外科病理学超越自我发展的思考

病理学是一门以组织形态学研究为基础的学科,经历了二百多年的发展历程.外科病理学作为病理学的重要部分,密切联系临床,以临床需要为方向,在医疗活动中充当着重要的角色,发挥着重要作用.随着免疫组织技术、基因芯片及组织芯片技术、图像分析技术、数字化图像技术、网络技术、流式细胞学技术等出现和应用,外科病理学在医疗活动中的权重日益增加,其中很多内容已远远超出病理形态学本身,向细胞分子,DNA,基因改变方向发展.     

皮肤缺损与皮瓣修复治疗的分析与思考

皮瓣移植是整形外科治疗皮肤缺损的重要方法.为皮瓣修复治疗更好的临床效果,需要在正确分析病情的基础上,兼顾医疗技术,关注预后,把握皮瓣修复治疗的指征;同时注重疾病的系统和综合治疗,并不断进行理论创新、技术创新,以促进皮瓣外科的发展.唯物辩证法的矛盾论、系统论和发展现对临床治疗具有普遍的指导意义.     

外科患者安全、医疗缺陷和并发症

在医疗工作中,由于客观存在的各种医疗缺陷、过失,甚至错误,会引起各种并发症,影响着患者安全。在以往常注意到了医疗工作中所发生的各种并发症的结果,但是没有或较少重视发生这些并发症的过程,以及在此过程存在的缺陷。在外科领域中,应注意可能发生外科并发症的环节和过程,尽量避免医疗缺陷,同时还要注意开展新技术,减少因技术能力不足带来的伤害;减少侵害性医疗干预。     

生物医学工程与医学结合的途径与突破口

生物医学工程是一门高度综合性的学科 ,它不仅是工程技术在生物学和医学上的应用 ,而且是以对人的生命运动的认识为核心的多学科的综合。目前国内外生物医学工程的发展十分迅速并已取得很大成绩 ,远程医疗经过几十年的发展 ,已经由模拟时代转入数字化时代 ,数字通信以其抗干扰能力强 ,在传输过程中不会引入新的噪音 ,可以保证医学图像无任何损失地传输 ,从而最大限度地减少因技术原因引起的误诊 ,医疗外科机器人系统的研究为提高手术的质量 ,减少手术创伤 ,缩短病人的恢复周期 ,降低病人和医院的开支等方面提供了新的办法 ,也改变着传统医疗…     

外科患者安全、医疗缺陷和并发症

在医疗工作中,由于客观存在的各种医疗缺陷、过失,甚至错误,会引起各种并发症,影响着患者安全.在以往常注意到了医疗工作中所发生的各种并发症的结果,但是没有或较少重视发生这些并发症的过程,以及在此过程存在的缺陷.在外科领域中,应注意可能发生外科并发症的环节和过程,尽量避免医疗缺陷,同时还要注意开展新技术,减少因技术能力不足带来的伤害;减少侵害性医疗干预.     

体外循环技术临床研究和应用的进展

体外循环技术因心血管外科的发展需要而产生,又随着心血管外科的发展而不断进步,并且推动着心血管外科向更高深的领域开拓;与此同时,体外循环的仪器设备,也随着科学技术的发展,在不断地研发和更新换代,为临床上利用体外循环技术提供了更安全、更有效的保障,因此,其应用范围几乎渗透发展到临床各个领域,应用前景相当广阔。     

我国医疗技术管理现状及卫生政策反思

医疗技术突破性发展在丰富临床诊治手段的同时,也带来了一系列负面效应。其中探索性、限制性医疗技术的滥用与适宜技术推广力度不够的现象并存,是当今医疗技术管理乱象的主要表征,这主要归咎于医改的市场化、立法的缺失、医疗保障制度设计的缺陷和价格管理的漏洞。建立应对医疗技术快速发展的良性管理系统需要从强化政府宏观调控、构建医疗技术组织管理体系、建立科学合理的卫生技术评估体系、加强医疗机构动态监管及跟踪评估到完善相关法律法规入手,以实现医疗技术管理的法治化。     

体外循环技术临床研究和应用的进展

体外循环技术因心血管外科的发展需要而产生,又随着心血管外科的发展而不断进步,并且推动着心血管外科向更高深的领域开拓;与此同时,体外循环的仪器设备,也随着科学技术的发展,在不断地研发和更新换代,为临床上利用体外循环技术提供了更安全、更有效的保障,因此,其应用范围几乎渗透发展到临床各个领域,应用前景相当广阔.     

微创外科与人文关怀

微创技术是医疗技术发展的重大进步。“人文关怀”的哲学思想始终贯穿微创外科发展之中,人文关怀的哲学基础是以人为本和人本主义思想。“以人为本”体现在外科治疗过程中“以病人为主体”,促进医务人员主观能动性的发挥,有利于“以人为本”的目的实现。     

微创外科与人文关怀

微创技术是医疗技术发展的重大进步."人文关怀"的哲学思想始终贯穿微创外科发展之中,人文关怀的哲学基础是以人为本和人本主义思想."以人为本"体现在外科治疗过程中"以病人为主体",促进医务人员主观能动性的发挥,有利于"以人为本"的目的实现.     

Cortical Language Mapping in Epilepsy: A Critical Review

One challenge in dominant hemisphere epilepsy surgery is to remove sufficient epileptogenic tissue to achieve seizure freedom without compromising postoperative language function. Electrical stimulation mapping (ESM) of language was developed specifically to identify essential language cortex in pharmacologically intractable epilepsy patients undergoing left hemisphere resection of epileptogenic cortex. Surprisingly, the procedure remains unstandardized, and limited data support its clinical validity. Nevertheless, ESM for language mapping has likely minimized postoperative language decline in numerous patients, and has generated a wealth of data elucidating brain–language relations. This article reviews the literature on topographical patterns of language organization inferred from ESM, and the influence of patient characteristics on these patterns, including baseline ability level, age, gender, pathology, degree of language lateralization and bilingualism. Questions regarding clinical validity and limitations of ESM are discussed. Finally, recommendations for clinical practice are presented, and theoretical questions regarding ESM and the findings it has generated are considered.     

4例肾上腺区局限性Castleman病临床诊治分析

探讨肾上腺区局限性Castleman病的临床特点及诊治方法。回顾性分析4例经术后病理证实的肾上腺区局限性 Castle-man病患者的临床资料,并结合文献复习讨论Castleman病的临床特点及诊治方法。结果4例肾上腺区局限性Castleman病均顺利手术切除,术后随访1个月～22个月,未见肿瘤复发。Castleman病临床上少见,表现为不明原因的淋巴结肿大,临床表现无特异性,最终确诊依靠病理诊断。病变可发生在淋巴组织的任何部位,肾上腺区罕见,手术切除为首选治疗。     

Gastric pathology and feeding deficits induced by hypothalamic damage in rats: effects of lesion type, size, and placement.

Three doses each of cathodal or anodal direct current were delivered to coagulate lateral hypothalamic tissue bilaterally in rats. Increases in hypothalamic tissue damage were associated with more instances of aphagia, greater amounts of glandular, but not rumenal, gastric pathology, and greater weight loss. Both anodal and cathodal lesions produced aphagia and similar amounts of gastric pathology, but anodal lesions also appeared to facilitate weight loss independently of the tissue damage. Extensive chromatolysis surrounding anodal lesion cavities may be importantly related to the postoperative effects. In additional experiments, anodal electrolytic lesions or cortical suction ablations were used to vary the location of neural damage. Fedding deficits and gastric pathology resulted from the destruction of several brain areas. In particular, eating of dry food in the presence of high gastric pathology was observed in rats with lesions ventral and medial to an area in the dorsolateral hypothalamus that was associated with aphagia. When aphagia was accompained by severe gastric pathology, the brain lesions typically encroached extensively on more ventromedial areas. Moreover, aphagia sometimes was observed with only negligible gastric pathology. It is suggested that gastric pathology is not primary to the expression of the aphagia that follows lateral hypothalamic damage.     

Identifying Personality Pathology Associated With Major Depressive Episodes: Incremental Validity of Informant Reports

Major limitations are associated with the use of a single source of information to assess personality pathology. The construct validity of standardized interviews and informant reports on personality pathology has been established relative to other measures of personality pathology, but it is also important to consider these measures in relation to other constructs that should be related to personality pathology. One example is major depression. In this study, we evaluated whether less common clinical methods of assessment for measuring the same personality pathology constructs, including semistructured interviews and informant reports, demonstrate unique validity, using major depressive episode (MDE) as the external criterion. This analysis focuses on a representative, community-based sample of 1,437 participants and informants. We conducted a hierarchical logistic regression analysis and determined the order of entering the predictor variables based on likelihood of being used in a clinical setting as well as empirical recommendations. Each step of our regression model significantly increased our ability to predict lifetime MDE, including self, interviewer, and informant reports of personality pathology. Overall, these findings indicate that multiple sources of personality assessment provide unique information about the relationship between maladaptive personality traits and a history of MDE. Thus, semistructured diagnostic interviews and informant reports can be used as a resource to improve the validity of personality assessments.     

The weighing of pathological and non-pathological information in clinical judgment

On the basis of the classic data of Meehl (1959), I examine how clinical psychologists use the MMPI scales to judge the degree of pathology of psychiatric patients by comparing linear models of the judgment to a linear model of the criterion (the actual diagnosis of the patients). This comparison reveals that excessively heavy weight is assigned to pathological information in comparison to non-pathological information. Additional analyses reveal that this biased weighing also influences the actual diagnosis and that it is a major determinant of the accuracy of clinical judgment. It is suggested that these effects arise from a confirmation bias associated with the hypothesis that a patient has severe, rather than mild, pathology.     

生物工程领域的崭新前沿--组织工程

组织工程是在组织水平上操作的生物工程,主要致力于组织和器官的形成和再生,它是对外科领域中组织、器官缺损和功能障碍传统治疗方法和模式的一次革命。同时组织工程是一门多学科交叉的边缘学科,将是２１世纪具有巨大潜力的高技术产业,必将产生巨大的社会和经济效益。     

探讨甲状腺结节内钙化对甲状腺癌的临床意义

为探讨甲状腺结节内钙化与甲状腺癌的关系,本文对手术病理证实的145例212个甲状腺钙化结节超声声像图表现进行回顾性分析,按照钙化的大小、形状及位置进行分型,统计癌性结节与非癌结节出现各类钙化的比例。结论为甲状腺良、恶性肿瘤均可出现钙化,位于内部、斑点状、针尖样或砂粒样的微钙化结节往往提示恶性可能。超声检查对诊断甲状腺疾...     

Three-dimensional scapula kinematics and shoulder function examined before and after surgical treatment for breast cancer

Shoulder motion loss following surgical treatment of breast cancer is common and may be associated with surgery-related soft tissue changes and altered shoulder kinematics. Knowledge of short term biomechanical changes at the shoulder will inform treatment decisions and may help prevent the development of shoulder pathology. Shoulder motion loss following surgery also impacts quality of life and shoulder function, and measuring function with a shoulder-specific tool may direct rehabilitation. This study examined the short term effects of surgery on scapula kinematics and function in breast cancer survivors. Bilateral three-dimensional scapular kinematics were quantified before and after surgery for unilateral breast cancer and analyzed with repeated measures ANOVA. Shoulder function was assessed with the Shoulder Rating Questionnaire (SRQ) and analyzed with ANOVA. Subjects (n = 11) demonstrated statistically significant increases in scapula internal rotation on their involved side following surgery. An intention to treat analysis on all enrolled subjects supported this finding. The findings suggest that soft tissues restrictions impact short-term scapula motion following surgery for breast cancer. Significantly poorer shoulder function was reported for pain, recreation/athletic activities and total SRQ score after surgery. The SRQ appears sensitive enough to identify areas of life affected by changes in shoulder function following surgical intervention for breast cancer.     

Interoceptive Awareness and Suicidal Ideation in a Clinical Eating Disorder Sample: The Role of Body Trust

Previous research has demonstrated that both suicidal ideation (SI) and eating disorders (EDs) are associated with poor interoceptive awareness (IA). Suicidality research has demonstrated that the IA dimension of lower body trust is associated with SI, suicide plans, and suicide attempts. Similarly, in ED samples, recent research supports that low body trust has been the most robust dimension of IA associated with eating pathology. However, to date, research is lacking in how dimensions of IA may be associated with SI in an ED sample, above and beyond the impact of eating pathology on SI. Thus, in a clinical ED sample, the present study sought to determine which IA dimensions predict the presence and severity of SI, above and beyond ED symptoms. Participants (N = 102) completed a clinical interview assessing SI and self-report assessments including the Multidimensional Assessment of Interoceptive Awareness (MAIA). Results demonstrated that patients with current SI reported greater ED psychopathology, lower MAIA Attention Regulation, MAIA Self-Regulation, and MAIA Trusting scores compared to patients without SI. Higher ED psychopathology and lower MAIA Attention Regulation, Self-Regulation, and Trusting subscale scores were all significantly associated with the presence of SI. However, only low MAIA Trusting scores predicted the presence of SI, above and beyond covariates (age, depression, and eating pathology). No MAIA subscales were correlated with the severity of SI. Consistent with previous research, results suggest low MAIA Trusting scores may be associated with SI in ED samples and highlight the need for future research on mechanisms of these associations.