Friday Night, Saturday Morning :::...> Nouvelle Vague

2008-09-21T07:46:00.001-07:00

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古筝 Guzheng : Yuan Sha Performs Ming Shan 袁莎 : 冥山

2008-09-20T12:39:00.001-07:00

Yuang Sha performs the composition "Ming Shan" on the Chinese instrument "guzheng," sometimes classified as an "Asian zither." I like this performance/composition for many reasons; a primary one is the "uncorny," abstracted nature of the music. No florid, gushing guzheng here!
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Notes from the person posting the video on YouTube: "Central Consertvatory's Yuan Sha plays Ming Shan, one of the pieces that brought her to the first prize of the 2002 International Chinese Instrumental Competition."
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Sister Rosetta Tharpe - Didn't It Rain

2008-09-15T18:45:00.001-07:00

Man! What "baddass" Sister Rosetta's bein' here! Check out the stinging, curt, cursory guitar licks, and her wicked little entrance in the old horse and buggy.

Yasmin Levy

2008-09-15T16:36:00.001-07:00

Mahamudra Meditation : Shambhala Tradition : Patrick Sweeney

2008-08-25T16:33:00.001-07:00

A beautifully-filmed video, this guided meditation and dharma talk by Shambhala teacher Patrick Sweeney (California) is quite a sharp, clear, awake, alive gift of intelligence. No junk here. Oh! And check out the Rebbe in the "audience," or practitioners' group.

Leonard Cohen : The Stranger : 1967

2008-08-24T20:14:00.001-07:00

Expresses all the cynical, mournful, disappointed, bitter, frightened hunger, longing, hopelessness, alienation, isolation, slim snaky hopes, and frank love I felt when I was 16 (sixteen) years old...1967...Vermont...and Cohen on the tiny teen turntable with its coarse needle in that crude, clunky cartridge...The hissing of the vinyl...

Sunset Over Sea (oh how cliched)

2008-07-12T20:53:00.001-07:00

, originally uploaded by deborah lattimore.

Great photo by "Ruir" on Flickr.

Bring a Little Love Into Your Day

2007-10-29T01:11:00.001-07:00

Welcome, sweet Asparagus! Congratulations, sister Rachael!

Being Alive, Being Alive

2007-10-20T12:22:00.001-07:00

×º°”~”°º× Companionship ×º°”~”°º× by moonlight_dreams.

"Don't ask yourself what the world needs; ask yourself what makes you come alive. And then go and do that. Because what the world needs is people who have come alive.

~Howard Thurman

Flickr

2007-10-20T12:07:00.001-07:00

clickr for ... !

DRUGS? ANGIOPLASTY? STENTS? WHAT'S A "STABLE ANGINA" PATIENT TO DO?

2007-09-24T04:20:00.000-07:00

I've got a much-loved friend who's struggling with a newly-discovered medical condition; he's got atherosclerosis, with a 99% occlusion of his left anterior descending (LAD) artery.

The LAD is a key conduit for blood distribution, and it's generally not good news to find that your most critical artery has been completely blocked with an ungodly muck of murky material---fatty streaks, lipid custards, calcium schist, necrotic plugs, black blood pudding, feisty fibrous caps---Talk about old plumbing! And the lad's only 56!

I've looked at quite a few obscene pictures of plugged coronary vessels, and I'm reminded of...of...Well, you've seen those beautiful, vintage copper pipes in cellars of old Manhattan apartment buildings, or hanging like teats from the rafters of unfinished farmhouses in Vermont's Northeast Kingdom, right? When you open one of those suckers with your rusty wrench, you aren't surprised to see it's 75% occluded with hardened rimes of off-white mineral deposits. You're unsurprised because you've been trying to take a decent shower for the whole winter now, and all you get is a feeble stream of sulphurous water that has you rinsing shampoo for 45 minutes, shivering in the crisp farmhouse air as this slack liquid trickles thinly down your spine.

Anyway. Back to my friend. That's where this all started. Can you imagine having your OWN pipes lined with a slurry of custardy, bloody, necrotic waste? Or imagine that this sewage might be studded with tiny knobs of calcium and collagen---and who knows what else---while your faithful heart is slowly dying for lack of oxygen?

Anyway, this is no time to be getting into such morbidity. I'm going to be ruefully, unforgiveably, possibly gleefully late for work. And all I really wanted to do when I sat down before this bloggy blankness was hastily enter some PubMed studies on "vulnerable plaque" and the massive 64-slice, multidetector, computed tomography monstrosities that might be employed against such plaque before it ruptures, carrying my friend off to never-never land well before his time. Ok. Gotta run!

But I'm so exhausted by all this talk-talk about...what?

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1: J Am Coll Cardiol. 2002 Mar 20;39(6):923-34. Links

Comment in: J Am Coll Cardiol. 2002 Oct 16;40(8):1541; author reply 1541-2.

Refractory angina pectoris: mechanism and therapeutic options

Kim MC, Kini A, Sharma SK.

Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York, USA.

As the survival of patients with primary coronary events continues to increase, the number of patients presenting with coronary artery disease unsuitable to further revascularization techniques and symptoms refractory to medical therapy also continues to rise. The aims of this review were to define the population of patients with refractory angina pectoris and to present the therapeutic options currently available for this condition. Refractory angina pectoris is defined, and traditional medical therapies are discussed. Then, current therapeutic options for patients with refractory angina are extensively reviewed. A multitude of therapeutic options exist for patients with refractory angina pectoris. Small, uncontrolled studies have shown a potential benefit for additional antiplatelet and antithrombotic therapy. In randomized trials, neurostimulation has been shown to be effective in reducing angina symptoms. Enhanced external counterpulsation is a viable treatment option for select patients with refractory angina. In many randomized trials, laser revascularization has been shown to diminish angina symptoms, although no placebo-controlled studies exist to date. Gene therapy is a promising area of research in this field. Percutaneous in situ coronary venous arterialization is in its infancy, but may be able to treat many patients if proved successful. No data support the role of chelation therapy in this population. Heart transplantation remains a final option for these patients. Further research of the techniques mentioned in this review is warranted. The importance of randomized, double-blinded, placebo-controlled trials cannot be overemphasized, as the placebo effect of these therapies is probably marked.

PMID: 11897431 [PubMed - indexed for MEDLINE]

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Angina treatment: Stents, drugs, lifestyle changes — What's best?

Angina treatment often involves using stents to widen blocked heart arteries. A study, the COURAGE trial, questions whether angioplasty and stents are necessary. A Mayo Clinic specialist discusses the findings.

Gerald Gau, M.D.

Your doctor says your chest pain (angina) is caused by blockages in your heart arteries, and that you need to get those blockages taken care of.

Now what?

It's likely, depending on how clogged your arteries are, that your doctor may suggest angioplasty and stent placement to open up your narrowed arteries and relieve angina. During an angioplasty — also called a percutaneous coronary intervention (PCI) — a tiny balloon is inserted into your narrowed artery. The balloon is inflated to widen the artery and then a small wire mesh coil (stent) is usually inserted to keep the artery open.

Angioplasty and stent placement is a common treatment strategy for coronary artery disease and chronic stable angina. Chronic stable angina is a form of chest pain that happens when your heart is working harder and needs more oxygen, such as during exercise. The pain goes away when you rest. Your narrowed arteries can be the cause of this form of angina.

Many doctors consider angioplasty with stent placement to be a good treatment for blocked arteries and angina because it's less invasive than open-heart surgery and has had good results. But now a large medical study suggests angioplasty and stent placement may not be necessary in many cases.

Here's what happened. From 1999 to 2004, 50 medical centers across the United States and Canada, including the Mayo Clinic, agreed to randomly divide 2,287 people with partially blocked coronary arteries and chronic stable angina into two groups. One group had angioplasty with a stent implanted along with medication and healthy lifestyle changes. The other group of people in the study just took medication and made healthy lifestyle changes, but did not have angioplasty and stent placement.

The study was known as the COURAGE trial. COURAGE stands for Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation. The COURAGE trial was formed to find out if combining angioplasty and stents with medication and lifestyle changes was more effective at preventing death or heart attacks than just taking medications and making lifestyle changes alone.

The results of the study were recently released. Gerald Gau, M.D., is a Mayo Clinic specialist in cardiovascular diseases who was involved in the study. Dr. Gau has been involved with the National Cholesterol Education Program Coordinating Committee, which develops national cholesterol guidelines. Dr. Gau discusses the findings of the study.

What did you and your colleagues discover when you compared the use of stents and medical therapy with medical therapy alone?

The COURAGE trial found that in people with chronic stable angina, having angioplasty and stent placement combined with medical therapy (drug treatment and lifestyle changes) did not prevent any additional deaths or heart attacks compared with medical therapy alone. Medical therapy is defined as diet and lifestyle changes along with medications including statins, anti-clotting drugs like aspirin and high blood pressure medications like angiotensin-converting enzyme (ACE) inhibitors and beta blockers.

This study suggests that if you have chronic stable angina, you may not need angioplasty and stenting immediately. It may be just as effective to try drug treatment and adopt a healthy lifestyle and diet.

The study did find that people who had angioplasty and stenting initially had earlier and better symptom relief, such as reduced chest pain, than those who just got medication. However, five years later the symptom relief was about the same between the groups. That's worth noting because it's often been argued that stents provide better relief of chest pain. We found that while that's true early on, over time there was no significant difference in relief of symptoms such as chest pain.

Do these results apply to everyone with a blocked or clogged artery?

No, but they apply to a lot of them. We looked at people who had chronic stable angina. In other words, these were people who had regular, predictable chest pain, due to partially blocked arteries. This is a large group of people. The American Heart Association estimates 400,000 people in the United States are diagnosed with chronic stable angina each year. The COURAGE trial results don't apply if you have unstable angina.

Unstable angina is a change in your usual pattern of chest pain. It's chest pain that's getting worse or lasts longer or that doesn't get better with rest or use of nitroglycerin. Unstable angina is dangerous and a warning sign of a heart attack. If your angina is unstable, then urgent medical care, and very possibly angioplasty with stents, is still recommended.

Are those with chronic stable angina commonly treated with angioplasty and stent placement right now?

They often are. Though the American Heart Association already recommends people with chronic stable angina first try medical therapy, the practice in many doctors' offices and hospitals has been to first try stents. In fact, about half of all angioplasty procedures are done in people with stable angina. We're saying that, based on the COURAGE trial results, angioplasty and stenting may not be necessary in this group of people.

If you have stable angina, you may have just as much success treating it with medical therapy alone — drug treatment and diet and lifestyle changes — and may not need to undergo angioplasty with stenting. If after trying medical therapy, you still have symptoms or are unable to reach goals such as lowering your cholesterol, a stent may be the next step. These study results suggest it might be reasonable to try more conservative steps first — medication and lifestyle therapy for a year or so — before considering a stent.

When might angioplasty and stents plus medical therapy be used for chronic stable angina?

If you try medication and lifestyle changes but they don't relieve angina, angioplasty and stents may be an option. Angioplasty with stenting is still a very appropriate treatment option for people with unstable angina as far as we know today. This study just suggests it may not be necessary as initial treatment for many people with chronic stable angina who today would undergo that procedure.

It's also worth pointing out that while percutaneous coronary intervention (PCI) — the procedure of angioplasty and stenting — is quite safe, it still involves some risk. There's a small risk of blockages re-forming after a stent is implanted, as well as additional risks — albeit small — of blood clots forming where the stent was implanted. Finally, inserting a stent is expensive, meaning you may want to factor the higher cost into your medical decision.

Drug treatment and some lifestyle changes sound pretty easy.

Make no mistake, what we're suggesting isn't easy to achieve. This is not just as simple as taking a pill. This is intensive medical therapy. For example, when we say you should take statins to reduce your cholesterol, we mean it.

Right now, the average American has a low-density lipoprotein, (LDL, or "bad") cholesterol of around 130. But to achieve the sort of results we saw in our study, you need to get your LDL to about half that — around 60 to 70. You also have to exercise regularly, at least five out of seven days of the week. You also have to maintain a healthy weight, eat a healthy diet and keep your blood pressure down.

It does sound challenging. Were the people in this study able to strictly follow their medical therapy?

Yes. Using medication and lifestyle changes alone is challenging, but it does work. I watched angina and clogged arteries disappear in those who were involved in this study at Mayo Clinic. You've got to reduce your blood sugar levels if they're too high, maintain a healthy blood pressure and lower your cholesterol. To do this, you have to exercise, eat more fruits and vegetables and lean meats, and take your medications. But if you do all that, our study showed that your angina and the blockages in your heart arteries can disappear, or be significantly reduced.

What if you already have a stent?

You still need to be on intensive medical management to treat remaining coronary artery disease and diseased arteries (atherosclerosis) elsewhere in your body.

However, if you've had a stent implanted and need future medical treatment for your clogged arteries, you'll likely need additional stents implanted. You won't be able to rely on medical therapy, such as drugs, alone as treatment. This is because if any future problems, such as blockages or clots, do recur they will likely happen near where your stent was implanted. Doctors will then have to insert one or more stents near those old stent sites to correct the problem.

Stents are still safe, and we still recommend stents for those with unstable angina. Though there's been some recent attention on the risk of blood clots forming with some drug-eluting stents, this risk is still quite small.

This is just one study. So, how should you use these results?

You're right. This is just one study. However, this was the largest study comparing the two treatment options and the results were quite clear. Having said that, as with any medical treatment, you should talk with your doctor about what's the best option for you. These results are new and will likely cause a lot of debate in the medical community, so it may take awhile for doctors to come to a consensus on how to use our study results.

Still, it should be emphasized that in our study, the use of stents in someone with stable angina did not prevent death or heart attacks over drug treatment and other medical therapy, and there was no long-term difference in chest pain relief.

Were there any limitations to this study?

Like many studies, the COURAGE trial was made up mostly of males (85 percent), and there were few minorities (14 percent). This makes it harder to generalize our results for everyone. Another issue some may point out was our study used primarily bare-metal stents, not the more recent and increasingly common drug-eluting stents. However, there's been no significant difference found between bare-metal stents and drug-eluting stents for preventing death or heart attack. So our using primarily bare-metal stents shouldn't have much impact on our results.

Finally! The (Not-So-Secret) Secret to Snatching Pictures from PowerPoints

2007-09-23T00:25:00.001-07:00

It's so easy!

All those times I was frustrated, trying to capture images from PowerPoint presentations (always in a hurry, never time to think), and now it dawns on me:

Simply save the .ppt file as an .html file (web page), rather than a .ppt file. PowerPoint will automatically extract every embedded image (or audio file) and save it to a local folder.

All you have to do is open the folder and pluck out the desired picture (or sound). Just do a "cut" or "copy" or "save as" to a new folder - or to a Word document, Paint program, online or desktop image editor, media player, blog, wiki, website...you name it!

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