病人坐着移除頸靜脈導管

November 27, 2010 at 12:03 am | Posted in medicine | Leave a comment
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另外一宗事故,為一名70歲要洗腎的病人,接受移除頸靜脈導管時,按一名初級醫生吩咐,坐着讓對方移除頸靜脈導管,但病人在移除導管後不久,覺得頭暈及沒有感覺,電腦掃描顯示病人出現頸動脈栓塞。病人接受高壓氧氣治療後,已康復出院。

醫管局指出,負責的初級醫生經驗不足,沒有意識到有關風險,為病人移除頸靜脈導管,應讓病人保持仰臥,或頭部向下的姿勢。報告建議要提高醫護人員對移除導管的風險警覺,以及加強對初級醫護人員的監督。

Total Thyroidectomy

January 8, 2010 at 1:50 am | Posted in medicine, thyroidectomy | Leave a comment
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During total thyroidectomy for papillary carcinoma, bilateral parathyroid galand can be preserved. Ten milliliters of 10% solution (1 g) of calcium gluconate may be administered over 10 minutes.  10ml10% calcium gluconate ivi q8h.  A calcium infusion may be started at a rate of 1-2 mg/kg/h if symptoms do not resolve. Titrate the infusion to the patient’s symptoms and calcium levels. Start oral calcium when the patient is able to tolerate it. One to two grams of elemental oral calcium should be supplied each day. Calcium carbonate 1250 mg provides 500 mg of elemental calcium; therefore, the patient should take 2500-5000 mg/day. The patient needs concomitant replacement of vitamin D with calcitriol (Rocaltrol) 0.25-1 mcg/d.

父母患有抑鬱症的子女有半數以上也出現抑鬱症徵

August 5, 2009 at 3:27 am | Posted in medicine | Leave a comment

【商台互動國際組】都市人每天都為工作、家庭、感情等複雜事情纏繞,心理健康容易受影響,其中患上抑鬱症、狂燥症的朋友人數遠比我們想像中為高。然而,原來這種都市問題並不只困擾着成年人,據美國一項調查所得,現在連三歲的小朋友也可能患上抑鬱症(Major Depressive Disorder, 或簡稱Depression),情況令人擔心。 數據顯示,1996至2005年期間,美國服用抗抑鬱藥的人數倍增,而到了08年,醫生所開出的抗憂鬱藥處方更多達1.64億張,突顯出問題的嚴重性。 華盛頓大學精神科團隊過去兩年,為200多名三歲至六歲的兒童進行了跟進研究,定期為他們進行精神檢查。結果發現,其中有75名小朋友被診斷出患有抑鬱症。而跟進的調查更發現,半年後抑鬱症狀持續或復發的小朋友多達六成四,而調查結束時,仍有四成兒童患有憂鬱症。 一般抑鬱症為人悲觀,長期情緒低落兼且容易緊張煩躁多憂慮,甚至經常感到絕望、缺乏自信,甚至有罪惡感,嚴重的可能有自殺傾向。此外身體極易疲倦,食欲不振,及出現失眠或過度睡眠等徵狀。至於學齡前的患者則比較情緒化及易發脾氣,而且他們在玩耍時也顯得特別悲傷,而且玩耍的遊戲亦多含有陰鬱的主題。幸而許多都會在玩耍過後或日常活動時情緒回復平穩。 其實在七月中,本港的一項調查亦發現,父母患有抑鬱症的子女有半數以上也出現抑鬱症徵

Limit of FNA cytology in diagnosis of thyroid tumor

June 6, 2009 at 11:26 am | Posted in medicine | Leave a comment

Microarray Analysis of Thyroid Nodule Fine-Needle Aspirates Accurately Classifies Benign and Malignant Lesions

Carrie C. Lubitz*, Stacy K. Ugras*, J. Jacob Kazam{dagger}, Biaxin Zhu*, Theresa Scognamiglio{ddagger}, Yao-Tseng Chen{ddagger} and Thomas J. Fahey, III*§

Although FNA has greatly increased the preoperative diagnostic accuracy of thyroid nodules throughout the past few decades, significant limitations remain. The majority of FNAs performed are classified as benign, while 5 to 10% are classified as malignant.4, 5, 6, 7 However, a subset of 10 to 20% of FNAs are found to be nondiagnostic, frequently secondary to cystic or hemorrhagic fluid and resultant hypocellularity in the aspirate.8, 9 An additional 10 to 20% of FNAs are classified as indeterminate or suspicious, diagnoses that typically include follicular neoplasms and atypical lesions (suggestive of, but not diagnostic for, malignancy). Only one in five of these cases diagnosed as indeterminate will prove to be malignant at surgery. The inability to classify follicular lesions by cytology (which requires nodule architecture for diagnosis), varying extent and spectra of nuclear pleomorphism allowing for subjectivity during histological examination, lack of specific classification algorithms, and fear of liability have all been cited for the difficulty in categorizing this intermediate group.10, 11

CSF rhinorrhoea

May 10, 2009 at 3:10 am | Posted in medicine | Leave a comment
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Fluid leaking from the nose or external auditory canal must first be positively identified as CSF. Drops of fluid from a CSF leak placed on absorbent filter paper may result in the double-ring sign, which is a central circle of blood and an outer clear ring of CSF. Results of glucose, chloride, and total protein tests of the fluid are not specific or conclusive for CSF.

抗 萬 古 霉 素腸 道 鏈 球 菌 帶 菌 者

April 2, 2009 at 1:11 pm | Posted in medicine | Leave a comment
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瑪 麗 醫 院 表 示 , 一 名 77 歲 腦 外 科 男 病 人 確 診 為 抗 萬 古 霉 素腸 道 鏈 球 菌 帶 菌 者 。 院 方 按 既 定 感 染 控 制 程 序 , 隔 離 同 期 住 院 的 同 房 病 人 , 並 跟 進檢 查 。 該 病 房 至 今 先 後 有 2 名 男 病 人 及 1 名 女 病 人 , 確 定 為 帶 菌 者 。 現 時 3 名 病 人 情 況 穩 定 , 正 接 受 進 一 步 觀 察 及 隔離 治 療 , 所 有 帶 菌 者 皆 沒 有 感 染 情 況 。 院 方 已 通 知 病 人 家 屬 有 關 情 況 , 並 已 根 據 既定 指 引 加 強 預 防 感 染 措 施 。 院 方 正 繼 續 為 其 他 相 關 病 人 進 行 測 試 , 正 等 待 結 果 。 院 方 已 通 知 醫 院 管 理 局 及 衞 生 防 護 中 心 跟 進 。

115: A reasonable life expectance for everyone in 21th century?

November 28, 2008 at 2:51 am | Posted in medicine | Leave a comment
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Indiana woman dies at 115 as world’s oldest person

SHELBYVILLE, Ind. (AP) — Edna Parker, who became the world’s oldest person more than a year ago, has died at age 115.

UCLA gerontologist Dr. Stephen Coles said Parker’s great-nephew notified him that Parker died Wednesday at a nursing home in Shelbyville. She was 115 years, 220 days old, said Robert Young, a senior consultant for gerontology for Guinness World Records.

Parker was born April 20, 1893, in central Indiana’s Morgan County and had been recognized by Guinness World Records as the world’s oldest person since the 2007 death in Japan of Yone Minagawa, who was four months her senior.

Coles maintains a list of the world’s oldest people and said Parker was the 14th oldest validated supercentenarian in history. Maria de Jesus of Portugal, who was born Sept. 10, 1893, is now the world’s oldest living person, according to the Gerontology Research Group.

Parker had been a widow since her husband, Earl Parker, died in 1939 of a heart attack. She lived alone in their farmhouse until age 100, when she moved into a son’s home and later to the Shelbyville nursing home.

Although she never drank alcohol or tried tobacco and led an active life, Parker didn’t offer tips for living a long life. Her only advice to those who gathered to celebrate when she became the oldest person was “more education.”

Study Suggests Some Cancers May Go Away

November 25, 2008 at 12:57 pm | Posted in medicine, oncology | Leave a comment
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By GINA KOLATA

The study was conducted by Dr. H. Gilbert Welch, a researcher at the VA Outcomes Group in White River Junction, Vt., and Dartmouth Medical School; Dr. Per-Henrik Zahl of the Norwegian Institute of Public Health; and Dr. Jan Maehlen of Ulleval University Hospital in Oslo. It compared two groups of women ages 50 to 64 in two consecutive six-year periods.

One group of 109,784 women was followed from 1992 to 1997. Mammography screening in Norway was initiated in 1996. In 1996 and 1997, all were offered mammograms, and nearly every woman accepted.

The second group of 119,472 women was followed from 1996 to 2001. All were offered regular mammograms, and nearly all accepted.

It might be expected that the two groups would have roughly the same number of breast cancers, either detected at the end or found along the way. Instead, the researchers report, the women who had regular routine screenings had 22 percent more cancers. For every 100,000 women who were screened regularly, 1,909 were diagnosed with invasive breast cancer over six years, compared with 1,564 women who did not have regular screening.

There are other explanations, but researchers say that they are less likely than the conclusion that the tumors disappeared.

The most likely explanation, Dr. Welch said, is that “there are some women who had cancer at one point and who later don’t have that cancer.”

breast cancer may disappear on its own
breast cancer may disappear on its own

Off label drug

November 25, 2008 at 2:56 am | Posted in medicine | Leave a comment
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http://en.wikipedia.org/wiki/Off-label_use
Off-label use is the practice of prescribing pharmaceuticals for a purpose outside the scope of a drug’s approved label, most often concerning the drug’s indication. In the United States, the Food and Drug Administration (FDA) requires numerous clinical trials to prove a drug’s safety and efficacy in treating a given disease or condition. If satisfied that the drug is safe and effective, the drug’s manufacturer and the FDA agree on specific language describing dosage, route and other information to be included on the drug’s label. More detail is included in the drug’s package insert.

However, once the FDA approves a drug for prescription use, they do not attempt to regulate the usage of the medicine, and so the physician makes decisions based on her or his best judgment. It is legal in the United States and in many other countries to use drugs off-label, including controlled substances such as opiates, even though it is a common misconception that it is unlawful to do so. Actiq, for example, is commonly prescribed off-label even though it is a Schedule II controlled substance. However, it is unlawful to market, advertise or otherwise promote the off-label use of drugs, including controlled substances.

Options beyond statins

November 17, 2008 at 2:15 pm | Posted in health care, medicine | Leave a comment
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http://www.boston.com/news/health/articles/2008/11/17/options_beyond_statins/

There is, they said, sound evidence that exercise and a healthy diet can lower levels of inflammation as measured by the high-sensitivity C-reactive protein test, known as hs-CRP. But – and this is where it gets a bit tricky – it has yet to be proved beyond a doubt that patients who reduce their inflammation levels through lifestyle changes have fewer cardiovascular emergencies.

Still, when Dr. Paul Ridker tells patients they have scored dangerously high on the test he created, this is his recommendation:

“The first, second, third, and fourth intervention for anyone with elevated hs-CRP is get to the gym, lose a few pounds, throw away the cigarettes, and start thinking about a healthier diet,” Ridker said. “That remains overwhelmingly the most important intervention for lowering cardiovascular risk.”

Just how important? A 2006 study by University of Massachusetts Medical School researchers showed people with fiber-laden diets were 63 percent less likely to have inflammation problems than people whose diets were low in fiber. An Italian study had similar findings, saying patients who consumed lots of whole grains, fruits, vegetables, and nuts significantly reduced their inflammation readings.

Dr. Ira S. Ockene, a preventive cardiology specialist at UMass and an author of the fiber study, said 30 grams of fiber is considered the benchmark for a healthy diet. You can get as much as one-third of that, he said, by eating a hearty bowl of pea soup.

“And if you want to lower your CRP and you have a big gut,” he said, “the best thing to do is to exercise and lose weight. When you lose weight, a whole bunch of good things happen.”

While researchers long recognized that physical activity reduces risk of heart attacks and strokes, the underlying reasons were not always so clear. A Brigham study last year yielded important clues, finding that lower inflammation levels matter most.

It doesn’t take a lot of exercise, Ridker said: A half-hour a day of aerobic exercise will do.

“I take a fair number of patients who travel quite a bit, and I tell them, ‘It’s as important to put your sneakers in your briefcase as it is your laptop,’ ” Ridker said.

It makes a world of sense that exercise and diet should contribute to reducing inflammation and, by extension, heart attacks and stroke, said Dr. Michael Lauer, of the National Heart, Lung, and Blood Institute.

“But I have to be honest,” Lauer said, “this is a hypothesis at this time – and a very good hypothesis – but I don’t think it’s a proven one.” And it won’t be, he said, until a study demonstrates for sure that an inflammation-reducing lifestyle changes result in fewer heart attacks and strokes.

At Cleveland Clinic, doctors don’t just preach about exercise and diet; they take patients on outings to restaurants to reinforce good habits. Patients are asked to be honest about whether they’re likely to heed the advice to eat well and exercise.

For some patients, “pills are an answer, but it’s not all of the answer,” Cho said. “I tell my patients all the time that pills are supplements, not substitutes, for a healthy lifestyle.”

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