介入性超声在卵巢囊肿中的治疗价值

卵巢囊肿是妇科常见病变,囊肿体积增大压迫邻近脏器及结构时会引起相应的症状或功能障碍.近年来,越来越多的研究表明,超声介入治疗卵巢囊肿不失为操作简单、有效的微创性治疗手段.     

关于小儿急腹症诊断思维模式的思考

1　全面认识小儿急腹症对小儿急腹症的认识不仅包括对其病因、临床表现、治疗的认识 ,也应包括对其种类、发病机率、与年龄的关系及发展趋势的认识。小儿急腹症一般包括阑尾炎、肠套叠、美克尔憩室炎、胃肠穿孔、胆道穿孔、肠梗阻、肠扭转、肾输尿管结石、卵巢囊肿合并扭转和胰腺炎等 10几种 ,在思考诊断时 ,上述疾病均应列入考虑范围。小儿急腹症病种虽多 ,但其发病几率相差很大。最为常见的是阑尾炎、肠套叠、分别占急腹症中的82 %和 14 %。其次为美克尔憩室炎、卵巢囊肿合并扭转、胰腺炎。而胃肠穿孔、肠扭转、肾输尿管膀胱结石则较少见…     

卵巢肿瘤蒂扭转急腹症诊治进展

卵巢肿瘤可因肿物扭转、破裂、出血等而导致剧烈腹痛、恶心呕吐、甚至出现失血性休克等急腹症的表现,是妇科临床常见的急腹症之一,有时容易误诊而导致严重后果。随着医疗水平的提高及微创观念的引入,目前对一些妇科急腹症如卵巢囊肿蒂扭转的处理等在诊断与治疗方面发生了很大的变化,现综述如下。     

卵巢肿瘤蒂扭转急腹症诊治进展

卵巢肿瘤可因肿物扭转、破裂、出血等而导致剧烈腹痛,恶心呕吐、甚至出现失血性休克等急腹症的表现,是妇科临床常见的急腹症之一,有时容易误诊而导致严重后果.随着医疗水平的提高及微创观念的引入,目前对一些妇科急腹症如卵巢囊肿蒂扭转的处理等在诊断与治疗方面发生了很大的变化,现综述如下.     

医患关系中的病人权利让渡——对某些特定医疗行为的伦理及法律分析

1　问题的提出案例 1:某医院妇产科为一位 5 0岁的女性患者因子宫肌瘤行子宫全切手术 ,术中医生发现患者左侧卵巢有问题 ,在未向家属和病人交待的情况下 ,将左侧卵巢与子宫一并切除。术后患者恢复顺利。数月后 ,患者在另一所医院行常规Ｂ超检查时 ,发现“右侧卵巢囊肿 ,左侧卵巢缺如” ,遂向原手术医院提出质疑[1] 。案例 2 :某医院为一位急性肠梗阻病人手术时 ,医生发现患者阑尾红肿 ,在未征得病人或家属同意的情况下 ,将其阑尾切除。虽然病人术后痊愈出院 ,但因此引发医患纠纷 ,病人起诉至法院 ,法院根据《民法通则》的规定 ,认为医生在病…     

需要改变的是谁--就"权利让渡"与雷锦程先生商榷

事情的起因是针对一个案例及分析 :某医院妇产科为一位 5 0岁的女性患者因子宫肌瘤行子宫全切手术。术中医生发现患者左侧卵巢有问题 ,在未向家属和病人交待的情况下 ,将左侧卵巢与子宫一并切除。术后患者恢复顺利。数月后 ,患者在另一所医院行常规B超检查时 ,发现“右侧卵巢囊肿 ,左侧卵巢缺如” ,向原手术医院提出质疑。原案例讨论的初衷是认为这有悖知情同意原则 ,希望提醒医务人员的注意。《医学与哲学》2 0 0 2年第 11期发表了雷锦程先生的“医患关系中的病人权利让渡”一文 ,提到广大临床医生对此案例的伦理分析持完全不同的看法 ,并…     

冬天

天冷了,堂屋里上了子。子,是春暖时卸下来的,一直在厢屋里放着。现在,搬出来,刷洗干净了,换了新的粉连纸,雪白的纸。上了子,显得严紧、安适,好像生活中多了一层保护。家人闲坐,灯火可亲。床上拆了帐子,铺了稻草。洗帐子要挑一个晴明的好天,当天就晒干。夏布的帐子,晾在院子里,夏天离得远了。稻草装在一个布套里,粗布的,和床一般大。铺了稻草,暄腾腾的,暖和,而且有稻草的香味,使人有幸福感。不过也还是冷的。南方的冬天比北方难受,屋里不生火。晚上脱了棉衣,钻进冰凉的被窝里;早     

轻轻地走路

轻轻地走路,既保存了自己的体力,又不会打搅别人。轻轻地走路,可以听见最细微的声响,包括来自心灵山谷的回声。要想与另一个自我交谈,你必须轻轻地走路。悠闲散步的时候,从容喝茶的时候,他们都会光顾。如果你心急火燎,就来不及思,也来不及想了。而心灵的舒展需要时间。轻轻地走路,这样的姿态,非常优雅。     

砚雪随感

雪落,纷纷扬扬。 有人说落雪如画。南方的第一场雪,亲切、动人,也舒爽。 独坐于图书馆中,凝望窗外。寒风中的雪花,舞着飘逸洒脱的身形,或斑斓,或晶莹,形态万千。娇羞的身形在弥漫中扩散,拥抱着些许的悠然,点缀着失绿的枝桠,亲吻着斑秃的瓦脊,歌颂着造物主的奇妙! 我喜欢雪,她洁白无瑕,她灵魂不染而触动着人们的心灵。我喜欢雪,她覆盖了城市的浮华和杂乱,带给人宁静安谧。雪是诗人心中酝酿已久的诗篇,读雪,读着短暂却充实美丽的生命。     

平分秋色

白露秋分夜,一夜冷一夜。秋分,白昼与夜晚平分一天的日程。古籍曰:秋分者,阴阳相半也。老祖宗定的节气如人生之气数,掐着秒似的,行到什么地方就有什么样的气象。24节气像守时的花儿,次第绽放。12小时的清醒加上12小时的沉睡,把秋日妆扮成披着盖头的嫁娘,那绯红半遮半掩,更见韵致。至于多情人儿的心,是缠绵悱恻,是梦还是醒,就不得而知了。     

单纯性肾囊肿外科手术适应证的选择

单纯性肾囊肿是临床常见的肾脏疾病之一,临床常采用去顶减压术治疗,但外科治疗的适应证目前尚不统一。除症状性肾囊肿及由囊肿引起尿路梗阻外,对于高血压病合并肾囊肿者,如囊肿直径大于5cm,考虑囊肿有可能对高血压产生影响,因此,有必要采取外科治疗措施;但如果不合并高血压,是否一定需要治疗有待进一步探讨。肾囊肿对肾功能影响目前尚无定论,对于小于60岁的肾囊肿患者其肾功能下降可能与肾脏原发病变有关,应积极查找病因并密切随访。对于肾囊肿Bosniak分型为Ⅰ、Ⅱ、ⅡF型的患者,可以不需要手术治疗,密切随访;对于Ⅲ、Ⅳ型患者,应进行外科手术治疗。     

Rathke囊肿的诊断和治疗

为了分析和讨论Rathke囊肿的诊断和治疗,我们回顾性分析45例经病理证实的Rathke囊肿病例,其中38例采用经鼻蝶窦入路显微外科手术,7例采用开颅手术。结果显示,术前明确诊断5例,术后患者症状均有不同程度的缓解或改善。因此,经鼻蝶窦入路显微外科手术是治疗Rathke囊肿的有效方法。     

Language localization in cases of left temporal lobe arachnoid cyst: evidence against interhemispheric reorganization

We investigated whether left-hemisphere arachnoid cysts lead to reorganization of the language function using PET. A group analysis demonstrated that patients showed no more right-hemisphere activation than a matched control group. Several patients had clear language localizations in the left hemisphere during language comprehension; none of the patients showed right-hemisphere activation. We conclude that left-hemisphere tissue must suffer considerable compromise before reorganization of language into the right hemisphere becomes necessary. Language activations within the left hemisphere are clearly displaced. This is consistent with mere physical displacement in some patients rather than reorganization within the left hemisphere; in others intrahemispheric reorganization cannot be excluded.     

Intracranial dermoid cyst (clinico-pathologic description of a case)

The authors describe the case of a female patient aged 49 years who received neurological treatment for various complaints over a period of 19 years. The disorder defied exact diagnosis despite the application of all neurological and other diagnostic techniques. Suspicions ranged from somnolence accompanied by cephalalgia, through demyelination, expansive processes in the region of the cerebellum or the diencephalon, encephalitis or tuber- cubma of the brain stem to multiple sclerosis. The autopsy revealed a dermoidal cyst that exerted a slight pressure on the extension of the medulla. This explained all of the patient's complaints. The occurrence of such cysts is discussed on the basis of data taken from the literature.     

Understanding anterograde amnesia: Disconnections and hidden lesions

Three emerging strands of evidence are helping to resolve the causes of the anterograde amnesia associated with damage to the diencephalon. First, new anatomical studies have refined our understanding of the links between diencephalic and temporal brain regions associated with amnesia. These studies direct attention to the limited numbers of routes linking the two regions. Second, neuropsychological studies of patients with colloid cysts confirm the importance of at least one of these routes, the fornix, for episodic memory. By combining these anatomical and neuropsychological data strong evidence emerges for the view that damage to hippocampal—mammillary body—anterior thalamic interactions is sufficient to induce amnesia. A third development is the possibility that the retrosplenial cortex provides an integrating link in this functional system. Furthermore, recent evidence indicates that the retrosplenial cortex may suffer “covert” pathology (i.e., it is functionally lesioned) following damage to the anterior thalamic nuclei or hippocampus. This shared indirect “lesion” effect on the retrosplenial cortex not only broadens our concept of the neural basis of amnesia but may also help to explain the many similarities between temporal lobe and diencephalic amnesia.     

EPS Mid-Career Award 2006. Understanding anterograde amnesia: disconnections and hidden lesions

Three emerging strands of evidence are helping to resolve the causes of the anterograde amnesia associated with damage to the diencephalon. First, new anatomical studies have refined our understanding of the links between diencephalic and temporal brain regions associated with amnesia. These studies direct attention to the limited numbers of routes linking the two regions. Second, neuropsychological studies of patients with colloid cysts confirm the importance of at least one of these routes, the fornix, for episodic memory. By combining these anatomical and neuropsychological data strong evidence emerges for the view that damage to hippocampal-mammillary body-anterior thalamic interactions is sufficient to induce amnesia. A third development is the possibility that the retrosplenial cortex provides an integrating link in this functional system. Furthermore, recent evidence indicates that the retrosplenial cortex may suffer "covert" pathology (i.e., it is functionally lesioned) following damage to the anterior thalamic nuclei or hippocampus. This shared indirect "lesion" effect on the retrosplenial cortex not only broadens our concept of the neural basis of amnesia but may also help to explain the many similarities between temporal lobe and diencephalic amnesia.     

COMMUNICATION CONCERNS OF PRESERVICE AND INSERVICE ELEMENTARY SCHOOL TEACHERS

The purposes of this study were: (1) to identify the communication concerns of prospective, student, and inservice teachers and (2) to determine differences in the concerns of the three groups with regard to a three-phase conceptualization: concern with self, task, and impact. Findings were that: (1) prospective teachers expressed more self than task or impact concerns, (2) student teachers expressed more task than impact concerns, (3) inservice teachers expressed more impact than self or task concerns, and (4) prospective teachers expressed more self concerns than student or inservice teachers, student teachers expressed more task concerns than prospective or inservice teachers, and inservice teachers expressed more impact concerns than prospective or student teachers.     

Ethnic group identification and group evaluation among minority and majority groups: testing the multiculturalism hypothesis

Following social identity theory, the author hypothesized that members of minority groups are more likely than majority group members to endorse multiculturalism more strongly and assimilationist thinking less strongly. In addition, the multiculturalism hypothesis proposes that the more minority groups endorse the ideology of multiculturalism (or assimilationism), the more (or less) likely they will be to identify with their ethnic in-group and to show positive in-group evaluation. In contrast, the more majority group members endorse multiculturalism (or assimilationism), the less (or more) likely they are to identify with their ethnic group and to show negative out-group evaluation. Results from 4 studies (correlational and experimental) provide support for this hypothesis among Dutch and Turkish participants living in the Netherlands.     

Motives to (not) forgive deviant group members: A comparison within and between cultures

This study examines people's motives to (not) forgive group members who violate an important group norm. More specifically, we attempt to determine what is the primary focus in such a situation (the group, the offender, the relationship, or the self), and whether this depends on how important the group is and on the cultural context (more individualist or more collectivist). Our sample includes Moluccans living in Indonesia (more collectivist) and Moluccans in the Netherlands (more individualist). Participants were asked to evaluate a scenario in which a group member (close or nonclose other) violated an important group norm. We find that Indonesian Moluccans are more likely not to forgive group members who violate a group norm than Dutch Moluccans. This finding suggests that the group is more important to Indonesian Moluccans. Across the two samples, however, participants were more inclined to forgive an ingroup deviant for the benefit of this person or their relationship than for the benefit of the group. Interestingly, self‐focused concerns were more important among Indonesian Moluccans and differences between the samples in the relative importance of the different motives could not be explained by people's self‐definition (i.e., more independent or interdependent). Implications of these findings for the literature on forgiveness and on individualism–collectivism are discussed.