#its not technically insufflation

[xxangeldustanalogx]

tfw halfway through a line and yr like. that's slightly more glitter than i. would have hoped to insufflate.

[rinshiroufan]

I've come to the conclusion recently that eloquent and sophisticated essays providing apologia for Rin/Shirou are pointless. It scarcely matters how compelling and articulate the argumentation is, or how well the passages adduced bolster the central thrust of the lucubration, if someone simply didn't initially understand Rin, they never will. Not really. I have lost track of how many times I have managed to "sway" someone around to appreciating Rin and the UBW romance more, with their proving themselves to be perfunctorily adroit at regurgitating my own prolix ramblings, and even rhetorically gifted at insufflating their own essays with impressive rhetorical flourish and ornate, evocative imagery, only for them to subsequently demonstrate themselves as congenitally incapable of truly applying what they had learned (through rote memorization) to reach deeper insights about the character on their own. If I didn't hold their hand like a fucking baby and condescended to them, they would never realize their errors.

Rin/Shirou is something that you simply intuitively understand, or you don't. You can certainly produce analyses, but you should never do so with the expectation that that is going to truly convince anyone. I certainly don't think the romance was a particularly abstruse and opaque part of the story, but for some reason it does appear that one needs access to mystical arcane means to comprehend it. But really, what's the point of deservedly singing the praises of Your distortion if you're going to spew bullshit like Rin was adapted well in the HF films (remember, it doesn't matter how much you explain to someone the nuances of Rin's character in HF and how her relationship with Shirou is crucial to groking her out, they'll still see her as nothing more than a support pillow for Sakura (the sisters storyline really was a mistake), and Rin is nothing but that in the HF films, so it works out for them right) or just spew factually incorrect, easily disprovable nonsense like "Shirou doesn't stay with Rin or settle down to have a family with her in UBW" (could the UBW ending poem and anime finale be more explicit, you morons?)...?

And this admittedly enough doesn't apply simply to Rin. I am perfectly willing to admit that I myself have many blindspots and there are many characters that I appreciate on a technical level but cannot confidently say I meaningfully comprehend (not just in FSN, but in general). The difference would ultimately be however that I simply don't discuss those subjects and characters. But some feel compelled to pontificate at length about Rin and spread contumely against her, whether intentionally or unintentionally. Just please shut the fuck up and don't discuss her at all if you're too obtuse to get it.

Anyway, I intend to write something on the underappreciated aspects of Rin and Archer's character dynamic, and its role in UBW. Been planning it for months, but things kept coming up.

[longformeditions]

LE073 Angel Bat Dawid Harkening Etudes

Angel Bat Dawid is a Black American composer, improviser, clarinetist, pianist, vocalist and DJ. In 2018 Angel composed Song of Solomon: A Cosmic Space Opera that was performed by prominent free jazz musicians in Chicago. Her critically acclaimed album The Oracle, released by Chicago label International Anthem was created entirely alone – performing, overdubbing and mixing all instruments and voices by herself – recorded using only her cell phone in various locations, from London, UK to Cape Town, RSA. In the fall of 2019, she composed and premiered Requiem for Jazz at the Hyde Park Jazz Festival, and in 2020 composed Peace: A Suite for Skylanding commissioned by the Art Institute of Chicago for Yoko Ono’s outdoor Skylanding Installation. Angel tours internationally with her septet Tha Brothahood and released their album LIVE making NPR’s best of 2020 list. She also leads the all-woman trio Sistazz of the Nitty Gritty, and has released the album Message from the DAOUI with electronic artist Oui Ennui as the duo DAOUI. Angel performs clarinet in Damon Locks Black Monument Ensemble and hosts a monthly music show on NTS Radio.

“Music is a language, you see, a universal language.” – Sun Ra

Artist notes: Harkening Etudes Three Numerical Insufflating Sound Exercises Composed by Angel Bat Dawid Etude 1: 4/4 Etude 2: 5/8 Etude 3: 6/8 According to Merriam-Webster Dictionary an Etude is a composition built on a technical motive but played for its artistic value. These three original compositions for clarinet and piano are designed to insufflate breath into the ears as sonic creative adventures monitored by the time signature of each etude. This technique is to abide the harkened in transmuting sound and breath into the ears.

I wanted to include breath as part of the listening process. I really want folks to inhale and exhale and then go on a ride of different sounds. Breathe into your ears…they need air too. Breathe with your ears… Practice the skill.

[arabellaflynn]

I finally caved and bought myself a pair of magic earplugs. I murder earbuds. I spent the years 1999-2016 inclusive destroying pair after pair of earbuds by getting the cord wrapped around something, or the bud caught under a heavy thing in the bottom of my bag, and yanking. I'm moderately fussy about earbuds in the same way I'm moderately fussy about shampoo -- which is to say, not very, but I do need something at least one step above cheap. My very favorite ones were Sony MDR-E9s, which were $10 a pair for a good ten years, and were absolutely everywhere until Sony broke my heart by discontinuing them. I ruined about a pair a month, on average. RIP, all my pretty blue earbuds. I graduated to Bluetooth earbuds when I got tired of knocking headphones off my noggin when practicing with my hoops. I tried braiding the wires (and at one point the actual Sansa Clip MP3 player) into my hair, but there's no way to do that and also keep the pads on or the earbuds in while I'm moving. You have no idea how much time you spend untangling yourself from your goddamn headphone cords until you don't have to do it anymore. Not having a tether always running from my head to my bag got me down from $10 a month to $35-40 once or twice a year, which was nice. They survive me long enough for the battery or USB port to flake out, which as cheap as I am, is about six months. Generally I got the ones with a wire linking the two buds. Acesori is nice for the (very low) price, as is Phaizer. (The magnetic backs are a nice touch -- they're meant to stick to each other when you wear them around your neck, but the buds are light enough that they'll also stick to, like, the fridge, or the side of my clothing rack, even with the USB charge cable hanging off of them.) I wanted the magical musical earplugs, but when I started looking around for them, AirPods were $160 when you tried to buy them without an iPhone attached. That's about $120 more than any sane person ought to be paying for a set of tiny speakers, no matter how snazzy they are. No. Just, no. I finally drove another set of Phaizers into the ground, so I went looking around on Amazon, and lo and behold, true wireless earbuds are down in the $35-40 range now. I have trouble convincing myself to spend money on just about anything, but I really do use these things every single day, and I go mad without a music player, so I gritted my teeth and clicked the order button. My main thought is, "I'm gonna lose these damn things someday." MicroSD cards have already gotten down to the point where you could accidentally insufflate the equivalent of the Library of Congress, and I have several times had to play hot-and-cold with my earbuds to find where I put the fucking phone down. ("My podcast is still running, it has to be in the house somewhere.") Now I have little plastic things smaller than my thumb joint that are streaming music into my ears from my tablet, that is... somewhere on the bed? And running Google Play Music, so it's actually spooling data from servers in, I have no idea, California? Iowa? The Marianas Trench? Who knows. It just finished playing something Samira Saïd recorded in Arabic like twenty years ago. I'm training myself to put them back into the case every single time I take them out of my ears. I've made it like three days and I still know where both of them are. So far, so good. I bought these, if anyone cares. I have no idea why they all insist they are for iPhone/Samsung; Bluetooth is Bluetooth, and they play fine with a really rather nice Lenovo IdeaPad Touch, a perfectly acceptable Kindle Fire 7, and an Alcatel OneTouch "smartphone" that rides the short bus to phone school. The case is also the charger; each bud is supposed to get 3-4 hours of play on a 45 mAh battery, with an additional 650 mAh reservoir in the case, which should be enough to cope even with me. They're about 98% as awesome as I thought they would be. The sound quality is solidly "$35 earbuds". They're not hyperintelligent Bose noise-canceling studio headphones. You are not going to master an album on these. On the other hand, they're pretty good earplugs -- that's how they stay in place. Any drivers with halfway decent bass response are going to sound pretty good when you jam them directly into your ear canals. The tannoy on the T sounds like the grown-ups in the Charlie Brown cartoons when I have them in, but the tannoy on the T sounds mostly like that when I have them out, too. The important part is that I can hear my music, and I cannot hear the conversation you're having on your speakerphone in the middle of the train car about that embarrassing medical condition, and that's all I care about. The downside is that they are not especially robust, and they're too small to have any controls on the earbud itself. The ones with the linking wire have the charge port/battery/buttons on one bud and I'm pretty sure the Bluetooth module is in the other; these have to have a Bluetooth chip and battery in each earplug, which doesn't leave a lot of room for anything else, so the only control on the earbuds themselves is a single click button. One click on either bud for play/pause, and press-hold to turn them on or off individually. You have to do everything else on the actual widget that is streaming the audio. I know most people are already staring at their phones all the time, but mine doth not internet, so it's usually in my bag, and I have to dig it out to skip a song. The earbuds have a very anxious-preoccupied attachment style with respect to the phone, and hate intervening walls, but I suspect I probably could have solved that issue by spending another $10 on them. In theory, they're Class III devices, which should have a range of about 10 meters, but in practice they're twitchy and have no real shielding, so if there's anything weird like power lines or catenary wires around, they get more like 5-10 feet. I shouldn't ever be farther from my bag than that, but still. The most interesting glitch is one I didn't expect. Instead of both pairing with the device, one bud pairs with the device, then the second bud pairs with the first. If there's any lag at all -- because, I don't know, the impedance of my head has suddenly changed? -- the audio gets ever so slightly out of sync. Like, milliseconds. It's not noticeable at all with music, where the stereo field tends to be wide and the background very busy, but it makes audiobooks or podcasts sound odd. If it's not specifically done as a radio drama, voice-only things tend to be recorded as if they're mono, from a single mic with no spatial orientation, but mixed down as two identical stereo channels, because everything expects stereo nowadays and it's easier than trying to dig through the menus for that one weird setting. The result is a voice track that seems to originate from a source that's "nowhere"/somewhere the middle of your head. When the buds slip out of sync, the slight temporal shift effectively becomes a slight shift in stereo phase, which suddenly either makes the voice seem to have a physical location, or be coming simultaneously from a source on either side, depending on how long the delay is. It's interesting on a technical level, but mildly annoying, so I've taken to just sticking one of the buds back into its case if I want to listen to podcasts. Which is what I do most of the time with the ones that hang around my neck anyway, so I can hear the stop announcements on the bus. Ain't technology grand? from Blogger https://ift.tt/2MYCro4 via IFTTT -------------------- Enjoy my writing? Consider becoming a Patron, subscribing via Kindle, or just toss a little something in my tip jar. Thanks!

[tipsycad147]

THORNAPPLE, GENDER AND RITUAL APPLICATION

THORNAPPLE, GENDER AND RITUAL APPLICATION | COBY MICHAEL WARD

Posted on September 16, 2019   By Crooked Bear Creek Organic Herbs

Cultivating the Devil’s Apple aka Thornapple

I spent part of this afternoon harvesting my Thornapple plants.  One of them grew to be close to five feet high!  The Thornapple I grew this year is a Datura stramonium var. tatula; similar to the common Datura stramonium only it is less shrubby and has lavender-purple flowers.  I harvested leaves, seedpods, and stems.  I have a few workshops coming up over Samhain season on different aspects of the Poison Path and like to have the actual plants on hand for anyone interested in working with them.  Part of my bargain with said plants is to make them available to others and teach people how to use them.  All parts of the plant are going to be put to various uses.  The leaves are dried and used for spirit offerings, intense personal cleansing and as spell ingredients.  The stems, when dried become hard and woody making them great for wands, working tools, and ritual fetishes.  Of course, the seeds are spread around for others to grow and I will also be using some to make oil infusions.  The pods, I incorporate into various herbal amulets and also fill with herbs, and seal them with wax to create a loaded jack ball type charm.  It is amazing all of the diverse uses that can be discovered when working with just a single herb.

While spending time harvesting the Thornapple, making it offerings and being pricked by its spines (which usually leaves me itching for a while); I received new insights and inspiration in regards to working with the plant in magic.  Appropriately, I am also taking Harold Roth’s Six Baneful Herbs class online.  The first plant that was discussed was Thornapple.  This discussion really got me thinking about the nature of this plant, in particular, its spirit.  So far I am loving Harold’s class, and look forward to the next few weeks to come!  He will be offering the class in the future, and more information can be found on his website Alchemy Works.

The Non-Binary Nature of Plants Spirits

In some ways, plants are like humans.  Their moods and behaviours changed from day to day, and are often influenced by external factors.  Plant spirits are also very non-human, and trying to describe them in human terms often leaves one with the feeling of chasing smoke.  To say that a plant is primarily masculine or feminine based on its characteristics is one example of this losing battle; while herbs may exhibit some characteristics that could be described as one or the other this is largely a human construct.  Plant spirits are vast and do not fit into human terms.  Even physically many plants have parts that are both male and female.  When it comes to Datura I have heard it being described as very masculine, aggressive and temperamental.  However, I have also seen it described in terms that are considered more feminine.  For example, because of its vespertine nature, it is associated with the Moon, psychic ability, intuition and the sub-conscious-all things that are ruled by more feminine energies.

While some plants are undeniably more fiery and active in their action and others are more watery and passive; I have found that the majority of plants particularly those associated with spirituality and expanding consciousness disrupt the whole gender paradigm.  After exploring these plants on a spiritual, energetic and symbolic level for many years I have come to the conclusion they contain both energies and are defined by neither.

Thornapple as an example, at first glance it appears to be a very masculine plant.  The Stramonium variety has deeply serrated-spiny leaves, and the thorns on its seed pods are very sharp and erect.  When ingested it often causes aggressive behaviour, mood swings, and paranoia.  On the other hand, Thornapple is used as a sedative, a pain reliever and to soothe exhaustion.  Varieties like Datura inoxia have soft-ovate leaves of a dark lush green.  Considering the herb’s esoteric characteristics we are looking at a plant that displays both martial and lunar aspects, while technically being a Saturnian plant.  One of the defining characteristics of Saturn, as seen in the Roman festival of Saturnalia is an inversion of social norms.  Binary gender is a social norm that is currently undergoing a rapid deconstruction.

Considering this, while Thornapple does have these characteristics they can all be applied to the opposite gender that they would initially be associated with.  The martial characteristics, for me, bring to mind the Valkyrie, the shieldmaiden, the Amazonian warrior and Celtic chieftain; all roles filled by women.  On the other hand, I see the wounded-healer, the two-souled shaman, the trickster and the androgynous gods of light and art.  The outdated gender binary is undergoing a Saturnian entropy, a static paradigm being broken down and reborn into something more reflective of our spiritual natures.

Magical Applications and Physical Characteristics

Thornapple has been used in rites of passage by indigenous Americans for centuries.  It is a plant, with the exception of a couple of varieties that are native to the Americas.  Its application as a catalyst for these liminal rites and its role as a gatekeeper to esoteric wisdom make it a powerful ally for aiding transitions, for letting go and for healing the trauma of the past.  I just recently recommended it to a lady who was dealing with anger and other emotional issues related to ancestral trauma.  I think of Thornapple as a “spirit food herb” like tobacco or sweetgrass.  As such, I feel like it is a good offering to appease the spirits, while also utilising its ability to bring catharsis or intense healing.  When taken homeopathically Thornapple (Stramonium) helps to overcome fears, anxiety, anger, and aggression.

Interestingly, Thornapple also has some applications in love magic.  It is a little more coercive, seductive and lusty than some of the more demure and gentle love herbs.  One insight that I’ve had recently is that the seed pods when empty has four chambers.  The same number of chambers that are in the human heart.  This sympathetic connection can be explored in love magic, and also used in rituals to protect one’s heart.  In the same way, the pods could be used in general protection magic, they could be tailored to protect an individual more specifically their heart or emotions through this sympathetic connection.

Like many of the visionary herbs used in otherworld travel and spirit flight, Thornapple has hollow stems.  These are thought to represent the avenues upon which the spirit travels when in flight.  Plant “straws” have been used for blowing sacred smoke and powder, and also for the insufflation of entheogenic herbs a technique called rapé.  Some practitioners may also visualise themselves travelling through these tiny passageways to connect with the plant on a deeper level or access the chthonic realms to bring back wisdom or plant medicine.

Conclusion

In short, these plants have so much to teach us.  I really believe that there is no end to their wisdom.  Even after years of working with specific plants, they continue to share new things about themselves and how we can better partner with them to make positive changes within ourselves and within the world around us.  If you want to read more about Thornapple or Datura, in general, I have another article here.

I have found that the majority of plants particularly those associated with spirituality and expanding consciousness disrupt the whole gender paradigm.The […]

Source: Thornapple, Gender and Ritual Application | Coby Michael Ward

https://goodwitcheshomestead.com/2019/09/16/thornapple-gender-and-ritual-application-coby-michael-ward/

[humanauction]

event terrors chapter 1 (1st final)

The event terrorists

prologue: The Run-in

In the induction they were told not to keep anything they "find" unless expressly told they could do so by Upper Management. not that this theoretical rule would physically be possible. Instant expulsion from site if they did. No recompense for hours completed. Automatic strike from any future work. Details circulated to other crewing companies. In short - immediate exile from the events world. Police involvement optional, dependent upon severity of the offence. And no drugs either. Ever. At all. No drinking on the job, too. They were told those were the rules they had already agreed to contractually. They said:

"Yeah, ok."

*************************************************   *************************************************

                                                              1.

Try and work for 453 hours over 29 days. Then have two days off and do it again. That’s what they do, and when you reach that point, thieving, drinking & drugs are all that keep you going. The first month is the worst - you work hard, dutifully fulfilling every request. with a smile. You are honest, diligent and perform every function to the letter. You are early for work. clean shaven and wearing clean clothes. If you find something of value you return it. You are careful not to break anything. if you do, you report it immediately, apologising profusely to all and sundry. You don't eat food unless it is given to you and even then you only take what you need. You are fair. The worst thing though, is that you believe the finish times you are given when you take each job. you can leave, but don't expect any more work unless someone is desperate for staff. no-one likes the guy who goes home when he was told he could. you have to work until the job is done. prove you are a team player. never mind no-one signed up to be on this team. at times it is like being here is something you entered into out of desire. that these people are your friends. you assume, naively, that the people paying for such excessive amounts of highly skilled and qualified scab labour actually have a clue what they are doing and a budget they need to adhere to. They don't. anything. Eventually this works in your favour, but at first it is just soul crushing. Especially when other staff are sent home in pre-paid taxis, on time. being the first in and the last to leave, you are expected to take multiple night buses home at your own expense.

The only thing worse than the relentless work schedule is the abject boredom it is interspersed with. As a crew they are brighter than they should be. The recession borne jobs void has meant an industry once staffed by students, backpackers and immigrants is now engorged with university educated natives. They don't share the same happy go lucky attitude. They don't see this as a means to an end. They don't look at "any pay at all" as good enough. They want more. And if it isn't supplied, willingly or begrudgingly, then like any intelligent animal they will learn how to help themselves.

By the end of the second month you can't afford anything despite the fact you have been working such long hours you can't possibly have spent much. every pay check is an argument about how many hours you put in for versus hours the clients put in for. you may win a few of these, but just like any good gambling operation, long-term, it never works in your favour. This is when you have to look at ways to supplement your meagre income.

Different people have different ways, but they all break down into one of three basic human categories:-

Firstly, there are the good ones: they work two jobs and pick shifts based on the best pay check. best case for them generally is only getting bent over the desk by the taxman at some stage during the process. and for the old-fashioned, unlucky, stupid, honest - call it what you want - it’s like being squeezed, slowly, to death by a mating ball of anacondas. legal, unfortunately, isn't usually best. not anymore.

second, come the normal ones and they, hence normal, make up the majority. that’s all normal means. if the largest mutually-identifying political group in the United Kingdom (which isn't the same thing as the majority) decided tomorrow that babies were a viable food source you’d be a cannibal by End Of Play this Friday. and if you don't think so, maybe google that famous advert from the 1950’s the “more doctors smoked Camel cigarettes than any other brand” one. or the 2017 British general election - where the conservatives got to run a country because the queen said they could. the queen.

through need or desire, the normal ones, they turn to the sale of contraband “found” at the end of each event. or maybe during set-up. or end of each day. cleaning. service. breakdown… it’s a matter of personal morality. most of the stuff coming up is though. they do what they do, or don’t, for vastly different reasons. there are new dads just trying to feed and clothe their kids and greedy, cowardly even, self-serving wolves hiding amongst the sheep where they think they are safely anonymous. people between jobs but not between owing rent and bills. people there for nothing but personal gain (who do make the competing case: “why else would you go to work?”) or the adrenaline kick of pulling off a heist however big or small. don’t underestimate that, either, that excitement in an otherwise body- and mind-numbing existence. these agency workers are invariably brighter, more competent and better qualified than their temporary bosses.

And that leaves the bad ones. they sell drugs. plain and simple old school racket.

you quickly gather enough food and drink for yourself and you’d be surprised how quickly word gets around a poor community when there’s guilt-free (ideally but not mandatorily) and cheap (mandatory) coffee, lightbulbs, washing liquid, cigarettes, booze… you'd probably be surprised how when the local police get word of it, and they do, and they confront you about it and you admit it (or more likely get caught scarlet-handed) all they want to know is where it came from. and so long as you don't get too greedy at the source that it gets reported and so long as your answer is right - the formula one main kitchen in the wing (it’s a building) VIP lounge storeroom at Silverstone (it’s a race-track) is a good example - then all they are really interested in is:

how many they can have right now for free; how much it’ll cost them after that.

cops, they like to swap stuff so much you could mistake them for the institutionalised members of society they are “busy” catching. but then every dog looks like its owner. cops become what they know best, eventually. cops they tend to have good swap stuff too. so long as good swap stuff to you means drugs. you can ask for something specific once you know them, but they get a bit jittery about handing over anything not designed to be ingested, insufflated or injected in the very near future. you can’t blame them, it’s just good business practice on their part. they only ever want disposable items from you. is this corruption? could be. are their wages and working conditions, yes, even though they are police, starting to reach such dire levels that they have to distinguish between “crime” and “crime”? possibly. would they be buying stolen toilet paper if everything was fine. maybe.

before too long, you're taking orders.

There is another group consisting of the slyest ones, like our heroes :-D they find a way of combining options two and three. already by this stage though it’s so murky - a sea consisting of so many shades of grey.

what counts as a write-off that you can take? what has been given to you that technically shouldn't have been? when can you take it? is ganja ok because it helps people unwind without the hangover? are selling crystal and crack ok because how the fuck else are you not going to collapse? does it matter if your baby is sick? that you’re behind on your mortgage? still live with your mother in your 30s?

Free time (time not working) is usually spent sleeping or slipping into debt. If there was decent regular work they'd get jobs, but there aren't, so they don’t. If you don't work you don't get paid. They are essentially skilled freelance workers on zero-hour contracts, getting agency wages. not so much an individual human being as a commodity. to be traded.

Escapism is the mot de jour, and generally this consists of further self-abuse, only of narcotics and alcohol instead of working 18 hour days. You are so tired you rarely see friends, erstwhile cohorts, old flames. As a member of the new underclass, forming healthy sexual relationships is very difficult too. When they do try, it consists of picking up waitresses, bar staff, pot washers, security guards, porters, cleaners... Chefs don't look at you. management largely ignore you. full-time staff don't know how to treat you. unless you fucked up. then everyone will always be all over that. In the real world everyone can tell you don't have a proper job, a career or whatever, and barely even notice you. Everyone likes you - you understand every demand made of you and do the jobs they don't want to - but you aren't a viable option for anyone. It isn't the rejection you find hard to deal with, as a man you get use to that, but the fact you slowly turn invisible is hard to stomach. You learn humility, you learn not to take life too seriously, you learn what a bunch of sycophantic assholes most of society has become. if you don't live to work, you may as well fuck off and die.

By month three your brain has had too long to think and you know what you can get away with. By month three you know who your mates are. By month three you start to fantasise about ways to not work but still get paid and collect extras instead. If you find survival to be a matter of choices, month three would be when you walk away. That is your prerogative, choice is a wonderful thing, but recently professional choice isn't a luxury most of the people can afford. The wealthy largely don't believe in victims of circumstance. But the poor will remind them of this with increasing regularity when their own position becomes so untenable that they mete out their own disorganised brand of misdirected, periodic, frustration based, revenge. rioting, say. It could cost our society dearly - there aren’t really winners in invisible wars - but when you always seem to have less, you can imagine not having anything. And if you think about it, you probably don't have much to lose now. When whole generations are written-off as lost causes, people, especially the young, will presumably and  increasingly look at ways of improving their immediate situation. A future even potentially able to provide success and prosperity through education and hard work has become an outdated concept. Morality becomes something measured only against your immediate peer group rather than including the society you live in as a whole. The populace desire consumable goods that provide only, albeit instant, short-lived gratification - trainers, TV's, alcohol, cigarettes, McDonalds, WiFi. These are the targets we now aspire to, the bar having been dropped to such impossibly low levels. Too many fundamentally good citizens live day to day to worry about tomorrow now. When you live like this, you get things and save money wherever you can.

***

END CH. 1

(c) HUMAN AUCTION

[rahangdale123-blog]

Global CO2 Insufflator Market Positive Demand and & Development Approaches through 2019-2024

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JuniperPublishers-Redo Mitral Valve Replacement through Right Thoracotomy on Beating Heart

Journal of Surgery-JuniperPublishers

Abstract

Redo mitral surgery via sternotomy can be associated with significant complications, including injuries to the heart, great vessels and patent coronary artery grafts, especially internal mammary artery leading to excessive blood loss, and may increase morbidity and mortality in these patients [1]. The right antero-lateral thoracotomy offers excellent exposure with less risk from re-entry associated complications. This approach is particularly valuable in patients with patent coronary bypass grafts avoiding the risk of perioperative graft injury. Resternotomy after coronary artery bypass grafting (CABG) is a technically challenging situation, especially in the presence of patent grafts. In this case report we present a case with a previous coronary bypass grafting along with mitral valve repair 15 years back, and stenting to left anterior descending artery (LAD) 2 years ago. Patient underwent on-pump beating heart normothermic mitral valve replacement without cross-clamping the aorta through right anterolateral thoracotomy.Keywords: Redo Mitral Valve; Beating Heart; Right ThoracotomyGo to

Case Report

A 58 year old female presented with increasing shortness of breath. Patient had history of coronary bypass surgery and mitral valve repair 5 year back. The patient had New York Heart Association class 4 symptoms. Transthoracic echocardiography showed severe mitral regurgitation. Coronary angiography and CT cardiac showed patent saphenous vein graft to diagonal and posterior descending artery and atretic and thinned out LIMA graft, patent LAD stent (Figures 1 & 2). Patient had right anterolateral thoracotomy through 4th intercostal space. Left atrium was opened through sulcus of sondergord. The ascending aorta and right atrium was used for cannulation. The ascending aorta and right superior pulmonary vein was vented for deairing and to maintain a bloodless surgical field. The surgery was performed under normothermic cardiopulmonary bypass without aortic cross clamping. The mitral valve was thickened fibrotic appeared to be rheumatic, and was not suitable for repair. Annuloplasty ring and anterior leaflet of the mitral were valving excised (Figures 3-5). The mitral valve replacement was done with 25 hancock 2 bioprosthetic valve using interrupted pledgeted sutures (Figure 6). The CPB time was 68 minutes. Postoperative bleeding was 250 ml and patient was extubated after three hours. Post-operative period was uneventful and the patient was discharged on the sixth postoperative day.

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Discussion

As life expectancy is increasing reoperative cardiac surgery continues to increase, techniques that are safe and easily reproducible should be adopted. Redo cardiac surgery is technically challenging due to increased rate of perioperative morbidity and mortality [2,3]. Redo mitral valve surgery is increasing because of increase of mitral valve repair and increasing use of bioprosthetic valve replacement over past few decades and these patients are coming for reoperation over the period of time. Resternotomy has its own inherent risk of injury to previous patent grafts, which can be catastrophic, injury to cardiac structures and great vessels [4]. It minimizes dissection of adhesions, avoids injury to right ventricle and prevents damage to patent grafts, which translates into reduced blood loss, less blood transfusions and expedited recovery [5]. Besides the above mentioned advantage beating heart repair/ replacement prevents myocardial damage caused by ischemiareperfusion injury by normothermic continuous myocardial perfusion.Normothermic perfusion also reduces the coagulopathy [1]. Through this approach pericardial dissection is limited to left atrial incision, which is quite safe and also saves time. It also provides good exposure to mitral valve with only moderate retraction. But this approach can have some disadvantages also. The major challenge while the heart is kept beating is to provide a relatively bloodless operative field, which can be achieved by putting sump suckers in left atrium and left ventricular venting. Another area of concern is the risk of air embolism. Trendlenberg position, continuous aortic venting, use of carbon dioxide gas insufflations of the operative field, vacuum assisted drainage are useful methods for preventing air embolism [1,6]. Ricci and colleagues in their series reported no incidence of neurological deficit due to air embolism [7]. According to Romano et al, right anterolateral thoracotomy mitral valve surgery in a redo case without cross clamping on the beating heart is associated with shorter bypass time, less post operative transfusion requirements, shorter postoperative ventilation, and lower mortality than with conventional surgery [8].Go to

Conclusion

Redo on-pump beating normothermic mitral valve replacement without cross-clamping the aorta through right anterolateral thoracotomy is a simple and safe procedure, especially in patients with patent bypass grafts.

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