tag:blogger.com,1999:blog-192972522024-03-08T05:51:34.394+06:00心盲眼將盲的外科工匠幽暗視界 一點微光blinddochttp://www.blogger.com/profile/10069564425091923168noreply@blogger.comBlogger651125tag:blogger.com,1999:blog-19297252.post-77203119430791115342016-02-02T20:35:00.000+06:002016-02-02T20:35:37.198+06:00月影<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgngIQ-oxDf6Fla7uiVjNe5CvbK5cyFPfGryfb62N4KHtxbLVCnam1w-U-Q9a6yEhM20HlL2vnjkGhRaIgiBnakiCQv0XZ8mJAKCJXXrvuZPiWmbWZgp36Q7Cbt5g3YSj0CnB3_/s1600/%25E6%259C%2588%25E5%25BD%25B1JPG.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgngIQ-oxDf6Fla7uiVjNe5CvbK5cyFPfGryfb62N4KHtxbLVCnam1w-U-Q9a6yEhM20HlL2vnjkGhRaIgiBnakiCQv0XZ8mJAKCJXXrvuZPiWmbWZgp36Q7Cbt5g3YSj0CnB3_/s400/%25E6%259C%2588%25E5%25BD%25B1JPG.JPG" width="300" /></a></div>
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轉身背月</div>
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惟能獨自面對踽踽獨行身影</div>
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任由寂寞啃蝕遊子漂泊宿命...</div>
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且</div>
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昂首向月</div>
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順從溫柔月光灑滿全身</div>
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撫慰旅人疲憊無依之心</div>
blinddochttp://www.blogger.com/profile/10069564425091923168noreply@blogger.com7tag:blogger.com,1999:blog-19297252.post-10112334616551796472016-01-31T20:20:00.000+06:002016-02-02T20:25:43.178+06:00冬天容易發生的眼科疾病<div class="MsoNormal">
<span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">在寒冷的季節裡,除了注意氣候的變化增添衣物保暖,也要留心冬天容易發生的眼科疾病。</span><span lang="EN-US"><o:p></o:p></span></div>
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<span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">四十幾歲的李先生,年輕時曾接受過近視雷射手術,本來不戴眼鏡時視線清晰。但近年來,隨著年紀增長,夏天時視力還好;但一進入冬天,氣候乾燥,眼白不僅出現血絲,還出現看東西模糊的現象。因為工作繁忙,終於無法忍耐到眼科就醫,經由淚液試驗,發現淚液分泌下降,證實有乾眼症;經由眼科醫師開立人工淚液,並建議他適宜的生活與用眼習慣,控制眼睛盯電腦或電視螢幕的時間後,現在即使身處寒冬,依然可以維持良好的視力品質,眼部也舒適多了。</span><span lang="EN-US"><o:p></o:p></span></div>
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<span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">七十幾歲的陳伯母,因為眼睛乾燥,到眼科就醫後,已經由淚液試驗,發現淚液分泌不足,確實得到乾眼症;經由眼科醫師開立人工淚液,按時點藥,眼部症狀得到緩解。就診期間,她又因為白內障造成視力下降,接受左眼白內障手術,手術後一週,視力就由術前的</span><span lang="EN-US"> 0.05 </span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">進步到術後</span><span lang="EN-US"> 0.9</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。原本很滿意的要準備要求眼科醫師安排右眼手術,卻突然掛號說右眼外側眼白出現血塊;醫師檢查發現結膜下出血。一問之下,原來陳伯母覺得視力恢復後,就可以不用再點人工淚液;因為眨眼時眼皮內面與結膜表面持續摩擦,所以扯破結膜血管而出血</span><span lang="EN-US"><o:p></o:p></span></div>
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<span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">殊不知接受過眼科手術,例如常見的白內障手術,近視雷射手術,會造成暫時性眼表面感覺神經異常,已經無法刺激淚腺正常分泌;若病患本來就有乾眼症,又忽略按時眼藥的必要性,就容易引發結膜下出血。</span><span lang="EN-US"><o:p></o:p></span></div>
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<b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">冬季眼科小常識(一)乾眼症</span><span lang="EN-US"><o:p></o:p></span></b></div>
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<span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">淚液分布在眼表面,厚度僅僅</span><span lang="EN-US"> 6.6 </span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">微米,即使這麼薄的一層液體,對於眼表面的健康維持卻非常重要。淚液與眼角膜形成的介面光滑平整與否,也影響視線的清晰度。乾眼症患者是目前眼科病人中最大的族群之一。乾眼症在總人口中,盛行率大約</span><span lang="EN-US">15-20%</span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,年齡越高,盛行率越高。而且女性比男性好發,停經後的婦女,幾乎八成皆為眼睛乾燥所苦,包括眼睛出現血絲、乾澀、畏光、異物感、灼熱感、癢痛,模糊或疲倦的症狀。接受過近視雷射的人,發生乾眼症的機率也比一般人高。</span><span lang="EN-US"><o:p></o:p></span></div>
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<span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">乾眼症常被忽略的原因,是因為除非到第四度嚴重乾眼症併發角膜上皮破損或感染、結痂,否則並無特別專屬於乾眼症的症狀。有時眼睛太乾、保護角膜的基本淚液(由外而內可分為油脂層、水液層、黏液層共三層)不足,反而刺激反射性的淚液分泌過多,而造成常常流眼淚擦不完的症狀,但此種反射性的淚液多為水液,缺乏黏液層的支撐,只能隨著地心引力而流出眼外,無法附著於角膜表面,達到保護角膜的效果。另外冬令進補飲食偏油膩,也會使眼皮周圍的油脂分泌異常旺盛,淚液變得濃稠,造成眼睛乾澀感。</span><span lang="EN-US"><o:p></o:p></span></div>
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<span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">冬天受寒風吹襲,眼睛更易乾澀刺痛;尤其在室內若又使用暖氣,空氣乾燥時更容易不適。要記得適度補充人工淚液,人工淚液與生理食鹽水大不同,它除了提供眼部表面潤濕等效用外,尚有稀釋發炎物質、降低淚液滲透壓等效用,故為乾眼症病患最常使用之療法。此外注意保濕,使用暖氣空調或在比較乾燥的房間,可考慮放一盆溫水增加濕度;出門要記得戴防風眼鏡,避免風沙直接吹襲眼睛。</span><span lang="EN-US"><o:p></o:p></span></div>
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<b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">冬季眼科小常識(二)結膜下出血</span><span lang="EN-US"><o:p></o:p></span></b></div>
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<span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">天氣變冷時體表血管會收縮,血壓跟著升高。若因為年紀增長加上高血壓、高血脂、或高血糖造成血管彈性差,則容易結膜血管破裂造成結膜下出血(圖一)。如果本身又有乾眼症,因為眨眼動作時眼皮內面與結膜表面摩擦力變大,更容易扯破血管而出血。其實結膜下出血大多不會影響視力,頂多只有輕微不適,但忽然眼白變紅,還是會引發當事人緊張,甚至掛急診,經由眼科醫師解釋,才發現虛驚一場。</span><span lang="EN-US"><o:p></o:p></span></div>
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<b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">冬季眼科小常識(三)過敏性結膜炎</span>
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<span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">通常過敏性體質患者在天氣轉涼時,眼睛會變得更敏感,容易紅癢,並產生白色分泌物。治療過敏性結膜炎眼藥水可分為含類固醇與非類固醇兩類,非類固醇藥物包括巨細胞安定劑,在春天及冬天過敏好發的季節,也可以預防性的使用在經常過敏的病人身上,屬於保養性質;還有抗組織胺藥水能改善過敏反應。急性期醫師多會開立含類固醇的藥水,只要遵照醫囑短期使用,不必過於擔心副作用。還要切記眼睛癢時不要去揉眼睛,可以適度冷敷緩解癢感。</span><span lang="EN-US"><o:p></o:p></span></div>
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<b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">冬季眼科小常識(四)急性青光眼</span><span lang="EN-US"><o:p></o:p></span></b></div>
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<span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">急性隅角閉鎖型青光眼多發生在五、六十歲以上長者。冬天由於日照時間短,瞳孔放大時間長,如此眼內的房水,從眼晴後方經由瞳孔流向前房的管道會變得狹窄,而使得房水灪積在後房,使得後房壓力升高而將虹膜向前推擠,淺房狹窄(圖二),造成對外引流的小樑通道被堵住,隅角閉鎖,眼壓便會急速升高。危險因子包括女性、遠視、東方人、或有家族史的人,特徵多為眼球較小較短,眼內組織擁擠,眼壓更容易飆高。急性青光眼眼壓典型症狀包括頭痛、視力模糊、光線周圍出現彩色光暈、噁心嘔吐、結膜充血、角膜水腫</span><span lang="EN-US">, </span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">前房狹窄</span><span lang="EN-US">, </span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">固定且半擴張的瞳孔</span><span lang="EN-US">, </span><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">急性青光眼相當危險,一定要馬上就診,否則幾天內就會喪失視力。</span><span lang="EN-US"><o:p></o:p></span></div>
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<b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">冬季眼科小常識(五)眼睛中風</span><span lang="EN-US"><o:p></o:p></span></b></div>
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<span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">寒流來襲,腦中風病例頻傳,要小心「眼睛中風」也可能無聲無息侵門踏戶。視網膜血管堵塞就是俗稱「眼睛中風」,包含「視網膜動脈阻塞」(圖三)、「視網膜靜脈阻塞」(圖四)。而依阻塞位置不同,又可分為分支視網膜動(靜)脈阻塞、與中央視網膜動(靜)脈阻塞。</span><span lang="EN-US"><o:p></o:p></span></div>
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<span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">視網膜血管阻塞成因包括:凝血機制異常,血糖、血脂或膽固醇過高,高血壓控制不佳,血管硬化等。致病危險因子包括高血壓、糖尿病、高血脂,抽煙,連續熬夜等。青光眼患者,因眼壓過高,罹患機率也上升。</span><span lang="EN-US"><o:p></o:p></span></div>
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<span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">眼睛中風主要發生在五十歲以上中老年人,發生時間常在早晚溫差大的冬天;但即使青壯年也要維持良好生活習慣,近來也有年輕人,因工作勞累,引發視網膜靜脈阻塞。</span><span lang="EN-US"><o:p></o:p></span></div>
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<span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">視網膜靜脈阻塞,會造成視力突然下降;若阻塞嚴重不治療,不僅引發視網膜新生血管,引起玻璃體出血,甚至視網膜剝離。最嚴重會引起青光眼,非但失明,且眼部會劇烈疼痛。所以一旦發現視力異常,應馬上就醫,以免錯過治療黃金期,造成視力不可逆的傷害。</span><span lang="EN-US"><o:p></o:p></span></div>
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<b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">冬季眼科小常識(六)</span></b><span style="font-family: , serif;"><b>葡萄膜炎</b></span><br />
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<span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">葡萄膜是眼內具緻密血管的組織,因為呈深紫色,因而得名。當葡萄膜發炎就是葡萄膜炎,由於葡萄膜含豐富血流,供應眼球重要組織營養,因此葡萄膜發炎,便可能造成角膜、視網膜、鞏膜、與視神經的損傷,所以葡萄膜炎遠較其他眼表面的結膜炎、或角膜炎更容易造成視力不可逆的傷害。</span><span lang="EN-US"><o:p></o:p></span></div>
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<span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">大部份葡萄膜炎若早期正確診斷,積極藥物或手術治療,多可控制病情;但若延誤就醫,就可能引發併發症,如白內障、青光眼、黃斑部水腫、視網膜壞死等。</span>
<span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">美國葡萄膜炎佔每年眼盲病因一成,所以已開發國家將葡萄膜炎列為致盲首要疾病之一。葡萄膜炎患者部分合併全身自體免疫疾病,如僵直性脊椎炎或風濕性關節炎等,所以對於葡萄膜炎最好能針對確切病因進行治療。</span><span lang="EN-US"><o:p></o:p></span><br />
<span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span>
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<b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">冬季眼科小常識</span> <span lang="EN-US">(</span></b><b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">七</span><span lang="EN-US">) </span></b><b><span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">不當進補造成眼內出血</span></b></div>
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<span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">趙伯父因為右眼出現漂浮物遮住視線,醫師檢查發現玻璃體出血(圖一),詢問用藥史,他說只有吃健康食品;醫師發現成分有通血路魚油;而他所服用安神丸,裡面也含當歸。當大眾為了「無病強身」時攝取好幾種保健食品時,卻可能吃進過量活血藥物。</span></div>
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<span style="font-family: "新細明體" , "serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">在冷冽的冬季,不僅身體必須抗寒,眼睛也接受內外挑戰。特此介紹氣候寒冷與溫度變化時容易發生或惡化的幾種眼疾。平時應做好預防保健工作,發現問題即早就醫,才不會對視力造成永久性損傷。</span><span lang="EN-US"><o:p></o:p></span></div>
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blinddochttp://www.blogger.com/profile/10069564425091923168noreply@blogger.com0tag:blogger.com,1999:blog-19297252.post-73508971951599337402015-12-31T20:57:00.000+06:002015-12-31T20:58:02.320+06:00以烈焰生命獻祭<div class="separator" style="clear: both; text-align: center;">
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從七月幽淡試探</div>
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到歲末狂熱相守</div>
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熬著蕭瑟深秋 </div>
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凜冽寒冬苦候</div>
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但願舞者與釘鞋</div>
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揚起玫瑰裙擺</div>
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以烈焰生命獻祭</div>
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久別重逢再不分離</div>
blinddochttp://www.blogger.com/profile/10069564425091923168noreply@blogger.com2tag:blogger.com,1999:blog-19297252.post-7054867011335268792015-11-01T07:35:00.000+06:002015-11-01T07:36:00.717+06:00Lost Cat<div class="separator" style="clear: both; text-align: center;">
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悲愴時寫詩
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雀躍時寫詩</div>
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瘋狂思念時寫詩</div>
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強迫遺忘時寫詩</div>
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唯獨深深望進摯愛眼眸時暫停寫詩</div>
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因為正低迴著最耐人尋味的俳句詩</div>
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blinddochttp://www.blogger.com/profile/10069564425091923168noreply@blogger.com2tag:blogger.com,1999:blog-19297252.post-74446154251505992312015-10-31T07:06:00.000+06:002015-11-01T07:12:23.942+06:00舊瓶裝新酒「Eales' disease」<br />
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「Eales' disease」是由 Henry Eales 在西元 1880年首先報告,當時認為是非發炎性的網膜疾病,後來演變為視網膜血管的自發性發炎疾患(主要是影響靜脈)。病徵是反覆發作的視網膜與玻璃體出血,造成忽然視力下降。近來研究文獻認為 多與結核病(tuberculosis)相關,多發生於特定地區(如印度),與特定年齡層(15 到 40 歲)。<br />
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在2013年Journal of Opthalmic Inflammation and Infection有一篇關於「Eales' disease」診斷與治療的回顧,Biswas等人提出新的疾病分期系統,Stage I 為Periphlebitis of small (Ia) and large (Ib) caliber vessels with superficial retinal hemorrhages,Stage IIa 為 Capillary nonperfusion,Stage IIb 為Revascularization elsewhere/of the disc,Stage IIIa 為Fibrovascular proliferation,Stage IIIb 為Vitreous hemorrhage,Stage IVa 為Traction/combined rhegmatogenous retinal detachment,Stage IVb 為Rubeosis iridis, neovascular glaucoma, complicated cataract, and optic atrophy。<br />
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關於「Eales' disease」的致病機轉,現在多認為與結核病及對tuberculoprotein的超敏反應(hypersensitivity)相關。50-70% 從Eales' disease 病患眼裡拿出的視網膜上膜以聚合連鎖反應(PCR)可驗出結核桿菌 (mycobacterium tuberculosis),其中MPB64 gene是最常被檢出的。但用玻璃體檢體培養並沒有長出結核桿菌,據以推論「Eales' disease」患者眼內可能沒有帶活菌,只有無活性的菌體或結核桿菌的片段 DNA。有研究推測「Eales' disease」免疫發炎造成的組織傷害,是被隔絕於眼球內的無活性結核桿菌所誘發,因為還是與典型的結核性視網膜血管炎大多發生於雙側,且發炎較嚴重有所不同。<br />
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「Eales' disease」的治療,包括(一)藥物治療:在活躍的血管周圍炎階段,皮質類固醇是主要使用的控制發炎藥物;如果病患皮膚結核菌素測試陽性,可給予抗結核藥物治療為期九個月。黃斑部水腫雖少見,但發生時,可使用後結膜下注射triamcinolone。補充抗氧化劑:如維生素E,C和A,胡蘿蔔素,銅,鋅和硒。當病患對類固醇治療反應不佳時,可考慮使用cyclosporine或 azathioprine。(二)網膜雷射治療:針對微血管無灌注的網膜,可施予雷射治療。(三)玻璃體內注射藥物:由於網膜缺血與慢性發炎,造成血管內皮生長因子濃度上升,所以玻璃體內注射bevacizumab,有用來使用於消退新生血管,雖然可能使玻璃體出血加速吸收,但亦可能增加牽扯性視網膜剝離的風險;至於以 ranibizumab 或 aflibercept 治療目前沒有報告。此外玻璃體內注射triamcinolone,雖可降低發炎,但有青光眼與白內障的併發症。(四)玻璃體切除手術:針對吸收緩慢的玻璃體出血,或併發視網膜剝離時,可進行手術治療,包括眼內雷射等術式。<br />
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近來已傾向於將「Eales' disease」稱為presumed tuberculous retinal periphlebitis,可用抗結核藥物加上短期口服類固醇來治療。若檢查結果排除結核感染,則可稱為 idiopathic occlusive vasculitis。但<b>皮膚結核菌素測試</b>缺點有判斷不易、需要專業受訓人員,病人需要48 至72 小時回診,在施打過卡介苗族群或非結核分枝桿菌感染患者易產生偽陽性。在免疫不全患者如愛滋病毒感染者則易呈現偽陰性。<br />
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<b>全血丙型干擾素檢驗</b>(T-cell interferon-gamma release assays, QuantiFERON) 為免疫診斷方法,可測量 T cells 因為特異性結核分枝桿菌抗原刺激所製造的丙型干擾素;感染過結核的淋巴球會活化並分泌丙型干擾素,再經由 E L I S A (Q F T - G )或 E L I S P O T 的方法(T -S POT . T B)來進行丙型干擾素的偵測及定量;越多結核分枝桿菌,全血檢測出的量越高。全血丙型干擾素檢驗可據以分辨施打過卡介苗族群或實際感染的病患,但是無法區別潛伏性結核和活動性結核。最近的研究顯示全血丙型干擾素檢驗對於結核性葡萄膜炎的診斷,優於皮膚結核菌素測試。此外可考慮安排核磁共振鑑別診斷視神經炎引發之視網膜新生血管。<br />
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「Eales' disease」這個病名,也許有天會成為歷史名詞。blinddochttp://www.blogger.com/profile/10069564425091923168noreply@blogger.com0tag:blogger.com,1999:blog-19297252.post-62662549862788016982015-09-06T15:36:00.001+06:002015-09-06T15:36:26.907+06:00未雨綢繆老花眼目前沒有預防或根治方法,無法像近視可以藉由藥物控制避免增加太快。<br />
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有人以為老花眼鏡會愈戴度數愈深,所以拒絕戴老花眼鏡,其實不管有沒有戴老花眼鏡,因為水晶體越來越失去彈性,伴隨睫狀肌調節力量減弱,還是會約五年增加五十度。<br />
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可以使用一些撇步,來改善生活不便。<br />
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1. 避免在四十歲前就老眼昏花,不宜長時間盯著電腦平板或手機螢幕,最好每30分鐘就休息一會,伸展四肢看看遠方,放鬆繃緊的睫狀體肌肉。<br />
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2. 四十歲之後,原來是近視的人,若工作上需要大量閱讀或使用電腦,可以考慮照原本近視度數減少一百至一百五十度來配戴眼鏡,用以抵銷老花眼。閱讀文件或生活中看近物時,大致可以清晰。只有開車或必須看遠很清楚時,才需要戴完全矯正的眼鏡。<br />
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3. 不要在路邊攤買老花眼鏡,因為每人雙眼度數不見得都相同,除了遠視近視外,還會有散光;必須由眼科團隊精確驗光試戴,選擇磨製光滑合格的鏡片。正確的雙眼瞳孔距離、眼睛到鏡片距離、精確光學中心,及適當鏡面傾斜度,全都到位,長期使用才會安全舒適。粗糙的鏡框與磨片,不僅會傷害眼睛,也可能侵蝕眼周皮膚。<br />
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4. 近視合併老花,若想接受雷射手術治療近視,近視度數最好超過四百度,如此接受雷射手術才能達到預期改善效果。
blinddochttp://www.blogger.com/profile/10069564425091923168noreply@blogger.com0tag:blogger.com,1999:blog-19297252.post-52286942575084512082015-08-18T15:29:00.003+06:002015-08-18T15:29:47.200+06:00破解老花眼全攻略<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5_rv7ouOcOFX46kPShEjRnuoN5K3TVfl1-bqnQPBddcEdi5tdu5CY2e3_GGxTVnVWZ4Z06Zdq9aq4DowZjW2QnBAejcoUI3HxnIUsMzpIuEjifqrlAo3_x-uTUIn34HK5m0mU/s1600/%25E7%25B0%25A1%25E6%2598%2593%25E8%2580%2581%25E8%258A%25B1%25E7%259C%25BC%25E9%258F%25A1.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5_rv7ouOcOFX46kPShEjRnuoN5K3TVfl1-bqnQPBddcEdi5tdu5CY2e3_GGxTVnVWZ4Z06Zdq9aq4DowZjW2QnBAejcoUI3HxnIUsMzpIuEjifqrlAo3_x-uTUIn34HK5m0mU/s400/%25E7%25B0%25A1%25E6%2598%2593%25E8%2580%2581%25E8%258A%25B1%25E7%259C%25BC%25E9%258F%25A1.jpg" width="300" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;"><b>簡易老花眼鏡</b></span></td></tr>
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<b>什麼是老花眼? </b><br />
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當人們發現要把說明書拿遠一點才看的清楚,看報紙或剪指甲時覺得吃力,看遠看近調節有時間差。常覺得閱讀時只看一會就開始疲勞酸澀,而且光線越暗越模糊,兩眉之間會酸痛,甚至頭痛噁心,老花眼已悄悄上身。
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<b>為何會老花眼?</b><br />
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水晶體位於眼球內的瞳孔後方,形狀有如雙凸透鏡,類似相機鏡頭。水晶體周圍連結彈性組織,稱為「懸韌帶」,再固定於睫狀體。水晶體的厚薄可以因睫狀體的收縮或放鬆,帶動懸韌帶的鬆緊而改變。當水晶體變薄使人類可看遠,水晶體變厚可看近。
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正常水晶體外由被膜包覆水溶性蛋白質所構成,但因吸收環境中可見光和紫外線同時,水溶性蛋白質會因光變性,成為不可水溶性蛋白質;隨著年齡增加,水晶體變愈大愈厚,也會越來越沒有彈性,改變形狀的能力愈差,再伴隨睫狀肌力量減弱,調焦能力於是降低,初期造成老花眼,水晶體混濁程度日漸嚴重,就形成白內障,造成視覺障礙。 <br />
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<b>如何改善尚未白內障的老花眼? </b><br />
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年齡45至50歲的人其調焦力會逐漸降低至小於2 屈光度,然後在70歲時會降低到0屈光度,水晶體就幾乎無法調焦。老花眼症狀約以40歲為分界,近視眼者約45歲開始有感覺,遠視眼者可能約38歲就有困擾。初期可以將室內光線調亮,手伸長些,最簡單方便的方法就是<b>配戴老花眼鏡</b>。<br />
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因為老花眼是生理老化過程中所表現的症狀,到目前為止,並無藥物、食物或運動可以預防它的產生。但如果有視覺疲勞症狀,可用眼藥水減輕症狀。
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_VfJSii9S523z7aH3rargECOu2cW-fgPIUKmQ6fc12v9KEHZ5JR5Ubf8rrn29JicyVei3UiYx6kWOtueq6NFEUqTtY7FvQ_dQYAwJSrTyv3UgkRvUKdp0_qA7ItDFOjdUiM30/s1600/%25E5%25B9%25B4%25E9%25BD%25A1%25E3%2580%2581%25E6%25B0%25B4%25E6%2599%25B6%25E9%25AB%2594%25E8%25AA%25BF%25E7%25AF%2580%25E5%258A%259B%25E5%2592%258C%25E8%2580%2581%25E8%258A%25B1%25E7%259C%25BC%25E9%258F%25A1%25E6%2589%2580%25E9%259C%2580%25E5%25BA%25A6%25E6%2595%25B8%25E5%258F%2583%25E8%2580%2583%25E8%25A1%25A8.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="285" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_VfJSii9S523z7aH3rargECOu2cW-fgPIUKmQ6fc12v9KEHZ5JR5Ubf8rrn29JicyVei3UiYx6kWOtueq6NFEUqTtY7FvQ_dQYAwJSrTyv3UgkRvUKdp0_qA7ItDFOjdUiM30/s400/%25E5%25B9%25B4%25E9%25BD%25A1%25E3%2580%2581%25E6%25B0%25B4%25E6%2599%25B6%25E9%25AB%2594%25E8%25AA%25BF%25E7%25AF%2580%25E5%258A%259B%25E5%2592%258C%25E8%2580%2581%25E8%258A%25B1%25E7%259C%25BC%25E9%258F%25A1%25E6%2589%2580%25E9%259C%2580%25E5%25BA%25A6%25E6%2595%25B8%25E5%258F%2583%25E8%2580%2583%25E8%25A1%25A8.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large;"><b>年齡、水晶體調節力和老花眼鏡所需度數參考表</b></span></td></tr>
</tbody></table>
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<b>為何有些人在得到白內障初期會有「視力的第二春」? </b><br />
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有些人的白內障是水晶體中心的晶核均勻變硬,形成固定的雙凸透鏡,類似看近的放大鏡功能,會自覺看近變得較清楚,但隨著白內障混濁程度日漸嚴重,接著而來就是視力降低。
如何改善已經白內障的老花眼?
白內障初期,若試戴合適度數還能得到夠用視力,可以先配戴眼鏡。但若仍無法有效改善視力,且影響日常生活時,就應該接受白內障手術。
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<b>如何改善已開好白內障手術的老花眼?</b><br />
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一般白內障術後,若植入單焦點人工水晶體,僅能提供看遠清楚的單一功能,閱讀時尚需配戴老花眼鏡,或預留一點近視來解決老花問題。多焦點人工水晶體則具備看遠和看近的功能,可以提高生活品質,降低老人對眼鏡的依賴,同時改善白內障及老花問題。<br />
<br />blinddochttp://www.blogger.com/profile/10069564425091923168noreply@blogger.com1tag:blogger.com,1999:blog-19297252.post-63329181479011474432015-08-01T06:14:00.000+06:002015-08-01T06:32:28.095+06:00不曾離開的植物<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTCzGZ4WBpvnMOTgvpLCkS2J3Ost21FURWvX_-6813Ak4CzUhgNLb1BH49Qz3tlX7Wz_wD6nDKJ7NJZrAWm2Py7RUOCoeaqAHs9MIWPmQ7IhE2ficp9wyauzg64Vvd9tLfestd/s1600/%25E6%25A1%2594%25E6%25A2%2597.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTCzGZ4WBpvnMOTgvpLCkS2J3Ost21FURWvX_-6813Ak4CzUhgNLb1BH49Qz3tlX7Wz_wD6nDKJ7NJZrAWm2Py7RUOCoeaqAHs9MIWPmQ7IhE2ficp9wyauzg64Vvd9tLfestd/s400/%25E6%25A1%2594%25E6%25A2%2597.jpg" width="400" /></a></div>
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春風拂面飄逝</div>
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那觸感如情人微顫又無影雙手</div>
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夏雨綿延再臨</div>
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耐旱植物俯首感念久違的清涼</div>
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人因樹蔭濃密而刀鋸相向時</div>
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植物雖有心啊 </div>
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依然認命且無聲</div>
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不怨念疏於照料枝枒枯黃</div>
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些微雨露溫情流轉</div>
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蓓蕾仍向陽守信而綻放</div>
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彷彿所有傷害都未留下印記</div>
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花蕊蘊藏著默默情意</div>
<br />blinddochttp://www.blogger.com/profile/10069564425091923168noreply@blogger.com3tag:blogger.com,1999:blog-19297252.post-76555555215611537902015-07-19T06:56:00.003+06:002015-07-19T06:59:21.684+06:00正確診斷黃斑部病變的利器 - 沒有輻射線的「光學同調斷層掃描」OCT網膜是形成眼球壁最內層的薄膜,功能相當於照相機底片,使我們能看到外界物體。而黃斑部位於網膜中央,雖然只是長軸三毫米橫向橢圓形,卻是感受精細視力最重要構造。<br />
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任何黃斑部的病變都會引起視力急劇下降,在視覺中心造成絕對暗點,或看東西扭曲變形等症狀;在周邊網膜較大的破洞對視力的殺傷力,有時反而不及病灶較小的黃斑部病變。
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所謂黃斑部病變,<span style="font-size: large;"><b>廣義來說只要是發生在黃斑部的問題</b>,<b>都可以統稱為黃斑部病變</b></span>。常見問題包括:<b>網膜內積水引發水腫、微血管管壁損壞出血、含膽脂結晶的黃色滲出物沉積、網膜微血管擴張或鼓脹造成微血管瘤、黃斑部中心產生裂孔、黃斑部表面增生皺褶、黃斑部視網膜劈裂、玻璃體對黃斑部拉扯</b>等。
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<br />
這些目不暇給的診斷,都因「<b>光學同調斷層掃描</b>」OCT 的發明而讓眼科醫師對黃斑部病因的判讀更為清晰詳盡。雖然冠上「斷層掃描」,但這項檢查沒有輻射線,不須注射顯影藥劑,使用 700 到 1000 奈米比可見光波長更長的紅外光源,是非接觸式、非侵入性眼科影像診斷技術,軸向解析度高達 5微米,解像力極佳。
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正確診斷才能提供病患有效治療,例如年齡相關性黃斑部病變(圖一)引起的出血、或糖尿病黃斑部水腫,可以使用眼球內注射<b>血管內皮細胞生成因子抑制劑</b>或是<b>類固醇藥物</b>,來改善或穩定視力。初期黃斑部裂孔、或拉扯範圍較小的玻璃體黃斑部牽引症,已可透過注射<b>蛋白質酶</b>,來改善病況。<br />
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<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyD6O2QQEF6GkVeF21qJIBmbtV2WGfj15te6nQWrEe3CxxeqBLLUGJ3I2Z1ng6BzHLP8aSK3ikHMCaZ2Ka4sTZwBcDEcKMP4J7lz8y6szRGL3Hj_ipLt7A9ZkPySNuzH0N_zBg/s1600/%25E5%259C%2596%25E4%25B8%2580_%25E5%258F%25AF%25E6%2589%2593%25E9%2587%259D%25E6%25B2%25BB%25E7%2599%2582%25E7%259A%2584%25E9%25BB%2583%25E6%2596%2591%25E9%2583%25A8%25E7%2597%2585%25E8%25AE%258A.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="253" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyD6O2QQEF6GkVeF21qJIBmbtV2WGfj15te6nQWrEe3CxxeqBLLUGJ3I2Z1ng6BzHLP8aSK3ikHMCaZ2Ka4sTZwBcDEcKMP4J7lz8y6szRGL3Hj_ipLt7A9ZkPySNuzH0N_zBg/s400/%25E5%259C%2596%25E4%25B8%2580_%25E5%258F%25AF%25E6%2589%2593%25E9%2587%259D%25E6%25B2%25BB%25E7%2599%2582%25E7%259A%2584%25E9%25BB%2583%25E6%2596%2591%25E9%2583%25A8%25E7%2597%2585%25E8%25AE%258A.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8000001907349px;">可<b>打針治療</b>的黃斑部病變</td></tr>
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而較大的黃斑部裂孔、黃斑部表面皺褶、黃斑部視網膜劈裂(圖二)、拉扯範圍過大的玻璃體黃斑部牽引症,則必須藉由<b>玻璃體切除手術</b>清除拉扯的不正常增生組織。<br />
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<tr><td class="tr-caption" style="font-size: 12.8000001907349px;">應該<b>手術治療</b>的黃斑部病變</td></tr>
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<span style="text-align: justify;"><br /></span>
<span style="text-align: justify;">由於黃斑部病變初期症狀並不明顯,僅有類似近視或老花的視力模糊,若只發生在單眼,患者通常難以即時察覺;平時可透過自我檢查,如雙眼輪流看磁磚、棋盤等方格,觀察是否有直線扭曲。</span><br />
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早期診斷後,還要選擇最妥適的治療,有些黃斑部疾病可以眼內打藥,但有些黃斑部疾病,還是必須手術;不要讓應該手術的問題,先打針嘗試,浪費金錢又沒得到最佳改善效果。
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjj9Hs4vYyVA9DHKYKV9LabMpJEDTGhTcxO55iJcFwk3Qxd0o6wbqsADNsypB6jCtDIguSLfFzcKjN_rRWBgZs3uW2JlzrAxWcbe3ZMfWb6mjOvDmOYXwnzzLNfIiFmz88syvj8/s1600/%25E9%2598%25BF%25E5%25A7%2586%25E6%2596%25AF%25E5%258B%2592%25E6%2596%25B9%25E6%25A0%25BC%25E8%25A1%25A8%25EF%25BC%2588%25E4%25B8%258A%25E7%2582%25BA%25E6%25AD%25A3%25E5%25B8%25B8%25EF%25BC%258C%25E4%25B8%258B%25E7%2582%25BA%25E8%25AE%258A%25E5%25BD%25A2%25E2%2580%25B5%2529.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjj9Hs4vYyVA9DHKYKV9LabMpJEDTGhTcxO55iJcFwk3Qxd0o6wbqsADNsypB6jCtDIguSLfFzcKjN_rRWBgZs3uW2JlzrAxWcbe3ZMfWb6mjOvDmOYXwnzzLNfIiFmz88syvj8/s640/%25E9%2598%25BF%25E5%25A7%2586%25E6%2596%25AF%25E5%258B%2592%25E6%2596%25B9%25E6%25A0%25BC%25E8%25A1%25A8%25EF%25BC%2588%25E4%25B8%258A%25E7%2582%25BA%25E6%25AD%25A3%25E5%25B8%25B8%25EF%25BC%258C%25E4%25B8%258B%25E7%2582%25BA%25E8%25AE%258A%25E5%25BD%25A2%25E2%2580%25B5%2529.jpg" width="316" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">阿姆斯勒方格表(上為正常,下為變形)</td></tr>
</tbody></table>
blinddochttp://www.blogger.com/profile/10069564425091923168noreply@blogger.com0tag:blogger.com,1999:blog-19297252.post-35535490369022709652015-06-29T20:18:00.000+06:002015-06-29T20:18:46.605+06:00明哲才能保身?<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7N_sYVdbMByoz1eJqoQdBeY0HADNFF6xg2s-YV4mNtbzCS3Ns8kiL4mkLOs2m_hkYvDvNNFA9kjZG0MtFWqQn22wMUd5HKLvIEMeV2XB497jggIi9D-wjS91jalIj9Dly74rX/s1600/%25E4%25B8%2589%25E7%25AB%258B.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7N_sYVdbMByoz1eJqoQdBeY0HADNFF6xg2s-YV4mNtbzCS3Ns8kiL4mkLOs2m_hkYvDvNNFA9kjZG0MtFWqQn22wMUd5HKLvIEMeV2XB497jggIi9D-wjS91jalIj9Dly74rX/s400/%25E4%25B8%2589%25E7%25AB%258B.jpg" /></a></div>
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擔心會聽到的話,終於在家屬情緒必須有個出口時脫口而出了 ...<br />
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說送去恩主公醫院是送錯,所以女兒才會走了; 現在兒子ㄧ定要轉到台大,不能再有任何疏失...<br />
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事已至此,誰還能怪和信醫院第一時間拒收傷者呢? 因為早可以想像盲目的媒體與無辜的民眾未來會如何責怪醫院治療不力。<br />
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家屬的痛苦全國上下感同身受,沒人敢苛責;但這個沉重的責任,怎麼又轉移到醫院與醫師身上來了。<br />
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若不是國家法令有欠嚴謹,不肖商人只顧賺錢,讓這個善良女孩第一時間受傷太重,呼吸道與肺部百分百灼傷,怎會有這個悲傷的結果?<br />
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我相信重傷者送到醫院後,醫護人員已經盡全力跟死神拔河了,真的無法承受家屬這種說法。<br />
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但現在恩主公的醫師雖然悲憤,也只能默默拭淚;更怕最後該負責的人脫罪脫產,反而是醫院與醫師背黑鍋。<br />
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好難受,為了傷者與家庭的漫漫痛苦,為了風雨飄搖的醫界必須像和信醫院一樣明哲才能保身。<br />
<br />blinddochttp://www.blogger.com/profile/10069564425091923168noreply@blogger.com0tag:blogger.com,1999:blog-19297252.post-58239328837998585862015-05-19T20:37:00.000+06:002015-05-19T20:38:09.707+06:00笑看他樓起 冷望他樓塌<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOfuVgmZcg5Q1Wn_p3qyKd-ruums7pYTGEeiZTbJl8r4Szg3drRDVlJcrBKiBkDSL51EsjmVHhFf5YeE3VWCNw9TzALEtvCxiiD-cZr2XAEIQ1ANKTM_EcuFlIX8qTmSEMfcQ_/s1600/%E7%BE%85%E9%A6%AC%E5%B8%82%E9%9B%86.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOfuVgmZcg5Q1Wn_p3qyKd-ruums7pYTGEeiZTbJl8r4Szg3drRDVlJcrBKiBkDSL51EsjmVHhFf5YeE3VWCNw9TzALEtvCxiiD-cZr2XAEIQ1ANKTM_EcuFlIX8qTmSEMfcQ_/s400/%E7%BE%85%E9%A6%AC%E5%B8%82%E9%9B%86.jpg" width="400" /></a></div>
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科內資深醫師重感冒發燒,聲音沙啞不停咳嗽, 所以門診已預約的病人只好拜託工作已經很繁重的醫師代診,而原安排手術的病人,由科秘書一位一位聯絡視病情另外安排時間。</div>
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所幸多數病家都能體諒「醫師也會生病」,但有位家屬不悅反映:「你們醫師生病,那是你們的問題,你們要自行解決;我因為爸爸白內障要開刀,特別從國外回來,下周我沒有空,我一定要我爸爸這週開刀,所以你們必須安排其他資深醫師幫他開刀。」</div>
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科秘書是個善解人意的甜姐兒, 和顏悅色答應一定會全力協助安排,所以就先問家屬:「那麼請問您想要找哪位醫師呢?」顯然家屬已經心中有定見了:「就找某醫師。」科秘書也不敢怠慢:「好的,那我馬上幫伯父安排這位醫師的門診,因為伯父都沒讓這位醫師檢查過,我們先讓醫師評估後,再安排手術。」</div>
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家屬又有意見:「我爸爸不是之前都已經檢查過了, 就教這位醫師直接幫他開刀就好了,為什麼還要再去給她看?」最後這事因為生病醫師撐著病體前來執行手術了結,反正醫師生病,那是他自己的問題,他日葬儂知是誰?不關家屬的事。</div>
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「醫糾法」若真的強度關山,這個行業真的不能待了。台灣醫療就像羅馬市集,輝煌的時代已經過去,剩幾根柱子搖搖欲墜或能撐些時日,但氣數已盡,只等著看哪一天全倒而已。<br />
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這幾日是對台灣醫師士氣打擊極大的時刻,但可怕的是,終結資深醫師悲慘的宿命只能靠醫師自行放棄、自求解脫,敢問捍衛全民健康的未來守護者在何處?</div>
blinddochttp://www.blogger.com/profile/10069564425091923168noreply@blogger.com3tag:blogger.com,1999:blog-19297252.post-40034193884716450052015-04-16T19:22:00.005+06:002015-04-16T19:23:55.719+06:00斯人已逝 典型猶在筆下<div class="separator" style="clear: both; text-align: center;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEga8hvdxtO-4_EFP62oGXvNwyJF0Ul6I-bElTcVx-1OP5NpeRTeNCIczZ3hDZ5_-GBXdTC5xFBALCIoYPSo8k_54zewYiNushXNUhApHQY8lR6SWTw8sclt_pydq0XtP7eLL237/s1600/%E5%A6%B9-%E5%B0%8F%E4%B8%91.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEga8hvdxtO-4_EFP62oGXvNwyJF0Ul6I-bElTcVx-1OP5NpeRTeNCIczZ3hDZ5_-GBXdTC5xFBALCIoYPSo8k_54zewYiNushXNUhApHQY8lR6SWTw8sclt_pydq0XtP7eLL237/s1600/%E5%A6%B9-%E5%B0%8F%E4%B8%91.jpg" height="640" width="360" /></a></div>
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不是我講,您看得出來上面這幅作品,是下面這位小妹妹畫出來的嗎?</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbaL2XoTRL-1LTU6JJlLCaNqdHz4o8M0u7I77_bsLTLTSos1fc7VhzMs6M6w8Z0n4J3I_-W21L6Hkol_V2GcNq1GMSeBD5tD_9WIRcd8RDj6TcVnnYnkr7Q2M74Og0Zu0iAawL/s1600/%E5%B0%8F%E5%A6%B9.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbaL2XoTRL-1LTU6JJlLCaNqdHz4o8M0u7I77_bsLTLTSos1fc7VhzMs6M6w8Z0n4J3I_-W21L6Hkol_V2GcNq1GMSeBD5tD_9WIRcd8RDj6TcVnnYnkr7Q2M74Og0Zu0iAawL/s1600/%E5%B0%8F%E5%A6%B9.jpg" height="400" width="362" /></a></div>
blinddochttp://www.blogger.com/profile/10069564425091923168noreply@blogger.com4tag:blogger.com,1999:blog-19297252.post-59750801742715281762015-04-03T19:27:00.000+06:002015-04-16T19:30:18.611+06:00銘謝惠顧<div class="separator" style="clear: both; text-align: center;">
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有被嚇到...</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhhYOt7VjmudYUidAF1vOgeOdDzqlulwKTmVniJ3a-UWSlQgoJqmFkAZJUlDJd-PYqaYu3wSHT0KpVaeo8yJBZvwnZkZVlMSmg706g6fh4FYsrZkz-gblMh33_m723-ekQbrFkr/s1600/237.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhhYOt7VjmudYUidAF1vOgeOdDzqlulwKTmVniJ3a-UWSlQgoJqmFkAZJUlDJd-PYqaYu3wSHT0KpVaeo8yJBZvwnZkZVlMSmg706g6fh4FYsrZkz-gblMh33_m723-ekQbrFkr/s1600/237.jpg" height="225" width="400" /></a></div>
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<div style="text-align: center;">
還能貼出這張照片,表示依然健在...</div>
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<br />blinddochttp://www.blogger.com/profile/10069564425091923168noreply@blogger.com4tag:blogger.com,1999:blog-19297252.post-66065906396037194262015-03-26T19:09:00.000+06:002015-04-16T19:13:23.366+06:00西西里獨有的警告標誌吧<div class="separator" style="clear: both; text-align: center;">
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非常豪氣的警告標誌...</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXHTQDlLSVD6AzFVWrNKKTLM3GWr0iRNYN05C5GWAv-Ypwiq9ziGlrmJ9Bj4nRGC-Fp7INl6MA_UsSgsdiueVixoKmmZWBhv6AuQwdSSlBBjHQLt_hcQRaByI6h84cs_fwFTN3/s1600/%E8%A5%BF%E8%A5%BF%E9%87%8C.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXHTQDlLSVD6AzFVWrNKKTLM3GWr0iRNYN05C5GWAv-Ypwiq9ziGlrmJ9Bj4nRGC-Fp7INl6MA_UsSgsdiueVixoKmmZWBhv6AuQwdSSlBBjHQLt_hcQRaByI6h84cs_fwFTN3/s1600/%E8%A5%BF%E8%A5%BF%E9%87%8C.jpg" height="225" width="400" /></a></div>
<br />blinddochttp://www.blogger.com/profile/10069564425091923168noreply@blogger.com0tag:blogger.com,1999:blog-19297252.post-19354500026511635512015-02-27T17:25:00.000+06:002015-02-28T19:37:12.544+06:00一個可怕的紀錄<div style="text-align: center;">
本人掛牌上市以來,最高的門診號碼。</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6SeNQ0q9ER3djm4fZbd2A6iy3G0_keL1dZdkqyzbA757yKrL_EIWNQws-2oog9h9OsAnbbjmUz5SaDlyXn5iS3BmKUjkXICxKwCI3vvCqVzr81PdQ_x19zz4SdDkgKWj9gmVT/s1600/20150227.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6SeNQ0q9ER3djm4fZbd2A6iy3G0_keL1dZdkqyzbA757yKrL_EIWNQws-2oog9h9OsAnbbjmUz5SaDlyXn5iS3BmKUjkXICxKwCI3vvCqVzr81PdQ_x19zz4SdDkgKWj9gmVT/s1600/20150227.jpg" height="300" width="400" /></a></div>
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如果能緩慢品生活,誰想要這樣過日子?</div>
blinddochttp://www.blogger.com/profile/10069564425091923168noreply@blogger.com2tag:blogger.com,1999:blog-19297252.post-17301000508241109062015-02-09T18:55:00.002+06:002015-02-09T18:57:11.495+06:00眼內結核<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEioJk0NgiErwY_qlzNYNXaCDi9NmI7SZmcAJzgc6wPpbl8D3mn_FCN0v9xaUBSeO5tj9OaSnpxKFYlAYsa6iYO4e-iJfxnuf7n-y3NZl0Lv_3eBeFg6lN23PxO7fEoaokmRNC5T/s1600/%E7%B6%B2%E8%86%9C%E8%A1%80%E7%AE%A1%E7%99%BC%E7%82%8E%E5%8F%8A%E5%87%BA%E8%A1%80%E8%99%95%E5%8D%B3%E7%82%BA%E7%9C%BC%E5%85%A7%E7%B5%90%E6%A0%B8%E6%89%80%E5%9C%A8.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEioJk0NgiErwY_qlzNYNXaCDi9NmI7SZmcAJzgc6wPpbl8D3mn_FCN0v9xaUBSeO5tj9OaSnpxKFYlAYsa6iYO4e-iJfxnuf7n-y3NZl0Lv_3eBeFg6lN23PxO7fEoaokmRNC5T/s1600/%E7%B6%B2%E8%86%9C%E8%A1%80%E7%AE%A1%E7%99%BC%E7%82%8E%E5%8F%8A%E5%87%BA%E8%A1%80%E8%99%95%E5%8D%B3%E7%82%BA%E7%9C%BC%E5%85%A7%E7%B5%90%E6%A0%B8%E6%89%80%E5%9C%A8.jpg" height="295" width="400" /></a></div>
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結核病為台灣主要傳染病,常見致病原為結核桿菌。結核桿菌是絕對需氧菌,生存在含氧高器官,由飛沫侵入肺部後,可能經由淋巴血液循環,侵犯眼部。眼內結核可單獨發生,或是合併其他部位結核。眼內結核較難診斷,除少見外,因眼部較難獲得細菌證據。<br />
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眼內結核可能以鞏膜炎、結膜炎、角膜炎、淚囊炎、淚腺炎、眼窩膿腫、視神經炎表現外,葡萄膜炎最多。五成為雙側發生,合併視網膜出血、局部脈絡膜炎、玻璃體混濁。當病患有以上眼部表現時,需選擇適當診斷工具,可先做螢光眼底血管攝影。 <br />
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眼部採樣檢查困難在於須手術才能獲取檢體。需要靠皮膚結核菌素測試、眼內房液聚合連鎖反應、酵素連結免疫吸附法等方式輔助診斷。因此以往多數眼內結核診斷是推論於眼部典型症狀,合併身體其他部位結核,及皮膚結核菌素測試陽性。但皮膚測試缺點為病人需要48小時回診判定,施打過卡介苗者易產生偽陽性,免疫不全者易呈現偽陰性。<br />
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結核桿菌群直接檢測法可直接檢測檢體中是否含有結核桿菌核糖體核糖核酸,藉此區別結核桿菌是否具繁殖力;全血丙型干擾素檢驗只需抽血。急性典型眼內炎加上陽性全血丙型干擾素檢驗,不論有無身體症狀,則可考慮眼內結核。研究顯示全血丙型干擾素檢驗對於眼內結核診斷,優於皮膚測試。<br />
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目前診斷眼內結核準則為:首先排除其他原因,臨床病史與接觸史,身體與眼部症狀;眼部檢驗屬直接證據,可確切診斷,包括抹片檢查陽性,或培養出結核桿菌;結核桿菌聚合連鎖反應陽性,或結核桿菌群直接檢測法陽性。身體檢驗為輔助診斷,包括皮膚結核菌素測試陽性,或全血丙型干擾素檢驗陽性,胸部X光有病灶,確有肺外結核;最後是治療試驗診斷,使用抗結核藥物治療四到六周,若眼部病況改善,也可考慮是眼內結核。<br />
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blinddochttp://www.blogger.com/profile/10069564425091923168noreply@blogger.com0tag:blogger.com,1999:blog-19297252.post-58414744791611731762015-01-11T08:12:00.001+06:002015-01-11T08:13:31.556+06:00Dennis Rodman<div class="separator" style="clear: both; text-align: center;">
特異獨行</div>
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<br />blinddochttp://www.blogger.com/profile/10069564425091923168noreply@blogger.com2tag:blogger.com,1999:blog-19297252.post-12488207307497119192015-01-05T19:11:00.002+06:002015-01-11T08:17:55.687+06:00視網膜剝離簡介<div class="MsoListParagraph" style="line-height: 150%; margin-left: 18.0pt; mso-list: l1 level1 lfo1; mso-para-margin-left: 0gd; text-indent: -18.0pt;">
<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: 標楷體;">何謂視網膜剝離?導致病發的因素有哪些?<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體;">A.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: 標楷體;">視網膜剝離即視網膜的感光細胞與網膜色素上皮層及脈絡膜分開,感光細胞無法吸收到來自脈絡膜的養份,而漸漸退化而失去功能。<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體;">B.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: 標楷體;">視網膜剝離分三種:<span lang="EN-US"><o:p></o:p></span></span></b></div>
<div class="MsoListParagraph" style="line-height: 150%; margin-left: 66.0pt; mso-list: l0 level2 lfo2; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體;">甲、<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: 標楷體;">原發性:裂孔性,臨床上最為常見。<span lang="EN-US"><o:p></o:p></span></span></b></div>
<div class="MsoListParagraph" style="line-height: 150%; margin-left: 66.0pt; mso-list: l0 level2 lfo2; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體;">乙、<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: 標楷體;">牽引性:糖尿病、外傷性。<span lang="EN-US"><o:p></o:p></span></span></b></div>
<div class="MsoListParagraph" style="line-height: 150%; margin-left: 66.0pt; mso-list: l0 level2 lfo2; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體;">丙、<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: 標楷體;">滲出性。 <span lang="EN-US"><o:p></o:p></span></span></b></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體;">C.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: 標楷體;">裂孔性視網膜剝離三要件<span lang="EN-US"><o:p></o:p></span></span></b></div>
<div class="MsoListParagraph" style="line-height: 150%; margin-left: 66.0pt; mso-list: l0 level2 lfo2; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體;">甲、<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: 標楷體;">有視網膜裂孔<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體;">乙、<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: 標楷體;">有拉力使裂孔掀開<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體;">丙、<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: 標楷體;">有水分滲入裂孔下使網膜剝離<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體;">D.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: 標楷體;">裂孔性視網膜剝離三大危險因子<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體;">甲、<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: 標楷體;">高度近視(六百度以上)<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體;">乙、<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: 標楷體;">家族中有裂孔性視網膜剝離病史<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<div class="MsoListParagraph" style="line-height: 150%; margin-left: 66.0pt; mso-list: l0 level2 lfo2; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體;">丙、<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: 標楷體;">眼球外傷或接受過眼部手術<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: 標楷體;">目前手術的方式和未來的趨勢為何?<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體;">A.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: 標楷體;">裂孔性視網膜剝離的治療方式<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體;">甲、<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: 標楷體;">視網膜雷射術<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體;">乙、<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: 標楷體;">氣體網膜固定手術<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體;">丙、<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: 標楷體;">鞏膜扣壓植入手術<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體;">丁、<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: 標楷體;">玻璃體切除手術<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<b><span style="font-family: 標楷體;"><br /></span></b></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體;">B.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: 標楷體;">手術未來的趨勢:微創玻璃體切除手術<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體;">甲、<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: 標楷體;">不但具有縮短手術時間、縮短住院時間或免住院、降低病患的不適感、術後復原較快等優點,萬一有必要進行多次手術時,亦可減少傳統手術上找不到適合位置插入器械等問題。<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體;">乙、<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: 標楷體;">微細器械(<span lang="EN-US"> 25G </span>)已成功發展,灌注管、光源管及玻璃體切除探頭的直徑已縮減至可通過<span lang="EN-US">0.05</span>公分特殊設計的套管。更微細的<span lang="EN-US">27G</span>預計<span lang="EN-US">2015</span>年在台灣經衛生署核准上市。<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體;">丙、<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: 標楷體;">不需要再將結膜、鞏膜切開,手術後直接將灌注管、光源管及玻璃體切除探頭的套管拔除,不需要再縫合結膜、鞏膜。
<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體;">丁、<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: 標楷體;">大約<span lang="EN-US"> 90</span>﹪的傳統視網膜玻璃體手術皆可以此採用此新方式<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體;">戊、<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: 標楷體;">其餘<span lang="EN-US"> 10</span>﹪可採用部分新的微細器械組合(灌注管、光源管)再加上傳統的結膜、鞏膜切口來完成手術(術後僅需縫合一處)。<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<b><span style="font-family: 標楷體;"><br /></span></b></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; mso-bidi-font-family: 標楷體;">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: 標楷體;">病人術後須注意事項為何?<span lang="EN-US"><o:p></o:p></span></span></b></div>
<div class="MsoListParagraph" style="line-height: 150%; margin-left: 42.0pt; mso-list: l0 level1 lfo3; mso-pagination: widow-orphan; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; line-height: 150%; mso-bidi-font-family: 標楷體; mso-bidi-font-size: 12.0pt;">A.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: 標楷體; line-height: 150%; mso-bidi-font-size: 12.0pt;">遵照醫生指示之姿勢,或趴臥或半坐臥休息。<span lang="EN-US"><o:p></o:p></span></span></b></div>
<div class="MsoListParagraph" style="line-height: 150%; margin-left: 42.0pt; mso-list: l0 level1 lfo3; mso-pagination: widow-orphan; mso-para-margin-left: 0gd; text-indent: -24.0pt;">
<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; line-height: 150%; mso-bidi-font-family: 標楷體; mso-bidi-font-size: 12.0pt;">B.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: 標楷體; line-height: 150%; mso-bidi-font-size: 12.0pt;">術後患眼會以眼墊紗布覆罩,以沾附眼部分泌物,可保持眼睛之清潔舒適。同時加蓋鐵眼罩,以防碰撞及壓力。<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; line-height: 150%; mso-bidi-font-family: 標楷體; mso-bidi-font-size: 12.0pt;">C.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: 標楷體; line-height: 150%; mso-bidi-font-size: 12.0pt;">病患應學會正確之點眼藥技術,於術後次日開始按醫囑點眼藥,以防感染及降低炎症反應。視需要會點用散瞳劑保持瞳孔散大,便於檢查眼底。<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; line-height: 150%; mso-bidi-font-family: 標楷體; mso-bidi-font-size: 12.0pt;">D.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: 標楷體; line-height: 150%; mso-bidi-font-size: 12.0pt;">手術中若因病情需要有注入空氣於眼球內,術後須遵照醫囑採適當臥姿,利用眼內空氣浮升的力量抵住造成視網膜剝離裂孔,促使網膜平貼黏合。常見的是俯臥和側睡,要持續十到十四天。這段時間平視前方時會覺得患側眼睛前有一片黑影,漸漸地黑影的範圍會向下減少,當黑影完全消失表示空氣被吸收完畢,從那天起就可以在不會壓迫患眼的情況下較自然地躺臥休息。<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; line-height: 150%; mso-bidi-font-family: 標楷體; mso-bidi-font-size: 12.0pt;">E.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: 標楷體; line-height: 150%; mso-bidi-font-size: 12.0pt;">術後患眼眼瞼會有紅腫現象,此與手術操作及術後趴臥姿勢有關,會慢慢消退。如感患眼疼痛不適以及顳部、上額部疼痛,可按醫囑服止痛劑緩解;如患眼疼痛不適持續且合併有噁心、嘔吐現象,則有眼壓過高的可能,應立即告知醫護人員,醫師會詳細檢查並緩解病患不適。<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; line-height: 150%; mso-bidi-font-family: 標楷體; mso-bidi-font-size: 12.0pt;">F.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: 標楷體; line-height: 150%; mso-bidi-font-size: 12.0pt;">出院後遵照醫囑繼續使用類固醇和抗生素眼藥四至六週,切記每次點眼藥前要用肥皂確實清洗雙手。</span></b></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; line-height: 150%; mso-bidi-font-family: 標楷體; mso-bidi-font-size: 12.0pt;">G.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: 標楷體; line-height: 150%; mso-bidi-font-size: 12.0pt;">出院一週內可看電視,但避免閱讀書報等近距離工作,因會引起眼球快速轉動而造成不適。<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; line-height: 150%; mso-bidi-font-family: 標楷體; mso-bidi-font-size: 12.0pt;">H.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: 標楷體; line-height: 150%; mso-bidi-font-size: 12.0pt;">出院二月內避免便秘(用力排便)、噴嚏、急速的頭部活動和過度運動等。六週後可從事勞力工作和非劇烈性之體能活動。<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: 標楷體; line-height: 150%; mso-bidi-font-family: 標楷體; mso-bidi-font-size: 12.0pt;">I.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: 標楷體; line-height: 150%; mso-bidi-font-size: 12.0pt;">遵照醫囑按時門診複查。<span lang="EN-US"><o:p></o:p></span></span></b></div>
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<b><span style="font-family: 標楷體; line-height: 150%; mso-bidi-font-size: 12.0pt;"><br /></span></b></div>
blinddochttp://www.blogger.com/profile/10069564425091923168noreply@blogger.com11tag:blogger.com,1999:blog-19297252.post-90608664456348693662015-01-04T18:38:00.002+06:002015-01-04T18:38:10.668+06:00Derrick Rose<div class="separator" style="clear: both; text-align: center;">
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<b>殺氣騰騰</b></div>
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<br />blinddochttp://www.blogger.com/profile/10069564425091923168noreply@blogger.com0tag:blogger.com,1999:blog-19297252.post-41096139294547636302015-01-02T20:13:00.001+06:002015-01-02T20:13:58.762+06:002015 我們來了<div style="text-align: center;">
無論如何,日子還是要過下去...</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMVqgJO4k2ZN2YHQT42gyfOyoLAD-DJwe-n04GYdC1c80Olm-IvxF8OQbreOpv3n2Jrv-7qMu5_0X753I0Bk4_zP8g1XVel_fbJFCDLFCeDqypGUqjNR9M_eK-AapCzp65_pJd/s1600/LUCY.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMVqgJO4k2ZN2YHQT42gyfOyoLAD-DJwe-n04GYdC1c80Olm-IvxF8OQbreOpv3n2Jrv-7qMu5_0X753I0Bk4_zP8g1XVel_fbJFCDLFCeDqypGUqjNR9M_eK-AapCzp65_pJd/s1600/LUCY.jpg" height="400" width="400" /></a></div>
<br />blinddochttp://www.blogger.com/profile/10069564425091923168noreply@blogger.com4tag:blogger.com,1999:blog-19297252.post-87673246904475726152014-12-31T23:59:00.000+06:002015-01-02T20:03:08.561+06:00令人悲傷的跨年<div class="separator" style="clear: both; text-align: center;">
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<br />blinddochttp://www.blogger.com/profile/10069564425091923168noreply@blogger.com0tag:blogger.com,1999:blog-19297252.post-67698263512170123432014-11-29T20:05:00.000+06:002014-11-29T20:06:01.061+06:00檢討 VS 改革<div class="separator" style="clear: both; text-align: center;">
信守對季節的承諾,茶花又開了。</div>
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花兒的要求非常少,陽光空氣水,和偶爾施予的養分。</div>
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把國家未來寄託於不思檢討而只會改革別人的傲慢領導時代必須過去,</div>
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人民今日的覺醒但願能給台灣後代活路;</div>
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有幸當選的人敬請戒慎擔負民眾的付託,</div>
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不然下一個失意政客就是你。</div>
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blinddochttp://www.blogger.com/profile/10069564425091923168noreply@blogger.com0tag:blogger.com,1999:blog-19297252.post-44964074918250719332014-11-15T09:20:00.000+06:002014-11-15T09:20:28.700+06:00好友與醇酒<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnyFtMy_aJHgsf7VQyo013nQCw_-3ABMS9iKztYoWDEQoZZxJ6ydXLBFirZ4PtpupVCGnNTlDyYcI14U5_7xBQ36d3SFvIMsuIbvoTIG1svPK5Gni9qj7cLv_KZZVTar6zwY_U/s1600/%E5%A5%BD%E9%85%92-2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnyFtMy_aJHgsf7VQyo013nQCw_-3ABMS9iKztYoWDEQoZZxJ6ydXLBFirZ4PtpupVCGnNTlDyYcI14U5_7xBQ36d3SFvIMsuIbvoTIG1svPK5Gni9qj7cLv_KZZVTar6zwY_U/s1600/%E5%A5%BD%E9%85%92-2.jpg" height="400" width="255" /></a></div>
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臆轉念得道 </div>
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事過閴無痕</div>
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嘆扯心崩潰</div>
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多在一瞬間</div>
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所幸有醇酒</div>
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伴好友懂我</div>
blinddochttp://www.blogger.com/profile/10069564425091923168noreply@blogger.com0tag:blogger.com,1999:blog-19297252.post-76226550346252763972014-11-08T08:13:00.000+06:002014-11-08T08:14:46.795+06:00泰晤士河畔<div class="separator" style="clear: both; text-align: center;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8J4dFhRL-gwSINZvuXIf8Y0zaXhyPM6ikWOcKOcJl36TV5KHCwuMusfPKjhZGZ2bD49IyAUQkyNDKrTe9J521NoIYpxOY43r47v-cLkM762d-hialCPVKBCkhMr3tH5BP5ELJ/s1600/Tames.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8J4dFhRL-gwSINZvuXIf8Y0zaXhyPM6ikWOcKOcJl36TV5KHCwuMusfPKjhZGZ2bD49IyAUQkyNDKrTe9J521NoIYpxOY43r47v-cLkM762d-hialCPVKBCkhMr3tH5BP5ELJ/s1600/Tames.jpg" height="110" width="400" /></a></div>
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初秋重逢倫敦,</div>
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揣度此生與你的緣分就走到這裡了。</div>
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在 Her Majesty's Theatre,</div>
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為心碎魅影再次流下一滴淚。</div>
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倫敦塔外洶湧虞美人花海,</div>
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花開花謝戰士魂兮來去當真灑脫?</div>
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無法盤據不羈心靈,</div>
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但倦乏 photoreceptors 終究歸向癡傻守候。</div>
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blinddochttp://www.blogger.com/profile/10069564425091923168noreply@blogger.com2tag:blogger.com,1999:blog-19297252.post-67760633862461930342014-10-12T09:42:00.001+06:002014-10-12T09:46:38.686+06:00第一故鄉<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZzhvZECPSZ_SrTVerbODwZG7wJDC7n9FX51NgP6klIyJCbBXhyyirjWuifyjo8WAEiA6hhIp8EYzOxuLeuZ9IDrmCBsVZDqhJGeHCH4KuxRA5EaeL7LDaXE6EwGTRQ-Rkakn3/s1600/%E5%98%89%E5%9F%BA.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZzhvZECPSZ_SrTVerbODwZG7wJDC7n9FX51NgP6klIyJCbBXhyyirjWuifyjo8WAEiA6hhIp8EYzOxuLeuZ9IDrmCBsVZDqhJGeHCH4KuxRA5EaeL7LDaXE6EwGTRQ-Rkakn3/s1600/%E5%98%89%E5%9F%BA.jpg" height="400" width="225" /></a></div>
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我的籍貫是台北,生長在高雄,第一份工作在嘉義。<br />
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雖然是台灣人,童年在眷村度過,台語是第一年住院醫師開始學的。<br />
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本來覺得自己的台語半路出家,只能仰賴鄉親包涵;但到台北受訓時,才發現比其他北部孩子略勝一籌(哈)。<br />
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工作了十年,不捨離開面對未知;爭取到回鄉支援,又四年多。再次結束,非自己所願,離情依依,溢於言表,但只能順服命運的安排。<br />
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但我最好的青春,最痛的經歷,都留在這裡,曾在這麼美的夜空下獨酌辛酸與甜美。<br />
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味全頂新的惡行,絕大多數台灣人都生氣了,不論我們出生在哪個角落,只要認同台灣,台灣就是我們的第一故鄉,要盡心愛護她。<br />
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一再辜負人民信任沒有良心的負責人,絕對要讓他們得到最嚴厲的制裁;但那些無辜辛勤工作的員工,敬請政府一定要幫助他們度過難關,不要讓他們生活陷入困境。<br />
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冷冽的血月總會圓滿,溫柔的月光請撫慰這土地上受傷的心好嗎?</div>
<br />blinddochttp://www.blogger.com/profile/10069564425091923168noreply@blogger.com0