T*R
发帖数: 36302 | 1 在医院里干了这么些年，癌症病人见多了。MASTECTOMY，HYSTERECTOMY，COLECTOMY做
了活了2，30年的病人多得是。
但是很少有病人有癌症史但是只做过化疗（血液病除外）还能活比较常时间的。
美国妇女从小就XX，特别是黑人，滥交那么厉害，但是CERVICAL CANCER发病率却不是
很高，很重要一个原因是很多病人医生稍有怀疑就建议做TOTAL HYSTERECTOMY。
肺癌是差点意思，存活率比较差。做了手术很多也挺不了多久。 |
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s******s
发帖数: 55 | 2 http://www.reuters.com/article/2013/05/15/us-cancer-chemo-idUSB
(Reuters) - After decades of using one-size-fits-all therapies to combat
cancer, doctors are using new tools to help decide when their patients can
skip chemotherapy or other harsh treatments.
An approach to oncology that has been in place for decades is beginning to
yield to an arsenal of long-term clinical studies, genetic tests and novel
drugs that target cancer cells and their infrastructure.
"What is happening is a combination ... 阅读全帖 |
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s******y
发帖数: 28562 | 3 美国高等法院今日裁定，在自然界自然存在的人类基因不能作为专利。
http://news.yahoo.com/court-says-human-genes-cannot-patented-14
Court says human genes cannot be patented
Associated PressBy JESSE J. HOLLAND | Associated Press – 5 mins ago
WASHINGTON (AP) — The Supreme Court ruled Thursday that companies cannot
patent parts of naturally-occurring human genes, a decision with the
potential to profoundly affect the emerging and lucrative medical and
biotechnology industries.
The high court's unanimous judgment reverses three de... 阅读全帖 |
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u***e
发帖数: 611 | 4 内科的同修们能不能进来交流一下有趣的病历，可以共同学习一下。
晚上一直在想前天值班收的一个病人，简单说一下，70yo female, cc:breast
swelling, PMH of breast cancer s/p mastectomy, PE/DVT on coumadin. 病人来时
血压有点低，80/50，但她没有什么不舒服的complaint, 看上去也挺好的，不像septic
。其他vital都没什么不稳定的，我也没在意，她之前有mammogram是另一侧乳房癌复发
了，就order了lab，给她1L NS bolus，就去看别的病人了。3-4个小时后护士page我说
病人心率有150，我觉得自己也要跳到150了，飞跑过去，EKG一拉 A-fib.......急了，
几个小时前还好好的sinus rhythm，怎么在我手里给fib了，死了死了。
你们觉得是什么原因，应该怎么处理？
下回再分解。 |
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I****a
发帖数: 407 | 5 In general, post mastectomy radiation for stage IIB ER/PR + breast cancer probably adds 8% survival in 10 years when combined with chemo and or hormonal therapy. According to adjuvant online, adding Tam/AI adds 8% survival, chemo further adds about 2% in 10 years. Patient needs be be educated about those number and makes the decision. If you look at numbers, it seems that hormonal tx and radiation give the best bang for the long term survival although a lot of patients also choose chemo in addit... 阅读全帖 |
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d****y
发帖数: 2180 | 6 选A还是E？
Paracentesis 虽说是比较general 的抽液，在这题可以理解为心包抽液吗？
18. A 50-year-old woman has had progressive dyspnea over the past 2
weeks
and constant, sharp chest pain for 4 days. The pain is localized to the
center of the chest and is worse while supine. She underwent a right,
modified radical mastectomy and adjuvant chemotherapy for breast cancer
3
years ago. She has a history of hypothyroidism treated with thyroid
replacement therapy. She has smoked one pack of cigarettes daily for 30
years and drinks t... 阅读全帖 |
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h*******8
发帖数: 115 | 7 total knee/hip replacement: set up CPM ASAP
total hysterectomy with BSO（bilateral salpingo oophorectomy）: blood loss,
passing gas
appendectomy: clear liquid and passing gas.
chest surgery: blood loss.vital signs, becareful this one,code blue anytime.
.......
mastectomy: 术后的运动吧。还有腹部的脖子的手术，注意出血量。。。
当然所有的手术都会痛，所以要给止痛药，呵呵。我知道的就这些了，欢迎大家补充 |
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a*i
发帖数: 1652 | 8 http://247wallst.com/2011/07/18/the-eleven-most-implanted-medic
11. Implantable Cardioverter Defibrillators
> Number of procedures: 133,262
> Total annual expenditure: $5.5 billion
> Average cost per procedure: $40,000
> Major manufacturer: Medtronic (40%), St. Jude Medical, and Boston
Scientific
Cardiac arrhythmia, or improper electric signaling in the heart, occurs in
millions of people a year. While the vast majority are benign, a select few
— usually in patients with a history of heart attac... 阅读全帖 |
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v*****e
发帖数: 30 | 9 国内的好朋友最近诊断乳腺癌。她有一个年幼的孩子，真的很替她着急担心。最近化疗
两个疗程之后，白细胞下降得很厉害。这里附上她的诊断和问题，这里哪位好心的大侠
能给回答一下？ 她已经把问题翻译成了英文.
Specimen Type: Specimen of modified radical mastectomy right breast
Tumour Site/Location: 2.5 cm from the top of the nipple
Size of Tumour: 2.5 x 2.3 x 1.4 cm
Tumour Type: Mucinous carcinomas, ductal carcinoma in situ was seen around
the surrounding area (low and intermediate grade)
Histologic Grade: (blank)
Intravenous Tumor Thrombus: (+) Nerve Invasion: ( - )
Nipple: no cancer cell ... 阅读全帖 |
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v*****e
发帖数: 30 | 10 感谢Icetea!
Here is the info:
patient age: 41
Family history: no breast cancer family history
medical history: no
Breast cancer with modified right radical mastectomy (right breast) and
axillary lymph node
dissection on 20th of May, 2011.
A lump under her right armpit was self-found but it was not checked out
until 1 and a half months later.
Her histopathology report has revealed that a tumour which was noted to be
at 2.5cm from the top of the nipple, 2.5 cm from the nipple.
It is also rep... 阅读全帖 |
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b*w
发帖数: 2062 | 11 Time line:
I do not know the typical time course, but conventional wisdom is that these
things can drag out for many years in certain cases.
This was my timeline (off the top of my head):
1) Surgery (modified radical mastectomy) May 2008
2) April 2009 - Settlement request letter sent
3) April 2009 - Settlement request refused
4) May 2009 - complaint to Arizona Medical Board
5) Early Spring 2010 - AZ Medical Board issued statement that I met standard
of care and that no action would be taken agai... 阅读全帖 |
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b*w
发帖数: 2062 | 12 some protective practice:
Documentation, documentation, documentation is key. We had a representation
from our malpractice carrier come out and review our charting. This was a
service they offered free of charge. She picked 10 random charts and read
through them, found no serious errors but made some suggestions about
wording or detail.
You need to document any patient complaints and your response to them. For
example, I documented my patient's pain and that she was not using the pain
medication... 阅读全帖 |
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b*w
发帖数: 2062 | 13 Time line:
I do not know the typical time course, but conventional wisdom is that these
things can drag out for many years in certain cases.
This was my timeline (off the top of my head):
1) Surgery (modified radical mastectomy) May 2008
2) April 2009 - Settlement request letter sent
3) April 2009 - Settlement request refused
4) May 2009 - complaint to Arizona Medical Board
5) Early Spring 2010 - AZ Medical Board issued statement that I met standard
of care and that no action would be taken agai... 阅读全帖 |
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b*w
发帖数: 2062 | 14 some protective practice:
Documentation, documentation, documentation is key. We had a representation
from our malpractice carrier come out and review our charting. This was a
service they offered free of charge. She picked 10 random charts and read
through them, found no serious errors but made some suggestions about
wording or detail.
You need to document any patient complaints and your response to them. For
example, I documented my patient's pain and that she was not using the pain
medication... 阅读全帖 |
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d****y
发帖数: 2180 | 15 选A还是E？
Paracentesis 虽说是比较general 的抽液，在这题可以理解为心包抽液吗？
18. A 50-year-old woman has had progressive dyspnea over the past 2
weeks
and constant, sharp chest pain for 4 days. The pain is localized to the
center of the chest and is worse while supine. She underwent a right,
modified radical mastectomy and adjuvant chemotherapy for breast cancer
3
years ago. She has a history of hypothyroidism treated with thyroid
replacement therapy. She has smoked one pack of cigarettes daily for 30
years and drinks t... 阅读全帖 |
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R*******t
发帖数: 367 | 16 有一半以上的乳癌都是multicentric/multifocal disease，做了lumpectomy应该结合
chemoradiation，可以降低死亡率。有些做了mastectomy的，可以避免放疗。 |
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h****i
发帖数: 41 | 17 多谢！ 那做了mastectomy的，哪些情况可以避免放疗呢？是根据肿瘤分级吗？化疗是
必须的吗？ |
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D**6
发帖数: 68 | 18 希望能得到大家的指点和建议，万分感谢。
my aunt just found the left breast ca. and did surgery early this month.
病理检查报告单
肉眼所见：肿块大小1*0.8cm，质较硬，界不清。
光镜所见：肿瘤细胞呈条索状，团块状排列，细胞核大，深染，核分裂易见并侵润间质
，周围可见多量高级别导管原位癌。
病理诊断：
免疫组化标记示：ER(-)、PR(-)、c-erbB-2(-)、Ki-67:5%(+)、E-cad(+++)、CK5/6（+
）、p53(-)、TOPOII(-)、GST-π(+)、Pgp(-)。
冰对及常规片:(左乳）侵入性导管癌（组织学评分6’，WHO2级），周围可见高级别导
管原位癌。
注：结合免疫组化可符合基底细胞样型乳腺癌，该型预后较差。
I have heard a lot bad comments on this type of Cancer.
My aunt already have mastectomy in my home town last week and is waiting for
ch... 阅读全帖 |
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L****n
发帖数: 12932 | 19 Supposedly more cases, more money. but somehow i don't feel funny or happy.
【 以下文字转载自 Joke 讨论区 】
发信人: daemonself (mit行为艺术专业博士后导师), 信区: Joke
标 题: SF Approves Taxpayer-Funded Transgender Surgeries (转载)
发信站: BBS 未名空间站 (Sun Nov 11 17:01:02 2012, 美东)
发信人: lczlcz (lcz), 信区: USANews
标 题: SF Approves Taxpayer-Funded Transgender Surgeries
发信站: BBS 未名空间站 (Sun Nov 11 15:29:01 2012, 美东)
看左棍们就是这么花纳税人的钱的.
Taxpayers in San Francisco, California will now pay for "gender-switching,"
transgender surgeries to "h... 阅读全帖 |
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C*****D
发帖数: 1299 | 20 最近碰到几例病例，感觉许多医生根本不问病史和体检。
一个40岁妇女咳嗽发热，胸ct发现纵隔淋巴结大，穿刺活检，腺癌，打电话问管床主治
，有无原发灶，说病人一直健康，没病没宰。当cancer of unknown primary 查，一大
堆梅表下去后，感觉是卵巢癌，再去问，回来说病人有个15公分盆腔肿块，最近两月长
的。
还有个更逗，冰冻送来腹腔肿块，像乳房癌，问有无病史，答没有，自己上网查，发现
病人都做过mastectomy了。 |
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M**1
发帖数: 327 | 21 Her2 是FISH结果还是免疫组化? 看上去Her 2阴性.
病人是乳腺全切吗? anyway pt need radiation to the axilla, may need radiation
to the breast if lumpectomy
如果Her 2 negative, then doxorubicin /cyclophosphamide q2 weeks x 4 followed
with
paclitaxel q 2 w x4; then radiation; then anti estrogen pill daily for 5
years (postmenopause)or 10 years for premenopause
if her2 POS, mastectomy, similarly doxorubicin plus cyclophasphamide q3
weeks x 4 followed by paclitaxcel plus transtuzumab weekly for 4 weeks and
continue transtuzuma... 阅读全帖 |
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e**********k
发帖数: 427 | 22 妈妈13年底做mammogram发现有左乳有两个小肿块，都不到1cm大，BIRAD 5，做了
mastectomy，病理结果是triple negative breast cancer，手术过后做了化疗，AC序
贯T，一共8个疗程。在２０１５年11月的时候胸骨部位靠近锁骨的地方疼得很厉害，一
开始是发麻，后来越来越痛，发展到坐车的时候车的颠簸都会造成疼痛，做了骨扫描，
发现胸骨处有异常浓聚，同时在肩膀和髂骨也发现了浓聚灶。CT报告上写胸骨骨质密度
不均，怀疑骨转移。MRI报告也说肩膀和髂骨有异常信号。内脏目前没发现问题。
我想问一下
1. 根据这些影像学检查，是不是就可以断定是骨转移了呢？不是说三阴性乳癌骨转移
是很少的吗？需不需要做活检确认了？
２．国内的肿瘤科大夫给的治疗方案是每月用一次唑来磷酸，吉西他滨＋顺铂化疗６个
疗程，可行吗？
拜谢了！ |
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e**********k
发帖数: 427 | 23 妈妈13年底做mammogram发现有左乳有两个小肿块，都不到1cm大，BIRAD 5，做了
mastectomy，病理结果是triple negative breast cancer，手术过后做了化疗，AC序
贯T，一共8个疗程。在２０１５年11月的时候胸骨部位靠近锁骨的地方疼得很厉害，一
开始是发麻，后来越来越痛，发展到坐车的时候车的颠簸都会造成疼痛，做了骨扫描，
发现胸骨处有异常浓聚，同时在肩膀和髂骨也发现了浓聚灶。CT报告上写胸骨骨质密度
不均，怀疑骨转移。MRI报告也说肩膀和髂骨有异常信号。内脏目前没发现问题。
我想问一下
1. 根据这些影像学检查，是不是就可以断定是骨转移了呢？不是说三阴性乳癌骨转移
是很少的吗？需不需要做活检确认了？
２．国内的肿瘤科大夫给的治疗方案是每月用一次唑来磷酸，吉西他滨＋顺铂化疗６个
疗程，可行吗？
拜谢了！ |
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