异位妊娠诊治的临床思考

异位妊娠是妇产科常见急症之一,也是目前早期妊娠妇女死亡的首要原因。其检查方法多种,治疗也趋于多样化。在异位妊娠的诊治中,我们应从整体上认识了解患者,掌握疾病的发展变化,作出最佳的诊治方案,并随时根据病情发展变化,对诊治方案做出相应的合理的改变。     

疾病难治原因面面观——一个临床医生的体会

疾病的治疗有难有易,而造成疾病难治的因素也是多样性的,有主观因素和客观因素之分。客观因素是指不依赖于医务人员主观意识而客观存在的情况和事实,主要是病情、患者、治疗的特点造成的难治。而主观因素是指医务人员的认识和决定,具体来说是由于医务人员的素质、能力、知识缺陷造成对临床资料的处置、病情评估或药学评估的不当所引起的难治。...     

脓毒症研究的综合思路

脓毒症是一种发病急、病情进展迅速、病死率高的危重疾病,长期以来脓毒症的本质及概念一直混淆不清.对脓毒症发病机理认识的深入、脓毒症概念的更新以及治疗方法的扩展都贯穿着综合思路,体现了当代医学发展的综合特征.脓毒症仍是危重病医学研究的热点及难点问题,未来研究的发展仍需以综合的思路来指导.     

脓毒症研究的综合思路

脓毒症是一种发病急、病情进展迅速、病死率高的危重疾病,长期以来脓毒症的本质及概念一直混淆不清。对脓毒症发病机理认识的深入、脓毒症概念的更新以及治疗方法的扩展都贯穿着综合思路,体现了当代医学发展的综合特征。脓毒症仍是危重病医学研究的热点及难点问题,未来研究的发展仍需以综合的思路来指导。     

证与病、体质关系的探讨

中医学中的“证”包含着对疾病、药物及体质等多方面相互作用的认识,关于病及体质失衡的知识是构成证的两大基本内容;现代医学是一种暗含所有人体质都相同的简化理论,在现代对疾病认识的基础上,从疾病与体质相互作用角度来研究人体与疾病,可以获得更全面的认识,从而弥补现代疾病理论的不足,是现代疾病理论的发展方向.     

走出不孕症诊断误区的新思维

走出不孕症诊断误区的新思维空军吉林医院妇产科（吉林市１３２０１１）王冬指导傅乃　一、一个值得重视的问题据国内外文献报道,不孕症的发病率占育龄妇女的６一１７％,平均１０％,美国调查结果表明不孕症占已婚妇女１０％,这组数字无疑能够说明此病在妇产科疾病中的...     

试论小儿肾脏病研究的发展方向

小儿肾脏疾病是儿科临床上的常见病与多发病。1987年对全国 2 1省市地区 2 2 4 2 91名 2～ 14岁儿童进行尿筛查结果发现 ,泌尿系统疾病患儿占总受检人数的 0 83%。据此估计我国约有 30 0万儿童患有各种泌尿系统疾病 ,严重地危害了我国儿童的身心健康。其中有相当一部分患儿病情反复迁延不愈 ,最后发展至终末肾。因此 ,小儿肾脏病研究究竟应走向何处 ,才能解除肾脏病患儿的身心痛苦 ,成为摆在我们每位儿科肾脏学工作者面前的严峻课题。1　基因组学的发展为彻底解除肾脏病的困扰带来了一丝曙光早年由于肾脏病免疫学基础的认识、肾活体组织检…     

论疾病治疗的自然观

人体本身对各类疾病有着强大的自我抵制和修复能力,疾病的发生和康复有其自然的进展规律,治疗疾病的过程应遵循相关规律,并辅助人体的这些能力去促进机体的修复。而现实医疗中,人们在享受医学科技成果和医疗保障实惠的同时,常常伴有过度的医疗处置或过度忽视疾病的存在,从而影响疾病本身的自然康复进程,或加重病情,甚至造成二次伤害。本文从疾病治疗自然观的角度探讨了医生和患者在应对疾病时需了解的辩证思想,并就如何认识和应用疾病治疗的自然观去诊治疾病做一探讨。     

超氧化物歧化酶与疾病关系的探讨

超氧化物歧化酶(superoxide dismutase,SOD)是避免细胞损害的一种重要的抗氧化酶.对近年来有关SOD与疾病关系的研究进行分析整理后,认为SOD含量随病情的发展而变化,动态监测对判断病情及观察疗效有一定的指导作用.在慢性病的病程发展中,联合检测SOD、NO和MDA更有价值.     

从误诊病例看综合理念对临床诊断的意义

人类对疾病的认识需要一个过程,故误诊是医学发展的正常现象。但对于那些可知可预见的疾病则应避免误诊。从临床误诊病例中分析误诊的主观原因有医生认识不足、思路狭窄、经验主义等。只有综合思维、辩证分析、不断学习,才能最大限度避免误诊。     

以难治病临床疗效为导向的中医病因病机创新研究

中医学是临床实践很强的经验医学,临床实践一直是中医理论创新的源泉,现代中医理论创新研究必须基于临床疗效为导向,以中医有治疗特色的重大疾病和难治病为突破口,借鉴现代科学和技术,深入开展证候构成要素的中医病因病机研究。中医病因病机既是构成病证的核心要素,又深刻揭示了病证的本质,它体现中医整体观、辨证论治的思维,是中医治病理论的结晶和精华浓缩,抓住重大疾病和难治病中医病证病因病机的本质和核心问题进行现代研究,必将导致中医药理论的重大创新和发展。     

The clinical overlap between the corticobasal degeneration syndrome and other diseases of the frontotemporal spectrum: three case reports

The corticobasal degeneration syndrome has been suggested to be part of a complex of conditions (including the different subtypes of frontotemporal dementia and progressive supranuclear palsy), which reflect a spectrum of pathological substrates. This concept is supported by the frequent clinical overlap that can be observed among patients diagnosed with these conditions. We report three clinical cases, characterized by the overlap of the clinical features of corticobasal degeneration syndrome with, respectively, nonfluent progressive aphasia, progressive supranuclear palsy and semantic dementia. Current diagnostic criteria emphasize differences in clinical presentation, which probably reflect the preferential location of pathology in the early stages of disease. However, with disease progression, a considerable clinical overlap can be expected among the different syndromes. This concept should be extended not only to the cognitive and behavioural features of the frontotemporal dementia subtypes, but also to the movement disorders of corticobasal degeneration and supranuclear palsy.     

Do we need a concept of disease?

The terms “health”, “disease” and “illness” are frequently used in clinical medicine. This has misled philosophers into believing that these concepts are important for clinical thinking and decision making. For instance, it is held that decisions about whether or not to treat someone or whether to relieve someone of moral responsibility depend on whether the person has a disease. In this paper it is argued that the crucial role of the ‘disease’ concept is illusory. The health/disease distinction is irrelevant for most decisions and represents a conceptual straightjacket. Sophisticated and mature clinical decision making requires that we free ourselves from the concept of disease.     

Schizophrenia: Disease,Syndrome, or Dimensions?

Schizophrenia has the status of a clinical syndrome and may comprise a number of specific disease entities. This construct is similar to dementia, in which several diseases have been defined within the syndrome. Alternatively, schizophrenia may be a single disease entity with quite variable manifestations across cases. Kraepelin proposed dementia praecox as a disease entity, and Bleuler proposed dissociative pathology as fundamental to each case, thus substantiating the single disease entity concept. More recently, the nuclear schizophrenia construct defined the disease entity using specific criteria proposed by Schneider and Langfeldt. This view has been challenged by a series of studies during the past three decades. These investigations are summarized in this report. Implications for clinical work with families are considered.     

Reflecting on self-care practices during clinical psychology training and beyond

In this paper, I will discuss the concept of self-care and its importance for clinical psychologists, both during training and post-qualification. I will review the pertinent literature in this area covering the concept of self-care and its meaning, the personal and professional impact of a lack of self-care for clinical psychologists, and discuss some of the barriers to implementing self-care practices. Throughout the discussion of barriers to self-care, I will intersperse three reflective pieces on my own experiences throughout clinical psychology training, which will allow for a more in-depth exploration of the issues. My conclusion will highlight the personal, professional and systemic barriers to self-care in clinical psychologists, and in other helping professionals, and suggest possible ways of tackling these barriers and promoting greater utilisation of self-care during clinical training and beyond and across different professional groups.     

Medical prognosis — Some fundamentals

Background: The concept of prognosis as a prediction concerning the probable outcome of an attack of disease shows some severe contextual drawbacks in the everyday clinical sense. It is often used to describe possible outcomes of the disease in general, or the progression of a disease course, not the expected course in a particular case. Goal: To render more discriminating uses of the term prognosis, in order to provide the prognosticating physician with a valid tool, comparable to the theoretical basis of diagnostic and therapeutic actions. Procedures: Analysis and discussion of etymology, definition and practical usage. Conclusion: Prognosis is not to be considered soothsaying, but forecasting on qualified grounds. Prognostic statements are announcements containing prognostic information. Prognostic factors are pieces of information associated with a specific outcome of disease, which can be utilized in the formulation of the prognosis. Prognostic estimates involve subjective probability and can be formulated by using frequencies along with (clinical) experience. A prognosis is a prediction of a particular future stage of disease, considering a single case — the prognosis is neither part of the patient, nor part of the disease.     

Neuropsychological Contributions to the Early Identification of Alzheimer’s Disease

A wealth of evidence demonstrates that a prodromal period of Alzheimer’s disease (AD) exists for some years prior to the appearance of significant cognitive and functional declines required for the clinical diagnosis. This prodromal period of decline is characterized by a number of different neuropsychological and brain changes, and reliable identification of individuals prior to the development of significant clinical symptoms remains a top priority of research. In this review we provide an overview of those neuropsychological changes. In particular, we examine specific domains of cognition that appear to be negatively affected during the prodromal period of AD, and we review newer analytic strategies designed to examine cognitive asymmetries or discrepancies between higher-order cognitive functions versus fundamental skills. Finally, we provide a critical examination of the clinical concept of Mild Cognitive Impairment and offer suggestions for an increased focus on the impact of cerebrovascular disease (CVD) and CVD risk during the prodromal period of AD.     

再论门静脉高压症的治疗观

门静脉高压症的治疗主要是断流术和分流术,就此笔者于１７年前在本刊发表过文章进行论述。１７年后,此病的治疗观出现以下进展和变化：１,对立和统一：这两种手术联合施行可产生优势互补,代偿充分者更适合做分流术,否则以断流术为宜,这是观念上的突破;２,有创和微创：微创概念和技术的出现,使治疗手段多样化和观念更新,医生有了更多的选择;３,治标和治本：肝移植的临床一改门静脉高压的治标手段而向治本手段发展。     

WHY BIOETHICS NEEDS THE PHILOSOPHY OF MEDICINE: SOME IMPLICATIONS OF REFLECTION ON CONCEPTS OF HEALTH AND DISEASE

Germund Hesslow has argued that concepts of health and disease serve no important scientific, clinical, or ethical function. However, this conclusion depends upon the particular concept of disease he espouses; namely, on Boorse's functional notion. The fact/value split embodied in the functional notion of disease leads to a sharp split between the “science” of medicine and bioethics, making the philosophy of medicine irrelevant for both. By placing this disease concept in the broader context of medical history, I shall show that it does capture an essential part of modern medical ideology. However, it is also a self-contradictory notion. By making explicit the value desiderata of medical nosologies, a reconfiguration of the relation between medicine, bioethics, and the philosophy of medicine is initiated. This, in turn, will involve a recovery of the caring dimensions of medicine, and thus a more humane practice.