candlelit─自信。承擔。勇敢─weishan的心情日誌

今天核醫姚主任和我們座談~
思賢問到了未來選科的事
興趣、能力、體力、....
嗯 聽心中的聲音 就朝著它往前進吧~

11/24~1/4 內科
11/24~12/7 CV        11/26值班10A
12/8~12/21 Chest   12/11值班10A
12/22~1/4    GI         12/24值班 6B

○醫療法律期末報告: 針對自己報告案件的爭議點作一份鑑定書  一人一份

恩慈堂大專團契 pm4:00~6:30
            主日聚會 am10:00~12:00
◎為基音團契大學部事工禱告(時間安排)
◎求主保守生活的優先次序：親近神、學校課業、教會/團契服事

1. 不找藉口 盡好本分
2. 不當"教會裡的"基督徒(持續尋找role model~~)
3. 焦點放在神 以基督的眼光看事情 改進缺點
4. 若是能行 與眾人和睦
5. 多禱告、多感恩、常喜樂~

245

Disorders of the Pleura, Mediastinum, Diaphragm, and Chest Wall

Richard W. Light

DISORDERS OF THE PLEURA

PLEURAL EFFUSION

The pleural space lies between the lung and chest wall and normally contains a very thin layer of fluid, which serves as a coupling system. A pleural effusion is present when there is an excess quantity of fluid in the pleural space.

Etiology

Pleural fluid accumulates when pleural fluid formation exceeds pleural fluid absorption. Normally, fluid enters the pleural space from the capillaries in the parietal pleura and is removed via the lymphatics situated in the parietal pleura. Fluid can also enter the pleural space from the interstitial spaces of the lung via the visceral pleura or from the peritoneal cavity via small holes in the diaphragm. The lymphatics have the capacity to absorb 20 times more fluid than is normally formed. Accordingly, a pleural effusion may develop when there is excess pleural fluid formation (from the interstitial spaces of the lung, the parietal pleura, or the peritoneal cavity) or when there is decreased fluid removal by the lymphatics.

Diagnostic Approach

When a patient is found to have a pleural effusion, an effort should be made to determine the cause (Fig. 245-1). The first step is to determine whether the effusion is a transudate or an exudate. A transudative pleural effusion occurs when systemic factors that influence the formation and absorption of pleural fluid are altered. The leading causes of transudative pleural effusions in the United States are left ventricular failure, pulmonary embolism, and cirrhosis. An exudative pleural effusion occurs when local factors that influence the formation and absorption of pleural fluid are altered. The leading causes of exudative pleural effusions are bacterial pneumonia, malignancy, viral infection, and pulmonary embolism. The primary reason to make this differentiation is that additional diagnostic procedures are indicated with exudative effusions to define the cause of the local disease.

FIGURE 245-1 Approach to the diagnosis of pleural effusions. CHF, congestive heart failure; CT, computed tomography; LDH, lactate dehydrogenase; PE, pulmonary embolism; TB, tuberculosis; PF, pleural fluid.

 

Transudative and exudative pleural effusions are distinguished by measuring the lactate dehydrogenase (LDH) and protein levels in the pleural fluid. Exudative pleural effusions meet at least one of the following criteria, whereas transudative pleural effusions meet none:

1.          pleural fluid protein/serum protein >0.5

2.          pleural fluid LDH/serum LDH >0.6

3.          pleural fluid LDH more than two-thirds normal upper limit for serum

The above criteria misidentify approximately 25% of transudates as exudates. If one or more of the exudative criteria are met and the patient is clinically thought to have a condition producing a transudative effusion, the difference between the albumin levels in the serum and the pleural fluid should be measured. If this gradient is greater than 12 g/L (1.2 g/dL), the exudative categorization by the above criteria can be ignored because almost all such patients have a transudative pleural effusion.

If a patient has an exudative pleural effusion, the following tests on the pleural fluid should be obtained: description of the fluid, glucose level, differential cell count, microbiologic studies, and cytology.

有時候對一個人那麼用心　卻還是搞不清楚他的邏輯
談戀愛誰沒演過一點戲　    裝沒事　裝忘記　裝相信
有時候和一個人那麼緊密　卻還是忍不住想保護自己
誰戀愛不曾藏一點秘密　    留防備　留回憶　留心情

謝謝你總是陪我分享　        不能跟情人說的話
我反反覆覆你也從不笑我　老是罵他卻又離不開他
謝謝你總是替我收藏　        不想跟情人說的話
我胡思亂想 你只握著我手   讓我釋放　然後慢慢寬廣

別人都說我很堅強　            只有你勸我別逞強
愛是漂亮卻不完美的天堂　舊了總有需要修補的地方  

不可少的只有一件 就是等候神
因為習慣於等候神
才能習慣等待
等待自己生命的成長
等待自己成為神的器皿、忠心的僕人
等待神將我帶入祂豐盛的賜福
沒有人喜歡等待 我也不喜歡
但我卻明白
時間的焠鍊 是不可免的
雖然路途寂寞 但我深相信
神必預備~

妳讓我第一次覺得台南離高雄這麼遠Orz....
花了三小時 &三百元才到.....
ㄜ.....也算是個經驗吧..
和另外三個不認識的人一起坐著小客車 一路奔馳到台南~
台鐵真的太誇張了啦><"
呼呼 原來應該可以搭中南客運的..
阿囉哈應該也有!?
下次就知道了....不要白花冤枉錢....
問了一個統聯沒有到台南..
還以為都沒有到台南的客運...
我果然是太沒經驗了...(嘆)...

昨天到今天 心情有點down...
連帶著身體也不舒服了@@"
煩.....沒有一件事情做的順利....
明天要去問兩個病人!!
晚上回家 終於可以回家了!!

我還滿容易欣賞人的耶~
每個人都有他的優點~
端看怎麼發掘囉:)
真有意思~!!

我向主說..
為何要我選擇一條看似不可能的道路..
我是一個如此軟弱的人
承受壓力的能力不佳、情感上也不能獨立~
(我甚至覺得自己有一天會因為寂寞而死吧..)
但是神總是要我等候祂
在等候的過程中
學習全心倚靠祂
當生命中許多吸引我注目的事物被一一挪去時
我是否能"不見一人 只見耶穌"
相信祂為我揀選的道路 是最充滿祝福與恩典的道路
這不是我能做到的~卻是神天天以他的話語鼓勵我
與弟兄姐妹一起分享神的恩典
在聚會中 時時經驗祂的榮耀
我的信心不足 但祂是可信的
我向主說 使我勇敢為祢來夢想
使我成為一個有異象的人~
在人不能 在祢凡事都能~~:D

1.      Zuckerkandl's tubercle

http://www.ingentaconnect.com/content/klu/595/2007/00000037/00000002/00003346

Zuckerkandl's tubercle (ZT) is the most posterior extension of the lateral lobes of the thyroid gland in the area of the ligament of Berry.

Zuckerkandl's tubercle indicated or passed over the ILN and the laryngeal branches. These findings suggest that an identifiable ZT could be used as a landmark to expose the ILN(Inferior Laryngeal Nerve) and the laryngeal branches.

2.      Graves’ disease 的手術，若無切除pyramidal lobe，會造成何種結果？

http://www.thyroidcancer.com/thyroid_newsletter_3_pyramidal_lobe.htm

The pyramidal lobe is of great importance to the thyroid surgeon for several reasons. First, when performing total thyroidectomy for Graves’ disease, it is crucial to look for, identify, and remove the pyramidal lobe, as this can be a cause of recurrent hyperthyroidism following an incomplete resection of the gland. 

3. Thyroglobulin (Tg) Measurement
    http://www.medscape.com/viewarticle/452669_4

如果耶穌沒有來 試探來臨誰能救助

如果耶穌沒有來 心靈的愁苦誰能擔當

如果耶穌沒有來 饒恕是沒有意義的神話

天人之間永遠地分開 如果耶穌沒有來

如果耶穌沒有來 萬物有如長夜

如果耶穌沒有來 人類看不到曙光

如果耶穌沒有來 生命是一切的空白

沒有絢麗的色彩 如果耶穌沒有來