我国胸心血管外科奠基人吴英恺院士逝世

本刊讯2003年11月13日凌晨4时50分,我国胸心血管外科奠基人、中国科学院院士、一代名医吴英恺溘然长逝,享年93岁。 吴英恺院士从医70多年以来,为我国胸心血管外科和心血管流行病学的发展做出了重要贡献。1940年他在北京协和医院首次成功切除食管癌。五十年代后期他在中国医学科学院阜外医院组织开展心脏血管外科,在心脏外     

中医全科医生在基层医疗机构中的重要作用

全科医生在基层医疗机构中从事的工作活动,是结合了生物医学、心理医学及社会医学的全科医疗活动,其整合了内科、外科、妇科、儿科等各个临床医疗专科的服务,故具有"全科"特点。全科医疗属于一体化的保健医疗服务体系,其以个人为中心服务对象,常以家庭为单位,以社区为基础范围,是综合性的防治保健基层医疗系统。基于中医医学和全科医学的基本医学理论指导下,中医全科医疗整合了多门医学领域的专科知识和医疗技能,充分发挥出中医全科在基层医疗机构中的特色及优势服务作用,解决了基层医疗机构中常见的健康问题。中医全科医生在预防、临床诊疗、保健、康复及养生等多方面充当着教育指导者、协调服务者,甚至扮演着卫生健康的守门人角色。中医的理念是"治未病",主要是通过未病先防、已病防变及瘥后防复等思想的贯彻,在临床预防医疗、临床诊治医疗、康复医疗过程中发挥出重要的作用。本文特此重点探讨了中医全科医生在基层医疗机构中的重要作用。     

中国成人心血管外科注册登记数据库的构建

目的:介绍中国成人心血管外科注册登记数据库构建思路和功能,供国内类似数据库参考。方法:通过参考同类数据库,并结合我国心血管外科注册登记现状、硬件条件和国际数据交流的需求,进行变量筛选、元数据创建及数据库逻辑构建等工作。最终构建基于网页的能够进行跨数据库交换并具备多种功能的心血管外科信息交流平台。结果:数据库包含患者基本信息、危险因素、医疗活动及终点事件等超过300个不同种类的变量,参照临床数据交换标准协会数据标准,可进行跨领域数据对接;收录受试者围术期所有重要信息,同时具有自动逻辑核查、研究进度自动统计、研究数据导出和电子病历数据导入功能。结论:中国成人心血管外科注册登记数据库是一个符合我国心血管外科发展现状,具有中国成人心血管外科特征,同时兼顾国际对接和交流的数据研究服务平台,将在医疗质量改善以及临床科研中起到重要作用。     

铁打的江山流水的兵

一、《中华内科杂志》是一本综合性内科杂志 早年,张孝骞年代,北京协和医院和其他大医院,大内科只是区别于动手术的外科.他的学生们到国外各分支学科学习后,大内科开始有专人从事不同分支学科工作.后分出:神经科、呼吸科、心血管科、肾科、血液科、肿瘤科等;继而各学科均已各有其专科杂志,中华内科杂志仍是内科系统中的一本综合性杂志. 1953年,中华内科杂志创刊时,我由上海市立敬业中学初中升入高中,当时开始有要"学医"的想法.1956年,考入上海第一医学院医疗系,所谓开始正式"从医".我的医学知识是读着中华内科杂志增长的.今年,是中华内科杂志60周岁,我"从医"56年,可谓是"同龄人".我对中华内科杂志确有很深感情.     

第二届中国呼吸医师奖

李振华医师　中国医科大学第一附属医院呼吸疾病研究所 李振华医师从医37年，一直工作在医疗，教学和科研的第一线，他医德高尚，技术精湛，体现出了崇高的职业道德，     

脾胃学说在腹部外科围手术期的应用

在中医外科学看来,手术疗法作为一种直接的"祛邪扶正"手段,始终享有非常重要的地位,但术后,尤其是腹部术后胃肠功能恢复不佳,营养不良一直是围手术期研究的重点[1].在长期的围手术期的中西医结合临床和实验研究中,该院蔡炳勤教授在继承脾胃论的学术思想的基础上,开拓创新,阐述脾胃学说的意义及在腹部外科围手术期的应用,有着重要的意义和学术价值.     

方圻：让心血管病低头！——独家专访：著名心血管病专家、北京协和医院名誉院长方圻教授

年过80的方圻教授是我国著名的心内科专家,我国医疗卫生工作者最高荣誉"白求恩奖章"的获得者,现任中国医学科学院北京协和医院名誉院长,内科教授。方圻教授从医半个多世纪,对我国医疗卫生保健事业做出了卓越的贡献。他专长于心血管内科疾病,对各种心血管病的诊断和处理积累了极为丰富的经验。他是首批被批准的博士生导师,曾培养博士生多名。     

运用ERM模式加强心血管内科医疗风险管理

正医疗风险是指临床诊断、治疗或患者护理过程中不良结局出现的机会,贯穿于疾病诊断、治疗与康复的全过程~([1])。医疗机构各科室纠纷分布情况显示,外科医疗纠纷发生率高于内科,内科纠纷发生率心内科居首位。这与心内科诊断治疗手段"外科化"相关~([2])。本文借鉴企业风险管理(ERM)模式,提出心血管内科医疗风险的新思路及方法。1 ERM理论的概念ERM是对企业内可能产生的各种风险进行识别、衡量、分析、评价并采取及时有效的方法进行风险防范和控制,以     

山西一患者胆囊结石5000粒

据新华社太原5月23日讯 山西医学院第二附属医院普外科最近从一男性患者胆囊中取出5000多粒仁丹大小的结石,总重量约100g。著名外科专家祝庆华教授称,这是他从医40多年,以往从未见过的病例。     

郭加强教授:杰出的心脏外科专家

我国心血管外科主要创始人之一,杰出的心脏外科专家,今年80岁高龄的郭加强教授,呕心沥血从医50余载,以崇高的爱国热情、精良的医疗技术、严谨的治学风范和卓越的医学成就,为祖国的医学事业,尤其是为我国心脏外科事业的普及、提高和发展,做出了不可磨灭的贡献,在我国医学界享有盛誉。 郭加强教授出生于1923年,青少年时期正值国难当头,他以民族兴亡为己任,在中央大学医学院就读期间,冒着生命危险,积极加入中国共产党,组织和发动群众积极投身于爱国学生运动。1951年,为保家卫国勇敢地参加了抗美援朝手术队。凯旋归国后,奉命先后就职于协和医院、解放军310胸科医院、阜外医院。1958年始,从师于阜外医院心脏外     

Experimental streptozotocin-induced diabetes and intestinal glucose metabolism in the rat,in vivo and in vitro

The intestine has a high glycolytic activity, but its metabolic role could be altered in diabetes mellitus. The aim of the present work was to investigate in vivo the glucose retained and the lactate produced by the intestine of normal and diabetic rats and in vitro the effect of different arterial glucose concentrations on glucose utilization and lactate, alanine, and pyruvate production in normal and diabetic rats when the glucose is supplied to the intestine exclusively via the vascular route. In vivo, the normal and diabetic rats retained similar percentages of the arterially supplied glucose (14.7±3.2 and 12.6±2.4, respectively). In vitro, when the preparations were perfused under hyperglycemic conditions, the glucose consumed, as a fraction of the quantity infused, was significantly lower (P<0.05) in the diabetic (247.0±22.8 mol/mmol infused glucose) than in normal (315.0±16.3 mol/mmol infused glucose) rats. The lactate produced was significantly higher in diabetic than in normal rats whether the preparations were perfused under isoglycemic (P<0.01; 1916.4±124.0 vs 1284±67.7 mol/mmol consumed glucose) or hyperglycemic (P<0.05; 1356.4±199.7 vs 898.0±87.3 mol/mmol consumed glucose) conditions. There was significantly (P<0.05) greater alanine release from the diabetic (123.7±21.8 mol/mmol consumed glucose) than from the normal (40.7±10.3 mol/mmol consumed glucose) rat preparations perfused under isoglycemic conditions.     

An unusual case of intestinal pseudo-obstruction presenting in an adolescent with juvenile-onset systemic lupus erythematosus: A diagnostic challenge

Introduction

Systemic lupus erythematosus (SLE) is an autoimmune disease with multiple systemic manifestations. The disease itself typically causes only 2–30% of SLE-associated gastrointestinal conditions.

Raymond George Rokeby Robinson, 8 July 1917-10 June 2005

With the death of Dr Ray Robinson, rheumatology lost one ofthe Australia's founding statesmen, a true world leader in thespecialty. Ray Robinson made a difference. He cared well and skilfullyfor his patients and contributed at many levels to the professionallife of his colleagues and to his specialty. But beyond thathe made important and enduring changes, setting up structuresthat continue to function and grow. Ray grew up in Sydney, was educated at Sydney Church of EnglandGrammar School and completed his medical degree at Sydney Universityin 1942. After a period of residency, he was appointed as theActing Medical Superintendent of the Royal North Shore Hospitalin 1944. In the same year, he married Pamela Fuller. Havingattained the rank of Captain in the Sydney University Regiment,he served in the Australian Imperial Force     

Colonic Obstruction Caused by Adhesive Splenomegaly: Report of a Case

INTRODUCTION Splenomegaly caused by hematologic or infectious diseases is a well-known complication that may cause discomfort because of increased intra-abdominal pressure; however, complete obstruction of the large bowel usually never occurs.METHODS We present a case of a 76-year-old male with polycythemia vera admitted with symptoms of complete colonic obstruction. At operation, the descending colon was found to be completely obstructed by a large adhesive spleen. Incision of the adhesions, complete colonoscopy, and mobilization of the colon was performed.RESULTS Afterward, the patient had a normal colonic function; however, four days later he had a magnetic resonance-confirmed cerebral thrombosis followed by an episode of aspiration pneumonia, which he died of ten days after the operation.CONCLUSIONS Colonic obstruction caused by splenomegaly is extremely rare, but may happen in patients with hematologic diseases.Reprints are not available.     

Optical clearing facilitates integrated 3D visualization of mouse ileal microstructure and vascular network with high definition

Intestinal microvasculature plays a central role in nutrient absorption and immune response against infections. Microscopic visualization of intestinal microvasculature under normal and pathological conditions such as inflammatory bowel disease is essential for understanding the pathophysiology of the disease. Despite the intensive need to characterize the intestinal microstructure and vasculature in an integrated fashion, 3-dimensional (3D) visualization of the gastrointestinal tissue is often limited by the spatial resolution of the imaging tools. In this research, we aimed to apply optical clearing to minimize the random light scattering in the mouse ileum, thereby facilitating photon penetration for high-resolution, 3D optical microscopy of the tissue network without microtome sectioning. We applied cardiac perfusion of lipophilic dialkylcarbocyanine dye DiD (1,1'-dioctadecyl-3,3,3',3'-tetramethylindodicarbocyanine perchlorate) to label the mouse blood vessels, including the intestinal microvasculature. The labeled and paraformaldehyde-fixed ileum was immersed in the aqueous optical-clearing solution to improve photon penetration. Optical clearing revealed the interior domain of the mouse ileal mucosa and submucosa, where random light scattering was suppressed and the size of the microstructure in the fixed specimen remained the same. Using fluorescent labeling, the intestinal microstructure and vasculature were simultaneously imaged by 3D confocal microscopy to allow for an integrated visualization of the tissue network with high definition. This new optical approach provides a useful tool for 3D presentation and analysis of the microvasculature for better understanding the intestinal physiology.     

Balint groups in psychotherapy of elderly patients]

Care of the elderly is typified by the relationship: elderly client/patient--younger helper/therapist. In Balint groups, relationships in interpersonal interactions are examined. This leads to a "patient-oriente" view and enables the participants to formulate a "comprehensive diagnosis". Multi-professional "gerontological"-Balint groups reduce reciprocal prejudices and value-judgements and promote cooperation between professional groups, further the understanding of the elderly in need of care, as well as the formulation of a patient-oriented "comprehensive treatment plan". By including creative productions in the Balint-group process, unconscious determinants of disturbed interpersonal relationships can be made "visible".     

Frank Thomas Paul 1851–1941

Frank Thomas Paul was born at Pentney, Norfolk, England and educated at the Yarmouth Grammar School. In 1869 he entered Guy's Hospital, and qualified MRCS in 1873. After a year as resident house-surgeon he left London for Liverpool, where he practiced for the rest of his professional life. In 1875 he was made the first resident medical officer at the Liverpool Royal Infirmary. He became, successively, pathologist, lecturer in dental surgery, surgeon to the Southern and Stanley Hospitals, Professor of Medical Jurisprudence, assistant and later full surgeon to the Royal Infirmary—in short, he became one of the leading surgeons of his day. In 1891, Paul wrote a paper on a method of performing an inguinal colotomy,¹ and in 1895 reported a number of cases, which are the subject of this Classics presentation. Colostomy had been an established procedure for approximately 50 years, an extraperitoneal approach that had been advocated by Amussat (Dis Colon Rectum 1893;26:483–487), a relatively safe procedure since the peritoneal cavity was not breached. Paul's operation, often performed for colonic obstruction, uses “Paul's tube” to drain the feces away to a bottle at the side of the bed, avoiding contamination of the wound. His operation of exteriorization of the colon antedated that of von Mikulicz (Dis Colon Rectum 1890;23:513–521), who achieved eponymous immortality for the extra-abdominal resection. While Paul did very little writing, he was considered a masterful technician. Lord Moynihan of Leeds often visited his theater to observe, stating that Paul was the “neatest operator he had ever seen.” At a presentation to the Liverpool Medical Institution, Mr. Frank Jeans stated, “Paul, operating in the heyday of his manual efficiency always made me think that he did with his hands what Pavlova did with her feet, only Paul's work was much more useful.” Paul retired to grow orchids and indulge in his hobby of photography. He died on January 17, 1941, in his ninetieth year.     

Delayed Ischemic Cecal Perforation Despite Optimal Decompression After Placement of a Self-Expanding Metal Stent: Report of a Case

Endoscopic deployment of self-expanding metal stents offers an alternative to surgical intervention in rectocolonic obstructions. Reported clinical failures in the literature are all related to the site of stent placement. We report a case of serious intra-abdominal disease after technically and clinically successful stent deployment: a potentially dangerous situation of which the surgeon should be aware. A previously healthy 72-year-old female was referred to our department with symptoms of an obstructing colorectal tumor. Successful stent placement resulted in resolution of the obstructive condition. Three days after stent deployment, x-ray examinations revealed a small-bowel obstruction and emergency surgery was performed. Intraoperative findings demonstrated a segment of ileum fixated to the tumor in the small pelvis, resulting in the obstructive condition. Furthermore, a cecal perforation, probably caused by ischemic conditions developed before stent-decompression of the colon was revealed during the operation. The patient died in the postoperative course. We discuss the observation of patients treated with self-expanding metal stents based on the selection-strategy used to allocate patients to this specific treatment. We conclude that although a patient is eligible for treatment with self-expanding metal stents, large-bowel obstruction can be too old for stent-decompression, causing ischemic perforation of the colon. Furthermore, we underline the need to focus on the possibility of obstructions other than those being treated.     

p-ANCA-associated periaortitis with histological proof of Wegener’s granulomatosis: case report

We describe a 63-year-old man who presented with an inflammatory aortic aneurysm. The patient had p-ANCA antibodies directed against myeloperoxidase. A diagnosis of idiopathic periaortitis was made. Seven years later, he was rehospitalized because of fever, weight loss, and polyneuropathy. After revision of the aortic biopsy, which showed necrotizing vasculitis with palisading granuloma, a diagnosis of Wegeners granulomatosis (WG) was made. This case report illustrates an unusual disease course in WG, resembling large vessel vasculitis, and we discuss the possible mechanisms of large vessel involvement in this form of vasculitis.     

Esophageal perforation associated with profound shock successfully managed with hemodynamic assistance using percutaneous cardiopulmonary support

A 51-year-old man was admitted to our hospital with complaints of severe chest pain, nausea, and vomiting. These symptoms had progressed rapidly and he was in shock. It was necessary to make a correct diagnosis as early as possible. However, the hemodynamic condition of the patient deteriorated rapidly before a definitive diagnosis could be established in spite of conventional therapies. Under hemodynamic assistance with percutaneous cardiopulmonary support (PCPS), a final diagnosis of esophageal perforation was made by esophagography. Our report illustrates a new application of PCPS for highly selected cases of noncardiogenic shock as a "bridge" until an accurate diagnosis is made and a specific treatment is applied.