爆破的靜脈怎止血?

上星期報章上報道，一名老伯在海邊垂釣時，突然腳部的靜脈曲張爆破，血流如注，需要友人報警求助，救護員替他止血及包紮後，情況穩定過來，伯伯竟然拒絕送院，有趣的是，他還跟記者說，這情況在家中已多次發生，好像完全不覺得是甚麼一回事。

若靜脈曲張已經到達流血的狀況，可以肯定的說，已到達後期或嚴重階段。倒流的靜脈血液，過量地積聚於小腿附近的靜脈血管，令血管膨脹，血管壁薄弱，加上過高的靜脈壓力，令皮膚出現慢性發炎，引致濕疹及痕癢。很多時患者會不自覺地抓癢的地方，一不小心便會把靜脈抓破，導致出血。此外，若患者進行長期站立的活動，好像這位老伯的海邊垂釣，曲張的靜脈也可因過分膨脹而自動爆破出血。

這情況若出現的話，只要有一點急救知識，保持鎮定，幾個步驟已可把血止過來。首先，是在流血的位置用力按下，因為靜脈的壓力是不會很高的，即使是用一隻手指，也足以堵住流血的靜脈。接着就是躺下來，並把腳部提起，置於高於心臟的位置；靜脈內的血液，便以水向低流的原理，回流到心臟，當靜脈內的壓力降低，血流便會自然停止。這時便應再傷口上包紮，保持傷口上的壓力，再到醫院求診。記着，這樣做只是於急症的情況下止血，並沒有根治問題，正確的做法是進行掃描找出有問題的靜脈，並以適當的手術清除。否則，流血的情況是肯定會重複出現的！

作者為外科專科醫生 謝卓華

資料來源: AM730
以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向醫生查詢，而不應單倚賴以上提供的資料。

Causes of Goiter

Goiters are not equivalent to hyperthyroidism. Goiter describes hyperplasia of the thyroid gland which most commonly due to problems with the immune system. However, the increase in size of the thyroid gland does not have any relationship with the amount of hormone to be secreted.

In the more underdeveloped countries, goiters could be caused by iodine deficiency, as patients may not be able to intake enough iodine from seafood to fulfill their body needs. This causes the thyroid hormones T3 and T4 in the blood to be lower than normal, prompting the pituitary glands to continuously secrete TSH (Thyroid Stimulating Hormones), stimulating growth of the thyroid glands.

Amazing Seaweed – Nutritious, Low in Calorie and Prevent Goiter

 

Seaweed, which grows in the ocean, has excellent source of minerals especially iodine that can possess powers to prevent goiter. Goiter refers to over-production of thyroid hormones, leading to enlargement of the thyroid glands. Iodine is essential to maintain proper functioning of thyroid glands, which helps to regulate body’s metabolism, growth, temperature, heart rates etc., and deficiency in iodine can lead to a disease called goiter. Large and thick neck resulted from goiter that affects nearby organs such as esophagus and trachea may lead to dysphagia and breathing difficulty, while stunted growth and mental retardation can be seen in children with goiter due to hypothyroidism.

Seaweed is categorized into three main groups, and they are red, green, and brown seaweeds. Brown seaweed has the highest iodine content, with dry kelp contains 1500-8000 ppm (parts per million), while red and green seaweeds have lower contents, about 100-300 ppm in dried seaweed, but still considered as high when compared to other land plants. Adults and children who are actively growing are recommended to have a daily intake of 150 µg and 90-120 µg iodine respectively, which is actually covered by very little amount of seaweed, as only one gram of dried brown seaweed can already provide 500-8,000 µg of iodine. Thus, just a tablespoon of seaweed is already enough for recommended daily intake.

In addition to iodine, seaweed is also an excellent source of calcium and iron, which is especially suitable for vegetarians who avoid dairy and meat products. Therefore, seaweed is highly recommended to be included in our diet. This can be done by sprinkling kelp flakes onto a salad or soup, wrapping rice or vegetables using nori sheets or having seaweeds snacks during tea time. Although iodine intake may be related to the situation of Goiter, other factors can also lead to Goiter. Thus, it is recommended to seek a doctor immediately for medical check when the problem of thyroid enlargement arises.




Reference information: http://www.thyro.com.hk/goiter-thyroid.html
It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your doctor for diagnosis and treatment.

Goiters

Goiter is a condition where enlargement of the thyroid gland causes swelling in the neck. It is a form of hyperplasia of the thyroid gland, and occurs more often among females. In Hong Kong, patients usually suffer from this condition due to problems with their immune systems.

The thyroid glands are located under both sides of the neck, with the main function of secreting thyroid hormones to regulate metabolism. However, when thyroid tissues increase excessively, pressure may be placed on the trachea which causes difficulty in breathing.

This condition may also affect the patient’s appearance and may create a risk of cancer. Patients can undergo minimally invasive thyroidectomy to remove the growth tissues without leaving any scars.





Reference information:  http://www.thyro.com.hk/goiter-disease.html
It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your doctor for diagnosis and treatment.

Colonoscopy

1. What is Colonoscopy?

Colonoscopy is the use of the endoscope, going into the lower digestive system through the patient's anus, rectum, sigmoid colon, descending colon, transverse colon, ascending colon, or cecum. Doctor can observe the internal status, to carry out examination, diagnosis and appropriate treatment.

2. What is the function of Colonoscopy?

The colonoscopy can check the patient's lower digestive tract, including anus, rectum, sigmoid colon, descending colon, transverse colon, ascending colon, cecum, and various parts of the colon internal situation. If patient is suspecting of suffering from the intestine diseases such as cancer, bleeding or with occult blood stool, change in bowel habits, chronic diarrhea or constipation, difficulty in defecation, etc, colonoscopy is advised to find out the causes of discomfort. During the colonoscopy, with the assistive devices, doctor can get a biopsy for further laboratory testing or treatment, such as removal of polyps.

3. Before Colonoscopy, what do I need to prepare and pay attention?

Points to note for patients before colonoscopy:

Sign the consent form for receiving colonoscopy examination or treatment after well understanding with doctor’s explanation.

   
Stop the iron supplement according to doctor’s instruction one week before the colonoscopy. Avoid high fiber food intake, such as fruits and vegetables. Administer the mild laxative medication under the doctor’s prescription.
   
One day before colonoscopy, patient needs to have the colon cleansing with laxative drug which is prescribed by doctor. Meanwhile, patient can take the fluid diet only on that day until the colonoscopy examination
   
Follow doctor’s instruction for arrangement of taking the chronic illness medication (diabetes, hypertension, or drug allergy).
   
Follow the date, time and place for meeting the appointment of the colonoscopy.

 
4. During the Colonoscopy, what do I need to cooperate for making procedure go smooth?

Before start, doctor will inject appropriate amount of tranquilizers or analgesic drug intravenously to patients for reducing patient anxiety and pain. Patient is required to band the knee and lie on one side. The endoscope can go into the colon via anus smoothly. During the process, doctor can make appropriate measures for diagnostic or treatment, such as taking biopsy, removal of polyps or hemostasis Patient is staying awake. Generally, the examination takes around 30 to 60 minutes. Time may take longer for some complicated cases or the need of special treatment.

5. After Colonoscopy, any follow-up or points to note for patients?

After the colonoscopy, the patient may feel abdominal discomfort, but it will disappear shortly. If feeling abdominal pain, please let doctor know. For those who has been taken biopsy, or polypectomy, patient may find the little blood stain stool. If the bloody stool passed, please let doctor know immediately. Patient can go home with friends or relatives after doctor final assessment.

6. What is the adverse effect(s) of Colonoscopy?

Patients usually feel mild abdominal discomfort after colonoscopy, which is a normal and no need to worry. It can be disappear shortly and advice to take rest. Colonoscopy may cause perforation of the intestines, intestinal bleeding or some other complications, but is highly unlikely to occur.




Reference information: http://esteemmedical.com.hk/colonoscopy.html
It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your doctor for diagnosis and treatment.

九十歲動手術

在新聞中看到英國國民大事慶祝他們女王的90歲大壽,的確,能健康活到90歲是值得慶祝的。其實在香港,90多歲的老人家,比比皆是,但在醫院遇到的,大多是健康有點問題。

最近收了一位九十多歲的婆婆,是長期煙民,那時開始吸煙她已經記不清楚了,故已患有慢性肺氣腫多年,走路快點也會氣喘,上樓梯也上不到一層。

她在作身體檢查時，無意中發現肚內的主動脈血管,不正常地擴張了，由正常的兩公分直徑，擴張至七公分。情況就好像把氣球不斷吹張直至爆破，體積越大，爆裂流血的機會越高。一旦爆裂,是百分百致命的。這情況,醫學上稱之為「腹部主動脈瘤」。

正常的的醫治方法,是接受手術修補血管瘤,雖說現今的手術,大多以微創方式進行,手術風險大大降低,但在90多歲的病人身上動手術,總是有很多變數的,況且婆婆的呼吸系統問題極不理想,稍有點感染或痰阻塞,也可有生命危險的。

若您是婆婆或其家人,你會接受手術嗎?

大家意見紛紜,有的說都90多歲了,還想一百歲嗎?還是順其自然吧!萬一手術有什麼差池,出現併發症,死可不怕,最怕受苦啊!

有的說可以醫的為什麼不醫,難道等爆破了流血時才動手術嗎?況且每天帶着計時炸彈,不知何時爆,什麼也做不了,像在等死,這才最受罪! 正是公說公有理、婆說婆有理。

醫生,你有什麼建議呢?….........待續。

外科專科醫生
謝卓華

資料來源: AM730
以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向醫生查詢，而不應單倚賴以上提供的資料。

Gastroscopy (2)

4. During the Gastroscopy, what do I need to cooperate for making procedure go smooth?

Firstly, doctor will give the anesthetic throat spray for local anesthesia. If necessary, relaxants or painkillers may be given intravenously to relieve the patient anxiety or stress. Patients should follow the doctor advice and gradually swallow the slender endoscope. Meanwhile, patient is able to breathe as usual. If keeping relax and cooperate, the whole procedure can be completed in minutes. Doctor can also get biopsy or specimen from the patient's stomach for laboratory test. Patient will not feel the pain under this process. Also for some other cases, doctor can treat the bleeding site in case it is found during the endoscopy.

 
5. After Gastroscopy, any follow-up or points to note for patients?

The throat anesthesia will last for about an hour after the endoscopy examination. Do not do the mouthwash immediately. Allow to drink or eat after at least 1 hour or doctor assessment. If patient has under the relaxant injection, he/she will forget some examination memory, so it is advised they should be accompanied by relatives or friends, to listen to the preliminary examination report and take care of patient when going home.

 
6. What is the adverse effect(s) of Gastroscopy?

Patients usually feel a sore throat, a small amount of flatulence and dizziness after gastroscopy, which will be subsided shortly. Gastroscopy may cause the stomach perforation, inner lining bleeding, but very rare to occur.





Reference information:  http://esteemmedical.com.hk/gastroscopy.html
It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your physicians for diagnosis and treatment. 

Gastroscopy (1)

1. What is Gastroscopy?

Gastroscopy is the use of endoscope, going into upper digestive system through the patient's mouth, esophagus, into the stomach, duodenum and jejunum. The doctor can observe the internal status in order to carry out the examination, diagnosis and appropriate treatment.

2. What is the function of Gastroscopy?

By the use of endoscope, doctor can check the internal conditions of the upper digestive system (esophagus, stomach, duodenum and jejunum). If necessary, the doctor can perform some treatments as follow:

    Biopsy collection for lab test
    Removal of foreign body
    Varicose veins treatment
    Laser treatment
    Pyloroplasty for Pyloric Stenosis
    Polypectomy
    Inner lining hemostasis


3. Before Gastroscopy, what do I need to prepare and pay attention?

Points to note for patients before gastroscopy:

Sign the consent form for receiving gastroscopy examination or treatment after well understanding with doctor’s explanation.
   
Do not eat within 6 hours before the examination in order to avoid aspiration when inducing vomiting, and provide a clear vision view for gastroscopy.
   
Follow doctor’s instruction for arrangement of taking the chronic illness medication (diabetes, hypertension, or drug allergy).
   
Follow the date, time and place for meeting the appointment of the gastroscopy.

.......cont'l











Reference information:  http://esteemmedical.com.hk/gastroscopy.html
It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your physicians for diagnosis and treatment. 

周邊血管疾病微創治療

腦血管或心血管硬化所衍生出來的腦中風或冠心病等嚴重疾病，讓大眾聞之色變；而隨着都市人「三高」（高膽固醇、高血壓、高血 糖）日趨嚴重，加上吸煙及年紀老化等風險因素，實際上我們全身血管均有可能出現不同程度硬化現象，血管逐漸缺乏原有彈性，血管壁逐漸變厚、鈣化甚至閉塞。 所謂的「周邊血管疾病」就是指心與腦血管以外，身體其他血管疾病所帶來的健康問題，血管硬化便是最常見成因。


臨床上，最常受影響的是下肢動脈，隨年紀增長，加上上述各高危因素，導致患者下肢血管壁逐漸變厚，血管亦因此變得狹窄，嚴重時 甚至可完全閉塞，令血液供應不足，引起「間歇性跛行」，即患者行走一段距離後便出現下肢疼痛，最常出現於小腿肌肉，通常休息一會便可紓緩，但隨着病情惡 化，走路距離愈來愈短，甚至連靜止不動下肢亦感痛楚，嚴重者更可出現不癒之潰瘍及壞疽，若仍未有妥善處理，約5%患者最終可能因下肢壞死而截肢。


統計顯示，六十歲以上的人口中，有15%出現間歇性跛行情況，到了七十歲，比率更上升至30%。外科醫生可根據患者的病情，安排合適的治療。早期個案，醫生可透過藥物改善病徵，再鼓勵病人透過適量運動，保持外圍並行血管的血流暢順，但已有問題的血管，仍然是閉塞或狹窄的。


因此病情中度至嚴重者需透過介入性治療處理，除傳統開放性手術，醫生亦可通過微創介入治療，以球囊或支架擴張狹窄或已閉塞血管，恢復腿部血液供應。對比於開放式手術，微創介入手術傷口細，可局部麻醉進行，復原較快。


一般球囊透過導管進入目標血管內，靠壓力擴張狹窄段，使阻塞的血管恢復下肢血液供應；但因大部分病人血管已產生病變，有報告指 約六至七成病人在十二個月內會有「翻塞」現象；現時較新式的「滲藥性球囊」，比一般球囊多一層藥物，會在擴張後在血管內壁內發揮藥效，目的是延長血管暢通 及血液流動，從而達到直接改善下肢血液供應目的，減少復發。

作者為香港大學外科學系榮譽臨床副教授、血管健康基金會會長



外科專科醫生
謝卓華
 

資料來源: 信報

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，

應向醫生查詢，而不應單倚賴以上提供的資料。

CO2 Laser Surgery

CO2 Laser circumcision is a new technology for circumcision. It uses laser, as opposed to a surgical knife, to remove the redundant foreskin. This new technology is preferred over traditional surgery as it can perform the dual task of circumcision and stopping the bleeding simultaneously. Even bleeding from the capillaries can be effectively stopped. During the circumcision, the laser knife removes the redundant foreskin using an arc-like motion, which results in a neat incision. Apart from effectively helping the surgeon control the area to be circumcised, laser circumcision is also suitable for patients with different penis sizes and lengths, making it preferable over traditional surgery that makes incisions in straight lines.




Reference information: http://circum.com.hk/laser-circumcision.html
It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your physicians for diagnosis and treatment.