and numbness that eventually cost her marriage, her home and her career as a psychotherapist.

Never mind the volumes of research, she said: "I was fine until I had the implants."

But Joseph Price, a Minneapolis lawyer who defended 3M against implant suits, says this is a case of "junk science run amok." After all these studies, he said, "Anybody who says there's still a risk these implants cause disease is saying the world is flat."

The FDA's ban prompted the kind of research that critics say should have been done years earlier. None of the studies found a link between the implants and disease in women.

The first was published in the New England Journal of Medicine in 1994 by epidemiologist Dr. Sherine Gabriel at the Mayo Clinic. She found that women with silicone implants and those without had the same rates of immune disorders that many blamed on the implants.

The most definitive scientific finding to date was delivered by the Institute of Medicine, the independent medical advisory body to the federal government. At the request of Congress, the institute's panel of 13 experts reviewed a thousand research reports on silicone breast implants and listened to days of testimony. In 1999 it issued a 400-page report that concluded there was no evidence implants caused any harm.

"The question is," Harrington said, "when will the FDA and the general public have enough information to put them back on the marketplace?"

The Associated Press and staff writer Janet Moore contributed to this report. The writers are at marcotty@startribune.com and mlerner@startribune.com.

 
Plastic surgery 
Top five female cosmetic surgical procedures, 2004 
- Liposuction       292,402 
- Breast implants#  264,041 
- Eyelid surgery    200,667 
- Nose reshaping    195,504 
- Facelift          103,994 
 
Surgical breast implant procedures, 2000-2004 
(See microfilm for chart.)

* Data does not specify between restricted silicone implants (available only in research studies and for reconstructive surgery) and saline implants, which account for the vast majority of implants.

SOURCE:American Society of Plastic Surgeons

Associated Press

2005-12-03T18:12:00.000-05:00

Byline: Tracy Ringolsby, Rocky Mountain News

PHOENIX -- Just a hunch, but the problems between players and fans are only getting started. One of the nice things about the new ballparks is their intimacy. One of the bad things about the new ballparks is their intimacy. The closer the fans are to the action, the closer baseball is going to be to ugly confrontations like the one that happened Monday night in Oakland, Calif., where Texas reliever Frank Francisco threw a plastic chair into the stands and opened up a legal nightmare for himself, the Rangers and the Oakland Athletics. Jennifer Bueno, whose husband admits to having heckled the players sitting in the Rangers bullpen, wound up with a broken nose, heavy medical bills and more legal advice than she can ever imagine. There is absolutely, positively no excuse for Francisco's actions. And he's going to pay for his transgressions in this litigation-happy world. The truth, however, is that it's surprising there aren't more serious confrontations between fans and players. The Network Associates Coliseum is far from one of the new-look ballparks, but over the years the stands around the visiting bullpen in Oakland have developed a vile reputation. Maybe they are Raiders renegades who couldn't find their way out of the park, but they are known for their obscenities, for hitting players with various objects and for pouring cups of urine on visiting relief pitchers. "In Milwaukee, you'd go down the line to get a ball and you would know a cup of beer was coming at you," Colorado Rockies manager Clint Hurdle said. "In Oakland . . . well, it wasn't beer." In 1976, when Kansas City was battling Oakland for the American League West title in the final week of the season, things got so ugly around the Royals bullpen that Kansas City players charged from the dugout. The next morning, the photo on the front of the Kansas City Times sports section featured Royals designated hitter Hal McRae in the stands, swinging an umbrella. And, last season, outfielder Carl Everett, then with Texas, was hit in the head by a cell phone thrown from the stands in Oakland. But the problem isn't Oakland's alone. In 2000, on the north side of Chicago, Los Angeles Dodgers players got into a brawl with fans after one reached over the wall, hit Dodgers catcher Chad Kreuter in the head and stole his cap. Frank Robinson, baseball's discipline czar at the time, initially handed down a record-setting 84 games of suspensions for 19 Dodgers players and coaches, although by the time the appeals were over, five players and two coaches missed games. Ty Cobb was suspended in 1912 for hitting a fan who, according to newspaper accounts, couldn't fight back because he had only one hand - and there were only two fingers on the hand. A year ago, four fans jumped out of the stands at U.S. Cellular Park in Chicago, with one attacking umpire Laz Diaz. The incident occurred one year after Kansas City first-base coach Tom Gamboa was attacked during a game in the same stadium. And one of the two most famous fan frenzies in history happened at old Comiskey Park on July 12, 1979. The White Sox, looking for a promotion to pump up attendance, decided to stage Disco Demolition Night. Between games of a doubleheader with Detroit, White Sox personnel blew up disco records that fans had presented to gain admission for 98 cents. The next thing anyone knew, fans from the sellout crowd were flooding the field and tearing down fences, and it took a half-hour for riot police to get things back in order. Fans don't always need an enticement like Disco Demolition or 10-Cent Beer Night, which forced a forfeiture in Cleveland in 1974, but they had better be aware whom they're attacking. In September 1995, Cubs reliever Randy Myers gave up a two-run, pinch-hit home run to Houston's James Mouton that gave the Astros a 9-7 lead at Wrigley Field. While Mouton circled the bases, John Murray, a 27-year-old-fan, jumped out of the stands and headed toward the mound, where Myers, well versed in martial arts, was waiting. "I felt the look in his eyes, that he wanted to hurt me," Myers said at the time. "He reached for his pocket and I thought it could be for a knife or a gun, so I dropped him with a forearm. I tried to defend myself and my teammates." INFOBOX 1 Game over There have been at least eight forfeits in Major League Baseball history because of fan involvement: Year Team Reason 1995 Dodgers Dodgers fans throw souvenir baseballs onto the field three times during a game with St. Louis. The Dodgers trailed 2-1 in the ninth inning. 1979 White Sox Disco Demolition Night sparks a riot between games of a doubleheader, forcing Chicago to forfeit the second game to Detroit. 1974 Indians 10-Cent Beer Night turns ugly, prompting Cleveland to forfeit to Texas with the score tied 5-5 in the ninth inning. 1971 Senators Fans swarm the field with two out in the ninth inning of the final game in Washington as the Senators lead the Yankees 7-5. 1949 Phillies Fans riot over an umpire's call in a game against the Giants. 1913 Phillies Fans waving handkerchiefs in center field are considered a distraction, resulting in the Phillies' ninth-inning forfeit of a game in which they led the Giants 8-6. 1907 Giants Fans throwing snowballs lead to a forfeit of an Opening Day shutout to the Phillies. 1901 Reds Fans come on the field, forcing a forfeit to the Giants of a game the Reds were trailing 25-13. INFOBOX 2 On second thought... Looks like Twins are planning ahead Even amid his team's battle for a postseason spot, Minnesota Twins general manager Terry Ryan must take time to look at the future. And, so far, Ryan has shown the ability to get a good glimpse. The Twins are on the verge of clinching a third consecutive title in the American League Central, and already Ryan has made a major move for 2005: He traded first baseman Doug Mientkiewicz, a popular figure but a growing financial concern who was expendable because Justin Morneau had proved his worth in the minors. And once the postseason comes to an end, Ryan will have other major decisions to make in an attempt to maintain a contending team with a payroll that barely is above $50 million. The left side of the Twins infield - third baseman Corey Kos- kie and shortstop Cristian Guzman - has free-agent potential. The Twins wouldn't mind keeping Guzman, but not at his $5.75 million option. And there is concern about whether the budget can accommodate two players eligible for arbitration, second baseman Luis Rivas and outfielder Jacque Jones. The potential loss of so many critical players would create consternation for most teams. But for the Twins, it's business as usual. They have been able to cope with such circumstances the past couple of years because Ryan and his staff, without much attention, have put together a farm system rich in talent to supply replacement parts. Think about last winter. Closer Eddie Guardado and his primary setup man, LaTroy Hawkins, were free agents, and left-handed starter Eric Milton's guaranteed salary of $9.3 million exceeded the reality of the Twins' financial situation. So Ryan traded catcher A.J. Pierzynski, whose $3.5 million price had exceeded his value to the Twins, to San Francisco for a couple of young pitchers, including Joe Nathan. Ryan shipped Milton to Philadelphia for unproven right-hander Carlos Silva. The general manager promoted catcher Joe Mauer, the No. 1 pick in the draft three years ago, then filled in by signing veteran free agents Henry Blanco (to back up Mauer) and Terry Mulholland, a left-handed swingman to fill bullpen and rotation needs. Get the picture? Ryan unloaded $18.3 million of salary in Guardado, Hawkins, Pierzynski and Milton; the replacement parts were paid $2.43 million. Despite all their moves, the Twins are preparing for the postseason, even if their Opening Day payroll of $53,585,000 ranked 19th - about $6 million less than Oakland, the only other contender in the same financial neighborhood as the Twins. INFOBOX 3 American League Anaheim has new ownership, which doesn't have the long-term loyalty to retain homegrown players such as third baseman Troy Glaus and right-handed closer Troy Percival. Baltimore has to regroup after failing to add any quality arms during its free-agent shopping spree in the winter. The Orioles will free up some money by unloading the contracts of designated hitters/first basemen Rafael Palmeiro and David Segui and left-hander Omar Daal. But they do figure to retain outfielder B.J. Surhoff, who has family reasons to remain in Baltimore - unless he decides to retire. Boston feels an urgency to re-sign catcher Jason Varitek, who has become a stabilizing influence on the roster, but it's going to be a challenge because of the presence of agent Scott Boras. The Red Sox are making sounds about keeping right-hander Pedro Martinez, but that could be more of a publicity stunt than reality in light of the heat Martinez has taken this season concerning his desire to be the highest-paid pitcher in the game. Chicago's four-year, $16 million offer to outfielder Magglio Ordonez was rejected, but it's not out of the question he'll re-sign with the White Sox on a one-year deal. His value has been affected by a season-ending injury to his left knee and the development of bone marrow edema. Cleveland is debating what to do about right-hander Scott Elarton, whose in-season improvement provides reason to believe he finally has overcome the injury problems that led to his release in Colorado. The Indians want a veteran presence in the rotation, but they also believe they have young starters waiting for an opportunity, so it could come down to how much money Elarton wants. Detroit made its free-agent move last off-season, signing outfielder Rondell White, catcher Ivan Rodriguez and right-hander Ugueth Urbina. The Tigers don't have any major decisions to make this off-season: Right-handers Esteban Yan and Al Levine are their only potential free agents, as long as the team exercises a $4 million option on Urbina. Kansas City made its major off-season move this week, re-signing outfielder Matt Stairs to a $1.2 million deal for 2005 that carries $500,000 in incentives. The Royals also would like to retain left-hander Dennys Reyes and infielder Desi Relaford, though Relaford wants to start, and Kansas City likes him in a utility role. Minnesota right-hander Brad Radke has indicated a desire to stay and has admitted he is not going to get a deal similar to the four-year, $36 million contract he is playing out this season. The Twins also would like to keep third baseman Corey Koskie, but he'll have to settle for less than $3 million or the job will go to Michael Cuddyer. New York is faced with a challenge to re-sign right-hander Orlando Hernandez. The Yankees, who have looked for ways to unload the Cuban defector, have a new-found appreciation for Hernandez, who has been responsible for the Yankees' ability to stay atop the East this season while Mike Mussina struggles and Kevin Brown fights injuries. Hernandez has gone 8-0 and the Yankees have won 11 of his 12 starts. There also is interest in keeping outfielder Ruben Sierra, but the price will have to be right. Oakland wants to get the price down but would like to keep its free agents - catcher Damian Miller, right-hander Chad Bradford and outfielder Jermaine Dye. After the Athletics deal with Dye's $1 million buyout on a $13 million option, they'll start to talk with him about 2005. Seattle is ready for Miguel Olivo to become the No. 1 catcher. But, in a bid to keep some continuity, the Mariners will make an effort to retain Dan Wilson, who, with Edgar Martinez's decision to retire, will become the senior member of the team in terms of continuous service. Tampa Bay is back to cost-cutting mode, which means limited free-agent action. It also adds to speculation the Devil Rays will hold out for a solid prospect in return for allowing the Mets to hire manager Lou Piniella. But, in reality, they'll be happy to get Piniella's $3 million-plus salary off the books. Texas has nine potential free agents, and the only ones the Rangers have shown interest in retaining are Eric Young and Dave Dellucci, both backups. Owner Tom Hicks does have to make that $7 million annual payment to Alex Rodriguez so he can play for the Yankees. Toronto already re-signed outfielder Frank Catalanotto but doesn't have another free agent it figures to make a strong run at keeping. INFOBOX 4 National League Arizona faces a major challenge in attempting to re-sign potential free agent Richie Sexson, who was limited to 23 games because of season-ending shoulder surgery. The first baseman said he doesn't want to be in a rebuilding situation, which will add to the Diamondbacks' challenge. But if Sexson doesn't return, left-handed pitcher Randy Johnson could force a trade for himself. Atlanta wants to keep outfielder J.D. Drew but realizes agent Scott Boras isn't into giving home-state discounts. The Braves also will need to focus financial efforts on right-hander Russ Ortiz, who is going to seek the best offer. Chicago faces a major decision with shortstop Nomar Garciaparra, whose history of injuries makes him a risk to sign if he wants anything close to the four-year, $60 million deal he turned down from Boston. He wants to go to Southern California, but with Khalil Greene in San Diego and Cesar Izturis in Los Angeles, Anaheim becomes Garciaparra's only option. Ramon Martinez and Tom Goodwin are favorites of manager Dusty Baker who have played well enough to probably return. Cincinnati declined to pursue right-hander Paul Wilson during the season, which will cost the Reds. He finally showed signs he could be a dependable big-league pitcher but says that, once he is on the open market, the best bid will get his interest. Colorado seems likely to retain third baseman Vinny Castilla, but the Rockies are iffy about outfielder Jeromy Burnitz, who declined a $3 million mutual option. Burnitz's agent countered with a two-year, $13 million deal that would have eliminated the cost savings the Rockies realized after trading Larry Walker, which supposedly was done so the Rockies could keep not only Burnitz but Castilla, Jason Jennings, Shawn Chacon and Joe Kennedy. Florida faces more than $20 million in losses for the second year in a row, even though the Marlins won the World Series last year and are battling this season to return to the playoffs. The Marlins' finances make it less likely they will try to keep any of their free agents, except right-hander Carl Pavano, who picked the perfect time to have a breakout season. Houston owner Drayton McLane has been excited about the efforts of right-hander Roger Clemens, whom McLane helped talk out of retirement. And the key to getting McLane to write checks is getting him to believe he has a personal stake in the issue. Los Angeles has made keeping third baseman Adrian Beltre a "top priority." It won't be easy. He's only 25 and as a starting point, Boras, his agent, will use the deals signed by Oakland's Eric Chavez (six years, $66 million) and St. Louis' Scott Rolen (eight years, $90 million). Milwaukee wants to keep shortstop Craig Counsell, but the Brewers will pay the $250,000 buyout on his $4.25 million option, then try to work out a better price. Montreal won't know what it can do until it knows where it's going to play and who is going to be the owner. But even with an open checkbook, there's no reason to go overboard for shortstop Alex Gonzalez, third baseman Tony Batista and catcher Einar Diaz. New York made in-season deals for right-hander Kris Benson and outfielder Richard Hidalgo, and given the Mets' struggle in the standings, it doesn't make sense to bid those players adieu after less than a year. Philadelphia has invested enough money already - with no results - that it doesn't believe it can afford to back off. The Phillies will make a strong push to retain left- hander Eric Milton in hopes they can reduce his $9 million salary. Pittsburgh is planning to hold its payroll to about $35 million next season, which doesn't leave room for keeping closer Jose Mesa. St. Louis needs to find a way to re-sign shortstop Edgar Renteria, but it's not going to be easy. The Cardinals' payroll is pretty well maxed out, although the farther the Cardinals go in the postseason, the more likely ownership will get caught up in the emotions and open the checkbook. San Diego got a bargain with left-hander David Wells ($1.25 million) during the off-season. But the newness of pitching near home doesn't exist any more, and Wells is sure to want a salary increase after the season he has had. San Francisco figures to keep first baseman J.T. Snow, who has a $2 million option, and will try to re-sign right-hander Dustin Hermanson, whose star quality and ability to close underscore his value.

CAPTION(S):

Photo (2)

Rangers reliever Frank Francisco hurls a chair into the Network Associates Coliseum stands Monday in response to persistent heckling. The ballpark - home to the Athletics and the NFL's Raiders - has a long history of hostile confrontations between spectators and athletes. D. ROSS CAMERON / ASSOCIATED PRESS CAPTION: Joe Crede

2005-12-03T03:06:00.000-05:00

NEW YORK, Jan. 12 /PRNewswire/ -- Dr. Norman Leaf, renowned Beverly Hills Plastic Surgeon, is offering free plastic surgery consultations (a $250 value) at Bergdorf Goodman (754 5th Avenue) on Friday, January 21st on the Beauty Level.

Learn if your skin imperfections need surgical attention or if a change in your skin care regimen can eliminate wrinkles, lines and sun damage. Also enjoy a complimentary facial with Dr. Leaf's own line of skincare products -- Leaf & Rusher -- a sworn favorite of some of Tinseltown's most well-known names.

Dr. Leaf was named one of the best plastic surgeons of his time by W Magazine and is responsible for the perfectly wrinkle-free faces of some of Hollywood's most beautiful leading ladies.

Appointments can be made by calling 212-872-2664. Walk-ins are also welcome from 12:00 noon to 6:00 p.m. so bring your friends.

Dr. Norman Leaf will be at Bergdorf Goodman (754 5th Avenue) on Friday, January 21st from 12:00 PM to 6:00 PM to offer free plastic surgery consultations and facials. He will be available for live or in-studio interviews as well as taped segments on Thursday, January 20th as well.

CONTACT: Lisa Lauri of Creative Media Marketing, +1-212-979-8884, lisa@cmmpr.com, for Leaf & Rusher

2005-11-27T17:12:00.000-05:00

Byline: Ben Cohen; Staff Writer

Dr. Donald McCormick of Sun City, Ariz., who performed more than 25,000 surgical procedures during his medical career and led surgeons at two Twin Cities area hospitals, died of complications from melanoma in Minnetonka on July 11.

He was 90.

A colleague, Dr. William Remole of Bloomington, said that McCormick, who began his private practice in 1948, performed all kinds of abdominal general surgeries. "No particular specialty. He just did them all well."

McCormick, who had been a longtime resident of Golden Valley, received his medical degree from the University of Minnesota in 1941. He landed in the Army toward the end of World War II.

He arrived in Italy the day the German Army surrendered, and was responsible for the care of German POWs, making sure they would not be subjected to unnecessary amputations.

After the war, Capt. McCormick served at a hospital in Springfield, Mo. The Army decided he would perform plastic surgery on troops, especially burn victims. "He helped them rebuild their lives after being wounded," said his son Don of Maple Grove.

"He was such a lovely man. Everybody who knew Mac loved him," said Dr. John Haserick of Pinehurst, N.C., a friend since their medical school days.

McCormick once served as chief of surgery at the former St. Mary's Hospital of Minneapolis, and later at Unity Hospital in Fridley. He practiced at several area hospitals and had his office in downtown Minneapolis.

McCormick retired in 1984, playing golf, bridge and enjoying the outdoor hunting and fly-fishing skills he learned in Montana as a youngster. He loved golf, but his game caused his buddies to "look away and laugh," Haserick said. "He had the wildest swing you ever saw, but he worked at it."

McCormick served on several boards and gave medical care to members of the Christian Brothers order and the Sisters of St. Joseph of Carondelet.

He also gave his time and money to help support medical students and research through the Minnesota Medical Foundation in Minneapolis.

In addition to his son, he is survived by his wife of 63 years, Sylvia of Sun City, Ariz.; sons Jim of Minnetonka, Robert of Minneapolis and Lee of Sacramento, Calif.; daughters Carol Batty of Golden Valley and Monica Linhoff of Minnetonka; a sister, Catherine Meehan of Seattle, and 15 grandchildren.

A private family service was held.

Ben Cohen is at bcohen@startribune.com.

2005-11-22T13:00:00.000-05:00

Byline: By Samantha Booth

THE world has changed a lot since the first edition of the Guinness Book Of Records was published back in 1955.

And the 2006 edition of the best-selling book - launched yesterday - reflects the trends and scientific advances of the modern world, alongside the traditional records relating to size, speed and stamina.

Here are some of the best new entries. Most plastic surgery:American Cindy Jackson has spent pounds 53,148 on 47 cosmetic ops since 1988.

Oldest woman to fly in zero gravity: Dorothy Simpson, from America, aged 79 years 237 days.

Longest surviving triple heart-bypass patient:Brit Richard Smith had the op in February 1978and lived for another 26years93 days.

Driving to the highest altitude: A Volkswagen Toureg SUV was driven to an altitude of 19,950ft on the slopes of a volcano on the Chile-Argentinian border.

Most casinos played in 24 hours: In March 2004,British brothers Martin and David Lawrance visited 55 in 24 hours in Las Vegas.

Most expensive omelette: The Zillion Dollar Lobster Frittata at Norma's restaurant in Le Parker Meridien Hotel, New York, costs $1000 (pounds 530) Most popular cosmetic procedure:Botox.It accounted for 14.73 per cent of all aesthetic plastic surgeries in 2003.

Most gender reassignment surgery: Fulvia Celica Siguas Sandoval of Peru has had 64 ops to complete his sex change.

Bras unhooked in a minute: Brit Chris Nicholson unhooked 20,using onehand Largest mobile phone: It measures 6.7 ft x 2.7ft x1.5ft and is fully functional Mostdurablemobilephone number:David Conorno, from America,hasownedandused the samenumber since August 1985Largest online community: Sony PlayStation2 hadmore than 1.4 million registered online users in August 2004Largest speeding fine: Jussi Salonja,of Finland,was fined pounds 116,000 in February2004 for doing50mph in a25mph zone.

Largest criminal DNA database: The UK's database contained 2,527,728 profiles in March 2004Smallest mammalused to detect land mines:AGambian giant pouch rat measuring76cm long,including the tail.

Most digital artists on a film: Sky Captain And The World Of Tomorrow had 320 visual effects artists working on it.

Most expensive TV advert:Baz Luhrmann's four-minute ad for Chanel No.5 perfume,starring Nicole Kidman,costpounds 18 million to make in 2004.

Biggest-selling download single in a week: Dogz Don't Kill People Wabbits Do by Mouldy Looking Stain sold more than 7000 in the UK in a week in October 2004.

Biggest-selling download single in the UK:Amarillo,by Tony Christie featuring Peter Kay,has sold 57,804 downloads to date.

Fastest 100 metres on a spacehopper: Ashrita Furman did the distance in 30.2 seconds.

Balloon dog made behind the back:Brit Craig Keith managed the feat in just 9.26 seconds last year.

Heaviest weight lifted with tongue: Brit Thomas Blackthorne lifted 24lb 3oz.

Most expensive ice-cream sundae:the Serendipity Golden Sundae from Serendipity restaurants in New York cost $1000 (pounds 530) in 2004.

Most crisp packets: Bernd Sikora, from Germany, owns 1482 from 43 countries

CAPTION(S):

LONG AND SHORT OF IT: Xi; Shun, 53, listed as the tallest man, and Kiran Shah, 52, the smallest stuntman, at the launch of the book outside the Houses of Parliament

2005-11-22T03:53:00.000-05:00

University Wire

11-18-2005

(Arizona Daily Wildcat) (U-WIRE) TUCSON, Ariz. -- "Beauty is in the eyes of the beholder," said Gauri Pathak, Miss India Arizona 2005, as she and other panelists discussed how beauty is perceived differently for various races and cultures.

Theta Nu Xi, a multicultural sorority at the University of Arizona, hosted a forum titled "Beauty in Popular Culture" on Thursday night to explore how the perception of beauty varies for women and men in different races, greek organizations, religions, backgrounds and lifestyles.

The panel comprised Pathak; Erin Cohen, Panhellenic Council president; and Danielle Abram, treasurer of Alpha Kappa Alpha sorority, who answered questions about how beauty is perceived in the groups they belong to and whether they agree with the stereotypes that result from such perceptions.

Each panelist discussed how beauty is defined and how those definitions can lead some women to have poor ideas of their self-image.

The stereotype of a "sorority woman," Cohen said, is someone who is "tall, tan, blonde and fit."

Cohen, a psychology senior, said she hopes people can look beyond that stereotype and see that most sorority women don't necessarily fit the mold.

Abram, a microbiology senior, said in her community black women are considered beautiful by other men if they are more "thick," or have "something to grab onto."

The women blamed the harsh stereotypes and standards of beauty on the competitiveness of women, who have the idea that they need to be and look better than everyone else to "fit in" and be welcomed into a group.

Theta Nu Xi President Amanda Droopad, who fielded questions to the panelists and audience, asked if they thought the new Dove skin care campaign showing average women in their underwear helped women feel better about themselves.

Cohen, who admitted she would buy the Dove products after seeing commercials of more natural-looking women, said others might still buy products like a Victoria's Secret bra because they think they might look like their models if they wear their products.

"I know that if I buy a Victoria's Secret Angel bra, I won't wake up and look like them in the morning," Cohen said. "But I feel like some people think they might."

Pathak, a public health senior, said she thinks the pressure is so strong to be considered beautiful and "perfect" that many women have plastic surgery to make themselves more beautiful, but that it should only be OK in special situations.

"Plastic surgery is only OK for a few reasons, and one of them is breast cancer," Pathak said.

The panel didn't come up with a solution to making women feel better about themselves in their own skin, but suggested "if you love yourself, other people will love you," Cohen said.

Droopad, a management senior, asked what classifications of beauty overlap in all of the cultures and groups, and Abram said everyone agrees that "it's what's inside that makes you beautiful no matter what group you are in."

Francesca Fabozzi, an undeclared freshman, said she eventually grew out of thinking all women should look like Barbie dolls until she came to the university.

"I grew up knowing women don't look like Barbie dolls, and then I moved from New York to Arizona, and everyone does look like Barbie dolls," Fabozzi said.



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(C) 2005 Arizona Daily Wildcat via U-WIRE

2005-11-20T15:11:00.000-05:00

By middle age, the marks of soft tissue laxity are visible on the face. The corners of the mouth are drooping, the lower eyelids have lengthened, and the malar fat pads are slipping south.

To correct these structural changes and rejuvenate the face, Paul Tessier, M.D., renowned craniofacial surgeon, first described the "midface lift."

Altering midface dynamic

In October 2003, the U.S. Food and Drug Administration (FDA) cleared the Endotine Midface developed by Coapt Systems for subperiosteal midface suspension.

Patient selection

Patient selection is a key factor in good outcomes. The target population is 40- to 60-year-old women and men who have minimal to moderate laxity and good elasticity.

Unfamiliarity

Very few patients are familiar with the midface lift.

Implanting the device

More dramatic results

In the first 75-plus consecutive patients, there have been no complications, no extrusions, no instances when the lift slipped, and no requests for removal of the device.

Benefits of sutureless fixation

The Endotine is the first device specifically designed for subperiosteal midface tissue fixation. It shaves 30 to 60 minutes and a lot of frustration from a standard operation.

Conclusion

2005-11-16T09:59:00.000-05:00

Spreader graft placement is indicated to: (1) correct internal valve collapse; (2) bridge and strengthen a long, narrow middle vault in patients with short nasal bones; (3) correct a lack of dorsal support of the lateral nasal walls; (4) widen the middle one-third of the nose; (5) straighten or stabilize a high dorsally deviated septum; and (6) create straight dorsal aesthetic lines (figure 1). Additionally, the spreader graft can be placed to extend past the anterior septal angle as a caudal extension graft to lengthen a short nose.

[FIGURE 1 OMITTED]

Placement of an endonasal spreader graft begins with the infiltration of 1% lidocaine with 1:50,000 epinephrine into the submucoperichondrial plane along the dorsal cartilaginous and osseous septum. Next, a 4- to 5-mm vertical incision is made approximately 2 to 3 mm caudally to the internal valve. A Freer elevator is placed through the incision and used to create a pocket that extends just past the osseocartilaginous junction (figure 2). The pocket should be made only 1 to 2 mm wider than the width of the Freer elevator to create a snug pocket for the spreader graft; too large a pocket will predispose the graft to slipping. If a septoplasty is being performed concurrently with spreader graft placement, a bridge of mucoperichondrium should be left attached to the septum at the inferior edge of the spreader pocket. It is preferred that the septoplasty dissection and the spreader grail pocket remain unconnected. The grafts are then fashioned from harvested cartilage.

[FIGURE 2 OMITTED]

After the creation of bilateral pockets, the graft is placed by grasping the cartilage at its distal tip with a pair of DeBakey forceps (figure 3). The graft is grasped at its distal edge to ensure that its leading edge is not bent or broken during placement. The graft should fit snugly into the pocket. Countertraction is provided during placement by having a surgical assistant retract the mucoperichondrial flap laterally with a tiny double-pronged hook. Immediately following placement, the lateralizing effect of the spreader graft can be visualized as an increase in the angle of the internal nasal valve as the upper lateral cartilage flares away from the septum.

[FIGURE 3 OMITTED]

A critical factor for the success of the operation rests with maintaining the connection between the upper lateral cartilage and the dorsal septum. The spreader graft fits into the angle between the upper lateral cartilage and the septum and exerts a cantilever effect. After graft placement, the incisions are closed with two interrupted 5-0 chromic sutures.