往事隨風
詞:許常德 曲:涂惠源
你的影子無所不在
人的心事像一顆塵埃
落在過去 飄向未來
掉在眼裡就留出淚來
曾經滄海無限感慨
有時孤獨比擁抱實在
讓心春去 讓夢秋來
讓你離開
捨不得忘 一切都是為愛
沒有遺憾 還有我
就讓往事隨風
都隨風 都隨風 心隨你動
昨天花謝花開
不是夢 不是夢 不是夢
就讓往事隨風
都隨風 都隨風 心隨你痛
明天潮起潮落
都是我 都是我 都是我
媽啊,真是太悲的一首歌了~~~
cufe 發表在 痞客邦 留言(1) 人氣(70)
遲來的梅雨季,
幾天下來雨勢稍緩,可是突如其來的陣雨驟降又驟停的,
讓人心情也起起伏伏.
人自詡為萬物之靈,但很多事情還是無法掌控.
cufe 發表在 痞客邦 留言(1) 人氣(30)
Pleural effusion:
1. 先分exudate or transudate: Light's criteria
TP of effu/TP in serum > 0.5
LDH of effusion/LDH in serum > 0.6 --> sensitivity最高
cufe 發表在 痞客邦 留言(0) 人氣(50,090)
今夜我重操舊業,爲學妹的演出伴奏.
話說某一天我難得響起的醫院手機在不是很合理的時間響起,
打電話的是五年級的學弟貿,他說他們想邀請星韻獎歷屆得主上台表演.
星韻獎已經停辦了三屆,今年本系兩位優秀的學弟扛起復興學生會(現稱系聯會)的大任,
cufe 發表在 痞客邦 留言(2) 人氣(17)
RCC的image character:
==>CT是最好的診斷及staging的工具,除非CT結果無法判斷時才用US或MRI輔助.
1)病灶<8-10mm時CT可能無法detect而呈現hypodensity,這時候可用US去評估為cyctic or solid lesion
2)當CT上看不到LAP時不一定就沒有LN involvement,可能只是沒有變大,所以可用MRI去輔助.
==>RCC在CT的特徵:
1) 大多數with contrast呈現solid lesion with enhancement of 15-20Hu;有時合併central necrosis or calcification
2) 有些為cystic lesion with thick septum and wall nodularity
3) 有些完全solid with high enhancement
==>MRI上的特色:
T1WI w/o C呈現hypointensity, T2WI呈現hyperintensity,不過都是heterogenous.
==>US上的特色:
hyper, hypo或是iso都有可能.所以sono的角色是看這個病灶內部的性質.用來輔助為主.所以並非通常是高回音性的.
Preferred Examination: Although a variety of examinations (ultrasound [US], magnetic resonance imaging [MRI], angiography) can be used in the workup of patients with suspected RCC, the preferred method of imaging these patients is dedicated renal computed tomography (CT). In most cases, this single examination can be used to detect and stage RCC and to provide information for surgical planning without additional imaging. In the few patients in whom the CT findings are equivocal, MRI or US can be useful. Recent literature suggests a use for contrast-enhanced Doppler US for lesions that show equivocal enhancement at CT. Angiography is rarely used in the workup of suggested RCC, but it can provide information about the origin of the tumor in troublesome cases. At present, no accepted protocol has been developed for RCC screening among asymptomatic individuals in the general population. Patients with a hereditary predisposition for RCC should be periodically examined by using dedicated renal CT. Limitations of Techniques: The primary limitation of CT is the characterization of hypoattenuation in masses smaller than 8-10 mm, in which pseudoenhancement may be a problem. In these cases, US may be of some use in characterizing the lesions as cysts. In addition, spread to regional lymph nodes in the absence of lymph node enlargement can be missed. If contrast material cannot be intravenously administered, CT is a poor choice for evaluating RCCS. MRI should be performed instead.
The primary limitations of US include problems related to incomplete staging (bones, lungs, regional nodes) and to the detection of small non–contour-deforming masses. In addition, large patients are not good candidates for US because of technical difficulties in obtaining adequate images.
MRI is limited by patient cooperation because MRI is more sensitive to motion artifact than CT. In addition, MRI is more expensive and less readily available than CT. Furthermore, patients with pacemakers, those with certain types of medical implants, and those with severe claustrophobia are excluded from undergoing MRI.
CT character:On initial nonenhanced CT scans, RCCs may appear as isoattenuating, hypoattenuating, or hyperattenuating relative to the remainder of the kidney. Calcifications may be present and are usually amorphous and internal, although rimlike calcifications can also be present. On contrast-enhanced CT scans, RCC is usually solid, and decreased attenuation suggestive of necrosis is often present. Sometimes RCC is a predominantly cystic mass, with thick septa and wall nodularity. RCC may also appear as a completely solid and highly enhancing mass.
MRI character:On nonenhanced T1-weighted images, RCCs usually appear isointense or hypointense relative to the remainder of the kidney. With chemical shift imaging, some clear cell carcinomas show focal or diffuse loss of signal intensity. On T2-weighted images, RCCs are usually hyperintense. Most often, they are heterogeneous.
US character:
On sonograms, RCC can be isoechoic, hypoechoic, or hyperechoic relative to the remainder of the renal parenchyma. Smaller lesions with less necrosis are more likely to be hyperechoic and may be confused with AMLs. Isoechoic tumors are detected only by distortion of the renal contour, focal enlargement of a portion of the kidney, or distortion of the central sinus fat. cufe 發表在 痞客邦 留言(1) 人氣(813)
肝膿瘍併發眼內炎 九成糖尿病患
【聯合報／記者許峻彬／台北報導】
國家衛生研究院研究發現，感染肺炎克雷白氏菌引發肝膿瘍的患者，若發生眼內炎等嚴重併發症，百分之百都是第一型與第二型菌株引起的，第三代抗生素提早用在嚴重肝膿瘍患者，可減少併發症。
日前有一名卅多歲的醫師，因為細菌感染引發肝膿瘍，國衛院臨床研究組研究員蕭樑基說，肝膿瘍患者約七成是糖尿病人，三成不明原因感染引發。
蕭樑基表示，肺炎克雷白氏菌引起的肝膿瘍，約占台灣化膿性肝膿瘍疾病的七成八，死亡率高達百分之十到廿八。雖然台灣醫療越來越進步，死亡率逐漸降低，但仍有部分患者因肝膿瘍發生腹痛時忍痛不就醫，直到受不了就醫時，已併發嚴重眼內炎，眼球突出眼眶，此時用藥效果有限。
肝膿瘍常見的症狀有右上腹疼痛、發燒、惡心、肝臟腫大且有壓痛感，民眾如果腹部疼痛，應該就醫檢查確認是否有肝膿瘍，以免延誤治療時機。
蕭樑基指出，肝膿瘍是病原菌在肝臟內感染造成肝臟被破壞化膿，肺炎克雷白氏菌引發的肝膿瘍約百分八到十會併發眼內炎、腦膜炎，有些患者甚至因眼內炎而失明。
蕭樑基表示，為了找出引發肝膿瘍的最主要分型，國衛院與台北榮總、三總感染科合作，發現從臨床病人血液、尿液或痰分離出的菌株，以第一型、第二型最多，第一型占六成三，併發眼內炎的患者，分離出第一型的更高達八成五。
蕭樑基指出，第一型與第二型的菌株，細菌外層的薄膜「血清莢膜」特別厚，可以對抗人體的白血球吞噬，造成病患嚴重感染，也是引發眼內炎、腦膿瘍等遠端轉移的原因。
國內糖尿病人眾多，蕭樑基提醒，糖尿病人免疫力較低，容易發生肝膿瘍，且肝膿瘍患者併發眼內炎者，有九成都是糖尿病人。
蕭樑基指出，研究發現感染肺炎克雷白氏菌的患者，若疾病嚴重度高，醫師評估發生眼內炎的嚴重併發症的可能性很高，應該提早使用第三代頭芽孢素抗生素，以降低併發症的發生與死亡率。
蕭樑基表示，研究也將第一分型的菌株基因定序，研究結果發表在臨床微生物學與感染症等國際期刊。未來可針對第一型與第二型等毒性強的主要致病菌株，研發標靶藥物，預防或治療肝膿瘍。
新聞辭典》肺炎克雷白氏菌
肺炎克雷白氏菌有七十七個分型，存在於人體的呼吸道或腸道，是院內感染常見的菌種。
當人體免疫力低下時，此菌會從呼吸道或腸道，移動到肝臟、血液，因此引發感染，導致肝膿瘍、肺炎、敗血症、腦膜炎等。
【2007/05/17 聯合報】
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國考會考: DM病人發生liver abscess最常見的pathogen為KP,且容易併發endophthalmitis.
(絕對不是lepto!!!)cufe 發表在 痞客邦 留言(0) 人氣(817)
前幾天看一個"女王的部落格",
女王說了一個故事,故事裡的男人對女人說,
他覺得這個女人根本就不需要他,
他被剝奪了這種被需要感覺,感到很沮喪.
cufe 發表在 痞客邦 留言(0) 人氣(118)
