Laparoscopic pancreaticoduodenectomy: From “standard” to “extended”

<正>Pancreatic cancer is one of the most desperate malignances worldwide with approximately 470 0 0 0 deaths per year, and the 5-year survival rate is only 11% [1]. Pancreaticoduodenectomy(PD) is the standard treatment for pancreatic head and periampullary lesions [2]. PD is often either described as “standard PD” or “extended PD”(e.g., “PD with portal vein resection, additional organ resection or arterial resection”) [3].     

“怪症”困惑医学界二:“超忆症”:记住一生所有事情

<正> 52岁的美国男子的大脑拥有"超级记忆力"对于大多数人来说,永不忘记一生中的所有事情本身就是一件难以想象的事情.然而世界上却有那么少数几个人,他们一生     

“怪症”困惑医学界五:“交替失明症”:这女孩每周“失明”3天

<正> 澳大利亚墨尔本市22岁女孩娜塔莉·艾德勒从5年前开始,她的眼皮每周都会瘫痪紧闭3天,使她陷入如同"失明"般的状态中;然而接下来的3天她的眼皮又会恢复正常,使她能够清楚视物,不过3天     

“怪症”困惑医学界六:“怕冷症”:一碰冷水就休克

<正> 和霍夫完全相反的是,还有一些人一碰到冷水,或被寒风刺激,就会浑身出现荨麻疹,甚至发生休克或死亡。这种怪病被医学家称做"寒冷性荨麻疹"——也就是对寒冷的温度过敏。据美国过敏、哮喘和免疫学学会副总裁托马斯·卡塞尔     

Four-contrast defecography: Pelvic “floor-oscopy”

PURPOSE: This study was designed to determine the accuracy of physical examination (as judged by four-contrast defecography) for women with pelvic floor relaxation disorders. METHODS: Sixty-two women (mean age, 59 years) who had obstructed defecation or constipation, vaginal prolapse, urinary difficulty, or pelvic pain underwent four-contrast defecography. Oral, vaginal, bladder, and rectal contrast were administered selectively and fluoroscopy was performed. Radiographic findings were compared with physical examination diagnosis. RESULTS: Four-contrast defecography changed the diagnosis in 46 patients (75 percent); 26 percent of presumed cystoceles, 36 percent of enteroceles, and 25 percent of rectoceles were not present on defecography. Defecography also revealed unsuspected coexisting defects in addition to known abnormalities detected on physical examination. In contrast, when physical examination was negative for these defects, 63 percent of patients were found to have cystoceles, 46 percent to have enteroceles, and 73 percent to have rectoceles on four-contrast defecography. The discovery of Grade 2 or 3 unsuspected abnormalities was significant, especially so for enteroceles. For posterior vaginal eversions extending to or past the introitus, physical examination was accurate in only 61 percent. Physical examination of large anterior defects was more accurate, with 74 percent of patients being correctly diagnosed. CONCLUSIONS: Physical examination diagnosis of pelvic floor relaxation disorders is frequently inaccurate, especially for large vaginal eversions. Four-contrast defecography improves diagnostic accuracy, helps to identify all pelvic floor defects before surgery, and can assist with planning the correct operative approach.     

“怪症”困惑医学界三:“失忆症”:50年记忆瞬间消失

<正> 和"超忆症"男子布拉德拥有惊人记忆不同的是,美国58岁女子贝基·普罗普斯特却恰恰相反,11年前,她遭遇了一次癫痫发作,结果她一生的记忆都在一瞬间全部消失。     

病灶:疾病的“安乐窝”

<正> 人体内有某些特定部位,很适宜细菌、病毒的隐藏繁殖,成为它们生存的"安乐窝"。它们在这"世处桃源"里既不老实,又不客气,常在人体内"大闹天宫",成为人体内的"凶犯",产生危害人体健康的毒素,并通过血液、淋     

“怪症”困惑医学界七:“音乐癫痫症”:一听音乐就昏厥

<正> 悦耳动听的音乐对于大多数人来说,都是一种艺术享受,但在长达5年时间中,音乐对于美国纽约市26岁女孩斯塔茜·盖尔来说却是一个恐怖的噩梦,因为她患有一种罕见的     

“怪症”困惑医学界八:“持续性冲动症”:随时处于性亢奋状态

<正> 对于那些从来没有亲身经历过"持续性冲动综合征"的人,这种怪病听起来就像是一个黄色笑话,然而事实上,对于患有"持续性冲动综合征"的女性们来说,这一怪病就     

“怪症”困惑医学界五:“抗冻症”:这个人永远不怕冷

<正> 荷兰50岁"冰人"威姆·霍夫拥有一种超常的抗冻能力,他能近乎赤身裸体地在冰块中待上至少1小时。霍夫称,他是在21年前突然发现自己拥有抵抗寒冷     

“怪症”困惑医学界八:“无痛症”:这个女童永远不怕痛

<正> 美国明尼苏达州大湖市9岁女童盖比·金拉斯是个"不怕痛的女孩",自她长这么大以来,不管走路摔跤还是磕落牙齿,她都从来没有哭过一声。事实上,盖比患有一种罕见的医学怪病——她天生就感觉不到任何疼     

Self-identity After Cancer: “Survivor”, “Victim”, “Patient”, and “Person with Cancer”

Background

Living through cancer often involves developing new identities which may strongly influence well-being and relationships with care providers, yet little is currently known about these post-cancer identities.

Objectives

To examine (1) the extent to which four post-cancer identities (patient, person who has had cancer, victim, and survivor) are adopted, (2) relations between each identity and involvement in cancer-related activities and mental and physical well-being, and (3) correlates of these identities.

Design

Cross-sectional questionnaire-based study.

Participants

168 young to middle-aged adults who had previously experienced cancer.

Measurements

Cancer identifications, background variables, psychological functioning, cancer risk appraisals and coping, cancer-related activities, and mental and physical well-being.

Results

At least somewhat, 83% endorsed survivor identity, 81% identity of “person who has had cancer”, 58% “patient”, and 18% “victim”. Identities were minimally correlated with one another and differentially associated with involvement in cancer-related activities. Survivor and person who has had cancer identities correlated with involvement in most cancer-related activities such as wearing cancer-related items and talking about prevention (ps?<? 0.5). Survivor identity correlated with better psychological well-being and post-traumatic growth, victim identity with poorer well-being (ps?<? 0.5); neither identifying as a patient nor a person with cancer was related to well-being. Through regression analyses, identities were shown to be explained by unique combination of background, functioning, appraisal and coping variables.

Conclusions

Survivor identity appears most common and most associated with active involvement and better psychological well-being, but other identifications are also common and simultaneously held. Adoption of specific cancer identities is likely to impact interactions with health care providers, including those in general internal medicine, and health behavior changes.

     

A Review of: “Cardiovascular Homeostasis”

Intrarenal and Extrarenal Mechanisms by Sheila M. Gardiner and Terence Bennett Oxford University Press Oxford 1981 158 pp. $37.50     

Pericardial Sarcoma: “Invisible” on Radiology

Primary pericardial tumour is an extremely rare disease and an aggressive carcinoma. Its main presenting symptoms are a large recurrent hemorrhagic pericardial effusion. Imaging is the significant tool in the evaluation of pericardial lesions and of tumours. We report the case of a 17-year-old patient with recurrent hemorrhagic pericardial effusion who was diagnosed with primary pericardial fibrosarcoma. However, multiple radiological examinations, including computed tomography and fludeoxyglucose/positron emission tomography-computed tomography (^[18F] FDG/PET-CT) suggested the presence of fluid and no sign of tumour. Actually, when a patient presents with recurrent hemorrhagic pericardial effusions, pericardial tumours must be taken into account as part of the differential diagnosis.