Archive for the ‘Peripheral Artery Disease’ Category
Share Our Mission to Heal
Holy Cross Hospital is seeking studio audience members for A Mission to Heal, a new show all about the heart.
Needed: 75 audience members for each show; Mix of demographics. No children under 18; Community groups are encouraged to have representation in the audience, as well as community leaders.
Where
A studio in Davie, FL. Details will be provided to audience members upon selection.
When
September 30, 2010; Refreshments will be served.
The show is not “live” but it is being recorded “live” so it will be edited and shown at a later date. Audience members should dress comfortably for long periods of sitting. No white blouses, shirts, hats or sweaters.
Please email info@holy-cross.com and put A Mission to Heal in the subject field OR call 954-776-3244 if you are interested in being part of the studio audience.
Please provide your full name, phone number, e-mail address, age range (20s, 30s, 40s, 50+) and race/ethnicity. Someone will be in touch to let you know if you have been selected and provide additional information.
The Start of Coronary Angiography
The start of coronary angiography was slow and began in earnest after a mistake was made. The reason was mostly that there wasn’t much to do with the information in the early 1960’s because bypass surgery wasn’t invented.
Dr. Charles Dotter played a seminal role in much of radiology. He is responsible for the concept of angioplasty, which started in the legs and first used ever increasing dilators to open arteries and finally went on to develop balloons for the task. Dr. Dotter was a mentor to Dr. Andreas Gruentzig, who miniaturized the balloons in his kitchen and then used them in the coronary arteries years later. In 1959, Dr. Dotter began experimenting on animals to visualize their coronary arteries by occluding the aorta and injecting contrast nonselectively. It was believed that even a small amount of contrast would kill the animal or a human.
In 1959, Mason Sones, a pediatric cardiologist, while doing an aortic root injection noticed that the catheter accidently entered the right coronary artery and visualized it. The patient sustained ventricular fibrillation and he thumped him on the chest and it stopped (luckily because cardiac defibrillators didn’t exist yet). He went into the animal lab and worked out how to inject coronaries without harming them. During this time, Sven-Ivar Seldinger in 1953 developed the technique that we still use today of entering the peripheral arteries with a small needle and using a wire to gain access to the main circulation and to move the catheters’ around.
Dr. Melvin Judkins developed many of the preformed shapes that the catheters are manufactured in to help enter the coronary arteries during the 1960’s and by the late 1960’s coronary bypass surgery was beginning and patients began to receive cardiac catheterizations for the purpose of defining their coronary anatomy. This process at first used 35mm film and required large amounts of radiation. Now, we use digital imaging and all the data is stored on a computer and the data can be manipulated for analysis by computer. The amount of radiation is significantly less.
Next…the problem now.
Vote for the Blog of the Year
Did Dr. Niederman post a blog in 2009 that you found particularly helpful? Was there a blog that you could not wait to share with someone else? We’d love to receive your feedback.
Please comment on what you think was Dr. Niederman’s best blog in 2009.
Aspirin: Risk vs. Benefit
Medicine is an enterprise that evolves over time. This is because new information comes to light and the synthesis of data takes time. Also, not surprisingly, much of what we do comes with the baggage of “that’s how we have always done it.” Change is incremental and often controversial.I have blogged in the past about the use of aspirin. This topic needs to be divided into those patients who have had a vascular event such as a stroke or myocardial infarction and those who are at risk and have not had an event. It is otherwise called primary and secondary prevention. Further, the groups need to be divided into male and female because the difference between them seems to be quite real but poorly understood.
If you have suffered stroke caused by a blood clot or a myocardial infarction, or have undergone coronary artery bypass grafting or angioplasty, then taking aspirin for life is generally recommended. It’s in the primary prevention group that the discussion is about.
This discussion dates back to 2002 when the US Preventive Services Task Force published its original study. This was updated in March of this year and states that aspirin is beneficial to men 45 to 79 in preventing myocardial infarction and preventing stroke in women aged 55-79. In 2003, the FDA advisory panel voted 11-3 to reject a petition by Bayer to expand aspirin’s indications to be used for primary prevention in moderate risk patients.
Since that time, papers have been published showing that in key patient populations such as those with asymptomatic atherosclerosis, type 2 diabetes and peripheral artery disease, no benefit over risk can be found. This was further propelled by the publication of an article by the group that started the whole debate the Antithrombotic Treatment Trialist group from Oxford, England. It was this group, in 2002, which published the original article. This group published again this March reversing their original opinion. I quote from their article, “We should be careful not to give the impression that aspirin doesn’t work. It works. But the balance of benefit / hazard is not good enough for a primary-prevention situation.”1
If you are taking low dose aspirin to “prevent” something and have never had an event then you should talk with your doctor. This is especially true of women who seem to be at the greatest risk and receive the least benefit. The risk of bleeding is real; the benefit seems more ephemeral.
1. Lancet 2009; 373:1849-1860.
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Posts are published by Holy Cross Hospital to provide general health information. They are not intended to provide personal medical advice, which should be obtained directly from your physician.
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