清代名医的医德（二）

用生动事例介绍清代名医的医德，以供后人效法和学习。     

Medical management of Crohn's disease: A guide for radiologists

The choice of therapies for Crohn's disease has expanded greatly over the past 30 years. Increasingly it is important that we attempt to identify subgroups of patients who will benefit most from each type of therapy. This article reviews the therapeutic options currently available, organized by the goal the practitioner hopes to achieve. Imaging is one critical way of aiding the classification of Crohn's disease by attempting to accurately determine the location, extent and, most importantly, the nature of the disease.     

When the standards aren't standard: Evidence-based medicine in the Russian context

This paper examines the uses of evidence-based medicine (EBM) in post-Soviet Russia through the use of semi-structured interviews. It asks what it means to talk about practicing evidence-based medicine in a setting where the context of practice presents considerable barriers to the implementation of EBM principles. Drawing on interviews with Russian physicians, medical students and users of the healthcare system, the paper argues that in post-Soviet Russia EBM serves as a strategic discourse for segments of the medical profession. With the collapse of the U.S.S.R. the healthcare system has been going through a period of crisis, and Russian physicians are finding that they have to redefine their professional identity with respect to the domestic and the international context and have to seek new sources for legitimating their professional position. The western origins of EBM endow this rhetoric with considerable power in the Russian context and render it a very useful tool in the project of redefinition.     

The Application of Number Needed to Treat (NNT) to Clinical Problems in Radiotherapy

The goals of this report are: 1) to review the number needed to treat (NNT) concept, which, although well established in many sectors of medicine, is still relatively new to the radiotherapy community; 2) to discuss several clinical radiotherapy examples illustrating the inherent advantages of the NNT approach; and 3) to discuss potential future roles of the NNT concept within radiotherapy.     

Three-dimensional assessment of urinary stone on non-contrast helical computed tomography as the predictor of stonestreet formation after extracorporeal shock wave lithotripsy for stones smaller than 20 mm

The incidence of stonestreet formation after extracorporeal shock wave lithotripsy (ESWL) rises with increasing stone burden. However, stonestreet after ESWL is often experienced even in stones smaller than 20 mm. To examine whether the non-contrast helical computed tomography (CT) data could predict stonestreet formation in these stones, 53 radiopaque stones of 5-20 mm treated with ESWL were evaluated. Maximal dimension was measured on plain radiograph. From an attenuation value histogram graphed from the CT data, total stone volume and mean attenuation value were calculated. Seven stonestreets longer than 25 mm developed. There was no significant difference in maximal dimension and total stone volume between stones that did and stones that did not develop stonestreet. Mean attenuation value was the sole significant predictive factor. Application of mean attenuation value with cut-off level of 650 HU would anticipate stonestreet formation with a sensitivity of 85.7% and a specificity of 71.7%. The estimated risk of stonestreet formation is high in the treatment of stones with higher mean attenuation value.     

Report from the 1st Japanese Urological Association-Japanese Society of Medical Oncology joint conference, 2006: ''A step towards better collaboration between urologists and medical oncologists''

The 1st Japanese Urological Association-Japanese Society of Medical Oncology Joint Conference, titled 'A step towards better collaboration between urologists and medical oncologists', was held to coincide with the 44th Meeting of the Japan Society of Clinical Oncology, Tokyo, in October 2006. The main theme of the conference addressed the need for a subspecialty of medical oncologist within urology to keep abreast of advances in medical oncology. Urologists should become more involved in the postoperative management of urologic cancer. Consensus on the optimal way to move forward in the treatment of urological cancer is needed. The conference featured eight lectures surveying the present status of uro-oncology in Europe, the USA, Korea, Singapore, and Japan; the relationship between surgical oncologists and medical oncologists; global trends and international clinical trials in uro-oncology; and the future of urologic oncology. These were followed by a general discussion titled 'Achieving better collaboration between the surgical oncologist and the medical oncologist.' This report presents a roundup of the 1st Japanese Urological Association-Japanese Society of Medical Oncology Joint Conference.     

五所医院特需医疗服务状况调查

通过对上海医科大学附属华山医院、协和医院、北京同仁医院、中山医科大学附属第一医院、浙江医科大学附属第二医院开展的特需医疗服务情况的调查，论述了五所医院的具体做法，在对调查结果进行分析的基础上，就特需医疗服务的管理提出了建议。     

新生儿呕吐性疾病的消化道造影研究

目的:研究新生儿呕吐性疾病的造影技术,探讨其影像特征。方法:对比剂引入方式采用吸吮法和插胃管抽液后再注入对比剂两种方法;选用对比剂有6 0 %～80 % (W/V)的硫酸钡混悬液30～4 0ml或30 %泛影葡胺30ml;采用不同体位多轴位观察摄片,并对5 4例造影表现进行分析。结果:5 4例新生儿消化道造影均满足诊断要求,其中先天性幽门狭窄11例(19 6 % ) ,胃食管反流34例(6 3 0 % ) ,环形胰腺9例(16 .7% )。经手术治疗2 0例均与术前X线诊断相一致。结论:传统的上消化道造影是诊断新生儿呕吐病因的有效方法,熟练掌握造影技术和特有的造影征像能够及时地明确诊断。     

SARS流行期间肺炎患者的临床表现和胸部影像变化的探讨

目的 探讨SARS流行期间肺炎患者的临床表现和胸部影像变化特点。方法 对76例SARS流行期间发热留观室收治的肺炎患者的临床表现及胸部影像进行分析。结果 (1)此组肺炎患者多为青壮年(占60．53％)，无固定职业或职业性质流动性较大者居多(69．74％)；(2)临床特征主要是发热，以中高热为多见(80．26％)，发病早期部分患者呼吸道症状并不明显(67．10％)，外周血WBC在正常或低于正常范围(85．53％)，淋巴细胞比例减少(75．00％)；(3)肺部CT表现为不同程度的炎性浸润；病灶形态以斑片状和球形多见(77．63％)；病灶常位于肺周边，常出现支气管气像；动态观察病变影像大多无明显进展(88．16％％)，经治疗均完全吸收。结论 SARS流行期间普通肺炎与非典型肺炎有相似的临床及胸部影像表现；肺部CT扫描能早期发现肺炎患者的异常阴影，明显优于胸片，但无特异性。因此，在SARS流行期间发热诊室医务人员应加强肺部炎性改变的早期诊断和鉴别诊断水平。