整晚盤腿追劇...小心「靜脈栓塞」！腳腫脹亂按壓可致命

深層靜脈栓塞俗稱「經濟艙症候群」，是因為血栓阻塞血液流動所引起。醫師表示，它與水腫不同，只會單腳腫痛，搭長途飛機久坐不動、整晚盤腿追劇都有可能發病。醫師也提醒，發現類似症狀要盡快就醫，千萬別亂按摩或按壓患處，否則導致血栓脫落的話，經由血液流走到肺部，會引起肺栓塞喪命。

人體血管分動脈和靜脈兩大類，將血液由心臟送往全身器官的是動脈，靜脈則負責將血液由器官帶回心臟，而下肢靜脈分為淺靜脈和深層靜脈，前者在表皮與脂肪之間，後者則為於肌肉間。


香港《東方日報》引述外科專科醫生謝卓華指出，俗稱「經濟艙症候群」的深層靜脈栓塞，是靜脈中出現血塊，最常在小腿位置出現，小腿並因長期積聚血液而紅腫；如果病發位置比較靠近大腿或盆腔，栓塞情況可能更嚴重，腫痛加劇。他說，一旦靜脈將帶血栓的血液回流到心臟及肺部，可能會塞住肺部血管，患者會呼吸困難、胸口痛及休克，甚至死亡。

謝卓華進一步表示，肥胖、懷孕、曾經接受手術的人是高危險群，如果搭長途飛機久坐不動，加上飲水不足，也可能形成血栓。他更透露，曾經接診過一個案例，有人整晚盤腿追劇，結果腳部腫痛持續不消，求診才確定是深層靜脈栓塞。

遇到深層靜脈栓塞，有些人會以為只是肌肉腫痛，所以沒有求診。謝卓華提醒，深層靜脈栓塞與水腫不同，只會單腳腫痛，一旦發現類似症狀，而自己又是高危險群，就要盡快就醫，千萬別亂按摩或按壓患處，否則導致血栓脫落的話，可能引起肺栓塞喪命。

去年曾經有一名泰國籍女性搭3個多小時的飛機來台遊玩，但一下飛機卻感到頭暈、胸悶、呼吸困難，送醫檢查竟發現是「經濟艙症候群」引發肺栓塞，血塊塞滿肺，住院5天才保住性命。桃園聯新機場醫療中心主任許詩典接受《ETtoday健康雲》訪問時提到，只要在狹小的機艙連續坐2小時，就容易引發血管栓塞，建議旅客定時起身上廁所，或做足部運動，才能讓血液免滯留。


許詩典指出，「經濟艙症候群」主要發生在生產後婦女、有服藥習慣者以及上機後喝太多酒的民眾；酒精會影響血管彈性，建議民眾搭機時多喝水、少喝酒，才不易發生憾事，而穿緊身褲或太合腳的鞋子，也容易引發身體不適，建議上機後可先脫鞋，避免足部腫脹影響血液流通。





資料來源: https://health.ettoday.net/news/1177937
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。

日本災民車中過夜 靜脈栓塞個案急升

除了坐飛機，長時間坐車都可致深層靜脈栓塞(DVT)。翻查外電，一六年日本九州熊本縣大地震後，大批災民被迫車中過夜，之後疑因長期躲在狹窄空間及缺乏活動，引發DVT。外科專科醫生謝卓華指，長時間擠在狹窄車廂加上少飲水，絕對有可能引起DVT。

熊本地震發生後，據報當地至少錄得廿宗DVT個案，估計是長期逼在車中過夜引致。謝卓華相信，當時災民如果一家大細都擠在車中，空間有限，引發DVT不出奇，而除了類似情況，平日亦有不少個案因坐長途車引發DVT。

坐長途車，空間有限，加上途中人有三急找洗手間麻煩，部分乘客傾向少飲水，結果令血液凝固積聚難流通，易結血栓。謝卓華曾接觸的個案，有人乘三至四小時長途車返內地旅遊，下車後感到一隻腳特別腫痛，下車活動一排後腫痛仍不散，到返港求醫時確診DVT，需服薄血藥治理。

謝說，長途車可致DVT，但對比飛機機艙氣壓低，空間更狹窄，因此坐飛機引致的DVT個案更常見。他建議旅遊或出差時若要長時間乘坐交通工具，要盡量多活動，即使坐飛機，也間中站立或散步，在車內則要多喝水，並嘗試轉換坐姿。

資料來源:  http://hk.on.cc/hk/bkn/cnt/news/20180526/bkn-20180526063027681-0526_00822_001.html
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。

Why DVT can strike anyone, any time and how to avoid a killer blood clot (2)

The first documented case of DVT was reported during the middle ages. In 1271, a 20-year-old Norman cobbler complained of pain in his lower leg. A visit to the tomb of canonised King Louis IX was advocated, where the cobbler massaged dust into his leg.

Subsequent DVTs were diagnosed in pregnant and postnatal women, believed to be the consequence of “evil humours” during pregnancy and post-delivery – meaning a build-up of unconsumed breast milk.

During the first world war, exhausted young soldiers in the trenches suffered from blood clots in their legs, caused by sleeping upright in chairs, their legs beneath them. Today’s taxi and bus drivers are at risk as they sit immobile for long stretches.

Tse says the incidence of DVT among Hongkongers is on the rise. “Overall annual incidences of thromboembolic disease in Hong Kong is 30 per 100,000 of the population; hospital mortality rates associated with DVT are 7.3 per cent.”

The US Centres for Disease Control and Prevention suggests the incidence is higher in America – one to two per 1,000.

One-third of people with DVT or a pulmonary embolism will have a recurrence within 10 years; 10 per cent to 30 per cent of people will die within one month of diagnosis. In the US, one person is diagnosed with DVT every minute, and a sufferer dies as a result of its complication, pulmonary embolism, every six.

Among those with DVT, half will have long-term complications (post-thrombotic syndrome) – as I do: a nagging pain presents in my right calf after prolonged standing or exercise due to enduring damage to valves in the vein.

Flying isn’t the only cause of DVT, and not all people who fly long-haul will develop it. Given the frequency of air travel today, though, it’s a risk we all need to take more seriously. I certainly do: I drink lots of water – “two litres during a seven-hour flight because the atmosphere in the cabin means you dehydrate 20 per cent faster”, my surgeon said.

This means I can’t help but walk up and down the aisle to get my blood circulating, as I get up to use the loo every hour, and instead of skinny jeans I wear toe-to-groin surgical stockings.

Air travel isn’t as sexy as it used to be.

Travel tips to prevent DVT

All air travellers, says Tse, should consider the following:

• Stand up and walk around every hour or two;
• Consider wearing knee-high (or higher) compression stockings;
• Apart from the stockings, wear loose-fitting, comfortable clothing;
• Avoid medications such as sedative or sleeping pills, and alcohol, which could impair your ability to get up and move around;
• Flex and extend the ankles and knees periodically, avoid crossing the legs or sitting on your legs, and change positions frequently while seated

The US Centres for Disease Control suggests three simple exercises to help keep the blood flowing:

1. Raise and lower your heels while keeping your toes on the floor
2. Raise and lower your toes while keeping your heels on the floor
3. Tighten and release your leg muscles



Reference information:  SCMP
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. 

Why DVT can strike anyone, any time and how to avoid a killer blood clot (1)

Who has not heard of DVT – deep vein thrombosis? I thought it happened only in overweight, unfit people over the age of 50, people who smoked too much, exercised too little and got their comeuppance as they ate their way through airline meals on seriously long-haul flights.

So when I – under 50 at the time, fit, non-smoker, lean – awoke after being cat-curled in a seat on a six-hour flight with a pain in my right calf, I naturally assumed it was only a cramp. I stretched my skinny-jean clad legs out, said “ouch”, gave it a rub and disembarked, certain I’d walk the soreness off in no time.

Except that I didn’t. Two days later, the deep ache was waking me at night and I resorted to pain medication. A nagging voice in my head began to question whether this was more than a mere cramp. A cautious friend advised a visit to a doctor’s clinic; the doctor examined my legs: no redness, no heat, no swelling – just pain.

“I’m sure it’s not DVT,” he said, “but we can’t take a chance.”

He sent me off to the accident and emergency department, where I had a blood test for D-dimer – a protein fragment from the breakdown of a blood clot. The test indicated I had DVT, confirmed by an ultrasound.

An injection of blood thinners to further break down the clot was plunged into my abdomen so that a bruise bloomed black and as big as my fist. X-rays of my chest followed, to ensure my lungs were clear and three months of anticoagulants were prescribed.

I was appalled. DVT didn’t happen to people like me: the young (ish), the fit, the lean non-smokers. Oh yes, they do, said the vascular surgeon who examined me.

Deep vein thrombosis is the medical term for blood clots in the deep veins of the leg. If a blood clot forms inside a blood vessel, explains Dr Chad Tse Cheuk-wa, a surgeon who specialises in vascular and endovascular surgery at Hong Kong’s Veno Clinic, “it can clog the vessel and keep blood from getting where it needs to go. When that happens, blood can back up and cause swelling and pain.”

DVT is always considered serious, as any clot in a vein “can travel to other parts of the body and clog blood vessels there”, Tse said. “Blood clots that form in the legs, for example, can end up blocking blood vessels in the lungs. This can make it hard to breathe and sometimes, when they are large, can lead to death.” A blood clot that travels to the lungs is a pulmonary embolism.

Many things can predispose a person to DVT, including obesity, smoking and age, as well as certain medical conditions, some medications – including birth control pills and hormone replacement therapy (HRT) – and surgery. Dr Tse says prolonged travel – whether by plane, train or automobile – appears to confer a two- to fourfold increase in risk, and taking one long-haul flight a year increases the risk by 12 per cent.

My surgeon said immobility and dehydration are the key reasons flying is a risk – and he warned that “long-haul” can be as short as four hours. Immobility allows the blood in your legs to pool in your calves, and a lack of hydration allows that blood to become “sticky”. The combination of thick, slow-flowing blood is not good.

 ..........cont'





Reference information:  SCMP
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. 

大頸泡/甲狀腺腫大

俗稱大頸泡的甲狀腺腫大，屬於多囊性增生，患者以女性較多，本港患者的成因多與免疫系統問題有關。甲狀腺位於頸項底部兩旁，其功用是發放甲狀腺荷爾蒙，維 持新陳代謝，惟當甲狀腺組織不斷增生，可能會壓住氣管，令呼吸不暢順。除此之外，亦會影響外觀，以及可能會有致癌危機。患者可透過甲狀腺微創切除手術，取 走增生組織，不會在頸部留下疤痕。


大頸泡的成因 

大頸泡是否等如甲狀腺亢進？這想法完全錯誤，大頸泡只是多囊性增生，是結構性問題，與荷爾蒙分泌未必有直接關係。不過，在其他較落後國家，大頸泡可能與缺 乏碘有關，因為患者未能從海產食物吸收足夠的碘，滿足身體所需，令血液內的甲狀腺荷爾蒙Ｔ３及Ｔ４偏低，引致腦下垂體不斷發放甲狀腺激素ＴＳＨ，刺激甲狀 腺增生。


大頸泡徵狀 

甲狀腺位於頸項底部兩旁，即喉核以下位置，一般約長1.5至2厘米，當甲狀腺增生至2至3厘米，會在頸部凸出，如泡狀般，並可以觸摸得到。甲狀腺腫大分為全部及局部兩種，由於甲狀腺增生時，會接觸到鎖骨，令頸入口位收窄，當增生組織愈來愈大，有機會壓住氣管，影響呼吸。




資料來源:  http://www.thyro.com.hk/
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. 

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。

認刺穿動脈致洗血少女半癱 聯合：不涉人為疏忽 母哭訴「搞到傷殘好心痛」

患有急性橫貫性脊髓炎的16歲陳姓少女，去年11月在聯合醫院接受洗血治療時，疑因醫生接連出錯致右腦中風。聯合完成調查，估計是金屬導線穿過病人頸內靜脈時，刺穿鎖骨下動脈導致出血；醫管局專家形容事件屬非常罕見嚴重併發症，並非醫療事故，不涉人為疏忽。家屬稱難以接受，陳媽媽昨哭訴指女兒現時仍半身癱瘓、小腿萎縮，需長期卧床，「好心酸、好心痛」。

夢想成為護士的16歲陳小姐，去年10月因頭痛及右半身無力等，到聯合急症室求醫，同日入住深切治療部，檢查後確診急性橫貫性脊髓炎；醫生11月中為病人進行洗血治療，在頸內靜脈放入導管後，病人血壓下降及出現血胸，因聯合未有心胸外科，病人轉到伊利沙伯醫院治療，確診右腦大範圍缺血性中風，並發現導管置入時動脈被刺穿。

小腿萎縮　未能吞嚥進食

事發至今5個多月，病人仍在伊院深切治療部留醫。其母透露，女兒現時清醒，但半身癱瘓需長期卧床，一隻手未有反應，小腿已出現萎縮，「大腿仲有少少反應」，正接受物理治療，在醫護人員鼓勵下「有返啲意志力」；惟她仍未能吞嚥進食，聲帶在手術後未能發聲，只能「做口形」溝通。陳太提及女兒病況時多次落淚，「我到𠵱家都接受唔到，原先脊髓炎已經好番晒，但（手術）之後就搞到傷殘同咁多後遺症」。她引述醫生稱女兒完全康復機會不大，「成家人都好心酸、好心痛……佢先得16歲，人生好漫長，自立唔到都唔知點算」。

聯合醫院昨公佈專家檢討結果，卻未有承認責任。負責調查的醫管局兒科中央統籌委員會副主席、威爾斯親王醫院兒科部門主管蘇景桓醫生稱，事件屬非常罕見併發症。他指，為病人放置中央靜脈導管的，是一名有逾20年經驗的兒科深切治療部醫生，該醫生在放置針芯至頸靜脈前及過程間，有用超聲波儀器協助，有抽血確保針芯進入靜脈，其後再放置金屬引導線、血管擴大器入靜脈時，或刺穿下方的鎖骨下動脈。他指醫生當時已做足程序，只是鎖骨下動脈非超聲波監察範圍。

手術前無提有中風風險

蘇續指刺穿動脈風險少於1%。一般情況下，如鎖骨下動脈有血塊積聚，一般會向下流向手部，但今次血塊往上流至腦部致中風，情況罕見，文獻也找不到同類個案故未能解釋。至於聯合為病人進行的血管造影檢查，未能發現病人鎖骨下動脈有損傷，轉送到伊院再做檢查時才發現，他指重看血管造影時有看到鎖骨下動脈不平坦，顯示該處或曾受傷，但強調很難察覺，他亦需要影像重組才看得到。

對於家屬質疑聯合未有察覺病人中風，蘇景桓同意當病人鎮靜劑藥力慢慢消失、血壓回復正常，意識應恢復，但早期難辨意識是否受鎮靜劑影響，惟4、5小時過去病人仍不清醒，應要警覺是否中風或休克等，當時聯合已準備將病人轉院，他指做法合適。但他確認醫生術前未有向少女家屬提及手術風險包括中風，理解家屬感到「落差大」，建議日後解釋清楚，避免使用高風險或低風險等籠統字眼。

外科專科醫生謝卓華指因動脈受損、血管閉塞形成血塊，流向腦部而造成的缺血性中風，情況往往比一般中風危急，「幾分鐘冇血到，腦組織就有永久性損害」。即使及早發現，亦難逆轉中風結果，「及早發現當然可以及早轉院做手術，但可能最終分別都唔大」

資料來源: https://hk.news.appledaily.com/local/daily/article/20180501/20378069
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