Upload
hatuong
View
220
Download
3
Embed Size (px)
Citation preview
Title The Caduceus: 啓思
OtherContributor(s) Hong Kong University Students' Union. Medical Society.
Citation
Issued Date 2011-09-16
URL http://hdl.handle.net/10722/138790
Rights This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
MEDICALSTUDENTS’CENTRE,SASSOONROAD,
HONGKONG.
Vol.3. No.II OFFICIALPUBLICATIONOF THE MEDICALSOCIETY,H.K.U.S.U. November,1971
SYMPOSIUM ON BRONCHOGENIC CARCINOMA
OnThursday,21stOctober,attheCityHallTheatre,a symposiumonbronchogeniccarcinomawaspresentedbytheAmeiicanCollegeofChestPhysicians,HongKongandMacauChapter.Thefollowingisasummary,compiledbyourreporters,of thepaperspresentedat thesymposium.
OpeningremarksTheopeningremarks,givenbytheHon.Dr.
(. H. Choa,pointedoutnowthattuberculosisis being broughtunder control,HongKongis facinganothermenace:a disturbingrisein theincidenceof bronchogeniccarcinomafor thelastdecade.Theresultof treatmentofthisconditionisstillpoor.Thegovernmentistryingherbesttocollecttherelevantdatas,encourageencouragefurtherresearchanddissuadethepublicfromsmoking.
IntroductionandEpidemiologyDr. H. C. Ho dealtwiththeepidemiology
of bronchogeniccarcinoma.Aetiologicalclassificationclassificationof cancercanbeasfollows:
I) Cultural2) Occupationalandenvironmental3) Genetic4) IdiopathicBronchogeniccarcinomais essentiallyan
environmentaldisease.It incidenceincreaseswithage.alineargraphcanheobtainedwhenthedeathrateis plottedagainstthe6thpowerofage,bothbeingin logarithm.Besidessmoking,airpollutionmightalsoplaya role. Asshownbythestudyin Denmark,theriskofgettingthecarcinomais higherin citydwellersthanruralinhabitants.Thepeculiarpointaboutthediseasein HongKongisthatthemale:femaleratioisvery close-3:2comparedwith5 to 10:1reportedreportedin thewesterncountries.Also,a highporportionof the femalepatients(30%) arenonsmokers.’Someotherfactorsmightcontribute,Researchalongthisfieldwouldhcfruitful.
PathologyThe pathologicalaspectwasexploredby
ProfessorGibson.Anatomically,it canheclassifiedinto:1) Central,arisingfromlobarbronchus,
producingcollapsewithsecondaryinfectinfection;closeapproximationto midlinemadesurgicaltreatmentdifficult.
2) Peripheral,arisingfromthe bronchusnearpleura,mightappearaslargenecroticnecroticmasssimulatinglungabscess:it mightinfiltratethechestwall,rootoftheneckand variousneighbouringstructures.
Histologically,it canbeclassifiedinto:I) Oatcellcarcinomaor smallcellanaplastic
anaplastictype mostmalignant,unsuitableunsuitableforsurgicaltreatment,usuallytreatedbyradiology.
2) Squamouscarcinoma— keratinisationusuallynotextensive,beingof littlerelationshiprelationshipto behaviour,mostsuitableforsurgicaltreatment.
3) Adenocarcinoma— mightbe mucinsecreting.quitecommonhere.
4) Polygonalor largecellanaplastictype.However,thereis discrepancyinthedistribution
distributionof varioustypesof bronchogeniccarcinomacarcinomaamongsurgical,radiotherpyandnecrospyspecimens.
lung.Butthereis noevidencetosupportthese01(1beliefs,it is evendubiousthatsquamousmetaplasiawouldleadtocarcinoma.
Spreadof thetumourtookplacethrough:
2) Lymphatic— 75%.of surgicalspecimensspecimensshowedlymphaticinvolvement.3) Blood— markedtendencyto invade
pulmonaryarteriesandveins40% ofsurgicalspecimensshowednakedeyeinvolvementof thevessels,especiallyintheoatcellandpcripheraltype.
4) Intra-alveolarspread leastcommon,onlyinalveolarcellcarcinoma,corpulmonalepulmonalemightresult.
Earlydiagnosisof bronchogeniccarcinomais veryimportant.Therearevariousancillarydiagnostictechniques:I) Cytologicalexaminationof sputumor
bronchialaspiration.Providedthe specimenis properlyobtainedobtainedandexaminedbyskillfulexpert,it is highlyaccurate,superiorto bronchoscopy.3 specimenson separateoccasionsare neededto excludecarcinoma.Therearecertainpitfalls:
a. Presenceof squamouscellsdidnotindicateindicatecarcinoma,it mightbeduetosquamousmetaplasia.
h. Falsecytoloicalresultflamniativediseaseof thecasionally.
Cytologyof pleuralfluidis lessuseful.2 Bronchoscopyandbiopsyofsuspectedarea.Their value is limitedas bronchoscopecouldnotreachthedistalbronchi.Thebiopsymighthetakenfromtheinflammatoryareasurroundingsurroundingthetumourorfromareanottypicalofthewhole.Thesurgicaltechniquehastobecarefulcarefulandproperhandlingof thetissuewasim—portant.3) Scalenelymphnodebiopsy.As a primarymethodof diagnosis,it is in—sensiti\e butthissimpleinvestigationcanconfirmcxtrapulmonaryspreadandindicatewhethersurgicalsurgicaltreatmentispossible.
Industrialcausesofcarcinomainotherpartsof theworldarealsofoundsuchasexposuretoasbestos,arsenic,chromium,nickel,radioactivesubstance,isopropyloil, coaltar fumes,petroleum.petroleum.Of these,onlyasbestosmightheof someimportancein theshipyardworkersoi textileworkersinHongKong.
ClinicalmanifestationsFirstlyDr.DonaldYupresentedthegeneralclinicalmanifestationsof patient’withhi-oneho-
geniecarcinoma.He hascihisstuds’on 39$patientsadmittedintoUniversity\‘IcdicalUnitfromI949to 1971. withemphasison featurespeculiarto HoneKong.However,thisgroupofpatientsmightnotbereprescntati\c of thewholeasthiswasa selectedgroupinsteadofa randomsamplc.Sex,age,incidence
Peakincidenceoccuredintheagegroup50-59 forbothmalesandfemals,Fromtheyearlyadmissionrate,maleto femaleratioas 1.9toI in 1960.and1.3:1in 1970.Therewasa lackof malepredominanceascomparedwithUnitedKingdom6:1
Shanghai(China)3:5:1(1959)Malaysia3:1(1966)
SmokinghabitsAbout66%of malepatientswereheavysmokcrs
smokcrs(greaterthan15 cigarettes/day)
ClinicalsniptornsTheseincludecough,haemoptysis,chestpain,
d\spnoea,clubbingoffingers,neurologicalsymptonis,symptonis,hoarseness.mediastinalobstruction,hvprtrophichvprtrophicpulmonaryoseoarthropathy.neckmass,1-lornersyndromeandpleuraleffusion.Sexandcelltypes:
male femaletotalAnaplastic 47.2% 47.2% 47.2%Squamous 34.8% 13.9%126.1%Adenocarcinoma %16.9 33.3% 24.2%Alveolarcelltype 1.1% 5.6% 3.1%Unspecified 32cases31cases63cases
Themostsignificantpointisthattherewasa highpercentageof adenocarcinomain femalepatients.Radiologicalappearance
Commonestbeinga mixedcentralandperipheralperipheralinvolvement.Peripheralshadowsaremorelikelyanaplastic.andaremoreliabletoproduceeffusionandmediastinalobstruction.Themajorityof hilarmasseswithobstructionsignareof thesquamoustype.Otherintermediatetypessuchasdffuseshadowsmightbeadenocarcinoma.
1.3%of caseshadnormalchestX-rayappearance.appearance.usuallysquamousinhistology.Comment
Thepatientswereseenatanadvancedstage,solatersignswereseenmorefrequently.Therewasa highincidenceof bronchogeniccarcinomaespeciallytheadenocarcinoniatypeamongfemaleshere,ahighproportionofthemwerenonsmokers.Researchalongthisfieldmightbefruitful.
ThenDr.RoseYoungdealtspeciallyontheendocrinologicalaspectofbronchogeniccarcinoma.Thevarioushormonesreportedtoheproducedbythetumour.espcciallvtheoatcelltype,are:
ACTHadrenocorticotropichormonePTHparathyroidhormoneTSHthyrotropichormoneMSHmelanocvtcstimulatinghormone(.onadotropiItSSerotoninErythropoietinOf these,thefirstt’.ohormonesaremore
commonlyencountered.In ectopcproductionofadrcaocoiticoptropichormone,a fullblownCush—ingssyndromeusuallydonothavetimetodevelop.develop.However,therema hemarkedweakness,in—creasedhloodpressure,h pokalaerniaandalkalosalkaloss. Plasmacortisol.urineI7 ketosteroidsand17 OHsteroidsareraisedandtheyarenotsuppisuppics%cdh administeringDexamethasone.Thepatientisusuallytooill fortotaladrenalectomyandhighpotassiumpotassiumsupplementis theonlys mptomatictreatment.
I) Directspreadsitated
— chestwallmightheinvolvedproximallyundermucosaneces—widerresectionof thebronchus.
24%werelightsmokers.16% offemalepatientswereheavysmoke
smokers.34%lightsmokers.50%non—smokers
occursin in—bronchusocPreviously.
ocPreviously.it wasbelievedandoatcelltypeswerecloselyingwhileadenocarcinomaarose
thatsquamousrelatedtosmokfromsmokfromscarsinthe
In ectopicantidiureticthereare hypotiatroeinia.anorexia,nauseaandmusclepressureisnormal,withno
hormonesecretion,mentalconfusion,
weakness.Thebloodevidenceofdehydra(Conliizued
dehydra(ConliizuedonPage4)
Page 2 CADUCEUS
LiiOtiL’iiStOtIll lost and byK.T.M.1 sUppt)sCflOOfleill Niis
MedicalSchoolunderstandshe suppressiveandtotalitaiantotalitaiannatureofModernWestc
Westcm society.IndeedaftersomeI3 earsofbeingpro—ecssedin thejufliorknovledeeknovledeefactories,everyoneenteringenteringthisMedicalSchoolhasalreadybeenmachinizedtoa er considerableextent.Inhere,the aresubjectfurtherfurtherto thefinalphaseof(iehumunuzItionbeautifulltermedtie intensivestudvofmedicine.Andwhentheleave,theyvill becomean—otherhatchof to-leggedsecond—ratecomputers.theirindividuality.liiimantv and
-mothered.(‘onformjt\is sacred.
1hosehoda:e toquestionand‘oicethefaintestdisapprovaldisapproval(iftheoldrottenstalesetof alues.nottomentionthepreciousfesshodaretoresist.falleasypre\to theharrassnientof thesstem.nottheEstablishmentonly.huteverysinglesegmentofthesystem.l hiso erdeveloped.erdeveloped.supercisilisedsocietyis builton thecruel andforcedconformityof evermanandwoman.Likeever\boltsandnailsandscrewsofa mechanicaldevice,theymlistobeythesame‘phvsicaIla\’,s’ in orderthatthesvs—
ternrna\workandsurvive.In returnfortheirownsur—ivalo.ithinthes stern.they
pa\thepriceofbeingtransformedtransformedinto humanmachines.machines.vithoutfeelingsoftheirown, ithoutaffectionsforothers.Thosewhotrea—stire their iitiman nattire,thosewhorefusetoconformthosewhoseetheultimatefutilityin scientificdevelopment.development.thosewhodonotwantto leada mereexistenceasamachinearereducedtothefringeofthesociety.Theyaretheoutcastsof thesystem,system,thehadelements,theundesirables.
Whogetsthebenefitoutof thesystem?No single
person.To thesocio-politicallvsocio-politicallvuninitiated,thismaysoundastounding.InourlifelongindoctrinationagainstCommunism,we are toldagainandagainthatit istheParty,thePolitburooreventhepartyleaderwhoisthefinalculpritforall thepoverty,poverty,sufferings,andsuppression.suppression.Weareat a losswhenwefindinourso-calleddemocraticsocietythesameafflictions.(lf indeedoureyesarestillopen.)CanwesaythesystemworksfortheGovernor,or the PrimeMinister,for thatmatter?TheCouncils?TheParliamentParliamentinLondon?No.Theansweris an emphaticno.Theyare huttheinstitutionalisedinstitutionalisedagentsofdifferentechelonsinthesamesystem.Therealvillainis,forthisCrown Colony, capitocolonialism,capitocolonialism,a tinyfeelerofthemammothWesternculturecultureintotheThirdWorldhutnonethelessanexceedinglyexceedinglyvast,perplexingsuperstructuresuperstructureofcoperations,consortiumsconsortiumsand governmentswhichbybringingintolineeachandeveryoneof the4millionpeopleherederivesitsbenefitfromthesystemandfeedsitself.OntopofallthisisthemorefrequentlyfrequentlydenouncedEstablishment,thosewhoholdrespectablepositions,reccivehandsomeincomes,commandtremendoustremendousinfluence,moralandactual,andwho,elatedbytheirapparentsuccessinthesystem,swearhardto defenddefendit.
In thissocietyofcapitalistscapitalistsandcolonialists,in thisageofknowledgeexplosion,andin thisstageof humancivilization,wecotoschoolnotto learnthetruemeaniligsmeaniligsoflifeandhumanexistence,existence,not to nourishanddiscoverhumannatureandourtrueself— affectionsand hates,emotionsandreason,instinctsandrationalactions—,nottoseebeautyin naturethroughliteratureand poetry.Instead,ourschoolsanduniversitiesarebutknowledgefactories(andeventhenonlythirdgrade)wherewearestuffedwithfacts,hardsolidfacts,meaninglessmeaninglessdeadrottenfactssothatweleaveasprocessedraw materialto join thearmyofspareparts,scramblingscramblingfor a filthyplaceinthemachineryof thesystem.system.Admitit,wearespareparts completelywithoutanyindividualitywhatsoever,replacebleat anymomentby anotherof our kind.Peopletalk abouttherecimentationrecimentationof peopleandlifeinCommunistcountries.Oursocietyhasaregimentationregimentationthatis equallycruel.Wearetoldto berationalin ourmoves,notto allow
ustoleada betterlife,butto suppressour instincts.Weareaskedtoreason,nottogainthefulluseofit,butto smotherour emotions.We are remindedthatweshouldhavea scientificmind,not to furtherourfellowmen’swelfare,buttoseetheirsufferingsinacold,indifferentmannerthatiscalledscientificdetachment.
My faith in humancivilisationis goneforever.The systemwill survive.Andmanwillsurvive.Buttheysurviveasmereexistence,existence,animatebut notliving.Whatisthepointofcuringpeoplewhenyoufindthattheyarenotanguishedhumansbutderangedsparepartsof a machine?Whatis the pointof makingfriendswhenyoudiscoverthattheyareindifferentandhostile?Whatis thepointof studyingwhenyouperceiveperceivethatit isbuthumiliatinghumiliatinganddegrading?Indeed,whatisthepointofallthiscivilisation?
IIIt comesas nosurprise
thatthemedicalprofession,a pillarstoneof thesystem.an Establishmentalmostby itself,demandsunyieldinglyunyieldinglyabsoluteconformityonthe part of its members.Buriedin a falsesenseofsuperiority,medicalmenclass themselvesin aseparatespeciesfromthelayman.Justbecausetheyaremedicalmen,theyindulgeindulgethemselvesin thefarcicalmyththattheyareservingpeople.Theyquiteconvenientlyforgetthefactthattheyclingdesperatelyto theuniversities,thebighospitals,maybedroppingahintthatthatis wheretheactionis,thatiswheretheircapabilitycanheexploitedto thefull,andtheyquiteneatlypaynoheedto thelamentablefact that theyconcentratein the citieswheretheycanchargeexorbitantlyexorbitantlyfor theirservice.Withoutsacrificeon thepartof thephysician,heisnot differentfromanyonewhohassomethingmarketablemarketableandthewholeaffairisnot in the leastanymorepraiseworhtythan anybusinesstransaction.Andthepooronesin thecountryside,countryside,in theslums,in thebackstreetsare left unattended.unattended.
I cometo thisMedicalSchoolwiththenaiveideathatI couldbecomea realphysician,onewhois likeany otherman,withhisshortcomingsandlimitations,withhisblundersandmistakes,mistakes,withhis fearsandfeelingsof uncertaintyIndeed,I just want to
(ContinuedonPage3)
VentolinTabletsorVentolinInhalermaybeusedVentolin(salbutarnol).whethergivenbymouthoraerosol,hasthreebasicpropertieswhich,together,makeit a realadvanceoverexistingbronchodilators:
ItisaneffectivebronchodilatorLi IthasarapidandprolongedactionLI Itactsonthebronchioleswithoutcardiovascular
cardiovascularinvolvement.VENTOLINTABLETSEachVenlohniablcicontainssalbutamof2mgassulphate.Suppliedinpacksof20,100and500.
separatelyortogethertopreventbronchospasmoccurring,orasbackgroundtherapyif spasmandwheezingareregularlypresent.Forbestresultspatientsshouldbeindividuallyassessed.VentolinInhaleristhepreferredtreatmentforacutebronchospasm.
VENTOLININHALERVentolinInhalerisameteredaerosol,delivering1OonicgofVentolinperinhalation,withaspecially,
designedactuator.Eachcanisterprovides200inhalations.
FullinformationisavailableonrequestVentolinisaTradeMarkGLAXOHONGKONGLIMITED
Ventolin - a real advance over existing bronchodilator therapy9thFloor,BlockB,Watson’sEstate,NorthPoint,HongKong.
Page 3 CADUCEUS
(ConlinuedfrontPage2)be on par with mypatient,albeitconversedintheartofhealing,butnotagod,nora saint.OnlythencouldI developa relation-shipwithhimthatis trulyhuman.Alas,a physicianhasto be a saint,evenifonly a proppedup one,reassertedtheEstablishment.
[hefireofnonconformityinsidemyselfblazeshigh,the hatredtowardstheEstablishmentturnshard,Iheedmoreandmorethecall01 revolution,the call ofaction.ButI ama weakman,inbothbodyandsoul.And I am nota capableman, only a bookworm.I here is nothingmorevaluablethancontrontationwiththeEstablishment,tohardenmyself,to makemyselfstrongerandtougherin the struggleto destroythe system.In the 7-7Incident,forall theseyearsolmylife,I firstdiscoveredmyscif:I amliberated,freedhuh all the bondswhichthisworldlaysonme,freedhornthecultsofreasonandcomposure.
Whereasall my fellowstudentsrushedto thebarberbarbershopto cuttheirshorthairevenshorterto welcomewelcomethenewterm,I madeupmymindandreassertedto myselfthatI wouldnotcutmyhair,I wouldkeepit thewayI liked,nooneasgoingtochangethat.I
appearedcalmandcomposed.composed.But deepdown,myvcakselfwastroubledandepset.A confrontationwiththeDeanis quiteanothermatterfromonewiththecops. Nevertheless,theurgetoconfront,tostagealacetofacestruggleandthedesiretoprovemyselfwereso overwhelmingand theIiidetcrminatenature,typicalofmyself,whichwasforeverat workin somehiddenrecessesrecessesof mymind,wassodominantthatI driftedoilwithouta haircutandattendedattendedthefirstlecturewithmyhairintact.
Thefirstweekprovedtobeanordeal,Thehardestlimeinmylife. Thefearofanddesirefora showdownwiththeEstablishment,thejceringsof my fellowstudents,students,the innocentbutmisplacedfriendly admonishingsadmonishingsof thosewhosimplydo notunderstand,myimaginedvisionsofthemlaughingat my back,and(heirplayfulteasingsmademefeellikeI hadneverfeltbefore.I was depressed.Irustrated,andcrosswiththeworld.Butthatwasapricelesslesson,drivinghometo methewaythesystem worked. TheEstablishmentdoesnothaveto hire secretpolicetocheckeveryboby.It doesnothavetopunishnonconformersnonconformersright away.Bymakinga moraljudgementon thenoneonformer,pro..claiminghimmoralisticallywrong,the Establishmenthas as its watchdogthewholecommunitywhohavebeenindoctrinatedthatway.Tl eonwil1lhWuld be
againstthe nonconformerwhowouldbealonein hisstruggleandthiswouldbeardownonthelonetrespasseras a boisterousonslaught.Thepressureisonthemindratherthanon the boby.The suppressionis byhumiliationratherthanbycoercion.It is subtleandintangibleyet immenselyrelentless.
Withall thisanguish,Ifoundconsolationandin-deedpleasureinfindingtheclasstullofclownsshoutingat eachother,commentingon eachother’shairanddoingmyriadsofothersillythingswhichdo notmeritrecordhere,amusingmy-selfwiththeirgutlesssub-missionto authorityandthelackof desireto defyauthority,any fornl ofauthority.
IllThesituationwasoneof
stalemate:theconfrontationseemedsonearandyetappearedappearednot to matetialise.LikethecondemnedOflthedeathroll,thewaitfor thechargeof theEstablishmenttwistedand strainedmymindto breakingpoint.Iwassotorturedbythecontradictorycontradictoryand conflictingnatureof my temperamentthatI thoughtI wouldsuccumb.succumb.Myferventobsessiontodefytheestablisheddrovememadlesslyonandyetthedeep-rootedfearofopendefiancedefianceandits consequenceconstantlymadeitspresenceknown.TheclimaxfinallycamewhenProfessorMacFadzeanMacFadzeandeliveredanintroductoryintroductorytalk.I couldstillrecallrecallthepictureofmyself,atimidlittlenothing,hidingrightat theback,lesttheProfessorshouldseeme,ratherthanwalkingrightuptometosay,‘Goddanioldsucker,hereI am.’
Hewasanoldman,weakandunsteady.Hishairwasshinywhiteandwithahloridfaceit lookedevenwhiterandshiner.He spokewithvisibleelTorttomakehimselfhimselfheard,changinghisspectaclestoreadtheOath,both the classicalandmodernversions.Withvigorouslyvigorouslytremblinghandsamidgrosslyunsteadygait,hisspeechinterruptednow& thenbya fewcoughs,liemanagedto standthroughthe15minutetalk.Pooroldman,aftera delicateopera—(ion,I saidtomyself.
He openedby saying,“Thereare certainrulesthatyoumustobeyin thisMedicalSchool.Longhairill notbetolerated.”He
wentonandexplainedthata physicianmusthe‘sober’inhisappearance.Notthathis sternattitudetowardlonghairand‘sober’appearanceappearancefrightededmc,northat the threatof beingkickedout of the wardssoftenedmydeterminadon.What1wasfeelingthenwasthat I couldnotpossiblyworkmyselfupto a headoncrashwithhim.Hewasa frailoldmanandI havenothingpersonalagainsthim,knowingthathewasjust anothernon-human
4gcntof theEstablishment,Itstrontlineintamitry.1heiastremnantsof themiddleciassvaluesinstilledintomynumbleseilwereworking,andI toolnoteofthesense(it scholarship,dignityandsincerityheconveyed.Ihcwayneheldthepracticeotniedicmflein hignesteem,nd thewayhe tell abouthisprotessionimpressedme.i-flUI believeinHissincerityin assertingthenecessityota sobcr’appearancetogiveconfidenceto the patientOIICtreats.
However,sincerityisonethingale prmncipiequiteanotnerJohnsonmightin—deednaveDCCnsincereinhisdisbeliel01CommunismBut it couldnot possiblyjustifytheuseof thousandsof tonsof bombs,mortar,andartillerylirewhichfelllikerainonVietnamsothatiiiihioiisof underciothed,under-lcd,Vietnamesemen,womcii,andchildrenranucsperatelyforsheltereveryday and night. Nigeriamightifldeedhave beensincereinkeepingBiafraintheFederation.Butdoesitjustify tile genocideinBiafra? ThereforethatProfessorMacFadzeanissincerein deniandingshorthairfromUSor, for thatmatter,bughair,doesnotnecessarilynicanthatshorthairis inherentlygoodorbadoranything.Mybeliefin thelengthof hairhavingnothingto do withone’sablity,intcrgrity,etc.,etc.,standsunshakenbutindeedicalTirmed.True,haircontrolcontrolis symbolicof theEstablishment’sdemandforconformityon thepartofthe commonpeopleandcaringone’shairlongthussignifiesa honestcivilprotest.protest.
Thestereotypingof manin modernsocityis ferociouslyferociouslypursued.all to thebenefitof the continuedexistenceof the system.Peoplebragabout(liefreedomsfreedomsthatareguaranteed,[hemanythingswecandointhissytem,andhintdarklythatCommunismwipesoutallthat.Oursystemthrivesontheregimentationofmanas muchas Communistcountries.Everyonewearsties, shirtsand businesssUits,variatioiiof whichisminimal.Sonexttimeyoulaughat theascetic‘Libera—[ion outfitof Chinathinkof whatvon ousclfarealloedtoputon.
The realsignificanceofwearingone’shairlongisthusthedeclarationof waron the Establishment.(liepursuitof opendefianceofauthorityandthefirststepin theliberationof (lieselffromthecageofthesystem.The valuableexperiencegainedthroughwearingyourhairlong,whichistrespassingtrespassingintotheforbiddenlandof the Establishment,ismostdesirableoralmostindispensableindispensableto everymanwhowantsto befree.
IvMywarwiththemedical
Establishment,personifiedin
the form of Prof.MacFadzean,MacFadzean,is doomed.IknowI shallbe as meekandsubmissiveasa child,at bestholdingona littlelonger.I knowI shallcutmyhairtoacceptablelength,I knowI shallbejustanotheranothermedicalstudentontheassemblyline to be processedprocessedandhammeredintoa curingmachine.Butletthisworldknowthattheburningflamesof rebellionof thismanwill neverbesmothered.Let (hisworldbeawarethatanunscrupulousunscrupulousmanlike myselfwhocouldforsakehisprincipleto evadesacrificeis goingintoa preicssionthisworldrespectsand adores.Leteveryoneknow that myradicalizationis onlytemporarilytemporarilyhaltedandwillgoon andon untilthetotal
destructioneitherof myselforofthesystem.
I shallclosethispiecewitha fewwordswrittenbya mannamedJamesSimonKunenof whomI do notexpectany of you haveheard.Indeed1 do notexpectanyofyoutounderstandunderstandmeor whatI have
ritten.‘My fathertalksabout
thebadassociationspeoplemakewhentheyseesomeonewithhair. ButI saygreat.1wantthecopstosneerandtheoldladiesswearandthebusinessmanworry.I wanteveryonetoseemeandsay‘Theregoesanenemyofthes(:mte’,’costhat’swhereI’mat,aswesayin therevolutionrevolutionhiz.”
JamesSimonKunen,Oneyearmysenior.
(lot tiuit wiw L)rirn . .
Duringthe5thDeansUndcrgradMeeting,the pro—hlcmof car—parksin QuectiMaryHospitalcompoundwasbroughtup.It wasnotedthatmanymedicalstudentspus-sessed‘parkingpermits’whichwereout-of-datepermitsorxeroxcopiesorpermitsstuckoncarswhentheywerepurchasedpurchasedby niedicalstudents.It mustbeemphasisedthatdrivinga car with a l)arkingperniit hearinganotherper—SOflSflamein orderto gainentryintoQueenMaryHos—pitalCompoundis equivalentto ‘personation,whichis aforniof forgery.Thelatteris a graveoflense,punishablebylaw.Anystudeiitfouil usinga false.parkingpermitisliableto prosecutionin courtandif heor sheis foundguiltyof personationor forgerythiswillhaveseriouscon—SC(.ItICiiCCS(Nihis01’hersubsequentprofessionalemploy—Ineiit.
Moreover.it wasFoundthatnianycarsof theniediealstudentsborebadgesniarked‘MD’ or ‘BMA’. iliesearebadgesdesignatingthe prol’cssionalqualificationof theowner.Undernocircunistancesshouldniedicalstudentstry to avoidbeingcauglufor traflicoffensesby stickingsuchbadgesOfltheircars. If theyarealreadyfixedtothecaisaIR!couldnothereniovcd,niedicalstudentsarcadvisedtocoverthemuptoavoidabuse.
..........I.. E D I T 0 R IA L ............: LUK’SVERSUSLEE’S :: Theone-manelectionoftheUnionExeceutives:: forthelastfewyearshaveneverbeenalltogether:N toointerestingfor us unionmembers;the can- :,, didateshavingto faceno competition,and us
beingofferednochoice.At lastlong,it is heart-warmingto seethat :
: therearetwocabinetes,Luk’sandLee’s,runningfornextsession’sunionexeceutives.
I By and large,Luk’scabinetprobablyrepre-:sentsa moreradicalwingof ourstudents’union.•‘; UnderLuk’s‘reign’,it canbeforseenthatHKUSUI willcommitherselfmoreandmorein socialand :: politicalissues,andtheywill alsoendeavourto: arousetheinterestoftheunionmembersinthese:
respects.However,if theoresentapathytowards:., theseaffairsremainsprevalentamongthegeneral:studentbody,actionstooboldonnartoftheunion.
centralmaynotbetrulyrepresentativeofthecon-sensusofthestudentsasa whole. :
Ontheotherhand,Lee’scabinetcertainlydoes:not representany extravagancein speech,nor: aggressivenessin action,andhispolicyfor next :
yearisprobablya conservativeone.Thiswillmean:thattheUnionwillbecautiousinplanningeachof •hermovesandavoidgettingherselfinvolvedinaffairsthatthe studentsarenotexactlytooen- :thusiasticabout.However,suchnolicymayalso •
: impliesthatthesocialandpoliticalconsciousness:: ofthestudentsasa wholewillcontinuetoremain• in itsinfancy,notto mentionthepossibilityof a: reconstructionof theivorytower. :• Sothereweare,fellowstudents,thechoiceis :: yours.Thinkcarefullyonwhatyouwouldprefer:: andcastyourvote! :: Thisviewsexpressedbyourcontributorsarenot :• necessarilythoseof theEditorialBoard.
TheEditorialBoardwishesto thankthespecialsupportof theGlaxoHongKongLtd. :••••••.•••••s•••••••••••••••a.• I••I•aRe.sI..
Page 4 CADUCEUS
(e’nIinuc/(l,n Pa.c’cItion.Restrictionof waterintaketo 500mIsisusuallyeffectivetoimproethementalconditionandmusclepower.Largedoseof 9 -flurohydrocortisonc-flurohydrocortisonccanalsoheused.
Thetrueincidenceofendocrinemanifestationisdifficulttoassessasthesearenonspecificandeasilymistakenasgeneralmanifestationsof themalignancy.Sothecliniciansshouldhe on thealertfor:
1) Theendocrinemanifestationmightbethefirstssmptomof anocculttumourwhichis amenableto treatment.
2) Theendocrinefunctionof thetumourmightaddtothep:lniarysymptornato—logyof themalignancytocausemorediscomfortof thepatient.Recognitionandtreatmentof theendocrinemanifestationmanifestation‘ould makethelastdaysofthepatientmoregratifying.
3j In adrenocorticotropichormoneproduc—(ion,theprogressof theprimaryandmetasticspreadarcaccelerated.
Finally,Dr.S.C.Sotalkedontheneurologicalneurologicalnianifcsta4ionof bronchogeniccarcinoma.
Classificationof non—mc.tstaticnetirologiclilmanifestation(BrainandAdamsI965):I) EncephalopathyI) Multifocal!eucoencep1alu)aLl1\: rarest,rapidly
rapidlyfatal.(2) Diffusepoliocnccphalopalhy
a) vith mentalsvmptom:hitarue,iion—specific.
b) subacutecerehellardegeneration;nystag—nus,heniihalIisnus.
c) brainstemlesions.
II) MyelopathyI) Chronicrnyelopath
a) Longtractdegenerationb) Longtractdegenerationand neuional
degeneratione) Motorneuronclikedisease
1roximalmuscleweaknesswithwastingandfaseiculation;lowerlimbsinvolvedinearlystage.BothupperandIo er motorneuwilcsigns.Protractedcourse.(lCliflitCtendencytoarrestif primaryremoved.
(2) Subacutenecroticrnyelopathy;rare,rapidlyfatal.
(3) Nutritionalmyelopathy.III) Ncuropathy(I) Sensoryneuropathy‘ith dorsalcolumnde—
generation.(2) Periphenilsensorirnotorneuropathy(poly—
neuritis).Thiswasthecommonestmanifestion.(3) Metabolicendocrinenutritionalneuropathies.1V)Musculardisorders(1) Polymyopathy(2) Disorderofneuromuseulartransmission.
a) myasthenicmyopathywithparadoxicalpotentiation:Repetitivestimulationofmotorncuroncshowedprogressivedecreasedecreaseinactionpotentialwhenrateofstimulationisslow;withrapidstimuLi(ion,stimuLi(ion,facilitationoccurred.It differsfrommyastheniagravisasbulbarsignsare minimal,easyfatigabilitywithwarmingupeffect,diminishedreflexes.prominentdrynessof mouthandminimalresponseto neostigmincbutmarkedimprovementwithguanidine.
b) myasthcniagravis(3) PolymyositisanddermatomyositisActiologyofcarcinomatousneuromyopathy:I. Carcirtotoxin(Oppenheim1868)2. Virusinfection(Hensen1954)
Thispostulatedthatinthedebilitatedpatienta normallyharmlessviruswasactivated.
3. Antigen-antibodyreaction(Russel1961)Thisis themostfavouredtheory.It ispostulatedthattumourantigenscausedantibodiesantibodieswhichmightcross-reactwithnervoustissue.
4. Metabolicdisorder(BrainandHensen1954)At present,thereisstillnoevidencetosupportsupporttheabovetheories.
Theneurologicalmanifestationmightbethefirstsymptomandsinceit is bizarre,theclinicianclinicianhastohavea clearunderstandingof it forearlydetection.
SurgicaltreatmentThisas delieredbyDr.JohnLeung.Hisstudywasbasedon260patientsadmitted
intotheUniversityThoracicUnit,allhavinghistologicalhistologicaldiagnosis.
Themaximumagegroupalsofellon50-59.Themalefemaleratiowas1.7:1Smokinghabit:inmale92%smokers.56%
infemaleHereDr.Leungsuggestedthatthehighpercentage
percentageof fcnialcnonsmokersmightbeduetoexposureoflungtothefoulatmosphereproducedbyill fittedkeroseneburnersin badlyventilatedkitehens.
1his asjusta suppositioaastherehasbeennoexperimentalstudyandciinicalevidencetosupportsupportit.Pithologofthespecimens:
Anaplastic(includingoatcell)I I(1Squanious6I
nocarcinoma45;\lco1ar2SarcomaILneLissified39
I)urationof illnessIeforesurgery:lessihaiiI month271-3iflOliths753—6iiioiit]is(m4(—12months38longerthan1year56
Ofthesepatients.68wereinoperablebypre-opera—tiveassessment
73vcueinoperableat thoracotomyPneunioncctonivdonein 41Lohectomin63Segmentedresecta)il 1\\edgeexcisionIExtendedradicalexcision13
O erallresectahilityrate46Segmentalrcscctiomiandwedgeexeisiomipov—
cdtohea inistakenchoiceasbothpatientsdied: recurrenceoftumour3-6monthsafteroperation
Also,theextendedradicalexcisionwasanunsuccessfulattempttoextendthehorizonofre—sectionto includechestwall,pericardium,diaphragm,diaphragm,partoftheatriumoroesophagus.Noneci thesepatientssurvivedmorethan2 yearsand[liepatientssufferedevenmoreduringtheirlastdays.Resultsof surgerywereasfollows:
Mortality55 yearssurvival8 (11% outof75rescctions)10yearssurvival315yearssurvival1
RadiotheraphyandChemotherapyDr.RudyKhootalkedonradiotherapyand
chemotherapyof bronchogeniccarcinoma.Hepointedoutthattheseareonlysecondarylinesoftreatmenttosurgery.Thesecasesmusthavehis—tologiealconfirmation.Theinoperablecasescanhedividedinto:
suitableforradicalradiotherapysuitableforpalliativeradiotherapyamidchemotherapy
Criteriaforradicalradiotherapyarc:I. Smallgrowth.confinedtolung,inoperable
inoperablebecauseof promirnitytocarina2. Smallgrowth,confinedto lungand
niediastinum.3. Growthconfinedtolungbutthepatient
isoldandof poorrespiratoryreserve.4. Thevolumeofthetumourwaslessthan
10x 10x 10cm.It is contraindicatedin widespreaddisease,
presenceofotherfociandpleuraleffusion.Pre-operativeradiotherapymightconvertinoperable
inoperabletumourtooperableone.Post-operativeradiotherapydoesnotincrease
survivalratebutmighthelpinanaplasticandoatcelltypes.
Cobalt60isemployed,aslittlenormallungtissueisincludedin thefieldof radiation.Outof288patientstreatedbytheUniversityRadiologyunit,only10 patientsweresuitableforradical
course(3.5%), 7 referredforpostoperativetreat-ment.2 arealive.one8 yearswithanaplasticcarcinomatreatedby radicalradiotherapy,theother9 yearswithanaplasticsarcomatreatedwithlobectomyandpost-operativeradiotherapy.Complicationsof radiotherapy:
I. PulmonaryfibrosisWhenlocalized,symptomlessthoughvlsi-bleonX ray.In some,a flaringfibrosisoccurscx-tendingoutsidetreatedvolumeproducinggrossdyspnoea,untreatable.
2. Irradiationoesophagitis,somedysphagiainevitableinradicalradiotherapy.
FroniastudyinNaniLongHospital,patientswithinoperablebronchogeniccarcinomawereputrandomlyOilthefollowing4 ways:
I. Waitforsignificantsymptombeforeanti-cancertreatmentstarted
2. Immediatetreatmentstarteda) radiotherapyto maximumtissue
toleranecLi) chemotherapywithmustinee) radiotherapy-i--mustinetreatment
Iherewasnosignificantdifferenceamongtheresultsobtained.Therefore,notreatmentisthebesttreatmentinpatientswithadvancedcarcinomawithoutmuchsymptoms.
Palliativeradiotherapyis usefulin thefollowifollowingconditions:
I) SkeletalnietastasesShortcourseof radiotherapysuccessful.
2) ParaplegiaduetospinalmetastasesEmergencyradiotherapyrequiredwithin48 to 72 hours,uselessin establishedcase.
3) Cerebralmetastases.4) Pancoasttumour
Maximaltolerateddoseisgivenwhenpainwassevere.
5) Superviorniediastinalobstructionwithprediiisolonebeforeradiotherapy.
(‘i) Pleuraleffusion.Butit isnotusefulinwidespreadpleunilpleunileffusion.Thepracticeofintrapleuralinstillationof colloidalgoldwasabandoned,abandoned,bettertreatedwithnitrogenmustard.mustard.
Chemotherapyisol’liniitedvalueonly. itis eniployedwhenradiotherapyis notavailableorthepatientwastooweakforit. Bestagentisstillalkylatingagent.FromtheclinicaltrialinNam Long,cyclosphosphmiceis as effectiveaswhenit iscombinedwith5 fluorouracil.
EPILOGUEDr.J.K. Craig,DeputyDirectorofMedical
andHealthServicesdidthegeneralswimdngupandexhortedthepublictoabstainfromsmoking.
Thevoteof thankswasgivenbySisterM.Aquinas.Beforeendingthe3 hoursofillustratinglectures.sheaskedthedoctors,especiallythegeneralpractitionerstohaveclinicalalertnessforthedisease.Earlydetectionisofvitalimportancein thetreatmentof bronehogeniccarcinoma,
DearSir,CORRESPONDENCE
I wasveryinterestedtosectheletterfromtheAnaesthesioiogistonpagethreeof yourSeptemberSeptember15,1971issuein whichhecomplainedthatinyourarticleaboutGranthamHospital,theAnaesthesiologistwasnotmentionedatall.I wasalsogratifiedto reactfromyourcommentsthat‘theroleof theanaesthesiologisthasbecomesoindispensabletoa hospitalthatthewriterof the‘GranthamHospital’hasobviouslytakenhispresencepresenceandhisworkforgranted.”
However,asit is consideredthatnotonlytheroleofanacsthesiologist,butalsotheroleofsurgeon,physinian,andallotherbranchesofMedicineMedicinehavebecomesoindispensablethattheirpresencepresenceandworkaretakenforgranted,it wouldappearthat,takingyourexplanationat i facevalue,it willinfutureonlybenccessarytoprinttheHeading“StaffingofHospital”andthenleaveallthefollowingspaceblank •
I.
I havethebonouttoremain,‘uis ,tathfI!lly,.AnodrAnaq.
香港大學學生會
醫學會
月刊
第
三
第十
九考一年十
月 期 懸
踏著沙宣道,一月過去了,片片黃葉乘西風飄下,始覺秋意
茫濃,夏去秋來,這就是生命的前進。
起初總是覺得很矛盾,著寶很久也未能接受自己是正在讀醫
的事實,明友們說你不像,但當教授說過:口ere.sn。artin
膩ediC。e我就必須要很實在地接受和明白自己是做著些什麼
,於是就將我小包囊裹的害,詩和育樂好好的收拾起來,放在架
卜的一角,還括L一枝小紫紅玫瑰,告訴自己不要再徹夜細讀張
秀亞,輕念辛協的一懷思一·或臥在床1:聽叫oni膩
itchell聽
Beatles,或斗你不懂可壯我的力量是如此微弱,而時問是如
此忽促;我必須要在感情卜抬棄另一樣如果我要選擇另一樣的話
。比如現在換巨甩讀著幾頁
Synapt-c
Transmission,總會比
塗這些束西更成功更有擁。
我從來沒仃T。。
craZy
abol"t讀醫。記得當時貝騷必須要
下一們重大的抉定,我曾想如果我木身沒有多大興趣教書而確實
富起教員來,我亦曾做個好的牧師,因為我明白到它工作的意義
,所以我會螂敬和樂於從事自己的工作,合田然從旁影晌的人為力
量亦不小,我深深地體偉到父母.底的希望,另一方面偶交的藍
人明友,他們仃青軀體卜洶炎缺,但仍然努力地生活工作,希望
帶給別、快樂,這儿.一都給予我縱限的鼓舞f11信念。很可!蹴的瞌我
著實亦澎漸喜歡J、過門俟·問。
抱若)伶訢坐的情懷,妒倫細斤尺一切訢的人新的事物,事寶
-l:每天荒淺嘗到有蒼祈趣味的生活,'-接觸每一張訢臉孔,都有一
個故事。講師們各有各格,當然有收沉悶乏味得寶在不敢儿維,
但尤愛士。超先生很有折味的B丫talks和漫書。同學方而,史有各
種不同的;、、物,有很友善可刊,有內含拒久詢,男孩子仔隱定酒
騰洶,卞有軾一叩一計l;J我·表現的。
不必,【講室總尼濫化樣奇冷,少上氣滲人每一個毛孔·令久師糾
不已。最俊為一刊,昏冷,門,身必的男孩子州塗目字卜門ergt:話,百
多張險孔的待一伐有收恪感覺,突然發覺周圍的都是將會在你生命
某一段路程州你七在一枕詢人。肥得巾請,、干、學時要鑄自己做的
豚
一篇文章內,曾期望多姿多釆的學府日子,交上很多很多除談天
氣外還可以握手談藝術,生存,國家和很多其他話題的朋友,但
畢竟我們不再是上小學一年級純真的孩量,一起跳幾同橡根繩便
可以成為好朋友的那種,我們已經長大了,大得有了成人那一份
成熟但頗虛偽的潛慧識和自我意識。冒昧探敲別人的心扉是會很
容易傷害別人和自己的,人的感情就是一個如此麻煩複雜的,交
結也就隨得它的自然飄流吧!反正你永不知道風是從那一方向
吹l·見到一草同屬於一個時室的人,特別有一份興奮喜悅,年青
是生命的力暈,我們是和平,愛和花的一代,棲身在這小島L無
論生命或是生活上都有著共通的地方,歷史的血脈,黃河,長江
,天山,廣漠草原都是在我們體內奔騰著,你感應到嗎?釣魚台
壯我們一個開始,終點還看不著,那麼就以懷望依歸的心情,毋
亡心中國,祝一幅她!
明友,年輕的朋友,我們在未來口子中會有無數的偶遇相逢
,就在這些偶然中,請不要忽忙,忽忙該在中環,該在尖沙咀旺
角o想他?J和自己走遠了內明友,大學就好像一個站,有人下車
有人上來,有久換上一列往另一方回走的,也有趕乘下一列的;
每日在疲乏的歸程,昔日與渡的lla天,雨天就會在腦海裹浮現,
我是個非常卷想緬懷過去的人,無限懷念那星夜,灘頭和那陋屋
夜談,很感謝霖林我剪了個很頗的頭尖,李受了一整個寫意的夏
大。為什麼我們總騷要很無可奈何地揮手?毋忘給大家一點訊息
李樹芬樓實在沒有茫麼地方可提·就貝喜歡附近幽雅沿山臨
海的小路,清晨晚風都給久清新舒適的感覺,不過那些環繞在這
裘的日子中,生活是愉快的,遺憾的是功課可要急追。l'pe爾亦可
在不可預知的生話州斷中找尋得詩相美麗的人,我會感到滿足,
事實但否,我還不鉑道。
最近瑪麗醫院執行一項說大不大,說小大小跑新攤政:魷是騰生
們所佩戴的名牌J皆一律白底黑字,並且中英文並厝.此舉不驕
縮短醫生病人之間之隔閑,並且將一向為資深大醫師們所專到的特糧
名牌加以普及,除學生及實習醫生們外無遠弗屆。余以為如此德政。
適宜予以推廣,不若各醫學生亦各配給白底黑字·中英對照之名
牌乙塊,lst實B試前者冠以紅色L字,試後則改為綠色。待畢業
後刪L字而發黑牌:換言之。五年醫科生涯,先為紅牌生,綠牌
生而晉升為黑牌大師傅,再進而為白牌大醫師。如此這般,則實氏界
中e應於何時起才可繫於白領上等等無聊問題,再無討論之價值。由
是實edic精神得以促進:天下太平,蒼生幸甚矣!
×
×
×
醫學生中心,由於擴建關係,通路屢有修改。現時往餐廳,圖書
館,宿舍等的通路,比前之L。。9and
winding
road,更長,更曲
折,使飢腸輓輓,身軀疲痛之各位同人,有長路漫浩浩之嘆,雖
努力加餐茶亦有得不償失之感。據說將來新廈落成後,休憩室內將
有電視,音響設備等裝置。可是對現時留駐實江片
Centre之同
學來說則有未見其利先蒙其害之感,因為新廈遮擋視錢,欲速眺
窈窕淑女,指而論之皆不可得也。有人以為將來新廈天台應用作集會
,猶其是月光舞會之類。竊以為此意甚佳:從今而後,實。魚C
BBQ,
SOCialg黑,週年拍攝留念等盛會此天台當可大派用場,無
耑假外求。願當局一一一思!
不過開舞會之際務請各位駑車人仕合作,純用低燈,以免破壞情
調,大煞風景,是盼!
×
×
×
自從醫學會之r小兒護理指導,一舉行之後,各方好評如潮,咸嘆
EnCore,不在話下,不必阿丁再贅。頗值一提者乃為本人之重大發
現:即撤多參加該指導之各位學兄,皆染上一種急性心臟病。此病學
名為
Roman江c
Heart
Disease,簡稱RHD。照本人研究所得,此
病一般多見於青春發動期,男女患者比例約付1。其病源雖尚未能確
定,但相信r異性接觸有關。其病徵:
(一口關節痛:尤以腰及下肢為甚,蓋此等關節於舞會中最工nv
0一vedon二)發熱:面紅耳赤·時而喃喃自語,時而手舞足蹈,或閉目
沅思,與現實隔絕。在最危急時期,病尺每被誤為神經失常而被送入
青山醫院,飽受不必要之痛苦。
戶三)頻頻搖州馬拉松式必電話,動輒數小時,其>
ssociated
Sym震。日s為.
6onst-
pation。fthe
brain
and
diarrhoea。f
t口e工nouth留、。
八州)衣著講究,細意打扮。男患者之先天性豪曠性格失諸
於無形;女患者ul變得傲慢;此病徵可能與內分泌失調有關。
阿丁徇椅學識有限,所以目前只能約忍將此症區分為急性與頑固
慢性兩大頻。急性者的症微約於二星期至四星期消退,慢性者則可能
拖延數年之次。急性听能引起之併發症較少;頑固慢性則較多。各方
大雅并J=,/a1對此病仔心得或理論,幸不吝賜教不勝感激。
PrintedbyshumshingPr加tingCbl,,州叮Tel..俘724s1)