Intractable epistaxis secondary to a post-traumatic pseudoaneurysm

Epistaxis is a common problem encountered in clinical practice. It is usually self-limiting and is usually controlled with conservative measures such as nasal compression or ice-packs. Occasionally nasal packing is required. It is rarely severe enough that surgical intervention is warranted. The following report illustrates a patient who presented to us with a rare cause of life-threatening epistaxis that is, a post-traumatic pseudoaneurysm who finally required surgical intervention to control the bleeding.     

The body as unwarranted life support: a new perspective on euthanasia

It is widely accepted in clinical ethics that removing a patient from a ventilator at the patient's request is ethically permissible. This constitutes voluntary passive euthanasia. However, voluntary active euthanasia, such as giving a patient a lethal overdose with the intention of ending that patient's life, is ethically proscribed, as is assisted suicide, such as providing a patient with lethal pills or a lethal infusion. Proponents of voluntary active euthanasia and assisted suicide have argued that the distinction between killing and letting die is flawed and that there is no real difference between actively ending someone's life and "merely" allowing them to die. This paper shows that, although this view is correct, there is even less of a distinction than is commonly acknowledged in the literature. It does so by suggesting a new perspective that more accurately reflects the moral features of end-of-life situations: if a patient is mentally competent and wants to die, his body itself constitutes unwarranted life support unfairly prolonging his or her mental life.     

Chylous ascites following repair of exomphalos major--a report

In cases of giant omphalocele anterior abdominal wall is so poorly developed that primary closure is not possible without excessive tension. The simplest of innovative strategies in such a situation is to provide epithellalisation of sac with secondary closure of ensuing ventral hernia at a later date. Postsurgical chylous ascites is a known entity and it usually responds with supportive therapy. Chylous ascites as a complication of reparative surgery of exomphalos is rare. Here a case of complete resolution of chylous ascites following conservative therapy who underwent a repair of ventral hernia as a sequela to non-operative treatment of giant omphalocele is reported.     

论完善医院科室管理工作的宏观思路和微观操作——以扬州大学临床医学院暨江苏省苏北人民医院医学影像科为例

管理既是一门科学,更是一门艺术,管理也是生产力。现代医院管理的一个重要组成部分是基层科室管理,科室管理将成为医院管理的新热点,完善医院科室管理工作将成为我们所要解决的重要课题。对待这一工作,我们不但要在宏观上明晰工作的思路,还要在微观上提出具体的操作路径。     

Partial calcanectomy in the treatment of chronic heel ulceration

Chronic decubitus ulceration of the heels is a common condition encountered by podiatric physicians, especially in diabetic patients. Very often these ulcerations can progress to osteomyelitis of the calcaneus. Many times, this in turn leads to a below-the-knee amputation. A partial calcanectomy is a viable alternative to below-the-knee amputation. A more functional limb both mechanically and cosmetically is achieved, and the morbidity and mortality associated with the calcanectomy is less than with a below-the-knee amputation. A brief overview of the history and outcomes associated with this procedure is outlined and a case utilizing a partial calcanectomy is presented.     

Fatal septicaemia due to Chromobacterium violaceum

Human infection caused by Chromobacterium violaceum is rare but when it occurs, it is associated with a high mortality rate. This is a report of a young adult male who presented as a surgical emergency and succumbed soon after. The most common feature of this infection is sepsis, followed by cutaneous involvement and liver abscesses. Chromobacterium infection as a differential in a case of sepsis is important for clinicians to suspect, especially in tropical countries.     

补肾活血中药对成骨细胞的影响

骨质疏松是以单位体积内骨组织量减少为特点的代谢性骨病变,成骨细胞与破骨细胞的动态平衡是维持正常骨量的关键,其中成骨细胞起到主要作用。中医认为骨质疏松的发病以肾虚为本,血瘀为标,治疗上予以标本兼治,补肾活血为法,多用补肾活血中药治疗取得良好的疗效。现对补肾活血中药对成骨细胞增殖分化及活性的影响研究进行总结,为今后的进一步深入研究提供科研思路。     

焦化塔双线性建模及变结构控制

给出了基于综合优化方法的双线性系统建模和变结构控制设计方法,并将此用于延迟焦化装置,建立了焦化塔双线性模型和变结构控制器,转好地解决了抖振问题,仿真结果表明这一方法是有效的。     

Mini Medical Record Application: Annual Register for Flu Shot Vaccinations

This application is an Intranet-based system. A database has been established utilizing patient information on the basis of age, medical diagnosis and employment history. If a health care provider or support staff states that a patient is over 65 years of age or has been diagnosed with a chronic disease and this limits the patient’s ability to fight off infection, the need for preventive care is activated. In this situation the preventive care is the administration of an annual flu shot. For anyone over 65 years of age or with a chronic illness, a bulk mail of reminder cards with the dates of availability of injection is generated and mailed. All health care workers are notified at work of vaccination sites that they can use. In addition, should a patient have an appointment with a provider and a preventive flu injection is indicated, a reminder appears on the registration form. This reminder indicates a flu shot is needed as well as other preventive intervention.     

An iterative requirements specification procedure for decision support systems

Requirements specification is a key element in a DSS development project because it not only determines what is to be done, it also drives the evolution process. A procedure for requirements elicitation is described that is based on the decomposition of the DSS design task into a number of functions, subfunctions, and operators. It is postulated that the procedure facilitates the building of a DSS that is complete and integrates MIS, modelling and expert system components. Some examples given are drawn from the health administration field.     

A dualist analysis of abortion: personhood and the concept of self qua experiential subject

There is no issue more central to the abortion debate than the controversial issue of whether the fetus is a moral person. Abortion-rights opponents almost universally claim that abortion is murder and should be legally prohibited because the fetus is a moral person at the moment of conception. Abortion-rights proponents almost universally deny the crucial assumption that the fetus is a person; on their view, whatever moral disvalue abortion involves does not rise to the level of murder and hence does not rise to the level of something that should be legally prohibited.In this essay, I argue that, under dualist assumptions about the nature of mind, the fetus is not a person until brain activity has begun.(i) First, I argue it is a necessary condition for a thing to be a moral person that it is (or has) a self. Second, I argue it is a necessary condition for a fetus to be (or have) a self, under dualist assumptions, that there has been some electrical activity in the brain. I conclude that a dualist can take the position that abortion ought to be legally permitted at least until the beginning of brain activity in the fetus.iI make no attempt to determine what conditions are sufficient for moral personhood; for this reason, the relevant claim about personhood is purely negative.     

Perforated choledochal cyst in a Jehovah's Witness patient

Perforation is a rare presentation of a choledochal cyst. The case reported is a 9-month-old female baby with a perforated choledochal cyst. Being a Jehovah's Witness, blood tranfusion was refused. Apart from highlighting this social dilemma, the suitability of a cystojejunostomy as a temporary measure in the above scenario is evaluated and discussed.     

Buying human kidneys: autonomy, commodity and power.

Buttle's reply to my objections to buying kidneys is helpful but unconvincing in two respects. Doing something freely leaves quite open the possibility that one is thereby making a commodity of a person; and the effects of institutionalising such a practice is itself a matter for concern. And while his emphasis on 'power' is important, the concept is hardly less problematic than 'commodification'.     

106例早期食管癌双对比造影分析

本文报道１０６例病理证实的早期食管癌（ＥＥＣ），分析了ＥＥＣ双对比造影表现征象为：①环征、半环征；②平盘、棒状隆起；③结节泡沫状阴影；④偏侧局限性管壁凹陷增厚或缺口、双边征；⑤斑状及条状龛影。文中分析了ＥＥＣ分型Ｘ线表现，讨论了ＥＥＣ与进展癌、良性隆起性病变以及食管炎的鉴别诊断。强调在基层医院利用现有机器条件，积极开展双对比造影是食管癌早期诊断的关键。     

What counts as success in genetic counselling?

The question of what counts as a successful outcome of the process of genetics counselling has recently become central because of the increasing calls for efficiency in health care, and for means of measuring efficiency. Angus Clarke has drawn attention to this trend, and has argued against both a measure in terms of the number of terminations of pregnancy performed as a result of counselling, and an assessment in terms of the contribution of genetics counselling to a national eugenics policy. He suggests instead a measure of workload. There are good arguments for supporting Clarke's position up to a point. In looking for an appropriate measure, much turns on how genetics counselling is defined. It is here understood in the context of an autonomy model of health care. It is argued that there is a contradiction between such an interpretation and the termination measure of outcome. The political philosophy underlying this outcome is also defective. Workload is not sufficient as a measure of outcome however; it is essential to look at the proper goals of an activity. It is argued that these must be connected in some way with the genetic health of the population; that the promotion of reproductive autonomy itself is not sufficient as a goal. The concern for genetic health, however, is interpreted in a way that avoids Clarke's concerns about a national eugenics policy.     

Sleep apnoea syndrome--a study of 5 cases

Sleep apnoea syndrome (SAS) is common in the West but its prevalence is uncertain in Southeast Asia. Five Chinese patients seen in a Sleep Assessment Unit in Hong Kong are presented to illustrate the spectrum of clinical features and treatment methods involved in obstructive and central sleep apnoea. The first patient is a 45-year old woman with severe obstructive SAS and cardiopulmonary complications who improved significantly after tracheostomy. The second patient is a 43-year old man who improved with weight reduction and protriptyline. The third is a 42-year old man whose SAS did not improve with uvulopalatopharyngoplasty but with continuous positive airway pressure (CPAP). The fourth is a 12-year old girl with obstructive SAS who improved significantly after tonsillectomy. The last patient is a 52-year old man with central SAS who improved with CPAP.     

白细胞介素18与特应性皮炎的研究进展

白细胞介素18(IL-18)具有多种生物学活性,在许多疾病和治疗中都具有重要的基础研究及临床应用前景。IL-18在特应性皮炎(AD)患者血清、皮肤角质层细胞、基因多态性表达等均存在异常,可通过影响AD患者皮损金黄色葡萄球菌感染、Th1/Th2细胞的失衡、皮肤屏障作用及角质形成细胞等方面,在AD发病机制中发挥作用。以IL-18为靶点或效应剂治疗AD是一种新的、有益的尝试。     

Epilepsy.

Epilepsy may be associated with major social and medical problems, and counselling of patient and family is essential for good management. The workup of a person with a seizure includes history, physical examination, and laboratory testing. An electroencephalogram is essential to help classify the seizure and epilepsy type. Neuroimaging (preferably by magnetic resonance imaging) helps to exclude a structural abnormality. Seizures can be controlled with a single drug (monotherapy) in 70% of patients. The incidence of drug side effects is increased if more than one drug is used. Pregnancy is associated with an increased risk of seizures in 30% of women with epilepsy. Frequent assessment throughout pregnancy is important. There is a slightly increased risk of congenital malformation associated with the antiepileptic drugs. Folic acid supplementation is advisable.     

Pyoderma gangrenosum associated with osteomyelitis in a paediatric patient: a case report

Pyoderma gangrenosum is a rare ulcerative skin disorder mainly occurring in adults. It is seen less frequently in children. The cause is unknown but it may occur in association with several disorders. Osteomyelitis is a very rare association. We report a case of pyoderma gangrenosum associated with osteomyelitis in a two-year-old girl.     

“好生活”、“精神健康”与社会公正

从公共健康伦理角度理解，“好生活”就是“精神健康”的生活。尽管人们对于什么是“精神健康”也会争论不休，但毋庸置疑的是精神健康构成好生活和幸福感的底线保障，而社会公正又是一个社会或个体具有良好精神健康状态的伦理基础。