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Anaesthesia and the Practice of Medicine: Historical Perspectives 麻醉和医学实践:历史的观点
Pub Date : 2008-05-01 DOI: 10.5860/choice.45-0914
D. Johnston
This is a delightful volume written by two retired anaesthetists, one a Cambridge graduate and the other a graduate from Harvard. Both worked together at the Massachusetts General Hospital in 1954–55. The book is divided into five parts. Part 1 deals with the origins of anaesthetic drugs. The first use of anaesthetics is open to considerable doubt but excluding alcohol, hemlock, hemp and laudanum, the earliest recorded soporific effects of ether were described as far back as 1540. Nitrous oxide, discovered by a clergyman, Joseph Priestley, started off as a recreational drug and as a cure for tuberculosis and other respiratory illnesses. Beddoes and Humphrey Davy identified its pain relieving properties and in 1800 proposed its use in surgery. It was not until 44 years later that nitrous oxide was used to relieve pain during surgical procedures. Volatile anaesthetics ether and chloroform also started off as recreational drugs and cocaine, the first effective local anaesthetic, continues in that role. Cocaine was initially used to anaesthetise the cornea in eye surgery but as far back as 1889 it was used by the German surgeon August Bier to produce spinal anaesthesia. The last chapter in this section deals with the mechanical aspects of anaesthetics and their development – ventilators, heart-lung machine, and various types of anaesthetic apparatus. Part 2 identifies the impact of a number of historical events, notably the Second World War, and the individuals who helped to establish anaesthetics as an important scientific and clinical discipline. The section concludes with three chapters on curare and neuromuscular blockade reflecting the enormous contribution of these drugs to modern day anaesthesia and the strong research interest of the authors. Part 3 deals with the extension of anaesthesia into other areas of medical practice – maintenance of respiration in poliomyelitis and other diseases requiring respiratory intensive care, cardiac bypass for open heart surgery, cardio-pulmonary resuscitation and the development of short-acting anaesthetic agents for day surgery. Halothane hepatitis and the safety of anaesthetic agents are also discussed. Part 4 discusses the role of the anaesthetist in childbirth and in the care of the newborn. Opposition to pain relief during Victorian times was largely silenced by Queen Victoria'a pronouncement, “We are going to have this baby and we are going to have chloroform”. The important contribution of Virginia Apgar to neonatal intensive care is also discussed. She introduced her Apgar score in 1953, which is probably the most famous eponymous acronym in medicine – Appearance, Pulse, Grimace, Activity, Respiration. The final section concludes on a less optimistic note. This chapter concludes that anaesthetics, like a number of other medical academic disciplines, faces two major problems: the impact of the European Working Time Directive on clinical services and training, and the erosion of the aca
这是由两位退休的麻醉师写的一本令人愉快的书,一位毕业于剑桥,另一位毕业于哈佛。1954年至1955年,两人在马萨诸塞州总医院(Massachusetts General Hospital)一起工作。这本书分为五个部分。第1部分讨论麻醉药物的起源。麻醉剂的首次使用存在很大的疑问,但除酒精、铁杉、大麻和鸦片外,最早记录的乙醚催眠作用早在1540年就被描述了。一氧化二氮是由牧师约瑟夫·普里斯特利(Joseph Priestley)发现的,一开始是作为一种娱乐性药物,用于治疗肺结核和其他呼吸系统疾病。Beddoes和Humphrey Davy发现了它缓解疼痛的特性,并于1800年提出将其用于外科手术。直到44年后,一氧化二氮才被用于减轻外科手术过程中的疼痛。挥发性麻醉剂乙醚和氯仿一开始也是作为娱乐性药物,而可卡因作为第一种有效的局部麻醉剂,继续扮演着这一角色。可卡因最初是在眼科手术中用于麻醉角膜的,但早在1889年,德国外科医生奥古斯特·比尔(August Bier)就将其用于脊髓麻醉。本节的最后一章涉及麻醉的机械方面及其发展——呼吸机、心肺机和各种类型的麻醉器具。第2部分确定了一些历史事件的影响,特别是第二次世界大战,以及帮助建立麻醉学作为重要科学和临床学科的个人。本节总结与三章curare和神经肌肉阻断反映了这些药物的巨大贡献,以现代麻醉和作者的强烈的研究兴趣。第3部分涉及将麻醉扩展到医疗实践的其他领域——小儿麻痹症和其他需要呼吸重症监护的疾病的呼吸维持、心内直视手术的心脏搭桥、心肺复苏和日间手术短效麻醉药的发展。并讨论了氟烷肝炎和麻醉药的安全性。第4部分讨论麻醉师在分娩和新生儿护理中的作用。维多利亚时代,反对止痛药的声音在很大程度上被维多利亚女王的声明所压制,“我们要生下这个孩子,我们要使用氯仿”。弗吉尼亚阿普加对新生儿重症监护的重要贡献也进行了讨论。她在1953年推出了她的阿普加评分,这可能是医学上最著名的同名首字母缩略词——外表、脉搏、鬼脸、活动、呼吸。最后一部分的结论不那么乐观。本章的结论是,麻醉学与许多其他医学学科一样,面临两个主要问题:欧洲工作时间指令对临床服务和培训的影响,以及对该学科未来发展至关重要的学术基础的侵蚀。基思·赛克斯和约翰·邦克共同构建了一个精彩而引人入胜的麻醉故事,从过去两个世纪的笑气派对和乙醚玩笑,到今天有针对性地使用局部和全身麻醉剂。这本书清楚地详细说明了在手术室中发展起来的技能如何越来越多地应用于医学中的许多其他疾病和学科。麻醉师,外科医生,那些参与疼痛管理和重症监护和那些对医疗史感兴趣的人将被这本书所吸引。
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引用次数: 5
Carpal tunnel syndrome 腕管综合症
Pub Date : 2008-01-01 DOI: 10.1016/b978-1-4377-2333-5.00154-1
Somaiah Aroori, R. Spence
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引用次数: 425
CORONARY ARTERY DISEASE 冠状动脉疾病
Pub Date : 2007-11-16 DOI: 10.1002/9780470994955.ch15
C. Oakley
UNLIKE most psychiatric textbooks for nurses, usually written by psychiatrists, these revision notes are written by a nurse tutor trained in both general and psychiatric nursing. The approach is problem orientated and the emphasis is on topics of practical value to nurses involved in patient care. A useful series of short selections contains sound advice on how to handle difficult types of patient. A team approach to the management of psychiatric patients is advocated and the functions of the various therapeutic team members are clearly defined. Brief notes are provided about many, though not all, modern developments in patient care. The common psychiatric syndromes are described in note form. A reading list is provided at the end of each section as well as a number of revision questions. The text is clear and concise , though necessarily condensed. Inevitably a number of inaccuracies of fact appear. Nevertheless, this book can be recommended to nurses as a useful short revision text. THIS monograph, which is one of a series on different tonics in medicine, is written by one of the most respected and leading experts in the field of coronary disease. In the preface the author states: "It is the purpose of Coronary Artery Disease to marshal in one place the majority of the available information concerning the current practice of coronary heart disease," and he succeeds not only in doing this, but in presenting it in a concise and interesting fashion. The early chapters cover such topics as methods of investigation, pathogenesis of athero-sclerosis and the anatomy and physiology of the coronary circlulation. Later chanters are devoted to current views on the medical iand surgical treatment of obstructive coronary disease and the material is presented in a well-balanced form. At £13.50 the book is expensive, but it can be strongly recommended to all physicians involved in treating patients with ischaemic heart disease. THE claim on the dust cover of this book states that it is "a full presentation, in accessible and largely non-technical language, of the biological and medical details of rabies, together with a discussion of present policies, in the U.K. and elsewhere, for its prevention and elimination". Eight authors have written seven chapters on different aspects of the rabies problem in man and in animals which do much to substantiate the above claim. However, because of the multiple authorship, some unevenness in style is evident and there is …
不像大多数精神病学的护士教科书,通常是由精神科医生写的,这些修订笔记是由受过普通和精神病学护理培训的护士导师写的。该方法以问题为导向,重点是对参与病人护理的护士具有实用价值的主题。一系列有用的简短选择包含了如何处理难对付的病人的合理建议。提倡以团队方式管理精神病人,并明确界定各治疗团队成员的职能。简要说明提供了许多,虽然不是全部,现代发展的病人护理。常见的精神症状以笔记的形式描述。在每个部分的末尾提供了一个阅读清单以及一些复习问题。这篇文章清晰而简洁,尽管有必要加以浓缩。不可避免地出现了一些不准确的事实。尽管如此,这本书可以推荐给护士作为一个有用的简短修订文本。本专著,这是一个系列的不同的补剂在医学上,是由冠状动脉疾病领域最受尊敬和领先的专家之一写的。在前言中,作者说:“《冠状动脉疾病》的目的是在一个地方汇集关于当前冠心病实践的大部分可用信息,”他不仅成功地做到了这一点,而且以简洁有趣的方式呈现了这些信息。早期的章节涵盖了诸如调查方法、动脉粥样硬化的发病机制以及冠状动脉循环的解剖学和生理学等主题。后来的颂歌致力于当前的观点对医学和手术治疗阻塞性冠状动脉疾病和材料是在一个平衡的形式提出。这本标价13.5英镑的书很贵,但强烈推荐给所有参与治疗缺血性心脏病患者的医生。这本书的封皮上声称,它是“一本完整的介绍,通俗易懂,大部分是非技术性的语言,狂犬病的生物学和医学细节,以及对英国和其他地方预防和消除狂犬病的现行政策的讨论”。八位作者写了七章关于人类和动物狂犬病问题的不同方面,这些都证实了上述说法。然而,由于作者多,风格上的不均匀是明显的,并且存在……
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引用次数: 0
Ethics Manual 道德手册
Pub Date : 2007-01-01 DOI: 10.7326/0003-4819-114-9-826_11
Bob Taylor
The differing activities and proclivities of males and females over the ages mean that Y-chromosomal DNA and mitochondrial DNA allow us to open a window on population histories, and put some flesh on the bare bones of legend and myth. Perhaps surprisingly, this approach is bearing significant fruit, some of which borders on the shocking. In 2003, Zerjal et al. reported an astonishingly high carriage rate of a recent Y-chromosome signature across the old Mongol empire up to 8% of the Y-chromosomes appeared to show an origin from around the time of Genghis Khan the tempting inference (which may well be correct) is that this is the genetic legacy of Genghis himself. He and his descendants were well known for their sexual voracity, and association with the ruling family would have boosted their reproductive luck somewhat.
随着年龄的增长,男性和女性的不同活动和倾向意味着y染色体DNA和线粒体DNA让我们打开了一扇了解人口历史的窗口,并为传说和神话的骨架增添了一些血肉。也许令人惊讶的是,这种方法正在取得重大成果,其中一些成果近乎令人震惊。2003年,Zerjal等人报道了一个最近的y染色体特征在旧蒙古帝国的携带率高得惊人,高达8%的y染色体似乎表明其起源大约在成吉思汗时期,诱人的推断(这很可能是正确的)是成吉思汗自己的遗传遗产。他和他的后代以性贪婪而闻名,与统治家族的联系会在一定程度上提高他们的生育运气。
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引用次数: 0
Oxford Desk Reference: Clinical Genetics 牛津桌面参考:临床遗传学
Pub Date : 2006-09-01 DOI: 10.1093/med/9780192628961.001.0001
T. Dabir
Clinical genetics is a relatively young speciality dealing with genetic disorders of all organ systems affecting all age groups. To say writing a comprehensive and useful book for clinical geneticists is a Herculean task is like stating the obvious. The authors of Oxford Desk Reference: Clinical Genetics deserve to be congratulated for achieving the impossible. This is one hands on guide sorely missed by trainee geneticists in the past. Dr Helen Firth and Dr Jane Hurst not only realised the need for such handbook but managed to address it effectively. Oxford Desk Reference is divided into seven sections and contains over 600 pages. The book begins with glossary of terms used in the world of dysmorphology and genetics followed by a brief introduction of basic and essential concepts such as modes of inheritance, genetic testing and confidentiality. This symbolises the approach of the authors through out the book of ‘not taking anything for granted’ as far as the basic knowledge for the speciality is concerned. The second section deals with the clinical approach to various clinical scenarios (almost a hundred) faced by geneticists in their day-to-day practice. Differential diagnosis of one single clinical finding and the practical approach to it highlights this section. This section emphasises on a structured approach to a clinical problem and is quite stimulating. The third section deals with common genetics consultations giving a brief overview of common and uncommon genetic conditions. Around 400 pages are dedicated to these two sections making it an indispensable tool for geneticists and other physicians with interest in genetics. The fourth and fifth section deals with cancer genetics and various chromosomal disorders. The sixth section is about pregnancy and fertility. This contains a useful overview of the differential diagnosis of various antenatal scan findings and other issues commonly encountered in prenatal clinics. All the chapters in these sections end with information about relevant support group and the expert advisors. The last section is equally valuable with more than 50 pages encompassing growth and development charts, skeletal dysplasia charts, ISCN nomenclature and other useful information for clinicians. Overall this book is a winner and is a must for every clinical genetics department. This is arguably the most important book ever published for trainees in genetics. However this should not be interpreted as less valuable for trained geneticists or other physicians with interest in clinical genetics. This is one book, which can be considered as an extremely useful reference source to any genetics physician. Be it a prenatal clinic, a cancer clinic or a dysmorphology clinic it is a desirable companion. As aptly described in the preface this book is a ‘peripheral brain’ and ‘life saver’ for the geneticists in many situations!
临床遗传学是一门相对年轻的专业,涉及影响所有年龄组的所有器官系统的遗传疾病。说为临床遗传学家写一本全面而有用的书是一项艰巨的任务,就像陈述显而易见的事情一样。《牛津桌面参考:临床遗传学》的作者完成了不可能的事情,值得祝贺。这是过去受训的遗传学家们非常错过的一次实践指导。海伦·费斯博士和简·赫斯特博士不仅意识到需要这样一本手册,而且设法有效地解决了这个问题。牛津桌参考分为七个部分,包含超过600页。这本书开始与词汇表中使用的词汇在畸形学和遗传学的世界随后简要介绍了基本和基本的概念,如模式的遗传,基因检测和保密。这象征着作者贯穿全书的“不把任何事情视为理所当然”的方法,就专业的基础知识而言。第二部分涉及临床方法,以各种临床方案(近一百)面临的遗传学家在他们的日常实践。鉴别诊断的一个单一的临床发现和实用的方法来强调这一节。本节强调对临床问题的结构化方法,非常刺激。第三部分涉及常见的遗传学咨询,给出了常见和不常见的遗传条件的简要概述。大约有400页专门用于这两个部分,使其成为遗传学家和其他对遗传学感兴趣的医生不可或缺的工具。第四和第五部分涉及癌症遗传学和各种染色体疾病。第六部分是关于怀孕和生育。这包含了对各种产前扫描结果的鉴别诊断和产前诊所常见的其他问题的有用概述。这些部分的所有章节都以有关支持小组和专家顾问的信息结束。最后一部分同样有价值,超过50页,包括生长和发育图表,骨骼发育不良图表,ISCN命名法和其他有用的信息,为临床医生。总的来说,这本书是一个赢家,是一个必须为每一个临床遗传学部门。这可以说是有史以来为遗传学学员出版的最重要的书。然而,这不应该被解释为对训练有素的遗传学家或其他对临床遗传学感兴趣的医生不那么有价值。这是一本书,这可以被认为是一个非常有用的参考来源,任何遗传学医生。无论是产前诊所,癌症诊所或畸形诊所,它是一个理想的伴侣。正如前言中恰当地描述的那样,这本书在许多情况下是遗传学家的“外围大脑”和“救命稻草”!
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引用次数: 45
Successful Stenting in Endobronchial Wegener's Granulomatosis 支气管内韦格纳肉芽肿病支架置入术的成功
Pub Date : 2006-05-01 DOI: 10.6084/M9.FIGSHARE.16037
J. Tiernan, C. Shah, J. McGuigan, J. Elborn
Wegener's Granulomatosis (WG) is a multisystem disorder characterized by granulomatous necrotizing vasculitis. Classic Wegener's granulomatosis is a triad of necrotizing angiitis of the upper and lower respiratory tract and focal glomerulonephritis of the kidney.1 The classic respiratory feature is multiple pulmonary nodules on chest radiograph.2. In many cases extensive medical evaluation and laboratory test have proven non-diagnostic. In 1966, Carrington and Liebow introduced the concept of “limited Wegener's” granulomatosis to identify otherwise classic vasculitis lacking renal involvement.3 Limited Wegener's granulomatosis has a better prognosis than classic disease but it may be extremely challenging to recognize and diagnose.3,4 We report an unusual case of limited Wegener's granulomatosis presenting with focal endobronchial WG with lobar collapse requiring stenting. CASE REPORT A 19 year old female student presented to Otorhinolaryngology in June 1997 with a 3-week history of nasal obstruction, anosmia, headache, post-nasal drip and cough, unresponsive to recurrent antibiotic courses. X-Ray of paranasal sinuses revealed both maxillary sinus opacity. She was admitted in January 1998 for bilateral antral washouts and nasal endoscopy. Postoperatively, she developed fever, malaise, anorexia and unexplained weight loss. CT scan of paranasal sinuses revealed pansinusitis. She had bilateral functional endoscopic sinus surgery without much benefit. A CT Scan of brain excluded intracranial abscess. Revision endoscopic sinus surgery, performed 9 days later, revealed pus with necrotic material in the maxillary sinuses. Despite repeated sinus drainage procedures and intravenous broad-spectrum antibiotics during her hospitalisation, she continued to be febrile with weight loss. She had persistently elevated C – reactive protein [130 – 393 mg/l]. Her Westergren erythrocyte sedimentation rate was 110mm/hour. All cultures were negative. No granuloma or fungus was observed on biopsies. Initial autoimmune and vasculitic tests demonstrated no elevation in autoantibodies. She developed a normocytic anaemia, transient polyarthralgia and destructive inflammation of her nasal bridge. Despite the initial absence of granuloma on histology or Anti Neutrophil Cytoplasmic Antibody (ANCA) in serum, a provisional clinical diagnosis of Wegener's granulomatosis was made. The patient was commenced on high dose oral steroids and co-trimoxazole. Steroid therapy resulted in prompt response and rapid clinical improvement, evident within 24 hours. Indirect serum immunofluoresence in early February 1998 showed an atypical positive pattern for cANCA and Antiproteinase 3 level 6.2U/L [Normal <2]. Cyclophosphamide was added to her management regime. Rapid symptomatic improvement followed and she was discharged home. In June 1998 she presented acutely unwell with shortness of breath and fever. A chest radiograph revealed complete collapse of the left lower lobe (fig
韦格纳肉芽肿病(WG)是一种以肉芽肿性坏死性血管炎为特征的多系统疾病。典型的韦格纳肉芽肿病是上呼吸道和下呼吸道坏死性脉管炎和局灶性肾小球肾炎的三联征典型的呼吸征象是胸片上的多发肺结节。在许多情况下,广泛的医疗评估和实验室检查证明无法诊断。1966年,Carrington和Liebow引入了“限制性韦格纳”肉芽肿病的概念,以识别不累及肾脏的典型血管炎局限性韦格纳肉芽肿病的预后比典型疾病好,但它的识别和诊断可能极具挑战性。我们报告一例罕见的局限性韦格纳肉芽肿病,表现为局灶性支气管内WG伴肺叶塌陷,需要支架植入术。病例报告一名19岁女学生于1997年6月就诊于耳鼻喉科,有3周的鼻塞、嗅觉丧失、头痛、后滴涕和咳嗽史,对反复使用抗生素疗程无反应。鼻窦x线显示双侧上颌窦混浊。她于1998年1月因双侧鼻窦冲洗和鼻内窥镜检查而入院。术后出现发热、不适、厌食和不明原因的体重减轻。副鼻窦CT示全鼻窦炎。她接受了双侧功能性内窥镜鼻窦手术,但没有多大效果。脑部CT扫描排除颅内脓肿。内镜下鼻窦翻修手术,9天后,发现上颌窦脓液坏死物质。尽管在住院期间反复进行鼻窦引流手术和静脉注射广谱抗生素,但她继续发热并体重减轻。C反应蛋白持续升高[130 ~ 393 mg/l]。Westergren红细胞沉降速率110mm/h。所有的培养都是阴性的。活检未见肉芽肿或真菌。最初的自身免疫和血管检查显示自身抗体未升高。她出现了正常细胞贫血、短暂性多关节痛和鼻桥破坏性炎症。尽管最初在组织学上没有肉芽肿或血清中没有抗中性粒细胞胞浆抗体(ANCA),但临床诊断为韦格纳肉芽肿病。患者开始服用大剂量口服类固醇和复方新诺明。类固醇治疗可在24小时内迅速产生反应和迅速的临床改善。1998年2月初的间接血清免疫荧光显示非典型的cana阳性和抗蛋白酶3水平为6.2U/L[正常<2]。治疗方案中加入环磷酰胺。随后症状迅速改善,出院回家。1998年6月,她出现呼吸急促和发烧的严重不适。胸片显示左下肺叶完全塌陷(图1)。支气管镜检查证实左主支气管完全闭塞。治疗开始于静脉注射甲基强的松龙、环磷酰胺和抗生素。重复支气管镜检查和左主支气管硬组织活检显示浅表部分水肿和反应性粘膜伴广泛鳞状皮化生。未见异常增生、恶性肿瘤、肉芽肿、血管炎或真菌。刚性支气管镜与激光消融狭窄段后进行扩张。迅速的改善随之而来。图1支架前胸部x线片。她的健康状况在三周内恶化,出现左主支气管再狭窄。重复支气管镜检查和激光消融狭窄段后扩张立即缓解。再狭窄发生,循环继续。在2个月的时间内,共进行了9次扩张,其中几次采用激光切除。每一种药物都能短暂缓解症状。患者于1998年10月接受支架植入术。刚性支气管镜可准确测量左主支气管狭窄段的范围。在激光消融和球囊扩张后放置支气管内支架(图2)。图2支架后的胸部x线片,她在支架置入后显着改善。到2000年7月,在呼吸门诊的随访使她的类固醇治疗逐渐减少到零。所有血液正常,并于2000年10月停止硫唑嘌呤治疗。2001年,她接受了鼻部重建手术。她完成了学业,并于2003年初结婚。在这5年期间,她唯一的抱怨是偶尔的上呼吸道感染,短期口服抗生素治疗效果良好。2003年末FEV1的恶化引起了对再狭窄的怀疑(2002年5月FEV1 3.4L - 2003年11月FEV1 1.75L)。
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引用次数: 10
Surgical And Medical Treatment In Art 外科和医学治疗的艺术
Pub Date : 2006-04-01 DOI: 10.1177/014107680609900428
N. Mcclure
This is a fascinating compilation of sixty-six paintings chosen by the authors to demonstrate the relationship between medicine and art from 1275 BC to 2002. Paintings are taken from all over the world and deal with all branches of medicine (including some which are no longer mainline practice!). Each painting is accompanied with a potted biography of the artist and a commentary which places the painting in its context: sociological, medical and artistic. Whilst I was aware of some of the paintings, many are new to me. I particularly liked the portrait of Sir Alexander Morrison by Richard Dadd – the father of Psychiatry in the United Kingdom. This is a stunning portrait by an inmate and is absolutely timeless in its style. The mediaeval representations of consultations between doctor and patient show just how much medicine has changed. Although on the previous page, the mediaeval surgery on haemorrhoids is a little distressing! In a wider sense, it is fascinating to see how our work has progressed over the years particularly since the Renaissance. It is also fascinating to see just how atmospheric so many of the paintings are – for example, that of Theodore Billroth operating by Sligenn. Here, we have a Master at work with seven scrubbed attendants and at least forty observers. Given the increasing numbers of medical students expected in our own medical school in Belfast, could this be the way of the future? I would commend this beautiful book to all with an interest in medical and surgical art: it is a fascinating read. Those of us who has been in clinical practice for many years will have undoubtedly encountered the patient who despite our best intentions is never cured or relieved of their symptoms by conventional medicines. Then one day they come into your consulting room and announce that they have been to an alternative practitioner, who has prescribed homeopathic medicine and this has miraculously cured them. Book Reviews Due to several experiences like this, I looked into the possibility of prescribing homeopathic medicine and I consulted the available textbooks. None really attempted to look at the various homeopathic medicines on a scientific basis. One was expected to believe that they all worked because the author stated that they did. However, at that time I wish I had had a book like this, which does attempt to try and bring a scientific basis to …
从公元前1275年到2002年,作者选择了66幅绘画来展示医学和艺术之间的关系,这是一本引人入胜的汇编。这些绘画来自世界各地,涉及医学的所有分支(包括一些不再是主流实践的分支!)。每幅画都附有艺术家的传记和评论,将绘画置于其背景下:社会学,医学和艺术。虽然我知道一些画,但许多对我来说都是新的。我特别喜欢英国精神病学之父理查德·达德对亚历山大·莫里森爵士的画像。这是一幅令人惊叹的囚犯肖像,其风格绝对是永恒的。中世纪医生和病人之间的会诊表明医学发生了多大的变化。虽然在前一页,中世纪的痔疮手术是有点痛苦!从更广泛的意义上说,看到我们的工作多年来特别是自文艺复兴以来取得的进展是令人着迷的。同样令人着迷的是,看到这么多的画作是多么的大气——例如,西奥多·比尔罗斯的作品由斯利根操作。在这里,我们有一位师父在工作,有七名洗漱服务员和至少四十名观察员。鉴于在贝尔法斯特我们自己的医学院预计会有越来越多的医科学生,这可能是未来的方式吗?我要向所有对医学和外科艺术感兴趣的人推荐这本美丽的书:这是一本引人入胜的读物。我们这些从事临床实践多年的人无疑会遇到这样的病人,尽管我们有最好的意图,但传统药物永远无法治愈或缓解他们的症状。然后有一天,他们来到你的诊室,告诉你他们去看了一位另类医生,他给他们开了顺势疗法的药,奇迹般地治好了他们。由于几次这样的经历,我研究了顺势疗法药物的可能性,并查阅了可用的教科书。没有人真正尝试在科学的基础上看待各种顺势疗法药物。人们被期望相信它们都有效,因为作者说它们都有效。然而,当时我希望我有一本这样的书,它确实试图尝试并为……带来科学依据。
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引用次数: 0
Medical Genetics 医学遗传学
Pub Date : 2006-01-01 DOI: 10.32388/n9d3ol
A. Magee
Medical Genetics has long been a part of the undergraduate curriculum and is a rapidly increasing component of postgraduate training at all levels, in all specialities. Ian Young has provided a textbook which will delight both undergraduate and postgraduate readers. There are many textbooks which claim to cover essential medical genetic teaching, but many of these are too big, too detailed and too expensive. This text is presented in a clear, logical manner with well illustrated chapters and excellent use of colour for key points and boxes. The text is interspersed with case histories, landmark publications and the novel use of a " case célèbre " to illustrate many chapters – and what an excellent memory tool that is. Do you know why Dolly the sheep was called Dolly? Or that Frédéric Chopin may have had cystic fibrosis? There are fourteen chapters from the first " Gene structure and function " travelling through the realm of clinical genetics to end with chapters on " Clinical skills " (so you think you know how to interpret a laboratory report?) and " Applied clinical genetics ". The useful appendices cover medical school core curriculum and teaching medical genetics to undergraduate medical students. Each chapter ends with a few MCQs, the answers having succinct explanations. Ian Young is respected worldwide as a clinician, author and teacher of medical genetics. From Northern Ireland originally, he has not lost the art of communication. This is a text clinicians at any level will enjoy either for serious study or occasional casual reading (it is just about the right size and has enough flexibility for reading in bed). My one criticism is that it was not available when I needed it as a student (far too many years ago). An Irish-American medic called Gus McWilliams returns home to Northern Ireland, his urgent mission to find a donor kidney for his ill son – whose renal function is deteriorating – at all costs. His own kidney problems suggest hereditary renal disease and other modern (and old) ethical and genetic dilemmas feature in this novel where in the quiet village of Rostrevor, his genealogy research uncovers a mysterious crime committed in the last century against his ancestors. He uncovers evidence of a 19th century rogue scientist called Diogenes who has discovered the secrets of human cloning. Sinister elements from both sides of the local terrorist divide mix with some …
医学遗传学长期以来一直是本科课程的一部分,并且是所有专业的各级研究生培训中迅速增加的组成部分。伊恩·杨提供了一本让本科生和研究生读者都高兴的教科书。有许多教科书声称涵盖了基本的医学遗传学教学,但其中许多太大,太详细,太昂贵。本文以清晰,合乎逻辑的方式呈现,配有插图的章节和出色的使用颜色的关键点和盒子。书中穿插了一些历史案例、具有里程碑意义的出版物,并新颖地使用了“案例c2013.2013.10”来说明许多章节——这是一个多么出色的记忆工具啊。你知道多利羊为什么叫多利吗?或者fracimdchopin可能患有囊性纤维化?从第一章“基因结构和功能”开始,全书共有14章,贯穿临床遗传学领域,最后是“临床技能”(所以你认为你知道如何解释实验室报告?)和“应用临床遗传学”。有用的附录包括医学院核心课程和医学遗传学本科教学。每章都以几个mcq结尾,答案都有简洁的解释。伊恩·杨是享誉全球的临床医生、作家和医学遗传学教师。来自北爱尔兰的他并没有失去沟通的艺术。这是一本任何水平的临床医生都喜欢的文本,无论是认真的研究还是偶尔的休闲阅读(它的大小刚刚好,并且有足够的灵活性,可以在床上阅读)。我的一个批评是,当我还是学生的时候(很多年前)需要它的时候,它却没有。爱尔兰裔美国医生格斯·麦克威廉姆斯(Gus McWilliams)回到了他在北爱尔兰的家,他的紧急任务是不惜一切代价为他生病的儿子找到一颗捐赠的肾脏,他的儿子的肾功能正在恶化。在这部小说中,他自己的肾脏问题表明了遗传性肾病和其他现代(和古老)的伦理和遗传困境。在宁静的罗斯特雷弗村,他的家谱研究揭示了上世纪对他祖先犯下的神秘罪行。他发现了19世纪流氓科学家第欧根尼发现人类克隆秘密的证据。来自当地恐怖分子分裂双方的邪恶分子与一些……
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引用次数: 0
Cicadas
Pub Date : 2006-01-01 DOI: 10.1515/9781400884018-003
P. Morrison
Medical Genetics has long been a part of the undergraduate curriculum and is a rapidly increasing component of postgraduate training at all levels, in all specialities. Ian Young has provided a textbook which will delight both undergraduate and postgraduate readers. There are many textbooks which claim to cover essential medical genetic teaching, but many of these are too big, too detailed and too expensive. This text is presented in a clear, logical manner with well illustrated chapters and excellent use of colour for key points and boxes. The text is interspersed with case histories, landmark publications and the novel use of a " case célèbre " to illustrate many chapters – and what an excellent memory tool that is. Do you know why Dolly the sheep was called Dolly? Or that Frédéric Chopin may have had cystic fibrosis? There are fourteen chapters from the first " Gene structure and function " travelling through the realm of clinical genetics to end with chapters on " Clinical skills " (so you think you know how to interpret a laboratory report?) and " Applied clinical genetics ". The useful appendices cover medical school core curriculum and teaching medical genetics to undergraduate medical students. Each chapter ends with a few MCQs, the answers having succinct explanations. Ian Young is respected worldwide as a clinician, author and teacher of medical genetics. From Northern Ireland originally, he has not lost the art of communication. This is a text clinicians at any level will enjoy either for serious study or occasional casual reading (it is just about the right size and has enough flexibility for reading in bed). My one criticism is that it was not available when I needed it as a student (far too many years ago). An Irish-American medic called Gus McWilliams returns home to Northern Ireland, his urgent mission to find a donor kidney for his ill son – whose renal function is deteriorating – at all costs. His own kidney problems suggest hereditary renal disease and other modern (and old) ethical and genetic dilemmas feature in this novel where in the quiet village of Rostrevor, his genealogy research uncovers a mysterious crime committed in the last century against his ancestors. He uncovers evidence of a 19th century rogue scientist called Diogenes who has discovered the secrets of human cloning. Sinister elements from both sides of the local terrorist divide mix with some …
医学遗传学长期以来一直是本科课程的一部分,并且是所有专业的各级研究生培训中迅速增加的组成部分。伊恩·杨提供了一本让本科生和研究生读者都高兴的教科书。有许多教科书声称涵盖了基本的医学遗传学教学,但其中许多太大,太详细,太昂贵。本文以清晰,合乎逻辑的方式呈现,配有插图的章节和出色的使用颜色的关键点和盒子。书中穿插了一些历史案例、具有里程碑意义的出版物,并新颖地使用了“案例c2013.2013.10”来说明许多章节——这是一个多么出色的记忆工具啊。你知道多利羊为什么叫多利吗?或者fracimdchopin可能患有囊性纤维化?从第一章“基因结构和功能”开始,全书共有14章,贯穿临床遗传学领域,最后是“临床技能”(所以你认为你知道如何解释实验室报告?)和“应用临床遗传学”。有用的附录包括医学院核心课程和医学遗传学本科教学。每章都以几个mcq结尾,答案都有简洁的解释。伊恩·杨是享誉全球的临床医生、作家和医学遗传学教师。来自北爱尔兰的他并没有失去沟通的艺术。这是一本任何水平的临床医生都喜欢的文本,无论是认真的研究还是偶尔的休闲阅读(它的大小刚刚好,并且有足够的灵活性,可以在床上阅读)。我的一个批评是,当我还是学生的时候(很多年前)需要它的时候,它却没有。爱尔兰裔美国医生格斯·麦克威廉姆斯(Gus McWilliams)回到了他在北爱尔兰的家,他的紧急任务是不惜一切代价为他生病的儿子找到一颗捐赠的肾脏,他的儿子的肾功能正在恶化。在这部小说中,他自己的肾脏问题表明了遗传性肾病和其他现代(和古老)的伦理和遗传困境。在宁静的罗斯特雷弗村,他的家谱研究揭示了上世纪对他祖先犯下的神秘罪行。他发现了19世纪流氓科学家第欧根尼发现人类克隆秘密的证据。来自当地恐怖分子分裂双方的邪恶分子与一些……
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引用次数: 4
Airways Obstruction 气道阻塞
Pub Date : 2005-07-02 DOI: 10.1007/978-94-009-8078-5
Mrcp Duncan M. Geddes MD
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引用次数: 11
期刊
The Ulster medical journal
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