Medical Insight （September 28^th, 2007）

Self-made Audio Programme 13 (本人原声)

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Welcome to Medical Insight September 28th, 2007, I’m Dr. Alex Roy. The cause of Syncope in older people can be a complicated subject. A case record from the Massachusetts general hospital have its diagnostic categories of this kind. A 68-year-old man was admitted to the hospital because of a syncopal episode, followed by hemiparesis and altered mental status. He was in his usual state of health until the morning of admission, when he suddenly lost consciousness and vomited while walking with a companion. He was transferred by ambulance to the emergency department within 35 minutes after the onset of symptoms. On examination, he was lethargic, with intermittent periods of unresponsiveness. The blood pressure was 166/80, the pulse 74 beats per minute, and the respirations were 18 breaths per minute. His gaze was deviated to the right, and he had a right facial droop and difficulty swallowing oral secretions. His left arm was flaccid, but he was able to move his other limbs. He has the history of carcinoma of the prostate and hypertension. Cerebral imaging suggests that the syncope was probably the result of emboli to the brain. In addition to his cerebral lesions, the patient had multiple embolic lesions in the vasculature of the heart, kidneys, and gut. Given the echocardiographic findings, the differential diagnosis includes cardiac sources of embolism. This case focuses on the three most likely diagnostic categories:

1)      Infective endocarditis

2)      Intracardiac thrombus

3)      Cardiac neoplasm

Four videos showing an echocardiogram of the patient’s heart and angiograms of affected arteries are available at nejm.org, and his final diagnosis: Left atrial cardiac myxoma with systemic embolization.

Medical Insight （September 26^th, 2007）

Self-made Audio Programme 12 (本人原声)

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http://www.zshare.net/audio/38569853d93808/

Welcome to Medical Insight September 26th, 2007, I’m Dr. Alex Roy. this week we will go to the Intensive Care Unit (ICU) to learn about Acute Respiratory Distress Syndrome &. Mechanical Ventilation. Acute respiratory distress syndrome (ARDS) is a more severe form of lung injury than acute lung injury, and is defined by a ratio of the partial pressure of arterial oxygen to FiO2 of less than 200. Common causes of ARDS are sepsis, trauma, aspiration, multiple blood transfusions, pancreatitis, inhalation injury, and certain types of drug toxicity. A consensus conference of the American College of Chest Physicians recommended In 1993,that low tidal volume ventilation be used in patients with ARDS. Low-tidal-volume ventilation should be implemented in the context of a broader strategy of critical care management in a patient with acute lung injury or ARDS. An initial tidal volume of 6 ml per kilogram of predicted, not actual, body weight should be used. The initial respiratory rate should be set in the range of 18 to 22 breaths per minute. The response to low-tidal-volume ventilation should be assessed initially on the basis of plateau airway pressure. The goal should be to maintain a plateau airway pressure of 30 cm of water or less. However, Low-tidal-volume ventilation can result in an increase in the partial pressure of carbon dioxide to above the normal range.That is permissive hypercapnia. This article reviews the pathophysiological characteristics of ARDS and the effect therapy with Low-tidal-volume ventilation. 

Advanced Seconds---《新概念》个人记录

原磁带录音：2分23秒

个人朗读记录：1分 24 秒

Advanced Sec：59秒

download this record at http://www.zshare.net/audio/3828628d06db45/

http://www.zshare.net/audio/3804452564d4b6/

Welcome to Medical Insight September 23rd, 2007, I’m Dr. Alex Roy, To clinicians in Respiratory Disease Department, “pulmonary nodule” in chest radiograph can be a big question. This week a case record from the Massachusetts General Hospital has just came in time. A 51-year-old man with a history of gastric cancer was admitted to the hospital because of a new pulmonary nodule. Helicobacter pylori infection had been diagnosed 5 years earlier, and a subtotal gastrectomy had been performed for adenocarcinoma of the gastric antrum and pylorus 2 years earlier. In the year before admission, pleuritic chest pain developed, and multiple pulmonary nodules and cysts were seen on CT. Two weeks before admission, a new pulmonary nodule with a ring of ground-glass opacification was seen on follow-up CT. He had two types of pulmonary lesions, which were probably not related. And evaluation of tissue specimens was warranted. The patient had been born in Brazil and had immigrated to the United States more than 20 years earlier. He visited Brazil approximately annually, and 7 years earlier, he had lived in Japan for 1 year. He ate cooked, but not raw, shellfish. He had smoked cigarettes for 25 years but had stopped 3 months before admission. This 51-year-old man with gastric cancer and a new pulmonary nodule has sequelae of two common infectious diseases( H. pylori and parasite). The differential diagnosis included worms that infect humans---roundworms, flatworms, and flukes. Final Diagonsis: Infection with a Lung fluke!

Advanced Seconds---《新概念》个人纪录

原磁带录音：2分11秒

个人朗读纪录：1分 11 秒

Advanced Sec：60秒

download this record at http://www.zshare.net/audio/37876650d42869

Medical Insight （September 22^nd, 2007）

Self-made Audio Programme 10 (本人原声)

you can download this audio material at http://www.zshare.net/audio/37828676b546f1/

Welcome to Medical Insight September 22th, 2007, I’m Dr. Alex Roy. The latest and more expensive is not a guarantee for a better result, anti thromboembolic drug Idraparinux is just an example. Venous thromboembolism is usually treated with unfractionated heparin or low-molecular weight heparin, followed by a Vitamin K antagonist. The long-acting factor X inhibitor ---Idraparinux, was compared with Standard anti thromboembolic regimen in two randomized trials: one for the treatment of deep-vein thrombosis(DVT), and the other for the treatment of pulmonary embolism. In the study of patients with deep venous thrombosis, the incidence of recurrence at day 92 was 2.9% in the idraparinux group as compared with 3.0% in the standard therapy group (odds ratio, 0.98). The rates of clinically relevant bleeding at day 92 were 4.5% in the idraparinux group and 7.0% in the standard-therapy group. At 6 months, bleeding rates were similar. In the study of patients with pulmonary embolism, the incidence of recurrence at day 92 was 3.4% in the idraparinux group and 1.6% in the standard-therapy group (odds ratio 2.14), a finding that did not meet the non-inferiority requirement. In patients with deep venous thrombosis, once-weekly subcutaneous idraparinux for 3 or 6 months had an efficacy similar to that of heparin plus a Vitamin K antagonist. However, in patients with pulmonary embolism, idraparinux was less efficacious than standard therapy. 

Medical Insight （September 19th, 2007）

Self-made Audio Programme 9 (本人原声)

you can download this audio material at

http://www.zshare.net/audio/37472110e31988/

Welcome to Medical Insight September 19th, 2007, I’m Dr. Alex Roy, This week a case record from the Massachusetts General Hospital will tell how Group B Streptococci can cause Intrauterine Fetal Death.A 30-year-old primigravida was admitted to the hospital in active spontaneous labor at approximately 40 weeks’ gestation. The patient was born and raised in West Africa and had immigrated to the United States 7 years earlier. At the first prenatal visit, ultrasonographic examination of the pelvis showed a normal appearing fetus with a normal heart rate. Urine culture grew moderate mixed bacteria and rare (100 to <1000) Group B Streptococci. The patient was immune to rubella, and the blood type was B Rh-positive. Approximately 6 weeks before admission, an oval-shaped red rash with central clearing developed on the left inner thigh. It resolved within 10 days; At weekly visits between 36 and 39 weeks’gestation, fetal movement was present. On the day of admission, the fetal movements ceased in midmorning. Thirty minutes after arrival at the hospital, the membranes were ruptured, and 4 minutes later, spontaneous vertex vaginal delivery of a stillborn male infant occurred. Even after a thorough evaluation, the cause of many stillbirths remains unexplained, and this is particularly true of stillbirths that occur in the last trimester. In this case, a full autopsy and including a placenta examination was performed.

为《The Legend of 1900》（海上钢琴师）操刀配乐的是世界电影界著名和资深的意大利最具风格的作曲家--埃尼奥·莫里康内(Ennio Morricone)，从处女作《法西斯分子》到去年的《西西里的美丽传说》，这位大师参与制作的各国电影配乐已不下400部了，故被音乐界冠以最多产的作曲家美誉。现时已经是70多岁高龄的他，仍拥有丰富的创作灵感和素材。在《海上钢琴师》里，大师以钢琴为主配合适当的管弦乐和室内乐创作出音色醉人、旋律优美和风格隽永的迷人乐章。《The Legend of 1900》的原声CD由著名发烧厂家索尼唱片公司出品，同样是质量和信心的保证，整部配乐就仿如一杯香醇的陈年旧酿那般沁人心脾，令人闻而不忘，回味无穷。

Medical Insight （September 13th, 2007）

Self-made Audio Programme 8 (本人原声)

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http://www.zshare.net/audio/3625470fe9646a/

Welcome to Medical Insight September 13th, 2007, I’m Dr. Alex Roy, This week we are going to focus on a subject, its name is T.I.D. ---Tropical Infectious Diseases. The 13 parasitic and bacterial infections known as the neglected tropical diseases include three soil-transmitted helminth infections (Ascariasis, Hookworm infection, and Trichuriasis), Lymphatic filariasis, Onchocerciasis, Dracunculiasis, Schistosomiasis, Chagas’ disease, Human African trypanosomiasis, Leishmaniasis, Buruli ulcer, Leprosy, and Trachoma. The parasitic and bacterial diseases identified as being neglected are among some of the most common infections in the estimated 2.7 billion people who live on less than $2 per day. These diseases occur primarily in rural areas and in some poor urban settings of low-income countries in sub-Saharan Africa, Asia, and Latin America. The neglected tropical diseases lead to long-term disability and poverty. The poverty results from disfigurement or other sequelae of long-term illness, impaired childhood growth and development, adverse outcomes of pregnancy, and reduced productive capacity. A blueprint for the control or elimination of the seven most prevalent neglected tropical diseases has been established by a group of private, public, and international organizations working together with pharmaceutical partners and national ministries of health. This review describe approaches to the globle control of this Tropical Infectious Diseases(T I D) 

Medical Insight （September 6th, 2007）

Self-made Audio Programme 7 (本人原声)

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http://www.zshare.net/audio/35003308394851/

Welcome to Medical Insight September 6th, 2007, I’m Dr. Alex Roy, Rosi-glitazone is a New Drug for Type 2 Diabetes Mellitus Treatment, but it isn’t good as expected, and finally become a lessons from an FDA Advisory Committee Meeting. Let’s take a close look.ON July 30, the Endocrinologic and Metabolic Drugs Advisory Committee and the Drug Safety and Risk Management Advisory Committee of the Food and Drug Administration (FDA) convened to discuss the myocardial ischemic risk associated with rosi-glitazone treatment in patients with type 2 diabetes mellitus. The basic plot of the rosiglitazone story quickly became obvious to the advisory committee: A new “wonder drug”, approved prema-turely, and for the wrong reasons by a weakened and underfunded government agency subjected to pressure from industry, had caused undue harm to patients. The joint Committee concluded that the use of rosiglitazone was associated with a greater risk of myocardial ischemic events than placebo, metformin, or sulfonylureas.Ultimately, the committee voted to recommend not that rosiglitazone be removed from the market but rather that label warnings and extensive educational efforts be instituted immediately. In fact, several basic tenets emerged at this meeting that might ideally be used as guiding principles for improving the process of approving new drugs: first, the pathogenesis of disorders that require intervention must be fully understood; second, treatment options for these diseases should be clarified through an evidence-based system; and third, a uniform approach should be used to determine the societal benefits and risks associated with a given intervention.Now ends this week Medical Insight September 6st, 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 （September 1st, 2007）

Self-made Audio Programme 5 (本人原声)

you can download this audio material at http://www.zshare.net/audio/341493115f6d4a/

Welcome to Medical Insight September 1st, 2007, I’m Dr. Alex Roy, this time let’s take a close look at a case record of Systemic Lupus Erythematosus(SLE) from the massachusetts general hospital。

A 60-year-old man was admitted to the hospital because of 5 months fatigue and weight loss, and recent onset of ar-thral-gias, ody-no-phagia, rash and fever. On examination, the rash involved the facial cheeks and the upper chest and back. There was palpable cervical, axillary, and inguinal lymphadenopathy. Imaging study shows focal lung consolidation and intrathoracic and retro-perito-neal lymphade-nopathy. In this patient, the escalation of fatigue, malaise, decreased appetite, and marked weight loss over a 5-month period suggested that the presenting features of fever, rash, and odyno-phagia were further mani-fes-tations of the same disease process. The development of my-al-gia, ar-thral-gia, and generalized lymphadenopathy suggested a sys-temic illness affecting multiple systems. On admission, important laboratory findings were a-nemia, thrombo-cyto-penia, poly-clonal hypergamma-globulin-nemia, proteinuria, and abnormal urinary sediment with the presence of casts, suggesting glomer-ular disease. The rash was evaluated, biopsy spe-cimen was obtained, and testing for auto-antiboby was performed. The patient was treated with prednisone, and his fever was abated and odyno-phagia was resolved. On the second day of therapy, he left the hospital floor to smoke a cigarette. Unfortunately, shortly thereafter the patient was found unresponsive in cardiac arrest in a remote corner of the outpatient building. The finding from the autopsy were described.Now This ends the Medical Insight September 1st, 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.