"Munchausen by proxy syndrome": not only pathological parenting but also problematic doctoring?

Certain social expectations of medicine combine with characteristics of subspecialised technological paediatrics to facilitate the form of child abuse labelled "Munchausen by proxy syndrome". Examining this form of child abuse highlights possible shortcomings of medical practice. The primary medical tasks of diagnosing and curing illness and of preventing suffering are sometimes overridden by other motivations of which doctors may not be fully aware. More open discussion of what motivates health professionals in their work may improve medical practice and lead to a reduced incidence of Munchausen by proxy syndrome.     

Mirizzi’s syndrome: a diagnostic dilemma

A 62-year-old male presented with a history of upper abdominal discomfort. Past history included asymptomatic gallstones. Abdominal ultrasound and CT demonstrated gallstones within a thick-walled gallbladder, and intra and extrahepatic duct dilatation. Endoscopic retrograde cholangiopancreatography (ERCP) revealed a stricture within the mid-portion of the common bile duct. At laparotomy, a single large stone was found causing external compression of the common bile duct causing a Mirizzi’s-type stricture. At repeat ERCP, cholangiogram showed no evidence of stricture. Clinicians should be aware that no definite clinical signs distinguish Mirizzi’s syndrome and surgical exploration is often required for diagnosis.     

也谈“AIDS:‘爱滋病’还是‘艾滋病’?”

杨枕旦先生在《中国翻译》1986年第4期发表的短文中曾肯定“爱滋病”这个译名是音意兼顾的一个例子，而该刊1987年第6期的一篇文章则将此视为对海外译名的盲从，并称”爱滋病”改译为“艾滋病”是一可喜的进步。嗣后，杨先生又另文‘AIDS：“爱滋病还是“艾滋病”？”（《外语教学与研究》1988年第4期），仍主张；“爱滋病”这个译名不宜随便放弃不用，更不能轻率地把采用这一译名指责为对海外译名的“盲从”。其理由包括：①“根据最近的一些报道，AIDS这种病的传播确实与性爱（不限于同性恋）有一定的关系，②“对术活的译名是否精确…     

‘Skin Trade’: Genealogy of Anti-ageing ‘Whiteness Therapy’ in Colonial Medicine

This article investigates the extent to which the emerging trend of do-it-yourself anti-ageing skin-whitening products represents a re-articulation of Western colonial concerns with environmental pollution and racial degeneracy into concern with gendered vulnerability. This emerging market is a multibillion dollar industry anchored in the USA, but expanding globally. Do-it-yourself anti-ageing skin-whitening products purport to address the needs of those looking to fight the visible signs of ageing, often promising to remove hyper-pigmented age spots from women’s skin, and replace it with ageless skin, free from pigmentation. In order to contextualize the investigation of do-it-yourself anti-ageing skin-whitening practice and discourse, this article draws from the literature in colonial commodity culture, colonial tropical medicine, the contemporary anti-ageing discourse, and advertisements for anti-ageing skin-whitening products. First, it argues that the framing of the biomedicalization of ageing as a pigmentation problem caused by deteriorating environmental conditions and unhealthy lifestyle draws tacitly from European colonial concerns with the European body’s susceptibility to tropical diseases, pigmentation disorders, and racial degeneration. Second, the article argues that the rise of do-it-yourself anti-ageing skin-whitening commodities that promise to whiten, brighten, and purify the ageing skin of women and frames the visible signs of ageing in terms of pigmentation pathology.     

‘Sehkollektiv’: Sight Styles in Diagnostic Computed Tomography

This paper aims to trace individual as well as collective aspects of ‘sight styles’ in diagnostic computed tomography. Radiologists need to efficiently translate the visualized data from the living human body into a reliable and significant diagnosis. During this process, their visual thinking and the created images are incorporated into a complex network of other visualizations, communication strategies, professional traditions, and (tacit) visual knowledge. To investigate the interplay of collective as well as individual dimensions of diagnostic seeing, the concept of ‘sight collective’ (Sehkollektiv) is developed. On the one hand, this concept is based on critical reading of Ludwik Fleck’s epistemological writings and his notions of thought collective (Denkkollektiv) and thought style (Denkstil). On the other hand, it is tested by means of qualitative empirical studies in a radiological university clinic (participatory observations and informal interviews). By employing this approach, the paper traces the collective foundations of a certain diagnostic sight. Moreover, it shows how the individual abilities of radiologists to perform stylized seeing rely remarkably on software-based interactions with the processed images and on tacit dimensions of visual knowledge.     

Pearson’s syndrome: a rare cause of non-immune hydrops fetalis

CASEREPORTAChinesegirlwasborntoa pairofhealthynon consanguineousparents Motherhad givenbirthtoahealthyboypreviously Thepregnancywasuneventfultill3 8weeksof gestationwhenantepartumhaemorrhageoccurred Onultrasoundexamination ,placentapreviaandahydropicfetuswerefound ThebabywasdeliveredbyemergencyCaesariansectionwithabirthweightof 2 85 5kg Shewas paleand grosslyedematouswithcardiomegaly,pleuraleffusion ,hepatosplenomegalyandmassiveascites Thefirsthaemoglobinwas 2 5g/dlwithareticulocytecou…     

Bouveret’s syndrome: a rare cause of gastric outlet obstruction

To the editor： Bouveret＇s syndrome is a very uncommon form of gastric outlet obstruction caused by a large gallstone travelingthrough a cholecystoduodenal fistula into the duodenum. It was first described by Beaussier in 1770. Leon Bouveret, a French physician, for the first time published two cases with the symptoms of upper abdominal pain, fever, and vomiting in elderly patients in 1896.It is responsible for less than 1% of gallstone ileus.2 Only 300 cases had been reported in worldwide literature by 2008.3     

Ovarian juvenile granulosa cell tumor associated with Maffucci’s syndrome: case report

Granulosa cell tumors (GCTs) are the most common ovarian sex-cord stromal tumors. Two histopathologically well defined patterns of GCTs are known : adult granulos acell tumor (AGCT) and juvenile granulosa cell tumor(JGCT). JGCTs are rare and those associated with enchondromatosis are much rarer. A review of the literature revealed four previous cases of JGCT were associated with Maffucci‘s syndrome (MS), and nine with Ollier‘s disease (OD). This report describes ovarian JGCT with MS in a 21-year-old woman, and reviews the clinicopathological causes of both disorders.     

The locus of control: It’s significance in the irritable bowel syndrome

PSYCHOLOGICAL factors have a role in Irritable Bowel Syndrome symptomatology. The locus of control test determines an individual’s degree of internality or externality. The degree of internality or externality does not influence the site of major Irritable Bowel Syndrome symptomatology. Externalizers have a worse prognosis than internalizers. This effect on prognosis should be borne in mind when testing for diet and or drug efficacy.     

Clinical diagnostic approach to severe acute respiratory syndrome: an institution’s experience

Objective To analyze diagnostic approach to severe acute respiratory syndrome (SARS) according to the diagnostic criteria issued by the Ministry of Health of China (MHC). Methods The clinical data and the diagnostic results of 108 cases of SARS were retrospectively reviewed according to the MHC criteria. Results There were 55 men and 53 women, with a median age of 34.5 years (range, 12-78 years). The interval between their first visit and clinical diagnosis was 3 days (range, 0-14 days). The diagnosis was made at the first visit in 7 (6.5%, 7/108) cases with a history of exposure to SARS patients and infiltrates on chest radiograph. Eighty-nine (82.4%) and 12 (11.1%) patients were categorized as probable cases and suspected cases respectively at their first visit and a clinical diagnosis of SARS was made subsequently. The interval between first visit and reaching the final diagnosis was 1-3 days in 72 (66.7%) cases and 4 days in 29 (26.9%) cases. The final diagnosis was made in 0-14 days (median, 2 days) for those (n=59, 54.6%) with a history of close contact with SARS patients and 2-8 days (median, 3 days) for those (n=49, 45.4%) living in Beijing but without such a history (P=0.03). The chest radiograph was interpreted as unremarkable in 26 (24.1%) cases at their first visit, and the diagnosis was made in 4 days (range 2-8 days), which was significantly longer compared with other cases (P<0.001). In patients without a history of close contact with SARS patients, all the five criteria were met after combination antibiotic therapy had failed. Conclusions A chest radiograph without infiltrates at the early stage of SARS is an important factor responsible for delayed diagnosis. In patients without a history of close contact with SARS cases, antibiotic effect was a major factor influencing doctors’ diagnosis.