淨元法師之大醫院小醫師: 2011-08

2011年8月25日星期四

The Nissen fundoplication is total (360º)

but partial fundoplications, known as
   Belsey fundoplication (270º anterior transthoracic)
   Dor fundoplication (anterior 180-200º) and
   Toupet fundoplication (posterior 270º)
are also alternative procedures with somewhat different indications

2011年8月24日星期三

trachea stent

2011年8月23日星期二

Pancoast tumor resection

usually RUL/LUL lobectomy
" en bloc " with involved ribs
" plus " one rib above and one rib below the diseased ribs

tracheobronchial tree tumor

mucoepidermoid tumor:
    uncommon
    often distal to the carina but within mainstem and lobar bronchi
    salivary gland-like on histology
    further classified as low or high grade

To estimate residual lung function

DLco is the best predictor of pulmonary complications

right lung ventilation is 55%
each lobe is 18.3%

left lung ventilation is 45%
each lobe is 22.5%

800 ml and 35% of predicted FEV1 are the lower limits of resectability

70歲以上的年長者因肺癌接受肺葉切除

風險比較高
死亡率根據統計有 5% ~7%

FVC (forced vital capacity) reflects compliance of the lungs
FEV1 (forced expiratory volume in 1 sec) reflects obstructive disease
the two values together are used to diagnose restrictive lung disease

世界很小

應該說
台灣很小
在這個城市的一個小角落
居然遇到了一個小女孩
就這樣又讓我想起了妳
親愛的

2011年8月22日星期一

bronchoscopic exam

Bronchus:the left-side
Main bronchus:
normal.
Structure of bronchi and the subdivisions:
B1+2:normal.
B3:normal.
B4:normal.
B5:normal.
B6:normal.
B8:normal.
B9:normal.
B10:normal.
Bronchus:the right-side
Main bronchus:
normal.
Structure of bronchi and the subdivisions:
B1:normal.
B2:normal.
B3:normal.
B4:normal.
B5:normal.
B6:normal.
B7:normal.
B8:normal.
B9:normal.
B10:normal.

LLL collapse due to lung cancer

old TB on CT image

膽囊結石 GB stone

2011年8月21日星期日

spirometry

Artery of Adamkiewicz

Artery of Adamkiewicz, a.k.a. AKA

In human anatomy, the Artery of Adamkiewicz is the largest anterior segmental medullary artery

It typically arises from a left posterior intercostal artery, which branches from the aorta, and supplies the lower two thirds of the spinal cord via the anterior spinal artery

Hold 住

Hold 住....
千萬要Hold 住....
加油....

2011年8月20日星期六

Plummer-Vinson syndrome

Plummer–Vinson syndrome (PVS), also called Paterson–Brown–Kelly syndrome or sideropenic dysphagia presents as a triad of dysphagia (due to esophageal webs), glossitis, and iron deficiency anemia. It most usually occurs in postmenopausal women

2011年8月18日星期四

Delete

手機裡的 old message
按一個按鍵
就可以全部刪除了

可心中的感情沒那麼容易刪掉
在心裡
一直無法忘記
沒有 delete 鍵可以按

2011年8月16日星期二

脊椎動脈先天性發育不全 Congenital hypoplasia of vertebral artery

厭了倦了

愛你的人你不愛
你愛的人不愛你

已經厭倦了這些感情的糾葛

兩個人
一個家
能安定下來
就好

主動脈"潰瘍" Penetraing aortic ulcer

主動脈壁內血腫 ( IMH ) 之後的主動脈壁
是一個不穩定的結構
血管內層像蘇花公路上的斷崖峭壁
會有落石坍方的可能
這時就會形成主動脈"潰瘍" ( Penetraing aortic ulcer )

治療的方法是用胸主動脈支架把 "潰瘍" "蓋掉"

希望這個病人不要再有其他地方落石坍方了
不然就更難處理了

胸壁纖維化 Fibrothorax

RLL pleural thickening

CT scan

patient turned out to be LUL lung cancer

the final diagnosis is     NSCLC, SCC
                                       T4 ( mediastinum, carina invasion )
                                       N3( supraclavicular LAP )
                                       M0
                                      stage IIIB