Self-made Audio Programme 4 (本人原声)you can download this audio material at http://www.zshare.net/download/33683985f36ca3/

Welcome to Medical Insight August 29, 2007, I’m Dr. Alex Roy, today we will bring u a case record from the Massachusetts.

A 61-year-old man was admitted to the hospital because of recurrent fevers follow by dyspnea. He had been well until approximately 3 and a half months earlier, when chills, fevers, and fatigue developed. His symptoms persisted despite anti-microbe therapy. On admission, the patient has daily fever to38.9°C. The e-ryhro-cyte sedimentation rate was 94 mm per hour. CT of the chest showed interlobular septal thickening and hilar and subcarinal lymphadenopathy. A PET scan showed diffuse uptake in the lungs. The patient had been born and raised in Bangladesh and had immigrated to the United States 4 years earlier. At the time of admission, he met the criteria for diagnosis of Fever of Unknown Origin: fevers higher than 38.2°C on several occasions for more than 4 weeks, with no spe-cific diagnosis despite extensive evaluation. fever of unknown origin remains humbling for the diagno-stician, since up to a third of patients with fever of unknown origin never receive a de-finitive diagnosis. This patient’s fever obeyed and the strategy of watchful-waiting seem reasonable. The watchful-waiting approach was abandoned when the patient’s fever recurred 3 months after discharge, accompanied by shortness of breath and hypox-emia. On readmission, he had weight loss, fever, sweats, and occasional rigors. The development of pulmonary, hepatic, renal, and gastrointestinal involvement provided clues that helped narrow differential diagnosis which focus on the three most likely causes of fever of unknown origin in this patient: Infection, Cancer, and Autoimmune disorders. Finally, Clinical diagnosis of Pulmonary intravascular lymphoma was made by thoraco-scopic biopsy. Now This ends the Medical Insight August 29, 2007. we are interested in yr feedback about our audio programme, any comments and suggestions are welcome to leave in this space. Thank u for listening.

Franz Liszt (October 22, 1811 – July 31, 1886) was a Hungarian virtuoso pianist and composer of the Romantic period. He was a renowned performer throughout Europe during the 19th century, noted especially for his showmanship and great skill with the piano. Today, he is considered to be one of the greatest pianists in history. Liszt is frequently credited with re-defining piano playing itself, and his influence is still visible today, both through his compositions and his legacy as a teacher. He is credited with the invention of the symphonic poem, as well as the modern solo piano recital, in which his virtuosity won him approval by composers and performers alike.

Medical Insight （August 24, 2007 ）

Self-made Audio Programme 3 (本人原声)

you can download this audio material at http://www.zshare.net/download/33055940873cf5/

Welcome to Medical Insight August 24, 2007, I’m Dr. Alex Roy, this time we will focus on a Study of Sexuality and Health among Older Adults in the United States.

There is limited information on sexual behaviors among older adults, and how sexual activities change with aging and illness. This survey of 3000 adults, 57 to 85 years of age show that rates of sexual activity decline with age, but many adults are sexually active. The prevalence of sexual activity declined with age (73% among respondents who were 57 to 64 years of age, 53% among respondents who were 65 to 74 years of age, and 26% among respondents who were 75 to 85 years of age); women were significantly less likely than men at all ages to report sexual activity. The most prevalent sexual problems among women were low desire (43%), difficulty with vaginal lubrication (39%), and inability to climax (34%). Among men, the most prevalent sexual problems were erectile difficulties (37%). Fourteen percent of all men reported using medication or supplements to improve sexual function. Men and women who rated their health as being poor were less likely to be sexually active. John Bancroft from the Kinsey Institute, Bloomington, Indiana writes an editorial that despite the high prevalence of sexual problems among the participants in the study by Lindau et al., only 38% of men and 22% of women reported having discussed sex with a doctor since the age of  50 years. For some  older couples, sex can continue to play an important part in their relationship and well-being, and some may benefit from counseling or medication for that purpose. Other couples choose to leave sex behind as they settle into their later life. Often there may be the need for negotiation between partners. The  medical profession should encourage older patients to feel comfortable in discussing sexual problems and in choosing whichever of these two options suits them best. Now This ends  the Medical Insight August 24, 2007. we are interested in yr feedback about our audio programme, any comments and suggestions are welcome to leave in this space. Thank u for listening. 

Medical Insight （August 21, 2007）

Self-made Audio programme 2 (本人原声)

You can download this MP3 at http://www.zshare.net/download/3241709cc2f01f/

Welcome to Medical Insight August 21, 2007, I’m Dr. Alex Roy, today we will focus the clinical practice of Acute Ischemic Stroke.

In morden societies, about 80% of Stroke are caused by focal cerebral ischemia due to arterial occlusion, and the remaining 20% are caused by hemorrhages. Ischemic brain injury is thought to result from a cascade of events from energy depletion to cell death. Intermediate factors include an excess of extracellular excita-tory amino acids, free-radical formation, and inflammation. Initially after arterial occlusion, a central core of very low perfusion is surrounded by an area of dysfunction caused by metabolic and ionic disturbances but in which structural inte-grity is preserved. In the first minutes to hours, therefore, clinical deficits do not necessarily reflect irre-versible damage. Depending on the rate of residual blood flow and the duration of ischemia, the penumbra will eventually be incorporated into the infarct if reperfusion is not achieved. In the majority of cases of stroke, making the diagnosis is straightforward. Atherosclerosis and cardioembolism are the leading causes of brain ischemia，In all patients with suspected ischemic stroke, CT or MRI of the brain is required. And noncontrast CT may suffice; The treatment of Acute Ischemic Stroke, including: intravenous Thrombolysis，Aspirin，and Prevention and Management of Complications.

Now This concludes  the Medical Insight August 21, 2007. we are interested in yr feedback about our audio programme, any comments and suggestions are welcome to leave in this space. Thank u for listening. 

Medical Insight  (Aug 17, 2007)

Self-made Audio Programme 1(本人原声）

You can download this audio MP3 at  http://www.zshare.net/download/31805503fd8a44/

Welcome to Medical Insight August 17, 2007, I’m Dr. Alex Roy, today we will bring u the lastest research about Medical Abortion, and new therapy for Extensive Lung Cancer. Despite the increasing use of medical abortion (abortion by means of medication), limited information is available regarding the effects of this procedure on subsequent pregnancies. Jasveer Virk from University of California, Los Angeles conducted a study on Medical Abortion and Subsequent Pregnancy Outcomes In this study the author identified all women living in Denmark who had undergone an abortion for nonmedical reasons between 1999 and 2004 and obtained information regarding subsequent pregnancies from national registries.

Among over 11,814 pregnancies in women who had had a previous first-trimester medical abortion, or surgical abortion, there were 274 ectopic pregnancies (respective incidence rates, 2.4% and 2.3%), 1426 spontaneous abortions (12.2% and 12.7%), 552 preterm births (5.4% and 6.7%), and 478 births with low birth weight (4.0% and 5.1%).medical abortion was not associated with a significantly increased risk of ectopic pregnancy), spontaneous abortion), preterm birth or low birth weight. the authors found no evidence that a previous medical abortion, as compared with a previous surgical abortion, increases the risk of spontaneous abortion, ectopic pregnancy, preterm birth, or low birth weight.

Symptomatic Brain metastases are a major clinical problem in Small-Cell Lung Cancer.this trial compare prophylactic cranial irradiation with observation in patients with small-cell lung cancer who had had any response to chemotherapy. Ben Slotman from VU University Medical Center,in Amsterdam found Patients in the irradiation group had a lower risk of symptomatic brain metastases (hazard ratio, 0.27); irradiation also have a significant effect on overall survival with hazard ratio for death of 0.68 and the prolongtion of median survival by 6 weeks, at 1 year survival in irradiation group was 27.1% as compare with 13.3% in the control group. Prophylactic cranial irradiation reduces the risk of symptomatic brain metastases and associated with a longer overall survival. Now This concludes  the Medical Insight August 17, 2007. we are interested in yr feedback about our audio programme, any comments and suggestions are welcome to leave in this space. Thank u for listening.